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Little Guidance (little + guidance)
Selected AbstractsTopical Tacrolimus in the Treatment of Bovine Collagen HypersensitivityDERMATOLOGIC SURGERY, Issue 9 2001Brent R. Moody MD Background. Soft tissue augmentation with bovine collagen is a common and safe aesthetic procedure. Despite adequate pretreatment testing, allergic reactions can develop. The medical literature provides little guidance to the clinician in the management of bovine collagen hypersensitivity. Objective. We describe a case of bovine collagen allergy treated with 0.1% topical tacrolimus and corticosteroids. Methods. Clinical evaluation and management of a patient with bovine collagen hypersensitivity. Results. Our patient responded to combined therapy with oral corticosteroids and topical tacrolimus. Conclusion. Topical tacrolimus may be a useful first-line or adjuvant therapy in the management of bovine collagen allergic reactions. Further clinical experience with its use for bovine collagen hypersensitivity is required to determine its true efficacy in this condition. [source] Responding to formal complaints about the emergency department: Lessons from the service marketing literatureEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2004Gavan Doig Abstract The ability to respond to formal complaints is a necessary part of emergency medicine practice. In spite of the significance of formal complaints there is little guidance within the medical literature to understand why patients complain or how to provide satisfaction to individuals who complain. Practitioners are usually left to their own devices in the style and substance of complaint responses even when working within a defined complaint management system. This article draws on relatively abundant literature in the service marketing field to provide an understanding of dissatisfaction, complaining and complaint handling. Having developed an appropriate theoretical framework the article provides guidance for applying these concepts in dealing with formal complaints. [source] Jumping off Arnstein's ladder: social learning as a new policy paradigm for climate change adaptationENVIRONMENTAL POLICY AND GOVERNANCE, Issue 6 2009Kevin Collins Abstract Participation of citizens, groups, organizations and businesses is now an essential element to tackle climate change effectively at international, European Union, national and local levels. However, beyond the general imperative to participate, major policy bodies offer little guidance on what this entails. We suggest that the dominance of Arnstein's ladder of citizen participation in policy discourses constrains the ways we think about, and critically the purposes we ascribe to, participation in a climate change context. We suggest an alternative framing of climate change, where no single group has clear access to understanding the issue and its resolution. Thus adaptation is fundamentally dependent on new forms of learning. Drawing on experiences of social learning approaches to natural resource managing, we explore how a commitment to social learning more accurately embodies the new kinds of role, relationship, practice and sense of purpose required to progress adaptive climate change agendas and practices. Copyright © 2009 John Wiley & Sons, Ltd and ERP Environment. [source] Work and Employment in Small Businesses: Perpetuating and Challenging Gender TraditionsGENDER, WORK & ORGANISATION, Issue 1 2000Susan Baines More and more women and men are becoming dependent on some form of small business activity for all or part of their livelihoods but there is little research offering insight into gender and working practices in small businesses. In this article we assess some theoretical approaches and discuss these against an empirical investigation of micro-firms run by women, men and mixed sex partnerships. In the ,entrepreneurship' literature, with its emphasis on the individual business owner, we find little guidance. We argue that in the ,modern' micro-business, family and work are brought into proximity as in the ,in between' organizational form described by Weber. The celebrated ,flexibility' of small firms often involves the reproduction within modernity of seemingly pre-modern practices in household organization and gender divisions of labour. This is true in the Britain of the 1990s in a growing business sector normally associated neither with tradition nor with the family. Tradition, however, is never automatic or uncontested in a ,post-traditional society'. A minority of women and men in micro-enterprises actively resist traditional solutions and even traditional imagery of male and female behaviour. For this small group alone new economic conditions seem to bring new freedom. [source] Good Enough Governance: Poverty Reduction and Reform in Developing CountriesGOVERNANCE, Issue 4 2004Merilee S. Grindle The good governance agenda is unrealistically long and growing longer over time. Among the multitude of governance reforms that "must be done" to encourage development and reduce poverty, there is little guidance about what's essential and what's not, what should come first and what should follow, what can be achieved in the short term and what can only be achieved over the longer term, what is feasible and what is not. If more attention is given to sorting out these questions, "good enough governance" may become a more realistic goal for many countries faced with the goal of reducing poverty. Working toward good enough governance means accepting a more nuanced understanding of the evolution of institutions and government capabilities; being explicit about trade-offs and priorities in a world in which all good things cannot be pursued at once; learning about what's working rather than focusing solely on governance gaps; taking the role of government in poverty alleviation seriously; and grounding action in the contextual realities of each country. [source] The impact of using different costing methods on the results of an economic evaluation of cardiac care: microcosting vs gross-costing approachesHEALTH ECONOMICS, Issue 4 2009Fiona M. Clement (Nee Shrive) Abstract Background: Published guidelines on the conduct of economic evaluations provide little guidance regarding the use and potential bias of the different costing methods. Objectives: Using microcosting and two gross-costing methods, we (1) compared the cost estimates within and across subjects, and (2) determined the impact on the results of an economic evaluation. Methods: Microcosting estimates were obtained from the local health region and gross-costing estimates were obtained from two government bodies (one provincial and one national). Total inpatient costs were described for each method. Using an economic evaluation of sirolimus-eluting stents, we compared the incremental cost,utility ratios that resulted from applying each method. Results: Microcosting, Case-Mix-Grouper (CMG) gross-costing, and Refined-Diagnosis-Related grouper (rDRG) gross-costing resulted in 4-year mean cost estimates of $16,684, $16,232, and $10,474, respectively. Using Monte Carlo simulation, the cost per QALY gained was $41,764 (95% CI: $41,182,$42,346), $42,538 (95% CI: $42,167,$42,907), and $36,566 (95% CI: $36,172,$36,960) for microcosting, rDRG-derived and CMG-derived estimates, respectively (P<0.001). Conclusions: Within subject, the three costing methods produced markedly different cost estimates. The difference in cost,utility values produced by each method is modest but of a magnitude that could influence a decision to fund a new intervention. Copyright © 2008 John Wiley & Sons, Ltd. [source] Multiple hypothesis evaluation in auditingACCOUNTING & FINANCE, Issue 3 2002Rajendra P. Srivastava In many audit tasks, auditors evaluate multiple hypotheses to diagnose the situation. Research suggests this is a complex task that individuals have difficulty performing. Further, there is little guidance in professional standards or literature dealing with the many complexities present in the audit environment. Using probability theory, this study derives the appropriate revision of likelihoods for multiple hypotheses given different realistic audit conditions. The analysis shows that the relationships among the hypotheses dramatically impact the use of audit evidence and the resulting pattern of probability revisions. We also identify testable hypotheses to guide future research and discuss practice implications regarding ways to improve the effectiveness of analytical procedures. [source] Review: evaluating information systems in nursingJOURNAL OF CLINICAL NURSING, Issue 5 2008Cristina Oroviogoicoechea MSc Aims., To review existing nursing research on inpatient hospitals' information technology (IT) systems in order to explore new approaches for evaluation research on nursing informatics to guide further design and implementation of effective IT systems. Background., There has been an increase in the use of IT and information systems in nursing in recent years. However, there has been little evaluation of these systems and little guidance on how they might be evaluated. Methods., A literature review was conducted between 1995 and 2005 inclusive using CINAHL and Medline and the search terms ,nursing information systems', ,clinical information systems', ,hospital information systems', ,documentation', ,nursing records', ,charting'. Results., Research in nursing information systems was analysed and some deficiencies and contradictory results were identified which impede a comprehensive understanding of effective implementation. There is a need for IT systems to be understood from a wider perspective that includes aspects related to the context where they are implemented. Conclusions., Social and organizational aspects need to be considered in evaluation studies and realistic evaluation can provide a framework for the evaluation of information systems in nursing. Relevance to clinical practice., The rapid introduction of IT systems for clinical practice urges evaluation of already implemented systems examining how and in what circumstances they work to guide effective further development and implementation of IT systems to enhance clinical practice. Evaluation involves more factors than just involving technologies such as changing attitudes, cultures and healthcare practices. Realistic evaluation could provide configurations of context-mechanism-outcomes that explain the underlying relationships to understand why and how a programme or intervention works. [source] Economic Shocks and Democratic Vulnerabilities in Latin America and the CaribbeanLATIN AMERICAN POLITICS AND SOCIETY, Issue 2 2010Abby Córdova ABSTRACT Historical evidence suggests that bad economic times often mean bad times for democracy, but prior research has given us little guidance on how this process may work. What economic conditions are most threatening, and how might they weaken consolidating democracies? This article uses the AmericasBarometer conducted by the Latin American Public Opinion Project (LAPOP) to answer these questions by focusing on core attitudes for the consolidation of democracy. We use survey data at the level of the individual and economic data at the country level to help detect democratic vulnerabilities in Latin America and the Caribbean. The study finds that conditions of low levels of economic development, low economic growth, and high levels of income inequality increase those vulnerabilities substantially, but the effects are not uniform across individuals. Some groups, especially the young and the poor, are particularly vulnerable to some antidemocratic appeals. [source] Confining and defining proprietary estoppel: the role of unconscionabilityLEGAL STUDIES, Issue 3 2010Martin Dixon The use of proprietary estoppel to make or support claims to property is now common. Case-law tells us that the concept of unconscionability is central to a successful claim, but little guidance is provided as to what ,unconscionability' means or how it is to be established. It is often assumed rather than explained. This paper argues that unconscionability in fact has a reasonably clear meaning within the law of proprietary estoppel and that it can be used to define and confine proprietary estoppel within reasonably clear boundaries. It seeks to explain that proprietary estoppel is at heart an antidote to a lack of required formality in the creation or transfer of property rights and, consequently, that the proper meaning of unconscionability is linked to these formality requirements. Unconscionability is therefore not a cover for unregulated judicial discretion, nor a loose term to describe a general sense of unfairness, but a concept which can be used to discriminate objectively between valid and invalid estoppel claims. [source] Deep brain stimulation hardware complications: The role of electrode impedance and current measurementsMOVEMENT DISORDERS, Issue 5 2008MPAS, Sierra Farris PAC Abstract Deep brain stimulation (DBS) is an effective therapy for advanced Parkinson's disease patients. Successful DBS outcomes depend on appropriate patient selection, surgical placement of the lead, intact hardware systems, optimal programming, and medical management. Despite its importance, there is little guidance in reference to hardware monitoring, hardware troubleshooting, and patient management. Technical manuals produced by the hardware manufacturer (Medtronic, Minneapolis, MN) are not presented in an applied clinical format, making impedance and current measurements difficult to interpret when the results are not straightforward. We present four patients with evolving DBS hardware complications that occurred during long-term follow-up, that shaped our clinical protocol for long-term care management and hardware troubleshooting. © 2007 Movement Disorder Society [source] Skin Cancer as a Contraindication to Organ TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2005Clark C. Otley Skin cancer is the most common malignancy worldwide. When patients with a history of skin cancer present for organ transplantation, the vast majority are appropriate candidates. However, there is little guidance in the literature regarding the advisability of transplantation in patients with a history of high-risk skin cancer. With limited allograft resources, it is important to allocate organs to patients who will derive the most benefit. Adverse outcomes that may be associated with prior skin cancer include recurrence, metastasis, or death from relapse or decreased quality of life from numerous new primary skin cancers. This review provides prognostic guidance to transplant physicians evaluating transplantation candidates who have a history of skin cancer. [source] Women, Federalism and Women Friendly PoliciesAUSTRALIAN JOURNAL OF PUBLIC ADMINISTRATION, Issue 1 2006Gwen Gray Australian women activists have never been enthusiastic about federalism because of its reputation as a system that restricts the scope of government and obstructs the path of progressive social change. Like their sisters in other countries, women's groups have sought collectivist solutions to economic and social problems. In the last couple of decades, however, orthodox ideas about the restrictive impact of federalism have been questioned. A revisionist view has emerged, which holds that the system sometimes facilitates the adoption of innovative policies and may lead to an expansion of the role of government. The revisionist perspective raises the question of whether women's groups have been wise to oppose federalism. This article examines relevant Canadian and Australian studies in order to test the validity of orthodox and revisionist perspectives and to draw conclusions about appropriate feminist approaches to federalism. The evidence is mixed. The main argument of this article is that, to the extent that we can distinguish its independent effect, federalism sometimes obstructs policy development and sometimes facilitates it. There are serious methodological problems involved in trying to isolate the impact of the federal variable from the many factors that influence policy, making generalisations precarious. Experience, therefore, offers little guidance to women's groups seeking to decide whether to support centralised or decentralised decision-making structures. However, this study concludes that in the context of present Australian federal arrangements, women are more likely to achieve their aims when the Commonwealth government takes action, either alone or in cooperation with sub-national jurisdictions. [source] A model predicting delivery of saquinavir in nanoparticles to human monocyte/macrophage (Mo/Mac) cellsBIOTECHNOLOGY & BIOENGINEERING, Issue 5 2008D. Ece Gamsiz Abstract Modeling the influence of a technology such as nanoparticle systems on drug delivery is beneficial in rational formulation design. While there are many studies showing drug delivery enhancement by nanoparticles, the literature provides little guidance regarding when nanoparticles are useful for delivery of a given drug. A model was developed predicting intracellular drug concentration in cultured cells dosed with nanoparticles. The model considered drug release from nanoparticles as well as drug and nanoparticle uptake by the cells as the key system processes. Mathematical expressions for these key processes were determined using experiments in which each process occurred in isolation. In these experiments, intracellular delivery of saquinavir, a low solubility drug dosed as a formulation of poly(ethylene oxide)-modified poly(epsilon- caprolactone) (PEO,PCL) nanoparticles, was studied in THP-1 human monocyte/macrophage (Mo/Mac) cells. The model accurately predicted the enhancement in intracellular concentration when drug was administered in nanoparticles compared to aqueous solution. This simple model highlights the importance of relative kinetics of nanoparticle uptake and drug release in determining overall enhancement of intracellular drug concentration when dosing with nanoparticles. Biotechnol. Bioeng. © 2008 Wiley Periodicals, Inc. [source] The Economics of Controlling Infectious Diseases on Dairy FarmsCANADIAN JOURNAL OF AGRICULTURAL ECONOMICS, Issue 3 2002Junwook Chi Cost-effective disease control on the dairy farm can enhance productivity and subsequently profitability. Previous economic studies on animal disease have focused on production losses and evaluation of disease eradication programs and have provided little guidance on the optimal prevention action. This paper presents a theoretical model on the economics of livestock disease and develops an empirical model to determine the optimal set of control strategies for four production-limiting cattle diseases: bovine viral diarrhea (BVD), enzootic bovine leukosis (EBL), Johne's Disease (JD) and neosporosis. Control functions indicating the prevalence of infection with each of the four diseases for each of the 10 strategies are estimated. The optimal strategies that minimize total disease cost (direct production losses and control expenditures) are provided for each disease on the basis of farm survey results from the maritime provinces. The results emphasize the importance of introduction checks before new animals enter the herd and adequate vaccination protection as cost-effective control strategies. Lutter contre la maladie d'une manière rentable dans les élevages de bovins laitiers peut déboucher sur un meilleur rendement et des profits plus élevés. Les études économiques antérieures s'intéressant à cet aspect portaient essentiellement sur les pertes de production et l'évaluation des programmes d'éradication. Elles donnaient peu d'indications sur la solution idéale au niveau de la prévention. Cet article présente un modèle théorique de l'économique des maladies du bétail et aboutit à un modèle empirique permettant d'établir le jeu optimal de moyens pour lutter contre quatre maladies réduisant la production animale : la diarrhée à virus des bovins (DVB), la leucose bovine enzootique (LBE), la paratuberculose et la néosporose. Les auteurs estiment les fonctions qui indiquent la prévalence d'une infection pour chacune des quatre maladies retenues, dans le cadre des dix stratégies examinées. Ensuite, ils présentent les meilleures stratégies, à savoir celles qui minimisent le coût total de la maladie (pertes de production directes et dépenses associées à la lutte contre la maladie), pour chaque maladie en fonction des résultats d'un sondage auprès des éleveurs des provinces de l'Atlantique. Tout indique que les méthodes de lutte les plus rentables sont l'examen de l'animal avant son addition au troupeau et une vaccination qui protègera les bêtes de manière adéquate. [source] | ||||||||||||||||