bluuebunny/crossref_metadata_2025 huggingface dataset:
PANCREATIC INJURY AFTER THORACOABDOMINAL AORTIC OCCLUSION IN A PORCINE MODEL
Authors: Papakostas John C. , Toumpoulis Ioannis K. , Pappa Lina S. , Arnaoutoglou Helen M. , Kirou Ioanna E. , Malamou‐Mitsi Vasiliki D. , Kappas Angelos M. , Matsagas Miltiadis I.
Published: May 2007

Background:  The aim of this study was to investigate pancreatic injury after 45 min of thoracoabdominal aortic occlusion in a porcine model.

Methods:  Twenty‐four pigs were used. Six pigs underwent sham operation and 18 intravascular balloon thoracoabdominal aortic occlusions for 45 min. The animals were randomly killed at 12, 48 and 120 h after reperfusion. After killing, all pancreata were examined macroscopically for any signs of acute pancreatitis, whereas gland specimens were harvested for histological study to evaluate pancreatic injury (haematoxylin and eosin staining) and acinar cell apoptosis (Terminal deoxynucleotidyl transferase mediated dUTP Nick‐End Labelling staining).

Results:  Pancreatic injury severity score was mildly increased in terms of oedematous features at 12 h after reperfusion, but normalized to sham levels by the second day and thereafter. Necrotic injury was not statistically significant at any time point. Acinar cell apoptotic index was mildly increased at 12 and 48 h, but showed a tendency to decrease towards sham levels by the fifth day. One animal developed acute pancreatitis.

Conclusion:  Acute pancreatitis is unlikely to occur after 45 min of thoracoabdominal aortic occlusion. However, an early, mild oedematous and apoptotic injury that occurs subclinically seems to be a constant event. This injury might have clinical significance when combined with pre‐existent pancreatic pathologies.
Engineering a safe landing: engaging medical practitioners in a systems approach to patient safety
Authors: Brand C. , Ibrahim J. , Bain C. , Jones C. , King B.
Published: May 2007

Background: Several event studies, including the Australian Safety and Quality in Healthcare Study, emphasize gaps in safety for hospitalized patients. It is now recognized that system‐based factors contribute significantly to risk of adverse events and this has led to a shift in focus of patient safety from the autonomous responsibility of medical clinicians to a systems‐based approach. The aim of this study was to determine medical practitioner awareness of, level of engagement in and barriers to engagement in a systems approach to patient safety and quality.

Methods: Information from acute and subacute care medical practitioners at a metropolitan public hospital was collected within an anonymous structured electronic survey, a discussion group and key informant interviews.

Results: There were 73 survey respondents (response rate 7.6%). Fifty‐one (69.9%) were unaware of the Institute of Medicine report ‘To Err is human’. Thirty‐six (49.3%) were unaware of the Australian Quality in Healthcare Study and 12 (16.4%) had read the article. There was a positive relation identified between awareness and seniority. There was a low level of participation in systems‐focused quality and safety activities and limited understanding of the role of systems in medical error causation. There was uncertainty about the changing role of medical practitioners in patient safety and perceived lack of skills to effectively engage with hospital management about safety and quality issues.

Conclusion: Several factors are limiting engagement of medical practitioners in a systems approach to patient safety. Increased educational support is needed and may be best focused within clinical effectiveness activities pertinent to practitioner interest and expertise.
Audit of the care of the dying in a network of hospitals and institutions in Queensland
Authors: Hardy J. R. , Haberecht J. , Maresco‐Pennisi D. , Yates P.
Published: May 2007

Background: Most Australians die in institutions and there is evidence to suggest that the care of these patients is not always optimal. Care pathways for the dying have been designed to transfer benchmarked hospice care to other settings (e.g. acute hospitals and residential age‐care facilities) by defining goals of best care, providing guidelines to provide that care and documenting outcome.

Method: A retrospective audit was undertaken across a network of health‐care institutions in Queensland. The 18 goals considered essential for the care of the dying within the Liverpool Care Pathway were taken as a benchmark. Documentation of achievement of each of these goals was sought.

Results: The notes of 160 patients who had died in eight institutions (four hospitals, three hospices, one nursing home) were reviewed. Several areas for improvement were identified, particularly in those goals relating to communication, resuscitation orders and care after death. Few units documented the provision of written information to families. Most patients were prescribed medications in anticipation of pain and agitation but less were prescribed drugs for other common symptoms in the dying. Most of the goals were achieved in a higher percentage of cases in hospice units. Marked differences in practice were noted between different institutions.

Conclusion: The audit identified several aspects in the care of the terminally ill that could be improved. End‐stage pathways may provide a model for improving the care of patients dying in hospitals and institutions in Australia.
Severe intimal hyperplasia with ischaemic colitis in two patients with hepatitis C
Authors: Randall K. L. , Yong J. , Steele R. H. , Spicer S. T. , Howlin K. J. , Quin J.
Published: May 2007

Many extrahepatic manifestations of hepatitis C have been described, including renal disease and vasculitis. We describe the novel finding of intimal hyperplasia associated with severe ischaemic events in two patients with hepatitis C. The combination of genotype 1a hepatitis C virus, rapidly progressive mesangiocapillary glomerulonephritis and intimal hyperplasia with ischaemic sequelae, may represent a new syndrome.
Good outcome in HIV‐infected refugees after resettlement in New Zealand: population study
Authors: Nisbet S. M. , Reeve A. M. , Ellis‐Pegler R. B. , Woodhouse A. F. , Ingram R. J. , Roberts S. A. , McAllister S. M. , Thomas M. G.
Published: May 2007

Background: The aims of this study were to determine the clinical characteristics on arrival and the subsequent clinical outcome of HIV‐infected UN quota refugees who settled in New Zealand during the last 11 years and to estimate their rate of HIV transmission.

Methods: A population study was conducted. Data were provided by the Mangere Refugee Resettlement Centre, the infectious disease physicians caring for the subjects, the New Zealand AIDS Epidemiology Group and laboratories carrying out HIV viral load assays.

Results: One hundred of 7732 (1.3%) UN quota refugees were HIV positive; mean age 30 years, 56% were men, median initial CD4 count was 320 (range 20–1358). HIV infection was most commonly acquired by heterosexual intercourse (74%). The median follow up was 5.0 years (range 1 month to 9.7 years). Five died and 15 subjects had 16 AIDS‐defining illnesses, most commonly tuberculosis (n = 10). Sixty subjects commenced highly active antiretroviral therapy of whom 36/59 (61%) had an undetectable HIV viral load after 1 year of treatment. None of the six children born to HIV‐infected women in New Zealand were infected. There were two known cases of horizontal transmission of HIV infection.

Conclusion: Although HIV‐infected quota refugees often have to overcome severe social, cultural and financial handicaps, their clinical outcome is generally very good, with response rates to highly active antiretroviral therapy that are similar to other patient groups. Furthermore, they have not been a significant source of transmission of HIV infection after resettlement in New Zealand.
How intravenous immunoglobulin is used in clinical practice: audits of two Sydney teaching hospitals
Authors: Lin M. W. , Kirkpatrick P. E. , Riminton D. S.
Published: May 2007

Background: The clinical demand for i.v. immunoglobulin (IVIg) continues to increase in Australia for reasons that are not clear. IVIg is distributed for approved indications according to Australian Health Ministers’ Advisory Council 2000 guidelines that are currently under review. IVIg may also be purchased by hospitals for uses not covered by these indications on an individual patient use basis. These audits were developed to examine current hospital practice in IVIg use.

Methods: Six‐month prospective audits of all IVIg use were conducted at two teaching hospitals in Sydney (Concord and Royal Prince Alfred Hospitals). Medical files and dispensing records were examined and compared with current guidelines.

Results: One hundred and sixty‐five recipients received 24 251 g of IVIg (mean total use 147 g/patient) for 36 distinct diagnoses, with 5.5% mortality. Drug committees supplied 1580 g of IVIg (6.5% of total product issued) to 12 recipients (7.3% of total recipients). The clinical specialties of immunology, haematology and neurology accounted for 92.9% of IVIg use, with 51.8% of overall use for replacement indications. Forty‐two patients (25.5%) received IVIg for non‐category 1 indications (4718 g, 19.5% of total product). Patients receiving IVIg for category 1 disorders had a 94.4% compliance with the guideline prerequisites where data were sufficient for assessment.

Discussion: Our findings show a greater than expected proportion of non‐category 1 IVIg use and substantial contributions from drug committees. Careful case selection within category 1 indications is evident in the high level of compliance with qualifying criteria. Current distribution procedures do not enable capture of outcome data to inform guideline revisions.

Conclusion: These audits emphasize the requirement for updated National Clinical Practice Guidelines, improved approval procedures, consensus statements in the specialties of immunology, haematology and neurology and clarification of the role of drug committees.
Road not taken: lessons to be learned from Queen v. Gillett
Authors: Beran R. G. , Devereux J. A.
Published: May 2007

Following the decision in the Gillet Case it may no longer be safe to rely on the Austroads guidelines when considering fitness to drive. This paper examines the case and its implications. Although the Guidelines claimed ‘… the identification and application of world best‐practice…’, they were disregarded by the court in Gillet. Both expert witnesses testified that on disclosure of epilepsy the accused would have been endorsed as fit for a licence application to the Roads & Traffic Authority, on the basis of 10 years of only nocturnal seizures, in accordance with the guidelines. The Court rejected this evidence and interpreted failure to disclose epilepsy as recognition of perceived risk and the previously undiagnosed sleep apnoea as the basis for that risk, despite being diagnosed after the accident. There needs to be greater certainty in the application of the guidelines, with legislative intervention and licenses should display a bold statement advising drivers of their responsibility to notify authorities of illnesses that could potentially affect driving.
The in‐plane and out‐of‐plane stress constraint factors and K‐T‐Tz description of stress fields near the border of a quarter‐elliptical corner crack
Authors: ZHAO J. , GUO W. , SHE C.
Published: May 2007

The elastic T‐stress and stress intensity factor K for quarter‐elliptical corner cracks have been investigated in elastic plates by detailed three‐dimensional finite‐element calculations. The distributions of normalized K and T‐stress have been obtained along the crack front with aspect ratios (a/c) of 0.2, 0.3, 0.4, 0.5, 0.6, 0.8 and 1.0, and far‐field tension and the effect of Poisson's ratio have also been considered. The normalized K increases and the normalized T‐stress decreases with the increase of Poisson's ratio v. For v= 0.3, the normalized K gradually increases in the range of crack‐face angle φ≥ 22.5° and decreases in the range of φ≤ 22.5° with the increase of a/c. The normalized T‐stress increases in the beginning and then decreases with increasing φ except for a/c= 0.2 and a/c= 0.3. By fitting the numerical results with the least squares method, empirical formulae have been given for the convenience of engineering applications. Combining with the corresponding out‐of‐plane constraint factor Tz, the three‐parameter K‐T‐Tz approach has been provided, which can accurately describe the stress field around the crack front.
Characterization of black band disease in Red Sea stony corals
Authors: Barneah Orit , Ben‐Dov Eitan , Kramarsky‐Winter Esti , Kushmaro Ariel
Published: May 2007

Microbial communities associated with black band disease (BBD) in massive stony corals from the Northern Red Sea (Eilat) were examined for the first time using molecular tools and microscopy. A high microbial diversity was revealed in the affected tissue in comparison with the healthy area of the same colony. Microscopy revealed the penetration of cyanobacteria into the coral mesoglea and adjacent tissues. Cyanobacterial sequences from Red Sea BBD‐affected corals formed a cluster with sequences previously identified from black band and red band diseased corals from the Indo‐Pacific and Caribbean. In addition, 11 sequences belonging to the genus Vibrio were retrieved. This group was previously documented as pathogenic to corals. Sulfate‐reducing bacteria, a group known to be associated with BBD and produce toxic sulfide, were studied using specific primers for the amplification of the dissimilatory sulfite reductase gene (dsrA). This technique facilitated and improved the resolution of the study of diversity of this group. All the sequences obtained were closely related to sequences of the genus Desulfovibrio and 46% showed high homology to Desulfovibrio desulfuricans. The complex nature of BBD and the lack of success in isolating a single causative agent suggest that BBD may be considered a polymicrobial disease.
The role of primary tumour resection in patients with stage IV colorectal cancer
Authors: Konyalian V. R. , Rosing D. K. , Haukoos J. S. , Dixon M. R. , Sinow R. , Bhaheetharan S. , Stamos M. J. , Kumar R. R.
Published: May 2007

Objective  The management of stage IV colorectal cancer is controversial. Resection of the primary tumour to prevent obstruction, bleeding or perforation is the traditional approach, although survival benefit is undetermined. Management consisting of diverting ostomy, enteric bypass, laser recanalization or endoscopic stenting is an alternative to radical resection. The purpose of this study was to determine the role of resection of the primary tumour in patients with stage IV colorectal cancer, with specific attention paid to survival benefit and safety.

Method  This was a retrospective review of all stage IV colon and rectal cancer patients in our tumour registry between 1991 and 2002. Data collected included patient demographics, presenting symptoms, detail from the hospital course including diagnostic data and operative management, complications and survival time (days). Survival analysis was performed to assess the effect of primary tumour resection on long‐term survival.

Results  109 patients were studied. Sixty‐two (57%) patients (group I) underwent resection of the primary tumour, whereas 47 (43%) patients (group II) were managed without resection. Median survival times for groups I and II were 375 (IQR: 179–759) and 138 (IQR: 35–262) days respectively (P < 0.0001). After controlling for age, sex, tumour location and level of liver involvement as well as liver function, patients who underwent resection still survived longer (HR = 0.34, 95% CI: 0.21–0.55).

Conclusion  Palliative resection of the primary tumour plays an essential role in the management of stage IV colorectal cancer. Resection can offer increased survival and is indicated in certain patients with incurable disease. Limited metastatic tumour burden of the liver was associated with better survival in such patients.
Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto‐genital prolapse and mechanical outlet obstruction
Authors: Slawik S. , Soulsby R. , Carter H. , Payne H. , Dixon A. R.
Published: May 2007

Objective  Whilst trans‐abdominal fixation +/− resection offers better functional results and lower recurrence than perineal procedures, mesh rectopexy is complicated by constipation. Laparoscopic autonomic nerve‐sparing, ventral rectopexy allows correction of the underlying abnormalities of the rectum, vagina, bladder and pelvic floor.

Method  A prospective database was used to audit our 7‐year experience of this technique. The recto‐vaginal septum was mobilized anteriorly to the pelvic floor avoiding nerve damage. A prolene mesh was sutured to the ventral rectum, posterior vagina and vaginal fornix and secured to the sacral promontory. Patients were assessed with questionnaires and Cleveland Clinic scores.

Results  Eighty patients, six males, median age 59 years (range 31–90) underwent laparoscopic prolapse surgery between Jan 1997 and Dec 2005; 55% had full thickness prolapse and 46% rectal anal intussusception. Five had a solitary rectal ulcer. A total of 58% had undergone previous surgery; hysterectomy 33%, posterior colporrhaphy 15%, posterior rectopexy 6%, Delorme's rectal mucosectomy 5% and Birch colposuspension 3%. Half (54%) were incontinent (mean Wexner score 11, range 2–17) and 31% reported symptoms of obstructed defecation; seven had slow transit constipation and underwent resection.

The median operative time was 125 min (range 50–210) with one conversion. Median time to diet was 12 h and median length of stay 3 days (1–12). No patient has developed recurrent full thickness prolapse at a median follow‐up of 54 months (30–96). Incontinence improved in 39 of 43 patients (91%); median post‐operative Wexner score 1 (0–9). Obstructed defecation resolved in 20 of 25 patients (80%). Pelvic pain resolved in all but one. Complications occurred in 21%; faecal impaction 4%, wound infection 2%, bleeding 2%, leak 1%, chest infection 1%, retention 1%. Three developed minor evacuatory difficulties and two, urinary stress incontinence.

Conclusion  Laparoscopic ventral rectopexy is safe with relatively low morbidity. In the medium‐term, it provides good results for prolapse and associated symptoms of incontinence and obstructed defecation.
Faecal incontinence in male patients
Authors: Kim T. , Chae G. , Chung S. S. , Sands D. R. , Speranza J. R. , Weiss E. G. , Nogueras J. J. , Wexner S. D.
Published: May 2007

Objective  Data concerning faecal incontinence (FI) in men are lacking. The aim of this study was to evaluate the historical aetiology and contrast aetiologies in younger and older men suffering from FI.

Method  After institutional review board approval, a retrospective chart review was undertaken of all patients with FI seen between 1999 and 2005. The data of male patients was further analysed to assess the impact of age and historical aetiology on FI.

Results  A total of 404 males were included, 203 patients were <70 years of age (group A) and 201 patients were ≥70 years of age (group B). The most common prior diagnosis in group A was perianal sepsis in 23 (11.3%) patients and symptomatic haemorrhoids in 20 (9.9%) patients; in group B it was prostate cancer in 57 (28.4%) patients, symptomatic haemorrhoids in 31 (15.4%) patients and neurological diseases in 18 (9%) patients. The most common prior procedure in group A was restorative proctectomy/proctocolectomy in 32 (15.8%) patients, fistulotomy or haemorrhoidectomy in 21 (10.3%) and 19 (9.4%) patients respectively. In group B, radiation therapy for prostate cancer was utilized in 48 (23.9%) patients and haemorrhoidectomy in 29 (14.4%) patients. Comparing group A and group B relative to diagnosis – perianal sepsis, perineal trauma, congenital disorders, HIV infection and anal cancer were more common in group A, whereas prostate cancer, neurological diseases and colon cancer were significantly more common in group B.

Conclusion  Prostate cancer, symptomatic haemorrhoids, perianal sepsis, rectal cancer and a history of restorative rectal resection were common associations with FI in men. The aetiologies for FI in men vary with age.
Eplerenone improves prognosis in postmyocardial infarction diabetic patients with heart failure: results from EPHESUS
Authors: O’Keefe J. H. , Abuissa H. , Pitt B.
Published: May 2007

Background:  The Epleronone Post‐Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) trial demonstrated that selective aldosterone blockade with eplerenone significantly reduced total mortality by 15%, combined cardiovascular (CV) mortality/CV hospitalization by 13%, CV mortality by 17% and sudden cardiac death by 21%, vs. placebo when added to standard care in patients with left ventricular systolic dysfunction (LVSD) and signs of congestive heart failure (CHF) following acute myocardial infarction (AMI). We retrospectively evaluated the effect of eplerenone vs. placebo in a subset of 1483 diabetic patients with LVSD and signs of CHF following AMI.

Methods:  Diabetic status was determined from medical histories at screening. Analyses were based on time to first occurrence of an event. Results were based on a Cox’s proportional hazards regression model stratified by region with treatment, subgroup and treatment‐by‐subgroup interaction as factors. The 95% confidence intervals for the risk ratios were based on the Wald’s test.

Results:  Treatment with eplerenone in diabetic patients with CHF following AMI reduced the risk of the primary endpoint, a composite of CV mortality or CV hospitalization, by 17% (p = 0.031). The absolute risk reduction of the primary endpoint was greater in the diabetic cohort (5.1%) than in the non‐diabetic cohort (3%). Hyperkalaemia occurred more often with eplerenone than with placebo (5.6 vs. 3%, p = 0.015). Among the diabetic cohorts, the prespecified endpoint of ‘any CV disorder’ occurred in 28% of the eplerenone group and 35% of the placebo group (p = 0.007).

Conclusion:  Eplerenone treatment may reduce adverse CV events in diabetic patients with LVSD and signs of CHF following AMI.
The majority of cases of neonatal diabetes in Spain can be explained by known genetic abnormalities
Authors: Rica I. , Luzuriaga C. , Pérez de Nanclares G. , Estalella I. , Aragonés A. , Barrio R. , Bilbao J. R. , Carlés C. , Fernández C. , Fernández J. M. , Fernández‐Rebollo E. , Gastaldo E. , Giralt P , Gomez Vida J. M. , Gutiérrez A. , López Siguero J. P. , Martínez‐Aedo M. J. , Muñoz M. , Prieto J. , Rodrigo J. , Vargas F. , Castano L.
Published: May 2007

Background  Neonatal diabetes is a rare disease characterized by hyperglycaemia within the first 3 months of life and requiring insulin treatment; it can either be transient (TNDM) or permanent (PNDM). Alterations at band 6q24 and heterozygous activating mutations in KCNJ11, the gene encoding the pore‐forming subunit of the KATP channel, can cause neonatal diabetes.

Aims  We screened the 6q24 region, KCNJ11, GCK, FOXP3 and IPF1 genes for mutations in families with PNDM or TNDM to establish a phenotype–genotype correlation.

Methods  Twenty‐two patients with neonatal diabetes were recruited. Inclusion criteria were insulin‐treated diabetes diagnosed within the first 3 months and insulin treatment for at least 15 days. Clinical data were recorded in a questionnaire.

Results  We identified 17 genetic alterations in our patients: six alterations at the 6q24 band associated with TNDM and nine mutations in KCNJ11, five of which were novel. The analysis for a phenotype–genotype correlation showed that patients with 6q24 alterations had a lower birth weight and were diagnosed earlier than patients with KCNJ11 mutations. At follow‐up of the TNDM patients with genetic alterations, 43% developed diabetes or impaired glucose tolerance in later life (one with 6q24 duplication and two with N48D and E227K mutations at KCNJ11 gene). Furthermore, half the first‐degree relatives who carried a genetic alteration but who had not suffered from neonatal diabetes were diagnosed with diabetes or impaired glucose tolerance before the age of 30 years.

Conclusions  KCNJ11 mutations are common in both TNDM and PNDM and are associated with a higher birth weight compared with patients with 6q24 abnormalities. Patients with TNDM should be screened for abnormalities in glucose metabolism in adult life.
Genetic variation within the APPL locus is not associated with metabolic or inflammatory traits in a healthy White population
Authors: Staiger H. , Machicao F. , Machann J. , Schick F. , Kuulasmaa T. , Laakso M. , Fritsche A. , Stefan N. , Häring H‐U.
Published: May 2007

Aims  APPL1 (adaptor protein containing PH domain, PTB domain and leucine zipper motif 1) is the first identified cytosolic protein that directly binds to adiponectin receptors and mediates cellular responses to adiponectin. We set out to determine whether genetic variation within the APPL locus (encoding APPL1) contributes to insulin resistance, changes in lipid metabolism or inflammatory parameters in a healthy White population.

Methods  We genotyped 640 healthy subjects with and without a family history of diabetes for the four single nucleotide polymorphisms (SNPs) rs6774584, rs3087684, rs17791685 and rs528035 and performed correlational analyses with metabolic and inflammatory traits.

Results  SNPs rs6774584, rs3087684, rs17791685 and rs528035 are representative of the four blocks of high linkage disequilibrium covering a 78‐kb genomic locus that harbours the APPL gene. None of these SNPs correlated with anthropometric data (gender, age, body mass index, body fat, waist–hip ratio) or with family history of diabetes. Furthermore, no correlations were found with parameters of insulin sensitivity or insulin secretion. None of the SNPs was correlated with ectopic lipid content or with plasma lipids (non‐esterified fatty acids, glycerol, triglycerides, total cholesterol, high‐density lipoprotein‐, low‐density lipoprotein‐cholesterol). Moreover, no correlations were detected with leucocyte measures or plasma concentrations of C‐reactive protein, monocyte chemoattractant protein 1, interleukin 6 or tumour necrosis factor‐alpha. Finally, diplotypes derived from these SNPs did not reveal correlations with insulin sensitivity, insulin secretion, lipid measures or inflammatory parameters either.

Conclusions  We conclude that genetic variation within the APPL locus may not play a major role in the development of prediabetes phenotypes.
The effect of α‐lipoic acid on symptoms and skin blood flow in diabetic neuropathy
Authors: Jin H. Y. , Joung S. J. , Park J. H. , Baek H. S. , Park T. S.
Published: May 2007

Aims  Multiple pathogenic pathways are involved in diabetic neuropathy and diverse treatments have been tried without success. The aim of this study was to assess the effect of α‐lipoic acid on skin blood flow in patients with diabetic neuropathy.

Methods  We measured skin blood flow in 13 control subjects and 19 patients with diabetic neuropathy using the laser Doppler blood flow technique. Skin blood flow and the extent of skin blood flow changes were compared before and after diabetic patients received 600 mg/day α‐lipoic acid intravenously for 14 days.

Results  Although no significant differences in absolute values of skin blood flow or in the extent of changes were noted, symptoms were reduced after α‐lipoic acid treatment.

Conclusions  This study suggests that α‐lipoic acid, a potent antioxidant, improves symptoms of diabetic neuropathy. Larger studies are needed to determine whether improvements in skin blood flow also occur in patients with diabetic neuropathy.
Governing Genetic Databases: Challenges Facing Research Regulation and Practice
Authors: Gibbons Susan M.C. , Kaye Jane , Smart Andrew , Heeney Catherine , Parker Michael
Published: May 2007

This paper reports on the initial findings of an interdisciplinary research project on the governance of human genetic databases in England and Wales. The number of biosample and information collections has expanded, yet considerable legal uncertainty surrounds their definition, collection, storage, management, and use which could inhibit research and clinical practice, while failing to protect the rights and interests of all stakeholders. We report some initial findings from the legal research and identify major challenges associated with defining ‘genetic databases’. We identify a wide range of relevant instruments and regulatory actors, and suggest that none adequately addresses the challenges posed by contemporary research techniques or the‘corporeal’and‘informational’materials used in the genetic databases context. This preliminary analysis seriously questions the efficacy of the current regulatory framework and concludes that developing an appropriate governance framework for the creation, maintenance, and use of genetic databases requires the bringing together of legal analysis with good quality empirical evidence.
Public (Interest) or Private (Gain)? The Curious Case of Network Rail's Status
Authors: Jupe Robert
Published: May 2007

This paper develops Whitehouse's 2003 examination of the creation of Network Rail, a case study of New Labour's attempt to operationalize the ‘third way’. Significant changes have occurred since 2003 which make Network Rail's position as a private company with private sector debt appear increasingly anomalous. These changes include: the reclassification of the debt of another rail company from private to public, and the introduction of‘imputed debt’into public sector debt measurement; new funding arrangements for Network Rail which make it heavily dependent on public support; and important rail regulatory policy changes. The paper analyses these changes, and revisits White‐house's conclusions. In particular, this paper challenges Whitehouse's contention that Network Rail's creation led to the de facto renationalization of the railway infrastructure at a reduced public cost. The paper demonstrates that Network Rail is a very expensive mechanism for channelling public money to private companies, and argues that the Labour government's attempt to maintain the company's private sector status as part of its third way approach is ultimately untenable.
Expression of cholera toxin B–proinsulin fusion protein in lettuce and tobacco chloroplasts – oral administration protects against development of insulitis in non‐obese diabetic mice
Authors: Ruhlman Tracey , Ahangari Raheleh , Devine Andrew , Samsam Mohtahsem , Daniell Henry
Published: May 2007

Lettuce and tobacco chloroplast transgenic lines expressing the cholera toxin B subunit–human proinsulin (CTB‐Pins) fusion protein were generated. CTB‐Pins accumulated up to ~16% of total soluble protein (TSP) in tobacco and up to ~2.5% of TSP in lettuce. Eight milligrams of powdered tobacco leaf material expressing CTB‐Pins or, as negative controls, CTB–green fluorescent protein (CTB‐GFP) or interferon–GFP (IFN‐GFP), or untransformed leaf, were administered orally, each week for 7 weeks, to 5‐week‐old female non‐obese diabetic (NOD) mice. The pancreas of CTB‐Pins‐treated mice showed decreased infiltration of cells characteristic of lymphocytes (insulitis); insulin‐producing β‐cells in the pancreatic islets of CTB‐Pins‐treated mice were significantly preserved, with lower blood or urine glucose levels, by contrast with the few β‐cells remaining in the pancreatic islets of the negative controls. Increased expression of immunosuppressive cytokines, such as interleukin‐4 and interleukin‐10 (IL‐4 and IL‐10), was observed in the pancreas of CTB‐Pins‐treated NOD mice. Serum levels of immunoglobulin G1 (IgG1), but not IgG2a, were elevated in CTB‐Pins‐treated mice. Taken together, T‐helper 2 (Th2) lymphocyte‐mediated oral tolerance is a likely mechanism for the prevention of pancreatic insulitis and the preservation of insulin‐producing β‐cells. This is the first report of expression of a therapeutic protein in transgenic chloroplasts of an edible crop. Transplastomic lettuce plants expressing CTB‐Pins grew normally and transgenes were maternally inherited in T1 progeny. This opens up the possibility for the low‐cost production and delivery of human therapeutic proteins, and a strategy for the treatment of various other autoimmune diseases.
Family‐ versus couple‐initiated marriages in Turkey: Similarities and differences over the family life cycle
Authors: Hortaçsu Nuran
Published: May 2007

The present study aimed to investigate marital relationships of the Urban Turkish family. Questionnaires were given to both members of 430 couples at various stages of the marriage cycle. Information concerning demographic characteristics, spousal feelings, marital functioning, including division of labour and satisfaction with division of labour, decision‐making, and conflict; and relationships with social network, including feelings for families of origin and frequency of interaction with families was obtained. Results revealed that in comparison to family‐initiated marriages, couple‐initiated marriages were more emotionally involving, less enmeshed with families, more egalitarian, and involved fewer conflicts. However, over successive stages of the marital cycle, conflict declined in family‐initiated marriages and division of labour became less equalitarian in couple‐initiated marriages. No differences between the two types of marriage emerged with respect to decision‐making and conflict management style. Wives were reportedly more influential with respect to decisions concerning families and children than their husbands in both types of marriage. Couples at later stages of the marital cycle reported lower emotional involvement and less equalitarian division of labour. Relationships between educational level and various marital measures were also obtained. The results are discussed in relation to the possibly different marital schema entertained by men and women within the modernising context of Turkey and with respect to possibly different effects of modernization on different aspects of marraige.
Placing age differences in the context of the Orissa supercyclone: Who experiences psychological distress?
Authors: Suar Damodar , Mishra Sasmita , Khuntia Rooplekha
Published: May 2007

The present study examines the influence of age on anxiety, depression, and post‐traumatic stress of the supercyclone‐affected people in Orissa. The data were collected in structured interview sessions 3 months after the disaster struck. Of the 130 interviewees, 65 persons were severely exposed and the rest were mildly exposed to the supercyclone. When the effects of exposure, caste, and gender were controlled, linear effects of age on psychological distress were found to be significant, whereas quadratic effects of age on psychological distress were non‐significant. With increasing age, survivors experienced more anxiety, depression and post‐traumatic stress. The elderly people were the most vulnerable.
Use of the single factoral terms of trade to analyse agricultural production*
Authors: Fleming Euan
Published: May 2007

The aim in this note is to reintroduce the single factoral terms of trade into the policy arena. This economic concept has scarcely been used by analysts or policy makers over the past three decades. It is defined and compared favourably with other terms of trade concepts in terms of their usefulness to agricultural policy makers in Australia. A distinction is made between the single factoral terms of trade from the viewpoint of the farm business and from the viewpoint of the farm household, but only slightly different indices are specified in each case because of the very high positive correlation between farm prices paid and consumer prices. Developing industry‐level indices appears to be a more attractive way to proceed given the substantially different rates of growth in total factor productivity (TFP) between agricultural industries. Despite its usefulness, challenges lie ahead in accurately estimating each of the two components of the single factoral terms of trade, the net barter terms of trade and TFP, and the relations between these two components.
Investigating distance effects on environmental values: a choice modelling approach*
Authors: Concu Giovanni B.
Published: May 2007

Analysis of the relationship between distance and willingness to pay (WTP) is important for estimation and transfer of environmental benefits. Several contingent valuation (CV) studies have investigated this topic, but results are mixed. This paper describes a choice modelling (CM) application that estimates distance effects on parameters of three environmental attributes. Combinations of these attributes create different management policies for native vegetation. The CM study is based on a sampling procedure that provides a geographically balanced sample and statistical tests to choose the best specification of the distance–WTP relationship. Welfare analysis shows that disregarding distance causes under‐estimation of individual and aggregated benefits and losses, seriously misdirecting resource allocation.
Listen to Me, Learn with Me: International Migration and Knowledge Transfer
Authors: Williams Allan M.
Published: May 2007

Existing research on the economic contribution of individual international labour migrants has been couched largely in terms of skills, and has focused on mobility within transnational corporations. This article explores some of the broader links between the literatures on international migration and management, and addresses four main questions: is migrant knowledge selective, is it distinctive, what are the barriers to migrant knowledge transfer and what are the implications for individual migrants and firms. This largely conceptual review is informed by three main premises: the value of adopting a knowledge as opposed to a skills perspective on migration; the importance of examining the cycle of migration rather than static snapshots at particular stages, and the need to consider inter‐firm and extra‐firm migration, as well as intra‐firm mobility.
Going Global? The Regulation of Nurse Migration in the UK
Authors: Bach Stephen
Published: May 2007

This article examines the growth of overseas nurse recruitment to the UK and reviews a number of explanations used by migration specialists to explain these developments. It is argued that these approaches provide an incomplete explanation and that an industrial relations perspective enables an integrated understanding of nurse mobility. By highlighting the role of the state in source and destination countries and by placing labour market institutions centre stage, a more adequate account of nurse migration to the UK is developed. Trends in mobility indicate that state policy and employer behaviour have resulted in the internationalization rather than the globalization of the nursing labour market. This facilitates state action to regulate nurse migration, although the results to date using forms of soft regulation have been modest.
Epistemic Authority and the Gender Lens
Authors: Lewis Lydia
Published: May 2007

Researching ‘hidden’ forms of social inequality such as gender often poses particular challenges. Not least of these is how to uncover such dimensions of social life whilst preserving the perspectives of research participants, who may not consider such matters relevant to their lives, particularly if other forms of identity or oppression are more prominent for them. Here, I reflect on these issues in the context of researching user involvement in mental health services from a feminist perspective. I show how ‘uncovering’ gender and other forms of social inequality in the field was aided through adopting a wide analytical lens focusing on power, along with reflexivity and openness in discussing my own political analysis and commitments in relation to the study area with the researched. I also describe how I attempted to resolve the epistemological-ethical issues involved through conceptualising these in terms of ‘situatedness’ and gender salience and adopting a feminist standpoint which emphasised what researchers can, and indeed should, bring to the research enterprise. Related issues of power and empowerment in the research process are discussed.
The Gift-Exchange and Reciprocity of Women in Donor-Assisted Conception
Authors: Shaw Rhonda
Published: May 2007

This paper explores the rhetoric of gift-exchange as it pertains to the donation of ovarian eggs (oocytes) and participation in surrogate pregnancy arrangements. It does so by drawing on the analysis of interviews with New Zealand women engaged in these practices. Contrary to the view that women's reproductive gift-giving is intrinsically coercive and exploitative, the narrative accounts of donors involved in this research tend to suggest that women's moral identities as ethical subjects are created in the donative process. Despite this, many anxieties and contradictions involving the exchanges of women involved in donor-assisted reproduction remain. This paper discusses some of these complexities in light of perceptions and theorisations of the gift relationship.
Whose Child is it Anyway? the Negotiation of Paternal Entitlements within Marriage
Authors: Gatrell Caroline
Published: May 2007

Based on qualitative research, this paper suggests that among some married/co-habiting couples, where mothers are professionally employed and there are pre-school children, fathers seek to enhance their paternal role. This contrasts with previous research, which indicates that married/co-habiting men leave to mothers the responsibility for nurturing both maternal and paternal relationships with children. Using the notions of situational and debilitative power, it is shown how married/co-habiting fathers developed strategies for augmenting paternal rights. While fathers’ involvement with children was perceived as beneficial by some mothers, others regarded it as a threat to maternal status. The paper suggests that power relations between married/co-habiting parents in the sample are similar to power struggles between couples who are separated or divorced. The possibility is raised that paternal strategies to diminish the maternal sphere of influence among both married/co-habiting and divorced fathers may be symptomatic of wider male fears about the erosion of male hegemony. It is observed that the schemes employed by fathers in the sample to enhance the paternal role are similar to the approach advocated in policy statements of fathers’ rights activists.
Organizational Ethics, Decision Making, Undecidability
Authors: Clegg Stewart , Kornberger Martin , Rhodes Carl
Published: May 2007

In this paper we develop a conceptualisation of organizational decision-making as a practice that is, necessarily, ethical. The paper starts with a discussion of the notion of decision-making as it relates to organizational rationality and the relationship between management and control. Drawing on Derrida's discussions of undecidability and responsibility, we suggest that as well as being able to consider organizational decision-making as an instance of (albeit bounded) rationality or calculability, it can also be regarded as a process of choice amongst heterogenous possibilities. On that basis, we follow Derrida in arguing that for a decision to be considered an instance of responsible action it must be made with neither recourse to knowledge of its outcome nor to the application of pre-ordained rules. Illustrating our argument with a discussion of Eichmann's ‘I was just following orders’ defence, we suggest that rules for ethical decision making, rather than ensuring ethical outcomes, can work to insulate organizations from moral responsibility. We conclude with a discussion of ethics and democracy in relation to responsible decision making in organizations.
Citizenship and Personal, Social and Health Education in Catholic Secondary Schools: Stakeholders' Views
Authors: FINCHAM DAVID
Published: May 2007

During 1999–2000, the writer carried out a survey of six randomly selected Catholic secondary schools in England to examine the attitudes of stakeholder groups towards Citizenship and Personal, Social and Health Education. Questionnaires were completed by six governors, 12 parents, 139 pupils, 12 teachers and six school leaders, providing insight into perceptions of the purposes of selected components of Citizenship and Personal, Social and Health Education, viz. Citizenship Education, Moral Education and Sex Education. Drawing on Hornsby‐Smith's (1996) definition of contrasting perspectives, which he characterises as ‘Open’ and ‘Closed’ Catholicism, the enquiry located attitudes of the stakeholder groups along a continuum of values. While there was evidence of consensus across stakeholder groups within each component, differences in attitudes were also identified. The results indicated that governors and school leaders adopt more ‘Open’ attitudes towards Citizenship Education compared with pupils, teachers and parents; that school leaders adopt more ‘Open’ attitudes towards Moral Education compared with pupils; and that pupils and teachers adopt more ‘Open’ attitudes towards Sex Education compared with governors. One conclusion is that these results demonstrate that, when traditional religious values are challenged by rapid social and technological changes, stakeholder groups in faith schools are faced with added tensions to resolve.
Consumption, retailing, and medicine in early‐modern London
Authors: WALLIS PATRICK
Published: May 2007

This article examines the early development of specialized retail shops in early modern London. It argues that apothecaries' shops were sites of innovative shop design and display. These practices were responses to attitudes to consumption, the problematic nature of the medical commodities which apothecaries sold, and, particularly, contemporary concerns about their reliability, trustworthiness, and honesty. The article concludes that analyses of the rise of the shop need to be revised to incorporate early developments by producer‐retailers, such as apothecaries and goldsmiths, and suggests that investments in retailing were driven more by worries about commodities than enticing customers.
Effectiveness and Market Reaction to the Stock Exchange's Inquiry in Australia
Authors: Gong Ning
Published: May 2007

Abstract:  This paper examines a unique stock market monitoring program used by the Australian Stock Exchange (ASX). When the ASX observes unusual share price or trading volume changes of a listed company, it sends a letter demanding an explanation. Companies need to respond publicly to several stylized questions. Such public communications between the stock exchange and listed companies contain information. This paper documents how companies respond to the ASX inquiry and how the market reacts to the replies. It is found that some companies do release new information to the market when asked. After the firm's reply is posted, the average trading volume and the bid‐ask spread are reduced, and in most cases, the share price is also stabilized with the following two exceptions: (1) The price will continue to rally on average if the company releases only partial information when questioned after a significant price jump; (2) The downward price trend will be reversed if the company states that no new information could explain the decline. Furthermore, there are statistically significant, positive abnormal returns for the first five trading days, which are not conditional upon the replies firms give to the ASX inquiries.
Implications of Components of Income Excluded from Pro Forma Earnings for Future Profitability and Equity Valuation
Authors: Landsman Wayne R. , Miller Bruce L. , Yeh Shu
Published: May 2007

Abstract:  This study addresses three research questions relating to total exclusions, special items, and other exclusions. Are each of these pro forma exclusion components forecasting irrelevant? Are each of the exclusion components value irrelevant? Are the valuation multiples on the exclusion components justified by their ability to forecast future profitability as predicted by the Ohlson (1999) model? Findings are generally consistent with the market‐inefficiency results presented in Doyle et al. (2003). Total exclusions are valued negatively by the market despite the prediction that total exclusions will be valued positively. Valuation results also suggest that stocks with positive other exclusions are overpriced.