Contradictory Outcome Research Articles

Nurse-patient communication in primary care diabetes management: an exploratory study.

BackgroundDiabetes is a major health issue for individuals and for health services. There is a considerable literature on the management of diabetes and also on communication in primary care consultations. However, few studies combine these two topics and specifically in relation to nurse communication. This paper describes the nature of nurse-patient communication in diabetes management.MethodsThirty-five primary health care consultations involving 18 patients and 10 nurses were video-recorded as part of a larger multi-site study tracking health care interactions between health professionals and patients who were newly diagnosed with Type 2 diabetes. Patients and nurses were interviewed separately at the end of the 6-month study period and asked to describe their experience of managing diabetes. The analysis used ethnography and interaction analysis.In addition to analysis of the recorded consultations and interviews, the number of consultations for each patient and total time spent with nurses and other health professionals were quantified and compared.ResultsThis study showed that initial consultations with nurses often incorporated completion of extensive checklists, physical examination, referral to other health professionals and distribution of written material, and were typically longer than consultations with other health professionals. The consultations were driven more by the nurses’ clinical agenda than by what the patient already knew or wanted to know. Interactional analysis showed that protocols and checklists both help and hinder the communication process. This contradictory outcome was also evident at a health systems level: although organisational targets may have been met, the patient did not always feel that their priorities were attended to. Both nurses and patients reported a sense of being overwhelmed arising from the sheer volume of information exchanged along with a mismatch in expectations.ConclusionsConscientious nursing work was evident but at times misdirected in terms of optimal use of time. The misalignment of patient expectations and clinical protocols highlights a common dilemma in clinical practice and raises questions about the best ways to balance the needs of individuals with the needs of a health system. Video- recording can be a powerful tool for reflection and peer review.

The association of ultraviolet radiation-B (305 nm), season of diagnosis, and latitude on the survival outcome of prostate cancer in the high UV environment of Australia

Positive associations between sun exposure and cancer survival have been observed in regions of high latitudes, where ambient solar ultraviolet (SUV) radiation is generally low. We examined the effects of ambient ultraviolet-B radiation (UVB) at time of diagnosis, season of diagnosis and latitude of residence on survival outcome from prostate cancer. Regression models for relative survival were used to estimate relative excess risks (RER) of death after diagnosis of prostate cancer from cancer registries in Eastern Australia (Queensland, New South Wales, Victoria and Tasmania). Relative excess risks was increased with diagnosis in summer (RER = 1.20; 95 % CI 1.14-1.26) relative to winter, high ambient UVB at the time of diagnosis (>60 mW/m(2); RER = 1.10; 95 % CI 1.05-1.15) relative to low SUV (<30 mW/m(2)), and with residence in high latitudes (35°S-43°S; RER = 1.20; 95 % CI 1.14-1.26) relative to low latitudes (9°S-29.9°S). RER was highest for summer diagnosis in all three latitude bands, after adjusting for age, follow-up period, and socioeconomic status. The contradictory outcome from season and latitude suggests that their use as surrogates for UV warrants validation. Our data suggest that high ambient solar ultraviolet radiation at the time of diagnosis of prostate cancer increases the risk of dying from this cancer.

West Bengal's Rural Commercial Capital

This paper aims to understand the achievement of high agricultural growth alongside persistent poverty and a mediocre record of human development in West Bengal under the democratically elected Left Front over the last 30 years. Contrary to conventional explanations which centre on the nature of land distribution and rental arrangements, it seeks to explain the contrast between the expansion of agriculture and the deprivation of its mainly rural population through an analysis of the social relations of the post-harvest marketing system which links production with circulation and distribution. Based on field work in West Bengal's agricultural commodity markets over the quarter century 1981–2004, it shows how the seemingly contradictory outcome can be explained in some measure through the control over the marketed surplus by a handful of oligopolistic firms and their dominance over petty producers and labour in the agricultural production and marketing system. It also highlights how the Left Front governments, despite their attack on large-scale landed property, continued to enhance the privileges of the local agro-commercial elite which prevented agrarian poverty from being addressed.

X‐ray diffraction, Raman, and differential thermal analyses of the thermal aging of a Kevlar®‐PBI blend fabric

AbstractA previous study of the effects of thermal aging on the tensile properties of a fabric made of a 60–40 wt % blend of Kevlar and PBI fibers has shown that exposure to elevated temperatures between 190 and 320°C results in a rapid decrease in tensile breaking force retention. In this article, X‐ray diffraction and Raman spectroscopy analyses were carried out to evaluate the consequences of thermal aging on the material's crystallinity. Differential thermal analyses were also undertaken to examine the evolution of the glass transition temperature of PBI following thermal exposure. X‐ray diffraction profiles show a gradual increase in the crystallinity with temperature and aging time, whereas a complete disappearance of spectral lines for aged samples in Raman analysis suggests instead a decrease in crystallinity as a consequence of exposure to elevated temperatures. The seemingly contradictory outcome obtained when using the two techniques led to the proposal of a new, alternative hypothesis to explain the observed results. This hypothesis involves two simultaneous events that occur during thermal aging: the increase of crystallite size in the direction parallel to coplanar sheets, and the disruption of the crystalline lattice in the direction perpendicular to those sheets. The glass transition temperature of PBI was found to shift towards the lower temperatures after thermal aging, a phenomenon that can be associated with random polymer chain scission caused by thermal aging. POLYM. COMPOS., 2011. © 2011 Society of Plastics Engineers

Marx and Engels on the US Civil War: The ‘Materialist Conception of History’ in Action

AbstractMarx’s analysis, supplemented by that of Engels, of the US Civil War is as instructive, if not more, as any of their writings to illustrate their ‘materialist conception of history’. Because the American experience figured significantly in the young Marx’s path to communist conclusions, the outbreak of the War in 1861 obligated him to devote his full attention to its course. His application of their method allowed him to see more accurately the course of the War than his partner. Also, he was able to see what President Abraham Lincoln had to do, that is, to convert the War from one to end secession to one to overthrow slavery, before the President himself. Despite its contradictory outcome, Marx’s expectation that the War would put the US working class on terra firma for the first time was justified.

The Expression Pattern of Annexin A1 in Urinary Bladder Urothelial Carcinoma and Its Clinicopathologic Significance

Annexin A1 (ANXA1) is a 37-kDa protein with calcium and phospholipid binding properties. It is a member of the subfamily A of annexin (ANX), and presents in organisms from molds to mammals. ANX shares a conserved COOH-terminal with repeated domains and an N-terminal region, the variability of which confers specific annexin function. Its anti-inflammatory property is attributed to ANXA1 binding to surface receptors of granulocytes and macrophages, and its ability to inhibit phospholipase A2. It plays various roles in the regulation of apoptosis, intracellular signal transduction, differentiation, and proliferation. ANXA1 is also known to be involved in the carcinogenesis of many tumors. The expression of ANXA1 is increased in hairy cell leukemia, pancreatic cancers, and hepatocellular carcinoma. However, it is decreased in cancers of esophagus, larynx, prostate and B-cell lymphoma. ANX is known to be localized in the cytoplasm and moves to the membrane or the nucleus depending on calcium level and stimulation. Recent studies have shown that specific subcellular localization of ANXA1 is associated with epithelial differentiation and may be a prognostic factor in oral squamous cell carcinoma (SCC). Urothelial carcinoma (UC) of the urinary bladder is the seventh most common cancer worldwide, and comprises approximately 90% of all primary tumors of this organ. Development of UC is associated with chemical exposure, cigarette smoking, schistosomal infections, and genetic alterations. UC is known to progress along two divergent pathways: one is characterized by low grade non-invasive papillary tumors preceded by hyperplasia. The other is that of high grade invasive tumors, which progress from carcinoma in situ (CIS) or arise de novo. While low grade papillary tumors have frequent mutations of HRAS and fibroblast growth factor receptor 3 (FGFR3) genes activating the receptor tyrosine kinase-RAS pathway, high grade invasive tumors harbor defects in the p53 and/or the retinoblastoma protein (RB) pathways. Recently, ANXA1 emerges as a tumorrelated protein in UC, however, the significance of ANXA1 in bladder carcinogenesis is not yet fully understood and study results remain inconsistent. Cui et al. showed that ANXA1 expression was down-regulated in higher histologic grade of UC, but Li et al. reported contradictory outcome with their The Expression Pattern of Annexin A1 in Urinary Bladder Urothelial Carcinoma and Its Clinicopathologic Significance

Risk Stratification for Sudden Cardiac Death: The Need to Go Beyond the Left Ventricular Ejection Fraction.

Sudden cardiac death (SCD) accounts for as many as 450,000 deaths yearly in the United States. Over the last 15 years, many clinical trials have established the effectiveness of an implantable cardioverter-defibrillator (ICD) in reducing sudden and total mortality in patients with structural heart disease. However, controversy remains about exactly how to identify the patients most likely to benefit from an ICD, as well as those who may safely do without an ICD implant. The first primary prevention ICD trials used an abnormal electrophysiological study in addition to a low left ventricular ejection fraction (LVEF) as high-risk markers for SCD. More recent ICD trials selected patients based on the presence of a low LVEF alone. Ideally, noninvasive electrophysiological markers that more directly reflect arrhythmia substrates may better identify patients for prophylactic ICD implant. Several of these markers have been associated with the risk of SCD, but all have yielded contradictory outcome results or have not been tested prospectively. This review focuses on the most promising tests to date, their clinical significance, and their possible use to improve efficacy and efficiency of risk stratification for SCD.

Response of Patient-Derived Non-Small Cell Lung Cancer Xenografts to Classical and Targeted Therapies Is Not Related to Multidrug Resistance Markers

Tumor cells that are nonsensitive to anticancer drugs frequently have a multidrug resistant (MDR) phenotype. Many studies with cell lines and patient material have been done to investigate the impact of different resistance markers at protein and mRNA level in drug resistance but with contradictory outcome. In the present study, 26 well-characterised patient-derived non-small cell lung cancer xenografts were used. The known chemosensitivity to etoposide, carboplatin, gemcitabine, paclitaxel and erlotinib was compared to the protein and mRNA expression of BCRP, LRP, MDR1, and MRP1. Further, four of these xenografts were short-term treated to analyse possible regulation mechanisms after therapeutic interventions. We found a borderline correlation between the bcrp mRNA expression and the response of xenografts to etoposide. All other constitutive mRNA and protein expression levels were not correlated to any drug response and were not significantly influenced by a short term treatment. The present results indicate that the expression levels of MDR proteins and mRNA investigated do not play an important role in the chemoresistance of NSCLC in the in vivo situation.

Adaptation to Human Populations Is Revealed by Within-Host Polymorphisms in HIV-1 and Hepatitis C Virus

CD8+ cytotoxic T-lymphocytes (CTLs) perform a critical role in the immune control of viral infections, including those caused by human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV). As a result, genetic variation at CTL epitopes is strongly influenced by host-specific selection for either escape from the immune response, or reversion due to the replicative costs of escape mutations in the absence of CTL recognition. Under strong CTL-mediated selection, codon positions within epitopes may immediately “toggle” in response to each host, such that genetic variation in the circulating virus population is shaped by rapid adaptation to immune variation in the host population. However, this hypothesis neglects the substantial genetic variation that accumulates in virus populations within hosts. Here, we evaluate this quantity for a large number of HIV-1– (n ≥ 3,000) and HCV-infected patients (n ≥ 2,600) by screening bulk RT-PCR sequences for sequencing “mixtures” (i.e., ambiguous nucleotides), which act as site-specific markers of genetic variation within each host. We find that nonsynonymous mixtures are abundant and significantly associated with codon positions under host-specific CTL selection, which should deplete within-host variation by driving the fixation of the favored variant. Using a simple model, we demonstrate that this apparently contradictory outcome can be explained by the transmission of unfavorable variants to new hosts before they are removed by selection, which occurs more frequently when selection and transmission occur on similar time scales. Consequently, the circulating virus population is shaped by the transmission rate and the disparity in selection intensities for escape or reversion as much as it is shaped by the immune diversity of the host population, with potentially serious implications for vaccine design.

Let the sisters speak

In this paper, I examine how and why the situated knowledge and lived experiences of working-class African American women shape their standpoint on information technology (IT). Using the biblical metaphor of the exodus and narratives of ascent, these women view IT access and training as part of a strategy for escaping poverty and despair. Whereas most of the extant gender and IT research provides rich insights into the marginalization of women, the women in this study felt empowered by IT. This contradictory outcome has three implications for the study of gender and IT. First, researchers must consider the multiple identities such as gender, race, ethnicity, socio-economic status, and sexuality that shape and are shaped by women's engagement with IT. Second, the notion of IT workforce should take into account not only the highly skilled IT workers who design and build IT artifacts, but should also consider the lower skilled workers who indirectly use IT. Third, IT training programs that serve working-class women must go beyond the transfer of IT skills to individuals. They must also redress the persistent structural barriers of poverty, spatial isolation, illiteracy, sporadic work, and racial and ethnic discrimination that systematically limit women's ability to compete for jobs that provide higher incomes, greater safety, more security, full-time hours, increased benefits, higher status, and less stressful work environments.

Evens and Odds in Newtonian Collision Mechanics

Perez Laraudogoitia ([2003]) proposes that self-excitations can prevent non-contact interactions in Newtonian collision mechanics. The proposal is weakened by the apparent arbitrariness of what will be shown as the requirement of only an odd number of sets of some ex nihilo-created self-exciting particles. There is, however, an initial condition such that, without the ex nihilo self-exciting particles, either there is a contradictory outcome, or there is a non-contact configuration law, or there are odds versus evens indeterminacies. With the various odds versus evens arbitrarinesses and other such difficulties, there seems to be an ontological unsatisfactoriness in the speed-unbounded Newtonian collision system.

Prognostic Factors of Maxillary Sinus Malignancies

Analysis of a series of tumors of the maxillary sinus show contradictory outcome data. The purpose of this article was to study the prognostic factors that may have implications for patient management. We present a retrospective review of 57 patients who underwent a maxillectomy over a 20-year period. At the time of presentation, 86% of patients had advanced local disease (T3-T4). The 5-year disease-specific survival rate of this series was 39%. No significant differences on survival were observed according the histology of the tumor (p = 0.213), extension to the infratemporal fossa (p = 0.314), and postoperative radiotherapy (p = 0.723). Factors that revealed a significant reduction of survival were skull base involvement (p = 0.013), involvement of the orbit (p = 0.043), and recurrent disease (p = 0.048). Multivariate analysis confirmed that the skull base and orbital involvement were significantly associated with disease-specific survival. Advanced T stage, base of skull involvement, orbital extension, and local recurrence are highly predictive of poor survival.

Re-evaluation of inhibin α subunit as a tumour suppressor in prostate cancer

Inhibin is a member of the TGF-β superfamily of growth and differentiation factors and a tumor suppressor. Consistent with the tumor suppressive function of the inhibin α subunit in prostate cancer, we reported a loss of gene expression due to DNA hypermethylation and loss of heterozygosity (LOH) as well as down regulation of inhibin α subunit immunoreactivity. Paradoxically, an expanded study to evaluate the prognostic significance of inhibin α subunit expression in men with prostate cancer resulted in a contradictory outcome, whereby an up-regulation of subunit expression was recorded. In seeking a more comprehensive explanation for all data sets, we offer a unifying hypothesis. We propose that the tumor suppressor activities of the inhibin α subunit dominate in non-malignant tissue, but its oncogenic activities emerge during tumorigenesis. An explanation such as this, involving a switch in gene function from being tumor suppressive to pro-oncogenic, may account for the discrepant findings in other types of cancer.

Book Review: AN INTRODUCTION TO EXECUTIVE COMPENSATION

This book examines the different components of executive pay packages such as basic salary, stock grants, stock options and also factors that determine the fulfilment of the agreement during and after the executive’s time in office. With data gathered from SEC filings, business publications (e.g. Forbes, The Wall Street Journal, Fortune, Business Week) and a data base (i.e. ExecuCom from Standard & Poors, which contains information on the remuneration of the top management of 1500 firms in the USA), the author provides a detailed analysis of the design of executive compensation. In more than 60 statistical tables, 20 exhibits of extract of real life contractual pay agreements, and numerous graphs and figures, he provides a comparative analysis of the usage, magnitude, and dollar value of the different components of executive pay packages. The life cycle of an executive compensation agreement begins when a firm launches a search for an individual to fill the top post and, in theory, ends when the executive actually receives money in his or her bank account. Most executives get rewarded but some may never see the pay check. This occurs when performance and targets have not been met. But many get rewarded even when performance is poor and sometimes, leaving shareholders vehemently vociferous. To explain these contradictions, the author reviews some of the theories that underpin the mechanics of modern finance and economics. These include, for example, the risk–reward characteristics of each individual CEO, owner–manager conflict, which is captured in the agency theory and the class hegemony and figure head theories, which partly explain the mythology of CEOs today. He explores the notion of incentive and the extent to which it can contribute to productivity or add value to shareholders as propounded by the tournament theory. The author shows how these theories interplay in the design of an executive compensation package with several illustrations of their mutually reinforcing effects and also of their contradictory outcome. The design and outcome of executive pay contracts also depends on many factors. Some such as statutory regulations and tax are outside of the firm control. Others such as ownership structure, financial and accounting results are endogenous to the firm. The design process can also be influenced by informal institutions (e.g. shareholder activists) and changing laws and economics environments. Within the firm, formal bodies such as compensation committees may provide additional input. They influence the design process by highlighting the opinion of major stakeholders and also, as they seek to strike a balance between objective criteria (e.g. benchmarking to peer review) and subjective considerations (i.e. the relations between CEOs and individual members of the firm’s Board). Analysing executive compensation can be complicated by the fact that new issues emerge as current ones are addressed through regulation and or improved corporate governance. Perhaps, for this reason, some important issues are inevitably not given the in-depth attention they

How Good is the South African Media for Democracy?

ABSTRACT This article argues that media are not merely conduits for the government, political parties or citizens in post-apartheid South Africa, but have emerged as autonomous power centres in competition with other power centres. The transformation of the South African media since the demise of apartheid has taken the form of significant changes in the media's environment. There is now freedom to criticise the government, unprecedented access to state-held information, and the state's monopoly over broadcasting and diversification of commercial print media has been broken. Yet these developments have not in themselves had very many positive effects on democratic participation, and the media have not engaged in an effective critique of the country's continuing high levels of social and economic inequality or the structural constraints on the democratisation of its political life. Jacob examines the nature of South Africa's political transition from white-domination and apartheid regime to negotiated and "mediated democracy" that has adopted neoliberal economic policies to ascertain the reasons for this seemingly contradictory outcome.

Attention training in the cognitive rehabilitation of schizophrenic patients:a review of efficacy studies

Objective: To review the literature on effects of attention and cognitive training on attentional functioning in schizophrenic patients. Method: Relevant efficacy studies were identified by literature searches (in Medline, Current Contents, Psyclit, and Psyndex databases) and through the reference lists of key papers. Results: Re‐examination of findings from nine methodologically adequate studies using computer‐based or non‐computer‐based training procedures provided inconsistent results. On 16 of 35 outcome measures significant performance improvements were observed from pre‐treatment to post‐treatment but on the majority of the applied measures no performance improvement could be determined. In general, treatment effect sizes but also power of tests were low. For nearly all the outcome measures for which differential training effects were reported there also exist contradictory outcome results. Conclusion: There is inconclusive evidence that attention training is effective in schizophrenia. Longitudinal efficacy studies are needed in which different aspects of attention are systematically exercised and assessed.

Attention training in the cognitive rehabilitation of schizophrenic patients: a review of efficacy studies.

To review the literature on effects of attention and cognitive training on attentional functioning in schizophrenic patients. Relevant efficacy studies were identified by literature searches (in Medline, Current Contents, Psyclit, and Psyndex databases) and through the reference lists of key papers. Re-examination of findings from nine methodologically adequate studies using computer-based or non-computer-based training procedures provided inconsistent results. On 16 of 35 outcome measures significant performance improvements were observed from pre-treatment to post-treatment but on the majority of the applied measures no performance improvement could be determined. In general, treatment effect sizes but also power of tests were low. For nearly all the outcome measures for which differential training effects were reported there also exist contradictory outcome results. There is inconclusive evidence that attention training is effective in schizophrenia. Longitudinal efficacy studies are needed in which different aspects of attention are systematically exercised and assessed.

Debt neutrality: theory and evidence from developing countries

This paper reviews the Ricardian-Barro hypothesis and tests the basic postulate of the model for a sample of developing countries including Mexico and Venezuela. Two specifications are utilized, the first is based on the simple consumption model associated with the work of Kormendi (1983). The alternative is based on a model developed by Haque and Montiel (1987). The outcome of the two-stage least square estimation technique rejected the hypothesis in Mexico, Trinidad and Tobago and Venezuela, all countries, which underwent adjustment programmes. However these results were reversed when the alternative model was utilized due to liquidity constraint and possibly the Yaari-Blanchard effect. The contradictory outcome alludes to the sensitivity of the results to the model specified.

Educating in Global Times: choice, charter and the market

The concepts of choice and charter are powerful and seductive images, evoking the sense of freedom, a continuity and enhancement of a freedom, democracy, negotiation, consensus, fairness and accountability. These images sell well, and most people would not want to oppose them. Yet the words themselves can be misleading. Often they can mean different things to different people. Our first task in this paper will be to try to get a grip on these slippery meanings, which, it could be argued, are used as a Trojan horse to bring fast capitalism into our classrooms. For this reason, these highly problematic developments need to be decoded, stripped naked, to use a phenomenological imagery, to reveal their Paleolithic conservatism, but also their social consequences. To begin our discussion, I would like to argue that because of the pluralistic and antagonistic make-up of contemporary societies, educational or public policies in general need to be to some extent ambiguous in order to elicit a broad social consensus. It is, therefore, to be expected that the implementation of public policies will often produce practical outcomes radically different from those anticipated in policy documents (cf. Torres, 1989). However, when these policies are intentionally couched in progressive terms in order to ensure consensus but also to achieve a hidden, often even contradictory outcome, the policy-making process moves beyond the realm of consensus seeking into a space reserved for a strategic manipulative action. This paper argues that to some extent this has always been the case with educational policy in North America since the emergence of early capitalism in the second half of the 19th century. The paper further argues that the current neoliberal educational policies in Canada, the UK, and New Zealand have shifted most decidedly towards the strategic, manipulative mode of policy making. This shift is examined in the context of the highly problematic concepts of choice

Implication operators versus regression analysis: Application to time series data

This article constitutes a study which compares the performance of implication operators to that of linear regression (Ordinary Least Squares—OLS) method. the emphasis of this study is focused on advantages versus disadvantages of each method from the standpoint of practical application of the method. Thus both methods are applied to solve identical problems, and then both—the process of application as well as the consistency of results—are studied. For the purpose of testing the consistency of results, both methods are applied to several ranges of the time series data.1 As the research progressed, it became apparent that conceptual and theoretical advantages of implication operator methodologies over the regression methods2 are countered by the incompleteness of research in that area (of implication operators) as reflected by the unavailability of significance indicators. Thus, both methods have some advantages and some disadvantages. the methodology of implication operators has a potential to become the superior method of the two,3 once the research and development of these techniques is complete, and the problem of significance tests is solved. But until then, the preferred approach is to utilize both methods to extract maximum information about phenomena under investigation, and then to apply common sense to sort out and interpret the results. As a greater number of relevant but independent methods of analysis are applied to the investigation process, the results could either reinforce one another-if they at least approximately point in the same direction-or call for some caution in the case of contradictory outcome. © 1993 John Wiley & Sons, Inc.