Affective Instability, Childhood Trauma and Major Affective Disorders

BACKGROUND: Affective instability (AI), childhood trauma, and mental illness are linked, but evidence in affective disorders is limited, despite both AI and childhood trauma being associated with poorer outcomes. Aims were to compare AI levels in bipolar disorder I (BPI) and II (BPII), and major depressive disorder recurrent (MDDR), and to examine the association of AI and childhood trauma within each diagnostic group. METHODS: AI, measured using the Affective Lability Scale (ALS), was compared between people with DSM-IV BPI (n=923), BPII (n=363) and MDDR (n=207) accounting for confounders and current mood. Regression modelling was used to examine the association between AI and childhood traumas in each diagnostic group. RESULTS: ALS scores in descending order were BPII, BPI, MDDR, and differences between groups were significant (p<0.05). Within the BPI group any childhood abuse (p=0.021), childhood physical abuse (p=0.003) and the death of a close friend in childhood (p=0.002) were significantly associated with higher ALS score but no association was found between childhood trauma and AI in BPII and MDDR. LIMITATIONS: The ALS is a self-report scale and is subject to retrospective recall bias. CONCLUSIONS: AI is an important dimension in bipolar disorder independent of current mood state. There is a strong link between childhood traumatic events and AI levels in BPI and this may be one way in which exposure and disorder are linked. Clinical interventions targeting AI in people who have suffered significant childhood trauma could potentially change the clinical course of bipolar disorder.

Troubled waters: an institutional analysis of ageing Dutch and American waterway infrastructure

Waterways are one of the oldest systems for the transportation of cargo and continue to play a vital role in the economies of some countries. Due to societal change, climate change and the ageing of assets, the conditions influencing the effective functioning of these systems seem to be changing. These changing conditions require measures to renew, adapt or renovate these waterway systems. However, measures with the sole aim of improving navigation conditions have encountered resistance, as the general public, and stakeholders in particular, value these waters in many more ways than navigation alone. Therefore, a more inclusive, integrated approach is required, rather than a sectoral one. Addressing these contemporary challenges requires a shift in the traditional waterway authorities' regimes. The aim of this study is to identify elements in the institutional setting where obstacles and opportunities for a more inclusive approach can be found. Two major waterway systems, the American and the Dutch, have been analyzed using the Institutional Analysis and Development framework to reveal those obstacles and opportunities. The results show that horizontal coordination and a low pay-off for an inclusive approach is particularly problematic. The American case also reveals a promising aspect – mandatory local co-funding for federal navigation projects acts as a stimulus for broad stakeholder involvement. Improving horizontal coordination and seizing opportunities for multifunctional development can open pathways to optimize the value of waterway systems for society.

Gentrifying the Peri-urban: Land use Conflicts and institutional dynamics at the Frontier of an Indonesian Metropolis

This paper aims to specify the meaning of gentrification in rapidly peri-urbanising metropolitan regions in the context of Indonesia’s rapid transition to decentralisation and democracy. It discusses a case study of conflict over an environmental revitalisation project in a peri-urban area of Bandung City. The analysis focuses on the political processes, tactics and strategies supporting and opposing peri-urban gentrification and their consequences. The analysis illustrates how these political dynamics mediate the interaction between the movement of capital and the spatial reorganisation of social classes. It is argued that in the context of a peri-urbanising metropolis, gentrification needs to be narrated less in terms of class-based neighbourhood succession and more in terms of competing cross-class coalitions emerging at local and regional levels.

Small farmers and sustainability: institutional barriers to investment and innovation in the Malaysian palm oil industry in Sabah

The Malaysian palm oil industry is well known for the social, environmental and sustainability challenges associated with its rapid growth over the past ten years. Technologies exist to reduce the conflict between national development aims of economic uplift for the rural poor, on the one hand, and ecological conservation, on the other hand, by raising yields and incomes from areas already under cultivation. But the uptake of these technologies has been slow, particularly in the smallholder sector. In this paper we explore the societal and institutional challenges that influence the investment and innovation decisions of micro and small enterprise (MSE) palm oil smallholders in Sabah, Malaysia. Based on interviews with 38 smallholders, we identify a number of factors that reduce the smallholders' propensity to invest in more sustainable practices. We discuss why more effective practices and innovations are not being adopted using the concepts of, firstly, institutional logics to explore the internal dynamics of smallholder production systems, including attitudes to sustainability and innovation; and, secondly, institutional context to explore the pressures the smallholders face, including problems of access to land, labour, capital, knowledge and technical resources. These factors include limited access to global market information, corruption and uncertainties of legal title, weak economic status and social exclusion. In discussing these factors we seek to contribute to wider theoretical debates about the factors that block innovation and investment in business improvements in marginal regions and in marginalised groups.

Unlocking the technology-mediated learning process : insights and articulating actions for an institutional approach

This paper is part of the results from the project "Implementation Strategies and Development of an Open and Distance Education System for the University of the Azores" funded by the European Social Fund. http://hdl.handle.net/10400.3/2327

Process virtualization theory (PVT) and institutional theory (INT) to explain SAAS adoption

Software as a service (SaaS) is a service model in which the applications are accessible from various client devices through internet. Several studies report possible factors driving the adoption of SaaS but none have considered the perception of the SaaS features and the pressures existing in the organization’s environment. We propose an integrated research model that combines the process virtualization theory (PVT) and the institutional theory (INT). PVT seeks to explain whether SaaS processes are suitable for migration into virtual environments via an information technology-based mechanism. INT seeks to explain the effects of the institutionalized environment on the structure and actions of the organization. The research makes three contributions. First, it addresses a gap in the SaaS adoption literature by studying the internal perception of the technical features of SaaS and external coercive, normative, and mimetic pressures faced by an organization. Second, it empirically tests many of the propositions of PVT and INT in the SaaS context, thereby helping to determine how the theory operates in practice. Third, the integration of PVT and INT contributes to the information system (IS) discipline, deepening the applicability and strengths of these theories.

Leverage instability and persistence: Evidence from the United States and Europe

We find that leverage behavior both in level and time-series variation is very similar between the United States and Europe throughout the 1990-2013 period. Leverage regimes are simultaneously unstable and persistent for both regions. We define instability as the extent to which firms largely deviate from their long-term leverage mean, while persistence as the extent to which today’s leverage influences its future levels. We then show that this simultaneous evidence imply a mean-reversion behavior of leverage and discuss some of its implications for future research on this field.

O financiamento hospitalar e a definição de preços

RESUMO - Inseridos num contexto onde as unidades prestadoras de cuidados de saúde não possuem autonomia para fixar os seus próprios preços, estuda-se através do presente documento o processo de definição de preços do internamento hospitalar português entre 1993 e 2001, no sentido de aferir o grau de sinalização proporcionado ao mercado, uma vez que, na sua essência, um sistema de preços constitui um sistema de incentivos influenciador de comportamentos produtivos ao nível prestador. Utilizou-se a base de dados nacionais do sistema de classificação de doentes Grupos de Diagnóstico Homogéneos e foi caracterizada a evolução e tendência dos pesos relativos dos produtos do internamento hospitalar português. Foi também avaliada a relação da estrutura de preços com a quantidade produzida, a eficiência técnica e as necessidades em saúde da população portuguesa durante o período considerado. Apesar de existir alguma instabilidade durante o período analisado, o ponto de partida e de chegada não diferiu significativamente. Não foi encontrado nenhum padrão de variação que explicasse a instabilidade encontrada entre os produtos mais complexos, mais produzidos ou os que apresentaram maior/menor variação ao longo da década de 90. A hipótese relativa à correlação entre a evolução de preços e as variáveis quantidade, eficiência e necessidades também foi infirmada. Conclui-se que a utilização do sistema de preços constituiu na sua essência um sistema de incentivos neutro, não foi sinalizador para os prestadores e possuiu uma forte correlação com o nível de reposição de custos históricos dos hospitais portugueses.

Validity, reliability and responsiveness of the French language translation of the Western Ontario Shoulder Instability Index (WOSI).

BACKGROUND: The WOSI (Western Ontario Shoulder Instability Index) is a self-administered quality of life questionnaire designed to be used as a primary outcome measure in clinical trials on shoulder instability, as well as to measure the effect of an intervention on any particular patient. It is validated and is reliable and sensitive. As it is designed to measure subjective outcome, it is important that translation should be methodologically rigorous, as it is subject to both linguistic and cultural interpretation. OBJECTIVE: To produce a French language version of the WOSI that is culturally adapted to both European and North American French-speaking populations. MATERIALS AND METHODS: A validated protocol was used to create a French language WOSI questionnaire (WOSI-Fr) that would be culturally acceptable for both European and North American French-speaking populations. Reliability and responsiveness analyses were carried out, and the WOSI-Fr was compared to the F-QuickDASH-D/S (Disability of the Arm, Shoulder and Hand-French translation), and Walch-Duplay scores. RESULTS: A French language version of the WOSI (WOSI-Fr) was accepted by a multinational committee. The WOSI-Fr was then validated using a total of 144 native French-speaking subjects from Canada and Switzerland. Comparison of results on two WOSI-Fr questionnaires completed at a mean interval of 16 days showed that the WOSI-Fr had strong reliability, with a Pearson and interclass correlation of r=0.85 (P=0.01) and ICC=0.84 [95% CI=0.78-0.88]. Responsiveness, at a mean 378.9 days after surgical intervention, showed strong correlation with that of the F-QuickDASH-D/S, with r=0.67 (P<0.01). Moreover, a standardized response means analysis to calculate effect size for both the WOSI-Fr and the F-QuickDASH-D/S showed that the WOSI-Fr had a significantly greater ability to detect change (SRM 1.55 versus 0.87 for the WOSI-Fr and F-QuickDASH-D/S respectively, P<0.01). The WOSI-Fr showed fair correlation with the Walch-Duplay. DISCUSSION: A French-language translation of the WOSI questionnaire was created and validated for use in both Canadian and Swiss French-speaking populations. This questionnaire will facilitate outcome assessment in French-speaking settings, collaboration in multinational studies and comparison between studies performed in different countries. TYPE OF STUDY: Multicenter cohort study. LEVEL OF EVIDENCE: II.

The Lausanne Institutional Biobank: a new resource to catalyse research in personalised medicine and pharmaceutical sciences.

Breakthrough technologies which now enable the sequencing of individual genomes will irreversibly modify the way diseases are diagnosed, predicted, prevented and treated. For these technologies to reach their full potential requires, upstream, access to high-quality biomedical data and samples from large number of properly informed and consenting individuals and, downstream, the possibility to transform the emerging knowledge into a clinical utility. The Lausanne Institutional Biobank was designed as an integrated, highly versatile infrastructure to harness the power of these emerging technologies and catalyse the discovery and development of innovative therapeutics and biomarkers, and advance the field of personalised medicine. Described here are its rationale, design and governance, as well as parallel initiatives which have been launched locally to address the societal, ethical and technological issues associated with this new bio-resource. Since January 2013, inpatients admitted at Lausanne CHUV University Hospital have been systematically invited to provide a general consent for the use of their biomedical data and samples for research, to complete a standardised questionnaire, to donate a 10-ml sample of blood for future DNA extraction and to be re-contacted for future clinical trials. Over the first 18 months of operation, 14,459 patients were contacted, and 11,051 accepted to participate in the study. This initial 18-month experience illustrates that a systematic hospital-based biobank is feasible; it shows a strong engagement in research from the patient population in this University Hospital setting, and the need for a broad, integrated approach for the future of medicine to reach its full potential.

Institutional legacies, employment and professional integration of non EU/EEA doctors in France

Internationally, policies for attracting highly-skilled migrants have become the guidelines mainly used by the Organisation for Economic Co-operation and Development (OECD) countries. Governments are implementing specific procedures to capture and facilitate their mobility. However, all professions are not equal when it comes to welcoming highly-skilled migrants. The medical profession, as a protective market, is one of these. Taking the case of non-EU/EEA doctors in France, this paper shows that the medical profession defined as the closed labour market, remains the most controversial in terms of professional integration of migrants, protectionist barriers to migrant competition and challenge of medical shortage. Based on the path-dependency approach, this paper argues that non-EU/EEA doctors' issues in France derive from a complex historical process of interaction between standards settled in the past, particularly the historical power of medical corporatism, the unexpected long-term effects of French hospital reforms of 1958, and budgetary pressures. Theoretically, this paper shows two significant findings. Firstly, the French medical system has undergone a series of transformations unthinkable in the strict sense of a path-dependence approach: an opening of the medical profession to foreign physicians in the context of the Europeanisation of public policy, acceptance of non-EU/EEA doctors in a context of medical shortage and budgetary pressures. Secondly, there is no change of the overall paradigm: significantly, the recruitment policies of non-EU/EEA doctors continue to highlight the imprint of the past and reveal a significant persistence of prejudices. Non-EU/EEA doctors are not considered legitimate doctors even if they have the qualifications of physicians which are legitimate in their country and which can be recognised in other receiving countries.