Genuine Contribution Research Articles

Intraneuronal accumulation of C99 contributes to synaptic alterations, apathy-like behavior, and spatial learning deficits in 3×TgAD and 2×TgAD mice.

The triple transgenic mouse model (3×TgAD: APPswe, TauP301L, PS1M146V) recapitulates both amyloid β (Aβ)- and tau-related lesions as well as synaptic and memory deficits. In these mice, we reported an early apathy-like behavior and alterations in synaptic plasticity appearing concomitantly with intraneuronal accumulation of C99 in the subiculum. To delineate the genuine contribution of C99 on the above phenotypes, we generated double transgenic mice (2×TgAD: APPswe, TauP301L) that accumulate C99 without Aβ deposition or hyperphosphorylation of tau and compared them to 3×TgAD mice. Here, we show that both TgAD mice display similar decreases in long-term potentiation and in spontaneous locomotor activity measured by actimetry suggesting that the synaptic alterations and the apathy-like behavior were likely linked to C99 rather than Aβ. However, spatial learning alterations, assessed by the Morris water maze task, are more pronounced in 3×TgAD than in 2×TgAD, suggesting that both Aβ and C99 contribute to defects in the acquisition of spatial information. Finally, even if similar results are observed in males, cognitive and non-cognitive deficits are more severe in females.

Different Types of Sounds and Their Relationship With the Electrocardiographic Signals and the Cardiovascular System - Review.

Background: For some time now, the effects of sound, noise, and music on the human body have been studied. However, despite research done through time, it is still not completely clear what influence, interaction, and effects sounds have on human body. That is why it is necessary to conduct new research on this topic. Thus, in this paper, a systematic review is undertaken in order to integrate research related to several types of sound, both pleasant and unpleasant, specifically noise and music. In addition, it includes as much research as possible to give stakeholders a more general vision about relevant elements regarding methodologies, study subjects, stimulus, analysis, and experimental designs in general. This study has been conducted in order to make a genuine contribution to this area and to perhaps to raise the quality of future research about sound and its effects over ECG signals.Methods: This review was carried out by independent researchers, through three search equations, in four different databases, including: engineering, medicine, and psychology. Inclusion and exclusion criteria were applied and studies published between 1999 and 2017 were considered. The selected documents were read and analyzed independently by each group of researchers and subsequently conclusions were established between all of them.Results: Despite the differences between the outcomes of selected studies, some common factors were found among them. Thus, in noise studies where both BP and HR increased or tended to increase, it was noted that HRV (HF and LF/HF) changes with both sound and noise stimuli, whereas GSR changes with sound and musical stimuli. Furthermore, LF also showed changes with exposure to noise.Conclusion: In many cases, samples displayed a limitation in experimental design, and in diverse studies, there was a lack of a control group. There was a lot of variability in the presented stimuli providing a wide overview of the effects they could produce in humans. In the listening sessions, there were numerous examples of good practice in experimental design, such as the use of headphones and comfortable positions for study subjects, while the listening sessions lasted 20 min in most of the studies.

Patient and Family Advisory Councils (PFACs): Identifying Challenges and Solutions to Support Engagement in Research.

The aim was to describe barriers to patient and family advisory council (PFAC) member engagement in research and strategies to support engagement in this context. We formed a study team comprising patient advisors, researchers, physicians, and nurses. We then undertook a qualitative study using focus groups and interviews. We invited PFAC members, PFAC leaders, hospital leaders, and researchers from nine academic medical centers that are part of a hospital medicine research network to participate. All participants were asked a standard set of questions exploring the study question. We used content analysis to analyze data. Eighty PFAC members and other stakeholders (45 patient/caregiver members of PFACs, 12 PFAC leaders, 12 hospital leaders, 11 researchers) participated in eight focus and 19 individual interviews. We identified ten barriers to PFAC member engagement in research. Codes were organized into three categories: (1) individual PFAC member reluctance; (2) lack of skills and training; and (3) problems connecting with the right person at the right time. We identified ten strategies to support engagement. These were organized into four categories: (1) creating an environment where the PFAC members are making a genuine and unique contribution; (2) building community between PFAC members and researchers; (3) best practice activities for researchers to facilitate engagement; and (4) tools and training. Barriers to engaging PFAC members in research include patients' negative perceptions of research and researchers' lack of training. Building community between PFAC members and researchers is a foundation for partnerships. There are shared training opportunities for PFAC members and researchers to build skills about research and research engagement.

Late Antique Ionic Column Capitals in the Countryside of Central Palestine between Provincial Trends and Classical Traditions

This article provides the first comprehensive synthesis of one of the least studied styles of column capitals—the Ionic order—in the countryside of the central Palestinian hill country in Late Antiquity. In this study a suggested typology and chronology of the documented finds of Ionic capitals—all are made of local limestone—is presented, while taking into account the geographical distribution of the capital types, and their archaeological/architectural and cultural contexts. Ionic capitals in late antique central Palestine were almost exclusively used in rural settlements of various forms, mostly villages (usually Christian but also Jewish and possibly Samaritan) and monasteries, and were virtually absent from the region's urban centers. While only one capital type represents the (quasi-)canonical or classical style of this order, the other five types clearly demonstrate provincial trends, especially an increasing heterogeneity in the development of the Ionic capital in the region, and the genuine contribution of rural artisans in this respect. The typological diversity and widespread distribution of Ionic-style capitals in the countryside of the late antique central Palestinian hill country is interpreted within local and pan-Levantine historical and socio-cultural contexts. This research inter alia suggests that the specific socio-political history of the central Palestinian hill country during the Early Roman period can partly explain the marked distinction between this area and the regions to its north regarding the evolution of the Ionic style in late antique times. By also using the code-switching model, this study further hypothesizes that the unique Ionic capitals used in the central Palestinian hill country contributed to the development of the cultural identity of the local rural population.

Mania for Freedom: American Literatures of Enthusiasm from the Revolution to the Civil War by John Mac Kilgore

Reviewed by: Mania for Freedom: American Literatures of Enthusiasm from the Revolution to the Civil War by John Mac Kilgore Jon Mee (bio) Mania for Freedom: American Literatures of Enthusiasm from the Revolution to the Civil War john mac kilgore Chapel Hill: University of North Carolina Press, 2016 300 pp. They who have made but superficial studies in the Natural History of the human mind, have been taught to look on religious opinions as the only cause of enthusiastick zeal, and sectarian propagation. But there is no doctrine whatever, on which men can warm, which is not capable of the very same effect. The social nature of man impels him to propagate his kind. The passions give zeal and vehemence. The whole man moves under the discipline of his opinions. Although he doesn't quote it directly, John Mac Kilgore's account of American literatures of enthusiasm from the Revolution to the Civil War accords with Edmund Burke's statement from the First Letter on a Regicide Peace (1796). Mac Kilgore is very well aware of the contribution made by Burke to the refreighting of the idea of enthusiasm in the age of democratic revolutions: the period, as he sees it, when the term was regularly used—whether positively or, like Burke, negatively—to describe the "mania for freedom" of his title. Methodologically, the difficulty of enthusiasm is that it is more often a [End Page 606] term of attribution than self-description. The discourse on enthusiasm is everywhere in this period and earlier, at least from the English Civil War, and Mac Kilgore is very well read in its archive on both sides of the Atlantic. The problem is identifying what is the discourse of enthusiasm, especially when those accused of it were often not always keen on the identification. Mac Kilgore makes a genuine contribution to recent studies on enthusiasm, a subject that has become conspicuous in several fields over the last two decades, by looking at its distinctive contribution to American literature and politics. He proceeds with a particular definition of enthusiasm, effectively derived from hostile accounts of an insurrectionary tradition at odds with the conservative narrative of the prudence of the American Revolution. His method is to use the term to find a positive continuity between groups often accused of enthusiasm: "commoners, slaves, Native Americans, women, abolitionists—who activated dissent against institutional tyranny and forged transnational, counternational, or antinationalistic political affiliations in the process" (1). Primarily concerned with the literary dimension of this American tradition, he more specifically identifies "literatures of enthusiasm" as "those texts that transform writing into a species or inciter of democratic revival and revolt" (1). The term is given a particularly American purchase through its complex relationship with the foundation of the United States. Exploiting recent theoretical writing on "constituent power," mostly indebted to Antonio Negri, Mac Kilgore sees the tradition as one that refuses to cede that constituent power to the state and continually insists on the originary power of "the people" to assert its authority. Of course, one might say that tradition persists in some of the populism, especially in its anticonstitutional formations, of the Right that has played a part in recent American politics, most obviously in last November's election result, an event horizon perhaps unforeseen when this book was written. On the other hand, Mac Kilgore's identification of constituent power with enthusiasm raises questions of organization, practical politics, and forms of progressivism whose dreams of revolutionary intervention have made no claim to inspiration or any kind of prophetic tradition. Have forms of American insurgency existed beyond Mac Kilgore's enthusiastic tradition? Do they still? Mac Kilgore's primary concern is with the way normative constructions of the sphere of politics have tended to distance it from enthusiasm because of the assumption that emotion is primarily a subjective form of experience. [End Page 607] Mania for Freedom invokes instead the work of Brian Massumi and others for whom "affect" (as opposed to "emotion") summons "exteriorized, intercorporeal, and pre-personal intensity or contact that has to do with relations exceeding but including the self" (19). Within the larger history of the term, Mac Kilgore writes intelligently of the...

The Nietzschean Self: Moral Psychology, Agency, and the Unconscious

The Nietzschean Self: Moral Psychology, Agency, and the Unconscious

Participatory action and dual lens research

PurposeThe purpose of this paper is to explore the idea that, in the last few decades, collaborative inquiry methods have evolved along a similar trajectory to dual lens research. Dual lens research, known in various contexts as both ways, two-eyed seeing Old Ways New Ways, and Koodjal Jinnung (looking both ways), is designed to generate new knowledge by exploring a theme through Aboriginal and contemporary western lenses. Participatory action research and a dual lens approach are considered in a number of projects with a particular focus on the issues such work can raise including conceptual challenges posed by fundamental differences between knowledge sets.Design/methodology/approachThe authors hypothesize that a dual lens approach will become a branch of participatory action research, as such, a robust description needs to be developed and its ethical implications are considered. Existing work in this direction, including principles and processes, are collated and discussed.FindingsDual lens research as a branch of participatory action research is of great significance in countries with Aboriginal populations that are undergoing a cultural renaissance. As dual lens practitioners, the authors are finding their research outputs have a high positive impact on both Aboriginal and non-Aboriginal populations and make a genuine contribution to reconciliation by finding ways of going forward together.Originality/valueThis paper joins a growing body of research that supports resonances between Aboriginal and “western” research methods.

How to Succeed as an International Horticultural Consultant

Although the term consultant is used extensively, the duty of an international horticultural consultant (IHC) lacks precision. We propose that the job of an IHC has many attributes similar to an extension agent in the United States. Accordingly, we highlight the responsibilities of an IHC and put them in a historic and organizational context. Subsequently, we give advice about how to act and behave adequately when going to a new country. We bring in experience from successful IHC and a synopsis of specialist literature. Because we stress the importance of the credibility of an IHC within the farming community he is working with, we emphasize interaction with her/his professional and social environment. An IHC must have a genuine interest in the people being served and their challenges and adequate competence to provide a genuine contribution.

The importance of small urban reserves for plant conservation

There has been much debate about the effectiveness of different sized reserves for nature conservation. However, in human-dominated landscapes such as cities, conservation reserve systems are, by necessity, often determined without using conservation planning principles. This can result in reserve systems that are small, fragmented and disconnected. In this study, we conducted a floristic survey of 68 urban grassland conservation reserves to assess how reserves of different areas contribute to species conservation. Species accumulation curves, species-area relationships, and proportion of native cover were explored. We found that 87% of all native plant species were found in small reserves <10ha in size, more small reserves contained a greater number of species than few large reserves of a comparable area, and cover of native species in small reserves was no different than cover in large reserves. However, large reserves harboured more uncommon species than smaller reserves. This research has several important implications for conservation planning and design, highlighting that both small and large reserves can help to conserve native plant species in urban areas. However, a preference for large reserves over small ones is embedded in much conservation planning and management. There is a danger that a normative belief that large reserves are ‘good’ and small reserves are ‘bad’ has become entrenched in conservation thinking. While the theory and evidence showing the conservation benefits of large reserves over small reserves for some organisms is clear, in some cases, small reserves can make a substantial and genuine contribution to conservation outcomes.

Publish or perish: Dr Victor Webster and cardiazol treatment in Western Australia, 1937-1938.

To examine the role of Dr Victor Henry Webster (1905-1980) in the introduction of cardiazol therapy to Western Australia in November 1937. A range of primary and secondary sources were consulted. Webster experimented with cardiazol treatment at Heathcote Reception Home, and published his findings in April 1938, at the same time as Ellery and Lear, but was not able to publish his results in a nationally-recognised journal. As a result, his contribution to early cardiazol treatment in Australia has been largely forgotten. Webster made a genuine contribution to the introduction of cardiazol treatment in Australia, and his story illustrates the need to publish early findings of new physical therapies.

Exploring the role of core and infrastructure quality management practices in ambidexterity

This paper explores the role of core and infrastructure quality management (QM) practices in creating ambidexterity. Based on an extensive literature review, the paper develops propositions about the modus operandi of each type of QM practices in causing ambidexterity. The paper shows that the core QM practices have a direct positive role in ambidexterity, whereas infrastructure QM practices have an indirect positive role through core QM practices. Overall, the paper makes three key contributions: first, it elaborates the role of core and infrastructure QM practices in ambidexterity. Given the fact that the role of QM in ambidexterity is an emerging topic, a discussion on this role is a genuine contribution. Second, the development of propositions is an important milestone towards developing a theory of creating ambidexterity through QM. Third, since the paper elaborates the role of QM practices in each exploitation and exploration, it can provide practical guidance on which practices to be used to support exploration (such as when finding novel solutions to problems) and which practices to be used for exploitation (such as during streamlining processes and increasing efficiency).

Subtracting infrared renormalons from Wilson coefficients: Uniqueness and power dependences on ΛQCD

In the context of OPE and using the large-$\beta_0$ approximation, we propose a method to define Wilson coefficients free from uncertainties due to IR renormalons. We first introduce a general observable $X(Q^2)$ with an explicit IR cutoff, and then we extract a genuine UV contribution $X_\mathrm{UV}$ as a cutoff-independent part. $X_\mathrm{UV}$ includes power corrections $\sim (\Lambda_\mathrm{QCD}^2/Q^2)^n$ which are independent of renormalons. Using the integration-by-regions method, we observe that $X_\mathrm{UV}$ coincides with the leading Wilson coefficient in OPE and also clarify that the power corrections originate from UV region. We examine scheme dependence of $X_\mathrm{UV}$ and single out a specific scheme favorable in terms of analytical properties. Our method would be optimal with respect to systematicity, analyticity and stability. We test our formulation with the examples of the Adler function, QCD force between $Q \bar{Q}$, and $R$-ratio in $e^{+} e^{-}$ collision.

Rational Mysticism: Hegel on Magic and China

Hegel’s conception of a universal history of reason is usually interpreted as a Eurocentric project that is dismissive of the genuine contributions by other cultures. In contrast to this assumption, his views concerning Chinese philosophical traditions evolved significantly in his late Lectures on the Philosophy of Religion. Hegel increasingly acknowledges a unique contribution of Confucianism and especially Daoism. While Confucianism is depicted as a natural religion of magic in which the emperor governs as the supreme magician, Daoism revolts against the emperor’s nepotism and turns to the Dao to elaborate a speculative philosophy of reason. The paper argues that the search for a rational form of mysticism is the basis for increasingly valuing the Chinese contributions to a conception of reason that incorporates mystical elements.

Association between neuropeptide Y receptor Y2 promoter variant rs6857715 and major depressive disorder.

Stress increases the risk for major depressive disorder (MDD), overeating, and alcohol dependence (AD). The neuropeptide Y system is one of the best-known modulators of the stress response, and some of its effects are mediated through the neuropeptide Y receptor Y2 (NPY2R). The functional NPY2R variant rs6857715 (C-599T) has been implicated in both obesity and AD, but with opposing alleles. The present study explored whether rs6857715 is also associated with MDD. Analysis of the overall sample (595 MDD cases; 1295 controls) showed an association with the AD risk allele C [P=0.020, odds ratio (OR) (C-allele)=1.18]. The association remained significant after excluding MDD patients with AD/alcohol abuse [P=0.038, OR (C-allele)=1.18]; increased weight/appetite [P=0.006, OR (C-allele)=1.23]; or both [P=0.008, OR (C-allele)=1.25]. The present findings suggest that the NPY2R rs6857715 C-allele makes a genuine contribution toward MDD.

Contribution of image-guided adaptive brachytherapy to pelvic nodes treatment in locally advanced cervical cancer

PurposeWith the increasing use of simultaneous integrated boost in the treatment of cervical cancer, there is a need to anticipate the brachytherapy (BT) contribution at the level of the pathologic pelvic lymph nodes. This study aimed to report the dose delivered at their level during BT. Methods and MaterialsPatients with pelvic nodal involvement and treated with a combination of chemoradiation followed by image-guided adaptive pulsed-dose-rate BT were selected. On per BT three-dimensional images, pelvic lymphadenopathies were delineated, without planning aim. For the purposes of the study, D100, D98, D90, and D50 were reviewed and converted in 2-Gy equivalent doses, using the linear quadratic model with an α/β of 10 Gy. ResultsNinety-one patients were identified, allowing evaluation at the level of 226 lymphadenopathies. The majority of them were external iliac (48%), followed by common iliac (25%), and internal iliac (16%) regions. The 2-Gy equivalent doses D98 were 4.4 ± 1.9 Gy, 5.4 ± 3.1 Gy, and 4.3 ± 2.1 Gy for the obturator, internal iliac, and external iliac, respectively, and 2.8 ± 2.5 Gy for the common iliac. The contribution to the common iliac nodes was significantly lower than the one of external and internal iliac (p < 0.001). ConclusionsBT significantly contributes to the treatment of pelvic nodes at the level of approximately 5 Gy in the internal, external, and obturator areas and 2.5 Gy in the common iliac, allowing the anticipation of nodal boost with the simultaneous integrated boost technique. However, important individual variations have been observed, and evaluation of the genuine BT contribution should be recommended.

Quark orbital angular momentum in the MIT bag model

We present the results for the Generalized Transverse Momentum Distribution related to quark Orbital Angular Momentum, {\it i.e.} $F_{14}$, in the MIT bag model. This model has been modified to include the Peierls--Yoccoz projection to restore translational invariance. Such a modification allows to fulfill more satisfactorily basic sum rules, that would otherwise be less elegantly carried out with the original version. Using the same model, we have calculated the twist-$3$ GPD that corresponds to Orbital Angular Momentum \`a la Ji, through the Penttinen--Polyakov--Shuvaev--Strikman sum rule. Recently, a new relation between the two definitions of the quark Orbital Angular Momentum at the density level has been proposed, which we illustrate here within the model. The sum rule is fulfilled. Still within the framework of the MIT bag model, we analyze the Wandzura--Wilczek expression for the GPD of interest. The genuine quark-gluon contribution is evaluated directly thanks to the equation of motion of the bag, which allows for a direct control of the kinematical contributions to the twist-3 GPD.

What Drives Institutional Reforms in Regional Organisations? Diffusion, Contextual Conditions, and the Modular Design of ASEAN

AbstractWhat drives institutional reforms in regional organisations? And what explains the institutional design of ASEAN? Despite many differences, conventional approaches to the institutional design of regional organisations more generally and ASEAN in particular are united in regarding them as either determined by factors endogenous to the region − such as varying state interests or collective norms − or as exogenously driven, most importantly by hegemonic states like the US or China. This article offers a diffusion account of ASEAN's institutional design. Building on a more recent strand in the diffusion literature emphasising that diffusion rarely leads to convergence, the article makes two genuine contributions. First, it argues that members of regional organisations engage in modular adoption: they select institutional templates from a variety of regional as well as international organisations thereby taking advantage of available information on the costs and benefits of alternative institutions. Second, it argues that contextual conditions and cognitive priors influence what templates are chosen. The argument will be illustrated with a case study on ASEAN's adoption of a single market and a dispute settlement mechanism. Finally, and contrary to arguments that institutional borrowing might increase the expectations-deliverance gap within regional organisations, it argues that if conducted consistently, modular adoption can lead to substantial innovation and success.

Depth Perception and the History of Three-Dimensional Art: Who Produced the First Stereoscopic Images?

The history of the expression of three-dimensional structure in art can be traced from the use of occlusion in Palaeolithic cave paintings, through the use of shadow in classical art, to the development of perspective during the Renaissance. However, the history of the use of stereoscopic techniques is controversial. Although the first undisputed stereoscopic images were presented by Wheatstone in 1838, it has been claimed that two sketches by Jacopo Chimenti da Empoli (c. 1600) can be to be fused to yield an impression of stereoscopic depth, while others suggest that Leonardo da Vinci’s Mona Lisa is the world’s first stereogram. Here, we report the first quantitative study of perceived depth in these works, in addition to more recent works by Salvador Dalí. To control for the contribution of monocular depth cues, ratings of the magnitude and coherence of depth were recorded for both stereoscopic and pseudoscopic presentations, with a genuine contribution of stereoscopic cues revealed by a difference between these scores. Although effects were clear for Wheatstone and Dalí’s images, no such effects could be found for works produced earlier. As such, we have no evidence to reject the conventional view that the first producer of stereoscopic imagery was Sir Charles Wheatstone.

Care paths as a tool for integration and change

Introduction : Chronic diseases are currently a significant health problem, conditioning the patient into a progressive deterioration and gradual autonomy loss. The study focuses on the organization of health service systems , in order to achieve a better preventive control and management of chronic disease treatment. Our route, incorporates risk stratification, considering the natural course of Diabetes Mellitus, Primary Care’s prominence, the cooperation between health care areas and support for patient’s autonomy. The allocation of dual, and shared leadership between clinical specialists (primary and hospital care) and Primary Care management within the Department is one of the most innovative and genuine contributions of the study. In this scenario, communication, becomes a fundamental element, for a comprehensive care which guarantees continuity. It is present at all stages of the route development and considers every person in the process, regardless their field. The methods are multifactorial, organizational attention, nursing care, clinical care and the improvement of drug treatment. Change of practice : A care path, is a pact among professionals, to provide a specific solution, to a specific health problem. It responds to foreseeable scenarios, within the good medical practice framework (ethical commitment). It is designed with a global and, integrated vision which organizes change and sequence of the intervention, has an owner, the founding group and a director of path. The patient is part of the group, and as a collaborator, gives his opinion about the form of work methodology and expresses their needs and priorities. While the fragmentation of care is inefficient, the integrated cares, applied to small systems, has room for efficiency. Main objective : To establish and implement an assistance strategy continued and integrated into patients with Tipe 2 Diabetes Mellitus, in the Department of health of Elda. Specific objectives : To minimize the involved processes. To improve the clinical approach, reduce the clinical variability. To promote the continuity of care. To reduce morbidity. To improve the quality of life. To promote self-care and self-control. To promote the engagement of professionals in the various evolutionary stages of disease. To standardize registration processes. To improve perceived quality and patient satisfaction. Target population : Type 2 Diabetics of the Department of Health of Elda. Main involved : General Practitioner (MFyC), Nursing of Primary care, Endocrinology, Nurse Educator, Nephrology, Social work, Ophthalmology, Clinical Psychology, Emergency, Clinical analysis, Cardiology, Area pharmacy, Neurology, Ambulatory information systems, Patient, Primary Care Management. Key findings : Care routes have in themselves the perfect equation for change. We started working in the welfare path in 2014. Since its submission to the Department in March and implementation in April and May 2015 to the primary care centers, evaluation of the indicators during the first six months, has been satisfactory. In 2015, there has been an improvement in the control of HbA1c, of 22.83% in 2013, 51.24%. Likewise, decreased the percentage of patients with a BMI > 30, 29.91% in 2013 to 22.10% in 2015. Both hypoglycemia and hyperglycemia registered declined in percentage: 1.32% in 2013, 1.17% in 2015 and 0.39% in 2013 to 0.32% in 2015, respectively. HTA control, has improved by 84,62% in 2013, to 86,06% in 2015. We are waiting to receive more hits that will be showcased in May 2016. Lessons learned since the implementation : The attention must be focused on people, professionals (they are people) and to provide an ethical follow-up. - The Department must be ready to change. Solve the lack of communication, the biased view and learn how to work in a team, creating the appropriate environment, then see what we can improve. - Meet the clinicians’ prioritizes. - Listen to the patient. - It is important to prioritize the contents of the route to implement, do it gradually, evaluating, redirecting and consolidating. - Corporative intervention in small groups in conjunction (different members of the Working Group) provides an additional plus and allows you to combine various lines of action. - There is a need for management of consultation and use training tools. Conclusion : Teamwork and collaborative work, create a wide opportunity for improvement. Proposals should focus on the patient and the practice of the profession. Care routes are an excellent tool for the improvement of the comprehensive and integrated care: more health, better care, more efficiency; always framed in departmental areas, as small systems of action, so it supports the sustainability of the system and can be easily extrapolated to others departments.

The political consequences of changes in district magnitude

It is conventional political science wisdom that electoral systems have political consequences. In order to systematically examine these consequences, we focus on the effects of electoral reforms in Central and Eastern European democracies. By analysing the consequences of electoral system changes for party systems and disproportionality, we make use of a quasi-experimental approach by isolating a single treatment – the electoral law change – and controlling for all other variables. Along the lines of classical electoral research, we argue that the introduction of more permissive rules will result in an increase of electoral and legislative fragmentation and a reduction of disproportionality while more restrictive rules will have the opposite effects. The article’s genuine contribution to the debate in the field of electoral research is the introduction of a dynamic perspective. Once we clearly distinguish between mechanical and psychological consequences of electoral systems and analyse them simultaneously, we can develop different hypotheses on the temporal patterning of these effects and hypothesise on the variations of electoral rule change effects over time. While mechanical effects set in immediately and quickly wear off, psychological effects, which are based on learning processes and strategic coordination, develop over time.