Lack of effect of intravenous administration on time to respond to azathioprine for steroid-treated Crohn's disease

AbstractBackground & Aims: Azathioprine is effective for Crohn's disease but acts slowly. A loading dose may decrease the time to response. Methods: A placebo-controlled study was conducted in patients with active Crohn's disease despite prednisone treatment. Patients were randomized to a 36-hour infusion of azathioprine, 40 mg/kg (51 patients), or placebo (45 patients) followed by oral azathioprine, 2 mg/kg, for 16 weeks. Prednisone was tapered over 5 weeks. The primary outcome measure was complete remission at week 8, defined by discontinuation of prednisone and a Crohn's Disease Activity Index of ≤150 points. Erythrocyte concentrations of the azathioprine active metabolite, 6-thioguanine nucleotide, were measured. Results: At week 8, 13 patients (25%) were in complete remission in the azathioprine-loaded group compared with 11 patients (24%) in the placebo group. The frequency of complete remission did not increase after 8 weeks in either group. Both groups achieved steady state of 6-thioguanine nucleotide by week 2, and no differences were found in mean concentrations between the groups. There were no significant differences in the frequency of adverse events between the groups. Conclusions: A loading dose does not decrease the time to response in patients with steroid-treated Crohn's disease beginning azathioprine therapy. Steady state of erythrocyte 6-thioguanine nucleotide and complete response occurred earlier than previously reported.GASTROENTEROLOGY 1999;117:527-53

Promoting choice and control in residential services for people with learning disabilities.

This paper discusses the gap between policy goals and practice in residential services for people with learning disabilities. Drawing on a nine month ethnographic study of three residential services, it outlines a range of obstacles to the promotion of choice and control that were routinely observed in the culture and working practices of the services. Issues discussed include conflicting service values and agendas, inspection regimes, an attention to the bigger decisions in a person's life when empowerment could more quickly and effectively be promoted at the level of everyday practice, problems of communication and interpretation and the pervasiveness of teaching. We offer a range of suggestions as to how these obstacles might be tackled

Task matters: a structural-instrumental analysis of the autonomy of Hong Kong government bodies

What might account for the varying degrees of autonomy granted to public agencies? One broad range of answers is provided by a structural-instrumental perspective on organizations, which assumes that the assignment of autonomy is a response to structural features of organizing on the one hand and to task considerations on the other. Taking the case of Hong Kong, data from a survey of chief executives of 111 government agencies on perceptions of autonomy are analyzed to explore a series of propositions concerning the relationships between structure, task, and perceived autonomy. The method of ordinary least square regression is used to analyze the data. Overall, the findings show that variables describing key features of structure and task do help to explain degrees of autonomy. However, two propositions drawn from rational choice theory concerning task-related variables are not confirmed: public service delivery organizations are under tighter, not looser control, whereas regulatory agencies show no tendency toward autonomy. Interpretation of the findings points to significant features of Hong Kong's constitutional and political history which highlight the importance of contextualization. © The Author(s) 2011.Link_to_subscribed_fulltex

Suing the Philadelphia Police: The Case for an Institutional Approach

This article examines the merits of two alternative briefs in Equal Protection litigation on police misconduct. The several suits brought against the Philadelphia Police Department illustrate the shortcomings of the judicially preferred intentionality brief and indicate the need for a more completely specified institutional brief. The background of the two briefs is traced to a dialectical conflict between discretion and control in the idea of law enforcement. The use of force is not a philosophical issue for a policeman. It is not a question of should or whether, but when and how much (Rubinstein 1973:323)