The CGIAR's Long-Term Governance and Financing Structure

Report of a panel chaired by Klaus Winkel, appointed by CGIAR Chairman Ismail Serageldin in July 1994 to study governance and financing in the CGIAR. The report presents recommendations, including alternative options in some cases, on research agenda setting, governance, the operating system, and funding. It has an annex on the pros and cons of establishing the CGIAR as an international organization. Among the recommendations were the establishment of a Global Forum on Agricultural Research (GFAR) and regional forums, expansion of developing country participation in the CGIAR, the establishment of a CGIAR Steering Committee, continuous and systematic efforts for impact assessment, increased public awareness and fund raising activities, and addition of UNEP to the CGIAR cosponsors.This report and discussion of it at ICW94 formed the basis for a paper on CGIAR governance presented at the Lucerne ministerial level meeting in February 1995.Agenda document at CGIAR International Centers Week, October 1994

Long-term Effects of Cabergoline and Levodopa in Japanese Patients with Early Parkinson’s Disease: A 5-Year Prospective Study

Several international studies have suggested that treatment of early Parkinsonʼs disease (PD) with a dopamine agonist instead of levodopa delays the occurrence of motor complications. This 5-year prospective, open, multicenter randomized study aimed to compare the effects of cabergoline on the onset of motor complications with those of levodopa in Japanese patients with early PD. Patients who had never been treated with dopamine agonists or levodopa were enrolled in this study. Four of 45 patients in the cabergoline group and 11 of 46 patients in the levodopa group developed motor complications. The estimated cumulative incidence of motor complications in the cabergoline and levodopa groups was 17ｵ and 34ｵ (hazard ratio, 0.57;95ｵ confidence interval, 0.18‒1.81;p＝0.347). Thirty-five adverse events (AEs) were reported in 24 patients in the cabergoline group, while 16 AEs were reported in 13 patients in the levodopa group. Patients in the cabergoline group showed fewer motor complications than did those in the levodopa group, although the difference was not statistically significant. However, the hazard ratio found in this study was similar to those in previous reports

Culture change needed

Malta remains a traditional country in several aspects and avant-garde in others. It is especially traditional in terms of family responsibilities and gender equality. Compared to EU28, Malta has the third lowest number of working women (58%), because women’s first role is the family. The older the woman, the less likely she is to work. In fact, Malta ranks first in terms of the employment gender gap in the higher age groups (25-55 and 55-64) with gaps of 25% and 38% respectively. Over the past years more women have entered the labour market, yet the employment gender gap at 26% (2016 data) remains the widest in the EU. In the lower age group (15-24) there are more women working and some sharing of responsibilities may be happening in the home environment, nonetheless the biggest burden of family responsibilities is assumed by women. This is evident because Eurostat data shows that women are more likely to be employed on a part-time basis, not be self-employed, be on reduced hours, have fixed term contracts, be taking care of children, the elderly or disabled relatives or do other unpaid care work, do more housework and opt for parental leave. In fact, if one looks at the full-time equivalent employment rate, the employment gender gap increases to 31%, and ranks Malta in the first place when compared to the other 27 EU Member States.peer-reviewe

COVID-19 highlights the need for universal adoption of standards of medical care for physicians in nursing homes in Europe

The nursing home sector has seen a disproportionately high number of deaths as part of the COVID-19 pandemic. This reflects, in part, the frailty and vulnerability of older people living in care homes but has also, in part, been a consequence of the failure to include care homes in the systematic planning of a response to COVID, as well as a measure of neglect of standards and quality improvement in the sector. In response, the EUGMS published a set of medical standards of care developed in consultation with experts across its member national societies in 2015. The standards consisted of seven core principles of medical care for physicians working in nursing homes as a first step in developing a programme of clinical, academic and policy engagement in improving medical care for older people who are living and frequently also dying as residents in nursing homes. The gravity of the concerns arising for nursing home care from the COVID-19 pandemic, as well as emerging insights on care improvement in nursing homes indicate that an update of these medical standards is timely. This was performed by the writing group from the original 2015 guidelines and is intended as an interim measure pending a more formal review incorporating a systematic review of emerging literature and a Delphi process

Improved description of charged Higgs boson production at hadron colliders

We present a new method for matching the two twin-processes gb->H+/-t and gg->H+/-tb in Monte Carlo event generators. The matching is done by defining a double-counting term, which is used to generate events that are subtracted from the sum of these two twin-processes. In this way we get a smooth transition between the collinear region of phase space, which is best described by gb->H+/-t, and the hard region, which requires the use of the gg->H+/-tb process. The resulting differential distributions show large differences compared to both the gb-> H+/-t and gg->H+/-tb processes illustrating the necessity to use matching when tagging the accompanying b-jet.Comment: 21 pages, 9 figures. Revised with updated discussion and reference

Comparing health system performance assessment and management approaches in the Netherlands and Ontario, Canada

BACKGROUND: Given the proliferation and the growing complexity of performance measurement initiatives in many health systems, the Netherlands and Ontario, Canada expressed interests in cross-national comparisons in an effort to promote knowledge transfer and best practise. To support this cross-national learning, a study was undertaken to compare health system performance approaches in The Netherlands with Ontario, Canada. METHODS: We explored the performance assessment framework and system of each constituency, the embeddedness of performance data in management and policy processes, and the interrelationships between the frameworks. Methods used included analysing governmental strategic planning and policy documents, literature and internet searches, comparative descriptive tables, and schematics. Data collection and analysis took place in Ontario and The Netherlands. A workshop to validate and discuss the findings was conducted in Toronto, adding important insights to the study. RESULTS: Both Ontario and The Netherlands conceive health system performance within supportive frameworks. However they differ in their assessment approaches. Ontario's Scorecard links performance measurement with strategy, aimed at health system integration. The Dutch Health Care Performance Report (Zorgbalans) does not explicitly link performance with strategy, and focuses on the technical quality of healthcare by measuring dimensions of quality, access, and cost against healthcare needs. A backbone 'five diamond' framework maps both frameworks and articulates the interrelations and overlap between their goals, themes, dimensions and indicators. The workshop yielded more contextual insights and further validated the comparative values of each constituency's performance assessment system. CONCLUSION: To compare the health system performance approaches between The Netherlands and Ontario, Canada, several important conceptual and contextual issues must be addressed, before even attempting any future content comparisons and benchmarking. Such issues would lend relevant interpretational credibility to international comparative assessments of the two health systems

MJA Practice Essentials - 2: Recent advances in therapy of diabetes - Endocrinology

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.As suboptimal blood glucose control has a lasting harmful effect even if control improves later, intensive insulin therapy to minimise hyperglycaemia is now recommended for all patients with type 1 diabetes. The new rapid- and long-acting insulin analogues offer more physiological insulin profiles than traditional insulin preparations. Continuous insulin infusion (“pump therapy”) may provide a solution for some patients with frequent hypoglycaemia or hypoglycaemic unawareness. Continuous blood glucose monitoring reveals postprandial hyperglycaemia and asymptomatic nocturnal hypoglycaemia and may be especially useful for programming overnight basal insulin rates for pump therapy. In type 2 diabetes, management should change with disease progression; introduction of insulin should not be delayed if metabolic control becomes suboptimal. More individualised and physiological therapy is now possible.Jennifer J Couper and Johannes B Prin

The Fate of Nearly Supersymmetric Vacua

Supersymmetric vacua are stable. It is interesting to ask: how long-lived are vacua which are nearly supersymmetric? This question is relevant if our universe is approximately supersymmetric. It is also of importance for a number of issues of the physics of the landscape and eternal inflation. In this note, we distinguish a variety of cases. In all of them the decay is slow. For a flat space theory decaying to a deep AdS vacuum, the leading behavior of the decay amplitude, if a thin wall approximation is valid, is ${\cal A} = \gamma e^{-2 \pi^2/({\rm Re} m_{3/2})^2}$ (where the phase of $m_{3/2}$ is defined in the text) for ${\rm Re} m_{3/2}>0$, and zero otherwise. Metastable supersymmetry breaking generally yields parametrically more rapid decays. For nearly supersymmetric decays, we will see that it is necessary to compute subleading terms in the exponential to extraordinarily high accuracy before one can meaningfully discuss the prefactor.Comment: 19 page

要介護認定基準の変更と影響の同期検証 －2009 年10 月版と2006 年版一次判定の較差－

本研究では，要介護認定基準2009年10月版と，旧版要介護認定基準2006年版との較差を比較するために，経年的な対象者における要介護状況の変化を除外して，それぞれを同期検証することを研究目的とした。その比較する対象を，同一対象者で同一時期に，それぞれの要介護認定基準ごとに別々の認定調査員の認定調査結果から要介護認定一次判定を実施した。それぞれの認定調査結果から，要介護認定基準の変更と影響について，8施設（400名）と8在宅事業所（208名）の要介護者等608名を研究対象として分析した。同期検証した結果，総体的に2009年10月版は，平均合計要介護時間は3.37分ほど多めに有意差を持って算出された。要介護度の2006年版から2009年10月版での一致率は，半数近くの調査対象者の要介護度が変化して，軽度化する調査対象者も2割半前後いた。要介護5の一致率が64.23%と最も高く，要支援1の一致率は29.73%と最も低くなった。要介護5以上の要介護時間に該当する要介護者は2009年10月版の方が2006年版よりも多く分布し，動ける認知症の要介護度はその全体の41.67%も軽度化していた。要介護認定には，要介護基準等介護時間だけによらない総合的指標である総合介護度の構築が必要である。In this research, the accreditation criteria of certifi cation standards of long-term care needed level have been changed to be stricter at the fiscal year 2009 in Japan. The difference and influence were compared in the primary judgment between the fiscal year 2006 and the fiscal year 2009 October version at the synchronized analysis. As for the synchronized analysis, each different investigator surveyed the same long-term care needed or assisted at the simultaneous time with the certifi cation standard for long-term care needed with 2009 October and 2006 version. The change and the influence of them were detected by each investigation result of the 608 long-term care needed who used the services of 8 institutions or the 8 in-home facilities. As a result, total 3.37 minutes needed more average time for total long-term care was signifi cantly calculated by 2009 October than 2006 version(p<0.01). The long-care needed levels of the same respondents have been changed with over half coincidence rate between 2009 October and 2006 versions. The 2009 October version was possible to slightly improve about 25 percent of the long-term care assisted level from 2006 to 2009 October, version, too. At the long-term care needed level 5, the 64.23% coincidence rate of the long-term care needed level was highest. At the long-term care assisted level 1, the 29.73% coincidence rate of the long-term care assisted level was lowest. There were more time and number distribution over the long-term care needed level 5 calculated by 2009 October than 2006 versions. 41.67% of the self-movable dementia was considerably lightened at the long-term care moderately needed and assisted level. The certification standard for long-term care needed should be constructed by not only the long-term care time but also total factors with the burden or necessity indexes for the judgment of the long-term care needed.報告Report