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Private certification intermediaries reduce the costs of trade by assessing the quality of firms’ products or processes and, in many cases, establishing a standard for making those quality assessments. That cost reduction occurs whenever certification intermediaries mitigate information asymmetries that would otherwise distort trade or block trade entirely. The result is a clear efficiency gain: a repeat-play intermediary supplies its reputational capital and evaluation expertise to sellers who cannot make credible commitments to, or buyers who cannot make independent evaluations of, product quality at a comparable cost.
Multisite intervention studies have become increasingly common in infection control, for example, looking for a change in hospital infection rates after a regional policy change. The design of these studies can take various forms, from pre–post observational studies to randomized trials, in which sites are randomly assigned to the intervention or in which the intervention is sequentially introduced to different sites over time. Data collected under these settings are clustered by hospital and/or ward, consist of repeated measurements and, in some cases, exhibit temporal and/or seasonal patterns. Failure to account for these features in data analysis could well result in biased estimates of intervention effectiveness and impact on the generalizability of model results.
Children exposed to trauma are predisposed to develop a number of mental health syndromes. They are prone to under-treatment with effective psychosocial interventions and over-treatment with high-risk psychotropic medications, especially polypharmacy and the use of antipsychotics for unapproved conditions. We review the evidence for psychosocial and pharmacological treatments for mental health problems associated with high exposure to childhood trauma – identifying those in foster care as an index group – and the frequency of high-risk pharmacological practices. We describe current efforts to reduce over-treatment of children with high-risk psychotropic medications and propose further recommendations to protect and provide effective care for these vulnerable children.
Shigellosis causes significant morbidity and mortality in developing and developed countries, mostly among infants and young children. The World Health Organization estimates that more than one million people die from Shigellosis every year. In order to evaluate trends in Shigellosis in Israel in the years 2002–2015, we analysed national notifiable disease reporting data. Shigella sonnei was the most commonly identified Shigella species in Israel. Hospitalisation rates due to Shigella flexenri were higher in comparison with other Shigella species. Shigella morbidity was higher among infants and young children (age 0–5 years old). Incidence of Shigella species differed among various ethnic groups, with significantly high rates of S. flexenri among Muslims, in comparison with Jews, Druze and Christians. In order to improve the current Shigellosis clinical diagnosis, we developed machine learning algorithms to predict the Shigella species and whether a patient will be hospitalised or not, based on available demographic and clinical data. The algorithms’ performances yielded an accuracy of 93.2% (Shigella species) and 94.9% (hospitalisation) and may consequently improve the diagnosis and treatment of the disease.
Digital markets offer abundant free content but exhibit extreme concentration among content aggregation intermediaries. These characteristics are linked. Weak copyright environments select against stand-alone content-delivery structures and select for bundled aggregation structures in which free content for users promotes positively priced advertising and data-collection services for firms. Dominant intermediaries promote commoditization, and the reallocation of market rents from content producers to content aggregators, through litigation and free content distribution that weaken copyright protections. The potential net welfare effects raise concern. Network effects, compounded by weak inventory constraints, scale economies, and learning effects, promote winner-takes-all outcomes in the intermediary services market while weak copyright may generate output distortions in the content production market.
While depression is a growing public health issue, the percentage of individuals with depression receiving treatment is low. Physical and social attributes of the neighborhood may influence the level of depressive symptoms and the prevalence of depression in older adults.
This review systematically examined the literature on neighborhood environmental correlates of depression in older adults. Findings were analyzed according to three depression outcomes: depressive symptoms, possible depression, and clinical depression. Based on their description in the article, environmental variables were assigned to one of 25 categories. The strength of evidence was statistically quantified using a meta-analytical approach with articles weighted for sample size and study quality. Findings were summarized by the number of positive, negative, and statistically non-significant associations by each combination of environmental attribute – depression outcome and by combining all depression outcomes.
Seventy-three articles met the selection criteria. For all depression outcomes combined, 12 of the 25 environmental attribute categories were considered to be sufficiently studied. Three of these, neighborhood socio-economic status, collective efficacy, and personal/crime-related safety were negatively associated with all depression outcomes combined. Moderating effects on associations were sparsely investigated, with 52 articles not examining any. Attributes of the physical neighborhood environment have been understudied.
This review provides support for the potential influence of some neighborhood attributes on population levels of depression. However, further research is needed to adequately examine physical attributes associated with depression and moderators of both social and physical neighborhood environment attribute – depression outcome associations.
Differences between verbal and non-verbal cognitive development from childhood to adulthood may differentiate between those with and without psychotic symptoms and affective symptoms in later life. However, there has been no study exploring this in a population-based cohort.
The sample was drawn from the MRC National Survey of Health and Development, and consisted of 2384 study members with self-reported psychotic experiences and affective symptoms at the age of 53 years, and with complete cognitive data at the ages of 8 and 15 years. The association between verbal and non-verbal cognition at age 8 years and relative developmental lag from age 8 to 15 years, and both adult outcomes were tested with the covariates adjusted, and mutually adjusted for verbal and non-verbal cognition.
Those with psychotic experiences [thought interference (n = 433), strange experience (n = 296), hallucination (n = 88)] had lower cognition at both the ages of 8 and 15 years in both verbal and non-verbal domains. After mutual adjustment, lower verbal cognition at age 8 years and greater verbal developmental lag were associated with higher likelihood of psychotic experiences within individuals, whereas there was no association between non-verbal cognition and any psychotic experience. In contrast, those with case-level affective symptoms (n = 453) had lower non-verbal cognition at age 15 years, and greater developmental lag in the non-verbal domain. After adjustment, lower non-verbal cognition at age 8 years and greater non-verbal developmental lag were associated with higher risk of case-level affective symptoms within individuals.
These results suggest that cognitive profiles in childhood and adolescence differentiate psychiatric disease spectra.
SnO2 doped with Sb and Nb has been investigated for its use as catalyst support materials replacing carbon to enhance PEM fuel cells stability. Nanostructured powders of various doping levels were prepared by flame spray pyrolysis (FSP). The specific requirements of surface area >50 m2g-1 and electronic conductivity >0.01 Scm-1 were obtained, and pore sizes ranging mainly from 10 to 100 nm. Pt particles (9-20 wt.% in loading targeted) of ∼1 nm well dispersed in Sb-doped SnO2 was prepared by a one-step FSP procedure providing microstructures of high interest for further investigations as cathode in PEM fuel cells.
A brief photographic history of a man-induced ice cone is given. This ephemeral feature created around a gas well on Melville Island, N.W.T., Canada, indicates that the present climate is not capable of sustaining a natural ice mass. Disappearance of the ice is projected by 1974 without intervention of man.
Over the past decade, state courts have been at the forefront of seeking to increase access to legal assistance and facilitating self-representation in civil cases. In this chapter, Helaine Barnett, former president of the Legal Services Corporation, describes her work on the Task Force to Expand Access to Civil Legal Services in New York, which was set in motion by former New York State Chief Judge Jonathan Lippman. The statewide task force first set out to assess the needs of New Yorkers who did not have legal assistance and then framed solutions around those findings.
“Equal Justice under Law” is a founding principle of our nation dating back to the Preamble of the Constitution and a concept that is familiar to most Americans. We all believe that rich or poor, we should be treated equally in our courts. Although equal access to justice remains an ideal, the reality is very different for those unable to afford the assistance of counsel in civil cases. Unlike in criminal cases, there is no constitutionally established right to counsel in civil cases for those who cannot afford it, even in cases involving essential issues such as housing, healthcare, child custody, or protection from domestic violence. For people of limited means, the result is that in the vast majority of civil cases where crucial issues are at stake, they have to navigate a complex legal system alone.
There is a system of civil legal services available to those who cannot afford counsel that addresses a small percentage of the need, supported by funding from a variety of sources. The biggest source of funding is the Legal Services Corporation (LSC), a private, nonprofit corporation created by Congress in 1974 that distributes funding from annual federal appropriations to 134 independent legal services providers throughout the country, in every state and territory of the United States. Current LSC funding is at about $375 million annually, to serve an eligible population of over 63 million Americans, the number of people who meet the qualifying criteria of earning no more than 125% of the federal poverty level. LSC funding supports programs to assist the 1 in 5 Americans at that income level or below, which is currently $30,313 for a family of four.
Flame spray pyrolysis (FSP) was applied to produce nanopowders of Ti1-xMxO2 and Sn1-xMxO2, where x = 0.05 and M = Nb/Sb, for use as catalyst support materials in PEM fuel cells/ electrolysers. FSP powders in the SnO2-IrO2 system were produced for the same applications. Homogenous particle size distribution (5-20 nm) was demonstrated by TEM, supported by BET and XRD analysis. Whereas two polymorphs were indicated for the Ti-based oxides, the Sb/Nb-doped SnO2 powders were single phase. FSP powders of Mn3O4 intended for supercapacitors were produced and the influence of the precursor/solvent mixtures on the physical and electrochemical properties evaluated.
Recurrent affective problems are predictive of cognitive impairment, but
the timing and directionality, and the nature of the cognitive
impairment, are unclear.
To test prospective associations between life-course affective symptoms
and cognitive function in late middle age.
A total of 1668 men and women were drawn from the Medical Research
Council National Survey of Health and Development (the British 1946 birth
cohort). Longitudinal affective symptoms spanning age 13–53 years served
as predictors; outcomes consisted of self-reported memory problems at
60–64 years and decline in memory and information processing from age 53
to 60–64 years.
Regression analyses revealed no clear pattern of association between
longitudinal affective symptoms and decline in cognitive test scores,
after adjusting for gender, childhood cognitive ability, education and
midlife socioeconomic status. In contrast, affective symptoms were
strongly, diffusely and independently associated with self-reported
Affective symptoms are more clearly associated with self-reported memory
problems in late midlife than with objectively measured cognitive
Cognitive impairment places older adults at increased risk of functional decline, injuries, and hospitalization. Assessments to determine whether older persons are still capable of meeting the cognitive challenges of everyday living are crucial to ensure their safe and independent living in the community. The present study aims to translate and validate the Chinese version of the Problems in Everyday Living (PEDL) test for use in Chinese population with mild cognitive impairment (MCI).
The cultural relevancy and content validity of the Chinese version of PEDL (C-PEDL) was evaluated by a seven-member expert panel. Forty patients with MCI and 40 cognitively healthy participants were recruited to examine the psychometric properties of C-PEDL.
Significant differences in the C-PEDL scores were found between the patients with MCI and the cognitively healthy controls in both educated (F = 9.96, p = 0.003) and illiterate (F = 10.43, p = 0.004) populations. The C-PEDL had excellent test-retest and inter-rater reliabilities, with intraclass correlation coefficient at 0.95 and 0.99 respectively. The internal consistency of C-PEDL was acceptable with Chronbach's α at 0.69. The C-PEDL had moderate correlation with the Mini-Mental State Examination (r = 0.45, p = 0.004) and the Category Verbal Fluency Test (r = 0.40, p = 0.012), and a moderate negative Spearman's correlation with the Global Deteriorating Scale (r = –0.42, p = 0.007).
The C-PEDL is a valid and reliable test for assessing the everyday problem-solving ability in Chinese older population with MCI.
Large scale, international clinical trials are formidable challenges, but they are the most effective means of answering important clinical questions in a definitive, generalizable manner. They require adequate funding and must be rigorously conducted. Much can be gleaned from such studies, which address the important research questions and provide answers to related questions. Such trials are enormously rewarding and are worth the expense and effort.