bluuebunny/crossref_metadata_2025 huggingface dataset:
Economics and Euthanasia
Authors: Heasell Stephen , Paton David
Published: January 2017

This paper argues that a cost/benefit-type economic analysis of whether or not to prohibit euthanasia should not be undertaken by health services managers unless ethical issues have been resolved to a particular conclusion. A conclusion on ethical grounds in favour of the prohibition of euthanasia renders the consideration of economic criteria redundant. The case of the German euthanasia programme in the 1930s is used to illustrate the danger of attempting to combine ethical and economic criteria into a single decision rule.
Measuring Hospital Workload in General Medicine
Authors: Jones Jeremy , Black Nick , Sanderson Colin
Published: January 2017

The study described here used routine data sources to consider three aspects of hospital workload-volume and case-mix of inpatients; volume of outpatients; and volume of procedures.
Recruiting for Success – the Potential for Using Occupational Personality Questionnaires for the Assessment of Doctors
Authors: Chambers Ruth , Wright Derek , Taylor Heather
Published: January 2017

Objectives: to evaluate the Saville and Holdsworth Occupational Personality Questionnaire (OPQ) to assess its potential and validity as a tool in the recruitment of doctors. To determine the range of personality characteristics in a group of general practitioners.

Design: an administered commercially available questionnaire.

Setting: general practitioners in North and Mid. Stafffordshire.

Subjects: 133 general practitioners or trainees.

Results: 44% of general practitioners agreed to participate. The majority found it useful and recognised its potential to increase self-awareness, highlight weaknesses that might be improved and for future recruitment of others to their teams. Doctors' personality traits were similar to those of managerial/professional norms. The validity of the OPQ was supported by (a) significant associations with subjects' previously reported mental health problems and (b) 83% of respondents confirming that their reports correctly described their personalities at work.

Conclusions: OPQs have a place in the recruitment of doctors by identifying appropriate people to strengthen the team.
Using Comparative Clinical and Economic Outcome Information to Profile Physician Performance
Authors: Hendryx Michael S. , Wakefield Douglas S. , Murray James F. , Uden-Holman Tanya , Helms Charles M. , Ludke Robert L.
Published: January 2017

This paper presents strategies and empirical examples of comparative physician profiling under conditions of limited patient sample sizes and varying patient severity. A method by which clinical and cost outcomes may be evaluated simultaneously is also presented. Physician economic and clinical performance are compared using data abstracted from nine hospitals into the MedisGroups clinical information management system for inpatients treated from July, 1990 through June, 1992. The main outcome measures are comparative total and ancillary adjusted charges, and morbidity status. Results suggest that objective comparative outcome data provide useful information to assist in evaluating physician performance. A simultaneous comparison of clinical outcomes and adjusted charges identifies physicians who experience favorable outcomes at lower charges, as well as those who have higher charges and/or poorer outcomes. Strategies outlined in this paper may be of value to clinicians, governing boards, and third party payors. These strategies may be used to assist with privileging and other peer review activities when pursued proactively within a Continuous Quality Improvement framework to improve care.
Does Health Information Alone Help in Equitable Distribution of Essential Drug Kits between Health Units at District Level?
Authors: Ahmed Abdullahi M. , Kanga George , Sandiford Peter
Published: January 2017

In Tanzania, the essential drugs programme (EDP) faces acute shortage of drugs brought about by a deteriorating economy and an expanding primary health care system. Many health units complain of shortages of drugs but no increase in the district allocation of EDP kits is foreseen. In the light of the aforementioned problem, a study was carried out in the Kisarawe district of Tanzania to discover, on behalf of the District Health Management Team (DHMT), the extent of the maldistribution with a view to reallocate the EDP kits among the health units on the basis of workload and catchment population. The relative workload of each health unit was estimated from the number of outpatient attendants and the catchment population estimates are based on a 1988 national census. An equitable distribution of EDP kits for each indicator was then developed by ranking the health units in order of workload and catchment population and dividing up the available number of EDP kits proportionately. Health units were categorised as either ‘over-allocated’, ‘appropriately-allocated’ or ‘under-allocated’ with EDP kits by comparing their actual drug supply with the equitable supply. The findings were presented to a meeting of the DHMT attended by the Regional Medical Officer and Ministry of Health officials. Despite being presented evidence of astounding inequity in drug distribution, there was a marked reluctance on the part of the DHMT to decide upon actions to redress some of the imbalance. In this study, we demonstrate that although data from the routine information system on essential drugs at peripheral health units provided sufficient information for managerial purposes, decision-making was delayed and limited. Several possible reasons for this are discussed.
Importance-Performance Analysis as a Guide for Hospitals in Improving Their Provision of Services
Authors: Whynes David K.
Published: January 2017

As a result of the 1990 National Health Services Act, hospitals now compete with one another to win service contracts. A high level of service quality represents an important ingredient of a successful competitive strategy, yet, in general, hospitals have little external information on which to base quality decisions. Specifically, in their efforts to win contracts from fundholding general practitioners, hospitals require information on that which these purchasers deem important with respect to quality, and on how these purchasers assess the quality of their current service performance. The problem is complicated by the fact that hospital service quality, in itself, is multi-dimensional. In other areas of economic activity, the information problem has been resolved by importance-performance analysis and this paper reports the findings of such an analysis conducted for hospitals in the Trent region. The importance and performance service quality ratings of fundholders were obtained from a questionnaire survey and used in a particular variant of importance-performance analysis, which possesses certain advantages over more conventional approaches. In addition to providing empirical data on the determinants of service quality, as perceived by the purchasers of hospital services, this paper demonstrates how such information can be successfully employed in a quality enhancement strategy.
Is the development of policy in New Zealand based on Prevention First?
Authors: den Heyer Garth
Published: January 2017

The New Zealand Police, in response to the global financial crisis and escalating operating costs, implemented in 2008 the first of a number of change programs to increase its service delivery efficiency and effectiveness. The programs concentrated on reallocating resources from reactive service delivery to more proactive or preventative activities. By 2012, the change in emphasis enabled the police to reduce its organizational costs and achieve a number of government outcomes. It was hypothesized that owing to the success of the New Zealand Police, other New Zealand Government departments have adopted a preventative approach to reduce long-term social costs. By analyzing the strategic documents of three randomly selected, nonjustice sector government agencies, it was found that all three agencies had changed the focus of their service delivery to concentrate on specific prevention outputs with the intention of improving services and decreasing operating costs.
Minimisation of specific cutting energy and back force in turning of AISI 1060 steel
Authors: Paul Sourabh , Bandyopadhyay PP , Paul S
Published: January 2017

A lot of research has been undertaken in the area of conventional machining to study the effect of process parameters, tool geometry, machining environment and so on on machinability. But only recently, the research community has started analysing the carbon footprint of manufacturing processes. But very few articles could be located that attempted simultaneous minimisation of specific cutting energy and back force over a wide domain of process and tool-geometric parameters. This article has experimentally studied the effect of variation in depth of cut, feed, nose radius and tool geometry on simultaneous minimisation of specific cutting energy and back force while turning AISI 1060 steel with uncoated carbide inserts under dry machining environment. Minimisation of specific cutting energy and back force as individual criterion leads to conflicting choice of machining parameters. A combined criterion based on specific cutting energy and back force has been defined and for the minimisation of the same, cutting tools with positive rake need to be used, with high feed and moderate depth of cut.
Blastocystosis: A New Disease in the Acquired Immunodeficiency Syndrome?
Authors: Garavelli Pietro L , Scaglione Lorenzo , Bicocchi Roberto , Libanore Marco
Published: January 2017

The protozoon Blastocystis hominis may cause episodes of diarrhoea with abdominal pain, tenesmus, fever and eosinophilia. We have observed 5 cases of blastocystosis in male subjects with symptomatic HIV infection. All patients had a complete response to metronidazole. This report confirms that Blastocystis hominis may be responsible for HIV-related diarrhoea.
Male Prostitution and Sexually Transmitted Disease
Authors: Hillman R J , Tomlinson D , Taylor-Robinson D , Harris J R W
Published: January 2017

There has been a relatively small number of studies of male prostitution compared with female prostitution. Cultural blindness to the existence of male prostitutes, together with difficulties in gaining access to a representative sample of such individuals, has led to a situation where male prostitution is poorly recognized, poorly understood and inadequately managed. Male prostitutes may be important in the spread of the human immunodeficiency virus (HIV) and other infections to both the homosexual and heterosexual communities, particularly in areas of the world where prostitution and drug abuse are common. Despite the high risk activities performed by male prostitutes, they are poor users of available health service resources. We review the existing literature on male prostitution, the acquisition of sexually transmitted infection and discuss possible ways of improving the provision of health care services for this group.
Management of Intrameatal Warts in Men
Authors: McKenna J G , McMillan A
Published: January 2017

The case notes of 1080 men with genital warts were analysed retrospectively over a 30-month period. One hundred and forty patients were identified with intrameatal warts and an audit of their treatment is discussed. When electrocautery and cryotherapy were compared the former produced a more rapid resolution of the lesions.

Cystourethroscopy was performed on 16 patients with intrameatal warts. No patient had involvement beyond the distal 3 cm of the urethra.

Data on concurrent sexually transmitted diseases, population characteristics and pattern of referral are presented and compared to previously reported studies.
Soluble Interleukin-2 Receptors in Serum and Urine of Patients with Chancroid and Their Response to Therapy
Authors: Abeck D , Korting H C , Zaba R , Dangor Y , Fehler G , Ballard R C
Published: January 2017

To investigate cell-mediated immune response in chancroid, soluble interleukin-2 receptor levels in serum and urine samples of healthy individuals and patients were measured by an enzyme-linked immunosorbent assay. Increased levels both in serum and in urine were observed in cases of Haemophilus ducreyi infection. In patients showing a prolonged incubation period, urine levels exceeded serum values. Therapy led to a reduction of elevated interleukin-2 receptor levels in serum and in urine.
Teucrium polium hexane extract downregulated androgen receptor in testis and decreased fertility index in rats
Authors: Al-Tikriti AAA , Al-Khateeb E , Abbas MA
Published: January 2017

Teucrium polium L. (Lamiaceae) is a commonly used medicinal plant in folk medicine. Among several uses, T. polium is used to treat male fertility problems. This research was conducted to study the effect of T. polium on spermatogenesis, testosterone level, androgen receptor expression, and fertility in male rats. Administration of hexane extract for 6 days to aging rats increased testosterone level. When administered for 60 days, T. polium hexane extract downregulated androgen receptors, decreased sperm count without producing histological changes in different stages of spermatogenesis. Also, fertility index decreased without making teratogenic effects when treated males were mated with untreated females on the 55th day of extract administration. Therefore, the downregulation of androgen receptor could be due to the continued elevation in testosterone level over time. In conclusion, this study suggests that the prolonged use of T. polium in folk medicine may negatively affect male fertility.
Ernest Henry Starling (1866–1927): The Scientist and the Man
Authors: Henriksen Jens H
Published: January 2017

The pre-eminent achievements of the English physician and physiologist Ernest Henry Starling were his quantitative explanation of the transcapillary transport of fluid, the discovery of the first hormone, secretin, and his formulation of the law of the heart. In some ways Starling was an outsider and he was the centre of several scientific and social controversies. However, throughout his life he stressed fundamental scientific attitudes and ideas with remarkable persistence and power, although also balance, and his scientific achievements have stood the test of time.
Dr F C Batchelor (1850–1915): Crusading Reformer
Authors: Clairs Rex E Wright-St
Published: January 2017

Ferdinand Campion Batchelor was a noted abdominal surgeon, obstetrician and gynaecologist. He was an ardent campaigner for hospital reform and other worthy causes, and had an up-to-date outlook on the future of medical science.
Tom Gibson, Plastic Surgeon (1915–93): His Life, the Second Set Phenomenon, the Host versus Graft Reaction, and the Birth of Tissue Transplantation
Authors: Conway H , Reid W H , Beaton J J
Published: January 2017

In the early 1940s Tom Gibson, a member of an MRC unit investigating infection in burns at the Glasgow Royal Infirmary, developed an interest in skin grafting. With Peter (later Sir Peter) Medawar, he described the ‘Second Set’ phenomenon which in 1943 laid the foundations for tissue transplantation. After war service (1944–47) he was the major force in the development of plastic surgery services in the West of Scotland. His researches at the Universities of Glasgow and Strathclyde earned him an international reputation.
Ludwig Guttmann (1899–1980) and David Ben Gurion (1886–1973): An Early Account of the Rehabilitation Facilities in Israel
Authors: Ohry Avi , Silver John Russell , Guttmann Ludwig
Published: January 2017

Ludwig Guttmann in 1944 at Stoke Mandeville Hospital established comprehensive care of spinal patients. His methods were extremely successful and he was responsible for the establishment of the comprehensive treatment of spinal injuries throughout Europe and large areas of the world. He was a Jew who had fled Nazi Germany, and he evinced strong loyalty to the State of Israel. In December 1949, he was invited by the Government of Israel to visit and advise on the status of rehabilitation of casualties who had suffered neurological injuries in the War of Independence (1948–49). His work is mentioned in his correspondence with Prime Minister Ben Gurion as well as in the Prime Minister's diaries. This episode offers a unique insight into Guttmann's approach to rehabilitation in his early years.
Not Just Malaria: Mary Slessor (1848–1915) and other Victorian Missionaries in West Africa
Authors: Hardage Jeanette
Published: January 2017

Fear of ‘fever’ was uppermost in the minds of many travellers to West Africa in Victorian times. ‘Not just malaria…’ chronicles attitudes, treatments and discoveries regarding malaria from the time of David Livingstone through the early 20th century. Missionaries often found themselves in the position of serving as untrained doctors and nurses among the people they went to evangelize. In addition, they suffered from the same maladies as the people did, and many died from malaria or other afflictions. Mary Slessor arrived in Calabar, in what is now southeastern Nigeria, to serve with the Scottish Presbyterian Mission in 1876. With only a few furloughs, she remained there until her death in 1915. The article relates instances of the illnesses and injuries she treated as well as those she suffered herself. She is remembered in Nigeria with statues and, along with David Livingstone, is one of Scotland's best-known missionary figures.
Effect of Parity on Human Chorionic Gonadotropin Levels and Down's Syndrome Screening
Authors: Haddow James E , Palomaki Glenn E , Knight George J
Published: January 2017

Objective

To investigate further the association between parity and human chorionic gonadotrophs (hCG) levels during the second trimester and determine whether prenatal screening for Down's syndrome might be made more efficient by adjusting for this variable.

Methods

Measurements of hCG were analysed in relation to parity from a cohort of 16 675 singleton pregnancies with viable outcomes, and from 108 singleton pregnancies affected by Down's syndrome. Cigarette smoking during pregnancy and maternal age were also analysed in relation to hCG levels.

Results

For both unaffected pregnancies and pregnancies with Down's syndrome the median hCG levels were 7% lower in parous than in nulliparous women. A doseresponse relation was also documented for the unaffected pregnancies. When para 0, para 1, and para 2 women were studied separately, hCG levels rose steadily as age advanced. Adjusting hCG levels for parity led to a 0£1% reduction in variance of the distribution of hCG measurements in unaffected pregnancies and to a negligible increase in Down's syndrome screening efficiency.

Conclusion

The effect of parity is not sufficiently great to warrant routine adjustment of hCG levels as part of prenatal screening for Down's syndrome.
Construction of a Community Height Surveillance Programme: The Hackney Growth Initiative
Authors: Hearn S , Cotterill A M , Majrowski W , Rohan C , Jenkins S , Savage M O
Published: January 2017

Objectives

To determine why, in the London Borough of Hackney before 1990, fewer children than expected were identified with remedial causes of short stature. To construct a practical model for height surveillance of 5 and 11 year old school entrants to improve the quality of child growth surveillance.

Setting

City and Hackney Borough, London, United Kingdom.

Methods

School nurses were trained by a clinical auxologist to measure children's height at school entry accurately and reproducibly. New procedures for measurement technique, plotting of data, referral, and audit were established. A reference manual was provided and a continuing training programme was started.

Results

During the first year the percentage of the target group measured was low. Changes in work practice led to improvements from 77% measured in the first year to 91% in the second year and 87% in the third year for 5 year olds. Improvements for 11 year olds were from 36% to 86% to 87% over the three years. Only 1£2% of 5 year olds and 2 6% of 11 year olds measured had height less than the third centile (compared with Tanner's height standards).

Conclusions

School nurses measured height reliably. New audit procedures led to rapid changes in working practice and improvements in the percentage of children measured. The low numbers of short children previously identified with unrecognised abnormality may indicate an upward trend in height in this inner city population.
Effect of Retesting with Dietary Restriction in Haemoccult Screening for Colorectal Cancer
Authors: Robinsno M H E , Moss S M , Hardcastle J D , Whynes D K , Chamberlain J O , Mangham C M
Published: January 2017

Objectives

To determine the detection rate, false positive and false negative rates associated with a policy of retesting with dietary restriction after an initial positive Haemoccult screening test for colorectal cancer, in order to compare the cost effectiveness of such a policy with the alternative, in which all subjects with a positive test would proceed directly to diagnostic colonoscopy.

Methods

Over four years in a large randomised control trial in Nottingham 35 260 subjects had a mean of 1£5 screening rounds each at two-yearly intervals, and were followed up for a minimum of 27 months. During this period subjects with positive screening tests were asked to repeat the test with dietary restrictions. Estimates of costs of the initial screening and of diagnostic colonoscopy were used to estimate the cost for each cancer detected by the different policies.

Results

1209 subjects had a positive initial screening test and 1033 (85£4%) completed the retests. Four hundred and ninety nine subjects were investigated and 89 cancers detected. In the 710 subjects with negative retests six interval cancers were diagnosed in the two years after screening. If these had been detected by screening under a policy of immediate colonoscopy, test sensitivity would have been improved from 53£6% to 57£2% (P = 0–02), but the cost for each cancer detected would have increased from £773 to £1509.

Conclusion

Retesting with dietary restrictions reduces costs and maximises the benefit of limited colonoscopy resources, but results in a small but significant reduction in test sensitivity compared with a policy for immediate colonoscopy.
Role of Screening in Reducing Invasive Cervical Cancer Registrations in England
Authors: Fouquet Roger , Gage Heather
Published: January 2017

Objective

–To estimate the effect of screening on invasive cervical cancer registrations in England.

Setting

–The Health of the Nation target for cervical cancer seeks to reduce the incidence of invasive cases (ICD 180) by at least 20% between 1986 and 2000. Method - The available area-level statistics on invasive cervical cancer registrations, screening activity, and socioeconomic and behavioural characteristics for 145 district health authorities in England over the period 1985–91 were collected. A multiple regression analysis sought to explain variations in incidence rates by relating screening and socioeconomic and behavioural variables to registration rates.

Results

—Districts with higher unemployment levels and higher numbers of pregnancies in young women had higher registration rates for invasive cervical cancer. The cervical smear rate for women aged 35–64 in a district was positively related to registrations, whereas the relation was negative for the 20–34 age group.

Conclusions

–The higher registration rates for invasive cervical cancer in districts with higher cervical smear rates for women aged 35–64 may reflect historically lower screening cover. The negative relation between the cervical smear rate and invasive cervical cancer registrations in women aged 20–34 is accompanied by high registration rates for preinvasive (ON III) cervical cancer (ICD 233.1). For the advantages of the Pap test to be fully realised, and for invasive cervical cancer registrations to fall in line with the Health of the Nation targets, a comprehensive screening programme, with a high take up rate is required. The various changes to the screening programme introduced since 1988 should help to achieve this. Public health policy should focus on educating the population about the risk factors for cervical cancer and the significance of screening.
Population Screening for Haemochromatosis: A Unifying Analysis of Published Intervention Trials
Authors: Bradley Linda A , Haddow James E , Palomaki Glenn E
Published: January 2017

Objectives—

To examine the efficacy of population screening for haemochromatosis by analysing the screening performance of seven intervention trials, and to compare this with the expected performance derived from family studies.

Setting—

Seven population intervention trials carried out between 1983 and 1995 in Australia, Scandinavia, Iceland, and the United States.

Methods—

Seven of 23 English language trials identified were suitable for the meta-analysis. Transferrin saturation and serum ferritin measurements derived from family studies were used to predict detection and false positive rates for each trial.

Results—

The seven trials used various screening and diagnostic criteria. A total of 18 396 men and 12 254 women were screened. Because some cases were not detected by screening, and some screen positive individuals did not complete diagnostic testing, the prevalence of homozygous individuals was underestimated in all the trials. The reported and predicted percentages of screen positive individuals nearly always agreed. The homozygote prevalence was estimated to be 34 men and 40 women per 10 000 (prevalence predicted from family studies is 53 per 10 000). Clinical manifestations were present in 50% of male and 44% of female homozygotes.

Conclusions—

False positive rates, homozygote prevalences, and frequency of clinical manifestations were in general agreement with predictions from family studies. However, incomplete understanding about a number of issues requires that further pilot trials be carried out before screening can be considered part of routine medical practice.
Molecular Screening of Families Affected by Familial Adenomatous Polyposis (FAP)
Authors: Gazzoli I , De Andreis C , Sirchia S M , Sala P , Rossetti C , Bertario L , Colucci G
Published: January 2017

Objectives—

To assess the risk of developing familial adenomatous polyposis (FAP) in presymptomatic individuals using APC gene flanking and intragenic polymorphic markers.

Setting—

Twenty families enrolled in the Italian Registry of Polyposis comprising a total of 217 individuals, including 53 (24%) presymptomatic subjects with a 50% a priori risk of FAP, were analysed. Direct analysis techniques had previously failed to identify the FAP mutation in these families.

Methods—

DNA isolated from peripheral mononuclear blood cells and tissue sections was analysed by the polymerase chain reaction and a panel of seven highly polymorphic markers—YN5.64, CB83, CB26, LNS, APC1458.5, MBC, 37AB. Amplification products were separated by a modified denaturing gel electrophoresis method.

Results—

The haplotype associated with the disease was identified in 18 families (90%). The segregation of the FAP haplotype in these kindreds showed that 10 presymptomatic individuals had inherited the FAP mutation and carried a high risk of developing the disease. The remaining two families were not informative because of the lack of a sufficient number of probands or biological specimens.

Conclusions—

These data indicate that indirect analysis with linked DNA markers has a high rate of success in defining the risk of FAP of presymptomatic subjects, provided that a sufficient number of probands or samples is available. Uninformative families accounted for 10% of the total, indicating that linkage analysis may still have higher sensitivity than direct mutation analysis techniques. The combined use of both approaches should be implemented, however, to enhance further the application of molecular genetics to the screening of families with FAP.
Family perspectives on organ and tissue donation for transplantation: A principlist analysis
Authors: dos Santos Marcelo José , Feito Lydia
Published: January 2017

Background:

The family interview context is permeated by numerous ethical issues which may generate conflicts and impact on organ donation process.

Objective:

This study aims to analyze the family interview process with a focus on principlist bioethics.

Method:

This exploratory, descriptive study uses a qualitative approach. The speeches were collected using the following prompt: “Talk about the family interview for the donation of organs and tissues for transplantation, from the preparation for the interview to the decision of the family to donate or not.” For the treatment of qualitative data, we chose the method of content analysis and categorical thematic analysis.

Participants:

The study involved 18 nurses who worked in three municipal organ procurement organizations in São Paulo, Brazil, and who conducted family interviews for organ donation.

Ethical considerations:

The data were collected after approval of the study by the Research Ethics Committee of the School of Nursing of the University of São Paulo.

Results:

The results were classified into four categories and three subcategories. The categories are the principles adopted by principlist bioethics.

Discussion:

The principles of autonomy, beneficence, non-maleficence, and justice permeate the family interview and reveal their importance in the organs and tissues donation process for transplantation.

Conclusion:

The analysis of family interviews for the donation of organs and tissues for transplantation with a focus on principlist bioethics indicates that the process involves many ethical considerations. The elucidation of these aspects contributes to the discussion, training, and improvement of professionals, whether nurses or not, who work in organ procurement organizations and can improve the curriculum of existing training programs for transplant coordinators who pursue ethics in donation and transplantation as their foundation.
Regionalism and Finance: A Conceptual Approach
Authors: Germain Randall D.
Published: January 2017

There is a widespread debate within the field of international political economy (IPE) regarding the causes and consequences of regionalism in world politics. Rarely, however, has this debate considered the effects of regionalism on finance. This article contributes to this debate by reaching beyond conventional categories of political economy to explore the way in which the organization of finance is being shaped by regionalism in Europe. By employing a theoretical framework adapted from the work of Fernand Braudel, it locales the effects of regionalism within the context of the market economy, or what Braudel identifies as the domain of transparent commercial exchange. It explores the changing nature of identity among selected financial institutions in order to ask how far a regional dimension is emerging within the organization of finance, and concludes that what may be called regional finance is in fact emerging in Europe. Such an approach contributes to existing debates on regionalism in world politics by drawing our attention to the changing motivations, practices and dynamics of finance in Europe, and the way in which this may be seen as part of the overarching structure of the contemporary world-economy.
Bilateral Economic Relations in a Global Political Economy: Australia and Japan
Authors: Beeson Mark
Published: January 2017

This paper argues that despite the internationalisation of economic activity, and a concomitant diminution of economic policy-making autonomy, national policy settings continue to display a surprising degree of divergence and remain important determinants of economic outcomes. Similarly, there are distinctively different and enduring patterns of corporate organisation across nations which confer specific competitive advantages. Important theoretical and practical questions are raised, therefore, about the potential efficacy of national economic policies and their capacity to accommodate such divergent practices. This paper examines the bilateral relationship between Australia and Japan, and assesses the effectiveness of Australia's predominantly neoliberal economic policy framework in the light of such national and organisational variation. It will be suggested that Australian policy-makers' faith in market mechanisms caused them to underestimate the significance of Japanese commercial practices and regional production strategies, rendering attempts to transform the relationship largely unsuccessful.
Evaluation of protein spectra cluster analysis for Streptococcus spp. identification from various swine clinical samples
Authors: Matajira Carlos E. C. , Moreno Luisa Z. , Gomes Vasco T. M. , Silva Ana Paula S. , Mesquita Renan E. , Doto Daniela S. , Calderaro Franco F. , de Souza Fernando N. , Christ Ana Paula G. , Sato Maria Inês Z. , Moreno Andrea M.
Published: January 2017

Traditional microbiological methods enable genus-level identification of Streptococcus spp. isolates. However, as the species of this genus show broad phenotypic variation, species-level identification or even differentiation within the genus is difficult. Herein we report the evaluation of protein spectra cluster analysis for the identification of Streptococcus species associated with disease in swine by means of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). A total of 250 S. suis–like isolates obtained from pigs with clinical signs of encephalitis, arthritis, pneumonia, metritis, and urinary or septicemic infection were studied. The isolates came from pigs in different Brazilian states from 2001 to 2014. The MALDI-TOF MS analysis identified 86% (215 of 250) as S. suis and 14% (35 of 250) as S. alactolyticus, S. dysgalactiae, S. gallinaceus, S. gallolyticus, S. gordonii, S. henryi, S. hyointestinalis, S. hyovaginalis, S. mitis, S. oralis, S. pluranimalium, and S. sanguinis. The MALDI-TOF MS identification was confirmed in 99.2% of the isolates by 16S rDNA sequencing, with MALDI-TOF MS misidentifying 2 S. pluranimalium as S. hyovaginalis. Isolates were also tested by a biochemical automated system that correctly identified all isolates of 8 of the 10 species in the database. Neither the isolates of the 3 species not in the database ( S. gallinaceus, S. henryi, and S. hyovaginalis) nor the isolates of 2 species that were in the database ( S. oralis and S. pluranimalium) could be identified. The topology of the protein spectra cluster analysis appears to sustain the species phylogenetic similarities, further supporting identification by MALDI-TOF MS examination as a rapid and accurate alternative to 16S rDNA sequencing.
Effect of Transcutaneous Acupoint Electrical Stimulation on Post-Hemorrhoidectomy-Associated Pain, Anxiety, and Heart Rate Variability: A Randomized-Controlled Study
Authors: Yeh Mei-Ling , Chung Yu-Chu , Hsu Lun-Chia , Hung Shuo-Hui
Published: January 2017

Hemorrhoidectomy is the current best treatment for severe hemorrhoids, but it causes significant postoperative pain and anxiety, which is associated with heart rate variability (HRV). Transcutaneous acupoint electrical stimulation (TAES) was assumed to alleviate pain and anxiety, and modify the autonomic nervous system. This study aimed to examine the effects of TAES intervention on postoperative pain, anxiety, and HRV in patients who received a hemorrhoidectomy. A randomized-controlled trial with five repeated measures was conducted. The TAES group ( n = 39) received four 20-min sessions of electrical stimulation at chengshan (BL57) and erbai (EX-UE2) after hemorrhoidectomy, whereas the control group ( n = 41) did not. Data were collected using Visual Analogue Scale (VAS), State Anxiety Inventory (STAI), and HRV physiological signal monitor. TAES resulted in a significant group difference in pain scores, anxiety levels, and some HRV parameters. The findings indicate that TAES can help reduce pain and anxiety associated with hemorrhoidectomy. TAES is a noninvasive, simple, and convenient modality for post-hemorrhoidectomy-associated pain control and anxiety reduction.
Effect of the Addition of Ciprofloxacin on Theophylline Pharmacokinetics in Subjects Inhibited by Cimetidine
Authors: Davis Robin L. , Quenzer Ronald W. , Kelly H. William , Powell J. Robert
Published: January 2017

OBJECTIVE:

Although the effect of individual enzyme inhibitors on hepatic microsomal enzyme activity has been studied extensively, little data exist on the effects of combinations of inhibiting agents. The purpose of this study was to investigate the effect of the addition of a second hepatic oxidative enzyme inhibitor on the inhibition of metabolism in subjects already maximally inhibited by cimetidine. Ciprofloxacin was used as the second inhibitor.

DESIGN:

In a randomized crossover sequence, subjects received theophylline 5 mg/kg on day 6 of therapy with cimetidine 2400 mg/d, ciprofloxacin 1 g/d, both drugs, or while drug-free.

SETTING:

National Institutes of Health-funded General Clinical Research Center.

PARTICIPANTS:

Eight normal volunteers (6 men, 2 women; mean age 25.2 y).

OUTCOME MEASURES:

Theophylline pharmacokinetic parameters after each treatment were determined by model independent pharmacokinetic analysis. Statistical analysis of the data for differences between treatments was assessed by ANOVA for repeated measures.

RESEARCH:

When administered alone, ciprofloxacin and cimetidine caused a significant increase in theophylline elimination half-life and a decrease in clearance. Theophylline elimination half-life was significantly longer during combined therapy compared with either drug alone. Theophylline clearance was lower during combined treatment, although this relationship did not reach statistical significance.

CONCLUSIONS:

The addition of a second enzyme inhibitor in subjects receiving maximally inhibiting doses of cimetidine can produce a further decrease in the hepatic metabolism of drugs that are metabolized by the cytochrome P-450 microsomal enzyme system. As cimetidine and ciprofloxacin are frequently used together for a variety of common clinical indications, clinicians should be aware of this drug interaction and should consider that a similar effect may occur when other enzyme inhibitors are used concomitantly.
Treatment of Valproic Acid-Associated Hepatic Failure with Orthotopic Liver Transplantation
Authors: Bell Edward A. , Shaefer Mark S. , Markin Rodney S. , Wood R. Patrick , Langnas Alan N. , Stratta Robert J. , Shaw Byers W.
Published: January 2017

OBJECTIVE:

To report a case of valproic acid (VPA)-induced hepatotoxicity and to discuss the incidence rates, risk factors, possible etiologies, preventive measures, and treatment courses for this severe reaction.

DATA SOURCES:

Case reports, review articles, and relevant laboratory studies identified by MEDLINE.

DATA EXTRACTION:

Data were abstracted from pertinent published sources by one author and reviewed by the remaining authors.

DATA SYNTHESIS:

The case of a 23-year-old woman with VPA-associated hepatic failure was successfully treated with orthotopic liver transplantation. Hepatic failure is a rare, often fatal, adverse effect of VPA. Most cases of VPA-associated hepatic failure have occurred within several months of initiation of therapy. Initial symptoms of presentation often include nausea and vomiting, lethargy, or loss of seizure control. Laboratory values to be monitored include serum concentrations of hepatic enzymes, and, in some patients, tests indicative of the liver's synthetic capabilities. The exact mechanism of VPA-associated hepatic failure has not been clearly established; however, it is postulated to involve the formation of toxic metabolites. Major risk factors include age less than two years and concomitant treatment with more than one anticonvulsant. Other significant risk factors include underlying metabolic or serious neurologic disorders.

CONCLUSIONS:

Caution should be taken when initiating VPA therapy and clinicians should be familiar with the risk factors and clinical presentation of this reaction.
Populations at Risk for Penicillin-Induced Seizures
Authors: Barrons Robert W. , Murray Kim M. , Richey Robert M.
Published: January 2017

OBJECTIVE:

This article reviews principles associated with penicillin's epileptogenic activity in an effort to alert clinicians of patients at high risk for penicillin-induced seizures. The case presentation exemplifies the most prevalent factor predisposing patients to penicillin-induced seizures—renal impairment.

DATA SOURCES:

References are identified from pertinent articles and books.

DATA SYNTHESIS:

The epileptogenic properties of penicillin are explained on the basis of the beta-lactam ring's binding to gamma aminobutyric acid receptors. Several patient populations are at risk for potentially fatal neurotoxic symptoms. Most of these patients demonstrate impaired renal function, either as the primary condition or secondary to an infectious process. The other at-risk populations include infants and the elderly, patients with meningitis, patients undergoing intraventricular antibiotic therapy, and patients with a history of seizures. Treatment remains controversial; however, benzodiazepines theoretically produce a favorable response.

CONCLUSIONS:

Pharmacokinetic parameters explain patient populations most at risk; a guideline equation has been recommended to allow clinicians to make appropriate dose adjustments based on creatinine clearance. Physicians and pharmacists must recognize the populations most at risk for high-dose, penicillin-induced neurotoxicities; monitor these patients at least during the first 72 hours, and reduce or discontinue therapy when appropriate.
“Brain Attack”: An Indication for Thrombolysis?
Authors: Fagan Susan C. , Zarowitz Barbara J. , Robert Sylvie
Published: January 2017

OBJECTIVE:

The primary objective of this article is to introduce the reader to the use of thrombolytics in the acute treatment of ischemic stroke. Theory and experimental evidence to support this approach are emphasized in addition to potential adverse effects of thrombolysis.

DATA SOURCES:

A MEDLINE search was used to identify pertinent literature, including reviews.

STUDY SELECTION:

Studies were selected for detailed review if they involved stroke patients and addressed possible toxicities of therapy. Any abstracts concerning ongoing clinical trials also were reviewed.

DATA EXTRACTION:

Data from animal investigations using tissue plasminogen activator for the acute treatment of several models of cerebral ischemia were used to support the importance of early treatment (within six hours of symptom onset). Also, studies performed in animal models of stroke revealed that thrombolysis could be accomplished safely in acute ischemic stroke. All human studies published to date are anecdotal case reports, but point to the safety of thrombolysis if administered early. Reviews of ongoing multicenter trials are taken from published abstracts and proceedings.

DATA SYNTHESIS:

Thrombolysis holds promise as a hyperacute therapy for acute stroke; however, the risk of intracerebral hemorrhage remains. Crucial to the success of this and any other therapy for acute stroke is the ability to treat patients within hours of symptom onset. Also, the importance of concomitant medications such as heparin and aspirin has not yet been addressed.

CONCLUSIONS:

Pharmacists need to be knowledgeable of new treatments of stroke and the risks associated with them. As patient educators, pharmacists can contribute to public awareness by promoting the early recognition of stroke symptoms. As pharmacotherapists, pharmacists need to understand the risks and the important monitoring parameters related to thrombolysis. The results of ongoing multicenter clinical trials are awaited before making a final judgment on the usefulness of thrombolysis in acute ischemic stroke.
Central Nervous System Toxicity after Abrupt Monoamine Oxidase Inhibitor Switch: A Case Report
Authors: Safferman Allan Z. , Masiar Stephen J.
Published: January 2017

DESCRIPTION:

There have been numerous case reports of adverse reactions involving monoamine oxidase inhibitors (MAOIs), including reactions that developed when one MAOI was substituted for another. Although most reports have usually described a switch from isocarboxazid or phenelzine to tranylcypromine, we report a case of acute central nervous system toxicity possibly associated with a switch from phenelzine to isocarboxazid.

SYMPTOMATOLOGY:

Predominant symptoms included stuporous sensorium, hypertension, tachycardia, tremor, and urinary retention. Onset of symptoms began within 48 hours after the abrupt MAOI switch.

CONCLUSIONS:

Clinicians must allow a sufficient washout period before adding any agent that has a known potential to interact adversely with MAOIs. In addition, patients who are unusually sensitive to one type of MAOI may also be at increased risk for developing problems with a different MAOI secondary to unforeseen pharmacokinetic or pharmacodynamic effects, even at doses that are usually considered subtherapeutic.
Effects of Heat Treatment on Selected Plasma Therapeutic Drug Concentrations
Authors: Delaney Robert A. , Mikkelsen Stephen L. , Jackson Margaret B.
Published: January 2017

OBJECTIVE:

We investigated the heat stability of six common therapeutic drugs routinely assayed in pharmacokinetic and clinical laboratories.

DESIGN:

Serum samples were spiked at three concentrations (subtherapeutic, therapeutic, and potentially toxic) with amikacin, gentamicin, tobramycin, phenytoin, theophylline, and phenobarbital. The samples were then heated at 56 ° and assayed by fluorescence polarization immunoassay at 15-minute intervals for one hour.

SETTING:

The study was conducted at a clinical research laboratory using standard laboratory methods.

MAIN OUTCOME MEASURES:

Drug concentrations of heated samples were compared with unheated controls using ANOVA to determine if degradation occurred over time with heating.

RESULTS:

Analysis of data revealed no degradation of any of the samples.

CONCLUSIONS:

Heat treatment of samples from high-risk individuals may be a mechanism to protect healthcare workers from exposure to the human immunodeficiency virus.
Is There a Role for Fluconazole in the Treatment of Vulvovaginal Candidiasis?
Authors: Thompson Dennis F. , Raebel Marsha A. , Patel Hina S. , Peters Mark D. , Smith Curtis L.
Published: January 2017

OBJECTIVE:

To review the data describing the use of fluconazole in the treatment of vulvovaginal candidiasis (VVC).

DATA IDENTIFICATION:

A MEDLINE search of the English-language literature and a bibliographic review of pertinent articles examining the use of fluconazole in the treatment of VVC.

STUDY SELECTION AND DATA EXTRACTION:

Relevant open and controlled studies reporting on the efficacy, associated adverse effects, or both of fluconazole for the treatment of VVC are reviewed. Appropriate conclusions and/or data are extracted from each article and described.

DATA SYNTHESIS:

Studies comparing fluconazole with ketoconazole and topical antifungal agents such as clotrimazole and miconazole have shown fluconazole to be equally efficacious with minimal adverse effects. Most of these trials used single-dose fluconazole, which would theoretically lead to a high degree of medication compliance. Fluconazole also has shown promise at diminishing VVC relapse or recurrence, possibly because of more complete vaginal and rectal eradication of Candida species. Pharmacoeconomically, single-dose fluconazole therapy is cost-effective; however, the recent approval of miconazole and clotrimazole by the Food and Drug Administration for over-the-counter use may limit this potential advantage.

CONCLUSIONS:

Until additional data are available, fluconazole may be considered a treatment alternative for women with VVC who experience frequent relapses or recurrences, or for those who are noncompliant with standard therapy.