Effective Environmental Enforcement: The Missing Link to Achieving Sustainable Development

In response to the emergence of sustainable development as the dominant environmental and economic paradigm, a number of mechanisms have been developed to assist in the implementation of these principles. Examples of these super instruments abound--market measures, eco-covenants, joint implementation and voluntary compliance. Appreciably less enthusiasm has been dedicated to capacity building for other more traditional tools prescribed by international laws. Counted among the disregarded tools is the widely maligned and misunderstood role of enforcement. This thesis argues that the potential for effecting innovative reforms may be significantly threatened by an underlying misunderstanding and failed appreciation of the critical role that enforcement can and must play in achieving sustainable development. Without a better understanding of the potential contribution of enforcement and the minimum framework necessary to ensure compliance, it will be difficult to fully comprehend the underlying barriers to implementing sustainable development. A lack of political will coupled with an under-commitment of resources, will inevitably result in failed capacity to achieve any measurable results

Conflicting Bureaucracies, Conflicted Work: Dilemmas in Case Management for Homeless People with Mental Illness

This ethnographic study finds a case management agency torn between the rules of two conflicting bureaucracies. Funded by a federal grant, the agency is administered by the county, and the regulations of the two systems turn out to be incompatible. This conflict creates dilemmas in providing services to clients: meeting eligibility criteria for services from the federal grant meant the clients did not meet the eligibility criteria for many County services. Agency staff reacted to this dilemma by bending rules, finding loopholes, and investing extra time and emotional labor in each client. The role-conflict engendered by bureaucratic disjunction creates frustration, resentment, and burnout within the agency

Amino-terminal dimerization of an erythropoietin mimetic peptide results in increased erythropoietic activity

AbstractBackground: Erythropoietin (EPO), the hormone involved in red blood cell production, activates its receptor by binding to the receptor's extracellular domain and presumably dimerizing two receptor monomers to initiate signal transduction. EPO-mimetic peptides, such as EMP1, also bind and activate the receptor by dimerization. These mimetic peptides are not as potent as EPO, however. The crystal structure of the EPO receptor (EBP) bound to EMP1 reveals the formation of a complex consisting of two peptides bound to two receptors, so we sought to improve the biological activity of EPO-mimetic peptides by constructing covalent dimers of EMP1 and other peptide mimetics linked by polyethylene glycol (PEG).Results: The potency of the PEG-dimerized EPO peptide mimetics both in vitro and in vivo was improved up to 1,000-fold compared to the corresponding peptide monomers. The dinners were constructed using peptide monomers which have only one reactive amine per molecule, allowing us to conclude that the increase in potency can be attributed to a structure in which two peptides are linked through their respective amino termini to the difunctional PEG molecule. In addition, an inactive peptide was converted into a weak agonist by PEG-induced dimerization.Conclusions: The potency of previously isolated peptides that are modest agonists of the EPO receptor was dramatically increased by PEG-induced dimerization. The EPO receptor is thought to be dimerized during activation, so our results are consistent with the proposed 2:2 receptor : peptide stoichiometry. The conversion of an inactive peptide into an agonist further supports the idea that dimerization can mediate receptor activation

Pregnant and Poor in the Suburb: The Experiences of Economically Disadvantaged Women of Color with Prenatal Services in a Wealthy Suburban County

This study explores the perinatal care experiences of disadvantaged women of color in a wealthy U.S. suburb. The women were asked to discuss the availability of health and social services during pregnancy, continuity of provider and/or treatment, communication issues with their providers, and the amount and type ofsupport and resources available. Many of the questions covered in literature on urban poverty emerged as well in this suburban sample, including economic and psychosocial barriers, and continuity and communication issues between low-income/minority women and providers of health and social services. Additional barriers in the suburbs were also discussed, including problems of access to care and services, with health insurance/reimbursement or financial accessibility, transportation and housing, and getting needed information. Overall findings support the argument that suburban poverty is an overlooked issue contributing to health disparities in infant mortality

Which primary care practitioners have poor human papillomavirus (HPV) knowledge? A step towards informing the development of professional education initiatives

Background: Primary care practitioners (PCP) play key roles in cervical cancer prevention. Human papillomavirus (HPV) knowledge is an important influence on PCPs’ cervical cancer prevention-related behaviours. We investigated HPV knowledge, and associated factors, among general practitioners (GPs) and practice nurses. Methods: A survey, including factual questions about HPV infection and vaccination, was mailed to GPs and practice nurses in Ireland. Multivariable logistic regression was used to determine which PCPs had low knowledge (questions correctly answered: infection ≤5/11; vaccination: ≤4/10). Questions least often answered correctly were identified. Results: 697 PCPs participated. For HPV infection, GPs and practice nurses answered a median of nine and seven questions correctly, respectively (p⅓ of PCPs. Conclusions: There are important limitations in HPV infection and vaccination knowledge among PCPs. By identifying factors associated with poor knowledge, and areas of particular uncertainty, these results can inform development of professional education initiatives thereby ensuring women have access to uniformly high-quality HPV-related information and advice

A multicenter evaluation of the efficacy and duration of action of alcaftadine 0.25% and olopatadine 0.2% in the conjunctival allergen challenge model

Background: The purpose of this study was to evaluate the efficacy and duration of action of once-daily dosing with alcaftadine 0.25% ophthalmic solution and olopatadine 0.2% ophthalmic solution as compared with placebo in the prevention of ocular itching, and to directly compare the efficacy of alcaftadine 0.25% with olopatadine 0.2% in the prevention of ocular itching associated with allergic conjunctivitis using the conjunctival allergen challenge model. Methods: Subjects with allergic conjunctivitis (n = 127) were enrolled in a multicenter, double-masked, randomized, active-controlled and placebo-controlled clinical trial. Using the conjunctival allergen challenge model, this study was conducted over the course of approximately 5 weeks. Subjects were randomized into one of three treatment arms: alcaftadine 0.25% ophthalmic solution, olopatadine 0.2% ophthalmic solution, or placebo. Study medications were administered twice over the course of the trial. The primary efficacy measure for the study was ocular itching evaluated by the subject at 3, 5, and 7 minutes post challenge. Secondary endpoints, measured at 7, 15, and 20 minutes post challenge, included conjunctival, ciliary, and episcleral redness, lid swelling, chemosis, and tearing. Duration of action was measured at 16 and 24 hours post-instillation of the study medication at visits 3 and 4, respectively. Results: For the primary measure of ocular itching, both actives, alcaftadine 0.25% and olopatadine 0.2%, were statistically superior to placebo at all three measured time points for both the 16-hour and 24-hour measures (P < 0.0001). Eyes treated with alcaftadine 0.25% had numerically lower mean ocular itching scores than eyes treated with olopatadine 0.2% at every time point, and this difference was statistically significant at the 3-minute time point 16 hours post instillation (P = 0.026). Eyes treated with alcaftadine 0.25% and with olopatadine 0.2% displayed significantly less lid swelling relative to placebo at every time point for the 16-hour and 24-hour post-instillation visits (P < 0.005). Alcaftadine 0.25% was the only active treatment that provided statistically significant relief of chemosis at every time point of the 24-hour post-instillation visit. Conclusion: Both the alcaftadine 0.25% and olopatadine 0.2% ophthalmic solutions provided highly effective relief of ocular itching at both 16 and 24 hours post-instillation. Treatment differences between the actives were most pronounced at the earliest time point (3 minutes post-challenge) following conjunctival allergen challenge (16 hours), when alcaftadine 0.25% ophthalmic solution was statistically superior to olopatadine 0.2% ophthalmic solution. Alcaftadine 0.25% was the only treatment to provide significant relief from chemosis at both 16 and 24 hours post-instillation. Both active treatments and placebo were generally safe and well tolerated

Do children have a right to do nothing? exploring the place of passive leisure in Australian school age care

In 2021, the Australian Government commissioned a review and update of My Time Our Place, its curriculum framework for School-Age Care services for primary-age children. One update trialled was the introduction of passive leisure. Whilst children’s passive use of leisure time is recognised as a right, it is often problematised and associated with negative health outcomes. This article explores a trial of passive leisure provision. It provides hopeful evidence that passive leisure spaces can be interactive, conversational and restful

Factors driving inequality in prostate cancer survival: a population based study

As cancer control strategies have become more successful, issues around survival have become increasingly important to researchers and policy makers. The aim of this study was to examine the role of a range of clinical and socio-demographic variables in explaining variations in survival after a prostate cancer diagnosis, paying particular attention to the role of healthcare provider(s) i.e. private versus public status. Data were extracted from the National Cancer Registry Ireland, for patients diagnosed with prostate cancer from 1998-2009 (N = 26,183). A series of multivariate Cox and logistic regression models were used to examine the role of healthcare provider and socio-economic status (area-based deprivation) on survival, controlling for age, stage, Gleason grade, marital status and region of residence. Survival was based on all-cause mortality. Older individuals who were treated in a private care setting were more likely to have survived than those who had not, when other factors were controlled for. Differences were evident with respect to marital status, region of residence, clinical stage and Gleason grade. The effect of socio-economic status was modified by healthcare provider, such that risk of death was higher in those men of lower socio-economic status treated by public, but not private providers in the Cox models. The logistic models revealed a socio-economic gradient in risk of death overall; the gradient was larger for those treated by public providers compared to those treated by private providers when controlling for a range of other confounding factors. The role of healthcare provider and socio-economic status in survival of men with prostate cancer may give rise to concerns that warrant further investigation