Environmental Scanning--The Impact of the Stakeholder Concept

This paper discusses the advantages of the use of the stakeholder framework as a basis for focusing an organization\u27s environmental scanning effort. Arising from the discussion, a contingency model for environmental scanning is developed to relate the focus and method used for environmental scanning to the dynamism of the environment and the power of the stakeholder relative to the organization. Steps for implementing the environmental scanning system are then discussed

Probing the molecules of the mind

The molecular dimension of biology has been finding practical applications in all fields of medicine over the last few decades, but arguably one of the most challenging and exciting areas is that of molecular psychiatry. Much progress has been gained from traditional linkage studies into gene candidates for various psychiatric disorders, including schizophrenia, bipolar states, bulimia, autism and attention deficit hyperactivity disorder. This review outlines basic principles of molecular medicine from the perspective of the human genome project and its role in enabling rapid progress in the understanding of molecular neuro-anatomy, physiology and pathology. These insights have facilitated rather than complicated the diagnostic process, and have paved the way, in what has been termed the “post-genome era”, for a rational approach to therapy in a growing range of disorders. A patient's inherited genetic constitution is but one aspect of molecular medicine, and rich insights are also being gained into the operation of the genome as it interacts with its environment, including its pharmacological environment. From parallel processing technologies and genomic expression profiling, massive knowledge is being gained into the anatomical and physiological patterns of gene expression in different tissues and organs, their derangements in disease and their pharmacological manipulation. The brain is no exception, and an appreciation is being accumulated of the three dimensional anatomical localization of cerebral gene expression patterns, of great relevance to a fundamental understanding of neurobiology. From this new paradigm and others, insights are now being gained into the molecular biology of a variety of topics previously thought to be beyond the scope of molecular dissection, such as language and emotion. Key words: Gene expression, Micro array, Pharmacogenetics, Psychiatric South African Psychiatry Review Vol. 8 (3) 2005: 89-9

Surgical trial in traumatic intracerebral haemorrhage (STITCH) : A randomised controlled trial of early surgery compared with Initial conservative treatment

Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme.Peer reviewedPublisher PD

Update on the Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II):Statistical analysis plan

<p>Abstract</p> <p>Background</p> <p>Previous studies had suggested that the outcome for patients with spontaneous lobar intracerebral haemorrhage (ICH) and no intraventricular haemorrhage (IVH) might be improved with early evacuation of the haematoma. The Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II) set out to establish whether a policy of earlier surgical evacuation of the haematoma in selected patients with spontaneous lobar ICH would improve outcome compared to a policy of initial conservative treatment. It is an international, multi-centre, prospective randomised parallel group trial of early surgery in patients with spontaneous lobar ICH. Outcome is measured at six months via a postal questionnaire.</p> <p>Results</p> <p>Recruitment to the study began on 27 November 2006 and closed on 15 August 2012 by which time 601 patients had been recruited. The protocol was published in <it>Trials</it> (<url>http://www.trialsjournal.com/content/12/1/124/</url>). This update presents the analysis plan for the study without reference to the unblinded data. The trial data will not be unblinded until after follow-up is completed in early 2013. The main trial results will be presented in spring 2013 with the aim to publish in a peer-reviewed journal at the same time.</p> <p>Conclusion</p> <p>The data from the trial will provide evidence on the benefits and risks of early surgery in patients with lobar ICH.</p> <p>Trial registration</p> <p>ISRCTN: ISRCTN22153967</p

PARADOXES OF INFORMATION SYSTEMS PLANNING

During two research projects to identify the difficulties associated with information systems planning (ISP), it became apparent that IS managers and users often do not apply a number of commonly accepted guidelines for successful ISP. This paper reports some instances in which the guidelines were not applied. It also explains the neglect of the guidelines and the incentives ISP participants had for not applying them. The findings suggest further research and also have practical implications for IS managers

Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II):a randomised trial

SummaryBackgroundThe balance of risk and benefit from early neurosurgical intervention for conscious patients with superficial lobar intracerebral haemorrhage of 10–100 mL and no intraventricular haemorrhage admitted within 48 h of ictus is unclear. We therefore tested the hypothesis that early surgery compared with initial conservative treatment could improve outcome in these patients.MethodsIn this international, parallel-group trial undertaken in 78 centres in 27 countries, we compared early surgical haematoma evacuation within 12 h of randomisation plus medical treatment with initial medical treatment alone (later evacuation was allowed if judged necessary). An automatic telephone and internet-based randomisation service was used to assign patients to surgery and initial conservative treatment in a 1:1 ratio. The trial was not masked. The primary outcome was a prognosis-based dichotomised (favourable or unfavourable) outcome of the 8 point Extended Glasgow Outcome Scale (GOSE) obtained by questionnaires posted to patients at 6 months. Analysis was by intention to treat. This trial is registered, number ISRCTN22153967.Findings307 of 601 patients were randomly assigned to early surgery and 294 to initial conservative treatment; 298 and 291 were followed up at 6 months, respectively; and 297 and 286 were included in the analysis, respectively. 174 (59%) of 297 patients in the early surgery group had an unfavourable outcome versus 178 (62%) of 286 patients in the initial conservative treatment group (absolute difference 3·7% [95% CI −4·3 to 11·6], odds ratio 0·86 [0·62 to 1·20]; p=0·367).InterpretationThe STICH II results confirm that early surgery does not increase the rate of death or disability at 6 months and might have a small but clinically relevant survival advantage for patients with spontaneous superficial intracerebral haemorrhage without intraventricular haemorrhage.FundingUK Medical Research Council

Russellian Monism and Ignorance of Non-structural Properties

Russellian monists argue that non-structural properties, or a combination of structural and non-structural properties, necessitate phenomenal properties. Different Russellian monists offer varying accounts of the structural/non-structural distinction, leading to divergent forms of Russellian monism. In this paper, I criticise Derk Pereboom’s characterisation of the structural/non-structural distinction proposed in his Consciousness and the Prospects of Physicalism and further work. I argue that from Pereboom’s characterisation of structural and non-structural properties, one can formulate general metaphysical principles concerning what structural and non-structural properties necessitate. These principles undermine the claim that non-structural properties – either alone or in combination with structural properties – necessitate phenomenal properties. Moreover, these principles are not affected by our supposed inability to conceive of non-structural properties in a manner conducive to the success of conceivability arguments