149 research outputs found
The Politics of Social Policy Reform in the United States: The Clinton and the W. Bush Presidencies Reconsidered
No full textThe purpose of this paper is to examine what key reform attempts during the Bill Clinton and George W. Bush presidencies reveal about the wider possibilities for social policy change in the United States. Most particularly, why were Presidents Clinton and Bush able to achieve their goals in some policy realms but so badly defeated in others? As argued, institutional variation from one policy area to another helps answer this question. On the one hand, strong institutional obstacles in the fields of Social Security and health insurance largely explain the defeat of the most ambitious social policy proposal put forward by each president. On the other hand, successful reforms occurred in a comparatively favourable institutional context. Yet, the analysis also suggests that paying close attention to the strategic ideas of political actors as they interact with existing institutions and policy legacies is necessary to fully understand the politics of social policy reform.social policy, Medicare, Social Security, welfare, institutions, United States
Fulminant Bacillus cereus food poisoning with fatal multi-organ failure.
No full textThis case represents a rare fulminant course of fried-rice associated food poisoning in an immunocompetent person due to pre-formed exotoxin produced by Bacillus cereus, with severe manifestations of sepsis, including multi-organ (hepatic, renal, cardiac, respiratory and neurological) failure, shock, metabolic acidosis, rhabdomyolysis and coagulopathy. Despite maximal supportive measures (continuous renal replacement therapy, plasmapheresis, N-acetylcysteine infusion and blood products, and broad-spectrum antimicrobials) and input from a multidisciplinary team (consisting of infectious diseases, intensive care, gastroenterology, surgery, toxicology, immunology and haematology), mortality resulted. This case is the first to use whole genome sequencing techniques to confirm the toxigenic potential of B. cereus It has important implications for food preparation and storage, particularly given its occurrence in home isolation during the COVID-19 pandemic
The effects of fiscal consolidation in the OECD
No full textDespite the current recession in many parts of the OECD, fiscal consolidation is likely in many OECD economies in the 1990s. The author asks: is fiscal consolidation in the OECD in a period of low growth a recipe for global stagnation? In particular, what effects are likely in developing countries? The author starts with an overview of cuts in the U.S. fiscal deficit proposed by the Clinton administration and the extent to which European governments must cut fiscal deficits between now and 1997 to satisfy deficit targets in the Maastricht Treaty. How changes in fiscal policy are transmitted within an economy and between that economy and the rest of the world depends on whether those changes lead to permanent or temporary changes in government saving; whether they are implemented through government spending or taxes; and whether the taxes fall on households or firms. The main channels of transmission are through changes in: agents'expectations about future taxes, interest rates, exchange rates, and economic activity. The author uses the MSG2 multicountry models to quantify the ramifications of those changes. He concludes, among other things, that fiscal contraction in the OECD will probably lead to slower growth over the next several years. But the current and likely paths of fiscal policy are such that deficit reduction programs may have stimulating effect in the short run, as long as future fiscal contraction is credible. And fiscal deficit reduction will probably increase long-run output in the OECD through its effects on savings and investment. Finally, growth in the developing countries (at least total growth) may not be impaired at all by fiscal consolidationin the OECD. The negative effects of fiscal contraction will occur through lower net exports of non-OECD economies. For developing countries with open capital markets, the initial reduction in demand through lower exports can be offset by the reduction in interest rates following an inflow of capital from the countries with contracting fiscal policy. A significant decline in real global interest rates is likely to increase growth in developing countries that are debt-constrained, either directly (through private capital inflows) or indirectly (by relaxing the balance of payments constraint, allowing more resources to be channeled to domestic investment needs).Economic Theory&Research,Economic Stabilization,Environmental Economics&Policies,Banks&Banking Reform,Macroeconomic Management
Pneumococcal bacteraemia in adults over a 10‐year period (2011–2020): a clinical and serotype analysis
No full textBackground: Streptococcus pneumoniae (pneumococcus) is a human nasopharyngeal tract coloniser responsible for invasive pneumococcal disease, which is largely vaccine preventable. Vaccination is recommended from birth for all, and through adulthood for those with risk conditions. Aims: To describe the clinical and serotype analysis of pneumococcus bacteraemia over a 10-year period. Methods: A 10-year (February 2011–December 2020) retrospective review was performed on all adult (age ≥18 years) pneumococcus bacteraemia presenting to the four public hospitals in Western Sydney, Australia. Comorbidities and risk factors were recorded. Results: Three hundred unique episodes of S. pneumoniae bloodstream infection (SPBI) were identified during the study period. The median age for SPBI was 63 years with 31.7% aged 70 years or older. A 94.7% had one or more risks factors for SPBI. Pneumonia was reported in 80% of all SPBI, whereas meningitis was reported in 6% and infective endocarditis in <1%. Asplenia was noted in 2.4%. Seven- and 30-day mortality was 6.6% and 11.9%, with a higher 30-day mortality in those aged ≥70 years (24.4%). The serotype distribution showed 7-valent conjugate vaccine covered 11.0% of all isolates, whereas 13-valent conjugate vaccine (13vPCV) and a 23-valent polysaccharide vaccine (23vPPV) covered 41.7% and 69.0% respectively. Immunisation details were available for 110 individuals, of whom, only 7.3% had received pneumococcal vaccination. Conclusions: Most patients with pneumococcal bacteraemia had age- or comorbidity-related risk factors but were not vaccinated. Two-thirds of cases occurred in people aged <70 years. 13vPCV and 23vPPV covered 41.7% and 69.0% of bacteraemic isolates.Full Tex
Perceptions of US and Australian medical students and instructors about clinical professional attire: Lapel study
No full textContext White coats have long been the professional uniform of physicians. However, when physicians opt to remove the white coat, their clothing underneath is brought to the forefront and can influence how they are perceived by their patients. Objective: To explore the perceptions of medical students and their instructors about appropriate clinical professional attire. MethodsAn anonymous, voluntary 55-question survey was electronically distributed to medical students and their instructors at 2 US and 2 Australian medical schools. The survey incorporated 30 images of sample attire, 9 demographic questions, and 16 questions regarding culture and context of clothing and accessories. ResultsIn total, 411 students and 73 instructors participated in this study. The data revealed that white coats and neckties are nearly absent in Australian clinical attire. Overall, students were significantly more supportive of full facial coverage due to religious or cultural values compared with instructors (P<.001), and US medical students were significantly more supportive than Australian students (P<.001). All cohorts preferred dress code policies that directed students to avoid but not prohibit the use of perfume or cologne. Nose rings were controversial with significantly more support for use from medical students than instructors (pooled cohorts, P=.002). Medical students in both the United States and Australia indicated that they were most influenced by observing the attire of physicians at work (155 [38%]), compared with courses in medical ethics (19 [5%]), school policy (16 [4%]), or hospital policy (9 [2%]). ConclusionAlthough regional dress code practices are different in the United States compared with Australia, medical students were overall most influenced by their instructors’ attire in clinical settings.</p
‐10 diagnostic coding
No full textThe cost and comorbidity of obesity in hospitalized inpatients, is less known. A retrospective study of patients presenting to a large district hospital in Western Sydney (April 2016-February 2017) using clinical, pathological as well as diagnostic coding data for obesity as per ICD-10. Of 43 212 consecutive hospital presentations, 390 had an obesity-coded diagnosis (Ob, 0.90%), of which 244 were gender and age matched to a non-obesity coded cohort (NOb). Weight and BMI were higher in the Ob vs NOb group (126 ± 37 vs 82 ± 25 kg; BMI 46 ± 12 vs 29 ± 8 kg/m2 , P < .001) with a medical record documentation rate of 62% for obesity among Ob. The Ob cohort had 2-5 higher rates of cardiopulmonary and metabolic complications (P < .001), greater pharmacologic burden, length of stay (LOS, 225 vs 89 hours, P < .001) and stay in intensive care but no differences in the prevalence of mental disorders. Compared with BMI 35 kg/m2 were 5 more likely to require intensive care (OR 5.08 [1.43-27.3, 95% CI], P = .0047). The initiation of obesity-specific interventions by clinical teams was very low. People with obesity who are admitted to hospital carry significant cost and complications, yet obesity is seldom recognized as a clinical entity or contributor
The Private Cost of Long-Term Care in Canada: Where You Live Matters
No full textCanadians expect the same access to health care whether they are rich or poor, and wherever they live, often without direct charge at the point of service. However, we find that the private cost of long-term care differs greatly across the country, and within provinces, we find substantial variation, depending on income level, marital status, and, in Quebec alone, on assets owned. A non-married person with average income would pay more than twice as much in the Atlantic provinces as in Quebec, while a couple with one in care would pay almost four times as much in Newfoundland as in Alberta.long-term care, private cost
Documenting immigrant experiences: A study of the Chinese-language newspapers published in North America
No full textThe intensifying competition among Chinese-language newspapers in North America was recently brought to spotlight by mainstream media. For well over a century, North America based Chinese newspapers have been informing generations of immigrants and documenting their collective and personal experiences. The steady flow of Chinese speaking population into the U.S. and Canada over the last several decades has created opportunities for this type
of publication to expand and proliferate, which in turn poses challenges to library community in respect to collection development and preservation.
After giving a brief outline of the history of Chinese-language press in both Canada and U.S., this paper will discuss the identity of this type of press, which is a particularly acute question in the context of U.S. A researcher who conducted two surveys in the U.S. in
1987 and 1997 concludes that it is Chinese American, while a campaign aid for Senator Hilary Clinton reportedly declared that it is “foreign media” when trying to prevent
reporters from entering Clinton’s fundraiser in San Francisco in early 2007. By contrast, this author tends to believe that the identity of Chinese press has changed over time and is more fluid today.
The next focus of this paper is the current status of Chinese newspapers in North America. Using information from this author's own investigation and media reports, the
paper will provide an account of Chinese newspapers in two regions with largest Chinese communities—Toronto and New York-New Jersey. Both the prominent daily newspapers and
small weeklies distributed in the supermarkets will be discussed in terms of their editorial policies, circulation numbers, distribution channels, web presences, and availability (or the lack of) in the libraries.
For different types of libraries, the challenges for collecting and preserving North America-based Chinese newspapers are somewhat different. A state library may have public mandate to do so, but may lack the language expertise required. Even though an academic library may possess such expertise, it may be restricted by its current curriculum focus. Therefore, a state-wide or even nation-wide collaboration needs to be developed in order to
collect these newspapers and ultimately preserve a unique portion of human experience
Proline-rich tyrosine kinase 2 mediates gonadotropin-releasing hormone signaling to a specific extracellularly regulated kinase-sensitive transcriptional locus in the luteinizing hormone beta-subunit gene
No full textG protein-coupled receptor regulation of gene transcription primarily occurs through the phosphorylation of transcription factors by MAPKs. This requires transduction of an activating signal via scaffold proteins that can ultimately determine the outcome by binding signaling kinases and adapter proteins with effects on the target transcription factor and locus of activation. By investigating these mechanisms, we have elucidated how pituitary gonadotrope cells decode an input GnRH signal into coherent transcriptional output from the LH beta-subunit gene promoter. We show that GnRH activates c-Src and multiple members of the MAPK family, c-Jun NH2-terminal kinase 1/2, p38MAPK, and ERK1/2. Using dominant-negative point mutations and chemical inhibitors, we identified that calcium-dependent proline-rich tyrosine kinase 2 specifically acts as a scaffold for a focal adhesion/cytoskeleton-dependent complex comprised of c-Src, Grb2, and mSos that translocates an ERK-activating signal to the nucleus. The locus of action of ERK was specifically mapped to early growth response-1 (Egr-1) DNA binding sites within the LH beta-subunit gene proximal promoter, which was also activated by p38MAPK, but not c-Jun NH2-terminal kinase 1/2. Egr-1 was confirmed as the transcription factor target of ERK and p38MAPK by blockade of protein expression, transcriptional activity, and DNA binding. We have identified a novel GnRH-activated proline-rich tyrosine kinase 2-dependent ERK-mediated signal transduction pathway that specifically regulates Egr-1 activation of the LH beta-subunit proximal gene promoter, and thus provide insight into the molecular mechanisms required for differential regulation of gonadotropin gene expression
Retraining displaced workers : what can developing countries learn from OECD nations?
No full textThe governments of most industrial countries provide financial support for adult training programs intended to retrain displaced workers. The author draws lessons from the experience of six industrial countries (Australia, Britain, Canada, Japan, Sweden, and the United States) on how to design and implement such retraining programs in low-income developing nations and middle-income countries. By retraining, the author means both improving job skills and remediating deficiencies in basic education. These are the lessons he emphasizes: Training programs should be independent of the educational system, with its rigid ties to degree requirements and academic schedules; links to employers must be developed and maintained so that trainees have marketable skills on completing the program. Training programs should be designed to minimize trainees'foregone earnings; basic education should be relevant to the jobs the trainees might seek. External providers of education must be made accountable - but with care; the system of accountability should also ensure that the needs of displaced workers most likely to suffer long-term unemployment are met. Not all displaced workers require relatively expansive retraining; some may need only inexpensive job-search assistance services. A permanent, institutionalized training system is preferable to short-term intervention.Labor Standards,Tertiary Education,ICT Policy and Strategies,Health Monitoring&Evaluation,Teaching and Learning
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