'American hegemony after September 11: Allies, rivals and contradictions'

11 September heralded and provided a pretext for a more aggressive but increasingly contradictory American hegemony. Some of the consequences are contrary to the United States' own interests. Its new doctrine of 'preemptive strike' against other sovereign states encourages similarly belligerent behaviour by other governments, and yet more terrorism by nonstate actors, the very threats which were to be eradicated by a re-asserted US hegemony. This essay focuses on three partly overlapping themes: different strategies towards allies - multilateral and unilateral; different forms of power - civil and military; and different ideologies of globalisation - neoliberal and neo-conservative. It argues that while US policy may oscillate between such poles, it often combines the different elements. The overall strategy of the Bush administration is best characterised as unilateral multilateralism. The main issue for US hegemonists is the ways in which their hegemony might best be exercised, maintained and strengthened vis à vis allies and rivals. But for a safer, more democratic world, the choice does not lie between one faction of US hegemonists and another: we need other alternatives such as cosmopolitan democracy and a genuine internationalist movement which would give it some much-needed substance.

Skin bradykinin-related peptides (BRPs) and their biosynthetic precusors (kininogens): comparisons between various taxa of Chinese and North American ranid frogs.

Bradykinins and related peptides (BRPs) occur in the defensive skin secretions of many amphibians. Here we report the structures of BRPs and their corresponding biosynthetic precursor cDNAs from the Chinese brown frog, Rana chensinensis, and the North American leopard frog, Lithobates pipiens. R. chensinensis skin contained four transcripts each encoding a different kininogen whose organizations and spectrum of encoded BRPs were similar to those reported for the pickerel frog, Lithobates palustris. In contrast, from L. pipiens, a single skin kininogen was cloned whose structural organization and spectrum of mature BRPs were similar to those reported for the Chinese piebald odorous frog, Huia schmackeri. These data also implied that the endogenous precursor processing proteases in each species pair have identical site-directed specificities, which in part may be dictated by the primary structures of encoded BRPs. Thus the spectra of skin BRPs and the organization of their biosynthetic precursors are not consistent with recent taxonomy. The natural selective pressures that mould the primary structures of amphibian skin secretion peptides are thought to be related to the spectrum of predators encountered within their habitats. Thus similarities and differences in skin bradykinins may be reflective of predator spectra rather than indicative of species relatedness.

The Chinese bamboo leaf odorous frog (Rana (Odorrana) versabilis) and North American Rana frogs share the same families of skin antimicrobial peptides.

The Chinese bamboo leaf odorous frog (Rana (Odorrana) versabilis) and the North American pickerel frog (Rana palustris) occupy different ecological niches on two different continents with no overlap in geographical distribution. R. palustris skin secretions contain a formidable array of antimicrobial peptides including homologs of brevinin-1, esculentin-1, esculentin-2, ranatuerin-2, a temporin and a family of peptides considered of unique structural attributes when isolated, palustrins 1–3. Here we describe the structures of mature peptides and precursors of eight putative antimicrobial peptides from the skin secretion of the Chinese bamboo leaf odorous frog (Rana (Odorrana) versabilis). Each peptide represents a structural homolog of respective peptide families isolated from R. palustris, including two peptides identical in primary structure to palustrin 1c and palustrin 3b. Additionally, two peptides were found to be structural homologs of ranatuerin 2B and ranatuerin 2P from the closely-related North American species, Rana berlandieri (the Rio Grande leopard frog) and Rana pipiens (the Northern leopard frog), respectively. Both palustrins and ranatuerins have hitherto been considered unique to North American ranid frogs. The use of primary structures of amphibian skin antimicrobial peptides is thus questionable as a taxonomic device or alternatively, the micro-evolution and/or ancestry of ranid frogs is more highly complex than previously thought.

'Like walking on eggshells': Service user views and expectations of the child protection system

This paper reports on a study of service users' views on Irish child protection services. Qualitative interviews were conducted with 67 service users, including young people between 13 and 23. The findings showed that despite refocusing and public service management reforms, service users still experience involvement with the services as intimidating and stressful and while they acknowledged opportunities to participate in the child protection process, they found the experience to be very difficult. Their definition of ‘needs’ was somewhat at odds with that suggested in official documentation, and they viewed the execution of a child protection plan more as a coercive requirement to comply with ‘tasks’ set by workers than a conjoint effort to enhance their children's welfare. As in previous studies, the data showed how the development of good relationships between workers and service users could compensate for the harsher aspects of involvement with child protection. In addition, this study demonstrated a high level of discernment on the part of service users, highlighting their expectation of quality standards in respect of courtesy, respect, accountability, transparency and practitioner expertise.

A comparative analysis of the health and wellbeing of cancer survivors to the general population

Background
The population of people surviving cancer is continually increasing and currently cancer survivors represent approximately 3.7% of the American population and 3% of the UK population. There is limited and inconclusive empirical evidence regarding the long-term health and well-being of cancer survivors.

Methods
Two hundred eighty-nine cancer survivors and 262 matched-age and sex patients from the same group of General (primary care) Practices completed postal questionnaires measuring health and well-being, health service utilisation and satisfaction and health care needs.

Main Results
Cancer survivors reported poorer health and well-being and health service utilisation than the general population. Despite this poorer health, the majority of cancer survivors reported satisfaction with services and almost two-thirds of the survivors did not report any needs.

Conclusions
The majority of cancer survivors do not appear to require additional support services. There is, however, a subgroup of survivors who warrant specialist support, particularly survivors who are older, experience late effects and have had adjuvant treatments. Future research should focus on developing methods that could be used in routine clinical practice to identify ‘at risk’ or vulnerable patients and to provide appropriate and timely support.

Stigmatised Identity and Service Usage in Disadvantaged Communities: Residents’, community workers’ and service providers’ perspectives.

The impact of community stigmatisation upon service usage has been largely overlooked from a social identity perspective. Specifically, the social identity-mediated mechanisms by which stigmatisation hinders service use remain unspecified. The present study examines how service providers, community workers and residents recount their experience of the stigmatisation of local community identity and how this shapes residents’ uptake of welfare, education and community support services. Twenty individual and group interviews with 10 residents, 16 community workers and six statutory service providers in economically disadvantaged communities in Limerick, Ireland, were thematically analysed.Analysis indicates that statutory service providers endorsed negative stereotypes of disadvantaged areas as separate and anti-social. The awareness of this perceived division and the experience of ‘stigma consciousness’ was reported by residents and community workers to undermine trust, leading to under-utilisation of community and government services. We argue that stigmatisation acts as a ‘social curse’ by undermining shared identity between service users and providers and so turning a potentially cooperative intragroup relationship into a fraught intergroup one. We suggest that tackling stigma in order to foster a sense of shared identity is important in creating positive and cooperative service interactions for both service users and providers.

An official American thoracic society research statement: Comparative effectiveness research in pulmonary, critical care, and sleep medicine

Background: Comparative effectiveness research (CER) is intended to inform decision making in clinical practice, and is central to patientcentered outcomes research (PCOR). Purpose: To summarize key aspects of CER definitions and provide examples highlighting the complementary nature of efficacy and CER studies in pulmonary, critical care, and sleep medicine. Methods: An ad hoc working group of the American Thoracic Society with experience in clinical trials, health services research, quality improvement, and behavioral sciences in pulmonary, critical care, and sleepmedicinewas convened. The group used an iterative consensus process, including a reviewbyAmerican Thoracic Society committees and assemblies. Results: The traditional efficacy paradigm relies on clinical trials with high internal validity to evaluate interventions in narrowly defined populations and in research settings. Efficacy studies address the question, "Can it work in optimal conditions?" The CER paradigm employs a wide range of study designs to understand the effects of interventions in clinical settings. CER studies address the question, "Does it work in practice?" The results of efficacy and CER studies may or may not agree. CER incorporates many attributes of outcomes research and health services research, while placing greater emphasis on meeting the expressed needs of nonresearcher stakeholders (e.g., patients, clinicians, and others). Conclusions: CER complements traditional efficacy research by placing greater emphasis on the effects of interventions in practice, and developing evidence to address the needs of the many stakeholders involved in health care decisions. Stakeholder engagement is an important component of CER. Copyright © 2013 by the American Thoracic Society.

Off-Duty Resilience: Re-orienting Tourism, Leisure and Recreation in the US Army BOSS program

Understanding how US imperial strategy is sustained by tourism and militarism requires an account of how American soldiers learn to understand themselves in relation to a variety of marginalized others. This paper explores how the US Army’s ‘Ready and Resilient’ (R2) campaign constructs soldier / other relations by mobilizing off-duty time through the ‘Better Opportunities for Single Soldiers’ (BOSS) program. BOSS’s first two platforms of ‘Well-Being’ and ‘Community Service’ feed into the R2 agenda by producing highly-skilled leaders (who govern a disengaged rank and file) and benevolent humanitarians (who provide charity for abject civilians). When these dispositions are transposed into BOSS’s third platform of ‘Recreation and Leisure’, soldiers turn away from the goals of leadership and humanitarianism to reveal the privileged narcissism underscoring the R2 agenda. This self-focus is intensified by familiar power relations in the tourism industry as soldiers pursue self-improvement by commodifying, distancing and effacing local tourist workers. Using the BOSS program as a case study, this paper critically interrogates how the US Army is assimilating off-duty practices of tourism, leisure and recreation into the wider program of resilience training.