bluuebunny/crossref_metadata_2025 huggingface dataset:
A Blinded, Randomised, Controlled Trial of Stapled Versus Tissue Glue Closure of Neck Surgery Incisions
Authors: Ridgway DM , Mahmood F , Moore L , Bramley D , Moore PJ
Published: March 2007

INTRODUCTION

Cosmetic acceptability of scar and neck mobility are important outcomes after collar line incision for neck surgery. This randomised, controlled trial compares these parameters in closures using tissue glue (Dermabond™, Ethicon, UK) and skin staples.

PATIENTS AND METHODS

Patients requiring a collar line incision were randomised to receiving tissue glue or staples for skin closure. Time for closure to be completed was recorded. Mobility of the neck was assessed using a visual analogue scale at 48 h and 1 week after surgery. At 6 weeks, cosmetic appearance was assessed using a linear 1–10 visual analogue scale by the patient, surgeon and an independent blinded assessor. Results were compared using appropriate statistical tests.

RESULTS

Glued (n = 14) and stapled (n = 15) closures were performed for hemithyroidectomy (n = 8 versus 6), sub-total thyroidectomy (n = 2 versus 4), total thyroidectomy (n = 1 versus 4) and parathyroidectomy (n = 3 versus 1). Closure with tissue glue took significantly longer than with staples (mean, 95 versus 28 s; P < 0.001). Neck mobility scores were comparable at 48 h and 1 week (mean, 4.8 versus 4.4; P = 0.552: and 2.7 versus 2.6; P = 0.886). Cosmetic appearance at 6 weeks was comparable when patient (mean, 1.7 versus 1.8; P = 0.898), surgeon (mean, 2.6 versus 2.3; P = 0.633) and independent assessment (mean, 1.4 versus 1.9; P = 0.365) was performed.

CONCLUSIONS

The use of glued skin closure may increase the duration of surgery but acceptable neck mobility and wound cosmesis can be achieved by the more rapid application of stapled skin closure in cervicotomy incisions.
A Review of Phase III Clinical Trials of Prostate Cancer Chemoprevention
Authors: Thorpe JF , Jain S , Marczylo TH , Gescher AJ , Steward WP , Mellon JK
Published: March 2007

INTRODUCTION

Prostate cancer is an excellent target for chemoprevention strategies; given its late age of onset, any delay in carcinogenesis would lead to a reduction in its incidence. This article reviews all the completed and on-going phase III trials in prostate cancer chemoprevention.

PATIENTS AND METHODS

All phase III trials of prostate cancer chemoprevention were identified within a Medline search using the keywords ‘clinical trial, prostate cancer, chemoprevention’.

RESULTS

In 2003, the Prostate Cancer Prevention Trial (PCPT) became the first phase III clinical trial of prostate cancer prevention. This landmark study was terminated early due to the 24.8% reduction of prostate cancer prevalence over a 7-year period in those men taking the 5α-reductase inhibitor, finasteride. This article reviews the PCPT and the interpretation of the excess high-grade prostate cancer (HGPC) cases in the finasteride group. The lack of relationship between cumulative dose and the HGPC cases, and the possible sampling error of biopsies due to gland volume reduction in the finasteride group refutes the suggestion that this is a genuine increase in HGPC cases. The other on-going phase III clinical trials of prostate cancer chemoprevention – the REDUCE study using dutasteride, and the SELECT study using vitamin E and selenium – are also reviewed.

CONCLUSIONS

At present, finasteride remains the only intervention shown in long-term prospective phase III clinical trials to reduce the incidence of prostate cancer. Until we have the results of trials using alternative agents including the on-going REDUCE and SELECT trials, the advice given to men interested in prostate cancer prevention must include discussion of the results of the PCPT. The increased rate of HGPC in the finasteride group continues to generate debate; however, finasteride may still be suitable for prostate cancer prevention, particularly in men with lower urinary tract symptoms.
Delayed Presentation of Life-Threatening Perineal Sepsis Following Stapled Haemorrhoidectomy: A Case Report
Authors: McCloud JM , Doucas H , Scott ADN , Jameson JS
Published: March 2007

Fournier's gangrene has been described after injection sclerotherapy and banding of haemorrhoids as well as after conventional haemorrhoidectomy. In addition, there have been several cases following stapled haemorrhoidopexy. A patient with this complication nearly always presents within the first week following surgery. We present an illustrative case of a patient who underwent stapled haemorrhoidopexy for prolapsed haemorrhoids and presented with fever, urinary retention and peri-anal pain 39 days later. At re-operation, there was extensive peri-anal necrosis. After wide excision and fashioning of a colostomy, the patient recovered. Our case shows that late presentation can occur.
MRSA Enteritis Causing a High Stoma Output in the Early Postoperative Phase After Bowel Surgery
Authors: Haq AI , Cook LJ
Published: March 2007

INTRODUCTION

Nosocomial MRSA infection has become an important healthcare issue. We present 6 cases of MRSA enteritis, acquired following bowel surgery and ileostomy formation.

PATIENTS AND METHODS

The data set was obtained from the experience of one consultant surgeon over 6 years in one medical centre. The clinical features and course of six patients that developed MRSA enteritis postoperatively were obtained through review of case notes and laboratory data.

RESULTS

Four male and two female patients (age range, 22–80 years) developed a clinical syndrome postoperatively requiring treatment within the high dependency unit. Three developed respiratory distress syndrome, and one died from multi-organ failure. Exploratory laparotomy carried out in three patients was negative. All patients were MRSA-negative on admission but had swabs positive for MRSA from ileostomy site postoperatively. All of the three patients who had ileostomy effluent cultured for MRSA had positive results.

DISCUSSION

Fever, abdominal pain, distension and high stoma output in the early postoperative period following bowel surgery should alert the clinician to the possibility of MRSA enteritis. Patients require aggressive resuscitation and culture of ileostomy effluent for MRSA. Exploratory laparotomy has no obvious benefits. As MRSA enteritis has the potential to be a lethally effective disseminator of MRSA, such clinical features should prompt early instigation of appropriate infection control practices.
Rectus Sheath Haematoma Associated with Low Molecular Weight Heparin: A Case Series
Authors: Donaldson J , Knowles CH , Clark SK , Renfrew I , Lobo MD
Published: March 2007

A report of three cases of spontaneous rectus sheath haematoma within a 1-month period in a single hospital. The common feature was the recent treatment with low molecular weight heparin. In contrast to the perceived benign nature of the classically-described haematoma, the cases described were life-threatening and required aggressive intervention.
From Grunts to Words: Experiments in Laryngeal Transplantation
Authors: Barker Emma V
Published: March 2007

INTRODUCTION

Laryngeal transplantation remains an increasingly viable option for patients with irreversible disease or damage to the larynx. Successful organ transplantation relies on minimising surgical, ischaemic and immunological insults. The inherent immunogenicity of an organ is dependent on the amount of immunologically active cells within it. The presence of immunologically active cells within non-transplanted NIH-minipigs was investigated and an in vivo laryngeal transplant model was developed.

MATERIALS AND METHODS

Quantitative, multiple-colour immunofluorescence using pig-specific monoclonal antibodies was used to assess the normal immunological architecture and the short-term immunological changes associated with 3 h of cold ischaemia and 8 h of reperfusion in an MHC-matched animal model.

RESULTS AND CONCLUSIONS

There is a complex immunological architecture within the non-transplanted, healthy pig larynx. In addition, an in vivo laryngeal transplant model was developed that allowed successful perfusion for 8 h post transplantation. There were significant changes in cell numbers within different anatomical subsites of the larynx. However, the biological significance remains debatable in view of the large range of cell numbers both within and between individual animals.
Suitability of London patient choice referrals to a diagnostic and treatment centre
Authors: Nitkunan T , Constantinou J , Nauth-Misir RN , Greenwell TJ
Published: March 2007

The London Patient Choice (LPC) programme started in October 2002 and covered procedures in orthopaedics, ear nose and throat, general surgery and urology. The aim of this programme was to offer London patients who had been on a waiting list for six months the choice of having their operation at another hospital or diagnostic and treatment centre at a time and date that was convenient to them, earlier than was possible at their original hospital. This project was discontinued in March 2005 due to cessation of funding. We have assessed the outcome of LPC patients referred to our diagnostic and treatment centre (DTC) from August 2003, when it opened.
Job planning for NHS consultants
Authors: Davidson Mike
Published: March 2007

Since the introduction of the new consultant contract in 2003, annual formal job planning has become increasingly important. It is likely that those subject to a new staff and associate specialist contract will have to complete a similar process. I may be 'teaching my grandmother to suck eggs' but colleagues, particularly the newly appointed or those with clinical lead responsibilities, find themselves unsure how to plan their jobs. Ideally, job planning should enable employer and employee to deliver an efficient, transparent service for patients. The implementation and interpretation of job plans and the contract vary between Trusts. Areas of particular difficulty surround supporting activities (structured professional activities (SPAs)) and external duties.
The new consultant contract – its impact on vascular surgeons
Authors: Davis M , Sorelli P , Davies AH
Published: March 2007

In October 2003 the British Medical Association (BMA) announced that 60.7% of consultants in England had voted in favour of the new consultant contract; since that time the option of taking up the new contract has been available. The basis of the new contract is a job plan with ten programmed activities (PAs) of four hours each (three hours in premium time). These may be divided into the following categories: direct clinical care, supporting professional activities (SPAs), additional NHS responsibilities and external duties.
Defining competencies in primary dental care research
Authors: Eaton Kenneth
Published: March 2007

At its meeting in February 2007, the FGDP(UK) Board approved a document setting out 'research competencies'. A research competency is defined as the level of knowledge and understanding, with sufficient practical experience, to be able to carry out a specified aspect of research in primary oral health care in an independent manner. The document is an important development and supports the FGDP(UK)'s wish to promote research. It states that:
Acamprosate and Primitive Reflexes
Authors: Guzik Patrycya , Bankes Lindey , Brown Thomas M
Published: March 2007

Objective:

To describe 3 cases of patients with alcohol dependence whose primitive reflexes resolved upon initiation of acamprosate 666 mg 3 times daily.

Case Summaries:

A 57-year-old man had a long-standing history of alcohol dependence and a prominent snout reflex. The snout reflex resolved within 24 hours of starting treatment with acamprosate. A 45-year-old man with a long history of alcohol dependence had both a snout and a grasp reflex. These reflexes were present throughout 3 admissions for alcohol detoxification and continued until the end of his third admission, when he elected to begin treatment with acamprosate. Within 24 hours of starting treatment, the snout and grasp reflexes were absent. A 55-year-old man who drank heavily for 35 years presented with both a snout and a grasp reflex on admission. These persisted throughout his detoxification until the day after he had begun treatment with acamprosate. His primitive reflexes remained resolved through the next 4 days until discharge. All 3 of these patients remained on acamprosate at discharge.

Discussion:

Alcohol dependence is a common, debilitating disorder. One of the difficulties in treating alcohol dependence is its adverse effect on the brain, as higher aspects of cortical function necessary to maintain abstinence are eroded by alcohol. Acamprosate is a drug intended to help prevent relapse among patients with alcohol dependence. Unexpectedly, acamprosate may resolve primitive reflexes—a neurologic finding that suggests cognitive impairment—among patients with alcohol dependence.

Conclusions:

Acamprosate may relieve snout and grasp reflexes among patients with alcohol dependence.
Proposal for a New Tool to Evaluate Drug Interaction Cases
Authors: Horn John R , Hansten Philip D , Chan Lingtak-Neander
Published: March 2007

The assessment of causation for a potential drug interaction requires thoughtful consideration of the properties of both the object and precipitant drugs, patient-specific factors, and the possible contribution of other drugs that the patient may be taking. The Naranjo nomogram was designed to evaluate single-drug adverse events, not drug–drug interactions. Several of the questions on the Naranjo nomogram do not apply to potential drug–drug interactions, while others do not specify object or precipitant drug. Nevertheless, it has been inappropriately used to evaluate drug–drug interactions. The Drug Interaction Probability Scale (DIPS) was developed to provide a guide to evaluating drug interaction causation in a specific patient. It is intended to be used to assist practitioners in the assessment of drug interaction–induced adverse outcomes. The DIPS uses a series of questions relating to the potential drug interaction to estimate a probability score. An accurate assessment using the DIPS requires knowledge of the pharmacologic properties of both the object and precipitant drugs. Inadequate knowledge of either the drugs involved or the basic mechanisms of interaction will be a limitation for some users. The DIPS can also serve as a guide in the preparation of articles describing case reports of drug interactions, as well as in the evaluation of published case reports.
Impact of a Continuing Education Program on Community Pharmacists' Interventions and Asthma Medication Use: A Pilot Study
Authors: Rouleau Rachel , Beauchesne Marie-France , Laurier Claudine
Published: March 2007

Background:

By upgrading the pharmacists' knowledge and skill set through continuing education (CE) programs, they could be better suited to contribute to the enhancement of the management of asthma.

Objective:

To assess the impact of an asthma CE program provided to community pharmacists on their knowledge, intervention frequency, and the appropriateness of asthma medication use.

Methods:

Community pharmacists were invited to participate in a CE program on asthma. Those who displayed an interest in the program were assigned to either a control or experimental group. Participants in the first group were not offered the CE program until the study was completed; the second group participated in the CE program at the onset of the study period. The knowledge on asthma of both groups of pharmacists was assessed using a questionnaire before the CE program, and the knowledge of the experimental group was reassessed after the CE program. Pharmacists were asked to document their interventions in the study log book over 6 months following the CE program. The appropriateness of asthma medication use was estimated by reviewing the prescription claims for a subgroup of patients covered by Québec's Public Prescription Drug Insurance Plan.

Results:

Pharmacists' knowledge improved after the CE program; however, the number of interventions reported during the 6 month period following the program was low and did not differ significantly between the groups, with an average of 3.04 per pharmacy in the experimental group versus 3.26 in the control group. The appropriateness of asthma medication use did not improve once the CE program had been completed.

Conclusions:

Our CE program had little impact on the number of interventions by community pharmacists and the appropriateness of asthma medication use.
Toward a Political Ecology in Early South India: Preliminary Considerations of the Sociopolitics of Land and Animal Use in the Southern Deccan, Neolithic through Early Historic Periods
Authors: Bauer Andrew M , Johansen Peter , Bauer Radhika L
Published: March 2007

The archaeology of southern India has long been dominated by cultural-historical paradigms, which have more recently become reliant on environmental stimuli to explain ''culture change.'' This interpretive framework has created a relatively fixed set of relationships between the environment and past human societies that oversimplifies issues of agency and causation in largely deterministic terms. At issue here is a lack of adequate treatment for the sociopolitical complexity of human-environment relationships. In this essay we examine the relationships between emerging social differences and both stable and dynamic aspects of land use throughout the South Indian Neolithic (3000–1200 B.C.), Iron Age (1200–500 B.C.), and Early Historic (500 B.C.–A.D. 500) periods in the southern Deccan region of South India. In an effort to contextualize land use in wider sociopolitical realms, we focus on the empirical components of three aspects of the archaeological record—animal use, agricultural regimes, and monument production and maintenance—through a lens of political ecology. Accepting that land use is socially and culturally mediated, we suggest how sociopolitical distinctions emergent during these periods could be viewed in relation to the production of a landscape that differentially included wild and domesticated animals, cultivars, water reservoirs, irrigation agriculture, and monumental architecture. In this sense, we argue that the landscape itself could be seen as a social product through which sociopolitical differences were experienced and perceived, and that the historical development of the landscape is both the artifact and medium of sociopolitics in early South India. As such, the determinants of social history remain in social and cultural fields of action, though not removed from the ecological-material world of which people are a part.
Stone Axe Technology in Neolithic South India: New Evidence from the Sanganakallu-Kupgal Region, Mideastern Karnataka
Authors: Brumm Adam , Boivin Nicole, Ph. D , Korisettar Ravi , Koshy Jinu , Whittaker Paula
Published: March 2007

This essay discusses the preliminary results of recent archaeological investigations into stone axe production and exchange processes at a Neolithic hilltop settlement in South India. The site in question comprises a stone-lined circular structure situated on a plateau area on the side of a topographically complex hill, known locally as Hiregudda. Across the plateau, extensive surface scatters of flaked dolerite material indicate a heavy focus on edge-ground bifacial axe manufacture at the site. Excavation of the structure and its immediate surrounds has revealed stratified deposits of dolerite axes, axe blanks and debitage, as well as a large lithic dumping area adjacent to the structure. Several clusters of axe-grinding grooves are documented on granite boulders and bedrock exposures both in and around the structure, and at least two intensively quarried outcrops of dolerite have been recorded within close vicinity of the plateau. Following a detailed examination of the axe manufacturing technology employed by knappers in the ''workshop'' structure, we suggest that the evidence for large-scale quarrying and industrial activity at Hiregudda points to the importance of this hilltop settlement in the axe production and exchange network of Neolithic South India. We present radiocarbon dating evidence from our investigations that implies the most intensive phase of axe manufacture and possibly distribution at Hiregudda took place during the Late Neolithic–Megalithic transition around the thirteenth or fourteenth millennia B.C.
Hinterlands, Urban Centers, and Mobile Settings: The "New" Old World Archaeology from the Eurasian Steppe
Authors: Honeychurch William , Amartu̇vshin Ch. (Chunagiĭn)
Published: March 2007

Archaeological studies of pastoral nomadic societies have been invigorated by recent collaborative research projects across the Eurasian steppe zone. This research contributes an important comparative perspective on processes of complex sociopolitical organization practiced among mobile groups. This essay employs a novel approach to understanding the organizational techniques and methods of finance that supported large-scale imperial polities of eastern Eurasia, specifically those centered on the Mongolian steppe. Using full-coverage survey data from the northern Mongolian valley of Egiin Gol, we present the results of diachronic spatial and environmental analyses in order to evaluate current models for nomadic political economy. We argue that eastern Eurasian subsistence economics are best understood not as a single ''type'' of production but as a productive process based on multiresource capacities (agro-pastoral, hunting, gathering, fishing) and the flexibility to readily adjust resource emphasis, degree of mobility, and specialization relative to a changeable environment. We o¤er a revised model for eastern steppe political integration emphasizing the spatial management of political relationships within a mobile setting. Our essay concludes with a brief overview of the potential for Eurasian steppe archaeology to contribute novel comparative insights for anthropologists studying the diversities and commonalities of complex social organization.
The Gold Coast: Suvannabhumi? Lower Myanmar Walled Sites of the First Millennium A.D.
Authors: Moore Elizabeth , Win. San
Published: March 2007

The high rainfall of the Lower Myanmar coast is balanced by the aridity of the country's inland plains. The article profiles three sites in a laterite-rich area located in the northern part of the Lower Myanmar peninsula. The walls and moats of these sites underline their role in water management, one where control of water was the decisive catalyst. The sites of Kyaikkatha, Kelasa, and Winka illustrate how slight changes in topography signal critical junctures, the points where walls and moats were constructed. As a result, up to seven walls flank the higher edges of these sites; these protected the interior by diverting excess water to lower areas. Using large finger-marked bricks and terra-cotta artifacts such as votive tablets, plaques, and architectural elements, a broad chronology of c. the sixth to ninth centuries A.D. is proposed, although a majority of the pieces dated to the seventh century A.D. Attention is also drawn to evidence of Lower Myanmar prehistoric habitation in lowland areas close to the coast, where natural and man-made changes continue to alter the ecology and affect archaeological interpretation. The survey is used to encourage comparative studies, drawing in environmentally diverse but culturally related areas of South and Southeast Asia.
Sedentism, Territorial Circumscription, and the Increased Use of Plant Domesticates Across Neolithic–Bronze Age Korea
Authors: Norton Christopher J
Published: March 2007

As evidenced from the Korean archaeological record, there is an increased use of plant domesticates and a decrease in other food sources during the Holocene. These changes in overall human diet breadth culminate with the Late Neolithic–Bronze Age (c. 3500 B.P.) transition where dependence on hunted and gathered food packages decreases during the former period and full-scale agriculture becomes the norm during the latter cultural stage. This dietary shift appears to coincide with Holocene shoreline stabilization and overall large-scale population increase and movement through time. It is proposed here that two primary reasons exist for the change in overall diet breadth: (1) increasing shoreline stabilization during the Holocene and (2) an increase in hunter-gatherer population pressure due to a sedentary lifestyle. Both of these factors would have led to some degree of territorial circumscription, resulting in a progressive decline in overall hunter-gatherer foraging e‰ciency. In turn, this would have prompted the Holocene Korean Peninsular peoples to find other ways to offset their lowered overall foraging efficiency that had originally focused primarily on higher-ranked food resources (e.g., deer, wild boar). In this case, Korean peoples expanded their overall diet breadth to include a lower-ranked set of food packages (e.g., fish, shellfish) that by the advent of the Bronze Age eventually included plant domesticates regularly.
The Lapita Occupation at Naitabale, Moturiki Island, Central Fiji
Authors: Nunn Patrick D. , Ishimura Tomo , Dickinson William R , Katayama Kazumichi , Thomas Frank R , Kumar Roselyn , Matararaba Sepeti , Davidson Janet , Worthy T. H
Published: March 2007

In 2003 the authors discovered and excavated a Lapita site at Naitabale close to the southern end of Moturiki Island (central Fiji). Today the site is 350 m inland from the coast, but in Lapita times it was located behind the active beach ridge. A large collection of potsherds (including 92 dentate-stamped or incised Lapita sherds), shell, and animal bones was recovered, together with a human burial. Sherd decorations show affinities with the Western Lapita Province rather than the Eastern Lapita Province (which includes Fiji). Temper analyses of 45 Lapita sherds do not show any unmistakably exotic (to Fiji) pottery, but 29 percent are nonlocal to Moturiki and nearby islands. Fish bones are mostly from inshore species (dominated by Scaridae), while nonfish vertebrates are dominated by turtle and include dog and chicken. Shellfish remains are dominated by gastropods, mostly Strombus spp. (43 percent of gastropod MNI). The surf clam (Atactodea striata) accounts for 38 percent of bivalve MNI, with Anadara antiquata and Gafrarium pectinatum each representing 14 percent of the bivalve MNI. The skeleton is that of a woman (Mana) 161–164 cm tall who died at 40–60 years of age. Six radiocarbon dates from bones overlap 2740–2739 cal. years B.P. (790–789 B.C.). The mandible lacks antegonial notches but is not a proper rocker jaw. The cranium was better preserved than any Lapitaassociated skeleton hitherto described, which allowed the head to be reconstructed. Stable-isotope analyses show that her diet contained significant amounts of reef foods but was probably dominated by terrestrial plants. The Lapita occupation of Naitabale is likely to have begun by 2850 cal. years B.P. (900 B.C.). Radiocarbon dates and pottery decorative styles both suggest Naitabale was first occupied within the early part of the Lapita history of Fiji.
Ancient Irrigation and Buddhist History in Central India: Optically Stimulated Luminescence Dates and Pollen Sequences from the Sanchi Dams
Authors: Shaw Julia, archaeologist , Sutcliffe J. V. (John V.) , Lloyd-Smith Lindsay , Schwenninger Jean-Luc , Chauhan M. S , Misra O. P , Harvey Emma
Published: March 2007

This paper presents the results of a recent pilot project aimed at obtaining optically stimulated luminescence (OSL) dates from a group of ancient irrigation dams in central India. The dams are all situated within an area of 750 km2 around the wellknown Buddhist site of Sanchi, the latter established in c. third century B.C. and having a continuous constructional sequence up to the twelfth century A.D. They were documented during earlier seasons of the Sanchi Survey, initiated in 1998 in order to relate the site to its wider archaeological landscape. The pilot project builds upon earlier hypotheses regarding the chronology and function of the Sanchi dams and their relationship to religious and political history in Central India. The principal suggestion is that the earliest phase of dam construction coincided with the rise of urbanization and the establishment of Buddhism in central India between c. third and second centuries B.C.; and that they were connected with wet-rice cultivation as opposed to wheat, the main agricultural staple today. Similarities with intersite patterns in Sri Lanka, where monastic landlordism is attested from c. second century B.C. onward, have also led to the working hypothesis that the Sanchi dams were central to the development of exchange systems between Buddhist monks and local agricultural communities. The pilot project focused on two out of a total of 16 dam sites in the Sanchi area and involved scraping back dam sections created by modern road cuttings. This cast new light on aspects of dam construction and allowed for the collection of sediments and ceramics for OSL dating. The results confirmed the suitability of local sediments to OSL dating methods, as well as affirming our working hypothesis that the dams were constructed—along with the earliest Buddhist monuments in Central India—in the late centuries B.C. Sediment samples were also collected from cores hand drilled in the dried-up reservoir beds, for supplementary OSL dating and pollen analysis, which shed useful insights into land use.
Ethnicity, Democratisation and Decentralization in Ethiopia: The Case of Oromia
Authors: Gudina. Merera
Published: March 2007

The 20th century has been shaped by class and national struggles intended to end the asymmetrical relations that arose in the historical process of the creation of the multi-ethnic polity of Ethiopia. This study explores and assesses the democratization and decentralization experiment in Ethiopia. It focuses on the Oromia region, which is the country's largest region as well as housing its single largest ethnic group. It describes the demand of the Oromo people for self-rule and democratic governance on the one hand, and the promises made on paper by the government in power, on the other. It concludes that the Oromia region is a classical case in terms of the degree of failure of the regime's policies on the national question and the continued struggle for real autonomy and democracy on the part of the local population.
Predictors of Unintended Pregnancy Among South African Youth
Authors: Ibisomi Latifat D. G , Odimegwu C.O
Published: March 2007

Although unintended pregnancy is recognized as a major public health problem in South Africa, studies on it have been limited and at local level. Using the 1998 South African Demographic and Health Survey (SADHS) data set, this study examined the distribution of and factors associated with unintended pregnancy among South African youth. Analysis was based on a sub-sample of 1, 395 women aged 15-24 who were interviewed during the survey and who had pregnancy at the time of and/or three years preceding the survey. Univariate, bivariate and multivariate methods of analysis were employed. The results show a high level of unintended pregnancy with only 29% of the pregnancies wanted. The level of unintended pregnancy varies by region and some socio-economic variables. Five critical predictors of unintended pregnancy among South African youth were identified. These are: age group, region, marital status, education and relationship to the last sexual partner. The findings of this study have implications for reproductive health policies and programmes in designing appropriate national programmes for reducing the incidence of unintended pregnancy among South African youth. The need for further research into this area using triangulated methodology is recommended.
Smallholder Cotton Production in Tanzania: Emerging Issues on Accountability in Kilosa District, Morogoro
Authors: Itika Josephat S , Makauki Adolf F
Published: March 2007

Traditional cash crop production in Tanzania has been declining with time. While some natural, infrastructure and marketing factors have been known to contribute to low agricultural productivity, reasons related to accountability on the part of officials managing different organs have been little known. This paper discusses emerging accountability issues on the part of government and other service providing institutions as far as cotton production in Kilosa District and more specifically in Malui Village is concerned. A cross-sectional research design that allows collection of information at one point in time was adopted covering several cases. Data for the study were collected through interviews of key informants and farmers, physical observations, documentation and meeting with village government. The emerging findings show that limited access of smallholders to sufficient and fertile land, appropriate farm inputs and reliable markets due to lack of effective accountability on the part of local government, cotton board, cooperatives and private traders has been among the responsible factors for the declining production of cotton. Establishing the right structures and enforcement mechanisms for accountability can disentangle smallholder agriculture from persistent, chronic dissatisfactions of farmers.
Assessment of Urban Governance in Zimbabwe: Case of the City of Gweru
Authors: Mhlahlo Samson Rwadzi
Published: March 2007

The objective of this paper is to assess urban governance in Zimbabwe with specific reference to the City of Gweru. In Zimbabwe urban governance is the immediate responsibility of Urban Councils in cogovernance with the Ministry of Local Government, Public Works and Urban Development, which has an overall supervisory role. Chapter 29: 15 of the Urban Councils Act of 1995, revised in 1996, provides for the establishment of municipalities and towns and the administration of local boards, municipal and town councils. It confers functions and powers that impose duties upon municipal and town councils, as well as local boards. In Zimbabwe urban governance is not totally autonomous. The responsibilities and functions of urban governance are often shared and take place within a policy framework, which is both set by national politicians and over which those same national politicians will want to exert influence and direction. The issue is less about autonomy and more about inter- dependence and balance. The paper explores the view that if urban councils are to be government in the real sense of the word, then they must have a strategic capacity for accountability, efficiency and transparency to help in combating corruption, urban poverty and enhancing civic engagement. Through the use of interviews, questionnaires and minutes of council and committee meetings, the research also examines the relations between councillors, electorate, officials, and central government in the urban governance of Gweru. The study concludes by discussing recommendations for good urban governance in Gweru.
Factors Affecting Adoption of Long Staple Cotton Variety among Smallholder Farmers in Zimbabwe
Authors: Mutandwa Edward , Gadzirayi Christopher T , Zingwe Farirai
Published: March 2007

The changing requirements of the international cotton market have created the need for continual investment in new technological innovations in developing countries. The main objective of this research was to identify factors that affect the adoption of Long Staple (LS9219) variety among smallholder cotton farmers in Matepatepa communal area of Mashonaland Central province of Zimbabwe. A total of 75 farmers were selected using stratified sampling and a structured questionnaire administered at the farm level. A binary logistic regression model was used to investigate adoption of the LS9219 variety. Results of the survey showed that the economic returns per hectare for the traditional (SZ9314) and LS9219 were not statistically different at the 5% level. Most farmers were aware of the new cotton variety. Agricultural credit was found to have a positive and significant effect on adoption. On the other hand, large farm size was negatively associated with adoption of LS9219 variety. These findings point to the need for a holistic approach in which agricultural credit and sufficient price premiums for long staple varieties are central for longterm sustainability.
Workplace Violence among Domestic Workers in Urban Households in Kenya: A Case of Nairobi City
Authors: Ondimu Kennedy Nyabuti
Published: March 2007

This paper discusses findings of a study conducted in 2004/2005 on the prevalence and impact of domestic labour migration in Nairobi. Specifically, the paper examines the profile of domestic workers and extent of their vulnerability and exposure to different forms of abuse. The study integrated both qualitative and quantitative research techniques to attain its objectives. The qualitative approach included key informant survey and in-depth interviews. The quantitative approach on the other hand involved a cross-sectional household stratified sample survey in urban residential areas in Nairobi. The results reveal that overall, children account for a higher proportion of domestic workers, most of them girls from poor family backgrounds. Child domestic workers in Nairobi face many workplace social hazards that include injury, verbal harassment and sexual abuse. Based on these findings, the study makes appropriate policy recommendations.
Seeing the Light: Cultural and Social Capital Productions in an Inner-city High School
Authors: Hemmings Annette B
Published: March 2007

Youth advocates employed in a school-to-work program in an inner-city public high school promoted the college attainments of low-income Black students through the production of cultural and social capital. Analysis framed by cultural reproduction and production theories explicate how they inverted the ideological aims of the program; redefined their roles as "surrogate" middle-class parents; generated cultural productions through reality therapy; and created useful links to social resources and networks. Youth advocates changed the educational trajectory of some students. But there were other students who used cultural and social capital in productions that kept them closely tied to their families, neighborhoods, and local workplaces.
Adolescent Overscheduling: The Relationship Between Levels of Participation in Scheduled Activities and Self-Reported Clinical Symptomology
Authors: Melman Shari , Little Steven G , Akin-Little K. Angeleque
Published: March 2007

The past 20 to 30 years has seen an increase in the time children and adolescents spend in structured activities outside of the regular school day. This has resulted in a significant reduction in the amount of free time children and youth have for leisure time activities. While much discussion has been given to this topic in the popular press, little systematic research has been conducted addressing this issue. The purpose of this study was to identify whether there is a relationship between the number of regularly scheduled activities in which adolescents are involved, the amount of time adolescents spend participating in these activities, and self-reports of anxiety, depression, and physical complaints. Results indicated that the greater the amount of time students reported participating in activities both at the time of the study and for the entire year, the higher their self-reported level of anxiety tended to be. Similar results were not observed for depression or somatization.
Redefining the Digital Divide: Beyond Access to Computers and the Internet
Authors: Valadez James R , Durán Richard P
Published: March 2007

This study critiqued the notion that a binary "digital divide" between high and low resource schools describes accurately the technology disparity in U.S society. In this study, we surveyed teachers from six southern California schools. Five of the schools were low resource schools and one school, chosen for comparative purposes, was characterized as a high resource school. We found that high resource school teachers had significantly more physical access to computers and the Internet (C&I), more frequent use of C&I, more creative uses of C&I for instruction, communicated by email more often with students, and engaged more frequently in professional activities such on on-line communication with other teachers. The study lent modest support to previous researchers (Natriello, 2001; Warschauer, 2003a, 2003b, 2003c; Wenglinksy, 1998) who claimed that high resource students are more likely to use C&I for more experimental and creative uses than students from low resource schools. In addition the findings contribute to a broader definition of the "digital divide" that includes social consequences including the impact of social networks and wider use of technology to improve instruction.
High school Class-size and College Performance in Science
Authors: Wyss Vanessa L , Tai Robert H , Sadler Philip Michael
Published: March 2007

This paper focuses on the influence of high school science class size on students' achievement in introductory college science courses and on the variation of teacher practice across class size. Surveys collected information about high school science class experiences from 2754 biology, 3521 chemistry, and 1903 physics students across 36 public and 19 private institutions from 31 different states. The first analysis includes a cross-tabulation of 6 different class sizes and the frequencies of teacher practices reported by students. The second analysis includes a multiple linear regression of class size and student achievement. Results show no differences for pedagogy and student achievement until class sizes fall to 10 or fewer students. These findings suggest that incremental reductions in class size are likely not to have a significant impact on later student achievement.
Negotiating Paternalism: Women and Canada's Largest Department Stores, 1890-1960
Authors: Belisle Donica
Published: March 2007

This article explores Canada's largest department stores' relationships with female shoppers and employees between 1890 and 1960. Showing that these giant retailers made paternalism central to their operations, it explains how they enforced broader hierarchies of gender, race, ethnicity, and class. This article contributes to historical understandings of women's relationships with mass retail by illuminating not only Canadian department stores' treatment of women, but also women's responses to such treatment. It also offers new perspectives on contemporary antiretailing movements by revealing areas of division and solidarity among shoppers and wage earners.
"The Rest Can Go to the Devil": Macy's Workers Negotiate Gender, Sex, and Class in the Progressive Era
Authors: Johnson Val Marie
Published: March 2007

This article uses the records of a 1913 moral reform investigation of Macy's Department Store to demonstrate that workingwomen, social reformers, and employers governed themselves and others through intertwined practices and norms of labor, gender, and sexuality. Analysis of these records reveals that workingwomen were important actors in the constitution of these dynamics. The negotiation of what was deemed proper in relation to gender and sex was central to techniques of capitalist management and bourgeois social reform, and also to the work and leisure cultures of Macy's female employees. Examining these negotiations of propriety in a New York department store enriches our comprehension of women as desiring and laboring agents. It also documents how women's cultures of work and leisure hindered feminist and class alliances and directed women's energies into forms of individualism, as well as social hierarchy and regulation, which were conducive to newly developing dynamics of consumerism and heteronormativity.
Clothing Stories: Consumption, Identity, and Desire in Depression-Era Toronto
Authors: Srigley Katrina
Published: March 2007

Using oral histories, this article explores the consumption stories of a diverse group of workingwomen who lived in Toronto during the Depression. At this difficult time, when men were struggling with exceptionally high rates of unemployment, young women often became family breadwinners. In these positions, they had to balance their desires for clothing with their economic situations, as apparel operated as both a strong indicator of their status, or desired status, and a tool for finding and keeping work. Because of its importance, women often used clothing to assert, construct, and contest their identities. They found ways to fulfill their needs and desires for apparel by purchasing cheap, ready-made clothing, sewing, and consuming—if only through their gazes—the latest fashions.
Reform and Its Discontents: Public Health in New York City During the Great Society
Authors: Colgrove James
Published: March 2007

The health-care system was one of the most visible and contentious battlegrounds on which the social conflicts of the 1960s unfolded. To an unprecedented extent, health status—especially the stark disadvantage in access and outcomes for racial and ethnic minorities and the poor—became an object of public and governmental concern during the Great Society era, as clinicians, community activists, politicians, and policymakers sought to create new models of medical care that were more equitable and efficient than those of the past. The social science theories that informed the ambitious programs of Lyndon Johnson's administration gave an imprimatur to the idea that illness was both cause and consequence of the “cycle of poverty.”
The Other War on Drugs: The Pharmaceutical Industry, Evidence-Based Medicine, and Clinical Practice
Authors: Kushner Howard I.
Published: March 2007

Over the past decade, evidence-based medicine (EBM) has become the standard for medical practice.1 Evidence-based practices have been established in general medicine and specialized fields; new evidence-based journals have been launched.2 Although its roots can be found in mid-nineteenth-century medical philosophy, contemporary EBM was largely developed by the clinical epidemiology program at McMaster University in 1992.3 According to the McMaster manifesto published inJAMA, EBM “deemphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making, and stresses the examination of evidence from clinical research.”4 The most frequently cited definition of EBM is reliance on the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients,” based on an integration of “individual clinical expertise with the best available external clinical evidence from systematic research.”5 However, as Stefan Timmermans and Aaron Mauck recently observed, EBM “is loosely used and can refer to anything from conducting a statistical meta-analysis of accumulated research to promoting randomized clinical trials, to supporting uniform reporting styles for research, to a personal orientation toward critical self-evaluation.”6
Introduction: New Perspectives on Public Health Policy
Authors: Mohr James
Published: March 2007

The makers of public health policy face enormous challenges in the twenty-first century. In the past, their field has been imprecisely defined, deeply conflicted, poorly organized, and constantly changing. Lines of responsibility within the field are blurred at best, and groups with similar goals sometimes find themselves at cross-purposes. In the United States, state and local agencies interact with each other, with federal programs, and with powerful private interests. Many decisions that profoundly affect the health of the public are made for reasons largely unrelated to public health per se. Since the human and financial stakes involved in public health policies are immense, these challenges are, to say the least, serious issues. Underlying this volume is the belief that historical analyses and international perspectives can help policymakers understand, and hopefully begin to address, some of those old challenges in new ways.