bluuebunny/crossref_metadata_2025 huggingface dataset:
WAVES: An Efficient Microcomputer Program for Site Response Analysis
Authors: Hart James D. , Wilson Edward L.
Published: August 2010

Abstract: A new microcomputer program for one dimensional site response analysis, which is based on the accurate direct step‐by‐step integration of the nonlinear equations of motion, is presented. The soil material properties are represented by a Ramberg‐Osgood hysteresis model in which the loading and unloading follow different nathas Therefare realistic soil properties can be incorporated in the analysis. The accuracy of the numerical methods and the computer program is demonstrated by analysis of a site in downtown Mexico City. The results compare favorably with the motions recorded during the 1985 Mexico City earthquake.
The Development of a knowledge Based System for Predicting building Maintence
Authors: Watson Ian D. , Brandon Peter S. , Basden Andrew
Published: August 2010

Abstract: This paper describes the development of a knowledge Based System for predicting strategic maintenance in residential property. An initial feasiility study identified a need for the long term strategic planning of building maintence in Housing Association. However, conventional Maintenance Management programs require too much data input, are too inflexible, do not explain their results, and not permit their users to explore potential alternatives. The application of knowledge Based Systems's technology to this area directly addresses these problems. This paper examines the need for such systems, and describes the implementation of one such system using a Client Centered Mehodology. The paper concludes by discussing some of the problems that were encourtered during the systems's development, how they were overcome, and what lessons may be learned for future systems developmets.
A Decision Support Tool for the Railway Industry Based on Computer Graphics and Intuitive Modelling Techniques
Authors: Tsiflakos K. , Owen D. B.
Published: August 2010

Abstract:The application of many operational research techniques employed by the railway industry requires as input a data model representing the geometrical, structural and operational characteristics of the railway network in question. However, constructing network models with the conventional methods requires a considerable amount of manual work that involves handling large amounts of both qualitative and predominantly, quantitative information. This paper presents an alternative approach for prototyping, constructing and querying railway models, incorporating interactive computer graphics. The presented approach allows the model builder to carry out the modelling task more quickly and accurately. After reviewing the transportation model building trends of the last decades, the authors present the characteristics of the proposed system, demonstrate its main functions and assess its impact on the efficiency of the modelling task.
Computational Methods for the Representation of Contour Lines
Authors: Anand Vera B.
Published: August 2010

Abstract: Various methods exist for the automatic representation of contour plots, frequently used in civil engineering to show, for example, stress distributions in a field or elevations in a survey map. This paper describes some of the contouring methods that influenced the development of algorithms for automatically contouring data specified on grids. Although many methods have been studied in the contouring field, the development of contour lines through a specified grid system is simple and very effective in the solution of various engineering problems. Specific details will be given on the creation of contour plots on regular grids, since routines to contour data that are scattered may interpolate values of points on a regular grid. Procedures for the creation of a three‐dimensional surface through the contour lines will also be given.
An Intelligent Vehicle Highway Information Management System
Authors: Shekhar Shashi , Yang Toneluh A. , Hancock Peter A.
Published: August 2010

Abstract:An IVHS (Intelligent Vehicle Highway System) information management system obtains information from road sensors, city maps and event schedules, and generates information to drivers, pafie controllers and researchers. We extend the relational database to model traffic information in a relational database by abstract data types and triggers. Abstract data types are needed for eficient modeling of spatial and temporal information, which create inefficiencies in traditional databases. We use monotonic continuous functions to map the object locations to disk addresses to save disk space and computation time. Model of spatial data is created to efficiently process moving objects. We provide schema for IVHS databases with the relevant abstract data types. We also have a large sample of the relations needed to model IVHS data. Several interesting queries are presented to show the power of the model. Triggers are defined, using rule‐definition mechanisms to represent incident detection and warning systems. An eficient physical model with MoBiLe access method is provided.
An Object‐Oriented Approach to ‐Detailed Structural Design
Authors: Biedermann J. D. , Crierson D. E.
Published: August 2010

Abstract: This paper describes an object‐oriented approach to the detailed design of structures. The objects and class relationships for the design of any structural system are identified at a high level of abstraction. It is shown that object‐oriented programming promotes modulariy, flexibiliy and extendibility, and this is illustrated through specialization of the class hierarchy identified for the general design case to a specific design example. Object‐oriented programming also allows for an eficient way of handling design heuristics, and this is illustrated by associating heuristics with the design objects of a specific example. The model is being implemented in C++ on a 386 microcomputer.
A New Approach to Multiphase‐Excitation Stochastic Seismic Response
Authors: Lin Jiahao , Williams F. W. , Zhang Wenshou
Published: August 2010

Abstract: A powerful new method for dealing with stationary random seismic response is described in detail. It is an extension of the early‐stage method. The emphasis is focused on multi‐support excitation problems. The main features of this method are:

The computational efficiency is much higher than for the conventional method, e.g. approximately 10,100, or even more times faster.

All cross‐correlation items, whether between the support excitations or between the participant modes, are involved naturally. Practically, it is impossible for this method to neglect these items

The principles and algorithm are simple and easy for engineering application. Complex 3D FEM models with dozens of ground excitations can be easily analysed on microcomputers as small as IBM‐pc/ AT.

The non‐proportional damping matrix can be dealt with easily and accurately and only real eigenmodes are used for degree reduction.
Trajectories, biographies and the evolving medical technology scene: labor and delivery and the intensive care nursery
Authors: Wiener Carolyn , Strauss Anselm , Fagerhaugh Shizuko , Suczek Barbara
Published: August 2010

Summary This paper is about the complexities of understanding the medical technology scene. A variety of attacks and defences on and of this scene — largely simplistic and encapsulated in catchwords and phrases like ‘dehumanization,’‘rising hospital costs, ‘quality of life’‐ have gained currency. There is a need to recognize the complexities stemming from medical technology, but also to find explanatory patterns. This paper uses the labor and delivery ward and the intensive care nursery (ICN) in the service of illuminating these complexities and patterns.
The social construction of teenage pregnancy: a problem in the ideologies of childhood and reproduction
Authors: Murcott Anne
Published: August 2010

Abstract There is a commonsense assumption that‘teenage pregnancy’constitutes some sort of a social problem. A neglected aspect of this social construction is explored. It is suggested that ideologies of reproduction go only so far in convincingly accounting for ambiguities contained in social constructions of teenage pregnancy and that appreciation of contemporary ideologies of childhood is also needed. Expressions of teenage pregnancy as a problem may then be understood as a matter of social pollution, located at the intersection of ideologies of reproduction on one hand and ideologies of childhood on the other.
Coronary Heart Disease and the Public Health 1850–1983
Authors: Bartley Mel
Published: August 2010

AbstractA historical and sociological re‐reading of the literature on a post Second World War epidemic of coronary heart disease provides some insight into ways in which public health texts may be analysed as official portraits of social problems. Historical epidemiology can be enriched by a careful consideration of the social processes underlying the designation and use of diagnostic categories.
The invention of infant mortality
Authors: Armstrong David
Published: August 2010

Abstract This paper traces the initial emergence of infant mortality as a socio‐medical problem and the development of its various forms ‐ from atrophy and debility to ‘sudden infant death’‐ in Britain during the 20th century. From the Registrar‐General's annual reports various analytic frameworks which were used in the investigation of infant mortality are identified; it is argued that the infant, in all its changing forms, was both object and effect of these frameworks.
Mental illness as social product or social construct: a contradiction in feminists’ arguments?
Authors: Busfield Joan
Published: August 2010

Abstract Feminists have been taken to task for suggesting both that the higher level of mental illness observed in women is a consequence of the oppression they face ‐ an oppression which drives them into madness and mental disorder ‐ and also that the concept of mental illness is a social construct inappropriately and incorrectly applied to women by a patriarchal order as a means of social control. This paper examines this supposed contradiction and the ideas that underly the contrasting contentions. It argues that the two positions are not in fact incompatible.
The malpractice crisis and the doctor‐patient relationship
Authors: Annandale Ellen C.
Published: August 2010

Abstract The current medical malpractice crisis in the United States provides an opportunity to explore the medical profession's response to threats to its autonomy of practice. Drawing on commentary in medical journals, I reveal the way in which physicians, and some lawyers, have explicitly targeted doctor‐patient interaction as a seat for malpractice reform. A good deal of attention is being given to developing a better rapport with patients, providing information and involving the patient in decision‐making about care. Such reforms should be welcomed. But any benefits need to be weighed against the possibility that changes in the doctor‐patient relationship may also have a covert purpose; as reform is focused at the interactional level, attention is drawn away from medical practice to the patient as the source of negligent injury. This can have negative consequences for patients who, in responding to this interactional gloss, may fail to gain compensation for the real errors of medical practice.
Coherence and incoherence: doctors' and patients' perspectives on the diagnosis of Parkinson's Disease
Authors: Pinder Ruth
Published: August 2010

This paper describes part of a qualitative project on patient‐doctor communication in the management of Parkinson's Disease. It explores how a group of general practitioners conceptualised the task of diagnosing patients with PD and the impact of diagnosis on a separate group of patients in terms of coherence and incoherence. My argument is that for GPs diagnosis represented a point of maximum theoretical coherence, whereas for patients it was a time of maximum experiential incoherence – a tension sharpened by reference to an analagous distinction: that between knowledge by description and knowledge by acquaintance.

The paper further examines how GPs considered their own experiential knowledge helped patients by way of three key assumptions they held about PD and PD patients: namely, age, the comparatively protracted nature of the disease course and the availability of treatment. It asks how far patients found such notions helpful in their initial efforts to accept the diagnosis. I see this meeting point between two worlds simultaneously as tragic and potentially creative, with implications for more sensitive and effective interaction between patient and GP in this and other chronic illnesses.
The construction of medical disposals Medical sociology and medical problem solving in clinical practice
Authors: Berg Marc
Published: August 2010

How do physicians construct medical disposals? In this paper it is argued that insights developed in the sociology of science (in particular so‐called laboratory studies) can be of help in addressing this relatively unexplored question. At the level of clinical action, medical sociologists have until recently generally separated the ‘content’ of medical action from the ‘social’ aspects, the former constituting a domain inaccessible to sociological investigation. This asymmetrical treatment of ‘cognitive’ and ‘social’ elements is stated to be based on two assumptions: (i) historical and examination data are seen as ‘facts’ which the physician only needs to ‘reveal’ and (ii) medical criteria and disposal options are regarded as scientific, fixed ‘givens’. A ‘laboratory study’ of medical problem solving in clinical practice, however, shows that these assumptions do not hold. It is argued that the physician, in transforming a patient's problem to a solvable problem, does not just combine some ‘cognitive’ items together, but actively articulates an array of heterogeneous elements with the transformation. In this construction process, both the elements and the transformation take shape. Finally, the importance of the concept of ‘routines’ for a sociological answer to the main question of this paper is shown.
Lay constructions of genetic risk
Authors: Parsons Evelyn , Atkinson Paul
Published: August 2010

The paper reports one aspect of research on women (mothers and daughters) in families with Duchenne Muscular Dystrophy (Duchenne), a genetically transmitted disorder. The data were collected by means of extended unstructured interviews with the women, all of whom had had either a brother or a son who had inherited the disease. All the women have been defined by medical professionals as having a specific ‘risk’ of carrying and transmitting the defective gene. Their lay understanding of carrier risk rates is explored. There are fundamental differences between medical and lay understandings of the statistical issues involved. The discrepancies may have important consequences for the women's reproductive behaviour. The implications of genetic risk for spoiled identity on the part of some women are also described.
Social selection: what does it contribute to social class differences in health?
Authors: Blane David , Smith George Davey , Bartley Mel
Published: August 2010

Social selection, or the idea that an individual's health can influence their social mobility and, hence, their position in the social hierarchy, has been suggested as an important element in the process which produces social class differences in health. The present paper examines this idea by drawing together evidence from a range of published research. Direct selection according to health is judged to have little effect on class gradients. The logically distinct idea of indirect selection can be seen most usefully as referring to the accumulation of advantage or disadvantage during life.
Transcending the dualisms: towards a sociology of pain
Authors: Bendelow Gillian A. , Williams Simon J.
Published: August 2010

Theories of pain have traditionally been dominated by biomedicine and concentrate upon its neurophysiological aspects, both in diagnosis and treatment. Hence, scientific medicine reduces the experience of pain to an elaborate broadcasting system of signals, rather than seeing it as moulded and shaped both by the individual and their particular socio‐cultural context. Although pain lies at the intersection between biology and culture, making it an obvious topic for sociological investigation, scant attention has been paid to understanding beliefs about pain within the study of health and illness. A major impediment to a more adequate conceptualisation of pain is due to the manner in which it has been ‘medicalised’, resulting in the inevitable Cartesian split between body and mind. Consequently, the dominant conceptualisation of pain has focused uponsensation, with the subsequent inference that it is able to be rationally and objectively measured. Yet as well as being a medical ‘problem’, pain is an everyday experience. Moreover,sociologicalandphenomenologicalapproaches to pain would add to, and enhance, existing bodies of knowledge and help to reclaim pain from the dominant scientific paradigm. In this paper, it is argued, firstly, that the elevation of sensation over emotion within medico‐psychological approaches to pain, can be shown to be limiting and reductionist. Secondly, we attempt to show how insights from the newly‐emerging sociological arenas of emotions and embodiment provide a framework which is able to both transcend the divide between mind and body and to develop a phenomenological approach to pain. Finally, in order to bring themeaningof pain into fuller focus, we draw attention to the importance of studying theodices and narratives, as well as the cultural shaping and patterning of beliefs and responses to pain.
Fear and loathing in health care settings reported by people with HIV
Authors: Green Gill , Platt Stephen
Published: August 2010

Abstract People with chronic or terminal diseases not only have to face the biophysical consequences but also the social impact of illness. The social impact or stigma associated with HIV/AIDS is high due to its infectivity and association with deviant behaviour. Social interaction with health professionals is critical for subsequent social adjustment to possession of a discreditable disease, including HIV. This paper examines the subjective reports of 61 people with HIV within this context and identifies processes of stigmatisation in health care settings. In agreement with surveys of health care workers, fear of contagion is identified as the principal source of negative reactions towards people with HIV in health care settings. Issues of confidentiality and the response of people with HIV to stigma in health care settings are also discussed. It is concluded that, although the biomedical model in which health professionals are trained ignores the social impact of disease, HIV‐related stigma in health care settings in Scotland is declining as health professionals become familiar with treating people with HIV.
Challenges to medicine: the case of prescribing
Authors: Weiss Marjorie , Fitzpatrick Ray
Published: August 2010

Abstract This paper examines recent developments in primary care prescribing as potential challenges to the dominance of medicine. These developments, as possible forces for the deprofes‐sionalisation and proletarianisation of medicine, were examined using unstructured interviews with five Family Health Service Authority (FHSA) medical advisors and 23 general practitioners (GPs). Three themes emerged from the data. First, GPs did not find the role of the FHSA advisor to be either constraining or inappropriate in relation to prescribing. Secondly, GPs recognised prescribing as a crucial discretionary power in which the prescription was used ‘irrationally’ to cope with a variety of patient, practice or workload pressures. Thus, the only serious managerial threat came from the possibility that such ‘irrational’ prescribing could be curtailed. Finally, GPs felt most concerned by the growing demands and expectations of patients, exacerbated by government policies endorsing greater consumerism. The greatest perceived challenge to clinical autonomy comes, not from proletarianisation in the sense of greater managerial control over medicine's work, but from deprofessionalisation through lay challenges to general practitioners' professional medical expertise.
The biographical challenge of caring
Authors: Chamberlayne Prue , King Annette
Published: August 2010

The article discusses the contribution of narrative methods to the contextualised study of subjectivity. More specifically, it introduces the key features of biographical interpretive methods, which derive from phenomenology, and presents four case studies of carers in East and West Germany. Through the cases, the article explores inner and outer dimensions of carers’ coming to terms with disability, together with patterns of biographical continuity and change. This is followed by a comparative discussion of the interplay between personal and structural factors in the two societies. The article thereby demonstrates the strength of the method in exploring interrelationships between the personal and the social, as well as its particular relevance for professional practice in the social field.
Anomalous patients: the experiences of doctors with an illness
Authors: McKevitt Christopher , Morgan Myfanwy
Published: August 2010

Variations in the distribution of power have been used to account for and to advocate different types of doctor‐patient relationship. It might be expected that doctors who become patients would have a ‘mutual’ relationship with their treating doctor. Data from interviews with doctors with a recent illness show that this is not necessarily the case and may not even be doctors’ preferred model of doctor‐patient relationship for themselves when they become ill. Doctors constitute anomalous patients since they confound two categories generally held to be separate, ‘doctor’ and ‘patient’. This affects the type of medical encounter they have, raising issues of identity and role performance for both patient and treating doctor. Doctor/patients may be in control of the encounter (through choice or default); they may consciously choose or have explicitly ascribed to them the status of ‘ordinary patient’; some believe that doctors should be treated as extraordinary patients with particular needs dependent on their insider status as much as their pathology. The negotiation of power in the encounter between doctors and medically qualified patients is problematic but the existence of the power differential in the medical encounter emerges as ‘natural’ and largely as desirable, since it is linked to the ability and authority to take charge of the disorder which illness represents.
Birth and social class: Northern Thai women's lived experiences of caesarean and vaginal birth
Authors: Liamputtong Pranee
Published: August 2010

Abstract  This paper, based on in‐depth interviews with Thai women in Northern Thailand, contributes to a sociological understanding of women's childbirth discourses. The findings indicate that the lived experiences of birth differ between individual women. It clearly shows that social resources such as financial resources and education play a salient role in shaping the embodied experience of birth among women in Northern Thailand. Because of their ‘everyday lifestyle’, middle class women have more control over the experience of childbirth than that of the rural poor women. Middle class women are able to choose where to give birth, have access to private care and actively seek medical technology as a way to have control over their birth. Their material resources enable their choices. These choices seem to be denied to the rural poor women. But not all rural poor women are passive victims of their material resources. No matter how limited the resources women have, they use them. Hence, there are some poor women who actively seek birthing care that enables them to have more control. But regardless of their social positions (urban middle class or rural poor), obstetric interventions are commonly experienced, and most women perceive caesarean birth in a positive light. Several discourses are employed to explain these findings including women's interpretations of their lived world including risk and the medicalisation of childbirth in Thailand. Taking a feminist standpoint, I argue that differences between women need to be taken into account in providing care to women in childbirth so that sensitive and appropriate birthing care can be achieved.
Co‐ordinating ‘ethical’ clinical trials: the role of research coordinators in the contract research industry
Authors: Fisher Jill A.
Published: August 2010

Change in the way new drugs are developed, including the privatisation of clinical trials, has altered the arrangement and roles of healthcare professions. In this paper I examine one aspect of this change: the role of research coordinators in the conduct of contract research in the United States. My focus on coordinators highlights the ethical conflicts embedded in clinical trials. I describe the ways in which coordinators experience and contend with the conflict between research and care and show how their construction of ethics is distinct from institutional conceptions formally associated with human subjects research. My analysis demonstrates how the coordinators’ focus on ethics is a response to their role conflict and an attempt to reinsert individualised care into the context of research.
Diets and discipline: the narratives of practice of university students with type 1 diabetes
Authors: Balfe Myles
Published: August 2010

Type 1 diabetes is one of the most common chronic conditions of adolescence and young adulthood. It is characterised by a demanding and complex management regime. Individuals with diabetes must engage in continual self‐care actions such as eating healthily and exercising if they are to minimise their risks of developing long‐term diabetes’ complications. Research has demonstrated, however, that many young adults experience difficulties with exercising and eating healthily. Narrative approaches could provide important insights into the reasons why young people do or do not experience difficulties here. In this article I examine the food consumption and exercise narratives of a particular group of young adults with type 1 diabetes, university students, to see what personal, social and cultural factors influence their practices.
Health lifestyles and the absence of the Russian middle class
Authors: Cockerham William C.
Published: August 2010

This paper examines the pivotal role of social stratification in Russia's health crisis. The primary level causal factor is increased mortality from heart disease and alcohol‐related poisonings and accidents. In order to understand the origin of the primary causes, it is necessary to look further for secondary level factors. Whereas policy and stress are important, the leading secondary determinant is negative health lifestyles. The question then arises: What is the source of this lifestyle? This question necessitates a search for tertiary level causes and the absence of a strong middle class in Russia is identified. In Western society, the middle class, especially the upper middle class, is the social carrier of positive health lifestyles across class boundaries. The Russian middle class has not initiated positive health lifestyles countering the predominately negative health lifestyle practices because a middle class similar to that in the West does not exist. Russia needs a civil society in which a similarly stable and empowered middle class can promote positive health lifestyles within its own stratum and elsewhere in the class structure; until this happens, the health situation in that country may not stabilise for the better.
Perceptions of evidence‐based medicine: traditional acupuncturists in the UK and resistance to biomedical modes of evaluation
Authors: Jackson Sue , Scambler Graham
Published: August 2010

Acupuncture and other types of ‘complementary and alternative medicine’ (CAM) are proving increasingly popular in the UK. As attempts to incorporate acupuncture into allopathic medicine have grown in number, the issue of assessing its effectiveness in ways consistent with the concept of evidence‐based medicine has become more urgent. The nature, relevance and applicability of such assessments remain controversial however. This paper reports a qualitative study of acupuncturists’ own perceptions of evidence and evidence‐based medicine in relation to their therapeutic interventions. The material is presented in two main sections: explaining how acupuncture works, and resisting evidence‐based medicine. The interviews reveal a great deal of scepticism and ambivalence and a deep questioning of the salience of conventional (biomedical) modes of evaluation of interventions.
Chronic illness, expert patients and care transition
Authors: Taylor David , Bury Michael
Published: August 2010

During the last century demographic and epidemiological transitions have had a radical impact upon health and health service provision. A considerable body of research on the sociological aspects of living with chronic illness has accumulated. Debate has focused on how social environments shape disability‐related experiences, and the extent to which individual responses define health outcomes. Through the establishment of the Expert Patients Programme (EPP) in 2001, the Department of Health has sought to enhance NHS patients’ self‐management capacities. This paper discusses three areas relevant to this: the policy formation process leading up to the EPP's present stage of development; the evidence base supporting claims made for its effectiveness; and the significance of psychological concepts such as self‐efficacy in approaches to improving public health. The conclusion discusses NHS developments in primary care and public involvement in health and healthcare, and the implications that initiatives such as the EPP carry for the future. It is argued that to facilitate a constructive process of ‘care transition’ in response to epidemiological and allied change, awareness of cognitive/psychological factors involved in illness behaviours should not draw attention away from the social determinants and contexts of health.
Avian flu: the creation of expectations in the interplay between science and the media
Authors: Nerlich Brigitte , Halliday Christopher
Published: August 2010

This paper examines the emerging cultural patterns and interpretative repertoires in reports of an impending pandemic of avian flu in the UK mass media and scientific journals at the beginning of 2005, paying particular attention to metaphors, pragmatic markers (‘risk signals’), symbolic dates and scare statistics used by scientists and the media to create expectations and elicit actions. This study complements other work on the metaphorical framing of infectious disease, such as foot and mouth disease and SARS, tries to link it to developments in the sociology of expectations and applies insights from pragmatics both to the sociology of metaphor and the sociology of expectations.
Globalisation and medicine in Trinidad
Authors: Reznik David L. , Murphy John W. , Belgrave Linda Liska
Published: August 2010

In a qualitative study of urban Trinidadians who work in the medical industry, the concept of medical globalisation was provisionally analysed. Two research questions were addressed: what is globalisation, in the context of mainstream medicine, and how is this process manifested in everyday practices? Four fundamental principles of medical globalisation emerged from in‐depth interviews and analysis of observational materials: (1) the notion of history as an autonomous force with globalisation as the latest stage, (2) the expansion of ‘Total Market’ philosophy as a driving social force, (3) the fragmentation of society into atomistic, self‐interested, and competitive individuals, and (4) the adoption of a ‘centralised’ set of ideals as the normative core necessary for social order. In this paper, findings from this investigation and their implications are discussed. In particular, medical globalisation is linked with major themes in medical sociological theory including dualism and medicalisation.
‘It puts things out of your control’: fear of consequences as a barrier to patient disclosure of mental health issues to general practitioners
Authors: Dew Kevin , Morgan Sonya , Dowell Anthony , McLeod Deborah , Bushnell John , Collings Sunny
Published: August 2010

Research indicates that there is a high level of trust in health professionals but also a high level of non‐disclosure of mental health issues to general practitioners (GPs). This paper explores the issue of patients’ willingness to disclose mental health problems to GPs through interviews with 33 patients from the lower half of the North Island of New Zealand. Patients’ willingness to disclose related to a range of factors but this paper focuses on fear and sense of control as these issues have received little attention in the extant literature and provide important discussion points for the conduct of consultations. Fear of the consequences of consultation warrants attention if general practice is to be promoted as the preferred point of contact for mental health consultations. The research reported here suggests that trust in a range of institutions and agencies, not just in the individual practitioner, would need to be achieved for the GP to be the preferred point of contact.
Internet social support groups as moral agents: the ethical dynamics of HIV+ status disclosure
Authors: Rier David A.
Published: August 2010

This paper examines how, on Internet HIV/AIDS support groups, participants discuss the ethics of disclosing HIV seropositivity to partners. The data consist of all mentions of disclosure culled from over 16,000 pages overall of posts from 16 different groups, hosted on seven separate sites. The paper focuses on two main questions. First, apart from providing support and information, did the groups also debate moral dilemmas (and, despite groups’ common perception as ‘safe spaces’ for non‐judgmental exchanges, did these discussions include moral judgments and conflicts)? Secondly, did use of this new medium generate a new, alternative ethical discourse, or merely replicate existing discourses? The data demonstrate that online support groups did engage in debating, and trying verbally to enforce, certain views of the ethics of seropositivity disclosure. The most common view advocated full disclosure, though a range of positions existed. Unlike with most online support groups described elsewhere, these discussions often included harshly‐expressed moral judgments. The groups did not generate a truly new, alternative discourse, but served as clearinghouses for and transmitters of existing ‘off‐line’ discourses, both mainstream and alternative. Implications and limitations of the present study, and areas for further research, are discussed.
‘Making the best you can of it’: living with early‐stage Alzheimer's disease
Authors: MacRae Hazel
Published: August 2010

Drawing upon data from a qualitative study of persons who are in the early stage of the condition, this paper examines the meaning of Alzheimer's disease. It contrasts the meaning of the disease as portrayed in popular culture with its meaning as interpreted by persons living with it. Findings show that persons with the illness do not necessarily accept the negative cultural meaning of the disease, nor the helpless ‘victim’ role in which they are generally cast. With a determination to ‘make the best of it’, strategies such as humour, normalisation, present‐time orientation, and life review are employed to create a meaningful life.
Regulating medical bodies? The consequences of the ‘modernisation’ of the NHS and the disembodiment of clinical knowledge
Authors: Nettleton Sarah , Burrows Roger , Watt Ian
Published: August 2010

The aim of this paper is to explore the consequences of modernisation and regulatory processes for the everyday lives of doctors working the UK National Health Service. We do this by reporting on interview data generated as part of a qualitative investigation into the working lives of 47 doctors. The analysis of the empirical findings is informed by two literatures: that which has sought to theorise the contemporary thrust of regulation and audit and that which has developed a sociology of embodiment. Doctors’ views are presented in relation to four areas of work which have – in the loosest sense of the word – been subject to regulation. Drawing on work from the sociology of embodiment we argue that changes in the institutional and cultural context of medical work could be altering both the ‘field’ and the ‘habitus’– to use Bourdieu's terms – of medicine, with a consequence that medical knowledge is becoming less embodied.
Distributed decision making: the anatomy of decisions‐in‐action
Authors: Rapley Tim
Published: August 2010

Conceptualising the doctor‐patient relationship has been a central project for both medicine and medical sociology. This paper seeks to show how an understanding of thedistributednature of medical practice can help us research the decision‐making process in doctor‐patient encounters. I draw on a range of empirical studies of medical interaction, knowledge, technology and work in primary and secondary care. I describe the ‘ethno‐methods’ (Garfinkel 1967) of patient‐orientated medical decision making in order to highlight some of the fundamental facets of distributed decision making. Initially, I outline how decision making is an ongoing event that often evolves over multiple encounters. I then show how decision making is never just a solo, cognitive activity but rather distributed over a range of people. Finally, I outline how decision making is initiated, sustained and transformed over a range of encounters with both people and technologies. I argue that recognising the distributed nature of decision making shifts the focus from overly prescriptive visions of decision making to more plausible, albeit, more mundane sets of ideals. Centrally, a focus on distribution offers new opportunities actively to engage with, support and research decision‐making‐in‐action.
‘It's something for you both to think about’: choice and decision making in nuchal translucency screening for Down's syndrome
Authors: Pilnick Alison
Published: August 2010

Policies and practices around antenatal screening services have long been the subject of debate in a sociological context. However, existing research has largely overlooked the way in which the policies and practices that underpin antenatal screening services are enacted through talk between pregnant women and their health professionals. This paper focuses on one such policy, that of informed choice. It uses data from 14 tape‐recorded pre‐screening consultations with community midwives, forming part of a newly introduced nuchal translucency screening programme, to examine how the issue of choice is topicalised and discussed. It concludes that, whilst there is clear evidence that midwives are at pains to explicitly invoke the issue of decision making, there are other more subtle factors in the interactional presentation of screening tests that serve to undermine whether and how a recognition of choice is received by pregnant women.
CITY NETWORKING WITH THE ‘GLOBAL SOUTH’: DUTCH POLICY AND PRACTICE
Authors: BONTENBAL MARIKE
Published: August 2010

Whereas the global networking of cities is commonly understood from a fiscal‐economical and technological perspective explaining world economy and globalisation structures, this paper discusses another viewpoint of city networking in which the exchange of knowledge on urban management and policy‐making is examined. It reviews the policy context and practice of Dutch cities in North‐South city networking and their role in international development co‐operation through the sharing of municipal knowledge and expertise with partner cities in developing countries. Against the background of shifts in development thinking leading to increased acknowledgement of the role of cities in development co‐operation, past and current policies at the national as well as the municipal level are considered that shape the framework for Dutch city networking with the ‘global South’.
EUROPEAN PLACE‐BASED DEVELOPMENT POLICY AND SUSTAINABLE ECONOMIC AGGLOMERATION
Authors: THISSEN MARK , VAN OORT FRANK
Published: August 2010

The inherent tension between regional equality and economic growth (efficiency) is recently much debated in the context of place based development policy and agglomeration in the European Union. A general conclusion reached in the literature is that a policy targeted at regional equality may be harmful for economic growth. Such policy therefore should be transformed in such a way that it also promotes the mobility of both people and firms and hence facilitates the possibilities of increased agglomeration. Recent insights from economic theories suggest that agglomeration externalities are not taken into account in the migration decision of firms and people, causing the dynamic urbanisation processes to not necessarily result in a (social) welfare optimum. This is even more so if other welfare effects than GDP and product variety are taken into account. Regional economic development is not sustainable if the dynamic urbanisation processes stemming from agglomeration economies do not lead to a welfare optimum. In this paper we assess the possibility of a non‐sustainable regional development path. We conclude that strong additional negative externalities of growing large agglomerations are harder to prove than negative externalities of small agglomerations becoming smaller. Moreover, the size of short run negative effects that will stimulate the migration of people has not been adequately assessed. The European Union should therefore be careful in interpreting place‐based costs and benefits of growing, large agglomerations at the detriment of small regions.
Guidelines on management of low‐grade gliomas: report of an EFNS–EANO* Task Force
Authors: Soffietti R. , Baumert B.G. , Bello L. , Von Deimling A. , Duffau H. , Frénay M. , Grisold W. , Grant R. , Graus F. , Hoang‐Xuan K. , Klein M. , Melin B. , Rees J. , Siegal T. , Smits A. , Stupp R. , Wick W.
Published: August 2010

Background:  Diffuse infiltrative low‐grade gliomas of the cerebral hemispheres in the adult are a group of tumors with distinct clinical, histological and molecular characteristics, and there are still controversies in management.

Methods:  The scientific evidence of papers collected from the literature was evaluated and graded according to EFNS guidelines, and recommendations were given accordingly.

Results and conclusions:  WHO classification recognizes grade II astrocytomas, oligodendrogliomas and oligoastrocytomas. Conventional MRI is used for differential diagnosis, guiding surgery, planning radiotherapy and monitoring treatment response. Advanced imaging techniques can increase the diagnostic accuracy. Younger age, normal neurological examination, oligodendroglial histology and 1p loss are favorable prognostic factors. Prophylactic antiepileptic drugs are not useful, whilst there is no evidence that one drug is better than the others. Total/near total resection can improve seizure control, progression‐free and overall survival, whilst reducing the risk of malignant transformation. Early post‐operative radiotherapy improves progression‐free but not overall survival. Low doses of radiation are as effective as high doses and better tolerated. Modern radiotherapy techniques reduce the risk of late cognitive deficits. Chemotherapy can be useful both at recurrence after radiotherapy and as initial treatment after surgery to delay the risk of late neurotoxicity from large‐field radiotherapy. Neurocognitive deficits are frequent and can be caused by the tumor itself, tumor‐related epilepsy, treatments and psychological distress.
Protection against cyclophosphamide‐induced alopecia by sulfhydryl‐containing agents in the newborn rat animal model
Authors: Hussein Atif M. , Ardalan Bach
Published: August 2010

Background Alopecia is a common side‐effect of cancer chemotherapy. Although this complication has been known for many decades, little progress has been made in its prevention or treatment. Previously, we made the following observations: (a) treatment of 8‐day‐old rats with 1‐0‐n‐arabinofuranosylcytosine (ara‐C), doxorubicin, and cyclophosphamide (CYC) produced either total body alopecia (ara‐C and CYC) or alopecia confined to the head and proximal part of the neck (doxorubicin); (b) Imuvert, a biological response modifier, and interleukin‐1 protected against alopecia‐induced by ara‐C; and (c) neither Imuvert or interleukin‐1 protected against CYC‐induced alopecia.

Objective Experiments were designed to test for agents to protect against CYC‐induced alopecia.

Methods Agents were tested in the 8‐day‐old rats as a model for chemotherapy‐induced alopecia.

Results Mesna and S‐2‐(3‐aminopropylamino)‐ethylphospnorothioic acid (WR‐2721) did not offer any protection against chemotherapy‐induced alopecia. N‐Acetylcysterine offered very good protection against alopecia induced by CYC but not that produced by ara‐C in the newborn rate animal model.

Conclusion N‐Acetylcysteine may prove to be important in the prevention of CYC‐induced alopecia, but this needs to be tested in the clinical setting.
Failure of cryosurgery to eradicate vulval intraepithelial neoplasia: a pilot study
Authors: Marren Pauline , Dawber Rodney , Wojnarowska Fenella , Millard Peter , Charnock Mark
Published: August 2010

Objective A pilot study to determine the efficacy of cryosurgery for the treatment of vulvar intraepithelial neoplasia (VIN) using a standardized treatment schedule.

Background Cryosurgery is known to be an effective epithelial cell killer in cutaneous neoplasia and pre‐neoplasia at other sites. It is widely available, inexpensive and most importantly does not cause the disfigurement and scarring of other treatment modalities.

Setting The Vulva Clinic, John Radcliffe Hospital, Oxford, England, UK.

Design Ten consecutive patients with VIN were selected from the outpatient clinic. Patients were evaluated and biopsied prior to therapy. The entire vulva and perineum was subjected to a single freeze‐thaw cycle of 30 s. Patients were observed for 12 months and repeat biopsies were done at 6 and 12 months.

Results Seven of eight patients with VIN Grade III had clinical and histological evidence of recurrence within 12 months and two patients with VIN Grade I had no sustained symptomatic relief.

Conclusion No effective cryosurgical treatment schedule has yet been established for VIN. Our efforts to find one must continue because of the advantages of this treatment modality.
Immunohistochemical aspects of the link between Malassezia ovalis and seborrheic dermatitis
Authors: Piérard‐Franchimont C. , Arrese J.E. , Piérard G.E.
Published: August 2010

Aim An immunohistochemical study was undertaken to look at immune reaction to Malassezia ovalis in seborrheic dermatitis.

Background The role of M. ovalis in seborrheic dermatitis remains a matter of controversy despite some therapeutic evidence with the use of antifungals, especially ketoconazole.

Methods immunohistochemistry was performed on skin samples to evaluate the density of M. ovalis and to disclose deposits of immunoreactants at the level of the yeasts inside the stratum corneum.

Results M. ovalis was always decorated with the antibody to Factor XIIIa. suggesting the presence of a transglutaminase in the yeast wall. Deposits of IgG and C3 were present underneath and in close apposition to collections of M. ovalis in seborrheic dermatitis, and absent in control materials, including various types of dermatitis.

Conclusion The close topographical relationship between M. ovalis, IgG and C3 deposits is a new evidence suggesting a unique inflammatory reaction to the yeast in seborrheic dermatitis.