+Psychometric evaluation of the MacDQoL individualised measure of the impact of macular degeneration on quality of life

Background: The MacDQoL is an individualised measure of the impact of macular degeneration (MD) on quality of life (QoL). There is preliminary evidence of its psychometric properties and sensitivity to severity of MD. The aim of this study was to carry out further psychometric evaluation with a larger sample and investigate the measure's sensitivity to MD severity. Methods: Patients with MD (n = 156: 99 women, 57 men, mean age 79 ± 13 years), recruited from eye clinics (one NHS, one private) completed the MacDQoL by telephone interview and later underwent a clinic vision assessment including near and distance visual acuity (VA), comfortable near VA, contrast sensitivity, colour recognition, recovery from glare and presence or absence of distortion or scotoma in the central 10° of the visual field. Results: The completion rate for the MacDQoL items was 99.8%. Of the 26 items, three were dropped from the measure due to redundancy. A fourth was retained in the questionnaire but excluded when computing the scale score. Principal components analysis and Cronbach's alpha (0.944) supported combining the remaining 22 items in a single scale. Lower MacDQoL scores, indicating more negative impact of MD on QoL, were associated with poorer distance VA (better eye r = -0.431 p < 0.001; worse eye r = -0.350 p < 0.001; binocular vision r = -0.419 p < 0.001) and near VA (better eye r -0.326 p < 0.001; worse eye r = -0.226 p < 0.001; binocular vision r = -0.326 p < 0.001). Poorer MacDQoL scores were associated with poorer contrast sensitivity (better eye r = 0.392 p < 0.001; binocular vision r = 0.423 p < 0.001), poorer colour recognition (r = 0.417 p < 0.001) and poorer comfortable near VA (r = -0.283, p < 0.001). The MacDQoL differentiated between those with and without binocular scotoma (U = 1244 p < 0.001). Conclusion: The MacDQoL 22-item scale has excellent internal consistency reliability and a single-factor structure. The measure is acceptable to respondents and the generic QoL item, MD-specific QoL item and average weighted impact score are related to several measures of vision. The MacDQoL demonstrates that MD has considerable negative impact on many aspects of QoL, particularly independence, leisure activities, dealing with personal affairs and mobility. The measure may be valuable for use in clinical trials and routine clinical care. © 2005 Mitchell et al; licensee BioMed Central Ltd.

Regional representations in the EU:between diplomacy and interest mediation

What are regional representations in the European Union? What do they hope to achieve? Since the mid-1980s, sub-state actors in the EU such as county councils, Länder, Autonomous Communities, local, municipal and city authorities have been opening representative offices in Brussels – mini 'embassies' for their territories. Although on the surface these representations might look the same, in practice they operate according to very different dynamics. Whilst some rival national governments for a stake in EU policy development, others have more modest ambitions. This book offers a comprehensive assessment of the burgeoning phenomenon of regional representation in the EU. Considering evidence from old member states as well as those which joined the EU more recently, it looks at where strategies and aims differ, positioning various 'types' of representation closer to the work of embassies or to that carried out by lobbying groups. The author also considers how regional representations contribute to our understanding of multi-level governance in the EU.

Inhibitors of lipolysis in tumor-induced cachexia

The MAC16 tumour produces a factor which exhibits lipid-mobilizing activity in vitro in addition to causing extensive depletion of host lipid stores. The mechanism of the anti-lipolytic effect of two anti-cachectic agents, eicosapentaenoic acid, an ω-3 polyunsaturated fatty acid (PUFA), and N-(3-phenoxycinnamyl)acetohydroxamic acid (BW A4C), a 5-lipoxygenase inhibitor, has been investigated. These two agents reduce tumour growth and reverse the weight loss which accompanies transplantation of the MAC16 murine colon adenocarcinoma into NMRI mice. Mice transplanted with the MAC16 tumour exhibited weight loss which was directly proportional to the serum lipolytic activity measured in vitro up to a weight loss corresponding to 16% of the original body weight. After this time, an inverse relationship between weight loss and lipolytic activity was observed. Body composition analysis revealed a large decrease in body fat relative to other body compartments. The anti-tumour/anti-cachectic effect of EPA did not appear to be due to its ability to inhibit the production of prostaglandin E2. The MAC16 lipolytic factor increased adenylate cyclase activity in adipocyte plasma membranes in a concentration-dependent manner. EPA inhibited the production of cAMP attributed to this lipid-mobilizing factor. EPA produced alterations in Gi , the guanine nucleotide binding protein which mediates hormonal inhibition of adenylate cyclase, in addition to altering cAMP production in adipocyte plasma membranes in response to hormonal stimulation. The alterations in adenylate cyclase activity were complex and not specific to EPA. EPA stimulated adenylate cyclase activity when in a relatively high fatty acid : membrane ratio and inhibited activity when this ratio was lowered. The inhibitory effect of EPA on adenylate cyclase activity may be the underlying mechanism which explains its anti-lipolytic and anti-cachectic effect. The inability of the related ω-3 PUFA, docosahexaenoic acid (DHA), to inhibit cachexia may be due to a difference in the metabolic fates of these two fatty acids. BW A4C inhibited lipolysis in isolated adipocytes which suggests that this compound may possess the potential for an anti-cachectic effect which is independent of its inhibitory effect on tumour growth.

Disentangling Double Politikverflechtung? The implications of the federal reforms for Bund-Länder relations on Europe

The recent reforms of German federalism (Reform I) have established a new framework for Bund–Länder co-operation on EU policy. These seek to safeguard Germany's ability to co-operate in Europe by disentangling the joint roles and responsibilities bound up within the complex arrangements of the EU policy-making system, defined as a multiple framework of joint decisions, or doppelte Politikverflechtung. Whilst on the surface, the reforms enacted may be read as a success for the Länder in their bid to secure autonomy on European issues, closer analysis reveals that these changes may in fact hamper the Länder agenda on European issues, closing off new opportunities for influence.

Party servants, ideologues or regional representatives? The German Länder and the reform of federalism

This article considers recent attempts to reform German federalism, the failed 2004 reform, and the reforms agreed in 2006 and 2009. It compares partisan, ideological and territorial factors which contribute to an understanding of reform, finding that all three have a role in explaining actors’ views of reform proposals. Two other claims are developed: that in some aspects of the reforms, a division between ‘generalist’ and ‘subject specialist’ politicians became apparent; and that a decisive change between 2004 and 2006 was the formation of a grand coalition at a federal level, which paved the way for agreement upon reform proposals.

Optimising primary care for people with dementia

This review considers key areas in primary care regarding the diagnosis of dementia. Issues surrounding assessment, policy and incentives are considered. In addition, the relevance of non-medication approaches for dementia in primary care, which aim to enhance or maintain quality of life by maximising psychological and social function in the context of existing disabilities, is deliberated. Finally, key issues about primary care medication management are considered, and relevant therapeutic strategies with recommendation for a collaborative approach that improve outcomes by linking primary and secondary healthcare services - including general practice and pharmacy - with social care needs are weighed up. A key aspect of such a collaborative approach is to support informal carers in optimising medication.

Regional policy variation in Germany:the diversity of living conditions in a 'unitary federal state'

The German federal system is conventionally understood as highly co-ordinated between federal and regional governments and aimed at producing a 'uniformity' of living conditions. This view has increasingly been challenged as new work focuses on innovation and diversity at the regional level, and also as a consequence of reforms to the federal system that took place in 2006. This contribution attempts to establish a more systematic basis for assessing and explaining the scope and significance of regional policy variation in Germany. Our findings suggest that - despite institutional structures that foster intense co-ordination between central and regional governments and apparent popular preferences for uniformity of policy outcomes - the extent of policy variation in Germany is much greater than conventionally understood and driven both by structural factors and partisan choices at the regional level. © 2014 © 2014 Taylor & Francis.

Let's stick together? Explaining boundaries to territorial policy variation:the case of Germany's prisons legislation

This article offers an initial impact assessment regarding the introduction of new legislative responsibilities at the Land level in a case study of prisons policy (Strafvollzug). Combining an analysis of new legislation produced across the 16 Länder since the responsibility for prisons policy was transferred to the Land level, and insights into the mechanics of policy development obtained through a series of interviews with senior politicians and officials, this article finds that the desire among Länder to legislative independently has varied, with substantial backing for co-ordination in the development of new legislation. This has helped to confound expectations of a ‘competition of harshness’ which many expected to result from decentralisation. However, even before the 2006 reforms, there were substantial variations between the Länder when it came to implementing prisons policy, so consideration of the sub-national level in this area remains essential.

Introduction to the special issue : reframing German Federalism

In recent years, Germany’s federal system has been subject to a number of pressures for change. A constitutional debate on ‘disentangling’ the legislative roles of federal and Länder institutions which stuttered through the 1990s and into the 2000s finally led to a re-allocation of competences in 2006. These reforms shifted some areas of legislative responsibility from the federal to the Länder level and relaxed rules which had earlier justified a federal override when both levels held legislative responsibilities concurrently. At the very least, these constitutional adjustments increased the potential for policy outputs to diverge from one Land to another and give expression to territorial differences in priority and preference.

Failure mechanism of the all-polyethylene glenoid implant

Fixation failure of glenoid components is the main cause of unsuccessful total shoulder arthroplasties. The characteristics of these failures are still not well understood, hence, attempts at improving the implant fixation are somewhat blind and the failure rate remains high. This lack of understanding is largely due to the fundamental problem that direct observations of failure are impossible as the fixation is inherently embedded within the bone. Twenty custom made implants, reflecting various common fixation designs, and a specimen set-up was prepared to enable direct observation of failure when the specimens were exposed to cyclic superior loads during laboratory experiments. Finite element analyses of the laboratory tests were also carried out to explain the observed failure scenarios. All implants, irrespective of the particular fixation design, failed at the implant-cement interface and failure initiated at the inferior part of the component fixation. Finite element analyses indicated that this failure scenario was caused by a weak and brittle implant-cement interface and tensile stresses in the inferior region possibly worsened by a stress raiser effect at the inferior rim. The results of this study indicate that glenoid failure can be delayed or prevented by improving the implant/cement interface strength. Also any design features that reduce the geometrical stress raiser and the inferior tensile stresses in general should delay implant loosening.