Search

Donor Advised Funds (DAFs) are the fastest growing destination for charitable giving, and subject to vigorous debate over whether they should be more tightly regulated. Virtually all of the research on DAFs and the arguments for increased regulation emanate from the US. This article compares regulation in Canada and Australia with the US to demonstrate how different regimes lead to different uses of DAFs and different ‘market’ configurations. The conceptual framework presents three motivational scenarios for their use: as pseudo foundations, tax savings and protection of privacy. The differential effects of regulation on these donor scenarios explains why total DAF assets in Australia are proportionately much lower than its North American counterparts, mainly because its regime is not skewed as heavily toward the tax savings motivated donor. The findings raise serious questions as to whether DAFs have actually democratized philanthropy, as is so often claimed. In terms of policy change, all three countries have experienced policy drift, although for different reasons. However, COVID-19 pandemic may have created new windows of opportunity for regulatory reform.

Objective: To provide input to Australian and New Zealand government decision making regarding an optimal strategy to reduce the rate of neural tube defects (NTD).Design: Standard comparative health economic evaluation techniques were employed for a set of intervention options for promoting folate/folic acid consumption in women capable of or planning a pregnancy. Evidence of effectiveness was informed by the international literature and costs were derived for Australia and New Zealand.Results: Population-wide campaigns to promote supplement use and mandatory fortification were the most effective at reducing NTD, at an estimated 36 and 31 fewer cases per annum respectively for Australia and New Zealand, representing an 8 % reduction in the current annual NTD rate. Population-wide and targeted approaches to increase supplement use were cost-effective, at less than $AU 12,500 per disability-adjusted life year (DALY) averted ($US 9893, pound 5074), as was extending voluntary fortification. Mandatory fortification was not cost-effective for New Zealand at $AU 138,500 per DALY ($US 109 609, pound 56,216), with results uncertain for Australia, given widely varying cost estimates. Promoting a folate-rich diet was least cost-effective, with benefits restricted to impact on NTD.Conclusions: Several options for reducing NTD appear to fall well within accepted societal cost-effectiveness norms. All estimates are subject to considerable uncertainty, exacerbated by possible interactions between interventions, including impacts on currently effective strategies. The Australian and New Zealand governments have decided to proceed with mandatory fortification; it is hoped they will support a rigorous evaluation which will contribute to the evidence base. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate 1) barriers to clinical guideline use and 2) the relationship between guideline use and inpatient outcomes in chronic obstructive pulmonary disease (COPD). Methods: 1) Four focus groups of specific health professions (n = 30), from three metropolitan hospitals, and interview of 99 medical officers (MOs), linked to 349 admissions, both guided by behavioural modelling theory; 2) association between guideline use and patient outcomes (length of hospital stay ≥ 14 days, and readmission within 28 or 90 days) was evaluated in a cohort of 405 COPD patients. Results: 1) In focus groups, nurses and allied health professionals emphasized facilitation issues including paperwork duplication and time limitations as barriers, but considered improved patient care outcomes as the major guideline use determinant. There were similar findings in junior MOs (nonconsultants) by both focus group and interview, with the addition of a need for a sense of ownership. Senior MOs (consultants) greatly emphasized sense of ownership. Barriers to guideline use varied between types of units. Behavioural modelling explained 49% of the variation in intention to use the guideline for MOs. For nonconsultants, habit and intention were significantly associated with extent of guideline use. 2) Patient outcomes: guideline use was not associated with length of stay or readmission. Conclusions : 1) Guideline implementation should address issues relevant to different health professions, units and seniority of profession. 2) Guideline use was not associated with reductions in readmission or length of stay. [ABSTRACT FROM AUTHOR]

A study of the histology of early acne lesions before and during treatment with isotretinoin showed gross atrophy of sebaceous glands in the affected skin within 4 weeks of commencing therapy. However, the morphology, cytology and intensity of the inflammatory reaction in individual early acne papules did not seem to be altered by therapy. This suggests that isotretinoin is exerting its influence on the intitiating events of acne, rather than acting as an anti-inflammatory agent. The gross atrophy of even those sebaceous glands in close proximity to inflammatory lesions during therapy may indicate that sebum or its break-down products are not necessarily the major components of the comedone responsible for initiating the inflammation in acne. [ABSTRACT FROM AUTHOR]

Twenty-three patients with severe longstanding discoid lupus erythematosus, unresponsive to conventional treatments, were treated with oral gold in a multicentre open study. Nineteen patients showed clinical improvement and in four of these there was complete resolution of lesions. Adverse reactions were generally mild and self limiting. [ABSTRACT FROM AUTHOR]

When an epidermoid cyst ruptures, a granulomatous infiltrate develops around the damaged structure. The same is true when other horn-containing cysts release their Content into the epidermis. A similar type of inflammation may be observed in the dermis around disrupted and horn-filled follicles in acne vulgaris. In this paper we describe experiments in which a granulomatous inflammation has been produced in guinea-pig skin by the intracutaneous implantation of stratum corneum and discuss the potential of this system as a model for the inflammation in acne. [ABSTRACT FROM AUTHOR]

In this investigation, tour non-invasive techniques were used to assess skin tumors. In particular a study was made to determine whether the malignant nature of a skin lesion could be obtained from these methods. Point thermometry using a thermocouple sensor did not yield any useful information. Skin blood flow measurements using the laser Doppler technique were statistically significantly higher in malignant compared to benign lesions. Ultrasound Doppler assessment of deeper dermal blood flow was also used and gave only one false-negative and three false-positive readings when arbitrary threshold values were used in the detection of malignancy. In 24 patients with malignant melanoma there was a significant positive correlation between the value for dermal expansion obtained by ultrasound. A-scan measurements and the histological depth of the lesion. We believe that these preliminary studies indicate that these methods to assess skin tumors may be important clinically and should be further explored in the assessment of tumors prior to treatment. [ABSTRACT FROM AUTHOR]

Two patients suffering from pemphigus vulgaris were found to have nail dystrophies which antedated the onset of mucocutaneous lesions by many years. The nail changes improved substantially on treatment of the bullous disease. One patient had nail matrix histology consistent with pemphigus, and both had positive direct immunofluorescence with intercellular IgG in the matrix epithelium, as well as at other body sites. We propose that dystrophic nails, as a non-specific indicator of autoimmune disease, are a genuine and relevant finding in pemphigus. [ABSTRACT FROM AUTHOR]

The clinical and histological response to 12 weeks of treatment with a very potent topical fluorinated steroid was studied in 15 patients with vulval lichen sclerosus (LS) who were treated with twice daily applications of clobetasol propionate 0-()5% cream (Dermovate, Glaxo U.K.). Thirteen patients completed the study and all showed a marked clinical improvement. Histological measurements of skin biopsies taken before and after treatment showed a significant reduction in the characteristic features of LS. One patient developed contact sensitivity to clobetasol propionate. There was no evidence of infection or skin atrophy during the study. Patients completing the study have been followed up for up to 22 months and have been maintained in remission with moderately potent topical steroids which had previously been ineffective. [ABSTRACT FROM AUTHOR]

We have studied 23 patients receiving penicillamine for the treatment of rheumatoid arthritis to determine the prevalence of penicillamine-induced elastosis. One female patient had pseudo- xanthoma elasticum-like skin changes and bramble-bush elastosis without calcification in the involved skin. Penicillamine elastosis was present in the joint capsule in 62% of eight patients or 64% of II joints examined and was detected in joint capsules after as little as 1 year of treatment. [ABSTRACT FROM AUTHOR]

A case is reported of cutaneous T-cell lymphoma in an elderly woman. Dystrophy of all 20 nails was caused by a lymphomatous infiltrate of the nail apparatus. [ABSTRACT FROM AUTHOR]

Follicular and sebaceous gland cell differentiation was investigated during treatment of acne patients with isotretinoin. Sebaceous glands were significantly reduced in volume and showed decreased metabolic activity as measured by glucose-6-phosphate dehydrogenase and succinic dehydrogenase enzyme activities. There was no measurable change in the volume of follicular duct epithelium or in its metabolic activity during treatment. Metabolic activity was also unchanged in the interfollicular epidermis, contrasting with the effects of another retinoid, etretinate. These findings provide no support for the proposition that alteration in the process of follicular keratinization forms a substantial part of the mode of action of isotretinoin. [ABSTRACT FROM AUTHOR]

We report the results of patch testing 85 patients with either long-standing venous ulceration or eczema complicating their leg ulcers. As previously reported, lanolin and its derivatives and topical antibiotics were the most frequent sensitizers. However, unlike previously published data, we found bacitracin to be the most potent sensitizer of all topical antiboitics tested. There were no positive reactions in a control group of patients, although we were unable to repeat the patch tests in patients with a positive reaction to bacitracin. In the past 10 years, our department has used a proprietary mixture of polymyxin and bacitracin in treating infected leg ulcers and other dermatoses. It is therefore possible that chronic usage of topical bacitracin on leg ulcers carries a significant risk of contact sensitization. [ABSTRACT FROM AUTHOR]

An unusual case of lichen sclerosus et atrophicus (LSA) with extracutaneous manifestations is described and the relationship between LSA and morphoea is discussed. [ABSTRACT FROM AUTHOR]

Abstract The development and implementation of an evidence-based approach to health workforce planning is a necessary step to achieve access to best practice chronic disease management. In its absence, the widely reported failure in implementation of clinical best practice guidelines is almost certain to continue. This paper describes a demand model to estimate the community-based primary care health workforce consistent with the delivery of best practice chronic disease management and prevention. The model takes a geographic region as the planning frame and combines data about the health status of the regional population by disease category and stage, with best practice guidelines to estimate the clinical skill requirement or competencies for the region. The translation of the skill requirement into a service requirement can then be modelled, incorporating various assumptions about the occupation group to deliver nominated competencies. The service requirement, when compared with current service delivery, defines the gap or surplus in services. The results of the model could be used to inform service delivery as well as a workforce supply strategy.