3,167 research outputs found

    Access regulation and the transition from copper to fiber networks in telecoms

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    In this paper we study the impact of different forms of access obligations on firms' incentives to migrate from the legacy copper network to ultra-fast broadband infrastructures. We analyze three different kinds of regulatory interventions: geographical regulation of access to copper networks-where access prices are differentiated depending on whether or not an alternative fiber network has been deployed; access obligations on fiber networks and its interplay with wholesale copper prices; and, finally, a mandatory switch-off of the legacy copper network-to foster the transition to the higher quality fiber networks. Trading-off the different static and dynamic goals, the paper provides guidelines and suggestions for policy makers' decision

    The relationship between glycaemic control and mortality in patients with type 2 diabetes in general practice (ZODIAC-11)

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    Background The relationship between the degree of glycaemic control and mortality remains an important topic of discussion.Aim This study aimed to investigate this relationship.Design of study Prospective cohort study.Setting Primary care.Method A total of 1145 patients with type 2 diabetes were enrolled in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) in 1998. Their survival status was recorded in September 2004. Mortality ratios were calculated using standardised mortality ratios (SMRs). Associations between haemoglobin A1c (HbA1c) levels and mortality were studied with a Cox proportional hazard model. HbA1c levels were studied as continuous and as categorical variables.Results A total of 335 patients died after a median follow-up period of 5.8 years. The SMR (95% confidence interval [CI]) for total mortality was 1.86 (95% CI = 1.66 to 2.06) and 2.24(95% CI = 1.91 to 2.61) for cardiovascular mortality. For each 1% increase in HbA1c there was a 21% increase in the hazard ratio for total mortality. When compared with the target HbA1c group (HbA1c 6.5-7%), the group with very poor glycaemic control (HbA1c &gt;9%) had a hazard ratio of 2.21 (95% CI = 1.42 to 3.42) for total mortality. The group with normal glycaemic control (HbA1cConclusion HbA1c level was associated with mortality and this effect seemed largely attributable to patients who were in really poor glycaemic control. The absence of differences in mortality in the groups with lower HbA% levels supports the position that there is no basis for continually decreasing the therapeutic target HbA1c level in patients with type 2 diabetes mellitus.</p

    Use of a comprehensive patient safety tool in primary care practices

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    Purpose To present a tool that can be used to evaluate patient safety in both nurse‐led and physician‐led practices. Data source This article describes our experience with the Physician Practice Patient Safety Assessment (PPPSA) tool in six safety net practices—three of which were primary care nurse‐managed health centers and three were physician‐led federally qualified health centers. The information provided is from the tool itself and how it might be used in clinical settings, especially primary care. Conclusions The PPPSA is a tool to measure the extent to which patient safety practices are rigorously and systematically implemented throughout a health center. The tool's methodology requires discussion and consensus, incorporating a team approach with multiple perspectives within a center. It is designed to promote changes in practices that would improve patient safety. Implications for practice The tool has enormous relevance for primary care settings, especially those preparing themselves for patient‐centered medical home status and meaningful use. But most important, it has relevance as we create healthcare environments that promote patient safety and a practice culture that is truly patient centered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99022/1/jaan12021.pd

    Availability, Affordability, and Accessibility of a Healthful Diet in a Low-Income Community, Central Falls, Rhode Island, 2007-2008

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    Background: Many Americans have diets that do not meet the dietary guidelines set by the US Department of Agriculture (USDA). Additionally, low-income people have the highest rates of obesity and have difficulty accessing the necessary foods for maintaining a healthful diet. Context: In December 2007 and January 2008, 21 retail food stores in Central Falls, Rhode Island, where residents were predominantly low-income Hispanics, were evaluated for the availability and costs of foods that fulfill the USDA's Thrifty Food Plan (TFP) guidelines. Methods: Each surveyed store was evaluated for variety and weekly cost of 3 different types of market baskets (2 families and an elder). Each store's proximity to public transportation was estimated by using geographic information systems mapping. Outcome: Only 2 stores in Central Falls and the discount supermarket in an adjacent city, Pawtucket, carried enough variety of foods to fill the TFP basket. At the 2 stores, costs were up to 40% higher, and at the discount store, costs were up to 18% cheaper, than the national average. Each of the stores was accessible by public transportation. Interpretation: Meeting the USDA TFP guidelines is difficult in this low-income, predominantly Hispanic city. Although the components of the TFP are available, high prices may make a nutritious diet unaffordable

    News discourses on distant suffering: A critical discourse analysis of the 2003 SARS outbreak

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    News carries a unique signifying power, a power to represent events in particular ways (Fairclough, 1995). Applying Critical Discourse Analysis and Chouliaraki's theory on the mediation of suffering (2006), this article explores the news representation of the 2003 global SARS outbreak. Following a case-based methodology, we investigate how two Belgian television stations have covered the international outbreak of SARS. By looking into the mediation of four selected discursive moments, underlying discourses of power, hierarchy and compassion were unraveled. The analysis further identified the key role of proximity in international news reporting and supports the claim that Western news media mainly reproduce a Euro-American centered world order. This article argues that news coverage of international crises such as SARS constructs and maintains the socio-cultural difference between 'us' and 'them' as well as articulating global power hierarchies and a division of the world in zones of poverty and prosperity, danger and safety


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    Stereologic techniques for electron microscopic morphometry have been applied to normal human interfollicular epidermis of the submammary and iliac crest regions. The aim was to obtain objective baseline data for the study of epidermal morphometric pathology. The results, expressed mainly in surface, volume, and numerical densities of epidermal components and keratinocyte organelles, revealed ascending or descending gradients throughout the epithelial strata. The cytoplasmic ground substance remained almost constant in the four studied layers. No important regional differences were found between the epidermal morphometric parameters at either site. The epidermis showed striking volumetric composition similarities with other keratinizing epithelia


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    Two independent thio­urea mol­ecules comprise the asymmetric unit of the title compound, C22H20N2OS. The central N–C(=S)N(H)C(=O) atoms in each mol­ecule are virtually superimposable and each is twisted [C—N—C—S torsion angles = 121.3 (3) and −62.3 (4)°]. The mol­ecules differ only in terms of the relative orientations of the benzyl benzene rings [major difference between the C—N—C—C torsion angles of −146.6 (3) and −132.9 (3)°]. The presence of N—H⋯S hydrogen bonding leads to the formation of supra­molecular chains along the a axis. These are consolidated in the crystal packing by C—H⋯O inter­actions. The crystal was found to be a combined non-merohedral and racemic twin (twin law 00/00/001), with the fractional contribution of the minor components being approximately 9 and 28%