bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple primary malignancies in patients with renal cell carcinoma: a national population‐based cohort study
Authors: BEISLAND CHRISTIAN , TALLERAAS OLAUG , BAKKE AUGUST , NORSTEIN JARLE
Published: March 2006

OBJECTIVE

To determine the possibly greater occurrence of multiple malignancies in patients with renal cell carcinoma (RCC).

PATIENTS AND METHODS

In the 7‐year period 1987–93, all 1425 patients aged 15–70 years with registered histopathologically verified RCC in Norway were included in the study. All clinical and histopathology reports were checked manually, to verify the registered diagnosis and to ensure that no tumour was a metastasis from another. After this process, 257 patients (287 tumours other than RCC) with multiple primary malignancies were identified. The primary tumours other than RCC were classified as antecedent, synchronous and subsequent. For the subsequently occurring tumours, the expected number of different tumour types was calculated according to age group, gender and observation time.

RESULTS

Of the 1425 patients, 228 (16%) had one, 23 (1.6%) had two, three (0.2%) had three and one (0.07%) had four other primary malignancies. In all, 100 (34.8%) of the other tumours were diagnosed as antecedent, 53 (18.7%) as synchronous and 134 (46.7%) as subsequent to the RCC. Cancer in the prostate, bladder, lung, breast, colon and rectal cancer, malignant melanomas (MM) and non‐Hodgkin's lymphomas (NHL) were the most common other malignancies. The observed overall number of subsequent other malignant tumours was 22% higher than the expected number. The observed number of subsequent tumours was significantly higher for bladder cancer, NHL and MM. The estimated 15‐year cumulative risk for patients with RCC and no previous or synchronous other malignancy for developing a later second cancer was 26.6% in men, and 15.5% in women (statistically significant, P = 0.04). Patients with antecedent or synchronous other cancer had significantly poorer overall survival than those without.

CONCLUSIONS

Patients with RCC seem to have a significantly higher risk of developing other subsequent primary malignancies. This should be considered during the follow‐up of patients with RCC.
Endoscopic treatment with polydimethylsiloxane in children with dilating vesico‐ureteric reflux
Authors: BARTOLI FABIO , NIGLIO FRANCESCO , GENTILE OTTAVIO , PENZA ROSA , ACETO GABRIELLA , LEGGIO SAMUELE
Published: March 2006

The much‐visited topic of endoscopic treatment of VUR in children with an injectable agent is assessed by authors from Italy. However, in this study using Macroplastique, they had a 72% success rate after the first injection, 97% after the second, and 100% after the third. What is interesting is that 68% of the cases had grade IV–V VUR.

OBJECTIVE

To report our experience of treating dilating vesico‐ureteric reflux (VUR) in children, using an injectable form of polydimethylsiloxane (MacroplastiqueTM, MPQ; Uroplasty BV, Geleen, The Netherlands), as medical treatment for moderate or severe VUR is associated with a high proportion of persistence or development of new scars.

PATIENTS AND METHODS

The study included 32 children (40 ureters) with VUR; 13 (32%) were grade III, 20 (50%) grade IV and seven (18%) grade V. They were treated over a period of 42 months, 66% for some form of bladder dysfunction and 38% had associated diseases. The main indications were VUR grade, recurrent urinary tract infection and progression of reflux nephropathy. MPQ was injected under general anaesthesia via an 11 F cystoscope, × 30 objective, with a 5 F working channel.

RESULTS

The mean (sd) follow‐up was 28.5 (10.2) months; VUR resolved in 80% of patients and improved to minimal VUR in the remaining 20%. The resolution/improvement rate was 72% after the first injection, 97% after the second and 100% after the third. There were no significant complications.

CONCLUSION

The endoscopic implantation of MPQ always corrected VUR even though 68% of the cases were grade IV–V. It should become the treatment of choice for severe VUR.
Uroepithelial cells can directly respond to Mycobacterium bovis bacillus Calmette‐Guérin through Toll‐like receptor signalling
Authors: MIYAZAKI JUN , KAWAI KOJI , OIKAWA TAKEHIRO , JOHRAKU AKIRA , HATTORI KAZUNORI , SHIMAZUI TORU , AKAZA HIDEYUKI
Published: March 2006

OBJECTIVE

To investigate, in a human urinary tract cell line, the interaction of Toll‐like receptor (TLR) signals with cytoplasmic adapter proteins MyD88 and bacillus Calmette‐Guérin (BCG), and evaluate the epithelial cytokine response to BCG infection. Intravesical BCG therapy is effective against carcinoma in situ and as prophylaxis for recurrence, but although immunological mechanisms have been assumed, the mechanisms of the antitumour effects of BCG have not been completely elucidated.

MATERIALS AND METHODS

The cell line was first screened for TLR expression by reverse transcription‐polymerase chain reaction (RT‐PCR). Total RNA was isolated from a human urinary cell line, Hu35E6E7, and cDNA synthesised. PCR was used to measure the gene expression of TLR‐2, ‐3, ‐4, ‐5, ‐9, MyD88, MD‐2, CD14 and interleukin‐8 and ‐6. The Hu35E6E7 cell line was cultured in keratinocyte serum‐free medium, and BCG was added to the cell culture. After Hu35E6E7 cells were stimulated by BCG for various periods, the total RNA of the cells was extracted. Quantitative real‐time PCR was conducted for MyD88 using appropriate probes, and the expression of MyD88 analysed. The cell supernatant was collected, and the levels of interferon‐γ, tumour necrosis factor‐α, interleukin‐2, ‐12, ‐4, ‐6, ‐10, ‐8 and ‐1β were assayed using an enzyme‐linked immunosorbent assay.

RESULTS

Uroepithelial cells expressed TLR‐2, ‐3, ‐4 and ‐9, and MyD88, MD2, CD14, interleukin‐6 and ‐8 were also detected. At 3, 6, 9 and 12 h after adding BCG, quantitative PCR assay showed that the expression of MyD88 was maximal at 6 h. The presence of BCG stimulated the release only of interleukin‐6 and ‐8 from Hu35E6E7 cells after 6 h. By contrast, interferon‐γ, tumour necrosis factor‐α, interleukin‐2, ‐12, ‐4, ‐10 and ‐1β were not detected in the culture supernatant.

CONCLUSION

These results show that uroepithelial cells, but not immune cells, responded directly to BCG through TLR signalling. Further investigation is needed to determine the role of cytokines released from uroepithelial cells after BCG infection.
Limited significance of routine excretory urography in the follow‐up of patients with superficial bladder cancer after transurethral resection
Authors: MIYAKE HIDEAKI , HARA ISAO , YAMANAKA KAZUKI , INOUE TAKA‐AKI , FUJISAWA MASATO
Published: March 2006

OBJECTIVES

To evaluate the utility of routine excretory intravenous urography (IVU) for detecting subsequent upper urinary tract cancer (UUTC) during the follow‐up of patients with superficial bladder cancer.

PATIENTS AND METHODS

The study included 413 patients who had transurethral resection (TUR) of superficial bladder cancer between January 1986 and December 2003, and were followed for at least 1 year. After TUR, patients were followed by periodic cystoscopy, urinary cytology and IVU. The risk factors for UUT recurrence after TUR were analysed, and based on this outcome, we then determined whether routine IVU should be used for patients with superficial bladder cancer.

RESULTS

During the observation period, UUTCs developed in 20 of the 413 patients (4.8%) within a median of 33 months from the initial TUR to the detection of UUTCs. Among several factors examined, only multiplicity was significantly associated with UUT recurrence after TUR. Of the 20 patients with secondary UUTCs, only two, who had multiple superficial bladder cancers at initial presentation, were diagnosed as having UUTCs by routine IVU, while the remaining 18 presented with symptoms suggesting possible UUT recurrence before IVU, including macrohaematuria (10 patients), intravesical recurrence (five), positive urinary cytology (five), abdominal pain (three) and high fever (two).

CONCLUSIONS

Most patients with recurrent UUTCs presented with some subjective and/or objective symptoms, and routine IVU failed to detect recurrent diseases in such patients. Therefore, routine IVU may not be required for all patients who have TUR of superficial bladder cancer.
Surgery for giant high‐flow renal arteriovenous fistula: experience in one institution
Authors: OSAWA TAKAHIRO , WATARAI YOSHIHIKO , MORITA KEN , KAKIZAKI HIDEHIRO , NONOMURA KATSUYA
Published: March 2006

OBJECTIVE

To present five cases of renal arteriovenous fistula (RAVF) seen at our institution, with an emphasis on surgical treatment.

PATIENTS AND METHODS

We assessed five patients with giant high‐flow RAVF. The affected kidney was evaluated functionally using 99mTc‐diethylenetriamine pentaacetic acid renal scintigraphy. The size, location, involvement of branched arteries, and renal function dictated the choice of operative method. Four patients were treated with in situ ligation of the feeding artery for extrarenal RAVF, and the remaining patient had a nephrectomy of the nonfunctioning kidney. The clinical outcome was analysed by renal function, blood pressure control, radiographic cardiothoracic ratio (CTR), occlusion of RAVF, and renal artery patency.

RESULTS

Of two patients with hypertension, the blood pressure was normalized in one. The renal function of the affected side was preserved in four patients. CTR was normalized or improved in all four patients with preoperative cardiomegaly. There was no recurrence of RAVF in any of the five patients and there was no major morbidity after surgery.

CONCLUSIONS

Surgery for giant high‐flow RAVF is safe and feasible from the perspective of complications and recurrence, even though transarterial embolization has become the first line of therapy for RAVF.
Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia but not acute urinary retention: results of a 2‐year placebo‐controlled study
Authors: ROEHRBORN CLAUS G. ,   ALTESS Study Group
Published: March 2006

OBJECTIVES

To evaluate the effect of alfuzosin 10 mg once daily administered for 2 years on progression events in men with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH).

PATIENTS AND METHODS

In all, 1522 men at risk of having progression events from LUTS/BPH were randomized to receive alfuzosin 10 mg once daily (759) or placebo (763) for 2 years. Endpoints assessed were the occurrence of a first episode of acute urinary retention (AUR; primary) and the need for BPH‐related surgery. Post hoc analyses included a deterioration in the International Prostate Symptom Score (IPSS) of ≥ 4 points and overall clinical progression of BPH (occurrence of AUR and/or surgery and/or symptom deterioration).

RESULTS

Over 2 years, symptom deterioration was the most common progression event (14.3%), followed by BPH‐related surgery (5.8%) and AUR (2.0%). Alfuzosin did not reduce the risk of AUR (alfuzosin 2.1% vs placebo 1.8%, P = 0.82) but tended to reduce the risk of surgery (5.1% vs 6.5%, P = 0.18); the reduction in risk (RR) and 95% confidence interval with alfuzosin was 22 (−18 to 48)%; and significantly reduced the risk of symptom deterioration (11.7% vs 16.8%; P = 0.0013); the RR was 30 (10–46)%. The overall clinical progression of BPH was significantly lower with alfuzosin than with placebo (16.3% vs 22.1%, P < 0.001); RR 26 (9–40)%. Alfuzosin also significantly improved the IPSS (P = 0.017), quality of life (P < 0.001) and peak flow rate (P = 0.001) compared with placebo. Baseline levels of prostate‐specific antigen (PSA) predicted both AUR and BPH‐related surgery events, while the baseline postvoid residual urine volume predicted symptom deterioration. The incidence of adverse events with alfuzosin was comparable to that with placebo.

CONCLUSIONS

Alfuzosin 10 mg once daily prevents the overall clinical progression of BPH, defined by the occurrence of a deterioration in IPSS of ≥ 4 points and/or AUR and/or BPH‐related surgery, but does not reduce the primary occurrence of AUR. Alfuzosin significantly improves LUTS and quality of life over 2 years, and is well tolerated.
Self‐Monitoring and Close Relationships
Authors: Leone Christopher , Hawkins LouAnne B.
Published: March 2006

ABSTRACT Three types of close relationships have received attention from theorists and researchers interested in self‐monitoring: friendships, romantic relationships, and marriage. Our review of this literature was organized around three phases of relationships: initiation, maintenance, and dissolution. Across the three types of relationships, consistent differences between high self‐monitors and low self‐monitors emerged concerning the structure of their social relationships (segmented vs. integrated), the basis for choosing friends and romantic partners (activity‐based vs. person‐based), and the orientation taken to romantic and marital partners (uncommitted vs. committed). Across all three types of relationships, however, little is known about the processes and consequences involved in the dissolution of close relationships for high self‐monitors and low self‐monitors. Relatively little is also known about the processes used by high self‐monitors and low self‐monitors to maintain their friendships and marriages. In addition to addressing these deficiencies in the literature, theorists and researchers interested in self‐monitoring and close relationships need to develop sophisticated, causal models that can account for (a) interaction exchanges in the relationships, (b) dyadic as well as individual levels of analysis, and (c) temporal and situational changes in the course of close relationships.
PLUG‐IN ESTIMATION OF GENERAL LEVEL SETS
Authors: Cuevas Antonio , González‐Manteiga Wenceslao , Rodríguez‐Casal Alberto
Published: March 2006

Given an unknown function (e.g. a probability density, a regression function, …) f and a constant c, the problem of estimating the level set L(c) ={f≥c} is considered. This problem is tackled in a very general framework, which allows f to be defined on a metric space different from . Such a degree of generality is motivated by practical considerations and, in fact, an example with astronomical data is analyzed where the domain of f is the unit sphere. A plug‐in approach is followed; that is, L(c) is estimated by Ln(c) ={fn≥c}, where fn is an estimator of f. Two results are obtained concerning consistency and convergence rates, with respect to the Hausdorff metric, of the boundaries ∂Ln(c) towards ∂L(c). Also, the consistency of Ln(c) to L(c) is shown, under mild conditions, with respect to the L1 distance. Special attention is paid to the particular case of spherical data.
ALL‐BIAS DESIGNS FOR POLYNOMIAL SPLINE REGRESSION MODELS
Authors: Woods David , Lewis Susan
Published: March 2006

Polynomial spline regression models of low degree have proved useful in modeling responses from designed experiments in science and engineering when simple polynomial models are inadequate. Where there is uncertainty in the number and location of the knots, or breakpoints, of the spline, then designs that minimize the systematic errors resulting from model misspecification may be appropriate. This paper gives a method for constructing such all‐bias designs for a single variable spline when the distinct knots in the assumed and true models come from some specified set. A class of designs is defined in terms of the inter‐knot intervals and sufficient conditions are obtained for a design within this class to be all‐bias under linear, quadratic and cubic spline models. An example of the construction of all‐bias designs is given.
ROBUST INFERENCE IN PARAMETRIC MODELS USING THE FAMILY OF GENERALIZED NEGATIVE EXPONENTIAL DISPARITIES
Authors: Bhandari Subir K. , Basu Ayanendranath , Sarkar Sahadeb
Published: March 2006

We examine robust estimators and tests using the family of generalized negative exponential disparities, which contains the Pearson's chi‐square and the ordinary negative exponential disparity as special cases. The influence function and α‐influence function of the proposed estimators are discussed and their breakdown points derived. Under the model, the estimators are asymptotically efficient, and are shown to have an asymptotic breakdown point of 50%. The proposed tests are shown to be equivalent to the likelihood ratio test under the null hypothesis, and their breakdown points are obtained. The competitive performance of the proposed estimators and tests relative to those based on the Hellinger distance is illustrated through examples and simulation results. Unlike the Hellinger distance, several members of this family of generalized negative exponential disparities generate estimators which also possess excellent inlier‐controlling capability. The corresponding tests of hypothesis are shown to have better power breakdown than the Hellinger deviance test in the cases examined.
Phonics self‐teaching materials for foundation literacy
Authors: Spencer Ken
Published: March 2006

The effect of irregular English orthography (spelling) on foundation literacy, and in particular on alphabetic decoding, is discussed within the context of the orthographic depth hypothesis. A method for circumventing the retarding effects of traditional English orthography, based on the support provided for Chinese pupils learning their character‐based system of writing, is described. Evidence for the beneficial effects of a regularised form of English to support conventional orthography is presented in the form of a case study and a small group experiment, both carried out in a primary school in the North of England.
Putting literature at the heart of the literacy curriculum
Authors: Nicholson Deborah
Published: March 2006

This paper documents an initiative in Continuing Professional Development, conceived and carried out by London's Centre for Literacy in Primary Education (CLPE). The intention was to improve the teaching and learning of writing in Years 5 and 6 of the primary school (9–11‐year‐olds), through working with challenging literature. This teacher education project drew on CLPE's earlier research project, published as The Reader in the Writer (Barrs and Cork, 2001). Classroom approaches developed through the initiative are described, and qualitative and quantitative changes in children's writing are discussed. Patterns of teaching in the classrooms that appear to have made a particular difference to the children's achievement are explored.
Children writing: Multimodality and assessment in the writing classroom
Authors: Vincent John
Published: March 2006

Multimedia has had a widely recognised impact on society, but it is still under‐represented in the literacy pedagogies of many schools. This may relate to the way we view assessment for literacy, which is still almost wholly monomodal. Students assessed at a low level as producers of verbal text may respond positively when working multimodally, but the only assessment instruments we have do not reveal this. In a class of 26 ten‐year‐olds in Victoria, Australia, with rich access to computers, five children performed at a very low level when working with verbal expression only, but responded remarkably when invited to work multimodally. A programme of text production was monitored and the results analysed, progressing from handwritten monomodal work, through stages of multimodality to full multimodal expression. The results suggest strongly that some children need multimodal scaffolding in order to communicate complex ideas effectively. This, however, requires an acceptance of multimodal texts as part of the primary literacy curriculum. It is therefore suggested that assessment of multimodal composition, both narrative and other texts, should be developed to help teachers accept the value of introducing multimodal literacies into the classroom.
The State, Institutional Transition and the Creation of New Urban Poverty in China
Authors: Liu Yuting , Wu Fulong
Published: March 2006

Since the 1990s, the introduction of a market economy and the process of rapid urbanization have been accompanied by a new urban poverty related to lay‐offs and unemployment as well as by large‐scale rural–urban migration, which is different from the traditional urban poverty of the ‘Three Nos’ (no relatives or dependants, no working capacity and no source of income). This article focuses on new urban poverty in China under market transition and discusses the causes of poverty creation. Instead of considering Chinese new urban poverty only as a result of market mechanisms, it argues that the state as the manipulator of institutions and policies does matter in the creation of new urban poverty, and that the cleavages between the old and new institutions further intensify it. Specifically, the following aspects of the creation of new urban poverty are examined in detail: the adjustment of industrial policy, the reform of state‐owned enterprises, evolution of the household registration system, and the transformation of the welfare state.
Social Policy between Plan and Market: Xiagang (Off‐duty Employment) and the Policy of the Re‐employment Service Centres in China
Authors: Wong Linda , Ngok Kinglun
Published: March 2006

China's gradual transition from a command economy to a market system has been vexed by its ailing state‐owned enterprises (SOEs) employing huge numbers of surplus workers. Under the growing challenge of market competition, the survival of SOEs depends critically on the release of unwanted staff. If not handled well, however, massive layoffs could trigger ugly protests, erode social stability and challenge the governing mandate of the Chinese Communist Party. Facing this dilemma, the state's response has been to invent a process of ‘xiagang’ (off‐duty employment) whereby redundant state workers can leave the production process without causing social turbulence, and to introduce a national programme of re‐employment service centres (RSCs) which offer living allowances, social security, job training and re‐employment assistance as a transitional measure. As a distinct form of unemployment, xiagang reflects the special challenge confronting the state and civil society in a critical stage of China's market transition. This article sets out to explore the political and social meanings of xiagang and the RSCs to elucidate how the state uses a specific social policy to balance both group and national interests and to steer the country on to the next stage of market development.
East Asian Welfare Regimes in Transition: From Confucianism to Globalisation
Authors: Choi Young Jun
Published: March 2006

Books reviewed:

Alan Walkerand Chack‐kie Wong, East Asian Welfare Regimes in Transition: From Confucianism to Globalisation.
English syllabification as the interaction of markedness constraints*
Authors: Hall T. A.
Published: March 2006

Abstract.  The present study offers an Optimality‐Theoretic analysis of the syllabification of intervocalic consonants and glides in Modern English. It will be argued that the proposed syllabifications fall out from universal markedness constraints – all of which derive motivation from other languages – and a language‐specific ranking. The analysis offered below is therefore an alternative to the traditional rule‐based analyses of English syllabification, e.g. Kahn (1976), Borowsky (1986), Giegerich (1992, 1999) and to the Optimality‐Theoretic treatment proposed by Hammond (1999), whose analysis requires several language‐specific constraints which apparently have no cross‐linguistic motivation.
Deictic projection: An inquiry into the future‐oriented past tense in Persian*
Authors: Tavangar Manoochehr , Amouzadeh Mohammad
Published: March 2006

Abstract.  The aim of this paper is to investigate the ways in which the Persian past tense form is projected into the future to designate events, states, and processes. While it must be admitted that the phenomenon under consideration is by no means confined to Persian, its examination in this language will reveal certain characteristics which are likely to contribute to a better understanding of how temporal deixis, together with aspectual and modal meanings, interact with contextual factors to yield socio‐culturally relevant utterances. Of special theoretical interest in this respect are the semantic‐pragmatic constraints levied, in varying degrees, on the projected tense in terms of negation, pronominal choice, speech act assignment, aspectual character, modal status, and pitch contour.

 Fundamental to the present study are three assumptions. First, the deictic projection at issue has pragmatic motivations, and, in addition, stems largely from the ontological asymmetry between pastness and futurity. Second, it has an indisputable edge over the other future‐indicating devices available to Persian speakers in that it denotes factivity with respect to the occurrence of a situation. And third, it is stylistically marked as it digresses from the normal function of the past tense.

“And of all the various aspects of time, it is its tensed aspect, the fact that we experience time in terms of a transient now, which is the most promiscuous.” (Robin Le Poidevin, 1998:10)
Debt Restructuring and Economic Recovery: Analysing the Argentine Swap
Authors: Dhillon Amrita , García‐Fronti Javier , Ghosal Sayantan , Miller Marcus
Published: March 2006

When Argentine sovereign default in December 2001 led to a collapse of the peso, the burden of dollar debt became demonstrably unsustainable. But it was not clear what restructuring was feasible, nor when. Eventually, in 2005 after a delay of more than three years, a super‐majority of creditors accepted a swap that essentially involved the ‘pesification’ of dollar liabilities. With the IMF not playing its customary role in arranging a swap, we consider whether a bilateral bargaining approach can help explain the final settlement and the delay in achieving it. We find that the swap broadly corresponds to a bargaining outcome where substantial delay occurred for both political and economic reasons. Even after political legitimacy was assured by general elections, negotiators seeking a sustainable outcome – at a time of deep recession, profound currency under‐valuation and high sovereign spreads – realised it was better to wait before settling. Other factors discussed include the definition of sustainability criteria, the effect of inter‐creditor conflict and the role of third parties in promoting ‘good faith’ bargaining. We suggest that, while these issues need further investigation, there are institutional changes that could make them less problematic.
Exchange Rates and Competition for FDI in Asia
Authors: Xing Yuqing , Wan Guanghua
Published: March 2006

This paper argues that relative exchange rates between the host countries of foreign direct investment affect their competition for FDI. Specifically, if the host country currency appreciates against the source country's currency more than that of its rival, FDI inflows of the host country will decrease, while FDI inflows increase in the rival country. Using the data of Japanese FDI in nine Asian manufacturing sectors from 1981 to 2002, the paper examines the hypothesis in the context of the competition between China and ASEAN‐4 (Indonesia, Malaysia, the Philippines and Thailand). Empirical results show that the relative exchange rate is a statistically significant factor that determines the relative inflows of Japanese FDI for manufacturing as a whole, and for such sub‐sectors as textiles, food, electronics, transportation equipment, and others. Exchange rate policies of China and ASEAN‐4 played a critical role in dynamically reshaping the geographic distribution of Japanese FDI in Asia.
Determinants of runaway episodes among adolescents using crisis shelter services
Authors: Thompson Sanna J. , Pillai Vijayan K.
Published: March 2006

This study investigated youth and family factors associated with runaway episodes. Youth and family characteristics are described for adolescents utilising emergency shelter services in Texas and New York, and the study explored multivariate models to determine the individual and family effects on runaway recidivism. A convenience sample of 349 youth using runaway shelter services was recruited; 154 runaway youth from New York and 195 from Texas shelters participated. Adolescents completed several self‐report measures; negative binomial regression analyses were conducted. Findings demonstrated that characteristics of adolescents and family factors are significant predictors of adolescents’ runaway episodes when statistically controlling for region of the country. Social workers in emergency youth shelters and child welfare settings are in a unique position to develop effective strategies to meet the needs of this high‐risk group of young people.
Why are Swedes sick but Finns unemployed?
Authors: Hytti Helka
Published: March 2006

While the Finnish and Swedish social security systems are structurally quite similar, the two countries show marked differences both in the recipiency rates of sickness and work disability benefits and in the level of open un­employment. In Sweden, the usage of sickness‐related benefits since the beginning of the 1990s has varied in inverse relation to the level of registered unemployment, whereas in Fin­land, recipiency rates of sickness and work disability benefits have remained fairly constant, registered unemployment having typically been more than twice the Swedish level. Using the available statistical data, the article explores the differences in the prevalences of sickness, work disability and unemployment benefits between Sweden and Finland. Factors that may explain the divergence between the two countries are sought and interpreted from the long‐term differences in welfare‐state strategies and the structural features of the social security systems under investigation.
Highly active anti‐retroviral treatment as a bridge towards education for all in sub‐Saharan Africa
Authors: Kombe Gilbert , Fieno John , Bhatt Paurvi , Smith Jessica
Published: March 2006

The dual campaigns of Education for All (EFA) and the Millennium Development Goals (MDG) have made universal primary school enrolment for boys and girls a priority for developing countries. The HIV/AIDS epidemic has affected millions of people in sub‐Saharan Africa and has depleted the teaching corps. As a result, the HIV/AIDS pandemic has pushed the targets of EFA and MDG further out of reach for many medium and high HIV‐prevalence countries. The provision of highly active antiretroviral therapy (HAART) in developing countries, however, has given hope to thousands who have not had access to treatment. The Commission on Human Rights in 2001 and again in 2002 confirmed that access to AIDS medication is a key component of the right to the highest attainable standard of health, enshrined in the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights and the Convention on the Rights of the Child. This article explores how scaling up of HAART for teachers can make the EFA and MDG targets attainable. A HAART programme for teachers can produce substantial fiscal savings in sick leave pay, the cost of training new teachers, and funeral expenses, even under high HIV prevalence situations.
Managing Crises in the EU: Some Reflections of a Non‐EU Scholar
Authors: Porfiriev Boris
Published: March 2006

In recent years the EU has been increasingly involved in development and implementation of crisis policy as a component of its development and security policy. This process is seriously complicated by the EU architects, who had never conceived it as a crisis management institute. Therefore they failed to design built‐in organisational capacities into the Union to mitigate and respond to crises. In addition, the EU‐agreed overarching concept of crisis as such and EU crisis in particular is missing. Both issues remain a primary question on research and policy agendas. Provided below are some of the author's considerations and comments on these issues. It is argued that, despite the existing divergence in crisis interpretations in the EU, coherent conceptualisation is possible and approaches to this are introduced. Practical implications of generic crisis conceptualisation for EU crisis management policy are analysed. Within this context three major lessons from international experience, including that from the USA and Russia, are emphasised. These concern the issues of organisational flexibility, learning from earlier major crises and comprehensive training of crisis decision units critical for efficient crisis management policy.
“Epidemic in Switzerland”: Description of a Strategic Leadership Exercise by the Swiss Government
Authors: Carrel Laurent F.
Published: March 2006

On January 20, 2005, a national strategic leadership exercise was held in Switzerland. The theme being the first day response to an epidemic outbreak. Special attention was paid to cooperation and coordination among the various federal departments, the definition of responsibilities within the leadership organisation, and the level of information and communication that served the leadership process, and how these elements played out under time pressure, during a crisis situation and within a federal and international setting. The evaluation of this exercise concludes that short term crisis management could be considered as adequate but strategic decision making was mostly absent. The value of this large scale exercise is considered positive for the preparation on crisis management because of heightened political attention which for example is visible in the swift implementation of the recommendations of the evaluation.
Diet of the gracile mouse opossum (Gracilinanus microtarsus) (Didelphimorphia: Didelphidae) in a Brazilian cerrado: patterns of food consumption and intrapopulation variation
Authors: Martins E. G. , Bonato V. , Pinheiro H. P. , Dos Reis S. F.
Published: March 2006

The diet of the gracile mouse opossumGracilinanus microtarsuswas studied in a cerrado remnant in south‐eastern Brazil through the analysis of faeces sampled from adult individuals. Patterns of food resource consumption were assessed using the statistics of per cent occurrence. Intrapopulation variation in the number of food items detected in faeces as a function of relevant factors was inferred using generalized linear models. The latter statistical formalism also allowed variation in the number of food items detected in faeces to be interpreted in terms of rate ratios among levels of significant factors. Insects, spiders, snails and fruits were detected in the faeces ofG. microtarsus, with insects, particularly termites, beetles and ants, being the most frequently detected food resource. These food resources were consumed in proportion to their relative abundance in the cerrado, suggesting thatG.microtarsusis an opportunistic forager feeding primarily on insects. The generalized linear model identified sex, season and food resource as significant factors affecting the number of food items detected in faeces, as well as interactions between sex and season and season and food resource. Rate ratios calculated between sexes within seasons showed that the number of food items detected in the faeces of males was larger than that detected in the faeces of females in the warm‐wet and cool‐dry seasons. Rate ratios calculated between seasons within sexes showed different trends in the number of food items detected in faeces for each significant food resource. It is suggested that differences in the number of food items detected in faeces between sexes within season and between seasons within sexes are related to energetic requirements associated with reproduction.
What do we know about duloxetine's mode of action? Evidence from animals to humans
Authors: Schuessler B
Published: March 2006

The serotonin (5‐hydroxytryptamine [5‐HT]) and noradrenalin (NA) reuptake inhibitor duloxetine is currently the only widely approved pharmacological treatment option for women with stress urinary incontinence (SUI). The rationale for employing duloxetine in SUI is based on the role of 5‐HT and NA in the neurological control of the lower urinary tract. Animal studies have shown that duloxetine increases the concentration of 5‐HT and NA in the sacral spinal cord, thereby facilitating an increased activity of the external urethral sphincter (rhabdosphincter) and preventing urine leakage during the storage phase of the micturition cycle. Importantly, 5‐HT and NA exert only a modulatory effect as they are not able to directly excite motor neurons. Glutamate is the key descending neurotransmitter and can be considered as the ‘on/off’ switch for micturition. In the absence of glutamate, no rhabdosphincter activity is observed, irrespective of the presence of 5‐HT and NA. Hence, duloxetine enhances sphincter activity during urine storage when glutamate is released but allows complete relaxation of the rhabdosphincter once glutamate release is inhibited during the voiding phase. The efficacy of duloxetine for treating women with SUI, as shown in several double‐blind, placebo‐controlled randomised clinical trials, has suggested a similar mode of action, although no direct evidence for this pathway in humans was available until recently. Two recent studies provide support for duloxetine's mechanism of action in humans. Duloxetine was shown to have a significant effect on the excitability of pudendal motor neurons and on sphincter contractility in healthy women. In contrast, no relevant effect was observed on urethral resting tone. Another study reported important increases in Valsalva leak point pressure and in the rhabdosphincter electrical activity at rest and with coughing in women with SUI who responded to duloxetine. These studies support the hypothesis that duloxetine in women with SUI enhances urethral closure through neuromodulation of the rhabdosphincter.
Optimal booking limits in the presence of strategic consumer behavior
Authors: Wilson John G. , Anderson Chris K. , Kim Sang‐Won
Published: March 2006

We consider a two‐period airline yield management problem where customers may act strategically. Specifically, we allow for the possibility that a customer may decide to defer purchase in the hope that a ticket cheaper than those currently on offer will become available. We also allow for the possibility that some customers will buy a more expensive ticket if the cheaper tickets are not available. We show how to find optimal booking limits in the presence of such strategic customer behavior. We also explicitly incorporate the fact that, once a booking limit has been reached, demand distributions are now censored distributions.
Investigating the Effects of Directly Electing the Prime Minister
Authors: O'Malley Eoin
Published: March 2006

There are good prima facie reasons to believe that directly electing a prime minister may provide the holder of that office with a tremendous power resource. Indeed some countries with weak prime ministers have debated this possible change, and one, Israel, carried it through. Using a theoretical argument based on the number of veto points in a political system, this article proposes that a directly elected prime minister will not increase the power of a prime minister. It studies what actually happened in Israel, and offers alternative explanations for the weakness of and lack of cohesion in its executive. Similarly, other factors are identified as causes of prime ministerial weakness in Italy and Japan.
The Left Against Europe? A Critical Engagement with New Constitutionalism and Structural Dependence Theory
Authors: Strange Gerard
Published: March 2006

This article offers a critical engagement with two important strands of left theorizations of European Union integration and globalization, namely, ‘new constitutionalism’ (a sub-form of neo-Gramscian analysis) and ‘structural dependence’ theory (rooted in a more orthodox Marxist approach). These approaches suffer, respectively, from an uncritical or one-sided approach to constitutionalism and competitiveness; and from a theoretical conflation of national with regional political economy. While new constitutionalism under-theorizes regionalism partly because of its implicit ‘methodological nationalism’ and attachment to the ethics of national political economy, structural dependence theory neglects regionalism in pursuing a highly pessimistic structuralist approach to globalization.
Co-decision and Inter-Committee Conflict in the European Parliament Post-Amsterdam
Authors: Burns Charlotte
Published: March 2006

This article makes a two-fold contribution to the European Parliament (EP) literature. First, it challenges the dominant assumption that post-Amsterdam the EP has experienced an increase in its powers. Through analysis of the Socrates case the article shows that the EP is now potentially weaker under the post-Amsterdam co-decision procedure (co-decision II), than it was under the earlier variant, co-decision I. Second, the article uncovers a hitherto overlooked aspect of internal divisions within the parliament, by revealing that there is scope for inter-committee conflict in the EP over budgetary allocations for multi-annual programmes. It is argued that such conflict can weaken the parliament in co-decision negotiations with the council, and that the negotiation of the EU's new multi-annual budgetary framework provides the perfect conditions for such internecine conflict to occur once more.
Consociational Theory, Northern Ireland's Conflict, and its Agreement 2.-What Critics of Consociation Can Learn from Northern Ireland
Authors: McGarry John , O'Leary Brendan
Published: March 2006

In the second of two articles the authors show what integrationist critics of consociational theory can learn from the case of Northern Ireland, namely, that consociation may be more realistic than integration, that a ‘grand coalition’ may have more virtue than the ‘minimum-winning’ variety, that consociations can be both liberal and democratic, and that PR-STV has considerable advantages over integrationists’ preferred electoral system, the Alternative Vote.
Patient Choice Cesarean—The Maine Experience
Authors: Wax Joseph R. , Cartin Angelina , Pinette Michael G. , Blackstone Jacquelyn
Published: March 2006

ABSTRACT:  Background:
Patient choice cesarean refers to elective primary cesarean in the absence of a medical or obstetrical indication. The purpose of this study was to determine obstetricians’ attitudes and practices with respect to patient choice cesarean in Maine, United States. Methods: A questionnaire was sent to all Maine Fellows of the American College of Obstetricians and Gynecologists actively practicing obstetrics, after receiving institutional review exemption. Data were analyzed using descriptive statistics, Fisher exact, or chi‐square tests. Results: Seventy‐eight of 110 (70.9%) obstetricians responded. Of these, 60 of 71 (84.5%) respondents performed or were willing to perform patient choice cesarean. However, 15 of 71 (21.1%) preferred a cesarean delivery for themselves (women) or partners (men). Indications included urinary continence (53.3%), adverse previous birth experience (41.7%), anal continence (35.0%), concern for fetal death or injury (33.3%), and fear of childbirth, preservation of sexual function, or pelvic organ prolapse (26.7% each). Less frequent were pain (11.7%), convenience (8.3%), and provider availability (10.0%). In addition, 82.1 percent believed medical evidence and 85.9 percent believed ethical issues sometimes or always supported patient choice cesarean. Responses were similar by gender, age, and time interval from training completion with two exceptions. Women under age 35 years were more likely to opt for a cesarean delivery themselves (p = 0.04), and 42.9 percent of respondents under age 35 years interpreted the medical literature as supporting cesarean in all cases versus 4.2 percent of older colleagues (p = 0.008). Sixty‐four of 78 (82.1%) respondents would find a randomized trial of planned vaginal versus planned cesarean delivery helpful in addressing the issue of patient choice cesarean. Conclusions: Although Maine obstetricians were willing to perform patient choice cesarean, few preferred this delivery mode for themselves or their partners. A randomized trial of planned vaginal versus planned cesarean delivery is highly desired.
Will the Medicare Prescription Drug Benefit Eliminate Cost Barriers for Older Adults with Diabetes Mellitus?
Authors: Tjia Jennifer , Schwartz J. Sanford
Published: March 2006

OBJECTIVES: To determine the proportion of older people with diabetes mellitus (DM) eligible to enroll in the standard Medicare Part D drug benefit who will exceed the initial $2,250 coverage limit and to determine the effect of hypoglycemic choice on risk of exceeding the coverage limit.

DESIGN: Cross‐sectional survey.

SETTING: Nationally representative sample of adults living in United States households participating in the 2001 Medical Expenditure Panel Survey (MEPS).

PARTICIPANTS: Individuals aged 65 and older with a diagnosis of DM eligible to enroll in the standard Medicare Part D drug benefit.

MEASUREMENTS: Prescription medication use and expenditures adjusted to 2006 U.S. dollars as reported in the MEPS prescribed medicine file. Survey‐weighted logistic regression models were used to estimate the odds of annual medication expenditures exceeding $2,250, controlling for hypoglycemic type, sociodemographic characteristics, chronic conditions, and health status.

RESULTS: Of the estimated 3.2 million elderly people with DM eligible for the standard drug benefit filling a prescription in 2001, approximately 64% had medication expenditures in excess of $2,250 in 2006 adjusted dollars. The proportion exceeding the initial coverage limit varied by type of hypoglycemic drug used from 60% of those using traditional hypoglycemics to more than 75% of those using novel hypoglycemics. Patients with more comorbidities and poorer health status were at greater risk of exceeding the initial coverage limit.

CONCLUSION: A large proportion of older adults with DM may exceed the initial coverage limit under the standard Medicare Part D drug benefit and incur significant out‐of‐pocket spending.
Detection of Delirium by Bedside Nurses Using the Confusion Assessment Method
Authors: Lemiengre Joke , Nelis Tine , Joosten Etienne , Braes Tom , Foreman Marquis , Gastmans Chris , Milisen Koen
Published: March 2006

A prospective, descriptive study was used to assess the diagnostic validity of the Confusion Assessment Method (CAM) administered at the bedside by nurses in daily practice. Two different scoring methods of the CAM (the specific (SPEC) and sensitive (SENS) methods) were compared with a criterion standard (CAM completed by trained research nurses). During a 5‐month period, all patients consecutively admitted to an acute geriatric ward of the University Hospitals of Leuven (Belgium) were enrolled in the study. The 258 elderly inpatients who were included underwent 641 paired but independent ratings of delirium by bedside and trained research nurses.

Delirium was identified in 36 of the 258 patients (14%) or in 42 of the 641 paired observations (6.5%). The SENS method of the CAM algorithm as administered by bedside nurses had the greatest diagnostic accuracy, with 66.7% sensitivity and 90.7% specificity; the SPEC method had 23.8% sensitivity and 97.7% specificity. Bedside nurses had difficulties recognizing the features of acute onset, fluctuation, and altered level of consciousness.

For both scoring methods, bedside nurses had difficulties with the identification of elderly patients with delirium but succeeded in diagnosing correctly those patients without delirium in more than 90% of observations. Given these results, additional education about delirium with special attention to guided training of bedside nurses in the use of an assessment strategy such as the CAM for the recognition of delirium symptoms is warranted.