bluuebunny/crossref_metadata_2025_split huggingface dataset:
Economic Instruments to Improve UK Home Energy Efficiency without Negative Social Impacts*
Authors: Dresner Simon , Ekins Paul 
Published: March 2006

AbstractThe research examined how to use economic instruments to reduce carbon emissions from the UK housing sector without causing negative impacts on the poorest households. Carbon taxes would worsen the problem of fuel poverty. Compensation mechanisms involving the tax and benefit system were examined, but found not to be entirely effective because of the enormous range in the existing energy efficiency of homes. Exemptions for low‐income households were examined, but found impractical to target. It was concluded that the best way to use economic instruments was through a scheme involving energy audits and surcharges to council tax and stamp duty for homeowners who failed to make cost‐effective energy efficiency improvements within a specified time, with grants and loans to assist low‐income households. After the implementation of such a scheme for 10 years, it would be practical to introduce a targeted carbon tax.
The Analysis of Poverty Data with Endogenous Transitions*
Authors: Burgess Simon , Propper Carol , Dickson Matt 
Published: March 2006

AbstractIt is common to analyse poverty data broken down by household or economic status. Implicitly, it is assumed that people change state (for example, single, married, children, no children) for exogenous reasons. If we bring economic behaviour into the problem, then such transitions become endogenous. The data are then insufficient to identify the claims made from them. The distribution of the characteristics of the individuals in the states will be endogenous, and the state average poverty rate will depend on the composition of the individuals in the state as well as on the economic impact of being in that state per se. In this paper, we set out a simple model with endogenous transitions to make our point, and apply this to Family Expenditure Survey data for Britain. We show that our argument has empirical content for Britain.
Quantifying the Costs of Investment Limits for Chilean Pension Funds*
Authors: Berstein Solange M. , Chumacero Rómulo A. 
Published: March 2006

AbstractSince the creation of the Chilean pension fund industry in 1981, pension fund administrators have not been free to choose their investment portfolios because of stringent regulation of investment limits. The diagnosis implicit with the imposition of limits was that the Chilean capital market was not deep, that there was an important demand for funds to finance the expansion of the productive sector and that, due to principal‐agent problems, protection for uninformed account holders was needed. As this regulation entails an inefficient combination of risk and return, this paper quantifies its costs.
UNRESOLVED ISSUES IN DIALYSIS: Ultrapure Dialysate: Facts and Myths
Authors: Bommer Juergen , Jaber Bertrand L. 
Published: March 2006

ABSTRACTDuring hemodialysis, blood comes in contact with a large volume of dialysate. Since the purity of dialysate has been linked to acute and long‐term complications in hemodialysis patients, the limit of bacterial and endotoxin contamination has been reduced in recent years. Questions have been raised as to whether ultrapure dialysate is required to prevent such complications; in particular, the chronic inflammatory status frequently found in chronically hemodialyzed patients. In vivo and in vitro data suggest that cytokine stimulation in the blood depends on the concentration of bacteria or endotoxin in the dialysate and on the endotoxin permeability of the dialysis membrane. It is not proven whether ultrapure dialysate reduces significantly proinflammatory cytokine generation compared with standard dialysate within the limits of recent recommendations, if rather impermeable dialysis membranes are used. Cuprophane membranes are more permeable to cytokine‐inducing substances compared with synthetic membranes such as polysulfone and polyamide. Clinical reports have also attempted to link several acute and chronic complications of hemodialysis to dialysate purity. To date, however, there is no large randomized clinical trial demonstrating that ultrapure dialysate significantly reduces biomarkers of inflammation and other consequential putative complications, including dialysis‐related amyloidosis, erythropoietin requirement, and cardiovascular morbidity and mortality. In conclusion, based on the existing clinical data, ultrapure dialysate is recommended in the setting of suboptimal bacteriologic quality of standard dialysate and the use of permeable dialysis membranes.
UNRESOLVED ISSUES IN DIALYSIS: Dialyzer Best Practice: Single Use or Reuse?
Authors: Lacson Eduardo , Lazarus J. Michael 
Published: March 2006

ABSTRACTOutcome studies have shown either no additional risk or a small additional risk for hospitalization and mortality associated with reprocessing dialyzers. Although the risks from reprocessing dialyzers have yet to be fully elucidated, reuse can be done safely if it is performed in full compliance with the standards of Association for the Advancement of Medical Instrumentation (AAMI). Like most industrial processes, however, complete control of the reuse process in a clinical environment and full compliance with regulations at all times is difficult. Potential errors and breakdowns in the reuse process are continuing concerns. The quality controls for reprocessing of dialyzers are not equal to the rigor of the manufacturing process under the purview of the U.S. Food and Drug Administration (FDA). Therefore, if one were to determine “best practice,” single use is preferable to reuse of dialyzers based on medical criteria and risk assessment. The long‐term and cumulative effects of exposure to reuse reagents are unknown and there is no compelling medical indication for reprocessing of dialyzers. The major impediment when deciding to convert from reuse to single use of dialyzers is economic. The experience in Fresenius Medical Care—North America (FMCNA) facilities demonstrates that converting from a practice of reuse to single use is achievable. However, the overall economic impact of conversion to single use is provider specific. The dominance of reuse has been negated of late by a major shift in practice toward single use. Physicians and patients should be well informed in making decisions regarding the practice of single use versus reuse of dialyzers.
UNRESOLVED ISSUES IN DIALYSIS: Adiposity in Dialysis: Good or Bad?
Authors: Friedman Allon N. 
Published: March 2006

ABSTRACTThere exists in the general population a complex and mostly positive relationship between adiposity and mortality risk. Because the dialysis population has a high prevalence of excess adiposity, in addition to a strikingly elevated mortality rate, the effects of obesity are of potential clinical importance. In contrast to the general population, the preponderance of data in dialysis, particularly hemodialysis patients, suggest that adiposity has a neutral or even protective association with mortality. Although methodological concerns exist with regards to confounding and survival bias, among others, the major limitation of this body of literature is its inability to establish causality. Thus, although obese dialysis patients, with certain exceptions, appear to live longer, there is no evidence to suggest that intentional weight loss adversely affects patient outcomes. In light of these limitations and the substantial body of literature implicating obesity as a pathophysiological state, it is currently premature to advocate for excess adiposity as being beneficial or intentional weight loss as dangerous. Decisions regarding optimal weight should be made by clinicians on an individual basis and with close supervision and follow‐up. Efforts should be made to preserve lean mass during weight loss regimens by encouraging exercise and recommending sufficient protein consumption. Future research efforts in this area should focus on interventional trials designed to manipulate weight and measure outcomes, identifying potentially beneficial secretory products of adipose tissue, and documenting obesity's effects on quality of life and resource utilization in the dialysis setting.
UNRESOLVED ISSUES IN DIALYSIS: Managing Erythropoietin Hyporesponsiveness
Authors: Kwack Christina , Balakrishnan Vaidyanathapuram S. 
Published: March 2006

ABSTRACTThe anemia of chronic kidney disease is associated with cardiovascular disease, decreased quality of life, and mortality. The introduction of recombinant human erythropoietin (rHuEPO) has transformed the management of this condition. However, a significant proportion of patients fail to respond to even high doses of rHuEPO. Several factors have been implicated in the hyporesponsiveness to rHuEPO. Iron deficiency, whether absolute or functional, is considered the most important, and maintenance of adequate iron stores reduces rHuEPO requirements among patients on hemodialysis. However, traditional indices of iron that are currently utilized may not reflect iron stores accurately, and there is also increasing concern regarding the potential long‐term toxicity of parenteral iron therapy. Infection and inflammation also influence the response to rHuEPO, both by disruption of iron metabolism and by eliciting the release of cytokines that inhibit erythropoiesis. Oxidative stress may contribute to rHuEPO hyporesponsiveness directly by promoting lipid peroxidation in cell membranes, leading to increased erythrocyte fragility and reduced life span and also through its strong association with inflammation. Severe hyperparathyroidism can lead to a reduced number of erythroid progenitor cells. Inadequate dialysis dose, aluminum overload, nutritional factors such as deficiencies of carnitine, vitamin B12, folic acid, and vitamin C can also reduce the efficacy of rHuEPO therapy. Hyporesponsiveness to rHuEPO presents a challenge to both diagnosis and management in an era where optimizing response to rHuEPO is critical both in limiting the burgeoning costs of anemia management and improving clinical outcomes in the dialysis population.
Interventional Nephrology in Brazil: Current and Future Status
Authors: Nascimento Marcelo M. , Chula Domingos , Campos Rodrigo , Nascimento Daniel , Riella Miguel C. 
Published: March 2006

ABSTRACTThe care of chronic kidney disease patients frequently involves many diagnostic and interventional procedures. Most of these procedures are currently performed by radiologists, vascular surgeons, and general surgeons. This has caused fragmented medical care, which has led many nephrologists to introduce a new paradigm, often referred as interventional nephrology (IN). The aim of this study was to establish the extent of involvement of the Brazilian nephrology community with regard to specific IN procedures. From October 2004 to February 2005, questionnaires were sent by e‐mail to all 2500 nephrologists throughout Brazil. The enrollment questionnaire was composed of five sections, with questions about renal biopsy, specific training in ultrasonography, peritoneal dialysis access (insertion of peritoneal catheters guided or not by peritoneoscopy), hemodialysis vascular access (ability to place tunneled catheters, construction of arteriovenous fistulas, and other vascular access procedures), and the nephrologist's interest in being trained in IN. A total of 239 nephrologists answered the questionnaire. Only 18% of Brazilian nephrologists perform kidney biopsy guided by ultrasonography assisted by a radiologist. On the other hand, 42% of them reported that this procedure was done without any image support. Most of the respondents (85%) indicated that they were not formally trained to perform renal ultrasonography. When asked about peritoneal dialysis catheter placement, 66% of the respondents reported that they referred their patients to a surgeon for this procedure. The insertion of peritoneal dialysis catheters guided by peritoneoscopy was reported by 3% of the respondents. Similar to the results for peritoneal dialysis catheter placement, the majority of the respondents (77%) indicated no training in the insertion of tunneled catheters for temporary hemodialysis. Regarding the interest of nephrologists to participate in an IN program, the great majority (87%) responded that they would like to be trained in these procedures. Most nephrologists are not trained in IN procedures. Therefore, in Brazil, it will be necessary to develop training centers for IN that will allow nephrologists to optimize nephrology care.
A Systematic Review of the Efficacy and Safety of Atypical Antipsychotics in Patients with Psychological and Behavioral Symptoms of Dementia
Authors: Carson Susan , McDonagh Marian S. , Peterson Kim 
Published: March 2006

Although the Food and Drug Administration (FDA) has not approved atypical antipsychotics for use in patients with dementia, they are commonly prescribed in this population. Recent concerns about increased risk of cerebrovascular events and mortality have led to warnings. A systematic review was conducted to assess the benefits and harms of atypical antipsychotics when used in patients with behavioral and psychological symptoms of dementia. Electronic searches (through March 2005) of the Cochrane Library, Medline, Embase, and PsycINFO were supplemented with hand searches of reference lists, dossiers submitted by pharmaceutical companies, and a review of the FDA Website and industry‐sponsored results database. Using predetermined criteria, each study was assessed for inclusion, and data about study design, population, interventions, and outcomes were abstracted. An overall quality rating (good, fair, or poor) was assigned based on internal validity.The evidence for olanzapine and risperidone supports their effectiveness compared with placebo. Short‐term adverse events were similar to placebo. Risperidone had no advantage over haloperidol on efficacy measures in the better‐quality studies. Risperidone had an advantage over haloperidol on some measures of extrapyramidal symptoms. Evidence for the other atypical antipsychotics is too limited to assess efficacy and safety. Trials were short term and conducted in highly selected populations.The potential for increased risk of cerebrovascular adverse events and mortality is a serious concern. To make judgments about when the benefits of atypical antipsychotics outweigh the potential harms, clinicians need more information. Additional data from existing trials and more‐complete reporting of trial results could provide this information.
Lower Extremity Physical Performance and Use of Compensatory Strategies for Mobility
Authors: Hoenig Helen , Ganesh Shanti Portia , Taylor Donald H. , Pieper Carl , Guralnik Jack , Fried Linda P. 
Published: March 2006

OBJECTIVES: To compare measured lower extremity physical performance in the clinic with the methods used to carry out mobility tasks at home and to identify key factors influencing day‐to‐day task performance.DESIGN: Cross‐sectional analysis of the Women's Health and Aging Study I.SETTING: Community‐dwelling female residents of Baltimore, Maryland.PARTICIPANTS: One thousand two cognitively intact women aged 65 and older with moderate to severe physical limitations.MEASUREMENTS: Compensatory strategies reportedly used for mobility in the home, distinguishing between use of no compensatory strategies, behavioral changes only, durable medical equipment (DME) with or without behavioral change, and human help; measured lower extremity (LE) physical performance (gait speed, timed chair stands, balance).RESULTS: There was a statistically significant difference in LE physical performance between women using the four types of compensatory strategy (P<.001). Women who used DME for mobility in the home had worse performance than those using human help who in turn had worse performance than those with behavioral changes only; women reporting no compensatory strategies for in‐home mobility performed best. Sequential multivariate logistic regressions identified several factors other than LE physical performance that were associated with use of specific compensatory strategies. Medical conditions, education, and environmental barriers influenced whether compensatory strategies were used at all, whereas income, contact with health providers, and availability of help in the home influenced the type of compensatory strategy.CONCLUSION: Physical abilities are an important factor influencing use of compensatory strategies for mobility, but several other factors also influence the ways that women adapt to mobility limitations.
Memory Complaint Is Not Necessary for Diagnosis of Mild Cognitive Impairment and Does Not Predict 10‐Year Trajectories of Functional Disability, Word Recall, or Short Portable Mental Status Questionnaire Limitations
Authors: Purser Jama L. , Fillenbaum Gerda G. , Wallace Robert B. 
Published: March 2006

OBJECTIVES: To evaluate the prevalence and utility of memory complaint in a geographically representative cohort and, in cases with mild cognitive impairment (MCI), to determine whether memory complaint alters 10‐year trajectories of disability in activities of daily living (ADLs), Short Portable Mental Status Questionnaire (SPMSQ) score, and 20‐item word recall.DESIGN: Prospective cohort study.SETTING: Washington and Iowa counties, Iowa.PARTICIPANTS: Iowa Established Populations for Epidemiologic Studies of the Elderly (N=3,673; aged ≥65; 61.3% female; 99.9% white).MEASUREMENTS: Age, sex, education, SPMSQ score, 20‐item word recall, ADL or instrumental ADL disability, and chronic medical conditions.RESULTS: The prevalence of memory complaint was 34%. Although proportionally more cognitively impaired individuals were in the memory complaint group (34% vs 27%), the pattern of subclassification into cognitively intact and MCI Stage 1 and 2 subgroups was similar for people with and without memory complaint. Median SPMSQ score and number of words recalled at baseline were comparable across memory complaint categories in each subgroup. MCI participants without subjective memory complaint constituted a larger proportion of the overall sample than individuals with subjective memory complaint (460 (14%) vs 295 (8.9%)) and of persons objectively classified as having MCI (61% vs 39%). The distribution of individual 10‐year change in ADL disability, SPMSQ score, and word recall were similar for those with and without memory complaint across all subgroups of cognitive impairment.CONCLUSION: Memory complaint is not necessary for MCI diagnosis and does not distinguish cases with different progression rates in disability or cognitive impairment. 2006.
Rates of Acute Care Admissions for Frail Older People Living with Met Versus Unmet Activity of Daily Living Needs
Authors: Sands Laura P. , Wang Yun , McCabe George P. , Jennings Kristofer , Eng Catherine , Covinsky Kenneth E. 
Published: March 2006

OBJECTIVES: To determine whether older people who do not have help for their activity of daily living (ADL) disabilities are at higher risk for acute care admissions and whether entry into a program that provides for these needs decreases this risk.DESIGN: A longitudinal cohort study.SETTING: Thirteen nationwide sites for the Program of All‐inclusive Care for the Elderly (PACE). PACE provides comprehensive medical and long‐term care to community‐living older adults.PARTICIPANTS: Two thousand nine hundred forty‐three PACE enrollees with one or more ADL dependencies.MEASUREMENTS: Unmet needs were defined as the absence of paid or unpaid assistance for ADL disabilities before PACE enrollment. Hospital admissions in the 6 months before PACE enrollment and acute admissions in the first 6 weeks and the 7th through 12th weeks after enrollment were determined.RESULTS: Those who lived with unmet ADL needs before enrollment were more likely to have a hospital admission before PACE enrollment (odds ratio (OR)=1.28, 95% confidence interval (CI)=1.01–1.63) and an acute admission in the first 6 weeks after enrollment (OR=1.45, 95% CI=1.00–2.09) but not after 6 weeks of receiving PACE services (OR=0.86, 95% CI=0.53–1.40).CONCLUSION: Frail older people who live without needed help for their ADL disabilities have higher rates of admissions while they are living with unmet ADL needs but not after their needs are met. With state governments under increasing pressure to develop fiscally feasible solutions for caring for disabled older people, it is important that they be aware of the potential health consequences of older adults living without needed ADL assistance.
Genetic Profile of Nine Autosomal STR Loci Among Halakki and Kunabhi Populations of Karnataka, India
Authors: Thangaraj Kumarasamy , Chaubey Gyaneshwer , Singh Vijay Kumar , Reddy Alla G. , Pavate P. P. , Singh Lalji 
Published: March 2006

POPULATION: Blood samples were collected from a total of 84 healthy and unrelated Halakki (44) and Kunabhi (40) populations, with their informed written consent. The geographic location of the sampled area is shown in Fig. 1. Both the populations are endogamous, and they belong to Dravidian linguistic family. Halakki is a tribal group having a population size of approximately 3383. They claim that they originally belong to Gujarat and Rajasthan, and migrated through Andhra Pradesh to Karnataka. Kunabhi is also a tribal population, who are approximately 35,214 in number. The male Kunabhi can be identified by their tattoo marks. A necklace is the symbol of married women. They were hunters and gatherers, but at present they practice agriculture.image
Black teeth: beauty or caries prevention? Practice and beliefs of the Kammu people
Authors: Tayanin Gisela Ladda , Bratthall Douglas 
Published: March 2006

Abstract –  Background:  To be beautiful and caries‐free, Kammu women in Laos and Vietnam habitually paint their teeth black. Although this practice existed for many generations, it is now known only among the elderly.Objectives:  To describe how the tooth‐blackening procedure is performed and to test the black stain for possible antimicrobial effects in laboratory experiments.Methods:  Information on how to blacken teeth was obtained by interviewing groups of elderly Kammu people living in different villages in Laos and Vietnam. Water extracts of the stain were placed in wells in agar plates and the plates incubated with Streptococcus mutans or S. sobrinus. The stain was also let such that it covered half of the strip test‐side of the Dentocult SM® Strip Mutans test kit and incubated with saliva from five persons known to carry mutans streptococci in their saliva.Results:  Interviews revealed that three plants were commonly used: Dracontomelon dao nuts (DD nuts), Cratoxylum formosum (CF) wood or Croton cascarilloides (CC) wood. The parts (nut, wood) were burned and soot collected on metal plates. The fresh soot, which had a viscous consistency, was applied to teeth with the index finger. Extracts of soot of the DD nuts had no effect on the streptococci on agar plates but inhibited the growth of salivary mutans streptococci on strips. Controls using soot from birch tree (Betula pendula) had no effect.Conclusions:  The procedure was simple and resulted in black, beautiful (?) teeth. The soot of DD nuts effectively inhibited growth of salivary mutans streptococci in in vitro experiments.