bluuebunny/crossref_metadata_2025 huggingface dataset:
Mycophenolate mofetil in pediatric renal transplantation: Non‐induction vs. induction with basiliximab
Authors: Ojogho O. , Sahney S. , Cutler D. , Baron P. W. , Abdelhalim F. M. , James S. , Zuppan C. , Franco E. , Concepcion W.
Published: January 2005

Abstract:  North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) reports have shown anti‐T cell antibody, OKT3, to be deleterious in pediatric renal transplant recipients treated with mycophenolate mofetil (MMF). Unlike OKT3, basiliximab is a chimeric monoclonal antibody to the alpha subunit of the interleukin‐2 receptor on activated T‐lymphocytes. We sought to examine the outcome of MMF with or without basiliximab induction therapy in pediatric renal transplantation. Between January 1998, and June 2001, 49 pediatric renal transplants were performed at our center and 41 met the criteria for this study. We retrospectively analyzed the records of 25 patients who received MMF, Prednisone, CSA or TAC, alone (group I) and 16 patients who received MMF, CSA or TAC, and Prednisone in combination with basiliximab (group II). The two groups were similar with respect to recipient or donor age, gender, ethnicity, donor source (LD vs. CAD), cold ischemia time, and primary diagnosis. The basiliximab group had a shorter follow up period because of its more recent addition to our pediatric immunosuppression protocol, 12.9 ± 5.9 months vs. 35.5 ± 7.2 months for group I (p < 0.0001). At 6 months, the acute rejection rate was 16% (group I) compared with 25% (group II) (p = 0.689). The patient and graft survival at 6 and 12 months were 100% respectively for both groups. Basiliximab was well tolerated without significant adverse events. At 6 months, there was no significant difference between the groups in the incidence of urinary tract infection or cytomegalovirus infection. These data suggest that in the short‐term, MMF with or without basiliximab induction therapy appears to yield excellent and statistically similar outcomes. However, further controlled studies are necessary to verify these findings as well as to define the role of basiliximab in MMF‐treated pediatric renal transplant recipients.
Improved outcome of pediatric kidney transplantations in the Netherlands – Effect of the introduction of mycophenolate mofetil?
Authors: Cransberg Karlien , Marlies Cornelissen E. A. , Davin Jean‐Claude , Van Hoeck Koen J. M. , Lilien Marc R. , Stijnen Theo , Nauta Jeroen
Published: January 2005

Abstract:  Collaboration of the Dutch centers for kidney transplantation in children started in 1997 with a shared immunosuppressive protocol, aimed at improving graft survival by diminishing the incidence of acute rejections. This study compares the results of transplantations in these patients to those in a historical reference group. Ninety‐six consecutive patients receiving a first kidney transplant were treated with an immunosuppressive regimen consisting of mycophenolate mofetil, cyclosporine and corticosteroids. The results were compared with those of historic controls (first transplants between 1985 and 1995, n = 207), treated with different combinations of corticosteroids, cyclosporine A and/or azathioprine. Cytomegalovirus (CMV) prophylaxis was prescribed to high‐risk patients in the study group, and only a small proportion of the reference group. The graft survival at 1 yr improved significantly: 92% in the study group, vs. 73% in the reference group (p < 0.001). In the study group 63% of patients remained rejection‐free during the first year; in the reference group 28% (p < 0.001). After statistical adjustment of differences in baseline data, as cold ischemia time, the proportion of LRD, preemptive transplantation, and young donors, the difference between study and reference group in graft survival (RR 0.33, p = 0.003) and incidence of acute rejection (RR 0.37, p < 0.001), as the only factor, remained statistically significant, indicating the effect of the immunosuppressive therapy. In the first year one case of malignancy occurred in each group. CMV disease occurred less frequently in the study group (11%) than in the reference group (26%, p = 0.02). As a new complication in 4 patients bronchiectasis was diagnosed. A new consensus protocol, including the introduction of mycophenolate mofetil, considerably improved the outcome of pediatric kidney transplantation in the Netherlands, measured as reduction of the incidence of acute rejection and improved graft survival.
Haemovigilance in a general university hospital: need for a more comprehensive classification and a codification of transfusion‐related events
Authors: Siegenthaler M. A. , Schneider P. , Vu D.‐H. , Tissot J.‐D.
Published: January 2005

Background and Objectives The purpose of this study was to analyse the transfusion‐related events recorded in a general university hospital.

Materials and Methods The method we used was retrospective analysis of the data collected between 1999 and 2003.

Results The incidence of transfusion reactions (n = 394) was 4·19 per 1000 blood products distributed: 59% (n = 231) were febrile non‐haemolytic transfusion reactions; 22% (n = 88) were caused by allergy; 5% (n = 21) were caused by bacterial infection; and 14% (n = 54) were classified as other reactions. Platelet concentrates gave rise to a significantly greater number of reactions than erythrocyte concentrates and fresh‐frozen plasma. Transfusion errors and near‐miss events were also observed and were analysed separately. A series of transfusion‐related events, such as haemosiderosis, metabolic disturbances or volume overload, were not reported.

Conclusions Our experience prompts us to propose a more comprehensive classification and codification of transfusion‐related events.
Association of ABO gene mutations resulting in a rare B subgroup
Authors: Sousa N. , Anicchino‐Bizzacchi J. M. , Leite E. M. , Locatelli M. F. , Albuquerque D. , Costa F. F. , Barjas‐Castro M. L.
Published: January 2005

Background and Objectives  B subgroups are rare and the genetic analysis reported to date has been limited.

Materials and Methods  Serological and molecular investigations were performed in blood from a B‐subgroup donor.

Results  Red cells did not react with anti‐B and anti‐AB reagents. However, cells absorbed anti‐B. Red cells presented positive reactions with anti‐H, and saliva secreted H substance. The molecular study demonstrated a B allele with the substitutions 467C>T, 646T>A, 681G>A, 771C>T, 796C>A, 803G>C, 829G>A and an O allele with the sequence of O02.

Conclusions  It is probable that the presence in exon 7 of some of the O02 substitutions could have weakened the enzymatic activity of the encoded B transferase.
Primary autoimmune neutropenia in children: a study of neutrophil antibodies and clinical course
Authors: Bruin M. , Dassen A. , Pajkrt D. , Buddelmeyer L. , Kuijpers T. , De Haas M.
Published: January 2005

Background and Objectives  Primary autoimmune neutropenia (AIN) in children is characterized by severe neutropenia, but mild bacterial infections and a spontaneous resolution. Neutrophil autoantibodies are involved in the disease. The precise relationship between the specificity and level of reactivity of the antibodies with the absolute neutrophil count and frequency of infections is not known. To obtain a better insight into this relationship, we performed a follow‐up study in 15 patients with primary AIN. In addition, we performed two different neutrophil antibody tests to evaluate their sensitivity and specificity.

Materials and Methods  Blood samples from 15 children were tested for neutrophil antibodies, at different time‐points during the disease, by using the indirect granulocyte immunofluorescence test (GIFT) and the monoclonal antibody‐specific immobilization of granulocyte antigens (MAIGA) assay. Clinical data related to the occurrence of bacterial infections and treatment, and neutrophil counts were collected.

Results  Early in the disease, antibodies with pan‐FcRIIIb specificity were detected, and HNA‐1a or HNA‐1b specificity of the antibodies developed over time. The sensitivity and specificity of neutrophil antibody detection tests were higher in the GIFT than in the MAIGA assay. Variables predicting time of recovery from neutropenia were not found. Prophylactic antibiotics led to the almost complete disappearance of infections.

Conclusions  In patients with primary neutropenia, neutrophil antibody specificity changes over time. Prophylactic antibiotics do benefit the patients.
Heterogeneity of platelet responsiveness to anti‐CD36 in plasma associated with adverse transfusion reactions
Authors: Wakamoto S. , Fujihara M. , Urushibara N. , Morishita K. , Kaneko S. , Yasuda H. , Takayama H. , Yamamoto S. , Azuma H. , Ikeda H.
Published: January 2005

Background and Objectives  Antibodies to CD36 (anti‐CD36) are clinically important. As some platelet immunoglobulins produced by transfusion or pregnancy have been shown to induce platelet activation and to play roles in non‐haemolytic transfusion reactions (NHTRs), we investigated the in vitro response of platelets to plasma containing anti‐CD36.

Materials and Methods  Plasma containing anti‐CD36, implicated in the development of NHTRs and subsequent thrombocytopenia, was incubated with CD36‐positive platelets. Plasma‐induced platelet activation was examined by evaluating platelet aggregation and RANTES (regulated on activation, normal, T‐cell expressed, and presumably secreted) release.

Results  Platelet activation was induced by plasma alone in four out of 20 CD36‐positive subjects. In seven subjects, platelet activation was synergistically induced by the combination of epinephrine priming and the plasma. The platelets of the nine remaining subjects failed to respond to the plasma. Platelet activation induced by either the plasma alone or by synergy with epinephrine required the involvement of FcγRIIa. The different responsiveness of the platelets was partially associated with the surface levels of CD36 and FcγRIIa, but not with FcγRIIa polymorphisms.

Conclusions  Plasma containing anti‐CD36, implicated in the development of NHTRs, exhibited a platelet‐activating capability. Additionally, platelets from healthy human subjects exhibited a considerable degree of heterogeneity in their responsiveness to this plasma. The heterogeneity of these responses may determine the occurrence of anti‐CD36‐related NHTRs.
Circulating endothelial (progenitor) cells reflect the state of the endothelium: vascular injury, repair and neovascularization
Authors: Hunting C. B. , Noort W. A. , Zwaginga J. J.
Published: January 2005

An increase in the number of circulating endothelial cells (CEC) and of bone marrow‐derived endothelial progenitor cells (EPC) in the peripheral blood is associated with vascular injury, repair and neovascularization. The phenotype and number of CEC may serve as diagnostic or prognostic parameters of vascular injury and tumour growth. An increase in the number of EPC may reflect repair of ischaemic vascular injury, a finding which has resulted in the initiation of clinical cardiovascular pilot trials using cell therapy. However, there is no consensus on the exact phenotype of the EPC and haematopoietic stem cells (HSC) and therefore the best candidate cell for transplant has not been established. Although the use of peripheral blood stem cells following mobilization, or of ex vivo‐expanded cells, may improve EPC‐mediated vascular graft endothelialization or tissue vascularization, sustained EPC‐induced neovascularization still needs to be proven. Flow cytometric characterization, in combination with functional assays, will further elucidate the phenotype of the CEC and EPC, thereby providing reliable detection to appreciate their role in vascular diseases and cancer and to evaluate and, if possible, improve their therapeutic potential.
The impact of two whole blood inline filters on markers of coagulation, complement and cell activation
Authors: Runkel S. , Bach J. , Haubelt H. , Anders C. , Hitzler W. , Hellstern P.
Published: January 2005

Background and Objectives  There exists a current lack of information about the impact of different inline filters, used for the leucoreduction of whole blood (WB), on the levels of clotting factors and markers of coagulation, complement and cell activation in plasma. Only a few small comparisons of different types of WB inline filters have been published to date.

Materials and Methods  This study compared two plasma types of 200 units each. Both study groups were derived from WB, inline‐filtered and held for 2 h at 20° between donation and filtration. Then, 200 units (Group A) were filtered using a positively charged polyester filter (Baxter RZ2000) and the other 200 units (Group B) were filtered using an uncharged polyester filter (Fresenius). After filtration, both groups were analysed for fibrinogen, factors V and VIII:C (FV and FVIII:C, respectively), immunoglobulin G (IgG), residual leucocytes and platelets, and markers of coagulation, complement and cell activation. Predonation plasma samples from CPDA1‐anticoagulated blood were obtained from 100 different individuals and served as controls.

Results  WB inline filtration did not influence fibrinogen, FV, FVIII:C or IgG levels. Neither filter induced thrombin or fibrin formation. The charged filter caused substantial complement activation and neutrophil elastase and platelet factor 4 release. In contrast, the plasma filtered through the uncharged filter showed markedly lower levels of C3a‐desArg, C5a, neutrophil elastase and platelet factor 4, and moderately reduced levels of prothrombin fragments 1+2 and d‐dimer, compared with controls.

Conclusions  Filter type has a significant impact on the quality of plasma derived from WB filtered through inline filtration systems. Some filters produce substantial coagulation and complement activation and cell release, while others appear to reduce the plasma levels of activation markers. The clinical significance of these findings remains to be determined.
A New Report of Fruit Rot of Lemon Caused byCeratocystis radicicolafrom Iran
Authors: Mirzaee M. R. , Mohammadi M.
Published: January 2005

In the year 2000, a fungus was isolated from rotting lemon (Citrus limon) fruit in the Kahnouj region, south‐eastern Iran and subsequently identified asCeratocystis radicicola(anamorph:Chalarasp.). A pathogenicity test was carried out to fulfil Koch's postulates. The pathogen could only enter the ripen lemon fruit and cause the rot disease through the wounds and cracks. The fungus was also pathogenic on fruit of other citrus species as well as date palm (Phoenix dactylifera). Symptom development was slow on fruits on the tree but accelerated after fruit harvest.
Sulphur Deficiency Causes a Reduction in Antimicrobial Potential and Leads to Increased Disease Susceptibility of Oilseed Rape
Authors: Dubuis P.‐H. , Marazzi C. , Städler E. , Mauch F.
Published: January 2005

The reduction of atmospheric sulphur dioxide pollution is causing increasing problems of sulphur deficiency in sulphur‐demanding crop plants in northern Europe. Elemental sulphur and many sulphur containing compounds such as cysteine‐rich antifungal proteins, glucosinolates (GSL) and phytoalexins play important roles in plant disease resistance. The aim of this work was to analyse the effect of inadequate sulphur supply on disease resistance of oilseed rape (Brassica napus). Compared with fertilized oilseed rape, healthy looking S‐deficient plants showed increased susceptibility to the blackleg fungus Leptosphaeria maculans, to the generalist necrotroph Botrytis cinerea and to the oomycete Phytophthora brassicae. To analyse possible causes of the increased disease susceptibility of S‐deficient plants, protein extracts and methanolic extracts of secondary metabolites of plants grown with and without adequate sulphur supply were tested for antimicrobial activity. None of the protein extracts showed antimicrobial activity. However, extracts containing secondary metabolites from normally grown plants showed a strong antimicrobial activity in in vitro tests with various fungal and bacterial pathogens. This activity was almost totally lost in extracts derived from S‐deficient plants. The antimicrobial activity did not appear to be based on the activity of phytoalexins because it was present in healthy plants and was not increased by a previous inoculation with Botrytis cinerea. The loss of antifungal activity in S‐deficient plants correlated with a strong reduction of various GSL, thus suggesting a reduced level of GSL as a possible cause of the reduced antimicrobial potential. However, limited tests of commercially available GSL or their degradation products did not demonstrate a causal link. Our results show that S‐deficiency of oilseed rape negatively affects disease resistance and suggest that this effect is at least partially caused by a reduction of sulphur‐dependent phytoanticipins.
A Real‐Time Quantitative PCR Assay for the Detection of Sphaeropsis sapinea from Inoculated Pinus nigra Shoots
Authors: Luchi N. , Capretti P. , Surico G. , Orlando C. , Pazzagli M. , Pinzani P.
Published: January 2005

Pinus nigra (Austrian pine) is a tree widely planted in central and southern Europe in the reforestation of areas with poor soils. One of the major constrains of P. nigra is a fungal disease caused by Sphaeropsis sapinea which causes shoot tip dieback and tree mortality. This paper describes a real‐time quantitative PCR assay based on the partial sequence of the small subunit ribosomal RNA of S. sapinea to detect and quantify DNA of the fungal pathogen in S. sapinea inoculated shoots. The study found that real‐time quantitative PCR was a reliable technique to diagnose this disease and suggests that it can also be used to study fungal behaviour in host tissue and particularly to quantify fungal growth in the latent or endophytic phase.
Effect of Sowing Time on Development of Safflower Anthracnose Disease and Degree of Resistance in Various Cultivars
Authors: Park S. D. , Park K. S. , Kim K. J. , Kim J. C. , Yoon J. T. , Khan Z.
Published: January 2005

Field experiments were conducted under natural as well as under vinyl house conditions to determine the effect of sowing time on development of anthracnose of safflower caused by Colletotrichum acutatum, and to determine the level of resistance of seven cultivars. When crops were sown from March 1 to April 1; safflower anthracnose disease (SAD) incidence was low and increased slowly (0.7–10.9%) throughout the growing season. When sowing was delayed to April 15, disease incidence ranged between 29.5 and 48.5% from late May to July. Similarly, SAD severity and its severity index were higher (3.5 and 3.3, respectively) in plots sown on April 15 than in the plots sown from March 1 to April 1 (1.9–2.4 and 1.8–2.2, respectively). In contrast under vinyl houses that sheltered from rain, sowing time did not affect neither SAD, nor severity and severity index, which were 5.7–6.4%, 1.5–1.7 and 1.5–1.7, respectively. Among seven cultivars tested for resistance to SAD, Uisong‐1, China‐2 and India were highly susceptible (80–97%) under natural conditions followed by China‐1, Uisan, Uisong‐7 and Cheongsu (27–35%); however, under vinyl house conditions, SAD was lower (5.7–8.2%) and there was no significant difference between cultivars.
In Vitro Selection for Improved Plant Resistance to Toxin‐Producing Pathogens
Authors: ŠVábová L. , Lebeda A.
Published: January 2005

Simultaneously with the progress in plant biotechnology since the 1980s, new methods in plant pathology have been developed. This review summarizes papers that cover basic research on the effects of selective agents on in vitro cultures of host plants, as well as applications of agents in regeneration systems that result in lines with increased variability in resistance or susceptibility. The first part of the study deals with theoretical aspects of the interactions between plants and toxin‐producing pathogens, mode of phytotoxic action, and host‐ and non‐host‐selective toxins. The second part lists and describes various agents used for selections in vitro. In the last two decades more than 100 publications focused on these selections for the improvement of resistance to plant pathogens. Over 30 plant species were examined to utilise various selection agents extracted from about 40 plant pathogens. The review covers basic research studies and methods that elucidate the relationships between in vitro and in vivo mechanisms of resistance, but also try to develop practical applications to obtain resistant breeding lines. Such methods often utilise some type of explant cultures of the host plants that are treated with various selective agents (culture filtrates, toxins, elicitors), which then elicit typical reactions that parallel those by the pathogens. Their application successfully resulted in resistant lines in banana, carnation, grapevine, strawberry and wheat. Nowadays, these techniques are an important complement to classical breeding methods.
The role of spatial scale and the perception of large‐scale species‐richness patterns
Authors: Rahbek Carsten
Published: January 2005

Despite two centuries of exploration, our understanding of factors determining the distribution of life on Earth is in many ways still in its infancy. Much of the disagreement about governing processes of variation in species richness may be the result of differences in our perception of species‐richness patterns. Until recently, most studies of large‐scale species‐richness patterns assumed implicitly that patterns and mechanisms were scale invariant. Illustrated with examples and a quantitative analysis of published data on altitudinal gradients of species richness (n = 204), this review discusses how scale effects (extent and grain size) can influence our perception of patterns and processes. For example, a hump‐shaped altitudinal species‐richness pattern is the most typical (c. 50%), with a monotonic decreasing pattern (c. 25%) also frequently reported, but the relative distribution of patterns changes readily with spatial grain and extent. If we are to attribute relative impact to various factors influencing species richness and distribution and to decide at which point along a spatial and temporal continuum they act, we should not ask only how results vary as a function of scale but also search for consistent patterns in these scale effects. The review concludes with suggestions of potential routes for future analytical exploration of species‐richness patterns.
Dispersal‐induced desynchronization: from metapopulations to metacommunities
Authors: Koelle Katia , Vandermeer John
Published: January 2005

The conceptualization of fragmented populations in terms of metapopulation theory has become standard over the last three decades. It is well known that increases in between‐patch migration rates cause more synchronous population fluctuations and that this coherence increases the risk of global metapopulation extinction. Because species’ migration rates and the probability of individuals surviving migration events depend on the effective distance between patches, the benefit of improving conservation corridors or the matrix between habitat patches has been questioned. As populations occur in the context of larger communities, moving from a metapopulation to a metacommunity model framework is a natural extension to address the generality of these conclusions. We show how considering a metacommunity can modify the conclusion that decreasing the effective distance between habitat patches (via improving matrix quality or other measures) necessarily increases the degree of metapopulation synchrony. We show that decreases in effective between‐patch distance may deter population synchrony because of the simultaneous effect this change has on the migration patterns of other species. These results indicate that species interactions need to be considered when the effect of conservation measures on population synchrony, and ultimately persistence, is addressed.
Anthropogenic impacts upon plant species richness and net primary productivity in California
Authors: Williams John W. , Seabloom Eric W. , Slayback Daniel , Stoms David M. , Viers Joshua H.
Published: January 2005

We assess the importance of anthropogenic land‐use, altered productivity, and species invasions for observed productivity–richness relationships in California. To this end, we model net primary productivity (NPP) c. 1750 AD and at present (1982–1999) and map native and exotic vascular plant richness for 230 subecoregions. NPP has increased up to 105% in semi‐arid areas and decreased up to 48% in coastal urbanized areas. Exotic invasions have increased local species diversity up to 15%. Human activities have reinforced historical gradients in species richness but reduced the spatial heterogeneity of NPP. Structural equation modelling suggests that, prior to European settlement, NPP and richness were primarily controlled by precipitation and other abiotic variables, with NPP mediating richness. Abiotic variables remain the strongest predictors of present NPP and richness, but intermodel comparisons indicate a significant anthropogenic impact upon statewide distributions of NPP and richness. Exotic and native species each positively correlate to NPP after controlling for other variables, which may help explain recent reports of positively associated native and exotic richness.
Microevolution in agricultural environments: how a traditional Amerindian farming practice favours heterozygosity in cassava (Manihot esculentaCrantz, Euphorbiaceae)
Authors: Pujol Benoît , David Patrice , McKey Doyle
Published: January 2005

We demonstrate a novel case of selection for heterozygosity in nature, involving inadvertent human selection on a population of domesticated plants. Amerindian farmers propagate cassava (Manihot esculenta) clonally by cuttings. Seedlings also appear spontaneously in fields, and farmers allow them to grow, later using some for cuttings. These ‘volunteers’ contribute new genotypes. However, many are inbred, whereas multiplied clones are highly heterozygous. We demonstrate the selective retention of heterozygous volunteers. When farmers weeded fields, they killed small volunteers, but retained large ones. Plant size and heterozygosity were correlated, and both increased after weeding. The process we document allows maintenance of genotypically diverse and heterozygous clonal stocks. Demonstrating heterosis in nature usually requires large sample sizes, but novel features of our system allowed escape of this constraint. Traditional agroecosystems offer unusual opportunities for the microevolutionary studies required to give on‐farm conservation of genetic resources a solid scientific basis.
Insect herbivory stimulates allelopathic exudation by an invasive plant and the suppression of natives
Authors: Thelen Giles C. , Vivanco Jorge M. , Newingham Beth , Good William , Bais Harsh P. , Landres Peter , Caesar Anthony , Callaway Ragan M.
Published: January 2005

Exotic invasive plants are often subjected to attack from imported insects as a method of biological control. A fundamental, but rarely explicitly tested, assumption of biological control is that damaged plants are less fit and compete poorly. In contrast, we find that one of the most destructive invasive plants in North America, Centaurea maculosa, exudes far higher amounts of (±)‐catechin, an allelopathic chemical known to have deleterious effects on native plants, when attacked by larvae of two different root boring biocontrol insects and a parasitic fungus. We also demonstrate that C. maculosa plants experimentally attacked by one of these biocontrols exhibit more intense negative effects on natives.
Why the Failure of the Prison Service and the Parole Board to Acknowledge Wrongful Imprisonment is Untenable
Authors: Naughton Michael
Published: January 2005

Abstract: This article analyses key documents that were produced in collaboration between the Prison Service and the Prison Reform Trust. It identifies an organisational inability on the part of the Prison Service and the Parole Board to acknowledge that the courts can return incorrect verdicts and that wrongful imprisonment can, and does occur. It argues that this renders the ways in which the Prison Service and the Parole Board deal with life prisoners who maintain that they are innocent of the crimes for which they were convicted untenable. To demonstrate this, the article distinguishes two broad categories of wrongful imprisonment. It concludes that those charged with a duty of care for, and the possible release of, those given custodial sentences by the courts must, therefore, be prepared to ‘think the unthinkable’ and make adequate provision for the innocent victims of wrongful imprisonment that are sure to come their way.
Young People, Crime and School Exclusion: A Case of Some Surprises
Authors: Hodgson Philip , Webb David
Published: January 2005

Abstract: During the 1990s the number of young people being permanently excluded from schools in England and Wales increased dramatically from 2,910 (1990/91) to a peak of 12,700 (1996/97). Coinciding with this rise was a resurgence of the debate centring on lawless and delinquent youth. With the publication of Young People and Crime (Graham and Bowling 1995) and Misspent Youth (Audit Commission 1996) the ‘common sense assumption’ that exclusion from school inexorably promoted crime received wide support, with the school excludee portrayed as another latter day ‘folk devil’. This article explores the link between school exclusion and juvenile crime, and offers some key findings from a research study undertaken with 56 young people who had experience of being excluded from school. Self‐report interview questions reveal that whilst 40 of the young people had offended, 90% (36) reported that the onset of their offending commenced prior to their first exclusion. Moreover, 50 (89.2% of the total number of young people in the sample), stated that they were no more likely to offend subsequent to being excluded and 31 (55.4%) stated that they were less likely to offend during their exclusion period. Often, this was because on being excluded, they were ‘grounded’ by their parents.
Prison Officers' Concerns About Blood Borne Viral Infections
Authors: Dillon Brendan , Allwright Shane
Published: January 2005

Abstract: Prison officers' knowledge and perceptions of hepatitis B, hepatitis C and HIV were explored by conducting a cross‐sectional survey in four Dublin prisons with high rates of blood borne viral infections among the inmates. Most officers (87%) reported not knowing enough about these diseases to enable them to take the necessary precautions at work. Longer serving and senior officers were less fearful and less anxious about contracting the infections. Officers who had received hepatitis B vaccination were no less worried about hepatitis B than unvaccinated colleagues. Training on blood borne viruses had little effect on prison officers' knowledge or perception of blood borne viral infections.
Evaluating Evidence for the Effectiveness of the Reasoning and Rehabilitation Programme
Authors: Wilkinson John
Published: January 2005

Abstract: Reasoning and Rehabilitation is a cognitive‐behavioual training programme for offenders, accredited by the Home Office for use with offenders in prison and on custodial sentences in England and Wales. Evidence the programme achieves significant reductions in offending is questionable. A matched control study is reported which used both offending and psychometric outcome measures. Findings for reconviction are mixed. Offenders whose attitudes changed pro‐socially were more likely to be reconvicted than were offenders whose attitudes did not change positively. This casts doubt on whether reconviction is reduced because of attitudinal change, and on the use of measures of attitudinal change in evaluation.
Service Contacts Among the Children Participating in the British Child and Adolescent Mental Health Surveys
Authors: Ford Tamsin , Hamilton Helena , Goodman Robert , Meltzer Howard
Published: January 2005

Method:  A third of the children from the 1999 British Child and Adolescent Mental Health Survey were followed up over 3 years. Parents provided summary information on service contacts for emotional, behavioural and concentration difficulties, with more detailed information being obtained by telephone interview for selected subgroups.

Results:  Having a psychiatric disorder predicted substantially increased contact with social services, special educational needs resources, the youth justice system and mental health services (district CAMHS and tier four, but not tier two). Of those children with psychiatric disorders, 58% had been in contact with at least one of these services for help with emotional, behavioural or concentration difficulties, including 23% who had been in contact with mental health services.

Conclusions:  British children attend a wide variety of services for help with emotional, behavioural and concentration difficulties. The proportion seeing specialist mental health services is higher than that generally reported in the research literature.
Justifiable Psychopharmacology or Overzealous Prescription? Examining Parental Reports of Lifetime Prescription Histories of Psychiatrically Hospitalised Children
Authors: Zakriski Audrey L. , Wheeler Elizabeth , Burda Jeffrey , Shields Ann
Published: January 2005

Background:  This research investigated parent reports of pre‐admission psychotropic medication histories of psychiatrically hospitalised children in the United States. The emphasis was on identifying factors related to potentially overzealous medication use.

Method:  Diagnosis, insurance type, and demographics for 170 consecutive admissions were assessed via research case conference and chart review. An extreme group of children with lengthy medication histories (n = 20) was also identified, and prescription and diagnostic patterns for this group were compared to other medicated children in the sample (n = 100). Cumulative medication history, rather than specific polypharmacy, was examined.

Results:  Psychopharmacotherapy was common (71%). Privately insured children, children with previous psychiatric hospitalisations, and children with Oppositional Defiant Disorder (ODD), Attention Deficit Hyperactivity Disorder (ADHD), and the specific comorbidities of ODD/ADHD, and ODD/Parent Child Relational Problems had more past medication trials. Depressed children had fewer. Analyses of the extreme group suggest that young, privately insured, oppositional children with parent‐child relationship problems were at highest risk for overmedication (including multiple trials of stimulants, as well as mood stabilisers, central adrenergic agonists, and antipsychotics).

Conclusions:  Results raise important questions about the role of health care pressures on clinical practice in the United States.
Father's Involvement and Psychological Adjustment in Indian and White British Secondary School Age Children
Authors: Flouri Eirini
Published: January 2005

Background: The study aimed to explore the relationship between father's involvement and psychological adjustment in Indian and White British secondary school age children.

Method: Psychological adjustment in the 360 White British and 222 Indian children of the study was measured with the Strengths and Difficulties Questionnaire (SDQ). All children lived in biological two‐parent families and attended the same secondary school in South England.

Results: Indian girls and White British girls reported similar levels of adjustment and father's involvement, although compared to White British boys Indian boys reported both lower total difficulties scores and higher prosocial behaviour scores, as well as higher levels of father's involvement. Multiple regression analyses showed that even after controlling for age, sibship size, family's socio‐economic status, and inter‐parental conflict, father's involvement was positively associated with prosocial behaviour in both genders in both ethnic groups. Father's involvement was not related to Indian boys’ or girls’ difficulties. However, in White British boys father's involvement was negatively related to peer problems, whereas in White British girls father's involvement was negatively related to total difficulties, conduct problems, and peer problems.

Conclusions: There would be merit in future studies extending our knowledge about differences in the relationship between father's involvement and child outcomes.
The Impact of Medicaid Managed Care on Hospitalizations for Ambulatory Care Sensitive Conditions
Authors: Bindman Andrew B. , Chattopadhyay Arpita , Osmond Dennis H. , Huen William , Bacchetti Peter
Published: January 2005

Objective. To determine whether Medicaid managed care is associated with lower hospitalization rates for ambulatory care sensitive conditions than Medicaid fee‐for‐service. We also explored whether there was a differential effect of Medicaid managed care by patient's race or ethnicity on the hospitalization rates for ambulatory care sensitive conditions.

Data Sources/Study Setting. Electronic hospital discharge abstracts for all California temporary assistance to needy families (TANF)‐eligible Medicaid beneficiaries less than age 65 who were admitted to acute care hospitals in California between 1994 and 1999.

Study Design. We performed a cross‐sectional comparison of average monthly rates of admission for ambulatory care‐sensitive conditions among TANF‐eligible Medicaid beneficiaries in fee‐for‐service, voluntary managed care, and mandatory managed care.

Data Collection/Extraction Methods. We calculated monthly rates of ambulatory care‐sensitive condition admission rates by counting admissions for specified conditions in hospital discharge files and dividing the monthly count of admissions by the size of the at‐risk population derived from a separate monthly Medicaid eligibility file. We used multivariate Poisson regression to model monthly hospital admission rates for ambulatory care‐sensitive conditions as a function of the Medicaid delivery model controlling for admission month, admission year, patient age, sex, race/ethnicity, and county of residence.

Principal Findings. The adjusted average monthly hospitalization rate for ambulatory care‐sensitive conditions per 10,000 was 9.36 in fee‐for‐service, 6.40 in mandatory managed care, and 5.25 in voluntary managed care (p<.0001 for all pairwise comparisons). The difference in hospitalization rates for ambulatory care sensitive conditions in Medicaid fee‐for‐service versus managed care was significantly larger for patients from minority groups than for whites.

Conclusions. Selection bias in voluntary Medicaid managed care programs exaggerates the differences between managed care and fee‐for‐service, but the 33 percent lower rate of hospitalizations for ambulatory care sensitive conditions found in mandatory managed care compared with fee‐for‐service suggests that Medicaid managed care is associated with a large reduction in hospital utilization, which likely reflects health benefits. The greater effect of Medicaid managed care for minority compared with white beneficiaries is consistent with other findings that suggest that managed care is associated with improvements in access to ambulatory care for those patients who have traditionally faced the greatest barriers to health care.
How Well Does Medicaid Work in Improving Access to Care?
Authors: Long Sharon K. , Coughlin Teresa , King Jennifer
Published: January 2005

Objective. To provide an assessment of how well the Medicaid program is working at improving access to and use of health care for low‐income mothers.

Data Source/Study Setting. The 1997 and 1999 National Survey of America's Families, with state and county information drawn from the Area Resource File and other sources.

Study Design. Estimate the effects of Medicaid on access and use relative to private coverage and being uninsured, using instrumental variables methods to control for selection into insurance status.

Data Collection/Extraction Method. This study combines data from 1997 and 1999 for mothers in families with incomes below 200 percent of the federal poverty level.

Principal Findings. We find that Medicaid beneficiaries' access and use are significantly better than those obtained by the uninsured. Analysis that controls for insurance selection shows that the benefits of having Medicaid coverage versus being uninsured are substantially larger than what is estimated when selection is not accounted for. Our results also indicate that Medicaid beneficiaries' access and use are comparable to that of the low‐income privately insured. Once insurance selection is controlled for, access and use under Medicaid is not significantly different from access and use under private insurance. Without controls for insurance selection, access and use for Medicaid beneficiaries is found to be significantly worse than for the low‐income privately insured.

Conclusions. Our results show that the Medicaid program improved access to care relative to uninsurance for low‐income mothers, achieving access and use levels comparable to those of the privately insured. Our results also indicate that prior research, which generally has not controlled for selection into insurance coverage, has likely understated the gains of Medicaid relative to uninsurance and overstated the gains of private coverage relative to Medicaid.
From Medicaid to Uninsured: Drop‐Out among Children in Public Insurance Programs
Authors: Sommers Benjamin D.
Published: January 2005

Objectives. To estimate a national disenrollment rate among children in Medicaid and the Children's Health Insurance Program (CHIP); to determine what share of disenrollment is due to acquiring other insurance or losing eligibility; and to examine what demographic and policy factors make disenrollment more likely.

Data Sources. Insurance status, income, and demographics from the Current Population Survey (CPS) March Supplement (1998–2001); eligibility data from the National Governors Association; and policy data from the former Health Care Financing Administration (HCFA), state welfare offices, and previous research.

Study Design. The study used a nationally representative sample of 5,551 children in Medicaid or CHIP. The key outcomes were the percentage of children still enrolled 1 year later, and the share of disenrollees who became uninsured despite remaining eligible. Multivariate logistic regression was used to explore demographics and policies predictive of disenrollment.

Data Collection and Analysis. CPS data were extracted using the Census Bureau's Federal Electronic Research and Review Extraction Tool 1.0. Data analysis was performed using Stata 7 (Stata Corporation 2001).

Principal Findings. Of the children enrolled in Medicaid or CHIP, 27.7 percent were no longer enrolled 12 months later. Of those, 45.4 percent dropped out despite apparently remaining eligible and having no other insurance—corresponding to 3.0 million children annually. Drop‐out varied significantly across states. Children without siblings in public insurance were at a higher risk for drop‐out. Children with more educated parents were more likely to leave Medicaid for private insurance or to lose Medicaid eligibility, while black children and infants were less likely to lose their eligibility. Decreased Medicaid provider reimbursement rates were strongly associated with drop‐out, while Medicaid managed care increased the exodus to private insurance.

Conclusions. Drop‐out from Medicaid and CHIP is a significant policy concern and helps explain the persistence of uninsurance among millions of eligible children. Clinical encounters with providers appear to play a key role in preventing drop‐out.
Incentives in a Medicaid Carve‐Out: Impact on Children with Special Health Care Needs
Authors: Inkelas Moira
Published: January 2005

Objective. To evaluate whether a specialty care payment “carve‐out” from Medicaid managed care affects caseloads and expenditures for children with chronic conditions.

Data Source. Paid Medicaid claims in California with service dates between 1994 and 1997 that were authorized by the Title V Children with Special Health Needs program for children under age 21.

Study Design. A natural experiment design evaluated the impact of California's Medicaid managed care expansion during the 1990s, which preserved fee‐for‐service payment for certain complex medical diagnoses. Outcomes in time series regression include Title V program participation and expenditures. Multiple comparison groups include children in managed care counties who were not mandated to enroll, and children in nonmanaged care counties.

Data Collection/Extraction Methods. Data on the study population were obtained from the state health department claims files and from administrative files on enrollment and managed care participation.

Principal Findings. The carve‐out policy increased the number of children receiving Title V‐authorized services. Recipients and expenditures for some ambulatory services increased, although overall expenditures (driven by inpatient services) did not increase significantly. Cost intensity per Title V recipient generally declined.

Conclusions. The carve‐out policy increased identification of children with special health care needs. The policy may have improved children's access to prevailing standards of care by motivating health plans and providers to identify and refer children to an important national program.
The “Minimizing Antibiotic Resistance in Colorado” Project: Impact of Patient Education in Improving Antibiotic Use in Private Office Practices
Authors: Gonzales Ralph , Corbett Kitty K. , Leeman‐Castillo Bonnie A. , Glazner Judith , Erbacher Kathleen , Darr Carol A. , Wong Shale , Maselli Judith H. , Sauaia Angela , Kafadar Karen
Published: January 2005

Objective. To assess the marginal impact of patient education on antibiotic prescribing to children with pharyngitis and adults with acute bronchitis in private office practices.

Data Sources/Study Setting. Antibiotic prescription rates based on claims data from four managed care organizations in Colorado during baseline (winter 2000) and study (winter 2001) periods.

Study Design. A nonrandomized controlled trial of a household and office‐based patient educational intervention was performed. During both periods, Colorado physicians were mailed antibiotic prescribing profiles and practices guidelines as part of an ongoing quality improvement program. Intervention practices (n=7) were compared with local and distant control practices.

Data Collection/Extraction Methods. Office visits were extracted by managed care organizations using International Classification of Diseases‐9‐Clinical Modification codes for acute respiratory tract infections, and merged with pharmacy claims data based on visit and dispensing dates coinciding within 2 days.

Principal Findings. Adjusted antibiotic prescription rates during baseline and study periods increased from 38 to 39 percent for pediatric pharyngitis at the distant control practices, and decreased from 39 to 37 percent at the local control practices, and from 34 to 30 percent at the intervention practices (p=.18 compared with distant control practices). Adjusted antibiotic prescription rates decreased from 50 to 44 percent for adult bronchitis at the distant control practices, from 55 to 45 percent at the local control practices, and from 60 to 36 percent at the intervention practices (p<.002 and p=.006 compared with distant and local control practices, respectively).

Conclusions. In office practices, there appears to be little room for improvement in antibiotic prescription rates for children with pharyngitis. In contrast, patient education helps reduce antibiotic use for adults with acute bronchitis beyond that achieved by physician‐directed efforts.