bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients with Temporoparietal Ictal Symptoms and Inferomesial EEG Do Not Benefit from Anterior Temporal Resection
Authors: Aghakhani Yahya , Rosati Anna , Dubeau François , Olivier André , Andermann Frederick 
Published: February 2004

Summary:  Purpose: The role of posterior structural lesions leading to inadequate results after inferomesial temporal resection is well recognized. Here we present poor surgical outcome in six patients with nonlesional intractable epilepsy, well‐defined focal anterior and inferomesial temporal epileptic discharges, and posterior temporoparietal symptoms. Methods: We reviewed patient data including scalp video‐EEG telemetry, intracranial EEG recording, magnetic resonance imaging (MRI) sequences (1.5 Tesla), and single‐photon emission computed tomography (SPECT) findings. Results: Ictal onset was uni‐ or bilateral diffuse with late preponderance over one temporal, or centrotemporoparietal regions. Four patients had preresection intracranial EEG monitoring, which suggested an epileptogenic zone in the posterior temporal and inferior parietal area in two, in the temporal lobe in one, and was inconclusive in the remaining one, who showed late epileptiform activity in the temporal neocortex. A second intracranial implantation was performed in three of them after a first anterior temporal resection. This led to posterior temporal neocortical localization in two and posterior temporal–inferior parietal localization in one. Including subpial transection, these six patients had one to four operations each, but only limited improvement occurred as a result of surgery in this group of individuals. Conclusions: We conclude that anterior and inferomesial interictal epileptiform temporal discharges and at times even intracranial EEG monitoring may be misleading. Anteromesial temporal resection is ineffective in patients with posterior temporoparietal clinical ictal features.
Autosomal Dominant Lateral Temporal Epilepsy: Two Families with Novel Mutations in the LGI1 Gene
Authors: Hedera Peter , Abou‐Khalil Bassel , Crunk Amy E. , Taylor Kelly A. , Haines Jonathan L. , Sutcliffe James S. 
Published: February 2004

Summary:  Purpose: Mutations in the leucine rich, glioma inactivated gene (LGI1) were recently described in a small number of families with autosomal dominant lateral temporal epilepsy (ADLTE). ADLTE is characterized by partial seizures with symptoms suggestive of a lateral temporal onset, including frequent auditory aura. Here we report the results of clinical and genetic analyses of two newly identified families with ADTLE. Methods: We identified two families whose seizure semiology was suggestive of ADLTE. Evaluation included a detailed history and neurologic examination, as well as collection of DNA. The coding sequence of the LGI1 gene from affected subjects from both families was analyzed for evidence of mutation. Results: Each patient had a history of partial seizures, often with secondary generalization earlier in the course. Auditory aura was reported by approximately two thirds of affected patients in each pedigree. Novel mutations in LGI1 were detected in both families. A heterozygous single‐nucleotide deletion at position 329 (del 329C) was detected in affected individuals from one family, whereas patients from the second family had a nonsynonymous variation, corresponding to C435G. Conclusions: We identified two novel mutations in the LGI1 gene. The phenotype of these two families was similar to that of other kindreds with ADLTE, as auditory aura was absent in one third of affected individuals. Our results further support that LGI1 mutations should be considered in patients with a history of partial seizures if the semiology of seizures is consistent with the onset in the lateral temporal lobe.
Epilepsy Duration, Febrile Seizures, and Cerebral Glucose Metabolism
Authors: Theodore William H. , Kelley Kathey , Toczek Maria T. , Gaillard William D. 
Published: February 2004

Summary:  Purpose: Studies using magnetic resonance imaging have shown that reduced hippocampal volume is associated with a history of febrile seizures, the duration of epilepsy, and the number of generalized tonic–clonic seizures. It is uncertain whether these factors have the same influence on functional as on structural measures of the integrity of the epileptogenic zone. Methods: We used positron emission tomography (PET) with fluorine 18 2‐deoxyglucose to study 91 patients with temporal lobe seizure foci localized by ictal video‐EEG. PET was performed in the awake interictal resting state with ears plugged and eyes patched. We recorded surface EEG during injection (5 mCi) and the 30‐min uptake period. We used a standard template to analyze PET scans. Results: A significant negative relation was found between the duration of epilepsy and hippocampal glucose metabolism ipsilateral to the epileptic focus. Patients with a history of either any febrile seizures, or complex, or prolonged febrile seizures, did not have greater hypometabolism ipsilateral to the epileptic focus than did patients without a febrile seizure history. We found no effect of generalized tonic–clonic seizure history. Conclusions: Longer epilepsy duration is associated with greater hypometabolism, suggesting that epilepsy is a progressive disease.
A Comparison of HMO Efficiencies as a Function of Provider Autonomy
Authors: Brockett Patrick L. , Chang Ray E. , Rousseau John J. , Semple John H. , Yang Chuanhou 
Published: February 2004

AbstractCurrent debates in the insurance and public policy literatures over health care financing and cost control measures continue to focus on managed care and HMOs. The lower utilization rates found in HMOs (compared to traditional fee‐for‐service indemnity plans) have generally been attributed to the organization's incentive to eliminate all unnecessary medical services. As a consequence HMOs are often considered to be a more efficient arrangement for delivering health care. However, it is important to make a distinction between utilization and efficiency (the ratio of outcomes to resources). Few studies have investigated the effect that HMO arrangements would have on the actual efficiency of health care delivery. Because greater control over provider autonomy appears to be a recurrent theme in the literature on reform, it is important to investigate the effects these restrictions have already had within the HMO market. In this article, the efficiencies of two major classes of HMO arrangements are compared using “game‐theoretic” data envelopment analysis (DEA) models. While other studies confirm that absolute costs to insurance firms and sponsoring companies are lowered using HMOs, our empirical findings suggest that, within this framework, efficiency generally becomes worse when provider autonomy is restricted. This should give new fuel to the insurance companies providing fee‐for‐service (FFS) indemnification plans in their marketplace contentions.
Why Are Managed Care Plans Less Expensive: Risk Selection, Utilization, or Reimbursement?
Authors: Polsky Daniel , Nicholson Sean 
Published: February 2004

AbstractThis article develops a new method of decomposing the cost difference between HMO and non‐HMO plans into observed risk selection, unobserved risk selection, utilization differences, and differences in provider reimbursement rates. We implement this method using a large national sample of employer‐sponsored health insurance enrollees from the Community Tracking Study Household Survey. We find no evidence that HMO plans attract a disproportionate share of low‐risk enrollees; the US$188 difference between HMO and non‐HMO medical expenditures per enrollee can be explained by the relatively low provider reimbursement rates paid by HMO plans. This indicates there may be little need for employers to risk adjust insurance premiums or otherwise restrict employee choice of plan types.
The Effects of Uncertainty on the Demand for Health Insurance
Authors: Koç Çaḡatay 
Published: February 2004

AbstractThis article analyzes the effects of uncertainty and increases in risk aversion on the demand for health insurance using a theoretical model that highlights the interdependence between insurance and health care demand decisions. Two types of uncertainty faced by the individuals are examined. The first one is the uncertainty in the consumer's pretreatment health and the second is the uncertainty surrounding the productivity of health care. Comparative statics results are reported indicating the impact on the demand for insurance of shifts in the distributions of pretreatment health and productivity of health care in the form of first‐order stochastic dominance, Rothschild–Stiglitz mean‐preserving spreads, and second‐order stochastic dominance. The demand for insurance increases in response to a Rothschild–Stiglitz increase in risk in the distribution of the pretreatment health provided that the health production function is in a special class and the price elasticity of health care is nondecreasing in the pretreatment health. Provided also that the demand for health care is own‐price inelastic, the same conclusion is obtained when the uncertainty is about the productivity of health care.
The Impact of the Health Insurance Market on Small Firm Employment
Authors: Kapur Kanika 
Published: February 2004

AbstractSmall firms that offer health insurance to their employees may face variable premiums if they hire employees with high expected health costs. To avoid expensive premium variability, small firms may attempt to maintain a workforce with low expected health costs. This results in employment distortions. I examine the magnitude of these employment distortions using the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Based on the underwriting behavior of insurance companies in 1988, I classify medical conditions into three categories: conditions that led to denial of coverage; conditions that led to exclusion restrictions; and, conditions that led to higher premiums. In 1987, I find that insured small firms were less likely to employ workers with families that had conditions that led to higher premiums than insured large firms. However, in 1996, possibly due to the passage of small group health insurance reforms that restrict insurers' ability to exclude or deny coverage, insured small firms were less likely to employ workers with denial conditions compared to insured large firms. These results suggest that the pattern of employment distortions in insured small firms is consistent with the evolving small group health insurance market.
An Analysis of the Effect of Tax Policy on Health Insurance Purchases by Risk Group
Authors: Ketsche Patricia G. 
Published: February 2004

AbstractThere is an extensive body of literature dealing with the welfare loss associated with generous levels of health insurance as a function of the tax subsidy. The theoretical discussion in this study considers the effect of the tax subsidy on pooling within plans, and suggests the hypotheses that the tax subsidy will have a disproportionately positive effect on the likelihood that a high‐risk worker will be eligible for and participate in employment‐based coverage, while the effect of the tax subsidy on plan generosity will be greatest for low‐risk employees. If coverage of high‐risk individuals enhances social welfare, this result may offset, at least in part, the welfare loss associated with generous plans. Data from the 1987 National Medical Expenditure Survey are used to test these hypotheses. The results provide evidence that the subsidy works to expand risk pools in the employment‐based health insurance market.
Pure Versus Mutual Health Insurance: Evidence From Swedish Historical Data
Authors: Nekby Lena 
Published: February 2004

AbstractUsing data from voluntary Swedish health insurance societies 1902‐1910, this article analyzes the coexistence of pure and mutual insurance societies where pure societies are characterized by charging ex ante premiums only while mutuals in addition charge ex post assessments. On average, mutual insurance societies are found to be larger and to offer greater insurance coverage per member. Pure insurance societies have, on average, higher insurance coverage per day, greater mean levels of moral hazard controls, a higher mean number of policy categories, and greater longevity.
Production Efficiency in the Austrian Insurance Industry: A Bayesian Examination
Authors: Ennsfellner Karl C. , Lewis Danielle , Anderson Randy I. 
Published: February 2004

AbstractThis paper examines the developments in the production efficiency of the Austrian insurance market for the period 1994‐1999 using firm‐specific data on life/health and non‐life insurers obtained from the Austrian insurance regulatory authority. The article uses a Bayesian stochastic frontier to obtain aggregate and firm‐specific estimates of production efficiency across insurer types and time. The study provides strong evidence that the process of deregulation had positive effects on the production efficiency of Austrian insurers. The life/health and non‐life firms showed similar patterns of development in that they were less efficient during the years 1994‐1996 and significantly more efficient in 1997‐1999. If the Austrian experience is representative, similar benefits from deregulation may be expected for the Central and Eastern European countries that prepare for the accession to the European Union.
A Critical Look at Risk Assessments for Global Catastrophes
Authors: Kent Adrian 
Published: February 2004

Recent articles by Busza et al. (BJSW) and Dar et al. (DDH) argue that astrophysical data can be used to establish small bounds on the risk of a “killer strangelet” catastrophe scenario in the RHIC and ALICE collider experiments. The case for the safety of the experiments set out by BJSW does not rely solely on these bounds, but on theoretical arguments, which BJSW find sufficiently compelling to firmly exclude any possibility of catastrophe.Nonetheless, DDH and other commentators (initially including BJSW) suggested that these empirical bounds alone do give sufficient reassurance. This seems unsupportable when the bounds are expressed in terms of expectation value—a good measure, according to standard risk analysis arguments. For example, DDH's main bound, pcatastrophe < 2 × 10−8, implies only that the expectation value of the number of deaths is bounded by 120; BJSW's most conservative bound implies the expectation value of the number of deaths is bounded by 60,000.This article reappraises the DDH and BJSW risk bounds by comparing risk policy in other areas. For example, it is noted that, even if highly risk‐tolerant assumptions are made and no value is placed on the lives of future generations, a catastrophe risk no higher than ≈10−15 per year would be required for consistency with established policy for radiation hazard risk minimization. Allowing for risk aversion and for future lives, a respectable case can be made for requiring a bound many orders of magnitude smaller.In summary, the costs of small risks of catastrophe have been significantly underestimated by BJSW (initially), by DDH, and by other commentators. Future policy on catastrophe risks would be more rational, and more deserving of public trust, if acceptable risk bounds were generally agreed upon ahead of time and if serious research on whether those bounds could indeed be guaranteed was carried out well in advance of any hypothetically risky experiment, with the relevant debates involving experts with no stake in the experiments under consideration.
Characterization of MCH‐gene‐overprinted‐polypeptide‐immunoreactive material in hypothalamus reveals an inhibitory role of pro‐somatostatin1−64 on somatostatin secretion
Authors: Allaeys Isabelle , Bouyer Karine , Loudes Catherine , Faivre‐Bauman Annie , Petit Florence , Ortola Christine , Cardinaud Bruno , Epelbaum Jacques , Nahon Jean‐Louis 
Published: February 2004

AbstractThe melanin‐concentrating hormone (MCH) gene encodes two proteins, pro‐MCH and MCH‐gene‐overprinted polypeptide (MGOP), produced through alternative splicing of the primary transcript. Our initial purpose was to characterize the MGOP‐immunoreactive material. First, MGOP mRNA was clearly found in rat and mouse hypothalami but Western blot analysis failed to unambiguously identify MGOP in protein extracts. Immunohistochemical experiments with wild‐type and MCH gene‐null mice demonstrated genuine expression of MGOP confined to the MCH‐containing neurons in the lateral hypothalamus area and the presence of an ‘MGOP‐like’ antigen in periventricular nucleus and arcuate nucleus neurons and their area of projection. This suggested a colocalization in somatostatin (SRIF) hypophysiotropic neurons. Further characterization, using SRIF gene‐null mice and Western blot analysis with recombinant proteins, revealed that the MGOP‐like product was pro‐SRIF1−64. The role of pro‐SRIF1−64 on fetal hypothalamic neurons was evaluated and a strong tonic inhibitory effect on SRIF secretion was found. These results (i) indicate that MGOP expression is restricted to the MCH neurons in the lateral hypothalamus and that MGOP‐like immunoreactivity outside this system corresponds to pro‐SRIF1−64, and (ii) provide the first evidence for a negative feedback regulation by pro‐SRIF1−64 on SRIF secretion, suggesting new mechanisms by which the pro‐region of a neuropeptide precursor may control the regulated secretion of a neuropeptide derived from the same precursor.
Enhancement of stimulation‐induced ERK activation in the spinal dorsal horn and gracile nucleus neurons in rats with peripheral nerve injury
Authors: Wang Hu , Dai Yi , Fukuoka Tetsuo , Yamanaka Hiroki , Obata Koichi , Tokunaga Atsushi , Noguchi Koichi 
Published: February 2004

AbstractIt has been suggested that low‐threshold sensory pathways have an important role in the formation and maintenance of sensory abnormalities which are observed after peripheral nerve injury. In the present study, we examined the involvement of these pathways in the development of hyperexcitability after sciatic nerve injury (SNI) by detecting the intracellular signal molecule. The rats that received a transection of the sciatic nerve 7 days before were electrically stimulated at 0.1 mA and 3 mA in the proximal region of the nerve injury site. We found a small number of phosphorylated extracellular signal‐regulated kinase (pERK)‐labelled neurons in laminae I–II and III–IV of the spinal dorsal horn in the control rats after 0.1 mA stimulation. By contrast, there was a marked increased of pERK‐labelled neurons both in the superficial laminae and laminae III–IV after the same stimulation in the SNI rats. Enhancement of ERK activation induced by 3 mA stimulation was also observed. Immunoreactivity of pERK in gracile nucleus neurons was also dramatically increased after 0.1 mA stimulation to the injured nerve. These data suggest that the rats with peripheral nerve injury had an increased responsiveness to the low‐ or high‐threshold peripheral stimuli in I–II, III–IV and gracile nucleus neurons. Furthermore, SNI rats that received neonatal capsaicin treatment showed a decreased number of pERK neurons after 0.1 mA stimulation in the dorsal horn and gracile nucleus neurons compared to the control rats. Thus, C‐fibres may contribute to the enhanced excitability of the low‐threshold sensory neurons after peripheral nerve injury.
008  The Effect of the Gelatin Sheet Containing bFGF on Wound Healing
Authors: Michiyo Goji , Shigehiko Suzuki , Takeshi Kawazoe , Yasumi Saso , Hisayuki Mihara , Yasuhiko Tabata 
Published: February 2004

Aim: It is well recognized that bFGF accelerates proliferation of almost all cells concerned with wound healing and there is a report that bFGF was well sorbed with time to the acidic gelatin hydrogel with isoelectric points of 5.0. We investigated the effect of the acidic gelatin sheet containg bFGF. Methods: Full thickness defects of skin (1.5 × 1.5 cm) were created on the backs of mice.1) The wounds were covered with gelatin sheets (2 × 2 cm)containg bFGF(100 ìg/site), (A), and without bFGF(B). The concentration of bFGF in plasma was estimated by ELISA. 2) The wounds were covered with A, B and hydrogel dressing(control group, C) and wound area was measured with computer planimeter and neoepithelium was observed using the light microscope. Results: 1) The concentration of bFGF in plasma in (A) was statistically greater than (B) by the 7th day. 2) Statistically smaller wound area was found 2 weeks postoperatively in (A) than in (C) and (D). Neoepithelium from edge of the wound was statistically longer in (A) than in (C). Conclusions: Controlled release of bFGF from the acidic gelatin sheet was fouhd and acidic gelatin sheet containg bFGF promoted neoepithelization and wound closure. The acidic gelatin sheet containg bFGF was thought to be effective on wound healing.
024  Accelerated Epithelization of STSG Donor Wounds by Cultured Cellular Sheet Composed of Mixture of Keratinocytes and Fibroblasts
Authors: Yoshihiro Takami , Hideharu Tanaka , Takako Wada , Mika Enoki , Ryo Yamaguchi , Hiroshi Miyauchi , Hideaki Goto , Takeo Koizumi , Matsuda Taketo , Shimazaki Syuuji , Ken Ogo 
Published: February 2004

Aim: Available donor skin is so limited in extensive burns that wounds are usually closed using STSG harvested repeatedly from unburned skin. In such cases, it is important to accelerate the epithelization process of the donor wounds. We have developed a cultured cellular sheet composed of mixture of keratinocytes (KC) and fibroblasts (FB) seeded on a polyurethane membrane (mixed culture sheet) and investigated its effectiveness for the wound healing of STSG donor wounds. Methods: Normal human KC and FB were primarily cultured from a surplus human skin in a skin graft surgery. After a few passages of the cultivation, both cells were seeded on a thin polyurethane membrane. Each seeding density of KC and FB were equal. Several days after the co‐cultivation, the mixed culture sheet was transferred to a freshly harvested STSG donor wound in an extensive burn patient. A polyurethane membrane without cells was used for control coverage. Seven patients were treated using the mixed culture sheets. Autologous cells were used in 3 cases, and allogenic cells were used in the other 4 cases. The time for the final epithelization was determined. In vitro production of several growth factors by a cellular sheet was also investigated by ELASA. Results and Conclusion: TGF‐alpha, EGF, TGF‐beta, VEGF were well produced by the mixed culture sheet. The time for final epithelization of the wounds was reduced by 2.5 days with the mixed culture sheet application as compared to the control sites. It was suggested that the mixed culture sheet may be useful for the treatment of STSG donor wounds.