Introducing Public Procurement

This chapter introduces the concept of public procurement and explains what itis and is not and how it is distinct from private purchasing. To do so it describesthe public-private continuum and explains what publicness is. Subsequently, thepublic procurement process is described using the circular 3P (Prepare, Purchase, and Perform) model. This is followed by a discussion of the seven developmental stages of public procurement. It explains how public procurement has developed over time from an executive management function aimed at fulfilling an internal demand to a policy instrument that can collaboratively create public value. The chapter ends with an explanation of the multifaceted nature of public procurement and why understanding and applying multiple perspectives (e.g., economic, legal, societal, and political) is necessary to bring public procurement into a new era and fully understand and utilize the impact of public procurement

Short and long term treatment of asthma with intravenous nutrients

BACKGROUND: Asthma is an increasing problem in this country and others. Although medications for the treatment of asthma abound and are improving, there are inherent risks and side effects with all of them. Intravenous magnesium has been employed in the treatment of acute asthma, but its use has not become universal, nor has it been studied for the treatment of chronic asthma. It is known to be a safe drug with minimal side effects. In this study, the author investigates the use of magnesium and other nutrients in the treatment of both acute and chronic asthma. METHODS: In this non-blinded outcome study, following informed consent, forty-three (43) randomly selected volunteer patients with both acute and chronic asthma were treated with IV infusions described herein. All patients were observed with spirometry 10 minutes post-infusion; two sub-groups of patients were also observed after multiple infusions over a short period of time (less than one month) and a longer period of time (average 5.8 months). Pulmonary function was analyzed by spirometric testing with pre- and post-infusion spirometric measurements with the pre/post group. For longer term (Trend) patients, baseline spirometry measurements were compared to spirometry measurements after patients had received multiple infusions over a period of time. Eight (8) patients were measured for both pre/post and Trend data. RESULTS: The 38 pre-infusion/post-infusion patients with acute and chronic asthma demonstrated an overall average improvement (percentage improvement in percent predicted) of 45%. The 13 patients measured for improvement over time (Trend data, average duration 5.82 months), demonstrated an overall average improvement (percentage improvement in percent predicted) of 57%. Of the 13 patients in the multiple infusion group, 9 patients who received longer-term therapy (average duration of 12.58 months) for chronic asthma demonstrated an overall average improvement of 95% (percentage improvement in percent predicted). CONCLUSION: The use of intravenous treatment with multiple nutrients, including magnesium, for acute and chronic asthma may be of considerable benefit. Pulmonary function improved progressively the longer patients received treatment

Kematian yang digandrungi: eutanasia dan hak menentukan nasib sendiri

vii, 171 hal.; 20 c

Introductie van publieke inkoop

Dit hoofdstuk introduceert het concept publieke inkoop en beschrijft hoe het zich onderscheidt van inkoop door private ondernemingen. Het publiek-private continuüm wordt uitgelegd en de betekenis van publiek verder toegelicht. Ook wordt het publieke inkoopproces beschreven aan de hand van het circulaire 3V-model van Voorbereiding, Verwerving en Verwezenlijking. Hierna wordt uitgelegd hoe publieke inkoop zich in zeven ontwikkelingsfasen van ontwikkelen van een intern georiënteerde uitvoerende managementfunctie tot een beleidsinstrument dat via co-creatie publieke waarde kan creëren. Het hoofdstuk eindigt met een toelichting op de veelzijdige aard van publieke inkoop en waarom het begrijpen en toepassen van meerdere perspectieven noodzakelijk is om publieke inkoop naar een nieuw tijdperk te leiden en de impact van publieke inkoop volledig te begrijpen en benutten

Introducing Public Procurement

This chapter introduces the concept of public procurement and explains what it is and is not and how it is distinct from private purchasing. To do so it describes the public-private continuum and explains what publicness is. Subsequently, the public procurement process is described using the circular 3P (Prepare, Purchase, and Perform) model. This is followed by a discussion of the seven developmental stages of public procurement. It explains how public procurement has developed over time from an executive management function aimed at fulfilling an internal demand to a policy instrument that can collaboratively create public value. The chapter ends with an explanation of the multifaceted nature of public procurement and why understanding and applying multiple perspectives (e.g., economic, legal, societal, and political) is necessary to bring public procurement into a new era and fully understand and utilize the impact of public procurement

Does playing a wind instrument influence tooth position and facial morphology?: Systematic review and meta-analysis

Purpose: To systematically search the scientific literature concerning the influence of playing a wind instrument on tooth position and/or facial morphology. Methods: The PubMed, EMBASE and Cochrane databases were searched up to September 2019. Orthodontic journals were hand searched and grey literature was sought via Google Scholar. Observational studies and (randomized) controlled clinical trials that assessed tooth position and/or facial morphology by profile cephalograms, dental casts or clinical examination were included. The potential risk of bias was assessed. Data from wind instrument players and controls were extracted. Descriptive analysis and meta-analysis were performed. Results: In total, 10 eligible studies with a cross-sectional (n = 7) or longitudinal design (n = 3) and an estimated low to serious risk of bias were included. Sample sizes ranged from 36 to 170 participants, varying from children to professional musicians. Descriptive analysis indicated that adults playing a single-reed instrument may have a larger overjet than controls. Playing a brass instrument might be associated with an increase in maxillary and mandibular intermolar width among children. Longitudinal data showed less increase in anterior facial height among brass and single-reed players between the age of 6 and 15. Children playing a wind instrument showed thicker lips than controls. Meta-analysis revealed that after a follow-up of 6 months to 3 years, children playing brass instruments had a significant reduction in overjet as compared to controls. The magnitude of the effect was of questionable clinical relevance and the generalizability was limited. Conclusions: Playing a wind instrument can influence tooth position and facial morphology in both children and adults. Aspects that stand out are overjet, arch width, facial divergence/convergence and lip thickness. However, evidence was sparse and the strength of the premise emerging from this review was graded to be “very low”

Patient's willingness to opt for external cephalic version

Objective: External cephalic version (ECV) is a relatively simple and safe maneuver that reduces the cesarean section (CS) rate for breech presentation. There is professional consensus that ECV should be offered to all women, but only up to 70% of patients opt for this treatment. To improve counseling, we investigated the value patients place on various aspects of ECV. Methods: We studied patient preferences by means of a vignette study. Varying levels of treatment characteristics were investigated in 16 scenarios, all including the “opt out” alternative of an elective CS. The probability that women preferred ECV was estimated using a logistic regression approach. Results: Forty seven women participated in the study. Pain was the most important factor negatively influencing the willingness to opt for ECV (OR 0.11 (95% confidence interval (CI) 0.05–0.23) for a pain score of 8–10 compared to 1–2 on a visual analog scale of 0–10). Higher success rates of vaginal delivery after successful ECV increased women’s willingness (OR 3.42 (95% CI 2.04–5.74), if chance of vaginal delivery after successful ECV increased from 24% to 52%). The risk of an emergency CS during ECV did not influence the willingness to opt for ECV (OR 0.83 (95% CI 0.59–1.18) of chance increased from 0% to 1%). Conclusions: We conclude that expected pain during treatment and the success rate are the most important factors influencing the willingness to undergo ECV. Taking this information into account when counseling for ECV and reassuring women that unbearable pain is always a reason to stop ECV, and that the vast majority of women reported that the experienced pain is bearable, might improve the uptake of ECV and decrease the number of CS due to breech presentation.Floortje Vlemmix, Marjon Kuitert, Joke Bais, Brent Opmeer, Joris van der Post, Ben Willem Mol, and Marjolein Ko