Home About us Contact
|
Home About us Contact | ||
|
|
||
Extensive Discussion (extensive + discussion)
Selected AbstractsType 2 diabetes mellitus and obesity in sub-Saharan AfricaDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 6 2010Vivian C. Tuei Abstract While communicable diseases such as human immunodeficiency virus/acquired immune deficiency syndrome, malaria, and tuberculosis have continued to pose greater threats to the public health system in sub-Saharan Africa (SSA), it is now apparent that non-communicable diseases such as diabetes mellitus are undoubtedly adding to the multiple burdens the peoples in this region suffer. Type 2 diabetes mellitus (T2DM) is the most common form of diabetes (90,95%), exhibiting an alarming prevalence among peoples of this region. Its main risk factors include obesity, rapid urbanization, physical inactivity, ageing, nutrition transitions, and socioeconomic changes. Patients in sub-Saharan Africa also show manifestations of ,-cell dysfunction and insulin resistance. However, because of strained economic resources and a poor health care system, most of the patients are diagnosed only after they have overt symptoms and complications. Microvascular complications are the most prevalent, but metabolic disorders and acute infections cause significant mortality. The high cost of treatment of T2DM and its comorbidities, the increasing prevalence of its risk factors, and the gaps in health care system necessitate that solutions be planned and implemented urgently. Aggressive actions and positive responses from well-informed governments appear to be needed for the conducive interplay of all forces required to curb the threat of T2DM in sub-Saharan Africa. Despite the varied ethnic and transitional factors and the limited population data on T2DM in sub-Saharan Africa, this review provides an extensive discussion of the literature on the epidemiology, risk factors, pathogenesis, complications, treatment, and care challenges of T2DM in this region. Copyright © 2010 John Wiley & Sons, Ltd. [source] Financial Intermediaries and Interest Rate Risk: IIFINANCIAL MARKETS, INSTITUTIONS & INSTRUMENTS, Issue 5 2006Sotiris K. Staikouras The current work extends and updates the previous survey (Staikouras, 2003) by looking at other aspects of the financial institutions' yield sensitivity. The study starts with an extensive discussion of the origins of asset-liability management and the subsequent work to identify effective ways of measuring and managing interest rate risk. The discussion implicates both regulatory and market-based approaches along with any issues surrounding their applicability. The literature is enriched by recognizing that structural and regulatory shifts affect financial institutions in different ways depending on the size and nature of their activities. It is also noted that such shifts could change the bank's riskiness, and force banks to adjust their balance sheet size by altering their maturity intermediation function. Besides yield changes, market cycles are also held responsible for asymmetric effects on corporate values. Furthermore, nonstandard investigations are considered, where embedded options and basis risk are significant above and beyond the intermediary's rate sensitivity, while shocks to the slope of the yield curve is identified as a new variable. When the discount privilege is modeled as an option, it is shown that its value is incorporated in the equities of qualifying banks. Finally, volatility clustering is further established while constant relative risk aversion is not present in the U.S. market. Although some empirical findings may be quite mixed, there is a general consensus that all forms of systematic risk, risk premia, and the risk-return trade-off do exhibit some form of variability, not only over time but also across corporate sizes and segments. [source] A Need for a Taxonomy for Profound Intellectual and Multiple DisabilitiesJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 2 2007H. Nakken Abstract, There is extensive discussion on the quality of education and support for individuals with profound intellectual and multiple disabilities (PIMD) in relation to inclusion and full citizenship. The discussions are complicated because of differences or lack of clarity in the description of the variations and types of PIMD. A description of the core group is offered, but it is also argued that there cannot be an absolute separation of this specific target group from other adjoining groups. The authors propose a multi-axial model-based taxonomy that distinguishes visual and/or auditory impairments, other physical impairments, and mental health problems, in addition to the two key defining characteristics (limited intellect and compromised physical functions). The authors also propose that assessment of people with PIMD be structured toward ascertainment of diagnostic objectives (e.g., confirming or disconfirming the person's level of intellectual disability) and the determination of a starting point and direction for support of the individual. They conclude that, to prevent misunderstanding in comparison of results of educational programs and interventions, it is recommended that workers describe individuals (or subgroups) with PIMD in publications in detail,using operational definitions. In addition, they propose that an international effort be undertaken to develop and use generally agreed assessment procedures. [source] Erythropoiesis stimulating agents are associated with reduced survival in patients with multiple myeloma,AMERICAN JOURNAL OF HEMATOLOGY, Issue 9 2008Eirini Katodritou The impact of erythropoiesis-stimulating agent (ESA) on cancer patients' survival has recently become a matter of extensive discussion. Studies in solid tumors demonstrated that ESA adversely affects survival. This issue has not been sufficiently studied in patients with multiple myeloma. In this study, which included 323 multiple myeloma patients followed in our Institution between 1988 and 2007, we demonstrated by using a proportional hazards model including multiple covariates (age, LDH, Hb, platelets, serum creatinine, ISS score, ,2 microglobulin, and ESA administration) that ESA administration is associated with reduced survival (hazards ratio: 1.88, 95% CI: 1.28,2.77). Anemia, which is considered a predictor for survival, platelets, serum creatinine, ISS score, and LDH, were not significant, whereas, age and ,2 microglobulin confirmed their predicting value in the multivariate analysis. With a median follow-up of 31 months (range 1,238), the median survival of patients in the ESA group was 31 months (95% CI: 25,37), whereas in the group without ESA administration it was 67 months (95% CI: 55,79) (P < 0.001). The median progression-free survival for patients in the ESA group was 14 months (95% CI: 12,16), and for the group without ESA it was 30 months (95% CI: 24,36) (P < 0.001). These results indicate that ESA may have a detrimental impact on MM patients' outcomes and, thus, in this context, they should be used with rigorous criteria. © 2008 Wiley-Liss, Inc. Am. J. Hematol., 2008. [source] The European Commission on Factors Influencing Labor MigrationPOPULATION AND DEVELOPMENT REVIEW, Issue 2 2001Article first published online: 27 JAN 200 A controversial issue in discussions on enlargement of the European Union beyond its existing membership of 15 countries is the migration flows that admission of new members could generate. Given major differences in income and wage levels between the EU states and the candidates for membership, casual theorizing suggests that the potential for massive international migration is very high. The fact that such migration has thus far been of modest size by most plausible criteria is attributed to the restrictive policies of the potential destination countries, policies that reflect national interests, in particular protection of labor markets, as perceived by voting majorities. With accession to membership in the EU this factor is removed: a cardinal principle of the Union, established by treaty, is the free movement of persons, including persons seeking gainful employment. The factors governing migratory movements between member states then come to resemble those that shape internal migration. This should facilitate analysis and forecasting. A clear sorting-out of the relevant forces affecting such "internal" migration remains of course an essential precondition for success in that task. An "Information note," entitled The Free Movement of Workers in the Context of Enlargement, issued by the European Commission, the EU's Executive Body, on 6 March 2001, presents extensive discussion of relevant information, opinion, and policy options concerning its topic. (The document is available at «http://europa.eu.int/comm/enlarge-ment/docs/pdf/migration_enl.pdf».) An Annex to the document. Factors Influencing Labour Movement, is a lucid enumeration of the factors migration theory considers operative in determining the migration of workers and, by extension, of people at large, that is likely to ensue upon EU enlargement. This annex is reproduced below. As is evident from the catalog of factors and their likely complex interactions, making quantitative forecasts of future migration flows, envisaged primarily as originating from countries to be newly admitted to the EU and destined for the countries of the current EU15, is exceedingly difficult. This is reflected in disparities among the existing studies that have made such forecasts. Yet there appears to be a fair degree of agreement that major increases in migration are unlikely, suggesting that the overall effect on the EU15 labor market should be limited. Typical forecasts (detailed in the Information note cited above) anticipate that in the initial year after admission, taken to be 2003, total migration from the eight prime candidate countries (the Czech Republic, Hungary, Poland, Slovakia, Slovenia, Estonia, Latvia, and Lithuania: the "CC8") might amount to around 200,000 persons, roughly one-third of which would be labor migration. According to these forecasts, the annual flow will gradually diminish in subsequent years. After 10 to 15 years the stock of CC8 migrants in the EU15 might be on the order of 1.8 to 2.7 million. The longer-run migration potential from the candidate countries would be on the order of 1 percent of the present EU population, currently some 375 million. (The combined current population of the CC8 is 74 million.) Such predictions are in line with the relatively minor migratory movements that followed earlier admissions to the EU of countries with then markedly lower per capita incomes, such as Spain and Portugal. The geographic impact of migration ensuing from enlargement would, however, be highly uneven, with Germany and Austria absorbing a disproportionately large share. Accordingly, and reflecting a prevailing expectation in these two countries that enlargement would have some short-run disruptive effects on labor markets, some of the policy options discussed envisage a period of transition following enlargement,perhaps five to seven years,during which migration would remain subject to agreed-upon restrictions. [source] A Large-sample Confidence Band for a Multi-response Ridge PathQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 7 2005Rui Ding Abstract Ridge analysis in response surface methodology has received extensive discussion in the literature, while little is known for ridge analysis in the multi-response case. In this paper, the ridge path is investigated for multi-response surfaces and a large-sample simultaneous confidence interval (confidence band) for the ridge path is developed. Copyright © 2005 John Wiley & Sons, Ltd. [source] Evidence-based medicine: the time has come to set standards for staging,THE JOURNAL OF PATHOLOGY, Issue 4 2010Phil Quirke Abstract For international communication in cancer, staging systems such as TNM are essential; however, the principles and processes used to decide about changes in every new edition of TNM need to be subject to debate. Changes with major impact for patient treatment are introduced without evidence. We think that TNM should be a continual reactive process, rather than a proactive process. Changes should only occur after extensive discussion within the community, and before the introduction of any changes these should be tested for reproducibility and compared to the currently used gold standard. TNM should not be used to test hypotheses. It should introduce established facts that are beneficial to predicting patient prognosis. TNM should thus be restructured on a basis equivalent to evidence-based guidelines. The strength of the evidence should be explicitly stated and the evidence base given. It is time for the principles of staging to be widely debated and new principles and processes to be introduced to ensure that we are not in the same situation in the future. The disparity between therapeutic decision making and TNM staging is marked and we would appeal for the radical overhaul of TNM staging to make it fit for the twenty-first century. TNM is central to the management of cancer patients and we must protect and enhance its reputation. Copyright © 2010 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source] Service user participation in diverse child protection contexts: principles for practiceCHILD & FAMILY SOCIAL WORK, Issue 4 2009Karen Healy ABSTRACT Promoting the participation of children and parents in child protection practice is one of the most complex and sensitive areas of social work practice. Increasingly, child protection legislation and policy in many parts of the world enshrines ideals of service user participation. Yet, with the exception of extensive discussion about family group conferencing, the principles and methods for achieving participatory practices in child protection work remain underdeveloped. We use the term ,child protection' to refer to a broad spectrum of child and family welfare services aimed at prevention of (or intervention to address) child abuse and neglect. This spectrum of services includes intensive family support, family support, domestic violence, statutory child protection and child and family advocacy services. In this paper, we present findings from the first phase of a 3-year study into participatory practice in child protection. In this paper, we present findings from a qualitative analysis of interviews with 28 child protection practitioners across five domains of child protection work. Our analysis reveals three core principles of participatory practice underpinning these practitioners' accounts as well as contextual differences among them. We conclude with a discussion of the educational implications of our findings. [source] The learning credit card: A tool for managing personal development,BRITISH JOURNAL OF EDUCATIONAL TECHNOLOGY, Issue 2 2008Nick Rushby This is the report of a five month study, undertaken by Sundridge Park Training Technologies in association with Guildford Educational Services to assess the potential of smart card technology to support learning and the management of learning. The study had two strands,the state of the art of the technology and its potential for supporting, delivering and managing learning. In addition to a study of the literature and extensive discussions with people using smart cards, potential users of smart card and visionaries, the project team developed two illustrative systems using cards to store personal data relating to education and training. The term ,smart card' is often used loosely to describe three different types of card, each of which is similar in general shape and size to a traditional credit card. These are: memory cards, laser cards,and true smart cards incorporating a processor and memory. This study has been concerned with memory cards and smart cards. The focus for smart card applications has been predominantly financial: there are relatively few applications in education or training. A notable exception is the large scale project at the University of Bologna which uses smart cards to manage the progress and achievements of a large number of students in the Department of Electronics. The two illustrative systems provided valuable experience of using memory cards and smart cards in quasi-real education and training applications. They highlighted the problems of limited memory capacities and confirmed the high level of user acceptance reported by other trials. We can expect considerable advances in the technology of both memory cards and smart cards over the next months and years. The memory capacities of both types of cards will increase many-fold and the unit costs will fall as large quantities of cards are produced for financial applications. Education and training applications will benefit from this expanding market. The major surprise from the study was the level of interest in the work and the enthusiasm expressed by almost all of those who came to hear of it. The general level of awareness of smart card technology was found to be low. However, the requirement for a system which will enable individuals to manage and own their learning on an extended timescale was generally recognised. Some of the possible applications for smart cards and memory cards in education and training had emerged before the official start of the study and it is clear that the technology is potentially pervasive. The project team and those consulted identified a wide range of possible applications both in education and in training. These focussed on assessment, personal course planning and management, identification of relevant learning opportunities, and the ownership of learning. It was felt that, over the next few years, smart cards are very likely to be in common use as credit cards for financial applications. Therefore, their use for education and training should be planned now. The recommendations from the study are that: More detailed studies are needed to find out how smart cards and memory cards could be used by different organisations in a fully operational system; Standards should be established for smart card applications in education and training, similar to those governing financial applications; Applications should be developed after the standards have been established. To be convincing, these should take a case study approach with small pilot studies in a variety of contexts and must follow real needs rather than attempt to drive them; The case studies would then form the basis for a campaign to increase awareness of smart cards and their potential for education and training, together with a programme for building an infrastructure to support the proposed systems. The public sector should fund the task of developing standards and providing interfaces with existing educational systems and projects to demonstrate the feasibility of various applications. Since educational standards have a European dimension, the European Community may be a source of support for work in the area of standards. At the same time, private sector funding should be sought for skill development and career development systems in industry and in education. The Training Agency itself should consider the application of smart card technology to the control and management of the Youth Training Scheme (YTS). [source] | |||||||||||||