bluuebunny/crossref_metadata_2025 huggingface dataset:
‘It was an Incredible Thrill’: The Social Meanings and Dynamics of Younger Gay Men’s Experiences of Barebacking in Melbourne
Authors: Ridge Damien Thomas
Published: July 2004

This study used a qualitative research design to examine the meanings and circumstances underpinning practices of ‘barebacking’ - unprotected anal intercourse in episodic sexual encounters among younger (mainly in their 20s) same-sex attracted men - in Melbourne, Australia. Using a modified grounded theory approach, a series of in-depth interviews with 24 men were conducted. The results reveal that understanding practices of barebacking requires an appreciation of how sex takes on multiple meanings in practice. Meanings in sex for the men in this study tend to be organized around masculinity. In sexual negotiations, meanings, initiation, emotions, dynamics (e.g. ‘shared’ communication, ‘directing’) and wider contextual influences (e.g. public health discourses) all play a role in sexual choreography and risk taking. Implications for health promotion and policy are discussed.
Transgendering Citizenship
Authors: Monro Surya , Warren Lorna
Published: July 2004

Transgender people are currently excluded from full citizenship in the UK. However, this is being challenged by a number of transgender groups. Sexual and feminist models of citizenship provide useful alternatives to mainstream models of citizenship, sharing a considerable amount of ground with transgender citizenship. However, transgender citizenship differs from sexual and feminist models in various ways. This article examines the commonalties and divergences between transgender citizenship and sexual and feminist approaches to citizenship, and explores some of the issues emerging in the area of transgender citizenship.
Self-Presentation of Small Developing Countries on the World Wide Web: A Study of Official Websites
Authors: Mohammed Shaheed N.
Published: July 2004

The author analyzes the official national websites of small developing countries for content and function. The surveyed websites are found to emphasize geographical, tourism and identifying information about the small states but contain little in terms of investment information, suggesting that the web is seen as a tool of self-promotion but is not equally perceived as a tool for attracting investment. A positive relationship is observed between literacy and the range of national websites published for each surveyed state. The study considers the content of national websites of small developing nations in the context of the new technologies and traditional geopolitical and information flow issues facing small states.
‘I’ve Never Clicked this Much with Anyone in My Life’: Trust and Hyperpersonal Communication in Online Friendships
Authors: Henderson Samantha , Gilding Michael
Published: July 2004

Earlier research on online communication has observed how its distinctive characteristics (such as limited cues and potential asynchronicity) facilitate online communication, notably ‘hyperpersonal communication’. Yet these distinctive characteristics do not explain the development of trust in online communication. This article uses qualitative interviews with 17 internet users to explore the foundations of trust in online friendships, drawing on Piotr Sztompka’s theoretical framework. It concludes that there are four main sources of online trust. First, reputation, whether grounded in a pseudonym or offline identity. Second, performance, due to the scope for enhanced performance in online communication. More than this, performance plays an especially important role in the building of online friendship, following Giddens’ model of the pure relationship (1991). Third, pre-commitment, through self-disclosure, which in turn encourages a ‘leap of faith’ and reciprocal self-disclosure. Finally, situational factors, especially the premium placed upon intimacy and the pure relationship in contemporary societies.
Ethnographic Interviews on the Digital Divide
Authors: Clark Lynn Schofield , Demont-Heinrich Christof , Webber Scott A.
Published: July 2004

Employing narrative analysis of ethnographic interviews with persons from a variety of socioeconomic, educational, and racial/ethnic backgrounds, this article examines the discursive structure of the digital divide debate as it is articulated among contemporary online users and non-users in the United States. The article argues that the discourse of individualism serves as a filter that shapes and distorts all private and public conversations about the digital divide and thus limits public debate on the subject. Some challenges to the dominance of individualism emerge when people discuss the digital divide in relation to the specific, lived situations of economic disadvantage. Yet we conclude that the potential political power of this critique is muted as it echoes rather than challenges the contradictions inherent to the promise of the digital era that are found at the heart of both corporate advertising and current social policies.
Governance in the Information Age: Building E-Government in Hong Kong
Authors: Holliday Ian , Kwok Rebecca C.W.
Published: July 2004

The article reviews the literatures on e-government and governance reform, and engages in detailed analysis of e-government initiatives and parallel policy changes undertaken in Hong Kong, which is currently an acknowledged leader in the field. It finds that the Hong Kong government has made considerable progress in developing online service delivery, notably for the business sector, but that wider governance changes are limited. The article holds that to succeed in addressing the challenges of the information age, the Hong Kong government needs to adopt a broader strategy that goes beyond service delivery to encompass citizen engagement and participation.
Consultation, Community and Empowerment
Authors: Mclaughlin Hugh , Brown Denise , Young Alys M.
Published: July 2004

• Summary: This article offers a critical examination of the conceptual basis of service user involvement through the analysis of a practice example derived from the Deaf community. The Deaf community is located both socio-culturally and historically.

• Findings: One authority’s attempts to consult with their own Deaf community is used as the lens to examine the issues, dilemmas and contradictions inherent in consultation and how consultation can be seen as a mechanism both for social control and for empowerment.

• Applications: The authors identify some of the lessons for practice and argue against the uncritical acceptance of consultation. They identify preconditions for consultation to be beneficial both for the Deaf community and for those wishing to consult with that community.
Using Standardized Measures to Prioritize Services for Children and Families in Need
Authors: Buchanan Ann , Ritchie Charlotte
Published: July 2004

• Summary: This article reports the findings of a small study on families in receipt of social services’ support (Buchanan et al., 2001b), which was commissioned in the UK by Barnardo’s and Wiltshire County Council. Children’s well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ) and parental well-being was assessed using the General Health Questionnaire (GHQ).

• Findings: The study showed high levels of both parental and child distress. Parents with high levels of distress often found it harder to access social services than those with lower levels.

• Application: This study suggests that using standardized measures of well-being for both parents and children may help in prioritizing service provision. There was also evidence to indicate that both policy makers and practitioners should ensure that choice and availability of services are user led.
Well-Being among Minority Students
Authors: Ben-Ari Adital , Gil Sharon
Published: July 2004

• Summary: The present study explores the relationship between perceived social support and well-being among students in the two main populations living in Israel: Jews and Arabs. More specifically, it compares the well-being of Israeli Jewish students and Palestinian students and examines the role of social support in their well-being. The sample comprised 207 undergraduate students in the schools of social work and nursing at one of the major universities in Israel, where more than half of the Palestinian students are enrolled. Three instruments were used: Psychological distress was measured by both the Brief Symptoms Inventory Scale( BSI;Derogatis, 1979) and the Beck Depression Inventory ( BDI; Beck and Steer, 1987); perceived social support was assessed by the Multidimensional Scale of Perceived Social Support( MSPSS;Zimet et al., 1988).

• Findings: Findings show that the Palestinian students are significantly more distressed than their Jewish counterparts, according to all measures of well-being. At the same time, their perceived social support is significantly higher than that of the Jewish students.

• Applications: The significance of the findings is discussed within the frameworks of stress and social support theories, as well as the modernization process and the prevailing norms and values of Arab culture.
Multinational Perspectives on Work Values and Commitment
Authors: Andolsěk Dana Mesner , Sťebe Janez
Published: July 2004

The aim of this article is to show how different factors influence the commitment of employees in an organization from an international comparative perspective. Commitment is studied as affective and continuance commitment. Personal characteristics, organizational and environmental factors are included as predictors that have an impact on commitment. The role of values and insecurity is also examined. It is proposed that these factors do not have the same impact on the two types of commitment in different countries and that this might have important practical implications. The study, which compared West Germany, East Germany, Japan, Hungary, Slovenia, the UK and the USA, was performed using the data from Work Orientations II, gathered by the International Social Survey Programme group (ISSP). The dataset is from 1997. The study finds that there are some predictors that are universal, but their configurations depend mainly on cultural background.
September 11, 2001
Authors: Olivas-Luján Miguel R. , Harzing Anne-Wil , McCoy Scott
Published: July 2004

This article investigates whether the September 11 attack had an impact on cultural values and the level of cosmopolitanism of US university students. Extending a model proposed by Esses, Dovidio and Hodson, we hypothesize a positive effect on the cultural dimensions of collectivism and hierarchy/power distance and a negative effect on cosmopolitanism. Our results - drawn from two separate quasi-experimental studies - support the two latter hypotheses. In addition, supplementary analyses showed that, after the September 11 attack, students exhibited a tendency to trade-in variety, adventure and challenge for security and stability in their ideal job after graduation. Implications for management and for cross cultural management research are discussed.
Cross Cultural Communication Competence and Multicultural Team Performance
Authors: Matveev Alexei V. , Nelson Paul E.
Published: July 2004

Starting with the hypothesis that cross cultural communication competence affects the performance of multicultural teams, we employed the Cross Cultural Communication Competence Model to compare American and Russian managers working in multicultural teams. We collected data from 124 upper and middle managers in the United States and the Russian Federation by administering the cross cultural communication competence and the high-performance team questionnaires. Drawing from proven conceptual cultural orientations suggested by Hall, Hofstede, and Javidan and House, we examined how national culture affects team members’ perceptions of cross cultural communication competence. The confirmed hypothesized relationship and salient effects of national culture on cross cultural communication competence led to theoretical and practical implications for multicultural organizational settings.
Where is Feminism in Planning Going? Appropriation or Transformation?
Authors: Rahder Barbara , Altilia Carol
Published: July 2004

Despite feminism’s contributions to planning theory and practice, it seems to be disappearing from the planning discourse. Drawing on the history of the feminist movement, experiences in the classroom, a scan of recent planning papers and publications, including some on planning curricula and women’s prospects within the profession in Canada and the USA, questions are raised about the reasons for this apparent decline. The authors ask if postmodernism is undermining the feminist and anti-racism movements by combining complex and intersecting identities into an amorphous notion of diversity, rather than explicating the differential relations of power embodied in these differences.
Peroxisome proliferator-activated receptor-γ and its ligands attenuate biologic functions of human natural killer cells
Authors: Zhang Xia , Rodriguez-Galán Maria Cecilia , Subleski Jeff J. , Ortaldo John R. , Hodge Deborah L. , Wang Ji-Ming , Shimozato Osamu , Reynolds Della A. , Young Howard A.
Published: July 2004

Interferon-γ (IFN-γ) production and cytolytic activity are 2 major biologic functions of natural killer (NK) cells that are important for innate immunity. We demonstrate here that these functions are compromised in human NK cells treated with peroxisome proliferator-activated-γ (PPAR-γ) ligands via both PPAR-γ-dependent and -independent pathways due to variation in PPAR-γ expression. In PPAR-γ-null NK cells, 15-deoxy-Δ12,14 prostaglandin J2 (15d-PGJ2), a natural PPAR-γ ligand, reduces IFN-γ production that can be reversed by MG132 and/or chloroquine, and it inhibits cytolytic activity of NK cells through reduction of both conjugate formation and CD69 expression. In PPARγ-positive NK cells, PPAR-γ activation by 15d-PGJ2 and ciglitazone (a synthetic ligand) leads to reduction in both mRNA and protein levels of IFN-γ. Overexpression of PPAR-γ in PPAR-γ-null NK cells reduces IFN-γ gene expression. However, PPAR-γ expression and activation has no effect on NK cell cytolytic activity. In addition, 15d-PGJ2 but not ciglitazone reduces expression of CD69 in human NK cells, whereas CD44 expression is not affected. These results reveal novel pathways regulating NK cell biologic functions and provide a basis for the design of therapeutic agents that can regulate the function of NK cells within the innate immune response. (Blood. 2004;104:3276-3284)
Dual role of phagocytic NADPH oxidase in bacterial killing
Authors: Rada Balázs K. , Geiszt Miklós , Káldi Krisztina , Timár Csaba , Ligeti Erzsébet
Published: July 2004

The classical model of bacterial killing by phagocytic cells has been recently challenged by questioning the toxic effect of oxygen products and attributing the fundamental role to K+ ions in releasing antimicrobial proteins within the phagosome. In the present study we followed \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\mathrm{O}_{2}^{{\cdot}-}\) \end{document} production, changes of membrane potential, K+ efflux, and bacterial killing in the presence of increasing concentrations of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor diphenylene iodonium. Efficiency of bacterial killing was assessed on the basis of bacterial survival measured by a new semiautomated method. Very low rates of \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\mathrm{O}_{2}^{{\cdot}-}\) \end{document} production were accompanied by significant membrane depolarization and K+ release and parallel improvement of bacterial killing. When \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\mathrm{O}_{2}^{{\cdot}-}\) \end{document} production exceeded 20% of its maximal capacity, no further change was detected in the membrane potential and only minimal further K+ efflux occurred, yet bacterial survival decreased parallel to the increase of \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\mathrm{O}_{2}^{{\cdot}-}\) \end{document} production. The presented results indicate that both electrophysiological changes (depolarization and consequent ion movements) and the chemical effect of reactive oxygen species play a significant role in the killing of certain pathogens. The observation that an increase of membrane depolarization can compensate for decreased \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\mathrm{O}_{2}^{{\cdot}-}\) \end{document} production may be important for potential therapeutic applications.
Protein kinase A mediates inhibition of the thrombin-induced platelet shape change by nitric oxide
Authors: Jensen Baard Olav , Selheim Frode , Døskeland Stein Ove , Gear Adrian R. L. , Holmsen Holm
Published: July 2004

The thrombin-induced platelet shape change was blocked by nitric oxide (NO), as revealed by scanning electron microscopy, light transmission, and resistive-particle volume determination. The inhibitory effect of NO was accompanied by an increase in levels of both cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP) and phosphorylation of the vasodilator-stimulated phosphoprotein (VASP). However, the inhibition of the shape change was only mimicked by cAMP analogs (Sp-5,6-DClcBIMPS, 8-AHA-cAMP, and 8-CPT-cAMP) and not by cGMP analogs (8-Br-PET-cGMP, 8-Br-cGMP, and 8-pCPT-cGMP). The effect of NO on the thrombin-induced shape change was prevented by the protein kinase A (PKA) antagonists Rp-8-Br-cAMPS and Rp-cAMPS. The protein kinase G (PKG) antagonist Rp-8-CPT-cGMPS strongly inhibited PKG-mediated 46-kDa VASP Ser239 phosphorylation, but did not inhibit the thrombin-induced shape change or the PKA-mediated VASP Ser157 phosphorylation. Whereas an inhibitor of cyclic nucleotide phosphodiesterase (PDE) 3A (milrinone) mimicked the effect of NO, inhibitors of PDE2 (erythro-9-(2-hydroxy-3-nonyl)adenine) and PDE5 (dipyridamole) were poorly effective. We concluded that (1) NO was a potent and reversible inhibitor of the platelet shape change, (2) the shape change was reversible, (3) the inhibitory effect of NO was mediated through activation of PKA, (4) the onset of the NO effect coincided with VASP Ser157 phosphorylation, and (5) removal of NO and platelet shape change coincided with VASP Ser157 dephosphorylation. These findings are compatible with elevation of cGMP by NO in a compartment close to PDE3A, PKA, and VASP, leading to a local increase of cAMP able to block thrombin-induced shape change. (Blood. 2004;104:2775-2782)
Neuropsychologic changes from before transplantation to 1 year in patients receiving myeloablative allogeneic hematopoietic cell transplant
Authors: Syrjala Karen L. , Dikmen Sureyya , Langer Shelby L. , Roth-Roemer Sari , Abrams Janet R.
Published: July 2004

Research indicates that myeloablative hematopoietic cell transplantation (HCT) impairs neurocognitive function. However, prospective studies on long-term effects are lacking. This longitudinal study examined neurocognitive changes over the first year in 142 adult recipients of allogeneic HC transplants who received neuropsychologic testing before transplantation and again after 80 days and 1 year. Age-, sex-, and education-adjusted population-based standardized scores were used for normative comparisons. Performance on all tests declined from before transplantation to 80 days (P < .05) and improved by 1 year (P < .05), returning to pretransplantation levels on all tests except for grip strength and motor dexterity. Although verbal fluency and memory recovered by 1 year, both were below norms at all 3 testing times (P < .01). Logistic regressions indicated that patients without chemotherapy, other than hydroxyurea, previous to HCT and patients not receiving chronic graft-versus-host disease (GVHD) medication at 1 year had lower risk of impaired function (P < .05). In conclusion, HCT was associated with significant generalized decline in neurocognitive performance at 80 days, with subsequent recovery to pretransplantation levels by 1 year for most survivors, except on motor tasks. Results indicate that long-term cognitive decrements, as distinct from motor disabilities, infrequently derive directly from HCT. (Blood. 2004;104:3386-3392)
A requirement for Notch1 distinguishes 2 phases of definitive hematopoiesis during development
Authors: Hadland Brandon K. , Huppert Stacey S. , Kanungo Jyotshnabala , Xue Yingzi , Jiang Rulang , Gridley Thomas , Conlon Ronald A. , Cheng Alec M. , Kopan Raphael , Longmore Gregory D.
Published: July 2004

Notch1 is known to play a critical role in regulating fates in numerous cell types, including those of the hematopoietic lineage. Multiple defects exhibited by Notch1-deficient embryos confound the determination of Notch1 function in early hematopoietic development in vivo. To overcome this limitation, we examined the developmental potential of Notch1–/– embryonic stem (ES) cells by in vitro differentiation and by in vivo chimera analysis. Notch1 was found to affect primitive erythropoiesis differentially during ES cell differentiation and in vivo, and this result reflected an important difference in the regulation of Notch1 expression during ES cell differentiation relative to the developing mouse embryo. Notch1 was dispensable for the onset of definitive hematopoiesis both in vitro and in vivo in that Notch1–/– definitive progenitors could be detected in differentiating ES cells as well as in the yolk sac and early fetal liver of chimeric mice. Despite the fact that Notch1–/– cells can give rise to multiple types of definitive progenitors in early development, Notch1–/– cells failed to contribute to long-term definitive hematopoiesis past the early fetal liver stage in the context of a wild-type environment in chimeric mice. Thus, Notch1 is required, in a cell-autonomous manner, for the establishment of long-term, definitive hematopoietic stem cells (HSCs).
STAT3 regulates NF-κB recruitment to the IL-12p40 promoter in dendritic cells
Authors: Hoentjen Frank , Sartor R. Balfour , Ozaki Michitaka , Jobin Christian
Published: July 2004

Interleukin-10-deficient (IL-10-/-) mice develop an IL-12-mediated intestinal inflammation in the absence of endogenous IL-10. The molecular mechanisms of the dysregulated IL-12 responses in IL-10-/- mice are poorly understood. In this study, we investigated the role of nuclear factor-κ B (NF-κB) and signal transducers and activators of transcription 3 (STAT3) in lipopolysaccharide (LPS)-induced IL-12p40 gene expression in bone marrow derived-dendritic cells (BMDCs) isolated from wild-type (WT) and IL-10-/- mice. We report higher IL-12p40 mRNA accumulation and protein secretion in LPS-stimulated BMDCs isolated from IL-10-/- compared with WT mice. LPS-induced NF-κB signaling is similar in IL-10-/- and WT BMDCs as measured by IκBα phosphorylation and degradation, RelA phosphorylation and nuclear translocation, and NF-κB transcriptional activity, with no down-regulatory effects of exogenous IL-10. Chromatin immunoprecipitation demonstrated enhanced NF-κB (cRel, RelA) binding to the IL-12p40 promoter in IL-10-/- but not WT BMDCs. Interestingly, LPS induced STAT3 phosphorylation in WT but not IL-10-/- BMDCs, a process blocked by IL-10 receptor blocking antibody. Adenoviral gene delivery of a constitutively active STAT3 but not control green fluorescence protein (GFP) virus blocked LPS-induced IL-12p40 gene expression and cRel recruitment to the IL-12p40 promoter. In conclusion, dysregulated LPS-induced IL-12p40 gene expression in IL-10-/- mice is due to enhanced NF-κB recruitment to the IL-12p40 promoter in the absence of activated STAT3.
Iron chelators with high antiproliferative activity up-regulate the expression of a growth inhibitory and metastasis suppressor gene: a link between iron metabolism and proliferation
Authors: Le Nghia T.V. , Richardson Des R.
Published: July 2004

Iron (Fe) is critical for proliferation, but its precise role in cell cycle progression remains unclear. In this study, we examined the mechanisms involved by assessing the effects of Fe chelators on the expression of molecules that play key roles in this process. In initial studies, gene arrays were used to assess gene expression after incubating cells with 2 Fe chelators, namely, desferrioxamine (DFO) and 2-hydroxy-1-naphthylaldehyde isonicotinoyl hydrazone (311), or the DNA-damaging agent, actinomycin D. From the genes assessed, only the N-myc downstream-regulated gene 1 (Ndrg1) was specifically up-regulated by Fe chelation. Although the function of Ndrg1 is unclear, previous studies showed it markedly slows tumor growth and acts as a potent metastasis suppressor. Incubation of cells with chelators markedly increased Ndrg1 mRNA and protein expression, but this was not found with their Fe complexes or when the Fe-binding site had been inactivated. Increased Ndrg1 expression following Fe chelation was related to the permeability and antiproliferative activity of chelators and could be reversed by Fe repletion. Moreover, Ndrg1 up-regulation after chelation occurred at the transcriptional level and was mediated by hypoxia inducible factor-1α (HIF-1α)-dependent and -independent mechanisms. Our investigation suggests Ndrg1 is a novel link between Fe metabolism and the control of proliferation.
Exploring the effects of first language influence on second language pragmatic processes from a syntactic deficit perspective
Authors: Liszka Sarah A.
Published: July 2004

Explaining the persistent optional use of overt forms of certain grammatical properties in adult second language acquisition (SLA) raises the question of whether or not such difficulties are directly attributable to first language (L1) influence. Using Sperber and Wilson’s Relevance Theoretic framework (1986/95), this paper considers how a grammatical deficit could contribute to non-native-like pragmatic processing at the level of explicature formation=recovery, on the assumption that the decoding of grammatical knowledge at logical form initiates the pragmatic development required for explicature formation. The study focuses on the contrast between the English present perfect (e.g., I have danced/sung) and the semantically close present (e.g., I dance/sing) and preterit (e.g., I danced/sang). Results from comparative data of second language (L2) English speakers from three typologically different language backgrounds (German, Japanese and Chinese) are used to explain how the L1 might influence the L2 acquisition of the present perfect and to assess pragmatic differences post-logical-form, resulting from such an influence.
Relevance Theory, Action Theory and second language communication strategies
Authors: Foster-Cohen Susan H.
Published: July 2004

The discussion in this article offers a comparison between Relevance Theory as an account of human communication and Herbert Clark’s (1996)sociocognitive Action Theory approach. It is argued that the differences are fundamental and impact analysis of all kinds of naturally occurring communicative data, including that produced by non-native speakers. The differences are discussed and illustrated with data from second language communication strategies. It is suggested that the often fraught interactions between native and non-native speakers are better captured through a Relevance Theory approach than through the alternatives.
The end of life: informal care for dying older people and its relationship to place of death
Authors: Visser G , Klinkenberg M , van Groenou M I Broese , Willems D L , Knipscheer C P M , Deeg D J H
Published: July 2004

Objective: This study examined the features of informal end-of-life care of older people living in the community and the association between informal care characteristics and dying at home. Methods: Retrospective data were obtained from interviews and self-administered questionnaires of 56 persons who had been primary caregivers of older relatives in the last three months of their lives. Results: Results showed that informal caregivers of terminally ill older people living in the community provided a considerable amount of personal, household, and management care. Secondary informal caregivers and formal caregivers assisted resident primary caregivers less often than nonresident primary caregivers. Primary caregivers who felt less burdened, who gave personal care more intensively, and/or who were assisted by secondary caregivers, were more likely to provide informal end-of-life care at home until the time of death. Conclusions: Our study showed that informal care at the end of life of older people living in the community is complex, since the care required is considerable and highly varied, and involves assistance from secondary informal caregivers, formal home caregivers as well as institutional care. Burden of informal care is one of the most important factors associated with home death. More attention is needed to help ease the burden on informal caregivers, specifically with regard to resident caregivers and spouses. Since these resident caregivers were disadvantaged in several respects (i.e., health, income, assistance from other carers) compared to nonresident caregivers, interventions by formal caregivers should also be directed towards these persons, enabling them to bear the burden of end-of-life care.
Awareness of husband's impending death from cancer and long-term anxiety in widowhood: a nationwide follow-up
Authors: Valdimarsdóttir Unnur , Helgason Ásgeir R , Fürst Carl-Johan , Adolfsson Jan , Steineck Gunnar
Published: July 2004

Background: We investigated the predictors and long-term consequences of awareness time — the length of time a woman is aware of her husband's impending death from cancer. Methods: All women (n / 506) living in Sweden under 80 years of age who lost their husband/partner owing to cancer of the prostate in 1996 or of the urinary bladder in 1995 or 1996 were followed with an anonymous postal questionnaire, 2–4 years after their loss. Results: We received completed questionnaires from 379 of the widows. Of these, 55 (15%) reported an awareness time of 24 hours or less, 56 (15%) of 3–6 months and 95 (26%) of one year or more. The associations between the awareness time and morbidity were of a reverted ‘J-shape,’ with awareness time of 24 hours or less carrying the highest risk and 3–6/6–12 months the lowest. On comparing the awareness time of 24 hours or less with 3–6 months (preformed response category), the relative risks for anxiety were found to be 1.9 (1.0–3.6) (visual digital scale) and 4.5 (1.0–20.0) for intake of tranquillising drugs. Those not informed of their husband's fatal condition or not provided with psychological support by caregivers during their husband's last months of life had an increased risk of a short awareness time. Conclusions: During a man's terminal cancer illness, the wife's awareness time varies considerably and is influenced by information and psychological support from caregivers. A short awareness time may result in an additional and avoidable psychological trauma.
Goal setting as a measure of outcome in palliative care
Authors: Needham P R , Newbury J
Published: July 2004

Setting goals and assessing outcomes are essential elements in palliative care. This paper describes a multiprofessional project, conducted under the auspices of clinical audit, which attempted to evaluate important outcomes of care. Over a six-month period there were 123 consecutive admissions to the hospice. These patients and their carers, as well as the staff, were encouraged to set explicit goals for, and evaluate outcomes of, their care. As anticipated, we encountered many difficulties in this, but there were benefits. We were able to record goals of admission from the patient in 97 cases (79%), their main carer in 74 cases (63%) and from hospice staff in 120 cases (98%). Patient and carer goals were often more functional and specific whereas the staff goals tended to be more problem or symptom focused. The achievement of these goals was evaluated by patients, carers and staff at discharge or death (where possible) with the majority being fully or partially met. Only 15 patients and 9 carers thought that some or all of their goals had not been achieved with just 4 recording that their goals had changed. Overall, it was a worthwhile (although time-consuming) exercise and, as a result of the ‘audit’, clear goals and outcomes from patient, carer and staff perspectives are now routinely recorded for all admissions to the hospice and are used to focus multiprofessional patient review. Having analysed the process as well as the results of the ‘audit’, we would encourage others not to be daunted from undertaking similar projects.
Recruiting patients into a primary care based study of palliative care: why is it so difficult?
Authors: Ewing Gail , Rogers Margaret , Barclay Stephen , McCabe Janet , Martin Anna , Todd Chris
Published: July 2004

In the UK, researchers' access to study populations and control over selection of participants is becoming increasingly constrained by data protection and research governance legislation. Intervening stages placed between researchers and the population they wish to study can have serious effects on recruitment and ultimately on the validity of studies. In this paper we describe our experiences of gaining access to patients for a study of palliative care in primary care. Despite considerable time and resources dedicated to recruitment, a smaller than anticipated study sample was achieved. We found that gatekeeping by ethics committees and practitioner control over sample selection were significant hurdles in accessing patients for the study. Gatekeeping responsibilities represent considerable challenges for researchers seeking to obtain a representative study sample, not just in palliative care, but for research in general in health care.
Is there such a thing as a good death?
Authors: Walters Geoffrey
Published: July 2004

The idea of a ‘good death’ is one which has been central to the palliative care movement but which in fact predates it. A number of recent articles have grappled with the concept. It is a subject which is difficult to quantify scientifically and this article explores the territory using a number of philosophical, theological, historical and literary sources. The changing meaning of the concept is traced through the premodern, modern and postmodern periods. In particular the influence on Western ideals about death of the two paradigmatic stories of the deaths of Socrates and Jesus are examined. It is argued that the dualistic thinking of Plato, which often underlies our thinking about death, is no longer adequate and the author offers the thinking of the Spanish philosopher Miguel de Unamuno as an alternative way of approaching our attitudes to death. Although the article does not seek to give a definitive answer to the question it raises, it suggests that thinking about good death should be broadened to accept the struggle with which many people face their death.
Systematic review of bisphosphonates for hypercalcaemia of malignancy
Authors: Saunders Y , Ross J R , Broadley K E , Edmonds P M , Patel S
Published: July 2004

Background: Bisphosphonates are the treatment of choice for hypercalcaemia of malignancy (HCM) but there is no consensus regarding which drug or dose should be given. We designed a systematic review to investigate the efficacy of bisphosphonates in the treatment of HCM. Methods: We identified randomized controlled trials (RCTs) by searching electronic databases, scanning of reference lists, and consultation with experts and pharmaceutical companies. Foreign papers were translated. Inclusion criteria were RCTs, confirmed malignant disease and measurement of serum calcium (ionized or corrected for albumin) postrehydration. The primary outcome was number of patients achieving normocalcaemia. Secondary outcomes were time to normocalcaemia, time to relapse and toxicity. Results: Twenty-seven papers and two abstracts, using intravenous bisphosphonates, fulfilled the inclusion criteria. Data from 26 studies were used in analyses. Due to the heterogeneity of studies, meta-analysis could not be performed. Pamidronate was more effective than placebo, mithramycin, etidronate (7.5 mg/kg) and low-dose clodronate (600 mg), but equal to higher dose clodronate (1500 mg). Clodronate and etidronate were superior to placebo; incadronate was superior to elcatonin; gallium nitrate was superior to etidronate. No difference was seen between alendronate and clodronate. Three dose finding studies showed no difference between 30–90 mg of pamidronate, but one well designed study showed increasing efficacy with increasing dose. Studies using increasing doses of ibandronate (0.6–4 mg), alendronate (2.5–15 mg), and incadronate (2.5–10 mg), showed a dose response. Duration of administration of pamidronate did not affect efficacy (six studies). Conclusion: Bisphosphonates normalize calcium in 70% patients with minimal side effects. Aminobisphosphonates are most effective at maintaining normocalcaemia and should be given in high dose irrespective of baseline serum calcium.
Governance Challenges and Coalition Building among Urban Environmental Stakeholders in Dar es Salaam, Tanzania
Authors: MTANI ANNA
Published: July 2004

Abstract: Rapid urbanization is arguably one of the most complex and important socioeconomic phenomena of the new millennium. It represents major and irreversible changes in production and consumption patterns and the way people interact with nature. The impact of urbanization will continue to bring about major changes especially in many countries in the developing world that are experiencing rapid urbanization. The serious environmental and development challenges facing Dar es Salaam, the largest commercial center of Tanzania, are highlighted in this report.
Urban Biosphere and Society: Partnership of Cities—Introduction
Authors: ALFSEN‐NORODOM CHRISTINE
Published: July 2004

Abstract: This paper reports on issues of conservation, equitable use of resources, and the improvement of quality of life for all persons living in densely populated cites. Case studies are presented that examine UNESCO's concept of biosphere reserve, demonstrating the elasticity and usefulness of the concept as a way to promote global sustainability and governance on local, regional and global levels.
Toward Urban Biosphere Reserves
Authors: DOGSÉ PETER
Published: July 2004

Abstract: The objective of this article is to outline the evolution in applying the biosphere reserve concept to urban areas and to present some of the potential benefits and possible difficulties in the design and management of urban biosphere reserves.
Biodiversity, Biosphere Reserves, and the Big Apple: A Study of the New York Metropolitan Region
Authors: SOLECKI WILLIAM D. , ROSENZWEIG CYNTHIA
Published: July 2004

Abstract: The objectives of this article were to assess the dimensions of biodiversity‐urban society interactions within the New York Metropolitan Region, a 31‐county area with a population of 21.5 million, and to explore pathways to reconcile dysfunctional relationships between these two ever‐entwined systems. The article builds on the premise that urban biodiversity exists at a crucial nexus of ecological and societal interactions, linking local, regional, and global scales, and that urban ecologies are projected to become even more dynamic in the future, particularly as a result of global climate change. The pathway proposed to reconcile the biodiversity‐urban society relationships is the incorporation of biosphere reserve strategies into regional environmental planning efforts focused on the New York/New Jersey Harbor/Estuary specifically and on the greater New York Metropolitan Region in general. The concepts of the “ecological footprint” and vulnerability to global environmental change are used to analyze the current interactions between biodiversity and urban society, and to evaluate the efficacy of adopting biosphere reserve strategies in the region. New York has long been at the forefront of American environmentalism and landscape planning. Coupled with this history is a still small but growing interest in regional environmental planning efforts (e.g., the U.S. EPA Harbor Estuary Program) and green infrastructure (e.g., the 2002 Humane Metropolis Conference organized by the Ecological Cities Project). The research presented here aims to contribute to these nascent activities. As a megacity, New York may serve as a model for other major cities of the world.
Managing the Megacity for Global Sustainability: The New York Metropolitan Region as an Urban Biosphere Reserve
Authors: ALFSEN‐NORODOM CHRISTINE , BOEHME SUSAN E. , CLEMANTS STEVEN , CORRY MELODY , IMBRUCE VALERIE , LANE BENJAMIN D. , MILLER ROBERTA BALSTAD , PADOCH CHRISTINE , PANERO MARTA , PETERS CHARLES M. , ROSENZWEIG CYNTHIA , SOLECKI WILLIAM , WALSH DANIEL
Published: July 2004

Abstract: The UNESCO World Network of Biosphere Reserves (WNBR), while not originally conceived to include urban areas, was intended to include sites representing all significant ecosystems with the goal of support for sustainable development locally and globally. Drawing on the example of the New York Metropolitan Region (NYMR), which has a population of 21.4 million, it is argued here that the eventual inclusion of the largest of the world's cities in WNBR not only is within the logic of the biosphere reserve concept, but would also benefit the network and its goals. The ecological significance of the NYMR, its role as a driver for global environmental change, as well as the efforts under way in the city to improve urban environmental management and governance are all examined. Potential added value to the WNBR of including megacities such as the NYMR is considered, in particular, regarding the sharing of best practices, lessons learned, and the strengthening of links between megacities and their global natural resource bases.
Environmental Factors in HIV/AIDS Epidemic Development: New Perspectives for Gender Equity and Global Protection against HIV Transmission
Authors: ALFSEN ANNETTE
Published: July 2004

Abstract: The HIV/AIDS epidemic is increasingly regarded as a socioeconomic problem. Among factors causing poverty, cultural aspects, including religion and traditions, appear to play an essential role in the rapid and global development of AIDS epidemic. AIDS is a pathologic syndrome caused by the human immunodeficiency virus (HIV). Scientific knowledge is required to prevent and treat AIDS. Although considerable progress has been made in antiretroviral therapy, neither actual cure of HIV infection, nor an efficient protection method, nor a vaccine are currently globally accessible. Consequently, the funding of scientific research is of utmost importance. On the basis of recent scientific findings, new perspectives for global protection and gender equity against HIV transmission are emerging. Progress is being made in developing microbicides or virucides, anti‐infective medication formulated for topical self‐administration, to protect against HIV and other sexually transmitted pathogens. Such developments need to be supported by extensive education campaigns geared to women to give them the possibility of protecting themselves and their children from HIV transmission. The level of funding for microbicide and vaccine development needs to be greatly increased. New possibilities have emerged for an efficient vaccine which would engage the mucosal immune system, first involved in the sexual transmission of HIV‐1. The idea of vaccine production in edible tissues of transgenic crop plants has also gained momentum. The use of minimally processed, low‐cost, orally delivered immunogens is especially valuable when raising mucosal antibodies is the object and when frequent boosting is anticipated, as is the case for mucosal immunity.
Inhabitants' Environmental Perceptions in the City of Rome within the Framework for Urban Biosphere Reserves of the UNESCO Programme on Man and Biospherea
Authors: BONNES MIRILIA , CARRUS GIUSEPPE , BONAIUTO MARINO , FORNARA FERDINANDO , PASSAFARO PAOLA
Published: July 2004

Abstract: The article presents the main tenets of the UNESCO Programme on Man and Biosphere (MAB), launched by the United Nations at the beginning of the 1970s. The program aimed at supporting applied research and scientific knowledge for managing natural resources in a rational and sustainable way. The implication of the full ecological perspective, typical of the MAB, for promoting multidisciplinary and integrated approaches in the study of environmental issues is briefly outlined. In particular, we point out the role of the MAB, through the biosphere reserve concept, in supporting the collaboration between natural‐biological and social‐behavioral sciences when dealing with biodiversity conservation problems and with urban ecosystems. Then, the specific UNESCO‐MAB Project on the city of Rome, launched at the end of the 1980s, is briefly presented, together with the recent project of the Department of the Environment of the Rome Municipality to propose Rome's urban and periurban green areas as a new UNESCO‐MAB Biosphere Reserve. The results of the main research activities conducted therein are summarized. In particular, the specific research lines of the environmental psychology research group, involved in the MAB‐Rome Project for approximately two decades, are presented. These research lines dealt with various aspects of residents' environmental perceptions and behaviors in the city of Rome. The practical implications of these results are also briefly discussed.
Chicago Wilderness: A New Force in Urban Conservationa
Authors: MOSKOVITS DEBRA K. , FIALKOWSKI CAROL , MUELLER GREGORY M. , SULLIVAN TIMOTHY A. , ROGNER JOHN , McCANCE ELIZABETH
Published: July 2004

Abstract: In 1996, a coalition of diverse and determined organizations launched a new initiative in the Chicago region. Our vision? Chicago Wilderness: a thriving mosaic of natural areas, connected by greenways and wildlife corridors, embedded in the nation's third largest metropolis. In this vision, the region's human communities reclaim a cultural tradition of protecting and restoring the globally outstanding natural communities that enrich our lives. Today, more than 170 organizations join forces to transform this vision into reality. A regional biodiversity recovery plan, the result of 3 years of assessment and planning by scientists, land managers, educators, and policy strategists, sets priorities and determines the lines of action for the coalition. This regional agenda stems from our vision and recovery goals for each ecological community; it encourages targeted research initiatives that focus on characterizing our native biological diversity and on analyzing elements critical to its recovery. Ultimately, though, the long‐term survival of our natural wealth rests on the support from the public. Although the challenges to conservation educators and communicators are many, Chicago Wilderness allows us to work together in understanding our audiences, channeling our resources, and creating novel approaches to engage the widest public in our conservation efforts.