Evidentiary vacuum, epistemic communities and rare disease policymaking in India: an evolutionary policy perspective

There are divergent views among scholars and policymakers about the nature of permissible evidence for policymaking. It is often not feasible to construct a policy system exclusively based on objective research findings, particularly for rare diseases where conventionally accepted evidence remains a rarity. Evolutionary theories in such cases offer an overarching framework to represent the various heterodox understandings of what constitutes evidence and how evidence-based policies can be formulated under knowledge uncertainty. We conduct an empirical investigation of India’s rare disease policymaking endeavour in evolutionary perspective. The existing rare diseases policy architecture in India, in our view, reflects a ‘rationalistic’ framework. It intends to act only on ‘hard evidence’ to make, what may be called, an optimum decision, rather than initiating a ‘good enough’ policy decision based on existing (limited, soft) evidence and improving it incrementally through learning and trial-and-error. Our findings suggest that in the presence of ‘evidentiary vacuum’ and knowledge uncertainty, broadening the contours of epistemic communities, to include ‘lived experiences’ of the ‘lay’-stakeholders, can be effective in formulating an adaptive policy framework, which would ‘learn’ to better fit with the dynamic environment through inclusive deliberations, and trial-and-error.

Measuring Use of a Distance Library Service

<p>As libraries strive and stride with new electronic resources and online services, providing at point of need and demonstrating value, it is necessary to build more comprehensive understanding of how changes might be impacting use of services and explore what this can tell us about library users. This research investigates use of a distance library service using the University of Otago Library in Dunedin, New Zealand as a case study. It examines the hard evidence of use of the service represented by requests received and processed by the Distance Library staff between 2007 and 2012. The analysis is made in light of growth in distance learning, advancing information and communications technology and escalation of resources being made available online. The study employs a retrospective quantitative approach and incorporates an analysis of qualification type, field of study and institution of requesters to provide a richer picture for the investigation. Results of the study provide information about the use of the Distance Library Service and its users revealing trends over time. Research implications of this investigation include better understanding of our information services and our users. Lessons learned from this study can help inform decision-making for future services, training of staff and comparison with other libraries.</p>

Measuring Use of a Distance Library Service

<p>As libraries strive and stride with new electronic resources and online services, providing at point of need and demonstrating value, it is necessary to build more comprehensive understanding of how changes might be impacting use of services and explore what this can tell us about library users. This research investigates use of a distance library service using the University of Otago Library in Dunedin, New Zealand as a case study. It examines the hard evidence of use of the service represented by requests received and processed by the Distance Library staff between 2007 and 2012. The analysis is made in light of growth in distance learning, advancing information and communications technology and escalation of resources being made available online. The study employs a retrospective quantitative approach and incorporates an analysis of qualification type, field of study and institution of requesters to provide a richer picture for the investigation. Results of the study provide information about the use of the Distance Library Service and its users revealing trends over time. Research implications of this investigation include better understanding of our information services and our users. Lessons learned from this study can help inform decision-making for future services, training of staff and comparison with other libraries.</p>

Cave Art and the Evolution of the Human Mind

<p>The discovery of cave paintings made by our Upper Paleolithic ancestors in Western Europe was an astonishing find – so astonishing, that they were originally believed to have been fakes. However, as more sites were uncovered, their authenticity was confirmed. But how could these people, who at the time of the discovery were believed to be merely dumb brutes, create such beautiful and naturalistic representations? And an even more difficult question to answer was, why? In this thesis I examine the phenomenon of Paleolithic cave art and what it might be able to tell us about the minds of the Cro-Magnon artists who produced it. I survey the paintings that have so far been discovered, as well as the processes involved in creating them. I also discuss and critique a selection of the many theories that have attempted to explain the motivation behind this radically different type of human behaviour. But due to the lack of hard evidence, none of these theories are ever likely to be fully substantiated. So a more promising line of investigation I take is to appraise the cognitive abilities Cro-Magnons would have needed to produce the paintings – and this then allows me to consider whether cave art was indicating any new cognitive development. I therefore highlight one of the effects that creating cave paintings had: it allowed information from the brain to be stored in the environment. But the manner in which this form of epistemic engineering might enhance human cognition is a hotly debated subject. I examine two theories: the extended mind hypothesis, and the theory of niche construction. In concluding this thesis, I argue that cave art seems more like an example of epistemic niche construction than a constituent of an extended mind.</p>

Cave Art and the Evolution of the Human Mind

<p>The discovery of cave paintings made by our Upper Paleolithic ancestors in Western Europe was an astonishing find – so astonishing, that they were originally believed to have been fakes. However, as more sites were uncovered, their authenticity was confirmed. But how could these people, who at the time of the discovery were believed to be merely dumb brutes, create such beautiful and naturalistic representations? And an even more difficult question to answer was, why? In this thesis I examine the phenomenon of Paleolithic cave art and what it might be able to tell us about the minds of the Cro-Magnon artists who produced it. I survey the paintings that have so far been discovered, as well as the processes involved in creating them. I also discuss and critique a selection of the many theories that have attempted to explain the motivation behind this radically different type of human behaviour. But due to the lack of hard evidence, none of these theories are ever likely to be fully substantiated. So a more promising line of investigation I take is to appraise the cognitive abilities Cro-Magnons would have needed to produce the paintings – and this then allows me to consider whether cave art was indicating any new cognitive development. I therefore highlight one of the effects that creating cave paintings had: it allowed information from the brain to be stored in the environment. But the manner in which this form of epistemic engineering might enhance human cognition is a hotly debated subject. I examine two theories: the extended mind hypothesis, and the theory of niche construction. In concluding this thesis, I argue that cave art seems more like an example of epistemic niche construction than a constituent of an extended mind.</p>

SP1.1.12Post laparotomy rectal sheath catheter analgesia, systematic review

Midline laparotomy is still performed in high proportion of patients during elective and emergency procedures. Effective analgesia is essential for enhanced recovery programs especially with the focus of multi-modal opioid sparing analgesia with its benefits in reducing opiate related side effects. Many centres adopted the use of rectal sheath catheters (RSC) in all patients undergoing laparotomy, yet its use not been standardised as there is no hard evidence supporting its use. We aim from this systematic review to explore the effectiveness of RSC in post laparotomy analgesia and to compare between different techniques of insertion. We performed a systematic review in accordance with PRISMA standards. Search of electronic information data base (Medline, Embase, Cochrane, Library, Dynamed). Results (45) studies reviewed. (33) included with (1326) patients. Conclusion There is lack of high level evidence investigating RSC rule in post laparotomy analgesia, nonetheless which is the most effective technique (USS vs surgically inserted), in spite of large heterogeneity in methodology and scarcity of trials; the consensus of the reviewed studies concluded that it decreases opiates requirements by at least (70%) in patients receiving PCA and as good as ED but with less side effects.

Top incomes in South Africa in the twentieth century

There have been important studies of recent income inequality and of poverty in South Africa, but very little is known about the long-run trends over time. There is speculation about the extent of inequality when the Union of South Africa was formed in 1910, but no hard evidence. In this paper, we provide evidence that is partial—being confined to top incomes—but which for the first time shows how the income distribution changed on a (near) annual basis from 1913 onwards. We present estimates of the shares in total income of groups such as the top 1% and the top 0.1%, covering the period from colonial times to the twenty-first century. For a number of years during the apartheid period, we have data classified by race. The estimates for recent years bear out the picture of South Africa as a highly unequal country, but allow this to be placed in historical and international context. The time series presented here will, we hope, provide the basis for detailed investigation of the impact of South African institutions and policies, past and present. But the similarity of the changes over time in top incomes across the four ex-dominions suggests that national developments have to be seen in the light of common global forces.

Blame avoidance, scapegoats and spin: Why Dutch politicians won’t evaluate ZBO-outcomes

Despite high expectations about the results of agencification and a legal obligation to evaluate executive agencies, ministers and MPs seem not very interested in evaluating agencies’ results. Hood’s theory on blame avoidance is used to explain the lack of evaluation in the case of the Dutch ZBOs. Only one in seven ZBOs is evaluated as frequently as mandated. Findings show that ZBO evaluations are more an administrative than a political process. Reports do not offer hard evidence and are seldom used in parliamentary debates. There are no clear patterns as to which ZBOs are evaluated more, or less, often.

Congenital erythrocytosis – A condition behind recurrent thromboses: A case report and literature review

Congenital erythrocytosis (CE) is an extremely rare disease and an infrequent cause of heamoglobin and haematocrit elevation. Genetic testing of CE is not widely available. Patients in whom a cause of erythrocytosis is not identified are classified as idiopathic erythrocytosis (IE) patients. In some types of CE thrombotic events have been reported but there is little hard evidence to advise on management in asymptomatic patients. Similarly is true for patients with IE. We describe a young patient who suffered several thromboembolic complications before the diagnosis of CE type 4 was established.

A Traditional Scientific Perspective on the Integrated Information Theory of Consciousness

This paper assesses two different theories for explaining consciousness, a phenomenon that is widely considered amenable to scientific investigation despite its puzzling subjective aspects. I focus on Integrated Information Theory (IIT), which says that consciousness is integrated information (as ϕMax) and says even simple systems with interacting parts possess some consciousness. First, I evaluate IIT on its own merits. Second, I compare it to a more traditionally derived theory called Neurobiological Naturalism (NN), which says consciousness is an evolved, emergent feature of complex brains. Comparing these theories is informative because it reveals strengths and weaknesses of each, thereby suggesting better ways to study consciousness in the future. IIT’s strengths are the reasonable axioms at its core; its strong logic and mathematical formalism; its creative “experience-first” approach to studying consciousness; the way it avoids the mind-body (“hard”) problem; its consistency with evolutionary theory; and its many scientifically testable predictions. The potential weakness of IIT is that it contains stretches of logic-based reasoning that were not checked against hard evidence when the theory was being constructed, whereas scientific arguments require such supporting evidence to keep the reasoning on course. This is less of a concern for the other theory, NN, because it incorporated evidence much earlier in its construction process. NN is a less mature theory than IIT, less formalized and quantitative, and less well tested. However, it has identified its own neural correlates of consciousness (NCC) and offers a roadmap through which these NNCs may answer the questions of consciousness using the hypothesize-test-hypothesize-test steps of the scientific method.