bluuebunny/crossref_metadata_2025 huggingface dataset:
Discriminant analysis of patients’ reasons for choosing or refusing treatments for partial edentulism
Authors: LELES C. R. , MARTINS R. R. , SILVA E. T. , NUNES M. F.
Published: October 2009

Summary  The aim of the study was to explore partially edentulous patients’ reasons for choosing or refusing prosthodontic treatment with removable partial dentures (RPD), fixed partial dentures (FPD) and implant partial dentures (IPD). Clinical and oral health‐related quality of life measures were collected from 165 partially edentulous patients undergoing treatment. Patients’ preferences were recorded and reasons for choosing or refusing treatments were measured with 32 questions using a five‐point Likert scale. Descriptive statistics, chi‐square and multiple logistic regression were used to compare patients’ preferences according to clinical variables. Discriminant analysis was used to examine the impact of each reason for a patient’s decision to choose or refuse treatment options. Results showed that older patients (P < 0·001) and with greater oral‐related quality of life impacts (P < 0·05) were more likely to choose RPD. IPD were preferred by patients with higher education levels (P < 0·01). Discriminant functions revealed that the desire to have a fixed or removable denture had great impact on preferences. Removal of tooth structure was the main reason for refusing FPD and financial cost had a great impact on refusing IPD. Overall agreement between observed patients’ decisions and those predicted by the discriminant function was >90% for all treatments. Reasons vary greatly among patients, and the role of individual perception of potential reasons for treatment selection was the most important determinants of patients’ decisions. The main reasons for choosing or refusing treatments focused in this study can be used to guide shared decision‐making, providing treatments that better match patients’ expectations and desires.
The effect of marker choice on estimated levels of introgression across an avian (Pipridae:Manacus) hybrid zone
Authors: YURI TAMAKI , JERNIGAN ROBERT W. , BRUMFIELD ROBB T. , BHAGABATI NIRMAL K. , BRAUN MICHAEL J.
Published: October 2009

Hybrid zones are often characterized by narrow, coincident clines for diverse traits, suggesting that little introgression occurs across them. However, this pattern may result from a bias in focussing on traits that are diagnostic of parental populations. Such choice of highly differentiated traits may cause us to overlook differential introgression in nondiagnostic traits and to distort our perception of hybrid zones. We tested this hypothesis in an avian hybrid zone by comparing cline structure in two sets of molecular markers: isozyme and restriction fragment length polymorphism markers chosen for differentiation between parental forms, and microsatellite markers chosen for polymorphism. Two cline‐fitting methods showed that cline centre positions of microsatellite alleles were more variable than those of isozyme and restriction fragment length polymorphism markers, and several were significantly shifted from those of the diagnostic markers. Cline widths of microsatellite alleles were also variable and two‐ to eightfold wider than those of the diagnostic markers. These patterns are consistent with the idea that markers chosen for differentiation are more likely to be under purifying selection, and studies focussed on these markers will underestimate overall introgression across hybrid zones. Our results suggest that neutral and positively selected alleles may introgress freely across many hybrid zones without altering perceived boundaries between hybridizing forms.
A comparison of single‐sample effective size estimators using empirical toad (Bufo calamita) population data: genetic compensation and population size‐genetic diversity correlations
Authors: BEEBEE T. J. C.
Published: October 2009

The accuracy and precision of four single‐sample estimators of effective population size, Ne (heterozygote excess, linkage disequilibrium, Bayesian partial likelihood and sibship analysis) were compared using empirical data (microsatellite genotypes) from multiple natterjack toad (Bufo calamita) populations in Britain (n = 16) and elsewhere in Europe (n = 10). Census size data were available for the British populations. Because toads have overlapping generations, all of these methods estimated the number of effective breeders Nb rather than Ne. The heterozygote excess method only provided results, without confidence limits, for nine of the British populations. Linkage disequilibrium gave estimates for 10 British populations, but only six had finite confidence limits. The Bayesian and sibship methods both produced estimates with finite confidence limits for all the populations. Although the Bayesian method was the most precise, on most criteria (insensitivity to locus number, correlation with other effective and census size estimates and correlation with genetic diversity) the sibship method performed best. The results also provided evidence of genetic compensation in natterjack toads, and highlighted how the relationship between effective size and genetic diversity can vary as a function of geographical scale.
Combined immunodeficiency, facial dysmorphism, optic nerve atrophy, skeletal anomalies and developmental delay: a new syndrome
Authors: Roifman CM , Chitayat D
Published: October 2009

Combined immunodeficiency (SCID) can be isolated and involve the immune system only or associated with abnormalities affecting other organs, mainly the skeletal and neurological systems. We report on sisters, born to consanguineous parents, with CID, facial dysmorphism, developmental delay, optic atrophy, myoclonic seizures, and skeletal anomalies. To the best of our knowledge, this is a hitherto new syndrome with most probably autosomal recessive inheritance and unknown etiology.
pH affects ammonium, nitrate and proton fluxes in the apical region of conifer and soybean roots
Authors: Hawkins Barbara J. , Robbins Samantha
Published: October 2009

The effect of pH on nitrate and ammonium uptake in the high‐affinity transport system and low‐affinity transport system ranges was compared in two conifers and one crop species. Many conifers grow on acidic soils, thus their preference for ammonium vs nitrate uptake can differ from that of crop plants, and the effect of pH on nitrogen (N) uptake may differ. Proton, ammonium and nitrate net fluxes were measured at seedling root tips and 5, 10, 20 and 30 mm from the tips using a non‐invasive microelectrode ion flux measurement system in solutions of 50 or 1500 µM NH4NO3 at pH 4 and 7. In Glycine max and Pinus contorta, efflux of protons was observed at pH 7 while pH 4 resulted in net proton uptake in some root regions. Pseudotsuga menziesii roots consistently showed proton efflux behind the root tip, and thus appear better adapted to maintain proton efflux in acid soils. P. menziesii's ability to maintain ammonium uptake at low pH may relate to its ability to maintain proton efflux. In all three species, net nitrate uptake was greatest at neutral pH. Net ammonium uptake in G. max and net nitrate uptake in P. menziesii were greatly reduced at pH 4, particularly at high N concentration, thus N concentration should be considered when determining optimum pH for N uptake. In P. menziesii and G. max, net N uptake was greater in 1500 than 50 µM NH4NO3 solution, but flux profiles of all ions varied among species.
Co‐evolution of plumage characteristics and winter sociality in New and Old World sparrows
Authors: TIBBETTS E. A. , SAFRAN R. J.
Published: October 2009

Understanding the evolution of phenotypic diversity, including the stunning array of avian plumage characters, is a central goal of evolutionary biology. Here, we applied a comparative analysis to test factors associated with the origin and maintenance of black chest and throat patches, which in some taxa are referred to as ‘badges‐of‐status’. Specifically, we tested whether the evolution of black colour patches in Old and New World sparrows is consistent with a signalling function during the nonbreeding season or breeding season. We found no positive associations between patch evolution and polygyny or summer sociality. Instead, patch evolution is significantly associated with sociality during the nonbreeding season. Additionally, unlike typical plumage characteristics under sexual selection, these patches are visible throughout the nonbreeding season. Further, the pattern of patch dimorphism uncovered in this study does not match expectations for a trait that evolved in a reproductive context. In particular, patch dimorphism is not associated with polygyny or the presence of extra‐pair mating although other types of plumage dimorphism are strongly associated with nonmonogamous mating systems. Overall, patterns of patch evolution suggest that they are more strongly associated with social competition during the nonbreeding season than sexual competition during the breeding season. These results clarify why some previous work has uncovered puzzling relationships between black plumage patches and reproductive behaviour. We discuss these findings in the context of signal theory and previous work on badges‐of‐status.
Retrospective comparison of maternal vs. HPA‐matched donor platelets for treatment of fetal alloimmune thrombocytopenia
Authors: Giers G. , Wenzel F. , Fischer J. , Stockschläder M. , Riethmacher R. , Lorenz H. , Tutschek B.
Published: October 2009

Background and Objectives  In fetal alloimmune thrombocytopenia (FAIT), transplacental maternal antibodies cause destruction of fetal platelets. FAIT is similar to fetal Rhesus haemolytic disease, but half of the affected fetuses are born to primiparous women. In 10–20% of cases, prenatal and perinatal intracranial haemorrhages are reported. Different therapeutic approaches have been described, including maternally administered high‐dose intravenous immunoglobulin (high dose IVIG) without or with steroids or intrauterine transfusion (IUT) of compatible platelets. For the latter, the use of plasma‐free maternal and donor platelets has been described, but a comparison of these two sources of platelets has not been reported.

Materials and Methods  We retrospectively analyzed the clinical courses of cases with FAIT treated with IUT of either HPA‐matched donor platelets or maternal platelets, done by a single team between 1990 and 1997. In 57 pregnancies, FAIT was treated by repeated IUT with either maternal (15 fetuses) or donor platelets (42 fetuses).

Results  There was no procedure‐related fetal or neonatal loss. Platelets from both sources reliably raised the fetal platelet counts. Donor platelet preparations contained more platelets and yielded higher fetal post‐transfusion platelet counts, but maternal platelets were clinically equally effective.

Conclusions  Donor and maternal platelet concentrates are effective sources for the treatment of FAIT.
Five years of mass trapping of Ephestia kuehniella Zeller: a component of IPM in a flour mill
Authors: Trematerra P. , Gentile P.
Published: October 2009

Results obtained by mass trapping using the synthetic pheromone (Z,E)‐9,12‐tetradecadienyl acetate (TDA) are reported. The trapping was carried out over a period of 5 years to control infestation by Mediterranean flour moth, Ephestia kuehniella Zeller, and protect a flour mill. From March 2004 till November 2008, 42 funnel traps, each baited with 2 mg of TDA, were placed in the mill. Eight additional traps were located at the exterior of the facility, especially in the wheat silo area and near the loading equipment. Over 5 years, the pheromone traps attracted a total of 54 170 male Mediterranean flour moths. The constant presence of the traps caused a marked decrease in the E. kuehniella population from 2004 to 2008. The results of the surveys show that the population density of the moth can be notably reduced and then maintained at a low level in flour mills by means of mass trapping techniques accompanied by localized insecticide treatments and careful cleaning of the various departments and of the interior of all equipment. As it is not possible at present to establish the economic injury level of insect infestation in flour mills, there is a need for investigations into how the effectiveness of IPM programs can be evaluated in more detail.
SCHOLARLY PAPER
Authors: Davidhizar Ruth , Newman Giger Joyce , Poole Victoria
Published: October 2009

Davidhizar R, Newman Giger J, Poole V. International Journal of Nursing Practice 1997; 3: 10–14

The interview that wins the job

Obtaining a nursing position is often the first challenge for the graduate nurse. Understanding the interview process and making a plan that will ensure the graduate is placed in the best possible light is important for success in the interview process. This paper discusses getting ready for the interview, setting up the interview, dressing for the interview, the actual interview and following up the interview. Adherence to these guidelines can facilitate the graduate’s success in obtaining the desired position.
Sex differences in epidemiological, clinical and pathological characteristics of colorectal cancer
Authors: Koo Jenn Hian , Leong Rupert WL
Published: October 2009

Sex significantly influences the clinical and pathological characteristics of colorectal cancer (CRC). These include differences in incidence and mortality rates, clinical presentations including age, emergency surgery for complications from CRC, screening participation rates, site, stage and treatment utilization, histopathology and survival. Environmental, behavioral and biological factors contribute to the differential risk. Recent advances in the molecular biology of CRC, specifically in microsatellite status, estrogen hormone and estrogen receptor β, have led to greater understanding of the effect of estrogen in colorectal carcinogenesis. Estrogen may preferentially protect against microsatellite unstable cancers through its effect on selected molecular targets; however, the exact pathways have not been elucidated. Recognition of important sex disparities in these areas may lead to the implementation of specific measures to diminish these differences and facilitate equitable distribution of health resources. Identifying specific molecular targets on CRC that interact with estrogen may stimulate research to improve the overall outcomes of all patients with CRC.
Narrow‐band imaging endoscopy with magnification is useful for detecting metachronous superficial pharyngeal cancer in patients with esophageal squamous cell carcinoma
Authors: Nonaka Satoru , Saito Yutaka , Oda Ichiro , Kozu Takahiro , Saito Daizo
Published: October 2009

Background and Aims:  Head and neck cancers, especially pharyngeal cancers, as well as esophageal cancers frequently coexist either synchronously or metachronously, but most cases of pharyngeal cancer are detected at an advanced stage resulting in poor prognosis. The aim of this study is to evaluate the effectiveness of using narrow‐band imaging (NBI) endoscopy with magnification for early detection of pharyngeal cancer on patients following their treatment for esophageal squamous cell carcinoma (SCC).

Methods:  This case series was conducted at the National Cancer Center Hospital in Tokyo between April and October 2005 and included 424 consecutive patients for surveillance endoscopy who had previously undergone chemoradiotherapy (CRT) and/or surgery for esophageal SCC. Observation of the pharyngeal region was randomly conducted on 91 patients using NBI endoscopy with magnification (NBI group) and 333 patients using conventional white light endoscopy (control group).

Results:  The detection rate for pharyngeal cancer was significantly higher using NBI endoscopy with magnification (10.9%; 10/91) compared with conventional endoscopy (1.2%; 4/333) (P < 0.0001). In particular, the detection rate in CRT patients was significantly higher in the NBI group (12.9%; 7/54) than the control group (0.5%; 1/191) (P < 0.0001). In addition, diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value for the NBI group were 100% (10/10), 97.5% (79/81), 97.8% (89/91), 83.3% (10/12) and 100% (79/79), respectively.

Conclusion:  NBI endoscopy with magnification is a promising technique for detecting superficial pharyngeal cancer at an early stage in patients previously treated for esophageal SCC.
Fecal lactoferrin, myeloperoxidase and serum C‐reactive are effective biomarkers in the assessment of disease activity and severity in patients with idiopathic ulcerative colitis
Authors: Masoodi Ibrahim , Kochhar Rakesh , Dutta Usha , Vaishnavi Chetana , Prasad Kaushal K , Vaiphei Kim , Kaur Sukhminder , Singh Kartar
Published: October 2009

Background and Aim:  Disease activity and severity of ulcerative colitis (UC) is assessed using colonoscopy, which is invasive, costly and has poor patient acceptability. The role of non‐invasive biomarkers of intestinal inflammation in the evaluation of patients with UC is not known. The aim of the study was to examine the role of serum C‐reactive protein (SCRP), fecal myeloperoxidase (FMPO) and fecal lactoferrin (FLF) in assessing disease severity, activity and response to therapy.

Methods:  Consecutive patients with idiopathic UC (IUC) attending our hospital from July 2005 to September 2006 were studied. All underwent clinical, endoscopic and histological assessment for disease activity, extent, severity and estimation of SCRP, FMPO and FLF levels at baseline and follow up (FU). An equal number of healthy age‐matched controls were studied for biomarker levels.

Results:  A total of 37 patients (mean age 37 ± 12 years) were studied. All three biomarkers were elevated more often in the cases than in the controls (all P = 0.000). Cases with severe IUC had higher CRP, MPO and FLF titers than those without severe IUC. At FU, a significant fall in biomarker levels paralleled the reduction in Mayo's scores. All three biomarkers showed a high degree of correlation with each other. The areas under the curve for FLF, MPO and CRP were 1.00, 0.867 and 0.622, respectively. The sensitivity and specificity of markers were: FLF (94%, 100%), FMPO (89%, 51%) and SCRP (24%, 100%).

Conclusion:  Biomarkers are useful in assessing disease activity, severity and response to therapy in patients with UC. They showed a high degree of correlation with each other.
In situ estrogen production and its regulation in human breast carcinoma: From endocrinology to intracrinology
Authors: Sasano Hironobu , Miki Yasuhiro , Nagasaki Shuji , Suzuki Takashi
Published: October 2009

The great majority of breast carcinomas arising in postmenopausal women are estrogen dependent or positive for estrogen receptor (ER) in carcinoma cells despite markedly low plasma or circulating estrogen concentrations. In these patients, biologically active estrogens are locally produced from circulating inactive steroids including adrenal androgens in an intracrine mechanism in the breast cancer tissues and confer estrogenic activities on carcinoma cells. A series of enzymes are involved in this intra‐tumoral or in situ production of estrogens in breast carcinoma tissues but aromatase, a member of the cytochrome P450 family, is a key enzyme of estrogen production through conversion from circulating adrenal androgens in estrogen‐dependent postmenopausal breast cancer. It then becomes important to identify the sites of this estrogen production. There has been, however, controversy regarding intra‐tumoral localization of aromatase in breast carcinoma, especially whether intra‐tumoral production of estrogens through aromatase occurs in carcinoma or stromal cells. The enzyme was demonstrated to be expressed in both carcinoma and stromal cells in breast carcinoma tissues on immunohistochemistry with a well‐characterized mAb 677 and combined laser capture microdissection/qualitative reverse transcriptase–polymerase chain reaction. Intra‐tumoral aromatase in both of these cell types was subsequently demonstrated to be induced by carcinoma–stromal interactions associated with carcinoma invasion in breast tissue. The signals through various nuclear receptors, especially estrogen‐related receptor‐α in carcinoma cells and liver receptor homologue‐1 in adipocytes adjacent to carcinoma invasion, in conjunction with various cytokines and/or growth factors, play pivotal roles in this induction of intra‐tumoral aromatase. This increased aromatase subsequently results in increased in situ estrogen concentrations of breast cancer. Aromatase inhibitors are currently established as the gold standard for the treatment for ER‐positive breast carcinoma but resistance to the therapy still remains to be solved by other modes of suppression of intra‐tumoral estrogen production.
Induction of apoptosis in the LNCaP human prostate carcinoma cell line and prostate adenocarcinomas of SV40T antigen transgenic rats by the Bowman–Birk inhibitor
Authors: Tang MingXi , Asamoto Makoto , Ogawa Kumiko , Naiki‐Ito Aya , Sato Shinya , Takahashi Satoru , Shirai Tomoyuki
Published: October 2009

The soybean‐derived serine protease inhibitor, Bowman–Birk inhibitor (BBI), has been reported as a potent chemoprevention agent against several types of tumors. The present study was undertaken to evaluate the effects of BBI on androgen‐sensitive/dependent prostate cancers using a human prostate cancer cell (LNCaP) and the transgenic rats developing adenocarcinoma of the prostate (TRAP) model. Treatment of LNCaP prostate cancer cells with 500 µg/mL BBI resulted in inhibition of viability measured on WST‐1 assays, with induction of connexin 43 (C×43) and cleaved caspase‐3 protein expression. Feeding of 3% roughly prepared BBI (BBIC) to TRAP from the age 3 weeks to 13 weeks resulted in significant reduction of the relative epithelial areas within the acinus and multiplicity of the adenocarcinomas in the lateral prostate lobes. C×43‐ and terminal deoxynucleotidyl transferase mediated dUTP‐biotin end labeling of fragmented DNA (TUNEL)‐positive apoptotic cancer cells were more frequently observed in the lateral prostates treated with BBIC than in the controls. Thesein vivoandin vitroresults suggest that BBI possesses chemopreventive activity associated with induction of C×43 expression and apoptosis.
Follicular dendritic cell sarcoma of small intestine with aberrant T‐cell marker expression
Authors: Yamada Yosuke , Haga Hironori , Hernandez Mako , Kubota Kanako C. , Orii Fumika , Nagashima Kazuo , Matsuno Yoshihiro
Published: October 2009

Follicular dendritic cell sarcoma (FDCS) is an uncommon neoplasia usually occurring in lymphoid tissue. Herein is presented a case of FDCS of the small intestine with positivity for T‐cell antigen, simulating T‐cell lymphoma. An 82‐year‐old man consulted a doctor for a 1 week history of epigastric pain. Imaging indicated a mass in the small intestine. Malignant lymphoma was suspected because of high serum levels of soluble interleukin‐2 receptor, and resection of the tumor was performed. Microscopically the tumor consisted of large pleomorphic cells with reactive small lymphocytes. Most of the nuclei of the tumor cells were round or ovoid, and some of the tumor cells also had spindle‐shaped nuclei. Although the tumor cells were diffusely positive for CD45RO and CD4 on immunohistochemistry, negativity for pan‐T‐cell markers and CD56 was unusual for T‐cell lymphoma of intestinal origin. Additional immunohistochemistry demonstrated that the tumor cells were positive for follicular dendritic cell markers including CD23, CD35 and CAN.42, and diagnosis of FDCS was made. To the authors' knowledge this is the first case of FDCS aberrantly expressing CD45RO; FDCS expressing T‐cell markers can be a pitfall for diagnosis of FDCS.
Birth outcomes and risk factors in adolescent pregnancies: Results of a Taiwanese national survey
Authors: Kuo Ching‐Pyng , Lee Shu‐Hsin , Wu Wei‐Ya , Liao Wen‐Chun , Lin Shio‐Jean , Lee Meng‐Chih
Published: October 2009

Background:  This study explores birth outcomes and determinants in adolescent pregnancies, using subjects drawn from the Taiwan Birth Cohort Study (TBCS) from 2005.

Methods:  Through completed interviews and surveys with mothers or other family members, differences in birth outcomes and personal, pregnancy and social profiles of mothers were analyzed.

Results:  A total of 533 adolescent mothers (<20 years old) and 9347 adult mothers (20–34 years old) were included in our study. There was a significantly higher incidence of low birthweight (LBW) (<2500 g, 10.2% vs 5.6%) and premature birth (<37 weeks, 14.8% vs 8.6%) in the adolescent group. When adjusted for covariates in the multiple‐variable model, youth remained a risk factor for LBW (OR = 1.50, 95%CI 1.09, 2.07) and premature delivery (OR = 1.42, 95%CI 1.07, 1.89). Age, prenatal care and weight gain during pregnancy are important predictors of LBW and premature birth.

Conclusion:  Adolescent pregnancy carries a high‐risk of LBW and premature birth. Inadequate prenatal care and weight gain during pregnancy are contributing factors that could be improved through strategies of health education, family support and case management.
Symptomatic omphalomesenteric duct remnants in children
Authors: Durakbasa Cigdem Ulukaya , Okur Hamit , Mutus Huseyin Murat , Bas Ahmet , Ozen Mehmet Ali , Sehiralti Varol , Tosyali Ahmet Nadir , Zemheri Itir Ebru
Published: October 2009

Background:  The present study gathers a single institutional experience of symptomatic omphalomesenteric duct (OMD) remnants in children with an emphasis on the age and modes of presentation, the surgical intervention and the histopathological findings.

Methods:  The data on children who underwent surgical treatment for symptomatic OMD remnants during a 17‐year period were reviewed retrospectively, excluding incidental diverticulectomies.

Results:  A total of 59 children with a median age of 36 months underwent operations for symptomatic OMD remnants. There were 48 boys and 11 girls. The presenting signs were gastrointestinal tract (GIT) obstruction in 21 (36%) patients, acute abdomen in 18 (31%), umbilical abnormalities in 17 (29%), and rectal bleeding in three (5%). Patients presenting with umbilical anomalies were significantly younger than others. At surgery, a wedge resection of the remnant was carried out in 32 cases and an ileal resection was carried out in 27. Children presenting with GIT obstruction underwent segmentary ileal resection more often than other groups. Histopathology revealed inflammation in 26 (44%) specimens, ectopic tissue in 18 (31%) and necrosis in four (7%). Ectopic gastric mucosa was detected in 15 specimens, pancreatic tissue in two and both gastric and pancreatic tissue in one.

Conclusions:  Symptomatic OMD remnants in children most commonly presented with GIT obstruction, acute abdomen and umbilical anomalies. Rectal bleeding was not a predominant finding in the present series. Surgery is curative and can safely be done either by way of wedge resection or ileal segmentary resection. Ectopic tissue is detected in approximately one third of symptomatic remnants.
Spirituality: A key factor in coping among Iranians chronically affected by mustard gas in the disaster of war
Authors: Ebadi Abbas , Ahmadi Fazlollah , Ghanei Mostafa , Kazemnejad Anoshirvan
Published: October 2009

The present study aimed to explore the approach used by Iranians chronically affected by mustard gas in the disaster of war to cope with their chronic illness complications. A qualitative approach was adopted using content analysis of unstructured interviews carried out with 20 patients in a medical center in Tehran and an outpatient clinic in the North West of Iran. Two main themes that emerged from the study were “religious sentiment” and “patriotism”. The subthemes that emerged were “divine will”, “illness as a means of absolving sin”, “saying prayers in the anticipation of divine rewards”, “defending the motherland” and “self‐sacrifice as a source of pride”. To sum up, spirituality was recognized as a key factor among the participants in accepting and coping with their chronic illness complications.
Pilot training program for developing disaster nursing competencies among undergraduate students in China
Authors: Pang Samantha M. C. , Chan Sunshine S. S. , Cheng Yichuan
Published: October 2009

As nurses constitute the largest group of health‐care providers, their readiness to respond to disasters and to participate in preparedness and disaster recovery activities will be significant for making a community more resilient against disaster. Concern is raised regarding how to build the capacity of all nurses with a knowledge base and a minimum set of skills in responding to various disasters. Drawing on the ICN Framework of Disaster Nursing Competencies and Global Standards for the Initial Education of Professional Nurses and Midwives, a training program entitled “Introduction to Disaster Nursing” was developed. Four teaching methods including action learning, problem‐based learning, skill training, and lecture were used to orchestrate a series of planned activities for helping students develop the required disaster nursing competencies in a 2‐week intensive training program held in Sichuan China in July 2009. The pre‐ and post‐tests which were given to assess the students' perceived level of competencies demonstrated a significant gain in relevant knowledge and skills constituting the required competencies upon completion of the program. In the program evaluation, most students indicated their willingness and capability in disaster relief work under supervision, and they were keen to advance their competencies in the field of disaster nursing.
Prediction of residual fatigue life under interspersed mixed‐mode (I and II) overloads by Artificial Neural Network
Authors: MOHANTY J. R. , PARHI D. R. K. , RAY P. K. , VERMA B. B.
Published: October 2009

Mixed‐mode (I and II) overloads are often encountered in an engineering structure due to either alteration of the loading direction or the presence of randomly oriented defects. Prediction of fatigue life in these cases is more complex than that of mode‐I overloads. The objective of this study is to explore the use of an artificial neural network (ANN) model for the prediction of fatigue crack growth rate under interspersed mixed‐mode (I and II) overload. The crack growth rates as predicted by the ANN method on two aluminium alloys, 7020 T7 and 2024 T3 have been compared with the experimental data and an Exponential Model. It is observed that the predicted results are in good agreement and facilitate determination of residual fatigue life.
Drainage of a pelvic collection with the Heald Silastic Anal Stent
Authors: Kamocka A. , Skipper D.
Published: October 2009

The Heald Silastic Anal Stent (HSAS) was designed to protect a newly constructed low colorectal anastomosis by keeping the anus open for up to 10 days postoperatively, and has also been used in combination with percutaneous drainage to treat a leak from a low rectal anastomosis. We describe a technique in two patients where the HSAS alone allowed adequate drainage of a leaking low colorectal anastomosis.
Ophthalmological, cognitive, electrophysiological and MRI assessment of visual processing in preterm children without major neuromotor impairment
Authors: O’Reilly Michelle , Vollmer Brigitte , Vargha‐Khadem Faraneh , Neville Brian , Connelly Alan , Wyatt John , Timms Chris , De Haan Michelle
Published: October 2009

Many studies report chronic deficits in visual processing in children born preterm. We investigated whether functional abnormalities in visual processing exist in children born preterm but without major neuromotor impairment (i.e. cerebral palsy). Twelve such children (< 33 weeks gestation or birthweight < 1000 g) without major neuromotor impairment and 12 born full‐term controls were assessed at 8–12 years of age by means of ophthalmological assessment (visual acuity, colour vision, stereopsis, stereoacuity, visual fields, ocular motility, motor fusion), cognitive tests of visual‐motor, visual‐perceptual and visual‐spatial skills and pattern‐reversal visual evoked potentials (PR‐VEPs). All participants also underwent magnetic resonance imaging (MRI) of the brain and neuromotor assessments. No significant differences were found between the groups on the ophthalmological, visual cognitive, neurological, neuromotor or MRI measures. The P100 component of the PR‐VEP showed a significantly shorter latency in the preterm compared with the full‐term participants. Whilst this P100 finding suggests that subtle abnormalities may exist at the neurophysiological level, we conclude that visual dysfunction is not systematically associated with preterm birth in the context of normal neurological status.
Screening for body‐weight disorders in Nigerian children using contrasting definitions
Authors: Goon D. T. , Toriola A. L. , Shaw B. S.
Published: October 2009

Several indices for body‐weight disorders exist in scientific literature, but it is inconclusive whether or not they can yield comparable results when applied to Nigerian children. The prevalence of weight disorders in Nigerian children was examined using the Centre for Disease Control and Prevention (CDC) body mass index (BMI) for age charts and the International Obesity Task Force's (IOTF) age‐ and sex‐specific BMI cut‐off points. Participants were 2015 pupils (979 boys and 1036 girls) aged 9–12 years, attending 19 public primary schools in Makurdi, Nigeria. Stature and body mass were measured using standard techniques. Results were analysed using student t‐test and Chi‐squared statistics, with the probability level set at ≤0.05. CDC's BMI charts categorized 2.1%, 1.6% (boys) and 3.2%, 2.8% (girls) as overweight and obese respectively. Corresponding data for the IOTF's BMI charts were 1.7%, 0.9% (boys) and 2.6%, 2.0% (girls). CDC cut‐off points indicated higher prevalence of overweight and obesity, thus suggesting the need for a single definition for evaluating measurements of body mass‐for‐stature in the children. However, more disconcerting is the fact that CDC charts showed a high prevalence of underweight for the boys (87.1%) and girls (79.7%). Prevalent underweight conditions in our sample need urgent intervention. The IOTF method is limited in its utility to identify children who are underweight and may be at risk of growth faltering.
The emergence of green talent
Authors: Glen John , Hilson Chris , Lowitt Eric
Published: October 2009

Several factors are driving an increase in the supply of and demand for “green talent”, employees with the mindsets and skills to drive sustainability. But many business leaders do not fully understand the implications of this change in the workforce. John Glen, Chris Hilson and Eric Lowitt believe corporate chiefs need to learn – quickly.
Debt Maturity: Is Long‐Term Debt Optimal?
Authors: Alfaro Laura , Kanczuk Fabio
Published: October 2009

We model and calibrate the arguments in favor and against short‐term and long‐term debt. These arguments broadly include: maturity premium, sustainability, and service smoothing. We use a dynamic‐equilibrium model with tax distortions and government outlays uncertainty, and model maturity as the fraction of debt that needs to be rolled over every period. In the model, the benefits of defaulting are tempered by higher future interest rates. We then calibrate our artificial economy and solve for the optimal debt maturity for Brazil as an example of a developing country and the US as an example of a mature economy. We obtain that the calibrated costs from defaulting on long‐term debt more than offset costs associated with short‐term debt. Therefore, short‐term debt implies higher welfare levels.
The Other Le Grand? Evaluating the ‘Other Invisible Hand’ in Welfare Services in England
Authors: Greener Ian , Powell Martin
Published: October 2009

Competition and choice have become central means of improving public services in England. The former adviser to the Blair government Julian Le Grand has suggested that increased choice and competition should be the cornerstone of policy that aims to deliver more responsive and fairer results for the public. This article explores Le Grand's claims, deploying the conditions earlier suggested by him to examine the conditions which ‘quasi‐markets will have to meet if they are to succeed as instruments of social policy’. Claims about the efficacy of choice and competition policies in 2007 are assessed against the earlier conditions of market structure, information, transaction costs, uncertainty, motivation and cream‐skimming, to examine the extent to which the reforms Le Grand has most recently proposed meet the conditions he earlier suggested would be necessary for markets to work in the public sector.
Choosing Welfare or Losing Social Citizenship? Citizens' Free Choice in Recent Italian Welfare State Reforms
Authors: Graziano Paolo R.
Published: October 2009

In the past fifteen years, the Italian welfare state has gone through various important reforms. Almost all social policy fields have been significantly challenged by the presence of both national and European constraints, and in different policy fields some fundamental principles of the welfare state have been questioned and changed. The purpose of this article is to present an analysis of the most recent arguments used for welfare state reforms in Italy, focusing in particular on one key question: have the reforms been formulated and implemented in order to increase the freedom of choice of Italian citizens with respect to social protection? After a brief introduction and conceptual clarification, each section of the article will focus on one social policy field (employment, pensions, health care) and discuss the origins and consequences of the reforms with respect to the freedom of choice of citizens. The main argument is that very limited attention has been paid in the national political discourse and reform design to the freedom of choice for citizens in welfare state policies, since other goals (such as cost containment) were much more crucial. The article will end with an overall assessment of the evolution of freedom of choice in the Italian welfare state setting.
The ‘Consumer Principle’ in the Care of Elderly People: Free Choice and Actual Choice in the German Welfare State
Authors: Eichler Melanie , Pfau‐Effinger Birgit
Published: October 2009

In the mid‐1990s, together with new long‐term care legislation, the German welfare state introduced care markets and consumer choice between family care and different types of formal care. However, instead of using the new option to choose publicly funded care by long‐term care agencies, the majority of elderly people in need of care continued to decide in favour of care exclusively provided by family members. The article examines how the persistence of family care in spite of the new options of consumer choice can be explained, using data from representative surveys on the care of elderly people in Germany and the results of guided interviews by the authors with family members involved in care. The findings indicate that there are two main reasons. The first is that elderly people and their families orient their behaviour towards traditional care values in which the first priority is given to mutual support between spouses and generations. The second reason is that elderly people on the one hand and care agencies on the other have substantially different definitions of a good quality of care.
Freedom of Choice through the Promotion of Gender Equality
Authors: Saxonberg Steven
Published: October 2009

This article argues that policies that promote gender equality actually also increase freedom of choice. Thus, despite the neo‐liberal criticism that welfare policies limit choices and privatization and market solutions increase freedom of choice, this article concludes that market‐liberal welfare regimes offer less choice than the Nordic type of social‐democratic welfare regimes, which have openly striven to promote gender equality. They do so by making it easier for mothers to choose to work (by making day care available and making it easier for fathers to stay at home with children) and by giving fathers the ability to choose to spend more time with children. However, within the realm of such policies, it is still possible to offer more or less freedom of choice, for example, by making parental leaves either extremely flexible or rigid in how they are utilized. Interestingly, it turns out that, in the real world, policies that promote gender equality even offer greater freedom of choice for the group of women considered to be ‘family oriented’ as well as for lesbian and homosexual couples.
RESTRUCTURING THE NHS AGAIN: SUPPLY SIDE REFORM IN RECENT ENGLISH HEALTH CARE POLICY
Authors: Allen Pauline
Published: October 2009

Introducing market‐like structures to public services is a key aspect of New Public Management. The restructuring of the NHS into an internal market of the 1990s is an example. Recent policies have further developed this notion. A new aspect of the restructuring is a focus on increasing the diversity of types of provider of healthcare organisations. The objectives of the restructuring policy entailing the increase in supply side diversity are examined, and the challenges raised by these changes are discussed. It is argued that the government is too optimistic about the benefits, and insufficiently concerned about possible undesirable consequences.
Investor Rationality and House Price Bubbles: Berlin and the German Reunification
Authors: Holtemöller Oliver , Schulz Rainer
Published: October 2009

We analyze the behavior of investors in the Berlin rental apartment house market over the years 1980-2004. Using constant-quality multipliers ( price- rent ratios), we reject the hypothesis that multipliers in the market were set in a rational manner. Supported by narrative evidence, we conjecture that investors misjudged the economic effects of the German reunification. To examine this, we employ a stylized structural economic model and analyze the effects of shocks on rational multipliers. It seems that investors confused the reunification with a permanent supply side shock to the economy. By basing their investment decisions on this misjudgement, investors behaved irrationally, but in a very uncertain and unprecedented environment.
PENTA 2009 guidelines for the use of antiretroviral therapy in paediatric HIV‐1 infection
Authors:   PENTA Steering Committee
Published: October 2009

PENTA Guidelines aim to provide practical recommendations for treating children with HIV infection in Europe. Changes to guidance since 2004 have been informed by new evidence and by expectations of better outcomes following the ongoing success of antiretroviral therapy (ART). Participation in PENTA trials of simplifying treatment is encouraged. The main changes are in the following sections:

‘When to start ART’: Treatment is recommended for all infants, and at higher CD4 cell counts and percentages in older children, in line with changes to adult guidelines. The number of age bands has been reduced to simplify and harmonize with other paediatric guidelines. Greater emphasis is placed on CD4 cell count in children over 5 years, and guidance is provided where CD4% and CD4 criteria differ.

‘What to start with’: A three‐drug regimen of two nucleoside reverse transcriptase inhibitors (NRTIs) with either a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (PI) remains the first choice combination. Lamivudine and abacavir are the NRTI backbone of choice for most children, based on long‐term follow‐up in the PENTA 5 trial. Stavudine is no longer recommended. Whether to start with an NNRTI or PI remains unclear, but PENPACT 1 trial results in 2009 may help to inform this. All PIs should be ritonavir boosted.

Recommendations on use of resistance testing, therapeutic drug monitoring and HLA testing draw from data in adults and from European paediatric cohort studies.

Recently updated US and WHO paediatric guidelines provide more detailed review of the evidence base. Differences between guidelines are highlighted and explained.
Cross‐national policy learning in health system reform: The case of Diagnosis Related Groups
Authors: Schmid Achim , Götze Ralf
Published: October 2009

Observations of policy convergence and the cross‐national diffusion of ideas, knowledge and policies have raised the question about the ways countries might learn from their peers. This article examines the role of cross‐national learning with regard to Diagnosis Related Groups (DRGs). We review the spread of this policy instrument and analyse the implementation of DRGs in three late‐adopting countries: Germany, Switzerland and the Netherlands. The three cases show that the implementation of this policy instrument required intense studies, cooperation with stakeholders and adjustment to country‐specific needs. The countries learned from foreign experience, but it was only with the introduction of a regulatory framework for competition between sickness funds that DRGs came fully onto the political agenda. While Germany and Switzerland drew upon foreign DRG models, the Netherlands developed an alternative system to classify patients according to case‐mix.
Policy learning and cross‐national diffusion in social long‐term care insurance: Germany, Japan, and the Republic of Korea
Authors: Campbell John Creighton , Ikegami Naoki , Kwon Soonman
Published: October 2009

Recently, many developed countries have moved toward comprehensive Long‐Term Care (LTC) systems. Along with the conventional explanations of these policy changes based on domestic factors, learning from abroad should be considered. We focus on the social insurance model of LTC, particularly how Japan learned from Germany and the Republic of Korea learned from Japan. Some approaches for how to think about policy learning in general as well as cross‐border learning are suggested.
Social pensions and policy learning: The case of southern Africa
Authors: Casey Bernard H. , McKinnon Roddy
Published: October 2009

In the last decade and particularly since the publication of the Millennium Development Goals, social pensions have captured the interest of those concerned with the well‐being of older people across that large part of the world where formal, contributions‐financed, old‐age benefit systems cover only a minority of the population. International organizations have turned their attention to such schemes and some see them as having a valuable role to play. However, information about what they are and how they work, and about their efficacy in meeting the objectives set for them, is still limited. Learning has been taking place not only in the international organizations but also in the region where they are most prominent – southern Africa. Such learning should be encouraged and the International Social Security Association has a part to play in this learning process.