bluuebunny/crossref_metadata_2025 huggingface dataset:
Urban–rural differences in psychiatric rehabilitation outcomes
Authors: Tirupati Srinivasan , Conrad Agatha , Frost Barry , Johnston Suzanne
Published: March 2010

Objective:  Employing rural and urban patient populations, the aim of the study was to examine the differences in rehabilitation intervention outcomes, particularly in regard to the social and clinical determinants.

Design:  The study employed a retrospective, cross‐sectional analysis of patient outcome and characteristics.

Setting:  Community‐based psychiatric rehabilitation service in regional and rural Australia.

Participants:  A total of 260 patients were included in the service evaluation phase of the study and 86 in the second part of the study. Participants were community‐based and suffered from a chronic mental illness.

Main outcome measure(s):  Clinical and functional outcomes were measured using the Health of Nations Outcome Scale and the 16‐item Life Skills Profile. The outcome score employed was the difference between scores at intake and at the last complete assessment. Clinical and sociodemographic characters were recorded using a proforma developed for the study.

Results:  Patients from rural Maitland had a significantly larger mean reduction in total scores and classified more often as ‘Improved’ on both the Health of Nations Outcome Scale and Life Skills Profile than patients from either of the urban areas (P < 0.01). Study of randomly selected patients showed that those from an urban area had a more complex illness with multiple needs and less often received family support than their rural counterparts.

Conclusions:  For rural communities the improvement in rehabilitation outcomes might be attributable to a more benign form of the illness and the availability of higher levels of social capital.
Evaluation of a mobile screening service for abdominal aortic aneurysm in Broken Hill, a remote regional centre in far western NSW
Authors: Lesjak Margaret S. , Flecknoe‐Brown Stephen C. , Sidford Jan R. , Payne Kerryn , Fletcher John P. , Lyle David M.
Published: March 2010

Objectives:  To evaluate the feasibility of a mobile screening service model for abdominal aortic aneurysm (AAA) in a remote population centre in Australia.

Design:  Screening test evaluation.

Setting:  A remote regional centre (population: 20 000) in far western NSW.

Participants:  Men aged 65–74 years, identified from the Australian Electoral roll.

Interventions:  A mobile screening service using directed ultrasonography, a basic health check and post‐screening consultation.

Main outcome measures:  Attendance at the screening program, occurrence of AAA in the target population and effectiveness of screening processes.

Results:  A total of 516 men without a previous diagnosis of AAA were screened, an estimated response rate of 60%. Of these, 463 (89.7%) had a normal aortic diameter, 28 (5.4%) ectatic and 25 (4.9%) a small, moderate or significant aneurysm. Two men with AAA were recommended for surgery. Feedback from participants indicated that the use of a personalised letter of invitation helped with recruitment, that the screening process was acceptable and the service valued.

Conclusions:  It is feasible to organise and operate a mobile AAA screening service from moderate sized rural and remote population centres. This model could be scaled up to provide national coverage for rural and remote residents.
Workplace violence: Differences in perceptions of nursing work between those exposed and those not exposed: A cross‐sector analysis
Authors: Hegney Desley , Tuckett Anthony , Parker Deborah , Eley Robert M
Published: March 2010

Hegney D, Tuckett A, Parker D, Eley RM. International Journal of Nursing Practice 2010; 16: 188–202 Workplace violence: Differences in perceptions of nursing work between those exposed and those not exposed: A cross‐sector analysis

Nurses are at high risk of incurring workplace violence during their working life. This paper reports the findings on a cross‐sectional, descriptive, self‐report, postal survey in 2007. A stratified random sample of 3000 of the 29 789 members of the Queensland Nurses Union employed in the public, private and aged care sectors resulted in 1192 responses (39.7%). This paper reports the differences: between those nurses who experienced workplace violence and those who did not; across employment sectors. The incidence of workplace violence is highest in public sector nursing. Patients/clients/residents were the major perpetrators of workplace violence and the existence of a workplace policy did not decrease levels of workplace violence. Nurses providing clinical care in the private and aged care sectors experienced more workplace violence than more senior nurses. Although workplace violence was associated with high work stress, teamwork and a supportive workplace mitigated workplace violence. The perception of workplace safety was inversely related to workplace violence. With the exception of public sector nursing, nurses reported an inverse relationship with workplace violence and morale.
The future of endoscopy
Authors: Roberts‐Thomson Ian C , Singh Rajvinder , Teo Edward , Nguyen Nam Q , Lidums Ilmars
Published: March 2010

Extraordinary developments have occurred in the field of endoscopy over the past 40 years. The era that began with the fiberoptic endoscope (fiberscope) has now moved to the videoscope and, more recently, to the capsule endoscope. Videoendoscopy will remain the major form of endoscopy for the next 5–10 years but, thereafter, diagnostic procedures including colonoscopy will increasingly be performed by capsule endoscopy. This change will be largely driven by patient preference rather than superior results from capsule studies. Image analysis of capsule studies will be accelerated by software that highlights abnormal areas and, by 2025, capsule studies will be ‘read’ by computer. For the next decade, more complex therapeutic procedures will be performed by a new group of therapeutic endoscopists using advanced videoscopes. Several new therapeutic procedures will emerge but natural orifice transluminal approaches will need to compete with advances in laparoscopic techniques. It is also likely that health administrators faced with escalating medical costs will demand that new and more expensive procedures not only facilitate patient care but result in superior health outcomes.
Impact of body mass index on perioperative outcomes of laparoscopic radical nephrectomy in Japanese patients with clinically localized renal cell carcinoma
Authors: Miyake Hideaki , Muramaki Mototsugu , Tanaka Kazushi , Takenaka Atsushi , Fujisawa Masato
Published: March 2010

Objective:  The aim of this study was to review the association between body mass index (BMI) and perioperative outcomes of laparoscopic radical nephrectomy (LRN) in Japanese patients with renal cell carcinoma (RCC).

Methods:  This study included 108 consecutive Japanese patients undergoing LRN for RCC between April 2001 and March 2009. These patients were divided into the following two groups according to BMI: the non‐obese group (n= 58, BMI 25 kg/m2 or less) and the obese group (n= 50, BMI greater than 25 kg/m2). Perioperative outcomes between these two groups were retrospectively compared.

Results:  There were no significant differences in clinicopathological parameters other than BMI between the non‐obese and obese groups. There were no significant differences in operative time, estimated blood loss during LRN, and the incidences of open conversion and postoperative complications between these two groups. In addition, there were no significant differences in parameters related to postoperative recovery, including time to walk, time to oral intake and time until permission for discharge, between these two groups. However, significant trends toward a prolonged operative time (P= 0.0050) and increased blood loss (P= 0.012) during LRN in relation to BMI were documented by linear regression analyses.

Conclusions:  Although the degree of obesity in patients included in this study was comparatively slight, these findings suggest that LRN can be safely performed for patients with RCC irrespective of BMI. However, the difficulty of LRN may increase with BMI considering the trends toward longer operative time as well as greater blood loss.
Granulosa cell tumor with activated mTOR‐HIF‐1α‐VEGF pathway
Authors: Miyazawa Masaki , Yasuda Masanori , Fujita Mariko , Hirabayashi Kenichi , Hirasawa Takeshi , Kajiwara Hiroshi , Muramatsu Toshinari , Miyazaki Sayuri , Harasawa Makiko , Matsui Naruaki , Ogane Naoki , Murakami Masaru , Mikami Mikio , Yanase Toshihiko , Osamura R. Yoshiyuki
Published: March 2010

The DNA‐binding activity of hypoxia‐inducible factor‐1 α (HIF‐1α) has been analyzed for various gynecological tumors. Among the tumors that were studied, there was a finding of a high level of DNA‐binding HIF‐1α activity, although it was limited to one case of adult type granulosa cell tumor (GCT). In this case a 60‐year‐old female had marked immunohistochemical expression of HIF‐1α. The expressions of the mammalian target of rapamycin (mTOR) and phosphorylated‐mTOR (p‐mTOR) were also marked, and vascular endothelial growth factor (VEGF) was moderately expressed. To compare the expression profiles, 11 consecutive cases with adult type GCT were used. All cases showed marked expressions of HIF‐1α and mTOR, but p‐mTOR expression was moderately to markedly observed in four of the 12 cases. VEGF was expressed in all cases in varying degrees. Based on the evidence that downregulation of the mTOR pathway due to treatment with rapamycin (everolimus) would suppress tumor cell growth, an experimental study using the GCT cell line was designed to clarify whether HIF‐1α and VEGF expressions decline. As a result, the expressions of p‐mTOR, HIF‐1α and VEGF were suppressed, but those of mTOR were not. It was concluded that mTOR‐targeted therapy may represent a promising strategy for some GCT with an activated mTOR‐HIF‐1α‐VEGF pathway.
Maternal tamoxifen treatment alters oocyte differentiation in the neonatal mice: Inhibition of oocyte development and decreased folliculogenesis
Authors: Roshangar Leila , Rad Jafar Soleimani , Afsordeh Kobra
Published: March 2010

Aim:  Primary germ cells after migration to the developing ovary differentiate to oogonia and oocytes. The formation and number of primordial follicles in early fetal life are determining factors in the fertility state of adult life. Tamoxifen is used both to stimulate ovulation and as an anticancer drug. The aim of the present study was to evaluate the effect of tamoxifen on oocyte and follicular development and differentiation in mice.

Methods:  Thirty adult female and 15 adult male mice were used in the present study. The female mice were divided into two groups: control and experimental. Two female mice at their sterous cycle were placed with one male mouse in a cage for mating. The observation of a vaginal plug was considered the 1st day of pregnancy. On the 13th day of pregnancy the mice received 100 µg tamoxifen by i.p. injection. At the end of pregnancy 2‐, 3‐, 6‐ and 7‐day‐old newborns were killed and their ovaries were fixed and prepared for light and electron microscopic studies. The number of follicular nests and diameter of primordial and primary follicles were determined using Motic software (Motic Incorporation Ltd, Canada) and compared with control values using t‐test.

Results:  Microscopy and morphometry showed that oocyte nests are formed on the 2nd and 3rd days and follicles are distinguished on the 6th and 7th days. Morphometric studies revealed that the number and diameters of oocyte nests were significantly (P < 0.001) reduced in the experimental groups compared to the control group. However, the numbers and diameters of primordial and primary follicles in experiential and controls were not significantly different. Electron microscopic studies revealed that in the control group, oocytes were separated from each other and were at primordial follicle stage. However, in the experimental group, the oocytes were in clusters as oocyte nests.

Conclusion:  The results indicate that tamoxifen suppresses follicular differentiation at early stages but does not affect the development of already differentiated follicles.
Difference in non‐weight‐bearing effects on bone mineral density between trunk and peripheral fat mass in women with polycystic ovary syndrome
Authors: Yanazume Yumi , Kawamura Yukie , Kuwahata Akiko , Yonehara Yukie , Matsuo Takashi , Iwamoto Ichiro , Douchi Tsutomu
Published: March 2010

Aim:  To investigate the difference in non‐weight‐bearing effects on bone mineral density (BMD) between trunk and peripheral fat mass in women with polycystic ovary syndrome (PCOS).

Methods:  Subjects were 123 amenorrheic PCOS women with right side dominance. Age, height, body weight, and body mass index were recorded. Trunk, peripheral (extremities), trunk–leg fat ratio as an index of body fat distribution, left arm (non‐weight‐bearing site) lean mass and BMD were measured by dual‐energy X‐ray absorptiometry. Serum testosterone and estradiol levels were measured. Relationships of BMD with trunk, peripheral fat mass, and sex hormones levels were investigated.

Results:  Trunk fat mass amount was 9.8 ± 6.7 kg and was lower than the peripheral fat mass amount (12.2 ± 4.4 kg, P < 0.01). On Pearson's correlation test, trunk fat mass and left arm lean mass were positively correlated with arm BMD (r = 0.359, P < 0.001 and r = 0.501, P < 0.0001, respectively), while peripheral fat mass and serum testosterone levels were not correlated with BMD (r = 0.083 and 0.114, respectively, NS). On multiple regression analysis, trunk fat mass was positively correlated with BMD (t‐value = 3.465; P < 0.001), independent of age and height. However, this relationship disappeared after additionally adjusting for left arm lean mass.

Conclusion:  Trunk fat mass, despite the smaller amount, is more associated with arm BMD than peripheral fat mass is through its non‐weight‐bearing effects.
Blastocyst embryo transfer is the primary determinant for improved outcomes in oocyte donation cycles
Authors: Porat Natalie , Boehnlein Lynn M. , Barker Matthew A. , Kovacs Peter , Lindheim Steven R.
Published: March 2010

Aim:  Using oocyte donation cycles as an ideal model, we sought to compare pregnancy and implantation rates in cleavage stage (day 3) versus blastocyst stage (day 6) embryo transfers (ET); assess the predictive value of blastocyst formation rates based on cleavage cell stage and morphology grade; and evaluate the ability to predict formation of high quality (HQ) blastocysts.

Methods:  Ninety three consecutive oocyte donation cycles from July 2003 to August 2005 were retrospectively evaluated and analyzed to determine if either resulted in a cleavage stage (n = 30) or blastocyst (n = 45) ET. The primary outcomes measured pregnancy rates, the percent development of HQ blastocysts based on day 3 embryo status, and the ability to select day 3 embryos suitable for transfer among four blinded evaluators by assessing their day 6 embryo outcome.

Results:  Cleavage stage ET resulted in significantly lower pregnancy rates, clinical pregnancy rates, and implantation rates (47% [n = 14/30]; 40% [n = 12/30] and 27 ± 7%) compared to blastocyst stage (82% [n = 37/45]; 73% [n = 33/45] and 64 ± 6% [±SE], P < 0.01). In total, HQ blastocysts resulted from high and good quality day 3 embryos 35% (191/546) and 17% (93/546), respectively. Blinded evaluation revealed at least one, two or all three day 3 embryos were correctly selected for ET on day 6, 97%, 67% and 19%, respectively.

Conclusion:  Day 6 ET resulted in significantly better clinical outcomes compared to day 3 ET. While day 3 status is not predictive of blastocyst quality, the selection of at least one day 3 embryo ultimately suitable for blastocyst ET underscores the significance of optimal endometrial receptivity.
Fulminant type 1 diabetes mellitus acutely emerged during pregnancy
Authors: Yamada Kyoko , Takakuwa Koichi , Takeyama Satoru , Minagawa Shinichi , Morikawa Hiroshi , Matsunaga Masamichi , Tomita Masatoshi , Tanaka Kenichi
Published: March 2010

A pregnant woman at 32 weeks of gestation was emergently admitted to our hospital with symptoms of nausea, vomiting, and uterine contraction. Cardiotocogram demonstrated a loss of variability and late deceleration in fetal heart rate pattern. Emergency cesarean section was performed, and a male infant weighing 1750 g was born with Apgar scores of 1 at 1 min, and 3 at 5 min after delivery. After cesarean section, the patient developed an acetone breath odor, and blood examination demonstrated remarkable acidemia and an extremely high level of blood glucose. The patient was diagnosed with ketoacidosis with acute onset of fulminant type 1 diabetes mellitus. Intensive care was applied due to the severe diabetes mellitus conditions. The patient's general condition ameliorated during the postoperative period, although there was a possibility of neurological complications in the infant.
Cardiac hypertrophy of one fetus and selective growth restriction of the other fetus in a monochorionic twin pregnancy
Authors: Kondo Yukiko , Hidaka Nobuhiro , Yumoto Yasuo , Fukushima Kotaro , Tsukimori Kiyomi , Wake Norio
Published: March 2010

Cardiac hypertrophy in the recipient fetus of twin‐twin transfusion syndrome (TTTS) has been reported previously. We encountered an unusual set of monochorionic twins in which one twin had cardiac hypertrophy without TTTS while the other fetus had selective growth restriction. In this case, the diagnosis of selective growth restriction was made at 17 weeks of gestation, and right ventricular hypertrophy was identified in the co‐twin at 21 weeks; however, no signs of TTTS were observed. At 29 weeks we concluded that the fetal circulation had deteriorated based on echocardiographic findings that included hydrops fetalis and an elevated preload index. Emergency cesarean section was performed. Our experience suggests that hypertrophic cardiomyopathy‐like change in a monochorionic twin pregnancy may arise in settings outside of TTTS, including growth restriction of a co‐twin. We believe our case will assist the discussion surrounding the etiology of cardiac hypertrophy in monochorionic twins.
Skull metastasis from carcinoma of the cervix: A rare case and review of the literature
Authors: Mohanty Asit , Dutta Debnarayan , Das Suman , Samanta Diptirani , Senapati Surendranath
Published: March 2010

Skeletal metastasis from carcinoma of the cervix occurs in 0.8–23% of cases. The majority of bone metastases occur either in the long bones or in the vertebrae. Metastasis to distal bones like the skull is rare. Metastasis to bone is commonly associated with advanced stage and poor control of primary disease. We present a rare case of scalp metastasis in a patient with stage IIIB carcinoma of the cervix. The patient had completed radiation therapy treatment resulting in controlled primary disease until she was diagnosed with skull bone metastasis. We present this case because of its rarity and for documentation and discussion.
Fibrous mastopathy: Clinical, imaging, and histopathologic findings of 31 cases
Authors: Pereira Maria Aparecida de Queiroz Freitas , Magalhães Albino Verçosa de , Motta Lucilia Domingues Casulari da , Santos Ana Maria de Souza , Segura Marcos Emanuel de Alcântara , Pereira Camila Freitas , Casulari Luiz Augusto
Published: March 2010

Aim:  The aim of this study was to analyze the cases of patients with a histological diagnosis of fibrous mastopathy, diabetic mastopathy, or lymphocytic mastopathy in association with other autoimmune diseases, and to conduct histological and imaging studies as well as follow up of the lesions.

Methods:  Thirty‐one patients meeting predetermined histopathological criteria for diabetic mastopathy, fibrous mastopathy, or lymphocytic mastopathy were analyzed for several factors: age at diagnosis; clinical manifestations; parity; breastfeeding; use of sex steroids for hormonal replacement therapy or hormonal contraception; associated diseases; mammographic findings; breast magnetic resonance imaging and ultrasound; histological and cytological diagnosis; immunohistochemical and immunophenotyping identification of T‐ and B‐lymphocytes and macrophages, and α‐smooth muscle actin; and follow up.

Results:  Fibrous mastopathy was present among diabetic and non‐diabetic patients, patients with autoimmune diseases, and healthy individuals. Relapses were found in one‐quarter of the lesions and spontaneous regression was observed in one case. There was a predominance of T‐lymphocytes over B‐lymphocytes in the fibrous mastopathic lesions (P < 0.001). Macrophages were demonstrated in 95.2% of the lesions. All of the lesions displayed reactivity for α‐smooth muscle actin, a characteristic of myofibroblasts.

Conclusions:  Fibrous mastopathy does not occur in diabetic patients only; fibrous mastopathy may also occur in healthy subjects; the lesion is characterized by a higher number of T‐lymphocytes over B‐lymphocytes, the presence of absolute lobular lymphocytic infiltrate, reactivity for α‐smooth muscle actin, and macrophages. Relapses were found in one‐quarter of the lesions and spontaneous regression was observed in one case.
Cervical insufficiency following cesarean delivery after prolonged second stage of labor: Experiences of two cases
Authors: Koyama Shinsuke , Tomimatsu Takuji , Kanagawa Takeshi , Sawada Kenjiro , Tsutsui Tateki , Kimura Tadashi
Published: March 2010

Cervical insufficiency is a known risk factor for preterm birth and miscarriage. The etiology of cervical insufficiency has not been fully recognized and the association between it and prior cesarean delivery is unknown. We experienced two similar characteristic cases of cervical insufficiency following term cesarean delivery. Interestingly, both cesarean sections were uneventfully performed after the prolonged second stage of labor. Our experience and recent literature strongly support the idea that an unintentional incision into the uterine cervix during a previous cesarean section may cause cervical insufficiency in subsequent pregnancies. It is important for obstetricians to take into account the possible occurrence of cervical insufficiency depending on the circumstances of previous deliveries. Our report highlights the need to alert obstetricians to take more care with their cesarean section technique.
Antiandrogen monotherapy in patients with localized or locally advanced prostate cancer: final results from the bicalutamide Early Prostate Cancer programme at a median follow‐up of 9.7 years
Authors: Iversen Peter , McLeod David G. , See William A. , Morris Thomas , Armstrong Jon , Wirth Manfred P. ,   on behalf of the Casodex Early Prostate Cancer Trialists’ Group
Published: March 2010

Study Type – Therapy (RCT) Level of Evidence 1b

OBJECTIVE

To evaluate the efficacy and tolerability of bicalutamide 150 mg once‐daily as immediate hormonal therapy in patients with prostate cancer or as adjuvant to radical prostatectomy or radiotherapy.

PATIENTS AND METHODS

In all, 8113 patients with localized (T1‐2, N0/Nx) or locally advanced (T3‐4, any N; or any T, N+) prostate cancer (all M0) were enrolled in three complementary, double‐blind, placebo‐controlled trials. Patients were randomized to receive standard care plus either oral bicalutamide 150 mg once‐daily or oral placebo. Primary endpoints were progression‐free survival (PFS) and overall survival (OS). Data were collated from individual trials and evaluated in a combined analysis.

RESULTS

Overall, at a median follow‐up of 9.7 years, bicalutamide significantly improved PFS (hazard ratio 0.85, 95% confidence interval 0.79–0.91; P= 0.001). Compared with placebo there was no difference in OS (hazard ratio 1.01, P= 0.77). Patients who derived benefit from bicalutamide in terms of PFS were those with locally advanced disease, with OS significantly favouring bicalutamide in patients with locally advanced disease undergoing radiotherapy (P= 0.031). Patients with localized disease showed no clinically or statistically significant improvements in PFS; there was a survival trend in favour of placebo in patients with localized disease undergoing watchful waiting (P= 0.054). The overall tolerability of bicalutamide was consistent with previous analyses, with breast pain (73.7%) and gynaecomastia (68.8%) the most frequently reported adverse events in patients randomized to bicalutamide.

CONCLUSIONS

Bicalutamide 150 mg, either as monotherapy or adjuvant to standard care, improved PFS in patients with locally advanced prostate cancer, but not in patients with localized disease. A pre‐planned subset analysis showed a benefit for OS in patients with locally advanced disease undergoing radiotherapy. Bicalutamide 150 mg might represent an alternative for patients with locally advanced prostate cancer considering androgen‐deprivation therapy.
Negotiating alliances: Muslims, gay rights and the Christian right in a Polish‐American city (Respond to this article at http://www.therai.org.uk/at/debate)
Authors: Perkins Alisa
Published: March 2010

Muslim involvement in debates over municipal gay rights legislation became a hotly contested issue in Hamtramck, Michigan, during the summer of 2008. The article analyzes how faith‐based and other kinds of alliance building that took place in the context of these debates impacted processes of boundary formation among Muslim, Christian and secular‐humanist groups. In Hamtramck, debate over the Human Rights Ordinance served as a rich and generative nexus point for the proliferation and exchange of ideas about the incorporation of Muslim values and sentiments in the public sphere. A study of these debates offers us a window into understanding the politicization of Islam as a minority religion, the symbolic space it occupies, and its engagement with the institutionalization of secularism in the US at the current time.
Pre‐Black Futures
Authors: Mitchell Katharyne
Published: March 2010

Abstract:  In this essay I look at the contemporary production of surplus life in liberal democracies, and how it manifests a new type of sovereign spatial power. This power operates through the capacity to exile individuals and populations who are defined—in advance—as risk failures. I investigate further the ways that these pre‐known risk failures are determined through historical and geographical processes of racial formation, arguing that certain kinds of bodies have become vessels for concepts of risk formed in anticipation of an inevitable future. This “inevitable future” involves the formation of populations, which I term Pre‐Black, who are projected as outside of the enabling web of pastoral power. Moreover, as a consequence of this pre‐failure, individuals and populations can be forcefully and, more importantly, “justifiably” removed from commonly held spaces and resources in a contemporary liberal form of sovereign dispossession.
The Shape of Capitalism to Come
Authors: Cammack Paul
Published: March 2010

Abstract:  The starting point for this paper is the observation that a reshaping of global capitalism is underway, centred on the rise of dynamic centres of accumulation in Asia. It is argued that a critical understanding of this process (supported without reservation by such organizations as the IMF, the OECD and the World Bank) requires a questioning of the imagined link between “capitalism” and the “West”, and a recognition that the international organizations are committed to a universal project aimed at empowering capital and promoting competitiveness on a global scale. A case study is provided of the recently adopted plan for the creation of an ASEAN Economic Community as a “single market and productive space” by 2015. The regional context in which it is placed is contrasted with that of the European Union, and the need for further study of varieties of capitalism in emerging economies is noted.
RISK AND MID‐LEVEL MORAL PRINCIPLES
Authors: ESPINOZA NICOLAS , PETERSON MARTIN
Published: March 2010

We discuss ethical aspects of risk‐taking with special focus on principlism and mid‐level moral principles. A new distinction between the strength of an obligation and the degree to which it is valid is proposed. We then use this distinction for arguing that, in cases where mid‐level moral principles come into conflict, the moral status of the act under consideration may be indeterminate, in a sense rendered precise in the paper. We apply this thought to issues related to pandemic influenza vaccines. The main conclusion of the paper is that on a principlist approach some acts may be neither right nor wrong (or neither permissible nor impermissible), and we claim that this has important implications for how we ought to make decisions under risk.
Parent Discipline Practices in an International Sample: Associations With Child Behaviors and Moderation by Perceived Normativeness
Authors: Gershoff Elizabeth T. , Grogan‐Kaylor Andrew , Lansford Jennifer E. , Chang Lei , Zelli Arnaldo , Deater‐Deckard Kirby , Dodge Kenneth A.
Published: March 2010

This study examined the associations of 11 discipline techniques with children’s aggressive and anxious behaviors in an international sample of mothers and children from 6 countries and determined whether any significant associations were moderated by mothers’ and children’s perceived normativeness of the techniques. Participants included 292 mothers and their 8‐ to 12‐year‐old children living in China, India, Italy, Kenya, Philippines, and Thailand. Parallel multilevel and fixed effects models revealed that mothers’ use of corporal punishment, expressing disappointment, and yelling were significantly related to more child aggression symptoms, whereas giving a time‐out, using corporal punishment, expressing disappointment, and shaming were significantly related to greater child anxiety symptoms. Some moderation of these associations was found for children’s perceptions of normativeness.
Determinants of cross‐border bank acquisitions in transition economies1
Authors: Poghosyan Tigran , De Haan Jakob
Published: March 2010

We analyse the microeconomic determinants of cross‐border bank acquisitions in 11 transition economies over the period 1992–2006. We find that foreign banks target relatively large and efficient banks when they enter transition economies with weak institutions. This evidence provides support for the ‘market power’ hypothesis. However, when foreign banks enter more developed transition economies that have made progress in economic reform, they acquire less efficient banks. This result is in line with the efficiency hypothesis. We use a multilevel mixed effects logit model that allows us to explicitly incorporate the macroeconomic and institutional heterogeneity of the transition economies into our analysis.
Public Management Policymaking in Spain: The Politics of Legislative Reform of Administrative Structures, 1991–1997
Authors: GALLEGO RAQUEL , BARZELAY MICHAEL
Published: March 2010

This case study focuses on extending research knowledge about the politics of public management policymaking in Spain. The case involves legislating to change politically sensitive features of the central government and administration. The study explains such analytically significant event conditions as: an agenda‐setting process that made a policy issue of the formal, structural attributes of state administration, an alternative‐specification process that proceeded without complication, and a decisional process that lasted five years and in which political leaders' positions on the issue flip‐flopped. Broadly speaking, the case analysis demonstrates that when policy proposals take the form of legislation, the politics of public management policymaking in Spain are highly influenced by political stream factors, themselves reflecting Spain's parliamentary form of government and relations between statewide and regional political parties.
The Comparative Historical Analysis of Public Management Policy Cycles in France, Italy, and Spain: Symposium Conclusion
Authors: BARZELAY MICHAEL , GALLEGO RAQUEL
Published: March 2010

This concluding article in the symposium develops generalizing arguments about the politics of public management reform in France, Italy, and Spain, by drawing out implications of the case studies presented in the three preceding articles. Some of these implications hold that established research arguments about politics of public management reform in the same cultural and geographical area require considerable qualification and reexamination. Some other implications of these case studies take the form of generalizing arguments about the process dynamics of public management policymaking. More specifically, an existing body of generalizing arguments is assessed and modified in the light of the research arguments crafted through the three case studies' dialogues between conceptual approaches and historical evidence. Together, these two discussions offer a contribution to the political science research literature on the politics of public management reform.
Explaining Regional and Local Government: An Empirical Test of the Decentralization Theorem
Authors: SCHAKEL ARJAN H.
Published: March 2010

Decentralization of policy provision is omnipresent yet we are not able to sufficiently account for the extent of this phenomenon. The decentralization theorem explains the decentralization of policy provision as a trade‐off between heterogenous preferences, interjurisdictional spillovers (externalities), and economies of scale. Empirical tests of the theorem have been hampered by a measurement problem on the independent as well as on the dependent variable. This article tackles these problems by using a new data set that combines a measure of externalities and scale effects of policies obtained from an expert survey with the actual provision of policies across governmental tiers in 40 countries. The analyses provide an empirical test of the decentralization theorem by showing that decentralization of policy provision is to a large extent determined by functional characteristics of policies and heterogenous preferences but other country‐specific variables, such as democracy, economic development, and European subsidies, also matter.
Nonoccupational HIV post‐exposure prophylaxis: a 10‐year retrospective analysis
Authors: Tissot F , Erard V , Dang T , Cavassini M
Published: March 2010

Background

We conducted a retrospective analysis of administration of nonoccupational HIV post‐exposure prophylaxis (nPEP) in a single centre where tracing and testing of the source of exposure were carried out systematically over a 10‐year period.

Methods

Files of all nPEP requests between 1998 and 2007 were reviewed. Characteristics of the exposed and source patients, the type of exposure, and clinical and serological outcomes were analysed.

Results

nPEP requests increased by 850% over 10 years. Among 910 events, 58% were heterosexual exposures, 15% homosexual exposures, 6% sexual assaults and 20% nonsexual exposures. In 208 events (23%), the source was reported to be HIV positive. In the remaining cases, active source tracing enabled 298 HIV tests to be performed (42%) and identified 11 HIV infections (3.7%). nPEP was able to be avoided or interrupted in 31% of 910 events when the source tested negative. Of 710 patients who started nPEP, 396 (56%) reported side effects, among whom 39 (5%) had to interrupt treatment. There were two HIV seroconversions, and neither was attributed to nPEP failure.

Conclusions

nPEP requests increased over time. HIV testing of the source person avoided nPEP in 31% of events and was therefore paramount in the management of potential HIV exposures. Furthermore, it allowed active screening of populations potentially at risk for undiagnosed HIV infection, as shown by the increased HIV prevalence in these groups (3.7%) compared with a prevalence of 0.3% in Switzerland as a whole.
HIV‐1 drug resistance mutations in children after failure of first‐line nonnucleoside reverse transcriptase inhibitor‐based antiretroviral therapy
Authors: Puthanakit T , Jourdain G , Hongsiriwon S , Suntarattiwong P , Chokephaibulkit K , Sirisanthana V , Kosalaraksa P , Petdachai W , Hansudewechakul R , Siangphoe U , Suwanlerk T , Ananworanich J ,   on behalf of the HIV‐NAT 086 study team
Published: March 2010

Objectives

The aim of the study was to assess the prevalence, predictors and patterns of genotypic resistance mutations in children after failure of World Health Organization‐recommended initial nonnucleoside reverse transcriptase inhibitor (NNRTI)‐based treatment regimens.

Methods

We carried out a multicentre retrospective study of genotyping tests performed for all HIV‐infected children at eight paediatric centres in Thailand who experienced failure of NNRTI therapy at a time when virological monitoring was not routinely available.

Results

One hundred and twenty children were included in the study. Their median age (interquartile range) was 9.1 (6.8–11.0) years, the median duration of their NNRTI regimens was 23.7 (15.7–32.6) months, their median CD4 percentage was 12% (4–20%), and their median plasma HIV RNA at the time of genotype testing was 4.8 (4.3–5.2) log10 HIV‐1 RNA copies/mL. The nucleoside reverse transcriptase inhibitor (NRTI) resistance mutations found were as follows: 85% of the children had M184V/I, 23% had at least four thymidine analogue mutations, 12% had the Q151M complex, 5% had K65R, and 1% had the 69 insertion. Ninety‐eight per cent of the children had at least one NNRTI resistance mutation, and 48% had etravirine mutation‐weighted scores ≥4. CD4 percentage <15% prior to switching regimens [odds ratio (OR) 5.49; 95% confidence interval (CI) 2.02–14.93] and plasma HIV RNA>5 log10 copies/mL (OR 2.46; 95% CI 1.04–5.82) were independent predictors of at least four thymidine analogue mutations, the Q151M complex or the 69 insertion.

Conclusions

In settings without routine viral load monitoring, second‐line antiretroviral therapy regimens should be designed assuming that clinical or immunological failure is associated with high rates of multi‐NRTI resistance and NNRTI resistance, including resistance to etravirine.
Daily Activity, Community Participation and Quality of Life in an Ordinary Housing Network
Authors: Rapley Mark , Beyer Stephen
Published: March 2010

Many studies of the quality of ordinary housing have relied upon objective indices, which permit only inferential judgements to be made about the quality of life of service users. Quality of Life (QOL) has recently emerged as a key outcome criterion against which to assess the success of community based services for people with intellectual disabilities. A small scale study was conducted to assess the extent to which objective measures of service quality were enhanced by the addition of a subjective, QOL, measure. Service users' engagement in domestic activity, staff contacts and participation in the local community were assessed and, in addition, the Quality of Life Questionnaire (Schalock & Keith, 1993) was completed. Data suggested that isolation and disengagement characterised the sample. Perceived QOL was correspondingly poor. It is concluded that the ordinary house remains a necessary, but insufficient, component of an integrative service model.
A Review of DRO: The Influence of the Degree of Intellectual Disability and the Frequency of the Target Behaviour
Authors: Whitaker Simon
Published: March 2010

A review of the use of Differential Reinforcement of Other Behaviours (DRO) showed that the majority of people had target behaviour with an initial frequency of greater than once a minute. There was a rapid drop in the number of published studies as the frequency of the initial target behaviour decreased. However, there were some studies that reported using DRO to reduce target behaviours with frequencies of less than once a day. There was evidence that DRO could be used with people with the full range of intellectual disabilities, to reduce target behaviours with frequencies as low as several times an hour, though those people with severe to profound disability needed more training on the DRO schedule before it was effective. It is suggested that DRO may not be as effective with lower frequency target behaviours and recommendations are made as to how its effectiveness might be increased.
The Pattern of Sleep Problems in Children with Down's Syndrome and Other Intellectual Disabilities
Authors: Stores R. , Stores G. , Buckley S.
Published: March 2010

This study investigates the occurrence and nature of sleep problems and behaviours in a group of children with Down's syndrome (n = 91) compared with their siblings (n = 54), children from the general population (n = 78) and children with an intellectual disability other than Down's syndrome (n = 71). A comprehensive questionnaire was sent to parents asking about the general sleeping habits and arrangements of the child and the frequency of occurrence of a range of sleep disorders and behaviours falling under the general headings of: disorders of initiating and maintaining sleep, features associated with obstructive sleep apnoea, other sleep disorders and behaviours occurring during sleep, and sleep related disorders and behaviours occurring during the day. Overall, children with Down's syndrome and children with other forms of intellectual disability showed a greater number of sleep problems than the siblings and children from the general population. However, whereas the sleep problems of the children with other intellectual disabilities, the siblings and children from the general population principally took the form of disorders of initiating and maintaining sleep, the children with Down's syndrome were characterised by features suggesting sleep related breathing problems, i.e. restlessness, snoring, sleeping with neck extended, apnoeic episodes, gagging or choking, and mouth breathing. A number of significant age differences were found in the occurrence of some sleep problems and behaviours. These were mainly in the group with Down's syndrome. The implications of the findings are discussed with reference to effective treatments and also the beneficial effects these might have on cognitive and behavioural problems in these children.
Aspects of the Use of Psychoactive Medication Among People with Intellectual Disabilities Who Have Been Resettled from Long‐stay Hospitals into Dispersed Housing
Authors: Fleming Ian , Caine Amanda , Ahmed Sameena , Smith Sharon
Published: March 2010

Aspects of the use of psychoactive medication were assessed among 118 adults with intellectual disabilities who had been resettled from long‐stay hospitals into two local dispersed housing services. The resulting data indicated that (1) 69% of people were receiving psychoactive medication primarily for the control of challenging behaviour; (2) only 8% had psychiatric diagnoses; (3) polypharmacy was frequent and (4) medication was continued over long periods sometimes without review. The prescribing practices of general practitioners tended to follow those inherited from the long‐stay hospitals. The findings are compared with recent policy statements concerning the use of anti‐psychotic medication and the need for multidisciplinary medication audit, and contrasted with evidence for the greater efficacy of non‐pharmacological alternatives.
Primary Care for People with an Intellectual Disability — A Group Practice Survey
Authors: Kerr M. P. , Richards D. , Glover Geraldine
Published: March 2010

This study describes the process of identification and subsequent examination of the delivery of health care to people with an intellectual disability in a single general practice.

The study was undertaken in group practice with a list size of 11,425. Identification through practice and community intellectual disability teams was followed by a note‐based assessment of health promotion and consultation rates. Comparison was made with age‐sex matched non‐disabled controls. A total of 26 individuals with an intellectual disability was identified, 14 male and 12 female, with an age range of 3 to 75 years. Of these 7 (26.9%) were on the local Social Services register. A diverse range of causes of disability was seen. People with an intellectual disability did not differ significantly from controls in terms of consultation rates. They were significantly less likely to have received regular immunisations (chi square = 4.92, df=1, p = 0.027), urine analysis (Fisher's exact test, two tail, p = 0.014)) and cervical cytology (Fisher's exact test, two tail, p = 0.01). They were more likely to have epilepsy (chi square = 8, df = 2, p = 0.02), have had a greater number of outpatient appointments (t = 3.4, df= 50, p = 0.001) and have seen a greater number of specialists (t = 3.65, df = 50, p = 0.001). Only one health gain target baseline could be measured, the name of the key‐worker in notes, this was present in 3 (11.5%) of cases.
The Integration of Children with Severe Learning Difficulties: A Review of the Recent Literature
Authors: Farrell Peter
Published: March 2010

This article reviews recent literature on the effects of integrating children with severe learning difficulties (or severe intellectual disabilities) into mainstream schools. It begins with a brief discussion of some of the inherent methodological problems in evaluating integration. This is followed by a review of the literature in the following areas: the role of support workers in facilitating integration; the effect of integration on communication and linguistic interaction; the relevance of curriculum differentiation; the impact of the age, ability and behaviour of the children with disabilities on integration; the effects of integration on children without disabilities; the attitudes of mainstream teachers and Local Education Authority staff towards integration. It concludes with a summary of the main findings and discusses the implications for future policy, provision and research.
Reductions in Self‐assessed Anxiety and Concurrent Improvement in Cognitive Performance in Adults who have Moderate Intellectual Disabilities
Authors: Morrison F. J. , Lindsay W.R.
Published: March 2010

Relaxation techniques have been identified as reducing physiological and behavioural manifestations of anxiety. This study considered whether these reductions were related to similar reductions in the client's self‐assessed experience of anxiety. This study replicates Lindsay and Morrison's (1996) findings of reductions in self‐assessed anxiety following relaxation training and extends these findings to a wider population. Thirty participants with moderate intellectual disabilities were assigned either to an experimental group receiving behavioural relaxation therapy or to a ‘placebo’ contrast group. Participants were assessed using the Zung Anxiety Inventory (Z AI), a test of short‐term memory (STM) span, an incidental learning task and a test of general knowledge. Experimental group findings suggest reductions in assessed levels of anxiety and concurrent improvements in cognitive performance with respect to STM and incidental learning, but not in general knowledge.