bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between prostate cancer mortality and number of unfavourable risk factors in men treated with definitive brachytherapy
Authors: Taira Al V. , Merrick Gregory S. , Galbreath Robert W. , Butler Wayne M. , Lief Jonathan H. , Wallner Kent E.
Published: March 2010

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

OBJECTIVE

To explore whether the number of unfavourable pretreatment risk factors predicts cause‐specific mortality in men treated with prostate brachytherapy.

PATIENTS AND METHODS

Between April 1995 and March 2006, 739 patients were treated who had at least one of the following adverse risk factors: pretreatment prostate‐specific antigen (PSA) level of >10 ng/mL, a Gleason score of ≥7, clinical stage ≥T2b, or a PSA velocity (PSAV) of >2 ng/mL/year. Supplemental external beam radiotherapy (EBRT) was delivered to 464 (62.8%) men and 301 (40.7%) received androgen deprivation therapy (ADT). Of men with more than two risk factors, 87% received EBRT and 62% received ADT.

RESULTS

The biochemical progression‐free survival (bPFS), cause‐specific survival (CSS) and overall survival for all patients were 95.0%, 97.9% and 70.0% at 12 years. Men with three or four risk factors had a prostate cancer‐specific mortality (PCSM) at 12 years of 5.3%, vs 1.7% for men with one or two risk factors (P= 0.006). When ‘percentage of positive biopsy cores >50%’ replaced PSAV as a risk factor, men with two or more risk factors had a PCSM of 8.9%, vs 1.0% for men with one or two risk factors (P= 0.001). There was no difference in all‐cause mortality between the groups in either analysis.

CONCLUSION

Multimodal brachytherapy results in high rates of bPFS and CSS, even for men with several unfavourable risk factors. Men with two or more unfavourable risk factors had a slightly greater risk of PCSM and no difference in all‐cause mortality. The presence of three or four unfavourable intermediate‐risk factors does not appear to clearly identify a group that requires further treatment intensification, although the percentage of positive cores might be more predictive than PSAV.
Plasma osteoprotegerin concentrations in peripheral sensory neuropathy in Type 1 and Type 2 diabetic patients
Authors: Nybo M. , Poulsen M. K. , Grauslund J. , Henriksen J. E. , Rasmussen L. M.
Published: March 2010

Diabet. Med. 27, 289–294 (2010)

Aims  Osteoprotegerin (OPG) has been linked to different diabetes complications, including cardiovascular disease, and new findings have indicated a specific role in diabetic peripheral neuropathy, but the exact mechanism is unknown. To investigate a possible association between OPG and diabetic peripheral sensory neuropathy, we therefore analysed plasma OPG in Type 1 and Type 2 diabetic patients with and without peripheral neuropathy.

Subjects and methods  Two hundred Type 1 diabetes mellitus (T1DM) patients and 305 Type 2 diabetes mellitus (T2DM) patients participated in the study. Plasma OPG was measured with a sandwich immunoassay. Peripheral neuropathy was assessed by the Semmes–Weinstein monofilament test.

Results  In T2DM, plasma OPG concentrations were significantly higher in the peripheral neuropathy group (P < 0.001). Furthermore, there was a significant relationship between the presence of neuropathy in T2DM and plasma OPG levels on logistic regression (P = 0.006). However, when investigated in a full multiple regression model including other long‐term diabetes complications, the association became insignificant (P = 0.092). In T1DM, the difference in plasma OPG between groups did not reach significance (P = 0.066). However, plasma OPG significantly correlated to peripheral neuropathy in this group also (P = 0.022), although this correlation was not significant in a multiple linear regression model (P = 0.051).

Conclusion  Plasma OPG levels are related to peripheral neuropathy in both Type 1 and Type 2 diabetes, although with the strongest relationship in T2DM. Before understanding the significance of this, the pathological mechanism involved and, speculatively, a possible use of plasma OPG as a peripheral sensory neuropathy marker, a larger prospective study is needed.
A simple Chinese risk score for undiagnosed diabetes
Authors: Gao W. G. , Dong Y. H. , Pang Z. C. , Nan H. R. , Wang S. J. , Ren J. , Zhang L. , Tuomilehto J. , Qiao Q.
Published: March 2010

Diabet. Med. 27, 274–281 (2010)

Aims  A diabetes risk score for screening undiagnosed diabetes was constructed and validated in Chinese adults.

Methods  Two consecutive population‐based diabetes surveys among Chinese adults aged 20–74 years were conducted in 2002 (n = 1986) and 2006 (n = 4336). Demographic and anthropometric measures were collected following similar procedures. Standard 2‐h 75‐g oral glucose tolerance tests (OGTTs) were performed to diagnose diabetes in both surveys. Fasting capillary plasma glucose (FCG) and glycated haemoglobin (HbA1c) were also measured together with the OGTTs on the same day of the 2006 survey. Beta coefficients estimated using logistic regression analysis derived from data of the 2002 survey were used to develop the risk assessment algorithm. The performance of the algorithm was validated in the study population of the 2006 survey.

Results  Of all the variables tested, waist circumference, age and family history of diabetes were significant predictors of diabetes and were used to construct the risk assessment score. The score, ranging from 3 to 32, performed well when applied to the study population of the 2006 survey. The area under the receiver operating characteristic curve was 67.3% (95% CI, 64.9–69.7%) for the score, while it was 76.3% (73.5–79.0%) for FCG alone and 67.8% (64.9–70.8%) for HbA1c alone. At a cut‐off point of 14, the sensitivity and specificity of the risk score were 84.2% (81.0–87.5%) and 39.8% (38.2–41.3%).

Conclusions  The risk score based on age, waist circumference and family history of diabetes is efficient as a layperson‐oriented diabetes screening tool for health promotion and for population‐based screening programmes.
Can children with Type 1 diabetes and their caregivers estimate the carbohydrate content of meals and snacks?
Authors: Smart C. E. , Ross K. , Edge J. A. , King B. R. , McElduff P. , Collins C. E.
Published: March 2010

Diabet. Med. 27, 348–353 (2010)

Aims  Carbohydrate (CHO) counting allows children with Type 1 diabetes to adjust mealtime insulin dose to carbohydrate intake. Little is known about the ability of children to count CHO and whether a particular method for assessing CHO quantity is better than others. We investigated how accurately children and their caregivers estimate carbohydrate, and whether counting in gram increments improves accuracy compared with CHO portions or exchanges.

Methods  One hundred and two children and adolescents (age range 8.3–18.1 years) on intensive insulin therapy and 110 caregivers independently estimated the CHO content of 17 standardized meals (containing 8–90 g CHO), using whichever method of carbohydrate quantification they had been taught (gram increments, 10‐g portions or 15‐g exchanges).

Results  Seventy‐three per cent (n = 2530) of all estimates were within 10–15 g of actual CHO content. There was no relationship between the mean percentage error and method of carbohydrate counting or glycated haemoglobin (HbA1c) (P > 0.05). Mean gram error and meal size were negatively correlated (r = −0.70, P < 0.0001). The longer children had been CHO counting the greater the mean percentage error (r = 0.173, P = 0.014). Core foods in non‐standard quantities were most frequently inaccurately estimated, while individually labelled foods were most often accurately estimated.

Conclusions  Children with Type 1 diabetes and their caregivers can estimate the carbohydrate content of meals with reasonable accuracy. Teaching CHO counting in gram increments did not improve accuracy compared with CHO portions or exchanges. Large meals tended to be underestimated and snacks overestimated. Repeated age‐appropriate education appears necessary to maintain accuracy in carbohydrate estimations.
INCENTIVES, EQUALITY AND CONTRACT RENEGOTIATIONS: THEORY AND EVIDENCE IN THE CHINESE BANKING INDUSTRY*
Authors: CAI HONGBIN , LI HONGBIN , ZHOU LI‐AN
Published: March 2010

Renegotiation plays an important role in contract theory, but the empirical study of renegotiation is almost non‐existent in the literature. Using a unique dataset from the Chinese banking industry, we find that the large majority of managerial incentive contracts are renegotiated after performances are realized. We develop a model of contract renegotiation where supervisors and managers sign incentive contracts and then renegotiate them. In the unique equilibrium of the model, incentive contracts are almost always renegotiated ex post. Even though renegotiation is fully anticipated, incentive contracts affect performance. The predictions of the model find strong support from our empirical results.
INVESTMENT SPIKES AND UNCERTAINTY IN THE PETROLEUM REFINING INDUSTRY*
Authors: DUNNE TIMOTHY , MU XIAOYI
Published: March 2010

This paper investigates the effect of uncertainty on the investment decisions of petroleum refineries in the U.S. We construct uncertainty measures from the commodity futures market and use data on actual capacity changes to measure investment episodes. Since capacity changes in U.S. refineries occur infrequently, we empirically model the investment process using hazard models. An increase in uncertainty decreases the probability that a refinery might adjust its capacity. The results are robust to various investment thresholds. Our findings lend support to theories that emphasize the role of irreversibility in investment decisions.
ORGANIZATIONAL STRUCTURE AND THE DIVERSIFICATION DISCOUNT: EVIDENCE FROM COMMERCIAL BANKING*
Authors: KLEIN PETER G. , SAIDENBERG MARC R.
Published: March 2010

We provide evidence on organizational structure and performance at bank holding companies (BHC's). First, we show that a BHC's member banks benefit from access to internal capital markets. Second, we ask if these benefits are best realized within loosely structured, decentralized organizations or more consolidated, centralized firms. We find that BHC's with many subsidiaries are less profitable and have lower q ratios than similar BHC's with fewer subsidiaries. However, because we study multi‐unit firms in a single industry, our results suggest that the diversification discount reported in the corporate finance literature reflects not only industry diversification, but also organizational structure.
OUTPUT‐EXPANDING COLLUSION IN THE PRESENCE OF A COMPETITIVE FRINGE*
Authors: MONTERO JUAN‐PABLO , GUZMAN JUAN IGNACIO
Published: March 2010

Following the structure of many commodity markets, we consider a few large firms and a competitive fringe of many small suppliers choosing quantities in an infinite‐horizon setting subject to demand shocks. We show that a collusive agreement among the large firms may not only bring an output contraction but also an output expansion (relative to the non‐collusive output level). The latter occurs during booms and is due to the strategic substitutability of quantities. We also find that the time at which maximal collusion is most difficult to sustain can be either at booms or recessions. The international copper cartel of 1935–39 is used to illustrate some of our results.
Information Technology, Organizational Transformation and Productivity Growth: An Examination of the Brynjolfsson–Hitt Proposition
Authors: Yuhn Ky‐hyang , Park Seung R.
Published: March 2010

This study investigates what happened to productivity growth during the Information Technology (IT) revolution in an IT‐driven economy, Korea. To this end, we have decomposed the source of productivity growth into technological change, technical efficiency and scale economies using a stochastic frontier function and examined how the composition of productivity growth has changed with different phases of IT developments. We have used panel data that is comprised of 4022 firms from 1996 to 2000. We have found that Korean firms have been quick to embrace organizational restructuring to adapt to a new business environment brought about by IT, which seems to be the major source of the success of Korean firms. We have also found that: (i) there is no substantial difference in productivity gains between IT‐producing firms and IT‐using firms; (ii) productivity growth is more robust to business cycles in an IT‐driven economy than in the traditional economy; and (iii) efficiency improvement attributed to organizational transformation plays a greater role in productivity growth as IT applications become more widespread.
Linkages between Trade and Financial Integration and Output Growth in East Asia
Authors: Gochoco‐Bautista Maria Socorro , Mapa Dennis S.
Published: March 2010

The effects of trade, financial and other variables generally seen as indicative of the degree of economic integration on movements in industrial production growth among countries in East Asia are assessed using the common component of movements in industrial production growth in the ASEAN 5 + 3 countries as a business cycle benchmark for the region. The results show the dominance of trade‐related variables, as well as the world price of oil, in driving regional industrial production growth. Financial variables, while important, are not as robust.
A DEFENSE OF THE NECESSARY UNITY OF PHENOMENAL CONSCIOUSNESS
Authors: ALTER TORIN
Published: March 2010

Some argue that split‐brain cases undermine the thesis that phenomenal consciousness is necessarily unified. This paper defends the phenomenal unity thesis against Michael Tye's (2003) version of that argument. Two problems are identified. First, his argument relies on a questionable analysis of the split‐brain data. Second, his analysis leads to the view that in experimental situations split‐brain patients are not single subjects – a result that would render the analysis harmless to the phenomenal unity thesis.
FIRST‐PERSON BELIEF AND EMPIRICAL CERTAINTY
Authors: MARTENS DAVID B.
Published: March 2010

This is a critical exposition and limited defence of a theory of first‐person belief transiently held byRoderick Chisholmafter giving up the early haecceity theory ofPerson and Object(1976) and before adopting the late self‐attribution theory ofThe First Person(1981). I reconstruct that ‘middle’ theory as involving what I call a ‘hard‐core’ approach tode rebelief and I rebut objections concerning epistemic supervenience and abnormal consciousness. In my rebuttals, I sketch a variant of the middle theory according to which first‐person belief essentially involves the believer's introspective acquaintance with herself.
THE SUSTAINED IMPACTS OF TAXI DEREGULATION
Authors: Barrett Sean D.
Published: March 2010

The Irish High Court decision in 2000 to deregulate entry to the taxi sector brought a large increase in taxi numbers and reduced waiting times for customers. These developments were sustained through to 2008 with increased output and reduced waiting times. In view of these lasting successes, arguments that taxi deregulation is unwise and unsustainable are examined.
WHITHER CONSUMER PROTECTION IN FINANCIAL MARKETS? LESSONS FROM THE FINANCIAL CRISIS OF 1857
Authors: Koehler Benedikt
Published: March 2010

Consumer protection regulation has not prevented a collapse of trust in financial markets. Theories underlying regulatory intervention require review. In the financial crisis of 1857, firms rather than public authorities restored consumer confidence. Future regulatory regimes may permit greater scope for market‐based design of consumer protection measures.
THE ‘BROKEN WINDOWS’ THEORY AND THE NEW YORK EXPERIENCE RECONSIDERED
Authors: Fulda Joseph S.
Published: March 2010

The undeniable success of order‐maintenance policing (also community policing or broken windows policing) is despite the deficiency in the theory which propelled the practice into policy: Wilson and Kelling's broken windows theory. We discuss what is wrong with the theory and why it nevertheless works when put into practice.
The Dependency of the Banks' Assets and Liabilities: Evidence from Germany
Authors: Memmel Christoph , Schertler Andrea
Published: March 2010

Two decades of developments in risk‐transfer instruments may have fundamentally changed the extent to which banks practice on‐balance sheet term and liquidity transformation. These changes should be deliberated in on‐balance sheet asset‐liability dependencies. By using correlation analyses, we investigate asset‐liability dependency for all three sectors of German universal banks from 1994 to 2007 and find that it declined over our sample period. We also investigate whether asset‐liability dependency varies systematically with a bank's affinity for using risk‐transfer instruments, regulatory capital, and profitability and document several differences between the three sectors of German universal banks.
Natural Intellectual Property Rights and the Public Domain
Authors: Breakey Hugh
Published: March 2010

No natural rights theory justifies strong intellectual property rights. More specifically, no theory within the entire domain of natural rights thinking – encompassing classical liberalism, libertarianism and left‐libertarianism, in all their innumerable variants – coherently supports strengthening current intellectual property rights. Despite their many important differences, all these natural rights theories endorse some set of members of a common family of basic ethical precepts. These commitments include non‐interference, fairness, non‐worsening, consistency, universalisability, prior consent, self‐ownership, self‐governance, and the establishment of zones of autonomy. Such commitments have clear applications pertaining to the use and ownership of created ideas. I argue that each of these commitments require intellectual property rights to be substantially limited in scope, strength and duration. In this way the core mechanisms of natural rights thinking ensure a robust public domain and categorically rule out strong intellectual property rights.
Evaluating an assertive outreach team for supporting clients who present behaviour that challenges
Authors: McKenzie Karen , Paterson Marion
Published: March 2010

Accessible summary

 Some people with a learning disability have behaviours that are hard for services to cope with.

 This study looked at a team that tried to help these people to stay in their own homes instead of having to move to a different area.

 The study looked at the good things about the team and things that could be better.

 We found that the team helped the services to support people in a different way, so that there were fewer behaviours which were hard to manage.

This article evaluates an assertive outreach team which aimed to help support people with a learning disability who displayed challenging behaviour in their own environment. The service was evaluated using Maxwell’s Multi‐dimensional Quality Evaluation Model (Maxwell 1984), which recognises that different stakeholders in a service are likely to focus on different indices of quality including effectiveness, efficiency, economy, equity, access to services, appropriateness and social acceptability. The main strengths of the team were staff skills and professionalism, whereas the most frequently cited weaknesses centred around issues of liaison, communication and the role and remit of the team.
Metal complexation and ion association in hydrothermal fluids: insights from quantum chemistry and molecular dynamics
Authors: SHERMAN D. M.
Published: March 2010

Geofluids (2010) 10, 41–57

Complexation by ligands in hydrothermal brines is a fundamental step in the transport of metals in the Earth's crust and the formation of ore deposits. Thermodynamic models of mineral solubility require an understanding of metal complexation as a function of pressure, temperature and composition. Over the past 40 years, mineral solubilities and complexation equilibria under hydrothermal conditions have been predicted by extrapolating thermodynamic quantities using equations of state based on the Born model of solvation. However, advances in theoretical algorithms and computational facilities mean that we can now explore hydrothermal fluids at the molecular level. Molecular or atomistic models of hydrothermal fluids avoid the approximations of the Born model and are necessary for any reliable prediction of metal complexation. First principles (quantum mechanical) calculations based on density functional theory can be easily used to predict the structures and relative energies of metal complexes in the ideal gas phase. However, calculations of metal complexation in condensed fluids as a function of temperature and pressure require sampling the configuration degrees of freedom using molecular dynamics (MD). Simulations of dilute solutions require very large systems (thousands of atoms) and very long simulation times; such calculations are only practical by treating the interatomic interactions using classical two‐ or three‐body interatomic potentials. Although such calculations provide some fundamental insights into the nature of crustal fluids, simple two‐ or three‐body classical potentials appear to be inadequate for reliably predicting metal complexation, especially in covalent systems such as Sn2+, Au3+ and Cu+. Ab initio MD (i.e. where the bonding is treated quantum mechanically, but the molecular motions are treated classically) avoids the use of interatomic potentials. These calculations are practical for systems with hundreds of atoms over short times (<10 psec) but enable us to predict complexation as a function of pressure, temperature and composition. In this paper, I provide an introductory outline of the computational methods and illustrations of their application to NaCl brines and the complexation of Cu, Au, Sn and Zn.
Magmatic fluids immiscible with silicate melts: examples from inclusions in phenocrysts and glasses, and implications for magma evolution and metal transport
Authors: KAMENETSKY VADIM S. , KAMENETSKY MAYA B.
Published: March 2010

Geofluids (2010) 10, 293–311

The first occurrence of immiscibility in magmas appears to be most important in the magmatic–hydrothermal transition, and thus studies of magmatic immiscibility should be primarily directed towards recognition of coexisting silicate melt and essentially non‐silicate liquids and fluids (aqueous, carbonic and sulphide). However, immiscible phase separation during decompression, cooling and crystallization of magmas is an inherently fugitive phenomenon. The only remaining evidence of this process and the closest approximation of natural immiscible magmatic liquids and vapours can be provided by melt and fluid inclusions trapped in silicate glasses and magmatic phenocrysts. Such inclusions are often used as a natural experimental laboratory to model the process of exsolution and the compositions of volatile‐rich phases from a wide range of terrestrial magmas. In this paper several examples from recent research on melt and fluid inclusions are used to demonstrate the significance of naturally occurring immiscibility in understanding some large‐scale magma chamber processes, such as degassing and partitioning of metals.
Using seafloor heat flow as a tracer to map subseafloor fluid flow in the ocean crust
Authors: FISHER A. T. , HARRIS R. N.
Published: March 2010

Geofluids (2010) 10, 142–160

We describe how seafloor heat flow is determined, review current understanding of advective heat loss from oceanic lithosphere, and present results from three field areas to illustrate how heat flow measurements are used (along with complementary data) to resolve fluid flow rates and patterns. Conductive heat flow through much of the seafloor is lower than predicted by lithospheric cooling models as a result of hydrothermal circulation; this discrepancy is the basis for global estimates of the magnitude of advective cooling of oceanic lithosphere. Hydrothermal circulation also redistributes heat within the ocean crustal aquifer, leading to local variability. Heat flow studies in Middle Valley, a sedimented spreading center in the northeastern Pacific Ocean, indicate multiple scales of fluid circulation, delineate conditions at the top of a hydrothermal reservoir, and show the influence of primary and secondary convection. Heat flow studies on the eastern flank of the Juan de Fuca Ridge document the thermal influence of isolated basement outcrops surrounded by thick, low‐permeability sediments. Warm hydrothermal fluids seep from the crust through a small volcanic edifice, having flowed into the crust through a larger outcrop ∼50 km to the south. These fluids generate a local geothermal anomaly, but have little influence on regional heat loss from the plate. In contrast, heat flow surveys on part of the Cocos Plate, eastern Equatorial Pacific Ocean, indicate that regional conductive heat loss is just 10–40% of predictions from lithospheric cooling models. Basement outcrops in this area focus massive discharge of cool, hydrothermal fluid and associated heat (4–80 × 103 l s‐1 of fluid, 0.8–1.4 GW of heat). Seafloor heat flow studies will be increasingly important in coming years for understanding marine hydrogeologic regimes and the role of fluids in a variety of Earth processes and settings.
Securing the British State, Indian Surpluses and Agrarian Change in Eighteenth Century Scotland
Authors: BYRES TERENCE J.
Published: March 2010

This important book is structured around two issues. The first concerns the political role and extent of East India patronage in Scotland between 1720 and 1784. The second relates to the ‘fortunes’ amassed by those in receipt of such patronage, the amounts remitted to Scotland, and the use to which these remitted surpluses were put. With respect to the former, a substantive, original contribution is made in four respects: in demonstrating the significance of colonial posts in overall patronage in Scotland; in showing the heavily disproportionate favouring of Scots in this patronage; in revealing that this was substantial and growing from the 1720s (and did not start only in the 1780s or 1770s, as has been previously assumed); and in arguing convincingly that this East India patronage was important in securing the post‐1707 British state. This is a considerable achievement. While the first issue has an impressively substantive outcome, the second, no less important, set of questions, is argued presumptively: to the effect that large fortunes were made by Scots in India, significant amounts were remitted, and these were crucial in the dramatic economic advance in Scotland from the 1750s on, especially in the countryside. A plausible presumptive case is made, but this is not supported by convincing evidence. There is a need for research of the intensity that gave such impressive shape to the first set of issues, if the presumptive case is to be adequately substantiated. A brief agenda for the necessary research on agrarian change is suggested.
Estimating GFR in children with 99mTc‐DTPA renography: a comparison with single‐sample 51Cr‐EDTA clearance
Authors: Gutte Henrik , Møller Michael L. , Pfeifer Andreas K. , Thorup Jørgen , Borgwardt Line , Borgwardt Lise , Kristoffersen Ulrik S. , Kjær Andreas
Published: March 2010

Glomerular filtration rate (GFR) measurement by 51Cr‐ethylenediaminetetraacetic acid (EDTA) and blood sampling in children is usually cumbersome for the patient, parents and laboratory technicians. We have previously developed a method accurately estimating GFR in adults. The aim of the present study was to evaluate the accuracy of this non‐invasive method in children. We calculated GFR from 99mTc‐diethylene triamine pentaacetic acid (DTPA) renography and compared with 51Cr‐EDTA plasma clearance of 29 children between the age of 1 month and 12 years (mean 4·7 years). The correlation between 99mTc‐DTPA renography and 51Cr‐EDTA plasma clearance was for all children R = 0·96 (n = 29, P<0·0001), for children above 2 years of age R = 0·96 (n = 18, P<0·0001) and for children <2 years R = 0·84 (n = 11, P<0·001). We conclude that assessment of GFR from 99mTc‐DTPA renography is reliable and comparable to GFR calculated from 51Cr‐EDTA plasma clearance. Because our method is non‐invasive and only takes 21 min, it may be preferable in many cases where an assessment of renal function is needed in children especially when renography is performed anyhow.
Increased brain damage after ischaemic stroke in mice lacking the chemokine receptor CCR5
Authors: Sorce S , Bonnefont J , Julien S , Marq‐Lin N , Rodriguez I , Dubois‐Dauphin M , Krause KH
Published: March 2010

Background and purpose:  The chemokine receptor CCR5 is well known for its function in immune cells; however, it is also expressed in the brain, where its specific role remains to be elucidated. Because genetic factors may influence the risk of developing cerebral ischaemia or affect its clinical outcome, we have analysed the role of CCR5 in experimental stroke.

Experimental approach:  Permanent cerebral ischaemia was performed by occlusion of the middle cerebral artery in wild‐type and CCR5‐deficient mice. Locomotor behaviour, infarct size and histochemical alterations were analysed at different time points after occlusion.

Key results:  The cerebral vasculature was comparable in wild‐type and CCR5‐deficient mice. However, the size of the infarct and the motor deficits after occlusion were markedly increased in CCR5‐deficient mice as compared with wild type. No differences between wild‐type and CCR5‐deficient mice were elicited by occlusion with respect to the morphology and abundance of astrocytes and microglia. Seven days after occlusion the majority of CCR5‐deficient mice displayed neutrophil invasion in the infarct region, which was not observed in wild type. As compared with wild type, the infarct regions of CCR5‐deficient mice were characterized by increased neuronal death.

Conclusions and implications:  Lack of CCR5 increased the severity of brain injury following occlusion of the middle cerebral artery. This is of particular interest with respect to the relatively frequent occurrence of CCR5 deficiency in the human population (1–2% of the Caucasian population) and the advent of CCR5 inhibitors as novel drugs.
Effects of COX‐2 inhibition on spinal nociception: the role of endocannabinoids
Authors: Staniaszek LE , Norris LM , Kendall DA , Barrett DA , Chapman V
Published: March 2010

Background and purpose:  Recent studies suggest that the effects of cyclooxygenase‐2 (COX‐2) inhibition are mediated by cannabinoid receptor activation. However, some non‐steroidal anti‐inflammatory drugs inhibit the enzyme fatty acid amide hydrolase, which regulates levels of some endocannabinoids. Whether COX‐2 directly regulates levels of endocannabinoids in vivo is unclear. Here, the effect of the COX‐2 inhibitor nimesulide, which does not inhibit fatty acid amide hydrolase, on spinal nociceptive processing was determined. Effects of nimesulide on tissue levels of endocannabinoids and related compounds were measured and the role of cannabinoid 1 (CB1) receptors was determined.

Experimental approach:  Effects of spinal and peripheral administration of nimesulide (1–100 µg per 50 µL) on mechanically evoked responses of rat dorsal horn neurones were measured, and the contribution of the CB1 receptor was determined with the antagonist AM251 (N‐(piperidin‐1‐yl)‐5‐(‐4‐iodophenyl)‐1‐(2,4‐dichlorophenyl)‐4‐methyl‐1H‐pyrazole‐3‐carboxamide), in anaesthetized rats. Effects of nimesulide on spinal levels of endocannabinoids and related compounds were quantified using liquid chromatography‐tandem mass spectrometry.

Key results:  Spinal, but not peripheral, injection of nimesulide (1–100 µg per 50 µL) significantly reduced mechanically evoked responses of dorsal horn neurones. Inhibitory effects of spinal nimesulide were blocked by the CB1 receptor antagonist AM251 (1 µg per 50 µL), but spinal levels of endocannabinoids were not elevated. Indeed, both anandamide and N‐oleoylethanolamide (OEA) were significantly decreased by nimesulide.

Conclusions and implications:  Although the inhibitory effects of COX‐2 blockade on spinal neuronal responses by nimesulide were dependent on CB1 receptors, we did not detect a concomitant elevation in anandamide or 2‐AG. Further understanding of the complexities of endocannabinoid catabolism by multiple enzymes is essential to understand their contribution to COX‐2‐mediated analgesia.

This article is part of a themed issue on Cannabinoids. To view the editorial for this themed issue visit http://dx.doi.org/10.1111/j.1476‐5381.2010.00831.x
China’s Agricultural Policy Transition: Impacts of Recent Reforms and Future Scenarios
Authors: Yu Wusheng , Jensen Hans G.
Published: March 2010

This article reviews recent developments in China’s agricultural domestic support policy, especially the transition from taxing farmers and agriculture to providing direct subsidies to grain production and purchased inputs. A model‐based quantitative analysis on the effects of these policy changes is presented. Simulation results suggest that recent policy changes have achieved the declared policy goals of increasing grain production and boosting farm income. Much of the increase in grain production and farm income can be attributed to higher per unit return to arable land, land reallocation to grain production and extra agricultural employment triggered by the policy changes. Based on the assumption that China’s public assistance to agriculture and farmers will continue and rise, two hypothetical future scenarios are simulated. Using all the support permitted under WTO de minimis limits with existing instruments, China’s policy will increase grain production, change trade patterns seemingly contrary to China’s comparative advantage, increase rural employment and significantly increase farm income (by more than 12%). If, however, decoupled instruments are applied to raise China’s agricultural domestic support to the same level, China’s agricultural production and trade will remain unchanged, rural employment remain stable, but farm income will be increased by nearly 15%.
Relative Risk Aversion as an Arc Elasticity
Authors: Eisenhauer Joseph G.
Published: March 2010

Abstract

Risk aversion is the central reason why individuals purchase insurance and undertake other forms of risk management. But deriving the Pratt–Arrow coefficient of relative risk aversion from a utility function requires familiarity with differential calculus—a level of mathematics beyond the prerequisites for most introductory risk management courses. Thus, students are not exposed to one of the most important and fundamental concepts in the field unless and until they take more advanced courses. The present article demonstrates that relative risk aversion can be obtained as an arc elasticity using only elementary mathematics. This approach highlights the relationship between risk aversion and the demand for insurance, and integrates concepts from the principles of economics course, helping to unify the business curriculum. Numerical examples are easily computed and graphed using electronic spreadsheets, providing students with a hands‐on learning experience. For sufficiently small risks, the arc elasticity measure reduces to the Pratt–Arrow coefficient, providing a platform for discussing the difference between large‐scale and small‐scale risk aversion in upper‐level courses.
“Hands‐Free” Continuous Echocardiography during Treadmill Exercise Using a Novel Ultrasound Transducer
Authors: Chandraratna P.A.N. , Gajanayaka Ranil , Makkena Surendra M. , Wijegunaratne Kanishka , Hafeez Haroon , Vijayasekaran Sridhar , Ali Asghar
Published: March 2010

Background: Echocardiographic imaging using a handheld transducer in conjunction with treadmill exercise testing is commonly used for the diagnosis of coronary artery disease. Motion of the hand and the transducer during peak exercise preclude optimal imaging. To circumvent the limitations of handheld transducers, we developed a low profile transducer (CONTISON) which can be attached to the chest wall for continuous cardiac imaging. Methods and Results: This feasibility study was performed in 10 normal male subjects (28 to 36 years). The ultrasound transducer was placed in the third or fourth intercostal space at the left sternal border to permit imaging of the left ventricle in its short axis. The transducer was interfaced with a commercially available ultrasound machine. The left ventricle was imaged at rest and while subjects exercised according to a standard Bruce protocol. All segments of the left ventricular short axis were seen at rest and peak exercise. Increased left ventricular wall thickening and wall motion were seen at peak exercise. There were no complications from the procedure. Conclusion: We demonstrated the feasibility of hands‐free left ventricular imaging during treadmill exercise using the CONTISON transducer. Further evaluation of the technique to detect stress‐induced wall motion abnormalities, as a means of diagnosing myocardial ischemia, appears warranted. (ECHOCARDIOGRAPHY 2010;27:563‐566)
S100A8/A9: A Potential New Diagnostic Aid for Acute Appendicitis
Authors: Bealer John F. , Colgin Mark
Published: March 2010

Objectives:  Diagnosing acute appendicitis is a daunting clinical challenge, as there is no single test that reliably distinguishes acute appendicitis from other etiologies of acute abdominal pain. In this study, the authors examined whether circulating levels of S100A8/A9 could be useful as a marker to aid in the diagnosis of acute appendicitis.

Methods:  Plasma samples from emergency department (ED) patients with acute abdominal pain (n = 181) were tested using an immunoassay for S100A8/A9.

Results:  The sensitivity and specificity for S100A8/A9 in diagnosing acute appendicitis were estimated to be 93% (95% confidence interval [CI] = 81% to 97%) and 54% (95% CI = 45% to 62%), respectively. Negative predictive value (NPV) was 96% (95% CI = 89% to 99%), and positive predictive value (PPV) was 37% (95% CI = 28% to 47%). Performance characteristics of elevated white blood cell (WBC) count were also estimated: sensitivity 63% (95% CI = 47% to 76%), specificity 67% (95% CI = 59% to 75%), NPV 86% (95% CI = 78% to 91%), and PPV 36% (95% CI = 26% to 47%).

Conclusions:  This is the first report exploring the relationship between circulating S100A8/A9 and acute appendicitis and establishes proof of concept for this biomarker as a diagnostic test for acute appendicitis. Further studies are indicated to optimize the use of this biomarker, in conjunction with other established approaches.

ACADEMIC EMERGENCY MEDICINE 2010; 17:333–336 © 2010 by the Society for Academic Emergency Medicine
The Efficacy of Factor VIIa in Emergency Department Patients With Warfarin Use and Traumatic Intracranial Hemorrhage
Authors: Nishijima Daniel K. , Dager William E. , Schrot Rudolph J. , Holmes James F.
Published: March 2010

Objectives:  The objective was to compare outcomes in emergency department (ED) patients with preinjury warfarin use and traumatic intracranial hemorrhage (tICH) who did and did not receive recombinant activated factor VIIa (rFVIIa) for international normalized ratio (INR) reversal.

Methods:  This was a retrospective before‐and‐after study conducted at a Level 1 trauma center, with data from 1999 to 2009. Eligible patients had preinjury warfarin use and tICH on cranial computed tomography (CT) scan. Patients before (standard cohort) and after (rFVIIa cohort) implementation of a protocol for administering 1.2 mg of rFVIIa in the ED were reviewed. Glasgow Coma Scale (GCS) score, Revised Trauma Score (RTS), Injury Severity Score (ISS), INR, and Marshall score were collected. Outcome measures included mortality, thromboembolic complications, and INR normalization.

Results:  Forty patients (median age = 80.5 years, interquartile range [IQR] = 63.5–85) were included (20 in each cohort). Age, GCS score, ISS, RTS, initial INR, and Marshall score were similar (p > 0.05) between the two cohorts. Survival was identical between cohorts (13 of 20, or 65.0%, 95% confidence interval [CI] = 40.8% to 84.6%). There were no differences in rate of thromboembolic complications in the standard cohort (1 of 20, 5.0%, 95% CI = 0.1% to 24.9%) than the rFVIIa cohort (4 of 20, 20.0%, 95% CI = 5.7% to 43.7%; p = 0.34). Time to normal INR was earlier in the rFVIIa cohort (mean = 4.8 hours, 95% CI = 3.0 to 6.7 hours) than in the standard cohort (mean = 17.5 hours, 95% CI = 12.5 to 22.6; p < 0.001).

Conclusions:  In patients with preinjury warfarin and tICH, use of rFVIIa was associated with a decreased time to normal INR. However, no difference in mortality was identified. Use of rFVIIa in patients on warfarin and tICH requires further study to demonstrate important patient‐oriented outcomes.

ACADEMIC EMERGENCY MEDICINE 2010; 17:244–251 © 2010 by the Society for Academic Emergency Medicine
Accuracy of the Emergency Severity Index Triage Instrument for Identifying Elder Emergency Department Patients Receiving an Immediate Life‐saving Intervention
Authors: Platts‐Mills Timothy F. , Travers Debbie , Biese Kevin , McCall Brenda , Kizer Steve , LaMantia Michael , Busby‐Whitehead Jan , Cairns Charles B.
Published: March 2010

Objectives:  The study objective was to determine the sensitivity and specificity of the Emergency Severity Index (ESI) triage instrument for the identification of elder patients receiving an immediate life‐saving intervention in the emergency department (ED).

Methods:  The authors reviewed medical records for consecutive patients 65 years or older who presented to a single academic ED serving a large community of elders during a 1‐month period. ESI triage scores were compared to actual ED course with attention to the occurrence of an immediate life‐saving intervention. The sensitivity and specificity of an ESI triage level of 1 for the identification of patients receiving an immediate intervention was calculated. For 50 cases, the triage nurse ESI designation was compared to the triage level determined by an expert triage nurse based on retrospective record review.

Results:  Of 782 consecutive patients 65 years or older who presented to the ED, 18 (2%) had an ESI level of 1, 176 (23%) had an ESI level of 2, 461 (60%) had an ESI level of 3, 100 (13%) had an ESI level of 4, and 18 (2%) had an ESI level of 5. Twenty‐six patients received an immediate life‐saving intervention. ESI triage scores for these 26 individuals were as follows: ESI 1, 11 patients; ESI 2, nine patients; and ESI 3, six patients. The sensitivity of ESI to identify patients receiving an immediate intervention was 42.3% (95% confidence interval [CI] = 23.3% to 61.3%); the specificity was 99.2% (95% CI = 98.0% to 99.7%). For 17 of 50 cases in which actual triage nurse and expert nurse ESI levels disagreed, undertriage by the triage nurses was more common than overtriage (13 vs. 4 patients).

Conclusions:  The ESI triage instrument identified fewer than half of elder patients receiving an immediate life‐saving intervention. Failure to follow established ESI guidelines in the triage of elder patients may contribute to apparent undertriage.

ACADEMIC EMERGENCY MEDICINE 2010; 17:238–243 © 2010 by the Society for Academic Emergency Medicine
Emergency Department Lactate Is Associated with Mortality in Older Adults Admitted With and Without Infections
Authors: Del Portal Daniel A. , Shofer Frances , Mikkelsen Mark E. , Dorsey Jr. Philip J. , Gaieski David F. , Goyal Munish , Synnestvedt Marie , Weiner Mark G. , Pines Jesse M.
Published: March 2010

Objectives:  Serum lactate values in the emergency department (ED) have been associated with mortality in diverse populations of critically ill patients. This study investigates whether serum lactate values measured in the ED are associated with mortality in older patients admitted to the hospital, both with and without infections.

Methods:  This is a retrospective cohort study performed at two urban teaching hospitals. The study population includes 1,655 older ED patients (age ≥ 65 years) over a 3‐year period (2004–2006) who had serum lactate measured prior to admission. The presence or absence of infection was determined by review of International Classification of Diseases Ninth Revision (ICD‐9) admission diagnosis codes. Mortality during hospitalization was determined by review of inpatient records. Mortality at 30 and at 60 days was determined using a state death registry.

Results:  In patients with infections, increasing serum lactate values of ≥2.0 mmol/L were linearly associated with relative risk (RR) of mortality during hospitalization (RR = 1.9 to 3.6 with increasing lactate), at 30 days (RR = 1.7 to 2.6), and at 60 days (RR = 1.4 to 2.3) when compared to patients with serum lactate levels of <2.0 mmol/L. In patients without infections, a similar association was observed (RR = 1.1 to 3.9 during hospitalization, RR = 1.2 to 2.6 at 30 days, RR = 1.1 to 2.4 at 60 days). In both groups of patients, serum lactate had a greater magnitude of association with mortality than either of two other commonly ordered laboratory tests, leukocyte count and serum creatinine.

Conclusions:  Higher ED lactate values are associated with greater mortality in a broad cohort of admitted patients over age 65 years, regardless of the presence or absence of infection.

ACADEMIC EMERGENCY MEDICINE 2010; 17:260–268 © 2010 by the Society for Academic Emergency Medicine
Oral complaints and stimulated salivary flow rate in 1188 adults
Authors: Toida Makoto , Nanya Yuki , Takeda‐Kawaguchi Tomoko , Baba Seiji , Iida Kazuki , Kato Keizo , Hatakeyama Daijiro , Makita Hiroki , Yamashita Tomomi , Shibata Toshiyuki
Published: March 2010

J Oral Pathol Med (2010) 39: 407–419

Background:  Recently, oral sensory complaints (OSC) were proposed as a disease entity to represent idiopathic sensory disturbances of dry mouth, burning mouth, and taste disturbance, even though neither the status of OSC in the general population nor its underlying mechanism has yet been elucidated. Moreover, these three OSC‐related complaints have not been assessed in combination by means of a visual analog scale (VAS) in a large‐scale, community‐dwelling population of a broad age range.

Methods:  In a 1188‐member community‐dwelling adult population, comprised of 373 males and 815 females, aged 20–90 years, the three OSC‐related complaints and stimulated salivary flow rate (SSFR) were assessed by means of a VAS and modified Saxon test, respectively. Association of each complaint with age, gender, SSFR, and other complaints was analyzed.

Results:  Increases in both prevalence and intensity of subjective dry mouth and burning mouth were associated closely with decreasing SSFR. Even for taste disturbance, which may be affected less significantly by salivation status than the other two complaints, a significant association was suggested between decreasing SSFR and especially severe taste disturbance. However, these oral complaints were found in considerable prevalence even in the individuals with high SSFR. Often overlapping presentation of these complaints and a close association in intensity between the complaints to each other were also found.

Conclusions:  Hyposalivation may be a significant and common etiology for the three oral complaints, although the considerable prevalence of complaints without hyposalivation suggests other etiologies, including those related to the OSC.