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Objectives Electroconvulsive therapy is an effective treatment for bipolar depression, but there are concerns about whether it causes long-term neurocognitive impairment. Methods In this multicenter randomized controlled trial, in-patients with treatment-resistant bipolar depression were randomized to either algorithm-based pharmacologic treatment or right unilateral electroconvulsive therapy. After the 6-week treatment period, all of the patients received maintenance pharmacotherapy as recommended by their clinician guided by a relevant treatment algorithm. Patients were assessed at baseline and at 6 months. Neurocognitive functions were assessed using the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery, and autobiographical memory consistency was assessed using the Autobiographical Memory Interview-Short Form. Results Seventy-three patients entered the trial, of whom 51 and 26 completed neurocognitive assessments at baseline and 6 months, respectively. The MATRICS Consensus Cognitive Battery composite score improved by 4.1 points in both groups (P = .042) from baseline to 6 months (from 40.8 to 44.9 and from 41.9 to 46.0 in the algorithm-based pharmacologic treatment and electroconvulsive therapy groups, respectively). The Autobiographical Memory Interview-Short Form consistency scores were reduced in both groups (72.3% vs 64.3% in the algorithm-based pharmacologic treatment and electroconvulsive therapy groups, respectively; P = .085). Conclusions This study did not find that right unilateral electroconvulsive therapy caused long-term impairment in neurocognitive functions compared to algorithm-based pharmacologic treatment in bipolar depression as measured using standard neuropsychological tests, but due to the low number of patients in the study the results should be interpreted with caution. Trial registration ClinicalTrials.gov: NCT00664976.

Objective Sleep problems in bipolar disorder (BD) are common, but reported rates vary from 10% to 80%, depending on definitions, methodologies and management of potential confounding factors. This multicenter study seeks to address these issues and also compares BD cases with Hypersomnia as well as the more commonly investigated Insomnia and No Sleep Problem groups. Method A cross-sectional comparison of sleep profiles in 563 BD I and II individuals who participated in a structured assessment of demographic, clinical, illness history and treatment variables. Results Over 40% cases met criteria for Insomnia and 29% for Hypersomnia. In univariate analysis, Insomnia was associated with BD II depression whilst Hypersomnia was associated with BD I depression or euthymia. After controlling for confounders and covariates, it was demonstrated that Hypersomnia cases were significantly more likely to be younger, have BD I and be prescribed antidepressants whilst Insomnia cases had longer illness durations and were more likely to be prescribed benzodiazepines and hypnotics. Conclusion Whilst Insomnia symptoms are common in BD, Hypersomnia is a significant, frequently underexplored problem. Detailed analyses of large representative clinical samples are critical to extending our knowledge of differences between subgroups defined by sleep profile.

We prove upper and lower bounds for certain sums of products of fractional parts by using majoring and minorizing functions from Fourier analysis. In special cases the upper bounds are sharp if there exist counterexamples to the Littlewood conjecture in Diophantine approximation. We introduce a generalization of such counterexamples which we call strongly badly approximable matrices. And we prove a transference principle for strongly badly approximable matrices., 32 pages

Finseth PI, Morken G, Andreassen OA, Malt UF, Vaaler AE. Risk factors related to lifetime suicide attempts in acutely admitted bipolar disorder inpatients. Bipolar Disord 2012: 14: 727–734. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective: The main aim of this study was to assess possible clinical characteristics of acutely admitted bipolar I disorder (BD-I) and bipolar II disorder (BD-II) inpatients at high risk of suicide by comparing patients who had made one or several serious suicide attempts with patients who had not. Methods: A total of 206 consecutive patients (mean age 42 ± 15 years; 54.9% women) with DSM–IV diagnosed BD-I (n = 140) and BD-II (n = 66) acutely admitted to a single psychiatric hospital department from November 2002 through June 2009 were included. Using a detailed retrospective questionnaire, patients with a history of a serious suicide attempt were compared to those with no history of a suicide attempt. Results: Ninety-three patients (45.1%) had a history of one or more serious suicide attempts. These constituted 60 (42.9%) of the BD-I patients and 33 (50%) of the BD-II patients (no significant difference). Lifetime suicide attempt was associated with a higher number of hospitalizations due to depression (p

Involuntary psychiatric admissions are widespread among patients with an immigrant background. According to a study in Norway, involuntary admissions are about 75% of admissions among immigrants compared to roughly 50% among ethnic Norwegians. The aim of the present study was to compare clinical and demographic characteristics of immigrant patients with involuntary or voluntary admissions to two acute psychiatric units. A 3-year prospective study of 94 immigrant patients involuntarily and voluntarily admitted to acute psychiatric units was carried out. Sixty-two patients (66.0%) were voluntarily and 30 (31.9%) involuntarily admitted. Involuntary admissions were significantly higher among men (22, 73.3%) compared to women (8, 26.7%; χ(2) = 4.507, d.f. = 1, P= 0.03). The mean length of stay for voluntary and involuntary patients were 7.8 (SD = 6.6) and 21.6 (SD = 27.3; t=-2.7, d.f. = 88, P= 0.01). Patients diagnosed with schizophrenia and psychotic disorder were more often admitted involuntarily (63.0%; χ(2) = 17.83, P= 0.001). This study confirms that immigrant patients diagnosed with psychotic disorders are more often involuntarily than voluntarily admitted. Comparing the clinical and demographic characteristics of immigrants helps identify the reasons behind involuntary admissions and might improve efforts towards reducing such admissions in the future.

Alfred Chandler's recent passing is cause to review and celebrate his many contributions to business history. It also presents an opportunity to highlight links between his rich historical analyses concerning organizational and industrial innovation and contemporary management studies of the firm and industrial organization. We illustrate this point by applying transaction costs theory to several case studies from his 1977 masterwork narrating the emergence of vertically-integrated firms in nineteenth-century America, The Visible Hand. Vertical integration, organizational control, and innovation in manufacturing at McCormick Harvester and Singer Sewing Machines, and in transportation and distribution at Swift and United Fruit reflect managerial responses to classic transaction costs considerations including commercial relationships requiring the creation of specialized equipment and knowledge. Transaction costs analysis provides complementary historical insight on organizational innovation at these and other firms in the nineteenth century, and suggests when and where we might expect vertical integration strategies in emerging industries of the twenty-first century.

This study examined multiple dimensions of religious involvement and the risk of divorce among a nationwide sample of 2,979 first-time married couples. Multivariate proportional hazards modeling was used to analyze two waves of the National Survey of Families and Households. Results indicated that although each partner's religious attendance bore a modest relationship to marital dissolution, the risk of divorce was lower if husbands had conservative theological beliefs and when both partners belonged to mainline Protestant denominations. Conversely, the risk of divorce was elevated if husbands attended services more frequently than their wives and if wives were more theologically conservative than their husbands. These patterns withstood controls for sociodemographic covariates, marital duration, and marital quality. Directions for future research are discussed.

UNLABELLED We compared sorbitol given alone and as part of a mixed meal to nine insulin-dependent diabetics (IDD's) during continuous subcutaneous insulin infusion (CSII). Blood glucose, sorbitol and breath hydrogen + methane were measured following six test meals: Pure glucose, sorbitol and lactulose, a mixed meal alone, and sweetened with sorbitol and sucrose. Blood glucose increase was very small after lactulose and sorbitol, significantly larger after glucose. A considerable increase in breath hydrogen + methane appeared after sorbitol and lactulose, but not after glucose. No differences in blood glucose responses were found after the mixed meal alone or sweetened with sorbitol and sucrose. A sustained low level increase in breath hydrogen + methane occurred after all solid meals. Sorbitol was not detected in serum after any meal. CONCLUSION Sorbitol ingested by IDD's during CSII in watery solution is not absorbed in the small intestine and causes osmotic diarrhoea. Ingested in a composite meal it does not affect blood glucose and does not cause osmotic diarrhoea.

This study examines the short- and long-term impact of AmeriCorps participation on members' civic engagement, education, employment, and life skills. The analysis compares changes in the attitudes and behaviors of participants over time to those of individuals not enrolled in AmeriCorps, controlling for interest in national and community service, member and family demographics, and prior civic engagement. Results indicate that participation in AmeriCorps led to positive impacts on members, especially in the area of civic engagement, members' connection to community, knowledge about problems facing their community, and participation in community-based activities. AmeriCorps had some positive impacts on its members' employment-related outcomes. Few statistically significant impacts were found for measures of participants' attitude toward education or educational attainment, or for selected life skills measures. Within a subset of community service programs that incorporate a residential component for members, the study also uncovered a short-term negative impact of participation on members' appreciation for ethnic and cultural diversity, which disappeared over time. The implications of these findings for future research on national service are discussed. © 2009 by the Association for Public Policy Analysis and Management.

We empirically examine whether and how opportunistic and partisan political business cycle (“PBC”) considerations explain election-period decisions by credit rating agencies (“agencies”) publishing developing country sovereign risk-ratings (“ratings”). Analyses of 391 agency ratings for 19 countries holding 39 presidential elections from 1987‐2000, initially suggest that elections themselves prompt rating downgrades consistent with opportunistic PBC considerations, that incumbents are all likely to implement electionperiod policies detrimental to post-election creditworthiness. But more refined analyses, integrating both opportunistic and partisan PBC considerations in a unified framework, suggest that election-period agency downgrades (upgrades) are more likely as right-wing (left-wing) incumbents, become more vulnerable to ouster by challengers. Together, these results underscore the importance of integrating both opportunistic and partisan PBC considerations into any explanation of election-period risk assessments of agencies and, perhaps, other private, foreign-based financial actors important to the pricing and allocation of capital for lending and investment in the developing world. This study investigates the impact of developing country electoral politics on private, often foreign-based financial actors making decisions about risks associated with lending and investment. We ground our approach in the theory of political business cycles (“PBCs”), which, following from the seminal papers of Nordhaus (1975) and Hibbs (1977), models interactions between domestic political incumbents and voters. We extend the empirical domain of both opportunistic and partisan PBC theories to consider the election-period reactions of international credit rating agencies (“agencies”) to potential PBC-style behavior by incumbents. Sovereign risk ratings (“ratings”) published by agencies play a critical role in conditioning the cost and availability of capital for lending and investment in developing countries. Agencies facilitate credit transactions for developing country borrowers by publishing lettergrade ratings, commonly relied on by capital market participants to assess both the specific capability and willingness of governments to honor their debts, and more general risks associated with lending and investment in the locale. Our study investigates whether these agencies also “vote” during election periods based on opportunistic or partisan PBC considerations. Their votes are in the form of election-year ratings. Opportunistic PBC considerations suggest that agencies are more likely to downgrade developing country sovereign ratings in election years, due to general concern that incumbents will implement spending sprees beneficial to garner

Hawawini, Subramanian, and Verdin (2003) examined the relative impact of industry- vs. firm-level factors shaping firm performance. They demonstrated that variance in firm performance attributable to industry-level factors increases, while variance attributable t to firm-level factors decreases when ‘exceptionally’ higher- and lower-performing ‘outlier’ firms in each industry are excluded. They concluded that previous research underestimated the relative impact of industry-level factors for ‘average’ firms that make up the bulk of an industry. We take issue with their methods used to identify and exclude outliers as well as their conclusions drawn from such analyses. Rather than excluding true ‘outlier’ firms, we argue that they incorporated an artificial restriction of within-industry sample variance that almost deterministically led to lower firm and higher industry variance component estimates. We demonstrate this point with a comparable sample of data to which we apply progressively greater restrictions on within-industry sample variance leading to similar results. Finally, we show that exclusion of firms from a data sample based on commonly understood standards of outlier identification leads to little change in industry and firm variance component estimates compared to full-sample estimates. Copyright © 2005 John Wiley & Sons, Ltd.

Aims To compare the effects of the rapid-acting insulin analogue insulin aspart and soluble human insulin on hypoglycaemia and glycaemic control in patients with Type 1 diabetes when injected immediately before meals as part of intensive insulin therapy. Methods In this multinational, double-blind, randomised, crossover trial, 155 patients with Type 1 diabetes (HbA(1c) Results The rate of major nocturnal (24.00-06.00 h) hypoglycaemic episodes was 72% lower with insulin aspart than with human insulin (0.067 vs. 0.225 events/month; P = 0.001). Total rate of major hypoglycaemia did not differ significantly between treatments (insulin aspart/human insulin relative risk 0.72; 95% CI 0.47-1.09, P = 0.12). The rate of minor events was significantly reduced by 7% with insulin aspart (P = 0.048). Reductions in rate of hypoglycaemia were achieved with maintained overall glycaemic control: Mean HbA(1c) remained constant, slightly below 7.7% on both treatments. Conclusions The use of insulin aspart in an intensive insulin regimen in patients with tightly controlled Type 1 diabetes led to clinically significant reductions in major nocturnal hypoglycaemia with no deterioration in glycaemic control. Major nocturnal hypoglycaemia appears to be a strong clinical indication for the use of rapid-acting insulin analogues during intensive insulin therapy.

High-dose chemotherapy (HDC) with autologous peripheral blood stem cell (PBSC) support is a common but expensive treatment for various hematological malignancies. A prospective cost analysis of evaluation/mobilization and the HDC + PBSC phase for patients with multiple myeloma was performed. Eleven consecutive patients at the National University Hospital Oslo, taking part in a Nordic treatment protocol, were included in the analysis during the period from May 1999 to December 2000. Clinical and resource use data were obtained prospectively on a daily basis registration and from patient records. The total cost for the evaluation/mobilization and the HDC + PBSC phase varied from 22,999 US dollars to 61,722 US dollars (mean 38,186 US dollars; median 30,569 US dollars). The mean length of hospital stay for the evaluation/mobilization phase was 8 days (range 4-17 days) and for the HDC + PBSC phase 19 days (range 14-29 days). A statistically significant correlation was found between the length of hospital stay and hospital costs for both phases (P < 0.003 and P < 0.010, respectively). A large part of the actual cost in the harvest phase was attributed to stem cell mobilization, including growth factors, harvesting and cryopreservation. In the HDC + PBSC phase, the most important part of the cost was paying nursing care personnel.

Some strategy scholars and practitioners contend that markets have become increasingly hypercompetitive in recent years. We examine this contention by analyzing industry and business performance patterns in a broad sample of firms drawn from the Compustat Industry Segment database for the 1978–97 period. We find little support for the argument that markets have become more hypercompetitive. From the late 1970s to the late-1980s we observe decreased performance and market stability, consistent with increasing hypercompetition contentions. From the late 1980s to the mid-1990s, however, trends reverse and performance and market stability increase. For strategy research, our results suggest that hypercompetitive perspectives are important but no more so now than they were in recent years. For practice, our results suggest that managers today face markets no more dynamic and opportunities to gain and sustain competitive advantage no more challenging than in the past. Accordingly, they should continue developing a portfolio of skills to manage businesses whether conditions are increasingly stable or unstable. Copyright © 2002 John Wiley & Sons, Ltd.

Summary. As more and more nations are scrutinizing their health care costs, attention has been focused on high-cost low-density disease. Assessment of actual total cost of care for haemophilia and its positive outcome becomes essential to justify support for these patients. In this study, we assessed hospital cost and diagnosis-related group (DRG) reimbursement for patients undergoing elective orthopaedic surgical procedures from May 1999 to December 1999. Hospital cost was assessed by a prospective microcost-analysis method. To identify real hospital costs, we performed registration of preoperative phase, operative phase and 1-year follow-up costs. Hospital cost included personnel costs and costs for clinical and laboratory procedures, blood products, prosthetic implants, coagulation factor concentrates and drugs. These data were compared with hospital DRG reimbursement. We included nine consecutive patients, with a mean age 38 years (19–54 years) who had had 10 major orthopaedic surgical procedures performed during the study period. Six patients had haemophilia A, two had haemophilia B and one had factor VII deficiency. Data analysis showed a mean cost of US$ 54 201 (range US$ 25 795–105 479; 1US$ = 8.5 NOK). The average actual hospital revenue (50% DRG reimbursement + income related to length of stay) was $4730 (range $ 1 308–13 601). Our study confirms that orthopaedic surgery in patients with severe bleeding disorders puts the hospital to a considerable expense. Activity-based financing, as used in Norway, does not provide a proper reimbursement for this part of the haemophilia care.

The increase in blood glucose in insulin-dependent diabetics after different fruit meals was investigated. Apple, banana and orange loads were compared with an equal amount of glucose dissolved in water. The postprandial blood glucose responses to pure glucose, apple and banana were almost identical, while the response after orange was somewhat weaker. We therefore conclude that though these fruits contain considerable amounts of fructose, they represent an important source of rapidly absorbable carbohydrate and should mainly be used in mixed meals.

Blood glucose levels following breakfast meals containing sorbitol or sucrose as sweeteners were investigated. Nine insulin-treated diabetics received two test meals after an overnight fast. The meals were composed of 90 g white bread, 9 g butter and 100 g strawberry jam which on one occasion contained 18 g sorbitol as sweetener and on another 18 g sucrose. Blood glucose was measured for three hours following the meal. The test meal sweetened with sucrose showed a slightly faster postprandial rise in blood glucose than the sorbitol-sweetened meal, but this difference is not statistically significant at any point of the curves. Taking into consideration that sorbitol has a sweetening effect of only 60% of that of sucrose, we conclude that neither sucrose nor sorbitol are acceptable sweeteners for insulin-dependent diabetics.

Dietary fibre may retard glucose absorption in normal and diabetic subjects. It is, however, unclear which type of fibre would be most suitable for this purpose. We therefore studied whether pectin differs from fibre from barley (85 %) and citrus (15%) (Dumovital®) in its effect on postprandial blood glucose responses. Eight insulin-dependent diabetics fasted overnight and were then given a meal without their morning insulin. The basic meal, composed of 90 g white bread and 120 g jam (total carbohydrate 105 g), was given three times: alone, with 15 g pectin and with 15 g Dumovital fibre. Blood glucose was measured for three hours. The tests showed that pectin administration considerably inhibited the postprandial rise in blood glucose, while Dumovital showed no such effect. Barley/citrus fibre (a mixture of cellulose, hemicellulose, lignin and pectin) has not the same inhibiting effect on postprandial rise in blood glucose as pure pectin in insulin-dependent diabetics. Thus, the specific type of fibre must be considered when prescribing dietary fibre to diabetics.

Obje ctive: To identify risk factors associated with cycle acceleration (CA), that is, progressive decrease in duration of syndrome-free intervals between affective episodes, in acutely admitted patients with bipolar disorder (BD). Method : All patients ( n = 210) with BD I (67%) and BD II (33%) (DSM-IV) acutely admitted to a hospital serving a catchment area were compared in retrospect with regard to a positive or negative history of CA. Putative risk factors of CA with a P-value

A four year follow-up of treatment with continuous subcutaneous insulin infusion (CSII) or multiple injections (MI) in not-highly selected insulin-dependent diabetic patients is presented. Forty patients (CSII 25; MI 15) were followed for 51.0 months from the start of intensified insulin therapy. Eleven patients (44%) changed from CSII to MI; none changed in the reverse direction or to any other regimen. The initial improvement in HbA1c was lost both in the CSII, MI and change-over groups. On CSII three patients experienced five subcutaneous abscesses at infusion sites, and two were hospitalised with diabetic ketoacidosis. Hypoglycaemia requiring assistance was equally common on the two treatment modalities. The initial weight gain tended to continue. We conclude that insulin-dependent diabetic patients clearly prefer Intensified Insulin therapy, especially MI, for long-term treatment. How ever, the initial improvement in glycaemic control was not maintained in the long-term in these patients who were not highly selected. Subcutaneous abscesses at infusion sites and diabetic ketoacidosis requiring hospitalisation occurred exclusively on CSII. These results have important implications for the long-term treatment of those with insulin-dependent diabetes.