Playing the Numbers: The spurious promise of global trafficking statistics

‘Playing the numbers,’ ‘the numbers game,’ ‘the policy racket’: for those unfamiliar with American illegal lotteries and some of the legendary gangsters like Bumpy Johnson and Dutch Schultz that turned them into a major revenue stream for organised crime that still flourishes today, the concept was simple. The odds were disproportionately long, but poor people could bet very small amounts. It was, as they used to say, ‘a mugs game’; the organisers did well, while the poor lived on hope

Commentary: is digital health technology empowering patients?

This brief commentary explores how Web 2.0 technology is leading to a new kind of digital health technology. It considers what this might mean for the patient–practitioner encounter; whether practitioners are signed up to the notion of shared decision-making, and whether patients feel empowered and confident to make decisions about their car

Overactive bladder: paediatric aspects

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106767/1/j.1464-410X.2000.tb16945.x.pd

Promising Payment Reform: Risk-Sharing With Accountable Care Organizations

Describes the implementation of shared payer-provider risk payment models at eight private accountable care organizations. Analyzes challenges for providers, purchasers, and payers, including securing the infrastructure for successful risk management

Effects of bioturbation on recruitment of algal cells from the "seed bank" of lake sediments

Effects of different bioturbators on recruitment of several nuisance algae, Anaboena spp. (Cyanophyta), Microcystis spp. (Cyanophyta), and Gonvostomum semen (Raphidophyta), from sediment to water were studied in a long-term laboratory experiment. Natural sediment, where macrofauna larger than 1 mm had been removed, was added to 18 aquaria. To each of six aquaria, individuals of Asellus aquaticus (Isopoda) or Chironomus plumosus (Arthropoda) larvae were added, and six aquaria were left as bioturbation-free controls. Recruitment of Anabaena, Microcystis, and G. semen from the sediment was detected using inverted traps that were sampled once a week during 8 weeks. The activities of the isopod A. aquaticus increased recruitment rates of all algal groups investigated, whereas chironomids had a less pronounced effect. With respect to Anabaena, increased recruitment rate was expressed as a promotion of growth in the pelagic habitat. To our knowledge, these results are the first to demonstrate that bioturbating invertebrates affect the recruitment of phytoplankton resting stages. Moreover, our results suggest that recruitment rate might be more pronounced in littoral areas, which are often dominated by A. aquaticus, rather than in profundal areas of a lake, generally dominated by chironomids. Hence, with respect to algal dynamics, the strength of the coupling between the benthic and pelagic zones might vary both spatially and temporally, depending on composition of the benthic invertebrate community and the ontogenetic development of the individuals within it

Zum Mechanismus einer gentoxischen Wirkung des 1,3-Butadien-Metaboliten 1,2:3,4-Diepoxybutan auf das Nierengewebe

Das gasförmige Monomer 1,3-Butadien (BD) findet vielfältige Verwendung bei der Herstellung synthetischer Kunststoffe. Für die als Humankanzerogen eingestufte Substanz besteht unter anderem der begründete Verdacht Nierenkrebs auszulösen. Als ein DNA-reaktiver Metabolit von BD gilt das über Cytochrom P450 2E1 (CYP2E1) enzymatisch gebildete 1,2:3,4-Diepoxybutan (DEB). Im Rahmen der Dissertation erfolgt eine Risikoabschätzung für das kanzerogene Potential von BD auf die humane Niere basierend auf enzymatischer Charakterisierung des Nierengewebes und in vitro Untersuchungen zur Glutathion Transferasen T1-1 (GSTT1-1)-abhängigen Weiterverstoffwechslung von DEB. Die gebildeten Verbindungen wurden durch µHPLC getrennt und mittels ESI-MSn sowie 13C-NMR-Spektroskopie analysiert. Zwischen DEB und dem GST-Cofaktor Glutathion bildete sich überwiegend das C1-Konjugat S-(2-Hydroxy-3,4-epoxybutyl)-glutathion. Darüber hinaus ergaben sich Hinweise für die zuvor nur postulierte Bildung eines sehr reaktiven intermediären Episulfoniumions, das als ultimales Kanzerogen angesehen werden kann. Die enzymatische Charakterisierung der Niere wurde mit Probenmaterial von Patienten mit Nierenzellkarzinom durchgeführt und beschränkte sich auf die für den BD-Metabolismus wichtigen Enzyme CYP2E1 und GSTs. Mit Hilfe spektralphotometrischer bzw. gaschromatographischer Methoden konnte für alle untersuchten GSTs Aktivität gemessen werden. Im Tumorgewebe war diese im Vergleich zu normalem Gewebe reduziert. Der Nachweis des Isoenzyms CYP2E1 mittels Western Blots im Nierengewebe war negativ.The gaseous monomer 1,3-butadiene (BD) is widely used in synthetic production of plastics. Classified as a human carcinogen the substance is suspected to cause kidney cancer. The DNA-reactive metabolite of BD is considered to be 1,2:3,4-diepoxybutane (DEB) formed by enzymatic reaction with cytochrome P-450 2E1 (CYP2E1). The thesis assesses the risk of BD for humans with regard to the nephrocarcinogenic potential based on results of enzymatic characterization of renal tissue and in vitro investigations concerning the glutathione transferase T1-1 (GSTT1-1)-dependent metabolism of DEB. The generated compounds were separated with µHPLC followed by analysis with ESI-MSn as well as 13C-NMR-spectroscopy. Mainly conjugation was observed between DEB and the GST-cofactor glutathione at the C1-position, resulting in S-(2-hydroxy-3,4-epoxybutyl)-glutathione. Different indications supported the prior postulation of a reactive episulfonium ion intermediate generated and assumed to be an ultimate carcinogen. The enzymatic characterization of renal tissue was carried out with samples from patients with renal cell carcinoma. The investigations were restricted to CYP2E1 and GSTs involved in BD-metabolism. Enzymatic activity was measured for all investigated GSTs by spectrophotometric and gaschromatographic assays, respectively. Compared to normal tissue activities in tumour tissue were reduced. No evidence for existence of CYP2E1 in human kidneys was obtained by Western blots

Den sociala näringskedjan. En studie om hur ungdomar uppfattar sociala positioner i skolan.

The aim of this study was to examine how adolescents perceive to social positions in school. The study was based on focus groups, we organised three different focus groups. One with four girls, one with five boys and one with two boys and two girls. We brought subjects to the groups that they freely discussed. The themes that we later on identified was popularity, social status, gender differences, the legacy of the parents or the family name. The groups also discussed what you could do to become more popular. The analysis is based on a social psychological perspective. There were both similarities and differences in what the research raised and what our groups discussed. The main difference was that the groups were more positive that it was possible to change your popularity and your social status, something that previous research does not fully agree with. In the result we could see that the groups over and over discussed how the social status and popularity was depending on the context. The groups also described that sports and appearances play a role in one’s popularity

Evaluating the impact of patients' online access to doctors' visit notes: designing and executing the OpenNotes project

Background: Providers and policymakers are pursuing strategies to increase patient engagement in health care. Increasingly, online sections of medical records are viewable by patients though seldom are clinicians' visit notes included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We hypothesized that patients and primary care physicians (PCPs) would want it to continue and that OpenNotes would not lead to significant disruptions to doctors' practices. Methods/Design: Using a mixed methods approach, we designed a quasi-experimental study in 3 diverse healthcare systems in Boston, Pennsylvania, and Seattle. Two sites had existing patient internet portals; the third used an experimental portal. We targeted 3 key areas where we hypothesized the greatest impacts: beliefs and attitudes about OpenNotes, use of the patient internet portals, and patient-doctor communication. PCPs in the 3 sites were invited to participate in the intervention. Patients who were registered portal users of participating PCPs were given access to their PCPs' visit notes for one year. PCPs who declined participation in the intervention and their patients served as the comparison groups for the study. We applied the RE-AIM framework to our design in order to capture as comprehensive a picture as possible of the impact of OpenNotes. We developed pre- and post-intervention surveys for online administration addressing attitudes and experiences based on interviews and focus groups with patients and doctors. In addition, we tracked use of the internet portals before and during the intervention. Results: PCP participation varied from 19% to 87% across the 3 sites; a total of 114 PCPs enrolled in the intervention with their 22,000 patients who were registered portal users. Approximately 40% of intervention and non-intervention patients at the 3 sites responded to the online survey, yielding a total of approximately 38,000 patient surveys. Discussion: Many primary care physicians were willing to participate in this "real world" experiment testing the impact of OpenNotes on their patients and their practices. Results from this trial will inform providers, policy makers, and patients who contemplate such changes at a time of exploding interest in transparency, patient safety, and improving the quality of care

Patients' satisfaction and opinions of their experiences during admission in a tertiary care hospital in Pakistan – a cross sectional study

<p>Abstract</p> <p>Background</p> <p>It is often felt that developing countries need to improve their quality of healthcare provision. This study hopes to generate data that can help managers and doctors to improve the standard of care they provide in line with the wishes of the patients.</p> <p>Methods</p> <p>It was a cross sectional study carried out at a major tertiary care hospital of Karachi. Patients between the ages of 18 and 80 years admitted to the hospital for at least one day were included. Patients in the maternity, psychiatry and chemotherapy wards and those in the ICU/CCU were excluded. A pretested, peer reviewed translation of a validated patient satisfaction scale developed by the Picker Institute of Europe was administered.</p> <p>Results</p> <p>A total of 173 patients (response rate: 78.6 %) filled the questionnaire. Patient satisfaction was at levels comparable to European surveys for most aspects of hospital care. However, nearly half the patients (48%) felt they had to wait too long to get a bed in the hospital after presenting to the ER. 68.6% of the patients said that they were never asked for views on the quality of care provided. 20% of the patients did not find anyone in the staff to talk to about their worries and fears while 27.6% felt that they were given emotional support to only some extent. Up to one third of the patients said they were not provided enough information regarding their operative procedures beforehand.</p> <p>Conclusion</p> <p>Although several components of patient care equal the quality levels of the west, many sections require considerable improvement in order to improve health care provision. The healthcare team needs to get more involved with the patients, providing them greater support and keeping them informed and involved with their medical treatment. Efforts should be made to get regular feedback from the patients.</p