Differences in In Vitro Properties of Pancreatin Preparations for Pancreatic Exocrine Insufficiency as Marketed in Russia and CIS

BACKGROUND: Pancreatic enzyme-replacement therapy (PERT), provided as pancreatin to patients with pancreatic exocrine insufficiency (PEI), is considered an essential substitute for the pivotal physiological function the pancreas fulfills in digestion. PEI involves a reduction in the synthesis and secretion of pancreatic enzymes (lipase, protease, amylase), which leads to an inadequate enzymatic response to a meal and consequently to maldigestion and malabsorption of nutrients. The efficacy of PERT is strongly dependent on enzyme activity, dissolution, and pancreatin particle size. OBJECTIVE: The physiological properties of eight pancreatin preparations (nine batches; five different brands) available in Russia and CIS (Commonwealth of Independent States: Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Uzbekistan) were investigated. METHODS: The lipase activity, dissolution, and particle size distribution of samples from multiple batches of pancreatin of different strengths were measured. RESULTS: Regarding lipase activities, all pancreatin preparations except Micrazim(R) matched the labeled content. Considerable differences were observed in particle size and dissolution. CONCLUSION: Pancreatin preparations available in Russia and CIS demonstrate product-to-product and batch-to-batch variability regarding the measured properties of lipase activity, dissolution, and particle size. This may impact the efficacy of PERT and therefore clinical outcomes

DEDICATE: proposal for a conceptual framework to develop dementia-friendly Integrated eCare support

Background: Evidence shows that the implementation of Information and Communication Technologies (ICT) enabled services supporting integrated dementia care represents an opportunity that faces multi-pronged challenges. First, the provision of dementia support is fragmented and often inappropriate. Second, available ICT solutions in this field do not address the full spectrum of support needs arising across an individual’s whole dementia journey. Current solutions fail to harness the potential of available validated e-health services, such as telehealth and telecare, for the purposes of dementia care. Third, there is a lack of understanding of how viable business models in this field can operate. The field comprises both professional and non-professional players that interact and have roles to play in ensuring that useful technologies are developed, implemented and used. Methods: Starting from a literature review, including relevant pilot projects for ICT-based dementia care, we define the major requirements of a system able to overcome the limitations evidenced in the literature, and how this system should be integrated in the socio-technical ecosystem characterizing this disease. From here, we define the DEDICATE architecture of such a system, and the conceptual framework mapping the architecture over the requirements. Results: We identified three macro-requirements, namely the need to overcome: deficient technology innovation, deficient service process innovation, and deficient business models innovation. The proposed architecture is a three level architecture in which the center (data layer) includes patients’ and informal caregivers’ preferences, memories, and other personal data relevant to sustain the dementia journey, is connected through a middleware (service layer), which guarantees core IT services and integration, to dedicated applications (application layer) to sustain dementia care (Formal Support Services, FSS), and to existing formal care infrastructures, in order to guarantee care coordination (Care Coordination Services, CCS). Conclusions: The proposed DEDICATE architecture and framework envisages a feasible means to overcome the present barriers by: (1) developing and integrating technologies that can follow the patient and the caregivers throughout the development of the condition, since the early stages in which the patient is able to build up preferences and memories will be used in the later stages to maximise personalization and thereby improve efficacy and usability (technology innovation); (2) guaranteeing the care coordination between formal and informal caregivers, and giving an active yet supported role to the latter (service innovation); and (3) integrating existing infrastructures and care models to decrease the cost of the overall care pathway, by improving system interoperability (business model innovation)

ASEAN's unchanged melody? The theory and practice of 'non-interference' in Southeast Asia

This is an Author's Accepted Manuscript of an article published as Jones, Lee. (2010). ASEAN's unchanged melody? The theory and practice of 'non-interference' in Southeast Asia. Pacific Review 23:4, 479-502 as published in PACIFIC REVIEW 2010 © Taylor & Francis, available online at: http://www.tandfonline.com/10.1080/09512748.2010.49599

Social Movements and International Relations: A Relational Framework

Social movements are increasingly recognized as significant features of contemporary world politics, yet to date their treatment in international relations theory has tended to obfuscate the considerable diversity of these social formations, and the variegated interactions they may establish with state actors and different structures of world order. Highlighting the difficulties conventional liberal and critical approaches have in transcending conceptions of movements as moral entities, the article draws from two under-exploited literatures in the study of social movements in international relations, the English School and Social Systems Theory, to specify a wider range of analytical interactions between different categories of social movements and of world political structures. Moreover, by casting social movement phenomena as communications, the article opens international relations to consideration of the increasingly diverse trajectories and second-order effects produced by social movements as they interact with states, intergovernmental institutions, and transnational actors

The New Multilateralism and Nonproliferation: Bringing In Domestic Politics

The so-called new world order compels new modes of thinking about the sources of behavior of countries suspected to harbor nuclear de­ signs. These "fence sitters" are undecided states reluctant to com­ mit themselves fully and effectively to the global nonproliferation regime (a full formal commitment, such as ratifying the nonproliferation treaty, is different from an effective commitment to such membership; in other words, Iraq is no Costa Rica). Such states can wait to make the ultimate declaratory political stand while sitting on various types of fences (some with basements), holding different levels of nuclear capabilities. Fence-sit­ ting, in other words, refers to effective international political postures, not military status. The term can thus accommodate an array of countries to which different ranges of capabilities, intentions, and formal commitments are often attributed, including India, Iran, Iraq, Israel, Libya, Pakistan, and North Korea (Argentina, Brazil, and South Africa left this group recently and are discussed below; Ukraine and Kazakhstan are particular cases, as countries that inherited nuclear weapons from the Soviet empire)