bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring effects of coordination on the autonomy of regulators: energy regulators in Belgium
Authors: Rommel Jan , Verhoest Koen 
Published: May 2014

Regulatory administrations are increasingly fragmented. Regulation is produced by multi-actor multi-level constellations. Researchers have described how actors in such constellations coordinate with each other. This article explores how coordination affects the decision-making autonomy of agencies, using a case study of energy regulation in Belgium. It describes the extent of autonomy from the parent minister and explores how the regulator coordinates with other actors at multiple levels of government. The findings indicate that de facto discretion of regulators can be increased or reduced by other governmental actors besides the parent minister. This calls for the development of a ‘relational perspective’ on (regulatory) agency autonomy, which looks at relations with multiple actors, even when these actors have no direct principal–agent relationship with the agency. Points for practitioners In recent decades, many Western governments have created independent regulatory agencies. The accumulation of these agencies across policy sectors and across levels of government has been associated with the creation of new coordination mechanisms. However, these trends may have certain unintended consequences. When authority is fragmented, the capacity for single actors to intervene may be reduced. Coordination may affect the de facto decision-making capacity of regulators. When agencies use inter-organizational relations to build up expertise, the autonomy vis-à-vis the parent minister may increase. However, when coordination mechanisms are based only on informal, voluntary agreements, these mechanisms may fail to compensate for all resource dependencies.
NOD2 Mediates Odontoblast Differentiation and RANKL Expression
Authors: Lee S.-I. , Kim G.-T. , Kim H.J. , Park S.-H. , Kim E.-C. 
Published: May 2014

The precise regulation of odontoblast differentiation and osteoclastogenic cytokine expression in human dental pulp cells (HDPCs) is crucial for the pathology of bacteria-related pulpitis. Although the up-regulation of nucleotide-binding oligomerization domain-containing protein 2 (NOD2) has been reported in inflamed human dental pulps, the role of NOD2 in the differentiation of HDPCs remains unclear. Here, we show the involvement of NOD2 in odontoblast differentiation together with osteoclastogenic cytokine expression in HDPCs. Treatment with muramyl dipeptide (MDP), a known NOD2-agonist, significantly inhibited odontoblast differentiation of HDPCs, as revealed by reduced ALP activity, osteoblast/odontoblast marker expression, and mineralized nodule formation. Importantly, the forced down-regulation of NOD2 by small interfering RNA (siRNA) recovered MDP-down-regulated odontoblast differentiation. MDP-elicited suppression of odontoblast differentiation resulted from the increased expression of MKP-1 protein and the subsequent decline of MAPKs phosphorylation, which is a prerequisite for odontoblast differentiation. Furthermore, we found that MDP treatment elevated the expression of osteoclastogenic cytokines in HDPCs, which was also reversed by NOD2 silencing. Analysis of these data, taken together, suggests that the regulation of NOD2 expression upon MDP challenge might serve as an intrinsic mechanism that underlies the hindered dentin formation and accelerated dentin resorption in bacterial infection-mediated pulpitis. Abbreviations: HDPCs, human dental pulp cells; NOD2, nucleotide-binding oligomerization domain-containing protein 2; MDP, muramyl dipeptide; siRNA, small interfering RNA; MAPKs, mitogen-activated protein kinases; MKP-1, MAPK phosphatase-1; BMMs, bone-marrow-derived macrophages; and CM, conditioned medium.
The cost-effectiveness of orthopaedic clinical officers in Malawi
Authors: Grimes Caris E , Mkandawire Nyengo C , Billingsley Michael L , Ngulube Christopher , Cobey James C 
Published: May 2014

Background In Malawi the orthopaedic clinical officer (OCO) training programme trains non-physician clinicians in musculoskeletal care. We studied the cost-effectiveness of this program. Methods Hospital logbooks were reviewed for data pertaining to activity in seven district hospitals over a 6-month period. The total costs were divided by the total effectiveness, calculated as disability adjusted life years (DALYs) averted. Results The total cost-effectiveness of providing orthopaedic care through the OCO training programme was US$92.06 per DALY averted. The mean per hospital was US$138.75 (95% CI: US$69.58–207.91) per DALY averted which is very cost-effective when compared with other health interventions. Of the 837 patients treated 63% were aged <15 years and 36% were in the ‘economically active’ demographic of ages 15–74 years. Conclusion Training of clinical officers in orthopaedic surgery is very cost-effective and allows transfer of skills into rural areas. The demographics suggest that failure to provide such care would have a negative economic impact.
Cuba’s Socialist Transition
Authors: Fernández Ríos Olga 
Published: May 2014

The Sixth Congress of the Cuban Communist Party, held in April 2011, ratified a socialist strategy for implementing a new model of economic and social development that rejects the centrist structures and practices of the “real socialist” model. The achievements of the Cuban Revolution and Cubans’ critical awareness of mistakes demand transformations of the model of development to meet the needs of the country. These transformations include perfecting political institutionality, confronting bureaucratism, establishing a balance between centralization and decentralization, and revitalizing popular participation in decision making and the management of resources. El VI Congreso del Partido Comunista de Cuba, celebrado en abril de 2011, ratificó una estrategia socialista implementando un nuevo modelo de desarrollo económico y social que rechaza estructuras y prácticas del modelo estadocentrista del “socialismo real.” Los logros de la Revolución Cubana y la conciencia crítica de caminos que resultaron errados exigen transformaciones en el modelo de desarrollo, acorde con las necesidades del país. Estas transformaciones incluyen el perfeccionamiento de la institucionalidad política, el enfrentamiento al burocratismo, el equilibrio entre centralización y descentralización y una revitalización permanente de la participación popular en la toma de decisiones y la gestión de recursos.
U.S. Proposals for an Unwanted Transition in Cuba
Authors: Núñez Sarmiento Marta 
Published: May 2014

Two recent U.S. government and scholarly projects on a “transition toward democracy in Cuba”—the reports to the president of the Commissions for Assistance to a Free Cuba and the results of the Brookings Institution’s seminars on U.S. policy toward a Cuba in transition—are typical of attempts by U.S. academics and policy makers to make Cuban society conform to U.S. models of social organization and bring Cuba once again under U.S. hegemony. Failing to consult the work of Cuban social scientists who have directly assessed the gains and losses of the Cuban transition to a better society and criticized it from within, they overlook Cuba’s permanent shift from capitalism to socialism in the past 50-plus years and ignore the distinctiveness of the Cuban socialist system. Dos recientes proyectos gubernamentales y académicos estadounidenses sobre una “transición hacia la democracia en Cuba”—los informes al presidente de las Comisiones de Asistencia para una Cuba Libre y los resultados de los seminarios de la Institución Brookings sobre la política de EE.UU. hacia una Cuba en transición—son típicas de los intentos de parte de los académicos y los legisladores estadounidenses para que la sociedad cubana se ajuste a los modelos de organización social de los Estados Unidos y para nuevamente llevar a Cuba bajo la hegemonía de EE.UU. En no consultar el trabajo de los científicos sociales cubanos que han evaluado directamente las ganancias y pérdidas de la transición cubana a una sociedad mejor y criticarla desde dentro, se pasan por alto el cambio permanente en Cuba del capitalismo al socialismo en los últimos más de 50 años y ignoran lo distintivo del sistema socialista cubano.
Nonstate Enterprises in Cuba
Authors: Harnecker Camila Piñeiro 
Published: May 2014

The new types of nonstate enterprises, private and cooperative firms, that are beginning to take root in Cuba are part of the reform process that is taking place in that nation and redefining its socialist path. There are different positions in Cuba with regard to the adequacy of nonstate enterprises for the advance of Cuban socialism. Some consider them simply a necessary evil, while others consider them essential for the functioning of any economy. A third position is that nonstate enterprises and enterprises in general are most useful to the goals of socialism to the extent that they are democratically managed and responsive to social interests. The current process in Cuba is an opportunity to perfect Cuban socialism and bring it closer to its humanist and emancipatory goals. Los nuevos tipos de empresas no estatales, empresas privadas y cooperativas, que están comenzando a echar raíces en Cuba son parte del proceso de reforma que se está llevando a cabo en esa nación y que redefine su trayectoria socialista. Hay diferentes posiciones en Cuba con respecto a la adecuación de las empresas no estatales para el avance del socialismo cubano. Algunos los consideran simplemente un mal necesario, mientras que otros los consideran esenciales para el funcionamiento de cualquier economía. Una tercera posición es que las empresas no estatales y las empresas en general son más útiles para los objetivos del socialismo en la medida en que se gestionan democráticamente y que responden a los intereses sociales. El proceso actual de Cuba es una oportunidad para perfeccionar el socialismo cubano y acercarlo a sus objetivos humanista y emancipadores.
The Frontier of Change in the Cuban Economy
Authors: Rodríguez José Luis 
Published: May 2014

Beginning in 2008, the Cuban leadership recognized the need for change in its economic policy to overcome the legacy of the Special Period and the shortcomings of the economic model that prevailed until 1989. A product of widespread grassroots discussion, the guidelines for economic and social policy approved in 2011 include a greater role for market relations and nonstate property in the management of the economy. They also identify a new area of cooperative, mixed, and private property alongside of state ownership, promote decentralization of management and the participation of workers in this process, and place greater emphasis on personal consumption in the incentive system. The implementation of these changes is already having an effect on economic indicators, among them a significant reduction in imports, a decrease in gross fixed capital formation, a reduction of the budget deficit, and an increase in labor productivity. More complex and decisive changes can be expected in the years to come. A partir de 2008, la dirigencia cubana reconoció la necesidad de un cambio en su política económica para superar el legado del Período Especial y las deficiencias del modelo económico que prevaleció hasta 1989. Un producto de la discusión popular generalizada, las pautas de la política económica y social aprobada en 2011 incluyen un mayor papel de las relaciones de mercado y de la propiedad no estatal en el manejo de la economía. También identifican una nueva área de la propiedad cooperativa, mixta y privada junto a la propiedad estatal, promueven la descentralización de la gestión y la participación de los trabajadores en este proceso, y ponen mayor énfasis en el consumo personal en el sistema de incentivos. La implementación de estos cambios ya está teniendo un efecto en los indicadores económicos, entre ellos una reducción significativa de las importaciones, la disminución de la formación bruta del capital fijo, una reducción del déficit presupuestario, y un aumento en la productividad del trabajo. En los próximos años se pueden esperar cambios más complejos y decisivos.
Advance Care Planning in palliative care: A systematic literature review of the contextual factors influencing its uptake 2008–2012
Authors: Lovell Allison , Yates Patsy 
Published: May 2014

Background: Advance Care Planning is an iterative process of discussion, decision-making and documentation about end-of-life care. Advance Care Planning is highly relevant in palliative care due to intersecting clinical needs. To enhance the implementation of Advance Care Planning, the contextual factors influencing its uptake need to be better understood. Aim: To identify the contextual factors influencing the uptake of Advance Care Planning in palliative care as published between January 2008 and December 2012. Methods: Databases were systematically searched for studies about Advance Care Planning in palliative care published between January 2008 and December 2012. This yielded 27 eligible studies, which were appraised using National Institute of Health and Care Excellence Quality Appraisal Checklists. Iterative thematic synthesis was used to group results. Results: Factors associated with greater uptake included older age, a college degree, a diagnosis of cancer, greater functional impairment, being white, greater understanding of poor prognosis and receiving or working in specialist palliative care. Barriers included having non-malignant diagnoses, having dependent children, being African American, and uncertainty about Advance Care Planning and its legal status. Individuals’ previous illness experiences, preferences and attitudes also influenced their participation. Conclusion: Factors influencing the uptake of Advance Care Planning in palliative care are complex and multifaceted reflecting the diverse and often competing needs of patients, health professionals, legislature and health systems. Large population-based studies of palliative care patients are required to develop the sound theoretical and empirical foundation needed to improve uptake of Advance Care Planning in this setting.
The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: A systematic review of views from patients, carers and health-care professionals
Authors: Oishi Ai , Murtagh Fliss EM 
Published: May 2014

Background: Primary care has the potential to play significant roles in providing effective palliative care for non-cancer patients. Aim: To identify, critically appraise and synthesise the existing evidence on views on the provision of palliative care for non-cancer patients by primary care providers and reveal any gaps in the evidence. Design: Standard systematic review and narrative synthesis. Data sources: MEDLINE, Embase, CINAHL, PsycINFO, Applied Social Science Abstract and the Cochrane library were searched in 2012. Reference searching, hand searching, expert consultations and grey literature searches complemented these. Papers with the views of patients/carers or professionals on primary palliative care provision to non-cancer patients in the community were included. The amended Hawker’s criteria were used for quality assessment of included studies. Results: A total of 30 studies were included and represent the views of 719 patients, 605 carers and over 400 professionals. In all, 27 studies are from the United Kingdom. Patients and carers expect primary care physicians to provide compassionate care, have appropriate knowledge and play central roles in providing care. The roles of professionals are unclear to patients, carers and professionals themselves. Uncertainty of illness trajectory and lack of collaboration between health-care professionals were identified as barriers to effective care. Conclusions: Effective interprofessional work to deal with uncertainty and maintain coordinated care is needed for better palliative care provision to non-cancer patients in the community. Research into and development of a best model for effective interdisciplinary work are needed.
Potential cost savings associated with dose rounding antineoplastic monoclonal agents
Authors: Francis Sarah M , Heyliger Alexander , Miyares Marta A , Viera Marcos 
Published: May 2014

Purpose This study explored the potential financial benefits associated with dose rounding three costly cancer agents: bevacizumab, trastuzumab, and cetuximab. Methods Electronic chemotherapy health record software was queried to identify inpatient and outpatient use of bevacizumab, trastuzumab, and cetuximab. Available drug vial sizes were noted. Costs of actual doses prescribed were compared to theoretically reduced doses (5% and 10%) adjusted to the nearest vial size. Only doses resulting in a decrease in the number of vials qualified for dose rounding. New doses were analyzed for potential cost savings considering the percent-change from the original dose. All institutional review board procedures were followed. Results In all, 425 doses of bevacizumab, trastuzumab, and cetuximab were identified. At a 5% dose reduction, 51 doses (12%) qualified for dose rounding, translating to a potential cost savings of $60,648 ($6,188, $52,640, and $1,820, respectively). Although a 5% limit was set, the average change in dose did not exceed 2.5%. At a 10% dose reduction, 124 doses (29%) qualified for dose rounding, translating to a potential cost savings of $112,585 ($26,520, $80,605, and $5,460, respectively). With the 10% dose reduction, the average change in dose did not surpass 6.1%. Projected annual savings were calculated as $181,944 or $337,755, depending on the rounding limit. Conclusion Consultation with key physicians regarding the proposed percent reduction resulted in a 10% dose reduction for all cases when utilizing these three agents. Implementation of a dose rounding protocol for bevacizumab, trastuzumab, and cetuximab represents a potentially substantial cost savings at this institution.
Surgery-related complications of ventral hernia reported to the Finnish Patient Insurance Centre
Authors: Ahonen-Siirtola M. , Vironen J. , Mäkelä J. , Paajanen H. 
Published: May 2014

Aim: Our aim was to evaluate the incidence and type of severe complications in adult primary and incisional ventral hernia surgery reported to the National Patient Insurance Centre in Finland during 2003–2010. Material and Methods: The Finnish National Patient Insurance Centre covers the whole country and handles financial compensation for patients’ injuries without proof of malpractice. All the claims concerning ventral hernioplasties in the Centre between the years 2003 and 2010 were retrospectively analyzed. The annual numbers of primary and incisional ventral hernioplasties in Finland were obtained from the National Hospital Discharge Register. Results: During the study years, 25,738 ventral hernia operations were performed and 127 claims from the whole country were reported to the Patient Insurance Centre. Overall rate of claims was 4.9/1000 hernia procedures. For primary hernias, 16,243 ventral hernioplasties (817 laparoscopic, 15,426 open) were performed and 41 complications were reported. The most common complication was infection (n = 28, 68%) followed by pain and hernia recurrence (n = 6, 15% in both), large hematoma (7%), bowel lesion (5%), urological injuries (2%), or severe bleeding (2%). In incisional hernioplasties, the rate of claims was 9.1/1000 operations (9495 operations, 86 claims). The most common complication reported was infection (n = 42, 49%) followed by hernia recurrence in 25 cases (29%) and bowel lesion in 24 cases (28%). Major complications (n = 15, 17%) consisted mainly of bowel lesions in laparoscopic operations. There was significantly more claims after laparoscopic than open hernioplasties (p = 0.001). Conclusions: The claims for financial compensation for injuries related to primary and incisional hernioplasties are quite uncommon. Major complications, though comparatively rare, are significantly more common after laparoscopic operations.
The contributors of emotional distress in painful diabetic neuropathy
Authors: Selvarajah Dinesh , Cash Thomas , Sankar Adhithya , Thomas Lloyd , Davies Jennifer , Cachia Elaine , Gandhi Rajiv , Wilkinson Iain D , Wilkinson Nicholas , Emery Celia J , Tesfaye Solomon 
Published: May 2014

Aims: To examine the contribution of demographic, social, clinical and psychological factors to emotional distress in patients with painful diabetic neuropathy (DN). Methods: In total, 142 patients with confirmed painful DN underwent detailed clinical and self-assessment measures (Neuropathic Pain Scale, Hospital Anxiety and Depression Scale, Pain Acceptance Questionnaire and Pain Catastrophizing Scale). Results: The prevalence of emotional distress was 51.4% in this cohort. Age, sex, marital status, employment history, pain intensity, duration of diabetes and the presence of diabetic and non-diabetic complications were significantly correlated to anxiety and depressive symptom scores. Multiple regression analysis confirmed that the presence of catastrophic thinking was an independent contributor to greater symptoms of anxiety and depression. Being young, single and unemployed significantly contributed to greater anxiety symptoms. Pain-related restriction of quality of life was associated with greater depression symptom scores. Conclusions: This study found a high prevalence of emotional distress in patients with painful DN. It highlights that the differing independent contributors to anxiety and depressive symptoms are based on an individual’s circumstances and experience. We conclude by highlighting the importance of adopting a holistic approach to pain management, incorporating interventions to increase psychological flexibility alongside conventional pharmacological treatments to improve emotional distress in painful DN.
A rare case of large isolated internal iliac artery aneurysm with ureteral obstruction and hydronephrosis: Compression symptoms are limitation for endovascular procedures
Authors: Nenezic Dragoslav , Tanaskovic Slobodan , Gajin Predrag , Ilijevski Nenad , Novakovic Aleksandra , Radak Djordje 
Published: May 2014

Introduction In this report, we aim to present a rare case of isolated internal iliac artery aneurysm with associated left ureteric obstruction and consequent hydronephrosis. Case report A 66-year-old male patient was admitted for occasional pain in the lower back that appeared one month earlier. CT arteriography revealed isolated internal iliac artery (diameter 99 mm) with ureteral obstruction, hydroureter and left kidney hydronephrosis occurrence. Aneurysm was resected, after six months the patient was doing well. Bearing in mind that 77% of the patients with isolated internal iliac artery have symptoms caused by aneurysmal compression on adjacent organs, we wanted to highlight that despite the amazing expansion of endovascular procedures in the last decades, its therapeutic effect in isolated internal iliac artery’s treatment is to a great extent limited since compression symptoms cannot be solved. Conclusion Open surgery remains the gold standard for isolated internal iliac artery’s treatment considering significant limitations of endovascular procedures due to the inability to eliminate problems caused by compression.