High prevalence but limited evidence in complementary and alternative medicine: guidelines for future research

The use of complementary and alternative Medicine (CAM) has increased over the past two decades in Europe. Nonetheless, research investigating the evidence to support its use remains limited. The CAMbrella project funded by the European Commission aimed to develop a strategic research agenda starting by systematically evaluating the state of CAM in the EU. CAMbrella involved 9 work packages covering issues such as the definition of CAM; its legal status, provision and use in the EU; and a synthesis of international research perspectives. Based on the work package reports, we developed a strategic and methodologically robust research roadmap based on expert workshops, a systematic Delphi-based process and a final consensus conference. The CAMbrella project suggests six core areas for research to examine the potential contribution of CAM to the health care challenges faced by the EU. These areas include evaluating the prevalence of CAM use in Europe; the EU cititzens’ needs and attitudes regarding CAM; the safety of CAM; the comparative effectiveness of CAM; the effects of meaning and context on CAM outcomes; and different models for integrating CAM into existing health care systems. CAM research should use methods generally accepted in the evaluation of health services, including comparative effectiveness studies and mixed-methods designs. A research strategy is urgently needed, ideally led by a European CAM coordinating research office dedicated to fostering systematic communication between EU governments, the public, charitable and industry funders, researchers and other stakeholders. A European Centre for CAM should also be established to monitor and further a coordinated research strategy with sufficient funds to commission and promote high quality, independent research focusing on the public’s health needs and pan-European collaboration. There is a disparity between highly prevalent use of CAM in Europe and solid knowledge about it. A strategic approach on CAM research should be established to investigate the identified gaps of knowledge and to address upcoming health care challenges.

Immune and genetic risk factors in glioma

Despite extensive research, the etiology of adult glioma remains largely unknown. We sought to further explore the role of immune and genetic factors in glioma etiology using data from the Harris County Brain Tumor Study and the first U.S. genome-wide association study of glioma. First, using a case-control study design, we examined the association between adult glioma risk and surrogates of the timing and frequency of common early childhood infections, birth order and sibship size, respectively. We found that each one-unit increase in birth order was associated with a 12% decreased risk of glioma development in adulthood (OR=0.88, 95% CI=0.81-0.96); however, sibship size was not associated with adult glioma risk (OR=0.96, 95% CI=0.91-1.02). Second, we used a multi-strategic approach to explore the relationships between glioma risk, history of asthma/allergies, and 23 functional SNPs in 11 inflammation genes. We found three inflammation gene SNPs to be significantly associated with glioma risk (COX2/PTGS2 rs20417 [OR=1.41]; IL10 rs1800896 [OR=1.57]; and IL13 rs20541 [OR=0.39]). Joint effects analysis of the risk-conferring alleles of these three SNPs revealed a trend of increasing risk with increasing number of adverse alleles among those without asthma/allergies (p<0.0001). Finally, we conducted a case-only study to explore pairwise SNP-SNP interactions in immune-related pathways among a population of 1304 non-Hispanic white glioma cases. After correction for multiple comparisons, we found 279 significant SNP-SNP interactions among polymorphisms of immune-related genes, many of which have not been previously examined. Our results, cumulatively, suggest an important role for immune and genetic factors in glioma etiology and provide several new hypotheses for future studies.^

Usos de la escritura en la enseñanza de la historia

Se presenta una caracterización de usos de la escritura en la enseñanza de la historia, producida en el marco de una investigación en Didácticas Específicas que estudia las relaciones entre la lectura y la escritura en la enseñanza y el aprendizaje escolar de historia. Se analizan usos de la escritura relacionados con distintas finalidades, además de los que impone el funcionamiento didáctico habitual de la historia como disciplina escolar. Se señalan posibles complementariedades y tensiones entre distintas racionalidades que intervienen en la generación de propuestas de escritura, en particular la tensión entre la lógica del estudio y la lógica del ejercicio. Por último, se caracteriza un problema del uso de las producciones escritas para la evaluación, relativo al modo en que pueden operar las consignas en la posibilidad de que los alumnos desplieguen -o no- los contenidos aprendidos sobre el tema evaluado

Entre lo informativo y lo estratégico : La cuestión de los abordajes del conocimiento histórico en la enseñanza de la historia

Este trabajo se centra en las distintas maneras en las cuales un lector-profesor de historia aborda el conocimiento histórico. Esos diferentes modos de abordarlo (informativa, operativa y estratégica) están presentes tanto en el momento de la lectura de los textos historiográficos como en el de la enseñanza del conocimiento que es su fruto. Así, la noción de abordaje se presenta como el eje tanto de la producción de sentido para la lectura de un libro de historia como de la configuración de los modos en que los contenidos de enseñanza son presentados a los estudiantes. Finalmente, es su condición de herramienta de análisis para la práctica de la enseñanza la que le permite dirigir una mirada renovada y más profunda a distintas situaciones relacionadas con la práctica de la enseñanza de la historia, que van desde la planificación de una clase o un curso hasta la comprensión de encuentros y desencuentros con los estudiantes en el plano de la ejercitación y la evaluación

Usos de la escritura en la enseñanza de la historia

Se presenta una caracterización de usos de la escritura en la enseñanza de la historia, producida en el marco de una investigación en Didácticas Específicas que estudia las relaciones entre la lectura y la escritura en la enseñanza y el aprendizaje escolar de historia. Se analizan usos de la escritura relacionados con distintas finalidades, además de los que impone el funcionamiento didáctico habitual de la historia como disciplina escolar. Se señalan posibles complementariedades y tensiones entre distintas racionalidades que intervienen en la generación de propuestas de escritura, en particular la tensión entre la lógica del estudio y la lógica del ejercicio. Por último, se caracteriza un problema del uso de las producciones escritas para la evaluación, relativo al modo en que pueden operar las consignas en la posibilidad de que los alumnos desplieguen -o no- los contenidos aprendidos sobre el tema evaluado

Entre lo informativo y lo estratégico : La cuestión de los abordajes del conocimiento histórico en la enseñanza de la historia

Este trabajo se centra en las distintas maneras en las cuales un lector-profesor de historia aborda el conocimiento histórico. Esos diferentes modos de abordarlo (informativa, operativa y estratégica) están presentes tanto en el momento de la lectura de los textos historiográficos como en el de la enseñanza del conocimiento que es su fruto. Así, la noción de abordaje se presenta como el eje tanto de la producción de sentido para la lectura de un libro de historia como de la configuración de los modos en que los contenidos de enseñanza son presentados a los estudiantes. Finalmente, es su condición de herramienta de análisis para la práctica de la enseñanza la que le permite dirigir una mirada renovada y más profunda a distintas situaciones relacionadas con la práctica de la enseñanza de la historia, que van desde la planificación de una clase o un curso hasta la comprensión de encuentros y desencuentros con los estudiantes en el plano de la ejercitación y la evaluación

Entre lo informativo y lo estratégico : La cuestión de los abordajes del conocimiento histórico en la enseñanza de la historia

Este trabajo se centra en las distintas maneras en las cuales un lector-profesor de historia aborda el conocimiento histórico. Esos diferentes modos de abordarlo (informativa, operativa y estratégica) están presentes tanto en el momento de la lectura de los textos historiográficos como en el de la enseñanza del conocimiento que es su fruto. Así, la noción de abordaje se presenta como el eje tanto de la producción de sentido para la lectura de un libro de historia como de la configuración de los modos en que los contenidos de enseñanza son presentados a los estudiantes. Finalmente, es su condición de herramienta de análisis para la práctica de la enseñanza la que le permite dirigir una mirada renovada y más profunda a distintas situaciones relacionadas con la práctica de la enseñanza de la historia, que van desde la planificación de una clase o un curso hasta la comprensión de encuentros y desencuentros con los estudiantes en el plano de la ejercitación y la evaluación

Usos de la escritura en la enseñanza de la historia

Se presenta una caracterización de usos de la escritura en la enseñanza de la historia, producida en el marco de una investigación en Didácticas Específicas que estudia las relaciones entre la lectura y la escritura en la enseñanza y el aprendizaje escolar de historia. Se analizan usos de la escritura relacionados con distintas finalidades, además de los que impone el funcionamiento didáctico habitual de la historia como disciplina escolar. Se señalan posibles complementariedades y tensiones entre distintas racionalidades que intervienen en la generación de propuestas de escritura, en particular la tensión entre la lógica del estudio y la lógica del ejercicio. Por último, se caracteriza un problema del uso de las producciones escritas para la evaluación, relativo al modo en que pueden operar las consignas en la posibilidad de que los alumnos desplieguen -o no- los contenidos aprendidos sobre el tema evaluado

Between energy security and energy market integration. Guidelines for the future development of the EU’s external energy policy in Europe’s neighbourhood. OSW Report, June 2011

For many years the European Union has been improving the efficient use of energy resources and yet the demand for energy in the EU continues to increase. When Europe belonged to one of the world’s key energy markets with relatively easy access to energy resources, growing energy needs were not seen as a source of concern. Today, however, as the competition for energy resources is intensifying and the global position of the EU energy market is being challenged by growing economies in the developing countries, above all China and India, the EU needs to adopt bold policies to guarantee the sustainable supply of energy. This report argues the EU needs to develop a fully-fledged external energy policy; i.e. a common, coherent, strategic approach that build bridges between the interests and needs of the EU integrated energy market on the one hand and supplier countries on the other. The EU’s external energy policy has two main objectives. The first one is to ensure a sustainable, stable and cost-effective energy supply. The second is to promote energy market integration and regulatory convergence with neighbouring countries (often but not always this supports the achievement of the first objective). However, in order to improve its effectiveness, the EU’s external energy policy needs to be seen in a broader economic and political context. Any progress in energy cooperation with third countries is contingent upon the EU’s general stance and offer to those countries.

ESMO consensus guidelines for the management of patients with metastatic colorectal cancer

Colorectal cancer (CRC) is one of the most common malignancies in Western countries. Over the last 20 years, and the last decade in particular, the clinical outcome for patients with metastatic CRC (mCRC) has improved greatly due not only to an increase in the number of patients being referred for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. This reflects the increase in the number of patients that are being managed within a multidisciplinary team environment and specialist cancer centres, and the emergence over the same time period not only of improved imaging techniques but also prognostic and predictive molecular markers. Treatment decisions for patients with mCRC must be evidence-based. Thus, these ESMO consensus guidelines have been developed based on the current available evidence to provide a series of evidence-based recommendations to assist in the treatment and management of patients with mCRC in this rapidly evolving treatment setting.

Developing New Tourism Services: Dinosaurs a New Drive Tourism Resource for Remote Areas

This paper examines issues encountered when developing new tourism services generally, and specific aspects relating to the development of remote area dinosaur fossil fields for tourism. It studies two sites, one in the USA and one in Australia. Access to both sites is by minor roads, and both sites are characterised by long drives separating the sites from small communities that offer limited infrastructure and few other attractions for visitors. In both areas, however, tourism is seen as one of the few possible ways to sustain existing communities in the face of declining primary-industry-based employment. In general, tourists visiting these areas are on touring holidays of two weeks’ duration or more where the attraction is the general attributes of the region as well as to a lesser extent their interest in dinosaur fossils. These provide a potential resource for remote-region economic development through commodification as a new tourism attraction. Development of dinosaur fossil finds as a tourism resource is conceptualised here as new service development. Developing new tourism services, especially in remote regions, is challenging and has not been well examined in the tourism literature. The new service development process used in this case study first examines the characteristics of the existing tourists travelling through the region. The characteristics of a number of potential market segments currently interested in dinosaur fossils were then examined and contrasted with the existing market. This is conceptualised on a specialist-generalist spectrum of interest in fossils. A study of the tourist service features associated with dinosaur fossil tourism in remote regions of the USA was conducted, leading to the identification of a number of possible incremental development opportunities. The paper then takes a strategic approach to examining potential new tourism service development related to dinosaur fossils in remote regions of Queensland, Australia. In particular, it describes use of information about existing services in similar regions as the basis for ideas about development as well as comparison between existing and potential markets.

Routine measurement of outcomes in Australia's public sector mental health services

OBJECTIVE: This paper describes the Australian experience to date with a national 'roll out' of routine outcome measurement in public sector mental health services. METHODS: Consultations were held with 123 stakeholders representing a range of roles. RESULTS: Australia has made an impressive start to nationally implementing routine outcome measurement in mental health services, although it still has a long way to go. All States/Territories have established data collection systems, although some are more streamlined than others. Significant numbers of clinicians and managers have been trained in the use of routine outcome measures, and thought is now being given to ongoing training strategies. Outcome measurement is now occurring 'on the ground'; all States/Territories will be reporting data for 2003-04, and a number have been doing so for several years. Having said this, there is considerable variability regarding data coverage, completeness and compliance. Some States/Territories have gone to considerable lengths to 'embed' outcome measurement in day-to-day practice. To date, reporting of outcome data has largely been limited to reports profiling individual consumers and/or aggregate reports that focus on compliance and data quality issues, although a few States/Territories have begun to turn their attention to producing aggregate reports of consumers by clinician, team or service. CONCLUSION: Routine outcome measurement is possible if it is supported by a co-ordinated, strategic approach and strong leadership, and there is commitment from clinicians and managers. The Australian experience can provide lessons for other countries.

Human resource development in the Sultanate of Oman

This study explores the scenario of human resource development (HRD) in the Sultanate of Oman. The investigation was conducted with the help of a questionnaire survey in stateowned enterprises (SOEs). The research findings highlight an increased emphasis on HRD initiatives at a national level in Omani firms. There is a significant degree of awareness among the top managers regarding the benefits of a strategic approach to HRD. Despite all this, the implementation of HRD programmes has not been particularly successful. This is because the state has not been able to develop the skills and competencies of the Omani workforce to the levels required under the sixth national five–year plan. The article makes a number of recommendations in this regard. It also highlights key research areas for further examination.

Economists' perceptions versus managers' decisions:an experiment in transaction cost analysis

Are the perceptions of professional economists on transaction costs consistent with make-or-buy decisions made within firms? The answer may have important implications for transaction cost research. Data on firms' outsourcing during the new product development process are taken from a largescale survey of UK, German and Irish manufacturing plants, and we test the consistency of these outsourcing decisions with the predictions derived from the transaction cost perceptions of a panel of economists. Little consistency is evident between actual outsourcing patterns and the predictions of the (Williamsonian) transactions cost model derived from the panel of economists. There is, however, evidence of a systematic pattern to the differences, suggesting that a competence or resource-based approach may be relevant to understanding firm outsourcing, and that firms are adopting a strategic approach to managing their external relationships. © Cambridge Political Economy Society 2005; all rights reserved.

Introduction: improving manufacturing performance through technology diffusion, implementation and management

The role of technology management in achieving improved manufacturing performance has been receiving increased attention as enterprises are becoming more exposed to competition from around the world. In the modern market for manufactured goods the demand is now for more product variety, better quality, shorter delivery and greater flexibility, while the financial and environmental cost of resources has become an urgent concern to manufacturing managers. This issue of the International Journal of Technology Management addresses the question of how the diffusion, implementation and management of technology can improve the performance of manufacturing industries. The authors come from a large number of different countries and their contributions cover a wide range of topics within this general theme. Some papers are conceptual, others report on research carried out in a range of different industries including steel production, iron founding, electronics, robotics, machinery, precision engineering, metal working and motor manufacture. In some cases they describe situations in specific countries. Several are based on presentations made at the UK Operations Management Association's Sixth International Conference held at Aston University at which the conference theme was 'Achieving Competitive Edge: Getting Ahead Through Technology and People'. The first two papers deal with questions of advanced manufacturing technology implementation and management. Firstly Beatty describes a three year longitudinal field study carried out in ten Canadian manufacturing companies using CADICAM and CIM systems. Her findings relate to speed of implementation, choice of system type, the role of individuals in implementation, organization and job design. This is followed by a paper by Bessant in which he argues that a more a strategic approach should be taken towards the management of technology in the 1990s and beyond. Also considered in this paper are the capabilities necessary in order to deploy advanced manufacturing technology as a strategic resource and the way such capabilities might be developed within the firm. These two papers, which deal largely with the implementation of hardware, are supplemented by Samson and Sohal's contribution in which they argue that a much wider perspective should be adopted based on a new approach to manufacturing strategy formulation. Technology transfer is the topic of the following two papers. Pohlen again takes the case of advanced manufacturing technology and reports on his research which considers the factors contributing to successful realisation of AMT transfer. The paper by Lee then provides a more detailed account of technology transfer in the foundry industry. Using a case study based on a firm which has implemented a number of transferred innovations a model is illustrated in which the 'performance gap' can be identified and closed. The diffusion of technology is addressed in the next two papers. In the first of these, by Lowe and Sim, the managerial technologies of 'Just in Time' and 'Manufacturing Resource Planning' (or MRP 11) are examined. A study is described from which a number of factors are found to influence the adoption process including, rate of diffusion and size. Dahlin then considers the case of a specific item of hardware technology, the industrial robot. Her paper reviews the history of robot diffusion since the early 1960s and then tries to predict how the industry will develop in the future. The following two papers deal with the future of manufacturing in a more general sense. The future implementation of advanced manufacturing technology is the subject explored by de Haan and Peters who describe the results of their Dutch Delphi forecasting study conducted among a panel of experts including scientists, consultants, users and suppliers of AMT. Busby and Fan then consider a type of organisational model, 'the extended manufacturing enterprise', which would represent a distinct alternative pure market-led and command structures by exploiting the shared knowledge of suppliers and customers. The three country-based papers consider some strategic issues relating manufacturing technology. In a paper based on investigations conducted in China He, Liff and Steward report their findings from strategy analyses carried out in the steel and watch industries with a view to assessing technology needs and organizational change requirements. This is followed by Tang and Nam's paper which examines the case of machinery industry in Korea and its emerging importance as a key sector in the Korean economy. In his paper which focuses on Venezuela, Ernst then considers the particular problem of how this country can address the problem of falling oil revenues. He sees manufacturing as being an important contributor to Venezuela's future economy and proposes a means whereby government and private enterprise can co-operate in development of the manufacturing sector. The last six papers all deal with specific topics relating to the management manufacturing. Firstly Youssef looks at the question of manufacturing flexibility, introducing and testing a conceptual model that relates computer based technologies flexibility. Dangerfield's paper which follows is based on research conducted in the steel industry. He considers the question of scale and proposes a modelling approach determining the plant configuration necessary to meet market demand. Engstrom presents the results of a detailed investigation into the need for reorganising material flow where group assembly of products has been adopted. Sherwood, Guerrier and Dale then report the findings of a study into the effectiveness of Quality Circle implementation. Stillwagon and Burns, consider how manufacturing competitiveness can be improved individual firms by describing how the application of 'human performance engineering' can be used to motivate individual performance as well as to integrate organizational goals. Finally Sohal, Lewis and Samson describe, using a case study example, how just-in-time control can be applied within the context of computer numerically controlled flexible machining lines. The papers in this issue of the International Journal of Technology Management cover a wide range of topics relating to the general question of improving manufacturing performance through the dissemination, implementation and management of technology. Although they differ markedly in content and approach, they have the collective aim addressing the concepts, principles and practices which provide a better understanding the technology of manufacturing and assist in achieving and maintaining a competitive edge.