bluuebunny/crossref_metadata_2025 huggingface dataset:
A method to establish the relationship between chronological age and stage of union from radiographic assessment of epiphyseal fusion at the knee: an Irish population study
Authors: O’Connor J. E. , Bogue C. , Spence L. D. , Last J.
Published: January 2008

Characteristic changes during epiphyseal union provide a skeletal age, which when compared with age‐based standards provides an estimation of chronological age. Currently there are no data on epiphyseal union for the purposes of age estimation specific to an Irish population. This cross‐sectional study aims to investigate the relationship between stage of epiphyseal union at the knee joint and chronological age in a modern Irish population. A novel radiographic method that sub‐divides the continuum of development into five specific stages of union is presented. Anteroposterior and lateral knee radiographs of 148 males and 86 females, aged 9–19 years, were examined. Fusion was scored as Stage 0, non‐union; Stage 1, beginning union; Stage 2, active union; Stage 3, recent union; or Stage 4, complete union. Stage of epiphyseal union is correlated with chronological age in both males and females. Mean age gradually increases with each stage of union and also varies between male and female subjects. A statistically significant difference in mean age was recorded between stages when compared to the previous stage, for the three epiphyses. Irish children are comparable to those from previously published studies with epiphyseal union in females occurring earlier than males. A significant difference was noted between the mean age of union for males and females for each of Stages 1 and 2 for the femur and Stages 0, 1, 2 and 3 for the tibia and the fibula. The results also suggest that the stages of union occur at earlier ages in this Irish population. Implementation of standardized methodology is necessary to investigate if this is due to a secular or population variation in maturation or to a methodology which clearly identifies five stages of union.
Histological and elemental analyses of impaired bone mineralization in klotho‐deficient mice
Authors: Suzuki Hironobu , Amizuka Norio , Oda Kimimitsu , Noda Masaki , Ohshima Hayato , Maeda Takeyasu
Published: January 2008

The klotho gene‐deficient mouse is known as an animal model for an accelerated gerontic state, mimicking osteoporosis, skin atrophy, ectopic calcification, and gonadal dysplasia. To elucidate the influence of klotho deficiency on bone mineralization, we examined the ultrastructures of osteoblasts and bone matrices in addition to performing the elemental mapping of calcium, phosphorus, and magnesium in the bone. Under anesthesia, 4‐ and 5‐week‐old klotho‐deficient mice (klotho−/–mice) and their wild‐type littermates were perfused with either 4% paraformaldehyde for light microscopic observation or 4% paraformaldehyde and 0.0125% glutaraldehyde for electron microscopic observation. The femurs and tibiae were processed for both observations. Paraffin sections were subject to alkaline phosphatase and tartrate resistant acid phosphatase histochemistry. Semithin and ultrathin sections obtained from epoxy resin‐embedded specimens were used for detecting mineralization – according to von Kossa's staining method – and for elemental mapping by electron probe micro‐analyzer, respectively. Alkaline phosphatase‐positive plump osteoblasts adjacent to the growth plate normally developed cell organelles in the klotho−/–metaphyses. This, however, contrasted with the flattened osteoblasts covering the metaphyseal trabeculae and accompanied by small tartrate resistant acid phosphatase‐positive osteoclasts. The wild‐type mice displayed the mineralized matrix at the zone of hypertrophic chondrocyte of the growth plate and well‐mineralized metaphyseal trabeculae parallel to the longitudinal axis of the bone. Alternatively, the klotho−/–mice demonstrated a thick mineralized matrix from the proliferative zone of the growth plate as well as the large non‐mineralized area in the metaphyseal trabeculae. Consistently, electron probe micro‐analysis verified sporadic distributions of higher or lower concentrations of calcium and phosphorus in each trabecule of the klotho−/–mice. The distribution of magnesium, however, was almost uniform. Under transmission electron microscopy, osteoblasts on the metaphyseal trabeculae displayed less‐developed cell organelles in the klotho−/–mice. Thus, the klotho deficiency appears not only to reduce osteoblastic population, but also to disturb bone mineralization.
Five large Chinese biomedical bibliographic databases: accessibility and coverage
Authors: Xia Jun , Wright Judith , Adams Clive E.
Published: January 2008

Background:   Much biomedical research is now undertaken in China.

Methods:   Five large biomedical databases originating from China (cbm, cmcc, cnki, vip and wanfang) are described and their utility and accessibility investigated.

Results:   These databases index 2500 journals largely not familiar to medline users. Free access, search features, record selection, ease of downloading and cost of subscription varies considerably between databases.

Conclusion:   Searches in all databases benefit from the use of simplified Chinese and all provide links to full text articles. Less than 6% of the 2500 journals in the five databases were listed as being indexed for medline.
The information trail of the ‘Freshman 15’—a systematic review of a health myth within the research and popular literature
Authors: Brown Cecelia
Published: January 2008

Question:   How does health misinformation become part of the American and Canadian vernacular?

Data sources and selection:   Twenty‐three databases were searched for articles discussing university freshmen weight gain. Research articles were examined for methodology, number and gender of the participants and weight gain. Popular press articles were reviewed for the types of information published: expert/anecdotal, weight gain, nutrition, exercise, health and alcohol. A timeline of article publication dates was generated.

Results:   Twenty peer‐reviewed, 19 magazine, 146 newspaper, and 141 university newspaper articles were discovered. Appearance of media articles about the ‘Freshman 15’ mirrored the peer‐reviewed articles, yet the information did not reliably depict the research. Research indicated a weight gain of less than five pounds (2.268 kg), while half of the popular press publications claimed a 15‐pound (6.804 kg) weight gain. The misinformation was frequently accompanied by information about achieving weight control through diet, exercise, stress reduction and alcohol avoidance.

Conclusion:   Understanding of how the concept of the ‘Freshman 15’ developed indicates that remediation efforts are needed. Collaborative efforts between health science and academic librarians, faculty and journalists to construct new paradigms for the translation of scientific evidence into information that individuals can use for decisions about health and well‐being is suggested.
Aquaporin 1 – a novel player in spinal cord injury
Authors: Nesic O. , Lee J. , Unabia G. C. , Johnson K. , Ye Z. , Vergara L. , Hulsebosch C. E. , Perez‐Polo J. R.
Published: January 2008

The role of water channel aquaporin 1 (AQP‐1) in uninjured or injured spinal cords is unknown. AQP‐1 is weakly expressed in neurons and gray matter astrocytes, and more so in white matter astrocytes in uninjured spinal cords, a novel finding. As reported before, AQP‐1 is also present in ependymal cells, but most abundantly in small diameter sensory fibers of the dorsal horn. Rat contusion spinal cord injury (SCI) induced persistent and significant four‐ to eightfold increases in AQP‐1 levels at the site of injury (T10) persisting up to 11 months post‐contusion, a novel finding. Delayed AQP‐1 increases were also found in cervical and lumbar segments, suggesting the spreading of AQP‐1 changes over time after SCI. Given that the antioxidant melatonin significantly decreased SCI‐induced AQP‐1 increases and that hypoxia inducible factor‐1α was increased in acutely and chronically injured spinal cords, we propose that chronic hypoxia contributes to persistent AQP‐1 increases after SCI. Interestingly; AQP‐1 levels were not affected by long‐lasting hypertonicity that significantly increased astrocytic AQP‐4, suggesting that the primary role of AQP‐1 is not regulating isotonicity in spinal cords. Based on our results we propose possible novel roles for AQP‐1 in the injured spinal cords: (i) in neuronal and astrocytic swelling, as AQP‐1 was increased in all surviving neurons and reactive astrocytes after SCI and (ii) in the development of the neuropathic pain after SCI. We have shown that decreased AQP‐1 in melatonin‐treated SCI rats correlated with decreased AQP‐1 immunolabeling in the dorsal horns sensory afferents, and with significantly decreased mechanical allodynia, suggesting a possible link between AQP‐1 and chronic neuropathic pain after SCI.
Regulated interactions of the norepineprhine transporter by the actin and microtubule cytoskeletons
Authors: Jeannotte Alexis M. , Sidhu Anita
Published: January 2008

One role of the actin cytoskeleton is to maintain the structural morphology and activity of the pre‐synaptic terminal. We sought to determine if the actin cytoskeleton plays a role in regulating interactions between the norepinephrine transporter (NET) and alpha‐Synuclein (α‐Syn), two proteins expressed in the pre‐synaptic terminal. In cells transfected with either 0.5 μg/mL or 3 μg/mL of α‐Syn and 1 μg/mL of NET DNA, treatment with cytochalasin D, an actin depolymerizing agent, caused a dose‐dependent decrease and increase, respectively, in [3H]‐NE uptake. Protein interactions between NET, β‐actin, and α‐Syn were modified, along with levels of surface transporters. Treatment of primary brainstem neurons and frontal cortex synaptosomes with cytochalasin D caused a 115% and 28% increase, respectively, in NET activity. Depolymerization of both actin and microtubules did not alter NET activity in cells with 0.5 μg/mL α‐Syn, but caused an increase in [3H]‐NE uptake in cells transfected with 3 μg/mL of α‐Syn and primary neurons. This is the first direct demonstration of NET activity being regulated via actin and modulated by interactions with α‐Syn.
Combined effects of silymarin and methylsulfonylmethane in the management of rosacea: clinical and instrumental evaluation
Authors: Berardesca Enzo , Cameli Norma , Cavallotti Claudia , Levy Jean Luc , Piérard Gérald E , De Paoli Ambrosi Gianfranco
Published: January 2008

Objective  This study aims to evaluate a topical treatment based on silymarin/methylsulfonilmethane (S‐MSM) to improve erythematous‐telangiectactic rosacea.

Methods  Forty‐six patients affected by stage I–III rosacea entered this double‐blind, placebo‐controlled study. Subjects were treated for 1 month. Clinical and instrumental evaluations were done at baseline, after 10 and 20 days, and at the end of the study. Itching, stinging, erythema, and papules were investigated clinically as well as hydration and erythema instrumentally with capacitance and color measurements.

Results  A statistically significant improvement was observed in many clinical and instrumental parameters investigated (P < 0.001). In particular, improvement of skin redness, papules, itching, hydration, and skin color occurred.

Conclusions  The combination of silymarin and S‐MSM can be useful in managing symptoms and condition of rosacea skin, especially in the rosacea subtype 1 erythemato‐telangiectatic phase. The action can be considered multicentric and multiphase because of the direct modulating action on cytokines and angiokines normally involved and up‐regulated in the case of such skin condition.
Effects of caffeine and siloxanetriol alginate caffeine, as anticellulite agents, on fatty tissue: histological evaluation
Authors: Velasco Maria Valéria Robles , Tano Clara Tsugmi Nakamura , Machado‐Santelli Gláucia Maria , Consiglieri Vladi Olga , Kaneko Telma Mary , Baby André Rolim
Published: January 2008

Background  Cellulite is a physiological condition that presents etiologic plurality. Caffeine and its derivatives are used in anticellulite cosmetics due to their lipolytic activity on fatty cells. Siloxanetriol alginate caffeine (SAC) is a silanol derived from organic silicon. Radicals primarily from SAC are caffeine and the mannuronic acid.

Aims  This study aims to analyze the effects of caffeine and siloxanetriol alginate caffeine on fatty tissue by histological evaluation.

Methods  Formulations were developed with caffeine, caffeine + sodium benzoate or SAC and were applied topically for 21 days on Wistar female mice. The study regarded the histological aspects by determination of diameter and number of fatty cells with a light microscope.

Results  Emulsion with caffeine caused a reduction of 17% on the diameter of the fatty cells compared with the control. The emulsion with caffeine + sodium benzoate did not cause alterations on cell diameter. Emulsion with SAC provoked reduction on fatty cell diameters of 16%. No significant alterations were observed on the diameter of the fatty cells treated with gels, although it was noticed that gel with SAC promoted a reduction of 26% on the number of fatty cells.

Conclusions  Emulsion with SAC was considered more indicated to promote the lipolytic action on fatty tissue, acting as a complement to treat cellulite. When sodium benzoate was added to the preparations, it inhibited the caffeine efficiency. Gel was not an adequate vehicle to be incorporated with caffeine and SAC.
Cohort study on patient response to botulinum toxin cosmetic therapy
Authors: Lee Heidi , Saladi Rao N , Fox Joshua L
Published: January 2008

Background  Botulinum toxin (BTX) therapy is currently the most popular cosmetic procedure in the United States. However, few studies exist regarding post‐procedure perceptions of the patients’ BTX therapy.

Objective  The aim of this cohort study was to determine patients’ responses from pre‐ to post‐BTX treatment experience.

Methods and materials  One hundred twenty‐three BTX patients of six different dermatologic cosmetic practices in various boroughs of New York and Long Island in the state of New York completed the questionnaire. Six hundred eighty‐three surveys were sent out, and 123 completed surveys were obtained. Numerous questions were asked regarding how patients felt and responded towards the overall procedure of their BTX therapy.

Results  Eighty‐eight percent of patients were satisfied or extremely satisfied with their dermatologists. Sixty‐five percent of patients felt over 60% improvement in areas treated. Fifty‐eight percent of patients anticipated making repeat visits, whereas the biggest concern for returning was due to the expensive cost of BTX.

Conclusion  Our study correlated with previous studies done on retention rate of BTX cosmetic patients and satisfaction level on areas treated. The cost of BTX remained one of the primary concerns for repeat visits. Most patients were happy with their visits to the dermatology offices for BTX procedure, although things can be done to further enhance their visits and the likelihood that they will return.
Photoepilation: a growing trend in laser‐assisted cosmetic dermatology
Authors: Nouri Keyvan , Vejjabhinanta Voraphol , Patel Shalu S , Singh Anita
Published: January 2008

Excess hair is an age‐old condition plaguing both men and women alike, of all races. Conditions such as hirsutism or hypertrichosis, procedures that involve grafted donor sites, transsexual transformations from male to female, and genetics are all responsible for excess or unwanted hair. Previous options for people seeking to remove or lessen the presence of hair have either been painful or resulted in short‐term hair removal. With the recent advent of laser technology, hair removal has been added to the many capabilities of the new generation nonablative lasers and light systems. Lasers are not yet a permanent solution for hair removal, but they are able to provide a safe, fast, and effective method of hair reduction.
A call for Australian loess: discussion and commentary
Authors: Smalley Ian
Published: January 2008

A study of loess in Australia brings the idea of ‘desert’ loess back into view. Production of particles in deserts still presents problems, but deserts do make adequate storage regions for loess particles – usually produced in adjacent mountains. Straightforward for Central Asia or China (a particle source in High Asia and convenient deserts en route to eventual deposition), but the Sahara and Australian deserts traditionally present problems. If loess material is allowed to be silt‐sized clay agglomerate particles as well as the usual clastic primary minerals, then loess in Australia seems reasonable. Loess acquires its remarkable loessic qualities via aeolian deposition – the nature of the particles is perhaps of lesser importance. A more generalised approach to airborne sediments might be attempted, with two major types of suspension material recognised: large dust (maybe coarse and very coarse silt, say 20–60 µm, or perhaps 4–6 phi) and small dust (fine and very fine silt, 2–8 µm, 7–9 phi). Loess is made from large dust.
Transactions after 9/11: the banal face of the preemptive strike
Authors: Amoore Louise , De Goede Marieke
Published: January 2008

This paper argues that the deployment of transactions data of many kinds has become the banal face of the war on terror's preemptive strike. Because the failure to predict and prevent 9/11 is partly thought to be a failure to ‘connect the dots’ of available intelligence, post 9/11 policies seek to register, mine and connect ever more ‘dots’, or association rules, in the form of credit card transactions, travel data, supermarket purchases and so on. We argue that it is in these ordinary transactions that another spatiality of exception is emerging, one in which the traces of habits, behaviours and past practices become the basis of security decisions to freeze assets, to apprehend, to stop and search or to deport. As such, these developments constitute a relatively unacknowledged violence in the war on terror, which is in need of critical questioning.
Managed zones for sex workers in Liverpool: contemporary proposals, Victorian parallels
Authors: Howell Philip , Beckingham David , Moore Francesca
Published: January 2008

Recent proposals to establish a ‘managed zone’ for female street sex workers in Liverpool are placed in this paper in historical and geographical context. Liverpool is shown to be an exemplar of a late Victorian municipal management of prostitution that was just as firmly committed to the containment and ‘localisation’ of sex work. This model is contrasted with alternative municipal strategies, and set within a national legislative agenda increasingly hostile to tolerance and regulation. The contours of this governmental regulation of commercial sexuality are explored in some detail here, but this historical geography is also offered as a way of informing contemporary concerns, cautioning as it does against averring either the novelty or the progressiveness of contemporary policies on the zoning of sex work.
Electoral promises and minority governments: An empirical study
Authors: ARTÉS JOAQUÍN , BUSTOS ANTONIO
Published: January 2008

Abstract.  This article studies the relationship between electoral policy proposals and subsequent government actions in the case of minority governments. Content analysis of electoral pledges of Spanish parties is utilised to study the gains that a relatively small party obtains when it helps to sustain the governing party in office without entering a coalition government. According to the authors' results, cooperating in parliament to maintain the minority government in office can be a rational choice for a party because it allows it to obtain significant gains in terms of programme fulfillment.
Lobbying with conflicting interests: Norwegian local‐central relations
Authors: HELLAND LEIF
Published: January 2008

Abstract.  The costly lobbying model of Potters and van Winden is confronted with data on lobbying interactions between local assemblies and the national assembly in Norway. A total of 239 interactions are studied. Survey responses by a large number of voters and politicians, as well as registry data on fiscal standing, demographics and elections are utilised. Two of the main predictions of the costly lobbying model gain support in the data. The probability of obtaining substantial discretionary funding from the central level increases: with decreasing conflict of interest between local and central politicians; and with the lobbying cost incurred by local politicians. For a given conflict and cost, however, the rate of lobbying success depends crucially on structural characteristics of the municipality. In particular, the success rate is significantly higher for poor municipalities located in national electoral districts with many seats per voter than for rich municipalities located in districts with few seats per voter.
Mapping the political discourse of globalisation and European integration in the United Kingdom and Ireland empirically1
Authors: SMITH NICOLA , HAY COLIN
Published: January 2008

Abstract.  Recent years have seen growing interest in the political power of ideas, especially in debates about globalisation and European integration. As is now widely noted, constructions of globalisation and European integration may play a powerful causal role in shaping policy prescriptions across Europe. Yet, while a substantial body of theoretical literature has pointed to the need for sustained empirical analysis of such discourses, little systematic and comparative analysis has been undertaken into policy makers' attitudes towards globalisation, European integration and the relationship between the two. This article presents the initial findings of a survey of elite political attitudes to globalisation and European integration in the United Kingdom and Ireland. The authors develop and apply a theoretical schema for the classification and mapping of such discourses. Their analysis reveals, on the one hand, the range and diversity of discourses of globalisation and European integration among elite political actors and, on the other, the continued prevalence of specific conceptions (and indeed misperceptions) of globalisation in particular that have now been challenged empirically. They identify a series of core tensions and contradictions within elite political discourse in both the United Kingdom and Ireland. This suggests a certain frailty in the prevalent understanding of globalisation to which elite political actors would otherwise seem committed when confronted with its distributive consequences.
From ‘welfare without work’ to ‘buttressed liberalization’: The shifting dynamics of labor market adjustment in France and Germany
Authors: VAIL MARK I.
Published: January 2008

Abstract.  During the past decade, prevailing scholarship has portrayed France and Germany as suffering from a persistent syndrome of ‘welfare without work’ entailing a vicious circle between stubbornly high rates of unemployment and non‐wage labor costs. Scholars blame this disease on dysfunctional political arrangements, deep insider‐outsider cleavages and failed systems of social partnership. As a result, the two countries are said to be more or less permanently mired in a context of high unemployment that is highly resistant to remediation. This article departs from this conventional wisdom in two important respects. First, it argues that France and Germany have undertaken major reforms of their labor market policies and institutions during the past decade and remediated many of their longstanding employment traps. Second, it shows that the political arrangements that adherents of the ‘welfare without work’ thesis identify as reasons for sclerosis have evolved quite dramatically. The article supports these arguments by exploring some of the most significant recent labor market reforms in the two countries, as well as the shifting political relationships that have driven these changes. In both countries, recent labor market reforms have followed a trajectory of ‘buttressed liberalization’. This has involved, on the one hand, significant liberalization of labor market regulations such as limits on overtime and worker protections such as unemployment insurance. On the other hand, it has entailed a set of supportive, ‘buttressing’ reforms involving an expansion of active labor market policies and support for workers' efforts to find jobs. The article concludes that these developments provide reasons for optimism about the countries' economic futures and offer important lessons about how public policy can confront problems of labor market stagnation.
Determinants of democratic successes and failures in Africa
Authors: BERG‐SCHLOSSER DIRK
Published: January 2008

Abstract. This article, first, identifies democratic, authoritarian and ‘praetorian’ political system types in Africa on the basis of major current indicators. It then systematically tests a broad variety of hypotheses concerning the historical, social‐structural, socio‐economic, political and institutional determinants and performance characteristics of these system types. A macro‐quantitative synopsis attempts to identify the most ‘parsimonious’ overall constellations of factors in this regard. This is supplemented by a macro‐qualitative analysis of major ‘conjunctural’ conditions identifying the main groups of cases and their determining factors in a ‘contradiction‐free’ manner. The conclusions point to the decisive importance of ‘governance’ aspects in the future.
Triggers for protest: Modelling responses to the political context in Britain, 2000–2002
Authors: HEATH OLIVER
Published: January 2008

Abstract.  Failing to take into account the impact of the political context on protest has serious empirical and theoretical implications for our understanding of the phenomenon. First, it means that protest is conceptualised in rather general terms, and second, accounts of why people participate are therefore somewhat static, emphasising factors that predispose people to protest over more dynamic factors that stimulate protest. This undermines theoretical explanations of action based on rational choice and privileges more sociological accounts of behaviour. By adopting a novel methodological approach and analysing change over time, this article sheds light on the factors that ‘trigger’ protest. In doing so, it shows that the dynamics of protest can be expressed successfully within a rational choice framework.
How Effective Are Copayments in Reducing Expenditures for Low‐Income Adult Medicaid Beneficiaries? Experience from the Oregon Health Plan
Authors: Wallace Neal T. , McConnell K. John , Gallia Charles A. , Smith Jeanene A.
Published: January 2008

Objectives. To determine the impact of introducing copayments on medical care use and expenditures for low‐income, adult Medicaid beneficiaries.

Data Sources/Study Setting. The Oregon Health Plan (OHP) implemented copayments and other benefit changes for some adult beneficiaries in February 2003.

Study Design. Copayment effects were measured as the “difference‐in‐difference” in average monthly service use and expenditures among cohorts of OHP Standard (intervention) and Plus (comparison) beneficiaries.

Data Collection/Extraction Methods. There were 10,176 OHP Standard and 10,319 Plus propensity score‐matched subjects enrolled during November 2001–October 2002 and May 2003–April 2004 that were selected and assigned to 59 primary care‐based service areas with aggregate outcomes calculated in six month intervals yielding 472 observations.

Results. Total expenditures per person remained unchanged (+2.2 percent, p=.47) despite reductions in use (−2.7 percent, p<.001). Use and expenditures per person decreased for pharmacy (−2.2 percent, p<.001; −10.5 percent, p<.001) but increased for inpatient (+27.3 percent, p<.001; +20.1 percent, p=.03) and hospital outpatient services (+13.5 percent, p<.001; +19.7 percent, p<.001). Ambulatory professional (−7.7 percent, p<.001) and emergency department (−7.9 percent, p=.03) use decreased, yet expenditures remained unchanged (−1.5 percent, p=.75; −2.0 percent, p=.68, respectively) as expenditures per service user rose (+6.6 percent, p=.13; +7.9 percent, p=.03, respectively).

Conclusions. In the Oregon Medicaid program applying copayments shifted treatment patterns but did not provide expected savings. Policy makers should use caution in applying copayments to low‐income Medicaid beneficiaries.
Use of Econometric Models to Estimate Expenditure Shares
Authors: Trogdon Justin G. , Finkelstein Eric A. , Hoerger Thomas J.
Published: January 2008

Objective. To investigate the use of regression models to calculate disease‐specific shares of medical expenditures.

Data Sources/Study Setting. Medical Expenditure Panel Survey (MEPS), 2000–2003.

Study Design. Theoretical investigation and secondary data analysis.

Data Collection/Extraction Methods. Condition files used to define the presence of 10 medical conditions.

Principal Findings. Incremental effects of conditions on expenditures, expressed as a fraction of total expenditures, cannot generally be interpreted as shares. When the presence of one condition increases treatment costs for another condition, summing condition‐specific shares leads to double‐counting of expenditures.

Conclusions. Condition‐specific shares generated from multiplicative models should not be summed. We provide an algorithm that allows estimates based on these models to be interpreted as shares and summed across conditions.
Predicting Changes in Staff Morale and Burnout at Community Health Centers Participating in the Health Disparities Collaboratives
Authors: Graber Jessica E. , Huang Elbert S. , Drum Melinda L. , Chin Marshall H. , Walters Amy E. , Heuer Loretta , Tang Hui , Schaefer Cynthia T. , Quinn Michael T.
Published: January 2008

Objective.To identify predictors of changes in staff morale and burnout associated with participation in a quality improvement (QI) initiative at community health centers (HCs).

Data Sources.Surveys of staff at 145 HCs participating in the Health Disparities Collaboratives (HDC) program in 2004.

Data Collection and Study Design.Self‐administered questionnaire data collected from 622 HC staff (68 percent response rate) were analyzed to identify predictors of reported change in staff morale and burnout. Predictive categories included outcomes of the QI initiative, levels of HDC integration, institutional support, the use of incentives, and demographic characteristics of respondents and centers.

Principal Findings.Perceived improvements in staff morale and reduced likelihood of staff burnout were associated with receiving personal recognition, career promotion, and skill development opportunities. Similar outcomes were associated with sufficient funding and personnel, fair distribution of work, effective training of new hires, and consistent provider participation.

Conclusions.Having sufficient personnel available to administer the HDC was found to be the strongest predictor of team member satisfaction. However, a number of low‐cost, reasonably modifiable, organizational and leadership characteristics were also identified, which may facilitate improvements in staff morale and reduce the likelihood of staff burnout at HCs participating in the HDC.
Publication of Quality Report Cards and Trends in Reported Quality Measures in Nursing Homes
Authors: Mukamel Dana B. , Weimer David L. , Spector William D. , Ladd Heather , Zinn Jacqueline S.
Published: January 2008

Objective. To examine associations between nursing homes' quality and publication of the Nursing Home Compare quality report card.

Data Sources/Study Settings. Primary and secondary data for 2001–2003: 701 survey responses of a random sample of nursing homes; the Minimum Data Set (MDS) with information about all residents in these facilities, and the Nursing Home Compare published quality measure (QM) scores.

Study Design. Survey responses provided information on 20 specific actions taken by nursing homes in response to publication of the report card. MDS data were used to calculate five QMs for each quarter, covering a period before and following publication of the report. Statistical regression techniques were used to determine if trends in these QMs have changed following publication of the report card in relation to actions undertaken by nursing homes.

Principal Findings. Two of the five QMs show improvement following publication. Several specific actions were associated with these improvements.

Conclusions. Publication of the Nursing Home Compare report card was associated with improvement in some but not all reported dimensions of quality. This suggests that report cards may motivate providers to improve quality, but it also raises questions as to why it was not effective across the board.
Senators or courtiers: negotiating models for the College of Cardinals under Julius II and Leo X
Authors: DeSilva Jennifer Mara
Published: January 2008

The early sixteenth century marked the intensification of papal efforts to transform the papacy from a senatorial model, with a cooperative relationship between the pope and cardinals, into a court. Using ecclesiastical ritual, Popes Julius II and Leo X constructed a courtly environment in which the College of Cardinals was a silent but visible supporter of the papacy, rather than a group of vocal political counsellors. The written work of the papal Master of Ceremonies Paris de' Grassi (1504–1521) shows the direction and expectation of the dominant courtly model, while Paolo Cortesi's treatise De cardinalatu (1510) exemplifies the eclipsed conciliarist ideals. While modern historians accord Cortesi's treatise attention that does not reflect its original interest to contemporaries, de' Grassi's diary has yet to be contextualized as a practical guide to publicly constructing the cardinal‐courtier as a client of the papal monarchy. This article examines the rituals of the cardinal elevation ceremony as a vehicle for this model's implementation, as well as a site for the expression of discontent by certain cardinals.
Effects of Human Subsistence Activities on Forest Birds in Northern Kenya
Authors: BORGHESIO LUCA
Published: January 2008

Abstract:  Indigenous tribes and conservation biologists may have common goals and may be able to collaborate on the maintenance of biodiversity, but few researchers have evaluated the impacts and potential benefits of human subsistence activities. I studied the effects of subsistence activities (primarily wood collection) of nomadic pastoralists in 3 Afromontane forests of northern Kenya. In surveys of 404, 25‐m‐radius plots, I recorded vegetation structure and composition of the forest bird community. Plots with higher levels of human activity had significantly different vegetation structure, with more‐open canopies, more grass, and fewer tree stems. Nectarivores (abundance +231%) and aerial insectivores (+66%) were more abundant in plots with more‐intense wood collecting than in plots with less human activity, whereas abundance of forest specialists (−28%) decreased in plots with more‐intense human activity. Abundance of 58% of the bird species either increased or decreased significantly in plots with more‐intense human activity. Generally, the number of individuals of forest specialists decreased (6 of 7 species showed significant responses) and the number of individuals of edge and nonforest species increased with increasing human activity. Canonical correspondence analysis showed that an intensification of human activities would favor nectarivores, aerial insectivores, granivores, and omnivores and would negatively affect large‐sized, ground‐foraging species and arboreal frugivores. Subsistence human activities favored the invasion of forest by edge species at the expense of forest specialists; thus, further intensification of forest exploitation by local peoples is not recommended. At the same time, however, subsistence activities in northern Kenya forests appeared to increase the structural diversity of the vegetation and provided suitable habitat for part (but not all) of the forest avifauna, which suggests that subsistence human activities may have a role in the maintenance of bird diversity.
Incidence of seizures in the acute phase of stroke: A population‐based study
Authors: Szaflarski Jerzy P. , Rackley Angela Y. , Kleindorfer Dawn O. , Khoury Jane , Woo Daniel , Miller Rosemary , Alwell Kathleen , Broderick Joseph P. , Kissela Brett M.
Published: January 2008

Summary

Purpose: The incidence of seizures within 24 h of acute stroke has not been studied extensively. We aimed to establish the incidence of acute poststroke seizures in a biracial cohort and to determine whether acute seizure occurrence differs by race/ethnicity, stroke subtype, and/or stroke localization.

Methods: We identified all stroke cases between July 1993 and June 1994 and in 1999 within the population of the Greater Cincinnati metropolitan region. Patients with a prior history of seizures/epilepsy were excluded from analysis.

Results: A total of 6044 strokes without a history of seizure(s) were identified; 190 (3.1%) had seizures within the first 24 h of stroke onset. Of ICH/SAH patients, 8.4% had a seizure within the first 24 h of stroke onset (p ≤ 0.0001 vs. all other stroke subtype). Of the patients with ischemic stroke, we observed higher incidence of seizures in cardioembolic versus small or large vessel ischemic (p = 0.02) strokes. Patients with seizures experienced higher mortality than patients without seizures (p < 0.001) but seizures were not an independent risk factor of mortality at 30 days after stroke. Independent risk factors for seizure development included hemorrhagic stroke, younger age, and prestroke Rankin score of ≥1. Race/ethnicity or localization of the ischemic stroke did not influence the risk for seizure development in the studied population.

Discussion: The overall incidence of acute seizures after stroke was 3.1%, with a higher incidence seen in hemorrhagic stroke, younger patients, and those presenting with higher prestroke Rankin scores. Acute seizures were associated with a higher mortality at 30 days after stroke.
Lamotrigine inhibits postsynaptic AMPA receptor and glutamate release in the dentate gyrus
Authors: Lee Chun‐Yao , Fu Wen‐Mei , Chen Chih‐Chuan , Su Ming‐Jai , Liou Horng‐Huei
Published: January 2008

Summary

Purpose: The dentate gyrus (DG) is a gateway that regulates seizure activity in the hippocampus. We investigated the site of action of lamotrigine (LTG), an effective anticonvulsant, in the regulation of alpha‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazole propionic acid (AMPA) and N‐methyl‐D‐aspartic acid (NMDA) receptor‐mediated excitatory synaptic transmission on DG.

Methods: Evoked AMPA and NMDA receptor‐mediated excitatory postsynaptic currents (eEPSC

ampa

and eEPSC

nmda

) were recorded by whole‐cell patch‐clamp recording from the granule cells of DG in brain slice preparation of young Wistar rats (60–120 g). Exogenously applied AMPA and NMDA‐induced currents and AMPA receptor‐mediated miniature EPSC (mEPSC

ampa

) were recorded in the presence of specific antagonists.

Results: LTG inhibited both eEPSC

ampa

and eEPSC

nmda

, and had no effect on exogenously applied NMDA‐induced current indicating LTG inhibited glutamate release. Previous studies demonstrated that alteration in glutamate concentration in synaptic cleft causes parallel changes of eEPSC

ampa

and eEPSC

nmda

. Our results showed that LTG inhibited eEPSC

ampa

significantly more than eEPSC

nmda

(p < 0.05), suggesting that LTG may also have blocked the postsynaptic AMPA receptor. The hypothesis is further supported by the facts that; (1) LTG (30–100 μM) inhibited direct exogenously applied AMPA‐induced currents (to 90%), (2) LTG significantly reduced the amplitude, but not the frequency of mEPSC

ampa

and asynchronous (EPSC), and (3) LTG‐induced reduction of eEPSC

ampa

was not associated with a modification of the paired‐pulse ratio. To sum up, LTG exerts a postsynaptic inhibitory mechanism on the AMPA receptor.

Conclusions: Our results demonstrate that LTG suppresses postsynaptic AMPA receptors and reduces glutamate release in granule cells of DG. The postsynaptic effect can be one of the underlying mechanisms of LTG's anticonvulsant action.
Analysis of Single Nucleotide Polymorphisms and Haplotypes in the Neuropeptide Y Gene: No Evidence for Association With Alcoholism in a German Population Sample
Authors: Zill Peter , Preuss Ulrich W. , Koller Gabrielle , Bondy Brigitta , Soyka Michael
Published: January 2008

Background:  Several lines of evidence from animal and electrophysiological studies indicate that the neuropeptide Y (NPY) gene is involved in the pathophysiology of alcohol dependence. Recent studies have provided evidence for an association between a Leu7Pro polymorphism, as well as 2 promoter single nucleotide polymorphisms (SNPs) in the NPY gene (G‐602T, T‐399C) and alcohol dependence. The aim of the present study was to analyze these variants in a large sample of the Munich Gene Bank of Alcoholism.

Methods:  We performed single SNP and haplotype studies in 465 alcohol dependent patients and 448 healthy controls with 3 SNPs in the promoter region (−883ins/del, G‐602T, T‐399C) and the Leu7Pro polymorphism in exon 2 of the NPY gene.

Results:  Neither single SNP‐, nor haplotype analysis could detect significant associations with alcohol dependence. Additionally we could not detect any relation to Cloninger’s Type 1/2 or Babor’s Type A/B classification, to withdrawal symptoms, to the age of onset or to the amount of alcohol intake.

Conclusions:  In conclusion, our results suggest that the analyzed SNPs, as well as the corresponding haplotypes of the NPY gene are unlikely to play a major role in the pathophysiology of alcohol dependence in the investigated sample from the German population. Further analyses are needed to confirm the present results.
Face Processing in Chronic Alcoholism: A Specific Deficit for Emotional Features
Authors: Maurage P. , Campanella S. , Philippot P. , Martin S. , De Timary P.
Published: January 2008

Background:  It is well established that chronic alcoholism is associated with a deficit in the decoding of emotional facial expression (EFE). Nevertheless, it is still unclear whether this deficit is specifically for emotions or due to a more general impairment in visual or facial processing. This study was designed to clarify this issue using multiple control tasks and the subtraction method.

Methods:  Eighteen patients suffering from chronic alcoholism and 18 matched healthy control subjects were asked to perform several tasks evaluating (1) Basic visuo‐spatial and facial identity processing; (2) Simple reaction times; (3) Complex facial features identification (namely age, emotion, gender, and race). Accuracy and reaction times were recorded.

Results:  Alcoholic patients had a preserved performance for visuo‐spatial and facial identity processing, but their performance was impaired for visuo‐motor abilities and for the detection of complex facial aspects. More importantly, the subtraction method showed that alcoholism is associated with a specific EFE decoding deficit, still present when visuo‐motor slowing down is controlled for.

Conclusion:  These results offer a post hoc confirmation of earlier data showing an EFE decoding deficit in alcoholism by strongly suggesting a specificity of this deficit for emotions. This may have implications for clinical situations, where emotional impairments are frequently observed among alcoholic subjects.
The Effect of Alcohol Intake on Cardiovascular Disease and Mortality Disappeared After Taking Lifetime Drinking and Covariates Into Account
Authors: Friesema Ingrid H.M. , Zwietering Paul J. , Veenstra Marja Y. , Knottnerus J. André , Garretsen Henk F.L. , Kester Arnold D.M. , Lemmens Paul H.H.M.
Published: January 2008

Background:  Current alcohol intake has been associated with cardiovascular morbidity and mortality. The effect of past and lifetime drinking has received less attention. In the present study, the impact of current, past and lifetime drinking on cardiovascular events and all‐cause mortality has been assessed. Secondly, the effect of accounting for covariates within these relationships has been studied.

Methods:  The Lifestyle and Health study is a prospective cohort study in 2 regions of the Netherlands. Men and women aged 45 to 70 years registered in 34 general practices were followed over the period July 1996 to June 2001. At baseline, an extensive questionnaire had to be filled in. It included 3 questionnaires about alcohol intake: a Weekly Recall, a Quantity‐Frequency about last year, and the Lifetime Drinking History questionnaire. Health problems were registered by the general practitioners.

Results:  During follow‐up, 679 men and 397 women had a cardiovascular event and 330 men and 204 women died. Current drinking was associated with lower risks of cardiovascular events (women) and all‐cause mortality (men and women) compared with never drinkers. The relationships were strongest for alcohol intake measured with the Weekly Recall. Lifetime alcohol intake and alcohol intake in the distant past did not seem to be related to all‐cause mortality or cardiovascular events. Adjustments for covariates weakened the relationships.

Conclusions:  Potential positive effects of drinking seem to be of a transient nature, as lifetime drinking and drinking in the past could not be related to all‐cause mortality or cardiovascular events. The alleged benefits of current drinking at baseline diminished with increasing methodological quality and rigor.
Fat Products
Authors: Alexandrov Alexei
Published: January 2008

The economics literature generally considers products as points in some characteristics space. With more products being flexible or self‐customizable to some degree, it makes sense to model products with positive measure. I develop a model of firms which can offer interval‐long “fat” products in the spatial model of differentiation. Contrary to the standard results, profits of the firms can decrease with increased differentiation in the market—there is a standard effect of lowering the incentive to cut prices, but there is also an incentive to provide more content, resulting in higher costs and possibly overall losses.
Distorted Performance Measures and Dynamic Incentives
Authors: Kaarbøe Oddvar M. , Olsen Trond E.
Published: January 2008

Incentive contracts must typically be based on performance measures that do not exactly match the agents' true contribution to the principals' objectives. Such misalignment may pose difficulties for effective incentive design. We analyze the extent to which implicit dynamic incentives, such as career concerns and ratchet effects, alleviate or aggfravate these problems. Our analysis demonstrates that the interplay between distorted performance measures and implicit incentives implies that career and ratchet effects have real effects in that stronger ratchet effects or greater distortion may increase optimal monetary incentives, and that distortion affects the optimality of different promotion rules.
Option Contracts in Supply Chains
Authors: Böckem Sabine , Schiller Ulf
Published: January 2008

This paper considers optimal contracts in supply chains that consist of

n≥ 2
firms and face a potential investment hold‐up problem. We show that option contracts may solve the incentive problems. First, we provide case‐study evidence for the use of option contracts in the semiconductor industry. As our second contribution, we generalize the earlier option contract approach by introducing continuous quantities. Third, we extend the setting to
n
parties. For long supply chains, the first‐best allocation can be achieved if there is a particular order of renegotiations.