Wider Literature Research Articles

Evaluating the UK House of Commons Science and Technology Committee\u2019s position on the implausible effectiveness of homeopathic treatments

In 2009, the UK House of Commons Science and Technology Committee (STC) conducted an ‘evidence check’ on homeopathy to evaluate evidence for its effectiveness. In common with the wider literature critical of homeopathy, the STC report seems to endorse many of the strong claims that are made about its implausibility. In contrast with the critical literature, however, the STC report explicitly does not place any weight on implausibility in its evaluation. I use the contrasting positions of the STC and the wider critical literature to examine the ‘implausibility arguments’ against homeopathy and the place of such arguments within evidence-based medicine (EBM). I argue that the STC report undervalues its strong claims about the mechanistic plausibility of homeopathy because it relies on a misunderstanding about the role of mechanistic evidence within EBM. This is not a conclusion for a revision of the role mechanistic evidence plays within EBM, however. It is a conclusion about the inconsistency of the STC report’s position towards implausibility arguments, given the evidential claims they endorse and the atypical situation that homeopathy presents. It provides a further example of the general point that mechanistic reasoning should not be seen as providing categorically lower quality evidence.

Pharmacogenetic testing through the direct-to-consumer genetic testing company 23andMe

BackgroundRapid advances in scientific research have led to an increase in public awareness of genetic testing and pharmacogenetics. Direct-to-consumer (DTC) genetic testing companies, such as 23andMe, allow consumers to access their genetic information directly through an online service without the involvement of healthcare professionals. Here, we evaluate the clinical relevance of pharmacogenetic tests reported by 23andMe in their UK tests.MethodsThe research papers listed under each 23andMe report were evaluated, extracting information on effect size, sample size and ethnicity. A wider literature search was performed to provide a fuller assessment of the pharmacogenetic test and variants were matched to FDA recommendations. Additional evidence from CPIC guidelines, PharmGKB, and Dutch Pharmacogenetics Working Group was reviewed to determine current clinical practice. The value of the tests across ethnic groups was determined, including information on linkage disequilibrium between the tested SNP and causal pharmacogenetic variant, where relevant.Results23andMe offers 12 pharmacogenetic tests to their UK customers, some of which are in standard clinical practice, and others which are less widely applied. The clinical validity and clinical utility varies extensively between tests. The variants tested are likely to have different degrees of sensitivity due to different risk allele frequencies and linkage disequilibrium patterns across populations. The clinical relevance depends on the ethnicity of the individual and variability of pharmacogenetic markers. Further research is required to determine causal variants and provide more complete assessment of drug response and side effects.Conclusion23andMe reports provide some useful pharmacogenetics information, mirroring clinical tests that are in standard use. Other tests are unspecific, providing limited guidance and may not be useful for patients without professional interpretation. Nevertheless, DTC companies like 23andMe act as a powerful intermediate step to integrate pharmacogenetic testing into clinical practice.

Maternity Management in SMEs: A Transdisciplinary Review and Research Agenda

AbstractThis paper provides a transdisciplinary critical review of the literature on maternity management in small and medium‐sized enterprises (SMEs), embedded within the wider literatures on maternity in the workplace. The key objectives are to describe what is known about the relations that shape maternity management in smaller workplaces and to identify research directions to enhance this knowledge. The review is guided by theory of organizational gendering and small business management, conceptualizing adaptions to maternity as a process of mutual adjustment and dynamic capability within smaller firms’ informally negotiated order, resource endowments and wider labour and product/service markets. A context‐sensitive lens is also applied. The review highlights the complex range of processes involved in SME maternity management and identifies major research gaps in relation to pregnancy, maternity leave and the return to work (family‐friendly working and breastfeeding) in these contexts. This blind spot is surprising, as SMEs employ the majority of women worldwide. A detailed agenda for future research is outlined, building on the gaps identified by the review and founded on renewed theoretical direction.

Trust and risk: a model for medical education.

Health care delivery, and therefore medical education, is an inherently risky business. Although control mechanisms, suchas external audit and accreditation, are designed to manage risk in clinical settings, another approach is 'trust'. The use of entrustable professional activities (EPAs) represents a deliberate way in which this is operationalised as a workplace-based assessment. Once engaged with the concept, clinical teachers and medical educators may have further questions about trust. This narrative overview of the trust literature explores how risk, trust and control intersect with current thinking in medical education, and makes suggestions for potential directions of enquiry. Beyond EPAs, the importance of trust in health care and medical education is reviewed, followed by a brief history of trust research in the wider literature. Interpersonal and organisational levels of trust and a model of trust from the management literature are used to provide the framework with which to decipher trust decisions in health care and medical education, in which risk and vulnerability are inherent. In workplace learning and assessment, the language of 'trust' may offer a more authentic and practical vocabulary than that of 'competency' because clinical and professional risks are explicitly considered. There are many other trust relationships in health care and medical education. At the most basic level, it is helpful to clearly delineate who is the trustor, the trustee, and for what task. Each relationship has interpersonal and organisational elements. Understanding and considered utilisation of trust and control mechanisms in health care and medical education may lead to systems that maturely manage risk while actively encouraging trust and empowerment.

Evidence for the effectiveness of minimum pricing of alcohol: a systematic review and assessment using the Bradford Hill criteria for causality

ObjectivesTo assess the evidence for price-based alcohol policy interventions to determine whether minimum unit pricing (MUP) is likely to be effective.DesignSystematic review and assessment of studies according to Preferred Reporting...

Integrative Skin Care: Dermatology and Traditional and Complementary Medicine.

Skin problems and diseases are extremely common globally and, due to their visibility, often result in severe distress and stigma for sufferers. Traditional (i.e., indigenous or local) and complementary health systems are widely used and incorporate many treatment modalities suitable for skin care, and a body of evidence for their efficacy and safety has built up over many decades. These approaches are often used as part of a broader "integrative medicine" (IM) approach that may also include, for example, nutrition and mind-body approaches. This article presents an overview of current knowledge about traditional and complementary medicine (T&CM) and IM principles and practices for skin health; reviews published epidemiologic studies, clinical trials, and wider literature; and discusses the challenges of conducting research into T&CM and IM. It also highlights the need for an innovative research agenda-one which is congruent with the principles of IM, as well as taking policy and public health dimensions into consideration.

The impact of social care expenditure at the end of life: a novel linkage study in Scotland

ABSTRACTBackgroundAnalyses of inpatient care admissions have shown that population ageing does not lead to an increase in future healthcare expenditure to the extent that might be expected and that remaining time to death (TTD) is an equally important cost element. But as people live longer and the onset of disease and death are postponed to older ages the utilisation of social care services is another major cost component for elderly people, in particular those with chronic diseases. However, there is a distinct lack of social care data in Scotland to estimate the impact of population ageing and TTD on social care expenditure.
 ObjectivesThis study aims to estimate the utilisation and associated costs of inpatient and home care services among end-of-life patients. It will also determine the feasibility of undertaking the linkage of home care service utilisation data, inpatient care episodes and death records.
 MethodsNHS Greater Glasgow and Clyde (NHSGGC) social home care data (Cordia), Scottish Morbidity Records (SMR01) and death records (National Records for Scotland, NRS) will be utilised in order to estimate utilisation and costs for home care services and inpatient care at the end of life. The ‘Cordia’ data is available for the period September 2013 to November 2013 and includes information on the type, duration and frequency of home care services utilised. Costs will be assigned using ‘Personal Social Services Research Unit’ (PSSRU) costs. Using multilevel modelling techniques the association between TTD, age, demographic and socio-economic measures and expenditure on home care services will be estimated, while allowing the effect of covariates to vary over hierarchical levels, such as episode of care and the patient.
 Expected OutcomesThe wider literature suggests that contrary to inpatient care, costs at the end of life for the oldest old might be higher when considering elements of social care provision. The ‘Cordia’ data consists of 7,367 individuals with 1,620 observed deaths. Further results are forthcoming and findings will significantly add to the knowledge base in the area of population ageing and related health- and social care expenditure. This is a novel linkage and given the difficulties in obtaining social care data, this study will i) help to evaluate the feasibility of using these data for research, and ii) identify where costs at the end of life occur, thus facilitating more targeted approaches to end-of-life care.

New Times revisited: Britain in the 1980s

The authors in this volume are collectively engaged with a historical puzzle: What happens if we examine the decade once we step out of the shadows cast by Thatcher? That is, does the decade of the 1980s as a significant and meaningful periodisation (equivalent to that of the 1960s) still work if Thatcher becomes but one part of the story rather than the story itself? The essays in this collection suggest that the 1980s only makes sense as a political period. They situate the 1980s within various longer term trajectories that show the events of the decade to be as much the consequence as the cause of bigger, long-term historical processes. This introduction contextualises the collection within the wider literature, before explaining the collective and individual contributions made.

Bronze metallurgy in the Late Phrygian settlement of Gordion, Turkey

A detailed understanding of bronze production remains absent in most archaeological contexts, despite the fundamental importance of this alloy. Here, we present a comprehensive discussion of the bronze production remains from Late Phrygian/Achaemenid Gordion: crucibles, moulds and casting waste and their find contexts. A detailed microscopic analysis of crucibles is complemented by chemical characterisation of their main materials (ceramic and slag) in order to discuss the technical performance of the crucibles and to evaluate the materials used for the metallurgical process. Given the lack of contemporary parallels, repeated reference is made to the Egyptian crucibles from Pi-Ramesse, for which similarly detailed descriptions are available. The crucible analyses are then connected to the other production remains to obtain a more holistic understanding of the metallurgical process. Finally, these technical observations are interpreted in their particular archaeological context at Gordion and discussed from a wider perspective. The results presented here offer the first detailed overview of bronze production for ancient Phrygia, as well as the wider region. Through the inclusion of extensive online supplementary data, this paper offers a detailed technical overview of ancient (bronze) crucible analysis, of which very few examples are currently available in the wider literature.

Twelve tips for teaching medical students with dyslexia

Dyslexia is a common learning difficulty. As a result of SS’ own experiences as a medical student with dyslexia, we have been researching and teaching on this topic for the past two years. Here, we present twelve tips for teaching medical students with dyslexia. These are gathered from our personal experiences and research, discussions with other educators, and wider literature on the topic. This article aims to shed some light on dyslexia, and also to make practical suggestions. Teaching students with dyslexia should not be a daunting experience. Small changes to existing methods, at minor effort, can make a difference – for example, adding pastel colors to slide backgrounds or avoiding Serif fonts. These tips can help educators gain more insight into dyslexia and incorporate small, beneficial adaptations into their teaching.

When organisational effectiveness fails

PurposeThe purpose of this paper is to consider the nature of the business continuity management (BCM) process and to frame it within wider literature on the performance of socio-technical systems. Despite the growth in BCM activities in organisations, some questions remain as to whether academic research has helped to drive this process. The paper seeks to stimulate discussion within this journal of the interplay between organisational performance and BCM and to frame it within the context of the potential tensions between effectiveness and efficiency.Design/methodology/approachThe paper considers how BCM is defined within the professional and academic communities that work in the area. It deconstructs these definitions in order to and set out the key elements of BCM that emerge from the definitions and considers how the various elements of BCM can interact with each other in the context of organisational performance.FindingsThe relationships between academic research in the area of crisis management and the practice-based approaches to business continuity remain somewhat disjointed. In addition, recent work in the safety management literature on the relationships between success and failure can be seen to offer some interesting challenges for the practice of business continuity.Research limitations/implicationsThe paper integrates work in safety, crisis and risk management with BCM in order to identify the main areas of overlap and synergy between these areas of academic research. By definition, the need for business continuity represents the risks and cost of failure in organisational performance in the absence of continuity. This calls into question the effectiveness of organisational processes around decision making, control, and strategic management. The paper sets out a series of issues that are in need of further research.Practical implicationsThe paper draws on some of the practice-based definitions of BCM and highlights the limitations and challenges associated with the construct. The paper sets out challenges for BCM based upon theoretical challenges arising in cognate areas of research. The aim is to ensure that BCM is integrated with emerging concepts in other aspects of the management of uncertainty and to do so in a strategic context.Originality/valueAcademic research on performance reflects both the variety and the multi-disciplinary nature of the issues around measuring and managing performance. Failures in organisational performance have also invariably attracted considerable attention due to the nature of a range of disruptive events. The paper reveals some of the inherent paradoxes that sit at the core of the BCM process and its relationships with organisational performance.

Introduction: leadership questions in transnational european governance

Even more so than the United States, the European Union (EU) marks a classic case of an ‘anti-leadership environment’ designed to hinder rather than facilitate political leadership. While there have been, nevertheless, manifestations of leadership since the very beginning of European integration, the enigmatic features of leadership at the European level, and the specific difficulties in getting hold of the subject, have limited more systematic political research in this field. This article seeks to relate some of the perennial questions of political leadership research to the study of transnational European governance. Such an inquiry suggests that, in light of the recent changes in the conceptualization of leadership to be found in the wider literature, the empirical features of collective and dispersed leadership in the EU have gradually lost their peculiarity. This notwithstanding, the EU continues to have both a leadership and a followership problem, and the challenges ahead are unlikely to be overcome by institutional adaptation and reform alone.

The origins of neoliberalism in late ‘socialist’ Hungary: The case of the Financial Research Institute and ‘Turnabout and Reform’

This article contributes to ongoing debates in the transformatology literature, as well as the wider literature on the global neoliberal revolution, on the origins of neoliberalism in Soviet-style economies. Within these debates, the transition to a (free) market economy and liberal democracy in Hungary and elsewhere in the former Soviet bloc has commonly been perceived as an exogenous process, dating to the annus mirabilis of 1989. This article challenges this consensus. Through a case study of the Financial Research Institute ( Pénzügykutatási Intézet), the official research institute of the Ministry of Finance, and a programme of radical economic reform, known as ‘Turnabout and Reform’ ( Fordulat és Reform), published in 1987 by a group of experts at the institute, the article demonstrates that in the case of Hungary, neoliberalism was not simply an ‘imported project’, which arrived ‘from the West’ on the eve of the formal transition in 1989–1990. Rather, it is argued that it emerged organically in Hungarian society in the 1980s, as a response by domestic economic and political elites to the deepening crisis of the Kádár regime. Hence, the essential aim of the ‘neoliberal turn’ was to reconfigure the Hungarian economy in line with the exigencies of the capitalist world economy, while ensuring that the political transition went as smoothly as possible. As such, while obviously a repudiation of past policy, policymakers in Budapest pursued the similar objectives as central planners under ‘actually existing socialism’.

Three-Phase Coexistence in Lipid Membranes

Phospholipid ternary systems are useful model systems for understanding lipid-lipid interactions and their influence on biological properties such as cell signaling and protein translocation. Despite extensive studies, there are still open questions relating to membrane phase behavior, particularly relating to a proposed state of three-phase coexistence, due to the difficulty in clearly distinguishing the three phases. We look in and around the region of the phase diagram where three phases are expected and use a combination of different atomic force microscopy (AFM) modes to present the first images of three coexisting lipid phases in biomimetic cell lipid membranes. Domains form through either nucleation or spinodal decomposition dependent upon composition, with some exhibiting both mechanisms in different domains simultaneously. Slow cooling rates are necessary to sufficiently separate mixtures with high proportions of lo and lβ phase. We probe domain heights and mechanical properties and demonstrate that the gel (lβ) domains have unusually low structural integrity in the three-phase region. This finding supports the hypothesis of a “disordered gel” state that has been proposed from NMR studies of similar systems, where the addition of small amounts of cholesterol was shown to disrupt the regular packing of the lβ state. We use NMR data from the literature on chain disorder in different mixtures and estimate an expected step height that is in excellent agreement with the AFM data. Alternatively, the disordered solid phase observed here and in the wider literature could be explained by the lβ phase being out of equilibrium, in a surface kinetically trapped state. This view is supported by the observation of unusual growth of nucleated domains, which we term “tree-ring growth,” reflecting compositional heterogeneity in large disordered lβ phase domains.

Time to Go? Head Coach Quits and Dismissals in Professional Football

That football Head Coaches will be dismissed for poor performance and will quit when they have better outside options seems to be nothing more than a statement of the obvious. But owners may find it hard to distinguish poor performance from bad luck and may find it difficult to identify and attract talented managers from other clubs. Indeed, most of the literature indicates little improvement in team performance when one coach replaces another. Equally, Head Coaches may have few options to move to better clubs even when they are performing well. We identify significant differences between determinants of quits and dismissals that are largely consistent with a standard model which predicts departures occur when the value of the job match specific surplus for one or both parties falls below the value of outside options. However, dismissals and quits are more common in Italy and Spain than in Germany and France, suggesting institutions may be important. We discuss the implications of our findings in the context of principal-agent theory and the wider literature on turnover among CEOs and other corporate leaders.

Policy learning and policy failure: definitions, dimensions and intersections

Policy failures present a valuable opportunity for policy learning, but public officials often fail to learn valuable lessons from these experiences. The studies in this volume investigate this broken link. This introduction defines policy learning and failure, and then organises the main studies in these fields along the key dimensions of: processes, products and analytical levels. We continue with an overview of the special issue articles, outlining where they sit in the wider literature and how they link learning and failure. We conclude sketching a research agenda linking policy scholars with policy practice.

Memory, post-socialism and the media: Nostalgia and beyond

While research on the mediation of post-socialist memory has gained momentum in recent years, the field remains fragmented and limited to small-scale case studies, with little attempt to develop a more general reflection on the nature of the processes investigated. Engagement with the wider literature on the mediatisation of memory has been limited as well, with research typically applying established conceptual frameworks rather than using post-socialist materials to generate new theoretical insights. Given the state of the field, this article has a double aim. First, it offers a critical review of the main trends in existing research, focussing on four key issues: the fascination with nostalgic modes of remembering, the dominance of national frames of analysis, the lack of research on the mediation of personal and vernacular remembering, and the privileging of descriptive over explanatory modes of analysis. Second, this article outlines a new agenda for the field and proposes three main research trajectories. The first pays attention to how mediated memories at local and national levels interact with transnational processes of remembering the Cold War, the second focusses on the intersections between personal and public modes of mediated remembering, and the last moves the discussion from description to explanation, using comparative approaches to advance explanations of different modes of mediated post-socialist memories.

A new standard of visual data representation for imaging mass spectrometry.

MALDI imaging MS (IMS) is principally used for cancer diagnostics. In our own experience with publishing IMS data, we have been requested to modify our protocols with respect to the areas of the tissue that are imaged in order to comply with the wider literature. In light of this, we have determined that current methodologies lack effective controls and can potentially introduce bias by only imaging specific areas of the targeted tissue EXPERIMENTAL DESIGN: A previously imaged sample was selected and then cropped in different ways to show the potential effect of only imaging targeted areas. By using a model sample, we were able to effectively show how selective imaging of samples can misinterpret tissue features and by changing the areas that are acquired, according to our new standard, an effective internal control can be introduced. Current IMS sampling convention relies on the assumption that sample preparation has been performed correctly. This prevents users from checking whether molecules have moved beyond borders of the tissue due to delocalization and consequentially products of improper sample preparation could be interpreted as biological features that are of critical importance when encountered in a visual diagnostic.

Father absence but not fosterage predicts food insecurity, relative poverty, and poor child health in northern Tanzania.

The importance of fathers in ensuring child health in rural developing populations is questioned by anthropologists and population health scientists. Existing literature focuses on paternal death and child mortality. A relative lack of studies consider alternative forms of father absence and/or more subtle health outcomes. Here we determine the frequency and form of father absence in northern Tanzania, and its relationship to household food security, wealth, and child anthropometric status. We conducted a cross-sectional survey of 3136 children under 5 years of age from 56 villages. Using multilevel regression we contrast children residing with both parents to those that (i) have experienced paternal death, (ii) reside with their mother but not their living father and (iii) are fostered apart from both living parents. Of the total, 3.5% of children had experienced paternal death. Thirteen percent resided with their mother but away from their living father. Supporting data indicate such cases primarily reflect parental divorce/separation, extra-marital birth, or polygynous fathers residing with an alternative cowife. Paternal death and residing apart from one's living father was associated with lower food security and/or relative poverty and there is suggestive evidence that children in such circumstances achieve lower height-for-age. Six percent of children were fostered, usually with grandparents, and were comparable to children residing with both parents in terms of household food security, wealth, and anthropometric status. Our results highlight diversity in the form and consequences of father absence. We discuss limitations of the current study and wider literature on fatherhood and make suggestions for future research.

Taking stock of Rwanda’s decentralisation: changing local governance in a post-conflict environment

This article takes stock of Rwanda’s decentralisation by reviewing the existing evidence and putting it into perspective with the wider literature on decentralisation. It challenges the narrative that depicts the Rwandan decentralisation as a wholly negative or destabilising process by arguing that the focus of the scholarship on lack of popular participation should not ignore key dynamics that had significant stabilising effects. Yet, as the Rwandan economy and society are becoming more diversified, introduction of bottom-up mechanisms of decision-making will be necessary in the future to enhance the government responsiveness to evolving local needs and ensure stability in the long run.