bluuebunny/crossref_metadata_2025 huggingface dataset:
Leukotriene-Receptor Antagonists and 5-Lipoxygenase Inhibitors in Asthma
Authors: Larsen Julie S. , Acosta Edward P.
Published: January 2017

OBJECTIVE:

To familiarize readers with a potentially new class of compounds for treating asthma. Background information on leukotrienes is provided in addition to an indepth review of pertinent clinical trials.

DATA SOURCES:

Information was obtained from controlled clinical trials, abstracts, and review articles identified through a MEDLINE search of English-language articles.

STUDY SELECTION:

Emphasis was placed on early clinical trials that showed some benefit with these compounds as well as more recent studies using newer agents that produced more promising results.

DATA EXTRACTION:

Information regarding leukotriene biochemistry was extracted from basic science research and data from human studies were evaluated by the authors according to patient selection, study design, methodology, and therapeutic response.

DATA SYNTHESIS:

Leukotrienes have a pathophysiologic role in asthma. Two distinct but pharmacologically similar classes of leukotriene inhibitors are currently being clinically evaluated. These are leukotriene receptor antagonists and 5-lipoxygenase inhibitors. Early clinical trials with these agents yielded unfavorable results primarily because of lack of drug potency and selectivity, poor patient tolerance, and possibly the route of administration. Subsequent studies with more potent and selective agents have further implicated leukotrienes as biochemical mediators in asthma and, consequently, have shown promising clinical outcomes with respect to pulmonary function testing and patient tolerance.

CONCLUSIONS:

Advancements in the pathogenesis of asthma are beginning to define a role for the leukotrienes. Although more studies are needed to assess the efficacy of leukotriene inhibitors, recent clinical trials using leukotriene-receptor antagonists and 5-lipoxygenase inhibitors indicate a potential for the expansion of therapeutic regimens currently used in the treatment of asthma.
Varicella in Pediatric Patients
Authors: Drwal-Klein Laureen A. , O'Donovan Carmel A.
Published: January 2017

OBJECTIVE:

To summarize the literature describing the epidemiology, transmission, clinical manifestations, diagnosis, treatment, and prevention of varicella in the pediatric population.

DATA SOURCES:

A literature search of English-language articles from 1982 to 1992 using MEDLINE and bibliographies of relevant articles. The search term used was varicella.

STUDY SELECTION:

All review articles and original studies addressing the epidemiology, transmission, clinical manifestations, complications, diagnosis, treatment, and prevention of varicella in pediatric patients were reviewed. Emphasis was placed on controlled studies done in the US.

DATA EXTRACTION:

Data from human studies were extracted by the authors and evaluated according to patient population, sample size, dosing regimen, efficacy, and safety.

DATA SYNTHESIS:

Varicella-zoster virus is a highly contagious virus that produces a common and costly disease in the pediatric population. The primary manifestation of varicella is the eruption of vesicular lesions. In most cases varicella is benign, but it can be associated with serious complications. Diagnosis is based primarily on clinical findings. Otherwise healthy children have traditionally received only symptomatic treatment for varicella, but recent literature suggests that antiviral therapy may be useful in these patients. Immunocompromised patients benefit from both symptomatic and antiviral therapy. Isolation and varicella-zoster immune globulin are used to prevent varicella. In the future, varicella vaccine will play an important role in preventing the disease. Varicella vaccine has been shown to be immunogenic and clinically effective in both healthy and immunocompromised children. Adverse reactions associated with the vaccine include fever, injection-site reactions, and rash. Although zoster can follow vaccination, the incidence appears to be lower in vaccinated individuals. Preliminary studies have shown that the vaccine provides protection from varicella-zoster virus for an extended period of time.

CONCLUSIONS:

Varicella is a common, usually benign disease of childhood. All patients may benefit from symptomatic therapy. Current literature does not support the use of antiviral therapy in all pediatric patients with varicella. When commercially available, varicella vaccine will play an important role in prevention. Long-term studies are needed to fully assess the risk of developing varicella and zoster following vaccination.
Erythromycin-Induced Hypoacusis: 11 New Cases and Literature Review
Authors: Sacristán José A. , Soto Javier A. , de Cos María A.
Published: January 2017

OBJECTIVE:

To report 11 cases of possible erythromycin-induced hearing loss and to review all cases reported in the literature.

CASE SUMMARY:

In the 11 cases reported, the following are reviewed: Age, gender, time to onset of and recovery from hypoacusis in relation to erythromycin administration, presence or absence of renal or hepatic disease, underlying disorders, and concurrent administration of other drugs. Hypoacusis appeared with dosages equal to or higher than 4 g/d in patients with a mean age of 52.5 ± 19 years, a high percentage of whom (45 percent) presented with renal impairment. The hearing loss was reversible in all cases, and subsided a few days (median=3) after dosage reduction or drug discontinuation.

DISCUSSION:

Our patients' characteristics are similar to those of patients reported in the literature. Most data indicate that erythromycin-induced hypoacusis is a dose-dependent effect; however, its occurrence in patients otherwise free from disposing factors suggests that it is idiosyncratic.

CONCLUSIONS:

Erythromycin administered for appropriate indications and dosage adjustments in patients with impaired renal and/or liver function may prevent or reduce the incidence of erythromycin-induced hypoacusis.
Pharmacoepidemiology of Bleeding Events after Use of R-Alteplase or Streptokinase in Acute Myocardial Infarction
Authors: McLeod Donald C. , Coln W. Gerald , Thayer Charles F. , Perfetto Eleanor M. , Hartzema Abraham G.
Published: January 2017

OBJECTIVE:

To determine in nonresearch, general medical practice conditions the comparative incidence and types of bleeding complications after the use of streptokinase (SK) and r-alteplase (recombinant tissue plasminogen activator, rt-PA) to treat acute myocardial infarction (AMI).

DESIGN:

Retrospective medical record review of concurrently treated patients (96-hour observation posttreatment) in 32 participating hospitals in the US.

MAIN OUTCOME MEASURES:

The medical record description of all bleeding events regarding the body site affected, changes in hemoglobin concentrations, blood products administered, and clinical outcome (permanent sequelae or death). Bleeding severity was determined by defined criteria.

CONTROL DATA:

Comorbidity and concomitant medications (e.g., aspirin, heparin, warfarin) likely to predispose or contribute to bleeding events were analyzed.

DATA ANALYSIS:

Logistic regression analysis.

RESULTS:

Data from 419 patients who received rt-PA and 207 who received SK were evaluated. In the 96-hour period after initiation of thrombolytic therapy, 30.5 and 31.9 percent of rt-PA and SK patients, respectively, experienced one or more bleeding events (crude risk ratio [CRR] = 1.04; 95 percent confidence interval [CI] 0.91–1.14; p=0.73). In the first 24-hour period, 21.5 percent of rt-PA and 15.9 percent of SK patients experienced bleeding events (CRR = 0.74; 95 percent CI 0.42–1.15; p=0.08). The leading types of bleeding and percents of all patients affected were: Perivascular access site (18.4 percent), gastrointestinal (6.4 percent), skin/soft tissue/muscle (5.0 percent), urinary (3.4 percent), pulmonary (2.2 percent), systemic (1.9 percent), and oral (1.4 percent). Intracranial bleeding occurred in 4 rt-PA and 2 SK patients; 4 of these patients died. Events deemed clinically significant occurred in 15 rt-PA and 9 SK patients (3.8 percent of all patients). Ten patients likely died from these events, 6 within the first 24 hours. Three rt-PA patients and 1 who received SK (0.6 percent) died of cerebrovascular events within the first 24 hours. After controlling for demographic factors and therapeutic variables, using logistic regression analyses, no thrombolytic-related differences were found in the incidence or severity of bleeding following use of the two thrombolytics.

CONCLUSIONS:

These clinical data do not support a theoretical advantage of rt-PA to cause less bleeding propensity than SK.
Whole-Cell and Acellular Pertussis Vaccines
Authors: Wintermeyer Susan M. , Nahata Milap C. , Kyllonen Kay S.
Published: January 2017

OBJECTIVE:

To provide a review of pertussis vaccines, including information on efficacy, adverse reactions, and antibody production following administration of both whole-cell and acellular pertussis vaccines.

DATA SOURCES:

A MEDLINE search and extensive review of journals was conducted to identify the information for this review.

DATA EXTRACTION:

Pertinent studies reporting experience with pertussis vaccinations were reviewed.

DATA SYNTHESIS:

The differences in efficacy, adverse reactions, and antibody responses between whole-cell and acellular pertussis vaccines are emphasized. The status of acellular pertussis vaccination in the US is defined.

CONCLUSIONS:

Acellular (chemically detoxified or recombinant) pertussis vaccine formulation appears to cause fewer adverse reactions than whole-cell vaccine in most studies. Clinical efficacy and safety in the very young has not been well established. Thus, acellular pertussis vaccine is reserved for the 4th and 5th doses in the US. Oral or intranasal formulations of the pertussis vaccine are being evaluated.
Aminoglycoside Pharmacokinetics: Volume of Distribution in Specific Adult Patient Subgroups
Authors: Dager William E.
Published: January 2017

OBJECTIVE:

To review the published clinical studies reporting volume of distribution for aminoglycosides in patient population subgroups. Controversies in methods used are discussed.

DATA SOURCES:

National Library of Medicine Medlars, searched using MEDLINE.

STUDY SELECTION:

Published articles primarily relating to pharmacokinetic properties of aminoglycosides in specific adult patient subgroups published within the past 20 years were included. Pediatric studies were excluded.

DATA EXTRACTION:

The methodology, assay technique, and results from clinical studies reporting aminoglycoside volume of distribution were evaluated.

DATA SYNTHESIS:

Clinical studies reporting aminoglycoside volume of distribution subgroups, including the methods by which their results were derived, are tabulated.

CONCLUSIONS:

The expected aminoglycoside volume of distribution can vary, depending on a patient's clinical presentation. Data presented will allow a more refined initial estimation of volumes of distribution, which may facilitate the achievement of desired aminoglycoside serum concentrations.
Factors Associated with Suboptimal Analgesic use in Community-Dwelling Elderly
Authors: Hanlon Joseph T , Fillenbaum Gerda G , Studenski Stephanie A , Ziqubu-Page Thandi , Wall William E
Published: January 2017

OBJECTIVE:

To examine patterns and factors associated with overall and suboptimal analgesic use among community-dwelling elderly.

DESIGN:

Cross-sectional survey.

SETTING:

Five-county urban and rural region in Piedmont, NC.

PARTICIPANTS:

A stratified random sample from the Duke Established Populations for Epidemiologic Studies of the Elderly of 3973 participants aged 65 years or older.

MAIN OUTCOME MEASURES:

Use of any analgesic medication, suboptimal analgesic use (taking 2 or more analgesics from the same class, using 3 or more analgesics concurrently, or use of an analgesic that has a major interaction with another drug).

RESULTS:

Analgesics were used by 60.4% of the participants. Use was more likely for those who had physical functional impairment, a history of cardiovascular disease, one or more health visits in the previous year, or were female. Use was less likely for older participants and for African-Americans with adequate financial status. Suboptimal use occurred for 9.2% of analgesic users. Therapeutic duplication was more likely in those who were depressed, needed help with basic activities of daily living, or used alcohol, and was less likely in those with adequate financial status. Multiple analgesic use was more likely in those who were depressed, had impaired physical functional status, had one or more health visits in the previous year, were African-American (of either sex), or were white women. Only two persons had a potential major analgesic-drug interaction.

CONCLUSIONS:

Suboptimal analgesic use is common in community-dwelling elderly, and its risk is consistently increased in those who are depressed or have impaired functional status.
Agranulocytosis, Plasmacytosis, and Thrombocytosis Followed by a Leukemoid Reaction Due to Acute Acetaminophen Toxicity
Authors: Gürsoy Murat , Haznedaroğlu Ibrahim C , Çelik Ismail , Sayinalp Nilgün , Özcebe Osman I , Dündar Semra V , Guévremont Chantal
Published: January 2017

OBJECTIVE:

To describe a patient who developed hepatotoxicity, reactive plasmacytosis with thrombocytosis and life-threatening agranulocytosis, followed by a leukemoid reaction, apparently caused by acute acetaminophen toxicity.

SETTING:

University-affiliated hospital.

CASE SUMMARY:

A 19-year-old white woman who took an overdose of acetaminophen developed hepatotoxicity and reactive plasmacytosis with thrombocytosis and life-threatening agranulocytosis, followed by a leukemoid reaction. Symptoms, signs, and laboratory findings regressed with symptomatic therapy during the follow-up period.

CONCLUSIONS:

We believe that acute acetaminophen toxicity was responsible for these hematologic abnormalities. This profile of hematologic adverse effects associated with acetaminophen toxicity has not been reported previously.
Risperidone-Induced Neuroleptic Malignant Syndrome
Authors: Sharma Roopali , Trappler Brian , Ng Yiu Kee , Leeman Cavin P
Published: January 2017

OBJECTIVE:

To describe a patient with neuroleptic malignant syndrome (NMS) induced by risperidone, an atypical antipsychotic, and to review the available literature related to risperidone-associated NMS.

DATA SOURCE:

Case report information was obtained from the resident physician and medical records. MEDLINE and Index Medicus were searched to obtain literature published between 1960 and 1995.

DATA SYNTHESIS:

We report an adolescent boy who developed NMS after treatment with risperidone. Risperidone therapy was started after unsuccessful treatment and development of extrapyramidal adverse effects with haloperidol. The patient demonstrated the classic tetrad of fever, generalized skeletal muscle rigidity, altered mental status, and autonomic dysfunction. Risperidone was discontinued and the patient recovered after a prolonged hospital course with supportive management.

CONCLUSIONS:

Clinicians are cautioned about the possibility of NMS with risperidone.
Bruising Associated with the Use of Fluoxetine
Authors: Pai Vinita B , Kelly Michael W
Published: January 2017

OBJECTIVE:

To report a case of suspected fluoxetine-induced bruising and review the literature surrounding this rare adverse effect.

CASE SUMMARY:

A 31-year-old white woman was diagnosed with depression and treated with fluoxetine. After fluoxetine 20 mg/d for 6 weeks, she reported bruising that was disproportionate to any trauma incurred. Her prothrombin time, partial thromboplastin time, and complete blood cell count were within normal limits. Fluoxetine was suspected to be the cause of this bruising. The patient did not want to discontinue the medication and has continued to bruise while continuing fluoxetine therapy.

DISCUSSION:

Frequently encountered adverse effects caused by fluoxetine use include nausea, nervousness, and insomnia, but hematologic effects have also been reported. These include bleeding or bruising with prolonged bleeding time, increased prothrombin time and partial thromboplastin time, and thrombocytopenia. The mechanism behind these adverse effects is the prevention of serotonin-induced amplification of platelet aggregation by fluoxetine. Blockade of 5-hydroxytryptamine uptake in the platelets by fluoxetine reduces or depletes the platelet serotonin stores, thereby predisposing a patient with a mild underlying platelet disorder to a fluoxetine-induced hematologic disorder.

CONCLUSIONS:

Fluoxetine has been reported to produce bruising, bleeding, and other hematologic disorders. It should be used with caution when treating patients with thrombocytopenia or with proven or suspected platelet dysfunction.
Pharmacologic Management of Postdural Puncture Headache
Authors: Choi Alice , Laurito Charles E , Cunningham Francesca E
Published: January 2017

OBJECTIVE:

To discuss the pathogenesis, incidence, and clinical presentation of postdural puncture headaches (PDPHs) and to provide a comprehensive evaluation on the pharmacologic management of PDPH.

DATA SOURCE:

A MEDLINE search was used to identify pertinent literature published in English including review articles, case reports, letters, and abstracts. Information was also extracted from textbooks for background purposes.

STUDY SELECTION:

All clinical studies, case reports, abstracts, and letters were included because of the limited amount of literature available on the pharmacologic therapy for PDPH. Related research articles and review articles were also used to provide background information on PDPH.

DATA EXTRACTION:

Methodology and results from clinical trials and abstracts were described and evaluated. Case reports and letters were summarized and critically reviewed for the feasibility of the different treatment modalities. Information on the pathophysiology, incidence and severity, and clinical presentation of PDPH was extracted from related research articles, review articles, and textbooks.

DATA SYNTHESIS:

The epidural blood patch (EBP) is one of the most effective treatments for PDPH. Pharmacologic management of PDPH offers a less invasive treatment modality than the EBP. Numerous drug therapies have been presented in the literature, though few merit clinical application. Caffeine therapy, both oral and parenteral, is the most commonly used pharmacologic treatment modality. Theophylline and sumatriptan are potentially promising agents for the treatment of PDPH. Epidural administration of fluids and drugs is also effective in the treatment of PDPH. Epidural administration of NaCl 0.9% and dextran may be an alternative to the EBP when the EBP is unsuccessful or contraindicated. Epidural adrenocorticotropic hormone and epidural morphine also demonstrate some potential in the treatment of PDPH. Individual patient characteristics (i.e., HIV, sepsis) need to be considered when deciding on a treatment. More reports, especially clinical studies, are necessary before a definitive statement can be made regarding any one treatment. In the meantime, therapy will be guided by clinical judgment based on the literature reviewed in this article.

CONCLUSIONS:

Intravenous and oral caffeine are effective and noninvasive treatments for PDPH. Epidural NaCl 0.9% or dextran are alternatives when the EBP is unsuccessful or contraindicated. Several methods of pharmacologic management have been cited in the literature, but all require further evaluation.
Pharmacoepidemiology of Urinary Tract Infections in Iowa Medicaid Patients in Urban Long-Term-Care Facilities
Authors: Bjornson Darrel C. , Rovers John P. , Burian Julie A. , Hall Nancy L.
Published: January 2017

OBJECTIVE:

To describe the therapeutic management of Medicaid patients with urinary tract infections (UTIs) in urban long-term-care facilities (LTCFs) and to link individual therapies to patient outcomes.

DESIGN:

Retrospective review of medical records in LTCFs of patients who had documented UTIs.

METHODS:

Patient data were collected from 17 LTCFs in the Des Moines, IA, metropolitan area during a 1-year period starting January 1, 1995. Patients with UTIs were selected from the LTCF infection control logs. Data collected on patients included demographics, concomitant diseases, type of UTI (i.e., symptomatic, asymptomatic, catheter-related), process measures for management, UTI treatment, patient outcomes, and follow-up. Patient outcome data were defined as either cure or no cure. A UTI cure was defined as a negative urine culture while taking antibiotic therapy and/or complete resolution of signs and symptoms, as well as no further treatment given within 2 weeks after the end of treatment.

RESULTS:

Data were collected on 310 patients who had at least one UTI over the 1-year study period. Patients were primarily elderly (mean age 82.2 ± 12.3 y), white (95.1%), and female (83.9%). Concomitant diseases were common and about one-fourth (23.0%) of the patients were catheterized. There were 536 UTI events (the unit of analysis) documented over the 1-year period, with about one-half (45.9%) being UTIs with symptoms consistent with uncomplicated lower UTI. Nearly two-thirds (62.3%) of the patients were cured, based on the study definition; there was no association between cure and type of antimicrobial therapy (p = 0.99). Over one-third (35.2%) of the UTIs were treated with a quinolone antibiotic. Others were treated with trimethoprim/sulfamethoxazole (24.4%), nitrofurantoin (13.9%), a cephalosporin (10.4%), or ampicillin/amoxicillin (9.8%). Sixty-day follow-up showed no association between type of therapy and hospital readmission, physician follow-up visits, or subsequent UTIs.

CONCLUSIONS:

There were no differences in cure rates when comparing LTCF UTI patients receiving various regimens. With outcomes being the same, the clinician should closely consider costs of drug therapy in selecting a treatment preference.
Paclitaxel Formulation as a Cause of Ethanol Intoxication
Authors: Wilson David B. , Beck Thomas M. , Gundlach Catherine A.
Published: January 2017

OBJECTIVE:

To report a case of ethyl alcohol intoxication associated with paclitaxel administration.

CASE SUMMARY:

A patient who received a 3-hour paclitaxel infusion for metastatic breast carcinoma and developed symptoms of acute alcohol intoxication. A blood ethanol concentration drawn at the end of the paclitaxel infusion was 97.8 mg/dL (0.098%).

DISCUSSION:

The amount of alcohol contained in paclitaxel is discussed. A review of the literature revealed one patient series where the highest blood alcohol concentration was one-third that seen in our patient.

CONCLUSIONS:

Clinicians should recognize the potential for alcohol intoxication with paclitaxel administration. This is especially pertinent when higher doses are given over a short period of time.
The Effect of Mesalamine and Nicotine in the Treatment of Inflammatory Bowel Disease
Authors: Bonapace Charles R. , Mays David A.
Published: January 2017

OBJECTIVE:

To characterize the usefulness of mesalamine and nicotine in the treatment of active ulcerative colitis and inactive Crohn's disease.

DATA SOURCES:

Citations were selected from the MEDLINE database. Only those involving human subjects, inflammatory bowel disease, and available in English were selected.

STUDY SELECTION:

Selection criteria consisted of clinical trials and review articles assessing the effects of mesalamine and nicotine in active ulcerative colitis or inactive Crohn's disease and the utility of reducing steroid dependence or relapse rate. Less than 20% of the articles identified met the selection criteria.

DATA SYNTHESIS:

In patients with inactive Crohn's disease, mesalamine 2 g/d significantly reduced the risk of relapse in high-relapse-risk patients compared with placebo, reducing the relapse rate from 71% to 55%, but was ineffective in preventing recurrence of inactive Crohn's disease following surgical resection. Mesalamine 4 g/d was effective in decreasing weaning failure due to steroid dependence by 67%, although the relapse rate was not significant compared with placebo at the end of 12 months. Following surgical resection, mesalamine was unable to significantly reduce the incidence of recurrence compared with placebo at the end of 1 year. In patients with active ulcerative colitis, oral mesalamine 2 and 4 g/d was superior to placebo in inducing remission compared with placebo. Among patients with prior steroid or sulfasalazine treatment, rectal mesalamine 4 g hs achieved a remission rate of 78% in more than 12 weeks of therapy. Other studies have not found a dose—response relationship with lower dosages of mesalamine. Whereas nicotine 15–25 mg/d administered as a transdermal patch produced greater symptomatic improvement in active ulcerative colitis compared with placebo, nicotine 15 mg/16 h produced results no different from those with placebo in maintaining remission in inactive ulcerative colitis. Nicotine appears to have an adverse effect on the course of Crohn's disease and is not recommended.

CONCLUSIONS:

Mesalamine has demonstrated clinical effectiveness as a therapeutic agent in the treatment of active ulcerative colitis and inactive Crohn's disease. Although its relationship to inflammatory bowel disease has been known for many years, the usefulness of nicotine for the treatment of active ulcerative colitis requires further exploration before it can be recommended as a therapeutic agent.
Later Abatement, Faster Abatement: Evidence and Explanations From the Global Phaseout of Leaded Gasoline
Authors: Hilton F. Hank
Published: January 2017

Some nations took decades to eliminate lead from gasoline. Others took only a few months. Still others are nowhere near completion. Although existing literature has identified factors that speed or impede abatement, it has not addressed international differences in abatement times. This article identifies, for lead phaseout, three important aspects of those international differences. First, later abatement implies faster abatement. Nations that started relatively late required relatively little time to eliminate lead. Second, the completion of "giant steps" explains much of the late abaters' speed. Late abaters have accelerated phaseout by making at least one very large reduction in a 2-year period. Third, accrued wisdom probably explains the giant steps and the later-faster pattern. Evidence suggests that late abaters learned important abatement-accelerating lessons from their predecessors.
A Comparative Study of Dam-Resistance Campaigns and Environmental Policy in Brazil
Authors: Rothman Franklin D.
Published: January 2017

This article examines the participation of Brazilian communities in the environmental impact assessment process of five hydroelectric dam projects in Minas Gerais State in the context of privatization of Brazil's electric sector. It focuses on how support of church, university, and environmental activists enabled dam-affected rural populations and their leaders to effectively contest dam plans. Popular rural mobilization and critiques of environmental impacts reports in public hearings by affected people and their allies, reinforced by support from urban political leaders, provided leverage needed by state environmental technocrats to vigorously enforce environmental regulations. Divergent project outcomes included private sponsor withdrawal of three projects and a relatively equitable resettlement agreement of another project. Findings suggest that under certain conditions, prior institutional reforms can facilitate the empowerment of affected people, enabling them to influence environmental decision making and energy policy.
Policy Responses to Tropical Deforestation: Are Debt-for-Nature Swaps Appropriate?
Authors: Kraemer Moritz , Hartmann Jörg
Published: January 2017

This paper examines passible causes for the acceleration of tropical deforestation and the role of a popular instrument to reverse this trend, debt-for-nature swamps (DNS). This instrument builds on the contention that the debt crisis of developing countries has created the need to exploit natural resources, such as tropical forest areas. Thus, DNS could potentially protect forests directly (through conservation projects) and indirectly (by reducing debt-induced pressure on the forests). First, an instrumental critique of DNS is given, followed by an empirical examination of the debt-deforestation link that stands behind the instrument of DNS. Neither this nor other plausible causes of the acceleration of deforestation can be identified as significant in a cross-country study. The paper concludes that appropriate policy instruments must be based on case-specific research.
The Road from Rio: Implications of the UN Conference on Environment and Development for the World Bank
Authors: El-Ashry Mohamed T.
Published: January 2017

The United Nations Conference on Environment and Development (UNCED) articulated the international community's commitment to a policy of sustainable development. In response to the fact that, too often, policies have not been successfully translated into effective action, UNCED produced Agenda 21, providing a blueprint to guide the implementation of national and international policies in support of sustainable development. The World Bank's strategy for implementing the environmental concerns embodied in Agenda 21 is fourfold: to incorporate a comprehensive environmental assessment procedure to ensure that the investment projects that it helps to finance take account of environmental considerations; to exploit the powerful synergies between poverty alleviation, economic efficiency and the enhancement of environmental quality; to assist member countries in setting priorities, building institutions, and formulating specifically targeted policies for sound environmental stewardship; and to support the Global Environment Facility as both a financial resource and an institution specifically designed to serve the interests of the world as a whole. The Bank's commitment to promoting sustainable development, of course, must be complemented by similar commitments from the private sector to provide capital and technology, and from international development institutions to play a major role in bringing about a new era of international cooperation.
A Program to Enhance Technological Choices in Asia and the Pacific
Authors: Montgomery John D.
Published: January 2017

This paper builds on the findings of a workshop that the Pacific Basin Research Center (PBRC) conducted in Bangkok in November 1992 at which thirty-four participants from fourteen countries presented their experiences with environmental policies. On the basis of these experiences, the PBRC concluded that important investment decisions on environment-related systems were being made in all of these countries, and at all levels of government, without access to potentially helpful information about similar decisions being made elsewhere. The paper sets forth a procedure that will permit regional exchange of information regarding prototypical experiences with environmental programs.
Issues of Importance to Patients Seeking Care from Members of the AOFAS: A Preliminary Report of the Outcomes Committee of the AOFAS
Authors: Sangeorzan Bruce J. , Beskin James L. , Britt Sarah M. , Brage Michael , Holt Sarah , Kadel Nancy J. , Legro Marcia W. , Sands Andrew K. , SooHoo Nelson F. , Stroud Chris C.
Published: January 2017

Background: The purpose of this multi-center study was to examine the outcomes of importance for patients seeking treatment for foot and ankle disorders. An improved understanding of patient outcome preferences will assist surgeons in improving patient satisfaction. Methods: An open-ended priority function questionnaire was administered to 235 patients presenting as new patients to five different outpatient locations. The questionnaire was designed to identify activities of importance to patients and was based on the McMaster Toronto Arthritis (MACTAR) patient preference disability questionnaire. Subjects were asked to list the specific activities that were limited by their condition. Open-ended answers were written on five blank spaces and then ranked as to their importance. The visual analog pain scale was recorded as a measure of the severity of the patient's symptoms at the time the response was made. The outpatient settings were two university hospitals, two private offices with academic affiliation, and one private office. Two hundred thirty-five surveys were collected between September and November of 2000; 227 surveys were acceptable for analysis. The respondents included 132 females (58.1%), 94 males (41.4%) and one patient who did not specify his gender (0.4%). The mean age was 45.8 (range 18 to 83) years. Results: Average pain at the time of assessment was 2.7 on a scale of 0 to 9 and was reported to increase to 4.8 in a typical day. The most frequently ranked limitations were difficulty with walking (159), running (73), standing (55), and exercise (54). Walking also was the issue ranked as the highest priority (77 of 159), while running (11 of 73), standing (10 of 55) and exercise (3 of 54) were assigned lesser priority values. Only 68 of 227 respondents failed to list walking as an issue. Work, sleep, and social activities were not commonly cited as issues of importance. Conclusion: Patients presenting to office practices identified as specializing in foot and ankle disorders are predominantly middle-aged women in mild to moderate pain. Walking is the function most frequently identified as a problem and ranked as the highest priority for improvement. Social limitations were unlikely to be named as a limitation in this population.
Racial and Ethnic Differences in Preventable Hospitalizations across 10 States
Authors: Gaskin Darrell J. , Hoffman Catherine
Published: January 2017

Using discharge data from 10 states, this study estimates the effects of race and ethnicity on the likelihood of being hospitalized for a preventable condition—an indicator of limited access to primary care. The authors find that African Americans and Hispanics are more likely to be hospitalized for preventable conditions. In particular, controlling for differences in patients’ health care needs, socioeconomic status, insurance coverage, and the availability of primary care, Hispanic children, working-age African American adults, and elderly patients from both minority groups are at greater risk than are similar white patients.
Choices in Health Care: What are they and What are they Worth?
Authors: Bernstein Amy B. , Gauthier Anne K.
Published: January 2017

This overview article provides a conceptual introduction to this special issue on health care choices, containing four main papers originally commissioned in 1997 for a conference titled “The Power of Choice in the Health Care Marketplace and Its Consequences,” sponsored by The Robert Wood Johnson Foundation under its Changes in Health Care Financing and Organization (HCFO) program and conducted by the Alpha Center on November 19, 1997. Drawing on information from these four papers, the authors discuss what factors affect the different choices we face, highlighting the fact that different players in the health care system face diverse and often conflicting choices and trade-offs. The authors then examine the consumer choice model and its premise that when consumers are presented with adequate information about these different choices, they will make selections about plans, providers, and health insurance that will move the health care system toward a higher quality/lower cost equilibrium.
Management by Objection? Public Policies to Protect Choice in Health Plans
Authors: Brown Lawrence D.
Published: January 2017

Consumer choice is a watchword of the market reforms now sweeping the U.S. health care system. Policy makers, however, must grapple with an important ambiguity: is the objective to expand choice or protect choosers, and what should be done if the two goals conflict? Concerns about health care market malfunctions trigger a politics of consumer protection that may emphasize regulatory standards over market flexibility. To complicate matters further, hopes that deluging consumers with information can ensure that choices are at once ample and prudent are likely to be disappointed.
Reconfiguring Television for a Networked, Produsage Context
Authors: Bruns Axel
Published: January 2017

The rise of user-led content creation and distribution, or produsage, is by now well recognised. User-produced content is providing a well-needed corrective to industrial journalism; user-produced creative work has become a regular component of the standard media diet for many users; and user-led distribution of content through file-sharing networks is now an important means of accessing content, and is cautiously being explored as a means of distribution by mainstream media producers. Such phenomena are beginning to affect the television industry. On the one hand, the user-led distribution of television programming now enables producers to bypass traditional distribution channels altogether; on the other, traditional television channels are already anticipating such moves through an increase in live content and event television. There is also a contrary movement of user-produced material further into the mainstream of the mediasphere. This article outlines a number of the operational models now available to players in the television industry: enlisting file-sharers in the direct distribution of TV shows to audiences; moving further towards a focus on live event television; and embracing user creativity in pursuit of produsage-based television models. It examines these options against a context of continuing convergence and change in the content industries.
The BBC's Second-Shift Aesthetics: Interactive Television, Multi-Platform Projects and Public Service Content for a Digital Era
Authors: Bennett James , Strange Niki
Published: January 2017

This article maps out some of the implications of interactivity and convergence for television's textual and industrial forms in relation to the BBC's status as a public service broadcaster. Whilst the digitalisation of television may bring about new textual, industrial and audience configurations, the goals for broadcasters remain the same: to attract viewers in a marketplace where there is increasing competition for screen-based leisure time. John Caldwell's work on ‘second-shift aesthetics’ demonstrates how TV-dot.com synergies must now attempt to ‘master textual dispersals and user navigations that can and will inevitably migrate across brand boundaries’ in order to keep audiences engaged with their proprietary content for as long as possible (Caldwell, 2003: 136). However, for public service broadcasters, mastering these user flows does not simply take the form of an economic transaction. Rather, these second-shift strategies must serve and fulfil public service (PS) obligations and engage viewers in new relationships. Based on a combination of textual analysis and critical industrial research, including interviews with key industry personnel, this article examines the BBC's early second-shift practices in relation to interactive television (iTV) and ‘multi-platform projects’, as the corporation moves from being a PS broadcaster to a PS content-provider.
The Shock of the New: Old Media Strategies in the Digital Age
Authors: Sinclair John
Published: January 2017

This paper provides an outline and analysis of the strategies with which the ‘old’ media empires of print and television have met the challenge of ‘new’ media in Australia, notably the internet. It places particular emphasis on the protection of, or the gaining of access to, advertising revenue as a motivating factor in such corporate strategies since the early 1990s. In order to achieve some historical perspective and narrative continuity on this process, the discussion is divided into a rough periodisation. The first period saw the beginning of internet advertising and media organisations establishing a web presence, before the dot.com crash of 2000. A period of more cautious consolidation of positions then followed, and internet advertising became differentiated into categories of search, directories, classified and display, leading up to the corporate discovery of social networking in 2005. The paper concludes with some observations on the recent influx of private equity capital, particularly noting the agile response of ‘old’ media proprietors.
Star Bodies/Freak Bodies/Women's Bodies
Authors: Delamoir Jeanette
Published: January 2017

An exploration of the contexts surrounding images of female celebrities in Australian weekly women's magazines complicates any simple cause-and-effect relationship between women's behaviour and celebrity glamour by revealing parallels between the construction of star personae and the discourses surrounding the display of sideshow ‘freaks’. This paper focuses on a series of stories about the weight loss and gain of Renee Zellweger, over the 18-month period during which Zellweger filmed her second Bridget Jones movie. The articles illustrate the freakshow contexts in which images of Zellweger are embedded, and establish a dynamic of attraction and disgust that is possibly more compelling than unalloyed admiration for celebrity bodies.
The Ecology of Emblem Eating: Environmentalism, Nationalism and the Framing of Kangaroo Consumption
Authors: Craw Charlotte
Published: January 2017

This paper investigates the alignment of environmentalist and nationalist narratives through an examination of discussions of kangaroo consumption in popular media such as newspapers and cookbooks. In her bible of contemporary home cooking, The Cook's Companion, Australian chef Stephanie Alexander remarks that using kangaroo meat must, as an indigenous product, ‘qualify a dish as Australian’. And, she adds, such usage makes environmental as well as iconic sense. As I discuss in this paper, Alexander's comments are indicative of the framing of native foods: indigenous ingredients are billed as the solution to both the search for an authentically Aussie cuisine and the plight of the continent's devastated ecologies. Using John and Jean Comaroff's work on the politics of ecological discussions, the paper examines the entanglement of territory and ecology — the slippage between the ‘native’, the ‘natural’ and the ‘nation’ — to reveal how the realm of ecology, conceived of as ‘natural’ and therefore exterior to politics, is used as a forum for very political questions of ‘belonging’. The paper demonstrates how the framing of environmental discussions in the public sphere cannot be separated from wider questions of the politics of settler (post-)colonies.
Celebrity Conservation: Interpreting the Irwins
Authors: Brockington Dan
Published: January 2017

Interactions between celebrity and conservation are proliferating. This paper reviews theories of celebrity, explores different perspectives on the role of celebrity in conservation and outlines a typology of celebrity involvement. It then examines the work of the late Steve Irwin and his daughter Bindi, and public responses to them, using these cases to illustrate how and why conservation and celebrity are becoming interwoven. Finally, it considers the long-term implications of celebrity conservation and the dangers of promoting conservation through para-social relations with nature.
Dispatches from the Depletion Zone: Edward Burtynsky and the Documentary Sublime
Authors: Zehle Soenke
Published: January 2017

The scope of China's contemporary transformation is measured by many observers according to the environmental crisis it has engendered. One of the most ambitious attempts to document this transformation has been the recent work by Edward Burtynsky. The China series is the latest contribution to the Canadian photographer's grand tour of industrial landscapes. Burtynsky employs the same approach and rules of composition across terrains and topics, and there is indeed nothing radically new in terms of subject or composition in the China series. Yet, linked to the question of scale that is so central to Burtynsky's approach, the question of the sublime offers a useful point of entry for approaching the China series, not only because it is so routinely inscribed in this (heterogeneous) tradition, but because the concept has also played a key role in the refashioning of Chinese aesthetics to stress the heroism of Chinese industrial ambition. And the suggestion, evident in the attentiveness to the scale of environmental devastation, that the sublime can no longer be invoked to legitimate a techno-feudalist course of development, can initiate a political conversation, even if the photographer's aesthetic does not offer an idiom with which to engage the complexities of cultural difference.
Introduction: Digital Literacy
Authors: McWilliam Kelly , Hartley John , Gibson Mark
Published: January 2017

This issue of MIA is based on several of the papers presented at the Digital Literacy and Creative Innovation in a Knowledge Economy symposium held by the ARC Centre of Excellence for Creative Industries and Innovation at QUT and the ARC Cultural Research Network in March 2007. The articles in this issue consider how the rapid development of digital technologies has changed the production and consumption of media content, altering the very nature of the relationship between ‘producers’ and ‘consumers’.
Making Media Policy: Looking Forward, Looking Back
Authors: Given Jock
Published: January 2017

Seeking papers for the media stream at the conference and articles for this issue of Media International Australia, our aim was to examine contemporary media policy issues that benefited from some kind of historical analysis. Rather than starting with history, confident that it served up powerful and useful lessons, the idea was to begin with the current policy challenges and see whether history helped. Unsurprisingly, most authors found it did — though not always, and for different reasons.
Broadband Bottleneck: History Revisited
Authors: Barr Trevor
Published: January 2017

The vexed issues currently surrounding broadband policy in Australia remind us that the public sector has a great track record in building valuable telecommunications infrastructure. One lesson from the past 150 years is the constructive role played by the public sector by providing the vision and seeding capital for the creation of three major communications platforms: Australia's overland telegraph in the 1870s, communications satellites funded by the National Aeronautics and Space Administration (NASA) from the 1950s, and the early internet, funded by the US government from the 1960s to the 1990s. But times have changed and new policy models have emerged. Australia's telecommunications public policy decisions during the past decade have locked us into having few choices for broadband. The sad irony to date is that the introduction of the open competition model in July 1997, its associated regulatory framework and the full privatisation of Telstra have actually made us less efficient in investment and impeded the development of the broadband networks we need. We might just benefit from revisiting some lessons from history.
Electronic Contracts: A Law Unto Themselves?
Authors: Clapperton Dale
Published: January 2017

Electronic contracts, however described, are everywhere in the digital environment. In computer games, they govern the relationship not only between the gamer and the game publisher, but the gamer and the game. Yet, despite their ubiquity, their substantive content receives relatively little attention. Consumers assent without reading them, and publishers and their lawyers adopt oppressive contracts, seemingly without thought for the rights of their customers. Whether a market failure or a rational response, electronic contracting seems to be stuck in a vicious cycle of apathy and indifference. This paper explores these issues, as well as examples of games-related electronic contracts, common terms in such contracts, and how those contracts might be affected areas of law including contract, copyright, competition and consumer protection. Might these areas of law provide a stimulus for ‘clickwrap reform’?