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Paid carers play an important role in helping older adults with care needs to remain living in their own homes. This paper examines changes in the home care field, specifically the emergence of self‐employed care entrepreneurs ('microentrepreneurs'). To do this, it employs Bourdieu's concepts of field, capital and habitus. Drawing on 105 semi‐structured interviews with stakeholders working in home care, the paper describes how the interaction of changes to field structures, and altered practices of care have challenged the taken‐for‐granted acceptance of traditional, transactional forms of care provision. This process has been highly dependent on local state actors, their ability to mobilise relevant forms of capital and the factors which shaped their habitus. It should be seen within the context of changes to local field structures and the hierarchical classification processes which underpin them. These changes threaten the distribution of capital in the home care field in ways that are beneficial to microentrepreneurs. Bourdieu might categorise these developments as 'partial revolutions', which do not challenge the fundamental axioms of the field. However, for care entrepreneurs, formerly employed as low‐paid home‐care workers, a revolution that is only partial may be better than none at all. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) testing for cervical screening increases diagnosis of precancer and reduces the incidence of cervical cancer more than cytology alone. However, real‐world evidence from diverse practice settings is lacking for the United States (U.S.) to support clinician adoption of primary HPV screening. Using a population‐based registry, which captures all cervical cytology (with or without HPV testing) and all cervical biopsies, we conducted a real‐world evidence study of screening in women aged 30 to 64 years across the entire state of New Mexico. Negative cytology was used to distinguish cotests from reflex HPV tests. A total of 264 198 cervical screening tests (with exclusions based on clinical history) were recorded as the first screening test between 2014 and 2017. Diagnoses of cervical intraepithelial neoplasia grades 2 or 3 or greater (CIN2+, CIN3+) from 2014 to 2019 were the main outcomes. Of cytology‐negative screens, 165 595 (67.1%) were cotests and 4.8% of these led to biopsy within 2 years vs 3.2% in the cytology‐only group. Among cytology‐negative, HPV tested women, 347 of 398 (87.2%) CIN2+ cases were diagnosed in HPV‐positive women, as were 147 of 164 (89.6%) CIN3+ cases. Only 29/921 (3.2%) CIN3+ and 67/1964 (3.4%) CIN2+ cases were diagnosed in HPV‐negative, cytology‐positive women with biopsies. Under U.S. opportunistic screening, across a diversity of health care delivery practices, and in a population suffering multiple disparities, we show adding HPV testing to cytology substantially increased the yield of CIN2+ and CIN3+. CIN3+ was rarely diagnosed in HPV‐negative women with abnormal cytology, supporting U.S. primary HPV‐only screening. [ABSTRACT FROM AUTHOR]

Health and care policy is increasingly promoted within competitive city‐region visions. Based on a two‐year study of health and social care devolution in Greater Manchester, England, we demonstrate how the "local problem" of governing health and care amid austerity politics was rearticulated as a "global opportunity" to forge new connections between place, health, and economy. The paper foregrounds the multiple tensions and contradictions accumulating through turning to health and care to push the city‐region further, faster. Health and care policy is increasingly promoted within visions of the competitive city‐region. This paper examines the importance of policy boosterism within the political construction of city‐regions in the context of English devolution. Based on a two‐year case study of health and social care devolution in Greater Manchester, England, we trace the relational and territorial geographies of policy across and through new "devolved" city‐regional arrangements. Contributing to geographical debates on policy assemblages and city‐regionalism, we advance a conceptual framework linking crisis and opportunity, emulation and exceptionalism, and evidence and experimentation. The paper makes two key contributions. First, we argue health and care policy is increasingly drawn towards the logic of global competitiveness without being wholly defined by neoliberal political agendas. Fostering transnational policy networks helped embed global "best practice" policies while simultaneously hailing Greater Manchester as a place beyond compare. Second, we caution against positioning the city‐region solely at the receiving end of devolutionary austerity. Rather, we illustrate how the urgency of devolution was conditioned by crisis, yet concomitantly framed as a unique opportunity by the local state harnessing policy to negotiate a more fluid politics of scale. In doing so, the paper demonstrates how attempts to resolve the "local problem" of governing health and care under austerity were rearticulated as a "global opportunity" to forge new connections between place, health, and economy. Consequently, we foreground the multiple tensions and contradictions accumulating through turning to health and care to push Greater Manchester further, faster. The paper concludes by asking what the present crisis might mean for city‐regions in good health and turbulent times. [ABSTRACT FROM AUTHOR]

The authors share findings from a study that incorporated two types of participatory interview approaches (conversational drawing interviews and walking tour interviews) to elicit young students' (K–2) motivation‐related perceptions of a reading intervention to better understand and support their motivation for doing reading in the program. All 14 students shared perceived benefits of intervention participation, and 10 students shared perceived costs. For five students, the perceived costs appeared to outweigh the perceived benefits; these students reported that if allowed to choose, they would not participate in the reading intervention. A perceived lack of autonomy within the intervention was a common theme woven through these students' responses. Given the connection between motivation and achievement, the authors emphasize the importance of eliciting students' motivation‐related perceptions of reading instruction and offer suggestions for probing young students' understandings. [ABSTRACT FROM AUTHOR]

In this paper, we examine how space is integral to the practices and politics of restructuring health and care systems and services and specifically how ideas of assemblage can help understand the remaking of a region. We illustrate our arguments by focusing on health and social care devolution in Greater Manchester, England. Emphasising the open‐ended political construction of the region, we consider the work of assembling different actors, organisations, policies and resources into a new territorial formation that provisionally holds together without becoming a fixed totality. We highlight how the governing of health and care is shaped through the interplay of local, regional and national actors and organisations coexisting, jostling and forging uneasy alliances. Our goal is to show that national agendas continued to be firmly embedded within the regional project, not least the politics of austerity. Yet through keeping the region together as if it was an integrated whole and by drawing upon new global policy networks, regional actors strategically reworked national agendas in attempts to leverage and compete for new resources and powers. We set out a research agenda that foregrounds how the political reorganisation of health and care is negotiated and contested across multiple spatial dimensions simultaneously. [ABSTRACT FROM AUTHOR]

This research examines how midstream social marketing programmes that adopt a relational and community‐based approach create opportunities for individuals to make incremental changes to health behaviour. Specifically, it applies Bourdieusian theory to explore how interactions between community healthcare workers (CHWs) and members of the public generate impetus for change and foster individual agency for improved health. Qualitative interviews were carried out with members of the public and CHWs engaged in a Smokefree home and cars initiative. The findings suggest that although CHWs are challenged by resource constraints, their practices in working with individuals and families build trust and enable dialogue that bridges smoking‐related health insight with home logics. These interactions can promote individual agency with a transformative effect through small changes to smoking‐related dispositions, norms and practices. However, tensions with the habitus of other household members and other capital deficits can inhibit progress towards embedding new practices. The study concludes that interventions built upon community relationships show potential for addressing limitations of information‐focused campaigns but there is a need to also respond to key social structures relating to the field of action for new health dispositions to become embedded in practice. [ABSTRACT FROM AUTHOR]

The authors emphasize the importance of cultivating autonomous motivation for literacy in early childhood by supporting students' basic psychological needs for autonomy, competence, and relatedness while building foundational skills. Additionally, the authors highlight four key findings specific to early childhood (pre‐K–2) literacy development: the power of teaching letters and associated phonemes in tandem, the impact of oral language on comprehension, the role of print concepts in learning to read, and the influence of early writing on reading. Sample activities, adapted from preexisting promising practices to incorporate opportunities for addressing students' basic psychological needs, accompany each finding. Finally, the authors make a sincere appeal for additional research, including educator action research specific to early childhood literacy motivation. [ABSTRACT FROM AUTHOR]

Objectives In many countries increasing use is being made of dental care professionals ( DCPs) to provide aspects of clinical activity previously undertaken by dentists. This study evaluates the differences in practice efficiency associated with the utilisation of DCPs in the provision of General Dental Services in the National Health Service ( NHS) in England. Methods One hundred twenty-one NHS practices completed a questionnaire and shared practice information held at the NHS Business Services Authority. Practice efficiency was estimated using data envelopment analysis with the robustness of the findings checked using Stochastic Frontier Model estimation. Results Dental practices operated at an estimated mean level of technical efficiency of 64%. Variations among practices in the use of DCPs were not associated with variations in practice efficiency after controlling for other staffing levels, patient population characteristics and practice variables. Conclusions The current NHS dental contract limits the potential for efficiency improvements by setting annual practice activity targets that produce little incentive for role substitution. Whilst DCPs may by practising efficiently, this is not reflected in practice-level efficiency, possibly because of dentists using the time released for other non- NHS activity. [ABSTRACT FROM AUTHOR]

Idealized climate change simulations with a new physical climate model, HadGEM3-GC2 from The Met Office Hadley Centre are presented and contrasted with the earlier MOHC model, HadGEM2-ES. The role of atmospheric resolution is also investigated. The Transient Climate Response (TCR) is 1.9 K/2.1 K at N216/N96 and Effective Climate Sensitivity (ECS) is 3.1 K/3.2 K at N216/N96. These are substantially lower than HadGEM2-ES (TCR: 2.5 K; ECS: 4.6 K) arising from a combination of changes in the size of climate feedbacks. While the change in the net cloud feedback between HadGEM3 and HadGEM2 is relatively small, there is a change in sign of its longwave and a strengthening of its shortwave components. At a global scale, there is little impact of the increase in atmospheric resolution on the future climate change signal and even at a broad regional scale, many features are robust including tropical rainfall changes, however, there are some significant exceptions. For the North Atlantic and western Europe, the tripolar pattern of winter storm changes found in most CMIP5 models is little impacted by resolution but for the most intense storms, there is a larger percentage increase in number at higher resolution than at lower resolution. Arctic sea-ice sensitivity shows a larger dependence on resolution than on atmospheric physics. [ABSTRACT FROM AUTHOR]

This study explores the ways in which patients make sense of 'safety' in the context of primary medical care. Drawing on qualitative interviews with primary care patients, we reveal patients' conceptualisation of safety as fluid, contingent, multi-dimensional, and negotiated. Participant accounts drew attention to a largely invisible and inaccessible (but taken for granted) architecture of safety, the importance of psycho-social as well as physical dimensions and the interactions between them, informal strategies for negotiating safety, and the moral dimension of safety. Participants reported being proactive in taking action to protect themselves from potential harm. The somewhat routinised and predictable nature of the primary medical care consultation, which is very different from 'one off' inpatient spells, meant that patients were not passive recipients of care. Instead they had a stock of accumulated knowledge and experience to inform their actions. In addition to highlighting the differences and similarities between hospital and primary care settings, the study suggests that a broad conceptualisation of patient safety is required, which encompasses the safety concerns of patients in primary care settings. [ABSTRACT FROM AUTHOR]

To describe the prevalence and outcomes of renal transplantation in children with ID we performed a retrospective cohort analysis of all children receiving a first kidney-alone transplant in the UNOS dataset from 2008 to 2011. Recipients with definite, probable, and without ID were compared using chi-square tests. Kaplan-Meier curves were constructed for patient and graft survival. Cox proportional hazard models were used to estimate the association between ID and graft failure and patient survival. Over the study period, 332 children with definite (117) or probable (215) ID underwent first renal transplant, accounting for 16% of all first pediatric renal transplants (n = 2076). Children with definite ID were not significantly different from children without ID with respect to sex, ethnicity, or prevalence of acute rejection. ID was associated with increased likelihood of deceased donor source. ID was not significantly associated with decreased graft or patient survival. In this first large-scale study, up to 16% of first pediatric renal transplants were performed in children with ID. Short-term graft and patient survival after transplant were equivalent between children with and without ID. Further research is needed to examine long-term outcomes of transplant in this population. [ABSTRACT FROM AUTHOR]

Kidney transplant recipients have an increased risk of cancer. Data on non- LPD malignancies (solid tumors) in pediatric renal transplant recipients are limited. We performed a cohort study using the NAPRTCS transplant registry to describe the incidence of non- LPD malignancy compared with the general pediatric population. The observed incidence rate of non- LPD malignancy in the NAPRTCS transplant registry was 72.1 per 100 000 person-years ( SIR 6.7; 95% CI, 5.3, 8.5); a 6.7-fold increased risk compared with the general pediatric population (10.7 cases per 100 000 person-years). Non- LPD malignancy was diagnosed in 35 subjects at a median of 726 days post-transplant. The most common type of malignancy was renal cell carcinoma. The increased risk of non- LPD malignancy was seen in all patients regardless of age, gender, race, etiology of end-stage kidney disease, and transplant era. The specific type of immunosuppression was not identified as a risk factor. In this first large-scale study of North American pediatric renal transplant recipients, we observed a 6.7-fold increased risk of non- LPD malignancy compared with the general pediatric population. Further examination of this unique patient population may provide greater insight into the impact of transplant and immunosuppression on malignancy risk. [ABSTRACT FROM AUTHOR]

In order to investigate questions concerning changes in the atmosphere and other components of the Earth system, it is desirable to have a seamless modelling system that operates across a wide range of time-scales and horizontal resolutions. The development of a low-resolution configuration of the model would greatly assist in addressing these scientific questions whose long time-scales or complexity are computationally demanding-a cost that cannot be sustained by higher resolutions. However, in order to be confident that results remain robust to changes in resolution, it is essential that such models include the same underlying fundamental processes as those at higher resolution. Some resolution-dependent biases are found to grow (notably when horizontal resolution decreases below ∼150 km) as a result of the lack of transient eddy kinetic energy (TEKE). The advection scheme used by many of the current general circulation models follows the semi-Lagrangian (SL) dynamics approach. Because of the need for interpolation to the departure point, the scheme is highly diffusive when low-order interpolation schemes are used. We analyse how the impact of the high diffusivity of SL schemes leads to a lack of TEKE, which inhibits the development of mid-latitude variability phenomena such as synoptic cyclones or blocking events. Conversely, some examples where the performance of the low resolution is acceptable are provided. We investigate two different traceable solutions to partially offset the misrepresentation of dynamical features in the low-resolution version: a change of the interpolation scheme from quasi-cubic to quintic interpolation; and vorticity confinement: a parametrization designed to preserve vorticity features in dissipative numerical schemes. Both solutions are found to increase TEKE and improve many of the mid-latitude metrics considered. Copyright © 2012 British Crown copyright, the Met Office. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives To explore the views of NHS dentists in England regarding reforms, which changed their incentive and payment structure. Methods Semi-structured interviews with 35 dentists, digitally recorded, transcribed verbatim and analysed using a constant comparative method. Results Dentists reported changing their behaviour in response to incentives in ways that were likely to have adverse impacts on patients. There was also a loss of trust in NHS paymasters, as well as a loss of faith in the ability to provide high quality care in NHS dentistry. Conclusions Responses suggest that many dentists were quick to change behaviour following the introduction of a revised contractual structure in 2006. The coalition government in the UK has stated its intention to introduce a new NHS dental contract. Our data suggest that part of the process of changing behaviours, norms and attitudes will require the rebuilding of trust in the NHS amongst NHS dentists, as opposed to merely redesigning incentive structures, though the two are related. [ABSTRACT FROM AUTHOR]

Tickle M, McDonald R, Franklin J, Aggarwal VR, Milsom K, Reeves D. Paying for the wrong kind of performance? Financial incentives and behaviour changes in NHS dentistry 1992-2009. Community Dent Oral Epidemiol 2011; 39: 465-473. © 2011 John Wiley & Sons A/S Abstract - Background: There is a tension between financial incentives and professional codes and norms, both of which are believed to influence the behaviour of health care professionals. This study examined the impact of changes to financial incentive structures on the behaviour of dentists working in the English National Health Service (NHS) as a result of a new national contract. Methods: Comparison of six reference treatments delivered by all NHS dentists in England for the period 1992-2009. Results: Large and abrupt changes in the provision of the reference treatments coincided with the introduction of changes in the incentive structure in 2006. Treatments which can be provided in the least amount of time (and therefore costs to dentists) such as extractions increased and treatments which are time consuming or have significant additional materials costs such as bridgework, crowns, root fillings and radiographs reduced substantially. Conclusions: Changes to financial incentive structures can produce large and abrupt changes in professional behaviours. In the context of multiple and conflicting goals, greater thought needs to be given to policies to change incentive structures to mitigate their unintended consequences. [ABSTRACT FROM AUTHOR]

Verghese PS, Smith JM, McDonald RA, Schwartz SM, Nelson KA, Warner PR. Impaired graft survival in pediatric renal transplant recipients with donor-specific antibodies detected by solid-phase assays. Pediatr Transplantation 2010: 14:730–734. © 2010 John Wiley & Sons A/S. SAB assays have increased the sensitivity and specificity to detect HLA alloantibodies, but there is uncertainty about the clinical relevance of SAB-positive alloantibodies when the FCXM is negative. We performed a retrospective study to evaluate the clinical significance of SAB-detected DSA in 82 pediatric recipients of a first kidney transplant between January 2000 and December 2005 who had a negative pretransplant FCXM. Pretransplant sera were evaluated by SAB for DSA. Graft loss and rejection between patients with (DSA+) and without DSA (DSA−) were compared. DSA were detected in 13.9%. Eighty percent of DSA+ subjects were DD transplant recipients vs. 56.9% in the DSA− cohort. The RR of graft loss in DSA+ vs. DSA− was 3.3 (95% CI, 1.4–7.9) and in DD was 4.3 (95% CI 1.4–13.1). By Cox regression, the HR of graft loss in DSA+ vs. DSA− was 2.8 (95% CI 0.7–10.9; p = 0.14) and in DD was 5.1 (95% CI 1–25.6; p = 0.05). Acute rejection occurred in 60% in the DSA+ vs. 44.4% in DSA− (p = 0.5). SAB-detected DSA was associated with impaired renal allograft survival in pediatric renal transplant recipients. Impaired graft survival in pediatric renal transplant recipients with DSA detected by solid-phase assays. [ABSTRACT FROM AUTHOR]

The new General Medical Services contract was introduced into general practice in the UK in 2004, and it links pay to performance far more than in the past. As a result, accurate data collection about patients and the care that they receive is now not only important for good patient care but also to prove that targets are being met. The use of electronic records and information technology has thus become much more sophisticated. This article reports the results from an ethnographic study of the early stages of the new contract in two general practices. As expected, electronic data collection had increased in importance in both practices, with consequences both for clinician–patient interactions and for the structures and processes in the practices, as uniform data collection instruments are put in place that privilege ‘hard’ biomedical data that can be easily coded above ‘softer’, more patient-centred information. Roles and responsibilities had been changed to reflect the needs of the new systems, and new software applications allowed increased surveillance of both doctors’ and nurses’ performance; both of these had an impact on patterns of authority in our study practices. Furthermore, the structural changes that were found acted to embed the new ways of working, ensuring their reproduction in the future. In spite of these effects, we found little opposition to or critical reflection on the changes, and the doctors in our study continued to view their improved computer systems as neutral recording devices. The implication of these findings is discussed. [ABSTRACT FROM AUTHOR]

This summary of the NAPRTCS 2006 Annual Report of the Transplant Registry highlights the significant impact the registry has had in advancing knowledge in pediatric renal transplantation worldwide. This cooperative group has collected clinical information on children undergoing a renal transplantation since 1987 and now includes over 150 participating medical centers in the USA, Canada, Mexico, and Costa Rica. Currently, the NAPRTCS transplant registry includes information on 9837 renal transplants in 8990 patients (NAPRTCS 2006 Annual Report). Since the first data analysis in 1989, NAPRTCS reports have documented marked improvements in outcome after renal transplantation in addition to identifying factors associated with both favorable and poor outcomes. The registry has served to document and influence practice patterns, clinical outcomes, and changing trends in renal transplantation. [ABSTRACT FROM AUTHOR]

We have previously reported sirolimus (SRL) pharmacokinetics (PK) in pediatric renal transplant recipients on a calcineurin inhibitor (CNI)-free protocol. We now report pediatric SRL PK in pediatric renal transplant patients receiving SRL + CNI. SRL was dosed to achieve target trough levels between 10 and 20 ng/mL. We performed 49 SRL PK profiles in pediatric renal transplant recipients receiving SRL in combination with either cyclosporine (CsA; 25 profiles), or tacrolimus (TCL; 24 profiles). Ten of the SRL + TCL profiles were obtained from children receiving SRL on a b.i.d. dosing regimen. All other SRL profiles were q.d. regimens. We calculated, the maximum concentration (Cmax), AUC, apparent clearance (aCL; dose/AUC) for dose in mg/m2, and mean residence time (MRT). SRL levels were measured at 6 and 7 time points for b.i.d. and q.d. dosing, respectively. Regression analysis of SRL trough values vs. AUC showed good correlation in the SRL q.d. + CsA, SRL q.d. + TCL, and SRL b.i.d. + TCL groups (r2 = 0.95, 0.68, and 0.44, respectively). SRL aCL corrected for body surface area was higher in children aged 0–5 yr receiving SRL with either CsA or TCL. SRL dosing schedule should be tailored to each patient. Higher SRL aCL may be present in younger children when administered with CNI. [ABSTRACT FROM AUTHOR]

Viral infections are an important complication of transplantation. The introduction of more potent immunosuppressive agents over the past decade correlates with an increase in the rate of hospitalizations of transplant patients with infections. Specifically, viral infections have emerged as a major source of morbidity and mortality in transplantation. There are several potential intervention strategies in the face of emerging infections and it is likely that the approach will differ depending on the virus in question. These include viral surveillance and pre-emptive therapy, intervention of the transplant community, and policy change at the level of government, blood bank and organ procurement organizations. This review focuses on the emergence of the herpesviruses; HHV-6 and HHV-7. In addition, the issue of virus transmission through organ transplant is addressed with a discussion of West Nile virus and the rabies virus. [ABSTRACT FROM AUTHOR]

Background Responding to the preferences of patients is a key focus of current health policy and is especially important in primary care. Responding effectively to patient preferences requires a clear understanding of the way in which patients assess primary care services. Objective This study was designed to provide a ‘map’ of the content and structure of the key attributes of patient preferences concerning primary care. Design The development of the ‘map’ used secondary research methods. Electronic databases were searched for published conceptual reviews of patient preferences, which were used to develop a basic ‘map’ through content analysis. A search for recently published primary empirical studies of patient preferences was conducted to extend and develop the ‘map’. The ‘map’ was tested by taking a random sample of patient assessment instruments and categorizing the item content. Results Seven major categories and multiple subcategories were described. The major categories were access, technical care, interpersonal care, patient-centredness, continuity, outcomes, and hotel aspects of care. The coverage of these attributes in a selection of patient assessment instruments varied widely, and the coding of a proportion of items in the patient assessment instruments according to the ‘map’ was problematic. Conclusions The conceptual ‘map’ can be used to plan comprehensive assessment of patient preferences in primary care. It also raises many theoretical issues concerning the nature of attributes and their interrelationships. The implications for the measurement of patient preferences are discussed. [ABSTRACT FROM AUTHOR]

Benfield MR, Tejani A, Harmon WE, McDonald R, Stablein DM, McIntosh M, Rose S, for The CCTPT Study group. A randomized multicenter trial of OKT3 mAbs induction compared with intravenous cyclosporine in pediatric renal transplantation.Pediatr Transplantation 2005.© 2005 Blackwell MunksgaardAcute rejection leading to renal graft failure is more frequent among children. In patients treated with T cell antibody induction, retrospective data from the pediatric registry show a 22% reduction in the risk of graft failure. We conducted a randomized trial (n = 287) using OKT3 mAbs in one (OKT3) arm and intravenous cyclosporine in the other arm (CYS). Maintenance therapy consisted of randomized, double blind Sandimmune® or Neoral® together with prednisone and either azathioprine (AZA) or mycophenolate mofetil (MMF). Morbidity, mortality, rejection rates and adverse reactions in the two study arms were similar. Through 4 yr, graft failure was 27% in OKT3 and 19% in CYS (p = 0.15). One-year graft survival was 89.1% in OKT3 and 89.2% in CYS (p = .19). In multivariate analysis, OKT3 had a numerically inferior graft survival (RR = 1.4, CI 0.8–2.2, p = 0.22). In OKT3 graft survival was inferior for children aged 6 yr or younger. Our trial demonstrates that the incidence of acute rejection or graft failure in pediatric patients is not improved by OKT3 induction therapy relative to cyclosporine induction. [ABSTRACT FROM AUTHOR]

The notion of empowerment has been increasingly used within management discourses in recent years. Enthusiastic supporters conceive it as an acknowledgement of the individual employee as a talented, creative being, and hence a productive resource for contributing to organisational goals. Alternatively, more critical commentators have interpreted it as another means of exercising control over employees and their identities. Although various commentators have speculated on the management of identity as a means of organizational control, there is very little empirical work from which to draw conclusions. This paper, using participant observation and interview data, represents a contribution to the small body of empirical research in the area. It focuses on an initiative aimed ostensibly at‘empowering’ staff in an English Primary Care Trust, which may be seen as an attempt at increasing organisational control by shaping employee identities. As such, these processes can be understood more readily in terms of ethics rather than empowerment. The term ethics is used here in a Foucauldian sense and is linked to the processes of self-definition and self-constraint by which individuals train themselves to become ethical persons. The paper suggests that the outcome of attempts to manufacture particular forms of subjectivity by such methods as‘empowerment’ programmes may be very different from those intended. [ABSTRACT FROM AUTHOR]

Smith JM, Nemeth TL, McDonald RA. Current immunosuppressive agents in pediatric renal transplantation: Efficacy, side-effects and utilization.Pediatr Transplantation 2004: 8: 445–453.© 2004 Blackwell MunksgaardAdvances in immunosuppressive therapy over the past decade have led to dramatic improvements in graft survival. The immunosuppression that is used is center-dependent and is constantly evolving with the development of new medications. The goal remains to find the best combination that will optimize graft survival, while minimizing the adverse effects. [ABSTRACT FROM AUTHOR]

Abstract: The North American Pediatric Renal Transplant Cooperative Study has collected clinical information on children undergoing a renal transplantation since 1987. This cooperative group now includes over 150 participating medical centers in the United States, Canada, Mexico, and Costa Rica. This report covers the years from 1987 through 2001 and includes data on 7545 renal transplants in 6878 patients. This report demonstrates changing trends in many areas of pediatric transplantation including increasing numbers of African American and Hispanic children receiving transplantation, remarkable improvements in the rate of acute rejection, rejection reversal, and short- and long-term allograft survival. In the most recent cohorts of patients, we now see that 1-yr allograft survival is no different in cadaver donor compared to living donor recipients and in infants compared to all other age groups. However, this analysis also reveals areas of continued challenges including inferior outcomes in African American and adolescent populations, chronic rejection, and the adverse effects of immunosuppression. [ABSTRACT FROM AUTHOR]

Abstract: Graft thrombosis is a common cause of graft failure in pediatric renal transplantation. Several previous studies, including a North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) review of pretransplant dialysis status and graft outcomes, have described a potential correlation of peritoneal dialysis (PD) and graft thrombosis. This issue is of particular concern for pediatric transplant programs as more than 65% of children with end stage renal disease are treated with PD. We reviewed 7247 pediatric renal transplants performed between 1987 and 2001. Thrombosis was the cause of graft loss in 2.7% (199) of all the transplants performed. Among failed transplants, thrombosis was the third most common cause of graft loss in both index (11.6%) and subsequent transplants (14.5%). Thrombosis becomes the most common cause of graft failure (21%, 61/294) if one looks at transplants in the later cohort, from 1996 to 2001. This change is primarily because of a decrease in the incidence of acute rejection. In the PD group, 3.4% of all grafts were lost as a result of thrombosis. This compares with 1.9% in the hemodialysis group, 2.4% in the pre-emptive transplant group, and 4.1% among patients who received both dialysis modalities. There was a statistically significant difference in thrombosis failure risk in the different dialysis groups (p = 0.005) with those who received only peritoneal dialysis having the highest risk. Additional significant risk factors for graft thrombosis included; cadaver donor source (p < 0.001), cold ischemia time >24 h (p < 0.001), history of prior transplant (p < 0.001), donor age <6 yr (p < 0.001), and >5 pretransplant blood transfusions (p = 0.02). Using stepwise proportional hazards modeling, only pretransplant peritoneal dialysis, >24 h cold ischemia time, prior transplant, and donor age <6 yr were simultaneously associated with an increased risk of thrombosis. We conclude that pretransplant PD is associated with an increased risk of graft thrombosis. Special precautions should be undertaken in pediatric renal transplant patients who have received PD, especially infants and young children. [ABSTRACT FROM AUTHOR]

Abstract: Recipient age at transplant is an important predictor of outcome. The age most commonly associated with increased risk is infancy. An important, but less recognized, age group at high risk is the adolescent. We analyzed the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) database to determine the patient and graft outcomes of adolescents (13–17 yr of age) compared with younger children. The adolescent age group had a similar percentage patient survival rate compared to that of the younger age groups, except for the infants (0–1 yr), who had a dramatic drop-off in the early post-transplant period. Regarding the long-term graft survival for living donor recipients, adolescents had the poorest percentage graft survival compared to the other age groups, including the infants (p < 0.001). Among cadaver donor recipients, the adolescent group had a significantly poorer graft survival than the 2–5 yr and 6–12 yr age groups (p < 0.001). Although the infants had the poorest graft survival (p < 0.001), after the sharp drop-off in the immediate post-transplant period the slope of their graft-survival curve was similar to that of the 13–17 yr age group. The percentage of late acute rejection episodes among the 6–12 yr (26.0%) and 13–17 yr (22.2%) age groups was significantly higher than in the younger age groups (p < 0.001). The adolescents had relatively poor rejection reversal outcomes compared to the other age groups, with fewer complete rejection reversals and a greater number of partial reversals (p < 0.001). The increased risk of graft loss, late acute rejection, and incomplete rejection reversal observed in the adolescent age group demands further investigation. Lack of compliance with immunosuppression regimens may be an important contributory factor. Strategies to address the unique concerns of this high-risk population will be essential to improve outcomes. [ABSTRACT FROM AUTHOR]

In previous studies, regional variations in the expression of the Na+-Ca2+ exchanger (NCX) have been examined qualitatively in human heart using the C2C12 monoclonal antibody [Wang, J., Schwinger, R.H., Frank, K., Muller-Ehmsen, J., Martin-Vasallo, P., Pressley, T.A., Xiang, A., Erdmann, E. & McDonough, A.A. (1996) J. Clin. Invest. 98, 1650–1658]. Although NCX expression was found to be significantly lower in the atria compared to the septum, no significant differences were found between atrial and ventricular tissue. NCX has been located in the general sarcolemma and t-tubules of ventricular muscle and as t-tubules are sparse in atrial tissue compared to ventricular tissue, it is surprising that NCX expression was found to be similar in both atria and ventricles [Wang et al. (1996)]. To reinvestigate this, we have used SDS/PAGE and a quantitative Western blotting technique to determine the pattern of expression of NCX in guinea-pig heart in tissue samples from left atrium, right atrium, septum, left ventricle and right ventricle. NCX protein expression was 17.5 ± 3.9 pmol·mg-1 of protein in the left atrium and 29.2 ± 6.1 pmol·mg-1 of protein in the right atrium, which were both significantly lower (P < 0.05) than NCX expression in the septum, left ventricle and right ventricle (64.7 ± 15.2, 76.8 ± 19.5 and 69.4 ± 14.1 pmol·mg-1 of protein, respectively, n = 7). These differences in NCX expression may reflect variations in the cellular location of NCX protein in these regions. To study this, we used confocal immunofluorescence of single isolated myocytes to examine differences in the proportion of fluorescent staining on the general surface membrane compared with the interior of the cell (which presumably reflects a t-tubular location). We found that the general membrane staining was 79.0 ± 1.2% in cells from the atria which was significantly higher (P <... [ABSTRACT FROM AUTHOR]

This report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) covers the years 1987-1997, and analyzes data on 2904 living donor (LD) transplants performed in 2779 patients. Since 1991, approximately 300 LD transplants have been performed each year at the participating centers of the NAPRTCS. Caucasian children account for 72% of all LD recipients while AfricanAmerican children constitute only 11%. There has been a gradual decline in the number of transplants performed in children under the age of 6 years from a peak of 30% in 1987, to 21% in 1997. Preoperative calcineurin inhibitor therapy has dropped from 71% in 1987 to 38% in 1997. Through 1996, at six months post-transplant 97% of recipients were receiving prednisone, 88% were maintained on cyclosporin A, and 79% were receiving azathioprine. Of patients transplanted in 1997, 47% are maintained on mycophenolate and 10% are maintained on tacrolimus. By day 15, 20% of index transplant patients have had an acute rejection and by the end of the first year 47% have had a rejection episode. Among patients transplanted in 1995-1996, 40% had a rejection in the first year. Nine per cent of rejection episodes are irreversible in children under 2 years of age and 5% of the episodes are irreversible in 25-year-old children. Estimated graft survival probability at 1 year is 91%, at 3 years it is 84% and at 5 years it is 78.5%. Rejection accounts for 33% of graft loss and recurrence constitutes another 10%. Influential prognostic variables for graft survival are race (African-American vs. others, relative risk (RR) = 2.0, p < 0.001), > 5 random transfusions (RR = 1.6, p < 0.001), T-cell induction therapy (RR = 0.78, p = 0.01), and later year of entry (1989-1990 vs. 1994-1995, RR = 0.95, p = 0.004). Patient survival at 1 and 3 years was 97% and 96.5%, respectively, however, the 3-year patient survival of children under 2 years was 89%. The mean height deficit at baseline (n = 2677) was 1.86, at 1... [ABSTRACT FROM AUTHOR]

We report two children with end‐stage renal disease (ESRD) found to have inferior vena cava (IVC) thrombosis at the time of renal transplantation. The children suffered from renal diseases that included congenital hepatic fibrosis and portal hypertension as part of their pathophysiology. Neither child had evidence of hypercoaguability or clinical symptoms of IVC thrombosis. Prior to transplantation, the renal replacement therapy consisted primarily of peritoneal dialysis. During their hospital courses, these children had central venous catheters placed for temporary hemodialysis, episodes of peritonitis and numerous abdominal surgeries. The medical literature to date has not identified a link between IVC thrombosis and portal hypertension, nor has an association between the patients’ primary renal disease and IVC thrombosis been found. We also report the finding of asymptomatic IVC narrowing in a third patient with obstructive uropathy, colonic dysmotility and numerous abdominal surgeries. IVC narrowing was diagnosed by CT scan during his pretransplant evaluation. In this paper, we consider similarities between these three patients that may have predisposed each of them to asymptomatic IVC pathology, including large‐bore central venous access as young children and/or recurrent scarring abdominal processes. A discussion regarding appropriate screening of the ‘high‐risk patient’ for IVC pathology prior to kidney transplantation and surgical options for children with this rare complication are presented. [ABSTRACT FROM AUTHOR]

Discusses instructional practices of American teachers in developing primary-level literacy competencies in their students. Variations of format instructions; Reading through long-term ethnographic observation; Characteristics of high effective first-grade literacy teachers.