Reforming economic institutions in transition economies: what determines the speed of reform?

This paper studies institutional divergence among two types of transition economies: (1) the former socialist economies of Central and Eastern Europe, which have gradually been converging to European levels of institutional quality, and (2) the countries of the Former Soviet Union, which have, on average, made much less progress with institutional reform. We aim to explain these differences in the speed of institutional reform, which we measure as improvements in four Worldwide Governance Indicators: government effectiveness, regulatory quality, rule of law (including property rights), and control of corruption. We find that the most robust factors explaining institutional divergence are cultural/religious roots (Huntington’s definition of "civilization"), the number of years under a socialist regime, and the presence of natural resource rents. Less significant factors are imperial history (whether a country used to be a member of the Russian empire) and the prospect of EU membership (as proxied by the distance to Brussels in order to avoid endogeneity problems). An interesting finding is that, when political institutions are controlled for, the impact of natural resources is no longer significant. This suggests that the influence of natural resource rents on institutional quality operates through their impact on political institutions

The self-perceived palliative care barriers and educational needs of clinicians working in hospital primary care teams and referral patterns: lessons learned from a single-center survey and cohort study

Background: Within the generalist-plus-specialist palliative care model, palliative care is mainly provided by nurses and physicians of hospital primary care teams. Palliative care consultation teams (PCCTs) support these clinicians in adequately caring for patients with advanced illnesses. Our team started in 2012. The aim of this study was to assess the self-perceived barriers, educational needs and awareness of available palliative care support options among our hospital primary care teams. In addition, palliative care referral patterns were evaluated.Methods: Single-center mixed methods study. Outcomes of two surveys of primary care team clinicians (2012 and 2016) on barriers to palliative care, educational needs and awareness of palliative care support options were compared ( chi-square, Mann-Whitney U tests, qualitative analysis). Palliative care referral characteristics were evaluated [2012- 2017], including referral timing (survival since referral) (descriptive statistics, Kaplan-Meier methodology). Predictions of survival at referral were analyzed (weighted Kappa).Results: In 2012 and 2016, the most frequently reported barrier was the late initiation of the palliative care approach. Clinicians reported a need for education on physical symptom management and basic palliative care principles. Awareness of support options increased from 2012 to 2016, including improved familiarity with the PCCT (56% vs. 85%, P= 3 months after referral) (P=0.016). Median survival after referral was 0.9 (range, 0-83.3) months. Referring physicians overestimated survival in 44% of patients (kappa 0.36, 95% CI: 0.30-0.42).Conclusions: Primary care team clinicians persistently reported needing support with basic palliative care skills. PCCTs should continuously focus on educating primary care teams and promoting the use of guidelines. Because physicians tend to overestimate survival and usually referred patients late for specialist palliative care, consultation teams should support primary care teams to identify, treat and refer patients with palliative care needs in a timely manner.Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Quantifying soil hydrology to explain the development of vegetation at an ex-arable wetland restoration site

Wetland restoration frequently sets well-defined vegetation targets, but where restoration occurs on highly degraded land such targets are not practical and setting looser targets may be more appropriate. Where this more ‘open-ended’ approach to restoration is adopted, surveillance methods that can track developing wetland habitats need to be established. Water regime and soil structure are known to influence the distribution and composition of developing wetland vegetation, and may be quantified using Sum Exceedence Values (SEV), calculated using the position of the water table and knowledge of soil stress thresholds. Use of SEV to explain patterns in naturally colonizing vegetation on restored, ex-arable land was tested at Wicken Fen (UK). Analysis of values from ten locations showed that soil structure was highly heterogeneous. Five locations had shallow aeration stress thresholds and so had the potential to support diverse wetland assemblages. Deep aeration stress thresholds at other locations precluded the establishment of a diverse wetland flora, but identified areas where species-poor wetland assemblages may develop. SEV was found to be a useful tool for the surveillance of sites where restoration targets are not specified in detail at the outset and may help predict likely habitat outcomes at sites using an open-ended restoration approach

Autoimmune Neuromuscular Disorders in Childhood

Autoimmune neuromuscular disorders in childhood include Guillain-Barré syndrome and its variants, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), juvenile myasthenia gravis (JMG), and juvenile dermatomyositis (JDM), along with other disorders rarely seen in childhood. In general, these diseases have not been studied as extensively as they have been in adults. Thus, treatment protocols for these diseases in pediatrics are often based on adult practice, but despite the similarities in disease processes, the most widely used treatments have different effects in children. For example, some of the side effects of chronic steroid use, including linear growth deceleration, bone demineralization, and chronic weight issues, are more consequential in children than in adults. Although steroids remain a cornerstone of therapy in JDM and are useful in many cases of CIDP and JMG, other immunomodulatory therapies with similar efficacy may be used more frequently in some children to avoid these long-term sequelae. Steroids are less expensive than most other therapies, but chronic steroid therapy in childhood may lead to significant and costly medical complications. Another example is plasma exchange. This treatment modality presents challenges in pediatrics, as younger children require central venous access for this therapy. However, in older children and adolescents, plasma exchange is often feasible via peripheral venous access, making this treatment more accessible than might be expected in this age group. Intravenous immunoglobulin also is beneficial in several of these disorders, but its high cost may present barriers to its use in the future. Newer steroid-sparing immunomodulatory agents, such as azathioprine, tacrolimus, mycophenolate mofetil, and rituximab, have not been studied extensively in children. They show promising results from case reports and retrospective cohort studies, but there is a need for comparative studies looking at their relative efficacy, tolerability, and long-term adverse effects (including secondary malignancy) in children