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Summary Numerous studies are published on the benefits of electric hand dryers vs paper towels (PT) for drying hands after washing. Data are conflicting and lacking key variables needed to assess infection risks. We provide a rapid scoping review on hand‐drying methods relative to hygiene and health risks. Controlled vocabulary terms and keywords were used to search PubMed (1946–2018) and Embase (1947–2018). Multiple researchers independently screened abstracts for relevance using predetermined criteria and created a quality assessment scoring system for relative study comparisons. Of 293 papers, 23 were included in the final analysis. Five studies did not compare multiple methods; however, 2 generally favoured electric dryers (ED); 7 preferred PT; and 9 had mixed or statistically insignificant results (among these, 3 contained scenarios favourable to ED, 4 had results supporting PT, and the remaining studies had broadly conflicting results). Results were mixed among and within studies and many lacked consistent design or statistical analysis. The breadth of data does not favour one method as being more hygienic. However, some authors extended generalizable recommendations without sufficient scientific evidence. The use of tools in quantitative microbial risk assessment is suggested to evaluate health exposure potentials and risks relative to hand‐drying methods. We found no data to support any human health claims associated with hand‐drying methods. Inconclusive and conflicting results represent data gaps preventing the advancement of hand‐drying policy or practice recommendations.

During the colonial era, the French colonial government in Canada experimented with paper money printed on the back of playing cards. The first experiment lasted from 1685 to 1719. In the first years, there was little inflation in spite of a rapidly expanding stock of playing card money. It is only in the later years of the experiment that prices rose. The behavior of the money stock and nominal output suggest that velocity fluctuated throughout the period. We argue here that these fluctuations can be explained by variations in the enforcement of legal tender laws. This interpretation provides insights into the debate over the inflationary impact of paper money in the colonial United States.

Immunoassays and high-performance liquid chromatography (HPLC) coupled with mass spectrometry (MS) are both widely used methods for drug screening in toxicology. We investigated an alternative approach for rapid drug screening: paper spray MS (PS-MS). In paper spray, the biofluid sample is spotted onto a paper substrate. Upon application of a spray solvent and an electric potential, extraction and ionization occur directly from the paper without any need for additional sample preparation. We developed two paper spray high-resolution MS/MS targeted drug screening assays using a quadrupole-orbitrap mass spectrometer, one the positive ion mode and one in the negative ion mode. In the positive ion mode, over 130 drugs and drug metabolites were semi-quantitatively screened at sub-toxic concentrations in a single 2.5 min analysis. Limits of detection and calibration performances for each target compound are reported. The PS-MS/MS assay was tested on authentic postmortem specimens, and its screening ability and semi-quantitative performance were evaluated against independent LC-MS-MS screening and confirmation assays with good agreement. The paper spray MS/MS showed good qualitative agreement with LC-MS-MS; the true positive rate of paper spray MS/MS was 92%, and the true negative rate was over 98%. The quantitative results between the two methods were also acceptable for a screening application; Passing-Bablok regression yielded a slope of 1.17 and a Pearson's correlation coefficient of 0.996. A separate PS-MS/MS negative ion screening method was also developed for a small panel of barbiturates and structural analogs, demonstrating its potential for acidic drug detection and screening.

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility; however, whether women with PCOS and spontaneous or drug-induced ovulatory cycles have the same reproductive potential as non-PCOS controls is a matter of debate. In the present opinion paper, the author takes the opportunity to summarize the collective evidence supporting the hypothesis of reduced fertility potential in women with PCOS, regardless of ovulatory status, and speculate that reduced reproductive potential may be caused by altered oocytes, embryo and endometrial competence, and infertility-related co-morbidities as well as an increased risk of pregnancy complications.

International audience; Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper on acute cardiovascular care organisation, using a multinational working group. The patient population has changed, and intensive cardiovascular care units now manage a large range of conditions from those simply requiring specialised monitoring, to critical cardiovascular diseases with associated multi-organ failure. To describe better intensive cardiovascular care units case mix, acuity of care has been divided into three levels, and then defining intensive cardiovascular care unit functional organisation. For each level of intensive cardiovascular care unit, this document presents the aims of the units, the recommended management structure, the optimal number of staff, the need for specially trained cardiologists and cardiovascular nurses, the desired equipment and architecture, and the interaction with other departments in the hospital and other intensive cardiovascular care units in the region/area. This update emphasises cardiologist training, referring to the recently updated Acute Cardiovascular Care Association core curriculum on acute cardiovascular care. The training of nurses in acute cardiovascular care is additionally addressed. Intensive cardiovascular care unit expertise is not limited to within the unit's geographical boundaries, extending to different specialties and subspecialties of cardiology and other specialties in order to optimally manage the wide scope of acute cardiovascular conditions in frequently highly complex patients. This position paper therefore addresses the need for the inclusion of acute cardiac care and intensive cardiovascular care units within a hospital network, linking university medical centres, large community hospitals, and smaller hospitals with more limited capabilities.

Position Paper transmitted to EU27 on intellectual property rights (including geographical indications), 6 September 2017, available at https://ec.europa.eu/commission/sites/beta-political/files/position-paper-intellectual-property-rights_en.pdf / The EU27 Position Paper on Intellectual Property sets out the EU Member States’ starting position in relation to pre-existing IP rights as part of the Brexit negotiations.

Objective Our aim was to develop an efficient search strategy for prognostic studies and clinical prediction guides (CPGs), optimally balancing sensitivity and precision while independent of MeSH terms, as relying on them may miss the most current literature. Materials and Methods We combined 2 Hedges-based search strategies, modified to remove MeSH terms for overall prognostic studies and CPGs, and ran the search on 269 journals. We read abstracts from a random subset of retrieved references until ≥ 20 per journal were reviewed and classified them as positive when fulfilling standardized quality criteria, thereby assembling a standard dataset used to calibrate the search strategy. We determined performance characteristics of our new search strategy against the Hedges standard and performance characteristics of published search strategies against the standard dataset. Results Our search strategy retrieved 16 089 references from 269 journals during our study period. One hundred fifty-four journals yielded ≥ 20 references and ≥ 1 prognostic study or CPG. Against the Hedges standard, the new search strategy had sensitivity/specificity/precision/accuracy of 84%/80%/2%/80%, respectively. Existing published strategies tested against our standard dataset had sensitivities of 36%–94% and precision of 5%–10%. Discussion We developed a new search strategy to identify overall prognosis studies and CPGs independent of MeSH terms. These studies are important for medical decision-making, as they identify specific populations and individuals who may benefit from interventions. Conclusion Our results may benefit literature surveillance and clinical guideline efforts, as our search strategy performs as well as published search strategies while capturing literature at the time of publication.

The use of reliable, valid measures in implementation practice will remain limited without pragmatic measures. Previous research identified the need for pragmatic measures, though the characteristic identification used only expert opinion and literature review. Our team completed four studies to develop a stakeholder-driven pragmatic rating criteria for implementation measures. We published Studies 1 (identifying dimensions of the pragmatic construct) and 2 (clarifying the internal structure) that engaged stakeholders—participants in mental health provider and implementation settings—to identify 17 terms/phrases across four categories: Useful, Compatible, Acceptable, and Easy. This paper presents Studies 3 and 4: a Delphi to ascertain stakeholder-prioritized dimensions within a mental health context, and a pilot study applying the rating criteria. Stakeholders (N = 26) participated in a Delphi and rated the relevance of 17 terms/phrases to the pragmatic construct. The investigator team further defined and shortened the list, which were piloted with 60 implementation measures. The Delphi confirmed the importance of all pragmatic criteria, but provided little guidance on relative importance. The investigators removed or combined terms/phrases to obtain 11 criteria. The 6-point rating system assigned to each criterion demonstrated sufficient variability across items. The grey literature did not add critical information. This work produced the first stakeholder-driven rating criteria to assess whether measures are pragmatic. The Psychometric and Pragmatic Evidence Rating Scale (PAPERS) combines the pragmatic criteria with psychometric rating criteria, from previous work. Use of PAPERS can inform development of implementation measures and to assess the quality of existing measures.

This essay, which is part of a larger book project, reflects my interest in rethinking concepts of Black modernity and speculating on its possible manifestations in different forms at different historical moments. Specifically, I posit the emergence of an urban Black modernity in US northern cities during the antebellum era. I begin by mapping a literary history of urban modernity in periodical culture over a span of 150 years. I examine its origins in Richard Steele’s Tatler (1709–11) and Joseph Addison and Steele’s Spectator (1711–12), which detail the rise of modern London and its new middle-class subjects, whose conspicuous consumption demanded the regulation of taste, deemed a crucial marker of modernity. This urban modernity is then reconfigured across the Atlantic in New York, specifically in Washington Irving’s Letters of Jonathan Oldstyle, Gent (1802) and Salmagundi (1807–08), which anatomize the behaviors of New York’s social elite. I then elucidate how a group of Black New York correspondents to Frederick Douglass’ Paper (1852–55)—notably James McCune Smith, William J. Wilson, and Philip Bell—take up and repurpose such representations of urban modernity to define the taste of the city’s Black urbanites and meet their intellectual, social, and political needs at mid-century.

Osler demonstrated two cultures in his practice, in accordance with the conventions of his time: humanity and science. He was aware that ill health is best managed by one who is both ‘a scientist and a humanist in one’. (This was the title of seminars that took place at 13 Norham Gardens Oxford, his former home, to celebrate the Osler centenary. See figure 1.) In terms of humanity, his friendliness was itself therapeutic. As for science, his accurate observations of symptoms in the living, and of signs in both the living and dead, were more numerous. well described and analysed than ever before. Those who state nowadays that there are two separate cultures that do not speak to each other should recall Osler’s last communication to be published in the British Medical Journal: ‘The old humanities and the new science’.1 Here, he complained himself that the culture of humanities in Oxford, while embracing the philosophy of ancient Greeks, was giving too little attention to their contributions to science. Later, CP Snow2 and others such as the American philanthropist John McGovern3 discussed how these two cultures should both be embraced by practicing physicians I will reinterpret these as the ‘attitude of care’ and the ‘technology of care’. Osler was the greatest exponent of both in his time, deserving the claim that he was both a bringer of cheer and a scientist in what he brought to the bedside, rather more than most of his contemporaries. Figure 1 13 Norham Gardens, built in 1870. Much has been written about Osler the clinician and it is no longer easy to find something new to say. One such attempt was in a recent article by a contemporary student of ethics and his supervisor in Melbourne, Fiddes and Komesaroff was entitled ‘An emperor …

The European Social Charter has recently received increased attention due to the evolution of its monitoring mechanism and the need to address a multitude of contemporary challenges to socio-economic rights. Although the treaty’s preamble has played a crucial role in the interpretation of substantive provisions and in shaping state obligations, little attention has been paid to the way in which the preamble has defined the fundamental lines of the ‘jurisprudence’ of the Charter’s monitoring body. The European Committee of Social Rights has deduced from the Charter’s preamble several important general principles for the protection of socio-economic rights, on which it grounds its interpretation. This article analyses these principles and evaluates their effects in the relevant practice. The findings suggest that the Charter’s preamble serves different purposes and performs multiple functions in international law, thus challenging the common assumption that human rights treaty preambles are empty phrases of a merely ceremonial nature.

William Osler wrote more than a dozen books and over 750 articles in his lifetime, but one book and one article are by far the best known. ‘Principles and Practice of Medicine’ was published in 1892 and was a huge success. It went through 17 editions and established a model for textbooks of general medicine to the present day. The enduring fame of his short piece entitled ‘Aequanimitas’,1 composed 3 years earlier, might have surprised him more. It was the transcript of an address he gave to new medical graduates at the University of Pennsylvania. It also served as his farewell lecture before he departed to become chief of staff at Johns Hopkins Hospital. Reading it now, it seems in some ways very much from a bygone age. Osler assumes, for example, that every member of his audience will have a comfortable familiarity with classical literature, the Bible and Shakespeare. The first paragraph alone contains at least five references to the classics, including the tale of Er the Pamphylian from Plato’s Republic. Later, he reminds his audience that the word ‘aequanimitas’ (‘equanimity’) was used by the benign Roman emperor Antoninus Pius on his deathbed, as his choice of the day’s military password. He would have taken it for granted that all his students knew the word meant ‘calmness of soul’, from the Latin words ‘aequus’ and ‘animus’. It is not a style that would appeal to many new medical graduates today. The first three pages do not mention equanimity at all but cover a related quality, imperturbability. His approach is striking because of his insistence that imperturbability is largely a physical endowment, or in other words genetic. According to Osler, you either have it or you do not. …

The Welsh Government has recently published a White Paper which sets out the key elements of the forthcoming Sustainable Development Bill. It is a significant stepping stone in incorporating sustainable development into dedicated primary legislation, and, in a wider sense, providing a governance framework for making strategic decisions on the part of the Welsh Government and the Welsh public service organisations. This article observes that the Welsh Government is diverting away from a meaning of sustainable development which emphasises the environmental pillar. The focus of the White Paper is to provide a framework for the exercise of discretion by public service organisations in order to increase the chances of mainstreaming sustainable development.

Background In the professional literature and among our professional societies, female sexual dysfunction nomenclature and diagnostic criterion sets have been the source of considerable controversy. Recently, a consensus group, supported by the International Society for Women’s Sexual Health, published its recommendations for nosology and nomenclature, which included only one type of arousal dysfunction, female genital arousal disorder, in its classification system. Subjective arousal was considered an aspect of sexual desire and not part of the arousal phase. Aim To advocate for the importance of including subjective arousal disorder in the diagnostic nomenclature in addition to the genital arousal subtype. Methods We reviewed how the construct of subjective arousal was included in or eliminated from the iterations of various diagnostic and statistical manuals. The Female Sexual Function Index (FSFI) was used to examine the relations among subjective arousal, genital arousal, and desire in women with and without sexual arousal concerns. Main Outcome Measures Sexual arousal through a self-report Film Scale, physiologic sexual arousal through vaginal photoplethysmography in response to an erotic film, and the FSFI. Results The clinical literature and experience support differentiating subjective arousal from desire and genital arousal. Correlations between the FSFI domains representing desire and subjective arousal, although sufficient to suggest relatedness, share approximately 58% of the variance between constructs—a lower shared variance than FSFI domains representing subjective arousal and orgasm. Similarly, when looking at FSFI individual items best representative of sexual desire and subjective arousal, the large majority of the variance in subjective arousal was unexplained by desire. A third line of evidence showed no significant difference in levels of subjective arousal to erotic films between sexually functional women and women with desire problems. If desire and subjective arousal were the same construct, then one would expect to see evidence of low subjective arousal in women with low sexual desire. Clinical Implications Optimized treatment efficacy requires differentiating mental and physical factors that contribute to female sexual dysfunction. Strengths and Limitations Support for our conclusion is based on clinical qualitative evidence and quantitative evidence. However, the quantitative support is from only one laboratory at this time. Conclusion These findings strongly support the view that female sexual arousal disorder includes a subjective arousal subtype and that subjective arousal and desire are related but not similar constructs. We advocate for the relevance of maintaining subjective arousal disorder in the diagnostic nomenclature and present several lines of evidence to support this contention. Althof SE, Meston CM, Perelman M, et al. Opinion Paper: On the Diagnosis/Classification of Sexual Arousal Concerns in Women. J Sex Med 2017;14:1365–1371.

With the growing availability of images of printed books online, it is increasingly possible to trace the use of specific printing types and design features across a wide range of publications to reveal new information about the trade. While instantly distinctive decorative initials or elaborate woodcuts might be the most obviously traceable elements, studies of more pervasive and less distinctive types can also reveal significant evidence about the careers, connections, and working practices of Elizabethan printers. This study concerns two of these: the fleuron and the blank printed stave, neither of which have received attention from more than the occasional scholar. These elements are used to clarify questions of chronology, to explore the diverse functions served by seemingly decorative elements of page design, to reveal new information concerning the career of the Elizabethan printer Thomas East, and to highlight the relationship between the music trade and the wider printing industry, neither of which can be treated in isolation.

Authors, readers, and editors share a common focus. Authors want to publish their work. Readers want to see high-quality, new information. Referees and editors serve to ensure that authors provide valid conclusions based on the quality of information that readers want.Common to each of these roles are instructions to authors. However, these are typically written in an uninspiring, legalistic style, as if they are a set of rules that authors must obey if they expect to get published. This renders the instructions boring and oppressive, if not forbidding. Yet they need not be so, if they are set in context.Instructions to authors can be cast in a way as to reflect common purpose. They can remind authors what perceptive readers want to see in a paper and, thereby, prompt authors to include all necessary information. If cast in this way, instructions to authors are not a set of rules by which to satisfy publishers; they become guidelines for the etiquette of communication between authors and their readers.Against this background, the present article has been composed to serve several purposes. Foremost, it amplifies instructions to authors beyond the conventional technicalities such as headings, layout, font size, and line spacing. It prescribes the type of information that should be communicated and explains the reasons for those recommendations. Doing so not only informs authors about what to write, but also informs readers and referees about what to look for in a good paper. Secondarily, the article publicizes examples of errors and deficiencies of manuscripts submitted to the Journal in the past that have delayed their acceptance and publication, which could have been avoided had the forthcoming recommendations been followed. The recommendations also reprise the elements taught in courses conducted by the Spine Intervention Society in their extended program on evidence-based medicine. Doing so underscores that instructions for authors are not a procedural technicality but a way to ensure that what authors write, what readers read, and what the Journal publishes comply with contemporary precepts of good evidence.Some 20 years ago, the Journal of the American Medical Association published a comprehensive series of articles with a common title: "Users' Guides to the Medical Literature" [1,2]. These articles focused on the science of statistical tests and critical appraisal, and their importance for properly understanding the literature. The present article differs in that it does not presume to teach technicalities. Instead, it describes and explains, step by step, the critical components of an article, what authors should include, and what readers should look for, so that the Journal can ensure that consistent, high-quality information is shared between its authors and readers.The present article focuses on articles concerning treatment of pain, largely because this type of article is more commonly submitted than articles on reliability or validity of diagnostic procedures. Although the present article principally focuses on papers for the Spine Section of the Journal, the same principles, appropriately adapted, serve for other sections.

The Territorial Papers of the United States are a valuable and underused resource containing almost 10,000 documents written between 1789 and 1848 about the formation of new sovereign states from US territory. These communications between the federal government and frontier settlers comprise the actual discourse of the nation’s expansion over six decades. Digitizing the Territorial Papers permits the possibility of analyzing the entire corpus globally. Text mining and topic modeling methods give us a lens on the language patterns through which new state governments and the expanding nation were formed. An initial statistical analysis of the textual information provides a visualization of content, helps discern how ideals about governance emerged, and lays the foundation for developing more sophisticated hypotheses and theoretical constructs.

Although gender mainstreaming has been long recognized as a strategy for addressing gender inequalities and associated negative health outcomes; its implementation has remained a challenge, even in the area of prevention of mother to child transmission of HIV (PMTCT). Despite recognition of gender in Tanzania’s political arena and prioritization of PMTCT by the health sector, there is very little information on how well gender has been mainstreamed into National PMTCT guidelines and organizational practices at service delivery level. Using a case study methodology, we combined document review with key informant interviews to assess gender mainstreaming in PMTCT on paper and in practice in Tanzania. We reviewed PMTCT policy/strategy documents using the WHO’s Gender Responsive Assessment Scale (GRAS). The scale differentiates between level 1 (gender unequal), 2 (gender blind), 3 (gender sensitive), 4 (gender specific), and 5 (gender transformative). Key informant interviews were also conducted with 26 leaders purposively sampled from three government health facilities in Mwanza city to understand their practices. The gender responsiveness of PMTCT policy/strategy documents varies, with some being at GRAS level 3 (gender sensitive) and others at GRAS level 4 (gender specific). Those which are gender sensitive indicate gender awareness, but no remedial action is developed; while those which are gender specific go beyond indicating how gender may hinder PMTCT to highlighting remedial measures, such as the promotion of couple counselling and testing for HIV. In addition, interviews on organizational processes and practices suggested that there has been little attention to the holistic integration of gender in the delivery of PMTCT services. The study has revealed limited integration of gender concerns in PMTCT policy documents. Similarly, health facility leader responses indicate perspectives and practices that pay little attention to the holistic integration of gender in the delivery PMTCT services.

In this note we show how the policy proposals contained in the government's Green Paper on pensions (DSS, 1998) affect the long term sustainability of the UK's public finances and redistribution between current and future generations. Using the methodology of generational accounting we show that the proposals in the Green Paper will marginally increase the tax rise needed to ensure intertemporal solvency, and slightly worsen generational imbalances. The effect of implied changes in National Insurance Contributions, and the fiscal and generational implications of fully funding the proposed State Second Pension, are also discussed. One of the main tasks of a Welfare State is to guarantee an adequate standard of living in old age. In the United Kingdom the events of the 1980s and 1990s, namely, the decision to index benefits to prices and the various reforms to the State Earnings-Related Pension Scheme (SERPS), have ultimately paved the way for a problem of poverty in retirement (Atkinson, 1994). With the release of the Green Paper A New Contract for Welfare: Partnership in Pensions (DSS, 1998), the government has revealed its plans to reform the system of transfers to pensioners and avoid this problem. The measures in the Green Paper can be considered from a number of different angles: for example, how will they affect saving behaviour? to what extent do they redistribute between rich and poor? In this note we consider the fiscal and generational effects of the reforms: how do they affect the longterm sustainability of the public finances and intergenerational redistribution.