bluuebunny/crossref_metadata_2025_split huggingface dataset:
TS01 COMPARISON OF POSSUM AND P‐POSSUM FOR RISK‐ADJUSTED AUDIT OF PATIENTS UNDERGOING EMERGENCY LAPAROTOMY
Authors: Rodrigues G. S. 
Published: April 2009

Background:   The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) scoring system, derived from a heterogeneous population, has been used successfully as an audit tool, but it has appeared to over‐predict mortality in low‐risk groups for which an alternative system, the Portsmouth Predictor Equation for Mortality (P‐POSSUM) was designed and used successfully. In this prospective study, we compared these two equations in predicting death and tested their validity in predicting morbidity and mortality in patients undergoing emergency laparotomy in a tertiary hospital.Methods:   Eighty‐two patients who underwent emergency laparotomy were included in this study. Actual morbidity and mortality rates were compared with the predicted mortality and morbidity rates using both POSSUM and P‐POSSUM equations by linear regression and exponential methods of analysis.Results:   POSSUM equation significantly over‐predicted both morbidity and mortality when linear regression analysis was used, but predicted well when exponential analysis was used. Prediction of mortality by P‐POSSUM was good using both linear and exponential analyses, and exponential method was better than linear regression analysis.Conclusion:   P‐POSSUM is a better equation than POSSUM in predicting mortality, and exponential method is better than linear regression analysis. Both equations are useful tools for risk‐adjusted surgical audit of patients undergoing emergency laparotomy.
TS06 *HEAD INJURY AND OUTCOME – WHAT INFLUENCE DOES PREHOSPITAL INTUBATION HAVE?
Authors: Bendinelli C. , Nebauer S. , Evans J. , Balogh Z. 
Published: April 2009

Mortality of severe traumatic brain injury (STBI) varies in literature between 23 and 81% depending on pre‐hospital use of neuromuscular blocking agents (NBA) for endotracheal intubation (ETI) (1, 2). In NSW paramedics are not equipped with NBA. Aim of this study was to determine mortality of STBI patients in a NSW Trauma Centre and compare to intentional standards as an initial step to evaluate potential applicability of NBA for ETI in NSW.Methods:   A four‐year retrospective study ending December 2008 on consecutive trauma patients admitted to a NSW Level‐1 Trauma Centre with a pre‐hospital Glasgow Coma Score (GCS) < 9 and STBI [Abbreviated Injury Scale (AIS) > 2]. Patients were identified from trauma registry and focused chart review was performed. Primary outcome was mortality. Results are presented as mean ± SD or percentages. Statistical significance was determined at p < 0.05 based on univariate analysis.Results:   A total of 124 patients were identified (age 36.4 ± 20, pre‐hospital GCS 4.8 ± 2, ISS 30.6 ± 13, head AIS 4.2 ± 0.7, 28% had systolic blood pressure (SBP) < 90 mmHg). The overall mortality was 34.6%. 27 patients had pre‐hospital ETI with 74.0% mortality. In 5 patients pre‐hospital ETT failed (mortality 20%). 92 patients had ETT on arrival to hospital (mortality 24.4%). Survivors differed from those who died (age <55: 91% vs 52%, ISS: 26.9 ± 10.7 vs 37 ± 16.3, AIS: 4.1 ± 0.6 vs 5.2 ± 2.0, GCS: 5.2 ± 2.0 vs 4.0 ± 1.7, and SBP < 90 mmHg: 15.8% vs 50%). ETI < 30 minutes from injury was more common among non‐survivors (2.7% vs 21.6%).Discussion:   Mortality is comparable with trauma systems without pre‐hospital NBA. State‐wide assessment of the STBI outcomes is recommended to determine the potential applicability of pre‐hospital use of NBA.
TS07 RETAINED WEAPONS IN TRAUMA – NON MISSILE PENETRATING INJURIES
Authors: Cacala S. R. , Khan Z. , Oosthuizen G. V. , Clarke D. L. 
Published: April 2009

Purpose:   Introduction:   Retained weapons present challenges to trauma surgeons. This retrospective review documents our experience with these injuries in Pietermaritzburg over an 18 month period.Methods:   A prospective trauma database is maintained by the general surgical service of the Pietermaritzburg metropolitan hospitals complex. All patients who presented with a retained weapon, non‐missile penetrating injury (NMPI) between July 2007 and November 2008 were identified and reviewed.Results:   We identified 22 patients who had presented with a retained weapon. Twenty‐one were male. The age range was 15–62 years, however 20 cases were <33 years of age. The location of the retained weapon was skull (6), face (6), neck (3), chest and back (6), leg (1). The investigations done included plain X‐rays on 21 cases, CT scan angiography (17) and formal angiography (2). Intercostal drains were required in 5 patients for pneumothoraces (1 bilateral). Twenty weapons were removed in operating room, 1 was accidentally dislodged and 1 was extracted on the ward in view of low Glasgow Coma Scale (GCS) score. Four patients required enucleation to remove a disrupted eye and 1 of these also repair of transected carotid artery. One required vascular repair of popliteal artery. One man improved his GCS score post knife removal. One patient remained paraplegic post knife removal, 1 had left arm paralysis, 1 hemiplegia. There were 2 unavoidable deaths.Conclusion:   Retained weapons must be investigated prior to removal in the haemodynamically compensated patient. They are potentially morbid injuries. The weapon should be removed under controlled conditions by the appropriate surgical service. Residual morbidity relates to the site of the weapon.
VS01 HYPERTENSIVE EXTRACORPOREAL LIMB PERFUSION – HELP
Authors: Lane R. J. , Phillips M. N. , Mcmillan D. , Huckson M. , Liang S. , Roger G. 
Published: April 2009

Objective:   To report the early human results of H.E.L.P. technology in the prevention of major limb amputation. In the short‐term, the aim was to pressure dilate collateral channels and in the long‐term to stimulate remodelling and new collateral pathways by increasing endothelial shear stress.Methods:   A pilot study consisted of the ischaemic limbs of 15 patients with critical limb ischaemia. These patients had no other option but major amputation as determined by at least two vascular surgeons. The limbs were connected to a commercially available cardiac pump via an access system. The limbs were hyperperfused pancycle at 2–3 times the mean arterial pressure (MAP). This was performed intermittently in sessions of 24–36 hours. The major endpoint was avoidance of major amputation.Results:   Given adequate arterial access, 29 of 30 connections developed flows 4–8 times the MAP. There was a progressive decrease in peripheral resistance. All patients developed a pain‐free, warm foot or hand whilst on the pump in the short‐term. In the longer term, a mean of 10.4 months (range 1–29 months) 50% had avoided major amputation. Pain scores changed from 0.9 ± 0.1 to 1.1 ± 1.3 under the visual analogue scale (V.A.S). The ankle brachial index (A.B.I) changed from 0.06 ± 0.09 to 0.57 ± 0.33, p < 0.05 (t test).Conclusions:   The collateral circulation of ischaemic limbs can be augmented and regulated via connection to an extracorporeal cardiac pump. The technique is similar to haemodialysis. Major amputation can be avoided in selective cases. Improvements in the technology are continuing.
VS14P THE USE OF ULTRASOUND TO ASSIST DEPLOYMENT OF THE STARCLOSE(TM) VASCULAR CLOSURE DEVICE
Authors: Puckridge P. J. , Spark I. , Thompson W. 
Published: April 2009

Purpose:   Arterial access site complications have not been reduced by the introduction of vascular closure devices. An ultrasound guided technique for the StarClose(tm) device was introduced in an attempt to reduce complications.Methodology:   A prospectively collected series of 197 consecutive StarClose deployments using standard and ultrasound guided techniques of deployment were studied from the Repatriation General Hospital. Outcomes with regards to complication and failure rates were collected and analysed.Results:   39.6% were deployed using an ultrasound guided technique and 60.1% with standard deployment. There was a significant reduction in failure rates (p < 0.05) with use of ultrasound guidance and a reduction in complications that did not reach significance (p = 0.23).Conclusion:   The introduction of an ultrasound guided technique of deployment can significantly reduce failure rates with the StarClose device and may reduce complications.
VS02 *UNILATERAL ILIOFEMORAL SYMPTOMATIC OCCLUSIVE DISEASE – THE RESULTS OF SEMI‐CLOSED ENDARTERECTOMY USING A RING‐STRIPPER
Authors: Muller J. C. , Ogg M. J. , Mcgahan T. J. , Quinn J. M. , Woodruff P. W. , Mayer R. C. 
Published: April 2009

Purpose:   Symptomatic unilateral occlusive iliofemoral disease is a common scenario in vascular surgical practice and its management is controversial as there are many revascularisation options. This study reviews semi‐closed iliofemoral endarterectomies using a ring stripper to report its efficacy, complications and longer‐term results.Methodology:   A retrospective review of 80 consecutive semi‐closed endarterectomies performed in 78 patients at our institution between 1998 and 2008. Mean age was 66. Surgical indications were for limb threatening ischaemia in 27 patients and disabling intermittent claudication in 53. Concurrent revascularisation procedures included 25 profundaplasties and 21 infra‐inguinal bypasses.Results:   Technical success was achieved in 92.5% of cases. 6 cases required alternative bypass or open endarterectomy and there was one perforation. There was no peri‐operative mortality. Major amputation was required in one patient. Postoperative thrombosis requiring early thrombectomy occurred in one patient. Follow‐up was for a mean of 36 months. The cumulative primary patency rate at 3 years was 86.2% and 88.8% for limb salvage. The patients who presented with limb threatening ischaemia compared to the claudicants were more likely to have multi‐level disease requiring concurrent revascularisation (66.7% vs. 35.8% p = 0.01), and were also at significantly increased risk of major amputation (30.8% vs. 4.0% p = 0.04) and mortality (58.3% vs. 28.6% p = 0.04) during follow‐up.Conclusion:   Treatment of long segment occlusive concurrent external iliac and common femoral artery disease is best individualised however semi‐closed endarterectomy using a ring stripper is an effective, safe and durable procedure.
VS07 EXCELLENT LATE OUTCOME WITH DENATURATED HUMAN UMBILICAL VEIN (HUV) IN FEMOROPOPLITEAL BYPASS SURGERY – A GOOD EXAMPLE FOR THE IMPORTANCE OF BIOLOGICAL MATERIALS IN VASCULAR SURGERY
Authors: Neufang A. C. , Espinola‐klein C. , Dorweiler B. , Savvidis S. , Maksan S. , Vahl C. F. 
Published: April 2009

Purpose:   Femoropopliteal bypass with autologous vein provides excellent long term results in lower limb bypass. In case of unsuitable vein generally synthetic PTFE prostheses are preferred. Denaturated human umbilical vein was used as femoropopliteal bypass graft when autologous vein was not available. Long term results of a consecutive single center series are presented.Methodology:   HUV was implanted in femoropopliteal position in case of unavailable vein for symptomatic peripheral vascular disease or popliteal aneurysm. Follow‐up examinations were performed after 3, 6, 12, 18, 24 months and annually thereafter. Duplex scan was used for detection of potential biodegeneration of the HUV.Results:   From 01/94 to 01/05 in 197 patients (119 male, 78 female; age 70 ± 8.7 years) 211 femoropopliteal bypasses were constructed with HUV (65 above knee and 146 below knee) for critical ischemia or severe disabling claudication. In 16% thrombotic occlusion prompted early postoperative revision to restore patency. After a mean follow up of 44 months primary, primary assisted and secondary 5 year patency were 54%, 63% und 76% with a limb salvage rate of 92%. In grafts patent for more than 36 months aneurysmal degeneration was found in 6 cases (7%).Conclusion:   Despite a considerable rate of early thrombotic occlusions femoropopliteal HUV bypass exhibits an excellent long term function with a tolerable rate of aneurysmal graft degeneration. Biological prosthetic small calibre grafts should be considered as a valuable alternative to the preferentially used synthetic PTFE grafts.
VS09 VENOUS THROMBOEMBOLISM: A 12 MONTH REVIEW OF PATIENTS ADMITTED TO ROYAL NORTH SHORE HOSPITAL
Authors: Pearce F. E. , Vandervord J. 
Published: April 2009

Purpose:   To review the incidence of Venous Thromboembolism (VTE) complications at Royal North Shore Hospital comparing medical and surgical specialties. To assess compliance to VTE prophylaxis and review the incidence of VTE complications when guidelines are adhered to. To identify strategies which would improve surgical and medical compliance to VTE guidelines.Methodology:   A review of the medical records of all patients diagnosed with PE or DVT over a 12 month period was undertaken. A ward survey of current in patients was conducted to determine compliance to guidelines in both surgical and medical patients.Results:   Both surgical specialties and medical specialties were reviewed. Surgical specialties complied with the guidelines more often than medical specialties. Surgical patients were broken down into specialties and reviewed as elective admissions and emergency admissions. DVT complications occurred more often than PEs. The ward survey confirmed surgical specialties complied more often with VTE prophylaxis than medical specialties.Conclusion:   VTE is a costly complication to both the patient and the hospital during hospital admission, which is potentially preventable when adequate assessment and prophylaxis is undertaken. RNSH has recently reviewed and implemented guidelines for VTE prophylaxis in accordance with current research. This paper indicates that surgical specialties are complying with guidelines more often than medical specialties but there is still room for improvement.
Slow waves, synaptic plasticity and information processing: insights from transcranial magnetic stimulation and high‐density EEG experiments
Authors: Massimini M. , Tononi G. , Huber R. 
Published: April 2009

AbstractSleep slow waves are the main phenomenon underlying NREM sleep. They are homeostatically regulated, they are thought to be linked to learning and plasticity processes and, at the same time, they are associated with marked changes in cortical information processing. Using transcranial magnetic stimulation (TMS) and high‐density (hd) EEG we can measure slow waves, induce and measure plastic changes in the cerebral cortex and directly assess corticocortical information transmission. In this manuscript we review the results of recent experiments in which TMS with hd‐EEG is used to demonstrate (i) a causal link between cortical plastic changes and sleep slow waves and (ii) a causal link between slow waves and the decreased ability of thalamocortical circuits to integrate information and to generate conscious experience during NREM sleep. The data presented here suggest a unifying mechanism linking slow waves, plasticity and cortical information integration; moreover, they suggest that TMS can be used as a nonpharmacological means to controllably induce slow waves in the human cerebral cortex.
Nonresectional palliative abdominal surgery for patients with advanced colorectal cancer
Authors: Mann C. D. , Norwood M. G. A. , Miller A. S. , Hemingway D. ,   On behalf of the Leicester Colorectal Specialist Interest Group
Published: April 2009

AbstractObjective  Nonresectional palliative abdominal surgery (e.g. defunctioning stoma/bypass) may be appropriate for patients unsuitable for curative resection, to deal with complications of advanced colorectal malignancy such as obstruction. Our aim was to review the outcome of surgery in these patients within our institution.Method  All patients undergoing palliative surgery without resection for colorectal carcinoma between July 1998 and January 2007 were identified from our prospectively compiled colorectal cancer database. Data were extracted related to patients’ demographics, presentation, tumour site, operative intervention, complications, oncological therapies, length of hospital stay and postoperative survival.Results  One hundred and ninety‐three patients were identified with a median age of 79 years (31–94 years). Fifty per cent were operated on an emergent basis for obstruction or perforation, and 50% on an elective basis. One hundred and sixty‐nine patients had defunctioning stomas formed of which 156 were loop stomas. Twenty‐four patients underwent bypass procedures. Thirty‐day mortality rate was 13.5% and postoperative morbidity rate 47%. Median survival was 247 days, with 1‐year survival of 38%. Patients undergoing operation on an emergent basis had poorer long‐term survival (127 vs 320 days, P = 0.002).Conclusion  Nonresectional palliative abdominal surgery is associated with relatively high morbidity and mortality, particularly when performed in the emergency setting. However, in this patient group with a very poor outlook, it may be offered with reasonable survival expectations.
Sex change and the genetic structure of marine fish populations
Authors: Chopelet Julien , Waples Robin S , Mariani Stefano 
Published: April 2009

AbstractThe interaction between environmental forces and dispersal characteristics is largely responsible for the patterns of population structure in marine fish. Yet, crucial gaps in knowledge on life‐histories and the relative contributions of numerous environmental factors still hinder a thorough understanding of marine population connectivity. One life‐history trait so far overlooked by most fish population geneticists is sequential hermaphroditism, whereby individuals first mature as one sex and later in life reverse into the other sex. Population genetic theory predicts that sex‐changing fish will present a higher potential for more spatially structured populations than gonochoristic species, as a result of their naturally skewed sex ratio, which is expected to reduce effective population size and hence increase genetic drift. We gathered published data on genetic population structure in marine fish, as summarized by the popular FST index, and – after controlling for several potentially confounding factors – we tested the hypothesis that sex‐changing species are more genetically structured than gonochoristic ones. Although we found no evidence to support the theoretical expectations, our results suggest new working hypotheses that can stimulate new research avenues at the intersection between physiology, genetics and fisheries science.
Supply‐Side Innovation and Technology Commercialization
Authors: Markman Gideon D. , Gianiodis Peter T. , Phan Phillip H. 
Published: April 2009

abstractThe majority of research and practice tends to conceptualize innovation as a vertically coupled, intra‐organizational process. We expand this perspective by conceptualizing innovation as a vertically decoupled, inter‐organizational process and by studying the role of research universities as suppliers of discoveries to thismarket for innovation. We combined logic from agency and real options theories to explain why the outcomes of technology commercialization are a function of licensing strategies, the autonomy of technology licensing offices (TLOs), and the incentives bestowed on scientists, research departments, and TLO officers. We rely on data from licensing surveys, interviews with 128 TLO directors, and – for convergent validity – from web‐based searches of the TLOs of American universities and the US Patent and Trademark Office. Results suggest that commercialization outcomes (in this case, revenue and start‐up creation) are enhanced when TLOs employ diverse licensing strategies, TLOs enjoy greater autonomy, universities share revenues with scientists' departments, and universities compensate TLOs officers well. Results also show that late entrants – typically underperforming universities – inflate royalty shares to scientists as a means to rectify their commercialization record. We conclude with a discussion of this study's contribution to the literature on innovation and technology commercialization.
TAKING ON INTENTIONS
Authors: Andreou Chrisoula 
Published: April 2009

AbstractI propose a model of intention formation and argue that it illuminates and does justice to the complex and interesting relationships between intentions on the one hand and practical deliberation, evaluative judgements, desires, beliefs, and conduct on the other. As I explain, my model allows that intentions normally stem from pro‐attitudes and normally control conduct, but it is also revealing with respect to cases in which intentions do not stem from pro‐attitudes or do not control conduct. Moreover, it makes the connection between forming an intention and altering one's deliberative framework transparent, and directly accounts for the fact that while intentions can affect how it makes sense for an agent to reason and what it makes sense for her to do, one cannot make an action that one is tempted to perform worth performing simply by forming a related intention.
Putting the “New” into New Trade Theory: Paul Krugman's Nobel Memorial Prize in Economics
Authors: Neary J. Peter 
Published: April 2009

AbstractThis paper reviews the scientific contributions of Paul Krugman to the study of international trade, on the occasion of his receipt of the 2008 Nobel Memorial Prize in Economics. A simplified exposition is presented of some of his principal findings, including: the effects of trade on firm scale and product diversity in a general model of monopolistic competition; the integration of monopolistic competition with factor endowments theory; the implications of transport costs, including home‐market effects and the possibility of agglomeration in models of economic geography; and the positive and normative consequences of oligopolistic trade.
Income Disparity, Inequity Aversion and the Design of the Healthcare System
Authors: Leach John 
Published: April 2009

AbstractAn ex post social welfare function is used to evaluate alternative healthcare systems. If a society is averse to inequality and there is some income disparity, social welfare under private healthcare insurance is sometimes higher and sometimes lower than social welfare under public healthcare. However, a third system—public healthcare with the option to purchase supplemental healthcare insurance—is always socially preferred to private healthcare insurance. Moreover, it is either socially preferred to public healthcare or equivalent to it.
Tax Reform, Sector‐specific Labor Supply and Welfare Effects*
Authors: Dagsvik John K. , Locatelli Marilena , Strøm Steinar 
Published: April 2009

AbstractThis paper focuses in particular on the 1992 tax reform in Norway. In this reform the top marginal tax rates were cut considerably. We find that the impact on overall labor supply is rather modest, but these modest changes shadow for stronger sectoral changes. The tax reform stimulated the women to shift their labor from the public to the private sector and to work longer hours. A calculation of mean compensated variation, calculated within the framework of a random utility model, shows that the richest households benefited far more from the 1992 tax reform than did the poorest households.
Endogenous Sunk Costs, Flexible Manufacturing and the Productivity Effects of International Trade
Authors: Eckel Carsten 
Published: April 2009

AbstractThe paper addresses the productivity effects of international trade in the presence of flexible manufacturing and endogenous sunk costs (cost‐reducing R&D). It shows that international trade raises R&D expenditures, but this will not necessarily boost productivity because of possibly counteracting market structure effects. The analysis is conducted in general equilibrium so that implications for real wages and welfare can also be addressed. Both can fall when trade leads to excessive R&D investment.