Personal Care Savings Bonds: A New Way of Saving Towards Social Care in Later Life

An ageing population ushers in a completely new era requiring society to find new solutions to funding social care and looking after older people. This is not a temporary issue that will go away and there are no quick economic fixes. In the U.K. it is estimated that the population aged 75+ will double from 5 million to 10 million by 2040. Financial building blocks are needed to pay for social care that will be sustained for decades and provide extra security for the individual. This paper proposes a new savings product called Personal Care Savings Bonds (PCSBs), which are designed to encourage saving for social care by providing extra money at the time of greatest financial need. PCSBs are likely to be attractive to older people who have only a basic pension and modest savings, but also to other age groups, as they not only attract interest but also pay prizes. Based on reasonable assumptions, the paper shows how the fund could build into a substantial investment worth £70 billion with regular monthly prize pay-outs. In concept they are somewhat similar to Premium Bonds, another U.K. personal savings product that has been successfully operating since 1956

Quality management in heavy duty manufacturing industry: TQM vs. Six Sigma

‘Is TQM a management fad?’ This question has been extensively documented in the quality management literature; and will be tackled in this research though a critical literature review on the area. ‘TQM versus Six-Sigma’ debate, which has also been a fundamental challenge in this research filed, is addressed by a thematic and chronological review on the peer papers. To evaluate this challenge in practice, a primary research in heavy duty machinery production industry have been conducted using a case-study on, J C Bamford Excavators Ltd (JCB), the largest European construction machinery producer. The result highlights that TQM is a natural foundation to build up Six-Sigma upon; and not surprisingly the quality yield in a TQM approach complemented by Six-sigma is far higher and more stable than when TQM with no Six-Sigma focus is being put in place; thus presenting the overall finding that TQM and Six Sigma are compliments, not substitutes. The study will be concluded with an overview on quality management approaches in the heavy duty manufacturing industry to highlight the way forward for the industry

Human Ophthalmomyiasis Interna Caused by Hypoderma tarandi, Northern Canada

Human myiasis caused by bot flies of nonhuman animals is rare but may be increasing. The treatment of choice is laser photocoagulation or vitrectomy with larva removal and intraocular steroids. Ophthalmomyiasis caused by Hypoderma spp. should be recognized as a potentially reversible cause of vision loss

Study protocol; thyroid hormone replacement for untreated older adults with subclinical hypothyroidism - a randomised placebo controlled trial (TRUST)

Background: Subclinical hypothyroidism (SCH) is a common condition in elderly people, defined as elevated serum thyroid-stimulating hormone (TSH) with normal circulating free thyroxine (fT4). Evidence is lacking about the effect of thyroid hormone treatment. We describe the protocol of a large randomised controlled trial (RCT) of Levothyroxine treatment for SCH. Methods: Participants are community-dwelling subjects aged ≥65 years with SCH, diagnosed by elevated TSH levels (≥4.6 and ≤19.9 mU/L) on a minimum of two measures ≥ three months apart, with fT4 levels within laboratory reference range. The study is a randomised double-blind placebo-controlled parallel group trial, starting with levothyroxine 50 micrograms daily (25 micrograms in subjects <50Kg body weight or known coronary heart disease) with titration of dose in the active treatment group according to TSH level, and a mock titration in the placebo group. The primary outcomes are changes in two domains (hypothyroid symptoms and fatigue / vitality) on the thyroid-related quality of life questionnaire (ThyPRO) at one year. The study has 80% power (at p = 0.025, 2-tailed) to detect a change with levothyroxine treatment of 3.0% on the hypothyroid scale and 4.1% on the fatigue / vitality scale with a total target sample size of 750 patients. Secondary outcomes include general health-related quality of life (EuroQol), fatal and non-fatal cardiovascular events, handgrip strength, executive cognitive function (Letter Digit Coding Test), basic and instrumental activities of daily living, haemoglobin, blood pressure, weight, body mass index and waist circumference. Patients are monitored for specific adverse events of interest including incident atrial fibrillation, heart failure and bone fracture. Discussion: This large multicentre RCT of levothyroxine treatment of subclinical hypothyroidism is powered to detect clinically relevant change in symptoms / quality of life and is likely to be highly influential in guiding treatment of this common condition. Trial registration: Clinicaltrials.gov NCT01660126; registered 8th June 2012

Session 5: Nutrition communication: The challenge of effective food risk communication

A chronology of food scares combined with a rapid, unchecked, rise in lifestyle-related diseases such as obesity highlights the need for a focus on effective food risk communication. However, food risk communication is highly complex. Many factors will affect its success, including the demeanour and conduct of the source, its transparency, interaction with the public, acknowledgement of risks and timely disclosure. How the message is developed is also important in terms of language, style and pretesting with target audiences, as is the choice of appropriate channels for reaching target audiences. Finally, there are many personal factors that may affect risk perception such as previous experience, knowledge, attitudes and beliefs, personality, psychological factors and socio-demographic factors, many of which remain unexplored. While there is evidence that campaigns that communicate health risk have been associated with behaviour change in relation to major public health and safety issues in the past, it is unknown at this stage whether targeting risk information based on risk-perception segmentation can increase the effectiveness of the messages

Conquest and Form: Narrativity in Joshua 5-11 and Historical Discourse in Ancient Judah

One goal of this essay is to offer an exploratory, historiographical analysis of the conquest account in the book of Joshua, an analysis that focuses upon the sociocultural milieu of ancient Judah. I propose to show how this narrative of conquest might have contributed to discourse(s) among the literate Judean community that perpetuated the text, and I will offer a few thoughts on the potential relationship between the narrative and the supposed cultic reforms of the late seventh century b.c.e. A number of biblical scholars have argued that the late monarchic period gave rise to the conquest story as recounted in Joshua. In this essay, I would like to pay special attention to precisely how this narrative might have functioned within the milieu of the late monarchic period, thus refining our understanding of the narrative’s contribution to the discourses of this era and our knowledge of its relationship to other narratives that were probably extant at the same time. In other words, what particular features of the narrative might have had special import in this period? Specifically, I will argue that the narrative reveals certain discursive statements about Yahweh’s cultic supremacy and about important cultic sites in late monarchic Judah, and that this is evident in particular narratival features that are present in the text

Manual / Issue 9 / Out of Line

Manual, a journal about art and its making. Out of Line. The nineth issue. This issue of *Manual*—themed Out of Line—is a collection about the way that lines disrupt, point outward. In poetry, the attention to detail one takes in crafting a line is all about making the line disappear, making something it holds to take front stage. . . . The space between the lines creating the image . . . the space around that argues for the importance of all that the lines hold. Manual 9 (Out of Line) complemented Lines of Thought: Drawing from Michelangelo to Now, presented in collaboration with the British Museum, on view at the RISD Museum October 6, 2017 to January 7, 2018. Softcover, 76 pages. Published 2017 by the RISD Museum. Manual 9 (Out of Line) contributors include Fida Adely, Reginald Dwayne Betts, Stefano Bloch, Mimi Cabell, Namita Vijay Dharia, Douglas W. Doe, Jared A. Goldstein, Lucinda Hitchcock, Jan Howard, Kate Irvin, Douglas Kearney, Amber Lopez, Jeffrey Moser, Sheida Soleimani, and Craig Taylor.https://digitalcommons.risd.edu/risdmuseum_journals/1035/thumbnail.jp

Association of thyroid hormone therapy with quality of life and thyroid-related symptoms in patients with subclinical hypothyroidism: a systematic review and meta-analysis

Importance: The benefit of thyroid hormone therapy for subclinical hypothyroidism is uncertain. New evidence from recent large randomized clinical trials warrants an update of previous meta-analyses. Objective: To conduct a meta-analysis of the association of thyroid hormone therapy with quality of life and thyroid-related symptoms in adults with subclinical hypothyroidism. Data Sources: PubMed, EMBASE, ClinicalTrials.gov, Web of Science, Cochrane Library, CENTRAL, Emcare, and Academic Search Premier from inception until July 4, 2018. Study Selection: Randomized clinical trials that compared thyroid hormone therapy with placebo or no therapy in nonpregnant adults with subclinical hypothyroidism were eligible. Two reviewers independently evaluated eligibility based on titles and abstracts of all retrieved studies. Studies not excluded in this first step were independently assessed for inclusion after full-text evaluation by 2 reviewers. Data Extraction and Synthesis: Two independent reviewers extracted data, assessed risk of bias (Cochrane risk-of-bias tool), and evaluated the quality of evidence (GRADE tool). For synthesis, differences in clinical scores were transformed (eg, quality of life) into standardized mean differences (SMDs; positive values indicate benefit of thyroid hormone therapy; 0.2, 0.5, and 0.8 correspond to small, moderate, and large effects, respectively). Random-effects models for meta-analyses were applied. Main Outcomes and Measures: General quality of life and thyroid-related symptoms after a minimum follow-up of 3 months. Results: Overall, 21 of 3088 initially identified publications met the inclusion criteria, with 2192 adults randomized. After treatment (range, 3-18 months), thyroid hormone therapy was associated with lowering the mean thyrotropin value into the normal reference range compared with placebo (range, 0.5-3.7 mIU/L vs 4.6 to 14.7 mIU/L) but was not associated with benefit regarding general quality of life (n = 796; SMD, −0.11; 95% CI, −0.25 to 0.03; I2=66.7%) or thyroid-related symptoms (n = 858; SMD, 0.01; 95% CI, −0.12 to 0.14; I2=0.0%). Overall, risk of bias was low and the quality of evidence assessed with the GRADE tool was judged moderate to high. Conclusions and Relevance: Among nonpregnant adults with subclinical hypothyroidism, the use of thyroid hormone therapy was not associated with improvements in general quality of life or thyroid-related symptoms. These findings do not support the routine use of thyroid hormone therapy in adults with subclinical hypothyroidism

Can Agent Cheap Talk Mitigate Agency Problems in the Presence of a Noisy Performance Measure? An Experimental Test in a Single- and Multi-Period Setting

Given traditional agency theory assumptions and unobservable effort in a single-period setting, a moral hazard arises in which the agent is expected to shirk and provide the minimal possible effort after contracting with the principal. Traditional solutions to this agency problem include paying the agent a financial incentive tied to some noisy measure of performance or allowing the agent to develop a reputation over multiple periods. As the noisiness of the performance-measure increases, however, these traditional solutions become increasingly costly and ineffective. In many single- and multi-period agency settings in the firm, however, the agent can communicate a promised level of effort to the principal prior to contracting. We document that this pre-contract communication, which is non-enforceable and therefore considered cheap talk by traditional economic theory, can be highly effective in mitigating the moral hazard problem in agency theory. In a repeating single-period experimental setting where production is observable but is a very noisy indicator of effort, communication of a promised level of effort results in higher pay for the agent, higher effort, and higher expected profit for the principal than the control group. When the principal and agent interact over multiple periods, reputation building is ineffective, but cheap talk continues to yield superior outcomes. These results are consistent with recent economic theory incorporating social norms such as the norm of promise-keeping