bluuebunny/crossref_metadata_2025 huggingface dataset:
Medicinal herbal extracts – renal friend or foe? Part one: The toxicities of medicinal herbs
Authors: WOJCIKOWSKI KEN , JOHNSON DAVID W , GOBÉ GLENDA
Published: October 2004

In recent years, an increasing percentage of people from industrialized countries have been using complementary and alternative medicines (CAM). This, combined with numerous warnings regarding the potential toxicity of these therapies, suggests the need for practitioners to keep abreast of the reported incidence of renal toxicity caused by the ingestion of medicinal herbs. The goal of the present two‐part series, on the toxic or beneficial effects of medicinal herbs on renal health, is to provide practitioners with a summary of the most recent information as well as the means by which evidence for benefit or toxicity has been found. In this first article, we explore in vivo evidence of toxicity. Included are nephrotoxicity from aristolochic acid and other components within herbs, herb–drug interactions resulting in adverse renal effects, and renal toxicity from contaminants within the extracts. The review aims to provide a guide to encourage future toxicity studies and rigorous clinical trials.
Low protein diet causes a decrease in serum concentrations of leptin and tumour necrosis factor‐alpha in patients with conservatively treated chronic renal failure
Authors: KOZŁOWSKA LUCYNA , ROSOŁOWSKA‐HUSZCZ DANUTA , RYDZEWSKI ANDRZEJ
Published: October 2004

Background:  Chronic renal failure (CRF) provokes derangement in various hormonal regulations of food intake and energy expenditure. In the present study, we have examined the effect of a low protein, low phosphorus diet on circulating levels of leptin, tumour necrosis factor (TNF)‐alpha, and insulin in patients with CRF.

Methods:  Seventeen male, non‐diabetic subjects with conservatively treated CRF (estimated creatinine clearance 39.5 ± 11.1 mL/min), and proteinuria below 2 g/day were prospectively studied. Measurements of hormonal, metabolic and anthropometric parameters were performed before and after 16 weeks of dietary treatment (protein 0.6 g/kg of ideal body mass, 30% of calories derived from fat, 62% of calories derived from carbohydrates and 10 mg/kg of phosphorus). Actual dietary intake in patients was measured by using 3‐day food records and was supervised by the dietician.

Results:  Body mass index and body fat mass remained unchanged during the 4 months of dietary treatment. Urea, leptin, and TNF‐alpha serum concentrations decreased significantly.

Conclusions:  A low protein, low phosphorus diet reduces TNF‐alpha and leptin levels in plasma. The effect on leptin appears not to be mediated by an insulin‐dependent mechanism.
Nursing culture of an operating theater in Italy
Authors: Yamaguchi Satomi
Published: October 2004

Abstract Sociocultural and organizational factors that influence the work culture of nurses in an Italian operating theater were the subject of the present qualitative explorative study. Italy is one of the world's wealthiest, most powerful countries. Yet little is known outside its borders about the unique culture of Italian nurses at work in hospitals and its effect on health care. Throughout this Japanese author's first hand experience of the microculture of Italian nursing, using a microethnographic design with focus groups for cultural interpretation, data were collected during 2000–2001 from 25 staff nurses working full‐time in one regional hospital. Nurses in the operating theater, considerably less educated than doctors and accustomed to the power and status of medicine, were directed in nearly all activities by physicians. Finding little leadership from management, the nurses developed solid defenses against change and conflict through concerted allegiance to one another. The findings suggest that with Italian nurses questioning tradition and seeking university education, there may be gradual recognition by medicine, management and the public of their contribution to health system performance, improved patient care outcomes, and the value of the nursing profession.
Client supervision: Meaning and experiences from the perspective of Norwegian public health nurses
Authors: Tveiten Sidsel , Severinsson Elisabeth
Published: October 2004

AbstractThe aim of the present study was to examine the meaning and experiences of client supervision from the perspective of Norwegian public health nurses. The World Health Organization (WHO) states that new intervention strategies to improve public health are necessary. Supervision represents such a strategy. Three focus groups were interviewed twice. The data were analyzed by qualitative content analysis. The findings revealed three themes: (i) the meaning of the umbrella term client supervision; informing, teaching, giving advice and ensuring the quality of supervision; (ii) factors influencing supervision; the public health nurses’ available time and competence and the clients’ ability to be supervised; and (iii) events and content representing the complexity of conducting supervision. In conclusion, the width of the concept, the influencing factors and the complexity claim that public health nurses have competence to supervise.
Case for blending pedigrees, genograms and ecomaps: Nursing's contribution to the ‘big picture’
Authors: Olsen Sharon , Dudley‐Brown Sharon , McMullen Patricia
Published: October 2004

Abstract In the 21st century, knowledge of genetics is closely linked to the ability to provide good care for all patients, not just the few with uncommon genetic diseases. The authors suggest that what is needed in nursing is a comprehensive, three generation pedigree that records a patient's medical, social and environmental history, thereby communicating a ‘big picture’ scenario for holistic nursing care. The case is made for blending pedigrees, genograms and ecomaps. Such a tool can guide risk factor identification and inform patient and family clinical decisions vis‐à‐vis care management strategies, psychosocial support and education for reproductive decisions, risk reduction, and the prevention, screening, diagnosis, referral and long‐term management of disease. Pedigrees, genograms and ecomaps are defined, and their clinical application and reliability are described. A case example that blends these tools is presented. Ethical, legal, educational and research implications are discussed.
IDUS IN THE DIAGNOSIS OF IPMT
Authors: Fujita Naotaka , Noda Yutaka , Kobayashi Go
Published: October 2004

Intraductal papillary mucinous tumor of the pancreas (IPMT) is considered as having low‐grade malignant potential, and malignancy is not infrequent. Therefore, accurate diagnosis is indispensable for appropriate patient care. IPMT is classified mainly into two categories based on the distribution of tumor, the main duct type and the branch duct type. In the diagnosis of IPMT, there are four important points: differentiation of IPMT from other pancreatic pathologies; differentiation of malignancy from benign lesions; evaluation of tumor extent along the MPD; and investigation of duct cell carcinoma coexistent with or derived from IPMT. IPMT should be distinguished from chronic pancreatitis, ductal adenocarcinoma, or cystic neoplasms. IPMT often requires pancreaticoduodenectomy for cure, but such invasive surgery should be avoided in patients with benign hyperplasia. Mural nodules in the MPD can be clearly visualized by intraductal ultrasonography (IDUS). Measurement of the height of the tumor mass by IDUS is useful in distinguishing benign from malignant IPMT. Intraductal spread of IPMT along the MPD is demonstrated by IDUS as irregular thickening of the MPD wall. To achieve a tumor‐free margin in surgery, evaluation by IDUS of the extent of the tumor along the MPD is important. The expected accuracy of IDUS in the diagnosis of invasive IPMT is reportedly over 90%.
ENDOSCOPIC ULTRASOUND AND FINE‐NEEDLE ASPIRATION FOR PANCREATIC CANCER
Authors: Wallace Michael B , Woodward Timothy , Raimondo Massimo
Published: October 2004

Background:  Accurate staging of pancreatic cancer is essential for surgical planning, and identification of locally advanced and metastatic disease that is incurable by surgery. Advances in EUS, CT, and PET have improved the accuracy of staging and reduced the number of incomplete surgical resections. Tissue acquisition is necessary in non‐surgical cases when chemo‐radiotherapy is considered. The complex regional anatomy of the pancreas makes cytologic diagnosis of malignancy at this region difficult without exploratory surgery. Although CT‐guided fine‐needle aspiration (FNA) is used for this purpose, reports of an increased risk of peritoneal dissemination of cancer cells and a false negative rate of nearly 20% makes this a less than ideal choice. The ability to position the EUS‐transducer in direct proximity to the pancreas by means of stomach and the duodenum, combined with the use of FNA, increases the specificity of EUS in detecting pancreatic malignancies.

Methods:  The current literature regarding the accuracy of EUS with FNA in the evaluation of pancreatic cancer is reviewed.

Results:  EUS accuracy for tumor (T) staging ranges from approximately 78–94% and nodal (N) stage accuracy between 64 and 82%. EUS also enables FNA of lesions that are too small to be identified by CT or MRI, or too close to vascular structures to safely allow percutaneous biopsy. The accuracy for detecting invasion into the superior mesenteric artery and vein is lower than that for detecting portal or splenic vein invasion, especially for large tumors. EUS permits delivery of localized therapy such as celiac plexus neurolysis for pain control and direct intralesional injection of antitumor therapy.

Conclusions:  EUS in combination with FNA is a highly accurate method of preoperative staging of pancreatic cancer especially those too small to characterize by CT or MRI, and has the ability to obtain cytological confirmation.
ENDOSCOPIC ULTRASONOGRAPHY EDUCATION IN ASIA: ARE WE THERE YET?
Authors: Ho Khek Yu
Published: October 2004

The growth of endoscopic ultrasonography (EUS) in Asia outside of Japan has not really kept pace with the development of this technology. One overriding factor inhibiting the wider use of EUS in Asia is the lack of training opportunities. In most hospitals of Asia, no formal training program is available. In order to achieve the highest quality EUS training attainable given these limited resources, we believe efforts will need to be channelled in two directions. One is by sending promising endoscopists to centers of excellence for hands‐on training so that when these endoscopists are trained, they will be able to contribute to the pool of qualified teachers to achieve ‘self‐sufficient’ training of future EUS fellows. The second direction is toward development of well‐structured courses for endoscopy trainees who are unable to obtain formal EUS attachment. These courses should incorporate the opportunity for hands‐on exposure in addition to observational training. We are hopeful that through these measures, we should be able to increase the pool of EUS practitioners and improve acceptance of this imaging modality in Asia in the near future.
HOW SHALL WE EXPERIENCE EUS AND EUS‐FNA BEFORE THE FIRST PROCEDURE?: THE DEVELOPMENT OF LEARNING TOOLS
Authors: Matsuda Koji , Tajiri Hisao , Hawes Robert H
Published: October 2004

The learning curve of endoscopic ultrasound (EUS) and EUS‐fine‐needle aspiration (EUS‐FNA) is long with existing data suggesting that > 150 supervised cased are required! To shorten the learning period of EUS, a few learning tools have been developed. The learning tools especially designed for EUS and EUS‐FNA (live animal model, computer simulator, simple phantom, EUS RK model) were reviewed. There is a need to develop learning tools for EUS that require no maintenance, are inexpensive, readily available, and proven to shorten the learning curve. Few centers have the faculty expertise and adequate caseload (to sufficiently train fellows in EUS).
EDUCATION AND TRAINING FOR ENDOSCOPIC ULTRASONOGRAPHY IN JAPAN
Authors: Maguchi Hiroyuki
Published: October 2004

While EUS was developed in 1980 originally for detecting small early stage biliopancreatic malignancies, it has been recently employed in Japan mostly for evaluating gastrointestinal diseases. The main reason for this seems to be the difficulty in understanding biliopancreatic anatomy compared with gastrointestinal diseases in the use of EUS; also because no standard EUS operation has been established for the examination of pancreatobiliary region, although there are several different ways to perform EUS. To promote the use of EUS, we need to establish a standard EUS scanning technique. It is fortunate that the guidebook Standard Imaging Techniques in the Pancreatobiliary Region Using Radial Scanning EUS was published in 2003 and EUS live demonstration seminars have already started at some institutions. These activities are good opportunities for doctors wishing to learn EUS examination procedures. We anticipate that it is necessary to foster a large number of EUS operators to establish effective training and education programs in Japan.
EUS EDUCATION IN EU
Authors: Caletti Giancarlo , Togliani Thomas , Fusaroli Pietro
Published: October 2004

Endoscopic ultrasonography (EUS) is a relatively new diagnostic technique; although it has greatly shown its utility in many diseases, its diffusion is still limited. In very few European academic centers EUS is included in basic endoscopic gastrointestinal (GI) fellowship; for this reason endoscopists interested in EUS generally attend intensive EUS workshops, where available. Recently, in some university centers, for example in Italy, long‐term training courses in advanced endoscopy, including EUS, have been organized. These educational periods comprehend an extensive calendar of didactic lectures, live procedures, and hands‐on training. Topics taught generally are: basics of ultrasound, indications, risks and expected outcome of EUS, normal/pathologic EUS anatomy, management of procedure‐related complications, and management of sedation during endoscopy. After a mean of 250–500 supervised EUS exams, the trainee is expected to achieve a good competence in this technique.
ENDOSCOPIC SUBMUCOSAL DISSECTION OF COLORECTAL LESION
Authors: Yahagi Naohisa , Fujishiro Mitsuhiro , Omata Masao
Published: October 2004

Endoscopic submucosal dissection (ESD) has been developed for en‐bloc resection of mucosal lesions of the gastrointestinal tract. It enables us to resect almost all mucosal and slightly submucosal invasive tumors, regardless of size and shape, even in the colon. Therefore, preoperative diagnosis, especially for the depth of invasion, is very important to determine the treatment strategy. The shape of the lesion, its pit pattern and also EUS findings are very useful in estimating the depth of invasion. We use an EndoEcho system with ultrasonic probe, which gives us both radial and linear image of the lesions. Remodeled three‐dimensional (3D) images are also very useful in evaluating the size and the expansion of the lesion when it is located on a fold. Although the large intestine involves structural and technical difficulties, we conduct en‐bloc resection by ESD while exercising various ingeunities in preparation, endoscopes, use of instruments and local injections. ESD is the reliable technique, which allows en‐bloc resection of gastrointestinal mucosal lesions, and has a excellent chance of success in the treatment of early stage colorectal cancer.
EUS IN THE DIAGNOSIS OF ULCERATIVE COLITIS
Authors: Cho Eisai , Yasuda Kenjiro , Nakajima Masatsugu
Published: October 2004

The ultrasonograms of ulcerative colitis (UC) in active stage show hypoechoic changes of the colorectal wall from the mucosal layer to the deeper layers. These endoscopic ultrasound (EUS) changes of the wall recognized in active stage disappear or normalize in the stage of remission. When the stage of UC is exacerbated, the hypoechoic changes of the wall extend from the mucosal layer to the deeper layers with the increase of wall thickness. These EUS images of active UC are classified into the following types: UC‐M, thickening of the whole wall with the structure preserved; UC‐SM, hypoechoic changes reach the superficial portion of third layer with the thickening of whole wall; UC‐SM deep, hypoechoic changes reach the deeper portion of third layer with the thickening of whole wall; UC‐MP, hypoechoic changes reach the fourth layer with the thickening of whole wall; UC‐SS/SE, hypoechoic changes penetrate through the fourth layer with the thickening of whole wall. With the help of EUS we can demonstrate the severity of inflammation in UC. Moreover, in severe cases of UC, the treatment strategy including emergency surgery can be determined. EUS is a valuable method in the management of UC.
ELECTRONIC RADIAL ULTRASOUND ENDOSCOPE
Authors: Hawes Robert H
Published: October 2004

Examination with a radial echoendoscope is an important part of endoscopic ultrasonography. Mechanical radial systems have been used since the initiation of endoscopic ultrasound (EUS) but a new generation of electronic array radial echoendoscopes offers some potential advantages. The lack of moving parts should improve the reliability and durability of the echoendoscope and with the electronic array, Doppler functions are possible. To date, however, no studies have conuincingly shown that the images are of superior quality or that diagnosis is improved with the electronic array systems versus the mechanical sector scanning echoendoscopes.
EUS GUIDED FNA FOR MEDIASTINAL TUMORS (LUNG CANCER AND LYMPH NODES)
Authors: Vilmann Peter , Larsen Søren S. , Krasnik Mark
Published: October 2004

Trans‐esophageal endoscopic ultrasound‐guided fine needle aspiration biopsy (EUS‐FNA) has proven to be a safe and minimally invasive tissue‐sampling method which can be used to obtain a cytological diagnosis from mediastinal lesions. The aims of EUS‐FNA in the mediastinum are either to diagnose a lesion of unknown origin, to stage mediastinal lymph nodes in lung cancer patients or to diagnose other diseases involving lymph nodes of the mediastinum. In patients with non‐small cell lung cancer (NSCLC), surgery may be regarded as futile in up to 45% of patients operated, apparently because the stage of the disease is more advanced than expected preoperatively. This, combined with a stage‐dependent multimodality treatment, underlines the importance of exact staging of the disease. Conventional imaging and tissue sampling methods all have variable sensitivities.

Twenty‐two studies concerning EUS‐FNA and mediastinal staging of lung cancer have been published with a total number of 1245 patients. The reported sensitivity for mediastinal malignancy range from 0.61–1.00 (median 0.90), and with specificities of 0.71–1.00 (median 1.00). The majority of the studies are retrospective and present the results of EUS‐FNA performed in lung cancer patients selected by computer tomography (CT). Recent data suggests that EUS‐FNA in addition can diagnose advanced mediastinal disease in 22–42% of NSCLC patients with normal sized lymph nodes (< 1 cm) on chest CT. EUS‐FNA may also be used as a re‐staging procedure after induction chemotherapy and it seems that EUS‐FNA is more accurate for mediastinal staging of NSCLC compared to positron emission tomography (PET). However, further studies are necessary before final conclusions can be made. At present, mediastinoscopy is still considered complementary to EUS‐FNA because EUS‐FNA cannot visualize structures anterior to the air‐filled trachea and main bronchi. Endoscopic trans‐bronchial real‐time ultrasound guided biopsy (EBUS‐TBNA) performed via the trachea and main bronchi seems to be an obvious solution. Preliminary experience with a prototype EBUS‐TBNA bronchoscope (Olympus, XBF‐UC40P, Tokyo, Japan) in 214 patients has shown promising results. Hopefully the combination of EUS‐FNA and EBUS‐TBNA will be able to replace more invasive and risky staging methods and improve the N‐staging accuracy of the mediastinum and lung hilar regions in the near future.
In situ analysis of p16/INK4 promoter hypermethylation in esophageal carcinoma and gastric carcinoma
Authors: ZHANG Fan , WANG Li , WU Ping Ping , YAN Zhao Wen , ZHENG Lin , YU Ying Yan , JIANG Xu Cheng
Published: October 2004

OBJECTIVE:  Inactivation of the tumor suppressor gene by CpG hypermethylation is a common event in a variety of tumors. The present study was designed to be a comprehensive analysis of p16/INK4 methylation in carcinomas of the upper digestive tract.

METHODS:  Series of esophageal carcinomas (34 cases) and gastric carcinomas (25 cases) were examined for CpG methylation in p16/INK4 using methylation‐specific PCR (MSP). The tissue sections underwent MSP in situ and were then examined microscopically. Immunohistochemical detection of the expression of p16 in the tumor specimens was also performed.

RESULTS:  Immunohistochemistry detected positive p16 expression in 8 cases of esophageal squamous cell carcinoma and 15 cases of gastric carcinoma. In esophageal carcinoma, hypermethylation of the p16/INK4 promoter region was detected in 5 cases without statistical correlation with its loss of expression, whereas in the gastric carcinomas, p16 expression was positively correlated with the T‐classification (r = 0.488, P = 0.01); p16/INK4 methylation was identified in 8 cases. In addition, p16 expression was lower in the methylated samples than in the non‐methylated samples (25% vs 76.47%, P = 0.03). Analysis of the MSP‐in‐situ sections showed that the distribution of methylated cells in esophageal carcinoma differed from that in gastric carcinoma.

CONCLUSION:  The role of DNA methylation in the silence of p16/INK4 may different between these two types of upper digestive tract tumor.
Clinical relevance of iceA and babA2 genotypes of Helicobacter pylori in a Shanghai population
Authors: HAN Yue Hua , LIU Wen Zhong , ZHU Hong Yin , XIAO Shu Dong
Published: October 2004

OBJECTIVE:  To determine the distribution of the iceA and babA2 genotypes of Helicobacter pylori in patients with various gastroduodenal diseases in Shanghai, and to explore the association between genotype and the clinical outcome of infection.

METHODS:  One hundred and forty‐one strains of H. pylori were isolated from gastric biopsies of 43 patients with chronic gastritis, 47 with duodenal ulcer (DU), 30 with gastric ulcer (GU) and 21 with non‐cardia gastric carcinoma. The iceA, babA2, cagA and vacA genotypes were determined by polymerase chain reaction (PCR).

RESULTS:  The iceA1, iceA2 and babA2 genotypes were detected in 74.5% (105/141), 15.6% (22/141) and 63.8% (90/141), respectively, of the H. pylori strains studied. Two H. pylori isolates (1.4%) were positive for both iceA alleles and 16 (11.3%) were negative for both. The prevalence of babA2 and its combination with cagA (cagA+/babA2+) in DU patients was significantly higher than that in GU patients (74.5%vs 50.0% for babA2, P = 0.028; 70.2%vs 46.7% for cagA+/babA2+, P = 0.039). There was no significant difference in the prevalence of babA2 among the other disease groups, and no significant association of the iceA genotypes with the different clinical diseases (P > 0.05).

CONCLUSIONS:  The most predominant genotype of the H. pylori strains isolated from patients in Shanghai are iceA1+/babA2+, and the babA2 genotype may play a different role in the pathogenesis of DU and GU. An association between iceA status and clinical outcome of H. pylori infection could not be confirmed in the present study.
Economics, Politics and Nations: Resistance to the Multidivisional Form in France, Germany and the United Kingdom, 1983–1993*
Authors: Mayer Michael , Whittington Richard
Published: October 2004

ABSTRACT  This paper assesses economic, political and national institutional explanations for continued resistance to the multidivisional form in France, Germany and the United Kingdom during the 1980s and 1990s. It finds that the economics of different diversification strategies play a significant but changing role in the structural choices of large corporations. The political interests of personal, banking and government owners are exercised variably. There remain strong national influences on structural choices, with resistance to the multidivisional form particularly pronounced in Germany. Overall, our results call for an increased contextual sensitivity in management research while acknowledging the possibility of convergent processes in business organization, represented here by the slow progress of the multidivisional firm.
Ownership Structure of Cooperatives as an Environmental Buffer*
Authors: Núñez‐Nickel Manuel , Moyano‐Fuentes José
Published: October 2004

ABSTRACT In this paper, we propose that the ownership structure in the cooperative form acts as an environmental buffer. It is a mechanism to obtain stronger linkages with suppliers by internalizing them, and in this way, obtaining fundamental resources. Using this strategy, the cooperative form can isolate itself from adverse environments and from competition from other organizational forms. Although cooperatives have higher survival probability in any economic context, in rival ideological environments they have less support than other organizational forms. To test these ideas, we have chosen data from the Spanish olive oil milling industry for 1944–98. During this period, Spain changed from a dictatorial to a democratic regime and from a self‐subsistence economy in the post civil‐war period to a broad liberal international economy. The results show that, whereas other organizational forms are affected by economic and ideological influences, the cooperative form isolates itself by changing the competition level.
Strategy as Simulacra? A Radical Reflexive Look at the Discipline and Practice of Strategy*
Authors: Grandy Gina , Mills Albert J.
Published: October 2004

ABSTRACT  Over the past three decades strategic management has become a crucial aspect of business education and practice. At the core of strategic management – linking technique to worldview – is modelling (e.g. value chain, SWOT analysis) whereby the complex elements of strategic thinking are simplified. This accounts in large part for the apparent popularity of strategic management as complex interrelationships are pursued through relatively simple models. Yet has the field of strategic management realized the third order of simulacra? Is strategic management a model of simulation whereby reality has been replaced by hyperreality? A review of the extant literature on strategy explores the study and practice of strategy as a discourse, engulfed by its own truth effects. An examination of the concepts of reflexivity demonstrates the value of a postmodern radical reflexive account through the application of Baudrillard's (1983, 1988, 1991, 1994) simulation and simulacra. It is through the development of a radical reflexive discourse of strategy as simulacra, this paper critically examines the study and practice of strategy and the lessons we can take from this perspective.
Human Resource Management and the Permeable Organization: The Case of the Multi‐Client Call Centre*
Authors: Rubery Jill , Carroll Carilyn , Cooke Fang Lee , Grugulis Irena , Earnshaw Jill
Published: October 2004

ABSTRACT Despite the interest over recent years in the fragmentation of organizations and the development of contracting, little attention has been paid to the impact of the associated inter‐organizational relationships on the internal organization of employment. Inter‐organizational relations have been introduced primarily as a means of externalizing – and potentially rendering invisible – employment issues and employment relations. In a context where inter‐organizational relationships appear to be growing in volume and diversity, this constitutes a significant gap in the literature that this paper in part aims to fill. The purpose of the paper is two‐fold: to develop a framework for considering the internal and external organizational influences on employment and to apply this framework within a case study of a multi‐client outsourcing call centre. We explore the interactions between internal objectives, client demands and the use of external contracting in relation to three dimensions of employment policy: managing the wage‐effort bargain, managing flexibility and managing commitment and performance. It is the interplay between these factors in a dynamic context that provides, we suggest, the basis for a more general framework for considering human resource policy in permeable organizations.
The Evolution of a ‘Meta-Policy’: The Case of the Private Finance Initiative and the Health Sector
Authors: Greenaway John , Salter Brian , Hart Stella
Published: October 2004

This article examines the evolution of the Private Finance Initiative in Britain since 1992 with particular reference to the health policy area. The initiative is presented as a ‘meta-policy’ in so far as it was not sectoral, but was situated above and beyond the normal run of Whitehall policies; it was also heavily ideologically driven. The evolution of the policy, however, was influenced by the policy networks and institutional interplay. In turn the PFI, as it gathered momentum, affected the culture, personnel and institutional structures within which it operated. The history of the PFI is then set against some recent theories of the policy process, particularly those produced by Peter John, stressing evolutionary approaches, and by David Marsh and Martin Smith, suggesting dialectical approaches to networks. It is suggested that there is a need for some theoretical revision which recognises the possibility that a policy itself can make a distinctive contribution to the causal process of policy change.
Exploring Variations in Turnout: Constituencies and Wards in the Scottish Parliament Elections of 1999 and 2003
Authors: Denver David , Hands Gordon
Published: October 2004

Elections for the Scottish Parliament and for all Scottish local authorities were held on the same day in 1999 and 2003, allowing a more detailed exploration of turnout variations than has been possible before. On both occasions, turnout in the two sets of elections was almost identical so that reported ward turnout at local level also indicates ward turnout in the parliament elections. Parliamentary turnout is analysed at both constituency and ward levels. The latter gives us greater confidence in the constituency results and also suggests some relationships which are not apparent at constituency level. The strongest determinant of turnout is consistently found to be the proportion of adults with a degree; religious affiliation, here analysed for the first time at the aggregate level, is also strongly related to turnout.
Lacanian Political Theory: A Reply to Robinson
Authors: Thomassen Lasse
Published: October 2004

In this response to Andrew Robinson's review of ‘The politics of lack,’ I argue that, although Robinson puts forward a number of interesting and succinct points about Lacanian political theory, his review rests on misunderstandings of post-structuralist political theory and misreadings of the texts under consideration. More specifically, I argue that his use of the labels ‘Lacanian’ and ‘theorist of lack’ is problematic; that his position rests on a misunderstanding of the relationship between ontology and politics in post-structuralist theory; and that it is a mistake to allege that Lacanian political theory is inherently conservative.
The Case for Disciplinary History: Political Studies in the 1950s and 1960s
Authors: Kenny Michael
Published: October 2004

This article proposes a greater emphasis upon the intellectual history of political studies in the UK. The limitations of conventional understandings of the disciplinary past are considered in relation to the 1950s and 1960s. The author seeks to challenge contemporary views of this period in two respects. First, he shows how the key institutions of the emergent discipline were formed for highly contingent reasons, and how they were underpinned by a disciplinary ethos that was inherited from the late 19th and early 20th centuries. Second, he draws attention to an important, and neglected, shift in disciplinary self-understanding in the late 1950s and 1960s, as figures like W. J. M. Mackenzie blended aspects of the dominant approach to political inquiry with newer ideas, thus generating an influential conception of a distinctively British political science.
Modelling Species Diversity Through Species Level Hierarchical Modelling
Authors: Gelfand Alan E. , Schmidt Alexandra M. , Wu Shanshan , Silander John A. , Latimer Andrew , Rebelo Anthony G.
Published: October 2004

Understanding spatial patterns of species diversity and the distributions of individ-ual species is a consuming problem in biogeography and conservation. The Cape floristic region of South Africa is a global hot spot of diversity and endemism, and the Protea atlas project, with about 60000 site records across the region, provides an extraordinarily rich data set to model patterns of biodiversity. Model development is focused spatially at the scale of 1′ grid cells (about 37000 cells total for the region). We report on results for 23 species of a flowering plant family known as Proteaceae (of about 330 in the Cape floristic region) for a defined subregion. Using a Bayesian framework, we developed a two-stage, spatially explicit, hierarchical logistic regression. Stage 1 models the potential probability of presence or absence for each species at each cell, given species attributes, grid cell (site level) environmental data with species level coefficients, and a spatial random effect. The second level of the hierarchy models the probability of observing each species in each cell given that it is present. Because the atlas data are not evenly distributed across the landscape, grid cells contain variable numbers of sampling localities. Thus this model takes the sampling intensity at each site into account by assuming that the total number of times that a particular species was observed within a site follows a binomial distribution. After assigning prior distributions to all quantities in the model, samples from the posterior distribution were obtained via Markov chain Monte Carlo methods. Results are mapped as the model-estimated probability of presence for each species across the domain. This provides an alternative to customary empirical ‘range-of-occupancy’ displays. Summing yields the predicted richness of species over the region. Summaries of the posterior for each environmental coefficient show which variables are most important in explaining the presence of species. Our initial results describe biogeographical patterns over the modelled region remarkably well. In particular, species local population size and mode of dispersal contribute significantly to predicting patterns, along with annual precipitation, the coefficient of variation in rainfall and elevation.
A Bayesian Ordinal Logistic Regression Model to Correct for Interobserver Measurement Error in a Geographical Oral Health Study
Authors: Mwalili Samuel M. , Lesaffre Emmanuel , Declerck Dominique
Published: October 2004

We present an approach for correcting for interobserver measurement error in an ordinal logistic regression model taking into account also the variability of the estimated correction terms. The different scoring behaviour of the 16 examiners complicated the identification of a geographical trend in a recent study on caries experience in Flemish children (Belgium) who were 7 years old. Since the measurement error is on the response the factor ‘examiner’ could be included in the regression model to correct for its confounding effect. However, controlling for examiner largely removed the geographical east–west trend. Instead, we suggest a (Bayesian) ordinal logistic model which corrects for the scoring error (compared with a gold standard) using a calibration data set. The marginal posterior distribution of the regression parameters of interest is obtained by integrating out the correction terms pertaining to the calibration data set. This is done by processing two Markov chains sequentially, whereby one Markov chain samples the correction terms. The sampled correction term is imputed in the Markov chain pertaining to the regression parameters. The model was fitted to the oral health data of the Signal–Tandmobiel® study. A WinBUGS program was written to perform the analysis.
Nonparametric Estimation of a Change in Defect Intensity
Authors: Denteneer D. , Keane M. S.
Published: October 2004

In an important class of problems involving mixture distributions, interest focuses on the mixture proportions, considering other possible parameters as nuisance parameters. We formulate a new variation on such problems that arose in a study on the link between the number of cells in a charge-coupled detector image sensor that turned defective because of cosmic radiation and the storage conditions of such sensors. In this variation, the component densities are bivariate, there are two classes and only a subset of the mixture proportions is of relevance. We propose a nonparametric method to estimate the relevant subset of the proportions and apply our method to the data in our study.
A Useful Distribution for Fitting Discrete Data: Revival of the Conway–Maxwell–Poisson Distribution
Authors: Shmueli Galit , Minka Thomas P. , Kadane Joseph B. , Borle Sharad , Boatwright Peter
Published: October 2004

A useful discrete distribution (the Conway–Maxwell–Poisson distribution) is revived and its statistical and probabilistic properties are introduced and explored. This distribution is a two-parameter extension of the Poisson distribution that generalizes some well-known discrete distributions (Poisson, Bernoulli and geometric). It also leads to the generalization of distributions derived from these discrete distributions (i.e. the binomial and negative binomial distributions). We describe three methods for estimating the parameters of the Conway–Maxwell–Poisson distribution. The first is a fast simple weighted least squares method, which leads to estimates that are sufficiently accurate for practical purposes. The second method, using maximum likelihood, can be used to refine the initial estimates. This method requires iterations and is more computationally intensive. The third estimation method is Bayesian. Using the conjugate prior, the posterior density of the parameters of the Conway–Maxwell–Poisson distribution is easily computed. It is a flexible distribution that can account for overdispersion or underdispersion that is commonly encountered in count data. We also explore two sets of real world data demonstrating the flexibility and elegance of the Conway–Maxwell–Poisson distribution in fitting count data which do not seem to follow the Poisson distribution.
A Modified False Discovery Rate Multiple-Comparisons Procedure for Discrete Data, Applied to Human Immunodeficiency Virus Genetics
Authors: Gilbert Peter B.
Published: October 2004

To help to design vaccines for acquired immune deficiency syndrome that protect broadly against many genetic variants of the human immunodeficiency virus, the mutation rates at 118 positions in HIV amino-acid sequences of subtype C versus those of subtype B were compared. The false discovery rate (FDR) multiple-comparisons procedure can be used to determine statistical significance. When the test statistics have discrete distributions, the FDR procedure can be made more powerful by a simple modification. The paper develops a modified FDR procedure for discrete data and applies it to the human immunodeficiency virus data. The new procedure detects 15 positions with significantly different mutation rates compared with 11 that are detected by the original FDR method. Simulations delineate conditions under which the modified FDR procedure confers large gains in power over the original technique. In general FDR adjustment methods can be improved for discrete data by incorporating the modification proposed.
Bayesian Methods for the Cross-Design Synthesis of Epidemiological and Toxicological Evidence
Authors: Peters Jaime L. , Rushton Lesley , Sutton Alex J. , Jones David R. , Abrams Keith R. , Mugglestone Moira A.
Published: October 2004

Systematic review and synthesis (meta-analysis) methods are now increasingly used in many areas of health care research. We investigate the potential usefulness of these methods for combining human and animal data in human health risk assessment of exposure to environmental chemicals. Currently, risk assessments are often based on narrative review and expert judgment, but systematic review and formal synthesis methods offer a more transparent and rigorous approach. The method is illustrated by using the example of trihalomethane exposure and its possible association with low birth weight. A systematic literature review identified 13 relevant studies (five epidemiological and eight toxicological). Study-specific dose–response slope estimates were obtained for each of the studies and synthesized by using Bayesian meta-analysis models. Sensitivity analyses of the results obtained to the assumptions made suggest that some assumptions are critical. It is concluded that systematic review methods should be used in the synthesis of evidence for environmental standard setting, that meta-analysis will often be a valuable approach in these contexts and that sensitivity analyses are an important component of the approach whether or not formal synthesis methods (such as systematic review and meta-analysis) are used.
A Bayesian Kriged Kalman Model for Short-Term Forecasting of Air Pollution Levels
Authors: Sahu Sujit K. , Mardia Kanti V.
Published: October 2004

Short-term forecasts of air pollution levels in big cities are now reported in news-papers and other media outlets. Studies indicate that even short-term exposure to high levels of an air pollutant called atmospheric particulate matter can lead to long-term health effects. Data are typically observed at fixed monitoring stations throughout a study region of interest at different time points. Statistical spatiotemporal models are appropriate for modelling these data. We consider short-term forecasting of these spatiotemporal processes by using a Bayesian kriged Kalman filtering model. The spatial prediction surface of the model is built by using the well-known method of kriging for optimum spatial prediction and the temporal effects are analysed by using the models underlying the Kalman filtering method. The full Bayesian model is implemented by using Markov chain Monte Carlo techniques which enable us to obtain the optimal Bayesian forecasts in time and space. A new cross-validation method based on the Mahalanobis distance between the forecasts and observed data is also developed to assess the forecasting performance of the model implemented.
Disease Resistance Modelled as First-Passage Times of Genetically Dependent Stochastic Processes
Authors: Sæbø S. , Almøy T. , Aastveit A. H.
Published: October 2004

Mastitis resistance data on dairy cattle are modelled as first-passage times of stochastic processes. Population heterogeneity is included by expressing process parameters as functions of shared random variables. We show how dependences between individuals, e.g. genetic relationships, can be exploited in the analyses. The method can be extended to handle situations with multiple hidden causes of failure. Markov chain Monte Carlo methods are used for estimation.
Second Language Fluency: Judgments on Different Tasks
Authors: Derwing Tracey M. , Rossiter Marian J. , Munro Murray J. , Thomson Ron I.
Published: October 2004

In this study we determined whether untrained raters’ assessments of fluency in low‐proficiency second language speech were related to temporal measures and whether they varied across tasks. We collected speech samples from 20 beginner Mandarin learners of English on picture description, monologue, and dialogue tasks. Temporal measures were made on each sample. Twenty‐eight untrained judges rated fluency, comprehensibility, and accentedness. Three trained raters also judged samples for “goodness of prosody.” The rating data paralleled the speech measurements: speakers’ performance on the monologue and dialogue tasks was significantly better than on the narratives; however, listeners’ judgments of goodness of prosody did not vary across tasks. Comprehensibility and fluency ratings were highly correlated; fluency was more strongly related to comprehensibility than to accentedness.
Topic and Subject Prominence in Interlanguage Development
Authors: Hyuk (Sarah) Jung Euen
Published: October 2004

Most previous studies on topic prominence in second language (L2) acquisition have investigated interlanguage from the direction either of topic prominence to subject prominence or subject prominence to subject prominence. The role of topic/subject prominence typology in L2 acquisition cannot be fully explained until additional studies are conducted in the direction of subject prominence to topic prominence. The current study examined topic‐prominent interlanguage of subject‐prominent first language (L1) speakers. The results did not support the early universal stage of topic prominence in L2 acquisition but showed that learners transferred their subject‐prominent L1 features in topic‐prominent L2 learning. With increasing L2 proficiency, learners gradually became sensitive to the characteristics of the target language, approximating its norms.
Micro‐credit programs and off‐farm migration in China
Authors: Li Hongbin , Rozelle Scott , Zhang Linxiu
Published: October 2004

Abstract.  This paper seeks to evaluate effects of micro‐credit projects on the poor. We utilize data that we collected in Sichuan Province in 1999 to investigate whether micro‐credit projects have targeted the poor and whether participation in the micro‐credit project increases the likelihood of migration and switching to off‐farm jobs. We find that, although the micro‐credit programs did not help increase assets of the participants, it did help to move one or more of their members into an off‐farm job. Our findings indicate that there is a great deal of benefit in supporting micro‐credit programs.
Growth‐Oriented Small Firms and the Nature and Extent of Local Embeddedness: The Case of a Traditional Metalworking Cluster
Authors: Wood Andrew M. , Watts H. Doug , Wardle Perry
Published: October 2004

ABSTRACT  Clusters now form a central element in many regional economic development policies. Location within a cluster of related industries is thought to increase a firm's competitive advantage resulting in higher output and productivity growth rates than in similar firms located beyond the cluster. This study focuses on owner‐managers operating small firms within a traditional cluster of metalworking industries and empirically examines the relationship between growth‐orientation and the extent and nature of cluster embeddedness. The results indicate only a limited number of differences in growth‐orientation given variations in levels of cluster embeddedness. Contrary to conventional wisdom, many of the most growth‐oriented entrepreneurs focus their activities outside the cluster, especially in terms of market‐based linkages. However, those firms with more advanced process technologies do tend to show above average within cluster linkages.