Reviewing challenges and gaps in European and global dementia policy

Purpose: The aim of this review is to scope out European and global policy documents focused on dementia with the purpose of providing a synthesis of the challenges the phenomenon poses and the gaps evident. Design: An adapted PESTEL framework as a data extraction tool resulted in an analysis of the political, economic, social, technological, environmental, organisational, educational, and research aspects of dementia policy. Findings: Policy documents showed variability of dementia strategy, plan, and programme development. All documents recognised rapidly growing ageing populations, and increasing numbers of people living with dementia. Dementia as a public health priority is inconsistent in growth. Global policy documents stress the impact of dementia will be felt most by low-and-middle income countries. Main themes were: a need to raise awareness of dementia and action to reduce stigma around it, the need for early diagnosis and preventative person-centred approaches with integrated care, fiscal investment, further research, training and education for workforces, increased involvement of and support for people living with dementia, and care and support close to home. Social and Practical Implications: By identifying current dementia challenges and policy gap implications this analysis urges engagement with broader frames of reference as potential for enabling bolder and radically better dementia care models. Originality: This paper offers a review of present global and European dementia policy, outlining the potential implications for the most marginalised in society if it fails to be critical of its own underpinning assumptions

Information architecture for a federated health record server

This paper describes the information models that have been used to implement a federated health record server and to deploy it in a live clinical setting. The authors, working at the Centre for Health Informatics and Multiprofessional Education (University College London), have built up over a decade of experience within Europe on the requirements and information models that are needed to underpin comprehensive multi-professional electronic health records. This work has involved collaboration with a wide range of health care and informatics organisations and partners in the healthcare computing industry across Europe though the EU Health Telematics projects GEHR, Synapses, EHCR-SupA, SynEx and Medicate. The resulting architecture models have fed into recent European standardisation work in this area, such as CEN TC/251 ENV 13606. UCL has implemented a federated health record server based on these models which is now running in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. The information models described in this paper reflect a refinement based on this implementation experience

Spatial distribution of Chlorpyrifos and Endosulfan in USA coastal waters and the Great Lakes

Between 1994 and 1997, 258 tissue and 178 sediment samples were analyzed for chlorpyrifos throughout the coastal United States and the Great Lakes. Subsequently, 95 of the 1997 tissue samples were reanalyzed for endosulfan. Tissue chlorpyrifos concentrations, which exceeded the 90th percentile, were found in coastal regions known to have high agricultural use rates but also strongly correlated with sites near high population. The highest concentrations of endosulfans in contrast, were generally limited to agricultural regions of the country. Detections of chlorpyrifos at several Alaskan sites suggest an atmospheric transport mechanism. Many Great Lakes sites had chlorpyrifos tissue concentrations above the 90th percentile which decreased with increasing distance from the Corn Belt region (Iowa, Indiana, Illinois, and Wisconsin) where most agriculturally applied chlorpyrifos is used. Correlation analysis suggests that fluvial discharge is the primary transport pathway on the Atlantic and Gulf of Mexico coasts for chlorpyrifos but not necessarily for endosulfans. (PDF contains 28 pages

Guide to Geographical Indications: Linking Products and Their Origins (Summary)

Geographical Indications present significant opportunities for differentiating products or services that are uniquely related to their geographic origin. While they can offer many positive economic, social, cultural, and even environmental benefits, they can also be problematic and therefore caution is warranted when pursuing them. The publication distills the relevant lessons that could apply, particularly to developing countries, from a review of more than 200 documents and a number of original Case Studies. It presents a groundwork to better understand the costs and the benefits of undertaking Geographical Indications by outlining the basic processes, covering the pros and cons of different legal instruments, and offering insights into the important factors of success. It reviews and presents current data on the key issues of global GIs such as: economic results, public and private benefits; and market relevance.Geographical Indications, developing country, marketing, local, traditional, culture, appellation, legal protection, Denomination of Origin

The Specific Heat of a Ferromagnetic Film.

We analyze the specific heat for the $O(N)$ vector model on a $d$-dimensional film geometry of thickness $L$ using ``environmentally friendly'' renormalization. We consider periodic, Dirichlet and antiperiodic boundary conditions, deriving expressions for the specific heat and an effective specific heat exponent, \alpha\ef. In the case of $d=3$, for $N=1$, by matching to the exact exponent of the two dimensional Ising model we capture the crossover for \xi_L\ra\infty between power law behaviour in the limit {L\over\xi_L}\ra\infty and logarithmic behaviour in the limit {L\over\xi_L}\ra0 for fixed $L$, where $\xi_L$ is the correlation length in the transverse dimensions.Comment: 21 pages of Plain TeX. Postscript figures available upon request from [email protected]

An evidence based ranking system for multiple studies designs for informing public policy. An example using interventions associated with Salmonella in swine.

Using the association between feed characteristics and Salmonella prevalence we will present an approach to combining data with multiple outcomes from multiple studies designs. The approach may be a method of informing policy makers in the area of food safety when a large amount of heterogeneous literature is available about a topic. The procedure for a systematic review of the literature was followed until the synthesis component. However, to combine the evidence we modified of the FDA Interim Evidence Ranking System for Scientific Information. Each study was characterized as one of 5 study design types based on evidentiary value. After classification by evidentiary value, the studies were considered collectively to rate the strength of the body of evidence based on quantity and consistency. The quantity ranking considered the number of studies, the number of individuals studied and generalizability to the target population. The consistency ranking considered whether studies with different designs reported similar findings. After ranking the body of evidence, an overall ranking was assigned for the strength of the evidence. The final ranking system had four levels. For example, the highest rank of scientific evidence, reflects a high level of comfort among qualified scientists that the association/relationship is scientifically valid. This level ranked relationship would be considered to have a very low probability of significant new data overturning the conclusion that the relationship is valid or significantly changing the nature of the relationship

Interventions associated with feeding management practices and feed characteristics, and measures of Salmonella prevalence in live and slaughtered swine: A systematic review and summation of evidence

The aim of this review is to evaluate and summarize the evidence for associations between feeding management practices and feed characteristics, and Salmonella prevalence in swine, which may represent opportunities for interventions. Salmonella prevalence in the reviewed literature was measured either by culture or by the presence of antibodies. A systematic review of the area was conducted, the goal being to minimize the impact of bias. Systematic reviews include an assessment of the quality of studies and exclusion of studies that fail to meet standards for published material. The review evaluated evidence for an association between feed withdrawal from swine prior to slaughter, acidification of feed, heat treatment of feed, pellet vs. mash, course vs fine grind, and wet vs. dry. A large number of intervention studies were excluded from the review because they failed to report design features designed to limit the introduction of bias such as randomization and blinding. The majority of studies included were cross sectional studies, however these failed to provide strong evidence of an association because of the potential for confounding and the failure to document a temporal association between exposure to the risk factor and the outcome. The review concluded that title strongest body of work was available for pelleted feed and dry feed, however there was still uncertainty about the situations were this association may be effective. The conclusion was that there should be a low level of comfort among qualified scientists that the claimed association/relationship is scientifically valid. This ranking is primarily based on moderate to low quality studies, or insufficient numbers of tested individuals or herds, resulting in a low degree of confidence that results could be extrapolated to the target population