Search

Purpose: The purpose of this study is to investigate the link between downsizing cues and market performance prior to and after a major crisis. We use a recent exogenous shock – the COVID-19 pandemic – to test hypotheses on the nature of the relationship between downsizing cues and market performance within two distinct groups: pre and post-crisis. We purport that the sudden increase in uncertainty brought about by a major crisis widens information asymmetry between firms and their shareholders, and that top managers sending downsizing cues to the market with high levels of authenticity may be more likely to trigger positive market reactions. Design/methodology/approach: The authors rely on computer-assisted text analysis (CATA) methodology, event-study methodology and a data set of 952 pre- and post-crisis earnings conference calls held by 476 S&P 500 firms to test the hypotheses in this study. Findings: The authors find that downsizing cues have no effect on market performance in the pre-crisis group, but are negatively related to market performance in the post-crisis group. The authors also find that authenticity cues positively mitigate the relationship between downsizing cues and market performance relationship in the post-crisis group. Originality/value: This empirical study extends our knowledge of the influence of a major crisis on the relationship between downsizing and market performance by leveraging the revelatory power of an exogenous environmental shock. The authors also explore the role played by managerial authenticity and find that the market is more inclined to accept post-crisis downsizing efforts when top managers are perceived as authentic. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to investigate whether cues of morality can mitigate stock sell-offs in the face of earnings uncertainty prior to earnings conference calls and draws on moral foundations theory to study the effect of universal moral cues (harm/care and fairness/reciprocity rhetoric) and primarily conservative moral cues (ingroup/loyalty, authority/respect and purity/sanctity rhetoric) on market performance. Design/methodology/approach: The study relies on a longitudinal data set of 1,920 firm-quarter observations corresponding to calls held by firms listed on the S&P 500 in 2015 and relies on computer-assisted-text-analysis and event-study methodology to test hypotheses. Findings: The results suggest that cues of universal moral foundations have a mitigating effect on stock sell-offs and are able to create firm value; while cues primarily conservative moral foundations are not found to have an effect on market performance. Originality/value: This investigation highlights why earnings conference calls may serve as a valuable tool for communicating a firm's moral inclination and why universal morality may appeal to a wider range of shareholders than primarily conservative morality. [ABSTRACT FROM AUTHOR]

This article examines the phenomenon of dynamic capabilities in international new ventures (INVs) from emerging markets. While this research stream is gaining traction, the literature is fragmented as to how INVs from emerging markets develop dynamic capabilities to overcome resource constraints and legitimacy issues. The authors highlight the importance of a comprehensive international entrepreneurial culture (IEC) to better understand how these INVs develop dynamic capabilities and foster international performance. This study draws on organisational learning and the knowledge-based view (KBV) to examine the role of IEC in shaping dynamic capabilities and international performance under various levels of market turbulence. To conduct our analyses, this study uses a sample of INVs from India – a key emerging market. The results indicate that IEC shapes dynamic capabilities and both support superior international performance. The findings also confirm the utility of IEC towards dynamic capabilities and international performance when operating in turbulent markets. [ABSTRACT FROM AUTHOR]

This study investigates whether cues of organizational virtue (conscientiousness, courage, empathy, integrity, warmth, and zeal) sent by top managers can create market value in the context of post‐earnings announcement conference calls and earnings uncertainty. We contend that executive cues of organizational virtue embedded within earnings conference calls can mitigate shareholders' reactions to earnings surprises and use textual analysis to test for the effect of organizational virtue cues on market performance in a longitudinal sample of 1920 firm‐quarter observations. The results suggest that cues of conscientiousness, courage, and zeal are capable of adding back firm value after the posting of earnings surprises, while empathy worsens the market's reaction to earnings surprises. Integrity and warmth were not found to have an effect. [ABSTRACT FROM AUTHOR]

This study assessed the effectiveness of training leaders in behaviors that satisfy meeting attendees' psychological needs for autonomy, competence, and relatedness. Three managers who regularly lead meetings with their workgroups participated in the study. The study used a research design of multiple baselines across groups and began with baselines ranging over three to five meetings. Group leaders then received a session of behavioral skills training with a role-play component, followed by post-training assessment over three to five meetings. The final assessment occurred one month later. Leaders reported the number of recommended leader behaviors they used prior to training and at subsequent meetings. Group members anonymously completed ratings of (1) the extent of their psychological need satisfaction, (2) their satisfaction with each meeting, and (3) how productive each meeting was. Meeting leaders showed significantly more use of the recommended behaviors after training than before training. Member ratings indicated a significant increase in need satisfaction, satisfaction with meetings, and meeting productivity after the training of their leader. Significant positive effects remained at a one-month follow-up. The findings show that training leaders in needs-focused behaviors to use in running meetings can be used to satisfy attendee-needs and to improve meeting satisfaction and productivity. [ABSTRACT FROM AUTHOR]

Purpose: Joint ventures (JVs) are known to create value for their parent firms, in part due to the mutually beneficial sharing of information that occurs at the JV level. Market orientation (MO) is a well-documented strategic orientation that has received little attention in the JV literature, despite considerable research suggesting that MO has a positive effect on performance. This study posits that the MO skills contributed to a new JV by parent firms are likely to play a central role in a shareholder's assessment of the potential for success of a newly announced JV, thereby triggering changes in market value for parent firms. Design/methodology/approach: Computer-Assisted-Text-Analysis (CATA) is used to calculate MO heterogeneity from annual reports, and event-study methodology is used to assess parent firm performance. The authors rely on a US sample of 82 public JV parents involved in 41 new equally-weighted JV formation announcements. Findings: The authors find that heterogeneity on MO's behavioral components (customer orientation, competitor orientation, and coordination) is negatively related to parent performance, while heterogeneity on MO's profitability component is positively related to parent performance. However, the effect of MO's long-term focus heterogeneity on parent performance was not supported. Originality/value: The results suggest that the benefits of information sharing in partnerships may be of a nuanced nature when it comes to MO. Although heterogeneity in profitability inclination created value for parent firms announcing a new JV; heterogeneity in customer, competitor and coordination market orientations did not appear to be rewarded by shareholders. [ABSTRACT FROM AUTHOR]

At the start of the First World War, the estate of Cliveden was offered as a hospital to the Canadian Government by its owner William Astor. This article describes its history, Sir William Osler's involvement in the hospital, and the involvement of other doctors and some of their research. The rehabilitation programs to help the injured soldiers are described, including the physical, occupational, sporting and social activities undertaken in order to help them towards their return to civilian life. Political ambitions in Canada and friction between the owner of Cliveden, Nancy Astor, and the medical/military establishment led to turmoil which engulfed Osler and is known as the 'Taplow Affair'. The hospital was dismantled after the war but became re-activated in the Second World War and is now a National Trust property. [ABSTRACT FROM AUTHOR]

This research examined the effects of meeting leader behavior on organizational meetings. Two studies investigated whether leader behavior that satisfies the psychological needs of meeting attendees, leads to higher levels of meeting productivity and satisfaction. Study 1 used correlational methods, with regressionbased mediation analysis, to assess whether satisfaction of attendee needs mediated the association between leader behavior and attendee ratings of actual meetings in a sample of 110 employees. Study 2 involved an analogue experiment with 158 employees to test the effects of leader behavior on ratings of hypothetical meeting scenarios. The studies provide correlational and experimental evidence for the positive impact of needs-focused behaviors, offering organizational leaders practical solutions for improving meetings. [ABSTRACT FROM AUTHOR]

Background Research into the use of digital technology for weight loss maintenance (intentionally losing at least 10% of initial body weight and actively maintaining it) is limited. The aim of this article was to systematically review randomized controlled trials (RCTs) reporting on the use of digital technologies for communicating on weight loss maintenance to determine its' effectiveness, and identify gaps and areas for further research. Methods A systematic literature review was conducted by searching electronic databases to locate publications dated between 2006 and February 2018. Criteria were applied, and RCTs using digital technologies for weight loss maintenance were selected. Results Seven RCTs were selected from a total of 6541 hits after de-duplication and criteria applied. Three trials used text messaging, one used e-mail, one used a web-based system and two compared such a system with face-to-face contact. From the seven RCTs, one included children (n = 141) and reported no difference in BMI Standard Deviation between groups. From the seven trials, four reported that technology is effective for significantly aiding weight loss maintenance compared with control (no contact) or face-to face-contact in the short term (between 3 and 24 months). Conclusions It was concluded that digital technologies have the potential to be effective communication tools for significantly aiding weight loss maintenance, especially in the short term (from 3 to 24 months). Further research is required into the long-term effectiveness of contemporary technologies. [ABSTRACT FROM AUTHOR]

Prosocial crowdfunding is a new business phenomenon which is transforming the microfinance sector, as more microloans are posted online for fundraising. Research suggests that prosocial lenders registered on crowdfunding platforms seek non-financial returns from their investments, such as the creation of value for the social good. This article adds moral ethics to the crowdfunding equation by drawing on Moral Foundations Theory (MFT). It is posited that cues of moral foundations embedded within borrower profile descriptions are likely to inform prosocial lenders about a borrower's potential for social value creation, thus triggering lending decisions. A Computer-Assisted-Text-Analysis (CATA) of 130,964 funded microloan profile descriptions on a crowdfunding platform suggests that prosocial lenders fund borrowers who cue universal moral foundations (Harm/Care and Fairness/Reciprocity) more quickly than those who cue primarily conservative moral foundations (Ingroup/Loyalty, Authority/Respect and Purity/Sanctity). [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate the effects of a firm’s entrepreneurial proclivity on market performance for large, publicly traded US firms. This study draws upon the five-dimensional view of corporate entrepreneurship (CE) and develops hypotheses aimed at understanding the effects of direct effect of CE cues of proactiveness, autonomy, innovativeness, competitive aggressiveness and risk-taking on stock performance during earnings conference calls.Design/methodology/approach The entrepreneurial orientation of 339 firm post-earnings announcement conference calls is analyzed through a content analysis of transcripts, and the impact of CE cues on stock price is measured using event-study methodology.Findings The results suggest that the cueing the CE dimensions of innovativeness, risk-taking and especially autonomy have a positive effect on market performance during conference calls, while competitive aggressiveness has a negative effect. No effect was found for proactiveness.Research limitations/implications The effect of entrepreneurial proclivity on firm value is not uniform. Not all dimensions of CE have a positive effect on market performance at a corporate level, and measuring each dimension of CE separately may be a valuable approach for future research.Practical implications Firms may create more value when they cue specific entrepreneurial attributes, and cueing competitive aggressiveness may not be desirable.Originality/value This study fills a gap in the literature by measuring the direct effect of CE cues on market performance through an innovative research design which relies on computer-aided text analysis. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to focus on investor reactions to unanticipated changes in income, and whether those reactions can be mitigated by managerial discussion. The authors investigate how top-management team certainty and optimism during post-earnings announcement conference calls can serve as corrective actions and add back firm value in times of unexpected changes in firm-specific risk. Design/methodology/approach – The research question is tested empirically in the context of large, publicly traded, US firms’ quarterly earnings announcements, and their subsequent post-earnings announcement conference calls. The authors use the advanced content analysis software DICTION to measure the levels of managerial certainty and optimism displayed during post-earnings announcement conference calls, and event-study methodology to measure investors’ reactions. Findings – Results indicate that earnings surprises are negatively associated with firm value, but that this relationship is mitigated positively by displays of managerial certainty and optimism during post-earnings announcement conference calls. Originality/value – This work uses an innovative research design to study top-management team rhetoric in post-earnings announcement conference calls, and how specific discussions mitigate investors’ negative reactions to increases in firm-specific risk. The study highlights the importance of top-management team certainty and optimism for value creation in times of change in firm-specific risk, and the importance of rhetoric as a tool for corrective action. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate factors influencing patients' self-management of urgent diabetes problems that precipitated unscheduled hospital care. Background Diabetes is placing increasing resource demands on health services and current policy advocates management in primary care and community settings whenever possible. Such policy has implications for patient education and empowerment and on mechanisms within primary and community care to support the management of diabetes when urgent healthcare problems arise. Design Qualitative, descriptive investigation, across two contrasting sites. Methods Forty-five people admitted to hospital for urgent/emergency care due to diabetes-related problems were recruited from urban and rural localities in the UK. Semi-structured interviews were conducted and data analysed using nvivo version 8 and framework techniques. Results Self-management of diabetes was typically habitual, and urgent problems that proved difficult to resolve necessitated recourse to unscheduled hospital care. Though skills relating to problem-solving, decision-making, resource use and formation of patient-provider partnerships were evident among some participants, these required further development. Evidence of action planning or self-tailoring skills was sparse. Conclusions Education plays an important role in assisting individuals to self-manage their diabetes on a daily basis, but urgent, unexpected health problems proved challenging for both patients and health service providers. A greater focus on empowering patients with core self-management skills is required to enhance ability to successfully manage unexpected diabetes complications, coupled with enhanced primary care resources, particularly out-of-hours. Relevance to clinical practice The importance of informal and structured diabetes education should not be underestimated; however, the challenge of improving skills such as problem-solving to manage urgent healthcare needs must be tackled. This study provokes debate regarding how best to deliver appropriate education and health services to cover urgent unscheduled care needs without automatically referring to emergency department hospital care. [ABSTRACT FROM AUTHOR]

Purpose - This study is a replication of Wolff and Reed's (2000) work. The purpose of this paper is to examine how the combination of resources brought to joint ventures influence parent-firm performance. This study is also interested in whether or not the exposure of immobile resources through the semi-transparent membrane of the joint venture can have negative effects on parent-firm performance. Design/methodology/approach - The sample consists of two-parent joint ventures formed by publicly traded US firms between 1997 and 2013. The event-study methodology is used to calculate each parent-firm's abnormal returns. This work also uses content analysis to analyze parent-firms' annual reports (10-K). Findings - While Wolff and Reed's results on resource allocation within joint ventures were not statistically significant, this replication study provided strong support to the resource allocation hypothesis. It was found that intangible resource heterogeneity within a joint venture creates higher performance gains for parent-firms than tangible resource heterogeneity. This work also successfully replicated Wolff and Reed's findings on the negative impact of immobile resources exposure on parent-firm performance. Wolff and Reed's results on resource complementarity were, however, not successfully replicated. Originality/value - This replication study goes beyond simply showing that engaging in a joint venture strategy creates value for parent-firms. Through the use of a new content analysis method, this study was able to provide strong support for Wolff and Reed's theory on the performance gains provided by resource heterogeneity in a joint venture setting, and to confirm the results on potential adverse performance effects of immobile resources exposure. [ABSTRACT FROM AUTHOR]

This article reports on a study which explored the potential of structural equation model to deal with measurement error using as an exemplar the estimation of an estimated average glucose regression equation. Researchers used data from a 12-month randomised controlled trial aimed at assessing the effect of self monitoring of blood glucose on glycaemic control in patients with newly diagnosed type 2 diabetes. It is suggested that the approach have wider applications in laboratory medicine.

Antiangiogenic therapy based on blocking the actions of vascular endothelial growth factor-A (VEGF) can lead to 'normalization' of blood vessels in both animal and human tumors. Differential expression of VEGF isoforms affects tumor vascular maturity, which could influence the normalization process and response to subsequent treatment. Fibrosarcoma cells expressing only VEGF120 or VEGF188 isoforms were implanted either subcutaneously (s.c.) or in dorsal skin-fold 'window' chambers in SCID mice. VEGF120 was associated with vascular fragility and hemorrhage. Tumor-bearing mice were treated with repeat doses of SU5416, an indolinone receptor tyrosine kinase inhibitor with activity against VEGFR-2 and proven preclinical ability to induce tumor vascular normalization. SU5416 reduced vascularization in s.c. implants of both VEGF120 and VEGF188 tumors. However, in the window chamber, SU5416 treatment increased red cell velocity in VEGF120 (representing vascular normalization) but not VEGF188 tumors. SU5416 treatment had no effect on growth or necrosis levels in either tumor type but tended to counteract the increase in interstitial fluid pressure seen with growth of VEGF120 tumors. SU5416 pretreatment resulted in the normally fragile blood vessels in VEGF120-expressing tumors becoming resistant to the vascular damaging effects of the tubulin-binding vascular disrupting agent (VDA), combretastatin A4 3- O-phosphate (CA4P). Thus, vascular normalization induced by antiangiogenic treatment can reduce the efficacy of subsequent VDA treatment. Expression of VEGF120 made tumors particularly susceptible to vascular normalization by SU5416, which in turn made them resistant to CA4P. Therefore, VEGF isoform expression may be useful for predicting response to both antiangiogenic and vascular-disrupting therapy. [ABSTRACT FROM AUTHOR]

Glucose derangement is commonly observed among adults admitted to hospital with acute stroke. This paper presents the findings from a descriptive cohort study that investigated the glucose monitoring practices of nurses caring for adults admitted to hospital with stroke or transient ischaemic attack. We found that a history of diabetes mellitus was strongly associated with initiation of glucose monitoring and higher frequency of that monitoring. Glucose monitoring was continued for a significantly longer duration of days for adults with a history of diabetes mellitus, when compared to the remainder of the cohort. As glucose monitoring was not routine practice for adults with no history of diabetes mellitus, the detection and treatment of hyperglycaemia and hypoglycaemia events could be delayed. There was a significant positive association between the admission hospital that is most likely to offer stroke unit care and the opportunity for glucose monitoring. We concluded that adults with acute stroke, irrespective of their diabetes mellitus status prior to admission to hospital, are vulnerable to both hyperglycaemic and hypoglycaemic events. This study suggests that the full potential of nurses in the monitoring of glucose among hospitalised adults with stroke has yet to be realised. [ABSTRACT FROM AUTHOR]

The participation of service users in the planning and delivery of social work services has become a familiar objective in the UK. Policy injunctions, however, mask a lack of clarity around what is meant by terms such as ‘participation’ and ‘engagement’. Moreover, since many service users do not engage with social workers voluntarily, the expectation that they become centrally involved in the planning and delivery of services highlights tensions and contradictions. This article explores social work engagement with involuntary clients, drawing on findings from a knowledge exchange project involving academics and local authority social workers. A review of the literature traces the background to user involvement and identifies its different stages and types. Data from small-scale practitioner research projects undertaken within the project is then drawn on to illuminate how social workers and clients negotiate mutual engagement in their everyday encounters. It is suggested that the ‘roll out’ of the user engagement agenda may be understood as an exercise in the problematics of government. More optimistically, the work of Michel De Certeau is drawn on to propose that a practice of the everyday in such encounters rescues them from an ill-defined, abstract and undifferentiated policy agenda. [ABSTRACT FROM PUBLISHER]

Study Type - Diagnosis (quality control) Level of Evidence 2b What's known on the subject? and What does the study add? Today, numerous assays for PSA detection are available from various manufacturers. However, these various assays do not detect PSA equally and several studies have demonstrated variability between them. In order to harmonise PSA results and reduce the discrepancies, reference materials are available for assay calibration. We have demonstrated significantly variability between 6 different assay methods currently in use in 9 hospitals despite assay calibration. Variability in PSA values was reduced with the standardisation of the assay method in 4 hospitals. Our results highlight the dilemma of PSA assay variability and stress the need for nationwide standardisation of PSA testing. OBJECTIVE To determine whether standardization of total prostate-specific antigen (tPSA) assay methods reduces variability in tPSA measurements., PATIENTS AND METHODS Blood samples from 84 patients attending a single urology department were distributed across nine hospitals selected throughout Ireland for the independent determination of tPSA under the same conditions., The selected hospitals collectively used six different assay methods for tPSA detection: Beckman Hybritech WHO Calibrated (used as reference method), Tosoh AIA 1800, Roche E170 (used in three hospitals), Abbott AxSYM, Immulite 2500 2nd Generation (used in two hospitals) and Siemens ADVIA Centaur., The method of tPSA detection was next standardized in a subset of four hospitals using the same assay method and the measurements were repeated., The difference in mean tPSA in the cohort across the hospitals tested was determined and the Bland-Altman test was used to assess the agreement between each test. Analysis was performed over both the full (0.5-30 µg/L, N= 84) and a narrow (3-7 µg/L, n= 25) tPSA range., RESULTS The range and the mean tPSA of the full cohort were inflated across the eight test hospitals, when compared with the reference hospital., The poorest agreement between assay methods was associated with a bias of 2.2 ± 2.4 µg/L. The variability in tPSA measurements between assay methods was inconsistent across the range of tPSA values tested and increased with increasing mean tPSA., Agreement in reported tPSA was excellent after standardization of tPSA assay methods (bias <0.2 µg/L)., Over the narrow 3-7 µg/L PSA range, 12/25 (48%) patients had a tPSA range of values across all hospitals in excess of 2 µg/L. Following standardization of the tPSA assay method, patient tPSA ranges were <0.5 µg/L for 13/25 (52%) patients., CONCLUSIONS We have shown that the lack of standardization of tPSA assay methods across a panel of Irish hospitals leads to significant variability in the measured tPSA values for the same patient samples., Variability in tPSA values was reduced with the standardization of the assay method in four hospitals., Standardization of PSA testing on a nationwide scale is warranted. [ABSTRACT FROM AUTHOR]

We used published accounts to describe the known statewide distribution of the lone star tick, Amblyomma americanum, in New Jersey and field surveys to characterize the geographical range of A. americanum and selected A. americanum-transmitted pathogens in Monmouth County, the hypothesized northern limit of the species distribution. Ticks were collected using standardized methods from 50 widely dispersed public access areas within 18 municipalities to produce estimates of relative abundance among sites. Collected A. americanum adults were stored at -80°C until processed for DNA extraction. Individual ticks were subjected to polymerase chain reaction analyses to detect the presence of Ehrlichia chaffeensis, E. ewingii, Rickettsia amblyommii, and Borrelia lonestari. The range of A. americanum was generally limited to the southern half of New Jersey. Within Monmouth County, we collected A. americanum from 9 of 18 municipalities (50%) and 24 (48%) of the surveyed properties. We found at least 1 pathogen at 17 (70.8%) sites located within 6 of 9 municipalities, while all 4 target pathogens were detected in 5 of those 6 (83.3%) municipalities. The geographical distribution of A. americanum and its associated pathogens appeared to be restricted to the southern portion of the county. Possible factors governing the distribution are discussed. [ABSTRACT FROM AUTHOR]

Objective: To examine the use of sex- and gender-based analysis (SGBA) in systematic reviews of cardiovascular health in order to strengthen the evidence base for clinical practice and policy. Methods: To determine the current status of SGBA in systematic reviews, an appraisal tool was developed by the research team and applied by an independent reviewer to a random sample of 38 Cochrane systematic reviews. The sample was drawn from reviews addressing interventions for cardiovascular diseases (CVD). A random sample of Cochrane reviews in cardiovascular health was selected from the Cochrane Library, Issue 3, 2001, to Issue 3, 2007. The main outcome measure was the number of reviews that included analysis of sex or gender or both. Results: Our findings showed that SGBA was generally absent in the sampled reviews. Data were rarely disaggregated by sex; only 2 of 38 reviews reported any sex or gender research gaps. Only one quarter of the reviews included a rationale as to why any subgroup analyses by sex were or were not completed. None of the 38 reviews met all of the appraisal tool criteria. As well, we found that where sex or gender was mentioned, the terms were used interchangeably. Conclusions: Despite increasing evidence over the past decade documenting that sex and gender frequently matter in CVD, this study demonstrated that SGBA was rarely considered in systematic reviews. We suggest this omission has important implications for assuring the quality of research and of evidence-based policy and practice and for achieving equitable health outcomes for women and men. To build a robust evidence base for future work in cardiovascular health, we propose that the methodologies of systematic reviews and of SGBA be refined and synchronized to enhance the collection, synthesis, and analysis of evidence for decision making. [ABSTRACT FROM AUTHOR]

Aim. To describe insulin initiation practices across the United Kingdom (UK) and identify factors influencing current practice. Background. The number of people commencing insulin therapy has escalated in recent years; due to increased incidence of diabetes and the evidence that improvements in glycaemic control can reduce and delay the onset of diabetic complications. However, the process of insulin initiation is not well described and the optimal way to start insulin therapy is unclear. There is currently a strong emphasis on moving diabetes care from secondary to primary care and this change in policy may also influence insulin initiation. Methods. A quantitative, cross-sectional, nationwide survey of diabetes specialist nurses (DSNs) and practice nurses (PNs) was completed in 2006. Data were gathered using a postal questionnaire, 1310 were returned (37·7% response rate). Results. Almost all DSNs working in secondary, or across primary and secondary, care initiate insulin in people with type 1 diabetes, but only 37·7% of DSNs working in primary care or 2·5% of PNs ( p < 0·001). Most DSNs initiate insulin in adults with type 2 diabetes compared with only 37·7% of PNs ( p < 0·001). Only 23·5% of respondents initiate insulin for those with gestational diabetes (GD), most working in secondary care ( p < 0·001). The most commonly used insulin regimen was multiple injection in type 1 diabetes (43·9%), a twice-daily mixture (19·2%) and night only basal insulin (17·9%) in type 2 diabetes and multiple injection in GD (46·8%). Analogue insulins were more frequently used than non-analogues in type 1 and 2 diabetes but almost equally in those with GD. Conclusion. Despite the drive for much more diabetes care to be delivered in primary care insulin initiation remains largely the province of secondary care, and regardless of the contested nature of the evidence base, analogue insulins are widely used. Relevance to clinical practice. The focus of this study was on one aspect of diabetes care (insulin initiation), however the findings illustrate that whilst policy relating to the care of people with a long-term condition such as diabetes may change, the practice implications in terms of community provision and availability of appropriate expertise are complex. [ABSTRACT FROM AUTHOR]

Objectives To assess the effect of self monitoring of blood glucose concentrations on glycaemic control and psychological indices in patients with newly diagnosed type 2 diabetes mellitus. Design Prospective randomised controlled trial of self monitoring versus no monitoring (control). Setting Hospital diabetes clinics. Participants 184 (111 men) people aged <70 with newly diagnosed type 2 diabetes referred to the participating diabetes clinics. Major exclusion criteria were secondary diabetes, insulin treatment, previous self monitoring of blood glucose. Interventions Participants were randomised to self ¦ monitoring or no monitoring (control) groups for one year with follow-up at three monthly intervals. Both groups underwent an identical structured core education programme.The self monitoringgroup received additional education on monitoring. Main outcome measures Between group differences in HbAlc, psychological indices, use of oral hypoglycaemic drugs, body mass index (BMI), and reported hypoglycaemia rates. Results 96 patients (55 men) were randomised to monitoring and 88 (56 men) to control. There were no baseline differences in mean (SD) age (57.7 (11.0) in monitoringgroup v60.9 (11.5) in control group) orHbAlc (8.8 (2.1)% 1/8.6 (2.3)%, respectively). Those in the monitoring group had a higher baseline BMI (34 (7) v 32 (6.2)). There were no significant differences between groups at any time point (12 months values given) in HbAlc (6.9 (0.8)% v 6.9 (1.2)%, P=0.69; 95% confidence interval for difference-0.2 5% to 0.38%), BMI (33.1 (6.4) v 31.8 (6.0); adjusted for baseline BMI, P=0.32), use of oral hypoglycaemic drugs, or reported incidence of hypoglycaemia. Monitoring was associated with a 6% higher score on the depression subscale of the well-being questionnaire (P=0.01). Conclusions In patients with newly diagnosed type 2 diabetes self monitoring of blood glucose concentration has no effect on glycaemic control but is associated with higher scores on a depression subscale. Trial registration ISRCTN 49814766. [ABSTRACT FROM AUTHOR]

Objective: To develop an image processing-based method to quantify the rate of extravasation of fluorescent contrast agents from tumor microvessels, and to investigate the effect of the tumor vascular disrupting agent combretastatin A-4-P (CA-4-P) on apparent tumor vascular permeability to 40 kDa fluorescein isothiocyanate (FITC) labeled dextran. Methods: Extravasation of FITC-dextran was imaged in 3 dimensions over time within P22 sarcomas growing in dorsal skin flap "window chambers" in BDIX rats using multiphoton fluorescence microscopy. Image processing techniques were used to segment the data into intra- and extravascular regions or classes. Quantitative estimates of the tissue influx (vascular leakage) rate constant, Ki, were obtained from the time courses of the fluorescence intensities in the two classes. Apparent permeability, P, was calculated, assuming Ki = PS/V, where S is vascular surface area in tumor volume V. Results: Combining image processing and kinetic analysis algorithms with multiphoton fluorescence microscopy enabled quantification of the rate of tumor vascular leakage, averaged over a large number of vessels. Treatment with CA-4-P caused a significant increase in Ki from 1.13 ± 0.33 to 2.59 ± 0.20 (s- 1× 10- 4; mean ± SEM), equivalent to an increase in P from 12.76 ± 3.36 to 30.94 ± 2.64 (cm s-1× 10-7). Conclusions: A methodology was developed that provided evidence for a CA-4-P-induced increase in tumor macromolecular vascular permeability, likely to be central to its anti-cancer activity. [ABSTRACT FROM AUTHOR]

Human seminal plasma has potent anti-inflammatory properties which are thought to confer a survival advantage to the spermatozoa within the hostile female genital tract. In contrast, a profound pro-inflammatory leukocytosis has been observed post-coitus in animals and humans. Whether components of seminal plasma are involved in initiating this leukocytic reaction is not known. This study investigated the effect of human seminal plasma, a seminal plasma fraction and its principal constituent prostaglandins, prostaglandin E2 (PGE2) and 19-hydroxy PGE, on the release of the pro-inflammatory neutrophil chemotactic factor interleukin-8 (IL-8) and the anti-inflammatory cytokines interleukin-10 (IL-10) and secretory leukocyte protease inhibitor (SLPI). The tissues studied were non-pregnant cervical explants, peripheral blood and the monocyte cell line U937. Seminal plasma fraction (SPF) significantly (P < 0.05) stimulated release of IL-8 and inhibited release of SLPI from non-pregnant cervical explants. SPF, PGE2 and 19-hydroxy PGE significantly (P < 0.005) stimulated IL-8 release from peripheral blood and U937 cells. 19-hydroxy PGE was significantly (P < 0.005) more effective than PGE2 in stimulating IL-8 release. Seminal plasma, SPF and PGE2 significantly (P < 0.05) stimulated IL-10 release from U937 cells. 19-hydroxy PGE stimulated IL-10 release from U937 cells but this failed to reach significance. Release of IL-10 by cervical explants and SLPI by peripheral blood and U937 cells were below the detection limit of the assays employed. We suggest that the anti- and pro-inflammatory immune responses which seminal plasma induces might act in combination initially to promote sperm survival and then to facilitate their removal from the female genital tract. [ABSTRACT FROM PUBLISHER]

The major purpose of this study was to investigate premises regarding self-disclosure as proposed in theories of homo- sexual development while gathering baseline empirical data on the coming-out process. Several variables that theoretically influence coming-out, such as, persons to whom a lesbian has self-disclosed, in what order she has chosen to do this, how her internalized homophobia has influenced her behavior and how her coming-out behavior is related to level of sexual identity development; were investigated. Participants were volunteers responding to advertisements (N = 407, 64% return rate). The sample was a diverse group, with not all respondents labeling themselves lesbian. Age of coming..out to themselves ranged from 3 to 63 years; coming-out to another, age 7 to 63; coming-out to another after coming-out to henelf less than one year to 33 years. After coming-out to themselves, respondents tended to come-out to other lesbian next. Despite the theoretical premise that coming-out to family is the most difficult, there was no specific pattern to indicate the respondents came-out to family last or to siblings before parents. Respondents with higher levels of homophobia tended to come-out to fewer groups of people, but their general predisposition to disclose was not related to coming-out behavior. Women at later stages of identity formation had come-out to more groups of people. [ABSTRACT FROM AUTHOR]

Changes in healthcare provision introduced in the early 1990s raised awareness of the issue of quality in health care. Quality, currently a fashionable topic, is an abstract concept and attempts to define and measure its properties have proved controversial and challenging. An equally challenging aspect of nursing care is the satisfactory delivery of health education to patients. This paper focuses on patient education and quality assurance in nursing. The results of a study concerning 20 young adults with insulin-dependent diabetes mellitus (IDDM) are reported. The findings indicate deficiencies in their experiences of patient education at initial diagnosis, discharge home after first hospital admission and when needing further information. It is contended that patient education is an area which requires qualitative as well as quantitative measurements of quality in order to capture the unique experience of information needs. [ABSTRACT FROM PUBLISHER]

This paper looks at how computers are used in education and discusses how the uses with which they have come to be commonly associated are more a reflection of dominant values about education and knowledge than of the intrinsic characteristics or qualities of computers themselves. The critique of educational computing offered by Michael Streibel is used as the start point. In his critique Streibel suggests that computers are not suitable for epistemological methods such as interpretation, intuition and introspection. Two examples are given in the paper where computers are used to support such epistemological methods. [ABSTRACT FROM PUBLISHER]

In this article the author suggests that it is important to look more closely at the educational process of distance learning courses. In particular she says there is a need to look at the interrelationship between a distance learning course's support system and its learning materials, and the influence this relationship has upon students’ experiences and approaches to learning. She then describes a study which has attempted to do precisely this. [ABSTRACT FROM PUBLISHER]

Four senior occu ational therapy students developed a 7-session vocational readiness program at a day facility, Step Ahead, for mental health clienrs. The purpose was to assist the members of Step Ahead to see their skills and goals realistically and positively and therefore enhance their possibilities of employment. The students' documentation of behavior supported the views reported by members and staff that the members were more realistic, were more aware of their assets, and felt more able to direct themselves toward employment than before the occupational therapy intervention. [ABSTRACT FROM PUBLISHER]

Four occupational therapy students developed and implemented within a voluntary community mental health day center a daily living skills program. This center, Step Ahead, had recently identified inclusion of daily living skills as a program need. To identify specific areas of skills, development needs, and to establish pretreatment scores, volunteer members were pretested with the Kohlman Evaluation of Living Skills (KELS) instrument. Based on the assessment, a seven week program was initiated to improve members' skills in Money Management, Safety and Health, and Leisure. At the end of the program the KELS was again administered. A one tailed paired t-test revealed significant improvement in the level of independence in the specific daily living skills in which the members participated. Through the occupational therapy students' program the members of Step Ahead, a community mental health day center, displayed improvement in daily living skills of (Money Management) Safety and Health and Leisure. [ABSTRACT FROM PUBLISHER]