Open research practices: unintended consequences and suggestions for averting them. (Commentary on the Peer Reviewers' Openness Initiative)

PubMed Central

2016-01-01

The Peer Reviewers' Openness Initiative (PROI) is a move to enlist reviewers in the promotion of data-sharing. In this commentary, I discuss objections that can be raised, first to the specific proposals in the PROI, and second to data-sharing in general. I argue that although many objections have strong counter-arguments, others merit more serious consideration. Regarding the PROI, I suggest that it could backfire if editors and authors feel coerced into data-sharing and so may not be the most pragmatic way of encouraging greater openness. More generally, while promoting data-sharing, we need to be sensitive to cases where sharing of data from human participants could create ethical problems. Furthermore, those interested in promoting reproducible science need to defend against an increased risk of data-dredging when large, multivariable datasets are shared. I end with some suggestions to avoid these unintended consequences. PMID:27152225

Neonatal Nurses Experience Unintended Consequences and Risks to Patient Safety With Electronic Health Records.

PubMed

Dudding, Katherine M; Gephart, Sheila M; Carrington, Jane M

2018-04-01

In this article, we examine the unintended consequences of nurses' use of electronic health records. We define these as unforeseen events, change in workflow, or an unanticipated result of implementation and use of electronic health records. Unintended consequences experienced by nurses while using electronic health records have been well researched. However, few studies have focused on neonatal nurses, and it is unclear to what extent unintended consequences threaten patient safety. A new instrument called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire has been validated, and secondary analysis using the tool explored the phenomena among neonatal nurses (N = 40). The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record, changes to the workflow, and altered communication patterns. Neonatal nurses used workarounds most often with motivation to better assist patients. Teamwork was moderately related to higher unintended consequences including patient safety risks (r = 0.427, P = .007), system design (r = 0.419, P = .009), and technology barriers (r = 0.431, P = .007). Communication about patients was reduced when patient safety risks were high (r = -0.437, P = .003). By determining the frequency with which neonatal nurses experience unintended consequences of electronic health record use, future research can be targeted to improve electronic health record design through customization, integration, and refinement to support patient safety and better outcomes.

Trust Building as a Strategy to Avoid Unintended Consequences of Education. The Case Study of International Summer Camps Designed to Promote Peace and Intercultural Dialogue among Adolescents

ERIC Educational Resources Information Center

Farini, Federico

2014-01-01

This article aims to offer both a theoretical contribution and examples of practices of trust building in peace education; the article presents an empirical analysis of videotaped interactions in the context of peace education activities in international groups of adolescents. The analysis regards two international summer camps promoted by the…

Biofuels: Network Analysis of the Literature Reveals Key Environmental and Economic Unknowns

PubMed Central

2012-01-01

Despite rapid growth in biofuel production worldwide, it is uncertain whether decision-makers possess sufficient information to fully evaluate the impacts of the industry and avoid unintended consequences. Doing so requires rigorous peer-reviewed data and analyses across the entire range of direct and indirect effects. To assess the coverage of scientific research, we analyzed over 1600 peer-reviewed articles published between 2000 and 2009 that addressed 23 biofuels-related topics within four thematic areas: environment and human well-being, economics, technology, and geography. Greenhouse gases, fuel production, and feedstock production were well-represented in the literature, while trade, biodiversity, and human health were not. Gaps were especially striking across topics in the Southern Hemisphere, where the greatest potential socio-economic benefits, as well as environmental damages, may co-occur. There was strong asymmetry in the connectedness of research topics; greenhouse gases articles were twice as often connected to other topics as biodiversity articles. This could undermine the ability of scientific and economic analyses to adequately evaluate impacts and avoid significant unintended consequences. At the least, our review suggests caution in this developing industry and the need to pursue more interdisciplinary research to assess complex trade-offs and feedbacks inherent to an industry with wide-reaching potential impacts. PMID:22229835

Digital Disturbances, Disorders, and Pathologies: A Discussion of Some Unintended Consequences of Technology in Higher Education

ERIC Educational Resources Information Center

Haughton, Noela A.; Yeh, Kuo-Chuan; Nworie, John; Romero, Liz

2013-01-01

As with any innovation, the adoption and diffusion of digital technologies in higher education have also brought unintended consequences. This article discusses the unintended misuse of these technologies in the higher education setting. Depending upon severity, these consequences discussed--distraction, addiction, academic dishonesty, and…

A Survey of the Literature on Unintended Consequences Associated with Health Information Technology: 2014–2015

PubMed Central

Abraham, J.; Novak, L. L.; Reynolds, T. L.; Gettinger, A.

2016-01-01

Summary Objective To summarize recent research on unintended consequences associated with implementation and use of health information technology (health IT). Included in the review are original empirical investigations published in English between 2014 and 2015 that reported unintended effects introduced by adoption of digital interventions. Our analysis focuses on the trends of this steam of research, areas in which unintended consequences have continued to be reported, and common themes that emerge from the findings of these studies. Method Most of the papers reviewed were retrieved by searching three literature databases: MEDLINE, Embase, and CINAHL. Two rounds of searches were performed: the first round used more restrictive search terms specific to unintended consequences; the second round lifted the restrictions to include more generic health IT evaluation studies. Each paper was independently screened by at least two authors; differences were resolved through consensus development. Results The literature search identified 1,538 papers that were potentially relevant; 34 were deemed meeting our inclusion criteria after screening. Studies described in these 34 papers took place in a wide variety of care areas from emergency departments to ophthalmology clinics. Some papers reflected several previously unreported unintended consequences, such as staff attrition and patients’ withholding of information due to privacy and security concerns. A majority of these studies (71%) were quantitative investigations based on analysis of objectively recorded data. Several of them employed longitudinal or time series designs to distinguish between unintended consequences that had only transient impact, versus those that had persisting impact. Most of these unintended consequences resulted in adverse outcomes, even though instances of beneficial impact were also noted. While care areas covered were heterogeneous, over half of the studies were conducted at academic medical centers or teaching hospitals. Conclusion Recent studies published in the past two years represent significant advancement of unintended consequences research by seeking to include more types of health IT applications and to quantify the impact using objectively recorded data and longitudinal or time series designs. However, more mixed-methods studies are needed to develop deeper insights into the observed unintended adverse outcomes, including their root causes and remedies. We also encourage future research to go beyond the paradigm of simply describing unintended consequences, and to develop and test solutions that can prevent or minimize their impact. PMID:27830227

A Survey of the Literature on Unintended Consequences Associated with Health Information Technology: 2014-2015.

PubMed

Zheng, K; Abraham, J; Novak, L L; Reynolds, T L; Gettinger, A

2016-11-10

To summarize recent research on unintended consequences associated with implementation and use of health information technology (health IT). Included in the review are original empirical investigations published in English between 2014 and 2015 that reported unintended effects introduced by adoption of digital interventions. Our analysis focuses on the trends of this steam of research, areas in which unintended consequences have continued to be reported, and common themes that emerge from the findings of these studies. Most of the papers reviewed were retrieved by searching three literature databases: MEDLINE, Embase, and CINAHL. Two rounds of searches were performed: the first round used more restrictive search terms specific to unintended consequences; the second round lifted the restrictions to include more generic health IT evaluation studies. Each paper was independently screened by at least two authors; differences were resolved through consensus development. The literature search identified 1,538 papers that were potentially relevant; 34 were deemed meeting our inclusion criteria after screening. Studies described in these 34 papers took place in a wide variety of care areas from emergency departments to ophthalmology clinics. Some papers reflected several previously unreported unintended consequences, such as staff attrition and patients' withholding of information due to privacy and security concerns. A majority of these studies (71%) were quantitative investigations based on analysis of objectively recorded data. Several of them employed longitudinal or time series designs to distinguish between unintended consequences that had only transient impact, versus those that had persisting impact. Most of these unintended consequences resulted in adverse outcomes, even though instances of beneficial impact were also noted. While care areas covered were heterogeneous, over half of the studies were conducted at academic medical centers or teaching hospitals. Recent studies published in the past two years represent significant advancement of unintended consequences research by seeking to include more types of health IT applications and to quantify the impact using objectively recorded data and longitudinal or time series designs. However, more mixed-methods studies are needed to develop deeper insights into the observed unintended adverse outcomes, including their root causes and remedies. We also encourage future research to go beyond the paradigm of simply describing unintended consequences, and to develop and test solutions that can prevent or minimize their impact.

British Military Mission (BMM) to Greece, 1942-44

DTIC Science & Technology

2009-05-21

Terrorism. Failure to take into account and accurately assess political and military actions in such environments can lead to unintended consequences ...such environments can lead to unintended consequences (potential civil war) affecting the stability of a country. Accurate assessment of the political...take into account and accurately assess political and military actions in such environments can lead to unintended consequences (potential civil war

The Unintended Consequences of Health Information Technology Revisited.

PubMed

Coiera, E; Ash, J; Berg, M

2016-11-10

The introduction of health information technology into clinical settings is associated with unintended negative consequences, some with the potential to lead to error and patient harm. As adoption rates soar, the impact of these hazards will increase. Over the last decade, unintended consequences have received great attention in the medical informatics literature, and this paper seeks to identify the major themes that have emerged. Rich typologies of the causes of unintended consequences have been developed, along with a number of explanatory frameworks based on socio-technical systems theory. We however still have only limited data on the frequency and impact of these events, as most studies rely on data sets from incident reporting or patient chart reviews, rather than undertaking detailed observational studies. Such data are increasingly needed as more organizations implement health information technologies. When outcome studies have been done in different organizations, they reveal different outcomes for identical systems. From a theoretical perspective, recent advances in the emerging discipline of implementation science have much to offer in explaining the origin, and variability, of unintended consequences. The dynamic nature of health care service organizations, and the rapid development and adoption of health information technologies means that unintended consequences are unlikely to disappear, and we therefore must commit to developing robust systems to detect and manage them.

Troubled Waters: Navigating Unintended Consequences of Health Information Technology.

PubMed

Lehmann, C U; Séroussi, B; Jaulent, M-C

2016-11-10

To provide an introduction to the 2016 IMIA Yearbook of Medical Informatics by the editors. We present a brief overview of the 2016 special topic "Unintended consequences of Health IT: new problems, new solutions", we review our choice of special topic section editors, and discuss the transitions in the editorial team for next year. This edition of the Yearbook acknowledges the fact that implementation and use of Health Information Technology (HIT) may result in unintended consequences, which may lead to both adverse and sometimes beneficial outcomes. However to date, in the literature, undesired outcomes are emphasized with a focus on the complex causes and the many sources that may generate them. The growing awareness of the importance of HIT's unintended consequences and their increasing documentation reflect a wider acceptance of HIT by users (more use generating more consequences) and and a new type of users (a shift from early adopters to late adopters and laggards), whith great expectations regarding the improvement of care quality through HIT solutions. Different points of view on new problems and new solutions of unintended consequences of Health IT are presented through the keynote paper, survey papers, and the working group contributions. The regular 2016 issue of the IMIA yearbook focuses on new unintended consequences of Health IT - brought on by wider adoption and different types of users as well as solutions to addressing them.

Unintended pregnancy and subsequent use of modern contraceptive among slum and non-slum women in Nairobi, Kenya

PubMed Central

2014-01-01

Background In spite of major gains in contraceptive prevalence over the last few decades, many women in most parts of the developing world who would like to delay or avoid pregnancy do not use any method of contraception. This paper seeks to: a) examine whether experiencing an unintended pregnancy is associated with future use of contraception controlling for a number factors including poverty at the household and community levels; and b) investigate the mechanisms through which experiencing an unintended pregnancy leads to uptake of contraception. Methods Quantitative and qualitative data from a cross-sectional research project conducted in 2009/10 in two slum settlements and two non-slum settings of Nairobi, Kenya are used. The quantitative component of the project was based on a random sample of 1,259 women aged 15–49 years. Logistic regression models were used to assess the effect of unintended pregnancy on future contraceptive use. The qualitative component of the project successfully interviewed a total of 80 women randomly selected from survey participants who had reported having at least one unintended pregnancy. Results Women whose last pregnancy was unintended were more likely to be using a modern method of contraception, compared to their peers whose last pregnancy was intended, especially among the wealthier group as shown in the interaction model. Among poor women, unintended pregnancy was not associated with subsequent use of contraception. The qualitative investigation with women who had an unplanned pregnancy reveals that experiencing an unintended pregnancy seems to have served as a “wake-up call”, resulting in greater attention to personal risks, including increased interest in pregnancy prevention. For some women, unintended pregnancy was a consequence of strong opposition by their partners to family planning, while others reported they started using contraceptives following their unintended pregnancy, but discontinued after experiencing side effects. Conclusion This study provides quantitative and qualitative evidence that women who have had an unintended pregnancy are “ready for change”. Family planning programs may use the contacts with antenatal, delivery and post-delivery care system as an opportunity to identify women whose pregnancy is unplanned, and target them with information and services. PMID:25012817

Unintended pregnancy and subsequent use of modern contraceptive among slum and non-slum women in Nairobi, Kenya.

PubMed

Fotso, Jean Christophe; Izugbara, Chimaraoke; Saliku, Teresa; Ochako, Rhoune

2014-07-10

In spite of major gains in contraceptive prevalence over the last few decades, many women in most parts of the developing world who would like to delay or avoid pregnancy do not use any method of contraception. This paper seeks to: a) examine whether experiencing an unintended pregnancy is associated with future use of contraception controlling for a number factors including poverty at the household and community levels; and b) investigate the mechanisms through which experiencing an unintended pregnancy leads to uptake of contraception. Quantitative and qualitative data from a cross-sectional research project conducted in 2009/10 in two slum settlements and two non-slum settings of Nairobi, Kenya are used. The quantitative component of the project was based on a random sample of 1,259 women aged 15-49 years. Logistic regression models were used to assess the effect of unintended pregnancy on future contraceptive use. The qualitative component of the project successfully interviewed a total of 80 women randomly selected from survey participants who had reported having at least one unintended pregnancy. Women whose last pregnancy was unintended were more likely to be using a modern method of contraception, compared to their peers whose last pregnancy was intended, especially among the wealthier group as shown in the interaction model. Among poor women, unintended pregnancy was not associated with subsequent use of contraception. The qualitative investigation with women who had an unplanned pregnancy reveals that experiencing an unintended pregnancy seems to have served as a "wake-up call", resulting in greater attention to personal risks, including increased interest in pregnancy prevention. For some women, unintended pregnancy was a consequence of strong opposition by their partners to family planning, while others reported they started using contraceptives following their unintended pregnancy, but discontinued after experiencing side effects. This study provides quantitative and qualitative evidence that women who have had an unintended pregnancy are "ready for change". Family planning programs may use the contacts with antenatal, delivery and post-delivery care system as an opportunity to identify women whose pregnancy is unplanned, and target them with information and services.

Unintended consequences of information technologies in health care--an interactive sociotechnical analysis.

PubMed

Harrison, Michael I; Koppel, Ross; Bar-Lev, Shirly

2007-01-01

Many unintended and undesired consequences of Healthcare Information Technologies (HIT) flow from interactions between the HIT and the healthcare organization's sociotechnical system-its workflows, culture, social interactions, and technologies. This paper develops and illustrates a conceptual model of these processes that we call Interactive Sociotechnical Analysis (ISTA). ISTA captures common types of interaction with special emphasis on recursive processes, i.e., feedback loops that alter the newly introduced HIT and promote second-level changes in the social system. ISTA draws on prior studies of unintended consequences, along with research in sociotechnical systems, ergonomics, social informatics, technology-in-practice, and social construction of technology. We present five types of sociotechnical interaction and illustrate each with cases from published research. The ISTA model should further research on emergent and recursive processes in HIT implementation and their unintended consequences. Familiarity with the model can also foster practitioners' awareness of unanticipated consequences that only become evident during HIT implementation.

Speaking out on safe sleep: evidence-based infant sleep recommendations.

PubMed

Bartick, Melissa; Smith, Linda J

2014-11-01

The American Academy of Pediatrics (AAP) issued recommendations in 2005 and 2011 to reduce sleep-related infant death, which advise against all bedsharing for sleep. These recommendations overemphasize the risks of bedsharing, and this overemphasis has serious unintended consequences. It may result in increased deaths on sofas as tired parents try to avoid feeding their infants in bed. Current evidence shows that other risks are far more potent, such as smoking, shared sleep on sofas, sleeping next to impaired caregivers, and formula feeding. The emphasis on separate sleep is diverting resources away from addressing these critical risk factors. Recommendations to avoid bedsharing may also interfere with breastfeeding. We examine both the evidence behind the AAP recommendations and the evidence omitted from those recommendations. We conclude that the only evidence-based universal advice to date is that sofas are hazardous places for adults to sleep with infants; that exposure to smoke, both prenatal and postnatal, increases the risk of death; and that sleeping next to an impaired caregiver increases the risk of death. No sleep environment is completely safe. Public health efforts must address the reality that tired parents must feed their infants at night somewhere and that sofas are highly risky places for parents to fall asleep with their infants, especially if parents are smokers or under the influence of alcohol or drugs. All messaging must be crafted and reevaluated to avoid unintended negative consequences, including impact on breastfeeding rates, or falling asleep in more dangerous situations than parental beds. We must realign our resources to focus on the greater risk factors, and that may include greater investment in smoking cessation and doing away with aggressive formula marketing. This includes eliminating conflicts of interest between formula marketing companies and organizations dedicated to the health of children.

Identifying unintended consequences of quality indicators: a qualitative study.

PubMed

Lester, Helen E; Hannon, Kerin L; Campbell, Stephen M

2011-12-01

For the first 5 years of the UK primary care pay for performance scheme, the Quality and Outcomes Framework (QOF), quality indicators were introduced without piloting. However, in 2009, potential new indicators were piloted in a nationally representative sample of practices. This paper describes an in-depth exploration of family physician, nurse and other primary-care practice staff views of the value of piloting with a particular focus on unintended consequences of 13 potential new QOF indicators. Fifty-seven family-practice professionals were interviewed in 24 representative practices across England. Almost all interviewees emphasised the value of piloting in terms of an opportunity to identify unintended consequences of potential QOF indicators in 'real world' settings with staff who deliver day-to-day care to patients. Four particular types of unintended consequences were identified: measure fixation, tunnel vision, misinterpretation and potential gaming. 'Measure fixation,' an inappropriate attention on isolated aspects of care, appeared to be the key unintended consequence. In particular, if the palliative care indicator had been introduced without piloting, this might have incentivised poorer care in a minority of practices with potential harm to vulnerable patients. It is important to identify concerns and experiences about unintended consequences of indicators at an early stage when there is time to remove or adapt problem indicators. Since the UK government currently spends over £1 billion each year on QOF, the £150,000 spent on each piloting cohort (0.0005% of the total QOF budget) appears to be good value for money.

People, planet and profit: Unintended consequences of legacy building materials.

PubMed

Zimmer, Anthony T; Ha, HakSoo

2017-12-15

Although an explosion of new building materials are being introduced into today's market, adequate up-front research into their chemical and physical properties as well as their potential health and environmental consequences is lacking. History has provided us with several examples where building materials were broadly deployed into society only to find that health and environmental problems resulted in unintended sustainability consequences. In the following paper, we use lead and asbestos as legacy building materials to show their similar historical trends and sustainability consequences. Our research findings show unintended consequences such as: increased remediation and litigation costs; adverse health effects; offshoring of related industries; and impediments to urban revitalization. As numerous new building materials enter today's market, another building material may have already been deployed, representing the next "asbestos." This paper also proposes an alternative methodology that can be applied in a cost-effective way into existing and upcoming building materials, to minimize and prevent potential unintended consequences and create a pathway for sustainable communities. For instance, our findings show that this proposed methodology could have prevented the unintended incurred sustainability costs of approximately $272-$359 billion by investing roughly $24 million in constant 2014 U.S. dollars on up-front research into lead and asbestos. Published by Elsevier Ltd.

The Consequences of Unintended Childbearing: A White Paper

ERIC Educational Resources Information Center

Logan, Cassandra; Holcombe, Emily; Manlove, Jennifer; Ryan, Suzanne

2007-01-01

This report provides a critical review of the current research literature on the consequences of unintended childbearing for families and children. The review addresses the following potential consequences: prenatal and perinatal risks (e.g., inadequate or delayed initiation of prenatal care, smoking/drinking/substance use during pregnancy,…

Unintended Consequences of Professionalizing Youth Work: Lessons from Teaching and Social Work

ERIC Educational Resources Information Center

Johnston-Goodstar, Katie; Velure Roholt, Ross

2013-01-01

In this article, the authors use a comparative historical approach to examine the consequences of professionalization within teaching and social work and to answer the following questions: What are the unintended consequences of professionalization? Has professionalization in these fields supported higher quality practice, increased working…

Unintended Perioperative Hypothermia

PubMed Central

Hart, Stuart R.; Bordes, Brianne; Hart, Jennifer; Corsino, Daniel; Harmon, Donald

2011-01-01

Background Hypothermia, defined as a core body temperature less than 36°C (96.8°F), is a relatively common occurrence in the unwarmed surgical patient. A mild degree of perioperative hypothermia can be associated with significant morbidity and mortality. A threefold increase in the frequency of surgical site infections is reported in colorectal surgery patients who experience perioperative hypothermia. As part of the Surgical Care Improvement Project, guidelines aim to decrease the incidence of this complication. Methods We review the physiology of temperature regulation, mechanisms of hypothermia, effects of anesthetics on thermoregulation, and consequences of hypothermia and summarize recent recommendations for maintaining perioperative normothermia. Results Evidence suggests that prewarming for a minimum of 30 minutes may reduce the risk of subsequent hypothermia. Conclusions Monitoring of body temperature and avoidance of unintended perioperative hypothermia through active and passive warming measures are the keys to preventing its complications. PMID:21960760

Improving Evaluation to Address the Unintended Consequences of Health Information Technology:. a Position Paper from the Working Group on Technology Assessment & Quality Development.

PubMed

Magrabi, F; Ammenwerth, E; Hyppönen, H; de Keizer, N; Nykänen, P; Rigby, M; Scott, P; Talmon, J; Georgiou, A

2016-11-10

With growing use of IT by healthcare professionals and patients, the opportunity for any unintended effects of technology to disrupt care health processes and outcomes is intensified. The objectives of this position paper by the IMIA Working Group (WG) on Technology Assessment and Quality Development are to highlight how our ongoing initiatives to enhance evaluation are also addressing the unintended consequences of health IT. Review of WG initiatives Results: We argue that an evidence-based approach underpinned by rigorous evaluation is fundamental to the safe and effective use of IT, and for detecting and addressing its unintended consequences in a timely manner. We provide an overview of our ongoing initiatives to strengthen study design, execution and reporting by using evaluation frameworks and guidelines which can enable better characterization and monitoring of unintended consequences, including the Good Evaluation Practice Guideline in Health Informatics (GEP-HI) and the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI). Indicators to benchmark the adoption and impact of IT can similarly be used to monitor unintended effects on healthcare structures, processes and outcome. We have also developed EvalDB, a web-based database of evaluation studies to promulgate evidence about unintended effects and are developing the content for courses to improve training in health IT evaluation. Evaluation is an essential ingredient for the effective use of IT to improve healthcare quality and patient safety. WG resources and skills development initiatives can facilitate a proactive and evidence-based approach to detecting and addressing the unintended effects of health IT.

Improving Evaluation to Address the Unintended Consequences of Health Information Technology:

PubMed Central

Ammenwerth, E.; Hyppönen, H.; de Keizer, N.; Nykänen, P.; Rigby, M.; Scott, P.; Talmon, J.; Georgiou, A.

2016-01-01

Summary Background and objectives With growing use of IT by healthcare professionals and patients, the opportunity for any unintended effects of technology to disrupt care health processes and outcomes is intensified. The objectives of this position paper by the IMIA Working Group (WG) on Technology Assessment and Quality Development are to highlight how our ongoing initiatives to enhance evaluation are also addressing the unintended consequences of health IT. Methods Review of WG initiatives Results We argue that an evidence-based approach underpinned by rigorous evaluation is fundamental to the safe and effective use of IT, and for detecting and addressing its unintended consequences in a timely manner. We provide an overview of our ongoing initiatives to strengthen study design, execution and reporting by using evaluation frameworks and guidelines which can enable better characterization and monitoring of unintended consequences, including the Good Evaluation Practice Guideline in Health Informatics (GEP-HI) and the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI). Indicators to benchmark the adoption and impact of IT can similarly be used to monitor unintended effects on healthcare structures, processes and outcome. We have also developed EvalDB, a web-based database of evaluation studies to promulgate evidence about unintended effects and are developing the content for courses to improve training in health IT evaluation. Conclusion Evaluation is an essential ingredient for the effective use of IT to improve healthcare quality and patient safety. WG resources and skills development initiatives can facilitate a proactive and evidence-based approach to detecting and addressing the unintended effects of health IT. PMID:27830232

More Is Not Always Better: Intuitions About Effective Public Policy Can Lead to Unintended Consequences

PubMed Central

Peters, Ellen; Klein, William; Kaufman, Annette; Meilleur, Louise; Dixon, Anna

2013-01-01

Public policy decisions often appear based on an assumption that providing more options, more information, and greater decision-making autonomy to consumers will produce better outcomes. We examine reasons why this “more-is-better” approach exists based on the psychological literature. Although better outcomes can result from informed consumer choice, we argue that more options, information, and autonomy can also lead to unintended negative consequences. We use mostly health-related policies and guidelines from the United States and elsewhere as exemplars. We consider various psychological mechanisms that cause these unintended consequences including cognitive overload, affect, and anticipated regret, information salience and availability, and trust in governments as authoritative information providers. We also point toward potential solutions based on psychological research that may reduce the negative unintended consequences of a “more-is-better” approach. PMID:24000291

Evaluation of Unintended Social and Economic Consequences of an Unplanned School Closure in Rural Illinois

ERIC Educational Resources Information Center

Tsai, Victoria; Khan, Nomana M.; Shi, Jianrong; Rainey, Jeanette; Gao, Hongjiang; Zheteyeva, Yenlik

2017-01-01

Background: School closure is one of the primary measures considered during severe influenza pandemics and other emergencies. However, prolonged school closures may cause unintended adverse consequences to schools, students, and their families. A better understanding of these consequences will inform prepandemic planning, and help public health…

78 FR 40156 - Agency Information Collection Activities; Proposed Collection; Comment Request; Copy Testing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-03

... effectiveness and unintended consequences of advertisements designed to target general market youth ages 12-17... effectiveness and unintended consequences of advertisements designed to target general market youth ages 12-17... consequences of advertisements designed to target general market youth ages 12-15 who reside in rural areas...

Tanning and teens: Is indoor exposure the tip of the iceberg?

PubMed Central

Hay, Jennifer L.; Riley, Kristen E.; Geller, Alan C.

2017-01-01

Due to recent state regulations and the reduced availability of free-standing tanning salons, indoor tanning prevalence is beginning to decline. This may lead to unintended consequences – increases in outdoor intentional tanning. We advance a series of research directions to track and intervene to address all forms of intentional tanning. First, we advocate for enforcement of indoor tanning regulation and encourage collection of data on tanning salon compliance and alternative indoor tanning strategies. Second, we suggest questions about outdoor and indoor tanning should be included in national surveys. Third, we need to understand the potentially complex patterns of indoor and outdoor tanning that may exist among those who tan. Fourth, research examining changing motivations for intentional tanning is needed. Finally, indoor tanning intervention studies should include outdoor tanning as an outcome to examine the effect of interventions on these related risk behaviors. These advances will ensure the development of novel interventions to address intentional tanning through multiple routes, and to avoid any unintended negative consequence of indoor tanning regulation. The promising downward direction of indoor tanning use in the United States should now lead the public health field to sharpen its focus on outdoor tanning. PMID:28765337

Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems.

PubMed

Rangachari, Pavani

2014-12-01

Despite the federal policy momentum towards "meaningful use" of Electronic Health Records, the healthcare organizational literature remains replete with reports of unintended adverse consequences of implementing Electronic Health Records, including: increased work for clinicians, unfavorable workflow changes, and unexpected changes in communication patterns & practices. In addition to being costly and unsafe, these unintended adverse consequences may pose a formidable barrier to "meaningful use" of Electronic Health Records. Correspondingly, it is essential for hospital administrators to understand and detect the causes of unintended adverse consequences, to ensure successful implementation of Electronic Health Records. The longstanding Technology-in-Practice framework emphasizes the role of human agency in enacting structures of technology use or "technologies-in-practice." Given a set of unintended adverse consequences from health information technology implementation, this framework could help trace them back to specific actions (types of technology-in-practice) and institutional conditions (social structures). On the other hand, the more recent Knowledge-in-Practice framework helps understand how information and communication technologies ( e.g. , social knowledge networking systems) could be implemented alongside existing technology systems, to create new social structures, generate new knowledge-in-practice, and transform technology-in-practice. Therefore, integrating the two literature streams could serve the dual purpose of understanding and overcoming unintended adverse consequences of Electronic Health Record implementation. This paper seeks to: (1) review the theoretical literatures on technology use & implementation, and identify a framework for understanding & overcoming unintended adverse consequences of implementing Electronic Health Records; (2) outline a broad project proposal to test the applicability of the framework in enabling "meaningful use" of Electronic Health Records in a healthcare context; and (3) identify strategies for successful implementation of Electronic Health Records in hospitals & health systems, based on the literature review and application.

Unintended Consequences of Wearable Sensor Use in Healthcare. Contribution of the IMIA Wearable Sensors in Healthcare WG.

PubMed

Schukat, M; McCaldin, D; Wang, K; Schreier, G; Lovell, N H; Marschollek, M; Redmond, S J

2016-11-10

As wearable sensors take the consumer market by storm, and medical device manufacturers move to make their devices wireless and appropriate for ambulatory use, this revolution brings with it some unintended consequences, which we aim to discuss in this paper. We discuss some important unintended consequences, both beneficial and unwanted, which relate to: modifications of behavior; creation and use of big data sets; new security vulnerabilities; and unforeseen challenges faced by regulatory authorities, struggling to keep pace with recent innovations. Where possible, we proposed potential solutions to unwanted consequences. Intelligent and inclusive design processes may mitigate unintended modifications in behavior. For big data, legislating access to and use of these data will be a legal and political challenge in the years ahead, as we trade the health benefits of wearable sensors against the risk to our privacy. The wireless and personal nature of wearable sensors also exposes them to a number of unique security vulnerabilities. Regulation plays an important role in managing these security risks, but also has the dual responsibility of ensuring that wearable devices are fit for purpose. However, the burden of validating the function and security of medical devices is becoming infeasible for regulators, given the many software apps and wearable sensors entering the market each year, which are only a subset of an even larger 'internet of things'. Wearable sensors may serve to improve wellbeing, but we must be vigilant against the occurrence of unintended consequences. With collaboration between device manufacturers, regulators, and end-users, we balance the risk of unintended consequences occurring against the incredible benefit that wearable sensors promise to bring to the world.

Unintended Consequences of Wearable Sensor Use in Healthcare

PubMed Central

McCaldin, D.; Wang, K.; Schreier, G.; Lovell, N. H.; Marschollek, M.; Redmond, S. J.

2016-01-01

Summary Objectives As wearable sensors take the consumer market by storm, and medical device manufacturers move to make their devices wireless and appropriate for ambulatory use, this revolution brings with it some unintended consequences, which we aim to discuss in this paper. Methods We discuss some important unintended consequences, both beneficial and unwanted, which relate to: modifications of behavior; creation and use of big data sets; new security vulnerabilities; and unforeseen challenges faced by regulatory authorities, struggling to keep pace with recent innovations. Where possible, we proposed potential solutions to unwanted consequences. Results Intelligent and inclusive design processes may mitigate unintended modifications in behavior. For big data, legislating access to and use of these data will be a legal and political challenge in the years ahead, as we trade the health benefits of wearable sensors against the risk to our privacy. The wireless and personal nature of wearable sensors also exposes them to a number of unique security vulnerabilities. Regulation plays an important role in managing these security risks, but also has the dual responsibility of ensuring that wearable devices are fit for purpose. However, the burden of validating the function and security of medical devices is becoming infeasible for regulators, given the many software apps and wearable sensors entering the market each year, which are only a subset of an even larger ‘internet of things’. Conclusion Wearable sensors may serve to improve wellbeing, but we must be vigilant against the occurrence of unintended consequences. With collaboration between device manufacturers, regulators, and end-users, we balance the risk of unintended consequences occurring against the incredible benefit that wearable sensors promise to bring to the world. PMID:27830234

System Safety and the Unintended Consequence

NASA Technical Reports Server (NTRS)

Watson, Clifford

2012-01-01

The analysis and identification of risks often result in design changes or modification of operational steps. This paper identifies the potential of unintended consequences as an over-looked result of these changes. Examples of societal changes such as prohibition, regulatory changes including mandating lifeboats on passenger ships, and engineering proposals or design changes to automobiles and spaceflight hardware are used to demonstrate that the System Safety Engineer must be cognizant of the potential for unintended consequences as a result of an analysis. Conclusions of the report indicate the need for additional foresight and consideration of the potential effects of analysis-driven design, processing changes, and/or operational modifications.

Unintended pregnancy and unsafe abortion in the Philippines: context and consequences.

PubMed

Hussain, Rubina; Finer, Lawrence B

2013-04-01

Despite advances in reproductive health law, many Filipino women experience unintended pregnancies, and because abortion is highly stigmatized in the country, many who seek abortion undergo unsafe procedures. This report provides a summary of reproductive health indicators in the Philippines—in particular, levels of contraceptive use, unplanned pregnancy and unsafe abortion—and describes the sociopolitical context in which services are provided, the consequences of unintended pregnancy and unsafe abortion,and recommendations for improving access to reproductive health services.

AACSB Accreditation and Possible Unintended Consequences: A Deming View

ERIC Educational Resources Information Center

Stepanovich, Paul; Mueller, James; Benson, Dan

2014-01-01

The AACSB accreditation process reflects basic quality principles, providing standards and a process for feedback for continuous improvement. However, implementation can lead to unintended negative consequences. The literature shows that while institutionalism and critical theory have been used as a theoretical base for evaluating accreditation,…

Psychological Aspects of Contraception, Unintended Pregnancy, and Abortion.

PubMed

Steinberg, Julia R; Rubin, Lisa R

2014-10-01

The knowledge of important biopsychosocial factors linking women's reproductive health and mental health is increasing. This review focuses on psychological aspects of contraception, unintended pregnancy, and abortion because these are common reproductive health experiences in U.S. women's lives. This review addresses the mental-health antecedents and consequences of these experiences, mostly focusing on depression and depressive symptoms before and after unintended pregnancy and contraception. As mental-health antecedents, depressive symptoms predict contraceptive behaviors that lead to unintended pregnancy, and mental-health disorders have been associated with having subsequent abortions. In examining the mental-health consequences, most sound research does not find abortion or contraceptive use to cause mental-health problems. Consequently, evidence does not support policies based on the notion that abortion harms women's mental health. Nevertheless, the abortion-care setting may be a place to integrate mental-health services. In contrast, women who have births resulting from unintended pregnancies may be at higher risk of postpartum depression. Social policies (e.g., paid maternity leave, subsidized child care) may protect women from mental-health problems and stress of unplanned children interrupting employment, education, and pre-existing family care responsibilities.

An Examination of the (Un)Intended Consequences of Performance Funding in Higher Education

ERIC Educational Resources Information Center

Umbricht, Mark R.; Fernandez, Frank; Ortagus, Justin C.

2017-01-01

Previous studies have shown that state performance funding policies do not increase baccalaureate degree production, but higher education scholarship lacks a rigorous, quantitative analysis of the unintended consequences of performance funding. In this article, we use difference-in-differences estimation with fixed effects to evaluate performance…

Smoking, vaping and public health: Time to be creative.

PubMed

Sweanor, David

2016-03-16

The development of policies on vaping in health care organizations (HCOs) needs to be based on a solid understanding of science and a recognition of individual rights. It should also be seen in the broader public health context of innovative alternative nicotine delivery systems playing a key role in ending the immense devastation of combustible cigarettes. Opposition to vaping based on inaccurate and incomplete information, or fear of unlikely and avoidable hypothetical unintended consequences, will invariably cause great harm to individuals, impede rather than assist the attainment of public health objectives, and unnecessarily prolong the epidemic of cigarette-caused diseases.

Transgene flow: Facts, speculations and possible countermeasures

PubMed Central

Ryffel, Gerhart U

2014-01-01

Convincing evidence has accumulated that unintended transgene escape occurs in oilseed rape, maize, cotton and creeping bentgrass. The escaped transgenes are found in variant cultivars, in wild type plants as well as in hybrids of sexually compatible species. The fact that in some cases stacked events are present that have not been planted commercially, implies unintended recombination of transgenic traits. As the consequences of this continuous transgene escape for the ecosystem cannot be reliably predicted, I propose to use more sophisticated approaches of gene technology in future. If possible GM plants should be constructed using either site-directed mutagenesis or cisgenic strategies to avoid the problem of transgene escape. In cases where a transgenic trait is needed, efficient containment should be the standard approach. Various strategies available or in development are discussed. Such a cautious approach in developing novel types of GM crops will enhance the sustainable potential of GM crops and thus increase the public trust in green gene technology. PMID:25523171

Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting.

PubMed

Bloomrosen, Meryl; Starren, Justin; Lorenzi, Nancy M; Ash, Joan S; Patel, Vimla L; Shortliffe, Edward H

2011-01-01

Federal legislation (Health Information Technology for Economic and Clinical Health (HITECH) Act) has provided funds to support an unprecedented increase in health information technology (HIT) adoption for healthcare provider organizations and professionals throughout the U.S. While recognizing the promise that widespread HIT adoption and meaningful use can bring to efforts to improve the quality, safety, and efficiency of healthcare, the American Medical Informatics Association devoted its 2009 Annual Health Policy Meeting to consideration of unanticipated consequences that could result with the increased implementation of HIT. Conference participants focused on possible unintended and unanticipated, as well as undesirable, consequences of HIT implementation. They employed an input-output model to guide discussion on occurrence of these consequences in four domains: technical, human/cognitive, organizational, and fiscal/policy and regulation. The authors outline the conference's recommendations: (1) an enhanced research agenda to guide study into the causes, manifestations, and mitigation of unintended consequences resulting from HIT implementations; (2) creation of a framework to promote sharing of HIT implementation experiences and the development of best practices that minimize unintended consequences; and (3) recognition of the key role of the Federal Government in providing leadership and oversight in analyzing the effects of HIT-related implementations and policies.

Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting

PubMed Central

Starren, Justin; Lorenzi, Nancy M; Ash, Joan S; Patel, Vimla L; Shortliffe, Edward H

2010-01-01

Federal legislation (Health Information Technology for Economic and Clinical Health (HITECH) Act) has provided funds to support an unprecedented increase in health information technology (HIT) adoption for healthcare provider organizations and professionals throughout the U.S. While recognizing the promise that widespread HIT adoption and meaningful use can bring to efforts to improve the quality, safety, and efficiency of healthcare, the American Medical Informatics Association devoted its 2009 Annual Health Policy Meeting to consideration of unanticipated consequences that could result with the increased implementation of HIT. Conference participants focused on possible unintended and unanticipated, as well as undesirable, consequences of HIT implementation. They employed an input–output model to guide discussion on occurrence of these consequences in four domains: technical, human/cognitive, organizational, and fiscal/policy and regulation. The authors outline the conference's recommendations: (1) an enhanced research agenda to guide study into the causes, manifestations, and mitigation of unintended consequences resulting from HIT implementations; (2) creation of a framework to promote sharing of HIT implementation experiences and the development of best practices that minimize unintended consequences; and (3) recognition of the key role of the Federal Government in providing leadership and oversight in analyzing the effects of HIT-related implementations and policies. PMID:21169620

The Unintended Consequences of Property Tax Relief: New York's STAR Program

ERIC Educational Resources Information Center

Eom, Tae Ho; Duncombe, William; Nguyen-Hoang, Phuong; Yinger, John

2014-01-01

New York's School Tax Relief Program, STAR, provides state-funded property tax relief for homeowners. Like a matching grant, STAR changes the price of education, thereby altering the incentives of voters and school officials and leading to unintended consequences. Using data for New York State school districts before and after STAR was…

Economics: An Analysis of Unintended Consequences. Volume 1: Introduction to Microeconomics.

ERIC Educational Resources Information Center

Schenk, Robert E.

This curriculum guide introduces high school students to the basic principles of microeconomics. Chapter 1 provides a basic definition of economics, while chapter 2 introduces a number of important economic concepts and ideas and examines reasons for unintended or unexpected consequences of decision-making. Chapter 3 considers how individual…

The Policy Delphi: A Method for Identifying Intended and Unintended Consequences of Educational Policy

ERIC Educational Resources Information Center

Manley, R. Adam

2013-01-01

This article highlights a rarely utilized but effective technique for identifying intended and unintended consequences of past or current policy or policy change. The author guides the reader through the process of identifying potential participants, contacting participants, developing the policy Delphi instrument, and analyzing the findings by…

Ethics and the Unintended Consequences of Social Research: A Perspective from the Sociology of Science

ERIC Educational Resources Information Center

Studer, Kenneth E.; Chubin, Daryl E.

1977-01-01

Argues that "successful" social science requires development of a social ethic or sense of research responsibility, and suggests that an individualistic orientation is ineffective in coping with the unintended consequences of social research. Available from: Elsevier Scientific Publishing Company, Box 211, Amsterdam, the Netherlands, single copies…

Unintended consequences of carbon enhancement in agricultural soils: The N2O problem

USDA-ARS?s Scientific Manuscript database

The potential of agricultural soils to accumulate C as a means of removing greenhouse gases (GHGs) from the atmosphere is complicated by the inherent coupling of the C and N cycles in soil. Practices that increase soil C content can have the unintended consequence of stimulating N mineralization, ni...

Potential unintended consequences of smoke-free policies in public places on pregnant women in China.

PubMed

Yao, Tingting; Lee, Anita H; Mao, Zhengzhong

2009-08-01

Smoke-free policies in public places have become more common in China. Little is known, however, about the potential unintended consequences of such policies on pregnant women. The study was conducted in 2006 in Chengdu, China. Nonsmoking pregnant women (N=55) whose husband were smokers participated in a study of their knowledge about secondhand smoke and smoke-free policies, their exposure to secondhand smoke, and their husbands' smoking status at home. This study presents descriptive statistics, analyses based on family income and pregnant women's education level, and the findings of focus group discussions that examined the potential unintended consequences of the smoke-free policies on pregnant women. Exposure to secondhand smoke at home was reported by 69.1% of the pregnant women. Both family income and the education level of the pregnant women had a significant (p<0.05) association with exposure to secondhand smoke. The four main potential unintended consequences of the smoke-free policies were: (1) increased exposure of pregnant women to secondhand smoke at home; (2) reduced work efficiency; (3) adverse effect on family harmony; and (4) poor air quality at home. Education is needed to increase knowledge of secondhand smoke among smokers and nonsmokers alike. When the smoking location is shifted from public places and workplaces to home, women, and in particular pregnant women, become the victims. Policymakers should recognize such potential unintended consequences and take necessary measures to increase awareness about the harms of secondhand smoke.

Risk Aversion and Public Reporting. Part 1: Observations From Cardiac Surgery and Interventional Cardiology.

PubMed

Shahian, David M; Jacobs, Jeffrey P; Badhwar, Vinay; D'Agostino, Richard S; Bavaria, Joseph E; Prager, Richard L

2017-12-01

Risk aversion is a potential unintended consequence of health care public reporting. In Part 1 of this review, four possible consequences of this phenomenon are discussed, including the denial of interventions to some high-risk patients, stifling of innovation, appropriate avoidance of futile interventions, and better matching of high-risk patients to more capable providers. We also summarize relevant observational clinical reports and survey results from cardiovascular medicine and surgery, the two specialties from which almost all risk aversion observations have been derived. Although these demonstrate that risk aversion does occur, the empirical data are much more consistent and compelling for interventional cardiology than for cardiac surgery. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Tanning and Teens: Is Indoor Exposure the Tip of the Iceberg?

PubMed

Hay, Jennifer L; Riley, Kristen E; Geller, Alan C

2017-08-01

Because of recent state regulations and the reduced availability of free-standing tanning salons, indoor tanning (IT) prevalence is beginning to decline. This may lead to unintended consequences, such as increases in outdoor intentional tanning. We advance a series of research directions to track and intervene to address all forms of intentional tanning. First, we advocate for enforcement of IT regulation and encourage collection of data on tanning salon compliance and alternative IT strategies. Second, we suggest questions about outdoor and IT should be included in national surveys. Third, we need to understand the potentially complex patterns of indoor and outdoor tanning that may exist among those who tan. Fourth, research examining changing motivations for intentional tanning is needed. Finally, IT intervention studies should include outdoor tanning as an outcome to examine the effect of interventions on these related risk behaviors. These advances will ensure the development of novel interventions to address intentional tanning through multiple routes, and to avoid any unintended negative consequence of IT regulation. The promising downward direction of IT use in the United States should now lead the public health field to sharpen its focus on outdoor tanning. Cancer Epidemiol Biomarkers Prev; 26(8); 1170-4. ©2017 AACR . ©2017 American Association for Cancer Research.

What if "Just Right" Is Just Wrong? The Unintended Consequences of Leveling Readers

ERIC Educational Resources Information Center

Hoffman, James V.

2017-01-01

The author questions the "just right" leveling of student texts as having put limitations on students and teachers in promoting literacy. The historical background for the leveling of text and readers is described. The author identifies a number of unintended consequences associated with the use of leveling and guided reading.…

Unintended Consequences: The Impact of Proposition 2½ Overrides on School Segregation in Massachusetts

ERIC Educational Resources Information Center

Zabel, Jeffrey

2014-01-01

I investigate a possible unintended consequence of Proposition 2½ override behavior--that it led to increased segregation in school districts in Massachusetts. This can occur because richer, low-minority towns tend to have more successful override votes that attract similar households with relatively high demands for public services who can afford…

Forest fire management to avoid unintended consequences: a case study of Portugal using system dynamics.

PubMed

Collins, Ross D; de Neufville, Richard; Claro, João; Oliveira, Tiago; Pacheco, Abílio P

2013-11-30

Forest fires are a serious management challenge in many regions, complicating the appropriate allocation to suppression and prevention efforts. Using a System Dynamics (SD) model, this paper explores how interactions between physical and political systems in forest fire management impact the effectiveness of different allocations. A core issue is that apparently sound management can have unintended consequences. An instinctive management response to periods of worsening fire severity is to increase fire suppression capacity, an approach with immediate appeal as it directly treats the symptom of devastating fires and appeases the public. However, the SD analysis indicates that a policy emphasizing suppression can degrade the long-run effectiveness of forest fire management. By crowding out efforts to preventative fuel removal, it exacerbates fuel loads and leads to greater fires, which further balloon suppression budgets. The business management literature refers to this problem as the firefighting trap, wherein focus on fixing problems diverts attention from preventing them, and thus leads to inferior outcomes. The paper illustrates these phenomena through a case study of Portugal, showing that a balanced approach to suppression and prevention efforts can mitigate the self-reinforcing consequences of this trap, and better manage long-term fire damages. These insights can help policymakers and fire managers better appreciate the interconnected systems in which their authorities reside and the dynamics that may undermine seemingly rational management decisions. Copyright © 2013 Elsevier Ltd. All rights reserved.

It's not about pager replacement: an in-depth look at the interprofessional nature of communication in healthcare.

PubMed

Quan, Sherman D; Wu, Robert C; Rossos, Peter G; Arany, Teri; Groe, Silvi; Morra, Dante; Wong, Brian M; Cavalcanti, Rodrigo; Coke, William; Lau, Francis Y

2013-03-01

Institutions have tried to replace the use of numeric pagers for clinical communication by implementing health information technology (HIT) solutions. However, failing to account for the sociotechnical aspects of HIT or the interplay of technology with existing clinical workflow, culture, and social interactions may create other unintended consequences. To evaluate a Web-based messaging system that allows asynchronous communication between health providers and identify the unintended consequences associated with implementing such technology. Intervention-a Web-based messaging system at the University Health Network to replace numeric paging practices in May 2010. The system facilitated clinical communication on the medical wards for coordinating patient care. Study design-pre-post mixed methods utilizing both quantitative and qualitative measures. Five residents, 8 nurses, 2 pharmacists, and 2 social workers were interviewed. Pre-post interruption-15 residents from 5 clinical teams in both periods. The study compared the type of messages sent to physicians before and after implementation of the Web-based messaging system; a constant comparative analysis of semistructured interviews was used to generate key themes related to unintended consequences. Interruptions increased 233%, from 3 pages received per resident per day pre-implementation to 10 messages received per resident per day post-implementation. Key themes relating to unintended consequences that emerged from the interviews included increase in interruptions, accountability, and tactics to improve personal productivity. Meaningful improvements in clinical communication can occur but require more than just replacing pagers. Introducing HIT without addressing the sociotechnical aspects of HIT that underlie clinical communication can lead to unintended consequences. Copyright © 2013 Society of Hospital Medicine.

Using Multiple Methods to Investigate Eleven-Year-Olds' Experiences of Preparing for a High-Stakes Public Examination in Trinidad and Tobago

ERIC Educational Resources Information Center

De Lisle, Jerome; McMillan-Solomon, Sabrina

2017-01-01

This study was designed to uncover and evaluate unintended and indirect consequences of using the "Secondary Entrance Assessment" ("SEA") in Trinidad and Tobago for high-stakes selection and placement. A major argument is that the test-taker is central to consequences, both intended and unintended. Data were obtained from…

Curriculum Reform and the Displacement of Knowledge in Peruvian Rural Secondary Schools: Exploring the Unintended Local Consequences of Global Education Policies

ERIC Educational Resources Information Center

Balarin, Maria; Benavides, Martin

2010-01-01

This paper draws attention to processes of policy implementation in developing contexts, and to the unintended consequences of education policies that follow international policy scripts without enough consideration of local histories and cultures. Drawing on a study of teaching practices in Peruvian rural secondary schools after a period of…

Conflict in a Sixth-Grade Book Club: The Impact of a Rule-Driven Discourse

ERIC Educational Resources Information Center

Hill, K. Dara

2008-01-01

This study examines unintended consequences during a 6th-grade book club discussion of Bette Bao Lord's (1984) In the Year of the Boar and Jackie Robinson. The participants modeled a book club discussion, otherwise known as the fish bowl, for a newly enrolled student. Unintended consequences occurred within the realm of deviating from the rules of…

The Unintended Consequences of the Adoption of Electronic Medical Record Systems on Healthcare Costs

ERIC Educational Resources Information Center

Ganju, Kartik K.

2016-01-01

In my dissertation, I study unintended consequences of the adoption of EMR systems. In my three essays, I examine how the adoption of EMR systems affects neighboring hospitals (spillover effects), can be used by hospitals to further its objectives in an unconventional manner ("upcoding" of patient case mix data), and how EMR adoption may…

Why so many "rigorous" evaluations fail to identify unintended consequences of development programs: How mixed methods can contribute.

PubMed

Bamberger, Michael; Tarsilla, Michele; Hesse-Biber, Sharlene

2016-04-01

Many widely-used impact evaluation designs, including randomized control trials (RCTs) and quasi-experimental designs (QEDs), frequently fail to detect what are often quite serious unintended consequences of development programs. This seems surprising as experienced planners and evaluators are well aware that unintended consequences frequently occur. Most evaluation designs are intended to determine whether there is credible evidence (statistical, theory-based or narrative) that programs have achieved their intended objectives and the logic of many evaluation designs, even those that are considered the most "rigorous," does not permit the identification of outcomes that were not specified in the program design. We take the example of RCTs as they are considered by many to be the most rigorous evaluation designs. We present a numbers of cases to illustrate how infusing RCTs with a mixed-methods approach (sometimes called an "RCT+" design) can strengthen the credibility of these designs and can also capture important unintended consequences. We provide a Mixed Methods Evaluation Framework that identifies 9 ways in which UCs can occur, and we apply this framework to two of the case studies. Copyright © 2016 Elsevier Ltd. All rights reserved.

Unintended pregnancy and abortion in Uganda.

PubMed

Hussain, Rubina

2013-01-01

Unintended pregnancy is common in Uganda, leading to high levels of unplanned births, unsafe abortions, and maternal injury and death. Because most pregnancies that end in abortion are unwanted, nearly all ill health and mortality resulting from unsafe abortion is preventable. This report summarizes evidence on the context and consequences of unintended pregnancy and unsafe abortion in Uganda, points out gaps in knowledge, and highlights steps that can be taken to reduce levels of unintended pregnancy and unsafe abortion, and, in turn, the high level of maternal mortality.

"A Baby Was an Added Burden": Predictors and Consequences of Unintended Pregnancies for Female Sex Workers in Mombasa, Kenya: A Mixed-Methods Study.

PubMed

Luchters, Stanley; Bosire, Wilkister; Feng, Amy; Richter, Marlise L; King'ola, Nzioki; Ampt, Frances; Temmerman, Marleen; Chersich, Matthew F

Female sex workers (FSW) have high rates of unintended pregnancy, sexually transmitted infections including HIV, and other adverse sexual and reproductive health outcomes. Few services for FSWs include contraception. This mixed-methods study aimed to determine the rate, predictors and consequences of unintended pregnancy among FSWs in Mombasa, Kenya. A prospective cohort study of non-pregnant FSWs was conducted. Quantitative data were collected quarterly, including a structured questionnaire and testing for pregnancy and HIV. Predictors of unintended pregnancy were investigated using multivariate logistic regression. Qualitative data were gathered through focus group discussions and in-depth interviews with FSWs who became pregnant during the study, and interviews with five key informants. These data were transcribed, translated and analysed thematically. Four hundred women were enrolled, with 92% remaining in the cohort after one year. Fifty-seven percent reported using a modern contraceptive method (including condoms when used consistently). Over one-third (36%) of women were using condoms inconsistently without another method. Twenty-four percent had an unintended pregnancy during the study. Younger age, having an emotional partner and using traditional or no contraception, or condoms only, were independent predictors of unintended pregnancy. Women attributed pregnancy to forgetting to use contraception and being pressured not to by clients and emotional partners, as well as "bad luck". They described numerous negative consequences of unintended pregnancy. Modern contraceptive uptake is surprisingly low in this at-risk population, which in turn has a high rate of unintended pregnancy. The latter may result in financial hardship, social stigma, risk of abandonment, or dangerous abortion practices. FSWs face considerable barriers to the adoption of dual method contraceptive use, including low levels of control in their emotional and commercial relationships. Reproductive health services need to be incorporated into programs for sexually transmitted infections and HIV, which address the socially-determined barriers to contraceptive use.

“A Baby Was an Added Burden”: Predictors and Consequences of Unintended Pregnancies for Female Sex Workers in Mombasa, Kenya: A Mixed-Methods Study

PubMed Central

Luchters, Stanley; Bosire, Wilkister; Feng, Amy; Richter, Marlise L.; King’ola, Nzioki; Ampt, Frances; Temmerman, Marleen; Chersich, Matthew F.

2016-01-01

Introduction Female sex workers (FSW) have high rates of unintended pregnancy, sexually transmitted infections including HIV, and other adverse sexual and reproductive health outcomes. Few services for FSWs include contraception. This mixed-methods study aimed to determine the rate, predictors and consequences of unintended pregnancy among FSWs in Mombasa, Kenya. Methods A prospective cohort study of non-pregnant FSWs was conducted. Quantitative data were collected quarterly, including a structured questionnaire and testing for pregnancy and HIV. Predictors of unintended pregnancy were investigated using multivariate logistic regression. Qualitative data were gathered through focus group discussions and in-depth interviews with FSWs who became pregnant during the study, and interviews with five key informants. These data were transcribed, translated and analysed thematically. Results Four hundred women were enrolled, with 92% remaining in the cohort after one year. Fifty-seven percent reported using a modern contraceptive method (including condoms when used consistently). Over one-third (36%) of women were using condoms inconsistently without another method. Twenty-four percent had an unintended pregnancy during the study. Younger age, having an emotional partner and using traditional or no contraception, or condoms only, were independent predictors of unintended pregnancy. Women attributed pregnancy to forgetting to use contraception and being pressured not to by clients and emotional partners, as well as “bad luck”. They described numerous negative consequences of unintended pregnancy. Conclusion Modern contraceptive uptake is surprisingly low in this at-risk population, which in turn has a high rate of unintended pregnancy. The latter may result in financial hardship, social stigma, risk of abandonment, or dangerous abortion practices. FSWs face considerable barriers to the adoption of dual method contraceptive use, including low levels of control in their emotional and commercial relationships. Reproductive health services need to be incorporated into programs for sexually transmitted infections and HIV, which address the socially-determined barriers to contraceptive use. PMID:27689699

Contraception and mental health: a commentary on the evidence and principles for practice.

PubMed

Hall, Kelli Stidham; Steinberg, Julia R; Cwiak, Carrie A; Allen, Rebecca H; Marcus, Sheila M

2015-06-01

Among the most prevalent and disabling chronic diseases affecting reproductive-aged women worldwide, depression and anxiety can contribute to adverse reproductive health outcomes, including an increased risk of unintended pregnancy and its health and social consequences. For women with these common mental health conditions who want to avoid an unintended pregnancy, effective contraception can be an important strategy to maintain and even improve health and well-being. Reproductive health clinicians play a critical role in providing and managing contraception to help women with mental health considerations achieve their desired fertility. In this commentary, we review the literature on relationships between mental health and contraception and describe considerations for the clinical management of contraception among women with depression and anxiety. We discuss issues related to contraceptive method effectiveness and adherence concerns, mental health-specific contraceptive method safety and drug interaction considerations, and clinical counseling and management strategies. Given important gaps in current scientific knowledge of mental health and contraception, we highlight areas for future research. Copyright © 2015 Elsevier Inc. All rights reserved.

What to consider when regulating electronic cigarettes: Pros, cons and unintended consequences.

PubMed

Caponnetto, Pasquale; Saitta, Daniela; Sweanor, David; Polosa, Riccardo

2015-06-01

Many public health experts, medical research societies, large health organizations and policy makers have expressed concerns about the increased popularity of electronic cigarettes and have pushed for more restrictive measures ranging from complete bans to tight regulations of these products either as medicines or as tobacco products. But these concerns have never been adequately qualified nor quantified. Without judicious assessment and thorough evaluation, regulations may have unintended consequences that can do more damage than good in public health terms. In this article, we will appraise the existing prominent regulatory frameworks for e-cigarettes, namely, general consumer product, medicinal product and tobacco product regulation, to highlight their pros and cons. Moreover, we provide concrete examples of the unintended consequences which may arise from inappropriate regulatory action. Copyright © 2015 Elsevier B.V. All rights reserved.

Problems and limitations of voluntary cleanup programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, S.F.

1995-12-31

At least a dozen states have already implemented voluntary cleanup programs (VCPs). Provisions to promote state VCPs were prominent in the EPA`s 1994 proposed revisions to CERCLA and in current legislative initiatives. Under the VCP, property owners voluntarily enroll to investigate and remediate contaminated sites with the aegis of a state agency and thus avoid involvement with the federal Superfund program. When the state agency is satisfied with the condition of the site, it issues a certificate to the owner. The VCP is meant to mitigate unintended consequences of CERCLA such as the economic abandonment of urban industrial sites inmore » favor of unpolluted suburban sites. The VCP concept has been combined with other reforms including cleanup standards, financial incentives, and independent action. The effectiveness of voluntary cleanup programs is limited by the costs of investigation and cleanup relative to the value of the property in question. It is also limited when property has environmental problems outside the traditional focus of state Superfund agencies on soil and groundwater contamination. VCPs also have potential unintended consequences of their own. The VCP concept is consistent with a 15 year trend of increasing government attention and involvement with sites of diminishing health and environmental significance. VCP may reinforce the perception of liability and unwittingly raise the standard of due diligence in property assessments, especially if combined with generic cleanup standard.« less

The Unintended Consequences of School Inspection: The Prevalence of Inspection Side-Effects in Austria, The Czech Republic, England, Ireland, The Netherlands, Sweden, and Switzerland

ERIC Educational Resources Information Center

Jones, Karen L.; Tymms, Peter; Kemethofer, David; O'Hara, Joe; McNamara, Gerry; Huber, Stephan; Myrberg, Eva; Skedsmo, Guri; Greger, David

2017-01-01

It has been widely documented that accountability systems, including school inspections, bring with them unintended side effects. These unintended effects are often negative and have the potential to undo the intended positive effects. However the empirical evidence is limited. Through a European comparative study we have had the rare opportunity…

Self-control, self-regulation, and doping in sport: a test of the strength-energy model.

PubMed

Chan, Derwin K; Lentillon-Kaestner, Vanessa; Dimmock, James A; Donovan, Robert J; Keatley, David A; Hardcastle, Sarah J; Hagger, Martin S

2015-04-01

We applied the strength-energy model of self-control to understand the relationship between self-control and young athletes' behavioral responses to taking illegal performance-enhancing substances, or "doping." Measures of trait self-control, attitude and intention toward doping, intention toward, and adherence to, doping-avoidant behaviors, and the prevention of unintended doping behaviors were administered to 410 young Australian athletes. Participants also completed a "lollipop" decision-making protocol that simulated avoidance of unintended doping. Hierarchical linear multiple regression analyses revealed that self-control was negatively associated with doping attitude and intention, and positively associated with the intention and adherence to doping-avoidant behaviors, and refusal to take or eat the unfamiliar candy offered in the "lollipop" protocol. Consistent with the strength-energy model, athletes with low self-control were more likely to have heightened attitude and intention toward doping, and reduced intention, behavioral adherence, and awareness of doping avoidance.

Using an Evidence-Based Approach to EMR Implementation to Optimize Outcomes and Avoid Unintended Consequences

PubMed Central

Longhurst, Christopher A.; Palma, Jonathan P.; Grisim, Lisa M.; Widen, Eric; Chan, Melanie; Sharek, Paul J.

2013-01-01

Implementation of an electronic medical record (EMR) with computerized physician order entry (CPOE) can provide an important foundation for preventing harm and improving outcomes. Incentivized by the recent economic stimulus initiative, healthcare systems are implementing vendor-based EMR systems at an unprecedented rate. Accumulating evidence suggests that local implementation decisions, rather than the specific EMR product or technology selected, are the primary drivers of the quality improvement performance of these systems. However, limited attention has been paid to effective approaches to EMR implementation. In this case report, we outline the evidence-based approach we used to make EMR implementation decisions in a pragmatic structure intended for replication at other sites. PMID:24771994

The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals.

PubMed

Wu, Robert C; Lo, Vivian; Morra, Dante; Wong, Brian M; Sargeant, Robert; Locke, Ken; Cavalcanti, Rodrigo; Quan, Sherman D; Rossos, Peter; Tran, Kim; Cheung, Mark

2013-01-01

Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness. To describe the effects of different communication interventions and their problems. Prospective observational case study using a mixed methods approach of quantitative and qualitative methods. General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals. Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards. Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010. We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories. Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.

Geomorphology and the Law of Unintended Consequences (Locke, 1691): Lessons from coastal weathering and erosion at Prawle (UK) and Kaikoura (NZ)

NASA Astrophysics Data System (ADS)

Mottershead, Derek N.; Stephenson, Wayne J.; Hemmingsen, Maree A.

2016-07-01

The sites of two field experiments based on micro-erosion metering, one in UK the other in New Zealand, were independently revisited respectively 33 and 17 years after installation. At both sites natural weathering and erosion processes had been inadvertently interrupted by the experimental works, leading to the development of new microscale landforms. These are interpreted in the context of modifications of the controls on weathering processes, leading to enhanced understanding of the processes themselves. This has lessons for the geomorphologist in maintaining a long-term watching brief over former experimental sites, lest some unintended and potentially beneficial outcome has ensued. This theme is embraced by the Law of Unintended Consequences.

Unintended Consequences of Smoke-Free Bar Policies for Low-SES Women in Three California Counties

PubMed Central

Moore, Roland S.; Annechino, Rachelle M.; Lee, Juliet P.

2009-01-01

Background To amplify earlier studies of unintended consequences of public policies, this article illustrates both negative and positive unanticipated consequences of smoke-free workplace policies in California bars for women of low SES. Methods The article relies on thematic analysis in 2008 of qualitative data gathered between 2001 and 2007 from three mixed-method studies of tobacco use in and around bars where indoor smoking is prohibited. Results Unanticipated consequences primarily occurred when bars did comply with the law and smokers went outside the bar to smoke, particularly when smokers stood on the street outside the bar. Key negative consequences for women who smoked outside of bars included threats to their physical safety and their public image. For women living near bars, increased smoking on the street may have increased their exposure to secondhand smoke and disruptive noise. For some women, however, unanticipated negative consequences were identified with noncompliant bars. Smokers were conjectured to congregate in the smaller number of bars where smoking was still allowed, resulting in increased exposure to secondhand smoke for low-SES women working in these bars. A common positive unintended consequence of the tobacco control ordinance was increased social circulation and solidarity, as smokers gathered outside bars to smoke. Conclusions Smoke-free workplace laws in bars can have both negative and positive consequences for workers and smokers, and low-income women in particular. PMID:19591753

Unintended consequences of smoke-free bar policies for low-SES women in three California counties.

PubMed

Moore, Roland S; Annechino, Rachelle M; Lee, Juliet P

2009-08-01

To amplify earlier studies of unintended consequences of public policies, this article illustrates both negative and positive unanticipated consequences of smoke-free workplace policies in California bars for women of low SES. The article relies on thematic analysis in 2008 of qualitative data gathered between 2001 and 2007 from three mixed-method studies of tobacco use in and around bars where indoor smoking is prohibited. Unanticipated consequences primarily occurred when bars did comply with the law and smokers went outside the bar to smoke, particularly when smokers stood on the street outside the bar. Key negative consequences for women who smoked outside of bars included threats to their physical safety and their public image. For women living near bars, increased smoking on the street may have increased their exposure to secondhand smoke and disruptive noise. For some women, however, unanticipated negative consequences were identified with noncompliant bars. Smokers were conjectured to congregate in the smaller number of bars where smoking was still allowed, resulting in increased exposure to secondhand smoke for low-SES women working in these bars. A common positive unintended consequence of the tobacco control ordinance was increased social circulation and solidarity, as smokers gathered outside bars to smoke. Smoke-free workplace laws in bars can have both negative and positive consequences for workers and smokers, and low-income women in particular.

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya

PubMed Central

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-01-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility’s bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers’ motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. PMID:25920355

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya.

PubMed

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-03-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Metric-driven harm: an exploration of unintended consequences of performance measurement.

PubMed

Rambur, Betty; Vallett, Carol; Cohen, Judith A; Tarule, Jill Mattuck

2013-11-01

Performance measurement is an increasingly common element of the US health care system. Typically a proxy for high quality outcomes, there has been little systematic investigation of the potential negative unintended consequences of performance metrics, including metric-driven harm. This case study details an incidence of post-surgical metric-driven harm and offers Smith's 1995 work and a patient centered, context sensitive metric model for potential adoption by nurse researchers and clinicians. Implications for further research are discussed. © 2013.

A blessing I can't afford: factors underlying the paradox of happiness about unintended pregnancy.

PubMed

Aiken, Abigail R A; Dillaway, Chloe; Mevs-Korff, Natasha

2015-05-01

An unresolved paradox in the measurement and interpretation of unintended pregnancy is that women frequently report feeling happy about pregnancies they also classify as unintended (i.e. they have incongruent intentions and feelings). This study explores the underlying reasons why women profess such happiness and how these relate to their motivations to avoid pregnancy. Between September 2013 and February 2014, semi-structured in-depth interviews were conducted with 27 women (8 white, 19 Latina) selected from a longitudinal study measuring prospective pregnancy intentions and feelings among 403 women in Austin, Texas. Women were selected for interview on the basis of wanting no more children and consistently professing either happiness (n = 17) or unhappiness (n = 10) at the prospect of pregnancy. Interviews were coded and analyzed following the principles of grounded theory. We found that it is possible for women to express happiness at the idea of pregnancy while simultaneously earnestly trying to prevent conception. Happiness at the idea of an unintended pregnancy was explained as the result of deep and heartfelt feelings about children taking precedence over practical considerations, the perception that the psychosocial stress resulting from another child would be low, and the ability to rationalize an unintended pregnancy as the result of fate or God's plan. The major exception to the sincerity of professed happiness was that conveyed as a result of social pressure despite truly negative feelings, predominantly expressed by foreign-born Latina women. Overall, equating incongruence with ambivalence about avoiding conception may undermine the sincerity of women's intentions and their desires for highly-effective contraception. At the same time, unintended pregnancies that are greeted with happiness may have different implications for maternal and child health outcomes compared to pregnancies that are greeted with unhappiness. Identifying which unintended pregnancies are most likely to result in adverse outcomes is a target for future research. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Blessing I Can’t Afford: Factors Underlying the Paradox of Happiness about Unintended Pregnancy

PubMed Central

Aiken, Abigail R.A.; Dillaway, Chloe; Mevs-Korff, Natasha

2015-01-01

An unresolved paradox in the measurement and interpretation of unintended pregnancy is that women frequently report feeling happy about pregnancies they also classify as unintended (i.e. they have incongruent intentions and feelings). This study explores the underlying reasons why women profess such happiness and how these relate to their motivations to avoid pregnancy. Between September 2013 and February 2014, semi-structured in-depth interviews were conducted with 27 women (8 white, 19 Latina) selected from a longitudinal study measuring prospective pregnancy intentions and feelings among 403 women in Austin, Texas. Women were selected for interview on the basis of wanting no more children and consistently professing either happiness (n=17) or unhappiness (n=10) at the prospect of pregnancy. Interviews were coded and analyzed following the principles of grounded theory. We found that it is possible for women to express happiness at the idea of pregnancy while simultaneously earnestly trying to prevent conception. Happiness at the idea of an unintended pregnancy was explained as the result of deep and heartfelt feelings about children taking precedence over practical considerations, the perception that the psychosocial stress resulting from another child would be low, and the ability to rationalize an unintended pregnancy as the result of fate or God’s plan. The major exception to the sincerity of professed happiness was that conveyed as a result of social pressure despite truly negative feelings, predominantly expressed by foreign-born Latina women. Overall, equating incongruence with ambivalence about avoiding conception may undermine the sincerity of women’s intentions and their desires for highly-effective contraception. At the same time, unintended pregnancies that are greeted with happiness may have different implications for maternal and child health outcomes compared to pregnancies that are greeted with unhappiness. Identifying which unintended pregnancies are most likely to result in adverse outcomes is a target for future research. PMID:25813729

Progesterone for Prevention of Preterm Birth: Shortcomings and Unintended Consequences of the Orphan Drug Act.

PubMed

Gee, Rebekah E; Kuy, SreyRam; Karas, Laura O

2017-12-01

Preterm birth is a problem of major public health significance that continues to plague our country despite the existence of a therapy, 17α-hydroxyprogesterone caproate, with known efficacy in reducing the risk of spontaneous preterm birth among high-risk women. Over the past several years, the Louisiana Department of Health has undertaken a robust, multifaceted initiative to improve access to 17α-hydroxyprogesterone caproate, which resulted in a 3.5-fold increase in the percentage of eligible high-risk pregnant women in the Medicaid program who received the therapy between 2013 and 2016. Yet despite Louisiana's progress, the vast majority of the eligible population still fails to receive 17α-hydroxyprogesterone caproate. In this Current Commentary, we argue that the high price of progesterone since U.S. Food and Drug Administration approval has unnecessarily complicated access, and our nation has potentially suffered nearly 60,000 avoidable premature births as a consequence. We present the history of the orphan drug approval and manufacturer-imposed price increase for injectable progesterone, the interplay between the drug's high price and the persistence of racial and ethnic disparities in preterm birth, which are particularly germane in Louisiana, and Louisiana's broad-reaching efforts to improve progesterone coverage. The story of 17α-hydroxyprogesterone caproate highlights the durable barriers that high prices place in the way of access and helps illuminate the shortcomings and unintended consequences of the Orphan Drug Act. This case, however, is not an outlier; it is the far-too-common product of monopoly pricing in the U.S. pharmaceutical market, inadvertently bolstered by existing law, at the expense of affordability and patient access.

The Medicare Policy of Payment Adjustment for Health Care-Associated Infections: Perspectives on Potential Unintended Consequences

PubMed Central

Hartmann, Christine W.; Hoff, Timothy; Palmer, Jennifer A.; Wroe, Peter; Dutta-Linn, M. Maya; Lee, Grace

2014-01-01

In 2008, the Centers for Medicare & Medicaid Services introduced a new policy to adjust payment to hospitals for health care-associated infections (HAIs) not present on admission. Interviews with 36 hospital infection preventionists across the United States explored the perspectives of these key stakeholders on the potential unintended consequences of the current policy. Responses were analyzed using an iterative coding process where themes were developed from the data. Participants’ descriptions of unintended impacts of the policy centered around three themes. Results suggest the policy has focused more attention on targeted HAIs and has affected hospital staff; relatively fewer systems changes have ensued. Some consequences of the policy, such as infection preventionists having less time to devote to HAIs other than those in the policy or having less time to implement prevention activities, may have undesirable effects on HAI rates if hospitals do not recognize and react to potential time and resource gaps. PMID:21810797

The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals

PubMed Central

Wu, Robert C; Lo, Vivian; Morra, Dante; Wong, Brian M; Sargeant, Robert; Locke, Ken; Cavalcanti, Rodrigo; Quan, Sherman D; Rossos, Peter; Tran, Kim; Cheung, Mark

2013-01-01

Background Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness. Objectives To describe the effects of different communication interventions and their problems. Design Prospective observational case study using a mixed methods approach of quantitative and qualitative methods. Setting General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals. Participants Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards. Methods Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010. Results We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories. Conclusions Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems. PMID:23355461

Unintended Consequences of Cost Recovery

ERIC Educational Resources Information Center

Piercey, David

2010-01-01

An Alberta school district that used a cost-recovery model to finance school services for 20 years is finding that the model produces unintended negative results. Some schools didn't spend this money on services but used it for other school operations. Some spent the money on external consultants. Professional relationships were damaged, and…

Respecting Intent and Dispelling Stereotypes by Reducing Unintended Pregnancy.

PubMed

Johnsen, Dawn

2015-01-01

In "Expectant Fathers, Abortion, and Embryos," Dara Purvis evaluates the concepts of intent and gender stereotypes in connection with "expectational fathers" in the related contexts of abortion and assisted reproductive technologies. This comment seeks to build upon Purvis's own analysis to obviate her concern that abortion discourse promotes harmful stereotypes of men as disinterested fathers. To the contrary, for men — no less than for women — a desire to avoid or terminate pregnancy is fully consistent with loving and shared parenthood of existing or future children. The same individuals who choose to become parents at other times in their long reproductive lives will use contraception and have abortions. In fact, most women who have abortions already have children. Policies that empower men and women to avoid unintended pregnancy are the sensible, win-win, front-line approach to avoid disputes over abortion. © 2015 American Society of Law, Medicine & Ethics, Inc.

Society of Behavioral Medicine (SBM) position statement: Enact taxes on sugar sweetened beverages to prevent chronic disease.

PubMed

Taber, Daniel R; Dulin-Keita, Akilah; Fallon, Megan; Chaloupka, Frank J; Andreyeva, Tatiana; Schwartz, Marlene B; Harris, Jennifer L

2018-04-10

The Society of Behavioral Medicine (SBM) encourages stakeholders to implement a sugar sweetened beverage excise tax. Sugar sweetened beverages are the largest source of added sugars in the USA and have detrimental effects on population health by increasing risks for chronic diseases. Based on existing research evidence, SBM supports an excise tax equivalent to at least 20% to meaningfully affect consumption patterns. As evidenced by research studies in Mexico and the USA, sugar sweetened beverage taxes can have positive impacts on population health and can raise significant tax revenue. To avoid potential unintended consequences that may arise from taxes to improve diet-related behaviors, it is important to monitor industry and consumer behavior in response to the tax.

Is It Time for Synthetic Biodiversity Conservation?

PubMed

Piaggio, Antoinette J; Segelbacher, Gernot; Seddon, Philip J; Alphey, Luke; Bennett, Elizabeth L; Carlson, Robert H; Friedman, Robert M; Kanavy, Dona; Phelan, Ryan; Redford, Kent H; Rosales, Marina; Slobodian, Lydia; Wheeler, Keith

2017-02-01

Evidence indicates that, despite some critical successes, current conservation approaches are not slowing the overall rate of biodiversity loss. The field of synthetic biology, which is capable of altering natural genomes with extremely precise editing, might offer the potential to resolve some intractable conservation problems (e.g., invasive species or pathogens). However, it is our opinion that there has been insufficient engagement by the conservation community with practitioners of synthetic biology. We contend that rapid, large-scale engagement of these two communities is urgently needed to avoid unintended and deleterious ecological consequences. To this point we describe case studies where synthetic biology is currently being applied to conservation, and we highlight the benefits to conservation biologists from engaging with this emerging technology. Published by Elsevier Ltd.

The Unintended Consequences of Targeting: Young People's Lived Experiences of Social and Emotional Learning Interventions

ERIC Educational Resources Information Center

Evans, Rhiannon; Scourfield, Jonathan; Murphy, Simon

2015-01-01

In the past twenty years there has been a proliferation of targeted school-based social and emotional learning (SEL) interventions. However, the lived experience of young peoples' participation is often elided, while the potential for interventions to confer unintended and even adverse effects remains under-theorised and empirically…

Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization.

PubMed

Wang, George Sam

2017-03-01

An "unintended consequence" of marijuana legalization is the impact on the pediatric population. From prenatal exposure to unintentional childhood exposures, through concerns of adolescence abuse and marijuana use for medicinal indications in children, marijuana exposure can affect pediatric patients at every stage in childhood. Regardless of the stage or reason of exposure, concerns exist about short-term and long-term consequences in a child's physical and mental health. The use of cannabidiol (CBD) may have some benefit for the treatment of epilepsy, but emphasis needs to be on rigorous clinical trials to evaluate efficacy and safety. As more states allow both medical and recreational marijuana, availability and prevalence of use will likely increase and more surveillance and research is needed to evaluate the consequences on the pediatric population.

The copper intrauterine device for emergency contraception: an opportunity to provide the optimal emergency contraception method and transition to highly effective contraception.

PubMed

Dermish, Amna I; Turok, David K

2013-07-01

Worldwide, 40% of all pregnancies are unintended. Widespread, over-the-counter availability of oral emergency contraception (EC) has not reduced unintended pregnancy rates. The EC visit presents an opportunity to initiate a highly effective method of contraception in a population at high risk of unintended pregnancy who are actively seeking to avoid pregnancy. The copper intrauterine device (IUD), the most effective method of EC, continues to provide contraception as effective as sterilization for up to 12 years, and it should be offered as the first-line method of EC wherever possible. Increased demand for and supply of the copper IUD for EC may have an important role in reducing rates of unintended pregnancy. The EC visit should include access to the copper IUD as optimal care but should ideally include access to all highly effective methods of contraception.

["Unintended consequences of scientific discoveries" or: "Heterogeny of purposes" as phenomena of the history of science].

PubMed

Wittkau-Horgby, A

2001-01-01

This paper deals with an old observation in respect to man's action--the problem of unintended consequences of human action. It presents the scientific approaches to this phenomenon in the 18th century and focusses then on the problem of unintended consequences of scientific discoveries. Using the prominent examples of Copernicus and Darwin the author shows that the actual outcomes and final effects of scientific discoveries must not necessarily be the originally intended ones. On the contrary, especially those results of scientific discoveries which have affected the sphere of world view (Weltanschauung) like the research works of Copernicus and Darwin were originally meant to be only scientific studies. The final results in respect to the world view were on Copernicus' side not even realized and on Darwin's side neither intended nor welcomed. The conclusion of this analysis is that due to the fact that both scientists did not have the intention to change the world view they can only partly be regarded to be responsible for the fundamental changes they finally caused.

Unintended Consequences of Incentive Provision for Behaviour Change and Maintenance around Childbirth

PubMed Central

Thomson, Gill; Morgan, Heather; Crossland, Nicola; Bauld, Linda; Dykes, Fiona; Hoddinott, Pat

2014-01-01

Financial (positive or negative) and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497) including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing service delivery, but may be detrimental to other health care areas. Financial incentives are controversial and generated emotive and oppositional responses. The planning, design and delivery of future incentive interventions should evaluate unexpected consequences to inform the evidence for effectiveness, cost-effectiveness and future implementation. PMID:25357121

Unintended consequences of incentive provision for behaviour change and maintenance around childbirth.

PubMed

Thomson, Gill; Morgan, Heather; Crossland, Nicola; Bauld, Linda; Dykes, Fiona; Hoddinott, Pat; Dombrowski, Stephan; MacLennan, Graeme; Rothnie, Kieran; Stewart, Fiona; Farrar, Shelley; Yi, Deokhee; Hislop, Jenni; Ludbrook, Anne; Campbell, Marion; Moran, Victoria Hall; Sniehotta, Falko; Tappin, David

2014-01-01

Financial (positive or negative) and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497) including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing service delivery, but may be detrimental to other health care areas. Financial incentives are controversial and generated emotive and oppositional responses. The planning, design and delivery of future incentive interventions should evaluate unexpected consequences to inform the evidence for effectiveness, cost-effectiveness and future implementation.

Cancer pain management and the opioid crisis in America: How to preserve hard-earned gains in improving the quality of cancer pain management.

PubMed

Paice, Judith A

2018-06-15

Cancer pain remains a feared consequence of the disease and its treatment. Although prevalent, cancer pain can usually be managed through the skillful application of pharmacologic and nonpharmacologic interventions. Unfortunately, access to these therapies has been hampered by interventions designed to contain another serious public health problem: the opioid misuse epidemic. This epidemic and the unintended consequences of efforts to control this outbreak are leading to significant barriers to the provision of cancer pain relief. Oncologists and other professionals treating those with cancer pain will require new knowledge and tools to provide safe and effective pain control while preventing additional cases of substance use disorders (SUDs), helping patients in recovery to maintain sobriety, and guiding those not yet in recovery to seek treatment. How do these 2 serious epidemics intersect and affect oncology practice? First, oncology professionals will need to adopt practices to prevent SUDs by assessing risk and providing safe pain care. Second, oncology practices are likely to see an increased number of patients with a current or past SUD, including opioid misuse. Few guidelines exist for the direct management of pain when opioids may be indicated in these individuals. Third, modified prescribing practices along with the education of patients and families are warranted to prevent the exposure of these medications to unintended persons. Finally, advocacy on behalf of those with cancer pain is imperative to avoid losing access to essential therapies, including opioids, for those who might benefit. Cancer 2018;124:2491-7. © 2018 American Cancer Society. © 2018 American Cancer Society.

Menu labeling: the unintended consequences to the consumer.

PubMed

Black, Ellen A

2014-01-01

The Affordable Care Act requires certain restaurants to provide nutritional information on their menus and menu boards, which is referred to as menu labeling. Menu labeling presupposes that providing consumers with the nutritional information about their food will cause them to reconsider their food choices by picking healthier food options over less healthy options, thereby reducing the nation's high obesity rate. However, several studies have shown that consumers do not make healthier food choices even when armed with menu labeling. The issue then becomes whether menu labeling provides a correlative benefit to consumers or whether there are unintended consequences that ultimately harm consumers.

Security and Privacy Grand Challenges for the Internet of Things

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fink, Glenn A.; Zarzhitsky, Dimitri V.; Carroll, Thomas E.

Abstract— The growth of the Internet of Things (IoT) is driven by market pressures, and while security is being considered, the relationship between the unintended consequences of billions of such devices connecting to the Internet cannot be described with existing mathematical methods. The possibilities for illicit surveillance through lifestyle analysis, unauthorized access to information, and new attack vectors will continue to increase by 2020, when up-to 50 billion devices may be connected. This paper discusses various kinds of vulnerabilities that can be expected to arise, and presents a research agenda for mitigating the worst of the impacts. We hope tomore » draw research attention to the potential dangers of IoT so that many of these problems can be avoided.« less

Unintended consequences and trade-offs of fish passage

USGS Publications Warehouse

McLaughlin, Robert L.; Smyth, Eric R.; Castro-Santos, Theodore; Jones, Michael L.; Koops, Marten A.; Pratt, Thomas C.; Vélez-Espino, Luis-Antonio

2012-01-01

We synthesized evidence for unintended consequences and trade-offs associated with the passage of fishes. Provisioning of fish passageways at dams and dam removals are being carried out increasingly as resource managers seek ways to reduce fragmentation of migratory fish populations and restore biodiversity and nature-like ecosystem services in tributaries altered by dams. The benefits of provisioning upstream passage are highlighted widely. Possible unwanted consequences and trade-offs of upstream passage are coming to light, but remain poorly examined and underappreciated. Unintended consequences arise when passage of native and desirable introduced fishes is delayed, undone (fallback), results in patterns of movement and habitat use that reduce Darwinian fitness (e.g. ecological traps), or is highly selective taxonomically and numerically. Trade-offs arise when passage decisions intended to benefit native species interfere with management decisions intended to control the unwanted spread of non-native fishes and aquatic invertebrates, or genes, diseases and contaminants carried by hatchery and wild fishes. These consequences and trade-offs will vary in importance from system to system and can result in large economic and environmental costs. For some river systems, decisions about how to manage fish passage involve substantial risks and could benefit from use of a formal, structured process that allows transparent, objective and, where possible, quantitative evaluation of these risks. Such a process can also facilitate the design of an adaptive framework that provides valuable insights into future decisions.

Missed pills: frequency, reasons, consequences and solutions.

PubMed

Chabbert-Buffet, Nathalie; Jamin, Christian; Lete, Iñaki; Lobo, Paloma; Nappi, Rossella E; Pintiaux, Axelle; Häusler, Günther; Fiala, Christian

2017-06-01

Oral hormonal contraception is an effective contraceptive method as long as regular daily intake is maintained. However, a daily routine is a constraint for many women and can lead to missed pills, pill discontinuation and/or unintended pregnancy. This article describes the frequency of inconsistent use, the consequences, the risk factors and the possible solutions. The article comprises a narrative review of the literature. Forgetting one to three pills per cycle is a frequent problem among 15-51% of users, generally adolescents. The reasons for this are age, inability to establish a routine, pill unavailability, side effects, loss of motivation and lack of involvement in the initial decision to use oral contraceptives. The consequences are 'escape ovulations' and, possibly, unintended pregnancy. Solutions are either to use a long-acting method or, for women who prefer to take oral contraceptives, use a continuous or long-cycle regimen to reduce the risks of follicular development and thus the likelihood of ovulation and unintended pregnancy. A progestogen with a long half-life can increase ovarian suppression. For women deciding to use oral contraceptives, a shortened or eliminated hormone-free interval and a progestogen with a long half-life may be an option to reduce the negative consequences of missed oral contraceptive pills.

The Unintended and Intended Academic Consequences of Educational Reforms: The Cases of Post-Soviet Estonia, Latvia and Russia

ERIC Educational Resources Information Center

Khavenson, Tatiana; Carnoy, Martin

2016-01-01

In this paper, we try to unravel some of the unintended and intended academic effects associated with post-Soviet educational reforms by focusing on three cases: Estonia, Latvia and Russia. We have chosen this comparison because a unique "natural experiment" in the three countries allows us to compare the changing academic performance on…

Does public reporting influence quality, patient and provider's perspective, market share and disparities? A review.

PubMed

Vukovic, Vladimir; Parente, Paolo; Campanella, Paolo; Sulejmani, Adela; Ricciardi, Walter; Specchia, Maria Lucia

2017-12-01

Public reporting (PR) of healthcare (HC) provider's quality was proposed as a public health instrument for providing transparency and accountability in HC. Our aim was to assess the impact of PR on five main domains: quality improvement; patient choice, service utilization and market share; provider's perspective; patient experience; and unintended consequences. PubMed, Scopus, ISI WOS, and EconLit databases were searched to identify studies investigating relationships between PR and five main domains, published up to April 1, 2016. Sixty-two papers published between 1988 and 2015 were included. Nineteen studies investigated quality improvement, 19 studies explored the unintended consequences of PR, 10 explored the effects on market share, 10 on patients' choice, 7 evaluated the provider's perspective, 4 economic outcome, 4 service utilization, 2 purchasers' use of PR and 2 studies explored patient experiences. The effect of PR was diverse throughout the studies-mostly positive on: patient experience (100%), quality improvement (63%), patient choice, service utilization and market share (46%); mixed on provider's perspective and economic outcome (27%) and mainly negative on unintended consequences (68%). Our research covering different outcomes and settings reported that PR is associated with changes in HC provider's behavior and can influence market share. Unintended consequences are a concern of PR and should be taken into account when allocating HC resources. The experiences collected in this paper could give a snapshot about the impact of PR on a HC user's perception of the providers' quality of care, helping them to make empowered choices. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Systematic iteration between model and methodology: A proposed approach to evaluating unintended consequences.

PubMed

Morell, Jonathan A

2018-06-01

This article argues that evaluators could better deal with unintended consequences if they improved their methods of systematically and methodically combining empirical data collection and model building over the life cycle of an evaluation. This process would be helpful because it can increase the timespan from when the need for a change in methodology is first suspected to the time when the new element of the methodology is operational. The article begins with an explanation of why logic models are so important in evaluation, and why the utility of models is limited if they are not continually revised based on empirical evaluation data. It sets the argument within the larger context of the value and limitations of models in the scientific enterprise. Following will be a discussion of various issues that are relevant to model development and revision. What is the relevance of complex system behavior for understanding predictable and unpredictable unintended consequences, and the methods needed to deal with them? How might understanding of unintended consequences be improved with an appreciation of generic patterns of change that are independent of any particular program or change effort? What are the social and organizational dynamics that make it rational and adaptive to design programs around single-outcome solutions to multi-dimensional problems? How does cognitive bias affect our ability to identify likely program outcomes? Why is it hard to discern change as a result of programs being embedded in multi-component, continually fluctuating, settings? The last part of the paper outlines a process for actualizing systematic iteration between model and methodology, and concludes with a set of research questions that speak to how the model/data process can be made efficient and effective. Copyright © 2017 Elsevier Ltd. All rights reserved.

Unintended pregnancy among HIV positive couples receiving integrated HIV counseling, testing, and family planning services in Zambia.

PubMed

Wall, Kristin M; Haddad, Lisa; Vwalika, Bellington; Htee Khu, Naw; Brill, Ilene; Kilembe, William; Stephenson, Rob; Chomba, Elwyn; Vwalika, Cheswa; Tichacek, Amanda; Allen, Susan

2013-01-01

We describe rates of unintended pregnancy among HIV positive couples in Lusaka, Zambia. We also identify factors associated with unintended pregnancy among oral contraceptive pill (OCP) using couples in this cohort. Data were analyzed from couples randomized in a factorial design to two family planning intervention videos. Rates of unintended pregnancy were stratified by contraceptive method used at time of pregnancy. Predictors of time to unintended pregnancy among OCP users were determined via multivariate Cox modeling. The highest rates of unintended pregnancy were observed among couples requesting condoms only (26.4/100CY) or OCPs (20.7/100CY); these rates were not significantly different. OCP users accounted for 37% of the couple-years (CY) observed and 87% of unintended pregnancies. Rates of unintended pregnancy for injectable (0.7/100CY) and intrauterine device (1.6/100CY) users were significantly lower relative to condom only users. No pregnancies occurred among contraceptive implant users or after tubal ligation. Factors associated (p<0.05) with time to unintended pregnancy among OCP users in multivariate analysis included the man wanting more children, the woman being HIV negative versus having stage IV HIV disease, and the woman reporting: younger age, no previous OCP use, missed OCPs, or sex without a condom. Long-acting reversible contraceptive methods were effective in the context of integrated couples HIV prevention and contraceptive services. Injectable methods were also effective in this context. Given the high user failure rate of OCPs, family planning efforts should promote longer-acting methods among OCP users wishing to avoid pregnancy. Where other methods are not available or acceptable, OCP adherence counseling is needed, especially among younger and new OCP users. ClinicalTrials.gov NCT00067522.

Intended and Unintended Effects of State-Mandated High School Science and Mathematics Course Graduation Requirements on Educational Attainment

ERIC Educational Resources Information Center

Plunk, Andrew D.; Tate, William F.; Bierut, Laura J.; Grucza, Richard A.

2014-01-01

Mathematics and science course graduation requirement (CGR) increases in the 1980s and 1990s might have had both intended and unintended consequences. Using logistic regression with Census and American Community Survey (ACS) data (n = 2,892,444), we modeled CGR exposure on (a) high school dropout, (b) beginning college, and (c) obtaining any…

The Unintended Hegemonic Effects of a Limited Concession: Institutional Incorporation of Chinese Schools in Post-War Hong Kong

ERIC Educational Resources Information Center

Wong, Ting-Hong

2012-01-01

Using the case of Chinese schools in post-Second World War Hong Kong, this paper explores the unintended consequences of an incomplete hegemonic project. After World War II, anti-imperialist pressures and rising educational demands in the local setting propelled the colonial authorities to be more active in providing and funding Chinese schools.…

Optimising import risk mitigation: anticipating the unintended consequences and competing risks of informal trade.

PubMed

Hueston, W; Travis, D; van Klink, E

2011-04-01

The effectiveness of risk mitigation may be compromised by informal trade, including illegal activities, parallel markets and extra-legal activities. While no regulatory system is 100% effective in eliminating the risk of disease transmission through animal and animal product trade, extreme risk aversion in formal import health regulations may increase informal trade, with the unintended consequence of creating additional risks outside regulatory purview. Optimal risk mitigation on a national scale requires scientifically sound yet flexible mitigation strategies that can address the competing risks of formal and informal trade. More robust risk analysis and creative engagement of nontraditional partners provide avenues for addressing informal trade.

The Unintended Consequences of Social Media in Healthcare: New Problems and New Solutions.

PubMed

Hors-Fraile, S; Atique, S; Mayer, M A; Denecke, K; Merolli, M; Househ, M

2016-11-10

Social media is increasingly being used in conjunction with health information technology (health IT). The objective of this paper is to identify some of the undesirable outcomes that arise from this integration and to suggest solutions to these problems. After a discussion with experts to elicit the topics that should be included in the survey, we performed a narrative review based on recent literature and interviewed multidisciplinary experts from different areas. In each case, we identified and analyzed the unintended effects of social media in health IT. Each analyzed topic provided a different set of unintended consequences. Most relevant consequences include lack of privacy with ethical and legal issues, patient confusion in disease management, poor information accuracy in crowdsourcing, unclear responsibilities, misleading and biased information in the prevention and detection of epidemics, and demotivation in gamified health solutions with social components. Using social media in healthcare offers several benefits, but it is not exempt of potential problems, and not all of these problems have clear solutions. We recommend careful design of digital systems in order to minimize patient's feelings of demotivation and frustration and we recommend following specific guidelines that should be created by all stakeholders in the healthcare ecosystem.

A Systematic Review of the Unintended Consequences of Clinical Interventions to Reduce Adverse Outcomes.

PubMed

Manojlovich, Milisa; Lee, Soohee; Lauseng, Deborah

2016-12-01

This is a systematic review of the literature on unintended consequences of clinical interventions to reduce falls, catheter-related urinary tract infection, and vascular catheter-related infections in hospitalized patients. A systematic search of the literature was conducted in CINAHL and PubMed. We developed a screening tool and a two-stage screening process to identify relevant articles. Nine articles met inclusion criteria, and of those, 8 reported on interventions to reduce patient falls. Four studies reported a positive, unexpected benefit; 3 studies reported a negative, unexpected detriment; and 4 reported a perverse effect (different from what was expected). Three studies reported both positive and perverse effects arising from the intervention. In 4 of the studies, despite fall prevention interventions, patients fell while trying to get to the bathroom, suggesting that interventions to reduce one adverse outcome (i.e., CAUTI) may be associated with another outcome (i.e., patient falls). In some cases, there were positive outcomes for those who implemented and/or evaluated interventions. We encourage colleagues to collect and report data on possible unintended consequences of their interventions to allow a fuller picture of the relationship between intervention and all outcomes to emerge.

Parents' experience of unintended childbearing: A qualitative study of factors that mitigate or exacerbate effects.

PubMed

Kavanaugh, Megan L; Kost, Kathryn; Frohwirth, Lori; Maddow-Zimet, Isaac; Gor, Vivian

2017-02-01

Births resulting from an unintended pregnancy affect individuals differentially, and some may experience more negative consequences than others. In this study, we sought to describe the mechanisms through which the severity of effects may be mitigated or exacerbated. We conducted in-depth interviews with 35 women and 30 men, all with a youngest child born resulting from an unintended pregnancy, in two urban sites in the United States. Respondents described both negative and positive effects of the child's birth in the areas of school; work and finances; partner relationships; personal health and outlook on life trajectories. Mechanisms through which unintended pregnancies mitigated or exacerbated certain effects fell at the individual (e.g. lifestyle modification), interpersonal (e.g. partner support) and structural (e.g. workplace flexibility) levels. These qualitative findings deepen understanding of the impact of unintended childbearing on the lives of women, men and families. Copyright © 2016 Elsevier Ltd. All rights reserved.

How the dual process model of human cognition can inform efforts to de‐implement ineffective and harmful clinical practices: A preliminary model of unlearning and substitution

PubMed Central

Rose, Adam J.; Hartmann, Christine W.; van Bodegom‐Vos, Leti; Graham, Ian D.; Wood, Suzanne J.; Majerczyk, Barbara R.; Good, Chester B.; Pogach, Leonard M.; Ball, Sherry L.; Au, David H.; Aron, David C.

2018-01-01

Abstract Rationale and objectives One way to understand medical overuse at the clinician level is in terms of clinical decision‐making processes that are normally adaptive but become maladaptive. In psychology, dual process models of cognition propose 2 decision‐making processes. Reflective cognition is a conscious process of evaluating options based on some combination of utility, risk, capabilities, and/or social influences. Automatic cognition is a largely unconscious process occurring in response to environmental or emotive cues based on previously learned, ingrained heuristics. De‐implementation strategies directed at clinicians may be conceptualized as corresponding to cognition: (1) a process of unlearning based on reflective cognition and (2) a process of substitution based on automatic cognition. Results We define unlearning as a process in which clinicians consciously change their knowledge, beliefs, and intentions about an ineffective practice and alter their behaviour accordingly. Unlearning has been described as “the questioning of established knowledge, habits, beliefs and assumptions as a prerequisite to identifying inappropriate or obsolete knowledge underpinning and/or embedded in existing practices and routines.” We hypothesize that as an unintended consequence of unlearning strategies clinicians may experience “reactance,” ie, feel their professional prerogative is being violated and, consequently, increase their commitment to the ineffective practice. We define substitution as replacing the ineffective practice with one or more alternatives. A substitute is a specific alternative action or decision that either precludes the ineffective practice or makes it less likely to occur. Both approaches may work independently, eg, a substitute could displace an ineffective practice without changing clinicians' knowledge, and unlearning could occur even if no alternative exists. For some clinical practice, unlearning and substitution strategies may be most effectively used together. Conclusions By taking into account the dual process model of cognition, we may be able to design de‐implementation strategies matched to clinicians' decision‐making processes and avoid unintended consequence. PMID:29314508

Legal and policy responses to children exposed to domestic violence: the need to evaluate intended and unintended consequences.

PubMed

Jaffe, Peter G; Crooks, Claire V; Wolfe, David A

2003-09-01

Greater training and specialization in working with children exposed to domestic violence has resulted in new policies, interagency protocols, and legislation in many states. This paper examines court-related responses in criminal, child protection, and family court custody proceedings, which highlight legislative changes and resulting systemic change. Although this legislation originated with the best of intentions to assist and protect children, some of the most striking outcomes have been negative and unintended. Laws that mandate reporting of children exposed to domestic violence can clash with inadequate training and resources, or inadvertently revictimize abused women. Similarly, child custody legislation that raises a rebuttable presumption that a violent spouse will not receive custody or joint custody of children after parental separation has resulted in greater skepticism about abuse allegations We propose that efforts at law reform can be enhanced by a more thoughtful analysis of potential intended and unintended consequences, and should be accompanied by a comprehensive evaluation plan to monitor implementation effects.

Governance of malaria prevention: How decision-makers' and pregnant women's sensemaking contribute to unintended consequences.

PubMed

Danhoundo, Georges; Wiktorowicz, Mary E; Yaya, Sanni

2017-03-01

Although malaria in pregnancy predisposes women to increased perinatal mortality and morbidity, complex issues underlie its persistence. To develop a better understanding of the factors affecting women's access to Intermittent Preventive Treatment in Benin, we used the theoretical lens of "sensemaking" to clarify policymakers', health professionals', and women's perspectives concerning preventive policies and barriers to access. Several assumptions were found to underlie Benin's malaria preventive policy that contribute to the unintended effect of deterring pregnant women in poverty from accessing preventive treatment. Health system dysfunctions including drug shortages and deficiencies in health care professionalism exacerbate the unintended effect.

Cost-effectiveness analysis of a low-dose contraceptive levonorgestrel intrauterine system in Sweden.

PubMed

Henry, Nathaniel; Hawes, Charlie; Lowin, Julia; Lekander, Ingrid; Filonenko, Anna; Kallner, Helena K

2015-08-01

To evaluate the cost-effectiveness of a novel intrauterine system, levonorgestrel intrauterine system 13.5 mg vs. oral contraception, in women at risk of unintended pregnancy. Cost-effectiveness model using efficacy and discontinuation data from published articles. Societal perspective including direct and indirect costs. Women at risk of unintended pregnancy using reversible contraception. An economic analysis was conducted by modeling the different health states of women using contraception over a 3-year period. Typical use efficacy rates from published articles were used to determine unintended pregnancy events. Discontinuation rates were used to account for method switching. Cost-effectiveness was evaluated in terms of the incremental cost per unintended pregnancy avoided. In addition, the incremental cost per quality-adjusted life-year was calculated. Levonorgestrel intrauterine system 13.5 mg generated costs savings of € 311,000 in a cohort of 1000 women aged 15-44 years. In addition, there were fewer unintended pregnancies (55 vs. 294) compared with women using oral contraception. Levonorgestrel intrauterine system 13.5 mg is a cost-effective method when compared with oral contraception. A shift in contraceptive use from oral contraception to long-acting reversible contraception methods could result in fewer unintended pregnancies, quality-adjusted life-year gains, as well as cost savings. © 2015 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

Measuring transplant center performance: The goals are not controversial but the methods and consequences can be.

PubMed

Jay, Colleen; Schold, Jesse D

2017-03-01

Risks of regulatory scrutiny has generated widespread concern about increasingly risk averse transplant center behaviors regarding both donor and candidate acceptance patterns. To address potential unintended consequences threatening access to care, we discuss recent changes in regulatory metrics and potential improvements in quality oversight of transplant centers. Despite many recent changes to one-year patient and graft survival regulatory criteria, the capacity to accurately identify true underperforming centers and avoiding false positive flagging remains an area of great concern. Numerous studies have demonstrated restrictions in transplant volume and access following transplant center flagging. Current regulatory criteria are limited in their capacity to accurately identify poorly performing centers and potentially encourage risk-averse behavior by transplant centers. Efforts to address these concerns should focus on (1) improving risk-adjustment models with better data which captures the acuity of candidate and donor risk, (2) reconsidering primary outcomes measured to assess comprehensive transplant center performance, (3) improving education to address rational or perceived disincentives, and (4) using data more effectively to share best practices.

People, Planet and Profit: Unintended Consequences of Legacy Building Materials

EPA Science Inventory

Although an explosion of new building materials are being introduced into today's market, adequate up-front research into their chemical and physical properties as well as their potential health and environmental consequences is lacking. History has provided us with several exam...

Burden of unintended pregnancy in the United States: Potential savings with increased use of long-acting reversible contraception

PubMed Central

Trussell, James; Henry, Nathaniel; Hassan, Fareen; Prezioso, Alexander; Law, Amy; Filonenko, Anna

2013-01-01

Background This study evaluated the total costs of unintended pregnancy (UP) in the United States from a third -party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure. Study Design An economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs that could be attributed to imperfect contraceptive adherence. The model considered all US women requiring reversible contraception: the pattern of contraceptive use and rates of UP were derived from published sources. The costs of UP in the United States and the proportion of total cost that might be avoided by improved adherence through increased use of LARC were estimated. Results Annual medical costs of UP in the United States were estimated to be $4.5 billion, and 53% of these were attributed to imperfect contraceptive adherence. If 10% of women aged 20–29 years switched from oral contraception to LARC, total costs would be reduced by $288 million per year. Conclusions Imperfect contraceptive adherence leads to substantial unintended pregnancy and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence. PMID:22959904

Young women's education and behavioural risk trajectories: clarifying their association with unintended-pregnancy resolution.

PubMed

Gomez-Scott, Jessica; Cooney, Teresa M

2014-06-01

In the USA, most pregnancies occurring to teenage women are unplanned, making both the decisions regarding their resolution and the consequences of those decisions important topics of inquiry. Substantial debate surrounds the potential consequences for young women of either carrying an unintended pregnancy to term or voluntarily terminating it. The present study utilises data from The US National Longitudinal Study of Adolescent Health prospectively to examine the predictors of pregnancy resolution decisions in terms of young women's educational goals and their engagement in risk behaviours. Additionally, the long-term consequences of these decisions for education and risk-taking behaviours are identified. Results indicate that young women with strong educational goals have a greater likelihood of terminating an unintended pregnancy than those with low aspirations, and that pregnancy termination predicts higher educational attainment compared to motherhood. Risk behaviours did not predict pregnancy-resolution decisions, but young women who became mothers reported lower rates of subsequent substance use and fewer sexual partners post-pregnancy than those who terminated the pregnancy or who had never been pregnant. Motherhood appears to be a catalyst for lifestyle change among young women, limiting substance use and sexual partnering, in contrast to abortion, which appears to allow adolescents to continue risk-taking trajectories.

The Unintended Consequences of Social Media in Healthcare: New Problems and New Solutions

PubMed Central

Atique, S.; Mayer, M. A.; Denecke, K.; Merolli, M.; Househ, M.

2016-01-01

Summary Objectives Social media is increasingly being used in conjunction with health information technology (health IT). The objective of this paper is to identify some of the undesirable outcomes that arise from this integration and to suggest solutions to these problems. Methodology After a discussion with experts to elicit the topics that should be included in the survey, we performed a narrative review based on recent literature and interviewed multidisciplinary experts from different areas. In each case, we identified and analyzed the unintended effects of social media in health IT. Results Each analyzed topic provided a different set of unintended consequences. Most relevant consequences include lack of privacy with ethical and legal issues, patient confusion in disease management, poor information accuracy in crowdsourcing, unclear responsibilities, misleading and biased information in the prevention and detection of epidemics, and demotivation in gamified health solutions with social components. Conclusions Using social media in healthcare offers several benefits, but it is not exempt of potential problems, and not all of these problems have clear solutions. We recommend careful design of digital systems in order to minimize patient’s feelings of demotivation and frustration and we recommend following specific guidelines that should be created by all stakeholders in the healthcare ecosystem. PMID:27830230

'Troubling' moments in health promotion: unpacking the ethics of empowerment.

PubMed

Spencer, Grace

2015-12-01

Concepts of empowerment feature strongly in global health discourses. Empowerment is frequently advocated as a positive approach to addressing individual and community-level health needs. Despite its popularity, relatively little has been said about the unintended consequences of empowerment, which may give rise to some troubling ethical issues or, indeed, result in outcomes that may not be considered health promoting. Drawing on current uses of empowerment within health promotion, along with insights from an ethnographic study on young people's health, this paper raises some critical questions about the ethics of empowerment. By doing so, the paper troubles the idea that empowerment is a 'good thing' without some careful attention to the varying ways in which the ethics of empowerment may unfold in practice. Findings revealed young people's different perspectives on health and priorities for health promotion. The present analysis highlights how these alternative framings prompt a number of ethical tensions for understanding and operationalising empowerment. In conclusion, the findings underscore the importance of promoting ethical reflexivity in health promotion and, crucially, attending to the unintended and potentially ethically problematic consequences of empowerment. So what? This paper raises some critical questions about the ethics of empowerment and calls for a more thorough engagement with the unintended consequences of empowerment within health promotion.

Sidelobe reduction and capacity improvement of open-loop collaborative beamforming in wireless sensor networks

PubMed Central

2017-01-01

Collaborative beamforming (CBF) with a finite number of collaborating nodes (CNs) produces sidelobes that are highly dependent on the collaborating nodes’ locations. The sidelobes cause interference and affect the communication rate of unintended receivers located within the transmission range. Nulling is not possible in an open-loop CBF since the collaborating nodes are unable to receive feedback from the receivers. Hence, the overall sidelobe reduction is required to avoid interference in the directions of the unintended receivers. However, the impact of sidelobe reduction on the capacity improvement at the unintended receiver has never been reported in previous works. In this paper, the effect of peak sidelobe (PSL) reduction in CBF on the capacity of an unintended receiver is analyzed. Three meta-heuristic optimization methods are applied to perform PSL minimization, namely genetic algorithm (GA), particle swarm algorithm (PSO) and a simplified version of the PSO called the weightless swarm algorithm (WSA). An average reduction of 20 dB in PSL alongside 162% capacity improvement is achieved in the worst case scenario with the WSA optimization. It is discovered that the PSL minimization in the CBF provides capacity improvement at an unintended receiver only if the CBF cluster is small and dense. PMID:28464000

System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.

PubMed

Worni, Mathias; Pietrobon, Ricardo; Zammar, Guilherme Roberto; Shah, Jatin; Yoo, Bryan; Maldonato, Mauro; Takemoto, Steven; Vail, Thomas P

2012-01-01

The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA. The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020. System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA.

Prevalence and predictors of unintended pregnancy among women: an analysis of the Canadian Maternity Experiences Survey.

PubMed

Oulman, Elizaveta; Kim, Theresa H M; Yunis, Khalid; Tamim, Hala

2015-10-13

Unintended pregnancies (mistimed or unwanted during the time of conception) can result in adverse outcomes both to the mother and to her newborn. Further research on identifying the characteristics of unintended pregnant women who are at risk is warranted. The present study aims to examine the prevalence and predictors of unintended pregnancy among Canadian women. The analysis was based on the 2006 Maternity Experiences Survey targeting women who were at least 15 years of age and who had a singleton live birth, between February 15, 2006 to May 15, 2006 in the Canadian provinces and November 1, 2005 to February 1, 2006 for women in the Canadian territories. The primary outcome was the mother's pregnancy intention, where unintended pregnancy was defined as women who wanted to become pregnant later or not at all. Sociodemographic, maternal and pregnancy related variables were considered for a multivariable logistic regression. Adjusted Odds Ratios (OR) and 95% Confidence Intervals (95% CI) were reported. Overall, the prevalence of unintended pregnancy among Canadian women was 27%. The odds of experiencing an unintended pregnancy were statistically significantly increased if the mother was: under 20 years of age, immigrated to Canada, had an equivalent of a high school education or less, no partner, experienced violence or abuse and had 1 or more previous pregnancies. Additionally, mothers who reported smoking, drinking alcohol and using drugs prior to becoming pregnant, were all associated with an increased likelihood of experiencing an unintended pregnancy. The study findings constitute the basis for future research into these associations to aid in developing effective policy changes and interventions to minimize the odds of experiencing an unintended pregnancy and its associated consequences.

HealthMarts, HIPCs (health insurance purchasing cooperatives), MEWAs (multiple employee welfare arrangements), and AHPs (association health plans): a guide for the perplexed.

PubMed

Hall, M A; Wicks, E K; Lawlor, J S

2001-01-01

This paper considers how pending proposals to authorize new forms of group purchasing arrangements for health insurance would fit and function within the existing, highly complex market and regulatory landscape and whether these proposals are likely to meet their stated objectives and avoid unintended consequences. Cost savings are more likely to result from increased risk segmentation than through true market efficiencies. Thus, these proposals could erode previous market reforms whose goal is increased risk pooling. On the other hand, these proposals contain important enhancements, clarifications, and simplification of state and federal regulatory oversight of group purchasing vehicles. Also, they address some of the problems that have hampered the performance of purchasing cooperatives. On balance, although these proposals should receive cautious and careful consideration, they are not likely to produce a significant overall reduction in premiums or increase in coverage.

Precision Medicine, Cardiovascular Disease and Hunting Elephants.

PubMed

Joyner, Michael J

2016-01-01

Precision medicine postulates improved prediction, prevention, diagnosis and treatment of disease based on patient specific factors especially DNA sequence (i.e., gene) variants. Ideas related to precision medicine stem from the much anticipated "genetic revolution in medicine" arising seamlessly from the human genome project (HGP). In this essay I deconstruct the concept of precision medicine and raise questions about the validity of the paradigm in general and its application to cardiovascular disease. Thus far precision medicine has underperformed based on the vision promulgated by enthusiasts. While niche successes for precision medicine are likely, the promises of broad based transformation should be viewed with skepticism. Open discussion and debate related to precision medicine are urgently needed to avoid misapplication of resources, hype, iatrogenic interventions, and distraction from established approaches with ongoing utility. Failure to engage in such debate will lead to negative unintended consequences from a revolution that might never come. Copyright © 2016 Elsevier Inc. All rights reserved.

Treatment of Fever After Stroke: Conflicting Evidence

PubMed Central

Wrotek, Sylwia E.; Kozak, Wieslaw E.; Hess, David C.; Fagan, Susan C.

2014-01-01

Approximately 50% of patients hospitalized for stroke develop fever. In fact, experimental evidence suggests that high body temperature is significantly correlated to initial stroke severity, lesion size, mortality, and neurologic outcome. Fever occurring after stroke is associated with poor outcomes. We investigated the etiology of fever after stroke and present evidence evaluating the efficacy and safety of interventions used to treat stroke-associated fever. Oral antipyretics are only marginally effective in lowering elevated body temperature in this population and may have unintended adverse consequences. Nonpharmacologic approaches to cooling have been more effective in achieving normothermia, but whether stroke outcomes can be improved remains unclear. We recommend using body temperature as a biomarker and a catalyst for aggressive investigation for an infectious etiology. Care must be taken not to exceed the new standard of a maximum acetaminophen does of 3 g/day to avoid patient harm. PMID:22026396

(De-) criminalization of attempted suicide in India: A review

PubMed Central

Ranjan, Rajeev; Kumar, Saurabh; Pattanayak, Raman Deep; Dhawan, Anju; Sagar, Rajesh

2014-01-01

Attempted suicide is a serious problem requiring mental health interventions, but it continues to be treated as a criminal offence under the section 309 of Indian Penal Code. The article reviews the international legal perspective across various regions of the world, discusses the unintended consequences of section 309 IPC and highlights the need for decriminalization of attempted suicide in India. The Mental Health Care Bill, 2013, still under consideration in the Rajya Sabha (upper house), has proposed that attempted suicide should not be criminally prosecuted. Decriminalization of suicidal attempt will serve to cut down the undue stigma and avoid punishment in the aftermath of incident, and lead to a more accurate collection of suicide-related statistics. From a policy perspective, it will further emphasize the urgent need to develop a framework to deliver mental health services to all those who attempt suicide. PMID:25535437

Public Reporting and Demand Rationing: Evidence from the Nursing Home Industry.

PubMed

He, Daifeng; Konetzka, R Tamara

2015-11-01

This paper examines an under-explored unintended consequence of public reporting: the potential for demand rationing. Public reporting, although intended to increase consumer access to high-quality products, may have provided the perverse incentive for high-quality providers facing fixed capacity and administrative pricing to avoid less profitable types of residents. Using data from the nursing home industry before and after the implementation of the public reporting system in 2002, we find that high-quality nursing homes facing capacity constraints reduced admissions of less profitable Medicaid residents while increasing the more profitable Medicare and private-pay admissions, relative to low-quality nursing homes facing no capacity constraints. These effects, although small in magnitude, are consistent with provider rationing of demand on the basis of profitability and underscore the important role of institutional details in designing effective public reporting systems for regulated industries. Copyright © 2014 John Wiley & Sons, Ltd.

Defining the road ahead: thinking strategically in the new era of health care reform.

PubMed

Pudlowski, Edward M

2011-01-01

Understanding the implications of the new health care reform legislation, including those provisions that do not take effect for several years, will be critical in developing a successful strategic plan under the new environment of health care reform and avoiding unintended consequences of decisions made without the benefit of long-term thinking. Although this article is not a comprehensive assessment of the challenges and opportunities that exist under health care reform, nor a layout of all of the issues, it looks at some of the key areas in order to demonstrate why employers need to identify critical pathways and the associated risks and benefits of each decision. Key health care reform areas include insurance market reforms, grandfather rules, provisions that have the potential to influence the underlying cost of health care, the individual mandate, the employer mandate (including the free-choice voucher program) and the excise tax on high-cost plans.

Death and Desirability: Retrospective Reporting of Unintended Pregnancy after a Child’s Death

PubMed Central

Smith-Greenaway, Emily; Sennott, Christie

2016-01-01

Social scientists have long debated how to best measure pregnancy intentions. The standard measure relies on mothers’ retrospective reports of their intentions at the time of their conception. Because women have already given birth at the time of this report, the resulting children’s health—including their vital status—may influence their mothers’ responses. We hypothesize that women are less likely to report deceased children were from unintended pregnancies, and this may explain why some longitudinal studies have shown that children from unintended pregnancies have lower survival, but cross-sectional studies produce counter findings. Using Demographic and Health Survey data from 31 sub-Saharan African countries, we confirm that mothers are less likely to report deceased children resulted from unintended pregnancies compared to surviving children, although the opposite is true for unhealthy children, who mothers more commonly report were from unintended pregnancies compared to healthier children. The results suggest that mothers (1) revise their recall of intentions after the traumatic experience of child death and/or (2) alter their reports in the face-to-face interview. The study challenges the reliability of retrospective reports of pregnancy intentions in high mortality settings, and thus our current knowledge of the levels and consequences of unintended pregnancies in these contexts. PMID:27150965

Patient inducement, provider priorities, and resource allocation in public mental health systems.

PubMed

Sinaiko, Anna D; McGuire, Thomas G

2006-12-01

Public mental health systems are increasingly facing demands from the criminal justice system and social services agencies to provide services and support in cases in which mental illness contributes to crime, homelessness, or poverty. In this article we analyze how policies from outside public mental health systems affect resource allocation within these systems, using examples from criminal justice. These policies use two types of mechanisms: inducing patients to consume treatment (by offering rewards or imposing penalties) and inducing clinicians to provide treatment (by creating priorities). We propose a classification of these social policies based on whether they affect demand through rewards or penalties or supply through priorities. We then relate the classification to data on patients treated in public systems to evaluate the current prevalence and potential for growth in these outside demands. These inducements impose a set of nonobvious costs on other patients who are not targeted by the policies. Furthermore, they create incentives for both patients and providers to modify their behavior in order to take advantage of rewards, avoid penalties, or better compete for resources with prioritized patients. We consider some policy implications for avoiding unintended consequences of these policies.

The incidence of induced abortion in Kinshasa, Democratic Republic of Congo, 2016.

PubMed

Chae, Sophia; Kayembe, Patrick K; Philbin, Jesse; Mabika, Crispin; Bankole, Akinrinola

2017-01-01

In the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion. Our study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa. We applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility. In 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15-49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15-49. Increasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality.

Sexual Harassment in the Workplace. Unanticipated Consequences of Modern Social Control in Organizations.

ERIC Educational Resources Information Center

Mueller, Charles W.; De Coster, Stacy; Estes, Sarah Beth

2001-01-01

Modern organizational changes purportedly intended to increase job satisfaction and reduce turnover are actually forms of social control. Analysis of data from 6,000 employees found that an unintended yet beneficial consequence of these changes is reduced sexual harassment. (Contains 60 references.) (SK)

The Intended and Unintended Consequences of International Service-Learning

ERIC Educational Resources Information Center

Crabtree, Robbin D.

2013-01-01

Previous research on service-learning in international contexts tends to focus on the benefits and outcomes for students and educational institutions. This essay is intended to provoke further examination of issues related to university-community engagement in global contexts, particularly in terms of the consequences for host communities. In…

Prevalence and determinants of terminated and unintended pregnancies among married women: analysis of pooled cross-sectional surveys in Nigeria

PubMed Central

Amouzou, Agbessi; Uthman, Olalekan A; Ekholuenetale, Michael; Bishwajit, Ghose; Udenigwe, Ogochukwu; Hudani, Alzahra; Shah, Vaibhav

2018-01-01

Background Induced pregnancy termination and unintended pregnancy are two commonly occurring phenomena in the discipline of women’s reproductive health. In the present study, we explored cross-sectional data pooled from three rounds of Nigeria Demographic and Health Survey (NDHS) to understand the trends of prevalence of pregnancy termination and unintended pregnancy as well as the interplay of various sociodemographic and economic factors whereby these health issues occur. Methods Study participants were 79 825 currently married women aged 15–49 years. Data were collected from NDHS conducted in 2003, 2008 and 2013. Outcome variables were self-reported history of pregnancy termination and unintended pregnancy for the last birth. Data were analysed using descriptive and multivariable logistic regression methods. Results Mean (±SD) age of the respondents was 28.7 years (±9.6). The overall prevalence of pregnancy termination and unintended pregnancy were about 11%. Older women had increase in the odds of terminated pregnancies, compared with women aged 15–19 years, while the converse was true for unintended pregnancy in the adjusted model. Educated women had significant higher odds of terminated and unintended pregnancies compared with women with no formal education. Women with higher wealth index were more likely to have unintended and terminated pregnancies after adjusting for other covariates. Remarkably, women who had unintended pregnancy were 1.47 times as likely to have terminated pregnancy compared with those who had no unintended pregnancy (OR=1.47; 95% CI 1.30 to 1.65). Experience of intimate partner violence had significant association with terminated and unintended pregnancies. Conclusion The findings of this study showed that unintended and terminated pregnancies remain part of the issues to be addressed if the goal of ensuring healthy lives and promoting the well-being for all at all ages must be met. Stakeholders in Nigerian healthcare system should protect the lives of women who are vulnerable to the fatal consequences of unsafe abortion, especially in cases of rape, sexual assault, incest and where continuing a pregnancy would endanger the lives of women. PMID:29713502

Avoiding humiliations in the clinical encounter.

PubMed

Malterud, Kirsti; Hollnagel, Hanne

2007-06-01

To explore potentials for avoiding humiliations in clinical encounters, especially those that are unintended and unrecognized by the doctor. Furthermore, to examine theoretical foundations of degrading behaviour and identify some concepts that can be used to understand such behaviour in the cultural context of medicine. Finally, these concepts are used to build a model for the clinician in order to prevent humiliation of the patient. Empirical studies document experiences of humiliation among patients when they see their doctor. Philosophical and sociological analysis can be used to explain the dynamics of unintended degrading behaviour between human beings. Skjervheim, Vetlesen, and Bauman have identified the role of objectivism, distantiation, and indifference in the dynamics of evil acts, pointing to the rules of the cultural system, rather than accusing the individual of bad behaviour. Examining the professional role of the doctor, parallel traits embedded in the medical culture are demonstrated. According to Vetlesen, emotional awareness is necessary for moral perception, which again is necessary for moral performance. A better balance between emotions and rationality is needed to avoid humiliations in the clinical encounter. The Awareness Model is presented as a strategy for clinical practice and education, emphasizing the role of the doctor's own emotions. Potentials and pitfalls are discussed.

Are Hispanic Women Happier About Unintended Births?

PubMed Central

Hartnett, Caroline Sten

2014-01-01

Reducing unintended pregnancies – particularly among Hispanic and Black women, who have relatively high rates – is a key public health goal in the United States. However, descriptive literature has suggested that Hispanic women are happier about these pregnancies compared with White and Black women, which could mean that there is variation across groups in the consequences of the resulting births. The purpose of this study was to examine variations in happiness about unintended births by race-ethnicity and to assess possible explanations for these differences. Using data from the National Survey of Family Growth (n=1,462 births) I find that Hispanic women report being happier about unintended births compared with White and Black women. Higher happiness among Hispanics was particularly pronounced among a subgroup of women: those who were foreign-born and very religious. Overall, results confirm previous findings that intention status alone is incomplete for capturing pregnancy experiences. Happiness offers complementary information that is important when making comparisons by race-ethnicity and nativity. PMID:25339786

Unintended pregnancy among female sex workers in Mekelle city, northern Ethiopia: a cross-sectional study.

PubMed

Weldegebreal, Rishan; Melaku, Yohannes Adama; Alemayehu, Mussie; Gebrehiwot, Tesfay Gebregzabher

2015-01-31

Unintended pregnancy is a significant public health concern in the world. Particularly, female sex workers are exposed to the risk of unintended pregnancy, abortion and their consequences. The aim of this study was, therefore, to assess unintended pregnancy and associated factors among female sex workers in Mekelle city, northern Ethiopia. A community based cross-sectional study was conducted among 346 female sex workers from five Kebelles (smallest administrative units in Ethiopia) of Mekelle city from March-April, 2014. Sex workers were selected with simple random sampling technique using sampling frame obtained from urban health extension program. Epi-data version 3.1 was used to enter data and analysis was done using SPSS version 20. Bivariate and multivariate logistic regressions were performed to identify factors associated with unintended pregnancy using odds ratio and 95% confidence interval with P-value of 0.05. The magnitude of unintended pregnancy among female sex workers in the past two years was 28.6%. During this period, 59 women had abortion which represents three-fifths, (59.6%), of those who had unintended pregnancies, and 17.1% of all female sex workers. Female sex workers who gave birth and had history of abortion formerly had 3.1 (AOR = 3.07, 95% CI: [1.54, 6.09]) and 15.6 (AOR = 15.64 95% CI: [8.03, 30.47]) times higher odds of unintended pregnancy compared to their counterparts, respectively. Sex workers who had steady partners had 2.9 (AOR = 2.87, 95% CI: [1.47, 5.61]) times higher odds of have unintended pregnancy than those who hadn't. Drug users had 2.7 (AOR = 2.68, 95% CI: [1.30, 5.52]) times higher odds of unintended pregnancy than those who hadn't use. Sex workers who had 60-96 months of duration in sex work were 67% less likely to have unintended pregnancy than those with <12 months (AOR = 0.33, 95% CI: [0.11, 0.95]). High level of unintended pregnancy and a range of associated factors were identified among sex workers. Improving utilization of effective pregnancy prevention methods in a consistent manner can avert the existing high level of unintended pregnancy among female sex workers.

System Dynamics to Model the Unintended Consequences of Denying Payment for Venous Thromboembolism after Total Knee Arthroplasty

PubMed Central

Worni, Mathias; Pietrobon, Ricardo; Zammar, Guilherme Roberto; Shah, Jatin; Yoo, Bryan; Maldonato, Mauro; Takemoto, Steven; Vail, Thomas P.

2012-01-01

Background The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA. Methods and Findings The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020. Conclusion System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA. PMID:22536313

Human Factors for More Usable and Safer Health Information Technology: Where Are We Now and Where do We Go from Here?

PubMed

Kushniruk, A; Nohr, C; Borycki, E

2016-11-10

A wide range of human factors approaches have been developed and adapted to healthcare for detecting and mitigating negative unexpected consequences associated with technology in healthcare (i.e. technology-induced errors). However, greater knowledge and wider dissemination of human factors methods is needed to ensure more usable and safer health information technology (IT) systems. This paper reports on work done by the IMIA Human Factors Working Group and discusses some successful approaches that have been applied in using human factors to mitigate negative unintended consequences of health IT. The paper addresses challenges in bringing human factors approaches into mainstream health IT development. A framework for bringing human factors into the improvement of health IT is described that involves a multi-layered systematic approach to detecting technology-induced errors at all stages of a IT system development life cycle (SDLC). Such an approach has been shown to be needed and can lead to reduced risks associated with the release of health IT systems into live use with mitigation of risks of negative unintended consequences. Negative unintended consequences of the introduction of IT into healthcare (i.e. potential for technology-induced errors) continue to be reported. It is concluded that methods and approaches from the human factors and usability engineering literatures need to be more widely applied, both in the vendor community and in local and regional hospital and healthcare settings. This will require greater efforts at dissemination and knowledge translation, as well as greater interaction between the academic and vendor communities.

Community level effects of gender inequality on intimate partner violence and unintended pregnancy in Colombia: testing the feminist perspective.

PubMed

Pallitto, Christina C; O'Campo, Patricia

2005-05-01

Violence against women, especially by intimate partners, is a serious public health problem that is associated with physical, reproductive, and mental health consequences. The effect of intimate partner violence on women's ability to control their fertility and the mechanisms through which these phenomena are related merit further investigation. Building on findings from a previous analysis in which a statistically significant relationship between intimate partner violence and unintended pregnancy in Colombia was found, this analysis examines the effect of gender inequality on this association using data from the 2000 Colombian Demographic and Health Survey. Specifically, the objective of this analysis is to explore whether gender inequality (as measured by women's autonomy, women's status, male patriarchal control, and intimate partner violence) in municipalities partially explains the association between intimate partner violence and unintended pregnancy in Colombia. Results of logistic regression analysis with multi-level data show that living in a municipality with high rates of male patriarchal control significantly increased women's odds of having an unintended pregnancy by almost four times. Also, living in a municipality with high rates of intimate partner violence increased one's odds of unintended pregnancy by more than 2.5 times, and non-abused women living in municipalities with high rates of intimate partner violence were at a significantly increased risk of unintended pregnancy. In addition, abused women living in a municipality with high personal female decision-making autonomy had more than a fourfold increased risk of having an unintended pregnancy. These findings demonstrate the need for reproductive health programs to target areas at particularly high risk for unintended pregnancy by reducing intimate partner violence and gender inequality.

Unintended Cognitive, Affective, and Behavioral Consequences of Group Assignments

ERIC Educational Resources Information Center

Neu, Wayne A.

2012-01-01

Pedagogical strategies can be thought of as a set of stimuli placed in students' environment to influence their cognition, affect, and behavior. The design of strategies such as group assignments and a comprehensive understanding of their consequences for students should then include an analysis of all three of these elements and the…

The Unintended Consequences of Intended Pregnancies: Youth, Condom Use, and HIV Transmission in Mozambique

ERIC Educational Resources Information Center

Speizer, Ilene S.; White, Justin S.

2008-01-01

Although unwanted pregnancies can cause social and economic problems for Sub-Saharan African youth, the consequences of "intended" adolescent pregnancies have gone unnoticed. Rarely do studies recognize that youth who desire a pregnancy are less likely to practice safe sex and, therefore, are at greater risk of contracting sexually…

Considerations regarding the unintended radiation exposure of the embryo, fetus or nursing child. NCRP commentary No. 9

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

NCRP Commentary No. 9 was developed in response to a request by the Nuclear Regulatory Commission (NRC) to address issues specific to the exposure of a nursing child or the exposure of an embryo or fetus subsequent to a medical misadministration or radioactive material. Thirteen pages of text, consisting of 5 chapters and 5 tables, comprise the document. The NRC requested this commentary be used as a guide in developing regulations on the unintended irradiation of an embryo, fetus or nursing child. The NCRP clearly implies that intentional irradiation is fully within the purview of medical judgement. Although it ismore » clear that appropriate medical procedures must be implemented to avoid unintended irradiation of a conceptus of nursing child, the NCRP provides no guidance on the division between medical and regulatory responsibilities for either preadministration or postadministration management of the pregnant patient or the nursing child. The important issue to address at this juncture regards the specific regulations, if any, that should be inaugurated for unintended exposures, and whether such regulations would represent a responsible protection of the public.« less

Hindsight Bias.

PubMed

Roese, Neal J; Vohs, Kathleen D

2012-09-01

Hindsight bias occurs when people feel that they "knew it all along," that is, when they believe that an event is more predictable after it becomes known than it was before it became known. Hindsight bias embodies any combination of three aspects: memory distortion, beliefs about events' objective likelihoods, or subjective beliefs about one's own prediction abilities. Hindsight bias stems from (a) cognitive inputs (people selectively recall information consistent with what they now know to be true and engage in sensemaking to impose meaning on their own knowledge), (b) metacognitive inputs (the ease with which a past outcome is understood may be misattributed to its assumed prior likelihood), and (c) motivational inputs (people have a need to see the world as orderly and predictable and to avoid being blamed for problems). Consequences of hindsight bias include myopic attention to a single causal understanding of the past (to the neglect of other reasonable explanations) as well as general overconfidence in the certainty of one's judgments. New technologies for visualizing and understanding data sets may have the unintended consequence of heightening hindsight bias, but an intervention that encourages people to consider alternative causal explanations for a given outcome can reduce hindsight bias. © The Author(s) 2012.

How the dual process model of human cognition can inform efforts to de-implement ineffective and harmful clinical practices: A preliminary model of unlearning and substitution.

PubMed

Helfrich, Christian D; Rose, Adam J; Hartmann, Christine W; van Bodegom-Vos, Leti; Graham, Ian D; Wood, Suzanne J; Majerczyk, Barbara R; Good, Chester B; Pogach, Leonard M; Ball, Sherry L; Au, David H; Aron, David C

2018-02-01

One way to understand medical overuse at the clinician level is in terms of clinical decision-making processes that are normally adaptive but become maladaptive. In psychology, dual process models of cognition propose 2 decision-making processes. Reflective cognition is a conscious process of evaluating options based on some combination of utility, risk, capabilities, and/or social influences. Automatic cognition is a largely unconscious process occurring in response to environmental or emotive cues based on previously learned, ingrained heuristics. De-implementation strategies directed at clinicians may be conceptualized as corresponding to cognition: (1) a process of unlearning based on reflective cognition and (2) a process of substitution based on automatic cognition. We define unlearning as a process in which clinicians consciously change their knowledge, beliefs, and intentions about an ineffective practice and alter their behaviour accordingly. Unlearning has been described as "the questioning of established knowledge, habits, beliefs and assumptions as a prerequisite to identifying inappropriate or obsolete knowledge underpinning and/or embedded in existing practices and routines." We hypothesize that as an unintended consequence of unlearning strategies clinicians may experience "reactance," ie, feel their professional prerogative is being violated and, consequently, increase their commitment to the ineffective practice. We define substitution as replacing the ineffective practice with one or more alternatives. A substitute is a specific alternative action or decision that either precludes the ineffective practice or makes it less likely to occur. Both approaches may work independently, eg, a substitute could displace an ineffective practice without changing clinicians' knowledge, and unlearning could occur even if no alternative exists. For some clinical practice, unlearning and substitution strategies may be most effectively used together. By taking into account the dual process model of cognition, we may be able to design de-implementation strategies matched to clinicians' decision-making processes and avoid unintended consequence. © 2018 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

The Effects of Print Comparative Political Advertising on Political Decision-Making and Participation.

ERIC Educational Resources Information Center

Pinkleton, Bruce E.

1998-01-01

Examines intended and unintended effects of print comparative political advertising on political decision making, voting preferences, and situational election involvement among a sample of communication and business undergraduate students. Suggests that comparative advertising reduces targeted-candidate voting preferences while avoiding most forms…

Why Do Infants Begin to Talk? Language as an Unintended Consequence.

ERIC Educational Resources Information Center

Locke, John L.

1996-01-01

This article looks into why infants learn to talk, using a series of illustrative proposals as to the short- and long-term consequences to the infant behaviors that lead to linguistic competence. The goal of the article is to encourage investigation of behavioral dispositions that nudge the child toward proficiency in the use of the spoken…

Calorie Labels on the Restaurant Menu: Is the Use of Weight-Control Behaviors Related to Ordering Decisions?

PubMed

Larson, Nicole; Haynos, Ann F; Roberto, Christina A; Loth, Katie A; Neumark-Sztainer, Dianne

2018-03-01

There is emerging evidence that calorie information on restaurant menus does not similarly influence the ordering decisions of all population groups and may have unintended consequences for individuals who struggle with disordered eating or other weight-related concerns. This study describes demographic patterns in the use of calorie information on restaurant menus and investigates relationships between using this information to limit calorie intake and measures of restaurant visit frequency and weight-related concerns and behavior. There were 788 men and 1042 women (mean age=31.0±1.6 years) who participated in the fourth wave of the Project EAT study. Participants were initially recruited from Minneapolis-St Paul, MN, schools and completed EAT-IV surveys online or by mail from 2015 to 2016. Participants self-reported weight-related concerns, restaurant eating, intuitive eating, dieting, healthy (eg, exercise) and unhealthy (eg, use of laxatives) weight-control behaviors, and binge eating. Descriptive statistics and linear and logistic regression models accounting for demographics and weight status. Approximately half of participants (52.7%) reported they had noticed calorie information while purchasing a meal or snack in a restaurant within the previous month. Among individuals who noticed calorie information, 38.2% reported they did not use it in deciding what to order. The most common use of calorie information was to avoid high-calorie menu items (50.1%) or to decide on a smaller portion (20.2%). Using menu labels to limit calories was related to binge eating among women and was associated with more weight-related concerns, dieting, and unhealthy weight-control behaviors among both women and men. Nutrition educators and other health care professionals should talk with clients who struggle with disordered eating or weight-related concerns to learn about their use of calorie information at restaurants, address any potential unintended consequences, and promote healthy uses of calorie information. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Improving Quality and Safety of Care Using “Technovigilance”: An Ethnographic Case Study of Secondary Use of Data from an Electronic Prescribing and Decision Support System

PubMed Central

Dixon-Woods, Mary; Redwood, Sabi; Leslie, Myles; Minion, Joel; Martin, Graham P; Coleman, Jamie J

2013-01-01

Context “Meaningful use” of electronic health records to improve quality of care has remained understudied. We evaluated an approach to improving patients’ safety and quality of care involving the secondary use of data from a hospital electronic prescribing and decision support system (ePDSS). Methods We conducted a case study of a large English acute care hospital with a well-established ePDSS. Our study was based on ethnographic observations of clinical settings (162 hours) and meetings (28 hours), informal conversations with clinical staff, semistructured interviews with ten senior executives, and the collection of relevant documents. Our data analysis was based on the constant comparative method. Findings This hospital's approach to quality and safety could be characterized as “technovigilance.” It involved treating the ePDSS as a warehouse of data on clinical activity and performance. The hospital converted the secondary data into intelligence about the performance of individuals, teams, and clinical services and used this as the basis of action for improvement. Through a combination of rapid audit, feedback to clinical teams, detailed and critical review of apparent omissions in executive-led meetings, a focus on personal professional responsibility for patients’ safety and quality care, and the correction of organizational or systems defects, technovigilance was—based on the hospital's own evidence—highly effective in improving specific indicators. Measures such as the rate of omitted doses of medication showed marked improvement. As do most interventions, however, technovigilance also had unintended consequences. These included the risk of focusing attention on aspects of patient safety made visible by the system at the expense of other, less measurable but nonetheless important, concerns. Conclusions The secondary use of electronic data can be effective for improving specific indicators of care if accompanied by a range of interventions to ensure proper interpretation and appropriate action. But care is needed to avoid unintended consequences. PMID:24028694

Health system reform in rural China: voices of healthworkers and service-users.

PubMed

Zhou, Xu Dong; Li, Lu; Hesketh, Therese

2014-09-01

Like many other countries China is undergoing major health system reforms, with the aim of providing universal health coverage, and addressing problems of low efficiency and inequity. The first phase of the reforms has focused on strengthening primary care and improving health insurance coverage and benefits. The aim of the study was to explore the impacts of these reforms on healthworkers and service-users at township level, which has been the major target of the first phase of the reforms. From January to March 2013 we interviewed eight health officials, 80 township healthworkers and 80 service-users in eight counties in Zhejiang and Yunnan provinces, representing rich and poor provinces respectively. Thematic analysis identified key themes around the impacts of the health reforms. We found that some elements of the reforms may actually be undermining primary care. While the new health insurance system was popular among service-users, it was criticised for contributing to fast-growing medical costs, and for an imbalance of benefits between outpatient and inpatient services. Salary reform has guaranteed healthworkers' income, but greatly reduced their incentives. The essential drug list removed perverse incentives to overprescribe, but led to falls in income for healthworkers, and loss of autonomy for doctors. Serious problems with drug procurement also emerged. The unintended consequences have included a brain drain of experienced healthworkers from township hospitals, and patients have flowed to county hospitals at greater cost. In conclusion, in the short term resources must be found to ensure rural healthworkers feel appropriately remunerated and have more clinical autonomy, measures for containment of the medical costs must be taken, and drug procurement must show increased transparency and accountability. More importantly the study shows that all countries undergoing health reforms should elicit the views of stakeholders, including service-users, to avoid and address unintended consequences. Copyright © 2014. Published by Elsevier Ltd.

Unintended consequences of increasing block tariffs pricing policy in urban water

NASA Astrophysics Data System (ADS)

Dahan, Momi; Nisan, Udi

2007-03-01

We exploit a unique data set to estimate the degree of economies of scale in water consumption, controlling for the standard demand factors. We found a linear Engel curve in water consumption: each additional household member consumes the same water quantity regardless of household size, except for a single-person household. Our evidence suggests that the increasing block tariffs (IBT) structure, which is indifferent to household size, has unintended consequences. Large households, which are also likely to be poor given the negative correlation between income and household size, are charged a higher price for water. The degree of economies of scale found here erodes the effectiveness of IBT price structure as a way to introduce an equity consideration. This implication is important in view of the global trend toward the use of IBT.

Unintended Consequences of Sensor, Signal, and Imaging Informatics: New Problems and New Solutions.

PubMed

Hughes, C; Voros, S; Moreau-Gaudry, A

2016-11-10

This synopsis presents a selection for the IMIA (International Medical Informatics Association) Yearbook 2016 of excellent research in the broad field of Sensor, Signal and Imaging Informatics published in the year 2015, with a focus on Unintended consequences: new problems and new solutions. We performed a systematic initial selection and a double blind peer review process to find the best papers in this domain published in 2015, from the PubMed and Web of Science databases. The set of MesH keywords used was provided by experts. The constant advances in medical technology allow ever more relevant diagnostic and therapeutic approaches to be designed. Nevertheless, there is a need to acquire expert knowledge of these innovations in order to identify precociously new associated problems for which new solutions need to be designed and developed.

Understanding Unintended Consequences and Health Information Technology:. Contribution from the IMIA Organizational and Social Issues Working Group.

PubMed

Kuziemsky, C E; Randell, R; Borycki, E M

2016-11-10

No framework exists to identify and study unintended consequences (UICs) with a focus on organizational and social issues (OSIs). To address this shortcoming, we conducted a literature review to develop a framework for considering UICs and health information technology (HIT) from the perspective of OSIs. A literature review was conducted for the period 2000- 2015 using the search terms "unintended consequences" and "health information technology". 67 papers were screened, of which 18 met inclusion criteria. Data extraction was focused on the types of technologies studied, types of UICs identified, and methods of data collection and analysis used. A thematic analysis was used to identify themes related to UICs. We identified two overarching themes. One was the definition and terminology of how people classify and discuss UICs. Second was OSIs and UICs. For the OSI theme, we also identified four sub-themes: process change and evolution, individual-collaborative interchange, context of use, and approaches to model, study, and understand UICs. While there is a wide body of research on UICs, there is a lack of overall consensus on how they should be classified and reported, limiting our ability to understand the implications of UICs and how to manage them. More mixed-methods research and better proactive identification of UICs remain priorities. Our findings and framework of OSI considerations for studying UICs and HIT extend existing work on HIT and UICs by focusing on organizational and social issues.

The ethics of data collection: unintended consequences?

PubMed

Wainwright, Delia; Sambrook, Sally

2010-01-01

The aims is to consider the political and ethical challenges involved in conducting ethnographic managerial/organisational behaviour research within the highly regulated health and social care context, in light of the emergence of more stringent "ethical approval" policies and requirements set by Local Research Ethics Committees in the United Kingdom. In the attempt and requirement to protect "vulnerable" employees, this paper aims to present an unintended paradox of consequences when participants voluntarily revealed themselves. The authors briefly review literature on research ethics and present an understanding of the ethical regulations currently existing within the British National Health Service. Within an ethnographic case study exploring the psychological contract, the authors consider the issues that arose during one stage of data collection: a qualitative questionnaire survey with 13 participants, including members of the lead author's team. Incorporating excerpts from the researcher's reflexive journal, the paper exposes the struggles of being an "insider" researcher and the tensions this raises for data analysis when participants voluntarily revealed themselves. Ethnography is at "risk" within health and social care and ethnographic "managerial" research is likely to be unduly restricted and potentially threatened. The evidence suggests that some employees either did not wish to be protected or, conversely, felt compelled to reveal their identities, raising questions of their motivation and creating a paradox of unintended consequences. This paper offers an insight into the challenges of conducting nurse-managerial ethnography in compliance with ethical guidelines, yet disrupted by participants. The findings will be useful to other nurse-researchers attempting to conduct insider research.

Risk management and post-marketing surveillance of CNS drugs.

PubMed

Henningfield, Jack E; Schuster, Charles R

2009-12-01

Drugs affecting the central nervous system span a broad range of chemical entities, dosage forms, indications, and risks. Unintended consequences include potential abuse and overdose in non-patient drug abusers, deliberate tampering of drug dosage forms, and criminal behavior associated with diversion. Regulators must consider diverse factors to find the appropriate conditions of approval to minimize unintended consequences while enabling a level of access desired by health care providers and patients. This commentary appears as part of a special issue of Drug and Alcohol Dependence that focuses on risk management and post-marketing surveillance and addresses key issues that pose real-world challenges to pharmaceutical sponsors and regulators in particular. For example, in the U.S., Controlled Substances Act drug scheduling can be considered a risk management strategy but its legal authorities and administrative processes are independent from those of risk management (including Risk Evaluation and Mitigation Strategies or REMS); better harmonization of these approaches is vital from drug development and regulatory perspectives. Risk management would ideally be implemented on a strong science foundation demonstrating that the tools employed to mitigate risks and ensure safe use are effective. In reality, research and evaluation of tools in this area is in its infancy and will necessarily be an evolutionary process; furthermore, there is little precedent for linking interventions and program evolution to unintended consequences such as regional outbreaks of abuse and diversion. How such issues are resolved has the potential to stimulate or stifle innovations in drug development and advance or imperil health care.

Avoiding humiliations in the clinical encounter

PubMed Central

Malterud, Kirsti; Hollnagel, Hanne

2007-01-01

Objectives To explore potentials for avoiding humiliations in clinical encounters, especially those that are unintended and unrecognized by the doctor. Furthermore, to examine theoretical foundations of degrading behaviour and identify some concepts that can be used to understand such behaviour in the cultural context of medicine. Finally, these concepts are used to build a model for the clinician in order to prevent humiliation of the patient. Theoretical frame of reference Empirical studies document experiences of humiliation among patients when they see their doctor. Philosophical and sociological analysis can be used to explain the dynamics of unintended degrading behaviour between human beings. Skjervheim, Vetlesen, and Bauman have identified the role of objectivism, distantiation, and indifference in the dynamics of evil acts, pointing to the rules of the cultural system, rather than accusing the individual of bad behaviour. Examining the professional role of the doctor, parallel traits embedded in the medical culture are demonstrated. According to Vetlesen, emotional awareness is necessary for moral perception, which again is necessary for moral performance. Conclusion A better balance between emotions and rationality is needed to avoid humiliations in the clinical encounter. The Awareness Model is presented as a strategy for clinical practice and education, emphasizing the role of the doctor's own emotions. Potentials and pitfalls are discussed. PMID:17497482

Preventing Unintended Disclosure of Personally Identifiable Data Following Anonymisation.

PubMed

Smith, Chris

2017-01-01

Errors and anomalies during the capture and processing of health data have the potential to place personally identifiable values into attributes of a dataset that are expected to contain non-identifiable values. Anonymisation focuses on those attributes that have been judged to enable identification of individuals. Attributes that are judged to contain non-identifiable values are not considered, but may be included in datasets that are shared by organisations. Consequently, organisations are at risk of sharing datasets that unintendedly disclose personally identifiable values through these attributes. This would have ethical and legal implications for organisations and privacy implications for individuals whose personally identifiable values are disclosed. In this paper, we formulate the problem of unintended disclosure following anonymisation, describe the necessary steps to address this problem, and discuss some key challenges to applying these steps in practice.

Unmet need for family planning, contraceptive failure, and unintended pregnancy among HIV-infected and HIV-uninfected women in Zimbabwe.

PubMed

McCoy, Sandra I; Buzdugan, Raluca; Ralph, Lauren J; Mushavi, Angela; Mahomva, Agnes; Hakobyan, Anna; Watadzaushe, Constancia; Dirawo, Jeffrey; Cowan, Frances M; Padian, Nancy S

2014-01-01

Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe. We analyzed baseline data from the evaluation of Zimbabwe's Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use. Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01). After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy. Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions.

Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe

PubMed Central

McCoy, Sandra I.; Buzdugan, Raluca; Ralph, Lauren J.; Mushavi, Angela; Mahomva, Agnes; Hakobyan, Anna; Watadzaushe, Constancia; Dirawo, Jeffrey; Cowan, Frances M.; Padian, Nancy S.

2014-01-01

Background Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe. Methods We analyzed baseline data from the evaluation of Zimbabwe’s Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use. Results Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01). After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy. Conclusions Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions. PMID:25144229

The incidence of induced abortion in Kinshasa, Democratic Republic of Congo, 2016

PubMed Central

Kayembe, Patrick K.; Philbin, Jesse; Mabika, Crispin; Bankole, Akinrinola

2017-01-01

Background In the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion. Objectives Our study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa. Methods We applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility. Results In 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15–49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15–49. Conclusions Increasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality. PMID:28968414

Not seeking yet trying long-acting reversible contraception: a 24-month randomized trial on continuation, unintended pregnancy and satisfaction.

PubMed

Hubacher, David; Spector, Hannah; Monteith, Charles; Chen, Pai-Lien

2018-06-01

To measure the 24-month impact on continuation, unintended pregnancy and satisfaction of trying long-acting reversible contraception (LARC) in a population seeking short-acting reversible contraception (SARC). We enrolled 916 women aged 18-29 who were seeking pills or injectables in a partially randomized patient preference trial. Women with strong preferences for pills or injectables started on those products, while others opted for randomization to LARC or SARC and received their methods gratis. We estimated continuation and unintended pregnancy rates through 24months. Intent-to-treat principles were applied after method initiation for comparing incidence of unintended pregnancy. We also examined how satisfaction levels varied by cohort and how baseline negative LARC attitudes were associated with satisfaction over time. Forty-three percent chose randomization, and 57% chose the preference option. Complete loss to follow-up was<2%. The 24-month LARC continuation probability was 64.3% [95% confidence interval (CI): 56.6-70.9], statistically higher than SARC groups [25.5% (randomized) and 40.0% (preference)]. The 24-month cumulative unintended pregnancy probabilities were 9.9% (95% CI: 7.2-12.6) (preference-SARC), 6.9% (95% CI: 3.3-10.6) (randomized-SARC) and 3.6% (95% CI: 1.8-6.4) (randomized-LARC). Statistical tests for comparing randomized groups on unintended pregnancy were mixed: binomial at 24-month time point (p=.02) and log-rank survival probabilities (p=.14 for first pregnancies and p=.07 when including second pregnancies). LARC satisfaction was high (80% happy/neutral, 73% would use LARC again, 81% would recommend to a friend). Baseline negative attitudes toward LARC (27%) were not clearly associated with satisfaction or early discontinuation. The decision to try LARC resulted in high continuation rates and substantial protection from unintended pregnancy over 24months. Despite participants' initial desires to begin short-acting regimens, they had high satisfaction with LARC. Voluntary decisions to try LARC will benefit large proportions of typical SARC users. Even women who do not necessarily view LARC as a first choice may have a highly satisfying experience and avoid unintended pregnancy if they try it. Copyright © 2018 Elsevier Inc. All rights reserved.

Partnership to Evaluate Alternatives to Bisphenol A in Thermal Paper

EPA Pesticide Factsheets

The partnership project for alternatives assessment of alternatives to BPA in thermal paper sought to assess potential hazards for BPA and alternatives to reduce the possibility of unintended consequences of using substitutes

Antimicrobial Stewardship and Urinary Tract Infections

PubMed Central

Abbo, Lilian M.; Hooton, Thomas M.

2014-01-01

Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients who have no or questionable urinary symptoms. Unfortunately, antimicrobials are often prescribed inappropriately in such patients. Antimicrobial use, whether appropriate or inappropriate, is associated with the selection for antimicrobial-resistant organisms colonizing or infecting the urinary tract. Infections caused by antimicrobial-resistant organisms are associated with higher rates of treatment failures, prolonged hospitalizations, increased costs and mortality. Antimicrobial stewardship consists of avoidance of antimicrobials when appropriate and, when antimicrobials are indicated, use of strategies to optimize the selection, dosing, route of administration, duration and timing of antimicrobial therapy to maximize clinical cure while limiting the unintended consequences of antimicrobial use, including toxicity and selection of resistant microorganisms. This article reviews successful antimicrobial stewardship strategies in the diagnosis and treatment of urinary tract infections. PMID:27025743

Antibiotic dosing in critically ill patients receiving CRRT: underdosing is overprevalent.

PubMed

Lewis, Susan J; Mueller, Bruce A

2014-01-01

Published CRRT drug dosing algorithms and other dosing guidelines appear to result in underdosed antibiotics, leading to failure to attain pharmacodynamic targets. High mortality rates persist with inadequate antibiotic therapy as the most important risk factor for death. Reasons for unintended antibiotic underdosing in patients receiving CRRT are many. Underdosing may result from lack of the recognition that better hepatic function in AKI patients yields higher nonrenal antibiotic clearance compared to ESRD patients. Other factors include the variability in body size and fluid composition of patients, the serious consequence of delayed achievement of antibiotic pharmacodynamic targets in septic patients, potential subtherapeutic antibiotic concentrations at the infection site, and the influence of RRT intensity on antibiotic concentrations. Too often, clinicians weigh the benefits of overcautious antibiotic dosing to avoid antibiotic toxicity too heavily against the benefits of rapid attainment of therapeutic antibiotic concentrations in critically ill patients receiving CRRT. We urge clinicians to prescribe antibiotics aggressively for these vulnerable patients. © 2014 Wiley Periodicals, Inc.

Seawater/Saline Agriculture for Energy, Warming, Water, Rainfall, Land, Food and Minerals

NASA Technical Reports Server (NTRS)

Bushnell, Dennis

2006-01-01

The combination of the incipient demise of cheap oil and increasing evidence of Global Warming due to anthropogenic fossil carbon release has reinvigorated the need for and efforts on Renewable energy sources, especially for transportation applications. Biomass/Bio-diesel appears to have many benefits compared to Hydrogen, the only other major renewable transportation fuel candidate. Biomass Production is currently limited by available arable land and fresh water. Halophyte Plants and seawater irrigation proffer a wholly new biomass production mantra using wastelands and very plentiful seawater. Such an approach addresses many-to-most of the major emerging Societal Problems including Land, Water, Food, Warming and Energy. For many reasons, including seawater agriculture, portions of the Sahara appear to be viable candidates for future Biomass Production. The apparent nonlinearity between vegetation cover and atmospheric conditions over North Africa necessitates serious coupled boundary layer Meteorology and Global Circulation Modeling to ensure that this form of Terra Forming is Favorable and to avoid adverse Unintended Consequences.

Applying social network analysis to the examination of interruptions in healthcare.

PubMed

McCurdie, Tara; Sanderson, Penelope; Aitken, Leanne M

2018-02-01

Examinations of interruptions in healthcare often focus on a single clinical discipline, and solutions are targeted accordingly. This approach does not take into account the inter-disciplinary dependencies and other sociotechnical aspects that make up the healthcare work system, and suggested solutions may not meet the needs of all stakeholders. In this article a sociotechnical systems perspective is used to uncover the interdependencies between 16 unique work roles that result in interruptions in an intensive care unit (ICU). By applying social network analysis techniques to data collected using the Dual Perspectives Method, we identified targeted systems-based interventions that may reduce unnecessary interruptions while avoiding unintended consequences that impose additional burden on ICU staff. The rich insights gained into the interruptive communication patterns in the ICU work system stand in contrast to findings that would have otherwise been obtained by focusing only on a single clinical discipline or a single perspective. Copyright © 2017. Published by Elsevier Ltd.

The generic danger and the idiosyncratic support

NASA Astrophysics Data System (ADS)

Temme, Arnaud; Nijp, Jelmer; van der Meij, Marijn; Samia, Jalal; Masselink, Rens

2016-04-01

This contribution argues two main points. First, that generic landscapes used in some modelling studies sometimes have properties or cause simulation results that are unrealistic. Such initially flat or straight-sloped landscapes, sometimes with minor random perturbations, e.g. form the backdrop for ecological simulations of vegetation growth and competition that predict catastrophic shifts. Exploratory results for semi-arid systems suggest that the results based on these generic landscapes are end-members from a distribution of results, rather than an unbiased, typical outcome. Apparently, the desire to avoid idiosyncrasy has unintended consequences. Second, we argue and illustrate that in fact new insights often come from close inspection of idiosyncratic case studies. Our examples from landslide systems, connectivity and soil formation show how a central role for the case study - either in empirical work or to provide model targets - has advanced our understanding. Both points contribute to the conclusion that it is dangerous to forget about annoying, small-scale, idiosyncratic and, indeed, perhaps bad-ass case studies in Earth Sciences.

The Educational-Industrial Complex.

ERIC Educational Resources Information Center

Brightman, Hank J.; Gutmore, Daniel

2002-01-01

Addresses issues of classroom commercialization, product placement, and the ethical implications of corporate influence. Discusses three policy implications: control of technology in the classroom, target marketing to children, and the unintended consequences of the first two. (Contains 39 references.) (SK)

A Review of Opportunities to Improve the Health of People Involved in the Criminal Justice System in the United States.

PubMed

Freudenberg, Nicholas; Heller, Daliah

2016-01-01

In the past decade, many constituencies have questioned the efficacy, cost, and unintended consequences of mass incarceration in the United States. Although substantial evidence now demonstrates that US incarceration policies have had unintended adverse health consequences, we know less about the strategies and policies that can prevent or reduce these problems for justice-involved individuals and how the criminal justice system (CJS) can contribute to the Healthy People 2020 national goal of eliminating inequities in health. This review examines strategies that have been used to improve the health of people at various stages of CJS involvement, including diversion from jail and prison stays into community settings, improvements to the social and physical environments within correctional facilities, provision of health and other services to inmates, assistance for people leaving correctional facilities to make the transition back to the community, and systems coordination and integration.

Intended and unintended consequences of China's zero markup drug policy.

PubMed

Yi, Hongmei; Miller, Grant; Zhang, Linxiu; Li, Shaoping; Rozelle, Scott

2015-08-01

Since economic liberalization in the late 1970s, China's health care providers have grown heavily reliant on revenue from drugs, which they both prescribe and sell. To curb abuse and to promote the availability, safety, and appropriate use of essential drugs, China introduced its national essential drug list in 2009 and implemented a zero markup policy designed to decouple provider compensation from drug prescription and sales. We collected and analyzed representative data from China's township health centers and their catchment-area populations both before and after the reform. We found large reductions in drug revenue, as intended by policy makers. However, we also found a doubling of inpatient care that appeared to be driven by supply, instead of demand. Thus, the reform had an important unintended consequence: China's health care providers have sought new, potentially inappropriate, forms of revenue. Project HOPE—The People-to-People Health Foundation, Inc.

Obesity and hormonal contraceptive efficacy.

PubMed

Robinson, Jennifer A; Burke, Anne E

2013-09-01

Obesity is a major public health concern affecting an increasing proportion of reproductive-aged women. Avoiding unintended pregnancy is of major importance, given the increased risks associated with pregnancy, but obesity may affect the efficacy of hormonal contraceptives by altering how these drugs are absorbed, distributed, metabolized or eliminated. Limited data suggest that long-acting, reversible contraceptives maintain excellent efficacy in obese women. Some studies demonstrating altered pharmacokinetic parameters and increased failure rates with combined oral contraceptives, the contraceptive patch and emergency contraceptive pills suggest decreased efficacy of these methods. It is unclear whether bariatric surgery affects hormonal contraceptive efficacy. Obese women should be offered the full range of contraceptive options, with counseling that balances the risks and benefits of each method, including the risk of unintended pregnancy.

Exploring the Context and Implementation of Public Health Regulations Governing Sex Work: A Qualitative Study with Migrant Sex Workers in Guatemala.

PubMed

Rocha-Jiménez, Teresita; Brouwer, Kimberly C; Silverman, Jay G; Morales-Miranda, Sonia; Goldenberg, Shira M

2017-10-01

Public health regulations practices surrounding sex work and their enforcement can have unintended consequences for HIV and sexually transmitted infection (STI) prevention and care among sex workers. This analysis was based on qualitative in-depth (n = 33) and focus groups interviews (n = 20) conducted with migrant female sex workers in Tecún Umán and Quetzaltenango, Guatemala, and explored the implementation of sex work regulations and related consequences for HIV prevention and care among migrant sex workers. Sex work regulations were found to have health-related benefits (e.g., access to HIV/STI testing) as well as negative impacts, such as abuse by police and harassment, detention/deportation of migrant sex workers. Whereas public health regulations may improve access to HIV/STI testing, their implementation may inadvertently jeopardize sex workers' health through unintended negative consequences. Non-coercive, evidence-based public health and sex work policies and programs are needed to expand access to HIV/STI prevention and care among migrant sex workers, while protecting their dignity and human rights.

Flood Risk Management: Exploring the Impacts of the Community Rating System Program on Poverty and Income Inequality.

PubMed

Noonan, Douglas S; Sadiq, Abdul-Akeem A

2018-03-01

Flooding remains a major problem for the United States, causing numerous deaths and damaging countless properties. To reduce the impact of flooding on communities, the U.S. government established the Community Rating System (CRS) in 1990 to reduce flood damages by incentivizing communities to engage in flood risk management initiatives that surpass those required by the National Flood Insurance Program. In return, communities enjoy discounted flood insurance premiums. Despite the fact that the CRS raises concerns about the potential for unevenly distributed impacts across different income groups, no study has examined the equity implications of the CRS. This study thus investigates the possibility of unintended consequences of the CRS by answering the question: What is the effect of the CRS on poverty and income inequality? Understanding the impacts of the CRS on poverty and income inequality is useful in fully assessing the unintended consequences of the CRS. The study estimates four fixed-effects regression models using a panel data set of neighborhood-level observations from 1970 to 2010. The results indicate that median incomes are lower in CRS communities, but rise in floodplains. Also, the CRS attracts poor residents, but relocates them away from floodplains. Additionally, the CRS attracts top earners, including in floodplains. Finally, the CRS encourages income inequality, but discourages income inequality in floodplains. A better understanding of these unintended consequences of the CRS on poverty and income inequality can help to improve the design and performance of the CRS and, ultimately, increase community resilience to flood disasters. © 2017 Society for Risk Analysis.

Unintended Consequences in Cancer Care Delivery Created by the Medicare Part B Proposal: Is the Clinical Rationale for the Experiment Flawed?

PubMed

Gordan, Lucio; Grogg, Amy; Blazer, Marlo; Fortner, Barry

2017-02-01

Medicare currently enrolls ≥ 45 million adults, and by 2030 this is projected to increase to ≥ 80 million beneficiaries. With this growth, the Centers for Medicare & Medicaid Services (CMS) issued a proposal, the Medicare Part B Drug Payment Model, to shrink drug expenditures, a major contributor to overall health care costs. For this to not adversely affect patient outcomes, lower-cost alternative medications with equivalent efficacy and no increased toxicity must be available. This is often not true in the treatment of cancer. Herein, we examine the flaws in the rationale of the CMS and the potential unintended consequences of this experiment. We identified the top three oncology expenditures (rituximab, bevacizumab, and trastuzumab) and their vetted alternatives (per the National Comprehensive Cancer Network guidelines) to ascertain whether lower-cost equivalent alternatives are available. Drug cost was based on April 2016 average sale price. We explored both efficacy of the agents and, when applicable, toxicity to compare alternatives to these high-dollar medications. For the largest Medicare oncology drug expenditures, there is not a lower-cost option with equal efficacy for their primary indications. Without lower-cost alternatives, the unintended consequence of this CMS experiment may include curtailing access to care or an increase in patient/program costs. The CMS proposal, by simply lowering reimbursement for drugs, does not acknowledge the value of these agents and could unintentionally reduce quality of care. Alternative approaches to value-based care, such as the Oncology Care Model and similar frameworks, should be explored.

Application of systems thinking: 12-month postintervention evaluation of a complex health system intervention in Zambia: the case of the BHOMA.

PubMed

Mutale, Wilbroad; Ayles, Helen; Bond, Virginia; Chintu, Namwinga; Chilengi, Roma; Mwanamwenge, Margaret Tembo; Taylor, Angela; Spicer, Neil; Balabanova, Dina

2017-04-01

Strong health systems are said to be paramount to achieving effective and equitable health care. The World Health Organization has been advocating for using system-wide approaches such as 'systems thinking' to guide intervention design and evaluation. In this paper we report the system-wide effects of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality. We conducted a qualitative study in three target districts. We used a systems thinking conceptual framework to guide the analysis focusing on intended and unintended consequences of the intervention. NVivo version 10 was used for data analysis. The addressed community responded positively to the BHOMA intervention. The indications were that in the short term there was increased demand for services but the health worker capacity was not severely affected. This means that the prediction that service demand would increase with implementation of BHOMA was correct and the workload also increased, but the help of clinic lay supporters meant that some of the work of clinicians was transferred to these lay workers. However, from a systems perspective, unintended consequences also occurred during the implementation of the BHOMA. We applied an innovative approach to evaluate a complex intervention in low-income settings, exploring empirically how systems thinking can be applied in the context of health system strengthening. Although the intervention had some positive outcomes by employing system-wide approaches, we also noted unintended consequences. © 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Union women, the tobacco industry, and excise taxes: a lesson in unintended consequences.

PubMed

Balbach, Edith D; Campbell, Richard B

2009-08-01

Between 1987 and 1997, the tobacco industry used the issue of cigarette excise tax increases to create a political partnership with the Coalition of Labor Union Women (CLUW), a group representing female trade unionists in the U.S. This paper documents how the industry created this relationship and the lessons tobacco-control advocates can learn from the industry's example, in order to mitigate possible unintended consequences of advocating excise tax increases. In 1998, under the terms of the Master Settlement Agreement, the tobacco industry began making documents produced in litigation available publicly. Currently, approximately 50 million pages are available online, including substantial documentation of the industry-CLUW relationship. For this study, a comprehensive search of these documents was conducted. The tobacco industry encouraged CLUW's opposition to excise tax increases by emphasizing the economic regressivity of these taxes, discussing excise taxes generically to deflect attention from cigarettes, and encouraging opposition to earmarking cigarette taxes to pay for specific programs. In addition, CLUW received at least $221,500 in financial support between 1987 and 1997 and in-kind support for its conferences, membership materials, and other services. Excise tax increases, if pursued without considering the impacts they may have on low-SES populations, may have unintended consequences. In this case, such proposals may have helped to create a relationship between CLUW and the tobacco industry. Because excise taxes are endorsed in the Framework Convention on Tobacco Control, tobacco-control advocates must understand how to build relationships with low-SES populations and mitigate potential alliances with the tobacco industry.

Houston, We Have a Problem: Studying the SAS Education Value-Added Assessment System (EVAAS) from Teachers' Perspectives in the Houston Independent School District (HISD)

ERIC Educational Resources Information Center

Collins, Clarin

2012-01-01

This study examined the intended and unintended consequences associated with the Education Value-Added Assessment System (EVAAS) as perceived and experienced by teachers in the Houston Independent School District (HISD). To evaluate teacher effectiveness, HISD is using EVAAS for high-stakes consequences more than any other district or state in the…

ESTABLISHMENT OF TRANSGENIC CREEPING BENTGRASS (AGROSTIS STOLONIFERA L.) IN NON-AGRONOMIC HABITATS

EPA Science Inventory

Concerns about genetically modified crops include transgene flow to compatible wild species and potential unintended ecological consequences associated with transgene introgression. To date, there has been little empirical documentation of the relative frequency of establishment...

Constellation Program Lessons Learned. Volume 2; Detailed Lessons Learned

NASA Technical Reports Server (NTRS)

Rhatigan, Jennifer; Neubek, Deborah J.; Thomas, L. Dale

2011-01-01

These lessons learned are part of a suite of hardware, software, test results, designs, knowledge base, and documentation that comprises the legacy of the Constellation Program. The context, summary information, and lessons learned are presented in a factual format, as known and described at the time. While our opinions might be discernable in the context, we have avoided all but factually sustainable statements. Statements should not be viewed as being either positive or negative; their value lies in what we did and what we learned that is worthy of passing on. The lessons include both "dos" and "don ts." In many cases, one person s "do" can be viewed as another person s "don t"; therefore, we have attempted to capture both perspectives when applicable and useful. While Volume I summarizes the views of those who managed the program, this Volume II encompasses the views at the working level, describing how the program challenges manifested in day-to-day activities. Here we see themes that were perhaps hinted at, but not completely addressed, in Volume I: unintended consequences of policies that worked well at higher levels but lacked proper implementation at the working level; long-term effects of the "generation gap" in human space flight development, the need to demonstrate early successes at the expense of thorough planning, and the consequences of problems and challenges not yet addressed because other problems and challenges were more immediate or manifest. Not all lessons learned have the benefit of being operationally vetted, since the program was cancelled shortly after Preliminary Design Review. We avoid making statements about operational consequences (with the exception of testing and test flights that did occur), but we do attempt to provide insight into how operational thinking influenced design and testing. The lessons have been formatted with a description, along with supporting information, a succinct statement of the lesson learned, and recommendations for future programs and projects that may be placed in similar circumstances.

The Cost-Effectiveness of Emergency Hormonal Contraception with Ulipristal Acetate versus Levonorgestrel for Minors in France

PubMed Central

Schmid, Ramona

2015-01-01

Objective To evaluate the cost-effectiveness of ulipristal acetate and levonorgestrel in minors in France, and analyze whether it is worthwhile to provide ulipristal acetate to minors free of charge. Methods The cost-effectiveness of two emergency contraceptive methods was compared based on a decision-analytical model. Pregnancy rates, outcomes of unintended pregnancies, and resource utilization were derived from the literature. Resources and their costs were considered until termination or a few days after delivery. Deterministic and probabilistic sensitivity analyses were performed. Results The cost of an unintended pregnancy in a French minor is estimated to be 1,630 € (range 1,330 € – 1,803 €). Almost 4 million € (3.1 € – 13.7 € million) in unintended pregnancy spending in 2010 could have been saved by the use of ulipristal acetate instead of levonorgestrel. The incremental cost of ulipristal acetate compared to levonorgestrel is 3.30 € per intake, or 418 € per pregnancy avoided (intake within 72 hours). In the intake within 24 hours subgroup, ulipristal acetate was found to be more efficacious at a lower cost compared to levonorgestrel. Conclusions Ulipristal acetate dominates levonorgestrel when taken within 24 hours after unprotected intercourse, i.e., it is more effective at a lower cost. When taken within 72 hours, ulipristal acetate is a cost- effective alternative to levonorgestrel, given that the cost of avoiding an additional pregnancy with ulipristal acetate is less than the average cost of these pregnancies. In the light of these findings, it is worthwhile to provide free access to minors. PMID:26422259

The Cost-Effectiveness of Emergency Hormonal Contraception with Ulipristal Acetate versus Levonorgestrel for Minors in France.

PubMed

Schmid, Ramona

2015-01-01

To evaluate the cost-effectiveness of ulipristal acetate and levonorgestrel in minors in France, and analyze whether it is worthwhile to provide ulipristal acetate to minors free of charge. The cost-effectiveness of two emergency contraceptive methods was compared based on a decision-analytical model. Pregnancy rates, outcomes of unintended pregnancies, and resource utilization were derived from the literature. Resources and their costs were considered until termination or a few days after delivery. Deterministic and probabilistic sensitivity analyses were performed. The cost of an unintended pregnancy in a French minor is estimated to be 1,630 € (range 1,330 € - 1,803 €). Almost 4 million € (3.1 € - 13.7 € million) in unintended pregnancy spending in 2010 could have been saved by the use of ulipristal acetate instead of levonorgestrel. The incremental cost of ulipristal acetate compared to levonorgestrel is 3.30 € per intake, or 418 € per pregnancy avoided (intake within 72 hours). In the intake within 24 hours subgroup, ulipristal acetate was found to be more efficacious at a lower cost compared to levonorgestrel. Ulipristal acetate dominates levonorgestrel when taken within 24 hours after unprotected intercourse, i.e., it is more effective at a lower cost. When taken within 72 hours, ulipristal acetate is a cost- effective alternative to levonorgestrel, given that the cost of avoiding an additional pregnancy with ulipristal acetate is less than the average cost of these pregnancies. In the light of these findings, it is worthwhile to provide free access to minors.

The role of men in induced abortion decision making in an urban area of the Philippines.

PubMed

Hirz, Alanna E; Avila, Josephine L; Gipson, Jessica D

2017-09-01

To understand beliefs about unintended pregnancy and abortion, and perceptions about male roles related to pregnancy decision-making among men in the Philippines. Qualitative data were collected during in-depth interviews and focus group discussions with men in an urban area of the Philippines between October 2007 and July 2008. Interview participants were purposively sampled from a local survey based on their having reported being "afraid or troubled" or "afraid and planned to terminate" in response to a recent pregnancy. Focus group participants were selected from the same communities. Data were analyzed using the constant comparative method. In-depth interview data from 15 men-each interviewed twice-and five focus group discussions were included. Male interview participants reported feeling morally responsible for the pregnancy and as wanting to avoid the "sin" of induced abortion; however, they were concerned about being able to support a family financially. Participants expressed resentment towards partners who attempted or completed an induced abortion without their knowledge. In such cases, men would disparage their partner and cease interacting with them to avoid the "sin" of induced abortion. Participants described negative feelings towards women seeking induced abortions, and their own desire to avoid associated "sin". This highlights the effects of unintended pregnancy and induced abortion on young Filipino men, including their own experience of abortion stigma. © 2017 International Federation of Gynecology and Obstetrics.

Productive Spillovers of the Take-Up of Index-Based Livestock Insurance

USDA-ARS?s Scientific Manuscript database

Does the provision of livestock insurance raise the unintended consequence of stimulating excessive herd accumulation and less environmentally-sustainable herd movement patterns? The impact of insurance is theoretically ambiguous: if precautionary savings motives for holding livestock assets domina...

A Toxicological Perspective on Disinfection ByProducts

EPA Science Inventory

Disinfection of water is essential for reduction of microbes harmful to human health and chemical disinfection is considered one of the major public health triumphs of the 20th Century. An unintended consequence of disinfection with oxidizing chemicals is formation of disinfectio...

ESTABLISHMENT OF TRANSGENETIC HERBICIDE-RESISTANT CREEPING BENTGRASS (AGROSTIS STOLONIFERA L.) IN NONAGRONOMIC HABITATS

EPA Science Inventory

Concerns about genetically modified (GM) crops include transgene flow to compatible wild species and unintended ecological consequences of potential transgene introgression. However, there has been little empirical documentation of establishment and distribution of transgenic pla...

A blind area of family planning services in China: unintended pregnancy among unmarried graduate students.

PubMed

Zhou, Yuanzhong; Xiong, Chengliang; Xiong, Jinwen; Shang, Xuejun; Liu, Guohui; Zhang, Meimei; Yin, Pin

2013-03-06

Status of premarital sex, unintended pregnancy and associated factors among Chinese graduate students remain unclear. And unmarried graduate students' needs of family planning services seem to be ignored. In the present study, we ascertained the prevalence rate of premarital sex and unintended pregnancy, as well as estimated the possible factors associated with unintended pregnancy among unmarried Chinese graduate students, and evaluated their reproductive health needs. We obtained the representative sample of graduate students using a multistage, stratified, cluster design, and collected data using a questionnaire. We obtained 11936 responders. Premarital sexual intercourse was acknowledged by 24.2% of responders; unintended pregnancy was acknowledged by 4.8% of responders (19.8% of students active in premarital sex); and abortion was acknowledged by 4.6% of responders (96.7% of pregnant students). In multivariate analysis, the identified risk factors for unintended pregnancy among both genders that were active in premarital sex were: (1) having no steady lover [for males: odds ratio (OR), 1.96, 95% confidence interval (CI), 1.41-2.70; for females: OR, 2.65; 95%CI, 1.56-4.84]; (2) younger age at the first sexual intercourse (for males: OR, 1.62, 95% CI, 1.22-2.15; for females: OR, 2.57; 95% CI, 1.64-4.02); (3) lack of condom use at the first sex (for males: OR, 1.13, 95% CI, 1.09-1.37; for females: OR, 2.81; 95% CI, 1.81-4.39); (4) unaware of the conditions of conception (for males: OR, 1.69, 95% CI, 1.31-2.19; for females: OR, 1.75; 95% CI, 1.16-2.65); and (5) unaware that abortion endangers women's future pregnancy (for males: OR, 2.98, 95% CI, 2.15-4.14; for females: OR, 2.34; 95% CI, 1.23-4.46). Medical graduates were not less likely to have unintended pregnancy than nonmedical graduates for both genders. The avoidable risk of being unintended pregnancy among graduate students in China indicates that an urgent need to take action on how to delay the age of first sex, promote condom use at first sex, and acquire accurate contraceptive information, as well as improve skills to use reliable contraception among graduate students.

A blind area of family planning services in China: unintended pregnancy among unmarried graduate students

PubMed Central

2013-01-01

Background Status of premarital sex, unintended pregnancy and associated factors among Chinese graduate students remain unclear. And unmarried graduate students’ needs of family planning services seem to be ignored. In the present study, we ascertained the prevalence rate of premarital sex and unintended pregnancy, as well as estimated the possible factors associated with unintended pregnancy among unmarried Chinese graduate students, and evaluated their reproductive health needs. Methods We obtained the representative sample of graduate students using a multistage, stratified, cluster design, and collected data using a questionnaire. Results We obtained 11936 responders. Premarital sexual intercourse was acknowledged by 24.2% of responders; unintended pregnancy was acknowledged by 4.8% of responders (19.8% of students active in premarital sex); and abortion was acknowledged by 4.6% of responders (96.7% of pregnant students). In multivariate analysis, the identified risk factors for unintended pregnancy among both genders that were active in premarital sex were: (1) having no steady lover [for males: odds ratio (OR), 1.96, 95% confidence interval (CI), 1.41-2.70; for females: OR, 2.65; 95%CI, 1.56-4.84]; (2) younger age at the first sexual intercourse (for males: OR, 1.62, 95% CI, 1.22-2.15; for females: OR, 2.57; 95% CI, 1.64-4.02); (3) lack of condom use at the first sex (for males: OR, 1.13, 95% CI, 1.09-1.37; for females: OR, 2.81; 95% CI, 1.81-4.39); (4) unaware of the conditions of conception (for males: OR, 1.69, 95% CI, 1.31-2.19; for females: OR, 1.75; 95% CI, 1.16-2.65); and (5) unaware that abortion endangers women's future pregnancy (for males: OR, 2.98, 95% CI, 2.15-4.14; for females: OR, 2.34; 95% CI, 1.23-4.46). Medical graduates were not less likely to have unintended pregnancy than nonmedical graduates for both genders. Conclusions The avoidable risk of being unintended pregnancy among graduate students in China indicates that an urgent need to take action on how to delay the age of first sex, promote condom use at first sex, and acquire accurate contraceptive information, as well as improve skills to use reliable contraception among graduate students. PMID:23497130

Origins of Western Literacy. Four Lectures delivered at the Ontario Institute for Studies in Education, Toronto, March 25-28, 1974. Monograph Series No. 14.

ERIC Educational Resources Information Center

Havelock, Eric A.

The four essays in this book are concerned with the cultural consequences of literacy in that they demonstrate that some forms of competence, highly valued in society, developed in large part as an unintended consequence of the Greek alphabetic writing system. The first essay, entitled "Spoken Sound and Inscribed Sign," discusses the…

Sometimes You Do Get a Second Chance: Emergency Contraception for Adolescents.

PubMed

Rome, Ellen S; Issac, Veronica

2017-04-01

Unplanned or unintended pregnancy remains a significant challenge for adolescents; many teens who plan ahead but opt not to choose long-acting reversible contraceptive methods have high failure rates with condom usage, oral contraceptives, and other less long-acting methods. Emergency contraception (EC) remains a necessity for those adolescents seeking a second chance to prevent the unintended consequences of unplanned sexual activity. At present, 5 postcoital methods remain available as EC globally: intrauterine devices, ulipristal acetate, a selective progesterone modulator, mifepristone; levonorgestrel, and ethinyl estradiol plus levonorgestrel or norgestrel (rarely used now that progestin only methods are more readily available). Copyright © 2017 Elsevier Inc. All rights reserved.

Liberating the Learner through Self-Assessment

ERIC Educational Resources Information Center

Bourke, Roseanna

2016-01-01

An international agenda to raise educational "standards" and increase the accountability of schools has the unintended consequence of increased uniformity around pedagogical practices, and of introducing assessment practices that influence the way students experience learning. This paper explores how the self-assessment experiences of…

CSR Cuts Bring Unintended Consequences, Prompt State Responses.

PubMed

Kirkner, Richard Mark

2017-12-01

Eliminating the cost-sharing payments (CSRs) to insurers to hold down out-of-pocket costs for low-income people who purchase individual health plans may wind up actually increasing overall federal spending by driving up premium subsidies to cover higher price plans.

Help Wanted.

ERIC Educational Resources Information Center

Keegan, Lisa Graham

2003-01-01

Argues that effective school leadership is key to implementing reform policies. Describes two unintended consequences of "A Nation at Risk" report: Increased resistance to change by school establishment and the proliferation of federal education programs. Sees several positive reform initiatives in No Child Left Behind Act such as…

Concluding Thoughts

ERIC Educational Resources Information Center

Palmer, James C.

2014-01-01

Community college leaders face several fundamental challenges as they work on sustaining the fiscal viability of their institutions. These include the need to anticipate the unintended consequences of performance-based funding, diversify revenue streams in ways that reduce fiscal dependence on tuition and state appropriations, control costs, and…

Some Unintended Consequences of "Top Down" Organization Development

ERIC Educational Resources Information Center

White, Bernard J.; Ramsey, V. Jean

1978-01-01

An organizational development consultant is expected to perform a thorough and unbiased diagnosis of the organization's functioning. This is an account of a case study of the effect of top management influence on the consultant's awareness and definition of problems. (Author/MLF)

ALTERED GENE EXPRESSION OF MOUSE EMBRYO CULTURES EXPOSED TO BROMOCHLOROACETIC ACID

EPA Science Inventory

An unintended consequence of chemical disinfection of municipal drinking water has been the production of disinfection by-products (DBPs) resulting from the interaction of chemical disinfectants and naturally occurring organic material present in the water. A major class of the ...

School Security Technologies

ERIC Educational Resources Information Center

Schneider, Tod

2010-01-01

Over the past decade electronic security technology has evolved from an exotic possibility into an essential safety consideration. Before resorting to high-tech security solutions, school officials should think carefully about the potential for unintended consequences. Technological fixes may be mismatched to the problems being addressed. They can…

Unintended consequences of human research ethics committees: au revoir workplace studies?

PubMed

Bamber, Greg J; Sappey, Jennifer

2007-07-01

To protect the welfare and rights of participants in research and to facilitate research that will be of benefit, as well as protect them against litigation, universities and research-funding agencies in Australia adopted the National Statement on Ethical Conduct in Research Involving Humans (NHMRC 1999). In many other countries there are similar statements. However, the ways in which such statements are often implemented by Human Research Ethics Committees (HRECs) are in conflict with an important stream of industrial sociological research. This stream seeks to deconstruct workplaces and de-layer management rhetoric to understand the realities and complexities of the social relations of production. There is a pluralist basis for much industrial sociology that challenges the unitarist view of the workplace as essentially harmonious. While views of workplaces as being conflictual and exploitative have to be tempered with an understanding of the accommodative and cooperative nature of workplace relations, there is nevertheless a general recognition of acts of resistance, as well as those of cooperation. The way in which the National Statement is typically implemented in Australia means that many HRECs require written, informed consent, which in the first instance will usually be that of management. An unintended consequence is a research focus on consensus, which is at best one-sided and at worst seriously misleading. It is unlikely that managerial consent will be granted unless there is a 'good news story' guaranteed. This article explores the ways in which HRECs may influence workplace research. The publication of the revised National Statement provides a valuable opportunity not to be missed by HRECs to implement more effective and efficient practices which would not have the unintended consequences of the earlier version. This would deserve the support of researchers in industrial sociology and other branches of the social sciences.

Experiences of general practices with a participatory pay-for-performance program: a qualitative study in primary care.

PubMed

Kirschner, Kirsten; Braspenning, Jozé; Jacobs, J E Annelies; Grol, Richard

2013-01-01

The involvement of target users in the design choices of a pay-for-performance program may enhance its impact, but little is known about the views of participants in these programs. To explore general practices' experiences with pay-for-performance in primary care we conducted a qualitative study in general practices in the Netherlands. Thirty out of 65 general practices participating in a pay-for-performance program, stratified for bonus, were invited for a semistructured interview on feasibility, feedback and the bonus, spending of the bonus, unintended consequences, and future developments. Content analysis was used to process the resulting transcripts. We included 29 practices. The feasibility of the pay-for-performance program was questioned due to the substantial time investment. The feedback on clinical care, practice management and patient experience was mostly discussed in the team, and used for improvement plans, but was also qualified as annoying for one GP and for another GP it brought feelings of insecurity. Most practices considered the bonus a stimulus to improve quality of care, in addition to compensation for their effort and time invested. Distinctive performance features were not displayed, for instance, on a website. The bonus was mainly spent on new equipment or team building. Practices referred to gaming and focusing on those aspects that were incentivised ('tunnel vision') as unintended consequences. Future developments should be directed to absolute thresholds, new indicators to keep the process going, and an independent audit. Linking a part of the bonus to innovation was also suggested. The participants thought the pay-for-performance program was a labour-intensive positive breakthrough to stimulate quality improvement, but warned of unintended consequences of the program and the sustainability of the indicator set.

Unintended consequences of delisting routine eye exams on retinopathy screening for people with diabetes in Ontario, Canada

PubMed Central

Kiran, Tara; Kopp, Alexander; Moineddin, Rahim; Victor, J. Charles; Campbell, Robert J.; Shah, Baiju R.; Glazier, Richard H.

2013-01-01

Background: Routine eye examinations for healthy adults aged 20–64 years were delisted from the Ontario Health Insurance Plan in 2004, but they continue to be insured for people with diabetes regardless of age. We sought to assess whether the delisting of routine eye examinations for healthy adults had the unintended consequence of decreasing retinopathy screening for adults with diabetes. Methods: We used administrative data to calculate eye examinations for people with diabetes ages 40–64 years and 65 years and older in each 2-year period from 1998 to 2010. We examined differences by sex, income, rurality and type of health care provider. We used segmented linear regression to assess the change in trend before and after 2004. Results: For people with diabetes aged 65 years and older, eye examinations rose gradually from 1998 to 2010, with no substantial change between 2004 and 2006. For people with diabetes aged 40–65 years, there was an 8.7% (95% confidence interval [CI] 6.3%–11.1%) decrease in eye examinations between 2004 and 2006. Results were similar for all population subgroups. Ophthalmologic examinations decreased steadily for both age groups during the study period, and there was a decline in optometry examinations for people ages 40–65 years after 2004. Interpretation: The delisting of routine eye examinations for healthy adults in Ontario had the unintended consequence of reducing publicly funded retinopathy screening for people with diabetes. More research is needed to understand whether patients are being charged for an insured service or to what degree misunderstanding has prevented patients from seeking care. PMID:23296581

Transformations, transport, and potential unintended consequences of high sulfur inputs to Napa Valley vineyards

PubMed Central

Hinckley, Eve-Lyn S.; Matson, Pamela A.

2011-01-01

Unintended anthropogenic deposition of sulfur (S) to forest ecosystems has a range of negative consequences, identified through decades of research. There has been far less study of purposeful S use in agricultural systems around the world, including the application of elemental sulfur (S0) as a quick-reacting fungicide to prevent damage to crops. Here we report results from a three-year study of the transformations and flows of applied S0 in soils, vegetation, and hydrologic export pathways of Napa Valley, CA vineyards, documenting that all applied S is lost from the vineyard ecosystem on an annual basis. We found that S0 oxidizes rapidly to sulfate () on the soil surface where it then accumulates over the course of the growing season. Leaf and grape tissues accounted for only 7–13% of applied S whereas dormant season cover crops accounted for 4–10% of applications. Soil S inventories were largely and ester-bonded sulfates; they decreased from 1,623 ± 354 kg ha-1 during the dry growing season to 981 ± 526 kg ha-1 (0–0.5 m) during the dormant wet season. Nearly all S applied to the vineyard soils is transported offsite in dissolved oxidized forms during dormant season rainstorms. Thus, the residence time of reactive S is brief in these systems, and largely driven by hydrology. Our results provide new insight into how S use in vineyards constitutes a substantial perturbation of the S cycle in Northern California winegrowing regions and points to the unintended consequences that agricultural S use may have at larger scales. PMID:21825150

The Incidence of Abortion in Nigeria

PubMed Central

Bankole, Akinrinola; Adewole, Isaac F.; Hussain, Rubina; Awolude, Olutosin; Singh, Susheela; Akinyemi, Joshua O.

2016-01-01

CONTEXT Because of Nigeria’s low contraceptive prevalence, a substantial number of women have unintended pregnancies, many of which are resolved through clandestine abortion, despite the country’s restrictive abortion law. Up-to-date estimates of abortion incidence are needed. METHODS A widely used indirect methodology was used to estimate the incidence of abortion and unintended pregnancy in Nigeria in 2012. Data on provision of abortion and postabortion care were collected from a nationally representative sample of 772 health facilities, and estimates of the likelihood that women who have unsafe abortions experience complications and obtain treatment were collected from 194 health care professionals with a broad understanding of the abortion context in Nigeria. RESULTS An estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15–49. The estimated unintended pregnancy rate was 59 per 1,000 women aged 15–49. Fifty-six percent of unintended pregnancies were resolved by abortion. About 212,000 women were treated for complications of unsafe abortion, representing a treatment rate of 5.6 per 1,000 women of reproductive age, and an additional 285,000 experienced serious health consequences but did not receive the treatment they needed. CONCLUSION Levels of unintended pregnancy and unsafe abortion continue to be high in Nigeria. Improvements in access to contraceptive services and in the provision of safe abortion and postabortion care services (as permitted by law) may help reduce maternal morbidity and mortality. PMID:26871725

Public Reporting of Primary Care Clinic Quality: Accounting for Sociodemographic Factors in Risk Adjustment and Performance Comparison.

PubMed

Wholey, Douglas R; Finch, Michael; Kreiger, Rob; Reeves, David

2018-01-03

Performance measurement and public reporting are increasingly being used to compare clinic performance. Intended consequences include quality improvement, value-based payment, and consumer choice. Unintended consequences include reducing access for riskier patients and inappropriately labeling some clinics as poor performers, resulting in tampering with stable care processes. Two analytic steps are used to maximize intended and minimize unintended consequences. First, risk adjustment is used to reduce the impact of factors outside providers' control. Second, performance categorization is used to compare clinic performance using risk-adjusted measures. This paper examines the effects of methodological choices, such as risk adjusting for sociodemographic factors in risk adjustment and accounting for patients clustering by clinics in performance categorization, on clinic performance comparison for diabetes care, vascular care, asthma, and colorectal cancer screening. The population includes all patients with commercial and public insurance served by clinics in Minnesota. Although risk adjusting for sociodemographic factors has a significant effect on quality, it does not explain much of the variation in quality. In contrast, taking into account the nesting of patients within clinics in performance categorization has a substantial effect on performance comparison.

The Occurrence and Comparative Toxicity of Haloacetaldehyde Disinfection Byproducts in Drinking Water

EPA Science Inventory

The introduction of drinking water disinfection greatly reduced the incidence of waterborne diseases. However, the reaction between disinfectants and natural organic matter in the source water can lead to an unintended consequence, which is the formation of drinking water disinfe...

Crossing the Rubric-Con

ERIC Educational Resources Information Center

Bailey, James R.

2014-01-01

This essay engages the prospect and peril of employing rubrics in America. It discusses how institutional independence affects the enterprise, and addresses whether rubrics will be received as salvation or subservience by educational agents. It asks how rubrics can benefit stakeholders while examining their unintended consequences. It concludes by…

Is Your Sick Leave Bank in Good Health?

ERIC Educational Resources Information Center

Hoover, James P.

2012-01-01

Sick leave banks are a common staple of teacher contracts. Although these banks may benefit employees, they expose school districts to a variety of complications and unintended consequences, including administrative complexity, potential cash flow implications, cost disparities, increased absenteeism, instructional instability, privacy issues, and…

Staying Afloat in an Information-Age Sea Change

ERIC Educational Resources Information Center

Spirduso, Waneen W.

2009-01-01

Scientific and technological advances, occurring with increasing frequency, allow for exciting opportunities for multidisciplinary research but may be accompanied by unintended consequences for kinesiology. These advances require depth of knowledge in subdisciplines and place pressures on kinesiology departments to hire experts with grants in…

Planning for compliance: OSHA's bloodborne pathogen rule.

PubMed

Bednar, B; Duke, M C

1990-11-01

Overall, the bloodborne pathogen rule constitutes a reasonable response to a significant threat to workplace safety. The risks to dialysis workers from HBV and HIV must be minimized or eliminated and the rule is generally consistent with the consensus approach. Unfortunately for dialysis providers, the rule is not exempt from the law of unintended consequences: government regulation will always have impact beyond its object. Promulgation of the final rule will immediately increase the expenses of dialysis providers. Additionally, the enormity of the HBV and HIV problem coupled with the open-ended nature of the rule's key provisions will almost certainly bring additional costs. So long as dialysis reimbursement remains flat, the unintended consequence of the bloodborne pathogen rule may be to quicken the pace of consolidation in the dialysis service market. The added burden of compliance may be too much for small independent facilities. Only large chains may have the resources to comply and survive. To forestall this effect and to provide employees with maximum protection, all dialysis providers should plan now for compliance.

Disparities in long-term care: building equity into market-based reforms.

PubMed

Konetzka, R Tamara; Werner, Rachel M

2009-10-01

A growing body of evidence documents pervasive racial, ethnic, and class disparities in long-term care in the United States. At the same time, major quality improvement initiatives are being implemented that rely on market-based incentives, many of which may have the unintended consequence of exacerbating disparities. We review existing evidence on disparities in the use and quality of long-term care services, analyze current market-based policy initiatives in terms of their potential to ameliorate or exacerbate these disparities, and suggest policies and policy modifications that may help decrease disparities. We find that racial disparities in the use of formal long-term care have decreased over time. Disparities in quality of care are more consistently documented and appear to be related to racial and socioeconomic segregation of long-term care facilities as opposed to within-provider discrimination. Market-based incentives policies should explicitly incorporate the goal of mitigating the potential unintended consequence of increased disparities.

Use of psychology and behavioral economics to promote healthy eating.

PubMed

Roberto, Christina A; Kawachi, Ichiro

2014-12-01

Understanding the psychology of how people make decisions can shed light on important factors contributing to the cause and maintenance of public health problems like obesity. This knowledge can and should inform the design of government and private-sector public health interventions. Several insights from psychology and behavioral economics that help explain why people are particularly vulnerable to the current food environment are discussed. These insights fall into the following categories: the influence of starting points (status quo bias and anchoring effects); communicating health information (simplicity and framing); and unintended consequences of policy interventions (compensation, substitution, and the peanuts effect). The paper discusses opportunities for improving the design of food policies and interventions by altering default options, providing the public with simple and meaningful nutrition information, carefully constructing the framing of public health messages, and designing food policies to minimize unintended consequences, such as compensation and substitution. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Unintended adverse consequences of a clinical decision support system: two cases.

PubMed

Stone, Erin G

2018-05-01

Many institutions have implemented clinical decision support systems (CDSSs). While CDSS research papers have focused on benefits of these systems, there is a smaller body of literature showing that CDSSs may also produce unintended adverse consequences (UACs). Detailed here are 2 cases of UACs resulting from a CDSS. Both of these cases were related to external systems that fed data into the CDSS. In the first case, lack of knowledge of data categorization in an external pharmacy system produced a UAC; in the second case, the change of a clinical laboratory instrument produced the UAC. CDSSs rely on data from many external systems. These systems are dynamic and may have changes in hardware, software, vendors, or processes. Such changes can affect the accuracy of CDSSs. These cases point to the need for the CDSS team to be familiar with these external systems. This team (manager and alert builders) should include members in specific clinical specialties with deep knowledge of these external systems.

Balancing measures or a balanced accounting of improvement impact: a qualitative analysis of individual and focus group interviews with improvement experts in Scotland.

PubMed

Toma, Madalina; Dreischulte, Tobias; Gray, Nicola M; Campbell, Diane; Guthrie, Bruce

2018-07-01

As quality improvement (QI) programmes have become progressively larger scale, the risks of implementation having unintended consequences are increasingly recognised. More routine use of balancing measures to monitor unintended consequences has been proposed to evaluate overall effectiveness, but in practice published improvement interventions hardly ever report identification or measurement of consequences other than intended goals of improvement. We conducted 15 semistructured interviews and two focus groups with 24 improvement experts to explore the current understanding of balancing measures in QI and inform a more balanced accounting of the overall impact of improvement interventions. Data were analysed iteratively using the framework approach. Participants described the consequences of improvement in terms of desirability/undesirability and the extent to which they were expected/unexpected when planning improvement. Four types of consequences were defined: expected desirable consequences ( goals ); expected undesirable consequences ( trade-offs ); unexpected undesirable consequences ( unpleasant surprises ); and unexpected desirable consequences ( pleasant surprises ). Unexpected consequences were considered important but rarely measured in existing programmes, and an improvement pause to take stock after implementation would allow these to be more actively identified and managed. A balanced accounting of all consequences of improvement interventions can facilitate staff engagement and reduce resistance to change, but has to be offset against the cost of additional data collection. Improvement measurement is usually focused on measuring intended goals , with minimal use of balancing measures which when used, typically monitor trade-offs expected before implementation. This paper proposes that improvers and leaders should seek a balanced accounting of all consequences of improvement across the life of an improvement programme, including deliberately pausing after implementation to identify and quantitatively or qualitatively evaluate any pleasant or unpleasant surprises. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Reproductive consequences of unwanted sexual debut among young adult women from Metro Cebu, Philippines.

PubMed

Wiles, Melissa; Agustin, Sonny; Narasimhan, Subasri; Gipson, Jessica D

2018-04-18

The circumstances surrounding sexual debut influence subsequent sexual and reproductive outcomes. We analysed longitudinal data from 397 women who participated in the Cebu Longitudinal Health and Nutrition Survey in Cebu, Philippines to examine associations between unwanted first sex and number of pregnancies, unintended pregnancy, and use of modern contraception. 72% of women reported unwanted first sex. Women whose first sex was unwanted had increased odds of unintended pregnancy compared to women whose first sex was wanted (aOR = 2.2, 95% CI 1.3, 3.6). Nationally-representative surveys should include culturally-relevant questions about sexual debut to inform public health programmes aimed at improving sexual/reproductive health.

Intentional Schools: Living in the Moment

ERIC Educational Resources Information Center

Van Bockern, Steve

2011-01-01

Schools with good intentions are not the same as schools being intentional. Sometimes the best intentions--a result of valuing efficiency, standard procedure (tradition), obedience, or the latest educational fad--create unintended consequences that are not necessarily in the best interest of children. Intentional schools develop a culture of…

Dollars to Discriminate: The (Un)Intended Consequences of School Vouchers

ERIC Educational Resources Information Center

Eckes, Suzanne E.; Mead, Julie; Ulm, Jessica

2016-01-01

Some private, religious schools that accept vouchers have been accused of discriminating against certain populations of students through their admissions processes. Discriminating against disfavored groups (e.g., racial minorities, LGBT students, students with disabilities, religious minorities) in voucher programs raises both legal and policy…

School-Based Condom Availability Programs

ERIC Educational Resources Information Center

Schmiedl, Renee

2004-01-01

The repercussions of sexual activity among teens continue to be a significant issue in the United States. Detrimental consequences to unprotected sexual activity among teens include unintended pregnancy and acquiring a sexually transmitted disease (STD) or human immunodeficiency virus (HIV). It is estimated that each year approximately 3 million…

Brazil: Opportunity and Crisis in Higher Education.

ERIC Educational Resources Information Center

Schwartzman, Simon

1988-01-01

The Brazilian system of higher education is discussed, including its evolution, the 1968 reform and its unintended consequences, and the recommendations of the 1985 presidential commission on higher education. Issues of interinstitutional diversity, institutional autonomy, and the influence of special interest groups on policy are addressed.…

78 FR 9865 - Air Carrier Contract Maintenance Requirements; Extension of Comment Period

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

..., RACCA believes the proposed rulemaking would result in significant unintended consequences, including greater operator cost and manpower requirements than those estimated in the NPRM, loss of efficiency, unbudgeted loss of aircraft availability, and a substantial additional workload for the FAA that would result...

High Risk Behavior among Adolescent Mothers: The Problem in Context.

ERIC Educational Resources Information Center

Kissman, Kris

1998-01-01

Discusses the particular consequences of high-risk behavior for adolescent women, including unintended pregnancies, sexually transmitted diseases, school dropout and poverty, developmental disabilities, and poor school performance. Considers the role of male partners in teenage women's high risk behavior. Describes prevention efforts such as…

Can we treat enough water to meet water quality goals

USDA-ARS?s Scientific Manuscript database

Denitrifying woodchip bioreactors are sized to treat a portion of subsurface drainage flow from a given system. Over sizing them can create conditions under which unintended consequences could occur. A potential solution for treating additional water is to use a cascading series of bioreactor cell...

Averted Vision: How Common Core May Help Struggling Readers

ERIC Educational Resources Information Center

Shanahan, Timothy

2016-01-01

In their article "Beyond the Common Core…," Cassidy, Ortlieb, and Grote-Garcia (2016), express concern that the new Common Core State Standards (CCSS; National Governors Association [NGA] Center for Best Practices & Council of Chief State School Officers [CCSSO], 2010) may have the "unintended consequence" of diverting…

Show Me the Data: Kristin Eschenfelder--University of Wisconsin-Madison

ERIC Educational Resources Information Center

Library Journal, 2005

2005-01-01

Many librarians have been concerned with the unintended consequences of new technologies, but Kristin Eschenfelder--librarian, scholar, and social scientist--gathers the data to enable rational policy decisions about technology's ramifications. As assistant professor in the School of Library and Information Studies at University of…

The Unintended Consequences of Grading Teaching

ERIC Educational Resources Information Center

Smith, Holly

2012-01-01

This article examines the possibility of a "Teaching Assessment Exercise" and attempts to quantify teaching quality as part of performance management schemes for academics. The primary sources of data are identified as student evaluation of teaching (SET) and peer observation of teaching (POT). The conceptual and empirical issues in…

The Integrated Disinfection By-Product Mixtures Project (“4-Lab Study”): An Overview

EPA Science Inventory

The intended result of chemical disinfection of drinking water is reduction of microbial contamination and a concomitant decrease in waterborne disease. The formation of a myriad of disinfection by-products (DBPs) is an unintended consequence. DBPs are present in water as high...

Side Effects of Virtual Environments: A Review of the Literature

DTIC Science & Technology

2004-05-01

Cybersickness symptoms are the unintended psychophysiological side effects of participation in virtual environments. Symptoms can occur both during...induced motion sickness, cybersickness is believed to result from sensory and perceptual mismatches between the visual and vestibular systems, and can...and the task carried out, can affect either incidence or severity of cybersickness . Taking account of these factors may avoid or minimize symptoms. This

Avoiding Unintended Bias

PubMed Central

VAN RYN, MICHELLE

2017-01-01

Research shows that unintentional bias on the part of physicians can influence the way they treat patients from certain racial and ethnic groups. Most physicians are unaware that they hold such biases, which can unknowingly contribute to inequalities in health care delivery. This article explains why a person’s thoughts and behaviors may not align, and provides strategies for preventing implicit biases from interfering with patient care. PMID:27089675

Measuring the quality of renal care: things to keep in mind when selecting and using quality indicators.

PubMed

van der Veer, Sabine N; van Biesen, Wim; Couchoud, Cécile; Tomson, Charles R V; Jager, Kitty J

2014-08-01

This educational paper discusses a variety of indicators that can be used to measure the quality of care in renal medicine. Based on what aspect of care they reflect, indicators can be grouped into four main categories: structure, process, surrogate outcome and outcome indicators. Each category has its own advantages and disadvantages, and we give some pointers on how to balance these pros and cons while taking into account the aim of the measurement initiative. Especially within initiatives that link payment or reputation to indicator measurement, this balancing should be done with utmost care to avoid potential, unintended consequences. Furthermore, we suggest consideration of (i) a causal chain-i.e. subsequent aspects of care connected by evidence-based links-as a starting point for composing a performance indicator set and (ii) adequate case-mix adjustment, not only of (surrogate) outcomes, but also of process indicators in order to obtain fair comparisons between facilities and within facilities over time. © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Unintended greenhouse gas consequences of lowering level of service in urban transit systems

NASA Astrophysics Data System (ADS)

Griswold, Julia B.; Cheng, Han; Madanat, Samer; Horvath, Arpad

2014-12-01

Public transit is often touted as a ‘green’ transportation option and a way for users to reduce their environmental footprint by avoiding automobile emissions, but that may not be the case when systems run well below passenger capacity. In previous work, we explored an approach to optimizing the design and operations of transit systems for both costs and emissions, using continuum approximation models and assuming fixed demand. In this letter, we expand upon our previous work to explore how the level of service for users impacts emissions. We incorporate travel time elasticities into the optimization to account for demand shifts from transit to cars, resulting from increases in transit travel time. We find that emissions reductions are moderated, but not eliminated, for relatively inelastic users. We consider two scenarios: the first is where only the agency faces an emissions budget; the second is where the entire city faces an emissions budget. In the latter scenario, the emissions reductions resulting from reductions in transit level of service are mitigated as users switch to automobile.

Sexual communication among young adult heterosexual Latinos: a qualitative descriptive study.

PubMed

Alvarez, Carmen Paula; Villarruel, Antonia

2013-01-01

Sexual communication between sexual partners is an important component in prevention efforts against unintended consequences of sex. The purpose of this study was to describe sexual communication among young adult Latinos. Four semistructured, sex-segregated focus groups were used for this study. Participants (N = 20) were 18-30 years old self-identified Latinos who were in heterosexual and sexually active relationships (more than 3 months). Participants revealed that initial sexual communication with their partners was avoided related to a lack of interest in a partner's sexual history, feeling embarrassed about the topic, or concern for offending one's partner or partner's family. As a result of these beliefs and attitudes, initial sexual communication was nonverbal and focused on sexual pleasure. After the initiation of sexual activity, verbal sexual communication expanded to include sexual history. These findings highlight the importance of attitudes and subjective norms toward verbal sexual communication. Attitudes and subjective norms toward sexual communication in the context of a romantic relationship and how it may impact sexual behavior in the relationship should be further explored.

Aging and goal-directed emotional attention: distraction reverses emotional biases.

PubMed

Knight, Marisa; Seymour, Travis L; Gaunt, Joshua T; Baker, Christopher; Nesmith, Kathryn; Mather, Mara

2007-11-01

Previous findings reveal that older adults favor positive over negative stimuli in both memory and attention (for a review, see Mather & Carstensen, 2005). This study used eye tracking to investigate the role of cognitive control in older adults' selective visual attention. Younger and older adults viewed emotional-neutral and emotional-emotional pairs of faces and pictures while their gaze patterns were recorded under full or divided attention conditions. Replicating previous eye-tracking findings, older adults allocated less of their visual attention to negative stimuli in negative-neutral stimulus pairings in the full attention condition than younger adults did. However, as predicted by a cognitive-control-based account of the positivity effect in older adults' information processing tendencies (Mather & Knight, 2005), older adults' tendency to avoid negative stimuli was reversed in the divided attention condition. Compared with younger adults, older adults' limited attentional resources were more likely to be drawn to negative stimuli when they were distracted. These findings indicate that emotional goals can have unintended consequences when cognitive control mechanisms are not fully available.

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

By working with builder partners on test homes, researchers from the U.S. Department of Energy’s Building America program can vet whole-house building strategies and avoid potential unintended consequences of implementing untested solution packages on a production scale. To support this research, Building America team Consortium for Advanced Residential Buildings (CARB) partnered with Preferred Builders Inc. on a high-performance test home in Old Greenwich, Connecticut. The philosophy and science behind the 2,700 ft2 “Performance House” was based on the premise that homes should be safe, healthy, comfortable, durable, efficient, and adaptable to the needs of homeowners. The technologies and strategies usedmore » in the “Performance House” were best practices rather than cutting edge, with a focus on simplicity in construction, maintenance, and operation. Achieving 30% source energy savings compared with a home built to the 2009 International Energy Conservation Code in the cold climate zone requires that nearly all components and systems be optimized. Careful planning and design are critical. The end result was a DOE Challenge Home that achieved a Home Energy Rating System (HERS) Index Score of 20 (43 without photovoltaics [PV]).« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

By working with builder partners on test homes, researchers from the U.S. Department of Energy's Building America program can vet whole-house building strategies and avoid potential unintended consequences of implementing untested solution packages on a production scale. To support this research, Building America team Consortium for Advanced Residential Buildings (CARB) partnered with Preferred Builders Inc. on a high-performance test home in Old Greenwich, Connecticut. The philosophy and science behind the 2,700 ft2 "Performance House" was based on the premise that homes should be safe, healthy, comfortable, durable, efficient, and adaptable to the needs of homeowners. The technologies and strategies usedmore » in the "Performance House" were best practices rather than cutting edge, with a focus on simplicity in construction, maintenance, and operation. Achieving 30% source energy savings compared with a home built to the 2009 International Energy Conservation Code in the cold climate zone requires that nearly all components and systems be optimized. Careful planning and design are critical. The end result was a DOE Challenge Home that achieved a Home Energy Rating System (HERS) Index Score of 20 (43 without photovoltaics [PV]).« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Alnajjar, Mikhail S.; Quigley, David; Kuntamukkula, Murty

Due to the inherent nature of pyrophoric substances to ignite spontaneously upon exposure to air, special precautions must be taken to ensure their safe handling and use. Pyrophoric gases (such as diborane, dichloroborane, phosphine, etc.) are typically the easiest class of pyrophoric substances to handle since the gas can be plumbed directly to the application and used remotely. Pyrophoric solids and liquids, however, require the user to physically manipulate them when transferring them from one container to another. Failure to follow proper safety precautions could result in serious injury or unintended consequences to laboratory personnel.12 Because of this danger, pyrophoricsmore » should be handled only by experienced personnel. Users with limited experience must be trained on how to handle pyrophoric reagents and consult with a knowledgeable staff member prior to performing the experimental task. The purpose of this article is three fold: 1) to provide guidelines and general safety precautions to avoid accidents, 2) describe proper techniques on how to successfully handle, store, and dispose of pyrophoric liquids and solids, and 3) illustrate best practices for working with this class of reactants in a laboratory environment.« less

PURPA: The spur to competition and utility restructuring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hirsh, R.F.

Without discussing the merits or deficiencies of the arguments made by contesting parties, this article explores the history of PURPA and its intended and unintended consequences. The article will serve as a background for discussion of the repeal or reform of PURPA so that participants in the debate will understand the profound consequences of this important law. Most notably, PURPA helped establish the free-market, competitive principles that many people hope to extend further in the utility system.

Understanding Unintended Consequences and Health Information Technology:

PubMed Central

Randell, R.; Borycki, E. M.

2016-01-01

Summary Objective No framework exists to identify and study unintended consequences (UICs) with a focus on organizational and social issues (OSIs). To address this shortcoming, we conducted a literature review to develop a framework for considering UICs and health information technology (HIT) from the perspective of OSIs. Methods A literature review was conducted for the period 2000-2015 using the search terms “unintended consequences” and “health information technology”. 67 papers were screened, of which 18 met inclusion criteria. Data extraction was focused on the types of technologies studied, types of UICs identified, and methods of data collection and analysis used. A thematic analysis was used to identify themes related to UICs. Results We identified two overarching themes. One was the definition and terminology of how people classify and discuss UICs. Second was OSIs and UICs. For the OSI theme, we also identified four sub-themes: process change and evolution, individual-collaborative interchange, context of use, and approaches to model, study, and understand UICs. Conclusions While there is a wide body of research on UICs, there is a lack of overall consensus on how they should be classified and reported, limiting our ability to understand the implications of UICs and how to manage them. More mixed-methods research and better proactive identification of UICs remain priorities. Our findings and framework of OSI considerations for studying UICs and HIT extend existing work on HIT and UICs by focusing on organizational and social issues. PMID:27830231

Policy, Practice and Practical Reason: Understanding Teaching in Times of Outcome Regulation

ERIC Educational Resources Information Center

Strandler, Ola

2015-01-01

Although there are reasons to believe that policies emphasising testing, accountability, assessments, evaluation and inspections have unintended and undesirable consequences for teaching practice, such reforms continue to be widely used in many countries in order to meet challenges in their educational systems. However, it is difficult to…

Unintended Consequences: Twelve Years under the DMCA

ERIC Educational Resources Information Center

Von Lohmann, Fred

2010-01-01

Since they were enacted in 1998, the "anti-circumvention" provisions of the Digital Millennium Copyright Act ("DMCA"), codified in section 1201 of the Copyright Act, have not been used as Congress envisioned. Congress meant to stop copyright infringers from defeating anti-piracy protections added to copyrighted works and to ban…

The High-Stakes Test Mess

ERIC Educational Resources Information Center

Goldberg, Mark F.

2004-01-01

Tests are a natural part of education, from the quizzes, essays, and classroom tests that teachers have traditionally administered to the high-stakes tests that states use to make decisions about graduation, promotion, and school funding and governance. In this article, the author stresses the need to learn the unintended consequences of…

One Size Fits All? A Different Perspective on University Rankings

ERIC Educational Resources Information Center

Goglio, Valentina

2016-01-01

In roughly a decade, university rankings gained the foreground in the policy arena for higher education and their influence is not going to decrease. However, several methodological shortcomings and warnings about the unintended consequences for national higher education systems have been raised. Against this background, this paper stresses that…

Waiver Culture: The Unintended Consequence of Ethics Compliance

ERIC Educational Resources Information Center

Genova, Gina L.

2008-01-01

The passage of the U.S. Sarbanes-Oxley Act (2002) spawned a series of compliance and ethics programs --the revised Principles of Federal Prosecution of Business Organizations known as the Thompson Memo (Thompson, 2003), the revised Federal Sentencing Guidelines that included the Effective Compliance and Ethics Program and the corporate…

Greening China Naturally

Treesearch

Shixiong Cao; Ge Sun; Zhiqiang Zhang; Liding Che; Qi Feng; et. al.

2011-01-01

China leads the world in afforestation, and is one of the few countries whose forested area is increasing. However, this massive “greening” effort has been less effective than expected; afforestation has sometimes produced unintended environmental, ecological, and socioeconomic consequences, and has failed to achieve the desired ecological benefits. Where afforestation...

78 FR 59029 - Information Collection Being Reviewed by the Federal Communications Commission

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-25

... Broadcast Station Antenna Patterns. Form No.: Not applicable. Type of Review: Revision of a currently... Rules Regarding AM Radio Service Directional Antenna Performance Verification, MM Docket No. 93-177, FCC... functions as the antenna. Consequently, a nearby tower may become an unintended part of the AM antenna...

The Impact of School Suspensions: A Student Wellbeing Issue

ERIC Educational Resources Information Center

Hemphill, Sheryl; Hargreaves, John

2009-01-01

School suspensions are commonly used in schools to address challenging student behaviours, often on the understanding that suspensions send a clear message to the school community about what is acceptable behaviour. However, there is a growing body of evidence that school suspensions have a range of unintended negative consequences including…

Think before You Share

ERIC Educational Resources Information Center

Read, Brock

2006-01-01

Students in the US are increasingly discovering that online socializing is far from private and that sharing personal details on social-networking Web sites, such as Facebook, can have unintended consequences. A growing number of colleges are moving to disabuse students of the notion that the Internet is their private playground and what they type…

Why Knowledge Matters: Rescuing Our Children from Failed Educational Theories

ERIC Educational Resources Information Center

Hirsch, E. D., Jr.

2016-01-01

In "Why Knowledge Matters," influential scholar E. D. Hirsch, Jr., addresses critical issues in contemporary education reform and shows how cherished truisms about education and child development have led to unintended and negative consequences. Hirsch, author of "The Knowledge Deficit," draws on recent findings in neuroscience…

Economics: An Analysis of Unintended Consequences. Volume 2: Introduction to Macroeconomics.

ERIC Educational Resources Information Center

Schenk, Robert E.

This curriculum guide emphasizes that economics is a method of thought or analysis and highlights the teaching of macroeconomic concepts. Definitions of economics, economic actions and their results, individual and group relationships, and supply and demand principles are reviewed. Macroeconomic concepts that are introduced include: (1) economic…

Community Impact Assessment Handbook.

ERIC Educational Resources Information Center

Northern Alberta Development Council, Peace River.

This handbook is intended for communities that wish to undertake their own community impact assessment (CIA). The goal is to enable communities to plan for changes before they occur, so they can cope with changes when they do occur. CIA involves forecasting and evaluating the full range of unintended consequences for the community of development…

Performativity, Propriety and Productivity: The Unintended Consequences of Investing in the Early Years

ERIC Educational Resources Information Center

Macfarlane, Kym; Lakhani, Ali

2015-01-01

This paper examines notions of childhood development in a significant Australian policy document. Using Fairclough's approaches to discourse analysis as guides, Foucault's understanding of regimes of truth and discourses as systems of power relations and Nikolas Rose's concept of "responsibilisation," the paper argues that discourses of…

Race-Ethnicity, Class and Zero Tolerance Policies: A Policy Discussion.

ERIC Educational Resources Information Center

Verdugo, Richard R.; Glenn, Beverly C.

This paper presents a history of zero tolerance policies, discusses the breadth and scope of zero tolerance policies in U.S. public schools, examines unintended consequences of zero tolerance policies (especially those conflicting with basic philosophical tenets of the public school system), and makes recommendations for creating and implementing…

Unidimensional Interpretations for Multidimensional Test Items

ERIC Educational Resources Information Center

Kahraman, Nilufer

2013-01-01

This article considers potential problems that can arise in estimating a unidimensional item response theory (IRT) model when some test items are multidimensional (i.e., show a complex factorial structure). More specifically, this study examines (1) the consequences of model misfit on IRT item parameter estimates due to unintended minor item-level…

Soviet Industrial Strategy and Reforms in Vocational Education, 1984-88: Policy Implications and Implementation.

ERIC Educational Resources Information Center

Sowtis, Dennis

1991-01-01

In 1984, Soviet educational reforms increased the number of vocational secondary schools, introduced pupils to vocational education at an earlier age, and strengthened vertical integration between local enterprises and schools. Unintended consequences may be occupational rigidity, course offerings based on obsolete manpower needs, and…

Audit Culture: Unintended Consequences of Accountability Practices in Evidence-Based Programs

ERIC Educational Resources Information Center

Owczarzak, Jill; Broaddus, Michelle; Pinkerton, Steven

2016-01-01

Evaluation has become expected within the nonprofit sector, including HIV prevention service delivery through community-based organizations (CBOs). While staff and directors at CBOs may acknowledge the potential contribution of evaluation data to the improvement of agency services, the results of evaluation are often used to demonstrate fiscal…

Knowledge Management and Higher Education: A Critical Analysis

ERIC Educational Resources Information Center

Metcalfe, Amy

2006-01-01

Rather than focusing on functional issues relating to implementation of knowledge management (KM) techniques, this book addresses the social aspects of KM. Using various social science perspectives, the volume provides critical analyses of KM in higher education, with an emphasis on unintended consequences and future implications. Fifteen chapters…

A Tale of Unintended Consequences

ERIC Educational Resources Information Center

Corn, Jennifer

2006-01-01

A teacher of Limited English Proficient elementary students in California describes how she put her students through daily timed read-aloud drills to boost their scores on a benchmark assessment of reading rate that her school district required. Corn briefly reviews the rationale behind measuring reading rate as an indicator of fluency. The reason…

Are Charitable Giving and Religious Attendance Complements or Substitutes? The Role of Measurement Error

ERIC Educational Resources Information Center

Kim, Matthew

2013-01-01

Government policies sometimes cause unintended consequences for other potentially desirable behaviors. One such policy is the charitable tax deduction, which encourages charitable giving by allowing individuals to deduct giving from taxable income. Whether charitable giving and other desirable behaviors are complements or substitutes affect the…

A New Era for Research Education in Australia?

ERIC Educational Resources Information Center

Marsh, Helene; Smith, Bradley; King, Max; Evans, Terry

2012-01-01

Use of the Australian research assessment exercise, Excellence in Research for Australia (ERA) to influence the policy and practice of research education in Australia will undoubtedly have many consequences, some of them unintended and potentially deleterious. ERA is a retrospective measure of research quality; research education is prospective.…

Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article

PubMed Central

YAZDKHASTI, Mansureh; POURREZA, Abolghasem; PIRAK, Arezoo; ABDI, Fatemeh

2015-01-01

Abstract Unintended pregnancy is among the most troubling public health problems and a major reproductive health issue worldwide imposing appreciable socioeconomic burden on individuals and society. Governments generally plan to control growth of births (especially wanted births as well as orphans and illegitimate births) imposing extra burden on public funding of the governments which inevitably affects economic efficiency and leads to economic slowdown, too. The present narrative review focuses on socioeconomic impacts of unintended pregnancy from the health system perspective. Follow of Computerized searches of Academic, 53 scientific journals were found in various databases including PubMed, EMBASE, ISI, Iranian databases, IPPE, UNFPA (1985-2013). Original articles, review articles, published books about the purpose of the paper were used. During this search, 20 studies were found which met the inclusion criteria. Unintended pregnancy is one of the most critical challenges facing the public health system that imposes substantial financial and social costs on society. On the other hand, affecting fertility indicators, it causes reduced quality of life and workforce efficiency. Therefore lowering the incidence of intended pregnancies correlates with elevating economic growth, socio-economic development and promoting public health. Regarding recent policy changes in Iran on family planning programs and adopting a new approach in increasing population may place the country at a higher risk of increasing the rate of unintended pregnancy. Hence, all governmental plans and initiatives of public policy must be regulated intelligently and logically aiming to make saving in public spending and reduce healthcare cost inflation. PMID:26060771

Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article.

PubMed

Yazdkhasti, Mansureh; Pourreza, Abolghasem; Pirak, Arezoo; Abdi, Fatemeh

2015-01-01

Unintended pregnancy is among the most troubling public health problems and a major reproductive health issue worldwide imposing appreciable socioeconomic burden on individuals and society. Governments generally plan to control growth of births (especially wanted births as well as orphans and illegitimate births) imposing extra burden on public funding of the governments which inevitably affects economic efficiency and leads to economic slowdown, too. The present narrative review focuses on socioeconomic impacts of unintended pregnancy from the health system perspective. Follow of Computerized searches of Academic, 53 scientific journals were found in various databases including PubMed, EMBASE, ISI, Iranian databases, IPPE, UNFPA (1985-2013). Original articles, review articles, published books about the purpose of the paper were used. During this search, 20 studies were found which met the inclusion criteria. Unintended pregnancy is one of the most critical challenges facing the public health system that imposes substantial financial and social costs on society. On the other hand, affecting fertility indicators, it causes reduced quality of life and workforce efficiency. Therefore lowering the incidence of intended pregnancies correlates with elevating economic growth, socio-economic development and promoting public health. Regarding recent policy changes in Iran on family planning programs and adopting a new approach in increasing population may place the country at a higher risk of increasing the rate of unintended pregnancy. Hence, all governmental plans and initiatives of public policy must be regulated intelligently and logically aiming to make saving in public spending and reduce healthcare cost inflation.

Cultural Dimensions of International Business

DTIC Science & Technology

1991-09-01

gain major objectives. -In Malaysia "saving face" is very important. To avoid a problem here, Malaysian will. say "we can" to anything. Then they proceed...twenty Malaysians . For Security Assistance Negotiations at Korean Air Force HQ-- Eight U.S. and fifteen to twenty ROKAF. For negotiations at Kordin Air...unintended insults; misunderstood direction. -Most Malaysians speak excellent English. The biggest problem is usually that very few Americans are bilingual

Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception.

PubMed

Trussell, James; Henry, Nathaniel; Hassan, Fareen; Prezioso, Alexander; Law, Amy; Filonenko, Anna

2013-02-01

This study evaluated the total costs of unintended pregnancy (UP) in the United States (US) from a third-party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure. An economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs that could be attributed to imperfect contraceptive adherence. The model considered all women requiring reversible contraception in the US: the pattern of contraceptive use and the rates of UP were derived from published sources. The costs of UP in the United States and the proportion of total cost that might be avoided by improved adherence through increased use of LARC were estimated. Annual medical costs of UP in the United States were estimated to be $4.6 billion, and 53% of these were attributed to imperfect contraceptive adherence. If 10% of women aged 20-29 years switched from oral contraception to LARC, total costs would be reduced by $288 million per year. Imperfect contraceptive adherence leads to substantial UP and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence. Copyright © 2013 Elsevier Inc. All rights reserved.

Smoker-free workplace policies: developing a model of public health consequences of workplace policies barring employment to smokers.

PubMed

Houle, B; Siegel, M

2009-02-01

A marked shift in tobacco-related workplace health promotion intervention involves the adoption of policies barring employment to smokers. We discuss the potential public health consequences of these policies on those affected-smokers, their families, the surrounding community and society at large. We find a lack of published evidence evaluating the effectiveness and consequences of these policies. By developing a model of policy effects, we outline possible unintended consequences. With such large gaps in the evidence base and the potential for deleterious consequences, we argue for increased discussion about the use of smoker-free employment policies as a public health intervention and for increased engagement of employers by the public health community in worksite health promotion.

Selective Internal Radiotherapy (SIRT) of Hepatic Tumors: How to Deal with the Cystic Artery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Theysohn, Jens M., E-mail: jens.theysohn@uni-due.de; Mueller, Stefan; Schlaak, Joerg F.

2013-08-01

PurposeSelective internal radiotherapy (SIRT) with the beta emitter yttrium-90 (Y90) is a rapidly developing therapy option for unresectable liver malignancies. Nontarget irradiation of the gallbladder is a complication of SIRT. Thus, we aimed to assess different strategies to avoid infusion of Y90 into the cystic artery (CA).MethodsAfter hepatic digital subtraction angiography and administration of technetium-99m-labeled human serum albumin ({sup 99}mTc-HSA), 295 patients with primary or secondary liver tumors underwent single-photon emission computed tomography/computed tomography (SPECT/CT). Different measures were taken before repeated Y90 mapping and SIRT to avoid unintended influx into the CA where necessary. Clinical symptoms, including pain, fever, ormore » a positive Murphy sign, were assessed during patient follow-up.ResultsA significant {sup 99}mTc-HSA accumulation in the gallbladder wall (higher {sup 99}mTc-HSA uptake than in normal liver tissue) was seen in 20 patients. The following measures were taken to avoid unintended influx into the CA: temporary/permanent occlusion of the CA with gelfoam (n = 5)/microcoil (n = 1), induction of vasospasm with a microwire (n = 4), or altering catheter position (n = 10). Clinical signs of cholecystitis were observed in only one patient after temporary CA occlusion with gelfoam and were successfully treated by antibiotics. Cholecystectomy was not required for any patient.ConclusionIt is important to identify possible nontarget irradiation of the gallbladder. The risk for radiation-induced cholecystitis can be easily minimized by temporary or permanent CA embolization, vasospasm induction, or altering the catheter position.« less

Conflicts, Competition and Social Support in Female-Dominated Vocational Education--Breaking or Reaffirming Stereotypical Femininity?

ERIC Educational Resources Information Center

Hegna, Kristinn

2017-01-01

One in four upper secondary school students in Norway experience nearly single-sex classrooms, an unintended consequence of choosing certain vocational study programmes, such as "Health care, childhood and youth development" or "Building and construction". This raises a question about how female students describe their…

The Unintended Consequences of Reorganization

ERIC Educational Resources Information Center

Zeng, Jie

2009-01-01

For the last five years, the lives of New York City (NYC) public school educators have been governed by constant change. With certainty, every January or June heralded something new--restructured departments and offices, staff changes and new initiatives. One of the most interesting chapters in the history of the NYC school system unfolded in the…

Intended and Unintended Consequences of Educational Technology on Social Inequality

ERIC Educational Resources Information Center

Tawfik, Andrew A.; Reeves, Todd D.; Stich, Amy

2016-01-01

While much has been written in the field of educational technology regarding educational excellence and efficiency, less attention has been paid to issues of equity. Along these lines, the field of educational technology often does not address key equity problems such as academic achievement and attainment gaps, and inequality of educational…

76 FR 23854 - Reclassification of Motorcycles (Two and Three Wheeled Vehicles) in the Guide to Reporting...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

... and the unintended consequences of misclassification. Harley Davidson Motor Company (HDMC) stated that... concerns about the administrative, logistical and financial burdens of providing information based on the... estimated that the cost of updating their computers to process the information included in the new guidance...

78 FR 23872 - HIPAA Privacy Rule and the National Instant Criminal Background Check System (NICS)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-23

... any unintended adverse consequences for individuals seeking needed mental health services that may be... Check System (NICS) to help enforce these prohibitions.\\4\\ The NICS Index, a database administered by... to the NICS. Such an amendment might produce clarity regarding the Privacy Rule and help make it as...

Why Continuous Improvement Is a Poor Substitute for School Choice

ERIC Educational Resources Information Center

Rose, David C.; Rochester, J. Martin

2008-01-01

Efforts to introduce school choice have produced pressures on public schools to improve their performance. As a result, many public schools have embraced the total quality management principle of continuous improvement. In this article we explain that while this may be well intentioned, it may have perverse unintended consequences. A likely…

Changes in hematology and serum biochemical profiles in lambs fed sericea lespedeza

USDA-ARS?s Scientific Manuscript database

Sericea lespedeza (SL; Lespedeza cuneata) is a legume rich in condensed tannins (CT) that can be grazed or fed to small ruminants for parasite control. Condensed tannins a secondary plant compound in SL may lead to unintended consequences such as changes in production. In our preliminary research, t...

Multifunctional Agriculture in Policy and Practice? A Comparative Analysis of Norway and Australia

ERIC Educational Resources Information Center

Bjorkhaug, Hilde; Richards, Carol Ann

2008-01-01

Ideals of productivist agriculture in the Western world have faded as the unintended consequences of intensive agriculture and pastoralism have contributed to rural decline and environmental problems. In Norway and Australia, there has been an increasing acceptance of the equal importance of social and environmental sustainability as well as…

Linking Air Land & Water to Examine the Vulnerability of Groundwater Nitrate Contamination from Increased Corn Production

EPA Science Inventory

The Renewable Fuel Standard (RFS) requires oil refiners to reach a target of 15 billion gallons of corn-based ethanol by 2022. However, there are concerns that the broad-scale use of corn as a source of ethanol may lead to unintended economic and environmental consequences. Thi...

Carbon Emissions Trading and Combined Heat and Power Strategies: Unintended Consequences

ERIC Educational Resources Information Center

Tysseling, John C.; Vosevich, Mary; Boersma, Benjamin R.; Zumwalt, Jefferey A.

2009-01-01

Facility professionals continuously search for projects that reduce energy consumption and operating costs so as to directly benefit their bottom line. Many institutions nationwide have contemplated or made investments in combined heat and power (CHP) projects as a life-cycle strategy to minimize operating costs. However, recent sustainability and…

78 FR 21457 - Self-Regulatory Organizations; New York Stock Exchange LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-10

..., particularly without any impact analysis, because such initiatives can have unintended consequences to the... development of ``subsystems within the national market system,'' objectives which are inconsistent with the... public interest or for the protection of investors and to facilitate the development of subsystems within...

The Social Studies are Essential to a Well-Rounded Education

ERIC Educational Resources Information Center

Duncan, Arne

2011-01-01

Social studies teachers live with the unintended consequences of the No Child Left Behind (NCLB) Act every day. They understand that the law has created flawed incentives for states and school districts to narrow their curricula to English and math. This fundamentally misguided practice leaves out core disciplines that are essential to a…

Manipulation of density of Pseudotsuga menziesii canopies: preliminary effects on understory vegetation.

Treesearch

D.R. Thysell; A.B. Carey

2001-01-01

Managing second-growth forests to conserve biodiversity has been proposed by both foresters and conservation biologists. Management, however, can have unintended consequences, including reduction in native species diversity and increased invasion by exotic species. Our goal was to determine if inducing heterogeneity in managed forest canopies could promote a diversity...

Unintended Consequences: How Science Professors Discourage Women of Color

ERIC Educational Resources Information Center

Johnson, Angela C.

2007-01-01

This study examined how 16 Black, Latina, and American Indian women science students reacted to their undergraduate science classes. I focused on the meanings they made of the common features of university science documented by Seymour and Hewitt (1997), including large, competitive, fast-paced classes, poor teaching, and an unsupportive culture.…

Parental Attitudes about Teenage Pregnancy: Impact on Sexual Risk Behaviour of African-American Youth

ERIC Educational Resources Information Center

Annang, Lucy; Lian, Brad; Fletcher, Faith E.; Jackson, Dawnyéa

2014-01-01

African-American youth suffer disproportionately from sexual risk consequences including unintended pregnancy and sexually transmitted infections. Parents educating young people about sex may be one approach to reduce sexual risk behaviour among this population. The purpose of this study was to determine young people's perceptions of parents'…

EMISSION REDUCTIONS AIMED AT IMPROVING AIR QUALITY: UNINTENDED CLIMATIC CONSEQUENCES AND THE EFFECT OF CLIMATE CHANGE ON THEIR SUCCESS

EPA Science Inventory

This work will provide improved understanding of the role of climate change, both in the recent past and future, on the success of pollutant control strategies, allowing for better planning and accountability of emission reductions. This work will also provide a quantitative a...

Public Schools in Marketized Environments: Shifting Incentives and Unintended Consequences of Competition-Based Educational Reforms

ERIC Educational Resources Information Center

Lubienski, Christopher

2005-01-01

By opening the system to competition, popular school choice reforms seek to remake public education into a more consumer-oriented endeavor. While the underlying theory holds that competitive pressures will induce change and improvement in educational processes, research indicates that organizations often respond instead by developing promotional…

Visual Portrayals of Obesity in Health Media: Promoting Exercise without Perpetuating Weight Bias

ERIC Educational Resources Information Center

Pearl, R. L.; Dovidio, J. F.; Puhl, R. M.

2015-01-01

Health education campaigns for preventing and reducing obesity often contain weight-stigmatizing visual content, which may have unintended negative health consequences. The goal of the present research was to identify non-stigmatizing visual content for health education materials that can promote exercise among people of diverse weight statuses.…

On the Problem of Motor Skill Development

ERIC Educational Resources Information Center

Clark, Jane E.

2007-01-01

As a way to address the serious obesity epidemic in the United States, many physical education classes have become fitness centers designed to raise heart rates and burn calories. An unintended consequence of this emphasis on fitness, however, is the lack of attention to motor skill development. Motor skills do not develop miraculously from one…

Unintended Consequences: An Uncertain Future for Distance Learning

ERIC Educational Resources Information Center

Halfond, Jay A.

2011-01-01

While most in the academic community know about the attempt to rein in the for-profits, few are aware of its collateral damage. In October, the Department of Education (DOE) issued its Program Integrity Rules, intended to protect federal funds especially from those for-profit institutions with high student loan default rates. Well-intentioned…

Linchpins or Lost Time: Creating Effective Advisories

ERIC Educational Resources Information Center

Johnson, Bil

2009-01-01

That advisories in secondary schools are fairly pervasive around the country may be one of the great unintended consequences of the Coalition of Essential Schools (CES) reform effort. While no CES Common Principle explicitly states that advisories should exist in schools, as Coalition Schools evolved, advisories became one of the logical ways for…

Investigation of some characteristics of polyhydroxy milkweed triglycerides and their acylated derivatives in relation to lubricity

USDA-ARS?s Scientific Manuscript database

Most industrial lubricants are derived from non-renewable petroleum-based sources. As useful as these lubricants are, their unintended consequences are the pollution of our environment as a result of the very slow degradation of the spent materials. Native seed oils, on the other hand, are renewa...

Invisibility: An Unintended Consequence of Standards, Tests, and Mandates

ERIC Educational Resources Information Center

Elish-Piper, Laurie; Matthews, Mona W.; Risko, Victoria J.

2013-01-01

As elementary and middle school teachers and students face standards, high-stakes testing, accountability, and one-size-fits all curricula, concerns have arisen that these practices limit the relevance and efficacy of teaching and learning. In this paper, we argue that such practices exact personal costs on students and the teachers expected to…

OPTIMIZATION OF A PULSED LIMESTONE BED REACTOR AT THE ARGO TUNNEL IN IDAHO SPRINGS, COLORADO

EPA Science Inventory

Acid Mine Drainage (AMD) is an unintended consequence of coal and metal mining that adversely affects thousands of miles of streams both in the eastern and western regions of the U.S. A novel AMD treatment process based on limestone based on limestone neutralization has been dev...

Evaluating the Unintended Consequences of Assessment Practices: Construct Irrelevance and Construct Underrepresentation

ERIC Educational Resources Information Center

Spurgeon, Shawn L.

2017-01-01

Construct irrelevance (CI) and construct underrepresentation (CU) are 2 major threats to validity, yet they are rarely discussed within the counseling literature. This article provides information about the relevance of these threats to internal validity. An illustrative case example will be provided to assist counselors in understanding these…

A landscape based, systems dynamic model for assessing impacts of urban development on water quality for sustainable seagrass growth in Tampa Bay, Florida

EPA Science Inventory

We present an integrated assessment model to predict potential unintended consequences of urban development on the sustainability of seagrasses and preservation of ecosystem services, such as catchable fish, in Tampa Bay. Ecosystem services are those ecological functions and pro...

Maximal Processing, or, Archivist on a Pale Horse

ERIC Educational Resources Information Center

Cox, Robert S.

2010-01-01

With the promise of greater economy in handling an ever-increasing volume of material, minimal processing has quickly become a new orthodoxy for the archival profession despite a raft of unintended consequences for service and discovery. Taking a long-term view of the costs and benefits entailed in the process of processing, the three-stage…

Participatory Action Research and Impact: An Ecological Ripples Perspective

ERIC Educational Resources Information Center

Trickett, Edison J.; Beehler, Sarah

2017-01-01

Assessment of the impact of varied forms of participatory research is enhanced by specific attention to the ripples, such work initiates in the social context. Ripples are defined as consequences either unintended or unanticipated by those carrying out the participatory research. Following a brief documentation of the range of reported ripples in…

Visits, Hits, Caching and Counting on the World Wide Web: Old Wine in New Bottles?

ERIC Educational Resources Information Center

Berthon, Pierre; Pitt, Leyland; Prendergast, Gerard

1997-01-01

Although web browser caching speeds up retrieval, reduces network traffic, and decreases the load on servers and browser's computers, an unintended consequence for marketing research is that Web servers undercount hits. This article explores counting problems, caching, proxy servers, trawler software and presents a series of correction factors…

Exploring unintended environmental and social-equity consequences of transit oriented development : a research report from the National Center for Sustainable Transportation.

DOT National Transportation Integrated Search

2015-10-01

Communities throughout the U.S. are pursuing land use and transportation plans that locate : high density, mixed-use development near high quality rail and bus transit service. The : objective of these plans is to meet important community goals, such...

Maize, switchgrass, and ponderosa pine biochar added to soil increased herbicide sorption and decreased herbicide efficacy

USDA-ARS?s Scientific Manuscript database

Biochars, a by-product of pyrolysis conversion of a wide array of plant biomass to biofuels, are being considered as soil amendments that may provide nutrients and increase soil water holding capacity. However, there may be unintended consequences to other crop management practices. We examined her...

Unintended Consequences: Potential Downsides of the Air Force’s Conversion to Biofuels

DTIC Science & Technology

2011-01-01

Mark N. Goltz , PhD, USAF, Retired Dr. Charles A. Bleckmann Dr. Douglas M. Mackay Maj Khai Vuong, USAF Capt Jerrod P. McComb, USAF* *Lieutenant...Colonel Goltz and Dr. Bleckmann are faculty members in the environmental engineering and science program at the Air Force Institute of Technology (AFIT

Prevalence and Determinants of Unintended Pregnancy Among Women in South-Western Nigeria.

PubMed

Lamina, M A

2015-09-01

To study the prevalence of unwanted pregnancy in urban and rural settlements in Southwestern Nigeria. A prospective cross-sectional study of women within reproductive age. Community-based study of unwanted pregnancy was conducted in 2012. They were women of reproductive age who had experienced unintended and/or unwanted pregnancies and they were randomly selected from rural and urban areas of Ogun state in Nigeria. A semi-structured questionnaire was used for data collection. The prevalence of unintended/unwanted pregnancy, associated factors including the views, perception and attitudes of community members in both urban and rural settlements and the pattern of help-seeking behavior on the problem. The age range of respondents was 15-48 years (mean age 31.2± 6.7 years). One thousand, two hundred and twenty-one (51.6%) of the respondents were married. The percentage of illiterate respondents was 3.5% in urban area and 4.1% in rural area. There was a statistically significant association between level of education and use of a method to avoid or delay pregnancy (p < 0.001). The prevalence of unintended pregnancy was 35.9% while that of induced abortion was 33.5%. Quality of service was the most important factor in the choice of a place for pregnancy termination in urban and rural areas. Economic reasons were often cited as reasons women make use of abortion services. Unwanted pregnancy constitutes a problem, even at the community level. The high contraceptive awareness should be translated to an increased use so as to bridge the large gap of unmet need.

Developmental interventions to address the STEM gender gap: exploring intended and unintended consequences.

PubMed

Liben, Lynn S; Coyle, Emily F

2014-01-01

Women and girls in the United States continue to be underrepresented in STEM, particularly in engineering and technology fields. This gap has been attracting recent attention from those motivated to ensure that girls and women have access to a full range of personally satisfying careers as well as from those concerned with developing a rich talent pool to meet national workforce needs. This chapter is focused on interventions that have been designed to address this STEM gender gap. We begin by documenting the STEM gender gap and then review change mechanisms emerging from theories of gender development that may be harnessed in intervention efforts. In addition, we pro vide a taxonomy of intervention goals which we then use to organize an illustrative review of sample interventions. After commenting on some of the findings and limitations of past work, we offer suggestions for enhancing the systematic evaluation of intervention programs that include careful selection of comparison groups, a broad array of STEM outcome measures, assessment of potentially unintended consequences, and meta-analyses.

Anticipating the unintended consequences of security dynamics.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Backus, George A.; Overfelt, James Robert; Malczynski, Leonard A.

2010-01-01

In a globalized world, dramatic changes within any one nation causes ripple or even tsunamic effects within neighbor nations and nations geographically far removed. Multinational interventions to prevent or mitigate detrimental changes can easily cause secondary unintended consequences more detrimental and enduring than the feared change instigating the intervention. This LDRD research developed the foundations for a flexible geopolitical and socioeconomic simulation capability that focuses on the dynamic national security implications of natural and man-made trauma for a nation-state and the states linked to it through trade or treaty. The model developed contains a database for simulating all 229 recognizedmore » nation-states and sovereignties with the detail of 30 economic sectors including consumers and natural resources. The model explicitly simulates the interactions among the countries and their governments. Decisions among governments and populations is based on expectation formation. In the simulation model, failed expectations are used as a key metric for tension across states, among ethnic groups, and between population factions. This document provides the foundational documentation for the model.« less

Attending unintended transformations of health care infrastructure

PubMed Central

Wentzer, Helle; Bygholm, Ann

2007-01-01

Introduction Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices. Results This paper develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT. Conclusion and discussion The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into health care practices and outcomes. PMID:18043725

Using systems thinking in patient safety: a case study on medicines management.

PubMed

Brimble, Mandy; Jones, Aled

2017-06-29

Systems thinking is used as a way of understanding behaviours and actions in complex healthcare organisations. An important premise of the concept is that every action in a system causes a reaction elsewhere in that system. These reactions can lead to unintended consequences, sometimes long after the original action, and so are not always attributed to them. This article applies systems thinking to a medicines management case study, to highlight how quality-improvement practitioners can use the approach to underpin planning and implementation of patient-safety initiatives. The case study is specific to transcribing in children's hospices, but the strategies can be applied to other areas. The article explains that, while root cause analysis tools are useful for identifying the cause of, and possible solutions to, problems, they need to be considered carefully in terms of unintended consequences, and how the system into which the solution is implemented can be affected by the change. Analysis of problems using a systems-thinking approach can help practitioners to develop robust and well informed business cases to present to decision makers.

Unintended consequences of atmospheric injection of sulphate aerosols.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brady, Patrick Vane; Kobos, Peter Holmes; Goldstein, Barry

2010-10-01

Most climate scientists believe that climate geoengineering is best considered as a potential complement to the mitigation of CO{sub 2} emissions, rather than as an alternative to it. Strong mitigation could achieve the equivalent of up to -4Wm{sup -2} radiative forcing on the century timescale, relative to a worst case scenario for rising CO{sub 2}. However, to tackle the remaining 3Wm{sup -2}, which are likely even in a best case scenario of strongly mitigated CO{sub 2} releases, a number of geoengineering options show promise. Injecting stratospheric aerosols is one of the least expensive and, potentially, most effective approaches and formore » that reason an examination of the possible unintended consequences of the implementation of atmospheric injections of sulphate aerosols was made. Chief among these are: reductions in rainfall, slowing of atmospheric ozone rebound, and differential changes in weather patterns. At the same time, there will be an increase in plant productivity. Lastly, because atmospheric sulphate injection would not mitigate ocean acidification, another side effect of fossil fuel burning, it would provide only a partial solution. Future research should aim at ameliorating the possible negative unintended consequences of atmospheric injections of sulphate injection. This might include modeling the optimum rate and particle type and size of aerosol injection, as well as the latitudinal, longitudinal and altitude of injection sites, to balance radiative forcing to decrease negative regional impacts. Similarly, future research might include modeling the optimum rate of decrease and location of injection sites to be closed to reduce or slow rapid warming upon aerosol injection cessation. A fruitful area for future research might be system modeling to enhance the possible positive increases in agricultural productivity. All such modeling must be supported by data collection and laboratory and field testing to enable iterative modeling to increase the accuracy and precision of the models, while reducing epistemic uncertainties.« less

Lost in Translation: The Unintended Consequences of Advance Directive Law on Clinical Care

PubMed Central

Castillo, Lesley S.; Williams, Brie A.; Hooper, Sarah M.; Sabatino, Charles P.; Weithorn, Lois A.; Sudore, Rebecca L.

2011-01-01

Background Advance directive law may compromise the clinical effectiveness of advance directives. Purpose To identify unintended legal consequences of advance directive law that may prevent patients from communicating end-of-life preferences. Data Sources Advance directive legal statutes for all 50 U.S. states and the District of Columbia and English-language searches of LexisNexis, Westlaw, and MEDLINE from 1966 to August 2010. Study Selection Two independent reviewers selected 51 advance directive statutes and 20 articles. Three independent legal reviewers selected 105 legal proceedings. Data Extraction Two reviewers independently assessed data sources and used critical content analysis to determine legal barriers to the clinical effectiveness of advance directives. Disagreements were resolved by consensus. Data Synthesis Legal and content-related barriers included poor readability (that is, laws in all states were written above a 12th-grade reading level), health care agent or surrogate restrictions (for example, 40 states did not include same-sex or domestic partners as default surrogates), and execution requirements needed to make forms legally valid (for example, 35 states did not allow oral advance directives, and 48 states required witness signatures, a notary public, or both). Vulnerable populations most likely to be affected by these barriers included patients with limited literacy, limited English proficiency, or both who cannot read or execute advance directives; same-sex or domestic partners who may be without legally valid and trusted surrogates; and unbefriended, institutionalized, or homeless patients who may be without witnesses and suitable surrogates. Limitation Only appellate-level legal cases were available, which may have excluded relevant cases. Conclusion Unintended negative consequences of advance directive legal restrictions may prevent all patients, and particularly vulnerable patients, from making and communicating their end-of-life wishes and having them honored. These restrictions have rendered advance directives less clinically useful. Recommendations include improving readability, allowing oral advance directives, and eliminating witness or notary requirements. Primary Funding Source U.S. Department of Veterans Affairs and the Pfizer Foundation. PMID:21242368

Design and development of a film-based intervention about teenage men and unintended pregnancy: applying the Medical Research Council framework in practice.

PubMed

Aventin, Áine; Lohan, Maria; O'Halloran, Peter; Henderson, Marion

2015-04-01

Following the UK Medical Research Council's (MRC) guidelines for the development and evaluation of complex interventions, this study aimed to design, develop and optimise an educational intervention about young men and unintended teenage pregnancy based around an interactive film. The process involved identification of the relevant evidence base, development of a theoretical understanding of the phenomenon of unintended teenage pregnancy in relation to young men, and exploratory mixed methods research. The result was an evidence-based, theory-informed, user-endorsed intervention designed to meet the much neglected pregnancy education needs of teenage men and intended to increase both boys' and girls' intentions to avoid an unplanned pregnancy during adolescence. In prioritising the development phase, this paper addresses a gap in the literature on the processes of research-informed intervention design. It illustrates the application of the MRC guidelines in practice while offering a critique and additional guidance to programme developers on the MRC prescribed processes of developing interventions. Key lessons learned were: (1) know and engage the target population and engage gatekeepers in addressing contextual complexities; (2) know the targeted behaviours and model a process of change; and (3) look beyond development to evaluation and implementation. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Smoker-Free Workplace Policies: Developing a Model of Public Health Consequences of Workplace Policies Barring Employment to Smokers

PubMed Central

Houle, Brian; Siegel, Michael

2009-01-01

A marked shift in tobacco-related workplace health promotion intervention involves the adoption of policies barring employment to smokers. We discuss the potential public health consequences of these policies on those affected – smokers, their families, the surrounding community, and society at large. We find a lack of published evidence evaluating the effectiveness and consequences of these policies. By developing a model of policy effects, we outline possible unintended consequences. With such large gaps in the evidence base and the potential for deleterious consequences, we argue for increased discussion about the use of smoker-free employment policies as a public health intervention and for increased engagement of employers by the public health community in worksite health promotion. PMID:19168490

(Un)Intended Consequences: The First-Year College Experience of Female Students with Dual Credits

ERIC Educational Resources Information Center

Tobolowsky, Barbara F.; Allen, Taryn Ozuna

2016-01-01

Using Merton's (1957) anticipatory socialization theory, this qualitative study explored how participation in dual credit in high school helped introduce 12 female students to the academic and social aspects of college to ease their first-year transitions. These students, who entered one Texas university with between 15 and 78 dual credits,…

High-Achieving Black Students, Biculturalism, and Out-of-School STEM Learning Experiences: Exploring Some Unintended Consequences

ERIC Educational Resources Information Center

McGee, Ebony O.

2013-01-01

In this article, the author discusses the complex challenges of high-achieving Black students who are successful in becoming immersed in predominately White STEM (science, technology, engineering, and mathematics) spaces and how such immersion can exacerbate their experiences of racial stereotyping and other forms of racial bias. The author…

Environmental Public Health Policy for Asbestos in Schools: Unintended Consequences.

ERIC Educational Resources Information Center

Corn, Jacqueline Karnell

This book explores the history of asbestos in schools and buildings and how this issue shaped the development of public health policy. It provides insight into past policy including how and why action was taken and who caused it to be taken; it also offers guidance for the scientific and regulatory communities in the future. While explaining…

Making College More Expensive: The Unintended Consequences of Federal Tuition Aid. Policy Analysis. No. 531

ERIC Educational Resources Information Center

Wolfram, Gary

2005-01-01

As Congress debates the reauthorization of the Higher Education Act (HEA), it should heed Friedrich Hayek's warning that democracy is "peculiarly liable, if not guided by accepted common principles, to produce over-all results that nobody wanted." One result of the federal government's student financial aid programs is higher tuition…

Declining Physical Activity Levels as an Unintended Consequence of Abolishing Mandatory Campus Service Fees

ERIC Educational Resources Information Center

Jones, Sandra C.; Barrie, Lance

2011-01-01

Objective: This study investigates the effect of the introduction of voluntary student unionism and subsequent increase in campus facility fees on engagement in physical activity on campus. Participants: Participants were 1,904 students from a large regional NSW (Australia) university across 3 time periods (926 in 2005, 504 in 2006, and 474 in…

When Unintended Consequences Become the Main Effect: Evaluating the Development of a Foster Parent Training Program.

ERIC Educational Resources Information Center

Loesch-Griffin, Deborah A.; Ringstaff, Cathy

A program of education, training, and support provided to foster parents in a California county through a nonprofit agency is evaluated. The evaluators' experience indicates that: (1) evaluations are gaining in popularity; (2) role shifts by evaluators are sometimes difficult to perceive; (3) program staff are unlikely to use evaluative feedback…

Seeking Clarity in New Jersey for Leadership Preparation Program Design: Confusion, Fragility, and Unintended Consequences

ERIC Educational Resources Information Center

Doolittle, Gini

2013-01-01

In 2004, the New Jersey Department of Education issued a mandate to the 17 leadership preparation program providers to revise their leadership preparation programs after completing a critical friends review. This case study explores the challenges, programmatic, and political experiences of one preparation program as state support dwindled.…

Short vs. Long: Cognitive Load, Retention and Changing Class Structures

ERIC Educational Resources Information Center

Sheridan, Brandon; Smith, Ben; Pleggenkuhle-Miles, Erin

2017-01-01

University class structure is changing. To accommodate working students, programmes are increasing their offerings of long night classes--some lasting as long as six hours. While these long classes may be more convenient for students, they have unintended consequences as a result of cognitive load. Using a panel of 124 students (372 observations)…

Writing IEPs for the Audience of Teachers, Parents, and Students: The Case for the Communicative Individual Education Program

ERIC Educational Resources Information Center

Lucido, Richard J.

2013-01-01

Our current paradigm of Individualized Education Program (IEP) construction, the creation of a legal document or contract between parents and schools, needs rethinking. This paradigm's unintended consequences have resulted in vast inefficiencies in special education and have detracted from the core purpose of the IEP document, the communication of…

Studying the Impact of Federal and State Changes in Student Aid Policy at the Campus Level.

ERIC Educational Resources Information Center

Fenske, Robert H.; Dillon, Kathryn A.; Porter, John D.

1997-01-01

Argues that shifts in government policies can produce unintended consequences for needy students and the institutions they attend, and illustrates how campus units can cooperate to examine the impact of these changes through creation of longitudinal databases and data warehousing techniques. Describes the approach used and results of a study at…

Unintended Consequences or Testing the Integrity of Teachers and Students.

ERIC Educational Resources Information Center

Kimmel, Ernest W.

Large-scale testing programs are generally based on the assumptions that the test-takers experience standard conditions for taking the test and that everyone will do his or her own work without having prior knowledge of specific questions. These assumptions are not necessarily true. The ways students and educators use to get around standardizing…

Unintended Consequences of Tuition Discounting. New Agenda Series[TM].

ERIC Educational Resources Information Center

Davis, Jerry Sheehan

Tuition discounting, the use of institutionally funded grants to help defray students' college costs, came into vogue in the late 1970s and has since become standard practice at U.S. four-year colleges and universities. Institutions use the discounts for a variety of purposes, but generally their use is to manage or tailor enrollment in some…

Can We Protect Our Communities from Natural Disasters?

ERIC Educational Resources Information Center

Robertson, William C.

2010-01-01

There are two ways one might protect communities from natural disasters. One is to minimize the damage from disasters, and the other is to prevent the disasters in the first place. However, preventing disasters is another matter, and in trying to do so, we have to be aware of unintended consequences of our efforts. To address the issues associated…

The Centrality of Teachers' Judgement Practice in Assessment: A Study of Standards in Moderation

ERIC Educational Resources Information Center

Wyatt-Smith, Claire; Klenowski, Val; Gunn, Stephanie

2010-01-01

There is a strong quest in several countries including Australia for greater national consistency in education and intensifying interest in standards for reporting. Given this, it is important to make explicit the intended and unintended consequences of assessment reform strategies and the pressures to pervert and conform. In a policy context that…

Early Learning: Unintended Consequences of the Push to Close the Gap by Increasing Quality

ERIC Educational Resources Information Center

Sirinides, Phil

2015-01-01

Public education in the United States continues to be marked by persistent disparities in test scores, high school completion rates, and college enrollment rates based on factors such as students' household income, race/ethnicity, and gender. These achievement gaps are already in evidence before children begin school. Students that are assessed as…

Sustainable forestry in the balance

Treesearch

Stephen R. Shifley

2006-01-01

In the United States we increasingly restrict wood production in the name of sustainability while going abroad for an ever larger share of the wood we consume, even though our own forest resources per capita are greater than the rest of the Earth. The unintended consequence is we transfer impacts of harvesting and consumption elsewhere. If we believe impacts of...

Adequate (Or Adipose?) Yearly Progress: Assessing the Effect of "No Child Left Behind" on Children's Obesity

ERIC Educational Resources Information Center

Anderson, Patricia M.; Butcher, Kristin F.; Schanzenbach, Diane Whitmore

2017-01-01

This paper investigates how accountability pressures under No Child Left Behind (NCLB) may have affected students' rate of overweight. Schools facing pressure to improve academic outcomes may reallocate their efforts in ways that have unintended consequences for children's health. To examine the impact of school accountability, we create a unique…

"Cigarettes Are Priority": A Qualitative Study of How Australian Socioeconomically Disadvantaged Smokers Respond to Rising Cigarette Prices

ERIC Educational Resources Information Center

Guillaumier, Ashleigh; Bonevski, Billie; Paul, Christine

2015-01-01

Despite substantial modelling research assessing the impact of cigarette taxes on smoking rates across income groups, few studies have examined the broader financial effects and unintended consequences on very low-income smokers. This study explored how socioeconomically disadvantaged smokers in a high-income country manage smoking costs on…

Influences of the Industrial Culture on a Partnership Program, Teachers, and Curriculum.

ERIC Educational Resources Information Center

Zuga, Karen F.

As schools begin to form partnerships with industry, many of the differences in the cultural values of each institution have not been explored or considered within the partnership agreements. A lack of knowledge and preparation about cultural differences between the partners can lead to unintended consequences. As teachers begin to work in…

In the Picture or off the Wall? Ethical Regulation, Research Habitus, and Unpeopled Ethnography

ERIC Educational Resources Information Center

Hurdley, Rachel

2010-01-01

This article focuses on two unintended consequences of ethical regulation of social enquiry: the exclusion of participants and, subsequently, a transformation of research practice. An ethnography of corridor life in a large university building forms the basis of the discussion. Originally intended as a pilot for a broader study of informal…

Catholic Schools and the Common Good

ERIC Educational Resources Information Center

DeFiore, Leonard

2006-01-01

There are at least two ways to think about the Common Good. One is the intentional, direct attempt to provide benefits to those beyond oneself and those connected to oneself. The second consists of those unintended consequences of the pursuit of some other benefit, usually private but not necessarily so. Probably the best-known example is that of…

Some Latent Effects of Current Social Policies on the Elderly.

ERIC Educational Resources Information Center

Valas, Lee

Current social policies for the elderly are intended to assure a better standard of living, promote adequate medical treatment, and assure safe and clean housing, but they have unintended consequences. It is argued that these social policies serve to keep older people in a state of dependency, poverty, and segregation. Some social policies may be…

Harvest intensity and competition control impacts on loblolly pine fusiform rust incidence

Treesearch

Robert J. Eaton; Paula Spaine; Felipe G. Sanchez

2006-01-01

The Long Term Soil Productivity experiment tests the effects of soil compaction, surface organic matter removal, and understory control on net primary productivity. An unintended consequence of these treatments may be an effect on the incidence of fusiform rust [Cronartium quercuum (Berk.) Miy. ex Shirai f. sp. fusiforme Burdsall et Snow]. Loblolly pine (Pinus...

Controlling flooding and water pollution with upland and streamside vegetation systems

Treesearch

Michael Dosskey

2003-01-01

Substantial research and development effort in the U.S. is being spent on developing strategies that address flooding and water pollution problems in agricultural areas. Concerns have been raised about the costs of flood damage, degradation of productive farm land, and declining water quality that are now recognized as unintended consequences of intensive, high-yield...

Developmental Cognitive Neuroscience of Adolescent Sexual Risk and Alcohol Use

PubMed Central

Ryman, Sephira G.; Gillman, Arielle S.; Weiland, Barbara J.; Thayer, Rachel E.; Bryan, Angela D.

2018-01-01

Human adolescents engage in very high rates of unprotected sex. This behavior has a high potential for unintended, serious, and sustained health consequences including HIV/AIDS. Despite these serious health consequences, we know little about the neural and cognitive factors that influence adolescents’ decision-making around sex, and their potential overlap with behaviorally co-occurring risk behaviors, including alcohol use. Thus, in this review, we evaluate the developmental neuroscience of sexual risk and alcohol use for human adolescents with an eye to relevant prevention and intervention implications. PMID:26290051

Unintended consequences of machine learning in medicine?

PubMed

McDonald, Laura; Ramagopalan, Sreeram V; Cox, Andrew P; Oguz, Mustafa

2017-01-01

Machine learning (ML) has the potential to significantly aid medical practice. However, a recent article highlighted some negative consequences that may arise from using ML decision support in medicine. We argue here that whilst the concerns raised by the authors may be appropriate, they are not specific to ML, and thus the article may lead to an adverse perception about this technique in particular. Whilst ML is not without its limitations like any methodology, a balanced view is needed in order to not hamper its use in potentially enabling better patient care.

Patient-physician relationships in the information age.

PubMed

Johnson, G L; Ramaprasad, A

2000-01-01

The ready and free availability of information that characterizes the Information Age--with health information on the Internet and direct-to-consumer advertising of prescription drugs as two of these major information sources--is bringing about significant changes in patient-physician relationships. By developing a matrix of intended and unintended consequences and desirable and undesirable consequences, it's possible to have a better understanding of the impact of the free flow of information on this traditional relationship. Ultimately, any marketing approach to these newly empowered patients must take their level of health care knowledge into consideration.

Online Professionalism and the Mirror of Social Media

PubMed Central

Kind, Terry; Chretien, Katherine C.

2010-01-01

The rise of social media—content created by Internet users and hosted by popular sites such as Facebook, Twitter, YouTube, and Wikipedia, and blogs—has brought several new hazards for medical professionalism. First, many physicians may find applying principles for medical professionalism to the online environment challenging in certain contexts. Second, physicians may not consider the potential impact of their online content on their patients and the public. Third, a momentary lapse in judgment by an individual physician to create unprofessional content online can reflect poorly on the entire profession. To overcome these challenges, we encourage individual physicians to realize that as they “tread” through the World Wide Web, they leave behind a “footprint” that may have unintended negative consequences for them and for the profession at large. We also recommend that institutions take a proactive approach to engage users of social media in setting consensus-based standards for “online professionalism.” Finally, given that professionalism encompasses more than the avoidance of negative behaviors, we conclude with examples of more positive applications for this technology. Much like a mirror, social media can reflect the best and worst aspects of the content placed before it for all to see. PMID:20632121

Short message service or disService: issues with text messaging in a complex medical environment.

PubMed

Wu, Robert; Appel, Lora; Morra, Dante; Lo, Vivian; Kitto, Simon; Quan, Sherman

2014-04-01

Hospitals today are experiencing major changes in their clinical communication workflows as conventional numeric paging and face-to-face verbal conversations are being replaced by computer mediated communication systems. In this paper, we highlight the importance of understanding this transition and discuss some of the impacts that may emerge when verbal clinical conversations are replaced by short text messages. In-depth interviews (n=108) and non-participatory observation sessions (n=260h) were conducted on the General Internal Medicine wards at five academic teaching hospitals in Toronto, Canada. From our analysis of the qualitative data, we identified two major themes. De-contextualization of complex issues led to an increase in misinterpretation and an increase in back and forth messaging for clarification. Depersonalization of communication was due to less verbal conversations and face-to-face interactions and led to a negative impact on work relationships. Text-based communication in hospital settings led to the oversimplification of messages and the depersonalization of communication. It is important to recognize and understand these unintended consequences of new technology to avoid the negative impacts to patient care and work relationships. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Online professionalism and the mirror of social media.

PubMed

Greysen, S Ryan; Kind, Terry; Chretien, Katherine C

2010-11-01

The rise of social media--content created by Internet users and hosted by popular sites such as Facebook, Twitter, YouTube, and Wikipedia, and blogs--has brought several new hazards for medical professionalism. First, many physicians may find applying principles for medical professionalism to the online environment challenging in certain contexts. Second, physicians may not consider the potential impact of their online content on their patients and the public. Third, a momentary lapse in judgment by an individual physician to create unprofessional content online can reflect poorly on the entire profession. To overcome these challenges, we encourage individual physicians to realize that as they "tread" through the World Wide Web, they leave behind a "footprint" that may have unintended negative consequences for them and for the profession at large. We also recommend that institutions take a proactive approach to engage users of social media in setting consensus-based standards for "online professionalism." Finally, given that professionalism encompasses more than the avoidance of negative behaviors, we conclude with examples of more positive applications for this technology. Much like a mirror, social media can reflect the best and worst aspects of the content placed before it for all to see.

The prepared emotional reflex: intentional preparation of automatic approach and avoidance tendencies as a means to regulate emotional responding.

PubMed

Eder, Andreas B; Rothermund, Klaus; Proctor, Robert W

2010-08-01

Advance preparation of action courses toward emotional stimuli is an effective means to regulate impulsive emotional behavior. Our experiment shows that performing intentional acts of approach and avoidance in an evaluation task influences the unintended activation of approach and avoidance tendencies in another task in which stimulus valence is irrelevant. For the evaluation-relevant blocks, participants received either congruent (positive-approach, negative-avoidance) or incongruent (positive-avoidance, negative-approach) mapping instructions. In the evaluation-irrelevant blocks, approach- and avoidance-related lever movements were selected in response to a stimulus feature other than valence (affective Simon task). Response mapping in the evaluation task influenced performance in the evaluation-irrelevant task: An enhanced affective Simon effect was observed with congruent mapping instructions; in contrast, the effect was reversed when the evaluation task required incongruent responses. Thus, action instructions toward affective stimuli received in one task determined affective response tendencies in another task where these instructions were not in effect. These findings suggest that intentionally prepared short-term links between affective valence and motor responses elicit associated responses without a deliberate act of will, operating like a "prepared reflex." Copyright 2010 APA

"Go Grrrls": A Randomized Controlled Trial of a Gender-Specific Intervention to Reduce Sexual Risk Factors in Middle School Females

ERIC Educational Resources Information Center

LeCroy, Craig Winston; McCullough Cosgrove, Jenny; Cotter, Katie; Fordney, Marie

2018-01-01

Purpose: Adolescent females continue to face health consequences associated with risky sexual behaviors such as unintended pregnancies and sexually transmitted diseases. The purpose of this study was to investigate the efficacy of a gender-specific intervention targeted to early adolescent females. Method: This study used an intent to treat…

Adequate (or Adipose?) Yearly Progress: Assessing the Effect of "No Child Left Behind" on Children's Obesity. NBER Working Paper No. 16873

ERIC Educational Resources Information Center

Anderson, Patricia M.; Butcher, Kristin F.; Schanzenbach, Diane Whitmore

2011-01-01

This paper investigates how accountability pressures under No Child Left Behind (NCLB) may affect children's rate of overweight. Schools facing increased pressures to produce academic outcomes may reallocate their efforts in ways that have unintended consequences for children's health. For example, schools may cut back on recess and physical…

The Tao of treating weeds: Reaching for restoration in the northern Rocky Mountains

Treesearch

Lisa-Natalie Anjozian

2008-01-01

Noxious weeds are a serious problem that is spreading across the West. Herbicides such as Picloram have proven to be powerful tools in reducing weed invaders, although use of this tool has often produced unintended consequences. Broadleaf herbicides kill forbs, such as the noxious knapweed, but also harm native forbs such as arrowleaf balsamroot. Removing weedy forbs...

Lesbian, Gay, and Bisexual Victimization in the Military: An Unintended Consequence of "Don't Ask, Don't Tell"?

ERIC Educational Resources Information Center

Burks, Derek J.

2011-01-01

The integration of lesbian, gay, and bisexual (LGB) individuals into the U.S. military is a long-standing and politically and socially divisive issue. Exclusionary and pseudo-inclusionary policies that restrict openly LGB individuals from military service are also of long duration. Yet LGB servicemembers have continued to serve covertly in the…

Human Trafficking in Southeast Asia: Causes and Policy Implications

DTIC Science & Technology

2009-06-01

use these networks throughout the region to transport equally destabilizing material, such as drugs and arms.3 As a result of the vast number of...18 Feingold, Human Trafficking, 32. 19 Ruta Tumenaite, “Rise in human trafficking tied to poverty, international church...79 Chiyuki Aoi, Cedric de Conin, Ramesh Thakur, eds., Unintended Consequences of Peacekeeping Operations (Tokyo, Japan: United Nations University

Is the Federal Government in the Business of Improving Charter Schools? An Investigation of the Unintended Consequences of ESEA Waivers

ERIC Educational Resources Information Center

Weiner, Jennie; Dougherty, Shaun M.

2016-01-01

This study investigates how recent policies employed under states' waivers to the Elementary and Secondary Education Act (ESEA) intersect with charter schools' purpose and functioning. By collecting and analyzing all ESEA waivers granted in 2013, we find that charter schools are disproportionately represented among schools as identified in the…

Knowledge and Authority in Shift: A Linguistic Ethnography of Multilingual News Media in the Buryat Territories of Russia

ERIC Educational Resources Information Center

Graber, Kathryn Elizabeth

2012-01-01

How might institutional projects to improve the status of minority languages and publics have unintended and contradictory consequences? This dissertation examines media and language practices in order to illuminate the everyday sociocultural processes by which the value of knowledge is figured. It focuses on news media institutions in the Buryat…

Early Childhood Activism, Minor Politics and Resuscitating Vision: A Tentative Foray into the Use of "Intersections" to Influence Early Childhood Policy

ERIC Educational Resources Information Center

Press, Frances; Skattebol, Jen

2007-01-01

Many postmodern and post-structural analyses of government policies affecting early childhood education stress the hegemonic nature of neo-liberalism and subsequently primarily focus upon identifying the manifestation of neo-liberal values in such interventions. An unintended and stultifying consequence of such analyses is, at times, to close off…

The "Missing Girls" of China and the Unintended Consequences of the One Child Policy

ERIC Educational Resources Information Center

Ebenstein, Avraham

2010-01-01

High ratios of males to females in China have concerned researchers (Sen 1990, Yi et al. 1993) and the recent increase has alarmed policymakers worldwide. This paper presents an analysis of China's census data that indicates that the "missing girls" phenomenon is causally linked to enforcement of the One Child Policy. Fertility is lower…

How Does Research Evaluation Impact Educational Research? Exploring Intended and Unintended Consequences of Research Assessment in the United Kingdom, 1986-2014

ERIC Educational Resources Information Center

Marques, Marcelo; Powell, Justin J. W.; Zapp, Mike; Biesta, Gert

2017-01-01

Research evaluation systems in many countries aim to improve the quality of higher education. Among the first of such systems, the UK's Research Assessment Exercise (RAE) dating from 1986 is now the Research Excellence Framework (REF). Highly institutionalised, it transforms research to be more accountable. While numerous studies describe the…

The Law of Unintended Consequences Revisited: The Case of Ricci v. DeStefano

ERIC Educational Resources Information Center

Vedder, Richard; Denhart, Matthew; Malesick, Michael; Templeton, Jordan

2009-01-01

Deciding it necessary to review the earlier ruling of the Second Circuit court, on January 9, 2009 the U.S. Supreme Court granted certiorari in the case "Ricci v. DeStefano." The case originates from New Haven, Connecticut where a group of firefighters argue that city officials violated their Title VII rights by dismissing the results of…

Do Work Incentives Have Unintended Consequences? Measuring "Entry Effects" in the Self-Sufficiency Project.

ERIC Educational Resources Information Center

Berlin, Gordon; Bancroft, Wendy; Card, David; Lin, Winston; Robins, Philip K.

The Self-Sufficiency Project (SSP) is a Canadian social demonstration and research project designed to test an employment alternative to welfare. The SSP makes work pay by offering generous earnings supplements to long-term, single-parent welfare recipients who find full-time jobs and leave Canada's Income Assistance (IA) welfare system. The SSP's…

Inclusive Education's Promises and Trajectories: Critical Notes about Future Research on a Venerable Idea

ERIC Educational Resources Information Center

Artiles, Alfredo J.; Kozleski, Elizabeth B.

2016-01-01

The purpose of this article is to offer critical notes on inclusive education research in the U.S. We discuss issues germane to conceptual clarity and the ways in which inclusive education interacts with reforms that share equity goals, noting disruptions and unintended consequences that arise at the nexus of these reforms. In addition, we…

SPECIAL PURPOSE IT DERAILED: UNINTENDED CONSEQUENCES OF UNIVERSAL IT LAWS AND POLICIES

DTIC Science & Technology

2017-10-26

Information Services Division ........................ 3 Figure 2: iNET Instrumentation Telemetry Ground Station...consolidate local Information Technology (IT) networks into an enterprise architecture to reduce costs and to increase security. Leadership coined this...IT network was established to link Air Force and contractor sites to seamlessly share program information . So when Air Force IT leadership tried to

The Race of Nimble Fingers: Changing Patterns of Children's Work in Post-Apartheid South Africa

ERIC Educational Resources Information Center

Levine, Susan

2011-01-01

This article considers the socioeconomic changes that have impacted on the lives of poor children since the end of apartheid in South Africa. In particular, the article highlights the ways in which child labour legislation after 1994 has had the unintended consequence of deepening chronic hunger and childhood poverty on food-rich farms where…

Making Schools Safer? The Unintended Consequences of Good Intentions

ERIC Educational Resources Information Center

Tanner, Julian

2009-01-01

It is now over 10 years since the shootings at Columbine High School in April 1999. While Columbine was not the first school shooting in the United States, or the last, it remains the most important. For many people, but especially for parents, the name "Columbine" has become a one-word summation of fears and concerns about the condition…

Involving Diverse Communities of Practice to Minimize Unintended Consequences of Test-Based Accountability Systems

ERIC Educational Resources Information Center

Behizadeh, Nadia; Engelhard, George, Jr.

2015-01-01

In his focus article, Koretz (this issue) argues that accountability has become the primary function of large-scale testing in the United States. He then points out that tests being used for accountability purposes are flawed and that the high-stakes nature of these tests creates a context that encourages score inflation. Koretz is concerned about…

Latino Employment and Black Violence: The Unintended Consequence of U.S. Immigration Policy

ERIC Educational Resources Information Center

Shihadeh, Edward S.; Barranco, Raymond E.

2010-01-01

U.S. immigration policies after 1965 fueled a rise in the Latino population and, thus, increased the competition for low-skill jobs. We examine whether Latino immigration and Latino dominance of low-skill industries increases black urban violence. Using city-level data for the year 2000, we find that (1. Latino immigration is positively linked to…

Intended and Unintended Consequences of Student Use of an Online Questioning Environment

ERIC Educational Resources Information Center

Ng'ambi, Dick; Brown, Irwin

2009-01-01

While supplementation of face-to-face (F2F) teaching with online engagement is increasingly common, the educators' challenge of teaching F2F personalities and facilitating online personalities has not been widely explored. In this paper, we report on a project in which 1st-year students attended F2F sessions and engaged with an anonymous online…

A Broken Promise: Examining the Merit-Aid Policy and Implementation Gap in the Michigan Promise Scholarship

ERIC Educational Resources Information Center

Daun-Barnet, Nathan; Hermsen, Albert; Vedder, Lori; Mabry, Beth

2013-01-01

In 2006, Michigan changed their traditional merit award to a credit contingent program based upon successful completion of 60 college credits. The Michigan Promise Scholarship was crafted by state policymakers without input from the financial aid community. This case study suggests that the change in policy resulted in two unintended consequences:…

Future trends in the health care economy.

PubMed

Kajander, J; Samuels, M

1996-01-01

Most articles on the future of health care are by professionals involved in the delivery of health care services. This article is unique in that trends are examined from the perspective of the public and purchasers of care. The authors focus on 12 trends that are or will be affecting the industry, and on the sometimes unintended consequences and new conflicts that may develop.

(Un)Intended Consequences? The Impact of the Brown v. Board of Education Decision on the Employment Status of Black Educators

ERIC Educational Resources Information Center

Tillman, Linda C.

2004-01-01

The displacement of Black educators after the "Brown v. Board of Education" decision was an extraordinary social injustice. The wholesale firing of Black educators threatened the economic, social, and cultural structure of the Black community, and ultimately the social, emotional, and academic success of Black children. The author presents a…

Responses of Schools to Accountability Systems Using Multiple Measures: The Case of New York City Elementary Schools

ERIC Educational Resources Information Center

Ehren, M. C. M.; Hatch, T.

2013-01-01

Many studies point to potential unintended consequences of accountability systems such as when schools narrow their teaching to fixate on tested subjects. As a result, some states and districts in the USA have complemented the federal test-based accountability system with additional measures of educational practices to hold schools accountable on…

A new invasive species in maryland: the biology and distribution of kudzu bug, megacopta cribraria (fabricius) (femiptera: plataspidae)

USDA-ARS?s Scientific Manuscript database

The relaxation of trade restrictions in the 1960s and 70s led to an unintended exchange of invasive insect species as well as manufactured goods between the United States and its new trade partners. Consequently, the number of exotic insect pests accidently entering and taking up residence in the U...

Is the Medium Really the Message? A Comparison of Face-to-Face, Telephone, and Internet Focus Group Venues

ERIC Educational Resources Information Center

Gothberg, June; Applegate, Brooks; Reeves, Patricia; Kohler, Paula; Thurston, Linda; Peterson, Lori

2013-01-01

With increased use of technology in qualitative research, it is important to understand unintended, unanticipated, and unobvious consequences to the data. Using a side-by-side comparison of face-to-face, telephone, and Internet with video focus groups, we examined the yield differences of focus group venue (medium) to the data (message) rendered…

Emergent Cultural Change: Unintended Consequences of a Strategic Information Technology Services Implementation in a United Kingdom University

ERIC Educational Resources Information Center

Waring, Teresa; Skoumpopoulou, Dimitra

2013-01-01

Over the past 20 years, universities in the United Kingdom have been undergoing a dramatic period of transformation and change which can be attributed to the expansion of the higher education sector, the growth in student numbers and the development of an ideological approach to public service management referred to as "new…

Good Intentions and Unanticipated Effects: The Unintended Consequences of the Application of Technology in Teaching and Learning Environments

ERIC Educational Resources Information Center

Nworie, John; Haughton, Noela

2008-01-01

The nature of disruptions encountered by classroom teachers is changing. In the past, disruptions were typically students chewing gum, eating or taking naps during class, engaging in acts of incivility including the occasional brawl, and the like. These disturbances, in many ways, pale in comparison to those accompanying the use of technologies in…

Effects of picloram application on community dominants vary with initial levels of spotted knapweed (Centaurea stoebe) invasion

Treesearch

Yvete K. Ortega; Dean E. Pearson

2010-01-01

Broadleaf herbicides are commonly used to suppress exotic weeds with the intent of releasing native species from negative impacts of invasion. However, weed control measures can also have unintended consequences that should be considered along with intended effects. We conducted a controlled field experiment within bunchgrass communities of western Montana to examine...

The Unintended Consequences of World War II and the Victory Corps on Austin High School

ERIC Educational Resources Information Center

Blankenship, Whitney

2016-01-01

Within two weeks of the bombing of Pearl Harbor, the U.S. Office of Education Wartime Commission was formed to provide guidance to institutions of higher learning and public schools for the duration of the war. The goals set for the commission included: (1) facilitating the adjustment of education agencies to war needs; (2) informing government…

Student Engagement Patterns over the Duration of Level 1 and Level 3 Geography Modules: Influences on Student Attendance, Performance and Use of Online Resources

ERIC Educational Resources Information Center

Stewart, Martyn; Stott, Tim; Nuttall, Anne-Marie

2011-01-01

Greater flexibility in delivery resulting from increased use of e-learning will inevitably change the way university students approach studying. Recent studies have examined relationships between attendance, online learning and performance but findings are inconclusive. One concern is that an unintended consequence of placing lecture resources…

"Diamond in the Rough": The Impact of a Remedial Program on College Access and Opportunity for Black Males at an Historically Black Institution

ERIC Educational Resources Information Center

Palmer, Robert T.; Davis, Ryan J.

2012-01-01

Researchers, policymakers, and administrations have shown great concern over the efficacy of college remediation, which has prompted some states to eliminate remedial programs from public 4-year institutions. However, research suggests that eliminating these programs may have unintended consequences on college access and opportunity for…

What Would You Ideally Do if There Were No Targets? An Ethnographic Study of the Unintended Consequences of Top-Down Governance in Two Clinical Settings

ERIC Educational Resources Information Center

Allard, Jon; Bleakley, Alan

2016-01-01

Top-down policy directives, such as targets and their associated protocols, may be driven politically rather than clinically and can be described as macro-political texts. While targets supposedly provide incentives for healthcare services, they may unintentionally shape practices of accommodation rather than implementation, deflecting…

The Computer as an Authority Figure: Some Effects of CAI on Student Perception of Teacher Authority. Technical Report Number 29.

ERIC Educational Resources Information Center

Brod, Rodney L.

A sociological theory of authority was used to investigate some nonintellective, perhaps unintended, consequences of computer-assisted instruction (CAI) upon student's attitudes and orientations toward the organization of the school. An attitudinal questionnaire was used to survey attitudes toward the teacher and the computer in a junior high…

Can landscape-level ecological restoration influence fire risk? A spatially-explicit assessment of a northern temperate-southern boreal forest landscape

Treesearch

Douglas J. Shinneman; Brian J. Palik; Meredith W. Cornett

2012-01-01

Management strategies to restore forest landscapes are often designed to concurrently reduce fire risk. However, the compatibility of these two objectives is not always clear, and uncoordinated management among landowners may have unintended consequences. We used a forest landscape simulation model to compare the effects of contemporary management and hypothetical...

Controlled Substance Lock-In Programs: Examining An Unintended Consequence Of A Prescription Drug Abuse Policy.

PubMed

Roberts, Andrew W; Farley, Joel F; Holmes, G Mark; Oramasionwu, Christine U; Ringwalt, Chris; Sleath, Betsy; Skinner, Asheley C

2016-10-01

Controlled substance lock-in programs are garnering increased attention from payers and policy makers seeking to combat the epidemic of opioid misuse. These programs require high-risk patients to visit a single prescriber and pharmacy for coverage of controlled substance medication services. Despite high prevalence of the programs in Medicaid, we know little about their effects on patients' behavior and outcomes aside from reducing controlled substance-related claims. Our study was the first rigorous investigation of lock-in programs' effects on out-of-pocket controlled substance prescription fills, which circumvent the programs' restrictions and mitigate their potential public health benefits. We linked claims data and prescription drug monitoring program data for the period 2009-12 for 1,647 enrollees in North Carolina Medicaid's lock-in program and found that enrollment was associated with a roughly fourfold increase in the likelihood and frequency of out-of-pocket controlled substance prescription fills. This finding illuminates weaknesses of lock-in programs and highlights the need for further scrutiny of the appropriate role, optimal design, and potential unintended consequences of the programs as tools to prevent opioid abuse. Project HOPE—The People-to-People Health Foundation, Inc.

The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations.

PubMed

Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

2014-06-01

To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations

PubMed Central

Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

2014-01-01

Objective To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Data Sources/Study Setting Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Study Design Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Principal Findings Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Conclusions Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. PMID:24417309

Health Information Technology Coordination to Support Patient-centered Care Coordination.

PubMed

Steichen, O; Gregg, W

2015-08-13

To select papers published in 2014, illustrating how information technology can contribute to and improve patient-centered care coordination. The two section editors performed a literature review from Medline and Web of Science to select a list of candidate best papers on the use of information technology for patient-centered care coordination. These papers were peer-reviewed by external reviewers and three of them were selected as "best papers". The first selected paper reports a qualitative study exploring the gap between current practices of care coordination in various settings and idealized longitudinal care plans. The second selected paper illustrates several unintended consequences of HIT designed to improve care coordination. The third selected paper shows that advanced analytic techniques in medical informatics can be instrumental in studying patient-centered care coordination. The realization of true patient-centered care coordination is dependent upon a number of factors. Standardization of clinical documentation and HIT interoperability across organization and settings is a critical prerequisite for HIT to support patient-centered care coordination. Enabling patient involvement is an efficient means for goal setting and health information sharing. Additionally, unintended consequences of HIT tools (both positive and negative) must be measured and taken into account for quality improvement.

Integrating Pregnancy Ambivalence and Effectiveness in Contraceptive Choice.

PubMed

Sundstrom, Beth; Ferrara, Merissa; DeMaria, Andrea L; Baker-Whitcomb, Annalise; Payne, Jackelyn B

2017-07-01

Approximately 70% of pregnancies among young unmarried women living in the United States are unintended. Unintended pregnancy results in negative health and economic outcomes for infants, children, women, and families. Further research into the decision-making process of contraceptive selection is needed to meet young women's contraceptive needs in the United States. Overall, 53 women ages 18-24 years completed in-depth qualitative interviews. Researchers used analytical techniques from grounded theory and HyperRESEARCH 3.5.2 qualitative data analysis software to identify emergent themes. Problematic integration theory provided a theoretical lens to identify young women's probabilistic and evaluative orientations toward contraception. Researchers identified two profound values at stake to participants regarding their contraceptive decisions: avoiding pregnancy in the present, and protecting future fertility. Participants resisted long-acting reversible contraception (LARC) methods (e.g., the intrauterine device and the implant) due to concerns about safety and fears about infertility. Participants experienced ambivalence toward the idea of pregnancy, which complicated contraceptive decisions, especially regarding long-term methods. Uncertainty led participants to rationalize their use of less effective methods and reduced information seeking. Findings from this study offer practical suggestions for practitioners and health communication campaign planners. Contraceptive access campaigns should focus on the effectiveness, safety, and convenience of LARC methods. Messages should help young women make contraceptive choices that better fit their needs in order to reduce unintended pregnancy.

Intended and Unintended Effects of State-Mandated High School Science and Mathematics Course Graduation Requirements on Educational Attainment

PubMed Central

Plunk, Andrew D.; Tate, William F.; Bierut, Laura J.; Grucza, Richard A.

2014-01-01

Mathematics and science course graduation requirement (CGR) increases in the 1980s and 1990s might have had both intended and unintended consequences. Using logistic regression with Census and American Community Survey (ACS) data (n = 2,892,444), we modeled CGR exposure on (a) high school dropout, (b) beginning college, and (c) obtaining any college degree. Possible between-groups differences were also assessed. We found that higher CGRs were associated with higher odds to drop out of high school, but results for the college-level outcomes varied by group. Some were less likely to enroll, whereas others who began college were more likely to obtain a degree. Increased high school dropout was consistent across the population, but some potential benefit was also observed, primarily for those reporting Hispanic ethnicity. PMID:25541563

DISE: A Seed-Dependent RNAi Off-Target Effect That Kills Cancer Cells.

PubMed

Putzbach, William; Gao, Quan Q; Patel, Monal; Haluck-Kangas, Ashley; Murmann, Andrea E; Peter, Marcus E

2018-01-01

Off-target effects (OTEs) represent a significant caveat for RNAi caused by substantial complementarity between siRNAs and unintended mRNAs. We now discuss the existence of three types of seed-dependent OTEs (sOTEs). Type I involves unintended targeting through the guide strand seed of an siRNA. Type II is caused by the activity of the seed on the designated siRNA passenger strand when loaded into the RNA-induced silencing complex (RISC). Both type I and II sOTEs will elicit unpredictable cellular responses. By contrast, in sOTE type III the guide strand seed preferentially targets essential survival genes resulting in death induced by survival gene elimination (DISE). In this Opinion article, we discuss DISE as a consequence of RNAi that may preferentially affect cancer cells. Copyright © 2017 Elsevier Inc. All rights reserved.

Why do infants begin to talk? Language as an unintended consequence.

PubMed

Locke, J L

1996-06-01

Scholars have addressed a range of questions about language development, but for some reason have neglected to ask why infants begin to talk. Biologists often prefer 'how' to 'why' questions, but it is possible to ask about the immediate consequences of developing behaviours--an acceptable strategy for attacking causation--and psycholinguists can study the immediate consequences to the infant of behaviours that lead to linguistic competence. This process is demonstrated with a series of illustrative proposals as to the short- and long-term consequences of vocal learning and utterance storage, two developmental phases that lead to talking, as well as the act of talking itself. The goal is to encourage investigation of behavioural dispositions that nudge the child, by degrees, towards proficiency in the use of spoken language.

An intervention delivered by text message to increase the acceptability of effective contraception among young women in Palestine: study protocol for a randomised controlled trial.

PubMed

McCarthy, Ona L; Wazwaz, Ola; Jado, Iman; Leurent, Baptiste; Edwards, Phil; Adada, Samia; Stavridis, Amina; Free, Caroline

2017-10-03

Unintended pregnancy can negatively impact women's lives and is associated with poorer health outcomes for women and children. Many women, particularly in low- and middle-income countries, continue to face obstacles in avoiding unintended pregnancy. In the State of Palestine, a survey conducted in 2006 estimated that 38% of pregnancies are unintended. In 2014, unmet need for contraception was highest among young women aged 20-24 years, at 15%. Mobile phones are increasingly being used to deliver health support. Once developed, interventions delivered by mobile phone are often cheaper to deliver than face-to-face support. The London School of Hygiene and Tropical Medicine and the Palestinian Family Planning and Protection Association have partnered to develop and evaluate a contraceptive behavioural intervention for young women in Palestine delivered by mobile phone. The intervention was developed guided by behavioural science and consists of short, mobile phone text messages that contain information about contraception and behaviour change methods delivered over 4 months. We will evaluate the intervention by conducting a randomised controlled trial. Five hundred and seventy women aged 18-24 years, who do not report using an effective method of contraception, will be allocated with a 1:1 ratio to receive the intervention text messages or control text messages about trial participation. The primary outcome is self-reported acceptability of at least one method of effective contraception at 4 months. Secondary outcomes include the use of effective contraception, acceptability of individual methods, discontinuation, service uptake, unintended pregnancy and abortion. Process outcomes include knowledge, perceived norms, personal agency and intervention dose received. Outcomes at 4 months will be compared between arms using logistic regression. This trial will determine the effect of the intervention on young women's attitudes towards the most effective methods of contraception. If the intervention is found to be effective, the intervention will be implemented widely across Palestine. The results could also be used to design a larger trial to establish its effect on unintended pregnancy. ClinicalTrials.gov, ID: NCT02905461 . Registered on 14 September 2016.

Pharmaceutical reform in South Korea and the lessons it provides.

PubMed

Kim, Hak-Ju; Ruger, Jennifer Prah

2008-01-01

Through implementation of its 2000 pharmaceutical reform, the South Korean government expected to reduce the cost of medications and improve service levels, medical appropriateness of care, and drug effectiveness. However, despite the reform's lofty goals, unintended consequences have distorted the supply of medical services and spending. These consequences have included increasing the use of uninsured services, prescribing high-price drugs, and a growing market share for multinational drug companies. Further reforms are needed to reduce the measure's adverse effects. This paper examines the Korean mandatory prescription system and offers an analysis of Korea's reforms.

Problems in counting and paying for multidisciplinary outpatient clinics.

PubMed

Jackson, T; Sevil, P

1997-01-01

Policy-makers have always found it problematic to formulate fair and consistent counting rules for public hospital outpatient activities. In the context of output-based funding, such rules have consequences which can affect patient care. This paper reviews the rationale for organising multidisciplinary clinics and reports on a series of focus groups convened in four Melbourne teaching hospitals to consider funding policy for such clinics. It discusses issues of targeting outpatient services, along with implications for payment policy. It evaluates counting rules in terms of intended and unintended consequences in the context of Victoria's introduction of output-based funding for outpatient services.

The plague under Commodus as an unintended consequence of Roman grain market regulation.

PubMed

Silver, Morris

2012-01-01

This paper begins with a review of Roman grain market policies. It is argued that policies such as forced sales and maximum prices made urban consumers hesitant to rely on the market for secure access to grain. Consequently, consumers hoarded grain in their homes. The hoarded grain formed a volatile fuel ready to be ignited by the arrival of the bubonic plague bacillus. This scenario fits events in the city of Rome under Commodus. Attested grain market interventions were followed by a severe epidemic, arguably bubonic plague, which decimated the city's population.

Unintended Consequences of State and Federal Antidiscrimination and Family Medical Leave Legislation on the Employment Rates of Persons with Disabilities

ERIC Educational Resources Information Center

Lehmann, Ilana; Crimando, William

2008-01-01

Although some writers have suggested that the Americans With Disabilities Act (ADA), contrary to its intent, was responsible for a decline in employment for persons with disabilities, there is little strong empirical support for such an assertion. This study is an attempt to demonstrate that, in fact, the dismal labor market experience following…

The Unintended Consequences of an Algebra-for-All Policy on High-Skill Students: Effects on Instructional Organization and Students' Academic Outcomes

ERIC Educational Resources Information Center

Nomi, Takako

2012-01-01

In 1997, Chicago implemented a policy that required algebra for all ninth-grade students, eliminating all remedial coursework. This policy increased opportunities to take algebra for low-skill students who had previously enrolled in remedial math. However, little is known about how schools respond to the policy in terms of organizing math…

The Hangover: Thinking about the Unintended Consequences of the Nation's Teacher Evaluation Binge. Teacher Quality 2.0. Special Report 2

ERIC Educational Resources Information Center

Mead, Sara; Rotherham, Andrew; Brown, Rachael

2012-01-01

Over the past three years, more than 20 US states have passed legislation establishing new teacher evaluation requirements and systems, and even more have committed to do so in Race to the Top or Elementary and Secondary Education Act Flexibility Waiver applications. These new evaluation systems have real potential to foster a more…

Medicaid's Role in Financing Health Care for Children with Behavioral Health Care Needs in the Special Education System: Implications of the Deficit Reduction Act

ERIC Educational Resources Information Center

Mandell, David S.; Machefsky, Aliza; Rubin, David; Feudtner, Chris; Pita, Susmita; Rosenbaum, Sara

2008-01-01

Background: Recent changes to Medicaid policy may have unintended consequences in the education system. This study estimated the potential financial impact of the Deficit Reduction Act (DRA) on school districts by calculating Medicaid-reimbursed behavioral health care expenditures for school-aged children in general and children in special…

Characterizing Predictability of Fire Occurrence in Tropical Forests and Grasslands: The Case of Puerto Rico

Treesearch

Ana Carolina Monmany; William Gould; Maria Jose Andrade-Nunez; Grizelle Gonzalez; Maya Quinones

2017-01-01

Global estimates of fire frequency indicate that over 70% of active fires occur in the tropics, and the size and frequency of fires are increasing every year. The majority of fires in the tropics are an unintended consequence of current land-use practices that promotes the establishment of grass and shrubland communities, which are more flammable and more adapted to...

Nondisclosure of Smoking Status to Health Care Providers among Current and Former Smokers in the United States

ERIC Educational Resources Information Center

Curry, Laurel Erin; Richardson, Amanda; Xiao, Haijun; Niaura, Raymond S.

2013-01-01

An unintended consequence of tobacco control's success in marginalizing smoking is that smokers may conceal their smoking from those who are best positioned to help them quit: health care providers (HCPs). The purpose of this study was to identify the prevalence of, and factors related to, nondisclosure of smoking to HCPs. Data were obtained from…

A Study of the Impact of Educational Reform on At-Risk Students in Texas: Preliminary Findings.

ERIC Educational Resources Information Center

Texas Education Agency, Austin.

A study was conducted to gain a better understanding of how the term "at-risk" is defined and applied in the schools and to assess the intended and unintended consequences of four policies: attendance, the Texas Educational Assessment of Minimum Skills exit-level examination, the no pass/no play rule, and the driver's license law on…

Historical framework to explain long-term coupled human and natural system feedbacks: application to a multiple-ownership forest landscape in the northern Great Lakes region, USA

Treesearch

Michelle M. Steen-Adams; Nancy Langston; Mark D. O. Adams; David J. Mladenoff

2015-01-01

Current and future human and forest landscape conditions are influenced by the cumulative, unfolding history of socialecological interactions. Examining past system responses, especially unintended consequences, can reveal valuable insights that promote learning and adaptation in forest policy and management. Temporal couplings are complex, however; they can be...

The Unintended Consequences of Killing Civilians

DTIC Science & Technology

2012-05-17

of the Geneva Conventions, the media invites domestic and international responses, publicizing the debate. Political leaders of America have always...the debate. Political leaders of America have always declared their commitment to protecting human rights in the many nations where the U.S. military...messaging and some activities of military units in the theater of operations. Political leaders of America have always declared their commitment to

The Nursing Home Minimum Data Set Assessment Instrument: Manifest Functions and Unintended Consequences--Past, Present, and Future

ERIC Educational Resources Information Center

Rahman, Anna N.; Applebaum, Robert A.

2009-01-01

The Minimum Data Set (MDS) is a uniform instrument used in nursing homes to assess residents. In January 2008, the Centers for Medicare and Medicaid Services published a draft of a new MDS--version 3.0. This article traces the instrument's development and the design decisions that shaped it, discusses the MDS's manifest functions--data collection…

An Analytic Model for DoD Investment & Divestment Decisions (Briefing Charts)

DTIC Science & Technology

2015-05-01

cost drives Strategic; Performance mixed; cost drives Invest Insurance Risk Mitigation √ “Making Trade-Offs in Corporate Portfolio Decisions...Effects (SE) + Insurance Intended externalities, unintended consequences Are SE measureable? Do they add/subtract so NPV is worthwhile? Deadweight...Sustainable Cost Effective Cost is supportable, LPO outsourced, or is income Advantageous NPV? Y Y Y Y either N N N N Secondary Effects+ Insurance

Fairly sustainable forestry: seven key concepts for defining local sustainability in a global ecosystem

Treesearch

Stephen R. Shifley

2008-01-01

In the U.S. we increasingly restrict wood production in the name of sustainability while going abroad for a growing share of the wood we consume, even though our own forest resources per capita are far greater than the global average. The unintended consequence is that we transfer impacts (positive and negative) of our timber harvesting and wood consumption to other...

Learning from Experience Case Studies of the Hyper-X Project

NASA Technical Reports Server (NTRS)

Peebles, Curtis

2009-01-01

The Hyper-X project (X-43A) provides a number of "lessons learned" which can be applied to other aerospace project. The specific areas examined were the selection of the goals of the Hyper-X. How the technical unknowns and assumptions were handled. The final lesson was the ambiguous nature of risk assessment, and how trying to remove a technical unknown can have unintended consequences.

Effect of methyl bromide on Bursaphelenchus xylophilus in pine wood

Treesearch

L. David Dwinell

2000-01-01

One of the unintended consequences of the globalization of trade has been an increase in the frequency of introductions and the numbers of exotic species intercepted at ports of entry. This is largely due to the increase in volume of trade and a broadening of trading partners, especially with the Pacific Rim and Asia. During the years 1985 through 1998, the U.S....

Impoverishment: An Unintended Consequence of Private Education Investment: An Atypical Case Study of a Typical Underdeveloped Chinese Village

ERIC Educational Resources Information Center

Yong, Zhong; Jie, Xie

2017-01-01

This paper presents a case study of the microeconomy of a typical underdeveloped village in southwest China and the role of elementary education in the village economy. The paper begins with a brief review of relevant theories on the economics of education and the current social conditions and state of education in the village under study, and…

"The Silence Itself Is Enough of a Statement": The Day of Silence and LGBTQ Awareness Raising

ERIC Educational Resources Information Center

Woolley, Susan W.

2012-01-01

This ethnographic study of a high school gay-straight alliance club examines unintended consequences of silence during the Day of Silence, a day of action aimed at addressing anti-LGBTQ bias in schools. While this strategy calls for students to engage in intentional silences to raise awareness of anti-LGBTQ bias, it does not necessarily lead…

The Unintended, Pernicious Consequences of "Staying the Course" on the United States' No Child Left Behind Policy

ERIC Educational Resources Information Center

Amrein-Beardsley, Audrey

2009-01-01

The phrase "no child left behind" has become a familiar expression in American education circles and in popular culture. The sentiment implied by these four words is noble. However, the effects of the top-down implementation of the high-stakes testing provisions of the law have been anything but salutary for public school children,…

Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework.

PubMed

Campbell, Stephen M; Kontopantelis, Evangelos; Hannon, Kerin; Burke, Martyn; Barber, Annette; Lester, Helen E

2011-08-10

Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP) using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF). The indicator testing protocol involved a multi-step and methodological process: 1) The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2) data extraction from patients' medical records, to test technical feasibility and reliability, 3) diaries, to test workload, 4) cost-effectiveness modelling, and 5) semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010) involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health care settings and may be of use to policy-makers and researchers worldwide to test the likely effect of implementing indicators prior to roll out. It builds on and codifies existing literature and other testing protocols to create a field testing methodology that can be used to produce country specific quality indicators for pay-for-performance or quality improvement schemes.

Boundary Avoidance Tracking: Consequences (and Uses) of Imposed Boundaries on Pilot-Aircraft Performance

DTIC Science & Technology

2009-03-01

BOUNDARY AVOIDANCE TRACKING: CONSEQUENCES (AND USES) OF IMPOSED BOUNDARIES ON PILOT-AIRCRAFT...States Government. AFIT/GAE/ENY/09-M03 BOUNDARY AVOIDANCE TRACKING: CONSEQUENCES (AND USES) OF IMPOSED BOUNDARIES ON PILOT-AIRCRAFT PERFORMANCE...Case 2 (Gray, 2005) ....................................... 20 Figure 8. Effect of BAT Parameters on Tracking Success (Gray, 2005

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument.

PubMed

Sittig, Dean F; Ash, Joan S; Guappone, Ken P; Campbell, Emily M; Dykstra, Richard H

2008-07-01

To determine what "average" clinicians in organizations that were about to implement Computer-based Provider Order Entry (CPOE) were expecting to occur, we conducted an open-ended, semi-structured survey at three community hospitals. We created an open-ended, semi-structured, interview survey template that we customized for each organization. This interview-based survey was designed to be administered orally to clinicians and take approximately 5 min to complete, although clinicians were allowed to discuss as many advantages or disadvantages of the impending system roll-out as they wanted to. Our survey findings did not reveal any overly negative, critical, problematic, or striking sets of concerns. However, from the standpoint of unintended consequences, we found that clinicians were anticipating only a few of the events, emotions, and process changes that are likely to result from CPOE. The results of such an open-ended survey may prove useful in helping CPOE leaders to understand user perceptions and predictions about CPOE, because it can expose issues about which more communication, or discussion, is needed. Using the survey, implementation strategies and management techniques outlined in this paper, any chief information officer (CIO) or chief medical information officer (CMIO) should be able to adequately assess their organization's CPOE readiness, make the necessary mid-course corrections, and be prepared to deal with the currently identified unintended consequences of CPOE should they occur.

Feasibility trial of a film-based educational intervention for increasing boys’ and girls’ intentions to avoid teenage pregnancy: Study protocol☆

PubMed Central

Lohan, Maria; Aventin, Áine; Maguire, Lisa; Clarke, Mike; Linden, Mark; McDaid, Lisa

2014-01-01

The World Health Organisation, amongst others, recognises that adolescent men have a vital yet neglected role in reducing teenage pregnancies and that there is a pressing need for educational interventions designed especially for them. This study seeks to fill this gap by determining the feasibility of conducting an effectiveness trial of the If I Were Jack intervention in post-primary schools. This 4-week intervention aims to increase teenagers’ intentions to avoid unintended pregnancy and addresses gender inequalities in sex education by explicitly focusing on young men. A cluster randomised feasibility trial with embedded process evaluation will determine: recruitment, participation and retention rates; quality of implementation; acceptability and feasibility of the intervention and trial procedures; and costs. PMID:25284956

Feasibility trial of a film-based educational intervention for increasing boys' and girls' intentions to avoid teenage pregnancy: Study protocol.

PubMed

Lohan, Maria; Aventin, Aine; Maguire, Lisa; Clarke, Mike; Linden, Mark; McDaid, Lisa

2014-01-01

The World Health Organisation, amongst others, recognises that adolescent men have a vital yet neglected role in reducing teenage pregnancies and that there is a pressing need for educational interventions designed especially for them. This study seeks to fill this gap by determining the feasibility of conducting an effectiveness trial of the If I Were Jack intervention in post-primary schools. This 4-week intervention aims to increase teenagers' intentions to avoid unintended pregnancy and addresses gender inequalities in sex education by explicitly focusing on young men. A cluster randomised feasibility trial with embedded process evaluation will determine: recruitment, participation and retention rates; quality of implementation; acceptability and feasibility of the intervention and trial procedures; and costs.

Framing Strategies to Avoid Mother-Blame in Communicating the Origins of Chronic Disease.

PubMed

Winett, Liana B; Wulf, Alyssa B; Wallack, Lawrence

2016-08-01

Evolving research in epigenetics and the developmental origins of health and disease offers tremendous promise in explaining how the social environment, place, and resources available to us have enduring effects on our health. Troubling from a communications perspective, however, is the tendency in framing the science to hold mothers almost uniquely culpable for their offspring's later disease risk. The purpose of this article is to add to the conversation about avoiding this unintended outcome by (1) discussing the importance of cognitive processing and issue frames, (2) describing framing challenges associated with communicating about developmental origins of health and disease and offering principles to address them, and (3) providing examples of conceptual metaphors that may be helpful in telling this complex and contextual story for public health.

Scientific, legal, and ethical challenges of end-of-life organ procurement in emergency medicine.

PubMed

Rady, Mohamed Y; Verheijde, Joseph L; McGregor, Joan L

2010-09-01

We review (1) scientific evidence questioning the validity of declaring death and procuring organs in heart-beating (i.e., neurological standard of death) and non-heart-beating (i.e., circulatory-respiratory standard of death) donation; (2) consequences of collaborative programs realigning hospital policies to maximize access of procurement coordinators to critically and terminally ill patients as potential donors on arrival in emergency departments; and (3) ethical and legal ramifications of current practices of organ procurement on patients and their families. Relevant publications in peer-reviewed journals and government websites. Scientific evidence undermines the biological criteria of death that underpin the definition of death in heart-beating (i.e., neurological standard) and non-heart-beating (i.e., circulatory-respiratory standard) donation. Philosophical reinterpretation of the neurological and circulatory-respiratory standards in the death statute, to avoid the appearance of organ procurement as an active life-ending intervention, lacks public and medical consensus. Collaborative programs bundle procurement coordinators together with hospital staff for a team-huddle and implement a quality improvement tool for a Rapid Assessment of Hospital Procurement Barriers in Donation. Procurement coordinators have access to critically ill patients during the course of medical treatment with no donation consent and with family or surrogates unaware of their roles. How these programs affect the medical care of these patients has not been studied. Policies enforcing end-of-life organ procurement can have unintended consequences: (1) erosion of care in the patient's best interests, (2) lack of transparency, and (3) ethical and legal ramifications of flawed standards of declaring death. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Adolescents' Responses to an Unintended Pregnancy in Ghana: A Qualitative Study.

PubMed

Aziato, Lydia; Hindin, Michelle J; Maya, Ernest Tei; Manu, Abubakar; Amuasi, Susan Ama; Lawerh, Rachel Mahoe; Ankomah, Augustine

2016-12-01

To investigate the experiences and perceptions of adolescents who have experienced a recent pregnancy and undergone a termination of pregnancy. A vignette-based focus group approach was used to have adolescents reflect on scenarios that happen to others during an unwanted pregnancy. The study was conducted in public health facilities in the 3 major urban areas of Ghana-Accra, Kumasi, and Tamale. Adolescents, aged 10-19 years, who had a recent termination of pregnancy were recruited from public health facilities in the 3 sites. Fifteen focus groups were conducted and digitally recorded in English, Twi, Ga, and Dagbani. Transcripts were transcribed and translated, and thematic analysis was used for the analysis. Adolescents reported that the characters in the vignettes would feel sadness, depression, and regret from an unintended pregnancy and some male partners would "deny" the pregnancy or suggest an abortion. They suggested some parents would "be angry" and "sack" their children for becoming pregnant while others would "support" them. Parents might send the pregnant girl to a distant friend or grandparents until she delivers to avoid shame and gossip. Health professionals might encourage the pregnant girl or insult/gossip about the girl. Adolescent unintended pregnancies in Ghana are met with a range of reactions and these reactions influence the pregnancy choices young women make for continuation or termination of pregnancy. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

A Comprehensive Internationalization Challenge: Learning from Failure or, When Your Best Just Isn't Good Enough

ERIC Educational Resources Information Center

Patton, Carl V.

2016-01-01

Why did our idea not work out? How did a program fail? Why did we get unintended consequences? Who is to blame? Could it be that our best just isn't good enough? There are many reasons policies, programs and projects fail. Failure can be informative if shared. This means that professionals should report on failures as well as successes. However,…

School-Based Sports Development and the Role of NSOs as 'Boundary Spanners': Benefits, Disbenefits and Unintended Consequences of the "Sporting Schools" Policy Initiative

ERIC Educational Resources Information Center

Hogan, Anna; Stylianou, Michalis

2018-01-01

The focus of this paper is on "Sporting Schools", a $100 million policy initiative intended to increase children's sport participation in Australia. Our account seeks to proffer a critical analysis of this federal policy, and the way it functions as part of the new heterarchical or networked form of sports governance in Australia. Using…

The Misplaced Math Student: Lost in Eighth-Grade Algebra. The 2008 Brown Center Report on American Education. Special Release

ERIC Educational Resources Information Center

Loveless, Tom

2008-01-01

This new study is being released as an advance excerpt of the 2008 Brown Center Report on American Education. This new report finds that the nation's push to challenge more students by placing them in advanced math classes in eighth grade has had unintended and damaging consequences, as some 120,000 middle-schoolers are now struggling in advanced…

Social Movements And Social Media: Surveillance And Unintended Consequences

DTIC Science & Technology

2017-12-01

of contentious politics: “ when ordinary people , often in league with more influential citizens, join forces in confrontations with elites...determination of that context.13 When change occurs in a society , the location, interests, and diminished relevance of existing interests facilitate the...distinguish it from previous forms of contention.21 Tarrow argues that “ when contention spreads across an entire society , as it sometimes does, we see a

Unintended Consequences: Effect of the American Jobs Creation Act Reforestation Incentives on Family Forest Owners in the South

Treesearch

John L. Greene; Thomas J. Straka

2008-01-01

Abstract: The American Jobs Creation Act of 2004 rewrote the reforestation tax incentives available to private forest owners. Owners can now deduct outright reforestation costs up to $10,000 per year for each qualified timber property and amortize any additional amount over 8 tax years. To assess the economic effect of the new incentives on forest owners, the authors...

2010 Global Maritime Information Sharing Symposium Held in Baltimore, Maryland on September 14-16, 2010

DTIC Science & Technology

2010-09-16

Fishing • Tourism • Transportation • Unintended consequences • The Devil is in the details • New layers of bureaucracy • Lack of adequate input in the...mobility administration, channel and harbor management, incident management Commercial and recreational fishing, tourism , commercial...how to provide and measure this value across the full spectrum of participants. • Governance: The IMSSE’s organizational and gover - nance structure

Identifying Acquisition Patterns of Failure Using Systems Archetypes

DTIC Science & Technology

2008-04-02

OF PAGES 18 19a. NAME OF RESPONSIBLE PERSON a. REPORT unclassified b . ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev...any but the smallest programs, complete path coverage for defect detection is impractical. Adapted from Pressman , R.S., Software Engineering: A...Firefighting” concept from “Past the Tipping Point” Fix S O B Problem Symptom R “Fixes That Fail” – Systems Archetype S Unintended Consequences S

Proposed Guideline Revisions for Dental Sedation and General Anesthesia: Why Target the Safest Level of Sedation?

PubMed

Dionne, Raymond A

2016-09-01

Recently proposed revisions to the American Dental Association's Guidelines for the Use of Sedation and General Anesthesia by Dentists, aimed at improving safety in dental offices, differentiate between levels of sedation based on drug-induced changes in physiologic and behavioral states. However, the author of this op-ed is concerned the proposed revisions may have far-reaching and unintended consequences.

Fracking: Unintended Consequences for Local Communities

DTIC Science & Technology

2016-12-01

holistic impact of fracking on the environment and socioeconomics of local communities at the epicenter of shale oil production . This study included...socioeconomics of local communities at the epicenter of shale oil production . This study included an evaluation of crucial environmental issues...un ts M ill io n Ba rr el s Annual Oil Production North Dakota Annual Average Rig Count 38 biggest daily drop ever, a 6% decrease, producing 1.04

Community Notification Laws

DTIC Science & Technology

2007-12-01

vehicle to enact more stringent control on sex offenders-an innocent 7 year old girl seduced into the home of a twice convicted pedophile with the hopes...criminal justice system that permitted a repeat pedophile to plea bargain his second offense from what would have amounted to 30 years in prison, if...numerous unintended consequences for sex offenders (not just pedophiles ), sex offender family members, victims (some of whom are incest victims), and

Unintended consequences of carbon enhancement in agricultural soils: The N2O problem

NASA Astrophysics Data System (ADS)

Venterea, R. T.; Breuillin-Sessoms, F.; Baker, J. M.; Griffis, T. J.; Spokas, K.; Turner, P. A.

2016-12-01

The potential of agricultural soils to accumulate C as a means of removing greenhouse gases (GHGs) from the atmosphere is complicated by the inherent coupling of the C and N cycles in soil. Practices that increase soil C content can have the unintended consequence of stimulating N mineralization, nitrification and/or denitrification; which can in turn promote production of N2O as well as other forms of reactive N that can be later transformed to N2O. These effects, combined with the large global warming potential of N2O, may partially or completely offset any gains in soil C from a GHG accounting perspective. Thus, ideally, management of soil C and N must be considered together in attempts to reduce net GHG budgets. However, the knowledge base for defining practices that optimize management of soil C and N together is still quite limited. In this presentation, we will illustrate these challenges with results from several recent studies examining effects of tillage, cover crops, biochar and other practices which aim to enhance soil C. Interactions of these practices with N management, climate, and other factors and their effects on N2O will be discussed with implications for improved management and future research.

Finding Resolution for the Responsible Transparency of Economic Models in Health and Medicine.

PubMed

Padula, William V; McQueen, Robert Brett; Pronovost, Peter J

2017-11-01

The Second Panel on Cost-Effectiveness in Health and Medicine recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses has a number of questions unanswered with respect to the implementation of transparent, open source code interface for economic models. The possibility of making economic model source code could be positive and progressive for the field; however, several unintended consequences of this system should be first considered before complete implementation of this model. First, there is the concern regarding intellectual property rights that modelers have to their analyses. Second, the open source code could make analyses more accessible to inexperienced modelers, leading to inaccurate or misinterpreted results. We propose several resolutions to these concerns. The field should establish a licensing system of open source code such that the model originators maintain control of the code use and grant permissions to other investigators who wish to use it. The field should also be more forthcoming towards the teaching of cost-effectiveness analysis in medical and health services education so that providers and other professionals are familiar with economic modeling and able to conduct analyses with open source code. These types of unintended consequences need to be fully considered before the field's preparedness to move forward into an era of model transparency with open source code.

Examining the relationship between medical cannabis laws and cardiovascular deaths in the US.

PubMed

Abouk, Rahi; Adams, Scott

2018-03-01

Several countries and many U.S. states have allowed, for cannabis to be used as therapy to treat chronic conditions or pain., This has increased the use of cannabis, particularly among older people.Because cannabis has been linked to adverse cardiac events in the medical literature, there may be unintended consequences on increased use among older people. We analyze cardiac-related mortality data from the U.S. National Vital Statistics System for 1990-2014. We use difference-in-difference fixed-effects models to assess whether there are increased rates of cardiac-related mortality following passage of medical cannabis programs. We also analyze whether states with more liberal rules on dispensing cannabis show higher mortality rates. For men, there is a statistically significant 2.3% increase in the rate of cardiac death following passage. For women, there is a 1.3% increase that is also statistically significant. he effects increase or both men and women with age. The effects are also stronger in states with more a lax approach to cannabis dispensing. Policymakers should be aware of a potential unintended consequence of allowing broader use of cannabis, specifically for those more at risk of cardiovascular events. Copyright © 2017. Published by Elsevier B.V.

Ambivalence, communication and past use: understanding what influences women's intentions to use contraceptives.

PubMed

Campo, Shelly; Askelson, Natoshia M; Spies, Erica L; Losch, Mary

2012-01-01

Unintended pregnancy among women in the 18-30 age group is a public health concern. The Extended Parallel Process Model (EPPM) provides a framework for exploring how women's perceptions of threat, efficacy, and fear influence intentions to use contraceptives. Past use and communication with best friends and partners were also considered. A telephone survey of 18-30-year-old women (N = 599) was completed. After univariate and bivariate analyses were conducted, the variables were entered into a hierarchal, multi-variate linear regression with three steps consistent with the EPPM to predict behavioral intention. The first step included the demographic variables of relationship status and income. The constructs for the EPPM were entered into step 2. Step 3 contained the fear measure. The model for the third step was significant, F(10,471) = 36.40, p < 0.001 and the variance explained by this complete model was 0.42. Results suggest that perceived severity of the consequences of an unintended pregnancy (p < 0.01), communication with friends (p < 0.01) and last sexual partner (p < 0.05), relationship status (p < 0.01), and past use (p < 0.001) were associated with women's intentions to use contraceptives. A woman's perception of the severity was related to her intention to use contraceptives. Half of the women (50.3%) reported ambivalence about the severity of an unintended pregnancy. In our study, talking with their last sexual partner had a positive effect on intentions to use contraceptives, while talking with friends influenced intentions in a negative direction. These results reconfirm the need for public health practitioners and health care providers to consider level of ambivalence toward unintended pregnancy, communication with partner, and relationship status when trying to improve women's contraceptive behaviors. Implications for effective communication interventions are discussed.

Silencing of the sulfur rich α-gliadin storage protein family in wheat grains (Triticum aestivum L.) causes no unintended side-effects on other metabolites

PubMed Central

Zörb, Christian; Becker, Dirk; Hasler, Mario; Mühling, Karl H.; Gödde, Victoria; Niehaus, Karsten; Geilfus, Christoph-Martin

2013-01-01

Wheat is an important source of proteins and metabolites for human and animal nutrition. To assess the nutritional quality of wheat products, various protein and diverse metabolites have to be evaluated. The grain storage protein family of the α-gliadins are suggested to be the primary initiator of the inflammatory response to gluten in Celiac disease patients. With the technique of RNAi, the α-gliadin storage protein fraction in wheat grains was recently knocked down. From a patient's perspective, this is a desired approach, however, this study aims to evaluate whether such a down-regulation of these problematic α-gliadins also has unintended side-effects on other plant metabolites. Such uncontrolled and unknown arbitrary effects on any metabolite in plants designated for food production would surely represent an avoidable risk for the consumer. In general, α-gliadins are rich in sulfur, making their synthesis and content depended of the sulfur supply. For this reason, the influence of the application of increasing sulfur amounts on the metabolome of α-gliadin-deficient wheat was additionally investigated because it might be possible that e.g., considerable high/low amounts of S might increase or even induce such unintended effects that are not observable under moderate S nutrition. By silencing the α-gliadin genes, a recently developed wheat line that lacks the set of 75 corresponding α-gliadin proteins has become available. The plants were subsequently tested for RNAi-induced effects on metabolites that were not directly attributable to the specific effects of the RNAi-approach on the α-gliadin proteins. For this, GC-MS-based metabolite profiles were recorded. A comparison of wild type with gliadin-deficient plants cultivated in pot experiments revealed no differences in all 109 analyzed metabolites, regardless of the S-nutritional status. No unintended effects attributable to the RNAi-based specific genetic deletion of a storage protein fraction were observed. PMID:24062763

The Role of Therapeutic Drugs on Acquired Mitochondrial Toxicity.

PubMed

Morén, Constanza; Juárez-Flores, Diana Luz; Cardellach, Francesc; Garrabou, Glòria

2016-01-01

Certain therapeutic drugs used in medical practice may trigger mitochondrial toxicity leading to a wide range of clinical symptoms including deafness, neuropathy, myopathy, hyperlactatemia, lactic acidosis, pancreatitis and lipodystrophy, among others, which could even compromise the life of the patient. The aim of this work is to review the potential mitochondrial toxicity derived from drugs used in health care, including anesthetics, antiepileptics, neuroleptics, antidepressants, antivirals, antibiotics, antifungals, antimalarics, antineoplastics, antidiabetics, hypolipemiants, antiarrhythmics, anti-inflammatories and nitric oxide. We herein have reviewed data from experimental and clinical studies to document the molecular mitochondrial basis, potential biomarkers and putative clinical symptoms associated to secondary effects of drugs. One hundred and forty-five articles were selected and the information was organized by means of the primary target to which pharmacologic drugs were directed. Adverse toxic events were classified depending on the mitochondrial offtarget effect and whether they had been demonstrated in the experimental or clinical setting. Since treatment of acquired mitochondriopathies remains supportive and therapeutic interventions cannot be avoided, information of molecular and clinical consequences of toxic exposure becomes fundamental to assess riskbenefit imbalance of treatment prescription. Additionally, there is a crucial need to develop less mitochondrial toxic compounds, novel biomarkers to follow up mitochondrial toxicity (or implement those already proposed) and new approaches to prevent or revert unintended mitochondrial damage.

Scenarios for Low Carbon and Low Water Electric Power Plant Operations: Implications for Upstream Water Use.

PubMed

Dodder, Rebecca S; Barnwell, Jessica T; Yelverton, William H

2016-11-01

Electric sector water use, in particular for thermoelectric operations, is a critical component of the water-energy nexus. On a life cycle basis per unit of electricity generated, operational (e.g., cooling system) water use is substantially higher than water demands for the fuel cycle (e.g., natural gas and coal) and power plant manufacturing (e.g., equipment and construction). However, could shifting toward low carbon and low water electric power operations create trade-offs across the electricity life cycle? We compare business-as-usual with scenarios of carbon reductions and water constraints using the MARKet ALlocation (MARKAL) energy system model. Our scenarios show that, for water withdrawals, the trade-offs are minimal: operational water use accounts for over 95% of life cycle withdrawals. For water consumption, however, this analysis identifies potential trade-offs under some scenarios. Nationally, water use for the fuel cycle and power plant manufacturing can reach up to 26% of the total life cycle consumption. In the western United States, nonoperational consumption can even exceed operational demands. In particular, water use for biomass feedstock irrigation and manufacturing/construction of solar power facilities could increase with high deployment. As the United States moves toward lower carbon electric power operations, consideration of shifting water demands can help avoid unintended consequences.

Translating reference doses into allergen management practice: challenges for stakeholders.

PubMed

Crevel, René W R; Baumert, Joseph L; Luccioli, Stefano; Baka, Athanasia; Hattersley, Sue; Hourihane, Jonathan O'B; Ronsmans, Stefan; Timmermans, Frans; Ward, Rachel; Chung, Yong-joo

2014-05-01

Risk assessment describes the impact of a particular hazard as a function of dose and exposure. It forms the foundation of risk management and contributes to the overall decision-making process, but is not its endpoint. This paper outlines a risk analysis framework to underpin decision-making in the area of allergen cross-contact. Specifically, it identifies challenges relevant to each component of the risk analysis: risk assessment (data gaps and output interpretation); risk management (clear and realistic objectives); and risk communication (clear articulation of risk and benefit). Translation of the outputs from risk assessment models into risk management measures must be informed by a clear understanding of the model outputs and their limitations. This will lead to feasible and achievable risk management objectives, grounded in a level of risk accepted by the different stakeholders, thereby avoiding potential unintended detrimental consequences. Clear, consistent and trustworthy communications actively involving all stakeholders underpin these objectives. The conclusions, integrating the perspectives of different stakeholders, offer a vision where clear, science-based benchmarks form the basis of allergen management and labelling, cutting through the current confusion and uncertainty. Finally, the paper recognises that the proposed framework must be adaptable to new and emerging evidence. Copyright © 2014 ILSI Europe. Published by Elsevier Ltd.. All rights reserved.

Cesarean delivery on maternal request: Can the ethical problem be solved by the principlist approach?

PubMed Central

Nilstun, Tore; Habiba, Marwan; Lingman, Göran; Saracci, Rodolfo; Da Frè, Monica; Cuttini, Marina

2008-01-01

In this article, we use the principlist approach to identify, analyse and attempt to solve the ethical problem raised by a pregnant woman's request for cesarean delivery in absence of medical indications. We use two different types of premises: factual (facts about cesarean delivery and specifically attitudes of obstetricians as derived from the EUROBS European study) and value premises (principles of beneficence and non-maleficence, respect for autonomy and justice). Beneficence/non-maleficence entails physicians' responsibility to minimise harms and maximise benefits. Avoiding its inherent risks makes a prima facie case against cesarean section without medical indication. However, as vaginal delivery can have unintended consequences, there is a need to balance the somewhat dissimilar risks and benefits. The principle of autonomy poses a challenge in case of disagreement between the pregnant woman and the physician. Improved communication aimed to enable better informed choice may overcome some instances of disagreement. The principle of justice prohibits unfair discrimination, and broadly favours optimising resource utilisation. Available evidence supports vaginal birth in uncomplicated term pregnancies as the standard of care. The principlist approach offered a useful framework for ethical analysis of cesarean delivery on maternal request, identified the rights and duties of those involved, and helped reach a conclusion, although conflict at the individual level may remain challenging. PMID:18559083

Cesarean delivery on maternal request: can the ethical problem be solved by the principlist approach?

PubMed

Nilstun, Tore; Habiba, Marwan; Lingman, Göran; Saracci, Rodolfo; Da Frè, Monica; Cuttini, Marina

2008-06-17

In this article, we use the principlist approach to identify, analyse and attempt to solve the ethical problem raised by a pregnant woman's request for cesarean delivery in absence of medical indications. We use two different types of premises: factual (facts about cesarean delivery and specifically attitudes of obstetricians as derived from the EUROBS European study) and value premises (principles of beneficence and non-maleficence, respect for autonomy and justice).Beneficence/non-maleficence entails physicians' responsibility to minimise harms and maximise benefits. Avoiding its inherent risks makes a prima facie case against cesarean section without medical indication. However, as vaginal delivery can have unintended consequences, there is a need to balance the somewhat dissimilar risks and benefits. The principle of autonomy poses a challenge in case of disagreement between the pregnant woman and the physician. Improved communication aimed to enable better informed choice may overcome some instances of disagreement. The principle of justice prohibits unfair discrimination, and broadly favours optimising resource utilisation. Available evidence supports vaginal birth in uncomplicated term pregnancies as the standard of care. The principlist approach offered a useful framework for ethical analysis of cesarean delivery on maternal request, identified the rights and duties of those involved, and helped reach a conclusion, although conflict at the individual level may remain challenging.

Maternal and fetal outcomes of intimate partner violence associated with pregnancy in the Latin American and Caribbean region.

PubMed

Han, Alice; Stewart, Donna E

2014-01-01

Very high rates of intimate partner violence during pregnancy (IPV-P) are reported in Latin America and the Caribbean (LAC) but data on prevalence and obstetric-related outcomes are limited. To conduct a literature review on risk factors, prevalence, and adverse obstetric-related outcomes of IPV-P in LAC. Systematic review of studies in MEDLINE (1946-2012) and LILACS (1982-2012), and hand searching of reference lists of included studies. Search terms were variations of partner abuse and pregnancy in LAC. Studies were excluded if they did not include IPV-P prevalence or if the perpetrator was not an intimate partner. Study quality was assessed via US Preventive Services Task Force criteria. In the 31 studies included, prevalence rates ranged from 3% to 44%. IPV-P was significantly associated with unintended pregnancies and adverse maternal (depression, pregnancy-related symptom distress, inadequate prenatal care, vaginal bleeding, spontaneous abortion, gestational weight gain, high maternal cortisol, hypertension, pre-eclampsia, STIs) and infant (prematurity, low birth weight, neonatal complications, stillbirth) outcomes (grade II-2 and 3 evidence). IPV-P is highly prevalent in LAC, with poor obstetric-related outcomes. Clinicians must identify women experiencing IPV-P and institute appropriate interventions and referrals to avoid its deleterious consequences. © 2013.

Comparison of arsenic content in pelletized poultry house waste and biosolids fertilizer.

PubMed

Nachman, Keeve E; Mihalic, Jana N; Burke, Thomas A; Geyh, Alison S

2008-03-01

Managers of human biosolids have been incorporating the practice of waste pelletization for use as fertilizer since the mid 1920s, and waste pelletization has recently been embraced by some poultry producers as a way to move nutrients away from saturated agricultural land. However, the presence of arsenic in pelletized poultry house waste (PPHW) resulting from the use of organoarsenical antimicrobial drugs in poultry production raises concerns regarding additional incremental population exposures. Arsenic concentrations were determined in PPHW and pelletized biosolids fertilizer (PBF) samples. Pellets were processed using strong acid microwave digestion and analyzed by graphite furnace atomic absorption spectroscopy. The mean arsenic concentration in PPHW (20.1 ppm) fell within the lower part of the range of previously report arsenic concentrations in unpelletized poultry house waste. Arsenic concentrations in PBF, the source of which is less clear than for PPHW, were approximately a factor of 5 times lower than those in PPHW, with a mean concentration of 4.1 ppm. The pelletization and sale of these biological waste fertilizers present new pathways of exposure to arsenic in consumer populations who would otherwise not come into contact with these wastes. Arsenic exposures in humans resulting from use of these fertilizer pellets should be quantified to avoid potential unintended negative consequences of managing wastes through pelletization.

Mother-daughter communication about sexual maturation, abstinence and unintended pregnancy: experiences from an informal settlement in Nairobi, Kenya.

PubMed

Crichton, Joanna; Ibisomi, Latifat; Gyimah, Stephen Obeng

2012-02-01

Parental communication and support is associated with improved developmental, health and behavioral outcomes in adolescence. This study explores the quality of mother-daughter communication about sexual maturation, abstinence and unintended pregnancy in Korogocho, an informal settlement in Nairobi, Kenya. We use data from 14 focus group discussions (n = 124) and 25 interviews with girls aged 12-17, mothers of teenage girls, and key informant teachers. Many girls and women believed that mothers are the best source of information and support during puberty but only a minority described good experiences with communication in practice. Girls preferred communication to begin early and be repeated regularly. Mothers often combined themes of sexual maturation, abstinence and avoiding pregnancy in their messages. Communication was facilitated by mothers' availability, warmth and close parent-child relationships. Challenges included communication taboos, embarrassment, ambiguous message content, and parental lack of knowledge and uncertainty. Neighborhood poverty undermined some mothers' time and motivation for communicating. Copyright © 2011 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

What can individuals do to reduce personal health risks from air pollution?

PubMed Central

Laumbach, Robert; Meng, Qingyu

2015-01-01

In many areas of the world, concentrations of ambient air pollutants exceed levels associated with increased risk of acute and chronic health problems. While effective policies to reduce emissions at their sources are clearly preferable, some evidence supports the effectiveness of individual actions to reduce exposure and health risks. Personal exposure to ambient air pollution can be reduced on high air pollution days by staying indoors, reducing outdoor air infiltration to indoors, cleaning indoor air with air filters, and limiting physical exertion, especially outdoors and near air pollution sources. Limited evidence suggests that the use of respirators may be effective in some circumstances. Awareness of air pollution levels is facilitated by a growing number of public air quality alert systems. Avoiding exposure to air pollutants is especially important for susceptible individuals with chronic cardiovascular or pulmonary disease, children, and the elderly. Research on mechanisms underlying the adverse health effects of air pollution have suggested potential pharmaceutical or chemopreventive interventions, such as antioxidant or antithrombotic agents, but in the absence of data on health outcomes, no sound recommendations can be made for primary prevention. Health care providers and their patients should carefully consider individual circumstances related to outdoor and indoor air pollutant exposure levels and susceptibility to those air pollutants when deciding on a course of action to reduce personal exposure and health risks from ambient air pollutants. Careful consideration is especially warranted when interventions may have unintended negative consequences, such as when efforts to avoid exposure to air pollutants lead to reduced physical activity or when there is evidence that dietary supplements, such as antioxidants, have potential adverse health effects. These potential complications of partially effective personal interventions to reduce exposure or risk highlight the primary importance of reducing emissions of air pollutants at their sources. PMID:25694820

What can individuals do to reduce personal health risks from air pollution?

PubMed

Laumbach, Robert; Meng, Qingyu; Kipen, Howard

2015-01-01

In many areas of the world, concentrations of ambient air pollutants exceed levels associated with increased risk of acute and chronic health problems. While effective policies to reduce emissions at their sources are clearly preferable, some evidence supports the effectiveness of individual actions to reduce exposure and health risks. Personal exposure to ambient air pollution can be reduced on high air pollution days by staying indoors, reducing outdoor air infiltration to indoors, cleaning indoor air with air filters, and limiting physical exertion, especially outdoors and near air pollution sources. Limited evidence suggests that the use of respirators may be effective in some circumstances. Awareness of air pollution levels is facilitated by a growing number of public air quality alert systems. Avoiding exposure to air pollutants is especially important for susceptible individuals with chronic cardiovascular or pulmonary disease, children, and the elderly. Research on mechanisms underlying the adverse health effects of air pollution have suggested potential pharmaceutical or chemopreventive interventions, such as antioxidant or antithrombotic agents, but in the absence of data on health outcomes, no sound recommendations can be made for primary prevention. Health care providers and their patients should carefully consider individual circumstances related to outdoor and indoor air pollutant exposure levels and susceptibility to those air pollutants when deciding on a course of action to reduce personal exposure and health risks from ambient air pollutants. Careful consideration is especially warranted when interventions may have unintended negative consequences, such as when efforts to avoid exposure to air pollutants lead to reduced physical activity or when there is evidence that dietary supplements, such as antioxidants, have potential adverse health effects. These potential complications of partially effective personal interventions to reduce exposure or risk highlight the primary importance of reducing emissions of air pollutants at their sources.

The dysfunctional consequences of a performance measurement system: the case of the Iranian national hospital grading programme.

PubMed

Aryankhesal, Aidin; Sheldon, Trevor A; Mannion, Russell; Mahdipour, Saeade

2015-07-01

Performance measurement systems are increasingly used to reward and improve provider performance. However, such initiatives may also inadvertently induce a range of unintended and dysfunctional side-effects. This study explores the unintended and adverse consequences induced by the Iranian national hospital grading programme, which incorporates financial incentives for meeting nationally defined standards. We interviewed key informants across four key groups with a legitimate interest in healthcare performance: four purposively selected hospitals; four health insurance organizations; the Iranian hospital accreditation body; and one grading agency. The transcribed interviews and field notes were analysed thematically, and subsequently, member checking was conducted. Seven dysfunctional consequences were identified: misrepresentation of data by hospitals; increased anxiety and stress among hospital employees; tunnel vision; financial pressures on poorly graded hospitals; incentives to purchase unnecessary equipment; erosion of public trust; and restricting access to hospital services by patients. These were caused by the way the grading system was implemented: poor standards of audit; the way in which the audit process was conducted; and the timing of audits. The pay for performance element of the grading system and the focus on structural aspects in the standards made improvement in grading particularly difficult for those hospitals that had been assessed as under-performing. Although the Iranian hospital grading system has resulted in a significant increase in the adoption of national standards, it has nevertheless induced a range of perverse outcomes. To mitigate these requires further refinement and recalibration of the system. © The Author(s) 2015.

Introducing rapid tests for malaria into the retail sector: what are the unintended consequences?

PubMed Central

Hutchinson, Eleanor; Hutchison, Coll; Lal, Sham; Hansen, Kristian; Kayendeke, Miriam; Nabirye, Christine; Magnussen, Pascal; Mbonye, Anthony; Chandler, Clare I R

2017-01-01

The observation that many people in Africa seek care for febrile illness in the retail sector has led to a number of public health initiatives to try to improve the quality of care provided in these settings. The potential to support the introduction of rapid diagnostic tests for malaria (mRDTs) into drug shops is coming under increased scrutiny. Those in favour argue that it enables the harmonisation of policy around testing and treatment for malaria and maintains a focus on market-based solutions to healthcare. Despite the enthusiasm among many global health actors for this policy option, there is a limited understanding of the consequences of the introduction of mRDTs in the retail sector. We undertook an interpretive, mixed methods study with drug shop vendors (DSVs), their clients and local health workers to explore the uses and interpretations of mRDTs as they became part of daily practice in drug shops during a trial in Mukono District, Uganda. This paper reports the unintended consequences of their introduction. It describes how the test engendered trust in the professional competence of DSVs; was misconstrued by clients and providers as enabling a more definitive diagnosis of disease in general rather than malaria alone; that blood testing made drug shops more attractive places to seek care than they had previously been; was described as shifting treatment-seeking behaviour away from formal health centres and into drug shops; and influenced an increase in sales of medications, particularly antibiotics. Trial registration number NCT01194557; Results. PMID:28588992

Harm Reduction Text Messages Delivered During Alcohol Drinking: Feasibility Study Protocol

PubMed Central

2012-01-01

Background: Recent research using mobile phone interventions to address public health issues such as smoking, obesity, depression, and diabetes provides a basis for trialing a similar approach toward reducing the negative consequences of risky drinking. Objective: This feasibility study aims to recruit drinkers between 18–34 years to a website where they will design and enter their own personal messages (repeating or one-off) to be sent to their mobile phones when they are drinking to remind them of their pre-drinking safety intentions. Methods/Design: Participants in the treatment group will have access to the messaging function for 3 months and will be compared to a control group who will have 3 months access to a web chat site only. Data collection will occur at baseline, 3 months, and 6 months. The primary outcome is a change in unintended negative consequences from drinking at 3 months. Secondary outcomes include the acceptability of the intervention to this population, recruitment rate, participant retention, reduction in alcohol consumption, and the self-motivation discourse in participant messages. Discussion: Existing alcohol interventions in New Zealand attempt to reduce alcohol consumption in the population, but with little effect. This study aims to target unintended negative consequences resulting from drinking by empowering the drinkers themselves to deliver safety messages during the drinking session. If proven effective, this strategy could provide a cost-effective means of reducing the public health burden associated with risky drinking. Trial Registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000242921 PMID:23611773

The Role of the Military in Counterterrorism: Unintended Consequences

DTIC Science & Technology

2012-12-01

mercy or regret because their relatives were killed in front of them, their sisters were raped , their houses were destroyed…These people have nothing...soldiers for ordering his twin sisters out of their beds.46 According to the Army, the responsibility for the innocent people’s sufferings lay on the...hope of finding them sleeping in their beds peacefully. As it did in classic conventional operations, the Army Headquarters in Northern Ireland

Developing Games for Health Behavior Change: Getting Started

PubMed Central

Buday, Richard; Thompson, Debbe; Lyons, Elizabeth J.; Lu, Amy Shirong; Baranowski, Janice

2013-01-01

Abstract Many investigators are considering developing videogames for health (video-G4Hs) but have questions about how to get started. This report provides guidance for investigators considering a G4H as a behavioral intervention procedure from a team of experienced G4H developers. Thirteen commonly asked questions are answered, including defining a G4H, considerations in developing a team, considerations in G4H design, and anticipating unintended consequences. PMID:24443708

Mexico’s Drug War and Its Unintended Regional Consequences

DTIC Science & Technology

2013-03-01

multiple approaches are designed to solve the problem.9 Analysis of the current strategic environment, relying on the environmental assessment model...current environmental assessment, this paper will provide a brief description of a more desired environment and also a problem statement that depicts...the 1980s the U.S. focused its counter drug efforts in Peru and Bolivia, then the world’s leaders in coca leaf supply. In the meantime, Colombian

Unintended Consequences of the Goldwater-Nichols Act (Joint Force Quarterly, Spring 1998)

DTIC Science & Technology

1998-01-01

Armed Forces to achieve mili- tary success, the unified direction of DOD neces- sary for budgetary efficiency, and the separation of powers demanded by...its actions. The Constitution has stood for two centuries precisely because it flexibly applies simple concepts such as the separation of powers and...replaced, it has created a national military command structure that ignores the separation of powers . The amended National Security Act has consolidated

Boys as Only-Children and Girls as Only-Children--Parental Gendered Expectations of the Only-Child in the Nuclear Chinese Family in Present-Day China

ERIC Educational Resources Information Center

Liu, Fengshu

2006-01-01

Studies on the effect of only-child status on girls' education indicate that the only-child policy has had an unintended consequence of engendering a child-centered culture with a strong belief and shared interest among the urban community in educating the only-child regardless of the child's sex. As the distribution of education by sex is…

The SAS Education Value-Added Assessment System (SAS[R] EVAAS[R]) in the Houston Independent School District (HISD): Intended and Unintended Consequences

ERIC Educational Resources Information Center

Amrein-Beardsley, Audrey; Collins, Clarin

2012-01-01

The SAS Educational Value-Added Assessment System (SAS[R] EVAAS[R]) is the most widely used value-added system in the country. It is also self-proclaimed as "the most robust and reliable" system available, with its greatest benefit to help educators improve their teaching practices. This study critically examined the effects of SAS[R] EVAAS[R] as…

Unintended Consequences of Advocating Use of Fixed-Price Contracts in Defense Acquisition Practice

DTIC Science & Technology

2011-04-30

put to use and tested to determine its value . We take seriously the pernicious effects of the so-called “theory– practice” gap, which would separate...related to accounting and finance. His research fields are financial and management accounting , corporate finance, and economics. His latest research...investigates the cost efficiency issue in the context of defense contracts. Professor Wang’s work has been published in Accounting and Finance

Afforestation and forests at the dryland edges: Lessons learned and future outlooks

Treesearch

Csaba Mátyás; Ge Sun; Yaoqi Zhang

2013-01-01

In the Drylands of Northern China, such as the Loess Plateau region, a buffer zone of planted forests—a “Green Great Wall”—has been created in the last five decades. These government programs have often generated unintended environmental consequences, and have failed to achieve the desired benefits. Planted forests withhold erosion, dust storms and silting of streams...

The kidney allocation score: methodological problems, moral concerns and unintended consequences.

PubMed

Hippen, B

2009-07-01

The growing disparity between the demand for and supply of kidneys for transplantation has generated interest in alternative systems of allocating kidneys from deceased donors. This personal viewpoint focuses attention on the Kidney Allocation Score (KAS) proposal promulgated by the UNOS/OPTN Kidney Committee. I identify several methodological and moral flaws in the proposed system, concluding that any iteration of the KAS proposal should be met with more skepticism than sanguinity.

Tradeoffs for Renewable Energy Projects: Environmental, Planning, and Mission Considerations

DTIC Science & Technology

2010-04-01

lands .” Land is leased for energy projects subject to payment of royalties on commercial sales , into a Navy fund re- served for energy projects. This...their water resources, and other uses on these lands and airspaces? How do we make informed deci- sions about the tradeoffs between renewable energy...to meet their energy needs by generating renewable energy on (and off) installation lands . At the same time, unintended consequences of these new

Can Rising Instructional Time Crowd out Student Pro-Social Behaviour? Unintended Consequences of a German High School Reform. CEP Discussion Paper No. 1495

ERIC Educational Resources Information Center

Krekel, Christian

2017-01-01

We study whether raising instructional time can crowd out student pro-social behaviour. To this end, we exploit a large educational reform in Germany that has raised weekly instructional hours for high school students by 12.5% as a quasi-natural experiment. Using a difference-in-differences design, we find that this rise has a negative and…

The Misconception of Corporal Punishment: A Rejoin to Albrecht's "Drop and Give Us 20, Seifried: A Practical Response to Defending the Use of Punishment by Coaches"

ERIC Educational Resources Information Center

Seifried, Chad

2010-01-01

Dr. Rick Albrecht's article, titled "Drop and Give Us 20, Seifried: A Practical Response to Defending the Use of Punishment by Coaches," argued that I held a disregard for the unintended negative consequences of punishment and pointed out several items of concern he felt obligated to communicate to the scholarly and professional community to…

Defensive Medicine Among Plastic and Aesthetic Surgeons in Israel.

PubMed

Silberstein, Eldad; Shir-Az, Ofir; Reuveni, Haim; Krieger, Yuval; Shoham, Yaron; Silberstein, Tali; Bogdanov-Berezovsky, Alexander

2016-11-01

Defensive medicine (DM) includes medical practices that are aimed at avoiding liability rather than benefitting the patient. DM has not been well characterized among plastic surgeons. The authors examined the extents of intended and unintended DM among members of the Israeli Society of Plastic and Aesthetic Surgery (ISPAS) and identified risk factors for DM. A total of 108 ISPAS members were asked to complete a questionnaire that addressed physician attitudes toward DM and intended or unintended DM practices. Seventy-eight surgeons (72.2% response rate) returned the questionnaire, although some questionnaires were returned incomplete. Forty respondents acknowledged practicing DM (ie, DM group), and 33 respondents did not (ie, non-DM group). There were no between-group differences in gender, years of practice, or number of previous litigations. Thirty-one percent of respondents in the DM group indicated that they avoid certain surgical procedures, compared with 6% of respondents in the non-DM group (P = .008). In private practice, 66.2% of respondents stated that they obtain written informed consent twice before surgery, and 100% request preoperative blood-coagulation testing. In contrast, 40% and 74% of respondents in public practice, respectively, acknowledged these behaviors (for consent, P = .027; for testing, P = .0059). Sixty-three percent of respondents prescribe antibiotics for more than 24 hours postoperatively, and this practice was slightly more common in the DM group (34 prescribe antibiotics vs 21 in the non-DM group; P = .079). DM is highly integrated into the daily medical practices of plastic surgeons in Israel. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Predictors of mistimed, and unwanted pregnancies among women of childbearing age in Rufiji, Kilombero, and Ulanga districts of Tanzania.

PubMed

Exavery, Amon; Kanté, Almamy Malick; Njozi, Mustafa; Tani, Kassimu; Doctor, Henry V; Hingora, Ahmed; Phillips, James F

2014-08-08

While unintended pregnancies pose a serious threat to the health and well-being of families globally, characteristics of Tanzanian women who conceive unintentionally are rarely documented. This analysis identifies factors associated with unintended pregnancies-both mistimed and unwanted-in three rural districts of Tanzania. A cross-sectional survey of 2,183 random households was conducted in three Tanzanian districts of Rufiji, Kilombero, and Ulanga in 2011 to assess women's health behavior and service utilization patterns. These households produced 3,127 women age 15+ years from which 2,199 gravid women aged 15-49 were selected for the current analysis. Unintended pregnancies were identified as either mistimed (wanted later) or unwanted (not wanted at all). Correlates of mistimed, and unwanted pregnancies were identified through Chi-squared tests to assess associations and multinomial logistic regression for multivariate analysis. Mean age of the participants was 32.1 years. While 54.1% of the participants reported that their most recent pregnancy was intended, 32.5% indicated their most recent pregnancy as mistimed and 13.4% as unwanted. Multivariate analysis revealed that young age (<20 years), and single marital status were significant predictors of both mistimed and unwanted pregnancies. Lack of inter-partner communication about family planning increased the risk of mistimed pregnancy significantly, and multi-gravidity was shown to significantly increase the risk of unwanted pregnancy. About one half of women in Rufiji, Kilombero, and Ulanga districts of Tanzania conceive unintentionally. Women, especially the most vulnerable should be empowered to avoid pregnancy at their own will and discretion.

Specificity of the Acute Tryptophan and Tyrosine Plus Phenylalanine Depletion and Loading Tests I. Review of Biochemical Aspects and Poor Specificity of Current Amino Acid Formulations

PubMed Central

Badawy, Abdulla A.-B.; Dougherty, Donald M.; Richard, Dawn M.

2010-01-01

The acute tryptophan or tyrosine plus phenylalanine depletion and loading tests are powerful tools for studying the roles of serotonin, dopamine and noradrenaline in normal subjects and those with behavioural disorders. The current amino acid formulations for these tests, however, are associated with undesirable decreases in ratios of tryptophan or tyrosine plus phenylalanine to competing amino acids resulting in loss of specificity. This could confound biochemical and behavioural findings. Compositions of current formulations are reviewed, the biochemical principles underpinning the tests are revisited and examples of unintended changes in the above ratios and their impact on monoamine function and behaviour will be demonstrated from data in the literature. The presence of excessive amounts of the 3 branched-chain amino acids Leu, Ile and Val is responsible for these unintended decreases and the consequent loss of specificity. Strategies for enhancing the specificity of the different formulations are proposed. PMID:20676231

Specificity of the acute tryptophan and tyrosine plus phenylalanine depletion and loading tests I. Review of biochemical aspects and poor specificity of current amino Acid formulations.

PubMed

Badawy, Abdulla A-B; Dougherty, Donald M; Richard, Dawn M

2010-01-01

The acute tryptophan or tyrosine plus phenylalanine depletion and loading tests are powerful tools for studying the roles of serotonin, dopamine and noradrenaline in normal subjects and those with behavioural disorders. The current amino acid formulations for these tests, however, are associated with undesirable decreases in ratios of tryptophan or tyrosine plus phenylalanine to competing amino acids resulting in loss of specificity. This could confound biochemical and behavioural findings. Compositions of current formulations are reviewed, the biochemical principles underpinning the tests are revisited and examples of unintended changes in the above ratios and their impact on monoamine function and behaviour will be demonstrated from data in the literature. The presence of excessive amounts of the 3 branched-chain amino acids Leu, Ile and Val is responsible for these unintended decreases and the consequent loss of specificity. Strategies for enhancing the specificity of the different formulations are proposed.

Just Say Yes: Winning the U.S. War on Drugs

DTIC Science & Technology

2010-03-01

Prohibition Clearly the U.S. needs to find ways to prevent Mexico’s drug war from threatening the safety and security of U.S. citizens. Many of...fines and incarceration. While the goal of the U.S. policy is to prevent all illegal drug use, many negative unintended consequences result from...any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient

Green biotechnology and European competitiveness.

PubMed

Enriquez, J

2001-04-01

Europe has led many aspects of gene research and yet it has been unable to translate these discoveries into a globally dominant industrial sector. There are valid societal, political and financial reasons for its reluctance to deploy agricultural biotechnology but this reluctance might have unintended consequences. It will be hard to de-commoditize agriculture and improve farmer's lives. Research in medical biotechnology and the global environment might suffer. Europe could damage its overall economy and its global competitive standing.

The Helms-Burton Act: A Strategic Critique.

DTIC Science & Technology

1998-03-31

Sänger, "U.S.- Canadian Split on Cuba Tangles Wal-Mart’s Pajamas ," The New York Times, 6 March 1997, Sec. A, pi. An unintended consequence of the...organizational framework; without strategy, tactics, or historical perspective; without a language, library, data bank , complete intelligence...Sänger, David E. "U.S.-Canadian Split on Cuba Tangles Wal-Mart’s Pajamas ." The New York Times, Sec. A, pi. "Saying Boo to Helms-Burton." The

The Effect of Share 35 on Biliary Complications: an Interrupted Time Series Analysis.

PubMed

Fleming, J N; Taber, D J; Axelrod, D; Chavin, K D

2018-05-16

The purpose of the Share 35 allocation policy was to improve liver transplant waitlist mortality, targeting high MELD waitlisted patients. However, policy changes may also have unintended consequences that must be balanced with the primary desired outcome. We performed an interrupted time series assessing the impact of Share 35 on biliary complications in a select national liver transplant population using the Vizient CDB/RM ™ database. Liver transplants that occurred between October 2012 and September 2015 were included. There was a significant change in the incident-rate of biliary complications between Pre-Share 35 (n=3,018) and Post-Share 35 (n=9,984) cohorts over time (p=0.023, r2=0.44). As a control, a subanalysis was performed throughout the same time period in Region 9 transplant centers, where a broad sharing agreement had previously been implemented. In the subanalysis, there was no change in the incident-rate of biliary complications between the two time periods. Length of stay and mean direct cost demonstrated a change after implementation of Share 35, although they did not meet statistical difference. While the target of improved waitlist mortality is of utmost importance for the equitable allocation of organs, unintended consequences of policy changes should be studied for a full assessment of a policy's impact. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

State of the Science Review: Potential for Beneficial Use of ...

EPA Pesticide Factsheets

Metal and metalloid contamination of soil and sediment is a widespread problem both in urban and rural areas throughout the United States (U.S. EPA, 2014). Beneficial use of waste by-products as amendments to remediate metal-contaminated soils and sediments can provide major economic and environmental advantages on both a site-specific and national scale. These waste by-products can also reduce our need to mine virgin materials or produce synthetic materials for amendments. Waste by-products must not be hazardous or pose unacceptable risk to human health and the environment, and should be a suitable replacement for virgin and synthetic materials. This review serves to present the state of science on in-situ remediation of metal-contaminated soil and sediment and the potential for beneficial usage of waste by-product materials. Not all unintended consequences can be fully understood or predicted prior to implementing a treatment option, however some realized, and potentially unrealized, benefits and unintended consequences are explored. The objectives of this review article are to: (1) summarize the current state of the science on in-situ treatment of metal-contaminated soils and sediments; (2) review the more recent use of non-municipal and non-hazardous waste by-products for use as soil and sediment amendments; and (3) identify physical and chemical properties that are indicative of the success or effectiveness of using a specific amendment to treat metal

The Dangers of Posthumous Diagnoses and the Unintended Consequences of Facile Associations: Jeffrey Dahmer and Autism Spectrum Disorders.

PubMed

Palermo, Mark T; Bogaerts, Stefan

2015-12-01

Posthumous diagnoses are not uncommonly given to notorious public and historical figures by applying retrospectively, and typically in the absence of the individual being diagnosed, contemporary diagnostic criteria. Although this may be relatively easy and free of consequences when it concerns clear-cut medical conditions, it may have unintended repercussions in the case of psychiatric disorders by creating myths and perpetuating stigma. The case of serial killer Jeffrey Dahmer is a typical example where a somewhat facile and almost syllogistic application of perhaps over-inclusive criteria may have contributed to the legend of solitary murderers as possibly suffering from an autism spectrum condition. Although there may be an understandable human need to explain abominable and heinous behaviors, the lack of the possibility to verify a diagnostic theory and the ill-advised attempt to make a diagnosis fit may de facto be the basis of prejudice and profiling that do not correspond to clinical reality. Although there is no doubt that the brain is the organ of behavior, the authors caution against a budding neo-Lombrosian approach to crime and criminality and against the all too common use of widely differing terms in the study of deviance, such as crime, delinquency, and aggression, the operational use of which, often used interchangeably even in association studies, often erroneously leads to further confusion. © The Author(s) 2014.

Case histories in pharmaceutical risk management.

PubMed

McCormick, Cynthia G; Henningfield, Jack E; Haddox, J David; Varughese, Sajan; Lindholm, Anders; Rosen, Susan; Wissel, Janne; Waxman, Deborah; Carter, Lawrence P; Seeger, Vickie; Johnson, Rolley E

2009-12-01

The development and implementation of programs in the U.S. to minimize risks and assess unintended consequences of new medications has been increasingly required by the Food and Drug Administration (FDA) since the mid 1990s. This paper provides four case histories of risk management and post-marketing surveillance programs utilized recently to address problems associated with possible abuse, dependence and diversion. The pharmaceutical sponsors of each of these drugs were invited to present their programs and followed a similar template for their summaries that are included in this article. The drugs and presenting companies were OxyContin, an analgesic marketed by Purdue Pharma L.P., Daytrana and Vyvanse, ADHD medications marketed by Shire Pharmaceuticals, Xyrem for narcolepsy marketed by Jazz Pharmaceuticals, and Subutex and Suboxone for opioid dependence marketed by Reckitt Benckiser Pharmaceuticals Inc. These case histories and subsequent discussions provide invaluable real-world examples and illustrate both the promise of risk management programs in providing a path to market and/or for keeping on the market drugs with serious potential risks. They also illustrate the limitations of such programs in actually controlling unintended consequences, as well as the challenge of finding the right balance of reducing risks without posing undue barriers to patient access. These experiences are highly relevant as the FDA increasingly requires pharmaceutical sponsors to develop and implement the more formalized and enforceable versions of the risk management term Risk Evaluation and Mitigation Strategies (REMS).

Meeting the challenge of interacting threats in freshwater ecosystems: A call to scientists and managers

USGS Publications Warehouse

Craig, Laura S.; Olden, Julian D.; Arthington, Angela; Entrekin, Sally; Hawkins, Charles P.; Kelly, John J.; Kennedy, Theodore A.; Maitland, Bryan M.; Rosi, Emma J.; Roy, Allison; Strayer, David L.; Tank, Jennifer L.; West, Amie O.; Wooten, Matthew S.

2017-01-01

Human activities create threats that have consequences for freshwater ecosystems and, in most watersheds, observed ecological responses are the result of complex interactions among multiple threats and their associated ecological alterations. Here we discuss the value of considering multiple threats in research and management, offer suggestions for filling knowledge gaps, and provide guidance for addressing the urgent management challenges posed by multiple threats in freshwater ecosystems. There is a growing literature assessing responses to multiple alterations, and we build off this background to identify three areas that require greater attention: linking observed alterations to threats, understanding when and where threats overlap, and choosing metrics that best quantify the effects of multiple threats. Advancing science in these areas will help us understand existing ecosystem conditions and predict future risk from multiple threats. Because addressing the complex issues and novel ecosystems that arise from the interaction of multiple threats in freshwater ecosystems represents a significant management challenge, and the risks of management failure include loss of biodiversity, ecological goods, and ecosystem services, we also identify actions that could improve decision-making and management outcomes. These actions include drawing insights from management of individual threats, using threat attributes (e.g., causes and spatio-temporal dynamics) to identify suitable management approaches, testing management strategies that are likely to be successful despite uncertainties about the nature of interactions among threats, avoiding unintended consequences, and maximizing conservation benefits. We also acknowledge the broadly applicable challenges of decision-making within a socio-political and economic framework, and suggest that multidisciplinary teams will be needed to innovate solutions to meet the current and future challenge of interacting threats in freshwater ecosystems. 

A policy analysis of the problem of the reproductive health of women in the workplace.

PubMed

Kotch, J B; Ossler, C C; Howze, D C

1984-06-01

Many occupations in which women comprise the majority of the workforce involve exposure to biological, physical, and chemical hazards. Potential reproductive effects of work-related substances include impaired reproductive capacity, mutagenesis, teratogenesis, and transplacental carcinogenesis. However, female-dominated occupations tend to be only minimally regulated by the US Occupational Safety and Health Administration, and the corporate response to the issue of reproductive and fetal health has been to institute "protective discrimination policies" such as the demotion or exclusion of women of childbearing age from certain jobs. This article rates the effectiveness of alternate policy responses to increase women's occupational health and safety through use of a series of analysis criteria: equity, efficiency, preference satisfaction, right to privacy, avoidance of stigma, and unintended consequences. Policy options include the following: 1) do nothing, 2) leave current policies intact while supporting a research program to document the health consequences of specific occupational risks to women's reproductive health, 3) restrict women for who pregnancy is not ruled out from occupations or work areas known or suspected to be hazardous, 4) improve working conditions for all women, and 5) improve working conditions for all workers. Policy analysis suggests the working conditions of all workers should be improved. This alternative reduces inequity, eliminates stigma, maintains privacy, and honors preferences. Implementation of this policy would be expensive, requiring an increase in knowledge of the effects of industrial substances on female and male reproductive health, expansion of the technical capacity to control occupational hazards, and an increase in the resources of programs that monitor and regulate occupational health. However, this approach is in accord with growing concern that workers should not have to compromise their health to keep their jobs.

Energy Portfolio Assessment Tool (EPAT): Sustainable Energy Planning Using the WEF Nexus Approach - Texas Case Study

NASA Astrophysics Data System (ADS)

Mroue, A. M.

2017-12-01

The future energy portfolio at the national and subnational levels should consider its impact on water resources and environment. Although energy resources are the main contributors to the national economic growth, these resources must not exploit other primary natural resources. A study of the connections between energy and natural systems, such as water, environment and land is required prior to proceeding to energy development. Policy makers are in need of a tool quantifying the interlinkages across energy, water and the environment, while demonstrating the consequent trade-offs across the nexus systems. The Energy Portfolio Assessment Tool (EPAT) is a tool that enables the policy maker to create different energy portfolio scenarios with various energy and electricity sources, and evaluate the scenario's sustainability environmentally and economically. The Water-Energy-Food nexus systematic approach is the foundation of the EPAT framework. The research evaluates the impact of the current and projected Texas energy portfolios on water and the environment, taking into consideration energy production, electricity generation and policy change. The three scenarios to be assessed include EIA projections for energy production, and EIA projections for electricity generation with and without the Clean Power Plan (CPP). Each scenario is accompanied by tradeoffs across water, land, emissions, energy revenue and electricity cost. The CPP succeeds in mitigating the emissions of the electricity portfolio, but leads to an increase in water consumption and land use. The cost of electricity generation is almost identical with and without environmental conservation. Revenue from energy production increased, but results are majorly influenced by commodity price. Therefore, conservation policies should move from the silo to the nexus mentality to avoid unintended consequences as improving one part of the nexus could end up worsening the other parts.

Unintended outcomes evaluation approach: A plausible way to evaluate unintended outcomes of social development programmes.

PubMed

Jabeen, Sumera

2018-06-01

Social development programmes are deliberate attempts to bring about change and unintended outcomes can be considered as inherent to any such intervention. There is now a solid consensus among the international evaluation community regarding the need to consider unintended outcomes as a key aspect in any evaluative study. However, this concern often equates to nothing more than false piety. Exiting evaluation theory suffers from overlap of terminology, inadequate categorisation of unintended outcomes and lack of guidance on how to study them. To advance the knowledge of evaluation theory, methods and practice, the author has developed an evaluation approach to study unintended effects using a theory building, testing and refinement process. A comprehensive classification of unintended outcomes on the basis of knowability, value, distribution and temporality helped specify various type of unintended outcomes for programme evaluation. Corresponding to this classification, a three-step evaluation process was proposed including a) outlining programme intentions b) forecasting likely unintended effects c) mapping the anticipated and understanding unanticipated unintended outcomes. This unintended outcomes evaluation approach (UOEA) was then trialled by undertaking a multi-site and multi-method case study of a poverty alleviation programme in Pakistan and refinements were made to the approach.The case study revealed that this programme was producing a number of unintended effects, mostly negative, affecting those already disadvantaged such as the poorest, women and children. The trialling process demonstrated the effectiveness of the UOEA and suggests that this can serve as a useful guide for future evaluation practice. It also provides the discipline of evaluation with an empirically-based reference point for further theoretical developments in the study of unintended outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Shifts in intended and unintended pregnancies in the United States, 2001-2008.

PubMed

Finer, Lawrence B; Zolna, Mia R

2014-02-01

We monitored trends in pregnancy by intendedness and outcomes of unintended pregnancies nationally and for key subgroups between 2001 and 2008. Data on pregnancy intentions from the National Survey of Family Growth (NSFG) and a nationally representative survey of abortion patients were combined with counts of births (from the National Center for Health Statistics), counts of abortions (from a census of abortion providers), estimates of miscarriages (from the NSFG), and population denominators from the US Census Bureau to obtain pregnancy rates by intendedness. In 2008, 51% of pregnancies in the United States were unintended, and the unintended pregnancy rate was 54 per 1000 women ages 15 to 44 years. Between 2001 and 2008, intended pregnancies decreased and unintended pregnancies increased, a shift previously unobserved. Large disparities in unintended pregnancy by relationship status, income, and education increased; the percentage of unintended pregnancies ending in abortion decreased; and the rate of unintended pregnancies ending in birth increased, reaching 27 per 1000 women. Reducing unintended pregnancy likely requires addressing fundamental socioeconomic inequities, as well as increasing contraceptive use and the uptake of highly effective methods.

Deviant Globalization and the Unintended Consequences of Coca Eradication in Colombia

DTIC Science & Technology

2012-06-01

OAS) and the Colombian , U.S., and British governments. Upon official request, an in-depth study and assessment of the human health and environmental ...regarded as major players in the cocaine trade, as well as a serious threat to political stability in the country. In response, a U.S. and Colombian ...trade, as well as a serious threat to political stability in the country. In response, a U.S. and Colombian partnership known as Plan Colombia (2000

Homegrown violent extremists: A seemingly undetectable threat

DOE Office of Scientific and Technical Information (OSTI.GOV)

Crawford, Justin

With today’s unlimited and instantaneous communication, it is easy for a United States citizen to easily connect with anyone in the world. There are many positives to this; however, the unintended consequences include vulnerable people being influenced by radical ideologies. This is evident with the increase in homegrown violent extremists (HVE).The challenge for law enforcement is how to work with constitutional constraints that require a criminal predicate to be present in order to allow intelligence teams to continue collecting information in a permanent file.

Barcode medication administration work-arounds: a systematic review and implications for nurse executives.

PubMed

Voshall, Barbara; Piscotty, Ronald; Lawrence, Jeanette; Targosz, Mary

2013-10-01

Safe medication administration is necessary to ensure quality healthcare. Barcode medication administration systems were developed to reduce drug administration errors and the related costs and improve patient safety. Work-arounds created by nurses in the execution of the required processes can lead to unintended consequences, including errors. This article provides a systematic review of the literature associated with barcoded medication administration and work-arounds and suggests interventions that should be adopted by nurse executives to ensure medication safety.

Accidents - Policy and Punishment Are there boundar ies to the effectiveness of cr iminal sanctions in preventing accidental conduct?

NASA Astrophysics Data System (ADS)

Fisher, Alan

This paper discusses recent and impending changes in Health and Safety law, questions the utility and supposed justification of tougher criminal sanctions and appeals for greater clarity in health and safety law as to what is truly a criminal offence. It also questions the use of the ‘reverse burden of proof’ and warns against unintended consequences if responsible people are made to feel that they are being treated unfairly.

A Relevant Risk Approach to Mental Health Inquiries in Question 21 of the Questionnaire for National Security Positions (SF-86)

DTIC Science & Technology

2015-03-24

5b. GRANT NUMBER: 5c. PROGRAM ELEMENT NUMBER: 6. AUTHOR(S): Jonathan Shedler, Eric L. Lang 5d. PROJECT NUMBER: 5e. TASK NUMBER: 5f...national security interests and represents an example of the law of unintended consequences. Inclusion of the question likely serves to undermine...certain positions. For example , a person who suffers from epilepsy and experiences uncontrolled seizures is not suited to be a pilot. He or she may

Knowledge Transfer Loss in a Base Realignment and Closure (BRAC) Environment: A Positive or Negative Acquisition Paradigm Shift

DTIC Science & Technology

2012-04-01

between 1946-1964), Gen-Xrs (born between 1965-1980), Millennials (born between 1981- 1990), and iGenerationals (born between 1991 and today). Research...generations (03 Traditionalist, 71 Generation X, 04 Millennial, and 00 iGeneration ). And there were 34 (11 percent) survey official responses where the...interesting insight into unintended consequences of “mass purge/new blood” on absorbing a short-term 0 50 100 150 200 No Response Opt-outs iGeneration

Nazi Germany and Fascist Italy: Totalitarian Menace or Monolithic Illusion? An Analysis of the Axis Coalition

DTIC Science & Technology

2004-06-17

no confidence in against Chancellor Franz von Papen . This led to new elections on 6 November which had unintended consequences--the Nazi’s lost 2...their living space and to maintain peace.1 Preamble to the Pact of Steel On 22 May 1939, the German Reich Minister for Foreign Affairs, Joachim von ...alliance and war. 5 In Germany, Hitler continued to accumulate power after January 1933. With the death of President Paul von Hindenburg, Hitler

Messaging, Missions, and Mindsets: The Unintended Consequences of National Messaging and Policy when Translated into Operations and Soldier Actions in the Second World War

DTIC Science & Technology

2013-06-23

abundant, and nearly every American had regular 6 access to radios and the cinema . For the first time, messages could reach nearly everyone in...still required for full support. On December 7th, 1941, the Japanese provided it.42 On December 11th, 1941, Hitler declared war on the U.S., without...Soviet, and anti-gypsy indoctrinating propaganda. Nazi public festivals and theater, contextually similar to the American cinema experience

Hybrid Masculinity and Young Men's Circumscribed Engagement in Contraceptive Management.

PubMed

Fefferman, Ann M; Upadhyay, Ushma D

2018-06-01

This research explores how gender shapes contraceptive management through in-depth interviews with 40 men and women of color ages 15 to 24, a life stage when the risk of unintended pregnancy is high in the United States. Although past research focuses on men's contraception-avoidant behaviors, little sociological work has explored ways men engage in contraception outside of condoms, such as contraceptive pills. Research often highlights how women manage these methods alone. Our research identifies how young men of color do help manage these methods through their engagement in contraceptive decision-making and use. Men accomplish this without limiting their partners' ability to prevent pregnancy. This is despite structural barriers such as poverty and gang-related violence that disproportionately affect low-income young men of color and often shape their reproductive goals. However, men's engagement is still circumscribed so that women take on a disproportionate burden of pregnancy prevention, reifying gender boundaries. We identify this as a form of hybrid masculinity, because men's behaviors are seemingly egalitarian but also sustain women's individualized risk of unintended pregnancy. This research points to the complexity of how race, class, and gender intersect to create an engaged but limited place for men in contraceptive management among marginalized youth.

Unintended pregnancy and interpregnancy interval by maternal age, National Survey of Family Growth.

PubMed

Ahrens, Katherine A; Thoma, Marie E; Copen, Casey E; Frederiksen, Brittni N; Decker, Emily J; Moskosky, Susan

2018-03-01

The relationship between unintended pregnancy and interpregnancy interval (IPI) across maternal age is not clear. Using data from the National Survey of Family Growth, we estimated the percentages of pregnancies that were unintended among IPI groups (<6, 6-11, 12-17, 18-23, 24+ months) by maternal age at last live birth (15-19, 20-24, 25-29, 30-44 years). Approximately 40% of pregnancies were unintended and 36% followed an IPI<18 months. Within each maternal age group, the percentage of pregnancies that were unintended decreased as IPI increased. Unintended pregnancies are associated with shorter IPI across the reproductive age spectrum. Published by Elsevier Inc.

Ecosystem context and historical contingency in apex predator recoveries.

PubMed

Stier, Adrian C; Samhouri, Jameal F; Novak, Mark; Marshall, Kristin N; Ward, Eric J; Holt, Robert D; Levin, Phillip S

2016-05-01

Habitat loss, overexploitation, and numerous other stressors have caused global declines in apex predators. This "trophic downgrading" has generated widespread concern because of the fundamental role that apex predators can play in ecosystem functioning, disease regulation, and biodiversity maintenance. In attempts to combat declines, managers have conducted reintroductions, imposed stricter harvest regulations, and implemented protected areas. We suggest that full recovery of viable apex predator populations is currently the exception rather than the rule. We argue that, in addition to well-known considerations, such as continued exploitation and slow life histories, there are several underappreciated factors that complicate predator recoveries. These factors include three challenges. First, a priori identification of the suite of trophic interactions, such as resource limitation and competition that will influence recovery can be difficult. Second, defining and accomplishing predator recovery in the context of a dynamic ecosystem requires an appreciation of the timing of recovery, which can determine the relative density of apex predators and other predators and therefore affect competitive outcomes. Third, successful recovery programs require designing adaptive sequences of management strategies that embrace key environmental and species interactions as they emerge. Consideration of recent research on food web modules, alternative stable states, and community assembly offer important insights for predator recovery efforts and restoration ecology more generally. Foremost among these is the importance of a social-ecological perspective in facilitating a long-lasting predator restoration while avoiding unintended consequences.

Ecosystem context and historical contingency in apex predator recoveries

PubMed Central

Stier, Adrian C.; Samhouri, Jameal F.; Novak, Mark; Marshall, Kristin N.; Ward, Eric J.; Holt, Robert D.; Levin, Phillip S.

2016-01-01

Habitat loss, overexploitation, and numerous other stressors have caused global declines in apex predators. This “trophic downgrading” has generated widespread concern because of the fundamental role that apex predators can play in ecosystem functioning, disease regulation, and biodiversity maintenance. In attempts to combat declines, managers have conducted reintroductions, imposed stricter harvest regulations, and implemented protected areas. We suggest that full recovery of viable apex predator populations is currently the exception rather than the rule. We argue that, in addition to well-known considerations, such as continued exploitation and slow life histories, there are several underappreciated factors that complicate predator recoveries. These factors include three challenges. First, a priori identification of the suite of trophic interactions, such as resource limitation and competition that will influence recovery can be difficult. Second, defining and accomplishing predator recovery in the context of a dynamic ecosystem requires an appreciation of the timing of recovery, which can determine the relative density of apex predators and other predators and therefore affect competitive outcomes. Third, successful recovery programs require designing adaptive sequences of management strategies that embrace key environmental and species interactions as they emerge. Consideration of recent research on food web modules, alternative stable states, and community assembly offer important insights for predator recovery efforts and restoration ecology more generally. Foremost among these is the importance of a social-ecological perspective in facilitating a long-lasting predator restoration while avoiding unintended consequences. PMID:27386535

Built Environment and Active Commuting: Rural-Urban Differences in the U.S.

PubMed

Fan, Jessie X; Wen, Ming; Wan, Neng

2017-12-01

The purpose of this research was to investigate rural-urban differences in participation rates in three modes of active commuting (AC) and their built environmental correlates. The 2010 Census supplemented with other datasets were used to analyze AC rates in percent of workers age 16+ walking, biking, or taking public transportation to work in 70,172 Census tracts, including 12,844 rural and 57,328 urban. Random-intercept factional logit regressions were used to account for zero-inflated data and for clustering of tracts within counties. We found that the average AC rates were 3.44% rural and 2.77% urban (p<0.01) for walking to work, 0.40% rural and 0.58% urban (p<0.01) for biking to work, and 0.59% rural and 5.86% urban (p<0.01) for public transportation to work. Some environmental variables had similar relationships with AC in rural and urban tracts, such as a negative association between tract greenness and prevalence of walking to work. Others had opposite correlational directions for rural vs. urban, such as street connectivity for walking to work and population density for both walking to work and public transportation to work. We concluded that rurality is an important moderator in AC-environment relationships. In developing strategies to promote AC, attention needs to be paid to rural-urban differences to avoid unintended consequences.

Security Informatics Research Challenges for Mitigating Cyber Friendly Fire

DOE Office of Scientific and Technical Information (OSTI.GOV)

Carroll, Thomas E.; Greitzer, Frank L.; Roberts, Adam D.

This paper addresses cognitive implications and research needs surrounding the problem of cyber friendly re (FF). We dene cyber FF as intentional o*ensive or defensive cyber/electronic actions intended to protect cyber systems against enemy forces or to attack enemy cyber systems, which unintentionally harms the mission e*ectiveness of friendly or neutral forces. We describe examples of cyber FF and discuss how it ts within a general conceptual framework for cyber security failures. Because it involves human failure, cyber FF may be considered to belong to a sub-class of cyber security failures characterized as unintentional insider threats. Cyber FF is closelymore » related to combat friendly re in that maintaining situation awareness (SA) is paramount to avoiding unintended consequences. Cyber SA concerns knowledge of a system's topology (connectedness and relationships of the nodes in a system), and critical knowledge elements such as the characteristics and vulnerabilities of the components that comprise the system and its nodes, the nature of the activities or work performed, and the available defensive and o*ensive countermeasures that may be applied to thwart network attacks. We describe a test bed designed to support empirical research on factors a*ecting cyber FF. Finally, we discuss mitigation strategies to combat cyber FF, including both training concepts and suggestions for decision aids and visualization approaches.« less

Impacts of groundwater management on energy resources and greenhouse gas emissions in California.

PubMed

Hendrickson, Thomas P; Bruguera, Maya

2018-09-15

California faces significant energy and water infrastructure planning challenges in response to a changing climate. Immediately following the most severe recorded drought, the state experienced one of its wettest water years in recorded history. Despite the recent severe wet weather, much of the state's critical groundwater systems have not recovered from the drought. The recent Sustainable Groundwater Management Act (SGMA) aims to eliminate future depletion risks, but may force California basins to seek alternative water sources by limiting groundwater withdrawals during droughts. These alternative water resources, such as recycled water or desalination, can have significantly higher energy demands in treatment and supply than local groundwater or surface water resources. This research developed potential scenarios of water supply sources for five overdrafted groundwater basins, and modeled the impacts of these scenarios on energy demands and greenhouse gas (GHG) emissions for water supply systems. Our results reveal that energy demands and GHG emissions in different water supply scenarios can vary substantially between basins, but could increase statewide energy consumption as much as 2% and GHG emissions by 0.5. These results highlight the need to integrate these energy and GHG impacts into water resource management. Better understanding these considerations enables water supply planners to avoid potential unintended consequences (i.e., increased energy demands and GHG emissions) of enhancing drought resilience. Copyright © 2018 Elsevier Ltd. All rights reserved.

The professionalising of breast feeding--where are we a decade on?

PubMed

Barclay, Lesley; Longman, Jo; Schmied, Virginia; Sheehan, Athena; Rolfe, Margaret; Burns, Elaine; Fenwick, Jennifer

2012-06-01

This paper is an empirically informed opinion piece revisiting an argument published in Midwifery 10 years ago, that the increasing professionalisation of breast feeding was not supporting women in Australia in sustaining breast feeding. We present the last 10 years of primary research on the topic, explore major policy initiatives and the establishment and growth of lactation consultants in Australia to see if this has made a difference to sustained rates of breast feeding. We present an analysis of the only consistently collected national statistics on breast feeding and compare this with national and state level government data collections from the last decade. We have found that the considerable effort invested in trying to improve duration of breast feeding amongst women in Australia appears to have failed to improve sustained breast-feeding rates. We argue that this situation might be related to losing sight of the embodied nature of breast feeding and the relationships that must exist between the mother and baby, the knowledge and skills women quickly develop, and a loss of woman to woman support. We conclude that midwives have a major role in avoiding us reproducing similar, unintended, negative consequences to those resulting from increasing obstetrician managed normal birth. These include midwifery scrutiny and involvement in policy development and institutional practices and the design of services. Copyright © 2012 Elsevier Ltd. All rights reserved.

The association and a potential pathway between gender-based violence and induced abortion in Thai Nguyen province, Vietnam.

PubMed

Nguyen, Phuong Hong; Nguyen, Son Van; Nguyen, Manh Quang; Nguyen, Nam Truong; Keithly, Sarah Colleen; Mai, Lan Tran; Luong, Loan Thi Thu; Pham, Hoa Quynh

2012-11-29

Gender-based violence (GBV) has profound adverse consequences on women's physical, mental, and reproductive health. Although Vietnam has high rates of induced abortion and GBV, literature examining this relationship is lacking. This study examines the association of GBV with induced abortion among married or partnered women of reproductive age in Thai Nguyen province, Vietnam. In addition, we explore contraceptive use and unintended pregnancy as mediators in the pathway between GBV and induced abortion. Data were drawn from a cross-sectional survey of 1,281 women aged 18-49 years in four districts of Thai Nguyen province. Bivariate and multivariate logistic regression analyses were applied to examine the associations between lifetime history of GBV, contraceptive use, unintended pregnancy, induced abortion, and repeat abortion, controlling for other covariates. One-third of respondents had undergone induced abortion in their lifetime (33.4%), and 11.5% reported having repeat abortions. The prevalence of any type of GBV was 29.1% (17.0% physical violence, 10.4% sexual violence, and 20.1% emotional violence). History of GBV was associated with induced abortion (OR=1.61, 95% CI: 1.20-2.16) and repeat abortion (OR=2.22, 95% CI: 1.48-3.32). Physical violence was significantly associated with induced abortion, and all three types of violence were associated with repeat abortion. Abused women were more likely than non-abused women to report using contraceptives and having an unintended pregnancy, and these factors were in turn associated with increased risk of induced abortion. GBV is pervasive in Thai Nguyen province and is linked to increased risks of induced abortion and repeat abortion. The findings suggest that a pathway underlying this relationship is increased risk of unintended pregnancy due in part to ineffective use of contraceptives. These findings emphasize the importance of screening and identification of GBV and incorporating women's empowerment in reproductive health and family planning programs.

The association and a potential pathway between gender-based violence and induced abortion in Thai Nguyen province, Vietnam

PubMed Central

Nguyen, Phuong Hong; Van Nguyen, Son; Nguyen, Manh Quang; Nguyen, Nam Truong; Keithly, Sarah Colleen; Tran Mai, Lan; Thi Thu Luong, Loan; Pham, Hoa Quynh

2012-01-01

Background Gender-based violence (GBV) has profound adverse consequences on women's physical, mental, and reproductive health. Although Vietnam has high rates of induced abortion and GBV, literature examining this relationship is lacking. Objective This study examines the association of GBV with induced abortion among married or partnered women of reproductive age in Thai Nguyen province, Vietnam. In addition, we explore contraceptive use and unintended pregnancy as mediators in the pathway between GBV and induced abortion. Design and methods Data were drawn from a cross-sectional survey of 1,281 women aged 18–49 years in four districts of Thai Nguyen province. Bivariate and multivariate logistic regression analyses were applied to examine the associations between lifetime history of GBV, contraceptive use, unintended pregnancy, induced abortion, and repeat abortion, controlling for other covariates. Results One-third of respondents had undergone induced abortion in their lifetime (33.4%), and 11.5% reported having repeat abortions. The prevalence of any type of GBV was 29.1% (17.0% physical violence, 10.4% sexual violence, and 20.1% emotional violence). History of GBV was associated with induced abortion (OR=1.61, 95% CI: 1.20–2.16) and repeat abortion (OR=2.22, 95% CI: 1.48–3.32). Physical violence was significantly associated with induced abortion, and all three types of violence were associated with repeat abortion. Abused women were more likely than non-abused women to report using contraceptives and having an unintended pregnancy, and these factors were in turn associated with increased risk of induced abortion. Conclusions GBV is pervasive in Thai Nguyen province and is linked to increased risks of induced abortion and repeat abortion. The findings suggest that a pathway underlying this relationship is increased risk of unintended pregnancy due in part to ineffective use of contraceptives. These findings emphasize the importance of screening and identification of GBV and incorporating women's empowerment in reproductive health and family planning programs. PMID:23195517

Socioeconomic inequality of unintended pregnancy in the Iranian population: a decomposition approach.

PubMed

Omani-Samani, Reza; Amini Rarani, Mostafa; Sepidarkish, Mahdi; Khedmati Morasae, Esmaeil; Maroufizadeh, Saman; Almasi-Hashiani, Amir

2018-05-09

There are several studies regarding the predictors or risk factors of unintended pregnancy, but only a small number of studies have been carried out concerning the socio-economic factors influencing the unintended pregnancy rate. This study aimed to determine the socioeconomic inequality of unintended pregnancy in Tehran, Iran, as a developing country. In this hospital based cross-sectional study, 5152 deliveries from 103 hospitals in Tehran (the capital of Iran) were included in the analysis in July 2015. Socioeconomic status (SES) was measured through an asset-based method and principal component analysis was carried out to calculate the household SES. The concentration index and curve was used to measure SES inequality in unintended pregnancy, and then decomposed into its determinants. The data was analyzed by statistical Stata software. The Wagstaff normalized concentration index of unintended pregnancy (- 0.108 (95% Confidence Interval (CI) = - 0.119 ~ - 0.054)) endorses that unintended pregnancy is more concentrated among poorer mothers. The results showed that SES accounted for 27% of unintended pregnancy inequality, followed by the mother's nationality (19%), father's age (16%), mother's age (10%), father's education level (7%) and Body Mass Index (BMI) groups (5%). Unintended pregnancy is unequally distributed among Iranian women and is more concentrated among poor women. Economic status had the most positive contribution, explaining 27% of inequality in unintended pregnancy.

Can tobacco control endgame analysis learn anything from the US experience with illegal drugs?

PubMed

Reuter, Peter

2013-05-01

The goals of tobacco control endgame strategies are specified in terms of the desired levels of tobacco use and/or tobacco related health consequences. Yet the strategies being considered may have other consequences beyond tobacco use prevalence, forms and related harms. Most of the proposed strategies threaten to create large black markets with potential attendant harms: corruption, high illegal earnings, violence and/or organised crime. Western societies of course have considerable experience with these problems in the context of prohibition of drugs such as cannabis, cocaine, heroin and methamphetamine. These experiences suggest that low prevalence has been achieved only by tough enforcement with damaging unintended consequences. Tobacco prohibition (total or partial) may not present the same trade-off but there is little basis for making a projection of the scale, form and harms of the attendant black markets. Nonetheless, these harms should not be ignored in analyses of the endgame proposals.

Unintended Consequences of Tele Health and their Possible Solutions

PubMed Central

Maeder, A.; Mars, M.; Hartvigsen, G.; Basu, A.; Abbott, P.

2016-01-01

Summary Objectives Assess unforeseen consequences of Telehealth and suggest solutions Methods An outline was created collecting all possible ill effects classified into Clinical considerations, Administrative concerns including interpersonal relations, Technical issues, Legal / Ethical concerns and Miscellaneous. Each topic was assigned to a particular WG member to lead, gather opinion and review existing literature. Results and Conclusion A wide array of problems have been described. Except for technical issues, literature on this topic is scant, so this article is based more on personal experience and data collected from surveys. Much can be done to prevent such problems, such as a need for standardization with related clinical studies for devices as well as processes used for telehealth is underlined, besides evaluation of outcomes of projects undertaken. PMID:27830229

Epidemiological Criminology: Contextualization of HIV/AIDS Health Care for Female Inmates.

PubMed

Lanier, Mark M; Zaitzow, Barbara H; Farrell, C Thomas

2015-04-01

Worldwide, women are increasingly being incarcerated. One unintended consequence is the increase in unhealthy female offenders. Among the more serious health concerns are HIV and AIDS. Challenges associated with caring for women with HIV/AIDS impacts not only disease management and infection control within correctional facilities but also the prisoners' home communities where they will need health care, drug and alcohol rehabilitation, housing assistance, and employment opportunities. No bridging theory has been presented that links prison and community health concerns with criminal justice policy. This article not only presents recommendations for effective HIV/AIDS policy but also suggests epidemiological criminology as a means of explicit merging of health with justice issues and consequently provides a bridging framework. © The Author(s) 2015.

Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya.

PubMed

Ikamari, Lawrence; Izugbara, Chimaraoke; Ochako, Rhoune

2013-03-19

The prevalence of unintended pregnancy in Kenya continues to be high. The 2003 Kenya Demographic and Health Survey (KDHS) showed that nearly 50% of unmarried women aged 15-19 and 45% of the married women reported their current pregnancies as mistimed or unwanted. The 2008-09 KDHS showed that 43% of married women in Kenya reported their current pregnancies were unintended. Unintended pregnancy is one of the most critical factors contributing to schoolgirl drop out in Kenya. Up to 13,000 Kenyan girls drop out of school every year as a result of unintended pregnancy. Unsafe pregnancy termination contributes immensely to maternal mortality which currently estimated at 488 deaths per 100 000 live births. In Kenya, the determinants of prevalence and determinants of unintended pregnancy among women in diverse social and economic situations, particularly in urban areas, are poorly understood due to lack of data. This paper addresses the prevalence and the determinants of unintended pregnancy among women in slum and non-slum settlements of Nairobi. This study used the data that was collected among a random sample of 1262 slum and non-slum women aged 15-49 years in Nairobi. The data was analyzed using simple percentages and logistic regression. The study found that 24 percent of all the women had unintended pregnancy. The prevalence of unintended pregnancy was 21 per cent among women in slum settlements compared to 27 per cent among those in non-slum settlements. Marital status, employment status, ethnicity and type of settlement were significantly associated with unintended pregnancy. Logistic analysis results indicate that age, marital status and type of settlement had statistically significantly effects on unintended pregnancy. Young women aged 15-19 were significantly more likely than older women to experience unintended pregnancy. Similarly, unmarried women showed elevated risk for unintended pregnancy than ever-married women. Women in non-slum settlements were significantly more likely to experience unintended pregnancy than their counterparts in slum settlements.The determinants of unintended pregnancy differed between women in each type of settlement. Among slum women, age, parity and marital status each had significant net effect on unintended pregnancy. But for non-slum women, it was marital status and ethnicity that had significant net effects. The study found a high prevalence of unintended pregnancy among the study population and indicated that young and unmarried women, irrespective of their educational attainment and household wealth status, have a higher likelihood of experiencing unintended pregnancy. Except for the results on educational attainments and household wealth, these results compared well with the results reported in the literature.The results indicate the need for effective programs and strategies to increase access to contraceptive services and related education, information and communication among the study population, particularly among the young and unmarried women. Increased access to family planning services is key to reducing unintended pregnancy among the study population. This calls for concerted efforts by all the stakeholders to improve access to family planning services among the study population. Increased access should be accompanied with improvement in the quality of care and availability of information about effective utilization of family planning methods.

Predictors of mistimed, and unwanted pregnancies among women of childbearing age in Rufiji, Kilombero, and Ulanga districts of Tanzania

PubMed Central

2014-01-01

Background While unintended pregnancies pose a serious threat to the health and well-being of families globally, characteristics of Tanzanian women who conceive unintentionally are rarely documented. This analysis identifies factors associated with unintended pregnancies—both mistimed and unwanted—in three rural districts of Tanzania. Methods A cross-sectional survey of 2,183 random households was conducted in three Tanzanian districts of Rufiji, Kilombero, and Ulanga in 2011 to assess women’s health behavior and service utilization patterns. These households produced 3,127 women age 15+ years from which 2,199 gravid women aged 15–49 were selected for the current analysis. Unintended pregnancies were identified as either mistimed (wanted later) or unwanted (not wanted at all). Correlates of mistimed, and unwanted pregnancies were identified through Chi-squared tests to assess associations and multinomial logistic regression for multivariate analysis. Results Mean age of the participants was 32.1 years. While 54.1% of the participants reported that their most recent pregnancy was intended, 32.5% indicated their most recent pregnancy as mistimed and 13.4% as unwanted. Multivariate analysis revealed that young age (<20 years), and single marital status were significant predictors of both mistimed and unwanted pregnancies. Lack of inter-partner communication about family planning increased the risk of mistimed pregnancy significantly, and multi-gravidity was shown to significantly increase the risk of unwanted pregnancy. Conclusions About one half of women in Rufiji, Kilombero, and Ulanga districts of Tanzania conceive unintentionally. Women, especially the most vulnerable should be empowered to avoid pregnancy at their own will and discretion. PMID:25102924

The Perceived Impact of the Patient Protection and Affordable Care Act on North Carolina's Free Clinics.

PubMed

Swan, Greg A; Foley, Kristie L

2016-01-01

The Patient Protection and Affordable Care Act of 2010 (ACA) may dramatically affect the demographics of the uninsured population and the funding prospects for free health clinics. We conducted a cross-sectional survey of 64 of 80 free clinics (80.0% response rate) in North Carolina to assess free clinic directors' knowledge of the ACA and their perceptions of how the ACA would affect clinic operations. Free clinic directors were knowledgeable about well publicized aspects of the ACA (eg, lack of Medicaid expansion in North Carolina), but they were less knowledgeable about provisions such as the Federal Tort Claims Act and high-risk pools, which may have direct and indirect effects on free clinics. Directors expressed concern over the unintended consequences of the ACA, such as reduced funding and reduced volunteerism. Anticipated clinic changes as a result of the ACA include initiation of electronic medical records and, to a lesser extent, a move to become "hybrid" clinics (federally qualified health center look-alikes). This study is focused on North Carolina free clinics that are members of the North Carolina Association of Free Clinics (NCAFC). Findings cannot be generalized to non-NCAFC free clinics or to free clinic networks outside the state. Despite its effort to expand health insurance coverage, the ACA may have unintended consequences to low-cost free clinics that serve uninsured populations. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Redox-Mediated and Ionizing-Radiation-Induced Inflammatory Mediators in Prostate Cancer Development and Treatment

PubMed Central

Miao, Lu; Holley, Aaron K.; Zhao, Yanming; St. Clair, William H.

2014-01-01

Abstract Significance: Radiation therapy is widely used for treatment of prostate cancer. Radiation can directly damage biologically important molecules; however, most effects of radiation-mediated cell killing are derived from the generated free radicals that alter cellular redox status. Multiple proinflammatory mediators can also influence redox status in irradiated cells and the surrounding microenvironment, thereby affecting prostate cancer progression and radiotherapy efficiency. Recent Advances: Ionizing radiation (IR)–generated oxidative stress can regulate and be regulated by the production of proinflammatory mediators. Depending on the type and stage of the prostate cancer cells, these proinflammatory mediators may lead to different biological consequences ranging from cell death to development of radioresistance. Critical Issues: Tumors are heterogeneous and dynamic communication occurs between stromal and prostate cancer cells, and complicated redox-regulated mechanisms exist in the tumor microenvironment. Thus, antioxidant and anti-inflammatory strategies should be carefully evaluated for each patient at different stages of the disease to maximize therapeutic benefits while minimizing unintended side effects. Future Directions: Compared with normal cells, tumor cells are usually under higher oxidative stress and secrete more proinflammatory mediators. Thus, redox status is often less adaptive in tumor cells than in their normal counterparts. This difference can be exploited in a search for new cancer therapeutics and treatment regimes that selectively activate cell death pathways in tumor cells with minimal unintended consequences in terms of chemo- and radio-resistance in tumor cells and toxicity in normal tissues. Antioxid. Redox Signal. 20, 1481–1500. PMID:24093432

Mediation of adoption and use: a key strategy for mitigating unintended consequences of health IT implementation.

PubMed

Novak, Laurie L; Anders, Shilo; Gadd, Cynthia S; Lorenzi, Nancy M

2012-01-01

Without careful attention to the work of users, implementation of health IT can produce new risks and inefficiencies in care. This paper uses the technology use mediation framework to examine the work of a group of nurses who serve as mediators of the adoption and use of a barcode medication administration (BCMA) system in an inpatient setting. The study uses ethnographic methods to explore the mediators' work. Data included field notes from observations, documents, and email communications. This variety of sources enabled triangulation of findings between activities observed, discussed in meetings, and reported in emails. Mediation work integrated the BCMA tool with nursing practice, anticipating and solving implementation problems. Three themes of mediation work include: resolving challenges related to coordination, integrating the physical aspects of BCMA into everyday practice, and advocacy work. Previous work suggests the following factors impact mediation effectiveness: proximity to the context of use, understanding of users' practices and norms, credibility with users, and knowledge of the technology and users' technical abilities. We describe three additional factors observed in this case: 'influence on system developers,' 'influence on institutional authorities,' and 'understanding the network of organizational relationships that shape the users' work.' Institutionally supported clinicians who facilitate adoption and use of health IT systems can improve the safety and effectiveness of implementation through the management of unintended consequences. Additional research on technology use mediation can advance the science of implementation by providing decision-makers with theoretically durable, empirically grounded evidence for designing implementations.

Renal denervation and hypertension - The need to investigate unintended effects and neural control of the human kidney.

PubMed

Grisk, Olaf

2017-05-01

Increased renal sympathetic nerve activity (RSNA) is present in human and experimental forms of arterial hypertension. Experimental denervation studies showed that renal nerves contribute to the development of hypertension. Clinical trials provided equivocal results on the antihypertensive efficacy of renal denervation in patients spurring discussions on technical aspects of renal denervation and further research on the role of renal nerves for the regulation of kidney function as well as the pathophysiology of hypertension. This review summarizes recent findings on adrenoceptor expression and function in the human kidney, adrenoceptor-dependent regulation of sodium chloride transport in the distal nephron, experimental data on chronic RSNA and the development of high arterial pressure and consequences of renal denervation that may limit its antihypertensive efficacy. Future research needs to reduce the gap between our knowledge on neural control of renal function in animals vs. humans to facilitate translation of experimental animal data to humans. More experimental studies on the temporal relationship between RSNA and arterial pressure in the chronic setting are needed to better define the pathogenetic role of heightened RSNA in different forms of arterial hypertension in order to improve the rational basis for renal denervation in antihypertensive therapy. Finally, research on unintended consequences of renal denervation including but not limited to reinnervation and denervation supersensitivity needs to be intensified to further assess the potential of renal denervation to slow the progression of renal disease and hypertension. Copyright © 2016 Elsevier B.V. All rights reserved.

New Unintended Adverse Consequences of Electronic Health Records

PubMed Central

Wright, A.; Ash, J.; Singh, H.

2016-01-01

Summary Although the health information technology industry has made considerable progress in the design, development, implementation, and use of electronic health records (EHRs), the lofty expectations of the early pioneers have not been met. In 2006, the Provider Order Entry Team at Oregon Health & Science University described a set of unintended adverse consequences (UACs), or unpredictable, emergent problems associated with computer-based provider order entry implementation, use, and maintenance. Many of these originally identified UACs have not been completely addressed or alleviated, some have evolved over time, and some new ones have emerged as EHRs became more widely available. The rapid increase in the adoption of EHRs, coupled with the changes in the types and attitudes of clinical users, has led to several new UACs, specifically: complete clinical information unavailable at the point of care; lack of innovations to improve system usability leading to frustrating user experiences; inadvertent disclosure of large amounts of patient-specific information; increased focus on computer-based quality measurement negatively affecting clinical workflows and patient-provider interactions; information overload from marginally useful computer-generated data; and a decline in the development and use of internally-developed EHRs. While each of these new UACs poses significant challenges to EHR developers and users alike, they also offer many opportunities. The challenge for clinical informatics researchers is to continue to refine our current systems while exploring new methods of overcoming these challenges and developing innovations to improve EHR interoperability, usability, security, functionality, clinical quality measurement, and information summarization and display. PMID:27830226