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Many Western countries have seen an increase in the volume and importance of external consultants in the public policy process. This book is the first to investigate this phenomenon in a comparative and interdisciplinary way. The analysis shows who these consultants are, how widely and for what reasons they are used in Britain, the United States, Canada, Australia, The Netherlands and Sweden. In doing so, the book addresses the positive and negative implications of high levels of external policy consultancy, including its implications for the nature of the state (transforming into a contractor state?) and for democratically legitimized and accountable decision-making (transforming into consultocracy?). It provides valuable new insights for students and practitioners in the fields of public administration, public policy, public management, political science and human resource management.
Philosophy of technology only came into existence as a specialist branch of professional philosophy during the 1970s, although the philosophical literature during the years between 1945 and the 1970s voices an increasing preoccupation with technology. Just as the First World War led to a wave of disillusionment among intellectuals as well as the common man, so did the Second World War. This disillusionment manifested itself as pessimism, which became characteristic of several influential philosophers during the two first decades after the war. We find it echoed, for instance, in Gabriel Marcel’s The Decline of Wisdom (1954), where Marcel describes the “horror and anxiety” he felt walking through “the ruins of Vienna in 1946, or more recently in Caen, Rouen or Würzburg” (21). But the 1970s, with growing social prosperity, industrial growth, and better technologies, changed that sentiment. The development of a professional philosophy of technology has, after the 1960s, developed along two different yet familiar trajectories: one into an analytical philosophy of technology and science, the other into a Continental (or more broadly humanities-oriented) philosophy of technology (see also Thomson, this volume).
Dynamics of Caste and Law breaks new ground in understanding how caste and law relate in India's democratic order. Caste has become a visible phenomenon often associated with discrimination, inequality and politics in India and globally. India's constitutional democracy has had a remarkable goal of creating equality in a context of caste. Despite constitutional promises with equal opportunities for the lower castes and outlawing of untouchability at the time of independence, recurring atrocities and inadequate implementation of law have called for rethinking and legal change. This book sheds new light on why caste oppression persists by using new theoretical perspectives as well as Bhimrao Ambedkar's concepts of the caste system. Focusing on struggles among India's Dalits, the castes formerly known as untouchables, the book draws on a rich material and explains, among other things, mechanisms of oppression and how powerful actors may gain influence in institutions of law and state.
This closing chapter summarizes the book’s themes. By gathering religious, secular moral, legal, and sociopolitical perspectives in one place, the book aims to be a resource so lawyers, policy activists, and policymakers in patent debates might better understand what religious perspectives have to offer, and so religious thinkers and leaders might better understand biotech patents and thus have more to offer. Three themes emerge from the balance of the chapters. First, patents on life call for evaluation under criteria of morality and social justice. Second, religious thought can contribute to–not dominate, but contribute to–such moral and social evaluation. Finally, however, for religious thought to contribute effectively, it must be better informed and sophisticated than it has been, about both patent law and biotechnology.
This volume brings together a unique collection of legal, religious, ethical, and political perspectives to bear on debates concerning biotechnology patents, or 'patents on life'. The ever-increasing importance of biotechnologies has generated continual questions about how intellectual property law should treat such technologies, especially those raising ethical or social-justice concerns. Even after many years and court decisions, important contested issues remain concerning ownership of and rewards from biotechnology - from human genetic material to genetically engineered plants – and regarding the scope of moral or social-justice limitations on patents or licensing practices. This book explores a range of related issues, including questions concerning morality and patentability, biotechnology and human dignity, and what constitute fair rewards from genetic resources. It features high-level international, interfaith, and cross-disciplinary contributions from experts in law, religion, and ethics, including academics and practitioners, placing religious and secular perspectives into dialogue to examine the full implications of patenting life.
Neuropsychological tests are important instruments to determine a cognitive profile, giving insight into the etiology of dementia; however, these tests cannot readily be used in culturally diverse, low-educated populations, due to their dependence upon (Western) culture, education, and literacy. In this review we aim to give an overview of studies investigating domain-specific cognitive tests used to assess dementia in non-Western, low-educated populations. The second aim was to examine the quality of these studies and of the adaptations for culturally, linguistically, and educationally diverse populations.
A systematic review was performed using six databases, without restrictions on the year or language of publication.
Forty-four studies were included, stemming mainly from Brazil, Hong Kong, Korea, and considering Hispanics/Latinos residing in the USA. Most studies focused on Alzheimer’s disease (n = 17) or unspecified dementia (n = 16). Memory (n = 18) was studied most often, using 14 different tests. The traditional Western tests in the domains of attention (n = 8) and construction (n = 15), were unsuitable for low-educated patients. There was little variety in instruments measuring executive functioning (two tests, n = 13), and language (n = 12, of which 10 were naming tests). Many studies did not report a thorough adaptation procedure (n = 39) or blinding procedures (n = 29).
Various formats of memory tests seem suitable for low-educated, non-Western populations. Promising tasks in other cognitive domains are the Stick Design Test, Five Digit Test, and verbal fluency test. Further research is needed regarding cross-cultural instruments measuring executive functioning and language in low-educated people.
Limited availability of fish oils (FO), rich in omega-3 long-chain (≥C20) polyunsaturated fatty acids (FA), is a major constraint for further growth of the aquaculture industry. Long-chain omega-3 rich oils from crops genetically modified with algal genes are promising new sources for the industry. This project studied the use of a newly developed omega-3 canola oil (DHA-CA) in diets of Atlantic salmon fingerlings in freshwater. The DHA-CA oil has high proportions of the omega-3 FA 18:3n-3 and DHA and lower proportions of omega-6 FA than conventional plant oils. Levels of phytosterols, vitamin E, and minerals in the DHA-CA were within the natural variation of commercial canola oils. Pesticides, mycotoxins, polyaromatic hydrocarbons, and heavy metals were below lowest qualifiable concentration. Two feeding trials were conducted to evaluate effects of two dietary levels of DHA-CA compared to two dietary levels of FO at two water temperatures. Fish increased their weight approximately 20-fold at 16 °C and 12-fold at 12 °C during the experimental periods, with equal growth in salmon fed the FO diets compared to DHA-CA diets. Salmon fed DHA-CA diets had approximately the same EPA+DHA content in whole body as salmon fed FO diets. Gene expression, lipid composition, and oxidative stress related enzyme activities showed only minor differences between the dietary groups and the effects were mostly a result of dietary oil level, rather than the oil source. The results demonstrated that DHA-CA is a safe and effective replacement for FO in diets of Atlantic salmon during the sensitive fingerling life-stage.
The Melody valve, designed for implantation into the pulmonary outflow tract, can also be used to treat the pathology of atrioventricular (AV) valves. Increasing gradients are seen as an indication for re-dilating the valve. Our case demonstrates the heart rate dependency of the gradient across a Melody implanted in the left AV valve position in an infant. Beta blockers were used to lower both heart rate and gradient.
The present study aimed to determine if the long-chain MUFA cetoleic acid (22 : 1n-11) can improve the capacity to synthesise the health-promoting n-3 fatty acids EPA and DHA in human and fish models. Human hepatocytes (HepG2) and salmon primary hepatocytes were first enriched with cetoleic acid, and thereafter their capacities to convert radio-labelled 18 : 3n-3 (α-linolenic acid, ALA) to EPA and DHA were measured. Increased endogenous levels of cetoleic acid led to increased production of radio-labelled EPA + DHA in HepG2 by 40 % and EPA in salmon hepatocytes by 12 %. In order to verify if dietary intake of a fish oil rich in cetoleic acid would have the same beneficial effects on the n-3 fatty acid metabolic pathway in vivo as found in vitro, Atlantic salmon were fed four diets supplemented with either sardine oil low in cetoleic acid or herring oil high in cetoleic acid at two inclusion levels (Low or High). The diets were balanced for EPA + DHA content within the Low and within the High groups. The salmon were fed these diets from 110 to 242 g. The level of EPA + DHA in liver and whole-body retention of docosapentaenoic acid and EPA + DHA relative to what was eaten, increased with increased dietary cetoleic acid levels. Thus, it is concluded that cetoleic acid stimulated the synthesis of EPA and DHA from ALA in human HepG2 and of EPA in salmon hepatocytes in vitro and increased whole-body retention of EPA + DHA in salmon by 15 % points after dietary intake of cetoleic acid.
This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study.
Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences.
Survey data were collected during 2011–2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling.
Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care.
The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor–patient relationship as well as a broad range of services offered by PC physicians.