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Sample records for adopted artemisinin-based combination

  1. Artemisinin-based combination therapies for uncomplicated malaria.

    PubMed

    Davis, Timothy M E; Karunajeewa, Harin A; Ilett, Kenneth F

    2005-02-21

    There has been a relentless increase in resistance of malaria parasites to conventional antimalarial drugs, including chloroquine, sulfadoxine-pyrimethamine and mefloquine. In response to this situation, short-course artemisinin-based combination therapies (ACTs) have been developed. The World Health Organization has endorsed ACT as first-line treatment where the potentially life-threatening parasite Plasmodium falciparum is the predominant infecting species. ACTs combine the rapid schizontocidal activity of an artemisinin derivative (artesunate, artemether or dihydroartemisinin) with a longer-half-life partner drug. Although the use of chloroquine and sulfadoxine-pyrimethamine as partners in ACT improves their efficacy, this may only have value as a short-term measure in patients with a degree of immunity to malaria. Alternative currently available partner drugs include mefloquine, lumefantrine and piperaquine. Artesunate-mefloquine is highly effective but is expensive and side effects (mainly neurotoxicity) can be problematic. Artemether-lumefantrine, the only ACT available in Australia, appears less effective than artesunate-mefloquine and needs to be administered with food to ensure adequate bioavailability. Dihydroartemisinin-piperaquine is highly effective, well tolerated and relatively inexpensive. The goal of potent, safe, easy-to-administer and inexpensive ACTs may see trioxolanes in place of artemisinin derivatives, as well as novel partner drugs such as pyronaridine or naphthoquine, in the future. PMID:15720175

  2. Degradation of Artemisinin-Based Combination Therapies under Tropical Conditions

    PubMed Central

    Hall, Zoe; Allan, Elizabeth Louise; van Schalkwyk, Donelly Andrew; van Wyk, Albert; Kaur, Harparkash

    2016-01-01

    Poor quality antimalarials, including falsified, substandard, and degraded drugs, are a serious health concern in malaria-endemic countries. Guidelines are lacking on how to distinguish between substandard and degraded drugs. “Forced degradation” in an oven was carried out on three common artemisinin-based combination therapy (ACT) brands to detect products of degradation using liquid chromatography mass spectrometry and help facilitate classification of degraded drugs. “Natural aging” of 2,880 tablets each of ACTs artemether/lumefantrine and artesunate/amodiaquine was undertaken to evaluate their long-term stability in tropical climates. Samples were aged in the presence and absence of light on-site in Ghana and in a stability chamber (London), removed at regular intervals, and analyzed to determine loss of the active pharmaceutical ingredients (APIs) over time and detect products of degradation. Loss of APIs in naturally aged tablets (both in Ghana and the pharmaceutical stability chamber) was 0–7% over 3 years (∼12 months beyond expiry) with low levels of degradation products detected. Using this developed methodology, it was found that a quarter of ACTs purchased in Enugu, Nigeria (concurrent study), that would have been classified as substandard, were in fact degraded. Presence of degradation products together with evidence of insufficient APIs can be used to classify drugs as degraded. PMID:26951346

  3. Degradation of Artemisinin-Based Combination Therapies Under Tropical Conditions.

    PubMed

    Hall, Zoe; Allan, Elizabeth Louise; van Schalkwyk, Donelly Andrew; van Wyk, Albert; Kaur, Harparkash

    2016-05-01

    Poor quality antimalarials, including falsified, substandard, and degraded drugs, are a serious health concern in malaria-endemic countries. Guidelines are lacking on how to distinguish between substandard and degraded drugs. "Forced degradation" in an oven was carried out on three common artemisinin-based combination therapy (ACT) brands to detect products of degradation using liquid chromatography mass spectrometry and help facilitate classification of degraded drugs. "Natural aging" of 2,880 tablets each of ACTs artemether/lumefantrine and artesunate/amodiaquine was undertaken to evaluate their long-term stability in tropical climates. Samples were aged in the presence and absence of light on-site in Ghana and in a stability chamber (London), removed at regular intervals, and analyzed to determine loss of the active pharmaceutical ingredients (APIs) over time and detect products of degradation. Loss of APIs in naturally aged tablets (both in Ghana and the pharmaceutical stability chamber) was 0-7% over 3 years (∼12 months beyond expiry) with low levels of degradation products detected. Using this developed methodology, it was found that a quarter of ACTs purchased in Enugu, Nigeria (concurrent study), that would have been classified as substandard, were in fact degraded. Presence of degradation products together with evidence of insufficient APIs can be used to classify drugs as degraded. PMID:26951346

  4. Artemisinin-based combination therapies and their introduction in Japan.

    PubMed

    Kano, Shigeyuki

    2014-05-01

    Artemisinin was discovered in 1971 from a herb, Artemisia annua, which had been used for more than 2,000 years in China against intermittent fever. Now, the artemisinin and its derivatives have become essential components of artemisinin-based combination therapies (ACTs). The ACTs are the recommended first-line treatments of malaria because they are effective against all four human malarias, produce rapid parasite/fever clearance, and show fewer adverse effects. Some ACTs are particularly important in cases of severe and complicated falciparum malaria, including cerebral malaria. However, neither the artemisinin and its derivatives nor any ACTs are registered in Japan. Indeed, the only licensed drugs for the treatment of malaria in Japan are quinine, mefloquine, and sulfadoxine/pyrimethamine. Although indigenous malaria has been eradicated in Japan since 1959, 60-100 imported malaria cases have been reported annually for the past decade. Some of the patients were, in fact, dying of the severe complications. Thus, the introduction of the ACTs and their application to imported malaria patients in Japan are urgently needed. A few clinical studies using the ACTs have been reported in Japan. The first application of an ACT, intramuscular artemether plus mefloquine, was reported in 1988 to be very effective against cerebral malaria with coma. Five cases with intravenous artesunate plus mefloquine were reported through 2001-2007, for severe or drug-resistant falciparum cases, resulting in successful treatment with some side effects such as hemolytic anemia or postmalaria neurological syndrome. Currently, a fixed-dose ACT, artemether-lumefantrine, is prescribed successfully for uncomplicated falciparum cases, with a limited number of recrudescences. PMID:24979951

  5. The challenges of changing national malaria drug policy to artemisinin-based combinations in Kenya

    PubMed Central

    Amin, Abdinasir A; Zurovac, Dejan; Kangwana, Beth B; Greenfield, Joanne; Otieno, Dorothy N; Akhwale, Willis S; Snow, Robert W

    2007-01-01

    Backgound Sulphadoxine/sulphalene-pyrimethamine (SP) was adopted in Kenya as first line therapeutic for uncomplicated malaria in 1998. By the second half of 2003, there was convincing evidence that SP was failing and had to be replaced. Despite several descriptive investigations of policy change and implementation when countries moved from chloroquine to SP, the different constraints of moving to artemisinin-based combination therapy (ACT) in Africa are less well documented. Methods A narrative description of the process of anti-malarial drug policy change, financing and implementation in Kenya is assembled from discussions with stakeholders, reports, newspaper articles, minutes of meetings and email correspondence between actors in the policy change process. The narrative has been structured to capture the timing of events, the difficulties and hurdles faced and the resolutions reached to the final implementation of a new treatment policy. Results Following a recognition that SP was failing there was a rapid technical appraisal of available data and replacement options resulting in a decision to adopt artemether-lumefantrine (AL) as the recommended first-line therapy in Kenya, announced in April 2004. Funding requirements were approved by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and over 60 million US$ were agreed in principle in July 2004 to procure AL and implement the policy change. AL arrived in Kenya in May 2006, distribution to health facilities began in July 2006 coincidental with cascade in-service training in the revised national guidelines. Both training and drug distribution were almost complete by the end of 2006. The article examines why it took over 32 months from announcing a drug policy change to completing early implementation. Reasons included: lack of clarity on sustainable financing of an expensive therapeutic for a common disease, a delay in release of funding, a lack of comparative efficacy data between AL and

  6. Pyrrolidine-Acridine hybrid in Artemisinin-based combination: a pharmacodynamic study.

    PubMed

    Pandey, Swaroop Kumar; Biswas, Subhasish; Gunjan, Sarika; Chauhan, Bhavana Singh; Singh, Sunil Kumar; Srivastava, Kumkum; Singh, Sarika; Batra, Sanjay; Tripathi, Renu

    2016-09-01

    Aiming to develop new artemisinin-based combination therapy (ACT) for malaria, antimalarial effect of a new series of pyrrolidine-acridine hybrid in combination with artemisinin derivatives was investigated. Synthesis, antimalarial and cytotoxic evaluation of a series of hybrid of 2-(3-(substitutedbenzyl)pyrrolidin-1-yl)alkanamines and acridine were performed and mode of action of the lead compound was investigated. In vivo pharmacodynamic properties (parasite clearance time, parasite reduction ratio, dose and regimen determination) against multidrug resistant (MDR) rodent malaria parasite and toxicological parameters (median lethal dose, liver function test, kidney function test) were also investigated. 6-Chloro-N-(4-(3-(3,4-dimethoxybenzyl)pyrrolidin-1-yl)butyl)-2-methoxyacridin-9-amine (15c) has shown a dose dependent haem bio-mineralization inhibition and was found to be the most effective and safe compound against MDR malaria parasite in Swiss mice model. It displayed best antimalarial potential with artemether (AM) in vitro as well as in vivo. The combination also showed favourable pharmacodynamic properties and therapeutic response in mice with established MDR malaria infection and all mice were cured at the determined doses. The combination did not show toxicity at the doses administered to the Swiss mice. Taken together, our findings suggest that compound 15c is a potential partner with AM for the ACT and could be explored for further development. PMID:27230403

  7. Access to artemisinin-based combination therapy (ACT) and quinine in malaria holoendemic regions of western Kenya

    PubMed Central

    2014-01-01

    Background Artemisinin-based combination therapy (ACT) has been adopted as the most effective treatment against malaria in many endemic countries like Kenya while quinine has remained the second line. The objective of the current study was to assess access to Kenya’s policy recommended anti-malarials, ACT and quinine in the public, private and not-for-profit drug outlets in western Kenya. Methods A cross-sectional survey using purposive sampling of 288 outlets (126 public, 96 private, 66 not-for-profit) was conducted in western Kenya in two regions with varying Plasmodium falciparum endemicities. Information on access (availability, price, affordability) on ACT and quinine was collected using the WHO and Healthcare Associated Infection (HAI) standardized methodologies for availability, prices and affordability of drugs. From a Ministry of Health database, the following were included in the analyses: one (1) main public hospital, followed by random selection of five hospitals under this main facility. Eight other public outlets under each of the hospitals were selected, to a total of 96. Matching number of private outlets (n = 96), all (66) not-for-profit outlets and additional 30 public health facilities were sampled to get the required sample size of 288. Results More public 111 (88.1%) and not-for-profit 27 (40.9%) outlets stocked subsidized ACT (artemether-lumefantrine, AL). Other artemisinin-based combinations were widely available for both children 93 (96.9%) and adults 82 (85.0%) in private outlets. Frequent stock-outs were in public in 106 (84%), reporting three times or more stock-outs in three months. Subsidized ACT (AL) was sold at median price of USD 0.94 and 0.75 in private and not-for-profit outlets respectively. The costs was higher than recommended price of USD 0.5 and requiring up to 0.20-0.25 days of disposable income for households in lowest economic status. Conclusion There is low availability of subsidized ACT (AL) and higher frequency of

  8. Simple Field Assays to Check Quality of Current Artemisinin-Based Antimalarial Combination Formulations

    PubMed Central

    Ioset, Jean-Robert; Kaur, Harparkash

    2009-01-01

    Introduction Malaria continues to be one of the major public health problems in Africa, Asia and Latin America. Artemisinin derivatives (ARTs; artesunate, artemether, and dihydroartemisinin) derived from the herb, Artemisia annua, are the most effective antimalarial drugs available providing rapid cures. The World Health Organisation (WHO) has recommended that all antimalarials must be combined with an artemisinin component (artemisinin-based combination therapy; ACT) for use as first line treatment against malaria. This class of drugs is now first-line policy in most malaria-endemic countries. Reports of ad hoc surveys from South East Asia show that up to 50% of the artesunate currently sold is counterfeit. Drug quality is rarely assessed in resource poor countries in part due to lack of dedicated laboratory facilities which are expensive to build, equip and maintain. With a view to address this unmet need we developed two novel colour reaction assays that can be used in the field to check the quality of ARTs. Methods and Findings Our assays utilise thin layer chromatography silica gel sheets and 2, 4 dinitrophenylhydrazine or 4-Benzoylamino-2, 5-dimethoxybenzenediazonium chloride hemi (zinc chloride) salt as the reagents showing a pink or blue product respectively only in the presence ARTs. We are able to detect as low as 10% of ARTs in ACTs (WINTHROP - artesunate/amodiaquine, Coartem®-artemether/lumefantrine and Duocortexcin - dihydroartemisinin/piperaquine). The assays have been validated extensively by testing eighty readily accessible and widely used drugs in malaria endemic countries. None of the other antimalarial drugs or a range of commonly used excipients, antiretroviral drugs or other frequently used drugs from the WHO essential drugs list such as analgesics or antibiotics are detected with our assays. Conclusions Our two independent assays requiring no specialist training are specific, simple to use, rapid, robust, reproducible, inexpensive and, have

  9. Increasing Access to Subsidized Artemisinin-based Combination Therapy through Accredited Drug Dispensing Outlets in Tanzania

    PubMed Central

    2011-01-01

    Background In Tanzania, many people seek malaria treatment from retail drug sellers. The National Malaria Control Program identified the accredited drug dispensing outlet (ADDO) program as a private sector mechanism to supplement the distribution of subsidized artemisinin-based combination therapies (ACTs) from public facilities and increase access to the first-line antimalarial in rural and underserved areas. The ADDO program strengthens private sector pharmaceutical services by improving regulatory and supervisory support, dispenser training, and record keeping practices. Methods The government's pilot program made subsidized ACTs available through ADDOs in 10 districts in the Morogoro and Ruvuma regions, covering about 2.9 million people. The program established a supply of subsidized ACTs, created a price system with a cost recovery plan, developed a plan to distribute the subsidized products to the ADDOs, trained dispensers, and strengthened the adverse drug reactions reporting system. As part of the evaluation, 448 ADDO dispensers brought their records to central locations for analysis, representing nearly 70% of ADDOs operating in the two regions. ADDO drug register data were available from July 2007-June 2008 for Morogoro and from July 2007-September 2008 for Ruvuma. This intervention was implemented from 2007-2008. Results During the pilot, over 300,000 people received treatment for malaria at the 448 ADDOs. The percentage of ADDOs that dispensed at least one course of ACT rose from 26.2% during July-September 2007 to 72.6% during April-June 2008. The number of malaria patients treated with ACTs gradually increased after the start of the pilot, while the use of non-ACT antimalarials declined; ACTs went from 3% of all antimalarials sold in July 2007 to 26% in June 2008. District-specific data showed substantial variation among the districts in ACT uptake through ADDOs, ranging from ACTs representing 10% of all antimalarial sales in Kilombero to 47% in

  10. Subsidising artemisinin-based combination therapy in the private retail sector

    PubMed Central

    Opiyo, Newton; Yamey, Gavin; Garner, Paul

    2016-01-01

    Background Malaria causes ill health and death in Africa. Treating illness promptly with artemisinin-based combination therapy (ACT) is likely to cure people and avoid the disease progressing to more severe forms and death. In many countries, ACT use remains low. Part of the problem is that most people seek treatment from the retail sector where ACTs are expensive; this expense is a barrier to their use. The Global Fund and other international organisations are subsidising the cost of ACTs for private retail providers to improve access to ACTs. The subsidy was initially organised through a stand-alone initiative, called the Affordable Medicines Facility-malaria (AMFm), but has since been integrated into the Global Fund core grant management and financial processes. Objectives To assess the effect of programmes that include ACT price subsidies for private retailers on ACT use, availability, price and market share. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1, The Cochrane Library, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register); MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EbscoHost), EconLit (ProQuest), Global Health (OvidSP), Regional Indexes (Global Health Library, WHO), LILACS (Global Health Library, WHO), Science Citation Index and Social Sciences Citation Index (ISI Web of Science) and Health Management (ProQuest). All databases were searched February 2015, except for Health Management which was searched November 2013, without any date, language or publication status restrictions. We also searched the International Clinical Trials Registry Platform (ICTRP; WHO), ClinicalTrials.gov (NIH) and various grey literature sources. We also conducted a cited reference search for all included studies in ISI Web of Knowledge, checked references of identified articles and contacted authors to identify additional studies. Selection criteria Randomised trials, non

  11. Should countries implementing an artemisinin-based combination malaria treatment policy also introduce rapid diagnostic tests?

    PubMed Central

    Zikusooka, Charlotte M; McIntyre, Diane; Barnes, Karen I

    2008-01-01

    Background Within the context of increasing antimalarial costs and or decreasing malaria transmission, the importance of limiting antimalarial treatment to only those confirmed as having malaria parasites becomes paramount. This motivates for this assessment of the cost-effectiveness of routine use of rapid diagnostic tests (RDTs) as an integral part of deploying artemisinin-based combination therapies (ACTs). Methods The costs and cost-effectiveness of using RDTs to limit the use of ACTs to those who actually have Plasmodium falciparum parasitaemia in two districts in southern Mozambique were assessed. To evaluate the potential impact of introducing definitive diagnosis using RDTs (costing $0.95), five scenarios were considered, assuming that the use of definitive diagnosis would find that between 25% and 75% of the clinically diagnosed malaria patients are confirmed to be parasitaemic. The base analysis compared two ACTs, artesunate plus sulfadoxine/pyrimethamine (AS+SP) costing $1.77 per adult treatment and artemether-lumefantrine (AL) costing $2.40 per adult treatment, as well as the option of restricting RDT use to only those older than six years. Sensitivity analyses considered lower cost ACTs and RDTs and different population age distributions. Results Compared to treating patients on the basis of clinical diagnosis, the use of RDTs in all clinically diagnosed malaria cases results in cost savings only when 29% and 52% or less of all suspected malaria cases test positive for malaria and are treated with AS+SP and AL, respectively. These cut-off points increase to 41.5% (for AS+SP) and to 74% (for AL) when the use of RDTs is restricted to only those older than six years of age. When 25% of clinically diagnosed patients are RDT positive and treated using AL, there are cost savings per malaria positive patient treated of up to $2.12. When more than 29% of clinically diagnosed cases are malaria test positive, the incremental cost per malaria positive patient

  12. Comparative safety of artemether-lumefantrine and other artemisinin-based combinations in children: a systematic review

    PubMed Central

    2013-01-01

    Background The purpose of the study was to compare the safety of artemether-lumefantrine (AL) with other artemisinin-based combinations in children. Methods A search of EMBASE (from 1974 to April 2013), MEDLINE (from 1946 to April 2013) and the Cochrane library of registered controlled trials for randomized controlled trials (RCTs) which compared AL with other artemisinin-based combinations was done. Only studies involving children ≤ 17 years old in which safety of AL was an outcome measure were included. Results Four thousand, seven hundred and twenty six adverse events (AEs) were recorded in 6,000 patients receiving AL. Common AEs (≥1/100 and <1/10) included: coryza, vomiting, anaemia, diarrhoea, vomiting and abdominal pain; while cough was the only very commonly reported AE (≥1/10). AL-treated children have a higher risk of body weakness (64.9%) than those on artesunate-mefloquine (58.2%) (p = 0.004, RR: 1.12 95% CI: 1.04-1.21). The risk of vomiting was significantly lower in patients on AL (8.8%) than artesunate-amodiaquine (10.6%) (p = 0.002, RR: 0.76, 95% CI: 0.63-0.90). Similarly, children on AL had a lower risk of vomiting (1.2%) than chlorproguanil-dapsone-artesunate (ACD) treated children (5.2%) (p = 0.002, RR: 0.63, 95% CI: 0.47-0.85). The risk of serious adverse events was significantly lower for AL (1.3%) than ACD (5.2%) (p = 0.002, RR: 0.45, 95% CI: 0.27-0.74). Conclusion Artemether-lumefantrine combination is as safe as ASAQ and DP for use in children. Common adverse events are cough and gastrointestinal symptoms. More studies comparing AL with artesunate-mefloquine and artesunate-azithromycin are needed to determine the comparative safety of these drugs. PMID:24175945

  13. Impact of retreatment with an artemisinin-based combination on malaria incidence and its potential selection of resistant strains: study protocol for a randomized controlled clinical trial

    PubMed Central

    2013-01-01

    Background Artemisinin-based combination therapy is currently recommended by the World Health Organization as first-line treatment of uncomplicated malaria. Recommendations were adapted in 2010 regarding rescue treatment in case of treatment failure. Instead of quinine monotherapy, it should be combined with an antibiotic with antimalarial properties; alternatively, another artemisinin-based combination therapy may be used. However, for informing these policy changes, no clear evidence is yet available. The need to provide the policy makers with hard data on the appropriate rescue therapy is obvious. We hypothesize that the efficacy of the same artemisinin-based combination therapy used as rescue treatment is as efficacious as quinine + clindamycin or an alternative artemisinin-based combination therapy, without the risk of selecting drug resistant strains. Design We embed a randomized, open label, three-arm clinical trial in a longitudinal cohort design following up children with uncomplicated malaria until they are malaria parasite free for 4 weeks. The study is conducted in both the Democratic Republic of Congo and Uganda and performed in three steps. In the first step, the pre-randomized controlled trial (RCT) phase, children aged 12 to 59 months with uncomplicated malaria are treated with the recommended first-line drug and constitute a cohort that is passively followed up for 42 days. If the patients experience an uncomplicated malaria episode between days 14 and 42 of follow-up, they are randomized either to quinine + clindamycin, or an alternative artemisinin-based combination therapy, or the same first-line artemisinin-based combination therapy to be followed up for 28 additional days. If between days 14 and 28 the patients experience a recurrent parasitemia, they are retreated with the recommended first-line regimen and actively followed up for another 28 additional days (step three; post-RCT phase). The same methodology is followed for each subsequent

  14. Stabilizing supply of artemisinin and artemisinin-based combination therapy in an era of wide-spread scale-up.

    PubMed

    Shretta, Rima; Yadav, Prashant

    2012-01-01

    The global demand for artemisinin-based combination therapy (ACT) has grown sharply since its recommendation by the World Health Organization in 2002. However, a combination of financing and programmatic uncertainties, limited suppliers of finished products, information opacity across the different tiers in the supply chain, and widespread fluctuations in raw material prices have together contributed to a market fraught with demand and supply uncertainties and price volatility. Various short-term solutions have been deployed to alleviate supply shortages caused by these challenges; however, new mechanisms are required to build resilience into the supply chain. This review concludes that a mix of strategies is required to stabilize the artemisinin and ACT market. First, better and more effective pooling of demand and supply risks and better contracting to allow risk sharing among the stakeholders are needed. Physical and financial buffer stocks will enable better matching of demand and supply in the short and medium term. Secondly, physical buffers will allow stable supplies when there are procurement and supply management challenges while financial buffer funds will address issues around funding disruptions. Finally, in the medium to long term, significant investments in country level system strengthening will be required to minimize national level demand uncertainties. In addition a voluntary standard for extractors to ensure appropriate purchasing and sales practices as well as minimum quality and ethical standards could help stabilize the artemisinin market in the long term. PMID:23198961

  15. Stabilizing supply of artemisinin and artemisinin-based combination therapy in an era of wide-spread scale-up

    PubMed Central

    2012-01-01

    The global demand for artemisinin-based combination therapy (ACT) has grown sharply since its recommendation by the World Health Organization in 2002. However, a combination of financing and programmatic uncertainties, limited suppliers of finished products, information opacity across the different tiers in the supply chain, and widespread fluctuations in raw material prices have together contributed to a market fraught with demand and supply uncertainties and price volatility. Various short-term solutions have been deployed to alleviate supply shortages caused by these challenges; however, new mechanisms are required to build resilience into the supply chain. This review concludes that a mix of strategies is required to stabilize the artemisinin and ACT market. First, better and more effective pooling of demand and supply risks and better contracting to allow risk sharing among the stakeholders are needed. Physical and financial buffer stocks will enable better matching of demand and supply in the short and medium term. Secondly, physical buffers will allow stable supplies when there are procurement and supply management challenges while financial buffer funds will address issues around funding disruptions. Finally, in the medium to long term, significant investments in country level system strengthening will be required to minimize national level demand uncertainties. In addition a voluntary standard for extractors to ensure appropriate purchasing and sales practices as well as minimum quality and ethical standards could help stabilize the artemisinin market in the long term. PMID:23198961

  16. Adherence to Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria: A Systematic Review and Meta-Analysis

    PubMed Central

    Yakasai, Ahmad M.; Hamza, Muhammad; Dalhat, Mahmood M.; Bello, Musa; Gadanya, Muktar A.; Yaqub, Zuwaira M.; Ibrahim, Daiyabu A.; Hassan-Hanga, Fatimah

    2015-01-01

    Adherence to artemisinin-based combination therapy (ACT) is not clearly defined. This meta-analysis determines the prevalence and predictors of adherence to ACT. Twenty-five studies and six substudies met the inclusion criteria. The prevalence of ACT adherence in the public sector was significantly higher compared to retail sector (76% and 45%, resp., P < 0.0001). However, ACT adherence was similar across different ACT dosing regimens and formulations. In metaregression analysis prevalence estimates of adherence significantly decrease with increasing year of study publication (P = 0.046). Factors found to be significant predictors of ACT adherence were years of education ≥ 7 {odds ratio (OR) (95% CI) = 1.63 (1.05–2.53)}, higher income {2.0 (1.35–2.98)}, fatty food {4.6 (2.49–8.50)}, exact number of pills dispensed {4.09 (1.60–10.7)}, and belief in traditional medication for malaria {0.09 (0.01–0.78)}. The accuracy of pooled estimates could be limited by publication bias, and differing methods and thresholds of assessing adherence. To improve ACT adherence, educational programs to increase awareness and understanding of ACT dosing regimen are interventions urgently needed. Patients and caregivers should be provided with an adequate explanation at the time of prescribing and/or dispensing ACT. PMID:26161095

  17. Globally prevalent PfMDR1 mutations modulate Plasmodium falciparum susceptibility to artemisinin-based combination therapies

    PubMed Central

    Veiga, M. Isabel; Dhingra, Satish K.; Henrich, Philipp P.; Straimer, Judith; Gnädig, Nina; Uhlemann, Anne-Catrin; Martin, Rowena E.; Lehane, Adele M.; Fidock, David A.

    2016-01-01

    Antimalarial chemotherapy, globally reliant on artemisinin-based combination therapies (ACTs), is threatened by the spread of drug resistance in Plasmodium falciparum parasites. Here we use zinc-finger nucleases to genetically modify the multidrug resistance-1 transporter PfMDR1 at amino acids 86 and 184, and demonstrate that the widely prevalent N86Y mutation augments resistance to the ACT partner drug amodiaquine and the former first-line agent chloroquine. In contrast, N86Y increases parasite susceptibility to the partner drugs lumefantrine and mefloquine, and the active artemisinin metabolite dihydroartemisinin. The PfMDR1 N86 plus Y184F isoform moderately reduces piperaquine potency in strains expressing an Asian/African variant of the chloroquine resistance transporter PfCRT. Mutations in both digestive vacuole-resident transporters are thought to differentially regulate ACT drug interactions with host haem, a product of parasite-mediated haemoglobin degradation. Global mapping of these mutations illustrates where the different ACTs could be selectively deployed to optimize treatment based on regional differences in PfMDR1 haplotypes. PMID:27189525

  18. Globally prevalent PfMDR1 mutations modulate Plasmodium falciparum susceptibility to artemisinin-based combination therapies.

    PubMed

    Veiga, M Isabel; Dhingra, Satish K; Henrich, Philipp P; Straimer, Judith; Gnädig, Nina; Uhlemann, Anne-Catrin; Martin, Rowena E; Lehane, Adele M; Fidock, David A

    2016-01-01

    Antimalarial chemotherapy, globally reliant on artemisinin-based combination therapies (ACTs), is threatened by the spread of drug resistance in Plasmodium falciparum parasites. Here we use zinc-finger nucleases to genetically modify the multidrug resistance-1 transporter PfMDR1 at amino acids 86 and 184, and demonstrate that the widely prevalent N86Y mutation augments resistance to the ACT partner drug amodiaquine and the former first-line agent chloroquine. In contrast, N86Y increases parasite susceptibility to the partner drugs lumefantrine and mefloquine, and the active artemisinin metabolite dihydroartemisinin. The PfMDR1 N86 plus Y184F isoform moderately reduces piperaquine potency in strains expressing an Asian/African variant of the chloroquine resistance transporter PfCRT. Mutations in both digestive vacuole-resident transporters are thought to differentially regulate ACT drug interactions with host haem, a product of parasite-mediated haemoglobin degradation. Global mapping of these mutations illustrates where the different ACTs could be selectively deployed to optimize treatment based on regional differences in PfMDR1 haplotypes. PMID:27189525

  19. Adherence and Uptake of Artemisinin-Based Combination Treatments for Uncomplicated Malaria: A Qualitative Study in Northern Ghana

    PubMed Central

    Chatio, Samuel; Aborigo, Raymond; Adongo, Philip Baba; Anyorigiya, Thomas; Akweongo, Patricia; Oduro, Abraham

    2015-01-01

    Background Based on the recommendations of the World Health Organization in 2004, Ghana changed her antimalarial drug policy from mono-therapy to Artemisinin-based Combination Therapy (ACTs). The country is currently using three first line drugs artesunate-amodiaquine, artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated malaria. Despite this policy, little or no qualitative studies have been conducted to establish the factors influencing adherence to the new treatment for malaria. This study explored factors influencing adherence to the use of ACTs in northern Ghana. Methods This was a qualitative study comprising forty (40) in-depth interviews with patients with malaria who visited selected public and private health facilities and received ACTs. Systematic sampling technique was used to select participants who were given ACTs for the interviews. Nvivo 9 software was used to code the data into themes for further analysis. Results The study revealed very important differences in knowledge about ACTs. As expected, the less or illiterates could not mention the type of ACT they would prefer to use for treating their malaria. The educated ones had a good knowledge on ACTs and preferred artemether-lumefantrinee in treating their malaria. The reason was that the drug was good and it had minimal or no side effects. Individual attitudes toward the use of medications and the side effects associated with the use of these ACTs were found to be the main factors affecting adherence to the use of ACTs. Perceived cure of illness after the initial dose greatly affected adherence. Other factors such as forgetfulness and lack of information also influenced patient adherence to ACTs use. Conclusion Individual knowledge, attitudes and behaviors greatly influence patients’ adherence to ACTs use. Since ACTs take a number of days to complete, continuous education by health professionals could improve on adherence to ACTs use by patients with

  20. Artemisinin-based combination therapy in the treatment of uncomplicated malaria: review of recent regulatory experience at the European Medicines Agency

    PubMed Central

    Pelfrene, Eric; Pinheiro, Marie-Hélène; Cavaleri, Marco

    2015-01-01

    Malaria remains a major public health challenge with almost half of the world's population exposed to the risk of contracting the illness. Prompt, effective and well tolerated treatment remains one of the cornerstones in the disease management, with artemisinin-based combination therapy the recommended option for non-severe malaria in endemic areas with predominant Plasmodium falciparum infections. Recent experience has been obtained at the European Medicines Agency with regulatory approval of two such antimalarial fixed combination products. For these cases, two different regulatory pathways were applied. As such, the present contribution describes this experience, emphasising main differences and applicability offered by these regulatory choices. PMID:25855638

  1. The costs of introducing artemisinin-based combination therapy: evidence from district-wide implementation in rural Tanzania

    PubMed Central

    Njau, Joseph D; Goodman, Catherine A; Kachur, S Patrick; Mulligan, Jo; Munkondya, John S; Mchomvu, Naiman; Abdulla, Salim; Bloland, Peter; Mills, Anne

    2008-01-01

    Background The development of antimalarial drug resistance has led to increasing calls for the introduction of artemisinin-based combination therapy (ACT). However, little evidence is available on the full costs associated with changing national malaria treatment policy. This paper presents findings on the actual drug and non-drug costs associated with deploying ACT in one district in Tanzania, and uses these data to estimate the nationwide costs of implementation in a setting where identification of malaria cases is primarily dependant on clinical diagnosis. Methods Detailed data were collected over a three year period on the financial costs of providing ACT in Rufiji District as part of a large scale effectiveness evaluation, including costs of drugs, distribution, training, treatment guidelines and other information, education and communication (IEC) materials and publicity. The district-level costs were scaled up to estimate the costs of nationwide implementation, using four scenarios to extrapolate variable costs. Results The total district costs of implementing ACT over the three year period were slightly over one million USD, with drug purchases accounting for 72.8% of this total. The composite (best) estimate of nationwide costs for the first three years of ACT implementation was 48.3 million USD (1.29 USD per capita), which varied between 21 and 67.1 million USD in the sensitivity analysis (2003 USD). In all estimates drug costs constituted the majority of total costs. However, non-drug costs such as IEC materials, drug distribution, communication, and health worker training were also substantial, accounting for 31.4% of overall ACT implementation costs in the best estimate scenario. Annual implementation costs are equivalent to 9.5% of Tanzania's recurrent health sector budget, and 28.7% of annual expenditure on medical supplies, implying a 6-fold increase in the national budget for malaria treatment. Conclusion The costs of implementing ACT are

  2. Adherence to artemisinin-based combination therapy for the treatment of malaria: a systematic review of the evidence

    PubMed Central

    2014-01-01

    Background Increasing access to and targeting of artemisinin-based combination therapy (ACT) is a key component of malaria control programmes. To maximize efficacy of ACT and ensure adequate treatment outcomes, patient and caregiver adherence to treatment guidelines is essential. This review summarizes the current evidence base on ACT adherence, including definitions, measurement methods, and associated factors. Methods A systematic search of the published literature was undertaken in November 2012 and updated in April 2013. Bibliographies of manuscripts were also searched and additional references identified. Studies were included if they involved at least one form of ACT and reported an adherence measurement. Results The search yielded 1,412 records, 37 of which were found to measure adherence to ACT. Methods to measure adherence focused on self-report, pill counts and bioassays with varying definitions for adherence. Most studies only reported whether medication regimens were completed, but did not assess how the treatment was taken by the patient (i.e. timing, frequency and dose). Adherence data were available for four different ACT formulations: artemether-lumefantrine (AL) (range 39-100%), amodiaquine plus artesunate (AQ + AS) (range 48-94%), artesunate plus sulphadoxine-pyrimethamine (AS + SP) (range 39-75%) and artesunate plus mefloquine (AS + MQ) (range 77-95%). Association between demographic factors, such as age, gender, education and socio-economic status and adherence to ACT regimens was not consistent. Some evidence of positive association between adherence and patient age, caregiver education levels, drug preferences, health worker instructions, patient/caregiver knowledge and drug packaging were also observed. Conclusions This review highlights the weak evidence base on ACT adherence. Results suggest that ACT adherence levels varied substantially between study populations, but comparison between studies was challenging due to differences in study

  3. Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites

    PubMed Central

    Ajayi, Ikeoluwapo O; Browne, Edmund N; Garshong, Bertha; Bateganya, Fred; Yusuf, Bidemi; Agyei-Baffour, Peter; Doamekpor, Leticia; Balyeku, Andrew; Munguti, Kaendi; Cousens, Simon; Pagnoni, Franco

    2008-01-01

    Background The Home Management of Malaria (HMM) strategy was developed using chloroquine, a now obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT) in health facility settings. Incorporation of ACT in HMM would greatly expand access to effective antimalarial therapy by the populations living in underserved areas in malaria endemic countries. The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated. Methods A multi-country study was performed in four district-size sites in Ghana (two sites), Nigeria and Uganda, with populations ranging between 38,000 and 60,000. Community medicine distributors (CMDs) were trained in each village to dispense pre-packaged ACT to febrile children aged 6–59 months, after exclusion of danger signs. A community mobilization campaign accompanied the programme. Artesunate-amodiaquine (AA) was used in Ghana and artemether-lumefantrine (AL) in Nigeria and Uganda. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance, caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs. Results Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites. Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks, of whom 1,289 (59%) were reported to have received ACT from a CMD. Coverage varied from 52% in Nigeria to 75% in Ho District, Ghana. Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver. A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites (range 86–97%, average 90%). The proportion of children correctly treated in terms of dose and duration was also high (range 74–97%, average 85%). Overall, the proportion of febrile children who received prompt treatment and the correct dose for

  4. Routine delivery of artemisinin-based combination treatment at fixed health facilities reduces malaria prevalence in Tanzania: an observational study

    PubMed Central

    2012-01-01

    Background Artemisinin-based combination therapy (ACT) has been promoted as a means to reduce malaria transmission due to their ability to kill both asexual blood stages of malaria parasites, which sustain infections over long periods and the immature derived sexual stages responsible for infecting mosquitoes and onward transmission. Early studies reported a temporal association between ACT introduction and reduced malaria transmission in a number of ecological settings. However, these reports have come from areas with low to moderate malaria transmission, been confounded by the presence of other interventions or environmental changes that may have reduced malaria transmission, and have not included a comparison group without ACT. This report presents results from the first large-scale observational study to assess the impact of case management with ACT on population-level measures of malaria endemicity in an area with intense transmission where the benefits of effective infection clearance might be compromised by frequent and repeated re-infection. Methods A pre-post observational study with a non-randomized comparison group was conducted at two sites in Tanzania. Both sites used sulphadoxine-pyrimethamine (SP) monotherapy as a first-line anti-malarial from mid-2001 through 2002. In 2003, the ACT, artesunate (AS) co-administered with SP (AS + SP), was introduced in all fixed health facilities in the intervention site, including both public and registered non-governmental facilities. Population-level prevalence of Plasmodium falciparum asexual parasitaemia and gametocytaemia were assessed using light microscopy from samples collected during representative household surveys in 2001, 2002, 2004, 2005 and 2006. Findings Among 37,309 observations included in the analysis, annual asexual parasitaemia prevalence in persons of all ages ranged from 11% to 28% and gametocytaemia prevalence ranged from <1% to 2% between the two sites and across the five survey years. A

  5. Assessment of global reporting of adverse drug reactions for anti-malarials, including artemisinin-based combination therapy, to the WHO Programme for International Drug Monitoring

    PubMed Central

    2011-01-01

    Background In spite of enhanced control efforts, malaria remains a major public health problem causing close to a million deaths annually. With support from several donors, large amounts of artemisinin-based combination therapy (ACT) are being deployed in endemic countries raising safety concerns as little is known about the use of ACT in several of the settings where they are deployed. This project was undertaken to profile the provenance of the pharmacovigilance reporting of all anti-malarials, including ACT to the WHO adverse drug reaction (ADR) database (Vigibase™) over the past 40 years. Methods The WHO Programme for International Drug Monitoring, the Uppsala Monitoring Centre (UMC) provided anonymized extracts of Vigibase™ covering the period 1968-2008. All countries in the programme were clustered according to their malaria control phase and income status. The number of individual case safety reports (ICSRs) of anti-malarials was analyzed according to those clusters. Results From 1968 to 2008, 21,312 ICSRs suspecting anti-malarials were received from 64 countries. Low-income countries, that are also malaria-endemic (categorized as priority 1 countries) submitted only 1.2% of the ICSRs. Only 60 out of 21,312 ICSRs were related to ACT, 51 of which were coming from four sub-Saharan African countries. Although very few ICSRs involved artemisinin-based compounds, many of the adverse events reported were potentially serious. Conclusions This paper illustrates the low reporting of ADRs to anti-malarials in general and ACT in particular. Most reports were submitted by non-endemic and/or high-income countries. Given the current mix of large donor funding, the insufficient information on safety of these drugs, increasing availability of ACT and artemisinin-based monotherapies in public and private sector channels, associated potential for inappropriate use and finally a pipeline of more than 10 new novel anti-malarials in various stages of development, the

  6. Artemisinin-Based Combination Therapy Versus Quinine or Other Combinations for Treatment of Uncomplicated Plasmodium falciparum Malaria in the Second and Third Trimester of Pregnancy: A Systematic Review and Meta-Analysis

    PubMed Central

    Burger, Renée J.; van Eijk, Anna M.; Bussink, Milena; Hill, Jenny; ter Kuile, Feiko O.

    2016-01-01

    The World Health Organization recommends artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated falciparum malaria in the second and third trimesters of pregnancy. We conducted a meta-analysis to compare efficacy, safety and tolerability of ACTs versus quinine and other non-ACT antimalarials. The median PCR-adjusted failure rate by days 28 to 63 in the non-ACT group was 6 (range 0–37) per 100 women, lower in the ACT group overall (pooled risk ratio [PRR] random effects, 0.41; 95% confidence interval [CI], 0.16–1.05; 6 trials), and significantly lower compared with oral quinine (PRR, 0.20; 95% CI, 0.08–0.49; 4 trials). There were no differences in fetal deaths and congenital abnormalities. Compared with quinine, artemisinin-based combinations therapies were associated with less tinnitus (PRR, 0.19; 95% CI, 0.03–1.11; 4 studies), dizziness (PRR, 0.64; 95% CI, 0.44–0.93; 3 trials), and vomiting (PRR, 0.33; 95% CI, 0.15–0.73; 3 trials). Artemisinin-based combination therapies are better than quinine in the second and third trimesters; their use should be encouraged among health workers. PMID:26788543

  7. Artemisinin-Based Combination Therapy Versus Quinine or Other Combinations for Treatment of Uncomplicated Plasmodium falciparum Malaria in the Second and Third Trimester of Pregnancy: A Systematic Review and Meta-Analysis.

    PubMed

    Burger, Renée J; van Eijk, Anna M; Bussink, Milena; Hill, Jenny; Ter Kuile, Feiko O

    2016-01-01

    The World Health Organization recommends artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated falciparum malaria in the second and third trimesters of pregnancy. We conducted a meta-analysis to compare efficacy, safety and tolerability of ACTs versus quinine and other non-ACT antimalarials. The median PCR-adjusted failure rate by days 28 to 63 in the non-ACT group was 6 (range 0-37) per 100 women, lower in the ACT group overall (pooled risk ratio [PRR] random effects, 0.41; 95% confidence interval [CI], 0.16-1.05; 6 trials), and significantly lower compared with oral quinine (PRR, 0.20; 95% CI, 0.08-0.49; 4 trials). There were no differences in fetal deaths and congenital abnormalities. Compared with quinine, artemisinin-based combinations therapies were associated with less tinnitus (PRR, 0.19; 95% CI, 0.03-1.11; 4 studies), dizziness (PRR, 0.64; 95% CI, 0.44-0.93; 3 trials), and vomiting (PRR, 0.33; 95% CI, 0.15-0.73; 3 trials). Artemisinin-based combination therapies are better than quinine in the second and third trimesters; their use should be encouraged among health workers. PMID:26788543

  8. Artemisinin-based combination therapy: knowledge and perceptions of patent medicine dealers in Owerri Metropolis, Imo State, Nigeria and implications for compliance with current malaria treatment protocol.

    PubMed

    Chukwuocha, Uchechukwu Madukaku; Nwakwuo, Geoffrey Chima; Mmerole, Ikechukwu

    2013-08-01

    This study was done to access the knowledge and perceptions of Patent Medicine Dealers (PMDs) in Owerri Metropolis of Nigeria about Artemisinin Based Combination Therapy as first line treatment for malaria using structured pre-tested questionnaires administered to 80 randomly selected and consenting respondents. About 67.5 and 32.5 % of males and females respectively participated in the study. Most of them (56.3 %) had secondary school education with about 50 % having 5-10 years experience in the business. The level of knowledge was shown to be high (82.5 %), with 81.3 % having proper understanding of the term "artemisinin-based combination therapies (ACTs)" and 80 % knowing the correct dosage for ACTs. But despite the level of awareness, only 32.5 % knew the correct timing for administration of the drugs. The result of this study showed no significant relationship between the level of knowledge and either educational attainment (χ(2) = 4.889, df = 4, p value = 0.558) or the years of experience (χ(2) = 29.095, df = 4, p value = 0.000) although knowledge improved a bit as experience increased. 93.8 % in the study reported that ACTs are more effective than other anti-malarial drugs. The quantity of ACT available on counters are low and there is no significant relationship (χ(2) = 18.833, df = 6, p value = 0.004) between the availability of ACT and the quantity of ACT available in stock at the time of this study. This study shows that awareness on ACTs has improved among PMDs, even though other anti-malarial drugs are still in use and are marketed by them. It becomes necessary that efforts towards awareness be scaled up with emphasis on recommended time of administration and correct prescriptions to enhance and sustain intermittent presumptive treatment as an effective method of malaria control since this group of people still provide the major access to drugs in Nigeria and other tropical endemic areas. PMID:23539134

  9. Lack of artemisinin resistance in Plasmodium falciparum in northwest Benin after 10 years of use of artemisinin-based combination therapy

    PubMed Central

    Ogouyèmi-Hounto, Aurore; Damien, Georgia; Deme, Awa Bineta; Ndam, Nicaise T.; Assohou, Constance; Tchonlin, Didier; Mama, Atika; Hounkpe, Virgile Olivier; Moutouama, Jules Doumitou; Remoué, Franck; Ndiaye, Daouda; Gazard, Dorothée Kinde

    2016-01-01

    Aim: In Benin, artemisinin-based combination therapy (ACT) has been recommended as the first-line treatment for uncomplicated Plasmodium falciparum malaria since 2004. The emergence in Southeast Asia of parasites that are resistant to artemisinins poses a serious threat to global control of this disease. The presence of artemisinin resistance genotypes in parasite populations in Benin is currently unknown. The present study investigated the prevalence of relevant K13-propeller gene polymorphisms in parasite isolates from the north-western region of Benin. Method: Plasmodium falciparum isolates were collected from children with a confirmed diagnosis of malaria aged 6 months to 5 years in two towns, Cobly and Djougou, in the north-western part of Benin. The study was conducted during the rainy season from July to November 2014 in local health facilities. The K13-propeller gene was amplified in parasite isolates using nested PCR and subsequently sequenced. Results: A total of 108 children were recruited into the study. The efficiency of amplification reactions was 72% (78/108). The propeller domain of the K13 gene was successfully sequenced in 78 P. falciparum isolates; all of them were wild type with no polymorphisms detectable. Conclusion: The absence of mutations in the K13 gene indicates that P. falciparum parasite populations in the study area are still fully susceptible to artemisinins. PMID:27443837

  10. Towards subsidized malaria rapid diagnostic tests. Lessons learned from programmes to subsidise artemisinin-based combination therapies in the private sector: a review.

    PubMed

    Lussiana, Cristina

    2016-09-01

    The idea of a private sector subsidy programme of artemisinin-based combination therapies (ACTs) was first proposed in 2004. Since then, several countries around the world have hosted pilot projects or programmes on subsidized ACTs and/or the Affordable Medicines Facility-malaria programme (AMFm). Overall the private sector subsidy programmes of ACTs have been effective in increasing availability of ACTs in the private sector and driving down average prices but struggled to crowd out antimalarial monotherapies. The results obtained from this ambitious strategy should inform policy makers in the designing of future interventions aimed to control malaria morbidity and mortality. Among the interventions recently proposed, a subsidy of rapid diagnostic tests (RDTs) in the private sector has been recommended by governments and international donors to cope with over-treatment with ACTs and to delay the emergence of resistance to artemisinin. In order to improve the cost-effectiveness of co-paid RDTs, we should build on the lessons we learned from almost 10 years of private sector subsidy programmes of ACTs in malaria-endemic countries. PMID:25862732

  11. Towards subsidized malaria rapid diagnostic tests. Lessons learned from programmes to subsidise artemisinin-based combination therapies in the private sector: a review

    PubMed Central

    Lussiana, Cristina

    2016-01-01

    The idea of a private sector subsidy programme of artemisinin-based combination therapies (ACTs) was first proposed in 2004. Since then, several countries around the world have hosted pilot projects or programmes on subsidized ACTs and/or the Affordable Medicines Facility-malaria programme (AMFm). Overall the private sector subsidy programmes of ACTs have been effective in increasing availability of ACTs in the private sector and driving down average prices but struggled to crowd out antimalarial monotherapies. The results obtained from this ambitious strategy should inform policy makers in the designing of future interventions aimed to control malaria morbidity and mortality. Among the interventions recently proposed, a subsidy of rapid diagnostic tests (RDTs) in the private sector has been recommended by governments and international donors to cope with over-treatment with ACTs and to delay the emergence of resistance to artemisinin. In order to improve the cost-effectiveness of co-paid RDTs, we should build on the lessons we learned from almost 10 years of private sector subsidy programmes of ACTs in malaria-endemic countries. PMID:25862732

  12. Piloting the Global Subsidy: The Impact of Subsidized Artemisinin-Based Combination Therapies Distributed through Private Drug Shops in Rural Tanzania

    PubMed Central

    Sabot, Oliver J.; Mwita, Alex; Cohen, Justin M.; Ipuge, Yahya; Gordon, Megumi; Bishop, David; Odhiambo, Moses; Ward, Lorrayne; Goodman, Catherine

    2009-01-01

    Background WHO estimates that only 3% of fever patients use recommended artemisinin-based combination therapies (ACTs), partly reflecting their high prices in the retail sector from where many patients seek treatment. To overcome this challenge, a global ACT subsidy has been proposed. We tested this proposal through a pilot program in rural Tanzania. Methods/Principal Findings Three districts were assigned to serve either as a control or to receive the subsidy plus a package of supporting interventions. From October 2007, ACTs were sold at a 90% subsidy through the normal private supply chain to intervention district drug shops. Data were collected at baseline and during intervention using interviews with drug shop customers, retail audits, mystery shoppers, and audits of public and NGO facilities. The proportion of consumers in the intervention districts purchasing ACTs rose from 1% at baseline to 44.2% one year later (p<0.001), and was significantly higher among consumers purchasing for children under 5 than for adults (p = 0.005). No change in ACT usage was observed in the control district. Consumers paid a mean price of $0.58 for ACTs, which did not differ significantly from the price paid for sulphadoxine-pyrimethamine, the most common alternative. Drug shops in population centers were significantly more likely to stock ACTs than those in more remote areas (p<0.001). Conclusions A subsidy introduced at the top of the private sector supply chain can significantly increase usage of ACTs and reduce their retail price to the level of common monotherapies. Additional interventions may be needed to ensure access to ACTs in remote areas and for poorer individuals who appear to seek treatment at drug shops less frequently. Trial Registration Controlled-Trials.com ISRCTN39125414. PMID:19724644

  13. Willingness-to-pay for a rapid malaria diagnostic test and artemisinin-based combination therapy from private drug shops in Mukono district, Uganda

    PubMed Central

    Hansen, Kristian Schultz; Pedrazzoli, Debora; Mbonye, Anthony; Clarke, Sian; Cundill, Bonnie; Magnussen, Pascal; Yeung, Shunmay

    2013-01-01

    In Uganda, as in many parts of Africa, the majority of the population seek treatment for malaria in drug shops as their first point of care; however, parasitological diagnosis is not usually offered in these outlets. Rapid diagnostic tests (RDTs) for malaria have attracted interest in recent years as a tool to improve malaria diagnosis, since they have proved accurate and easy to perform with minimal training. Although RDTs could feasibly be performed by drug shop vendors, it is not known how much customers would be willing to pay for an RDT if offered in these settings. We conducted a contingent valuation survey among drug shop customers in Mukono District, Uganda. Exit interviews were undertaken with customers aged 15 years and above after leaving a drug shop having purchased an antimalarial and/or paracetamol. The bidding game technique was used to elicit the willingness-to-pay (WTP) for an RDT and a course of artemisinin-based combination therapy (ACT) with and without RDT confirmation. Factors associated with WTP were investigated using linear regression. The geometric mean WTP for an RDT was US$0.53, US$1.82 for a course of ACT and US$2.05 for a course of ACT after a positive RDT. Factors strongly associated with a higher WTP for these commodities included having a higher socio-economic status, no fever/malaria in the household in the past 2 weeks and if a malaria diagnosis had been obtained from a qualified health worker prior to visiting the drug shop. The findings further suggest that the WTP for an RDT and a course of ACT among drug shop customers is considerably lower than prevailing and estimated end-user prices for these commodities. Increasing the uptake of ACTs in drug shops and restricting the sale of ACTs to parasitologically confirmed malaria will therefore require additional measures. PMID:22589226

  14. Understanding the Impact of Subsidizing Artemisinin-Based Combination Therapies (ACTs) in the Retail Sector – Results from Focus Group Discussions in Rural Kenya

    PubMed Central

    Kedenge, Sarah V.; Kangwana, Beth P.; Waweru, Evelyn W.; Nyandigisi, Andrew J.; Pandit, Jayesh; Brooker, Simon J.; Snow, Robert W.; Goodman, Catherine A.

    2013-01-01

    Background There is considerable interest in the potential of private sector subsidies to increase availability and affordability of artemisinin-based combination therapies (ACTs) for malaria treatment. A cluster randomized trial of such subsidies was conducted in 3 districts in Kenya, comprising provision of subsidized packs of paediatric ACT to retail outlets, training of retail staff, and community awareness activities. The results demonstrated a substantial increase in ACT availability and coverage, though patient counselling and adherence were suboptimal. We conducted a qualitative study in order to understand why these successes and limitations occurred. Methodology/Principal Findings Eighteen focus group discussions were conducted, 9 with retailers and 9 with caregivers, to document experiences with the intervention. Respondents were positive about intervention components, praising the focused retailer training, affordable pricing, strong promotional activities, dispensing job aids, and consumer friendly packaging, which are likely to have contributed to the positive access and coverage outcomes observed. However, many retailers still did not stock ACT, due to insufficient supplies, lack of capital and staff turnover. Advice to caregivers was poor due to insufficient time, and poor recall of instructions. Adherence by caregivers to dosing guidelines was sub-optimal, because of a wish to save tablets for other episodes, doses being required at night, stopping treatment when the child felt better, and the number and bitter taste of the tablets. Caregivers used a number of strategies to obtain paediatric ACT for older age groups. Conclusions/Significance This study has highlighted that important components of a successful ACT subsidy intervention are regular retailer training, affordable pricing, a reliable supply chain and community mobilization emphasizing patient adherence and when to seek further care. PMID:23342143

  15. Willingness-to-pay for a rapid malaria diagnostic test and artemisinin-based combination therapy from private drug shops in Mukono District, Uganda.

    PubMed

    Hansen, Kristian Schultz; Pedrazzoli, Debora; Mbonye, Anthony; Clarke, Sian; Cundill, Bonnie; Magnussen, Pascal; Yeung, Shunmay

    2013-03-01

    In Uganda, as in many parts of Africa, the majority of the population seek treatment for malaria in drug shops as their first point of care; however, parasitological diagnosis is not usually offered in these outlets. Rapid diagnostic tests (RDTs) for malaria have attracted interest in recent years as a tool to improve malaria diagnosis, since they have proved accurate and easy to perform with minimal training. Although RDTs could feasibly be performed by drug shop vendors, it is not known how much customers would be willing to pay for an RDT if offered in these settings. We conducted a contingent valuation survey among drug shop customers in Mukono District, Uganda. Exit interviews were undertaken with customers aged 15 years and above after leaving a drug shop having purchased an antimalarial and/or paracetamol. The bidding game technique was used to elicit the willingness-to-pay (WTP) for an RDT and a course of artemisinin-based combination therapy (ACT) with and without RDT confirmation. Factors associated with WTP were investigated using linear regression. The geometric mean WTP for an RDT was US$0.53, US$1.82 for a course of ACT and US$2.05 for a course of ACT after a positive RDT. Factors strongly associated with a higher WTP for these commodities included having a higher socio-economic status, no fever/malaria in the household in the past 2 weeks and if a malaria diagnosis had been obtained from a qualified health worker prior to visiting the drug shop. The findings further suggest that the WTP for an RDT and a course of ACT among drug shop customers is considerably lower than prevailing and estimated end-user prices for these commodities. Increasing the uptake of ACTs in drug shops and restricting the sale of ACTs to parasitologically confirmed malaria will therefore require additional measures. PMID:22589226

  16. Prevalence of Malaria Parasitemia and Purchase of Artemisinin-Based Combination Therapies (ACTs) among Drug Shop Clients in Two Regions in Tanzania with ACT Subsidies

    PubMed Central

    Briggs, Melissa A.; Kalolella, Admirabilis; Bruxvoort, Katia; Wiegand, Ryan; Lopez, Gerard; Festo, Charles; Lyaruu, Pierre; Kenani, Mitya; Abdulla, Salim; Goodman, Catherine; Kachur, S. Patrick

    2014-01-01

    Background Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. Method and Findings A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6–18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9–11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2–6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5–7.4). Conclusion Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives

  17. A pharmacy too far? Equity and spatial distribution of outcomes in the delivery of subsidized artemisinin-based combination therapies through private drug shops

    PubMed Central

    2010-01-01

    Background Millions of individuals with malaria-like fevers purchase drugs from private retailers, but artemisinin-based combination therapies (ACTs), the only effective treatment in regions with high levels of resistance to older drugs, are rarely obtained through these outlets due to their relatively high cost. To encourage scale up of ACTs, the Affordable Medicines Facility – malaria is being launched to subsidize their price. The Government of Tanzania and the Clinton Foundation piloted this subsidized distribution model in two Tanzanian districts to examine concerns about whether the intervention will successfully reach poor, rural communities. Methods Stocking of ACTs and other antimalarial drugs in all retail shops was observed at baseline and in four subsequent surveys over 15 months. Exit interviews were conducted with antimalarial drug customers during each survey period. All shops and facilities were georeferenced, and variables related to population density and proximity to distribution hubs, roads, and other facilities were calculated. To understand the equity of impact, shops stocking ACTs and consumers buying them were compared to those that did not, according to geographic and socioeconomic variables. Patterning in ACT stocking and sales was evaluated against that of other common antimalarials to identify factors that may have impacted access. Qualitative data were used to assess motivations underlying stocking, distribution, and buying disparities. Results Results indicated that although total ACT purchases rose from negligible levels to nearly half of total antimalarial sales over the course of the pilot, considerable geographic variation in stocking and sales persisted and was related to a variety of socio-spatial factors; ACTs were stocked more often in shops located closer to district towns (p<0.01) and major roads (p<0.01) and frequented by individuals of higher socioeconomic status (p<0.01). However, other antimalarial drugs displayed

  18. Factors associated with non-adherence to Artemisinin-based combination therapy (ACT) to malaria in a rural population from holoendemic region of western Kenya

    PubMed Central

    2012-01-01

    Background Over the years, reports implicate improper anti-malarial use as a major contributor of morbidity and mortality amongst millions of residents in malaria endemic areas, Kenya included. However, there are limited reports on improper use of Artemisinin-based Combination Therapy (ACT) which is a first-line drug in the treatment of malaria in Kenya. Knowing this is important for ensured sustainable cure rates and also protection against the emergence of resistant malarial parasites. We therefore investigated ACT adherence level, factors associated with non-adherence and accessibility in households (n = 297) in rural location of Southeast Alego location in Siaya County in western Kenya. Methods ACT Adherence level was assessed with reference to the duration of treatment and number of tablets taken. Using systematic random sampling technique, a questionnaire was administered to a particular household member who had the most recent malaria episode (<2 weeks) and used ACT for cure. Parents/caretakers provided information for children aged <13 years. Key Informant Interviews (KIIs) were also conducted with healthcare providers and private dispensing chemist operators. Results Adherence to ACT prescription remained low at 42.1% and 57.9% among individuals above 13 and less than 13 years, respectively. Stratification by demographic and socio-economic characteristics in relation to ACT adherence revealed that age (P = 0.011), education level (P < 0.01), ability to read (P < 0.01) and household (HH) monthly income (P = 0.002) significantly affected the level of ACT adherence. Consistently, logistic regression model demonstrated that low age (OR, 0.571, 95% CI, 0.360-0.905; P = 0.017), higher education level (OR, 0.074; 95% CI 0.017-0.322; P < 0.01), ability to read (OR, 0.285, 95% CI, 0.167-0.486; P < 0.01) and higher income (Ksh. > 9000; OR, 0.340; 95% CI, 0.167-0.694; P = 0.003) were associated with ACT adherence. In

  19. Effect of Single Nucleotide Polymorphisms in Cytochrome P450 Isoenzyme and N-Acetyltransferase 2 Genes on the Metabolism of Artemisinin-Based Combination Therapies in Malaria Patients from Cambodia and Tanzania

    PubMed Central

    Staehli Hodel, Eva Maria; Csajka, Chantal; Ariey, Frédéric; Guidi, Monia; Kabanywanyi, Abdunoor Mulokozi; Duong, Socheat; Decosterd, Laurent Arthur; Olliaro, Piero; Genton, Blaise

    2013-01-01

    The pharmacogenetics of antimalarial agents are poorly known, although the application of pharmacogenetics might be critical in optimizing treatment. This population pharmacokinetic-pharmacogenetic study aimed at assessing the effects of single nucleotide polymorphisms (SNPs) in cytochrome P450 isoenzyme genes (CYP, namely, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5) and the N-acetyltransferase 2 gene (NAT2) on the pharmacokinetics of artemisinin-based combination therapies in 150 Tanzanian patients treated with artemether-lumefantrine, 64 Cambodian patients treated with artesunate-mefloquine, and 61 Cambodian patients treated with dihydroartemisinin-piperaquine. The frequency of SNPs varied with the enzyme and the population. Higher frequencies of mutant alleles were found in Cambodians than Tanzanians for CYP2C9*3, CYP2D6*10 (100C→T), CYP3A5*3, NAT2*6, and NAT2*7. In contrast, higher frequencies of mutant alleles were found in Tanzanians for CYP2D6*17 (1023C→T and 2850C→T), CYP3A4*1B, NAT2*5, and NAT2*14. For 8 SNPs, no significant differences in frequencies were observed. In the genetic-based population pharmacokinetic analyses, none of the SNPs improved model fit. This suggests that pharmacogenetic data need not be included in appropriate first-line treatments with the current artemisinin derivatives and quinolines for uncomplicated malaria in specific populations. However, it cannot be ruled out that our results represent isolated findings, and therefore more studies in different populations, ideally with the same artemisinin-based combination therapies, are needed to evaluate the influence of pharmacogenetic factors on the clearance of antimalarials. PMID:23229480

  20. Early variations in plasmodium falciparum dynamics in Nigerian children after treatment with two artemisinin-based combinations: implications on delayed parasite clearance

    PubMed Central

    2010-01-01

    Background Combination treatments, preferably containing an artemisinin derivative, are recommended to improve efficacy and prevent Plasmodium falciparum drug resistance. Artemether-lumefantrine (AL) and artesunate-amodiaquine (AA) are efficacious regimens that have been widely adopted in sub-Saharan Africa. However, most study designs ignore the effects of these regimens on peripheral parasitaemia in the first 24 hours of therapy. The study protocol was designed to evaluate more closely the early effects and the standard measures of efficacies of these two regimens. Methods In an open label, randomized controlled clinical trial, children aged 12 months to 132 months were randomized to receive AL (5-14 kg, one tablet; 15-24 kg, two tablets and 25-34 kg, three tablets twice daily) or artesunate (4 mg/kg daily) plus amodiaquine (10 mg/kg daily) for three days. Peripheral blood smears were made hourly in the first 4 hours, 8 h, 16 h, 24 h, and daily on days 2-7, and on days 7, 14, 21, 28, 35, and 42 for microscopic identification and quantification of Plasmodium falciparum. Results A total of 193 children were randomized to receive either AL (97) or AA (96). In children that received both medications, early response of peripheral parasitaemia showed that 42% of children who received AL and 36.7% of those who received AA had an immediate rise in peripheral parasitaemia (0-4 h after treatment) followed by a rapid fall. The rise in parasitaemia was significant and seems to suggest a mobilization of asexual parasites from the deep tissues to the periphery. Days 3, 7, 14, 28, and 42 cure rates in the per protocol (PP) population were > 90% in both groups of children. Both drug combinations were well tolerated with minimal side effects. Conclusion The study showed the high efficacy of AL and AA in Nigerian children. In addition the study demonstrated the mobilisation of asexual parasites from the deep to the periphery in the early hours of commencing ACT treatment in a

  1. Quality of Artemisinin-Based Combination Formulations for Malaria Treatment: Prevalence and Risk Factors for Poor Quality Medicines in Public Facilities and Private Sector Drug Outlets in Enugu, Nigeria

    PubMed Central

    Kaur, Harparkash; Allan, Elizabeth Louise; Mamadu, Ibrahim; Hall, Zoe; Ibe, Ogochukwu; El Sherbiny, Mohamed; van Wyk, Albert; Yeung, Shunmay; Swamidoss, Isabel; Green, Michael D.; Dwivedi, Prabha; Culzoni, Maria Julia; Clarke, Siân; Schellenberg, David; Fernández, Facundo M.; Onwujekwe, Obinna

    2015-01-01

    Background Artemisinin-based combination therapies are recommended by the World Health Organisation (WHO) as first-line treatment for Plasmodium falciparum malaria, yet medication must be of good quality for efficacious treatment. A recent meta-analysis reported 35% (796/2,296) of antimalarial drug samples from 21 Sub-Saharan African countries, purchased from outlets predominantly using convenience sampling, failed chemical content analysis. We used three sampling strategies to purchase artemisinin-containing antimalarials (ACAs) in Enugu metropolis, Nigeria, and compared the resulting quality estimates. Methods ACAs were purchased using three sampling approaches - convenience, mystery clients and overt, within a defined area and sampling frame in Enugu metropolis. The active pharmaceutical ingredients were assessed using high-performance liquid chromatography and confirmed by mass spectrometry at three independent laboratories. Results were expressed as percentage of APIs stated on the packaging and used to categorise each sample as acceptable quality, substandard, degraded, or falsified. Results Content analysis of 3024 samples purchased from 421 outlets using convenience (n=200), mystery (n=1,919) and overt (n=905) approaches, showed overall 90.8% ACAs to be of acceptable quality, 6.8% substandard, 1.3% degraded and 1.2% falsified. Convenience sampling yielded a significantly higher prevalence of poor quality ACAs, but was not evident by the mystery and overt sampling strategies both of which yielded results that were comparable between each other. Artesunate (n=135; 4 falsified) and dihydroartemisinin (n=14) monotherapy tablets, not recommended by WHO, were also identified. Conclusion Randomised sampling identified fewer falsified ACAs than previously reported by convenience approaches. Our findings emphasise the need for specific consideration to be given to sampling frame and sampling approach if representative information on drug quality is to be obtained

  2. Status of allele frequency and diversity of Plasmodium falciparum msp1, msp2 and glurp before implementation of an artemisinin-based combined therapy in Northwestern Colombia.

    PubMed Central

    Arango, Eliana; Carmona-Fonseca, Jaime

    2013-01-01

    Introduction: The status of msp1, msp2 and glurp allele frequency and the diversity of Plasmodium falciparum in Northwestern Colombia before the implementation of an artemisinin-combined therapy have been explored only by a few authors and in a relatively small number of samples from this highly endemic region. Objective: To evaluate the frequency of msp1, msp2, and glurp alleles and the diversity of P. falciparum in two Colombian regions before the use of an artemisinin-combined therapy. Methods: This study was part of a major anti-malarial efficacy trial designed as a random, clinically-controlled study for which 224 subjects were recruited. Region 2 of msp1 and msp2 (central region) were amplified by a nested PCR; glurp (region R2) was amplified by a semi-nested PCR. Results: For msp1, five genotypes were observed, representing the K1, MAD20, and RO33 allelic families. All samples corresponded to a MAD20 150 bp allele. For msp2 (IC family), two alleles were detected and for glurp, eight were observed. A total 33 haplotypes were detected. Conclusions: Analysis of glurpcan be used to successfully genotype parasite populations in the new studies in Colombia aimed at exploring Plasmodium spp population dynamics. In addition, analysis of msp1 and msp2 can also be of value for comparisons with past studies, but not when the objective is to study parasites obtained from the same patient in a reduced period of time; for instance, during treatment efficacy studies. PMID:24892236

  3. Artemisinin-Based Treatments in Pregnant Women with Malaria.

    PubMed

    Adekunle, Adeshina I; Cromer, Deborah; Davenport, Miles P

    2016-07-21

    To the Editor: The Pregnancy Artemisinin-Based Combination Treatments (PREGACT) Study Group compared the polymerase-chain-reaction (PCR)-adjusted "recrudescence" rates of Plasmodium falciparum infection after treatment and suggest that this indicates the failure to eradicate the initial infection (March 10 issue).(1) However, analysis of the PCR-adjusted and PCR-unadjusted survival curves of time to "treatment failure" (Fig. S1 in the Supplementary Appendix, available with the full text of the article at NEJM.org) suggests that the curves are equally well explained by a constant rate of new infections, a proportion of which are misclassified as recrudescent. The percentage of infections classified as recrudescent is 9.9% . . . PMID:27468068

  4. Artemisinin-Based Treatments in Pregnant Women with Malaria.

    PubMed

    2016-07-21

    To the Editor: The Pregnancy Artemisinin-Based Combination Treatments (PREGACT) Study Group compared the polymerase-chain-reaction (PCR)-adjusted "recrudescence" rates of Plasmodium falciparum infection after treatment and suggest that this indicates the failure to eradicate the initial infection (March 10 issue).(1) However, analysis of the PCR-adjusted and PCR-unadjusted survival curves of time to "treatment failure" (Fig. S1 in the Supplementary Appendix, available with the full text of the article at NEJM.org) suggests that the curves are equally well explained by a constant rate of new infections, a proportion of which are misclassified as recrudescent. The percentage of infections classified as recrudescent is 9.9% . . . PMID:27468067

  5. Access to artemisinin-based anti-malarial treatment and its related factors in rural Tanzania

    PubMed Central

    2013-01-01

    Background Artemisinin-based combination treatment (ACT) has been widely adopted as one of the main malaria control strategies. However, its promise to save thousands of lives in sub-Saharan Africa depends on how effective the use of ACT is within the routine health system. The INESS platform evaluated effective coverage of ACT in several African countries. Timely access within 24 hours to an authorized ACT outlet is one of the determinants of effective coverage and was assessed for artemether-lumefantrine (Alu), in two district health systems in rural Tanzania. Methods From October 2009 to June 2011we conducted continuous rolling household surveys in the Kilombero-Ulanga and the Rufiji Health and Demographic Surveillance Sites (HDSS). Surveys were linked to the routine HDSS update rounds. Members of randomly pre-selected households that had experienced a fever episode in the previous two weeks were eligible for a structured interview. Data on individual treatment seeking, access to treatment, timing, source of treatment and household costs per episode were collected. Data are presented on timely access from a total of 2,112 interviews in relation to demographics, seasonality, and socio economic status. Results In Kilombero-Ulanga, 41.8% (CI: 36.6–45.1) and in Rufiji 36.8% (33.7–40.1) of fever cases had access to an authorized ACT provider within 24 hours of fever onset. In neither of the HDSS site was age, sex, socio-economic status or seasonality of malaria found to be significantly correlated with timely access. Conclusion Timely access to authorized ACT providers is below 50% despite interventions intended to improve access such as social marketing and accreditation of private dispensing outlets. To improve prompt diagnosis and treatment, access remains a major bottle neck and new more innovative interventions are needed to raise effective coverage of malaria treatment in Tanzania. PMID:23651521

  6. CRISPR-Cas9-modified pfmdr1 protects Plasmodium falciparum asexual blood stages and gametocytes against a class of piperazine-containing compounds but potentiates artemisinin-based combination therapy partner drugs.

    PubMed

    Ng, Caroline L; Siciliano, Giulia; Lee, Marcus C S; de Almeida, Mariana J; Corey, Victoria C; Bopp, Selina E; Bertuccini, Lucia; Wittlin, Sergio; Kasdin, Rachel G; Le Bihan, Amélie; Clozel, Martine; Winzeler, Elizabeth A; Alano, Pietro; Fidock, David A

    2016-08-01

    Emerging resistance to first-line antimalarial combination therapies threatens malaria treatment and the global elimination campaign. Improved therapeutic strategies are required to protect existing drugs and enhance treatment efficacy. We report that the piperazine-containing compound ACT-451840 exhibits single-digit nanomolar inhibition of the Plasmodium falciparum asexual blood stages and transmissible gametocyte forms. Genome sequence analyses of in vitro-derived ACT-451840-resistant parasites revealed single nucleotide polymorphisms in pfmdr1, which encodes a digestive vacuole membrane-bound ATP-binding cassette transporter known to alter P. falciparum susceptibility to multiple first-line antimalarials. CRISPR-Cas9 based gene editing confirmed that PfMDR1 point mutations mediated ACT-451840 resistance. Resistant parasites demonstrated increased susceptibility to the clinical drugs lumefantrine, mefloquine, quinine and amodiaquine. Stage V gametocytes harboring Cas9-introduced pfmdr1 mutations also acquired ACT-451840 resistance. These findings reveal that PfMDR1 mutations can impart resistance to compounds active against asexual blood stages and mature gametocytes. Exploiting PfMDR1 resistance mechanisms provides new opportunities for developing disease-relieving and transmission-blocking antimalarials. PMID:27073104

  7. Adoption

    MedlinePlus

    ... the birth nor adoptive parents know the others' identities. Other adoptions are handled more openly. Open adoptions, ... desire to seek out more information about the identity of the birth family. Most of us (whether ...

  8. [Adoption].

    ERIC Educational Resources Information Center

    Pawl, Jeree, Ed.; And Others

    1990-01-01

    This newsletter theme issue addresses adoption and the young child's life. Contributors suggest ways in which practitioners in many professions and settings can better understand and support adoptive families. The first article, "Adoption, 1990" by Barbara F. Nordhaus and Albert J. Solnit, reviews the history of adoption and notes obstacles to…

  9. Measuring the association between artemisinin-based case management and malaria incidence in southern Vietnam, 1991-2010.

    PubMed

    Peak, Corey M; Thuan, Phung Duc; Britton, Amadea; Nguyen, Tran Dang; Wolbers, Marcel; Thanh, Ngo Viet; Buckee, Caroline O; Boni, Maciej F

    2015-04-01

    In addition to being effective, fast-acting, and well tolerated, artemisinin-based combination therapies (ACTs) are able to kill certain transmission stages of the malaria parasite. However, the population-level impacts of ACTs on reducing malaria transmission have been difficult to assess. In this study on the history of malaria control in Vietnam, we assemble annual reporting on malaria case counts, coverage with insecticide-treated nets (ITN) and indoor residual spraying (IRS), and drug purchases by provincial malaria control programs from 1991 to 2010 in Vietnam's 20 southern provinces. We observe a significant negative association between artemisinin use and malaria incidence, with a 10% absolute increase in the purchase proportion of artemisinin-containing regimens being associated with a 29.1% (95% confidence interval: 14.8-41.0%) reduction in slide-confirmed malaria incidence, after accounting for changes in urbanization, ITN/IRS coverage, and two indicators of health system capacity. One budget-related indicator of health system capacity was found to have a smaller association with malaria incidence, and no other significant factors were found. Our findings suggest that including an artemisinin component in malaria drug regimens was strongly associated with reduced malaria incidence in southern Vietnam, whereas changes in urbanization and coverage with ITN or IRS were not. PMID:25667053

  10. Measuring the Association between Artemisinin-Based Case Management and Malaria Incidence in Southern Vietnam, 1991–2010

    PubMed Central

    Peak, Corey M.; Thuan, Phung Duc; Britton, Amadea; Nguyen, Tran Dang; Wolbers, Marcel; Thanh, Ngo Viet; Buckee, Caroline O.; Boni, Maciej F.

    2015-01-01

    In addition to being effective, fast-acting, and well tolerated, artemisinin-based combination therapies (ACTs) are able to kill certain transmission stages of the malaria parasite. However, the population-level impacts of ACTs on reducing malaria transmission have been difficult to assess. In this study on the history of malaria control in Vietnam, we assemble annual reporting on malaria case counts, coverage with insecticide-treated nets (ITN) and indoor residual spraying (IRS), and drug purchases by provincial malaria control programs from 1991 to 2010 in Vietnam's 20 southern provinces. We observe a significant negative association between artemisinin use and malaria incidence, with a 10% absolute increase in the purchase proportion of artemisinin-containing regimens being associated with a 29.1% (95% confidence interval: 14.8–41.0%) reduction in slide-confirmed malaria incidence, after accounting for changes in urbanization, ITN/IRS coverage, and two indicators of health system capacity. One budget-related indicator of health system capacity was found to have a smaller association with malaria incidence, and no other significant factors were found. Our findings suggest that including an artemisinin component in malaria drug regimens was strongly associated with reduced malaria incidence in southern Vietnam, whereas changes in urbanization and coverage with ITN or IRS were not. PMID:25667053

  11. Evaluation of the Quality of Artemisinin-Based Antimalarial Medicines Distributed in Ghana and Togo

    PubMed Central

    Agbonon, Amegnona; Konadu, Daniel Yeboah; Edoh, Mamadou; Gordon, Andrew; Gbeassor, Messanvi; Addae-Mensah, Ivan

    2014-01-01

    This study, conducted as part of our overall goal of regular pharmacovigilance of antimalarial medicines, reports on the quality of 132 artemisinin-based antimalarial medicines distributed in Ghana and Togo. Three methods were employed in the quality evaluation—basic (colorimetric) tests for establishing the identity of the requisite active pharmaceutical ingredients (APIs), semi-quantitative TLC assay for the identification and estimation of API content, and HPLC assay for a more accurate quantification of API content. From the basic tests, only one sample totally lacked API. The HPLC assay, however, showed that 83.7% of the ACTs and 57.9% of the artemisinin-based monotherapies failed to comply with international pharmacopoeia requirements due to insufficient API content. In most of the ACTs, the artemisinin component was usually the insufficient API. Generally, there was a good correlation between the HPLC and SQ-TLC assays. The overall failure rates for both locally manufactured (77.3%) and imported medicines (77.5%) were comparable. Similarly the unregistered medicines recorded a slightly higher overall failure rate (84.7%) than registered medicines (70.8%). Only two instances of possible cross-border exchange of medicines were observed and there was little difference between the medicine quality of collections from border towns and those from inland parts of both countries. PMID:25400975

  12. Adoptive immunotherapy combined chemoradiotherapy for non-small-cell lung cancer: a meta-analysis.

    PubMed

    Qian, Haili; Wang, Haijuan; Guan, Xiuwen; Yi, Zongbi; Ma, Fei

    2016-06-01

    The aim of this study was to compare the efficacies between adoptive immunotherapy combined chemoradiotherapy and chemoradiotherapy alone in patients with non-small-cell lung cancer (NSCLC). The databases PubMed, EMBASE, and Cochrane database were searched to identify eligible clinical trials. Data analyses were carried out using a comprehensive meta-analysis program, version 2 software. A total of seven articles were finally included in the analysis. Meta-analyses showed that compared with chemoradiotherapy alone, adoptive immunotherapy combined with chemoradiotherapy could improve the 2-year overall survival [odds ratio (OR)=2.45, 95% confidence interval (CI): 1.60-3.75, P<0.001], but not 2-year progression-free survival (OR=1.81, 95% CI: 0.61-5.36, P=0.284). Specifically, early (OR=3.32, 95% CI: 1.38-7.95, P<0.01) but not advanced (OR=3.75, 95% CI: 0.96-14.68, P=0.057) NSCLC patients were likely to gain a large benefit from the adoptive immunotherapy. Most of the adoptive immunotherapy-induced adverse effects were self-limited, mainly including fever, shiver, nausea, fatigue, etc. and severe toxicities were not observed. Adoptive immunotherapy combined with chemoradiotherapy can delay the recurrence of NSCLC and improve survival in patients, where the benefits are even more significant in patients with early-stage NSCLC. PMID:26872311

  13. Early efficacy of stereotactic body radiation therapy combined with adoptive immunotherapy for advanced malignancies

    PubMed Central

    WANG, YI-SHAN; YANG, GUIQING; WANG, YUAN-YUAN; YANG, JIA-LIN; YANG, KE

    2013-01-01

    Stereotactic body radiation therapy (SBRT) concentrates radiation to a predefined target, affecting all the cells within it. Adoptive immunotherapy is not restricted by the major histocompatibility complex (MHC) in recognizing and eliminating target cells. We investigated the effects of the combined modality of SBRT and adoptive immunotherapy on patients with advanced malignant tumors. The database of 316 patients with 845 tumors who underwent SBRT between April, 2010 and February, 2012 was retrospectively reviewed. Of the 316 patients, 145 received biological immunotherapy and were assigned into the observation group, whereas the remaining patients constituted the control group. Patients in the two groups were recorded on efficacy assessment, Karnofsky performance status (KPS), cell phenotype expression level in vitro and the percentages of lymphocyte subsets and ratio of CD4+/CD8+ lymphocytes in the peripheral blood. Following treatment, the total effectiveness [complete response (CR) + partial response (PR)], the KPS score, the percentages of lymphocyte subsets and the CD4+/CD8+ lymphocyte ratio in the observation group were higher compared to those in the control group, with a statistically significant difference (P<0.05). The expression of CD3+ and CD3+CD56+ cytokine-induced killer (CIK) cells were increased from 56.76±4.54% and 11.32±2.96% to 94.67±4.46% and 32.65±1.12%, respectively, when cultured in vitro (P<0.01). The percentages of lymphocyte subsets and the CD4+/CD8+ lymphocyte ratio were significantly increased compared to prior to treatment in the observation group (P<0.05). SBRT combined with adoptive immunotherapy may be a novel therapeutic option for patients with advanced malignant tumors. PMID:24649272

  14. Combining α-Radioimmunotherapy and Adoptive T Cell Therapy to Potentiate Tumor Destruction.

    PubMed

    Ménager, Jérémie; Gorin, Jean-Baptiste; Maurel, Catherine; Drujont, Lucile; Gouard, Sébastien; Louvet, Cédric; Chérel, Michel; Faivre-Chauvet, Alain; Morgenstern, Alfred; Bruchertseifer, Frank; Davodeau, François; Gaschet, Joëlle; Guilloux, Yannick

    2015-01-01

    Ionizing radiation induces direct and indirect killing of cancer cells and for long has been considered as immunosuppressive. However, this concept has evolved over the past few years with the demonstration that irradiation can increase tumor immunogenicity and can actually favor the implementation of an immune response against tumor cells. Adoptive T-cell transfer (ACT) is also used to treat cancer and several studies have shown that the efficacy of this immunotherapy was enhanced when combined with radiation therapy. α-Radioimmunotherapy (α-RIT) is a type of internal radiotherapy which is currently under development to treat disseminated tumors. α-particles are indeed highly efficient to destroy small cluster of cancer cells with minimal impact on surrounding healthy tissues. We thus hypothesized that, in the setting of α-RIT, an immunotherapy like ACT, could benefit from the immune context induced by irradiation. Hence, we decided to further investigate the possibilities to promote an efficient and long-lasting anti-tumor response by combining α-RIT and ACT. To perform such study we set up a multiple myeloma murine model which express the tumor antigen CD138 and ovalbumine (OVA). Then we evaluated the therapeutic efficacy in the mice treated with α-RIT, using an anti-CD138 antibody coupled to bismuth-213, followed by an adoptive transfer of OVA-specific CD8+ T cells (OT-I CD8+ T cells). We observed a significant tumor growth control and an improved survival in the animals treated with the combined treatment. These results demonstrate the efficacy of combining α-RIT and ACT in the MM model we established. PMID:26098691

  15. Combining α-Radioimmunotherapy and Adoptive T Cell Therapy to Potentiate Tumor Destruction

    PubMed Central

    Ménager, Jérémie; Gorin, Jean-Baptiste; Maurel, Catherine; Drujont, Lucile; Gouard, Sébastien; Louvet, Cédric; Chérel, Michel; Faivre-Chauvet, Alain; Morgenstern, Alfred; Bruchertseifer, Frank; Davodeau, François

    2015-01-01

    Ionizing radiation induces direct and indirect killing of cancer cells and for long has been considered as immunosuppressive. However, this concept has evolved over the past few years with the demonstration that irradiation can increase tumor immunogenicity and can actually favor the implementation of an immune response against tumor cells. Adoptive T-cell transfer (ACT) is also used to treat cancer and several studies have shown that the efficacy of this immunotherapy was enhanced when combined with radiation therapy. α-Radioimmunotherapy (α-RIT) is a type of internal radiotherapy which is currently under development to treat disseminated tumors. α-particles are indeed highly efficient to destroy small cluster of cancer cells with minimal impact on surrounding healthy tissues. We thus hypothesized that, in the setting of α-RIT, an immunotherapy like ACT, could benefit from the immune context induced by irradiation. Hence, we decided to further investigate the possibilities to promote an efficient and long-lasting anti-tumor response by combining α-RIT and ACT. To perform such study we set up a multiple myeloma murine model which express the tumor antigen CD138 and ovalbumine (OVA). Then we evaluated the therapeutic efficacy in the mice treated with α-RIT, using an anti-CD138 antibody coupled to bismuth-213, followed by an adoptive transfer of OVA-specific CD8+ T cells (OT-I CD8+ T cells). We observed a significant tumor growth control and an improved survival in the animals treated with the combined treatment. These results demonstrate the efficacy of combining α-RIT and ACT in the MM model we established. PMID:26098691

  16. Effects of a carbon tax on microgrid combined heat and power adoption

    SciTech Connect

    Siddiqui, Afzal S.; Marnay, Chris; Edwards, Jennifer L.; Firestone, Ryan M.; Ghosh, Srijay; Stadler, Michael

    2004-11-01

    This paper describes the economically optimal adoption and operation of distributed energy resources (DER) by a hypothetical California microgrid consisting of a group of commercial buildings over an historic test year, 1999. The optimization is conducted using a customer adoption model (DER-CAM) developed at Berkeley Lab and implemented in the General Algebraic Modeling System (GAMS). A microgrid is a semiautonomous grouping of electricity and heat loads interconnected to the existing utility grid (macrogrid) but able to island from it. The microgrid minimizes the cost of meeting its energy requirements (consisting of both electricity and heat loads) by optimizing the installation and operation of DER technologies while purchasing residual energy from the local combined natural gas and electricity utility. The available DER technologies are small-scale generators (< 500 kW), such as reciprocating engines, microturbines, and fuel cells, with or without combined heat and power (CHP) equipment, such as water and space heating and/or absorption cooling. By introducing a tax on carbon emissions, it is shown that if the microgrid is allowed to install CHP-enabled DER technologies, its carbon emissions are mitigated more than without CHP, demonstrating the potential benefits of small-scale CHP technology for climate change mitigation. Reciprocating engines with heat recovery and/or absorption cooling tend to be attractive technologies for the mild southern California climate, but the carbon mitigation tends to be modest compared to purchasing utility electricity because of the predominance of relatively clean central station generation in California.

  17. Cancer treatment by photodynamic therapy combined with NK-cell-line-based adoptive immunotherapy

    NASA Astrophysics Data System (ADS)

    Korbelik, Mladen; Sun, Jinghai

    1998-05-01

    Treatment of solid cancers by photodynamic therapy (PDT) triggers a strong acute inflammatory reaction localized to the illuminated malignant tissue. This event is regulated by a massive release of various potent mediators which have a profound effect not only on local host cell populations, but also attract different types of immune cells to the treated tumor. Phagocytosis of PDT-damaged cancerous cells by antigen presenting cells, such as activated tumor associated macrophages, enables the recognition of even poorly immunogenic tumors by specific immune effector cells and the generation of immune memory populations. Because of its inflammatory/immune character, PDT is exceptionally responsive to adjuvant treatments with various types of immunotherapy. Combining PDT with immuneactivators, such as cytokines or other specific or non-specific immune agents, rendered marked improvements in tumor cures with various cancer models. Another clinically attractive strategy is adoptive immunotherapy, and the prospects of its use in conjunction with PDT are outlined.

  18. Intermittent preventive treatment using artemisinin-based combination therapy reduces malaria morbidity among school-aged children in Mali

    PubMed Central

    Barger, Breanna; Maiga, Hamma; Traore, Oumar Bila; Tekete, Mamadou; Tembine, Intimbeye; Dara, Antoine; Traore, Zoumana Isaac; Gantt, Soren; Doumbo, Ogobara K.; Djimde, Abdoulaye A.

    2011-01-01

    Summary OBJECTIVE To assess the efficacy of intermittent preventive treatment (IPT) against malaria in school-aged children. METHODS This was an open randomized controlled trial of seasonal IPT among school children (IPTsc) aged 6–13 years in Kollé, Mali. The study began in September 2007 and completed follow-up in May 2008. Students were randomized to one of three study arms: Sulfadoxine–pyrimethamine plus artesunate (SP/AS), amodiaquine plus artesunate (AQ/AS) or vitamin C. All students received two full treatment doses, given 2 months apart during the season of high transmission from September to December. Groups were compared with respect to incidence of clinical malaria, asymptomatic parasitemia and haemoglobin concentration. RESULTS A total of 296 students were randomized, and retention in the study was 99.3%. Clinical malaria incidence in the SP/AS and AQ/AS arms was reduced by 66.6% and 46.5%, respectively, vs. vitamin C (P < 0.001). There were fewer clinic visits for any cause among the children receiving SP/AS or AQ/AS (P = 0.024). The prevalence of asymptomatic parasitemia was fivefold higher in the vitamin C arm than either SP/AS or AQ/AS at each post-treatment evaluation (P < 0.001). At the end of the transmission period, children treated with IPT had lower rates of anaemia (SP/AS, 17.7%; AQ/AS, 16.0%; vitamin C, 29.6%; P = 0.039). CONCLUSION IPT among school children reduced the rates of clinical malaria, all-cause acute clinic visits, asymptomatic parasitemia and anaemia among school-aged children. PMID:19497079

  19. Effects of a carbon tax on combined heat and power adoption by a microgrid

    SciTech Connect

    Marnay, Chris; Edwards, Jennifer L.; Firestone, Ryan M.; Ghosh, Srijay; Siddidqui, Afzal S.; Stadler, Michael

    2002-10-01

    This paper describes the economically optimal adoption and operation of distributed energy resources (DER) by a hypothetical California microgrid ((mu)Grid) consisting of a group of commercial buildings over an historic test year, 1999. The optimization is conducted using a customer adoption model (DER-CAM) developed at Berkeley Lab and implemented in the General Algebraic Modeling System (GAMS). A (mu)Grid is a semiautonomous grouping of electricity and heat loads interconnected to the existing utility grid (macrogrid) but able to island from it. The (mu)Grid minimizes the cost of meeting its energy requirements (consisting of both electricity and heat loads) by optimizing the installation and operation of DER technologies while purchasing residual energy from the local combined natural gas and electricity utility. The available DER technologies are small-scale generators (< 500 kW), such as reciprocating engines, microturbines, and fuel cells, with or without CHP equipment, such as water- and space-heating and/or absorption cooling. By introducing a tax on carbon emissions, it is shown that if the (mu)Grid is allowed to install CHP-enabled DER technologies, its carbon emissions are mitigated more than without CHP, demonstrating the potential benefits of small-scale CHP technology for climate change mitigation. Reciprocating engines with heat recovery and/or absorption cooling tend to be attractive technologies for the mild southern California climate, but the carbon mitigation tends to be modest compared to purchasing utility electricity because of the predominance of relatively clean generation in California.

  20. Distributed energy resources customer adoption modeling with combined heat and power applications

    SciTech Connect

    Siddiqui, Afzal S.; Firestone, Ryan M.; Ghosh, Srijay; Stadler, Michael; Edwards, Jennifer L.; Marnay, Chris

    2003-07-01

    In this report, an economic model of customer adoption of distributed energy resources (DER) is developed. It covers progress on the DER project for the California Energy Commission (CEC) at Berkeley Lab during the period July 2001 through Dec 2002 in the Consortium for Electric Reliability Technology Solutions (CERTS) Distributed Energy Resources Integration (DERI) project. CERTS has developed a specific paradigm of distributed energy deployment, the CERTS Microgrid (as described in Lasseter et al. 2002). The primary goal of CERTS distributed generation research is to solve the technical problems required to make the CERTS Microgrid a viable technology, and Berkeley Lab's contribution is to direct the technical research proceeding at CERTS partner sites towards the most productive engineering problems. The work reported herein is somewhat more widely applicable, so it will be described within the context of a generic microgrid (mGrid). Current work focuses on the implementation of combined heat and power (CHP) capability. A mGrid as generically defined for this work is a semiautonomous grouping of generating sources and end-use electrical loads and heat sinks that share heat and power. Equipment is clustered and operated for the benefit of its owners. Although it can function independently of the traditional power system, or macrogrid, the mGrid is usually interconnected and exchanges energy and possibly ancillary services with the macrogrid. In contrast to the traditional centralized paradigm, the design, implementation, operation, and expansion of the mGrid is meant to optimize the overall energy system requirements of participating customers rather than the objectives and requirements of the macrogrid.

  1. Malaria treatment failures after artemisinin-based therapy in three expatriates: could improved manufacturer information help to decrease the risk of treatment failure ?

    PubMed Central

    Jackson, Yves; Chappuis, François; Loutan, Louis; Taylor, Walter

    2006-01-01

    Background Artemisinin-containing therapies are highly effective against Plasmodium falciparum malaria. Insufficient numbers of tablets and inadequate package inserts result in sub-optimal dosing and possible treatment failure. This study reports the case of three, non-immune, expatriate workers with P. falciparum acquired in Africa, who failed to respond to artemisinin-based therapy. Sub-therapeutic dosing in accordance with the manufacturers' recommendations was the probable cause. Method Manufacturers information and drug content included in twenty-five artemisinin-containing specialities were reviewed. Results A substantial number of manufacturers do not follow current WHO recommendations regarding treatment duration and doses. Conclusion This study shows that drug packaging and their inserts should be improved. PMID:17020598

  2. Combining Antiangiogenic Therapy with Adoptive Cell Immunotherapy Exerts Better Antitumor Effects in Non-Small Cell Lung Cancer Models

    PubMed Central

    Shi, Shujing; Wang, Rui; Chen, Yitian; Song, Haizhu; Chen, Longbang; Huang, Guichun

    2013-01-01

    Introduction Cytokine-induced killer cells (CIK cells) are a heterogeneous subset of ex-vivo expanded T lymphocytes which are characterized with a MHC-unrestricted tumor-killing activity and a mixed T-NK phenotype. Adoptive CIK cells transfer, one of the adoptive immunotherapy represents a promising nontoxic anticancer therapy. However, in clinical studies, the therapeutic activity of adoptive CIK cells transfer is not as efficient as anticipated. Possible explanations are that abnormal tumor vasculature and hypoxic tumor microenvironment could impede the infiltration and efficacy of lymphocytes. We hypothesized that antiangiogenesis therapy could improve the antitumor activity of CIK cells by normalizing tumor vasculature and modulating hypoxic tumor microenvironment. Methods We combined recombinant human endostatin (rh-endostatin) and CIK cells in the treatment of lung carcinoma murine models. Intravital microscopy, dynamic contrast enhanced magnetic resonance imaging, immunohistochemistry, and flow cytometry were used to investigate the tumor vasculature and hypoxic microenvironment as well as the infiltration of immune cells. Results Our results indicated that rh-endostatin synergized with adoptive CIK cells transfer to inhibit the growth of lung carcinoma. We found that rh-endostatin normalized tumor vasculature and reduced hypoxic area in the tumor microenvironment. Hypoxia significantly inhibited the proliferation, cytotoxicity and migration of CIK cells in vitro and impeded the homing of CIK cells into tumor parenchyma ex vivo. Furthermore, we found that treatment with rh-endostatin significantly increased the homing of CIK cells and decreased the accumulation of suppressive immune cells in the tumor tissue. In addition, combination therapy produced higher level of tumor-infiltration lymphocytes compared with other treatments. Conclusions Our results demonstrate that rh-endostatin improves the therapeutic effect of adoptive CIK cells therapy against lung

  3. Shared environmental influences on personality: A combined twin and adoption approach

    PubMed Central

    Matteson, Lindsay K.; McGue, Matt; Iacono, William G.

    2013-01-01

    In the past, shared environmental influences on personality traits have been found to be negligible in behavior genetic studies (e.g., Bouchard & McGue, 2003). However, most studies have been based on biometrical modeling of twins only. Failure to meet key assumptions of the classical twin design could lead to biased estimates of shared environmental effects. Alternative approaches to the etiology of personality are needed. In the current study we estimated the impact of shared environmental factors on adolescent personality by simultaneously modeling both twin and adoption data. We found evidence for significant shared environmental influences on Multidimensional Personality Questionnaire (MPQ) Absorption (15% variance explained), Alienation (10%), Harm Avoidance (14%), and Traditionalism (26%) scales. Additionally, we found that in most cases biometrical models constraining parameter estimates to be equal across study type (twins versus adoptees) fit no worse than models allowing these parameters to vary; this suggests that results converge across study design despite the potential (sometimes opposite) biases of twin and adoption studies. Thus, we can be more confident that our findings represent the true contribution of shared environmental variance to personality development. PMID:24065564

  4. Systemic Combination Virotherapy for Melanoma with Tumor Antigen-Expressing Vesicular Stomatitis Virus and Adoptive T-cell Transfer

    PubMed Central

    Rommelfanger, Diana M.; Wongthida, Phonphimon; Diaz, Rosa M.; Kaluza, Karen M.; Thompson, Jill M.; Kottke, Timothy J.; Vile, Richard G.

    2013-01-01

    Oncolytic virotherapy offers the potential to treat tumors both as a single agent and in combination with traditional modalities such as chemotherapy and radiotherapy. Here we describe an effective, fully systemic treatment regimen, which combines virotherapy, acting essentially as an adjuvant immunotherapy, with adoptive cell transfer (ACT). The combination of ACT with systemic administration of a vesicular stomatitis virus (VSV) engineered to express the endogenous melanocyte antigen glycoprotein 100 (gp100) resulted in regression of established melanomas and generation of antitumor immunity. Tumor response was associated with in vivo T-cell persistence and activation as well as treatment-related vitiligo. However, in a proportion of treated mice, initial tumor regressions were followed by recurrences. Therapy was further enhanced by targeting an additional tumor antigen with the VSV-antigen + ACT combination strategy, leading to sustained response in 100% of mice. Together, our findings suggest that systemic virotherapy combined with antigen-expressing VSV could be used to support and enhance clinical immunotherapy protocols with adoptive T-cell transfer, which are already used in the clinic. PMID:22836753

  5. Artemisinin-based antimalarial research: application of biotechnology to the production of artemisinin, its mode of action, and the mechanism of resistance of Plasmodium parasites.

    PubMed

    Muangphrom, Paskorn; Seki, Hikaru; Fukushima, Ery Odette; Muranaka, Toshiya

    2016-07-01

    Malaria is a worldwide disease caused by Plasmodium parasites. A sesquiterpene endoperoxide artemisinin isolated from Artemisia annua was discovered and has been accepted for its use in artemisinin-based combinatorial therapies, as the most effective current antimalarial treatment. However, the quantity of this compound produced from the A. annua plant is very low, and the availability of artemisinin is insufficient to treat all infected patients. In addition, the emergence of artemisinin-resistant Plasmodium has been reported recently. Several techniques have been applied to enhance artemisinin availability, and studies related to its mode of action and the mechanism of resistance of malaria-causing parasites are ongoing. In this review, we summarize the application of modern technologies to improve the production of artemisinin, including our ongoing research on artemisinin biosynthetic genes in other Artemisia species. The current understanding of the mode of action of artemisinin as well as the mechanism of resistance against this compound in Plasmodium parasites is also presented. Finally, the current situation of malaria infection and the future direction of antimalarial drug development are discussed. PMID:27250562

  6. Combining the Power of Statistical Analyses and Community Interviews to Identify Adoption Barriers for Stormwater Best-Management Practices

    NASA Astrophysics Data System (ADS)

    Hoover, F. A.; Bowling, L. C.; Prokopy, L. S.

    2015-12-01

    Urban stormwater is an on-going management concern in municipalities of all sizes. In both combined or separated sewer systems, pollutants from stormwater runoff enter the natural waterway system during heavy rain events. Urban flooding during frequent and more intense storms are also a growing concern. Therefore, stormwater best-management practices (BMPs) are being implemented in efforts to reduce and manage stormwater pollution and overflow. The majority of BMP water quality studies focus on the small-scale, individual effects of the BMP, and the change in water quality directly from the runoff of these infrastructures. At the watershed scale, it is difficult to establish statistically whether or not these BMPs are making a difference in water quality, given that watershed scale monitoring is often costly and time consuming, relying on significant sources of funds, which a city may not have. Hence, there is a need to quantify the level of sampling needed to detect the water quality impact of BMPs at the watershed scale. In this study, a power analysis was performed on data from an urban watershed in Lafayette, Indiana, to determine the frequency of sampling required to detect a significant change in water quality measurements. Using the R platform, results indicate that detecting a significant change in watershed level water quality would require hundreds of weekly measurements, even when improvement is present. The second part of this study investigates whether the difficulty in demonstrating water quality change represents a barrier to adoption of stormwater BMPs. Semi-structured interviews of community residents and organizations in Chicago, IL are being used to investigate residents understanding of water quality and best management practices and identify their attitudes and perceptions towards stormwater BMPs. Second round interviews will examine how information on uncertainty in water quality improvements influences their BMP attitudes and perceptions.

  7. Dynamics of Plasmodium falciparum Parasitemia Regarding Combined Treatment Regimens for Acute Uncomplicated Malaria, Antioquia, Colombia

    PubMed Central

    Álvarez, Gonzalo; Tobón, Alberto; Piñeros, Juan-Gabriel; Ríos, Alexandra; Blair, Silvia

    2010-01-01

    Selecting suitable anti-malarial treatment represents one of the best tools for reducing morbidity and mortality caused by this disease. Sexual and asexual parasite dynamics were thus evaluated in patients involved in antimalarial drug efficacy studies by using combined treatment with and without artemisinin derivatives for treating uncomplicated acute Plasmodium falciparum malaria in Antioquia, Colombia. All treatment doses were supervised and administered according to patients' weight; sexual and asexual parasitemia were evaluated during 28- or 42-days follow-up in 468 patients. Artemisinin-based combination therapy showed greater parasiticidal ability, showing a mean asexual parasitemia survival rate of one day and mean gametocyte survival rate of 1–2 days. Sexual and asexual parasitemias were eliminated more quickly and effectively in the group receiving artemisinin-based combination therapy. Adding 45 mg of primaquine to treatment with artesunate and mefloquine reduced gametocyte and asexual parasite survival by one day. PMID:20595483

  8. Modulation of tumor response to photodynamic therapy in severe combined immunodeficient (SCID) mice by adoptively transferred lymphoid cells

    NASA Astrophysics Data System (ADS)

    Korbelik, Mladen; Krosl, Gorazd; Krosl, Jana; Dougherty, Graeme J.

    1996-04-01

    Photodynamic treatment, consisting of intravenous injection of PhotofrinR (10 mg/kg) followed by exposure to 110 J/cm2 of 630 plus or minus 10 nm light 24 hours later, cured 100% of EMT6 tumors (murine mammary sarcoma) growing in syngeneic immunocompetent BALB/C mice. In contrast, the same treatment produced no cures of EMT6 tumors growing in either nude or SCID mice (immunodeficient strains). EMT6 tumors growing in BALB/C and SCID mice showed no difference in either the level of PhotofrinR accumulated per gram of tumor tissue, or the extent of tumor cell killing during the first 24 hours post photodynamic therapy (PDT). In an attempt to improve the sensitivity to PDT of EMT6 tumors growing in SCID mice, these hosts were given either splenic T lymphocytes or whole bone marrow from BALB/C mice. The adoptive transfer of lymphocytes 9 days before PDT was successful in delaying tumor recurrence but produced no cures. A better improvement in PDT response was obtained with tumors growing in SCID mice reconstituted with BALB/C bone marrow (tumor cure rate of 63%). The results of this study demonstrate that, at least with the EMT6 tumor model, antitumor immune activity mediated by lymphoid cell populations makes an important contribution to the curative effect of PDT.

  9. Combined IL-15 and IL-12 drives the generation of CD34+-derived natural killer cells with superior maturation and alloreactivity potential following adoptive transfer

    PubMed Central

    Cany, Jeannette; van der Waart, Anniek B; Spanholtz, Jan; Tordoir, Marleen; Jansen, Joop H; van der Voort, Robbert; Schaap, Nicolaas M; Dolstra, Harry

    2015-01-01

    Adoptive transfer of allogeneic natural killer (NK) cells represents a promising treatment approach against cancer, including acute myeloid leukemia (AML). Previously, we reported a cytokine-based culture method for the generation of NK cell products with high cell number and purity. In this system, CD34+ hematopoietic progenitor cells (HPC) were expanded and differentiated into NK cells under stroma-free conditions in the presence of IL-15 and IL-2. We show that combining IL-15 with IL-12 drives the generation of more mature and highly functional NK cells. In particular, replacement of IL-2 by IL-12 enhanced the cytolytic activity and IFNγ production of HPC-NK cells toward cultured and primary AML cells in vitro, and improved antileukemic responses in NOD/SCID-IL2Rγnull (NSG) mice bearing human AML cells. Phenotypically, IL-12 increased the frequency of HPC-NK cells expressing NKG2A and killer immunoglobulin-like receptor (KIR), which were more responsive to target cell stimulation. In addition, NK15/12 cell products demonstrated superior maturation potential, resulting in >70% positivity for CD16 and/or KIR within 2 weeks after infusion into NSG mice. We predict that higher functionality and faster in vivo maturation will favor HPC-NK cell alloreactivity toward malignant cells in patients, making this cytokine combination an attractive strategy to generate clinical HPC-NK cell products for cancer adoptive immunotherapy. PMID:26140247

  10. Change in peripheral blood lymphocyte count in dogs following adoptive immunotherapy using lymphokine-activated T killer cells combined with palliative tumor resection.

    PubMed

    Mie, Keiichiro; Shimada, Terumasa; Akiyoshi, Hideo; Hayashi, Akiyoshi; Ohashi, Fumihito

    2016-09-01

    We evaluated changes in peripheral blood lymphocyte (PBL) count in dogs following adoptive immunotherapy using lymphokine-activated T killer cells (T-LAK) in combination with surgery. Fifteen tumor-bearing dogs treated with T-LAK therapy combined with palliative resection of tumors were enrolled in the present study. T-LAK were generated from autologous peripheral blood mononuclear cells (PBMC) by culture with recombinant human interleukin -2 (rhIL-2) and solid phase anti-canine cluster of differentiation (CD)3 antibody. T-LAK were administrated intravenously at 2-4-week intervals. After the first administration of T-LAK, counts of PBL and T lymphocyte subsets (CD3(+), CD4(+) and CD8(+) cells) increased and the CD4/CD8 ratio decreased, with significant increases in CD8(+) cells (P<0.05). In 8 tumor-bearing dogs that were administered sequential T-LAK, available data on changes in PBL and T lymphocyte phenotypes until the fifth administration were also analyzed. In tumor-bearing dogs administered 5 rounds of T-LAK, CD8(+) cell counts were maintained high until the fifth administration of T-LAK. Moreover, the CD4/CD8 ratio remained low until the fifth administration of T-LAK. These results indicate that T-LAK therapy combined with surgery may increase peripheral blood T lymphocytes, particularly CD8(+) cells, in tumor-bearing dogs. PMID:27436446

  11. Pilot Cluster Randomized Controlled Trials to Evaluate Adoption of Water, Sanitation, and Hygiene Interventions and Their Combination in Rural Western Kenya

    PubMed Central

    Christensen, Garret; Dentz, Holly N.; Pickering, Amy J.; Bourdier, Tomoé; Arnold, Benjamin F.; Colford, John M.; Null, Clair

    2015-01-01

    In preparation for a larger trial, the Water, Sanitation, and Hygiene (WASH) Benefits pilot study enrolled 72 villages and 499 subjects in two closely related randomized trials of WASH interventions in rural western Kenya. Intervention households received hardware and promotion for one of the following: water treatment, sanitation and latrine improvements, handwashing with soap, or the combination of all three. Interventions were clustered by village. A follow-up survey was conducted 4 months after intervention delivery to assess uptake. Intervention households were significantly more likely than controls to have chlorinated stored water (36–60 percentage point increases), covers over latrine drop holes (55–75 percentage point increases), less stool visible on latrine floors (16–47 percentage point reductions), and a place for handwashing (71–85 percentage point increases) with soap available (49–66 percentage point increases). The high uptake in all arms shows that combined interventions can achieve high short-term adoption rates if well-designed. PMID:25422394

  12. Pilot cluster randomized controlled trials to evaluate adoption of water, sanitation, and hygiene interventions and their combination in rural western Kenya.

    PubMed

    Christensen, Garret; Dentz, Holly N; Pickering, Amy J; Bourdier, Tomoé; Arnold, Benjamin F; Colford, John M; Null, Clair

    2015-02-01

    In preparation for a larger trial, the Water, Sanitation, and Hygiene (WASH) Benefits pilot study enrolled 72 villages and 499 subjects in two closely related randomized trials of WASH interventions in rural western Kenya. Intervention households received hardware and promotion for one of the following: water treatment, sanitation and latrine improvements, handwashing with soap, or the combination of all three. Interventions were clustered by village. A follow-up survey was conducted 4 months after intervention delivery to assess uptake. Intervention households were significantly more likely than controls to have chlorinated stored water (36-60 percentage point increases), covers over latrine drop holes (55-75 percentage point increases), less stool visible on latrine floors (16-47 percentage point reductions), and a place for handwashing (71-85 percentage point increases) with soap available (49-66 percentage point increases). The high uptake in all arms shows that combined interventions can achieve high short-term adoption rates if well-designed. PMID:25422394

  13. Aerosol Delivery of Interleukin-2 in Combination with Adoptive Transfer of Natural Killer Cells for the Treatment of Lung Metastasis: Methodology and Effect.

    PubMed

    Kiany, Simin; Gordon, Nancy

    2016-01-01

    Natural killer (NK) cells are a subtype of lymphocytes with a major role as a host defense mechanism against tumor cells. Allogeneic NK cell therapy is being used as an alternative promising therapy for many different cancers. Interleukin-2 (IL-2) is a critical cytokine for NK cell proliferation, survival, and effector functions. Cytokine support is essential to activate, expand, and increase the life span of NK cells. Aerosol delivery of IL-2 in combination with adoptive transfer of NK cells offers a reasonable approach for the treatment of lung metastases as it avoids the deleterious side effects of systemic IL-2. Using a human OS mouse model, we demonstrated the efficacy of this approach. Combination therapy of aerosol IL-2 with NK cells resulted in a better therapeutic effect against OS lung metastases as compared with each therapy alone. Aerosol IL-2 selectively increased infiltration, retention, and proliferation of infused NK cells in the lung, and there was no local inflammation or toxicity in the lungs or any other organ. Our results demonstrate that delivery of IL-2 via the aerosol route offers a feasible and innovative approach to enhance the immunotherapeutic effect of NK cells against pulmonary metastases. In the following chapter, we describe the methodology and effect of this innovative therapeutic approach. PMID:27177675

  14. Optimized human CYP4B1 in combination with the alkylator prodrug 4-ipomeanol serves as a novel suicide gene system for adoptive T-cell therapies.

    PubMed

    Roellecke, K; Virts, E L; Einholz, R; Edson, K Z; Altvater, B; Rossig, C; von Laer, D; Scheckenbach, K; Wagenmann, M; Reinhardt, D; Kramm, C M; Rettie, A E; Wiek, C; Hanenberg, H

    2016-07-01

    Engineering autologous or allogeneic T cells to express a suicide gene can control potential toxicity in adoptive T-cell therapies. We recently reported the development of a novel human suicide gene system that is based on an orphan human cytochrome P450 enzyme, CYP4B1, and the naturally occurring alkylator prodrug 4-ipomeanol. The goal of this study was to systematically develop a clinically applicable self-inactivating lentiviral vector for efficient co-expression of CYP4B1 as an ER-located protein with two distinct types of cell surface proteins, either MACS selection genes for donor lymphocyte infusions after allogeneic stem cell transplantation or chimeric antigen receptors for retargeting primary T cells. The U3 region of the myeloproliferative sarcoma virus in combination with the T2A site was found to drive high-level expression of our CYP4B1 mutant with truncated CD34 or CD271 as MACS suitable selection markers. This lentiviral vector backbone was also well suited for co-expression of CYP4B1 with a codon-optimized CD19 chimeric antigen receptor (CAR) construct. Finally, 4-ipomeanol efficiently induced apoptosis in primary T cells that co-express mutant CYP4B1 and the divergently located MACS selection and CAR genes. In conclusion, we here developed a clinically suited lentiviral vector that supports high-level co-expression of cell surface proteins with a potent novel human suicide gene. PMID:27092941

  15. Artemisinin-Naphthoquine Combination (ARCO®): An Overview of the Progress

    PubMed Central

    Hombhanje, Francis W.; Huang, Qingyun

    2010-01-01

    With the rapidly spreading resistance of Plasmodium falciparum to available non-artemisinin antimalarial drugs, new and novel pharmaceuticals are needed. ARCO® is a new generation ACT, one of several artemisinin-based combinations developed in China to counter antimalarial drug resistance. ARCO® is a derivative of two independently developed antimalarials, artemisinin and naphthoquine phosphate, which were combined to form the artemisinin-naphthoquine combination. Both artemisinin and naphthoquine drugs have proven to be efficacious, safe and well tolerated as monotherapies. The artemisinin-naphthoquine combination offers a novel advantage over existing ACTs: it can be administered as a single oral dose (or a 1-day treatment). Several therapeutic studies conducted recently indicate that a single oral dose administration of artemisinin-naphthoquine combination is equally effective and safe as the 3-day treatment with artemether-lumefantrine combination and other existing ACTs. This would make ARCO® the next generation ACT for the treatment of uncomplicated falciparum malaria.

  16. The effect of an anti-malarial subsidy programme on the quality of service provision of artemisinin-based combination therapy in Kenya: a cluster-randomized, controlled trial

    PubMed Central

    2013-01-01

    Background Many patients with suspected malaria in sub-Saharan Africa seek treatment from private providers, but this sector suffers from sub-standard medicine dispensing practices. To improve the quality of care received for presumptive malaria from the highly accessed private retail sector in western Kenya, subsidized pre-packaged artemether-lumefantrine (AL) was provided to private retailers, together with a one day training for retail staff on malaria diagnosis and treatment, job aids and community engagement activities. Methods The intervention was assessed using a cluster-randomized, controlled design. Provider and mystery-shopper cross-sectional surveys were conducted at baseline and eight months post-intervention to assess provider practices. Data were analysed based on cluster-level summaries, comparing control and intervention arms. Results On average, 564 retail outlets were interviewed per year. At follow-up, 43% of respondents reported that at least one staff member had attended the training in the intervention arm. The intervention significantly increased the percentage of providers knowing the first line treatment for uncomplicated malaria by 24.2% points (confidence interval (CI): 14.8%, 33.6%; adjusted p=0.0001); the percentage of outlets stocking AL by 31.7% points (CI: 22.0%, 41.3%; adjusted p=0.0001); and the percentage of providers prescribing AL for presumptive malaria by 23.6% points (CI: 18.7%, 28.6%; adjusted p=0.0001). Generally outlets that received training and job aids performed better than those receiving one or none of these intervention components. Conclusion Overall, subsidizing ACT and retailer training can significantly increase the percentage of outlets stocking and selling AL for the presumptive treatment of malaria, but further research is needed on strategies to improve the provision of counselling advice to retail customers. PMID:23452547

  17. Strengthening Adoption Practice, Listening to Adoptive Families

    ERIC Educational Resources Information Center

    Atkinson, Anne; Gonet, Patricia

    2007-01-01

    In-depth interviews with 500 adoptive families who received postadoption services through Virginia's Adoptive Family Preservation (AFP) program paint a richly detailed picture of the challenges adoptive families face and what they need to sustain adoption for many years after finalization. Findings document the need for support in a variety of…

  18. Medical Issues in Adoption

    MedlinePlus

    ... to Know About Zika & Pregnancy Medical Issues in Adoption KidsHealth > For Parents > Medical Issues in Adoption Print ... or emotional abuse of the child continue Agency Adoptions If you adopt through an agency, you might ...

  19. The Place of Genetic Counselling in Adoption.

    ERIC Educational Resources Information Center

    Hockey, Athel; Bain, Jill

    1982-01-01

    An approach combining social worker and geneticist expertise in adoption is outlined in the study involving 180 families. Genetic counseling has shown to be an essential safeguard to the preservation of the adoptive family unit. (Author/SW)

  20. Combination immunotherapy using adoptive T-cell transfer and tumor antigen vaccination on the basis of hTERT and survivin after ASCT for myeloma

    PubMed Central

    Aqui, Nicole A.; Stadtmauer, Edward A.; Vogl, Dan T.; Fang, Hong-Bin; Cai, Ling; Janofsky, Stephen; Chew, Anne; Storek, Jan; Akpek, Gorgun; Badros, Ashraf; Yanovich, Saul; Tan, Ming T.; Veloso, Elizabeth; Pasetti, Marcela F.; Cross, Alan; Philip, Sunita; Murphy, Heather; Bhagat, Rita; Zheng, Zhaohui; Milliron, Todd; Cotte, Julio; Cannon, Andrea; Levine, Bruce L.; Vonderheide, Robert H.; June, Carl H.

    2011-01-01

    In a phase 1/2 two-arm trial, 54 patients with myeloma received autografts followed by ex vivo anti-CD3/anti-CD28 costimulated autologous T cells at day 2 after transplantation. Study patients positive for human leukocyte antigen A2 (arm A, n = 28) also received pneumococcal conjugate vaccine immunizations before and after transplantation and a multipeptide tumor antigen vaccine derived from the human telomerase reverse transcriptase and the antiapoptotic protein survivin. Patients negative for human leukocyte antigen A2 (arm B, n = 26) received the pneumococcal conjugate vaccine only. Patients exhibited robust T-cell recoveries by day 14 with supraphysiologic T-cell counts accompanied by a sustained reduction in regulatory T cells. The median event-free survival (EFS) for all patients is 20 months (95% confidence interval, 14.6-24.7 months); the projected 3-year overall survival is 83%. A subset of patients in arm A (36%) developed immune responses to the tumor antigen vaccine by tetramer assays, but this cohort did not exhibit better EFS. Higher posttransplantation CD4+ T-cell counts and a lower percentage of FOXP3+ T cells were associated with improved EFS. Patients exhibited accelerated polyclonal immunoglobulin recovery compared with patients without T-cell transfers. Adoptive transfer of tumor antigen vaccine-primed and costimulated T cells leads to augmented and accelerated cellular and humoral immune reconstitution, including antitumor immunity, after autologous stem cell transplantation for myeloma. This study was registered at www.clinicaltrials.gov as NCT00499577. PMID:21030558

  1. Adoption and Korea.

    ERIC Educational Resources Information Center

    Chun, Byung Hoon

    1989-01-01

    Because of Korean attitudes towards adoption and other reasons, attempts to promote intracountry adoption have met with limited success, and intercountry adoption is used as an alternative way of meeting children's needs. (RJC)

  2. Adopted Children and Discipline

    MedlinePlus

    ... a Pediatrician Family Life Medical Home Family Dynamics Adoption & Foster Care Communication & Discipline Types of Families Media ... Your Community Healthy Children > Family Life > Family Dynamics > Adoption & Foster Care > Adopted Children & Discipline Family Life Listen ...

  3. Adoption & Foster Care

    MedlinePlus

    ... Children > Family Life > Family Dynamics > Adoption & Foster Care Adoption & Foster Care Article Body ​Each year, many children join families through adoption and foster care. These families may face unique ...

  4. Hemolysis after Oral Artemisinin Combination Therapy for Uncomplicated Plasmodium falciparum Malaria

    PubMed Central

    Lingscheid, Tilman; Steiner, Florian; Stegemann, Miriam S.; Bélard, Sabine; Menner, Nikolai; Pongratz, Peter; Kim, Johanna; von Bernuth, Horst; Mayer, Beate; Damm, Georg; Seehofer, Daniel; Salama, Abdulgabar; Suttorp, Norbert; Zoller, Thomas

    2016-01-01

    Episodes of delayed hemolysis 2–6 weeks after treatment of severe malaria with intravenous artesunate have been described. We performed a prospective observational study of patients with uncomplicated malaria to investigate whether posttreatment hemolysis also occurs after oral artemisinin-based combination therapy. Eight of 20 patients with uncomplicated malaria who were given oral artemisinin-based combination therapy met the definition of posttreatment hemolysis (low haptoglobin level and increased lactate dehydrogenase level on day 14). Five patients had hemolysis persisting for 1 month. Patients with posttreatment hemolysis had a median decrease in hemoglobin level of 1.3 g/dL (interquartile range 0.3–2.0 g/dL) in the posttreatment period, and patients without posttreatment hemolysis had a median increase of 0.3 g/dL (IQR −0.1 to 0.7 g/dL; p = 0.002). These findings indicate a need for increased vigilance for hemolytic events in malaria patients, particularly those with predisposing factors for anemia. PMID:27434054

  5. Hemolysis after Oral Artemisinin Combination Therapy for Uncomplicated Plasmodium falciparum Malaria.

    PubMed

    Kurth, Florian; Lingscheid, Tilman; Steiner, Florian; Stegemann, Miriam S; Bélard, Sabine; Menner, Nikolai; Pongratz, Peter; Kim, Johanna; von Bernuth, Horst; Mayer, Beate; Damm, Georg; Seehofer, Daniel; Salama, Abdulgabar; Suttorp, Norbert; Zoller, Thomas

    2016-08-01

    Episodes of delayed hemolysis 2-6 weeks after treatment of severe malaria with intravenous artesunate have been described. We performed a prospective observational study of patients with uncomplicated malaria to investigate whether posttreatment hemolysis also occurs after oral artemisinin-based combination therapy. Eight of 20 patients with uncomplicated malaria who were given oral artemisinin-based combination therapy met the definition of posttreatment hemolysis (low haptoglobin level and increased lactate dehydrogenase level on day 14). Five patients had hemolysis persisting for 1 month. Patients with posttreatment hemolysis had a median decrease in hemoglobin level of 1.3 g/dL (interquartile range 0.3-2.0 g/dL) in the posttreatment period, and patients without posttreatment hemolysis had a median increase of 0.3 g/dL (IQR -0.1 to 0.7 g/dL; p = 0.002). These findings indicate a need for increased vigilance for hemolytic events in malaria patients, particularly those with predisposing factors for anemia. PMID:27434054

  6. Combined effects of solvation and aggregation propensity on the final supramolecular structures adopted by hydrophobic, glycine-rich, elastin-like polypeptides.

    PubMed

    Salvi, Anna M; Moscarelli, Pasquale; Bochicchio, Brigida; Lanza, Giuseppe; Castle, James E

    2013-05-01

    Previous work on elastin-like polypeptides (ELPs) made of hydrophobic amino acids of the type XxxGlyGlyZzzGly (Xxx, Zzz = Val, Leu) has consistently shown that differing dominant supramolecular structures were formed when the suspending media were varied: helical, amyloid-like fibers when suspended in water and globules evolving into "string of bead" structures, poly(ValGlyGlyValGly), or cigar-like bundles, poly(ValGlyGlyLeuGly), when suspended in methyl alcohol. Comparative experiments with poly(LeuGlyGlyValGly) have further indicated that the interface energy plays a significant role and that solvation effects act in concomitance with the intrinsic aggregation propensity of the repeat sequence. Continuing our investigation on ELPs using surface (X-ray photoelectron spectroscopy, atomic force microscopy) and bulk (circular dichroism, Fourier transform infrared spectroscopy) techniques for their characterization, here we have compared the effect of suspending solvents (H(2)O, dimethylsulfoxide, ethylene glycol, and MeOH) on poly(ValGlyGlyValGly), the polypeptide most inclined to form long and well-refined helical fibers in water, searching for the signature of intermolecular interactions occurring between the polypeptide chains in the given suspension. The influence of sequence specificities has been studied by comparing poly(ValGlyGlyValGly) and poly(LeuGlyGlyValGly) with a similar degree of polymerization. Deposits on substrates of the polypeptides were characterized taking into account the differing evaporation rate of solvents, and tests on their stability in ultra high vacuum were performed. Finally, combining experimental and computational studies, we have revaluated the three-dimensional modeling previously proposed for the supramolecular assembly in water of poly(ValGlyGlyValGly). The results were discussed and rationalized also in the light of published data. PMID:23426573

  7. The Family of Adoption.

    ERIC Educational Resources Information Center

    Pavao, Joyce Maguire

    This book aims to provide a broad framework within which to think about adoption as a whole system, so that everyone involved will learn to feel some empathy for the other members of the adoption process. The book, written by a family and adoption therapist who was adopted as an infant, describes predictable developmental stages and challenges for…

  8. Questions about Adoption

    MedlinePlus

    ... Español Text Size Email Print Share Questions About Adoption Page Content Article Body What's the best way to handle my child's questions about her adoption? Many parents want to know when is the ...

  9. What's Happening in Adoption?

    ERIC Educational Resources Information Center

    Gallagher, Ursula M.

    1975-01-01

    Reviews current issues in adoption: termination of parental rights, rights of unwed fathers, subsidized adoption, the recent influx of Vietnamese children, black market babies, agency accountability in placing children, the right of the adoptee to know his biological parents. (ED)

  10. Single Parent Adoptive Homes.

    ERIC Educational Resources Information Center

    Shireman, Joan F.

    1996-01-01

    Reviews research and reports on a longitudinal study of 15 single-parent adoptive homes over a 14-year period that demonstrated that these homes have the capacity to be successful adoptive placements. Identifies unique characteristics of single-parent adoptive homes, and notes the need for additional research to identify children for whom these…

  11. Adoption and Identity.

    ERIC Educational Resources Information Center

    Lieberman, E. James

    1998-01-01

    Discusses how adoption responds to ancient questions about origins. Maintains that one's identity hinges on actual relationships more than on pedigree and genes. Discusses reasons for informing a child about his or her adoption. Suggests that adoption is a constructive process involving too many worrisome warnings and anxiety-raising advice by the…

  12. The Transracial Adoption Paradox

    PubMed Central

    Lee, Richard M.

    2008-01-01

    The number of transracial adoptions in the United States, particularly international adoptions, is increasing annually. Counseling psychology as a profession, however, is a relatively silent voice in the research on and practice of transracial adoption. This article presents an overview of the history and research on transracial adoption to inform counseling psychologists of the set of racial and ethnic challenges and opportunities that transracial adoptive families face in everyday living. Particular attention is given to emergent theory and research on the cultural socialization process within these families. PMID:18458794

  13. Companion animal adoption study.

    PubMed

    Neidhart, Laura; Boyd, Renee

    2002-01-01

    To better understand the outcomes of companion animal adoptions, Bardsley & Neidhart Inc. conducted a series of 3 surveys over a 1-year period with dog and cat owners who had adopted their pet through either a (a) Luv-A-Pet location, (b) Adopt-a-thon, or (c) traditional shelter. This article suggests opportunities to improve owners' perceptions of their pets and the adoption process through (a) providing more information before adoption about pet health and behaviors, (b) providing counseling to potential adopters to place pets appropriately, and (c) educating adopters to promote companion animal health and retention. Results demonstrate that the pet's relationship to the family unit, such as where the pet sleeps and how much time is spent with the pet, is related to the amount of veterinary care the companion animal receives, and to long-term retention. Satisfaction and retention are attributed to the pet's personality, compatibility, and behavior, rather than demographic differences among adopters or between adoption settings. The age of the companion animal at adoption, the intended recipient, and presence of children in the home also play a role. Health problems were an issue initially for half of all adopted pets, but most were resolved within 12 months. Roughly one fourth of adopters who no longer have their companion animal said their pet died. Characteristics of pets that died support the contention that spaying and neutering profoundly affects a companion animal's life span. Although retention is similar for dogs and cats, mortality is higher among cats in the first year after adoption. PMID:12578739

  14. Single Parent Adoption.

    ERIC Educational Resources Information Center

    Administration for Children, Youth, and Families (DHHS), Washington, DC.

    Presenting two views of the single-parent family, this pamphlet includes an article by two researchers (William Feigelman and Arnold R. Silverman) and a short statement by a single adoptive parent (Amanda Richards). The first paper summarizes earlier research on single-parent adoptions and discusses the results of a nationwide survey of 713…

  15. Adoptive immunotherapy against ovarian cancer.

    PubMed

    Mittica, Gloria; Capellero, Sonia; Genta, Sofia; Cagnazzo, Celeste; Aglietta, Massimo; Sangiolo, Dario; Valabrega, Giorgio

    2016-01-01

    The standard front-line therapy for epithelial ovarian cancer (EOC) is combination of debulking surgery and platinum-based chemotherapy. Nevertheless, the majority of patients experience disease recurrence. Although extensive efforts to find new therapeutic options, cancer cells invariably develop drug resistance and disease progression. New therapeutic strategies are needed to improve prognosis of patients with advanced EOC.Recently, several preclinical and clinical studies investigated feasibility and activity of adoptive immunotherapy in EOC. Our aim is to highlight prospective of adoptive immunotherapy in EOC, focusing on HLA-restricted Tumor Infiltrating Lymphocytes (TILs), and MHC-independent immune effectors such as natural killer (NK), and cytokine-induced killer (CIK). Adoptive cell therapy (ACT) has shown activity in several pre-clinical models. Available preclinical and clinical data suggest that adoptive cell therapy may provide the best benefit in settings of low tumor burden, minimal residual disease, or maintenance therapy. Further studies are needed to better define the optimal clinical setting. PMID:27188274

  16. Parenting Your Adopted Teenager

    MedlinePlus

    ... https: / / www. childwelfare. gov/ pubs/ f- openadopt/ .) The Internet and the explosion of social media sites (e. ... 4 Howard, J. (2012). Untangling the web: The Internet’s transformative impact on adoption . New York, NY: Evan ...

  17. Adoption and Sibling Rivalry

    MedlinePlus

    ... child in your family should understand her own origins, and those of her brothers and sisters. But ... children can seem exaggerated because of their different origins. For instance, i f your adoptive child does ...

  18. Travelers' Health: International Adoption

    MedlinePlus

    ... preadoption living standards, varying disease epidemiology in the countries of origin, the presence of previously unidentified medical problems, and ... know the disease risks in the adopted child’s country of origin and the medical and social histories of the ...

  19. Adverse drug events resulting from use of drugs with sulphonamide-containing anti-malarials and artemisinin-based ingredients: findings on incidence and household costs from three districts with routine demographic surveillance systems in rural Tanzania

    PubMed Central

    2013-01-01

    Background Anti-malarial regimens containing sulphonamide or artemisinin ingredients are widely used in malaria-endemic countries. However, evidence of the incidence of adverse drug reactions (ADR) to these drugs is limited, especially in Africa, and there is a complete absence of information on the economic burden such ADR place on patients. This study aimed to document ADR incidence and associated household costs in three high malaria transmission districts in rural Tanzania covered by demographic surveillance systems. Methods Active and passive surveillance methods were used to identify ADR from sulphadoxine-pyrimethamine (SP) and artemisinin (AS) use. ADR were identified by trained clinicians at health facilities (passive surveillance) and through cross-sectional household surveys (active surveillance). Potential cases were followed up at home, where a complete history and physical examination was undertaken, and household cost data collected. Patients were classified as having ‘possible’ or ‘probable’ ADR by a physician. Results A total of 95 suspected ADR were identified during a two-year period, of which 79 were traced, and 67 reported use of SP and/or AS prior to ADR onset. Thirty-four cases were classified as ‘probable’ and 33 as ‘possible’ ADRs. Most (53) cases were associated with SP monotherapy, 13 with the AS/SP combination (available in one of the two areas only), and one with AS monotherapy. Annual ADR incidence per 100,000 exposures was estimated based on ‘probable’ ADR only at 5.6 for AS/SP in combination, and 25.0 and 11.6 for SP monotherapy. Median ADR treatment costs per episode ranged from US$2.23 for those making a single provider visit to US$146.93 for patients with four visits. Seventy-three per cent of patients used out-of-pocket funds or sold part of their farm harvests to pay for treatment, and 19% borrowed money. Conclusion Both passive and active surveillance methods proved feasible methods for anti-malarial ADR

  20. Adolescents' Feelings about Openness in Adoption: Implications for Adoption Agencies

    ERIC Educational Resources Information Center

    Berge, Jerica M.; Mendenhall, Tai J.; Wrobel, Gretchen M.; Grotevant, Harold D.; McRoy, Ruth G.

    2006-01-01

    Adoption research commonly uses parents' reports of satisfaction when examining openness in adoption arrangements. This qualitative study aimed to fill a gap in the adoption research by using adolescents' voices to gain a better understanding of their adoption experiences. Adopted adolescents (n = 152) were interviewed concerning their…

  1. Toddler Adoption: The Weaver's Craft.

    ERIC Educational Resources Information Center

    Hopkins-Best, Mary

    Based on concern about the lack of information on adopting toddlers, this book examines the special needs of adopted toddlers and their adoptive parents. Chapter 1, "Why Write a Book on Toddler Adoption?" details the lack of information on the difficulties of adopted toddlers in forming attachments and parents' child rearing difficulties. Chapter…

  2. CERTS customer adoption model

    SciTech Connect

    Rubio, F. Javier; Siddiqui, Afzal S.; Marnay, Chris; Hamachi,Kristina S.

    2000-03-01

    This effort represents a contribution to the wider distributed energy resources (DER) research of the Consortium for Electric Reliability Technology Solutions (CERTS, http://certs.lbl.gov) that is intended to attack and, hopefully, resolve the technical barriers to DER adoption, particularly those that are unlikely to be of high priority to individual equipment vendors. The longer term goal of the Berkeley Lab effort is to guide the wider technical research towards the key technical problems by forecasting some likely patterns of DER adoption. In sharp contrast to traditional electricity utility planning, this work takes a customer-centric approach and focuses on DER adoption decision making at, what we currently think of as, the customer level. This study reports on Berkeley Lab's second year effort (completed in Federal fiscal year 2000, FY00) of a project aimed to anticipate patterns of customer adoption of distributed energy resources (DER). Marnay, et al., 2000 describes the earlier FY99 Berkeley Lab work. The results presented herein are not intended to represent definitive economic analyses of possible DER projects by any means. The paucity of data available and the importance of excluded factors, such as environmental implications, are simply too important to make such an analysis possible at this time. Rather, the work presented represents a demonstration of the current model and an indicator of the potential to conduct more relevant studies in the future.

  3. Obstacles to Interstate Adoption.

    ERIC Educational Resources Information Center

    Hunt, Roberta

    A documentation of the obstacles in law, policy and administrative procedure that interfere with effecting adoptions across State lines is presented. Major problems include: (1) Nonjudicial termination or relinquishment proceedings, although legal in many States, do not satisfy the courts in other states on the issue of the child's freedom for…

  4. The precaution adoption process.

    PubMed

    Weinstein, N D

    1988-01-01

    This article presents a critique of current models of preventive behavior. It discusses a variety of factors that are usually overlooked-including the appearance of costs and benefits over time, the role of cues to action, the problem of competing life demands, and the ways that actual decision behavior differs from the rational ideal implicit in expectancy-value and utility theories. Such considerations suggest that the adoption of new precautions should be viewed as a dynamic process with many determinants. The framework of a model that is able to accommodate these additional factors is described. This alternative model portrays the precaution adoption process as an orderly sequence of qualitatively different cognitive stages. Data illustrating a few of the suggestions made in the article are presented, and implications for prevention programs are discussed. PMID:3049068

  5. Open Adoption: Adoptive Parents' Reactions Two Decades Later

    ERIC Educational Resources Information Center

    Siegel, Deborah H.

    2013-01-01

    Unlike in the past, most adoption agencies today offer birth parents and adoptive parents the opportunity to share identifying information and have contact with each other. To understand the impacts of different open adoption arrangements, a qualitative descriptive study using a snowball sample of 44 adoptive parents throughout New England began…

  6. Hospitious Adoption: How Hospitality Empowers Children and Transforms Adoption

    ERIC Educational Resources Information Center

    Gritter, James L.

    2009-01-01

    Building on previous books by the author, "Hospitious Adoption: How Hospitality Empowers Children and Transforms Adoption" examines the next step after open adoption. Gritter takes the approach that practicing goodwill, respect, and courage within the realm of adoption makes the process move smoother and enriches children's lives. Following a…

  7. Artemisinin combination therapy for vivax malaria?

    PubMed Central

    Douglas, Nicholas M.; Anstey, Nicholas M.; Angus, Brian J.; Nosten, Francois; Price, Ric N.

    2012-01-01

    Early parasitological diagnosis and treatment with artemisinin-based combination therapies (ACT) are seen as key components of global malaria elimination programmes. In general, use of ACTs has been limited to patients with falciparum malaria whereas blood-stage P. vivax infections are mostly still treated with chloroquine. We review the evidence for the relative benefits and disadvantages of the existing ‘separate’ treatment approach versus a ‘unified’ ACT-based strategy for treating P. falciparum and P. vivax infections in regions where both species are endemic (co-endemic). The ‘separate’ treatment scenario is justifiable where P. vivax remains sensitive to chloroquine and providing that diagnostic tests reliably distinguish P. vivax from P. falciparum. However, with the high frequency of misdiagnosis in routine practice and the rise and spread of chloroquine-resistant P. vivax, there may be a compelling rationale for a unified ACT-based strategy for vivax and falciparum malaria in all co-endemic areas. Analyses of the cost-effectiveness of ACTs for both Plasmodium species are required to assess the role of these drugs in vivax malaria control and elimination efforts. PMID:20510281

  8. Adoption Research: Trends, Topics, Outcomes

    ERIC Educational Resources Information Center

    Palacios, Jesus; Brodzinsky, David

    2010-01-01

    The current article provides a review of adoption research since its inception as a field of study. Three historical trends in adoption research are identified: the first focusing on risk in adoption and identifying adoptee-nonadoptee differences in adjustment; the second examining the capacity of adopted children to recover from early adversity;…

  9. The Development of Adoption Law.

    ERIC Educational Resources Information Center

    Bussiere, Alice

    1998-01-01

    Reviews the evolution of U.S. adoption law since 1851. Recounts changes in the perceived "best interests" of all members of the adoption triad over time, and growing recognition of links between adoption and child welfare policy. Discusses current controversies including open adoption, birth parents' rights, unmarried fathers, and the role of…

  10. Becoming Lesbian Adoptive Parents: An Exploratory Study of Lesbian Adoptive, Lesbian Birth, and Heterosexual Adoptive Parents.

    ERIC Educational Resources Information Center

    Shelley-Sireci, Lynn M.; Ciano-Boyce, Claudia

    2002-01-01

    Surveyed lesbian adoptive parents, heterosexual adoptive parents, and lesbian parents who had used assisted fertilization, regarding the adoption process. Found that the process was similar for both heterosexual and lesbian parents, but lesbian adoptive parents perceived more discrimination and were more inclined to omit information during the…

  11. EHR adopters vs. non-adopters: Impacts of, barriers to, and federal initiatives for EHR adoption

    PubMed Central

    Jamoom, Eric W.; Patel, Vaishali; Furukawa, Michael F.; King, Jennifer

    2016-01-01

    While adoption of electronic health record (EHR) systems has grown rapidly, little is known about physicians’ perspectives on its adoption and use. Nationally representative survey data from 2011 are used to compare the perspectives of physicians who have adopted EHRs with those that have yet to do so across three key areas: the impact of EHRs on clinical care, practice efficiency and operations; barriers to EHR adoption; and factors that influence physicians to adopt EHRs. Despite significant differences in perspectives between adopters and non-adopters, the majority of physicians perceive that EHR use yields overall clinical benefits, more efficient practices and financial benefits. Purchase cost and productivity loss are the greatest barriers to EHR adoption among both adopters and non-adopters; although non-adopters have significantly higher rates of reporting these as barriers. Financial incentives and penalties, technical assistance, and the capability for electronic health information exchange are factors with the greatest influence on EHR adoption among all physicians. However, a substantially higher proportion of non-adopters regard various national health IT policies, and in particular, financial incentives or penalties as a major influence in their decision to adopt an EHR system. Contrasting these perspectives provides a window into how national policies have shaped adoption thus far; and how these policies may shape adoption in the near future. PMID:26250087

  12. Special topics in international adoption.

    PubMed

    Jenista, Jerri Ann

    2005-10-01

    As international adoption has become more "mainstream," the issues recently addressed in domestic adoption have become more important in adoptions involving children originating in other countries. Certain groups of prospective adoptive parents, such as gay or lesbian couples, single parents, and parents with disabilities, have begun to apply to adopt in ever increasing numbers. Children who may have been considered unadoptable in the past are now routinely being offered to prospective adoptive parents. The numbers and ages of the children placed and the spacing between adoptions have come under scrutiny. The rates of adoption dissolutions and disruptions are being examined carefully by the receiving and sending countries. There is a pressing need for research into numerous social aspects of adoption. PMID:16154473

  13. The emotional aftermath of adoption.

    PubMed

    Nadelson, C C

    1976-09-01

    Adopted children are emotionally vulnerable. Adoptive parents must cope with more complex problems than biologic parents. The family physician can provide valuable counseling. Preadoption counseling focuses on motivation and ambivalence. After adoption, however, serious, sometimes predictable, issues arise, such as: how and when to tell the child he is adopted; the child's search for knowledge; the problem of subsequent divorce; the birth of a natural sibling, and the involvement of other family members. New concepts include "open adoption" and "single parent adoption." PMID:961560

  14. Adoptions Without Agencies: A Study of Independent Adoptions.

    ERIC Educational Resources Information Center

    Meezan, William; And Others

    The purposes of this national study of independent, nonagency adoptions were: (1) to determine the experience of the parties involved (biological parents, adoptive parents, agencies, intermediaries, and law enforcement agents); (2) to identify agency policies, procedures and resources that deter agency adoptions and thus encourage independent…

  15. Parents' Feelings towards Their Adoptive and Non-Adoptive Children

    ERIC Educational Resources Information Center

    Glover, Marshaun B.; Mullineaux, Paula Y.; Deater-Deckard, Kirby; Petrill, Stephen A.

    2010-01-01

    In the current study, we examined parent gender differences in feelings (negativity and positivity) and perceptions of child behavioural and emotional problems in adoptive and biological parent-child dyads. In a sample of 85 families, we used a novel within-family adoption design in which one child was adopted and one child was a biological child…

  16. A Phenomenological Exploration of Adoption

    ERIC Educational Resources Information Center

    Baltimore, Diana L.; Crase, Sedahlia Jasper

    2009-01-01

    This qualitative analysis explored children's and adults' experiences with adoption. We used phenomenological methodology and individually interviewed 25 participants and included adoptive mothers and fathers, and their children, each adopted before 18 months of age. Two research questions guided the data analysis: (a) What are children's and…

  17. Dogmatism and Attitudes Toward Adoption

    ERIC Educational Resources Information Center

    Dembroski, Betty G.; Johnson Dale L.

    1969-01-01

    Using Rokeach's Dogmatism Scale and an Adoption Attitude Scale administered to 113 college students study supports hypothesis that among males dogmatism and intolerance toward areas relating to adoption would be positively correlated. Negative correlation for females suggests that emphasis on maternal role makes adoption attitudes exception to…

  18. Adoption Resources for Black Children

    ERIC Educational Resources Information Center

    Gallagher, Ursula M.

    1971-01-01

    The growing number of adoptions in this country, including racially mixed adoptions, attest to the general acceptance of adoption as a way of bringing love to children in need of families of their own and the satisfactions of parenthood to childless couples, single men and women, and families who have room for one more. (Author/AJ)

  19. Technology Adoption: an Interaction Perspective

    NASA Astrophysics Data System (ADS)

    Sitorus, Hotna M.; Govindaraju, Rajesri; Wiratmadja, I. I.; Sudirman, Iman

    2016-02-01

    The success of a new technology depends on how well it is accepted by its intended users. Many technologies face the problem of low adoption rate, despite the benefits. An understanding of what makes people accept or reject a new technology can help speed up the adoption rate. This paper presents a framework for technology adoption based on an interactive perspective, resulting from a literature study on technology adoption. In studying technology adoption, it is necessary to consider the interactions among elements involved in the system, for these interactions may generate new characteristics or new relationships. The interactions among elements in a system adoption have not received sufficient consideration in previous studies of technology adoption. Based on the proposed interaction perspective, technology adoption is elaborated by examining interactions among the individual (i.e. the user or prospective user), the technology, the task and the environment. The framework is formulated by adopting several theories, including Perceived Characteristics of Innovating, Diffusion of Innovation Theory, Technology Acceptance Model, Task-Technology Fit and usability theory. The proposed framework is illustrated in the context of mobile banking adoption. It is aimed to offer a better understanding of determinants of technology adoption in various contexts, including technology in manufacturing systems.

  20. Intercountry versus Transracial Adoption: Analysis of Adoptive Parents' Motivations and Preferences in Adoption

    ERIC Educational Resources Information Center

    Zhang, Yuanting; Lee, Gary R.

    2011-01-01

    The United States is one of the major baby-receiving countries in the world. Relatively little research has focused on why there is such a high demand for intercountry adoption. Using in-depth qualitative interviews with adoptive parents, the authors explored the reasons why Americans prefer to adopt foreign-born children instead of adopting…

  1. Quantifying the pharmacology of antimalarial drug combination therapy.

    PubMed

    Hastings, Ian M; Hodel, Eva Maria; Kay, Katherine

    2016-01-01

    Most current antimalarial drugs are combinations of an artemisinin plus a 'partner' drug from another class, and are known as artemisinin-based combination therapies (ACTs). They are the frontline drugs in treating human malaria infections. They also have a public-health role as an essential component of recent, comprehensive scale-ups of malaria interventions and containment efforts conceived as part of longer term malaria elimination efforts. Recent reports that resistance has arisen to artemisinins has caused considerable concern. We investigate the likely impact of artemisinin resistance by quantifying the contribution artemisinins make to the overall therapeutic capacity of ACTs. We achieve this using a simple, easily understood, algebraic approach and by more sophisticated pharmacokinetic/pharmacodynamic analyses of drug action; the two approaches gave consistent results. Surprisingly, the artemisinin component typically makes a negligible contribution (≪0.0001%) to the therapeutic capacity of the most widely used ACTs and only starts to make a significant contribution to therapeutic outcome once resistance has started to evolve to the partner drugs. The main threat to antimalarial drug effectiveness and control comes from resistance evolving to the partner drugs. We therefore argue that public health policies be re-focussed to maximise the likely long-term effectiveness of the partner drugs. PMID:27604175

  2. Efficacy of antimalarial treatment in Guinea: in vivo study of two artemisinin combination therapies in Dabola and molecular markers of resistance to sulphadoxine-pyrimethamine in N'Zérékoré

    PubMed Central

    Bonnet, Maryline; Roper, Cally; Félix, Martine; Coulibaly, Léonie; Kankolongo, Gabriel Mufuta; Guthmann, Jean Paul

    2007-01-01

    Background In the last five years, countries have been faced with changing their malaria treatment policy to an artemisinin-based combination therapy (ACT), many with no national data on which to base their decision. This is particularly true for a number of West African countries, including Guinea, where these studies were performed. Two studies were conducted in 2004/2005 in programmes supported by Medecins Sans Frontieres, when chloroquine was still national policy, but artesunate (AS)/sulphadoxine-pyrimethamine (SP) had been used in refugee camps for two years. Methods In Dabola (central Guinea), 220 children aged 6–59 months with falciparum malaria were randomized to receive either AS/amodiaquine (AQ) or AS/SP. In vivo efficacy was assessed following the 2003 World Health Organization guidelines. In a refugee camp in Laine (south of Guinea), where an in vivo study was not feasible due to the unstable context, a molecular genotyping study in 160 patients assessed the prevalence of mutations in the dihydrofolate reductase (dhfr) (codons 108, 51, 59) and dihydropteroate synthase (dhps) (codons 436, 437, 540) genes of Plasmodium falciparum, which have been associated with resistance to pyrimethamine and sulphadoxine, respectively. Results In Dabola, after 28 days of follow-up, Polymerase Chain Reaction (PCR)-adjusted failure rates were 1.0% (95%CI 0–5.3) for AS/AQ and 1.0% (95%CI 0–5.5) for AS/SP. In the refugee camp in Laine, the molecular genotyping study found three dhfr mutations in 85.6% (95%CI 79.2–90.7) patients and quintuple dhfr/dhps mutations in 9.6% (95%CI 5.2–15.9). Conclusion Both AS/AQ and AS/SP are highly efficacious in Dabola, whereas there is molecular evidence of established SP resistance in Laine. This supports the choice of the national programme of Guinea to adopt AS/AQ as first line antimalarial treatment. The results highlight the difficulties faced by control programmes, which have gone through the upheaval of implementing ACTs

  3. Openness in Adoption: Research with the Adoption Kinship Network.

    ERIC Educational Resources Information Center

    Grotevant, Harold D.

    2000-01-01

    Summarizes current research on the outcomes of open adoption. Discusses issues involved in conducting research on openness and offers methodological recommendations. Provides examples from one research program with adoptive kinship networks. Concludes that psychological outcomes were less related to the level of openness than to the dynamics of…

  4. Adoption and Assisted Reproduction. Adoption and Ethics, Volume 4.

    ERIC Educational Resources Information Center

    Freundlich, Madelyn

    The controversies in adoption have extended across a spectrum of policy and practice issues, and although the issues have become clear, resolution has not been achieved nor has consensus developed regarding a framework on which to improve the quality of adoption policy and practice. This book is the fourth in a series to use an ethics-based…

  5. Homosexuality and adoption in Brazil.

    PubMed

    Uziel, A P

    2001-11-01

    Western societies are undergoing legal and policy changes in relation to laws governing the family, marital status, sexual orientation and the welfare of children, including in Brazil where, in the 1990s, the rights of homosexuals were incorporated into ongoing debates about what constitutes a family. This paper discusses the issue of adoption of children by homosexual men in Brazil, using information from court records from 1995-2000 in Rio de Janeiro, and from interviews with two judges, five psychologists and four social workers who evaluate those wishing to adopt. It uses the case records of one man's application to adopt, in which homosexuality became a central issue. Both the construction of masculinity in relation to parenting and concepts of the family were the parameters upon which the decision to allow him to adopt or not depended. Because the legislation does not specify what the sexual orientation of would-be adoptive parents should be, it is possible for single persons to adopt if they show they can be good parents. As more single people, alone or in couples, seek to adopt, it is important to clarify the criteria for judicial decisions on adoption applications. A dialogue is therefore needed on the meaning of family and whether and how it relates to sexual orientation. It is only on this basis that the courts can take a clear decision as to whether being homosexual is a relevant issue in regard to applications to adopt or not. PMID:11765396

  6. Stories of Aboriginal Transracial Adoption

    ERIC Educational Resources Information Center

    Nuttgens, Simon

    2013-01-01

    Despite the significant number of transracial Aboriginal adoptions that have taken place in Canada, little research is available that addresses the psychological and psychosocial ramifications for the children involved. The scant literature that does exist raises concerns about the psychological impact of this type of adoption. The present…

  7. Faculty Adoption of Educational Technology

    ERIC Educational Resources Information Center

    Moser, Franziska Zellweger

    2007-01-01

    Although faculty support has been identified as a critical factor in the success of educational-technology programs, many people involved in such efforts underestimate the complexities of integrating technology into teaching. In this article, the author proposes an adoption cycle to help tackle the complex issue of technology adoption for…

  8. The Temporal Context of Adoption.

    ERIC Educational Resources Information Center

    Pontius, Steven K.

    This paper analyzes the amount of time required by farmers in four villages on the western edge of the central plain of Thailand to adopt four agricultural innovations--fertilizer, herbicide, insecticide, and fungicide. The general objective is to help researchers interested in the relationship of the adoption of new ideas to economic development…

  9. Characteristics of adopted juvenile delinquents.

    PubMed

    Kim, W J; Zrull, J P; Davenport, C W; Weaver, M

    1992-05-01

    There have been many reports describing the uniqueness of adopted children and adolescents' delinquent behaviors in terms of both their delinquent characteristics and courts' treatment of them. A total of 43 adopted juveniles, 32 extrafamilial (1.0%) and 11 intrafamilial (0.3%) adoptions were initially identified out of 3,280 juvenile delinquents. The adopted subjects were then compared with the demographically matched and offense matched nonadopted subjects. The family variables, such as marital and employment status of parents, were significantly different. However, there were only a few discernible trends, and in general there were no significant differences between the adopted and nonadopted juveniles in terms of their offense characteristics and dispositions. PMID:1592787

  10. Personality disorders in adopted versus non-adopted adults.

    PubMed

    Westermeyer, Joseph; Yoon, Gihyun; Amundson, Carla; Warwick, Marion; Kuskowski, Michael A

    2015-04-30

    The goal of this epidemiological study was to investigate lifetime history and odds ratios of personality disorders in adopted and non-adopted adults using a nationally representative sample. Data, drawn from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), were compared in adopted (n=378) versus non-adopted (n=42,503) adults to estimate the odds of seven personality disorders using logistic regression analyses. The seven personality disorders were histrionic, antisocial, avoidant, paranoid, schizoid, obsessive-compulsive, and dependent personality disorder. Adoptees had a 1.81-fold increase in the odds of any personality disorder compared with non-adoptees. Adoptees had increased odds of histrionic, antisocial, avoidant, paranoid, schizoid, and obsessive-compulsive personality disorder compared with non-adoptees. Two risk factors associated with lifetime history of a personality disorder in adoptees compared to non-adoptees were (1) being in the age cohort 18-29 years (but no difference in the age 30-44 cohort), using the age 45 or older cohort as the reference and (2) having 12 years of education (but no difference in higher education groups), using the 0-11 years of education as the reference. These findings support the higher rates of personality disorders among adoptees compared to non-adoptees. PMID:25752207

  11. Re an Adoption Application (Surrogacy)

    PubMed

    1987-03-01

    In England, it is illegal under the Adoption Act 1958 to pay or reward anyone in an effort to adopt a child. A family court was asked in this case whether a surrogacy arrangement involving the payment of 5,000 pounds violated the Act. The applicants, a husband and wife, were unable to have children and had entered into an informal arrangement with a woman who agreed to engage in sexual intercourse with the husband and bear a child for the couple in exchange for 10,000 pounds. Because the surrogate wrote a book about her experience from which she made money, and sincerely wanted to help out the childless couple, she accepted only half of her fee. Convinced that the surrogate arrangement was not commercial in nature, the court found no violation of English law, authorized the payment to the mother, and authorized adoption of the child by the father and his wife. PMID:11648176

  12. Determinants of internet poker adoption.

    PubMed

    Philander, Kahlil S; Abarbanel, B Lillian

    2014-09-01

    In nearly all jurisdictions, adoption of a new form of gambling has been a controversial and contentious subject. Online gambling has been no different, though there are many aspects that affect online gambling that do not appear in the brick and mortar environment. This study seeks to identify whether demographic, economic, political, technological, and/or sociological determinants contribute to online poker gambling adoption. A theoretical discussion of these categories' importance to online poker is provided and exploratory empirical analysis is used to examine their potential validity. The analysis revealed support for all of the proposed categories of variables thought to be predictive of online gambling legality. PMID:23661279

  13. Adoption Failure: A Social Work Postmortem

    ERIC Educational Resources Information Center

    Kadushin, Alfred; Seidl, Frederick W.

    1971-01-01

    Failed adoption is defined as removal of the adoptive child at any time between placement and legal adoption. A study of failed adoptions in a statewide adoption agency found a failure rate of less than 3 percent. Reasons for failure are analyzed and implications for practice are suggested. (Author)

  14. Canadian Adoption Statistics: 1981-1990.

    ERIC Educational Resources Information Center

    Sobol, Michael P.; Daly, Kerry J.

    1994-01-01

    Obtained data on Canadian adoptions (1981-90) from adoption coordinators of all 10 provinces and 2 territories. Found downward trends in use of adoption as means of family formation across decade. By 1990, most infant adoptions were facilitated by private practitioners and agencies whereas older children were primarily adopted through public…

  15. Why Adoption of Standards Matters

    ERIC Educational Resources Information Center

    Journal of Staff Development, 2016

    2016-01-01

    A total of 39 states have adopted, adapted, or endorsed the Standards for Professional Learning, including the standards issued in 2011 (labeled in red) and those published earlier (labeled in blue). Making a commitment to the standards is a commitment to continuous learning for all educators in a school.

  16. Internet Adoption: An Empirical Investigation

    ERIC Educational Resources Information Center

    Ma, Junzhao

    2011-01-01

    The Internet has brought significant changes to the retail industry because it revolutionizes how information is transmitted and accessed. The main objective of this research is to enhance our understanding of people's adoption of the Internet and its implications for retail competition. This dissertation consists of two essays. The first essay…

  17. Has the Academy Adopted TQM?

    ERIC Educational Resources Information Center

    Birnbaum, Robert; Deshotels, Judy

    1999-01-01

    A survey of 469 colleges and universities assessed the degree to which colleges and universities have adopted total quality management (TQM) or continuous quality improvement (CQI) techniques. Results suggest use of TQM/CQI is lower than predicted, at about 13% of institutions. Variations in extent of use of the approach are discussed. (MSE)

  18. Adoption Issues, Trends and Networking.

    ERIC Educational Resources Information Center

    Pierce, William L.

    Teenage women with unplanned pregnancies constitute one of America's greatest challenges in terms of providing good services and sound counseling on options. Only about 7% of teenagers having babies make alternate childrearing plans either through formal adoption or informally with members of their families. The emphasis on making teenagers good…

  19. National Foster Care and Adoption Directory Search

    MedlinePlus

    ... Adoption Directory Search National Foster Care & Adoption Directory Search Many concerned individuals have expressed the desire to ... how to become a foster or adoptive parent. Search results for this category include contact information for: ...

  20. The Texas Adoption Project: Adopted Children and Their Intellectual Resemblance to Biological and Adoptive Parents.

    ERIC Educational Resources Information Center

    Horn, Joseph M.

    1983-01-01

    Intelligence test scores were obtained from parents and children in 300 adoptive families and compared with similar data available from the children's biological mothers. Results support the hypothesis that genetic variability is an important influence in the development of individual differences in intelligence. (Author/RH)

  1. Embryo adoption: Some further considerations.

    PubMed

    Patterson, Colin

    2015-02-01

    Recent discussions of embryo adoption have sought to make sense of the teaching of the Congregation for the Doctrine of the Faith (CDF) document Dignitas personae which appeared to provide a negative judgment on such a practice. This article aims to provide a personalist account of the process of fertilization and implantation that might serve as the basis for the negative judgment of the CDF document. In doing so, it relies upon the idea that a person, including an embryo, is not to be considered in isolation, but always in relation to God and to others. This approach extends the substantialist conceptualizations commonly employed in discussions of this issue. More generally, the article seeks to highlight the value of a personalist re-framing for an understanding of the moral questions surrounding the beginning of life. Lay summary: This article seeks to make sense of what appears to be a clear-cut rejection, set out in the Congregation for the Doctrine of the Faith (CDF) document Dignitas personae, of the proposal for women to "adopt" surplus frozen embryos. It draws upon more recently developed modes of philosophical/theological reasoning to argue that, in human procreation, both fertilization and implantation represent constitutive dimensions of divine creative activity and so must be protected from manipulative technological intervention. Since embryo adoption requires this kind of technology, it makes sense for the Church document not to approve it. PMID:25698841

  2. 18 CFR 341.6 - Adoption rule.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false Adoption rule. 341.6... SUBJECT TO SECTION 6 OF THE INTERSTATE COMMERCE ACT § 341.6 Adoption rule. (a) Change in name of carrier... such occurrence. The filing of adoption notices and adoption supplements requires no notice period....

  3. 33 CFR 230.21 - Adoption.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... FOR IMPLEMENTING NEPA § 230.21 Adoption. See 40 CFR 1506.3. A district commander will normally adopt... recirculated as provided in 40 CFR 1506.3 (b) or (c), the adopted EIS with the supplement, if any, will be... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Adoption. 230.21 Section...

  4. 33 CFR 230.21 - Adoption.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... FOR IMPLEMENTING NEPA § 230.21 Adoption. See 40 CFR 1506.3. A district commander will normally adopt... recirculated as provided in 40 CFR 1506.3 (b) or (c), the adopted EIS with the supplement, if any, will be... 33 Navigation and Navigable Waters 3 2014-07-01 2014-07-01 false Adoption. 230.21 Section...

  5. 18 CFR 341.6 - Adoption rule.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Adoption rule. 341.6... SUBJECT TO SECTION 6 OF THE INTERSTATE COMMERCE ACT § 341.6 Adoption rule. (a) Change in name of carrier... such occurrence. The filing of adoption notices and adoption supplements requires no notice period....

  6. 33 CFR 230.21 - Adoption.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... FOR IMPLEMENTING NEPA § 230.21 Adoption. See 40 CFR 1506.3. A district commander will normally adopt... recirculated as provided in 40 CFR 1506.3 (b) or (c), the adopted EIS with the supplement, if any, will be... 33 Navigation and Navigable Waters 3 2011-07-01 2011-07-01 false Adoption. 230.21 Section...

  7. 18 CFR 341.6 - Adoption rule.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false Adoption rule. 341.6... SUBJECT TO SECTION 6 OF THE INTERSTATE COMMERCE ACT § 341.6 Adoption rule. (a) Change in name of carrier... such occurrence. The filing of adoption notices and adoption supplements requires no notice period....

  8. 33 CFR 230.21 - Adoption.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... FOR IMPLEMENTING NEPA § 230.21 Adoption. See 40 CFR 1506.3. A district commander will normally adopt... recirculated as provided in 40 CFR 1506.3 (b) or (c), the adopted EIS with the supplement, if any, will be... 33 Navigation and Navigable Waters 3 2013-07-01 2013-07-01 false Adoption. 230.21 Section...

  9. 18 CFR 341.6 - Adoption rule.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Adoption rule. 341.6... SUBJECT TO SECTION 6 OF THE INTERSTATE COMMERCE ACT § 341.6 Adoption rule. (a) Change in name of carrier... such occurrence. The filing of adoption notices and adoption supplements requires no notice period....

  10. 33 CFR 230.21 - Adoption.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... FOR IMPLEMENTING NEPA § 230.21 Adoption. See 40 CFR 1506.3. A district commander will normally adopt... recirculated as provided in 40 CFR 1506.3 (b) or (c), the adopted EIS with the supplement, if any, will be... 33 Navigation and Navigable Waters 3 2012-07-01 2012-07-01 false Adoption. 230.21 Section...

  11. Experiences of Black Families as Adoptive Parents.

    ERIC Educational Resources Information Center

    Prater, Gwendolyn S.; King, Lula T.

    1988-01-01

    Conducted descriptive study in which 12 Black families shared their ideas about adoptive parenthood. Found most common reason for adopting was inability to have children biologically. Found need for post-adoptive services for Black families on an as-needed basis. Recommends adoption agencies and communities build on positive experiences of Black…

  12. Policy Issues in Gay and Lesbian Adoption.

    ERIC Educational Resources Information Center

    Sullivan, Ann

    1995-01-01

    Notes that adoption agencies have developed few specific policies on the issue of lesbian and gay adoption. Provides an overview of key considerations about homosexual adopters, including beliefs and values of agency professionals, the legal and social ramifications of adoption into a relationship not based on marriage, and possible consequences…

  13. Adoption and Single Parents: A Review.

    ERIC Educational Resources Information Center

    Groze, Vic

    1991-01-01

    Examines the literature about people who choose to become single adoptive parents. Reviews the demographic and personal characteristics of single parents who adopt, and summarizes the experiences of single parents with the children they adopt. Calls for further research on single parents who adopt special needs children. (GH)

  14. Adoption: Pediatric, Legislative and Social Issues

    PubMed Central

    Davis, Joseph H.; Brown, Dirck W.

    1981-01-01

    Physicians may find themselves involved in many phases of the adoption process, ranging from advising infertile couples who wish to adopt a child to caring for adopted children, adolescents or adults. Recent legislation has been aimed at making it possible for children to be adopted who have been receiving foster care and at providing financial assistance to implement the adoption of children with handicaps and with medical problems. The adoption process is becoming more open. Adoptees are searching for and finding their biological parents and all parties in the “adoption triangle” are developing relationships with one another. PMID:7257384

  15. Adoptive cell therapy for sarcoma

    PubMed Central

    Mata, Melinda; Gottschalk, Stephen

    2015-01-01

    Current therapy for sarcomas, though effective in treating local disease, is often ineffective for patients with recurrent or metastatic disease. To improve outcomes, novel approaches are needed and cell therapy has the potential to meet this need since it does not rely on the cytotoxic mechanisms of conventional therapies. The recent successes of T-cell therapies for hematological malignancies have led to renewed interest in exploring cell therapies for solid tumors such as sarcomas. In this review, we will discuss current cell therapies for sarcoma with special emphasis on genetic approaches to improve the effector function of adoptively transferred cells. PMID:25572477

  16. Council Adopts Two Major Statements

    NASA Astrophysics Data System (ADS)

    2005-06-01

    On 27 May, the AGU Council approved an update to the Union's vision statement and adopted a position statement concerning the U.S. plans for a Moon-Mars initiative. The vision statement, which is reproduced in this section of Eos, describes what the AGU is expected to look like 10 years in the future. The Planning Committee, under the chairmanship of President-elect Tim Killeen, and with input from the policy committees, Sections, and Focus Groups, is updating AGU's strategic plan, which is intended to move measurably toward the vision.

  17. Bridging the Divide: Openness in Adoption and Post-adoption Psychosocial Adjustment among Birth and Adoptive Parents

    PubMed Central

    Ge, Xiaojia; Natsuaki, Misaki N.; Martin, David; Leve, Leslie; Neiderhiser, Jenae; Shaw, Daniel S.; Villareal, Georgette; Scaramella, Laura; Reid, John; Reiss, David

    2008-01-01

    Using 323 matched parties of birth mothers and adoptive parents, this study examined the association between the degree of adoption openness (e.g., contact and knowledge between parties) and birth and adoptive parents’ post-adoption adjustment shortly after the adoption placement (6 to 9 months). Data from birth fathers (N=112), an understudied sample, also were explored. Openness was assessed by multiple informants. Results indicated that openness was significantly related to satisfaction with adoption process among adoptive parents and birth mothers. Increased openness was positively associated with birth mothers’ post-placement adjustment as indexed by birth mothers’ self reports and the interviewers’ impression of birth mothers’ adjustment. Birth fathers’ report of openness was associated with their greater satisfaction with the adoption process and better post-adoption adjustment. PMID:18729667

  18. Adoptive T-cell therapy.

    PubMed

    Lokhorst, H M; Liebowitz, D

    1999-01-01

    Adoptive immunotherapy, or the transfer of immunocompetent cells, has been shown to be a promising new strategy for treatment of a variety of malignancies, including leukemia and non-Hodgkin's lymphoma. The possibility that it may likewise benefit patients with multiple myeloma is now being explored by researchers in Europe and the United States. Two alternatives, one using donor leukocyte infusions (DLIs) and the other using autologous T cells, are described. In the Netherlands, researchers studied the use of DLIs in 17 patients with multiple myeloma who relapsed after bone marrow transplant (BMT). Of 16 evaluable patients, 10 (62%) responded, with six (37%) achieving a complete response (CR). After a median follow-up duration of 28 months, five patients relapsed and five remained in remission. Graft-versus-host disease (GVHD) developed in nine patients. In the United States, adoptive immunotherapy is currently being tested in eight patients with chemotherapy-resistant lymphoma. Autologous T cells were obtained prior to BMT and expanded using an anti-CD3/CD28 culture system. After BMT, the cells were reinfused into the patient. At approximately day 14, granulocyte levels began to recover in the six evaluable patients, and levels remained relatively stable over the posttreatment course. Two patients developed severe autoimmune toxicity, which responded to treatment in one and resolved spontaneously in the other. PMID:9989486

  19. Embryo adoption: Some further considerations

    PubMed Central

    Patterson, Colin

    2015-01-01

    Recent discussions of embryo adoption have sought to make sense of the teaching of the Congregation for the Doctrine of the Faith (CDF) document Dignitas personae which appeared to provide a negative judgment on such a practice. This article aims to provide a personalist account of the process of fertilization and implantation that might serve as the basis for the negative judgment of the CDF document. In doing so, it relies upon the idea that a person, including an embryo, is not to be considered in isolation, but always in relation to God and to others. This approach extends the substantialist conceptualizations commonly employed in discussions of this issue. More generally, the article seeks to highlight the value of a personalist re-framing for an understanding of the moral questions surrounding the beginning of life. Lay summary: This article seeks to make sense of what appears to be a clear-cut rejection, set out in the Congregation for the Doctrine of the Faith (CDF) document Dignitas personae, of the proposal for women to “adopt” surplus frozen embryos. It draws upon more recently developed modes of philosophical/theological reasoning to argue that, in human procreation, both fertilization and implantation represent constitutive dimensions of divine creative activity and so must be protected from manipulative technological intervention. Since embryo adoption requires this kind of technology, it makes sense for the Church document not to approve it. PMID:25698841

  20. Neuroauditory Toxicity of Artemisinin Combination Therapies—Have Safety Concerns Been Addressed?

    PubMed Central

    Ramos-Martín, Virginia; González-Martínez, Carmen; Mackenzie, Ian; Schmutzhard, Joachim; Pace, Cheryl; Lalloo, David G.; Terlouw, Dianne J.

    2014-01-01

    Although artemisinin-based combination therapies (ACTs) are widely viewed as safe drugs with a wide therapeutic dose range, concerns about neuroauditory safety of artemisinins arose during their development. A decade ago, reviews of human data suggested a potential neuro-ototoxic effect, but the validity of these findings was questioned. With 5–10 years of programmatic use, emerging artemisinin-tolerant falciparum malaria in southeast Asia, and the first calls to consider an increased dose of artemisinins, we review neuroauditory safety data on ACTs to treat uncomplicated falciparum malaria. Fifteen studies reported a neurological or auditory assessment. The large heterogeneity of neuro-ototoxic end points and assessment methodologies and the descriptive nature of assessments hampered a formal meta-analysis and definitive conclusions, but they highlight the persistent lack of data from young children. This subgroup is potentially most vulnerable to any neuroauditory toxicity because of their development stage, increased malaria susceptibility, and repeated ACT exposure in settings lacking robust safety monitoring. PMID:24865683

  1. Electronic Dental Records System Adoption.

    PubMed

    Abramovicz-Finkelsztain, Renata; Barsottini, Claudia G N; Marin, Heimar Fatima

    2015-01-01

    The use of Electronic Dental Records (EDRs) and management software has become more frequent, following the increase in prevelance of new technologies and computers in dental offices. The purpose of this study is to identify and evaluate the use of EDRs by the dental community in the São Paulo city area. A quantitative case study was performed using a survey on the phone. A total of 54 offices were contacted and only one declinedparticipation in this study. Only one office did not have a computer. EDRs were used in 28 offices and only four were paperless. The lack of studies in this area suggests the need for more usability and implementation studies on EDRs so that we can improve EDR adoption by the dental community. PMID:26262001

  2. In Their Own Words: Adopted Persons' Experiences of Adoption Disclosure and Discussion in Their Families

    ERIC Educational Resources Information Center

    Wydra, Maria; O'Brien, Karen M.; Merson, Erica S.

    2012-01-01

    This study explored adoption disclosure in a sample of 18 adult adoptees who were adopted as infants. A qualitative analysis of semistructured interviews with adoptees was used to learn about participants' experiences of adoption disclosure. The majority always knew they were adopted, were able to talk openly with parents about adoption, and had…

  3. Adoption of Children with Disabilities: An Exploration of the Issues for Adoptive Families

    ERIC Educational Resources Information Center

    Good, Gretchen A.

    2016-01-01

    This systematic literature review is an exploration of issues for adoptive families throughout the adoption process and into the various phases of the life of the adoptive family. Although there has been much recent research related to adoption, in general, very little adoption literature addresses the often unspoken needs of families who want to…

  4. Impact of Adoption on Birth Parents

    MedlinePlus

    ... This relationship, as well as the birth parent’s perception of his or her identity, may change over ... McRoy, R. G., & Grotevant, H. D. (2000). Birthmother perceptions of the psychologically present adopted child: Adoption openness ...

  5. Macro influencers of electronic health records adoption.

    PubMed

    Raghavan, Vijay V; Chinta, Ravi; Zhirkin, Nikita

    2015-01-01

    While adoption rates for electronic health records (EHRs) have improved, the reasons for significant geographical differences in EHR adoption within the USA have remained unclear. To understand the reasons for these variations across states, we have compiled from secondary sources a profile of different states within the USA, based on macroeconomic and macro health-environment factors. Regression analyses were performed using these indicator factors on EHR adoption. The results showed that internet usage and literacy are significantly associated with certain measures of EHR adoption. Income level was not significantly associated with EHR adoption. Per capita patient days (a proxy for healthcare need intensity within a state) is negatively correlated with EHR adoption rate. Health insurance coverage is positively correlated with EHR adoption rate. Older physicians (>60 years) tend to adopt EHR systems less than their younger counterparts. These findings have policy implications on formulating regionally focused incentive programs. PMID:26559074

  6. When to Tell Your Child About Adoption

    MedlinePlus

    ... adopted youngsters need to be told about their origins, ideally even before middle childhood. Introducing the Information ... needs to have an honest understanding of his origin. Adopted children who have not been told seem ...

  7. Innovation Type, Radicalness, and the Adoption Process.

    ERIC Educational Resources Information Center

    Damanpour, Fariborz

    1988-01-01

    Reviews studies on the impact of organizational factors on the adoption of innovations along three dimensions (innovation type, innovation radicalness, and stages of adoption), finding considerable agreement. Proposes a research agenda for future studies. (SR)

  8. The Adopted Adolescent. Selected Papers Number 55.

    ERIC Educational Resources Information Center

    Banning, Anne

    This review of studies on clinical and nonclinical populations explores outcomes of adoption and developmental issues for adolescents, and in particular, developmental problems for adopted adolescents. Studies on nonclinical populations demonstrate that adoption is a highly successful form of substitute care. Prospective longitudinal studies show…

  9. 47 CFR 61.171 - Adoption notice.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 3 2013-10-01 2013-10-01 false Adoption notice. 61.171 Section 61.171 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) TARIFFS Adoption of Tariffs and Other Documents of Predecessor Carriers § 61.171 Adoption notice. When a...

  10. 47 CFR 61.171 - Adoption notice.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 3 2014-10-01 2014-10-01 false Adoption notice. 61.171 Section 61.171 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) TARIFFS Adoption of Tariffs and Other Documents of Predecessor Carriers § 61.171 Adoption notice. When a...

  11. 14 CFR 221.160 - Adoption notice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Adoption notice. 221.160 Section 221.160... REGULATIONS TARIFFS Adoption Publications Required To Show Change in Carrier's Name or Transfer of Operating Control § 221.160 Adoption notice. (a) When the name of a carrier is changed or when its operating...

  12. 32 CFR 584.4 - Adoption proceedings.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Adoption proceedings. 584.4 Section 584.4... CUSTODY, AND PATERNITY § 584.4 Adoption proceedings. (a) General. This chapter does not apply to those... normally may not be put up for adoption without the consent of the parents. Therefore, communications...

  13. 40 CFR 1506.3 - Adoption.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 34 2013-07-01 2013-07-01 false Adoption. 1506.3 Section 1506.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY OTHER REQUIREMENTS OF NEPA § 1506.3 Adoption. (a) An agency may adopt a Federal draft or final environmental impact statement or portion...

  14. 40 CFR 1506.3 - Adoption.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Adoption. 1506.3 Section 1506.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY OTHER REQUIREMENTS OF NEPA § 1506.3 Adoption. (a) An agency may adopt a Federal draft or final environmental impact statement or portion...

  15. 14 CFR 221.160 - Adoption notice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Adoption notice. 221.160 Section 221.160... REGULATIONS TARIFFS Adoption Publications Required To Show Change in Carrier's Name or Transfer of Operating Control § 221.160 Adoption notice. (a) When the name of a carrier is changed or when its operating...

  16. 32 CFR 584.4 - Adoption proceedings.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Adoption proceedings. 584.4 Section 584.4... CUSTODY, AND PATERNITY § 584.4 Adoption proceedings. (a) General. This chapter does not apply to those... normally may not be put up for adoption without the consent of the parents. Therefore, communications...

  17. 47 CFR 61.171 - Adoption notice.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 3 2011-10-01 2011-10-01 false Adoption notice. 61.171 Section 61.171 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) TARIFFS Adoption of Tariffs and Other Documents of Predecessor Carriers § 61.171 Adoption notice. When a...

  18. 14 CFR 221.160 - Adoption notice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Adoption notice. 221.160 Section 221.160... REGULATIONS TARIFFS Adoption Publications Required To Show Change in Carrier's Name or Transfer of Operating Control § 221.160 Adoption notice. (a) When the name of a carrier is changed or when its operating...

  19. 25 CFR 75.18 - Adoption.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Adoption. 75.18 Section 75.18 Indians BUREAU OF INDIAN... OF CHEROKEE INDIANS, NORTH CAROLINA § 75.18 Adoption. The Tribal Council of the Eastern Band of Cherokee Indians shall be empowered to enact ordinances governing the adoption of new members....

  20. 32 CFR 584.4 - Adoption proceedings.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Adoption proceedings. 584.4 Section 584.4... CUSTODY, AND PATERNITY § 584.4 Adoption proceedings. (a) General. This chapter does not apply to those... normally may not be put up for adoption without the consent of the parents. Therefore, communications...

  1. 40 CFR 1506.3 - Adoption.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 33 2014-07-01 2014-07-01 false Adoption. 1506.3 Section 1506.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY OTHER REQUIREMENTS OF NEPA § 1506.3 Adoption. (a) An agency may adopt a Federal draft or final environmental impact statement or portion...

  2. 25 CFR 75.18 - Adoption.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Adoption. 75.18 Section 75.18 Indians BUREAU OF INDIAN... OF CHEROKEE INDIANS, NORTH CAROLINA § 75.18 Adoption. The Tribal Council of the Eastern Band of Cherokee Indians shall be empowered to enact ordinances governing the adoption of new members....

  3. 14 CFR 221.160 - Adoption notice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Adoption notice. 221.160 Section 221.160... REGULATIONS TARIFFS Adoption Publications Required To Show Change in Carrier's Name or Transfer of Operating Control § 221.160 Adoption notice. (a) When the name of a carrier is changed or when its operating...

  4. 47 CFR 61.171 - Adoption notice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Adoption notice. 61.171 Section 61.171 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) TARIFFS Adoption of Tariffs and Other Documents of Predecessor Carriers § 61.171 Adoption notice. When a...

  5. A Narrative Inquiry of International Adoption Stories

    ERIC Educational Resources Information Center

    Pryor, Christin; Pettinelli, J. Douglas

    2011-01-01

    The international adoption entrance story is an unexplored topic in the adoption literature. The stories that families tell of beginning life with their new children has important implications for the development of an autobiographical narrative of an adopted child. A coherent autobiographical narrative is vital for healthy childhood development.…

  6. 25 CFR 75.18 - Adoption.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Adoption. 75.18 Section 75.18 Indians BUREAU OF INDIAN... OF CHEROKEE INDIANS, NORTH CAROLINA § 75.18 Adoption. The Tribal Council of the Eastern Band of Cherokee Indians shall be empowered to enact ordinances governing the adoption of new members....

  7. 25 CFR 75.18 - Adoption.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false Adoption. 75.18 Section 75.18 Indians BUREAU OF INDIAN... OF CHEROKEE INDIANS, NORTH CAROLINA § 75.18 Adoption. The Tribal Council of the Eastern Band of Cherokee Indians shall be empowered to enact ordinances governing the adoption of new members....

  8. 40 CFR 1506.3 - Adoption.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 34 2012-07-01 2012-07-01 false Adoption. 1506.3 Section 1506.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY OTHER REQUIREMENTS OF NEPA § 1506.3 Adoption. (a) An agency may adopt a Federal draft or final environmental impact statement or portion...

  9. 47 CFR 61.171 - Adoption notice.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 3 2012-10-01 2012-10-01 false Adoption notice. 61.171 Section 61.171 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) TARIFFS Adoption of Tariffs and Other Documents of Predecessor Carriers § 61.171 Adoption notice. When a...

  10. 32 CFR 584.4 - Adoption proceedings.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Adoption proceedings. 584.4 Section 584.4... CUSTODY, AND PATERNITY § 584.4 Adoption proceedings. (a) General. This chapter does not apply to those... normally may not be put up for adoption without the consent of the parents. Therefore, communications...

  11. 40 CFR 1506.3 - Adoption.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false Adoption. 1506.3 Section 1506.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY OTHER REQUIREMENTS OF NEPA § 1506.3 Adoption. (a) An agency may adopt a Federal draft or final environmental impact statement or portion...

  12. 25 CFR 75.18 - Adoption.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true Adoption. 75.18 Section 75.18 Indians BUREAU OF INDIAN... OF CHEROKEE INDIANS, NORTH CAROLINA § 75.18 Adoption. The Tribal Council of the Eastern Band of Cherokee Indians shall be empowered to enact ordinances governing the adoption of new members....

  13. 14 CFR 221.160 - Adoption notice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Adoption notice. 221.160 Section 221.160... REGULATIONS TARIFFS Adoption Publications Required To Show Change in Carrier's Name or Transfer of Operating Control § 221.160 Adoption notice. (a) When the name of a carrier is changed or when its operating...

  14. Modeling technology adoption in developing countries

    SciTech Connect

    Besley, T.; Case, A. )

    1993-05-01

    An analysis of technology adoption decisions by poor farmers is provided. Some possible empirical models for studying technology adoption are reviewed. The issue of theoretical consistency is dealt with in terms of the costs of such consistency, measured in data needs and model complexity, and the benefits, measured in terms of understanding the micro-economic foundations of adoption.

  15. Adoption Bibliography and Multi-Ethnic Sourcebook.

    ERIC Educational Resources Information Center

    Van Why, Elizabeth Wharton, Comp.

    Designed for parents who have adopted or who contemplate adoption, and for educational, legal, medical, social, and theological professionals, this bibliography and source book contains over 1250 citations relating to adoption. The book is divided into two parts. The first section is a bibliography of articles, personal narratives, dissertations,…

  16. Child Adoption in Contemporary Rural China

    ERIC Educational Resources Information Center

    Zhang, Weiguo

    2006-01-01

    Based on qualitative information from in-depth interviews and quantitative data from a survey of 425 adoptive families conducted in summer 2001 in rural China, this study attempts to explain the social and demographic patterns of adoption and investigate the roles of the State and families in adoption processes in contemporary rural China. Within…

  17. International Adoption: Current Status and Future Prospects.

    ERIC Educational Resources Information Center

    Bartholet, Elizabeth

    1993-01-01

    Laws regulating adoption are varied and complex in countries that offer children for international adoption (IA), while United States Immigration laws pose additional obstacles to Americans wishing to adopt foreign-born children. Declarations by the United Nations and the development of a convention on IA by the Hague Conference offer some hope…

  18. [Attachment and Adoption: Diagnostics, Psychopathology, and Therapy].

    PubMed

    Brisch, Karl-Heinz

    2015-01-01

    This presentation describes the development of attachment between adopted children and their adoptive parents with a focus on the particular issues seen in international adoptions. The questions of settling in, trauma in the country of origin, and the motivations of the adoptive parents will be discussed. Diagnosis and various psychopathological manifestations will be examined, as will outpatient and inpatient modes of therapy. The treatment of children of various ages will be covered along with the necessity for intensive counseling and psychotherapy for the adoptive parents. This will enable the parents to work through early trauma, which will give them and their adopted child the basis for developing healthy attachment patterns. This in turn will enable the child to mature and integrate into society. Possibilities of prevention are discussed. Many of the approaches discussed here regarding attachment and adoption may be applied to foster children and their foster parents. PMID:26645775

  19. Shanghai adopts family planning regulations.

    PubMed

    1990-04-01

    These Regulations, adopted by the Municipal People's Congress of Shanghai on 14 March 1990, do the following: a) strictly prohibit any units and individuals from identifying the sex of a fetus without medical reasons; b) add 1 additional week to the marriage leave of couples who marry at the age set for late marriage (25 for males and 23 for females); c) add 15 days of maternity leave for women who give birth at the age set for late birth (24) and 3 days for their spouses; d) impose a fine equal to 3 to 6 times their average annual income if a couple have an unplanned birth (calculated on the basis of their income 2 years before the birth); and e) subject a couple who have an unplanned birth to disciplinary action by their working units if they work for others or by the administrative department of industry and commerce if they are self employed. Second births are allowed if a first child "can not become normal because of nonhereditary diseases," if both husband and wife are single children, or if a "remarried couple had only one child before their remarriage." The Regulations provide that "the improvement of birth quality and good upbringing of children should be promoted, advice on heredity should be provided, and premarital examinations [should] be conducted." They also stipulate that "A woman should terminate her pregnancy or undergo a sterilization operation if both husband and wife (or either of them) have [a] hereditary or other disease not medically suitable for birth." The provisions of these Regulations prohibiting prenatal sex selection were reported in Annual Review of Population Law, Vol. 17, 1990, Section 240. PMID:12348767

  20. EBV latency types adopt alternative chromatin conformations.

    PubMed

    Tempera, Italo; Klichinsky, Michael; Lieberman, Paul M

    2011-07-01

    Epstein-Barr Virus (EBV) can establish latent infections with distinct gene expression patterns referred to as latency types. These different latency types are epigenetically stable and correspond to different promoter utilization. Here we explore the three-dimensional conformations of the EBV genome in different latency types. We employed Chromosome Conformation Capture (3C) assay to investigate chromatin loop formation between the OriP enhancer and the promoters that determine type I (Qp) or type III (Cp) gene expression. We show that OriP is in close physical proximity to Qp in type I latency, and to Cp in type III latency. The cellular chromatin insulator and boundary factor CTCF was implicated in EBV chromatin loop formation. Combining 3C and ChIP assays we found that CTCF is physically associated with OriP-Qp loop formation in type I and OriP-Cp loop formation in type III latency. Mutations in the CTCF binding site located at Qp disrupt loop formation between Qp and OriP, and lead to the activation of Cp transcription. Mutation of the CTCF binding site at Cp, as well as siRNA depletion of CTCF eliminates both OriP-associated loops, indicating that CTCF plays an integral role in loop formation. These data indicate that epigenetically stable EBV latency types adopt distinct chromatin architectures that depend on CTCF and mediate alternative promoter targeting by the OriP enhancer. PMID:21829357

  1. Building Adoption of Visual Analytics Software

    SciTech Connect

    Chinchor, Nancy; Cook, Kristin A.; Scholtz, Jean

    2012-01-05

    Adoption of technology is always difficult. Issues such as having the infrastructure necessary to support the technology, training for users, integrating the technology into current processes and tools, and having the time, managerial support, and necessary funds need to be addressed. In addition to these issues, the adoption of visual analytics tools presents specific challenges that need to be addressed. This paper discusses technology adoption challenges and approaches for visual analytics technologies.

  2. Measures for Predictors of Innovation Adoption

    PubMed Central

    Chor, Ka Ho Brian; Wisdom, Jennifer P.; Olin, Su-Chin Serene; Hoagwood, Kimberly E.; Horwitz, Sarah M.

    2014-01-01

    Building on a narrative synthesis of adoption theories by Wisdom et al. (2013), this review identifies 118 measures associated with the 27 adoption predictors in the synthesis. The distribution of measures is uneven across the predictors and predictors vary in modifiability. Multiple dimensions and definitions of predictors further complicate measurement efforts. For state policymakers and researchers, more effective and integrated measurement can advance the adoption of complex innovations such as evidence-based practices. PMID:24740175

  3. [Health-related problems in adopted children].

    PubMed

    Laubjerg, Merete; Petersson, Birgit H

    2006-10-01

    International research shows that the standard of health among children adopted from abroad, especially those adopted by single parents, is not as good as that of other children. Danish studies indicate similar problems. The causes could be several, such as poor development in the embryonic and fetal stages, low birth weight, starvation, neglect, infections, and the lack of the natural bonds between mother and child. Surveys indicate that many adoptive parents, single parents in particular, receive children with health problems. There is no Danish research available, but it is important to be aware of these issues in order for both adoptees and adoptants to receive the most support. PMID:17059801

  4. Adoptive T-cell Immunotherapy

    PubMed Central

    Gottschalk, Stephen; Rooney, Cliona

    2015-01-01

    Epstein-Barr virus (EBV) is associated with a range of malignancies involving B-cells, T-cells, natural killer (NK)-cells, epithelial cells and smooth muscle. All of these are associated with the latent life cycles of EBV, but the pattern of latency-associated viral antigens expressed in tumor cells depends on the type of tumor. EBV-specific T cells (EBVSTs) have been explored as prophylaxis and therapy for EBV-associated malignancies for more than two decades. EBVSTs have been most successful as prophylaxis and therapy for post-transplant lymphoproliferative disease (PTLD), which expresses the full array of latent EBV antigens (type 3 latency), in hematopoietic stem cell transplant recipients. While less effective, clinical studies have also demonstrated their therapeutic potential for PTLD post solid organ transplant, and for EBV-associated malignancies such as Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and nasopharyngeal carcinoma that express a limited array of latent EBV antigens (type 2 latency),. Several approaches are actively being pursued to improve the antitumor activity of EBVSTs including activation and expansion of T cells specific for the EBV antigens expressed in type 2 latency, genetic approaches to render EBVSTs resistant to the immunosuppressive tumor environment and combination approaches with other immune-modulating modalities. Given the recent advances and renewed interest in cell therapy, we hope that EBVSTs will become an integral part of our treatment armamentarium against EBV-positive malignancies in the near future. PMID:26428384

  5. Predictors of race, adoption, and sexual orientation related socialization of adoptive parents of young children.

    PubMed

    Goldberg, Abbie E; Smith, JuliAnna Z

    2016-04-01

    Using a sample of 125 lesbian, gay, and heterosexual adoptive parent couples with young children (M = 6.32 years), this study examined predictors of direct socialization (preparation for adoptism, racism, and heterosexism) and indirect socialization (modeling interactions by responding to outsiders' inquiries about their child's adoptive status, racial background, or family structure). In terms of direct socialization, parents of older children tended to engage in more socialization around adoptism and heterosexism, and parents of daughters tended to engage in more socialization around racism and heterosexism. Greater perceived child interest in adoption was related to more direct socialization around adoptism. Parents of color reported more direct socialization around racism. Having a child of color was related to more direct socialization around heterosexism. Regarding indirect socialization, sexual minority parents reported more socialization around adoption and race. Greater perceived child interest in adoption was related to more indirect adoption socialization. Being more "out" was related to more indirect socialization around parent sexual orientation. PMID:26371450

  6. Envisaging the adoption process to strengthen gay- and lesbian-headed families: recommendations for adoption professionals.

    PubMed

    Matthews, John D; Cramer, Elizabeth P

    2006-01-01

    Although a growing number of child placement agencies are serving lesbians and gay men, a dearth of literature exists for adoption agency policies and practices related to working with this population. This article explores the unique characteristics and strengths of prospective gay and lesbian adoptive parents throughout each of the three phases of the adoption process-preplacement, placement, and postplacement-as well as provides suggestions for adoption professionals working with gays and lesbians. Data from a recent qualitative study of single, gay adoptive fathers are used to illustrate examples and expose areas of potential strengths of adoptive parents not generally explored in the preplacement or preparatory stage. Special attention also is given to the continuing needs of adoptive families headed by gays and lesbians after adoptive placement. Specifically explored are the needs for developing linkages with similar families, as well as providing resources designed to promote successful outcomes of adopted children raised by gays and lesbians. PMID:16846118

  7. Adoption of Information Technology by Advertising Agencies.

    ERIC Educational Resources Information Center

    Herling, Thomas J.; Merskin, Debra

    Since little empirical research has been conducted on adoption of currently available information technology by the advertising industry, a study explored the extent of advertising agencies' adoption of selected information technologies such as online database services and electronic mail. The study discussed data from earlier studies and analyzed…

  8. 32 CFR 584.4 - Adoption proceedings.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... situations were a soldier is trying to adopt a child. It applies to those situations where another person is trying to adopt a legitimate or illegitimate child of a soldier. A child born in or out of wedlock... has stated that he or she is not the natural parent of the child. (v) Since the soldier is not...

  9. Faculty Adoption of Active Learning Classrooms

    ERIC Educational Resources Information Center

    Van Horne, Sam; Murniati, Cecilia Titiek

    2016-01-01

    Although post-secondary educational institutions are incorporating more active learning classrooms (ALCs) that support collaborative learning, researchers have less often examined the cultural obstacles to adoption of those environments. In this qualitative research study, we adopted the conceptual framework of activity theory to examine the…

  10. 43 CFR 10010.20 - Adoption.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Adoption. 10010.20 Section 10010.20 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH RECLAMATION MITIGATION AND... Environmental Assessments § 10010.20 Adoption. (a) An EA prepared for a proposal before the Commission...

  11. 43 CFR 10010.20 - Adoption.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Adoption. 10010.20 Section 10010.20 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH RECLAMATION MITIGATION AND... Environmental Assessments § 10010.20 Adoption. (a) An EA prepared for a proposal before the Commission...

  12. 43 CFR 10010.20 - Adoption.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Adoption. 10010.20 Section 10010.20 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH RECLAMATION MITIGATION AND... Environmental Assessments § 10010.20 Adoption. (a) An EA prepared for a proposal before the Commission...

  13. 43 CFR 10010.20 - Adoption.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Adoption. 10010.20 Section 10010.20 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH RECLAMATION MITIGATION AND... Environmental Assessments § 10010.20 Adoption. (a) An EA prepared for a proposal before the Commission...

  14. Single Adoptive Mothers and Their Children

    ERIC Educational Resources Information Center

    Dougherty, Sharon Ann

    1978-01-01

    In view of the increasing number of single women who adopt children, the social work profession has an obligation to learn more about this group of mothers. This article is based on a research study to identify characteristics of single adoptive mothers and their children and to learn what community supports the mothers believe would be helpful.…

  15. 76 FR 68613 - National Adoption Month, 2011

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-04

    ... Sig.) [FR Doc. 2011-28839 Filed 11-3-11; 11:15 am] Billing code 3295-F2-P ... Documents#0;#0; ] Proclamation 8744 of November 1, 2011 National Adoption Month, 2011 By the President of... basic support, and still more children abroad live without families. During National Adoption Month,...

  16. 78 FR 66609 - National Adoption Month, 2013

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-05

    .... (Presidential Sig.) [FR Doc. 2013-26669 Filed 11-4-13; 11:15 am] Billing code 3295-F4 ... Documents#0;#0; ] Proclamation 9049 of October 31, 2013 National Adoption Month, 2013 By the President of... million children and teenagers. During National Adoption Month, we celebrate these families and...

  17. 77 FR 66517 - National Adoption Month, 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-06

    ... Sig.) [FR Doc. 2012-27190 Filed 11-5-12; 8:45 am] Billing code 3295-F3 ... Documents#0;#0; ] Proclamation 8896 of November 1, 2012 National Adoption Month, 2012 By the President of... knowing the love and protection of a permanent family. During National Adoption Month, we give voice...

  18. Covering Adoption: General Depictions in Broadcast News

    ERIC Educational Resources Information Center

    Kline, Susan L.; Karel, Amanda I.; Chatterjee, Karishma

    2006-01-01

    Using theories of stigma (Goffman, 1963) and media frames (Iyengar, 1991), 292 news stories pertaining to adoption that appeared on major broadcast networks between 2001 and 2004 were analyzed. Media coverage of adoptees contained more problematic than positive depictions. Although birth parents were not always depicted, adoptive parent and…

  19. Predicting Language Outcomes for Internationally Adopted Children

    ERIC Educational Resources Information Center

    Glennen, Sharon L.

    2007-01-01

    Purpose: Language and speech are difficult to assess in newly arrived internationally adopted children. The purpose of this study was to determine if assessments completed when toddlers were first adopted could predict language outcomes at age 2. Local norms were used to develop early intervention guidelines that were evaluated against age 2…

  20. States Adopt Standards at Fast Clip

    ERIC Educational Resources Information Center

    Gewertz, Catherine

    2010-01-01

    Nearly half the states have adopted a new set of common academic standards, barely a month after their final release and, in most cases, with little opposition. As of July 9, 23 states had decided to replace their mathematics and English/language arts standards with the common set. Another flurry of adoptions is expected by Aug. 2, since the $4…

  1. Adoption of Improved Agricultural Practices in Uruguay.

    ERIC Educational Resources Information Center

    Rucks, Carlos Alberto

    Conducted in Uruguay during 1965-68, this study compared adoption rates for selected agricultural practices between one area which received an extension program and one which did not; and sought relationships between selected characteristics of individual farmers and the adoption of new practices. Data came from interviews with 69 experimental and…

  2. Fuzzy Cognitive Map Modelling Educational Software Adoption

    ERIC Educational Resources Information Center

    Hossain, Sarmin; Brooks, Laurence

    2008-01-01

    Educational software adoption across UK secondary schools is seen as unsatisfactory. Based on stakeholders' perceptions, this paper uses fuzzy cognitive maps (FCMs) to model this adoption context. It discusses the development of the FCM model, using a mixed-methods approach and drawing on participants from three UK secondary schools. The study…

  3. Why Wasn't This Child Adopted?

    ERIC Educational Resources Information Center

    Raspberry, William

    1982-01-01

    Critizes the public child care policy with regard to adoption services through the story of "Joey", a black child in his teens. Shortly after his birth, Joey was sent by his teenage mother to a city agency for adoption and until now no real effort has been made to place him in a permanent home. (Author/MP)

  4. Nurturing Development of Foster and Adopted Children

    ERIC Educational Resources Information Center

    Nowak-Fabrykowski, Krystyna Teresa

    2015-01-01

    The goal of this study is to investigate early childhood teachers' perspective of teaching foster and adopted children. The main purpose is to seek suggestions how teachers can nurture the development of foster and adopted children. A 6 question survey was sent to 44 teachers pursuing graduate studies in early childhood education. Of this 50%…

  5. Issues in Adoption and Foster Care.

    ERIC Educational Resources Information Center

    Hepworth, H. Philip

    This speech presents an overview of issues and trends in the provision of foster care and adoption services in Canada. The number of children "in care" in Canada (in foster homes, institutions, or adoptive homes) appears to have peaked around 1969 and declined thereafter. Information on contraceptives and the availaibility of abortions are seen as…

  6. A Research and Development Adoption Model

    ERIC Educational Resources Information Center

    Hull, Ronald E.

    1974-01-01

    An elaboration of the adoption phase of the Clark and Guba R and D model. A brief discussion of the normative structures of the organizations and organizational boundary permeability provides the rationale for a set of suggested procedures for adoption of innovations at the school building level. (Author)

  7. Predictors of Adopting Motivational Enhancement Therapy

    ERIC Educational Resources Information Center

    Ager, Richard; Roahen-Harrison, Stephanie; Toriello, Paul J.; Kissinger, Patricia; Morse, Patricia; Morse, Edward; Carney, Linton; Rice, Janet

    2011-01-01

    Substance abuse counselors have shown limited success in adopting evidence-based practices (EBPs). The purpose of this paper is to identify the barriers and facilitators of adopting an EBP called motivational enhancement therapy (MET). One hundred thirty-six predominantly female (60%) African American (68%) addiction counselors representing over…

  8. Conservation Tillage: Monitoring Adoption with Satellite Imagery

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Conservation tillage is a commonly adopted best management practice for improving soil quality and reducing erosion. However, there are currently no methods in place to monitor conservation tillage adoption at the watershed scale. The primary objective of this study was to evaluate the utility of ...

  9. Atovaquone and ELQ-300 Combination Therapy as a Novel Dual-Site Cytochrome bc1 Inhibition Strategy for Malaria.

    PubMed

    Stickles, Allison M; Smilkstein, Martin J; Morrisey, Joanne M; Li, Yuexin; Forquer, Isaac P; Kelly, Jane X; Pou, Sovitj; Winter, Rolf W; Nilsen, Aaron; Vaidya, Akhil B; Riscoe, Michael K

    2016-08-01

    Antimalarial combination therapies play a crucial role in preventing the emergence of drug-resistant Plasmodium parasites. Although artemisinin-based combination therapies (ACTs) comprise the majority of these formulations, inhibitors of the mitochondrial cytochrome bc1 complex (cyt bc1) are among the few compounds that are effective for both acute antimalarial treatment and prophylaxis. There are two known sites for inhibition within cyt bc1: atovaquone (ATV) blocks the quinol oxidase (Qo) site of cyt bc1, while some members of the endochin-like quinolone (ELQ) family, including preclinical candidate ELQ-300, inhibit the quinone reductase (Qi) site and retain full potency against ATV-resistant Plasmodium falciparum strains with Qo site mutations. Here, we provide the first in vivo comparison of ATV, ELQ-300, and combination therapy consisting of ATV plus ELQ-300 (ATV:ELQ-300), using P. yoelii murine models of malaria. In our monotherapy assessments, we found that ATV functioned as a single-dose curative compound in suppressive tests whereas ELQ-300 demonstrated a unique cumulative dosing effect that successfully blocked recrudescence even in a high-parasitemia acute infection model. ATV:ELQ-300 therapy was highly synergistic, and the combination was curative with a single combined dose of 1 mg/kg of body weight. Compared to the ATV:proguanil (Malarone) formulation, ATV:ELQ-300 was more efficacious in multiday, acute infection models and was equally effective at blocking the emergence of ATV-resistant parasites. Ultimately, our data suggest that dual-site inhibition of cyt bc1 is a valuable strategy for antimalarial combination therapy and that Qi site inhibitors such as ELQ-300 represent valuable partner drugs for the clinically successful Qo site inhibitor ATV. PMID:27270285

  10. Adoption of intensive care unit telemedicine in the United States

    PubMed Central

    Kahn, Jeremy M.; Cicero, Brandon D.; Wallace, David J.; Iwashyna, Theodore J.

    2013-01-01

    Objective Intensive care unit (ICU) telemedicine is a novel approach for providing critical care services from a distance. We sought to study the extent of use and patterns of adoption of this technology in United States ICUs. Design Retrospective study combining a systematic listing of ICU telemedicine installations with hospital characteristic data from the Centers for Medicare and Medicaid Services. We examined adoption over time and compared hospital characteristics between facilities that have adopted ICU telemedicine and those that have not. Setting United States hospitals from 2003 to 2010. Measurements and main results The number of hospitals using ICU telemedicine increased from 16 (0.4% of total) to 213 (4.6% of total) between 2003 and 2010. The number of ICU beds covered by telemedicine increased from 598 (0.9% of total) to 5,799 (7.9% of total). The average annual rate of ICU bed coverage growth was 101% per year in the first four study years but slowed to 8.1% per year over the last four study years (p<0.001 for difference in linear trend). Compared to non-adopting hospitals, hospitals adopting ICU telemedicine were more likely to be large (percentage with >400 beds: 11.1% vs. 3.7%, p<0.001), teaching (percentage with resident coverage: 31.4% vs. 21.9%, p=0.003) and urban (percentage located in metropolitan statistical areas with over one million residents: 45.3% vs. 30.1%, p<0.001). Conclusions ICU telemedicine adoption was initially rapid but recently slowed. Efforts are needed to uncover the barriers to future growth, particularly regarding the optimal strategy for using this technology most effectively and efficiently. PMID:24145839

  11. A Model of U.S. Commercial Distributed Generation Adoption

    SciTech Connect

    LaCommare, Kristina Hamachi; Ryan Firestone; Zhou, Nan; Maribu,Karl; Marnay, Chris

    2006-01-10

    Small-scale (100 kW-5 MW) on-site distributed generation (DG) economically driven by combined heat and power (CHP) applications and, in some cases, reliability concerns will likely emerge as a common feature of commercial building energy systems over the next two decades. Forecasts of DG adoption published by the Energy Information Administration (EIA) in the Annual Energy Outlook (AEO) are made using the National Energy Modeling System (NEMS), which has a forecasting module that predicts the penetration of several possible commercial building DG technologies over the period 2005-2025. NEMS is also used for estimating the future benefits of Department of Energy research and development used in support of budget requests and management decisionmaking. The NEMS approach to modeling DG has some limitations, including constraints on the amount of DG allowed for retrofits to existing buildings and a small number of possible sizes for each DG technology. An alternative approach called Commercial Sector Model (ComSeM) is developed to improve the way in which DG adoption is modeled. The approach incorporates load shapes for specific end uses in specific building types in specific regions, e.g., cooling in hospitals in Atlanta or space heating in Chicago offices. The Distributed Energy Resources Customer Adoption Model (DER-CAM) uses these load profiles together with input cost and performance DG technology assumptions to model the potential DG adoption for four selected cities and two sizes of five building types in selected forecast years to 2022. The Distributed Energy Resources Market Diffusion Model (DER-MaDiM) is then used to then tailor the DER-CAM results to adoption projections for the entire U.S. commercial sector for all forecast years from 2007-2025. This process is conducted such that the structure of results are consistent with the structure of NEMS, and can be re-injected into NEMS that can then be used to integrate adoption results into a full forecast.

  12. Metabolite identification of the antimalarial piperaquine in vivo using liquid chromatography-high-resolution mass spectrometry in combination with multiple data-mining tools in tandem.

    PubMed

    Yang, Aijuan; Zang, Meitong; Liu, Huixiang; Fan, Peihong; Xing, Jie

    2016-08-01

    Artemisinin-based combination therapy is widely used for the treatment of uncomplicated Plasmodium falciparum malaria, and piperaquine (PQ) is one of important partner drugs. The pharmacokinetics of PQ is characterized by a low clearance and a large volume of distribution; however, metabolism of PQ has not been thoroughly investigated. In this work, the metabolite profiling of PQ in human and rat was studied using liquid chromatography tandem high-resolution LTQ-Orbitrap mass spectrometry (HRMS). The biological samples were pretreated by solid-phase extraction. Data processes were carried out using multiple data-mining techniques in tandem, i.e., isotope pattern filter followed by mass defect filter. A total of six metabolites (M1-M6) were identified for PQ in human (plasma and urine) and rat (plasma, urine and bile). Three reported metabolites were also found in this study, which included N-oxidation (M1, M2) and carboxylic products (M3). The subsequent N-oxidation of M3 resulted in a new metabolite M4 detected in urine and bile samples. A new metabolic pathway N-dealkylation was found for PQ in human and rat, leading to two new metabolites (M5 and M6). This study demonstrated that LC-HRMS(n) in combination with multiple data-mining techniques in tandem can be a valuable analytical strategy for rapid metabolite profiling of drugs. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26821381

  13. Developmental Outcomes of Internationally Adopted Children

    PubMed Central

    Welsh, Janet A.; Viana, Andres G.

    2013-01-01

    This study followed the development of a sample of 106 (67 girls) internationally adopted children over a period of 18 months. Children were adopted from five birth regions, including China, Korea, Latin America, Eastern Europe, and other Asian countries. Mean age at adoption was 11 months. Mothers completed the Ages and Stages Questionnaire (ASQ) at 6, 12, and 24 months post-adoption, assessing children's gross and fine motor, communicative, personal-social, and problem solving skills. Results revealed that the sample as a whole demonstrated linear improvement over time in most developmental domains, but children with initially low scores remained significantly lower than other children at the 18-month follow-up. At the first time point, communication was the domain where children most commonly experienced delays. Children with medical problems had significantly lower developmental scores than those without medical diagnoses. ASQ scores were unrelated to age at adoption, but significant differences by birth country region were found. Across most domains, children adopted from Eastern Europe showed generally lower scores than children adopted from other birth regions. PMID:23908583

  14. 20 CFR 404.733 - Evidence you are the legally adopting parent or legally adopted child.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... needed, evidence of the date of adoption; (b) If the widow or widower adopted the child after the insured... or legally adopted child. 404.733 Section 404.733 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Evidence Evidence for Child's and...

  15. Parallel Process Issues for Lesbian and Gay Adoptive Parents and Their Adopted Children

    ERIC Educational Resources Information Center

    Matthews, John D.; Cramer, Elizabeth P.

    2005-01-01

    Gays and lesbians, both single and coupled, are increasingly turning to adoption to create or expand their families. This manuscript specifically addresses the continuing needs of adoptees and adoptive parents by exploring key issues in the life course of gays and lesbians and their adopted children, and identifying potential parallel development…

  16. Skin Color in Transracial and Inracial Adoptive Placements: Implications for Special Needs Adoptions.

    ERIC Educational Resources Information Center

    McRoy, Ruth G.; Grape, Helen

    1999-01-01

    Explores interview excerpts of African-American adults adopted either transracially or interracially to discuss implications of color for special-needs adoptions. Finds that the issue of color extends beyond racial differences to include skin tone and that children are aware of and internalize color at an early age. Suggests that adoption agencies…

  17. Open Adoption of Infants: Adoptive Parents' Perceptions of Advantages and Disadvantages.

    ERIC Educational Resources Information Center

    Siegel, Deborah H.

    1993-01-01

    Conducted qualitative study of adoptive parents' (n=21 couples) reactions to recent open adoptions of their infants. Findings indicated overwhelmingly positive feelings about open adoption. Respondents often noted that issue of openness was eclipsed by other concerns: coping with infertility, finding a baby, dealing with personnel, and dealing…

  18. Korean Adoptee Identity: Adoptive and Ethnic Identity Profiles of Adopted Korean Americans

    ERIC Educational Resources Information Center

    Beaupre, Adam J.; Reichwald, Reed; Zhou, Xiang; Raleigh, Elizabeth; Lee, Richard M.

    2015-01-01

    Adopted Korean adolescents face the task of grappling with their identity as Koreans and coming to terms with their adoptive status. In order to explore these dual identities, the authors conducted a person-centered study of the identity profiles of 189 adopted Korean American adolescents. Using cluster analytic procedures, the study examined…

  19. Cultural Tourism in Transnational Adoption: "Staged Authenticity" and Its Implications for Adopted Children

    ERIC Educational Resources Information Center

    Quiroz, Pamela Anne

    2012-01-01

    The discursive practices of adoptive parents in two online transnational adoption forums (2006-2008) and observations of five international adoption workshops suggest that what Heather Jacobson described as "culture keeping", the cultural socialization of children that retains a sense of native group identity, is more aptly characterized as…

  20. A Study of Self-Esteem in Adopted Non-adopted Adolescents.

    ERIC Educational Resources Information Center

    Steward, Robbie J.; Lynn, Betty Jane

    This study tested the hypothesis that adopted adolescents have lower self-esteem than do non-adopted adolescents. Male and female students (N=159) between the ages of 18 and 22 were conveniently sampled from college undergraduate populations. Forty-four of the participants reported adoptive status. Each participant completed the Coopersmith…

  1. Pricing Health Behavior Interventions to Promote Adoption

    PubMed Central

    Ribisl, Kurt M.; Leeman, Jennifer; Glasser, Allison M.

    2015-01-01

    The relatively high cost of delivering many public health interventions limits their potential for broad public impact by reducing their likelihood of adoption and maintenance over time. Practitioners identify cost as the primary factor for which interventions they select to implement, but researchers rarely disseminate cost information or consider its importance when developing new interventions. A new approach is proposed, whereby intervention developers assess what individuals and agencies adopting their interventions are willing to pay and then design interventions that are responsive to this price range. The ultimate goal is to develop effective and affordable interventions, called lean interventions, which are widely adopted and have greater public health impact. PMID:24842743

  2. Internationally Adopted Children: Important Information for Parents

    MedlinePlus

    ... iodine). Newborn metabolic screen up to 2 years. Infectious Diseases PPD or currently recommended testing for tuberculosis exposure ( ... Pediatrics. Medical Evaluation of Internationally Adopted Children for Infectious Diseases. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, ...

  3. Distributed PV Adoption in Maine Through 2021

    SciTech Connect

    Gagnon, Pieter; Sigrin, Ben

    2015-11-06

    NREL has used its dSolar (distributed solar) model to generate low-medium-high estimates of distributed PV adoption in Maine through 2021. This presentation gives a high-level overview of the model and modeling results.

  4. Drivers and Barriers in Health IT Adoption

    PubMed Central

    Avgar, A.C.; Litwin, A.S.; Pronovost, P.J.

    2012-01-01

    Despite near (and rare) consensus that the adoption and diffusion of health information technology (health IT) will bolster outcomes for organizations, individuals, and the healthcare system as a whole, there has been surprisingly little consideration of the structures and processes within organizations that might drive the adoption and effective use of the technology. Management research provides a useful lens through which to analyze both the determinants of investment and the benefits that can ultimately be derived from these investments. This paper provides a conceptual framework for understanding health IT adoption. In doing so, this paper highlights specific organizational barriers or enablers at different stages of the adoption process – investment, implementation, and use – and at different levels of organizational decision-making – strategic, operational, and frontline. This framework will aid both policymakers and organizational actors as they make sense of the transition from paper-based to electronic systems. PMID:23646093

  5. Are You Pregnant and Thinking about Adoption?

    MedlinePlus

    ... stories . O.J. Howard Publishing. Siegel, D.H., & Smith, S.L. (2012). Openness in adoption: From secrecy and ... from- secrecy- and- stigma- to- knowledge- and- connections/ Smith, S. (2007). Safeguarding the rights and well-being of ...

  6. Adopting Integrated Pest Management in Schools.

    ERIC Educational Resources Information Center

    Currie, William E.

    1991-01-01

    The development of an effective Integrated Pest Management program is discussed. Provided are the common goals and procedures involved in adopting an Integrated Pest Management program for schools. (CW)

  7. Disparities in Primary Care EHR Adoption Rates

    PubMed Central

    Mack, Dominic; Zhang, Shun; Douglas, Megan; Sow, Charles; Strothers, Harry; Rust, George

    2016-01-01

    This study evaluates electronic health record (EHR) adoption by primary care providers in Georgia to assess adoption disparities according to practice size and type, payer mix, and community characteristics. Frequency variances of EHR “Go Live” status were estimated. Odds ratios were calculated by univariate and multivariate logistic regression models. Large practices and community health centers (CHCs) were more likely to Go Live (>80% EHR adoption) than rural health clinics and other underserved settings (53%). A significantly lower proportion (68.9%) of Medicaid predominant providers had achieved Go Live status and had a 47% higher risk of not achieving Go Live status than private insurance predominant practices. Disparities in EHR adoption rates may exacerbate existing disparities in health outcomes of patients served by these practices. Targeted support such as that provided to CHCs would level the playing field for practices now at a disadvantage. PMID:27587942

  8. Intercountry Adoption and the Family Life Cycle.

    ERIC Educational Resources Information Center

    Deacon, Sharon A.

    1997-01-01

    Provides family therapists with an understanding of intercountry adoption. The special life-cycle issues of multinational families and the challenges intercountry adoptees face are discussed to help therapists treat such families more empathically and effectively. (Author/MKA)

  9. Parental Bonding in Older-Child Adoptions.

    ERIC Educational Resources Information Center

    Ward, Margaret

    1981-01-01

    Examines various factors (such as periods of high emotion, ritual and claiming behaviors and positive interaction) in the attachment process between adoptive parents and older children. Shows that most components parallel those of bonding in biological parents. (Author/RH)

  10. [The outcomes of Adoption in the Case of the "British Chinese Adoption Study"].

    PubMed

    Rushton, Alan

    2015-01-01

    Practitioners can over-estimate the incidence of problems in adopted children and adults because they do not see those who make good psychological and social adjustments. Research into adoption outcomes can be hard to interpret without information about differing pre-adoption histories. Examples are given of research into three types of adoption: domestic infant adoption, adoptions from public care of maltreated children and international adoption of ex-orphanage children. Although negative outcomes are indisputably evident for some, recovery from adversity is more common than many would predict. It is important to recognize that subsequent nurturing in consistent and stimulating environments can build a platform for effective adaptations to challenges in the future. However, a proper understanding of the consequences of adoption has been limited by the fact that follow-up studies have rarely extended beyond adolescence and early adulthood. The British Chinese Adoption Study is a 50 year follow-up of orphanage girls internationally adopted into the United Kingdom, and is given as an example of good outcomes despite early years of adversity. Scores on mental health assessments were equivalent to the non-adopted, age-matched comparison group of UK women. Most of the women were rated as "good functioning" and educational achievements were many times higher than the comparison women. Life-long adverse effects are not inevitable following early adversity. Improved circumstances can promote recovery and good adult adjustment. Practice and research implications are discussed. PMID:26645770

  11. Psychological Ramifications of Adoption and Implications for Counseling.

    ERIC Educational Resources Information Center

    Helwig, Andrew A.; Ruthven, Dorothy H.

    1990-01-01

    Examines adoption issues including family member loss, infertility, transracial adoptions, special-needs adoptions, older child adoption, inherited traits, adoptive family, biological parents, and open adoption. Suggests specific therapeutic interventions including redefinition, use of paradox, family therapy approaches, group therapy, and…

  12. 5 CFR 843.404 - Proof of adoption.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Proof of adoption. 843.404 Section 843... Proof of adoption. (a) An adopted child is— (1) A child adopted by the employee or retiree before the... petition for adoption was filed by the employee or retiree and who is adopted by the current spouse of...

  13. 5 CFR 843.404 - Proof of adoption.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Proof of adoption. 843.404 Section 843... Proof of adoption. (a) An adopted child is— (1) A child adopted by the employee or retiree before the... petition for adoption was filed by the employee or retiree and who is adopted by the current spouse of...

  14. 5 CFR 843.404 - Proof of adoption.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Proof of adoption. 843.404 Section 843... Proof of adoption. (a) An adopted child is— (1) A child adopted by the employee or retiree before the... petition for adoption was filed by the employee or retiree and who is adopted by the current spouse of...

  15. Adoption Activities on the Internet: A Call for Regulation

    ERIC Educational Resources Information Center

    Roby, Jini L.; White, Holly

    2010-01-01

    There is a growing practice of adoption services on the Internet with varying degrees of regulation, depending on whether it is domestic infant adoption, public foster care adoption, or international adoption. Regulation is particularly lacking in domestic infant adoptions, with Web sites connecting prospective birth and adoptive parents,…

  16. 5 CFR 843.404 - Proof of adoption.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Proof of adoption. 843.404 Section 843... Proof of adoption. (a) An adopted child is— (1) A child adopted by the employee or retiree before the... petition for adoption was filed by the employee or retiree and who is adopted by the current spouse of...

  17. 5 CFR 843.404 - Proof of adoption.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Proof of adoption. 843.404 Section 843... Proof of adoption. (a) An adopted child is— (1) A child adopted by the employee or retiree before the... petition for adoption was filed by the employee or retiree and who is adopted by the current spouse of...

  18. Moses and Superman Come Home: Counseling Adoptees and Adoptive Families.

    ERIC Educational Resources Information Center

    Saiz, Stephen G.

    This paper looks at three parties impacted by adoption: the adoptive parents, the adopted child, and the adoptive family. When working with adoptive parents, counselors should respect the strength of the couple, their commitment to parenthood, and the closeness that may develop from weathering the issue of childlessness. Adoptive parents are…

  19. The Practice of Adoption: History, Trends, and Social Context

    ERIC Educational Resources Information Center

    Zamostny, Kathy P.; O'Brien, Karen M.; Baden, Amanda L.; Wiley, Mary O'Leary

    2003-01-01

    This article presents an overview of the practice of adoption to counseling psychologists to promote clinical understanding of the adoption experience and to stimulate research on adoption. The article includes definitions of adoption terminology, important historical and legal developments for adoption, a summary of adoption statistics,…

  20. Adoption in the age of reproductive technology.

    PubMed

    van den Akker, O B A

    2001-05-01

    The choice of adoption over genetic parenthood was investigated in 105 women retrospectively by questionnaire. Participants were divided into four groups: female/male subfertility; female subfertility; male subfertility; and female/male fertility. Half the sample (59/105) answered the question about the importance of a genetic link. Women who failed to adopt thought a genetic link was important, as did those who were less likely to disclose alternative reproductive conceptions to their child. First thoughts following diagnosis were more focused and actions more centered on adoption in the female/male subfertile group compared to the other groups. Communication of the child's origins was least prevalent in the female/male subfertile group, followed by the male subfertile group, although all groups would disclose adoption. The choice of adoption was determined by a number of factors, not all associated with infertility resolution. Although it is unlikely that resolution to infertility can be achieved in any population attempting to overcome infertility, the cognitive dissonance identified in this population is likely to be generalizable to those choosing other options to overcome infertility. Cultural and counselling acknowledgement of postmodern family theory principles is likely to ease cognitive consistency regarding the status of adoptive familyhood, and dispel the importance of reproductive options emphasizing a genetic link. PMID:12449936

  1. Assessing access for prospective adoptive parents living with HIV: an environmental scan of Ontario's adoption agencies.

    PubMed

    Underhill, Angela A; Kennedy, V Logan; Lewis, Johanna; Ross, Lori E; Loutfy, Mona

    2016-10-01

    Work has been underway to increase the availability of parenting options for people living with and affected by HIV. One option, adoption, has not yet been explored in the literature. The study aimed to gain a better understanding of the potential of adoption for individuals/couples living with HIV in Ontario, and to assess potential structural barriers or facilitators that may impact their experience navigating the adoption system by conducting an environmental scan of adoption service providers in Ontario. A list of adoption service providers was compiled using the Ontario government's website. Information relevant to the study's measures was collected using service providers' websites. Service providers without websites, or with websites that did not address all of the research measures, were contacted via telephone to complete a structured interview. Online data extraction was possible for 2 and telephone surveys were completed with 75 adoption service providers (total n = 77). Most service providers reported that HIV status is not an exclusion criterion for prospective parents (64%). However, more than one-fifth of the participants acknowledged they were not sure if people with HIV were eligible to adopt. Domestic service providers were the only providers who did not report knowledge of restrictions due to HIV status. Private domestic adoption presented social barriers as birth parent(s) of a child can access health records of a prospective parent and base their selection of an adoptive parent based on health status. Adoption practitioners and licensees involved in international adoptions reported the most structural barriers for prospective parent(s) living with HIV, attributed to the regulations established by the host country of the child(ren) eligible for adoption. Although international adoptions may present insurmountable barriers for individuals living with HIV, public and private domestic adoption appears to be a viable option. PMID:27136971

  2. Validation of ELISA for Quantitation of Artemisinin-Based Antimalarial Drugs

    PubMed Central

    Wang, Min; Cui, Yongliang; Zhou, Guofa; Yan, Guiyun; Cui, Liwang; Wang, Baomin

    2013-01-01

    The circulation of counterfeit or substandard artemisinins (ARTs) in malaria-endemic areas poses a serious threat to the long-term use of these drugs. Here, we validated an indirect competitive enzyme-linked immunosorbent assay (icELISA) for quantification of ARTs and found that 50% of inhibitory concentrations of dihydroartemisinin, artemether, and artesunate were 8.1, 207.0, and 4.7 ng/mL, respectively. We compared the icELISA with high-performance liquid chromatography (HPLC) for quantifying ART and its derivatives in 22 convenience samples of commercial antimalarial drugs. Paired t tests showed a borderline significant difference between the two methods (mean = 0.03, 95% confidence interval [CI] 0.00–0.07, P = 0.074) and the icELISA results were more variable than those of the HPLC analysis (P < 0.001), suggesting that further improvement is needed to enhance the performance of the icELISA. Our results showed that the icELISA has the potential to be improved for quality assurance of ARTs at the point of care in endemic settings. PMID:24080636

  3. Sensitive and selective electrochemical detection of artemisinin based on its reaction with p-aminophenylboronic acid.

    PubMed

    Wang, Chao; Zholudov, Yuriy T; Nsabimana, Anaclet; Xu, Guobao; Li, Jianping

    2016-09-21

    The electrochemical detection of artemisinin generally requires high oxidation potential or the use of complex electrode modification. We find that artemisinin can react with p-aminophenylboronic acid to produce easily electrochemically detectable aminophenol for the first time. By making use of the new reaction, we report an alternative method to detect artemisinin through the determination of p-aminophenol. The calibration curve for the determination of artemisinin is linear in the range of 2 μmol L(-1) to 200 μmol L(-1) with the detection limit of 0.8 μmol L(-1), which is more sensitive than other reported electrochemical methods. The relative standard deviation is 4.83% for the determination of 10 μM artemisinin. Because the oxidation potential of p-aminophenol is around 0 V, the present method is high selective. When 40 μM, 90 μM and 140 μM of artemisinin were spiked to compound naphthoquine phosphate tablet samples, the recoveries are 107.6%, 105.4% and 101.7%, respectively. This detection strategy is attractive for the detection of artemisinin and its derivatives. The finding that artemisinin can react with aromatic boronic acid has the potential to be exploited for the development of other sensors, such as fluorescence artemisinin sensors. PMID:27590543

  4. Adopted children from the former Soviet Union

    PubMed Central

    Koren, Gideon

    2013-01-01

    Abstract Question One of the families in my practice is considering adoption of a 2-year-old child from the former Soviet Union. The family has been reassured by the agency that a doctor will examine the child to rule out developmental delays. However, my understanding from your previous articles is that one cannot rule out fetal alcohol spectrum disorder (FASD) at that age. Are these children at increased risk of developing FASD? Answer You are correct: FASD cannot be ruled out at 2 years of age. The risk of FASD, neglect, and abuse among children in orphanages in the former Soviet Union is high. While adoption of children with known developmental delays should be encouraged and supported, most families seek to adopt with the assumption that these children will be healthy. PMID:24130279

  5. Breaking the addiction to technology adoption.

    PubMed

    Bryan, Stirling; Mitton, Craig; Donaldson, Cam

    2014-04-01

    A major driver of cost growth in health care is the rapid increase in the utilisation of existing technology and not simply the adoption of new technology. Health economists and their health technology assessment colleagues have become obsessed by technology adoption questions and have largely ignored 'technology management' questions. Technology management would include the life-cycle assessment of technologies in use, to assess their real-world performance; and monitoring of technology indication creep. A rebalancing of focus might serve to encourage a more self-critical and learning culture amongst those involved in technology evaluation analysis. Further, health economists and health technology assessment analysts could make a more significant contribution to system efficiency through rebalancing their efforts away from technology adoption questions towards technology management issues. PMID:24590701

  6. Health worker factors associated with prescribing of artemisinin combination therapy for uncomplicated malaria in rural Tanzania

    PubMed Central

    2013-01-01

    Background Improving malaria case management is partially dependent on health worker compliance with clinical guidelines. This study assessed health worker factors associated with correct anti-malarial prescribing practices at two sites in rural Tanzania. Methods Repeated cross-sectional health facility surveys were conducted during high and low malaria transmission seasons in 2010 and collected information on patient consultations and health worker characteristics. Using logistic regression, the study assessed health worker factors associated with correct prescription for uncomplicated malaria defined as prescription of artemisinin-based combination therapy (ACT) for patients with fever and Plasmodium falciparum asexual infection based on blood slide or malaria rapid diagnostic test (RDT) according to national treatment guidelines. Results The analysis included 685 patients with uncomplicated malaria who were seen in a health facility with ACT in stock, and 71 health workers practicing in 30 health facilities. Overall, 58% of malaria patients were correctly treated with ACT. Health workers with three or more years’ work experience were significantly more likely than others to prescribe correctly (adjusted odds ratio (aOR) 2.9; 95% confidence interval (CI) 1.2-7.1; p = 0.019). Clinical officers (aOR 2.2; 95% CI 1.1-4.5; p = 0.037), and nurse aide or lower cadre (aOR 3.1; 95% CI 1.3-7.1; p = 0.009) were more likely to correctly prescribe ACT than medical officers. Training on ACT use, supervision visits, and availability of job aids were not significantly associated with correct prescription. Conclusions Years of working experience and health worker cadre were associated with correct ACT prescription for uncomplicated malaria. Targeted interventions to improve health worker performance are needed to improve overall malaria case management. PMID:24053679

  7. Correlates of household seismic hazard adjustment adoption.

    PubMed

    Lindell, M K; Whitney, D J

    2000-02-01

    This study examined the relationships of self-reported adoption of 12 seismic hazard adjustments (pre-impact actions to reduce danger to persons and property) with respondents' demographic characteristics, perceived risk, perceived hazard knowledge, perceived protection responsibility, and perceived attributes of the hazard adjustments. Consistent with theoretical predictions, perceived attributes of the hazard adjustments differentiated among the adjustments and had stronger correlations with adoption than any of the other predictors. These results identify the adjustments and attributes that emergency managers should address to have the greatest impact on improving household adjustment to earthquake hazard. PMID:10795335

  8. On Adopting Educational Materials: A Cautionary Tale

    NASA Astrophysics Data System (ADS)

    Stewart, S.; Brown, D.; Dotger, S.

    2014-07-01

    The astronomy education community has made many educational materials publically available through various outlets. Unfortunately, adoption of educational materials does not guarantee instructional change. The materials—being nothing more than words on paper—are static, inert representations of abstract concepts that come to life only through interpretation and use by instructors and students. Research has previously demonstrated how instructors adopt, interpret, change, modify, and use materials in ways unanticipated by their developers (Brown 2009). This study investigates how a professor and teaching assistants used Engaging in Astronomical Inquiry (Slater, Slater, & Lyons 2010) during a laboratory section of an introductory astronomy course for nonscience majors.

  9. Adoptive Immunotherapy for Cancer or Viruses

    PubMed Central

    Maus, Marcela V.; Fraietta, Joseph A.; Levine, Bruce L.; Kalos, Michael; Zhao, Yangbing; June, Carl H.

    2015-01-01

    Adoptive immunotherapy, or the infusion of lymphocytes, is a promising approach for the treatment of cancer and certain chronic viral infections. The application of the principles of synthetic biology to enhance T cell function has resulted in substantial increases in clinical efficacy. The primary challenge to the field is to identify tumor-specific targets to avoid off-tissue, on-target toxicity. Given recent advances in efficacy in numerous pilot trials, the next steps in clinical development will require multicenter trials in order to establish adoptive immunotherapy as a mainstream technology. PMID:24423116

  10. Hurdling barriers through market uncertainty: Case studies ininnovative technology adoption

    SciTech Connect

    Payne, Christopher T.; Radspieler Jr., Anthony; Payne, Jack

    2002-08-18

    The crisis atmosphere surrounding electricity availability in California during the summer of 2001 produced two distinct phenomena in commercial energy consumption decision-making: desires to guarantee energy availability while blackouts were still widely anticipated, and desires to avoid or mitigate significant price increases when higher commercial electricity tariffs took effect. The climate of increased consideration of these factors seems to have led, in some cases, to greater willingness on the part of business decision-makers to consider highly innovative technologies. This paper examines three case studies of innovative technology adoption: retrofit of time-and-temperature signs on an office building; installation of fuel cells to supply power, heating, and cooling to the same building; and installation of a gas-fired heat pump at a microbrewery. We examine the decision process that led to adoption of these technologies. In each case, specific constraints had made more conventional energy-efficient technologies inapplicable. We examine how these barriers to technology adoption developed over time, how the California energy decision-making climate combined with the characteristics of these innovative technologies to overcome the barriers, and what the implications of hurdling these barriers are for future energy decisions within the firms.

  11. 43 CFR 4750.4-2 - Adoption fee.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Adoption fee. 4750.4-2 Section 4750.4-2... HORSES AND BURROS Private Maintenance § 4750.4-2 Adoption fee. (a) Does BLM charge an adoption fee for wild horses and burros? You must pay an adoption fee for each wild horse or burro you adopt....

  12. 43 CFR 4750.4-2 - Adoption fee.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Adoption fee. 4750.4-2 Section 4750.4-2... HORSES AND BURROS Private Maintenance § 4750.4-2 Adoption fee. (a) Does BLM charge an adoption fee for wild horses and burros? You must pay an adoption fee for each wild horse or burro you adopt....

  13. 20 CFR 222.34 - Relationship resulting from equitable adoption.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Relationship resulting from equitable adoption... adoption. In many States, where a legal adoption proceeding was defective under State law or where a contemplated legal adoption was not completed, a claimant may be considered to be an equitably adopted child....

  14. 43 CFR 4750.4-2 - Adoption fee.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Adoption fee. 4750.4-2 Section 4750.4-2... HORSES AND BURROS Private Maintenance § 4750.4-2 Adoption fee. (a) Does BLM charge an adoption fee for wild horses and burros? You must pay an adoption fee for each wild horse or burro you adopt....

  15. 20 CFR 222.34 - Relationship resulting from equitable adoption.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Relationship resulting from equitable adoption... adoption. In many States, where a legal adoption proceeding was defective under State law or where a contemplated legal adoption was not completed, a claimant may be considered to be an equitably adopted child....

  16. 43 CFR 4750.4-2 - Adoption fee.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Adoption fee. 4750.4-2 Section 4750.4-2... HORSES AND BURROS Private Maintenance § 4750.4-2 Adoption fee. (a) Does BLM charge an adoption fee for wild horses and burros? You must pay an adoption fee for each wild horse or burro you adopt....

  17. Books on Adoption for Young Children: Looking at Language.

    ERIC Educational Resources Information Center

    Schimmel, Nancy; Love, Susan

    1997-01-01

    Books can inform, reassure, and give young children the vocabulary to talk about adoption. This article presents and examines the language used to talk about adoption in eleven current children's books. Discusses surrogacy, adoption, "natural" parents, grief, "chosen-baby" stories, age at adoption, international adoption, foster children, and open…

  18. Adoption Practice in Canada: Emerging Trends and Challenges.

    ERIC Educational Resources Information Center

    Sobol, Michael P.; Daly, Kerry

    1995-01-01

    Reports the results of the National Adoption Study of Canada (NAS), which is based on demographic adoption statistics and a survey of adoption agencies and practitioners. The NAS found that between 1981 and 1990 the number of adoptions decreased by 47% and that private adoptions are accounting for an ever-increasing proportion of infant…

  19. A comparison of adoptive parents' perceptions of their child's behavior among Indian children adopted to Norway, the United States, and within country: implications for adoption policy.

    PubMed

    Brown, Suzanne; Groza, Victor

    2013-01-01

    The Hague Convention on the Protection of Children suggests that intercountry adoption be considered as a permanent care option only after other solutions within the child's country of origin have been exhausted. Data from the Child Behavior Checklist (CBCL) were examined for 478 Indian children ages 4-18 adopted domestically, adopted to Norway, and adopted to the United States. The CBCL has a reported reliability of .9 (Achenbach, 1991; Achenbach & Edelbrock, 1983) and contains five subscales assessing internalizing problems plus a summative Internalizing Scale, and three subscales assessing externalizing problems plus a summative Externalizing Scale. Perceptions of Norwegian, American, and Indian adoptive parents regarding their child's functioning were compared. Children adopted to Norway and the United States were perceived by their parents to be functioning significantly better behaviorally than children adopted within country, while controlling for age of child and gender of adoptive parent completing the CBCL. Policymakers should examine the evidence prioritizing within country adoption over intercountry adoption. PMID:24818433

  20. Enhancing the Fiscal Base for NDN Adoptions.

    ERIC Educational Resources Information Center

    Capla Associates, Inc., Rochelle Park, NJ.

    This material is intended to help state facilitators or developer/demonstrators locate the funding sources most likely to meet the needs of local education agencies (LEAs) as potential National Diffusion Network adopters. LEAs that have identified a specific need that may be met by one of the NDN programs would be encouraged to submit a grant…

  1. Factors Influencing Adoption of the IGE Innovation.

    ERIC Educational Resources Information Center

    Felker, Roberta M.

    This paper looks beyond the language of shared decision-making and team teaching to provide insight into how the norms of Individually Guided Education are translated into specific adoption outcomes. Its purposes are (1) to explicate the historical context and assumptions about the nature of schooling and the role of the teacher that are implicit…

  2. International Adoption: Benefits, Risks, and Vulnerabilities

    ERIC Educational Resources Information Center

    Rochat, Tamsen; Richter, Linda

    2007-01-01

    International adoption is on the rise in the United States and is not without controversy. Reasons for the increase include higher rates of infertility in couples who have delayed parenthood; increased numbers of children who are relinquished, abandoned, or orphaned around the world; and the influence of third party agencies. Internationally…

  3. 76 FR 81 - Adoption of Recommendation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-03

    ... of Executive Departments and agencies (May 20, 2009), 74 FR 24,693, 24,693-94 (May 22, 2009), available at http://www.gpo.gov/fdsys/pkg/FR-2009-05-22/pdf/E9-12250.pdf#page=1 (last visited October 29...; ] ADMINISTRATIVE CONFERENCE OF THE UNITED STATES Adoption of Recommendation AGENCY: Administrative Conference...

  4. Outcomes of Children Adopted from Eastern Europe

    ERIC Educational Resources Information Center

    Miller, Laurie; Chan, Wilma; Tirella, Linda; Perrin, Ellen

    2009-01-01

    Behavioral problems are frequent among post-institutionalized Eastern European adoptees. However, risk factors related to outcomes have not been fully delineated. We evaluated 50 Eastern European adoptees, age 8-10 years, with their adoptive families for more than five years. Cognitive and behavioral outcomes and parenting stress were evaluated in…

  5. Cultural Competence for Transracial Adoptive Parents.

    ERIC Educational Resources Information Center

    Vonk, M. Elizabeth

    2001-01-01

    Provides a clear conceptual definition of cultural competence for transracial-cultural adoptive (TRA) parents based on an extensive review of the literature and feedback from experts and parents. A three part definition of cultural competence for TRA parents includes: racial awareness, multicultural planning, and survival skills. Implications for…

  6. TILE at Iowa: Adoption and Adaptation

    ERIC Educational Resources Information Center

    Florman, Jean C.

    2014-01-01

    This chapter introduces a University of Iowa effort to enhance and support active learning pedagogies in technology-enhanced (TILE) classrooms and three elements that proved essential to the campus-wide adoption of those pedagogies. It then describes the impact of those professional development efforts on the curricula and cultures of three…

  7. Adoption of Energy Conservation among California Homeowners.

    ERIC Educational Resources Information Center

    Leonard-Barton, Dorothy; Rogers, Everett M.

    In spring 1977, just as California was emerging from one of the worst droughts in its history, 215 Palo Alto homeowners were interviewed about their views on energy and water conservation, and about the extent to which they had adopted 11 energy-conserving practices (ECP) in the home. The objective was to discover variables both important to…

  8. Environmental Justice and Green-Technology Adoption

    ERIC Educational Resources Information Center

    Ong, Paul

    2012-01-01

    This paper presents an analysis of an environmental justice (EJ) program adopted by the South Coast Air Quality Management District (SCAQMD) as a part of its regulation to phase out a toxic chemical used by dry cleaners. SCAQMD provided financial incentives to switch early and gave establishments in EJ neighborhoods priority in applying for…

  9. Negotiating the Dance: Consulting with Adoptive Systems.

    ERIC Educational Resources Information Center

    Becker, Kent W.; Carson, David K.; Seto, Atsuko; Becker, Carol A.

    2002-01-01

    For marriage and family therapists and educators who train future marriage and family therapists, families formed by means of adoption offer an abundance of learning opportunities in both the areas of assessment and intervention. The following consultation case represents a composite family designed to highlight the unique features of adoptive…

  10. 75 FR 68166 - National Adoption Month, 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-04

    ... From the Federal Register Online via the Government Publishing Office TD04NO10.016 [FR Doc. 2010... the United States of America the two hundred and thirty-fifth. (Presidential Sig.) [FR Doc. 2010-28117...; ] Proclamation 8597 of November 1, 2010 National Adoption Month, 2010 By the President of the United States...

  11. Adopting Learning Technologies: From Belief to Practice

    ERIC Educational Resources Information Center

    Bothma, Cornelius H.; Cant, Michael C.

    2011-01-01

    A challenge faced by most heads of academic departments around the world is to manage the adoption and use of appropriate learning technologies in order to support the department's learning offerings to students. Earlier research undertaken by the authors revealed that lecturers within the Department of Marketing and Retail Management at the…

  12. Personal Contacts and the Adoption of Innovations.

    ERIC Educational Resources Information Center

    Alleyne, E. Patrick; Verner, Coolie

    A study undertaken among commercial strawberry growers in the Fraser Valley of British Columbia, Canada, sought to define the network of personal contacts as used by the farmers in obtaining information relevant to growing practices. Growers were divided into four adopter categories: laggards, late majority, early majority, and innovator-early…

  13. 50 CFR 38.7 - Adopted offenses.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... NATIONAL WILDLIFE REFUGE SYSTEM MIDWAY ATOLL NATIONAL WILDLIFE REFUGE Prohibitions § 38.7 Adopted offenses. Any person who commits any act or omission on Midway Atoll National Wildlife Refuge which, although... commits any act or omission on Midway Atoll National Wildlife Refuge which, although not made...

  14. 50 CFR 38.7 - Adopted offenses.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... NATIONAL WILDLIFE REFUGE SYSTEM MIDWAY ATOLL NATIONAL WILDLIFE REFUGE Prohibitions § 38.7 Adopted offenses. Any person who commits any act or omission on Midway Atoll National Wildlife Refuge which, although... commits any act or omission on Midway Atoll National Wildlife Refuge which, although not made...

  15. 50 CFR 38.7 - Adopted offenses.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... NATIONAL WILDLIFE REFUGE SYSTEM MIDWAY ATOLL NATIONAL WILDLIFE REFUGE Prohibitions § 38.7 Adopted offenses. Any person who commits any act or omission on Midway Atoll National Wildlife Refuge which, although... commits any act or omission on Midway Atoll National Wildlife Refuge which, although not made...

  16. 50 CFR 38.7 - Adopted offenses.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... NATIONAL WILDLIFE REFUGE SYSTEM MIDWAY ATOLL NATIONAL WILDLIFE REFUGE Prohibitions § 38.7 Adopted offenses. Any person who commits any act or omission on Midway Atoll National Wildlife Refuge which, although... commits any act or omission on Midway Atoll National Wildlife Refuge which, although not made...

  17. 50 CFR 38.7 - Adopted offenses.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... NATIONAL WILDLIFE REFUGE SYSTEM MIDWAY ATOLL NATIONAL WILDLIFE REFUGE Prohibitions § 38.7 Adopted offenses. Any person who commits any act or omission on Midway Atoll National Wildlife Refuge which, although... commits any act or omission on Midway Atoll National Wildlife Refuge which, although not made...

  18. Examining Teachers' Decisions to Adopt New Technology

    ERIC Educational Resources Information Center

    Sugar, William; Crawley, Frank; Fine, Bethann

    2004-01-01

    This study examined teachers' beliefs about technology adoption as a reasoned, deliberate, intentional decision-making process, as reflected in Ajzen's (1985) Theory of Planned Behavior. Qualitative and quantitative data were collected from teachers in four schools located in the southeastern region of the United States. Overall results indicated…

  19. The African Orphan Crisis and International Adoption

    ERIC Educational Resources Information Center

    Roby, Jini L.; Shaw, Stacey A.

    2006-01-01

    The plight of Africa's AIDS orphans has reached crisis proportions, and the international community is beginning to mobilize at the family, community, national, and international levels. Despite these encouraging efforts, the response is inadequate, and increased attention and action are needed. The authors suggest that international adoption,…

  20. Adopt-A-Stream Teacher's Handbook.

    ERIC Educational Resources Information Center

    Delta Labs, Inc., Rochester, NY.

    Water pollution is not a recently discovered problem. Humankind's ability to generate pollutants continues to exceed its ability to control them. The Adopt-A-Stream program invites people who care for waterways to take an active role in assuring their well-being. High school groups supported by local co-sponsors agree to evaluate their adopted…

  1. Trailblazing Teacher Contract Agreement Adopted in Baltimore

    ERIC Educational Resources Information Center

    Education Digest: Essential Readings Condensed for Quick Review, 2011

    2011-01-01

    The Baltimore City Public Schools made national headlines late last year when the district adopted a new contract designed to take student learning and teacher professionalism to the next level. The three-year deal replaced conventional approaches to compensation--regular pay increases based on years in the system--with a new approach that gives…

  2. Are Young Muslims Adopting Australian Values?

    ERIC Educational Resources Information Center

    Kabir, Nahid Afrose

    2008-01-01

    Recently politicians in Australia have raised concerns that some Muslims are not adopting Australian values to a sufficient extent. In this paper I explore the notion of Australian values with respect to immigrant youth. By analysing interviews with 32 Muslim students who are 15-18 years of age and of diverse backgrounds in two state schools in…

  3. Envisaging the Adoption Process to Strengthen Gay- and Lesbian-Headed Families: Recommendations for Adoption Professionals

    ERIC Educational Resources Information Center

    Matthews, John D.; Cramer, Elizabeth P.

    2006-01-01

    Although a growing number of child placement agencies are serving lesbians and gay men, a dearth of literature exists for adoption agency policies and practices related to working with this population. This article explores the unique characteristics and strengths of prospective gay and lesbian adoptive parents throughout each of the three phases…

  4. The Role of Race, Culture, and National Origin in Adoption. Adoption and Ethics, Volume 1.

    ERIC Educational Resources Information Center

    Freundlich, Madelyn

    The controversies in adoption have extended across a spectrum of policy and practice issues, and although the issues have become clear, resolution has not been achieved nor has consensus developed regarding a framework on which to improve the quality of adoption policy and practice. This book is the first in a series to use an ethics-based…

  5. An Investigation of How Teachers' Concerns Influence Innovation Adoption. Procedures for Adopting Educational Innovations Project.

    ERIC Educational Resources Information Center

    Rutherford, William L.

    An overview is presented of the Concerns-Based Adoption Model, which describes the major factors influencing the decisions and actions of individuals in the innovation adoption process. The two critical indicators hypothesized by the model, Level of Use of the Innovation, and Stages of Concern About the Innovation, are discussed. The seven stages…

  6. Effects of the history of adoption in the emotional adjustment of adopted adolescents.

    PubMed

    Reppold, Caroline Tozzi; Hutz, Claudio Simon

    2009-11-01

    Since the decade of 1980, the model of stress and coping proposed for the assessment of vulnerability of adoptive families emphasizes that the emotional adjustment of those adopted is moderated by variables such as institutionalization, the manner and age at which the adoption was revealed, the change of first name, and the contact with the biological family. The objective of this study was to investigate the relationship of these variables to the perceived parenting style, mood, and self-esteem of the adopted adolescents. Participants in the study were 68 adolescents, between the ages of 14 and 15, adopted during infancy through judicial channels. The adolescents responded to a questionnaire about the history of adoption and to scales of Parenting Styles, Depression and Self-esteem. The main results indicated that the late revelation of adoption and the change of the first name are connected to higher levels of depression and low self-esteem and to more frequent perceptions of negligent or authoritarian parenting style. The contact with the biological family was frequently mentioned among those who perceived their parents as authoritative and presented the best indicator of mood and self-esteem. These findings were discussed in light of the necessity for multidisciplinary actions which can improve the psychological adaptation of the adopting families. PMID:19899647

  7. The Impact of Previous Type of Abuse and Sibling Adoption upon Adoptive Families.

    ERIC Educational Resources Information Center

    Erich, Stephen; Leung, Patrick

    2002-01-01

    Fifty-two parents of adopted children with histories of abuse or neglect were interviewed. Parents of children with histories of physical and sexual abuse reported lower family functioning than parents of children with histories of neglect. Also, parents who adopted sibling groups reported fewer child externalizing behavior problems but lower…

  8. Adoption: Three Alternatives. A Comparative Study of Three Alternative Forms of Adoptive Placement.

    ERIC Educational Resources Information Center

    Shireman, Joan F.; Johnson, Penny R.

    This is the second report in a longitudinal study designed to examine experiences of black children adopted by white couples, black couples and single parents. Begun in 1970, the study plan is to follow a cohort of black children, adopted as infants or toddlers, through their childhood years until the age of 20. The present report, based on…

  9. Adoption: Three Alternatives. A Comparative Study of Three Alternative Forms of Adoptive Placement.

    ERIC Educational Resources Information Center

    Shireman, Joan F.; Johnson, Penny R.

    This descriptive report covers the first phase of a 20-year longitudinal study of black children adopted under 3 years of age by black couples, white couples, and single persons. The sample of three groups of approximately equal size was selected from the adoptive placements of two private child welfare agencies between June 1970 and June 1972.…

  10. Review: Adoption, fostering, and the needs of looked-after and adopted children

    PubMed Central

    Fisher, Philip A.

    2014-01-01

    Background This review of the literature examines adoption, fostering, and the needs of looked-after and adopted children. Three domains of research about looked-after children are examined. Findings There is extensive evidence that early adverse experiences affect psychological and neurobiological development in looked-after and adopted children. There is also evidence that some looked-after and adopted children show remarkable resilience in the face of adversity; intervention research provides evidence of the ability to reduce risks and promote positive outcomes in this population. The intervention studies have revealed not only the potential for improved behavioral trajectories, but also the plasticity of neurobiological systems affected by early stress. Conclusion Foster and adopted children face many challenges, but scientific knowledge also provides reason for hope and information about how to maximize positive outcomes. PMID:25678858

  11. A Swedish national adoption study of criminality

    PubMed Central

    Kendler, K. S.; Lönn, S. Larsson; Morris, N. A.; Sundquist, J.; Långström, N.; Sundquist, K.

    2014-01-01

    Background To clarify the role of genetic and environmental factors in criminal behavior (CB), we examined all CB and violent and non-violent subtypes (VCB and NVCB, respectively) in a Swedish national sample of adoptees and their relatives. Method CB was defined by a conviction in the Swedish Crime Register with standard definitions for VCB and NVCB subtypes. We examined adoptees born 1950–1991 (n=18070) and their biological (n=79206) and adoptive (n=47311) relatives. Results The risk for all CB was significantly elevated in the adopted-away offspring of biological parents of which at least one had CB [odds ratio (OR) 1.5, 95% confidence interval (CI) 1.4–1.6] and in the biological full and half-siblings of CB adoptees (OR 1.4, 95% CI 1.2–1.6 and OR 1.3, 95% CI 1.2–1.3, respectively). A genetic risk index (including biological parental/sibling history of CB and alcohol abuse) and an environmental risk index (including adoptive parental and sibling CB and a history of adoptive parental divorce, death, and medical illness) both strongly predicted probability of CB. These genetic and environmental risk indices acted additively on adoptee risk for CB. Moderate specificity was seen in the transmission of genetic risk for VCB and NVCB between biological parents and siblings and adoptees. Conclusions CB is etiologically complex and influenced by a range of genetic risk factors including a specific liability to CB and a vulnerability to broader externalizing behaviors, and by features of the adoptive environment including parental CB, divorce and death. Genetic risk factors for VCB and NVCB may be at least partially distinct. PMID:24180693

  12. Evaluating IPv6 Adoption in the Internet

    NASA Astrophysics Data System (ADS)

    Colitti, Lorenzo; Gunderson, Steinar H.; Kline, Erik; Refice, Tiziana

    As IPv4 address space approaches exhaustion, large networks are deploying IPv6 or preparing for deployment. However, there is little data available about the quantity and quality of IPv6 connectivity. We describe a methodology to measure IPv6 adoption from the perspective of a Web site operator and to evaluate the impact that adding IPv6 to a Web site will have on its users. We apply our methodology to the Google Web site and present results collected over the last year. Our data show that IPv6 adoption, while growing significantly, is still low, varies considerably by country, and is heavily influenced by a small number of large deployments. We find that native IPv6 latency is comparable to IPv4 and provide statistics on IPv6 transition mechanisms used.

  13. Adopting a direction. Forum of Parliamentarians.

    PubMed

    Sakurai, S

    1999-01-01

    National security, poverty alleviation, and refugees are global issues which all urgently need to be addressed. However, no major issue will be resolved until the population problem is solved. Humankind needs to find a way to live in harmony with the earth and its natural environment. The 1994 International Conference on Population and Development (ICPD) adopted a program of action outlining practical measures to be taken with regard to population and development. The concepts of reproductive health and women's empowerment were also adopted. The ICPD was in many ways an historic conference which set the future direction for the issues of population and development. The conference program of action must be fully implemented to ensure a healthy future for humankind and the earth. Elected officials must do their best to ensure that the ICPD program of action is successfully implemented. PMID:12322180

  14. Overcoming barriers to physician adoption of EHRs.

    PubMed

    Hochron, Stuart M; Goldberg, Paul

    2014-02-01

    A hospital's success in implementing an electronic health record will depend largely on physicians' willingness to adopt the new technology. Therefore, before embarking on such an initiative, finance leaders should conduct a targeted survey to assess the likelihood that the initiative will meet with physician resistance. The survey results can provide a basis for developing an outreach program that will bring physicians on board by helping them understand the initiative's purpose and giving them a stake in its success. PMID:24611225

  15. Treaty to Curb Mercury Pollution Adopted

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    2013-10-01

    The international Minamata Convention on Mercury to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds was formally adopted at a 10 October meeting in Minamata, Japan. The legally binding treaty, currently signed by 92 countries, comes 57 years after the government of Japan officially acknowledged, in 1956, the existence of Minamata disease, which was caused by eating seafood contaminated with methylmercury compounds discharged into Minamata Bay in southern Japan.

  16. An Analysis of the External Environmental and Internal Organizational Factors Associated with Adoption of the Electronic Health Record

    ERIC Educational Resources Information Center

    Kruse, Clemens Scott

    2013-01-01

    Despite a Presidential Order in 2004 that launched national incentives for the use of health information technology, specifically the Electronic Health Record (EHR), adoption of the EHR has been slow. This study attempts to quantify factors associated with adoption of the EHR and Computerized Provider Order Entry (CPOE) by combining multiple…

  17. Inadequate efficacy of a new formulation of fosmidomycin-clindamycin combination in Mozambican children less than three years old with uncomplicated Plasmodium falciparum malaria.

    PubMed

    Lanaspa, Miguel; Moraleda, Cinta; Machevo, Sónia; González, Raquel; Serrano, Beatriz; Macete, Eusebio; Cisteró, Pau; Mayor, Alfredo; Hutchinson, David; Kremsner, Peter G; Alonso, Pedro; Menéndez, Clara; Bassat, Quique

    2012-06-01

    The combination of fosmidomycin and clindamycin (F/C) is effective in adults and older children for the treatment of malaria and could be an important alternative to existing artemisinin-based combinations (ACTs) if proven to work in younger children. We conducted an open-label clinical trial to assess the efficacy, safety, and tolerability of F/C for the treatment of uncomplicated P. falciparum malaria in Mozambican children <3 years of age. Aqueous solutions of the drugs were given for 3 days, and the children were followed up for 28 days. The primary outcome was the PCR-corrected adequate clinical and parasitological response at day 28. Secondary outcomes included day 7 and 28 uncorrected cure rates and fever (FCT) and parasite (PCT) clearance times. Fifty-two children were recruited, but only 37 patients were evaluable for the primary outcome. Day 7 cure rates were high (94.6%; 35/37), but the day 28 PCR-corrected cure rate was 45.9% (17/37). The FCT was short (median, 12 h), but the PCT was longer (median, 72 h) than in previous studies. Tolerability was good, and most common adverse events were related to the recurrence of malaria. The poor efficacy observed for the F/C combination may be a consequence of the new formulations used, differential bioavailability in younger children, naturally occurring variations in parasite sensitivity to the drugs, or an insufficient enhancement of their effects by naturally acquired immunity in young children. Additional studies should be conducted to respond to the many uncertainties arising from this trial, which should not discourage further evaluation of this promising combination. PMID:22430959

  18. The Economics of Adoption of Children from Foster Care

    ERIC Educational Resources Information Center

    Hansen, Mary Eschelbach; Hansen, Bradley A.

    2006-01-01

    Federal initiatives since 1996 have intensified the efforts of states to achieve adoption for children in foster care. For many waiting children, the path to adoption is long. The authors offer an economic analysis of adoption from foster care, with an emphasis on the reasons why achieving the goal of adoption for all waiting children may be so…

  19. Partitioning the Adoption Process to Better Predict Permanency

    ERIC Educational Resources Information Center

    McDonald, Tom; Press, Alan; Billings, Peggy; Moore, Terry

    2007-01-01

    Under federal outcome standards established by the Adoption and Safe Families Act of 1997, discharges to adoption are expected to occur within 24 months of the most recent removal from home for at least 32% of cases. In the research recounted here, adoption is treated as a process composed of two discrete steps: adoptive placement, and adoption…

  20. Using the Innovation Adoption Diffusion Model to Target Educational Programming.

    ERIC Educational Resources Information Center

    Rollins, Timothy

    1993-01-01

    A telephone survey of 200 farm operators regarding adoption of innovations found 52% were early adopters or early majority adopters and 48% were late majority adopters or laggard. Importance of scientific research, learning about new concepts, and use of sources other than extension were factors distinguishing the categories. (SK)

  1. 27 CFR 17.125 - Adoption of formulas and processes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Adoption of formulas and... NONBEVERAGE PRODUCTS Formulas and Samples § 17.125 Adoption of formulas and processes. (a) Adoption of... of adoption with the appropriate TTB officer. The notice shall be filed with the first claim...

  2. 27 CFR 24.127 - Adoption of formulas.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Adoption of formulas. 24... Establishment § 24.127 Adoption of formulas. The adoption of approved formulas by a successor proprietor will be... formulas for adoption by formula number, name of product, and date of approval. The application...

  3. 20 CFR 222.33 - Relationship resulting from legal adoption.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Relationship resulting from legal adoption... RETIREMENT ACT FAMILY RELATIONSHIPS Relationship as Child § 222.33 Relationship resulting from legal adoption... applicable State law. Legal adoption differs from equitable adoption in that in the case of legal...

  4. 27 CFR 17.125 - Adoption of formulas and processes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Adoption of formulas and... NONBEVERAGE PRODUCTS Formulas and Samples § 17.125 Adoption of formulas and processes. (a) Adoption of... of adoption with the appropriate TTB officer. The notice shall be filed with the first claim...

  5. 27 CFR 17.125 - Adoption of formulas and processes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Adoption of formulas and... NONBEVERAGE PRODUCTS Formulas and Samples § 17.125 Adoption of formulas and processes. (a) Adoption of... of adoption with the appropriate TTB officer. The notice shall be filed with the first claim...

  6. 20 CFR 222.34 - Relationship resulting from equitable adoption.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... adoption. 222.34 Section 222.34 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE... equitable adoption. In many States, where a legal adoption proceeding was defective under State law or where a contemplated legal adoption was not completed, a claimant may be considered to be an...

  7. 22 CFR 96.12 - Authorized adoption service providers.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Authorized adoption service providers. 96.12... AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA) Accreditation and Approval Requirements for the Provision of Adoption Services § 96.12 Authorized adoption service providers. (a) Once...

  8. 20 CFR 222.34 - Relationship resulting from equitable adoption.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... adoption. 222.34 Section 222.34 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE... equitable adoption. In many States, where a legal adoption proceeding was defective under State law or where a contemplated legal adoption was not completed, a claimant may be considered to be an...

  9. 22 CFR 96.12 - Authorized adoption service providers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Authorized adoption service providers. 96.12... AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA) Accreditation and Approval Requirements for the Provision of Adoption Services § 96.12 Authorized adoption service providers. (a) Once...

  10. 27 CFR 24.127 - Adoption of formulas.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Adoption of formulas. 24... Establishment § 24.127 Adoption of formulas. The adoption of approved formulas by a successor proprietor will be... formulas for adoption by formula number, name of product, and date of approval. The application...

  11. 20 CFR 222.34 - Relationship resulting from equitable adoption.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... adoption. 222.34 Section 222.34 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE... equitable adoption. In many States, where a legal adoption proceeding was defective under State law or where a contemplated legal adoption was not completed, a claimant may be considered to be an...

  12. 27 CFR 24.127 - Adoption of formulas.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Adoption of formulas. 24... Establishment § 24.127 Adoption of formulas. The adoption of approved formulas by a successor proprietor will be... formulas for adoption by formula number, name of product, and date of approval. The application...

  13. Connecting the Dots: Exploring Themes in Adoption Picturebooks

    ERIC Educational Resources Information Center

    Mattix, April A.; Crawford, Patricia A.

    2011-01-01

    Approximately 1.4 million school-aged children entered their families through adoption. As such, adoption represents a real and complex social issue with which young children--adopted or not--can grapple. Adoption picturebooks provide a medium by which children can explore this complicated concept. This manuscript analyzes a standard library…

  14. 22 CFR 96.12 - Authorized adoption service providers.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Authorized adoption service providers. 96.12... AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA) Accreditation and Approval Requirements for the Provision of Adoption Services § 96.12 Authorized adoption service providers. (a) Once...

  15. 20 CFR 222.33 - Relationship resulting from legal adoption.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Relationship resulting from legal adoption... RETIREMENT ACT FAMILY RELATIONSHIPS Relationship as Child § 222.33 Relationship resulting from legal adoption... applicable State law. Legal adoption differs from equitable adoption in that in the case of legal...

  16. 22 CFR 96.12 - Authorized adoption service providers.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Authorized adoption service providers. 96.12... AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA) Accreditation and Approval Requirements for the Provision of Adoption Services § 96.12 Authorized adoption service providers. (a) Once...

  17. 27 CFR 24.127 - Adoption of formulas.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Adoption of formulas. 24... Establishment § 24.127 Adoption of formulas. The adoption of approved formulas by a successor proprietor will be... formulas for adoption by formula number, name of product, and date of approval. The application...

  18. 20 CFR 222.33 - Relationship resulting from legal adoption.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Relationship resulting from legal adoption... RETIREMENT ACT FAMILY RELATIONSHIPS Relationship as Child § 222.33 Relationship resulting from legal adoption... applicable State law. Legal adoption differs from equitable adoption in that in the case of legal...

  19. 7 CFR 1794.71 - Adoption of an EA.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false Adoption of an EA. 1794.71 Section 1794.71... AGRICULTURE (CONTINUED) ENVIRONMENTAL POLICIES AND PROCEDURES Adoption of Environmental Documents § 1794.71 Adoption of an EA. RUS may adopt a Federal EA or EIS or a portion thereof as its EA. RUS shall make the...

  20. 27 CFR 17.125 - Adoption of formulas and processes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Adoption of formulas and... NONBEVERAGE PRODUCTS Formulas and Samples § 17.125 Adoption of formulas and processes. (a) Adoption of... of adoption with the appropriate TTB officer. The notice shall be filed with the first claim...

  1. 27 CFR 17.125 - Adoption of formulas and processes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Adoption of formulas and... NONBEVERAGE PRODUCTS Formulas and Samples § 17.125 Adoption of formulas and processes. (a) Adoption of... of adoption with the appropriate TTB officer. The notice shall be filed with the first claim...

  2. 20 CFR 222.33 - Relationship resulting from legal adoption.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Relationship resulting from legal adoption... RETIREMENT ACT FAMILY RELATIONSHIPS Relationship as Child § 222.33 Relationship resulting from legal adoption... applicable State law. Legal adoption differs from equitable adoption in that in the case of legal...

  3. 22 CFR 96.12 - Authorized adoption service providers.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Authorized adoption service providers. 96.12... AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA) Accreditation and Approval Requirements for the Provision of Adoption Services § 96.12 Authorized adoption service providers. (a) Once...

  4. 7 CFR 1794.71 - Adoption of an EA.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 12 2012-01-01 2012-01-01 false Adoption of an EA. 1794.71 Section 1794.71... AGRICULTURE (CONTINUED) ENVIRONMENTAL POLICIES AND PROCEDURES Adoption of Environmental Documents § 1794.71 Adoption of an EA. RUS may adopt a Federal EA or EIS or a portion thereof as its EA. RUS shall make the...

  5. Understanding Technology Adoption: Theory and Future Directions for Informal Learning

    ERIC Educational Resources Information Center

    Straub, Evan T.

    2009-01-01

    How and why individuals adopt innovations has motivated a great deal of research. This article examines individuals' computing adoption processes through the lenses of three adoption theories: Rogers's innovation diffusion theory, the Concerns-Based Adoption Model, the Technology Acceptance Model, and the United Theory of Acceptance and Use of…

  6. 7 CFR 1794.71 - Adoption of an EA.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 12 2011-01-01 2011-01-01 false Adoption of an EA. 1794.71 Section 1794.71... AGRICULTURE (CONTINUED) ENVIRONMENTAL POLICIES AND PROCEDURES Adoption of Environmental Documents § 1794.71 Adoption of an EA. RUS may adopt a Federal EA or EIS or a portion thereof as its EA. RUS shall make the...

  7. 27 CFR 24.127 - Adoption of formulas.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Adoption of formulas. 24... Establishment § 24.127 Adoption of formulas. The adoption of approved formulas by a successor proprietor will be... formulas for adoption by formula number, name of product, and date of approval. The application...

  8. 20 CFR 222.33 - Relationship resulting from legal adoption.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Relationship resulting from legal adoption... RETIREMENT ACT FAMILY RELATIONSHIPS Relationship as Child § 222.33 Relationship resulting from legal adoption... applicable State law. Legal adoption differs from equitable adoption in that in the case of legal...

  9. 27 CFR 19.187 - Adoption of formulas.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Adoption of formulas. 19... After Original Qualification § 19.187 Adoption of formulas. (a) Forms 5110.38. The adoption by a... the appropriate TTB officer. The application shall list the formulas for adoption by (1)...

  10. 7 CFR 1794.71 - Adoption of an EA.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 12 2013-01-01 2013-01-01 false Adoption of an EA. 1794.71 Section 1794.71... AGRICULTURE (CONTINUED) ENVIRONMENTAL POLICIES AND PROCEDURES Adoption of Environmental Documents § 1794.71 Adoption of an EA. RUS may adopt a Federal EA or EIS or a portion thereof as its EA. RUS shall make the...

  11. The Effect of Family Communication Patterns on Adopted Adolescent Adjustment

    ERIC Educational Resources Information Center

    Rueter, Martha A.; Koerner, Ascan F.

    2008-01-01

    Adoption and family communication both affect adolescent adjustment. We proposed that adoption status and family communication interact such that adopted adolescents in families with certain communication patterns are at greater risk for adjustment problems. We tested this hypothesis using a community-based sample of 384 adoptive and 208…

  12. Implications of Transnational Adoption Status for Adult Korean Adoptees

    ERIC Educational Resources Information Center

    Langrehr, Kimberly J.; Yoon, Eunju; Hacker, Jason; Caudill, Kathy

    2015-01-01

    This study used a consensual qualitative research method to explore the implications of transnational adoption in the lives of 12 adult Korean adoptees. From the analysis, 6 domains emerged: (a) adoption history and preadoptive memories, (b) meaning of adoption, (c) adoptive family dynamics, (d) racism, (e) identity formation, and (f) counseling…

  13. Adoption and the Guatemalan Journey to American Parenthood

    ERIC Educational Resources Information Center

    Noonan, Emily J.

    2007-01-01

    Examining the adoption of Guatemalan children by US citizens, this article argues that adoptive parents make meanings and form identities through their participation in the adoption process and in their production of both Internet-based and spoken narratives about adoption. Using theories of globalization and narrative theory, the article…

  14. The Adoption Experience: Families Who Give Children a Second Chance.

    ERIC Educational Resources Information Center

    Morris, Ann

    This book examines the adoption process in Great Britain, recounting first-hand experiences to take the reader through each stage of the process from the adopter's point of view. The book also examines the success and failure of several types of adoption. The chapters are: (1) "You Want to Adopt"; (2) "First Meetings, First Months, Falling in…

  15. Sensory Processing in Internationally Adopted, Post-Institutionalized Children

    ERIC Educational Resources Information Center

    Wilbarger, Julia; Gunnar, Megan; Schneider, Mary; Pollak, Seth

    2010-01-01

    Background/Methods: Sensory processing capacities of 8-12-year-old internationally adopted (IA) children who experienced prolonged institutional care (greater than 12 months with 75% of pre-adoption lives in institutional care) prior to adoption into family environments (PI) were compared to a group of IA children who were adopted early (less than…

  16. Communication Development in Infants and Toddlers Adopted from Abroad

    ERIC Educational Resources Information Center

    Hwa-Froelich, Deborah A.

    2009-01-01

    Approximately 20,000 children are adopted from foreign countries each year. Of these children, approximately 46% are adopted before they are 12 months old and 43% are adopted between 1 and 4 years of age. The development of children adopted from abroad before or by 2 years of age is the focus of this article. Given the impoverished language input…

  17. 45 CFR Appendix B to Part 1355 - Adoption Data Elements

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Adoption Data Elements B Appendix B to Part 1355... to Part 1355—Adoption Data Elements Section I—Adoption Data Elements I. General Information A. Title...: 1 No: 2 Section II—Definitions of Instructions for Adoption Data Elements Reporting Population...

  18. 45 CFR Appendix B to Part 1355 - Adoption Data Elements

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Adoption Data Elements B Appendix B to Part 1355... to Part 1355—Adoption Data Elements Section I—Adoption Data Elements I. General Information A. Title...: 1 No: 2 Section II—Definitions of Instructions for Adoption Data Elements Reporting Population...

  19. 45 CFR Appendix B to Part 1355 - Adoption Data Elements

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Adoption Data Elements B Appendix B to Part 1355... to Part 1355—Adoption Data Elements Section I—Adoption Data Elements I. General Information A. State...? ____ Yes: 1 No: 2 Section II—Definitions of Instructions for Adoption Data Elements Reporting...

  20. 45 CFR Appendix B to Part 1355 - Adoption Data Elements

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 4 2013-10-01 2013-10-01 false Adoption Data Elements B Appendix B to Part 1355... to Part 1355—Adoption Data Elements Section I—Adoption Data Elements I. General Information A. Title...: 1 No: 2 Section II—Definitions of Instructions for Adoption Data Elements Reporting Population...

  1. 45 CFR Appendix B to Part 1355 - Adoption Data Elements

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Adoption Data Elements B Appendix B to Part 1355... to Part 1355—Adoption Data Elements Section I—Adoption Data Elements I. General Information A. State...? ____ Yes: 1 No: 2 Section II—Definitions of Instructions for Adoption Data Elements Reporting...

  2. Modeling of customer adoption of distributed energy resources

    SciTech Connect

    Marnay, Chris; Chard, Joseph S.; Hamachi, Kristina S.; Lipman, Timothy; Moezzi, Mithra M.; Ouaglal, Boubekeur; Siddiqui, Afzal S.

    2001-08-01

    This report describes work completed for the California Energy Commission (CEC) on the continued development and application of the Distributed Energy Resources Customer Adoption Model (DER-CAM). This work was performed at Ernest Orlando Lawrence Berkeley National Laboratory (Berkeley Lab) between July 2000 and June 2001 under the Consortium for Electric Reliability Technology Solutions (CERTS) Distributed Energy Resources Integration (DERI) project. Our research on distributed energy resources (DER) builds on the concept of the microgrid ({mu}Grid), a semiautonomous grouping of electricity-generating sources and end-use sinks that are placed and operated for the benefit of its members. Although a {mu}Grid can operate independent of the macrogrid (the utility power network), the {mu}Grid is usually interconnected, purchasing energy and ancillary services from the macrogrid. Groups of customers can be aggregated into {mu}Grids by pooling their electrical and other loads, and the most cost-effective combination of generation resources for a particular {mu}Grid can be found. In this study, DER-CAM, an economic model of customer DER adoption implemented in the General Algebraic Modeling System (GAMS) optimization software is used, to find the cost-minimizing combination of on-site generation customers (individual businesses and a {mu}Grid) in a specified test year. DER-CAM's objective is to minimize the cost of supplying electricity to a specific customer by optimizing the installation of distributed generation and the self-generation of part or all of its electricity. Currently, the model only considers electrical loads, but combined heat and power (CHP) analysis capability is being developed under the second year of CEC funding. The key accomplishments of this year's work were the acquisition of increasingly accurate data on DER technologies, including the development of methods for forecasting cost reductions for these technologies, and the creation of a credible

  3. Adoption: biological and social processes linked to adaptation.

    PubMed

    Grotevant, Harold D; McDermott, Jennifer M

    2014-01-01

    Children join adoptive families through domestic adoption from the public child welfare system, infant adoption through private agencies, and international adoption. Each pathway presents distinctive developmental opportunities and challenges. Adopted children are at higher risk than the general population for problems with adaptation, especially externalizing, internalizing, and attention problems. This review moves beyond the field's emphasis on adoptee-nonadoptee differences to highlight biological and social processes that affect adaptation of adoptees across time. The experience of stress, whether prenatal, postnatal/preadoption, or during the adoption transition, can have significant impacts on the developing neuroendocrine system. These effects can contribute to problems with physical growth, brain development, and sleep, activating cascading effects on social, emotional, and cognitive development. Family processes involving contact between adoptive and birth family members, co-parenting in gay and lesbian adoptive families, and racial socialization in transracially adoptive families affect social development of adopted children into adulthood. PMID:24016275

  4. Enabling international adoption of LOINC through translation

    PubMed Central

    Vreeman, Daniel J.; Chiaravalloti, Maria Teresa; Hook, John; McDonald, Clement J.

    2012-01-01

    Interoperable health information exchange depends on adoption of terminology standards, but international use of such standards can be challenging because of language differences between local concept names and the standard terminology. To address this important barrier, we describe the evolution of an efficient process for constructing translations of LOINC terms names, the foreign language functions in RELMA, and the current state of translations in LOINC. We also present the development of the Italian translation to illustrate how translation is enabling adoption in international contexts. We built a tool that finds the unique list of LOINC Parts that make up a given set of LOINC terms. This list enables translation of smaller pieces like the core component “hepatitis c virus” separately from all the suffixes that could appear with it, such “Ab.IgG”, “DNA”, and “RNA”. We built another tool that generates a translation of a full LOINC name from all of these atomic pieces. As of version 2.36 (June 2011), LOINC terms have been translated into 9 languages from 15 linguistic variants other than its native English. The five largest linguistic variants have all used the Part-based translation mechanism. However, even with efficient tools and processes, translation of standard terminology is a complex undertaking. Two of the prominent linguistic challenges that translators have faced include: the approach to handling acronyms and abbreviations, and the differences in linguistic syntax (e.g. word order) between languages. LOINC’s open and customizable approach has enabled many different groups to create translations that met their needs and matched their resources. Distributing the standard and its many language translations at no cost worldwide accelerates LOINC adoption globally, and is an important enabler of interoperable health information exchange PMID:22285984

  5. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption.

    PubMed

    Tang, Paul C; Ash, Joan S; Bates, David W; Overhage, J Marc; Sands, Daniel Z

    2006-01-01

    Recently there has been a remarkable upsurge in activity surrounding the adoption of personal health record (PHR) systems for patients and consumers. The biomedical literature does not yet adequately describe the potential capabilities and utility of PHR systems. In addition, the lack of a proven business case for widespread deployment hinders PHR adoption. In a 2005 working symposium, the American Medical Informatics Association's College of Medical Informatics discussed the issues surrounding personal health record systems and developed recommendations for PHR-promoting activities. Personal health record systems are more than just static repositories for patient data; they combine data, knowledge, and software tools, which help patients to become active participants in their own care. When PHRs are integrated with electronic health record systems, they provide greater benefits than would stand-alone systems for consumers. This paper summarizes the College Symposium discussions on PHR systems and provides definitions, system characteristics, technical architectures, benefits, barriers to adoption, and strategies for increasing adoption. PMID:16357345

  6. The intricacies of induced lactation for same-sex mothers of an adopted child.

    PubMed

    Wilson, Erica; Perrin, Maryanne Tigchelaar; Fogleman, April; Chetwynd, Ellen

    2015-02-01

    The definition of a modern family is changing. In this case study, we describe the breastfeeding experience of a child receiving human milk from all 3 of his mothers: his 2 adoptive mothers, who induced lactation to nurse him, and his birth mother, who shared in his early feeding during the open adoption process and continued to pump and send milk to him for several months. We review the lactation protocol used by his adoptive mothers and the unique difficulties inherent in this multi-mother family dynamic. Both adoptive mothers successfully induced moderate milk production using a combination of hormonal birth control, domperidone, herbal supplements, and a schedule of breast pumping. However, because of the increased complexity of the immediate postpartum period and concerns with defining parental roles in a same-sex marriage, maintenance of milk production was difficult. PMID:25311827

  7. Accelerating Industrial Adoption of Metal Additive Manufacturing Technology

    NASA Astrophysics Data System (ADS)

    Vartanian, Kenneth; McDonald, Tom

    2016-03-01

    While metal additive manufacturing (AM) technology has clear benefits, there are still factors preventing its adoption by industry. These factors include the high cost of metal AM systems, the difficulty for machinists to learn and operate metal AM machines, the long approval process for part qualification/certification, and the need for better process controls; however, the high AM system cost is the main barrier deterring adoption. In this paper, we will discuss an America Makes-funded program to reduce AM system cost by combining metal AM technology with conventional computerized numerical controlled (CNC) machine tools. Information will be provided on how an Optomec-led team retrofitted a legacy CNC vertical mill with laser engineered net shaping (LENS®—LENS is a registered trademark of Sandia National Labs) AM technology, dramatically lowering deployment cost. The upgraded system, dubbed LENS Hybrid Vertical Mill, enables metal additive and subtractive operations to be performed on the same machine tool and even on the same part. Information on the LENS Hybrid system architecture, learnings from initial system deployment and continuing development work will also be provided to help guide further development activities within the materials community.

  8. Development and Validation of the "Attitudes toward Adoption Scale" and the "Gay and Lesbian Parents' Adoption Scale."

    ERIC Educational Resources Information Center

    Shelley-Sireci, Lynn M.; Ciano-Boyce, Claudia

    Two studies were conducted to evaluate newly developed measures of attitudes about adoption. The Attitudes toward Adoption Scale was developed, based on research literature, to investigate the attitudes of people with and without experience with adoption toward adoption. Eighty-six college students completed this scale and made open-ended comments…

  9. Mitigating Effects of the Adoptive Caregiving Environment on Inattention/Overactivity in Children Adopted from Romanian Orphanages

    ERIC Educational Resources Information Center

    Audet, Karyn; Le Mare, Lucy

    2011-01-01

    We examined inattention/overactivity (I/O) over time and in relation to caregiving in three matched groups: (1) Romanian Orphans (RO) with a minimum of eight months' deprivation prior to adoption, (2) Early Adopted (EA) children adopted from Romania prior to age four months, and (3) Canadian Born (CB) non-adopted children. Comparisons among groups…

  10. How To Adopt Internationally: A Guide for Agency-Directed and Independent Adoptions. 2000-2002 Edition.

    ERIC Educational Resources Information Center

    Nelson-Erichsen, Jean; Erichsen, Heino R.

    Many potential adoptive parents seeking international adoption find the process to be extremely complex. This guide details the international adoption process, including organizing a home study and fulfilling state requirements as well as selecting a country from which to adopt, working through emigration and immigration agencies, and traveling…

  11. Skin diseases in internationally adopted children.

    PubMed

    Rigal, Émilie; Nourrisson, Céline; Sciauvaud, Julie; Pascal, Julie; Texier, Charlotte; Corbin, Violaine; Poirier, Véronique; Beytout, Jean; Labbe, André; Lesens, Olivier

    2016-08-01

    Internationally adopted children often present diseases contracted in the country of origin. Skin diseases are common in new arrivals, and diagnosis may prove challenging for GPs or even dermatologists if they are inexperienced in the extensive geographic and ethnic diversity of international adoptees. To analyse the frequency and characteristics of skin diseases in international adoptees. In total, 142 adoptees were evaluated for a cross-sectional cohort study. The most frequent diseases observed at arrival were dermatological conditions. Of the adoptees, 70% presented at least one skin disease, of which 57.5% were infectious; Tinea capitis being the most frequent (n = 42). The recovery rate of Tinea capitis was 89% (n = 32/36). Ten cases of scabies were diagnosed. Other diseases included viral skin infection (n = 22), with 16 cases of Molluscum contagiosum and bacterial infection. Skin diseases are very common in internationally adopted children. There is a need for close collaboration between dermatologists and paediatricians to diagnose such infections, as well as clear guidelines to treat them. PMID:27436771

  12. Overcoming the Adoption Barrier to Electric Flight

    NASA Technical Reports Server (NTRS)

    Borer, Nicholas K.; Nickol, Craig L.; Jones, Frank P.; Yasky, Richard J.; Woodham, Kurt; Fell, Jared S.; Litherland, Brandon L.; Loyselle, Patricia L.; Provenza, Andrew J.; Kohlman, Lee W.; Samuel, Aamod G.

    2016-01-01

    Electrically-powered aircraft can enable dramatic increases in efficiency and reliability, reduced emissions, and reduced noise as compared to today's combustion-powered aircraft. This paper describes a novel flight demonstration concept that will enable the benefits of electric propulsion, while keeping the extraordinary convenience and utility of common fuels available at today's airports. A critical gap in airborne electric propulsion research is addressed by accommodating adoption at the integrated aircraft-airport systems level, using a confluence of innovative but proven concepts and technologies in power generation and electricity storage that need to reside only on the airframe. Technical discriminators of this demonstrator concept include (1) a novel, high-efficiency power system that utilizes advanced solid oxide fuel cells originally developed for ultra-long-endurance aircraft, coupled with (2) a high-efficiency, high-power electric propulsion system selected from mature products to reduce technical risk, assembled into (3) a modern, high-performance demonstration platform to provide useful and compelling data, both for the targeted early adopters and the eventual commercial market.

  13. Adoption of an official ISEA glossary.

    PubMed

    Zartarian, Valerie; Bahadori, Tina; McKone, Tom

    2005-01-01

    The International Society for Exposure Analysis (ISEA) and its Nomenclature Committee have been involved since the mid-1990s in an intermittent but ongoing effort to develop an official ISEA glossary. Several related activities have stimulated greater interest and discussion nationally and internationally on a common exposure language. Among these activities are a 1997 Journal of Exposure Analysis and Environmental Epidemiology feature article on exposure and dose definitions and a 1999-initiated project of the International Programme on Chemical Safety (IPCS) (WHO/ILO/UNEP) to confront terminology issues hindering harmonization in the area of exposure assessment. Recently, the ISEA members voted in support of adopting the IPCS glossary as the official ISEA glossary, and the ISEA Executive Board agreed to accept this recommendation. In this feature article, we (1) describe the process through which the ISEA adopted the IPCS glossary as the official ISEA glossary, (2) present the joint IPCS/ISEA glossary of terms and their definitions, and (3) discuss plans for how the glossary can be used by ISEA and updated over time by ISEA and IPCS. The glossary is intended to be a living document that reflects the latest usage and maintains international harmonization of exposure terminology that can be practically applied to improve communication in exposure and related fields. PMID:15562291

  14. Determinants of HMO Formulary Adoption Decisions

    PubMed Central

    Dranove, David; Hughes, Edward FX; Shanley, Mark

    2003-01-01

    Objective To identify economic and organizational characteristics that affect the likelihood that health maintenance organizations (HMOs) include new drugs on their formularies. Data Sources We administered an original survey to directors of pharmacy at 75 HMOs, of which 41 returned usable responses. We obtained drug-specific data from an industry trade journal. Study Design We performed multivariate logistic regression analysis, adjusting for fixed-drug effects and random-HMO effects. We used factor analysis to limit the number of predictors. Data Collection Methods We held initial focus groups to help with survey design. We administered the survey in two waves. We asked respondents to report on seven popular new drugs, and to describe a variety of HMO organizational characteristics. Principal Findings Several HMO organizational characteristics, including nonprofit status, the incentives facing the director of the pharmacy, size and make-up of the pharmacy and therapeutics committee, and relationships with drugs makers, all affect formulary adoption. Conclusions There are many organizational factors that may cause HMOs to make different formulary adoption decisions for certain prescription drugs. PMID:12650387

  15. Information architecture: Profile of adopted standards

    SciTech Connect

    1997-09-01

    The Department of Energy (DOE), like other Federal agencies, is under increasing pressure to use information technology to improve efficiency in mission accomplishment as well as delivery of services to the public. Because users and systems have become interdependent, DOE has enterprise wide needs for common application architectures, communication networks, databases, security, and management capabilities. Users need open systems that provide interoperability of products and portability of people, data, and applications that are distributed throughout heterogeneous computing environments. The level of interoperability necessary requires the adoption of DOE wide standards, protocols, and best practices. The Department has developed an information architecture and a related standards adoption and retirement process to assist users in developing strategies and plans for acquiring information technology products and services based upon open systems standards that support application software interoperability, portability, and scalability. This set of Departmental Information Architecture standards represents guidance for achieving higher degrees of interoperability within the greater DOE community, business partners, and stakeholders. While these standards are not mandatory, particular and due consideration of their applications in contractual matters and use in technology implementations Department wide are goals of the Chief Information Officer.

  16. Endogenous Technology Adoption and Medical Costs.

    PubMed

    Lamiraud, Karine; Lhuillery, Stephane

    2016-09-01

    Despite the claim that technology has been one of the most important drivers of healthcare spending growth over the past decades, technology variables are rarely introduced explicitly in cost equations. Furthermore, technology is often considered exogenous. Using 1996-2007 panel data on Swiss geographical areas, we assessed the impact of technology availability on per capita healthcare spending covered by basic health insurance whilst controlling for the endogeneity of health technology availability variables. Our results suggest that medical research, patent intensity and the density of employees working in the medical device industry are influential factors for the adoption of technology and can be used as instruments for technology availability variables in the cost equation. These results are similar to previous findings: CT and PET scanner adoption is associated with increased healthcare spending, whilst increased availability of percutaneous transluminal coronary angioplasty facilities is associated with reductions in per capita spending. However, our results suggest that the magnitude of these relationships is much greater in absolute value than that suggested by previous studies that did not control for the possible endogeneity of the availability of technologies. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27492052

  17. Adoption of safety eyewear among citrus harvesters in rural Florida.

    PubMed

    Monaghan, Paul F; Bryant, Carol A; McDermott, Robert J; Forst, Linda S; Luque, John S; Contreras, Ricardo B

    2012-06-01

    The community-based prevention marketing program planning framework was used to adapt an evidence-based intervention to address eye injuries among Florida's migrant citrus harvesters. Participant-observer techniques, other direct observations, and individual and focus group interviews provided data that guided refinement of a safety eyewear intervention. Workers were attracted to the eyewear's ability to minimize irritation, offer protection from trauma, and enable work without declines in productivity or comfort. Access to safety glasses equipped with worker-designed features reduced the perceived barriers of using them; deployment of trained peer-leaders helped promote adoption. Workers' use of safety glasses increased from less than 2% to between 28% and 37% in less than two full harvesting seasons. The combination of formative research and program implementation data provided insights for tailoring an existing evidence-based program for this occupational community and increase potential for future dissemination and worker protection. PMID:21643727

  18. Ethnic and adoption attitudes among Guatemalan University students.

    PubMed

    Gibbons, Judith L; González-Oliva, Ana Gabriela; Mylonas, Kostas

    2015-01-01

    Intercountry adoptions from Guatemala were highly controversial, because of the large numbers of children being adopted to the USA, along with evidence of corruption and child theft. Since the implementation of the Hague Convention on Intercountry Adoption in 2008, Guatemala's central authority for adoption has prioritized domestic placements for children over intercountry adoption. A possible attitudinal barrier to domestic adoption in Guatemala-negative attitudes and prejudice against Indigenous people-was investigated through questionnaires measuring attitudes toward adoption and attitudes toward and social distance from the two major ethnic groups (Ladino and Indigenous). Guatemalan university students (N = 177, 61 % men) were recruited from basic required courses at a private university. Results showed that attitudes toward adoption in general were more favorable than toward interethnic adoption, with the most negative attitudes toward adoption of Ladino children by Indigenous parents. Multiple regression and analysis of covariance models revealed that female gender, experience with adoption and more positive attitudes about Indigenous persons were associated with more positive attitudes toward adoption. The findings imply that negative attitudes toward Indigenous persons are associated with negative attitudes toward adoption, and serve as barriers to promoting domestic adoption in Guatemala. PMID:26702374

  19. MSU Adopts Business-Engineering Program

    ERIC Educational Resources Information Center

    Chemical and Engineering News, 1973

    1973-01-01

    A program leading to a bachelor of science degree is discussed which combines a required core of engineering studies with application studies in one of four fields: industrial design, business, communication, or social sciences. (DF)

  20. City Governments and Aging in Place: Community Design, Transportation and Housing Innovation Adoption

    ERIC Educational Resources Information Center

    Lehning, Amanda J.

    2012-01-01

    Purpose of the study: To examine the characteristics associated with city government adoption of community design, housing, and transportation innovations that could benefit older adults. Design and methods: A mixed-methods study with quantitative data collected via online surveys from 62 city planners combined with qualitative data collected via…

  1. Awareness and pro-active adoption of surface water BMPs.

    PubMed

    Hadrich, Joleen C; Van Winkle, Andrea

    2013-09-30

    Beef cow operators were surveyed to determine the effect of cost-share awareness and farm management characteristics on the adoption of surface water best management practices (BMPs) in a state without defined BMPs. Results demonstrated that farm management characteristics determined nutrient management adoption, farm characteristics determined filter strip adoption, and human capital and farm characteristics played the largest role with streambank fencing adoption. Cost-share awareness was not found to increase the probability of adopting any BMPs and Extension education was found to positively and significantly increase the adoption of all three BMPs. PMID:23764472

  2. Adopting Internet Standards for Orbital Use

    NASA Technical Reports Server (NTRS)

    Wood, Lloyd; Ivancic, William; da Silva Curiel, Alex; Jackson, Chris; Stewart, Dave; Shell, Dave; Hodgson, Dave

    2005-01-01

    After a year of testing and demonstrating a Cisco mobile access router intended for terrestrial use onboard the low-Earth-orbiting UK-DMC satellite as part of a larger merged ground/space IP-based internetwork, we reflect on and discuss the benefits and drawbacks of integration and standards reuse for small satellite missions. Benefits include ease of operation and the ability to leverage existing systems and infrastructure designed for general use, as well as reuse of existing, known, and well-understood security and operational models. Drawbacks include cases where integration work was needed to bridge the gaps in assumptions between different systems, and where performance considerations outweighed the benefits of reuse of pre-existing file transfer protocols. We find similarities with the terrestrial IP networks whose technologies we have adopted and also some significant differences in operational models and assumptions that must be considered.

  3. Enhancing prescription drug innovation and adoption.

    PubMed

    Alexander, G Caleb; O'Connor, Alec B; Stafford, Randall S

    2011-06-21

    The adoption and use of a new drug would ideally be guided by its innovation and cost-effectiveness. However, information about the relative efficacy and safety of a drug is typically incomplete even well after market entry, and various other forces create a marketplace in which most new drugs are little better than their older counterparts. Five proposed mechanisms are considered for promoting innovation and reducing the use of therapies ultimately found to offer poor value or have unacceptable risks. These changes range from increasing the evidence required for U.S. Food and Drug Administration approval to modifying the structure of drug reimbursement. Despite the challenges of policy implementation, the United States has a long history of successfully improving the societal value and safe use of prescription medicines. PMID:21690598

  4. Adopting software quality measures for healthcare processes.

    PubMed

    Yildiz, Ozkan; Demirörs, Onur

    2009-01-01

    In this study, we investigated the adoptability of software quality measures for healthcare process measurement. Quality measures of ISO/IEC 9126 are redefined from a process perspective to build a generic healthcare process quality measurement model. Case study research method is used, and the model is applied to a public hospital's Entry to Care process. After the application, weak and strong aspects of the process can be easily observed. Access audibility, fault removal, completeness of documentation, and machine utilization are weak aspects and these aspects are the candidates for process improvement. On the other hand, functional completeness, fault ratio, input validity checking, response time, and throughput time are the strong aspects of the process. PMID:19745339

  5. From Norm Adoption to Norm Internalization

    NASA Astrophysics Data System (ADS)

    Conte, Rosaria; Andrighetto, Giulia; Villatoro, Daniel

    In this presentation, advances in modeling the mental dynamics of norms will be presented. In particular, the process from norm-adoption, possibly yielding new normative goals, to different forms of norm compliance will be focused upon, including norm internalization, which is at study in social-behavioral sciences and moral philosophy since long. Of late, the debate was revamped within the rationality approach pointing to the role of norm internalization as a less costly and more reliable enforcement system than social control. So far, poor attention was paid to the mental underpinnings of internalization. In this presentation, a rich cognitive model of different types, degrees and factors of internalization is shown. The initial implementation of this model on EMIL-A, a normative agent architecture developed and applied to the.

  6. Home Energy Displays. Consumer Adoption and Response

    SciTech Connect

    LaMarche, Janelle; Cheney, K.; Akers, C.; Roth, K.; Sachs, O.

    2012-12-01

    The focus of this project was to investigate the factors influencing consumer adoption of Home Energy Displays (HEDs) and to evaluate electricity consumption in households with basic HEDs versus enhanced feedback methods - web portals or alerts. The team hypothesized that providing flexible and relatable information to users, in addition to a basic HED, would make feedback more effective and achieve persistent energy savings. In Phase I, Fraunhofer conducted three user research studies and found preferences for aesthetically pleasing, easy to understand feedback that is accessible through multiple media and offered free of charge. The deployment of HEDs in 150 households planned for Phase II encountered major recruitment and HED field deployment problems. In light of these challenges, the team is pursuing a modified study investigating the energy savings of a web portal versus alert-based energy feedback instead of a physical HED.

  7. Adoptive T Cell Immunotherapy for Cancer

    PubMed Central

    Perica, Karlo; Varela, Juan Carlos; Oelke, Mathias; Schneck, Jonathan

    2015-01-01

    Harnessing the immune system to recognize and destroy tumor cells has been the central goal of anti-cancer immunotherapy. In recent years, there has been an increased interest in optimizing this technology in order to make it a clinically feasible treatment. One of the main treatment modalities within cancer immunotherapy has been adoptive T cell therapy (ACT). Using this approach, tumor-specific cytotoxic T cells are infused into cancer patients with the goal of recognizing, targeting, and destroying tumor cells. In the current review, we revisit some of the major successes of ACT, the major hurdles that have been overcome to optimize ACT, the remaining challenges, and future approaches to make ACT widely available. PMID:25717386

  8. Adoptive parenting and attachment: association of the internal working models between adoptive mothers and their late-adopted children during adolescence

    PubMed Central

    Pace, Cecilia S.; Di Folco, Simona; Guerriero, Viviana; Santona, Alessandra; Terrone, Grazia

    2015-01-01

    Introduction: Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs) of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children, previously maltreated and neglected. While most research on adoptive families focused on pre-school and school-aged children, the aim of this study was to assess the concordance of IWMs of attachment in adoptive dyads during adolescence. Method: Our pilot-study involved 76 participants: 30 adoptive mothers (mean age = 51.5 ± 4.3), and their 46 late-adopted adolescents (mean age = 13.9 ± 1.6), who were all aged 4–9 years old at time of adoption (mean age = 6.3 ± 1.5). Attachment representations of adopted adolescents were assessed by the Friend and Family Interview (FFI), while adoptive mothers’ state-of-mind with respect to attachment was classified by the Adult Attachment Interview (AAI). Adolescents’ verbal intelligence was controlled for. Results: Late-adopted adolescents were classified as follows: 67% secure, 26% dismissing, and 7% preoccupied in the FFI, while their adoptive mothers’ AAI classifications were 70% free-autonomous, 7% dismissing, and 23% unresolved. We found a significant concordance of 70% (32 dyads) between the secure–insecure FFI and AAI classifications. Specifically adoptive mothers with high coherence of transcript and low unresolved loss tend to have late-adopted children with high secure attachment, even if the adolescents’ verbal intelligence made a significant contribution to this prediction. Discussion: Our results provides an empirical contribution to the literature concerning the concordance of attachment in adoptive dyads, highlighting the beneficial impact of highly coherent

  9. Technology Adoption of Medical Faculty in Teaching: Differentiating Factors in Adopter Categories

    ERIC Educational Resources Information Center

    Zayim, Nese; Yildirim, Soner; Saka, Osman

    2006-01-01

    Despite large investments by higher education institutions in technology for faculty and student use, instructional technology is not being integrated into instruction in higher education institutions including medical education institutions. While the diffusion of instructional technologies has reached a saturation point among early adopters of…

  10. Advanced Adoption of Computer Technology in the Classroom and Teachers' Participation in Voluntary Innovation Adoption Activities.

    ERIC Educational Resources Information Center

    Wesley, Marion T., Jr.; Franks, Melvin Eugene

    A case study was conducted to seek improved understanding of processes related to teachers' adoption of two classroom-based computer technologies--networked computer-assisted instruction (CAI) and desktop computer multimedia resources--at a selected magnet elementary school. A Stages of Concern Questionnaire was used to gather quantitative data,…

  11. The British Chinese Adoption Study: Orphanage Care, Adoption and Mid-Life Outcomes

    ERIC Educational Resources Information Center

    Rushton, Alan; Grant, Margaret; Feast, Julia; Simmonds, John

    2013-01-01

    Background: While studies of ex-orphanage care show adverse effects on development, the longer-term impact on mid-life psychosocial functioning and physical health has not been established. Methods: Orphanage records provided baseline data on a sample of 100 Hong Kong Chinese girls who were subsequently adopted into the UK. A mid-life follow-up…

  12. Adoption of a Non-Lecture Pedagogy in Chemical Engineering: Insights Gained from Observing an Adopter

    ERIC Educational Resources Information Center

    Golter, P. B.; Thiessen, D. B.; Van Wie, B. J.; Brown, G. R.

    2012-01-01

    Promoting the adoption of an alternative pedagogy can be a difficult process. Many professors are not interested in significantly modifying how they teach their course. Those that are interested in pedagogical reform still have concerns that must be addressed before or during an implementation. This paper presents a case study following the…

  13. Single Parent Adoptions: An Issue of Difficulty and Import for Adoption Agencies.

    ERIC Educational Resources Information Center

    Rosenberg, Jeffrey

    Little theoretical and empirical knowledge is available in the social work field to guide practitioners in the area of single parent adoption. In the context of demographics, the single parent family is now conventional. However there is not yet conclusive research on the success or failure of single parent households. Research has suggested that…

  14. The Adopting Single Mother: Four Portraits of American Women Adopting from China.

    ERIC Educational Resources Information Center

    Mannis, Valerie S.

    2000-01-01

    Explored the influences, life experiences, and social factors that made it possible for four women to become single mothers through international adoption. Discusses four themes that emerged from a grounded theory analysis: moral issues; fear and prejudice; agency; and support. (JPB)

  15. Post-Adoption Face-to-Face Contact with Birth Parents: Prospective Adopters' Views

    ERIC Educational Resources Information Center

    Turkington, Selina; Taylor, Brian J.

    2009-01-01

    The trend in adoption since the 1960s has been away from secrecy and towards greater openness; contact through an intermediary, and direct contact by letter, is now widely accepted. More controversial is the challenge of face-to-face contact with birth parents, and social workers involved in the decision-making process find themselves having to…

  16. Power combiner

    DOEpatents

    Arnold, Mobius; Ives, Robert Lawrence

    2006-09-05

    A power combiner for the combining of symmetric and asymmetric traveling wave energy comprises a feed waveguide having an input port and a launching port, a reflector for reflecting launched wave energy, and a final waveguide for the collection and transport of launched wave energy. The power combiner has a launching port for symmetrical waves which comprises a cylindrical section coaxial to the feed waveguide, and a launching port for asymmetric waves which comprises a sawtooth rotated about a central axis.

  17. CTLA-4 blockade plus adoptive T cell transfer promotes optimal melanoma immunity in mice

    PubMed Central

    Mahvi, David A.; Meyers, Justin V.; Tatar, Andrew J.; Contreras, Amanda; Suresh, M.; Leverson, Glen E.; Sen, Siddhartha; Cho, Clifford S.

    2014-01-01

    Immunotherapeutic approaches to the treatment of advanced melanoma have relied on strategies that augment the responsiveness of endogenous tumor-specific T cell populations (e.g., CTLA-4 blockade-mediated checkpoint inhibition) or introduce exogenously-prepared tumor-specific T cell populations (e.g., adoptive cell transfer). Although both approaches have shown considerable promise, response rates to these therapies remain suboptimal. We hypothesized that a combinatorial approach to immunotherapy using both CTLA-4 blockade and non-lymphodepletional adoptive cell transfer could offer additive therapeutic benefit. C57BL/6 mice were inoculated with syngeneic B16F10 melanoma tumors transfected to express low levels of the lymphocytic choriomeningitis virus peptide GP33 (B16GP33), and treated with no immunotherapy, CTLA-4 blockade, adoptive cell transfer, or combination immunotherapy of CTLA-4 blockade with adoptive cell transfer. Combination immunotherapy resulted in optimal control of B16GP33 melanoma tumors. Combination immunotherapy promoted a stronger local immune response reflected by enhanced tumor-infiltrating lymphocyte populations, as well as a stronger systemic immune responses reflected by more potent tumor antigen-specific T cell activity in splenocytes. In addition, whereas both CTLA-4 blockade and combination immunotherapy were able to promote long-term immunity against B16GP33 tumors, only combination immunotherapy was capable of promoting immunity against parental B16F10 tumors as well. Our findings suggest that a combinatorial approach using CTLA-4 blockade with non-lymphodepletional adoptive cell transfer may promote additive endogenous and exogenous T cell activities that enable greater therapeutic efficacy in the treatment of melanoma. PMID:25658614

  18. Declining Efficacy of Artemisinin Combination Therapy Against P. Falciparum Malaria on the Thai–Myanmar Border (2003–2013): The Role of Parasite Genetic Factors

    PubMed Central

    Phyo, Aung Pyae; Ashley, Elizabeth A.; Anderson, Tim J. C.; Bozdech, Zbynek; Carrara, Verena I.; Sriprawat, Kanlaya; Nair, Shalini; White, Marina McDew; Dziekan, Jerzy; Ling, Clare; Proux, Stephane; Konghahong, Kamonchanok; Jeeyapant, Atthanee; Woodrow, Charles J.; Imwong, Mallika; McGready, Rose; Lwin, Khin Maung; Day, Nicholas P. J.; White, Nicholas J.; Nosten, Francois

    2016-01-01

    Background. Deployment of mefloquine–artesunate (MAS3) on the Thailand–Myanmar border has led to a sustained reduction in falciparum malaria, although antimalarial efficacy has declined substantially in recent years. The role of Plasmodium falciparum K13 mutations (a marker of artemisinin resistance) in reducing treatment efficacy remains controversial. Methods. Between 2003 and 2013, we studied the efficacy of MAS3 in 1005 patients with uncomplicated P. falciparum malaria in relation to molecular markers of resistance. Results. Polymerase chain reaction (PCR)–adjusted cure rates declined from 100% in 2003 to 81.1% in 2013 as the proportions of isolates with multiple Pfmdr1 copies doubled from 32.4% to 64.7% and those with K13 mutations increased from 6.7% to 83.4%. K13 mutations conferring moderate artemisinin resistance (notably E252Q) predominated initially but were later overtaken by propeller mutations associated with slower parasite clearance (notably C580Y). Those infected with both multiple Pfmdr1 copy number and a K13 propeller mutation were 14 times more likely to fail treatment. The PCR-adjusted cure rate was 57.8% (95% confidence interval [CI], 45.4, 68.3) compared with 97.8% (95% CI, 93.3, 99.3) in patients with K13 wild type and Pfmdr1 single copy. K13 propeller mutation alone was a strong risk factor for recrudescence (P = .009). The combined population attributable fraction of recrudescence associated with K13 mutation and Pfmdr1 amplification was 82%. Conclusions. The increasing prevalence of K13 mutations was the decisive factor for the recent and rapid decline in efficacy of artemisinin-based combination (MAS3) on the Thailand–Myanmar border. PMID:27313266

  19. Sustained, new, never, and discontinued tobacco cessation services adopters.

    PubMed

    Eby, Lillian T; Laschober, Tanja C; Muilenburg, Jessica L

    2015-02-01

    This study examined longitudinal adoption patterns of tobacco cessation (TC) counseling and TC pharmacotherapy in substance use disorder treatment programs and baseline predictors (program characteristics and program culture) of these patterns 12-months later. Telephone survey data were collected in 2010 from 685 randomly sampled program administrators working in geographically representative treatment programs across the U.S. Regarding TC counseling, about 41% of programs never adopt, 33% sustain, and 27% change adoption patterns. Concerning TC pharmacotherapy, about 62% of programs never adopt, 19% sustain, and 18% change adoption patterns. The three most consistent predictors of counseling adoption patterns are TC reimbursement, TC financial resource availability, and smoking culture. For TC pharmacotherapy adoption patterns, the most consistent predictors include profit status, TC reimbursement, level of care, TC financial resource availability, and smoking culture. Findings provide insights into program characteristics and program culture as both potential barriers and facilitators of longitudinal TCS adoption. PMID:25178991

  20. Openness in adoption and the level of child participation.

    PubMed

    Wrobel, G M; Ayers-Lopez, S; Grotevant, H D; McRoy, R G; Friedrick, M

    1996-10-01

    There is great controversy regarding the impact of openness in adoption, especially the impact of such an arrangement on adopted children. Three indicators of the level of child participation in the openness arrangement were examined: (a) level of openness reported by adoptive parents, (b) level of information adopted children reported having about their birthparents, and (c) whether adoptive parents have withheld any pertinent information gained through communication with the birthmother from the adopted child. 171 children (90 males, 81 females; mean age = 7.99) wee studied to assess how that participation influenced their conceptual understanding of what adoption means, general self-worth, satisfaction with level of openness, and curiosity about birthparents. Overall it does not appear that providing information about a child's birthparents will confuse the child about the meaning of adoption or lower the child's self-esteem, but neither will it move them to levels of understanding that are beyond their cognitive capabilities to reach. PMID:9022246

  1. SOCIOLOGICAL FACTORS IN THE ADOPTION OF AGRICULTURAL BEST MANAGEMENT PRACTICES

    EPA Science Inventory

    The primary goal of this research was to determine the relevant socioeconomic, demographic and agricultural factors that influence the adoption and maintenance of agricultural best management practices. A general theoretic model describing the adoption of technology was modified ...

  2. The Role of Social Networks in Early Adoption of Mobile Devices

    NASA Astrophysics Data System (ADS)

    Tscherning, Heidi; Mathiassen, Lars

    As mobile devices have become the personal information-processing interface of choice, many individuals seem to swiftly follow fashion. Yet, the literature is silent on how early adopters of mobile devices overcome uncertainties related to shifts in technology. Based on purposive sampling, this paper presents detailed insights into why and how five closely related individuals made the decision to adopt the iPhone before it was available through traditional supply chains. Focusing on the role played by social networks, we analyze how adoption threshold, opinion leaders, social contagion, and social learning shaped adoption behaviors and outcomes. The analyses confirm that network structures impact the early decision to accept the iPhone; they show that when facing uncertainty, adoption decisions emerged as a combined result of individual adoption reflections and major influences from the social network as well as behaviors observed within the network, and, they reveal interesting behaviors that differed from expectations. In conclusion, we discuss implications for both theory and practice.

  3. Ising-like agent-based technology diffusion model: Adoption patterns vs. seeding strategies

    NASA Astrophysics Data System (ADS)

    Laciana, Carlos E.; Rovere, Santiago L.

    2011-03-01

    The well-known Ising model used in statistical physics was adapted to a social dynamics context to simulate the adoption of a technological innovation. The model explicitly combines (a) an individual's perception of the advantages of an innovation and (b) social influence from members of the decision-maker's social network. The micro-level adoption dynamics are embedded into an agent-based model that allows exploration of macro-level patterns of technology diffusion throughout systems with different configurations (number and distributions of early adopters, social network topologies). In the present work we carry out many numerical simulations. We find that when the gap between the individual's perception of the options is high, the adoption speed increases if the dispersion of early adopters grows. Another test was based on changing the network topology by means of stochastic connections to a common opinion reference (hub), which resulted in an increment in the adoption speed. Finally, we performed a simulation of competition between options for both regular and small world networks.

  4. PET imaging of adoptive progenitor cell therapies.

    SciTech Connect

    Gelovani, Juri G.

    2008-05-13

    Objectives. The overall objective of this application is to develop novel technologies for non-invasive imaging of adoptive stem cell-based therapies with positron emission tomography (PET) that would be applicable to human patients. To achieve this objective, stem cells will be genetically labeled with a PET-reporter gene and repetitively imaged to assess their distribution, migration, differentiation, and persistence using a radiolabeled reporter probe. This new imaging technology will be tested in adoptive progenitor cell-based therapy models in animals, including: delivery pro-apoptotic genes to tumors, and T-cell reconstitution for immunostimulatory therapy during allogeneic bone marrow progenitor cell transplantation. Technical and Scientific Merits. Non-invasive whole body imaging would significantly aid in the development and clinical implementation of various adoptive progenitor cell-based therapies by providing the means for non-invasive monitoring of the fate of injected progenitor cells over a long period of observation. The proposed imaging approaches could help to address several questions related to stem cell migration and homing, their long-term viability, and their subsequent differentiation. The ability to image these processes non-invasively in 3D and repetitively over a long period of time is very important and will help the development and clinical application of various strategies to control and direct stem cell migration and differentiation. Approach to accomplish the work. Stem cells will be genetically with a reporter gene which will allow for repetitive non-invasive “tracking” of the migration and localization of genetically labeled stem cells and their progeny. This is a radically new approach that is being developed for future human applications and should allow for a long term (many years) repetitive imaging of the fate of tissues that develop from the transplanted stem cells. Why the approach is appropriate. The novel approach to

  5. Adoptive T-cell therapy for Leukemia.

    PubMed

    Garber, Haven R; Mirza, Asma; Mittendorf, Elizabeth A; Alatrash, Gheath

    2014-01-01

    Allogeneic stem cell transplantation (alloSCT) is the most robust form of adoptive cellular therapy (ACT) and has been tremendously effective in the treatment of leukemia. It is one of the original forms of cancer immunotherapy and illustrates that lymphocytes can specifically recognize and eliminate aberrant, malignant cells. However, because of the high morbidity and mortality that is associated with alloSCT including graft-versus-host disease (GvHD), refining the anti-leukemia immunity of alloSCT to target distinct antigens that mediate the graft-versus-leukemia (GvL) effect could transform our approach to treating leukemia, and possibly other hematologic malignancies. Over the past few decades, many leukemia antigens have been discovered that can separate malignant cells from normal host cells and render them vulnerable targets. In concert, the field of T-cell engineering has matured to enable transfer of ectopic high-affinity antigen receptors into host or donor cells with greater efficiency and potency. Many preclinical studies have demonstrated that engineered and conventional T-cells can mediate lysis and eradication of leukemia via one or more leukemia antigen targets. This evidence now serves as a foundation for clinical trials that aim to cure leukemia using T-cells. The recent clinical success of anti-CD19 chimeric antigen receptor (CAR) cells for treating patients with acute lymphoblastic leukemia and chronic lymphocytic leukemia displays the potential of this new therapeutic modality. In this review, we discuss some of the most promising leukemia antigens and the novel strategies that have been implemented for adoptive cellular immunotherapy of lymphoid and myeloid leukemias. It is important to summarize the data for ACT of leukemia for physicians in-training and in practice and for investigators who work in this and related fields as there are recent discoveries already being translated to the patient setting and numerous accruing clinical trials. We

  6. Innovation Adoption Decisions in Organizations: An Empirical Investigation.

    ERIC Educational Resources Information Center

    Gottschalk, Rand; Schmitt, Neal

    Research on educational and criminal justice programs sought to clarify the relationship between organizational characteristics and innovation adoption. It focused on the reasons why organizations adopt innovations and the differences in clientele, staff, and decision-making participation between organizations adopting or unaware of an innovative…

  7. Post-Adoption Depression: Clinical Windows on an Emerging Concept

    ERIC Educational Resources Information Center

    Speilman, Eda

    2011-01-01

    In recent years, the concept of post-adoption depression--with both parallels and differences from postpartum depression--has emerged as a salient descriptor of the experience of a significant minority of newly adoptive parents. This article offers a clinical perspective on post-adoption depression through the stories of several families seen in…

  8. 49 CFR 1110.8 - Adoption of final rules.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 8 2014-10-01 2014-10-01 false Adoption of final rules. 1110.8 Section 1110.8 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT... Adoption of final rules. If, after consideration of all comments received, final rules are adopted,...

  9. 49 CFR 553.29 - Adoption of final rules.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 6 2013-10-01 2013-10-01 false Adoption of final rules. 553.29 Section 553.29... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RULEMAKING PROCEDURES Procedures for Adoption of Rules § 553.29 Adoption of final rules. Final rules are prepared by representatives of the office concerned and the...

  10. 10 CFR 1021.103 - Adoption of CEQ NEPA regulations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PROCEDURES General § 1021.103 Adoption of CEQ NEPA regulations. DOE adopts the regulations for implementing NEPA published by CEQ at 40 CFR parts 1500 through 1508. ... 10 Energy 4 2010-01-01 2010-01-01 false Adoption of CEQ NEPA regulations. 1021.103 Section...

  11. 36 CFR 905.735-102 - Adoption of regulations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... CORPORATION STANDARDS OF CONDUCT General Provisions § 905.735-102 Adoption of regulations. Under the authority of 5 CFR 735.104(f), the Corporation adopts the following sections of the Civil Service Commission... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false Adoption of regulations....

  12. 27 CFR 5.28 - Adoption of predecessor's formulas.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Adoption of predecessor's..., DEPARTMENT OF THE TREASURY LIQUORS LABELING AND ADVERTISING OF DISTILLED SPIRITS Formulas § 5.28 Adoption of predecessor's formulas. The adoption by a successor of approved Forms 5110.38 (27-B Supplemental) shall be...

  13. 18 CFR 401.24 - Preparation and adoption.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Preparation and adoption... ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Water Resources Program § 401.24 Preparation and adoption. The Water Resources Program will be prepared and considered by the Commission for adoption...

  14. A School District's Adoption of an Elementary Science Curriculum

    ERIC Educational Resources Information Center

    Lorsbach, Anthony W.

    2008-01-01

    The author describes how case study methods were used to understand the intricacies of curriculum adoption in one school district and the context in which an adoption decision was made. As data collection and interpretation commenced, understanding of the perceptions of the district stakeholders of their process of curriculum adoption became an…

  15. 49 CFR 1110.8 - Adoption of final rules.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 8 2012-10-01 2012-10-01 false Adoption of final rules. 1110.8 Section 1110.8 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT... Adoption of final rules. If, after consideration of all comments received, final rules are adopted,...

  16. 10 CFR 1021.103 - Adoption of CEQ NEPA regulations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... PROCEDURES General § 1021.103 Adoption of CEQ NEPA regulations. DOE adopts the regulations for implementing NEPA published by CEQ at 40 CFR parts 1500 through 1508. ... 10 Energy 4 2014-01-01 2014-01-01 false Adoption of CEQ NEPA regulations. 1021.103 Section...

  17. 18 CFR 401.24 - Preparation and adoption.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... adoption. 401.24 Section 401.24 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Water Resources Program § 401.24 Preparation and adoption. The Water Resources Program will be prepared and considered by the Commission for adoption...

  18. 36 CFR 905.735-102 - Adoption of regulations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... CORPORATION STANDARDS OF CONDUCT General Provisions § 905.735-102 Adoption of regulations. Under the authority of 5 CFR 735.104(f), the Corporation adopts the following sections of the Civil Service Commission... 36 Parks, Forests, and Public Property 3 2013-07-01 2012-07-01 true Adoption of regulations....

  19. 7 CFR 1794.71 - Adoption of an EA.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 12 2014-01-01 2013-01-01 true Adoption of an EA. 1794.71 Section 1794.71 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) ENVIRONMENTAL POLICIES AND PROCEDURES Adoption of Environmental Documents § 1794.71 Adoption...

  20. 49 CFR 389.29 - Adoption of final rules.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 5 2012-10-01 2012-10-01 false Adoption of final rules. 389.29 Section 389.29 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY...-FEDERAL MOTOR CARRIER SAFETY REGULATIONS Procedures for Adoption of Rules § 389.29 Adoption of final...

  1. 49 CFR 389.29 - Adoption of final rules.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 5 2011-10-01 2011-10-01 false Adoption of final rules. 389.29 Section 389.29 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY...-FEDERAL MOTOR CARRIER SAFETY REGULATIONS Procedures for Adoption of Rules § 389.29 Adoption of final...

  2. 14 CFR 221.162 - Receiver shall file adoption notices.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Receiver shall file adoption notices. 221... (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS TARIFFS Adoption Publications Required To Show Change in Carrier's Name or Transfer of Operating Control § 221.162 Receiver shall file adoption notices. A...

  3. 49 CFR 553.29 - Adoption of final rules.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 6 2010-10-01 2010-10-01 false Adoption of final rules. 553.29 Section 553.29... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RULEMAKING PROCEDURES Procedures for Adoption of Rules § 553.29 Adoption of final rules. Final rules are prepared by representatives of the office concerned and the...

  4. 45 CFR 1356.41 - Nonrecurring expenses of adoption.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Nonrecurring expenses of adoption. 1356.41 Section..., FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES REQUIREMENTS APPLICABLE TO TITLE IV-E § 1356.41 Nonrecurring expenses of adoption. (a) The amount of the payment made...

  5. 36 CFR 905.735-102 - Adoption of regulations.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... CORPORATION STANDARDS OF CONDUCT General Provisions § 905.735-102 Adoption of regulations. Under the authority of 5 CFR 735.104(f), the Corporation adopts the following sections of the Civil Service Commission... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false Adoption of regulations....

  6. 14 CFR 221.162 - Receiver shall file adoption notices.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Receiver shall file adoption notices. 221... (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS TARIFFS Adoption Publications Required To Show Change in Carrier's Name or Transfer of Operating Control § 221.162 Receiver shall file adoption notices. A...

  7. 49 CFR 1110.8 - Adoption of final rules.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 8 2011-10-01 2011-10-01 false Adoption of final rules. 1110.8 Section 1110.8 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT... Adoption of final rules. If, after consideration of all comments received, final rules are adopted,...

  8. 49 CFR 389.29 - Adoption of final rules.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 5 2014-10-01 2014-10-01 false Adoption of final rules. 389.29 Section 389.29 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY...-FEDERAL MOTOR CARRIER SAFETY REGULATIONS Procedures for Adoption of Rules § 389.29 Adoption of final...

  9. 14 CFR 221.162 - Receiver shall file adoption notices.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Receiver shall file adoption notices. 221... (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS TARIFFS Adoption Publications Required To Show Change in Carrier's Name or Transfer of Operating Control § 221.162 Receiver shall file adoption notices. A...

  10. 27 CFR 5.28 - Adoption of predecessor's formulas.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Adoption of predecessor's..., DEPARTMENT OF THE TREASURY LIQUORS LABELING AND ADVERTISING OF DISTILLED SPIRITS Formulas § 5.28 Adoption of predecessor's formulas. The adoption by a successor of approved Forms 5110.38 (27-B Supplemental) shall be...

  11. 49 CFR 389.29 - Adoption of final rules.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 5 2013-10-01 2013-10-01 false Adoption of final rules. 389.29 Section 389.29 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY...-FEDERAL MOTOR CARRIER SAFETY REGULATIONS Procedures for Adoption of Rules § 389.29 Adoption of final...

  12. 36 CFR 905.735-102 - Adoption of regulations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... CORPORATION STANDARDS OF CONDUCT General Provisions § 905.735-102 Adoption of regulations. Under the authority of 5 CFR 735.104(f), the Corporation adopts the following sections of the Civil Service Commission... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false Adoption of regulations....

  13. 49 CFR 190.329 - Adoption of final rules.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 3 2014-10-01 2014-10-01 false Adoption of final rules. 190.329 Section 190.329 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... REGULATORY PROCEDURES Procedures for Adoption of Rules § 190.329 Adoption of final rules. Final rules...

  14. 49 CFR 190.329 - Adoption of final rules.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Adoption of final rules. 190.329 Section 190.329 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... PROCEDURES Procedures for Adoption of Rules § 190.329 Adoption of final rules. Final rules are prepared...

  15. 10 CFR 1021.103 - Adoption of CEQ NEPA regulations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... PROCEDURES General § 1021.103 Adoption of CEQ NEPA regulations. DOE adopts the regulations for implementing NEPA published by CEQ at 40 CFR parts 1500 through 1508. ... 10 Energy 4 2013-01-01 2013-01-01 false Adoption of CEQ NEPA regulations. 1021.103 Section...

  16. 49 CFR 190.329 - Adoption of final rules.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Adoption of final rules. 190.329 Section 190.329 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... PROCEDURES Procedures for Adoption of Rules § 190.329 Adoption of final rules. Final rules are prepared...

  17. 36 CFR 905.735-102 - Adoption of regulations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... CORPORATION STANDARDS OF CONDUCT General Provisions § 905.735-102 Adoption of regulations. Under the authority of 5 CFR 735.104(f), the Corporation adopts the following sections of the Civil Service Commission... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Adoption of regulations....

  18. 45 CFR 1151.43 - Adoption of grievance procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 3 2011-10-01 2011-10-01 false Adoption of grievance procedures. 1151.43 Section 1151.43 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE... Enforcement § 1151.43 Adoption of grievance procedures. A recipient may adopt an internal grievance...

  19. 18 CFR 401.24 - Preparation and adoption.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... adoption. 401.24 Section 401.24 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Water Resources Program § 401.24 Preparation and adoption. The Water Resources Program will be prepared and considered by the Commission for adoption...

  20. 27 CFR 5.28 - Adoption of predecessor's formulas.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Adoption of predecessor's..., DEPARTMENT OF THE TREASURY LIQUORS LABELING AND ADVERTISING OF DISTILLED SPIRITS Formulas § 5.28 Adoption of predecessor's formulas. The adoption by a successor of approved Forms 5110.38 (27-B Supplemental) shall be...

  1. 49 CFR 1110.8 - Adoption of final rules.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 8 2013-10-01 2013-10-01 false Adoption of final rules. 1110.8 Section 1110.8 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT... Adoption of final rules. If, after consideration of all comments received, final rules are adopted,...

  2. 49 CFR 553.29 - Adoption of final rules.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 6 2014-10-01 2014-10-01 false Adoption of final rules. 553.29 Section 553.29... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RULEMAKING PROCEDURES Procedures for Adoption of Rules § 553.29 Adoption of final rules. Final rules are prepared by representatives of the office concerned and the...

  3. 45 CFR 1151.43 - Adoption of grievance procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 3 2012-10-01 2012-10-01 false Adoption of grievance procedures. 1151.43 Section 1151.43 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE... Enforcement § 1151.43 Adoption of grievance procedures. A recipient may adopt an internal grievance...

  4. 27 CFR 5.28 - Adoption of predecessor's formulas.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Adoption of predecessor's..., DEPARTMENT OF THE TREASURY ALCOHOL LABELING AND ADVERTISING OF DISTILLED SPIRITS Formulas § 5.28 Adoption of predecessor's formulas. The adoption by a successor of approved Forms 5110.38 (27-B Supplemental) shall be...

  5. 49 CFR 190.329 - Adoption of final rules.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 3 2012-10-01 2012-10-01 false Adoption of final rules. 190.329 Section 190.329 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... PROCEDURES Procedures for Adoption of Rules § 190.329 Adoption of final rules. Final rules are prepared...

  6. 14 CFR 221.162 - Receiver shall file adoption notices.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Receiver shall file adoption notices. 221... (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS TARIFFS Adoption Publications Required To Show Change in Carrier's Name or Transfer of Operating Control § 221.162 Receiver shall file adoption notices. A...

  7. 27 CFR 5.28 - Adoption of predecessor's formulas.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Adoption of predecessor's..., DEPARTMENT OF THE TREASURY ALCOHOL LABELING AND ADVERTISING OF DISTILLED SPIRITS Formulas § 5.28 Adoption of predecessor's formulas. The adoption by a successor of approved Forms 5110.38 (27-B Supplemental) shall be...

  8. 10 CFR 1021.103 - Adoption of CEQ NEPA regulations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PROCEDURES General § 1021.103 Adoption of CEQ NEPA regulations. DOE adopts the regulations for implementing NEPA published by CEQ at 40 CFR parts 1500 through 1508. ... 10 Energy 4 2011-01-01 2011-01-01 false Adoption of CEQ NEPA regulations. 1021.103 Section...

  9. 45 CFR 1151.43 - Adoption of grievance procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Adoption of grievance procedures. 1151.43 Section 1151.43 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE... Enforcement § 1151.43 Adoption of grievance procedures. A recipient may adopt an internal grievance...

  10. 49 CFR 553.29 - Adoption of final rules.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 6 2012-10-01 2012-10-01 false Adoption of final rules. 553.29 Section 553.29... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RULEMAKING PROCEDURES Procedures for Adoption of Rules § 553.29 Adoption of final rules. Final rules are prepared by representatives of the office concerned and the...

  11. 10 CFR 1021.103 - Adoption of CEQ NEPA regulations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... PROCEDURES General § 1021.103 Adoption of CEQ NEPA regulations. DOE adopts the regulations for implementing NEPA published by CEQ at 40 CFR parts 1500 through 1508. ... 10 Energy 4 2012-01-01 2012-01-01 false Adoption of CEQ NEPA regulations. 1021.103 Section...

  12. 45 CFR 1151.43 - Adoption of grievance procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 3 2014-10-01 2014-10-01 false Adoption of grievance procedures. 1151.43 Section 1151.43 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE... Enforcement § 1151.43 Adoption of grievance procedures. A recipient may adopt an internal grievance...

  13. 18 CFR 401.24 - Preparation and adoption.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... adoption. 401.24 Section 401.24 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Water Resources Program § 401.24 Preparation and adoption. The Water Resources Program will be prepared and considered by the Commission for adoption...

  14. 45 CFR 1356.41 - Nonrecurring expenses of adoption.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Nonrecurring expenses of adoption. 1356.41 Section..., FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES REQUIREMENTS APPLICABLE TO TITLE IV-E § 1356.41 Nonrecurring expenses of adoption. (a) The amount of the payment made...

  15. 49 CFR 1110.8 - Adoption of final rules.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Adoption of final rules. 1110.8 Section 1110.8 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT... Adoption of final rules. If, after consideration of all comments received, final rules are adopted,...

  16. 14 CFR 221.162 - Receiver shall file adoption notices.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Receiver shall file adoption notices. 221... (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS TARIFFS Adoption Publications Required To Show Change in Carrier's Name or Transfer of Operating Control § 221.162 Receiver shall file adoption notices. A...

  17. 49 CFR 553.29 - Adoption of final rules.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 6 2011-10-01 2011-10-01 false Adoption of final rules. 553.29 Section 553.29... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RULEMAKING PROCEDURES Procedures for Adoption of Rules § 553.29 Adoption of final rules. Final rules are prepared by representatives of the office concerned and the...

  18. 49 CFR 389.29 - Adoption of final rules.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false Adoption of final rules. 389.29 Section 389.29 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY...-FEDERAL MOTOR CARRIER SAFETY REGULATIONS Procedures for Adoption of Rules § 389.29 Adoption of final...

  19. 45 CFR 1151.43 - Adoption of grievance procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 3 2013-10-01 2013-10-01 false Adoption of grievance procedures. 1151.43 Section 1151.43 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE... Enforcement § 1151.43 Adoption of grievance procedures. A recipient may adopt an internal grievance...

  20. 45 CFR 1356.41 - Nonrecurring expenses of adoption.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Nonrecurring expenses of adoption. 1356.41 Section..., FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES REQUIREMENTS APPLICABLE TO TITLE IV-E § 1356.41 Nonrecurring expenses of adoption. (a) The amount of the payment made...

  1. 18 CFR 401.24 - Preparation and adoption.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... adoption. 401.24 Section 401.24 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Water Resources Program § 401.24 Preparation and adoption. The Water Resources Program will be prepared and considered by the Commission for adoption...

  2. Reliability and Validity of the Transracial Adoption Parenting Scale

    ERIC Educational Resources Information Center

    Massatti, Richard R.; Vonk, M. Elizabeth; Gregoire, Thomas K.

    2004-01-01

    The present study provides information on the reliability and validity of the Transracial Adoption Parenting Scale (TAPS), a multidimensional 36-item Likert-type scale that measures cultural competence among transracial adoptive (TRA) parents. The TAPS was theoretically developed and refined through feedback from experts in TRA adoption. A…

  3. Autism Spectrum Disorder in Children Adopted after Early Care Breakdown

    ERIC Educational Resources Information Center

    Green, Jonathan; Leadbitter, Kathy; Kay, Catherine; Sharma, Kishan

    2016-01-01

    Syndromic autism has been described in children adopted after orphanage rearing. We investigated whether the same existed in children adopted after family breakdown. Families of 54/60 adopted children aged 6-11 years (mean 102 months; SD 20; 45% male) returned screening questionnaires for autism spectrum disorder (ASD); 21/54 (39%) screened…

  4. 38 CFR 3.58 - Child adopted out of family.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Child adopted out of... ADJUDICATION Pension, Compensation, and Dependency and Indemnity Compensation Relationship § 3.58 Child adopted out of family. A child of a veteran adopted out of the family of the veteran either prior...

  5. 38 CFR 3.58 - Child adopted out of family.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Child adopted out of... ADJUDICATION Pension, Compensation, and Dependency and Indemnity Compensation Relationship § 3.58 Child adopted out of family. A child of a veteran adopted out of the family of the veteran either prior...

  6. 38 CFR 3.58 - Child adopted out of family.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Child adopted out of... ADJUDICATION Pension, Compensation, and Dependency and Indemnity Compensation Relationship § 3.58 Child adopted out of family. A child of a veteran adopted out of the family of the veteran either prior...

  7. Our Own: Adopting and Parenting the Older Child.

    ERIC Educational Resources Information Center

    Maskew, Trish

    Children adopted when they are older come with histories, fully formed personalities, and intense anger over what they have lost. Drawing on stories of families who have adopted older children, as well as research, interviews with professionals, and opinions of adults who were adopted as children, this book explores the joys and challenges of…

  8. 49 CFR 237.31 - Adoption of bridge management programs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Railroad Bridge Safety Assurance § 237.31 Adoption of bridge management programs. Each track owner shall adopt a bridge safety management program to... 49 Transportation 4 2013-10-01 2013-10-01 false Adoption of bridge management programs....

  9. 49 CFR 237.31 - Adoption of bridge management programs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Railroad Bridge Safety Assurance § 237.31 Adoption of bridge management programs. Each track owner shall adopt a bridge safety management program to... 49 Transportation 4 2014-10-01 2014-10-01 false Adoption of bridge management programs....

  10. 49 CFR 237.31 - Adoption of bridge management programs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Railroad Bridge Safety Assurance § 237.31 Adoption of bridge management programs. Each track owner shall adopt a bridge safety management program to... 49 Transportation 4 2010-10-01 2010-10-01 false Adoption of bridge management programs....

  11. The Neogene: Origin, adoption, evolution, and controversy

    NASA Astrophysics Data System (ADS)

    Walsh, Stephen L.

    2008-07-01

    Some stratigraphers have recently insisted that for historical reasons, the Neogene (Miocene + Pliocene) should be extended to the present. However, despite some ambiguity in its application by Moriz Hörnes in the 1850s, the "Neogene" was widely adopted by European geologists to refer to the Miocene and Pliocene of Lyell, but excluding the "Diluvium" (later to become the Pleistocene) and "Alluvium" (later to become the Holocene). During the late 19th and early 20th centuries, the ends of the Neogene, Tertiary and Pliocene evolved in response to the progressive lowering of the beginnings of the Quaternary and Pleistocene. This evolution was a logical result of the widespread views that the most recent "ice ages" were worthy of recognition as a formal unit of the standard geologic time scale, and that the structure of this time scale must be strictly hierarchical. Motivations for the extension of the Neogene to the present include the desire to establish a monopoly for marine biochronology in the definition of standard global chronostratigraphic boundaries. This agenda would also eliminate the Tertiary, Quaternary, and Holocene. These changes are unnecessary. There is every reason to retain the traditional hierarchical structure of the Cenozoic time scale.

  12. Medical group adoption of Internet services.

    PubMed

    Coye, M J; Jacks, G; Everett, W E; Akay, L

    2001-10-01

    Physician leaders and office-based practicing physicians in medium and large practice organizations were surveyed regarding their use of administrative and clinical systems enabled by the Internet. More than 85% of medical groups reported using one or more Internet-enabled services and 35 reported use of more than five Internet-enabled services, including both business and clinical applications. Physician leaders and practicing physicians identified six Internet-enabled services as "essential" for the future success of their practice and indicated that reduced administrative costs, faster payments, and improved quality of care are the most important benefits derived from Internet-enabled applications. Ninety-six percent of survey respondents estimated that Internet-enabled technologies will have a significant, positive impact on the practice of medicine in general and will improve the quality of care before 2003. The lack of industrywide standards for health information and the inability of current computer systems to exchange information across health care delivery networks were cited as the most important barriers to the adoption of Internet-enabled applications by physicians. Respondents believed that action by the Health Care Financing Administration (HCFA) or major health plans to require participating physicians to use the Internet for administrative services will be needed to bring about rapid migration to Internet-enabled services. PMID:11680240

  13. Home Energy Displays: Consumer Adoption and Response

    SciTech Connect

    LaMarche, J.; Cheney, K.; Akers, C.; Roth, K.; Sachs, O.

    2012-12-01

    The focus of this project was to investigate the factors influencing consumer adoption of Home Energy Displays (HEDs) and to evaluate electricity consumption in households with basic HEDs versus enhanced feedback methods - web portals or alerts. We hypothesized that providing flexible and relatable information to users, in addition to a basic HED, would make feedback more effective and achieve persistent energy savings. In Phase I, we conducted three user research studies and found preferences for aesthetically pleasing, easy to understand feedback that is accessible through multiple media and offered free of charge. The deployment of HEDs in 150 households planned for Phase II encountered major recruitment and HED field deployment problems. First, after extensive outreach campaigns to apartment complexes with 760 units, only 8% of building's tenants elected to receive a free HED in their homes as part of the field study. Second, the HED used, a leading market model, had a spectrum of problems, including gateway miscommunications, failure to post to a data-hosting third party, and display malfunctions. In light of these challenges, we are pursuing a modified study investigating the energy savings of a web portal versus alert-based energy feedback instead of a physical HED.

  14. Adoption of Clinical Decision Support in Multimorbidity: A Systematic Review

    PubMed Central

    Arguello Casteleiro, Mercedes; Ainsworth, John; Buchan, Iain

    2015-01-01

    Background Patients with multiple conditions have complex needs and are increasing in number as populations age. This multimorbidity is one of the greatest challenges facing health care. Having more than 1 condition generates (1) interactions between pathologies, (2) duplication of tests, (3) difficulties in adhering to often conflicting clinical practice guidelines, (4) obstacles in the continuity of care, (5) confusing self-management information, and (6) medication errors. In this context, clinical decision support (CDS) systems need to be able to handle realistic complexity and minimize iatrogenic risks. Objective The aim of this review was to identify to what extent CDS is adopted in multimorbidity. Methods This review followed PRISMA guidance and adopted a multidisciplinary approach. Scopus and PubMed searches were performed by combining terms from 3 different thesauri containing synonyms for (1) multimorbidity and comorbidity, (2) polypharmacy, and (3) CDS. The relevant articles were identified by examining the titles and abstracts. The full text of selected/relevant articles was analyzed in-depth. For articles appropriate for this review, data were collected on clinical tasks, diseases, decision maker, methods, data input context, user interface considerations, and evaluation of effectiveness. Results A total of 50 articles were selected for the full in-depth analysis and 20 studies were included in the final review. Medication (n=10) and clinical guidance (n=8) were the predominant clinical tasks. Four studies focused on merging concurrent clinical practice guidelines. A total of 17 articles reported their CDS systems were knowledge-based. Most articles reviewed considered patients’ clinical records (n=19), clinical practice guidelines (n=12), and clinicians’ knowledge (n=10) as contextual input data. The most frequent diseases mentioned were cardiovascular (n=9) and diabetes mellitus (n=5). In all, 12 articles mentioned generalist doctor(s) as the

  15. Adoption in rock and white-tailed ptarmigan

    USGS Publications Warehouse

    Wong, M.M.L.; Fedy, B.C.; Wilson, S.; Martin, K.M.

    2009-01-01

    Reports of adoption in birds are widespread, but few studies report rates of adoption or possible mechanisms for this phenomenon, particularly in the Order Galliformes. We report incidents of adoption in Rock Ptarmigan (Lagopus muta) and White-tailed Ptarmigan (L. leucura) from two sites in western Canada. Adoption rates for White-tailed Ptarmigan on Vancouver Island, British Columbia, and the Ruby Ranges, Yukon Territory were 13% (n = 16 broods) and 4% (n = 27), respectively, while rates for Rock Ptarmigan were 14% (n = 29) in the Ruby Ranges. Low brood densities may result in lower rates of adoption for ptarmigan. ?? 2009 The Wilson Ornithological Society.

  16. Awareness, persuasion, and adoption: Enriching the Bass model

    NASA Astrophysics Data System (ADS)

    Colapinto, Cinzia; Sartori, Elena; Tolotti, Marco

    2014-02-01

    In the context of diffusion of innovations, we propose a probabilistic model based on interacting populations connected through new communication channels. The potential adopters are heterogeneous in the connectivity levels and in their taste for innovation. The proposed framework can model the different stages of the adoption dynamics. In particular, the adoption curve is the result of a micro-founded decision process following the awareness phase. Eventually, we recover stylized facts pointed out by the extant literature in the field, such as delayed adoptions and non-monotonic adoption curves.

  17. 20 CFR 222.54 - When a legally adopted child is dependent-grandchild or stepgrandchild adopted after entitlement.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false When a legally adopted child is dependent... RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT FAMILY RELATIONSHIPS Child Support and Dependency § 222.54 When a legally adopted child is dependent—grandchild or stepgrandchild adopted...

  18. 20 CFR 222.54 - When a legally adopted child is dependent-grandchild or stepgrandchild adopted after entitlement.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true When a legally adopted child is dependent... RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT FAMILY RELATIONSHIPS Child Support and Dependency § 222.54 When a legally adopted child is dependent—grandchild or stepgrandchild adopted...

  19. 20 CFR 222.54 - When a legally adopted child is dependent-grandchild or stepgrandchild adopted after entitlement.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true When a legally adopted child is dependent... RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT FAMILY RELATIONSHIPS Child Support and Dependency § 222.54 When a legally adopted child is dependent—grandchild or stepgrandchild adopted...

  20. 20 CFR 222.54 - When a legally adopted child is dependent-grandchild or stepgrandchild adopted after entitlement.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false When a legally adopted child is dependent... RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT FAMILY RELATIONSHIPS Child Support and Dependency § 222.54 When a legally adopted child is dependent—grandchild or stepgrandchild adopted...

  1. Adoption and Cognitive Development: A Meta-Analytic Comparison of Adopted and Nonadopted Children's IQ and School Performance

    ERIC Educational Resources Information Center

    van Ijzendoorn, Marinus H.; Juffer, Femmie; Poelhuis, Caroline W. Klein

    2005-01-01

    This meta-analysis of 62 studies (N=17,767 adopted children) examined whether the cognitive development of adopted children differed from that of (a) children who remained in institutional care or in the birth family and (b) their current (environmental) nonadopted siblings or peers. Adopted children scored higher on IQ tests than their nonadopted…

  2. OPIMIZATION OF COMBINED SEWER OVERFLOW CONTROL SYSTEMS

    EPA Science Inventory

    The highly variable and intermittent pollutant concentrations and flowrates associated with wet-weather events in combined sewersheds necessitates the use of storage-treatment systems to control pollution. A strategy should be adopted to develop an optimized combined sewer overfl...

  3. Experiences of school bullying among internationally adopted children: results from the Finnish Adoption (FINADO) Study.

    PubMed

    Raaska, Hanna; Lapinleimu, Helena; Sinkkonen, Jari; Salmivalli, Christina; Matomäki, Jaakko; Mäkipää, Sanna; Elovainio, Marko

    2012-08-01

    This study investigated the prevalence of and factors associated with school bullying and victimization among Finnish international adoptees. The Olweus bully/victim questionnaire was sent to all 9-15-year-old children adopted in Finland between 1985 and 2007 through the mediating organizations officially approved by the Ministry of Social Affairs and Health. The children were identified through official adoption organizations. The response rate in the target sample was 49.4%: the study sample consisted of 364 children (190 girls, 52.2%). The children's background factors and symptoms of reactive attachment disorder (RAD) were evaluated using a FINADO questionnaire. Their learning difficulties and social and language skills were assessed using a standardized parental questionnaire (Five to Fifteen). Of the participants, 19.8% reported victimization by peers while 8% had bullied others. Both victimization and bullying were associated with severe symptoms of RAD at the time of adoption (RR 2.68, 95%CI 1.50-4.77 and RR 2.08, 95%CI 1.17-3.69 for victimization and bullying, respectively). Lack of social skills was associated with victimization (RR 1.74, 95%CI 1.06-2.85) but not independently with being a bully (RR 1.50, 95%CI 0.91-2.45). In a multivariate analysis the child's learning difficulties and language difficulties were not associated with either bullying others or victimization. PMID:22362203

  4. Differences in public and private sector adoption of telemedicine: Indian case study for sectoral adoption.

    PubMed

    Sood, Sanjay P; Negash, Solomon; Mbarika, Victor W A; Kifle, Mengistu; Prakash, Nupur

    2007-01-01

    Telemedicine is the use of communication networks to exchange medical information for providing healthcare services and medical education from one site to another. The application of telemedicine is more promising in economically developing countries with agrarian societies. The American Telemedicine Association (ATA) identifies three healthcare services: clinical medical services, health and medical education, and consumer health information. However, it is not clear how these services can be adopted by different sectors: public and private. This paper looks at four Indian case studies, two each in public and private sectors to understand two research questions: Are there differences in telemedicine adoption between public and private hospitals. If there are differences: What are the differences in telemedicine adoption between public and private sectors? Authors have used the extant literature in telemedicine and healthcare to frame theoretical background, describe the research setting, present the case studies, and provide discussion and conclusions about their findings. Authors believe that as India continues to develop its telemedicine infrastructures, especially with continued government support through subsidies to private telemedicine initiatives, its upward trend in healthcare will continue. This is expected to put India on the path to increase its life expectancy rates, especially for it rural community which constitute over 70% of its populace. PMID:17917199

  5. Remote sensing to monitor cover crop adoption in southeastern Pennsylvania

    USGS Publications Warehouse

    Hively, Wells; Sjoerd Duiker; Greg McCarty; Prabhakara, Kusuma

    2015-01-01

    In the Chesapeake Bay Watershed, winter cereal cover crops are often planted in rotation with summer crops to reduce the loss of nutrients and sediment from agricultural systems. Cover crops can also improve soil health, control weeds and pests, supplement forage needs, and support resilient cropping systems. In southeastern Pennsylvania, cover crops can be successfully established following corn (Zea mays L.) silage harvest and are strongly promoted for use in this niche. They are also planted following corn grain, soybean (Glycine max L.), and vegetable harvest. In Pennsylvania, the use of winter cover crops for agricultural conservation has been supported through a combination of outreach, regulation, and incentives. On-farm implementation is thought to be increasing, but the actual extent of cover crops is not well quantified. Satellite imagery can be used to map green winter cover crop vegetation on agricultural fields and, when integrated with additional remote sensing data products, can be used to evaluate wintertime vegetative groundcover following specific summer crops. This study used Landsat and SPOT (System Probatoire d’ Observation de la Terre) satellite imagery, in combination with the USDA National Agricultural Statistics Service Cropland Data Layer, to evaluate the extent and amount of green wintertime vegetation on agricultural fields in four Pennsylvania counties (Berks, Lebanon, Lancaster, and York) from 2010 to 2013. In December of 2010, a windshield survey was conducted to collect baseline data on winter cover crop implementation, with particular focus on identifying corn harvested for silage (expected earlier harvest date and lower levels of crop residue), versus for grain (expected later harvest date and higher levels of crop residue). Satellite spectral indices were successfully used to detect both the amount of green vegetative groundcover and the amount of crop residue on the surveyed fields. Analysis of wintertime satellite imagery

  6. Elementary School-Based Adopted Grandparent Programs: Combining Intergenerational Programming with Aging Education.

    ERIC Educational Resources Information Center

    Woodward, Karla A.

    The Grandpals program at Oak Hill Elementary School in Overland Park, Kansas, meets teachers' needs while providing successful intergenerational programming. The first step in developing a program like Grandpals is to determine program goals, objectives, and theme. A next step is to determine the two populations to be involved. For example, whole…

  7. Adoption in Eastern Grey Kangaroos: A Consequence of Misdirected Care?

    PubMed Central

    King, Wendy J.; Forsyth, David M.; Coulson, Graeme; Festa-Bianchet, Marco

    2015-01-01

    Adoption is rare in animals and is usually attributed to kin selection. In a 6-year study of eastern grey kangaroos (Macropus giganteus), 11 of 326 juveniles were adopted. We detected eight adoptions by observing behavioural associations and nursing between marked mothers and young and three more by analysing the relatedness of mothers and young using microsatellite DNA. Four adoptions involved reciprocal switches and three were by mothers whose own pouch young were known to subsequently disappear. Adoptive mothers were not closely related to each other or to adoptees but adoptive mothers and young associated as closely as did biological pairs, as measured by half-weight indices. Switch mothers did not associate closely. Maternal age and body condition did not influence the likelihood of adoption but females were more likely to adopt in years with high densities of females with large pouch young. Adoption did not improve juvenile survival. We conclude that adoptions in this wild population were potentially costly and likely caused by misdirected care, suggesting that eastern grey kangaroos may have poorly developed mother-offspring recognition mechanisms. PMID:25970624

  8. Adoption of telemedicine: from pilot stage to routine delivery

    PubMed Central

    2012-01-01

    Background Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery. Discussion We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1) the process of adoption of telemedicine in comparison with other technologies; and 2) the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur. Summary The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify suitable financial and

  9. Combinations Therapies.

    PubMed

    Reinmuth, Niels; Reck, Martin

    2015-01-01

    Immunotherapy of cancer encompasses different strategies that elicit or enhance the immune response against tumors. The first results from clinical studies have provided promising data for the treatment of lung cancer patients with immunomodulating monotherapies. To improve the potential benefit of cancer immunotherapy, synergistic combinations of the various immunotherapy approaches or of different elements within each of the immunotherapy approaches are being explored. The rationale typically involves different but complementary mechanisms of action, eventually impinging on more than one immune system mechanism. As a prominent example, the simultaneous blockade of PD-1 and CTLA-4 is giving rise to therapeutic synergy, while still offering room for efficacy improvement. Moreover, combinations of immunomodulating agents with chemotherapy or targeted molecules are being tested. Animal models suggest that immunotherapies in combination with these various options offer evidence for synergistic effects and are likely to radically change cancer treatment paradigms. However, data obtained so far indicate that toxic side effects are also potentiated, which may even restrict the selection of patients that are suitable for these combinational approaches. Advancing the field of combinatorial immunotherapy will require changes in the way investigational agents are clinically developed as well as novel experimental end-points for efficacy evaluation. However, this combined therapeutic manipulation of both tumor and stromal cells may lead to a dramatic change in the therapeutic options of lung cancer patients in any disease stage that can only grossly be appreciated by the current studies. PMID:26384009

  10. Assessing access for prospective adoptive parents living with HIV: an environmental scan of Ontario’s adoption agencies

    PubMed Central

    Underhill, Angela A.; Kennedy, V. Logan; Lewis, Johanna; Ross, Lori E.; Loutfy, Mona

    2016-01-01

    ABSTRACT Work has been underway to increase the availability of parenting options for people living with and affected by HIV. One option, adoption, has not yet been explored in the literature. The study aimed to gain a better understanding of the potential of adoption for individuals/couples living with HIV in Ontario, and to assess potential structural barriers or facilitators that may impact their experience navigating the adoption system by conducting an environmental scan of adoption service providers in Ontario. A list of adoption service providers was compiled using the Ontario government’s website. Information relevant to the study’s measures was collected using service providers’ websites. Service providers without websites, or with websites that did not address all of the research measures, were contacted via telephone to complete a structured interview. Online data extraction was possible for 2 and telephone surveys were completed with 75 adoption service providers (total n = 77). Most service providers reported that HIV status is not an exclusion criterion for prospective parents (64%). However, more than one-fifth of the participants acknowledged they were not sure if people with HIV were eligible to adopt. Domestic service providers were the only providers who did not report knowledge of restrictions due to HIV status. Private domestic adoption presented social barriers as birth parent(s) of a child can access health records of a prospective parent and base their selection of an adoptive parent based on health status. Adoption practitioners and licensees involved in international adoptions reported the most structural barriers for prospective parent(s) living with HIV, attributed to the regulations established by the host country of the child(ren) eligible for adoption. Although international adoptions may present insurmountable barriers for individuals living with HIV, public and private domestic adoption appears to be a viable option. PMID

  11. Exploring links between innovation and diffusion: adoption of NOx control technologies at U.S. coal-fired power plants

    SciTech Connect

    Popp, D.

    2006-03-15

    While many studies have looked at innovation and adoption of technologies separately, the two processes are linked. Advances (and expected advances) in a single technology should affect both its adoption rate and the adoption of alternative technologies. Moreover, advances made abroad may affect adoption differently than improvements developed domestically. This paper combines plant-level data on US coal-fired electric power plants with patent data pertaining to NOx pollution control techniques to study these links. It is shown that technological advances, particularly those made abroad, are important for the adoption of newer post-combustion treatment technologies, but have little effect on the adoption of older combustion modification techniques. Moreover, it provides evidence that adaptive R&D by US firms is necessary before foreign innovations are adopted in the US. Expectations of future technological advances delay adoption. Nonetheless, as in other studies of environmental technologies, the effect of other explanatory variables is dominated by the effect of environmental regulations, demonstrating that the mere presence of environmental technologies is not enough to encourage its usage.

  12. Attitudes of European farmers towards GM crop adoption.

    PubMed

    Areal, Francisco J; Riesgo, Laura; Rodríguez-Cerezo, Emilio

    2011-12-01

    This article analyses European Union (EU) farmers' attitudes towards adoption of genetically modified crops by identifying and classifying groups of farmers. Cluster analysis provided two groups of farmers allowing us to classify farmers into potential adopters or rejecters of genetically modified herbicide-tolerant (GMHT) crops. Results showed that economic issues such as the guarantee of a higher income and the reduction of weed control costs are the most encouraging reasons for potential adopters and rejecters of GMHT crops. This article also examines how putting in place measures to ensure coexistence between GM and non-GM crops may influence farmers' attitudes towards GMHT crop adoption. Results show that the implementation of a coexistence policy would have a negative impact on farmers' attitudes on adoption and consequently may hamper GMHT adoption in the EU. PMID:21923717

  13. Re an Adoption Application (Surrogacy), 11 March 1987.

    PubMed

    1987-01-01

    The Court was asked to make an adoption order in favor of a couple who had paid another woman to bear a child for them using the husband's sperm. The Court made the order, noting that the Surrogacy Arrangements Act 1985, which bans commercial surrogacy agencies, negotiations, and advertisements had not been enacted at the time of this arrangement. It also held that the arrangement did not violate the Adoption Act 1958, which prohibits payments or rewards for or in consideration of adoption, because the payment to the surrogate was not made in contemplation of adoption. Moreover, it concluded that even if the payment had been made in contemplation of adoption, the Adoption Act gave the Court the power to authorize the payment retrospectively. PMID:12346765

  14. The Effect of Family Communication Patterns on Adopted Adolescent Adjustment

    PubMed Central

    Rueter, Martha A.

    2008-01-01

    Adoption and family communication both affect adolescent adjustment. We proposed that adoption status and family communication interact such that adopted adolescents in families with certain communication patterns are at greater risk for adjustment problems. We tested this hypothesis using a community-based sample of 384 adoptive and 208 nonadoptive families. Adolescents in these families were, on average, 16 years of age. The results supported our hypothesis. Adopted adolescents were at significantly greater risk for adjustment problems compared to nonadopted adolescents in families that emphasized conformity orientation without conversation orientation and in families that emphasized neither conformity nor conversation orientation. Adolescents in families emphasizing conversation orientation were at lower risk for adjustment problems, regardless of adoption status. PMID:19649145

  15. Attitude, interest, and motivation for adoption and foster care.

    PubMed

    Tyebjee, Tyzoon

    2003-01-01

    This survey compares prospective foster and adoptive parents' attitudes, willingness, and motivations, and discusses implications for media campaigns. The results show that demographic profiles of targets for adoption and foster placements are the same, an opportunity exists to shape positive attitudes toward foster care in immigrant populations, the most compelling way to attract parents is to focus on the child in need, and testimonials of personal experiences of foster and adoptive parents should address perceived barriers to adopting or fostering. Political, religious, and environmental ideology were unrelated to attitudes or willingness to adopt or foster. Respondents with strong identifications with gay or lesbian lifestyles exhibited a higher than average willingness to adopt or foster. PMID:14736030

  16. The Structure of Families who Adopt Children from Foster Care.

    PubMed

    Hansen, Mary Eschelbach

    2008-12-01

    The 1997 Adoption and Safe Families Act (ASFA) gave incentives to states to expedite the adoption of children from foster care. Administrative data describe the changes in adoptive families from 1996 to 2003 in terms of the marital status and sex of the household head and in terms of the relationship of the parents to the child prior to adoption. Patterns in the way children with special needs were matched with different kinds of families are described. The data show that agencies have tapped the resources of families headed by single parents to provide permanency for older children and that older children adopted by fathers have spent more time as legal orphans than children adopted by single mothers. PMID:19890459

  17. Associations between Discussions of Racial and Ethnic Differences in Internationally Adoptive Families and Delinquent Behavior among Korean Adopted Adolescents

    PubMed Central

    Anderson, Kayla N.; Lee, Richard M.; Rueter, Martha A.; Kim, Oh Myo

    2015-01-01

    Internationally adopted adolescents may have more delinquent behavior than non-adopted adolescents. One explanation is these adolescents experience discrimination and loss of culture, and adoptive parents are not adequately addressing these experiences. However, studies have not examined the effects of family discussions of racial and ethnic differences within adoptive families on adopted adolescents’ delinquent behavior. To test this relationship, this study utilized data from 111 U.S. internationally adoptive families with 185 South Korean adopted adolescents (55% female, M age = 17.75). During an observational assessment, families discussed the importance of their racial and ethnic differences, and adolescents completed a delinquent behavior questionnaire. Analysis of covariance showed differences in adolescent delinquent behavior across three ways adoptive families discussed racial and ethnic differences; adolescents whose families acknowledged differences had the fewest mean delinquent behaviors. There were no significant differences in delinquent behavior between adolescents whose families acknowledged or rejected the importance of racial and ethnic differences. However, adopted adolescents whose families held discrepant views of differences had significantly more problem behavior than adolescents whose families either acknowledged or rejected the importance of racial and ethnic differences. Clinicians, adoption professionals, and other parenting specialists should focus on building cohesive family identities about racial and ethnic differences, as discrepant views of differences are associated with the most adoptee delinquent behavior. PMID:25729119

  18. Public Policy, Technology Adoption, and Aggregate Energy Efficiency

    SciTech Connect

    Harrington, W.; Kopp, R.J.; Morgenstern, R.D.; Pizer, W.A.; Shih, J.S.

    1999-04-01

    This research examines the factors that influence the adoption of new energy-saving technologies among U.S. manufacturing plants and explores their potential impact on aggregate energy efficiency. We conduct this analysis using two models: a conventional diffusion model and a stand-alone model of new technology adoption we develop in this paper. The latter model allows us to compute effects on aggregate efficiency based solely on adoption data.

  19. Adoption of new drugs by physicians: a survival analysis

    PubMed Central

    2012-01-01

    Background New drugs often substitute others cheaper and with a risk-benefit balance better established. Our aim was to analyse the diffusion of new drugs during the first months of use, examining the differences between family physicians and specialists. Methods Prescription data were obtained of cefditoren, duloxetine, etoricoxib, ezetimibe, levocetirizine, olmesartan, pregabalin and tiotropium 36 months after their launching. We obtained the monthly number of prescriptions per doctor and the number prescribers of each drug by specialty. After discarding those with less than 10 prescriptions during this period, physicians were defined as adopters if the number of prescriptions was over the 25th percentile for each drug and level (primary or secondary care). The diffusion of each drug was studied by determining the number of adopter family physicians throughout the study period. Among the group of adopters, we compared the month of the first prescription by family physicians to that of other specialists using the Kaplan-Meier method. Results The adoption of the drugs in primary care follows an exponential diffusion curve that reaches a plateau at month 6 to 23. Tiotropium was the most rapidly and widely adopted drug. Cefditoren spread at a slower rate and was the least adopted. The diffusion of etoricoxib was initially slowed down due to administrative requirements for its prescription. The median time of adoption in the case of family physicians was 4-6 months. For each of the drugs, physicians of a specialty other than family physicians adopted it first. Conclusions The number of adopters of a new drug increases quickly in the first months and reaches a plateau. The number of adopter family physicians varies considerably for different drugs. The adoption of new drugs is faster in specialists. The time of adoption should be considered to promote rational prescribing by providing timely information about new drugs and independent medical education. PMID:22401169

  20. Lesbian and heterosexual preadoptive couples' openness to transracial adoption.

    PubMed

    Goldberg, Abbie E

    2009-01-01

    This study uses data from 147 White preadoptive couples (54 lesbian, 93 heterosexual) to examine adopters' subjective explanations for why they are open or not open to adopting transracially. Participant perceptions of racial-ethnic diversity in their communities and families, perceptions of family support or nonsupport, and attitudes about race were among the factors they cited as influencing their openness. These findings hold important implications for training and service delivery in transracial adoption. PMID:19290730