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The uniqueness of communities precludes a homogenous approach to program design, delivery, and evaluation. To account for such uniqueness, such approaches should necessitate that program managers have a thorough understanding of the targeted participants or consumers. This understanding can be achieved by determining residents' perceived personal ability, or personal agency, to act and function within the community. This paper represents an effort to operationalize the various capitals that comprise the Community Capitals Framework, focusing on the analysis and validation of an empirical instrument designed to quantify and measure perceived personal agency. Specifically, the objectives of this study were to (1) establish the factor structure of an overall personal agency scale and its capital components, (2) determine if the proposed models adequately fit the collected data, and (3) validate the scales by analyzing internal structure and consistency. The findings indicate that this personal agency scale is a valid and reliable instrument for developing community profiles based on personal agency perceptions. In addition, to account for individuals' personal agency offers a significant contribution to potentially evaluating the social impact of community development efforts longitudinally. [ABSTRACT FROM AUTHOR]

The purpose of this research was to develop and validate a robust scale, based on the community capital framework, to provide an empirical measure of community perceptions. The proposed measure was completed by a sample of Georgia citizens (n = 3374) representing a diverse cross-section of community characteristics. Data indicate that the six proposed scales (natural, social, human, cultural, built-financial, and political) subsumed within the instrument measure unique underlying latent variables with evidence of internal validity through multiple analytic techniques. This study represents an initial examination of a quantitative instrument – the Community Diagnostics + Social Impact (CD + SI) ToolkitTM – that can be used by researchers, educators, and community development professionals to measure the stocks of the various capitals within a community. The theoretical implications of this study are that the CD + SI ToolkitTM holds promise as a valid and reliable instrument for establishing holistic community profiles, identifying targeted areas for in-depth research inquiry or programmatic design, guiding policy design and implementation, and ultimately evaluating the impacts of community development programs and policies. The CD + SI ToolkitTM addresses an omission in the literature and in broader community development. While various frameworks such as the CCF exist to provide a more general blueprint for program development and assessment, the CD + SI ToolkitTM represents an effort to specifically quantify the community capitals and establish a replicative process for measuring community capitals. The results of this initial validation effort demonstrate the potential for such a tool. [ABSTRACT FROM AUTHOR]

Rural stress is the physiological reaction brought upon by internal and socioeconomic stressors characteristic of rural residents. This type of stress is exacerbated by the complex issues facing rural populations and serves to inhibit the growth of vibrant, resilient communities. The current study sought to construct and validate an instrument intended to quantify perceptions of rural stress among neighbors and communities. The proposed scale was confirmed to have robust content, internal structure, and consequential validity. An exploratory factor analysis indicated one variable accounted for 57.74% of the total variance, while a one-way between subjects ANOVA found a statistically significant effect of group on scale scores under rural-urban continuum (RUC) conditions. One implication from these findings is that changes in communities may function as predictors of stress. Agricultural and extension educators hold a unique position that allows them to interact with the community on a daily basis. We recommend that they leverage this position to educate residents on the effects of stress, reduce the stigma associated with help-seeking behaviors, and discuss available stress management resources. Future research should consider modifying the instrument to focus on individual levels of stress instead of perceptions of stress within the community. [ABSTRACT FROM AUTHOR]

There is a natural separation between production decisions affecting the firm as a whole and individual decisions by each shareholder about his portfolio of securities. The end result of these two types of decisions is normally referred to as a productive exchange equilibrium. At such an equilibrium, no individual wants to adjust his portfolio and no firm can muster majority support for a change in its production plans. This paper presents a partial theory of takeover bids in that it examines the role of a takeover bid as a mechanism by which a simultaneous change in shareholdings and production plans can be achieved. This enables a new production exchange equilibrium to be reached which is preferred by a majority of the shareholders but which is inaccessible without a contingent contract in the form of a takeover bid. [ABSTRACT FROM AUTHOR]

The article focuses on interactions between investment decisions and corporate financing and its implications for capital budgeting. It comments on alternative methods utilized in calculating adjusted present value and demonstrates that the adjusted present value is equivalent to using two simple net present values to form a linear combination. It mentions the relationship between adjusted present value cut-off rates and weighted average costs of capital discount rates. It suggests that formulas for perpetuities and lease evaluation are actually special cases of the general formula.

Background Families with food allergy ( FA) are at risk of reduced quality of life and elevated anxiety. A moderate level of anxiety may be beneficial to sustain vigilance for food avoidance; however, excessive anxiety may increase risk for burden and maladjustment. The current study presents a framework for understanding the patterns of adaptation to FA across families and to identify typologies of families that would benefit from intervention. Methods Participants included 57 children, 6-12 years old with documented FA, and their mothers. Families were assessed using the Food Allergy Management and Adaptation Scale. Families also completed measures of quality of life, anxiety, FA management, and psychosocial impairment. Results A hierarchical cluster analysis revealed that 56 of the 57 families of food-allergic children were categorized into four groups that differed on their adequacy of family FA management, levels of anxiety, and balanced psychosocial functioning: balanced responders ( n = 23; 41%), high responders ( n = 25; 45%), and low responders ( n = 3; 5%). The fourth group, anxious high responders ( n = 5; 9%), was characterized by extremely high maternal FA anxiety scores and low scores for balanced integration of FA management and psychosocial functioning. Families in clusters differed across illness and psychosocial outcome variables. Conclusion Families with FA were characterized by patterns of FA management, anxiety, and ability to integrate FA demands into daily life. Identified adaptation patterns correspond with clinical impressions and provide a framework for identifying families in need of intervention. [ABSTRACT FROM AUTHOR]

Objective: Reducing serum cholesterol lowers the risk for ischemic heart disease, but its effects on other vascular diseases are unknown. Published trials were reviewed to determine the effect of cholesterol-lowering interventions on fatal and nonfatal stroke.Design: Meta-analysis of randomized, controlled trials.Data Identification: A literature search of English-language studies examining the effect of modified diets or medications on cardiovascular end points from 1965 to 1992 using MEDLINE and a review of references of five quantitative overviews of cholesterol reduction and coronary disease.Data Analysis: Thirteen studies met three eligibility criteria: patients randomized to intervention or control; fatal or nonfatal stroke reported separately; and end points assessed without knowledge of treatment status. Heterogeneity among studies and overall effects of treatment on fatal and nonfatal stroke were estimated using the Mantel-Haenszel-Peto method to combine independent study results. The influence of various study designs and interventions was explored using subgroup comparisons.Results: For fatal stroke, the overall odds ratio associated with cholesterol-lowering interventions in 13 trials was 1.32 (95% Cl, 0.94 to 1.86), and the odds ratio for the 10 single-intervention trials was 1.34 (Cl, 0.91 to 1.96). Among eight trials reporting nonfatal events, the summary odds ratio for nonfatal stroke for treated participants compared with controls was 0.88 (Cl, 0.70 to 1.11), and the odds ratio for total strokes was 0.98 (Cl, 0.80 to 1.19). Among three trials using clofibrate, treatment significantly increased the risk for fatal stroke (odds ratio, 2.64; Cl, 1.42 to 4.92) but not for nonfatal stroke (odds ratio, 0.87; Cl, 0.61 to 1.26). Regression analysis showed no statistical association between the magnitude of cholesterol reduction and the risk for fatal stroke.Conclusions: Lowering serum cholesterol through modified diets or medications does not reduce stroke mortality or morbidity in middle-aged men. Clofibrate appears to increase the risk for fatal strokes, but the mechanism for this effect is unknown. [ABSTRACT FROM AUTHOR]

Neurofibromatosis 1 (NF1) is a tumour suppressor gene syndrome characterized by multiple cutaneous and plexiform neurofibromas. Focal osseous abnormalities, short stature, and decreased bone mineral density are also frequent in people with NF1. We measured serum 25-hydroxyvitamin D concentrations in 55 patients with NH and 58 healthy controls, and correlated the findings in the patients with NF1 with their estimated number of dermal neurofibromas. Geometric mean (SD) serum 25-hydroxyvitamin D concentration was 14.0 (1.6) ng/mL among the patients with NFl compared with 31.4 (1 .7) ng/mL among healthy controls (p⪡O.0001). The serum vitamin D concentration and number of dermal neurofibromas reported by patients with NFl were inversely correlated (Spearman's p= -0.572, p<0.00001). The occurrence of low serum vitamin D concentrations in people with NFl, especially those with many dermal neurofibromas, may provide new pathogenic insights and have important therapeutic implications. [ABSTRACT FROM AUTHOR]

About 70–80% of breast cancers express estrogen receptor alpha (ER-α), and estrogens play important roles in the development and growth of hormone-dependent tumors. Together with lymph node metastasis, tumor size, and histological grade, ER status is considered as one of the prognostic factors in breast cancer, and an indicator for hormonal treatment. To investigate genes and pathways that are associated with ER status and epithelial cells in breast tumor, we applied laser capture microdissection (LCM) technology to capture epithelial tumor cells from 28 lymph node-negative breast tumor samples, in which 17 patients had ER-α+ tumors, and 11 patients have ER-α− tumors. Gene expression profiles were analysed on Affymetrix Hu133A GeneChip. Meanwhile, gene profiles using total RNA isolated from bulk tumors of the same 28 patients were also generated. In total, 146 genes and 112 genes with significant P-value and having significant differential expression between ER-α+ and ER-α− tumors were identified from the LCM data set and bulk tissue data set, respectively. A total of 61 genes were found to be common in both data sets, while 85 genes were unique to the LCM data set and 51 genes were present only in the bulk tumor data set. Pathway analysis with the 85 genes using Gene Ontology suggested that genes involved in endocytosis, ceramide generation, Ras/ERK/Ark cascade, and JAT-STAT pathways may play roles related to ER. The gene profiling with LCM-captured tumor cells provides a unique approach to study epithelial tumor cells and to gain an insight into signaling pathways associated with ER.Oncogene (2006) 25, 1413–1419. doi:10.1038/sj.onc.1209165; published online 31 October 2005 [ABSTRACT FROM AUTHOR]

Randomized, controlled trials (RCTs) are firmly established as the standard for determining which medical treatments are effective. In some areas of health care, however, among them surgery, public health, and the organization of health care delivery, most evidence addressing the effectiveness of clinical or policy interventions rests on nonrandomized studies. We examine the use of study designs other than RCTs in Evidence-based Practice Center reports addressing questions of the effectiveness of treatment interventions. These reports offer the opportunity to examine the approaches used and the challenges faced by reviewers when nonrandomized studies are included and their quality assessed. We then offer recommendations for using these studies in systematic reviews of treatment interventions. [ABSTRACT FROM AUTHOR]

To provide decision makers with the best available evidence, the Agency for Healthcare Research and Quality established a network of Evidence-based Practice Centers across North America. The centers perform systematic reviews on important questions posed by partner organizations about clinical, organizational, and policy interventions in healthcare. The Agency works closely with partners and other decision maker s to help translate that evidence into practice or policy. In this paper, we review important lessons we have learned over the past 7 years about how to increase the efficiency and impact of systematic reviews. Lessons concern selecting the right topics and scope, working effectively with partners, and balancing consistency and flexibility in methods. We examine continuing evolutions of the program and the impact of planned work on comparative effectiveness performed as part of the Medicare Modernization Act of 2003. [ABSTRACT FROM AUTHOR]

A model of flavor release from encapsulated flavor particles immersed in water has been developed that correlates well with experimental data. Flavor release from particles was determined by measuring both the quantities released from the particle to water and from water to air in the headspace. The model presented here predicts a very different release with time from the encapsulated favor if the particle develops a hydrogel at the surface (swelling) compared to gradual erosion. Controlled heating showed more retention of flavor when the particle swells compared to a more rapid flavor release under conditions of particle erosion. [ABSTRACT FROM AUTHOR]

Purpose: There are few data on the effects of disease biology and competing mortality on the effectiveness of screening women for breast cancer after age 65 years. The authors performed a review to determine the costs and benefits of mammography screening after age 65 years.Data Sources: Cost-effectiveness articles published between January 1989 and March 2002.Study Selection: Studies were identified by using MEDLINE and the National Health Service Economic Evaluation Database. The authors included research on screening after age 65 years conducted from a societal or government perspective; reviews and analyses of other technologies were excluded.Data Synthesis: 115 studies were identified and 10 met inclusion criteria. One study modeled age-dependent assumptions of disease biology. No study fully captured the potential harms of screening, including anxiety associated with false-positive results, overdiagnosis, and previous knowledge of cancer or living longer with the consequences of treatment. Studies differed in the specific strategies compared and in analytic approaches. On average, extending biennial screening to age 75 or 80 years was estimated to cost 34 000 dollars to 88 000 dollars (2002 U.S. dollars) per life-year gained, compared with stopping screening at age 65 years. Two studies suggested that it was more cost-effective to target healthy women than those with several competing risks for death.Conclusions: Current estimates suggest that biennial breast cancer screening after age 65 years reduces mortality at reasonable costs for women without clinically significant comorbid conditions. More data are needed on disease biology and preferences for benefits and harms in older women. [ABSTRACT FROM AUTHOR]

Background: The Long QT Syndrome (LQTS) is a genetic channelopathy with life-threatening implications. The LQT3 form of this disease is caused by mutations of the SCN5A sodium-channel gene. A specific mutation, SCN5A:DeltaKPQ, is associated with repetitive reopenings of the sodium channel and prolonged inward current. This dominant inward current is manifest on the electrocardiogram as QT prolongation. Flecainide is a potent blocker of the open sodium channel.Methods and Results: The effect of flecainide on the duration of the QT-interval and the T-wave morphology was systematically evaluated in five male patients age 2-64 years having the SCN5A:DeltaKPQ mutation. After baseline electrocardiograms were obtained, low-dose oral flecainide was administered for 48 hours. Serial electrocardiograms and blood flecainide levels were obtained during flecainide therapy. The QTc interval decreased on average by 104 ms, from a baseline value of 565 +/- 60 ms to 461 +/- 23 ms (P < 0.04) at a mean flecainide level of 0.28 +/- 0.08 mg/L, with shortening of the QTonset interval (P < 0.003) and normalization of T-wave morphology. The effects of flecainide were compared with oral mexiletine in two patients, with flecainide showing greater QTc shortening and more complete normalization of repolarization. No adverse side effects or proarrhythmia were observed with flecainide in this study.Conclusion: Low-dose, oral flecainide consistently shortened the QTc interval and normalized the repolarization T-wave pattern in five LQT3 patients with SCN5A:DeltaKPQ mutation. This preliminary study indicates that low-dose flecainide is a promising therapeutic agent for LQTS patients with the SCN5A:DeltaKPQ sodium channel mutation. [ABSTRACT FROM AUTHOR]

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the prevalence of psychopathology and level of behavioral symptomatology in incarcerated youth versus youth receiving community mental health services or hospitalization. We randomly recruited youth from middle South Carolina served by a local CMHC ( n = 60), youth served by the state adolescent inpatient program ( n = 50), and youth in the S.C. Dept. of Juvenile Justice facilities from the same region ( n = 75). We used the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and the CBCL and YSR to evaluate behavioral symptomatology. On the DISC, incarcerated youth had significantly higher mean number of diagnoses and symptoms than CMHC youth, but lower numbers than hospitalized youth. Level of “caseness” (at least one diagnosis) was 86% in hospital youth, 72% in incarcerated youth, and 60% in CMHC youth. The groups differed in CBCL mean total T, internalizing T, and externalizing T scores as well as mean YSR internalizing T scores. Our results indicate the comparability in level of psychopathology in incarcerated and community-treated populations of youth, and the need to develop diversionary programs to prevent the entry of such youth into the juvenile justice system. [ABSTRACT FROM AUTHOR]

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the level of prior service utilization in incarcerated youth versus youth receiving community mental health services. We randomly recruited youth from middle South Carolina served by a local community mental health center (CMHC; n = 60), hospitalized in the state adolescent inpatient program ( n = 50), and incarcerated in the S.C. Dept. of Juvenile Justice facilities ( n = 75). We used a Services History to evaluate episodes of prior utilization of mental health, social service, educational, residential, and volunteer services, as well as the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and symptoms and the CBCL and YSR to evaluate behavioral symptomatology. Incarcerated, hospitalized, and CMHC youth utilized similar levels of educational services and social services. Incarcerated youth had a significantly lower lifetime utilization of outpatient and acute mental health services and significantly higher utilization of out-of-home residential services than the other groups. These services utilization variables, along with gender and age, significantly distinguish incarcerated youth from the clinical groups, with clinical variables not serving to significantly distinguish them. Our results indicate the need to develop programs to prevent the entry of mentally ill/emotionally disturbed youth into the juvenile justice system. Youth who are at risk for incarcenation may benefit from intensive mental health services to prevent out-of-home placement and later incarceration. [ABSTRACT FROM AUTHOR]

This is the first report of the association of spina bifida and eating disorders. Five patients were diagnosed rather late in the course of their illness. They all had been overweight premorbidly and had been urged to lose weight for years in order to improve their mobility. As they dieted, they experienced their weight loss as a source of power that could somehow compensate for their losses and neurologic limitations. They responded to a multidisciplinary intervention. Clinicians taking care of patients with spina bifida need to be cognizant that they may be at risk of developing an eating disorder. Such awareness should influence the quality of nutritional counseling (prevention aspect) and the clinical assessment of sudden weight loss (early intervention). [ABSTRACT FROM AUTHOR]

An infant who received haploidentical BM for severe combined immunodeficiency (SCID) developed acute, reversible complete heart block in association with an exacerbation of GVHD. Respiratory distress and myocardial dysfunction were also seen with this and previous GVHD exacerbations. The patient had not received chemotherapy or radiation prior to BMT. The complete heart block resolved after 1 week of intensive immunosuppression. The association of complete heart block with GVHD is important because the heart block is potentially reversible with prompt, aggressive control of the GVHD. [ABSTRACT FROM AUTHOR]

Published guidelines differ -- sharply, at times -- on whom, when, and how to screen for elevated cholesterol levels. At the heart of the controversy is the question of which strategy will target those most in need of cholesterol-lowering therapy. [ABSTRACT FROM AUTHOR]

Proper efficient solutions of nonconvex vector maximum problems can be generated by solving a parametric family of ordinary nonlinear programs. This parametric scheme follows from the characterization of proper efficiency by an extended form of the generalized Tchebycheff norm. [ABSTRACT FROM AUTHOR]