eHealth as a challenge to `expert' power: a focus group study of internet use for health information and management

Objective To investigate current use of the internet and eHealth amongst adults. Design Focus groups were conducted to explore participants' attitudes to and reasons for health internet use. Main outcome measures The focus group data were analysed and interpreted using thematic analysis. Results Three superordinate themes exploring eHealth behaviours were identified: decline in expert authority, pervasiveness of health information on the internet and empowerment. Results showed participants enjoyed the immediate benefits of eHealth information and felt empowered by increased knowledge, but they would be reluctant to lose face-to-face consultations with their GP. Conclusions Our findings illustrate changes in patient identity and a decline in expert authority with ramifications for the practitioner–patient relationship and subsequent implications for health management more generally.

Pronounced reduction of postprandial glucagon by lixisenatide:a meta-analysis of randomized clinical trials

Glucagon-like peptide-1 (GLP-1) receptor agonists improve islet function and delay gastric emptying in patients with type 2 diabetes mellitus (T2DM). This meta-analysis aimed to investigate the effects of the once-daily prandial GLP-1 receptor agonist lixisenatide on postprandial plasma glucose (PPG), glucagon and insulin levels. Methods: Six randomized, placebo-controlled studies of lixisenatide 20μg once daily were included in this analysis: lixisenatide as monotherapy (GetGoal-Mono), as add-on to oral antidiabetic drugs (OADs; GetGoal-M, GetGoal-S) or in combination with basal insulin (GetGoal-L, GetGoal-Duo-1 and GetGoal-L-Asia). Change in 2-h PPG and glucose excursion were evaluated across six studies. Change in 2-h glucagon and postprandial insulin were evaluated across two studies. A meta-analysis was performed on least square (LS) mean estimates obtained from analysis of covariance (ANCOVA)-based linear regression. Results: Lixisenatide significantly reduced 2-h PPG from baseline (LS mean difference vs. placebo: -4.9mmol/l, p<0.001) and glucose excursion (LS mean difference vs. placebo: -4.5mmol/l, p<0.001). As measured in two studies, lixisenatide also reduced postprandial glucagon (LS mean difference vs. placebo: -19.0ng/l, p<0.001) and insulin (LS mean difference vs. placebo: -64.8 pmol/l, p<0.001). There was a stronger correlation between 2-h postprandial glucagon and 2-h PPG with lixisenatide than with placebo. Conclusions: Lixisenatide significantly reduced 2-h PPG and glucose excursion together with a marked reduction in postprandial glucagon and insulin; thus, lixisenatide appears to have biological effects on blood glucose that are independent of increased insulin secretion. These effects may be, in part, attributed to reduced glucagon secretion. © 2014 John Wiley and Sons Ltd.

Use of social network analysis to identify the coopetition in a Commercial Cluster Plan

The cluster provides a greater commercial relationship between the companies that comprise it. This encourages companies to adopt competitive structures that allow solving problems that would hardly alone (Lubeck et. Al., 2011). With that this paper aims to describe the coopetition between companies operating on a commercial cluster planned, from the point of view of retailers, taking as a basis the theoretical models proposed by Bengtsson and Kock (1999) and Leon (2005) and operationalized by means of Social Network Analysis (SNA). Data collection consisted of two phases, the first exploratory aspect to identify the actors, and the second was characterized as descriptive as it aims to describe the coopetition among the enterprises. As a result we identified the companies that cooperate and compete simultaneously (coopetition), firms that only compete, companies just cooperate and businesses that do not compete and do not cooperate (coexistence).

Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015 : a systematic analysis for the Global Burden of Disease Study 2015

Avaliação do potencial de Tillandsia recurvata (L.) L., Bromeliaceae, como bioindicadora da poluição atmosférica urbana

Air pollution can threat the environment and public health, and is assess by pollutant ́s concentration measurements in order to verify whether the limits set by environmental agencies are being respected. However, these measures do not indicate immediately the impacts to living beings. To faced this problem, plants are been investigated as potential bioindicators of air pollution and, among them, stand out bromeliads Tillandsia genus which colonize various substrates,. obtaining water and nutrients from the atmosphere directly. In this context, this research assessed the potential of epiphytic bromeliad Tillandsia recurvata (L.) L. found in urbanized areas of the city of Curitiba - PR as a bioindicator of urban air pollution. According to vehicle traffic, five sample points were selected and classified. Points P1 and P2 were classified as high-traffic vehicle due presenting trucks and urban transport; point P3 was classified as moderate traffic due the predominance of private vehicles and urban transport; and points P4 and P5 were classified as low-traffic, presenting circulation of private vehicles only. There were analyzed the abundance of T. recurvata, morphophysiological parameters (leaf area, leaf specific area, sclerophylly index, percentage dry weight / fresh weight, chlorophyll (a + b), analysis of structural mesophyll organization) and the heavy metals accumulation (Fe, Cd, Cr, Cu, Pb and Zn). The abundance analysis and the results obtained for metals analysis were correlated with the intensity of vehicular traffic, directing the sampling points P1 > P2 = P3 > P4 = P5. This result demonstrate that the abundance of T. recurvata is greater in urban air pollution impacted areas, thus indicating that T. recurvata absorbs and accumulates metals and can be used in biomonitoring of urban air pollution in areas impacted by vehicular traffic. Morphophysiological parameters analyzed shows that the internal plant ́s structure is not significantly impacted by urban air pollution due plant ́s adptations. The presence of absorbing scales, the CAM metabolism pathway and it ́s store water ability, among other features, demonstrate their potential as bio-indicator in urban areas, especially regarding heavy metals accumulation .

Chronic Diseases: Chronic Diseases and Development 2 Health, agricultural, and economic effects of adoption of healthy diet recommendations

Transition to diets that are high in saturated fat and sugar has caused a global public health concern as the pattern of food consumption is a mayor modifiable risk factor for chronic non-communicable diseases Although agri food systems are intimately associated with this transition, agriculture and health sectors are largely disconnected in their priorities policy, and analysis with neither side considering the complex inter relation between agri trade patterns of food consumption health, and development We show the importance of connection of these perspectives through estimation of the effect of adopting a healthy diet on population health, agricultural production trade the economy and livelihoods, with a computable general equilibrium approach on the basis of case studies from the UK and Brazil we suggest that benefits of a healthy diet policy will vary substantially between different populations, not only because of population dietary intake but also because of agricultural production trade and other economic factors

O dever constitucional de eficiência administrativa na jurisprudência do Supremo Tribunal Federal

O dever constitucional de eficiência administrativa consiste em norma reitora da atividade regulatória e das demais funções estatais. Este trabalho tem o objetivo de investigar seus sentidos, os tipos de norma em que se classifica e as estruturas argumentativas para a sua aplicação. Entende-se, por sentidos, os critérios usados para se considerar que uma conduta ou medida cumpre ou viola o dever de eficiência, incluindo consideração da relação entre meios para o exercício da atividade administrativa e resultados dessa atividade. Parte-se de diagnóstico de indefinição conceitual, na literatura jurídica brasileira, acerca desse dever constitucional, para investigar a existência de subsídios, na jurisprudência do Supremo Tribunal Federal, que viabilizem elaboração de conceito. Desse modo, verifica-se, na literatura, multiplicidade de definições. Além disso, o aspecto da análise custo-benefício, referido tanto na literatura sobre economicidade quanto nos textos sobre análise econômica do direito, sugere que o assunto também possa ser abordado de modo a correlacioná-lo ao conceito econômico de eficiência de Kaldor-Hicks ou de maximização da riqueza. Na jurisprudência, foi encontrada grande quantidade de sentidos de eficiência, a indicar que o STF pode não ter um posicionamento claro, senão em relação à concepção do dever constitucional de eficiência como um todo, pelo menos em relação a aspectos do conceito, a implicar a necessidade de elaboração, pelo tribunal, casuisticamente, de critérios para considerar que determinada conduta ou medida cumpre ou viola esse dever constitucional. Verificou-se, ainda, a ocorrência de aparentes divergências entre os ministros não apenas com relação à solução concreta de um caso, mas com relação à definição, em um mesmo caso, do sentido do dever de eficiência. Não se pode afirmar, no entanto, com segurança, que a concepção do dever de eficiência em um acórdão seja determinante, no STF, para a orientação dos votos. Ainda assim, um mesmo caso pode ter soluções distintas a depender do sentido de eficiência que se adote. Ademais, os acórdãos que parecem proceder a análise custo-benefício não se parecem referir a conceitos ou a critérios de eficiência econômica para fundamentar essa análise. Esses acórdãos também raramente fazem referência a dados empíricos. Quanto aos tipos de norma às estruturas argumentativas para aplicação, a literatura faz referência a teorias incompatíveis que dificultam compreender de maneira inequívoca como ocorre essa aplicação. O STF, a seu turno, faz uso de pelo menos 3 (três) estruturas argumentativas para aplicar o dever de eficiência: o consequencialismo, a análise custo-benefício e a ponderação de normas. O uso concomitante da análise custo-benefício e da ponderação de normas, contudo, enseja confusão entre o dever de eficiência e a máxima da proporcionalidade. Nesse contexto, a proposta conceitual busca tornar claros os sentidos, os tipos de norma e os modos de aplicação do dever constitucional de eficiência, mediante adoção de referencial teórico único que seja compatível com os achados de jurisprudência. Sendo assim, propõe-se a classificação do dever de eficiência como sobreprincípio e do dever de economicidade como postulado, com referência às concepções teóricas de Humberto Ávila, buscando-se evitar incorrer nos problemas diagnosticados na doutrina e na jurisprudência.

Cost-benefit, cost-effectiveness research of drug abuse prevention : implications for programming and policy /

Shipping list no.: 99-0004-P.

A COST-BENEFIT ANALYSIS OF A 25% RPS IN MICHIGAN

Michigan depends heavily on fossil fuels to generate electricity. Compared with fossil fuels, electricity generation from renewable energy produces less pollutants emissions. A Renewable Portfolio Standard (RPS) is a mandate that requires electric utilities to generate a certain amount of electricity from renewable energy sources. This thesis applies the Cost-Benefits Analysis (CBA) method to investigate the impacts of implementing a 25% in Michigan by 2025. It is found that a 25% RPS will create about $20.12 billion in net benefits to the State. Moreover, if current tax credit policies will not change until 2025, its net present value will increase to about $26.59 billion. Based on the results of this CBA, a 25% RPS should be approved. The result of future studies on the same issue can be improved if more state specific data become available.

Building energy saving techniques and indoor air quality : a dilemma

In European countries and North America, people spend 80 to 90% of time inside buildings and thus breathe indoor air. In Switzerland, special attention has been devoted to the 16 stations of the national network of observation of atmospheric pollutants (NABEL). The results indicate a reduction in outdoor pollution over the last ten years. With such a decrease in pollution over these ten years the question becomes: how can we explain an increase of diseases? Indoor pollution can be the cause. Indoor contaminants that may create indoor air quality (IAQ) problems come from a variety of sources. These can include inadequate ventilation, temperature and humidity dysfunction, and volatile organic compounds (VOCs). The health effects from these contaminants are varied and can range from discomfort, irritation and respiratory diseases to cancer. Among such contaminants, environmental tobacco smoke (ETS) could be considered the most important in terms of both health effects and engineering controls of ventilation. To perform indoor pollution monitoring, several selected ETS tracers can be used including carbon monoxide (CO), carbon dioxide (CO2), respirable particles (RSP), condensate, nicotine, polycyclic aromatic hydrocarbons (PAHs), nitrosamines, etc. In this paper, some examples are presented of IAQ problems that have occurred following the renewal of buildings and energy saving concerns. Using industrial hygiene sampling techniques and focussing on selected priority pollutants used as tracers, various problems have been identified and solutions proposed. [Author]

Evaluating the climate and air quality impacts of short-lived pollutants

This paper presents a summary of the work done within the European Union's Seventh Framework Programme project ECLIPSE (Evaluating the Climate and Air Quality Impacts of Short-Lived Pollutants). ECLIPSE had a unique systematic concept for designing a realistic and effective mitigation scenario for short-lived climate pollutants (SLCPs; methane, aerosols and ozone, and their precursor species) and quantifying its climate and air quality impacts, and this paper presents the results in the context of this overarching strategy. The first step in ECLIPSE was to create a new emission inventory based on current legislation (CLE) for the recent past and until 2050. Substantial progress compared to previous work was made by including previously unaccounted types of sources such as flaring of gas associated with oil production, and wick lamps. These emission data were used for present-day reference simulations with four advanced Earth system models (ESMs) and six chemistry transport models (CTMs). The model simulations were compared with a variety of ground-based and satellite observational data sets from Asia, Europe and the Arctic. It was found that the models still underestimate the measured seasonality of aerosols in the Arctic but to a lesser extent than in previous studies. Problems likely related to the emissions were identified for northern Russia and India, in particular. To estimate the climate impacts of SLCPs, ECLIPSE followed two paths of research: the first path calculated radiative forcing (RF) values for a large matrix of SLCP species emissions, for different seasons and regions independently. Based on these RF calculations, the Global Temperature change Potential metric for a time horizon of 20 years (GTP20) was calculated for each SLCP emission type. This climate metric was then used in an integrated assessment model to identify all emission mitigation measures with a beneficial air quality and short-term (20-year) climate impact. These measures together defined a SLCP mitigation (MIT) scenario. Compared to CLE, the MIT scenario would reduce global methane (CH4) and black carbon (BC) emissions by about 50 and 80 %, respectively. For CH4, measures on shale gas production, waste management and coal mines were most important. For non-CH4 SLCPs, elimination of high-emitting vehicles and wick lamps, as well as reducing emissions from gas flaring, coal and biomass stoves, agricultural waste, solvents and diesel engines were most important. These measures lead to large reductions in calculated surface concentrations of ozone and particulate matter. We estimate that in the EU, the loss of statistical life expectancy due to air pollution was 7.5 months in 2010, which will be reduced to 5.2 months by 2030 in the CLE scenario. The MIT scenario would reduce this value by another 0.9 to 4.3 months. Substantially larger reductions due to the mitigation are found for China (1.8 months) and India (11–12 months). The climate metrics cannot fully quantify the climate response. Therefore, a second research path was taken. Transient climate ensemble simulations with the four ESMs were run for the CLE and MIT scenarios, to determine the climate impacts of the mitigation. In these simulations, the CLE scenario resulted in a surface temperature increase of 0.70 ± 0.14 K between the years 2006 and 2050. For the decade 2041–2050, the warming was reduced by 0.22 ± 0.07 K in the MIT scenario, and this result was in almost exact agreement with the response calculated based on the emission metrics (reduced warming of 0.22 ± 0.09 K). The metrics calculations suggest that non-CH4 SLCPs contribute ~ 22 % to this response and CH4 78 %. This could not be fully confirmed by the transient simulations, which attributed about 90 % of the temperature response to CH4 reductions. Attribution of the observed temperature response to non-CH4 SLCP emission reductions and BC specifically is hampered in the transient simulations by small forcing and co-emitted species of the emission basket chosen. Nevertheless, an important conclusion is that our mitigation basket as a whole would lead to clear benefits for both air quality and climate. The climate response from BC reductions in our study is smaller than reported previously, possibly because our study is one of the first to use fully coupled climate models, where unforced variability and sea ice responses cause relatively strong temperature fluctuations that may counteract (and, thus, mask) the impacts of small emission reductions. The temperature responses to the mitigation were generally stronger over the continents than over the oceans, and with a warming reduction of 0.44 K (0.39–0.49) K the largest over the Arctic. Our calculations suggest particularly beneficial climate responses in southern Europe, where surface warming was reduced by about 0.3 K and precipitation rates were increased by about 15 (6–21) mm yr−1 (more than 4 % of total precipitation) from spring to autumn. Thus, the mitigation could help to alleviate expected future drought and water shortages in the Mediterranean area. We also report other important results of the ECLIPSE project.