bluuebunny/crossref_metadata_2025 huggingface dataset:
North American Snow Depth and Climate Teleconnection Patterns
Authors: Ge Yan , Gong Gavin
Published: June 2008

Snow–atmosphere relationships have been studied for nearly half a century, but the primary focus has been on snow extent variability, largely because of the relative scarcity of snow depth data. A recently released North American snow depth dataset, with extensive spatial coverage and multidecadal temporal duration, provides a new opportunity to compare snow depth–climate relationships with snow extent–climate relationships over North America. Robust concurrent lead and lag correlations are observed between snow depth and two major climate modes, the Pacific decadal oscillation (PDO) and the Pacific–North America (PNA) pattern, across North America and throughout the snow season. In contrast, snow extent exhibits a less coherent relationship with PDO and PNA except in late spring, which can be interpreted as a residual of the snow depth–climate mode relationship. A regional signature for the snow depth–PDO/PNA relationship is also identified, centered over interior central-western North America. Smaller scales mask the regional effect of PDO and PNA because of local snow depth variability, while larger continental scales exceed the regional domain of the climate mode teleconnections. Overall these results suggest that North American snow depth variability may have greater climatic causes and consequences than snow extent. Physical mechanisms that may be responsible for the observed snow depth–climate teleconnection patterns such as the surface energy balance, moisture transport, and atmospheric flow regimes are briefly discussed.
Probabilistic Forecasts of (Severe) Thunderstorms for the Purpose of Issuing a Weather Alarm in the Netherlands
Authors: Schmeits Maurice J. , Kok Kees J. , Vogelezang Daan H. P. , van Westrhenen Rudolf M.
Published: June 2008

The development and verification of a new model output statistics (MOS) system is described; this system is intended to help forecasters decide whether a weather alarm for severe thunderstorms, based on high total lightning intensity, should be issued in the Netherlands. The system consists of logistic regression equations for both the probability of thunderstorms and the conditional probability of severe thunderstorms in the warm half-year (from mid-April to mid-October). These equations have been derived for 12 regions of about 90 km × 80 km each and for projections out to 12 h in advance (with 6-h periods). As a source for the predictands, reprocessed total lightning data from the Surveillance et d’Alerte Foudre par Interférométrie Radioélectrique (SAFIR) network have been used. The potential predictor dataset not only consisted of the combined postprocessed output from two numerical weather prediction (NWP) models, as in previous work by the first three authors, but it also contained an ensemble of advected radar and lightning data for the 0–6-h projections. The NWP model output dataset contained 17 traditional thunderstorm indices, computed from a reforecasting experiment with the High-Resolution Limited-Area Model (HIRLAM) and postprocessed output from the European Centre for Medium-Range Weather Forecasts (ECMWF) model. Brier skill scores and attributes diagrams show that the skill of the MOS thunderstorm forecast system is good and that the severe thunderstorm forecast system generally is also skillful, compared to the 2000–04 climatology, and therefore, the preoperational system was made operational at the Royal Netherlands Meteorological Institute (KNMI) in 2008.
A Study of the Error Covariance Matrix of Radar Rainfall Estimates in Stratiform Rain
Authors: Berenguer Marc , Zawadzki Isztar
Published: June 2008

The contribution of various physical sources of uncertainty affecting radar rainfall estimates at the ground is quantified toward deriving and understanding the error covariance matrix of these estimates. The focus here is on stratiform precipitation at a resolution of 15 km, which is most relevant for data assimilation onto mesoscale numerical models. In the characterization of the error structure, the following contributions are considered: (i) the individual effect of the range-dependent error (associated with beam broadening and increasing height of radar measurements with range), (ii) the error associated with the transformation from reflectivity to rain rate due to the variability of drop size distributions, and (iii) the interaction of the first two, that is, the term resulting from the cross correlation between the effects of the range-dependent error and the uncertainty related to the variability of drop size distributions (DSDs).

For this purpose a large database of S-band radar observations at short range (where reflectivity near the ground is measured and the beam is narrow) is used to characterize the range-dependent error within a simulation framework, and disdrometric measurements collocated with the radar data are used to assess the impact of the variability of DSDs. It is noted that these two sources of error are well correlated in the vicinity of the melting layer as result of the physical processes that determine the density of snow (e.g., riming), which affect both the DSD variability and the vertical profile of reflectivity.
Administrative change in the Gulf: modernization in Bahrain and Oman
Authors: Common Richard
Published: June 2008

States in the Middle East tend to be overlooked by researchers in comparative public administration. However, these states offer potentially useful insights into the nature of administrative change as they defy standard assumptions about pressures for reform. The aim of the article is to provide an account of reform by analysing important contextual factors in Bahrain and Oman. Given the large gap in the literature regarding the Gulf States, this article is supplemented by observations and evidence gathered on regular visits to both countries by the researcher. The analysis reveals systems of public administration highly resistant to international reform trends. Many of these factors are situational; including highly centralized political systems, tradition and strong national and administrative cultures. It is concluded that while reform processes are emerging in these countries, they are slow and evolutionary and are more adapted to the domestic rather than the international context.

Points for practitioners

The article may be of interest for practitioners working for international consultants, not only in Bahrain and Oman, but also in the wider Gulf Region (Kuwait, Qatar, Saudi Arabia and the United Arab Emirates, which have similar political and social contexts to those of Bahrain and Oman). In addition to providing contextual information, the article discusses the institutional and cultural barriers to reform in terms of providing Western-style administrative solutions. The article also alludes to the different time horizons in the Gulf States, and the slow (by Western standards) and evolutionary nature of the reform process.
The National Governance Programme (2006—10) and the modernization of the administration: Cameroon and New Public Management
Authors: Tamekou Raoul
Published: June 2008

New Public Management (NPM) emerged in the 1980s as the recognized instrument of public administration modernization. It has been introduced into African countries through National Governance Programmes (NGPs), programmes that set out to reform and improve the action of the State. It is only natural that we should study the impacts, whether concrete or planned, of their application. That is the core purpose of this document, which looks into the mutation of Cameroon's public administration from the perspective of NPM on the basis of the reform planned by the latest NGP straddling 2006—10. It also analyses the reasons that prompted Cameroon to adopt NPM, as well as its political and, in particular, administrative consequences.

Points for practitioners

The article examines the administrative reform planned by the National Governance Programme (2006—10) in Cameroon. Given that this reform can be interpreted as a consecration of New Public Management (NPM) as the principle behind the modernization of public administration in this country, it sets out to analyse the process involved. Moreover, the author also looks at the underlying causes of this reform and at its political and administrative implications. The article adopts a critical approach and raises the fundamental issue of institutional transfer from the countries of the North towards those of the South, and the consequences for African reform projects.
Facing management choices: an analysis of managerial choices in 18 complex environmental public—private partnership projects
Authors: Klijn Erik-Hans , Edelenbos Jurian , Kort Michiel , van Twist Mark
Published: June 2008

This article looks at how managers in large infrastructure projects in The Netherlands deal with difficult choices, which are labelled dilemmas in this article, in their managerial activities. It presents the results of a survey of 32 managers in 18 complex decision-making projects in which public—private partnerships (PPPs) play an important role. The managers were presented with a number of choices and asked to rate the amount of attention they paid to each of the choices. The article focuses on four (groups of) dilemmas managers face in the inter-organizational context of these processes: (1) interaction with parties, (2) strategic orientation, (3) management style and (4) process dynamics.After a brief elaboration of the role of (network) managers in complex PPP projects and the nature of the dilemmas they face, the four groups of dilemmas are explored by looking at how managers scored on the dilemmas within each group. Conclusions are drawn about managers' perceptions of these dilemmas and the differences between projects. The different choices of dilemmas are then compared with the differences between the scores of the outputs of the projects as perceived by the managers. Finally, general conclusions are drawn about the dilemmas chosen by managers and the consequences of these choices.

Points for practioners

Pay attention to commitment, goal searching, communication and vertical relations if you want good outcomes in complex environmental projects. Do managers of complex spatial and environmental projects in general choose to open up the decision-making process for stakeholders to enhance support and use the knowledge of stakeholders or do they choose a more closed decision-making process that reduces the number of actors and might speed up the decision-making process? In general, one can see many of these managerial choices between a more project oriented style, that focuses on control, specifying goals, keeping the budget, etc., and a more process oriented style that focuses on activating actors, creating support, or exploring possible content. If we look at the 32 managerial strategies that were researched, there are a few strategies that are positively and strongly correlated to positive perceived outcomes of projects: commitment, goals searching, vertical relationships and communication.
Swiss public servants' perceptions of performance in a fast-changing environment
Authors: Emery Yves , Wyser Carole , Martin Noemi , Sanchez Joelle
Published: June 2008

The notion of performance is central in all the modernization processes that have been conducted during the last 20 years, notably under the New Public Management (NPM) movement. Since the models and notions of performance analysed in research nearly always reflect the vision of top management, this article proposes to consider the vision of personnel at the street level, specifically Swiss civil servants. A highly capable public sector organization, focused on efficiency, quality services provided for the citizens and outcomes needs motivated employees to achieve these ambitious objectives. But how is `performance' perceived by civil servants without any management responsibilities? Using the typology of Boltanksi and Thévenot, the article highlights several reference worlds to which civil servants refer when speaking of performance, revealing the dominant influence of the industrial world over that of the civic world, with the domestic and commercial worlds placed third and fourth in importance, respectively. It details the evolution of performance as seen by civil servants, allowing us to better understand their reactions when faced with the transformations under way as well as the identity crisis caused by the contradictory worlds they currently face.

Points for practitioners

Under the NPM-banner, performance management has been introduced in almost every public sector organization. Performance must be clearly operationalized at all levels of the hierarchy, which is a difficult process because NPM has introduced new values that potentially conflict with traditional public sector values. This article highlights and analyses the way Swiss civil servants at the street level perceive performance, providing useful insight into their dominant value framework. Their perception of a `highly capable public sector' must be set against actual standards in order to achieve a shared vision of the main dimensions and criteria of performance, a prerequisite for effectiveness in every performance management system.
Performance-related pay and work motivation: theoretical and empirical perspectives for the French civil service
Authors: Forest Virginie
Published: June 2008

At a time when the civil services of most OECD countries have embarked on a process of modernization of their practices, we are questioning the relevance of introducing performance-related pay systems, particularly in view of the, more often than not, negative effects on the work motivation of civil servants. The French civil service has recently decided to pay a part of its public officials on the basis of their performance, and we show how these individualized remuneration practices can, in the long term, undermine the public service motivations that drive some civil servants. Our reasoning is supported by the empirical results of studies conducted in the United States, in England and also in France, as well as on the developments of intrinsic motivation theories, combined with the developments of the public service motivation theory.

Points for the practitioners

Whereas the implementation of performance-related pay as an instrument of motivation has become widespread within the civil service, this article focuses on the difficulties inherent to these compensation practices. We underline in particular the negative effects of performance-related pay on the public service motivations of civil servants. As these specific motivations can be pushed aside, human resource management tools should be adopted that encourage the development of intrinsic motivation, such as task enlargement or enrichment or the implementation of participative management methods.
Global governance and local government in the Congo: the role of the IMF, World Bank, the multinationals and the political elites
Authors: Kuditshini Jacques Tshibwabwa
Published: June 2008

This article follows in the wake of the territorial dynamic of globalization. It highlights the interactions between local government and an asymmetric global competitiveness in a country where the wealth of mining and forestry resources are under the control of the neo-liberal players of globalization (multinational companies, IMF, World Bank) and the Congolese political and military elites, thanks in particular to the privatization of land and the natural resources of the entities decentralized by the new mining, forestry and investment codes. Having become a real means of generating artificial revenues for the aforementioned players, these new pieces of legislation dispossess the Congolese local governments upstream, not only financially but also economically and materially and thus undermine their development capacity.

Points for practitioners

In the light of the data produced and analysed in this study, the government practitioners should be aware of the fact that global competitiveness as it has emerged today has severe effects on the natural resources and the economies of the local governments of developing countries, and those of the DRC in particular. This competitiveness, favoured by new mining and forestry codes, profits the foreign multinational companies that are better endowed in terms of capital and cutting-edge technological equipment. Furthermore, these pieces of legislation have become a source of profiteering for the Congo's political elites. Repealing all this imposed legislation and introducing new reforms are the most effective means of fighting against this ever-changing competitiveness and against all forms of profiteering.
An exploratory study of organizational uncertainty in times of changing and transitional public administration in Korea
Authors: Younhyun Song
Published: June 2008

This research examines perceptions of organizational uncertainty among Korean public employees during an administrative paradigm shift. Using the data from Korean public employees in the central ministries, this article explores the extent to which public employees perceive organizational uncertainty and how separate instances of perceived uncertainty are associated. The findings reveal four dimensions of uncertainty: structural and systematic; new administrative demand; job-related; and unpredictability in the decision-making process. In addition, all of these types of uncertainty are linked; new administrative demand uncertainty has a strong influence on the other three. This research concludes by suggesting the roles of leaders in solving uncertain aspects from an increased burden of administrative reform.

Points for practitioners

Public managers need to recognize that when administrative reforms and organizational change take place, employees become anxious about their job prospects, organizational systems, and external demands. Such perceived organizational uncertainties are associated with one another: jobs, organizational systems, decision-making process, and external administrative demand. More specifically, the inability to cope well with uncertain environmental conditions negatively affects organizational members' behaviors and eventually results in individual stress and uncertainty about their jobs. Nevertheless, organizational uncertainties cannot be avoided in changing and transitional administrative environments. Thus, public managers need to consider and mitigate the negative aspects of organizational uncertainty by adopting innovative approaches and practices for successful administrative reform.
Deciphering the Dutch drop: ten explanations for decreasing political trust in The Netherlands
Authors: Bovens Mark , Wille Anchrit
Published: June 2008

The Netherlands has always been the odd case out regarding trust in public institutions. In the 1980s and 1990s, contrary to international trends, trust in government remained high and even increased. Suddenly, from 2002 onwards, public trust in government declined dramatically. In this article we examine the plausibility of ten explanations, embedded in the international scholarly literature, and explore whether they are empirically supported or rebutted in case of the Dutch drop. We find that because most of the literature concentrates on the cross-national erosion of political support over a long period within Western democracies, explanations tend to focus on gradual, long-term demographic, social, and political trends. Sudden dips in trust levels, however, require different sets of explanatory factors; they are better explained by political or economic contingencies, such as sudden political or economic crises. In the case of the Dutch drop, the most plausible explanation is a combination of an economic decline, combined with high political instability and contestation during the first Balkenende cabinets. As of 2007, with a new cabinet in office, and an economic recovery in place, trust figures are on the rise again.

Points for practitioners

Sudden dips in public trust in government are better explained by political or economic contingencies, such as political or economic crises, than by a deterioration in government performance or by long-term demographic, social, and political trends. In the case of the sudden drop in trust in The Netherlands, the most plausible explanation is a combination of an economic decline, combined with high political instability and contestation during the first Balkenende cabinets. As of 2007, with a new cabinet in office, and economic recovery in place, trust figures are on the rise again.
Is There Long-run Convergence among Regional House Prices in the UK?
Authors: Holmes Mark J. , Grimes Arthur
Published: June 2008

This paper investigates the long-run convergence of regional house prices in the UK. Existing studies have failed to reach a consensus on whether or not regional house prices exhibit long-run convergence with each other. The application is proposed of a new test involving unit root testing of the first principal component based on regional—national house price differentials. Using mix-adjusted quarterly data for 1973—2006, it is found that the first principal component is stationary. This suggests that all UK regional house prices are driven by a single common stochastic trend. Further analysis suggests that those regions that are more distant from London exhibit the highest degrees of persistence with respect to deviations in house price differentials.
Moving Window Approaches for Hedonic Price Estimation: An Empirical Comparison of Modelling Techniques
Authors: Páez Antonio , Fei Long  , Farber Steven
Published: June 2008

Recognition of the limitations of traditional hedonic models to account for spatial effects has led in recent years to the development and use of spatial econometric and statistical techniques in real estate applications. It seems appropriate, as the number of applications grows, to evaluate the relative ability of some newer approaches in terms of producing accurate spatial predictions. This article compares a selection of techniques to assess their performance. The focus is on moving window approaches that can be conceptualised as sliding neighbourhoods (i.e. soft market segmentations) and that can incorporate spatial dependency effects. Comparison of moving windows regression (MWR), geographically weighted regression (GWR) and moving windows Kriging (MWK) sheds light on the relevance of different spatial effects. Results using Toronto as a case study indicate that market segmentation may be more important than spatial dependencies. The findings suggest practical guidelines with regard to the use of the models investigated.
`Optimal' Accessibility Landscapes? Development of a New Methodology for Simulating and Assessing Jobs—Housing Relationships in Urban Regions
Authors: Horner Mark W.
Published: June 2008

Research into land use—transport relationships through the lens of the jobs—housing balance and the closely related excess commuting framework continues to draw substantial interdisciplinary attention. There have been several recent research efforts aimed at extending the excess commuting framework and its GIS-based spatial models to more prescriptive, policy-relevant situations. This paper puts forward the idea of a theoretical `optimal' urban jobs—housing balance and proposes a new spatial model for finding it. The developed model treats the region's theoretical minimum commute as a baseline indicator of the jobs—housing balance. Alternative patterns of workers and jobs are simulated in order to improve this indicator. The model is demonstrated in several scenarios using data from the decennial US census (2000). Results demonstrate the model's capability for finding `optimal' spatial distributions of jobs and housing, as well as pointing out inefficiencies in existing urban structure. Summary remarks and suggestions for future research are provided.
Redefining Rural Collectives in China: Land Conversion and the Emergence of Rural Shareholding Co-operatives
Authors: Po Lanchih
Published: June 2008

As land conversion has led inevitably to socioeconomic dislocations in China, a variety of bottom—up reforms have been designed to mitigate and contain the resultant conflicts. This evolves the creation of a mechanism both to allow peasants to benefit from the increase of land value in the urbanisation process and also to redistribute interests to individual rural villagers. This paper focuses on on-going shareholding reforms which aim to clarify villagers' property rights under the current structure of collective ownership. Three cases best exemplify these issues: Wusha village in Guangdong, Qunyi village in Jiangsu and Daliushu village in Beijing. The comparison reveals divergent experiences of reform among landless farmers and how the adoption of property rights reforms has restructured the concept and organisation of rural collectives.
Deconstructing the Global City: Unravelling the Linkages that Underlie Hong Kong's World City Status
Authors: Chu Yin-wah
Published: June 2008

This paper questions the hyper-globalist orientation among some leading analysts of the global city and their tendency to define it in functional terms, accounting for its presence by the agglomeration of talents and therefore to underexamine the global city's actual linkages. It argues that an examination of the linkages (geographical scope as well as capital, knowledge and labour-mediated) will alert one to the changing configurations of a global city. It will also facilitate an exploration into factors other than the agglomeration of talents that have made for the changes. The paper examines Hong Kong's changing configuration as a global city from the mid 1980s to the early 2000s. It starts with an overview of three sets of trend data and goes on to examine the capital, knowledge and labour mediated by two types of producer service and the circuits they support.
Land Values and the 1957 Comprehensive Amendment to the Chicago Zoning Ordinance
Authors: Jian Zhou  , McMillen Daniel P. , McDonald John F.
Published: June 2008

In 1957 Chicago enacted a Comprehensive Amendment to the Chicago Zoning Ordiance of 1923. In contrast to the hierarchical zoning of the 1923 ordinance, the 1957 ordinance made each zoning category exclusive and mandated the removal of non-conforming uses. This study examines land parcels at the borders between residential and non-residential (commercial or manufacturing) zones, and finds that land values in non-residential zones enjoyed a one-time jump in growth over the time-period 1955—58 during which the 1957 ordinance was adopted. No significant change is detected in land value growth in residential zones. These results suggest that non-residential landowners valued the insurance that the 1957 ordinance provided against mixed land uses more than the value of the option to change land use that was terminated.
The Impact of Globalisation on Different Social Groups: Competitiveness, Social Cohesion and Spatial Segregation in Istanbul
Authors: Eraydin Ayda
Published: June 2008

The main objective of this paper is to explore relations between competitiveness and social cohesion in Istanbul. It mainly questions whether it is possible to expect a positive change in socio-spatial inequalities if increasing competitiveness generates not only international business and high-level services, but also traditional low-cost production activities. The findings show that competition in different types of activities has generated large numbers of jobs, but has not been able to overcome existing income disparities. The increasing income differences, however, do not mean an increase in socio-spatial segmentation, since the non-market processes and policies related to education, gender and the urban land and housing markets have played important roles in the redistribution of different social groups within urban space, in addition to the endogenous dynamics of labour markets.
Race, Space and the Post-Fordist Spatial Order of Johannesburg
Authors: Crankshaw Owen
Published: June 2008

The deindustrialisation of Johannesburg has taken a particular spatial form. Service-sector businesses are increasingly located in the mostly White northern suburbs, whereas the mostly Black southern suburbs bear the brunt of unemployment and increasingly resemble an excluded ghetto. Some authors argue that Johannesburg's post- apartheid spatial order is just as racially unequal as it was during apartheid. This study tests this argument by using the results of the 2001 population census to examine the extent to which edge city development in Johannesburg is characterised by racial residential desegregation. The results show that the northern suburbs are undergoing fairly substantial desegregation. To the extent that this trend continues, the geography of apartheid racial divisions will be eroded and Johannesburg's racially mixed edge city will become an exception among world cities.
Improving Outcomes of Forced Residential Relocation: The Development of an Australian Tenants' Spatial Decision Support System
Authors: Baker Emma
Published: June 2008

The Australian public housing sector has undergone significant change in recent years. The public tenant profile has changed and public housing infrastructure has become largely unsuitable. At the same time, the Australian government has retreated from funding public housing infrastructure. The results of these changes are fewer public dwellings, fewer tenants housed and a stock mismatched to the needs of public tenants. Urban regeneration allows housing providers to trade unsuitable and run-down housing for fewer better-quality dwellings, but necessitates forced public tenant relocation. This paper explores residential choice among Australian public tenants and describes the development of a novel application of spatial technology—a tenants' spatial decision support system (SDSS)—to improve tenant outcomes in forced relocation.
Revisiting depression in palliative care settings: the need to focus on clinical utility over validity
Authors: Reeve JL , Lloyd-Williams M , Dowrick C
Published: June 2008

Objective: To review the literature on depression in palliative care patients to identify implications for development of clinical practice and individual patient care.

Method: A qualitative review of depression prevalence studies in palliative care settings. We explore the utility of existing prevalence studies for clinical practice through testing two hypotheses: that high prevalence rates are associated with increased risk factors in study samples, and that poor methodological quality of the studies artefactually inflate prevalence estimates. Eighteen studies were identified in the search and included in this review.

Results: Risk factors may contribute to depression prevalence but through a complex interaction of factors making individual risk levels hard to determine. Measurement artefact cannot, alone, account for elevated levels of depression in this population but may contribute to imprecision. The importance of organic decline as a potential confounding variable is highlighted.

Conclusion: Future research into the causes and prevalence of depression should adopt longitudinal approaches using large samples, and consider the impact of organic disorder as an important confounding factor. Clinical practice and care of individual patients may be better supported by development of a prognostic index considering the predictive power of depressive symptoms and risk factors on well-being.
Variable response to opioid treatment: any genetic predictors within sight?
Authors: Skorpen F , Laugsand EA , Klepstad P , Kaasa S
Published: June 2008

The aim of this literature review is to summarize and discuss the available evidence for a relationship between polymorphisms in human genes and variability in opioid analgesia and side effects among patients treated for moderate or severe pain. The evidence supporting a role of certain alleles, genotypes or haplotypes in modulation of opioid analgesia is derived from a limited number of studies, a limited number of genes and a limited number of opioids. Although several interesting candidates have emerged as potentially relevant factors, only for one polymorphism, the prevalent 118A>G of the μ-opioid receptor, the accumulated evidence is sufficient to suggest a clinically relevant effect for an opioid used for moderate or severe pain. Still the data are valid only at the group level and cannot be used to predict treatment outcome in individual patients. Only a few of the symptoms often seen as opioid adverse effects in palliative care, such as nausea, vomiting, constipation and sedation, have been associated with genetic variants in various genes, but the results have been based on case reports, healthy volunteers or post-operative patients. So far, there is no clear evidence that genetic markers can be used to predict opioid efficacy or adverse effects in palliative care patients. This reflects the general lack of studies performed in the context of palliative care, the lack of sufficiently scaled studies and the lack of international standards for the assessment of subjective symptoms.
Opioids in context: relieving the pain of cancer. The role of comprehensive cancer management
Authors: Hoskin PJ
Published: June 2008

Optimal pain control requires detailed appraisal of each symptom; in many cases definitive treatment of the underlying cause will be the most effective means of pain control. As an example back pain may be due not only to bone metastases but also enlarging lymph nodes, renal pain or retroperitoneal tumour. Benign causes including degenerative joint disease should also be considered and each cause treated specifically alongside the use of analgesics.
Global warming in the palliative care research environment – adapting to change
Authors: Fainsinger RL
Published: June 2008

Advocates of palliative care research have often described the cold and difficult environment that has constrained the development of research internationally. The development of palliative care research has been slow over the last few decades and has met with resistance and sometimes hostility to the idea of conducting research in ‘vulnerable populations’. The seeds of advocacy for research can be found in palliative care literature from the 1980s and early 1990s. Although we have much to do, we need to recognize that palliative care research development has come a long way. Of particular note is the development of well-funded collaboratives that now exist in Europe, Canada, Australia and the USA. The European Association for Palliative Care and the International Association for Hospice and Palliative Care has recognized the need to develop and promote global research initiatives, with a special focus on developing countries. Time is needed to develop good research evidence and in a more complex healthcare environment takes increasingly more resources to be productive. The increased support (global warming) evident in the increased funding opportunities available to palliative care researchers in a number of countries brings both benefits and challenges. There is evidence that the advocacy of individuals such as Kathleen Foley, Neil MacDonald, Balfour Mount, Vittorio Ventafridda, Robert Twycross and Geoff Hanks is now providing fertile ground and a much friendlier environment for a new generation of interdisciplinary palliative care research. We have achieved many of the goals necessary to avoid failure of the ‘palliative care experiment’, and need to accept the challenge of our present climate and adapt and take advantage of the change.
Research methodologies in palliative care: a bibliometric analysis
Authors: Payne SA , Turner JM
Published: June 2008

The aspiration to design and conduct high-quality research in palliative care has been an important but elusive goal. The article evaluates the nature of research methodologies presented in published research within the broad remit of palliative care. A systematic search of the Medline database between 1997 and 2006, using the keywords ‘palliative care’ or ‘end-of-life care’ and ‘research methodology’, identified over 318 publications. A bibliometric analysis indicates an incremental increase in published outputs per year, from 27 countries, with articles widely distributed across 108 journals. The heterogeneity of the research methodologies and the journals publishing them, present challenges in defining what constitutes ‘high quality’. We argue that although this diversity leads to a lack of coherence for a single disciplinary paradigm for palliative care, there is a greater acknowledgement of the differing epistemological and theoretical frameworks used by researchers. This could be regarded as enriching our understanding of what it means to be dying in contemporary society.
Effect of a population-based educational intervention focusing on end-of-life home care, life-prolonging treatment and knowledge about palliative care
Authors: Miyashita M , Sato K , Morita T , Suzuki M
Published: June 2008

The effectiveness of population-based educational interventions in palliative care is unclear. We conducted an educational intervention study for the general public focusing on end-of-life home care, life-prolonging treatment and knowledge about palliative care and measured the change in perception about these issues. Participants were recruited from the 11 districts of Fukushima City, Japan. One-hour educational lectures were conducted in each district from April 2006 to March 2007. Meetings were held in a community centre or hall in each district. We asked participants to fill in a questionnaire before and after the educational lecture. Of 607 participants, 595 (98%) answered both pre- and post-intervention questionnaires. The feasibility of a home death changed from 9% before to 34% after the intervention ( P < 0.001). In addition, preference for life-prolonging treatment and attitudes toward end-of-life care including symptom management at home, misconceptions about opioids, artificial hydration and communication issues between patient and medical practitioners were significantly improved after the intervention. Factors that were significantly associated with changing perceptions about the feasibility of a home death were male gender, change in beliefs regarding burden to family caregivers, anxiety regarding admission to the hospital with worsening physical condition and fear that pain would not be relieved at home. This population-based educational intervention was effective in changing beliefs regarding the feasibility of home care, preference for life-prolonging treatment and attitudes toward end-of-life care.
Cultural meanings of pain: a qualitative study of Black Caribbean and White British patients with advanced cancer
Authors: Koffman J , Morgan M , Edmonds P , Speck P , Higginson IJ
Published: June 2008

Pain is a common cancer-related symptom, but little research has been conducted that explores the meanings of this symptom across different ethnic groups. This study involved qualitative interviews to explore and compare the meanings of pain among 26 Black Caribbean and 19 White patients with advanced cancer. Patients were recruited from oncology outpatient clinics, a lung clinic and palliative care teams. Interview transcripts were analysed using the framework approach. A total of 23/26 Black Caribbean and 15/19 White patients reported cancer-related pain. Accounts of Black Caribbean and White patients identified pain as a ‘challenge’ that needed to be mastered by the individual, not necessarily by drugs and identified pain as an ‘enemy’ that represented an unfair attack. Two further meanings of pain emerged from Black Caribbean patients’ accounts: pain as a ‘test of faith’ that referred to confirmation and strengthening of religious belief, and pain as a ‘punishment’ that was associated with wrongdoing. These meanings influenced the extent patients were able to accommodate their distress. Pain assessment needs to consider the patients’ narratives that include the meanings they attribute to this symptom, and which may be governed by culture.
Use of a palliative care order set to improve resident comfort with symptom management in palliative care
Authors: Jarabek BR , Jama AA , Cha SS , Ruegg SR , Moynihan TJ , McDonald FS
Published: June 2008

Although one-fourth of all medicare dollars are spent during the last year of life, symptom management for terminal hospitalized patients has continued to be inadequate. Quality end-of-life care is often overlooked, seldom taught and rarely measured within Internal Medicine Residency Programmes. We studied the effects of a palliative care order set and educational e-mail on resident comfort. Survey of residents showed that only 54% were comfortable across nine aspects of palliative care. Three months after release, 88% of residents were using the order set and 63% believed it increased their comfort with palliative care. Resident comfort managing palliative symptoms increased an average 10% ( P = 0.02). First-year residents exposed to this order set increased in comfort from 40% to 65% ( P < 0.0001), which significantly surpassed the 48% of second-year residents who reported being comfortable ( P = 0.002). Introducing a palliative care order set improves resident comfort with symptom management in dying patients.
A Delphi study to develop the Association for Palliative Medicine consensus syllabus for undergraduate palliative medicine in Great Britain and Ireland
Authors: Paes P , Wee B
Published: June 2008

The Association for Palliative Medicine (APM) produced a previous undergraduate palliative medicine syllabus in 1992. This study describes the process of developing the new APM consensus syllabus against the background of changes in medical education and palliative medicine since 1992. The syllabus was derived by means of a Delphi study carried out amongst experts in palliative medicine across Britain and Ireland. Forty-three participants agreed to take part. Three rounds of the Delphi study took place. Consensus (75% agreement) was achieved in over 90% of the outcomes. The new syllabus is broken down into the following sections: basic principles, physical care, psychosocial care, culture, language, religious and spiritual issues, ethics and legal frameworks. Learning outcomes are categorised as essential or desirable. Using a Delphi study, we have developed a consensus syllabus for undergraduate palliative medicine. This is sufficiently flexible to allow all medical schools to ensure that their students achieve the essential learning outcomes by the time they graduate, whereas those with more generous curricular space will additionally be able to deliver selected desirable learning outcomes.
Effectiveness of a three-day communication skills course in changing nurses’ communication skills with cancer/palliative care patients: a randomised controlled trial
Authors: Wilkinson S , Perry R , Blanchard K , Linsell L
Published: June 2008

This multi-centre, two-armed parallel-group pragmatic randomised controlled trial (RCT) evaluated the effectiveness of a 3-day communication skills course in changing nurses’ communication skills. The primary outcome was the change in the nurses’ communication skills score from pre-course to 12 weeks post-course. The main secondary outcome was the change in the nurses’ level of confidence in communicating with patients. A total of 172 nurses were randomised to the course or control. The communication skills score for the intervention group increased by 3.4 points post-course but decreased in the control by 0.05 points (between-group difference in change: 3.41, 95% CI: 2.16–4.66, P < 0.001). Confidence scores increased by 18.16 points for the intervention group but decreased 0.7 points in the control (between-group difference in change: 18.86, 95% CI: 13.39–24.34, P < 0.001). This RCT contributes to the evidence base on the effectiveness of communication skills training in cancer and palliative care.
A new self-rating scale for detecting atypical or second-generation antipsychotic side effects
Authors: Waddell L. , Taylor M.
Published: June 2008

We aimed to construct and assess a new self rating scale to detect the side effects of second generation antipsychotics. This scale was designed to allow a timely, sensitive and reliable method of gathering information on the number and severity of side effects an individual suffers from. The Glasgow Antipscyhotic Side-effect Scale (GASS) was developed after literature review, discussion with members of the mental health team and with service user feedback. Fifty indivudals taking second generation antipsychotics completed the GASS along with the Liverpool Univeristy Neuroleptic Side Effect Rating Scale, and one week later completed the GASS for a second time. Fifty comparison subjects also completed the GASS. The GASS was shown to have good discrimatory power and construct validity, along with good re-test reliablity, and is put forward as a short, helpful and valid clinical tool.
Reorganization of the composition of brain oscillations and their temporal characteristics during opioid withdrawal
Authors: Fingelkurts AlA , Kähkönen S. , Fingelkurts AnA , Kivisaari R. , Borisov S. , Puuskari V. , Jokela O. , Autti T.
Published: June 2008

Majority of the opioid-dependence and withdrawal studies are dominated with many inconsistencies and contradictions. One of the reasons for such inconsistencies may be methodological while performing EEG analysis. To overcome methodological limitations, in the present study we examined the composition of electroencephalographic (EEG) brain oscillations in broad frequency band (0.5—30 Hz) in 13 withdrawal opioid-dependent patients and 14 healthy subjects during resting condition (closed eyes). The exact compositions of brain oscillations and their temporal behaviour were assessed by the probability-classification analysis of short-term EEG spectral patterns (SPs). It was reported that early withdrawal had a generalized effect: the activity in all EEG channels was affected nearly equally. EEG of withdrawal patients was characterized by (a) different dominant SP types (had unique SP types which describe β-frequency band), (b) increased number of SP types observed in each EEG channel, (c) a larger percentage of α2-, β- and poly-rhythmic activity, and by a smaller percentage of δ-, θ- and α1-rhythmic activity, (d) predominantly right-sided asymmetry and (e) longer periods of temporal stabilization for α- and β-brain oscillations and by shorter periods of temporal stabilization for θ-activity when compared with control subjects. When taken together, these findings suggest a considerable reorganization of composition of brain oscillations, which reflects a disorganization process and an allostatic state with neuronal activation in EEG of opioid withdrawal patients.