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The UK parliament of 2017–2019 had to decide what form of Brexit, if any, it would accept in the government's negotiations with the EU over a withdrawal agreement. Despite a large majority of MPs having supported Remain in the 2016 referendum, with most opposed to a 'hard' Brexit of looser ties between the UK and the EU, all attempts to pass a 'soft' Brexit failed. The final withdrawal agreement reflected a hard Brexit that was closer to the preferences of a 28-strong group of Eurosceptic Conservative MPs than to those of any other party or faction in a 650-seat parliament. This article identifies the two-party system for government as a crucial variable in explaining this unexpected outcome. Governments seek majorities from among their own MPs rather than relying on the uncertain support of the opposition. This not only makes party cohesion vital, but also creates leverage for organised factions to hold sway.

The UK parliament of 2017–2019 had to decide what form of Brexit, if any, it would accept in the government's negotiations with the EU over a withdrawal agreement. Despite a large majority of MPs having supported Remain in the 2016 referendum, with most opposed to a 'hard' Brexit of looser ties between the UK and the EU, all attempts to pass a 'soft' Brexit failed. The final withdrawal agreement reflected a hard Brexit that was closer to the preferences of a 28-strong group of Eurosceptic Conservative MPs than to those of any other party or faction in a 650-seat parliament. This article identifies the two-party system for government as a crucial variable in explaining this unexpected outcome. Governments seek majorities from among their own MPs rather than relying on the uncertain support of the opposition. This not only makes party cohesion vital, but also creates leverage for organised factions to hold sway.

This longitudinal study examined differences in driving while intoxicated (DWI) recidivism among defendants with multiple DWI offenses after receiving a 16-week cognitive-behavioral therapy (CBT) program compared with those who received standard services. Defendants on probation supervision with histories of repeated DWI offenses ( N = 286; male = 240, female = 46) were referred to CBT. There was a significant difference in DWI recidivism 3 years after CBT among participants (11%) and the New York State (25%) and national (30%) rates; the comparison group reoffended at the rate of 25%. Level of Service Inventory–Revised (LSI-R) scores of the CBT group also decreased significantly compared with the comparison group, and CBT participants showed significant improvement in overall functioning measured by Global Assessment of Functioning (GAF). CBT offered in this innovative manner was more effective with recalcitrant, hard to treat, DWI offenders. It may also benefit precontemplative offenders by helping them recognize that their drinking is negatively impacting their lives and may warrant more traditional alcohol treatment.

The global human immunodeficiency virus (HIV) pandemic reached staggering proportions over the past 2 decades, particularly in areas of sub-Saharan Africa and other developing countries. Tremendous increases in donor resources over the past decade have allowed for a rapid scale-up of antiretroviral treatment and greater access to basic care and prevention programs in countries worst affected by HIV infection and AIDS. These programs have had a tremendous impact on the lives of millions of individuals and have also created optimism and hope where previously there was despair. Major challenges remain in combating the current HIV pandemic with regard to access to treatment; efficiency, quality, and sustainability of current programs; and the scale-up of evidence-based, effective prevention strategies. The global health community and political leaders will need to overcome these challenges if a long-term effective response to the HIV pandemic is to be achieved.

The accuracy of detection of genital Neisseria gonorrhoeae infection in pooled urine samples by ligase chain reaction (LCR) was examined in three populations. Firstly, urine specimens from 300 female military recruits (FMR) were tested by LCR individually and in pools of four and six. Secondly, 300 urine specimens from middle-school students (MSS) were tested individually by LCR, and then the processed specimens were stored frozen for subsequent testing in pools of 4 and 10. Thirdly, 600 frozen urine specimens from high-school students (HSS) were tested by using the LCR pooling algorithm, i.e., testing processed specimens in pools of four in one test unit dose, and retesting individual specimens from positive pools. Finally, the pooling algorithm results were compared to culture results for a subset of 344 students from the original 600 HSS from whom cervical or urethral samples were taken at the discretion of the school nurse practitioners. Compared to individual testing of specimens by LCR in the FMR population, the pooling-by-four algorithm was 100% sensitive (5 of 5) and 100% pool specific (70 of 70), and the pool-by-six algorithm was 100% sensitive (5 of 5) and 100% pool specific (45 of 45). In the MSS population, the pool-by-4 algorithm was 95.8% sensitive (23 of 24) and 100% (52 of 52) pool specific, and the pool-by-10 algorithm was 95.8% sensitive (23 of 24) and 100% (17 of 17) pool specific. In the subset of 344 HSS from whom endocervical or urethral specimens were collected for culture, 31 were positive by LCR in urine and 26 were positive by culture. After results discrepant between culture and LCR were adjudicated by a confirmatory LCR test, the pooling algorithm was 93.8% (30 of 32) sensitive and 99.7% (311 of 312) specific. Culture from these 344 HSS was 81.3% (26 of 32) sensitive. The pooling algorithm reduced the cost of the N. gonorrhoeae LCR assay by 60% compared to individual testing of the HSS specimens and was both sensitive and specific.

"Women of Massachusetts": p. 62. ; Consists almost entirely of brief biographical sketches of men prominent in business, government and the professions, illustrated by their portraits. ". [T]he publishers have chosen to represent Massachusetts of Today by the men of today, by those sons of the State, by birth or adoption, who in their lives, their works, or their influence, must be considered by him who would examine and know the fabric of this Commonwealth."--P. 7. ; Mode of access: Internet.

Ligase chain reaction (LCR) (Abbott Laboratories, Abbott Park, Ill.) with first-catch urine specimens was used to detect Chlamydia trachomatis infections in 465 asymptomatic military women attending clinics for routine Papanicolaou smear tests. Results were compared to results of cervical culture to determine the sensitivity of the urine LCR and the possible presence of inhibitors of amplification in pregnant and nonpregnant women. Discrepant results for LCR and culture were resolved by direct fluorescent antibody staining of culture sediments, two different PCR assays, and LCR for the outer membrane protein 1 gene. The prevalence of Chlamydia in specimens by urine LCR was 7.3% compared to 5% by culture. For 434 women with matching specimens, there were 11 more specimens positive by LCR than were positive by culture, of which all but one were determined to be true positives. There were four culture-positive, LCR-negative specimens, all from nonpregnant women. The sensitivity, specificity, and positive and negative predictive values of urine LCR after discrepant results were resolved were 88.6, 99.7, 96.9, and 99.0%, respectively. The sensitivity of culture was 71.4%. From the 148 pregnant women (prevalence by LCR, 6.8%), there were no patients who were cervical culture positive and urine LCR negative to indicate the presence in pregnant women of inhibitors of LCR. Additionally, a subset of 55 of the LCR-negative frozen urine specimens from pregnant women that had been previously processed in LCR buffer were inoculated with 5 cell culture inclusion forming units of C. trachomatis each and retested by LCR; all tested positive, indicating the absence of inhibitors of LCR in urine from these pregnant women. The use of LCR testing of urine specimens from asymptomatic women, whether pregnant or not, offers a sensitive and easy method to detect C. trachomatis infection in women.

Screening women for sexually transmitted diseases (STD) in nonclinic settings is highly desirable because many infections are asymptomatic. This is especially true for military women, for whom logistical, social, and other job-related obstacles present barriers to accessing medical care. We assessed the accuracy of intravaginal swabs transported by mail in a wet versus a dry state for PCR (Amplicor CT/NG test) detection of chlamydia and gonorrhea infections in a cross-sectional study of 793 active-duty military women attending an STD clinic. PCR tests of vaginal swabs (wet and dry) were compared to local clinical methods used on cervical swabs. Standard wet vaginal swab PCR testing detected more chlamydia (11.6%) than cervical enzyme immunoassay (9.3%). For detection of chlamydia using wet swabs, the sensitivity and specificity compared with adjudicated true positives were 94.6% (87 of 92) and 99.3% (696 of 701), respectively. Comparing dry swabs to true-positives for chlamydia, the sensitivity was 91.3% (84 of 92) and the specificity was 99.3% (696 of 701). Standard wet vaginal swab PCR detected more gonorrhea (3.3%) than routine cervical culture (2.1%). The sensitivity and specificity of PCR testing of wet swabs compared to true-positives (infected patients) were 96.3% (26 of 27) and 98.2% (752 of 766) for gonorrhea, respectively. For gonorrhea, the sensitivity and specificity of dry swabs compared to true-positives (infected patients) were 88.9% (24 of 27) and 98.3% (753 of 766), respectively. PCR testing of wet and dry transported intravaginal swabs to detect chlamydia and gonorrhea infections was an accurate diagnostic method for military women.