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Current System (current + system)
Selected AbstractsInterannual changes in sablefish (Anoplopoma fimbria) recruitment in relation to oceanographic conditions within the California Current SystemFISHERIES OCEANOGRAPHY, Issue 1 2006MICHAEL J. SCHIRRIPA Abstract Sablefish (Anoplopoma fimbria) supports substantial fisheries in both the eastern and western Pacific Oceans. Juvenile recruitment along the west coast of the continental United States has been highly variable over the past three decades. Using a generalized additive model, we demonstrate that physical oceanographic variables within the California Current System have significant effects on sablefish recruitment. Significant relationships were found between juvenile recruitment and northward Ekman transport, eastward Ekman transport, and sea level during key times and at key locations within the habitat of this species. The model explains nearly 70% of the variability in sablefish recruitment between the years 1974 and 2000. The predictive power of the model was demonstrated by refitting without the last 5 yr of data and subsequent prediction of those years. Bootstrap assessments of bias associated with parameter estimates and jackknife-after-bootstrap assessments of the influence of individual data on parameter estimates are presented and discussed. Using this model, it is possible to draw preliminary conclusions concerning year-class strength of cohorts not yet available to the survey gear as well as historic year-class strengths. We discuss changes in zooplankton abundance and shifts in species of copepods associated with fluctuations in the physical variables that appear to have a major influence on sablefish recruitment. [source] Timing is everything: flexible phenology and shifting selection in a colonial seabirdJOURNAL OF ANIMAL ECOLOGY, Issue 2 2009Thomas E. Reed Summary 1In order to reproduce successfully in a temporally varying environment, iteroparous animals must exhibit considerable behavioural flexibility across their lifetimes. By adjusting timing of breeding each year, parents can ensure optimal overlap between the energy intensive period of offspring production and the seasonal peak in favourable environmental conditions, thereby increasing their chances of successfully rearing young. 2Few studies investigate variation among individuals in how they respond to fluctuating conditions, or how selection acts on these individual differences, but this information is essential for understanding how populations will cope with rapid environmental change. 3We explored inter-annual trends in breeding time and individual responses to environmental variability in common guillemots Uria aalge, an important marine top predator in the highly variable California Current System. Complex, nonlinear relationships between phenology and oceanic and climate variables were found at the population level. Using a novel application of a statistical technique called random regression, we showed that individual females responded in a nonlinear fashion to environmental variability, and that reaction norm shape differed among females. 4The pattern and strength of selection varied substantially over a 34-year period, but in general, earlier laying was favoured. Females deviating significantly from the population mean laying date each year also suffered reduced breeding success, with the strength of nonlinear selection varying in relation to environmental conditions. 5We discuss our results in the wider context of an emerging literature on the evolutionary ecology of individual-level plasticity in the wild. Better understanding of how species-specific factors and local habitat features affect the timing and success of breeding will improve our ability to predict how populations will respond to climate change. [source] Changing marine productivity off northern Chile during the past 19,000 years: a multivariable approachJOURNAL OF QUATERNARY SCIENCE, Issue 4 2004M. Mohtadi Abstract A multivariable approach utilising bulk sediment, planktonic Foraminifera and siliceous phytoplankton has been used to reconstruct rapid variations in palaeoproductivity in the Peru,Chile Current System off northern Chile for the past 19,000,cal.,yr. During the early deglaciation (19,000,16,000,cal.,yr,BP), our data point to strongest upwelling intensity and highest productivity of the past 19,000,cal.,yr. The late deglaciation (16,000,13,000,cal.,yr,BP) is characterised by a major change in the oceanographic setting, warmer water masses and weaker upwelling at the study site. Lowest productivity and weakest upwelling intensity are observed from the early to the middle Holocene (13,000,4000,cal.,yr,BP), and the beginning of the late Holocene (<4000,cal.,yr,BP) is marked by increasing productivity, mainly driven by silicate-producing organisms. Changes in the productivity and upwelling intensity in our record may have resulted from a large-scale compression and/or displacement of the South Pacific subtropical gyre during more productive periods, in line with a northward extension of the Antarctic Circumpolar Current and increased advection of Antarctic water masses with the Peru,Chile Current. The corresponding increase in hemispheric thermal gradient and wind stress induced stronger upwelling. During the periods of lower productivity, this scenario probably reversed. Copyright © 2004 John Wiley & Sons, Ltd. [source] In-patient management of diabetes mellitus and patient satisfactionDIABETIC MEDICINE, Issue 5 2002A. Bhattacharyya Abstract Aims To devise a system for assessing in-patient glycaemic control and care satisfaction in diabetic patients admitted to hospital for reasons other than their diabetes. Methods Consecutive January to March 2001 case-notes were reviewed. Admissions with acute metabolic complications, acute myocardial infarction and pregestational or gestational diabetes were excluded. Glycaemic control, frequency of blood monitoring and management of hyperglycaemia were recorded. The diabetes treatment satisfaction questionnaire was used to assess preadmission satisfaction with care. Post-admission a 12-stem questionnaire was used to assess satisfaction with in-patient diabetes management. Results Hypoglycaemia was common. Although none developed a hyperglycaemic emergency, high blood glucose was prevalent and, frequently, persistent hyperglycaemia or recurrent hypoglycaemia was not acted on appropriately. The overall score for in-patient satisfaction with treatment was fair (4.1 ± 1.8 on a six-point scale; 6 = very satisfied and 1 = very dissatisfied). Scores were higher among patients on surgical wards than on medical wards (P = 0.008), but satisfaction did not vary when patients were stratified according to sex, age and mode of treatment. Conclusion Current systems are not achieving satisfactory in-patient glycaemic control and there is poor satisfaction with medical in-patient diabetes care. Following changes intended to produce improvements, this assessment system can be used recurrently to monitor in-patient care and satisfaction. [source] Reviewing child deaths,learning from the American experience,CHILD ABUSE REVIEW, Issue 2 2005Lisa Bunting Abstract Current systems for investigating child deaths in England, Wales and Northern Ireland have come under intense scrutiny in recent years and questions have been raised about the accuracy of child death investigations and resulting statistics. Research has highlighted the ways in which multidisciplinary input can contribute to investigative and review processes, a perspective which is further supported by recent UK policy developments. The experience of creating multidisciplinary child death review teams (CDRTs) in America highlights the potential benefits the introduction of a similar system might have. These benefits include improved multi-agency working and communication, more effective identification of suspicious cases, a decrease in inadequate death certification and a broader and more in-depth understanding of the causes of child deaths through the systematic collection and analysis of data. While a lack of funding, regional coordination and evaluation limit the impact of American CDRTs, the positive aspects of this process make it worthwhile, and timely, to consider how such a model might fit within our own context. Current policy developments such as the Home Office review of coroner services, the Children Bill and related Department for Education and Skills (DfES) work on developing screening groups demonstrate that strides have been made in respect of introducing a multidisciplinary process. Similarly, the development of local protocols for the investigation and[sol ]or review of child deaths in England, Wales and Northern Ireland highlights an increased focus on multidisciplinary processes. However, key issues from the American experience, such as the remit of CDRTs[sol ]screening panels, the need for national coordination and the importance of rigorous evaluation, can inform the development of a similar process in the UK. Copyright © 2005 John Wiley & Sons, Ltd. [source] Do Proper Accommodation Assignments Make a Difference?EDUCATIONAL MEASUREMENT: ISSUES AND PRACTICE, Issue 3 2007Examining the Impact of Improved Decision Making on Scores for English Language Learners Does it matter if students are appropriately assigned to test accommodations? Using a randomized method, this study found that individual students assigned accommodations keyed to their particular needs were significantly more efficacious for English language learners (ELLs) and that little difference was reported between students receiving incomplete or not recommended accommodations and no accommodations whatsoever. A sample of third and fourth grade ELLs in South Carolina (N = 272) were randomly assigned to various types of test accommodations on a mathematics assessment. Results indicated that those students who received the appropriate test accommodations, as recommended by a version of a computerized accommodation taxonomy for ELLs (the selection taxonomy for English language learners accommodations; STELLA), had significantly higher test scores than ELLs who received no accommodations or those who received incomplete or not recommended accommodation packages. Additionally, students who were given no test accommodations scored no differently than those students that received accommodation packages that were incomplete or not recommended, given the students' particular needs and challenges. These findings are important in light of research and anecdotal reports that suggest a general lack of systematicity in the current system of assigning accommodations and a tendency to give all available accommodations regardless of individual child characteristics. The results also have important implications for how future accommodation research should be structured to determine the benefits of particular accommodations and accommodation packages. This study would suggest that control and treatment groups should be assembled based on specific student needs in order for direct comparisons to be made. [source] INTIMATE PARTNER VIOLENCE IN THE MILITARY: SECURING OUR COUNTRY, STARTING WITH THE HOME1FAMILY COURT REVIEW, Issue 2 2009Simeon StammArticle first published online: 13 MAR 200 This Note discusses domestic violence in the military. Currently, in cases of domestic violence in the military, the Case Review Committee uses the Incident Severity Index for Spouse Abuse to determine the severity of abuse. The Case Review Committee uses this index when determining treatment options for the perpetrator of domestic violence. However, this index is extremely inconsistent with the current views and emerging research of domestic violence. This Note identifies the problems with the current system and gives recommendations for ways to improve the system. The Note concludes that a new system would enhance the military's ability to combat domestic violence. [source] European Banking Integration: Don't Put the Cart before the HorseFINANCIAL MARKETS, INSTITUTIONS & INSTRUMENTS, Issue 2 2006Jean Dermine This paper reviews the progress in European banking integration over the last twenty years, and evaluates the current system of banking supervision and deposit insurance based on ,home country' control. The public policy implications to draw from the paper are threefold: First, after a relatively slow start, European banking integration is gaining momentum, in terms of cross-border flows, market share of foreign banks in several domestic markets, and cross-border M&As of significant size. If this trend continues, the issue of adequate supervision and safety nets in an integrated European banking market will become even more pressing. Second, although until recently banks have relied mostly on subsidiary structures to go cross-border, this is changing with the recent creation of the European company statute, which facilitates cross-border branch banking. A review of the case of the Scandinavian bank, Nordea Bank AB, helps to understand some remaining barriers to integration, and the supervisory issues raised by branch banking. Third, it is argued that the principle of ,home country' supervision is unlikely to be adequate in the future for large international banks. Because the closure of an international bank would be likely to have cross-border spillovers, and because some small European countries might be unable to finance the bail-out of their very large banks, centralization, or at least Europe-wide coordination, of the decision to close or bail-out international banks is needed. This raises the issue of European funding of bail-out costs, European banking supervision, and European deposit insurance. [source] Distributional Implications of Tax Relief on Voluntary Private Pensions in Spain,FISCAL STUDIES, Issue 2 2007José-Ignacio Antón Using taxation statistics, this paper explores the distributional implications of tax relief on private pensions in Spain in 2002. For this purpose, the author suggests a decomposition of the Kakwani index and its generalisations that allows us to distinguish between the regressivity caused by targeting and that due to benefits allocation among recipients. This paper finds that these tax incentives are regressive - mainly for the latter reason - and have negative although small distributional effects. Finally, this work presents several proposals for reform of the current system and simulates their implications for equity. [source] Producing Supramolecular Functional Materials Based on Fiber Network ReconstructionADVANCED FUNCTIONAL MATERIALS, Issue 14 2009Shaokun Tang Abstract Here, the creation of new supramolecular functional materials based on the reconstruction of three-dimensional interconnecting self-organized nanofiber networks by a surfactant is reported. The system under investigation is N -lauroyl- L -glutamic acid di- n -butylamide in propylene glycol. The architecture of networks is implemented in terms of surfactants, e.g. sorbitan monolaurate. The elastic performance of the soft functional material is either weakened or strengthened (up to 300% for the current system) by reconstructing the topology of a fiber network. A topology transition of gel fiber network from spherulite-like to comb-like to spherulite-like is performed with the introduction of this surfactant. The Span 20 molecules are selectively adsorbed on the side surfaces of the crystalline fibers and promote the nucleation of side branches, giving rise to the transformation of the network architecture from spherulite-like topology to comb-like topology. At high surfactant concentrations, the occurrence of micelles may provide an increasing number of nucleation centers for spherulitic growth, leading to the reformation of spherulite-like topology. An analysis on fiber network topology supports and verifies a perfect agreement between the topological behavior and the rheological behavior of the functional materials. The approach identified in this study opens up a completely new avenue in designing and producing self-supporting supramolecular functional materials with designated macroscopic properties. [source] Institutional Review Boards and Multisite Studies in Health Services Research: Is There a Better Way?HEALTH SERVICES RESEARCH, Issue 1 2005Jennifer L. Gold Objective. The following paper examines the issue of whether the current system for ethics review of multisite health services research protocols is adequate, or whether there exist alternative methods that should be considered. Principal Findings. (1) Investigators at different sites in a multisite project often have very different experiences with respect to the requirements and requests of the review board. Other problems include the waste of time and resources spent on document preparation for review boards, and delays in the commencement of research activities. (2) There are several possible reasons why there is variability in ethics review. These include the absence of standardized forms, differences in the background and experiences of board members, the influence of institutional or professional culture, and regional thinking. (3) Given the limited benefits derived from the variability in recommendations of multiple boards and the numerous problems encountered in seeking ethics approval from multiple boards suggest that some sort of reform is in order. Conclusions. The increasing number of multisite, health services research studies calls for a centralized system of ethics review. The local review model is simply not conducive to multisite studies, and jeopardizes the integrity of the research process. Centralized multisite review boards, together with standardized documents and procedure, electronic access to documentation, and training for board members are all possible solutions. Changes to the current system are necessary not only to facilitate the conduct of multisite research, but also to preserve the integrity of the ethics approval process in general. [source] Social protection and poverty in Azerbaijan, a low-income country in transition: Implications of a household surveyINTERNATIONAL SOCIAL SECURITY REVIEW, Issue 4 2007Nazim Habibov Using a nationally representative survey, this study examines the performance of social protection in Azerbaijan from the perspective of poverty reduction. Empirical evidence presented suggests that social protection programmes have an important impact on poverty alleviation. However, poverty is still widespread. The findings demonstrate that the current system of social protection has several important limitations. First, a significant proportion of the poor population is not covered by the social protection system. Second, the poor typically receive a smaller share of total benefits than the non-poor. Finally, most social transfers are too small to lift households out of poverty. The current system of social protection in Azerbaijan requires further strengthening. In particular, the government should develop and implement new social assistance programmes specifically directed towards poverty reduction. [source] Has the Portuguese NHS Achieved its Objectives of Equity and Efficiency?INTERNATIONAL SOCIAL SECURITY REVIEW, Issue 4 2000Anna Dixon The Portuguese healthcare system has been in a state of continuous change since the political revolution of 1974, which brought about a constitutional commitment to a universal and comprehensive national health service. Despite much legislative activity, only partial implementation of these laws has taken place and the current system requires further changes if it is to attain its stated objectives of increasing equity and efficiency. This article analyses and assesses the state of the healthcare system in Portugal based on a review of the literature and interviews with key policymakers and academics and evaluates it against the criteria of equity and efficiency. [source] Systemic Leadership, Evolutionary Processes, and International Relations Theory: The Unipolarity Question,INTERNATIONAL STUDIES REVIEW, Issue 1 2006WILLIAM R. THOMPSON Scholars disagree about the nature of the current international distribution of power and its implications for world politics. Is the current system unipolar, and, if so, is unipolarity likely to persist for very long? Fifteen generalizations about the structure of the international system are culled from the literature and addressed critically from a leadership long cycle point of view. Although the current system is militarily unipolar, it is not buttressed by a new wave of radical technological innovation that is critical to the operation of systemic leadership. Until or unless US military predominance is based on economic predominance, the effects of unipolarity are likely to be relatively weak and probably also short-lived. [source] Implantable Cardioverter-Defibrillator Malfunction due to Mechanical Failure of the Header ConnectionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2004R. ANDREW PICKETT III M.D. Four cases of ICD system malfunction occurring within the Medtronic Marquis family over a limited time frame are reported. These cases shared a common element of defective connections between the header post and the right ventricular pace/sense terminal pin that required intervention and reconnection. Inappropriate shocks occurred in two cases. The circumstances of these cases provide important information about the potential difficulties with these devices and highlight the deficiencies of the current system in tracking and analyzing device-related problems. [source] Developing interdisciplinary maternity services policy in Canada.JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2010Evaluation of a consensus workshop Abstract Context, Four maternity/obstetrical care organizations, representing women, midwives, obstetricians and family doctors conducted interdisciplinary policy research under auspices of four key stakeholder groups. These projects teams and key stakeholders subsequently collaborated to develop consensus on strategies for improved maternity services in Ontario. Objectives, The objective of this study is to evaluate a 2-day research synthesis and consensus building conference to answer policy questions in relation to new models of interdisciplinary maternity care organizations in different settings in Ontario. Methods, The evaluation consisted of a scan of individual project activities and findings as were presented to an invited audience of key stakeholders at the consensus conference. This involved: participant observation with key informant consultation; a survey of attendees; pattern processing and sense making of project materials, consensus statements derived at the conference in the light of participant observation and survey material as pertaining to a complex system. The development of a systems framework for maternity care policy in Ontario was based on secondary analysis of the material. Findings, Conference participants were united on the importance of investment in maternity care for Ontario and the impending workforce crisis if adaptation of the workforce did not take place. The conference participants proposed reforming the current system that was seen as too rigid and inflexible in relation to the constraints of legislation, provider scope of practice and remuneration issues. However, not one model of interdisciplinary maternity/obstetrical care was endorsed. Consistency and coherence of models (rather than central standardization) through self-organization based on local needs was strongly endorsed. An understanding of primary maternity care models as subsystems of networked providers in complex health organizations and a wider social system emerged. The patterns identified were incorporated into a complexity framework to assist sense making to inform policy. Discussion, Coherence around core values, holism and synthesis with responsiveness to local needs and key stakeholders were themes that emerged consistent with complex adaptive systems principles. Respecting historical provider relationships and local history provided a background for change recognizing that systems evolve in part from where they have been. The building of functioning relationships was central through education and improved communication with ongoing feedback loops (positive and negative). Information systems and a flexible improved central and local organization of maternity services was endorsed. Education and improved communication through ongoing feedback loops (positive and negative) were central to building functioning relationships. Also, coordinated central organization with a flexible and adaptive local organization of maternity services was endorsed by participants. Conclusions, This evaluation used an approach comprising scoping, pattern processing and sense making. While the projects produced considerable typical research evidence, the key policy questions could not be addressed by this alone, and a process of synthesis and consensus building with stakeholder engagement was applied. An adaptive system with local needs driving a relationship based network of interdisciplinary groupings or teams with both bottom up and central leadership. A complexity framework enhanced sense making for the system approaches and understandings that emerged. [source] Smart Labels for Waste and Resource ManagementJOURNAL OF INDUSTRIAL ECOLOGY, Issue 2 2008An Integrated Assessment Summary This article explores the potential of RFID (radio frequency identification device) for improving the current waste and resource management system in Switzerland. It presents the following three possible options for utilizing RFID tags to support waste management processes: "at source automation" (using a "smart" trash can), "end of pipe I" (combination of the current system with an additional separation of recyclables before incineration), and "end of pipe II" (replacement of the current recycling infrastructure by sorting at the incineration plant). These options tackle the waste and resource management chain during different processes (i.e., waste generation, waste separation, and treatment). Based on an MFA (material flow analysis), we performed a multicriteria assessment of these options with experts from the waste management sector. The assessment of ten experts in the waste management field regarding the proposed options for batteries and electrical appliances showed that, from an ecological perspective, the implementation of RFID in waste management would be desirable and would lead to an improvement in the current recycling rate in Switzerland for the goods studied. From an economic perspective, new investments would be required in the range of 1 to 5 times the maintenance costs of the current separate collection system. From a social perspective, the utilization of RFID tags in the waste management process was ambiguous. In particular, the end of pipe II option would, on the one hand, significantly improve convenience for consumers. On the other hand, experts see privacy and, what is more, social responsibility as being under threat. The experts considered the ecological and social aspects to be more relevant than the economic ones, preferring the end of pipe I option over the other options and the status quo. [source] Pharmaceutical marketing: a question of regulationJOURNAL OF PUBLIC AFFAIRS, Issue 2 2007Elinor Devlin In recent years, the marketing practices of the pharmaceutical industry have been subject to scrutiny and criticism. In the UK, prescription-only (PO) medicines cannot be marketed directly to the public, and marketing to health professionals is self-regulated by the Association of the British Pharmaceutical Industry's (ABPI) Code of Practice. This study uses internal document analyses to examine the effectiveness of this regulatory framework. Specifically, a qualitative analysis was conducted of internal marketing documents from five UK pharmaceutical companies which were obtained by the House of Commons Health Committee. This analysis suggests that major pharmaceutical companies are contravening the ABPI Code in four key areas. The authors conclude that the current system is not effectively regulating the marketing of PO medicines to the general public or health professionals in the UK and suggest that the Code and indeed the whole regulatory procedure needs a thorough review. Copyright © 2007 John Wiley & Sons, Ltd. [source] Phylogeny and phylogeography of the Lozekia,Kovacsia species group (Gastropoda: Hygromiidae)JOURNAL OF ZOOLOGICAL SYSTEMATICS AND EVOLUTIONARY RESEARCH, Issue 4 2009Zoltán Fehér Abstract The Lozekia,Kovacsia species group comprises three species of high conservation concern, Lozekia transsilvanica (Westerlund, 1876), Lozekia deubeli (M. Kimakowicz, 1890) and Kovacsia kovacsi (Varga and L. Pintér, 1972), which occupy relatively small ranges in the Carpathian-Pannonian region. Despite their conservation concern, the phylogeny and biogeographical history of these species have not been studied by molecular methods up to now. This study, based on mitochondrial cytochrome oxidase subunit I gene sequences, has two main objectives: (i) to infer the phylogenetic relationships within the group in order to test the latest morphology-based system, proposed by Nordsieck [1993, Das System der paläarktischen Hygromiidae (Gastropoda: Stylommatophora: Helicoidea). Arch Molluskenkunde 122:1] and (ii) to reconstruct the distribution history of the three species. The monophyly and thus the systematic distinctness of the three species was confirmed, but our findings do not support the monophyly of the Lozekia genus and therefore contradict the current system of the species group. Genetic diversity was found to be much higher within L. deubeli than within the other two species, a possible explanation of this phenomenon is that L. transsilvanica and K. kovacsi are more recently evolved, younger species. Nested clade phylogeographycal analysis showed that the three species evolved by fragmentation events; probably L. deubeli and the ancestor of the other two species split first. At the intraspecific level, fragmentation events, as well as range expansion, played a significant role in the biogeographical history of this species group. As our findings are based on a single mitochondrial gene, we feel premature to propose changes in the generally accepted system and nomenclature. Further molecular phylogenetic analyses, also involving nuclear DNA sequences, should clarify if the evolutionary scenario suggested by our data is valid, and the three species can indeed be placed within the same genus, Lozekia. Zusammenfassung Die Lozekia,Kovacsia Artengruppe umfasst drei endemische Arten, Lozekia transsilvanica (Westerlund, 1876), Lozekia deubeli (M. Kimakowicz, 1890) und Kovacsia kovacsi (Varga and L. Pintér, 1972), die relativ kleine Verbreitungsgebiete in der karpatisch-pannonischen Region besitzen. Trotz ihrer naturschutzfachlichen Bedeutung wurde die Phylogenie ind biogeographische Historie dieser Arten bisher nicht mit molekularen Methoden untersucht. In dieser Studie werden, basierend auf mitochondrialen COI-Sequenzen, zwei Hauptziele verfolgt: (i) Ermittlung der phylogenetischen Beziehungen in der Gruppe um das aktuelle morphologie.basierte System von Nordsieck (1993) zu testen, und (ii) Rekonstruktion der Verbreitungsgeschichte der drei Arten. In Übereinstimmung mit morphologischen Merkmalsausprägungen wurde die Monophylie und somit die systematische Eigenständigkeit der drei Arten bestätigt, im Gegensatz zur Monophylie der Gattung Lozekia. Die genetische Diversität in L. deubeli war viel höher als in den anderen beiden Arten. Eine mögliche Erklärung dieses Befundes ist, dass L. transsilvanica und K. kovacsi rezenter evolvierte, junge Arten sind. Eine Nested clade phylogeographical analysis (NCPA) zeigte, dass die drei Arten durch Fragmentierungsereignisse entstanden, wahrscheinlich teilten sich L. deubeli und der Vorläufer der anderen beiden Arten zuerst. Auf dem intraspezifischen Niveau spielten Fragmentierungsereignisse und ebenso Arealausdehnungen eine signifikante Rolle in der biogeographischen Geschichte der Artengruppe. Da unsere Ergebnisse auf einem einzigen mitochondrialen Gen basieren, ist es zu früh für Veränderungen am generell akzeptierten System und der Nomenklatur. Weitere molekular-phylogenetische Analysen, die auch nukleäre DNA sequenzen involvieren, müssen das auf unseren Daten basierende evolutionäre Szenario bestätigen und die Fragen klären, ob die drei Arten tatsächlich zur gleichen Gattung, Lozekia, gehören. [source] Differential Mortality and the Design of the Italian System of Public PensionsLABOUR, Issue 2003Graziella Caselli After reviewing the secular trends in elderly mortality in Italy, and the evolution of regional differences in survival over the last three decades, we evaluate the impact, on the conversion factors introduced by the Dini reform, of a further decline in elderly mortality over the next few decades. We compute the conversion factors using a close approximation to the unknown formula employed in the Dini reform but allowing for gender- and region-specific survival probabilities. Our results leave no doubt about the importance of frequently updating the conversion factors in the light of the rapid increase in elderly survival. The paper also quantifies to what extent gender- and region-specific conversion factors may differ from their currently legislated values, that only vary by age. Finally, we recognize that the actuarial fairness of the system introduced by the recent reform can only be guaranteed on average and that, in the presence of a heterogeneous population of individuals that differ considerably in their mortality prospects, the current system implies a substantial degree of redistribution from high-mortality groups (typically characterized by low income and low wealth) to low-mortality groups (typically characterized by high income and high wealth). [source] Making amends or making things worse?LEGAL STUDIES, Issue 4 2007Clinical negligence reform, patient redress in England This paper examines the government's reform of the current system of clinical negligence litigation in England, focusing on an analysis of the redress scheme for low value claims to be established under the NHS Redress Act 2006. The Act establishes a scheme to provide a package of redress to patients in circumstances where they have suffered harm as a result of negligence during the course of medical treatment provided by the NHS. One of the British Government's central aims in embarking upon reform in this area was to provide a low cost, quick and genuine alternative to the current clinical negligence litigation system. This paper critically analyses this reform of the current system by reference to an examination of what constitutes a just redress scheme in the circumstances. Such analysis shows that the government has missed a golden opportunity to establish a scheme which truly ,makes amends' to patients who have suffered harm through medical treatment in the NHS. Instead, the scheme is likely to operate in practice as an administrative scheme for low value claims that serves the institutional and financial interests of the NHS, and therefore fails to address longstanding patient concerns over the provision of redress arising out of harm suffered through medical treatment. As a result, patient confidence in the scheme is likely to be undermined in the long term. [source] Frequency and predictors of de novo hepatocellular carcinoma in patients awaiting orthotopic liver transplantation during the model for end-stage liver disease era,LIVER TRANSPLANTATION, Issue 2 2008Carla W. Brady In the current system of allocation, patients awaiting orthotopic liver transplantation (OLT) remain at risk of developing de novo hepatocellular carcinoma (HCC) and removal from the waiting list. Using the United Network for Organ Sharing database, we calculated the rate and identified predictors of de novo HCC in patients listed for OLT between February 2002 and December 2004. Among 8566 patients, 1167 (13.6%) developed de novo HCC. Predictors of increased odds of de novo HCC were older age, male gender, Asian race, other race, hepatitis C, and hepatitis B. A sensitivity analysis of 2067 patients waiting at least 6 months found that 16.2% developed de novo HCC. Older age [odds ratio (OR) 1.05; 95% confidence interval (CI) 1.03, 1.07], male gender (OR 2.01; 95% CI 1.49, 2.71), Asian race (OR 2.39; 95% CI 1.20, 4.76), other race (OR 1.94; 95% CI 1.40, 2.68), hepatitis C (OR 2.36; 95% CI 1.76, 3.16), and hepatitis B (OR 1.96; 95% CI 1.19, 3.23) remained predictors of increased odds of de novo HCC, and alcoholic liver disease (OR 1.40; 95% CI 1.06, 1.86) emerged as a predictor of increased odds of de novo HCC. A significant proportion of patients listed for OLT develop de novo HCC. Identifying predictors of HCC in these patients may facilitate timely HCC screening and diagnosis. Liver Transpl 14:228,234, 2008. © 2008 AASLD. [source] Summary report of a national conference: Evolving concepts in liver allocation in the MELD and PELD eraLIVER TRANSPLANTATION, Issue S10 2004Kim M. Olthoff A national conference was held to review and assess data gathered since implementation of MELD and PELD and determine future directions. The objectives of the conference were to review the current system of liver allocation with a critical analysis of its strengths and weaknesses. Conference participants used an evidence-based approach to consider whether predicted outcome after transplantation should influence allocation, to discuss the concept of minimal listing score, to revisit current and potential expansion of exception criteria, and to determine whether specific scores should be used for automatic removal of patients on the waiting list. After review of data from the first 18 months since implementation, association and society leaders, and surgeons and hepatologists with wide regional representation were invited to participate in small group discussions focusing on each of the main objectives. At the completion of the meeting, there was agreement that MELD has had a successful initial implementation, meeting the goal of providing a system of allocation that emphasizes the urgency of the candidate while diminishing the reliance on waiting time, and that it has proven to be a powerful tool for auditing the liver allocation system. It was also agreed that the data regarding the accuracy of PELD as a predictor of pretransplant mortality were less conclusive and that PELD should be considered in isolation. Recommendations for the transplant community, based on the analysis of the MELD data, were discussed and are presented in the summary document. (Liver Transpl 2004;10:A6,A22.) [source] Redrawing organ distribution boundaries: Results of a computer-simulated analysis for liver transplantationLIVER TRANSPLANTATION, Issue 8 2002Richard B. Freeman MD For several years, the Organ Procurement and Transplantation Network/United Network for Organ Sharing (UNOS) Liver and Intestinal Transplantation Committee has been examining effects of changes and proposed changes to the liver allocation system. The Institute of Medicine recently recommended that the size of liver distribution units be increased to improve the organ distribution system. Methods to achieve this and the potential impact on patients and transplant centers of such a change are evaluated in this study. In hypothetical scenarios, we combined geographically contiguous organ procurement organizations (OPOs) in seven different configurations to increase the size of liver distribution units to cover populations greater than 9 million persons. Using the UNOS Liver Allocation Model (ULAM), we examined the effect of 17 different organ allocation sequences in these proposed realignments and compared them with those predicted by ULAM for the current liver distribution system by using the following primary outcome variables: number of primary liver transplantations performed, total number of deaths, and total number of life-years saved. Every proposed new liver distribution unit plan resulted in fewer primary transplantations. Many policies increased the total number of deaths and reduced total life-years saved compared with the current system. Most of the proposed plans reduced interregional variation compared with the current plan, but no one plan consistently reduced variation for all outcome variables, and all reductions in variations were relatively small. All new liver distribution unit plans led to significant shifts in the number of transplantations performed in individual OPOs compared with the current system. The ULAM predicts that changing liver distribution units to larger geographic areas has little positive impact on overall results of liver transplantation in the United States compared with the current plan. Enlarging liver distribution units likely will result in significant shifts in organs across current OPO boundaries, which will have a significant impact on the activity of many transplant centers. [source] Twelve-hour shift on ITU: a nursing evaluationNURSING IN CRITICAL CARE, Issue 3 2003Annette Richardson Summary ,This paper describes the introduction and subsequent evaluation of a 12-h shift system in a large ITU in the northeast of UK ,To date, only a small number of studies has evaluated nurses working the 12-h shifts in critical care areas ,To evaluate the level of staff satisfaction, data were collected by means of a questionnaire involving 41 nurses, at 3 months following the introduction of the 12-h shifts ,The responses from the evaluation advocated the continuation of 12-h shifts with alternative shift patterns for nurses who felt dissatisfied with the current system ,Twelve-hour shifts can be seen as a flexible system for nurses working in intensive care and may assist with staff satisfaction and improving nurse recruitment and retention [source] Alan Greenspan on the Economic Implications of Population AgingPOPULATION AND DEVELOPMENT REVIEW, Issue 4 2004Article first published online: 15 DEC 200 At the 2004 annual symposium of central bank leaders sponsored by the Federal Reserve Bank of Kansas City at Jackson Hole, Wyoming, Alan Greenspan, Chairman of the US Federal Reserve Board, devoted his opening remarks on 27 August to a discussion of the economic implications of population aging. The full text of his remarks is reproduced below. Greenspan's high prestige and great influence on US economic policy lend special interest to his views on this much-discussed subject (see also the next Documents item in this issue). He outlines the coming demographic shift in the United States in language that is characteristically cautious and qualified. (The elderly dependency ratio will "almost certainly" rise as the baby boom generation retires, Greenspan says, although elsewhere he terms the process, more accurately, inexorable.) The main factor responsible for population aging he identifies as the decline of fertility. Immigration is an antidote, but, to be effective, its size would have to be much larger than is envisaged in current projections. Greenspan's assessment of the economic consequences of the changing age structure highlights the prospect of a deteriorating fiscal situation in the United States: chronic deficits in the Social Security program over the long haul, assuming that existing commitments for benefits per retiree are met, and even greater difficulties for the health care system for the elderly,Medicare,in which the effects of increasing numbers in old age are amplified by advances in medical technology and the bias inherent in the current system of subsidized third-party payments. The sober outline of policy choices imposed by population aging,difficult in the United States, but less so, Greenspan notes, than in Europe and Japan,underlies the need for counteracting the declining growth of the population of labor force age through greater labor force participation and later retirement. Beyond that, growth of output per worker can provide the key "that would enable future retirees to maintain their expected standard of living without unduly burdening future workers." This requires continuation of policies that enhance productivity, such as deregulation and globalization, and greater investment. In turn, the latter presupposes greater domestic saving, both personal and by the government, as the United States cannot "continue indefinitely to borrow saving from abroad." Demographic aging requires a new balance between workers and retirees. Curbing benefits once bestowed is difficult: only benefits that can be delivered should be promised. Public programs should be recalibrated, providing incentives for individuals to adjust to the inevitable consequences of an aging society. [source] Ukrainian Local Governments' Finance on the Threshold of a New Millenium: Will Interbudgetary Reform Meet Public Needs?PUBLIC BUDGETING AND FINANCE, Issue 3 2002Sergii Slukhai Since independence, market,oriented reforms have been undertaken in Ukraine. Yet, intergovernmental relations are obsolete, remaining as they were in the Soviet time. In fact, Ukrainian subcentral governments have no significant discretion in revenues and expenditures. First, the article delivers an overview of the current system of intergovernmental finance in Ukraine. Second, the article reveals some negative trends in Ukrainian local governments' fiscal performance through the late 1990s that made a reform of intergovernmental fiscal arrangements timely. Third, the article analyzes recent reform steps as presented by the recent Budget Code, proposing policy options that could strengthen Ukrainian intergovernmental policy. [source] Americans' Views of Health Care Costs, Access, and QualityTHE MILBANK QUARTERLY, Issue 4 2006ROBERT J. BLENDON For more than two decades, polls have shown that Americans are dissatisfied with their current health care system. However, the public's views on how to change the current system are more conflicted than often suggested by individual poll results. At the same time, Americans are both dissatisfied with the current health care system and relatively satisfied with their own health care arrangements. As a result of the conflict between these views and the public's distrust of government, there often is a wide gap between the public's support for a set of principles concerning what needs to be done about the overall problems facing the nation's health care system and their support for specific policies designed to achieve those goals. [source] Elective Surgical Patients as Living Organ Donors: A Clinical and Ethical InnovationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2009G. Testa We propose a new model for living organ donation that would invite elective laparoscopic cholecystectomy patients to become volunteer, unrelated living kidney donors. Such donors would be surgical patients first and living donors second, in contrast to the current system, which ,creates' a surgical patient by operating on a healthy individual. Elective surgery patients have accepted the risks of anesthesia and surgery for their own surgical needs but would face additional surgical risks when a donor nephrectomy is combined with their cholecystectomy procedure. Because these two procedures have never been performed together, the precise level of additional risk entailed in such a combined approach is unknown and will require further study. However, considering the large number of elective cholecystectomies performed each year in the United States, if as few as 5% of elective cholecystectomy patients agreed to also serve as living kidney donors, the number of living kidney donors would increase substantially. If this proposal is accepted by a minority of patients and surgeons, and proves safe and effective in a protocol study, it could be applied to other elective abdominal surgery procedures and used to obtain other abdominal donor organs (e.g. liver and intestinal segments) for transplantation. [source] A CRITIQUE OF THE INNOVATION ARGUMENT AGAINST A NATIONAL HEALTH PROGRAMBIOETHICS, Issue 6 2007ALEX RAJCZI ABSTRACT President Bush and his Council of Economic Advisors have claimed that the US shouldn't adopt a national health program because doing so would slow innovation in health care. Some have attacked this argument by challenging its moral claim that innovativeness is a good ground for choosing between health care systems. This reply is misguided. If we want to refute the argument from innovation, we have to undercut the premise that seems least controversial , the premise that our current system produces more innovation than a national health program would. I argue that this premise is false. The argument requires clarifying the concept ,national health program' and examining various theories of human well-being. [source] | |||||||||||||||||||||||||||||||||||||||||||