bluuebunny/crossref_metadata_2025 huggingface dataset:
GIANT CYSTIC LYMPHANGIOMA OF PANCREAS
Authors: Lyngdoh Toijam S , Konsam Reena , Th Bipin , Marak Bethel
Published: August 2008

Background:  We report a case of a giant cystic lymphangioma of pancreas in a symptomatic middle‐aged lady. Preoperative evaluation suggested benign ovarian cyst.

Methods:  Complete excision of the cyst was carried out. Excised specimen measures 32 cm × 28 cm, containing haemorrhagic fluid with multiple thin septa and attached by a pedicle to the tail of the pancreas. Pancreatic and ovarian tumour markers were within normal limits.

Results:  Histopathological examination showed a rare case of cystic lymphangioma of pancreas.

Conclusion:  Cystic lymphangioma is a rare congenital malformation of the lymphatic system. Involvement of pancreas is still rarer, accounting for less than 1%. On a review of pullshed work, only 70 cases have been reported since 1913. Complete excision is the treatment of choice. This case is being presented in view of its rarity and the involvement of a complex diagnostic challenge for the surgeons.
CURE, CONTINENCE AND QUALITY OF LIFE AFTER TREATMENT FOR FISTULA‐IN‐ANO
Authors: Wong Shing , Solomon Michael , Crowe Philip , Ooi Kevin
Published: August 2008

Background:  The best operation for high anal fistulas is difficult to nominate because they have varying cure and incontinence rates. The objective of this study was to quantify the relative importance of the outcomes of cure, continence and other quality‐of‐life (QOL) factors.

Methods:  A questionnaire was sent in October 2006 to patients with anal fistulas and to colorectal surgeons. Participants were asked to nominate up to five QOL domains. They were also asked to choose between two treatment options (with different cure and continence rates).

Results:  Seventy‐five of 134 (56%) surgeons and 28 of 199 (14%) patients replied. Comparing draining and cutting setons, surgeons (57 of 71, six neutral) favoured the former and patients (15 of 27, four neutral) preferred the latter. Comparing mucosal advancement flap with cutting seton, both surgeons (71 of 75, four neutral) and patients (13 of 26, two neutral) preferred the former. There was greater uncertainty among surgeons when comparing draining seton (23) and mucosal advancement flap (33), with 18 neutral. Patients preferred the mucosal advancement flap (19) to draining seton (three) and four were neutral. In direct questioning of objectives, surgeons nominated continence, leakage, pain, cure and sepsis as the five most important QOL factors. Patients nominated independent activity, pain, continence, psychological health and leakage as their five factors.

Conclusion:  Functional impairment and QOL do not necessarily correlate. The development of a validated specific QOL scale for patients with anal fistulas would be important to compare the results of different treatment options. This scale should include social and psychological factors in addition to the physical outcomes.
SURGICAL SITE MARKING DOES NOT AFFECT STERILITY
Authors: Rooney John , Khoo Oliver K. S. , Higgs Andrew R. , Small Timothy J. , Bell Sydney
Published: August 2008

Background:  In 2005, surgical site marking became mandatory in Australia, with the introduction of the first Australian guidelines to prevent wrong site surgery. It has been our experience that most surgical site marking occurs with the use of a non‐sterile marking pen, which has been used on multiple patients and there is little information in the published work about the effects of surgical site marking carried out in this fashion. Our aim was to determine whether the sterility of a surgical site was affected by surgical site marking with a non‐sterile surgical marking pen.

Methods:  Both forearms of 20 volunteers would simulate surgical sites. Surgical site marking was carried out on right forearms with the same non‐sterile surgical marking pen, whereas left forearms were unmarked controls. Microbiology swabs were taken from both forearms before, and after, skin sterilization with 10% povidone–iodine. Routine cultures were carried out on the swabs after sodium thiosulphate was used to deactivate residual iodine. Cultures were assessed for growth after 5 days.

Results:  One of the 20 marked forearms and 15 of the 20 unmarked forearms had bacterial growth on cultures before skin sterilization (P < 0.1). After sterilization with iodine, no bacterial growth occurred in the cultures of the swabs taken from the marked or control arms.

Conclusion:  Surgical site marking carried out with a non‐sterile surgical marking pen did not contaminate the surgical site. We recommend the practice of surgical site marking.
TOWARDS QUALITY CONTROL IN RECTAL CANCER SURGERY: A PRELIMINARY GREEK EXPERIENCE
Authors: Taflampas Panagiotis , Christodoulakis Manousos , DeBree Eelco , Schoretsanitis Giorgios , Zacharopoulos Giorgios , Tsiftsis Dimitrios D.
Published: August 2008

Background:  The purpose of this study was to evaluate the effect of the introduction of a colorectal unit on provided services for patients with rectal cancer.

Methods:  The colorectal unit in our department was initiated in January 2004. A dedicated database was used to retrieve data from 127 consecutive patients who were operated on electively from March 1995 to December 2005. Treatment parameters were compared for patients before (n = 90) and after (n = 37) the introduction of the colorectal unit.

Results:  In the entire group of patients, 50.3% presented with locally advanced disease (stage III) and 40.9% with tumours located in the lower third of the rectum. A higher preoperative versus postoperative radiotherapy ratio (P < 0.0001), a higher local excision rate (P = 0.04) and a higher low anterior resection to abdominoperineal resection ratio (P = 0.0011) were noted after the initiation of the colorectal unit. In this small series, although parameters like the number of examined lymph nodes, anastomotic leakage rate and distal resection margin improved, they did not reach statistical significance.

Conclusions:  The establishment of a colorectal unit seems to have resulted in improved quality of rectal cancer treatment by a dedicated multidisciplinary approach, even after only 2 years of service.
To What Extent Do Third Parties Influence Business Compliance?
Authors: Nielsen Vibeke Lehmann , Parker Christine
Published: August 2008

Regulatory scholars have increasingly observed that it is not only public regulatory agencies and official enforcement action that motivate and enforce businesses' compliance with the law; in many situations, certain third parties may have greater capacity and power to motivate and enforce compliance with the law than do official regulatory agencies. This paper examines the extent to which businesses' worries about, and perceptions of pressure from, various third parties influence their internal compliance management activities and moral commitment in relation to complying with the objectives of competition and consumer protection law. Using data from a survey of 999 large Australian businesses, we find that businesses worry a lot about the reactions of a range of third parties including customers, shareholders, employees, and business partners to non‐compliance. We find little evidence that these worries have much impact on what businesses actually do. However, perceptions of risk of complaints do influence what they do.
Constitutionalizing Employment Relations: Sinzheimer, Kahn‐Freund, and the Role of Labour Law
Authors: Dukes Ruth
Published: August 2008

Hugo Sinzheimer and his one‐time student Otto Kahn‐Freund are widely regarded as the founding fathers of German and British labour law respectively. While, at first glance, the two scholars might appear to have advocated rather different approaches to the regulation of employment relations, a review of their work reveals that both argued, in essence, for the ‘constitutionalization’ of those relations. Both argued, in other words, for the removal from the economic sphere of the otherwise inequitable consequences of the functioning of private law, so that collectivized labour might participate with capital, on a parity basis, in the autonomous regulation of the economy.
Health, Social Movements, and Rights‐based Litigation in South Africa
Authors: Pieterse Marius
Published: August 2008

This article investigates the impact of rights‐based litigation on social struggles in the South African health sector. It considers the manner in which individuals and social movements have utilized rights and the legal process in their efforts to dismantle the ill‐health/poverty cycle, in the particular context of the struggle for universal access to treatment for HIV/AIDS. Relying on literature concerning the transformative potential of socio‐economic rights litigation and on examples from South African case law, the article critically evaluates the gains that have been made and the obstacles that have been encountered in this context. It argues that rights‐based litigation presents a powerful tool in the struggle against poverty, but also elaborates on structural and institutional hurdles that continue to inhibit the effectiveness of rights‐based strategies in this regard.
The Scope of Criminal Law and Criminal Sanctions: An Economic View and Policy Implications
Authors: Bowles Roger , Faure Michael , Garoupa Nuno
Published: August 2008

This paper considers why some harm‐generating activities are controlled by criminal law and criminal sanctions while others are subject to some other mechanism such as civil law, administrative law, regulation or the tax system. It looks at the question from the perspective of the law and economics approach. We seek to identify the comparative benefits of using the criminal law relative to other enforcement mechanisms and – more broadly – why certain specific behaviours are criminalized. The paper argues that an economic approach emphasizing the relative merits of alternative legal instruments for bringing about harm reduction can provide an explanation for a number of recent legal developments. It argues also that the willingness of legislators to combine the use of sanctions traditionally used in one area of the law with sanctions from other areas is more readily explicable in economic terms than in other terms.
Advanced rescue techniques: lessons learned from the collapse of a building in Nairobi, Kenya
Authors: Rokach Ariel , Nemet Dani , Dudkiewicz Mickey , Albalansi Alberto , Pinkert Moshe , Schwartz Dagan , Bar‐Dayan Yaron
Published: August 2008

This paper examines the collapse of a five‐storey building in Nairobi, Kenya, on 23 January 2006. It draws on reports from local authorities and on debriefings by Israel's Home Front Command (HFC), including information on injury distribution, rescue techniques, and the mode of operation. Most of the 117 people found under the structure were evacuated on the first day to a public hospital, which was overwhelmed by the incident. HFC forces arrived 23 hours after the disaster. At that stage, two people were still buried under the building and special techniques (tunnelling and scalping) were required to secure their evacuation. The two people quickly recovered after a short stay in hospital. Local technology is the preferred option during such events because time is crucial. International cooperation is required when this technology is not available. All of the hospitals in the disaster area, including private facilities, should participate in treating casualties.
A scenario‐based study on information flow and collaboration patterns in disaster management
Authors: Sagun Aysu , Bouchlaghem Dino , Anumba Chimay J.
Published: August 2008

Disaster management (DM) is a continuous, highly collaborative process involving governments, DM organisations, responders, the construction sector, and the general public. Most research approaches to DM include the development of information and communication technologies (ICT) to support the collaboration process rather than the creation of a collaboration process to provide information flows and patterns. An Intelligent Disaster Collaboration System (IDCS) is introduced in this paper as a conceptual model to integrate ICT into DM and the mitigation process and to enhance collaboration. The framework is applicable to the collaboration process at the local, regional and national levels. Within this context, the deployment of ICT tools in DM is explored and scenario‐based case studies on flooding and terrorism—examples of natural and human‐induced disasters, respectively—are presented. Conclusions are drawn regarding the differences found in collaboration patterns and ICT used during natural and human‐induced disasters and the differences between currently available ICT and proposed ICT.
Great Expectations: Understanding Bali and the Climate Change Negotiations Process
Authors: Spence Chris , Kulovesi Kati , Gutiérrez María , Muñoz Miquel
Published: August 2008

This article reviews the December 2007 United Nations Climate Change Conference in Bali. It considers expectations for the meeting and whether the event delivered on these expectations. It also evaluates the long‐term context of the meeting and examines the discussions in Bali on the post‐2012 period (when the Kyoto Protocol's first ‘commitment period’ expires). The article finds that the Bali meeting did not necessarily meet public expectations or respond directly to the latest scientific assessments calling for urgent action. However, the article also finds that Bali was successful in the context of the prevailing political and diplomatic realities and the immense complexity of the climate change challenge – a problem that does not lend itself to a ‘quick fix’ solution. The article concludes that Bali produced a solid outcome that gives direction to future talks and sets a clear deadline for their completion. Finally, it argues that, contrary to some experts’ opinion, the lack of detail in the Bali outcome may prove to be a strength rather than a weakness, since it provides flexibility to negotiators as they try to craft a consensus by the end of 2009.
Crafting the Copenhagen Consensus: Some Reflections
Authors: Depledge Joanna
Published: August 2008

The 2007 Bali Climate Conference launched a ‘meta‐negotiation’ of unprecedented scale and complexity. Culminating in 2009, climate change delegates must now define the next round of targets for the Kyoto Protocol developed country parties, and comparable provisions for the USA. Most dauntingly, negotiators must also devise a new architecture for further ‘action’ by developing countries under the Convention. This paper reflects on the key challenges involved in crafting a consensus at the climate conference in 2009 in Copenhagen. In particular, it explores options for reaching agreement with the USA and developing countries, suggesting a transition phase up to 2020. For developing countries, the paper outlines a possible ‘choose and no‐lose’ approach, along with options for increased financing. The paper concludes by looking beyond 2009, emphasizing that, given the complexity of the negotiations, a work programme post‐Copenhagen will be needed.
The Legality of the EU's Stand‐Alone Approach to the Climate Impact of Aviation: The Express Role Given to the ICAO by the Kyoto Protocol
Authors: Petersen Malte
Published: August 2008

The aviation sector is not yet covered by the European Union's Emissions Trading Scheme (EU ETS). Taking into account the fact that aviation increasingly contributes to climate change, the European Commission adopted a proposal for legislation to include aviation in the EU ETS. The proposal foresees the inclusion of internal EU flights as well as external flights to and from the Union within the EU ETS. On 20 December 2007, EU Environment Ministers reached political agreement in the Environment Council on the basis of a new compromise text tabled by the Presidency. However, the International Civil Aviation Organization (ICAO), as well as various stakeholders, does not consider that the EU has the competence to include aviation within the EU ETS. A crucial point concerning the legality of including aviation in the EU ETS is the fact that Article 2(2) of the Kyoto Protocol states that the parties ‘shall pursue limitation or reduction of emissions of greenhouse gases not controlled by the Montreal Protocol from aviation . . . working through the International Civil Aviation Organization . . .’. This article reviews the legality of the EU's stand‐alone approach, focusing on the European and international legal framework and taking into account the express role given to the ICAO by the Kyoto Protocol.
Reducing Emissions from Deforestation and Forest Degradation: Opportunities and Pitfalls in Developing a New Legal Regime
Authors: Fry Ian
Published: August 2008

Deforestation of tropical forests contributes approximately 10–20% of global greenhouse gas emissions. This paper reviews various options proposed by countries to address reducing these emissions, including market‐based approaches to fund activities to make these reductions. The paper explores some of the opportunities and pitfalls of market‐based mechanisms, including such concepts as permanence, measurement, additionality, undermining the carbon market and sovereignty concerns. Possibly the greatest difficulty with market‐based approaches is the issue of emissions displacement – a concept often called ‘leakage’. One cause of leakage is the growing market for tropical timber, particularly in China. Options to address leakage are considered, including a new concept relating to carbon deficits as part of a demand‐side management approach. Non‐market mechanisms are also explored. Elements of the United Nations Framework Convention on Climate Change (UNFCCC)'s Bali Action Plan, such as conservation, sustainable management of forests and the enhancement of carbon stocks, are also examined. The paper concludes that a step‐by‐step approach is needed to build the capacity of developing countries to meet the challenges of reducing emissions from deforestation in developing countries (REDD).
Nature Protection and the Introduction into the Environment of Genetically Modified Organisms: Risk Analysis in EC Multilevel Governance
Authors: Winter Gerd
Published: August 2008

Genetically modified organisms (GMOs) are usually introduced into the environment through experimental releases or extensive cultivation. The risks involved are controlled via both the authorization for deliberate release and the authorization for the placing on the market of a GMO. In these two steps, the core issues of legal protection are public health and the environment. GMO‐free agriculture has been introduced as a third – economic – protected good. This has triggered coexistence measures keeping GM and non‐GM agriculture separated. Given the fact that much has already been said about risks of GMOs to human health, this article will rather focus on the environmental dimension, and more precisely on aspects of nature protection. It will accordingly explore whether nature is adequately protected through the authorization for the release and the authorization for the market placement of GMOs. While these questions concern regimes aiming at preventing environmental damage, co‐existence, if related to natural ecosystems (rather than to the protection of a variety of agriculture), raises the question of whether ecosystems can be considered as protectable goods even if no traditional damage is caused.
Eco‐Compensation Policies and Mechanisms in China
Authors: Liu Guihuan , Wan Jun , Zhang Huiyuan , Cai Lijie
Published: August 2008

In recent years, China has felt the urgent need to address the ecological issues caused by its rapid economic growth. In doing so, one challenge it faces is how to address the interests of the various stakeholders involved. To this end, the Government of China at various levels has been exploring and implementing policies, measures and projects that serve as mechanisms or measures of eco‐compensation. This article attempts to capture some of the key policies and practices established to date in China. The article concludes by outlining China's possible future priority actions in eco‐compensation and key challenges ahead.
Environmental Impact Assessments in International Law
Authors: Gillespie Alexander
Published: August 2008

The purpose of this article is to assess what the current state of play with regard to environmental impact assessments (EIAs) is in international law. This question is posed because of the casual use of the term, and the often fundamental misunderstandings of what EIAs can and cannot do. This paper aims to clarify the current strength of EIAs in the international context, and provide guidance on how they may be applied.
The Bali Road Map: Can it Deliver an Equitable Post‐2012 Climate Agreement for Small Island States?
Authors: Mace M.J.
Published: August 2008

The ambition and architecture of the post‐2012 climate change regime will be critical to the survival of many small island developing nations, many of which are low‐lying, vulnerable to the impacts of sea‐level rise and exposed to increasingly frequent and severe extreme weather events. This paper highlights the key outcomes sought by the Alliance of Small Island States in the international negotiating process on the post‐2012 regime and compares these calls with what has been achieved thus far. The paper concludes that while little progress has been made to date, useful avenues for progress do exist if only the political will can be found.
Building and Fitting Non‐Gaussian Latent Variable Models via the Moment‐Generating Function
Authors: KLEPPE TORE SELLAND , SKAUG HANS J.
Published: August 2008

Abstract.  For certain classes of hierarchical models, it is easy to derive an expression for the joint moment‐generating function (MGF) of data, whereas the joint probability density has an intractable form which typically involves an integral. The most important example is the class of linear models with non‐Gaussian latent variables. Parameters in the model can be estimated by approximate maximum likelihood, using a saddlepoint‐type approximation to invert the MGF. We focus on modelling heavy‐tailed latent variables, and suggest a family of mixture distributions that behaves well under the saddlepoint approximation (SPA). It is shown that the well‐known normalization issue renders the ordinary SPA useless in the present context. As a solution we extend the non‐Gaussian leading term SPA to a multivariate setting, and introduce a general rule for choosing the leading term density. The approach is applied to mixed‐effects regression, time‐series models and stochastic networks and it is shown that the modified SPA is very accurate.
Saddlepoint‐Based Bootstrap Inference for Quadratic Estimating Equations
Authors: PAIGE ROBERT L. , ALEXANDRE TRINDADE A. , HARSHINI FERNANDO P.
Published: August 2008

Abstract. We propose an easy to implement method for making small sample parametric inference about the root of an estimating equation expressible as a quadratic form in normal random variables. It is based on saddlepoint approximations to the distribution of the estimating equation whose unique root is a parameter's maximum likelihood estimator (MLE), while substituting conditional MLEs for the remaining (nuisance) parameters. Monotoncity of the estimating equation in its parameter argument enables us to relate these approximations to those for the estimator of interest. The proposed method is equivalent to a parametric bootstrap percentile approach where Monte Carlo simulation is replaced by saddlepoint approximation. It finds applications in many areas of statistics including, nonlinear regression, time series analysis, inference on ratios of regression parameters in linear models and calibration. We demonstrate the method in the context of some classical examples from nonlinear regression models and ratios of regression parameter problems. Simulation results for these show that the proposed method, apart from being generally easier to implement, yields confidence intervals with lengths and coverage probabilities that compare favourably with those obtained from several competing methods proposed in the literature over the past half‐century.
Strong Consistency of the Maximum Likelihood Estimator for Finite Mixtures of Location–Scale Distributions When Penalty is Imposed on the Ratios of the Scale Parameters
Authors: TANAKA KENTARO
Published: August 2008

Abstract.  In finite mixtures of location–scale distributions, if there is no constraint or penalty on the parameters, then the maximum likelihood estimator does not exist because the likelihood is unbounded. To avoid this problem, we consider a penalized likelihood, where the penalty is a function of the minimum of the ratios of the scale parameters and the sample size. It is shown that the penalized maximum likelihood estimator is strongly consistent. We also analyse the consistency of a penalized maximum likelihood estimator where the penalty is imposed on the scale parameters themselves.
The Unrelenting Exchange Paradox
Authors: Falk Ruma
Published: August 2008

An elusive probability paradox is analysed. The fallacy is traced back to improper use of a symbol that denotes at the same time a random variable and two different values that it may assume.
Teaching Statistical Concepts, Fundamentals and Modelling
Authors: O’Brien Timothy E.
Published: August 2008

This article considers some issues in designing a course focusing on statistical concepts rather than memorizing formulae.
An Exponential Misconception
Authors: Zullo Holly
Published: August 2008

This article points out an unexpected but common misconception by students dealing with the exponential distribution.
Degrees of Freedom
Authors: Eisenhauer Joseph G.
Published: August 2008

This article reviews several attempts to define degrees of freedom, and offers some simple explanations of how they are derived and why they are used in various contexts.
Implementing New Reform Guidelines in Teaching Introductory College Statistics Courses
Authors: Everson Michelle , Zieffler Andrew , Garfield Joan
Published: August 2008

This article introduces the recently adopted Guidelines for the Assessment and Instruction in Statistics Education (GAISE) and provides two examples of introductory statistics courses that have been redesigned to better align with these guidelines.
People Graphs in Primary School
Authors: Sales Diane
Published: August 2008

This article describes use of a novel statistical activity with primary school children.
Illustrating Dependence between Random Variables Using Slot Machines
Authors: Durbach Ian N. , Barr Graham D. I.
Published: August 2008

This article illustrates the concept of statistical independence using the example of slot machines that may be played on multiple lines.
Constructing a European Society by Jurisdiction
Authors: Münch Richard
Published: August 2008

Abstract:  From a sociological point of view, European integration is specifically a process of transforming deeper structures of solidarity, legal order and justice away from the segmentally differentiated European family of nations and towards an emerging European society. This transformation is the subject matter to be explained (explanandum) in this article by a set of mutually supporting explanatory factors (explanans) with the example of jurisdiction by the European Court of Justice: (1) establishing formal legitimate power of European jurisdiction in order to complement and form the driving force of international labour division: preliminary reference, supremacy and direct effect of European law; (2) establishing a substantial conception of control in the field of legal discourse: free movement and non‐discrimination; (3) enforcing a genuinely European legal order against national varieties of law by establishing a dominant European legal community; (4) making transnational sense of legal change by legitimating Europeanised law in terms of advancing justice as equality of opportunity across and within nations, as opposed to equality of results within nations accompanied by inequality of opportunity across nations.
A European Constitutional Patriotism? The Case Restated
Authors: Müller Jan‐Werner
Published: August 2008

Abstract:  Especially since the failure of the European Constitutional Treaty, the idea of a European constitutional patriotism has become subject to ever more intense criticism. This article argues that many of the criticisms of the idea of a European constitutional patriotism have been based on philosophical misunderstandings (both of the notion of constitutional patriotism as such, and of the role it could play in Europe) or rely on implausible empirical claims. Accordingly, the normative idea of constitutional patriotism is first clarified; second, the article discusses some of the most common normative and empirical traps when trying to ‘transfer’ constitutional patriotism from a domestic nation‐state context to the supranational level, as well as the tendency to overburden constitutional patriotism with expectations of solidarity and deliberative democracy; third, an EU‐specific post‐sovereign, pluralist version of constitutional patriotism is defended against critics who see even such a vision as insufficiently sensitive to value pluralism and cultural diversity.
Non‐governmental Organisation Participation in the EU Law‐making Process: The Example of Social Non‐governmental Organisations at the Commission, Parliament and Council
Authors: De Jesús Butler Israel
Published: August 2008

Abstract:  This article explores the avenues used by non‐governmental organisations working in the sector of EU social policy to influence the law‐making process at the EU. The Commission's current transparency initiative has focused attention on the rules (or lack of) governing access to the Commission as the initiator of legislation. This article examines more broadly, on the basis of interviews, both the formal and informal means of accessing not only the Commission, but also the European Parliament (in particular through intergroups) as well as the Council. By using specific examples of legislation it illustrates the routes by which ‘social’ non‐governmental organisations currently interact with these institutions, offering examples of how their work may impact on the output of the Commission, Council and Parliament. The article avoids an overly legalistic analysis with an original glimpse at the ‘hidden’ workings of the EU law‐making process which has hitherto received little attention among legal academics and practitioners.
In Search of Better Quality of EU Regulations for Prompt Transposition: The Brussels Perspective
Authors: Kaeding Michael
Published: August 2008

Abstract:  Better regulation cannot be achieved without serious attention to transposition. The quality of EU regulation is crucial to ensuring that Community law is promptly transposed into national law within the prescribed deadlines. But good quality transposition (clear, simple, and effective) goes beyond pre‐legislative consultation processes and more frequent use of impact assessments as agreed in the 2003 Interinstitutional Agreement on Better Lawmaking. Presenting new data that covers the full population of all EU transport directives from 1995 to 2004—including the national implementing instruments of France, Germany, Greece, Italy, Ireland, Spain, Sweden, the Netherlands and the UK—this study shows that elements of the EU directives delay transposition. The binding time limit for transposition, the EU directive's level of discretion, its level of detail, its nature and further characteristics of the directive's policy‐making process are all factors. These determining factors are crucial to explaining why Member States miss deadlines when transposing EU Internal Market directives. Brussels' efforts to simplify and improve the regulatory environment have to go beyond more preventive action to strengthen the enforcement of EU legislation at the member‐state level if they want to address the Internal Market constraining effects of Member States' non‐compliance. This study argues that far‐reaching decisions made in the European Commission's drafting and EU policy‐making phase have the greatest effect on the European regulatory framework in which businesses operate and the free movement of goods, persons, services, and capital is at stake. Implementation should be part of the design.
Deliberation at the European Convention: The Final Verdict
Authors: Karlsson Christer
Published: August 2008

Abstract:  Negotiations in Amsterdam 1996 and Nice 2000 resulted in deadlocks impossible to break. The failure of these Intergovernmental Conferences gave rise to demands for a new and improved process of treaty reform. The answer offered by the European Council in Laeken was to create a Convention with a mandate to prepare the next reform of the treaties. The broad composition of this Convention raised hopes for a process not exclusively defined by bargaining on behalf of national interests, but rather a more open process where actors would be prepared to listen to each other's arguments. Today, we find two divergent images of deliberation in this body. The first sees the Convention as a deliberative success story; the second argues bargaining dominated the proceedings. However, this far the empirical evidence in support of either claim has been inconclusive. On the basis of interviews with 28 conventioneers, this article ventures a ‘final verdict’ on the matter, arguing that deliberation was, indeed, a defining characteristic of the proceedings.
On the Legal Effects of Framework Decisions and Decisions: Directly Applicable, Directly Effective, Self‐executing, Supreme?
Authors: Hinarejos Alicia
Published: August 2008

Abstract:  This article seeks to, first, clarify the meaning and scope of an array of ‘legal‐effect labels’ which are often used interchangeably or in a loose way in the literature and, second, assess to what extent they can be applied to two kinds of very representative third pillar measures: Framework Decisions and Decisions, defined in Article 34(2) TEU. These ‘labels’ are ‘directly applicable’, ‘directly effective’, ‘self‐executing’ and ‘supreme’. The main conclusion is that these are interconnected concepts, in that the way in which we define one of them may prejudge the scope and/or the role played by others. This is particularly so in the case of direct effect, expressly excluded in the Treaty definition of Framework Decisions and Decisions. Arguably, our definition of direct effect will determine whether these measures can develop other effects—especially those emanating from the principle of supremacy (should we accept the latter as applicable to the third pillar). Further, the article argues that even if we adopt a narrow reading of direct effect that would allow for a hypothetical application of the principle of primacy to these third pillar measures, there are powerful reasons to reject the judicial extension of the Simmenthal duty to this area within the current framework of the TEU.
The Institutional Interplay Regarding the New Architecture for the EC's External Assistance
Authors: Bartelt Sandra
Published: August 2008

Abstract:  The article concerns the inter‐institutional relations and describes the dynamics between the main EC institutions in the decision‐making process regarding the adoption of the new external action instruments. In 2004, the Commission had proposed a set of new external action instruments as base for the delivery of the Community's external assistance. By that time, the existing instruments amounted to more than 30 different legal instruments, which implicated a loss of efficiency in the management of the EC's external assistance. After 2 years of inter‐institutional negotiations between the European Parliament, Council and the Commission, the new set of instruments was finally adopted. Compared to the initial Commission proposals, the design of the new instruments got significantly reshaped in the course of the inter‐institutional decision‐making procedure. In particular, the European Parliament had gained an unprecedented degree of power over the legislative framework for external spending.

Compared to the former range of geographic and thematic regulations, the new external action instruments fundamentally reform the delivery of external financial assistance with their streamlined and simplified structure. They consist of three horizontal instruments to respond to particular needs or crisis situation: an Instrument for Stability, an Instrument for Nuclear Safety Co‐operation) and a European Instrument for Democracy and Human Rights. With regard to geographic coverage, four instruments will implement particular policies: the Instrument for Pre‐accession Assistance, the European Neighbourhood and Partnership Instrument and the Instrument for Development Co‐operation and an Instrument for Co‐operation with Industrialised Countries.
EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases
Authors: Elovaara I. , Apostolski S. , Van Doorn P. , Gilhus N. E. , Hietaharju A. , Honkaniemi J. , Van Schaik I. N. , Scolding N. , Soelberg Sørensen P. , Udd B.
Published: August 2008

Despite high‐dose intravenous immunoglobulin (IVIG) is widely used in treatment of a number of immune‐mediated neurological diseases, the consensus on its optimal use is insufficient. To define the evidence‐based optimal use of IVIG in neurology, the recent papers of high relevance were reviewed and consensus recommendations are given according to EFNS guidance regulations. The efficacy of IVIG has been proven in Guillain‐Barré syndrome (level A), chronic inflammatory demyelinating polyradiculoneuropathy (level A), multifocal mononeuropathy (level A), acute exacerbations of myasthenia gravis (MG) and short‐term treatment of severe MG (level A recommendation), and some paraneoplastic neuropathies (level B). IVIG is recommended as a second‐line treatment in combination with prednisone in dermatomyositis (level B) and treatment option in polymyositis (level C). IVIG should be considered as a second or third‐line therapy in relapsing–remitting multiple sclerosis, if conventional immunomodulatory therapies are not tolerated (level B), and in relapses during pregnancy or post‐partum period (good clinical practice point). IVIG seems to have a favourable effect also in paraneoplastic neurological diseases (level A), stiff‐person syndrome (level A), some acute‐demyelinating diseases and childhood refractory epilepsy (good practice point).
Globalization, the ‘Competition’ State and the Rise of the ‘Regulatory’ State in European Telecommunications*
Authors: HUMPHREYS PETER , SIMPSON SEAMUS
Published: August 2008

This article examines European telecommunications through the conceptual lenses of the ‘competition’ and the ‘regulatory’ state, exploring their complementarities and tensions. It analyses the EU's electronic communications regulatory framework, exposing contradictions in the EU‐level competition and regulatory state in telecommunications in the context of the well‐developed variety at the national level.
The European Policy for the Development of an Information Society: the Right Path?*
Authors: GÓMEZ‐BARROSO JOSÉ LUIS , FEIJÓO CLAUDIO , KARNITIS EDVINS
Published: August 2008

The end of 2005 marked the closure of one stage in the European strategy for the promotion of the information society (the eEurope programme) and the start of the next one (i2010). This seems to be a good time for assessing the results achieved to date by the community policy in this area and analysing whether the correct approach has been adopted. Despite the satisfaction shown in certain official appraisals, the picture resulting from consulting different classifications globally measuring the adaptation of countries to the information society is not that optimistic. Only the European Union leaders in this field (the Nordic countries) have improved their positions, broadening the gap with the rest: western European countries have lost ground (or at least have not improved) in the rankings, the southern countries do not seem to have corrected their deficiencies and the indices for the new Member States have not evolved as expected or have even deteriorated in some cases. Even though becoming one of the most competitive and dynamic knowledge‐based economies in the world was the first Leitmotiv of the Lisbon strategy, the interpretation of the documents connected to the definition of the new stage in the strategy led to doubts over whether the European Union has a clear notion on the course of action to take in order to make progress on the information society a matter of priority.
Government Learning in German and British European Policies*
Authors: BANDELOW NILS C.
Published: August 2008

Why do some governments change their policies toward European integration while other national positions endure? Governments may change their policies even while the governmental parties remain the same. This article focuses on the explanatory capacities of policy learning, and thereby develops some contra‐intuitive theses concerning the impact of political systems. Under some circumstances even the existence of many veto‐players with opposite belief systems may increase the probability of learning.
The Broad Economic Policy Guidelines: Before and After the Re‐launch of the Lisbon Strategy*
Authors: DEROOSE SERVAAS , HODSON DERMOT , KUHLMANN JOOST
Published: August 2008

This article explores the evolution of the European Union's Broad Economic Policy Guidelines (BEPGs) since their introduction in 1993. It argues that the BEPGs have demonstrated value‐added as an overarching instrument of policy co‐ordination and as a catalyst for co‐operation between European and national policy‐makers. Notwithstanding this, the effectiveness of the BEPGs appears to have been hindered by the progressive accumulation of guidelines and by the failure of peer pressure to bite as a sanction mechanism. The re‐launch of the Lisbon Strategy in March 2005 simplified and streamlined the BEPGs, embedding them within a new set of Integrated Guidelines for Growth and Jobs. Key issues surrounding the future of the BEPGs concern their potential as a trigger for ‘home grown’ peer pressure, their attention to euro area specific issues and the involvement of the European Parliament in multilateral surveillance.
The level of Internet access and ICT training for health information professionals in sub‐Saharan Africa
Authors: Ajuwon Grace Ada , Rhine Lenny
Published: August 2008

Background:   Information and Communication Technologies (ICTs) are important tools for development. Despite its significant growth on a global scale, Internet access is limited in sub‐Saharan Africa (SSA). Few studies have explored Internet access, use of electronic resources and ICT training among health information professionals in Africa.

Objective:  The study assessed Internet access, use of electronic resources and ICT training among health information professionals in SSA.

Methods:  A 26‐item self‐administered questionnaire in English and French was used for data collection. The questionnaire was completed by health information professionals from five Listservs and delegates at the 10th biannual Congress of the Association of Health Information and Libraries in Africa (AHILA).

Results:  A total of 121 respondents participated in the study and, of those, 68% lived in their countries’ capital. The majority (85.1%) had Internet access at work and 40.8% used cybercafes as alternative access points. Slightly less than two‐thirds (61.2%) first learned to use ICT through self‐teaching, whilst 70.2% had not received any formal training in the previous year. Eighty‐eight per cent of respondents required further ICT training.

Conclusions and recommendations:  In SSA, freely available digital information resources are underutilized by health information professionals. ICT training is recommended to optimize use of digital resources. To harness these resources, intergovernmental and non‐governmental organizations must play a key role.
Let's stick together: collaborative purchasing of electronic journals in the National Health Service
Authors: Marriott Richard
Published: August 2008

Aim:  To describe the process and the lessons learned from the collaborative purchasing of electronic journals by National Health Service (NHS) libraries in the East Midlands, UK.

Results:  The background to a successful joint purchasing initiative is described, including the methodology for selecting titles and the formula for dividing the payment. Factors that have a bearing on successful collaboration are discussed, including use of a Framework Agreement, licensing conditions and measuring impact.

Conclusion:  NHS librarians working together can leverage collective benefits for users through collaborative purchasing.
Strategies in assessing the need for updating evidence‐based guidelines for six clinical topics: an exploration of two search methodologies
Authors: Voisin Christiane E. , De La Varre Claire , Whitener Lynn , Gartlehner Gerald
Published: August 2008

Background:  Because of the expense of updating practice guidelines, recent attention has focused on approaches that can reliably assess any updating required. Shekelle et al. (Journal of the American Medical Association 2001, 286, 1461–7) proposed using limited literature searches with expert involvement to reduce resources used in assessing whether a guideline needs updating.

Objectives:  This study compared Shekelle's method and the traditional systematic review method regarding comprehensiveness and effort.

Methods:  Two research teams translated critical key questions on screening test treatments and outcomes to Medical Subjects Headings (MeSH) and search strategies. They refined Shekelle's method over three iterations, seeking greater efficiency. Using both methods independently, teams assessed the need to update six topics from the 1996 Guide to Clinical Preventive Services (US Preventive Services Task Force). Outcomes included completeness of study identification, importance of missed studies and effort involved.

Results:  The revised review approach produced fewer citations than the traditional approach and saved time, identifying fewer eligible studies than the traditional approach. None of the studies missed was rated important by the experts consulted.

Conclusions:  The revised review approach provides an acceptable method for judging whether a guideline requires updating. Librarians were an integral part of the research process that streamlined the searches.
Increasing the rural general practitioners’ use of library and information services through publicity: a randomized controlled trial in Cornwall, UK
Authors: Oak Katy , Gegg Rod
Published: August 2008

Objectives:  To provide evidence on the effectiveness of publicity with the aim of encouraging general practitioners (GPs) in Cornwall to make better use of the Cornwall Health Library Service (CHLS). In the light of the findings, a second objective was formulated to determine which resources they used to look for health information.

Methods:  A cluster randomized controlled trial (RCT) measured the effect of two types of publicity, comparing emails with visiting GP practices. After the trial period, a questionnaire was sent to all 332 GPs to ascertain the resources they accessed for their information and any barriers to their use of the CHLS.

Results:  The GP's use of the library services was lower than the level needed for a conclusive statistical analysis; however, visiting practices was associated with an apparent increase in library use and warrants further investigation. The questionnaire showed that GPs make good use of databases and colleagues.

Conclusion:  The RCT confirmed the low uptake of library services anticipated, but was inconclusive in demonstrating the most effective form of publicity. The questionnaire suggested that a substantial number of GPs are interested in the library services and has provided an insight into the way that GPs look for information in Cornwall.