Identifying Barriers and Practical Solutions to Conducting Site-Based Research in North America: Exploring Acute Heart Failure Trials As a Case Study.

Although the prognosis of ambulatory heart failure (HF) has improved dramatically there have been few advances in the management of acute HF (AHF). Despite regional differences in patient characteristics, background therapy, and event rates, AHF clinical trial enrollment has transitioned from North America and Western Europe to Eastern Europe, South America, and Asia-Pacific where regulatory burden and cost of conducting research may be less prohibitive. It is unclear if the results of clinical trials conducted outside of North America are generalizable to US patient populations. This article uses AHF as a paradigm and identifies barriers and practical solutions to successfully conducting site-based research in North America.

Empirical measurement of illicit tobacco trade in the Philippines.

Cigarette smuggling reduces the price of cigarettes, thwarts youth access restrictions, reduces government revenue, and undercuts the ability of taxes to reduce consumption. The tobacco industry often opposes increases to tobacco taxes on the claim that greater taxes induce more smuggling. To date, little is known about the magnitude of smuggling in the Philippines. his information is necessary to effectively address illicit trade and to measure the impacts of tax changes and the introduction of secure tax markings on illicit trade. This study employs two gap discrepancy methods to estimate the magnitude of illicit trade in cigarettes for the Philippines between 1994 and 2009. First, domestic consumption is compared with tax-paid sales to measure the consumption of illicit cigarettes. Second, imports recorded by the Philippines are compared with exports to the Philippines by trade partners to measure smuggling. Domestic consumption fell short of tax-paid sales for all survey years. The magnitude of these differences and a comparison with a prevalence survey for 2009 suggest a high level of survey under-reporting of smoking. In the late 1990s and the mid 2000s, the Philippines experienced two sharp declines in trade discrepancies, from a high of $750 million in 1995 to a low of $133.7 million in 2008. Discrepancies composed more than one-third of the domestic market in 1995, but only 10 percent in 2009. Hong Kong, Singapore, and China together account for more than 80 percent of the cumulative discrepancies over the period and 74 percent of the discrepancy in 2009. The presence of large discrepancies supports the need to implement an effective tax marking and tobacco track and trace system to reduce illicit trade and support tax collection. The absence of a relation between tax changes and smuggling suggests that potential increases in the excise tax should not be discouraged by illicit trade. Finally, the identification of specific trade partners as primary sources for illicit trade may facilitate targeted efforts in cooperation with these governments to reduce illicit trade.

Numerical optimisation of water curtain barriers design

The interactions between water curtain protective barriers and impinging cold gas clouds released during industrial accidents are simulated by a 2D finite difference code using a PSI-cell of the heat, mass and momentum transfer processes between the phases. A consistent derivation of the continuous phase source terms is presented. The results of early simulations of an existing 1:10 experimental model of a water curtain impacted by a cold gas cloud are presented for two typical curtain configurations.

The 2001 World Trade Centre evacuation

The WTC evacuation of 11 September 2001 provides an unrepeatable opportunity to probe into and understand the very nature of evacuation dynamics and with this improved understanding, contribute to the design of safer, more evacuation efficient, yet highly functional, high rise buildings. Following 9/11 the Fire Safety Engineering Group (FSEG) of the University of Greenwich embarked on a study of survivor experiences from the WTC Twin Towers evacuation. The experiences were collected from published accounts appearing in the print and electronic mass media and are stored in a relational data base specifically developed for this purpose. Using these accounts and other available sources of information FSEG also undertook a series of numerical simulations of the WTC North Tower. This paper represents an overview of the results from both studies.

Approximating the evacuation of the World Trade Center North Tower using computer simulation

This article concerns an investigation of the full scale evacuation of a building with a configuration similar to that of the World Trade Center (WTC) North Tower using computer simulation. A range of evacuation scenarios is explored in order to better understand the evacuation of the WTC on 11 September 2001. The analysis makes use of response time data derived from a study of published WTC survivor accounts. Geometric details of the building are obtained from architects' plans while the total building population used in the scenarios is based on estimates produced by the National Institute of Standards and Technology formal investigation into the evacuation. This paper attempts to approximate the events of 11 September 2001 and pursue several `what if' questions concerning the evacuation. In particular, the study explores the likely outcome had a single staircase survived intact from top to bottom. More generally, this paper explores issues associated with the practical limits of building size that can be expected to be efficiently evacuated using stairs alone.

Barriers to effective pain management in sickle cell disease

Sickle cell disease (SCD) is a long-term condition that would benefit from a long-term conditions approach to its care and management. SCD is growing in prevalence, affecting 10,000-12,000 people in the UK, with SCD sufferers having an increased life expectancy from in the past. The most problematic aspect of managing SCD is management of the pain from vaso-occlusive crises. Vaso-occlusive pain is the most common reason for hospital admissions in people with SCD and accounts for large numbers of accident and emergency (A&E) attendances. A literature review was carried out to examine the management of vaso-occlusive pain in SCD. The review identified three main barriers to effective pain management in SCD: the manifestation of vaso-occlusive pain, the sociocultural factors affecting pain assessment, and the concerns regarding addiction and pseudo-addiction. Addressing these barriers will allow people with SCD to have their pain managed more effectively, improve their quality of life and potentially reduce A&E attendances and admissions to hospital.

Trade unions, civil society organisations and health reforms

This article provides an analysis of resistance to neoliberalism and commodification in the public healthcare sector as seen from a trade union perspective. It uses recent research on social-movement unionism and new labour internationalism to structure a series of case studies examining resistance to different dimensions of healthcare commodification in four countries. The range of alliances trade unions are making do not fit tidily into one model, but give insights into the movement elements of trade unionism. This dimension must be strengthened, but can also be in tension with collective bargaining and other institutional processes. How to constantly reconcile these different positions is the future challenge facing trade unions.

Trade credit linkages along the supply chain: evidence for the Italian textile sector

We examine the trade credit linkages among firms within a supply chain to reckon the effect of such linkages on the propagation of liquidity shocks from downstream to upstream firms. We choose a sample appropriate for this task, consisting of a large data set of Italian firms from the textile industry, a well known example of a comprehensive manufacturing cluster featuring a large number of small and specialized firms at each level of the supply chain. The results of the analysis indicate that the level of trade credit that firms provide to their suppliers is positively related to the level of trade credit granted to their clients: when the level of trade credit granted to clients divided by sales goes up by 1, the level of trade credit provided to suppliers divided by cost-of goods-sold goes up by an amount that varies between 0,22 and 0,52. Since all firms along the chain are linked by trade credit relationships, an increase in the level of trade credit granted by wholesalers generates a liquidity cascade throughout the chain. We designate the overall increase in the level of trade credit among all firms in the chain as a result of a unitary impulse in the level of trade credit granted by wholesalers as the multiplier effect of trade credit for the industry chain. We estimate such multiplier to vary between 1.28 and 2.04. We also investigate the effect of final demand on the level of trade credit sourced by firms at various levels of the chain and, in particular, whether such effect is amplified for firms further up in the chain as a result of liquidity propagation via trade credit linkages. We uncover evidence of such amplification when the links of liquidity transmission along the chain are individually modeled and estimated. An unitary increase in wholesalers’ sales is found to produce an effect on trade payables among firms at the top of the chain (i.e., Preparers and Spinners) that is more than twice as big as the corresponding effect among firms at the bottom of the chain (i.e., Wholesalers).

Developing global trade union "space"

International unions and international solidarity strategies have been changing partly as a response to changes in the global economy. Global union federations have played an important role in expanding communication and developing alliances with other social movements. One of the issues facing trade unions wanting to be effective at an international level is to what extent national concerns can inform and even be transcended by international perspectives. Proposals for studying the global labor force "horizontally", that is, according to different categories and forms of work rather than on a nation-by-nation basis, demonstrates a recognition of global- national dimensions (Harrod and O'Brien 2002:49). This paper will discuss the development of a global trade union "space", which enables national and global unions to work together effectively, using a series of case studies drawn from the experience of global and European public service unions.

Occupational health regulations and health workers: protection or vulnerability?

Several trade agreements include occupational health and safety regulations but there are many barriers to implementation. Mechanisms for sanctions are often weak but the lack of political will is the biggest barrier.

Sex talk? overcoming barriers about sex and contraception after childbirth

Anecdotal evidence tells professionals that childbirth is the best form of contraception. However, sexual health problems are the very common after childbirth with Barrett et al (2000) arguing that only 15% of women who have a postnatal sexual problem reported discussing it with a health professional. As health professionals with a predilection for the ‘clinical’ and the ‘prescriptive’ we organise antenatal classes to discuss bathing the baby and post partum reunions to recount birth stories, but often fail to address sexual health problems and contraception after birth.(Glazener 1997). Many women who have carefully used contraception for years prior to pregnancy are often not helped to re-engage with the issues following birth. This would seem to be a particular problem for the most vulnerable parents such as adolescent mothers and their partners (Social Exclusion Unit 1999, 2004) where some young women go on to have more than one baby in a short time period (Reeves 2003). The focus of this paper is to explore the apparent general failure of health professionals to discuss sex after childbirth and provide information regarding reliable contraception. Glazener (1997) tells us that health professionals are encouraged to educate and prepare patients antenatally, for example to be trained to identify problems and deal with them openly and sympathetically. What is brought into question is why this form of rigorous support is not extended to providing sexual health advice in the immediate and often vulnerable postnatal period and why this provision is not a priority for some groups. The paper will explore if this situation caused by a lack of training or is it a symptom of our culture and a British attitude towards sex and contraception.