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Underlying Problems (underlying + problem)
Selected AbstractsThe Health Sector Gap in the Southern Africa Crisis in 2002/2003DISASTERS, Issue 4 2004Andre Griekspoor The southern Africa crisis represents the first widespread emergency in a region with a mature HIV/AIDS epidemic. It provides a steep learning curve for the international humanitarian system in understanding and responding to the complex interactions between the epidemic and the causes and the effects of this crisis. It also provoked much debate about the severity and causes of this emergency, and the appropriateness of the response by the humanitarian community. The authors argue that the over-emphasis on food aid delivery occurred at the expense of other public health interventions, particularly preventative and curative health services. Health service needs were not sufficiently addressed despite the early recognition that ill-health related to HIV/AIDS was a major vulnerability factor. This neglect occurred because analytical frameworks were too narrowly focused on food security, and large-scale support to health service delivery was seen as a long-term developmental issue that could not easily be dealt with by short-term humanitarian action. Furthermore, there were insufficient countrywide data on acute malnutrition, mortality rates and performance of the public health system to make better-balanced evidence-based decisions. In this crisis, humanitarian organisations providing health services could not assume their traditional roles of short-term assistance in a limited geographical area until the governing authorities resume their responsibilities. However, relegating health service delivery as a long-term developmental issue is not acceptable. Improved multisectoral analytical frameworks that include a multidisciplinary team are needed to ensure all aspects of public health are dealt with in similar future emergencies. Humanitarian organisations must advocate for improved delivery and access to health services in this region. They can target limited geographical areas with high mortality and acute malnutrition rates to deliver their services. Finally, to address the underlying problem of the health sector gap, a long-term strategy to ensure improved and sustainable health sector performance can only be accomplished with truly adequate resources. This will require renewed efforts on part of governments, donors and the international community. Public health interventions, complementing those addressing food insecurity, were and are still needed to reduce the impact of the crisis, and to allow people to re-establish their livelihoods. These will increase the population's resilience to prevent or mitigate future disasters. [source] Communication and Equilibrium in Discontinuous Games of Incomplete InformationECONOMETRICA, Issue 5 2002Matthew O. Jackson This paper offers a new approach to the study of economic problems usually modeled as games of incomplete information with discontinuous payoffs. Typically, the discontinuities arise from indeterminacies (ties) in the underlying problem. The point of view taken here is that the tie,breaking rules that resolve these indeterminacies should be viewed as part of the solution rather than part of the description of the model. A solution is therefore a tie,breaking rule together with strategies satisfying the usual best,response criterion. When information is incomplete, solutions need not exist; that is, there may be no tie,breaking rule that is compatible with the existence of strategy profiles satisfying the usual best,response criteria. It is shown that the introduction of incentive compatible communication (cheap talk) restores existence. [source] Private Actors and the State: Internationalization and Changing Patterns of GovernanceGOVERNANCE, Issue 1 2002Christoph Knill This article investigates the implications of political and economic internationalization on patterns of governance from a statecentric perspective. The actual patterns of governance in internationalized environments can be related to the respective governance capacity of public and private actors, which hinges in turn on the strategic constellation underlying the provision of a public good. The specific strategic constellation varies in three dimensions: the congruence between the scope of the underlying problem and the organizational structures of the related actors, the type of problem, and the institutional context, all of which involve a number of factors. With this concept in mind, we identify four ideal-typed patterns of governance, enabled by different configurations of public and private capacities to formally or factually influence in various ways the social, economic, and political processes by which certain goods are provided. [source] The Role of Benzodiazepines in the Treatment of InsomniaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2001Meta-Analysis of Benzodiazepine Use in the Treatment of Insomnia PURPOSE: To obtain a precise estimate of the efficacy and common adverse effects of benzodiazepines for the treatment of insomnia compared with those of placebo and other treatments. BACKGROUND: Insomnia, also referred to as disorder of initiating or maintaining sleep, is a common problem and its prevalence among older people is estimated to be 23% to 34%.1 The total direct cost in the United States for insomnia in 1995 was estimated to be $13.9 billion.2 The complaint of insomnia in older people is associated with chronic medical conditions; psychiatric problems, mainly depression, chronic pain, and poor perceived general condition;1,3,4 and use of sleep medications.5 Thus in most cases, insomnia is due to some other underlying problem and is not just a consequence of aging.6 Accordingly, the management of insomnia should focus on addressing the primary problem and not just short-term treatment of the insomnia. Benzodiazepines belong to the drug class of choice for the symptomatic treatment of primary insomnia.7 This abstract will appraise a meta-analysis that compared the effect of benzodiazepines for short-term treatment of primary insomnia with placebo or other treatment. DATA SOURCES: Data sources included articles listed in Medline from 1966 to December 1998 and the Cochrane Controlled Trials Registry. The medical subject heading (MeSH) search terms used were "benzodiazepine" (exploded) or "benzodiazepine tranquillizers" (exploded) or "clonazepam,""drug therapy,""randomized controlled trial" or "random allocation" or "all random,""human," and "English language." In addition, bibliographies of retrieved articles were scanned for additional articles and manufacturers of brand-name benzodiazepines were asked for reports of early trials not published in the literature. STUDY SELECTION CRITERIA: Reports of randomized controlled trials of benzodiazepine therapy for primary insomnia were considered for the meta-analysis if they compared a benzodiazepine with a placebo or an alternative active drug. DATA EXTRACTION: Data were abstracted from 45 randomized controlled trials representing 2,672 patients, 47% of whom were women. Fifteen studies included patients age 65 and older and four studies involved exclusively older patients. Twenty-five studies were based in the community and nine involved inpatients. The duration of the studies ranged from 1 day to 6 weeks, with a mean of 12.2 days and median of 7.5 days. The primary outcome measures analyzed were sleep latency and total sleep duration after a sleep study, subjects' estimates of sleep latency and sleep duration, and subjects' report of adverse effects. Interrater reliability was checked through duplicate, independent abstraction of the first 21 articles. Overall agreement was between 95% and 98% (kappa value of 0.90 and 0.95 accordingly) for classification of the studies and validity of therapy, and 76% (kappa value of 0.51) for study of harmful effects. A scale of 0 to 5 was used to rate the individual reports, taking into account the quality of randomization, blinding, follow-up, and control for baseline differences between groups. Tests for homogeneity were applied across the individual studies and, when studies were found to be heterogeneous, subgroup analysis according to a predefined group was performed. MAIN RESULTS: The drugs used in the meta-analysis included triazolam in 16 studies; flurazepam in 14 studies; temazepam in 13 studies; midazolam in five studies; nitrazepam in four studies; and estazolam, lorazepam, and diazepam in two studies each. Alternative drug therapies included zopiclone in 13 studies and diphenhydramine, glutethimide, and promethazine in one study each. Only one article reported on a nonpharmacological treatment (behavioral therapy). The mean age of patients was reported in 33 of the 45 studies and ranged between 29 and 82. SLEEP LATENCY: In four studies involving 159 subjects, there was sleep-record latency (time to fall asleep) data for analysis. The pooled difference indicated that the latency to sleep for patients receiving a benzodiazepine was 4.2 minutes (95% CI = (,0.7) (,9.2)) shorter than for those receiving placebo. Patient's estimates of sleep latency examined in eight studies showed a difference of 14.3 minutes (95% CI = 10.6,18.0) in favor of benzodiazepines over placebo. TOTAL SLEEP DURATION: Analysis of two studies involving 35 patients in which total sleep duration using sleep-record results was compared indicated that patients in the benzodiazepine groups slept for an average of 61.8 minutes (95% CI = 37.4,86.2) longer than those in the placebo groups. Patient's estimates of sleep duration from eight studies (566 points) showed total sleep duration to be 48.4 minutes (95% CI = 39.6,57.1) longer for patients taking benzodiazepines than for those on placebo. ADVERSE EFFECTS: Analysis of eight studies (889 subjects) showed that those in the benzodiazepine groups were more likely than those in the placebo groups to complain of daytime drowsiness (odds ratio (OR) 2.4, 95% confidence interval (CI) = 1.8,3.4). Analysis of four studies (326 subjects) also showed that subjects in the benzodiazepine groups were more likely to complain of dizziness or lightheadedness than the placebo groups. (OR 2.6, 95% CI = 0.7,10.3). Despite the increased reported side effects in the benzodiazepine groups, drop-out rates were similar in the benzodiazepine and placebo groups. For patient reported outcome, there was no strong correlation found for sleep latency data, (r = 0.4, 95% CI = (,0.3) (,0.9)) or for sleep duration (r = 0.2, 95% CI = ,0.8,0.4) between benzodiazepine dose and outcome. COMPARISON WITH OTHER DRUGS AND TREATMENTS: In three trials with 96 subjects, meta-analysis of the results comparing benzodiazepines with zopiclone, did not show significant difference in sleep latency in the benzodiazepine and placebo groups, but the benzodiazepine groups had increased total sleep duration (23.1 min. 95% CI = 5.6,40.6). In four trials with 252 subjects, the side effect profile did not show a statistically significant difference (OR 1.5, CI 0.8,2.9). There was only one study comparing the effect of behavioral therapy with triazolam. The result showed that triazolam was more effective than behavioral therapy in decreasing sleep latency, but its efficacy declined by the second week of treatment. Behavioral therapy remained effective throughout the 9-week follow-up period. There were four small trials that involved older patients exclusively, with three of the studies having less than 2 weeks of follow-up. The results were mixed regarding benefits and adverse effects were poorly reported. CONCLUSION: The result of the meta-analysis shows that the use of benzodiazepines results in a decrease in sleep latency and a significant increase in total sleep time as compared with placebo. There was also a report of significantly increased side effects, but this did not result in increased discontinuation rate. There was no dose-response relationship for beneficial effect seen with the use of benzodiazepines, although the data are scant. Zopiclone was the only alternative pharmacological therapy that could be studied with any precision. There was no significant difference in the outcome when benzodiazepines were compared with zopiclone. There was only one study that compared the effect of benzodiazepines with nonpharmacological therapy; thus available data are insufficient to comment. [source] Scared to lose control?JOURNAL OF CLINICAL PSYCHOLOGY, Issue 1 2008General, health locus of control in females with a phobia of vomiting Abstract The term emetophobia (i.e., a fear of vomiting) exists as rather an elusive predicament, often eluding conventional treatment. The present study involved 149 participants, consisting of 51 emetophobics, 48 phobic controls (i.e. those who suffered from a different phobia), and 50 nonphobic controls. Participants were administered the Rotter (1966) Locus of Control Scale and the Health Locus of Control Scale by B.S. Wallston, Wallston, Kaplan, and Maides (1976). Significant differences were found among the three groups; specifically, that emetophobics had a significantly higher internal Locus of Control Scale score with regard to both general and health-related issues than did the two control groups. It is suggested that vomiting phobics may have a fear of losing control, and that their vomiting phobia is reflective of this alternative, underlying problem. More research is required to explore the association between emetophobia and issues surrounding control; however, the current study suggests that it may be helpful for therapists to consider this aspect when treating a patient with vomiting phobia. © 2007 Wiley Periodicals, Inc. J Clin Psychol 64: 30,39, 2008. [source] Liberal Democrat Leadership: The Cases of Ashdown and KennedyTHE POLITICAL QUARTERLY, Issue 1 2007DUNCAN BRACK Effective leadership of the Liberal Democrats requires a combination of strengths: communications skills, a clear agenda, the ability to manage the party and personal abilities, including stamina, self-confidence and a love for the party itself. This article assesses Paddy Ashdown's and Charles Kennedy's periods as leader. It concludes that the first two phases of Ashdown's leadership were successful: he first ensured the party's survival and then positioned it so that it was able to benefit from the rise in support for the centre-left without being squeezed out by Labour. In the third phase, however, the attempt to deliver a common agenda with Labour was a failure, and Ashdown increasingly lost touch with his own party. Kennedy's first two years as leader were also relatively successful, but after that his leadership fell apart, suffering from a lack of an agenda, a failure of party management, a weakness in communication skills and a lack of self-confidence. His underlying problem was not alcoholism; it was that he was not capable of being an effective leader. [source] Studying protein folding on the Grid: experiences using CHARMM on NPACI resources under LegionCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 4 2004Anand Natrajan Abstract One benefit of a computational Grid is the ability to run high-performance applications over distributed resources simply and securely. We demonstrated this benefit with an experiment in which we studied the protein-folding process with the CHARMM molecular simulation package over a Grid managed by Legion, a Grid operating system. High-performance applications can take advantage of Grid resources if the Grid operating system provides both low-level functionality as well as high-level services. We describe the nature of services provided by Legion for high-performance applications. Our experiences indicate that human factors continue to play a crucial role in the configuration of Grid resources, underlying resources can be problematic, Grid services must tolerate underlying problems or inform the user, and high-level services must continue to evolve to meet user requirements. Our experiment not only helped a scientist perform an important study, but also showed the viability of an integrated approach such as Legion's for managing a Grid. Copyright © 2004 John Wiley & Sons, Ltd. [source] When density dependence is not instantaneous: theoretical developments and management implicationsECOLOGY LETTERS, Issue 2 2008Irja I. Ratikainen Abstract Most organisms live in changing environments or do not use the same resources at different stages of their lives or in different seasons. As a result, density dependence will affect populations differently at different times. Such sequential density dependence generates markedly different population responses compared to the unrealistic assumption that all events occur simultaneously. Various field studies have also shown that the conditions that individuals experience during one period can influence success and per capita vital rates during the following period. These carry-over effects further complicate any general principles and increase the diversity of possible population dynamics. In this review, we describe how studies of sequential density dependence have diverged in directions that are both taxon-specific and have non-overlapping terminology, despite very similar underlying problems. By exploring and highlighting these similarities, we aim to improve communication between fields, clarify common misunderstandings, and provide a framework for improving conservation and management practices, including sustainable harvesting theory. [source] SUMMIT ON UNIFIED FAMILY COURTS: SERVING CHILDREN AND FAMILIES EFFICIENTLY, EFFECTIVELY, AND RESPONSIBLYFAMILY COURT REVIEW, Issue 2 2008Karen J. Mathis As president of the American Bar Association when the "Summit on Unified Family Courts" convened in May 2007, Karen J. Mathis welcomed summit attendees. Recounting the many reasons children wind up in court, Mathis observed that society is lucky if these problems even come before the courts. Too often, she said, the underlying problems of destructive behavior among youth are lost in the shuffle of too many lawyers, case workers, and judges. "Many times they're ignored by the professionals among us who are not trained to be aware that the problems even exist," she said. The solution to this fragmented approach is unified family courts, she concluded. [source] The quality of treatment of eating disorders: A comparison of the therapists' and the patients' perspectiveINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2008Simone de la Rie MA Abstract Objective: The aims of this study were to investigate the quality of treatment of eating disorders (EDs) from the therapists' and patients' perspective and to compare their views. Method: The Questionnaire for Eating Problems and Treatment (QEPT) was administered to 73 therapists working with patients with ED, to 156 current ED and 148 former ED patients. The QEPT addresses the quality of treatment of EDs. ED diagnosis was assessed by the Eating Disorder Examination Questionnaire. Answers were analyzed quantitatively and qualitatively. Results: Both therapists and patients most often mentioned focus of treatment, therapeutic alliance, and communicational skills as important aspects of the quality of treatment. However, they valued similar topics differently. Therapists valued the focus on ED symptoms and behavioral change more highly, whereas patients underscored the importance of the therapeutic relationship and addressing underlying problems. Most therapists work from a cognitive behavioral orientation, but protocol-based treatment was not found important. Conclusion: There is an avid need for dissemination of evidence-based treatment. Therapists' and patients' views supplement current evidence-based knowledge on treatment quality of EDs. Optimal treatment of EDs will be facilitated when these three bodies of knowledge,the available evidence and the therapists' and patients' views,are integrated. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord, 2008 [source] Is iPS cell the panacea?IUBMB LIFE, Issue 3 2010Li Ou Abstract In 2006, it was reported that transgenic expression of merely four defined transcription factors (c-Myc, Klf4, Oct4, and Sox2) is sufficient to reprogram somatic cells to a pluripotent state. The resulting induced pluripotent stem (iPS) cells ignited intense interest in the field of life science for their promising applications in basic biology, drug development, and transplantation. However, the underlying problems of iPS cells seem to be ignored. This review shed light on the problems pertaining iPS cells, including the elusive origin, risk of tumorgenesis, and its relationship with natural selection. © 2010 IUBMB IUBMB Life, 62(3): 170,175, 2010 [source] Psychological aspects of hair diseaseJOURNAL OF COSMETIC DERMATOLOGY, Issue 2 2005Ramon Grimalt Summary Balding men are viewed as less desirable in a physical, personal, and social sense. Given the stereotype, it is not surprising that some men with androgenetic alopecia (AGA) appear to have a lower self-image, depression resulting in increased introversion, and increased feelings of unattractiveness. Ours is a culture that places a premium on physical appearance. In this context, appearance-altering conditions can be psychosocially insidious, especially conditions such as AGA with an uncertain course and a negative social meaning. To date, little or no data have been available regarding the psychosocial and quality-of-life aspects of AGA in a representative sample of community men. It is unknown whether AGA is a causal factor in the development of low self-esteem, depression, introversion, and feeling of unattractiveness, or whether there are underlying problems in certain patients prior to hair loss. Longitudinal studies will be important to investigate the temporal relationships between the degree of hair loss and psychosocial variables associated with AGA. A patient with male pattern baldness will be better treated and consequently more satisfied (better quality of life) if he receives effective anti-alopecia agents and simultaneously is evaluated and treated, if needed, for his psychological disorder. [source] Presidential Address: Liquidity and Price DiscoveryTHE JOURNAL OF FINANCE, Issue 4 2003Maureen O'Hara This paper examines the implications of market microstructure for asset pricing. I argue that asset pricing ignores the central fact that asset prices evolve in markets. Markets provide liquidity and price discovery, and I argue that asset pricing models need to be recast in broader terms to incorporate the transactions costs of liquidity and the risks of price discovery. I argue that symmetric information-based asset pricing models do not work because they assume that the underlying problems of liquidity and price discovery have been solved. I develop an asymmetric information asset pricing model that incorporates these effects. [source] Capital Markets Regulation: How Can Accounting Research Contribute?AUSTRALIAN ACCOUNTING REVIEW, Issue 4 2009Stephen Taylor In examining the possible contribution that accounting research can play in ensuring effective and efficient regulation of securities markets, two principal opportunities stand out. First, the role of research in informing debate about proposed regulatory intervention (ex ante contribution to regulatory debate). Second, the ability of research to inform analysis as to the effectiveness of previously implemented regulatory changes (ex post contribution to regulatory debate). In the ex ante case, there is a natural tension between the way in which regulatory initiatives often arise quickly and the inevitable passage of time required to fully appreciate the degree to which underlying problems have been correctly characterised and can be framed in a manner suitable for addressing via rigorous analytical and empirical research. It is also impossible to empirically assess the effect of regulatory intervention that has not yet occurred. Finally, if data are simply not available, then research is limited to analytical analysis and prediction. In the ex post case, there is often a natural reluctance to subject regulatory intervention to mandatory analysis, and even when a statutory requirement exists for such analysis and review, the time horizon is often far too short for meaningful analysis. In both the ex ante and ex post cases, what is unavoidable is that regulation can only be legitimately informed by research that is sufficiently rigorous so as to have robust conclusions. Assessing research on these dimensions means that transparency is required so as to allow researchers to engage in meaningful debate about the validity of the conclusions. This inevitably means that research needs to be a partnership between regulatory agencies and academia, and that when research is used to justify regulatory interventions it must be publicly available and subject to robust debate. [source] Context and its significance in identifying ,what works' in child protectionCHILD ABUSE REVIEW, Issue 3 2005Adrian Barton Abstract The repetitive nature of the underlying problems with child protection systems identified by many inquiries into child deaths suggests that the ability to transpose successful strategies from one area to another may be contingent on more than a ,technical' approach to best practice. Current policy responses to failing child protection systems are arguably based on an assumption that practices that work in one area may be applied in other areas without reference to the existing base for practice. Drawing on our own experiences in the field, we attempt to explore some methodological issues relevant to the evaluation of service provision and the dissemination of effective practice in interagency working. Copyright © 2005 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||