bluuebunny/crossref_metadata_2025_split huggingface dataset:
Notes for a Discussion on the European Single Currency
Authors: Wilkie A.D. 
Published: June 2011

ABSTRACTThis paper forms notes for discussions about the European single currency at the Institute of Actuaries and the Faculty of Actuaries. The author assumes (and hopes) that the single currency will start on time in 1999, with most of the Member States of the European Union included. The key dates are 1 January 1999, when the exchange rates between currencies will become irrevocably locked and become conversion rates, and 2002, when euro notes and coins will be introduced, and the retail banking sector will convert to euros. The advantages of a single currency are potentially very great; the costs are also considerable. Governments of Member States will no longer be able to get a competitive advantage by devaluing their currency, or be able to choose an inflation rate that is different from that of the E.U. as a whole. The key document is the Maastricht Treaty, and the conversion criteria included therein are discussed. The author concludes that, if governments choose to interpret the criteria leniently, all countries, except possibly Greece, will be included in 1999, with Greece joining a year or two later. Some of the practical considerations for actuaries, including life insurance, general insurance, pensions, banking and investment are mentioned. The paper is not comprehensive, and is a personal contribution to stimulate discussion.
The Financial Theory of Defined Benefit Pension Schemes
Authors: Exley C.J. , Mehta S.J.B. , Smith A.D. 
Published: June 2011

ABSTRACTIncreasingly, modern business and investment management techniques are founded on approaches to measurement of profit and risk developed by financial economists. This paper begins by analysing corporate pension provision from the perspective of such financial theory. The results of this analysis are then reconciled with the sometimes contradictory messages from traditional actuarial valuation approaches and the alternative market-based valuation paradigm is introduced. The paper then proposes a successful blueprint for this mark-to-market valuation discipline and considers whether and how it can be applied to pension schemes both in theory and in practice. It is asserted that adoption of this market based approach appears now to be essential in many of the most critical areas of actuarial advice in the field of defined benefit corporate pension provision and that the principles can in addition be used to establish more efficient and transparent methodologies in areas which have traditionally relied on subjective or arbitrary methods. We extend the hope that the insights gained from financial theory can be used to level the playing field between defined benefit and defined contribution arrangements from both corporate and member perspectives.
Modelling Extreme Market Events. A Report of the Benchmarking Stochastic Models Working Party
Authors: Frankland R. , Smith A. D. , Wilkins T. , Varnell E. , Holtham A. , Biffis E. , Eshun S. , Dullaway D. 
Published: June 2011

ABSTRACTThis paper focusses on some practical issues that can arise when developing methodologies for calculating benchmark figures for extreme market events, particularly in the context of the Financial Services Authority's ICAS regime. The paper limits discussion to equity and interest rate risks. Whilst not intended to constitute formal guidance, it is hoped that the material contained within the paper will be useful to practitioners. The paper acknowledges the role of prior beliefs in the choice of data to be used for modelling and its influence upon the ensuing results.
Cohort Differences in Mortality and Morbidity
Authors: Jagger Carol , Christensen Kaare , Murphy Michael 
Published: June 2011

ABSTRACTIn 1900 life expectancy at birth in the UK was only 46 years for men and 53 years for women. Just over a century later life expectancy at birth has increased by around 30 years and by 2007 had reached 77.5 years for men and 81.7 years for women. The population aged 85 years and over, often termed the ‘oldest old’, are now the fastest growing section of our population. For the 1921 cohort only 18% of men and a third of women reached the age of 85 years but for the 1951 birth cohort it is expected that almost half of men and 60% of women will achieve that age. The important question for health care planners and society is whether the large number of those who will reach 85 years in the future are similar in health characteristics to those attaining 85 years now.This question was addressed by substantive results and by methodological papers in the ‘Cohort’ theme of the Joining Forces on Mortality and Longevity conference in October 2009. Here we provide an overview of the papers, some of which are presented in full in this issue (see Murphy (2009), Di Cesare & Murphy (2009), O'Connell & Dunstan (2009), Forfar (2009)).
Do Cohort Mortality Trends Emigrate? Insights on The U.K.'s Golden Cohort From A Comparison with a British Settler Country
Authors: O'Connell Alison , Dunstan Kim 
Published: June 2011

ABSTRACTThe assumed rate of future mortality improvement has increased over three recent sets of the United Kingdom's national population projections. This optimism has not been so marked in countries which share ancestors with the U.K. population. New Zealand is one such country that provides a data-rich case example in which to investigate the portability of mortality trends.This paper compares mortality trends in New Zealand with those in England & Wales. Both countries seem to have a ‘golden cohort’ which enjoys faster improving mortality than people born before or after. The birth of the golden cohort in England & Wales coincided with cohort life expectancy there catching up with New Zealand's.We show that first generation migrants from the U.K. have better mortality than New Zealand born residents likely to have British ancestry. The advantage lasts into older ages, decades after migration. We hypothesise that migrants from the U.K.'s golden cohort brought with them an early life mortality improvement advantage, and additionally benefited from the healthier environment of New Zealand at middle to older ages. Further, given the recent strong mortality improvement in New Zealand, the U.K.'s assumptions for future mortality look relatively optimistic.
The ‘Golden Generations’ in Historical Context
Authors: Murphy Michael 
Published: June 2011

ABSTRACTAssumptions about future mortality are more important than those for factors such as fertility, migration, disability trends or real interest rates for cost projections of the U.S. Old Age, Survivors, Disability and Health Insurance scheme. Recently, one factor has been assumed to be the key driver of future mortality in both official British population projections and actuarial ones: a ‘cohort effect’ associated with a group who were born in a period centred on the early 1930s who have been identified as having experienced particularly rapid improvements in mortality rates and are often referred to as the ‘golden generations’ or ‘golden cohorts’. The concept of ‘cohort effects’ is discussed; limitations of national-level cohort data considered; and methods for identifying such effects are reviewed. Particular attention is given to the analysis of populations which have been identified as having clear cut cohort effects; those of Britain and Sweden in the later part of the nineteenth century and early twentieth century, as well as the contemporary British population. The likely magnitude of such effects is discussed using a stylised model to assess the extent to which members of the ‘golden generations’ are especially privileged.
Forecasting Mortality, Different Approaches for Different Cause of Deaths? The Cases of Lung Cancer; Influenza, Pneumonia, and Bronchitis; and Motor Vehicle Accidents
Authors: Cesare Mariachiara Di , Murphy Mike 
Published: June 2011

ABSTRACTMost of the methods of mortality forecasting have been assessed using performance on overall mortality, and few studies address the issue of identifying the appropriate forecasting models for specific causes of deaths. This study analyses trends and forecasts mortality rates for three major causes of death — lung cancer, influenza-pneumonia-bronchitis, and motor vehicle accidents — using Lee–Carter, Booth–Maindonald–Smith, Age-Period-Cohort, and Bayesian models, to assess how far different causes of death need different forecasting methods. Using data from the Twentieth and Twenty-First Century Mortality databases for England and Wales, results show major differences among the different forecasting techniques. In particular, when linearity is the main driver of past trends, Lee–Carter-based approaches are preferred due to their straightforward assumptions and limited need for subjective judgment. When a clear cohort pattern is detectable, such as with lung cancer, the Age-Period-Cohort model shows the best outcome. When complete and reliable historical trends are available the Bayesian model does not produce better results than the other models.
Isolation ofAcinetobacter baumanniiComplex and Methicillin-ResistantStaphylococcus aureusfrom Hospital Rooms Following Terminal Cleaning and Disinfection: Can We Do Better?
Authors: Manian Farrin A. , Griesenauer Sandra , Senkel Diane , Setzer Janice M. , Doll Sara A. , Perry Annie M. , Wiechens Michelle 
Published: June 2011

Objective.To study the frequency of isolation ofAcinetobacter baumanniicomplex (ABC) and methicillin-resistantStaphylococcus aureus(MRSA) from surfaces of rooms newly vacated by patients with multidrug-resistant (MDR) ABC following various rounds of routine terminal cleaning and disinfection (C/D) with bleach or 1 round of C/D followed by hydrogen peroxide vapor (HPV) treatment.Setting.A 900-bed tertiary care hospital.Methods.ABC and MRSA cultures were obtained from hospital rooms including 312 rooms (mean, 18.3 sites/room) following 4 rounds of C/D, 37 rooms (mean, 20 sites/room) following 1 round of C/D before and after HPV treatment, and 134 rooms (mean, 20 sites/room) following 1 round of C/D and HPV treatment.Results.Following 4 rounds of C/D, 83 (26.6%) rooms had 1 or more culture-positive sites; 102 (1.8%) sites in 51 (16.4%) rooms grew ABC, and 108 (1.9%) sites in 44 (14.1%) rooms grew MRSA. The addition of HPV treatment to 1 round of C/D resulted in a significant drop in ABC- and MRSA-positive room sites (odds ratio, 0 [95% confidence interval, 0–0.8];P= .04 for both organisms). Following 1 round of C/D and HPV treatment, 6 (4.5%) rooms were culture-positive for ABC, MRSA, or both.Conclusions.Routine terminal C/D of hospital rooms vacated by MDRABC-positive patients may be associated with a significant number of ABC- or MRSA-positive room surfaces even when up to 4 rounds of C/D are performed. The addition of HPV treatment to 1 round of C/D appears effective in reducing the number of persistently contaminated room sites in this setting.
Institutional Control Measures to Curtail the Epidemic Spread of Carbapenem-Resistant Klebsiella pneumoniae: A 4-Year Perspective
Authors: Cohen Matan J. , Block Colin , Levin Phillip D. , Schwartz Carmela , Gross Ilana , Weiss Yuval , Moses Allon E. , Benenson Shmuel 
Published: June 2011

Objective.To describe the implementation of an institution-wide, multiple-step intervention to curtail the epidemic spread of carbapenem-resistant Klebsiella pneumoniae (CRKP).Design.Consecutive intervention analyses.Patients and Setting.All patients admitted to a 775-bed tertiary care medical center in Jerusalem, Israel, from 2006 through 2010.Interventions.The effects of 4 interventions were assessed: (1) a policy of isolation for patients colonized or infected with CRKP in single rooms, which was started in March 2006; (2) cohorting of CRKP patients with dedicated nursing staff and screening of patients neighboring a patient newly identified as a carrier of CRKP, which was started in March 2007; (3) weekly active surveillance of intensive care unit patients, which was started during August 2008; and (4) selective surveillance of patients admitted to the emergency department, which was started in March 2009. Interrupted regression analysis and change-point analysis were used to assess the effect of each intervention on the CRKP epidemic.Results.Patient isolation alone failed to control the spread of CRKP, with incidence increasing to a peak of 30 new cases per 1,000 hospital beds per month. Institution of patient cohorting led to a steep decline in the incidence of CRKP acquisition (P< .001). Introduction of active surveillance interventions was followed by a decrease in the incidence of CRKP-positive clinical cultures but an increase in the incidence of CRKP-positive screening cultures. The mean prevalence of CRKP positivity for the period after cohorting began showed a statistically significant change from the mean prevalence in the preceding period (P< .001).Conclusions.The cohorting of patients with dedicated staff, combined with implementation of focused active surveillance, effectively terminated the epidemic spread of CRKP. Cohorting reduced cross-infection within the hospital, and active surveillance allowed for earlier detection of carrier status. Both interventions should be considered in attempts to contain a hospital epidemic.
Nerve Stimulator-guided Supplemental Popliteal Sciatic Nerve Block after a Failed Sciatic Block Does Not Increase the Incidence of Transient Postoperative Neurologic Sequelae
Authors: Nader Antoun , Kendall Mark C. , Doty Robert , DeLeon Alexander , Yaghmour Edward , Kelikian Armen S. , McCarthy Robert J. 
Published: June 2011

Background
Supplemental peripheral nerve blocks are not commonly performed in adults because of concerns of cumulative exposure of the nerve to the local anesthetic as well as increased ischemia from epinephrine. The purpose of this study was to compare the incidence of postoperative neurologic symptoms after a failed subgluteal sciatic nerve block and a supplemental popliteal sciatic nerve block.

Methods
Five hundred twelve adult patients undergoing ambulatory surgery were prospectively studied (1 yr). Sciatic nerve blocks were performed using levobupivacaine 0.625% with epinephrine 1:200,000 (0.5 ml/kg). Patients who failed to achieve sensory and motor anesthesia at 30-60 min were given a popliteal sciatic nerve block (lidocaine 2% 10 ml + levobupivacaine 0.5% 10 ml). Subjects were contacted at 24 h to 48 h, 2 weeks, and 1 month. Symptomatic patients were contacted biweekly and reevaluated during follow-up surgeon visits until symptom resolution.

Results
Four hundred thirty-nine subjects were analyzed. Fifty-six received a popliteal sciatic nerve block. Four subjects (0.9%) had self-reported neurologic symptoms in the distribution of the sciatic nerve. Investigator-initiated follow-up revealed 33 subjects (8.7%) who received a single subgluteal sciatic block and 4 subjects (7.1%) after a supplemental sciatic nerve block with neurologic symptoms (P = 0.80). The median duration of symptoms was 4 weeks (95% CI 3-5) in the subgluteal and 4 weeks (95% CI 3-5) weeks in the popliteal group (P = 0.98). All symptoms resolved by 14 weeks postprocedure.

Conclusion
Blocking the sciatic nerve at a more distal site after a failed subgluteal sciatic nerve block does not appear to influence the incidence or duration of neurologic sequelae.
Murine models in critical care research*
Authors: Haouzi Philippe 
Published: June 2011

Introduction:
Access to genetically engineered mice has opened many new opportunities to address questions relevant to the pathophysiology and treatment of patients in critical conditions. However, the results of studies in mice cannot disregard the unique ability of small rodents to adjust their temperature and high metabolic rate and the corresponding respiratory and circulatory requirements in response to hypoxia.

Point of View:
Studies performed in mice on questions related to metabolic, circulatory, and respiratory regulation should always be considered in light of the ability of mice to rapidly drop their nonshivering thermogenesis-related metabolism. As an example, it has been recently argued that a moderate level of inhaled hydrogen sulfide may have a potential benefit in patients in coma or shock or during an anoxic or ischemic insult, as this toxic gas dramatically reduces the metabolic rate in resting mice. However, acute hypometabolism has long been described in small mammals in response to hypoxia and is not specific to hydrogen sulfide. More importantly, mice have a specific metabolic rate that is 15–20 times higher than the specific metabolic level of a resting human. This difference can be accounted for by the large amount of heat produced by mice through nonshivering thermogenesis, related to the activity of uncoupling proteins. This mechanism, which is essential for maintaining homeothermia in small mammals, is virtually absent in larger animals, including in adult humans. Accordingly, no direct metabolic effect of hydrogen sulfide is observed in large mammals. We present the view that similar reasoning should be applied when the circulatory or respiratory response to hypoxic exposure is considered. This leads us to question whether a similar strategy could occur in mice in critical conditions other than hypoxia, such as in hypovolemic, septic, or cardiogenic shock.

Conclusion:
Mouse models developed to understand the mechanisms of protection against hypoxia or ischemia or to propose new therapeutic approaches applicable in critical care patients should be understood in light of the specificity of the metabolic, respiratory, and circulatory responses of mice to a hypoxic insult, since many of these adaptations have no clear equivalent in humans.
Long‐term Changes in Food Consumption Trends in Overweight Children in the HIKCUPS Intervention
Authors: Burrows Tracy , Janet Warren M. , Collins Clare E. 
Published: June 2011

ABSTRACTBackground and Aim:Energy intake is a major contributor to energy imbalance and is a key modifiable factor for successful treatment of obesity. Long‐term changes in dietary intake from pediatric obesity treatment programs are rarely reported. The aim of this study was to describe the changes in food intake of children from all intervention groups from baseline to 2‐year follow‐up after a 6‐month obesity intervention.Subjects and Methods:Overweight children (n = 160, 5–9 years), 58% girls and body mass index z score (mean ± SD) 2.89 ± 0.79, were recruited to the Hunter Illawarra Kids Challenge using the Parent Support randomized controlled trial. Dietary intake was reported by parents for children at baseline and 2‐year follow‐up (n = 87) using a food frequency questionnaire. Linear mixed models were used to determine differences by time.Results:Parents reported decreases in total energy (total kcal, kcal/kg), child percentage of total energy from energy‐dense, nutrient‐poor foods (sweetened drinks, potato crisps, sweets, and carry‐out foods) from 42% ± 1.0% at baseline to 34.8% ± 1.0% at 2 years (P < 0.001), with an increase in percentage of energy from nutrient‐dense foods (fruits, vegetables, dairy, breads, and cereals) from 57% ± 0.9% at baseline to 65% ± 1.0% at 2 years (P < 0.001).Conclusions:This is the only one of a few studies that report dietary data of overweight children who participated in a treatment program with long‐term follow‐up. It provides evidence that improvements in food intake can be sustained up to 2 years through decreased consumption of energy‐dense, nutrient‐poor foods, particularly sweetened drinks, and increased consumption of core foods following an intervention.
Celiac Disease in Normal‐weight and Overweight Children
Authors: Reilly Norelle Rizkalla , Aguilar Kathleen , Hassid Benjamin G. , Cheng Jianfeng , DeFelice Amy R. , Kazlow Philip , Bhagat Govind , Green Peter H. 
Published: June 2011

ABSTRACTObjectives:There are few data on pediatric celiac disease in the United States. The aim of our study was to describe the presentation of celiac disease among children with a normal and an elevated body mass index (BMI) for age, and to study their BMI changes following a gluten‐free diet (GFD).Patients and Methods:One hundred forty‐two children (age 13 months–19 years) with biopsy‐proven celiac disease, contained in a registry of patients studied at our center from 2000 to 2008, had follow‐up growth data available. Patients’ height, weight, and BMI were converted to z scores for age and grouped by BMI as underweight, normal, and overweight. Compliance was confirmed using results of serological assays, and data of noncompliant patients were analyzed separately. Data were analyzed during the observation period and were expressed as change in height, weight, and BMI z score per month of dietary treatment.Results:Nearly 19% of patients had an elevated BMI at diagnosis (12.6% overweight, 6% obese) and 74.5% presented with a normal BMI. The mean duration of follow‐up was 35.6 months. Seventy‐five percent of patients with an elevated BMI at diagnosis decreased their BMI z scores significantly after adherence to a GFD, normalizing it in 44% of cases. Of patients with a normal BMI at diagnosis, weight z scores increased significantly after treatment, and 13% became overweight.Conclusions:Both normal weight and overweight frequently occur in North American children presenting with celiac disease. A GFD may have a beneficial effect upon the BMI of overweight and obese children with celiac disease.
Pharmacokinetics of two formulations of omeprazole administered through a gastrostomy tube in patients with severe neurodevelopmental problems
Authors: Boussery Koen , De Smet Julie , De Cock Pieter , Vande Velde Saskia , Mehuys Els , De Paepe Peter , Remon Jean Paul , Van Bocxlaer Jan F. P. , Van Winckel Myriam 
Published: June 2011

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• In tube‐fed patients with severe neurodevelopmental problems, omeprazole for the treatment of gastro‐oesophageal reflux disease often needs to be administered through the feeding tube.• In daily practice, various procedures are used to administer the commercially available, enteric‐coated omeprazole formulations through a feeding tube.• No bioavailability data are available to support a rational choice between the available administration procedures.WHAT THIS STUDY ADDS• This study demonstrates a substantial interindividual variability in omeprazole pharmacokinetics after administration through the gastrostomy tube in patients with severe neurodevelopmental problems.• In most patients, plasma concentration–time profiles seem more favourable with a suspension formulation than with a MUPS® formulation.• Consequently, there is no apparent advantage in choosing a MUPS® formulation over the more easily administered suspension formulation.AIMS Omeprazole is often administered through a gastrostomy tube as either (i) a Multiple Unit Pellet System (MUPS®) tablet disintegrated in water (MUPS® formulation), or (ii) a suspension in 8.4% sodium bicarbonate (suspension formulation). This bioavailability study evaluates this practice in tube‐fed patients with severe neurodevelopmental problems.METHODS Nonblinded, two‐phase cross‐over trial.RESULTS In seven of 10 patients, bioavailability was higher for the suspension formulation than for the MUPS® formulation. Median (90% confidence interval) area under the plasma concentration–time curve ratio (MUPS® over suspension) was 0.5 (0.06–2.37).CONCLUSIONS In this population, omeprazole MUPS® formulation has no apparent advantage over the more easily administered suspension formulation.