This article investigates the use of gold as an investment asset. The data consist of U.S. and foreign equity returns from 1975 to 2005. The results indicate that investment in gold is inferior to a simple buy-and-hold strategy of U.S. equities over the long term. Gold is often believed to provide potential as a defensive asset, given its low correlation with U.S. equities. However, a portfolio optimization technique using actual and simulated data indicates that the long-term portfolio benefits of holding gold are marginal at best TOPICS:Other real assets, portfolio management/multi-asset allocation, performance measurement

Since its introduction in 1950, a variety of methods of measurement and calculation have been used to establish the ankle-arm index (AAI). This has resulted in variations of its normal range and difficulty in comparing study results. Hence, the objective of our study was to analyze the disparate methods used to assess AAI and its normal range and to recommend a standardized method to assess AAI based on that analysis. We made an inventory of the disparate AAI methods and its normal range reported in 100 randomly selected publications and recommend the means of such standardization. We recommend that an experienced observer assess AAI with the patient at rest in the supine position. The width of the sphygmometer cuffs should be 1.5 times that of the extremity to be measured, and brachial and crural pulses should be detected using a Doppler device. Systolic pressures should be measured at both arms and over the anterior and posterior arteries of both legs, with the cuff placed just proximally to the malleoli. The left arm pressure ought to be used as denominator and the mean of pressures of both crural arteries of each leg ought to be used for the numerator of the AAI for that leg. We advocate 0.90 as the cut-off value to distinguish patients who need further arterial assessment.

Spector, Ira J. MD; Klein, Steven A. MD; Faustin, Daniel MD; Goldstein, Jonathan G. MD; Mackenzie, Andrew MD Author Information

The free fibula flap is the microsurgeon's workhorse for the reconstruction of osseous or osteocutaneous defects. Donor‐site morbidity of this flap is reported to occur infrequently, and is generally considered minor and transient. We present the case histories of three patients with necrosis at the fibula flap donor site to stress the risks and explain the possible mechanisms of such severe complications. The small risk of debilitating donor‐site necrosis should be considered and discussed preoperatively with the patient. © 2005 Wiley‐Liss, Inc. Microsurgery 25:538–542, 2005.

To determine the influence of cervical length on the anatomic relationship of the cervix to the maternal bladder. 101 patients, referred from 10/97 to 7/98, who had routine transvaginal sonography of the cervix, comprised the study population (from 12-35 weeks of gestation). The post-voiding image of the cervix included the cervical canal and the posterior vesical angle (PVA) between the superior and posterior walls of the bladder. The position of the internal os was noted relative to the PVA. Patients were divided into 3 groups based on cervical length (CL): group A, CL of <20 mm; B, CL of 21-29 mm; and C, CL of >30 mm. The bladder was noted as high (H) if its lowest point was proximal to the internal os and low (L) if the angle was distal to it. 101 patients underwent 105 sonograms. In group C there were significantly (P < .05) more patients with a low bladder position (51/54). But, in the shorter cervix group, 20 of 21 patients had a high bladder position. In group B, there was no statistically significant difference in bladder location. See Table.TableBladder PositionCervix (%) <20 mmCervix (%) 21-29 mmCervix (%) >30 mmTotalLow1 (5%)13 (43%)51 (94%)65 (62%)High20 (95%)17 (57%)3 (6%)40 (38%)TOTAL213054105 Open table in a new tab We have found that a short cervix is associated with a low position of the internal os relative to the bladder. Our prior finding of a lower position of the internal os with advancing gestational age combined with the cervical length effect is consistent with knowledge of the initiation of cervical changes at the internal os. The relationships of the posterior vesical angle to the internal os of the cervix can be utilized as a valuable means of identifying early changes in the cervix.

The objective of this study was to determine the reliability of maternal perception of uterine contractions and the influence of gestational age and maternal training on the perception level. Three hundred fifty patients at high risk for preterm delivery were followed from 20 to 35 weeks of gestation. The average maternal perception (79%) of contractions did not significantly vary as a function of gestational age. Four groups of women were identified according to the perception index (PI) defined as the ratio of contractions felt by the mother and the contractions documented by tocodynamometer. Within each group, the PI did not significantly vary during consecutive monitoring sessions, as the women become more familiar with self detection of uterine contractions (R < .65, P > .95). Twenty-one percent (+/-5%) of all preterm uterine contractions were not perceived by the pregnant women from 21 to 35 weeks. Thirty-two patients (9.1%) fail to perceive most or all uterine contractions while 189 (54%) detect most or all at any time during the study period.

Administered the Low Back Pain Scale (LB) and the K Scale of the MMPI, the College Schedule of Recent Experience (CSRE), a psychosomatic disorder checklist, and the item, "I frequently have problems with my mother," to 53 male and 70 female college freshmen. Ss with a psychosomatic disorder scored higher on LB and on the CSRE. Females who reported problems with their mothers were more likely to have a psychosomatic disorder. The results suggest different etiology for psychosomatic disorders between males and females.

The relationship between birth order and introversion-extraversion was investigated. Subjects were 70 male and 77 female undergraduates, all from three-child families. The measure of introversion employed was the Social Introversion Scale (Scale 0) of the Minnesota Multiphasic Personality Inventory. A two-way analysis of variance indicated that first borns were more introverted than either middle-horns or last-horns, with no difference between the latter two groups. It was suggested that inconsistent results in this area may be due to the use of different measures of introversion.

(1) Six Macaca mulatta monkeys were rendered chronically epileptic by subpial alumina injection in left percentral cortex. The monkeys were then trained to operantly control the firing patterns of single units from the epileptic focus and contralatral homotopic cortex using a standardized operant paradigm. In 30 experiments, units were recorded simulataneously from both hemispheres.(2) For epileptic and normal neurons, there are no consistent relationships between cortical EEG spikes and unit firing.(3) Previous parameters for quantifying single unit epileptogenicity are not adequate for defining the complex spectrum and relative degree of unit abnormalities within the chronic focus. A primary difference between normal and epileptic neurons is that monkeys can modify the firing pattern and rate of the former but can modify, only slightly, the integrated firing rate of the latter.(4) A previously described ‘non-burst’ epileptiform firing pattern consisting of 8–18 msec doublets is investigated in further detail. This pattern may represent units along a continuum between normalcy and long-first-interval burst firing.(5) The majority of epileptic units' firing patterns become more normal when the monkey is reinforced to control the firing pattern of a contralateral unit. Then, if the monkey is reinforced to control the epileptic unit, subtle abnormal firing patterns become more apparent. Therefore, the firing patterns of epileptic units are effected in two ways: the non-specific effect of alerting to the operant task, and the more specific effect that accompanies the monkey's attempts to attain reinforcement when it is contingent on the behavior of the specific neuron.(6) Although epileptiform EEG spikes are projected to homotopic contralaterl precentral cortex, there is no evidence to suggest that single units within such cortex fire in patterns correlative with intrinsic epileptogenic burst generating properties. Therefore, if the ‘mirror focus’ is defined as cortex which has become autonomously epileptogenic secondary to persistent transsynaptic activity from a primary focus, these data do not support the concept that mirror foci develop in primate precentral cortex.