bluuebunny/crossref_metadata_2025 huggingface dataset:
The Current State of Economics: Needs Lots of Work
Authors: Bergmann Barbara R.
Published: June 2005

The study of the economy has not developed as have other sciences, in which direct observation and data collection by the scientists themselves play a large part. Rather than evidence, which is mostly scarce and indirect, it is political ideology that determines which side of any controversy any economist is likely to take. Two methodological habits of the economics profession have contributed to the poor state of development of economics as a science. One is theorizing based on simple made-up scenarios and assumptions about human cupidity and rationality. The other is the lack of a rigorous connection between the modeling of the macroeconomy and an empirically based description of the behavior of consumers, firms, banks, and individual markets. This article provides a brief discussion of the work of those economists doing systematic observation of economic actors and an assessment of whether their work will lead toward an economics that is empirically based.
Toward an Anthropology of Public Policy
Authors: Wedel Janine R. , Shore Cris , Feldman Gregory , Lathrop Stacy
Published: June 2005

As the rational choice model of “policy” proliferates in “policy studies, ” the social sciences, modern governments, organizations, and everyday life, a number of anthropologists are beginning to develop a body of work in the anthropology of public policy that critiques the assumptions of “policy” as a legal-rational way of getting things done. While de-masking the framing of public policy questions, an anthropological approach attempts to uncover the constellations of actors, activities, and influences that shape policy decisions, their implementation, and their results. In a rapidly changing world, anthropologists’ empirical and ethnographic methods can show how policies actively create new categories of individuals to be governed. They also suggest that the long-established frameworks of “state” and “private, ”“local” or “national” and “global, ”“macro” and “micro, ”“top down” and “bottom up, ” and “centralized” and “decentralized” not only fail to capture current dynamics in the world but actually obfuscate the understanding of many policy processes.
The Return of the Repressed: Recovering the Public Face of U.S. Sociology, One Hundred Years On
Authors: Burawoy Michael
Published: June 2005

At its inception one hundred years ago, the American Sociological Society was concerned to separate itself from the social movements and reform impulses to which it had hitherto been connected. One hundred years of professionalism have achieved the splitting and amassed an impressive body of theory, empirical analysis, and innovative techniques, but sociology’s public face has remained underdeveloped. Public sociology today requires rethinking the meaning of the public sphere as well as that of the discipline of sociology. Moreover, in today’s world, reaching out to publics demands recognition of the interests of the different social sciences within the new global dispensation.
The Uses and Usefulness of Psychology
Authors: Ash Mitchell G.
Published: June 2005

Psychology occupies a peculiar place among the sciences, suspended between methodological orientations derived from the physical and biological sciences and a subject matter that extends into the social and human sciences. This article traces the history of psychology from the late nineteenth century to the end of the twentieth century. Early in the field’s history, psychologists distanced themselves from spiritualists and psychical researchers and embraced empirical methods of natural science. In the twentieth century, schools of thought—psychoanalysis, behaviorism, Gestalt, cognitive, operationalist, and neo-behaviorist—diverged within the field. Government programs during World War II and public visibility helped to shape the field. Academics and practitioners of the various schools agreed on the importance of scientific methods of research and experimentation. Given the century-long struggle for scientific and professional autonomy and authority, psychology today is diffuse and widespread.
Nature and Nurture: Genetic and Environmental Influences on Behavior
Authors: Plomin Robert , Asbury Kathryn
Published: June 2005

The appropriate conjunction between the words nature and nurture is not versus but and. There is increasing acceptance of the evidence for substantial genetic influence on many behavioral traits, but the same research also provides the best available evidence for the importance of environmental influence and important clues about how the environment works. Because much developmental action is at the interface between genes and environment, genetic research needs to incorporate measures of the environment, and environmental research will be enhanced by collecting DNA.
Optimal Adult Development: An Inquiry into the Dynamics of Growth
Authors: Pfaffenberger Angela H.
Published: June 2005

Half a century ago, Abraham Maslow’s theory of self-actualization described advanced development in adulthood. This article reviews the empirical research as well as additional efforts of theory building that have been undertaken in the area of optimal development. Jane Loevinger’s stage theory of ego development, which takes a neo-Piagetian approach to the study of personality, has come to serve as a framework that integrates different research projects because it allows for a dynamic understanding of the process of change. This literature review pays particular attention to what facilitates and promotes development to higher stages. It is concluded that advanced development is facilitated by certain stable personality characteristics and by meaningful engagement with challenging life events. Research supports the conclusion that meditation and specifically targeted educational interventions have shown a potential to further adult development.
How do we Recover? An Analysis of Psychiatric Survivor Oral Histories
Authors: Cohen Oryx
Published: June 2005

This article analyzes interview and survey data collected during the course of the MindFreedom International Oral History Project from June 1 through September 1, 2001. The purpose of the MindFreedom Oral History Project was to gather stories of experiences in the mental health system from the psychiatric survivor or ex-patient perspective. Thirty-six people participated in the study, most of who consider themselves “psychiatric survivors.” Qualitative and quantitative analysis reveals four major themes emerging from these histories: trauma, social control, internalized oppression, and recovery. The focus of this article is on the theme of recovery. Participants demonstrated resiliency and a strong ability to “recover.” No “magic bullet” was found to work for all participants’ recovery process; instead, participants used a variety of self-designed strategies to recapture their once broken lives.
Psychiatric Fraud and Force: A Reply to Szasz
Authors: Torrey E. Fuller
Published: June 2005

Thomas Szasz has made major contributions to many areas of psychiatric thought. He has correctly decried “diagnosis creep” in American psychiatry and emphasized the potential for political abuse of psychiatric labels. He has correctly asserted that only individuals with a true brain disease should qualify as having a “mental illness” but unfortunately ignores overwhelming evidence that schizophrenia has been proven to be a brain disease. His unchanging views on schizophrenia, despite contemporary scientific evidence, appear increasingly anachronistic and allow critics to dismiss his other contributions, many of which remain valuable.
Pharmacokinetics of Eplerenone After Single and Multiple Dosing in Subjects With and Without Renal Impairment
Authors: Ravis William R. , Reid Susan , Sica Domenic A. , Tolbert Dwain S.
Published: June 2005

The influence of renal impairment on the pharmacokinetics of eplerenone following single and multiple dosing was evaluated. Subjects (n = 64) were stratified based on creatinine clearance values as follows: renal impairment (mild, moderate, severe), hemodialysis, and normal matches. Subjects received a single dose of eplerenone 100 mg on day 1 and then received 100 mg once daily on days 3 to 8. There were no statistically significant differences between any of the renal impairment groups and their matched‐normal groups for area under the curve (AUC), Cmax, or CL/F or CL/F/WT following either single or multiple dosing (P ≥ .093). The inactive metabolite and inactive ring‐opened form displayed greater AUCs in renal impairment. Hemodialysis removed approximately 10% of the eplerenone dose. Eplerenone 100 mg once daily was well tolerated in all groups. Considering that renal function had no significant effects on eplerenone CL/F and that eplerenone metabolites are inactive, no dose adjustment appears necessary in patients with renal dysfunction.
Dipyridamole Bioavailability in Subjects With Reduced Gastric Acidity
Authors: Derendorf Hartmut , VanderMaelen Cam P. , Brickl Rolf‐Stefan , MacGregor Tom R. , Eisert Wolfgang
Published: June 2005

Dipyridamole (DP) is an antiplatelet agent that shows decreased oral bioavailability with increased gastric pH that occurs with commonly prescribed antacids. An extended‐release (ER) formulation of DP that employs tartaric acid to improve bioavailability of DP in the presence of elevated gastric pH was developed as a combination antiplatelet product with immediate‐release aspirin. This crossover‐designed study examined the relative bioavailability of DP from the composite product compared to conventional DP tablets during reduced gastric acidity. Gastric pH was increased (pH > 4.0) in 20 healthy subjects with lansoprazole (30 mg/d for 5 days). Dipyridamole systemic exposure over 12 hours was compared after oral administration of a single composite ER capsule (200 mg DP ± 25 mg aspirin) versus two 100‐mg conventional DP tablets given 6 hours apart combined with 81 mg aspirin. DP relative bioavailability was reduced 53% with conventional tablets compared to the composite buffered ER capsule in reduced gastric acid conditions. Peak DP plasma concentrations were 57% lower with immediate‐release tablets compared to the composite formulation with high stomach pH. Substituting generic DP plus low‐dose aspirin may be less effective than the buffered DP composite product in patients with concomitant antacid therapies.
Effect of Hepatic Impairment on the Multiple‐Dose Pharmacokinetics of Ranolazine Sustained‐Release Tablets
Authors: Abdallah Hisham , Jerling Markus
Published: June 2005

The effect of hepatic impairment on the pharmacokinetics of a sustained‐release formulation of ranolazine and 3 major metabolites was investigated in an open‐label, parallel‐group study. Ranolazine (875‐mg loading dose followed by 500 mg every 12 hours for a total of 4 maintenance doses) was administered to subjects with mild (n = 8) or moderate (n = 8) hepatic impairment and a matched control group of healthy volunteers (n = 16). Moderate, but not mild, hepatic impairment significantly increased ranolazine steady‐state area under the concentration‐time curve (AUC0–12) by 76% (P < .001) and maximum plasma concentration Cmax by 51% (P < .01). The AUC0–12 ratio (metabolite/ranolazine) decreased for all metabolites in parallel with the degree of hepatic impairment. AUC0‐∞ for the CYP3A substrate midazolam administered as a single dose was significantly correlated with ranolazine AUC0–12 at steady state (r2 = .33, P <.001). Over the time interval studied, ranolazine was well tolerated in healthy subjects and hepatically impaired subjects.
The Effects of NN414, a SUR1/Kir6.2 Selective Potassium Channel Opener, in Healthy Male Subjects
Authors: Zdravkovic Milan , Kruse Matthias , Rost Karl Ludwig , MSc Judi Møss , Kecskes Andrei , Dyrberg Thomas
Published: June 2005

The aim of the present study was to investigate the effect of a single dose of NN414 (a selective SUR1/Kir6.2 potassium channel opener). Sixty‐four healthy male subjects were enrolled at 8 dose levels (0.625–12.5 mg/kg or placebo). The study consisted of a baseline day and a dosing day. NN414 or placebo was administered in the evening about 10 PM. On both study days, an oral glucose tolerance test (OGTT) was performed following an overnight fast (corresponding to 9 hours postdose), and glucose, insulin, glucagon, and growth hormone concentrations were determined. NN414 was well tolerated, with no clinically relevant changes in safety parameters, although there was an increase in gastrointestinal side effects. NN414 treatment lowered glucose during the OGTT and 24‐hour insulin and glucose levels. In conclusion, a single dose of NN414 is associated with improvements in glucose‐related parameters in healthy male subjects.
Population Pharmacokinetics of Rituximab (Anti‐CD20 Monoclonal Antibody) in Rheumatoid Arthritis Patients During a Phase II Clinical Trial
Authors: Ng Chee M. , Bruno Rene , Combs Dan , Davies Brian
Published: June 2005

Rituximab is a B cell‐depleting anti‐CD20 chimeric IgGK monoclonal antibody being investigated for the treatment of rheumatoid arthritis. The purpose of this study was to develop a population pharmacokinetic model in rheumatoid arthritis patients. In addition, the final pharmacokinetic model was used to assess the variability in drug exposure (AUC0‐∞) for fixed versus body surface area‐based dosing. A total of 102 patients were included in this population pharmacokinetic analysis. A 2‐compartment pharmacokinetic model described the data reasonably well. Body surface area and gender were the most significant covariates for both CL and Vc. Body surface area alone only explained about 19.7% of the total interindividual variability of CL. In a simulation study, body surface area‐based dosing normalized drug exposure over a wide range of body surface area but did not seem to improve the predictability of rituximab AUC0‐∞ in rheumatoid arthritis patients. Therefore, no rationale for body surface area‐based dosing for rituximab in rheumatoid arthritis patients was found.
Influence of Everolimus on Steady‐State Pharmacokinetics of Cyclosporine in Maintenance Renal Transplant Patients
Authors: Budde Klemens , Lehne Gustav , Winkler Michael , Renders Lutz , Lison Arno , Fritsche Lutz , Soulillou Jean‐Paul , Fauchald Per , Neumayer Hans‐Hellmut , Dantal Jaques ,   Behalf of the RADW 102 Renal Transplant Study Group
Published: June 2005

To investigate possible interactions of the novel immunosuppressant everolimus with cyclosporine, a multicenter, randomized, double‐blind, placebo‐controlled, dose‐escalating phase I study was performed. Everolimus regimens (0.75–10 mg/d) were administered for 28 days to stable renal allograft recipients receiving the microemulsion form of cyclosporine. Steady‐state cyclosporine profiles were assessed at baseline on day 0 (cyclosporine alone) and on day 21 with everolimus on steady state. By day 21, mean dose‐normalized cyclosporine AUC0–12 increased by 15% in patients receiving placebo. In everolimus‐treated patients, mean increases in cyclosporine AUC0–12 ranged from 7% to 43%, which were not significantly different across all dosing cohorts including placebo. Linear regression of everolimus AUC on day 21 versus the increase in cyclosporine AUC0–12 yielded a slope not significantly different from a horizontal line (P = ns). In conclusion, these results suggest that steady‐state everolimus exposure over the wide range assessed in this study did not affect steady‐state cyclosporine pharmacokinetics.
The Cardiovascular Toxicity of Selective and Nonselective Cyclooxygenase Inhibitors: Comparisons, Contrasts, and Aspirin Confounding
Authors: Konstantinopoulos Panagiotis A. , Lehmann David F.
Published: June 2005

The premature suspension of the Alzheimer Disease Anti‐inflammatory Prevention (ADAPT) and the Adenoma Prevention with Celecoxib (APC) trials prompted intense review of the cardiovascular safety profile of selective and nonselective cyclooxygenase (COX) inhibitors. This article reviews the current state of selective COX‐2 inhibitors, discusses the mechanistic evidence underlying the cardiovascular risk associated with selective COX‐2 inhibition, outlines the pharmacodynamics of aspirin effects on platelets and the interference of propionic acid derivatives (ibuprofen and naproxen) with these effects, and poses that aspirin confounding may have led to the erroneous conclusion of naproxen‐associated adverse cardiovascular outcomes in the ADAPT trial. Finally, recommendations regarding selective COX‐2 inhibitors and appropriate timing of aspirin coadministration with traditional NSAIDs are proposed in relevance to patient safety and future trial design.
To Go Where No Han Could Go for Long
Authors: Bello David A.
Published: June 2005

Malaria was one of the most important factors for the maintenance of the native chieftainship system and its attendant tribal identities in Yunnan’s southwestern borderlands during the eighteenth and nineteenth centuries. The Qing dynasty (1644-1911) was forced to rely on chieftainship administrative space and its tribal inhabitants as unreliable bulwarks against incursions by “wild” tribals and Myanmar primarily because Han Chinese vulnerability to malaria precluded a more stable and direct Qing official presence. The article examines the Qing construction of both chieftainship and wild tribals, as well as the ethnic administrative spaces intended to keep these two identities separate, as products of the interaction between disease and human agency. It concludes that the Qing frontier order in southwest Yunnan was a compromise with both malarial nature and tribal culture.
State Building, Capitalist Development, and Social Justice
Authors: Fung Edmund S. K.
Published: June 2005

This article explores social democracy in China as an intellectual current and political movement, seeking to demonstrate, on one hand, its similaritiesto European classical social democracy and, on the other, its Chinese peculiarities. It revises the earlier historiography that viewed liberalism in China as irrelevant to the crisis of Chinese society at the time. Instead, it argues that social democracy, linked to state building, capitalist development, and social justice, was a dominant feature of Chinese liberalism and politics, which provided an impetus to China’s modern transformation. Many intellectuals, such as Hu Shi, Zhang Junmai, and Zhang Dongsun, were simultaneously liberal, democratic, and socialist. Their frustrations in the end had much to do with the dominant mainstream political culture, represented by the GMD and the CCP, and little to do with the liberal, democratic, or socialist creed itself.
Perfectionism, Academic Motivation, and Psychological Adjustment: An Integrative Model
Authors: Miquelon Paule , Vallerand Robert J. , Grouzet Frédérick M. E. , Cardinal Geneviève
Published: June 2005

The purpose of this article was to propose and test an integrative model on the role of perfectionism, academic motivation, and psychological adjustment difficulties in undergraduate students. The model posits that self-oriented perfectionism facilitates self-determined academic motivation, whereas socially prescribed perfectionism enhances non-self-determined academic motivation. In turn, self-determined and non-self-determined academic motivations, respectively, lead to lower and higher levels of psychological adjustment difficulties. Results from two studies using structural equation modeling analyses provided support for the model.
Implementation Intentions, Perfectionism, and Goal Progress: Perhaps the Road to Hell Is Paved With Good Intentions
Authors: Powers Theodore A. , Koestner Richard , Topciu Raluca A.
Published: June 2005

Two studies explored whether perfectionism moderates the impact of implementation intentions on goal progress. Study 1 used an implementation intention manipulation to examine the effects of these plans in interaction with perfectionism on the progress of New Year’s resolutions. Study 2 added a repeated implementation intention condition and monitored affect and monthly goal progress. The results of both studies revealed a significant backfire effect of the implementation intentions on goal progress for participants high on a particular dimension of perfectionism (socially prescribed perfectionism). These perfectionists reported doing significantly worse at reaching their personal goals when they were asked to formulate implementation intentions than when they completed a control exercise. There also was evidence that implementation planning aroused negative affect for socially prescribed perfectionists. These results are the first to suggest that implementation planning may be contra-indicated for individuals with self-critical tendencies.
Development and Validation of a Self-Report Measure of Emotional Intelligence as a Multidimensional Trait Domain
Authors: Tett Robert P. , Fox Kevin E. , Wang Alvin
Published: June 2005

Psychometric review of 33 peer-reviewed studies of six self-report emotional intelligence (EI) measures supports a multidimensional conceptualization of EI. The nature and number of EI facets, however, and their distinctiveness from more established trait domains is unclear. Building on earlier efforts, three studies were undertaken (Ns = 138, 163, 152) to develop self-report measures of 10 facets of EI proposed by Salovey and Mayer (1990). Results support the reliability (internal consistency, test-retest) and validity (content, criterion, construct, structural) of the proposed scales and their distinctiveness among themselves and with respect to more established trait domains (e.g., personality). Specifically, three satisfaction and four cross-cultural adaptability facets were predicted uniquely by 9 of the 10 proposed subscales, controlling for social desirability, the Big Five, positive and negative affect, and self-monitoring. All told, results confirm that trait-EI can be measured using self-report and conceptualized as a distinct multidimensional domain.
Attitude Importance as a Moderator of the Relationship Between Implicit and Explicit Attitude Measures
Authors: Karpinski Andrew , Steinman Ross B. , Hilton James L.
Published: June 2005

The authors examined attitude importance as a moderator of the relationship between the Implicit Association Test (IAT) and explicit attitude measures. In Study 1 (N = 194), as ratings of attitude importance regarding the 2000 presidential election increased, the strength of the relationship between a Bush-Gore IAT and explicit attitude measures also increased. Study 2 provided a conceptual replication of these results using attitudes toward Coke and Pepsi (N = 112). In addition, across both studies, explicit attitude measures were better predictors of deliberative behaviors than IAT scores. In Study 3 (N = 77), the authors examined the role of elaboration as a mechanism by which attitude importance may moderate IAT-explicit attitude correlations. As predicted, increased elaboration resulted in stronger IAT-explicit attitude correlations. Other possible mechanisms by which attitude importance may moderate the IAT-explicit attitude relationship also are discussed.
Attributional Inference Across Cultures: Similar Automatic Attributions and Different Controlled Corrections
Authors: Lieberman Matthew D. , Jarcho Johanna M. , Obayashi Junko
Published: June 2005

Five studies examined the automatic and controlled components of attributional inference in U.S. and East Asian (EA) samples. Studies 1 through 3 used variations of the “anxious woman” paradigm, manipulating the inferential goal (dispositional or situational) and the normative impact of situational constraint information (discounting or augmenting). In each study, U.S. and EA participants under cognitive load produced strong automatic attributions to the focus of their inferential goal (dispositional or situational). Compared with the U.S. cognitive load participants, U.S. no load participants corrected their attributions according to the normative rules of inference. In contrast, EA no load participants corrected in the direction of situational causality, even when the specific content of the situational information provided should have promoted stronger dispositional inferences. Studies 4 and 5 examined and ruled out alternative accounts. Results are discussed in terms of a situational causality heuristic present in EA individuals.
Giving Advice or Making Decisions in Someone Else’s Place: The Influence of Impression, Defense, and Accuracy Motivation on the Search for New Information
Authors: Jonas Eva , Schulz-Hardt Stefan , Frey Dieter
Published: June 2005

When making decisions, people have been found predominantly to seek information supporting their preferred choice and to neglect conflicting information. In this article, the authors investigate to what extent different types of advisors, who recommend a choice to someone or make a decision on behalf of someone, show the same confirmatory information search. In Experiment 1, the authors presented participants, in the role of advisors, with a client’s decision problem and found that when making a recommendation, advisors conducted a more balanced information search than participants who were making a decision for themselves. However, advisors who had to make a decision on behalf of their clients revealed an increased preference for information supporting their position. Experiment 2 suggested that this confirmatory information search was caused by impression motivation: The advisors bolstered their decision to justify it to the client. The results are discussed within the multiple motive framework of the heuristic systematic model.
Sexual Victimization in Relation to Perceptions of Risk: Mediation, Generalization, and Temporal Stability
Authors: Brown Amy L. , Messman-Moore Terri L. , Miller Arthur G. , Stasser Garold
Published: June 2005

There is evidence that personal experience with trauma is associated with increases in both personal and comparative risk perception. This study investigates this relation in terms of sexual victimization among women, focusing on three potential mediators: perceived control over sexual assault, perceived similarity to a typical sexual assault victim, and psychological distress. Mediational analyses were investigated using structural equation modeling. Although victimization experience was not related to comparative risk perception, it was associated with greater personal risk perception. This relation was mediated by perceived similarity to a typical sexual assault victim. Prospective analyses indicated that personal risk perception does change in response to sexual victimization but also indicated that heightened risk perception may be an accurate assessment of risk that actually precedes victimization experience. Implications for the meaning of perceived similarity and perceptions of risk for sexual assault victims are discussed.
A People’s History of Empire, or the Imperial Recuperation of Vietnam? Countermyths and Myths in Heaven and Earth
Authors: Killmeier Matthew A. , Kwok Gloria
Published: June 2005

Using the concept of myth, this essay mounts a diagnostic critique of Oliver Stone’s Heaven and Earth to interrogate its historical and political significance. The film provides critical correctives to the limited representations of most Hollywood Vietnam War films, contributing to a fuller historical accounting of the war. As a political construction, it contributes to the American recuperation of Vietnam as an object of neoliberal imperialism. The film’s historical and political-economic context suggests that its countermyths are in the service of a new type of intervention by the United States: enclosing Vietnam within the neoliberal economic Washington consensus.
The Essence of Cooking Shows: How the Food Network Constructs Consumer Fantasies
Authors: Ketchum Cheri
Published: June 2005

Television has a history of creating stories that invite viewers to engage in fantasy. But the most commonly analyzed television programs have been fiction. This article examines the nonfiction programming aired on the Food Networkto discover the fantasy food consumer worlds it creates through production conventions and narrative. This nonfiction media relies on a similarly fictitious construction of consumer realities in an attempt to build a viewer base beyond the traditional cooking show audience. The network offers the possibility of pleasure through creating the fantasy of an intimate connection to viewers and the promise of satisfaction through consumption. It is argued that the networkisan important element in the intricate web of discourses that sustain consumer culture as viewers are told their dreams should be realized through the acquisition and use of particular goods.
Assessing the Likelihood of an Important Clinical Outcome: New Insights from a Comparison of Clinical and Actuarial Judgment
Authors: Rakow Tim , Vincent Charles , Bull Kate , Harvey Nigel
Published: June 2005

Purpose. To assess and rank the performance of different methods of predicting the probability of death following a specified surgical procedure. Method. Actuarial estimates of the probability of early mortality for 40 patients were derived from 2 sources: a large published surgical series and a smaller series from the center where surgery was performed. Surgeons and cardiologists also provided probability estimates for these patients. Results. Estimates derived from the published literature were too optimistic and did not differentiate between patients more, or less, likely to die (i.e., failed to discriminate). Doctors’ judgments were unbiased but failed to discriminate. Local actuarial estimates (influenced by only 1 or 2 variables) were unbiased, did discriminate, but exhibited more random variation. Conclusions. The preferred source of estimates depends upon which aspect of accuracy is of greatest importance. Differences in patient selection and error in the identification of risk factors mean that published results will not always appropriately predict surgical risk at other institutions. Risk stratification may be more robust when based on a small set of cross-validated predictors rather than a larger set of predictors that includes some whose reliability has not been confirmed.
Decreased Use of Adjuvant Breast Cancer Therapy in a Randomized Controlled Trial of a Decision Aid with Individualized Risk Information
Authors: Peele Pamela B. , Siminoff Laura A. , Xu Ying , Ravdin Peter M.
Published: June 2005

Objective. Oncology patients often seek involvement in their medical consultations. Such involvement is endorsed by most health care providers and mirrored in practice guidelines. However, oncologists exhibit great variation in how they provide patients with disease-relevant information, and many remain reluctant to do so at all. The authors examined the impact of a patient-specific decision aid on women’s decisions about adjuvant therapy for breast cancer. Method. 386 women with breast cancer were randomized to receive either an informational pamphlet about adjuvant therapy (usual care) or a patient-specific, evidence-based decision aid about adjuvant therapy. The authors compared rates of adjuvant therapy between the groups controlling for age, education, marital status, race, tumor severity, and practice type of their physician (university-based or community-based). Results. Among women with low tumor severity, only 58% (35/60) of women in the decision aid group chose adjuvant therapy, compared to 87% (33/38) of their counterparts in usual care (P < 0.01). Conclusions. This study illustrates the important impact of medical decision aids on treatment choices, particularly for patients for whom treatment has little benefit. In the case of adjuvant therapy for breast cancer, providing individualized, evidence-based risk information for shared decision making resulted in fewer women with low tumor severity choosing adjuvant treatment.
Is Antibiotic Prophylaxis for Bacterial Endocarditis Cost-Effective?
Authors: Agha Zia , Lofgren Richard P. , VanRuiswyk Jerome V.
Published: June 2005

Background. Antibiotic prophylaxis for bacterial endocarditis is recommended by the American Heart Association (AHA) before undergoing certain dental procedures. Whether such antibiotic prophylaxis is cost-effective is not clear. The authors’ objective is to estimate the cost-effectiveness of predental antibiotic prophylaxis in patients with underlying heart disease. Methods. The authors conducted a cost-effectiveness analysis using a Markov model to compare cost-effectiveness of 7 antibiotic regimens per AHA guidelines and a no prophylaxis strategy. The study population consisted of a hypothetical cohort of 10 million patients with either a high or moderate risk for developing endocarditis. Results. Prophylaxis for patients with moderate or high risk for endocarditis cost $88,007/quality-adjusted life years saved if clarithromycin was used. Prophylaxis with amoxicillin and ampicillin resulted in a net loss of lives. All other regimens were less cost-effective than clarithromycin. For 10 million persons, clarithromycin prophylaxis prevented 119 endocarditis cases and saved 19 lives. Conclusion. Predental antibiotic prophylaxis is cost-effective only for persons with moderate or high risk of developing endocarditis. Contrary to current recommendations, our data demonstrate that amoxicillin and ampicillin are not cost-effective and should not be considered the agents of choice. Clarithromycin should be considered the drug of choice and cephalexin as an alternative drug of choice. The current published guidelines and recommendations should be revised.
Can Patients Interpret Health Information? An Assessment of the Medical Data Interpretation Test
Authors: Schwartz Lisa M. , Woloshin Steven , Welch H. Gilbert
Published: June 2005

Objective. To establish the reliability/validity of an 18-item test of patients’ medical data interpretation skills. Design. Survey with retest after 2 weeks. Subjects. 178 people recruited from advertisements in local newspapers, an outpatient clinic, and a hospital open house. Results. The percentage of correct answers to individual items ranged from 20% to 87%, and medical data interpretation test scores (on a 0- 100 scale) were normally distributed (median 61.1, mean 61.0, range 6-94). Reliability was good (test-retest correlation = 0.67, Cronbach’s alpha = 0.71). Construct validity was supported in several ways. Higher scores were found among people with highest versus lowest numeracy (71 v. 36, P < 0.001), highest quantitative literacy (65 v. 28, P < 0.001), and highest education (69 v. 42, P = 0.004). Scores for 15 physician experts also completing the survey were significantly higher than participants with other postgraduate degrees (mean score 89 v. 69, P < 0.001). Conclusion. The medical data interpretation test is a reliable and valid measure of the ability to interpret medical statistics.
Sufficiently Important Difference: Expanding the Framework of Clinical Significance
Authors: Barrett Bruce , Brown David , Mundt Marlon , Brown Roger
Published: June 2005

Background. It is generally agreed that randomized controlled trials should be powered to detect small but clinically significant treatment effects. Toward these ends, minimal important difference (MID) was proposed as a benchmark for designing trials and for interpreting health-related quality-of-life instrument scores. MID was defined in 1989 as “the smallest difference in score in the domain of interest which patients perceive as beneficial and which would mandate, in the absence of troubling side effects and excessive cost, a change in the patient’s management.” Objective. 1) To expand the idea of minimal clinically important difference so as to take into account harms as well as benefits. 2) To propose concepts and methods with which to do so. Summary. The authors define sufficiently important difference (SID) as the smallest amount of patient-valued benefit that an intervention would require to justify associated costs, risks, and other harms. As a means toward estimation of SID, the authors propose benefit-harm tradeoff methods, in which domains of benefit and harm are systematically traded off against each other and assessed in relation to the global decision of whether a treatment choice is worthwhile. Specific SID estimates can be used to power and interpret clinical trials or to inform health services research and/or public health policy. This article briefly describes the evolution of the important difference concept and outlines similarities and differences between MID and SID.
Transformative Learning in Intraorganization Partnerships
Authors: Franz Nancy K.
Published: June 2005

This research examines transformative learning in intraorganization cross-profession partnerships. Partnerships can enhance individual and organizational success through more effective problem solving and improved adaptation to change. Working in partnership is difficult and often requires learning for successful collaboration; learning may result in transformation. Therefore, it is important to understand how successful partnerships transform individuals, partnerships, and organizations. This study reveals common elements for partnership success, types of learning in partnerships, and conditions for transformative learning in these partnerships. The results of this study identify specific conditions that promote transformative learning in intraorganization cross-profession partnerships. These include (a) a learning environment with strong partner facilitation of learning, critical reflection, and critical events; (b) personal difference between partners bridged by common purpose; and (c) independence with interdependence from the intersection of professional isolation, local need, a transformative partnership mission, and work team leadership.
Reconceptualization of Teacher Education
Authors: Ashraf Dilshad , Khaki Jan-e-Alam , Shamatov Duishon Alievich , Tajik Mir Afzal , Vazir Nilofar
Published: June 2005

Teacher education in developing countries faces great challenges attributable to economic constraints, including shrinking resources, the low status of teachers—exacerbated by declining incentives—and an entirely theoretical approach in teacher training programs. These challenges are further intensified by variations in the trainees’ cultural, regional, and religious backgrounds and by the lack of collaboration between different education sectors. In this context, the Aga Khan University Institute for Educational Development (AKU-IED) in Karachi, Pakistan, is attempting to provide contextually appropriate, effective teacher education programs for Pakistan and other developing countries. This article draws on the authors’ personal experiences in the teacher education programs at AKU-IED and on studies that examine the impact of these programs on participants. Several studies show that teacher education transforms teachers’ beliefs and practices if accomplished through more effective approaches. The article discusses how teacher education programs are conceptualized and implemented in the multicultural context of AKU-IED, where the course participants come from various developing countries and diverse backgrounds.
Transformations Through Teaching and Learning
Authors: Lightfoot Kali , Brady E. Michael
Published: June 2005

The history of the Osher Lifelong Learning Institute (OLLI) at University of Southern Maine (USM) presents a microcosm of lifelong learning institutes in the United States. These grassroots, largely volunteer-managed organizations providing educational opportunities for adults older than 50 started at the New School for Social Research in 1962. Recently, OLLI at USM conducted two research studies, one on the experience of peer teaching in lifelong learning institutes and another on the nature of the learning experience for students in such an organization. Both provide evidence of transformation possible for older adults through engagement in the learning process either as teacher or student. The next research, still in progress, looks at service learning as part of institute curricula. And finally, the authors pose questions about the future of lifelong learning institutes and the changes that may come as a result of the philanthropy of the Bernard Osher Foundation.
IL-7 receptor α chain expression distinguishes functional subsets of virus-specific human CD8+ T cells
Authors: van Leeuwen Ester M. M. , de Bree Godelieve J. , Remmerswaal Ester B. M. , Yong Si-La , Tesselaar Kiki , Berge Ineke J. M. ten , van Lier René A. W.
Published: June 2005

Virus-specific CD8+ T cells emerge after infection with herpesviruses and maintain latency to these persistent pathogens. It has been demonstrated that murine memory CD8+ T-cell precursors specific for acute lymphocytic choriomeningitis virus express interleukin-7 receptor α (IL-7Rα), and IL-7 is involved in maintaining memory populations after the clearance of antigen. To investigate whether human CD8+ T cells reactive toward persistent viruses are maintained similarly, we analyzed IL-7Rα expression and function on these virus-specific cells. During primary infection, all cytomegalovirus (CMV)-specific CD8+ T cells and most Epstein-Barr virus (EBV)-specific CD8+ T cells lacked IL-7Rα expression. Only some virus-specific T cells expressed IL-7Rα late after viral replication became undetectable. CD8+ T cells specific for cleared viruses, influenza (FLU), and respiratory syncytial virus (RSV) all expressed IL-7Rα. Remarkably, the percentage of IL-7Rα- CMV-specific T cells correlated with the height of viral replication in the acute phase. Virus-specific IL-7Rα+ cells proliferated vigorously in response to IL-7, IL-15, or peptide, whereas IL-7Rα- cells required both peptide and helper-cell activation or IL-2 or IL-15 for optimal expansion. Our data suggest that although IL-7 is essential for the maintenance of memory cells in the absence of antigen, CD8+ T cells specific for latent viruses need T-cell receptor activation plus helper factors to persist. (Blood. 2005;106:2091-2098)
A novel molecular basis for β thalassemia intermedia poses new questions about its pathophysiology
Authors: Premawardhena Anuja , Fisher Christopher A. , Olivieri Nancy F. , de Silva Shanthimala , Sloane-Stanley Jackie , Wood William G. , Weatherall David J.
Published: June 2005

During a study of the molecular basis for severe forms of β thalassemia in Sri Lanka, 2 patients were found to be heterozygous for β thalassemia mutations. Further analysis revealed that one of them has a previously unreported molecular basis for severe thalassemia intermedia, homozygosity for quadruplicated α globin genes in combination with heterozygous β thalassemia. The other is homozygous for a triplicated α globin gene arrangement and heterozygous for β thalassemia. Their differences in clinical phenotype are explainable by the interaction of other genetic factors and, in particular, their early management. The clinical course of the 2 propositi underlines the importance of full genotyping and a long period of observation before treatment is instituted, particularly in patients with β thalassemia intermedia associated with extended α globin gene arrangements. The hemoglobin (Hb) F levels in these patients with severe β thalassemia intermedia, compared with other forms of this condition in the Sri Lankan population and elsewhere, are unusually low, a consistent finding in extended α globin gene interactions and in dominant β thalassemia, raising the possibility that increased levels of HbF production in β thalassemia may require mutations at both β globin gene loci.
Functional abnormalities of heparan sulfate in mucopolysaccharidosis-I are associated with defective biologic activity of FGF-2 on human multipotent progenitor cells
Authors: Pan Chendong , Nelson Matthew S. , Reyes Morayma , Koodie Lisa , Brazil Joseph J. , Stephenson Elliot J. , Zhao Robert C. , Peters Charles , Selleck Scott B. , Stringer Sally E. , Gupta Pankaj
Published: June 2005

In mucopolysaccharidosis-I (MPS-I), α-L-iduronidase deficiency leads to progressive heparan sulfate (HS) and dermatan sulfate (DS) glycosaminoglycan (GAG) accumulation. The functional consequences of these accumulated molecules are unknown. HS critically influences tissue morphogenesis by binding to and modulating the activity of several cytokines (eg, fibroblast growth factors [FGFs]) involved in developmental patterning. We recently isolated a multipotent progenitor cell from postnatal human bone marrow, which differentiates into cells of all 3 embryonic lineages. The availability of multipotent progenitor cells from healthy volunteers and patients with MPS-I (Hurler syndrome) provides a unique opportunity to directly examine the functional effects of abnormal HS on cytokine-mediated stem-cell proliferation and survival. We demonstrate here that abnormally sulfated HS in Hurler multipotent progenitor cells perturb critical FGF-2–FGFR1-HS interactions, resulting in defective FGF-2–induced proliferation and survival of Hurler multipotent progenitor cells. Both the mitogenic and survival-promoting activities of FGF-2 were restored by substitution of Hurler HS by normal HS. This perturbation of critical HS–cytokine receptor interactions may represent a mechanism by which accumulated HS contributes to the developmental pathophysiology of Hurler syndrome. Similar mechanisms may operate in the pathogenesis of other diseases where structurally abnormal GAGs accumulate.
KLF2 is essential for primitive erythropoiesis and regulates the human and murine embryonic β-like globin genes in vivo
Authors: Basu Priyadarshi , Morris Pamela E. , Haar Jack L. , Wani Maqsood A. , Lingrel Jerry B. , Gaensler Karin M. L. , Lloyd Joyce A.
Published: June 2005

The Krüppel-like factors (KLFs) are a family of C2/H2 zinc finger DNA-binding proteins that are important in controlling developmental programs. Erythroid Krüppel-like factor (EKLF or KLF1) positively regulates the β-globin gene in definitive erythroid cells. KLF2 (LKLF) is closely related to EKLF and is expressed in erythroid cells. KLF2-/- mice die between embryonic day 12.5 (E12.5) and E14.5, because of severe intraembryonic hemorrhaging. They also display growth retardation and anemia. We investigated the expression of the β-like globin genes in KLF2 knockout mice. Our results show that KLF2-/- mice have a significant reduction of murine embryonic Ey- and βh1-globin but not ζ-globin gene expression in the E10.5 yolk sac, compared with wild-type mice. The expression of the adult βmaj- and βmin-globin genes is unaffected in the fetal livers of E12.5 embryos. In mice carrying the entire human globin locus, KLF2 also regulates the expression of the human embryonic ϵ-globin gene but not the adult β-globin gene, suggesting that this developmental-stage-specific role is evolutionarily conserved. KLF2 also plays a role in the maturation and/or stability of erythroid cells in the yolk sac. KLF2-/- embryos have a significantly increased number of primitive erythroid cells undergoing apoptotic cell death. (Blood. 2005;106: 2566-2571)