Do institutional arrangements make a difference to transport policy and implementation? Lessons for Britain

This paper describes local government decision-making in transport in three areas of the UK, London, West Yorkshire and Edinburgh, in which major changes in local government decision-making structures have taken place over the last decade, and between which arrangements are now very different. The research discusses whether institutional change has had a beneficial or adverse effect, and whether any of the current structures provides a more effective framework for policy development and implementation. The results show that although the sites share a broadly common set of objectives there are differences in devolved responsibilities and in the extent to which various policy options are within the control of the bodies charged with transport policy delivery. The existence of several tiers of government, coupled with the many interactions required between these public sector bodies and the predominantly private sector public transport operators appears to create extra transactional barriers and impedes the implementation of the most effective measures for cutting congestion. There is, however, a compelling argument for the presence of an overarching tier of government to organise travel over a spatial scale compatible with that of major commuter patterns. The extent to which such arrangements currently appear to work is a function of the range of powers and the funding levels afforded to the co-ordinating organisation

Direct-to-consumer genetic testing: where and how does genetic counseling fit?

Direct-to-consumer genetic testing for disease ranges from well-validated diagnostic and predictive tests to ‘research’ results conferring increased risks. While being targeted at public curious about their health, they are also marketed for use in reproductive decision-making or management of disease. By virtue of being ‘direct-to-consumer’ much of this testing bypasses traditional healthcare systems. We argue that direct-to-consumer genetic testing companies should make genetic counseling available, pre- as well as post-test. While we do not advocate that mandatory genetic counseling should gate-keep access to direct-to-consumer genetic testing, if the testing process has the potential to cause psychological distress, then companies have a responsibility to provide support and should not rely on traditional healthcare systems to pick up the pieces

Policy making under uncertainty in electric vehicle demand

The introduction of electric vehicles (EVs) into the passenger vehicle market has, in recent years, become viewed as a primary solution to the significant carbon dioxide emissions attributed to personal mobility. Moreover, EVs offer a means by which energy diversification and efficiency can be improved compared to the current system. The UK government and European Commission have played an active role in steering the development and market introduction of EVs. However, a great deal of uncertainty remains regarding the effectiveness of these policies and the viability of EV technology in the mainstream automotive market. This paper investigates the prevalence of uncertainty concerning the demand for EVs. This is achieved through the application of a conceptual framework that assesses the locations of uncertainty. UK and EU documents are assessed through a review of the published policy alongside contributions from academia to determine how uncertainty has been reduced. This assessment offers insights to decision makers in this area by evaluating the work done to date through a landscape analysis. Results have identified six different locations of uncertainty covering: consumer, policy, infrastructure, technical, economic and social issues

Azacitidine for the treatment of lower risk myelodysplastic syndromes : a retrospective study of 74 patients enrolled in an Italian named patient program.

BACKGROUND: Azacitidine induces responses and prolongs overall survival compared with conventional care regimens in patients who have high-risk myelodysplastic syndromes (MDS). However, limited data are available concerning the efficacy and safety of azacitidine in patients who have lower risk MDS. METHODS: The authors retrospectively evaluated 74 patients with International Prognostic Scoring System low-risk or intermediate 1-risk MDS, who received azacitidine on a national named patient program. At baseline, 84% of patients were transfusion-dependent, 57% had received erythropoietin, and 51% were aged >70 years. Azacitidine was administered subcutaneously for 5 days (n = 29 patients), 7 days (n = 43 patients), or 10 days (n = 2 patients) every month at a dose of 75 mg/m(2) daily (n = 45 patients) or at a fixed dose of 100 mg daily (n = 29 patients) and for a median of 7 cycles (range, 1-30 cycles). RESULTS: According to the 2006 International Working Group criteria, overall response rate (ORR) was 45.9%, including complete responses (10.8%), partial responses (9.5%), hematologic improvements (20.3%), and bone marrow complete responses (5.4%). The ORR was 51.6% in 64 patients who completed > or = 4 cycles of treatment. The median duration of response was 6 months (range, 1-30 months). After a median follow-up of 15 months, 71% of patients remained alive. A survival benefit was observed in responders versus nonresponders (94% vs 54% of patients projected to be alive at 2.5 years, respectively; P < .0014). The most common grade 3 or 4 adverse events were myelosuppression (21.6%) and infection (6.8%). CONCLUSIONS: The current results indicated that azacitidine may be a feasible and effective treatment for patients with lower risk MDS

Chloroleucon chacӧense (Leguminosae): A Study on Morphometry of Fruits and Seeds, Germinability and Development of Seedlings

Abstract The dehiscent legumes of Chloroleucon chacöense (Leguminosae, Mimosoideae) are highly predated. The seeds of an intermediate type (neither orthodox, nor recalcitrant) remain in latency until the rainy station start can germinate efficiently when are imbibed 36 h in water before the sown, reaching similar % than those treated with sand paper or sulphuric acid. The seeds lose their germinability when are treated with warm water, perhaps because it kills the embryo. The seedlings are developed in a high percentage (92%) although they do not receive scarification treatments. The scarified seeds increase their weight more than the no scarified, as the Baskin Index denotes. The ANOVA and MTG show that the mechanical and chemical treatments allow the seeds to germinate till 24 h since the sown. The &quot;t&quot; test highlights that the no scarified seeds exhibit high difference of weight only at 24 h since the sown; perhaps the seeds need that lapse of time to imbibe to start the germination. Between the unhealthy seeds, those with arrested development constitute a high percentage, and perhaps some problems in the reproductive system exist. The germination is epigeal, phanerocotyledonar, with photosynthesizing cotyledons, and the seedlings have two sub-opposite protophylls (one pinnate, the other bipinnate) and two or more alternate, bipinnate eophylls. This fact implies that the classification commonly used does not cover the variability existent in the Leguminosae. Studies are needed to elucidate the origin of the low density of individuals because the species is included in the RED BOOK

New Media and Fat Democracy: The Paradox of Online Participation

This piece speculates on the internet’s wider influences on the shape of institutional politics in representative ‘actually existing democracies’. Findings, based on 100 semi-structured interviews with political actors (politicians, journalists and officials) operating around the UK Parliament, suggest two contrasting trends. On the one hand, more political actors at the immediate edges of the UK institutional political process are being further engaged in a sort of centrifugal movement going outwards from the centre. At the same time, the space between this extended political centre and its public periphery is increasing. This fatter, democratic elitist shift in UK politics may be interpreted as ‘new’ and ICT-driven. It might equally be argued that new media is exacerbating pre-existing political party and media trends in mature democracies which fail to engage ordinary citizens

A multinational randomized, controlled, clinical trial of etoricoxib in the treatment of rheumatoid arthritis [ISRCTN25142273]

BACKGROUND: Etoricoxib is a highly selective COX-2 inhibitor which was evaluated for the treatment of rheumatoid arthritis (RA). METHODS: Double-blind, randomized, placebo and active comparator-controlled, 12-week study conducted at 67 sites in 28 countries. Eligible patients were chronic NSAID users who demonstrated a clinical worsening of arthritis upon withdrawal of prestudy NSAIDs. Patients received either placebo, etoricoxib 90 mg once daily, or naproxen 500 mg twice daily (2:2:1 allocation ratio). Primary efficacy measures included direct assessment of arthritis by counts of tender and swollen joints, and patient and investigator global assessments of disease activity. Key secondary measures included the Stanford Health Assessment Questionnaire, patient global assessment of pain, and the percentage of patients who achieved ACR20 responder criteria response (a composite of pain, inflammation, function, and global assessments). Tolerability was assessed by adverse events and routine laboratory evaluations. RESULTS: 1171 patients were screened, 891 patients were randomized (N = 357 for placebo, N = 353 for etoricoxib, and N = 181 for naproxen), and 687 completed 12 weeks of treatment (N = 242 for placebo, N = 294 for etoricoxib, and N = 151 for naproxen). Compared with patients receiving placebo, patients receiving etoricoxib and naproxen showed significant improvements in all efficacy endpoints (p<0.05). Treatment responses were similar between the etoricoxib and naproxen groups for all endpoints. The percentage of patients who achieved ACR20 responder criteria response was 41% in the placebo group, 59% in the etoricoxib group, and 58% in the naproxen group. Etoricoxib and naproxen were both generally well tolerated. CONCLUSIONS: In this study, etoricoxib 90 mg once daily was more effective than placebo and similar in efficacy to naproxen 500 mg twice daily for treating patients with RA over 12 weeks. Etoricoxib 90 mg was generally well tolerated in RA patients