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Limited Effectiveness (limited + effectiveness)
Selected AbstractsSearching for a Role for Citizens in the Budget ProcessPUBLIC BUDGETING AND FINANCE, Issue 1 2004Carol Ebdon Citizen participation in the local budget process is not prevalent, despite encouragement from scholars and professional organizations. This case study of two Kansas cities that have used a variety of input mechanisms in the budget process analyzes the effectiveness of citizen budget participation. Limited effectiveness was found, which may largely be due to the timing of the input, unstated or unclear goals, implementation difficulties, and political and environmental constraints. Citizen input appears to have had little effect on budget decisions, and neither city has institutionalized participation in the process. However, the input mechanisms serve other purposes, such as education and support for specific proposals. Describing the benefits as well as the difficulty of involving citizens in a meaningful way is beneficial to other governments as they wrestle with the issue of defining the citizens' role in the budget process. [source] ASIA PACIFIC COLUMN: New challenges and opportunities in managing substance abuse in MalaysiaDRUG AND ALCOHOL REVIEW, Issue 5 2006MAHMUD MAZLAN MD Abstract Until recently, Malaysia has lagged behind in the treatment of drug addiction and related disorders, despite experiencing severe drug problems. By the end of 2004, 234 000 heroin users or heroin-dependent individuals had been registered in the official government registry, but other estimates exceed 500 000 for heroin abusers in the country. Amphetamine-type stimulant abuse is also increasing and of considerable public and government concern. Among the population of drug users, HIV and other infectious diseases rates are very high. In the Western Pacific regions, Malaysia has the second highest HIV prevalence (after Vietnam) among adult populations (0.62%) and the highest proportion of HIV cases resulting from injection drug use (76.3%). Drug use and related disorders exert a heavy burden on the country's health care and legal systems. Historically, drug abusers were rehabilitated involuntarily in correctional, rather than health-care, facilities. This primarily criminal treatment approach had limited effectiveness which led to widespread public dissatisfaction and the recent introduction of medical treatments for addiction. Naltrexone was introduced in 1999; buprenorphine was introduced in 2001 and methadone in 2003. Agonist maintenance programmes were embraced rapidly by the medical community in Malaysia. Currently, over 30 000 opiate-dependent patients are treated with agonist maintenance treatments by more than 500 medical practitioners in Malaysia. Despite these recent advances, treatments for amphetamine-type stimulant abuse or dependence are underdeveloped, and diversion of agonist medications is an emerging concern. [source] Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysisINTERNATIONAL ENDODONTIC JOURNAL, Issue 1 2007C. Sathorn Abstract Aim, To determine to what extent does calcium hydroxide intracanal medication eliminate bacteria from human root canals, compared with the same canals before medication, as measured by the number of positive cultures, in patients undergoing root canal treatment for apical periodontitis (teeth with an infected root canal system). Methodology, CENTRAL, MEDLINE and EMBASE databases were searched. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through the Science Citation Index to identify potentially relevant subsequent primary research. Review methods, The included studies were pre-/post-test clinical trials comparing the number of positive bacterial cultures from treated canals. Data in those studies were independently extracted. Risk differences of included studies were combined using the generic inverse variance and random effect method. Results, Eight studies were identified and included in the review, covering 257 cases. Sample size varied from 18 to 60 cases; six studies demonstrated a statistically significant difference between pre- and post-medicated canals, whilst two did not. There was considerable heterogeneity among studies. Pooled risk difference was ,21%; 95% CI: ,47% to 6%. The difference between pre- and post-medication was not statistically significant (P = 0.12). Conclusions, Calcium hydroxide has limited effectiveness in eliminating bacteria from human root canal when assessed by culture techniques. [source] An analysis of the evidence-practice continuum: is surgery for obstructive sleep apnoea contraindicated?JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007Adam G. Elshaug BA BSc(Hons) MPH Abstract Rationale, aims and objectives, Currently there are multiple surgical interventions utilized in the treatment of adult obstructive sleep apnoea (OSA). The role of these operations remains controversial, with perspectives on treatment efficacy varying considerably. Despite this, their use is proliferating. Objectives, In this paper, we present the degree of variability that occurs in the application of these procedures, and examine the effectiveness of surgical intervention as a treatment for OSA. Method, A multi-centre retrospective clinical audit of consecutive, unselected surgical cases presenting at the sleep disorder clinics of two teaching hospitals in a major Australian city. Patients acted as their own historical controls, undergoing polysomnography pre and post surgery to gauge effectiveness. Results, On variability demonstrate 94 individuals in this cohort received 220 individual upper airway surgical procedures, 184 occurred in their first operation (mean 2.5 per person; range 1,7) and 36 occurred in a second operation (n = 18; cumulative mean of 4 per person; range 3,7). These 94 individuals received 41 varying combinations of surgery. Results on effectiveness demonstrate an overall physiological success rate of 13% (87% fail). One operation reduced OSA severity by 20% (patients still had severe OSA), and two operations by 35% (still moderate OSA). In contrast, conventional Continuous Positive Airway Pressure therapy controlled OSA (n = 64). Conclusions, This case study demonstrates substantial procedural variability and limited effectiveness. This raises questions as to the quality of care, the treatment-derived health outcomes of this population and of efficient resource allocation. This issue requires greater policy attention. [source] Intratumoral cancer chemotherapy and immunotherapy: opportunities for nonsystemic preoperative drug deliveryJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 2 2002Eugene P. Goldberg The recent literature documents the growing interest in local intratumoral chemotherapy as well as systemic preoperative chemotherapy with evidence for improved outcomes using these therapeutic modalities. Nevertheless, with few exceptions, the conventional wisdom and standard of care for clinical and surgical oncology remains surgery followed by radiation and/or systemic chemotherapy, as deemed appropriate based on clinical findings. This, in spite of the fact that the toxicity of conventional systemic chemotherapy and immunotherapy affords limited effectiveness and frequently compromises the quality of life for patients. Indeed, with systemic chemotherapy, the oncologist (and the patient) often walks a fine line between attempting tumour remission with prolonged survival and damaging the patient's vital functions to the point of death. In this context, it has probably been obvious for more than 100 years, due in part to the pioneering work of Ehrlich (1878), that targeted or localized drug delivery should be a major goal of chemotherapy. However, there is still only limited clinical use of nonsystemic intratumoral chemotherapy for even those high mortality cancers which are characterized by well defined primary lesions i.e. breast, colorectal, lung, prostate, and skin. There has been a proliferation of intratumoral chemotherapy and immunotherapy research during the past two to three years. It is therefore the objective of this review to focus much more attention upon intratumoral therapeutic concepts which could limit adverse systemic events and which might combine clinically feasible methods for localized preoperative chemotherapy and/or immunotherapy with surgery. Since our review of intratumoral chemo-immunotherapy almost 20 years ago (McLaughlin & Goldberg 1983), there have been few comprehensive reviews of this field; only one of broad scope (Brincker 1993), three devoted specifically to gliomas (Tomita 1991; Walter et al. 1995; Haroun & Brem 2000), one on hepatomas (Venook 2000), one concerning veterinary applications (Theon 1998), and one older review of dermatological applications (Goette 1981). However, none have shed light on practical opportunities for combining intratumoral therapy with subsequent surgical resection. Given the state-of-the-art in clinical and surgical oncology, and the advances that have been made in intratumoral drug delivery, minimally invasive tumour access i.e. fine needle biopsy, new drugs and drug delivery systems, and preoperative chemotherapy, it is timely to present a review of studies which may suggest future opportunities for safer, more effective, and clinically practical non-systemic therapy. [source] The challenge of altering elementary school teachers' beliefs and practices regarding linguistic and cultural diversity in science instructionJOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 9 2007Okhee Lee This study examined the impact of a professional development intervention aimed at helping elementary teachers incorporate elements of students' home language and culture into science instruction. The intervention consisted of instructional units and materials and teacher workshops. The research involved 43 third- and fourth-grade teachers at six elementary schools in a large urban school district. These teachers participated in the intervention for 2 consecutive years. The study was conducted using both quantitative and qualitative methods based on focus group interviews, a questionnaire, and classroom observations. The results indicate that as teachers began their participation in the intervention, they rarely incorporated students' home language or culture into science instruction. During the 2-year period of the intervention, teachers' beliefs and practices remained relatively stable and did not show significant change. Possible explanations for the limited effectiveness of the intervention are addressed, and implications for professional development efforts are discussed. © 2007 Wiley Periodicals, Inc. J Res Sci Teach 44: 1269,1291, 2007 [source] Comparison of relaxation responses to multiple vasodilators in TxA2 -analog and endothelin-1-precontracted pulmonary arteriesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2007C. Piamsomboon Background:, Peri-operative pulmonary hypertension can lead to right ventricular dysfunction and to an increase in morbidity and mortality. Altered function of the pulmonary vascular endothelium and vasoconstriction play a crucial role in the development of elevated pulmonary vascular resistance. Because pulmonary artery vasoreactivity is dependent on many factors including the constricting agent that precipitated the event therefore the aim of the current study was to investigate the effectiveness of different classes of vasodilator agents to reverse endothelin-1 (ET-1) or thromboxane A2 (TxA2)-induced vasoconstriction in porcine pulmonary artery (PA) in vitro. Methods:, Relaxation responses to vasodilatory drugs were studied in PA precontracted with ET-1 (1 × 10,8 M) or TxA2 analog (U46619, 1 × 10,8 M). All vasodilating drugs were added in a cumulative fashion and isometric tension measurements were obtained using an organ chamber technique. Results:, In both groups relaxation responses to the vasodilators were dose dependent. When ET-1 was used as a constrictor nitroglycerin and milrinone caused nearly complete (80,100%) relaxation, whereas other agents were of limited effectiveness (40,50%). On the other hand, in the vessels constricted with U46619, olprinone, indomethacin, prostaglandin E1 (PGE1), nitroglycerin, milrinone and clevidipine induced complete (90,110%) vasodilatation but brain natriuretic peptide (BNP), l -arginine, and isoproterenol relaxed the vessels maximally by 45,60%. Conclusions:, Nitroglycerin and milrinone are very effective in reversing ET-1 and U46619-induced pulmonary vasoconstriction in vitro. The effectiveness of other drugs studied was dependent on the type of constrictor used. BNP, l -arginine and isoproterenol were shown to have minimal vasodilatory effects in porcine PA. [source] Design of translactam HCMV protease inhibitors as potent antiviralsMEDICINAL RESEARCH REVIEWS, Issue 4 2005Alan D. Borthwick Abstract Human cytomegalovirus (HCMV) is an important pathogen for which there is a significant unmet medical need. New HCMV antivirals, active against novel molecular targets, are undoubtedly needed as the currently available drugs ganciclovir, cidofovir, and foscarnet, which are all viral DNA inhibitors, suffer from limited effectiveness, mainly due to the development of drug resistance, poor bioavailability, and toxicity. One of the newer molecular targets that has been exploited in the search for better drug candidates is HCMV protease. Our ,Ala HCMV protease (wild type variant with the internal cleavage site deleted) was cloned and expressed in E. coli. This viral enzyme was used to develop HCMV protease assays to evaluate potential inhibitors. The chirally pure (SRS)-,-methyl pyrrolidine-5,5- trans -lactam template was synthesized, which together with the natural substrate requirements of HCMV protease and detailed SAR, was used to design potent and selective mechanism based inhibitors of HCMV protease. The mechanism of action of these inhibitors of HCMV protease was investigated by ESI/MS, and the X-ray crystal structure of the HCMV protease was used to refine our selective viral enzyme inhibitors to obtain plasma stable antivirals. A novel ELISA antiviral assay was developed which, together with a cytotoxicity assay, enabled us to discover anti-HCMV drug candidates equivalent in potency to ganciclovir that had good pharmacokinetics in the dog and good brain and ocular penetration in the guinea pig. © 2005 Wiley Periodicals, Inc. Med Res Rev. [source] Recent strategies in the development of new human cytomegalovirus inhibitorsMEDICINAL RESEARCH REVIEWS, Issue 3 2001Ana Martinez Abstract Human cytomegalovirus (HCMV) is one of the most common opportunistic infections in immunucompromised individuals, such as AIDS patients and organ transplant recipients, and is the most frequent congenital viral infection in humans. Despite a reduction of the incidence of AIDS-related opportunistic infections in patients under highly active antiretroviral treatment, attention should be paid to the HCMV risk factor in these individuals. Furthermore, HCMV may have an important role in atherosclerosis. Existing antiviral treatments for the HCMV infection suffer from poor bioavailability, toxicity, and limited effectiveness, mainly due to the development of drug resistance. Fortunately there are novel and potentially very effective new compounds undergoing pre-clinical and clinical evaluation. This review provides an overview in the last five years of new HCMV inhibitors (chemical structures, SAR, and new mechanisms of action) with the aim to provide new clues for the development of future drugs against this opportunistic virus. © 2001 John Wiley & Sons, Inc. Med Res Rev, 21, No. 3, 227,244, 2001 [source] 9.,Human Rights: Historical Learning in the Shadow of ViolenceAMERICAN JOURNAL OF ECONOMICS AND SOCIOLOGY, Issue 1 2009Article first published online: 18 FEB 200, Richard T. Peterson This paper emphasizes the historical dimension of human rights understood as a social ethic. Rather than timeless principles, human rights and the universality proper to them emerge in a process of suffering, conflict, political assertion, and institutional change. We can understand them as historical yet also universal by seeing that human rights arise in processes of social learning that take place in an increasingly globalized world. Such learning often has advanced in the face of dramatic violence, for example, the bombing of Hiroshima. But the demands on a global social ethic today are not only a matter of responding to threats and acts of dramatic violence in isolation. Attention to the example of Hiroshima suggests that the problem of violence is bound up with other questions about the regulation of emerging technical powers in a context of inequality and social conflict. To what extent can an ethic centered on human rights provide an ethics that can inform effective responses to these problems? To consider the promise of human rights, we look more closely at the kind of social learning they involve and explore in particular the role of social movements in forging new identities and reciprocities along with normative claims proper to a global public sphere (the anti-apartheid movement provides an example). We go on to see that these political experiences can inform interpretations of historical experience that can inform a widened sense of historical possibilities, both those missed in the past and those that confront us today. While this argument may thicken our sense of the promise of a human rights ethic, it remains speculative, not least because of the limited effectiveness of these norms in practice today. We close with the suggestion that nonetheless a coherent ethical response is possible, one that in the wealthy parts of the globe might take the form of an ethic of democratic responsibility. This would both represent a distinctive kind of learning and perhaps contribute to a wider advance of human rights. [source] Evaluation of existing and new insecticides including spirotetramat and pyridalyl to control Frankliniella occidentalis (Pergande) (Thysanoptera: Thripidae) on peppers in QueenslandAUSTRALIAN JOURNAL OF ENTOMOLOGY, Issue 2 2010Iain R Kay Abstract Insecticides are used by growers to control Frankliniella occidentalis (western flower thrips) in Australian vegetable crops. However, limited information was available on the efficacy of some insecticides used against F. occidentalis and data on new insecticides that could be included in a resistance management program were required. The efficacy of 16 insecticides in controlling F. occidentalis was tested in four small plot trials in chillies and capsicums. Spinosad, fipronil and methamidophos were effective against adults and larvae. Spirotetramat had no efficacy against adults but was very effective against larvae. Pyridalyl was moderately effective against larvae. Methidathion showed limited effectiveness. Abamectin, amorphous silica, bifenthrin, chlorpyrifos, dimethoate, emamectin benzoate, endosulfan, imidacloprid, methomyl and insecticidal soap were not effective. Laboratory bioassays on F. occidentalis collected from the field trials showed resistance to bifenthrin but not to the other insecticides tested. The trials demonstrated that some insecticides permitted for use against F. occidentalis are not effective and identified a number of insecticides, including the new ones spirotetramat and pyridalyl, that are effective and that could be used to manage the pest within a resistance management program. [source] Role of chemotherapy for patients with recurrent platinum-resistant advanced epithelial ovarian cancer,CANCER, Issue 3 2006A cost-effectiveness analysis Abstract BACKGROUND. Current chemotherapy in platinum-resistant ovarian cancer patients has demonstrated minimal to no improvements in survival. Despite the lack of benefit, significant resources are utilized with such therapies. Therefore, the objective in the current study was to assess the cost-effectiveness of salvage chemotherapy for patients with platinum-resistant epithelial ovarian cancer (EOC). METHODS. A decision analysis model evaluated a hypothetical cohort of 4000 platinum-resistant patients with recurrent EOC. Several chemotherapy strategies were analyzed: 1) best supportive care (BSC); 2) second-line chemotherapy-monotherapy; 3) second-line chemotherapy-combination therapy; 4) third-line chemotherapy after disease progression on second-line monotherapy; and 5) third-line chemotherapy after disease progression on second-line combination therapy. Sensitivity analyses were performed on all pertinent uncertainties. RESULTS. Using costs alone, BSC was the only definitive cost-effective treatment for platinum-resistant recurrent ovarian cancer patients, and second-line monotherapy was a reasonable cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of $64,104. The cost-effectiveness ranged from $4,065 per month of overall survival (OS) for BSC to $12,927 for third-line previous combination therapy. Compared with BSC, second-line monotherapy gained an additional 3 months of OS, with a cost-effectiveness of $4,703 per month of OS. Second-line combination therapy and third-line therapies exhibited unfavorable ICER. CONCLUSIONS. The current decision analysis was intended to be thought-provoking and bring awareness to the high costs of subsequent chemotherapy with limited effectiveness in patients with recurrent platinum-resistant EOC. Although actual patients may receive multiple lines of chemotherapy, from the perspective of costs alone this model using a hypothetical cohort demonstrated that best supportive care was the only cost-effective strategy, with second-line monotherapy appearing to be a reasonable cost-effective strategy given current chemotherapeutic options. Cancer 2006. © 2006 American Cancer Society. [source] | ||||||||||