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I was asked by the Law and Economics Association of New Zealand to reflect tonight on my time as Chairman of the Commerce Commission (NZCC). I expect that the conference [...]

Background: There is increased awareness that, to minimize variation in clinician practice and improve quality, performance reporting should be implemented at the provider level. This optimizes physician engagement and creates a sense of professional responsibility for quality and performance measurement at the individual and organizational levels. Methods: Individual provider level reporting was implemented within a provincial health region involving 56 clinicians (general surgeons, surgical oncologists, urologists and pathologists). The 2 surgical pathology indicators chosen were colorectal cancer (CRC) lymph node retrieval rate and pT2 prostate cancer margin positivity rate. Surgical resections for all prostate and colorectal cancer performed between Jan. 1, 2011, and Mar. 30, 2012, were included. We used a pre- and postsurvey design to obtain physician perceptions and focus groups with program leadership to determine organizational impact. Results: Survey results showed that respondents felt the data provided in the reports were valid (67%), consistent with expectations (70%), maintained confidentiality (80%) and were not used in a punitive manner (77%). During the study period the pT2 prostate margin positivity rate decreased from 57.1% to 27.5%. For the CRC lymph node retrieval rate indicator, high baseline performance was maintained. Conclusion: We developed a robust process for providing physicians with confidential, individualized surgical and pathology quality indicator reports. Our results reinforce the importance of individual physician feedback as a strategy for improving and sustaining quality in surgical and diagnostic oncology. Contexte : On prend de plus en plus conscience que, pour minimiser la variation des pratiques medicales et en ameliorer la qualite, il faut instaurer la production de rapports de rendement des fournisseurs de soins. Cette demarche renforce l'engagement des medecins et cree un sentiment de responsabilite professionnelle a l'endroit du controle de la qualite et des evaluations de rendement a l'echelle individuelle et organisationnelle. Methodes : Une region sanitaire provinciale regroupant 56 medecins (chirurgiens generaux, chirurgiens oncologues, urologues et anatomopathologistes) a instaure la production de rapports individuels pour ses fournisseurs de soins. Les 2 indicateurs retenus dans le cas de l'anatomopathologie chirurgicale ont ete le taux d'ablation des ganglions lymphatiques dans le cancer colorectal (CCR) et le taux de positivite des marges dans le cancer de la prostate de stade pT2. Les resections chirurgicales pour tous les cancers de la prostate et colorectaux effectuees entre le 1er janvier 2011 et le 30 mars 2012 ont ete incluses. Nous avons utilise un prequestionnaire et un postquestionnaire pour obtenir la perception des medecins, et des groupes de discussion avec les responsables des programmes pour mesurer l'impact a l'echelle organisationnelle. Resultats: Selon les reponses aux questionnaires, les participants ont estime que les donnees fournies dans les rapports etaient valides (67%), conformes aux attentes (70%) et respectueuses de la confidentialite (80%), et n'avaient pas ete utilisees de maniere punitive (77%). Durant la periode de l'etude, le taux de positivite des marges du cancer de la prostate de stade pT2 est passe de 57,1% a 27,5%. Dans le cas de l'autre indicateur, le taux d'ablation des ganglions lymphatiques dans le CCR, on a maintenu le rendement de base eleve. Conclusion: Nous avons elabore une marche a suivre rigoureuse pour fournir aux medecins des rapports confidentiels et individuels concernant les indicateurs de qualite chirurgicaux et anatomopathologiques. Nos resultats rappellent l'importance d'une approche individuelle aupres des medecins comme strategie d'amelioration et de maintien de la qualite en oncologie chirurgicale et diagnostique., Clinical practice guidelines provide an evidence-based foundation for the delivery of high-quality patient care, monitoring of patient outcomes and minimizing the degree of variation in clinical practices. (1) As quality [...]

HAYDN'S TWO GREAT ORATORIOS, The Creation and The Seasons (Die Schopfung and Die Jahreszeiten) stand as monuments--on either side of the year 1800--to the Enlightenment and to the Austrian Enlightenment [...]

Cellular therapy for myocardial injury has improved ventricular function in both animal and clinical studies, though the mechanism of benefit is unclear. This study was undertaken to examine the effects of cellular injection after infarction on myocardial elasticity. Coronary artery ligation of Lewis rats was followed by direct injection of human mesenchymal stem cells (MSCs) into the acutely ischemic myocardium. Two weeks postinfarct, myocardial elasticity was mapped by atomic force microscopy. MSC-injected hearts near the infarct region were twofold stiffer than myocardium from noninfarcted animals but softer than myocardium from vehicle-treated infarcted animals. After 8 wk, the following variables were evaluated: MSC engraftment and left ventricular geometry by histological methods, cardiac function with a pressure-volume conductance catheter, myocardial fibrosis by Masson Trichrome staining, vascularity by immunohistochemistry, and apoptosis by TdT-mediated dUTP nick-end labeling assay. The human cells engrafted and expressed a cardiomyocyte protein but stopped short of full differentiation and did not stimulate significant angiogenesis. MSC-injected hearts showed significantly less fibrosis than controls, as well as less left ventricular dilation, reduced apoptosis, increased myocardial thickness, and preservation of systolic and diastolic cardiac function. In summary, MSC injection after myocardial infarction did not regenerate contracting cardiomyocytes but reduced the stiffness of the subsequent scar and attenuated postinfarction remodeling, preserving some cardiac function. Improving scarred heart muscle compliance could be a functional benefit of cellular cardiomyoplasty. cell transplantation; myocardial remodeling

Primary care is defined as a regular source of care characterised by continuity, comprehensiveness, co-ordination, availability and convenience (Donaldson et al 1996, Stewart et al 1997). Lack of such a [...]

This article outlines Richard Wagner's conception of music-drama during the period in which he formulated his intentions for composition of the epic Ring of the Nibelung. Attempting to renew rather titan to restore the communal, political nature of Attic tragedy, he wished to transform that model from celebration of the Athenian political order into a savage critique of the contemporary political order, indeed into an incitement to and celebration of revolution. Wagner was determined to restore the dignity of art, a dignity he believed to have been lost in the pursuit of base, commercial consideration; but this determination should not be confused with the idea of art for art's sake. Instead, he wished to renew art in a socialist, even communist, sense as the paradigm of free, productive activity. The direct revolutionary, experience of participation in the Dresden uprising of 1849 bolstered his conviction of the necessity, of such a transformation. With his magnum opus, Wagner wrote, he intended to 'make clear to the men of the Revolution the meaning of that Revolution, in its noblest sense'.

Point counts of diurnal birds of prey on Boulder, CO, grasslands were performed for three winters and summers and related to the landscape features of the count areas. Counts of the wintering raptors Bald Eagles, Ferruginous Hawks, Rough-legged Hawks and Prairie Falcons were observed to be negatively correlated with the degree of urban development in the area. Findings showed that urban grasslands can support most diurnal birds of prey as long as prey populations are present. However, some species are very susceptible to the degree of urbanization.

The effects of temperature and longitudinal stress on the phase delay of reference signals in a fiber-optic link are discussed. A feedback system that uses a fiber-optic phase modulator is used to compensate for the phase fluctuations of a reference signal in the link. The phase deviations of a 50-MHz reference frequency that are caused by temperature variations of the link is reduced by more than 95% on optimization of the correction system. The advantages of this technique are that the fiber-optic phase modulator has a greater stability compared with the electronic phase modulators, and signal conversions from electric to optic and optic to electric are avoided. Key words: Phase stabilization, standard frequency distribution, fiber-optic phase modulator.

Introduction: There are limited data characterizing the burden of HIV among men who have sex with men (MSM) in Malawi. Epidemiologic research and access to HIV prevention, treatment and care services have been traditionally limited in Malawi by criminalization and stigmatization of same‐sex practices. To inform the development of a comprehensive HIV prevention intervention for Malawian MSM, we conducted a community‐led assessment of HIV prevalence and correlates of infection. Methods: From April 2011 to March 2012, 338 MSM were enrolled in a cross‐sectional study in Blantyre, Malawi. Participants were recruited by respondent‐driven sampling methods (RDS), reaching 19 waves. Trained staff administered the socio‐behavioural survey and HIV and syphilis voluntary counselling and testing. Results: Crude HIV and syphilis prevalence estimates were 15.4% (RDS‐weighted 12.5%, 95% confidence interval (CI): 7.3–17.8) and 5.3% (RDS‐weighted 4.4%, 95% CI: 3.1–7.6), respectively. Ninety per cent (90.4%, unweighted) of HIV infections were reported as being previously undiagnosed. Participants were predominantly gay‐identified (60.8%) or bisexually identified (36.3%); 50.7% reported recent concurrent relationships. Approximately half reported consistent condom use (always or almost always) with casual male partners, and proportions were relatively uniform across partner types and genders. The prevalence of perceived and experienced stigma exceeded 20% for almost all variables, 11.4% ever experienced physical violence and 7% were ever raped. Current age >25 years (RDS‐weighted adjusted odds ratio (AOR) 3.9, 95% CI: 1.2–12.7), single marital status (RDS‐weighted AOR: 0.3; 95% CI: 0.1–0.8) and age of first sex with a man Conclusions: Results demonstrate that MSM represent an underserved, at‐risk population for HIV services in Malawi and merit comprehensive HIV prevention services. Results provide a number of priorities for research and prevention programmes for MSM, including providing access to and encouraging regular confidential HIV testing and counselling, and risk reduction counselling related to anal intercourse. Other targets include the provision of condoms and compatible lubricants, HIV prevention information, and HIV and sexually transmitted infection treatment and adherence support. Addressing multiple levels of HIV risk, including structural factors, may help to ensure that programmes have sufficient coverage to impact this HIV epidemic among MSM., Introduction Recent years have witnessed an increased awareness of the high burden of HIV among men who have sex with men (MSM) across the globe [1–3]. Emerging research suggests a [...]

Introduction: There are limited data characterizing the burden of HIV among men who have sex with men (MSM) in Malawi. Epidemiologic research and access to HIV prevention, treatment and care services have been traditionally limited in Malawi by criminalization and stigmatization of same-sex practices. To inform the development of a comprehensive HIV prevention intervention for Malawian MSM, we conducted a community-led assessment of HIV prevalence and correlates of infection. Methods: From April 2011 to March 2012, 338 MSM were enrolled in a cross-sectional study in Blantyre, Malawi. Participants were recruited by respondent-driven sampling methods (RDS), reaching 19 waves. Trained staff administered the socio- behavioural survey and HIV and syphilis voluntary counselling and testing. Results: Crude HIV and syphilis prevalence estimates were 15.4% (RDS-weighted 12.5%, 95% confidence interval (CI): 7.3- 17.8) and 5.3% (RDS-weighted 4.4%, 95% CI: 3.1-7.6), respectively. Ninety per cent (90.4%, unweighted) of HIV infections were reported as being previously undiagnosed. Participants were predominantly gay-identified (60.8%) or bisexually identified (36.3%); 50.7% reported recent concurrent relationships. Approximately half reported consistent condom use (always or almost always) with casual male partners, and proportions were relatively uniform across partner types and genders. The prevalence of perceived and experienced stigma exceeded 20% for almost all variables, 11.4% ever experienced physical violence and 7% were ever raped. Current age >25 years (RDS-weighted adjusted odds ratio (AOR) 3.9, 95% CI: 1.2- 12.7), single marital status (RDS-weighted AOR: 0.3; 95% CI: 0.1-0.8) and age of first sex with a man Conclusions: Results demonstrate that MSM represent an underserved, at-risk population for HIV services in Malawi and merit comprehensive HIV prevention services. Results provide a number of priorities for research and prevention programmes for MSM, including providing access to and encouraging regular confidential HIV testing and counselling, and risk reduction counselling related to anal intercourse. Other targets include the provision of condoms and compatible lubricants, HIV prevention information, and HIV and sexually transmitted infection treatment and adherence support. Addressing multiple levels of HIV risk, including structural factors, may help to ensure that programmes have sufficient coverage to impact this HIV epidemic among MSM. Keywords: HIV; men who have sex with men (MSM); behavioural risks; stigma; Malawi; prevention., Introduction Recent years have witnessed an increased awareness of the high burden of HIV among men who have sex with men (MSM) across the globe [1-3]. Emerging research suggests a [...]

The article discusses Arnold Schoenberg's path from 'Die Jakobsleiter' to 'Moses und Aron' with reference to his works of spoken drama 'Der biblische Weg'. The path which leads from the religious syncretism of 'Die Jakobsleiter' through Zionism in 'Der biblische Weg' to the negative monotheism in 'Moses und Aron' reveals his German, Lutheran and Judaist influences.

Recent articles have highlighted numerous additional functions of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) that are independent of its well-documented glycolytic function. One of the most intriguing of these functions is as an [...]

INTRODUCTION The monopoly problem is central to antitrust. Theoretically, the adverse consequences of monopolization are well understood.(1) However, the development of appropriate laws to deal with the monopoly problem has [...]

Notley, Margaret. Lateness and Brahms: Music and Culture in the Twilight of Viennese Liberalism. AMS Studies in Music. Oxford: Oxford University Press, 2007. Pp. 245, illus., tables, musical examples. doi: [...]