bluuebunny/crossref_metadata_2025 huggingface dataset:
A Tool for Performance Evaluation in a Formal Codesign Framework
Authors: Carchiolo Vincenza , Malgeri Michele , Mangioni Giuseppe
Published: April 2004

Hardware-software (HW-SW) codesign is an attempt to integrate hardware and software design techniques. A critical feature of all codesign methods is evaluation of the performance of the system. The best approach is to estimate performance based on the high-level specifications of the system before starting the subsequent partitioning and synthesis phases: these phases waste a large amount of resources, which causes delays in delivering the end product and higher costs. The authors propose an approach to reduce the number of redesign cycles, allowing continuous adjustments of the specification based on results of the performance evaluation before the next steps in the method are taken. To deal with these problems, the authors have developed an HW-SW codesign method that supports the designer from specification to the final implementation of the system. They present a performance analysis tool that operates at the specification level and tracks the input-output behavior of the system.
The Perception of Inequalities
Authors: Lam Marie
Published: April 2004

While we know much about structural types of inequalities or the inferred principles of justice that the public use to evaluate inequality, we do not know much about the empirical and direct link between these structural locations, people’s principles and sentiments.Through interviews with 28 contemporary Hong Kong single middle-class educated women in their 20s, I explore how people understand and explain their (un)equal experiences in their immediate milieux and society with explicit reference to their principles of justice. This study of how and why these women endorse, accommodate or oppose gender inequalities illuminates how structural locations and principles of justice channel respondents’ feelings of acquiescence or resentment. It exposes the structural barriers that prevent respondents from perceiving, and hence resenting, inequalities. It specifies who is being equal to whom, what goals respondents value, and what principles of (in)equality they apply to various contexts. Respondents use the principles of equality or differentiation between the sexes to legitimize and de-legitimize unequal opportunities, although the gender gap in income is rarely identified as a critical type of inequality that arouses discontent.
Practitioners’ Views about Equity within Prenatal Services
Authors: Alderson Priscilla , Williams Clare , Farsides Bobbie
Published: April 2004

The British National Health Service (NHS) is based on principles of equal access, treatment and outcomes.This article reviews health professionals’ aims to provide equitable prenatal services and their views on whether women could be equal in their access to services, understanding during choice-making, and satisfaction about their care. Inequalities which compromise equity, conflicting meanings of equity, and the contribution of in-hospital ethics seminars to ethical health services are considered. Qualitative research, combining sociological and philosophical methods, investigated the experiences of health care staff attempting to provide equitable services and their practical and ethical problems. A total of 70 staff at a teaching hospital and a district general hospital took part in semi-structured interviews, followed by 11 innovative in-hospital ethics seminars based on themes derived from the interviews.The 56 seminar participants usually began with clear statements of their equitable aims, but, encouraged by the health care ethicist, they went on to discuss their many concerns about obstacles which complicated the achievement of these aims. The sociological-ethics seminars provided unique opportunities for multi-disciplinary discussion of these inequalities and their impact on equitable intentions in health care. Analysis of the contradictions revealed during the seminars is guided by sociological theories that seek to explain the persistence of inequalities in health, and how NHS policies appear to perpetuate and increase them, despite practitioners’ stated intentions to promote equality.
Controllable Laughter
Authors: Sanders Teela
Published: April 2004

This article contributes to the sociology of work by analysing the nature and prevalence of humour as a coping strategy in the sex industry. In conjunction with describing six different types of humour observed in the female sex industry, this article establishes humour as a form of ‘emotion work’ (Hochschild, 1979). Evidence from an empirical study of female prostitution in a large British city documents how sex workers consciously manipulate humour as a social and psychological distancing technique. First, humour is adopted as a business strategy where impression management and ‘body work’ (Tyler and Abbott, 1998) enable individuals to conform to the aesthetic ideal of the ‘prostitute’. Second, joking relations shape the emotions aroused by selling sex, manage client interaction and establish support networks with colleagues. They are also a vehicle for defining group membership, dissent and divisions. It is argued that these social and psychological processes are an example of how women in extreme professions perform ‘ emotion work’. In the case of sex workers, humour contributes to a range of defence mechanisms that are necessary to protect personal and emotional well being.
Punctualizing Identity
Authors: Munro Rolland
Published: April 2004

Questions of identity, the nuance of self to context or culture, continue to dominate despite a fashion to imagine ‘structures’ of class, status and ethnicity as becoming less demanding and, hence, more fluid and open to choice. In contrast to a picture of individuals suspended in fluids of their own making, this article introduces the idea of identity being punctualized: a ‘revealing’ of each specified identity within the here and now; and in response to the ‘demand’ of others. Accepting there is a positioning effect, requiring those making demands to be in a position to make their specific reading on identity, the article draws on Henry James’s novel The Ambassadors, to illustrate a timing effect, in which each ‘call’ demands a display of identity that annuls other ‘calls’ – precisely by overtaking these in the here and now. These demands arguably overlap with Heidegger’s formulation, in which the demanding relation is general and is presented as the effect of technology: technology transforms everything in nature, including ourselves, into things ‘standing in advance’. Relations are not attenuated, so much as it matters more what identity is being produced (and when).
AIDS and Security
Authors: Altman Dennis
Published: April 2004

The war on terrorism has drawn attention to non-conventional threats to security, even as it led to conventional warfare in the case of the attack on Iraq. HIV/AIDS is arguably an even greater threat to security, with the effect of destabilizing the social and economic order to the extent that the very survival of entire nations is at stake. This article examines both the security implications of AIDS, and the various international responses aimed at slowing its spread and mitigating its impact.
Huntington’s Shift to the Declinist Camp: Conservative Declinism and the ‘Historical Function’ of the Clash of Civilizations
Authors: Aysha Emad El-Din
Published: April 2004

Samuel Huntington, a severe critic of decline theory and an adamant revivalist, shifted radically to the declinist camp with the end of the Cold War, his penultimate declinist vision being found in The Clash of Civilizations. A chronological analysis of his work (intellectual biography), though, shows continuity in his analysis of what is ‘wrong’ with America. His true focus is not relative, but absolute decline, or normative (moral) decline, a concern he shares with the new declinists, that is, right-wing realists who were also revivalists. For them decline is a code word for what is wrong with America, normatively, and an instrument of mobilization to return America to a state they consider ideal. The clash of civilizations thesis is part of this project. Unlike these new declinists, Huntington is a Democrat who grounds his appreciation of the new declinists’ ‘conservatism’ in his analysis of America’s ‘liberal’ exceptionalism, which makes it difficult for the country to adopt a realist foreign policy.
Human Security and the Disaffected of Central Asia
Authors: Glenn John
Published: April 2004

Since the dissolution of the Soviet Union, Central Asia has witnessed a precipitous decline in the population’s welfare. This article argues that in order to ensure stability within the region, the human security of the peoples of Central Asia must be improved. To achieve such an outcome, it is argued that a Marshall Plan for contemporary times is required. Such a plan would involve the implementation of two major strategies. First, the policies of the international financial institutions and the trading practices between the Central Asian states and the industrialized countries should return to the principles of ‘embedded liberalism’ that guided the post-Second World War international economy for three decades. Second, the debt of these countries should be substantially reduced and, at the same time, welfare provision by these states should be raised as a result of this debt relief.
Tragedy, Ethics and International Relations
Authors: Frost Mervyn
Published: April 2004

This article considers the charge that scholars in the field of ethics in international relations have been remiss in not paying attention to tragedy in international affairs. The classical tragedies in drama had political content and were fundamentally concerned with ethical issues. Prima facie it would seem that tragedy would be pertinent to scholars researching international ethics. The case is made that the notion of tragedy is useful in normative international relations theory as it enables us to see ethical dilemmas clearly and to consider possible transformations of our international practices.
‘We the Peoples’: Contending Discourses of Security in Human Rights Theory and Practice
Authors: Dunne Tim , Wheeler Nicholas J.
Published: April 2004

This article develops a critical conception of security by showing the limits of traditional realist and pluralist discourses. It does this by exploring the deficiencies of realist and pluralist approaches when it comes to thinking about the promotion of human rights. Realism leads to moral indifference and a myopic approach to security and pluralism is complacent about how the rules and norms of international society exclude humanitarian concerns. The article argues for a critical approach to security that places human rights at the centre of theory and praxis, reflecting the fundamental indivisibility of security and human rights. The article concludes by reflecting on the implications for agency of this position.
Community Versus Deterrence: Managing Security and Nuclear Proliferation in Latin America and South Asia
Authors: Davies Simon J.
Published: April 2004

This article contrasts the quality of security afforded by evolving community values in Latin America with the alleged virtues of security founded on nuclear deterrent postures between India and Pakistan in South Asia. A case is made for ‘security through community’ as a preferred basis for long-term regional security planning and some thoughts are offered on the means by which common security practices may be fostered in regions where the risks of nuclear conflict remain high. Important similarities between the conflictual history of Argentine–Brazilian relations and the current Indo-Pakistani nuclear stand-off suggest that it may be possible to learn substantively from the Latin American experience. In particular, analysis of the evolving Argentine–Brazilian relationship suggests that the cooperative security practices associated with regional security regimes such as Nuclear Free Zones can play a significant part in positively transforming security relations between otherwise mistrustful states.
Mechano-Chemical Reclamationof Waste Rubber Powder andIts Effect on the performanceof NR and SBR Vulcanizates
Authors: Yehia A. A. , Ismail M. N. , Hefny Y. A. , Abdel-Bary E. M. , Mull M. A.
Published: April 2004

Waste rubber powder (RP) was processed in a Brabenderpremixer under various conditions in the presence of reclaiming agents toconvert the RP into plastic mass (reclaimed rubber), then the obtained reclaimwas blended with both NR and SBR in different ratios. It was found that thebehavior of the reclaim in both NR and SBR is the same. The rheometriccharacteristics show that by increasing the reclaim ratio, the curing time wasdecreased and consequently the cure rate index was increased. Also themaximum torque of the same rubber compounds was decreased.

The physico-mechanical data of the reclaim/NR and reclaim/SBR blends showthat the tensile strength as well as elongation at break were decreased withincreasing the reclaim ratio in the blend. On the other hand the equilibrium swellingwas increased. However one can replace about 10–30% of NR or SBR by thereclaim without sacrificing the essential characteristics of the rubber vulcanizates.
Effect of Ethylene Copolymers as Polymeric Compatibilizers for LDPE and PDMS Rubber Blends
Authors: Jana R. N. , Nando G. B.
Published: April 2004

The effect of different ethylene copolymers such as ethylenemethyl acrylate (EMA), ethylene vinyl acetate (EVA), ethylene acrylic acid(EAA) and an ionomer (Lotek-4200) as compatibilizers for 75: 25 blends of lowdensity polyethylene (LDPE) and poly dimethyl siloxane rubber (PDMS) havebeen studied. The results are based on physico-mechanical properties, thermalanalysis, phase morphology, dynamic mechanical properties and X-raydiffraction (XRD) studies. It has been observed that mechanical properties of theblends improve with the incorporation of compatibilizers. A study of lap shearadhesion strength of the blend shows an increase in adhesion strength as thecompatibilizer concentration is increased in the system up to a certain level ofcompatibilizers. Phase morphology studies by scanning electron microscope(SEM), show a reduced domain size (2–5 mm) for the compatibilized blend.Dynamic mechanical analysis also supports the strong interaction of thecompatibilizer with the blend constituents. Thermogravimetric analysis indicates anincrease in thermal stability of the blends with the addition of compatibilizers.
Study on Viscoelastic Propertiesof Cord–Rubber CompositeSubjected to Biaxial Loading
Authors: Zhang Fengfa , Fan Zhihui , Du Xingwen , Kuang Zhengbang
Published: April 2004

Creep and stress relaxation behaviors of unidirectional nylon6–rubber composite under biaxial tensile loading are studied in this paper.Experiments of creep and stress relaxation are performed at room temperatureat different stress levels and different strain levels on both longitudinal andtransverse directions respectively. The influence of different stress levels oncreep strain and the interaction between longitudinal and transverse stressesare studied. Similar analyses are conducted to assess stress relaxation whenspecimens are subjected to biaxial tensile loading. These analyses provide solidexperimental foundation for understanding nylon6–rubber compositeproperties. A new relaxation-type constitutive model is presented for predicting stressrelaxation behaviors under biaxial tensile condition. In this model, octahedralshear strain is introduced as a variable parameter, which is related tolongitudinal strain and transverse strain respectively. Schapery unidirectionalintegral model and the least square method are applied to determine parametersin the constitutive model. Comparisons of experimental data with theoreticalcurves are made and good agreements are obtained for rubber compositesubjected to biaxial tensile loads.
HIV Treatment in African Americans: Challenges and Opportunities
Authors: Cargill Victoria A. , Stone Valerie E. , Robinson M. Renee
Published: April 2004

This article reviews the current standard of care for HIV infection as well as how health disparities in the HIV care of African Americans present challenges for both providers and patients. The potential side effects in these antiretroviral treatment regimens that may be a source of additional challenges in treating African Americans are highlighted. A brief review of these issues as they relate to treatment adherence further demonstrates how adherence is closely linked to the medical and psychosocial issues African Americans face including access to HIV care services. The article concludes with a discussion of gender-related issues that affect treatment and that may confound effective behavioral interventions aimed at reducing HIV risk and increasing treatment adherence.
Economic Growth in Washington: An Examination of Migration Response and a Test of Model Accuracy
Authors: Yeo JunHo , Holland David
Published: April 2004

This study develops a regional econometric model to extend and complement input-output economic impact analysis. Following the tradition of “linking” econometric and input-output models, this work extends the previous linear econometric specification to a more accurate nonlinear form. It also extends previous specification of these models to address the issue of job creation and job capture by residents. The resulting empirical model is based on a cross-sectional econometric analysis of allWashington counties. The use of the estimated econometric model is illustrated with a real job growth scenario using the growth in jobs between 1990 and 1997 for each Washington county. The simultaneous equation model evaluated by examining how closely the estimated population variable tracks its actual values in 1997. The rootmean square (RMS) percent error for population was 5.46 percent. Most of the new jobs are captured by immigrants instead of county residents. However, the positive long-run effect of job growth on labor force participation remains, though its effect is small.
Christian Conservatives Go to Court:Religion and Legal Mobilization in the united States and Canada
Authors: Hoover Dennis R. , den Dulk Kevin R.
Published: April 2004

The American exceptionalism thesis holds that American political culture produces an unusually litigious society. The US Christian right has participated in litigation, especially in constitutional rights cases dealing with issues such as religious schools and abortion. However, since 1982 Canada has had a constitutional Charter of Rights and an increasingly active Christian right of its own. We compare data on Christian right involvement in education, abortion, and “right to die” (euthanasia, assisted suicide or mercy killing) cases at the Supreme Court level in both countries. Among North America’s Christian conservatives, exceptionalism has eroded, but not disappeared. We employ interviews and data on religious interest groups to analyze the sources of legal mobilization, and find that it is a matter not just of political culture, but also resource mobilization, political opportunity structures, and religious worldviews.
The Place of Power in Political Discourse
Authors: Newman Saul
Published: April 2004

This article examines the concept of a central, symbolic place of power in political theory. I trace the genealogy of “place” from sovereign conceptions of power in classical political theory to the problem of state power in radical politics. I then examine the theoretical and political implications of Foucault’s reconfiguration of the concept of power, in particular, his contention that power does not have a place, but rather, is dispersed throughout the social network. I argue that this decentralization of the concept of power denies a universal dimension that “sutures” the political field. I critically engage with the limitations and flaws of Foucault’s theory of power, and turn to the work of Lefort and Laclau for a more viable understanding of the relationship between power, its place or non-place, and the contemporary possibilities for radical politics.
The American System of Separated Government: An Historical-Institutional Interpretation
Authors: Fabbrini Sergio
Published: April 2004

How should one define the American system of government? Sometimes, especially among non-American scholars, it is taken for granted that the American is a presidential system, or that it is the archetype of presidentialism. At other times, especially among American scholars, it is taken for granted that it incarnates the separation of power system envisioned by Madison. An historical-institutional analysis shows that both interpretations are unsatisfactory. The American system is better defined as a system of separated government which experienced different institutional pre-eminances during its two centuries of democratic history. The very same Constitution allowed a long period of congressional and then of presidential pre-eminence, recently tamed by a regime of divided government.
Sustainable Development: Exploring the Ethics of Our Common Future
Authors: Langhelle Oluf
Published: April 2004

The concept of sustainable development was placed on the international agenda with the release of the report Our Common Future by the World Commission on Environment and Development in 1987. Although considerable attention has since been devoted to the idea of sustainable development itself, the broader conceptual framework of the idea—whereby the Commission tried to integrate environmental policies and development strategies in order to create the foundation for a global partnership—has been neglected in much of the literature. The purpose of the present article is to offer an interpretation of Our Common Future, where the concept of sustainable development is linked to the broader framework of normative preconditions and empirical assumptions. The structure of the argument is to demonstrate that the relationship between sustainable development and economic growth has been over-emphasized, and that other vital aspects of the normative framework have been neglected. Social justice (both within and between generations), humanistic solidarity, a concern for the world’s poor, and respect for the ecological limits to global development, constitute other aspects of sustainable development; aspects which are indeed relevant for the growing disparity between North and South.
Economic Instruments for Environmental Protection: Can We Trust the “Magic Carpet”?
Authors: Bressers Hans Th. A. , Huitema Dave
Published: April 2004

Economic instruments appear at first to be a promising alternative to regulations as instruments of environmental policy. Because they put market forces to work for the goal of a sustainable society, they are often portrayed as achieving goals at much lower costs. In this sense, economic instruments appear as a type of “magic carpet” for the trip to sustainable development. The article presents a “pre-flight check” of the carpet’s viability, and finds several potential design problems. Economic instruments in practice often don’t comply with the underlying economic theory. Further, the dominating notion of cost-effectiveness is only one of many criteria which policy-makers must taken into account in the real world. It is not a question of “good science” vs. “bad politics,” but a recognition that politics has a rationality of its own. The lessons learned from analyses of policy-making and implementation deserve, therefore, equal attention with the presupposed behavioral reactions of key target groups. Issues to be taken into account include the interests of the actors involved, and the institutional contexts of both policy-making and policy-learning. Such factors are discussed by using them to shed light on observed deviations in instrument design.
The Politics of Sustainable Development: Emergent Arenas and Challenges for Political Science
Authors: Meadowcroft James
Published: April 2004

There has been a remarkable evolution in environment-related policy-making at both national and international levels during the ten years since the Report of the Brundtland Commission formulated its well-known appeal for sustainable development. This article examines three developments in industrialized countries which appear to be closely associated with national efforts to engage with sustainable development: (1) the preparation of national environmental policy plans and strategies for sustainable development; (2) the growth of patterns of multi-partite environmental governance; and (3) the emergence of Sustainable Cities and Local Agenda 21 initiatives. It is argued that these phenomena, as well as a series of other important changes in approaches to the management of environmental burdens now occurring in contemporary societies, require serious attention from political scientists.
Analysts Analyzed: A Socio-Economic Approach to Financial and Emerging Markets
Authors: Santiso Javier
Published: April 2004

The reaction time of financial markets presently constitutes one of the major challenges facing the state. Using the results of a qualitative research study, this article formulates and discusses an hypothesis concerning the short-termism of financial markets by presenting an analysis of the temporal horizons and cognitive maps of actors who “make or break” prices on emerging markets. Behind the power of the market hides a multitude of actors, analysts, strategists, economists, and portfolio managers who constitute a veritable epistemic community with its own dynamic of opportunity and constraint. The aim in this article is to unravel the various strands in the tapestry that weaves the interactions of those who “make the market.” It is not embroidered by the invisible hand of God, or the devil, but, more simply, by the unceasing anticipations and interactions of a myriad of analysts and investors who draw their breath from Wall Street.
Power, Connected Coalitions, and Efficiency: Challenges to the Council of the European Union
Authors: Hosli Madeleine O.
Published: April 2004

This article is concerned with challenges to reforming the voting procedures of the Council of the European Union (EU). The next major waves of EU enlargement will cause the Union to increase to a membership of first twenty-one, and then twenty-six or possibly even more states. How does enlargement affect the Council's inherent “capacity to act” under the currently used qualified majority voting rule? It is demonstrated here that the expected increase in EU membership will most likely induce a larger “status quo bias” as compared to the present situation in the Council if the crucial majority decision quota is not lowered. In addition, the article is responding to some criticism that has been applied against assessing the leverage of EU governments in one of the EU's most important institutions: the Council of the EU. By resorting to techniques that capture the influence of a priori coalitions on the one hand and “connected coalitions” among EU governments on the other—applying n-person cooperative game theory—the piece illustrates how the assessment of relative voting leverage in the framework of weighted voting systems may be extended and applied to situations in which the specific distribution of members' preferences is known. These calculations are again relevant in the face of the upcoming rounds of EU enlargement and projects for institutional reform.
The Internationalizing Smaller Craft Firm
Authors: Fillis Ian
Published: April 2004

Craft sector analysis was carried out in order to determine the range of factors impinging upon domestic and export market behaviour. Existing craft sector research is practitioner specific, with little evidence of theoretical rigour. Internationalization theories are discussed, and the conclusion made that the majority of these frameworks fail to readily explain smaller firm internationalization behaviour generally and craft firm behaviour in particular. A pluralistic research methodology was followed. Quantitative results identified the majority of firms as micro-enterprises with those firms exhibiting entrepreneurial flair achieving significant amounts of turnover, despite severe resource constraints. The main export markets were European Union countries and North America. Combining the qualitative and quantitative results enabled profiling of craft firm types. Four orientations were uncovered: the entrepreneur, the idealist, the ‘lifestyler’ and the latecomer. Implications include promotion of the belief that the Marketing/Entrepreneurship interface paradigm provides additional understanding of smaller firm internationalization.
Anxiogenic-Like Effect of Corticotropin-Releasing Factor Receptor 2 Antisense Oligonucleotides Infused into Rat Brain
Authors: Isogawa Koichi , Akiyoshi Jotaro , Tsutsumi Takashi , Kodama Kensuke , Horinouti Yukiko , Nagayama Haruo
Published: April 2004

Corticotropin-releasing factor (CRF) is widely distributed in the brain and coordinates behavioural responses to stress. Its receptor subtypes, CRF-R1 and CRF-R2, are expressed in the brain. For this study, we tested the effect of a continuous infusion of CRF-R2 antisense oligonucleotides into the lateral ventricle on anxiety-related behaviours in rats. Our results indicate that CRF-R2 antisense oligonucleotides produced an anxiogenic-like effect in elevated plus maze, black and white box and conditioned fear stress in rats. No significant effect on general locomotor activity was seen. These results indicate that inhibition of CRF-R2 induces an increase in anxiety-related behaviours suggesting an anxiogenic-like effect.
Patterns of Drug Use and the Influence of Gender on Self-Reports of Memory Ability in Ecstasy Users: A Web-Based Study
Authors: Rodgers J. , Buchanan T. , Scholey A. B. , Heffernan T. M. , Ling J. , Parrott A. C.
Published: April 2004

Research indicates that the use of recreational drugs, including MDMA (‘ecstasy’) can result in impairments in cognitive functioning. Recent evidence, based on accounts of ‘on drug’ effects and cortical binding ratios suggests that women may be more susceptible to the effects of MDMA; however, no research has explored whether there are differences in the long-term behavioural sequelae of the drug between men and women. In addition, little is known about the profile of functioning of the ‘typical’ user. The present investigation accessed a large sample of recreational drug users, using the Internet, to obtain self-reports of memory functioning with a view to exploring any differences in self-reported ability amongst male and female users, and the level of difficulty reported by the ‘typical’ ecstasy user. A web site (www.drugresearch.org.uk) was developed and used for data collection. Prospective memory ability was assessed using the Prospective Memory Questionnaire. Self-report of day-to-day memory performance was investigated using the Everyday Memory Questionnaire. The UEL Drug Questionnaire assessed the use of other substances. The number of mistakes made while completing the questionnaires was also taken as an objective measure of performance errors. Findings, based on datasets submitted from 763 respondents, indicate no differences in self-reports of functioning between male and female participants. An overall dissociation between the effects of cannabis and ecstasy on self-reported memory functioning and on the likelihood of making an error during the completion of the questionnaire was found. Typical ecstasy users were found to report significantly more difficulties in long-term prospective memory and to make more completion errors than users of other substances and drug naïve controls. Whilst taking into account the fact that participants were recruited via the World Wide Web and that a number of stringent exclusion criteria were applied to the data, a number of conclusions can be drawn. Recreational drug users perceive their memory ability to be impaired compared to non-users. The type of memory difficulties reported varies depending upon the drug of choice. These difficulties are exacerbated in ecstasy users. Individuals reporting average levels of use of ecstasy are more likely to report memory problems than non-ecstasy drug users or drug free individuals. The deleterious effects of ecstasy are therefore not restricted to heavy or chronic users. No gender differences were detected, suggesting that there may be a dissociation between cognitive impairment and cortical binding worthy of further exploration.
Psychopharmacological Treatment of Depression, Anxiety, Irritability and Insomnia in Patients Receiving Interferon-α: a Prospective Case Series and a Discussion of Biological Mechanisms
Authors: Maddock Clementine , Baita Antonella , Orrù M. Germana , Sitzia Rossella , Costa Alessandra , Muntoni Elisabetta , Farci M. Giulia , Carpiniello Bernardo , Pariante Carmine M.
Published: April 2004

We studied 60 patients receiving a 1-year course of interferon (IFN)-αtherapy for chronic viral hepatitis. Patients underwent psychiatric assessment before starting the IFN-αtherapy, and monthly throughout the therapy, using the Structured Clinical Interview for the DSM-III-R, the 17-item Hamilton Depression Rating Scale, the Beck Depression Inventory and the Spielberg State and Trait Anxiety Inventory. Five patients had a baseline diagnosis of major depression and 18 (30%) developed an IFN-α-induced psychiatric adverse effect; 12 of these 23 patients received psychopharmacological treatment (patients and clinicians jointly decided the need for treatment). Two of the five patients with baseline depression started an antidepressant treatment (paroxetine) together with the IFN-α and successfully completed the IFN-αtherapy. Ten patients received treatment for the IFN-α-induced psychiatric adverse effects (depression in five patients, anxiety in two patients, severe irritability in two patients and insomnia in one patient). Depression was treated with paroxetine, amisulpride or levosulpiride; anxiety and insomnia were treated with benzodiazepines; and irritability was treated with thioridazine. Individual response to medications was measured with the Clinical Global Impression scale. Of the patients with IFN-α-induced depression, two received paroxetine (one showed a good response), two received amisulpride (one showed a good response) and one did not respond to levosulpiride but responded to paroxetine. The patients experiencing anxiety or insomnia responded well to benzodiazepines. One patient showed a good response, and one a poor response, to thioridazine for irritability. Only one patient interrupted the therapy because of psychiatric adverse effects. Overall, the 12 patients that received psychopharmacological treatment developed less severe psychopathological symptoms during the IFN-αtherapy compared to the 11 patients who had untreated baseline depression or untreated IFN-α-induced psychiatric adverse effects. Thus, psychopharmacological management can successfully treat psychiatric symptoms in patients who are receiving IFN-α.
Heat Stroke in Schizophrenia During Clozapine Treatment: Rapid Recognition and Management
Authors: Kerwin R. W. , Osborne Sarah , Sainz-Fuertes Ricardo
Published: April 2004

A case of heatstroke is reported in a 32-year-old man diagnosed with schizophrenia and on clozapine monotherapy. The importance of the need to avoid misdiagnosing heat stroke as neuroleptic malignant syndrome is reviewed.
Management of diabetes mellitus occurring during treatment with olanzapine: report of six cases and clinical implications
Authors: Ashim S. , Warrington S. , Anderson I. M.
Published: April 2004

In spite of conflicting reports, there is emerging evidence that at least two of the atypical antipsychotics, clozapine and olanzapine, are associated with an increased risk of developing glucose dysregulation or new onset diabetes mellitus. We report on the management of six patients who developed diabetes mellitus following treatment with olanzapine, five of whom had independent risk factors for diabetes. Olanzapine was changed to quetiapine in all patients with improvement in glycaemic control in two patients. In view of the uncertainty of the size and mechanism of the link between olanzapine and diabetes, we discuss issues surrounding routine clinical management and monitoring of patients on antipsychotics and the clinical implications.
P-glycoprotein reduces the ability of amitriptyline metabolites to cross the blood brain barrier in mice after a 10-day administration of amitriptyline
Authors: Grauer Markus T. , Uhr Manfred
Published: April 2004

P-glycoprotein (P-gp) is a 170-kDa membrane protein and the gene product of the multiple drug resistance ( MDR1 or ABCB1) gene. It constitutes an important part of the blood–brain barrier and actively exports a number of molecules across the blood–brain barrier back into the vascular space, subsequently reducing central nervous system (CNS) bioavailability of these substances. The aim of the present study was to investigate the pharmacokinetics of amitriptyline and its metabolites in P-gp (also called mdr1ab or abcb1ab) knockout mice and controls after a long-term adminstration for 10 days. Knockout mice and controls received s.c. injections of amitriptyline (10 µg/g bodyweight) twice daily for 10 days. After 10 days, the animals were sacrificed and the concentrations of amitriptyline and nortriptyline and both their E-10-OH and Z-10-OH metabolites were measured with high-performance liquid chromatography in the cerebrum, plasma, spleen, kidney, testes, lung, liver, muscle and fat. Except for amitriptyline, the brain concentrations of all other examined substances were significantly higher in the P-gp knockout mice. Compared to controls, concentrations of nortriptyline were 2.6-fold higher, E-10-OH-nortriptyline 10-fold higher, Z-10-OH-nortriptyline seven-fold higher, E-10-OH-amitriptyline two-fold higher and Z-10-OH-amitriptyline five-fold higher. The present study confirms that P-gp plays an important role in the interaction between CNS drugs and the blood–brain barrier. Without P-gp at the blood–brain barrier, the brain concentrations of the substances were up to 10-fold higher, showing that P-gp plays an active role in exporting CNS drugs out of the brain. Recent clinical studies showing different side-effects in patients with P-gp polymorphisms confirm the clinical importance of these findings.
Optimal Allocation of Resources across Four Interventions for Type 2 Diabetes
Authors: Earnshaw Stephanie R. , Richter Anke , Sorensen Stephen W. , Hoerger Thomas J. , Hicks Katherine A. , Engelgau Michael , Thompson Ted , Venkat Narayan K. M. , Williamson David F. , Gregg Edward , Zhang Ping
Published: April 2004

Background

Several interventions can be applied to prevent complications of type 2 diabetes. This article examines the optimal allocation of resources across 4 interventions to treat patients newly diagnosed with type 2 diabetes. The interventions are intensive glycemic control, intensified hypertension control, cholesterol reduction, and smoking cessation.

Methods

A linear programming model was designed to select sets of interventions to maximize quality-adjusted life years (QALYs), subject to varied budget and equity constraints.

Results

For no additional cost, approximately 211,000 QALYs can be gained over the lifetimes of all persons newly diagnosed with diabetes by implementing interventions rather than standard care. With increased availability of funds, additional health benefits can be gained but with diminishing marginal returns. The impact of equity constraints is extensive compared to the solution with the same intervention costs and no equity constraint. Under the conditions modeled, intensified hypertension control and smoking cessation interventions were provided most often, and intensive glycemic control and cholesterol reduction interventions were provided less often.

Conclusions

A resource allocation model identifies trade-offs involved when imposing budget and equity constraints on care for individuals with newly diagnosed diabetes.
Cost-Effectiveness of the Pneumococcal Vaccine in Healthy Younger Adults
Authors: Vold Pepper Patricia , Owens Douglas K.
Published: April 2004

Objectives

Routine vaccination for Streptococcus pneumoniae has been recommended as a cost-effective measure for elderly and immunocompromised patients, yet no analysis has been performed for healthy younger adults in America. The authors evaluated the cost-effectiveness of the pneumococcal vaccine and determined the net health benefits conferred for the healthy young adult population.

Methods

The authors developed a decision model to compare the health and economic outcomes of vaccinate versus do not vaccinate for S. pneumoniae.

Results

Vaccinating patients for S. pneumoniae generates benefits that are dependent on incidence rates and the efficacy of the vaccine. In the 22-year-old patient with a pneumonia incidence of 0.3/1000, the vaccine would need to be >71 percent effective for the vaccination strategy to cost less than $50,000/QALY gained. At an incidence of 0.4/1000, the threshold efficacy is 53 percent, whereas at 0.5/1000 it is 43 percent. In the 35-year-old patient where the incidence of pneumococcal pneumonia is higher (0.85/1000), the vaccine would be cost-effective with an efficacy as low as 30 percent.

Conclusions

Use of the S. pneumoniae vaccine in young adults would provide modest reductions in pneumonia-associated morbidity and mortality. Vaccination of young adults is moderately expensive unless vaccine efficacy is above 50% to 60%. In 35-year-old adults, use of the vaccine is cost-effective even with moderate efficacy.
The Impact of Expected HIV Transmission Rates on the Effectiveness and Cost of Ruling Out HIV Infection in Infants
Authors: Mrus Joseph M. , Yi Michael S. , Eckman Mark H. , Tsevat Joel
Published: April 2004

Objective

To quantify the costs and effectiveness of different strategies for ruling out HIV infection in infants born to HIV-infected mothers in the United States.

Methods

The authors assessed 4 different testing strategies that incorporated serial HIV DNA polymerase chain reaction (PCR) testing with or without enzyme-linked immunosorbent assay (ELISA) antibody testing. Testing costs, false reassurance rates, and incremental cost-effectiveness ratios were compared for the 4 strategies.

Results

In HIV-exposed infants, HIV DNA PCR testing at birth, 1 month, and 4 months of age results in a false reassurance rate of 21 per million (at a 2% transmission rate). Adding an ELISA test lowers the false reassurance rate to 0.052 per million at a cost of $570,000 per additional case detected; adding another PCR lowers the false reassurance rate to 1.49 per million at a cost of $720,000 per additional case detected compared with the 3-PCR strategy. At a high transmission rate (20%), there would be substantially more erroneously negative results (false reassurance rate is 256 per million with PCR testing at birth, 1 month, and 4 months) and consequently more favorable cost-effectiveness ratios with additional testing: $47,000 per additional case detected by adding 1 ELISA test and $59,000 per additional case detected by adding an other PCR test.

Conclusions

False-negative HIV results after serial testing in exposed infants are rare, and the incremental cost-effectiveness ratios of additional tests are substantial at low transmission rates. However, the false reassurance rate increases considerably with a 3-PCR strategy and additional testing becomes more cost-effective at greater transmission rates; therefore, additional testing may be warranted in infants at greater risk of infection.
Cost-Benefit Analysis of a New HEDIS Performance Measure for Pneumococcal Vaccination
Authors: Ahmed Faruque , Elbasha Elamin E. , Thompson Betsy L. , Harris Jeffrey R. , Sneller Vishnu-Priya
Published: April 2004

Objectives

Measurement of the quality of care provided by managed care organizations (MCOs) has achieved national prominence, though there is controversy regarding its value. This article assesses the economic implications of a new Health Plan Employer Data and Information Set (HEDIS®) measure for pneumococcal vaccination.

Methods

A Markov decision model, with Monte Carlo simulations, was utilized to conduct a cost-benefit analysis of annual HEDIS-associated interventions, which were repeated for 5 consecutive years, in an average Medicare MCO, using a societal perspective and a 3% annual discount rate.

Results

Compared with the status quo, the HEDIS intervention will be cost saving 99.8% of the time, with an average net savings of $3.80 per enrollee (95% probability interval: $0.73–$6.87).

Conclusions

The new HEDIS measure will save societal dollars. This type of analysis is essential if performance measurement is to become a legitimate part of our health care landscape.
Assessing Preferences for Prevention versus Treatment Using Willingness to Pay
Authors: Corso Phaedra S. , Hammitt James K. , Graham John D. , Dicker Richard C. , Goldie Sue J.
Published: April 2004

Background

Rising health care costs and limited resources necessitate trade-offs between resources allocated toward prevention and those toward treatment. Information from opinion polls suggests citizens favor spending a higher proportion of all health care dollars on prevention rather than treatment.

Objectives

To assess the policy implications of willingness to pay (WTP) for use in cost-benefit analysis (CBA) as a method for capturing individual preferences for prevention and treatment in the context of resource allocation decisions.

Methods

The authors recruited a random sample of 1456 US residents age 18 years and greater by telephone using random-digit dialing. The survey was designed as a 3-stage (phone-mail-phone) process and was conducted between December 1998 and March 1999. For all persons completing the survey (N = 1104), the authors 1st collected respondents’ opinions about the costs and effectiveness of prevention versus treatment programs in general. Half of respondents were then asked to state their WTP for a hypothetical prevention scenario and half were asked to state their WTP for a hypothetical treatment scenario. Both scenarios were specific to the same health context and included an identical reduction in mortality risk.

Results

WTP for treatment was significantly greater than WTP for prevention, $665 and $223, respectively. Prior opinions on the relative effectiveness afforded by preventive and treatment interventions moderately influenced the WTP estimates for persons randomized to either scenario. Prior opinions on costs had no significant effect on WTP estimates for either scenario. WTP significantly increased with age and household income in the full sample but was not significantly affected by gender or educational attainment.

Conclusions

The aggregated WTP responses from the prevention and treatment scenarios presented in our study would imply that treatment is more strongly preferred by society than prevention when the health context is the same and benefits of each are held constant. A better understanding is needed of the discrepancy between citizens’ stated preferences for prevention (e.g., through polling) and our findings that they were willing to pay substantially more for treatment than for prevention.
The Relationship between the Visual Analog Scale and the SF-36 Scales in the General Population: An Update
Authors: Shmueli Amir
Published: April 2004

Objective. To update the 1993 relationship between the visual analog scale (VAS) and the 8 SF-36 scales found in the Israeli Jewish urban population aged 45 to 75 years and reported inMedical Decision Making (1999;19:122–7). Methods. Interviews with a sample of 2505 persons representing the same population in 2000 were used to estimate the above relationship. Results. The distributions of the VAS and the SF-36 8 scales were similar in 1993 and in 2000. In 2000, the Role-Emotional scale was not associated with the VAS, while the General Health scale proved to be its major determinant. Generally, the effects of the SF-36 scales on the VAS did not change between 1993 and 2000. Discussion. The relationship between the VAS and the SF-36 scales was found generally stable in the general population between 1993 and 2000, controlling for sociodemographic changes. The estimated relationship might be useful in predicting VAS scores from SF-36 scales in the general population.