bluuebunny/crossref_metadata_2025 huggingface dataset:
Boundless Biofuels? Between Environmental Sustainability and Vulnerability
Authors: Mol Arthur P. J.
Published: October 2007

Biofuels currently appear to be one of the major controversies in the agriculture/environment nexus, not unlike genetically modified organisms. While some countries (such as Brazil) have for quite some time supported successful large‐scale programmes to improve the production and consumption of biofuels, policy‐makers and research institutions in most developed and developing countries have only recently turned their attention to biofuels. Threat of climate change, new markets for agricultural output, reduced dependencies on OPEC countries and high fossil fuel prices are driving this development. But opposition to biofuels is growing, pointing at the various vulnerabilities – not in the least for developing countries – that come along with large‐scale ‘energy’ plantations. Against this background this article analyses the sustainability and vulnerability of biofuels, from the perspective of a sociology of networks and flows. Current biofuel developments should be understood in terms of the emergence of a global integrated biofuel network, where environmental sustainabilities are more easily accommodated than vulnerabilities for marginal and peripheral groups and countries, irrespective of what policy‐makers and biofuel advocates tell us.
Overconfidence and Investor Size
Authors: Ekholm Anders , Pasternack Daniel
Published: October 2007

Recent research documents that institutional or large investors act as antagonists to other investors by showing opposite trading behaviour following the disclosure of new information. Using an extremely comprehensive official transactions data set from Finland, we set out to explore the interrelation between investor size and behaviour. More specifically, we test whether investor size is positively (negatively) correlated with investor reaction following positive (negative) news. We document robust evidence of that investor size affects investor behaviour under new information, as larger investors on average react more positively (negatively) to good (bad) news than smaller investors. We furthermore find that the performance of smaller, or more overconfident, investors is in general hurt by their behaviour.
Minority Protection and Dividend Policy in Finland
Authors: Kinkki Seppo
Published: October 2007

This paper highlights some theoretical arguments and empirical results on whether legal‐based minority protection affects corporate cash dividends in Finland. The Company Act in Finland states that shareholders having one tenth of all shares can demand a so‐called minority dividend, which is half of the profit of the fiscal year, yet not more than 8% of the equity. Minority dividend, as in Finland, is rarely used in EU countries. I find, that minority protection is a better influence over managerial control than controlling shareholders having absolute voting power. When there is no controlling shareholder and coalition costs are lowest, minority protection in Finland is better than minority protection in mandatory dividend countries. Combining strong shareholder rights (as in the USA) and minority dividend (as in Finland) could decrease agency costs both vertically and horizontally.
Dispersed Trading and the Prevention of Market Failure: the Case of the Copenhagen Stock Exchange
Authors: Porter David C. , Tanggaard Carsten , Weaver Daniel G. , Yu Wei
Published: October 2007

With augmented demands on power grids resulting in longer and larger blackouts combined with heightened concerns of terrorist attacks, trading institutions and policy makers have widened their search for systems that avoid market failure during these disturbing events. We provide insight into this issue by examining trading behaviour at the Copenhagen Stock Exchange during a major blackout. We find that although market quality declined, markets remained functional and some price discovery occurred during the blackout period suggesting that the NOREX structure of interlinked trading systems combined with widely dispersed trading locations may be a viable means of protection against market failure during massive power disruptions or terrorist attacks.
Behavioural Finance: A Review and Synthesis
Authors: Subrahmanyam Avanidhar
Published: October 2007

I provide a synthesis of the Behavioural finance literature over the past two decades. I review the literature in three parts, namely, (i) empirical and theoretical analyses of patterns in the cross‐section of average stock returns, (ii) studies on trading activity, and (iii) research in corporate finance. Behavioural finance is an exciting new field because it presents a number of normative implications for both individual investors and CEOs. The papers reviewed here allow us to learn more about these specific implications.
Investigating Web‐Based Recruitment Sources: Employee testimonials vs word‐of‐mouse
Authors: Van Hoye Greet , Lievens Filip
Published: October 2007

Although the internet has dramatically changed recruitment practices, many web‐based recruitment sources have not yet been investigated. The present study examines the effects of web‐based employee testimonials and web‐based word‐of‐mouth (i.e., ‘word‐of‐mouse’) on organizational attraction. The source credibility framework is used to compare these company‐dependent and company‐independent recruitment sources. In a sample of potential applicants for a head nurse position, word‐of‐mouse was associated with higher organizational attractiveness than web‐based employee testimonials. However, potential applicants were more attracted when testimonials provided information about individual employees than about the organization. Conversely, word‐of‐mouse was associated with higher organizational attractiveness and more organizational pursuit behavior when it focused on the organization instead of on employees. Most of these effects were mediated by credibility perceptions.
Applicant Attraction: The role of recruiter function, work–life balance policies and career salience
Authors: Carless Sally A. , Wintle Josephine
Published: October 2007

This study examined the impact of salient identity, career path and recruiter functional area [internal human resource (HR) personnel vs external recruitment company] on perceptions of organizational attraction with a sample of young, inexperienced job seekers. Two hundred and one participants responded to a questionnaire and rated their attraction to two different job advertisements. The results partially supported the first hypothesis; applicants perceived a job opportunity in an organization that offered either a flexible career path or a dual career path as significantly more attractive than a position in an organization that offered a traditional career path. There was no support for the second hypothesis that identity salience would interact with career path. The results showed that recruiter functional area had no impact on attraction to the organization. It was concluded that flexible HR policies increase applicants' perceptions of organizational attraction during the initial stages of the recruitment process. Practical and research applications are discussed.
Creating Alternate In‐Basket Forms Through Cloning: Some preliminary results
Authors: Lievens Filip , Anseel Frederik
Published: October 2007

Research on constructing alternate forms of assessment center exercises is very scarce. This study examines the effectiveness of a cloning procedure (incident isomorphic approach) for developing alternate forms of a computerized in‐basket. In this approach, original and alternate items are essentially similar (they are based on the same critical incident), while being superficially different (they are situated in a different context). Results showed there was no significant difference between the overall in‐basket score across the alternate forms. In addition, these overall scores correlated .66, with projected estimates for the full in‐basket approaching .80. Implications and limitations of the use of cloning in designing alternate assessment center exercises are discussed.
Planning for Success: A Scenariobased Approach to Contingency Planning Using Expert Judgment
Authors: Harrald John R. , Mazzuchi Thomas
Published: October 2007

This paper proposes an innovative alternative approach to contingency planning using the techniques of gaming, decision analysis and risk analysis. A hindcasting scenario exercise conducted with over 60 oil spill experts is described. The exercise identifies the critical success factors that must be achieved and the problems that must be resolved in order to accomplish a successful oil spill response. The experts' ratings of the relative criticality and difficulty in achieving the critical success factors and solving the critical problems are presented and discussed. The use of influence‐diagramming techniques to structure the results of the hindcasting exercise is described. Experts may use this model to assess the response readiness of their area of responsibility, to identify critical problems or to assess the status of an emergency response.
Geographic Information System Applications in Emergency Management
Authors: Newsom Donald E. , Mitrani Jacques E.
Published: October 2007

One of the most useful and readily available technologies to aid emergency managers is the geographic information system (GIS). Many applications discussed in the GIS literature indicate the potential usefulness of GISs in emergency management. This paper will discuss two instances in which the authors used a GIS, in combination with simulation models, to address emergency preparedness concerns.1 A sampling, though not an exhaustive survey, of other GIS applications in emergency management will also be presented.
Simulation of the Effectiveness of Protection and Assistance for Victims of Armed Conflict (Sepavac): An Example from Mali, West Africa
Authors: Benini Aldo A.
Published: October 2007

Taking as a point of departure the philosopher Karl Popper's (1974) well‐known dictum that it was better to let scientific hypotheses die rather than human beings, this paper investigates a case of humanitarian action by means of computer simulation. It looks at a segment of the programme that the International Committee of the Red Cross (ICRC) has been carrying out, since 1991, for the benefit of victims of low‐intensity warfare in Mali, West Africa. Scenarios with different arrangements between protection and assistance activities are examined in a formal model using a discrete‐event generator simulating the occurrence of violent abuses against the civilian population. The various mixes of protection and assistance are compared for their relative effectiveness in helping reduce the violence. Protection and assistance achieve that by dampening violence‐ and famine‐related tensions. The link between humanitarian activity and conflict behaviour is made through the different social clockworks that regulate retaliation against the opposing ethnic group as well as famine pressures.

Tentative results of a small number of simulation runs point to surprising aspects of humanitarian effectiveness in the Malian setting. For example, delays in fielding the relief are shown to have less disastrous effects than one would fear by un‐aided reasoning. However, short‐time food assistance (to reverse a famine build‐up) may be less effective than traditionally believed even if after the end of distribution the delegates enhance their protection activities.

Computer simulation is new for most humanitarian agencies. At this stage of early introduction, the emphasis should be less on programming sophistication than on changing the organizational culture for greater use of scenarios with explicit assumptions about the world in which humanitarian strategies are to work. Computer simulation may be welcomed as a means of scientifically improving methods to help save more victims of war.
Smart Spatial Information Systems: Extending Geographic Information Systems in the Space Age
Authors: Jarman Alan M.G.
Published: October 2007

The use of geographic information systems (GISs) in local, regional and state governments is increasing, now at a rapid rate, with regard to conventional applications. However, the requirements of emergency management are not usually included within the design and original phases of GIS's acquisition. The author believes that it is both necessary and technically possible to define emergency‐related applications into specifications. With regard to ‘creeping crises’, this is a matter of urgency, so that hazard index analysis should be conducted at the onset of systems' design. The role of a range of existing and future space technologies is also considered in the context of enhancing existing GISs, especially with regard to remote sensing applications.
A nose that roars: anatomical specializations and behavioural features of rutting male saiga
Authors: Frey Roland , Volodin Ilya , Volodina Elena
Published: October 2007

The involvement of the unique saiga nose in vocal production has been neglected so far. Rutting male saigas produce loud nasal roars. Prior to roaring, they tense and extend their noses in a highly stereotypic manner. This change of nose configuration includes dorsal folding and convex curving of the nasal vestibulum and is maintained until the roar ends. Red and fallow deer males that orally roar achieve a temporary increase of vocal tract length (vtl) by larynx retraction. Saiga males attain a similar effect by pulling their flexible nasal vestibulum rostrally, allowing for a temporary elongation of the nasal vocal tract by about 20%. Decrease of formant frequencies and formant dispersion, as acoustic effects of an increase of vtl, are assumed to convey important information on the quality of a dominant male to conspecifics, e.g. on body size and fighting ability. Nasal roaring in saiga may equally serve to deter rival males and to attract females. Anatomical constraints might have set a limit to the rostral pulling of the nasal vestibulum. It seems likely that the sexual dimorphism of the saiga nose was induced by sexual selection. Adult males of many mammalian species, after sniffing or licking female urine or genital secretions, raise their head and strongly retract their upper lip and small nasal vestibulum while inhalating orally. This flehmen behaviour is assumed to promote transport of non‐volatile substances via the incisive ducts into the vomeronasal organs for pheromone detection. The flehmen aspect in saiga involves the extensive flexible walls of the greatly enlarged nasal vestibulum and is characterized by a distinctly concave configuration of the nose region, the reverse of that observed in nasal roaring. A step‐by‐step model for the gradual evolution of the saiga nose is presented here.
Dynamic social system in Nubian ibex: can a second mating season develop in response to arid climate?
Authors: Massolo A. , Spalton J. A. , Tear T. H. , Lawrence M. W. , Said al Harsusi L. , Lovari S.
Published: October 2007

We studied a population of Nubian ibex Capra ibex nubiana in the eastern extreme of its range, the hyper‐arid central desert of the Sultanate of Oman. Long‐term data were collected from January 1983 to December 1997 by direct observation, as well as VHF telemetry on 12 animals (eight from 1987 to 1990; four from 1994 to 1996). We recorded 884 sightings: 40.4% of single animals and 59.6% of groups. Although no significant monthly variation of group size (Jarman's Typical Group Size) was found, there were distinct peaks in March (4.0 ind. group−1) and September (5.1 ind. group−1). Groups of males and females formed especially in March and November, and female–kid groups in February and July–August. Our data may suggest two mating periods: the first one in autumn (similar to the rut of ibex in temperate mountain areas), with kids born in spring/early summer, after winter–spring rainfall, and the second one in spring, with kids born in late summer/autumn, before winter–spring rainfalls. We suggest that the second rutting period may have evolved as a micro‐evolutionary process, with the local population adapting to hyper‐arid environment constraints. The spring mating season may favour only females in prime conditions, who can afford a pregnancy in the local severe summers and will deliver kids when plant greening begins, in the autumn, whereas the autumn (original) mating season may be afforded by any female, but kids will be born in an unfavourable period, before the summer drought.
Breeding strategies of Antarctic PetrelsThalassoica antarcticaand Southern FulmarsFulmarus glacialoidesin the high Antarctic and implications for reproductive success
Authors: CREUWELS JEROEN C. S. , VAN FRANEKER JAN A. , DOUST SUSAN J. , BEINSSEN ANNA , HARDING BELINDA , HENTSCHEL OLIVER
Published: October 2007

Breeding strategies of two closely related fulmarine petrels were studied on Ardery Island, on the continental coast of East Antarctica, where short summers are expected to narrow the time‐window for reproduction. Both species had a similar breeding period (97 days from laying to fledging) but Antarctic PetrelsThalassoica antarcticabred up to 16 days earlier than Southern Fulmars. During the pre‐laying exodus, all Antarctic Petrels deserted the colony, whereas some Southern FulmarsFulmarus glacialoidesremained. Antarctic Petrels exhibited stronger synchronization in breeding, made longer foraging trips and spent less time guarding their chicks than Southern Fulmars. Overall breeding success of both species was similar but failures of Antarctic Petrels were concentrated in the early egg‐phase and after hatching, when parents ceased guarding. Southern Fulmars lost eggs and chicks later in the breeding cycle and so wasted more parental investment in failed breeding attempts. Different breeding strategies may be imposed by flight characteristics; Southern Fulmars are less capable of crossing large expanses of pack ice and need to delay breeding until the sea ice retreats and breaks up. However, due to the short summer they risk chick failure when weather conditions deteriorate late in the season.
An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unit
Authors: McFetridge Brian , Gillespie Mark , Goode Deborah , Melby Vidar
Published: October 2007

The transfer of information between nurses from emergency departments (EDs) and critical care units is essential to achieve a continuity of effective, individualized and safe patient care. There has been much written in the nursing literature pertaining to the function and process of patient handover in general nursing practice; however, no studies were found pertaining to this handover process between nurses in the ED environment and those in the critical care environment. The aim was to explore the process of patient handover between ED and intensive care unit (ICU) nurses when transferring a patient from ED to the ICU. This study used a multi‐method design that combined documentation review, semistructured individual interviews and focus group interviews. A multi‐method approach combining individual interviews, focus group interviews and documentation review was used in this study. The respondents were selected from the ED and ICU of two acute hospitals within Northern Ireland. A total of 12 respondents were selected for individual interviews, three nurses from ED and ICU, respectively, from each acute hospital. Two focus groups interviews were carried out, each consisting of four ED and four ICU nurses, respectively. Qualitative analysis of the data revealed that there was no structured and consistent approach to how handovers actually occurred. Nurses from both ED and ICU lacked clarity as to when the actual handover process began. Nurses from both settings recognized the importance of the information given and received during handover and deemed it to have an important role in influencing quality and continuity of care. Nurses from both departments would benefit from a structured framework or aide memoir to guide the handover process. Collaborative work between the nursing teams in both departments would further enhance understanding of each others’ roles and expectations.
Commentary: Kause J et al. (2004). A comparison of antecedents to cardiac arrest, deaths and emergency intensive care admissions in Australia and ANZ, and the UK – the ACADEMIA study
Authors: Crocker Cheryl
Published: October 2007

Many patients have physiological deterioration prior to cardiac arrest, death and intensive care unit (ICU) admission that are detected and documented by medical and nursing staff. Appropriate early response to detected deterioration is likely to benefit patients. In a multi‐centre, prospective, observational study over three consecutive days, we studied the incidence of antecedents (serious physiological abnormalities) preceding primary events (defined as in‐hospital deaths, cardiac arrests and unanticipated ICU admissions) in 90 hospitals [69 UK, 19 Australia and two New Zealand (ANZ)]. Sixty‐eight hospitals reported primary events during the 3‐day study period (50 UK, 16 Australia and two ANZ). Data on the availability of ICU/high‐dependency unit (HDU) beds and cardiac arrest teams and medical emergency teams (METs) were also collected. Of 638 primary events, there were 308 (48.3%) deaths, 141 (22.1%) cardiac arrests and 189 (29.6%) unplanned ICU admissions. There were differences in the pattern of primary events between the UK and ANZ (P < 0.001). There were proportionally more deaths in the UK (52.3% versus 35.3%) and a higher number of unplanned ICU admissions in ANZ (47.3% versus 24.2%). Sixty per cent (383) of primary events had a total of 1032 documented antecedents. The most common antecedents were hypotension and a fall in Glasgow Coma Scale. The proportion of ICU/HDU to general hospital beds was greater in ANZ (0.034 versus 0.016, P < 0.001) and METs were more common in ANZ (70.0% versus 27.5%, P = 0.001). The data confirm antecedents are common before death, cardiac arrest and unanticipated ICU admission. The study also shows differences in patterns of primary events, the provision of ICU/HDU beds and resuscitation teams, between the UK and ANZ. Future research, focusing upon the relationship between service provision and the pattern of primary events, is suggested.

This abstract was published in Resuscitation, volume 62, Kause J et al., ‘A comparison of antecedents to cardiac arrest, deaths and emergency intensive care admissions in Australia and ANZ, and the UK – the ACADEMIA study.’, pages 275–282. Copyright Elsevier 2004.
MUSCLE CRAMPS: I
Authors: Rutecki Gregory W. , Whittier Frederick C.
Published: October 2007

A 52‐year‐old white male presented for evaluation of moderate azotemia (blood urea nitrogen [BUN] 52 mg/dl and creatinine 5.4 mg/dl). Renal history was positive for hypertension (156/100), nocturia, and polyuria. There was a 10‐year history of an idiopathic seizure disorder. Medications were phenytoin 100 po tid and diltiazem 240 mg sustained release bid. An S4 and 1+peripheral edema were the only positive physical findings. Postural blood pressure changes were absent.

Laboratory findings included a urinalysis with 2+protein, finely granular casts, and 5–10 WBCs/ HPF. Twenty‐four hour urine protein was 1.1 g/24 h. Renal ultrasound: 9.2 cm left, 8.9 cm right kidney, and left renal biopsy demonstrated chronic interstitial nephritis. Other potential causes for interstitial injury were ruled out and phenytoin was discontinued. Prevention of seizures was obtained with phenobarbital.

A few months later, the patient complained of excruciating nocturnal cramps in both gastrocnemius, occurring four to five times per night and necessitating hot baths and passive stretching of the calf muscles for temporary relief. Muscle exam was normal; neurologic exam revealed symmetric sensory and motor neuropathy consistent with renal failure. Thyroid function, magnesium, sodium, and calcium concentrations were normal. The patient was treated with vitamin E 400 IU/day with a decreased frequency and severity of cramps. Azotemia progressed to dialysis dependence (continuous ambulatory peritoneal dialysis [CAPD]). His cramp frequency and intensity on CAPD has waxed and waned. His dry weight has been frequently reassessed and increased as necessary. He has continued vitamin E with periodic use of verapamil or quinine, in addition, for cramp relief.
ACCESS RECIRCULATION
Authors: Sherman Richard A.
Published: October 2007

A 72‐year‐old white female with end‐stage renal disease (ESRD) secondary to chronic glomerulonephritis has been on chronic hemodialysis for the past one and a half years. She has a history of congestive heart failure which has not been symptomatic since she began dialysis. She weighs 47 kg (103.4 lbs) and receives 3 hr of “conventional” hemodialysis with a blood flow rate of 350 ml/min which is well tolerated. Treatments are provided using a left upper arm polytetraflourethylene (PTFE) graft. Monthly percentage reduction in urea (PRU) values have been approximately 65%. However, her most recent PRU was 57% (predialysis blood urea nitrogen (BUN) 82 mg/dl, postdialysis BUN 35 mg/dl). Since her treatment parameters had not been changed, recirculation studies were obtained. The BUN values were: peripheral vein (P)—58 mg/dl, arterial line (A)—48 mg/dl, venous line (V)—23 mg/dl. Calculated recirculation was 29% ([P ‐ A]/[P ‐ V], 158 ‐ 48]/[58 ‐ 23]). The high level of recirculation prompted radiologic evaluation of the access. A fistulogram, including views of arterial inflow and central veins, showed no stenotic lesions. Needle placement was reviewed and found to be satisfactory. Repeat recirculation studies yielded similar results.
REFRACTORY CHF AND MODEST RENAL FAILURE: I
Authors: Latos Derrick L.
Published: October 2007

A 56‐year‐old white male had longstanding insulin‐requiring diabetes mellitus and diffuse vascular disease. At age 50, he underwent coronary artery bypass grafting and placement of a permanent cardiac pacemaker. Four years later, he required bilateral above‐knee amputations for severe peripheral arterial disease. Over the next two years, he was hospitalized fifteen times for angina pectoris and congestive heart failure (CHF).

In September 1990, six years following his cardiac surgery, Swan‐Ganz catheter data confirmed low cardiac performance. He required dopamine, dobutamine, angiotensin‐converting enzyme inhibitors, and high dose parenteral diuretics. Blood urea nitrogen (BUN) was 30 mg/dl, serum creatinine was 1.8 mg/dl, serum albumin was 3.9 g/dl and total serum protein was 7.1 g/dl. Fractional urinary sodium excretion was 0.36. Endogenous creatinine clearance was 20 ml/min. Urine protein excretion was 640 mg/day. Anasarca was attributed to CHF, and renal insufficiency was felt to be due to a combination of nephrosclerosis and low renal perfusion. Conservative management proved futile with development of worsening edema, progressive azotemia, and hyponatremia. At the time of nephrologic consultation, BUN was 159 mg/dl, serum creatinine was 4.5 mg/dl and serum sodium was 114 mEq/l. Pulmonary capillary wedge pressure was 22 mmHg and chest X ray confirmed the presence of large bilateral pleural effusions. Blood pressure had remained surprisingly normal at 126/70 mmHg.

A Tenckhoff peritoneal dialysis catheter was placed and peritoneal dialysis begun using 1 l volume exchanges. Over the next several days, dialysis fluid volume was increased to 2 l, with dwell time and dextrose concentration being adjusted to allow for gradual fluid loss. Dialysis was continued on a daily basis for two weeks with a 40 pound weight loss and total resolution of CHF. He was discharged home, but required intermittent peritoneal dialysis over the next six weeks.

He was trained to perform peritoneal dialysis using the technique of continuous ambulatory peritoneal dialysis (CAPD). His regimen consisted of 4 two‐liter exchanges daily with variable use of 1.5% and 4.25% dextrose‐containing solutions and intraperitoneal insulin. Over the ensuing months he required only 24 days of hospitalization. He regained use of his lower extremity prostheses and was able to drive his truck. He had no episodes of peritonitis, but required short‐term oral antibiotics for peritoneal catheter exit‐site infection. He expired of acute myocardial infarction after 14 months of CAPD.
SEIZURES: II
Authors: Bleyer Anthony J. , Burkart John M.
Published: October 2007

A 55‐year‐old African‐American hemodialysis patient presented to the emergency room with complaints of nausea and vomiting. The patient had been on hemodialysis for two years secondary to diabetic nephropathy. Her baseline blood pressure was approximately 120/70 mm Hg on no antihypertensive medications. Five months previously, she was started on erythropoietin, 2000 units subcutaneously twice weekly, at which time her hematocrit was 23%. Her erythropoietin dose was gradually increased to 3500 units subcutaneously thrice weekly two months prior to admission. With this dosage, her hematocrit increased to 31%. Several weeks prior to admission, the patient's calcium carbonate was increased to correct a rising serum phosphate. In the emergency room her physical examination was remarkable for a blood pressure of 196/94 mm Hg. Funduscopic examination showed changes consistent with diabetic retinopathy but no evidence of papilledema or hemorrhages. Neurologic examination was nonfocal. An electrolyte panel revealed a serum sodium of 139 mEq/1, potassium 4.8 mEq/l, chloride 98 mEq/l, total CO2 29 mEq/l, blood urea nitrogen (BUN) 50 mg/dl, creatinine 11.4 mg/dl, glucose 125 mg/dl, calcium 13.6 mg/dl, phosphate 5.7 mg/dl, and albumin 4.2 mg/dl.

While in the emergency room, the patient sustained a generalized tonic‐clonic seizure. Seizure activity ceased with the administration of diazepam 5 mg intravenously. Electrolytes were repeated immediately after the seizure, with sodium 137 mEq/l, potassium 4.6 mEq/l, chloride 98 mEq/l, and total CO2 17 mEq/l. Three hours later, electrolytes were again repeated, showing a sodium of 133 mEq/l, potassium 6.0 mEq/l, chloride 100 mEq/l, and total CO2 26 mEq/l. She was admitted for further evaluation. Phenytoin was begun at 100 mg po tid, and the patient had no further seizures. Without intervention, her blood pressure decreased to 114/70, which was stable over the next several days. Head computerized axial tomographic (CAT) scan, lumbar puncture, and electroencephalogram (EEG) were all unremarkable. The intact PTH level returned at less than 15 pg/ml, and the aluminum level was 14 mcg/ml. Hypercalcemia was treated with intravenous etidronate followed by adjusting the patient's calcium carbonate regimen. Over the next several months, phenytoin was withdrawn, and erythropoietin reintroduced. The patient has remained seizure‐free and normocalcemic over the following twelve months.
HEALTH SCREENING: I
Authors: Mahmood Khalid , Rasgon Scott , Yeoh Hock H.
Published: October 2007

L. G. is a 37‐year‐old black female, first seen in the Nephrology Clinic in May 1987 with a serum creatinine of 3.7 mg/dl. Ultrasound studies revealed bilaterally contracted kidneys. Over the next 18 months, the patient's renal function continued to deteriorate and she was started on hemodialysis. She stayed on hemodialysis for about one year but finally changed to continuous ambulatory peritoneal dialysis (CAPD) because of multiple vascular access problems. Over the next two and a half years the patient did well on CAPD. Then on a routine breast self‐examination, she discovered a firm, approximately 1.5 cm mass below the right nipple. A mammogram was done which revealed the lesion to be suspicious for malignancy. Biopsy of the lesion revealed a poorly differentiated mammary carcinoma. The patient subsequently underwent a right mastectomy without complication.

Past medical history includes cholecystectomy which was done about seven years previously, and an abnormal Tiberoxime Stress Test, but a normal coronary angiogram done as part of her renal transplant evaluation. About four years ago, the patient complained of swelling in the right breast. She was seen by a surgeon and had a mammogram performed which was normal. She had a follow‐up mammogram in 1991 which was again normal.
HEALTH SCREENING: II
Authors: Windus David W. , Delmez James A.
Published: October 2007

A 77‐year‐old black female began in‐center hemodialysis in early 1992 because of hypertensive nephrosclerosis. Her past medical history was significant only for a pericardial window done in 1990 because of pericarditis of unknown etiology. Cultures of the pericardial sac and fluid were negative for bacteria and tuberculosis (TB). There was no history of exposure to TB‐ She was anergic to both purified protein derivative (PPD) and Candida skin tests. The patient tolerated dialysis well and gained 2 kg in five months. At that time she complained of severe pain and swelling over her proximal right thumb. She denied a history of trauma. On examination she was afebrile and not ill‐appearing. There was no adenopathy, hepatosplenomegaly, or ascites. The proximal thumb was swollen and tender to palpation but not warm or erythematous. The white cell count, liver function tests, and radiographs of the chest and hand were all negative. Observation and acetaminophen were recommended. The pain worsened but the examination and laboratory findings were unchanged. A repeat hand radiograph showed destruction of the proximal phalanx, consistent with osteomyelitis. Repeat skin tests for TB and Candida were negative. The patient promptly underwent surgical curettage of the phalanx. The stains were negative for bacteria and mycobacteria, however, the cultures grew M. tuberculosis. She was begun on isoniazid 300 mg/ day, rifampin 600 mg/day, pyrazinamide 600 mg/ day and pyridoxine 50 mg/day with subsequent improvement in her signs and symptoms.
INTRADIALYTIC CARDIAC ARRHYTHMIAS: I
Authors: Bailey Robert A. , Kaplan Andre A.
Published: October 2007

An 87‐year‐old white male with adult onset diabetes mellitus and progressive renal insufficiency was admitted because of dyspnea. Admission workup revealed a blood urea nitrogen (SUN) of 133 mg/dl, a creatinine of 5.6 mg/dl, a potassium of 5.0 mEq/l, and echocardiographic evidence of a pericardial effusion. The pericardial effusion was not hemodynamically significant, with no pulsus paradoxus and no evidence of right atrial or right ventricular collapse on echocardiogram. Of significance was a past medical history of third degree heart block managed by the placement of a sequential atrial‐ventricular (DDD) cardiac pacemaker. On admission his pacemaker was A‐V sequential pacing at a rate of 80 bpm.

Hemodialysis was initiated without heparin, and transmembrane pressure was minimized so as not to precipitate cardiac tamponade. No net ultrafiltration occurred during the dialysis. Two hours after the initiation of hemodialysis, hypotension and an irregular tachycardia occurred. The hypotension was not volume responsive. Echocardiogram and rhythm strip showed atrial fibrillation with irregularly irregular ventricular pacing. Cardiology consultation was requested to further evaluate the pacemaker status. The pacemaker was emergently converted to a VVI mode of 90 bpm. The patient subsequently became normotensive and hemodynamically stable. He was also given a loading dose of 1000 mg of procainamide and a continuous infusion of procainamide was initiated at 1 mg/min. Organized atrial activity was restored within 15 min. No further atrial arrhythmias were noted during subsequent hemodialyses.
INTRADIALMIC CARDlAC ARRHYTHMIAS: II
Authors: Kant K Shashi
Published: October 2007

M.F., a 62‐year‐old black female, began hemodialysis on August 4, 1990. End‐stage renal disease (ESRD) was caused by diabetic glomerulosclerosis proved by renal biopsy. Past history was remarkable for insulin‐requiring Type II diabetes mellitus for more than 20 years and hypertension of approximately the same duration. The patient had documented coronary artery disease for at least five years, having culminated in two non‐Q wave myocardial infarcts, one year and three years prior to initiating dialysis. Cardiac systolic function was decreased with lefi ventricular ejection fraction being 45% when determined in fate 1989. Functional capacity gradually deteriorated to Class III on the New York Heart Association (NYHA) scale just prior to the initiation of dialysis.

For the first two months after hemodialysis was begun, the patient gradually improved. Ultrafiltration decreased the patient's blood pressure and use of antihypertensive medication. On September 24, 1990, towards the end of a routine dialysis, the patient became hypotensive and had a cardiac arrest. The first rhythm strip showed ventricular tachycardia that quickly degenerated into fibrillation. She responded to defibrillation by electrical counter shock and was admitted to the coronary core unit (CCU). The subsequent hospital course ruled out a new ischemic event. Subsequent dialysis in the CCU with the patient being monitored showed the development of multifocal premature ventricular contractions (PVC) in the second hour of dialysis. These were subsequently quantitated at >300/hr.

Medications at the time of arrest included Isordil 20 mg thrice daily, digoxin.125 mg thrice weekly, nifedipine XL 60 mg a day, multivitamins, ferrous sufate, and calcium citrate.

At the conclusion of the aforementioned dialysis a renal profile and a set of blood gases were obtained. Serum K+ was 2.8 mEq/l, blood pH 7.48 with unremarkable paO2 and paCO2 values. A serum digoxin level at admission was 1.8 mg/ml. Serum calcium was normal. Digoxin was discontinued and the dialysate potassium level increased to 3.0 mEq/l. The patient was continuously monitored during the next several dialyses. The number of PVCs decreased but were still greater than 150/hr. They were most frequent immediately after dialysis and gradually decreased in number to 30/hr prior to the next dialysis. At this point, a serum magnesium was checked before and after dialyses and found to be 2.5 and 1.0 mg/dl respectively. Dialysate magnesium was increased from 0.75 to 1.25 mg/dl with almost complete resolution of the PVCs postdialysis. Since discharge from the hospital, the patient has done well and no further hemodynamic problems have been documented on dialysis.
Value of Measuring Erythropoietin Levels
Authors: Eschbach Joseph W.
Published: October 2007

Does the measurement of endogenous erythropoietin levels have any role in patients with renal failure?
Enhancing Host Defenses in Peritoneal Dialysis
Authors: Holmes Clifford J.
Published: October 2007

Much has been written about host defenses in peritoneal dialysis. In a practical sense, is there anything a clinician can do to enhance peritoneal resistance to infection to help patients with frequent peritonitis? (I understand that the primary problem is probably related to contamination not resistance; however, I'd like to address the latter issue as well.)
Bisphosphonates for the Hypercalcemia of Malignancy in End‐Stage Renal Disease
Authors: Morton A. Ross
Published: October 2007

Bisphosphonates appear to be the optimal therapy for the hypercalcemia of malignancy; however, they are contraindicated for patients with end‐stage renal disease (ESRD). I have read that, normally, half of the drug is excreted unchanged by the kidney and half is taken up by bone. It's not apparent why a 50% reduction in dose wouldn't be satisfactory for dialysis patients.
Which anesthetic should be used in the treatment of refractory status epilepticus?
Authors: Rossetti Andrea O.
Published: October 2007

Summary

While the treatment of refractory status epilepticus (SE) relies on the use of anesthetic agents, mostly barbiturates, propofol, or midazolam, the study of the available literature discloses that the evidence level is low. Therapeutic coma induction appears straightforward for generalized convulsive or subtle SE, but this approach is debated for complex partial SE. Each anesthetic has its own advocates, and specific advantages and risks; furthermore, several different protocols have been reported regarding the duration and depth of sedation. However, it seems that the biological background of the patient (especially the etiology) remains the main prognostic determinant in SE. There is a clear need of controlled trials regarding this topic
Neuroprotection in epilepsy
Authors: Walker Matthew
Published: October 2007

Summary

Neuroprotection following status epilepticus should encompass not only the prevention of neuronal death, but also preservation of neuronal and network function. This is critical because these aims are not necessarily equivalent; prevention of neuronal loss, for example, does not inevitably prevent epileptogenesis. There are endogenous neuroprotective mechanisms that can serve dichotomous roles (e.g. ERK1/2 activation can result in either neuroprotection or promote neuronal death). The roles of potential endogenous mechanisms can depend upon the pattern and timing of their activation. The simplest exogenous neuroprotective mechanism is to halt seizure activity. Other approaches consist of early NMDA receptor antagonism or later inhibition of apoptotic pathways. The problem with the latter approach is that calcium accumulation results in the activation of a number of downstream pathways, the importance of which varies from region to region and in a cell‐type specific manner. Neuroprotection in epilepsy is not a straightforward concept, and we need to be clear about our eventual objectives (e.g. preventing cognitive decline). There are numerous possible approaches to neuroprotection, and the efficacy of these depends upon their timing, the specific aims and even the method of status epilepticus induction.
What is animal experimentation telling us about new drug treatments of status epilepticus?
Authors: Nehlig Astrid
Published: October 2007

Summary

Basic research is mostly focused on the consequences of status epilepticus (SE) in terms of neuronal loss, behavior, epileptogenesis or disease‐modifying effects such as preventing epilepsy or reducing seizure severity. Among the drugs tested, several were able to trigger neuroprotection but only a few had disease‐modifying effects. At this point, many data are still missing, namely which drugs could efficiently stop SE or which mechanisms of action should be searched for to prevent the harmful consequences of SE.
Cognitive outcome of status epilepticus in adults
Authors: Helmstaedter Christoph
Published: October 2007

Summary

There is no doubt that structural morphological brain lesions and malformations in epilepsy represent major etiological factors for the cognitive impairments seen in this disease. The role of epileptic activity and seizures for cognition and cognitive development, however, is less easily determined. Epileptic dysfunction ranges from interictal and periictal activity over self‐terminating seizures to non‐convulsive and convulsive status epilepticus, which appear the most severe conditions along this continuum. The decisive question in this regard is as to whether cognitive impairments observed in the acute epileptic condition are reversible or not. Impairments from interictal or postictal epileptic dysfunction are reversible and may interfere at most with brain maturation and cognitive development in the young patient. Seizures and ictal dysfunction in contrast, even when reversible, can leave a permanent trace which extends the phase of postictal recovery. As for status epilepticus and subsequent cognitive decline it often remains open whether the epileptic condition itself or the underlying clinical condition is causative for the aftermath. While there is evidence for both possibilities, group data from neuropsychological cross sectional and longitudinal studies indicate that more severe mental impairments, which in turn indicate more severe clinical conditions, appear to be a risk factor for sustaining status epilepticus, rather than that status epilepticus causes the cognitive decline. Reviewing the literature the cognitive condition in patients with status epilepticus varies with the type of epilepsy, the etiology of epilepsy, severity of the status, and the age of the patient.
Delivering Effective Primary Care to Older Adults: A Randomized, Controlled Trial of the Senior Resource Team at Group Health Cooperative
Authors: Phelan Elizabeth A. , Balderson Benjamin , Levine Martin , Erro Janet H. , Jordan Luesa , Grothaus Lou , Sandhu Nirmala , Perrault Patrick J. , LoGerfo James P. , Wagner Edward H.
Published: October 2007

OBJECTIVES: To assess the effect of a team of geriatrics specialists on the practice style of primary care providers (PCPs) and the functioning of their patients aged 75 and older.

DESIGN: Randomized, controlled trial.

SETTING: Two primary care clinics in the Seattle, Washington, area.

PARTICIPANTS: Thirty‐one PCPs and 874 patients aged 75 and older.

INTERVENTION: An interdisciplinary team of geriatrics specialists worked with patients and providers to enhance the geriatric focus of care.

MEASUREMENTS: Main outcomes were a practice style reflecting a geriatric orientation and patient scores on the physical and affect subscales of the Arthritis Impact Measurement Scale 2—Short Form. Secondary outcomes were hospitalizations, incident disability in activities of daily living (ADLs), and PCP perceptions of the intervention. Death rates were also assessed.

RESULTS: Intervention providers screened significantly more for geriatric syndromes at 12 months, but this finding did not persist at 24 months. There were no significant differences in adequate hypertension control or high‐risk prescribing at 12 or 24 months of follow‐up. There were no significant differences in patient functioning or significant differences in hospitalization rates at either time point. Meaningful differences were observed in ADL disability at 12 but not 24 months. PCPs viewed the intervention favorably. Seventy‐eight participants died over the 24 months of follow‐up; the proportion dying was higher in the intervention group (11.4% in intervention group vs 7.1% of controls, P=.03).

CONCLUSION: The addition of an interdisciplinary geriatric team was acceptable to PCPs and had some effect on care of geriatric conditions but little effect on patient function or the use of inpatient care and was associated with greater mortality.
Serum Calcium and Cognitive Function in Old Age
Authors: Schram Miranda T. , Trompet Stella , Kamper Adriaan M. , De Craen Anton J. M. , Hofman Albert , Euser Sjoerd M. , Breteler Monique M. B. , Westendorp Rudi G. J.
Published: October 2007

OBJECTIVES: To determine whether serum calcium is associated with cognitive function in elderly individuals in the general population.

DESIGN: Prospective follow‐up study of two independent, population‐based cohorts.

SETTING: The Rotterdam Study (median follow‐up 11 years) and the Leiden 85‐plus Study (median follow‐up 5 years).

PARTICIPANTS: Three thousand nine hundred ninety‐four individuals, mean age 71, from the Rotterdam Study and 560 individuals, all aged 85, from the Leiden 85‐plus Study.

MEASUREMENTS: Global cognitive function was assessed in both cohorts using the Mini‐Mental State Examination; attention, psychomotor speed, and memory function were assessed in the Leiden 85‐plus Study only. Linear regression and linear mixed models were used for statistical analyses.

RESULTS: In the Rotterdam Study, high serum calcium was associated with worse global cognitive function at baseline (P<.05) and a faster rate of decline in cognitive function during follow‐up (P=.005) in individuals aged 75 and older but not in younger individuals. In the Leiden 85‐plus Study, high serum calcium was associated with worse global cognitive function from age 85 through 90 (P<.001). This observation also held for the specific cognitive domains tested (all P<.01). These results did not change when individuals with serum calcium levels greater than normal (>2.55 mmol/L) were excluded from the analyses.

CONCLUSION: In the general population, high serum calcium levels are associated with faster decline in cognitive function over the age of 75.