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PurposeAs globalization increasingly affects the university sector around the world, there is a great advantage being placed on those universities that can respond timely and flexibly with appropriate innovation and internationalization strategies. The purpose of this paper is to review the literature of strategic aspects of innovation and internationalization in higher education. Based upon the premises of the Salford Prime Minister's Initiative 2 (PMI2) project, this paper aims to develop a theoretical framework which demonstrates how various objectives of innovation and internationalization can be translated and achieved in a learning organization context.Design/methodology/approachTheoretical analysis supported by empirical experiences. The paper explores the ideas and links between globalization and innovation/internationalization in higher education. The main concern of the paper is the implementation strategy of innovation and internationalization rather than the concepts and process of innovation and internationalization in higher education.FindingsWith examination of the impact of globalization upon higher education and strategic aspects of innovation and internationalization, this paper focuses on the implementation of innovation and internationalization and how to translate the overall institutional strategy into managed objectives. Organizational learning not only asserts and promotes organizational outcome and improved performance but also plays a significant role in achieving innovation and internationalization, e.g. staff engagement, staff motivation, empowerment, leadership and configuration. Furthermore, the paper identifies a number of strategic elements which are crucial to the successful implementation strategy of innovation and internationalization. The paper is based on the Salford PMI2 project and how various objectives were implemented which demonstrates the significance of collaboration in higher education between China and the UK.Originality/valueBased on a comprehensive examination of the theoretical elements on innovation and internationalization and critical analysis of the Salford PMI2 project, adapting a typology of learning organizational framework, this study emphasizes the significance of incorporating both cultural and organizational learning factors. The paper develops a theoretical framework which enables policy makers and decision makers to make appropriate arrangements in designing international development strategy. Furthermore, the paper addresses the appropriateness and effectiveness of knowledge transfer, individual and organizational learning during the implementation of the internationalization strategy.

Those with chronic diseases, including inflammatory bowel disease (IBD), often do not receive preventive care at the same rate as the general population. Attitudes of primary care providers could be key factors in the receipt of preventive care. We surveyed attendees of a family medicine review course. The survey contained nine demographic items, four items to assess exposure to and comfort level with IBD, and six clinical vignettes. Of surveys, 36% (61/169) were returned. The large majority were males practicing outpatient family medicine. Mean age was 51 years, and 48% reported a mostly rural practice. Of subjects, 10% reported either having IBD themselves or having a close associate or relative with IBD. Only 37% of subjects felt comfortable providing primary care across a range of illness severity. Forty-six percent reported moderate or high exposure to IBD. For the case vignettes, the overall highest rate of endorsement of the active role was 84% for a case related to stage I hypertension, while the lowest rate was 30% for an item relating to vaccination for immunosuppressed persons. We assessed the following predictors of comfort level and active role responses and found no significant associations: age, gender, years of medical practice, and close contact with IBD. Our study suggests that family medicine practitioners often do not feel comfortable providing care to IBD patients. Lack of familiarity with IBD medications may be a key factor.

Industrial philanthropist Edward Akroyd created the Yorkshire Penny Savings Bank in 1859. Despite competition from the Post Office Savings Bank after 1861 and a serious reserve problem in 1911, it sustained his overall strategy to become a successful regional bank. Using archival and contemporary sources to build on recent scholarship illustrating how savings banks were integrated into local economies and the complementary roles of philanthropy and paternalism, we analyse an English regional bank's strategy, including an assessment of strategic innovation, ownership changes and management structure. This will demonstrate that the founder's vision continued, even though the 1911 crisis radically altered both strategy and structure.

The article offers a defence of business history and responds to the suggestion from Taylor et al. (2009) that it should engage more with reflexive historiography and in particular with the work of the continental philosopher, Paul Ricoeur.We argue that such an engagement would not be helpful to business history in general, and would not address the specific issue of business history's isolation from management and organisation studies.To explain why, the article uses examples from literatures in business history, general history and historiography. It concludes that although business history's achievements are significant, they are predominantly empirical and to engage more with management and organization studies, it is necessary for business history to use a wider range of perspectives to become more theoretically informed.

PurposeThe purpose of this paper is to explore, within the context of developing Sino‐UK educational relationships, the evolution of a specific partnership, that between Tianjin Business School, Tianjin University of Commerce, Tianjin, and Salford Business School, University of Salford, UK. The paper is the first in an intended series, which will track the evolution of the on‐going collaboration and will document the various opportunities and barriers in establishing a successful strategic partnership. Specifically, the paper focuses on the context of the embryonic relationship, notably the policy drivers in China and the UK and the profile of the two participant partners.Design/methodology/approachThis is a case study‐based paper of two business schools.FindingsThis paper stresses the importance of the context and factors involved in establishing successful, and sustainable, collaborative partnerships in higher education (HE) and specifically between institutions based in China and the UK. It draws upon the experiences of two partner institutions, one in Tianjin, China, and one in Salford, UK and both of which are business schools.Originality/valueThe paper contributes to the limited literature on Sino‐UK collaboration in HE and does so through an original case study, involving description and analysis of an evolving collaborative relationship.

PurposeThis paper aims to review the international economic and political context within which China is developing its technology management strategy and its economy. The context represents a time of fundamentally significant change in and between the countries of East and West.Design/methodology/approachThe paper is a conceptual one, which considers the changes in the prevailing politico‐economic consensus including changes in the West, between East and West and within China.FindingsIn the context of the current political and economic landscape, the paper suggests there are perhaps three watersheds emerging which will define the present era and the foreseeable future and within which China's technology management strategy and economic development needs to be considered.Originality/valueGiven all the recent developments in international markets and the historic scale of the intervention of governments in the West, the paper is a timely and original analysis of the ending of the neo‐liberal consensus which has prevailed for the last 30 years and the significance of current developments, not least for China.

Background Resident physicians' beliefs about cardiopulmonary resuscitation (CPR) may impact their communication with patients about end-of-life care. We sought to understand how these perceptions and experiences have changed in the past decade because both medical education and American society have focused more on this domain. Method We surveyed 2 internal medicine resident cohorts at a large academic medical center in 1995 and 2005. Residents were asked of their beliefs about survival after CPR, perceived patient understanding, and regret after attempted resuscitation. Residents in 2005 reported more numerical experience with CPR. Current internal medicine residents are more optimistic than the 1995 cohort about survival after an inpatient cardiac arrest. They believe that far fewer patients and families understand resuscitation but report less regret about attempting to resuscitate patients. Conclusions These pilot data reveal potential changes in the attitudes of resident physicians toward CPR. The perceived poor understanding among decision makers calls into question the standard of informed consent. Despite this, residents report less regret leading one to ask what factors may underlie this response.

Despite evidence-based recommendations for communication and decision making about life-sustaining treatment, resident physicians' actual practice may vary. Few prior studies have examined these conversations qualitatively to uncover why ineffective communication styles may persist.To explore how discussions about life-sustaining treatment occur and examine the factors that influence physicians' communicative practices in hopes of providing novel insight into how these processes can be improved. PARTICIPANTS AND APPROACH: We conducted and recorded 56 qualitative semi-structured interviews with participants from 28 matched dyads of a resident physician and a hospitalized patient or their surrogate decision maker with whom cardiopulmonary resuscitation was discussed. Transcripts were analyzed and coded using the constant comparative method to develop themes.Resident physicians introduced decisions about resuscitation in a scripted, depersonalized and procedure-focused manner. Decision makers exhibited a poor understanding of the decision they were being asked to make and resident physicians often disagreed with the decision. Residents did not advocate for a particular course of action; however, the discussions of resuscitation were framed in ways that may have implicitly influenced decision making.Residents' communication practices may stem from their attempt to balance an informed choice model of decision making with their interest in providing appropriate care for the patient. Physicians' beliefs about mandatory autonomy may be an impediment to improving communication about patients' choices for life-sustaining treatment. Redefining the role of the physician will be necessary if a shared decision making model is to be adopted.

PurposeThe purpose of this paper is to show that since its election in 1997, the Labour Government in the United Kingdom has pursued a policy agenda which in some senses represents a continuation of the New Right agenda it inherited. Central to this agenda has been the emphasis placed on choice in public services.Design/methodology/approachWithin the context of the New Right agenda this paper explores the concept and suggested merits of choice in public service provision. It does so by focusing on the experiences in England, particularly in relation to health and education.FindingsBy reference to the empirical evidence, the paper evaluates the conceptual arguments in favour of choice and finds that the current emphasis is consistent with the news of the New Right.Originality/valueThe paper questions the merits of choice in public service provision and, in doing so, suggests that the apparent political consensus in favour of choice can not be justified.

Objective To explore the ways in which seriously ill hospitalized patients, their family members and physicians interpret the discussion of the patient's preferences for cardiopulmonary resuscitation (CPR). Methods Resident physicians, their patients, and family members were interviewed following a discussion regarding preferences for CPR. We sought the participants’ perceptions of the resulting decision, examined how often these interpretations differed, and explored the communicative factors underlying discrepancies when they occurred. Results Fifty-six interviews with 28 matched dyads were completed. In six dyads (21%), the participants reported differing results of the discussion. Two patients had orders to limit their care based on the physician's interpretation of their discussion. Another two patients who did not want resuscitation lacked a DNR order. Two patients did not recall having the conversation. These discrepancies could be attributed to the physician misconstruing the patient's wishes, interference of a family member, and fluctuating preferences. Conclusions Discrepant interpretations of a DNR discussion occur with a concerning frequency between resident physicians and their hospitalized patients. Practice implications Educational efforts should focus on training physicians to clarify the language used in these discussions, remain vigilant about discerning the patient's preferences, and be aware that these preferences may be contextually fluid.

RIME is a descriptive framework in which students and their teachers can gauge progress throughout a clerkship from R (reporter) to I (interpreter) to M (manager) to E (educator). RIME, as described in the literature, is complemented by residents and attending physicians meeting with a clerkship director to discuss individual student progress, with group discussion resulting in assignment of a RIME stage.1) to determine whether a student's RIME rating is associated with end-of-clerkship examination performance; and 2) to determine whose independent RIME rating is most predictive of a student's examination performance: attendings, residents, or interns.Prospective cohort study.Third year medical students from academic years 2004-2005 and early 2005-2006 at 1 medical school.Each attending, resident, and intern independently assessed the student's final RIME stage attained. For the purpose of analysis, R stage=1, I=2, M=3, and E=4. Regression analyses were performed with examination scores as dependent variables (National Board of Medical Examiners [NBME] medicine subject examination and a clinical performance examination [CPE]), with independent variables of mean attending RIME score, mean resident score, and mean intern score. For the 122 students, significant predictors of NBME subject exam score were resident RIME rating (p = .008) and intern RIME rating (p = .02). Significant predictor of CPE performance was resident RIME rating (p = .01).House staff RIME ratings of students are associated with student performance on written and clinical skills examinations.

Cystic fibrosis (CF) is a life-limiting congenital disease, with most patients dying at a young age of progressive lung disease. Lung transplantation offers hope for many but may not occur. There is little to guide the provision of palliative care to this young population who maintain hope in the possibility of lung transplantation.To inform the development of an appropriate model of palliative care, a medical record review of CF patients dying within a 5-year period without lung transplantation was undertaken. The aspects of care that were preventative, therapeutic, or palliative were quantified.Of the 20 records studied, all died in hospital. Only 15% of patients had a do-not-resuscitate order agreed to more than 1 week prior to death, increasing to 90% at the time of death (median of 2 days before death). Opioids were prescribed for 1 patient (5%) at 1 week prior to death, increasing to 85% of patients in the last 24 hours of life (median of 36 hours before death). During the last 24 hours of life, intravenous antibiotics continued in 85%, and assisted ventilation in 90% of subjects.We conclude that the circumstances surrounding the death of patients with CF holds challenges for their effective palliative care. CF patients continue life prolonging and preventative treatments until the last hours of life. There is an urgent need to examine palliative care approaches that may usefully coexist with maintaining transplantation options in the end-of-life care of this population.

Background: Persons with chronic diseases often do not receive preventive care at the same rate as the general population. Reasons for this are not clear. We conducted a cross-sectional survey of patients with inflammatory bowel disease (IBD) and controls to assess receipt of 10 preventive health services. Methods: From March through October 2006, IBD outpatients and primary care outpatients at the University of Kentucky (UK) were surveyed by trained clinicians, using chart data to augment patient response. A second sample of IBD patients from the University of Chicago was studied with a self-administered survey. Results: One hundred and seventeen IBD subjects were enrolled at UK, 125 IBD subjects were enrolled at UCH, and 100 control subjects were recruited from UK primary care clinics. The overall age-/sex-adjusted screening rate, as measured by the screening index, was significantly lower in UK IBD subjects than in UK controls (75.1% versus 83.9%, P = 0.0002). The UCH data showed a 67% overall age-/sex-adjusted screening rate. After adjusting for insurance status, the difference in screening rates was still lower for IBD patients than for controls (71% versus 78%; P = 0.022). Neither disease type nor disease control rating predicted screening rate. Conclusions: Our data suggest IBD patients do not receive preventive services at the same rate as general medical patients. Preventive care is a facet of global IBD management that deserves further study. (Inflamm Bowel Dis 2007)

Responding to a recent special issue of Environment and Planning A on decline in mature industrial regions, the paper summarises and presents recent historical work on English industrial districts and regions. The paper argues that historical methods, informed by cognate social sciences, allow us to place the concepts of contingency and lock-in on a firmer footing. The paper presents a nondeterministic life-cycle model of industrial districts.

Residents feel inadequately trained to treat domestic violence victims.The purpose was to assess clinical skills of residents participating in a domestic violence workshop.Twenty-seven internal medicine residents were randomized to receive one of two workshops (domestic violence or control workshop). Standardized patients were trained to two domestic violence cases (depressed; injured). The two cases were randomized and insinuated into each resident's continuity clinic at either 1 to 3 months or more than 3 months after the workshops.The domestic violence workshop residents did not identify the standardized patients as domestic violence victims any more often than residents participating in the control workshop; 16/25 (64%) versus 13/23 (56%), p=.86. However, domestic violence workshop residents were more likely to score 75% or higher on the domestic violence checklist items compared to control workshop residents; 9/25 (36%) versus 2/23 (9%), p=.04.Once a standardized patient was identified in clinic as a domestic violence victim, domestic violence workshop participating residents demonstrated better clinical skills than a control group.

Debates about the role of capitalist corporations depend ultimately on their response to the enduring question of ‘who controls the large modern corporation’. This article aims to identify various competing schools of thought that can be classified as ‘managerialist’ and ‘anti-managerialist’, ‘mainstream’ and ‘radical’, which have emerged over the course of the last 70 years, moving on to consider how each has impacted on the discipline of business history. The paper utilizes a two-by-two matrix that divides theories along two dimensions to set out four alternative perspectives. Along the horizontal dimension, anti-managerialism is opposed to managerialism; along the vertical dimension, mainstream and radical perspectives are opposed. The article then assesses the extent to which these conflicting perspectives have influenced the work of business historians, from Chandler's earliest work through to more recent thinking on the links between corporate governance, accountability and broader market forces. Em...

Resident physicians are inadequately taught how to communicate with patients about end-of-life decision making. Their beliefs about resuscitation and prior experiences with end-of-life care may impact the manner in which they approach patients.To explore residents' perceptions of end-of-life discussions, determine the features they find most important, and discern the challenges they face in this process.Internal medicine residents were surveyed about their experiences discussing resuscitation with patients including perceptions of patient understanding, outcomes of resuscitation, and regret about attempting to resuscitate patients. They were asked what features of these discussions are most important and which are the most challenging. Qualitative content analysis was used to examine the responses to open-ended questions.Fifty-five residents completed the survey. Residents reported rarely feeling satisfied with the results of these discussions and disagreed with the decision for resuscitation numerous times. They perceive that few patients and families understand resuscitation. In their description of important features, they focus on the content of the discussion rather than the process, with the most common responses centering on a description of resuscitation. In contrast, the greatest challenge they identify is dealing with the emotional aspects of the discussion.Residents report internal conflict about their experiences discussing resuscitation with patients. Their approach to these discussions focuses on resuscitation itself with less attention paid to processes that might improve patient decision making. The challenges they describe may be overcome with improved education about end-of-life communication.

Standardized patient (SP) exams are becoming an important part of testing clinical skills. The dynamics of this test format warrant exploration. This study is designed to measure the relationship between experience with SPs and performance on a SP examination. A general linear model is used to determine if a relationship exists and the pattern of that relationship as experience increases. There is a linear association between increased experience and better performance in technical domains. In interpersonal skill domains, there is a curvilinear association between experience and performance with improved performance with moderate levels of experience but not in the most experienced group. Different levels of experience with SPs are associated with differences in performance. The varied pattern of associations suggests a possible practice effect or test-taking behavior. Additional studies are needed to assess this potential effect on SP exam validity.

A feature common to many countries over the last thirty years has been that of radical change in the management of public services. In the United Kingdom, successive Conservative and Labour governments have implemented measures to bring about change in local government, including Labour's Best Value initiative. In documenting and evaluating the effect of such policies, however, the focus has largely been on developed economies and little emphasis has been placed on those countries which regained their independence following the collapse of the Soviet Union and which are now in transition from a planned to a market economy. One such transitional economy is Estonia. This article considers the changes taking place in Estonian local government. The research findings are based on a national questionnaire survey of the Heads of Estonian local authorities. The questionnaire was in part based on a key component of the Best Value framework and the results provide some evidence as to the changing nature of...

The role of endogenous opioids in aerobic fitness-induced decrements in cardiovascular stress reactivity was examined by comparing the effects of opioid antagonism with naltrexone on responses to stress in young adults with high versus low levels of aerobic fitness. Two hundred forty subjects were given an activity questionnaire and males with the highest (Fit) and lowest (Nonfit) aerobic activity profiles were recruited for maximal oxygen consumption (VO2max) treadmill testing and psychological stress testing (final sample N = 28). Heart rate and blood pressures were measured during performance on a computer-controlled arithmetic task after pretreatment with either naltrexone (Trexan, DuPont) or a placebo. During placebo challenges, Fit subjects, compared with Nonfit, showed lower heart rate reactivity during stress and lower mean arterial blood pressures immediately before and during recovery from stress. Naltrexone eliminated these reactivity differences by increasing heart rate reactivity and raising mean arterial blood pressure in Fit subjects. These data suggest that aerobic fitness is associated with enhanced opioidergic inhibition of circulatory stress reactivity. Opioidergic modulatory effects on stress reactivity may comprise an important mechanism in fitness-associated risk reduction for cardiovascular disease.

Sexual history and HIV counseling (SHHIVC) are essential clinical skills. Our project's purpose was to evaluate a standardized patient educational intervention teaching third-year medical students SHHIVC.A four-hour standardized patient workshop was delivered to one-half of the class each of three consecutive years at one medical school. Approximately 3.5 weeks later, all students engaged in a standardized patient examination including one station assessing SHHIVC, answered an open-ended written exercise following the standardized patient encounter, and completed a written examination including sexual history and HIV-related questions.Workshop participants scored higher than non-participants on SHHIVC items on the standardized patient station (P.0001), written exam (P.0001), and open-ended written exercise after the standardized patient encounter (P = .024).Our SHHIVC curriculum was associated with students demonstrating better clinical skills on a SHHIVC standardized patient examination station and more SHHIVC knowledge on two measures of medical knowledge than students not participating in the SHHIVC educational intervention.

Based on the premise that ‘History matters’, and looking at the main trends and stages in British management since the late nineteenth century through to the present day, this article provides a rationale for including management history in business school curricula. In particular, in looking at how British managers have made the transition from an essentially ‘salaried’ to a ‘professional’ status, as well as applying Lewin's force-field analysis to tracing the rise of managerial capitalism, we stress the value of taking a long-term perspective in studying the essence and dynamics of managerial change.

The paper combines economic and sociological perspectives on organizations in order to gain a better understanding of the forces shaping the structures of industrial districts (IDs) and the organizations of which they are constituted. To effect the combination , the resource based view (RBV) and resource dependency theory are combined to explain the evolution of different industry structures. The paper thus extends work by Toms and Filatotchev by spatializing consideration of resource distribution and resource dependence. The paper has important implications for conventional interpretations in the fields of business and organizational history and for the main areas of theory hitherto considered separately, particularly the Chandlerian model of corporate hierarchy as contrasted with the alternative of clusters of small firms coordinated by networks.

The debate over ownership and control of corporations is one of the most enduring in social science. It is a debate that continues to influence, and is informed by accounting and accountability research as well as labor process theory, and it is a debate that is vital for understanding the relation between accounting and the labor process. This paper offers a roadmap for locating alternative perspectives concerning ownership and control. First, ‘mainstream anti-managerialism’ maintains that corporations remain answerable to their owners. Second, ‘mainstream managerialism’ argues that corporations are one form of organization and that organizations in general are shaped by inter-organizational factors. Third, ‘radical managerialism’ views corporations as self-perpetuating bureaucracies. Finally ‘Marxist anti-managerialism’ views corporations as constrained by the interests of an identifiable capitalist class.

This study examined the association between measures of spirituality and religiosity and characteristics of current criminal conviction in a male prison population. Spirituality was operationalized as spiritual well-being and existential well-being. Religiosity was operationalized as frequency of religious service attendance, whether an individual considered himself to be religious, and how strongly an individual believed his religious beliefs influenced his behavior. Inmates whose convictions were property related reported greater spiritual wellbeing, were more likely to consider themselves religious, and to say that religious beliefs influenced their behavior than inmates whose crimes were not property related. Inmates whose convictions were drug related were less likely to consider themselves religious, and inmates whose conviction involved violence were more likely to consider themselves religious but less likely to endorse statements that religious beliefs influenced their behavior. The distinction between religiosity and spirituality is discussed in terms of the type-of-crime hypothesis.

PurposeThis paper aims to advance a theoretical framework that integrates knowledge management, change management and “soft” issues, focussing on uncovering the nature of “soft” issues embedded in knowledge management and change management processes.Design/methodology/approachBoth empirical work (case study at an electronics contract manufacturing plant) and literature review were used in order to build the proposed theoretical framework.FindingsIt argues that the “soft” dimension assists in better understanding the process of organizational knowledge transfer. In this context, “soft” issues refers to the mutual understanding – of both sender and receiver units – of underlying assumptions, the role of macro‐institutional factors affecting firm level actions (the macro‐micro link) and interpretative aspects that permeate the process of organizational knowledge transfer, including knowledge management and change management issues.Practical implicationsGuidelines for managerial action were formulated in order to make explicit, be aware of and understand embedded “soft” issues. Presented guidelines represent an attempt to uncover the crucial “soft” issues that are usually overlooked by the conventional literature.Originality/valueThis paper offers an alternative framework for guiding both practical intervention and further research on knowledge management‐related issues. It contributes to a better understanding of the process of organizational knowledge transfer.

Since its election in May 1997, the Labour Government in the United Kingdom has emphasized the need for modernization in the improvement of public services. For local government, this emphasis has led to the introduction of a variety of measures intended, primarily, to improve political management and service delivery. Two key policies have been the introduction of Best Value and the Comprehensive Performance Assessment (CPA). CPA is used by the Audit Commission for measuring local authority performance in England and has led to each authority being classified as excellent, good, fair, weak or poor. Each authority's classification has implications, financially and in terms of its freedom to determine priorities and policies. In addition, the structure of local government is being reviewed by central government, alongside discussions as to the merits of establishing regional assemblies. In considering the justification for, and the impact of, changes, it is important to consider the views of local government employees, not least professional groupings and chief officers. This paper reports the findings of a national survey of chief financial officers (CFOs) of the single tier and county council local authorities in England to establish their views on key features of the Government's modernization agenda.

The purpose of our study was to determine how time spent with the physician might be related to patient dissatisfaction with their waiting time. During a 2-month period, patients in our internal medicine resident continuity clinic completed a survey assessing their satisfaction with their waiting time and their estimates of their waiting time and time spent with the resident physician. For patients with long waiting times (more than 15 min in the waiting room or more than 10 min in the exam room), patient dissatisfaction with waiting time was associated with a shorter physician visit (48% were dissatisfied if the physician spent less than 15 min vs. 18% if the physician spent more than 15 min with them, p = .03). These data suggest that physicians can mediate the negative effects of long waiting times by spending more time with their patients. Future studies on patient satisfaction should consider this interaction.

Sexual history and HIV counseling are essential clinical skills. Our project's purpose was to evaluate a standardized patient (SP) educational intervention teaching third-year medical students sexual history taking and HIV counseling. A 4-hour SP workshop was delivered to one-half of the class. Four weeks later, all students engaged in an SP examination including one station on assessing sexual history taking and HIV counseling. Workshop participants scored one standard deviation higher on sexual history and HIV counseling items than nonparticipants. Our sexual history and HIV counseling curriculum was associated with students asking more thorough sexual histories and providing more HIV counseling.

Historical and contemporary discourses on American culture were applied to work stress for the purpose of identifying the cultural assumptions, values, and beliefs that may predispose Americans to certain types of distress and, by association, stress-related illnesses within the context of work. Six primary American (albeit democratic) values and beliefs were identified and applied to work stress. The findings suggest that for work stress to be addressed effectively, professionals who study and seek to ameliorate it should understand the cultural underpinnings and assumptions that drive American business specifically, and all democratic societies generally; influence worker behaviors; shape employee–employer cognitions; and bias work stress research. Suggestions for future research are provided.

In the United Kingdom the Labour government has placed considerable emphasis on the need to modernise public services. In the case of local government, Labour's belief in the need for modernisation has resulted in radical measures to change local authorities' political management arrangements designed, in part, to achieve greater efficiency, transparency and accountability. In its response to the Labour government's agenda, Redcar & Cleveland Borough Council established interim political management arrangements in May 2000 prior to the establishment of permanent arrangements. The permanent arrangements were to be decided upon following public consultation and a review of the interim arrangements. This article reports the outcomes and, in doing so, provides evidence of the impact of Labour's measures to achieve change in local government.

Since its election in 1997, the Labour Government in the UK has emphasised the need to improve the quality of public services. In the case of local government, this emphasis has led to the introduction of Comprehensive Performance Assessment (CPA). This article considers the merits of actual and intended CPA strategy within the wider context of public service performance measurement. The author concludes that the methodology leading to the December 2002 results and the intended way forward raise legitimate questions as to whether CPA can justifiably lay claim to being a comprehensive measure of performance.

This article extends Chandler's scale and scope perspective using a synthesis with accountability and governance perspectives. The article also explains how various paradigms of political economy might be accommodated within the proposed business history synthesis. Accordingly, the intended outcome is a model that can explain why diverse organisational forms emerge, alongside the business strategies that accompany these changes during historical transitions. Using British business history as an example, empirical vignettes based on important transition points in support of the main propositions are also offered. This allows conclusions to be drawn on the joint impact of scale and scope economies with systems of corporate governance, the development of ‘efficient’ capital markets and the impact of globalisation on multinationals and business networks.

Historically, the survival of children and adolescents with Burkitt's and Burkitt-like lymphoma had been poor. Recently, short and intensive chemotherapy appears to have improved disease outcome. We therefore reviewed the results of four successive Children's Cancer Group trials conducted on 470 children with disseminated Burkitt's and Burkitt-like lymphoma. Of the patients studied, the median age was 8 years (0-21 years), the male:female ratio was 4:1, 58% had lactate dehydrogenase (LDH) > or = 500 IU/l, 23% had M2 or M3 bone marrow (BM), and 12% demonstrated central nervous system involvement. In a multivariate analysis, the 4-year event-free survival (EFS) in patients > or = 15-years-old compared with or = 500 IU/l compared with LDH < 500 IU/l was 49 +/- 3 versus 71 +/- 4% (P < 0.001). Furthermore, patients treated on the most recent protocol, which was short and more intensive, had a significantly improved survival compared with those on previous trials (4-year EFS 80 +/- 6 versus 54 +/- 2%, P < 0.001). In summary, the outcome for childhood Burkitt's and Burkitt-like lymphoma has recently improved with the use of short and intensive B-cell non-Hodgkin's lymphoma-directed therapy.

Purpose: Determine whether gender predicted student performance on a clinical performance examination (CPX) when controlling for pre-matriculation and medical school performance. Method: A sixteen-station CPX, utilizing standardized patients (SPs), was administered to the fourth-year students three successive years at one United States medical school. Scores for each student by discipline and skills across stations were generated. Bivariate correlation and multiple regression analyses were performed to determine relationships between students' scores and pre-matriculation information (age, gender, MCAT, and undergraduate GPA) and medical school performance (first-, second- and third-year GPA, and USMLE Step 1). Results: The CPX mean score for all students was 65.1% (SD 6.2). The mean total score for men (n = 182) and women (n = 93) was 64.0% and 67.0%, respectively. Being a woman, positively affected a student's score in two models controlling for pre-matriculation and medical school performance by 2.8% or 0.47 standard deviations (SD) and 2.3% or 0.39 SD, respectively. Women scored numerically higher than men in all seven disciplines (internal medicine, obstetrics/gynecology, pediatrics and psychiatry, p < 0.05) and for nine skills across all stations (introduction, history, physical examination, counseling and interpersonal, p < 0.05). Conclusion: Women performed better than men on the University of Kentucky CPX. Being a woman was a positive and independent predictor of performance.

The Labour Government has introduced radical measures to change local authorities' constitutions. These include a requirement to abandon the traditional committee system and to replace it with political executives. Local authority chief executives will play a critical role in these changes and they are also uniquely placed to offer observations on the likelihood of the measures being successful. Because of this, a questionnaire survey was undertaken of the chief executives of all local authorities in England and Wales to discover how councils are responding to the Government's measures and to obtain their views on the proposed political management arrangements.

States that public administration reform has been a global phenomenon over the last two decades, but that its justification, impact and effectiveness are strongly contested. Reveals that evidence across developed countries varies, but in developing countries conclusions are more difficult to arrive at. Examines the case of the Republic of Kazakhstan taking into account the views of local government. Concludes that, in the case of Kazakhstan there is considerable support for an enhanced, more autonomous role for local government.

PURPOSE: Concerns over teratogenicity of antiepileptic drugs (AEDs) during pregnancy must be balanced against the risks of seizures to the mother and developing fetus. Pharmacokinetic changes and vomiting may alter drug levels, but more important may be the patient's decision to stop medication before or during pregnancy. Compliance assessment traditionally relies either on self-reporting or on AED plasma level monitoring; neither provides reliable information on drug-taking behaviour over an extended interval (e.g., before, during, and after pregnancy). METHODS: We have used hair analysis to assess AED-taking behavior in pregnant women compared with nonpregnant female controls. Twenty-six pregnant women [mean age, 27.5 +/- 6.7 (SD) years] and 13 nonpregnant female epilepsy outpatients (mean age, 31.9 +/- 8.3 years) were studied. Carbamazepine (CBZ) or lamotrigine (LTG) concentrations were measured in 1-cm hair segments, and the within-subject variance in segmental hair concentrations of these drugs was calculated for each group. The variances of each group were then compared by using a variance ratio test. RESULTS: The variance of AED concentration in hair differed significantly between the pregnant and nonpregnant groups [variance ratio, 1.59 (p < 0.01)]. Four (15%) of the 26 pregnant patients had little or no AED in their proximal hair segments compared with more distal segments, apparently having discontinued their medication during pregnancy. Only one of these later disclosed having stopped her medication. One pregnant woman whose hair profile was similar to controls died suddenly at 30 weeks of gestation. CONCLUSIONS: This study confirms the perception that pregnant women with epilepsy frequently stop or greatly reduce their prescribed medication, usually without reference or acknowledgement to their clinician.

Objectives: We sought to investigate the effects of short- and long-term vitaminC therapy on endothelial dysfunction in patients with homocystinuria. Background: Untreated homocystinuria due to cystathionine b-synthase deficiency is associated with premature atherothrombotic disease; 25% of untreated patients suffer a vascular event by the age of 16 years and 50% by 29 years. Treatment directed at reducing homocysteine accumulation significantly reduces this risk. However, despite ‘optimal’ treatment and compliance, hyperhomocysteinaemia usually persists and individuals exhibit endothelial dysfunction indicative of an adverse cardiovascular prognosis. Additional intervention is therefore required to further reduce cardiovascular risk. Methods: We investigated the endothelial effects of acute (2 g single dose) and chronic (1 g/day for 6 months) administration of oral vitamin C in 5 patients with homocystinuria (mean age 26 years, 1 male) and 5 age- and sex-matched controls. Brachial artery endothelium-dependent £ow-mediated dilatation (FMD) and endothelium-independent responses to nitroglycerin (NTG) were measured using high-resolution ultrasonic vessel wall-tracking. Results: Baseline: Plasma total homocysteine was 100:8±61:6 and 9:2±1:9 µmol/L in the patient and control groups, respectively (p < 0:001). FMD responses were impaired in the patient group (20±40 µm) compared with the controls (116±30 µm) (p < 0:001). Vitamin C administration: FMD responses in the patient group improved both acutely, 160±65 µm at 4h (p < 0:001), and chronically, 170±70 µm at 2 weeks (p < 0:001) and 170±40 µm at 6 months (p < 0:001). FMD responses in the control group were unaltered (p = 0:526). Within both groups, neither the vascular response to NTG nor plasma homocysteine was altered (p > 0:4). Conclusions: Vitamin C ameliorates endothelial dysfunction in patients with homocystinuria, independent of changes in homocysteine concentration and should therefore be considered as an additional adjunct to therapy to reduce the potential long-term risk of atherothrombotic disease.