bluuebunny/crossref_metadata_2025_split huggingface dataset:
Explaining gender segregation
Authors: Blackburn Robert M. , Browne Jude , Brooks Bradley , Jarman Jennifer 
Published: January 2003

ABSTRACTOccupational gender segregation — the tendency for women and men to work in different occupations — is an important feature of all societies, and particularly the wealthy industrialized ones. To understand this segregation, and to explain its significance, we need to distinguish between vertical segregation entailing inequality and horizontal segregation representing difference without inequality, with overall segregation being the resultant of these components. Three major theoretical approaches to understanding occupational gender segregation are examined: human capital/rational choice, patriarchy, and preference theories. All are found to be inadequate; they tend to confuse overall segregation with its vertical component, and each entails a number of other faults. It is generally assumed or implied that greater empowerment of women would reduce gender segregation. This is the reverse of what actually happens; in countries where the degree of women's empowerment is greater, the level of gender segregation is also greater. An alternative theoretical approach based on processes of social reproduction is shown to be more useful.
Employment, flexible working and the family
Authors: Crompton Rosemary 
Published: January 2003

ABSTRACTThis paper assesses some of the implications of one of the major social changes to have taken place in the West during the second half of the twentieth century — that is, the increased employment of women, together with normative changes in gender relations and in women's expectations. These changes have been linked to an increase in individualism, which itself is associated with the transcendence of ‘first modernity’. Thus it is suggested that new approaches to social analysis are required (Beck). Here it is argued that, rather than develop completely new approaches in order to grasp the changes that are under way, the ‘economic’ and the ‘social’ (that is, employment and the family) should be seen as intertwined, rather than approached as separate phenomena. Past debates in feminism, changes in the family, and flexible employment are critically examined. The growing tensions between employment and family life are discussed. It is argued that these changes are associated with the intensification of capitalist development, rather than reflecting a fundamental transformation of society. Existing approaches to the analysis of social change, including Polanyi's analysis of the development of ‘counter‐movements’ against the ‘self‐regulating’ market, will, therefore, still be relevant to our enquiries. In the concluding section, a programme of research that would examine these changes is outlined.
Culture, the ‘sick role’ and the consumption of health
Authors: Shilling Chris 
Published: January 2003

ABSTRACTThis paper revisits Parsons's conception of the ‘sick role’ and examines the relevance of his writings on the cultural understanding of sickness to the consumption of health in the contemporary era. In terms of current developments, I focus on the development of pro‐active approaches towards the healthy body, and the growth of ‘information rich’ consumers of health care. These have become prominent themes in sociology, and while Parsons's writings are usually viewed as anachronistic I argue they remain highly pertinent to understanding the emergence of informed, body conscious lay people. If Parsons's analysis of health is more relevant to current circumstances than many critics assume, however, it is not unproblematic. The residual categories associated with the sick role obscure the continued utility of his work on the general cultural values informing health care. It is Parsons's analysis of these values, I suggest, that needs rescuing from restricted understandings of the sick role and highlighting as an important resource for contemporary theorists.
Global anti‐corporate struggle: a preliminary analysis 1
Authors: Crossley Nick 
Published: January 2003

ABSTRACTThis paper offers a preliminary analysis of the recent wave of anti‐corporate protest that has swept across numerous countries throughout the world. In the first part of the paper the social structure of this phenomenon is examined. Specifically, it is argued that it should be understood as a ‘field’, in Pierre Bourdieu's sense of the term. In the second part of the paper the factors which account for the emergence of this field are explored, using a ‘value‐added’ model which focuses upon the interplay of strains, situational definitions, focal events, opportunities and the circulation of protest relevant resources. The paper is conceived as a preliminary analysis which outlines a framework and draws out important themes. It is not offered as a complete account but rather as a basis from which more specific and focused studies might stem.
New strategies to overcome antimicrobial resistance in Streptococcus pneumoniae with β-lactam antibiotics
Authors: Aguilar L. , Giménez M. J. , Garcia-Rey C. , Martín J. E. 
Published: January 2003

Abstract
The worldwide epidemic of antibiotic resistance in Streptococcus pneumoniae appears to advance inexorably and the measures taken to date to contain its progression have not been successful. Consideration should be given to the complex relationship between antibiotic consumption and resistance to the drug administered and also to other agents in the same and other antibiotic groups. We propose an integrated triple strategy that maximizes the use of the current antibiotic arsenal and is designed to curb the spread of resistance in S. pneumoniae. There are three main parts to this strategy: (i) reduction of prescribing, with particular emphasis on those drugs whose consumption has been shown to correlate strongly with resistance; (ii) development of new formulations or dosing schedules of those drugs whose pharmacodynamic parameters are better suited to cope with highly resistant strains; and (iii) encouragement of the use of antibiotics with the maximal capability of bacterial eradication. We believe such a strategy would reduce the spread of resistance both in the current ecological situation and in the post-pneumococcal vaccination era to come. Of all current antibiotics amoxicillin meets the above requirements, and seems to be the least ecologically disturbing oral antibiotic with regard to resistance in S. pneumoniae .
β-Lactam activity against resistant pneumococcal strains is enhanced by the immune system
Authors: Casal J. , Giménez M. J. , Aguilar L. , Yuste J. , Jado I. , Tarragó D. , Fenoll A. 
Published: January 2003

Abstract
Pandemic resistance in Streptococcus pneumoniae is compromising antibiotic activity. Antibiotics that act on the cell wall, such as β-lactams, may have a combined effect with the immune system against S. pneumoniae , since both act on the bacterial envelope. This combined effect can be studied in vitro or in vivo with respect to bacterial killing, since lysis is the end-point of both β-lactams and the immune system. We review here the in vitro increase in the bactericidal activity of aminopenicillins by non-specific immunity (complement and polymorphonuclear leucocytes). Few data are available on the collaboration of specific immunity and β-lactams. We also review the effect of the presence of specific antibodies on the in vivo T &gt; MIC needed for the therapeutic efficacy of amoxicillin, and on blood bacterial clearance in animal models. The effect that immunity has on pharmacodynamic parameters, such as T &gt; MIC, in non-human studies may be used as a tool to predict the effect of these pharmacodynamic variations in overcoming resistance and its selection, in the context of increasing the use of pneumococcal conjugated vaccines.
Pharmacodynamic and kinetic basis for the selection of pneumococcal resistance in the upper respiratory tract
Authors: Soriano F. , Rodriguez-Cerrato V. 
Published: January 2003

Abstract
The oropharynx is both the reservoir where antibiotic-resistant Streptococcus pneumoniae strains are selected and the focus for further spread of these organisms. In order to select antibiotic-resistant organisms, the antibiotic must be able to eradicate the susceptible population. How an antibiotic acts on oropharyngeal flora is not fully understood, although data on salivary antibiotic concentrations could be useful for establishing some correlation. Many β-lactam antibiotics are very active against S. pneumoniae , and although their saliva concentrations are very low, there may be enough to eradicate the majority of β-lactam-sensitive strains. Other antibiotics achieve salivary concentrations in the range 10–30% of serum concentrations (erythromycin, clindamycin, doxycycline and rifampicin), and are also able to eradicate the antibiotic-susceptible population. Antibiotics achieving higher salivary concentrations (≥40% of the serum levels) are not very active against S. pneumoniae (ciprofloxacin) or are able to eradicate antibiotic-sensitive and -intermediate strains (clarithromycin, azithromycin and telithromycin). Only antibiotics for which there are no highly resistant pneumococcal strains, for instance some β-lactams administered at very high dose and for a short course, are associated with a lower risk of antibiotic resistance selection. To diminish the risk, the antibiotics should be dosed in order to obtain inhibitory quotients (maximal serum concentration/MIC ratios) ≥ 4, which depends not only on the antibiotic concentration achieved but also on the lack of highly resistant organisms.
Implications of antimicrobial resistance in the empirical treatment of community-acquired respiratory tract infections: the case of macrolides
Authors: Lonks J. R. , Garau J. , Medeiros A. A. 
Published: January 2003

Abstract
Macrolide resistance among pneumococci is increasing worldwide and is associated with increasing macrolide use. Recent studies show that use of macrolides and azalides increases nasopharyngeal carriage of both macrolide-resistant and penicillin-resistant pneumococci. Carriage of a resistant pneumococcus may foster dissemination. The clinical relevance of in vitro resistance has been debated. However, recent data from a matched case–control study showed that 18 (24%) of 76 patients had breakthrough bacteraemia with an erythromycin-resistant pneumococcus while taking a macrolide, whereas none of the 136 matched controls with an erythromycin-susceptible pneumococcal bacteraemia was taking a macrolide ( P = 0.0000001). Moreover, five (24%) of 21 patients bacteraemic with the low-level resistant M phenotype and none of the 40 matched controls were taking a macrolide ( P = 0.00157). These data indicate that macrolide resistance due to both the efflux and the methylase mechanisms is clinically relevant. Furthermore, they favour guidelines for the empirical treatment of outpatients with community-acquired pneumonia that recommend high-dose oral amoxicillin and reserve coverage of atypical pathogens for selected high-risk populations.
New designs for phase 2 clinical trials
Authors: Estey Elihu H. , Thall Peter F. 
Published: January 2003

AbstractConventional phase 2 clinical trials are typically single-arm experiments, with outcome characterized by one binary “response” variable. Clinical investigators are poorly served by such conventional methodology. We contend that phase 2 trials are inherently comparative, with the results of the comparison determining whether to conduct a subsequent phase 3 trial. When different treatments are studied in separate single-arm trials, actual differences between response rates associated with the treatments, “treatment effects,” are confounded with differences between the trials, “trial effects.” Thus, it is impossible to estimate either effect separately. Consequently, when the results of separate single-arm trials of different treatments are compared, an apparent treatment difference may be due to a trial effect. Conversely, the apparent absence of a treatment effect may be due to an actual treatment effect being cancelled out by a trial effect. Because selection involves comparison, single-arm phase 2 trials thus fail to provide a reliable means for selecting which therapies to investigate in phase 3. Moreover, reducing complex clinical phenomena, including both adverse and desirable events, to a single outcome wastes important information. Consequently, conventional phase 2 designs are inefficient and unreliable. Given the limited number of patients available for phase 2 trials and the increasing number of new therapies that must be evaluated, it is critically important to conduct these trials efficiently. These concerns motivated the development of a general paradigm for randomized selection trials evaluating several therapies based on multiple outcomes. Three illustrative applications of trials using this approach are presented.
Prospective Evaluation of a Follow-Up Schedule in Cutaneous Melanoma Patients: Recommendations for an Effective Follow-Up Strategy
Authors: Garbe Claus , Paul Andrena , Kohler-Späth Hanna , Ellwanger Ulf , Stroebel Waltraud , Schwarz Monika , Schlagenhauff Bettina , Meier Friedegund , Schittek Birgit , Blaheta Hans-Juergen , Blum Andreas , Rassner Gernot 
Published: January 2003

Purpose: To prospectively examine and evaluate the results of follow-up procedures in a large cohort of cutaneous melanoma patients.Patients and Methods: This was a prospective study in 2,008 consecutive patients with stage I to IV cutaneous melanoma from 1996 to 1998 on the yield of stage-appropriate follow-up examinations according to the German guidelines. Documentation of patient and follow-up data comprised patient demography, primary tumor specifics, and any clinical and technical examinations performed. The detection of metastasis was classified as early or late, and the means of their detection and the resulting overall survival probabilities were examined.Results: A total of 3,800 clinical examinations and 12,398 imaging techniques were documented. Sixty-two second primary melanomas in 46 patients and 233 disease recurrences in 112 patients were detected during this time. In stage I to III disease, physical examination was responsible for the discovery of 50% of all recurrences. In the primary tumor stages, 21% of all recurrences were discovered by lymph node sonography, with the majority being classified as early detection. Forty-eight percent of the recurrences were classified as early detection, and these patients had a significant benefit of overall survival probability.Conclusion: The results of our study suggest that an elaborated follow-up schedule in cutaneous melanoma is suitable for the early detection of second primary melanomas and early recurrences. The intensity of clinical and technical examinations can be reduced during follow-up of patients in the primary tumor stages and may be intensified in locoregional disease. Recommendations for an effective follow-up strategy are outlined.
Effect of Upper Extremity Exercise on Secondary Lymphedema in Breast Cancer Patients: A Pilot Study
Authors: McKenzie Donald C. , Kalda Andrea L. 
Published: January 2003

Purpose: To examine the effect of a progressive upper-body exercise program on lymphedema secondary to breast cancer treatment. Methods: Fourteen breast cancer survivors with unilateral upper extremity lymphedema were randomly assigned to an exercise (n = 7) or control group (n = 7). The exercise group followed a progressive, 8-week upper-body exercise program consisting of resistance training plus aerobic exercise using a Monark Rehab Trainer arm ergometer. Lymphedema was assessed by arm circumference and measurement of arm volume by water displacement. Patients were evaluated on five occasions over the experimental period. The Medical Outcomes Trust Short-Form 36 Survey was used to measure quality of life before and after the intervention. Significance was set at alpha ≤ 0.01. Results: No changes were found in arm circumference or arm volume as a result of the exercise program. Three of the quality-of-life domains showed trends toward increases in the exercise group: physical functioning (P = .050), general health (P = .048), and vitality (P = .023). Mental health increased, although not significantly, for all subjects (P = .019). Arm volume measured by water displacement was correlated with calculated arm volume (r = .973, P < .001), although the exercise and control group means were significantly different (P < .001). Conclusions: Participation in an upper-body exercise program caused no changes in arm circumference or arm volume in women with lymphedema after breast cancer, and they may have experienced an increase in quality of life. Additional studies should be done in this area to determine the optimum training program.
Thymidylate Synthase Expression in Hepatic Tumors Is a Predictor of Survival and Progression in Patients With Resectable Metastatic Colorectal Cancer
Authors: Gonen Mithat , Hummer Amanda , Zervoudakis Alice , Sullivan Deidre , Fong Yuman , Banerjee Debabrata , Klimstra David , Cordon-Cardo Carlos , Bertino Joseph , Kemeny Nancy 
Published: January 2003

Purpose: To investigate the role of thymidylate synthase (TS),p53, and epidermal growth factor receptor (EGF-R) expressions in hepatic tumors in predicting overall survival (OS), progression-free survival (PFS), and hepatic progression-free survival (HPFS) in patients with resectable metastatic colorectal cancer who were randomly assigned to receive either systemic chemotherapy (SYS) alone or systemic and hepatic arterial infusion (HAI+SYS) chemotherapy following liver surgery. Patients and Methods: Tissues from metastatic tumors were collected during liver resection from 156 patients, and marker expressions were determined using immunohistochemistry on frozen samples. Univariate associations between marker expressions and baseline variables with OS, PFS, and HPFS were examined. Independent predictors of outcome were determined using a multivariate Cox model. Results: In multivariate analyses, TSoverexpression was found to be an independent factor of poor prognosis in OS (P < .01), PFS (P = .06), and HPFS (P < .01). In addition, resection margin was a significant independent factor for all three outcomes. Patients who received HAI+SYS experienced delayed progression in general, and in the liver, specifically. Increased levels of serum alkaline phosphatase correlated with hepatic progression. We also found a significant TS-treatment interaction for OS (P = .01) in multivariate analysis. In particular, TS+ patients receiving HAI+SYS had significantly higher survival than those receiving SYS (64 monthsv 21 months; P = .01). Conclusion: TSlevels in hepatic tumors and resection margin are independent predictors of survival and progression in patients with metastatic colorectal cancer, whereasp53and EGFRare not independent predictors. Treatment with HAI+SYS significantly improved the survival profile of TS+ patients.
Elevated Expression of Valosin-Containing Protein (p97) in Hepatocellular Carcinoma Is Correlated With Increased Incidence of Tumor Recurrence
Authors: Yamamoto Shinji , Tomita Yasuhiko , Nakamori Shoji , Hoshida Yoshihiko , Nagano Hiroaki , Dono Keizo , Umeshita Koji , Sakon Masato , Monden Morito , Aozasa Katsuyuki 
Published: January 2003

Purpose: Valosin-containing protein (VCP; also known as p97) has been shown to be associated with antiapoptotic function and metastasis via activation of the nuclear factor-κB signaling pathway. In this study, association of VCP expression with recurrence of hepatocellular carcinoma (HCC) and patient survival was examined. Patients and Methods: VCP expression in 170 patients (139 male and 31 female) with ages ranging from 31 to 81 years (median, 61 years) was analyzed by quantitative reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry, in which staining intensity in tumor cells was categorized as weaker (level 1) or equal to or stronger (level 2) than that in endothelial cells. Results: Immunohistochemically, 57 patients (35.2%) showed level 1, and 105 patients (64.8%) showed level 2, VCP expression. Quantitative RT-PCR analysis revealed higher VCP mRNA expression in level 2 patients (n = 7) than level 1 (n = 4) (P < .05). Patients with VCP-level 2 HCC showed higher rate of portal vein invasion in the tumor (P < .01) and poorer disease-free and overall survival (P < .0001 and P < .05, respectively) compared with level 1 patients. Multivariate analysis revealed VCP expression level, tumor multiplicity, and degree of fibrosis in the noncancerous liver tissue to be independent prognosticators for disease-free and overall survival. VCP level was an indicator for disease-free survival in each early- (I and II) and advanced- (III and IV) stage group of pathologic tumor-node-metastasis classification (P < .001 and P < .01, respectively). Conclusion: VCP expression level has prognostic significance for disease-free and overall survival of patients with HCC.
Approaching the End of Life: Attitudes, Preferences, and Behaviors of African-American and White Patients and Their Family Caregivers
Authors: Phipps Etienne , True Gala , Harris Diana , Chong Umi , Tester William , Chavin Stephen I. , Braitman Leonard E. 
Published: January 2003

Purpose: To investigate differences in attitudes, preferences, and behaviors regarding end of life in terminally ill patients and their designated family caregivers. Patients and Methods: 68 African-American and white patients with stage III-B or IV lung or stage IV colon cancer and 68 patient-designated family caregivers interviewed between December 1999 and May 2001. Results: White patients were more likely to have a durable power of attorney (34% v 8%, P = .01) and were more likely to have a living will (LW; 41% v 11%, P = .004) than were African-American patients. More African-American than white patients desired the use of life-sustaining measures (cardiopulmonary resusitation [CPR], mechanical ventilation, tube feeding) in their current condition (all P > .12). In a near-death condition, African-American patients were more likely than white patients to desire each of the life-sustaining measures (all P < .004). There was no patient-caregiver agreement beyond chance regarding preferences for initiation of CPR, tube feeding, or mechanical ventilation in the patient’s current condition or in the near-death condition. In the near-death condition in patients without LWs, there was disagreement in 46% of patient-caregiver pairs about CPR, in 50% about mechanical ventilation, and in 43% about tube feeding. Conclusion: Although most patients and families endorse the primacy of the patient in decisions at end of life, the majority do not take supporting actions. Disagreements between patients and families about the use of life-sustaining measures in patients without LWs may result in patients’ preferences being superseded at end of life.