bluuebunny/crossref_metadata_2025 huggingface dataset:
Leibniz on Conatus, Causation, and Freedom
Authors: CARLIN LAURENCE
Published: November 2004

Abstract:  In this paper, I address the topic of free will in Leibniz with particular attention to Leibniz's concept of volition, and its analogue in his physics – his concept of force. I argue against recent commentators that Leibniz was a causal determinist, and thus a compatibilist, and I suggest that logical consistency required him to adopt compatibilism given some of the concepts at work in his physics. I conclude by pointing out that the pressures to adopt causal determinism in Leibniz's system are perhaps more severe than those facing the contemporary libertarian, pressures that stem from empirical considerations about the behavior of bodies in the physical world, and the “well‐founding” of those bodies in simple substances.
Luminosity and the Safety of Knowledge
Authors: NETA RAM , ROHRBAUGH GUY
Published: November 2004

Abstract:  In his recent Knowledge and its Limits, Timothy Williamson argues that no non‐trivial mental state is such that being in that state suffices for one to be in a position to know that one is in it. In short, there are no “luminous” mental states. His argument depends on a “safety” requirement on knowledge, that one's confident belief could not easily have been wrong if it is to count as knowledge. We argue that the safety requirement is ambiguous; on one interpretation it is obviously true but useless to his argument, and on the other interpretation it is false.
The Cartesian Context of Berkeley's Attack on Abstraction
Authors: OTT WALTER R.
Published: November 2004

Abstract:  I claim that Berkeley's main argument against abstraction comes into focus only when we see Descartes as one of its targets. Berkeley does not deploy Winkler's impossibility argument but instead argues that what is impossible is inconceivable. Since Descartes conceives of extension as a determinable, and since determinables cannot exist as such, he falls within the scope of Berkeley's argument.
The Place of Semantic Theory
Authors: WEISS BERNHARD
Published: November 2004

Abstract:  Some twenty years since its publication Putnam's model‐theoretic argument is still much discussed. The present paper aims to defend a reconstruction of the argument but begins by attempting to clarify the form of the argument. Usually, and with good textual grounds, the argument is treated as a reductio argument against metaphysical realism. I argue instead that it should be treated as developing a paradox. I go on to claim that the most promising response to this paradox is to be able to provide a theory of (Fregean) sense, in the style recommended by Dummett. So, according to this reasoning, the argument is not an argument against metaphysical realism but an argument against positions which reject the notion of sense.
Social Justice in European Contract Law: a Manifesto
Authors:   Study Group on Social Justice in European Private Law
Published: November 2004

The Study Group on Social Justice in European Private Law are: Gert Brüggemeier (Bremen), Mauro Bussani (Trieste), Hugh Collins (London), Aurelia Colombi Ciacchi (Bremen), Giovanni Comandé (Pisa), Muriel Fabre‐Magnan (Nantes), Stefan Grundmann (Berlin), Martijn Hesselink (Amsterdam) (Chairman), Christian Joerges (Florence), Brigitta Lurger (Graz), Ugo Mattei (Torino), Marisa Meli (Catania), Jacobien Rutgers (Amsterdam), Christoph Schmidt (Florence), Jane Smith (Bremen), Ruth Sefton‐Green (Paris), Horatia Muir Watt (Paris), Thomas Wilhelmsson (Helsinki).
An algorithm‐based genotypic resistance score is associated with clinical outcome in HIV‐1‐infected adults on antiretroviral therapy
Authors: Ormaasen V , Sandvik L , Åsjø B , Holberg‐Petersen M , Gaarder PI , Bruun JN
Published: November 2004

Objectives

The aim of this study was to evaluate the association between genotypic drug resistance and the occurrence of HIV‐related diseases and death in HIV‐1‐infected adults on antiretroviral therapy.

Methods

We performed an observational study on patients from an out‐patient clinic in a university hospital. Genotypic drug resistance analysis after virological treatment failure was performed in 141 patients receiving two or more antiretroviral drugs. All patients had follow up of at least 6 months after the resistance test. An algorithm was developed to estimate the level of genotypic drug resistance and to assign an actual resistance score (ARS) for the drugs prescribed to each patient. The patient population was divided into quartiles according to patients' ARS values. Our endpoint was the risk of developing an HIV‐related disease [Centers for Disease Control and Prevention (CDC) category B or C] during the period starting 6 months prior to and ending 6 months after the genotypic resistance test, or death during the 6 months following the resistance test.

Results

There was a significant association between the level of resistance to the drugs prescribed (ARS) and our clinical endpoint: the odds ratio for an endpoint (with 95% confidence interval) was 3.20 (1.28–7.99), adjusted for CD4 cell count and HIV RNA, in patients in the highest ARS quartile compared with patients in the other three quartiles.

Conclusions

Our study indicates that patients with high‐level genotypic drug resistance are at increased risk of developing an HIV‐related disease. This association could not be explained by differences in CD4 cell count or HIV RNA levels.
Merkel cell carcinoma and multiple basal cell carcinoma in an African albino woman with HIV infection
Authors: Colebunders R , Bottieau E , Van den Brande J , Colpaert C , Van Marck E
Published: November 2004

A 25‐year‐old HIV‐infected African albino woman developed an aggressive Merkel cell carcinoma on her face and at least 10 basal cell carcinomas, mainly on sun‐exposed parts of her body. HIV infection, immune deficiency and sun exposure are known risk factors for the development of Merkel cell carcinoma. Chemotherapy and radiotherapy were only temporarily successful. She died shortly after surgery was performed to remove the tumour.
The Ethics of History: From the Double Binds of (Moral) Meaning to Experience
Authors: ANKERSMIT F. R.
Published: November 2004

Fidelities. Now that she has brought it out, she recognizes it as the word on which all hinges.

J. M. Coetzee, Elizabeth Costello, 224.

The point of departure of this essay is a paradox in traditional conceptions of historical objectivity. This paradox can best be analyzed in terms of the notion of the “double bind”: the requirement of historical objectivity is formulated in such a way that it is impossible to satisfy the requirement. The substance of this essay is an investigation of how J. M. Coetzee deals with the moral impasses of this double bind in his most recent novel, Elizabeth Costello (2003). In essence Coetzee forces his way through the double bind by an appeal to a direct experience of the world. The Spinozism implied by this strategy is indicated at the end of the essay. The analysis of Coetzee's novel is preceded by a discussion of Kafka's “Before the Law,” since the relevant part of Coetzee's novel clearly is a paraphrase of the Kafka parable. Moreover, insight into the textual double binds in the Kafka parable contributes to an understanding of the moral double binds that are addressed in Elizabeth Costello.
How to Overcome Ethnocentrism: Approaches to a Culture of Recognition by History in the Twenty‐First Century1
Authors: RÜSEN JÖRN
Published: November 2004

Die wahre Liberalität ist Anerkennung.

Goethe2

Much international and intercultural discourse about historiography is influenced by a way of historical thinking deeply rooted in human historical consciousness and that works throughout all cultures and in all times: ethnocentrism. Ethnocentric history conceives of identity in terms of “master‐narratives” that define togetherness and difference as essential for identity in a way that causes tension and struggle. These narratives conceive of history in terms of “clashes of civilizations,” and they reinforce the idea that international and intercultural relations are merely struggles for power.

The main elements of ethnocentrism are: asymmetrical evaluation, teleological continuity, and centralized perspective. This essay articulates possibilities for overcoming these three elements by replacing asymmetrical evaluation with normative equality; teleological continuity with reconstructive concepts of development that emphasize contingency and discontinuity; and centralized perspectives with multi‐perspectivity and polycentric approaches to historical experience. Adopting these possibilities would lead to a new mode of universal history rooted in a concept of humankind that can help solve the problem of ethnocentrism. This idea of humankind conceptualizes the unity of the human species as being manifest in a variety of cultures and historical developments. This is in fact the traditional concept of historicism, which can be further developed towards a historiography that responds to the challenges of globalization and cultural differences.

The essay outlines theoretical and methodological means in historical studies that bring this idea of humankind into the work of historians, thus enabling them to contribute to a new culture of recognition. The article is based on the assumption that the creation of such a culture is the most important task of scholarly work in the humanities in general, and historical studies in particular, at the beginning of the twenty‐first century.
Restorative Justice – Is More Better? The Experience of Police‐led Restorative Cautioning Pilots in Northern Ireland
Authors: O'Mahony David , Doak Jonathan
Published: November 2004

Abstract: In recent years there has been a considerable growth in the use of restorative justice schemes, particularly for young offenders. This article describes how two police‐led restorative cautioning pilots for juveniles operated in Northern Ireland. The pilots were found to offer a number of distinct advantages over the traditional cautioning practice and helped secure some of the values of restorative justice. However, they were not without fault and the research found evidence of ‘net‐widening’, whereby some offenders appeared to have been drawn into the schemes unnecessarily. It was also evident that the schemes required significant resources in order to involve participants (particularly victims) and to operate effectively. In light of the government's intention to greatly expand restorative practice in Northern Ireland generally, this article argues for the need to do so with care, if the quality of restorative justice is not to be compromised.
The Future of Remand Custody and its Alternatives in Belgium
Authors: Raes An , Snacken Sonja
Published: November 2004

Abstract: Searching for solutions to Belgian prison overcrowding, the authors examine how both the admissions into remand and the average length of remand custody can be reduced. Belgian alternatives to remand custody are compared to foreign initiatives aiming either at limiting the application of remand custody (judicial authorisation, regional quota, legal restrictions and guidelines) or at increasing the application of alternatives for remand custody (electronic monitoring and the creation of a special service in the courthouse).
Dynamism and embeddedness: towards a lower road? British subsidiaries of American multinationals
Authors: Clark Ian , Almond Phil
Published: November 2004

This article examines the effects of changes in the dynamics of the American national business system on industrial relations settlements in the UK subsidiaries of American multinational corporations (MNCs). While institutionalist analyses of country‐of‐origin and host‐country effects must take account of changes in national business systems, such as the rise of the shareholder value ideology in the USA, empirical analysis reveals a pattern of pathway adjustment rather than radical change in employment relations at the UK subsidiary level. This suggests that although US MNCs are embedded within the American business system, their subsidiaries are not passive ciphers but autonomous sites through which influences must pass.
Regulierungswettbewerb im Deutschen Reich (1871–1914): Welche Erfahrungen sind für die Europäische Union relevant?
Authors: Ambrosius Gerold
Published: November 2004

The question to what extent national regulations should compete or be harmonised within the European Union is important for the further process of integration. The past experiences of economically and politically integrated areas are neglected in this discussion. On the basis of an evolutionary concept of institutional competition this paper outlines how regulatory competition between the ‘Bundesstaaten’ of the German Empire of 1871 - in its political structure comparable with the European Union - and between the Empire and foreign countries performed up to First World War. The special case study deals with the regulation of food of wine, beer and meat, but the article tries to work out general hypotheses about institutional competition between different jurisdictions. Especially the limits of regulatory competition are brought out.
Sind die Probleme der Bevölkerungsalterung durch eine höhere Geburtenrate lösbar?
Authors: Berkel Barbara , Börsch-Supan Axel , Ludwig Alexander , Winter Joachim
Published: November 2004

Can the aging problem be solved by a higher birth rate? While the popular notion - ‘‘if we have too many elderly we need more children in order to compensate for this” - seems plausible, the results of economic theory are ambiguous at best. This paper employs a quantitative macroeconomic simulation model for Germany and leads to a more subtle view, stressing the importance of human capital formation for long-term economic growth in this context. Moreover, it takes a very long transitional period until a higher fertility rate results in a larger and bettereducated labour force that contributes to social security. Therefore, reforms of the social security system still have the highest priority because this is the only way to solve the problems of an aging baby-boomer generation in the short and medium term - meaning the time until the baby boomers will retire.
Stress incontinence and pelvic floor neurophysiology 15 years after the first delivery
Authors: Dolan Lucia M. , Hosker Gordon L. , Mallett Veronica T. , Allen Ruth E. , Smith Anthony R.B.
Published: November 2004

Headline
This is a longitudinal study of a cohort of primigravidae recruited between 1985 and 1987 and followed up 7 and 15 years later. Pelvic floor neurophysiology was performed and questionnaires were administered to determine the natural history of stress incontinence and to establish whether pelvic floor denervation after the first delivery is associated with symptoms of stress urinary incontinence in the future.

Objectives
To study the natural history of stress urinary incontinence arising during the first pregnancy, to determine whether postnatal pelvic floor denervation progresses with time and whether it predisposes to stress urinary incontinence in the future.

Design
Prospective longitudinal cohort study.

Setting
Tertiary referral urogynaecology unit.

Sample
Cohort of 96 primigravidae studied prospectively between 1985 and 1987 and followed up 7 years (n= 76) and 15 years (n= 55) later.

Methods
Urinary incontinence symptoms were recorded and pelvic floor neurophysiology was performed antenatally and postnatally between 1985 and 1987. Repeat neurophysiological tests and questionnaires were completed by those relocated 7 and 15 years later.

Main outcome measure
Symptoms of stress urinary incontinence.

Secondary outcomes
Symptoms of urge urinary incontinence and anal incontinence; motor unit potential duration and pudendal nerve terminal latency; vaginal squeeze pressure measured by perineometry.

Results
Prevalence of stress incontinence was highest during pregnancy and had increased seven years after the first postnatal period (P= 0.0129). Two‐thirds of women with antenatal stress incontinence had stress incontinence 15 years later. One‐third of women with stress incontinence at any time appear to undergo resolution of symptoms. Motor unit potential duration increased at seven years (P= 0.036). Vaginal squeeze pressure improved during the same period (P= 0.0007).

Conclusions
When stress urinary incontinence arises during the first pregnancy, the risk of stress incontinence occurring 15 years later is doubled. Although pelvic floor reinnervation progressed after the postnatal period, the absence of an adequate marker for pelvic floor denervation makes it of uncertain clinical significance.
Jacob's journey: developing sociability and communication in a young boy with severe and complex learning difficulties using the Intensive Interaction teaching approach
Authors: Kellett Mary
Published: November 2004

This case study evaluates the efficacy of Intensive Interaction in developing the social and communication ability of a young boy with severe learning difficulties. The Intensive Interaction approach is based on the model of caregiver–infant interaction and underpinned by theoretical foundations of psychological literature of early development. A multiple‐method approach was adopted mixing quantitative and qualitative data. An intricate system of behaviour coding was devised so that progress could be measured via video‐recorded observation. Findings showed that substantial progress was made in sociability and communication, with some new behaviours such as eye contact emerging. Stereotypy was also observed to reduce substantially.
Using portfolios: a way to improve performance and self‐esteem with poor readers?
Authors: van der Aalsvoort G. M. , Verheggen Marjolein
Published: November 2004

The main questions answered by the intervention of using portfolios during reading and spelling lessons were: do poor readers in the intervention condition perform better and do they show a higher self‐esteem than poor readers in the control condition? A post‐hoc design was used to compare an intervention group with a control group. The independent variable was using portfolios as part of reading and spelling instruction. The dependent variables were literacy skills, conceptual knowledge on reading and writing, and self‐esteem. Intelligence score was used as a covariable. The study included 92 students from grade 3 (six to seven‐year‐olds) from two schools providing regular education. The results on the quantitative measurements indicated that using portfolios did not improve performance with reading and spelling and self‐esteem. The qualitative findings with respect to the 14 poor readers of the participating subjects revealed that their reading performance and self‐esteem decreased further in both conditions. It is argued that teachers should explicitly use portfolios as a way to evaluate and discuss performance with poor readers so as to better understand the student's level of instruction and feelings of competence, and actually apply that knowledge during instruction.
Isolation and characterization of polymorphic microsatellite loci in white truffle (Tuber magnatum)
Authors: Rubini A. , Topini F. , Riccioni C. , Paolocci F. , Arcioni S.
Published: November 2004

Tuber spp. are fungi that establish symbiosis with several trees and shrubs. Some of these fungal species produce edible ascomata, also known as truffles, which are highly appreciated for their taste and odour. We isolated and characterized eight polymorphic microsatellite loci from Tuber magnatum, the finest white truffle species, and assessed their variability in 370 individuals collected from all over the species range of distribution. Although two to 18 alleles per locus were found, no heterozygous individuals were observed. The availability of simple sequence repeat loci provides valuable tools for assessment of the genetic structure and population dynamics in this species.
Name that microbe: rapid identification of taxa responsible for individual fragments in fingerprints of microbial community structure
Authors: Grant Alastair , Ogilvie Lesley Ann
Published: November 2004

Polymerase chain reaction (PCR)‐based ‘fingerprinting’ methods, such as Terminal restriction fragment length polymorphism, Length Heterogeneity‐Polymerase Chain Reaction (LH‐PCR) and Automated Ribosomal Intergenic Spacer Analysis (ARISA) make possible quantitative studies of microbial community structure and dynamics. Here we outline a strategy for the rapid and cost‐effective isolation of 16S clones corresponding to particular fragment sizes in a fingerprint, based on applying the fingerprinting method to pools of colonies from a clone library. This allows the definitive identification of taxa responsible for the most important bands in the community fingerprint from a full 16S sequence. It offers significant advantages over random selection of clones and removes a significant barrier to the use of these methods.
Synergism of atenolol and amlodipine on lowering and stabilizing blood pressure in spontaneously hypertensive rats
Authors: Xu Li‐Ping , Shen Fu‐Ming , Shu He , Miao Chao‐Yu , Jiang Yúan‐Ying , Su Ding‐Feng
Published: November 2004

This study was designed to investigate the possible synergism of atenolol and amlodipine on lowering and stabilizing blood pressure (BP) in spontaneously hypertensive rats. Sixty‐four spontaneously hypertensive rats were randomly divided into eight groups. They were given 0.8% carboxymethylcellulose sodium (control), atenolol (10 mg/kg), amlodipine (0.5, 1 and 2 mg/kg) and the combinations of atenolol and amlodipine (10 + 0.5, 10 + 1 and 10 + 2 mg/kg), respectively. The drugs were given via a catheter of gastric fistula. BP was recorded for 25 h from 1 h before drug administration to 24 h after administration, in conscious, freely moving rats. It was found that combination of atenolol and amlodipine significantly decreased BP and systolic BP variability. From probability sum analysis it was found that the combination of atenolol and amlodipine, in a proportion as 10 : 1, was the best one (q = 1.54). In conclusion, the present work clearly demonstrated that there is a synergistic effect between atenolol and amlodipine in lowering and stabilizing the BP. The synergistic effect is highest when the dose proportion of the two drugs is 10 : 1.
Trends in peptic ulcer pharmacotherapy
Authors: Sivri Bülent
Published: November 2004

Considering the diseases of the stomach and duodenum, peptic ulcer has been the one with a significant clinical impact. The pathophysiology of peptic ulcer has centred on an imbalance between aggressive and protective factors. The discovery of Helicobacter pylori as a cause of peptic ulcer has changed our approach greatly towards this disease. Despite the decreasing frequency of H. pylori‐induced peptic ulcers, peptic ulcer remains a major clinical problem partly because nonsteroidal anti‐inflammatory drug (NSAID)‐related ulcers and hospital admissions for ulcer complications associated with NSAIDs have increased in frequency. The interaction between H. pylori and NSAIDs is one of the most controversial issues in peptic ulcer. In this article, current concepts of peptic ulcer etiopathogenesis and the management of peptic ulcer according to the etiology were reviewed.
Differential effects of FK506 and cyclosporin A on catecholamine release from bovine adrenal chromaffin cells
Authors: Matsumura C. , Kuwashima H. , Kimura T.
Published: November 2004

1 The effects of the immunosuppressants, tacrolimus (FK506) and cyclosporin A (CsA), on catecholamine (CA) release were examined in cultured bovine adrenal chromaffin cells.

2 In intact cells, FK506 (1–30 μm) inhibited CA release stimulated by acetylcholine (ACh; 100 μm), 1,1‐dimethyl‐4‐phenyl‐piperazinium (DMPP, 10 μm) or high K+ (40 mm). CsA (1–30 μm) had a little inhibitory effect on the ACh‐ or DMPP‐stimulated CA release, whereas it enhanced the high K+‐stimulated CA release.

3 In β‐escin‐permeabilized cells, FK506 inhibited CA release stimulated by Ca2+ (1 and 10 μm) in the presence and absence of MgATP (2 mm). CsA induced CA release under Ca2+‐free condition and enhanced the Ca2+‐stimulated CA release in the presence and absence of MgATP.

4 It is known that the Ca2+‐dependent exocytosis involves at least two distinct steps, ATP‐requiring priming stage and ATP‐independent fusion step in adrenal chromaffin cells. Therefore, it is suggested that FK506 inhibits the Ca2+‐dependent exocytosis probably at the fusion step whereas CsA induces CA release from bovine adrenal chromaffin cells.
Identification of Lanius species and subspecies using tandem repeats in the mitochondrial DNA control region
Authors: Hernández M. Angeles , Campos Francisco , Gutiérrez‐Corchero Francisco , Amezcua Ana
Published: November 2004

The number of tandem repeats in the mitochondrial control region were used to differentiate the Red‐backed Shrike Lanius collurio, Woodchat Shrike Lanius senator, Great Grey Shrike (subspecies Lanius excubitor excubitor) and the Southern Grey Shrike (subspecies L. meridionalis meridionalis, L. m. koenigi, L. m. pallidirostris and L. m. aucheri). The Red‐backed and Woodchat Shrikes lacked repeats whereas the Great Grey and Southern Grey had two, three and 2 + 3 repeats. A subspecies of Southern Grey (L. m. koenigi) had 2 + 3 + 4 repeats. These findings are discussed in terms of the taxonomy of the Lanius genus, especially with respect to the Great Grey and Southern Grey Shrikes.
Consequences of the settlement of migrant European Robins Erithacus rubecula in wintering habitats occupied by conspecific residents
Authors: Tellería José Luis , Pérez‐Tris Javier
Published: November 2004

In wintering areas where migrant birds meet sedentary conspecifics, early settlement of local residents in the best habitat patches might reduce the availability of suitable sites for arriving migrants. We studied how sympatric migratory and sedentary European Robins Erithacus rubecula occupy two wintering habitats of different quality (forests and shrublands) in southern Spain, and how such a distribution affects individuals of each population sector. In September, before migrants arrived, Robins were only found in forests, and they had already saturated these habitats, so that rather than increasing Robin abundance in these habitats, the arrival of migrants caused a massive occupation of the previously vacant shrublands. During the winter, we captured Robins and identified them as migrants or residents using a discriminant function based on morphological traits. Residents always predominated in forests, and migrants in shrublands, but through the winter around 35% of residents (mainly juveniles) moved to shrublands, having been replaced by some migrants in forests. Although food was more abundant in shrublands, Robins had better body condition in forests, suggesting that other factors determined habitat preferences (e.g. shelter availability or food diversity, which were higher in forests). In addition, we observed a greater variance in body mass relative to body size in forests, suggesting that energy management was less constrained in this habitat (for example owing to a lower exposure to predators or a higher food predictability). Our results suggest that sedentary Robins benefit from an early occupation of the best habitats in the wintering grounds, forcing migrants to colonize apparently less suitable sites. This would explain the persistence of these small southern populations despite the yearly flooding of the area by huge numbers of migrant conspecifics.
Habitat associations of Yellow Wagtails Motacilla flava flavissima on lowland wet grassland
Authors: Bradbury Richard B. , Bradter Ute
Published: November 2004

In common with many other previously widespread British birds, Yellow Wagtail Motacilla flava flavissima populations have declined substantially in the UK in recent decades. Recent national data suggest particular problems in grassland. We investigated how habitat management in a grassland area of East Anglia, England, influenced the habitat selection of this species. Breeding territories were associated with fields previously subject to prolonged winter floods and which contained shallow‐edged ponds or wet ditches during summer. Territories were also associated with fields with short, sparse swards and high proportions of bare earth within the sward, and these features were themselves associated with previous winter flooding. However, nests were associated with taller swards than were random points within the same field, suggesting that Yellow Wagtails would benefit from within‐field heterogeneity of sward height to provide both nesting and foraging habitat. We discuss how grazing, cutting and water‐level management regimes could be used to promote optimal sward structure for Yellow Wagtails.
The BTO Heronries Census of England and Wales 1928–2000: new indices and a comparison of analytical methods
Authors: Marchant John H. , Freeman Stephen N. , Crick Humphrey Q. P. , Beaven L. Peter
Published: November 2004

A census of Grey Heron Ardea cinerea colonies has been made annually by volunteer observers in England and Wales since a first national survey in 1928. This data set has recently been thoroughly upgraded and here we apply a new method of indexing Heron population changes to produce a new 73‐year time‐series, the longest time‐series describing the abundance of any breeding bird in the world. The indexing methodology is based on the use of weighted ratio estimators, as developed by G.E. Thomas, but with modifications that use reasonable assumptions regarding the likely rates of colony extinction and formation. There is little reliable information about such rates of site turnover, but the results were not sensitive to the assumptions made. The new analytical method, based on counts since 1964, suggests a population estimate of just over 9000 breeding pairs (95% CI 8529–9776) in England and Wales in the year 2000, some 2000 more than suggested in earlier publications. Only minor differences in trend are apparent over the course of the time‐series between the new results and those previously published. Regional analysis suggests that the population in southern England and South Wales has remained relatively constant since the 1970s, but those in the North have tended to increase in the 1990s.
The Impact of Diabetes on Workforce Participation: Results from a National Household Sample
Authors: Vijan Sandeep , Hayward Rodney A. , Langa Kenneth M.
Published: November 2004

Objective. Diabetes is a highly prevalent condition that results in substantial morbidity and premature mortality. We investigated how diabetes‐associated mortality, disability, early retirement, and work absenteeism impacts workforce participation.

Data Source. We used the Health and Retirement Study (HRS), a national household sample of adults aged 51–61 in 1992, as a data source.

Study Design. We conducted cross‐sectional analyses on the baseline HRS data, and longitudinal analyses using data from eight years of follow‐up. We used two‐part regression models to estimate the adjusted impact of diabetes on workforce participation, and then estimated the economic impact of diabetes‐related losses in productivity.

Principal Findings. Diabetes is a significant predictor of lost productivity. The incremental lost income due to diabetes by 1992 was $60.0 billion over an average diabetes duration of 9.7 years. From 1992 to 2000, diabetes was responsible for $4.4 billion in lost income due to early retirement, $0.5 billion due to increased sick days, $31.7 billion due to disability, and $22.0 billion in lost income due to premature mortality, for a total of $58.6 billion dollars in lost productivity, or $7.3 billion per year.

Conclusions. In the U.S. population of adults born between 1931 and 1941, diabetes is associated with a profound negative impact on economic productivity. By 1992, an estimated $60 billion in lost productivity was associated with diabetes; additional annual losses averaged $7.3 billion over the next eight years, totaling about $120 billion by the year 2000. Given the rising prevalence of diabetes, these costs are likely to increase substantially unless countered by better public health or medical interventions.
An Algorithm for the Use of Medicare Claims Data to Identify Women with Incident Breast Cancer
Authors: Nattinger Ann B. , Laud Purushottam W. , Bajorunaite Ruta , Sparapani Rodney A. , Freeman Jean L.
Published: November 2004

Objective. To develop and validate a clinically informed algorithm that uses solely Medicare claims to identify, with a high positive predictive value, incident breast cancer cases.

Data Source. Population‐based Surveillance, Epidemiology, and End Results (SEER) Tumor Registry data linked to Medicare claims, and Medicare claims from a 5 percent random sample of beneficiaries in SEER areas.

Study Design. An algorithm was developed using claims from 1995 breast cancer patients from the SEER‐Medicare database, as well as 1995 claims from Medicare control subjects. The algorithm was validated on claims from breast cancer subjects and controls from 1994. The algorithm development process used both clinical insight and logistic regression methods.

Data Extraction. Training set: Claims from 7,700 SEER‐Medicare breast cancer subjects diagnosed in 1995, and 124,884 controls. Validation set: Claims from 7,607 SEER‐Medicare breast cancer subjects diagnosed in 1994, and 120,317 controls.

Principal Findings. A four‐step prediction algorithm was developed and validated. It has a positive predictive value of 89 to 93 percent, and a sensitivity of 80 percent for identifying incident breast cancer. The sensitivity is 82–87 percent for stage I or II, and lower for other stages. The sensitivity is 82–83 percent for women who underwent either breast‐conserving surgery or mastectomy, and is similar across geographic sites. A cohort identified with this algorithm will have 89–93 percent incident breast cancer cases, 1.5–6 percent cancer‐free cases, and 4–5 percent prevalent breast cancer cases.

Conclusions. This algorithm has better performance characteristics than previously proposed algorithms. The ability to examine national patterns of breast cancer care using Medicare claims data would open new avenues for the assessment of quality of care.
Care following Acute Myocardial Infarction in the Veterans Administration Medical Centers: A Comparison with Medicare
Authors: Landrum Mary Beth , Guadagnoli Edward , Zummo Rose , Chin David , McNeil Barbara J.
Published: November 2004

Objective. To compare patients treated for acute myocardial infarction (AMI) in a Veterans Health Administration (VHA) facility to similar patients treated under Medicare.

Data Sources. Administrative data on 13,129 elderly male veterans hospitalized for AMI in a VHA facility between October 1, 1996, and September 30, 1999, and a matched set of male Medicare beneficiaries with AMI treated in a non‐VHA facility during the same time period.

Study Design. We conducted a retrospective cohort study using propensity score methods to identify a matched set of male elderly AMI patients treated either in a VHA facility or in a non‐VHA facility under Medicare. We compared the two groups of patients according to characteristics of the admitting hospital, distances traveled for care, the use of invasive procedures, and mortality. We assessed the robustness of our conclusions to biases arising from unmeasured confounders using sensitivity analyses.

Principal Findings. VHA patients were significantly less likely than Medicare beneficiaries to be admitted to high‐volume facilities (for example, 25 percent versus 46 percent in 1999, p<0.001) or facilities with the capability to perform invasive cardiac procedures. Compared to Medicare patients, VHA patients traveled almost twice as far to their admitting hospital. The VHA patients were significantly less likely to undergo coronary angiography or revascularization in the 30 days following their AMI (p<0.001 for all comparisons). Veterans treated in the VHA had significantly higher mortality at one‐year in all years studied (for example, 35.2 percent versus 30.6 percent in 1999). The proportion of elderly VHA patients admitted to high‐volume facilities increased and 30‐day mortality rates decreased between 1997 and 1999. Using sensitivity analyses to assess possible effects of unmeasured confounders, we could explain some but not all of the observed mortality differences.

Conclusions. We observed differences in the way care for AMI patients was structured, in the use of invasive therapies, and in long term mortality between patients treated in VHA hospitals and those treated in non‐VHA facilities under Medicare. Future research should focus on explanations for the differences between the two systems and for the reduction in short‐term mortality among VHA patients. Further study of these differences both between and within the systems of care may help identify cost‐effective strategies to improve care in both sectors.
The Magnitude and Nature of Risk Selection in Employer‐Sponsored Health Plans
Authors: Nicholson Sean , Bundorf Kate , Stein Rebecca M. , Polsky Daniel
Published: November 2004

Objective. To determine whether health maintenance organizations (HMOs) attract enrollees who use relatively few medical resources and whether a simple risk‐adjustment system could mitigate or eliminate the inefficiency associated with risk selection.

Data Sources. The first and second rounds of the Community Tracking Study Household Survey (CTSHS), a national panel data set of households in 60 different markets in the United States.

Study Design. We use regression analysis to examine medical expenditures in the first round of the survey between enrollees who switched plan types (i.e., from a non‐HMO plan to an HMO plan, or vice versa) between the first and second rounds of the survey versus enrollees who remained in their original plan. The dependent variable is an enrollee's medical resource use, measured in dollars, and the independent variables include gender, age, self‐reported health status, and other demographic variables.

Data Collection Methods. We restrict our analysis to the 6,235 non‐elderly persons who were surveyed in both rounds of the CTSHS, received health insurance from their employer or the employer of a household member in both years of the survey, and were offered a choice of an HMO and a non‐HMO plan in both years.

Principal Findings. We find that people who switched from a non‐HMO to an HMO plan used 11 percent fewer medical services in the period prior to switching than people who remained in a non‐HMO plan, and that this relatively low use persisted once they enrolled in an HMO. Furthermore, people who switched from an HMO to a non‐HMO plan used 18 percent more medical services in the period prior to switching than those who remained in an HMO plan.

Conclusions. HMOs are experiencing favorable risk selection and would most likely continue to do so even if employers adjusted health plan payments based on enrollees' gender and age because the selection is based on enrollee characteristics that are difficult to observe, such as preferences for medical care and health status.
America's Health Centers: Reducing Racial and Ethnic Disparities in Perinatal Care and Birth Outcomes
Authors: Shi Leiyu , Stevens Gregory D. , Wulu John T. , Politzer Robert M. , Xu Jiahong
Published: November 2004

Objective. To examine whether community health centers (CHCs) reduce racial/ethnic disparities in perinatal care and birth outcomes, and to identify CHC characteristics associated with better outcomes.

Background. Despite great national wealth, the U.S. continues to rank poorly relative to other industrialized nations on infant mortality and other birth outcomes, and with wide inequities by race/ethnicity. Disparities in primary care (including perinatal care) may contribute to disparities in birth outcomes, which may be addressed by CHCs that provide safety‐net medical services to vulnerable populations.

Methods. Data are from annual Uniform Data System reports submitted to the Bureau of Primary Health Care over six years (1996–2001) by about 700 CHCs each year.

Results. Across all years, about 60% of CHC mothers received first‐trimester prenatal care and more than 70% received postpartum and newborn care. In 2001, Asian mothers were the most likely to receive both postpartum and newborn care (81.7% and 80.3%), followed by Hispanics (75.0% and 76.3%), blacks (70.8% and 69.9%), and whites (70.7% and 66.7%). In 2001, blacks had higher rates of low birth weight (LBW) babies (10.4%), but the disparity in rates for blacks and whites was smaller in CHCs (3.3 percentage points) compared to national disparities for low‐socioeconomic status mothers (5.8 percentage points) and the total population (6.2 percentage points). In CHCs, greater perinatal care capacity was associated with higher rates of first‐trimester prenatal care, which was associated with a lower LBW rate.

Conclusion. Racial/ethnic disparities in certain prenatal services and birth outcomes may be lower in CHCs compared to the general population, despite serving higher‐risk groups. Within CHCs, increasing first‐trimester prenatal care use through perinatal care capacity may lead to further improvement in birth outcomes for the underserved.
Hospital Choice of Rural Medicare Beneficiaries: Patient, Hospital Attributes, and the Patient–Physician Relationship
Authors: Tai Wan‐Tzu Connie , Porell Frank W. , Adams E. Kathleen
Published: November 2004

Objective. To examine how patient and hospital attributes and the patient–physician relationship influence hospital choice of rural Medicare beneficiaries.

Data Sources. Medicare Current Beneficiary Survey (MCBS), Health Care Financing Administration (HCFA) Provider of Services (POS) file, American Hospital Association (AHA) Annual Survey, and Medicare Hospital Service Area (HSA) files for 1994 and 1995.

Study Design. The study sample consisted of 1,702 hospitalizations of rural Medicare beneficiaries. McFadden's conditional logit model was used to analyze hospital choices of rural Medicare beneficiaries. The model included independent variables to control for patients' and hospitals' attributes and the distance to hospital alternatives.

Principal Findings. The empirical results show strong preferences of aged patients for closer hospitals and those of greater scale and service capacity. Patients with complex acute medical conditions and those with more resources were more likely to bypass their closest rural hospitals. Beneficiaries were more likely to bypass their closest rural hospital if they had no regular physician, had a shorter patient–physician tie, were dissatisfied with the availability of health care, and had a longer travel time to their physician's office.

Conclusions. The significant influences of patients' socioeconomic, health, and functional status, their satisfaction with and access to primary care, and their strong preferences for certain hospital attributes should inform federal program initiatives about the likely impacts of policy changes on hospital bypassing behavior.
Using Vignettes to Compare the Quality of Clinical Care Variation in Economically Divergent Countries
Authors: Peabody John W. , Tozija Fimka , Muñoz Jorge A. , Nordyke Robert J. , Luck Jeff
Published: November 2004

Objective. To determine whether clinical vignettes can measure variations in the quality of clinical care in two economically divergent countries.

Data Source/Study Setting. Primary data collected between February 1997 and February 1998 at two Veterans Affairs facilities in the United States and four government‐run outpatient facilities in Macedonia.

Study Design. Randomly selected, eligible Macedonian and U.S. physicians (>97 percent participation rate) completed vignettes for four common outpatient conditions. Responses were judged against a master list of explicit quality criteria and scored as percent correct.

Data Collection/ Extraction. An ANOVA model and two‐tailed t‐tests were used to compare overall scores by case, study site, and country.

Principal Findings. The mean score for U.S. physicians was 67 percent (+/−11 percent) compared to 48 percent (+/−11 percent) for Macedonian physicians. The quality of clinical practice, which emphasizes basic skills, varied greatly in both sites, but more so in Macedonia. However, the top Macedonian physicians in all sites approached or—in one case—exceeded the median score in the U.S. sites.

Conclusions. Vignettes are a useful method for making cross‐national comparisons of the quality of care provided in very different settings. The vignette measurements revealed that some physicians in Macedonia performed at a standard comparable to that of their counterparts in the United States, despite the disparity of the two health systems. We infer that in poorer countries, policy that promotes improvements in the quality of clinical practice—not just structural inputs—could lead to rapid improvements in health.
Assessing the Efficiency of HIV Prevention around the World: Methods of the PANCEA Project
Authors: Marseille Elliot , Dandona Lalit , Saba Joseph , McConnel Coline , Rollins Brandi , Gaist Paul , Lundberg Mattias , Over Mead , Bertozzi Stefano , Kahn James G.
Published: November 2004

Objective. To develop data collection methods suitable to obtain data to assess the costs, cost‐efficiency, and cost‐effectiveness of eight types of HIV prevention programs in five countries.

Data Sources/Study Setting. Primary data collection from prevention programs for 2002–2003 and prior years, in Uganda, South Africa, India, Mexico, and Russia.

Study Design. This study consisted of a retrospective review of HIV prevention programs covering one to several years of data. Key variables include services delivered (outputs), quality indicators, and costs.

Data Collection/Extraction Methods. Data were collected by trained in‐country teams during week‐long site visits, by reviewing service and financial records and interviewing program managers and clients.

Principal Findings. Preliminary data suggest that the unit cost of HIV prevention programs may be both higher and more variable than previous studies suggest.

Conclusions. A mix of standard data collection methods can be successfully implemented across different HIV prevention program types and countries. These methods can provide comprehensive services and cost data, which may carry valuable information for the allocation of HIV prevention resources.
Private Care and Public Health: Do Vaccination and Prenatal Care Rates Differ between Users of Private versus Public Sector Care in India?
Authors: Howard David H. , Roy Kakoli
Published: November 2004

Objective. To determine whether patients who use private sector providers for curative services have lower vaccination rates and are less likely to receive prenatal care.

Data Sources/Study Setting. This study uses data from the 52d round of the National Sample Survey, a nationally representative socioeconomic and health survey of 120,942 rural and urban Indian households conducted in 1995–1996.

Study Design. Using logistic regression, we estimate the relationship between receipt of preventive care at any time (vaccinations for children, prenatal care for pregnant women) and use of public or private care for outpatient curative services, controlling for demographics, household socioeconomic status, and state of residence.

Data Collection/Extraction Methods. We analyzed samples of children ages 0 to 4 and pregnant women who used medical care within a 15‐day window prior to the survey.

Principal Findings. With the exception of measles vaccination, predicted probabilities of the receipt of vaccinations and prenatal care do not differ based on the type of provider at which children and women sought curative care. Children and pregnant women in households who use private care are almost twice as likely to receive preventive care from private sources, but the majority still obtains preventive care from public providers.

Conclusions. We do not find support for the hypothesis that children and pregnant women who use private care are less likely to receive public health services. Results are consistent with the notion that Indian households are able to successfully navigate the coexisting public and private systems, and obtain services selectively from each. However, because the study employed an observational, cross‐sectional study design, findings should be interpreted cautiously.