Outcomes for elderly patients with mental illness following relocation from a stand-alone psychiatric hospital to community-based extended care units

Objective: To assess the outcomes for a group of elderly patients with mental illness following their discharge from a stand-alone psychiatric facility to seven extended care units (ECUs). Method: All patients (n = 60) who were relocated to the ECUs were assessed using a number of standardized clinical and general functioning instruments at 6 months and 6 weeks pre-move, and again at 6 weeks, 6 months and 18 months post-move. Results: By 18 months post-discharge, 13 of the 60 patients (21.7%) had died and seven others had been transferred to nursing homes. Those who died were older and had significantly higher levels of physical ill health when compared to those who did not die. Changes on measures of clinical and behavioural functioning in those who remained in the study did not reach statistical significance by 18 months post-move. However, participants did demonstrate improvements in quality of life with significantly higher scores on measures of social contact and community access. Conclusions: The mortality observed in the follow-up period is likely to be related to physical ill health and old age rather than the trauma associated with relocation. While overall functioning did not improve following relocation, patients had more independence and greater access to community-based activities.

Shifting EU Institutional Reform into High Gear. Report of the CEPS High-Level Group. CEPS Task Force Reports

To contribute to the important debate on EU institutional reform in the run-up to the European Parliament elections and the start of a new Commission, CEPS formed a High-Level Group on EU Institutional Reform under the leadership of Danuta Hübner MEP and member of the CEPS Board of Directors. The report of this distinguished group of MEPs, former and current EU institutional members and leading scholars on EU law and institutional affairs focuses on reforms that could be taken within the framework of the current treaties to build a more responsive and accountable Union. The report analyses the main inter- and intra-institutional weaknesses in terms of efficiency, democracy and differentiation and puts forward a number of recommendations addressing issues such as the reorganisation of the College of Commissioners, the promotion of strategic legislative planning, the enhancement of the role of the EP and the rotating Presidency of the Council, the improvement of the democratic accountability of the European Council and the adequate engagement of the national parliaments.

Geografia do poder em goffman: vigilância e resistência, dominação e produção de subjetividade no hospital psiquiátrico

Neste artigo, estamos procurando recuperar alguns estudos de Goffman, lidos a partir das discussões atuais da análise institucional, das contribuições de Michel Foucault relativas à microfísica do poder e das investigações de alguns pesquisadores quanto à produção de subjetividade nas instituições de Saúde Coletiva. Goffman, apesar de não estar munido dos recursos teóricos de tais pesquisadores, já era capaz de explicitar em suas análises muito mais do que provavelmente imaginava articular. Acreditamos que Goffman já produz acuradas cartografias do dispositivo manicomial, descrevendo toda uma geografia do poder na instituição total, atento aos detalhes da rotina cotidiana. Suas investigações da dimensão intrainstitucional desses dispositivos continuam atuais e eficazes para a compreensão da produção da subjetividade no contexto institucional. Também encontramos muitas ressonâncias notáveis entre Goffman e Foucault.

Weathering the crisis? Managing democracy at a national broadcaster

With post-2008 political and economic crises as its backdrop, this inquiry into the political roles and functions of public service broadcasting (PSB) in Ireland is principally concerned with examining the capacities for and actuality of critical and counter-hegemonic professional journalistic and institutional mediations of crisis. Recognising the diversity of influences on the normative identity of Irish PSB, the dissertation adopts a sociological approach that acknowledges the systemic embedding of media institutions in the broader field of power. An initial tracing of the formative impacts of endogenous and exogenous forces on the democratic horizons of PSB suggests that the present crisis conjuncture does not represent promising terrain for engendering critical crisis and recovery imaginaries. A methodologically diverse intra-institutional empirical research agenda aims to explore at close hand Irish PSB’s contingent navigation of crisis, encompassing ethnographic observation in the newsroom, practitioner interviews and textual analysis of broadcast output. These methods afford close analysis of practices of journalistic production and reflexivity, self-conceptions of the journalistic habitus, and ideological affinities of crisis framings in broadcast output. These analyses are supplemented by a participant observation study of the possibilities for public agenda-building in a key institutional venue of public participation in broadcasting governance. The findings offer an evidential basis for the arguments that the crisis has prompted only minimal changes to professional norms and practices of representation and inclusion; that journalistic crisis framings tend toward effecting hegemonic repair by lending support to neoliberal crisis and recovery imaginaries; and that the institutional openings for the building of public counterpower are highly constrained. The overall conclusion is made that the normative democratic orientation embedded in the professional and institutional projects of public service broadcasting help render it ill-equipped to act as a re-democratising countervailing power against the democratic regressions engendered by the present crisis of democratic capitalism.

The institutional design of intra-party democracy through legal instruments: Turkish case

The importance of political parties for contemporary representative democracies is beyond dispute. Despite their significance for state-level democracy, political parties continue to be regarded as oligarchical and to be criticised because of their internal practices. For this reason, intra-party democracy (IPD) warrants in-depth analysis. This thesis investigates IPD in Turkey, primarily from the perspective of participatory democracy, with the purpose of suggesting reforms to the Turkish Political Parties Law (TPPL). Turkish political parties and Turkish party regulation provide an interesting case because there is a significant difference between mature democracies and Turkey regarding IPD regulation. IPD in established democracies has always been regarded as a private concern of parties and has been left unregulated. IPD in Turkey, by contrast, is provided for both by the constitution and the TPPL. Although IPD is a constitutional and legal requirement in Turkey, however, political parties in fact display a high level of non-democratic administration. The main reason is that the TPPL only pays lip service to the idea of IPD and requires no specific measures apart from establishing a party congress with a representative form of democracy. By establishing and holding party congresses, political parties are perceived as conforming to the requirements of IPD under the law. In addition, the contested nature of democracy as a concept has impeded the creation of efficacious legal principles. Thus, the existing party law fails to tackle the lack of IPD within political parties and, for this reason, is in need of reform. Furthermore, almost every Turkish party’s own constitution highlights the importance of IPD and promises IPD. However, these declared commitments to IPD in their constitutions alone, especially in countries where the democratic culture is weak, are unlikely to make much difference in practice. Accordingly, external regulation is necessary to ensure the protection of the rights and interests of the party members with regards to their participation in intra-party decision-making processes. Nevertheless, in spite of a general consensus in favour of reforming the TPPL, a lack of consensus exists as to what kind of reforms should be adopted. This thesis proposes that reforming the TPPL in line with an approach based on participatory democracy could provide better IPD within Turkish political parties, citing as evidence comparative case studies of the participatory practices for policy-making, leadership selection and candidate selection in mature democracies. This thesis also analyses membership registration and the effect of state funding on IPD, which are highly problematic in Turkey and represent impediments to the flourishing of IPD.

Adjuvant intra-arterial hepatic fotemustine for high-risk uveal melanoma patients

Uveal melanoma metastases occur most commonly in the liver. Given the 50% mortality rate in patients at high risk of developing liver metastases, we tested an adjuvant intra-arterial hepatic (i.a.h.) chemotherapy with fotemustine after proton beam irradiation of the primary tumour. We treated 22 high-risk patients with adjuvant i.a.h. fotemustine. Planned treatment duration was 6 months, starting with four weekly doses of 100 mg/m(2), and after a 5-week rest, repeated every 3 weeks. The survival of this patient group was compared with that of a 3 : 1 matched control group randomly selected from our institutional database. Half of the patients experienced > or =grade 3 hepatotoxicity (one patient developing cholangitis 8 years later). Catheter-related complications occurred in 18%. With a median follow-up of 4.6 years for the fotemustine group and 8.5 years for the control group, median overall survival was 9 years [95% confidence interval (CI) 2.2-12.7] and 7.4 years (95% CI 5.4-12.7; P=0.5), respectively, with 5-year survival rates of 75 and 56%. Treatment with adjuvant i.a.h. fotemustine is feasible. However, toxicities are important. Although our data suggest a survival benefit, it was not statistically significant. Confirming such a benefit would require a large, internationally coordinated, prospective randomized trial.

Adjuvant intra-arterial hepatic fotemustine for high-risk uveal melanoma patients.

Uveal melanoma metastases occur most commonly in the liver. Given the 50% mortality rate in patients at high risk of developing liver metastases, we tested an adjuvant intra-arterial hepatic (i.a.h.) chemotherapy with fotemustine after proton beam irradiation of the primary tumour. We treated 22 high-risk patients with adjuvant i.a.h. fotemustine. Planned treatment duration was 6 months, starting with four weekly doses of 100 mg/m(2), and after a 5-week rest, repeated every 3 weeks. The survival of this patient group was compared with that of a 3 : 1 matched control group randomly selected from our institutional database. Half of the patients experienced > or =grade 3 hepatotoxicity (one patient developing cholangitis 8 years later). Catheter-related complications occurred in 18%. With a median follow-up of 4.6 years for the fotemustine group and 8.5 years for the control group, median overall survival was 9 years [95% confidence interval (CI) 2.2-12.7] and 7.4 years (95% CI 5.4-12.7; P=0.5), respectively, with 5-year survival rates of 75 and 56%. Treatment with adjuvant i.a.h. fotemustine is feasible. However, toxicities are important. Although our data suggest a survival benefit, it was not statistically significant. Confirming such a benefit would require a large, internationally coordinated, prospective randomized trial.

Dynamic single cell measurements of kinase activity by synthetic kinase activity relocation sensors.

BACKGROUND: Mitogen activated protein kinases (MAPK) play an essential role in integrating extra-cellular signals and intra-cellular cues to allow cells to grow, adapt to stresses, or undergo apoptosis. Budding yeast serves as a powerful system to understand the fundamental regulatory mechanisms that allow these pathways to combine multiple signals and deliver an appropriate response. To fully comprehend the variability and dynamics of these signaling cascades, dynamic and quantitative single cell measurements are required. Microscopy is an ideal technique to obtain these data; however, novel assays have to be developed to measure the activity of these cascades. RESULTS: We have generated fluorescent biosensors that allow the real-time measurement of kinase activity at the single cell level. Here, synthetic MAPK substrates were engineered to undergo nuclear-to-cytoplasmic relocation upon phosphorylation of a nuclear localization sequence. Combination of fluorescence microscopy and automated image analysis allows the quantification of the dynamics of kinase activity in hundreds of single cells. A large heterogeneity in the dynamics of MAPK activity between individual cells was measured. The variability in the mating pathway can be accounted for by differences in cell cycle stage, while, in the cell wall integrity pathway, the response to cell wall stress is independent of cell cycle stage. CONCLUSIONS: These synthetic kinase activity relocation sensors allow the quantification of kinase activity in live single cells. The modularity of the architecture of these reporters will allow their application in many other signaling cascades. These measurements will allow to uncover new dynamic behaviour that previously could not be observed in population level measurements.

Intraregional trade in South America, 1913-50. Economic linkages before institutional agreements

Dejando de lado NAFTA, la integración comercial en América Latina sigue siendo muy moderada hoy en día, representando alrededor del 20% del comercio total. Lo sorprendente es que estos valores eran más altos en 1945. Esto constituye un hecho paradoxal: la integración comercial alcanzó su récord antes de la firma de acuerdos de integración comercial. En el presente trabajo se estudia el comercio intrarregional a lo largo del período de entreguerras (1913-1950) a través del análisis de cinco casos: Argentina, Bolivia, Brasil, Chile y Peru. El análisis de la integración comercial en este período representa una novedad en la literatura, ya que los trabajos sobre América Latina, específicos de comercio intraregional, se centran en el período a partir de la década de 1960. El documento destaca dos conclusiones principales: a) con la excepción de los períodos de las guerras mundiales, el comercio intraregional ha sido muy modesto desde 1913 hasta la actualidad, b) en general, el comercio intrarregional repitió la especialización del comercio mundial: una alta concentración en productos de bajo valor añadido.

Intraregional trade in South America, 1913-50. Economic linkages before institutional agreements

Dejando de lado NAFTA, la integración comercial en América Latina sigue siendo muy moderada hoy en día, representando alrededor del 20% del comercio total. Lo sorprendente es que estos valores eran más altos en 1945. Esto constituye un hecho paradoxal: la integración comercial alcanzó su récord antes de la firma de acuerdos de integración comercial. En el presente trabajo se estudia el comercio intrarregional a lo largo del período de entreguerras (1913-1950) a través del análisis de cinco casos: Argentina, Bolivia, Brasil, Chile y Peru. El análisis de la integración comercial en este período representa una novedad en la literatura, ya que los trabajos sobre América Latina, específicos de comercio intraregional, se centran en el período a partir de la década de 1960. El documento destaca dos conclusiones principales: a) con la excepción de los períodos de las guerras mundiales, el comercio intraregional ha sido muy modesto desde 1913 hasta la actualidad, b) en general, el comercio intrarregional repitió la especialización del comercio mundial: una alta concentración en productos de bajo valor añadido.

Intra-empreendedorismo e organizações não-governamentais: prática e discurso

Essa tese tem como objetivo contribuir para a compreensão da ocorrência de práticas associadas ao intra-empreendedorismo em organizações não-governamentais (ONGs). Elaborou-se um referencial de análise preliminar a partir da revisão bibliográfica sobre os conceitos de intra-empreendedorismo, organizações não-governamentais e teoria institucional. Esse arcabouço teórico orientou a realização de pesquisa empírica, qualitativa e de natureza exploratória, empreendida por meio de estudo de caso, tendo como objeto de estudo organizações não-governamentais. Foram realizados dois estudos de casos. O primeiro analisou uma ONG localizada na cidade do Rio de Janeiro, cujo foco principal de atuação é a área da saúde, e que emprega o trabalho voluntário de forma intensiva. O segundo estudo de caso foi voltado à análise de uma ONG localizada na cidade de São Paulo, cujo foco principal de atuação é a educação, que desenvolve suas atividades valendo-se basicamente de trabalho remunerado, e que se enquadra na categoria de Organização da Sociedade Civil de Interesse Público - OSCIP. Com os estudos de casos, foi possível obter subsídios para analisar e refinar o referencial previamente elaborado. São levantadas, também, considerações referentes à adoção de práticas associadas ao intra-empreendedorismo e ao discurso empreendedor legitimador das organizações não-governamentais.

Can the new refugee relocation system work? Perils in the Dublin logic and flawed reception conditions in the EU. CEPS Policy Brief No. 332, October 2015 Thursday, 1 October 2015

This Policy Brief argues that the newly adopted EU temporary relocation (quota) system constitutes a welcome yet timid step forward in addressing a number of central controversies of the current refugee debate in Europe. Two main challenges affect the effective operability of the new EU relocation model. First, EU member states’ asylum systems show profound (on-the-ground) weaknesses in reception conditions and judicial/administrative capacities. These prevent a fair and humane processing of asylum applications. EU states are not implementing the common standards enshrined in the EU reception conditions Directive 2013/33. Second, the new relocation system constitutes a move away from the much-criticised Dublin system, but it is still anchored to its premises. The Dublin system is driven by an unfair and unsustainable rule according to which the first EU state of entry is responsible for assessing asylum applications. It does not properly consider the personal, private and family circumstances or the preferences of asylum-seekers. Policy Recommendations In order to respond to these challenges, the Policy Brief offers the following policy recommendations: The EU should strengthen and better enforce member states’ reception capacities, abolish the current Dublin system rule of allocation of responsibility and expand the new relocation distribution criteria to include in the assessment (as far as possible) asylum-seekers’ preferences and personal/family links to EU member states. EU member countries should give priority to boosting their current and forward-looking administrative and judicial capacities to deal and welcome asylum applications. The EU should establish a permanent common European border and asylum service focused on ensuring the highest standards through stable operational support, institutional solidarity across all EU external borders and the practical implementation of new distribution relocation criteria.

Does institutional quality affect firm performance? Insights from a semiparametric approach

Using a novel modeling approach, and cross-country firm level data for the textiles industry, we examine the impact of institutional quality on firm performance. Our methodology allows us to estimate the marginal impact of institutional quality on productivity of each firm. Our results bring into question conventional wisdom about the desirable characteristics of market institutions, which is based on empirical evidence about the impact of institutional quality on the average firm. We demonstrate, for example, that once both the direct impact of a change in institutional quality on total factor productivity and the indirect impact through changes in efficiency of use of factor inputs are taken into account, an increase in labor market rigidity may have a positive impact on firm output, at least for some firms. We also demonstrate that there are significant intra-country variations in the marginal impact of institutional quality, such that the characteristics of “winners” and “losers” will have to be taken into account before policy is introduced to change institutional quality in any direction.