bluuebunny/crossref_metadata_2025 huggingface dataset:
Molluscum Contagiosum: A Neglected Sentinel Infection
Authors: Radcliffe K W , Daniels D , Evans B A
Published: January 2017

Perigenital molluscum contagiosum in adults is recognized as being a sexually transmitted infection. A retrospective casenote review was performed on patients attending a department of genitourinary medicine (GUM) who had been diagnosed as having molluscum. One or more co-existent sexually transmitted diseases (STD) were present in 30.4% of 158 men and in 32.1% of 78 women. High rates of concurrent STD were also found in patients whose only presenting symptom was molluscum—in 23.2% of men and 10.5% of women. These rates of STD would undoubtedly have been higher still had the screening of these patients been more comprehensive. In view of these findings it is advisable that adults with perigenital molluscum contagiosum be screened for other STD and that their sexual partners be contact-traced. This will usually require referral to a department of GUM.
Epidemiology of an Outbreak of Infectious Syphilis in Alberta
Authors: Romanowski Barbara , Sutherland Ruth , Love Edgar J , Mooney Debbie
Published: January 2017

An outbreak of 1089 cases of infectious syphilis (primary, secondary and early latent) which occurred in the province of Alberta from 1981 to 1987 was analysed by stage of disease, age, sex, sexual preference and geographic distribution. The majority of cases occurred between 1983 and 1985 inclusive. Men accounted for 75.8% of the study population. The majority of men (71%) and women (98.5%) were heterosexual. Of the infected women, 58.7% were North American Indians and many worked as prostitutes. There was clustering in urban locations with 71.8% and 17.7% of cases reported in Edmonton and Calgary, respectively. Clinical signs of syphilis were more commonly present in men than women. Contact tracing played an important role in controlling the outbreak with 15.9% of men and 44.7% of women being diagnosed and treated as a result of this activity.
Patients' Assessment of and Suggestions for a Genitourinary Medicine Service
Authors: Rogstad K E
Published: January 2017

One thousand consecutive attenders at a Department of Genitourinary Medicine (GUM) completed an anonymous questionnaire to assess the GUM services and provide suggestions for improvement. The replies showed patient preferences to be for an appointment system (68%), separate waiting rooms (84% women, 57% men) and to see the same doctor at each visit (75%). Forty-six per cent of women and 33% of men preferred to be seen by a doctor of the same sex, 38% requested evening clinics and 20% of patients wished to be interviewed with their partner.
Haemophilus Ducreyi
Authors: Jonasson J A
Published: January 2017

Genital ulcer disease as a risk factor for HIV transmission has become apparent in the fight against AIDS. In poor communities in developing countries with people living under low hygienic conditions chancroid is often reported to be the most common form of genital ulcer. It is caused by Haemophilus ducreyi; a fastidious bacterium, notoriously difficult to grow in the laboratory. Apart from a few small micro-epidemics from time to time the disease, which has interesting immunological aspects, is now rare and almost forgotten in most industrialized countries. This may be part of the reason why there is no simple and inexpensive diagnostic test available yet that would be useful in the low-resource settings where chancroid is prevalent. The present review focuses on the diagnosis and pathogenesis of chancroid.
Harmonious Principles and Clutters of Expedients: The Environment White Paper
Authors: Skea Jim
Published: January 2017

This paper assesses the degree to which the British Government's recent Environment White Paper has changed the country's energy and environmental policies. It is concluded that the process by which the White Paper was produced may be of greater long term significance than the document itself. There has recently been a considerable change in the rhetoric of environmental policy and environmental issues are now taken seriously across all Whitehall departments. However, potential conflicts between environmental objectives and energy issues, notably electricity privatisation, mean that it has been difficult for the Government to establish a proactive environmental policy. Consequently, many challenges remain to be faced during the 1990s.
Energy, Environment and Rationality
Authors: James Peter
Published: January 2017

Energy-environment interactions are subject to great uncertainty. When uncertainty is great the perceptions of decision-makers are influenced by their underlying ‘world views’. Three such world views can be identified in recent debates -that of egalitarian greens individualistic entrepreneurs and establishment hierarchies. Each has a different stance on the stability of nature, the best means by which to realise environmental ends and the forms of society which are most compatible with environmental well-being. Energy-environmental policies will only be successful if they take these differences into account. Such policies must meet four basic criteria: the accommodation of alternative viewpoints, cost-effectiveness, maximisation of flexibility and recognition of the value of non-energy benefits. In practice this means a greater reliance on energy efficiency and natural gas and a short-medium downgrading or nuclear power and coal, but with measures to retain them as options for the longer term. Sweden is already following such policies and, as a consequence, will be placed in the next century to either pioneer a new pattern of nuclear development or make a transition to a largely renewable based energy regime.
Environmental Challenges for Asian-Pacific Energy Systems in the 1991's
Authors: Markham Adam , Ramani K. V.
Published: January 2017

The paper provides an overview of the main issues addressed and conclusions arrived at by the Regional Conference on Environmental Challenges for Asian and Pacific Energy Systems in the 1990s', jointly organized by the Asian and Pacific Development Centre and the World Wide Fund for Nature during 14–18 January 1991 at Kuala Lumpur, Malaysia. The first part of the paper focuses on the regional and global context of the conference. This is followed by a review of the key isues that are considered relevant to the shaping of a new energy policy for the region to ensure environmental sustainability. The concluding part provides some cautionary notes and suggestions for the immediate future. The authors were joint coordinators of the conference.
Local Energy Concepts in Germany – An Environmental Alternative to Liberalisation?
Authors: Collier Ute
Published: January 2017

Liberalisation in the energy sector continues as a dominant theme in the European Union in the 1990s but little attention is being given to its potential environmental implications. However, issues of regulation, structure, ownership and scale of operation are crucial determinants in the environmental performance of the energy sector. This paper examines the situation in Germany where, as both federal energy policy measures and activities of the large energy companies have given limited attention to environmental matters, an increasing number of local councils and municipally owned energy companies have been adopting so-called local energy concepts with environmental concerns as a main driving force. It is shown that while countries like the UK struggle to induce their privatised energy companies into environmental activities, local public companies in Germany are at the forefront of implementing more environmentally benign energy systems. It is argued that, at a time when many decision-makers are preoccupied with promoting greater competition and private ownership, the benefits of local public ownership and decentralised planning in at lease part of the energy sector may be overlooked. If the political priorities at the local level are skewed in favour of the environment, local, integrated energy plans, implemented by public utilities, can reap substantial environmental benefits.
Setting Targets and the Choice of Policy Instruments for Limiting CO2 Emissions1
Authors: Zhang Zhongxiang
Published: January 2017

Increasing concern in scientific and policy making circles about the possibility of global warming induced by the accumulation of CO2 and other GHGs in the atmosphere has advanced for consideration of policies to limit emissions of these GHGs. This paper gives an overview of policy instruments that might be used to control CO2 emissions, including command-and-control approach, energy taxes, carbon taxes, and tradeable carbon permits, with special attention paid to the economic instruments. It highlights the differences between energy taxes and carbon taxes in terms of target achievement. It presents some main findings arising from those studies on carbon taxes, with the emphasis placed on some aspects of domestic carbon tax design and incidence. The allocations of emission permits (or reimbursement of carbon tax revenues) are also discussed. Moreover, a comparison of carbon taxes with tradeable carbon permits is briefly made. This paper ends with some conclusions.
Industrial Structure and Source of Carbon Dioxide Emissions in East Asia: Estimation and Comparison
Authors: Chung Hyun-Sik
Published: January 2017

This study estimates and compares carbon dioxide (CO2) emissions of three East Asian countries; China, Japan and South Korea by using the well-known input-output model. The differences in CO2 emissions between countries are then analyzed by a decomposition method. The sources of differences in CO2 emissions are attributed to various factors such as different fuel efficiency, production techniques, consumption patterns and the size of the economy. It is argued that an industrial sector with high total emission intensity (TEI) can reduce pollution at lower cost than others with low TEI, assuming that the reduction in emissions entails reduction in output. In this connection, China provides a challenging case for a potential regional joint effort towards the CO2 reduction, because her emissions are shown to be the largest, both in the absolute term and in terms of average TEI.
Effects of Energy Conservation and Better Power Production Efficiency on Australia's Greenhouse Gas Emissions
Authors: Hessami Mir-Akbar
Published: January 2017

The thinning of the UV-absorbing ozone layer, and the global warming effects of the higher than sustainable levels of greenhouse gases in the stratosphere cause climatic changes of catastrophic global consequences if not controlled. In order to illustrate how greenhouse gas emissions can be abated, in this paper, using Australian energy production and consumption data for 1991–92, it is first described that the nation's annual energy consumption is about 4,000 PJ, and the total annual equivalent CO2 emission (including the greenhouse effects of other gases such as CH4, N2O, SO2, and R-11 and R-12) is 495 Mte. Then, by focusing on the Australian power production and residential sectors, the potential for reducing the greenhouse gas emission is estimated to be (a) 81 Mte per annum which could be realised by improving the efficiency of power generation facilities in the country, and (b) an additional 16 Mte per annum by conserving energy in the residential sector. The sum of these reductions in greenhouse gas emission is shown to be in excess of the 1988 Toronto Conference recommendations, and the Australian government's target of 20% reduction of greenhouse gas emission below the 1988 level by 2005. Such a drop in greenhouse gas emission would also exceed the more than generous limits set for Australia in the 1997 Kyoto Summit on Climate Change. It is argued that if similar methodologies can be devised for all energy consuming sectors of the society, this endeavour would help protect our environment and preserve life on earth not only for ourselves but also for our descendants.
Protection of human upper respiratory tract cell lines against sulphur mustard toxicity by hexamethylenetetramine (HMT)
Authors: Andrew D J , Lindsay C D
Published: January 2017

1. Sulphur mustard (`mustard gas', HD) is a highly toxic chemical warfare agent which affects the skin and respiratory tract. The primary targets of inhaled HD are the epithelia of the upper respiratory tract. Hexamethylenetetramine (HMT) has been shown to protect human lung cells against HD toxicity and has also been shown to be effective in vivo against the chemical warfare agent phosgene. The ability of HMT to protect against the toxicity of HD was investigated in the human upper respiratory tract cell lines BEAS-2B and RPMI 2650.

2. HD was highly toxic to both cell lines, with LC50 values of 15 - 30 mM. HMT, at a concentration of 10 mM, was shown to protect the cell lines against the toxic effects of 20 mM and 40 mM HD. Results demonstrated that it was necessary for HMT to be in situ at the time of exposure to HD for effective cytoprotection. No protection was seen when cells were treated with HMT following exposure to HD, or where HMT was removed prior to HD exposure.

3. Results suggest that HMT may be effective prophylaxis for exposure to HD by inhalation.
Clusters of disease manifestations in patients with antiphospholipid syndrome demonstrated by factor analysis
Authors: Krause I , Leibovici L , Blank M , Shoenfeld Y
Published: January 2017

The antiphospholipid syndrome (APS) is now recognized as a multi-system disease, the clinical expression of which may include various target-organs involvements. Despite the reported heterogeneity in clinical presentation of APS, the interrelations between various manifestations of the disease has not yet been studied. We evaluated the principle associations between a variety of clinical manifestations in APS patients, applying factor analysis. Two-hundred and forty-six APS patients were studied. The following disease manifestations were used for the factor analysis: recurrent fetal loss, intrauterine growth restriction (IUGR), venous and arterial thrombosis, cardiac valves thickening/dysfunction, valvular vegetations, stroke, epilepsy, migraine, arthritis, livedo reticularis, thrombocytopenia, leukopenia and autoimmune hemolytic anemia (AIHA). The results were further analysed in relation to sex and to primary APS versus APS associated with SLE. Five factors were derived, which accounted for 59.7% of the variance of the matrix. Factor 1 (which explained 18.5% of variance of the original matrix) represented the association between cardiac valves abnormalities, livedo reticularis and AIHA. Factor 2 (13.8% of variance) represented association between arthritis, thrombocytopenia and leukopenia. Factor 3 (10.3% of variance) represented an association between recurrent fetal loss and IUGR. Factor 4 (9.3% of variance) represented inverse correlation between arterial and venous thrombosis. Factor 5 (7.8% of variance) represented an association between epilepsy and migraine. Application of factor analysis revealed specific clusters of cardiac, cutaneous, hematological and neurological manifestations. Our result also point to a possible divergence of arterial and venous thrombotic tendency. Awareness of these patterns might give us a better understanding of the disease.
Personalized dynamic prediction of death according to tumour progression and high-dimensional genetic factors: Meta-analysis with a joint model
Authors: Emura Takeshi , Nakatochi Masahiro , Matsui Shigeyuki , Michimae Hirofumi , Rondeau Virginie
Published: January 2017

Developing a personalized risk prediction model of death is fundamental for improving patient care and touches on the realm of personalized medicine. The increasing availability of genomic information and large-scale meta-analytic data sets for clinicians has motivated the extension of traditional survival prediction based on the Cox proportional hazards model. The aim of our paper is to develop a personalized risk prediction formula for death according to genetic factors and dynamic tumour progression status based on meta-analytic data. To this end, we extend the existing joint frailty-copula model to a model allowing for high-dimensional genetic factors. In addition, we propose a dynamic prediction formula to predict death given tumour progression events possibly occurring after treatment or surgery. For clinical use, we implement the computation software of the prediction formula in the joint.Cox R package. We also develop a tool to validate the performance of the prediction formula by assessing the prediction error. We illustrate the method with the meta-analysis of individual patient data on ovarian cancer patients.
A regulatory perspective on pharmacokinetic/pharmacodynamic modelling
Authors: Machado S G , Miller R , Hu C
Published: January 2017

We present an integrated summary from statistical and pharmacological perspectives of pharmacokinetic/pharmacodynamic (PK/PD) modelling and its use in drug development and regulation for guiding appropriate dosing. An overview of the technical aspects of PK/PD modelling describes how structural models are constructed and refined using pharmacokinetic and pharmacodynamic principles and how random effects models are used to account for individual differences in desired (and undesired) responses due to patient characteristics. Lastly, we describe applications of PK/PD modelling for the purposes of drug labelling, for resolving a safety concern, and for improving therapeutic monitoring of anaesthetic depth during surgery.
A nurse working for the Third Reich: Eva Justin, RN, PhD
Authors: Benedict Susan , Shields Linda , Holmes Colin , Kurth Julia
Published: January 2017

Eugenics underpinned the Nazi race theories which saw the murder of over 10 million people from “undesirable” groups, including Sinti (referred to in Nazi times as “Gypsies”), during the Holocaust. Eva Justin, from Dresden, completed a doctoral dissertation which examined a group of Sinti children of St Josef’s Home in Mulfingen, Germany. She aimed to prove the racial inferiority of these children; her work was done with no informed consent, and the children were sent to Auschwitz after her experiments. The study was supported by senior Nazis, supervised by Nazi “scientists” and examined by committed Nazis. We argue that her work was biased, poorly designed, and ultimately unethical, but was in keeping with methods of the emerging disciplines of anthropology and racial hygiene, in Germany and other countries, at the time. It is not possible to say that her work caused the children to meet their deaths (of the 39 children she included, only four survived); however, she did reinforce the Nazi racial theories. It is unfortunate that one of the first nurses in the world to receive a PhD did so through research attempting to prove that a group of children were “racially inferior” in support of National Socialism.
Can Reliable Down's Syndrome Detection Rates Be Determined from Prenatal Screening Intervention Trials?
Authors: Palomaki Glenn E , Neveux Louis M , Haddow James E
Published: January 2017

Objectives—

To develop a standardised approach for analysing Down's syndrome screening performance in clinical practice and to apply it to published intervention trials in order to estimate detection and false positive rates more accurately.

Methods—

Peer reviewed intervention trials, grouped by specific combination of analytes, were reanalysed. Revised detection rates were calculated for each study, taking into account both the high spontaneous loss during the last half of pregnancy and the possible under ascertainment of Down's syndrome live births not detected by screening. Collective screening performance was estimated, when possible, using a published methodology based on fitting receiver—operator characteristic curves.

Results—

Sixteen trials were analysed; 11 using three, and five using two, analytes. Collective screening performance for the triple analyte trials was Down's syndrome detection rates of 57, 64, and 69% at amniocentesis referral rates of 3, 5, and 7% respectively. Four of the five studies involving two analytes performed less well, individually, when compared with the overall performance of the three analyte studies. It was not possible to estimate collective performance for the two analyte studies because there were too few.

Conclusions—

Accurate Down's syndrome detection rates are difficult to obtain in intervention trials owing to two potential biases, both of which tend to produce overestimates of the true rates. These sources of bias need to be taken into account when analysing and reporting Down's syndrome intervention trials. The methodology presented here offers the opportunity to achieve a more reliable, standardised estimate of both individual and collective intervention trial screening performance.
CA 125 as a Screening Test for Ovarian Cancer
Authors: Hakama Marti , Stenman Ulf—Håkan , Knekt Paul , Järvisalo Jorma , Hakulinen Timo , Maatela Jouni , Aromaa Arpo
Published: January 2017

Background—

Screening for ovarian cancer is based on ultrasound, colour Doppler, and tumour markers. There is only limited evidence on their discriminatory performance and no evidence on their effectiveness in reducing mortality.

Objective—

To investigate the discriminatory performance of CA 125 as a screening test for ovarian cancer.

Methods—

A registry of 15 093 serum samples drawn in 1968–72 was linked to the cancer registry. During follow up between 1968 and 1980 24 ovarian cancers were identified. One or two matched case—control design nested within the sample bank was applied and the concentrations of CA 125 were assessed.

Results—

Case—control differences (relative risk 4.0, 95% confidence interval 1.0 to 15.5 at 20kU/l) were found. Detection rate of the CA 125 test was 21–33% and the true negative rate was 75–98% depending on the cut off level and interval between drawing of the blood sample and diagnosis of the cancer.

Conclusion—

CA 125 is not a valid screening test if used alone. Case—control differences of borderline significance were found in CA 125 before diagnosis of ovarian cancer, but they were not large enough to provide a sufficient detection rate.
Inside-out and outside-in: Applying the concept of conventions in the analysis of policy implementation through sport clubs
Authors: Skille Eivind , Stenling Cecilia
Published: January 2017

The aim of this article is to enrich theoretically the analysis of processes of policy implementation through sport clubs. Subsequent to reviewing previous theoretical contributions on this topic, we make the case that available conceptualizations are marked by an inside-out perspective and that they conceptually and empirically stop short at the end implementer, i.e. the sport club. Consequently, analyses of policy implementation through sport clubs have not taken into account the fact that sport clubs are distinctly local phenomena. As such, past, current and potential future participants, volunteers and local inter-organizational relationships are found in a sport club’s local community. Because of this, there is a need for a concept that provides analytical coverage of an outside-in perspective, i.e. a concept that takes into account outside actors’ conceptions of the implementing sport club and the impact their views have on the implementation process. In relation to this need, we propose the application of the concept ‘convention’. In addition to describing the concept, we exemplify the methodological and analytical implications of its use in sport policy implementation analysis.
“They do treat us as a bit normal now”: Students’ experiences of liminality and communitas whilst volunteering on a sports-based outreach project
Authors: Hayton John
Published: January 2017

Student volunteering during university has been widely championed for its purported benefits to both students and society alike. Internationally, universities have increasingly coupled student volunteering opportunities or embedded forms of service learning with sport-for-development programmes (SFD) as a means of contributing to strategic institutional objectives. However, there is a paucity of academic research that documents the social processes experienced by students as they converge with hard-to-reach client groups when volunteering on university-led SFD platforms. Therefore, and utilising data captured from semi-structured interviews ( n=40), this article explores the lived experiences of undergraduate students who volunteered on a sports-based community outreach project: the Sport Universities North East England (SUNEE) project. Largely run by student volunteers, the SUNEE project delivers a raft of sports-based and personal development programmes to hard-to-reach groups. This article utilises Victor Turner’s concepts of liminality and communitas to illustrate the processes of initiation and integration that confer both membership upon student volunteers and their legitimacy as leaders, when working with the hard-to-reach clientele on the project.
Experiential (informal/non-formal) practice does not improve sight-reading skills
Authors: Zhukov Katie
Published: January 2017

This study investigates whether experiential (informal/non-formal) sight-reading practice has an impact on sight-reading skills of classical university-level pianists. Data collected from 80 self-report practice diaries of students participating in trials of new sight-reading pedagogies were analysed to evaluate the effect of experiential sight-reading practice on improvement in sight-reading performance, focusing on the overall duration of sight-reading activities accumulated over the 10-week period and different patterns across this time. Data were subjected to bivariate regressions and bivariate correlations analyses. Results showed that improvement in sight-reading performance on three out of the four key indicators (beat adjustment, extra notes and missing notes) could not be predicted by participants’ overall hours of experiential practice. Yet the total number of hours engaged in sight-reading practice did predict an improvement in participant RMS accuracy (average timing errors for each correct note played). Findings also revealed no consistent pattern of practice across the 10 weeks that was associated with any of the four performance indicators. Implications for education include the need to embrace multi-faceted approaches to sight-reading training by focusing on skills contributing to expert sight-reading and their development, individually and in combinations. Rhythm and pitch training, development of pattern recognition and prediction skills, and collaborative playing activities have the potential to enhance sight-reading skills of music undergraduates and have positive flow-on effects for their preparation for 21st century music careers.
Problem Internet Use and Internet Gaming Disorder: a survey of health literacy among psychiatrists from Australia and New Zealand
Authors: Dullur Pravin , Hay Phillipa
Published: January 2017

Objectives:

Research is limited on psychiatrists’ opinions on the concepts of Internet Gaming Disorder (IGD) and Problematic Internet Use (PIU). We aimed to assess health literacy among psychiatrists on IGD/PIU.

Methods:

A self-report survey was administered online to members of the Royal Australia and New Zealand College of Psychiatrists (RANZCP) ( n=289).

Results:

The majority (93.7%) were familiar with the concepts of IGD/PIU. The majority (78.86%) thought it is possible to be ‘addicted’ to non-gaming internet content, and 76.12% thought non-gaming addictions could possibly be included in classificatory systems. Forty-eight (35.6%) felt that IGD maybe common in their practice. Only 22 (16.3%) felt they were confident in managing IGD. Child psychiatrists were more likely to screen routinely for IGD (11/45 vs. 7/95; Fishers Exact test χ2=7.95, df=1, p<0.01) and were more likely to elicit specific symptoms of addiction (16/45 vs. 9/95; Fishers Exact test χ2=14.16, df=1, p<0.001).

Conclusions:

We recommend adoption of terms alternate to PIU/IGD which are more in line with the content of material irrespective of medium of access. Screening instruments/ protocols are needed to assist in early diagnosis and service planning. Barriers to screening would need to be addressed both in research and service settings.
The Development of a Brief Version of the Posttraumatic Cognitions Inventory (PTCI-9)
Authors: Wells Stephanie Y. , Morland Leslie A. , Torres Elisa M. , Kloezeman Karen , Mackintosh Margaret-Anne , Aarons Gregory A.
Published: January 2017

Negative posttraumatic cognitions lead to the development and maintenance of posttraumatic stress disorder symptoms. There is a need for a brief measure to assess these cognitions. Participants were administered the Posttraumatic Cognitions Inventory (PTCI) and measures of mental health symptomatology. These data were used to develop a brief version of the PTCI (PTCI-9) in 223 male and female veterans, which was then examined in a sample of 117 female civilians. Confirmatory factor analyses demonstrated an acceptable fit in both samples. The PTCI-9 total and subscale scores showed strong internal consistencies (Cronbach’s αs = .80-.87) and strong correlations with the PTCI in veterans ( rs = .90-.96) and civilians ( rs = .91-.96). Measurement invariance testing demonstrated partial invariance between the two samples. The PTCI-9 significantly correlated with measures of PTSD, depression, and quality of life. These findings demonstrate that the PTCI-9 is a reliable and valid measure of posttraumatic cognitions that can reduce patient and provider burden.
Teaching Journalism for Better Community
Authors: Robinson Sue
Published: January 2017

This research used interviews with producers and sources in news about racial disparities to understand obstacles in covering issues involving race. These data along with a Deweyan framework informed the creation of a service-learning class called “Journalism for Racial Justice: Amplifying Voices in Local Communities” aimed at better aligning the journalism profession with more inclusive democracy. Students explored how their privileges affected reporting, redefined roles of “source” as relational in collaborative work, and worked to build trust with wary citizens to knit communities together in conversation. It promotes a relational journalism, positioning reporters as within community as opposed to apart.
Developing Tools for Addressing Ethical Issues
Authors: Robbins Dennis A.
Published: January 2017

Ethics is thought by many to be an interesting intellectual exercise that offers little solution for addressing complex issues. Many believe ethics can be reduced to mere opinion rather than seeing it as an important tool to clarify issues and reduce, if not preclude, conflict. This article will examine misconceptions about ethics and show how a combination of ethical theory and proven practical strategies for addressing ethical issues can provide direction and assistance in problem clarification and problem solving. Key concepts from the field of both ethics and law, including rights, wishes, self determination, capacity and related issues, will be introduced, followed by discussions of consent and knowledge, as well as knowledge and ethics, providing the reader with both historical and methodological frameworks for problem solving. Among the methodological techniques discussed will be defining the problem, framing the issue, and justifying the position you take. This will be followed by a step-by-step model for decision making created by the author dealing with an ethical issue in home health. Also, novel method of addressing community-wide ethical issues will be introduced via the concept of the community-based ethics committee as well as through examining the notion of continuity of consent.
Synergistic effect between organic borate esters and phosphorus-based additives on tribological performances as lubricant additives in mineral oil
Authors: Fu Xisheng , Li Jianchang , Sun Lingguo , Zhou Xuguang , Fan Bingji , Ren Tianhui
Published: January 2017

Nowadays, looking for environment-friendly lubricant additives to replace phosphorus-based derivatives in automotive lubricating system is one of the main objectives. Organic borate ester is one kind of potential substitutes for phosphorus-based derivatives. In this paper, the interactions of organic borate esters and dioctylphosphite ester on tribological performances were studied. Results showed that they had a synergistic effect on antiwear performance and friction-reducing property as lubricant additives in mineral oil. The chemical nature of worn surface was explored by X-ray absorption near-edge structure spectroscopy. Borate ester could facilitate the decomposition of phosphorus-based additive and the formation of phosphate. What is more, boron-containing species could react with phosphate to form boron–phosphorus-based thin film on the surface. Boron mainly forms B2O3 on the surface. In the near surface of tribofilm, nitrogen-containing borate ester reduced the polyphosphate chain length due to the formation of ammonium cation. The polyphosphate chain length of the tribofilm generated from dioctylphosphite ester mixed with nitrogen-containing alkyl borate ester is shorter compared to that of the tribofilm generated from dioctylphosphite ester mixed with nitrogen-containing heterocyclic borate ester.
Switching from branded to generic glatiramer acetate: 15-month GATE trial extension results
Authors: Selmaj Krzysztof , Barkhof Frederik , Belova Anna N , Wolf Christian , van den Tweel Evelyn RW , Oberyé Janine JL , Mulder Roel , Egging David F , Koper Norbert P , Cohen Jeffrey A ,   on behalf of the GATE study group
Published: January 2017

Background:

Open-label 15-month follow-up of the double-blind, placebo-controlled Glatiramer Acetate clinical Trial to assess Equivalence with Copaxone® (GATE) trial.

Objective:

To evaluate efficacy, safety, and tolerability of prolonged generic glatiramer acetate (GTR) treatment and to evaluate efficacy, safety, and tolerability of switching from brand glatiramer acetate (GA) to GTR treatment.

Methods:

A total of 729 patients received GTR 20 mg/mL daily. Safety was assessed at months 12, 15, 18, 21, and 24 and Expanded Disability Status Scale and magnetic resonance imaging (MRI) scans at months 12, 18, and 24. The presence of glatiramer anti-drug antibodies (ADAs) was tested at baseline and months 1, 3, 6, 9, 12, 18, and 24.

Results:

The mean number of gadolinium-enhancing lesions in the GTR/GTR and GA/GTR groups was similar at months 12, 18, and 24. The change in other MRI parameters was also similar in the GTR/GTR and GA/GTR groups. The annualized relapse rate (ARR) did not differ between the GTR/GTR and GA/GTR groups, 0.21 and 0.24, respectively. The incidence, spectrum, and severity of reported adverse events did not differ between the GTR/GTR and GA/GTR groups. Glatiramer ADA titers were similar in the GTR/GTR and GA/GTR groups.

Conclusion:

Efficacy and safety of GTR is maintained over 2 years. Additionally, switching from GA to GTR is safe and well tolerated.
Long-term cultured astrocytes inhibit myelin formation, but not axonal growth in the co-cultured nerve tissue
Authors: Ishikawa Mikio , Tsukamoto Tetsuro , Yamamoto Teiji
Published: January 2017

The chronic demyelinated plaque of multiple sclerosis (MS) is characterised by a loss of oligodendrocytes, astrogliosis, and incomplete or no remyelination which probably results in part from the suppressive effects of gliotic astrocytes on myelin formation. We explanted mouse cerebella on astrocyte cultures which had been maintained for 2 to 12 weeks and assessed the myelination in the cerebellar tissue at 18 days after explanation. Myelination occurred vigorously in the tissue explanted on 2-to 4-week-old astrocytes, but was poorer in the tissue explanted on astrocytes older than 4 weeks. No myelin sheath was formed on 12-week-old astrocytes, although axons developed equally as well as those in the tissues explanted on 2-week-old astrocytes. As astrocytes were maintained longer, they became fibrous and immunostained more deeply with anti-glial fibrillary acidic protein antibody, being analogous to astrogliosis. These findings imply that astrogliosis in chronic demyelinated lesions of MS may potentially block remyelination.
Confrontation and competition
Authors: Henceroth Nathan , Jensen Christian B
Published: January 2017

Recent research has shown that niche parties are both increasing in importance in European party systems and behave differently than their more mainstream counterparts. Indeed, there is growing evidence that the dynamic between green parties and social democratic parties is especially nuanced. Regionalist parties differ from other niche parties in that they can be found on the left, right, and center of the ideological spectrum. We find that regionalist parties benefit from increasing the ideological distance between themselves and the mainstream party that most often wins at the national level. However, regionalist parties’ relationship with the mainstream party that most often wins in their home region is more nuanced. Regionalist parties must be distinct enough from the mainstream rival in their home region to be an alternative but close enough to serious compete for the same voters.
What Determines the Need for Nursing Home Admission in a Universally Insured Population?
Authors: Mustard Cameron , Finlayson Marcia , Derksen Shelley , Berthelot Jean-Marie
Published: January 2017

Objectives:

People in lower socio-economic groups are more likely to experience disability and cognitive impairments at earlier ages than those in higher status groups. As a result, the need for nursing home care would be expected to be greater among older people of lower socio-economic status. This study examines the effects of income and education on the probability of nursing home entry in a universally insured elderly population.

Methods:

Using a prospective observational study design, a range of predictors of nursing home admission was examined over a three-year period in a representative sample of 7220 residents, aged 60 years or older, in a Canadian province. Individual census records and computerized administrative records of health care utilization were linked to form a database for analysis.

Results:

An increased risk of institutionalization was associated with older age, male gender, unmarried status and self-reported disability. In addition, lower household income and lower attained education were independently associated with a higher risk of nursing home admission.

Conclusions:

These results emphasize the independent role of socio-economic status in accentuating or accelerating the need for institutional care towards the end of life. It is important that these effects are recognized in policies that determine the finance of both nursing home care and formal community-based supportive care.
Evolution of Physicians' Attitudes towards Practice Guidelines
Authors: Grilli Roberto , Trisolini Rosanna , Labianca Roberto , ZoIa Paolo
Published: January 2017

Objectives:

To assess changes in physicians' attitudes towards practice guidelines and towards the role of empirical evidence in their development.

Methods:

The findings from two surveys carried out in 1993 and 1997 on the same random sample from two Italian medical specialty societies were compared. In both studies, physicians were mailed a questionnaire asking their views on the goals and role of practice guidelines in influencing clinical decision-making, and the role of empirical evidence versus subjective clinical experience in their development.

Results:

One hundred and seventy physicians participated in both surveys. An increasing proportion of physicians accepted that cost containment could be a legitimate goal of practice guidelines (from 26% in 1993 to 40% in 1997; P = 0.010). More clinicians (43% in 1993 and 57% in 1997; P < 0.01) supported the use of empirical evidence, as opposed to subjective clinical experience, as the primary basis for practice guidelines. Although only a tiny minority of physicians (6% in 1993 and 1997) supported the view that practice guidelines should reflect patient preferences, an increased proportion of physicians supported the participation of representatives from outside the medical profession in their development. The level of support increased from 6% in 1993 to 26% in 1997 ( P < 0.001) in the case of consumers, from 24% to 38% ( P = 0.015) for patient involvement and from 16% to 33% ( P = 0.003) in the case of health care administrators.

Conclusions:

The documented changes suggest that more clinicians acknowledge the role of empirical evidence and the need for a dialogue with other professionals and patient groups in the development of practice guidelines than was the case in the recent past.
Contracting for Quality: Does Length Matter?
Authors: Goddard Maria , Ferguson Brian , Dawson Diane
Published: January 2017

Objectives:

To examine whether longer-term contracts for health services will shift attention away from concern for finance and activity levels and towards the achievement of better quality services.

Methods:

Analysis of 288 contracts from the British National Health Service (NHS) and 12 semi-structured interviews with staff from provider (NHS hospital trusts) and purchaser (health authorities) organisations.

Results:

No relationship was found between the duration of a contract and the duration of service specifications or quality frameworks. The annual contracting cycle is concerned largely with ensuring that all parties stay within activity targets and financial constraints, and this is unlikely to be affected by a shift to longer-term contracts. The setting of standards and initiatives to improve quality is largely independent of the contracting process and the duration of contracts, and relies on relationships rather than contracts.

Conclusions:

It is optimistic to expect longer-term contracts automatically to produce a greater focus on quality and the incentives needed to ensure that improvements in quality are delivered. However, this may not matter as issues of quality are being addressed more appropriately in the British NHS through a variety of other routes.
Consensus Development Methods: A Review of Best Practice in Creating Clinical Guidelines
Authors: Black Nick , Murphy Maggie , Lamping Donna , McKee Martin , Sanderson Colin , Askham Janet , Marteau Theresa
Published: January 2017

Background:

Although there is debate about the appropriate place of guidelines in clinical practice, guidelines can be seen as one way of assisting clinicians in decision-making. Given the likely diversity of opinion that any group of people may display when considering a topic, methods are needed for organising subjective judgements. Three principal methods (Delphi, nominal group technique, consensus development conference) exist which share the common objective of synthesising judgements when a state of uncertainty exists.

Objectives:

To identify the factors that shape and influence the clinical guidelines that emerge from consensus development methods and to make recommendations about best practice in the use of such methods.

Methods:

Five electronic databases were searched: Medline (1966-1996), PsychLIT (1974-1996), Social Science Citation Index (1990-1996), ABI Inform and Sociofile. From the searches and reference lists of articles a total of 177 empirical and review articles were selected for review.

Results:

The output from consensus development methods may be affected by: the way the task is set (choice of cues, recognition of contextual cues, the focus of the task, the comprehensiveness of the scenarios); the selection of participants (choice of individuals, degree of homogeneity of the group, their background, their number); the selection and presentation of scientific information (format, extent to which its quality and content is assessed); the way any interaction is structured (number of rating rounds, ensuring equitable participation, physical environment for meetings); and the method of synthesising individual judgements (definition of agreement, rules governing outliers, method of mathematical aggregation).

Conclusions:

Although a considerable amount of research has been carried out, many aspects have not been investigated sufficiently. For the time being at least, advice on those aspects has, therefore, to be based on the user's own commonsense and the experience of those who have used or participated in these methods. Even in the long term, some aspects will not be amenable to scientific study. Meanwhile, adherence to best practice will enhance the validity, reliability and impact of the clinical guidelines produced.
Can the Impact of Ageing on Health Care Costs be Avoided?
Authors: Metz David
Published: January 2017

A rapid ageing of the population is taking place in all developed countries. In many countries, the number of those aged 75 years and over will double by the middle of the next century. The implications for health services, however, are unclear because of uncertainties about trends in health expectancy. In addition, there is considerable scope for the potentially large growth in the costs of care to be reduced through research-led innovation.
‘Long live the friendship between the Soviet Union and Finland!’ Irony, nostalgia, and melodrama in Finnish historical television drama and documentary series
Authors: Pajala Mari
Published: January 2017

In critical studies on historical television programmes, the affective qualities of televisual memory have been discussed mainly in terms of nostalgia. This article argues that conceptualizing the affective modes of relating to the past in more varied ways can help us to better understand the politics of memory on television. As a case study, the article analyses Finnish Broadcasting Company Yleisradio’s historical drama and documentary series that deal with the relationship between Finland and the Soviet Union. The article identifies three affective modes in the programmes: irony, nostalgia and melodrama. Each of these modes offers different possibilities for critiquing, understanding and justifying the past. By studying televisual memories of the Soviet Union in a non-socialist country with important political, economic and cultural ties with the socialist bloc, the article moreover questions a clear East–West binary in studies on post-socialist memory.
Persistent social inequality in life expectancy and disability-free life expectancy: Outlook for a differential pension age in Denmark?
Authors: Brønnum-Hansen Henrik , Eriksen Mette Lindholm , Andersen-Ranberg Karen , Jeune Bernard
Published: January 2017

Aims: The state old-age pension in Denmark increases to keep pace with the projected increase in average life expectancy (LE) without any regard to the social gap in LE and expected lifetime in good health. The purpose of this study was to compare changes in LE and disability-free life expectancy (DFLE) between groups of Danes with high, medium and low levels of education. Methods: Nationwide register data on education and mortality were combined with data from the Surveys of Health, Ageing and Retirement in Europe (SHARE) surveys in 2006–2007, 2010–2011 and 2013–2014 and the DFLE by educational level was estimated by Sullivan’s method for each of these three time points. Results: Between 2006–2007 and 2013–2014, LE among 65-year-old men and women with a low educational level increased by 1.3 and 1.0 years, respectively, and by 1.4 and 1.3 years for highly educated men and women. The gap in LE between people with high and low levels of education remained more than 2 years. In 2006–2007, 65-year-old men with a high level of education could expect 3.2 more years without disability than men of the same age with a low level of education. In 2013–2014, the difference was 2.9 years. For women, the results were 3.7 and 3.4 years, respectively. Conclusions: With the persistent social inequality in LE of more than 2 years and the continuous gap between high and low educational groups in DFLE of about 3 years, a differential pension age is recommended.