Economic aspects of pharmacotherapy for chronic constipation

Constipation is one of the most common digestive complaints. It is a symptom, not a disease. The subjectivity that this involves means that assessments of clinical epidemiology, socioeconomic costs and pharmacotherapy are difficult, since there is no definition of 'normal' bowel habit. Although constipation can affect all ages, the problem increases with age, and is of particular concern for those who are frail and in long term care. Cultural influences may affect the prevalence in older people. Drug therapy of constipation cannot be considered in isolation, since there are issues in the prevention of constipation and the principles of good management that also apply. Furthermore, some consideration of the pathophysiology and diagnosis is important. This is because a number of remediable causes can be identified, and the diagnostic process involves patient education, which in turn may be effective in reducing costs. It is the complaint of constipation which leads either to self-medication or to consultation with the medical profession. Both of these courses of action have a significant influence on utilisation of laxatives (cathartics), obtained both over-the-counter and by prescription. Although there are a large number of laxative preparations available, therapy has changed little in half a century. Costs may vary considerably, and with such a significant problem there is a need for comparative studies. However, study methodologies are difficult, and a significant placebo response may be found. Education and preventive measures have been shown to reduce laxative use and costs in institutions. Unfortunately, there are few comparative studies of individual laxatives and even fewer cost-effectiveness studies. Those that there are have been based in institutions, and so extrapolation to other situations may be difficult. In general, little attention is given to constipation. It is, however, an area with significant resource implications in which education and preventive measures have been shown to be beneficial. Even so, there is still a need for good comparative studies, particularly where cost effectiveness is concerned.

Censoring the 1970s: The BBFC and the Decade that Taste Forgot

This book is a study of the British Board of Film Censors in the 1970s. In permitting and refusing specific material to be shown on cinema screens the BBFC were dictating patterns of taste and helping shape and determine notions of acceptability. Contentious and controversial texts like A Clockwork Orange (1971), Straw Dogs (1971) The Devils (1971) and Life of Brian (1979) have been used to draw attention to the way in which the BBFC operated in the 1970s. While it is true to say that these films encountered major censorship problems, what of the hundreds of other films which were being classified at the same time? Did all films struggle with the British censors in this period, and can these famous examples be fitted into broader patterns of censorship policy and practice?

In studying over 250 film files from the BBFC archive, this work reveals how 1970s films such as Vampire Circus (1971), Confessions of a Window Cleaner (1974) and Carry on Emmannuelle (1978) also ran in to trouble with the film censor. This work explores the complex process of negotiation and compromise which affected all film submissions in the 1970s and the way in which the BBFC actively, and often sympathetically, negotiated with film directors, producers and distributors to assign the correct category to each film. The lack of any defined formal censorship policy in this period allowed the BBFC to work alongside the film industry and push cultural, social and artistic boundaries; however it also left the Board open to accusations of favouritism, subjectivity and personal bias.

This work is not simply a study of controversial films and contentious issues, but rather engages with wider issues of changing permission, legal struggles, the influence of the media and the legislative and governmental controls which both helped and hindered the BBFC in this important post-war decade. The approach used within this work focuses on historical and archival research, making it importantly inter-textual and offering a great deal to scholars from a number of associated disciplines, including history, social policy, media and communications and politics.

A Case for Humanity in the Law of Rape.

One of Irigaray’s most insistent criticisms of the operation of patriarchal law is its overwhelming focus on the protection of property at the expense of law that regulates relations between and amongst persons. This paper argues, with reference to Irigaray’s work, that the conceptual change involved in such a reorientation of law’s focus has important implications for the legal perception of the harm of rape and woman’s sexuality. The possessive paradigm operates in the law of rape by disassociating the harm of rape from its psychic and subjective impact and encouraging the ‘simple’rape/ ‘real’ rape dichotomy. In returning subjectivity to woman herself we can begin to see perhaps how the crime of rape involves a harm to woman that affects the whole of her being, and to be. Such a reading allows the law to perhaps move away from understanding rape as a violation of undifferentiated bodies to a violation of the innate ‘virginity’ of woman.

Irony as discipline: Self-help and gender in the knowledge economy:Self-help and gender in the knowledge economy

In this article, we explore the role of self-help literature within the knowledge economy. We point to the recent growth of ironic humour within such texts, and examine how this operates to construct gendered and embodied subjectivities that position women according to a masculine gaze. Drawing on empirical data from self-help books for career women published between 1997 and 2007, we analyse the styles of embodiment that these texts promote. We find that career women are encouraged to maintain a stance of constant attention to themselves and their bodily presentations, a position that is in line with wider cultural features of contemporary knowledge economy working. We note that ironic humour is deployed in ways that subtly reinforce existing gender relations within contemporary organizations. Our article contributes to debates on subjectivity within the knowledge economy; while scholars have pointed to an increasing normative emphasis on embodied performances, we provide insights into the mechanisms by which this occurs, with a specific focus upon the growing genre of self-help literature and its recent shift to ironic humour.

Who was Andrea? Writing Oneself as a Feminist Icon

This article explores the construction of Andrea Dworkin as a public persona, or a ‘feminist icon’, revered by some and demonized by others. It argues that in both her fiction and non-fiction, Dworkin engaged in a process of writing herself as an exceptional woman, a ‘feminist militant’ as she describes herself in the subheading of her 2002 memoir, Heartbreak. The article illustrates Dworkin’s autobiographical logic of exceptionalism by comparing the story told in Heartbreak to the story of Dworkin’s major novel, Mercy, which features a heroine, Andrea, who shares Dworkin’s name and significant biographical details. While Dworkin has insisted that Mercy is not an autobiographical novel, the author undertakes a reading here of Mercy as the story of Dworkin if she had not become the feminist icon of her own and others’ construction. In Mercy, Andrea unsuccessfully attempts to escape the silent, victimized status that Dworkin has insistently argued is imposed upon women. In her repeated victimization, Andrea functions for Dworkin as an ‘everywoman’ who both embodies Dworkin’s world-view and highlights how Dworkin’s own biography exists in tension with some of her central assumptions about women, gender and contemporary society.

From gendered organizations to compassionate borderspaces: Reading corporeal ethics with Bracha Ettinger

In this article, we propose a new way of approaching the topic of ethics for management and organization theory. We build on recent developments within critical organization studies that focus on the question of what kind of ethics is possible in organizational contexts that are inevitably beset by difference. Addressing this ‘ethics of difference’, we propose a turn to feminist theory, in which the topic has long been debated but which has been underutilized in organization theory until very recently. Specifically, we draw on the work of Bracha Ettinger to re-think and extend existing understandings. Inspired by gender studies, psychoanalysis, philosophy and art, Ettinger’s work has been celebrated for its revolutionary re-theorization of subjectivity. Drawing on a feminist ethics of the body inspired by psychoanalysis, she presents a concept of ‘trans-subjectivity’. In this, subjectivity is defined by connectedness, co-existence and compassion towards the other, and is grounded in what Ettinger terms the ‘matrixial borderspace’. An ethics of organization derived from the concept of the matrixial suggests that a different kind of ethical relation with the Other is possible. In this article, we demonstrate this through examining the issue of gender in the workplace. We conclude by outlining the implications of this perspective for rethinking ethics, embodiment and gender, and in particular for the development of a corporeal ethics for organization studies.

Optical coherence tomography (OCT) for detection of macular oedema in patients with diabetic retinopathy

Background

Diabetic macular oedema (DMO) is a thickening of the central retina, or the macula, and is associated with long-term visual loss in people with diabetic retinopathy (DR). Clinically significant macular oedema (CSMO) is the most severe form of DMO. Almost 30 years ago, the Early Treatment Diabetic Retinopathy Study (ETDRS) found that CSMO, diagnosed by means of stereoscopic fundus photography, leads to moderate visual loss in one of four people within three years. It also showed that grid or focal laser photocoagulation to the macula halves this risk. Recently, intravitreal injection of antiangiogenic drugs has also been used to try to improve vision in people with macular oedema due to DR.Optical coherence tomography (OCT) is based on optical reflectivity and is able to image retinal thickness and structure producing cross-sectional and three-dimensional images of the central retina. It is widely used because it provides objective and quantitative assessment of macular oedema, unlike the subjectivity of fundus biomicroscopic assessment which is routinely used by ophthalmologists instead of photography. Optical coherence tomography is also used for quantitative follow-up of the effects of treatment of CSMO.

Objectives

To determine the diagnostic accuracy of OCT for detecting DMO and CSMO, defined according to ETDRS in 1985, in patients referred to ophthalmologists after DR is detected. In the update of this review we also aimed to assess whether OCT might be considered the new reference standard for detecting DMO.

Search methods

We searched the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA) and the NHS Economic Evaluation Database (NHSEED) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1950 to June 2013), Web of Science Conference Proceedings Citation Index - Science (CPCI-S) (January 1990 to June 2013), BIOSIS Previews (January 1969 to June 2013), MEDION and the Aggressive Research Intelligence Facility database (ARIF). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 June 2013. We checked bibliographies of relevant studies for additional references.

Selection Criteria

We selected studies that assessed the diagnostic accuracy of any OCT model for detecting DMO or CSMO in patients with DR who were referred to eye clinics. Diabetic macular oedema and CSMO were diagnosed by means of fundus biomicroscopy by ophthalmologists or stereophotography by ophthalmologists or other trained personnel.

Data collection and analysis

Three authors independently extracted data on study characteristics and measures of accuracy. We assessed data using random-effects hierarchical sROC meta-analysis models.

Main results

We included 10 studies (830 participants, 1387 eyes), published between 1998 and 2012. Prevalence of CSMO was 19% to 65% (median 50%) in nine studies with CSMO as the target condition. Study quality was often unclear or at high risk of bias for QUADAS 2 items, specifically regarding study population selection and the exclusion of participants with poor quality images. Applicablity was unclear in all studies since professionals referring patients and results of prior testing were not reported. There was a specific 'unit of analysis' issue because both eyes of the majority of participants were included in the analyses as if they were independent.In nine studies providing data on CSMO (759 participants, 1303 eyes), pooled sensitivity was 0.78 (95% confidence interval (CI) 0.72 to 0.83) and specificity was 0.86 (95% CI 0.76 to 0.93). The median central retinal thickness cut-off we selected for data extraction was 250 µm (range 230 µm to 300 µm). Central CSMO was the target condition in all but two studies and thus our results cannot be applied to non-central CSMO.Data from three studies reporting accuracy for detection of DMO (180 participants, 343 eyes) were not pooled. Sensitivities and specificities were about 0.80 in two studies and were both 1.00 in the third study.Since this review was conceived, the role of OCT has changed and has become a key ingredient of decision-making at all levels of ophthalmic care in this field. Moreover, disagreements between OCT and fundus examination are informative, especially false positives which are referred to as subclinical DMO and are at higher risk of developing clinical CSMO.

Authors' conclusions

Using retinal thickness thresholds lower than 300 µm and ophthalmologist's fundus assessment as reference standard, central retinal thickness measured with OCT was not sufficiently accurate to diagnose the central type of CSMO in patients with DR referred to retina clinics. However, at least OCT false positives are generally cases of subclinical DMO that cannot be detected clinically but still suffer from increased risk of disease progression. Therefore, the increasing availability of OCT devices, together with their precision and the ability to inform on retinal layer structure, now make OCT widely recognised as the new reference standard for assessment of DMO, even in some screening settings. Thus, this review will not be updated further.

Development and Validation of a Novel Lateral Flow Immunoassay (LFIA) for the Rapid Screening of Paralytic Shellfish Toxins (PSTs) from Shellfish Extracts

A single-step lateral flow immunoassay (LFIA) was developed and validated for the rapid screening of paralytic shellfish toxins (PSTs) from a variety of shellfish species, at concentrations relevant to regulatory limits of 800 μg STX-diHCl equivalents/kg shellfish meat. A simple aqueous extraction protocol was performed within several minutes from sample homogenate. The qualitative result was generated after a 5 min run time using a portable reader which removed subjectivity from data interpretation. The test was designed to generate noncompliant results with samples containing approximately 800 μg of STX-diHCl/kg. The cross-reactivities in relation to STX, expressed as mean ± SD, were as follows: NEO: 128.9% ± 29%; GTX1&4: 5.7% ± 1.5%; GTX2&3: 23.4% ± 10.4%; dcSTX: 55.6% ± 10.9%; dcNEO: 28.0% ± 8.9%; dcGTX2&3: 8.3% ± 2.7%; C1&C2: 3.1% ± 1.2%; GTX5: 23.3% ± 14.4% (n = 5 LFIA lots). There were no indications of matrix effects from the different samples evaluated (mussels, scallops, oysters, clams, cockles) nor interference from other shellfish toxins (domoic acid, okadaic acid group). Naturally contaminated sample evaluations showed no false negative results were generated from a variety of different samples and profiles (n = 23), in comparison to reference methods (MBA method 959.08, LC-FD method 2005.06). External laboratory evaluations of naturally contaminated samples (n = 39) indicated good correlation with reference methods (MBA, LC-FD). This is the first LFIA which has been shown, through rigorous validation, to have the ability to detect most major PSTs in a reliable manner and will be a huge benefit to both industry and regulators, who need to perform rapid and reliable testing to ensure shellfish are safe to eat.

These Fine Lines: Locating Noncitizenship in Political Protest in Europe

Since 2012, refugee protest camps and occupations have been established throughout Europe that contest the exclusion of refugees and asylum seekers, but that also make concrete demands for better living conditions and basic rights. It is a movement that is led by migrants as noncitizens, and so reveals new ways of thinking of the political agency and status of noncitizenship not as simply reactive to an absence of citizenship, but as a powerful and transgressive subjectivity in its own right. This paper argues that we should resist collapsing analysis back into the frameworks of citizenship, and instead be attentive to the politics of presence and solidarity manifest in these protest camps as a way of understanding, and engaging, noncitizen activism.

Care Leavers’ Experiences of Transition and Turning Points: Findings from a Biographical Narrative Study

This paper reports on the findings of a PhD research project that set out to explore how young people leaving out of home care experienced and made sense of their transition to adulthood. Using the Biographical Narrative Interpretative Method, in-depth accounts were collected and analysed for eight care leavers. The data suggest that in addition to care leavers living their lives as a series of biographical events, their ‘care career’, they also experience changes in the way they make sense of their lives which form a ‘subjective pathway’. Influenced by the literature on resilience, the research had anticipated that ‘turning point’ events would play a significant role in the young people’s subjective pathways. But the findings show a more gradual, phased shifting of subjectivity. It is suggested that legislation, policy, services and care practices need to facilitate this more drawn out ‘subjective pathway’. Attachment, resilience and humanistic social psychology are proposed as useful theoretical underpinnings for that work