Preoperative predictors of extended hospital length of stay following total knee arthroplasty.

The purpose of this study was to identify the preoperative predictors of hospital length of stay after primary total knee arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not require scoring systems. A single-center, multi-surgeon retrospective chart review of two hundred and sixty consecutive patients who underwent primary total knee arthroplasty was performed. The mean length of stay was 3.0 days. Among the different variables studied, increasing comorbidities, lack of adequate assistance at home, and bilateral surgery were the only multivariable significant predictors of longer length of stay. The study was adequately powered for statistical analyses and the concordance index of the multivariable logistic regression model was 0.815.

What the brain stem tells the frontal cortex. II. Role of the SC-MD-FEF pathway in corollary discharge.

One way we keep track of our movements is by monitoring corollary discharges or internal copies of movement commands. This study tested a hypothesis that the pathway from superior colliculus (SC) to mediodorsal thalamus (MD) to frontal eye field (FEF) carries a corollary discharge about saccades made into the contralateral visual field. We inactivated the MD relay node with muscimol in monkeys and measured corollary discharge deficits using a double-step task: two sequential saccades were made to the locations of briefly flashed targets. To make second saccades correctly, monkeys had to internally monitor their first saccades; therefore deficits in the corollary discharge representation of first saccades should disrupt second saccades. We found, first, that monkeys seemed to misjudge the amplitudes of their first saccades; this was revealed by systematic shifts in second saccade end points. Thus corollary discharge accuracy was impaired. Second, monkeys were less able to detect trial-by-trial variations in their first saccades; this was revealed by reduced compensatory changes in second saccade angles. Thus corollary discharge precision also was impaired. Both deficits occurred only when first saccades went into the contralateral visual field. Single-saccade generation was unaffected. Additional deficits occurred in reaction time and overall performance, but these were bilateral. We conclude that the SC-MD-FEF pathway conveys a corollary discharge used for coordinating sequential saccades and possibly for stabilizing vision across saccades. This pathway is the first elucidated in what may be a multilevel chain of corollary discharge circuits extending from the extraocular motoneurons up into cerebral cortex.

Fuerzas impulsoras de una organización colectiva exitosa : el caso de los pequeños productores de banano orgánico para exportación en Perú

En Perú muchos de los pequeños productores de banano se han organizado en asociaciones y su producción tradicional de banano convencional está siendo reemplazada por la producción de banano orgánico. Una de estas asociaciones es la de pequeños productores de banano orgánico de Samán y Anexos (APPBOSA) que a partir del año 2008 viene exportando su producción sin intermediarios e incrementando las cantidades exportadas cada año. Esta ocupa el primer puesto en el ranking de exportación de banano orgánico de Perú. Teniendo en cuenta que todas las asociaciones operan bajo el mismo ambiente institucional formal, surge como pregunta de investigación cuáles han sido las fuerzas impulsoras de APPBOSA sobre las que se ha apalancado el éxito de esta asociación. El objetivo de este trabajo fue estudiar la relación entre el crecimiento de las exportaciones de banano orgánico de APPBOSA y los factores de los ambientes organizacional, tecnológico y comercial para identificar aquellos de mayor relevancia sobre crecimiento exportador de la asociación. La metodología de trabajo utilizada fue el estudio de caso simple incrustado, utilizando como tipo de investigación la epistemología fenomenológica y combinando la investigación cualitativa con la cuantitativa (mediante encuestas). Se encuestaron 100 socios (24 por ciento) de la organización en base a un muestreo aleatorio simple. Los resultados se procesaron a partir del software PC-ORD con herramientas de análisis multivariado: Análisis de Componentes Principales (ACP) y el Análisis de Cluster. Del análisis de las variables del ambiente organizacional surge que la transacción entre el productor asociado y APPBOSA está alineada, existe dependencia bilateral y bajos costos de transacción. Los productores presentaron un reconocimiento positivo en torno a la variable del liderazgo y conformidad en el precio y plazo de pago. En el ambiente tecnológico los asociados manifestaron un alto impacto de la tecnología implementada por APPBOSA, que les permitió posicionarse por encima de la media tecnológica del subsistema de banano orgánico de Perú. En el ambiente comercial, se caracterizó por dos estrategias: la diferenciación y la segmentación (mercado de orgánico y comercio justo). Se encontró alta conformidad de los asociados en torno a las decisiones comerciales tomadas por la asociación. A partir del ACP se retuvieron los dos primeros autovalores (F1: liderazgo y F2: estrategias comerciales) por acumular el 62,38 por ciento del total de la varianza. Los indicadores de conformidad de precio y plazo de pago guardaron una alta correlación positiva con las estrategias comerciales y con la innovación tecnológica. Se concluye que las fuerzas impulsoras sobre las que se apalancó el éxito exportador de APPBOSA tienen su base en la dependencia bilateral entre productores y Asociación, donde con un objetivo común, innovaron y definieron estrategias comerciales acordes a un negocio de especialidad y bajo un liderazgo marcado. De este modo, fue posible que pequeños productores alcancen mediante la acción colectiva, a ubicar su producto en el mercado externo.

Fuerzas impulsoras de una organización colectiva exitosa : el caso de los pequeños productores de banano orgánico para exportación en Perú

En Perú muchos de los pequeños productores de banano se han organizado en asociaciones y su producción tradicional de banano convencional está siendo reemplazada por la producción de banano orgánico. Una de estas asociaciones es la de pequeños productores de banano orgánico de Samán y Anexos (APPBOSA) que a partir del año 2008 viene exportando su producción sin intermediarios e incrementando las cantidades exportadas cada año. Esta ocupa el primer puesto en el ranking de exportación de banano orgánico de Perú. Teniendo en cuenta que todas las asociaciones operan bajo el mismo ambiente institucional formal, surge como pregunta de investigación cuáles han sido las fuerzas impulsoras de APPBOSA sobre las que se ha apalancado el éxito de esta asociación. El objetivo de este trabajo fue estudiar la relación entre el crecimiento de las exportaciones de banano orgánico de APPBOSA y los factores de los ambientes organizacional, tecnológico y comercial para identificar aquellos de mayor relevancia sobre crecimiento exportador de la asociación. La metodología de trabajo utilizada fue el estudio de caso simple incrustado, utilizando como tipo de investigación la epistemología fenomenológica y combinando la investigación cualitativa con la cuantitativa (mediante encuestas). Se encuestaron 100 socios (24 por ciento) de la organización en base a un muestreo aleatorio simple. Los resultados se procesaron a partir del software PC-ORD con herramientas de análisis multivariado: Análisis de Componentes Principales (ACP) y el Análisis de Cluster. Del análisis de las variables del ambiente organizacional surge que la transacción entre el productor asociado y APPBOSA está alineada, existe dependencia bilateral y bajos costos de transacción. Los productores presentaron un reconocimiento positivo en torno a la variable del liderazgo y conformidad en el precio y plazo de pago. En el ambiente tecnológico los asociados manifestaron un alto impacto de la tecnología implementada por APPBOSA, que les permitió posicionarse por encima de la media tecnológica del subsistema de banano orgánico de Perú. En el ambiente comercial, se caracterizó por dos estrategias: la diferenciación y la segmentación (mercado de orgánico y comercio justo). Se encontró alta conformidad de los asociados en torno a las decisiones comerciales tomadas por la asociación. A partir del ACP se retuvieron los dos primeros autovalores (F1: liderazgo y F2: estrategias comerciales) por acumular el 62,38 por ciento del total de la varianza. Los indicadores de conformidad de precio y plazo de pago guardaron una alta correlación positiva con las estrategias comerciales y con la innovación tecnológica. Se concluye que las fuerzas impulsoras sobre las que se apalancó el éxito exportador de APPBOSA tienen su base en la dependencia bilateral entre productores y Asociación, donde con un objetivo común, innovaron y definieron estrategias comerciales acordes a un negocio de especialidad y bajo un liderazgo marcado. De este modo, fue posible que pequeños productores alcancen mediante la acción colectiva, a ubicar su producto en el mercado externo.

Birth-death processes with disaster and instantaneous resurrection

A new structure with the special property that instantaneous resurrection and mass disaster are imposed on an ordinary birth-death process is considered. Under the condition that the underlying birth-death process is exit or bilateral, we are able to give easily checked existence criteria for such Markov processes. A very simple uniqueness criterion is also established. All honest processes are explicitly constructed. Ergodicity properties for these processes are investigated. Surprisingly, it can be proved that all the honest processes are not only recurrent but also ergodic without imposing any extra conditions. Equilibrium distributions are then established. Symmetry and reversibility of such processes are also investigated. Several examples are provided to illustrate our results.

Beneficial ownership and detriment

Considers the factors which contribute to a court finding that a cohabitee has a beneficial interest in property, in particular the detriment which is required to establish a constructive trust, with reference to the Chancery Division decision in Levi v Levi and previous case law. Outlines the provisions on express or inferred common intention. Considers whether a loan of money from the non-owning to the owning cohabitant, made at a lower level than commercial loans, towards the purchase the property was sufficient detriment to entitle her to proceeds of sale from the property.

The influence of crank configuration on muscle activity and torque production during arm crank ergometry

This study investigated the effect of crank configuration on muscle activity and torque production during submaximal arm crank ergometry. Thirteen non-specifically trained male participants volunteered. During the research trials they completed a warm-up at 15 W before two 3-min exercise stages were completed at 50 and 100 W; subjects used either a synchronous or asynchronous pattern of cranking. During the final 30-s of each submaximal exercise stage electromyographic and torque production data were collected. After the data had been processed each parameter was analysed using separate 2-way ANOVA tests with repeated measures. The activity of all muscles increased in line with external workload, although a shift in the temporal pattern of muscle activity was noted between crank configurations. Patterns of torque production during asynchronous and synchronous cranking were distinct. Furthermore, peak, minimum and delta (peak-minimum) torque values were different (P < 0.05) between crank configurations at both workloads. For example, at 100 W, peak torque using synchronous [19.6 (4.3) Nm] cranking was higher (P < 0.05) compared to asynchronous [16.8 (1.6) Nm] cranking. In contrast minimum torque was lower (P < 0.05) at 100 W using synchronous [4.8 (1.7) Nm] compared to asynchronous [7.3 (1.2) Nm] cranking. There was a distinct bilateral asymmetry in torque production during asynchronous cranking with the dominant transmitting significantly more force to the crank arm. Taken together, these preliminary data demonstrate the complex nature of muscle activity during arm crank ergometry performed with an asynchronous or synchronous crank set-up. Further work is required to determine how muscle activity (EMG activity) and associated patterns of torque production influence physiological responses and functional capacity during arm crank ergometry.

Relational dimensions of corporate governance in translation: networked governance in China and India

The effectiveness of corporate governance mechanisms has been a subject of academic research for many decades. Although the large majority of corporate governance studies prior to mid 1990s were based on data from developed market economies such as the U.S., U.K. and Japan, in recent years researchers have begun examining corporate governance in transition economies. A comparison of China and India offers a unique environment for analyzing the effectiveness of corporate governance. First, both countries state-owned enterprise (SOE) reform strategies hinges on the Modern Enterprise System characterized by the separation of ownership and control. Ownership of an SOE’s assets is distributed among the government, institutional investors, managers, employees, and private investors. Effective control rights are assigned to management, which generally has a very small, or even nonexistent ownership stake. This distinctive shareholding structure creates conflict of interest not only between management (insiders) and outside investors but also between large shareholders and minority investors. Moreover, because both governments desire to retain some control—in part through partial retained ownership of commercialized SOEs, further conflicts arise between politicians and firms. Second, directors in publicly listed firms in both countries are predominantly drawn from institutions with significant non-market objectives: the government and other state enterprises, particularly in China, and extended families, particularly in India. As a result, the effectiveness of internal governance mechanisms, such as the number of independent directors on the board and the number of independent supervisors on the supervisory committee, are likely to be quiet limited, although this has yet to be fully evaluated. Third, because of the political nature of the privatization process itself, typical external governance mechanisms, such as debt (in conjunction with appropriate bankruptcy procedures), takeover threats, legal protection of investors, product market competition, etc., have not been effective. Bank loans have traditionally been viewed as grants from the state designed to bail out failing firms. State-owned banks retain monopoly or quasi-monopoly positions in the banking sector and profit is not their overriding objective. If political favor is deemed appropriate, subsidized loans, rescheduling of overdue debt or even outright transfer of funds can be arranged with SOEs (soft budget constraints). In addition, a market for private, non-bank debt is limited in India and has yet to be established China. There is no active merger or takeover activity in Chinese stock markets to discipline management. Information available in the capital markets is insufficient to keep at arm’s length of the corporate decisions. In light of the above peculiarities, China and India share many of the typical institutional characteristics as a transition economy, including poor legal protection of creditors and investors, the absence of an effective takeover market, an underdeveloped capital market, a relative inefficient banking system and significant interference of politicians in firm management. Su (2005) finds that the extent of political interference, managerial entrenchment and institutional control can help explain corporate dividend policies and post-IPO financing choices in this situation. Allen et al. (2005) demonstrate that standard corporate governance mechanisms are weak and ineffective for publicly listed firms while alternative governance mechanisms based on reputation and relationship have been remarkably effective in the private sector. Because the peculiarities are significant in this context, the differences in the political-economies of the two countries are likely to be evident in such relational terms. In this paper we explore the peculiarities of corporate governance in this transitional environment through a systematic examination of certain aspects of these reputational and relationship dimensions. Utilising the methods of social network analysis we identify the inter-organisational relationships at board level formed by equity holdings and by shared directors. Using data drawn from the Orbis database we map these relations among the 3700 largest firms in India and China respectively and identify the roles played in these relational networks by the particularly characteristic institutions in each case. We find greatly different social network structures in each case with some support in these relational dimensions for their distinctive features of governance. Further, the social network metrics allow us to considerably refine proxies for political interference, managerial entrenchment and institutional control used in earlier econometric analysis.

Sovereign rescheduling probabilities in emerging markets: a comparison with credit rating agencies' ratings

This study estimates default probabilities of 124 emerging countries from 1981 to 2002 as a function of a set of macroeconomic and political variables. The estimated probabilities are then compared with the default rates implied by sovereign credit ratings of three major international credit rating agencies (CRAs) – Moody's Investor's Service, Standard & Poor's and Fitch Ratings. Sovereign debt default probabilities are used by investors in pricing sovereign bonds and loans as well as in determining country risk exposure. The study finds that CRAs usually underestimate the risk of sovereign debt as the sovereign credit ratings from rating agencies are usually too optimistic.

Finance for water and sanitation as a public service

Drawing on empirical evidence gathered through the PSIRU database, this contribution aims at addressing the potential of public finance to enhance the provision of water supply and sanitation as a public service. It highlights the problems associated with (and the disappointing results obtained from) resort to Private Sector Participation and private finance, both historically and in the last 15-20 years, in developed and developing countries. It also addresses the advantages of using public finance as a more cost-effective and equitable instrument to achieve developmental objectives such as the expansion of service coverage and development of water and sanitation infrastructure. The potential of public operations in maximising developmental impact from the social, economic and environmental points of view is then explored referring to specific examples from a variety of countries and regions. These include the in-house restructuring of public operations to enhance transparency, accountability and effectiveness, as well as the use of Public-Public Partnerships (PUPs) to build capacity. Attention is devoted to the specific financial requirements of expanding sewerage services at global level to achieve MDGs or broader developmental goals. These requirements are revisited in light of a regional breakdown of coverage gaps, available resources and development aid flows. These findings challenge the established view among international and bilateral agencies that expanding sewerage services in developing countries is excessively costly and should be abandoned as a priority because unaffordable. This contribution draws on a number of PSIRU Reports, and particularly the following. - http://www.psiru.org/reports/2008-03-W-sewers.pdf - http://boell-latinoamerica.org/download_es/agua08_privatizacion_LA_2007.pdf - http://boell-latinoamerica.org/download_es/agua08_agua_un_servicio_publico.pdf - http://www.psiru.org/reports/2006-03-W-investment.pdf All PSIRU Reports are accessible at http://www.psiru.org/publicationsindex.asp.

Impacts of wildlife on household food security and income in northeastern Tanzania

We evaluated the impacts of wildlife on household food security and income in three semi-arid villages adjacent to Lake Manyara National Park (LMNP) and Mkomazi Game Reserve (MGR) in Northeastern Tanzania. Survey data were collected using both household interviews and human-wildlife conflict related archive information from the village government offices. Crop destruction by wildlife influenced both household food security and cash income. Crop damage to households was, on average, 0.08 ton/annum, equivalent to two months household loss of food and reduced household cash income by 1.3%. A combination of measures is proposed as incentives for conservation. These include provision of economic incentives, soft loans to initiate non-farm (e.g., ecotourism, business enterprises) projects to ease dependency on natural resources, increasing of reserves buffer zones and fencing of reserves.

Changes in fos expression in the rat brain after unilateral lesions of the anterior thalamic nuclei

Activity of the immediate early gene c-fos was compared across hemispheres in rats with unilateral anterior thalamic lesions. Fos protein was quantified after rats performed a spatial working memory test in the radial-arm maze, a task that is sensitive to bilateral lesions of the anterior thalamic nuclei. Unilateral anterior thalamic lesions produced evidence of a widespread hippocampal hypoactivity, as there were significant reductions in Fos counts in a range of regions within the ipsilateral hippocampal formation (rostral CA1, rostral dentate gyrus, 'dorsal' hippocampus, presubiculum and postsubiculum). A decrease in Fos levels was also found in the rostral and caudal retrosplenial cortex but not in the parahippocampal cortices or anterior cingulate cortices. The Fos changes seem most closely linked to sites that are also required for successful task performance, supporting the notion that the anterior thalamus, retrosplenial cortex and hippocampus form key components of an interdependent neuronal network involved in spatial mnemonic processing.

Ischemic preconditioning before lower limb ischemia-reperfusion protects against acute lung injury

Objective: Prolonged limb ischemia followed by reperfusion (I/R) is associated with a systemic inflammatory response syndrome and remote acute lung injury. Ischemic preconditioning (IPC), achieved with repeated brief periods of I/R before the prolonged ischemic period, has been shown to protect skeletal muscle against ischemic injury. The aim of this study was to ascertain whether IPC of the limb before I/R injury also attenuates systemic inflammation and acute lung injury in a fully resuscitated porcine model of hind limb I/R. Methods: This prospective, randomized, controlled, experimental animal study was performed in a university-based animal research facility with 18 male Landrace pigs that weighed from 30 to 35 kg. Anesthetized ventilated swine were randomized (n = 6 per group) to three groups: sham-operated control group, I/R group (2 hours of bilateral hind limb ischemia and 2.5 hours of reperfusion), and IPC group (three cycles of 5 minutes of ischemia/5 minutes of reperfusion immediately preceding I/R). Plasma was separated and stored at -70° C for later determination of plasma tumor necrosis factor-a and interleukin-6 with bioassay as markers of systemic inflammation. Circulating phagocytic cell priming was assessed with a whole blood chemiluminescence assay. Lung tissue wet-to-dry weight ratio and myeloperoxidase concentration were markers of edema and neutrophil sequestration, respectively. The alveolar-arterial oxygen gradient and pulmonary artery pressure were indices of lung function. Results: In a porcine model, bilateral hind limb (I/R) injury significantly increased plasma interleukin-6 concentrations, circulating phagocytic cell priming, and pulmonary leukosequestration, edema, and impaired gas exchange. Conversely, pigs treated with IPC before the onset of the ischemic period had significantly reduced interleukin-6 levels, circulating phagocytic cell priming, and experienced significantly less pulmonary edema, leukosequestration, and respiratory failure. Conclusion: Lower limb IPC protects against systemic inflammation and acute lung injury in lower limb I/R injury.

Bactericidal/permeability-increasing protein attenuates systemic inflammation and acute lung injury in porcine lower limb ischemia-reperfusion injury.

OBJECTIVE: To investigate the role of recombinant bactericidal/permeability-increasing protein (rBPI21) in the attenuation of the sepsis syndrome and acute lung injury associated with lower limb ischemia-reperfusion (I/R) injury. SUMMARY BACKGROUND DATA: Gut-derived endotoxin has been implicated in the conversion of the sterile inflammatory response to a lethal sepsis syndrome after lower torso I/R injury. rBPI21 is a novel antiendotoxin therapy with proven benefit in sepsis. METHODS: Anesthetized ventilated swine underwent midline laparotomy and bilateral external iliac artery occlusion for 2 hours followed by 2.5 hours of reperfusion. Two groups (n = 6 per group) were randomized to receive, by intravenous infusion over 30 minutes, at the start of reperfusion, either thaumatin, a control-protein preparation, at 2 mg/kg body weight, or rBPI21 at 2 mg/kg body weight. A control group (n = 6) underwent laparotomy without further treatment and was administered thaumatin at 2 mg/kg body weight after 2 hours of anesthesia. Blood from a carotid artery cannula was taken every half-hour for arterial blood gas analysis. Plasma was separated and stored at -70 degrees C for later determination of plasma tumor necrosis factor (TNF)-alpha, interleukin (IL)-6 by bioassay, and IL-8 by enzyme-linked immunosorbent assay (ELISA), as a markers of systemic inflammation. Plasma endotoxin concentration was measured using ELISA. Lung tissue wet-to-dry weight ratio and myeloperoxidase concentration were used as markers of edema and neutrophil sequestration, respectively. Bronchoalveolar lavage protein concentration was measured by the bicinclinoic acid method as a measure of capillary-alveolar protein leak. The alveolar-arterial gradient was measured; a large gradient indicated impaired oxygen transport and hence lung injury. RESULTS: Bilateral hind limb I/R injury increased significantly intestinal mucosal acidosis, intestinal permeability, portal endotoxemia, plasma IL-6 concentrations, circulating phagocytic cell priming and pulmonary leukosequestration, edema, capillary-alveolar protein leak, and impaired gas exchange. Conversely, pigs treated with rBPI21 2 mg/kg at the onset of reperfusion had significantly reduced intestinal mucosal acidosis, portal endotoxin concentrations, and circulating phagocytic cell priming and had significantly less pulmonary edema, leukosequestration, and respiratory failure. CONCLUSIONS: Endotoxin transmigration across a hyperpermeable gut barrier, phagocytic cell priming, and cytokinemia are key events of I/R injury, sepsis, and pulmonary dysfunction. This study shows that rBPI21 ameliorates these adverse effects and may provide a novel therapeutic approach for prevention of I/R-associated sepsis syndrome.