Having Your Cake and Eating It, Too: Can Regulatory Agencies Be Both Independent and Accountable?

Independent regulatory agencies (IRAs) were created in various sectors and on different governmental levels to implement liberalization policies. This paper investigates the link between IRAs' independence, which is said to promote regulatory credibility and the use of technical expertise, and their accountability, which is related to the need for controlling and legitimizing independent regulators. The literature on the regulatory state anticipates a positive relation between the independence and accountability of IRAs, but systematic empirical evidence is still lacking. To tackle this question, this paper measures and compares the independence and the accountability of IRAs in three differentially liberalized sectors in Switzerland (telecommunications, electricity and railways). With the application of Social Network Analysis, this piece of research shows that IRAs can be de facto independent and accountable at the same time, but the two features do not necessarily co-evolve in the same direction.

Does unemployment hurt less if there is more of it around? A panel analysis of life satisfaction in Germany and Switzerland

This article examines the existence of a habituation effect to unemployment: Does the subjective well-being of unemployed people decline less if unemployment is more widespread? The underlying idea is that unemployment hysteresis may operate through a sociological channel: if many people in the community lose their job and remain unemployed over an extended period, the psychological cost of being unemployed diminishes and the pressure to accept a new job declines. We analyze this question with individual-level data from the German Socio-Economic Panel (1984-2010) and the Swiss Household Panel (2000-2010). Our fixed-effects estimates show no evidence for a mitigating effect of high surrounding unemployment on the subjective well-being of the unemployed. Becoming unemployed hurts as much when regional unemployment is high as when it is low. Likewise, the strongly harmful impact of being unemployed on well-being does not wear off over time, nor do repeated episodes of unemployment make it any better. It thus appears doubtful that an unemployment shock becomes persistent because the unemployed become used to, and hence reasonably content with, being without a job.

Médecine sociale en 2013 : quand la précarité précède la pauvreté [Social medicine : does it still make sense in 2013?]

Social medicine is a medicine that seeks to understand the impact of socio-economic conditions on human health and diseases in order to improve the health of a society and its individuals. In this field of medicine, determining the socio-economic status of individuals is generally not sufficient to explain and/or understand the underlying mechanisms leading to social inequalities in health. Other factors must be considered such as environmental, psychosocial, behavioral and biological factors that, together, can lead to more or less permanent damages to the health of the individuals in a society. In a time where considerable progresses have been made in the field of the biomedicine, does the practice of social medicine in a primary care setting still make sense? La médecine sociale est une médecine qui cherche à comprendre l'impact des conditions socio-économiques sur la santé humaine et les maladies, dans la perspective d'améliorer l'état de santé d'une société et de ses individus. Dans ce domaine, la détermination du statut socio-économique des individus ne suffit généralement pas à elle seule pour expliquer et comprendre les mécanismes qui sous-tendent les inégalités sociales de santé. D'autres facteurs doivent être pris en considération, tels que les facteurs environnementaux, psychosociaux, comportementaux et biologiques, facteurs qui peuvent conduire de manière synergique à des atteintes plus ou moins durables de l'état de santé des individus d'une société. A une époque où les connaissances, les compétences et les moyens à disposition en biomédecine ont fait des progrès considérables, la pratique de la médecine sociale en cabinet a-t-elle encore sa place en 2013?

"I'll look it up on the Web first": barriers and overcoming barriers to consult for sexual dysfunction among young men.

QUESTIONS UNDER STUDY: Our aim was to identify the barriers young men face to consult a health professional when they encounter sexual dysfunctions and where they turn to, if so, for answers. METHODS: We conducted an exploratory qualitative research including 12 young men aged 16-20 years old seen in two focus groups. Discussions were triggered through vignettes about sexual dysfunction. RESULTS: Young men preferred not to talk about sexual dysfunction problems with anyone and to solve them alone as it is considered an intimate and embarrassing subject which can negatively impact their masculinity. Confidentiality appeared to be the most important criterion in disclosing an intimate subject to a health professional. Participants raised the problem of males' accessibility to services and lack of reason to consult. Two criteria to address the problem were if it was long-lasting or considered as physical. The Internet was unanimously considered as an initial solution to solve a problem, which could guide them to a face-to-face consultation if necessary. CONCLUSIONS: Results suggest that Internet-based tools should be developed to become an easy access door to sexual health services for young men. Wherever they consult and for whatever problem, sexual health must be on the agenda.

Squamous cell carcinoma in 6 patients with chronic discharging osteomyelitis: Is it really rare?

Introduction: Development of a squamous cell carcinoma (Marjolin's ulcer) is a rare but well-known complication of chronic discharging osteomyelitis. A high index of suspicion and highquality of histopathological examination are paramount in order to make the correct diagnosis. Methods: During a 15-year period (1993 and 2008), patients with long-standing chronic osteomyelitis with clinical symptoms of >1 year of duration, were retrospectively reviewed. Included were patients with histologically confirmed squamous-cell carcinoma associated with chronic wound overlying the site of chronic osteomyelitis. Clinical features and treatment approaches of these patients were analyzed. Results: During the study period, 6 patients were identified (2 women and 4 men) aged 52 to 67 years (mean 59 years). All patients had a long history of chronic discharging osteomyelitis (12, 19, 21, 30, 39 and 40 years), localized in the lower (5 patients) or upper extremitiy (1 patient). All tumors were histologically highly-differentiated squamous-cell carcinomas involving the deep soft tissues and the bone. 5 of 6 patients were initially misdiagnosed as chronic bone infection since bacteria were isolated in wound swabs, including Staphylococcus aureus (n = 3), Escherichia coli (n = 1) and Staphylococcus epidermidis (n = 1). Treatment consisted of major amputation in 4 patients and radical surgical excision in 2 patients refusing amputation. 4 patients were lost to follow-up due to return to their country of origin, the remaining 2 patients were without signs of tumor recurrence (both after major amputation). Conclusion: Malignant transformation of is a rare, but serious complication of long-standing discharging chronic osteomyelitis. All 6 patients were diagnosed after >10 years of persistent or recurrent wounds. It should be particularly suspected in case of a pathological fracture, development of exophytic mass and changes in local pattern of the ulcers itself. Multiple biopsies, including deep soft tissues and bone, are recommended to distinguish between chronic osteomyelitis, pseudoepitheliomatous hyperplasia and highly-differentiated squamous cell carcinoma. Early diagnosis and a team approach (orthopaedic and plastic surgeon) are crucial for optimal management of the patient

Corruption and decentralization : what economists have to say about it

This paper deals with both theoretical and empirical aspects of the link between corruption and decentralization in both developing and emerging countries. Only mixed results can be drawn from the literature. Decentralization can help discipline "predative" governments, but only under certain conditions. Indeed, it depends on fiscal arrangements and political features that are likely to be different between countries. The way incentives to local governments are designed by the central governments also plays an essential role.

Skin hyperemia induced by local heating : why is it blunted on repeat stimulations ?

Background: In human skin, local heating produces local vasodilatation, a response termed thermal hyperemia. Thermal hyperemia is largely mediated by nitric oxide (NO). It is blunted on repeat stimulations applied to the same skin spot, a phenomenon termed desensitization. As this phenomenon could reflect a desensitization in the vasodilator effects of NO, we investigated whether a prior exposure to exogenous NO would result in an attenuated vasodilatory response to a subsequent thermal challenge. Methods: Thirteen healthy young men were studied. Skin blood flow (SkBF) was mesured on forearm skin with laser Doppler imaging. Exposure to exogenous NO was carried out by iontophoresis of sodium nitroprusside (SNP), a donor of NO. A local thermal stimulus (temperature step from 34 to 41°C maintained for 30 minutes) was applied with temperature-controlled chambers. We tested the influence of a previous transient exposure to exogenous NO on : 1) thermal hyperemia and 2) the response to a second identical exposure to exogeneous NO. Results: Thermal hyperemia (plateau SkBF at 30 minutes minus SkBF at 34°C) obtained on a site preexposed to exogenous NO two hours before was lower than obtained on a site preexposed to iontophoretic current only (mean±SD 395±139 perfusion units [PU] vs 540±79 PU ; p<0.01). When repeated on the same skin site two hours after the first one, exposure to exogenous NO led to a blunted vasodilatory response (298±121 PU vs 394±92 PU), although this difference was not statistically significant (p≈0.09). Conclusion: In forearm human skin, prior exposure to exogenous NO partially inhibits thermal hyperemia. These data support that desensitization of thermal hyperemia depends on a downregulation of the NO-cGMP pathway, possibly downstream from the endogenous production of NO.

Reduced ejection fraction after myocardial infarction: is it sufficient to justify implantation of a defibrillator ?

Introduction : La diminution de la fraction d'éjection après infarctus du myocarde est-elle suffisante pour justifier l'implantation prophylactique de défibrillateur ? Introduction: La diminution de la fraction d'éjection (FE) est un facteur prédictif majeur de mortalité cardiaque chez les patients avec ancien infarctus du myocarde (IM). Les plus récentes études, pour la plupart conduites à la fin des années 90, montrent une diminution de la mortalité post-hospitalière à 10 à 20% par année. Une amélioration de la survie par implantation prophylactique de défibrillateurs a été démontrée chez les patients avec dysfonction myocardique avancée après ancien IM dans la cadre de l'étude MADIT II (Multicenter Automatic Defibrillator Implantation Trial) et est depuis lors, considérée comme une thérapie recommandée. Le bénéfice de l'implantation prophylactique de défibrillateurs en terme de nombre nécessaire de patients à traiter pour prévenir un évènement est d'un intérêt primordial en raison des complications potentielles liées à la procédure et l'appareillage, des implications psychologiques ainsi qu'en raison de l'analyse coût-efficacité. Le nombre de patients à traiter est corrélé au risque actuel de mortalité rythmique, probablement influencé par les récentes avancées thérapeutiques dans la prise en charge aigue de l'IM (notamment par angioplastie primaire) et de l'insuffisance cardiaque. Or, dans '' l'étude MADIT II, le recrutement des patients était effectué entre 1997 et 2001 et l'intervalle moyen entre l'IM et le recrutement était de plus de 6 ans. Le but de l'étude était donc d'évaluer, dans la pratique générale, la mortalité actuelle de patients ayant survécu à un IM avec diminution consécutive significative de la FE. La stratification du risque sur la base des variables hospitalières a de même été explorée. Méthode: Une analyse de cohorte de patients avec infarctus aigu du myocarde admis de 1999 à 2000 a été effectuée dans 2 centres hospitaliers (un universitaire et un cantonal). Tous les dossiers cliniques des patients sortis d'hôpital avec FE documentée ≤ 0.40 ont été inclus. Les caractéristiques des patients, les procédures diagnostiques et thérapeutiques ainsi que la médication étaient reportées. La période de suivi débutait à la sortie d'hôpital. Les end-points primaires étaient la mortalité globale, la mortalité cardiaque et les morts subites. Une analyse bivariée et multivariée a été effectuée. Résultats: 165 patients ont été inclus. Durant un suivi médian de 30 mois (interquartile range 22-36), 18 patients sont décédés (5 morts classifiées comme cardiaques, 8 comme subites, 5 de causes non cardiaques). Les taux de mortalité à un et deux ans selon analyse de Kaplan-Meier étaient de 6.7 et 8.6%, respectivement. Les variables reflétant l'atteinte coronarienne et sa prise en charge (antécédent d'IM, reperfusion aigue, revascularisation complète) étaient plus significativement associées à la mortalité comparées aux variables reflétant la dysfonction myocardique (FE, classe Killip à l'admission). Conclusion : La mortalité des patients ayant survécu à un IM avec dysfonction myocardique avancée a diminué de façon substantielle depuis la fin des années 90. La diminution de la mortalité rythmique implique une augmentation proportionnelle du nombre de patients à traiter par implantation de défibrillateur pour prévenir un évènement. Par ailleurs, une stratification du risque après IM basée uniquement sur la FE semble être inappropriée au vu de son impact mineur sur la mortalité comparé aux autres facteurs de risque identifiés dans notre étude. Les patients sans antécédents d'infarctus et ceux ayant bénéficié d'une revascularisation aigue ou complète avait une mortalité cumulée à 2 ans de, respectivement, 2.5%, 3.9% et 2.3%. Pour ce type de patients à bas risque le bénéfice de l'implantation prophylactique de défibrillateur doit être remis en question. Au vu de cette étude, une stratification additionnelle du risque avant implantation de défibrillateur est à considérer.

Assessing the prevalence of hypertension in populations: are we doing it right?

BACKGROUND: Although it is well recognized that the diagnosis of hypertension should be based on blood pressure (BP) measurements taken on several occasions, notably to account for a transient elevation of BP on the first readings, the prevalence of hypertension in populations has often relied on measurements at a single visit. OBJECTIVE: To identify an efficient strategy for assessing reliably the prevalence of hypertension in the population with regards to the number of BP readings required. DESIGN: Population-based survey of BP and follow-up information. SETTING AND PARTICIPANTS: All residents aged 25-64 years in an area of Dar es Salaam (Tanzania). MAIN OUTCOME MEASURES: Three BP readings at four successive visits in all participants with high BP (n = 653) and in 662 participants without high BP, measured with an automated BP device.RESULTS BP decreased substantially from the first to third readings at each of the four visits. BP decreased substantially between the first two visits but only a little between the next visits. Consequently, the prevalence of high BP based on the third reading--or the average of the second and third readings--at the second visit was not largely different compared to estimates based on readings at the fourth visit. BP decreased similarly when the first three visits were separated by 3-day or 14-day intervals. CONCLUSIONS: Taking triplicate readings on two visits, possibly separated by just a few days, could be a minimal strategy for assessing adequately the mean BP and the prevalence of hypertension at the population level. A sound strategy is important for assessing reliably the burden of hypertension in populations.

Mate and fuse: how yeast cells do it.

Many cells are able to orient themselves in a non-uniform environment by responding to localized cues. This leads to a polarized cellular response, where the cell can either grow or move towards the cue source. Fungal haploid cells secrete pheromones to signal mating, and respond by growing a mating projection towards a potential mate. Upon contact of the two partner cells, these fuse to form a diploid zygote. In this review, we present our current knowledge on the processes of mating signalling, pheromone-dependent polarized growth and cell fusion in Saccharomyces cerevisiae and Schizosaccharomyces pombe, two highly divergent ascomycete yeast models. While the global architecture of the mating response is very similar between these two species, they differ significantly both in their mating physiologies and in the molecular connections between pheromone perception and downstream responses. The use of both yeast models helps enlighten both conserved solutions and species-specific adaptations to a general biological problem.

Are there positive emotions in short-term dynamic psychotherapy or is it all Freude-less ?

Psychodynamic therapists are often suspicious of positive emotions and consider them to be nothing more than a form of denial or of another defense aiming to diminish painful or difficult affects. Positive emotions seem to exist only through the absence of negative emotions or as something that may happen outside of therapy. On the other hand, clinicians also agree that psychoanalytic work could not be successful without such positive emotions as interest, pleasure, surprise and creativity. Contemporary psychoanalytic thinking and new research findings in the area of relationship regulation are likely to give positive emotions an increasingly prominent place in dynamically oriented therapies. With today's emphasis on the therapeutic relationship and intersubjectivity, the time appears right to integrate positive emotions more formally into psychodynamic clinical theories.