bluuebunny/crossref_metadata_2025 huggingface dataset:
The Endorsement of Minority Rights: The Role of Group Position, National Context, and Ideological Beliefs
Authors: Verkuyten Maykel , Yildiz Ali Aslan
Published: June 2006

The present research was conducted in the Netherlands and used an experimental design to examine the endorsement of minority rights among Turkish and Kurdish participants in two framed, national contexts: the Netherlands and Turkey. In the Dutch context, each group is a minority, whereas in the Turkish context the Kurds are an oppressed national minority and the Turks are the national majority. The results showed that the Turks were less in favor of minority rights in the Turkish context than in the Dutch context, whereas the Kurds were more in favor of minority rights in the Turkish than in the Dutch context. In addition, the endorsement of minority rights was related to beliefs about majority rule, state unity, and ingroup identification, as well as to cultural diversity and perceived pervasive discrimination. The associations with the former three measures differed between the two groups and the two national contexts, whereas the latter two measures had main effects on the endorsement of minority rights.
Constitutional Rights and Social Welfare: A Comment on the Canadian Chaoulli Health Care Decision
Authors: King Jeff A.
Published: June 2006

Chaoulli v Quebec (A.G.) may be the most controversial Supreme Court of Canada decision to date. The Court used social science evidence of foreign health care systems to justify its finding that a provincial ban on private health care insurance unjustifiably violated the right to security of the person. The decision could lead to fundamental structural changes in the way Canadian provinces deliver health care services. Given the importance of Charter jurisprudence in the United Kingdom, and recent debate about the wisdom of incorporating social rights, the case raises a number of pertinent issues for British lawyers. This comment advances two general arguments. First, that the case was wrongly decided because of its poor characterisation of the legislative objective of the ban, unprincipled approach to judicial deference, and poor treatment of expert and social science evidence. Second, far from justifying suspicion of constitutional social rights, the case illustrates precisely why such rights can make a positive difference.
Why gender and ‘difference’ matters: a critical appraisal of industrial relations research
Authors: Holgate Jane , Hebson Gail , McBride Anne
Published: June 2006

Through a critical rereading of key UK workplace case studies this article explores why gender analysis matters to studies of people at work. We argue that the field of industrial relations could benefit from a greater engagement with feminist‐influenced methodologies. In particular, we analyse three methodological approaches that can assist in understanding the lives of workers; a framework that recognises intersectionality; an account that accommodates both material and cultural explanations; and a research process that is reflexive and recognises positionality. These are identified as intrinsic to a gender‐sensitive analysis, and through a comparison of key texts it is possible to highlight why their absence leads to much research in this field remaining ‘gender blind’.
Gender: the missing link in industrial relations research
Authors: Danieli Ardha
Published: June 2006

This article extends the critique of how industrial relations research continues to be gender‐blind and argues that it is in part a result of early definitions which relegated ‘personal’ relations as outside the boundaries of the field and in part a result of a simultaneous strategy of acknowledgement and abdication, acknowledging that gender is important while at the same time arguing that gender does not need to be addressed. In order to demonstrate how gender is central to industrial relations, the article uses Antonio Gramsci’s concepts of ‘hegemony’, ‘ideology’, ‘good sense’ and ‘common sense’ to illustrate how patriarchal common sense is drawn on by both managers and trade unionists in negotiations over hours of work in a manufacturing firm in the North ‐west of England. It is argued that in order to include gender as a central feature of industrial relations research, it is necessary to analyse how the interests of capital, labour and patriarchy are embedded in negotiations on the shopfloor.
Unequal and low pay in the public sector
Authors: Thornley Carole
Published: June 2006

This article assesses unequal and low pay in the public sector, and UNISON’s action on these issues. It is argued that gendered employment and pay are crucial to an understanding of sources of conflict and pressures for institutional change. The case is made for ‘mainstreaming’ women in accounts of public sector industrial relations.
Victimisation and agency: the social construction of union women’s leadership
Authors: Briskin Linda
Published: June 2006

This article interrogates the notion that women union leaders lead differently. Despite significant variation in the union movements in Australia, Canada, Sweden, the UK and the USA, similar discourses on women’s union leadership emerge in all five countries. Based on a materialist social construction approach which supports a recognition of difference without reference to essentialist ideas about women’s nature, this article seeks to identify what may be common across these countries to explain this phenomenon. The article argues that the fact that women face discrimination in unions, on the one hand, and organise as a constituency and have access to women‐only education, on the other, supports the development of transformational leadership among women unionists, even across diverse contexts and cultures. Unpacking union women’s leadership practices in this way reveals a dialectic of victimisation and agency.
Small is beautiful? The development of women’s activism in a small union
Authors: Sayce Susan , Greene Anne‐marie , Ackers Peter
Published: June 2006

This article draws together two aspects of union renewal strategy: merger and increasing women’s involvement and activism. The article utilises a case study of the National Union of the Lock and Metal Workers (NULMW), a small union that appears to have successfully promoted women’s involvement contrary to the usual expectations about manufacturing union contexts. We argue that the reasons why women have done so well within the NULMW relates to the small size and community‐based nature of the union, including its alignment with the historical development of the lock workforce. In light of this, we reflect on the potential effects of a recent amalgamation of the NULMW with the TGWU.
Sick Leave is Related to Frequencies of Migraine and Non-Migrainous Headache—The HUNT Study
Authors: Fiane I , Haugland ME , Stovner LJ , Zwart J-A , Bovim G , Hagen K
Published: June 2006

The aim of this large, cross-sectional, population-based study was to examine the association between sick leave and headache. Between 1995 and 1997, all 92 566 adults in Nord-Tr⊘ndelag County in Norway were invited to participate in a health survey. Out of 73 327 invited individuals <67 years old, a total of 38 192 (52±) responded to questions about headache, work situation and sick leave during the past year. Associations between sick leave, headache and migraine included were assessed in multivariate analyses, estimating prevalence odds ratios (ORs) with 95± confidence intervals (CIs). There was an increasing prevalence of sick leave with increasing frequency of migraine and non-migrainous headache. The prevalence of sick leave >8 weeks during the past year was more than three times higher among individuals with headache >14 days per month (20±) compared with those without headache (6±). The results may indicate that better treatment of individuals with chronic headache may have beneficial economic implications.
Age‐specific hormonal decline is accompanied by transcriptional changes in human sebocytes in vitro
Authors: Makrantonaki Evgenia , Adjaye James , Herwig Ralf , Brink Thore C. , Groth Detlef , Hultschig Claus , Lehrach Hans , Zouboulis Christos C.
Published: June 2006

The importance of hormones in endogenous aging has been displayed by recent studies performed on animal models and humans. To decipher the molecular mechanisms involved in aging we maintained human sebocytes at defined hormone‐substituted conditions that corresponded to average serum levels of females from 20 (f20) to 60 (f60) years of age. The corresponding hormone receptor expression was demonstrated by reverse transcription–polymerase chain reaction (RT–PCR), Western blotting and immunocytochemistry. Cells at f60 produced significantly lower lipids than at f20. Increased mRNA and protein levels of c‐Myc and increased protein levels of FN1, which have been associated with aging, were detected in SZ95 sebocytes at f60 compared to those detected at f20 after 5 days of treatment. Expression profiling employing a cDNA microarray composed of 15 529 cDNAs identified 899 genes with altered expression levels at f20 vs. f60. Confirmation of gene regulation was performed by real‐time RT–PCR. The functional annotation of these genes according to the Gene Ontology identified pathways related to mitochondrial function, oxidative stress, ubiquitin‐mediated proteolysis, cell cycle, immune responses, steroid biosynthesis and phospholipid degradation – all hallmarks of aging. Twenty‐five genes in common with those identified in aging kidneys and several genes involved in neurodegenerative diseases were also detected. This is the first report describing the transcriptome of human sebocytes and its modification by a cocktail of hormones administered in age‐specific levels and provides an in vitro model system, which approximates some of the hormone‐dependent changes in gene transcription that occur during aging in humans.
Gender Differences in Perceived Work Demands, Family Demands, and Life Stress among Married Chinese Employees
Authors: Choi Jaepil , Chen Chao C.
Published: June 2006

Although gender-based division of labour and the identity theory of stress suggest that the relationship between work and family demands and life stress may vary as a function of gender, it is largely unknown whether these arguments are also valid in China. To address this gap in the existing literature, the current study investigates the gender differences in perceived work and family demands, and the effects of these perceived demands on the life stress of Chinese male and female employees. The study of 153 married Chinese employees found that Chinese women perceived a higher level of family demands than did Chinese men, whereas there was no significant gender difference in the perception of work demands. In addition, while perceived family demands were similarly related to life stress differently for men and women, perceived work demands were associated more strongly with the life stress of men than that of women.
Cultural and Personality Determinants of Leniency in Self-Rating among Chinese People
Authors: Xie Jia Lin , Chen Ziguang , Roy Jean-Paul
Published: June 2006

This study examines how cultural values (i.e., individualism and collectivism) and personality (i.e., self-perceived superiority and exhibitionism) jointly affect self-rating among Chinese respondents from mainland China (N= 161), Hong Kong (N= 350), and Taiwan (N= 398). The results demonstrated that respondents with a more individualistic cultural orientation exhibit greater leniency in self-rating than those with a more collectivistic cultural orientation. Furthermore, self-perceived superiority and exhibitionism are related to high self-ratings among individuals who expressed low individualism values, but not among individuals who expressed high individualism or collectivism values. The results suggest that self-rating research needs to take both the individual's cultural values and personality traits into account.
Presentation and management of aural foreign bodies in two Australian emergency departments
Authors: Ryan Caroline , Ghosh Angajendra , Wilson‐Boyd Brian , Smit DeVilliers , O’Leary Stephen
Published: June 2006

Objective:  To survey and compare the type and management of foreign bodies found in adult and paediatric ears presenting to an Australian otorhinolaryngology and a general ED.

Methods:  Retrospective case study with data collated from two centres. Chart reviews of a total of 330 patients presenting with aural foreign bodies to the ED of the Royal Victorian Eye and Ear Hospital and the ED of The Bendigo Hospital, both situated in the state of Victoria, Australia, were surveyed for patient demographics, foreign body description and referral and removal pattern.

Results:  Two hundred and seventeen adults and 113 children were included in the study. The most common foreign bodies in children were beads, cotton tips, insects and paper, and in adults cotton tips, insects, cotton wool and silicone ear plugs. Flying insects were far more common in the Australian population than cockroaches found in surveys in other countries. Children were significantly more likely to have initially been seen by their Local Medical Officer than adults (P < 0.001) and to require a general anaesthetic for removal of the object(s) (P < 0.001). Adults were more likely to have associated otitis externa at the time of presentation (P < 0.05).

Conclusions:  Aural foreign bodies are a frequent presentation to the ED. Recognition of patients requiring early specialist referral is important. Adults present with a different profile of aural foreign objects to children and require different management. The use of cotton tips or cotton wool in the external ear canal and silicone ear plugs should be discouraged.
Emergency nurse practitioner care and emergency department patient flow: Case–control study
Authors: Considine Julie , Martin Roslyn , Smit DeVilliers , Winter Craig , Jenkins Jane
Published: June 2006

Objective:  The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care.

Methods:  A case–control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care.

Results:  There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS.

Conclusion:  Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes.
Redesigning emergency department patient flows: Application of Lean Thinking to health care
Authors: King Diane L , Ben‐Tovim David I , Bassham Jane
Published: June 2006

Objective:  To describe in some detail the methods used and outcome of an application of concepts from Lean Thinking in establishing streams for patient flows in a teaching general hospital ED.

Methods:  Detailed understanding was gained through process mapping with staff followed by the identification of value streams (those patients likely to be discharged from the ED, those who were likely to be admitted) and the implementation of a process of seeing those patients that minimized complex queuing in the ED.

Results:  Streaming had a significant impact on waiting times and total durations of stay in the ED. There was a general flattening of the waiting time across all groups. A slight increase in wait for Triage categories 2 and 3 patients was offset by reductions in wait for Triage category 4 patients. All groups of patients spent significantly less overall time in the department and the average number of patients in the ED at any time decreased. There was a significant reduction in number of patients who do not wait and a slight decrease in access block.

Conclusions:  The streaming of patients into groups of patients cared for by a specific team of doctors and nurses, and the minimizing of complex queues in this ED by altering the practices in relation to the function of the Australasian Triage Scale improved patient flow, thereby decreasing potential for overcrowding.
Inhaled methoxyflurane as a prehospital analgesic in children
Authors: Babl Franz E , Jamison Sarah R , Spicer Maureen , Bernard Stephen
Published: June 2006

Objective:  Despite widespread use of methoxyflurane as an inhaled analgesic by ambulance services in Australia there are no published data as to its use pattern, efficacy and safety in the prehospital setting. We set out to characterize methoxyflurane use in children in the prehospital setting.

Methods:  An observational case series was conducted over an 8 month period. Children who received methoxyflurane while being transported to a tertiary children’s hospital by ambulance were enrolled. We analysed indications for use, verbal numerical pain scores, adverse events and depth of sedation based on paramedic, patient, parent and ED staff surveys and review of ambulance care records.

Results:  During the study period 105 patients were enrolled with an age range of 15 months to 17 years (median age 11 years). Methoxyflurane was mainly used for extremity injuries (82%). Paramedic pain scores dropped from a mean of 7.9 (95% confidence interval [CI] 7.5–8.3) prior to methoxyflurane use to 4.5 (95% CI 3.9–5.0) at 2–5 min and to 3.2 (95% CI 2.8–3.7) at 10 min. There were no serious adverse events (one‐sided 97.5% CI 0–3%). Mild adverse events occurred in 38 patients (36.2%; 95% CI 27.0–46.1%). Five of 15 (33.3%) patients under 5 years of age were deeply sedated.

Conclusion:  In the present paediatric case series methoxyflurane appears to be an efficacious analgesic with a low adverse events profile. In young children in particular it can briefly lead to deep sedation.
Aims and objectives of the Australian Resuscitation Council; and guideline decision making, process, principles and format
Authors:   Australian Resuscitation Council
Published: June 2006

Aims and Objectives of the Australian Resuscitation Council

Guideline Decisions of the Australian Resuscitation Council

Process for Developing Resuscitation Guidelines

Principles and Format for Developing Guidelines
Cardiopulmonary resuscitation: Australian Resuscitation Council Guideline 2006
Authors:   Australian Resuscitation Council
Published: June 2006

This guideline is applicable to adults, children and infants.

7 Cardiopulmonary Resuscitation
Paediatric advanced life support: Australian Resuscitation Council Guidelines 2006
Authors:   Australian Resuscitation Council
Published: June 2006

12.1 Introduction to Paediatric Advanced Life Support

12.2 Advanced Life Support for Infants and Children, Diagnosis and Management

12.3 Flowchart for the Sequential Management of Life‐Threatening Arrhythmias in Infants and Children

12.4 Medications & Fluids in Paediatric Advanced Life Support

12.5 Management of Specific Arrhythmias in Paediatric Advanced Life Support

12.6 Techniques in Paediatric Advanced Life Support

12.7 Management after Resuscitation in Paediatric Advanced Life Support
Correction of Penile Curvature by Rotation of the Corpora Cavernosa: A Case Report
Authors: Shaeer Osama
Published: June 2006

Aim

We report on the corporal rotation technique, customized for the management of ventral curvature in patients without hypospadias.

Methods

A male patient with ventral curvature of 90 degrees was operated on. The neurovascular bundle was mobilized for a short distance at the point of maximum curvature. The corpora cavernosa were approximated to each other in the dorsal midline by suturing pairs of longitudinal parallel incisions. To avoid urethral narrowing, minimal dissection was used to develop the groove on either side of the corpus spongiosum, to release it from its attachment to the rotated corpora cavernosa.

Results

Full correction of the curvature was achieved, without shortening, erectile dysfunction, or micturition problems.

Conclusion

Corporal rotation can be applied for the correction of ventral penile curvature in patients with and without hypospadias, without sacrificing penile length.
Awareness and Use of Folic Acid Among Women in the Lower Mississippi Delta
Authors: Robbins James M. , Hopkins Sarah E. , Mosley Bridget S. , Casey Patrick H. , Cleves Mario A. , Hobbs Charlotte A.
Published: June 2006

ABSTRACT: 
Context: National and state efforts to increase folic acid awareness and use may not be reaching large segments of the population. Purpose: This study examines folic acid awareness and use among women of childbearing age in a representative, economically at‐risk rural sample and identifies factors that influence awareness and use. Methods: A cross‐sectional random digit dialing telephone survey was completed with a representative sample of 646 women aged 14‐45 years in 36 counties of the lower Mississippi Delta. Folic acid awareness and supplement use were estimated by percentages weighted to reflect the 36‐county population. Pregnancy intentions and the ability to become pregnant were used to predict awareness and use among a subsample of sexually active women. Findings: Compared to national samples, Delta women were less likely to have heard of folic acid (75% vs 64%) or to take a regular (5‐7 days/wk) folic acid supplement (34% vs 22%). The proportion of women who took regular folic acid supplements was very low among some subgroups: African Americans (14%), those 14‐19 years of age (12%), and those with low incomes (13%) and low educational levels (14%). Of the women who reported being sexually active, the ability to become pregnant more than doubled their likelihood of regular supplement use. Conclusions: The national folic acid campaign has not reached many women in the rural Mississippi Delta. A new mode of folic acid education is needed that is focused on low‐income and young women and women not planning pregnancies. In the Delta and similar geographic regions, health care providers, black church leaders, and youth group leaders could be valuable advocates for folic acid.
Academic Degrees and Clinical Practice Characteristics: The University of Washington Physician Assistant Program: 1969‐2000
Authors: Evans Timothy C. , Wick Keren H. , Brock Douglas M. , Schaad Douglas C. , Ballweg Ruth
Published: June 2006

ABSTRACT: 
Context: The physician assistant profession has been moving toward requiring master’s degrees for new practitioners, but some argue this could change the face of the discipline. Purpose: To see if there is an association between physician assistants’ academic degrees and practice in primary care, in rural areas, and with the medically underserved. Methods: Surveys were sent to 880 graduates of the first 32 University of Washington physician assistant classes through 2000. Respondents noted their academic degree at program entry and the highest degree attained at any time up to the time of survey. Relationships between practice characteristics and academic degree levels were tested by unadjusted odds ratios and logistic regression after controlling for year of graduation and sex. Results: Of the 478 respondents, 54% worked in primary care, about 30% practiced in nonmetropolitan communities, and 42% reported providing care for the medically underserved. Respondents with no degree (33% of total at entry, 24% at survey) were significantly more likely than degree holders to work in primary care and nonmetropolitan areas. Respondents with no degree at program entry were significantly more likely, and those with no degree at the time of the survey were marginally more likely, to self‐report work with the medically underserved. Conclusion: Respondents with no academic degree are significantly more likely to demonstrate a commitment to primary, rural, and underserved health care. These findings may inform the national debate about the impact of required advanced degrees on the practice patterns of nonphysician providers.
Physicians Who Treat the Elderly in Rural Florida: Trends Indicating Concerns Regarding Access to Care
Authors: Gunderson Anne , Menachemi Nir , Brummel‐Smith Ken , Brooks Robert
Published: June 2006

ABSTRACT: Context:Rural elderly patients are faced with numerous challenges in accessing care. Additional strains to access may be occurring given recent market pressures, which would have significant impact on this vulnerable population.Purpose:This study focused on the practice patterns and future plans of rural Florida physicians who routinely see elderly patients. Additionally, we examine those who provide services to a high volume of Medicare (HVM) patients.Methods:A self‐administered mailed survey was sent to rural physicians who identified themselves as practicing family medicine, internal medicine, psychiatry, general surgery, a surgical specialty, or a medical specialty. Questions examined changes in services offered by all rural physicians and among them, the HVM physicians. Impact of the professional liability insurance situation, satisfaction with current practice, and future practice plans on changes in service availability was also examined.Results:Overall, 539 physicians responded for a participation rate of 42.7%. Two hundred eighty eight (54.9%) of all physicians in the study indicated a decrease or elimination of patient services in the last year. HVM physicians, compared to low volume of Medicare providers, were significantly more likely to decrease or eliminate services overall (66% vs 45%,P =.001). Mental health services (47% vs 18%,P =.001), vaccine administration (39% vs 16%,P =.008), and Pap smears (41% vs 13%,P =.008) were more likely to be eliminated among the HVM physicians. HVM physicians were also significantly more likely to be somewhat or very dissatisfied (40% vs 23%,P =.012) with their practice.Conclusions:Physicians in rural Florida report dissatisfaction with their practice and are decreasing or eliminating services that are important to the elderly. Given the aging population and increasing need for health care services, these trends raise concern about the ability for these patients to receive necessary care.
Availability of Diagnostic and Treatment Services for Acute Stroke in Frontier Counties in Montana and Northern Wyoming
Authors: Okon Nicholas J. , Rodriguez Daniel V. , Dietrich Dennis W. , Oser Carrie S. , Blades Lynda L. , Burnett Anne M. , Russell Joseph A. , Allen Martha J. , Chasson Linda , Helgerson Steven D. , Gohdes Dorothy , Harwell Todd S.
Published: June 2006

ABSTRACT: 
Context: Rapid diagnosis and treatment of ischemic stroke can lead to improved patient outcomes. Hospitals in rural and frontier counties, however, face unique challenges in providing diagnostic and treatment services for acute stroke. Purpose: The aim of this study was to assess the availability of key diagnostic technology and programs for acute stroke evaluation and treatment in Montana and northern Wyoming. Methods: In 2004, hospital medical directors or their designees were mailed a survey about the availability of diagnostic technology, programs, and personnel for acute stroke care. Findings: Fifty‐eight of 67 (87%) hospitals responded to the survey. Seventy‐nine percent (46/58) of responding hospitals were located in frontier counties, with an average bed size of 18 (11 SD). Of the hospitals in frontier counties, 44% reported emergency medical services prehospital stroke identification programs, 39% had 24‐hour computed tomography capability, 44% had an emergency department stroke protocol, and 61% had a recombinant tissue plasminogen activator protocol. Thirty percent of hospitals in frontier counties reported that they met 6‐10 of the criteria established by the Brain Attack Coalition to improve acute stroke care compared to 67% of hospitals in the nonfrontier counties. Conclusion: A stroke network model could enhance care and improve outcomes for stroke victims in frontier counties.
Barriers to Quality Care for Dying Patients in Rural Communities
Authors: Van Vorst Rebecca F. , Crane Lori A. , Barton Phoebe Lindsey , Kutner Jean S. , Kallail K. James , Westfall John M.
Published: June 2006

ABSTRACT: 
Context: Barriers to providing optimal palliative care in rural communities are not well understood. Purpose: To identify health care personnel’s perceptions of the care provided to dying patients in rural Kansas and Colorado and to identify barriers to providing optimal care. Methods: An anonymous self‐administered survey was sent to health care personnel throughout 2 rural practice‐based research networks. Targeted personnel included clinicians, nurses, medical assistants, chaplains, social workers, administrators, and ancillary staff, who worked at hospice organizations, hospitals, ambulatory clinics, public health agencies, home health agencies, and nursing homes. Findings: Results from 363 completed surveys indicated that most health care personnel were satisfied with the palliative care being provided in their health care facilities (84%) and that most were comfortable helping dying patients transition from a curative to a palliative focus of care (87%). Yet, many reported that the palliative care provided could be improved and many reported that family members’ avoidance of issues around dying (60%) was a barrier to providing optimal care in rural health care facilities. Conclusions: Findings suggest that health care personnel perceive they are effective at providing palliative care in their rural health care facilities, yet face barriers to providing optimal end‐of‐life care. Results of this study suggest that differences in training and experience may influence health care personnel’s perceptions of the existing barriers. It may be important in rural areas to customize interventions to both the professional role and the site of care.
An Instrument for Assessing Public Health System Performance: Validity in Rural Settings
Authors: Driscoll David , Rojas‐Smith Lucia , Sotnikov Sergey , Gadsden‐Knowles Kim , Perry Natalie Brevard , Lenaway Dennis D. , Halverson Paul K.
Published: June 2006

ABSTRACT: 
Purpose: This study evaluated the validity and utility of the Local Public Health System Assessment Instrument (Local Instrument) of the National Public Health Performance Standards Program in rural settings. Methods: The study compared the Local Instrument scores of 6 rural local public health systems to external assessments of those public health systems. The 6 public health systems represented 3 states in which 1 of the 2 local jurisdictions had scored well below and the other well above the state median in a pilot test of the Local Instrument. The study design featured a case study approach consisting of an iterative and integrated combination of semistructured individual and focus group interviews along with the collection of archival materials provided by the 6 public health systems. Findings: Despite differences in Local Instrument scores, the representative public health systems in each state provided roughly the same levels of public health services. Sites varied tremendously in the percentage of survey items rated highly or less relevant. Conclusions: The National Public Health Performance Standards Program Local Instrument can provide a useful structure and process for assessing public health system performance at the local level. Key informants provided several recommendations to improve the Local Instrument, including clarification of difficult terminology and acronyms, and development of multiple instruments structured around subsets of survey items.
Connecting Allied Health Students to Rural Communities
Authors: Guion W. Kent , Mishoe Shelley C. , Taft Arthur A. , Campbell Carol A.
Published: June 2006

ABSTRACT: 
Context: Statewide studies indicate a continuing shortfall of personnel in several allied health disciplines in rural Georgia. National trends indicate lagging enrollment in allied health education programs, suggesting that the workforce shortages will worsen. Purpose: This article describes the efforts of the School of Allied Health Sciences at the Medical College of Georgia to increase allied health student participation in interdisciplinary health care services in rural areas of the state during fiscal years 2001‐2003. Methods: Brief program description and results from survey data provided by the student participants, program administrators, and clinical site supervisors. Results: Three‐year totals indicate that 98 students (70 female, 28 male) participated and 42% reported low‐income status. In line with the goals of the grant, the proportion of minority student participants steadily increased from 5% to 12% over the 3‐year period. Rotation locations included 62 designated Health Professional Shortage Area counties, 71 federally designated Rural Health Clinics, and 6 Community Health Clinics. At the conclusion of the students’ rural health care experience, 76% (55/72) responded positively when asked: If you had the opportunity, would you accept employment at the rotation health care site? Conclusions: The project appears to be positively affecting allied health students’ perceptions and opinions of rural health practices and willingness to work in rural areas. Although long‐term goals have yet to be accomplished, early indicators show benefits to the students and the community at‐large, suggesting that the current program strategies are appropriate connectors between allied health students and rural communities.
Lack of HIV Seropositivity Among a Group of Rural Probationers: Explanatory Factors
Authors: Oser Carrie B. , Smiley McDonald Hope M. , Havens Jennifer R. , Leukefeld Carl G. , Webster J. Matthew , Cosentino‐Boehm Abby L.
Published: June 2006

ABSTRACT: 
Context: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in rural America has been described as an epidemic, and the HIV prevalence rate among criminal justice populations is higher than the general population. Thus, criminally involved populations in Southern rural areas are at elevated risk for contracting HIV because of drug and sexual practices; however, little is known about HIV/AIDS in the fastest growing criminal justice population—probationers. Purpose: To examine possible explanations for the lack of HIV seropositivity found in a purposive sample of rural probationers. Methods: Data were examined from 800 felony probationers from 30 counties in Kentucky’s Appalachian region. Measures included HIV prevalence within the 30 counties, migration patterns, HIV knowledge, substance use, and sexual risk behaviors. Findings: These probationers had a high level of HIV knowledge, reported minimal injection drug use, practiced serial monogamy, and reported minimal engagement in transactional sex. However, these probationers also reported negligible condom use, and injection drug users shared needles and works. Conclusion: Findings suggest the importance of developing programs targeting safe sex practices in rural areas.
Trends in Controlled‐Release Oxycodone (OxyContin®) Prescribing Among Medicaid Recipients in Kentucky, 1998‐2002
Authors: Havens Jennifer R. , Talbert Jeffrey C. , Robert Walker , Cynthia Leedham , Leukefeld Carl G.
Published: June 2006

ABSTRACT: 
Context: Prescription opioid abuse has emerged as a public health problem, particularly in rural America. Purpose: To examine temporal and geographic trends in rates of controlled‐release oxycodone (OxyContin) prescribing for Kentucky Medicaid recipients. Methods: A cross‐sectional analysis was completed in which the state was divided into 3 regions (distressed Appalachia, Appalachia, and other Kentucky), and data from Medicaid pharmacy claims from 1998 to 2002 were analyzed. Claims were further stratified by disability status. Findings: Temporary Assistance for Needy Families Medicaid recipients in distressed Appalachia were more likely than those in other Kentucky regions to file controlled‐release oxycodone claims in 1999, 2001, and 2002. Even after adjusting for the proportion of Temporary Assistance for Needy Families recipients in each region, the distressed region still had significantly higher rates (P< .05) than the non‐Appalachian region of controlled‐release oxycodone prescription claims among Temporary Assistance for Needy Families recipients. Similar findings were observed for disabled Medicaid recipients in 2002. Conclusions: Higher rates of claims for controlled‐release oxycodone in the distressed Appalachian region of Kentucky suggest that economic and health factors unique to this area may be contributing to increased use of this product. The increased availability of controlled‐release oxycodone in distressed Appalachian regions may facilitate abuse.
Rural Women and Osteoporosis: Awareness and Educational Needs
Authors: Matthews Hollie L. , Laya Mary , DeWitt Dawn E.
Published: June 2006

ABSTRACT: 
Context: Little is known about rural women’s knowledge about osteoporosis. Purpose: To explore what women from high‐prevalence rural communities know about osteoporosis and to assess their learning preferences. Methods: We surveyed 437 women in rural Washington and Oregon. Findings: The response rate was 93% (N = 406). The mean age of respondents was 63 years (range 16‐95) and 74% (n = 301) of women were postmenopausal. While 27% over age 40 (n = 111) reported having a fracture as an adult, less than half of this group (42%, n = 47) considered themselves at risk for osteoporosis. Of the 42% (n = 171) who rated their knowledge of osteoporosis good or excellent, only 18% (n = 30) answered calcium and vitamin D questions correctly. About half (53%; n = 214) exercised 3 or more times per week. Reported sources of osteoporosis information included television, magazines, health care providers, and personal contacts. Over half of the women in this study wanted more information about osteoporosis, most wanted it before age 50, and health care providers were a preferred source. Less than half of participants reported having Internet access. Conclusions: While many participants underestimated their osteoporosis risk, most women wanted to learn more about osteoporosis and health care providers remain a preferred source of information.
Tissue- and Tumor-Specific Targeting of Murine Leukemia Virus-Based Replication-Competent Retroviral Vectors
Authors: Metzl Christian , Mischek Daniela , Salmons Brian , Günzburg Walter H. , Renner Matthias , Portsmouth Daniel
Published: June 2006

Replication-competent retrovirus vectors based on murine leukemia virus (MLV) have been shown to effectively transfer therapeutic genes over multiple serial infections in cell culture and through solid tumors in vivo with a high degree of genomic stability. While simple retroviruses possess a natural tumor selectivity in that they can transduce only actively dividing cells, additional tumor-targeting strategies would nevertheless be advantageous, since tumor cells are not the only actively dividing cells. In this study, we used the promiscuous murine cytomegalovirus promoter, a chimeric regulatory sequence consisting of the hepatitis B virus enhancer II and the human α1-antitrypsin (EII-Pa1AT) promoter, and a synthetic regulatory sequence consisting of a series of T-cell factor binding sites named the CTP4 promoter to generate replicating MLV vectors, whereby the last two are transcriptionally restricted to liver- and β-catenin/T-cell factor-deregulated cells, respectively. When the heterologous promoters were used to replace almost the entire MLV U3 region, including the MLV TATA box, vector replication was inefficient since nascent virus particle production from infected cells was greatly decreased. Fusion of the heterologous promoters lacking the TATA box to the MLV TATA box, however, generated vectors which replicated with almost-wild-type kinetics throughout permissive cells while exhibiting low or negligible spread in nonpermissive cells. The genomic stability of the vectors was shown to be comparable to that of a similar vector containing wild-type MLV long terminal repeats, and tropism analysis over repeated infection cycles showed that the targeted vectors retained their original specificity.
Preferential Infection Shortens the Life Span of Human ImmunodeficiencyVirus-Specific CD4+T Cells In Vivo
Authors: Brenchley Jason M. , Ruff Laura E. , Casazza Joseph P. , Koup Richard A. , Price David A. , Douek Daniel C.
Published: June 2006

CD4+T-cell help is essential for effective immune responses to viruses. In human immunodeficiency virus (HIV) infection, CD4+T cells specific for HIV are infected by the virus at higher frequencies than other memory CD4+T cells. Here, we demonstrate that HIV-specific CD4+T cells are barely detectable in most infected individuals and that the corresponding CD4+T cells exhibit an immature phenotype compared to both cytomegalovirus (CMV)-specific CD4+T cells and other memory CD4+T cells. However, in two individuals, we observed a rare and diametrically opposed pattern in which HIV-specific CD4+T-cell populations of large magnitude exhibited a terminally differentiated immunophenotype; these cells were not preferentially infected in vivo. Clonotypic analysis revealed that the HIV-specific CD4+T cells from these individuals were cross-reactive with CMV. Thus, preferential infection can be circumvented in the presence of cross-reactive CD4+T cells driven to maturity by coinfecting viral antigens, and this physical proximity rather than activation status per se is an important determinant of preferential infection based on antigen specificity. These data demonstrate that preferential infection reduces the life span of HIV-specific CD4+T cells in vivo and thereby compromises the generation of effective immune responses to the virus itself; further, this central feature in the pathophysiology of HIV infection can be influenced by the cross-reactivity of responding CD4+T cells.
Consistent Effects of
TSG101
Genetic Variability on Multiple Outcomes of Exposure to Human Immunodeficiency Virus Type 1
Authors: Bashirova Arman A. , Bleiber Gabriela , Qi Ying , Hutcheson Holli , Yamashita Traci , Johnson Randall C. , Cheng Jie , Alter Galit , Goedert James J. , Buchbinder Susan , Hoots Keith , Vlahov David , May Margaret , Maldarelli Frank , Jacobson Lisa , O'Brien Stephen J. , Telenti Amalio , Carrington Mary
Published: June 2006

Tumor susceptibility gene 101 (
TSG101
) encodes a host cellular protein that is appropriated by human immunodeficiency virus type 1 (HIV-1) in the budding process of viral particles from infected cells. Variation in the coding or noncoding regions of the gene could potentially affect the degree of TSG101-mediated release of viral particles. While the coding regions of the gene were found to lack nonsynonymous variants, two polymorphic sites in the
TSG101
5′ area were identified that were associated with the rate of AIDS progression among Caucasians. These single-nucleotide polymorphisms (SNPs), located at positions −183 and +181 relative to the translation start, specify three haplotypes termed A, B, and C, which occur at frequencies of 67%, 21%, and 12%, respectively. Haplotype C is associated with relatively rapid AIDS progression, while haplotype B is associated with slower disease progression. Both effects were dominant over the intermediate haplotype A. The haplotypes also demonstrated parallel effects on the rate of CD4 T-cell depletion and viral load increase over time, as well as a possible influence on HIV-1 infection. The data raise the hypothesis that noncoding variation in
TSG101
affects the efficiency of TSG101-mediated release of viral particles from infected cells, thereby altering levels of plasma viral load and subsequent disease progression.
The L4 22-Kilodalton Protein Plays a Role in Packaging of the Adenovirus Genome
Authors: Ostapchuk Philomena , Anderson Mary E. , Chandrasekhar Sharanya , Hearing Patrick
Published: June 2006

Packaging of the adenovirus (Ad) genome into a capsid is absolutely dependent upon the presence of a
cis
-acting region located at the left end of the genome referred to as the packaging domain. The functionally significant sequences within this domain consist of at least seven similar repeats, referred to as the A repeats, which have the consensus sequence 5′ TTTG-N
8
-CG 3′. In vitro and in vivo binding studies have demonstrated that the adenovirus protein IVa2 binds to the CG motif of the packaging sequences. In conjunction with IVa2, another virus-specific protein binds to the TTTG motifs in vitro. The efficient formation of these protein-DNA complexes in vitro was precisely correlated with efficient packaging activity in vivo. We demonstrate that the binding activity to the TTTG packaging sequence motif is the product of the L4 22-kDa open reading frame. Previously, no function had been ascribed to this protein. Truncation of the L4 22-kDa protein in the context of the viral genome did not reduce viral gene expression or viral DNA replication but eliminated the production of infectious virus. We suggest that the L4 22-kDa protein, in conjunction with IVa2, plays a critical role in the recognition of the packaging domain of the Ad genome that leads to viral DNA encapsidation. The L4 22-kDa protein is also involved in recognition of transcription elements of the Ad major late promoter.
Experimental Confirmation of Global Murine Cytomegalovirus Open Reading Frames by Transcriptional Detection and Partial Characterization of Newly Described Gene Products
Authors: Tang Qiyi , Murphy Eain A. , Maul Gerd G.
Published: June 2006

Murine cytomegalovirus (MCMV) and human CMV (HCMV) share many features making the mouse system a potential small-animal model for HCMV. Although the genomic DNA sequence and the predicted open reading frames (ORFs) of MCMV have been determined, experimental evidence that the ORFs are actually transcribed has been lacking. We developed an MCMV global-DNA microarray that includes all previously predicted ORFs and 14 potential ones. A total of 172 ORFs were confirmed to be transcribed, including 7 newly discovered ORFs not previously predicted. No gene products from 10 previously predicted ORFs were detected by either DNA microarray analysis or reverse transcriptase PCR in MCMV-infected mouse fibroblasts, although 2 of those were expressed in a macrophage cell line, suggesting that potential gene products from these open reading fames are silenced in fibroblasts and required in macrophages. Immunohistochemical localization of the six newly described ORF products and three recently identified ones in cells transfected with the respective construct revealed four of the products in the nucleus and five in mitochondria. Analysis of two ORFs using site-directed mutagenesis showed that deletion of one of the mitochondrion-localized gene products led to significantly decreased replication in fibroblasts.