Rethinking transparency and accountability in medicines regulation in the United Kingdom

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Reciprocity in international student exchange: challenges posed by neo-colonialism and the dominance of the Western voice

Introduction: Internationalisation of social work education is part of a rapidly growing international tertiary education sector; one that is actively being promoted by governments and universities to support student learning and engagement and to develop global citizens. International partnership programmes form a core part of the internationalisation of social work education, and these programmes may involve inequity in the benefits to the different partners. This article critically reflects on, and explores, concepts of reciprocity and collaboration in international social work student exchanges with a specific focus on exchanges between Australia and the Asia-Pacific. Methods: A critical lens was applied to the literature that conceptualises international student exchanges with a particular focus on reciprocity and collaboration. The concept of neo-colonialism is used to explore international student exchanges and consider ways forward; the term is used to refer to newer and more subtle forms of colonialism that are often based on linguistic or cultural domination. The discussion is further drawn out with anecdotal evidence from the authors’ own long-term engagement with international student exchange as well as an Australian government funded project “Going Places” that explores internationalisation in social work education. Findings: A critical review of the literature highlights the continued dominance of the Western voice and issues of neo-colonialism as challenges to ensuring equitable processes in the internationalisation of social work education. Reciprocity is a contested concept that needs deep engagement to support transformative partnerships. Conclusions: It is argued that concepts of reciprocity, voice and collaboration have to be carefully considered in order to create transformative partnerships in international social work education

Determining the Predictors for Cardiac Etiology on Syncope Patients in the ED

Introduction: Syncope remains one of the most challenging presentations to the ED physician as well as the Internist. The goal of this study is to determine which combination of variables during the clinical encounter at bed side can better predict among all patients presenting to the ED with syncope who is likely to have a cardiac diagnosis and who is not. Methods: A retrospective chart review was done on a random sample of cases presenting to the emergency department of a Miami hospital between 2014 and 2016. Results: The final regression model showed male patients being 3 times more likely to have a cardiac final diagnosis for syncope than women. There is a 5% increased chance of having a cardiac etiology per year increment between these groups. Palpitations occurring with the event and a personal history of coronary artery disease multiplied the odds of a cardiac diagnosis 24.43 times and 3.63 times respectively. Bradycardia or a prolonged QRS segment (\u3e120ms) multiplied the odds of a cardiac diagnosis by 4.24 times and 5.06 times respectively. Valvular stenosis on cardiac echography multiplied the odds of having a cardiac diagnosis by a factor of 7.35. ROC curve was calculated to be 0.901. Creating a model excluding the result of the cardiac echography yielded a ROC curve with an area under the curve of 0.895. Conclusion: Syncope has a variety of etiologies some of which are benign in nature like Orthostasis, others carry a high risk of severe detrimental consequences like cardiac arrhythmias. Thus, it is imperative to differentiate those patients with a potential of having a life-threatening diagnosis from those that do not. The cardiac model developed during this study showed great potential for development of a stratification risk tool for cardiac diagnosis for patients presenting with a syncopal episode to the ED

Silhouette of cardiac impairment in diabetic patients at a medical college in Rewa district

Background: The modern technology (TMT) had helped to detect cardiac impairment in diabetes patients relative to past. This study had attempted to use modern tools for detection of cardiac impairment in patients who attended OPD in a medical college of Rewa district. Objectives of the study was to evaluate cardiac dysfunction and factors associated with cardiac dysfunction (using values of TMT) in diabetic patients.Methods: A descriptive study was done with help of recording history of variables like smoking, alcohol, BMI, HBA1C value, cholesterol level and others. Chi square was done to assess test of significance.Results: Diastolic dysfunction was more in patients with diabetic complications than those without diabetic complications. Most patients having peripheral neuropathy, nephropathy and retinopathy had diastolic dysfunction. Patients had also shown high incidence of positivity to TMT. Half of the patients (50%) positive results for stress test were higher with cases who led a sedentary life style (13.64%). Most of patients (70%) had serum. cholesterol level less than 200 mg/dl but the positive results for stress test were higher in patients with Serum. cholesterol level 200 to 239 mg/dl.  Conclusions: The study could shower light on the conclusion that left ventricular diastolic dysfunction in type 2 diabetes mellitus patients is more relative to systolic dysfunction

Estimating the value of watershed services following forest restoration

Declining forest health, climate change, and development threaten the sustainability of water supplies in the western United States. While forest restoration may buffer threats to watershed services, funding shortfalls for landscape-scale restoration efforts limit management action. The hydrologic response and reduction in risk to watersheds following forest restoration treatments could create significant nonmarket benefits for downstream water users. Historic experimental watershed studies indicate a significant and positive response from forest thinning by a reallocation of water from evapotranspiration to surface-water yield. In this study, we estimate the willingness to pay (WTP) for improved watershed services for one group of downstream users, irrigators, following forest restoration activities. We find a positive and statistically significant WTP within our sample of $183.50 per household, at an aggregated benefit of more than$400,000 annually for 2181 irrigators. Our benefit estimate provides evidence that downstream irrigators may be willing to invest in landscape-scale forest restoration to maintain watershed services

Coupling groundwater and riparian vegetation models to assess effects of reservoir releases

Although riparian areas in the arid southwestern United States are critical for maintaining species diversity, their extent and health have been declining since Euro-American settlement. The purpose of this study was to develop a methodology to evaluate the potential for riparian vegetation restoration and groundwater recharge. A numerical groundwater flow model was coupled with a conceptual riparian vegetation model to predict hydrologic conditions favorable to maintaining riparian vegetation downstream of a reservoir. A Geographic Information System(GIS) was used for this one-way coupling. Constant and seasonally varying releases from the dam were simulated using volumes anticipated to be permitted by a regional water supplier. Simulations indicated that seasonally variable releases would produce surface flow 5.4-8.5 km below the dam in a previously dry reach. Using depth to groundwater simulations from the numerical flow model with conceptual models of depths to water necessary for maintenance of riparian vegetation, the GIS analysis predicted a 5- to 6.5-fold increase in the area capable of sustaining riparian vegetation

Total Cerebral Small Vessel Disease MRI Score Is Associated with Cognitive Decline in Executive Function in Patients with Hypertension

Objectives: Hypertension is a major risk factor for white matter hyperintensities (WMH), lacunes, cerebral microbleeds, and perivascular spaces, which are MRI markers of cerebral small vessel disease (SVD). Studies have shown associations between these individual MRI markers and cognitive functioning and decline. Recently, a “total SVD score” was proposed in which the different MRI markers were combined into one measure of SVD, to capture total SVD-related brain damage. We investigated if this SVD score was associated with cognitive decline over 4 years in patients with hypertension. Methods: In this longitudinal cohort study, 130 hypertensive patients (91 patients with uncomplicated hypertension and 39 hypertensive patients with a lacunar stroke) were included. They underwent a neuropsychological assessment at baseline and after 4 years. The presence of WMH, lacunes, cerebral microbleeds, and perivascular spaces were rated on baseline MRI. Presence of each individual marker was added to calculate the total SVD score (range 0–4) in each patient. Results: Uncorrected linear regression analyses showed associations between SVD score and decline in overall cognition (p = 0.017), executive functioning (p < 0.001) and information processing speed (p = 0.037), but not with memory (p = 0.911). The association between SVD score and decline in overall cognition and executive function remained significant after adjustment for age, sex, education, anxiety and depression score, potential vascular risk factors, patient group, and baseline cognitive performance. Conclusion: Our study shows that a total SVD score can predict cognitive decline, specifically in executive function, over 4 years in hypertensive patients. This emphasizes the importance of considering total brain damage due to SVD