Insulin resistance and management of the menopause: a clinical hypothesis in practice

Insulin resistance (IR) is associated with a number of metabolic abnormalities including glucose intolerance, dyslipidemia and central obesity (the metabolic syndrome), which predispose to cardiovascular disease, diabetes mellitus and some cancers. The incidence of many of these conditions increases after the menopause, a time when IR also increases. Medical intervention to help alleviate menopausal symptoms, frequently vasomotor in origin, usually involves hormone replacement therapy (HRT), but some women may only experience partial symptom relief. We have hypothesized that this may be due to concurrent IR. Our approach is therefore to manage menopausal symptoms in conjunction with the treatment of any concurrent IR, achieved through a combination of hormone replacement, dietary intervention and, if necessary, an insulin sensitizer. We suggest that this approach may not only improve symptom relief but may also reduce the risk of developing more serious health complaints in the future.     

Employing policy and purchasing levers to increase the use of evidence-based practices in community-based substance abuse treatment settings: reports from single state authorities

State public health authorities are critical to the successful implementation of science based addiction treatment practices by community-based providers. The literature to date, however, lacks examples of state level policy strategies that promote evidence-based practices (EBPs). This mixed-methods study documents changes in two critical state-to-provider strategies aimed at accelerating use of evidence-based practices: purchasing levers (financial incentives and mechanisms) and policy or regulatory levers. A sample of 51 state representatives was interviewed. Single State Authorities for substance abuse treatment (SSAs) that fund providers directly or through managed care were significantly more likely to have contracts that required or encouraged evidence-based interventions, as compared to SSAs that fund providers indirectly through sub-state entities. Policy levers included EBP-related legislation, language in rules and regulations, and evidence-based criteria in state plans and standards. These differences in state policy are likely to result in significant state level variations regarding both the extent to which EBPs are implemented by community-based treatment providers and the quality of implementation.     

Recruitment and retention issues in rural labour markets

This paper aims to provide insights into the recruitment and retention issues faced by employers in rural areas. To this end, information gathered through interviews with employers and labour market intermediaries in the predominantly rural county of Lincolnshire, UK was used as a source of data and focal point to discuss the demand side of the labour market. A distinction is made between circumstances in which there are hard-to-fill vacancies on the one hand, and the effects of an abundant labour supply on the other. The factors that affect labour retention are also discussed, including situations in which staff retention is a non-issue. Recognising the fact that economic life exists within, and is affected by the social context, the views of employers and labour market intermediaries are also analysed in the light of data from other sources. The paper concludes by suggesting that employers’ recruitment and retention issues cannot be studied in isolation; the supply side as well as the demographic, economic, and political context need to be considered as well.     

Child sex abuse and the Irish criminal justice system

The aims of this study were to develop scales to assess experiences of sexually abused children in the Irish criminal justice system (CJS); identify aspects of the CJS which children experience as negative; compare the perceptions of children, parents and professionals of sexually abused children's experiences of the CJS; and determine correlations between perceptions of children's CJS experiences and current psychological adjustment. Forty‐three children, 101 parents, 32 mental health professionals, 27 police officers and 21 lawyers completed parallel versions of the Criminal Justice System Questionnaire (CJSQ) which assessed satisfaction with aspects of the CJS relevant to sexually abused children, specifically: Gardaí (police), medical examination, Director of Public Prosecutions, waiting for court, court professionals, court context and the CJS. Fifteen scales were developed by conducting principal component analyses. Children gave negative ratings on nine of these, and on seven children, parents and professionals differed in their perceptions of how children experienced the CJS with mental health professionals viewing the impact of the CJS as more problematic than parents and children. Scores of children and parents on CJSQ scales correlated with indices of current psychological adjustment. These results point to the importance of making the Irish CJS more child‐friendly and for evaluating these reforms with the CJSQ. Copyright © 2011 John Wiley & Sons, Ltd.     

Social work and transitions of care: observations from an intervention for older adults

Making the transition from hospital to home can be challenging for many older adults. This article presents practice perspectives on these transitions, based on a social work intervention for older adults discharged from an acute care setting to home. An analysis of interviews with clinical social workers who managed 356 cases (n = 3) and a review of their clinical notes (n = 581) were used to identify salient themes relevant to care transitions. Concepts developed and discussed identify the role of surprises after discharge, an expanded view of the client system, and relationship building as instrumental in carrying out effective care transitions.     

Managing Imbalanced Supply Chain Relationships for Sustainability: A Power Perspective

This study adopts a power perspective to investigate sustainable supply chain relationships and specifically uses resource‐dependence theory (RDT) to critically analyze buyer–supplier–supplier relationships. Empirical evidence is provided, extending the RDT model in this context. The concept of power relationships is explored through a qualitative study of a multinational company and agricultural growers in the UK food industry that work together to implement sustainable practices. We look at multiple triadic relationships involving a large buyer and its small suppliers to investigate how relative power affects the implementation of sustainable supply‐management practices. The study highlights that power as dependence is relevant to understanding compliance in sustainable supply chains and to identifying appropriate relationship‐management strategies to build more sustainable supply chains. We show the influences of power on how players manage their relationships and how it affects organizational responses to the implementation of sustainability initiatives. Power notably influences the sharing of sustainability‐related risks and value between supply chain partners. From a managerial perspective, the study contributes to developing a better understanding of how power can become an effective way to achieve sustainability goals. This article offers insights into the way in which a large organization works with small and medium size enterprises to implement sustainable practices and shows how power management—that is, the way in which power is used—can support or hinder effective cooperation around sustainability in the supply chain.     

Investigation of the robustness of two models for assessing synergy in pre‐clinical drug combination studies

Pre‐clinical studies may be used to screen for synergistic combinations of drugs. The types of in vitro assays used for this purpose will depend upon the disease area of interest. In oncology, one frequently used study measures cell line viability: cells placed into wells on a plate are treated with doses of two compounds, and cell viability is assessed from an optical density measurement corrected for blank well values. These measurements are often transformed and analysed as cell survival relative to untreated wells. The monotherapies are assumed to follow the Hill equation with lower and upper asymptotes at 0 and 1, respectively. Additionally, a common variance about the dose–response curve may be assumed. In this paper, we consider two models for incorporating synergy parameters. We investigate the effect of different models of biological variation on the assessment of synergy from both of these models. We show that estimates of the synergy parameters appear to be robust, even when estimates of the other model parameters are biased. Using untransformed measurements provides better coverage of the 95% confidence intervals for the synergy parameters than using transformed measurements, and the requirement to fit the upper asymptote does not cause difficulties. Assuming homoscedastic variances appears to be robust. The added complexity of determining and fitting an appropriate heteroscedastic model does not seem to be justified. Copyright © 2013 John Wiley & Sons, Ltd.     

Approximate mean squared errors of estimations of reliability in the two-parameter exponential case

Combining the method used i n Chao (1981) and conditional procedure, we extend our previous results for one-parameter exponential to two-parameter case, i .e. we provide simple approximation formulas for the mean squared errors of the maximum likelihood and minimum variance unbiased estimators of reliability of general k-out-of-m systems when the component lifetimes are independent and follow a two-parameter exponential distribution.