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The study analyzes the consistency of future precipitation extremes projected over China under moderate climate scenarios (RCP4.5 and SSP2-4.5) and extreme climate scenarios (RCP8.5 and SSP5-8.5), based on best models' ensembles for each extreme index (best-MME), best models' ensembles regarding all indices (best-rankMME), and multi-model ensembles (MME). To select the best models, the integrated quadratic distance (IQD) combined with the Taylor skill score are used. This evaluation is a practical example of the benefits of using IQD to evaluate the models compared with root mean square error since the former is not sensitive to the similarity of the distribution's averages. All ensembles in each scenario consistently project the decrease of consecutive dry days (CDD) periods in western and northeast China, the increase of the number of days with heavy precipitation (R10mm) over the Qinghai-Tibet Plateau, and the increase of the precipitation intensity (SDII) in most of the Chinese territory. The moderate and extreme scenarios project very similar climate change patterns but more extreme scenarios show greater climate change signal magnitudes. In the case of the moderate scenarios, the most significant uncertainty relies on the CDD projections over southeastern China, where best-rankMME and MME project increasing CDD in the future whilst best-MME project decreasing CDD, although these changes are not statistically significant. Regarding extreme scenarios, the most significant uncertainty relies on the R10mm projections over southeastern China, where the best-MME CMIP5 projects decreasing R10mm (not statistically significant), whilst all the remaining ensembles project increasing values.

The association of Comamonas kerstersii with peritonitis resulting from the presence of perforated appendix has previously been described by our research team. In the present study, we describe the isolation of this microorganism from two forms of unusual presentations of C. kerstersii infection not previously described in the literature: localized intra-abdominal infection (psoas abscess) and pelvic peritonitis.

Small cell bladder cancer (SCBC) is found in 0.5–1.2% of all bladder tumors. Ureteroceles are dilatation of the distal portion of an ectopic ureter, which association with tumors are rare. This article reports the first case described of an SCBC developed into a ureterocele, beyond a literature review. Keywords: Ureterocele, Double ureter, Small-cell, Bladder cancer

Although enterprise systems (ES) are ubiquitous, many firms report less than stellar payoffs from these costly investments, with underutilization often attributed to failures in the implementation process. Unfortunately, research has not provided sufficient insights into these failures, in part because it has focused on actual usage, as opposed to proficient usage, as the benchmark for successful implementation. Moreover, research has not generally examined how the adoption process unfolds over time, thus overlooking potential underlying mechanisms that may help explain how adopters achieve proficiency. To begin addressing these shortcomings, we study how adopters’ pre-adoption expectations, enacted over time, can influence their post-adoption proficiency, by shaping how and why they spend time using the system during the adoption period. We analyzed time-lagged survey data from 153 financial analysts, required to adopt new ES-based software, at a multinational bank. We found that adopters who hold pre-adoption expectations reflecting greater internal and external motives to adopt the system as well as systematically integrate it into their work routines are more apt to use the system in ways that enhance their cumulative knowledge of it, and subsequently develop higher levels of proficiency post-adoption. Moreover, greater organizational support enhanced the impact of adopters’ expectations on proficiency, except when their actual use is low in which case organizational support had an adverse effect.

Although managers and professionals still compete in a career tournament for advancement and pay, the career boundaries that they cross in order to compete have changed. Traditionally, such individuals came up through the ranks within the same company by specializing in one functional area and changing, as needed, the geographic location of work in order to advance their careers. However, in the current era of less constrained, boundary-crossing careers, they are more apt to cross several boundaries, including functional, organizational, geographic, and family, as they pursue career opportunities. Using survival analysis with data from the career histories of 760 managers and professionals who collectively made 3917 moves up to midcareer, we examined the impact of the rate of crossing each boundary on the subsequent likelihood of advancement. In addition, over this span of career, we examined the extent to which more rapid advancement contributed to the rate of growth in annual salary. Our findings suggest that crossing functional, organizational, and geographic boundaries more often significantly increased the likelihood of advancement, whereas the duration of family boundary crossings had a negative impact. Moreover, as expected, advancement had a long-term impact on salary growth.

ARTICLE I NFO The literature has suggested that an entrepreneurially alert information system may be a salient driver of corporate entrepreneurship, even though this role has been neither theoretically articulated nor empirically substantiated. Building upon the organizational learning, information orientation, and entrepreneurial awareness literatures we identify three key elements of a firm's entrepreneurially alert information system, and then develop a parsimonious model that examines the impact of these elements on corporate entre- preneurship. Using both single- and multi-source survey data from 495 small- to medium-sized firms, we test our model and find that each element individually and collectively imparts significant positive influence on corporate entrepreneurship.

We take stock of the current body of knowledge and understanding on organizational ambidexterity to further specify the construct and develop a typology to focus this line of research. To that end, we first synthesize the various insights on ambidexterity's conceptualization in extant research. We then develop a parsimonious, yet coherent typology that delineates four archetypes of ambidexterity using two primary dimensions underlying previous conceptualizations of this construct. To help focus and align extant research, we next map these types onto the most salient theories, antecedents, and outcomes that are uniquely germane to each. Finally, we offer several recommendations and promising avenues for future inquiries that follow from our typology and associated discussion.

Research about transformational CEOs' impact on firm-level outcomes, particularly corporate entrepreneurship, has been equivocal, partially because the underlying mechanisms remain largely unexplored. Given that the individuals most closely influenced by a firm's CEO are its top management team (TMT) members, we focus on the CEO-TMT interface as a salient intervening mechanism. We posit that transformational CEOs influence TMTs' behavioral integration, risk propensity, decentralization of responsibilities, and long-term compensation and that these TMT characteristics impact corporate entrepreneurship. Data from 152 firms supported most of our hypothesized links, underscoring how the CEO-TMT interface helps explain transformational CEOs' role in promoting corporate entrepreneurship.

While it is generally believed that superior-subordinate relationships play a salient role in determining individual work outcomes, given the increasing popularity of virtual work arrangements, we ...

Extending Hambrick's (1994) concept of behavioral integration, a meta-construct of top management team process, we theorized on the extent to which CEO-, team-, and firm-level determinants shape be...

Despite the fact that many organizations have implemented family-friendly programs to meet the needs of today's diverse workforce, employees have been reluctant to use them. Drawing on the theories of planned behavior, help-seeking, and distributive justice, we propose a framework that focuses initially on the more proximal factors that influence an employee's likelihood of participating in such programs. We then examine the role of organization-based situational characteristics in shaping both personal and normative assessments and describe the implications of our framework for researchers and practitioners.

Accommodation benefits employers and helps create equal opportunity for people with disabilities. Yet while there is evidence of reluctance to ask, little is known about requesters' decisions to as...

OBJETIVO: comparar dois grupos de meninas em idade escolar, de diferentes extratos sociais, quanto à percepção e conhecimento sobre aleitamento materno. MÉTODOS: aplicou-se um questionário estruturado a todas as 346 meninas da 4ª à 8ª séries de duas escolas, uma particular, com alunos de alto poder aquisitivo (Escola A), e outra pública, com alunos de nível econômico-social baixo (Escola B). RESULTADOS: cerca de 90% das meninas relataram ter sido amamentadas, e mais de 98% já viram alguma mãe amamentando. Somente 14% das da Escola A e 26% da Escola B (p=0,01) ofereciam exclusivamente o seio ou o seio e mamadeira em suas brincadeiras com bonecas. Mais de 80% das meninas gostariam que seu parto fosse normal e de amamentar seu filho por mais de 6 meses, mas 46% das da Escola A e 32% da B teriam vergonha de amamentar em público. Cerca de 90% das meninas consideram o leite humano o melhor alimento para o bebê, porém apenas pequena parcela delas reconhece outras vantagens mais específicas. Menos de 1/3 delas optaria pelo aleitamento exclusivo e perto de 60% delas ofereceria chupeta para o nenê. CONCLUSÕES: as meninas de ambos extratos sociais sabem que o aleitamento materno é a melhor dieta de um recém-nascido, porém desconhecem vantagens específicas. O aleitamento materno exclusivo não está incorporado no conhecimento da maioria dessas meninas, já que foram consideradas como práticas adequadas o oferecimento de água, chá, sucos e chupeta. O ensino do aleitamento nas escolas deve enfatizar esses conceitos. OBJECTIVE: to compare two groups of school age girls from different social strata were compared in terms of their perception and knowledge about breastfeeding. METHODS: a structured questionnaire was applied to all 346 4th to 8th grade girls attending two schools, a private one, whose students belonged to the upper class (School A), and a public one, whose students belonged to the lower class (School B). RESULTS: about 90% of the girls reported having been breastfed and more than 98% had seen a mother breastfeeding. Only 14% of girls from School A and 26% from School B (p = 0.01) exclusively offered their breast or their breast and a bottle when playing with dolls. More than 80% of the girls stated that they would like to have a normal delivery and to breast-feed their child for more than 6 months, but 46% of the girls from School A and 32% from School B stated that they would be ashamed to breastfeed in public. About 90% of the girls considered human milk to be the best food for the baby, but only a small portion of them recognized other more specific advantages. Less than 1/3 would choose exclusive breastfeeding and about 60% would offer a pacifier to the baby. CONCLUSIONS: girls from both social strata are aware of the fact that breastfeeding is the best diet for a newborn baby, but are not aware of its specific advantages. Exclusive breastfeeding is not incorporated into the knowledge of most of these girls, since most of them consider offering water, tea, juices and a pacifier to be adequate practices. Teaching about breastfeeding at school should emphasize these concepts.

Objetivo Evaluar la eficacia y seguridad del tratamiento de la tromboembolia pulmonar submasiva (TEP) con enoxaparina en comparacion con heparina no fraccionada Pacientes Y Metodos Se incluyo en el estudio, de forma prospectiva, a 56 pacientes con TEP que no precisaron tratamiento fibrinolitico. Se asignaron de forma aleatoria a dos grupos de tratamiento: el grupo A, que recibio enoxaprina (1 mg/kg cada 12 h) y el grupo B, al que se le administraron dosis ajustadas de heparina no fraccionada. La anticoagulacion oral se inicio una vez que el diagnostico se comprobo y se mantuvo durante 6 meses. Se evaluo la incidencia de recurrencia tromboembolica y de hemorragia mayor al cabo de ese tiempo Resultados Seis pacientes fueron excluidos del estudio. De los 50 finalmente incluidos, 29 fueron asignados al grupo A (enoxaparina) y 21 al grupo B (heparina no fraccionada). Tres pacientes del grupo A (10,7%) fueron diagnosticados de recurrencia tromboembolica, mientras que dicha complicacion se constato en dos pacientes del grupo B (9,5%). No se encontraron diferencias significativas. Dos pacientes fallecieron, siendo una de las muertes achacada a hemorragia secundaria a la anticoagulacion oral (grupo A) y la otra a un proceso independiente a la enfermedad tromboembolica Conclusiones El empleo de enoxaparina en el tratamiento inicial del TEP parece ser tan efectivo y seguro como el uso de heparina no fraccionada

Two of the most significant forces shaping organizations are globalization and the continued, rapid and, some would say, radical changes taking place in information technology (IT). To date, the extant literature has centred on the technology acceptance model (TAM) because it is arguably one of the most widely cited and influential models used for explaining the acceptance of IT. However, this literature has remained relatively silent with respect to the role that differences in national culture might play in IT acceptance as globalization continues. In order to begin to address this deficit, this paper offers a series of research propositions that explore the potential impact of differences in national culture on IT implementation and acceptance. Specifically, the paper explores the effects of culturally induced beliefs - including individualism-collectivism, uncertainty avoidance, long-/short-term orientation and power distance - on the implementation processes that impact on key variables in the TAM. The paper then discusses the potential importance of the revisions it has made for both researchers interested in employing the model for predicting IT acceptance in cross-cultural contexts and for managers faced with introducing new IT in a global organization.

With so many individuals linked to the Internet and so many possible ways to reach them, the debate for organizational scholars is no longer over whether Internet self-administered surveys are possible but rather over the comparative understanding and the relative advantages and disadvantages of these surveys. Because relevant research has generally been fragmented and narrow in scope, making comparisons difficult, the authors review and assess the research on Internet selfadministered surveying modalities of electronic mail and the World Wide Web. Then, they provide recommendations that address problematic and controversial aspects of these modalities, including ways to increase the representativeness of samples, construct sampling frames, increase response rates, and manage anonymity and confidentiality.

Although the Americans with Disabilities Act requires most employers to provide reasonable accommodation, there is reason to believe that people with disabilities are often unwilling to make such requests. We therefore focus on factors influencing the requester's likelihood of seeking an accommodation. By drawing upon the theories of planned behavior, help-seeking, and distributive justice, we propose a framework identifying several salient beliefs that may influence request likelihood and then explore the role of select situational characteristics in shaping these beliefs as a way to more fully understand the requester's assessment process.

Workplace accommodation plays a critical role in the successful inclusion of people with disabilities. While past studies have examined reactions to workplace accommodation, none have explored the ...

Executive Overview There's a disturbing disconnect in organizational management. Research, experience, and common sense all increasingly point to a direct relationship between a company's financial success and its commitment to management practices that treat people as assets. Yet trends in management practice are actually moving away from these very principles. Why is common sense so remarkably uncommon when it comes to managing people? Why do organizations habitually overlook readily available opportunities to boost their financial performance? Drawing on extensive empirical research, an irrefutable business case can be made that the culture and capabilities of an organization—derived from the way it manages its people—are the real and enduring sources of competitive advantage. Managers today must begin to take seriously the often heard, yet frequently ignored, adage that “people are our most important asset”

Executive Overview Over the past several years, the authors of this article have been gathering real-life stories that reflect the difficulties of managing a diverse workforce. What follows is one of those stories about a manager, who after the ordeal of brain tumor surgery, was fired for poor performance. To provide insights for effective management of such situations, a physician-manager and two human resources executives share their views. The law is also discussed. Concluding remarks are offered by two people with disabilities—one who actually suffered, and survived, the same trauma as the person in this story, and another whom we asked to offer his views based on his personal experience.

Executive Overview Our annual survey of members of the Executive's Advisory Board reveals a good deal of information-technology-related angst. To be sure, of the 350 executives who accepted our invitation to vent, many still felt that information technology had a very strong upside and urged then colleagues to be patient. Having said that, as you will see, the executives we surveyed (average age 44, one-third female) from many of the nation's major corporations had a number of common concerns. Whether you are a Netizen or a novice, we think you'll find that some of the griping is legitimate.

This paper presents the design of a pneumatic robotic system to support the inspection of conduits according to the Electric Energy Company of the State of Rio Grande do Sul standard. Throughout the text is given an emphasis on mechanical solution developed, based on the movement of a caterpillar. Moreover, the pneumatic actuators are specified, the onboard electronics and thermal sensor used in the project. Results of the mechanical design and acquisition of images of the thermal camera are presented.

Executive Overview It has been said that over half the decisions reached by teams never get carried out and of the rest only half should have been. Whether or not this old saw is accurate is not the point. Managers today are more than a little cynical when it comes to their participation in decision-making teams. While many feel compelled to sit through endless meetings, they frequently surrender—at least privately—withholding any real effort. And, by their own account, they “raise a white flag” in over half the teams in which they participate. In this article, we will explore why this happens, and offer ways to manage teams that will minimize the withholding of effort.

The acculturation process involved when one organization is acquired by another, and the two organizational cultures merge, has not been adequately conceptualized in the strategic management literature. It is argued here that the acculturation process can be more fully understood by utilizing Lewin's (1951) force-field approach. In addition, major forces of cultural differentiation and organizational integration are identified. It is also argued that the dynamic acculturative change process will both influence and be influenced by postacquisition organizational performance. Predictions as to how post-acquisition performance influences subsequent acculturation modes are offered.

The present study was performed in vivo in rabbits to evaluate the functional and morphologic effects of verapamil in a model of ischemic acute renal failure (ARF). Particularly impressive was the ultrastructural integrity of renal tubules in the animals exposed to both ischemia and verapamil. Three groups were studied: Group A: no ischemia; Group B: renal ischemia alone; and Group C: renal ischemia with verapamil. Creatinine clearance was higher in Group C (0.77 mL/min/kg) compared to Group B (0.13 mL/min/kg) at 24 h of reperfusion (p.005) as well as at 48 and 72 h (0.73 mL/min/kg) vs. 0.35 mL/min/kg; p.05 and 0.90 mL/min/kg vs. 0.46 mL/min/kg; p0.05, respectively). Light microscopic evaluation of Group C rabbits revealed significantly better preservation of proximal tubule (PT) brush border (p.0005) and less desquamation of PT (p.05) compared to Group B. Ultrastructural examination of in vivo perfused kidneys also demonstrated decreased loss of microvilli of PT (p.0005) as well as less cellular edema (p.005), fewer cells with apical PT membrane rupture (p.01), better preservation of mitochondria (p.005), less flattening of the PT basolateral labyrinth (p.05), and fewer hypertrophic actin bands at the basal surface of PT epithelial cells (p.05). These results suggest that verapamil markedly attenuates PT morphologic injury in a rabbit model of reversible ischemic ARF. The functional protection observed in these studies may be related, in part, to the improved structural integrity of the renal tubules. Renal transplantation and anticipated renal ischemia (i.e., surgical interventions) are two important situations where treatment with verapamil or other calcium channel blockers may prove to be clinically beneficial.

rosuvastatin on coronary atheroma in stable coronary artery disease: multicenter coronary atherosclerosis study measuring effects of rosuvastatin using intravascular ultrasound in Japanese subjects (COSMOS). Circ J 2009;73:2110–7. [5] Smith Jr SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation 2006;113:2363–72. [6] Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143–421. [7] Grundy SM, Cleeman JI, Merz CN, Brewer Jr HB, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227–39. [8] Deedwania P, Singh V, Davidson MH. Low high-density lipoprotein cholesterol and increased cardiovascular disease risk: an analysis of statin clinical trials. Am J Cardiol 2009;104:3E–9E. [9] Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med 2007;357:1301–10. [10] Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD, et al. Highdensity lipoprotein cholesterol and cardiovascular disease: Four prospectiveAmerican studies. Circulation 1989;79:8–15. [11] Shewan LG, Coats AJ. Ethics authorship publishing scientific articles Int J Cardiol 2010;144:1–2.

Editor's Note As part of this special issue on executive health, our consulting editor, Jack Veiga, was asked to poll AME's executive advisory panel. Out of the full panel, 50 executives responded—giving us a glimpse into their firms' health practices and their own health maintenance practices. What follows is a mock panel interview, a hypothetical rendition of what a dialogue might sound like with the entire panel based on responses to the survey. In the interview, we hear about the factors that contribute to executive health problems, learn what executives do to maintain their health, and find out that some executives are afraid to reveal their health problems because to do so might make them appear weak.

Although the teleworking literature continues to raise concerns regarding the adverse consequences of professional isolation, researchers have not examined its impact on work outcomes. Consequently, the authors first examine professional isolation's direct impact on job performance and turnover intentions among teleworkers and then investigate the contingent role of 3 salient work-mode-related factors. Survey data from a matched sample of 261 professional-level teleworkers and their managers revealed that professional isolation negatively impacts job performance and, contrary to expectations, reduces turnover intentions. Moreover, professional isolation's impact on these work outcomes is increased by the amount of time spent teleworking, whereas more face-to-face interactions and access to communication-enhancing technology tend to decrease its impact. On the basis of these findings, an agenda for future research on professional isolation is offered that takes into account telework's growing popularity as a work modality.

International audience; While a firm’s ability to jointly pursue both an exploitative and exploratory orientation has been posited as having positive performance effects, little is currently known about the antecedents and consequences of such ambidexterity in small- to medium-sized firms (SMEs). To that end, this study focuses on the pivotal role of top management team (TMT) behavioral integration in facilitating the processing of disparate demands essential to attaining ambidexterity in SMEs. Then, to address the bottom-line importance of an ambidextrous orientation, the study hypothesizes its association with relative firm performance. Multisource survey data, including CEOs and TMT members from 139 SMEs, provide support for both hypotheses.

Given the ubiquity of Internet access in the business world, the question for strategy researchers is no longer over whether or not Internet surveys are viable, but rather over the comparative advantages and disadvantages of this modality. To address this question, we provide guidelines for researchers to help minimize the challenges while still reaping the benefits. We begin by first defining Internet survey modalities and some of their benefits, and then we focus on the associated sampling challenges and often ways that strategy researchers can address them. To further assist researchers in using this survey modality, we present a comparison of some software packages that might be useful, followed by a discussion of the lessons that we have learned from our own use of Internet surveys.

Objective.– To determine the value of procalcitonin (PCT) as a prognostic biomarker in elderly patients with respiratory infection comparing it with Curb-65 and acute phase reactants: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)and leukocytes. Methods.– Prospective observational study in elderly patients admitted to an Acute Geriatric Unit with the diagnosis of upper respiratory infection or pneumonia. We collected sociodemographic variables, clinical and geriatric assessment. Samples were taken to determine PCT, CRP and ESR at admission and 72hours after. Results.– We included 50 patients, 30 with pneumonia and 20 with respiratory infection, with an average age of 86 years, significant comorbidity (Charlson Index≥3 in more than 50%), cognitive impairment (70%) and poor functional status (Katz≥D 56%). Mortality during admission was high (37% in pneumonia and 25% in upper respiratory infection). At admission 60% of patients have elevated PCT (≥0.25ng/mL), 100% PCR, 84% ESR and 36% leukocytes. In all patients the PCT difference between admission and 72hours was marginal (P=0.059); in patients with respiratory infection decreased significantly at 72hours (P=0.046),while there wasnovariation inpatientswithpneumonia. Theother acutephase reactants, except leukocytes (P≤0.05) showedno significant differences during the first 72hours. Conclusions.– In elderly patients with suspected upper respiratory infection, decreased procalcitonin levels at 72hours indicates a good prognosis. In those with pneumonia study these evolutionary parameters at 72hours show no change, so control should be delayed.

In business today, a firm's ability to continuously develop new products or services is essential. Many practitioners and scholars suggest that the extent to which any firm can continuously innovat...

A new technique of choledochoenterostomy was devised to solve some of the problems of enterobiliary anastomosis with a normal calibre. The distal extremity of the common bile duct is completely surrounded by the bowel mucosa to a length of 3 cm after seromyectomy of a bowel wall rectangle of 4 × 1 cm. Experimental studies in rats and dogs demonstrated that this procedure prevents the risks of anastomotic disruption and functions like a mechanical unidirectional valve, which has great efficacy in stopping enterobiliary reflux. Studies in ten patients with obstructive jaundice with an extrahepatic biliary dilation less than 1.2 cm diameter submitted to this procedure confirmed the experimental results. All patients were asymptomatic, without jaundice and with normalization of the liver enzymes after 2 months. The permeability of the valvular anastomosis studied by cholangiography, the HIDA 99mTc test and manometry was quite similar to other classical biliary-enteric anastomosis. In contrast, anti-reflux efficacy was only demonstrated in patients with a valvular anastomosis.

The aim of this study was to develop a new computerized gammagraphic method to evaluate gastrooesophageal (GER), bileo-oesophageal (BER) and bileogastric reflux (BGR) simultaneously with gastric and gallbladder emptying: a long duration (60 min) and a dual energy detection (113Inm-sulphur colloid and 99Tcm-HIDA) test of the different refluxes during slow gastric emptying of an enteric feeding liquid meal. Forty patients with oesophagitis and 18 normal volunteers were evaluated. Good reproducibility of all the quantified parameters was found with r Spearman between 0.75 (P < 0.05) and 1.0 (P < 0.001). Patients with oesophagitis have a tendency for slower gastric emptying patterns (gastric emptying T1/2, GT1/2 P < 0.05). The calculated specificity for gallbladder emptying parameters was 77.8% for the gallbladder T1/2 BT1/2) and 94.4% for gallbladder residue at 60 min (BR60). The calculated accuracy for the GER index was 90%. The predictability for positive values was 95%, owing to a 90% sensitivity and 89% specificity. The predictability for negative values was 80%. The mean GER index in oesophagitis was greater than in controls (P < 0.001). The calculated specificity for BGR was 94.4% and reflux was detected in 12 out of 40 patients. The calculated specificity for BER was 83.3% for a '+' index and 94.4% for a '++' BER index. In 14 patients a positive BER index has been determined ('+' in three and '++' in 11 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Personal value profiles constructed through the use of a cluster analytic technique successfully indentified similar managerial subgroups in India and the United States. The value profiles, "Pragma...

The purpose of this report was to evaluate the efficacy of cardiomyotomy combined with fundoplication in the treatment of achalasia. Results obtained in 15 patients are compared with those collected in 19 asymptomatic patients treated by the classical Heller operation (12 patients), or by cardiomyotomy combined with suture of phrenoesophageal ligament to the underside of the diaphragm (7 patients). The preventive action of fundoplication on reflux esophagitis and especially the effect of surgery on esophageal emptying are particularly examined, using two rigorous isotopic tests. It is demonstrated that even asymptomatic patients have, after cardiomyotomy without antireflux maneuvers, a very high risk of esophagitis. The statistical comparison using the gastroesophageal reflux index between patients treated by Heller cardiomyotomy and normals wasp 0.1), and maintained the improvement of the esophageal emptying.

SummaryThis study aims to establish the relative effectiveness and safety of low molecular weight heparin in elderly patients with venous thrombosis in order to find an alternative to oral anticoagulant therapy with less bleeding complications in the long-term treatment of deep venous thrombosis (DVT).One hundred consecutive elderly patients (>75 years old) with venographically demonstrated proximal DVT were included in a randomized trial. All patients were treated for ten days with adjusted doses of intravenous heparin. Informed consent was obtained and on the eight day, patients were randomly allocated to receive acenocoumarol (INR 2.0-3.0) or subcutaneous enoxaparin (4000 anti-Xa units once a day) for three months. All patients were followed-up clinically and venographically for a one year period. The results were analyzed with Fisher’s exact test or chi-square test as appropriate.During the treatment and surveillance period, 6 of the 50 patients (12%) who received acenocoumarol and 8 of the 50 patients (16%) who received enoxaparin had new episodes of venous thromboembolism confirmed by objective testing (p = 0.6; 95% CI for the difference: −19.5 to 11.5). Hemorrhagic complications occurred in six of the 50 patients (12%) who received acenocoumarol and in one (2%) of those on enoxaparin (p = 0.1; 95% CI for the difference: -1.8 to 21.8). Vertebral fractures developed in 2 patients (4%) in the enoxaparin group (p = 0.5; 95% CI for the diference: −11.4 to 3.4).These results show that fixed dose enoxaparin seems to be effective and safe in the long-term treatment of proximal DVT in the elderly. In comparison with oral anticoagulants, the findings are inconclusive due to the wide confidence intervals for differences between outcomes, however they suggest that the former may have less bleeding complications with similar efficacy.