bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined low‐dose imatinib mesylate and paclitaxel lack synergy in an experimental model of extra‐osseous hormone‐refractory prostate cancer
Authors: Corcoran Niall M. , Costello Anthony J.
Published: August 2005

OBJECTIVE

To determine the efficacy of low‐dose imatinib mesylate (STI571) alone or combined with a taxane (paclitaxel) in inhibiting the growth of experimental extra‐osseous hormone‐refractory prostrate cancer.

MATERIALS AND METHODS

Orthotopic PC3 prostate tumours were established in male severe combined‐immunodeficient mice; on day 3 the mice were randomly assigned to one of four groups: paclitaxel 10 mg/kg intraperitoneally once a week; STI571 50 mg/kg once a day for 6/7 weekdays; combined paclitaxel and STI571; and vehicle‐treated controls. On day 40, the primary prostate tumour and metastatic lymphadenopathy were removed and measured. Effects were correlated with tumour cell proliferation and microvessel density.

RESULTS

Paclitaxel reduced the mean tumour weight and volume by 21.3% (not significant) and 73.7% (P < 0.05), respectively, compared to controls, and reduced the number of lymph node metastases by 49.1% (P < 0.05) and mean lymph node size by 13.5% (not significant). Adding low‐dose STI571 had a small additive effect on tumour weight and the incidence of lymph node metastases, but this was not significant compared to paclitaxel alone. STI571 alone did not inhibit tumour progression. Antitumour effects were associated with parallel changes in tumour cell proliferation with no significant changes in neo‐angiogenesis.

CONCLUSION

Combined low‐dose STI571 and paclitaxel had little synergy in this experimental model. Low‐dose STI571 monotherapy was not effective in extra‐osseous disease, apparently due to a site‐specific failure to up‐regulate β‐platelet‐derived growth factor receptor expression in prostate cancer cells and associated tumour stroma.
The Potential and Limits of Consumer Empowerment by Information
Authors: Howells Geraint
Published: August 2005

Consumer policy increasingly places emphasis on the role of information in allowing consumers to protect themselves and promoting a competitive economy. Increasing the information available to consumers is undoubtedly beneficial, but this article cautions that the limitations of consumer protection though information also have to be recognized. In particular, emphasis is placed on the insights provided by behavioural economics which suggests that consumers may not always respond to information provided as rationally as traditional economic models sometimes assume. One implication of this is that the way information rules are framed needs to be revisited. Other consumer policy approaches (altering the default rules, using bans and regulations, and risk sharing) need to be considered alongside a strategy of information provision. To analyse which approach should be adopted or to find the appropriate balance between different approaches requires policy makers to engage more fully with the legal and consumer policy research community.
Property and Agri‐Environmental Legislation Europe
Authors: Sikor Thomas
Published: August 2005

Governments across Central and Eastern Europe have enacted agri‐environmental legislation over the past decade. This paper explores how the legislation has played out in practice, using property as an analytical lens to examine the social dynamics surrounding agri‐environmental problems. The analysis proceeds by way of three case studies on irrigation management in Bulgaria, biodiversity conservation in the Czech Republic, and the preservation of open space in Poland. The findings highlight the discrepancy between the legal rights accorded to land owners and their rights‐in‐practice. Land owners contest the constraints imposed by agri‐environmental legislation through strategies ranging from avoidance to open violation. They also counter the goal of environmental protection by invoking competing social values. The material and symbolic contestations form new sets of regulations blurring the boundary between public oversight and private rights delineated in agri‐environmental legislation.
Pre‐accession Europeanisation: The Strategic Realignment of the Environmental Policy Systems of Lithuania, Poland and Slovakia towards Agricultural Pollution in Preparation for EU Membership
Authors: Gorton Matthew , Lowe Philip , Zellei Anett
Published: August 2005

The divergent responses of three CEECs ‐ Lithuania, Poland and Slovakia ‐ to the common evolution of problems of agriculturally induced water pollution into matters of international concern is analysed from the end of their communist regimes to accession to the European Union (EU) in 2004. The early years of transition were characterised by an emerging international socialisation of domestic elites with Western academics and policy networks. These networks presented opportunities for norm entrepreneurs, who sought to draw attention to the problem of agriculturally induced water pollution and realign domestic policy. The success of these norm entrepreneurs depended on the positions they held in elite networks, their state's geo‐political concerns and desires for international legitimacy, and the degree to which productionist interests were entrenched in agricultural ministries. In contrast, the late 1990s and early 2000s were dominated by preparations for EU membership, particularly adoption of the acquis communautaire. While the CEECs had no option but to transpose EU directives into domestic legislation, the nature of directives has meant that they have had considerable leeway in terms of the administrative solutions chosen. This is illustrated by the Nitrates Directive; the three countries studied have adopted markedly different responses and sought expertise from established Member States that closely matched their own outlook. Arguments that the CEECs are en masse environmental laggards or merely passive players in the process of Europeanisation are rejected.
Towards a Unified Approach for Proving Geometric Ergodicity and Mixing Properties of Nonlinear Autoregressive Processes
Authors: Liebscher Eckhard
Published: August 2005

Abstract. In this paper we attempt to establish unified sufficient conditions for geometric ergodicity of autoregressive models. It is shown that there is a close relationship between geometric ergodicity and mixing properties. The case of nonstationary time series is incorporated into the investigations. Several time series models including threshold and EXPARCH‐models are examined with respect to geometric ergodicity. In some cases we obtain regions of geometric ergodicity in the parameter space, which are larger than that known from the literature.
Quasi‐Maximum Likelihood Estimation for a Class of Continuous‐time Long‐memory Processes
Authors: Tsai Henghsiu , Chan K. S.
Published: August 2005

Tsai and Chan (2003) has recently introduced the Continuous‐time Auto‐Regressive Fractionally Integrated Moving‐Average (CARFIMA) models useful for studying long‐memory data. We consider the estimation of the CARFIMA models with discrete‐time data by maximizing the Whittle likelihood. We show that the quasi‐maximum likelihood estimator is asymptotically normal and efficient. Finite‐sample properties of the quasi‐maximum likelihood estimator and those of the exact maximum likelihood estimator are compared by simulations. Simulations suggest that for finite samples, the quasi‐maximum likelihood estimator of the Hurst parameter is less biased but more variable than the exact maximum likelihood estimator. We illustrate the method with a real application.
On the use of Sub‐sample Unit Root Tests to Detect Changes in Persistence
Authors: Robert Taylor A. M.
Published: August 2005

Abstract.  We investigate the behaviour of rolling and recursive augmented Dickey–Fuller (ADF) tests against processes which display changes in persistence. We show that the power of the tests depend crucially on the window width and warm up parameter for the rolling and recursive procedures respectively, on whether forward or reverse recursive sequences of tests are computed, and on the persistence change process generating the data. To ameliorate these dependencies we extend the available critical values for these tests, and propose a number of new sub‐sample unit root tests for which finite sample and asymptotic critical values are also provided. An empirical illustration on OECD real output data is also provided.
Using the Penalized Likelihood Method for Model Selection with Nuisance Parameters Present only under the Alternative: An Application to Switching Regression Models
Authors: Preminger Arie , Wettstein David
Published: August 2005

Abstract. We study the problem of model selection with nuisance parameters present only under the alternative. The common approach for testing in this case is to determine the true model through the use of some functionals over the nuisance parameters space. Since in such cases the distribution of these statistics is not known, critical values had to be approximated usually through computationally intensive simulations. Furthermore, the computed critical values are data and model dependent and hence cannot be tabulated. We address this problem by using the penalized likelihood method to choose the correct model. We start by viewing the likelihood ratio as a function of the unidentified parameters. By using the empirical process theory and the uniform law of the iterated logarithm (LIL) together with sufficient conditions on the penalty term, we derive the consistency properties of this method. Our approach generates a simple and consistent procedure for model selection. This methodology is presented in the context of switching regression models. We also provide some Monte Carlo simulations to analyze the finite sample performance of our procedure.
Broad Outcome Measures May Underestimate Effectiveness: An Instrument Comparison Study
Authors: Lee William , Jones Lynne , Goodman Robert , Heyman Isobel
Published: August 2005

Background:  Outcome measures are routinely used in child and adolescent mental health services to demonstrate the effectiveness or otherwise of interventions.

Methods:  We followed up a consecutive sample from a large teaching hospital's Obsessive Compulsive Disorder (OCD) service for young people, comparing improvements using instruments of differing broadness.

Results:  The effect size of improvement decreased as the breadth of the questionnaire increased.

Conclusion:  Specialist clinics are recommended to use two questionnaires: a broad one to facilitate comparability with other clinics, and a narrow one to maximise power to detect significant changes.
Benchmarks for Antibiotic Use and Cost in Long‐Term Care
Authors: Mylotte Joseph M. , Keagle Jessica
Published: August 2005

Objectives: To evaluate previously described antibiotic use and cost indicators in community nursing homes to determine whether they may be useful as benchmarks and to evaluate the association between functional status, infection occurrence, and antibiotic use.

Design: Retrospective observational study.

Setting: Eleven proprietary long‐term care facilities owned by one company.

Participants: Only facility‐specific cumulative data were used.

Measurements: Antibiotic use and cost indicators (incidence of antibiotic use, antibiotic utilization ratio, cost of antibiotics per resident care day (RCD), and cost per antibiotic day), infection rates, and functional status as measured using the case‐mix index (CMI) of the Resource Utilization Groups II system. Mean yearly values for each measure were calculated for each facility.

Results: There was significant variation in all of the antibiotic indicators between the 11 nursing homes, but there was no correlation between mean facility CMI and infection rate. However, there was a trend toward a significant correlation between mean facility CMI and mean facility incidence of antibiotic use, antibiotic utilization rate, and cost per RCD. Variation in mean facility infection rate explained 66% of the variation in mean facility incidence of antibiotic use (P<.001). In a multivariate analysis, mean facility infection rate (P=.003) and mean facility CMI (P=.046) were predictors of mean incidence of antibiotic use and explained 83% of the variation in dependent variable.

Conclusion: The significant variation in mean antibiotic use and cost indicators between the 11 study facilities suggests that these indicators may be useful as benchmarks for quality‐improvement efforts. For the first time, objective evidence is provided demonstrating the influence of functional status on antibiotic use in the nursing home setting.
Physicians' Experiences with Demented Patients with Advance Euthanasia Directives in the Netherlands
Authors: Rurup Mette L , Onwuteaka‐Philipsen Bregje D , Van Der Heide Agnes , Van Der Wal Gerrit , Van Der Maas Paul J
Published: August 2005

Objectives: To estimate the incidence of (compliance with) advance euthanasia directives of patients suffering from dementia in the Netherlands and to gain knowledge about the experiences of physicians.

Design: Retrospective interview study.

Setting: Physicians in the Netherlands.

Participants: Four hundred ten physicians.

Measurements: Physicians were interviewed about their demented patients who had an advance euthanasia directive. Nursing home physicians were interviewed more extensively.

Results: Approximately 2,200 demented patients with an advance euthanasia directive die annually after being treated by a physician who knows about this directive. In 76% of such cases, compliance with the directive was discussed, but euthanasia was seldom performed. In two‐thirds of the cases of demented nursing home patients with an advance euthanasia directive, the physician was able to identify during the course of the disease a situation for which the patient had intended the directive. One‐quarter of the nursing home physicians thought that their most recent patient suffered unbearably to a (very) high degree, and half of them thought that the patient suffered hopelessly to a (very) high degree. In three‐quarters of the cases, the relatives did not want the nursing home physician to comply with the directive, but they did want to respect the patient's wishes by forgoing life‐prolonging treatment, which occurred in approximately 90% of cases.

Conclusion: Most nursing home physicians think that the suffering of patients with dementia can be unbearable and hopeless as a consequence of dementia, but most physicians do not consider dementia to be grounds for euthanasia, unless perhaps the patient has an additional illness.
Are Older People Dying of Depression? Findings from the Medical Research Council Trial of the Assessment and Management of Older People in the Community
Authors: Adamson Joy A. , Price Gill M. , Breeze Elizabeth , Bulpitt Christopher J. , Fletcher Astrid E.
Published: August 2005

Objectives: To examine the relationship between symptoms of depression and mortality in older people.

Design: Prospective longitudinal study.

Setting: Fifty‐three general practices in the United Kingdom.

Participants: Thirteen thousand ninety‐seven people aged 75 and older participating in the Medical Research Council Trial of the Assessment and Management of Older People in the Community.

Measurements: Depression was measured using the 15‐item Geriatric Depression Scale (GDS‐15); the main outcome was all‐cause mortality.

Results: Morbidity, disability, and lifestyle factors can explain most of the observed relationship between symptoms of depression and mortality (hazard ratio=1.75, 95% confidence interval (CI)=1.53–1.99), but after mutual adjustment for these factors, subjects who reported six or more symptoms of depression on the GDS‐15 were still 27% more likely to have died by the end of the follow‐up period than those below the threshold for depression (95% CI=1.11–1.45).

Conclusion: The findings from this study suggest that depression confers a small risk for mortality in older people, not explained solely by poor health. The results support the encouragement of effective diagnosis, treatment, and support for individuals with depression as highlighted by the World Health Organization and the UK National Service Framework for older people.
Skilled Care Requirements for Elderly Patients After Coronary Artery Bypass Grafting
Authors: Nallamothu Brahmajee K. , Rogers Mary A. M. , Saint Sanjay , McMahon Laurence J. , Fries Brant E. , Kaufman Samuel R. , Langa Kenneth M.
Published: August 2005

Objectives: To examine the extent to which elderly individuals use various skilled care facilities after coronary artery bypass grafting (CABG).

Design: Retrospective cohort study.

Setting: State of Michigan from 1997 to 1998.

Participants: Residents aged 65 and older enrolled in Medicare who underwent CABG.

Measurements: Cumulative incidence of admission within 100 days of hospital discharge, relative risk (RR) of admission, readmission or extended stay at a skilled care facility, and length of stay in a skilled care facility.

Results: Fifty percent of patients aged 80 and older used a skilled care facility after CABG, with most requiring admission to a skilled nursing facility (SNF) or readmission to an acute‐care hospital within 100 days after discharge. Patients aged 80 and older had a significantly higher risk of admission to a SNF (adjusted RR=3.3, 95% confidence interval (CI)=2.8–4.0) than did those aged 65 to 69, as did patients aged 75 to 79 (adjusted RR=2.2, 95% CI=1.8–2.6) and those aged 70 to 74 (adjusted RR=1.5, 95% CI=1.3–1.8). The length of time spent in skilled care facilities significantly increased with age (mean days=13.3 for aged 65–69, 16.9 for 70–74, 19.6 for 75–79, and 22.9 for 80 and older; P<.001).

Conclusion: Older patients are more likely to be admitted to a SNF, be readmitted to an acute‐care hospital, and have longer institutional stays after CABG. When balancing the risks and benefits of CABG, physicians, patients, families, and policy‐makers need to carefully consider the likelihood of follow‐up institutional care in elderly patients.
Associations Between Dementia/Mild Cognitive Impairment and Cognitive Performance and Activity Levels in Youth
Authors: Fritsch Thomas , Smyth Kathleen A. , McClendon McKee J. , Ogrocki Paula K. , Santillan Concepcion , Larsen Janet D. , Strauss Milton E.
Published: August 2005

Objectives: To study the associations between dementia/mild cognitive impairment (MCI) and cognitive performance and activity levels in youth.

Design: Retrospective cohort study.

Setting: Research volunteers living throughout the United States.

Participants: A total of 396 persons (mean age 75) who were graduates of the same high school in the mid‐1940s.

Measurements: Adolescent intelligence quotient (IQ) scores were gathered from archived student records, and activity levels were determined from yearbooks. A two‐stage telephone screening procedure (Modified Telephone Interview for Cognitive Status or Informant Questionnaire on Cognitive Decline in the Elderly followed by Dementia Questionnaire) was used to determine adult cognitive status. Data were analyzed using logistic regression to model the risk of cognitive impairment (dementia/MCI) versus no cognitive impairment as a function of IQ and activity level, adjusting for sex and education.

Results: High adolescent IQ and greater activity level were each independently associated with a lower risk for dementia/MCI (odds ratio (OR) for a 1‐standard deviation increase in IQ=0.51, 95% confidence interval (CI)=0.32–0.79; OR for a unit increase in activity=0.32, 95% CI=0.12–0.84). No association was found between sex or education and adult cognitive status in this model.

Conclusion: High IQ and greater activity levels in youth reduce the risk for cognitive impairments in aging. The mechanism(s) underlying these associations are unknown, but intelligence may be a marker for cognitive/neurological “reserve,” and involvement in activities may contribute to “reserve.” Early neuropathology and ascertainment bias are also possible explanations for the observed associations.
Predictors of Combined Cognitive and Physical Decline
Authors: Atkinson Hal H. , Cesari Matteo , Kritchevsky Stephen B. , Penninx Brenda W. J. H. , Fried Linda P. , Guralnik Jack M. , Williamson Jeff D.
Published: August 2005

Objectives: To determine the incidence and correlates of combined declines in cognitive and physical performance.

Design: Cohort study of community‐dwelling older women with moderate to severe disability.

Setting: The community surrounding Baltimore, Maryland.

Participants: Participants in the Women's Health and Aging Study I with Mini‐Mental State Examination (MMSE) score or 24 or greater and walking speed greater than 0.4 m/s at baseline.

Measurements: Cognitive decline was defined as an MMSE score less than 24 and physical decline as a walking speed of 0.4 m/s or less in at least one of the three annual follow‐up visits. Participants were stratified into groups based on cognitive or physical decline or both. Group characteristics were compared, and results were adjusted for age, race, education, and significant covariates.

Results: Of 558 women that met the baseline MMSE and walking speed inclusion criteria, 21% developed physical decline, 12% developed cognitive decline, and 11% experienced combined cognitive and physical decline. After adjustment, physical decline was associated with age, nonwhite race, former smoking, baseline walking speed, and instrumental activities of daily living (IADL) impairment. Cognitive decline was associated with age and baseline MMSE score. Combined decline was associated with age, baseline walking speed, MMSE score, IADL impairment, as well as current smoking (odds ratio (OR)=5.66, 95% confidence interval (CI)=1.49–21.54) and hemoglobin level (OR=0.68, 95% CI=0.47–0.98).

Conclusion: Potential predictors of cognitive and physical performance decline were identified. The association between smoking and lower hemoglobin levels and combined cognitive and physical decline may represent potentially modifiable risk factors and should be confirmed in future studies.
Potential Mediators of Ethnic Differences in Physical Activity in Older Mexican Americans and European Americans: Results from the San Antonio Longitudinal Study of Aging
Authors: Dergance Jeannae M. , Mouton Charles P. , Lichtenstein Michael J. , Hazuda Helen P.
Published: August 2005

Factors were examined that might explain reported ethnic differences in leisure time physical activity (LTPA) between Mexican Americans (MAs) and European Americans (EAs). Data were from a random sample of 749 community‐dwelling MAs and EAs, aged 65 and older, who participated in the San Antonio Longitudinal Study of Aging (SALSA) baseline examination. Variables examined included LTPA measured as kilocalories of energy expended per week, contextual variables (age, sex, socioeconomic status (SES), acculturation/structural assimilation), psychosocial measures (self‐esteem, mastery, perceived health control), lifestyle variables (fat avoidance, current alcohol drinker, years smoking, body mass index (BMI)), and presence of chronic diseases (diabetes mellitus, angina pectoris, myocardial infarction, stroke, hypertension, arthritis, chronic obstructive pulmonary disease, depression, mild cognitive impairment). Hierarchical multiple regression was used to examine potential mediators of the ethnic group–LTPA association. EAs expended almost 300 kcal/wk more energy than did MAs (1,287 kcal/wk vs 1,001 kcal/wk). SES and psychosocial (self‐esteem), lifestyle (fat avoidance, smoking, BMI), and disease (depression) factors that vary by SES explained this ethnic difference. In MAs, structural assimilation, but not acculturation, was significantly associated with LTPA independent of SES. Self‐esteem, BMI, and depression explained this association. Psychosocial resources, lifestyle behaviors, and depression explain differences in LTPA between older MAs and EAs. Interventions to increase LTPA in both ethnic groups should be targeted especially at women and persons who have low self‐esteem, smoke, and are obese or depressed. In MAs, additional emphasis should be focused on those who are less structurally assimilated into the broader American society.
Association Between Acculturation and Structural Assimilation and Mini‐Mental State Examination–Assessed Cognitive Impairment in Older Mexican Americans: Findings from the San Antonio Longitudinal Study of Aging
Authors: Simpao Marc P. , Espino David V. , Palmer Raymond F. , Lichtenstein Michael J. , Hazuda Helen P.
Published: August 2005

Older Mexican Americans (MAs) have consistently scored lower on the Folstein Mini‐Mental State Examination (MMSE) than older European Americans (EAs). These lower scores may arise from factors other than those traditionally posited (age and education). Thus, this study examined the association between acculturation and structural assimilation and MMSE‐assessed cognitive impairment, taking into account education, income, and other contextual factors. Subjects were participants in the San Antonio Longitudinal Study of Aging, a community‐based study of chronic disease and functional status in 457 older MAs and 376 older EAs. Scales were used to measure two dimensions of acculturation: (family attitude, cultural values) and structural assimilation (functional integration into the broader American society). Logistic regression was used to examine the association between age, sex, acculturation, and structural assimilation and MMSE scores suggestive of cognitive impairment (<24). After adjusting for contextual factors (age, sex, education and household income), diseases (diabetes mellitus, stroke, and hypertension), and sensory impairments (hearing and vision), structural assimilation, but neither dimension of acculturation, was significantly and negatively associated with MMSE‐assessed cognitive impairment. Older MAs in the lowest structural assimilation stratum were 1.89 times as likely to have MMSE‐assessed cognitive impairment as those in the highest. Age, education, and visual impairment were also independently associated with cognitive impairment. These findings highlight the need for geriatricians to take contextual factors (including age, education, and structural assimilation) into account when interpreting MMSE scores of MA patients.
Effect of Blood Pressure and Diabetes Mellitus on Cognitive and Physical Functions in Older Adults: A Longitudinal Analysis of the Advanced Cognitive Training for Independent and Vital Elderly Cohort
Authors: Kuo Hsu‐Ko , Jones Richard N. , Milberg William P. , Tennstedt Sharon , Talbot Laura , Morris John N. , Lipsitz Lewis A.
Published: August 2005

Objectives: To evaluate the effect of blood pressure (BP) and diabetes mellitus (DM) on cognitive and physical performance in older, independent‐living adults.

Design: Longitudinal study with secondary data analysis from the Advanced Cognitive Training for Independent and Vital Elderly randomized intervention trial.

Setting: Six field sites in the United States.

Participants: Two thousand eight hundred two independent‐living subjects aged 65 to 94.

Measurements: Cognitive functions in different domains and physical functions measured using activities of daily living, instrumental activities of daily living (IADLs), and the physical function subscale from the Medical Outcomes Study Short Form‐36 (SF‐36) Health Survey.

Results: After the first annual examination, hypertension was associated with a faster decline in performance on logical reasoning tasks (ability to solve problems following a serial pattern), whereas DM was associated with accelerated decline on the Digit Symbol Substitution Test (speed of processing). The reasoning and Digit Symbol Substitution test are executive function tasks thought to be related to frontal‐lobe function. Hypertension and DM were associated with a significantly faster pace of decline on the SF‐36 physical function component score. Individuals with DM had a faster pace of decline in IADL functioning than nondiabetic subjects. There was no evidence for an interaction between BP and DM on cognitive or physical function decline.

Conclusion: Hypertension and DM are associated with accelerated decline in executive measures and physical function in independent‐living elderly subjects. Further research is needed to determine whether cardiovascular risk modification ameliorates cognitive and functional decline in elderly people.
Hypoalbuminemia 3 Months After Hospital Discharge: Significance for Long‐Term Survival
Authors: Sullivan Dennis H. , Roberson Paula K. , Bopp Melinda M.
Published: August 2005

Objectives: To determine change in albumin from hospital discharge to 3‐month follow‐up and the prognostic significance of persistent hypoalbuminemia in older veteran patients.

Design: A prospective cohort study.

Setting: A geriatric rehabilitation unit of a university‐affiliated Department of Veterans Affairs hospital.

Participants: The study population consisted of 282 subjects (of 322 randomly selected discharges who were free of cancer and terminal conditions) that completed the 90‐day postdischarge assessment; most were older (75.4±8.6), white (76%), and male (99%).

Measurements: Each subject completed a comprehensive discharge assessment, had a repeat albumin an average of 94 days later, and was then tracked for 5 years. The strongest predictors of survival were identified using Cox proportional hazards regression analysis.

Results: Between hospital discharge and the 3‐month reassessment, albumins improved by more than 2 g/L in 122 subjects (43%), stayed the same in 112 subjects (40%), and deteriorated by more than 2 g/L in the rest. During follow‐up, 190 subjects (67%) died. Of the 38 nutritional, functional, demographic, and illness severity variables evaluated, the 3‐month postdischarge albumin was the strongest predictor of long‐term mortality. Those with albumins less than 35 g/L had a 2.6 times greater mortality than those with albumins of 40 g/L or greater (relative risk=2.6, 95% confidence interval=1.8–3.8). After controlling for 3‐month albumin, hospital‐discharge albumin was not significantly associated with long‐term mortality.

Conclusion: In older people, a low serum albumin 3 months after hospital discharge is associated with a poor long‐term prognosis. It is not known whether this represents ongoing inflammation or inadequate nutrition.
Septic Arthritis in Patients Aged 80 and Older: A Comparison with Younger Adults
Authors: Gavet Florence , Tournadre Anne , Soubrier Martin , Ristori Jean Michel , Dubost Jean Jacques
Published: August 2005

Objectives: To compare the frequency and characteristics of septic arthritis in patients younger than 80 and aged 80 and older.

Design: Retrospective.

Setting: Single hospital center.

Participants: Patients admitted between 1979 and 2002 for septic arthritis.

Measurements: Age, sex, time to diagnosis, predisposing factors, joint, temperature, white blood cell count, microorganism, and short‐term outcome.

Results: Of 335 patients, 206 (61.4%) were aged 60 and older, and 42 (12.5%) were 80 and older. The latter had an average age of 84 (range 80–97) and were mainly women (72%). Eighteen of the 42 had at least one risk factor. The mean time to diagnosis was 21 days (range 1 day to 3 months). Twenty patients (47%) had knee involvement, six (14%) shoulder involvement, ten (23.8%) a prosthetic infection, and five (12%) polyarticular infection. Ten (23%) were afebrile. In half of the cases, there was no increase in white blood cell count. The microorganisms isolated were Staphylococcus aureus (n=16, 38%), coagulase negative staphylococci (n=8, 19%), streptococci (n=12, 28%), and gram‐negative bacilli (n=6, 14%). The mortality rate increased with age: 0.7% of patients younger than 60, 4.8% of those aged 60 to 79, and 9.5% of those aged 80 and older.

Conclusion: Advanced age is a risk factor for septic arthritis and poor outcome.
Agreement Between Patient and Proxy Responses of Health‐Related Quality of Life After Hip Fracture
Authors: Jones C. Allyson , Feeny David H.
Published: August 2005

Objectives: To examine agreement between patient and proxy respondents on health‐related quality of life (HRQL) over time during the 6‐month recovery after hip fracture.

Design: Prospective longitudinal cohort study.

Setting: A healthcare region serving Edmonton, Alberta, and the surrounding area.

Participants: Two hundred forty‐five patients aged 65 and older, were treated for hip fracture, and had Mini‐Mental State Examination scores greater than 17; 245 family caregivers participated as proxy respondents.

Measurements: Primary outcome was HRQL (Health Utilities Mark 2 and Mark 3). Interviews were completed within 5 days after surgery and at 1, 3, and 6 months. Agreement was evaluated using intraclass correlation coefficients (ICCs).

Results: Agreement was considered moderate to excellent for HRQL. ICC values ranged from 0.50 to 0.85 (P<.001) for physically based observable dimensions of health status and from 0.32 to 0.66 (P<.01) for less‐observable dimensions. Agreement improved with time. Time and the number of days between patient and proxy interviews were significant factors in accounting for patient–proxy differences.

Conclusion: Although proxy and patient responses are not interchangeable, proxy responses provide an option for assessing function and health status in patients who are unable to respond on their own behalf.
Impaired Vision and the Ability to Take Medications
Authors: Windham Beverly Gwen , Griswold Michael E. , Fried Linda P. , Rubin Gary S. , Xue Qian‐Li , Carlson Michelle C.
Published: August 2005

Objectives: To assess relationships between vision (contrast sensitivity, stereopsis, visual acuity) and a performance‐based measure of ability to implement new medications.

Design: Cross‐sectional analysis; prospective cohort study.

Setting: Community‐based.

Participants: Three hundred thirty‐five participants aged 73 to 82 in Year 3 of the Women's Health and Aging Study II, a representative sample of the two‐thirds least‐disabled community‐dwelling women.

Measurements: Hopkins Medication Schedule Pillbox Ratio, a joint measure of accuracy and time, and a performance‐based measure of ability to implement a prescription. Participants received written and verbal instructions for taking two medications and were directed to place pills in a pillbox accordingly. Vision assessments: contrast sensitivity (Pelli‐Robson letter sensitivity chart), stereopsis (Randot Circles), and visual acuity (Early Treatment Diabetic Retinopathy Study eye chart).

Results: Forty‐four percent (148/335) of women incorrectly placed one or both medications. Each vision measure was positively associated with Pillbox Ratio scores and varied with cognition and time to completion. Better visual acuity, contrast sensitivity, and stereopsis were each associated with better performance in women with poor cognition who filled the pillbox quickly. Additionally, better visual acuity was associated with better performance in participants with good cognition who filled the pillbox slowly; better stereopsis was associated with better performance in participants with poor cognition who filled the pillbox slowly and whose stereoacuity was below normal.

Conclusion: Visual acuity, contrast sensitivity, and stereopsis should be considered potential risk factors for impaired ability to implement a medication regimen in older adults. Future research should investigate the role of vision, including contrast sensitivity and stereopsis, on performance of other instrumental activities of daily living.
Mentoring in a Post‐Affirmative Action World
Authors: Girves Jean E. , Zepeda Yolanda , Gwathmey Judith K.
Published: August 2005

Mentoring can be an effective strategy in improving retention of college students and faculty from fields where historical underrepresentation has occurred. This article reviews the benefits of mentoring in higher education, and identifies components of effective mentoring strategies that promote educational and career advancement. It illustrates how effective programs can be institutionalized and scaled through consortial and national collaborations. Traditional and alternative mentoring models are described through four successful programs designed to increase the academic and professional success of undergraduates, graduate students, and junior faculty. The article concludes with a set of general recommendations and caveats gleaned from the literature and programs reviewed.
Affirmative Action and Job Satisfaction: Understanding Underlying Processes
Authors: Niemann Yolanda Flores , Dovidio John F.
Published: August 2005

In the present article, we examine the relationship between perceptions of affirmative action and the satisfaction of racial and ethnic minority faculty members. We develop a conceptual model of factors that mediate the impact of affirmative action on the satisfaction of faculty of color, and investigate this model based on survey responses of 84 African‐American, 48 Latina/o, and 59 Asian faculty. Analyses showed that the satisfaction of faculty of color is significantly related to how affirmative action is perceived to be embraced by the community, and that this effect is mediated by how supportive colleagues are seen and how much self‐doubt faculty experience. Data also indicated the important role of mentoring for supporting the goals of affirmative action.
Understanding the Relationship Between Egalitarianism and Affective Bias: Avenues to Reducing Prejudice Among Adolescents
Authors: Rabinowitz Joshua L. , Wittig Michele A. , Von Braun Malte , Franke Roman , Zander‐Music Lysann
Published: August 2005

In an era during which affirmative action in education is in jeopardy, it is important to understand how the ideologies of high‐status ethnic group members maintain (or reduce) social inequality. We examine the extent to which the relationship between egalitarianism and prejudice among European American and Asian American adolescents can be explained by outgroup orientation (i.e., how much one values interacting with members of other ethnic groups) and strength of identification with one's ethnic group. Using structural equation modeling, we tested whether these two variables mediate the relationship between egalitarianism and intergroup prejudice. Results revealed that outgroup orientation was a mediator, but ethnic identity was not. Implications for mutual acculturation theory, prejudice‐reduction programs, and affirmative action in education are discussed.
Affirmative Reaction: The Influence of Type of Justification on Nonbeneficiary Attitudes Toward Affirmative Action Plans in Higher Education
Authors: Knight Jennifer L. , Hebl Michelle R.
Published: August 2005

It is popularly believed that justifying an affirmative action plan (AAP) through emphasizing the advantages that diverse students can bring to a college campus will increase nonbeneficiary support for the program. However, there has been little empirical support for this proposition, perhaps because previous research has not directly articulated to participants the value of a diverse student body. As such, the current study sought to determine how the explicit framing of an AAP influences subsequent reactions. Both quantitative and qualitative data from 216 White undergraduate participants revealed that the utilitarianism justification that highlighted the benefits of the AAP to both minority and majority students, was the most effective means of increasing support for the plan.
Incidence of Complications in Patients with Implantable Cardioverter/Defibrillator Who Receive Additional Transvenous Pace/Sense Leads
Authors: WOLLMANN CHRISTIAN G. , BÖCKER DIRK , LÖHER ANDREAS , KÖBE JULIA , SCHELD HANS H. , BREITHARDT GÜNTER E. , GRADAUS RAINER
Published: August 2005

Background: Implantation of an additional pace/sense (P/S) lead is commonly used in patients with implantable cardioverter/defibrillators (ICDs) to overcome P/S defects of integrated defibrillation leads (HV‐P/S leads). No information is available about the clinical outcome and the incidence of complications in these patients.

Methods: Retrospective analysis was performed in 151 patients (125 male, age 54.9 ± 13.6 years, LVEF 48.1 ± 17.8%, CAD in 86 [57%], DCM in 24 [16%], ARVCM in 11 [7%]) who received an additional P/S lead between 1990 and 2002 (54 patients with abdominal and 97 patients with pectoral ICD system). Statistical analysis was done using Kaplan‐Meier survival curves.

Results: The average follow‐up (FU) after implantation of the additional P/S lead was 43 ± 27 months. In total 117 patients [77.5%] remain implanted; 22 patients died due to cardiac‐related reasons. After a FU of 23 ± 23 months, 43 patients [28.5%] experienced lead‐related problems after implantation of the additional P/S lead: oversensing in 23 [53.5%], insulation defect in 3 [7.0%], fracture in 1 [2.3%], system infection in 4 [9.3%], and defect of the HV‐P/S lead in 6 [14.0%] patients. The event‐free cumulative survival of the additional P/S lead after 1, 2, and 5 years was 87.0%, 79.8%, and 59.4%, respectively (for pectoral leads: 89.6%, 82.0%, and 60.0%, respectively).

Conclusions: Implantation of an additional P/S lead in case of failure of an HV‐P/S lead is safe. However, it is associated with a substantial rate of complications during FU. Therefore, extraction of damaged defibrillation leads instead of implantation of P/S leads should be favored.
The Impact of Povidone‐Iodine Pocket Irrigation Use on Pacemaker and Defibrillator Infections
Authors: LAKKIREDDY DHANUNJAYA , VALASAREDDI SRILAXMI , RYSCHON KAY , BASARKODU KRISHNAMOHAN , ROVANG KAREN , MOHIUDDIN SYED M. , HEE TOM , SCHWEIKERT ROBERT , TCHOU PATRICK , WILKOFF BRUCE , NATALE ANDREA , LI HUAGUI
Published: August 2005

Background: Infection is a devastating complication of permanent pacemakers (PMs) implantable cardioverter defibrillators (ICDs). Many implanting physicians commonly use povidone‐iodine solution to irrigate the device pocket before implanting the device. We sought to assess if such a measure would alter the rate of infection.

Methods: A total of 2,564 consecutive patients who received implantable PM or ICD devices between 1994 and 2002 were studied. Povidone‐iodine was used for pocket irrigation in 53% and saline in 47%. A total of 18 (0.7%) patients developed pocket infections with 0.7% (10/1,359) in povidone‐iodine (group I) and 0.6% (8/1,205) in saline (group II) pocket irrigation (p = ns). Groups I and II were studied for various clinical and demographic variables described in the results section.

Results: There was no statistical difference in the baseline demographic and clinical characteristics between groups I and II, respectively. ICDs were most frequently infected than PMs (56% vs 44%). Most (83%) of the devices were dual chamber. Reopening of the pocket for either lead or generator replacement had a higher incidence of infection than new implants (61% vs 39%). There was no difference in the use of preimplantation antibiotic prophylaxis. Late (61%) and deep pocket infections (78%) were more common than early (39%) and superficial infections (22%). Blood cultures were positive in 67% and Staphylococcus aureus was the common most pathogen (50%). The mean duration of antibiotics use after the diagnosis of device infection was 35 ± 23 days with 72% requiring device explantation. The device was reimplanted on the contralateral side in 56% cases. One patient in each group died due to device infection and related complications. No significant allergy to iodine was seen in either group.

Conclusion: Povidone‐iodine irrigation of the subcutaneous pocket did not alter the rates of pocket infection after pacemaker/defibrillator implantation.
Clinical and Quality of Life Comparison of Accelerometer, Piezoelectric Crystal, and Blended Sensors in DDDR‐Paced Patients with Sinus Node Dysfunction in the Mode Selection Trial (MOST)
Authors: SHUKLA HIMANSHU H. , FLAKER GREG C. , HELLKAMP ANNE S. , JAMES ERSKINE A. , LEE KERRY L. , GOLDMAN LEE , ORAV E. JOHN , LAMAS GERVASIO A.
Published: August 2005

Introduction: Permanent pacemakers are capable of increasing heart rate in response to physical activity by a variety of sensors including accelerometers, piezoelectric crystals, or blended sensors. The impact of these different physiologic sensors on cardiovascular events and quality of life is not known.

Methods: Of 2,010 patients randomized in the Mode Selection Trial, 1,245 patients were selected with the most commonly used pacemakers with these three sensors. Clinical characteristics and quality of life were compared between groups at baseline, 3 months, and then yearly.

Results: There were 449 patients with an accelerometer sensor device, 682 with a piezoelectric sensor, and 114 with a blended sensor. The groups were similar in terms of age (mean 74 years), gender, and cardiac risk factors but differences existed in weight, heart rate, mitral regurgitation, revascularization history, and drug therapy. The median ventricular pacing frequency was 80% (25th, 75th percentiles 42, 97). After a median follow‐up of 33.1 months, the risk of death, heart failure hospitalization, atrial fibrillation, and the combined endpoint of mortality and stroke was not significantly different between the sensor types, after adjustment for baseline differences. Quality of life analyses demonstrated that patients with blended sensors had significantly worse (P < 0.01) physical function than did patients with the other two sensor systems. Moreover, patients receiving blended sensors had the poorest absolute scores, without reaching statistical significance, on 9 of 13 quality of life measures after adjusting for differences in the groups.

Conclusion: We found no significant differences among the three most utilized sensors in clinical endpoints. Those patients who received blended sensors had worse physical function quality of life scores. However, clinical selection of the most sophisticated sensor for the most ill patients cannot be excluded as an explanation of these results.
Guided Wave Focusing Mechanics in Pipe
Authors: Hayashi Takahiro , Kawashima Koichiro , Sun Zongqi , Rose Joseph L.
Published: August 2005

Guided waves can be used in pipe inspection over long distances. Presented in this paper is a beam focusing technique to improve the S∕N ratio of the reflection from a tiny defect. Focusing is accomplished by using nonaxisymmetric waveforms and subsequent time delayed superposition at a specific point in a pipe. A semianalytical finite element method is used to present wave structure in the pipe. Focusing potential is also studied with various modes and frequencies.
Defect Classification in Pipes by Neural Networks Using Multiple Guided Ultrasonic Wave Features Extracted After Wavelet Processing
Authors: Rizzo Piervincenzo , Bartoli Ivan , Marzani Alessandro , Lanza di Scalea Francesco
Published: August 2005

This paper casts pipe inspection by ultrasonic guided waves in a feature extraction and automatic classification framework. The specific defect under investigation is a small notch cut in an ASTM-A53-F steel pipe at depths ranging from 1% to 17% of the pipe cross-sectional area. A semi-analytical finite element method is first used to model wave propagation in the pipe. In the experiment, reflection measurements are taken and six features are extracted from the discrete wavelet decomposition of the raw signals and from the Hilbert and Fourier transforms of the reconstructed signals. A six-dimensional damage index is then constructed, and it is fed to an artificial neural network that classifies the size and the location of the notch. Overall, the wavelet-based multifeature analysis demonstrates good classification performance and robustness against noise and changes in some of the operating parameters.