R&D policy instruments – a critical review of what we do and don’t know

In recent years, the term ‘policy instrument’ has been used more frequently with regard to R&D policy and innovation policy. What does this term mean? Where did it come from? What do we know about it, both with regard to the general field of policy studies but also in the specific context of R&D policy? This article examines the development of the notion of policy instruments as part of a body of research known as ‘policy design’. Over the last 50 years, there has been substantial progress in setting policy design on a more systematic basis, with the development of established concepts and analytical frameworks, including various taxonomies of policy instruments. However, with just a few exceptions, this body of research seems to have had little impact in the world of R&D policy. The paper reviews the literature on R&D policy instruments. It identifies a number of challenges for R&D policy instruments in the light of four transitions – the shift from linear to systemic thinking about R&D and innovation, the shift from national governments to multi-level governance, the shift from individual actors to collaborations and networks, and the shift from individual policies to policy mixes. It sets out a research agenda for the study of R&D policy instruments, before ending with a number of conclusions

Effect of Groundwater Pumping on Seawater Intrusion in Coastal Aquifers

Many aquifers around the globe are located in coastal areas and are thus subjected to the seawater intrusion phenomenon. The growth of population in coastal areas and the conjugate increase in human, agricultural, and industrial activities have imposed an increasing demand for freshwater. This increase in water demand is often covered by extensive pumping of fresh groundwater, causing subsequent lowering of the water table (or piezometric head) and upsetting the dynamic balance between freshwater and saline water bodies. The classical result of such a development is seawater intrusion. This paper presents a review for the seawater intrusion phenomenon in coastal aquifers. The effect of pumping activities on the seawater intrusion in the Nile Delta aquifer of Egypt is investigated. It was concluded that any additional pumping should be located in the middle Delta and avoided in the eastern and western sides of the Delta

Differential expression of the host lipid regulators angptl‐3 and angptl‐4 in hcv infection and treatment

Host lipid metabolism reprogramming is essential for hepatitis C virus (HCV) infection and progression to severe liver disease. Direct‐acting antivirals (DAAs) achieve a sustained virological response (SVR) in most patients, but virus eradication does not always protect against hepatocellular carcinoma (HCC). Angiopoietin‐like protein‐3 (ANGPTL‐3) and angiopoietin‐like protein‐ 4 (ANGPTL‐4) regulate the clearance of plasma lipids by inhibiting cellular lipase activity and possess emerging roles in tumourigenesis. We used ELISA and RT‐qPCR to investigate ANGPTL‐3 and ANGPTL‐4 expression in HCV patients with characterised fibrosis throughout the natural history of hepatitis C and in long‐term HCV infection in vitro, before and after DAA treatment. ANGPTL‐ 3 was decreased in patients with advanced fibrosis compared to other disease stages, while ANGPTL‐4 was progressively increased from acute infection to cirrhosis and HCC, peaking at the advanced fibrosis stage. Only ANGPTL‐3 mRNA was down‐regulated during early infection in vitro, although both ANGPTLs were increased later. DAA treatment did not alter ANGPTL‐3 levels in advanced fibrosis/cirrhosis and in HCV infection in vitro, in contrast to ANGPTL‐4. The association between ANGPTLs and fibrosis in HCV infection was underlined by an inverse correlation between the levels of ANGPTLs and serum transforming growth factor‐ β (TGF‐β). Collectively, we demonstrate the pivotal role of advanced fibrosis in defining the expression fate of ANGPTLs in HCV infection and after treatment and propose a role for ANGPTL‐3 as a contributor to post‐treatment deregulation of lipid metabolism that could predispose certain individuals to HCC development. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

The practice and teaching of palpation of the head and neck: A scoping review

Objective: To explore how palpation of the head and neck is practiced and taught. Methods: The scoping review methodology was guided by Arksey and O’Malley’s five-stage approach. Three experienced and independent reviewers searched nine databases according to a predetermine inclusion and exclusion criteria. Results: A total of 15 articles from medicine, chiropractic and dentistry published between 1987 and 2016 were included. Two overarching themes emerged, a Cartesian and a Pragmatic perspective in practicing and teaching palpating of the head and neck. Although both perspectives are valuable, we advocate to practice and teach palpation of head and neck from a Pragmatic perspective particularly with the increase use of ultrasound technology to detect masses. A pragmatic perspective takes into account the patient’s context, the ethics of care and highlights the importance of health care providers fostering interpersonal relationships with others during physical assessment. Conclusions: Although nursing studies were absent from this review we believe nurses play a vital role when they are aware of the Cartesian and Pragmatics perspectives when practicing and teaching head and neck palpation as part of a physical assessment. Learning how other disciplines are practicing and teaching head and neck palpation skills will improve interdisciplinary collaboration

Psychosocial Benefits of Postmastectomy Lymphedema Therapy

The effect of a comprehensive lymphedema management program was assessed in 25 patients in whom moderate to severe lymphedema had developed after surgery and/or radiotherapy for carcinoma of the breast. Intensive treatment (4 weeks) involved massage, compression bandaging, and sequential pneumatic compression, with an adjunct program of education to provide skills in exercise, massage, bandage, and containment garment use. The intensive treatment phase was followed by a self-management phase based on the skills had been acquired. A significant reduction in limb circumference and volume, with continuing improvement over 12 months of self-management, was observed. There was a decrease in need for physical assistance. Quality of life generally remained high and stable throughout the 12 months. Quality of life specific to lymphedema, however, declined during the intensive phase of treatment, but recovered and surpassed pretreatment levels during the self-management phase of treatment. Perceived comfort and strength in the lymphedematous limb improved, and perceived size decreased. The study confirmed that the combination of multimodal physical therapy and education for self-management reduces lymphedema and its adverse subjective consequences and maintains the improvement thus achieved