263 research outputs found

    Health Care in Federal Systems

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    How do multilevel health care systems evolve? Do they develop in a similar manner, or are their respective paths of evolution more sui generis? The aim of this article is to compare the way in which Canada and the European Union have attempted to coordinate health policy between their component multilevel jurisdictions over time. This article argues that the EU—despite its limited authority over health care—has been better able than Canada to develop a greater capacity for addressing health policy at a supranational level, notwithstanding Canada’s greater federal involvement in financing health care. While the experience of the EU supports the theoretical premises of neofunctionalism (that a certain level of integration will induce even greater integration in other areas, especially in response to crisis), the experience of Canadian health care federalism does not fit that theoretical paradigm. This suggests a limited applicability for neofunctionalist theory across multilevel systems more widely

    Getting Representation Right for Women in Development: Accountability, Consent, and the Articulation of Women's Interests

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    Summary To what extent does the recent emphasis upon accountability by development institutions augur well for women? This article firstly describes how accountability is grounded upon the concept of consent as the principal prerequisite of legitimate authority; secondly notes how consent has historically played an ambivalent role for women; and finally argues that placing consent within a ‘context of choice’ which recognizes cultural identity threatens to negate the value of consent for women in development. RESUME La représentation fidèle des femmes dans le développement: la responsabilité financière, l'assentiment, et l'articulation des intérêts des femmes L'emphase récente sur la responsabilité financière exigée par les institutions de développement estelle de bonne augure pour les femmes, et jusqu'à quel point? Dans un premier temps, cet article examine comment la responsabilité financière se fonde sur un concept où l'assentiment est l'exigence préalable et primordiale de l'autorité légitime; ensuite l'auteur observe comment, dans l'histoire, l'assentiment a joué un rôle ambivalent du point des femmes; et en dernier lieu, elle affirme que le fait de cerner l'assentiment dans un ‘contexte de choix’ qui reconnaît l'identité culturelle, risque de réduire à zéro la valeur de l'assentiment des femmes au développement. RESUMEN Representación acertada de la mujer en el desarrollo; responsabilidad, consentimiento, y la articulación de los intereses de la mujer ¿Hasta qué punto augura bien para la mujer el énfasis reciente en la responsabilidad a cargo de las instituciones de desarrollo? Este artículo describe primeramente cómo la responsabilidad se basa en el concepto de consentimiento como requerimiento principal para la autoridad legítima; en segundo lugar, se destaca en qué forma el consentimiento ha jugado históricamente un papel ambivalente para la mujer, y finalmente se argumenta qué la ubicación de consentimiento dentro de un ‘contexto de libre selección’ que reconoce la identidad cultural, amenaza con negar el valor de aquél para la mujer en el proceso de desarrollo

    Intracranial Penetration During Temporal Soft Tissue Filler Injection-Is It Possible?

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    BACKGROUND Treating temporal volume loss for aesthetic and reconstructive purposes can be achieved by superficial or deep injections of soft tissue fillers into the temples. The latter is performed with bone contact that can lead to intracranial penetration when the bone is accidentally penetrated. OBJECTIVE Based on a clinical case, the potential risk of accidental intracranial penetration was investigated. MATERIALS AND METHODS Twenty fresh-frozen hemi-faces (all Caucasian ethnicity, 10 women, 10 men, mean age 72.8 +/- 11.2 years) were investigated. Shape of pterion and bone-stability parameters of the temporal fossa were investigated. Bone stability was tested using uniaxial mechanical indentation (18-G, 1.25-mm diameter, 15-mm length blunt-tip device) until intracranial perforation occurred. RESULTS Variations in the shape of the pterion, bone thickness, and density correlates were detected, however, without statistical significant differences in side symmetry. Minimum force necessary to penetrate intracranially was 40.4 N. Maximum force generated by an 18-g, 70-mm length blunt-tip cannula was 32.1 +/- 4.2 N in 70 mm length and 75.3 +/- 10.2 N in 15 mm length. CONCLUSION Based on the results of this investigation, it can be concluded that there is a risk for intracranial penetration performing the deep temple injection technique with direct pressure on the bone

    Transparency Too Little, Too Late? Why and How Health Canada Should Make Clinical Data and Regulatory Decision-Making Open to Scrutiny in the Face of COVID-19

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    Hard-won gains in the transparency of therapeutic product data in recent years1 have occurred alongside growing reliance by regulators upon expedited review processes.2 The concurrence of these two trends raises fundamental questions for the future of pharmaceutical regulation about whether the institutionalization of transparency will foster improved oversight of drugs, biologics, vaccines, and other interventions, or else, provide cover for a relaxing of regulatory standards of safety, effectiveness, and quality.3 The urgency of the COVID-19 pandemic, however, has brought this tension into immediate and sharp relief. During the course of the global health crisis, regulatory bodies have markedly expanded the number and use of expedited review processes for COVID-19 therapies, and at the same time, the proliferation of misinformation about any potential SARS-CoV-2 intervention4 reveals the limitations of recently implemented transparency measures

    Bonding of articular cartilage using a combination of biochemical degradation and surface cross-linking

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    After trauma, articular cartilage often does not heal due to incomplete bonding of the fractured surfaces. In this study we investigated the ability of chemical cross-linkers to facilitate bonding of articular cartilage, either alone or in combination with a pre-treatment with surface-degrading agents. Articular cartilage blocks were harvested from the femoropatellar groove of bovine calves. Two cartilage blocks, either after pre-treatment or without, were assembled in a custom-designed chamber in partial apposition and subjected to cross-linking treatment. Subsequently, bonding of cartilage was measured as adhesive strength, that is, the maximum force at rupture of bonded cartilage blocks divided by the overlap area. In a first approach, bonding was investigated after treatment with cross-linking reagents only, employing glutaraldehyde, 1-ethyl-3-diaminopropyl-carbodiimide (EDC)/N-hydroxysuccinimide (NHS), genipin, or transglutaminase. Experiments were conducted with or without compression of the opposing surfaces. Compression during cross-linking strongly enhanced bonding, especially when applying EDC/NHS and glutaraldehyde. Therefore, all further experiments were performed under compressive conditions. Combinations of each of the four cross-linking agents with the degrading pre-treatments, pepsin, trypsin, and guanidine, led to distinct improvements in bonding compared to the use of cross-linkers alone. The highest values of adhesive strength were achieved employing combinations of pepsin or guanidine with EDC/NHS, and guanidine with glutaraldehyde. The release of extracellular matrix components, that is, glycosaminoglycans and total collagen, from cartilage blocks after pre-treatment was measured, but could not be directly correlated to the determined adhesive strength. Cytotoxicity was determined for all substances employed, that is, surface degrading agents and cross-linkers, using the resazurin assay. Taking the favourable cell vitality after treatment with pepsin and EDC/NHS and the cytotoxic effects of guanidine and glutaraldehyde into account, the combination of pepsin and EDC/NHS appeared to be the most advantageous treatment in this study. In conclusion, bonding of articular cartilage blocks was achieved by chemical fixation of their surface components using cross-linking reagents. Application of compressive forces and prior modulation of surface structures enhanced cartilage bonding significantly. Enzymatic treatment in combination with cross-linkers may represent a promising addition to current techniques for articular cartilage repair

    Spread of psoriasiform inflammation to remote tissues is restricted by the atypical chemokine receptor ACKR2

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    Elucidating the poorly defined mechanisms by which inflammatory lesions are spatially restricted in vivo, is of critical importance in understanding skin disease. Chemokines are the principal regulators of leukocyte migration and are essential in the initiation and maintenance of inflammation. The membrane-bound psoriasis associated atypical chemokine receptor ACKR2 binds, internalises and degrades most pro-inflammatory CC-chemokines. Here we investigate the role of ACKR2 in limiting the spread of cutaneous psoriasiform inflammation to sites that are remote from the primary lesion.  Circulating factors capable of regulating ACKR2 function at remote sites were identified and examined using a combination of clinical samples, relevant primary human cell cultures, in vitro migration assays and the imiquimod-induced model of psoriasiform skin inflammation. Localised inflammation and IFN together upregulate ACKR2 in remote tissues, protecting them from the spread of inflammation. ACKR2 controls inflammatory T-cell chemotaxis and positioning within the skin, preventing an epidermal influx that is associated with lesion development. Our results have important implications for our understanding of how spatial restriction is imposed on the spread of inflammatory lesions, and highlight systemic ACKR2 induction as a therapeutic strategy in the treatment and prevention of psoriasis and potentially a broad range of other immune-mediated diseases

    Sleepiness and fatigue in multiple sclerosis - same same but different? A systematic review on the Epworth Sleepiness Scale as an assessment tool

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    Objectives: Fatigue is a frequent and distressing symptom in patients with multiple sclerosis (MS). In contrast, sleepiness, characterized by difficulties to stay awake and alert during the day, seems to be less prevalent in MS; however exact studies are lacking. In addition, there is a semantic confusion of the concepts of “fatigue” and “sleepiness”, which are often used interchangeably. Methods: We conducted a systematic review of studies using the Epworth Sleepiness Scale (ESS) for the assessment of daytime sleepiness in patients with MS. Results: The summarized results of 48 studies demonstrate that sleepiness, as indicated by elevated ESS scores, is less prevalent and less severe than fatigue but is present in a significant proportion of patients with MS. In most cross-sectional and longitudinal studies, there was a moderate association between ESS scores and various fatigue rating scales. Longitudinal studies on the effect of wakefulness- promoting agents failed to show a consistent improvement of sleepiness or fatigue as compared to placebo. It has also been shown that daytime sleepiness is frequently associated with comorbid sleep disorders that are often underrecognized and undertreated in MS. Conclusions: Sleepiness and potential sleep disorders may also precipitate and perpetuate fatigue in patients with MS and should be part of the differential diagnostic assessment. To support an appropriate decision-making process, we propose an algorithm for the evaluation of sleepiness as compared to fatigue in patients with MS. Disclosure: Nothing to disclose
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