Last Resort (last + resort)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


MICROECONOMIC FOUNDATION OF LENDER OF LAST RESORT FROM THE VIEWPOINT OF PAYMENTS*

THE JAPANESE ECONOMIC REVIEW, Issue 2 2008
YASUO MAEDA
We construct a model to clarify the mechanism by which the lender of last resort (LLR) can prevent bank runs. In our model, a bank has both the function of facilitating payments in which inside money is settled using outside money and the function of financial intermediation using a deposit contract. The deposit contract might lead to a bank run, and might even contribute to an efficient allocation. Therefore, to consider the liquidity supply by the LLR, we introduce the deposit contract as a factor of instability in the banking model. We show that the LLR can assist in the recovery of both the efficiency and stability of the financial system. [source]


The UK climate change levy: good intentions but potentially damaging to business

CORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 4 2004
Ann Hansford
The climate change levy (CCL) is an important part of the UK Government's response to being a signatory to the Kyoto agreement. Prior to the introduction of the levy there were sharply contrasting views, which ranged from Sir Robert May's view that it was ,an opportunity, not a threat' to the CBI's view that it should be an option of last resort. In order to consider the impact of the CCL on UK businesses, interviews were undertaken within one ,not for profit' and two commercial organizations to explore reactions to its introduction. The findings from the study suggest the primary foci of concerns are based upon increases to the cost base and threats to international competitiveness. Further, there is doubt that the ambitious targets signed up to by the UK Government are likely to be achieved, unless there are fundamental changes in support for businesses, or the targets are revised. Copyright © 2004 John Wiley & Sons, Ltd and ERP Environment. [source]


MANDATORY HIV TESTING IN PREGNANCY: IS THERE EVER A TIME?

DEVELOPING WORLD BIOETHICS, Issue 1 2008
RUSSELL ARMSTRONG
ABSTRACT Despite recent advances in ways to prevent transmission of HIV from a mother to her child during pregnancy, infants continue to be born and become infected with HIV, particularly in southern Africa where HIV prevalence is the highest in the world. In this region, emphasis has shifted from voluntary HIV counselling and testing to routine testing of women during pregnancy. There have also been proposals for mandatory testing. Could mandatory testing ever be an option, even in high-prevalence settings? Many previous examinations of mandatory testing have dealt with it in the context of low HIV prevalence and a well-resourced health care system. In this discussion, different assumptions are made. Within this context, where mandatory testing may be a strategy of last resort, the objections to it are reviewed. Special attention is paid in the discussion to the entrenched vulnerability of women in much of southern Africa and how this contributes to both HIV prevalence and ongoing challenges for preventing HIV transmission during pregnancy. While mandatory testing is ethically plausible, particularly when coupled with guaranteed access to treatment and care, the discussion argues that the moment to employ this strategy has not yet come. Many barriers remain for pregnant women in terms of access to testing, treatment and care, most acutely in the southern African setting, despite the presence of national and international human rights instruments aimed at empowering women and removing such barriers. While this situation persists, mandatory HIV testing during pregnancy cannot be justified. [source]


Epilepsy surgery in children , no longer a last resort

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2010
J HELEN CROSS
No abstract is available for this article. [source]


Barriers in initiating insulin therapy in a South Asian Muslim community

DIABETIC MEDICINE, Issue 2 2010
U. S. Ahmed
Diabet. Med. 27, 169,174 (2010) Abstract Aims, Insulin therapy is often required for optimal glycaemic control. Pakistani patients display reluctance to use insulin. We aimed to determine the reasons for this and to assess impressions after initiation of insulin in our patients. Methods, Patients with Type 2 diabetes attending Aga Khan Hospital were surveyed using a questionnaire detailing opinions on insulin use. This was a cross-sectional study of two groups, one with no experience with insulin use and the other who were insulin users. Results, Three hundred and seventeen patients were interviewed, 55.8% male, mean age 53.6 years. Of 210 patients who had never used insulin, 72.9% felt insulin was a measure of last resort and 45.2% thought that tolerance developed to insulin. Only 45.7% felt insulin would reduce complications, while 24% thought that insulin use would interfere with religious obligations. Thirty-four percent thought that it was difficult or very difficult to learn insulin administration, 41% felt that they could not self-inject even if absolutely necessary and 25% stated they would not use insulin in any circumstances. There was an association of lack of education with negative image of insulin usage. Among 107 patients using insulin, 52.3% were hesitant before initiation. However, 78.5% noted an improvement in glucose control and 86% said they would recommend insulin to others. Conclusions, Reluctance to use insulin prior to initiation is high, but views improve considerably after insulin initiation. Further awareness of the benefits of insulin use needs to be highlighted and the concerns of our population addressed. [source]


CENTRAL BANKS: FROM POLITICALLY INDEPENDENT TO MARKET-DEPENDENT INSTITUTIONS

ECONOMIC AFFAIRS, Issue 3 2009
Pedro Schwartz
Responses to the financial crisis are undermining the Chinese walls painfully built between monetary and fiscal authorities. Central banks and state treasuries are working side by side as lenders of last resort. Central banks are helping economic ministers with purchases of public debt and discounting of private paper. Regulation and control of financial institutions is now a political football. Central banks must be seen again as market-dependent institutions in a world of currency competition. Privatisation in law or in fact is back on the table. [source]


Crack,heroin speedball injection and its implications for vein care: qualitative study

ADDICTION, Issue 11 2007
Tim Rhodes
ABSTRACT Background We report on an exploratory qualitative study investigating drug injectors' narratives of vein damage and groin (femoral vein) injection associated with the injection of crack,heroin speedball. Methods We undertook 44 in-depth qualitative interviews among injectors of crack,heroin speedball in Bristol and London, England, in 2006. Findings The data suggest an emerging culture of crack-based speedball injection. Injectors' narratives link speedball injection with shifts towards groin injection articulated as an acceptable risk, and not merely as a last resort in the face of increased vein deterioration associated with speedball. Accounts of vein damage linked to speedball emphasize ,missed hits' related to the local anaesthetic action of crack, the excess use of citric in the preparation of speedball injections and ,flushing' when making a hit. We find that groin injection persists despite an awareness of health risks and medical complications. Conclusions We emphasize an urgent need for reviewing harm reduction in relation to vein care in the context of shifts to crack-based speedball injection, and the use of the femoral vein, among UK injectors. There is an additional need for interventions to promote safer groin and speedball injecting as well as to prevent transitions toward groin and crack injection. [source]


"MORE OF A STREET COP THAN A DETECTIVE": AN ANALYSIS OF THE ROLES AND FUNCTIONS OF PARENTING COORDINATORS IN NORTH CAROLINA

FAMILY COURT REVIEW, Issue 4 2010
Sherrill W. Hayes
This research project examined roles and functions of parenting coordinators (PCs) identified by AFCC's Guidelines for Parenting Coordination and other literature. The researcher used a semi-structured interview schedule that included information about practices, procedures, and a series of five case-based vignettes that contained commonly occurring ethical and legal dilemmas in PC practice. The results found that PCs generally saw their role as enforcers of existing orders and primarily used skills in conflict management, parent education, and information coordination with other professionals. PCs would use arbitration powers to make minor decisions or refer to court as a last resort. [source]


A cost evaluation of treatment alternatives for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil

HAEMOPHILIA, Issue 5 2007
M. C OZELO
Summary., The first-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil is currently activated prothrombin complex concentrate (aPCC), with recombinant activated factor VII (rFVIIa) used as second-line therapy or as a last resort. The aim of this study was to determine the cost and effectiveness of these treatments from the perspective of the Brazilian National Health Service. A decision analysis model was constructed to assess total direct medical costs (including drug costs, costs of outpatient or inpatient care, ambulance transportation and cost of concomitant medications) of first-line treatment with aPCC or rFVIIa. Clinical outcome and resource utilization data were obtained both retrospectively and prospectively and validated by the consensus of an expert panel of Brazilian haematologists. A total of 103 bleeds in 25 patients were included in the analysis. rFVIIa resolved bleeds more quickly (4.4 h) than aPCC (62.6 h) and was more effective (100% vs. 56.7% respectively). Mean total direct medical costs (from initiation to cessation of bleed) were estimated to be US$13 500 (aPCC) and US$7590 (rFVIIa). Extensive sensitivity analyses confirmed the cost-effectiveness of rFVIIa. Compared with aPCC, rFVIIa was more effective and less expensive when used as first-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil. rFVIIa should be considered a first-line treatment for the management of these patients. [source]


Capturing the voice of older consumers in relation to financial products and services

INTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 2 2010
Carol Brennan
Abstract The purpose of this pilot study was to focus on the suitability of selected financial products for older people. Bank accounts and equity release products were selected for this study by an expert advisory panel. New marketing initiatives are being used to promote bank accounts, including forms of insurance, for the ,50+' market. Also, older people are now expected to provide for their retirement and it is anticipated that equity release will be one product which may be used to fund and maintain consumer lifestyles. In the first phase of the study, a questionnaire was distributed to 152 people aged over 50 years in Scotland. Eighty-three were completed, a response rate of 55%. The results informed the development of questions for the second phase which were discussed with 46 participants via the World Café in June 2008, enabling a deeper insight into their opinions. The research found that consumers had lost trust in financial product and service providers because of the perceived excessive profits of banks and lack of customer service. Further, many products and services were prohibited for or incurred extra costs to those aged over 60 or 65 years, leaving limited choices, and equity release products were seen as a last resort for those in financial difficulty. Although the profitability of banks has changed dramatically since the completion of data collection, the issues identified by older consumers in Scotland will be of international interest. The demographic changes resulting in an increasing proportion of elderly people in the population are reflected throughout the UK and many Organisation for Economic Co-operation and Development countries. Similar financial products and services, which were the focus of this study, are promoted internationally, offering opportunities to replicate the research methods. [source]


Attitudes of Egyptian nursing home residents towards staying in a nursing home: a qualitative study

INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 4 2009
Thomas Boggatz RN
Aim., The aim of this study was to identify the attitudes of Egyptian nursing home residents towards staying in a nursing home and to differentiate between various types of these attitudes. Background., The number of older persons in Egypt who require nursing care is increasing. In response, nursing homes in bigger cities like Cairo were founded, although family care seems to be the prevalent norm. Methods., Semi-structured guideline interviews were performed with 21 residents from four different nursing homes in Cairo. Interviews were analyzed using qualitative content analysis. Findings., One category of resident was those who were sent to the nursing home by persons closely related to them. Another category made their own decision to move to a nursing home. Relationships with social networks and self-help abilities are factors of importance in influencing decision-making. Conclusion., Nursing homes in Egypt fulfil different functions for different types of older persons. Charitable institutions are a last resort for those with no income and a disrupted social network. For better-off older persons, nursing homes may provide the benefits of socialising with peers and receiving medical treatment. [source]


Rethinking UK small employers' skills policies and the role of workplace learning

INTERNATIONAL JOURNAL OF TRAINING AND DEVELOPMENT, Issue 2 2008
John Kitching
Small business employers in the UK are widely perceived as adopting a reactive, ad hoc approach to employee skill formation. Employer reliance on workplace learning is often treated, explicitly or implicitly, as evidence of such an approach. Small employers' approaches to skill creation are investigated using data from two employer samples. Three main conclusions challenging these arguments are presented. First, small employers' skills policies are highly diverse: strategic, tactical and restrictive policies are distinguished. Second, employers perceive particular benefits in enabling workplace learning; simplistic views that a reliance on workplace learning necessarily constitutes an inferior last resort for those employers unable to provide access to external training are rejected. Third, enabling workplace learning is important to strategic employers, as well as to those attaching a lower value to skills. For some employers, the workplace is the primary source of new knowledge and skills because they are unavailable elsewhere. The prevalence, diversity and significance of workplace learning in small businesses require a reappraisal of UK small employers' skills policies. The implications for research, practice and policy are discussed. [source]


Effect of immunoadsorption on refractory idiopathic focal and segmental glomerulosclerosis,

JOURNAL OF CLINICAL APHERESIS, Issue 4 2006
Christian Kuhn
Abstract A case of a young adult with refractory nephrotic syndrome due to focal segmental glomerulosclerosis is reported. Several treatments had been used without success including steroids, cyclophosphamide, cyclosporine A, tacrolimus, and mycophenolate mofetil. Immunoadsorption was performed as a last resort to manage the nephrotic syndrome, which led to a drastic urinary protein reduction. We review the literature supporting immunoadsorption in primary focal segmental glomerulosclerosis. J. Clin. Apheresis. © 2006 Wiley-Liss, Inc. [source]


Diabetic persons with foot ulcers and their perceptions of hyperbaric oxygen chamber therapy

JOURNAL OF CLINICAL NURSING, Issue 14 2009
Hjelm Katarina
Aim., To elucidate how diabetic patients with limb-threatening foot lesions perceive and evaluate content and organisation of treatment in a multi-place hyperbaric oxygen chamber. Background., To our knowledge there are no patients' evaluations of diabetes care in a high-technology area like the hyperbaric oxygen chamber. The burden on persons with diabetic foot complications might be increased if adjuvant therapy with hyperbaric oxygen therapy (HBOT) within a locked airtight vessel is given. Design., Explorative study. Participants., Participants were included in the HODFU study, a prospective randomised double-blind study, designed to evaluate whether HBOT heals more chronic foot ulcers than placebo treatment with hyperbaric air. Six females and 13 males, aged 44,83 years (median 70), with diabetic foot ulcers, participated. Method., Focus-group interviews by an external evaluator. Results., Management was perceived as well-functioning with competent staff delivering quick treatment in a positive manner and in good co-operation. HBOT sessions, in groups, were described as unproblematic and pleasant, through sharing experiences with others, although time-consuming and tiring. Recognising the responsible physician and communication with other physicians in the health-care chain was perceived as problematic. Placebo treatment, when given, did not reveal any problems; many perceived HBOT as the last resort and respondents had a negative view of future health and expressed fears of new wounds and amputation. Conclusions and relevance to clinical practice., From patients' perspective HBOT in the delivered health-care model was perceived as well-functioning, taking into consideration both technical and relational aspects of care in this high-technology environment. Communication with the patient and between different care givers, with a consistent message given and information about who is responsible and to whom one should turn, wherever treated, is the most crucial aspect of the model. Future fears need to be recognised and group interaction can be encouraged to share the burden of disease. [source]


The State as Parent: The Reluctant Parent?

JOURNAL OF LAW AND SOCIETY, Issue 1 2008
The Problems of Parents of Last Resort
This paper will explore the idea of the local authority as a reluctant parent. It will consider the extent to which this reluctance is produced by the care proceedings system and its consequences for children. Local authorities are both expected to refrain from intervening (care proceedings are a measure of last resort) and to be fully prepared for intervention (whilst leaving children with their parents). Amongst the themes which will be developed here are the impact of the juridification of social work and the emphasis on the courts for holding local authorities to account; the balance between voluntary accommodation and compulsory care; and the problems of resourcing care services. Its main focus will be on children who enter care because of abuse or neglect. Its thesis is that the conflicting expectations on local authorities, resource constraints, and considerations of legal process make them reluctant parents. [source]


The Federal Home Loan Bank System: The Lender of Next-to-Last Resort?

JOURNAL OF MONEY, CREDIT AND BANKING, Issue 4 2010
ADAM ASHCRAFT
government-sponsored enterprise; lender of last resort; liquidity The Federal Home Loan Bank (FHLB) System is a large cooperatively owned government-sponsored liquidity facility that lends predominately to U.S. depository institutions. This paper documents the significant role played by the FHLB System at the outset of the recent financial crisis and provides evidence on the uses of FHLB funding by member banks and thrifts during that time. We then compare lending activity by the FHLB System and the Federal Reserve during 2007 and 2008, discuss the types of institutions seeking government-sponsored liquidity at various times, and identify the trade-offs faced by borrowers eligible to tap liquidity from both facilities. [source]


Managing the risks of physical intervention: developing a more inclusive approach

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2010
L. HOLLINS bsc physiotherapy
Accessible summary ,,It is imperative that the use of physical interventions be reduced. However, when they are used the safety of recipients must be maximized. ,,A focus on the ,prone restraint position' has led to a narrowed understanding of the risks associated with the application of force during restraints. ,,The ,transitional stabilizing position' offers a platform upon which to consider the broader risks arising during restraints. ,,Training staff to manage such situational risks, using a variation on the existing ABC safety check could be instrumental in reducing the likelihood of adverse outcomes associated with restraints. Abstract Since psychiatry evolved as a professional discipline, mental healthcare professionals have had to, as a last resort, physically intervene to manage physically aggressive patients. In the United Kingdom, physical intervention techniques migrated from the prison service in the mid 1980s where there was extensive use of two particularly controversial practices; ,pain compliance' and the ,prone restraint position'. This paper examines how the classification of the ,prone restraint position' has led to a narrowed focus on one technique and a resultant misunderstanding around the wider risks associated with the applying force and managing restraints. The paper goes on to propose the ,transitional stabilizing position' (TSP) as an alternative concept and puts forward a dynamic risk assessment model. It explores how a shift in staff training away from developing pure competence in the performance of tightly specified techniques to managing the patient in TSPs could conceivably reduce the relatively low risk of death or serious injury associated with the application of restraint techniques to an even lower level. [source]


Restraint and seclusion: a distressing treatment option?

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 7 2009
A. MORAN phd bns (hons) rgn
The effectiveness of restraint and seclusion interventions in the nursing management of disturbed and aggressive clients remains questionable. Considerable debate continues regarding the use of these treatment options in psychiatric hospitals. The existing literature suggests that the controversial nature of restraint and seclusion creates a complex dilemma for nurses, which initiates emotional distress. This study specifically explored the emotions and feelings experienced by a group of psychiatric nurses working in Ireland in relation to incidents of restraint and seclusion. A qualitative research approach was employed incorporating focus group discussions. A total of 23 nurses participated in three focus group interviews. The data were analysed using qualitative interpretive analysis. Three themes were created consisting of: (1) the last resort , restraint and seclusion; (2) emotional distress; and (3) suppressing unpleasant emotions. It is suggested that the nurses' experience of restraint and seclusion created a dynamic movement between the release and suppression of distressing emotions. The oscillatory characteristics embedded within the nurses' emotional responses were reminiscent of a model of suffering developed by Morse in 2001. Consequently, this model is incorporated throughout the discussion of the findings to provide a more in-depth description of the emotional distress experienced by the nurses in the study. [source]


OUTSOURCING: TRANSACTION COST ECONOMICS AND SUPPLY CHAIN MANAGEMENT,

JOURNAL OF SUPPLY CHAIN MANAGEMENT, Issue 2 2008
OLIVER E. WILLIAMSON
This article examines outsourcing from the transaction cost economics (TCE) perspective. The transaction is made the basic unit of analysis and the procurement decision, as between make and buy, is made (principally) with reference to a transaction cost economizing purpose. As sketched herein, the ease of contracting varies with the attributes of the transaction, with special emphasis on whether preserving continuity between a particular buyer,seller pair is the source of added value. The basic regularity is this: as bilateral dependency builds up, the efficient governance of contractual relations progressively moves from simple market exchange to hybrid contracting (with credibility supports) to hierarchy. This last corresponds to the "make" decision, which, as viewed from the TCE perspective, is viewed as the organization form of last resort. The article successively describes the lens of contract approach to economic organization, the operationalization of TCE, different styles of outsourcing, qualifications to the foregoing and the main lessons of TCE for the supply chain literature. [source]


Maintaining knowledge management systems: A strategic imperative

JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY, Issue 7 2005
Kevin C. Desouza
Most organizations have reported dismal returns on their investments in knowledge portals,Intranet Web sites aimed at enabling the storage and exchange of explicit knowledge artifacts. In our research, we were surprised to find that knowledge workers have for the most part abandoned the use of knowledge portals. Moreover, in cases where they do turn to knowledge portals they use it as a last resort. In this brief communication, we call attention both to research and practice to help transform current knowledge portals to ones that are more sensitive to the issues faced by practitioners. To this end, we will elaborate on the need to pay attention to maintenance of knowledge management portals. [source]


Ease and effectiveness of costly autotomy vary with predation intensity among lizard populations

JOURNAL OF ZOOLOGY, Issue 3 2004
William E. Cooper Jr
Abstract Costly anti-predatory defences are used in ecological time and maintained in evolutionary time by natural selection favouring individuals that survive through their use. Autotomy of expendable body parts is a striking example of a defence having multiple substantial costs, including loss of ability to use the same defence, loss of energy, and decreased growth, reproductive success and survival following autotomy, plus the energetic cost of replacing the lost body part in species capable of regenerating them. Our study shows that autotomy in the lacertid lizard Podarcis lilfordi reduces sprint speed, indicating decreased capacity to escape as well as the loss of energy. Autotomy carries substantial cost, and thus should be avoided except as a last resort. Ease of autotomy and post-autotomic movements were studied in three populations of lacertid lizards. Two were islet populations of P. lilfordi from Aire (lowest predation pressure) and Colom (intermediate predation pressure) off Minorca. The third was a mainland population of Podarcis hispanica, a closely related species from the mainland of the Iberian Peninsula where predation pressure is higher than on the islets. As predicted, a suite of autotomic traits increases the effectiveness of autotomy as a defence as predation pressure increases. With increasing predation pressure, the frequency of voluntary autotomy increases, latency to autotomy decreases, pressure on the tail needed to induce autotomy decreases, vigour of post-autotomic tail movements increases, and distance moved by the shed tail increases. Additional changes that might be related to predation pressure, but could have other causes, are the presence of tail coloration contrasting with body coloration except under the lowest predation pressure (Aire) and longer tails in the mainland species P. hispanica. Correspondence between predation pressure and the suite of autotomic traits suggests that autotomy is an important defence that responds to natural selection. Comparative data are needed to establish the generality of relationships suggested in our study of only three populations. [source]


Aripiprazole: A treatment for severe coprolalia in "refractory" Gilles de la Tourette syndrome

MOVEMENT DISORDERS, Issue 3 2008
Mouna Ben Djebara MD
Abstract Coprolalia is one of the most distressing symptoms in Gilles de la Tourette syndrome. We report on a 28-year-old man with severe coprolalia at the forefront of symptoms, which had a dramatic impact on his social and professional life and that did not fluctuate for years. Moreover, he presented hypersensitivity to neuroleptics. The use of aripiprazole, as a last resort, induced a 75% of improvement of his symptoms with good tolerance. This suggests that aripiprazole constitutes a valuable therapeutic in coprolalia. Moreover, its biochemical class specificity makes it an alternative for patients hypersensitive to other classes of neuroleptics. © 2007 Movement Disorder Society [source]


Latest news and product developments

PRESCRIBER, Issue 10 2008
Article first published online: 3 JUN 200
Glitazones more than double fracture risk An analysis of the UK General Practice Research Database has found that both glitazones increase the risk of fracture more than two-fold (Arch Intern Med 2008;168:820-5). Compared with nonusers, the odds ratio for fracture (mostly hip and wrist) was 2.59 for pioglitazone and 2.38 for rosiglitazone. The risk increased with dose but was unrelated to age and sex. Reduce antipsychotics in dementia patients Antipsychotics should be prescribed for patients with dementia only as a last resort at times of severe distress or critical need, the All-Party Parliamentary Group on Dementia has concluded. Its inquiry (available at www.alzheimers.org.uk) found that antipsychotics are being prescribed for patients with mild behavioural symptoms and for prolonged periods despite the limited benefits they offer and the risk of serious adverse effects such as stroke. Contributory factors include lack of training for staff, inadequate leadership and exclusion of family and friends from decisions about treatment. High-dose atorvastatin in chronic kidney disease High-dose atorvastatin (Lipitor) reduces cardiovascular events in patients with chronic kidney disease (CKD) more than a low dose , despite similar reductions in LDL-C (J Am Coll Cardiol 2008;51:1448-54). A post hoc subgroup analysis of the Treating-to-New-Targets study involving 10 001 patients with CHD, with or without CKD, found that atorvastatin 10 and 80mg per day reduced LDLC and triglycerides to similar levels; there was no change in HDL-C. After a median follow-up of five years, the incidence of cardiovascular events in patients with CKD was 9.3 per cent at 80mg per day and 13.4 per cent at 10mg per day (number needed to treat to prevent one event, NNT, 24). In patients with no CKD, the corresponding figures were 7.9 vs 9.2 per cent (NNT 74). There was no difference in all-cause mortality; adverse events were more frequent at the higher dose. COX-2 NSAIDs not more cost-effective An economic analysis of COX-2 selective NSAIDs has concluded that they are not more cost effective than older agents plus a proton pump inhibitor (PPI) in the treatment of osteoarthritis and rheumatoid arthritis (Health Technology Assessment 2008;12:No. 11). The analysis concluded that selective and nonselective NSAIDs were similarly effective but selective agents were associated with a lower risk of upper GI events and a higher risk of cardiovascular events. However, the available evidence includes only low numbers of events and further studies are needed. Compared with ibuprofen or diclofenac plus a PPI, the COX-2 selective NSAIDs look ,generally unattractive from a cost effectiveness point of view', even in high-risk patients with a history of peptic ulcer. There were insufficient data to allow a reliable comparison within the COX-2s. Naftidrofuryl helps intermittent claudication Naftidrofuryl increases pain-free walking distance (PFWD) in patients with intermittent claudication, a new Cochrane review has shown (Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001368. DOI: 10.1002/ 14651858.CD001368.pub3; also see page 49 in this issue). The meta-analysis of six trials involving a total of 1083 patients found that, compared with placebo, naftidrofuryl increased PFWD by over a third with a proportion successfully treated of 20 per cent (NNT 4.5). Coversyl Arginine To clarify any confusion following our recent news item (Perindopril brand switch, 19 April issue, page 12), Servier has asked us to reiterate that the new formulations Coversyl Arginine 2.5, 5 and 10mg are equivalent to 2, 4 and 8mg of the discontinued Coversyl formulation. Coversyl Arginine contains perindopril arginine, a salt that offers greater stability and a longer shelf-life. Prescriptions for the Coversyl brand of perindopril must in future be written as Coversyl Arginine in its revised strengths. Coversyl Plus has also been replaced by Coversyl Arginine Plus and the same revised dosages apply. Generic formulations of perindopril remain unaffected. Copyright © 2008 Wiley Interface Ltd [source]


MICROECONOMIC FOUNDATION OF LENDER OF LAST RESORT FROM THE VIEWPOINT OF PAYMENTS*

THE JAPANESE ECONOMIC REVIEW, Issue 2 2008
YASUO MAEDA
We construct a model to clarify the mechanism by which the lender of last resort (LLR) can prevent bank runs. In our model, a bank has both the function of facilitating payments in which inside money is settled using outside money and the function of financial intermediation using a deposit contract. The deposit contract might lead to a bank run, and might even contribute to an efficient allocation. Therefore, to consider the liquidity supply by the LLR, we introduce the deposit contract as a factor of instability in the banking model. We show that the LLR can assist in the recovery of both the efficiency and stability of the financial system. [source]


Successful Salvage of Kidney Allografts Threatened by Ureteral Stricture Using Pyelovesical Bypass

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010
R. A. Azhar
Ureteral stricture is the most common urologic complication after renal transplantation. When endourologic management fails, open ureteral reconstruction remains the standard treatment. The complexity of some of these procedures makes it necessary to explore other means of repair. This study evaluated the intermediate-term outcome of subcutaneous pyelovesical bypass graft (SPBG) on renal transplant recipients. We reviewed 8 patients (6 male and 2 female; mean age 52 years) with refractory ureteral strictures postrenal transplantation, who received SPBG as salvage therapy. All patients failed endourologic management and half failed open management of their strictures. After a mean follow-up of 19.4 months, 7 out of 8 renal grafts have good function with mean GFR of 58.5 mL/min/1.73 m2, without evidence of obstruction or infection. One patient lost his graft due to persistent infection of the SPBG and one patient developed a recurrent urinary tract infection managed with long-term antibiotics. SPBG offers a last resort in the treatment of ureteral stricture after renal transplantation refractory to conventional therapy. [source]


A study of meiotic segregation of chromosomes in spermatozoa of translocation carriers using fluorescent in situ hybridisation

ANDROLOGIA, Issue 1 2010
A. Perrin
Summary In the infertile male population, there is a 2,20-time higher probability of having a structural chromosomal abnormality than in general population. Generally, these men have a normal phenotype but they can have sperm abnormalities. As they can produce a variable proportion of unbalanced gametes, it is important to evaluate the percentage of unbalanced chromosomal spermatozoa to assess the risk of injecting a chromosomally unbalanced gamete during ICSI procedure. We report here the meiotic segregation analysis of chromosomes in spermatozoa of 12 men with a balanced reciprocal translocation and 4 men with a Robertsonian translocation using a fluorescent in situ hybridisation analysis. The frequencies of normal or balanced spermatozoa ranged from 34.4% to 49.1% in balanced reciprocal translocation carriers. For Robertsonian translocation, the frequencies of normal or balanced spermatozoa ranged from 78.4% to 91.2%. These analyses allow us to define the orientation of genetic counselling according to the results of meiotic segregation obtained. As a last resort, it could then be discussed of the possibility of having recourse to donor spermatozoa or adoption. [source]


Front and Back Covers, Volume 21, Number 5.

ANTHROPOLOGY TODAY, Issue 5 2005
October 200
Front and back cover caption, volume 21 issue 5 Front cover Children in the favela (squatter community) of 'Caxambu', in the northern zone of Rio de Janeiro, Brazil. Although favelas are often depicted as dangerous and as the housing option of last resort, they are also characterized by dense and multi-stranded social ties between residents, long histories of occupation and settlement, and multi-generational families. Caxambu (a pseudonym) was originally settled at the beginning of the 20th century, and residents often describe the neighbourhood as a 'big family'. As the photo makes clear, the alleys, street corners and other public spaces in the favela often serve as giant playgrounds for local children. Back cover THE HUMAN BODY The photo on the back cover shows one of the exhibits from Gunther von Hagens' anatomical exhibition Body Worlds, discussed by Uli Linke in this issue. The exhibits in this show are fashioned from human corpses. The male figure shown here, the body of a man holding and gazing at his own skin, attempts to convey something about the human skin. The anatomical museum markets corpses, artfully transformed to appeal to the viewer. Body Worlds has toured internationally, and attracted millions of visitors. Dead bodies are transformed into sensually appealing 'works of art', playing to fantasies of the alluring body common to the dream worlds promoted by multinational media and entertainment industries. In the exhibition anatomy and pedagogy, economy and medical science, pathology and human rights are closely intertwined. But where do the bodies come from? The corpses, contrary to the exhibitor's claims, are not supplied by German donors - they are procured from Eastern Europe, Russia, Kyrgyzstan and China, from places where human rights and bioethical standards are not enforced. Von Hagens insists that bodies displayed are from donors, and his exhibition website (www.bodyworlds.com) welcomes donations to its body donation programme. In his body factory in Dalian, China, thousands of corpses, including the remains of executed prisoners, are flayed and prepared for later use. This trade in bodies, a multi-million-dollar enterprise, is highly problematic. For the trumpeted 'art of anatomy', with its beautified corpses and eroticized installations, also has a violent dimension, with human victims whose bodies are bought and sold for profit. In November 2002, Gunther von Hagens risked prosecution by holding the first public dissection of a (donated) body in the UK since the 1830s, in London's Atlantis Gallery. The issues surrounding procurement, preparation, dissection and display of human remains are central to anthropology, and in this article Uli Linke discusses in particular the various ways in which this exhbition was interpreted in Germany. [source]


The Colonial Strut: Australian Leaders on the World Stage

AUSTRALIAN JOURNAL OF POLITICS AND HISTORY, Issue 1 2005
Graeme Davison
In his influential account of modern nationalism, Benedict Anderson emphasises the role of the press in creating a sense of "imagined community". But the nation's identity is also constituted through the performances of representative nationals for an international audience. The visits of Australia's political leaders to London and Washington are carefully stage-crafted events, designed to elicit, or at least create an impression of, a favourable reception by its "great and powerful friends". This essay examines the international debuts of several Australian political leaders from Alfred Deakin (1887) and Robert Menzies (1935) to Bob Hawke and John Howard. It focuses especially on the interplay between the leaders' private and public selves; how they have crafted their public appearances and utterances to capture the attention of the desired international audience, and how their performances have been seen by the audience that, in the last resort, mattered most to them, the Australian one. [source]


As the last resort: reducing the use of restrictive physical interventions using organisational approaches

BRITISH JOURNAL OF LEARNING DISABILITIES, Issue 3 2009
Roy Deveau
Accessible summary ,,People living in a home should not be restrained unless they are really hurting themselves or somebody else. ,,People living in a home should be helped to manage their own behaviour without being restrained. Summary The development of restrictive physical interventions (RPI) to manage challenging behaviours based upon control and restraint during the 1980s and 1990s led to widespread professional disquiet and campaigning to improve the policies, training and application of physical techniques. This included the promotion of a value base within which physical techniques should be used. This value base may be summarised as any use of physical interventions must be in the person's best interests, ,least restrictive' and used as the last resort following preventive strategies. The last resort principle implies that services should be able to demonstrate support plans to prevent or reduce the frequency and/or restrictiveness of PI used in individual cases. This paper proposes that adopting explicit policies and practice to reduce restrictive PI is likely to be more effective in improving quality of support as opposed to solely managing PI use. Discussion of current policy and practice is followed by discussion of organisations' roles in relation to RPI reduction, with international comparisons. [source]


Primary exclusions: are they rising?

BRITISH JOURNAL OF SPECIAL EDUCATION, Issue 4 2003
Sue Pavey
Reducing the number of pupils excluded from school has formed part of the Government's strategy for school improvement in recent years. The study reported here was conducted within an inner-city LEA. In their article, Sue Pavey, research in special education, and John Visser, senior fellow lecturer in special education, both of whom work in the School of Education at the University of Birmingham, question the veracity of collected data on exclusions relating to the primary sector. Furthermore, they suggest that findings from their study indicate that exclusions are considered ineffective for the pupils concerned and are seen as a last resort by primary headteachers. More effective strategies for meeting the pupils' needs, argue Sue Pavey and John Visser, lie within enhanced, in-school support services and multi-agency approaches. The authors conclude that statistics on exclusion do not give a representative picture of real levels of exclusion in the LEA. This situation adversely affects strategic planning and the distribution of resources. In concluding their article, Sue Pavey and John Visser propose that resources should be spent on developing alternative strategies to exclusion and methods of identifying children at risk of disaffection. [source]