bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of obstructive jaundice on the pharmacodynamics of propofol: does the sensitivity of intravenous anesthetics change among icteric patients?
Authors: SONG J. C. , ZHANG M. Z. , LU Z. J. , YANG L. Q. , SONG J. G. , SUN Y. M. , YU W. F.
Published: August 2009

Background
Some studies suggest that certain clinical symptoms of cholestasis, such as fatigue and pruritus, result from altered neurotransmission. Patients with obstructive jaundice also have labile blood pressure and heart rate. In the present study, the authors investigated whether obstructive jaundice affects a patient's sensitivity to hypnotics and the haemodynamic profile of propofol.

Methods
Thirty‐six ASA physical status I/II/III patients with serum total bilirubin (TBL) from 7.8 to 362.7 μmol/l scheduled for bile duct surgery were recruited. A computer‐controlled propofol infusion programmed for effect site target was used to rapidly attain and maintain sequential increase of the compartment concentration (from 1 to 3 μg/ml). Each target‐controlled concentration was maintained for about 12 min, and arterial blood samples were drawn for propofol concentration determination. The bispectral index (BIS) and mean arterial pressures (MAP) were used as indices of the propofol effect. The relation between the concentration and the effects was described by the Hill equation. The pharmacodynamic parameters were optimized using a nonlinear mixed‐effect model.

Results
TBL was not a significant covariate of EC50 for the pharmacodynamic model. For BIS and MAP, the parameters of the pharmacodynamic model were Emax=75.77%, EC50=2.34 μg/ml, and γ=1.82, and Emax=47.83%, EC50=1.49 μg/ml, and γ=1.88, respectively.

Conclusions
We demonstrated that obstructive jaundice with serum TBL from 7.8 to 362.7 μmol/l had no effect on propofol pharmacodynamics observed by BIS and MAP.
Single vs. double stimulation during a lateral sagittal infraclavicular block
Authors: AKYιLDιZ E. , GÜRKAN Y. , ÇAĞLAYAN Ç. , SOLAK M. , TOKER K.
Published: August 2009

Background: The objective of this study was to evaluate the influence of single vs. dual control during an ultrasound‐guided lateral sagittal infraclavicular block on the efficacy of sensory block and the time of block onset.

Methods: In a prospective manner, 60 adult patients scheduled for distal upper limb surgery were randomly allocated to single (Group S) or double stimulation (Group D) groups. A local anesthetic (LA) mixture of 20 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml with 5 μg/ml epinephrine (total 40 ml) was administered in both groups. In the Group S following a median, an ulnar or a radial nerve response, the entire LA was administered at a single site. In Group D 10 ml of LA was administered following the electrolocation of the musculocutaneous nerve and 30 ml LA was injected following median, ulnar or radial nerves. A successful block was defined as analgesia or anesthesia of all five nerves distal to the elbow. Sensory and motor blocks were tested at 5‐min intervals for 30 min.

Results: The block was successful in 27 patients in Group S and 28 patients in Group D. The time from starting the block until satisfactory anesthesia was significantly shorter in Group D than in Group S (19.3 vs. 23.2 min) (P<0.05). Total sensory scores were significantly higher in the double stimulation group at 20 and 30 min after the block performance (P<0.05).

Conclusions: Although the block performance time was longer in the double stimulation group, block onset time and extent of anesthesia were more favorable in the double stimulation group.
Screening citrus genotypes for resistance to canker disease (Xanthomonas axonopodis pv. citri)
Authors: Deng Z. N. , Xu L. , Li D. Z. , Long G. Y. , Liu L. P. , Fang F. , Shu G. P.
Published: August 2009

With 3 figures and 3 tables

Citrus canker (Xanthomonas axonopodis pv. citri) has brought great damage to citrus industry worldwide, and it is difficult to control, so the use of resistant genotypes seems the only choice. All the tested citrus species showed typical symptoms when artificial inoculation was performed. The present study aimed to find genotypes possessing active resistance to canker disease. A total of 14 accessions from three species were investigated by puncture inoculation of excised leaves with the pathogen, and it was found that ‘Huaihua’, ‘Sanye’ and ‘No.25–86’ in Citrus ichangenesis, ‘Shenju’ and ‘Zhencheng’ in C. junos had fewer disease spots on pin‐holes with delayed symptom appearance; while ‘Chinese Citron’ (C. medica) did not show any lesions. These six genotypes were further tested in an epidemic field by inoculation with 2.5 × 107 cfu/ml of pathogen solution for 2 years. Only the tested citron showed complete and active resistance, with tissue necrosis on the pin‐holes; the other five accessions were all infected with different disease incidences. Therefore, the citron accession was considered as a resistant genotype, and was already used for resistant cultivar breeding.
Spontaneous regression of primary breast lymphoma
Authors: Oya Masafumi , Hirahashi Minako , Ochi Miho , Hashimoto Mitsunori , Ohshima Koichi , Kikuchi Masahiro , Tsuneyoshi Masazumi
Published: August 2009

Described herein is a case of primary breast lymphoma (PBL) that underwent spontaneous regression (SR). A 71‐year‐old woman visited hospital because of the rapid growth of a tumor in her left breast. On imaging, including magnetic resonance imaging (MRI), a discrete solid nodule was detected, which suggested malignant tumor. Histology of the following core needle biopsy (CNB) specimen indicated diffuse large B‐cell lymphoma (DLBCL). The patient had no past history of lymphoma and there was no evidence of systemic lymph nodes enlargement. After CNB, however, the patient noticed that her breast nodule gradually decreased in size without any specific treatment. Subsequent MRI showed an ill‐defined nodular area suggesting a regressing tumor. Excisional biopsy indicated fibrotic mammary tissue devoid of large neoplastic lymphoid cells. The patient has remained well without evidence of recurrent lymphoma more than 18 months after her original diagnosis. This case is considered to be unique in a PBL showing SR, probably induced by an intervention of CNB and histologically confirmed on sequential examinations in addition to illustrative before‐and‐after imaging. To the best of the authors' knowledge no other PBL of DLBCL has been reported as undergoing a complete SR in the English‐language literature.
Renal functional outcomes for tumours in a solitary kidney managed by ablative or extirpative techniques
Authors: Raman Jay D. , Raj Ganesh V. , Lucas Steven M. , Williams Steve K. , Lauer Eric M. , Ahrar Kamran , Matin Surena F. , Leveillee Raymond J. , Cadeddu Jeffrey A.
Published: August 2009

Study Type – Therapy (case series)  Level of Evidence 4

OBJECTIVE

To present the renal functional outcomes for patients treated with open partial nephrectomy (OPN) or radiofrequency ablation (RFA) for tumours in a solitary kidney, as renal masses in a solitary kidney present a challenging treatment dilemma.

PATIENTS AND METHODS

A retrospective review of institutional databases identified 89 patients with 98 renal tumours in a solitary kidney managed by RFA or OPN under cold ischaemia between January 1997 and September 2007. The choice of therapy was based on patient and surgeon preference, tumour characteristics and comorbidities. Renal function was calculated using the modified Modification of Diet in Renal Disease equation.

RESULTS

Outcomes from 47 patients treated by RFA and 42 by OPN were analysed at a median follow‐up of 18.1 and 30.0 months, respectively (P = 0.02). The median age (65.9 vs 59.6 years, P = 0.03) and American Society of Anesthesiology score (3.0 vs 2.0, P = 0.01) were both higher in patients treated with RFA. The median tumour size was greater for tumours managed by OPN (3.9 vs 2.8 cm, P = 0.001), while the median preoperative glomerular filtration rate (GFR) was lower in the RFA group (46.5 vs 55.9 mL/min/1.73 m2 for OPN, P = 0.04). Compared to RFA, patients treated with OPN had a greater decline in GFR at all times evaluated, including soon after the procedure (15.8% vs 7.1%), 12 months after surgery (24.5% vs 10.4%) and at the last follow‐up (28.6% vs 11.4%, all P < 0.001). For patients with a pretreatment GFR of > 60 or > 30 mL/min/1.73 m2, there was a new onset of decline in GFR of <60 and <30 mL/min/1.73 m2 in none and 7% of patients after RFA, and in 35% and 17% after OPN.

CONCLUSION

Ablative techniques, which obviate ischaemic insults, might be a particularly attractive option for managing tumours in solitary renal units at risk of declining function. Renal functional outcomes compare favourably to extirpative surgery using cold ischaemia.
Dual segmental arterial supply to a single renal lobule: a study using semi‐serial sections of mid‐term fetuses
Authors: Yasumoto Hiroaki , Hirai Ichiro , Takenaka Atsushi , Fujimiya Mineko , Murakami Gen , Kimura Wataru , Teishima Jun , Matsubara Akio
Published: August 2009

OBJECTIVE

To determine which and how many segmental arteries supply a single renal lobule especially at and near the segmental border, as no data are available on the arterial supply to a single renal lobule (a pyramid and its covering cortex) at the border between renal segments.

MATERIALS AND METHODS

We studied semi‐serial sections (100 µm intervals; haematoxylin and eosin staining) of 26 kidneys obtained from 13 mid‐term human fetuses (20–30 weeks gestation). Eleven fetuses were used for horizontal sections and two for sagittal sections. Section to section, we first traced the renal pyramids using a pen to understand the lobular configuration.

RESULTS

Fusion of the medullary pyramids was usually evident along the segmental borders, except for the border between the upper and middle segments. This fusion often accompanied a pair of arcuate arteries, each of which arose from a different renal segment, but shared a common corticomedullary junction to supply a single lobule. The incidence of fusion was high along the anterior border of the posterior segment as well as the border between the apical and upper segments. When the lower segmental artery entered the parenchyma distant from the renal hilus, fusion of pyramids occurred along the border between the posterior and lower segments in association with double arcuate arteries.

CONCLUSIONS

A single lobule is most likely to be shared by double segments at or near the segmental border. This morphology seems to be a result of lobule fusion during development and growth. Thus, in adults, a dual segmental supply to a single lobule seems to be more frequent than in fetuses.
Sympathetic skin response in patients with erectile dysfunction
Authors: Valles‐Antuña Consuelo , Fernandez‐Gomez Jesus , Escaf Safwan , Fernandez‐Gonzalez Fernando
Published: August 2009

OBJECTIVES

To evaluate the role of the sympathetic skin response (SSR) in men with erectile dysfunction (ED), focusing on detecting SSR in the penis.

PATIENTS AND METHODS

We assessed the SSR in 82 patients with ED, as an indicator of abnormalities both in amyelinic C‐fibres and in autonomic pathways in these patients. The SSR was carried out according to the to the Technical Standards of the International Federation of Clinical Neurophysiology. Electrical stimulation was applied through superficial electrodes over the contralateral median nerve. Values were recorded with superficial electrodes on the skin in the contralateral hand and foot, as well as in the penis. The percentage of SSR (SSR%) was classified into three groups, i.e. 0–20%, 21–89% and 90–100%. Results of latency were also classified into three groups of normal or abnormal (increased) latency, and response blocking (no response), the last two being considered pathological conditions.

RESULTS

In the penis, the mean (sd) SSR% was 52.8 (43.19)% and significantly lower than responses in hands and feet. There was a significant correlation of the SSR% between the palm of the hand and the sole of the foot (P = 0.01) and between the sole of foot and penis (P = 0.05). Diabetics showed a significant decrease (P = 0.001) in the mean SSR% in the palm of the hand and sole of the foot. Although not statistically different, the mean SSR% in the penis was lower in diabetics than in patients with other risk factors for ED. Likewise, the mean SSR% in hand, foot and penis increased with an increase in the International Index of Erectile Function. In the penis, latency was normal (<1.5 ms) in 14 and abnormal in 37 patients. There was a significant association between pathological chronic re‐innervation in the bulbocavernosus muscle and SSR latencies in the foot (P = 0.002) and penis (P = 0.03). Bulbocavernosus muscle electromyography showed a higher frequency of chronic bilateral axonomnesis in patients with abnormal latencies (28%) than in patients with normal SSR latencies in the penis.

CONCLUSION

These results establish an indication of the SSR in patients with ED, registering responses not only in classic locations like the palm of the hand or sole of the foot, but also in the penis. The SSR% was useful as an indicator of the effect on efferent C fibres. Despite SSR being a polysynaptic potential of long latency and regulated by the cerebral cortex, the present results show that it is advisable to record the latencies of SSR in the three areas registered, and especially in the penis, where it seems be more useful as a marker of lumbosacral and/or pudendal alterations.
The 9/21 earthquake in Taiwan: a local government disaster rescue system1
Authors: Yang Yungnane
Published: August 2009

This paper employs a three‐element model to examine how the disaster rescue system of the government of Nantou County in Middle Taiwan functioned following the earthquake of 21 September 1999. The three elements are information gathering, local government mobilisation, and inter‐organisational cooperation. The paper finds that the Nantou County government needs to address many problems associated with these three elements. Disaster information, for example, was not processed instantly because of the destruction of the electricity and telephone systems in the earthquake. Insufficient information caused ineffectiveness in the realms of mobilisation and inter‐organisational cooperation. As for mobilisation, while the Nantou County magistrate successfully used specific information to encourage flows of huge resources in the county, he did not successfully mobilise human resources there. With regard to inter‐organisational cooperation, myriad voluntary actors and international rescue teams travelled to Nantou County, but the fire and police services experienced cooperation and coordination problems.
Teaching the Fuzzy Front End of Innovation: Experimenting with Team Learning and Cross‐Organizational Integration
Authors: Martinsuo Miia
Published: August 2009

How can the extremely uncertain front end of innovation – managing the fuzzy front end – be taught to graduate students? This paper describes and analyses experiments with experiential, problem‐based learning focused on the front end of innovation. The focus is on the learning and cross‐organizational integration of student teams; factors that have been identified as central to the success of teams involved in the front end of innovation. An experiential course, ‘From an idea to a business plan in product development’, was developed in conjunction with an actual company, and piloted with four student groups in 2007 and 2008. Data on this novel course were collected through participant observation, team self‐assessment and questionnaires. This paper reports favourable results for the effectiveness of the course design; it discusses the impact of team size and cross‐organizational team composition on team performance; and identifies the implications for teaching the front end of innovation.
Facial Structure Is a Reliable Cue of Aggressive Behavior
Authors: Carré Justin M. , McCormick Cheryl M. , Mondloch Catherine J.
Published: August 2009

Facial width-to-height ratio is a sexually dimorphic metric that is independent of body size and may have been shaped by sexual selection. We recently showed that this metric is correlated with behavioral aggression in men. In Study 1, observers estimated the propensity for aggression of men photographed displaying neutral facial expressions and for whom a behavioral measure of aggression was obtained. The estimates were correlated strongly with the facial width-to-height ratio of the stimulus faces and with the actual aggression of the men. These results were replicated in Study 2, in which the exposure to each stimulus face was shortened to 39 ms. Participants' estimates of aggression for each stimulus face were highly correlated between Study 2 (39-ms exposure) and Study 1 (2,000-ms exposure). These findings suggest that the facial width-to-height ratio may be a cue used to predict propensity for aggression in others.
Genes Determine Stability and the Environment Determines Change in Cognitive Ability During 35 Years of Adulthood
Authors: Lyons Michael J. , York Timothy P. , Franz Carol E. , Grant Michael D. , Eaves Lindon J. , Jacobson Kristen C. , Schaie K. Warner , Panizzon Matthew S. , Boake Corwin , Xian Hong , Toomey Rosemary , Eisen Seth A. , Kremen William S.
Published: August 2009

Previous research has demonstrated stability of cognitive ability and marked heritability during adulthood, but questions remain about the extent to which genetic factors account for this stability. We conducted a 35-year longitudinal assessment of general cognitive ability using the Armed Forces Qualification Test administered to 7,232 male twins in early adulthood and readministered to a subset of 1,237 twins during late middle age. The proportion of variance in cognitive functioning explained by genetic factors was .49 in young adulthood and .57 in late middle age. The correlation between the two administrations was .74 with a genetic correlation of 1.0, indicating that the same genetic influences operated at both times. Genetic factors were primarily responsible for stability, and nonshared environmental factors were primarily responsible for change. The genetic factors influencing cognition may change across other eras, but the same genetic influences are operating from early adulthood to late middle age.
A Macroeconomic Perspective on Reserve Accumulation
Authors: Bar‐Ilan Avner , Marion Nancy P.
Published: August 2009

This paper nests the buffer stock model within a standard open‐economy model to capture two motives for international reserves accumulation—the insurance motive and the export‐led growth motive. The model is solved for two exchange‐rate policies, discretion and a rule with escape clause. It illustrates the behavior of international reserves and other macroeconomic variables when the policymaker pursues output and inflation stabilization and recognizes the supply of reserves can constrain the choice of exchange rate and the choice of exchange rate affects the supply of reserves. When output is below potential, it is optimal under both discretion and the rule to adopt a weak currency and promote export‐led growth to achieve output and inflation stabilization. This policy leads to reserve accumulation and is consistent with the behavior of China. When reserves are low initially, welfare is higher when the policymaker follows a rule.
Option Pricing Approach to International Reserves
Authors: Lee Jaewoo
Published: August 2009

This paper brings forward the insurance aspect of holding reserves by using the conceptual equivalence between insurance and financial options, and explores when reserves are likely to become the primary means of precautionary arrangement, in particular in emerging markets. The sharp rise in the amount of reserves held by many emerging markets since the mid‐1990s can be traced to the rise in the “globalization hazard” that confronts emerging markets. A modest probability of globalization hazard (sudden stop) can induce emerging markets to self‐insure fully by hoarding international reserves, rather than relying on nonreserve alternatives of taking precautions.
2. Estimating Net Interracial Mobility in the United States: A Residual Methods Approach
Authors: Perez Anthony Daniel , Hirschman Charles
Published: August 2009

This paper presents a residual methods approach to identifying social mobility across race/ethnic categories. In traditional demographic accounting models, population growth is limited to changes in natural increase and migration. Other sources of population change are absorbed by the model residual and can be estimated only indirectly. While these residual estimates have been used to illuminate a number of elusive demographic processes, there has been little effort to incorporate shifts in racial identification into formal accounts of population change. In light of growing evidence that a number of Americans view race/ethnic identities as a personal choice, not as a fixed characteristic, mobility across racial categories may play important roles in the growth of race/ethnic subpopulations and changes to the composition of the United States. To examine this potential, we derive a reduced-form population balancing equation that treats fertility and international migration as given and estimates survival from period life table data. After subtracting out national increase and net international migration and adjusting for changes in racial measurement and census coverage, we argue that the remaining error of closure provides a reasonable estimate of net interracial mobility among the native born. Using recent U.S. Census and ACS microdata, we illustrate the impact that identity shifts may have had on the growth of race/ethnic subpopulations in the past quarter century. Findings suggest a small drift from the non-Hispanic white population into race/ethnic minority groups, though the pattern varies by age and between time periods.
EVEN IMPORTANT CONNECTIONS ARE NOT ALWAYS MEANINGFUL: ON THE USE OF A POLARISATION MEASURE IN A TYPOLOGY OF EUROPEAN CITIES IN AIR TRANSPORT NETWORKS
Authors: VAN NUFFEL NATHALIE , DERUDDER BEN , WITLOX FRANK
Published: August 2009

This paper aims to refine existing approaches for classifying nodes in spatial networks. Apart from generally used variables measuring (i) the total connectivity of a node and (ii) the spatial make‐up of this total connectivity, we argue that a third indicator should be taken into account when describing the structure of a spatial network, namely, (iii) the degree of ‘polarisation’ in a node's connectivity configuration. We measure ‘polarisation’ by applying multiple linkage analysis, a technique that allows determining the number of meaningful connections for each node in the network. In this paper, we illustrate this approach by clustering 65 European cities based on their insertion in European air transport networks in 2005. The number of meaningful flows of a city is hereby considered alongside both traditional measures of connectivity. The results of the cluster analysis suggest that including a measure of polarisation may indeed lead to a more satisfying typology.
ECONOMIC DEVELOPMENT, STRUCTURAL CHANGE AND NATURAL RESOURCE BOOMS: A STRUCTURALIST PERSPECTIVE
Authors: Botta Alberto
Published: August 2009

In this paper we present a structuralist two‐sector model on economic development, structural change and natural resource booms. We describe a multiple equilibria scenario, in which manufacturing development is the main source of economic progress. Natural resource booms, by modifying the productive structure of the economy, may set destabilizing forces. De‐industrialization processes may take place, confining developing countries in poverty traps. Public intervention in the economic sphere, both through short‐run macro policies and through long‐run development strategies, may help to free the economy from poverty traps and to foster the development process.
Long‐term (96‐week) follow‐up of antiretroviral‐naïve HIV‐infected patients treated with first‐line lopinavir/ritonavir monotherapy in the MONARK trial*
Authors: Ghosn J , Flandre P , Cohen‐Codar I , Girard P‐M , Chaix M‐L , Raffi F , Dellamonica P , NgoVan P , Norton M , Delfraissy J‐F ,   for the MONARK,   Study Group
Published: August 2009

Background

The toxicities, cost and complexity of triple combinations warrant the search for other treatment options, such as boosted protease inhibitor (PI) monotherapy. MONotherapy AntiRetroviral Kaletra (MONARK) is the first randomized trial comparing lopinavir/ritonavir monotherapy to triple combination therapy with zidovudine/lamivudine and lopinavir/ritonavir in antiretroviral‐naïve patients.

Methods

A total of 136 antiretroviral‐naïve patients, with a CD4 cell count above 100 cells/μL and a plasma HIV RNA below 100 000 HIV‐1 RNA copies/mL, were randomized and dosed with either lopinavir/ritonavir monotherapy (n=83) or lopinavir/ritonavir+zidovudine/lamivudine (n=53). We focus here on patients in the lopinavir/ritonavir monotherapy arm followed to week 96. The intent‐to‐treat (ITT) analysis initially involved all patients randomized to lopinavir/ritonavir monotherapy (n=83), and then focused on patients who had an HIV RNA <50 copies/mL at week 48 (n=56).

Results

At week 96, 39 of 83 patients (47%) had HIV RNA <50 copies/mL, five of 83 had HIV RNA between 50 and 400 copies/mL, and three of 83 had HIV RNA >400 copies/mL. Focusing on the 56 patients with an HIV RNA <50 copies/mL at week 48, 38 of 56 patients (68%) had a sustained HIV RNA <50 copies/mL to week 96. To week 96, a total of 28 patients (34%) had discontinued the study treatment. In addition, the allocated treatment was changed for seven patients. PI‐associated resistance mutations were evident in five of 83 patients in the monotherapy arm from baseline to week 96.

Conclusion

By ITT analysis, 39 of the 83 patients initially randomized to lopinavir/ritonavir monotherapy had HIV RNA <50 copies/mL at week 96. The occurrence in some patients of low‐level viraemia (50–500 copies/mL) may increase the risk of drug resistance. First‐line lopinavir/ritonavir monotherapy cannot be systematically recommended.
Patient‐specific recovery patterns over time measured by dependence in activities of daily living after stroke and post‐stroke care: The South London Stroke Register (SLSR)
Authors: Toschke A. M. , Tilling K. , Cox A. M. , Rudd A. G. , Heuschmann P. U. , Wolfe C. D. A.
Published: August 2009

Background and purpose:  Data on patient‐specific recovery after stroke are lacking and the effects of complex healthcare interventions on the course of recovery were not reported. To quantify the recovery pattern up to 1 year post‐stroke and assess effects of evidence‐based treatments on the patient‐specific course of recovery allowing its prediction.

Methods:  A total of 355 patients after first‐ever stroke from the population‐based South London Stroke Register (source population >270 000) participated in a substudy between August 2002 and October 2004. At 1, 2, 3, 4, 6, 8, 12, 26, and 52 weeks post‐stroke, Barthel Index (BI; ranging from 0 to 20) was documented. Multilevel growth models allowing predictions for patients with specific characteristics were calculated.

Results:  Mean age was 70 years, 48% were male and 23% died within the first year. The age‐, gender‐ and stroke subtype‐adjusted BI curve sharply increased until week 8 to 24 depending on patient characteristics and subsequently plateaued. Multivariable analysis identified stroke unit care, appropriate secondary prevention and physiotherapy for those with disabilities as independent predictors of improved functional ability over time (P < 0.05). Patients receiving stroke unit care additionally gained 4 BI points within 6 months compared with their counterparts (P = 0.004).

Conclusions:  Functional outcome in the general population showed an increase followed by a plateau. Care parameters reflecting guideline treatment independently improved recovery illustrating the beneficial effects of evidence‐based interventions on recovery in an unbiased population.
Simultaneous blockade of alpha and beta adrenoceptors impairs cutaneous wound healing in rats
Authors: Romana‐Souza B , Monte‐Alto‐Costa A
Published: August 2009

Background  Recent studies showed that propranolol administration (beta‐antagonist), but not phentolamine administration (alpha‐antagonist), delays cutaneous wound healing. However, alpha adrenoceptor activation may be participating in propranolol‐induced alterations.

Objective  This study aims to investigate the effects of simultaneous blockade of beta and alpha adrenoceptors on cutaneous wound healing.

Methods  Rats were treated with propranolol plus phentolamine dissolved in water. An excisional lesion was done and measured. Lesions were formalin‐fixed and paraffin‐embedded 21 days after wounding. Sections were stained with haematoxylin and eosin, toluidine blue and Sirius red, and immunostained for alpha‐smooth muscle actin or proliferating cell nuclear antigen.

Results  Administration of propranolol plus phentolamine reduced wound contraction and re‐epithelialization, but increased cellular proliferation and the number of mast cells. There was no difference in myofibroblast density, collagen fibre organization and polymorphonuclear number between the control and treated groups.

Conclusion  Simultaneous blockade of beta and alpha adrenoceptors impairs cutaneous wound healing. Furthermore, propranolol‐induced impairment on cutaneous wound healing does not occur through alpha adrenoceptor activation.
Effects of Buzzwords on Experiential Learning: The Swedish Case of ‘Shared Situation Awareness’
Authors: Hansén Dan
Published: August 2009

This article takes an interest in the effects of buzzwords in the lesson‐drawing efforts of governmental bureaucracy. Buzzwords are viewed here as policy ideas for which policy makers are enthusiastic beyond subjecting them to critical scrutiny. They are in that sense detrimental to policy‐oriented learning and lesson‐drawing in the long run. They can, however, serve as heuristic devices in the short run; the reason for their usage and spreading may be that they pinpoint recurring structural problems (however, not solutions). This argument is corroborated by a case study on the effects of the buzzword ‘shared situation awareness’, which has been overly tractable in the Swedish crisis management system for a number of years.
Crises as Learning Triggers: Exploring a Conceptual Framework of Crisis‐Induced Learning
Authors: Deverell Edward
Published: August 2009

This article contributes to the debate on organizational learning from crisis by shedding light on the phenomenon of crises as learning triggers. To unveil theoretical patterns of how organizational crisis‐induced learning may appear and develop, I suggest a conceptual framework based on concept categories and answers to four fundamental questions: what lessons are learned (single‐ or double‐loop)?; what is the focus of the lessons (prevention or response)?; when are lessons learned (intra‐ or intercrisis)?; is learning blocked from implementation or carried out (distilled or implemented)? The framework's applicability is explored in a study of how a Swedish utility and the city of Stockholm responded to two large‐scale blackouts in Stockholm. The final sections suggest four propositions for further research.
Noninvasive methods of detecting fetal anaemia: a systematic review and meta‐analysis
Authors: Pretlove SJ , Fox CE , Khan KS , Kilby MD
Published: August 2009

Objectives  To estimate in a systematic review of the literature the diagnostic value of ultrasound and Doppler blood flow velocity in the evaluation of fetal anaemia.

Study selection and data extraction  Literature from 2000 to 2008 was identified using MEDLINE and EMBASE, the Cochrane Library and relevant specialist register of the Cochrane Collaboration, and by checking reference lists of known primary studies and review articles. Studies were selected if the accuracy of the fetal ultrasound parameters or Doppler studies of blood flow in the fetal vessels was estimated compared with a reference standard. Data from the selected studies were abstracted as 2 × 2 tables comparing the diagnostic test result with the reference standard. Results were pooled where appropriate. Diagnostic accuracy was expressed as likelihood ratios.

Results  Twenty‐five primary studies were identified containing suitable data on middle cerebral artery Doppler peak systolic velocity (MCA‐PSV). The largest group of studies whose data could be pooled containing nine studies gave a positive likelihood ratio of 4.30 (95% CI: 2.50 to 7.41) and a negative likelihood ratio of 0.30 (95% CI: 0.13 to 0.69) for 675 cases in detecting severe anaemia in the analysis.

Discussion  Although middle cerebral artery peak systolic velocity Doppler has limited diagnostic accuracy, it remains the gold standard for noninvasive screening of fetal anaemia.
Haemostatic changes in the puerperium ‘6 weeks postpartum’ (HIP Study) — implication for maternal thromboembolism
Authors: Saha P , Stott D , Atalla R
Published: August 2009

Objective  We aim to measure the thrombotic changes during the postnatal period up to 6 weeks after delivery and assess the extent of the risk period.

Design  Prospective observational study.

Setting  Queen Elizabeth II, an acute District General Hospital, Hertfordshire.

Population  Women booked at the antenatal clinic and prepared to deliver at the hospital.

Methods  We assessed the haemoglobin, platelet count and function, fibrinogen, prothrombin time, activated partial thromboplastin time, protein C, S and antithrombin level and as well as rotational thromboelastometry (ROTEM) from predelivery till 6 weeks postpartum.

Results  A total 50 women were recruited of which four dropped out. Results compared against the finding at 6 weeks after delivery. Platelet was significantly elevated on day 19 compared to day 42 (P < 0.001). Fibrinogen was elevated from predelivery till day 15 after delivery (P < 0.01). Prothrombin time (PT) was low till day 15 (P < 0.05) and activated partial thromboplastin time (APTT) was significantly lower till day 3 after delivery (P < 0.001). ROTEM revealed low clotting time (CT) at predelivery and continued to be low till day 7. Clot formation time (CFT) significantly low till day 25 (P < 0.05). Maximum clot firmness, alpha angle and amplitude at 20 minutes were raised till day 19 (P < 0.001, P < 0.01 and P < 0.001 respectively). While, comparing vaginal delivery against caesarean section there were nonsignificant increase in thrombotic parameters in caesarean section.

Conclusion  Coagulation screens as well as thomboelastometry suggest a persistent hypercoagulation during the first 3 weeks after delivery.
Maternal complications and pregnancy outcome in women with mechanical prosthetic heart valves treated with enoxaparin
Authors: McLintock C , McCowan LME , North RA
Published: August 2009

Objective  To determine maternal and fetal outcomes in women with mechanical heart valves managed with therapeutic dose enoxaparin during pregnancy.

Design  Retrospective audit.

Setting  Hospital‐based high‐risk antenatal clinics.

Population  Pregnant women with mechanical heart valves attending high‐risk antenatal clinics, treated with enoxaparin (1 mg/kg twice daily) during pregnancy.

Methods  Women with mechanical heart valves treated with enoxaparin at any stage during pregnancy (1997–2008) identified using a database of women with mechanical heart valves attending the high‐risk clinics and a prospective database of women prescribed enoxaparin for any indication during pregnancy.

Main outcome measures  Maternal outcomes included thromboembolic and haemorrhagic complications. Pregnancy and fetal outcomes included miscarriage, stillbirth, baby death and live birth, small‐for‐gestational‐age infants, warfarin embryopathy and warfarin‐related fetal loss.

Results  Thirty‐one women underwent 47 pregnancies. In 34 pregnancies (72.3%), anticoagulation was with predominantly enoxaparin and 13 (27.7%) pregnancies women received mainly warfarin, with enoxaparin given in the first trimester and/or peri‐delivery. Seven (14.9%) thrombotic complications occurred, of which five (10.6%) were associated with enoxaparin treatment. Non‐compliance or sub‐therapeutic anti‐Xa levels contributed in each case. Antenatal and postpartum haemorrhagic complications occurred in eight (17%) and 15 (32%) pregnancies respectively. Of 35 pregnancies continuing after 20 weeks’ gestation, 96% (22/23) of women taking predominantly enoxaparin had a surviving infant compared with 75% (9/12) in women taking primarily warfarin. Four perinatal deaths occurred, three attributable to warfarin.

Conclusions  Compliance with therapeutic dose enoxaparin and aspirin during pregnancy in women with mechanical heart valves is associated with a low risk of valve thrombosis and good fetal outcomes, but close monitoring is essential.
Haplotype structure and allele frequencies ofCYP2B6in Spaniards and Central Americans
Authors: Arenaz Izaskun , Vicente Jorge , Fanlo Ana , Vásquez Patricia , Medina Juan Carlos , Conde Blanca , González‐Andrade Fabricio , Sinués Blanca
Published: August 2009

This study was aimed to investigate the potential differences in allele frequencies of theCYP2B6gene between Spaniards and Central Americans. Three single nucleotide polymorphisms of theCYP2B6gene 516 G>T, 785 A>G and 1459 C>T were assayed by a polymerase chain reaction in 180 Spaniards and 182 Central Americans. The allele frequencies forCYP2B6*1,CYP2B6*4,CYP2B6*5,CYP2B6*6,CYP2B6*9in Spaniards and Central Americans were 0.593 and 0.642, 0.062 and 0.073, 0.113 and 0.030, 0.215 and 0.230, 0.014 and 0.023, respectively.CYP2B6*5was less prevalent among Central Americans than in Spaniards (P < 0.001). In comparison to other previously studied populations, theCYP2B6*5allele frequency among Spaniards was similar to other Caucasian or African groups, and higher than that in Asian populations. TheCYP2B6*5allele frequency in Central Americans was lower than that in Africans or Caucasian groups and higher than in Asians. The results indicate the presence of ethnic differences inCYP2B6genetic variants between Spaniards and Central Americans, and support the need for further investigations to explore whether these differences significantly alter the efficacy or toxicity of CYP2B6 substrate drugs.
Association between inosine triphosphate pyrophosphohydrolase deficiency and azathioprine‐related adverse drug reactions in the Chinese kidney transplant recipients
Authors: Xiong Hui , Xin Hua‐Wen , Wu Xiao‐Chun , Li Qing , Xiong Lei , Yu Ai‐Rong
Published: August 2009

Azathioprine (AZA) is a thiopurine prodrug commonly used in patients with kidney transplantation. The aim of this study is to explore in patients with kidney transplantation whether AZA‐related side effects can be explained by the inosine triphophate pyrophosphatase (ITPA) or thiopurine S‐methyltransferase (TPMT) polymorphisms using both pheno‐and genotyping. Erythrocyte ITPA and TPMT activity of 155 patients with kidney transplantation and AZA therapy was determined by HPLC. The frequencies of ITPA and TPMT polymorphisms were detected. Among 155 patients, three cases with zero activity were homozygote for 94C>A. The allele frequency of the 94C>A polymorphism was 0.12. Allele for the IVS2+21A>C mutation in the patients of this study was not found. Thirty‐five cases had stopped azathioprine medication or were on reduced dose due to AZA‐related side effects, including hematotoxicity (n = 12), hepatotoxicity (n = 18), gastrointestinal toxicity (n = 5, one patient developed hepatotoxicity simultaneously) and flu‐like symptoms (n = 1). No statistical significant associations between ITPA 94C>A phenotype or genotype and AZA‐related hematotoxicity or hepatotoxicity could be detected. However, five patients who developed gastrointestinal disturbance, two patients were homozygote for 94C>A and other three patients had 94C>A heterozygous allele. The patient who experienced flu‐like symptoms were the remaining homozygote for 94C>A. This study demonstrates that ITPA activity reduced in patients with 94C>A mutation (P < 0.01). Patients with ITPA 94C>A homozygous allele are at high risk to develop AZA‐related gastrointestinal toxicity and flu‐like symptoms (P < 0.01). TPMT wild‐type/ITPA variant (homozygote) is closely related to the AZA‐induced side effects (P < 0.01).
The Use of Physical Restraints in Home Care in the Netherlands
Authors: De Veer Anke J. E. , Francke Anneke L. , Buijse Rian , Friele Roland D.
Published: August 2009

OBJECTIVES: To gain more knowledge of the application of physical restraints to restrict, restrain, or prevent movement by elderly people living at home.

DESIGN: Survey.

SETTING: Nursing staff in Dutch home care.

PARTICIPANTS: One hundred fifty‐seven nursing staff in home care (registered nurses and certified nursing assistants) from a randomly selected and nationally representative panel returned the questionnaire (response rate 72%).

MEASUREMENTS: A structured questionnaire on the use of physical restraints.

RESULTS: Four of every five nursing staff members have applied physical restraints. The use of bed rails, putting the client in a deep chair or using a chair with a table, and locking doors to prevent wandering were most frequently applied, often at the request of the client or his or her family. Protection of the client is the reason most frequently given for these actions. Almost all respondents (94%) know of no alternatives, nor does consensus exist on what is considered to be a physical restraint.

CONCLUSION: Guidelines are necessary regarding the course of action to be taken when a client is in danger of hurting him‐ or herself. Further education on and due consideration of the use of physical restraints in home care are also required.
Comment on William C. Brainard and Herbert E. Scarf's “How to Compute Equilibrium Prices in 1891”
Authors: Sreenivasan K. R.
Published: August 2009

Abstract.  In commenting on Brainard and Scarf's essay, the engineer and physicist K. R. Sreenivasan considers why Fisher resorted to hydraulic machines in the first place.
Controlling the Price Level
Authors: Hall Robert E.
Published: August 2009

Abstract.  Governments determine the size of the unit of value just as they determine the length and weight of physical units of measure. What are the different ways that a government can control the size of the unit of value, that is, control the price level? In general, the government designates a resource—gold, paper currency, another country's currency—and defines its unit of value as a particular amount of that resource. An interesting variant, proposed by Irving Fisher in 1913 and implemented more recently in Chile, is to alter the resource content of the unit to stabilize the price level. Another idea is to alter the interest rate paid on reserves in a way that stabilizes the price level. This essay originally appeared as “Controlling the Price Level,”Contributions to Macroeconomics 2(1), Article 5. See http://www.bepress.com/bejm/contributions/vol2/iss1/art5. Reprinted with kind permission of the Berkeley Electronic Press.
Fisher, Keynes, and the Corridor of Stability
Authors: Dimand Robert W.
Published: August 2009

Abstract.  This chapter draws on the debt‐deflation process of Fisher (1933) as well as on Keynes (1936, chapter 19) and Tobin (1975, 1980) to explore the concept of a corridor of stability, where an economy will be self‐adjusting only for demand shocks small enough to leave it within that corridor.
Irving Fisher's Spendings (Consumption) Tax in Retrospect
Authors: Shoven John B. , Whalley John
Published: August 2009

Abstract.  Irving Fisher wrote a significant number of papers towards the end of his career on the design of the U.S. tax system. These writings culminated in a book that he wrote with his brother Herbert in 1942. Fisher thought that the double taxation of saving under an income tax was extremely harmful to the economy and he therefore proposed a “spendings” tax or what he referred to as a “real income” tax. Even though he disliked the terminology, he advocated what today would be referred to as a progressive consumption tax. Fisher's analysis was both theoretical and practical. His 1942 book contained a proposed tax return that implemented his ideas. His analysis is surprisingly modern and relevant today. This paper presents the Fisher proposal and examines the current U.S. tax system in light of his tax views. We argue that Fisher would find that the U.S. tax system lacks intellectual coherence, is economically inefficient, and unnecessarily complex.
Sex biased intra‐tree oviposition site selection and larval foraging behavior of a specialist herbivore
Authors: Johns Rob C. , Quiring Dan T. , Ostaff Don P.
Published: August 2009

Heterogeneity in the quality of oviposition and feeding sites within plants can significantly influence the distribution and abundance of herbivorous insects, but remains poorly understood. Field surveys and a manipulative study were conducted to evaluate the influence of variation within the crown of black spruce, Picea mariana (Mill.) B.S.P. (Pinaceae), on adult oviposition and larval feeding behavior of yellowheaded spruce sawfly, Pikonema alaskensis Rohwer (Hymenoptera: Tenthredinidae). Most eggs were laid in the mid to lower crown of 1.5–2 m tall trees. However, most of the few eggs that were laid in the upper crown (i.e., whorl 2) were female. Fourth and fifth instars dispersed acropetally, from the mid and lower to the upper crown, causing high defoliation in the upper crown. Late‐instar females were generally more abundant than males on the leader, the most apical shoot on a tree where eggs and early instars rarely occurred, strongly suggesting that more females than males disperse acropetally. This hypothesis was supported in a manipulative experiment, where only 15–20% of larvae in all‐male broods, but almost three‐quarters of larvae in mixed broods, dispersed to the upper crown. To our knowledge, this is only the second study to explicitly demonstrate preferential allocation of progeny sex through oviposition site selection by a herbivorous insect, and the first study to unambiguously demonstrate sex‐biased dispersal by the juveniles of an insect whose adult females can fly. This study emphasizes the important role of intra‐plant variation in shaping both oviposition site selection and the dispersal behavior of juvenile phytophagous insects within their hosts, and suggests that sex‐biased foraging behaviors may be necessary for some insects to accommodate the respective needs of immature females and males within heterogeneous host plants.