bluuebunny/crossref_metadata_2025 huggingface dataset:
Statement Regarding the Pre and Post Market Assessment of Durable, Implantable Ventricular Assist Devices in the United States
Authors: Acker Michael A. , Pagani Francis D. , Stough Wendy Gattis , Mann Douglas L. , Jessup Mariell , Kormos Robert , Slaughter Mark S. , Baldwin Timothy , Stevenson Lynne , Aaronson Keith D. , Miller Leslie , Naftel David , Yancy Clyde , Rogers Joseph , Teuteberg Jeffrey , Starling Randall C. , Griffith Bartley , Boyce Steven , Westaby Stephen , Blume Elizabeth , Wearden Peter , Higgins Robert , Mack Michael
Published: November 2012

The incorporation of complex medical device technologies into clinical practice is governed by critical oversight of the US Food and Drug Administration. This regulatory process requires a judicious balance between assuring safety and efficacy, while providing efficient review to facilitate access to innovative therapies. Recent contrasting views of the regulatory process have emphasized the difficulties in obtaining an optimal balance. Mechanical circulatory support has evolved to become an important therapy for patients who have advanced heart failure with the advent of more durable, implantable ventricular assist devices. The regulatory oversight of these new technologies has been difficult owing to the complexities of these devices, associated adverse event profile, and severity of illness of the intended patient population. Maintaining a regulatory environment to foster efficient introduction of safe and effective technologies is critical to the success of ventricular assist device therapy and the health of patients with advanced heart failure. Physicians representing key surgical and cardiology societies, and representatives from the Food and Drug Administration, National Heart, Lung, and Blood Institute, Centers for Medicare and Medicaid Services, Interagency Registry of Mechanically Assisted Circulatory Support, and industry partners gathered to discuss relevant issues regarding the current regulatory environment assessing ventricular assist devices. The goal of the meeting was to explore innovative ways to foster the introduction of technologically advanced, safe, and effective ventricular assist devices. The following summary reflects opinions and conclusions endorsed by The Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, Heart Failure Society of America, International Society for Heart and Lung Transplantation, and Interagency Registry of Mechanically Assisted Circulatory Support.
Lifestyle Risk Factors for Ischemic Stroke and Transient Ischemic Attack in Young Adults in the Stroke in Young Fabry Patients Study
Authors: von Sarnowski Bettina , Putaala Jukka , Grittner Ulrike , Gaertner Beate , Schminke Ulf , Curtze Sami , Huber Roman , Tanislav Christian , Lichy Christoph , Demarin Vida , Basic-Kes Vanja , Ringelstein E. Bernd , Neumann-Haefelin Tobias , Enzinger Christian , Fazekas Franz , Rothwell Peter M. , Dichgans Martin , Jungehulsing Gerhard J. , Heuschmann Peter U. , Kaps Manfred , Norrving Bo , Rolfs Arndt , Kessler Christof , Tatlisumak Turgut
Published: November 2012

Background and Purpose—

Although many stroke patients are young or middle-aged, risk factor profiles in these age groups are poorly understood.

Methods—

The Stroke in Young Fabry Patients (sifap1) study prospectively recruited a large multinational European cohort of patients with cerebrovascular events aged 18 to 55 years to establish their prevalence of Fabry disease. In a secondary analysis of patients with ischemic stroke or transient ischemic attack, we studied age- and sex-specific prevalences of various risk factors.

Results—

Among 4467 patients (median age, 47 years; interquartile range, 40–51), the most frequent well-documented and modifiable risk factors were smoking (55.5%), physical inactivity (48.2%), arterial hypertension (46.6%), dyslipidemia (34.9%), and obesity (22.3%). Modifiable less well-documented or potentially modifiable risk factors like high-risk alcohol consumption (33.0%) and short sleep duration (20.6%) were more frequent in men, and migraine (26.5%) was more frequent in women. Women were more often physically inactive, most pronouncedly at ages <35 years (18–24: 38.2%; 25–34: 51.7%), and had high proportions of abdominal obesity at age 25 years or older (74%). Physical inactivity, arterial hypertension, dyslipidemia, obesity, and diabetes mellitus increased with age.

Conclusions—

In this large European cohort of young patients with acute ischemic cerebrovascular events, modifiable risk factors were highly prevalent, particularly in men and older patients. These data emphasize the need for vigorous primary and secondary prevention measures already in young populations targeting modifiable lifestyle vascular risk factors.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique Identifier: NCT00414583.
Analysis of a Coordinated Stroke Center and Regional Stroke Network on Access to Acute Therapy and Clinical Outcomes
Authors: Rymer Marilyn M. , Armstrong Edward P. , Walker Gary , Pham Sissi , Kruzikas Denise
Published: November 2012

Background and Purpose—

Compare access and outcomes in a tertiary care community hospital (Saint Luke’s Neuroscience Institute) and its stroke network to hospitals in 3 national databases.

Methods—

Retrospective analysis of ischemic stroke patients (2005, 2007, 2010) in Saint Luke’s (n=1576), Get With The Guidelines-Stroke (n=423 809), Premier (n=91 598), and Merci Registry (n=966). Study measures were use of computed tomography scans and tissue plasminogen activator (tPA), symptomatic intracranial hemorrhage, discharge disposition, discharge National Institutes of Health Stroke Scale scores, and 90-day modified Rankin Scores.

Results—

Saint Luke’s increased access to care with higher tPA use than other hospitals (17.2% received intravenous tPA therapy compared with 5.8% at Get With The Guidelines–Stroke hospitals,
P
<0.001; 22.1% of Saint Luke’s patients received tPA by any route compared with 3.5% of Premier patients,
P
<0.001). Use of intravenous tPA within 4.5 hours of onset was associated with more discharges to home (odds ratio, 2.123; 95% confidence interval, 1.394–3.246) and improved National Institutes of Health Stroke Scale scores (
P
=0.001). Saint Luke’s patients also were more likely than those in other hospitals to receive computed tomography scans (99.4% vs 58.6% at Premier hospitals). Embolectomy at Saint Luke’s was associated with better outcomes than peer hospitals, and treatment at Saint Luke’s was independently associated with more discharges to home (odds ratio, 3.92; 95% confidence interval, 1.84–8.32). In 2010, symptomatic intracranial hemorrhages after tPA therapy was similar for Saint Luke’s patients and Premier patients (2.2% vs 1.5%;
P
=0.590).

Conclusions—

Regionally coordinated stroke programs can substantially improve access and patient outcomes.
Prestroke Modified Rankin Stroke Scale Has Moderate Interobserver Reliability and Validity in an Acute Stroke Setting
Authors: Fearon Patrica , McArthur Kate S. , Garrity Kevin , Graham Laura J. , McGroarty Geraldine , Vincent Sarah , Quinn T. J.
Published: November 2012

Background and Purpose—

The modified Rankin Scale (mRS) is the recommended functional outcome assessment in stroke trials. Utility of mRS may be limited by interobserver variability. prestroke function, described using mRS, is often used as trial entry criterion. We assessed the reliability and validity of prestroke mRS in acute stroke.

Methods—

We present two complementary analyses of the properties of prestroke mRS: (1) Paired interviewers (trained in mRS) performed independently a blinded assessment of mRS and prestroke mRS. Interobserver variability was described using percentage agreement and weighted (kw) κ statistics with 95% confidence interval (95% CI). Validity was assessed by comparing prestroke mRS with other markers of function (comorbidity; medication count; need for carers). (2) We further assessed validity using a larger retrospective dataset. We compared prestroke mRS with Charlson comorbidity index (CCI) and the Rockwood frailty index. Rank correlation coefficient or Fisher exact test were used as appropriate.

Results—

Paired interviewers assessed 74 stroke survivors. Median standard mRS was 4 (interquartile range [IQR], 2–4), median prestroke mRS was 1 (IQR, 0–3; range, 0–4). Reliability for standard mRS interview was 56% agreement, kw=0.55 (95% CI, 0.39–0.71). Reliability for prestroke mRS was 70%, kw=0.70 (95% CI, 0.53–0.87). The retrospective dataset described 231 subjects. In this data set, Spearman Rho for prestroke mRS and frailty index was J. 0.82 (95% CI, 0.78–0.86); CCI 0.50 (95% CI, 0.40–0.59); patient age 0.45 (95% CI, 0.34–0.54); medication count 0.28 (95% CI, 0.15–0.40). There was no association between need for carers and prestroke mRS (p=0.10).

Conclusions—

Interobserver reliability of prestroke mRS is limited but comparable with standard mRS. Poor correlation of prestroke mRS with certain markers of function suggests limited validity. Our data would suggest that relying on mRS alone may be a suboptimal measure of prestroke function and could potentially bias trial samples.
Prevalence of Poststroke Cognitive Impairment
Authors: Douiri Abdel , Rudd Anthony G. , Wolfe Charles D.A.
Published: November 2012

Background and Purpose—

Stroke is a common long-term condition with an increasing incidence as the population ages. This study evaluates temporal changes in the prevalence of cognitive impairment after first-ever stroke stratified by sociodemography, vascular risk factors, and stroke subtypes, up to 15 years after stroke.

Methods—

Data were collected between 1995 and 2010 (n=4212) from the community-based South London Stroke Register covering an inner-city multiethnic population of 271 817 inhabitants. Patients were assessed for cognitive function using Abbreviated Mental Test or Mini-Mental State Examination at the onset, 3 months, and annually thereafter. All estimates were age adjusted to the European standard.

Results—

The overall prevalence of cognitive impairment 3 months after stroke and at annual follow-up remained relatively unchanged at 22% (24% [95% CI, 21.2–27.8] at 3 months; 22% [17.4–26.8] at 5 years to 21% [3.6–63.8] at 14 years). In multivariate analyses, the poststroke prevalence ratio of cognitive impairment increased with older age (2% [1–3] for each year of age), ethnicity (2.2 [1.65–2.89]-fold higher among black group) and socioeconomic status (42% [8–86] increased among manual workers). A significant, progressive trend of cognitive impairment was observed among patients with small vessel occlusion and lacunar infarction (average annual percentage change: 10% [7.9–12.8] and 2% [0.3–2.7], respectively, up to 5 years after stroke).

Conclusions—

The prevalence of cognitive impairment after stroke remains persistently high over time, with variations being predominantly explained by sociodemographic characteristics. Given population growth and ageing demographics, effective preventive strategies and poststroke surveillance are needed to manage survivors with cognitive impairment.
Secondary Signal Change and an Apparent Diffusion Coefficient Decrease of the Substantia Nigra After Striatal Infarction
Authors: Nakajima Makoto , Inatomi Yuichiro , Okigawa Takashi , Yonehara Toshiro , Hirano Teruyuki
Published: November 2012

Background and Purpose—

Diffusion-weighted imaging can depict secondary signal change of the substantia nigra of patients with ipsilateral striatal infarction via a decrease in the apparent diffusion coefficient (ADC). Clinical predictors of this phenomenon remain unclear.

Methods—

We assessed 98 stroke patients with acute ischemic lesions in the hemilateral basal ganglia, external capsule, or internal capsule. The ADC values of the bilateral substantia nigra obtained from a follow-up MRI, various clinical factors, and patients’ outcome were analyzed. Nineteen patients who underwent a follow-up MRI within 3 days were excluded from analysis because none of them demonstrated a significant ADC change of substantia nigra.

Results—

Of 79 patients, 21 (26.6%) revealed a decreased ADC in the substantia nigra. Ischemic lesions in the globus pallidus (odds ratio 12.90) and the presence of emboligenic diseases (odds ratio 6.95) were independent predictors for an ADC decrease in the substantia nigra. The clinical outcome 3 months after stroke onset was not different between patients with an ADC decrease and patients without.

Conclusions—

A reduction of ADC in the substantia nigra after acute striatal infarction was more frequently observed when the globus pallidus was affected or when the patient had emboligenic diseases, however, did not necessarily relate to the patient’s clinical outcome.
Lunar Cemetery: Global Heterotopia and the Biopolitics of Death
Authors: Damjanov Katarina
Published: November 2012

The burial of human remains on the Moon conjures up the idea of a lunar cemetery. This paper reviews related artistic projects and practices and situates the concept of the lunar cemetery in relation to Michel Foucault's articulation of the notions of heterotopia and biopolitics to explore the implications of perceiving the Moon as a globally shared space populated by the dead. The author also suggests that the possibility of a cemetery on the Moon reveals peculiar biopolitical approaches toward lunar space, in which death is used to uphold its heterotopic potential and support the envisioning of prospects for humanity's future beyond the globe.
Children’s Grammar of Null Subjects: Evidence from Comprehension
Authors: Orfitelli Robyn , Hyams Nina
Published: November 2012

The null subject (NS) stage is one of the best-described hallmarks of first language development. We present a series of experiments assessing children’s interpretation of NS sentences, as a way of testing the two main competing analyses of the phenomenon: grammatical accounts, under which young children’s grammars license NSs in declarative sentences; and performance accounts, which hold that children have an adult grammar, but omit subjects in production for extrasyntactic reasons. Overall, we find evidence of an NS stage in comprehension, just as in production. This suggests that child and adult grammars differ, in line with grammatical accounts.
Voiding Island Effects via Head Movement
Authors: Stepanov Arthur
Published: November 2012

I argue that Bošković’s (2011c) generalization concerning the island-voiding effect of incorporation can be captured naturally within minimalist bare phrase structure if head movement (a) is a syntactic operation and (b) leaves no trace/copy. É. Kiss’s (2008) ‘‘domain-flattening’’ phenomena are also expected under the proposed account. Further empirical consequences are discussed.
Examining Mechanisms of Variability within the Pacific Storm Track: Upstream Seeding and Jet-Core Strength
Authors: Penny Sandra M. , Battisti David S. , Roe Gerard H.
Published: November 2012

This paper examines how variations in two mechanisms, upstream seeding and jet-core strength, relate to storminess within the cold season (October–April) Pacific storm track. It is found that about 17% of observed storminess covaries with the strength of the upstream wave source, and the relationship is robust throughout the cold season and for both the Pacific and Atlantic basins. Further analyses of the intraseasonal variability in the strength and structure of the wintertime [December–February (DJF)] Pacific jet stream draw upon both Eulerian-variance and feature-tracking statistics to diagnose why winter months with a strong-core jet stream have weaker storminess than those with a weak-core jet stream. Contrary to expectations, it is shown that the basic spatial patterns actually conform to a simple linear picture: regions with a weaker jet have weaker storminess. The overall decrease in storminess is most strongly linked to the weaker amplitude of individual storms in strong-core months. Previously proposed mechanisms are evaluated in the context of these new results. Last, this analysis provides further evidence that the midwinter suppression in storminess over the North Pacific Ocean is primarily due to a notable lack of storminess upstream of the Pacific storm track in the heart of winter.
Polarizing Patriots
Authors: Gelpi Christopher , Roselle Laura , Barnett Brooke
Published: November 2012

We demonstrate that the use of patriotic imagery in news reporting may increase rather than decrease public polarization regarding foreign policy issues. Specifically, we examine the impact of patriotic imagery in the context of an online news story about terrorism on individuals’ attitudes toward civil liberties in the “war on terror” and spillover effects on support for the war in Afghanistan. We expect that images of the American flag will be associated with differing clusters of values depending on the level of right-wing authoritarianism (RWA) that an individual’s personality exhibits. Specifically, we expect that flag imagery will decrease support for civil liberties and increase support for the war in Afghanistan among individuals who are high in RWA. But we expect flag exposure to have the opposite effect among those who are low in RWA. Finally, we expect patriotic imagery cues will influence only individuals who are not a part of the terrorism “issue public.” We test these hypotheses with an experiment that presents participants with a single news story on the Times Square bomber. The experiment frames the news story as coming from Fox News, CNN, or MSNBC and varies the presence or absence of patriotic flag imagery in the pictures accompanying the news story. The results provide strong support for our expectations regarding the contingent impact of patriotic imagery as well as our expectations regarding the spillover effects of news coverage on terrorism on attitudes toward Afghanistan.
The Rise of Uncivil Agreement
Authors: Mason Lilliana
Published: November 2012

The debate over whether polarization is occurring in the mass public has been limited by a lack of definition and theory. This article contributes to both, arguing that polarization can be characterized as either behavioral polarization or issue position polarization, but that the two are not synonymous. One reason for the difference between the two types of polarization is that the partisan-ideological sorting that has occurred over the past few decades has contributed to behavioral polarization, but not as strongly to issue position polarization. The consequence of this is a new electorate that generally agrees on most issues but is nevertheless increasingly biased, active, and angry. An examination of American National Election Studies data from 1972 to 2004 finds strong support for these hypotheses.
Homesteading a Pioneer Mental Health Court
Authors: Trawver Kathi R. , Rhoades Stephanie L.
Published: November 2012

Although judges with interests in improving the criminal justice response to individuals with serious mental illness have long been principal leaders in the development and innovation of mental health courts (MHCs), little is known about the experiences of pioneering MHC judges. Through an edited written narrative, this article provides a history of one “first-generation” MHC through the lens of its founding judge. This chronicle of the Anchorage Mental Health Court’s 15-year history details its inception and evolving challenges, triumphs, sustainability, and philosophy. The history of the Anchorage Mental Health Court, in the context of evolving national changes in MHC practices, is presented to inform both current and developing MHCs.
Rethinking ADHD and LD in DSM-5: Proposed Changes in Diagnostic Criteria
Authors: Tannock Rosemary
Published: November 2012

The Diagnostic and Statistical Manual of Mental Disorders ( DSM) is currently undergoing revision that will lead to a fifth edition ( DSM-5) in 2013. This article first provides a brief synopsis of the DSM-5 administrative structure, procedures, and guiding principles to enhance understanding of how changes are made in the DSM. The next two sections (on attention-deficit/hyperactivity disorder and learning disorders, respectively) highlight the major concerns and controversies surrounding the DSM-IV diagnostic criteria for these two disorders and provide a rationale for the proposed changes to the criteria, along with a commentary on the empirical evidence on which the proposed changes were based.
Specific Learning Disability and Its Newest Definition
Authors: Scanlon David
Published: November 2012

The American Psychiatric Association’s proposed definition of specific learning disability (“specific learning disorder”) for the DSM-5 reflects current thinking and best practice in learning disabilities. It continues the core conceptualization of learning disability (LD) as well as proposes identification criteria to supplant the discredited aptitude–achievement discrepancy formula. Improvements can be found along with long-standing and new controversies about the nature of LD. The proposed definition both provides a model of a currently acceptable definition and reflects critical issues in the operationalization of LD that the field continues to neglect.
Comorbidity of LD and ADHD
Authors: DuPaul George J. , Gormley Matthew J. , Laracy Seth D.
Published: November 2012

Attention-deficit/hyperactivity disorder (ADHD) and learning disability (LD) can co-occur for a significant minority of children with each disorder. A total of 17 studies (2001–2011) examining ADHD-LD comorbidity were reviewed, revealing a higher mean comorbidity rate (45.1%) than has been obtained previously. Higher comorbidity may be the result of including students with writing disorders, not just reading and/or math disabilities. Proposed DSM-5 criteria for both disorders will likely affect comorbidity rates; however, it is unclear whether such rates will increase or decrease. Regardless of the specific impact of DSM revisions, academic skill and/or performance deficits should be assessed for students with ADHD as part of screening, comprehensive evaluation, and treatment monitoring. Comprehensive intervention services for students with comorbid ADHD and LD will require empirically supported treatment strategies that address both disorders and that are implemented across school and home settings.
The Political Logic of Ethnic Violence
Authors: Dhattiwala Raheel , Biggs Michael
Published: November 2012

Ethnic violence in Gujarat in 2002 killed at least a thousand Muslims. Compiling data from the Times of India, we investigate variation across 216 towns and rural areas. Analysis reveals the political logic of violence. Killing was less likely where the Hindu nationalist Bharatiya Janata Party (BJP) was weakest, but was even less likely where the BJP was strong; it was most likely where the party faced the greatest electoral competition. Underemployment and Muslim in-migration also increased violence. The political logic is confirmed by analysis of the subsequent election: the BJP’s vote increased most in districts with the worst violence. Police chiefs in districts where violence was severe were more likely to be promoted.
Combining Statistical Evidence From Several Studies
Authors: Kuiper Rebecca M. , Buskens Vincent , Raub Werner , Hoijtink Herbert
Published: November 2012

The effect of an independent variable on a dependent variable is often evaluated with hypothesis testing. Sometimes, multiple studies are available that test the same hypothesis. In such studies, the dependent variable and the main predictors might differ, while they do measure the same theoretical concepts. In this article, we present a Bayesian updating method that can be used to quantify the joint evidence in multiple studies regarding the effect of one variable of interest. We apply our method to four studies on how trust in social and economic exchange depends on experience from previous exchange with the same partner. In addition, we examine five hypothetical situations in which the results from the separate studies are less clear-cut than in our trust example.
Speed Dating and the Presentation of Self
Authors: Larson Jeff A. , Tsitsos William
Published: November 2012

This article presents an in-class exercise for teaching theories of the presentation of self that is organized around two key concepts, impression management and impression formation. By highlighting the interpretive, interactive aspects of the presentation of self, this exercise is also useful for teaching the major principles of symbolic interactionism. The exercise is a modified form of speed dating in which students are paired together in a rapid succession of brief interactions (three to five minutes). Rather than seeking a date, however, students are participant-observers paying careful attention to how they form impressions of others and manage the impressions others are forming of them. Because of its brief and repeated interactions, speed dating puts students in a good position to observe their interactions with some analytical distance. With this exercise, students become active learners, which has been found to improve engagement and retention. Drawing on students’ essays, we present evidence that the exercise helps students to develop a basic understanding of presentation-of-self concepts and symbolic interactionism more generally as well as an ability to apply them to their experience.
“It Was a Real Village”
Authors: Gafford Farrah D.
Published: November 2012

After World War II, members of a small black middle class in southern cities such as Dallas, Atlanta, and New Orleans settled in newly built suburban-style subdivisions of single-family homes. While scholars have examined the design process and political negotiations that led to the development of black middle-class planned subdivisions, very little is known about how and why residents formed communal bonds. This article seeks to understand how original residents in Pontchartrain Park, a subdivision located in New Orleans, Louisiana, created a sense of community in the early years of the neighborhood. The research specifically focuses on the process of community building among adults who spent the majority if not all of their childhood and adolescent years in Pontchartrain Park. Interview data show how residents relied on communal bonds to offset some of their early experiences with racial hostility. Former residents retain strong ties to the neighborhood by attending church services, visiting neighborhood friends and participating in neighborhood organizations. Longstanding communal bonds have also played a vital role in the neighborhood’s post-Katrina recovery.
The Changs Next Door to the Diazes
Authors: Cheng Wendy
Published: November 2012

Asian Americans and Mexican Americans began to purchase homes in Los Angeles’s San Gabriel Valley in large numbers beginning in the 1950s and 1960s. They approached the task with a full awareness of the realities of structural racial discrimination and the limitations it imposed on where they could and could not live. As largely middle-income homebuyers, however, they had a degree of choice distinct from their poorer, nonwhite counterparts that was also informed by differentiated positions in American racial hierarchies vis-à-vis property—in particular, the “model minority” status of Asian Americans, and the ambiguously white standing of Mexican Americans. However, even while housing market discrimination shaped their initial movements to a large degree, Asian American and Latina/Latino residents of the area ultimately participated in producing what George Lipsitz has called a moral geography of differentiated space, in which their motivations and long-term actions differed significantly from those of white residents, who fled the area en masse during the same time period. This “moral geography” is both continuous with earlier histories of multiracial communities in the greater Los Angeles region, and distinctively new. It signifies an emergent multiracial, “nonwhite” identity that challenges conventional notions of race and class in American suburbs.
Glass and Steel: The Shell Oil/Bulova Tower as a Psychospatial Aglet of the Canadian National Exhibition, 1955-1985
Authors: Munroe Jesse Allan
Published: November 2012

The Shell Oil/Bulova Tower in Toronto was built as an “elaborate billboard” but became a real public space because of its vital role in the Canadian National Exhibition. As a place marker in the literal and perceived landscapes of its site, it overcame its corporate origins to serve important social and cultural needs. It was demolished for many reasons: the lack of heritage awareness in Toronto, the unsympathetic nature of neoliberal planning initiatives, and the liminal nature of the park it occupied. This demolition both further impoverished the city’s historical landscape and impelled its preservationist community to act; though no longer a physical landmark, it remains a dialectical one.
Behaviour change potential for energy saving in non-domestic buildings: Development and pilot-testing of a benchmarking tool
Authors: Ucci M , Domenech T , Ball A , Whitley T , Wright C , Mason D , Corrin K , Milligan A , Rogers A , Fitzsimons D , Gaggero C , Westaway A
Published: November 2012

Due to recent studies and government policies, designers and facilities managers are becoming increasingly aware of the role of occupant behaviour in energy conservation in buildings. While the use of post-occupancy surveys and benchmark tools is widespread in the built environment, there is limited research on assessing environmental and energy saving behaviours – particularly in non-domestic buildings. This article focuses on the development and pilot-testing of a novel benchmarking tool for the assessment of behaviour change potential for energy saving in the workplace, with findings from an industrial case study comprising a manufacturing and office environment. Beyond the findings of the case study, the article aims to provide a methodological framework for an easy-to-use benchmarking tool of user-behaviour within the context of energy saving in factories and offices.

Practical Implications: This article discusses the development and pilot-testing of a novel questionnaire-based benchmarking tool for the assessment of behaviour change potential for energy saving in office and industrial settings. Its application to a case-study from the manufacturing sector demonstrates that the tool is easy to use, and it provides valuable insights on areas for improvement in energy use within non-domestic buildings, with a focus on user behaviour and management approaches. The tool can be used in applied research, for example in intervention studies for comparison within the same organisation (before and after), and/or for benchmarking against the performance of similar organisations.
The Impact of Point-of-Care A1C Testing on Provider Compliance and A1C Levels in a Primary Setting
Authors: Egbunike Veronica , Gerard Sally
Published: November 2012

Purpose

The purpose of the research was to investigate the impact of point-of-care (POC) A1C testing among patients with type 2 diabetes in a primary care setting.

Methods

This study used a pretest-posttest design with data from patient charts matched for age, sex, race, body mass index, insurance status, and the number of comorbidities. A random sample of charts of patients with type 2 diabetes in the primary care setting was reviewed 6 months and 3 months pre- and post-implementation of the POC A1C testing.

Results

There was a significant difference in the number of A1Cs documented in the medical record pre- versus post-implementation of POC A1C. There was also a significant difference in A1C values pre- versus post-implementation. There was also a difference in the treatment changes pre- versus post-implementation of POC A1C.

Conclusion

Point-of-care A1C testing represents an opportunity for improved care of people with diabetes. The significance of this improvement will become more critical as the number of people with type 2 diabetes continues to increase.
Labor Differentiation and Agglomeration in General Equilibrium
Authors: Berliant Marcus , Zenou Yves
Published: November 2012

The aim of this article is to explore the structure of cities as a function of labor differentiation, gains to trade, a fixed cost for constructing the transportation network, a variable cost of commodity transport, and the commuting costs of consumers. Firms use different types of labor to produce different outputs. Locations of all agents are endogenous as are prices and quantities. This is among the first articles to apply smooth economy techniques to urban economics. Existence of equilibrium and its determinacy properties depend crucially on the relative numbers of outputs, types of labor, and firms. More differentiated labor implies more equilibria. We provide tight lower bounds on labor differentiation for existence of equilibrium. If these sufficient conditions are satisfied, then generically there is a continuum of equilibria for given parameter values. Finally, an equilibrium allocation is not necessarily Pareto optimal in this model.
Weighting Ripley’s K-Function to Account for the Firm Dimension in the Analysis of Spatial Concentration
Authors: Giuliani Diego , Arbia Giuseppe , Espa Giuseppe
Published: November 2012

The spatial concentration of firms has long been a central issue in economics under both the theoretical and the applied point of view mainly due to the important policy implications. A popular approach to its measurement, which does not suffer from the problem of the arbitrariness of the regional boundaries, makes use of micro data and looks at the firms as if they were dimensionless points distributed in the economic space. However, in practical circumstances the points (firms) observed in the economic space are far from being dimensionless and are conversely characterized by different dimension in terms of the number of employees, the product, the capital, and so on. In the literature, the works that originally introduce such an approach disregard the aspect of the different firm dimension and ignore the fact that a high degree of spatial concentration may result from the case of both many small points clustering in definite portions of space and only few large points clustering together (e.g., few large firms). We refer to this phenomenon as clustering of firms and clustering of economic activities. The present article aims at tackling this problem by adapting the popular K-function to account for the point dimension using the framework of marked point process theory.
Innovation and Employment Dynamics in European Regions
Authors: Capello Roberta , Lenzi Camilla
Published: November 2012

The impact of technological change on employment growth has long been debated. Most of the literature approaches this issue at the firm, the sectoral, or national level, whereas the regional approach has been largely neglected, especially in the European context. The article analyzes the relationship between innovation and employment growth at the regional level (Nomenclature of Territorial Units for Statistics - NUTS2) for twenty-seven European countries. Despite the undisputable difficulties of empirical analyses due to the fact that employment change depends on various aspects—such as macroeconomic and cyclical conditions as well as labor market dynamics and regulation—the results show that the direct effects of product and process innovation are moderated by specific regional structural characteristics, namely the region’s functional specialization and settlement structure. In particular, the effect of product innovation on regional employment is positive in regions with a larger presence of production functions, whereas the impact of process innovation is negative in metropolitan settings.
New Spatial Econometrics–Based Areal Interpolation Method
Authors: Tsutsumi Morito , Murakami Daisuke
Published: November 2012

Spatial data are often aggregated into spatial units and differences between spatial units can complicate the analysis of the data. One solution to this problem is spatial unit conversion, also called areal interpolation. Of the many areal interpolation methods proposed thus far, few method are based on spatial econometrics: a subset of econometrics which is concerned with the role of spatial autocorrelation (a general property of spatial data that implies that data in nearby locations are similar) in the regional economic model response. In this article, an areal interpolation method that considers both the spatial autocorrelation and the pycnophylactic property (a most basic premise of areal interpolation that the sum of the data given in a specific area must be constant) is proposed by combining a spatial econometric model and a linear regression-based areal interpolation method. Parameters of the proposed method are estimated using the expectation-maximization algorithm. The performance of the proposed method was examined through empirical analysis using real data and ratios on aging populations. The results indicate the importance of considering both the pycnophylactic property and the spatial autocorrelation in areal interpolation. The results also show the applicability of spatial econometrics to areal interpolation problems.
Isserman’s Impact
Authors: Feser Edward
Published: November 2012

Applications using quasi-experimental comparison group designs in regional science and geography have increased substantially over the last three decades, inspired by the work of Andrew Isserman and colleagues in the 1980s and 1990s, robust literatures on quasi-experimental design in fields like education and psychology, a vast program evaluation literature, observational studies methodology in statistics, and the growing interest in experimental and nonexperimental (natural) designs in empirical economics. This article discusses the state of quasi-experimental comparison group research today, with a primary focus on studies in which regions—census tracts, counties, cities, metropolitan areas, provinces, or states—are the units of analysis. There is still progress to be made in improving matching methods, making more extensive use of time-series designs, undertaking more systematic sensitivity testing and checks for the robustness of findings, focusing greater attention on effect heterogeneity and research designs that aid policy and program improvement, and improving the practice of regional quasi-experimental research generally.
Toxicologic Pathology in the 21st Century
Authors: Ettlin Robert A.
Published: November 2012

Toxicology is and will be heavily influenced by advances in many scientific disciplines. For toxicologic pathology, particularly relevant are the increasing array of molecular methods providing deeper insights into toxicity pathways, in vivo imaging techniques visualizing toxicodynamics and more powerful computers anticipated to allow (partly) automated morphological diagnoses. It appears unlikely that, in a foreseeable future, animal studies can be replaced by in silico and in vitro studies or longer term in vivo studies by investigations of biomarkers including toxicogenomics of shorter term studies, though the importance of such approaches will continue to increase. In addition to changes based on scientific progress, the work of toxicopathologists is and will be affected by social and financial factors, among them stagnating budgets, globalization, and outsourcing. The number of toxicopathologists in North America, Europe, and the Far East is not expected to grow. Many toxicopathologists will likely spend less time at the microscope but will be more heavily involved in early research activities, imaging, and as generalists with a broad biological understanding in evaluation and management of toxicity. Toxicologic pathology will remain important and is indispensable for validation of new methods, quality assurance of established methods, and for areas without good alternative methods.
Management of patients with spontaneous intracranial hypotension causing altered level of consciousness: Report of two cases and review of literature
Authors: Ghavanini Amer A , Scott Courtney A , Chan David K , Tang-Wai David F
Published: November 2012

Background

Decreased level of consciousness is a rare neurological manifestation of spontaneous intracranial hypotension (SIH), which typically presents with orthostatic headache. The optimal management of this uncommon presentation remains uncertain.

Methods

We analyzed the presentation, management and outcome of two patients in our institution and reviewed 22 patients reported in the literature with SIH and decreased level of consciousness, defined as any decrease in the patient’s Glasgow Coma Scale score.

Results

There were 20 male and four female patients (M:F ratio of 5:1) with an average age of 52 years (range 37 to 68 years). There was a variable time interval of up to many months between the initial presentation of SIH and changes in the level of consciousness. An epidural autologous blood patch was eventually successful in 79% of the patients, although up to three trials were necessary in seven of these patients. Intrathecal saline infusion used as a temporizing measure resulted in excellent response within hours in five out of six patients who received this treatment. Drainage of the subdural collection either did not result in any sustained improvement or resulted in clinical deterioration in 12 out of 12 patients who received this treatment.

Conclusions

In the absence of a clinical trial because of the rarity of this entity, the treatment of SIH complicated by decreased level of consciousness remained controversial in the past. However, current collective experience supports early treatment of patients with SIH and decreased level of consciousness with one or more epidural blood patches. Fibrin glue and surgical duroplasty are the next steps in the management of patients in whom epidural blood patches fail. Drainage of the subdural collections may be detrimental.
Medication-overuse headache and opioid-induced hyperalgesia: A review of mechanisms, a neuroimmune hypothesis and a novel approach to treatment
Authors: Johnson Jacinta L , Hutchinson Mark R , Williams Desmond B , Rolan Paul
Published: November 2012

Introduction

Patients with chronic headache who consume large amounts of analgesics are often encountered in clinical practice. Excessive intake of analgesics is now considered to be a cause, rather than simply a consequence, of frequent headaches, and as such the diagnosis “medication-overuse headache” (MOH) has been formulated. Despite the prevalence and clinical impact of MOH, the pathophysiology behind this disorder remains unclear and specific mechanism-based treatment options are lacking.

Discussion

Although most acute headache treatments have been alleged to cause MOH, here we conclude from the literature that opioids are a particularly problematic drug class consistently associated with worsening headache. MOH may not be a single entity, as each class of drug implicated may cause MOH via a different mechanism. Recent evidence indicates that chronic opioid administration may exacerbate pain in the long term by activating toll-like receptor-4 on glial cells, resulting in a pro-inflammatory state that manifests clinically as increased pain. Thus, from the available evidence it seems opioid-overuse headache is a phenomenon similar to opioid-induced hyperalgesia, which derives from a cumulative interaction between central sensitisation, due to repeated activation of nociceptive pathways by recurrent headaches, and pain facilitation due to glial activation.

Conclusion

Treatment strategies directed at inhibiting glial activation may be of benefit alongside medication withdrawal in the management of MOH.
The Effect of Initial Graft Tension After Anterior Cruciate Ligament Reconstruction
Authors: Fleming Braden C. , Fadale Paul D. , Hulstyn Michael J. , Shalvoy Robert M. , Oksendahl Heidi L. , Badger Gary J. , Tung Glenn A.
Published: November 2012

Background:

The initial graft tension applied at the time of anterior cruciate ligament (ACL) reconstruction alters joint contact and may influence cartilage health. The objective was to compare outcomes between 2 commonly used “laxity-based” initial graft tension protocols.

Hypotheses:

(1) The high-tension group would have less knee laxity, improved clinical and patient-oriented outcomes, and less cartilage damage than would the low-tension group after 36 months of healing. (2) The outcomes of the high-tension group would be equivalent to those of a matched control group.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

Ninety patients with isolated unilateral ACL injuries were randomized to undergo ACL reconstruction using 1 of 2 initial graft tension protocols: (1) autografts tensioned to restore normal anterior-posterior (AP) laxity at the time of surgery (ie, low tension; n = 46) and (2) autografts tensioned to overconstrain AP laxity by 2 mm (ie, high tension; n = 44). Sixty matched healthy patients formed the control group. Outcomes were assessed preoperatively, intraoperatively, and at 6, 12, and 36 months after surgery.

Results:

No significant differences were found between the 2 initial graft tension protocols for any of the outcome measures at 36 months. However, there were differences when comparing the 2 treatment groups to the control group. On average, AP laxity was 2 mm greater in the ACL-reconstructed groups than in the control group ( P < .007). International Knee Documentation Committee (IKDC) knee evaluation scores, peak isokinetic knee extension torques, and 4 of 5 Knee Osteoarthritis Outcome Scores (KOOS) were significantly worse than the control group ( P < .001, P < .027, and P < .05, respectively). Short Form–36 Health Survey (SF-36) scores and reinjury rates were similar between groups at 36 months. Although there were significant changes in radiography and magnetic resonance imaging present in the ACL-reconstructed knees of both treatment groups, the magnitude was relatively small and likely clinically insignificant at 36 months.

Conclusion:

Both laxity-based initial graft tension protocols produced similar outcomes without fully restoring joint function or patient-oriented outcomes (KOOS) when compared with the control group. There was minimal evidence of cartilage damage 36 months after surgery.