Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis.

PubMed

Iwami, Michiyo; Ahmad, Raheelah; Castro-Sánchez, Enrique; Birgand, Gabriel; Johnson, Alan P; Holmes, Alison

2017-01-23

(1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). 3 senior managers from 5 hospitals for qualitative interviews. As primary outcome measures, a 'Red-Amber-Green' (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Research Capacity for Local Innovation: The Case of Conservation Agriculture in Ethiopia, Malawi and Mozambique

ERIC Educational Resources Information Center

Brown, Brendan; Nuberg, Ian; Llewellyn, Rick

2018-01-01

Purpose: The limited uptake of improved agricultural practices in Africa raise questions on the functionality of current agricultural research systems. Our purpose is to explore the capacity for local innovation within the research systems of Ethiopia, Malawi and Mozambique. Design/Methodology/Approach: Using Conservation Agriculture (CA) as a…

Sports Medicine and Arthroscopic Treatment of the Foot and Ankle: What Is New and Current in Singapore.

PubMed

Ho, Sean Wei Loong; Thevendran, Gowreeson

2016-06-01

Foot and ankle abnormalities are common in Singapore because of the compulsory conscription, the slipper-wearing culture, and the promotion of healthy living through exercise. The rapidly aging population, lack of elite sportsmen, and social and cultural norms pose unique challenges to foot and ankle surgery. Orthopedic surgery in Singapore has progressed because of the good infrastructure and modern practices executed by fellowship-trained surgeons. Evolving local practices are polarized by practice trends emulated from North America and Europe. The small community of foot and ankle surgeons currently practicing in Singapore allows for easier communication, corroborative educational events, and research initiatives. Copyright © 2016 Elsevier Inc. All rights reserved.

Local Anesthetics: Review of Pharmacological Considerations

PubMed Central

Becker, Daniel E; Reed, Kenneth L

2012-01-01

Local anesthetics have an impressive history of efficacy and safety in medical and dental practice. Their use is so routine, and adverse effects are so infrequent, that providers may understandably overlook many of their pharmacotherapeutic principles. The purpose of this continuing education article is to provide a review and update of essential pharmacology for the various local anesthetic formulations in current use. Technical considerations will be addressed in a subsequent article. PMID:22822998

Translingual Practices and Monoglot Policy Aspirations: A Case Study of Pakistan's Plurilingual Classrooms

ERIC Educational Resources Information Center

Ashraf, Hina

2018-01-01

Current research in multilingual countries supports local languages and recognizes plurilingual practices as a proficiency (e.g. Luxembourg and Nordic countries in Europe, Bolivia, Argentina, and Columbia in South America). Yet linguistically diverse and multilingual regions, such as Pakistan, continue to be challenged by monoglot language…

Reshaping the Boundaries of Community Engagement in Design Education: Global and Local Explorations

ERIC Educational Resources Information Center

Hicks, Travis L.; Radtke, Rebekah Ison

2015-01-01

Community-driven design is a current movement in the forefront of many designers' practices and on university campuses in design programs. The authors examine work from their respective public state universities' design programs as examples of best practices. In these case studies, the authors share experiences using community-based design…

75 FR 25852 - Agency Information Collection Activities; Proposed Collection; Comment Request; Stormwater...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-10

... order to evaluate current stormwater management practices, the scope of the current State and local...; Stormwater Management Including Discharges From Developed Sites Questionnaires AGENCY: Environmental... forwarded to the Office of Management and Budget (OMB) for review and approval. This is a request for a new...

Formative assessment as a vehicle for changing classroom practice in a specific cultural context

NASA Astrophysics Data System (ADS)

Chen, Jingping

2015-09-01

In this commentary, I interpret Xinying Yin and Gayle Ann Buck's collaborative action research from a social-cultural perspective. Classroom implementation of formative assessment is viewed as interaction between this assessment method and the local learning culture. I first identify Yin and Buck's definition of the formative assessment, and then analyze the role of formative assessment in the change of local learning culture. Based on the practice of Yin and Buck I emphasize the significance of their "bottom up" strategy to the teachers' epistemological change. I believe that this strategy may provide practicable solutions to current Chinese educational problems as well as a means for science educators to shift toward systematic professional development.

Current challenges in adherence to clinical guidelines for antibiotic prophylaxis in surgery.

PubMed

Khan, Sohail Ahmad; Rodrigues, Gabrial; Kumar, Pramod; Rao, Padma G M

2006-06-01

To study the impact of guidelines on surgical antibiotic prophylaxis in clinical practice, barriers involved in adherence to guidelines and how to overcome the same. Literature pertaining to prophylactic antibiotic usage was searched. Medscape, Medline, Cochrane, Surgical Infection Prevention (SIP) project databases were reviewed. Recent articles from relevant journals, texts, and standard guidelines were also studied. Local guidelines seem more likely to be accepted and followed than those developed nationally. Major barriers involved in adherence to guidelines include lack of awareness about the guidelines, general perception of guideline as a bureaucratic rather than educational tool. Some practitioners perceive guidelines as "cookbook medicine" that does not permit them to make their own medical decisions. Other barriers are complex, multi-step systems that create confusion, decrease accountability. Methods for guideline adherence include surveillance and data analysis, new systems to facilitate documentation and improving workflow, education regarding current evidence-based guidelines and promoting the development of local guidelines or protocol, development and implementation of reminders to facilitate adherence to the local guidelines. A multidisciplinary steering team of surgeons, infectious disease specialists, pharmacists, anesthesiologists, microbiologists and nurses should develop local guidelines suitable to their institution and methods for adherence to prevent the surgical site infections. The gap between evidence-based guidelines and practice must be addressed in order to achieve optimal practice in this domain.

Towards Social Radiology as an Information Infrastructure: Reconciling the Local With the Global

PubMed Central

2014-01-01

The current widespread use of medical images and imaging procedures in clinical practice and patient diagnosis has brought about an increase in the demand for sharing medical imaging studies among health professionals in an easy and effective manner. This article reveals the existence of a polarization between the local and global demands for radiology practice. While there are no major barriers for sharing such studies, when access is made from a (local) picture archive and communication system (PACS) within the domain of a healthcare organization, there are a number of impediments for sharing studies among health professionals on a global scale. Social radiology as an information infrastructure involves the notion of a shared infrastructure as a public good, affording a social space where people, organizations and technical components may spontaneously form associations in order to share clinical information linked to patient care and radiology practice. This article shows however, that such polarization establishes a tension between local and global demands, which hinders the emergence of social radiology as an information infrastructure. Based on an analysis of the social space for radiology practice, the present article has observed that this tension persists due to the inertia of a locally installed base in radiology departments, for which common teleradiology models are not truly capable of reorganizing as a global social space for radiology practice. Reconciling the local with the global signifies integrating PACS and teleradiology into an evolving, secure, heterogeneous, shared, open information infrastructure where the conceptual boundaries between (local) PACS and (global) teleradiology are transparent, signaling the emergence of social radiology as an information infrastructure. PMID:25600710

The Albert Einstein Distinguished Educator Fellowship: Bridging the Gap Between Policy and Practice

NASA Astrophysics Data System (ADS)

Milbourne, Jeff; Wheeler, Sam

2017-02-01

In an ideal world, education policy and practice would exist as parts of a coherent system. Effective practice would inform policy and that policy would, in turn, promote the tenets of effective practice at the local, state, and national levels. Policymakers and practitioners would collaborate and, by extension, have familiarity and respect for one another's perspective. Unfortunately, our current education system is a far cry from the ideal, a fact that we as practitioners know all too well.

Language Choice and Education Quality in Eastern and Southern Africa: A Review

ERIC Educational Resources Information Center

Trudell, Barbara

2016-01-01

In 2014, UNICEF commissioned a review of language policy and education quality in the 21 countries of UNICEF's Eastern and Southern Africa Region. This paper examines findings from the review, related to the role of English and local languages in current education practice in the region. National language policies and implementation practices are…

Changing the individual to promote health-enhancing physical activity: the difficulties of producing evidence and translating it into practice.

PubMed

Blamey, Avril; Mutrie, Nanette

2004-08-01

This paper presents conclusions from recent systematic reviews and highlights individually targeted interventions that are effective at increasing physical activity. It discusses the limitations of currently available evidence, considers what factors lead to these limitations and what barriers exist in terms of implementing the evidence as part of local and national policy and practice. Barriers present themselves in terms of getting evidence into practice and in terms of ensuring that practice informs the evidence base. These barriers include difficulties in conducting systematic reviews, disaggregating knowledge from complex interventions, making local adaptations to existing evidence, the lack of an evaluation culture, ethical and pragmatic difficulties in designing interventions, selecting appropriate outcome measures, poor designs and implementation of evidence and, finally, a recognition that policy making is not only based on the available evidence. New and more integrated approaches to evaluation and to practice are needed.

Case management: developing practice through action research.

PubMed

Smith, Annetta; Mackay, Seonaid; McCulloch, Kathleen

2013-09-01

This article is a report of an action research study carried out with community nurses to help develop case management within their practice. Using action research principles, nurses reviewed and analysed their current practice and developed recommendations for further embedding case management as a means of supporting patients with complex care needs in their own homes. Findings indicate that a number of factors can influence the community nurse's ability to implement case management. These factors include approaches to case finding, availability of resources and interprofessional working. Important considerations for nurses were the influence of the context of care, the geographical location and the health needs of the local patient population, which meant that case management may need to be adapted to meet local circumstances.

A material flow analysis on current electrical and electronic waste disposal from Hong Kong households

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

Lau, Winifred Ka-Yan; Chung, Shan-Shan, E-mail: sschung@hkbu.edu.hk; Zhang, Chan

2013-03-15

Highlights: ► Most household TWARC waste is sold directly to private e-waste collectors in HK. ► The current e-waste recycling network is popular with HK households. ► About 80% of household generated TWARC is exported overseas each year. ► Over 7000 tonnes/yr of household generated TWARC reach landfills. ► It is necessary to upgrade safety and awareness in HK’s e-waste recycling industry. - Abstract: A material flow study on five types of household electrical and electronic equipment, namely television, washing machine, air conditioner, refrigerator and personal computer (TWARC) was conducted to assist the Government of Hong Kong to establish anmore » e-waste take-back system. This study is the first systematic attempt on identifying key TWARC waste disposal outlets and trade practices of key parties involved in Hong Kong. Results from two questionnaire surveys, on local households and private e-waste traders, were used to establish the material flow of household TWARC waste. The study revealed that the majority of obsolete TWARC were sold by households to private e-waste collectors and that the current e-waste collection network is efficient and popular with local households. However, about 65,000 tonnes/yr or 80% of household generated TWARC waste are being exported overseas by private e-waste traders, with some believed to be imported into developing countries where crude recycling methods are practiced. Should Hong Kong establish a formal recycling network with tight regulatory control on imports and exports, the potential risks of current e-waste recycling practices on e-waste recycling workers, local residents and the environment can be greatly reduced.« less

Opportunities and Best Practices to Support Sustainable Production for Small Growers and Post-Harvest Processors in Southern California

ERIC Educational Resources Information Center

Fissore, Cinzia; Duran, Daniel F.; Russell, Robert

2015-01-01

This article describes current practices and needs associated with water and gas conservation among Southern California greenhouse growers, Post-Harvest Processors (PHPs), and agricultural associations. Two communication forums were held with the goal of educating the local gas company and small growers and PHPs on the most compelling needs and…

LEADERSHIP FOR VOCATIONAL EDUCATION IN CALIFORNIA--THEORY AND PRACTICE OF PROGRAM DEVELOPMENT, SUMMARY REPORT OF THE COASTAL, NORTHERN, AND SOUTHERN REGIONAL CONFERENCES (NOVEMBER, 1965).

ERIC Educational Resources Information Center

California State Dept. of Education, Sacramento. Vocational Education Services.

APPROXIMATELY 105 SUPERVISORS AND COORDINATORS OF PUBLIC SCHOOL VOCATIONAL EDUCATION PROGRAMS IN CALIFORNIA PARTICIPATED IN CONFERENCES TO STUDY CURRENT LEADERSHIP PRACTICES AND VOCATIONAL EDUCATION PROGRAMS AS RELATED TO NATIONAL, STATE, AND LOCAL REQUIREMENTS. PRESENTATIONS WERE--(1) "A THEORETICAL MODEL FOR VOCATIONAL EDUCATION IN A…

Sustainability and local people's participation in coastal aquaculture: regional differences and historical experiences in Sri Lanka and the Philippines.

PubMed

Bergquist, Daniel A

2007-11-01

This article discusses environmental sustainability in aquaculture and its contribution to poverty alleviation, based on field studies in Sri Lanka and the Philippines. The aquaculture practices studied are the monoculture of the black tiger prawn (Penneaus monodon) and milkfish (Chanos chanos) and the polyculture of the two species together with the mud crab (Scylla serrata). Factors affecting economic viability, social equity and environmental impacts in aquaculture are discussed and used to illuminate local and regional differences between aquaculture in Sri Lanka and the Philippines. Findings indicate that the most significant difference is the level of participation by local people (i.e., people originating < or =10 km away from the farm location). In the Philippines, 84 % of the people involved in aquaculture are locals, whereas in Sri Lanka, 55% are outsiders. Whether differences between the two areas can be explained by analyzing regional conditions, which might have resulted in different aquaculture practices, is discussed. In Sri Lanka, semi-intensive shrimp monoculture is currently the most common practice, whereas in the Philippines, extensive shrimp/fish polyculture is more common. Previous studies, as well as fieldwork, indicate that extensive culture practices reduce environmental impacts and benefit local people more. Sustainability in aquaculture is, however, also dependent on the extent of mangrove conversion into ponds. As such, extensive and locally owned farms do not necessarily result in an all but sustainable situation. Keeping this in mind, it is discussed if extensive polyculture practices might result in a more sustainable aquaculture, both environmentally and socioeconomically.

Sustainability and Local People's Participation in Coastal Aquaculture: Regional Differences and Historical Experiences in Sri Lanka and the Philippines

NASA Astrophysics Data System (ADS)

Bergquist, Daniel A.

2007-11-01

This article discusses environmental sustainability in aquaculture and its contribution to poverty alleviation, based on field studies in Sri Lanka and the Philippines. The aquaculture practices studied are the monoculture of the black tiger prawn ( Penneaus monodon) and milkfish ( Chanos chanos) and the polyculture of the two species together with the mud crab ( Scylla serrata). Factors affecting economic viability, social equity and environmental impacts in aquaculture are discussed and used to illuminate local and regional differences between aquaculture in Sri Lanka and the Philippines. Findings indicate that the most significant difference is the level of participation by local people (i.e., people originating ≤10 km away from the farm location). In the Philippines, 84 % of the people involved in aquaculture are locals, whereas in Sri Lanka, 55% are outsiders. Whether differences between the two areas can be explained by analyzing regional conditions, which might have resulted in different aquaculture practices, is discussed. In Sri Lanka, semi-intensive shrimp monoculture is currently the most common practice, whereas in the Philippines, extensive shrimp/fish polyculture is more common. Previous studies, as well as fieldwork, indicate that extensive culture practices reduce environmental impacts and benefit local people more. Sustainability in aquaculture is, however, also dependent on the extent of mangrove conversion into ponds. As such, extensive and locally owned farms do not necessarily result in an all but sustainable situation. Keeping this in mind, it is discussed if extensive polyculture practices might result in a more sustainable aquaculture, both environmentally and socioeconomically.

Practicing health promotion in primary care -a reflective enquiry.

PubMed

Pati, S; Chauhan, A S; Mahapatra, S; Sinha, R; Pati, S

2017-12-01

Health promotion is an integral part of routine clinical practice. The physicians' role in improving the health status of the general population, through effective understanding and delivery of health promotion practice, is evident throughout the international literature. Data from India suggest that physicians have limited skills in delivering specific health promotion services. However, the data available on this is scarce. This study was planned to document the current health promotion knowledge, perception and practices of local primary care physicians in Odisha. An exploratory study was planned between the months of January - February 2013 in Odisha among primary care physicians working in government set up. This exploratory study was conducted, using a two-step self-administered questionnaire, thirty physicians practicing under government health system were asked to map their ideal and current health promotion practice, and potential health promotion elements to be worked upon to enhance the practice. The study recorded a significant difference between the mean of current and ideal health promotion practices. The study reported that physicians want to increase their practice on health education. We concluded that inclusion of health promotion practices in routine care is imperative for a strong healthcare system. It should be incorporated as a structured health promotion module in medical curriculum as well.

CDOT rapid debris removal research project.

DOT National Transportation Integrated Search

2014-07-01

Highway debris represents a traffic safety problem that requires a prompt response from state or local transportation : agencies. The most common practice for debris removal currently is for agency personnel to leave their vehicles and : remove the d...

Reducing inequalities in access to health care: developing a toolkit through action research.

PubMed

Goyder, E C; Blank, L; Ellis, E; Furber, A; Peters, J; Sartain, K; Massey, C

2005-10-01

Healthcare organisations are expected both to monitor inequalities in access to health services and also to act to improve access and increase equity in service provision. Locally developed action research projects with an explicit objective of reducing inequalities in access. Eight different health care services in the Yorkshire and Humber region, including community based palliative care, general practice asthma care, hospital based cardiology clinics, and termination of pregnancy services. Changes in service provision, increasing attendance rates in targeted groups. Local teams identified the population concerned and appropriate interventions using both published and grey literature. Where change to service provision was achieved, local data were collected to monitor the impact of service change. A number of evidence based changes to service provision were proposed and implemented with variable success. Service uptake increased in some of the targeted populations. Interventions to improve access must be sensitive to local settings and need both practical and managerial support to succeed. It is particularly difficult to improve access effectively if services are already struggling to meet current demand. Key elements for successful interventions included effective local leadership, identification of an intervention which is both evidence based and locally practicable, and identification of additional resources to support increased activity. A "toolkit" has been developed to support the identification and implementation of appropriate changes.

National survey on the practice of radiation therapists in Australia.

PubMed

Sale, Charlotte; Halkett, Georgia; Cox, Jenny

2016-06-01

Radiation therapy (RT), like many allied health professions, has lacked professional practice clarity, which until 2008 had not been comprehensively investigated. This manuscript describes the first phase of a three-phase project investigating the current and future practices of radiation therapists (RTs) in Australia. The aim of phase 1 was to define the practice of RTs in Australia. A quantitative approach was used to gain an understanding of RT practice. A national survey was distributed to RTs in Australia. Descriptive statistics and content analysis were used to analyse the data. RT practice was analysed in relation to core and non-core roles, where non-core roles were further divided into basic and advanced practices. The data from the national survey were representative of the Australian RT population (n = 525). The current practice of RTs is presented in summary tables for each area of work (treatment, planning, simulation, mould room and general). This study provided clarification of RT practice and indicated there was a desire to relinquish administrative roles to focus on RT-specific practice. There was evidence that some advanced roles were currently practiced in Australia; however, there was no structure to support these roles and they were based only on local need. This study identified that the profession needs to consider how they will maintain core RT practice, while encouraging the development of new roles, and whether some roles need to be relinquished.

The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis

PubMed Central

Al-Jahdali, Hamdan; Alshimemeri, Abdullah; Mobeireek, Abdullah; Albanna, Amr S.; Al Shirawi, Nehad N.; Wali, Siraj; Alkattan, Khaled; Alrajhi, Abdulrahman A.; Mobaireek, Khalid; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.; Chang, Anne B.; Aliberti, Stefano

2017-01-01

This is the first guideline developed by the Saudi Thoracic Society for the diagnosis and management of noncystic fibrosis bronchiectasis. Local experts including pulmonologists, infectious disease specialists, thoracic surgeons, respiratory therapists, and others from adult and pediatric departments provided the best practice evidence recommendations based on the available international and local literature. The main objective of this guideline is to utilize the current published evidence to develop recommendations about management of bronchiectasis suitable to our local health-care system and available resources. We aim to provide clinicians with tools to standardize the diagnosis and management of bronchiectasis. This guideline targets primary care physicians, family medicine practitioners, practicing internists and respiratory physicians, and all other health-care providers involved in the care of the patients with bronchiectasis. PMID:28808486

Applications of geographic information systems (GIS) for transportation and climate change

DOT National Transportation Integrated Search

2011-08-31

This report describes the current practice and application of GIS technologies for integrating climate change into the transportation decision-making process. It examines how select state, regional, and local agencies are using GIS to analyze, mitiga...

Adaptation to Climatic Hazards in the Savannah Ecosystem: Improving Adaptation Policy and Action

NASA Astrophysics Data System (ADS)

Yiran, Gerald A. B.; Stringer, Lindsay C.

2017-10-01

People in Ghana's savannah ecosystem have historically experienced a range of climatic hazards that have affected their livelihoods. In view of current climate variability and change, and projected increases in extreme events, adaptation to climate risks is vital. Policies have been put in place to enhance adaptation across sub-Saharan Africa in accordance with international agreements. At the same time, local people, through experience, have learned to adapt. This paper examines current policy actions and their implementation alongside an assessment of barriers to local adaptation. In doing so it links adaptation policy and practice. Policy documents were analysed that covered key livelihood sectors, which were identified as climate sensitive. These included agriculture, water, housing and health policies, as well as the National Climate Change Policy. In-depth interviews and focus group discussions were also held with key stakeholders in the Upper East Region of Ghana. Analyses were carried using thematic content analysis. Although policies and actions complement each other, their integration is weak. Financial, institutional, social, and technological barriers hinder successful local implementation of some policy actions, while lack of local involvement in policy formulation also hinders adaptation practice. Integration of local perspectives into policy needs to be strengthened in order to enhance adaptation. Coupled with this is a need to consider adaptation to climate change in development policies and to pursue efforts to reduce or remove the key barriers to implementation at the local level.

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

Ha, Kyoo-Man, E-mail: ha1999@hotmail.com

In Korea, there is a pervasive feeling of invincibility to the point that people and organizations do not believe that disasters can strike them. This has impact on the level of preparedness for disasters. This study aims to delve into how Korea has to change its governmental policies/practices with some private partners' efforts to mitigate disaster risks. A case study was utilized as the major methodology by comparing exclusive management with inclusive management. These two approaches have been comparatively analyzed via four variables, namely the central government, the local governments, the incident commander, and other stakeholders. The major finding ismore » that Korea's practices and policies have to evolve from the current exclusive management into future-oriented inclusive management. Moreover, the importance of communication, cooperation, collaboration, and multi-discipline coordination is discussed. Additionally, the problem of reductionism and equal participation among all stakeholders, as well as the resistance from vested interests, are recognized and elaborated for Korea and the international community. - Highlights: • Only a few stakeholders in Korea believe that disaster can happen to anyone. This study aims to delve into how Korea has to change its current practices to mitigate disaster risks. • To compare exclusive management with inclusive management, we have examined four comparative variables, namely the central government's policy, local government's strategy, the incident commander's post, and other stakeholders' efforts. • The major finding is that Korea's practices and policies have to evolve from the current exclusive management into future-oriented inclusive management.« less

Multi-centre parallel arm randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based cognitive behavioural approach to managing fatigue in people with multiple sclerosis.

PubMed

Thomas, Peter W; Thomas, Sarah; Kersten, Paula; Jones, Rosemary; Nock, Alison; Slingsby, Vicky; Green, Colin; Baker, Roger; Galvin, Kate; Hillier, Charles

2010-06-16

Fatigue is one of the most commonly reported and debilitating symptoms of multiple sclerosis (MS); approximately two-thirds of people with MS consider it to be one of their three most troubling symptoms. It may limit or prevent participation in everyday activities, work, leisure, and social pursuits, reduce psychological well-being and is one of the key precipitants of early retirement. Energy effectiveness approaches have been shown to be effective in reducing MS-fatigue, increasing self-efficacy and improving quality of life. Cognitive behavioural approaches have been found to be effective for managing fatigue in other conditions, such as chronic fatigue syndrome, and more recently, in MS. The aim of this pragmatic trial is to evaluate the clinical and cost-effectiveness of a recently developed group-based fatigue management intervention (that blends cognitive behavioural and energy effectiveness approaches) compared with current local practice. This is a multi-centre parallel arm block-randomised controlled trial (RCT) of a six session group-based fatigue management intervention, delivered by health professionals, compared with current local practice. 180 consenting adults with a confirmed diagnosis of MS and significant fatigue levels, recruited via secondary/primary care or newsletters/websites, will be randomised to receive the fatigue management intervention or current local practice. An economic evaluation will be undertaken alongside the trial. Primary outcomes are fatigue severity, self-efficacy and disease-specific quality of life. Secondary outcomes include fatigue impact, general quality of life, mood, activity patterns, and cost-effectiveness. Outcomes in those receiving the fatigue management intervention will be measured 1 week prior to, and 1, 4, and 12 months after the intervention (and at equivalent times in those receiving current local practice). A qualitative component will examine what aspects of the fatigue management intervention participants found helpful/unhelpful and barriers to change. This trial is the fourth stage of a research programme that has followed the Medical Research Council guidance for developing and evaluating complex interventions. What makes the intervention unique is that it blends cognitive behavioural and energy effectiveness approaches. A potential strength of the intervention is that it could be integrated into existing service delivery models as it has been designed to be delivered by staff already working with people with MS. Service users will be involved throughout this research. Current Controlled Trials ISRCTN76517470.

A Novel Approach to Improving Utilization of Laboratory Testing.

PubMed

Zhou, Yaolin; Procop, Gary W; Riley, Jacquelyn D

2018-02-01

- The incorporation of best practice guidelines into one's institution is a challenging goal of utilization management, and the successful adoption of such guidelines depends on institutional context. Laboratorians who have access to key clinical data are well positioned to understand existing local practices and promote more appropriate laboratory testing. - To apply a novel approach to utilization management by reviewing international clinical guidelines and current institutional practices to create a reliable mechanism to improve detection and reduce unnecessary tests in our patient population. - We targeted a frequently ordered genetic test for HFE-related hereditary hemochromatosis, a disorder of low penetrance. After reviewing international practice guidelines, we evaluated 918 HFE tests and found that all patients with new diagnoses had transferrin saturation levels that were significantly higher than those of patients with nonrisk genotypes (72% versus 42%; P < .001). - Our "one-button" order that restricts HFE genetic tests to patients with transferrin saturation greater than 45% is consistent with published practice guidelines and detected 100% of new patients with HFE-related hereditary hemochromatosis. - Our proposed algorithm differs from previously published approaches in that it incorporates both clinical practice guidelines and local physician practices, yet requires no additional hands-on effort from pathologists or clinicians. This novel approach to utilization management embraces the role of pathologists as leaders in promoting high-quality patient care in local health care systems.

An Exploration of the Interaction between Global Education Policy Orthodoxies and National Education Practices in Cambodia, Illuminated through the Voices of Local Teacher Educators

ERIC Educational Resources Information Center

Courtney, Jane

2017-01-01

This research is based on a multi-disciplinary and multi-levelled analysis of evidence to present the case that education reform needs to be contextualised far more widely than is currently practised. It focuses on the voices of Cambodian local teacher trainers through interviews over a five-year period. Interview data is triangulated against…

Management of tinnitus in English NHS audiology departments: an evaluation of current practice

PubMed Central

Hoare, Derek J; Gander, Phillip E; Collins, Luke; Smith, Sandra; Hall, Deborah A

2012-01-01

Rationale, aim and objective In 2009, the UK Department of Health formalized recommended National Health Service practices for the management of tinnitus from primary care onwards. It is timely therefore to evaluate the perceived practicality, utility and impact of those guidelines in the context of current practice. Methods We surveyed current practice by posting a 36-item questionnaire to all audiology and hearing therapy staff that we were able to identify as being involved in tinnitus patient care in England. Results In total, 138 out of 351 clinicians responded (39% response rate). The findings indicate a consensus opinion that management should be tailored to individual symptom profiles but that there is little standardization of assessment procedures or tools in use. Conclusions While the lack of standardized practice might provide flexibility to meet local demand, it has drawbacks. It makes it difficult to ascertain key standards of best practice, it complicates the process of clinical audit, it implies unequal patient access to care, and it limits the implementation of translational research outcomes. We recommend that core elements of practice should be standardized, including use of a validated tinnitus questionnaires and an agreed pathway for decision making to better understand the rationale for management strategies offered. PMID:21087449

Finding the Genomic Basis of Local Adaptation: Pitfalls, Practical Solutions, and Future Directions.

PubMed

Hoban, Sean; Kelley, Joanna L; Lotterhos, Katie E; Antolin, Michael F; Bradburd, Gideon; Lowry, David B; Poss, Mary L; Reed, Laura K; Storfer, Andrew; Whitlock, Michael C

2016-10-01

Uncovering the genetic and evolutionary basis of local adaptation is a major focus of evolutionary biology. The recent development of cost-effective methods for obtaining high-quality genome-scale data makes it possible to identify some of the loci responsible for adaptive differences among populations. Two basic approaches for identifying putatively locally adaptive loci have been developed and are broadly used: one that identifies loci with unusually high genetic differentiation among populations (differentiation outlier methods) and one that searches for correlations between local population allele frequencies and local environments (genetic-environment association methods). Here, we review the promises and challenges of these genome scan methods, including correcting for the confounding influence of a species' demographic history, biases caused by missing aspects of the genome, matching scales of environmental data with population structure, and other statistical considerations. In each case, we make suggestions for best practices for maximizing the accuracy and efficiency of genome scans to detect the underlying genetic basis of local adaptation. With attention to their current limitations, genome scan methods can be an important tool in finding the genetic basis of adaptive evolutionary change.

Construction Quality Assurance for Federally Funded Local Public Agency Projects

DOT National Transportation Integrated Search

2015-03-01

The purpose of this TechBrief is to summarize a comprehensive investigation of current construction QA practices from both SHA and LPA perspectives undertaken in 2012 and to present recommendations from this analysis. The review included a content an...

Options for improving the coordination of transportation and land use planning in Virginia.

DOT National Transportation Integrated Search

2004-01-01

Virginia's 2003 General Assembly directed the Secretary of Transportation to (1) assess best practices used by other states to coordinate transportation and land use planning, (2) review current state efforts to provide technical assistance to local ...

An assessment of the Bhutanese traditional medicine for its ethnopharmacology, ethnobotany and ethnoquality: Textual understanding and the current practices.

PubMed

Wangchuk, Phurpa; Pyne, Stephen G; Keller, Paul A

2013-06-21

: This study involves the assessment of the Bhutanese traditional medicine (BTM) which was integrated with the mainstream biomedicine in 1967 to provide primary health care services in the country. It caters to 20-30% of the daily out-patients within 49 traditional medicine units attached to 20 district modern hospitals and 29 Basic Health Units in the country. : This study presents the ethnopharmacological, ethnobotanical and the ethnoquality concepts in relation to mainstream Tibetan medicine and describes the current practices of BTM. : Experienced BTM practitioners (Drung-tshos and Smen-pas) were selected using a convenience sampling method and were interviewed using an open questionnaire followed by informal discussions. The corpus of BTM, Tibetan and scientific literature was obtained and the information on ethnopharmacological, ethnoquality and ethnobotanical concepts and current practices of BTM was extracted. : This study found that the BTM shares many similarities in terms of materia medica, pharmacopoeia and the principles and concepts of ethnopharmacology and ethnobotany with its mainstream Tibetan medicine. However, the resourceful Bhutanese Drung-tshos and Smen-pas have adapted this medical system based on the local language, culture, disease trend, health care needs and their familiarity with the locally available medicinal ingredients making it particular to the country. A number of notable distinctions observed in the current practices include a code of classification of diseases (only 79 of 404 types of disorders recognized), formulations (currently used only 103 of thousands formulation types), usage of medicinal plants (only 229 species of thousands described) and selected treatment procedures (golden needle and water therapy). This BTM was found to cater to 20-30% of daily out-patients visiting 49 modern hospitals and basic health units in the country. : The BTM has been evolved from the Tibetan medicine. While the pharmacopoeia, ethnopharmacology, ethnobotany and the ethnoquality aspects shares commonalities with the mainstream Tibetan medicine, there are some practices unique to BTM. Such uniqueness observed in the current practices of BTM include formulations, medicinal plants collection and usage, and the treatment procedures including golden needle and water therapy. This could be a promising source of information for the rediscovery of useful remedies, the development of modern phytotherapeutics and the establishment of efficient quality control measures. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Criteria for setting speed limits in urban and suburban areas in Florida

DOT National Transportation Integrated Search

2003-03-01

Current methods of setting speed limits include maximum statutory limits by road class and geometric characteristics and speed zoning practice for the roads where the legislated limit does not reflect local differences. Speed limits in speed zones ar...

Simulators for training in ultrasound guided procedures.

PubMed

Farjad Sultan, Syed; Shorten, George; Iohom, Gabrielle

2013-06-01

The four major categories of skill sets associated with proficiency in ultrasound guided regional anaesthesia are 1) understanding device operations, 2) image optimization, 3) image interpretation and 4) visualization of needle insertion and injection of the local anesthetic solution. Of these, visualization of needle insertion and injection of local anaesthetic solution can be practiced using simulators and phantoms. This survey of existing simulators summarizes advantages and disadvantages of each. Current deficits pertain to the validation process.

Putting the public (back) into public health: leadership, evidence and action.

PubMed

South, J; Connolly, A M; Stansfield, J A; Johnstone, P; Henderson, G; Fenton, K A

2018-03-13

There is a strong evidence-based rationale for community capacity building and community empowerment as part of a strategic response to reduce health inequalities. Within the current UK policy context, there are calls for increased public engagement in prevention and local decision-making in order to give people greater control over the conditions that determine health. With reference to the challenges and opportunities within the English public health system, this essay seeks to open debate about what is required to mainstream community-centred approaches and ensure that the public is central to public health. The essay sets out the case for a reorientation of public health practice in order to build impactful action with communities at scale leading to a reduction in the health gap. National frameworks that support local practice are described. Four areas of challenge that could potentially drive an implementation gap are discussed: (i) achieving integration and scale, (ii) effective community mobilization, (iii) evidencing impact and (iv) achieving a shift in power. The essay concludes with a call to action for developing a contemporary public health practice that is rooted in communities and offers local leadership to strengthen local assets, increase community control and reduce health inequalities.

Use of local anesthesia during dental rehabilitation with general anesthesia: a survey of dentist anesthesiologists.

PubMed

Townsend, Janice A; Hagan, Joseph L; Smiley, Megann

2014-01-01

The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: "stabilization of vital signs/decreased depth of general anesthesia" (92.9%, 26/28) and "improved patient recovery" (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia.

Investigating local sustainable environmental perspectives of Kenyan community members and teachers

NASA Astrophysics Data System (ADS)

Quigley, Cassie F.; Dogbey, James; Che, S. Megan; Hallo, Jeffrey

2015-09-01

Efforts to conserve and preserve the environment in developing or marginalized locales frequently involve a one-way transfer of knowledge and materials from a source in a more developed location. This situation often degenerates into a short-term donor project which risks little to no long-term impacts on local or indigenous relationships with the environment. This research study with educators in Narok, Kenya investigates the current perspectives of local key stakeholders on the environment and sustainability with the purpose of sharing these understandings among local groups to generate a locally constructed meaning of environmental conservation and sustainability. It is the researchers' aim that through locally constructed meanings of environmental hazards and conservation, the Maasai community will empower themselves to transform their relationship with their environment and begin to construct and enact sustainable alternatives to destructive environmental practices. The approach used in this study is a qualitative study of representative stakeholders' environmental perspectives called photovoice. Two major themes emerged during the data analysis: How do we co-habit? and How do we modernize? This community demonstrated a complex understandings including navigate traditional practices, made connections to a larger system, and describing positive ways in which humans influence our environment.

Product-based Safety Certification for Medical Devices Embedded Software.

PubMed

Neto, José Augusto; Figueiredo Damásio, Jemerson; Monthaler, Paul; Morais, Misael

2015-01-01

Worldwide medical device embedded software certification practices are currently focused on manufacturing best practices. In Brazil, the national regulatory agency does not hold a local certification process for software-intensive medical devices and admits international certification (e.g. FDA and CE) from local and international industry to operate in the Brazilian health care market. We present here a product-based certification process as a candidate process to support the Brazilian regulatory agency ANVISA in medical device software regulation. Center of Strategic Technology for Healthcare (NUTES) medical device embedded software certification is based on a solid safety quality model and has been tested with reasonable success against the Class I risk device Generic Infusion Pump (GIP).

Local antimicrobial administration for prophylaxis of surgical site infections.

PubMed

Huiras, Paul; Logan, Jill K; Papadopoulos, Stella; Whitney, Dana

2012-11-01

Despite a lack of consensus guidelines, local antibiotic administration for prophylaxis of surgical site infections is used during many surgical procedures. The rationale behind this practice is to provide high antibiotic concentrations at the site of surgery while minimizing systemic exposure and adverse effects. Local antibiotic administration for surgical site prophylaxis has inherent limitations in that antibiotics are applied after the incision is made, rather than the current standard for surgical site prophylaxis that recommends providing adequate antibiotic concentrations at the site before the incision. The efficacy and safety of local application of antibiotics for surgical site prophylaxis have been assessed in different types of surgery with a variety of antibiotic agents and methods of application. We identified 22 prospective, randomized, controlled trials that evaluated local application of antibiotics for surgical site prophylaxis. These trials were subsequently divided and analyzed based on the type of surgical procedure: dermatologic, orthopedic, abdominal, colorectal, and cardiothoracic. Methods of local application analyzed included irrigations, powders, ointments, pastes, beads, sponges, and fleeces. Overall, there is a significant lack of level I evidence supporting this practice for any of the surgical genres evaluated. In addition, the literature spans several decades, and changes in surgical procedures, systemic antibiotic prophylaxis, and microbial flora make conclusions difficult to determine. Based on available data, the efficacy of local antibiotic administration for the prophylaxis of surgical site infections remains uncertain, and recommendations supporting this practice for surgical site prophylaxis cannot be made. © 2012 Pharmacotherapy Publications, Inc.

Healthcare improvement as planned system change or complex responsive processes? a longitudinal case study in general practice

PubMed Central

2013-01-01

Background Interest in how to implement evidence-based practices into routine health care has never been greater. Primary care faces challenges in managing the increasing burden of chronic disease in an ageing population. Reliable prescriptions for translating knowledge into practice, however, remain elusive, despite intense research and publication activity. This study seeks to explore this dilemma in general practice by challenging the current way of thinking about healthcare improvement and asking what can be learned by looking at change through a complexity lens. Methods This paper reports the local level of an embedded case study of organisational change for better chronic illness care over more than a decade. We used interviews, document review and direct observation to explore how improved chronic illness care developed in one practice. This formed a critical case to compare, using pattern matching logic, to the common prescription for local implementation of best evidence and a rival explanation drawn from complexity sciences interpreted through modern sociology and psychology. Results The practice changed continuously over more than a decade to deliver better chronic illness care in line with research findings and policy initiatives – re-designing care processes, developing community linkages, supporting patient self-management, using guidelines and clinical information systems, and integrating nurses into the practice team. None of these improvements was designed and implemented according to an explicit plan in response to a documented gap in chronic disease care. The process that led to high quality chronic illness care exhibited clear complexity elements of co-evolution, non-linearity, self-organisation, emergence and edge of chaos dynamics in a network of agents and relationships where a stable yet evolving way of organizing emerged from local level communicative interaction, power relating and values based choices. Conclusions The current discourse of implementation science as planned system change did not match organisational reality in this critical case of improvement in general practice. Complexity concepts translated in human terms as complex responsive processes of relating fit the pattern of change more accurately. They do not provide just another fashionable blueprint for change but inform how researchers, policymakers and providers participate in improving healthcare. PMID:23617833

Air quality management: evolution of policy and practice in the UK as exemplified by the experience of English local government

NASA Astrophysics Data System (ADS)

Beattie, C. I.; Longhurst, J. W. S.; Woodfield, N. K.

The air quality management (AQM) framework in the UK is designed to be an effects-based solution to air pollutants currently affecting human health. The AQM process has been legislated through The Environment Act 1995, which required the National Air Quality Strategy (NAQS) to be published. AQM practice and capability within local authorities has flourished since the publication of the NAQS in March 1997. This paper outlines the policy framework within which the UK operates, both at a domestic and European level, and reviews the air quality management process relating to current UK policy and EU policy. Data from questionnaire surveys are used to indicate the involvement of various sectors of local government in the air quality management process. These data indicate an increasing use of monitoring, and use of air dispersion modelling by English local authorities. Data relating to the management of air quality, for example, the existence and work of air quality groups, dissemination of information to the public and policy measures in place on a local scale to improve air quality, have also been reported. The UK NAQS has been reviewed in 1999 to reflect developments in European legislation, technological and scientific advances, improved air pollution modelling techniques and an increasingly better understanding of the socio-economic issues involved. The AQM process, as implemented by UK local authorities, provides an effective model for other European member states with regards to the implementation of the Air Quality Framework Directive. The future direction of air quality policy in the UK is also discussed.

Model Legislation for GAAP and GASB.

ERIC Educational Resources Information Center

Bissell, George E.

1987-01-01

The use of generally accepted accounting principles (GAAP) by all state and local governments may require legislation. Findings from a survey of states to get data on current accounting and financial reporting practices are summarized. Model legislation to provide uniformity in accounting and reporting is presented. (MLF)

Integrating Sensor Monitoring Technology into the Current Air Pollution Regulatory Support Paradigm: Practical Considerations

EPA Science Inventory

The US Environmental Protection Agency (EPA) along with state, local, and tribal governments operate Federal Reference Method (FRM) and Federal Equivalent Method (FEM) instruments to assess compliance with US air pollution standards designed to protect human and ecosystem health....

Total Water Management, the New Paradigm for Urban Water Systems

EPA Science Inventory

There is a growing need for urban water managers to take a more holistic view of their water resource systems as population growth, urbanization, and current resource management practices put different stresses on local water resources and urban infrastructure. Total Water Manag...

Total Water Management: The New Paradigm for Urban Water Resources Planning

EPA Science Inventory

There is a growing need for urban water managers to take a more holistic view of their water resource systems as population growth, urbanization, and current resource management practices put different stresses on local water resources and urban infrastructure. Total Water Manag...

Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association.

PubMed

Cheng, Adam; Nadkarni, Vinay M; Mancini, Mary Beth; Hunt, Elizabeth A; Sinz, Elizabeth H; Merchant, Raina M; Donoghue, Aaron; Duff, Jonathan P; Eppich, Walter; Auerbach, Marc; Bigham, Blair L; Blewer, Audrey L; Chan, Paul S; Bhanji, Farhan

2018-06-21

The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest. © 2018 American Heart Association, Inc.

The practice of pediatric neurocritical care by the child neurologist.

PubMed

Riviello, James J; Chang, Cherylee

2014-12-01

Pediatric neurocritical care (NCC) has emerged as a defined subspecialty in child neurology and requires a collaborative effort among child neurologists, pediatric critical care medicine specialists, and pediatric neurosurgeons. Pediatric NCC has evolved differently in children than in adults, and its delivery depends on the local resources available for pediatric care. This article reviews the current practice of pediatric NCC by child neurologists: where it is practiced, how it is practiced, the disorders encountered (that differ from adult NCC), the training required to care for these disorders, and what is needed for the future of pediatric NCC. Copyright © 2014 Elsevier Inc. All rights reserved.

School Facility Projects in Latin America

ERIC Educational Resources Information Center

Berk, Jeffrey; de Cassia Alves Vaz, Rita; Honorio, Joao; Baza, Jadille; Origel, Ricardo; Gomez, Fredys

2004-01-01

Many Latin American countries are undertaking projects, in line with practices disseminated by PEB, to share school facilities with the local community, to adapt traditional schools for students with disabilities, and to collaborate with private companies to finance educational buildings. The articles below describe current initiatives in five…

Responsibility without legal authority? Tackling alcohol-related health harms through licensing and planning policy in local government.

PubMed

Martineau, F P; Graff, H; Mitchell, C; Lock, K

2014-09-01

The power to influence many social determinants of health lies within local government sectors that are outside public health's traditional remit. We analyse the challenges of achieving health gains through local government alcohol control policies, where legal and professional practice frameworks appear to conflict with public health action. Current legislation governing local alcohol control in England and Wales is reviewed and analysed for barriers and opportunities to implement effective population-level health interventions. Case studies of local government alcohol control practices are described. Addressing alcohol-related health harms is constrained by the absence of a specific legal health licensing objective and differences between public health and legal assessments of the relevance of health evidence to a specific place. Local governments can, however, implement health-relevant policies by developing local evidence for alcohol-related health harms; addressing cumulative impact in licensing policy statements and through other non-legislative approaches such as health and non-health sector partnerships. Innovative local initiatives-for example, minimum unit pricing licensing conditions-can serve as test cases for wider national implementation. By combining the powers available to the many local government sectors involved in alcohol control, alcohol-related health and social harms can be tackled through existing local mechanisms. © The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health.

Assessing local health department performance in diabetes prevention and control--North Carolina, 2005.

PubMed

Porterfield, Deborah S; Reaves, Janet; Konrad, Thomas R; Weiner, Bryan J; Garrett, Joanne M; Davis, Mary; Dickson, Curtis W; Plescia, Marcus; Alexander, Janet; Baker, Edward L

2009-07-01

To improve the public health system's ability to prevent and control chronic diseases, we must first understand current practice and develop appropriate strategies for measuring performance. The objectives of this study were to measure capacity and performance of local health departments in diabetes prevention and control and to investigate characteristics associated with performance. In 2005, we conducted a cross-sectional mailed survey of all 85 North Carolina local health departments to assess capacity and performance in diabetes prevention and control based on the 10 Essential Public Health Services and adapted from the Local Public Health System Performance Assessment Instrument. We linked survey responses to county-level data, including data from a national survey of local health departments. Local health departments reported a median of 0.05 full-time equivalent employees in diabetes prevention and 0.1 in control. Performance varied across the 10 Essential Services; activities most commonly reported included providing information to the public and to policy makers (76%), providing diabetes education (58%), and screening (74%). The mean score on a 10-point performance index was 3.5. Characteristics associated with performance were population size, health department size and accreditation status, and diabetes-specific external funding. Performance was not better in localities where the prevalence of diabetes was high or availability of primary care was low. Most North Carolina local health departments had limited capacity to conduct diabetes prevention or control programs in their communities. Diabetes is a major cause of illness and death, yet it is neglected in public health practice. These findings suggest opportunities to enhance local public health practice, particularly through targeted funding and technical assistance.

Subject cataloging practices in North American medical school libraries.

PubMed Central

Fredericksen, R B; Michael, H N

1976-01-01

A survey of North American medical school libraries was made to determine current trends in subject cataloging practices. First, responses from 114 of these libraries are recorded and analyzed in the following areas: subject heading authority lists employed; use of the divided versus the dictionary catalog; and the form in which local subject authority files are kept. Then, focusing on 78 libraries that use MeSH in combination with a divided catalog, a further analysis of responses is made concerning issues relating to subject cataloging practices: updating the subject catalog to conform to annual MeSH changes; use of guide cards in the catalog; use of MeSH subheadings; filing conventions; and related issues. An attempt is made to analyze the extent to which these libraries vary from NLM practices. Suggestions are offered for formulating subject cataloging practices for an individual library. Finally, while it is concluded that MeSH and the Current Catalog are useful tools, a more detailed explication of the use of MeSH and NLM cataloging practices would be beneficial. PMID:989741

Globalization, localization and food culture: perceived roles of social and cultural capitals in healthy child feeding practices in Japan.

PubMed

Goto, Keiko; Ominami, Chihiro; Song, Chunyan; Murayama, Nobuko; Wolff, Cindy

2014-03-01

The current study examined parental perceptions of sociocultural factors associated with healthy child feeding practices among parents of preschool-age children in rural Japan. Fifteen Japanese mothers of preschool-age children participated in this qualitative study. These participants were aged 22-39 years and resided in a rural town in western Japan. We conducted semi-structured qualitative interviews to assess parental perceptions of healthy child feeding practices and their relationships with globalization and localization. These interviews were transcribed, translated into English and coded, based on the principles of grounded theory. A codebook was developed and pre-identified, and the newly-identified themes from this codebook were examined and compared. Overall, local and seasonal foods, along with traditional Japanese foods and simple foods (soshoku), were considered to be beneficial for children. Participants also noted that children were expected to be mindful and exhibit good table manners that reflect cultural values related to meal-time socializing or family bonding, and food appreciation. On the other hand, the majority of the participants stated that foods containing food additives and imported foods were unsuitable for children. Participants noted that strong social capital, especially social support from their mothers or mothers-in-law, as well as social networks for obtaining fresh local foods, contributed to healthy child feeding practices. Cultural capital (including the preservation of traditional Japanese dietary habits, eating rules and inter-generational commensality), was also identified as being key to healthy feeding practices. Identifying and promoting the social and cultural capital that positively support healthy child feeding practices may be an important component of nutrition education programs.

A survey of local anaesthesia education in European dental schools.

PubMed

Brand, H S; Kuin, D; Baart, J A

2008-05-01

A survey of European dental schools was conducted in 2006 to determine the curricular structure, techniques and materials used in local anaesthesia teaching to dental students. A questionnaire was designed to collect information about local anaesthesia education. The questionnaires were sent to the Dean of each dental school in Europe and Israel; 49 returned the completed survey, resulting in a response rate of 18.4%. Results from this survey show that dental schools are managing local anaesthesia education in different ways. At most schools, theoretical teaching begins during the first half of the third year (41%), half a year before the practical instruction (43%). In 37% of the dental schools, students use non-human objects to practice before they inject an anaesthetic in humans. The first injection in humans, usually a fellow student (61%), is mostly supervised by an oral and maxillofacial surgeon (65%). The number of injections under supervision usually depends on the individual capabilities of the student (41%). Ten per cent of the schools need permission of a medical ethics committee for the practical instruction on fellow students. All dental curricula include teaching of mandibular block anaesthesia. The majority also include instruction of infiltration anaesthesia of the upper (98%) and lower (92%) jaws in addition to infra-orbital block anaesthesia (57%). Although 82% of the schools are satisfied with the current curriculum with regard to local anaesthesia, 43% are planning changes, frequently the introduction of preclinical training models. Local anaesthesia teaching programmes show considerable variation across the surveyed European dental schools.

Succession Planning and Management Practice in Washington State Local Public Health Agencies.

PubMed

Wiesman, John M; Babich, Suzanne M; Umble, Karl; Baker, Edward L

2016-01-01

Turnover of top local public health officials is expected to be great, with 23% being 60 years of age or older, and another 42% being 50 to 59 years of age. Yet, we know little about the use of succession planning in public health agencies. Describe succession planning practices in local public health agencies. We conducted a Web-based, cross-sectional survey of succession planning practices and followed the career paths of public health officials for 40 months. The top local public health officials from Washington State's 35 local governmental public health agencies. Twenty-five succession planning best practices. All 35 agencies responded, resulting in a 100% response rate. Our study found evidence of succession planning practices in Washington State local public health agencies: 85% of agencies selected high-performing high potential employees for development, 76% sent them to formal technical and management/leadership training, 70% used cross-functional team projects, and 67% used stretch assignments to develop their employees. Impetuses to implement succession planning were discovering that large percentages of employees were able to retire soon and that national accreditation requires workforce development plans. Barriers to implementing succession planning included other competing demands for time, belief that the agency's workforce was too small for a formal program, and concerns that there would be union barriers. In 2012, 50% of the officials surveyed said that it would be at least possible that they would leave their current jobs within 5 years. Forty months later, 12 (34%) had left their positions. We were encouraged by the level of succession planning in Washington State and recommend creating a greater sense of urgency by focusing on agency retirement profiles and emphasizing the need for workforce development plans for accreditation. Developing the public health leaders of tomorrow is too important to be left to chance.

Current Legal Trends Regarding Abortions for Minors: A Dilemma for Counselors.

ERIC Educational Resources Information Center

Talbutt, Lou Culler

1983-01-01

Reviews court cases dealing with abortion and the counselor's legal responsibility to both the student and parents. Provides practical recommendations on abortion counseling with minors and suggests that counselors urge minors to discuss abortion plans with parents. Counselor should consider local mores and be knowledgeable about appropriate…

Western Perspectives in Applied Linguistics in Africa

ERIC Educational Resources Information Center

Makoni, Sinfree; Meinhof, Ulrike H.

2004-01-01

The aim of this article is to analyze the nature of the historical and contemporary social contexts within which applied linguistics in Africa emerged, and is currently practiced. The article examines the challenges "local" applied Linguistics in Africa is confronted with as it tries to amplify applied linguistic programs emanating from…

Collaborative Practitioner Research: Opening a Third Space for Local Knowledge Production

ERIC Educational Resources Information Center

Skattebol, Jen; Arthur, Leonie Maree

2014-01-01

Early childhood education and care is currently experiencing unprecedented policy interest and expansion. This policy and practice landscape requires new forms of adaptive leadership, new spaces for production of the knowledge necessary for this changing context, and tools that can support the development of leadership qualities. This paper…

Tensions and Challenges in China's Education Policy Borrowing

ERIC Educational Resources Information Center

Tan, Charlene

2016-01-01

Background: This article critically discusses the key tensions and challenges arising from the educational policy borrowing in China, through its current education reform. Focussing on the new curriculum reform (NCR), the paper highlights the interactions and conflicts between foreign and local ideologies and practices. Sources of evidence: The…

Public Employee Retirement Systems: The Structure and Politics of Teacher Pensions.

ERIC Educational Resources Information Center

Taylor, Suzanne Saunders

This book describes the operation of state and local government pension systems for teachers, explores the rationale behind current administrative and financial practices, and describes the interaction of special interest groups, pension professionals, and investment personnel with the administration of these systems. The pension systems in 23…

Local randomness: Examples and application

NASA Astrophysics Data System (ADS)

Fu, Honghao; Miller, Carl A.

2018-03-01

When two players achieve a superclassical score at a nonlocal game, their outputs must contain intrinsic randomness. This fact has many useful implications for quantum cryptography. Recently it has been observed [C. Miller and Y. Shi, Quantum Inf. Computat. 17, 0595 (2017)] that such scores also imply the existence of local randomness—that is, randomness known to one player but not to the other. This has potential implications for cryptographic tasks between two cooperating but mistrustful players. In the current paper we bring this notion toward practical realization, by offering near-optimal bounds on local randomness for the CHSH game, and also proving the security of a cryptographic application of local randomness (single-bit certified deletion).

Computationally optimized ECoG stimulation with local safety constraints.

PubMed

Guler, Seyhmus; Dannhauer, Moritz; Roig-Solvas, Biel; Gkogkidis, Alexis; Macleod, Rob; Ball, Tonio; Ojemann, Jeffrey G; Brooks, Dana H

2018-06-01

Direct stimulation of the cortical surface is used clinically for cortical mapping and modulation of local activity. Future applications of cortical modulation and brain-computer interfaces may also use cortical stimulation methods. One common method to deliver current is through electrocorticography (ECoG) stimulation in which a dense array of electrodes are placed subdurally or epidurally to stimulate the cortex. However, proximity to cortical tissue limits the amount of current that can be delivered safely. It may be desirable to deliver higher current to a specific local region of interest (ROI) while limiting current to other local areas more stringently than is guaranteed by global safety limits. Two commonly used global safety constraints bound the total injected current and individual electrode currents. However, these two sets of constraints may not be sufficient to prevent high current density locally (hot-spots). In this work, we propose an efficient approach that prevents current density hot-spots in the entire brain while optimizing ECoG stimulus patterns for targeted stimulation. Specifically, we maximize the current along a particular desired directional field in the ROI while respecting three safety constraints: one on the total injected current, one on individual electrode currents, and the third on the local current density magnitude in the brain. This third set of constraints creates a computational barrier due to the huge number of constraints needed to bound the current density at every point in the entire brain. We overcome this barrier by adopting an efficient two-step approach. In the first step, the proposed method identifies the safe brain region, which cannot contain any hot-spots solely based on the global bounds on total injected current and individual electrode currents. In the second step, the proposed algorithm iteratively adjusts the stimulus pattern to arrive at a solution that exhibits no hot-spots in the remaining brain. We report on simulations on a realistic finite element (FE) head model with five anatomical ROIs and two desired directional fields. We also report on the effect of ROI depth and desired directional field on the focality of the stimulation. Finally, we provide an analysis of optimization runtime as a function of different safety and modeling parameters. Our results suggest that optimized stimulus patterns tend to differ from those used in clinical practice. Copyright © 2018 Elsevier Inc. All rights reserved.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 8: developing, implementing and evaluating an evidence dissemination service in a local healthcare setting.

PubMed

Harris, Claire; Garrubba, Marie; Melder, Angela; Voutier, Catherine; Waller, Cara; King, Richard; Ramsey, Wayne

2018-03-02

This is the eighth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for disinvestment within a large Australian health service. One of the aims was to explore methods to deliver existing high quality synthesised evidence directly to decision-makers to drive decision-making proactively. An Evidence Dissemination Service (EDS) was proposed. While this was conceived as a method to identify disinvestment opportunities, it became clear that it could also be a way to review all practices for consistency with current evidence. This paper reports the development, implementation and evaluation of two models of an in-house EDS. Frameworks for development of complex interventions, implementation of evidence-based change, and evaluation and explication of processes and outcomes were adapted and/or applied. Mixed methods including a literature review, surveys, interviews, workshops, audits, document analysis and action research were used to capture barriers, enablers and local needs; identify effective strategies; develop and refine proposals; ascertain feedback and measure outcomes. Methods to identify, capture, classify, store, repackage, disseminate and facilitate use of synthesised research evidence were investigated. In Model 1, emails containing links to multiple publications were sent to all self-selected participants who were asked to determine whether they were the relevant decision-maker for any of the topics presented, whether change was required, and to take the relevant action. This voluntary framework did not achieve the aim of ensuring practice was consistent with current evidence. In Model 2, the need for change was established prior to dissemination, then a summary of the evidence was sent to the decision-maker responsible for practice in the relevant area who was required to take appropriate action and report the outcome. This mandatory governance framework was successful. The factors influencing decisions, processes and outcomes were identified. An in-house EDS holds promise as a method of identifying disinvestment opportunities and/or reviewing local practice for consistency with current evidence. The resource-intensive nature of delivery of the EDS is a potential barrier. The findings from this study will inform further exploration.

Advances in regional anaesthesia: A review of current practice, newer techniques and outcomes

PubMed Central

Wahal, Christopher; Kumar, Amanda; Pyati, Srinivas

2018-01-01

Advances in ultrasound guided regional anaesthesia and introduction of newer long acting local anaesthetics have given clinicians an opportunity to apply novel approaches to block peripheral nerves with ease. Consequently, improvements in outcomes such as quality of analgesia, early rehabilitation and patient satisfaction have been observed. In this article we will review some of the newer regional anaesthetic techniques, long acting local anaesthetics and adjuvants, and discuss evidence for key outcomes such as cancer recurrence and safety with ultrasound guidance. PMID:29491513

Use of Local Anesthesia During Dental Rehabilitation With General Anesthesia: A Survey of Dentist Anesthesiologists

PubMed Central

Townsend, Janice A.; Hagan, Joseph L.; Smiley, Megann

2014-01-01

The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: “stabilization of vital signs/decreased depth of general anesthesia” (92.9%, 26/28) and “improved patient recovery” (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia. PMID:24697820

Local health rules and building regulations: a survey on local hygiene and building regulations in Italian municipalities.

PubMed

Gola, Marco; Signorelli, Carlo; Buffoli, Maddalena; Rebecchi, Andrea; Capolongo, Stefano

2017-01-01

WHO has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Local Health Rules (LHRs) and Building Regulations (BRs) are tools which provide safety and building hygiene in construction practices. Currently the Italian Government is considering to establish a National Building Regulation and, related to the following purpose, this paper presents a survey on the status of adoption and updating of LHRs and BRs in Italian municipalities. The current Italian state of LHRs, BRs and Municipal Development Plans (MDPs) have been examined by a survey considering a sample of about 550 cities, with different demo graphic and geographic features, starting from the previous research work by Signorelli et al. (1999). The analysis underlines a serious shortage of updated LHRs, especially in small and medium-sized municipalities whereas BRs and MDPs are widespread. Only 30% of them are previously approved and validated by Local Health Authorities. Starting from a survey, the present scenario of Building Regulations requires the introduction of further performance guidelines instead of normative ones and, therefore, the current actions to give rise to a National Building Regulation could be integrated by building hygiene contents of LHRs.

AN ANALYSIS OF THE RATIONALE AND PROCEDURES FOR LONG-RANGE PLANNING --FOUND IN SELECTED CORPORATE ENTERPRISES, GOVERNMENT AGENCIES OR DEPARTMENTS, AND SCHOOL SYSTEMS--WHICH ARE APPROPRIATE FOR EDUCATIONAL AND ADMINISTRATIVE PLANNING IN LOCAL SCHOOL SYSTEMS.

ERIC Educational Resources Information Center

RULIFFSON, WILLARD ADAMS

THIS STUDY REVIEWS SOME OF THE CURRENT PLANNING PRACTICES IN SCHOOL SYSTEMS WHICH ARE CONSIDERED TO BE ALREADY INVOLVED IN LONG-RANGE PLANNING, AND DESCRIBES FURTHER LONG-RANGE TECHNIQUES WHICH COULD BE ADAPTED FOR SCHOOL SYSTEMS FROM CURRENT CORPORATE AND GOVERNMENTAL PLANNING PROCEDURES. INDIVIDUAL INTERVIEWS WERE CONDUCTED WITH SELECTED…

Evaluation of Existing Structure and Civil Protection Management Framework in Greek Local Authorities: A Questionnaire Survey Demonstrates Why Prevention Fails

NASA Astrophysics Data System (ADS)

Papanikolaou, Dimitrios; Papanikolaou, Ioannis; Diakakis, Michalis; Deligiannakis, Georgios

2013-04-01

In the face of a growing number of natural disasters and the increasing costs associated with them, Europe and Greece in particular, have devoted significant efforts and resources in natural hazards mitigation during the last decades. Despite the significant legislative efforts (e.g. 1998/22/EC, 2001/792/EC, 2007/60/EC Directives, 3013/2002 Act) and even though a number of steps has been taken towards improving civil protection, recent catastrophic events have illustrated the weaknesses of current approaches. In particular, in Greece, events such as the 1999 Athens earthquake, the 2007 and 2009 wildfires have shown the inadequacy of prevention and mitigation practices. Given the enhanced civil protection responsibilities, given by the Greek national law (Acts 3013/2002, 3852/2010) to local authorities in Greece, this work analyses and evaluates the existing structure and current management framework under which local authorities function and examines their risk mitigation practices. We conducted the largest questionnaire survey regarding Civil Protections issues, among the municipalities of Greece. To this aim, this work used a innovative online tool to assess current framework. Therefore, a network connecting civil protection departments of municipalities was developed, based on an Internet platform that acted also as a communication tool. Overall, we had feedback either online or offline from 125 municipalities across the country (representing more than one/third of the total municipalities of Greece). Through this network, municipal civil protection officials completed surveys designed to obtain and quantify information on several aspects of civil protection practices and infrastructure. In particular, the examined factors included: (i) personnel and equipment, (ii) inter-agency cooperation, (iii) training, (iv) compliance with existing regulations and (v) persistent problems encountered by civil protection departments, that prevent the effectiveness of current practices. Responses showed that civil protection personnel lack adequate training and expertise, many are overstretched with several duties, while several prevention actions are carried out by seasonal or voluntary staff. Approximately half of the heads of civil protection offices do not hold a university degree, only 27% have a relevant scientific background (geoscientists or engineers) and more than half of them are elected members and not permanent staff, implying that no continuity is secured. Inter-agency cooperation is shown to be poor and organizational learning from international practices not adequate. Half of the municipalities report that the authorization processes are too slow so that prevention actions particularly regarding forest fires are severely delayed. Existing regulations are not followed by a significant portion of municipalities since 19% have not established a civil protection office and 23% have not compiled an action plan yet. Existing action plans lack important information, present no spatial data and are predominantly catalogues and tables of information regarding authorised personnel and equipment. Overall, underfunding, poor coordination of the different actors involved, lack of training and understaffing, lack of proper equipment and several other issues are held responsible by officials for preventing effectiveness of current practices. Finally, the EU emergency number 112 is widely unknown (87%). This work was held under the LIFE+ project "Local Authorities Alliance for Forest Fire Prevention - LIFE08/ENV/GR/000553" which is implemented with the contribution of the LIFE financial instrument of the European Community.

Resolving bulimia nervosa using an innovative neural therapy approach: two case reports.

PubMed

Gurevich, Michael I; Chung, Myung Kyu; LaRiccia, Patrick J

2018-02-01

Conventional treatment of Bulimia Nervosa is long term, expensive, and often ineffective. Neural therapy holds promise for treating Bulimia Nervosa in a shorter term, lower cost, and more effective manner. Much of neural therapy involves the superficial injection of local anesthetic injections. Implementation into current practice would be feasible.

The New Vocationalism in Rural Locales.

ERIC Educational Resources Information Center

Theobald, Paul

This paper critiques current "school-to-work" practices in rural schools. A look at the rural context reveals that rural workers are more likely to be unemployed and are paid less than workers elsewhere, resulting in high rural poverty. In addition, many kinds of rural decline (in services, transportation, job availability) are tied to…

LO sources for 1-3 THz: present status and future prospective

NASA Technical Reports Server (NTRS)

Mehdi, Imran

2003-01-01

This talk will present an overview of the current technologies that are available for implementing local oscillator sources for 1-3 THz applications. Progress to date on specific components will be discussed in some detail. Outstanding issues and concerns regarding practical implementation of these new technologies will also be discussed.

Documenting Outcomes for Learners and Their Communities: A Report on a NCSALL Action Research Project. NCSALL Reports.

ERIC Educational Resources Information Center

Bingman, Mary Beth

Action research focused on developing approaches local programs can use to document outcomes of student participation in adult basic education (ABE) programs. Teams of teachers and administrators from three ABE programs examined current documentation practices, were introduced to approaches to documentaion, and developed documentation processes…

Developmental and Autism Screening: A Survey across Six States

ERIC Educational Resources Information Center

Arunyanart, Wirongrong; Fenick, Ada; Ukritchon, Supak; Imjaijitt, Worarachanee; Northrup, Veronika; Weitzman, Carol

2012-01-01

The American Academy of Pediatrics (AAP) recommends screening children for developmental delay and autism. Studies of current screening practice to date have been limited in scope and primarily focused on small, local samples. This study is designed to determine compliance with AAP screening recommendations: (1) developmental screening at 9, 18,…

Towards inverse modeling of turbidity currents: The inverse lock-exchange problem

NASA Astrophysics Data System (ADS)

Lesshafft, Lutz; Meiburg, Eckart; Kneller, Ben; Marsden, Alison

2011-04-01

A new approach is introduced for turbidite modeling, leveraging the potential of computational fluid dynamics methods to simulate the flow processes that led to turbidite formation. The practical use of numerical flow simulation for the purpose of turbidite modeling so far is hindered by the need to specify parameters and initial flow conditions that are a priori unknown. The present study proposes a method to determine optimal simulation parameters via an automated optimization process. An iterative procedure matches deposit predictions from successive flow simulations against available localized reference data, as in practice may be obtained from well logs, and aims at convergence towards the best-fit scenario. The final result is a prediction of the entire deposit thickness and local grain size distribution. The optimization strategy is based on a derivative-free, surrogate-based technique. Direct numerical simulations are performed to compute the flow dynamics. A proof of concept is successfully conducted for the simple test case of a two-dimensional lock-exchange turbidity current. The optimization approach is demonstrated to accurately retrieve the initial conditions used in a reference calculation.

Perceptions of good medical practice in the NHS: a survey of senior health professionals.

PubMed

Hutchinson, A; Williams, M; Meadows, K; Barbour, R S; Jones, R

1999-12-01

To categorize senior health professionals' experience with poor medical practice in hospitals and in general practice, to describe perceptions which senior NHS staff have of good medical practice, and to describe how problems of poor medical practice are currently managed. A postal questionnaire survey. The questionnaire sought perceptions of good medical practice, asked participants to characterise deviations from good practice, and to describe experience with managing poor performance at the time of the introduction of the General Medical Council (GMC) performance procedures. A range of NHS settings in the UK: hospital trusts, health authorities/boards, local medical committees, community health councils. Senior health professionals involved in the management of medical professional performance. Perceptions of what constitutes good medical practice. Most respondents considered that persistent problems related to clinical practice (diagnosis, management, and outcome and prescribing) would require local management and, possibly, referral to the GMC performance procedures. Informal mechanisms, including informal discussion, education, training, and work shifting, were the most usual means of handling a doctor whose performance was poor. Many took a less serious view of deficiencies in performance on manner and attitude and communication, although consultation skills rather than technical skills comprised the greatest number of complaints about doctors. Senior NHS professionals seem reluctant to consider persistently poor consultation skills in the same critical light as they do persistently poor technical practice. These attitudes may need to change with the implementation of clinical governance and updated guidance from the GMC on what constitutes good medical practice.

Electromagnetic toroidal excitations in matter and free space.

PubMed

Papasimakis, N; Fedotov, V A; Savinov, V; Raybould, T A; Zheludev, N I

2016-03-01

The toroidal dipole is a localized electromagnetic excitation, distinct from the magnetic and electric dipoles. While the electric dipole can be understood as a pair of opposite charges and the magnetic dipole as a current loop, the toroidal dipole corresponds to currents flowing on the surface of a torus. Toroidal dipoles provide physically significant contributions to the basic characteristics of matter including absorption, dispersion and optical activity. Toroidal excitations also exist in free space as spatially and temporally localized electromagnetic pulses propagating at the speed of light and interacting with matter. We review recent experimental observations of resonant toroidal dipole excitations in metamaterials and the discovery of anapoles, non-radiating charge-current configurations involving toroidal dipoles. While certain fundamental and practical aspects of toroidal electrodynamics remain open for the moment, we envision that exploitation of toroidal excitations can have important implications for the fields of photonics, sensing, energy and information.

Critical carbon input to maintain current soil organic carbon stocks in global wheat systems

PubMed Central

Wang, Guocheng; Luo, Zhongkui; Han, Pengfei; Chen, Huansheng; Xu, Jingjing

2016-01-01

Soil organic carbon (SOC) dynamics in croplands is a crucial component of global carbon (C) cycle. Depending on local environmental conditions and management practices, typical C input is generally required to reduce or reverse C loss in agricultural soils. No studies have quantified the critical C input for maintaining SOC at global scale with high resolution. Such information will provide a baseline map for assessing soil C dynamics under potential changes in management practices and climate, and thus enable development of management strategies to reduce C footprint from farm to regional scales. We used the soil C model RothC to simulate the critical C input rates needed to maintain existing soil C level at 0.1° × 0.1° resolution in global wheat systems. On average, the critical C input was estimated to be 2.0 Mg C ha−1 yr−1, with large spatial variability depending on local soil and climatic conditions. Higher C inputs are required in wheat system of central United States and western Europe, mainly due to the higher current soil C stocks present in these regions. The critical C input could be effectively estimated using a summary model driven by current SOC level, mean annual temperature, precipitation, and soil clay content. PMID:26759192

Current practices of construction waste reduction through 3R practice among contractors in malaysia: Case study in penang

NASA Astrophysics Data System (ADS)

Ng, L. S.; Tan, L. W.; Seow, T. W.

2017-11-01

The effectiveness of the implementation of construction waste reduction through 3R reflects the sustainability in construction waste management. Weak implementation of construction waste reduction through 3R among contractors will lead to unsustainable construction waste management. Increase in construction waste on landfills is critical especially on islands where land is very limited for solid waste disposal. This aim of this paper is to investigate current practice of construction waste reduction through 3R practice among contractors in Penang, Malaysia. The findings reported herein is based on feedbacks from 143 construction contractors of grade CIDB G7, G6 and G5 in Penang and experts from Penang Local Authority, CIDB in Penang and its Headquarters, National Solid Waste Management Department, and Headquarters of Solid Waste and Public Cleansing Management Corporation. Interviews and questionnaire surveys have been found that 3R practice is not mandatory in construction waste management in Penang. Only 39.8% construction contractors practiced 3R in managing their waste. Therefore, 3R practices should be emphasized in construction industry. Reducing wastes through 3R practices in construction industry is a way forward towards sustainable construction waste management especially in expanding the lifetime of landfill.

Long-distance measurement-device-independent multiparty quantum communication.

PubMed

Fu, Yao; Yin, Hua-Lei; Chen, Teng-Yun; Chen, Zeng-Bing

2015-03-06

The Greenberger-Horne-Zeilinger (GHZ) entanglement, originally introduced to uncover the extreme violation of local realism against quantum mechanics, is an important resource for multiparty quantum communication tasks. But the low intensity and fragility of the GHZ entanglement source in current conditions have made the practical applications of these multiparty tasks an experimental challenge. Here we propose a feasible scheme for practically distributing the postselected GHZ entanglement over a distance of more than 100 km for experimentally accessible parameter regimes. Combining the decoy-state and measurement-device-independent protocols for quantum key distribution, we anticipate that our proposal suggests an important avenue for practical multiparty quantum communication.

Local food in Iceland: identifying behavioral barriers to increased production and consumption

NASA Astrophysics Data System (ADS)

Ósk Halldórsdóttir, Þórhildur; Nicholas, Kimberly A.

2016-11-01

Increased production and consumption of local food may reduce the negative environmental, social, and economic impacts of industrialized and globalized food production. Here we examined potential barriers to increasing production and consumption of food produced in Iceland. First, we developed a new framework to address the behaviors of production and consumption simultaneously, to comprehensively analyze their potential barriers. We examined structural barriers by estimating the food production capacity of Iceland, and cultural and personal barriers through survey data on cultural norms and purchasing behavior from Matís, a research and development company. We found no structural barriers preventing Iceland from increasing production of local cereals, which would compliment current local production of meat and dairy and reduce reliance on imports, currently at 50% of the daily caloric intake. However, if food production became entirely local without changing the current mix of crops grown, there would be a 50% reduction in diversity (from 50 to 25 items in eight out of ten food categories). We did not identify any cultural barriers, as survey results demonstrated that consumers hold generally positive worldviews towards local food, with 88% satisfied with local food they had purchased. More than two-thirds of consumers regarded supporting the local farmer and considerations such as environmentally friendly production, fewer food miles, lower carbon footprint as important. However, they rated the local food they have access to as lower in meeting sustainability criteria, showing that they make justifications for not choosing local food in practice. This is a personal barrier to increased consumption of local food, and implies that marketing strategies and general knowledge connected to local food in Iceland might be improved. Although the results apply to the case of Iceland, the method of identifying behavioral barriers to change is applicable to other countries, regions, or foodsheds interested in assessing their food security through an analysis of local food.

Enhancing superconducting critical current by randomness

DOE PAGES

Wang, Y. L.; Thoutam, L. R.; Xiao, Z. L.; ...

2016-01-11

The key ingredient of high critical currents in a type-II superconductor is defect sites that pin vortices. Here, we demonstrate that a random pinscape, an overlooked pinning system in nanopatterned superconductors, can lead to a substantially larger critical current enhancement at high magnetic fields than an ordered array of vortex pin sites. We reveal that the better performance of a random pinscape is due to the variation of the local density of its pinning sites, which mitigates the motion of vortices. This is confirmed by achieving even higher enhancement of the critical current through a conformally mapped random pinscape, wheremore » the distribution of the local density of pinning sites is further enlarged. Our findings highlight the potential of random pinscapes in enhancing the superconducting critical currents of applied superconductors in which random pin sites of nanoscale defects emerging in the materials synthesis process or through ex-situ irradiation are the only practical choice for large-scale production. Our results may also stimulate research on effects of a random pinscape in other complementary systems such as colloidal crystals, Bose-Einstein condensates, and Luttinger liquids.« less

An Investigation into Dental Local Anaesthesia Teaching in United Kingdom Dental Schools.

PubMed

Oliver, Graham; DavidD, Ailsa; Bell, Christopher; Robb, Nigel

2016-01-01

To review the current teaching of the use and administration of local anaesthesia in United Kingdom dental schools, along with their local guidelines and protocols. A qualitative and quantitative questionnaire was sent to sixteen UK dental schools to probe the methods of local anaesthetic teaching within each school. 14 of the 16 schools replied and the responses show a variety of practices being taught in the dental schools. 2% Lidocaine 1:80,000 Adrenaline is the first choice local anaesthetic solution for the majority of clinical situations. 2% Lidocaine with 1:80,000 Adrenaline remains the gold standard dental local anaesthetic with teaching about its safety and uses in all but a few situations. Most are taught the use of additional aids such as safety syringes and topical anaesthesia. There is variation with regards to the use of alternative anaesthetic agents.

A rights-based approach to science literacy using local languages: Contextualising inquiry-based learning in Africa

NASA Astrophysics Data System (ADS)

Babaci-Wilhite, Zehlia

2017-06-01

This article addresses the importance of teaching and learning science in local languages. The author argues that acknowledging local knowledge and using local languages in science education while emphasising inquiry-based learning improve teaching and learning science. She frames her arguments with the theory of inquiry, which draws on perspectives of both dominant and non-dominant cultures with a focus on science literacy as a human right. She first examines key assumptions about knowledge which inform mainstream educational research and practice. She then argues for an emphasis on contextualised learning as a right in education. This means accounting for contextualised knowledge and resisting the current trend towards de-contextualisation of curricula. This trend is reflected in Zanzibar's recent curriculum reform, in which English replaced Kiswahili as the language of instruction (LOI) in the last two years of primary school. The author's own research during the initial stage of the change (2010-2015) revealed that the effect has in fact proven to be counterproductive, with educational quality deteriorating further rather than improving. Arguing that language is essential to inquiry-based learning, she introduces a new didactic model which integrates alternative assumptions about the value of local knowledge and local languages in the teaching and learning of science subjects. In practical terms, the model is designed to address key science concepts through multiple modalities - "do it, say it, read it, write it" - a "hands-on" experiential combination which, she posits, may form a new platform for innovation based on a unique mix of local and global knowledge, and facilitate genuine science literacy. She provides examples from cutting-edge educational research and practice that illustrate this new model of teaching and learning science. This model has the potential to improve learning while supporting local languages and culture, giving local languages their rightful place in all aspects of education.

A Fault Location Algorithm for Two-End Series-Compensated Double-Circuit Transmission Lines Using the Distributed Parameter Line Model

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

Kang, Ning; Gombos, Gergely; Mousavi, Mirrasoul J.

A new fault location algorithm for two-end series-compensated double-circuit transmission lines utilizing unsynchronized two-terminal current phasors and local voltage phasors is presented in this paper. The distributed parameter line model is adopted to take into account the shunt capacitance of the lines. The mutual coupling between the parallel lines in the zero-sequence network is also considered. The boundary conditions under different fault types are used to derive the fault location formulation. The developed algorithm directly uses the local voltage phasors on the line side of series compensation (SC) and metal oxide varistor (MOV). However, when potential transformers are not installedmore » on the line side of SC and MOVs for the local terminal, these measurements can be calculated from the local terminal bus voltage and currents by estimating the voltages across the SC and MOVs. MATLAB SimPowerSystems is used to generate cases under diverse fault conditions to evaluating accuracy. The simulation results show that the proposed algorithm is qualified for practical implementation.« less

Making Sense While Steering through the Fog: Principals' Metaphors within a National Reform Implementation

ERIC Educational Resources Information Center

Ganon-Shilon, Sherry; Schechter, Chen

2017-01-01

Principals' implementation of national reforms in the educational arena resembles a wild ride on a roller coaster as they face with contradicting demands, ongoing confusion and ambiguity. As critical change agents, principals interpret and translate reform demands into local practices through a process of sense-making. This current qualitative…

The Perceived Impact of E-Books on Student Reading Practices: A Local Study

ERIC Educational Resources Information Center

Gilbert, Julie; Fister, Barbara

2015-01-01

This study investigates the perceived impact of future e-book collections on student research and recreational reading habits at our institution through three questions: how students currently use library print collections, how students use e-books, and how these factors impact student perception of the effects of future library e-books on their…

State-Level Support for Comprehensive School Reform: Implications for Policy and Practice

ERIC Educational Resources Information Center

Lane, Brett; Gracia, Susan

2005-01-01

In the current context of standards-based reform and heightened accountability for school performance, state education agencies (SEAs) have an important, but not yet well-articulated, role to play in local school improvement efforts. This article starts to articulate such a role by examining the variety of approaches and strategies used by 7 SEAs…

The Use of Self-Pleasure: Masturbation and Body Image among African American and European American Women

ERIC Educational Resources Information Center

Shulman, Julie L.; Horne, Sharon G.

2003-01-01

The current investigation examined the relationship between masturbation and body image among 96 women seeking services at a local family planning clinic in a mid-southern U.S. city. Participants completed a questionnaire that assessed body image and masturbatory practices. Ethnic differences were found with European American women reporting…

Policies and Practices of School Leaderships in Japan: A Case of Leadership Development Strategies in Akita

ERIC Educational Resources Information Center

Yamamoto, Yukiko; Enomoto, Naoko; Yamaguchi, Shinobu

2016-01-01

Reflecting the social and economic change, Japanese education has shifted to decentralization since the 1980s. With an increased autonomy and responsibility, the local government plays an important role to develop competent school leaders. This descriptive study employs case study approach to illustrate current status of leadership development at…

Right to Inclusive Education for Students with Disabilities in Kenya

ERIC Educational Resources Information Center

Elder, Brent C.

2015-01-01

This article explores the current inclusive education system in Kenya, and how those practices relate to Article 24 of the United Nations' Convention on the Rights of Persons with Disabilities (CRPD). Local laws and international instruments are presented to shed light on the extent to which students with disabilities have a right to inclusive…

The visual arts in Northern Ireland hospitals.

PubMed Central

Cromie, H.

1995-01-01

Since 1989 there has been a burgeoning of the visual arts in Northern Ireland hospitals. This paper compares the three organisational models for hospital arts currently operating within the Province and in an overview discusses ways to coordinate working practice for future development of the visual arts in local hospitals. Images Fig 1 Fig 2 Fig 3 PMID:8533183

Rural School Finance: A Critical Analysis of Current Practice in Illinois.

ERIC Educational Resources Information Center

Lows, Raymond L.

School finance is basic to understanding and improving the condition of rural education. Information necessary for financial planning and policy development at the state and local levels is stored in large computer readable data bases and needs to be accessed. Pertinent data elements need to be extracted from the data base and relationships among…

General Surgery Programs in Small Rural New York State Hospitals: A Pilot Survey of Hospital Administrators

ERIC Educational Resources Information Center

Zuckerman, Randall; Doty, Brit; Gold, Michael; Bordley, James; Dietz, Patrick; Jenkins, Paul; Heneghan, Steven

2006-01-01

Context: Hospitals play a central role in small rural communities and are frequently one of the major contributors to the local economy. Surgical services often account for a substantial proportion of hospital revenues. The current shortage of general surgeons practicing in rural communities may further threaten the financial viability of rural…

Disinfection methods in general practice and health authority clinics: a telephone survey

PubMed Central

Farrow, S.C.; Kaul, S.; Littlepage, B.C.

1988-01-01

Concern about the epidemic of the acquired immune deficiency syndrome led to discussions in one health district about the dangers of cross-infection from instruments in general practice and health authority clinics. In order to establish what current disinfection practices were in use a telephone survey was adopted as a quick and easy method of data collection. Information was collected on who was responsible for disinfection as well as details of how each instrument was disinfected. Results from 69 general practices and 21 health authority clinice in one health district are reported. Some form of sterilizer was used in 63 general practices. These included water boilers (49%), dry heat sterilizers (41%), autoclaves (5%) and pressure cookers (5%). Sixty one practices were using metal vaginal specula and of these 29 were disinfecting by boiling, three were using pressure cookers, 18 dry heat, seven chemical methods, three autoclaves and one the central sterile department of the local hospital. Of those who were boiling after simple washing, three practices boiled for five to 10 minutes and reused instruments during the same clinic. Of the 29 using simple boiling 20 (69%) were boiling for less than 20 minutes. The study highlights the fact that no formal advice has been given on disinfection practice by the DHSS, the health authorities or the family practitioner committees. The need to set up local guidelines and develop practical steps for their introduction are discussed. PMID:3271009

Wi-Fi/MARG Integration for Indoor Pedestrian Localization.

PubMed

Tian, Zengshan; Jin, Yue; Zhou, Mu; Wu, Zipeng; Li, Ze

2016-12-10

With the wide deployment of Wi-Fi networks, Wi-Fi based indoor localization systems that are deployed without any special hardware have caught significant attention and have become a currently practical technology. At the same time, the Magnetic, Angular Rate, and Gravity (MARG) sensors installed in commercial mobile devices can achieve highly-accurate localization in short time. Based on this, we design a novel indoor localization system by using built-in MARG sensors and a Wi-Fi module. The innovative contributions of this paper include the enhanced Pedestrian Dead Reckoning (PDR) and Wi-Fi localization approaches, and an Extended Kalman Particle Filter (EKPF) based fusion algorithm. A new Wi-Fi/MARG indoor localization system, including an Android based mobile client, a Web page for remote control, and a location server, is developed for real-time indoor pedestrian localization. The extensive experimental results show that the proposed system is featured with better localization performance, with the average error 0.85 m, than the one achieved by using the Wi-Fi module or MARG sensors solely.

Key Ingredients-Target Groups, Methods and Messages, and Evaluation-of Local-Level, Public Interventions to Counter Stigma and Discrimination: A Lived Experience Informed Selective Narrative Literature Review.

PubMed

Ashton, Laura J; Gordon, Sarah E; Reeves, Racheal A

2018-04-01

A proliferation of recent literature provides substantial direction as to the key ingredients-target groups, messages and methods, and evaluation-of local-level, public interventions to counter stigma and discrimination. This paper provides a selective narrative review of that literature from the perspective or standpoint of anti-stigma experts with lived experience of mental distress, the key findings of which have been synthesised and presented in diagrammatic overviews (infographics). These are intended to guide providers in planning, delivering and evaluating lived experience-directed local-level, public interventions to counter stigma and discrimination in accord with current best practice.

The Experimental Measurement of Local and Bulk Oxygen Transport Resistances in the Catalyst Layer of Proton Exchange Membrane Fuel Cells.

PubMed

Wang, Chao; Cheng, Xiaojing; Lu, Jiabin; Shen, Shuiyun; Yan, Xiaohui; Yin, Jiewei; Wei, Guanghua; Zhang, Junliang

2017-12-07

Remarkable progress has been made in reducing the cathodic Pt loading of PEMFCs; however, a huge performance loss appears at high current densities, indicating the existence of a large oxygen transport resistance associated with the ultralow Pt loading catalyst layer. To reduce the Pt loading without sacrificing cell performance, it is essential to illuminate the oxygen transport mechanism in the catalyst layer. Toward this goal, an experimental approach to measure the oxygen transport resistance in catalyst layers is proposed and realized for the first time in this study. The measuring approach involves a dual-layer catalyst layer design, which consists of a dummy catalyst layer and a practical catalyst layer, followed by changing the thickness of dummy layer to respectively quantify the local and bulk resistances via limiting current measurements combined with linear extrapolation. The experimental results clearly reveal that the local resistance dominates the total resistance in the catalyst layer.

An Assessment of Information Exchange Practices, Challenges, and Opportunities to Support US Disease Surveillance in 3 States.

PubMed

Garcia, Macarena C; Garrett, Nedra Y; Singletary, Vivian; Brown, Sheereen; Hennessy-Burt, Tamara; Haney, Gillian; Link, Kimberly; Tripp, Jennifer; Mac Kenzie, William R; Yoon, Paula

2017-12-07

State and local public health agencies collect and use surveillance data to identify outbreaks, track cases, investigate causes, and implement measures to protect the public-s health through various surveillance systems and data exchange practices. The purpose of this assessment was to better understand current practices at state and local public health agencies for collecting, managing, processing, reporting, and exchanging notifiable disease surveillance information. Over an 18-month period (January 2014-June 2015), we evaluated the process of data exchange between surveillance systems, reporting burdens, and challenges within 3 states (California, Idaho, and Massachusetts) that were using 3 different reporting systems. All 3 states use a combination of paper-based and electronic information systems for managing and exchanging data on reportable conditions within the state. The flow of data from local jurisdictions to the state health departments varies considerably. When state and local information systems are not interoperable, manual duplicative data entry and other work-arounds are often required. The results of the assessment show the complexity of disease reporting at the state and local levels and the multiple systems, processes, and resources engaged in preparing, processing, and transmitting data that limit interoperability and decrease efficiency. Through this structured assessment, the Centers for Disease Control and Prevention (CDC) has a better understanding of the complexities for surveillance of using commercial off-the-shelf data systems (California and Massachusetts), and CDC-developed National Electronic Disease Surveillance System Base System. More efficient data exchange and use of data will help facilitate interoperability between National Notifiable Diseases Surveillance Systems.

Atmospheric LiDAR coupled with point measurement air quality samplers to measure fineparticulate matter (PM) emissions from agricultural operations. Part 2 of the California 2007 - 2008 Tillage Campaigns: Spring 2008 Data Analysis

EPA Science Inventory

Concern with health effects resulting from PM10 exposure is drawing increased regulatory scrutiny and research toward local agricultural tillage operations. To investigate the control effectiveness of one of the current Conservation Management Practices (CMPs) written for agricul...

41 CFR 302-11.306 - How can I know if my expenses are reasonable and will be reimbursed by the Government?

Code of Federal Regulations, 2010 CFR

2010-07-01

... TRANSACTION ALLOWANCES 11-ALLOWANCES FOR EXPENSES INCURRED IN CONNECTION WITH RESIDENCE TRANSACTIONS Request... locality in which your expenses will be incurred and request: (a) The current schedule of closing costs... and practices with respect to charging of closing costs which relate to either your sale or purchase...

Primary Care Trusts involving the community: is community development the way forward?

PubMed

Crowley, Philip; Green, Judith; Freake, Debbie; Drinkwater, Chris

2002-01-01

Patient and user involvement is central to current government thinking on the NHS. More comprehensive approaches to organised community participation and community development have received less support and examples of effective and genuine participation in key areas such as primary care decision-making are rare. The initiative described in this paper was established in Newcastle upon Tyne in 1995 to promote community participation in decision-making about local health services. It has particular relevance to current concerns about addressing social exclusion and tackling health inequalities since it operates in an area of social disadvantage with a significant black and ethnic minority population (6 percent). This case study is based on an independent evaluation which used multiple research methods, including interviews, questionnaire surveys and direct observation, to assess the project's practice and impact. Describes a community development approach to public participation. An emphasis on inclusive practices has facilitated meaningful involvement of minority groups such as ethnic minority residents and those with disabilities who tend to be marginalised in public debate. Argues that the project has made a significant impact on the ways in which local health services are planned and delivered

Fast-mode duplex qPCR for BCR-ABL1 molecular monitoring: innovation, automation, and harmonization.

PubMed

Gerrard, Gareth; Mudge, Katherine; Foskett, Pierre; Stevens, David; Alikian, Mary; White, Helen E; Cross, Nicholas C P; Apperley, Jane; Foroni, Letizia

2012-07-01

Reverse transcription quantitative polymerase chain reaction (RTqPCR)is currently the most sensitive tool available for the routine monitoring of disease level in patients undergoing treatment for BCRABL1 associated malignancies. Considerable effort has been invested at both the local and international levels to standardise the methodology and reporting criteria used to assess this critical metric. In an effort to accommodate the demands of increasing sample throughput and greater standardization, we adapted the current best-practice guidelines to encompass automation platforms and improved multiplex RT-qPCR technology.

Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients.

PubMed

Gonzalez-Suarez, Consuelo B; Dizon, Janine Margarita R; Grimmer, Karen; Estrada, Myrna S; Liao, Lauren Anne S; Malleta, Anne-Rochelle D; Tan, Ma Elena R; Marfil, Vero; Versales, Cristina S; Suarez, Jimah L; So, Kleon C; Uyehara, Edgardo D

2015-01-01

Stroke is one of the leading medical conditions in the Philippines. Over 500,000 Filipinos suffer from stroke annually. Provision of evidence-based medical and rehabilitation management for stroke patients has been a challenge due to existing environmental, social, and local health system issues. Thus, existing western guidelines on stroke rehabilitation were contextualized to draft recommendations relevant to the local Philippine setting. Prior to fully implementing the guidelines, an audit of current practice needs to be undertaken, thus the purpose of this audit protocol. A clinical audit of current practices in stroke rehabilitation in the Philippines will be undertaken. A consensus list of data items to be captured was identified by the audit team during a 2-day meeting in 2012. These items, including patient demographics, type of stroke, time to referral for rehabilitation management, length of hospital stay, and other relevant descriptors of stroke management were included as part of the audit. Hospitals in the Philippines will be recruited to take part in the audit activity. Recruitment will be via the registry of the Philippine Academy of Rehabilitation Medicine, where 90% of physiatrists (medical doctors specialized in rehabilitation medicine) are active members and are affiliated with various hospitals in the Philippines. Data collectors will be identified and trained in the audit process. A pilot audit will be conducted to test the feasibility of the audit protocol, and refinements to the protocol will be undertaken as necessary. The comprehensive audit process will take place for a period of 3 months. Data will be encoded using MS Excel(®). Data will be reported as means and percentages as appropriate. Subgroup analysis will be undertaken to look into differences and variability of stroke patient descriptors and rehabilitation activities. This audit study is an ambitious project, but given the "need" to conduct the audit to identify "gaps" in current practice, and the value it can bring to serve as a platform for implementation of evidence-based stroke management in the Philippines to achieve best patient and health outcomes, the audit team is more than ready to take up the challenge.

Electronic health records and transgender patients--practical recommendations for the collection of gender identity data.

PubMed

Deutsch, Madeline B; Buchholz, David

2015-06-01

Transgender (Trans, Trans*) persons may have a gender identity and a preferred name that differ from those assigned at birth, and/or those listed on their current legal identification (Gender ID, Birth-assigned Sex, Legal Sex). Transgender people who are referred to in a clinical setting using the wrong pronoun or name may suffer distress, ridicule or even assault by others in the waiting area, and may not return for further care. Furthermore, failure to accurately document (and therefore count) transgender identities has negative implications on quality improvement and research efforts, funding priorities and policy activities. The recent announcement that gender identity data may be included in Meaningful Use Stage 3 has accelerated the need for guidance for both vendors and local implementation teams on how to best record and store these data. A recent study demonstrated wide variation in current practices. This manuscript provides a description of identifiers associated with gender identity, and makes practical and evidence based recommendations for implementation and front-end functionality.

Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients.

PubMed

Roemer, Lorrie K; Rocha, Roberto A; Del Fiol, Guilherme; Bradshaw, Richard L; Hanna, Timothy P; Hulse, Nathan C

2006-01-01

At Intermountain Healthcare (Intermountain), executive clinical content experts are responsible for disseminating consistent evidence-based clinical content throughout the enterprise at the point-of-care. With a paper-based system it was difficult to ensure that current information was received and was being used in practice. With electronic information systems multiple applications were supplying similar, but different, vendor-licensed and locally-developed content. These issues influenced the consistency of clinical practice within the enterprise, jeopardized patient and clinician safety, and exposed the enterprise and its employees to potential financial penalties. In response to these issues Intermountain is developing a knowledge management infrastructure providing tools and services to support clinical content development, deployment, maintenance, and communication. The Intermountain knowledge management philosophy includes strategies guiding clinicians and consumers of health information to relevant best practice information with the intention of changing behaviors. This paper presents three case studies describing different information management problems identified within Intermountain, methods used to solve the problems, implementation challenges, and the current status of each project.

Adjuvant Agents in Regional Anesthesia in the Ambulatory Setting.

PubMed

Koyyalamudi, Veerandra; Sen, Sudipta; Patil, Shilpadevi; Creel, Justin B; Cornett, Elyse M; Fox, Charles J; Kaye, Alan D

2017-01-01

A majority of surgical practice has involved ambulatory centers with the number of outpatient operations in the USA doubling to 26.8 million per year. Local anesthesia delivery provides numerous benefits, including increased satisfaction, earlier discharge, and reduction in unplanned hospital admission. Further, with the epidemic of opioid mediated overdoses, local anesthesia can be a key tool in providing an opportunity to reduce the need for other analgesics postoperatively. Adjuvants such as epinephrine and clonidine enhance local anesthetic clinical utility. Further, dexmedetomidine prolongs regional blockade duration effects. There has also been a significant interest recently in the use of dexamethasone. Studies have demonstrated a significant prolongation in motor and sensory block with perineural dexamethasone. Findings are conflicting as to whether intravenous dexamethasone has similar beneficial effects. However, considering the possible neurotoxicity effects, which perineural dexamethasone may present, it would be prudent not to consider intravenously administered dexamethasone to prolong regional block duration. Many studies have also demonstrated neurotoxicity from intrathecally administered midazolam. Therefore, midazolam as an adjuvant is not recommended. Magnesium prolongs regional block duration but related to paucity of studies as of yet, cannot be recommended. Tramadol yields inconsistent results and ketamine is associated with psychotomimetic adverse effects. Buprenorphine consistently increases regional block duration and reduce opioid requirements by a significant amount. Future studies are warranted to define best practice strategies for these adjuvant agents. The present review focuses on the many roles of local anesthetics in current ambulatory practice.

Experimental and Numerical Investigation of Local Scour Around Submarine Piggyback Pipeline Under Steady Current

NASA Astrophysics Data System (ADS)

Zhao, Enjin; Shi, Bing; Qu, Ke; Dong, Wenbin; Zhang, Jing

2018-04-01

As a new type of submarine pipeline, the piggyback pipeline has been gradually adopted in engineering practice to enhance the performance and safety of submarine pipelines. However, limited simulation work and few experimental studies have been published on the scour around the piggyback pipeline under steady current. This study numerically and experimentally investigates the local scour of the piggyback pipe under steady current. The influence of prominent factors such as pipe diameter, inflow Reynolds number, and gap between the main and small pipes, on the maximum scour depth have been examined and discussed in detail. Furthermore, one formula to predict the maximum scour depth under the piggyback pipeline has been derived based on the theoretical analysis of scour equilibrium. The feasibility of the proposed formula has been effectively calibrated by both experimental data and numerical results. The findings drawn from this study are instructive in the future design and application of the piggyback pipeline.

Imaging ac losses in superconducting films via scanning Hall probe microscopy

NASA Astrophysics Data System (ADS)

Dinner, Rafael B.; Moler, Kathryn A.; Feldmann, D. Matthew; Beasley, M. R.

2007-04-01

Various local probes have been applied to understanding current flow through superconducting films, which are often surprisingly inhomogeneous. Here, we show that magnetic imaging allows quantitative reconstruction of both current density J and electric field E resolved in time and space in a film carrying subcritical ac current. Current reconstruction entails inversion of the Biot-Savart law, while electric fields are reconstructed using Faraday’s law. We describe the corresponding numerical procedures, largely adapting existing work to the case of a strip carrying ac current, but including other methods of obtaining the complete electric field from the inductive portion determined by Faraday’s law. We also delineate the physical requirements behind the mathematical transformations. We then apply the procedures to images of a strip of YBa2Cu3O7-δ carrying an ac current at 400Hz . Our scanning Hall probe microscope produces a time series of magnetic images of the strip with 1μm spatial resolution and 25μs time resolution. Combining the reconstructed J and E , we obtain a complete characterization including local critical current density, E-J curves, and power losses. This analysis has a range of applications from fundamental studies of vortex dynamics to practical coated conductor development.

Scoping the role and education needs of practice nurses in London.

PubMed

Procter, Susan; Griffiths, Lauren; Fanning, Agnes; Wallman, Lizzie; Loveday, Heather P

2017-07-01

Aims To identify education priorities for practice nursing across eight London Clinical Commissioning Groups (CCGs); to identify the education, training, development and support needs of practice nurses in undertaking current and future roles. The education needs of practice nurses have long been recognised but their employment status means that accessing education requires the support of their GP employer. This study scopes the educational requirements of the practice nurse workforce and working with educational providers and commissioners describes a coherent educational pathway for practice nurses. A survey of practice nurses to scope their educational attainment needs was undertaken. Focus groups were carried out which identified the education, training, development and support needs of practice nurses to fulfil current and future roles. Findings A total of 272 respondents completed the survey. Practice nurses took part in three focus groups (n=34) and one workshop (n=39). Findings from this research indicate a practice nurse workforce which lacked career progression, role autonomy or a coherent educational framework. Practice nurses recognised the strength of their role in building relationship-centred care with patients over an extended period of time. They valued this aspect of their role and would welcome opportunities to develop this to benefit patients. This paper demonstrates an appetite for more advanced education among practice nurses, a leadership role by the CCGs in working across the whole system to address the education needs of practice nurses, and a willingness on the part of National Health Service education commissioners to commission education which meets the education needs of the practice nurse workforce. Evidence is still required, however, to inform the scope of the practice nurse role within an integrated system of care and to identify the impact of practice nursing on improving health outcomes and care of local populations.

Applying TOGAF for e-government implementation based on service oriented architecture methodology towards good government governance

NASA Astrophysics Data System (ADS)

Hodijah, A.; Sundari, S.; Nugraha, A. C.

2018-05-01

As a Local Government Agencies who perform public services, General Government Office already has utilized Reporting Information System of Local Government Implementation (E-LPPD). However, E-LPPD has upgrade limitation for the integration processes that cannot accommodate General Government Offices’ needs in order to achieve Good Government Governance (GGG), while success stories of the ultimate goal of e-government implementation requires good governance practices. Currently, citizen demand public services as private sector do, which needs service innovation by utilizing the legacy system as a service based e-government implementation, while Service Oriented Architecture (SOA) to redefine a business processes as a set of IT enabled services and Enterprise Architecture from the Open Group Architecture Framework (TOGAF) as a comprehensive approach in redefining business processes as service innovation towards GGG. This paper takes a case study on Performance Evaluation of Local Government Implementation (EKPPD) system on General Government Office. The results show that TOGAF will guide the development of integrated business processes of EKPPD system that fits good governance practices to attain GGG with SOA methodology as technical approach.

Object localization, discrimination, and grasping with the optic nerve visual prosthesis.

PubMed

Duret, Florence; Brelén, Måten E; Lambert, Valerie; Gérard, Benoît; Delbeke, Jean; Veraart, Claude

2006-01-01

This study involved a volunteer completely blind from retinis pigmentosa who had previously been implanted with an optic nerve visual prosthesis. The aim of this two-year study was to train the volunteer to localize a given object in nine different positions, to discriminate the object within a choice of six, and then to grasp it. In a closed-loop protocol including a head worn video camera, the nerve was stimulated whenever a part of the processed image of the object being scrutinized matched the center of an elicitable phosphene. The accessible visual field included 109 phosphenes in a 14 degrees x 41 degrees area. Results showed that training was required to succeed in the localization and discrimination tasks, but practically no training was required for grasping the object. The volunteer was able to successfully complete all tasks after training. The volunteer systematically performed several left-right and bottom-up scanning movements during the discrimination task. Discrimination strategies included stimulation phases and no-stimulation phases of roughly similar duration. This study provides a step towards the practical use of the optic nerve visual prosthesis in current daily life.

Development and implementation of the Good Neighbor Agreement (GNA) practice in the USA sustainable mining development.

NASA Astrophysics Data System (ADS)

Masaitis, Alexandra

2014-05-01

New economic, environmental and social challenges for the mining industry in the USA show the need to implement "responsible" mining practices that include improved community involvement. Conflicts which occur in the US territory and with US mining companies around the world are now common between the mining proponents, NGO's and communities. These conflicts can sometimes be alleviated by early development of modes of communication, and a formal discussion format that allows airing of concerns and potential resolution of problems. One of the methods that can formalize this process is to establish a Good Neighbor Agreement (GNA), which deals specifically with challenges in relationships between mining operations and the local communities. It is a new practice related to mining operations that are oriented toward social needs and concerns of local communities that arise during the normal life of a mine, which can achieve sustainable mining practices. The GNA project being currently developed at the University of Nevada, USA in cooperation with the Newmont Mining Corporation has a goal of creating an open company/community dialog that will help identify and address sociological and environmental concerns associated with mining. Discussion: The Good Neighbor Agreement currently evolving will address the following: 1. Identify spheres of possible cooperation between mining companies, government organizations, and NGO's. 2. Provide an economically viable mechanism for developing a partnership between mining operations and the local communities that will increase mining industry's accountability and provide higher levels of confidence for the community that a mine is operated in a safe and sustainable manner. Implementation of the GNA can help identify and evaluate conflict criteria in mining/community relationships; determine the status of concerns; determine the role and responsibilities of stakeholders; analyze problem resolution feasibility; maintain the community involvement and support through economic benefits and environmental safeguards; develop options for the concerns resolution. Difficulties in establishing the GNA standards include lack of insurance/bonding policies, and by the lack of audit and monitoring that could determine the level of exposure of the local community and the environment to the contaminants released at the mine sites. Since many problems of mines can occur during closure and post-closure, GNA's should address those issues also. The goal of the GNA is to have open access for the public to the safety, health, and environmental information pertaining to the mining operation, as well as to educate the local communities about mining practices that promote mutual acknowledgment of the need to build a relationship amenable to each other's needs. Frequent conflicts between mining companies and surrounding communities lead to work disruptions or even mine closures and show the necessity of a less confrontational approach to environmental and social justice. The Good Neighbor Agreement is a unique way to provide the benefits for the both mining operations and local community to provide a mechanism for risk redaction and communication that offer the potential to protect both mining and community interests.

Ethical review issues in collaborative research between us and low-middle income country partners: a case example.

PubMed

McIntosh, Scott; Sierra, Essie; Dozier, Ann; Diaz, Sergio; Quiñones, Zahira; Primack, Aron; Chadwick, Gary; Ossip-Klein, Deborah J

2008-09-01

The current ethical structure for collaborative international health research stems largely from developed countries' standards of proper ethical practices. The result is that ethical committees in developing countries are required to adhere to standards that might impose practices that conflict with local culture and unintended interpretations of ethics, treatments, and research. This paper presents a case example of a joint international research project that successfully established inclusive ethical review processes as well as other groundwork and components necessary for the conduct of human behavior research and research capacity building in the host country.

Lorentz factor determination for local electric fields in semiconductor devices utilizing hyper-thin dielectrics

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

McPherson, J. W., E-mail: mcpherson.reliability@yahoo.com

The local electric field (the field that distorts, polarizes, and weakens polar molecular bonds in dielectrics) has been investigated for hyper-thin dielectrics. Hyper-thin dielectrics are currently required for advanced semiconductor devices. In the work presented, it is shown that the common practice of using a Lorentz factor of L = 1/3, to describe the local electric field in a dielectric layer, remains valid for hyper-thin dielectrics. However, at the very edge of device structures, a rise in the macroscopic/Maxwell electric field E{sub diel} occurs and this causes a sharp rise in the effective Lorentz factor L{sub eff}. At capacitor and transistor edges,more » L{sub eff} is found to increase to a value 2/3 < L{sub eff} < 1. The increase in L{sub eff} results in a local electric field, at device edge, that is 50%–100% greater than in the bulk of the dielectric. This increase in local electric field serves to weaken polar bonds thus making them more susceptible to breakage by standard Boltzmann and/or current-driven processes. This has important time-dependent dielectric breakdown (TDDB) implications for all electronic devices utilizing polar materials, including GaN devices that suffer from device-edge TDDB.« less

Local food-based complementary feeding recommendations developed by the linear programming approach to improve the intake of problem nutrients among 12-23-month-old Myanmar children.

PubMed

Hlaing, Lwin Mar; Fahmida, Umi; Htet, Min Kyaw; Utomo, Budi; Firmansyah, Agus; Ferguson, Elaine L

2016-07-01

Poor feeding practices result in inadequate nutrient intakes in young children in developing countries. To improve practices, local food-based complementary feeding recommendations (CFR) are needed. This cross-sectional survey aimed to describe current food consumption patterns of 12-23-month-old Myanmar children (n 106) from Ayeyarwady region in order to identify nutrient requirements that are difficult to achieve using local foods and to formulate affordable and realistic CFR to improve dietary adequacy. Weekly food consumption patterns were assessed using a 12-h weighed dietary record, single 24-h recall and a 5-d food record. Food costs were estimated by market surveys. CFR were formulated by linear programming analysis using WHO Optifood software and evaluated among mothers (n 20) using trial of improved practices (TIP). Findings showed that Ca, Zn, niacin, folate and Fe were 'problem nutrients': nutrients that did not achieve 100 % recommended nutrient intake even when the diet was optimised. Chicken liver, anchovy and roselle leaves were locally available nutrient-dense foods that would fill these nutrient gaps. The final set of six CFR would ensure dietary adequacy for five of twelve nutrients at a minimal cost of 271 kyats/d (based on the exchange rate of 900 kyats/USD at the time of data collection: 3rd quarter of 2012), but inadequacies remained for niacin, folate, thiamin, Fe, Zn, Ca and vitamin B6. TIP showed that mothers believed liver and vegetables would cause worms and diarrhoea, but these beliefs could be overcome to successfully promote liver consumption. Therefore, an acceptable set of CFR were developed to improve the dietary practices of 12-23-month-old Myanmar children using locally available foods. Alternative interventions such as fortification, however, are still needed to ensure dietary adequacy of all nutrients.

The place and practices of well-being in local governance.

PubMed

Atkinson, Sarah; Joyce, Kerry E

2010-10-20

The concept of well-being has become prominent within national policy goals in the UK since the end of the 1990s. However, the concept of well-being remains ill defined, an instability that is increasingly understood as problematic to policy making. We engage with this terminological instability through an exploration of how the concept of well-being is practised discursively in local governance and critically examine the place of the concept in local policy making. In contrast to the current enthusiasm to define and measure well-being, we argue that the conceptual instability has inherent value for local governance. The concept of well-being is practised through a number of potentially conflicting discourses, but it is exactly this conceptual instability that enables a local negotiation and combination of alternative policy frameworks for local place-shaping strategies. As such, well-being not only is an overarching goal of governance but also contributes to the dynamics of the policy process.

What is the effect of area size when using local area practice style as an instrument?

PubMed

Brooks, John M; Tang, Yuexin; Chapman, Cole G; Cook, Elizabeth A; Chrischilles, Elizabeth A

2013-08-01

Discuss the tradeoffs inherent in choosing a local area size when using a measure of local area practice style as an instrument in instrumental variable estimation when assessing treatment effectiveness. Assess the effectiveness of angiotensin converting-enzyme inhibitors and angiotensin receptor blockers on survival after acute myocardial infarction for Medicare beneficiaries using practice style instruments based on different-sized local areas around patients. We contrasted treatment effect estimates using different local area sizes in terms of the strength of the relationship between local area practice styles and individual patient treatment choices; and indirect assessments of the assumption violations. Using smaller local areas to measure practice styles exploits more treatment variation and results in smaller standard errors. However, if treatment effects are heterogeneous, the use of smaller local areas may increase the risk that local practice style measures are dominated by differences in average treatment effectiveness across areas and bias results toward greater effectiveness. Local area practice style measures can be useful instruments in instrumental variable analysis, but the use of smaller local area sizes to generate greater treatment variation may result in treatment effect estimates that are biased toward higher effectiveness. Assessment of whether ecological bias can be mitigated by changing local area size requires the use of outside data sources. Copyright © 2013 Elsevier Inc. All rights reserved.

Wi-Fi/MARG Integration for Indoor Pedestrian Localization

PubMed Central

Tian, Zengshan; Jin, Yue; Zhou, Mu; Wu, Zipeng; Li, Ze

2016-01-01

With the wide deployment of Wi-Fi networks, Wi-Fi based indoor localization systems that are deployed without any special hardware have caught significant attention and have become a currently practical technology. At the same time, the Magnetic, Angular Rate, and Gravity (MARG) sensors installed in commercial mobile devices can achieve highly-accurate localization in short time. Based on this, we design a novel indoor localization system by using built-in MARG sensors and a Wi-Fi module. The innovative contributions of this paper include the enhanced Pedestrian Dead Reckoning (PDR) and Wi-Fi localization approaches, and an Extended Kalman Particle Filter (EKPF) based fusion algorithm. A new Wi-Fi/MARG indoor localization system, including an Android based mobile client, a Web page for remote control, and a location server, is developed for real-time indoor pedestrian localization. The extensive experimental results show that the proposed system is featured with better localization performance, with the average error 0.85 m, than the one achieved by using the Wi-Fi module or MARG sensors solely. PMID:27973412

From troglodytes to information managers: information management and technology needs to achieve the primary care NHS modernization agenda--the views of three GPs.

PubMed

Rooney, I; Hornby, S

2000-09-01

In response to the information management and technology changes proposed by the Government's NHS modernization initiative this article examines the issues that GPs feel to be of major significance to their work. Although information and communications technology is widely used in general practice there is no one agreed standard system. The level of technology and the manner in which it is used is also diverse throughout the profession, as are the attitudes that exist amongst GPs regarding the value of information management and technology, and the benefits efficient information management offers to them and to their patients. The views of three local GPs from practices with varying levels of information technology were obtained through semi-structured interviews and the findings developed in the light of current discussions in the published literature. The GPs chosen reflect the disparity within general practice and, perhaps, other units of the NHS in the use and understanding of information management. The main conclusions were that there is ambivalence and scepticism about what NHSnet currently has to offer; that local electronic records benefit patient care, but when networked more widely problems of confidentiality and security result. Practitioners were also mindful of the financial costs of changes and concerned, given the impact of PCGs and clinical governance, as to who will be responsible for ensuring a common level of electronic records, IT provision, and financial and technological support.

Are Public Health Organizations Tweeting to the Choir? Understanding Local Health Department Twitter Followership

PubMed Central

Choucair, Bechara; Maier, Ryan C; Jolani, Nina; Bernhardt, Jay M

2014-01-01

Background One of the essential services provided by the US local health departments is informing and educating constituents about health. Communication with constituents about public health issues and health risks is among the standards required of local health departments for accreditation. Past research found that only 61% of local health departments met standards for informing and educating constituents, suggesting a considerable gap between current practices and best practice. Objective Social media platforms, such as Twitter, may aid local health departments in informing and educating their constituents by reaching large numbers of people with real-time messages at relatively low cost. Little is known about the followers of local health departments on Twitter. The aim of this study was to examine characteristics of local health department Twitter followers and the relationship between local health department characteristics and follower characteristics. Methods In 2013, we collected (using NodeXL) and analyzed a sample of 4779 Twitter followers from 59 randomly selected local health departments in the United States with Twitter accounts. We coded each Twitter follower for type (individual, organization), location, health focus, and industry (eg, media, government). Local health department characteristics were adopted from the 2010 National Association of City and County Health Officials Profile Study data. Results Local health department Twitter accounts were followed by more organizations than individual users. Organizations tended to be health-focused, located outside the state from the local health department being followed, and from the education, government, and non-profit sectors. Individuals were likely to be local and not health-focused. Having a public information officer on staff, serving a larger population, and “tweeting” more frequently were associated with having a higher percentage of local followers. Conclusions Social media has the potential to reach a wide and diverse audience. Understanding audience characteristics can help public health organizations use this new tool more effectively by tailoring tweet content and dissemination strategies for their audience. PMID:24571914

'It ain't what you do it's the way that you do it': lessons for health care from decommissioning of older people's services.

PubMed

Robinson, Suzanne; Glasby, Jon; Allen, Kerry

2013-11-01

Public sector organisations are facing one of the most difficult financial periods in history and local decision-makers are tasked with making tough rationing decisions. Withdrawing or limiting services is an emotive and complex task and something the National Health Service has always found difficult. Over time, local authorities have gained significant experience in the closure of care homes - an equally complex and controversial issue. Drawing on local knowledge and best practice examples, this article highlights lessons and themes identified by those decommissioning care home services. We believe that such lessons are relevant to those making disinvestment decisions across public sector services, including health-care. The study employed semi-structured interviews with 12 Directors of Adult Social Services who had been highlighted nationally as having extensive experience of home closures. Interviews were conducted over a 2-week period in March 2011. Results from the study found that having local policy guidance that is perceived as fair and reasonable was advocated by those involved in home closures. Many local policies had evolved over time and had often been developed following experiences of home closures (both good and bad). Decisions to close care home services require a combination of strong leadership, clear strategic goals, a fair decision-making process, strong evidence of the need for change and good communication, alongside wider stakeholder engagement and support. The current financial challenge means that public sector organisations need to make tough choices on investment and disinvestment decisions. Any such decisions need to be influenced by what we know constitutes best practice. Sharing lessons and experiences within and between sectors could well inform and develop decision-making practices. © 2013 John Wiley & Sons Ltd.

Medicinal animals used in ethnoveterinary practices of the 'Cariri Paraibano', NE Brazil

PubMed Central

2011-01-01

Background Zootherapy is important in various socio-cultural environments, and innumerous examples of the use of animal derived remedies can currently be found in many urban, semi-urban and more remote localities in all parts of the world, particularly in developing countries. However, although a number of ethnobiological inventories concerning the use of medicinal animals in human health care have been compiled in Brazil in recent years, zootherapeutic practices in ethnoveterinary medicine (EVM) are poorly described and neglected in favor of human ethnomedicine. In this sense, the purpose of this study was to describe the local zootherapeutic practices in ethnoveterinary medicine of semi-arid of NE Brazil (Caatinga biome) and to contribute to future research about the validation of the effects and side effects of these animal products Methods The information obtained through semi-structured interviews was complemented by free interviews and informal conversations. A total of 67 people were interviewed (53 men and 14 women) about the use and commercialization of medicinal animals. To determine the relative importance of each local known species, their use-values (UV) were calculated. Diversity of species utilized was compared, between localities, using rarefaction curves and diversity estimate (Chao2) Results and Conclusions A total of 44 animal species (37 vertebrates and 7 invertebrates), distributed among 6 taxonomic categories were found to be used to treat 30 different ailments in livestock and pets. The results of our surveys revealed a rich traditional knowledge of local residents about the use of animals in traditional veterinary medicine. Although it is gradually being discontinued, the perceived efficacy, economic and geographic accessibility were main reasons for popularity of zootherapy in studied areas. PMID:21985401

The challenges and opportunities of translating best practice immunisation strategies among low performing general practices to reduce equity gaps in childhood immunisation coverage in New Zealand.

PubMed

Turner, Nikki M; Charania, Nadia A; Chong, Angela; Stewart, Joanna; Taylor, Lynn

2017-01-01

Immunisation coverage rates vary considerably at the local level across New Zealand and challenges remain with effectively translating best available research evidence into public health practice. This study aimed to translate best practices from high performing general practices into strategies to improve childhood immunisation coverage among low performing practices. An intervention study was undertaken of general practices with low immunisation coverage rates and a high percentage of the enrolled population being of Māori ethnicity. Intervention groups received customised action plans and support for a 12 month period while control groups received 'business as usual' support. Structured interviews were conducted with key informants from all participating practices to understand current aspects related to childhood immunisation delivery and surveys were conducted to understand how the intervention worked. Collected data were thematically analysed. Ten sites were randomised to either intervention ( n  = 6) or control group ( n  = 4). Positive aspects of childhood immunisation delivery included high prioritisation at the practice and staff being pro-immunisation and knowledgeable. Key challenges experienced included inaccurate family contact information and discrepancies with referral processes to other providers. Other challenges noted were building rapport with families and vaccine hesitancy. The action plans included various strategies aimed to improve processes at the practice, contact and engagement with parents, and partnership development with local service providers. Creating customised action plans and providing support to providers were considered as helpful approaches when attempting to improve childhood immunisation coverage rates. Our study supports the notion that one strategy will not solely by itself improve childhood immunisation rates and highlights the importance of having a toolkit of strategies from which to draw from.

Determination of localization accuracy based on experimentally acquired image sets: applications to single molecule microscopy

PubMed Central

Tahmasbi, Amir; Ward, E. Sally; Ober, Raimund J.

2015-01-01

Fluorescence microscopy is a photon-limited imaging modality that allows the study of subcellular objects and processes with high specificity. The best possible accuracy (standard deviation) with which an object of interest can be localized when imaged using a fluorescence microscope is typically calculated using the Cramér-Rao lower bound, that is, the inverse of the Fisher information. However, the current approach for the calculation of the best possible localization accuracy relies on an analytical expression for the image of the object. This can pose practical challenges since it is often difficult to find appropriate analytical models for the images of general objects. In this study, we instead develop an approach that directly uses an experimentally collected image set to calculate the best possible localization accuracy for a general subcellular object. In this approach, we fit splines, i.e. smoothly connected piecewise polynomials, to the experimentally collected image set to provide a continuous model of the object, which can then be used for the calculation of the best possible localization accuracy. Due to its practical importance, we investigate in detail the application of the proposed approach in single molecule fluorescence microscopy. In this case, the object of interest is a point source and, therefore, the acquired image set pertains to an experimental point spread function. PMID:25837101

Expanded function allied dental personnel and dental practice productivity and efficiency.

PubMed

Beazoglou, Tryfon J; Chen, Lei; Lazar, Vickie F; Brown, L Jackson; Ray, Subhash C; Heffley, Dennis R; Berg, Rob; Bailit, Howard L

2012-08-01

This study examined the impact of expanded function allied dental personnel on the productivity and efficiency of general dental practices. Detailed practice financial and clinical data were obtained from a convenience sample of 154 general dental practices in Colorado. In this state, expanded function dental assistants can provide a wide range of reversible dental services/procedures, and dental hygienists can give local anesthesia. The survey identified practices that currently use expanded function allied dental personnel and the specific services/procedures delegated. Practice productivity was measured using patient visits, gross billings, and net income. Practice efficiency was assessed using a multivariate linear program, Data Envelopment Analysis. Sixty-four percent of the practices were found to use expanded function allied dental personnel, and on average they delegated 31.4 percent of delegatable services/procedures. Practices that used expanded function allied dental personnel treated more patients and had higher gross billings and net incomes than those practices that did not; the more services they delegated, the higher was the practice's productivity and efficiency. The effective use of expanded function allied dental personnel has the potential to substantially expand the capacity of general dental practices to treat more patients and to generate higher incomes for dental practices.

Discussion of examination of a cored hydraulic fracture in a deep gas well

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

Nolte, K.G.

Warpinski et al. document information found from a core through a formation after a hydraulic fracture treatment. As they indicate, the core provides the first detailed evaluation of an actual propped hydraulic fracture away from the well and at a significant depth, and this evaluation leads to findings that deviate substantially from the assumptions incorporated into current fracturing models. In this discussion, a defense of current fracture design assumptions is developed. The affirmation of current assumptions, for general industry applications, is based on an assessment of the global impact of the local complexity found in the core. The assessment leadsmore » to recommendations for the evolution of fracture design practice.« less

Anesthesia Practices for Interventional Radiology in Europe.

PubMed

Vari, Alessandra; Gangi, Afshin

2017-06-01

The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic practices for interventional radiology, in consideration of the current variability of IR suite settings, staffing and anesthetic practices reported in the literature and of the growing debate on sedation administered by non-anesthesiologists, in Europe. Anonymous online survey available to all European CIRSE members to assess IR setting, demographics, peri-procedural care, anesthetic management, resources and staffing, pain management, data collection, safety, management of emergencies and personal opinions on the role CIRSE should have in promoting anesthetic care for interventional radiology. Predictable differences between countries and national regulations were confirmed, showing how significantly many "local" factors (type and size of centers, the availability of dedicated inpatient bed, availability of anesthesia staff) can affect the routine practice and the expansion of IR as a subspecialty. In addition, the perception of the need for IR to acquire more sedation-related skills is definitely stronger for those who practice with the lowest availability of anesthesia care. Significant country variations and regulations along with a controversial position of the anesthesia community on the issue of sedation administered by non-anesthesiologists substantially represent the biggest drawbacks for the expansion of peri-procedural anesthetic care for IR and for potential initiatives at an European level.

Survey of Irish general practitioners' preferences for continuing professional development.

PubMed

Maher, B; O'Neill, R; Faruqui, A; Bergin, C; Horgan, M; Bennett, D; O'Tuathaigh, C M P

2018-01-01

Doctors' continuing professional development (CPD) training needs are known to be strongly influenced by national and local contextual characteristics. Given the changing national demographic profile and government-mandated changes to primary care health care provision, this study aimed to investigate Irish General Practitioners' (GPs) perceptions of, and preferences for, current and future CPD programmes. A cross-sectional questionnaire, using closed- and open-ended questions, was administered to Irish GPs, focusing on training needs analysis; CPD course content; preferred format and the learning environment. The response rate was 719/1000 (71.9%). GPs identified doctor-patient communication as the most important and best-performed GP skill. Discrepancies between perceived importance (high) and current performance (low) emerged for time/workload management, practice finance and business skills. GPs identified clinically-relevant primary care topics and non-clinical topics (stress management, business skills, practice management) as preferences for future CPD. Flexible methods for CPD delivery were important. Gender and practice location (urban or rural) significantly influenced CPD participation and future course preference. The increasing diversity of services offered in the Irish primary care setting, in both clinical and non-clinical areas, should be tailored based to include GP practice location and structure.

Contributing towards the betterment of translational epilepsy research in Africa: needs, challenges, resources, and opportunities.

PubMed

Woldeamanuel, Yohannes W; Girma, Belaineh

2014-08-01

Epilepsy affects approximately 50 million people worldwide. Among them, at least 40 million people are currently living in the developing world, where resources and standards of care are suboptimal. Around 90 % of people with epilepsy in resource-poor countries do not currently receive appropriate treatments, at a time when two thirds of these patients could have achieved good control of their epileptic seizures had they had access to appropriate therapies. Scarcity of epilepsy specialists, poor availability or access to diagnostic facilities and treatments, poor community knowledge about epilepsy-related issues, stigma, and other societal and cultural barriers are only some of the issues contributing to this deficiency. These issues in epilepsy treatment have been well recognized, and ongoing concerted efforts to address them have been undertaken by both local authorities and international organizations. In many cases, patients resort to the use of traditional local and alternative medicines (herbs, religious practices, etc.) that are closer to indigenous cosmovision, are more holistic, and are more culture-friendly, preserving an optimum subtlety of Afrocentric character shading. Compared with imported Western medicines, patients find these approaches to be more relevant to their ways of thinking, their ways of being, and their belief systems, more accessible, and more acceptable methods of dealing with health and disease states. The impressive local wealth in these natural resources has established them as a preferred source of healing in these regions, but has also fueled interest in exploring their therapeutic potential in the very few existing local research centers. In this review, we discuss the known issues related to the epilepsy treatment gap in resource-poor regions, focusing in particular on African countries, introduce the role and issues related to the use and validation of alternative medical therapies in epilepsy, and comment on the importance and repercussions of initiatives to validate such therapies, primarily for local practices, but also for possible wider international applications.

The evolution of the surgical treatment of chronic pancreatitis.

PubMed

Andersen, Dana K; Frey, Charles F

2010-01-01

To establish the current status of surgical therapy for chronic pancreatitis, recent published reports are examined in the context of the historical advances in the field. The basis for decompression (drainage), denervation, and resection strategies for the treatment of pain caused by chronic pancreatitis is reviewed. These divergent approaches have finally coalesced as the head of the pancreas has become apparent as the nidus of chronic inflammation. The recent developments in surgical methods to treat the complications of chronic pancreatitis and the results of recent prospective randomized trials of operative approaches were reviewed to establish the current best practices. Local resection of the pancreatic head, with or without duct drainage, and duodenum-preserving pancreatic head resection offer outcomes as effective as pancreaticoduodenectomy, with lowered morbidity and mortality. Local resection or excavation of the pancreatic head offers the advantage of lowest cost and morbidity and early prevention of postoperative diabetes. The late incidences of recurrent pain, diabetes, and exocrine insufficiency are equivalent for all 3 surgical approaches. Local resection of the pancreatic head appears to offer best outcomes and lowest risk for the management of the pain of chronic pancreatitis.

Economic benefits of high value medicinal plants to Pakistani communities: an analysis of current practice and potential.

PubMed

Sher, Hassan; Aldosari, Ali; Ali, Ahmad; de Boer, Hugo J

2014-10-10

Poverty is pervasive in the Swat Valley, Pakistan. Most of the people survive by farming small landholdings. Many earn additional income by collecting and selling plant material for use in herbal medicine. This material is collected from wild populations but the people involved have little appreciation of the potential value of the plant material they collect and the long term impact their collecting has on local plant populations. In 2012, existing practices in collecting and trading high value minor crops from Swat District, Pakistan, were analyzed. The focus of the study was on the collection pattern of medicinal plants as an economic activity within Swat District and the likely destinations of these products in national or international markets. Local collectors/farmers and dealers were surveyed about their collection efforts, quantities collected, prices received, and resulting incomes. Herbal markets in major cities of Pakistan were surveyed for current market trends, domestic sources of supply, imports and exports of herbal material, price patterns, and market product-quality requirements. It was observed that wild collection is almost the only source of medicinal plant raw material in the country, with virtually no cultivation. Gathering is mostly done by women and children of nomadic Middle Hill tribes who earn supplementary income through this activity, with the plants then brought into the market by collectors who are usually local farmers. The individuals involved in gathering and collecting are largely untrained regarding the pre-harvest and post-harvest treatment of collected material. Most of the collected material is sold to local middlemen. After that, the trade pattern is complex and heterogeneous, involving many players. Pakistan exports of high value plants generate over US$10.5 million annually in 2012, with a substantial percentage of the supply coming from Swat District, but its market share has been declining. Reasons for the decline were identified as unreliable and often poor quality of the material supplied, length of the supply chain, and poor marketing strategies. These problems can be addressed by improving the knowledge of those at the start of the supply chain, improving linkages among all steps in the chain, and developing sustainable harvesting practices.

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition.

PubMed

Rossaint, Rolf; Bouillon, Bertil; Cerny, Vladimir; Coats, Timothy J; Duranteau, Jacques; Fernández-Mondéjar, Enrique; Filipescu, Daniela; Hunt, Beverley J; Komadina, Radko; Nardi, Giuseppe; Neugebauer, Edmund A M; Ozier, Yves; Riddez, Louis; Schultz, Arthur; Vincent, Jean-Louis; Spahn, Donat R

2016-04-12

Severe trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution. The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013. The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome. A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome.

Ion Electrodiffusion Governs Silk Electrogelation.

PubMed

Kojic, Nikola; Panzer, Matthew J; Leisk, Gary G; Raja, Waseem K; Kojic, Milos; Kaplan, David L

2012-07-14

Silk electrogelation involves the transition of an aqueous silk fibroin solution to a gel state (E-gel) in the presence of an electric current. The process is based on local pH changes as a result of water electrolysis - generating H(+) and OH(-) ions at the (+) and (-) electrodes, respectively. Silk fibroin has a pI=4.2 and when local pH

Economic analysis of athletic team coverage by an orthopedic practice.

PubMed

Lombardi, Nicholas; Freedman, Kevin; Tucker, Brad; Austin, Luke; Eck, Brandon; Pepe, Matt; Tjoumakaris, Fotios

2015-11-01

Coverage of high school football by orthopedic sports medicine specialists is considered standard of care in many localities. Determining the economic viability of this endeavor has never been investigated. The primary purpose of the present investigation was to perform an economic analysis of local high school sports coverage by an orthopedic sports medicine practice. From January 2010 to June 2012, a prospective injury report database was used to collect sports injuries from five high school athletic programs covered by a single, private orthopedic sports medicine practice. Patients referred for orthopedic care were then tracked to determine expected cost of care (potential revenue). Evaluation and management codes and current procedure terminology codes were obtained to determine the value of physician visits and surgical care rendered. Overhead costs were calculated based on historical rates within our practice and incorporated to determine estimated profit. 19,165 athletic trainer contacts with athletes playing all sports, including both those 'on-field' and in the training room, resulted in 473 (2.5%) physician referrals. The covering orthopedic practice handled 89 (27.9%) of the orthopedic referrals. Of orthopedic physician referrals, 26 (5.4%) required orthopedic surgical treatment. The covering team practice handled 17/26 (65%) surgical cases. The total revenue collected by the covering team practice was $26,226.14. The overhead cost of treatment was $9441.41. Overall estimated profit of orthopedic visits and treatment during this period for the covering practice was $16,784.73. The covering team practice handled 28% of the orthopedic referrals, 65% of the surgical cases and captured 59% of the potential profit. An increase in physician referrals could increase the benefit for orthopedic surgeons.

Technique for Periarticular Local Infiltrative Anesthesia Delivery Using Liposomal Bupivacaine in Total Knee Arthroplasty.

PubMed

Connelly, Jacob O; Edwards, Paul K; Mears, Simon C; Barnes, C Lowry

2015-01-01

Postoperative pain control after total knee arthroplasty is a major contributing factor to patient satisfaction, rehabilitation, and length of stay. Current clinical practice guidelines recommend a multimodal pain management protocol, including the use of regional anesthesia. Periarticular injection (PAI) has been shown to provide excellent pain relief after total knee arthroplasty. Recently, liposomal bupivacaine has been introduced as a long-acting alternative to traditional local anesthetics, such as bupivacaine or ropivacaine. Liposomal bupivacaine is a sustained-release preparation designed to provide local analgesia up to 72 hours after initial application. The efficacy of PAI relies significantly on a meticulous, systematic injection technique. This article details recommendations for solution preparation and injection during total knee arthroplasty on the basis of the experience of a high-volume orthopaedic reconstruction service.

Laboratory Diagnosis and Characterization of Fungal Disease in Patients with Cystic Fibrosis (CF): A Survey of Current UK Practice in a Cohort of Clinical Microbiology Laboratories.

PubMed

Boyle, Maeve; Moore, John E; Whitehouse, Joanna L; Bilton, Diana; Downey, Damian G

2018-03-02

There is much uncertainty as to how fungal disease is diagnosed and characterized in patients with cystic fibrosis (CF). A 19-question anonymous electronic questionnaire was developed and distributed to ascertain current practice in clinical microbiology laboratories providing a fungal laboratory service to CF centres in the UK. Analyses of responses identified the following: (1) current UK laboratory practice, in general, follows the current guidelines, but the scope and diversity of what is currently being delivered by laboratories far exceeds what is detailed in the guidelines; (2) there is a lack of standardization of fungal tests amongst laboratories, outside of the current guidelines; (3) both the UK CF Trust Laboratory Standards for Processing Microbiological Samples from People with Cystic Fibrosis and the US Cumulative Techniques and Procedures in Clinical Microbiology (Cumitech) Guidelines 43 Cystic Fibrosis Microbiology need to be updated to reflect both new methodological innovations, as well as better knowledge of fungal disease pathophysiology in CF; (4) there is a need for clinical medicine to decide upon a stratification strategy for the provision of new fungal assays that will add value to the physician in the optimal management of CF patients; (5) there is also a need to rationale what assays should be performed at local laboratory level and those which are best served at National Mycology Reference Laboratory level; and (6) further research is required in developing laboratory assays, which will help ascertain the clinical importance of 'old' fungal pathogens, as well as 'emerging' fungal pathogens.

Social media in plastic surgery practices: emerging trends in North America.

PubMed

Wheeler, Chad K; Said, Hakim; Prucz, Roni; Rodrich, Rod J; Mathes, David W

2011-05-01

Social media is a common term for web-based applications that offer a way to disseminate information to a targeted audience in real time. In the current market, many businesses are utilizing it to communicate with clients. Although the field of plastic surgery is constantly changing in response to innovative technologies introduced into the specialty, the utilization of social media in plastic surgery practices is currently unclear. The authors evaluate the current attitudes and practices of aesthetic surgeons to emerging social media technology and compare these to attitudes about more traditional modes of communication. A 19-question web-based survey was disseminated by e-mail to all board-certified or board-eligible American plastic surgeons (n = 4817). Respondents were asked to answer questions on three topics: (1) their use of social media in their personal and professional lives, (2) their various forms of practice marketing, and (3) their demographic information. There were 1000 responses (20.8%). Results showed that 28.2% of respondents used social media in their practice, while 46.7% used it in their personal life. Most plastic surgeons managed their social media themselves or through a staff member. The majority of respondents who used social media in their practice claimed that their efforts were directed toward patient referrals. The typical plastic surgery practice that used social media was a solo practice in a large city with a focus on cosmetic surgery. Local competition of plastic surgeons did not correlate with social media use. Most plastic surgeons (88%) advertised, but the form of marketing varied. The most common forms included websites, print, and search engine optimization, but other modalities, such as television, radio, and billboards, were still utilized. Social media represents a new avenue that many plastic surgeons are utilizing, although with trepidation. As social media becomes commonplace in society, its role in plastic surgery practice development and communication will become more prominent and defined.

Sociological and ethical issues in transplant commercialism.

PubMed

Epstein, Miran

2009-04-01

'Global transplant commercialism' (practices and policies involving international trade in organs from living vendors, e.g., 'transplant tourism') is currently subjected to unprecedented criticism. In parallel, the debate around 'local transplant commercialism' (practices and policies that confine trade in organs from living vendors to national markets or economic unions) is heating up. In an attempt to assess the potential outcomes of these trends, this article reviews and discusses some sociological and ethical issues, ending with a proposal for a reinvigorated anticommercialist strategy. The current international campaign against global transplant commercialism is conducted by an ad hoc alliance between strange bedfellows, proponents of local transplant commercialism on the one hand and opponents of any transplant commercialism on the other. Disparities in the rigor of the respective ethical discourses, the expanding list of precedents of legitimized commerce in the human body, and the political economy of transplantation, all suggest that the former have the upper hand. Recent achievements in the struggle against international organ trafficking may not herald the abolition of transplant commercialism but rather presage its reconfiguration in deglobalized forms. In light of such a prospect, those who wish to prevent the pervasive commodification of the human body from entering the gates of transplant medicine should consider devising a new, perhaps more radical, strategy.

Quantified carbon input for maintaining existing soil organic carbon stocks in global wheat systems

NASA Astrophysics Data System (ADS)

Wang, G.

2017-12-01

Soil organic carbon (SOC) dynamics in croplands is a crucial component of global carbon (C) cycle. Depending on local environmental conditions and management practices, typical C input is generally required to reduce or reverse C loss in agricultural soils. No studies have quantified the critical C input for maintaining SOC at global scale with high resolution. Such information will provide a baseline map for assessing soil C dynamics under potential changes in management practices and climate, and thus enable development of management strategies to reduce C footprint from farm to regional scales. We used the soil C model RothC to simulate the critical C input rates needed to maintain existing soil C level at 0.1°× 0.1° resolution in global wheat systems. On average, the critical C input was estimated to be 2.0 Mg C ha-1 yr-1, with large spatial variability depending on local soil and climatic conditions. Higher C inputs are required in wheat system of central United States and western Europe, mainly due to the higher current soil C stocks present in these regions. The critical C input could be effectively estimated using a summary model driven by current SOC level, mean annual temperature, precipitation, and soil clay content.

Adoption of Evidence-Based Practices Among Substance Abuse Treatment Providers*

PubMed Central

Haug, Nancy A.; Shopshire, Michael; Tajima, Barbara; Gruber, Valerie; Guydish, Joseph

2009-01-01

This research was conducted at a Substance Abuse Forum designed to address local community needs by focusing on Evidence-Based Practices (EBPs) in addiction treatment. The purpose of the study was to assess substance abuse treatment professionals’ readiness to adopt EBPs, experience with EBPs, and attitudes toward EBPs, as well as agency support for EBPs. A total of 119 addiction treatment providers completed pre-test measures, and 82% completed a post-test. Eighty-three percent of participants reported using some EBPs in the past year, and 75% reported currently using EBPs. Participants who were currently licensed or certified in addictions had less negative attitudes toward EBPs than those without credentials. While respondents reported agency support for EBPs, most expressed interest in further training. This study underscores the movement toward EBPs in addiction treatment and the need for effective dissemination and training in this area. PMID:18724657

Internationalizing forensic assessments of criminal responsibility.

PubMed

Meynen, Gerben; Oei, Karel

2011-12-01

One of the important characteristics of current medicine is that it is an international endeavor. The fact that medicine is a global undertaking might even be one of its core strengths. However, the universal nature of medicine can be compromised when local issues become significant factors in medical practice. In this paper we identify criminal law as a relevant factor complicating the process of internationalizing a particular medical practice: the assessment of a defendant within the context of the question of criminal responsibility. Since criminal law--especially the laws relevant to assessments of criminal responsibility--may differ from country to country, or rather from jurisdiction to jurisdiction, forensic psychiatrists face the challenge of finding common ground and a common framework to advance these forensic psychiatric assessments. We describe the current situation and argue for internationalizing the discussion about this assessment, pointing to the example provided by assessments of competence.

Management of arthropod pathogen vectors in North America: Minimizing adverse effects on pollinators

USGS Publications Warehouse

Ginsberg, Howard; Bargar, Timothy A.; Hladik, Michelle L.; Lubelczyk, Charles

2017-01-01

Tick and mosquito management is important to public health protection. At the same time, growing concerns about declines of pollinator species raise the question of whether vector control practices might affect pollinator populations. We report the results of a task force of the North American Pollinator Protection Campaign (NAPPC) that examined potential effects of vector management practices on pollinators, and how these programs could be adjusted to minimize negative effects on pollinating species. The main types of vector control practices that might affect pollinators are landscape manipulation, biocontrol, and pesticide applications. Some current practices already minimize effects of vector control on pollinators (e.g., short-lived pesticides and application-targeting technologies). Nontarget effects can be further diminished by taking pollinator protection into account in the planning stages of vector management programs. Effects of vector control on pollinator species often depend on specific local conditions (e.g., proximity of locations with abundant vectors to concentrations of floral resources), so planning is most effective when it includes collaborations of local vector management professionals with local experts on pollinators. Interventions can then be designed to avoid pollinators (e.g., targeting applications to avoid blooming times and pollinator nesting habitats), while still optimizing public health protection. Research on efficient targeting of interventions, and on effects on pollinators of emerging technologies, will help mitigate potential deleterious effects on pollinators in future management programs. In particular, models that can predict effects of integrated pest management on vector-borne pathogen transmission, along with effects on pollinator populations, would be useful for collaborative decision-making.

Implementation of a clinical practice guideline for antenatal magnesium sulphate for neuroprotection in Australia and New Zealand.

PubMed

Bain, Emily; Bubner, Tanya; Ashwood, Pat; Crowther, Caroline A; Middleton, Philippa

2013-02-01

Health professionals at 25 Australian and New Zealand tertiary maternity hospitals were surveyed about local implementation of a clinical practice guideline for antenatal magnesium sulphate for fetal neuroprotection. Seventy-six percent of respondents reported that their hospital is currently following a guideline; 36% confirmed that their hospital is auditing uptake. Estimates of uptake ranged from 53 to 90%. Ongoing education and support are needed to ensure that the guidelines are optimally implemented, and uptake and important health outcomes are monitored. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Ethical Review Issues in Collaborative Research between US and Low – Middle Income Country Partners: A Case Example

PubMed Central

McIntosh, Scott; Sierra, Essie; Dozier, Ann; Diaz, Sergio; Quiñones, Zahira; Primack, Aron; Chadwick, Gary; Ossip-Klein, Deborah J.

2012-01-01

The current ethical structure for collaborative international health research stems largely from developed countries’ standards of proper ethical practices. The result is that ethical committees in developing countries are required to adhere to standards that might impose practices that conflict with local culture and unintended interpretations of ethics, treatments, and research. This paper presents a case example of a joint international research project that successfully established inclusive ethical review processes as well as other groundwork and components necessary for the conduct of human behavior research and research capacity building in the host country. PMID:18554278

Plastic apron wear during direct patient care.

PubMed

Candlin, Josie; Stark, Sheila

To identify factors that influence nurses' practice in apron use during direct patient care. A small-scale documentary analysis of a purposive sample of 15 journal articles relating to nurses' apron use during patient care was undertaken. The analysis sought to address what factors affect nurses' decisions in relation to apron use. Nurses' decisions regarding apron use during patient care tend to be ritualistic rather than evidence-based. Their knowledge of infection control is limited. Although there is current literature available on infection control, as well as health and safety regulations, if local policy regarding apron use in nursing care is scant this can result in inconsistent and, perhaps, less desirable practices.

To Meet or Not To Meet Physical vs. Virtual Configuration Control Board

NASA Technical Reports Server (NTRS)

Rice, Shelley

2017-01-01

This presentation will define the CCB, discuss its functions and members. We will look into traditional processes of managing change control via the CCB meeting and advanced practices utilizing enhanced product tools and technologies. Well step through a summary of the feedback from the community of CM professionals at NASA Goddard Space Flight Center of best practices as well as pros and cons for facilitating both a physical CCB and managing stakeholder approvals in a virtual environment. Attendees will come away with current industry strategies to determine if process for managing change control and approvals can be streamlined within their local work environments.

Blending Western Biomedicine with Local Healing Practices.

PubMed

Chary, Anita; Sargent, Carolyn

2016-07-01

Western allopathic physicians working internationally might encounter allopathic colleagues who endorse local healing practices that are not scientifically supported and, hence, might pose harm to patients. Respect for the autonomy of local physicians and patients thus can conflict with the ethical principles of beneficence and nonmaleficence. In such a situation, it is advisable for Western allopathic physicians to communicate their concerns to local colleagues as equal partners. Making an effort to understand local meanings associated with a traditional therapy demonstrates one's respect for local cultural ideas and practices, even if one disagrees with that therapy, and is crucial to tailoring messages about clinical practice change. A realistic approach to cross-cultural clinical practice change seeks to reduce, rather than eliminate, harm. © 2016 American Medical Association. All Rights Reserved. ISSN 2376-6980.

78 FR 37164 - Revisions to the Air Emissions Reporting Requirements: Revisions to Lead (Pb) Reporting Threshold...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-20

...Today's action proposes changes to the existing EPA emission inventory reporting requirements on state, local, and tribal agencies in the current Air Emissions Reporting Requirements rule published on December 17, 2008. The proposed amendments would lower the current threshold for reporting Pb sources as point sources; eliminate the requirement for reporting emissions from wildfires and prescribed fires; and replace a requirement for reporting mobile source emissions with a requirement for reporting the input parameters that can be used to run the EPA models that generate the emissions estimates. In addition, the proposed amendments would reduce the reporting burden on state, local, and tribal agencies by removing the requirements to report daily and seasonal emissions associated with carbon monoxide (CO), ozone (O3), and particulate matter up to 10 micrometers in size (PM10) nonattainment areas and nitrogen oxides (NOX) State Implementation Plan (SIP) call areas, although reporting requirements for those emissions would remain in other regulations. Lastly, the proposed amendments would clarify, remove, or simplify some current emissions reporting requirements which we believe are not necessary or are not clearly aligned with current inventory terminology and practices.

Guidelines for computer security in general practice.

PubMed

Schattner, Peter; Pleteshner, Catherine; Bhend, Heinz; Brouns, Johan

2007-01-01

As general practice becomes increasingly computerised, data security becomes increasingly important for both patient health and the efficient operation of the practice. To develop guidelines for computer security in general practice based on a literature review, an analysis of available information on current practice and a series of key stakeholder interviews. While the guideline was produced in the context of Australian general practice, we have developed a template that is also relevant for other countries. Current data on computer security measures was sought from Australian divisions of general practice. Semi-structured interviews were conducted with general practitioners (GPs), the medical software industry, senior managers within government responsible for health IT (information technology) initiatives, technical IT experts, divisions of general practice and a member of a health information consumer group. The respondents were asked to assess both the likelihood and the consequences of potential risks in computer security being breached. The study suggested that the most important computer security issues in general practice were: the need for a nominated IT security coordinator; having written IT policies, including a practice disaster recovery plan; controlling access to different levels of electronic data; doing and testing backups; protecting against viruses and other malicious codes; installing firewalls; undertaking routine maintenance of hardware and software; and securing electronic communication, for example via encryption. This information led to the production of computer security guidelines, including a one-page summary checklist, which were subsequently distributed to all GPs in Australia. This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making these guidelines relevant to local contexts should help maximise their uptake.

Effects of local institutional review board review on participation in national practice-based research network studies.

PubMed

Finch, Stacia A; Barkin, Shari L; Wasserman, Richard C; Dhepyasuwan, Niramol; Slora, Eric J; Sege, Robert D

2009-12-01

To describe the process and outcomes of local institutional review board (IRB) review for 2 Pediatric Research in Office Settings (PROS) studies. Pediatric Research in Office Settings conducted 2 national studies concerning sensitive topics: (1) Child Abuse Recognition Experience Study (CARES), an observational study of physician decision making, and (2) Safety Check, a violence prevention intervention trial. Institutional review board approval was secured by investigators' sites, the American Academy of Pediatrics, and practices with local IRBs. Practices were queried about IRB rules at PROS enrollment and study recruitment. Pediatric Research in Office Settings practices in 29 states. Eighty-eight PROS practices (75 IRBs). Main Exposure Local IRB presence. Local IRB presence, level of PROS assistance, IRB process, study participation, data collection completion, and minority enrollment. Practices requiring additional local IRB approval agreed to participate less than those that did not (CARES: 33% vs 52%; Safety Check: 41% vs 56%). Of the 88 practices requiring local IRB approval, 55 received approval, with nearly 50% needing active PROS help, many requiring consent changes (eg, contact name additions, local IRB approval stamps), and 87% beginning data collection. Median days to obtain approval were 81 (CARES) and 109 (Safety Check). Practices requiring local IRB approval were less likely to complete data collection but more likely to enroll minority patients. Local IRB review was associated with lower participation rates, substantial effort navigating the process (with approval universally granted without substantive changes), and data collection delays. When considering future reforms, the national human subject protections system should consider the potential redundancy and effect on generalizability, particularly regarding enrollment of poor urban children, related to local IRB review.

Environmental Harmony and Evaluation of Advertisement Billboards with Digital Photogrammetry Technique and GIS Capabilities: A Case Study in the City of Ankara

PubMed Central

Aydın, Cevdet C.; Nişancı, Recep

2008-01-01

Geographical Information Systems (GIS) have been gaining a growing interest in Turkey. Many local governments and public agencies have been struggling to set up such systems to serve the needs and meet public requirements. Urban life shelters the advertisement reality which is presented at various places, on vehicles, shops etc. in daily life. It can be said that advertisement is a part of daily life in urban area, especially in city centers. In addition, one of the main sources of revenue for municipalities comes from advertising and notices. The advertising sector provides a great level of income today. Therefore advertising is individually very important for local governments and urban management. Although it is valuable for local governments, it is also very important for urban management to place these advertisement signs and billboards in an orderly fashion which is pleasing to the eye. Another point related to this subject is the systematic control mechanism which is necessary for collecting taxes regularly and updating. In this paper, first practical meaning of notice and advertisement subject, problem definition and objectives are described and then legal support and daily practice are revised. Current practice and problems are mentioned. Possibilities of measuring and obtaining necessary information by using digital images and transferring them to spatial databases are studied. By this study, a modern approach was developed for urban management and municipalities by using information technology which is an alternative to current application. Criteria which provide environmental harmony such as urban beauty, colour, compatibility and safety were also evaluated. It was finally concluded that measuring commercial signs and keeping environmental harmony under control for urban beauty can be provided by Digital Photogrammetry (DP) technique and GIS capabilities which were studied with pilot applications in the city center of Ankara. PMID:27879877

Environmental Harmony and Evaluation of Advertisement Billboards with Digital Photogrammetry Technique and GIS Capabilities: A Case Study in the City of Ankara.

PubMed

Aydın, Cevdetx C; Nisancı, Recep

2008-05-19

Geographical Information Systems (GIS) have been gaining a growing interest in Turkey. Many local governments and public agencies have been struggling to set up such systems to serve the needs and meet public requirements. Urban life shelters the advertisement reality which is presented at various places, on vehicles, shops etc. in daily life. It can be said that advertisement is a part of daily life in urban area, especially in city centers. In addition, one of the main sources of revenue for municipalities comes from advertising and notices. The advertising sector provides a great level of income today. Therefore advertising is individually very important for local governments and urban management. Although it is valuable for local governments, it is also very important for urban management to place these advertisement signs and billboards in an orderly fashion which is pleasing to the eye. Another point related to this subject is the systematic control mechanism which is necessary for collecting taxes regularly and updating. In this paper, first practical meaning of notice and advertisement subject, problem definition and objectives are described and then legal support and daily practice are revised. Current practice and problems are mentioned. Possibilities of measuring and obtaining necessary information by using digital images and transferring them to spatial databases are studied. By this study, a modern approach was developed for urban management and municipalities by using information technology which is an alternative to current application. Criteria which provide environmental harmony such as urban beauty, colour, compatibility and safety were also evaluated. It was finally concluded that measuring commercial signs and keeping environmental harmony under control for urban beauty can be provided by Digital Photogrammetry (DP) technique and GIS capabilities which were studied with pilot applications in the city center of Ankara.

The new Waste Law: Challenging opportunity for future landfill operation in Indonesia.

PubMed

Meidiana, Christia; Gamse, Thomas

2011-01-01

The Waste Law No. 18/2008 Article 22 and 44 require the local governments to run environmentally sound landfill. Due to the widespread poor quality of waste management in Indonesia, this study aimed to identify the current situation by evaluating three selected landfills based on the ideal conditions of landfill practices, which are used to appraise the capability of local governments to adapt to the law. The results indicated that the local governments have problems of insufficient budget, inadequate equipment, uncollected waste and unplanned future landfill locations. All of the selected landfills were partially controlled landfills with open dumping practices predominating. In such inferior conditions the implementation of sanitary landfill is not necessarily appropriate. The controlled landfill is a more appropriate solution as it offers lower investment and operational costs, makes the selection of a new landfill site unnecessary and can operate with a minimum standard of infrastructure and equipment. The sustainability of future landfill capacity can be maintained by utilizing the old landfill as a profit-oriented landfill by implementing a landfill gas management or a clean development mechanism project. A collection fee system using the pay-as-you-throw principle could increase the waste income thereby financing municipal solid waste management.

Community health information sources--a survey in three disparate communities.

PubMed

Dart, Jared; Gallois, Cindy; Yellowlees, Peter

2008-02-01

To determine the current utilisation, importance, trust and future preference for contemporary sources of health information in three different socioeconomic groups. A pilot study including key informant interviews and direct observation was conducted in a low socioeconomic community. From this work a survey questionnaire was designed and implemented across three different communities. Semi-structured key informant interviews and focus groups capturing 52 respondents. Paper-based surveys were left in community organisations and local health practices in a low socioeconomic (LSE) community on the outskirts of Ipswich, Queensland, a mid-high socioeconomic (MSE) community in the western suburbs of Brisbane, and at a local university. Rank of current and preferred future sources of health information, importance and trustworthiness of health information sources. Across all three communities the local doctor was the most currently used, important, trusted and preferred future source of health information. The most striking difference between the three communities related to the current use and preferred future use of the internet. The internet was a more currently used source of health information and more important source in the university population than the LSE or MSE populations. It was also a less preferred source of future health information in the LSE population than the MSE or university populations. Importantly, currently used sources of health information did not reflect community members' preferred sources of health information. People in different socioeconomic communities obtain health information from various sources. This may reflect access issues, education and awareness of the internet as a source of health information, less health information seeking as well as a reluctance by the e-health community to address the specific needs of this group.

Factors affecting implementation of an evidence-based practice in the Veterans Health Administration: Illness management and recovery.

PubMed

McGuire, Alan B; Salyers, Michelle P; White, Dominique A; Gilbride, Daniel J; White, Laura M; Kean, Jacob; Kukla, Marina

2015-12-01

Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation. Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion. Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time. IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation. (c) 2015 APA, all rights reserved).

Local, national, and service component cost variations in the management of low back pain: Considerations for the clinician.

PubMed

Babu, Ashwin N; McCormick, Zachary; Kennedy, David J; Press, Joel

2016-11-21

In the past two decades, the cost associated with managing low back pain has increased significantly. Improved consciousness of how clinicians utilize resources when managing low back pain is necessary in the current economic climate. The goal of this review is to examine the component costs associated with managing low back pain and provide practical solutions for reducing healthcare costs. This is accomplished by utilizing examples from a major metropolitan area with several major academic institutions and private health care centers. It is clear that there is considerable local and national variation in the component costs of managing low back pain, including physician visits, imaging studies, medications, and therapy services. By being well informed about these variations in one's environment, clinicians and patients alike can make strides towards reducing the financial impact of low back pain. Investigation of the cost discrepancies for services within one's community of practice is important. Improved public access to both cost and outcomes data is needed.

Contemporary evidence-based practice in Canadian emergency medical services: a vision for integrating evidence into clinical and policy decision-making.

PubMed

Jensen, Jan L; Travers, Andrew H

2017-05-01

Nationally, emphasis on the importance of evidence-based practice (EBP) in emergency medicine and emergency medical services (EMS) has continuously increased. However, meaningful incorporation of effective and sustainable EBP into clinical and administrative decision-making remains a challenge. We propose a vision for EBP in EMS: Canadian EMS clinicians and leaders will understand and use the best available evidence for clinical and administrative decision-making, to improve patient health outcomes, the capability and quality of EMS systems of care, and safety of patients and EMS professionals. This vision can be implemented with the use of a structure, process, system, and outcome taxonomy to identify current barriers to true EBP, to recognize the opportunities that exist, and propose corresponding recommended strategies for local EMS agencies and at the national level. Framing local and national discussions with this approach will be useful for developing a cohesive and collaborative Canadian EBP strategy.

Study of the zinc-silver oxide battery system

NASA Technical Reports Server (NTRS)

Nanis, L.

1973-01-01

Theoretical and experimental models for the evaluation of current distribution in flooded, porous electrodes are discussed. An approximation for the local current distribution function was derived for conditions of a linear overpotential, a uniform concentration, and a very conductive matrix. By considering the porous electrode to be an analog of chemical catalyst structures, a dimensionless performance parameter was derived from the approximated current distribution function. In this manner the electrode behavior was characterized in terms of an electrochemical Thiele parameter and an effectiveness factor. It was shown that the electrochemical engineering approach makes possible the organizations of theoretical descriptions and of practical experience in the form of dimensionless parameters, such as the electrochemical Thiele parameters, and hence provides useful information for the design of new electrochemical systems.

The epidemic of HIV/AIDS in developing countries; the current scenario in Pakistan.

PubMed

Yousaf, Muhammad Z; Zia, Sadia; Babar, Masroor E; Ashfaq, Usman A

2011-08-12

HIV (Human Immunodeficiency virus) causes (acquired immunodeficiency syndrome) AIDS, in which the immune system of body totally fails to develop any defense against the foreign invaders. Infection with HIV occurs by transfer of blood, semen, and breast milk. HIV/AIDS is a global problem and it results nearly 25 million deaths worldwide. Developing countries like Pakistan have issues regarding Public Health. Currently, epidemic of HIV/AIDS is established in Pakistan and there is a threat of an expanded HIV/AIDS outbreak in the country. The major reason is that population is engaging in high-risk practices, low awareness about HIV/AIDS, and treacherous blood transfusion practices. A supplementary threat to Pakistan is India because both sharing a border and India is facing a rapidly growing HIV/AIDS epidemic. Local NGOs, National and International organizations are warning that in near future Pakistan may experiences bad situation regarding HIV/AIDS.In the present article we focused current situation of surveillance of HIV/AIDS, its virology, genotype, diagnostics, high-risk groups, reasons of vulnerability in Pakistani population, and the role of different national and international organizations in this situation.

From theory to practice: what drives the core business of public health?

PubMed

Smith, Tina Anderson; Minyard, Karen J; Parker, Christopher A; Van Valkenburg, Rachel Ferencik; Shoemaker, John A

2007-01-01

In 1994, the Public Health Functions Steering Committee proffered a description of the Essential Public Health Services (Essential Services). Questions remain, however, about the relationship between the roles defined therein and current public health practice at state and local levels. This case study describes the core business of public health in Georgia relative to the theoretical ideal and elucidates the primary drivers of the core business, thus providing data to inform future efforts to strengthen practice in the state. The principal finding was that public health in Georgia is not aligned with the Essential Services. Further analysis revealed that the primary drivers or determinants of public health practice are finance-related rather than based in need or strategy, precluding an integrated and intentional focus on health improvement. This case study provides a systems context for public health financing discussions, suggests leverage points for public health system change, and furthers the examination of applications for systems thinking relative to public health finance, practice, and policy.

Singapore Neonatal Resuscitation Guidelines 2016

PubMed Central

Yeo, Cheo Lian; Biswas, Agnihotri; Ee, Teong Tai Kenny; Chinnadurai, Amutha; Baral, Vijayendra Ranjan; Chang, Alvin Shang Ming; Ereno, Imelda Lustestica; Ho, Kah Ying Selina; Poon, Woei Bing; Shah, Varsha Atul; Quek, Bin Huey

2017-01-01

We present the revised Neonatal Resuscitation Guidelines for Singapore. The 2015 International Liaison Committee on Resuscitation Neonatal Task Force’s consensus on science and treatment recommendations (2015), and guidelines from the American Heart Association and European Resuscitation Council were debated and discussed. The final recommendations of the National Resuscitation Council, Singapore, were derived after the task force had carefully reviewed the current available evidence in the literature and addressed their relevance to local clinical practice. PMID:28741001

Pavement condition assessment to forecast maintenance program on JKR state roads in Petaling district

NASA Astrophysics Data System (ADS)

Hamsan, R.; Hafiz, H.; Azlan, A.; Keprawi, M. F.; Malik, A. K. A.; Adamuddin, A.; Abdullah, A. H.; Shafie, A. M.

2018-02-01

This research allows local authorities to project road maintenance in term of activities and financial expenditure through pavement condition assessment and then Highway Development and Management (HDM-4) analysis. Current form of road maintenance carried out by local authority is on reactive manner where corrective actions were taken based on reports recorded. Some went unrecorded hence causing prolonged damages. This causes the local authority unable to project the required cost to maintain the roads. This affects the socio-economy of the surrounding routes. Hence, it is seen, as preventive maintenance of the roads will provide more feasible option in term of work force and finance to the local authority. To overcome this issue, a preventive model was introduced. This was done through pavement condition assessment (PCA) where analysis was done through HDM-4. Nondestructive test and destructive test were conducted in order to provide an indicator to the road's health. This were then analyzed in HDM-4 where the result was benchmarked with maintenance standard. The scope of this research is set to PCA where DT and NDT were performed on the routes of Petaling and the output is analyzed in HDM-4. The result of this research provides a 10 years forecast maintenance budget in maintaining the roads in Petaling. This allows the local authority to perform good practice in term of maintaining the roads while at the same time helps them in forecasting their budget for the upcoming years. This research will have a strong impact on the local socio-economy as well as local road user confidence towards the authority over good practices. This research can be further expanded to other type of roads as well as highway bridges.

Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa - a qualitative study.

PubMed

Muhwava, Lorrein Shamiso; Murphy, Katherine; Zarowsky, Christina; Levitt, Naomi

2018-05-10

Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders' perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant's first year of life. Following a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa's two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures. The document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers. Although there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided.

Climate warming alters effects of management on population viability of threatened species: results from a 30-year experimental study on a rare orchid.

PubMed

Sletvold, Nina; Dahlgren, Johan P; Oien, Dag-Inge; Moen, Asbjørn; Ehrlén, Johan

2013-09-01

Climate change is expected to influence the viability of populations both directly and indirectly, via species interactions. The effects of large-scale climate change are also likely to interact with local habitat conditions. Management actions designed to preserve threatened species therefore need to adapt both to the prevailing climate and local conditions. Yet, few studies have separated the direct and indirect effects of climatic variables on the viability of local populations and discussed the implications for optimal management. We used 30 years of demographic data to estimate the simultaneous effects of management practice and among-year variation in four climatic variables on individual survival, growth and fecundity in one coastal and one inland population of the perennial orchid Dactylorhiza lapponica in Norway. Current management, mowing, is expected to reduce competitive interactions. Statistical models of how climate and management practice influenced vital rates were incorporated into matrix population models to quantify effects on population growth rate. Effects of climate differed between mown and control plots in both populations. In particular, population growth rate increased more strongly with summer temperature in mown plots than in control plots. Population growth rate declined with spring temperature in the inland population, and with precipitation in the coastal population, and the decline was stronger in control plots in both populations. These results illustrate that both direct and indirect effects of climate change are important for population viability and that net effects depend both on local abiotic conditions and on biotic conditions in terms of management practice and intensity of competition. The results also show that effects of management practices influencing competitive interactions can strongly depend on climatic factors. We conclude that interactions between climate and management should be considered to reliably predict future population viability and optimize conservation actions. © 2013 John Wiley & Sons Ltd.

Anthropology, knowledge-flows and global health.

PubMed

Feierman, S; Kleinman, A; Stewart, K; Farmer, D; Das, V

2010-01-01

Global health programmes are damaged by blockages in the upward flow of information from localities and regional centres about realities of professional practice and about patients' lives and conditions of treatment. Power differentials between local actors and national or international decision-makers present further obstacles to effective action. Anthropological research and action, in its most effective current forms, make important contributions to these issues. This research often continues over the long term, intensively. It can be multi-sited, studying actors at local, national and international levels simultaneously. It studies the relative knowledge and power of impoverished patients and global decision-makers, all within a single frame. By doing so, anthropological research is capable of providing new and important insights on the diverse meanings of patient decision-making, informed consent, non-compliance, public health reporting, the building of political coalitions for health and many other issues.

Current practices of organ donation and transplantation among different French-speaking countries and regions.

PubMed

Squifflet, J P; Barrou, B; Rifle, G

2011-11-01

The aim of the "Transplantation Sans Frontières" (TSF) questionnaire, which was sent to French-speaking centers in 6 different countries and regions, was to establish the current status of organ donation and transplantation in their environments. It was also to examine ways to collaborate and exchange scientific information, teaching, and training in the field of organ transplantation. The French Society of Transplantation and the Agency of Biomedicine already offer specific programs to expand local activities, and the World Health Organization (WHO) regulates them. Therefore, TSF could be a coordinating platform in the near future. Copyright © 2011. Published by Elsevier Inc.

Matriarchy, Buddhism, and food security in Sanephong, Thailand.

PubMed

Sirisai, Solot; Chotiboriboon, Sinee; Sapsuwan, Charana; Tantivatanasathien, Praiwan; Setapun, Nuchjaree; Duangnosan, Prangtong; Thongkam, Nattapach; Chuangyanyong, Sasiwimon

2017-11-01

Sanephong is a matriarchal Karen community located in western Thailand. The community benefits greatly from the availability of local foods, such as cereals, tubers, wild vegetables, mushrooms, fruits, and animals. In the first phase of this project, 387 distinct local foods were identified, which were shown to be good sources of energy, protein, and vitamins. Despite the availability of a variety of nutritious local foods, the majority of households surveyed expressed concern over a decline in local foods due to changing socio-economic and environmental conditions. This study used a qualitative research approach to look at the dual influences of matriarchy and Buddhism on food security in the community. Through this approach, matriarchal values central to the community were adopted as a framework; these included care, consensus, collaboration, and cosmological respect. In Sanephong, women are central to life in the community, and matriarchal cultural practices reflect a nurturing spirit-for both the earth and family. The community practices Buddhism, which is very complementary to the matriarchal system. A type of gift economy within the Buddhist context, known as dhana, transfers food from the wealthy to the poor with no expectation of reciprocity. Consequently, matriarchy and Buddhism jointly promote food security in the community. Studies of matriarchal societies help society-at-large to understand the potential benefits of systems that contrast the current patriarchal paradigm. © 2018 John Wiley & Sons Ltd.

States of Cybersecurity: Electricity Distribution System Discussions

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

Pena, Ivonne; Ingram, Michael; Martin, Maurice

State and local entities that oversee the reliable, affordable provision of electricity are faced with growing and evolving threats from cybersecurity risks to our nation's electricity distribution system. All-hazards system resilience is a shared responsibility among electric utilities and their regulators or policy-setting boards of directors. Cybersecurity presents new challenges and should be a focus for states, local governments, and Native American tribes that are developing energy-assurance plans to protect critical infrastructure. This research sought to investigate the implementation of governance and policy at the distribution utility level that facilitates cybersecurity preparedness to inform the U.S. Department of Energy (DOE),more » Office of Energy Policy and Systems Analysis; states; local governments; and other stakeholders on the challenges, gaps, and opportunities that may exist for future analysis. The need is urgent to identify the challenges and inconsistencies in how cybersecurity practices are being applied across the United States to inform the development of best practices, mitigations, and future research and development investments in securing the electricity infrastructure. By examining the current practices and applications of cybersecurity preparedness, this report seeks to identify the challenges and persistent gaps between policy and execution and reflect the underlying motivations of distinct utility structures as they play out at the local level. This study aims to create an initial baseline of cybersecurity preparedness within the distribution electricity sector. The focus of this study is on distribution utilities not bound by the cybersecurity guidelines of the North American Electric Reliability Corporation (NERC) to examine the range of mechanisms taken by state regulators, city councils that own municipal utilities, and boards of directors of rural cooperatives.« less

The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies.

PubMed

Dhaliwal, Rupinder; Cahill, Naomi; Lemieux, Margot; Heyland, Daren K

2014-02-01

Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances, and are designed to minimize practice variation, improve costs, and improve clinical outcomes. The Canadian Critical Care Practice Guidelines (CCPGs) were first published in 2003 and most recently updated in 2013. A total of 68 new randomized controlled trials were identified since the last version in 2009, 50 of them published between 2009 and 2013. The remaining articles were trials published before 2009 but were not identified in previous iterations of the CCPGs. For clinical practice guidelines to be useful to practitioners, they need to be up-to-date and be reflective of the current body of evidence. Herein we describe the process by which the CCPGs were updated. This process resulted in 10 new sections or clinical topics. Of the old clinical topics, 3 recommendations were upgraded, 4 were downgraded, and 27 remained the same. To influence decision making at the bedside, these updated guidelines need to be accompanied by active guideline implementation strategies. Optimal implementation strategies should be guided by local contextual factors including barriers and facilitators to best practice recommendations. Moreover, evaluating and monitoring performance, such as participating in the International Nutrition Survey of practice, should be part of any intensive care unit's performance improvement strategy. The active implementation of the updated CCPGs may lead to better nutrition care and improved patient outcomes in the critical care setting.

Experience of Using Information Systems in Public Health Practice: Findings from a Qualitative Study

PubMed Central

Vest, Joshua R; Issel, L. Michele; Lee, Sean

2014-01-01

Objective Data collection and management by local health departments (LHDs) is a complex endeavor, complicated by system level and organizational factors. The purpose of this study was to describe the processes and use of information systems (IS) utilized for data collection, management, and sharing by LHD employees. Methods We interviewed a purposive sample of 12 staff working in the key public health practice areas of communicable disease control, immunizations, and vital records from three LHDs in different states. Our interview questions addressed job descriptions, daily activities, and the use and perceptions of both data and IS in support of their work. A content analytic approach was used to derive themes and categories common across programmatic areas. Results Local public health involves the use of mix of state-supplied and locally implemented IS supported by paper records. Additionally, each LHD in this study used at least one shadow system to maintain a duplicate set of information. Experiences with IS functionality and the extent to which it supported work varied by programmatic area, but inefficiencies, challenges in generating reports, limited data accessibility, and workarounds were commonly reported. Conclusions Current approaches to data management and sharing do not always support efficient public health practice or allow data to be used for organizational and community decision making. Many of the challenges to effective and efficient public health work were not solely technological. These findings suggest the need for interorganizational collaboration, increasing organizational capacity, workflow redesign, and end user training. PMID:24678380

The gap between currently available evidence and awareness in clinical practice of wound care: It is the time to shower earlier.

PubMed

Yu, Ya-Hsuan; Chao, Sylvia; Lin, Yen-Kuang; Chou, Yun-Yun; Liao, Hsun-Hsiang; Loh, El-Wui; Wong, Chung-Shun; Tam, Ka-Wai

2018-03-01

A postoperative water-forbidden strategy has been used for many decades. However, evidence shows that early contact with water postoperatively does not increase the infection rate. Our study evaluated the gap between currently available evidence and awareness in clinical practice of postoperative wound care. We conducted a systematic review to compare the outcomes between postoperative water-contact and water-forbidden groups. PubMed, EMBASE, and Cochrane databases were searched. A meta-analysis was conducted to calculate a pooled effect size by using random-effects models. On the basis of pooling results, a questionnaire survey was conducted to evaluate the gap from systematic review to clinical practice by clinical staff and patients. We reviewed 12 trials including 4,086 patients. Incidence of infection and wound complications did not differ significantly between water-contact and water-forbidden groups. Satisfaction was significantly higher in water-contact group than in water-forbidden group (risk ratio: 17.33; 95% confidence interval, 11.11-27.03). A survey of clinicians showed that awareness, acceptance of the evidence, and the current water-contact strategy differed among departments. However, many clinicians showed no willingness to apply the water-contact strategy for various reasons. A survey of patients showed low awareness of the issue and variety in willingness to contact water. Water-forbidden strategy causes inconvenience to patients. However, a majority of patients and clinicians still hesitated to apply the early water-contact strategy, even after viewing the results of the current review. Establishment of local clinical practice guidelines, advocacy from authorities, and promotion by social media for this strategy are warranted. Copyright © 2018 Elsevier Inc. All rights reserved.

Workshop V: Cultural Perception and Bias/Science Practice and Ethics

NASA Astrophysics Data System (ADS)

Chuan, Kwek Leong; Lin, Jauyn Grace; Pierron-Bohnes, Veronique; Dawson, Silvina Ponce

2015-12-01

Despite the objectivity of science, the local work environment affects the daily activities of scientists. Differences in cultural perception can affect female scientists in the workplace directly. The pressure currently exerted on researchers, on the other hand, is altering how science is practiced and seems to affect women and men differently. In this paper we summarize the discussions that took place on this topic in Workshop V of the 5th IUPAP International Conference on Women in Physics. We present some of the results of the 2010 Global Survey of Physicists analyzed by region and data from France and Taiwan. We also include the recommendations that were formulated at the end of the workshop.

The BLISS cluster randomised controlled trial of the effect of 'active dissemination of information' on standards of care for premature babies in England (BEADI) study protocol [ISRCTN89683698].

PubMed

Acolet, Dominique; Jelphs, Kim; Davidson, Deborah; Peck, Edward; Clemens, Felicity; Houston, Rosie; Weindling, Michael; Lavis, John; Elbourne, Diana

2007-10-08

Gaps between research knowledge and practice have been consistently reported. Traditional ways of communicating information have limited impact on practice changes. Strategies to disseminate information need to be more interactive and based on techniques reported in systematic reviews of implementation of changes. There is a need for clarification as to which dissemination strategies work best to translate evidence into practice in neonatal units across England. The objective of this trial is to assess whether an innovative active strategy for the dissemination of neonatal research findings, recommendations, and national neonatal guidelines is more likely to lead to changes in policy and practice than the traditional (more passive) forms of dissemination in England. Cluster randomised controlled trial of all neonatal units in England (randomised by hospital, n = 182 and stratified by neonatal regional networks and neonatal units level of care) to assess the relative effectiveness of active dissemination strategies on changes in local policies and practices. Participants will be mainly consultant lead clinicians in each unit. The intervention will be multifaceted using: audit and feedback; educational meetings for local staff (evidence-based lectures on selected topics, interactive workshop to examine current practice and draw up plans for change); and quality improvement and organisational changes methods. Policies and practice outcomes for the babies involved will be collected before and after the intervention. Outcomes will assess all premature babies born in England during a three month period for timing of surfactant administration at birth, temperature control at birth, and resuscitation team (qualification and numbers) present at birth.

Using economic analyses for local priority setting : the population cost-impact approach.

PubMed

Heller, Richard F; Gemmell, Islay; Wilson, Edward C F; Fordham, Richard; Smith, Richard D

2006-01-01

Standard methods of economic analysis may not be suitable for local decision making that is specific to a particular population. We describe a new three-step methodology, termed 'population cost-impact analysis', which provides a population perspective to the costs and benefits of alternative interventions. The first two steps involve calculating the population impact and the costs of the proposed interventions relevant to local conditions. This involves the calculation of population impact measures (which have been previously described but are not currently used extensively) - measures of absolute risk and risk reduction, applied to a population denominator. In step three, preferences of policy-makers are obtained. This is in contrast to the QALY approach in which quality weights are obtained as a part of the measurement of benefit. We applied the population cost-impact analysis method to a comparison of two interventions - increasing the use of beta-adrenoceptor antagonists (beta-blockers) and smoking cessation - after myocardial infarction in a scaled-back notional local population of 100,000 people in England. Twenty-two public health professionals were asked via a questionnaire to rank the order in which they would implement four interventions. They were given information on both population cost impact and QALYs for each intervention. In a population of 100,000 people, moving from current to best practice for beta-adrenoceptor antagonists and smoking cessation will prevent 11 and 4 deaths (or gain of 127 or 42 life-years), respectively. The cost per event prevented in the next year, or life-year gained, is less for beta-adrenoceptor antagonists than for smoking cessation. Public health professionals were found to be more inclined to rank alternative interventions according to the population cost impact than the QALY approach. The use of the population cost-impact approach allows information on the benefits of moving from current to best practice to be presented in terms of the benefits and costs to a particular population. The process for deciding between alternative interventions in a prioritisation exercise may differ according to the local context. We suggest that the valuation of the benefit is performed after the benefits have been quantified and that it takes into account local issues relevant to prioritisation. It would be an appropriate next step to experiment with, and formalise, this part of the population cost-impact analysis to provide a standardised approach for determining willingness to pay and provide a ranking of priorities. Our method adds a new dimension to economic analysis, the ability to identify costs and benefits of potential interventions to a defined population, which may be of considerable use for policy makers working at the local level.

Identifying, monitoring and implementing "sustainable" agricultural practices for smallholder farmers over large geographic areas in India and Vietnam

NASA Astrophysics Data System (ADS)

Kritee, K.; Ahuja, R.; Nair, D.; Esteves, T.; Rudek, J.; Thu Ha, T.

2015-12-01

Industrial agriculture systems, mostly in developed and some emerging economies, are far different from the small-holder farms (size <1 acre) in Asia and Africa. Along with our partners from non-governmental, corporate, academic and government sectors and tens of thousands of farming families, we have worked actively in five states in India and two provinces in Vietnam for the last five years to understand how sustainable and climate smart farming practices can be monitored at small-holder farms. Here, any approach to monitor farming must begin by accounting for the tremendous management variability from farm to farm and also the current inability to ground-truth remote sensing data due to lack of relaible basic parameters (e.g., yields, N use, farm boundaries) which are necessary for calibrating empirical/biogeochemical models. While we continue to learn from new research, we have found that it is crucial to follow some steps if sustainable farming programs are to succeed at small-holder farms Demographic data collection and GPS plot demarcation to establish farm size and ownership Baseline nutrient, water & energy use and crop yield determination via surveys and self-reporting which are verifiable through farmer networks given the importance of peer to peer learning in the dissemination of new techniques in such landscapes "Sustainable" practice determination in consultation with local universities/NGO experts Measurements on representative plots for 3-4 years to help calibrate biogeochemical models and/or empirical equations and establish which practices are truly "sustainable" (e.g., GHG emission reduction varies from 0-7 tCO2e/acre for different sustainable practices). Propagation of sustainable practices across the landscape via local NGOs/governments after analyzing the replicability of identified farming practices in the light of local financial, cultural or socio-political barriers. We will present results from representative plots (including soil and weather parameters, GHG emissions, yields, inputs, economic and environmental savings), farmer surveys and diary data; and discuss our key conclusions based on our approach and the analysis of the collected data which was enabled by use of a commercially available comprehensive agricultural data collection software.

Treatment of Lipoma by Injection Lipolysis

PubMed Central

Nanda, Soni

2011-01-01

Injection lipolysis or lipodissolve is the practice of injecting phosphatidyl choline/ sodium deoxycholate (PDC/DC) compounds in the subcutaneous fat. Though this practice is being used extensively for nonsurgical contouring of body and dissolving localized collections of excess fat, it's use as a treatment modality for lipomas needs further evaluation. We present a case where this technique was used for treating a lipoma, with no recurrence after 9 months of follow up. Injection lipolysis as a treatment modality for lipomas needs to be evaluated for safety and efficacy in trials on larger population. This could prove to be a very valuable adjunct to the current practice of excision, if done by a trained person in a properly selected patient. Also the side effects and the controversies regarding this procedure have been discussed in detail in the present paper. PMID:21976907

Collaboration of general practitioners and exercise providers in promotion of physical activity a written survey among general practitioners.

PubMed

Leemrijse, C J; de Bakker, D H; Ooms, L; Veenhof, C

2015-08-06

General practitioners have an ideal position to motivate inactive patients to increase their physical activity. Most patients are able to exercise in regular local facilities outside the health care setting. The purpose of this study was to get insight into general practitioners perceptions and current practices regarding referral of patients to local exercise facilities. Furthermore, collaboration with exercise providers in the community was investigated, and motivators and barriers for referral. A written questionnaire sent to a representative random sample of 800 Dutch general practitioners. Descriptive statistics and Chi(2) tests were used. All responding general practitioners (340) recommend their patients to take more exercise when necessary and 87 % say to refer patients sometimes. Limited motivation of the patient (44 %) and reduced health status (34 %) are the most mentioned barriers for advising patients to increase physical activity. When referred, most patients are send to a physical therapist (69 %) but also local exercise facilities were mentioned (54 %). The most important barrier for referring patients to local exercise activities are patients limited financial possibilities (46 %). Restricted knowledge of local exercise- or sport facilities was an additional barrier (19 %). There is little structural collaboration between general practitioners and exercise providers, but when collaboration exists general practitioners refer more often. Positive experiences of patients (67 %), affordable offers (59 %) and information of local exercise facilities (46 %) are seen as important promoting factors for referral. Although 32 % of the general practitioners think that good collaboration would be stimulating, regular meetings with sports and exercise providers were considered the least important for increasing referral (3 %). Dutch physicians have a positive attitude towards stimulating physical activity but referral to local exercise facilities is low. Referral is partly hindered by restricted knowledge of local exercise facilities. Although general practitioners think that collaboration is important for physical activity promotion, it should not cost them much extra time. A coordinator with knowledge of the local situation can facilitate contacts between GP practices and sports providers.

Minimally invasive surgery fellowship graduates: Their demographics, practice patterns, and contributions.

PubMed

Park, Adrian E; Sutton, Erica R H; Heniford, B Todd

2015-12-01

Fellowship opportunities in minimally invasive surgery, bariatric, gastrointestinal, and hepatobiliary arose to address unmet training needs. The large cohort of non-Accreditation Council for Graduate Medical Education -accredited fellowship graduates (NACGMEG) has been difficult to track. In this, the largest survey of graduates to date, our goal was to characterize this unique group's demographics and professional activities. A total of 580 NACGMEG were surveyed covering 150 data points: demographics, practice patterns, academics, lifestyle, leadership, and maintenance of certification. Of 580 previous fellows, 234 responded. Demographics included: average age 37 years, 84% male, 75% in urban settings, 49% in purely academic practice, and 58% in practice <5 years. They averaged 337 operating room cases/year (approximately 400/year for private practice vs 300/year for academic). NACGMEG averaged 100 flexible endoscopies/year (61 esophagogastroduodenoscopies, 39 colon). In the past 24 months, 60% had submitted abstracts to a national meeting, and 54% submitted manuscripts to peer-reviewed journals. Subset analyses revealed relevant relationships. There was high satisfaction (98%) that their fellowship experience met expectations; 78% termed their fellowships, versus 50% for residencies, highly pertinent to their current practices. 63% of previous fellows occupy local leadership roles, and most engage in maintenance of certification activities. Fellowship alumnae appear to be productive contributors to American surgery. They are clinically and academically active, believe endoscopy is important, have adopted continuous learning, and most assume work leadership roles. The majority acknowledge their fellowship training as having met expectations and uniquely equipping them for their current practice. Copyright © 2015 Elsevier Inc. All rights reserved.

Update on ropivacaine.

PubMed

Wang, R D; Dangler, L A; Greengrass, R A

2001-12-01

Long-acting local anaesthetics are primarily used in the practice of anaesthesia, particularly in regional anaesthesia and analgesia. Ropivacaine is a new long-acting local anaesthetic that has been the focus of interest because of its increased cardiovascular safety compared with bupivacaine. Other advantages of ropivacaine over bupivacaine include a greater sensorimotor differential block and shorter elimination half-life (t(1/2)), with a lower potential for accumulation. The most important attribute of ropivacaine, however, is its increased margin of safety compared with bupivacaine when given in equal doses. Many post-marketing studies have focused on the comparisons of efficacy in blocks and toxicity profiles of bupivacaine versus ropivacaine. Recent animal toxicity studies confirm the results of original studies showing that ropivacaine has less cardiovascular toxicity than bupivacaine with respect to direct myocardial depression, success of resuscitation and arrhythmogenic potential when given in equal doses. Reduced cardiotoxicity may be a distinct characteristic of ropivacaine. A review of current literature suggests that, at clinically relevant doses, ropivacaine provides the lowest potential risk of cardiotoxicity for inadvertent intravascular injection. Studies are currently under way comparing ropivacaine with levobupivacaine, the latest addition to the group of long-acting local anaesthetics.

Addressing education of speech-language pathologists in the World Report on Disability: development of a speech-language pathology program in Malaysia.

PubMed

Ahmad, Kartini; Ibrahim, Hasherah; Othman, Basyariatul Fathi; Vong, Etain

2013-02-01

The current paper is a response to the Wiley, McAllister, Davidson, and Marshall lead article regarding the application of the World Report on Disability (WRD) to people with communication disorders. The current paper directly addresses recommendation 5 (improvement of human resource capacity) and indirectly addresses recommendations 7, 8, and 9 (related to improving local knowledge and data on communicative disabilities) indirectly. The paper describes Malaysia's initiatives in the early 1990s, in developing its local professional capacity to provide services for people with communication disorders (PWCD). It charts the history of development of a local undergraduate entry-level degree program for speech-language pathology (SLP) from the point of conceptualization to full execution. The article provides glimpses to the processes and challenges faced by Universiti Kebangsaan Malaysia as the pioneer university in the South East Asia region to undertake the training and education of the SLP profession and highlights relevant issues faced by newly introduced professions in a country where resources and practice traditions were previously unavailable. It underscores the important role played by government institutions and an international professional network in driving forward-looking policies to implement and sustain the program.

Living kidney donation and masked nationalism in Israel.

PubMed

Epstein, Miran

2017-01-01

This paper draws attention to a current trend of masked conditional-nationalist living kidney donation in Israel, to which the local transplant system has been turning a blind eye. The paper seeks to make the international transplant and bioethics communities aware of this disturbing trend. It also explains why it is wrong and suggests how to tackle it. Finally, it calls on the Israeli system to bring the practice to a halt for the benefit of all parties involved.

Getting It Right the First Time: Defining Regionally Relevant Training Curricula and Provider Core Competencies for Point-of-Care Ultrasound Education on the African Continent.

PubMed

Salmon, Margaret; Landes, Megan; Hunchak, Cheryl; Paluku, Justin; Malemo Kalisya, Luc; Salmon, Christian; Muller, Mundenga Mutendi; Wachira, Benjamin; Mangan, James; Chhaganlal, Kajal; Kalanzi, Joseph; Azazh, Aklilu; Berman, Sara; Zied, El-Sayed; Lamprecht, Hein

2017-02-01

Significant evidence identifies point-of-care ultrasound (PoCUS) as an important diagnostic and therapeutic tool in resource-limited settings. Despite this evidence, local health care providers on the African continent continue to have limited access to and use of ultrasound, even in potentially high-impact fields such as obstetrics and trauma. Dedicated postgraduate emergency medicine residency training programs now exist in 8 countries, yet no current consensus exists in regard to core PoCUS competencies. The current practice of transferring resource-rich PoCUS curricula and delivery methods to resource-limited health systems fails to acknowledge the unique challenges, needs, and disease burdens of recipient systems. As emergency medicine leaders from 8 African countries, we introduce a practical algorithmic approach, based on the local epidemiology and resource constraints, to curriculum development and implementation. We describe an organizational structure composed of nexus learning centers for PoCUS learners and champions on the continent to keep credentialing rigorous and standardized. Finally, we put forth 5 key strategic considerations: to link training programs to hospital systems, to prioritize longitudinal learning models, to share resources to promote health equity, to maximize access, and to develop a regional consensus on training standards and credentialing. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Aspirin desensitization in patients undergoing percutaneous coronary intervention: a survey of current practice.

PubMed

Chapman, Andrew R; Rushworth, Gordon F; Leslie, Stephen J

2013-01-01

Aspirin remains the mainstay of anti-platelet therapy in cardiac patients. However, if a patient is allergic to aspirin and dual anti-platelet therapy is indicated - such as with percutaneous coronary intervention (PCI), then there is no clear guidance. One possibility is aspirin desensitization. A variety of protocols exist for the rapid desensitization of patients with aspirin allergy. The aim of this survey was to assess current knowledge and practice regarding aspirin desensitization in the UK. We conducted a UK wide survey of all UK 116 PCI centers and obtained complete responses from 40 (35.4%) centers. Of these, just 7 (17.5%) centers had previously desensitised patients; 29 (87.9%) centers suggested a lack of a local protocol prevented them from desensitizing, with 10 (30.3%) unsure of how to conduct desensitization. Only 5 (12.5%) centers had a local policy for aspirin desensitization although 25 (64.1%) units had a clinical strategy for dealing with aspirin allergy; the majority (72%) giving higher doses of thienopyridine class drugs. In the UK, there appears to be no consistent approach to patients with aspirin allergy. Patients undergoing PCI benefit from dual anti-platelet therapy (including aspirin), and aspirin desensitization in those with known allergy may facilitate this. Sustained effort should be placed on encouraging UK centers to use desensitization as a treatment modality prior to PCI rather than avoiding aspirin altogether.

Is it working? A look at the changing nutrient practices in Oregon's Southern Willamette Valley Groundwater Management Area

NASA Astrophysics Data System (ADS)

Pearlstein, S.; Compton, J.; Eldridge, A.; Henning, A.; Selker, J. S.; Brooks, J. R.; Schmitz, D.

2016-12-01

Groundwater nitrate contamination affects thousands of households in the southern Willamette Valley and many more across the Pacific Northwest. The southern Willamette Valley Groundwater Management Area (SWV GWMA) was established in 2004 due to nitrate levels in the groundwater exceeding the human health standard of 10 mg nitrate-N L-1. Much of the nitrogen inputs to the GWMA comes from agricultural nitrogen use, and thus efforts to reduce N inputs to groundwater are focused upon improving N management. Previous work in the 1990s in the Willamette Valley by researchers at Oregon State University determined the importance of cover crops and irrigation practices and made recommendations to the local farm community for reducing nitrogen (N) leaching. We are currently re-sampling many of the same fields studied by OSU to examine the influence of current crops and nutrient management practices on nitrate leaching below the rooting zone. This study represents important crops currently grown in the GWMA and includes four grass fields, three vegetable row-crop fields, two peppermint and wheat fields, and one each of hazelnuts and blueberries. New nutrient management practices include slow release fertilizers and precision agriculture approaches in some of the fields. Results from the first two years of sampling show nitrate leaching is lower in some crops like row crops grown for seed and higher in others like perennial rye grass seed when compared to the 1990s data. We will use field-level N input-output balances in order to determine the N use efficiency and compare this across crops and over time. The goal of this project is to provide information and tools that will help farmers, managers and conservation groups quantify the water quality benefits of management practices they are conducting or funding.

Effects of head movement and proprioceptive feedback in training of sound localization

PubMed Central

Honda, Akio; Shibata, Hiroshi; Hidaka, Souta; Gyoba, Jiro; Iwaya, Yukio; Suzuki, Yôiti

2013-01-01

We investigated the effects of listeners' head movements and proprioceptive feedback during sound localization practice on the subsequent accuracy of sound localization performance. The effects were examined under both restricted and unrestricted head movement conditions in the practice stage. In both cases, the participants were divided into two groups: a feedback group performed a sound localization drill with accurate proprioceptive feedback; a control group conducted it without the feedback. Results showed that (1) sound localization practice, while allowing for free head movement, led to improvement in sound localization performance and decreased actual angular errors along the horizontal plane, and that (2) proprioceptive feedback during practice decreased actual angular errors in the vertical plane. Our findings suggest that unrestricted head movement and proprioceptive feedback during sound localization training enhance perceptual motor learning by enabling listeners to use variable auditory cues and proprioceptive information. PMID:24349686

Current decision-making in prostate cancer therapy.

PubMed

Cox, Jared; Amling, Christopher L

2008-05-01

Prostate cancer continues to be the most prevalent cancer among American men. Localized prostate cancer is commonly diagnosed because of improved screening practices nationwide. Several options exist for the treatment of localized prostate cancer, and this review discusses the decision-making process facing patients diagnosed with this disease. No one treatment for localized prostate cancer has proven superior to date. For this reason patients have been found to use a number of resources to make an informed decision. These include physicians, spouses, family, friends, and different media. Urologists serve as the primary and most influential physicians and play an important role in the decision-making process. Patients, however, are assuming a more active role in this process as time evolves, especially with ease of access to multiple information resources. In deciding on a treatment for localized prostate cancer, patients must weigh the risks and benefits of each option. Urologists must provide patients with up-to-date information on these options and be aware of the different influences that surround these men during the decision-making process.

Wind energy on the horizon in British Columbia. A review and evaluation of the British Columbia wind energy planning framework

NASA Astrophysics Data System (ADS)

Day, Jason

This study examines the wind energy planning frameworks from ten North American jurisdictions, drawing important lessons that British Columbia could use to build on its current model which has been criticized for its limited scope and restriction of local government powers. This study contributes to similar studies conducted by Kimrey (2006), Longston (2006), and Eriksen (2009). This study concludes that inclusion of wind resource zones delineated through strategic environmental assessment, programme assessment, and conducting research-oriented studies could improve the current British Columbia planning framework. The framework should also strengthen its bat impact assessment practices and incorporate habitat compensation. This research also builds upon Rosenberg's (2008) wind energy planning framework typologies. I conclude that the typology utilized in Texas should be employed in British Columbia in order to facilitate utilizing wind power. The only adaptation needed is the establishment of a cross-jurisdictional review committee for project assessment to address concerns about local involvement and site-specific environmental and social concerns.

Genomic epidemiology of artemisinin resistant malaria

PubMed Central

2016-01-01

The current epidemic of artemisinin resistant Plasmodium falciparum in Southeast Asia is the result of a soft selective sweep involving at least 20 independent kelch13 mutations. In a large global survey, we find that kelch13 mutations which cause resistance in Southeast Asia are present at low frequency in Africa. We show that African kelch13 mutations have originated locally, and that kelch13 shows a normal variation pattern relative to other genes in Africa, whereas in Southeast Asia there is a great excess of non-synonymous mutations, many of which cause radical amino-acid changes. Thus, kelch13 is not currently undergoing strong selection in Africa, despite a deep reservoir of variations that could potentially allow resistance to emerge rapidly. The practical implications are that public health surveillance for artemisinin resistance should not rely on kelch13 data alone, and interventions to prevent resistance must account for local evolutionary conditions, shown by genomic epidemiology to differ greatly between geographical regions. DOI: http://dx.doi.org/10.7554/eLife.08714.001 PMID:26943619

[Statement of the Advisory Committee on Immunizations of Sociedad Chilena de Infectología about outbreaks of hepatitis A in Chile].

PubMed

Villena, Rodolfo; Wilhelm, Jan; Calvo, Ximena; Cerda, Jaime; Escobar, Carola; Moreno, Gabriela; Veliz, Liliana; Potin, Marcela

2017-08-01

This document represents the position of the Chilean Infectious Diseases Society Advisory Committee on Immunization Practices regarding hepatitis A epidemiological situation in Chile. The recommendations are based on local epidemiological data, the hepatitis A virus infection characteristics and the global experience with the available vaccines. In relation to hepatitis A, Chile is no longer a highly endemic area but actually an intermediate one, currently concentrating cases in individuals over 15 years of age, with frequent outbreaks. In 2017 we have seen an important outbreak of genotype 1A in men who have sex with men (MSM). The current endemic, the presence of regular outbreaks, the frequency of natural disasters in Chile, together with the availability of safe, effective vaccines and local cost-effectiveness studies led us to propose measures for outbreak control for high risk groups protection and mid and long term, including a more definitive solution which is universal vaccination against this disease in small children.

Nipple pain associated with breastfeeding: incorporating current neurophysiology into clinical reasoning.

PubMed

Amir, Lisa H; Jones, Lester E; Buck, Miranda L

2015-03-01

New mothers frequently experience breastfeeding problems, in particular nipple pain. This is often attributed to compression, skin damage, infection or dermatitis. To outline an integrated approach to breastfeeding pain assessment that seeks to enhance current practice. Our clinical reasoning model resolves the complexity of pain into three categories: local stimulation, external influences and central modulation. Tissue pathology, damage or inflammation leads to local stimulation of nociceptors. External influences such as creams and breast pumps, as well as factors related to the mother, the infant and the maternal-infant interaction, may exacerbate the pain. Central nervous system modulation includes the enhancement of nociceptive transmission at the spinal cord and modification of the descending inhibitory influences. A broad range of factors can modulate pain through central mechanisms including maternal illness, exhaustion, lack of support, anxiety, depression or history of abuse. General practitioners (GPs) can use this model to explain nipple pain in complex settings, thus increasing management options for women.

Current use of wild plants with edible underground storage organs in a rural population of Patagonia: between tradition and change.

PubMed

Ochoa, Juan José; Ladio, Ana Haydee

2015-09-25

Edible plants with underground storage organs (USOs) are neglected resources. We studied the local ecological knowledge edible plants with (USOs) in rural populations of North-Patagonia in order to establish how people are utilizing these plants. Some aspect of corpus-praxis-cosmos complex associated to the local ecological knowledge was documented and discussed. In addition, variation in this ecological knowledge due to age, gender, family structure, ethnic self-determination was also evaluated. Semi-structured interviews were conducted with 51 inhabitants in order to study the relationship between the current use of plants with USOs and the age, sex, family group composition and ethnic self-identification of interviewees. In addition, the Cultural Importance Index for each species was calculated. The current richness of known species in these populations is a total of 9 plants. Plants with USOs tend to be used more frequently as the age of the interviewee increases. Women and men showed no differences in the average richness of species cited. The interviewees who share their homes with other generations use these plants more frequently than those who live alone. Our results indicate that the interviewees who identified themselves as belonging to the Mapuche people use these plants more frequently. For the Mapuche people, wild plants have constituted material and symbolic resources of great importance in their historical subsistence. In addition, they are currently being redefined as elements which present a connection with ancestral practices, produce a strong relationship with the 'land', and become markers which identify the 'natural' (historical) ways of their people; these are key elements in the current political processes of identity revaluation. This research is valuable to stimulate cultural revival and health promotion programs in the communities with their own local, cultural food.

A Non-invasive Real-time Localization System for Enhanced Efficacy in Nasogastric Intubation.

PubMed

Sun, Zhenglong; Foong, Shaohui; Maréchal, Luc; Tan, U-Xuan; Teo, Tee Hui; Shabbir, Asim

2015-12-01

Nasogastric (NG) intubation is one of the most commonly performed clinical procedures. Real-time localization and tracking of the NG tube passage at the larynx region into the esophagus is crucial for safety, but is lacking in current practice. In this paper, we present the design, analysis and evaluation of a non-invasive real-time localization system using passive magnetic tracking techniques to improve efficacy of the clinical NG intubation process. By embedding a small permanent magnet at the insertion tip of the NG tube, a wearable system containing embedded sensors around the neck can determine the absolute position of the NG tube inside the body in real-time to assist in insertion. In order to validate the feasibility of the proposed system in detecting erroneous tube placement, typical reference intubation trajectories are first analyzed using anatomically correct models and localization accuracy of the system are evaluated using a precise robotic platform. It is found that the root-mean-squared tracking accuracy is within 5.3 mm for both the esophagus and trachea intubation pathways. Experiments were also designed and performed to demonstrate that the system is capable of tracking the NG tube accurately in biological environments even in presence of stationary ferromagnetic objects (such as clinical instruments). With minimal physical modification to the NG tube and clinical process, this system allows accurate and efficient localization and confirmation of correct NG tube placement without supplemental radiographic methods which is considered the current clinical standard.

Management of Nasopharyngeal Carcinoma: Current Practice and Future Perspective.

PubMed

Lee, Anne W M; Ma, Brigette B Y; Ng, Wai Tong; Chan, Anthony T C

2015-10-10

Nasopharyngeal carcinoma of the undifferentiated subtype is endemic to southern China, and patient prognosis has improved significantly over the past three decades because of advances in disease management, diagnostic imaging, radiotherapy technology, and broader application of systemic therapy. Despite the excellent local control with modern radiotherapy, distant failure remains a key challenge. Advances in molecular technology have helped to decipher the molecular pathogenesis of nasopharyngeal carcinoma as well as its etiologic association with the Epstein-Barr virus. This in turn has led to the discovery of novel biomarkers and drug targets, rendering this cancer site a current focus for new drug development. This article reviews and appraises the key literature on the current management of nasopharyngeal carcinoma and future directions in clinical research. © 2015 by American Society of Clinical Oncology.

Stocking activities for the Arctic charr in Lake Geneva: Genetic effects in space and time.

PubMed

Savary, Romain; Dufresnes, Christophe; Champigneulle, Alexis; Caudron, Arnaud; Dubey, Sylvain; Perrin, Nicolas; Fumagalli, Luca

2017-07-01

Artificial stocking practices are widely used by resource managers worldwide, in order to sustain fish populations exploited by both recreational and commercial activities, but their benefits are controversial. Former practices involved exotic strains, although current programs rather consider artificial breeding of local fishes (supportive breeding). Understanding the complex genetic effects of these management strategies is an important challenge with economic and conservation implications, especially in the context of population declines. In this study, we focus on the declining Arctic charr ( Salvelinus alpinus ) population from Lake Geneva (Switzerland and France), which has initially been restocked with allochtonous fishes in the early eighties, followed by supportive breeding. In this context, we conducted a genetic survey to document the evolution of the genetic diversity and structure throughout the last 50 years, before and after the initiation of hatchery supplementation, using contemporary and historical samples. We show that the introduction of exotic fishes was associated with a genetic bottleneck in the 1980-1990s, a break of Hardy-Weinberg Equilibrium (HWE), a reduction in genetic diversity, an increase in genetic structure among spawning sites, and a change in their genetic composition. Together with better environmental conditions, three decades of subsequent supportive breeding using local fishes allowed to re-establish HWE and the initial levels of genetic variation. However, current spawning sites have not fully recovered their original genetic composition and were extensively homogenized across the lake. Our study demonstrates the drastic genetic consequences of different restocking tactics in a comprehensive spatiotemporal framework and suggests that genetic alteration by nonlocal stocking may be partly reversible through supportive breeding. We recommend that conservation-based programs consider local diversity and implement adequate protocols to limit the genetic homogenization of this Arctic charr population.

An exploration of GPs' use of MRI: a critical incident study.

PubMed

Robling, M; Kinnersley, P; Houston, H; Hourihan, M; Cohen, D; Hale, J

1998-06-01

Direct access to Magnetic Resonance Imaging (MRI) is becoming available to GPs in the UK, offering major benefits for the improved diagnosis and management of certain clinical conditions. Variations in usage of this service may be large, and effective locally produced guidelines are not currently available. The Department of General Practice is conducting a research programme to develop and evaluate methods to optimize MRI use by GPs. We aimed to describe the current use of MRI by GPs in South Glamorgan; to summarize their reasons for requesting MRI; and to produce criteria to assess the appropriateness of magnetic resonance (MR) scan requests. Using the critical incident technique, 25 GPs were interviewed about recent scans requested for patients with knee and lumbar spine complaints. A local panel of primary and secondary care doctors was convened to develop criteria for assessing MR scan requests. Sixty-two scan requests were discussed. Doctors' reasons for requesting MR scans were identified and classified. Reasons for requests included personal, contextual and biomedical variables. Fifteen patients (24%) were managed in primary care following MRI when otherwise they would have been referred. When referrals were made, GPs felt able to reinforce the request and occasionally to direct the patient somewhere more appropriate. The panel reviewed the interview data to produce objective criteria to assess scan requests. The criteria reflect the relative importance of non-biomedical variables in the decision to request MRI. The study identified those reasons which are important to GPs when requesting MR scans and the impact of this new technology upon patient management. Interview data have been used to inform locally developed consensus criteria, which will be made available as practice guidelines as the research programme progresses.

Localized scleroderma.

PubMed

Kreuter, Alexander

2012-01-01

Localized scleroderma (also called morphea) is a term encompassing a spectrum of sclerotic autoimmune diseases that primarily affect the skin, but also might involve underlying structures such as the fat, fascia, muscle, and bones. Its exact pathogenesis is still unknown, but several trigger factors in genetically predisposed individuals might initially lead to an immunologically triggered release of pro-inflammatory cytokines, resulting in a profound dysregulation of the connective tissue metabolism and ultimately to induction of fibrosis. To date, there are no specific serological markers available for localized scleroderma. Within the last years, several validated clinical scores have been introduced as potential outcome measures for the disease. Given the rarity of localized scleroderma, only few evidence-based therapeutical treatment options exist. So far, the most robust data is available for ultraviolet A1 phototherapy in disease that is restricted to the skin, and methotrexate alone or in combination with systemic corticosteroids in more severe disease that additionally affects extracutaneous structures. This practical review summarizes relevant information on the epidemiology, pathogenesis, clinical subtypes and classifications, differential diagnoses, clinical scores and outcome measures, and current treatment strategies of localized scleroderma. © 2012 Wiley Periodicals, Inc.

Management of Symptomatic Floaters: Current Attitudes, Beliefs, and Practices Among Vitreoretinal Surgeons.

PubMed

Cohen, Michael N; Rahimy, Ehsan; Ho, Allen C; Garg, Sunir J

2015-09-01

To assess the current attitudes, beliefs, and practice patterns among vitreoretinal surgeons when dealing with symptomatic floaters in patients with otherwise healthy eyes. A cross-sectional, Internet-based anonymous survey of 10 questions was distributed via email to vitreoretinal specialists practicing in the United States. The survey response rate was 6.1% (159 of 2,600). Forty of 159 respondents (25%) reported they would perform pars plana vitrectomy (PPV) to reduce symptomatic floaters, and 110 of 159 (69%) had previously performed PPV for this indication. When compared to those unlikely to intervene for symptomatic floaters, 33 of 40 (83%) of those likely to intervene performed more than 100 vitrectomy surgical cases annually (P<.05). Between those that had and had not performed PPV for symptomatic floaters in the past, statistically significant differences were observed regarding the likelihood to perform PPV for symptomatic floaters in the future (35% vs. 4%; P<.0001) and tendency to elect a procedure if the surgeon's own vision were impacted by symptomatic floaters (55% vs. 8%; P<.001). When compared to those likely to perform surgery for symptomatic floaters, those unlikely to intervene identified three statistically significant barriers: the surgical risks involved with PPV (28% vs. 86%; P<.001), unrealistic patient expectations (25% vs 58%; P<.001), and the possibility of ridicule from the local retina community (10% vs. 32%; P<.01). Vitreoretinal specialists are more likely to intervene for symptomatic floaters if they have previously done so and if they perform more than 100 surgical cases per year. The major barriers preventing physicians from performing an intervention for floaters are standard risks associated with PPV, the fear of unreasonable patient expectations, and the possibility of ridicule within the local retina community. Copyright 2015, SLACK Incorporated.

A Study of Applying Pulsed Remote Field Eddy Current in Ferromagnetic Pipes Testing

PubMed Central

Luo, Qingwang; Shi, Yibing; Wang, Zhigang; Zhang, Wei; Li, Yanjun

2017-01-01

Pulsed Remote Field Eddy Current Testing (PRFECT) attracts the attention in the testing of ferromagnetic pipes because of its continuous spectrum. This paper simulated the practical PRFECT of pipes by using ANSYS software and employed Least Squares Support Vector Regression (LSSVR) to extract the zero-crossing time to analyze the pipe thickness. As a result, a secondary peak is found in zero-crossing time when transmitter passed by a defect. The secondary peak will lead to wrong quantification and the localization of defects, especially when defects are found only at the transmitter location. Aiming to eliminate the secondary peaks, double sensing coils are set in the transition zone and Wiener deconvolution filter is applied. In the proposed method, position dependent response of the differential signals from the double sensing coils is calibrated by employing zero-mean normalization. The methods proposed in this paper are validated by analyzing the simulation signals and can improve the practicality of PRFECT of ferromagnetic pipes. PMID:28475141

A Study of Applying Pulsed Remote Field Eddy Current in Ferromagnetic Pipes Testing.

PubMed

Luo, Qingwang; Shi, Yibing; Wang, Zhigang; Zhang, Wei; Li, Yanjun

2017-05-05

Pulsed Remote Field Eddy Current Testing (PRFECT) attracts the attention in the testing of ferromagnetic pipes because of its continuous spectrum. This paper simulated the practical PRFECT of pipes by using ANSYS software and employed Least Squares Support Vector Regression (LSSVR) to extract the zero-crossing time to analyze the pipe thickness. As a result, a secondary peak is found in zero-crossing time when transmitter passed by a defect. The secondary peak will lead to wrong quantification and the localization of defects, especially when defects are found only at the transmitter location. Aiming to eliminate the secondary peaks, double sensing coils are set in the transition zone and Wiener deconvolution filter is applied. In the proposed method, position dependent response of the differential signals from the double sensing coils is calibrated by employing zero-mean normalization. The methods proposed in this paper are validated by analyzing the simulation signals and can improve the practicality of PRFECT of ferromagnetic pipes.

Adoption, implementation and prioritization of specialist outreach policy in Australia: a national perspective.

PubMed

O'Sullivan, Belinda G; Joyce, Catherine M; McGrail, Matthew R

2014-07-01

The World Health Organization has endorsed the use of outreach to promote: efficient redeployment of the health-care workforce; continuity of care at the local level; and professional support for local, rural, health-care workers. Australia is the only country that has had, since 2000, a sustained national policy on outreach for subsidizing medical specialist outreach to rural areas. This paper describes the adoption, implementation and prioritization of a national specialist outreach policy in Australia. Adoption of the national policy followed a long history of successful outreach, largely driven by the professional interest and personal commitment of the workforce. Initially the policy supported only new outreach services but concerns about the sustainability of existing services resulted in eligibility for funding being extended to all specialist services. The costs of travel, travel time, accommodation, professional support, staff relief at specialists' primary practices and equipment hire were subsidized. Over time, a national political commitment to the equitable treatment of indigenous people resulted in more targeted support for outreach in remote areas. Current priorities are: (i) establishing team-based outreach services; (ii) improving local staff's skills; (iii) achieving local coordination; and (iv) conducting a nationally consistent needs assessment. The absence of subsidies for specialists' clinical work can discourage private specialists from providing services in remote areas where clinical throughput is low. To be successful, outreach policy must harmonize with the interests of the workforce and support professional autonomy. Internationally, the development of outreach policy must take account of the local pay and practice conditions of health workers.

Adoption, implementation and prioritization of specialist outreach policy in Australia: a national perspective

PubMed Central

Joyce, Catherine M; McGrail, Matthew R

2014-01-01

Abstract The World Health Organization has endorsed the use of outreach to promote: efficient redeployment of the health-care workforce; continuity of care at the local level; and professional support for local, rural, health-care workers. Australia is the only country that has had, since 2000, a sustained national policy on outreach for subsidizing medical specialist outreach to rural areas. This paper describes the adoption, implementation and prioritization of a national specialist outreach policy in Australia. Adoption of the national policy followed a long history of successful outreach, largely driven by the professional interest and personal commitment of the workforce. Initially the policy supported only new outreach services but concerns about the sustainability of existing services resulted in eligibility for funding being extended to all specialist services. The costs of travel, travel time, accommodation, professional support, staff relief at specialists’ primary practices and equipment hire were subsidized. Over time, a national political commitment to the equitable treatment of indigenous people resulted in more targeted support for outreach in remote areas. Current priorities are: (i) establishing team-based outreach services; (ii) improving local staff’s skills; (iii) achieving local coordination; and (iv) conducting a nationally consistent needs assessment. The absence of subsidies for specialists’ clinical work can discourage private specialists from providing services in remote areas where clinical throughput is low. To be successful, outreach policy must harmonize with the interests of the workforce and support professional autonomy. Internationally, the development of outreach policy must take account of the local pay and practice conditions of health workers. PMID:25110376

Improving Empirical Approaches to Estimating Local Greenhouse Gas Emissions

NASA Astrophysics Data System (ADS)

Blackhurst, M.; Azevedo, I. L.; Lattanzi, A.

2016-12-01

Evidence increasingly indicates our changing climate will have significant global impacts on public health, economies, and ecosystems. As a result, local governments have become increasingly interested in climate change mitigation. In the U.S., cities and counties representing nearly 15% of the domestic population plan to reduce 300 million metric tons of greenhouse gases over the next 40 years (or approximately 1 ton per capita). Local governments estimate greenhouse gas emissions to establish greenhouse gas mitigation goals and select supporting mitigation measures. However, current practices produce greenhouse gas estimates - also known as a "greenhouse gas inventory " - of empirical quality often insufficient for robust mitigation decision making. Namely, current mitigation planning uses sporadic, annual, and deterministic estimates disaggregated by broad end use sector, obscuring sources of emissions uncertainty, variability, and exogeneity that influence mitigation opportunities. As part of AGU's Thriving Earth Exchange, Ari Lattanzi of City of Pittsburgh, PA recently partnered with Dr. Inez Lima Azevedo (Carnegie Mellon University) and Dr. Michael Blackhurst (University of Pittsburgh) to improve the empirical approach to characterizing Pittsburgh's greenhouse gas emissions. The project will produce first-order estimates of the underlying sources of uncertainty, variability, and exogeneity influencing Pittsburgh's greenhouse gases and discuss implications of mitigation decision making. The results of the project will enable local governments to collect more robust greenhouse gas inventories to better support their mitigation goals and improve measurement and verification efforts.

Analysis of the current rib support practices and techniques in U.S. coal mines

PubMed Central

Mohamed, Khaled M.; Murphy, Michael M.; Lawson, Heather E.; Klemetti, Ted

2016-01-01

Design of rib support systems in U.S. coal mines is based primarily on local practices and experience. A better understanding of current rib support practices in U.S. coal mines is crucial for developing a sound engineering rib support design tool. The objective of this paper is to analyze the current practices of rib control in U.S. coal mines. Twenty underground coal mines were studied representing various coal basins, coal seams, geology, loading conditions, and rib control strategies. The key findings are: (1) any rib design guideline or tool should take into account external rib support as well as internal bolting; (2) rib bolts on their own cannot contain rib spall, especially in soft ribs subjected to significant load—external rib control devices such as mesh are required in such cases to contain rib sloughing; (3) the majority of the studied mines follow the overburden depth and entry height thresholds recommended by the Program Information Bulletin 11-29 issued by the Mine Safety and Health Administration; (4) potential rib instability occurred when certain geological features prevailed—these include draw slate and/or bone coal near the rib/roof line, claystone partings, and soft coal bench overlain by rock strata; (5) 47% of the studied rib spall was classified as blocky—this could indicate a high potential of rib hazards; and (6) rib injury rates of the studied mines for the last three years emphasize the need for more rib control management for mines operating at overburden depths between 152.4 m and 304.8 m. PMID:27648341

Mass Casualty Decontamination in the United States: An Online Survey of Current Practice

PubMed Central

Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Larner, Joanne; Matar, Hazem; Chilcott, Robert P.

2016-01-01

Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. Survey respondents were asked to provide details of various aspects of their decontamination procedures, including expected response times to reach casualties, disrobing procedures, approaches to decontamination, characteristics of the decontamination showering process, provision for special populations, and any actions taken following decontamination. The aim of the survey was to identify any differences in the way in which decontamination guidance is implemented across US states. Results revealed that, in line with current guidance, many US fire departments routinely use the “ladder-pipe system” for conducting rapid, gross decontamination of casualties. The survey revealed significant variability in ladder-pipe construction, such as the position and number of fire hoses used. There was also variability in decontamination characteristics, such as water temperature and water pressure, detergent use, and shower duration. The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination. PMID:27442794

Assessing the Importance of Domestic Vaccine Manufacturing Centers: An Overview of Immunization Programs, Vaccine Manufacture, and Distribution.

PubMed

Rey-Jurado, Emma; Tapia, Felipe; Muñoz-Durango, Natalia; Lay, Margarita K; Carreño, Leandro J; Riedel, Claudia A; Bueno, Susan M; Genzel, Yvonne; Kalergis, Alexis M

2018-01-01

Vaccines have significantly reduced the detrimental effects of numerous human infectious diseases worldwide, helped to reduce drastically child mortality rates and even achieved eradication of major pathogens, such as smallpox. These achievements have been possible due to a dedicated effort for vaccine research and development, as well as an effective transfer of these vaccines to public health care systems globally. Either public or private institutions have committed to developing and manufacturing vaccines for local or international population supply. However, current vaccine manufacturers worldwide might not be able to guarantee sufficient vaccine supplies for all nations when epidemics or pandemics events could take place. Currently, different countries produce their own vaccine supplies under Good Manufacturing Practices, which include the USA, Canada, China, India, some nations in Europe and South America, such as Germany, the Netherlands, Italy, France, Argentina, and Brazil, respectively. Here, we discuss some of the vaccine programs and manufacturing capacities, comparing the current models of vaccine management between industrialized and developing countries. Because local vaccine production undoubtedly provides significant benefits for the respective population, the manufacture capacity of these prophylactic products should be included in every country as a matter of national safety.

Assessing the Importance of Domestic Vaccine Manufacturing Centers: An Overview of Immunization Programs, Vaccine Manufacture, and Distribution

PubMed Central

Rey-Jurado, Emma; Tapia, Felipe; Muñoz-Durango, Natalia; Lay, Margarita K.; Carreño, Leandro J.; Riedel, Claudia A.; Bueno, Susan M.; Genzel, Yvonne; Kalergis, Alexis M.

2018-01-01

Vaccines have significantly reduced the detrimental effects of numerous human infectious diseases worldwide, helped to reduce drastically child mortality rates and even achieved eradication of major pathogens, such as smallpox. These achievements have been possible due to a dedicated effort for vaccine research and development, as well as an effective transfer of these vaccines to public health care systems globally. Either public or private institutions have committed to developing and manufacturing vaccines for local or international population supply. However, current vaccine manufacturers worldwide might not be able to guarantee sufficient vaccine supplies for all nations when epidemics or pandemics events could take place. Currently, different countries produce their own vaccine supplies under Good Manufacturing Practices, which include the USA, Canada, China, India, some nations in Europe and South America, such as Germany, the Netherlands, Italy, France, Argentina, and Brazil, respectively. Here, we discuss some of the vaccine programs and manufacturing capacities, comparing the current models of vaccine management between industrialized and developing countries. Because local vaccine production undoubtedly provides significant benefits for the respective population, the manufacture capacity of these prophylactic products should be included in every country as a matter of national safety. PMID:29403503

Removal of Differential Capacitive Interferences in Fast-Scan Cyclic Voltammetry.

PubMed

Johnson, Justin A; Hobbs, Caddy N; Wightman, R Mark

2017-06-06

Due to its high spatiotemporal resolution, fast-scan cyclic voltammetry (FSCV) at carbon-fiber microelectrodes enables the localized in vivo monitoring of subsecond fluctuations in electroactive neurotransmitter concentrations. In practice, resolution of the analytical signal relies on digital background subtraction for removal of the large current due to charging of the electrical double layer as well as surface faradaic reactions. However, fluctuations in this background current often occur with changes in the electrode state or ionic environment, leading to nonspecific contributions to the FSCV data that confound data analysis. Here, we both explore the origin of such shifts seen with local changes in cations and develop a model to account for their shape. Further, we describe a convolution-based method for removal of the differential capacitive contributions to the FSCV current. The method relies on the use of a small-amplitude pulse made prior to the FSCV sweep that probes the impedance of the system. To predict the nonfaradaic current response to the voltammetric sweep, the step current response is differentiated to provide an estimate of the system's impulse response function and is used to convolute the applied waveform. The generated prediction is then subtracted from the observed current to the voltammetric sweep, removing artifacts associated with electrode impedance changes. The technique is demonstrated to remove select contributions from capacitive characteristics changes of the electrode both in vitro (i.e., in flow-injection analysis) and in vivo (i.e., during a spreading depression event in an anesthetized rat).

"Closing the Loop": Overcoming barriers to locally sourcing food in Fort Collins, Colorado

NASA Astrophysics Data System (ADS)

DeMets, C. M.

2012-12-01

Environmental sustainability has become a focal point for many communities in recent years, and restaurants are seeking creative ways to become more sustainable. As many chefs realize, sourcing food locally is an important step towards sustainability and towards building a healthy, resilient community. Review of literature on sustainability in restaurants and the local food movement revealed that chefs face many barriers to sourcing their food locally, but that there are also many solutions for overcoming these barriers that chefs are in the early stages of exploring. Therefore, the purpose of this research is to identify barriers to local sourcing and investigate how some restaurants are working to overcome those barriers in the city of Fort Collins, Colorado. To do this, interviews were conducted with four subjects who guide purchasing decisions for restaurants in Fort Collins. Two of these restaurants have created successful solutions and are able to source most of their food locally. The other two are interested in and working towards sourcing locally but have not yet been able to overcome barriers, and therefore only source a few local items. Findings show that there are four barriers and nine solutions commonly identified by each of the subjects. The research found differences between those who source most of their food locally and those who have not made as much progress in local sourcing. Based on these results, two solution flowcharts were created, one for primary barriers and one for secondary barriers, for restaurants to assess where they are in the local food chain and how they can more successfully source food locally. As there are few explicit connections between this research question and climate change, it is important to consider the implicit connections that motivate and justify this research. The question of whether or not greenhouse gas emissions are lower for locally sourced food is a topic of much debate, and while there are major developments for quantitatively determining a generalized answer, it is "currently impossible to state categorically whether or not local food systems emit fewer greenhouse gases than non-local food systems" (Edwards-Jones et al, 2008). Even so, numerous researchers have shown that "83 percent of emissions occur before food even leaves the farm gate" (Weber and Matthews, Garnett, cited in DeWeerdt, 2011); while this doesn't provide any information in terms of local vs. non-local, it is significant when viewed in light of the fact that local farmers tend to have much greater transparency and accountability in their agricultural practices. In other words, "a farmer who sells in the local food economy might be more likely to adopt or continue sustainable practices in order to meet…customer demand" (DeWeerdt, 2011), among other reasons such as environmental concern and desire to support the local economy (DeWeerdt, 2009). In identifying solutions to barriers to locally sourcing food, this research will enable restaurants to overcome these barriers and source their food locally, thereby supporting farmers and their ability to maintain sustainable practices.

Hybrid upwind discretization of nonlinear two-phase flow with gravity

NASA Astrophysics Data System (ADS)

Lee, S. H.; Efendiev, Y.; Tchelepi, H. A.

2015-08-01

Multiphase flow in porous media is described by coupled nonlinear mass conservation laws. For immiscible Darcy flow of multiple fluid phases, whereby capillary effects are negligible, the transport equations in the presence of viscous and buoyancy forces are highly nonlinear and hyperbolic. Numerical simulation of multiphase flow processes in heterogeneous formations requires the development of discretization and solution schemes that are able to handle the complex nonlinear dynamics, especially of the saturation evolution, in a reliable and computationally efficient manner. In reservoir simulation practice, single-point upwinding of the flux across an interface between two control volumes (cells) is performed for each fluid phase, whereby the upstream direction is based on the gradient of the phase-potential (pressure plus gravity head). This upwinding scheme, which we refer to as Phase-Potential Upwinding (PPU), is combined with implicit (backward-Euler) time discretization to obtain a Fully Implicit Method (FIM). Even though FIM suffers from numerical dispersion effects, it is widely used in practice. This is because of its unconditional stability and because it yields conservative, monotone numerical solutions. However, FIM is not unconditionally convergent. The convergence difficulties are particularly pronounced when the different immiscible fluid phases switch between co-current and counter-current states as a function of time, or (Newton) iteration. Whether the multiphase flow across an interface (between two control-volumes) is co-current, or counter-current, depends on the local balance between the viscous and buoyancy forces, and how the balance evolves in time. The sensitivity of PPU to small changes in the (local) pressure distribution exacerbates the problem. The common strategy to deal with these difficulties is to cut the timestep and try again. Here, we propose a Hybrid-Upwinding (HU) scheme for the phase fluxes, then HU is combined with implicit time discretization to yield a fully implicit method. In the HU scheme, the phase flux is divided into two parts based on the driving force. The viscous-driven and buoyancy-driven phase fluxes are upwinded differently. Specifically, the viscous flux, which is always co-current, is upwinded based on the direction of the total-velocity. The buoyancy-driven flux across an interface is always counter-current and is upwinded such that the heavier fluid goes downward and the lighter fluid goes upward. We analyze the properties of the Implicit Hybrid Upwinding (IHU) scheme. It is shown that IHU is locally conservative and produces monotone, physically-consistent numerical solutions. The IHU solutions show numerical diffusion levels that are slightly higher than those for standard FIM (i.e., implicit PPU). The primary advantage of the IHU scheme is that the numerical overall-flux of a fluid phase remains continuous and differentiable as the flow regime changes between co-current and counter-current conditions. This is in contrast to the standard phase-potential upwinding scheme, in which the overall fractional-flow (flux) function is non-differentiable across the boundary between co-current and counter-current flows.

Ethical issues in the export, storage and reuse of human biological samples in biomedical research: perspectives of key stakeholders in Ghana and Kenya.

PubMed

Tindana, Paulina; Molyneux, Catherine S; Bull, Susan; Parker, Michael

2014-10-18

For many decades, access to human biological samples, such as cells, tissues, organs, blood, and sub-cellular materials such as DNA, for use in biomedical research, has been central in understanding the nature and transmission of diseases across the globe. However, the limitations of current ethical and regulatory frameworks in sub-Saharan Africa to govern the collection, export, storage and reuse of these samples have resulted in inconsistencies in practice and a number of ethical concerns for sample donors, researchers and research ethics committees. This paper examines stakeholders' perspectives of and responses to the ethical issues arising from these research practices. We employed a qualitative strategy of inquiry for this research including in-depth interviews and focus group discussions with key research stakeholders in Kenya (Nairobi and Kilifi), and Ghana (Accra and Navrongo). The stakeholders interviewed emphasised the compelling scientific importance of sample export, storage and reuse, and acknowledged the existence of some structures governing these research practices, but they also highlighted the pressing need for a number of practical ethical concerns to be addressed in order to ensure high standards of practice and to maintain public confidence in international research collaborations. These concerns relate to obtaining culturally appropriate consent for sample export and reuse, understanding cultural sensitivities around the use of blood samples, facilitating a degree of local control of samples and sustainable scientific capacity building. Drawing on these findings and existing literature, we argue that the ethical issues arising in practice need to be understood in the context of the interactions between host research institutions and local communities and between collaborating institutions. We propose a set of 'key points-to-consider' for research institutions, ethics committees and funding agencies to address these issues.

High Resolution Modeling of Coastal Inundation: User Requirements and Current Practice, A Navy Perspective

DTIC Science & Technology

2007-07-27

often located at Within this paper the general role of in- period. These changes in the operational ret- the cusp of the land- sea interface where algo...vegetation, and sediment proper- summarizes the user requirements set forth NNS060820-01, www.news.navy.mil). Fur- ties. Since the Navy operational...role are dis- modeling the circulation and pollutant trans- bal, regional, and local systems with two pri- cussed below, port in estuarine and coastal

Foil focusing of relativistic electron beams

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

Ekdahl, Jr., Carl August

2017-10-26

When an intense relativistic electron beams (IREB) passes through a grounded metal foil, the transverse electric field due to the beam space charge is locally shorted out, and the beam is focused by the magnetic field of its current. The effect can be treated as focusing by a thin lens with first order aberration. Expressions for the focal length and aberration coefficient of the equivalent thin lens are developed in this note. These are then applied to practical examples representative of IREB research at Los Alamos National Laboratory.

Automated Quantitative Nuclear Cardiology Methods

PubMed Central

Motwani, Manish; Berman, Daniel S.; Germano, Guido; Slomka, Piotr J.

2016-01-01

Quantitative analysis of SPECT and PET has become a major part of nuclear cardiology practice. Current software tools can automatically segment the left ventricle, quantify function, establish myocardial perfusion maps and estimate global and local measures of stress/rest perfusion – all with minimal user input. State-of-the-art automated techniques have been shown to offer high diagnostic accuracy for detecting coronary artery disease, as well as predict prognostic outcomes. This chapter briefly reviews these techniques, highlights several challenges and discusses the latest developments. PMID:26590779

Fiber-optic technology for transport aircraft

NASA Astrophysics Data System (ADS)

1993-07-01

A development status evaluation is presented for fiber-optic devices that are advantageously applicable to commercial aircraft. Current developmental efforts at a major U.S. military and commercial aircraft manufacturer encompass installation techniques and data distribution practices, as well as the definition and refinement of an optical propulsion management interface system, environmental sensing systems, and component-qualification criteria. Data distribution is the most near-term implementable of fiber-optic technologies aboard commercial aircraft in the form of onboard local-area networks for intercomputer connections and passenger entertainment.

Singapore Paediatric Resuscitation Guidelines 2016.

PubMed

Ong, Gene Yong Kwang; Chan, Irene Lai Yeen; Ng, Agnes Suah Bwee; Chew, Su Yah; Mok, Yee Hui; Chan, Yoke Hwee; Ong, Jacqueline Soo May; Ganapathy, Sashikumar; Ng, Kee Chong

2017-07-01

We present the revised 2016 Singapore paediatric resuscitation guidelines. The International Liaison Committee on Resuscitation's Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, as well as the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council released in October 2015, were debated and discussed by the workgroup. The final recommendations for the Singapore Paediatric Resuscitation Guidelines 2016 were derived after carefully reviewing the current available evidence in the literature and balancing it with local clinical practice. Copyright: © Singapore Medical Association.

Con_A-CNT (Carbon Nanotube) Conjugate with Short Wave Near-Infrared (SWIR) Laser Ablation for Tumor Therapy

DTIC Science & Technology

2010-02-11

W.F., Kavanagh, P.V., Ho, C.P., Shen, P., Zagoria, R.J., Staging and current treatment of hepatocellular carcinoma . RadioGraphics 25:S2-S23. (2005...2] Kudo, M. and Okanoue, T., Clinical Practice Manual of HCC Expert Panel. Management of hepatocellular carcinoma in Japan: Consensus-based clinical...local therapy for hepatocellular carcinoma and survival outcomes in the US population. Am J Surg 195:829-836 (2008). [4] Chen, W.Y., Cheng, W.T., Lei

WSDOT pavement preservation guide for local agencies.

DOT National Transportation Integrated Search

2012-11-01

This report was intended to address two key objectives: (1) identify usage and implementation gaps : found in local agency asset management practices due to decreased resources and develop guidance for : local agencies on recommended practices and to...

The Health Policy and Legislative Awareness Initiative at the Pennsylvania State University College of Medicine: theory meets practice.

PubMed

Quraishi, Sadeq A; Orkin, Fredrick K; Weitekamp, Michael R; Khalid, Ayesha N; Sassani, Joseph W

2005-05-01

In a constantly evolving health care landscape shaped by many voices--including those of third party payers and government--physicians must learn to play a more proactive role to become better advocates for their patients and to uphold the basic tenets of their noble profession. As legislation and public health become increasingly intertwined with the practice of medicine, educators must provide future physicians with the tools to meet these new challenges. Accordingly, in 1996 Pennsylvania State University College of Medicine embarked on its Health Policy and Legislative Awareness Initiative, a medical school elective designed to provide theoretical knowledge as well as practical experience in legislative and policy issues for future physicians early in their careers. The Initiative has three key elements: a series of lectures taught by national and local experts covering a basic health policy curriculum, a mini-internship conducted at the office of a Pennsylvania State legislator, and a practical assignment leading to authorship of a resolution to a national medical organization or assisting in drafting a bill intended for introduction to the Pennsylvania State Legislature. Following several years of successful implementation and a moderate growth in enrollment, recent changes in the local and national scene have peaked the interest of most students to learn about the system in which they will practice medicine. Therefore, in addition to describing the Initiative in its current form, the authors discuss future plans for expanded elective opportunities and consider the issue of integrating health policy education into core medical school curricula.

Marked variation in newborn resuscitation practice: A national survey in the UK☆

PubMed Central

Mann, Chantelle; Ward, Carole; Grubb, Mark; Hayes-Gill, Barrie; Crowe, John; Marlow, Neil; Sharkey, Don

2012-01-01

Background Although international newborn resuscitation guidance has been in force for some time, there are no UK data on current newborn resuscitation practices. Objective Establish delivery room (DR) resuscitation practices in the UK, and identify any differences between neonatal intensive care units (NICU), and other local neonatal services. Methods We conducted a structured two-stage survey of DR management, among UK neonatal units during 2009–2010 (n = 192). Differences between NICU services (tertiary level) and other local neonatal services (non-tertiary) were analysed using Fisher's exact and Student's t-tests. Results There was an 89% response rate (n = 171). More tertiary NICUs institute DR CPAP than non-tertiary units (43% vs. 16%, P = 0.0001) though there was no significant difference in frequency of elective intubation and surfactant administration for preterm babies. More tertiary units commence DR resuscitation in air (62% vs. 29%, P < 0.0001) and fewer in 100% oxygen (11% vs. 41%, P < 0.0001). Resuscitation of preterm babies in particular, commences with air in 56% of tertiary units. Significantly more tertiary units use DR pulse oximeters (58% vs. 29%, P < 0.01) and titrate oxygen based on saturations. Almost all services use occlusive wrapping to maintain temperature for preterm infants. Conclusions In the UK, there are many areas of good evidence based DR practice. However, there is marked variation in management, including between units of different designation, suggesting a need to review practice to fulfil new resuscitation guidance, which will have training and resource implications. PMID:22245743

Toward a North-South dialogue: revisiting nursing theory (from the South).

PubMed

Santos Salas, Anna

2005-01-01

In nursing, the current world situation calls us to revisit our knowledge schemes and revise the extent to which they assist us in improving the health of the world peoples. In this discussion, I offer a Latin American nursing perspective to knowledge development in our discipline. I suggest that a persistent concern to develop elaborate conceptualizations has distracted our attention from the realities practicing nurses face throughout the world. In their abstractness, (North) American nursing theories have conveyed a view that presumingly universal imposes itself as hegemonic in the international nursing community. Yet the exportation of these theories to other countries introduces a view that is foreign to practicing nurses. The world situation as well as the disparate and concurrent human paths that we witness and experience calls for approaches that are more in tune with the local realities of nursing practices.

Opioid Use Disorder in Pregnancy: Health Policy and Practice in the Midst of an Epidemic

PubMed Central

Krans, Elizabeth E.; Patrick, Stephen W.

2016-01-01

Opioid abuse among pregnant women has reached epidemic proportions and has influenced maternal and child health policy at the federal, state and local levels. As a result, we review the current state of opioid use in pregnancy and evaluate recent legislative and health policy initiatives designed to combat opioid addiction in pregnancy. We emphasize the importance of safe and responsible opioid prescribing practices, expanding the availability and accessibility of medication-assisted treatment and standardizing care for infants at risk of neonatal abstinence syndrome. Efforts to penalize pregnant women and negative consequences for disclosing substance use to providers are harmful and may prevent women from seeking prenatal care and other beneficial health care services during pregnancy. Instead, providers should advocate for health policy informed by scientific research and evidence-based practice to reduce the burden of prenatal opioid abuse and optimize outcomes for mothers and their infants. PMID:27275812

A question of dissemination: Assessing the practices and implications of research in tropical landscapes.

PubMed

Toomey, Anne H; Alvaro, María Eugenia Copa; Aiello-Lammens, Matthew; Loayza Cossio, Oscar; Barlow, Jos

2018-04-24

Current debates in the conservation sciences argue for better integration between research and practice, often citing the importance of the diffusion, dissemination and implementation of scientific knowledge for environmental management and policy. This paper focuses on a relatively well-researched protected area (Madidi National Park) in Bolivia in order to present different interpretations and understandings of the implications and availability of research findings. We draw on findings from quantitative and qualitative methods to determine the extent to which research carried out in the region was disseminated and/or implemented for management actions, and to understand subsequent implications for how local actors perceive the value of research and its role in management and conservation. We discuss the critical consequences of these findings for the future of conservation science and practice in biologically and culturally diverse landscapes, with an explicit call to action for academic institutions to support researchers in developing appropriate dissemination strategies.

Tonometer disinfection practice in the United Kingdom: a national survey.

PubMed

Hillier, R J; Kumar, N

2008-08-01

To assess current tonometer disinfection practice in the UK, and compare with published recommendations. Every ophthalmology unit with training recognition in the UK was contacted (n=155). A senior nurse at each institution completed a telephone questionnaire regarding local tonometer disinfection practice. The response rate was 100%. Thirty-five units (23%) reported exclusive use of disposable tonometer heads and were excluded from further analysis. One hundred and twenty units (77%) used either reusable or a combination of reusable and disposable tonometer heads. Where reusable heads were used, 80 units (67%) immersed them in a chlorine-based solution such as sodium hypochlorite or sodium dichloroisocyanurate. Others used isopropyl alcohol (18 units), hydrogen peroxide (12 units), chloramine (5 units), chlorhexidine (4 units) and peracetic acid (1 unit). Where a chlorine-based agent was used, the concentration of available chlorine ranged from 125 to 30 000 p.p.m., with 50 units (63%) using a concentration of less than 5 000 p.p.m. (i.e., inadequate based on published recommendations). Where the tonometer head was immersed in disinfectant between patients (n=101), 29 units (29%) provided just one tonometer head per practitioner, making adequate soak time between patients unlikely. Every unit replenished the disinfectant at least daily, deemed sufficient for most agents. However, hydrogen peroxide solutions should be replenished twice daily, which did not take place in nine units. This survey reveals disparity between current tonometer disinfection practice and published international recommendations, with some institutions using practices that may render patients susceptible to transmissible infection.

Dual modality surgical guidance of non-palpable breast lesions

NASA Astrophysics Data System (ADS)

Judy, Patricia Goodale

Although breast conserving therapy has some advantages over the traditional mastectomy procedure, the biggest disadvantage is the chance of local re-occurrence in which a second surgery is often required. Adequate surgical removal of breast tumors requires accurate tumor localization in order to ensure a balance between optimal cosmetic results and minimization of the risk for local re-occurrence. These challenges have motivated the search for alternative, more accurate methods for intraoperative localization of non-palpable breast lesions. The overall goal of this project was to develop an innovative technique for radioguided localization of non-palpable breast lesions that is more accurate, easier for the breast surgeon, and more comfortable for the patient than the current practice of wire localization. The technique uses a dual modality breast imaging system to place a marker composed of radiolabeled albumin (99mTc-MAA or 111ln-MAA) into the lesion. Preliminary studies were made to evaluate the localization accuracy of the system, which showed that the dual modality breast scanner is capable of accurate 3-dimensional localization using either X-ray or gamma ray imaging. A 3-axis needle positioning system was built and integrated into the dual modality breast scanner and its accuracy tested. A pilot clinical trial to evaluate the dual-modality surgical guidance technique was designed and preliminary clinical data collected. Detailed results were presented on the first three subjects; although a total of seven subjects have been recruited to the study to date. So far, it has been demonstrated that the radioguided surgery technique can be performed with approximately 10 times less radiomarker activity than is currently being used by other researchers employing 99mTc-MAA as a radiomarker, while maintaining comparable localization accuracy. Although the DMSG technique has not been tested in a large cohort of subjects, the preliminary data on the first few are encouraging. Feedback on the technique from the surgeons, for this limited population, has been positive. Recruitment to the study is ongoing.

Identifying poor performance among doctors in NHS organizations.

PubMed

Locke, Rachel; Scallan, Samantha; Leach, Camilla; Rickenbach, Mark

2013-10-01

To account for the means by which poor performance among career doctors is identified by National Health Service organizations, whether the tools are considered effective and how these processes may be strengthened in the light of revalidation and the requirement for doctors to demonstrate their fitness to practice. This study sought to look beyond the 'doctor as individual'; as well as considering the typical approaches to managing the practice of an individual, the systems within which the doctor is working were reviewed, as these are also relevant to standards of performance. A qualitative review was undertaken consisting of a literature review of current practice, a policy review of current documentation from 15 trusts in one deanery locality, and 14 semi-structured interviews with respondents with an overview of processes in use. The framework for the analysis of the data considered tools at three levels: individual, team and organizational. Tools are, in the main, reactive--with an individual focus. They rely on colleagues and others to speak out, so their effectiveness is hindered by a reluctance to do so. Tools can lack an evidence base for their use, and there is limited linking of data across contexts and tools. There is more work to be done in evaluating current tools and developing stronger processes. Linkage between data sources needs to be improved and proactive tools at the organizational level need further development to help with the early identification of performance issues. This would also assist in balancing a wider systems approach with a current over emphasis on individual doctors. © 2012 John Wiley & Sons Ltd.

Practice Innovation for Care Integration, Opioid Management, and Quality Measurement in Family Medicine.

PubMed

Neale, Anne Victoria; Bowman, Marjorie A; Seehusen, Dean A

Ringing in the new year 2017! This may finally be the year of real practice improvement after many false starts. Research into practice transformation has informed both local work and national policy. Human factors and payment structures are key. And payment structures depend on how quality is measured. Large gaps between practicing physician recommendations for the most important quality measures and those currently imposed externally are exposed in this issue. Also see information on in-practice social work consultations and their outcomes and recommendations from innovators in integrated care, and for chronic opioid therapy management based on visits to many family medicine offices. Visit entropy is negative for hospital readmissions. Another article reaffirms the importance of family physicians in rural obstetrics, including Cesarean deliveries. Two articles address changing Latino health care access. New Mexico's innovative health extension agent implementation now includes research in ways that benefit all. And a glass half-full: the growth in the diversity of family medicine faculty is above average, but is not occurring as quickly as in the general population. © Copyright 2017 by the American Board of Family Medicine.

Participatory approach: from problem identification to setting strategies for increased productivity and sustainability in small scale irrigated agriculture

NASA Astrophysics Data System (ADS)

Habtu, Solomon; Ludi, Eva; Jamin, Jean Yves; Oates, Naomi; Fissahaye Yohannes, Degol

2014-05-01

Practicing various innovations pertinent to irrigated farming at local field scale is instrumental to increase productivity and yield for small holder farmers in Africa. However the translation of innovations from local scale to the scale of a jointly operated irrigation scheme is far from trivial. It requires insight on the drivers for adoption of local innovations within the wider farmer communities. Participatory methods are expected to improve not only the acceptance of locally developed innovations within the wider farmer communities, but to allow also an estimation to which extend changes will occur within the entire irrigation scheme. On such a base, more realistic scenarios of future water productivity within an irrigation scheme, which is operated by small holder farmers, can be estimated. Initial participatory problem and innovation appraisal was conducted in Gumselassa small scale irrigation scheme, Ethiopia, from Feb 27 to March 3, 2012 as part of the EAU4FOOD project funded by EC. The objective was to identify and appraise problems which hinder sustainable water management to enhance production and productivity and to identify future research strategies. Workshops were conducted both at local (Community of Practices) and regional (Learning Practice Alliance) level. At local levels, intensive collaboration with farmers using participatory methods produced problem trees and a "Photo Safari" documented a range of problems that negatively impact on productive irrigated farming. A range of participatory methods were also used to identify local innovations. At regional level a Learning Platform was established that includes a wide range of stakeholders (technical experts from various government ministries, policy makers, farmers, extension agents, researchers). This stakeholder group did a range of exercise as well to identify major problems related to irrigated smallholder farming and already identified innovations. Both groups identified similar problems to productive smallholder irrigation: soil nutrient depletion, salinization, disease and pest resulting from inefficient irrigation practices, infrastructure problems leading to a reduction of the size of the command area and decrease in reservoir volume. The major causes have been poor irrigation infrastructure, poor on-farm soil and water management, prevalence of various crop pests and diseases, lack of inputs and reservoir siltation. On-farm participatory research focusing on soil, crop and water management issues, including technical, institutional and managerial aspects, to identify best performing innovations while taking care of the environment was recommended. Currently, a range of interlinked activities are implemented a multiple scales, combining participatory and scientific approaches towards innovation development and up-scaling of promising technologies and institutional and managerial approaches from local to regional scales. ____________________________ Key words: Irrigation scheme, productivity, innovation, participatory method, Gumselassa, Ethiopia

Seven Steps to the Diagnosis of NSAIDs Hypersensitivity: How to Apply a New Classification in Real Practice?

PubMed Central

Makowska, Joanna S.

2015-01-01

Frequent use of non-steroidal anti-inflammatory drugs (NSAIDs) has been paralleled by increasing occurrence of adverse reactions, which vary from mild local skin rashes or gastric irritation to severe, generalized symptoms and even life-threatening anaphylaxis. NSAID-induced hypersensitivity reactions may involve both immunological and non-immunological mechanisms and should be differentiated from type A adverse reactions. Clinical diagnosis and effective management of a hypersensitive patient cannot be achieved without identifying the underlying mechanism. In this review, we discuss the current classification of NSAID-induced adverse reactions and propose a practical diagnostic algorithm that involves 7 steps leading to the determination of the type of NSAID-induced hypersensitivity and allows for proper patient management. PMID:25749768

Quality assurance and improvement: the Pediatric Regional Anesthesia Network.

PubMed

Polaner, David M; Martin, Lynn D

2012-01-01

Quality assurance and improvement (QA/QI) is a critical activity in medicine. The use of large-scale collaborative databases is increasingly essential to obtain enough reports with which to establish standards of practice and define the incidence of complications and risk/benefit ratios for rare events. Such projects can enhance local QA/QI endeavors by enabling institutions to obtain benchmark data against which to compare their performance and can be used for prospective analyses of inter-institutional differences to determine 'best practice'. The pediatric regional anesthesia network (PRAN) is such a project. The first data cohort is currently being analyzed and offers insight into how such data can be used to detect trends in adverse events and improve care. © 2011 Blackwell Publishing Ltd.

Making COD statistics useful for public health at local level in the city of Cape Town: utilidad para la salud pública a nivel local en Ciudad del Cabo.

PubMed Central

Bradshaw, Debbie; Groenewald, Pamela; Bourne, David E.; Mahomed, Hassan; Nojilana, Beatrice; Daniels, Johan; Nixon, Jo

2006-01-01

OBJECTIVE: To review the quality of the coding of the cause of death (COD) statistics and assess the mortality information needs of the City of Cape Town. METHODS: Using an action research approach, a study was set up to investigate the quality of COD information, the accuracy of COD coding and consistency of coding practices in the larger health subdistricts. Mortality information needs and the best way of presenting the statistics to assist health managers were explored. FINDINGS: Useful information was contained in 75% of death certificates, but nearly 60% had only a single cause certified; 55% of forms were coded accurately. Disagreement was mainly because routine coders coded the immediate instead of the underlying COD. An abridged classification of COD, based on causes of public health importance, prevalent causes and selected combinations of diseases was implemented with training on underlying cause. Analysis of the 2001 data identified the leading causes of death and premature mortality and illustrated striking differences in the disease burden and profile between health subdistricts. CONCLUSION: Action research is particularly useful for improving information systems and revealed the need to standardize the coding practice to identify underlying cause. The specificity of the full ICD classification is beyond the level of detail on the death certificates currently available. An abridged classification for coding provides a practical tool appropriate for local level public health surveillance. Attention to the presentation of COD statistics is important to enable the data to inform decision-makers. PMID:16583080

Making COD statistics useful for public health at local level in the city of Cape Town: utilidad para la salud pública a nivel local en Ciudad del Cabo.

PubMed

Bradshaw, Debbie; Groenewald, Pamela; Bourne, David E; Mahomed, Hassan; Nojilana, Beatrice; Daniels, Johan; Nixon, Jo

2006-03-01

To review the quality of the coding of the cause of death (COD) statistics and assess the mortality information needs of the City of Cape Town. Using an action research approach, a study was set up to investigate the quality of COD information, the accuracy of COD coding and consistency of coding practices in the larger health subdistricts. Mortality information needs and the best way of presenting the statistics to assist health managers were explored. Useful information was contained in 75% of death certificates, but nearly 60% had only a single cause certified; 55% of forms were coded accurately. Disagreement was mainly because routine coders coded the immediate instead of the underlying COD. An abridged classification of COD, based on causes of public health importance, prevalent causes and selected combinations of diseases was implemented with training on underlying cause. Analysis of the 2001 data identified the leading causes of death and premature mortality and illustrated striking differences in the disease burden and profile between health subdistricts. Action research is particularly useful for improving information systems and revealed the need to standardize the coding practice to identify underlying cause. The specificity of the full ICD classification is beyond the level of detail on the death certificates currently available. An abridged classification for coding provides a practical tool appropriate for local level public health surveillance. Attention to the presentation of COD statistics is important to enable the data to inform decision-makers.

The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia.

PubMed

Suresh, Santhanam; Ecoffey, Claude; Bosenberg, Adrian; Lonnqvist, Per-Anne; de Oliveira, Gildasio S; de Leon Casasola, Oscar; de Andrés, José; Ivani, Giorgio

2018-02-01

Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Representatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Spinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07-0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children. High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice.

Review of Cryptosporidium and Giardia in the eastern part of Europe, 2016

PubMed Central

Plutzer, Judit; Lassen, Brian; Jokelainen, Pikka; Djurković-Djaković, Olgica; Kucsera, István; Dorbek-Kolin, Elisabeth; Šoba, Barbara; Sréter, Tamás; Imre, Kálmán; Omeragić, Jasmin; Nikolić, Aleksandra; Bobić, Branko; Živičnjak, Tatjana; Lučinger, Snježana; Stefanović, Lorena Lazarić; Kučinar, Jasmina; Sroka, Jacek; Deksne, Gunita; Keidāne, Dace; Kváč, Martin; Hůzová, Zuzana; Karanis, Panagiotis

2018-01-01

Introduction This paper reviews the current knowledge and understanding of Cryptosporidium spp. and Giardia spp. in humans, animals and the environment in 10 countries in the eastern part of Europe: Bosnia and Herzegovina, Croatia, Czech Republic, Estonia, Hungary, Latvia, Poland, Romania, Serbia and Slovenia. Methods: Published scientific papers and conference proceedings from the international and local literature, official national health service reports, national databases and doctoral theses in local languages were reviewed to provide an extensive overview on the epidemiology, diagnostics and research on these pathogens, as well as analyse knowledge gaps and areas for further research. Results: Cryptosporidium spp. and Giardia spp. were found to be common in eastern Europe, but the results from different countries are difficult to compare because of variations in reporting practices and detection methodologies used. Conclusion: Upgrading and making the diagnosis/detection procedures more uniform is recommended throughout the region. Public health authorities should actively work towards increasing reporting and standardising reporting practices as these prerequisites for the reported data to be valid and therefore necessary for appropriate control plans. PMID:29382412

Binaural hearing with electrical stimulation

PubMed Central

Kan, Alan; Litovsky, Ruth Y.

2014-01-01

Bilateral cochlear implantation is becoming a standard of care in many clinics. While much benefit has been shown through bilateral implantation, patients who have bilateral cochlear implants (CIs) still do not perform as well as normal hearing listeners in sound localization and understanding speech in noisy environments. This difference in performance can arise from a number of different factors, including the areas of hardware and engineering, surgical precision and pathology of the auditory system in deaf persons. While surgical precision and individual pathology are factors that are beyond careful control, improvements can be made in the areas of clinical practice and the engineering of binaural speech processors. These improvements should be grounded in a good understanding of the sensitivities of bilateral CI patients to the acoustic binaural cues that are important to normal hearing listeners for sound localization and speech in noise understanding. To this end, we review the current state-of-the-art in the understanding of the sensitivities of bilateral CI patients to binaural cues in electric hearing, and highlight the important issues and challenges as they relate to clinical practice and the development of new binaural processing strategies. PMID:25193553

16 CFR 315.11 - Effect on state and local laws.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Effect on state and local laws. 315.11 Section 315.11 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CONTACT LENS RULE § 315.11 Effect on state and local laws. (a) State and local laws and regulations that...

Evaluation of all African clinical practice guidelines for hypertension: Quality and opportunities for improvement.

PubMed

Okwen, Patrick Mbah; Maweu, Irene; Grimmer, Karen; Margarita Dizon, Janine

2018-06-14

Good-quality clinical practice guidelines (CPGs) provide recommendations based on current best-evidence summaries. Hypertension is a prevalent noncommunicable disease in Africa, with disastrous sequelae (stroke, heart, and kidney disease). Its effective management relies on good quality, current, locally relevant evidence. This paper reports on an all African review of the guidance documents currently informing hypertension management. Attempts were made to contact 62 African countries for formal guidance documents used nationally to inform diagnosis and management of hypertension. Their quality was assessed by using Appraisal of Guidelines for Research & Evaluation (AGREE) II, scored by 2 independent reviewers. Differences in domain scores were compared between documents written prior to 2011 and 2011 onward. Findings were compared with earlier African CPG reviews. Guidelines and protocols were provided by 26 countries. Six used country-specific stand-alone hypertension guidelines, and 10 used protocols embedded in Standard Treatment Guidelines for multiple conditions. Six used guidelines developed by the World Health Organization, and 4 indicated ad hoc use of international guidance (US, Portugal, and Brazil). Only 1 guidance document met CPG construction criteria, and none scored well on all AGREE domain scores. The lowest-scoring domain was rigour of development. There was no significant quality difference between pre-2011 and post-2011 guidance documents, and there were variable AGREE II scores for the same CPGs when comparing the African reviews. The quality of hypertension guidance used by African nations could be improved. The need for so many guidance documents is questioned. Adopting a common evidence base from international good-quality CPGs and layering it with local contexts offer 1 way to efficiently improve African hypertension CPG quality and implementation. © 2018 John Wiley & Sons, Ltd.

AAC services for multilingual populations: South African service provider perspectives.

PubMed

Tönsing, Kerstin M; van Niekerk, Karin; Schlünz, Georg I; Wilken, Ilana

In South Africa, many persons in need of augmentative and alternative communication (AAC) come from multilingual backgrounds. There is as yet a limited evidence base (locally and internationally) for the provision of AAC services to multilingual populations. The perspectives of service providers can assist in gaining an understanding of current practices and the factors that influence these. The study aimed to obtain the perspectives of AAC service providers about practices in providing AAC systems and AAC intervention to clients from multilingual backgrounds. Fifteen AAC service providers were purposefully chosen to participate in one of three focus groups - two face-to-face and one online focus group. Data from the face-to-face focus groups was transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data. Four overarching themes were identified, namely (a) current practices, (b) factors influencing current practices, (c) service provides' orientation towards different language options in AAC intervention, and (d) needs and desired developments regarding AAC technology. This paper reports on the first three themes. Service providers reported their practices to range from a focus on L1 exclusively, L2 exclusively, to a multilingual (sequential or simultaneous) approach. The South African language context, family language preferences and choices, service provider skill and knowledge, as well as AAC technology were identified as factors influencing their practices. Although many viewed access to multiple languages through AAC as positive, they also expressed concerns and reservations about providing multilingual AAC services. Although service providers in general saw the need to give clients from multilingual backgrounds access to multiple languages using AAC, this did not always translate into multilingual AAC practices. Both extrinsic factors (e.g. the lack of appropriate AAC devices, software and apps giving access to non-English languages) and intrinsic factors (service providers' language competency and their beliefs about the cognitive demands of multilingual AAC systems) influenced their practices and choices. Appropriate AAC service delivery to multilingual populations in South Africa would require not only appropriate AAC technology developments, but also research evidence to establish the efficacy of multilingual AAC interventions for clients with a variety of characteristics. Copyright © 2018 Elsevier Inc. All rights reserved.

Discourses in stroke rehabilitation as they present themselves in current physiotherapy and occupational therapy.

PubMed

Kristensen, Hanne Kaae; Præstegaard, Jeanette; Ytterberg, Charlotte

2017-02-01

Aim This study aims to discuss current perceptions of rehabilitation and how present rehabilitation practice is affected by dominating discourses in Danish society by exploring discourses expressed in official publications and the constructed journal notes of occupational and physiotherapists' practice of stroke rehabilitation. Method The frame of reference is Fairclough's critical discourse analysis. The analysis comprises seven official documents relevant to stroke rehabilitation provided in Danish health services in 2012-2013. Also, notes written by occupational therapists and physiotherapists in medical records of 10 patients with a stroke diagnosis admitted to hospital in 2012. The documents included were read thoroughly. The texts were analyzed deductively, focusing on discursive practice on articulated understandings of rehabilitation, health practice approaches, and social practice. Results The dominating discourses seem to be Western neoliberalism organizational, medical and ethical discourses. The macro level of discourses consisted of political documents addressing rehabilitation nationally. The meso level mainly concerned medical discourses within stroke rehabilitation whereas the micro level represented local medical and ethical discourses. Conclusion The neoliberal discourse supports the medical discourse with strong emphasis on evidence-based interventions. In contrast to ethical discourses, documentation of rehabilitation practice marked more attention being paid to facilitating the patient's independence than to enabling the regaining of meaningful activities and participation. Implications for Rehabilitation Individualized rehabilitation must be organized with flexibility as it is a complex process Critical reflectiveness among health professionals is needed to provide individualized rehabilitation of high quality A broader range of stake holders, including patient organizations, are in demand within health policy making The discourses that construct rehabilitation policy and practices are sometimes in conflict, which may impact on, and impede, the rehabilitation for the individual patient.

Practices for the disbudding and dehorning of dairy calves by veterinarians and dairy producers in Ontario, Canada.

PubMed

Winder, Charlotte B; LeBlanc, Stephen J; Haley, Derek B; Lissemore, Kerry D; Godkin, M Ann; Duffield, Todd F

2016-12-01

Disbudding and dehorning dairy calves is very common, despite the introduction of polled genetics to most dairy breeds. Appropriate pain-control practices for these procedures affect both calf welfare and public perception of the dairy industry. Previously published work has shown that North American dairy producers have not widely adopted use of these medications for disbudding or dehorning. However, since the last published work examining these practices in Canada, changes regarding awareness, availability, and future requirements for pain control have occurred in the industry. With this in mind, online and telephone surveys of both veterinarians (n=238) and dairy producers (n=603) in Ontario, Canada, were conducted in the fall of 2014 with a goal of describing current disbudding and dehorning practices and examining factors associated with the adoption of pain control use. Approximately three-quarters of dairy producers reported performing disbudding or dehorning themselves, whereas the remainder used a veterinarian or technician. Almost all (97%) of the veterinarians surveyed reported using local anesthetic, 62% used sedation, and 48% used a nonsteroidal anti-inflammatory drug. Producer use of local anesthetic was 62%, 38% used sedation and 24% used a nonsteroidal anti-inflammatory drug. Seventy-eight percent of veterinarian disbudding or dehorning was done before 8wk of age, whereas 64% of dairy producers performed this procedure before 8wk of age. Seventy-two percent of veterinarians and 63% of producers reported changing their disbudding or dehorning practices over the past 10 yr; of producers that changed their practices, 73% cited their herd veterinarian as influential. The use of pain control described in these surveys is higher than previously reported in Ontario. Identification of factors associated with best practices, or the lack of adoption of these practices, may help veterinarians target appropriate educational opportunities for their dairy clients. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Preparing Master of Public Health Graduates to Work in Local Health Departments.

PubMed

Hemans-Henry, Calaine; Blake, Janice; Parton, Hilary; Koppaka, Ram; Greene, Carolyn M

2016-01-01

To identify key competencies and skills that all master of public health (MPH) graduates should have to be prepared to work in a local health department. In 2011-2012, the New York City Department of Health and Mental Hygiene administered electronic surveys to 2 categories of staff: current staff with an MPH as their highest degree, and current hiring managers. In all, 312 (77%) staff members with an MPH as their highest degree and 170 (57%) hiring managers responded to the survey. Of the respondents with an MPH as their highest degree, 85% stated that their MPH program prepared them for work at the New York City Health Department. Skills for which MPH graduates most often stated they were underprepared included facility in using SAS® statistical software, quantitative data analysis/statistics, personnel management/leadership, and data collection/database management/data cleaning. Among the skills hiring managers identified as required of MPH graduates, the following were most often cited as those for which newly hired MPH graduates were inadequately prepared: quantitative data analysis, researching/conducting literature reviews, scientific writing and publication, management skills, and working with contracts/requests for proposals. These findings suggest that MPH graduates could be better prepared to work in a local health department upon graduation. To be successful, new MPH graduate hires should possess fundamental skills and knowledge related to analysis, communication, management, and leadership. Local health departments and schools of public health must each contribute to the development of the current and future public health workforce through both formal learning opportunities and supplementary employment-based training to reinforce prior coursework and facilitate practical skill development.

Private practice outcomes: validated outcomes data collection in private practice.

PubMed

Goldstein, Jack

2010-10-01

Improved patient care is related to validated outcome measures requiring the collection of three distinct data types: (1) demographics; (2) patient outcome measures; and (3) physician treatment. Previous impediments to widespread data collection have been: cost, office disruption, personnel requirements, physician motivation, data integration, and security. There are currently few means to collect data to be used for collaborative analysis. We therefore developed an inexpensive, patient-centric mechanism to reduce redundant data entry, limiting cost and personnel requirements. Using an intuitive touch-screen kiosk interface program, all data elements have been captured in a private practice setting since 2000. Developed for small to medium sized offices, this is scalable to larger organizations. Questionnaire navigation is patient driven, with demographics shared with EMR and billing systems. Integration of billing and EMR with outcomes minimizes cost and personnel time. Data are deidentified locally and may be centrally shared. Since data are entered by the patients, minimal personnel costs are incurred. Physician disincentives are minimized with cost reduction, time savings and ease of use. To date, we have collected high level data on most total joint patients, with excellent patient compliance. By addressing impediments to broad application, we may enable widespread local data collection in all practice settings. Data may be shared centrally, allowing comparative effectiveness research to become a reality. Future success will require broad physician participation, uniformity of data collected, and designation of a central site for receipt of data and its collaborative comparative analysis.

iElectrodes: A Comprehensive Open-Source Toolbox for Depth and Subdural Grid Electrode Localization.

PubMed

Blenkmann, Alejandro O; Phillips, Holly N; Princich, Juan P; Rowe, James B; Bekinschtein, Tristan A; Muravchik, Carlos H; Kochen, Silvia

2017-01-01

The localization of intracranial electrodes is a fundamental step in the analysis of invasive electroencephalography (EEG) recordings in research and clinical practice. The conclusions reached from the analysis of these recordings rely on the accuracy of electrode localization in relationship to brain anatomy. However, currently available techniques for localizing electrodes from magnetic resonance (MR) and/or computerized tomography (CT) images are time consuming and/or limited to particular electrode types or shapes. Here we present iElectrodes, an open-source toolbox that provides robust and accurate semi-automatic localization of both subdural grids and depth electrodes. Using pre- and post-implantation images, the method takes 2-3 min to localize the coordinates in each electrode array and automatically number the electrodes. The proposed pre-processing pipeline allows one to work in a normalized space and to automatically obtain anatomical labels of the localized electrodes without neuroimaging experts. We validated the method with data from 22 patients implanted with a total of 1,242 electrodes. We show that localization distances were within 0.56 mm of those achieved by experienced manual evaluators. iElectrodes provided additional advantages in terms of robustness (even with severe perioperative cerebral distortions), speed (less than half the operator time compared to expert manual localization), simplicity, utility across multiple electrode types (surface and depth electrodes) and all brain regions.

iElectrodes: A Comprehensive Open-Source Toolbox for Depth and Subdural Grid Electrode Localization

PubMed Central

Blenkmann, Alejandro O.; Phillips, Holly N.; Princich, Juan P.; Rowe, James B.; Bekinschtein, Tristan A.; Muravchik, Carlos H.; Kochen, Silvia

2017-01-01

The localization of intracranial electrodes is a fundamental step in the analysis of invasive electroencephalography (EEG) recordings in research and clinical practice. The conclusions reached from the analysis of these recordings rely on the accuracy of electrode localization in relationship to brain anatomy. However, currently available techniques for localizing electrodes from magnetic resonance (MR) and/or computerized tomography (CT) images are time consuming and/or limited to particular electrode types or shapes. Here we present iElectrodes, an open-source toolbox that provides robust and accurate semi-automatic localization of both subdural grids and depth electrodes. Using pre- and post-implantation images, the method takes 2–3 min to localize the coordinates in each electrode array and automatically number the electrodes. The proposed pre-processing pipeline allows one to work in a normalized space and to automatically obtain anatomical labels of the localized electrodes without neuroimaging experts. We validated the method with data from 22 patients implanted with a total of 1,242 electrodes. We show that localization distances were within 0.56 mm of those achieved by experienced manual evaluators. iElectrodes provided additional advantages in terms of robustness (even with severe perioperative cerebral distortions), speed (less than half the operator time compared to expert manual localization), simplicity, utility across multiple electrode types (surface and depth electrodes) and all brain regions. PMID:28303098

Design and short-term impact of an event to promote careers in clinical pharmacy.

PubMed

Ray, Sarah; Ticcioni, Andrew; Mueller, Robert; Battaglia, Jessica

2018-03-01

There is a role for local pharmacy organizations to promote clinical pharmacy and increase awareness to both potential and current pharmacy students. The Greater Milwaukee College of Clinical Pharmacy (GMCCP) chapter sought to promote clinical pharmacy amongst current and prospective pharmacy students to increase the knowledge, awareness, and interest in clinical pharmacy. Subcommittee members designed programming to introduce the basics of clinical pharmacy. Students from three schools of pharmacy and more than 40 colleges in the region were invited to the event. Didactic and discussion-based content was developed. Pharmacists from GMCCP were solicited as presenters, along with a current pharmacy student and resident. Participants were asked to complete pre-event and post-event surveys to assess their awareness of and interest in clinical pharmacy. Volunteer pharmacists were also surveyed after the event. Twenty-eight individuals attended the event. Nineteen students completed both the pre- and post-survey. The comparison between median score pre- and post-event was analyzed with the Wilcoxon Signed-Rank test. Students' awareness and knowledge of clinical pharmacy improved after attending the event. Students' interest in a career in clinical pharmacy also increased after attending the event. Nine of the thirteen volunteer breakout session pharmacists (69%) responded to the post-event survey. The majority strongly agreed that participants were interested in learning about their area of practice and asked meaningful questions appropriate for their area of practice. The Exploring Careers in Clinical Pharmacy event increased awareness of clinical pharmacy career choices available within the profession of pharmacy. Local, regional, and national pharmacy organizations may consider utilizing the diverse talent of their membership and collaborate with colleges of pharmacy or other organizations to impact the knowledge, awareness, and interest in clinical pharmacy as a future career choice for pre-pharmacy and current pharmacy students. Copyright © 2017 Elsevier Inc. All rights reserved.

12 CFR 308.101 - Scope of Local Rules.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Scope of Local Rules. 308.101 Section 308.101... PRACTICE AND PROCEDURE General Rules of Procedure § 308.101 Scope of Local Rules. (a) Subparts B and C of the Local Rules prescribe rules of practice and procedure to be followed in the administrative...

12 CFR 308.101 - Scope of Local Rules.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Scope of Local Rules. 308.101 Section 308.101... PRACTICE AND PROCEDURE General Rules of Procedure § 308.101 Scope of Local Rules. (a) Subparts B and C of the Local Rules prescribe rules of practice and procedure to be followed in the administrative...

Review: Towards the agroecological management of ruminants, pigs and poultry through the development of sustainable breeding programmes. II. Breeding strategies.

PubMed

Phocas, F; Belloc, C; Bidanel, J; Delaby, L; Dourmad, J Y; Dumont, B; Ezanno, P; Fortun-Lamothe, L; Foucras, G; Frappat, B; González-García, E; Hazard, D; Larzul, C; Lubac, S; Mignon-Grasteau, S; Moreno, C R; Tixier-Boichard, M; Brochard, M

2016-11-01

Agroecology uses ecological processes and local resources rather than chemical inputs to develop productive and resilient livestock and crop production systems. In this context, breeding innovations are necessary to obtain animals that are both productive and adapted to a broad range of local contexts and diversity of systems. Breeding strategies to promote agroecological systems are similar for different animal species. However, current practices differ regarding the breeding of ruminants, pigs and poultry. Ruminant breeding is still an open system where farmers continue to choose their own breeds and strategies. Conversely, pig and poultry breeding is more or less the exclusive domain of international breeding companies which supply farmers with hybrid animals. Innovations in breeding strategies must therefore be adapted to the different species. In developed countries, reorienting current breeding programmes seems to be more effective than developing programmes dedicated to agroecological systems that will struggle to be really effective because of the small size of the populations currently concerned by such systems. Particular attention needs to be paid to determining the respective usefulness of cross-breeding v. straight breeding strategies of well-adapted local breeds. While cross-breeding may offer some immediate benefits in terms of improving certain traits that enable the animals to adapt well to local environmental conditions, it may be difficult to sustain these benefits in the longer term and could also induce an important loss of genetic diversity if the initial pure-bred populations are no longer produced. As well as supporting the value of within-breed diversity, we must preserve between-breed diversity in order to maintain numerous options for adaptation to a variety of production environments and contexts. This may involve specific public policies to maintain and characterize local breeds (in terms of both phenotypes and genotypes), which could be used more effectively if they benefited from the scientific and technical resources currently available for more common breeds. Last but not least, public policies need to enable improved information concerning the genetic resources and breeding tools available for the agroecological management of livestock production systems, and facilitate its assimilation by farmers and farm technicians.

Wildlife uses and hunting patterns in rural communities of the Yucatan Peninsula, Mexico.

PubMed

Santos-Fita, Dídac; Naranjo, Eduardo J; Rangel-Salazar, José Luis

2012-10-02

Subsistence hunting is a traditional practice providing food and many other goods for households in the Yucatan Peninsula, southeast Mexico. Economic, demographic, and cultural change in this region drive wildlife habitat loss and local extinctions. Improving our understanding about current practices of wildlife use may support better management strategies for conserving game species and their habitat. We aimed to evaluate if wildlife use remained relevant for the subsistence of rural residents of the Yucatan Peninsula, as well as if local hunting practices were related to environmental, geographical, and cultural factors. Fieldwork was done between March 2010 and March 2011. Information was obtained through conversations, interviews, and participant observation. Record forms allowed recording animals hunted, biomass extracted, distance intervals to hunting sites, habitat types and seasonality of wildlife harvests. Data were analyzed using one-way Analysis of Variance, and Generalized Linear Models. Forty-six terrestrial vertebrate species were used for obtaining food, medicine, tools, adornments, pets, ritual objects, and for sale and mitigating damage. We recorded 968 animals taken in 664 successful hunting events. The Great Curassow, Ocellated Turkey, paca, white-tailed deer, and collared peccary were the top harvested species, providing 80.7% of biomass (10,190 kg). The numbers of animals hunted and biomass extracted declined as hunting distances increased from villages. Average per capita consumption was 4.65 ± 2.7 kg/person/year. Hunting frequencies were similar in forested and agricultural areas. Wildlife use, hunting patterns, and technologies observed in our study sites were similar to those recorded in previous studies for rural Mayan and mestizo communities in the Yucatan Peninsula and other Neotropical sites. The most heavily hunted species were those providing more products and by-products for residents. Large birds such as the Great Curassow and the Ocellated Turkey were extremely important for local hunters, representing around 40% of total prey taken. Our results suggest that hunting is frequent in our study areas. Low human densities allow low hunting pressure on most game species and favor conservation of the tropical forest. We suggest that co-management may help regulating hunting, prioritizing cultural practices of sustainable use and conservation for benefiting local users and animal populations.

Learning from the Cardiologists and Developing Eluting Stents Targeting the Mtor Pathway for Pulmonary Application; A Future Concept for Tracheal Stenosis

PubMed Central

Zarogoulidis, Paul; Darwiche, Kaid; Tsakiridis, Kosmas; Teschler, Helmut; Yarmus, Lonny; Zarogoulidis, Konstantinos; Freitag, Lutz

2014-01-01

Tracheal stenosis due to either benign or malignant disease is a situation that the pulmonary physicians and thoracic surgeons have to cope in their everyday clinical practice. In the case where tracheal stenosis is caused due to malignancy mini-interventional interventions with laser, apc, cryoprobe, balloon dilation or with combination of more than one equipment and technique can be used. On the other hand, in the case of a benign disease such as; tracheomalacia the clinician can immediately upon diagnosis proceed to the stent placement. In both situations however; it has been observed that the stents induce formation of granuloma tissue in both or one end of the stent. Therefore a frequent evaluation of the patient is necessary, taking also into account the nature of the primary disease. Evaluation methodologies identifying different types and extent of the trachea stenosis have been previously published. However; we still do not have an effective adjuvant therapy to prevent granuloma tissue formation or prolong already treated granuloma lesions. There have been proposed many mechanisms which induce the abnormal growth of the local tissue, such as; local pressure, local stress, inflammation and vascular endothelial growth factor overexpression. Immunomodulatory agents inhibiting the mTOR pathway are capable of inhibiting the inflammatory cascade locally. In the current mini-review we will try to present the current knowledge of drug eluting stents inhibiting the mTOR pathway and propose a future application of these stents as a local anti-proliferative treatment. PMID:24454525

Learning from the Cardiologists and Developing Eluting Stents Targeting the Mtor Pathway for Pulmonary Application; A Future Concept for Tracheal Stenosis.

PubMed

Zarogoulidis, Paul; Darwiche, Kaid; Tsakiridis, Kosmas; Teschler, Helmut; Yarmus, Lonny; Zarogoulidis, Konstantinos; Freitag, Lutz

2013-08-26

Tracheal stenosis due to either benign or malignant disease is a situation that the pulmonary physicians and thoracic surgeons have to cope in their everyday clinical practice. In the case where tracheal stenosis is caused due to malignancy mini-interventional interventions with laser, apc, cryoprobe, balloon dilation or with combination of more than one equipment and technique can be used. On the other hand, in the case of a benign disease such as; tracheomalacia the clinician can immediately upon diagnosis proceed to the stent placement. In both situations however; it has been observed that the stents induce formation of granuloma tissue in both or one end of the stent. Therefore a frequent evaluation of the patient is necessary, taking also into account the nature of the primary disease. Evaluation methodologies identifying different types and extent of the trachea stenosis have been previously published. However; we still do not have an effective adjuvant therapy to prevent granuloma tissue formation or prolong already treated granuloma lesions. There have been proposed many mechanisms which induce the abnormal growth of the local tissue, such as; local pressure, local stress, inflammation and vascular endothelial growth factor overexpression. Immunomodulatory agents inhibiting the mTOR pathway are capable of inhibiting the inflammatory cascade locally. In the current mini-review we will try to present the current knowledge of drug eluting stents inhibiting the mTOR pathway and propose a future application of these stents as a local anti-proliferative treatment.

Non-local currents and the structure of eigenstates in planar discrete systems with local symmetries

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

Röntgen, M., E-mail: mroentge@physnet.uni-hamburg.de; Morfonios, C.V., E-mail: christian.morfonios@physnet.uni-hamburg.de; Diakonos, F.K., E-mail: fdiakono@phys.uoa.gr

Local symmetries are spatial symmetries present in a subdomain of a complex system. By using and extending a framework of so-called non-local currents that has been established recently, we show that one can gain knowledge about the structure of eigenstates in locally symmetric setups through a Kirchhoff-type law for the non-local currents. The framework is applicable to all discrete planar Schrödinger setups, including those with non-uniform connectivity. Conditions for spatially constant non-local currents are derived and we explore two types of locally symmetric subsystems in detail, closed-loops and one-dimensional open ended chains. We find these systems to support locally similarmore » or even locally symmetric eigenstates. - Highlights: • We extend the framework of non-local currents to discrete planar systems. • Structural information about the eigenstates is gained. • Conditions for the constancy of non-local currents are derived. • We use the framework to design two types of example systems featuring locally symmetric eigenstates.« less

Environmental health risk assessment of dioxin in foods at the two most severe dioxin hot spots in Vietnam.

PubMed

Tuyet-Hanh, Tran Thi; Minh, Nguyen Hung; Vu-Anh, Le; Dunne, Michael; Toms, Leisa-Maree; Tenkate, Thomas; Thi, Minh-Hue Nguyen; Harden, Fiona

2015-07-01

Bien Hoa and Da Nang airbases were bulk storages for Agent Orange during the Vietnam War and currently are the two most severe dioxin hot spots. This study assesses the health risk of exposure to dioxin through foods for local residents living in seven wards surrounding these airbases. This study follows the Australian Environmental Health Risk Assessment Framework to assess the health risk of exposure to dioxin in foods. Forty-six pooled samples of commonly consumed local foods were collected and analyzed for dioxin/furans. A food frequency and Knowledge-Attitude-Practice survey was also undertaken at 1000 local households, various stakeholders were involved and related publications were reviewed. Total dioxin/furan concentrations in samples of local "high-risk" foods (e.g. free range chicken meat and eggs, ducks, freshwater fish, snail and beef) ranged from 3.8 pg TEQ/g to 95 pg TEQ/g, while in "low-risk" foods (e.g. caged chicken meat and eggs, seafoods, pork, leafy vegetables, fruits, and rice) concentrations ranged from 0.03 pg TEQ/g to 6.1 pg TEQ/g. Estimated daily intake of dioxin if people who did not consume local high risk foods ranged from 3.2 pg TEQ/kg bw/day to 6.2 pg TEQ/kg bw/day (Bien Hoa) and from 1.2 pg TEQ/kg bw/day to 4.3 pg TEQ/kg bw/day (Da Nang). Consumption of local high risk foods resulted in extremely high dioxin daily intakes (60.4-102.8 pg TEQ/kg bw/day in Bien Hoa; 27.0-148.0 pg TEQ/kg bw/day in Da Nang). Consumption of local "high-risk" foods increases dioxin daily intakes far above the WHO recommended TDI (1-4 pg TEQ/kg bw/day). Practicing appropriate preventive measures is necessary to significantly reduce exposure and health risk. Copyright © 2015 Elsevier GmbH. All rights reserved.

Modeling the Electrode-Neuron Interface of Cochlear Implants: Effects of Neural Survival, Electrode Placement, and the Partial Tripolar Configuration

PubMed Central

Goldwyn, Joshua H.; Bierer, Steven M.; Bierer, Julie A.

2010-01-01

The partial tripolar electrode configuration is a relatively novel stimulation strategies that can generate more spatially focused electric fields than the commonly used monopolar configuration. Focused stimulation strategies should improve spectral resolution in cochlear implant users, but may also be more sensitive to local irregularities in the electrode-neuron interface. In this study, we develop a practical computer model of cochlear implant stimulation that can simulate neural activation in a simplified cochlear geometry and we relate the resulting patterns of neural activity to basic psychophysical measures. We examine how two types of local irregularities in the electrode-neuron interface, variations in spiral ganglion nerve density and electrode position within the scala tympani, affect the simulated neural activation patterns and how these patterns change with electrode configuration. The model shows that higher partial tripolar fractions activate more spatially restricted populations of neurons at all current levels and require higher current levels to excite a given number of neurons. We find that threshold levels are more sensitive at high partial tripolar fractions to both types of irregularities, but these effects are not independent. In particular, at close electrode-neuron distances, activation is typically more spatially localized which leads to a greater influence of neural dead regions. PMID:20580801

What Is "Good" Mentoring? Understanding Mentoring Practices of Teacher Induction through Case Studies of Finland and Australia

ERIC Educational Resources Information Center

Pennanen, Matti; Bristol, Laurette; Wilkinson, Jane; Heikkinen, Hannu L. T.

2016-01-01

Mentoring is a practice widely utilised to support new teachers. However, in locally formed systems, the practice of mentoring is conditioned by traditions and arrangements specific to the site. To understand "good" mentoring, these local arrangements cannot be ignored. In this article, the theory of practice architectures is employed to…

Incorporating Local Wisdom Sasi into Marine Zoning to Increase the Resilience of a Marine Protected Area Network in Raja Ampat, Indonesia.

NASA Astrophysics Data System (ADS)

Purwanto, P., Jr.; Mangubhai, S.; Muhajir, M.; Hidayat, N. I.; Rumetna, L.; Awaludinnoer, A.; Thebu, K.

2016-02-01

The Raja Ampat government and local communities established 6 Marine Protected Areas (MPAs) in 2007 to protect the unique marine biodiversity and ensure sustainable fisheries in West Papua, Indonesia. Increasing human populations resulting in overfishing and the use of destructive fishing practices are the main threats and challenges the region faces. Biophysical, socioeconomic and climate change criteria and factors were developed for zoning the Raja Ampat MPA network. Resilience principles such as replication, habitat representation, protection of critical habitat and connectivity were applied to the final zoning design. Reef resilience data using global monitoring protocols were collected to provide insights into the resilience of different reefs to further guide zoning. Resilience rankings showed that fishing pressure on reef fish communities especially on piscivores, herbivores and excavators was the main factor lowering resilience in MPAs. In addition data were collected on `sasi' areas throughout the MPAs. Sasi is a type of traditional resource management practice used by local communities to open and close areas to fishing single or multiple fisheries species. Once the fishery recovers local communities then harvest the species for food or sale. Raja Ampat MPAs network managed as multi-objective zoning system. The current zoning system explicitly recognizes community sasi within Traditional Use Zones, which often are adjacent or close to No-Take Zones. The explicit inclusion of sasi areas within zoning plans for the MPAs will likely lead to good compliance by local communities, and the increase fish biomass. Improving the management of fisheries through the incorporation of traditional fisheries management will therefore increase the overall resilience of coral reefs in the Raja Ampat MPA network.

Biomonitoring of intermittent rivers and ephemeral streams in Europe: Current practice and priorities to enhance ecological status assessments.

PubMed

Stubbington, Rachel; Chadd, Richard; Cid, Núria; Csabai, Zoltán; Miliša, Marko; Morais, Manuela; Munné, Antoni; Pařil, Petr; Pešić, Vladimir; Tziortzis, Iakovos; Verdonschot, Ralf C M; Datry, Thibault

2018-03-15

Intermittent rivers and ephemeral streams (IRES) are common across Europe and dominate some Mediterranean river networks. In all climate zones, IRES support high biodiversity and provide ecosystem services. As dynamic ecosystems that transition between flowing, pool, and dry states, IRES are typically poorly represented in biomonitoring programmes implemented to characterize EU Water Framework Directive ecological status. We report the results of a survey completed by representatives from 20 European countries to identify current challenges to IRES status assessment, examples of best practice, and priorities for future research. We identify five major barriers to effective ecological status classification in IRES: 1. the exclusion of IRES from Water Framework Directive biomonitoring based on their small catchment size; 2. the lack of river typologies that distinguish between contrasting IRES; 3. difficulties in defining the 'reference conditions' that represent unimpacted dynamic ecosystems; 4. classification of IRES ecological status based on lotic communities sampled using methods developed for perennial rivers; and 5. a reliance on taxonomic characterization of local communities. Despite these challenges, we recognize examples of innovative practice that can inform modification of current biomonitoring activity to promote effective IRES status classification. Priorities for future research include reconceptualization of the reference condition approach to accommodate spatiotemporal fluctuations in community composition, and modification of indices of ecosystem health to recognize both taxon-specific sensitivities to intermittence and dispersal abilities, within a landscape context. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Language Ideologies and Local Languages as the Medium-of-Instruction Policy: A Critical Ethnography of a Multilingual School in Nepal

ERIC Educational Resources Information Center

Phyak, Prem

2013-01-01

This paper analyzes the ideologies and practices of local languages as the medium-of-instruction (MOI) policy in a multilingual school in Nepal. Grounded on the notion of language policy as a locally situated social practice, this critical ethnographic study investigates challenges--both ideological and implementational--that local languages MOI…

Food plants used during traditional wrestling in Kabyè land of Togo.

PubMed

Kpatcha, Tchazou; Agbonon, Amegnona; Gbeassor, Messanvi

2016-01-01

In the traditional sports like the fight, natural products from minerals, animals and plants are used to increase physical resistance and performance. For a better understanding of this practice, an ethnopharmacological survey was carried out in kabyè land, North of Togo, to identify current plants used as foods plants during traditional wrestling. Ethnopharmacological data were collected through semi-structured method and personal interviews in the Kabyè locality during traditional wrestling. At least, twelve villages were surveyed in the study. Results indicated that 57 plants are widely used by local people as food plants generally during wrestling time. These plants are used traditionally for many others purposes. We concluded that these plants may serve as sources for pharmacological investigations in physical performance improvement.

Food plants used during traditional wrestling in Kabyè land of Togo

PubMed Central

Kpatcha, Tchazou; Agbonon, Amegnona; Gbeassor, Messanvi

2016-01-01

Introduction In the traditional sports like the fight, natural products from minerals, animals and plants are used to increase physical resistance and performance. For a better understanding of this practice, an ethnopharmacological survey was carried out in kabyè land, North of Togo, to identify current plants used as foods plants during traditional wrestling. Methods Ethnopharmacological data were collected through semi-structured method and personal interviewsin the Kabyè locality during traditional wrestling. At least, twelve villages were surveyed in the study. Results Results indicated that 57 plants are widely used by local people as food plants generally during wrestling time. These plants are used traditionally for many others purposes. Conclusion We concluded that these plants may serve as sources for pharmacological investigations in physical performance improvement. PMID:27200130

The European Society of Therapeutic Radiology and Oncology-European Institute of Radiotherapy (ESTRO-EIR) report on 3D CT-based in-room image guidance systems: a practical and technical review and guide.

PubMed

Korreman, Stine; Rasch, Coen; McNair, Helen; Verellen, Dirk; Oelfke, Uwe; Maingon, Philippe; Mijnheer, Ben; Khoo, Vincent

2010-02-01

The past decade has provided many technological advances in radiotherapy. The European Institute of Radiotherapy (EIR) was established by the European Society of Therapeutic Radiology and Oncology (ESTRO) to provide current consensus statement with evidence-based and pragmatic guidelines on topics of practical relevance for radiation oncology. This report focuses primarily on 3D CT-based in-room image guidance (3DCT-IGRT) systems. It will provide an overview and current standing of 3DCT-IGRT systems addressing the rationale, objectives, principles, applications, and process pathways, both clinical and technical for treatment delivery and quality assurance. These are reviewed for four categories of solutions; kV CT and kV CBCT (cone-beam CT) as well as MV CT and MV CBCT. It will also provide a framework and checklist to consider the capability and functionality of these systems as well as the resources needed for implementation. Two different but typical clinical cases (tonsillar and prostate cancer) using 3DCT-IGRT are illustrated with workflow processes via feedback questionnaires from several large clinical centres currently utilizing these systems. The feedback from these clinical centres demonstrates a wide variability based on local practices. This report whilst comprehensive is not exhaustive as this area of development remains a very active field for research and development. However, it should serve as a practical guide and framework for all professional groups within the field, focussed on clinicians, physicists and radiation therapy technologists interested in IGRT. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Interpretation of the MEG-MUSIC scan in biomagnetic source localization

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

Mosher, J.C.; Lewis, P.S.; Leahy, R.M.

1993-09-01

MEG-Music is a new approach to MEG source localization. MEG-Music is based on a spatio-temporal source model in which the observed biomagnetic fields are generated by a small number of current dipole sources with fixed positions/orientations and varying strengths. From the spatial covariance matrix of the observed fields, a signal subspace can be identified. The rank of this subspace is equal to the number of elemental sources present. This signal sub-space is used in a projection metric that scans the three dimensional head volume. Given a perfect signal subspace estimate and a perfect forward model, the metric will peak atmore » unity at each dipole location. In practice, the signal subspace estimate is contaminated by noise, which in turn yields MUSIC peaks which are less than unity. Previously we examined the lower bounds on localization error, independent of the choice of localization procedure. In this paper, we analyzed the effects of noise and temporal coherence on the signal subspace estimate and the resulting effects on the MEG-MUSIC peaks.« less

Relative Localization in Wireless Sensor Networks for Measurement of Electric Fields under HVDC Transmission Lines

PubMed Central

Cui, Yong; Wang, Qiusheng; Yuan, Haiwen; Song, Xiao; Hu, Xuemin; Zhao, Luxing

2015-01-01

In the wireless sensor networks (WSNs) for electric field measurement system under the High-Voltage Direct Current (HVDC) transmission lines, it is necessary to obtain the electric field distribution with multiple sensors. The location information of each sensor is essential to the correct analysis of measurement results. Compared with the existing approach which gathers the location information by manually labelling sensors during deployment, the automatic localization can reduce the workload and improve the measurement efficiency. A novel and practical range-free localization algorithm for the localization of one-dimensional linear topology wireless networks in the electric field measurement system is presented. The algorithm utilizes unknown nodes' neighbor lists based on the Received Signal Strength Indicator (RSSI) values to determine the relative locations of nodes. The algorithm is able to handle the exceptional situation of the output permutation which can effectively improve the accuracy of localization. The performance of this algorithm under real circumstances has been evaluated through several experiments with different numbers of nodes and different node deployments in the China State Grid HVDC test base. Results show that the proposed algorithm achieves an accuracy of over 96% under different conditions. PMID:25658390

Relative localization in wireless sensor networks for measurement of electric fields under HVDC transmission lines.

PubMed

Cui, Yong; Wang, Qiusheng; Yuan, Haiwen; Song, Xiao; Hu, Xuemin; Zhao, Luxing

2015-02-04

In the wireless sensor networks (WSNs) for electric field measurement system under the High-Voltage Direct Current (HVDC) transmission lines, it is necessary to obtain the electric field distribution with multiple sensors. The location information of each sensor is essential to the correct analysis of measurement results. Compared with the existing approach which gathers the location information by manually labelling sensors during deployment, the automatic localization can reduce the workload and improve the measurement efficiency. A novel and practical range-free localization algorithm for the localization of one-dimensional linear topology wireless networks in the electric field measurement system is presented. The algorithm utilizes unknown nodes' neighbor lists based on the Received Signal Strength Indicator (RSSI) values to determine the relative locations of nodes. The algorithm is able to handle the exceptional situation of the output permutation which can effectively improve the accuracy of localization. The performance of this algorithm under real circumstances has been evaluated through several experiments with different numbers of nodes and different node deployments in the China State Grid HVDC test base. Results show that the proposed algorithm achieves an accuracy of over 96% under different conditions.

Complex Socio-Ecological Dynamics driven by extreme events in the Amazon

NASA Astrophysics Data System (ADS)

Pinho, P. F.

2015-12-01

Several years with extreme floods or droughts in the past decade have caused human suffering in remote communities of the Brazilian Amazon. Despite documented local knowledge and practices for coping with the high seasonal variability characteristic of the region's hydrology (e.g. 10m change in river levels between dry and flood seasons), and despite 'civil Defense' interventions by various levels of government, the more extreme years seem to have exceeded the coping capacity of the community. In this paper, we explore whether there is a real increase in variability, whether the community perceives that recent extreme events are outside the experience which shapes their responses to 'normal' levels of variability, and what science-based policy could contribute to greater local resilience. Hydrological analyses suggest that variability is indeed increasing, in line with expectations from future climate change. However, current measures of hydrological regimes do not predict years with social hardship very well. Interviewees in two regions are able to express their strategies for dealing with 'normal' variability very well, but also identify ways in which abnormal years exceed their ability to cope. Current Civil Defense arrangements struggle to deliver emergency assistance in a sufficiently timely and locally appropriate fashion. Combining these insights in the context of social-ecological change, we suggest how better integration of science, policy and local knowledge could improve resilience to future trends, and identify some contributions science could make into such an arrangement.

International workshop on "professionalism in the practice of medicine- where are we now?"

PubMed

Paltiel, Ora; Lowenstein, Lior; Demma, Jonathan; Manor, Orly

2017-04-03

Medical professionalism refers to attributes, values, behaviors, responsibilities and commitments of physicians that are congruent with the public's expectations. An international workshop on medical professionalism took place at the Dead Sea, Israel, on December 11-12, 2016. The meeting brought together local medical professionals, physicians and others, as well as international experts, to discuss definitions of professionalism and wrestle with current challenges facing the profession including its perceived status and physician satisfaction, unprofessional behavior and its relation to health care quality and patient safety, and professionalism as a learned competence. Individual medical schools reported on educational efforts to promote professionalism in their curricula. Patient complaints as an improvement mechanism were explored on a national and health plan level. I was found that complaints regarding physician behavior are rare in the Israeli context and need to be dealt with expeditiously at a local level in order to be effective tools for change. The meeting provided a venue to understand local and international strategies and mechanism for regulation and self-regulation, highlighting the role of the Israel Medical Association. A major focus of the meeting was on intergenerational differences in attitude and practice and the necessary adaptation of medicine to the digital age. We provide an overview of the topics addressed, synopsis, evaluation and lessons learned in this first-ever national meeting on medical professionalism in Israel.

Climate change mitigation and adaptation in the land use sector: from complementarity to synergy.

PubMed

Duguma, Lalisa A; Minang, Peter A; van Noordwijk, Meine

2014-09-01

Currently, mitigation and adaptation measures are handled separately, due to differences in priorities for the measures and segregated planning and implementation policies at international and national levels. There is a growing argument that synergistic approaches to adaptation and mitigation could bring substantial benefits at multiple scales in the land use sector. Nonetheless, efforts to implement synergies between adaptation and mitigation measures are rare due to the weak conceptual framing of the approach and constraining policy issues. In this paper, we explore the attributes of synergy and the necessary enabling conditions and discuss, as an example, experience with the Ngitili system in Tanzania that serves both adaptation and mitigation functions. An in-depth look into the current practices suggests that more emphasis is laid on complementarity-i.e., mitigation projects providing adaptation co-benefits and vice versa rather than on synergy. Unlike complementarity, synergy should emphasize functionally sustainable landscape systems in which adaptation and mitigation are optimized as part of multiple functions. We argue that the current practice of seeking co-benefits (complementarity) is a necessary but insufficient step toward addressing synergy. Moving forward from complementarity will require a paradigm shift from current compartmentalization between mitigation and adaptation to systems thinking at landscape scale. However, enabling policy, institutional, and investment conditions need to be developed at global, national, and local levels to achieve synergistic goals.

Management of climatic heat stress risk in construction: a review of practices, methodologies, and future research.

PubMed

Rowlinson, Steve; Yunyanjia, Andrea; Li, Baizhan; Chuanjingju, Carrie

2014-05-01

Climatic heat stress leads to accidents on construction sites brought about by a range of human factors emanating from heat induced illness, and fatigue leading to impaired capability, physical and mental. It is an occupational characteristic of construction work in many climates and the authors take the approach of re-engineering the whole safety management system rather than focusing on incremental improvement, which is current management practice in the construction industry. From a scientific viewpoint, climatic heat stress is determined by six key factors: (1) air temperature, (2) humidity, (3) radiant heat, and (4) wind speed indicating the environment, (5) metabolic heat generated by physical activities, and (6) "clothing effect" that moderates the heat exchange between the body and the environment. By making use of existing heat stress indices and heat stress management processes, heat stress risk on construction sites can be managed in three ways: (1) control of environmental heat stress exposure through use of an action-triggering threshold system, (2) control of continuous work time (CWT, referred by maximum allowable exposure duration) with mandatory work-rest regimens, and (3) enabling self-paced working through empowerment of employees. Existing heat stress practices and methodologies are critically reviewed and the authors propose a three-level methodology for an action-triggering, localized, simplified threshold system to facilitate effective decisions by frontline supervisors. The authors point out the need for "regional based" heat stress management practices that reflect unique climatic conditions, working practices and acclimatization propensity by local workers indifferent geographic regions. The authors set out the case for regional, rather than international, standards that account for this uniqueness and which are derived from site-based rather than laboratory-based research. Copyright © 2013 Elsevier Ltd. All rights reserved.

Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians

PubMed Central

Ramsay, Jean; Rutterford, Clare; Gregory, Alison; Dunne, Danielle; Eldridge, Sandra; Sharp, Debbie; Feder, Gene

2012-01-01

Background Domestic violence affects one in four women and has significant health consequences. Women experiencing abuse identify doctors and other health professionals as potential sources of support. Primary care clinicians agree that domestic violence is a healthcare issue but have been reluctant to ask women if they are experiencing abuse. Aim To measure selected UK primary care clinicians’ current levels of knowledge, attitudes, and clinical skills in this area. Design and setting Prospective observational cohort in 48 general practices from Hackney in London and Bristol, UK. Method Administration of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), comprising five sections: responder profile, background (perceived preparation and knowledge), actual knowledge, opinions, and practice issues. Results Two hundred and seventy-two (59%) clinicians responded. Minimal previous domestic violence training was reported by participants. Clinicians only had basic knowledge about domestic violence but expressed a positive attitude towards engaging with women experiencing abuse. Many clinicians felt poorly prepared to ask relevant questions about domestic violence or to make appropriate referrals if abuse was disclosed. Forty per cent of participants never or seldom asked about abuse when a woman presented with injuries. Eighty per cent said that they did not have an adequate knowledge of local domestic violence resources. GPs were better prepared and more knowledgeable than practice nurses; they also identified a higher number of domestic violence cases. Conclusion Primary care clinicians’ attitudes towards women experiencing domestic violence are generally positive but they only have basic knowledge of the area. Both GPs and practice nurses need more comprehensive training on assessment and intervention, including the availability of local domestic violence services. PMID:22947586

An audit of clinical practice, referral patterns, and appropriateness of clinical indications for brain MRI examinations: A single-centre study in Ghana.

PubMed

Piersson, A D; Nunoo, G; Gorleku, P N

2018-05-01

The aim of this study was to investigate current brain MRI practice, pattern of brain MRI requests, and their appropriateness using the American College of Radiology (ACR) Appropriateness Criteria. We used direct observation and questionnaires to obtain data concerning routine brain MRI practice. We then retrospectively analyzed (i) demographic characteristics, (ii) clinical history, and (iii) appropriateness of brain MRI requests against published criteria. All patients were administered the screening questionnaire; however, no reviews were undertaken directly with patients, and no signature of the radiographer was recorded. Apart from routine brain protocol, there were dedicated protocols for epilepsy and stroke. Brain MRI images from 161 patients (85 Males; 76 Females) were analyzed. The age group with most brain MRI requests were from 26 to 45 year olds. The commonest four clinical indications for imaging were brain tumour, headache, seizure, and stroke. Using the ACR Appropriateness Criteria, almost 43% of the brain MRI scans analyzed were found to be "usually appropriate", 38% were "maybe appropriate" and 19% were categorized as "usually not appropriate". There was knowledge gap with regards to MRI safety in local practice, thus there is the utmost need for MRI safety training. Data on the commonest indications for performing brain MRI in this study should be used to inform local neuroradiological practice. Dedicated stroke and epilepsy MRI protocols require additional sequences i.e. MRA and 3D T1 volume acquisition, respectively. The ACR Appropriateness Criteria is recommended for use by the referring practitioners to improve appropriateness of brain MRI requests. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

'The child that tiire doesn't give you, God won't give you either.' The role of Rotheca myricoides in Somali fertility practices.

PubMed

Mire, Sada

2016-12-01

The paper introduces the Baanashada Dumarka, a Somali fertility therapy carried out by a spirit medium, known locally as 'Alaqad. Baanashada is aimed at women whose fertility issues are believed to be caused by spirits. The study also explores a component of the Baanashada, namely, the use of tiire (Rotheca myricoides), or the butterfly bush. Although Rotheca myricoides is known to possess a number of medicinal components as confirmed by studies of modern science, so far, there exist no studies on its potential (or lack of) fertility effects. Hence, the alleged fertility benefits of the butterfly bush need examining. In 2008 a British Somali woman died of herbs placed in her cervix by a traditional healer in Somaliland. This piece of information indicated not only the role of herbal medicine in fertility practices, but also the popularity of traditional reproductive medicine beyond border, class or educational background. Yet, current research into Somali women's health focuses mainly on Female Genital Mutilation (FGM), examined often without the context of wider cultural practices. This paper, however, suggests that rituals, beliefs and material culture play a paramount role in women's practices. For example, as explored elsewhere, the wagar, a wooden and sacred object made of the African olive, is critical for fertility practices. The current paper illuminates further the significance of reproduction practices in Somali society and the potential continuity of traditions associated with the perpetuation of kinship. It concludes that fertility rituals are part of a wider context of interaction with sacred landscapes, objects and archaeological sites, often associated with past legends in the Horn of Africa.

The world as the new local clinic: a critical analysis of three discourses of global medical competency.

PubMed

Martimianakis, Maria Athina Tina; Hafferty, Frederic W

2013-06-01

The effects of globalization on health are the focus of administrators, educators, policy makers and researchers as they work to consider how best to train and regulate health professionals to practice in a globalized world. This study explores what happens to constructs such as medical competence when the context of medical practice is discursively expanded to include the whole world. An archive of texts was assembled (1970-2011) totaling 1100 items and analyzed using a governmentality approach. Texts were included that articulated rationales for pursuing global education activities, and/or that implicitly or explicitly took a position on medical competencies in relation to practicing medicine in international or culturally diverse contexts, or in dealing with health issues as global concerns. The analysis revealed three distinct visions, representative of a primarily western mentality, for preparing physicians to practice in a globalized world: the universal global physician, the culturally versed global physician and the global physician advocate. Each has its own epistemological relationship to globalization and is supported by an evidence base. All three discourses are active and productive, sometimes within the same context. However, the discourse of the universal global physician is currently the most established. The challenge to policy makers and educators in evolving regulatory frameworks and curricula that are current and relevant necessitates a better understanding of the socio-political effects of globalization on medical education, and the ethical, political, cultural and scientific issues underlying efforts to prepare students to practice competently in a globalized world. Copyright © 2013 Elsevier Ltd. All rights reserved.

Preparedness and Emergency Response Learning Centers: supporting the workforce for national health security.

PubMed

Richmond, Alyson L; Sobelson, Robyn K; Cioffi, Joan P

2014-01-01

The importance of a competent and prepared national public health workforce, ready to respond to threats to the public's health, has been acknowledged in numerous publications since the 1980s. The Preparedness and Emergency Response Learning Centers (PERLCs) were funded by the Centers for Disease Control and Prevention in 2010 to continue to build upon a decade of focused activities in public health workforce preparedness development initiated under the Centers for Public Health Preparedness program (http://www.cdc.gov/phpr/cphp/). All 14 PERLCs were located within Council on Education for Public Health (CEPH) accredited schools of public health. These centers aimed to improve workforce readiness and competence through the development, delivery, and evaluation of targeted learning programs designed to meet specific requirements of state, local, and tribal partners. The PERLCs supported organizational and community readiness locally, regionally, or nationally through the provision of technical consultation and dissemination of specific, practical tools aligned with national preparedness competency frameworks and public health preparedness capabilities. Public health agencies strive to address growing public needs and a continuous stream of current and emerging public health threats. The PERLC network represented a flexible, scalable, and experienced national learning system linking academia with practice. This system improved national health security by enhancing individual, organizational, and community performance through the application of public health science and learning technologies to frontline practice.

Promoting Evidence-Based Decision Making in a Local Health Department, Pueblo City–County, Colorado

PubMed Central

Nevin-Woods, Christine; Proud, Sylvia; Brownson, Ross C.

2015-01-01

Background Evidence-based decision making (EBDM) is an effective strategy for addressing population health needs. Assessing and reducing barriers to using EBDM in local health departments may improve practice and provide insight into disseminating EBDM principles among public health practitioners. Community Context Administrative leaders at the Pueblo City–County Health Department, Pueblo, Colorado, used a systematic approach for implementing EBDM. Research partners engaged staff to understand factors that increase or deter its use. Methods A survey was distributed to staff members at baseline to identify gaps in administrative and individual practice of EBDM. In-depth interviews were also conducted with 11 randomly selected staff members. Results were shared with staff and administration, after which activities were implemented to improve application of EBDM. A follow up survey was administered 1 year after the initial assessment. Outcome Survey data showed evidence of progress in engaging and educating staff members, and data showed improved attitudes toward EBDM (ie, several items showed significant improvement from baseline to follow-up). For example, staff members reported having the necessary skills to develop evidence-based interventions (73.9%), the ability to effectively communicate information on evidence-based strategies to policy makers (63.0%), access to current information on improving EBDM processes (65.2%), and a belief that evidence-based interventions are designed to be self-sustaining (43.5%). Interpretation Within a local health department in which leaders have made EBDM a priority, addressing the culture and climate of the department may build EBDM. Future research may provide insight into tailoring EBDM within and across local health departments. PMID:26111156

Promoting Evidence-Based Decision Making in a Local Health Department, Pueblo City-County, Colorado.

PubMed

Hardy, Anna K; Nevin-Woods, Christine; Proud, Sylvia; Brownson, Ross C

2015-06-25

Evidence-based decision making (EBDM) is an effective strategy for addressing population health needs. Assessing and reducing barriers to using EBDM in local health departments may improve practice and provide insight into disseminating EBDM principles among public health practitioners. Administrative leaders at the Pueblo City-County Health Department, Pueblo, Colorado, used a systematic approach for implementing EBDM. Research partners engaged staff to understand factors that increase or deter its use. A survey was distributed to staff members at baseline to identify gaps in administrative and individual practice of EBDM. In-depth interviews were also conducted with 11 randomly selected staff members. Results were shared with staff and administration, after which activities were implemented to improve application of EBDM. A follow up survey was administered 1 year after the initial assessment. Survey data showed evidence of progress in engaging and educating staff members, and data showed improved attitudes toward EBDM (ie, several items showed significant improvement from baseline to follow-up). For example, staff members reported having the necessary skills to develop evidence-based interventions (73.9%), the ability to effectively communicate information on evidence-based strategies to policy makers (63.0%), access to current information on improving EBDM processes (65.2%), and a belief that evidence-based interventions are designed to be self-sustaining (43.5%). Within a local health department in which leaders have made EBDM a priority, addressing the culture and climate of the department may build EBDM. Future research may provide insight into tailoring EBDM within and across local health departments.

Foreign exam management in practice: seamless access to foreign images and results in a regional environment.

PubMed

Nagels, Jason; MacDonald, David; Parker, David

2015-04-01

A challenge for many clinical users is that a patient may receive a diagnostic imaging (DI) service at a number of hospitals or private imaging clinics. The DI services that patients receive at other locations could be clinically relevant to current treatments, but typically, there is no seamless method for a clinical user to access longitudinal DI results for their patient. Radiologists, and other specialists that are intensive users of image data, require seamless ingestion of foreign exams into the picture archiving and communication system (PACS) to achieve full clinical value. Most commonly, a clinical user will depend on the patient to bring in a CD that contains imaging from another location. However, a number of issues can arise when using this type of solution. Firstly, a CD will not provide the clinical user with the full longitudinal record of the patient. Secondly, a CD often will not contain the report associated with the images. Finally, a CD is not seamless, due to the need to manually import the contents of the CD into the local PACS. In order to overcome these limitations, and provide clinical users with a greater benefit related to a patient's longitudinal DI history, the implementation of foreign exam management (FEM) at the local site level is required. This paper presents the experiences of FEM in practice. By leveraging industry standards and edge devices to support FEM, multiple sites with disparate PACS and radiology information system (RIS) vendors are able to seamlessly ingest foreign exams within their local PACS as if they are local exams.

Breast-feeding: encourage mothers to "give it a go"!

PubMed

Carson, Christine

2005-01-01

Breast-feeding is a part of the Government health agenda with a particular emphasis on encouraging those mothers who are least likely to breast-feed. Current and recent breast-feeding support materials from the Department of Health outline good practice for Primary Care Trusts, in line with targets for the increase in breast-feeding initiation. Breast-feeding reduces health inequalities, in the short and long term. The 2005 National Breastfeeding Awareness Week has the key message "Give it a go!" and materials including a Local Action booklet are available.

GASB proposes new standards for financial reporting of postemployment benefits by state and local governments.

PubMed

Johnson, Karl D

2003-03-01

GASB has proposed new standards that will affect the way in which governments report postemployment health care benefits in audited external financial statements, resulting in more complete and transparent reporting by employers and plans and more relevant and useful information for the users of governmental financial reports. This article provides an overview of current financial reporting standards and practice, the financial reporting objectives of the project, the proposed measurement approach, noteworthy specific proposals, and the projected timetable for completion of the project and implementation of the new standards.

Globalization and its discontents: challenges to developmental theory and practice in Africa.

PubMed

Super, Charles M; Harkness, Sara

2008-04-01

The three contributions to this Special Section on Culture and Human Development are summarized and critiqued. In considering the nature of contemporary psychological science, as well as applications to early childhood care and development, education to prevent HIV/AIDS, and formal academic education, the various authors are in general agreement on the limitations of current knowledge as it applies to African populations. There is also a common focus on the promise of scientific procedures that take seriously the importance of local understandings, institutions, and social settings.

The use of local anesthesia during dental rehabilitations: a survey of AAPD members.

PubMed

Townsend, Janice A; Martin, Ashla; Hagan, Joseph L; Needleman, Howard

2013-01-01

The purpose of this study was to document current practices among pediatric and general dentists who are members of the American Academy of Pediatric Dentistry (AAPD) regarding the use of local anesthesia (LA) on children undergoing dental rehabilitation under general anesthesia (GA). A survey was administered via e-mail to AAPD members to document the use of LA during dental rehabilitations under GA and the rationales for its use. A total of 952 of 5,599 members responded to this survey; 79 percent of respondents use LA at least part of the time during dental rehabilitations under GA. "Improved patient recovery" was the most commonly cited rationale for administering LA. Extraction of permanent and primary teeth were the two most common procedures cited for the use of LA, respectively. There is no consensus among the respondents on the use of local anesthesia during dental rehabilitation under general anesthesia, but the majority responded that it does play a role in their perioperative patient management.

Adult education and the challenges of regional development: Policy and sustainability in North Denmark

NASA Astrophysics Data System (ADS)

Rasmussen, Palle; Staugaard, Hans Jørgen

2016-10-01

Adult education is governed at many levels - internationally, nationally and locally. The authors of this paper look at the challenges, structures and practices of adult education policy at the local level, more specifically in North Denmark (Northern Jutland), one of the five administrative regions of the Danish nation-state. In many ways, the current educational challenges in this remote region of Europe are similar to what can be observed worldwide and especially in countries which are generally considered welfare states. The authors see the growing social and educational divide between the region's peripheral areas and its largest city centre as a major challenge - for society as a whole and for adult education in particular. It is from this perspective that the authors describe the present structures of adult education in the region and the strategies employed by local authorities and educational institutions. This is followed by an evaluation of both structures and efforts in terms of their ability to cope with the challenges.

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

Sato, M.; Kamide, Y.; Richmond, A.D.

A new technique is presented to estimate electric fields and currents in a localized region of the high-latitude ionosphere by combining two magnetogram-inversion algorithms. This paper describes the concept and practical procedures of the method as well as the first results of our efforts in which this new scheme is applied to northern Scandinavia, computing the ionospheric parameters on a small scale. Examining latitudinal profiles of these parameters and precipitating particles, it is found that the region of the most intense precipitation in the morning sector is located equatorward of the region of the strongest electric field. To evaluate themore » relative importance of ionospheric and magnetospheric effects, the field-aligned current is divided into two components: (del Sigma) dot E and Sigma del dot E. These two components give often the opposite directions in the resultant field-aligned currents. The relative strength of the two components appears to vary considerably with latitude.« less

Influence of manufacturing practices on quality of pharmaceutical products manufactured in Kenya.

PubMed

Orwa, J A; Keter, L K; Ouko, S P A; Kibwage, I O; Rukunga, G M

2004-06-01

To establish the quality of pharmaceutical products manufactured by the respective industries in Kenya and determine the effect of manufacturing practices on the quality of these products. Cross-sectional study. Industries examined are in Nairobi, Kenya. Laboratory analysis was carried out using available facilities at Kenya Medical Research Institute and University of Nairobi, Faculty of Pharmacy. Structured Questionnaires were administered to examine how the code of good manufacturing practices has been used in the production of each pharmaceutical product by respective companies. Questionnaires designed to evaluate the distribution and carry out limited post-market surveillance study were administered to community pharmacy outlets. Drugs were sampled and analyzed for their quality according to the respective monographs. The questionnaires administered to the industry included the source of raw materials, quarantine procedure before and after manufacture, manufacturing procedure, quality audit, quality assurance procedure, equipment, and staff. That administered to the pharmacy outlet included availability, affordability and acceptability of locally manufactured pharmaceutical products. Quality analysis of products involved the establishment of the chemical content, dissolution profile, friability, uniformity of weight and identity. For antibiotic suspensions the stability after reconstitution was also determined. There were 15 respondents and two non-respondents from the industry and six out of nine respondents from the pharmacy outlets. The ratio of qualified staff to product range produced seemed to influence product quality. Industries producing several products with only limited number of pharmaceutical staff had more products failing to comply with pharmacopoeia specifications compared to those producing only few products. Nevertheless, all companies are well equipped with quality control equipment, in accordance with type of product manufactured. Private pharmacies stocked few of the locally manufactured products. The reason, they said, was due to low doctor and/or patient acceptance. Compliance with quality specifications as set out in respective monographs was overall 76%. Although the local pharmaceutical industries have adopted good manufacturing practices leading to many good quality products currently in commerce, these manufacturing practices are not comprehensive and measures need to be taken to continue improving them.

Practical ways to facilitate ergonomics improvements in occupational health practice.

PubMed

Kogi, Kazutaka

2012-12-01

Recent advances in participatory programs for improving workplace conditions are discussed to examine practical ways to facilitate ergonomics improvements. Participatory training programs are gaining importance, particularly in promoting occupational health and safety in small-scale workplaces. These programs have led to many improvements that can reduce work-related risks in varied situations. Recent experiences in participatory action-oriented training programs in small workplaces and agriculture are reviewed.The emphasis of the review is on training steps, types of improvements achieved, and the use of action tools by trainers and training participants. Immediate improvements in multiple technical areas are targeted, including materials handling,workstation design, physical environment, welfare facilities, and work organization. In facilitating ergonomics improvements in each local situation, it is important to focus on (a) building on local good practices; (b) applying practical, simple improvements that apply the basic principles of ergonomics; and (c) developing action-oriented toolkits for direct use by workers and managers. This facilitation process is effective when locally designed action toolkits are used by trainers, including local good examples, action checklists, and illustrated how-to guides. Intervention studies demonstrate the effectiveness of participatory steps that use these toolkits in promoting good practices and reducing work-related risks. In facilitating ergonomics improvements in small-scale workplaces, it is important to focus on practical, low-cost improvements that build on local good practices. The use of action-oriented toolkits reflecting basic ergonomics principles is helpful.The promotion of the intercountry networking of positive experiences in participatory training is suggested.

Guarding against land-expropriation-related mass incidents (LERMIs): Practical evidence from China's local governments

NASA Astrophysics Data System (ADS)

Tan, Shukui; Wang, Siliang

2017-04-01

China is faced with serious challenges brought by large-scale social protests in the period of rapid urbanization and profound social transition. In rural areas, the vast majority of mass incidents were related with land expropriation. In this paper, we intend to show how China's local governments guard against land-expropriation-related mass incidents (LERMIs) at the practical level. We first construct a comprehensive three-dimensional theoretic framework to define the boundary, to uncover the incentives, and to recognize the features of involved practices, then, on the basis of description evidenced by detailed data and/or cases, break various local practices down into two categories, the common local practices which refer to the nationwide top-down responses to the unified deployment by the central authority that aims to mitigate discontentment of land-deprived peasants and reduce the probabilities of conflicts through regulating land expropriation behavior and safeguarding economic interests and participation rights of affected peasants, and the specific local practices which point to the innovative local government behaviors with heterogeneity, in general, the tactical approaches to reduce the probabilities of disputes or conflicts evolving into group actions. We further argue that both of them follow a central tenet of instrumental orientation. As to the former, it is corroborated by local governments' paying more attention to promote the stylization and quantification in the aspects of regulating procedure, formulating and renewing compensation standards, resolving disputes, and evaluating risks, while the latter is mainly reflected from the outcome-orientation organization strategies to maintain overall stability in a relatively short term.

DOE's Environmental Management Site-Specific Advisory Board: The Roles, Work, and Assessment of the Constituent Local Boards - 13587

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

Alexander, Catherine; Freeman, Jenny; Cantrell, Yvette

2013-07-01

The charter for the Department of Energy's Environmental Management (EM) Site-Specific Advisory Board (SSAB) was approved under the Federal Advisory Committee Act (FACA) in 1994. With a unique mandate to provide public input on issues associated with the cleanup of nuclear legacy sites in the U.S., the EM SSAB comprises eight local boards, which are based at major EM sites. While each board is unique to the community in which it is located and reflects the diversity of the local population, the boards are governed by FACA, related regulations, and DOE policies that are intended to standardize agency advisory boardmore » operations. The EM SSAB local boards are made up of a diverse group of citizens who want to understand the mission and goals of the EM program and to help EM achieve those goals for the benefit of their communities. Some are quite passionate about their mission; others need to be coaxed into active participation. Maintaining productive relationships and a supportive environment for effective board operations is the challenge of board management for DOE EM and the board members themselves. DOE draws on research findings and best practices literature from academics and practitioners in the field of public involvement in its board management practices. The EM SSAB is also evaluated annually under the law to ensure that the investment of taxpayer dollars in the board is warranted in light of the contributions of the board. Further evaluation takes place at the agency and site levels in order to identify what aspects of board functioning the agency and board members find important to its success and to address areas where improvement is needed. Board contributions, compliance factors, and measurable outcomes related to board products and process areas are key to agency commitment to ongoing support of the boards and to participant satisfaction and thus continued member involvement. In addition to evaluation of these factors in improving board effectiveness, the agency draws on the experience of members to create best practices for the EM SSAB, as a unique form of public involvement. Four areas that have been identified by local board Chairpersons as important to their local board operations are - Enhancing communication between technical and non-technical board members; - Building on common ground toward recommendations; - Public involvement in EM SSAB local board activities; - The EM SSAB annual work plan process. The first three areas are addressed below by current or former chairpersons of the EM SSAB: Ralph Phelps, former Chairperson of the Northern New Mexico Citizens' Advisory Board; Susan Leckband, former Chairperson and current Vice Chairperson of the Hanford Advisory Board; and Val Francis, Vice Chairperson of the Portsmouth (PORTS) SSAB. In addition, Eric Roberts, facilitator of the PORTS SSAB, has contributed to the section on public involvement. In a separate paper for this session, Ralph Young, Chairperson of the Paducah Citizens' Advisory Board addresses the EM SSAB annual work plan process. (authors)« less

Innovative medical devices and hospital decision making: a study comparing the views of hospital pharmacists and physicians.

PubMed

Billaux, Mathilde; Borget, Isabelle; Prognon, Patrice; Pineau, Judith; Martelli, Nicolas

2016-06-01

Objectives Many university hospitals have developed local health technology assessment processes to guide informed decisions about new medical devices. However, little is known about stakeholders' perceptions and assessment of innovative devices. Herein, we investigated the perceptions regarding innovative medical devices of their chief users (physicians and surgeons), as well as those of hospital pharmacists, because they are responsible for the purchase and management of sterile medical devices. We noted the evaluation criteria used to assess and select new medical devices and suggestions for improving local health technology assessment processes indicated by the interviewees. Methods We randomly selected 18 physicians and surgeons (nine each) and 18 hospital pharmacists from 18 French university hospitals. Semistructured interviews were conducted between October 2012 and August 2013. Responses were coded separately by two researchers. Results Physicians and surgeons frequently described innovative medical devices as 'new', 'safe' and 'effective', whereas hospital pharmacists focused more on economic considerations and considered real innovative devices to be those for which no equivalent could be found on the market. No significant difference in evaluation criteria was found between these groups of professionals. Finally, hospital pharmacists considered the management of conflicts of interests in local health technology assessment processes to be an issue, whereas physicians and surgeons did not. Conclusions The present study highlights differences in perceptions related to professional affiliation. The findings suggest several ways in which current practices for local health technology assessment in French university hospitals could be improved and studied. What is known about the topic? Hospitals are faced with ever-growing demands for innovative and costly medical devices. To help hospital management deal with technology acquisition issues, hospital-based health technology assessment has been developed to support decisions. However, little is known about the different perceptions of innovative medical devices among practitioners and how different perceptions may affect decision making. What does this paper add? This paper compares and understands the perceptions of two groups of health professionals concerning innovative devices in the university hospital environment. What are the implications for practitioners? Such a comparison of viewpoints could facilitate improvements in current practices and decision-making processes in local health technology assessment for these medical products.

Is health systems integration being advanced through Local Health District planning?

PubMed

Saunders, Carla; Carter, David J

2017-05-01

Objective Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned. Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans. Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care. Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW. What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems. What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of its kind to assess the planned activity in health systems integration in the NSW public health system. NSW health districts play a central role in health systems integration; each health service plan outlines the strategic directions for the development and delivery of all state-funded services across each district for the coming years, equating to hundreds of millions of dollars in health sector funding. The inclusion of effective health systems integration strategies allows Local Health Districts to lay the foundation for quality patient outcomes and long-term financial sustainability despite projected increases in demand for health services. What are the implications for practice? Establishing robust ongoing mechanisms for effective health systems integration is now a necessary part of health planning. The present study identifies several key areas and strategies that are wide in scope and indicative of efforts towards health systems integration, which may support Local Health Districts and other organisations in systematic planning and implementation.

Underreporting of high-risk water and sanitation practices undermines progress on global targets.

PubMed

Vedachalam, Sridhar; MacDonald, Luke H; Shiferaw, Solomon; Seme, Assefa; Schwab, Kellogg J

2017-01-01

Water and sanitation indicators under the Millennium Development Goals failed to capture high-risk practices undertaken on a regular basis. In conjunction with local partners, fourteen rounds of household surveys using mobile phones with a customized open-source application were conducted across nine study geographies in Asia and Africa. In addition to the main water and sanitation facilities, interviewees (n = 245,054) identified all water and sanitation options regularly used for at least one season of the year. Unimproved water consumption and open defecation were targeted as high-risk practices. We defined underreporting as the difference between the regular and main use of high-risk practices. Our estimates of high-risk practices as the main option matched the widely accepted Demographic and Health Surveys (DHS) estimates within the 95% confidence interval. However, estimates of these practices as a regular option was far higher than the DHS estimates. Across the nine geographies, median underreporting of unimproved water use was 5.5%, with a range of 0.5% to 13.9%. Median underreporting of open defecation was much higher at 9.9%, with a range of 2.7% to 11.5%. This resulted in an underreported population of 25 million regularly consuming unimproved water and 50 million regularly practicing open defecation. Further examination of data from Ethiopia suggested that location and socio-economic factors were significant drivers of underreporting. Current global monitoring relies on a framework that considers the availability and use of a single option to meet drinking water and sanitation needs. Our analysis demonstrates the use of multiple options and widespread underreporting of high-risk practices. Policies based on current monitoring data, therefore, fail to consider the range of challenges and solutions to meeting water and sanitation needs, and result in an inflated sense of progress. Mobile surveys offer a cost-effective and innovative platform to rapidly and repeatedly monitor critical development metrics.

Underreporting of high-risk water and sanitation practices undermines progress on global targets

PubMed Central

Vedachalam, Sridhar; MacDonald, Luke H.; Shiferaw, Solomon; Seme, Assefa; Schwab, Kellogg J.

2017-01-01

Water and sanitation indicators under the Millennium Development Goals failed to capture high-risk practices undertaken on a regular basis. In conjunction with local partners, fourteen rounds of household surveys using mobile phones with a customized open-source application were conducted across nine study geographies in Asia and Africa. In addition to the main water and sanitation facilities, interviewees (n = 245,054) identified all water and sanitation options regularly used for at least one season of the year. Unimproved water consumption and open defecation were targeted as high-risk practices. We defined underreporting as the difference between the regular and main use of high-risk practices. Our estimates of high-risk practices as the main option matched the widely accepted Demographic and Health Surveys (DHS) estimates within the 95% confidence interval. However, estimates of these practices as a regular option was far higher than the DHS estimates. Across the nine geographies, median underreporting of unimproved water use was 5.5%, with a range of 0.5% to 13.9%. Median underreporting of open defecation was much higher at 9.9%, with a range of 2.7% to 11.5%. This resulted in an underreported population of 25 million regularly consuming unimproved water and 50 million regularly practicing open defecation. Further examination of data from Ethiopia suggested that location and socio-economic factors were significant drivers of underreporting. Current global monitoring relies on a framework that considers the availability and use of a single option to meet drinking water and sanitation needs. Our analysis demonstrates the use of multiple options and widespread underreporting of high-risk practices. Policies based on current monitoring data, therefore, fail to consider the range of challenges and solutions to meeting water and sanitation needs, and result in an inflated sense of progress. Mobile surveys offer a cost-effective and innovative platform to rapidly and repeatedly monitor critical development metrics. PMID:28489904

Learning about and Practice of Designing Local Data Bases as an Harmonizing Factor.

ERIC Educational Resources Information Center

Neelameghan, A.

This paper provides information workers with some practical approaches to the design, development, and use of local databases that form components of information storage and retrieval systems (ISR) and of automated library operations. Topics discussed include: (1) course objectives for the design and development of local databases for library and…

History of Schooling: Politics and Local Practice

ERIC Educational Resources Information Center

Aubry, Carla, Ed.; Westberg, Johannes, Ed.

2012-01-01

The relationship between education policy and local practices is at the core of research pertaining to the history of education. In this volume, the authors examine this issue from a multitude of perspectives, presenting a broad and comprehensive picture of schooling on international, national and local levels. Three issues of great significance,…

Localizing the Transdisciplinary in Practice: A Teaching Account of a Prototype Undergraduate Seminar on Linguistic Landscape

ERIC Educational Resources Information Center

Malinowski, David

2016-01-01

Building upon paradigms of language and languaging practices as "local" phenomena (Canagarajah, 2013; Pennycook, 2010, Pietikäinen & Kelly-Holmes, 2013), this paper narrates a teacher's experience in an undergraduate seminar in applied language studies as an exploration in transdisciplinarity-as-localization. Taught by the author in…

Effort-reward imbalance and depression among private practice physicians.

PubMed

Tsutsumi, Akizumi; Kawanami, Shoko; Horie, Seichi

2012-02-01

Current private practice physicians provide medical services in a harsh economic situation. The effort-reward imbalance (ERI) model puts its emphasis on an imbalance between high efforts spent and low rewards received in occupational life. ERI model includes three different reward factors from task to organizational levels. We examined whether ERI in terms of low organizational reward (poor prospective and job insecurity) could be the most relevant and strongly associated with depression among private practice physicians. This is a cross-sectional questionnaire study of 1,103 private practice physicians who were currently working in clinical settings and completed the data of exposure and outcome. The study questionnaire was mailed to all the physicians listed as members of a local branch of the Japan Medical Association (n = 3,441) between November and December 2008. Outcomes were prevalence of depression as measured by the Center for Epidemiologic Studies Depression Scale and adjusted odds ratios (OR) of depression with respect to ERI. Fifty-seven percent of physicians were exposed to ERI, and 18% of the physicians were depressed. Logistic regression analyses revealed that ERI was significantly associated with depression (OR and 95% confidence interval = 3.57; 2.43-5.26). ERI with regard to organizational reward was most prevalent (60%) and had the strongest association with depression (5.14; 3.36-7.92). Predominant prevalence of ERI in terms of organizational level low reward and strong associations between the ERI component and depression suggests that countermeasures from social perspective are crucial.

Data Curation Education Grounded in Earth Sciences and the Science of Data

NASA Astrophysics Data System (ADS)

Palmer, C. L.

2015-12-01

This presentation looks back over ten years of experience advancing data curation education at two Information Schools, highlighting the vital role of earth science case studies, expertise, and collaborations in development of curriculum and internships. We also consider current data curation practices and workforce demand in data centers in the geosciences, drawing on studies conducted in the Data Curation Education in Research Centers (DCERC) initiative and the Site-Based Data Curation project. Outcomes from this decade of data curation research and education has reinforced the importance of key areas of information science in preparing data professionals to respond to the needs of user communities, provide services across disciplines, invest in standards and interoperability, and promote open data practices. However, a serious void remains in principles to guide education and practice that are distinct to the development of data systems and services that meet both local and global aims. We identify principles emerging from recent empirical studies on the reuse value of data in the earth sciences and propose an approach for advancing data curation education that depends on systematic coordination with data intensive research and propagation of current best practices from data centers into curriculum. This collaborative model can increase both domain-based and cross-disciplinary expertise among data professionals, ultimately improving data systems and services in our universities and data centers while building the new base of knowledge needed for a foundational science of data.

Postgraduate Emergency Medicine Training in India: An Educational Partnership with the Private Sector.

PubMed

Douglass, Katherine; Pousson, Amelia; Gidwani, Shweta; Smith, Jeffrey

2015-11-01

Emergency medicine (EM) is a recently recognized specialty in India, still in its infancy. Local training programs are developing, but remain very limited. Private, for-profit hospitals are an important provider of graduate medical education (GME) in India, and are partnering with United States (US) universities in EM to expand training opportunities. Our aim was to describe current private-sector programs affiliated with a US university providing postgraduate EM training in India, the evolution and structure of these programs, and successes and challenges of program implementation. Programs have been established in seven cities in India in partnership with a US academic institution. Full-time trainees have required didactics, clinical rotations, research, and annual examinations. Faculty members affiliated with the US institution visit each program monthly. Regular evaluations have informed program modifications, and a local faculty development program has been implemented. Currently, 240 trainees are enrolled in the EM postgraduate program, and 141 physicians have graduated. A pilot survey conducted in 2012 revealed that 93% of graduates are currently practicing EM, 82% of those in India; 71% are involved in teaching, and 32% in research. Further investigation into programmatic impacts is necessary. Challenges include issues of formal program recognition both in India and abroad. This unique partnership is playing a major early role in EM GME in India. Future steps include official program recognition, expanded numbers of training sites, and a gradual transition of training and education to local faculty. Similar partnership programs may be effective in other settings outside of India. Copyright © 2015 Elsevier Inc. All rights reserved.

An extended field test of the WHO severe malnutrition guidelines in hospitals in developing countries: preliminary observations.

PubMed

Deen, J L; Weber, M; Qazi, S; Fontaine, O

2003-01-01

The WHO has published guidelines for the inpatient management of severe malnutrition. A qualitative study in hospitals in developing countries is being conducted to document the re-organisation of the clinical ward and support services required to implement these guidelines and to gain an impression of the feasibility and sustainability of such a re-organisation. Following a postal survey of experts in the management of malnutrition in children in developing countries, hospitals were contacted and asked if they were interested to participate in the study. If so, they were requested to submit background information about admission patterns, the frequency of malnutrition, and current practice. Based on this information, hospitals are selected for a preliminary visit. Following this, and the final selection, a paediatrician conducts three visits to the study hospital over a one-year period to appraise the current practice, assist the health staff in recognising the strengths and shortcomings of their current management, help them find locally appropriate solutions, support the implementation process through a participatory approach and assess the outcome. A structured survey instrument is used to guide the assessment and identification of problems. Results of the first visit, which documents the existing situation, and changes identified by staff and implemented during the second visit are presented.

A systematic review of psychosocial interventions for adult refugees and asylum seekers.

PubMed

Tribe, Rachel H; Sendt, Kyra-Verena; Tracy, Derek K

2017-05-09

Europe is in the midst of the largest refugee migration since the Second World War; there is an urgent need to provide an updated systematic review of the current best evidence for managing mental distress in refugee populations. The aim of this review is to provide an exhaustive summary of the current literature on psychosocial interventions, both trauma- and non-trauma-focused, for refugee populations experiencing post-traumatic stress disorder (PTSD), depressive or anxiety symptoms. To produce recommendations for future research and current clinical practice. Searches were conducted in PubMed, PsychINFO (Hosted by Ovid), PILOTS and Social Services Abstracts; 5305 articles were screened and 40 were included. This review found medium to high quality evidence supporting the use of narrative exposure therapy (NET). A lack of culturally adapted treatments was apparent and there was less evidence to support standard cognitive behavioural therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR) and multidisciplinary treatments. NET produced positive outcomes in refugees from a diverse range of backgrounds and trauma types. There is a general dearth of research in all intervention types: further research should include more "real-world" multidisciplinary interventions that better model clinical practice. Recommendations for evaluating local need, and creating a culturally sensitive workforce are discussed.

Linking local knowledge with global action: examining the Global Fund to Fight AIDS, Tuberculosis and Malaria through a knowledge system lens.

PubMed Central

van Kerkhoff, Lorrae; Szlezák, Nicole

2006-01-01

New global public health institutions are increasingly emphasizing transparency in decision-making, developing-country ownership of projects and programmes, and merit- and performance-based funding. Such principles imply an institutional response to the challenge of bridging the "know-do gap", by basing decisions explicitly on results, evidence and best practice. Using a knowledge systems framework, we examine how the Global Fund to Fight AIDS, Tuberculosis and Malaria has affected the ways in which knowledge is used in efforts to combat these three diseases. We outline the formal knowledge system embedded in current rules and practices associated with the Global Fund's application process, and give three examples that illustrate the complexity of the knowledge system in action: human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) policy in China; successful applications from Haiti; and responses to changing research on malaria. These examples show that the Global Fund has created strong incentives for knowledge to flow to local implementers, but with little encouragement and few structures for the potentially valuable lessons from implementation to flow back to global best practice or research-based knowledge. The Global Fund could play an influential role in fostering much-needed learning from implementation. We suggest that three initial steps are required to start this process: acknowledging shared responsibility for learning across the knowledge system; analysing the Global Fund's existing data (and refining data collection over time); and supporting recipients and technical partners to invest resources in linking implementation with best practice and research. PMID:16917650

Diffusion of surgical techniques in early stage breast cancer: variables related to adoption and implementation of sentinel lymph node biopsy.

PubMed

Vanderveen, Kimberly A; Paterniti, Debora A; Kravitz, Richard L; Bold, Richard J

2007-05-01

Understanding how physicians acquire and adopt new technologies for cancer diagnosis and treatment is poorly understood, yet is critical to the dissemination of evidence-based practices. Sentinel lymph node biopsy (SLNB) has recently become a standard technique for axillary staging in early breast cancer and is an ideal platform for studying medical technology diffusion. We sought to describe the timing of SLNB adoption and patterns of surgeon interactions with the following educational sources: local university training program, surgical literature, national meetings/courses, national specialty centers, and other local surgeons. A cross-sectional survey that used semistructured interviews was used to assess timing of adoption, practice patterns, and learning sources for SLNB among surgical oncologists and general surgeons in a single metropolitan area. A total of 44 eligible surgeons were identified; 38 (86%) participated. All surgical oncologists (11 of 11) and most general surgeons (26 of 27) had implemented SLNB. Surgical oncologists were older (mean 51 vs. 48 years, P = .02) and had used SLNB longer (6.1 vs. 3.3 years, P = .01) than general surgeons. By use of social network diagrams, surgical oncologists and the university training program were shown to be key intermediaries between general surgeons and national specialty centers. Surgeons in group practice tended to use more learning sources than solo practitioners. Surgical oncologists and university-based surgeons play key educational roles in disseminating new cancer treatments and therefore have a professional responsibility to educate other community physicians to increase the use of the most current, evidence-based practices.

Harvest and trade of caterpillar mushroom (Ophiocordyceps sinensis) and the implications for sustainable use in the Tibet Region of Southwest China.

PubMed

He, Jun

2018-07-15

Caterpillar mushroom (Ophiocordyceps sinensis) is a unique medicinal fungi which is only found in alpine grasslands in Himalayan mountain regions and the Tibetan Plateau. Known locally as Yartsa Gunbu, it has been widely used in Tibetan and Chinese Medicine for centuries. It is crucial to understand local commercial harvest and trade practices of caterpillar mushroom to support the sustainable management of this valuable resource. However, data derived from empirically grounded research is currently limited, particularly in China. The research aims to provide the most up-to-date insights into caterpillar mushroom harvest and trade in the main production area of the Tibet Region in Southwest China and to generate policy recommendations for sustainable use. The research was conducted in 2015-2016 in six Tibetan communities located in two counties in Diqing Tibetan Autonomous Prefecture, Southwest China. Quantitative and qualitative data were collected from in-depth interviews with local households engaged in caterpillar mushroom harvesting (n = 157), local caterpillar mushroom traders (n = 14), and from focus groups discussions (n = 5) with regional caterpillar mushroom industry stakeholders. The research found large regional- and community-level differences in caterpillar mushroom harvest practices. The harvest practices of communities involved in the co-management of a Nature Reserve were more sustainable than those communities not involved in such a scheme, and this was due to the external support and training provided via the co-management scheme. Moreover, a customary tenure system was proving effective for avoiding competition over caterpillar mushroom collection. However, in both counties, narrow marketing channel and non-grading system in trade limits the possibility of improving the local benefits generated from the commercial harvest of caterpillar mushroom. Meanwhile, the local traders play an important bridging role in the value chain and generate greater benefits from product grading. To support the sustainable management of the caterpillar mushroom industry in Southwest China, the prefectural governments should invest in training on appropriate harvesting techniques and the dissemination of market information. It is also critical that prefectural governments recognize and support the customary tenure system of mushroom collection to avoid competition between collectors. Copyright © 2018 Elsevier B.V. All rights reserved.

77 FR 67657 - Request for Public Comment: 30-Day Proposed Information Collection: Indian Health Service (IHS...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-13

... Practice, and Local Effort (BPPPLE) Form.'' Need and Use of Information Collection: The IHS goal is to.../Disease Prevention, Nursing, and Dental) have developed a centralized program database of best practices, promising Practices and local efforts and resources. This database was previously referred as OSCAR, but the...

Second Language Socialization in a Bilingual Chat Room: Global and Local Considerations

ERIC Educational Resources Information Center

Lam, Wan Shun Eva

2004-01-01

This paper considers how global practices of English on the Internet intersect with local practices of English in the territorial or national sphere in constructing the language experiences of immigrant learners. Using a multi-contextual approach to language socialization, this paper examines the social and discursive practices in a…

Sustainability in Health care by Allocating Resources Effectively (SHARE) 7: supporting staff in evidence-based decision-making, implementation and evaluation in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; Waller, Cara; Dyer, Tim; Brooke, Vanessa; Garrubba, Marie; Melder, Angela; Voutier, Catherine; Gust, Anthony; Farjou, Dina

2017-06-21

This is the seventh in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for resource allocation within a large Australian health service. It aimed to facilitate proactive use of evidence from research and local data; evidence-based decision-making for resource allocation including disinvestment; and development, implementation and evaluation of disinvestment projects. From the literature and responses of local stakeholders it was clear that provision of expertise and education, training and support of health service staff would be required to achieve these aims. Four support services were proposed. This paper is a detailed case report of the development, implementation and evaluation of a Data Service, Capacity Building Service and Project Support Service. An Evidence Service is reported separately. Literature reviews, surveys, interviews, consultation and workshops were used to capture and process the relevant information. Existing theoretical frameworks were adapted for evaluation and explication of processes and outcomes. Surveys and interviews identified current practice in use of evidence in decision-making, implementation and evaluation; staff needs for evidence-based practice; nature, type and availability of local health service data; and preferred formats for education and training. The Capacity Building and Project Support Services were successful in achieving short term objectives; but long term outcomes were not evaluated due to reduced funding. The Data Service was not implemented at all. Factors influencing the processes and outcomes are discussed. Health service staff need access to education, training, expertise and support to enable evidence-based decision-making and to implement and evaluate the changes arising from those decisions. Three support services were proposed based on research evidence and local findings. Local factors, some unanticipated and some unavoidable, were the main barriers to successful implementation. All three proposed support services hold promise as facilitators of EBP in the local healthcare setting. The findings from this study will inform further exploration.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 11: reporting outcomes of an evidence-driven approach to disinvestment in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; Ramsey, Wayne; King, Richard; Green, Sally

2018-05-30

This is the final paper in a thematic series reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was established to explore a systematic, integrated, evidence-based organisation-wide approach to disinvestment in a large Australian health service network. This paper summarises the findings, discusses the contribution of the SHARE Program to the body of knowledge and understanding of disinvestment in the local healthcare setting, and considers implications for policy, practice and research. The SHARE program was conducted in three phases. Phase One was undertaken to understand concepts and practices related to disinvestment and the implications for a local health service and, based on this information, to identify potential settings and methods for decision-making about disinvestment. The aim of Phase Two was to implement and evaluate the proposed methods to determine which were sustainable, effective and appropriate in a local health service. A review of the current literature incorporating the SHARE findings was conducted in Phase Three to contribute to the understanding of systematic approaches to disinvestment in the local healthcare context. SHARE differed from many other published examples of disinvestment in several ways: by seeking to identify and implement disinvestment opportunities within organisational infrastructure rather than as standalone projects; considering disinvestment in the context of all resource allocation decisions rather than in isolation; including allocation of non-monetary resources as well as financial decisions; and focusing on effective use of limited resources to optimise healthcare outcomes. The SHARE findings provide a rich source of new information about local health service decision-making, in a level of detail not previously reported, to inform others in similar situations. Multiple innovations related to disinvestment were found to be acceptable and feasible in the local setting. Factors influencing decision-making, implementation processes and final outcomes were identified; and methods for further exploration, or avoidance, in attempting disinvestment in this context are proposed based on these findings. The settings, frameworks, models, methods and tools arising from the SHARE findings have potential to enhance health care and patient outcomes.

STEM professional volunteers in K-12 competition programs: Educator practices and impact on pedagogy

NASA Astrophysics Data System (ADS)

Zintgraff, Alfred Clifton

This mixed methods dissertation study explored how secondary school educators in specific K-12 competition programs recruited and deployed STEM professional volunteers. The study explored which practices were viewed as most important, and how practices related to constructivist pedagogy, all from the viewpoint of educators. The non-positivist approach sought new knowledge without pursuing generalized results. Review of the literature uncovered extensive anecdotal information about current practices, and suggested that large investments are made in engaging volunteers. One National Science Foundation-sponsored study was identified, and its recommendations for a sustained research agenda were advanced. Three study phases were performed, one to explore practices and operationalize definitions, a second to rate practice's importance and their relation to pedagogy, and a third to seek explanations. Educators preferred recruiting local, meaning recruiting parents and former students, versus from industry or other employers. Most educators preferred volunteers with mentoring skills, and placing them in direct contact with students, versus deploying volunteers to help with behind-the-scenes tasks supporting the educator. Relationships were identified between the highest-rated practices and constructivism in programs. In STEM professional volunteers, educators see affordances, in the same way a classroom tool opens affordances. A model is proposed which shows educators considering practicality, pedagogy, knowledge and skills, and rapport when accessing the affordances opened by STEM professional volunteers. Benefits are maximized when programs align with strong industry clusters in the community.

Titanium wire implants with nanotube arrays: A study model for localized cancer treatment.

PubMed

Kaur, Gagandeep; Willsmore, Tamsyn; Gulati, Karan; Zinonos, Irene; Wang, Ye; Kurian, Mima; Hay, Shelley; Losic, Dusan; Evdokiou, Andreas

2016-09-01

Adverse complications associated with systemic administration of anti-cancer drugs are a major problem in cancer therapy in current clinical practice. To increase effectiveness and reduce side effects, localized drug delivery to tumour sites requiring therapy is essential. Direct delivery of potent anti-cancer drugs locally to the cancer site based on nanotechnology has been recognised as a promising alternative approach. Previously, we reported the design and fabrication of nano-engineered 3D titanium wire based implants with titania (TiO2) nanotube arrays (Ti-TNTs) for applications such as bone integration by using in-vitro culture systems. The aim of present study is to demonstrate the feasibility of using such Ti-TNTs loaded with anti-cancer agent for localized cancer therapy using pre-clinical cancer models and to test local drug delivery efficiency and anti-tumour efficacy within the tumour environment. TNF-related apoptosis-inducing ligand (TRAIL) which has proven anti-cancer properties was selected as the model drug for therapeutic delivery by Ti-TNTs. Our in-vitro 2D and 3D cell culture studies demonstrated a significant decrease in breast cancer cell viability upon incubation with TRAIL loaded Ti-TNT implants (TRAIL-TNTs). Subcutaneous tumour xenografts were established to test TRAIL-TNTs implant performance in the tumour environment by monitoring the changes in tumour burden over a selected time course. TRAIL-TNTs showed a significant regression in tumour burden within the first three days of implant insertion at the tumour site. Based on current experimental findings these Ti-TNTs wire implants have shown promising capacity to load and deliver anti-cancer agents maintaining their efficacy for cancer treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Typhoid fever in Fiji: a reversible plague?

PubMed

Thompson, Corinne N; Kama, Mike; Acharya, Shrish; Bera, Una; Clemens, John; Crump, John A; Dawainavesi, Aggie; Dougan, Gordon; Edmunds, W John; Fox, Kimberley; Jenkins, Kylie; Khan, M Imran; Koroivueta, Josefa; Levine, Myron M; Martin, Laura B; Nilles, Eric; Pitzer, Virginia E; Singh, Shalini; Raiwalu, Ratu Vereniki; Baker, Stephen; Mulholland, Kim

2014-10-01

The country of Fiji, with a population of approximately 870 000 people, faces a growing burden of several communicable diseases including the bacterial infection typhoid fever. Surveillance data suggest that typhoid has become increasingly common in rural areas of Fiji and is more frequent amongst young adults. Transmission of the organisms that cause typhoid is facilitated by faecal contamination of food or water and may be influenced by local behavioural practices in Fiji. The Fijian Ministry of Health, with support from Australian Aid, hosted a meeting in August 2012 to develop comprehensive control and prevention strategies for typhoid fever in Fiji. International and local specialists were invited to share relevant data and discuss typhoid control options. The resultant recommendations focused on generating a clearer sense of the epidemiology of typhoid in Fiji and exploring the contribution of potential transmission pathways. Additionally, the panel suggested steps such as ensuring that recommended ciprofloxacin doses are appropriate to reduce the potential for relapse and reinfection in clinical cases, encouraging proper hand hygiene of food and drink handlers, working with water and sanitation agencies to review current sanitation practices and considering a vaccination policy targeting epidemiologically relevant populations. © 2014 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd.

What blocks health visitors from taking on a leadership role?

PubMed

Hyett, Erika

2003-07-01

Current government documents in the United Kingdom call for all nurses to take on a greater leadership role. This paper critically considers some of the management factors that block one group of specialist nurses (health visitors) from fulfilling their leadership role. Health visitors have a key role to play in meeting the public health targets of local primary care trusts, known as local health improvement plans. But to take on a greater public health role, health visitors need to move away from working independently within separate general practitioner surgeries and to work in teams which share the vision and goals of the primary care trusts. The paper explores different styles of management that promote transformational leadership and relate to practice. It is suggested that use of the Servant-Leader model of management should encourage the empowerment of staff, and through empowerment health visitors should be able to instigate change and become more innovative in their practice. Persistent recruitment and retention problems have resulted in little time being available to focus on the effectiveness of services. The future management of health visitors will be to primarily run the service while supporting staff in accessing and influencing those in power.

Automated retinal nerve fiber layer defect detection using fundus imaging in glaucoma.

PubMed

Panda, Rashmi; Puhan, N B; Rao, Aparna; Padhy, Debananda; Panda, Ganapati

2018-06-01

Retinal nerve fiber layer defect (RNFLD) provides an early objective evidence of structural changes in glaucoma. RNFLD detection is currently carried out using imaging modalities like OCT and GDx which are expensive for routine practice. In this regard, we propose a novel automatic method for RNFLD detection and angular width quantification using cost effective redfree fundus images to be practically useful for computer-assisted glaucoma risk assessment. After blood vessel inpainting and CLAHE based contrast enhancement, the initial boundary pixels are identified by local minima analysis of the 1-D intensity profiles on concentric circles. The true boundary pixels are classified using random forest trained by newly proposed cumulative zero count local binary pattern (CZC-LBP) and directional differential energy (DDE) along with Shannon, Tsallis entropy and intensity features. Finally, the RNFLD angular width is obtained by random sample consensus (RANSAC) line fitting on the detected set of boundary pixels. The proposed method is found to achieve high RNFLD detection performance on a newly created dataset with sensitivity (SN) of 0.7821 at 0.2727 false positives per image (FPI) and the area under curve (AUC) value is obtained as 0.8733. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Pediatric Obesity Initiative: development, implementation, and evaluation.

PubMed

Sample, Denise A; Carroll, Heather L; Barksdale, Debra J; Jessup, Ann

2013-09-01

Pediatric obesity rates have nearly tripled over the past three decades contributing to increased morbidity and mortality in the United States and around the world. Pediatric obesity is most prevalent in developed countries and affects all races, ethnicities, cultures, and age groups. To combat this epidemic locally, a team of dedicated providers developed a comprehensive evidenced-based toolkit and training program for clinical practices providing primary care services to children in a North Carolina county. The toolkit and training program were developed using the most current treatment guidelines for pediatric obesity and included resources developed by Healthy Carolinians. One unique feature of the training was a demonstration of motivational interviewing with additional resources included in the toolkit. Staff and providers in three pediatric practices and the local Health Department received the training. In a 3 months follow-up survey after the training, the providers indicated that the toolkit and training program were useful but that they still did not consistently use the guidelines or tools. Ensuring the use of available guidelines and resources by providers remains a challenge. Further study is needed on how to improve implementation of guidelines in primary care settings. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

Power plant maintenance scheduling using ant colony optimization: an improved formulation

NASA Astrophysics Data System (ADS)

Foong, Wai Kuan; Maier, Holger; Simpson, Angus

2008-04-01

It is common practice in the hydropower industry to either shorten the maintenance duration or to postpone maintenance tasks in a hydropower system when there is expected unserved energy based on current water storage levels and forecast storage inflows. It is therefore essential that a maintenance scheduling optimizer can incorporate the options of shortening the maintenance duration and/or deferring maintenance tasks in the search for practical maintenance schedules. In this article, an improved ant colony optimization-power plant maintenance scheduling optimization (ACO-PPMSO) formulation that considers such options in the optimization process is introduced. As a result, both the optimum commencement time and the optimum outage duration are determined for each of the maintenance tasks that need to be scheduled. In addition, a local search strategy is presented in this article to boost the robustness of the algorithm. When tested on a five-station hydropower system problem, the improved formulation is shown to be capable of allowing shortening of maintenance duration in the event of expected demand shortfalls. In addition, the new local search strategy is also shown to have significantly improved the optimization ability of the ACO-PPMSO algorithm.

Typhoid fever in Fiji: a reversible plague?

PubMed Central

Thompson, Corinne N; Kama, Mike; Acharya, Shrish; Bera, Una; Clemens, John; Crump, John A; Dawainavesi, Aggie; Dougan, Gordon; Edmunds, W John; Fox, Kimberley; Jenkins, Kylie; Khan, M Imran; Koroivueta, Josefa; Levine, Myron M; Martin, Laura B; Nilles, Eric; Pitzer, Virginia E; Singh, Shalini; Raiwalu, Ratu Vereniki; Baker, Stephen; Mulholland, Kim

2014-01-01

The country of Fiji, with a population of approximately 870 000 people, faces a growing burden of several communicable diseases including the bacterial infection typhoid fever. Surveillance data suggest that typhoid has become increasingly common in rural areas of Fiji and is more frequent amongst young adults. Transmission of the organisms that cause typhoid is facilitated by faecal contamination of food or water and may be influenced by local behavioural practices in Fiji. The Fijian Ministry of Health, with support from Australian Aid, hosted a meeting in August 2012 to develop comprehensive control and prevention strategies for typhoid fever in Fiji. International and local specialists were invited to share relevant data and discuss typhoid control options. The resultant recommendations focused on generating a clearer sense of the epidemiology of typhoid in Fiji and exploring the contribution of potential transmission pathways. Additionally, the panel suggested steps such as ensuring that recommended ciprofloxacin doses are appropriate to reduce the potential for relapse and reinfection in clinical cases, encouraging proper hand hygiene of food and drink handlers, working with water and sanitation agencies to review current sanitation practices and considering a vaccination policy targeting epidemiologically relevant populations. PMID:25066005

To adopt, to adapt, or to contextualise? The big question in clinical practice guideline development.

PubMed

Dizon, Janine Margarita; Machingaidze, Shingai; Grimmer, Karen

2016-09-13

Developing new clinical practice guidelines (CPGs) can be time-consuming and expensive. A more efficient approach could be to adopt, adapt or contextualise recommendations from existing good quality CPGs so that the resultant guidance is tailored to the local context. The first steps are to search for international CPGs that have a similar purpose, end-users and patients to your situation. The second step is to critically appraise the methodological quality of the CPGs to ensure that your guidance is based on credible evidence. Then the decisions begin. Can you simply 'adopt' this (parent) clinical practice guidelines, and implement the recommendations in their entirety, without any changes, in your setting? If so, then no further work is required. However this situation is rare. What is more likely, is that even if recommendations from the parent clinical practice guidelines can be adopted, how they are implemented needs to address local issues. Thus you may need to 'contextualise' the guidance, by addressing implementation issues such as local workforce, training, health systems, equipment and/or access to services. Generally this means that additional information is required (Practice/Context Points) to support effective implementation of the clinical practice guidelines recommendations. In some cases, you may need to 'adapt' the guidance, where you will make changes to the recommendations so that care is relevant to your local environments. This may involve additional work to search for local research, or obtain local consensus, regarding how best to adapt recommendations. For example, adaptation might reflect substituting one drug for another (drugs have similar effects, but the alternative drug to the recommended one may be cheaper, more easily obtained or more culturally acceptable). There is lack of standardisation of clinical practice guidelines terminology, leading clinical practice guideline activities often being poorly conceptualised or reported. We provide an approach that would help improve efficiency and standardisation of clinical practice guidelines activities.

Foodways in transition: food plants, diet and local perceptions of change in a Costa Rican Ngäbe community.

PubMed

D'Ambrosio, Ugo; Puri, Rajindra K

2016-01-06

Indigenous populations are undergoing rapid ethnobiological, nutritional and socioeconomic transitions while being increasingly integrated into modernizing societies. To better understand the dynamics of these transitions, this article aims to characterize the cultural domain of food plants and analyze its relation with current day diets, and the local perceptions of changes given amongst the Ngäbe people of Southern Conte-Burica, Costa Rica, as production of food plants by its residents is hypothesized to be drastically in recession with an decreased local production in the area and new conservation and development paradigms being implemented. Extensive freelisting, interviews and workshops were used to collect the data from 72 participants on their knowledge of food plants, their current dietary practices and their perceptions of change in local foodways, while cultural domain analysis, descriptive statistical analyses and development of fundamental explanatory themes were employed to analyze the data. Results show a food plants domain composed of 140 species, of which 85 % grow in the area, with a medium level of cultural consensus, and some age-based variation. Although many plants still grow in the area, in many key species a decrease on local production-even abandonment-was found, with much reduced cultivation areas. Yet, the domain appears to be largely theoretical, with little evidence of use; and the diet today is predominantly dependent on foods bought from the store (more than 50 % of basic ingredients), many of which were not salient or not even recognized as 'food plants' in freelists exercises. While changes in the importance of food plants were largely deemed a result of changes in cultural preferences for store bought processed food stuffs and changing values associated with farming and being food self-sufficient, Ngäbe were also aware of how changing household livelihood activities, and the subsequent loss of knowledge and use of food plants, were in fact being driven by changes in social and political policies, despite increases in forest cover and biodiversity. Ngäbe foodways are changing in different and somewhat disconnected ways: knowledge of food plants is varied, reflecting most relevant changes in dietary practices such as lower cultivation areas and greater dependence on food from stores by all families. We attribute dietary shifts to socioeconomic and political changes in recent decades, in particular to a reduction of local production of food, new economic structures and agents related to the State and globalization.

Globalisation And Local Indigenous Education In Mexico

NASA Astrophysics Data System (ADS)

Reinke, Leanne

2004-11-01

Globalisation is often viewed as a threat to cultural and linguistic diversity and therefore is a central concern of educational practices and policy. The present study challenges this common view by demonstrating that local communities can use global means to support and enhance their specific practices and policies. An historical exploration of education policy in Mexico reveals that there has been a continuing struggle by indigenous peoples to maintain locally relevant modes of teaching. Indigenous peoples have increasingly used technology to maintain their languages and local cultural practices. Such accentuation of the local in a global context is exemplified by the people of Chiapas: They live in subsistence-type communities, yet their recent education movements and appeals to international solidarity (such as in the Zapatista rebellion) have employed computer-aided technologies.

The “Minimizing Antibiotic Resistance in Colorado” Project: Impact of Patient Education in Improving Antibiotic Use in Private Office Practices

PubMed Central

Gonzales, Ralph; Corbett, Kitty K; Leeman-Castillo, Bonnie A; Glazner, Judith; Erbacher, Kathleen; Darr, Carol A; Wong, Shale; Maselli, Judith H; Sauaia, Angela; Kafadar, Karen

2005-01-01

Objective To assess the marginal impact of patient education on antibiotic prescribing to children with pharyngitis and adults with acute bronchitis in private office practices. Data Sources/Study Setting Antibiotic prescription rates based on claims data from four managed care organizations in Colorado during baseline (winter 2000) and study (winter 2001) periods. Study Design A nonrandomized controlled trial of a household and office-based patient educational intervention was performed. During both periods, Colorado physicians were mailed antibiotic prescribing profiles and practices guidelines as part of an ongoing quality improvement program. Intervention practices (n=7) were compared with local and distant control practices. Data Collection/Extraction Methods Office visits were extracted by managed care organizations using International Classification of Diseases-9-Clinical Modification codes for acute respiratory tract infections, and merged with pharmacy claims data based on visit and dispensing dates coinciding within 2 days. Principal Findings Adjusted antibiotic prescription rates during baseline and study periods increased from 38 to 39 percent for pediatric pharyngitis at the distant control practices, and decreased from 39 to 37 percent at the local control practices, and from 34 to 30 percent at the intervention practices (p=.18 compared with distant control practices). Adjusted antibiotic prescription rates decreased from 50 to 44 percent for adult bronchitis at the distant control practices, from 55 to 45 percent at the local control practices, and from 60 to 36 percent at the intervention practices (p<.002 and p=.006 compared with distant and local control practices, respectively). Conclusions In office practices, there appears to be little room for improvement in antibiotic prescription rates for children with pharyngitis. In contrast, patient education helps reduce antibiotic use for adults with acute bronchitis beyond that achieved by physician-directed efforts. PMID:15663704

Anatomy of a public health agency turnaround: the case of the general health district in Mahoning County.

PubMed

Honoré, Peggy A; Stefanak, Matthew; Dessens, Scott

2012-01-01

A turnaround describes an organization's ability to recover from successive periods of decline. Current and projected declines in US economic conditions continue to place local public health departments at risk of fiscal exigency. This examination focused on turnaround methodologies used by a local public health department to reverse successive periods of operational and financial declines. Illustrations are provided on the value added by implementing financial ratio and trend analysis in addition to using evidence-based private sector turnaround strategies of retrenchment, repositioning, and reorganization. Evidence has shown how the financial analysis and strategies aided in identifying operational weakness and set in motion corrective measures. The Public Health Uniform Data System is introduced along with a list of standards offered for mainstreaming these and other routine stewardship practices to diagnose, predict, and prevent agency declines.

Choice as a Global Language in Local Practice: A Mixed Model of School Choice in Taiwan

ERIC Educational Resources Information Center

Mao, Chin-Ju

2015-01-01

This paper uses school choice policy as an example to demonstrate how local actors adopt, mediate, translate, and reformulate "choice" as neo-liberal rhetoric informing education reform. Complex processes exist between global policy about school choice and the local practice of school choice. Based on the theoretical sensibility of…

What does locality commissioning in Avon offer? Retrospective descriptive evaluation.

PubMed Central

Hine, C. E.; Bachmann, M. O.

1997-01-01

OBJECTIVE: To describe the impact, direct costs of, and participants' attitudes to the first two years and eight months of locality commissioning in Avon. DESIGN: Retrospective description of programme. SETTING: Thirteen localities in Avon Health Authority area, covering 982000 population and 147 general practices. METHODS: Postal questionnaire survey of 147 general practitioners (one per practice); interviews with and questionnaire survey of 13 lead general practitioners and 13 so called link staff from the health authority. MAIN OUTCOME MEASURES: Locality initiatives, perceived influence, general practitioners' attitudes, management costs. RESULTS: Twenty initiatives were identified that had changed services to patients, and another nine were planned. The commonest initiatives concerned primary mental health care (seven), nurse specialists for primary care of chronic diseases (three), referral and clinical practice guidelines (seven), and access to hospital outpatient departments (one, with two others planned). Localities were more likely to have influenced the authority, trust managers, and consultants than social services, community health councils, and voluntary organisations. Activity varied between localities, lead general practitioners estimating that 120/147 (82%) of practices had been involved in locality meetings (range 44-100% in different localities). The authority had spent 6 p per capita on running the scheme, and the total time used by general practitioners for locality commissioning was estimated at 1.5 whole time equivalents. CONCLUSION: Locality commissioning has selectively changes services with limited extra funding and without delegation of hospital and community health service budgets. General practitioners wanted more policy and financial support. Further development should be based on evidence of costs, benefits, and limitations of locality commissioning schemes. PMID:9154029

Shared decision making and use of decision AIDS for localized prostate cancer : perceptions from radiation oncologists and urologists.

PubMed

Wang, Elyn H; Gross, Cary P; Tilburt, Jon C; Yu, James B; Nguyen, Paul L; Smaldone, Marc C; Shah, Nilay D; Abouassally, Robert; Sun, Maxine; Kim, Simon P

2015-05-01

The current attitudes of prostate cancer specialists toward decision aids and their use in clinical practice to facilitate shared decision making are poorly understood. To assess attitudes toward decision aids and their dissemination in clinical practice. A survey was mailed to a national random sample of 1422 specialists (711 radiation oncologists and 711 urologists) in the United States from November 1, 2011, through April 30, 2012. Respondents were asked about familiarity, perceptions, and use of decision aids for clinically localized prostate cancer and trust in various professional societies in developing decision aids. The Pearson χ2 test was used to test for bivariate associations between physician characteristics and outcomes. Similar response rates were observed for radiation oncologists and urologists (44.0% vs 46.1%; P=.46). Although most respondents had some familiarity with decision aids, only 35.5% currently use a decision aid in clinic practice. The most commonly cited barriers to decision aid use included the perception that their ability to estimate the risk of recurrence was superior to that of decision aids (7.7% in those not using decision aids and 26.2% in those using decision aids; P<.001) and the concern that patients could not process information from a decision aid (7.6% in those not using decision aids and 23.7% in those using decision aids; P<.001). In assessing trust in decision aids established by various professional medical societies, specialists consistently reported trust in favor of their respective organizations, with 9.2% being very confident and 59.2% being moderately confident (P=.01). Use of decision aids among specialists treating patients with prostate cancer is relatively low. Efforts to address barriers to clinical implementation of decision aids may facilitate greater shared decision making for patients diagnosed as having prostate cancer.

Integrating an agent-based model into a large-scale hydrological model for evaluating drought management in California

NASA Astrophysics Data System (ADS)

Sheffield, J.; He, X.; Wada, Y.; Burek, P.; Kahil, M.; Wood, E. F.; Oppenheimer, M.

2017-12-01

California has endured record-breaking drought since winter 2011 and will likely experience more severe and persistent drought in the coming decades under changing climate. At the same time, human water management practices can also affect drought frequency and intensity, which underscores the importance of human behaviour in effective drought adaptation and mitigation. Currently, although a few large-scale hydrological and water resources models (e.g., PCR-GLOBWB) consider human water use and management practices (e.g., irrigation, reservoir operation, groundwater pumping), none of them includes the dynamic feedback between local human behaviors/decisions and the natural hydrological system. It is, therefore, vital to integrate social and behavioral dimensions into current hydrological modeling frameworks. This study applies the agent-based modeling (ABM) approach and couples it with a large-scale hydrological model (i.e., Community Water Model, CWatM) in order to have a balanced representation of social, environmental and economic factors and a more realistic representation of the bi-directional interactions and feedbacks in coupled human and natural systems. In this study, we focus on drought management in California and considers two types of agents, which are (groups of) farmers and state management authorities, and assumed that their corresponding objectives are to maximize the net crop profit and to maintain sufficient water supply, respectively. Farmers' behaviors are linked with local agricultural practices such as cropping patterns and deficit irrigation. More precisely, farmers' decisions are incorporated into CWatM across different time scales in terms of daily irrigation amount, seasonal/annual decisions on crop types and irrigated area as well as the long-term investment of irrigation infrastructure. This simulation-based optimization framework is further applied by performing different sets of scenarios to investigate and evaluate the effectiveness of different water management strategies and how policy interventions will facilitate drought adaptation in California.

Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals.

PubMed

Geurtzen, R; Van Heijst, Arno; Hermens, Rosella; Scheepers, Hubertina; Woiski, Mallory; Draaisma, Jos; Hogeveen, Marije

2018-01-03

Since 2010, intensive care can be offered in the Netherlands at 24 +0  weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care. Online nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice. One hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals. Dutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents' opinions are needed in order to develop a national framework. Clinicaltrials.gov, NCT02782650 , retrospectively registered May 2016.

The Afya Bora Fellowship: An Innovative Program Focused on Creating an Interprofessional Network of Leaders in Global Health.

PubMed

Green, Wendy M; Farquhar, Carey; Mashalla, Yohana

2017-09-01

Most current health professions education programs are focused on the development of clinical skills. As a result, they may not address the complex and interconnected nature of global health. Trainees require relevant clinical, programmatic, and leadership skills to meet the challenges of practicing in an increasingly globalized environment. To develop health care leaders within sub-Saharan Africa, the Afya Bora Consortium developed a one-year fellowship for medical doctors and nurses. Fellows from nine institutions in the United States and sub-Saharan Africa participate in 12 learning modules focused on leadership development and program management. Classroom-based training is augmented with an experiential apprenticeship component. Since 2011, 100 fellows have graduated from the program. During their apprenticeships, fellows developed projects beneficial to their development and to host organizations. The program has developed fellows' skills in leadership, lent expertise to local organizations, and built knowledge in local contexts. Most fellows have returned to their countries of origin, thus building local capacity. U.S.-based fellows examine global health challenges from regional perspectives and learn from sub-Saharan African experts and peers. The Consortium provides ongoing support to alumni through career development awards and alumni network engagement with current and past fellow cohorts. The Consortium expanded from its initial network of five countries to six and continues to seek opportunities for geographical and institutional expansion.

What is India speaking? Exploring the "Hinglish" invasion

NASA Astrophysics Data System (ADS)

Parshad, Rana D.; Bhowmick, Suman; Chand, Vineeta; Kumari, Nitu; Sinha, Neha

2016-05-01

Language competition models help understand language shift dynamics, and have effectively captured how English has outcompeted various local languages, such as Scottish Gaelic in Scotland, and Mandarin in Singapore. India, with a 125 million English speakers boasts the second largest number of English speakers in the world, after the United States. The 1961-2001 Indian censuses report a sharp increase in Hindi/English Bilinguals, suggesting that English is on the rise in India. To the contrary, we claim supported by field evidence, that these statistics are inaccurate, ignoring an emerging class who do not have full bilingual competence and switch between Hindi and English, communicating via a code popularly known as "Hinglish". Since current language competition models occlude hybrid practices and detailed local ecological factors, they are inappropriate to capture the current language dynamics in India. Expanding predator-prey and sociolinguistic theories, we draw on local Indian ecological factors to develop a novel three-species model of interaction between Monolingual Hindi speakers, Hindi/English Bilinguals and Hinglish speakers, and explore the long time dynamics it predicts. The model also exhibits Turing instability, which is the first pattern formation result in language dynamics. These results challenge traditional assumptions of English encroachment in India. More broadly, the three-species model introduced here is a first step towards modeling the dynamics of hybrid language scenarios in other settings across the world.

Modeling the electrode-neuron interface of cochlear implants: effects of neural survival, electrode placement, and the partial tripolar configuration.

PubMed

Goldwyn, Joshua H; Bierer, Steven M; Bierer, Julie Arenberg

2010-09-01

The partial tripolar electrode configuration is a relatively novel stimulation strategy that can generate more spatially focused electric fields than the commonly used monopolar configuration. Focused stimulation strategies should improve spectral resolution in cochlear implant users, but may also be more sensitive to local irregularities in the electrode-neuron interface. In this study, we develop a practical computer model of cochlear implant stimulation that can simulate neural activation in a simplified cochlear geometry and we relate the resulting patterns of neural activity to basic psychophysical measures. We examine how two types of local irregularities in the electrode-neuron interface, variations in spiral ganglion nerve density and electrode position within the scala tympani, affect the simulated neural activation patterns and how these patterns change with electrode configuration. The model shows that higher partial tripolar fractions activate more spatially restricted populations of neurons at all current levels and require higher current levels to excite a given number of neurons. We find that threshold levels are more sensitive at high partial tripolar fractions to both types of irregularities, but these effects are not independent. In particular, at close electrode-neuron distances, activation is typically more spatially localized which leads to a greater influence of neural dead regions. Copyright (c) 2010 Elsevier B.V. All rights reserved.

Brain activity underlying auditory perceptual learning during short period training: simultaneous fMRI and EEG recording

PubMed Central

2013-01-01

Background There is an accumulating body of evidence indicating that neuronal functional specificity to basic sensory stimulation is mutable and subject to experience. Although fMRI experiments have investigated changes in brain activity after relative to before perceptual learning, brain activity during perceptual learning has not been explored. This work investigated brain activity related to auditory frequency discrimination learning using a variational Bayesian approach for source localization, during simultaneous EEG and fMRI recording. We investigated whether the practice effects are determined solely by activity in stimulus-driven mechanisms or whether high-level attentional mechanisms, which are linked to the perceptual task, control the learning process. Results The results of fMRI analyses revealed significant attention and learning related activity in left and right superior temporal gyrus STG as well as the left inferior frontal gyrus IFG. Current source localization of simultaneously recorded EEG data was estimated using a variational Bayesian method. Analysis of current localized to the left inferior frontal gyrus and the right superior temporal gyrus revealed gamma band activity correlated with behavioral performance. Conclusions Rapid improvement in task performance is accompanied by plastic changes in the sensory cortex as well as superior areas gated by selective attention. Together the fMRI and EEG results suggest that gamma band activity in the right STG and left IFG plays an important role during perceptual learning. PMID:23316957

A Finite-Orbit-Width Fokker-Planck solver for modeling of energetic particle interactions with waves, with application to Helicons in ITER

NASA Astrophysics Data System (ADS)

Petrov, Yuri V.; Harvey, R. W.

2017-10-01

The bounce-average (BA) finite-difference Fokker-Planck (FP) code CQL3D [1,2] now includes the essential physics to describe the RF heating of Finite-Orbit-Width (FOW) ions in tokamaks. The FP equation is reformulated in terms of Constants-Of-Motion coordinates, which we select to be particle speed, pitch angle, and major radius on the equatorial plane thus obtaining the distribution function directly at this location. Full-orbit, low collisionality neoclassical radial transport emerges from averaging the local friction and diffusion coefficients along guiding center orbits. Similarly, the BA of local quasilinear RF diffusion terms gives rise to additional radial transport. The local RF electric field components needed for the BA operator are usually obtained by a ray-tracing code, such as GENRAY, or in conjunction with full-wave codes. As a new, practical application, the CQL3D-FOW version is used for simulation of alpha-particle heating by high-harmonic waves in ITER. Coupling of high harmonic or helicon fast waves power to electrons is a promising current drive (CD) scenario for high beta plasmas. However, the efficiency of current drive can be diminished by parasitic channeling of RF power into fast ions, such as alphas, through finite Larmor-radius effects. We investigate possibilities to reduce the fast ion heating in CD scenarios.

A single institution study of radiation dose received from CT imaging: A comparison to Malaysian NDRL

NASA Astrophysics Data System (ADS)

Osman, N. D.; Shamsuri, S. B. M.; Tan, Y. W.; Razali, M. A. S. M.; Isa, S. M.

2017-05-01

Advancement of CT technology has led to an increase in CT scanning as it improves the diagnosis. However, it is important to assess health risk of patients associated with ionising radiation received from CT. This study evaluated current dose distributions at Advanced Medical and Dental Institute (AMDI), Malaysia and was used to establish Local Diagnostic Reference Level (LDRL). Dose indicators such as CT Dose Index (CTDIvol and CTDIw) and Dose-Length Product (DLP) were gathered for all routine CT examinations performed at the Imaging Unit, AMDI from January 2015 to June 2016. The first and third quartile values for each dose indicator were determined. A total of 364 CT studies were performed during that period with the highest number of cases being Thorax-Abdomen-Pelvis (TAP) study (57% of total study). The CTDIw ranged between 2.0 mGy to 23.4 mGy per procedure. DLP values were ranged between 94 mGy.cm to 1687 mGy.cm. The local dose data was compared with the national DRL to monitor the current CT practice at AMDI and LDRL will be established from the calculated third quartile values of dose distribution. From the results, some of the local dose values exceeded the Malaysian and further evaluation is important to ensure the dose optimisation for patients.

How are Canadian universities training and supporting undergraduate medical, physiotherapy and occupational therapy students for global health experiences in international low-resource settings?

PubMed

Bessette, Jennifer; Camden, Chantal

2016-12-27

Canadian medical (MD), physiotherapy (PT) and occupational therapy (OT) students increasingly show an interest in global health experiences (GHEs). As certain moral hazards can occur as a result of student GHEs, a growing consensus exists that universities must have an established selection process, in-depth pre-departure training (PDT), adequate onsite supervision and formal debriefing for their students. This study aimed to identify current practices in Canadian MD, PT and OT programs and discuss areas for improvement by comparing them with recommendations found in the literature. Canadian MD, PT and OT programs (n = 45) were invited to answer an online survey about their current practices for GHE support and training. The survey included 24 close-ended questions and 18 open-ended questions. Descriptive statistics and a thematic analysis were performed on the data and results were discussed in comparison with recommendations found in the literature. Twenty-three programs responded to the survey. Student selection processes varied across universities; examples included using academic performance, interviews and motivation letters. All but one MD program had mandatory PDT; content and teaching formats varied, as did training duration (2-38 hours). All but one MD program had onsite supervision; local clinicians were frequently involved. Debriefing, although not systematic, covered similar content; debriefing was variable in duration (1-8 hours). Many current practices are encouraging, but areas for improvement exist. Integrating global health content into the regular curriculum, with advanced study options for students participating in GHEs, could help universities standardize support and training.

Nonlinear reconnecting edge localized modes in current-carrying plasmas

DOE PAGES

Ebrahimi, F.

2017-05-22

Nonlinear edge localized modes in a tokamak are examined using global three-dimensional resistive magnetohydrodynamics simulations. Coherent current-carrying filament (ribbon-like) structures wrapped around the torus are nonlinearly formed due to nonaxisymmetric reconnecting current sheet instabilities, the so-called peeling-like edge localized modes. These fast growing modes saturate by breaking axisymmetric current layers isolated near the plasma edge and go through repetitive relaxation cycles by expelling current radially outward and relaxing it back. The local bidirectional fluctuation-induced electromotive force (emf) from the edge localized modes, the dynamo action, relaxes the axisymmetric current density and forms current holes near the edge. Furthermore, the three-dimensionalmore » coherent current-carrying filament structures (sometimes referred to as 3-D plasmoids) observed here should also have strong implications for solar and astrophysical reconnection.« less

[Practical advices in choosing local anesthesia tools in dentistry. Management of carpule's quality in local anesthesia in dentistry].

PubMed

Kuzin, A V

2014-01-01

The equipment for local anesthesia is described in this article. Practical recommendations for the selection of the injection needle length, size, bevel type is given. Using dental needle for local anesthesia should be guided by the "one injection - one needle" rule, as a needle tends to deform by even the slightest contact with jawbone. Some of the shortcomings of carpule quality may be detected before use: signs of cup corrosion, the presence of sediment, air bubbles, rubber plunger disposition. In the case of such defects being identified all the package should not be used. The use of such carpule in clinical practice is unsafe.

A survey of current practice of vascular surgeons in venous disease management.

PubMed

Bush, Ruth L; Gloviczki, Peter

2013-01-01

Acute venous thromboembolism and chronic venous diseases are common conditions that affect a large proportion of the United States population. The diagnosis of venous disease has improved, and the treatment options have rapidly evolved over the past decade. To date, it is unclear to what extent vascular surgeons have become involved in the modern management of venous disorders. This survey was undertaken to explore the current interest and practice of vascular surgeons in the contemporary care of venous disease. A survey was administered via a web-based platform to active and candidate members of the Society for Vascular Surgery (SVS). The survey included 30 questions investigating the characteristics of venous surgeons and scope of venous practice. Open-ended questions were also included for commentary. A total of 1879 surveys were sent to SVS members nationwide, and 385 members participated (response rate of 20.5%). The participants were mostly men (89.6%) with 37.7% practicing in an academic setting and 59.2% in private practice. The respondents treated superficial veins (92.9%) and deep veins (85.8%) in clinical practice, with 89.9% having their own vascular laboratory. A wide spectrum of interventions for superficial (91.9%), deep (85.8%), and perforator veins (52.7% endovenous, 19.4% subfascial endoscopic perforator surgery) are being performed by respondents. Only 26.2% had learned endovenous thermal ablation in their training program; however, over 96% of those performing venous interventions utilized this technique. Overall, the majority (85.5%) devoted 50% or less of practice to venous disorders. Respondents indicated that limitations to expansion of vein practices mainly involved challenges with third party payers, local competition, and existing large volumes of arterial interventions needing to be performed. Despite the widespread incorporation of venous disease into current vascular practices, 66.1% are not members of the American Venous Forum (AVF) or other venous society. Many believe there is still a lack of standardization of care and guidelines for venous disease. The care of patients with venous disease has become more widespread among SVS members, with most offering both deep and superficial venous interventions as well as incorporation of minimally invasive techniques into their treatment armamentarium. Dissemination and incorporation of protocols and guidelines into clinical practice as well as postgraduate courses in venous disease may be areas in which the SVS could facilitate members' involvement in the care of patients with venous disease. Published by Elsevier Inc.

Perspectives on setting limits for RF contact currents: a commentary.

PubMed

Tell, Richard A; Tell, Christopher A

2018-01-15

Limits for exposure to radiofrequency (RF) contact currents are specified in the two dominant RF safety standards and guidelines developed by the Institute of Electrical and Electronics Engineers (IEEE) and the International Commission on Non-Ionizing Radiation Protection (ICNIRP). These limits are intended to prevent RF burns when contacting RF energized objects caused by high local tissue current densities. We explain what contact currents are and review some history of the relevant limits with an emphasis on so-called "touch" contacts, i.e., contact between a person and a contact current source during touch via a very small contact area. Contact current limits were originally set on the basis of controlling the specific absorption rate resulting from the current flowing through regions of small conductive cross section within the body, such as the wrist or ankle. More recently, contact currents have been based on thresholds of perceived heating. In the latest standard from the IEEE developed for NATO, contact currents have been based on two research studies in which thresholds for perception of thermal warmth or thermal pain have been measured. Importantly, these studies maximized conductive contact between the subject and the contact current source. This factor was found to dominate the response to heating wherein high resistance contact, such as from dry skin, can result in local heating many times that from a highly conductive contact. Other factors such as electrode size and shape, frequency of the current and the physical force associated with contact are found to introduce uncertainty in threshold values when comparing data across multiple studies. Relying on studies in which the contact current is minimized for a given threshold does not result in conservative protection limits. Future efforts to develop limits on contact currents should include consideration of (1) the basis for the limits (perception, pain, tissue damage); (2) understanding of the practical conditions of real world exposure for contact currents such as contact resistance, size and shape of the contact electrode and applied force at the point of contact; (3) consistency of how contact currents are applied in research studies across different researchers; (4) effects of frequency.

The Future of Pork Production in the World: Towards Sustainable, Welfare-Positive Systems

PubMed Central

McGlone, John J.

2013-01-01

Simple Summary More pork is eaten in the world than any other meat. Making production systems and practices more sustainable will benefit the animals, the planet and people. A system is presented by which production practices are evaluated using a sustainability matrix. The matrix shows why some practices are more common in some countries and regions and the impediments to more sustainable systems. This method can be used to assess the sustainability of production practices in the future where objective, science-based information is presented alongside ethical and economic information to make the most informed decisions. Finally, this paper points to current pork production practices that are more and less sustainable. Abstract Among land animals, more pork is eaten in the world than any other meat. The earth holds about one billion pigs who deliver over 100 mmt of pork to people for consumption. Systems of pork production changed from a forest-based to pasture-based to dirt lots and finally into specially-designed buildings. The world pork industry is variable and complex not just in production methods but in economics and cultural value. A systematic analysis of pork industry sustainability was performed. Sustainable production methods are considered at three levels using three examples in this paper: production system, penning system and for a production practice. A sustainability matrix was provided for each example. In a comparison of indoor vs. outdoor systems, the food safety/zoonoses concerns make current outdoor systems unsustainable. The choice of keeping pregnant sows in group pens or individual crates is complex in that the outcome of a sustainability assessment leads to the conclusion that group penning is more sustainable in the EU and certain USA states, but the individual crate is currently more sustainable in other USA states, Asia and Latin America. A comparison of conventional physical castration with immunological castration shows that the less-common immunological castration method is more sustainable (for a number of reasons). This paper provides a method to assess the sustainability of production systems and practices that take into account the best available science, human perception and culture, animal welfare, the environment, food safety, worker health and safety, and economics (including the cost of production and solving world hunger). This tool can be used in countries and regions where the table values of a sustainability matrix change based on local conditions. The sustainability matrix can be used to assess current systems and predict improved systems of the future. PMID:26487410

Web-based classroom data collection in ADHD: a best practices case study.

PubMed

Bhatara, Vinod; Vogt, H Bruce; Ellis, Roland; Alshari, Ghyath; Patrick, Sarah

2003-09-01

Best practices research identifies and disseminates effective clinical strategies developed and refined by clinicians for their practices. As opposed to the content of health care, medical students and residents are typically not trained in the process of its provision. This paper illustrates a best practices approach to development of a Web-based classroom data collection method to improve medication management in attention deficit hyperactivity disorder (ADHD). 1) To increase Primary Care Physician (PCP) awareness of the process of best practices research, and; 2) to highlight the use of the World Wide Web as a tool for integration of care of children with ADHD. Based on the review of a large national study in ADHD, the key ingredients for the best pharmacotherapy practices were identified. The lessons from the literature were adapted for local practice using the framework and steps for best practices outlined by Mold and Gregory. A conceptual model of managing information provided by parents/caregivers and teachers to PCPs was developed. Several steps were identified, including Web-based classroom behavioral data collection by a care manager and feedback reports to PCPs from a child psychiatrist based on the data collected. This model is currently being tested. Our preliminary experience suggests that a best practices approach has potential applications to a variety of primary care settings in South Dakota. We encourage PCPs to consider best practice strategies for their own practices. The practice-based research network (Rush Net) being developed by the Center for Rural Health Improvement of the University of South Dakota School of Medicine's Department of Family Medicine can be helpful in this regard.

Health technology assessments conducted in health care facilities: A strategic practice? Findings from a content analysis of HTA reports

PubMed Central

Lalancette, Pascal; Racine, Alexandre

2017-01-01

In this paper, we test the hypothesis that health technology assessment units located in hospitals tend to be more optimistic toward technologies that are currently in use in their organization than technologies that are not. The data include 108 health technologies assessed in 87 full-scale health technology assessment reports produced by the four main local health technology assessment units in Quebec (Canada) on behalf of decision makers from the same facility. We found that 58 (53.7 percent) of the 108 technologies were currently in use within the hospital during their assessment. Based on the assessors' interpretation of the scientific evidence regarding the efficacy of the technologies, 67.3 percent of the technologies that were in use in the hospital during the evaluation were effective (56 percent for those that were not currently being used), but the difference is not statistically significant (chi-square 1.38; p = 0.24). Controlling for the efficacy judgment, the type of technologies (i.e. preventive, diagnostic, therapeutic or organizational), the number of technologies assessed in the report and the assessment unit, we found that the technologies that were currently in use in the facility during the evaluation were 62 percent more likely to be recommended favorably by the assessment unit than the technologies that were not currently being used (RR = 1.62; 95 percent CI = 1.06–1.88). This suggests that the local health technology units that were examined in the study tended to be more optimistic toward technologies that were currently in use in their hospital at the time of the evaluation. PMID:28945772

Health, climate change and energy vulnerability: a retrospective assessment of strategic health authority policy and practice in England.

PubMed

Richardson, J; Kagawa, F; Nichols, A

2008-11-17

A number of policy documents suggest that health services should be taking climate change and sustainability seriously and recommendations have been made to mitigate and adapt to the challenges health care providers will face. Actions include, for example, moving towards locally sourced food supplies, reducing waste, energy consumption and travel, and including sustainability in policies and strategies. A Strategic Health Authority (SHA) is part of the National Health Service (NHS) in England. They are responsible for developing strategies for the local health services and ensuring high-quality performance. They manage the NHS locally and are a key link between the U.K. Department of Health and the NHS. They also ensure that national priorities are integrated into local plans. Thus they are in a key position to influence policies and practices to mitigate and adapt to the impact of climate change and promote sustainability. The aim of this study was to review publicly available documents produced by Strategic Health Authorities (SHA) to assess the extent to which current activity and planning locally takes into consideration climate change and energy vulnerability. A retrospective thematic content analysis of publicly available materials was undertaken by two researchers over a six month period in 2008. These materials were obtained from the websites of the 10 SHAs in England. Materials included annual reports, plans, policies and strategy documents. Of the 10 SHAs searched, 4 were found to have an absence of content related to climate change and sustainability. Of the remaining 6 SHAs that did include content related to climate change and energy vulnerability on their websites consistent themes were seen to emerge. These included commitment to a regional sustainability framework in collaboration with other agencies in the pursuit and promotion of sustainable development. Results indicate that many SHAs in England have yet to embrace sustainability, or to integrate preparations for climate change and energy vulnerability within their organisational strategies. Evidence also suggests that SHAs that have recognised the importance of sustainability within their documentation and policies have yet to fully demonstrate this in practice through the implementation of these policies. Further research is required to investigate means by which SHAs (U.K.) and agencies responsible for health service policy in other countries may be enabled to include a greater consideration of sustainability and climate change within their policies, and to find effective ways of implementing these policies within daily working practice.

Exporting DBCP and other banned pesticides: consideration of ethical issues.

PubMed

Lowry, L K; Frank, A L

1999-01-01

Many developed countries permit the export of pesticides that are banned, restricted, or unregistered within their own borders. This practice, which leads to the exposure of agricultural workers in developing countries to high levels of pesticides that are not permitted in the country of manufacture, raises many ethical issues as well as economic, social, political, and public health issues. Worldwide attempts to control export of such pesticides, through the FAO/UNEP Prior Informed Consent program, moves this issue in the right direction. This article explores the current U.S. and international practices, using the specific example of export of DBCP to banana-producing countries. The actions taken by multinational corporations, manufacturers of the pesticides, and public health officials in both the exporting and importing countries are explored, along with the impacts on workers, local economies, governments, and the environment.

Observations on the NHS internal market: will the dodo get the last laugh?

PubMed Central

Royce, R. G.

1995-01-01

Distinguishing between the theory and practice of the internal market has been obscured by the considerable controversy generated by the reforms themselves. In such an environment both the advocates and the opponents of a market based solution have tended to promote their respective claims by reference to underlying political philosophies and economic theories rather than practical experience. Royce gives his observations of the actual operation of the internal market with particular reference to the commissioning function in Wales. He highlights inadequacies and inequities in the current system and proposes some remedial actions. Central to these are the importance of ensuring equitable funding for all purchasers, acknowledging the necessity of rationing, and promoting efficient and effective health care, sometimes at the expense of patient choice and guaranteed local service provision. Images p432-a PMID:7640593

Need for "conflict version" of primary surgery: war surgery in the era of low-intensity conflicts.

PubMed

Morikawa, Masahiro J

2006-01-01

The conventional wars between nations have widely been replaced by low-intensity conflicts within nations today, resulting in different patterns of injuries and practice of surgical care. A blurred front line, protracted durations of violence, indiscriminant fighting, and the emergence of specific surgical problems characterize low-intensity conflicts. In protracted conflicts with limited resources, surgical outcomes depend on many factors other than surgical skills, such as social/cultural values and economical feasibility. This paper examines how the characteristics of current conflicts affect surgical practice and will address key issues to evolve care to adapt to these changes. Key issues are (1) need for comprehensive surgical skills, (2) importance of improving local capacities, (3) long-term impact of trauma, and (4) limited access to information required to improve surgical skills.

From IB2 to IIIB locally advanced cervical cancers: report of a ten-year experience.

PubMed

Espenel, Sophie; Garcia, Max-Adrien; Trone, Jane-Chloé; Guillaume, Elodie; Harris, Annabelle; Rehailia-Blanchard, Amel; He, Ming Yuan; Ouni, Sarra; Vallard, Alexis; Rancoule, Chloé; Ben Mrad, Majed; Chauleur, Céline; De Laroche, Guy; Guy, Jean-Baptiste; Moreno-Acosta, Pablo; Magné, Nicolas

2018-02-02

Despite screening campaigns, cervical cancers remain among the most prevalent malignancies and carry significant mortality, especially in developing countries. Most studies report outcomes of patients receiving the usual standard of care. It is possible that these selected patients may not correctly represent patients in a real-world setting, which may be a limitation in interpreting outcomes. This study was undertaken to identify prognostic factors, management strategies and outcomes of locally advanced cervical cancers (LACC) treated in daily clinical practice. Medical files of all consecutive patients treated with curative intent for LACC in a French Cancer Care Center between 2004 and 2014 were reviewed retrospectively. Ninety-four patients were identified. Performance status was ≥ 2 in 10.6%. Median age at diagnosis was 63.0. Based on the International Federation of Gynecology and Obstetrics classification, tumours were classified as follows: 10.6% IB2, 22.3% IIA, 51.0% IIB, 4.3% IIIA and 11.7% IIIB. Pelvic lymph nodes were involved in 34.0% of cases. Radiotherapy was delivered for all patients. Radiotherapy technique was intensity modulated radiation therapy or volumetric modulated arc therapy in 39.4% of cases. A concurrent cisplatin chemotherapy was delivered in 68.1% of patients. Brachytherapy was performed in 77.7% of cases. The recommended standard care (concurrent chemoradiotherapy with at least five chemotherapy cycles during radiotherapy, followed by brachytherapy) was delivered in 43.6%. The median overall treatment time was 56 days. Complete tumour sterilisation was achieved in 55.2% of cases. Mean follow-up was 54.3 months. Local recurrence rate was 18.1%. Five-year overall survival was 61.9% (95% Confident Interval (CI) = 52.3-73.2) and five-year disease-specific survival was 68.5% (95% CI = 59.2-79.2). Poor performance status, lymph nodes metastasis and absence of concurrent chemotherapy were identified as poor prognostic factors in multivariate analysis. Less than 50% of patients received the standard care. Because LACC patients and disease are heterogeneous, treatment tailoring appears to be common in current clinical practice. However, guidelines for tailoring management are not currently available. More data about real-world settings are required in order to to optimise clinical trials' aims and designs, and make them translatable in daily clinical practice. retrospectively registered.

Traditional medicines and globalization: current and future perspectives in ethnopharmacology.

PubMed

Leonti, Marco; Casu, Laura

2013-01-01

The ethnopharmacological approach toward the understanding and appraisal of traditional and herbal medicines is characterized by the inclusions of the social as well as the natural sciences. Anthropological field-observations describing the local use of nature-derived medicines are the basis for ethnopharmacological enquiries. The multidisciplinary scientific validation of indigenous drugs is of relevance to modern societies at large and helps to sustain local health care practices. Especially with respect to therapies related to aging related, chronic and infectious diseases traditional medicines offer promising alternatives to biomedicine. Bioassays applied in ethnopharmacology represent the molecular characteristics and complexities of the disease or symptoms for which an indigenous drug is used in "traditional" medicine to variable depth and extent. One-dimensional in vitro approaches rarely cope with the complexity of human diseases and ignore the concept of polypharmacological synergies. The recent focus on holistic approaches and systems biology in medicinal plant research represents the trend toward the description and the understanding of complex multi-parameter systems. Ethnopharmacopoeias are non-static cultural constructs shaped by belief and knowledge systems. Intensified globalization and economic liberalism currently accelerates the interchange between local and global pharmacopoeias via international trade, television, the World Wide Web and print media. The increased infiltration of newly generated biomedical knowledge and introduction of "foreign" medicines into local pharmacopoeias leads to syncretic developments and generates a feedback loop. While modern and post-modern cultures and knowledge systems adapt and transform the global impact, they become more relevant for ethnopharmacology. Moreover, what is traditional, alternative or complementary medicine depends on the adopted historic-cultural perspective.

Traditional medicines and globalization: current and future perspectives in ethnopharmacology

PubMed Central

Leonti, Marco; Casu, Laura

2013-01-01

The ethnopharmacological approach toward the understanding and appraisal of traditional and herbal medicines is characterized by the inclusions of the social as well as the natural sciences. Anthropological field-observations describing the local use of nature-derived medicines are the basis for ethnopharmacological enquiries. The multidisciplinary scientific validation of indigenous drugs is of relevance to modern societies at large and helps to sustain local health care practices. Especially with respect to therapies related to aging related, chronic and infectious diseases traditional medicines offer promising alternatives to biomedicine. Bioassays applied in ethnopharmacology represent the molecular characteristics and complexities of the disease or symptoms for which an indigenous drug is used in “traditional” medicine to variable depth and extent. One-dimensional in vitro approaches rarely cope with the complexity of human diseases and ignore the concept of polypharmacological synergies. The recent focus on holistic approaches and systems biology in medicinal plant research represents the trend toward the description and the understanding of complex multi-parameter systems. Ethnopharmacopoeias are non-static cultural constructs shaped by belief and knowledge systems. Intensified globalization and economic liberalism currently accelerates the interchange between local and global pharmacopoeias via international trade, television, the World Wide Web and print media. The increased infiltration of newly generated biomedical knowledge and introduction of “foreign” medicines into local pharmacopoeias leads to syncretic developments and generates a feedback loop. While modern and post-modern cultures and knowledge systems adapt and transform the global impact, they become more relevant for ethnopharmacology. Moreover, what is traditional, alternative or complementary medicine depends on the adopted historic-cultural perspective. PMID:23898296

Strategies for reforestation under uncertain future climates: guidelines for Alberta, Canada.

PubMed

Gray, Laura K; Hamann, Andreas

2011-01-01

Commercial forestry programs normally use locally collected seed for reforestation under the assumption that tree populations are optimally adapted to local environments. However, in western Canada this assumption is no longer valid because of climate trends that have occurred over the last several decades. The objective of this study is to show how we can arrive at reforestation recommendations with alternative species and genotypes that are viable under a majority of climate change scenarios. In a case study for commercially important tree species of Alberta, we use an ecosystem-based bioclimate envelope modeling approach for western North America to project habitat for locally adapted populations of tree species using multi-model climate projections for the 2020s, 2050s and 2080s. We find that genotypes of species that are adapted to drier climatic conditions will be the preferred planting stock over much of the boreal forest that is commercially managed. Interestingly, no alternative species that are currently not present in Alberta can be recommended with any confidence. Finally, we observe large uncertainties in projections of suitable habitat that make reforestation planning beyond the 2050s difficult for most species. More than 50,000 hectares of forests are commercially planted every year in Alberta. Choosing alternative planting stock, suitable for expected future climates, could therefore offer an effective climate change adaptation strategy at little additional cost. Habitat projections for locally adapted tree populations under observed climate change conform well to projections for the 2020s, which suggests that it is a safe strategy to change current reforestation practices and adapt to new climatic realities through assisted migration prescriptions.

Local, regional and national interoperability in hospital-level systems architecture.

PubMed

Mykkänen, J; Korpela, M; Ripatti, S; Rannanheimo, J; Sorri, J

2007-01-01

Interoperability of applications in health care is faced with various needs by patients, health professionals, organizations and policy makers. A combination of existing and new applications is a necessity. Hospitals are in a position to drive many integration solutions, but need approaches which combine local, regional and national requirements and initiatives with open standards to support flexible processes and applications on a local hospital level. We discuss systems architecture of hospitals in relation to various processes and applications, and highlight current challenges and prospects using a service-oriented architecture approach. We also illustrate these aspects with examples from Finnish hospitals. A set of main services and elements of service-oriented architectures for health care facilities are identified, with medium-term focus which acknowledges existing systems as a core part of service-oriented solutions. The services and elements are grouped according to functional and interoperability cohesion. A transition towards service-oriented architecture in health care must acknowledge existing health information systems and promote the specification of central processes and software services locally and across organizations. Software industry best practices such as SOA must be combined with health care knowledge to respond to central challenges such as continuous change in health care. A service-oriented approach cannot entirely rely on common standards and frameworks but it must be locally adapted and complemented.

21 CFR 110.5 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 110.5 Section...) FOOD FOR HUMAN CONSUMPTION CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING, PACKING, OR HOLDING HUMAN FOOD General Provisions § 110.5 Current good manufacturing practice. (a) The criteria and...

Global characteristics of auroral Hall currents derived from the Swarm constellation: dependences on season and IMF orientation

NASA Astrophysics Data System (ADS)

Huang, Tao; Lühr, Hermann; Wang, Hui

2017-11-01

On the basis of field-aligned currents (FACs) and Hall currents derived from high-resolution magnetic field data of the Swarm constellation, the average characteristics of these two current systems in the auroral regions are comprehensively investigated by statistical methods. This is the first study considering both current types determined simultaneously by the same spacecraft in both hemispheres. The FAC distribution, derived from the novel Swarm dual-spacecraft approach, reveals the well-known features of Region 1 (R1) and Region 2 (R2) FACs. At high latitudes, Region 0 (R0) FACs appear on the dayside. Their flow direction, up or down, depends on the orientation of the interplanetary magnetic field (IMF) By component. Of particular interest is the distribution of auroral Hall currents. The prominent auroral electrojets are found to be closely controlled by the solar wind input, but we find no dependence of their intensity on the IMF By orientation. The eastward electrojet is about 1.5 times stronger in local summer than in winter. Conversely, the westward electrojet shows less dependence on season. As to higher latitudes, part of the electrojet current is closed over the polar cap. Here the seasonal variation of conductivity mainly controls the current density. During local summer of the Northern Hemisphere, there is a clear channeling of return currents over the polar cap. For positive (negative) IMF By a dominant eastward (westward) Hall current circuit is formed from the afternoon (morning) electrojet towards the dawn side (dusk side) polar cap return current. The direction of polar cap Hall currents in the noon sector depends directly on the orientation of the IMF By. This is true for both signs of the IMF Bz component. Comparable Hall current distributions can be observed in the Southern Hemisphere but for opposite IMF By signs. Around the midnight sector the westward substorm electrojet is dominating. As expected, it is highly dependent on magnetic activity, but it shows only little response to season and IMF By polarity. An important finding is that all the IMF By dependences of FACs and Hall currents practically disappear in the dark winter hemisphere.

A Clinical Nurse Leader (CNL) practice development model to support integration of the CNL role into microsystem care delivery.

PubMed

Kaack, Lorraine; Bender, Miriam; Finch, Michael; Borns, Linda; Grasham, Katherine; Avolio, Alice; Clausen, Shawna; Terese, Nadine A; Johnstone, Diane; Williams, Marjory

The Veterans Health Administration (VHA) Office of Nursing Services (ONS) was an early adopter of Clinical Nurse Leader (CNL) practice, generating some of the earliest pilot data of CNL practice effectiveness. In 2011 the VHA ONS CNL Implementation & Evaluation Service (CNL I&E) piloted a curriculum to facilitate CNL transition to effective practice at local VHA settings. In 2015, the CNL I&E and local VHA setting stakeholders collaborated to refine the program, based on lessons learned at the national and local level. The workgroup reviewed the literature to identify theoretical frameworks for CNL practice and practice development. The workgroup selected Benner et al.'s Novice-to-Expert model as the defining framework for CNL practice development, and Bender et al.'s CNL Practice Model as the defining framework for CNL practice integration. The selected frameworks were cross-walked against existing curriculum elements to identify and clarify additional practice development needs. The work generated key insights into: core stages of transition to effective practice; CNL progress and expectations for each stage; and organizational support structures necessary for CNL success at each stage. The refined CNL development model is a robust tool that can be applied to support consistent and effective integration of CNL practice into care delivery. Published by Elsevier Inc.

Medicinal plants traditionally used in the northwest of the Basque Country (Biscay and Alava), Iberian Peninsula.

PubMed

Menendez-Baceta, Gorka; Aceituno-Mata, Laura; Molina, María; Reyes-García, Victoria; Tardío, Javier; Pardo-de-Santayana, Manuel

2014-02-27

Many ethnobotanical studies show that people in industrial countries still rely on their traditional knowledge of medicinal plants for self-treatment, although the trend might not be as common as some decades ago. Given the social and public health implications of ethnopharmacological practices, this survey aims at recording and analysing the medicinal plants used in the folk medicine of the Northwest of the Basque Country focusing on how medicinal plants knowledge and practices evolve. Fieldwork consisted of 265 orally consented semi-structured interviews with 207 informants about medicinal uses of plants. Interviews were conducted between September 2008 and January 2011. Informants were on average 76 years old (minimum 45, maximum 95), being more than half of them (112) men. Data collected were structured in use-reports (UR). Following informants' comments, medicinal use-reports were classified as abandoned-UR, when the informants reported that the use was only practiced in the past, and prevalent-UR, when the informants reported to continue the practice. A total of 2067 UR for 139 species that belong to 58 botanical families were recorded, being the most important families Asteraceae, Liliaceae sensu latu and Urticaceae. Some of the most important species are commonly used in other European areas (e.g., Chamaemelum nobile, Urtica dioica and Chelidonium majus). However, there are also plants commonly used in the area such as Helleborus viridis or Coronopus didymus, that are scarcely used in other areas, and whose record is an original contribution of the local pharmacopeia. It is also the case of remedies such as the use of Plantago leaves against strains in a local remedy called zantiritu. Overall, and for all variables analysed (total UR, medicinal use-categories, drug preparation and administration), the percentage of UR being currently practiced (prevalence ratio) was very low (near 30%) suggesting a strong decay in the use of traditional medicinal plants. Exceptionally, some species (Chamaemelum nobile, Verbena officinalis or Anagallis arvensis) had a high prevalence ratio, reflecting the fact that this erosion process is not evolving homogeneously. Informants also reported that new species and medicinal plant uses were entering into the local pharmacopeia via non-traditional sources such as books, courses, or the internet. These modern ways are now being used to spread some traditional remedies that in the past were only orally transmitted. This study shows that traditional knowledge is continuously changing, evolving and adapting to the new social and environmental conditions. The image of the local folk medicine as a dying reality doomed to disappear should be reviewed. It also shows the need of a culturally sensitive approach by the official health systems to these practices. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Wildlife uses and hunting patterns in rural communities of the Yucatan Peninsula, Mexico

PubMed Central

2012-01-01

Background Subsistence hunting is a traditional practice providing food and many other goods for households in the Yucatan Peninsula, southeast Mexico. Economic, demographic, and cultural change in this region drive wildlife habitat loss and local extinctions. Improving our understanding about current practices of wildlife use may support better management strategies for conserving game species and their habitat. We aimed to evaluate if wildlife use remained relevant for the subsistence of rural residents of the Yucatan Peninsula, as well as if local hunting practices were related to environmental, geographical, and cultural factors. Methods Fieldwork was done between March 2010 and March 2011. Information was obtained through conversations, interviews, and participant observation. Record forms allowed recording animals hunted, biomass extracted, distance intervals to hunting sites, habitat types and seasonality of wildlife harvests. Data were analyzed using one-way Analysis of Variance, and Generalized Linear Models. Results Forty-six terrestrial vertebrate species were used for obtaining food, medicine, tools, adornments, pets, ritual objects, and for sale and mitigating damage. We recorded 968 animals taken in 664 successful hunting events. The Great Curassow, Ocellated Turkey, paca, white-tailed deer, and collared peccary were the top harvested species, providing 80.7% of biomass (10,190 kg). The numbers of animals hunted and biomass extracted declined as hunting distances increased from villages. Average per capita consumption was 4.65 ± 2.7 kg/person/year. Hunting frequencies were similar in forested and agricultural areas. Discussion Wildlife use, hunting patterns, and technologies observed in our study sites were similar to those recorded in previous studies for rural Mayan and mestizo communities in the Yucatan Peninsula and other Neotropical sites. The most heavily hunted species were those providing more products and by-products for residents. Large birds such as the Great Curassow and the Ocellated Turkey were extremely important for local hunters, representing around 40% of total prey taken. Final considerations Our results suggest that hunting is frequent in our study areas. Low human densities allow low hunting pressure on most game species and favor conservation of the tropical forest. We suggest that co-management may help regulating hunting, prioritizing cultural practices of sustainable use and conservation for benefiting local users and animal populations. PMID:23031274

Developing Policy and Practice for Dyslexia across a Local Authority: A Case Study of Educational Psychology Practice at Organisational Level

ERIC Educational Resources Information Center

Woods, Kevin; Stothard, Jan; Lydon, Jackie; Reason, Rea

2013-01-01

In this paper two premises are set out: first, that within Children's Services educational psychologists (EPs) have a distinctive contribution to make towards policy and practice in relation to "dyslexia"; second, that they may be well placed to lead development work at an organisational level within a local authority. Building on…

A neo-strategic planning approach to enhance local tobacco control programs.

PubMed

Douglas, Malinda R; Carter, Sara Sally R; Wilson, Andrew P; Chan, Andie

2015-01-01

Research in tobacco control demonstrating best practices is widely disseminated; however, application at the local level is often difficult. Translating research into practice requires a concerted effort to develop an understanding of the evidence and how it can be applied within diverse contexts. A strategic planning infrastructure was developed to support the translation of evidence-based interventions into community practice. This paper highlights the strategic process of turning "know-what" into "know-how" to facilitate the strategic planning and implementation of tobacco control best practices at the local level. The purpose, people, process, and product strategies of knowledge management and translation provided a framework for the strategic planning infrastructure. The knowledge translation concepts of audience, motivations, and mechanisms were synergized in the neo-strategic planning component design. The participants were 20 community coalitions funded to implement local tobacco control programs. From 2004 to 2011, the strategic planners facilitated a cyclical process to translate research into practice using a trio of integrated tools, skill-building workshops on strategic planning, and grantee-driven technical assistance and consultation. In the short term, the usefulness of the strategic planning components to the programs was measured. The intermediate outcome was the successful movement of the community programs from the planning stage to the implementation stage. The achievement of community-level changes in planned tobacco control efforts was the overall outcome measure for the success of the local coalitions. Seventeen of 20 communities that began the planning process implemented strategic plans. All 17 of the programs implemented evidence-based practices, resulting in numerous tobacco-free policies, increased cessation, and increased support from the media and community. Bridging the gap between research and practice can enhance the practicality, efficiency, and effectiveness of tobacco control programs at the local level, maximizing the potential positive health impact. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

From management to mediation: local forestry management and the forestry crisis in post-socialist Russia.

PubMed

Eikeland, Sveinung; Eythorsson, Einar; Ivanova, Lyudmila

2004-03-01

The local branches of the Russian Forestry Service, the leskhozy, were known for their efficiency and management skills in the Soviet era and were one of the very few community-based "Soviet-type" institutions to survive the transition. This article examines the role of the leskhozy in the new market economy. Our analysis is based on data from interviews with informants attached to the forestry sector in the Murmansk area. In some cases their knowledge of the leskhozy stretches back to the emergence of the system in 1947. Our principal finding is that the struggle to survive as a federal body in the current legal and economic climate is forcing the leskhozy to relegate sustainable forestry management, presumably their primary raison d'être, to the lower portions of their list of priorities. Several consequences result. There is a heightened incidence of illegal logging, and corruption informs the allocation of forest areas to private interests. Stumpage prices have plummeted as timber from subsidized commercial cutting (ostensibly sanitary cutting or thinning) has flooded the markets. The root cause of these tribulations lies with the market-based harvesting permit system. Its introduction in the 1990s did little to eliminate the self-seeking practices of the old Soviet forestry management hierarchies. In the free market, local forestry managers can turn their dual responsibilities to their own advantage inasmuch as they control the allocation of harvesting permits while at the same time controlling logging practices.

Kees: a Practical Ict Solution for Rural Areas

NASA Astrophysics Data System (ADS)

Dai, Xiaoye; Tabirca, Sabin; Lenihan, Eamon

This paper introduces a practical e-learning system, identified as Knowledge Exchange E-learning System (abbr. KEES), for knowledge distribution in rural areas. Particularly, this paper is about providing a virtual teaching and learning environment for small holders in agriculture in those rural areas. E-learning is increasingly influencing the agricultural education (information and knowledge learning) in all forms and the current e-learning in agricultural education appears in informal and formal methods in many developed countries and some developing areas such as Asian Pacific regions. KEES is a solution to provide education services including other services of information distribution and knowledge sharing to local farmers, local institutes or local collection of farmers. The design of KEES is made to meet the needs of knowledge capacity building, experience sharing, skill upgrading, and information exchanging in agriculture for different conditions in rural areas. The system allows the online lecture/training materials to be distributed simultaneously with all multimedia resources through different file formats across different platforms. The teaching/training content can be contextless and broad, allowing for greater participation by more small holders, commercial farmers, extension workers, agriculturists, educators, and other agriculture-related experts. The relative inconsistency in content gives farmers more localised and useful knowledge. The framework of KEES has been designed to be a three-tier architecture logic workflow, which can configure the progressive approach for KEES to pass on and respond to different requests/communications between the client side and the server.

From Dyadic Ties to Information Infrastructures: Care-Coordination between Patients, Providers, Students and Researchers

PubMed Central

Purkayastha, S.; Biswas, R.; Jai Ganesh, A.U.; Otero, P.

2015-01-01

Summary Objective To share how an effectual merging of local and online networks in low resource regions can supplement and strengthen the local practice of patient centered care through the use of an online digital infrastructure powered by all stakeholders in healthcare. User Driven Health Care offers the dynamic integration of patient values and evidence based solutions for improved medical communication in medical care. Introduction This paper conceptualizes patient care-coordination through the lens of engaged stakeholders using digital infrastructures tools to integrate information technology. We distinguish this lens from the prevalent conceptualization of dyadic ties between clinician-patient, patient-nurse, clinician-nurse, and offer the holistic integration of all stakeholder inputs, in the clinic and augmented by online communication in a multi-national setting. Methods We analyze an instance of the user-driven health care (UDHC), a network of providers, patients, students and researchers working together to help manage patient care. The network currently focuses on patients from LMICs, but the provider network is global in reach. We describe UDHC and its opportunities and challenges in care-coordination to reduce costs, bring equity, and improve care quality and share evidence. Conclusion UDHC has resulted in coordinated global based local care, affecting multiple facets of medical practice. Shared information resources between providers with disparate knowledge, results in better understanding by patients, unique and challenging cases for students, innovative community based research and discovery learning for all. PMID:26123908

From Dyadic Ties to Information Infrastructures: Care-Coordination between Patients, Providers, Students and Researchers. Contribution of the Health Informatics Education Working Group.

PubMed

Purkayastha, S; Price, A; Biswas, R; Jai Ganesh, A U; Otero, P

2015-08-13

To share how an effectual merging of local and online networks in low resource regions can supplement and strengthen the local practice of patient centered care through the use of an online digital infrastructure powered by all stakeholders in healthcare. User Driven Health Care offers the dynamic integration of patient values and evidence based solutions for improved medical communication in medical care. This paper conceptualizes patient care-coordination through the lens of engaged stakeholders using digital infrastructures tools to integrate information technology. We distinguish this lens from the prevalent conceptualization of dyadic ties between clinician-patient, patient-nurse, clinician-nurse, and offer the holistic integration of all stakeholder inputs, in the clinic and augmented by online communication in a multi-national setting. We analyze an instance of the user-driven health care (UDHC), a network of providers, patients, students and researchers working together to help manage patient care. The network currently focuses on patients from LMICs, but the provider network is global in reach. We describe UDHC and its opportunities and challenges in care-coordination to reduce costs, bring equity, and improve care quality and share evidence. UDHC has resulted in coordinated global based local care, affecting multiple facets of medical practice. Shared information resources between providers with disparate knowledge, results in better understanding by patients, unique and challenging cases for students, innovative community based research and discovery learning for all.

Better parks through law and policy: a legal analysis of authorities governing public parks and open spaces.

PubMed

Henderson, Ana; Fry, Christine R

2011-01-01

Improving parks in low income and minority neighborhoods may be a key way to increase physical activity and decrease overweight and obesity prevalence among children at the greatest risk. To advocate effectively for improved recreation infrastructure, public health advocates must understand the legal and policy landscape in which public recreation decisions are made. In this descriptive legal analysis, we reviewed federal, state, and local laws to determine the authority of each level of government over parks. We then examined current practices and state laws regarding park administration in urban California and rural Texas. We identified several themes through the analysis: (1) multiple levels of governments are often involved in parks offerings in a municipality, (2) state laws governing parks vary, (3) local authority may vary substantially within a state, and (4) state law may offer greater authority than local jurisdictions use. Public health advocates who want to improve parks need to (1) think strategically about which levels of government to engage; (2) identify parks law and funding from all levels of government, including those not typically associated with local parks; and (3) partner with advocates with similar interests, including those from active living and school communities.

21 CFR 225.1 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Current good manufacturing practice. 225.1 Section...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR MEDICATED FEEDS General Provisions § 225.1 Current good manufacturing practice. (a) Section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act...

21 CFR 210.1 - Status of current good manufacturing practice regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Status of current good manufacturing practice... SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING, PROCESSING, PACKING, OR HOLDING OF DRUGS; GENERAL § 210.1 Status of current good manufacturing practice regulations...

21 CFR 226.1 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Current good manufacturing practice. 226.1 Section...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR TYPE A MEDICATED ARTICLES General Provisions § 226.1 Current good manufacturing practice. (a) The criteria in §§ 226.10 through 226.115, inclusive...

Are there practical opportunities for developing leadership skills during GP training and beyond? A survey of GP trainees and trainers in South East Scotland.

PubMed

Curry, Nicola; Denney, MeiLing

2016-01-01

There is currently a lack of formal training in leadership skills, particularly during GP training. This study aimed to explore the current training and practical opportunities which exist, specifically exploring the views of GP trainees and trainers. An electronic questionnaire was sent to 266 GP trainees and trainers in south-east Scotland. Questions focused on respondents' experience of leadership-specific training and opportunities to engage with leadership roles. There were a total of 76 respondents (28.6% response rate). Response rate was 19.0% in trainees and 34.6% in trainers. A majority of respondents (80.0%) were established GPs. Of those who had received training in leadership, most (72.1%) underwent this after qualifying as a GP. Respondents identified a range of leadership roles within and outside the practice covering clinical and non-clinical areas. Most were interested in future leadership roles (46.7% moderately interested; 28% very interested). More time, training opportunities and the presence of GP role models were motivating factors in terms of participants' readiness to take on future leadership roles. Signposting trainees, trainers and general practitioners to leadership opportunities and training would be relatively easy but addressing a lack of motivating factors at a local level is essential. The effectiveness of such training and opportunities for experiential learning in leadership roles requires further research.

Non-vitamin K antagonist oral anticoagulants and atrial fibrillation guidelines in practice: barriers to and strategies for optimal implementation

PubMed Central

Camm, A. John; Pinto, Fausto J.; Hankey, Graeme J.; Andreotti, Felicita; Hobbs, F.D. Richard

2015-01-01

Stroke is a leading cause of morbidity and mortality worldwide. Atrial fibrillation (AF) is an independent risk factor for stroke, increasing the risk five-fold. Strokes in patients with AF are more likely than other embolic strokes to be fatal or cause severe disability and are associated with higher healthcare costs, but they are also preventable. Current guidelines recommend that all patients with AF who are at risk of stroke should receive anticoagulation. However, despite this guidance, registry data indicate that anticoagulation is still widely underused. With a focus on the 2012 update of the European Society of Cardiology (ESC) guidelines for the management of AF, the Action for Stroke Prevention alliance writing group have identified key reasons for the suboptimal implementation of the guidelines at a global, regional, and local level, with an emphasis on access restrictions to guideline-recommended therapies. Following identification of these barriers, the group has developed an expert consensus on strategies to augment the implementation of current guidelines, including practical, educational, and access-related measures. The potential impact of healthcare quality measures for stroke prevention on guideline implementation is also explored. By providing practical guidance on how to improve implementation of the ESC guidelines, or region-specific modifications of these guidelines, the aim is to reduce the potentially devastating impact that stroke can have on patients, their families and their carers. PMID:26116685

Training maternal and child health epidemiologists: leaders for the twenty first century.

PubMed

Handler, Arden; Klaus, Jaime; Rankin, Kristin; Rosenberg, Deborah

2015-02-01

This paper reports on the structure, implementation and outcomes of the Maternal and Child Health (MCH) Epidemiology (MCHEPI) program at the University of Illinois School of Public Health (UIC-SPH) and discusses the successes and challenges in developing MCH Epidemiology leaders for the local, state, and national public health workforce. The MCHEPI program at UIC-SPH offers both the MPH and PhD degree and is based on six key components: integration across school divisions, competency-based training, tailored curricula, practica/dissertations with public health agencies, personal leadership training and development, and socialization. Based on data from the 1998-2012 cohorts, all former and current MCHEPI MPH students (n = 28) have participated in practica with local or state public health agencies and former and current MCHEPI doctoral students at the dissertation stage (12 out of 15) have partnered with local, state or national public health agencies in conducting their dissertations. The alumni of the MCHEPI MPH program (n = 25) appear to serve in higher level positions in their second compared to their first placements post-graduation. All MCHEPI doctoral alumni (n = 8) serve at the emerging senior level or senior scientist level upon graduation, in local, state and federal agencies, or in academe. Explicit linkage of MCHEPI students to practice through tailored curricula, practica, and dissertations with public health agencies, and the development of an identity as a member of the MCHEPI field appear to be important to the generation of epidemiology leaders for the MCH workforce. Leadership development is a lifelong process and as such, snapshots of current students and alumni at any one point in time do not provide the entire picture of the impact of MCH epidemiology training programs. Examining the trajectories of emerging leaders over time is essential for evaluating the true success of Maternal and Child Health Bureau workforce and training investments.

Female genital mutilation.

PubMed

Ladjali, M; Rattray, T W; Walder, R J

1993-08-21

Female genital mutilation, also misleadingly known as female circumcision, is usually performed on girls ranging in from 1 week to puberty. Immediate physical complications include severe pain, shock, infection, bleeding, acute urinary infection, tetanus, and death. Longterm problems include chronic pain, difficulties with micturition and menstruation, pelvic infection leading to infertility, and prolonged and obstructed labor during childbirth. An estimated 80 million girls and women have undergone female genital mutilation. In Britain alone an estimated 10,000 girls are currently at risk. Religious, cultural, medical, and moral grounds rationalize the custom which is practiced primarily in sub-Saharan Africa, the Arab world, Malaysia, Indonesia, and among migrant populations in Western countries. According to WHO it is correlated with poverty, illiteracy, and the low status of women. Women who escape mutilation are not sought in marriage. WHO, the UN Population Fund, the UN Children's Fund, the International Planned Parenthood Federation, and the UN Convention on the Rights of the Child have issued declarations on the eradication of female genital mutilation. In Britain, local authorities have intervened to prevent parents from mutilating their daughters. In 1984, the Inter-African Committee Against Harmful Traditional Practices Affecting Women and Children was established to work toward eliminating female genital mutilation and other damaging customs. National committees in 26 African countries coordinate projects run by local people using theater, dance, music, and storytelling for communication. In Australia, Canada, Europe, and the US women have organized to prevent the practice among vulnerable migrants and refugees.

Electrical, Electronic, and Electromechanical (EEE) Parts Management and Control Requirements for Space Flight Hardware and Critical Ground Support Equipment...aka... The NASA EEE Parts Standard, NASA-STD 8739.10

NASA Technical Reports Server (NTRS)

Majewicz, Peter; Sampson, Michael

2016-01-01

Describes development and content of a new NASA Standard for Electrical Electronic and Electromechanical (EEE) parts. This Standard reflects current practices, instead of changing them. Most NASA Centers utilize local documents, but there is minimal consistency across the Agency. A gap analysis clearly shows the differences that exist among the different centers and with respect to the NASA Parts Policy. Once approved, the new standard can be referenced in contracts and agreements with organizations outside of NASA.

Federalism and social justice: implications for social work.

PubMed

Linhorst, Donald M

2002-07-01

Federalism is a system of government that divides power between two or more levels of government. During the current conservative political climate in the United States, power has shifted increasingly from the federal government to states, a move that has implications for the achievement of social justice. Consequently, it is now necessary for social workers to engage in political activity at the state and local levels, in addition to the federal level, to promote social justice. Implications for social work policy practice, research, and education for advancing social justice within the federal system of government are explored.

Land use politics and law in the 1970's

NASA Technical Reports Server (NTRS)

Lamb, C. M.

1975-01-01

Political facets of the general land use challenge faced in the United States, and the legal authority for governmental action by state and federal officials under given conditions are discussed. Some current and future implications of these political and legal developments are presented. An overview of local versus state versus federal powers is presented along with practices for solving the nation's land use challenge. An analysis is provided of land use law and politics in five states playing active roles in land control. Land use politics and law at the federal level is addressed, with emphasis on three key legislative measures.

Orientation and spread of reconnection x-line in asymmetric current sheets

NASA Astrophysics Data System (ADS)

Liu, Y. H.; Hesse, M.; Wendel, D. E.; Kuznetsova, M.; Wang, S.

2017-12-01

The magnetic field in solar wind plasmas can shear with Earth's dipole magnetic field at arbitrary angles, and the plasma conditions on the two sides of the (magnetopause) current sheet can greatly differ. One of the outstanding questions in such asymmetric geometry is what local physics controls the orientation of the reconnection x-line; while the x-line in a simplified 2D model (simulation) always points out of the simulation plane by design, it is unclear how to predict the orientation of the x-line in a fully three-dimensional (3D) system. Using kinetic simulations run on Blue Waters, we develop an approach to explore this 3D nature of the reconnection x-line, and test hypotheses including maximizing the reconnection rate, tearing mode growth rate or reconnection outflow speed, and the bisection solution. Practically, this orientation should correspond to the M-direction of the local LMN coordinate system that is often employed to analyze diffusion region crossings by the Magnetospheric Multiscale Mission (MMS). In this talk, we will also discuss how an x-line spread from a point source in asymmetric geometries, and the boundary effect on the development of the reconnection x-line and turbulence.

21 CFR 212.2 - What is current good manufacturing practice for PET drugs?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false What is current good manufacturing practice for... HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR POSITRON EMISSION TOMOGRAPHY DRUGS (Eff. 12-12-2011) General Provisions § 212.2 What is current good manufacturing practice for...

21 CFR 1271.150 - Current good tissue practice requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Current good tissue practice requirements. 1271... HUMAN CELLS, TISSUES, AND CELLULAR AND TISSUE-BASED PRODUCTS Current Good Tissue Practice § 1271.150 Current good tissue practice requirements. (a) General. This subpart D and subpart C of this part set...

Evaluating the placement and performance of nature based measures for managing flood runoff in intensively farmed landscapes

NASA Astrophysics Data System (ADS)

Wilkinson, Mark; Quinn, Paul; Hewett, Caspar; Stutter, Marc

2017-04-01

Over the past decade economic losses from fluvial floods have greatly increased and it is becoming less viable to use traditional measures for managing flooding solely. This has given rise to increasing interest in alternative, nature based solutions (NBS) for reducing flood risk that aim to manage runoff at the catchment source and deliver multiple benefits. In many cases these measures need to work with current agricultural practices. Intensive agriculture often results in increases in local runoff rates, water quality issues, soil erosion/loss and local flooding problems. However, there is potential for agriculture to play a part in reducing flood risk. This requires knowledge on the effectiveness of NBS at varying scales and tools to communicate the risk of runoff associated with farming. This paper assesses the placement, management and effectiveness of a selection of nature-based measures in the rural landscape. Measures which disconnect overland flow pathways and improve soil infiltration are discussed. Case study examples are presented from the UK where a large number of nature-based measures have been constructed as part of flood protection schemes in catchment scales varying from 50 ha to 25 km2. Practical tools to help locate measures in agricultural landscapes are highlighted including the Floods and Agriculture Risk Matrix (FARM), an interactive communication/visualization tool and FARMPLOT, a GIS mapping tool. These have been used to promote such measures, by showing how and where temporary ponded areas can be located to reduce flood and erosion risk whilst minimising disruption to farming practices. In most cases land managers prefer small ( 100-1000m3) temporary ponding areas which fill during moderate to large storm events since they incur minimal loss of land. They also provide greater resillience to multi-day storm events, as they are designed to drain over 1-2 days and therefore allow for storage capacity for proceeding events. However, the performance of isolated temporary storage areas can be limited during extreme events. At larger scales taking a treatment train approach using a network of measures has been shown to achieve greater benefits, e.g. by reducing local flood peaks and capturing sediments. Current local scale evidence presented here has been used to inform environmental policy on the correct placement and design of flood reduction measures. Further long term data collection is required to assess the larger scale impact of these measures. These data can be used to inform scenario-based modelling approaches. By holding and attenuating runoff in rural landscapes, benefits for local flood peak reduction, water quality improvement and sediment management can be achieved. However, there is still a need to examine the sustainability of such measures through long term environmental payment schemes, considering how they could be funded across generational timescales rather than political cycles, and to monitor these measures over longer timescales and in multiple settings.

A survey to identify the clinical coding and classification systems currently in use across Europe.

PubMed

de Lusignan, S; Minmagh, C; Kennedy, J; Zeimet, M; Bommezijn, H; Bryant, J

2001-01-01

This is a survey to identify what clinical coding systems are currently in use across the European Union, and the states seeking membership to it. We sought to identify what systems are currently used and to what extent they were subject to local adaptation. Clinical coding should facilitate identifying key medical events in a computerised medical record, and aggregating information across groups of records. The emerging new driver is as the enabler of the life-long computerised medical record. A prerequisite for this level of functionality is the transfer of information between different computer systems. This transfer can be facilitated either by working on the interoperability problems between disparate systems or by harmonising the underlying data. This paper examines the extent to which the latter has occurred across Europe. Literature and Internet search. Requests for information via electronic mail to pan-European mailing lists of health informatics professionals. Coding systems are now a de facto part of health information systems across Europe. There are relatively few coding systems in existence across Europe. ICD9 and ICD 10, ICPC and Read were the most established. However the local adaptation of these classification systems either on a by country or by computer software manufacturer basis; significantly reduces the ability for the meaning coded with patients computer records to be easily transferred from one medical record system to another. There is no longer any debate as to whether a coding or classification system should be used. Convergence of different classifications systems should be encouraged. Countries and computer manufacturers within the EU should be encouraged to stop making local modifications to coding and classification systems, as this practice risks significantly slowing progress towards easy transfer of records between computer systems.

Sustainable Land Management in the Ethiopian Highlands

NASA Astrophysics Data System (ADS)

Haile, Mitiku; Nyssen, Jan; Araya, Tesfay

2014-05-01

Through centuries of farming practices the farmers and pastoralists in Ethiopia were managing their land resources pertaining to the needs of prevalent populations. With an increasing population and growing demands, more land was put under cultivation. Subsequently forest areas were cleared, encroaching agriculture into steep slopes and areas that were not suitable for agricultural activities. Land degradation and particularly soil erosion by water not only reduced the productivity of the land but also aggravated the effects of drought, such as famine and migration. Obvious signs of degradation in the highlands of Ethiopia are wide gullies swallowing fertile lands and rock outcrops making farming a risky business. But also less visible sheet erosion processes result in a tremendous loss of fertile topsoil, particularly on cropland. Efforts have been made by the farming communities to mitigate land degradation by developing local practices of conserving soil and water. With keen interest and openness one can observe such indigenous practices in all corners of Ethiopia. Notwithstanding these practices, there were also efforts to introduce other soil and water conservation interventions to control erosion and retain the eroded soils. Since the early 1980s numerous campaigns were carried out to build terraces in farmlands and sloping areas. Major emphasis was given to structural technologies rather than on vegetative measures. Currently the landscape of the northern highlands is dotted with millions of hectares of terraced fields and in some places with planned watershed management interventions including exclosures. Apparently these interventions were introduced without prior investigating the detailed problems and conservation needs of the local population. Intensive research is undertaken on the processes of degradation, the impact of the different intervention measures and the role of communities in sustainably managing their land. This paper attempts to review the relevant studies undertaken with emphasis on the approaches to sustainable land management.

Perioperative glycaemic control in diabetic patients undergoing cataract surgery under local anaesthesia: a survey of practices of Singapore ophthalmologists and anaesthesiologists

PubMed Central

Woo, Jyh Haur; Ng, Wei Di; Salah, Maaz Mohammad; Neelam, Kumari; Eong, Kah-Guan Au; Kumar, Chandra Mohan

2016-01-01

INTRODUCTION Perioperative glycaemic control is an important aspect of clinical management in diabetic patients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore. METHODS This was a cross-sectional questionnaire-based survey conducted in four public hospitals in Singapore with established ophthalmology and anaesthesia units. Respondents were approached individually, and the self-administered questionnaires comprised questions related to practice patterns, clinical scenarios and awareness of pre-existing guidelines. RESULTS A total of 129 doctors responded to the questionnaire survey. 76 (58.9%) were from ophthalmology departments and 53 (41.1%) were from anaesthesia departments. The majority chose to withhold oral hypoglycaemic agents (82.9%) and/or insulin (69.8%), and keep the patient fasted preoperatively. A blood glucose level ≥ 17 mmol/L prompted 86.0%–93.8% of respondents to adopt a treat-and-defer strategy, while a level ≥ 23 mmol/L prompted 86.0%–96.9% of respondents to cancel the cataract surgery. The respondents were consistently more concerned about perioperative hyperglycaemia (n = 99, 76.7%) than intraoperative hypoglycaemia (n = 83, 64.3%). CONCLUSION The current study presented the prevalent practice patterns of ophthalmologists and anaesthesiologists in the perioperative management of diabetic patients undergoing cataract surgery in four public hospitals in Singapore. Further research in this field is required, and may be useful for the future formulation of formal guidelines and protocols. PMID:26892742

Perioperative glycaemic control in diabetic patients undergoing cataract surgery under local anaesthesia: a survey of practices of Singapore ophthalmologists and anaesthesiologists.

PubMed

Woo, Jyh Haur; Ng, Wei Di; Salah, Maaz Mohammad; Neelam, Kumari; Au Eong, Kah-Guan; Kumar, Chandra Mohan

2016-02-01

Perioperative glycaemic control is an important aspect of clinical management in diabetic patients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore. This was a cross-sectional questionnaire-based survey conducted in four public hospitals in Singapore with established ophthalmology and anaesthesia units. Respondents were approached individually, and the self-administered questionnaires comprised questions related to practice patterns, clinical scenarios and awareness of pre-existing guidelines. A total of 129 doctors responded to the questionnaire survey. 76 (58.9%) were from ophthalmology departments and 53 (41.1%) were from anaesthesia departments. The majority chose to withhold oral hypoglycaemic agents (82.9%) and/or insulin (69.8%), and keep the patient fasted preoperatively. A blood glucose level ≥ 17 mmol/L prompted 86.0%-93.8% of respondents to adopt a treat-and-defer strategy, while a level ≥ 23 mmol/L prompted 86.0%-96.9% of respondents to cancel the cataract surgery. The respondents were consistently more concerned about perioperative hyperglycaemia (n = 99, 76.7%) than intraoperative hypoglycaemia (n = 83, 64.3%). The current study presented the prevalent practice patterns of ophthalmologists and anaesthesiologists in the perioperative management of diabetic patients undergoing cataract surgery in four public hospitals in Singapore. Further research in this field is required, and may be useful for the future formulation of formal guidelines and protocols. Copyright © Singapore Medical Association.

Ergonomics support for local initiative in improving safety and health at work: International Labour Organization experiences in industrially developing countries.

PubMed

Kawakami, T; Kogi, K

2005-04-15

Ergonomics has played essential roles in the technical cooperation activities of the International Labour Organization (ILO) in occupational safety and health in industrially developing countries. Ergonomics support focusing on practical day-to-day needs at the grass-root workplace has strengthened the local initiative in improving safety and health. Practical action-tools such as ergonomics checklists, local good example photos and group discussions have assisted workers and employers in identifying feasible solutions using locally available resources. Direct participation of workers and employers has been promoted in ergonomics training aimed at immediate solutions. ILO Guidelines on Occupational Safety and Health Management Systems have played increasingly important roles in the systematic planning of local improvement actions. Policy-level programmes to develop network support mechanisms to the grass-root workplace were essential for following up and sustaining local achievements. Practical ergonomics support tools, such as action checklists and low-cost improvement guides, should be developed and widely applied so as to reach grass-root levels and help local people create safer and healthier workplaces.

Traditional uses of medicinal plants used by Indigenous communities for veterinary practices at Bajaur Agency, Pakistan.

PubMed

Aziz, Muhammad Abdul; Khan, Amir Hasan; Adnan, Muhammad; Ullah, Habib

2018-01-29

The pastoral lifestyle of Indigenous communities of Bajaur Agency is bringing them close to natural remedies for treating their domestic animals. Several studies have been conducted across the globe describing the importance of traditional knowledge in veterinary care. Therefore, this study was planned with the aim to record knowledge on ethnoveterinary practices from the remote areas and share sit with other communities through published literature. Data was gathered from community members through semi-structured interviews and analyzed through informant consensus factor (Fic) to evaluate the consent of current ethnoveterinary practices among the local people. In total, 73 medicinal plants were recorded under the ethnoveterinary practices. Most widely used medicinal plants with maximum use reports (URs) were Visnaga daucoides Gaertn., Foeniculum vulgare Mill., Solanum virginianum L., Withania somnifera (L.) Dunal, Glycyrrhiza glabra L., and Curcuma longa L. New medicinal values were found with confidential level of citations for species including Heracleum candicans and Glycerhiza glabra. Family Apiaceae was the utmost family with high number (7 species) of medicinal plants. Maximum number of medicinal plants (32) was used for gastric problems. High Fic was recorded for dermatological (0.97) followed by reproductive (0.93) and gastrointestinal disorders (0.92). The main route of remedies administration was oral. Current study revealed that the study area has sufficient knowledge on ethnoveterinary medicinal plants. This knowledge is in the custody of nomadic grazers, herders, and aged community members. Plants with new medicinal uses need to be validated phytochemically and pharmacologically for the development of new alternative drugs for veterinary purposes.

Urban ecosystem services for resilience planning and management in New York City.

PubMed

McPhearson, Timon; Hamstead, Zoé A; Kremer, Peleg

2014-05-01

We review the current state of knowledge about urban ecosystem services in New York City (NYC) and how these services are regulated, planned for, and managed. Focusing on ecosystem services that have presented challenges in NYC-including stormwater quality enhancement and flood control, drinking water quality, food provisioning and recreation-we find that mismatches between the scale of production and scale of management occur where service provision is insufficient. Adequate production of locally produced services and services which are more accessible when produced locally is challenging in the context of dense urban development that is characteristic of NYC. Management approaches are needed to address scale mismatches in the production and consumption of ecosystem services. By coordinating along multiple scales of management and promoting best management practices, urban leaders have an opportunity to ensure that nature and ecosystem processes are protected in cities to support the delivery of fundamental urban ecosystem services.

Studies in Software Cost Model Behavior: Do We Really Understand Cost Model Performance?

NASA Technical Reports Server (NTRS)

Lum, Karen; Hihn, Jairus; Menzies, Tim

2006-01-01

While there exists extensive literature on software cost estimation techniques, industry practice continues to rely upon standard regression-based algorithms. These software effort models are typically calibrated or tuned to local conditions using local data. This paper cautions that current approaches to model calibration often produce sub-optimal models because of the large variance problem inherent in cost data and by including far more effort multipliers than the data supports. Building optimal models requires that a wider range of models be considered while correctly calibrating these models requires rejection rules that prune variables and records and use multiple criteria for evaluating model performance. The main contribution of this paper is to document a standard method that integrates formal model identification, estimation, and validation. It also documents what we call the large variance problem that is a leading cause of cost model brittleness or instability.

Systemic therapy in muscle-invasive and metastatic bladder cancer: current trends and future promises.

PubMed

Aragon-Ching, Jeanny B; Trump, Donald L

2016-09-01

Bladder urothelial cancers remain an important urologic cancer with limited treatment options in the locally advanced and metastatic setting. While neoadjuvant chemotherapy for locally advanced muscle-invasive cancers has shown overall survival benefit, clinical uptake in practice have lagged behind. Controversies surrounding adjuvant chemotherapy use are also ongoing. Systemic therapies for metastatic bladder cancer have largely used platinum-based therapies without effective standard second-line therapy options for those who fail, although vinflunine is approved in Europe as a second-line therapy based on a Phase III trial, and most recently, atezolizumab, a checkpoint inhibitor, was approved by the US FDA. Given increasing recognition of mutational signatures expressed in urothelial carcinomas, several promising agents with use of VEGF-targeted therapies, HER2-directed agents and immunotherapies with PD-1/PD-L1 antibodies in various settings are discussed herein.

A planning approach for agricultural watersheds using precision conservation

USDA-ARS?s Scientific Manuscript database

This brief article, written for a non-technical audience, discusses a recently-developed approach for watershed planning and nutrient reduction. The approach can help local stakeholders identify conservation practices that are locally preferred and determine how those practices can be distributed ac...

Putting Public Health Into Practice: A Model for Assessing the Relationship Between Local Health Departments and Practicing Physicians

PubMed Central

Perlman, Sharon E.; Koppaka, Ram; Greene, Carolyn M.

2012-01-01

The New York City (NYC) Department of Health and Mental Hygiene (Health Department) surveyed practicing NYC physicians to quantify Health Department resource use. Although the Health Department successfully reaches most physicians, and information is valued in practice, knowledge of several key resources was low. Findings suggested 3 recommendations for all local health departments seeking to enhance engagement with practicing physicians: (1) capitalize on physician interest, (2) engage physicians early and often, and (3) make interaction with the health department easy. Also, older physicians may require targeted outreach. PMID:22690968

Palatal Injection for the Removal of Maxillary Teeth: Current Practice Among Oral and Maxillofacial Surgeons.

PubMed

Badenoch-Jones, Emma K; David, Michael; Lincoln, Trent

2017-07-01

Conventional teaching regarding palatal injection for the removal of maxillary teeth dictates the administration of buccal and palatal injections. Recently, some investigators have questioned the necessity of the palatal injection, suggesting that contemporary local anesthetics might diffuse sufficiently across the buccopalatal cortical bone distance. It has been suggested that because the buccopalatal cortical bone distance increases anteriorly to posteriorly in the maxilla, the success of maxillary extractions with buccal injection only might be related to the anteroposterior position of the tooth. Evidence from clinical trials has only recently become available. Since 2006, 15 clinical trials that examined outcomes of maxillary tooth extractions performed with buccal injection of local anesthetic only have been published. However, there are limited data available on the clinical practice of surgeons. An online survey was sent to 276 full members of the Canadian Association of Oral and Maxillofacial Surgeons. Respondents were asked about their use of palatal injection for the removal of maxillary teeth under local anesthesia, including how often they administer a palatal injection for maxillary extractions in each region of the maxilla. Ninety-two responses were received (33%). Most practitioners deliver a palatal injection for every maxillary tooth extraction under local anesthesia. However, there is a substantial number who do not always administer a palatal injection (ie, they give it "most of the time," "occasionally," or "never"). This number decreased in a linear fashion anteriorly to posteriorly in the maxilla (incisors, 17 of 89; canines, 16 of 88; premolars, 13 of 88; first and second molars, 10 of 89; third molars, 10 of 88). Some surgeons who do not always administer a palatal injection for extraction of maxillary teeth under local anesthesia. The number is larger for anterior compared with posterior teeth. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Practice Benchmarking in the Age of Targeted Auditing

PubMed Central

Langdale, Ryan P.; Holland, Ben F.

2012-01-01

The frequency and sophistication of health care reimbursement auditing has progressed rapidly in recent years, leaving many oncologists wondering whether their private practices would survive a full-scale Office of the Inspector General (OIG) investigation. The Medicare Part B claims database provides a rich source of information for physicians seeking to understand how their billing practices measure up to their peers, both locally and nationally. This database was dissected by a team of cancer specialists to uncover important benchmarks related to targeted auditing. All critical Medicare charges, payments, denials, and service ratios in this article were derived from the full 2010 Medicare Part B claims database. Relevant claims were limited by using Medicare provider specialty codes 83 (hematology/oncology) and 90 (medical oncology), with an emphasis on claims filed from the physician office place of service (11). All charges, denials, and payments were summarized at the Current Procedural Terminology code level to drive practice benchmarking standards. A careful analysis of this data set, combined with the published audit priorities of the OIG, produced germane benchmarks from which medical oncologists can monitor, measure and improve on common areas of billing fraud, waste or abuse in their practices. Part II of this series and analysis will focus on information pertinent to radiation oncologists. PMID:23598847

Practice benchmarking in the age of targeted auditing.

PubMed

Langdale, Ryan P; Holland, Ben F

2012-11-01

The frequency and sophistication of health care reimbursement auditing has progressed rapidly in recent years, leaving many oncologists wondering whether their private practices would survive a full-scale Office of the Inspector General (OIG) investigation. The Medicare Part B claims database provides a rich source of information for physicians seeking to understand how their billing practices measure up to their peers, both locally and nationally. This database was dissected by a team of cancer specialists to uncover important benchmarks related to targeted auditing. All critical Medicare charges, payments, denials, and service ratios in this article were derived from the full 2010 Medicare Part B claims database. Relevant claims were limited by using Medicare provider specialty codes 83 (hematology/oncology) and 90 (medical oncology), with an emphasis on claims filed from the physician office place of service (11). All charges, denials, and payments were summarized at the Current Procedural Terminology code level to drive practice benchmarking standards. A careful analysis of this data set, combined with the published audit priorities of the OIG, produced germane benchmarks from which medical oncologists can monitor, measure and improve on common areas of billing fraud, waste or abuse in their practices. Part II of this series and analysis will focus on information pertinent to radiation oncologists.

Effect of localized states on the current-voltage characteristics of metal-semiconductor contacts with thin interfacial layer

NASA Astrophysics Data System (ADS)

Chattopadhyay, P.

1994-10-01

The role of discrete localized states on the current-voltage characteristics of metal-semiconductor contact is examined. It is seen that, because of these localized states, the logarithmic current vs voltage characteristics become nonlinear. Such nonlinearity is found sensitive to the temperature, and the energy and density of the localized states. The predicted temperature dependence of barrier height and the current-voltage characteristics are in agreement with the experimental results of Aboelfotoh [ Phys. Rev. B39, 5070 (1989)].

A conceptual framework for international service-learning course planning: promoting a foundation for ethical practice in the physical therapy and occupational therapy professions.

PubMed

Lattanzi, Jill Black; Pechak, Celia

2011-01-01

As physical therapy (PT) and occupational therapy (OT) educational programs endeavor to foster core values of social responsibility, justice, and altruism in an increasingly global community, the incorporation of local and international service-learning (ISL) into the curriculum is growing. Much of the research has focused on the measurement of student learning, with little written about the impact on the host community. Proponents of global health initiatives are calling for consideration of all stakeholders to ensure ethical practice. This paper explores the current literature related to PT and OT ISL and builds a conceptual framework for ISL course planning. The essential phases in the framework include: 1) pre-experience planning/preparation stage, 2) field immersion experience stage, and 3) postexperience stage. The essential elements are: 1) cultural competency training, 2) communication and coordination with community, 3) comprehensive assessment, and 4) strategic planning. The authors suggest this framework as a practical tool to structure ISL courses with an explicit emphasis on ethical concerns. Additionally, they seek to foster more dialogue and action related to the promotion of ethical practices in ISL in PT and OT education programs.

Toward a Transdisciplinary Model of Evidence-Based Practice

PubMed Central

Satterfield, Jason M; Spring, Bonnie; Brownson, Ross C; Mullen, Edward J; Newhouse, Robin P; Walker, Barbara B; Whitlock, Evelyn P

2009-01-01

Context This article describes the historical context and current developments in evidence-based practice (EBP) for medicine, nursing, psychology, social work, and public health, as well as the evolution of the seminal “three circles” model of evidence-based medicine, highlighting changes in EBP content, processes, and philosophies across disciplines. Methods The core issues and challenges in EBP are identified by comparing and contrasting EBP models across various health disciplines. Then a unified, transdisciplinary EBP model is presented, drawing on the strengths and compensating for the weaknesses of each discipline. Findings Common challenges across disciplines include (1) how “evidence” should be defined and comparatively weighted; (2) how and when the patient's and/or other contextual factors should enter the clinical decision-making process; (3) the definition and role of the “expert”; and (4) what other variables should be considered when selecting an evidence-based practice, such as age, social class, community resources, and local expertise. Conclusions A unified, transdisciplinary EBP model would address historical shortcomings by redefining the contents of each model circle, clarifying the practitioner's expertise and competencies, emphasizing shared decision making, and adding both environmental and organizational contexts. Implications for academia, practice, and policy also are discussed. PMID:19523122

[Parent's perspective on child rearing and corporal punishment].

PubMed

Donoso, Miguir Terezinha Vieccelli; Ricas, Janete

2009-02-01

To describe parents' current perception of corporal punishment associated to child rearing and its practices. There were studied 31 family members whose children were warded due to child abuse complaints (12) and not warded (19) at a health care unit and a local social service unit in the city of Belo Horizonte (Southeastern Brazil) in 2006. Data was collected through semi-structured interviews and speech analysis was performed grouped by subjects and categories. ANALYSIS OF DISCOURSE: There was limitation of the respondents' speeches based on their production means. There was a diversity of conceptions on child rearing and its practices and corporal punishment was reported by all parents, even among those who expressed strong disapproval of this practice. Speeches were characterized by heterogeneity and polyphony with emphasis on the tradition speech, the religious speech and the popular scientific speech. Respondents did not express concepts of legal interdiction of corporal punishment or its excesses. The culture of corporal punishment of children is changing; tradition approving it has weakened and prohibition has been slowly adopted. Reinforcing legal actions against this practice can contribute to speed up the process to end corporal punishment of children.

Implementation strategies for collaborative primary care-mental health models.

PubMed

Franx, Gerdien; Dixon, Lisa; Wensing, Michel; Pincus, Harold

2013-09-01

Extensive research exists that collaborative primary care-mental health models can improve care and outcomes for patients. These programs are currently being implemented throughout the United States and beyond. The purpose of this study is to review the literature and to generate an overview of strategies currently used to implement such models in daily practice. Six overlapping strategies to implement collaborative primary care-mental health models were described in 18 selected studies. We identified interactive educational strategies, quality improvement change processes, technological support tools, stakeholder engagement in the design and execution of implementation plans, organizational changes in terms of expanding the task of nurses and financial strategies such as additional collaboration fees and pay for performance incentives. Considering the overwhelming evidence about the effectiveness of primary care-mental health models, there is a lack of good studies focusing on their implementation strategies. In practice, these strategies are multifaceted and locally defined, as a result of intensive and required stakeholder engagement. Although many barriers still exist, the implementation of collaborative models could have a chance to succeed in the United States, where new service delivery and payment models, such as the Patient-Centered Medical Home, the Health Home and the Accountable Care Organization, are being promoted.

Implementing the work disability prevention paradigm among therapists in Hong Kong: facilitators and barriers.

PubMed

Szeto, Grace P Y; Cheng, Andy S K; Lee, Edwin W C; Schonstein, Eva; Gross, Douglas P

2011-03-01

This is a discussion paper to examine the issues surrounding management of work-related injuries by physiotherapists and occupational therapists in Hong Kong. Therapists working in public hospitals are faced with managing injured workers with limited resources and this frequently results in suboptimal outcomes. In this paper, five experienced therapists critically reviewed the current practices in the physiotherapy and occupational therapy professions in Hong Kong, with regard to managing patients with work injuries. In many hospitals, therapists still practice with a disease-based model focusing on symptom relief and restoration of general physical function. We collated information about current programs initiated by physiotherapists and occupational therapists to provide more strategic intervention strategies for early screening of high-risk patients and adaptive biopsychosocial interventions targeting return-to-work outcomes. Clinical and system-level barriers and facilitators of a major paradigm shift towards work disability prevention are discussed. Physiotherapists and occupational therapists need to develop more strategic collaborations and actively voice out the need for major systematic changes within the local healthcare system, in order to provide a more effective management approach in line with the concept of Work Disability Prevention.

The national suicide prevention strategy for England: the reality of a national strategy for the nursing profession.

PubMed

Anderson, M; Jenkins, R

2006-12-01

Suicide is recognized as a global phenomenon and many countries now have national suicide prevention strategies. International guidance on suicide prevention and accepted epidemiological and treatment-based research underpins healthcare policy relating to suicide reduction. There has been an established comprehensive strategy in England since 2002. However, the rate of suicide continues to be a concern and nurses hold a key role in the implementation of national, regional and local policy into practice. The aim of this paper is to consider the current implications of the national suicide prevention strategy in England for nursing. This discussion paper draws upon both empirical evidence-based literature, governmental guidance and policy-related documentation. The national suicide prevention strategy for England currently continues to have a multifaceted impact on the nursing profession. This ranges from clinical practice issues such as risk assessment through to broader public health responsibilities. If nurses and allied health professionals are to be effective in their role within suicide prevention, they will need to be supported in building awareness of the wider context of the national policy. In particular, this will mean working effectively and collaboratively with the voluntary sector, service users and other non-medical agencies.

A multi-setting audit of the management of genital Chlamydia trachomatis infection.

PubMed

Morgan, Jane; Donnell, Andre; Bell, Anita

2010-05-28

To audit current management of genital chlamydia infection in the Waikato District Health Board (DHB), using 2008 Ministry of Health (MOH) management guidelines as the standard. Any setting within Waikato DHB that diagnosed 25 or more cases of chlamydia during February-October 2008 was eligible to participate. Each site was asked to complete an audit using a proforma for 20 consecutive cases. Nineteen of 20 eligible sites provided data on 415 cases; 18.4% of all Waikato DHB cases during the 9 months. Treatment was documented for 380 (91.6%); of these, 369 (97.1%), or 88.9% of all 415 cases, had treatment within 28 days. Documentation of discussions with cases and outcomes was limited, restricting assessment of actual practice. Nonetheless, effective partner notification was lacking. Participants noted they had reviewed their own processes and made suggestions for improvements. The audit has identified potential gaps between recommendations within the MOH guidelines and current practice. This has helped the development of ongoing education and training resources for local providers. Further, it is hoped participation in the audit may contribute to improved case management in high-caseload settings in our district. There is commitment to re-audit to evaluate this.

Snow Tweets: Emergency Information Dissemination in a US County During 2014 Winter Storms

PubMed Central

Bonnan-White, Jess; Shulman, Jason; Bielecke, Abigail

2014-01-01

Introduction: This paper describes how American federal, state, and local organizations created, sourced, and disseminated emergency information via social media in preparation for several winter storms in one county in the state of New Jersey (USA). Methods: Postings submitted to Twitter for three winter storm periods were collected from selected organizations, along with a purposeful sample of select private local users. Storm-related posts were analyzed for stylistic features (hashtags, retweet mentions, embedded URLs). Sharing and re-tweeting patterns were also mapped using NodeXL. Results: Results indicate emergency management entities were active in providing preparedness and response information during the selected winter weather events. A large number of posts, however, did not include unique Twitter features that maximize dissemination and discovery by users. Visual representations of interactions illustrate opportunities for developing stronger relationships among agencies. Discussion: Whereas previous research predominantly focuses on large-scale national or international disaster contexts, the current study instead provides needed analysis in a small-scale context. With practice during localized events like extreme weather, effective information dissemination in large events can be enhanced. PMID:25685629

Translating National Level Forest Service Goals to Local Level Land Management: Carbon Sequestration

NASA Astrophysics Data System (ADS)

McNulty, S.; Treasure, E.

2017-12-01

The USDA Forest Service has many national level policies related to multiple use management. However, translating national policy to stand level forest management can be difficult. As an example of how a national policy can be put into action, we examined three case studies in which a desired future condition is evaluated at the national, region and local scale. We chose to use carbon sequestration as the desired future condition because climate change has become a major area of concern during the last decade. Several studies have determined that the 193 million acres of US national forest land currently sequester 11% to 15% of the total carbon emitted as a nation. This paper provides a framework by which national scale strategies for maintaining or enhancing forest carbon sequestration is translated through regional considerations and local constraints in adaptive management practices. Although this framework used the carbon sequestration as a case study, this framework could be used with other national level priorities such as the National Environmental Protection Act (NEPA) or the Endangered Species Act (ESA).

Snow Tweets: Emergency Information Dissemination in a US County During 2014 Winter Storms.

PubMed

Bonnan-White, Jess; Shulman, Jason; Bielecke, Abigail

2014-12-22

This paper describes how American federal, state, and local organizations created, sourced, and disseminated emergency information via social media in preparation for several winter storms in one county in the state of New Jersey (USA). Postings submitted to Twitter for three winter storm periods were collected from selected organizations, along with a purposeful sample of select private local users. Storm-related posts were analyzed for stylistic features (hashtags, retweet mentions, embedded URLs). Sharing and re-tweeting patterns were also mapped using NodeXL. RESULTS indicate emergency management entities were active in providing preparedness and response information during the selected winter weather events. A large number of posts, however, did not include unique Twitter features that maximize dissemination and discovery by users. Visual representations of interactions illustrate opportunities for developing stronger relationships among agencies. Whereas previous research predominantly focuses on large-scale national or international disaster contexts, the current study instead provides needed analysis in a small-scale context. With practice during localized events like extreme weather, effective information dissemination in large events can be enhanced.

Real fuel effects on flame extinction and re-ignition

NASA Astrophysics Data System (ADS)

Zhao, Xinyu; Wu, Bifen; Xu, Chao; Lu, Tianfeng; Chen, Jacqueline H.

2016-11-01

Flame-vortex interactions have significant implications in studying combustion in practical aeronautical engines, and can be used to facilitate the model development in capturing local extinction and re-ignition. To study the interactions between the complex fuel and the intense turbulence that are commonly encountered in engines, direct numerical simulations of the interactions between a flame and a vortex pair are carried out using a recently-developed 24-species reduced chemistry for n-dodecane. Both non-premixed and premixed flames with different initial and inlet thermochemical conditions are studied. Parametric studies of different vortex strengths and orientations are carried out to induce maximum local extinction and re-ignition. Chemical-explosive-mode-analysis based flame diagnostic tools are used to identify different modes of combustion, including auto-ignition and extinction. Results obtained from the reduced chemistry are compared with those obtained from one-step chemistry to quantify the effect of fuel pyrolysis on the extinction limit. Effects of flame curvature, heat loss and unsteadiness on flame extinction are also explored. Finally, the validity of current turbulent combustion models to capture the local extinction and re-ignition will be discussed.

Provision of foot health services for people with rheumatoid arthritis in New South Wales: a web-based survey of local podiatrists

PubMed Central

2013-01-01

Background It is unclear if podiatric foot care for people with rheumatoid arthritis (RA) in New South Wales (NSW) meets current clinical recommendations. The objective of this study was to survey podiatrists’ perceptions of the nature of podiatric foot care provision for people who have RA in NSW. Methods An anonymous, cross-sectional survey with a web-based questionnaire was conducted. The survey questionnaire was developed according to clinical experience and current foot care recommendations. State registered podiatrists practising in the state of NSW were invited to participate. The survey link was distributed initially via email to members of the Australian Podiatry Association (NSW), and distributed further through snowballing techniques using professional networks. Data was analysed to assess significant associations between adherence to clinical practice guidelines, and private/public podiatry practices. Results 86 podiatrists participated in the survey (78% from private practice, 22% from public practice). Respondents largely did not adhere to formal guidelines to manage their patients (88%). Only one respondent offered a dedicated service for patients with RA. Respondents indicated that the primary mode of accessing podiatry was by self-referral (68%). Significant variation was observed regarding access to disease and foot specific assessments and treatment strategies. Assessment methods such as administration of patient reported outcome measures, vascular and neurological assessments were not conducted by all respondents. Similarly, routine foot care strategies such as prescription of foot orthoses, foot health advice and footwear were not employed by all respondents. Conclusions The results identified issues in foot care provision which should be explored through further research. Foot care provision in NSW does not appear to meet the current recommended standards for the management of foot problems in people who have RA. Improvements to foot care could be undertaken in terms of providing better access to examination techniques and treatment strategies that are recommended by evidence based treatment paradigms. PMID:23972081

An integrated sea monitoring system based on a X-band wave radar to support the removal activities of the Costa Concordia wreck.

NASA Astrophysics Data System (ADS)

Gozzini, Bernardo; Serafino, Francesco; Lugni, Claudio; Antonini, Andrea; Costanza, Letizia; Orlandi, Andrea; Arturi, Daniele; Ludeno, Giovanni; Natale, Antonio; Soldovieri, Francesco; Ortolani, Alberto; Brandini, Carlo

2013-04-01

The planning and management of different types of operations at sea requires a number of sea state data as much in real-time as possible, for rapid and effective response to different situations. This need is particularly strong in emergency management practices, in accidents due to man-made or natural causes, that require the planning of civil protection activities (such as search-and-rescue, cleaning of pollution, ship recovery), transport planning etc. The use of X-band radar technology nowadays provides great advantages over traditional in-situ and satellite-based techniques for sea state measuring, to update information on waves and currents over a sea area with high spatial and temporal resolution. Other advantages include a good spatial coverage around the area of interest, the flexibility of use, the capacity to provide, on-demand and when necessary, complementary information (possible oil spills detection, integration with VTS, etc.). X-band coastal radars (so-called "wave-radars") are widely used in the monitoring of large marine areas, in integration with in-situ measurements, satellites and other radar types (HF), as a key element of the observational component of present operational oceanography systems. Outside of these systems, the use of this technology to support emergency management practices is very promising for both the quality and quantity of available parameters, and for an easy integration with all other available monitoring and forecasting tools. A case study particularly relevant is offered by the presence of the Costa Concordia ship near the Giglio Island. The management of this disaster has requested at an early stage a large number of data to support the monitoring of marine environment around the ship, e.g. to optimally plan water samples. In the next and present phase, to support the highly risky and costly activities linked to the wreck removal, which are extremely sea-state dependent, the installation of a wave-radar allows to detect, in real-time and with high revisiting time, waves and currents in the area surrounding the wreck. In addition wave spectra measures allow to check the reliability of present wave forecasting models, which are unlikely to represent the local and coastal scales of interest and therefore require a continuous process of verification, calibration and quality control. Similar considerations can be made for the reconstruction of marine currents at a local scale, whose uncertainty is inherently greater. The integration of X-band radar data with in-situ data has allowed to optimally calibrate the data itself (especially for what concerns the significant wave height) and to provide a local scale observation system which proved to be fundamental to support the work of continuous sea state monitoring and forecasting around the area of the disaster. The observation system at Giglio is a kind of laboratory unique in its kind, to test the reliability of the wave and hydrodynamic models at a local scale, to assess our present ability to use X-band radars for emergency management activities, and to evaluate the response capacity of such practices to the actual needs of involved stakeholders and private users.

Health workers who ask about social determinants of health are more likely to report helping patients: Mixed-methods study.

PubMed

Naz, Anila; Rosenberg, Ellen; Andersson, Neil; Labonté, Ronald; Andermann, Anne

2016-11-01

To assess the feasibility of implementing a clinical decision aid called the CLEAR Toolkit that helps front-line health workers ask their patients about social determinants of health, refer to local support resources, and advocate for wider social change. A mixed-methods study using quantitative (online self-completed questionnaires) and qualitative (in-depth interviews, focus groups, and key informant interviews) methods. A large, university-affiliated family medicine teaching centre in Montreal, Que, serving one of the most ethnically diverse populations in Canada. Fifty family doctors and allied health workers responded to the online survey (response rate of 50.0%), 15 completed in-depth interviews, 14 joined 1 of 2 focus groups, and 3 senior administrators participated in key informant interviews. Our multimethod approach included an online survey of front-line health workers to assess current practices and collect feedback on the tool kit; in-depth interviews to understand why they consider certain patients to be more vulnerable and how to help such patients; focus groups to explore barriers to asking about social determinants of health; and key informant interviews with high-level administrators to identify organizational levers for changing practice. Senior administrators consider asking about social determinants to be part of the mandate of health workers. However, barriers perceived by front-line clinicians include insufficient training in social history taking, uncertainty about how to address these issues in clinical practice, and a lack of knowledge of local referral resources. Health workers with specific ways of asking patients about their social challenges were more likely to report having helped their patients as compared with those who did not know how to ask (93.8% vs 52.9%; P = .003). While health workers recognize the importance of social determinants, many are unsure how to ask about these often sensitive issues or where to refer patients. The CLEAR Toolkit can be easily adapted to local contexts to help front-line health workers initiate dialogue around social challenges and better support patients in clinical practice. Copyright© the College of Family Physicians of Canada.

Decision support for evidence-based integration of disease control: A proof of concept for malaria and schistosomiasis

PubMed Central

Graeden, Ellie; Kerr, Justin; Sorrell, Erin M.; Katz, Rebecca

2018-01-01

Managing infectious disease requires rapid and effective response to support decision making. The decisions are complex and require understanding of the diseases, disease intervention and control measures, and the disease-relevant characteristics of the local community. Though disease modeling frameworks have been developed to address these questions, the complexity of current models presents a significant barrier to community-level decision makers in using the outputs of the most scientifically robust methods to support pragmatic decisions about implementing a public health response effort, even for endemic diseases with which they are already familiar. Here, we describe the development of an application available on the internet, including from mobile devices, with a simple user interface, to support on-the-ground decision-making for integrating disease control programs, given local conditions and practical constraints. The model upon which the tool is built provides predictive analysis for the effectiveness of integration of schistosomiasis and malaria control, two diseases with extensive geographical and epidemiological overlap, and which result in significant morbidity and mortality in affected regions. Working with data from countries across sub-Saharan Africa and the Middle East, we present a proof-of-principle method and corresponding prototype tool to provide guidance on how to optimize integration of vertical disease control programs. This method and tool demonstrate significant progress in effectively translating the best available scientific models to support practical decision making on the ground with the potential to significantly increase the efficacy and cost-effectiveness of disease control. Author summary Designing and implementing effective programs for infectious disease control requires complex decision-making, informed by an understanding of the diseases, the types of disease interventions and control measures available, and the disease-relevant characteristics of the local community. Though disease modeling frameworks have been developed to address these questions and support decision-making, the complexity of current models presents a significant barrier to on-the-ground end users. The picture is further complicated when considering approaches for integration of different disease control programs, where co-infection dynamics, treatment interactions, and other variables must also be taken into account. Here, we describe the development of an application available on the internet with a simple user interface, to support on-the-ground decision-making for integrating disease control, given local conditions and practical constraints. The model upon which the tool is built provides predictive analysis for the effectiveness of integration of schistosomiasis and malaria control, two diseases with extensive geographical and epidemiological overlap. This proof-of-concept method and tool demonstrate significant progress in effectively translating the best available scientific models to support pragmatic decision-making on the ground, with the potential to significantly increase the impact and cost-effectiveness of disease control. PMID:29649260

Throat swabs have no influence on the management of patients with sore throats.

PubMed

Cheung, L; Pattni, V; Peacock, P; Sood, S; Gupta, D

2017-11-01

Throat swabs are neither specific nor sensitive for micro-bacteria causing sore throat symptoms; however, current guidelines suggest they are still useful in some cases. Retrospective and prospective analyses were conducted of throat swabs requested within the months of January 2016 and August 2016, respectively. The study comprised 247 patients. Fifty-nine (24 per cent) had a positive culture. Forty-six grew group A beta-haemolytic streptococci, with the remainder growing candida (n = 10), coliform (n = 1) and klebsiella (n = 2). There was no significant difference in culture rates between primary or secondary care sources (χ2 = 0.56, p = 0.45). None of the swabs influenced a variation in patient management from local antimicrobial policies. Current practice has an estimated annual financial impact of £3 434 340 on the National Health Service. Throat swabs do not influence the antimicrobial treatment for patients with sore throats, even under current guidelines, and incur unnecessary cost. Current clinical guidelines could be reviewed to reduce the number of throat swabs being conducted unnecessarily.

Breast imaging. A practical look at its capabilities and its limitations.

PubMed

Clark, R; Nemec, L; Love, N

1992-10-01

The film-screen technique is evolving as the standard for mammography. Sonography is the only other method that currently has a defined role in breast imaging. Mammography should be performed at facilities that have received American College of Radiology accreditation or its equivalent, because technical quality assurance is an important part of mammographic practice. Interpretive quality may be assured by outcome audits performed by mammography facilities. Primary care physicians are best suited to encouraging eligible women to undergo screening studies and should consider these recommendations: Refer patients for screening mammography to accredited facilities according to established guidelines. Educate patients about the need for regular screening. Provide annual breast physical examination. Refresh your knowledge on breast health and the techniques of physical examination if necessary. Teach patients breast self-examination techniques. Demand low-cost, high-quality screening mammography; be aware of local variability of charges and quality.

Reducing the risks of delegation: use of procedure skills checklists for unlicensed assistive personnel in schools, Part 1.

PubMed

Shannon, Robin Adair; Kubelka, Suzanne

2013-07-01

School nurses are challenged by federal civil rights laws and the standards of school nursing practice to care for a burgeoning population of students with special health care needs. Due to the realities of current school nurse-to-student ratios, school nurses are frequently responsible for directing unlicensed assistive personnel (UAPs) to support the health and safety needs of students, where State Nurse Practice Acts, state legislation, and local policy mandates allow. The delegation of health care tasks to UAPs poses many professional, ethical, and legal dilemmas for school nurses. One strategy to reduce the risks of delegation is through the use of procedure skills checklists, as highlighted by the experience of one large urban school district. Part 1 of this two-part article will explore the scope of the problem and the principles of delegation, including legal and ethical considerations.

Prediction of ground effects on aircraft noise

NASA Technical Reports Server (NTRS)

Pao, S. P.; Wenzel, A. R.; Oncley, P. B.

1978-01-01

A unified method is recommended for predicting ground effects on noise. This method may be used in flyover noise predictions and in correcting static test-stand data to free-field conditions. The recommendation is based on a review of recent progress in the theory of ground effects and of the experimental evidence which supports this theory. It is shown that a surface wave must be included sometimes in the prediction method. Prediction equations are collected conveniently in a single section of the paper. Methods of measuring ground impedance and the resulting ground-impedance data are also reviewed because the recommended method is based on a locally reactive impedance boundary model. Current practice of estimating ground effects are reviewed and consideration is given to practical problems in applying the recommended method. These problems include finite frequency-band filters, finite source dimension, wind and temperature gradients, and signal incoherence.

Determining Need for School-Based Physical Therapy Under IDEA: Commonalities Across Practice Guidelines.

PubMed

Vialu, Carlo; Doyle, Maura

2017-10-01

The Individuals with Disabilities Education Act (IDEA) includes physical therapy (PT) as a related service that may be provided to help students with disabilities benefit from their education. However, the IDEA does not provide specific guidance for the provision of school-based PT, resulting in variations in practice across the United States. The authors examined 22 state and local education agency guidelines available online to find commonalities related to the determination of a student's need for PT. Seven commonalities found: educational benefit, team decision, need for PT expertise, establishment of Individualized Education Program (IEP) goal before determining need for PT, distinction between medical and educational PT, the student's disability adversely affects education, and the student's potential for improvement. These commonalities are discussed in relation to current PT and special education literature. This article suggests applying these commonalities as procedural requirements and questions for discussion during an IEP team meeting.

A PTSD Screen for Forensic Populations.

PubMed

Guston, Kaitlin; Combs, Elizabeth; Kopak, Albert; Raggio, Alyssa; Hoffmann, Norman

2018-06-01

Posttraumatic stress disorder (PTSD) has been observed in a sizable proportion of the U.S. adult correctional population. Jail administrators must pay particularly close attention to inmates with PTSD symptoms, considering these facilities serve as the gateway to the criminal justice system and inmates with PTSD may pose a risk to themselves, other inmates, and staff. The reality of conducting behavioral health assessments in a jail environment is wrought with significant challenges, including limited time. The current study examined prior research on PTSD screening tools to establish an empirical basis for a practical screen to be used among adults recently booked into local jails. Data from a random sample of 283 adults assessed specificity and sensitivity rates of different combinations of criteria. Results indicated a two-item screen achieved an 86.4% sensitivity rate as well as an 80.4% specificity rate. This evidence demonstrates a practical and clinically relevant approach to conducting PTSD screens among adult jail inmates.

Building Capacity to Use Earth Observations in Decision Making: A Case Study of NASA's DEVELOP National Program Methods and Best Practices

NASA Astrophysics Data System (ADS)

Childs-Gleason, L. M.; Ross, K. W.; Crepps, G.; Miller, T. N.; Favors, J. E.; Rogers, L.; Allsbrook, K. N.; Bender, M. R.; Ruiz, M. L.

2015-12-01

NASA's DEVELOP National Program fosters an immersive research environment for dual capacity building. Through rapid feasibility Earth science projects, the future workforce and current decision makers are engaged in research projects to build skills and capabilities to use Earth observation in environmental management and policy making. DEVELOP conducts over 80 projects annually, successfully building skills through partnerships with over 150 organizations and providing over 350 opportunities for project participants each year. Filling a void between short-term training courses and long-term research projects, the DEVELOP model has been successful in supporting state, local, federal and international government organizations to adopt methodologies and enhance decision making processes. This presentation will highlight programmatic best practices, feedback from participants and partner organizations, and three sample case studies of successful adoption of methods in the decision making process.

The ethics of Soviet medical practice: behaviours and attitudes of physicians in Soviet Estonia.

PubMed

Barr, D A

1996-02-01

To study and report the attitudes and practices of physicians in a former Soviet republic regarding issues pertaining to patients' rights, physician negligence and the acceptance of gratuities from patients. Survey questionnaire administered to physicians in 1991 at the time of the Soviet breakup. Estonia, formerly a Soviet republic, now an independent state. A stratified, random sample of 1,000 physicians, representing approximately 20 per cent of practicing physicians under the age of 65. Most physicians shared information with patients about treatment risks and alternatives, with the exception of cancer patients: only a third of physicians tell the patient when cancer is suspected. Current practice at the time of the survey left patients few options when physician negligence occurred; most physicians feel that under a reformed system physician negligence should be handled within the local facility rather than by the government. It was common practice for physicians to receive gifts, tips, or preferential access to scarce consumer goods from their patients. Responses varied somewhat by facility and physician nationality. The ethics of Soviet medical practice were different in a number of ways from generally accepted norms in Western countries. Physicians' attitudes about the need for ethical reform suggest that there will be movement in Estonia towards a system of medical ethics that more closely approximates those in the West.

Screening food-borne and zoonotic pathogens associated with livestock practices in the Sumapaz region, Cundinamarca, Colombia.

PubMed

Arenas, Nelson E; Abril, Diego A; Valencia, Paola; Khandige, Surabhi; Soto, Carlos Yesid; Moreno-Melo, Vilma

2017-04-01

Hazardous practices regarding antibiotics misuse, unsanitary milking procedures, and the commercial sales of raw milk and unpasteurized dairy products are currently being practiced by livestock farmers in the Sumapaz region (Colombia). The purpose of this study was to screen for food-borne and zoonotic pathogens associated with local livestock practices. We evaluated 1098 cows from 46 livestock farms in the Sumapaz region that were selected by random. Of the total population of cattle, 962 animals (88%) were tested for bovine TB using a caudal-fold tuberculin test and 546 (50%) for brucellosis by a competitive ELISA. In the population tested, 23 cows were positive for Brucella sp. representing a 4.2% seroprevalence and no cases of bovine tuberculosis were found. In addition, food-borne contamination with Escherichia coli and Staphylococcus aureus was assessed together with antibiotic susceptibility for ten different antibiotics in milk samples from 16 livestock farms. We found that 12 of the farms (75%) were contaminated with these food-borne pathogens. Noteworthy, all of the isolated pathogenic strains were resistant to multiple antibiotics, primarily to oxytetracycline and erythromycin. Our findings suggest that livestock products could be a source of exposure to Brucella and multidrug-resistant E. coli and S. aureus strains as a result of unhygienic livestock practices in the Sumapaz region. Training in good farming practices is the key to improving safety in food production.

The ethics of Soviet medical practice: behaviours and attitudes of physicians in Soviet Estonia.

PubMed Central

Barr, D A

1996-01-01

OBJECTIVES: To study and report the attitudes and practices of physicians in a former Soviet republic regarding issues pertaining to patients' rights, physician negligence and the acceptance of gratuities from patients. DESIGN: Survey questionnaire administered to physicians in 1991 at the time of the Soviet breakup. SETTING: Estonia, formerly a Soviet republic, now an independent state. SURVEY SAMPLE: A stratified, random sample of 1,000 physicians, representing approximately 20 per cent of practicing physicians under the age of 65. RESULTS: Most physicians shared information with patients about treatment risks and alternatives, with the exception of cancer patients: only a third of physicians tell the patient when cancer is suspected. Current practice at the time of the survey left patients few options when physician negligence occurred; most physicians feel that under a reformed system physician negligence should be handled within the local facility rather than by the government. It was common practice for physicians to receive gifts, tips, or preferential access to scarce consumer goods from their patients. Responses varied somewhat by facility and physician nationality. CONCLUSION: The ethics of Soviet medical practice were different in a number of ways from generally accepted norms in Western countries. Physicians' attitudes about the need for ethical reform suggest that there will be movement in Estonia towards a system of medical ethics that more closely approximates those in the West. PMID:8932723

Male and female genital cutting among Southern Thailand's Muslims: rituals, biomedical practice and local discourses.

PubMed

Merli, Claudia

2010-10-01

This paper explores how local people in a province in southern Thailand perceive the practice of male and female genital cutting. In order to understand the importance placed on these practices, a comparison is drawn between the two and also between the male circumcision and the Buddhist ordination of monks as rites of passage. Discourses on the exposure or concealment of male and female bodies, respectively, witness to the relevance of both the local political-historical context and biomedical hegemony to gendered bodies. The comparisons evince the need to reflect upon the theoretical and ethical implications of studying genital cutting and focusing exclusively on one of the two practices rather than, as this paper claims to be necessary, considering them as inextricably connected.

Ethnopharmacology in the work of Melville William Hilton-Simpson (1881-1938)--historical analysis and current research opportunities.

PubMed

Helmstädter, A

2016-06-01

In the early 20th century, the British anthropologist Melville William Hilton-Simpson (1881-1938) did explorations in Africa, mainly the Congo region and the Aurès region in Algeria. He showed considerable interest in local medicinal practices and plants used by the natives, mainly the Algerian Berbers. He left notes, letters and publications about traditional medicine which were screened for relevant information about medicinal plant use. His reports were compared with current knowledge and recent study results. Many plants described by Hilton-Simpson as therapeutically relevant could prove their efficacy in current studies which again shows that historical sources may exert some reliability. The study, however, unveiled a couple of plants reported as traditionally used, but neglected by modern science so far. These, including Marrubium supinum, Cynoglossum pictum (= C. creticum), Sonchus maritimus, and two Erodium species, are strongly recommended to be further studied. Foresightedly, this approach was already intended by Hilton-Simpson himself.

Development of an Accelerated Test Method for the Determination of Susceptibility to Atmospheric Corrosion

NASA Technical Reports Server (NTRS)

Ambrose, John R.

1991-01-01

The theoretical rationale is presented for use of a repetitive cyclic current reversal voltammetric technique for characterization of localized corrosion processes, including atmospheric corrosion. Applicability of this proposed experimental protocol is applied to characterization of susceptibility to crevice and pitting corrosion, atmospheric corrosion and stress corrosion cracking. Criteria upon which relative susceptibility is based were determined and tested using two iron based alloys commonly in use at NASA-Kennedy; A36 (a low carbon steel) and 4130 (a low alloy steel). Practicality of the procedure was demonstrated by measuring changes in anodic polarization behavior during high frequency current reversal cycles of 25 cycles per second with 1 mA/sq cm current density amplitude in solutions containing Cl anions. The results demonstrated that, due to excessive polarization which affects conductivity of barrier corrosion product layers, A36 was less resistant to atmospheric corrosion than its 4130 counterpart; behavior which was also demonstrated during exposure tests.

Theoretical evaluation of maximum electric field approximation of direct band-to-band tunneling Kane model for low bandgap semiconductors

NASA Astrophysics Data System (ADS)

Dang Chien, Nguyen; Shih, Chun-Hsing; Hoa, Phu Chi; Minh, Nguyen Hong; Thi Thanh Hien, Duong; Nhung, Le Hong

2016-06-01

The two-band Kane model has been popularly used to calculate the band-to-band tunneling (BTBT) current in tunnel field-effect transistor (TFET) which is currently considered as a promising candidate for low power applications. This study theoretically clarifies the maximum electric field approximation (MEFA) of direct BTBT Kane model and evaluates its appropriateness for low bandgap semiconductors. By analysing the physical origin of each electric field term in the Kane model, it has been elucidated in the MEFA that the local electric field term must be remained while the nonlocal electric field terms are assigned by the maximum value of electric field at the tunnel junction. Mathematical investigations have showed that the MEFA is more appropriate for low bandgap semiconductors compared to high bandgap materials because of enhanced tunneling probability in low field regions. The appropriateness of the MEFA is very useful for practical uses in quickly estimating the direct BTBT current in low bandgap TFET devices.

Can local staff reliably assess their own programs? A confirmatory test-retest study of Lot Quality Assurance Sampling data collectors in Uganda.

PubMed

Beckworth, Colin A; Anguyo, Robert; Kyakulaga, Francis Cranmer; Lwanga, Stephen K; Valadez, Joseph J

2016-08-17

Data collection techniques that routinely provide health system information at the local level are in demand and needed. LQAS is intended for use by local health teams to collect data at the district and sub-district levels. Our question is whether local health staff produce biased results as they are responsible for implementing the programs they also assess. This test-retest study replicates on a larger scale an earlier LQAS reliability assessment in Uganda. We conducted in two districts an LQAS survey using 15 local health staff as data collectors. A week later, the data collectors swapped districts, where they acted as disinterested non-local data collectors, repeating the LQAS survey with the same respondents. We analysed the resulting two data sets for agreement using Cohens' Kappa. The average Kappa score for the knowledge indicators was k = 0.43 (SD = 0.16) and for practice indicators k = 0.63 (SD = 0.17). These scores show moderate agreement for knowledge indicators and substantial agreement for practice indicators. Analyses confirm that respondents were more knowledgeable on retest; no evidence of bias was found for practice indicators. The findings of this study are remarkably similar to those produced in the first reliability study. There is no evidence that using local healthcare staff to collect LQAS data biases data collection in an LQAS study. The bias observed in the knowledge indicators was most likely due to a 'practice effect', whereby respondents increased their knowledge as a result of completing the first survey; no corresponding effect was seen in the practice indicators.

Modelling the dispersion of treated wastewater in a shallow coastal wind-driven environment, Geographe Bay, Western Australia: implications for environmental management.

PubMed

Dunn, Ryan J K; Zigic, Sasha; Shiell, Glenn R

2014-10-01

Numerical models are useful for predicting the transport and fate of contaminants in dynamic marine environments, and are increasingly a practical solution to environmental impact assessments. In this study, a three-dimensional hydrodynamic model and field data were used to validate a far-field dispersion model that, in turn, was used to determine the fate of treated wastewater (TWW) discharged to the ocean via a submarine ocean outfall under hypothetical TWW flows. The models were validated with respect to bottom and surface water current speed and direction, and in situ measurements of total nitrogen and faecal coliforms. Variations in surface and bottom currents were accurately predicted by the model as were nutrient and coliform concentrations. Results indicated that the ocean circulation was predominately wind driven, evidenced by relatively small oscillations in the current speeds along the time-scale of the tide, and that dilution mixing zones were orientated in a predominantly north-eastern direction from the outfall and parallel to the coastline. Outputs of the model were used to determine the 'footprint' of the TWW plume under a differing discharge scenario and, particularly, whether the resultant changes in TWW contaminants, total nitrogen and faecal coliforms would meet local environmental quality objectives (EQO) for ecosystem integrity, shellfish harvesting and primary recreation. Modelling provided a practical solution for predicting the dilution of contaminants under a hypothetical discharge scenario and a means for determining the aerial extent of exclusion zones, where the EQOs for shellfish harvesting and primary recreation may not always be met. Results of this study add to the understanding of regional discharge conditions and provide a practical case study for managing impacts to marine environments under a differing TWW discharge scenario, in comparison to an existing scenario.

Use of Rapid, Point-of-Care Assays by Private Practitioners in Chennai, India: Priorities for Tuberculosis Diagnostic Testing.

PubMed

Bronner Murrison, Liza; Ananthakrishnan, Ramya; Sukumar, Sumanya; Augustine, Sheela; Krishnan, Nalini; Pai, Madhukar; Dowdy, David W

2016-01-01

Private practitioners are frequently the first point of healthcare contact for patients with tuberculosis (TB) in India. As new molecular tests are developed for point-of-care (POC) diagnosis of TB, it is imperative to understand these individuals' practices and preferences for POC testing. To evaluate rapid testing practices and identify priorities for novel POC TB tests among private practitioners in Chennai. We conducted a cross-sectional survey of 228 practitioners practicing in the private sector from January 2014 to February 2015 who saw at least one TB patient in the previous year. Practitioners were randomly selected from both the general community and a list of practitioners who referred patients to a public-private mix program for TB treatment. We used standardized questionnaires to collect data on current practices related to point-of-care diagnosis and interest in hypothetical POC tests. We used multivariable Poisson regression with robust estimates of standard error to calculate measures of association. Among 228 private practitioners, about half (48%) utilized any rapid testing in their current practice, most commonly for glucose (43%), pregnancy (21%), and malaria (5%). Providers using POC tests were more likely to work in hospitals (56% vs. 43%, P = 0.05) and less likely to be chest specialists (21% vs. 54%, P<0.001). Only half (51%) of providers would use a hypothetical POC test for TB that was accurate, equipment-free, and took 20 minutes to complete. Chest specialists were half as likely to express interest in performing the hypothetical POC TB test in-house as other practitioners (aPR 0.5, 95%CI: 0.2-0.9). Key challenges to performing POC testing for TB in this study included time constraints, easy access to local private labs and lack of an attached lab facility. As novel POC tests for TB are developed and scaled up, attention must be paid to integrating these diagnostics into healthcare providers' routine practice and addressing barriers for POC testing.

Borderline resectable pancreatic cancer: conceptual evolution and current approach to image-based classification.

PubMed

Gilbert, J W; Wolpin, B; Clancy, T; Wang, J; Mamon, H; Shinagare, A B; Jagannathan, J; Rosenthal, M

2017-09-01

Diagnostic imaging plays a critical role in the initial diagnosis and therapeutic monitoring of pancreatic adenocarcinoma. Over the past decade, the concept of 'borderline resectable' pancreatic cancer has emerged to describe a distinct subset of patients existing along the spectrum from resectable to locally advanced disease for whom a microscopically margin-positive (R1) resection is considered relatively more likely, primarily due to the relationship of the primary tumor with surrounding vasculature. This review traces the conceptual evolution of borderline resectability from a radiological perspective, including the debates over the key imaging criteria that define the thresholds between resectable, borderline resectable, and locally advanced or metastatic disease. This review also addresses the data supporting neoadjuvant therapy in this population and discusses current imaging practices before and during treatment. A growing body of evidence suggests that the borderline resectable group of patients may particularly benefit from neoadjuvant therapy to increase the likelihood of an ultimately margin-negative (R0) resection. Unfortunately, anatomic and imaging criteria to define borderline resectability are not yet universally agreed upon, with several classification systems proposed in the literature and considerable variance in institution-by-institution practice. As a result of this lack of consensus, as well as overall small patient numbers and lack of established clinical trials dedicated to borderline resectable patients, accurate evidence-based diagnostic categorization and treatment selection for this subset of patients remains a significant challenge. Clinicians and radiologists alike should be cognizant of evolving imaging criteria for borderline resectability given their profound implications for treatment strategy, follow-up recommendations, and prognosis. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Experimental canopy removal enhances diversity of vernal pond amphibians.

PubMed

Skelly, David K; Bolden, Susan R; Freidenburg, L Kealoha

2014-03-01

Vernal ponds are often treated as protected environments receiving special regulation and management. Within the landscapes where they are found, forest vegetation frequently dominates surrounding uplands and can grow to overtop and shade pond basins. Two bodies of research offer differing views of the role of forest canopy for vernal pond systems. Studies of landscape conversion suggest that removing forest overstory within uplands can cause local extinctions of amphibians by altering terrestrial habitat or hindering movement. Studies of canopy above pond basins imply an opposite relationship; encroachment of overstory vegetation can be associated with local extinctions potentially via changes in light, thermal, and food resource environments. Unresolved uncertainties about the role of forest canopy reveal significant gaps in our understanding of wetland species distributions and dynamics. Any misunderstanding of canopy influences is simultaneously important to managers because current practices emphasize promoting or conserving vegetation growth particularly within buffers immediately adjacent to ponds. We evaluated this apparent contradiction by conducting a landscape-scale, long-term experiment using 14 natural vernal ponds. Tree felling at six manipulated ponds was limited in spatial scope but was nevertheless effective in increasing water temperature. Compared with eight control ponds, manipulated ponds maintained more amphibian species during five years post-manipulation. There was little evidence that any species was negatively influenced, and the reproductive effort of species for which we estimated egg inputs maintained pretreatment population densities in manipulated compared with control ponds. Overall, our experiment shows that a carefully circumscribed reduction of overhead forest canopy can enhance the capacity of vernal ponds to support wildlife diversity and suggests a scale dependence of canopy influences on amphibians. These findings have implications for the connection between current wetland management practices and the goals of wetland stewardship and conservation of wetland-dependent species.

Thailand Momentum on Policy and Practice in Local Legislation on Dengue Vector Control

PubMed Central

Bhumiratana, Adisak; Intarapuk, Apiradee; Chujun, Suriyo; Kaewwaen, Wuthichai; Sorosjinda-Nunthawarasilp, Prapa; Koyadun, Surachart

2014-01-01

Over a past decade, an administrative decentralization model, adopted for local administration development in Thailand, is replacing the prior centralized (top-down) command system. The change offers challenges to local governmental agencies and other public health agencies at all the ministerial, regional, and provincial levels. A public health regulatory and legislative framework for dengue vector control by local governmental agencies is a national topic of interest because dengue control program has been integrated into healthcare services at the provincial level and also has been given priority in health plans of local governmental agencies. The enabling environments of local administrations are unique, so this critical review focuses on the authority of local governmental agencies responsible for disease prevention and control and on the functioning of local legislation with respect to dengue vector control and practices. PMID:24799896

The applicability of the UK Public Health Skills and Knowledge Framework to the practitioner workforce: lessons for competency framework development.

PubMed

Shickle, Darren; Stroud, Laura; Day, Matthew; Smith, Kevin

2018-06-05

Many countries have developed competency frameworks for public health practice. While the number of competencies vary, frameworks cover similar knowledge and skills although they are not explicitly based on competency theory. A total of 15 qualitative group interviews (of up to six people), were conducted with 51 public health practitioners in 8 local authorities to assess the extent to which practitioners utilize competencies defined within the UK Public Health Skills and Knowledge Framework (PHSKF). Framework analysis was applied to the transcribed interviews. The overall framework was seen positively although no participants had previously read or utilized the PHSKF. Most could provide evidence, although some PHSKF competencies required creative thinking to fit expectations of practitioners and to reflect variation across the domains of practice which are impacted by job role and level of seniority. Evidence from previous NHS jobs or education may be needed as some competencies were not regularly utilized within their current local authority role. Further development of the PHSKF is required to provide guidance on how it should be used for practitioners and other members of the public health workforce. Empirical research can help benchmark knowledge/skills for workforce levels so improving the utility of competency frameworks.

Antibiotics Smart Use: a workable model for promoting the rational use of medicines in Thailand

PubMed Central

Chongtrakul, Pisonthi; Anuwong, Kunyada; Pumtong, Somying; Kongsomboon, Kedsenee; Butdeemee, Parichart; Khonglormyati, Jurairat; Chomyong, Santi; Tongyoung, Parnuchote; Losiriwat, Suraphol; Seesuk, Piyanooch; Suwanwaree, Pongthep; Tangcharoensathien, Viroj

2012-01-01

Abstract The Antibiotics Smart Use (ASU) programme was introduced in Thailand as a model to promote the rational use of medicines, starting with antibiotics. The programme’s first phase consisted of assessing interventions intended to change prescribing practices; the second phase examined the feasibility of programme scale-up. Currently the programme is in its third phase, which centres on sustainability. This paper describes the concept behind ASU, the programme’s functional modalities, the development of its conceptual framework and the implementation of its first and second phases. To change antibiotic prescription practices, multifaceted interventions at the individual and organizational levels were implemented; to maintain behaviour change and scale up the programme, interventions at the network and policy levels were used. The National Health Security Office has adopted ASU as a pay-for-performance criterion, a major achievement that has led to the programme’s expansion nationwide. Despite limited resources, programme scale-up and sustainability have been facilitated by the promotion of local ownership and mutual recognition, which have generated pride and commitment. ASU is clearly a workable entry point for efforts to rationalize the use of medicines in Thailand. Its long-term sustainability will require continued local commitment and political support, effective auditing and integration of ASU into routine systems with appropriate financial incentives. PMID:23284196

Antibiotics Smart Use: a workable model for promoting the rational use of medicines in Thailand.

PubMed

Sumpradit, Nithima; Chongtrakul, Pisonthi; Anuwong, Kunyada; Pumtong, Somying; Kongsomboon, Kedsenee; Butdeemee, Parichart; Khonglormyati, Jurairat; Chomyong, Santi; Tongyoung, Parnuchote; Losiriwat, Suraphol; Seesuk, Piyanooch; Suwanwaree, Pongthep; Tangcharoensathien, Viroj

2012-12-01

The Antibiotics Smart Use (ASU) programme was introduced in Thailand as a model to promote the rational use of medicines, starting with antibiotics. The programme's first phase consisted of assessing interventions intended to change prescribing practices; the second phase examined the feasibility of programme scale-up. Currently the programme is in its third phase, which centres on sustainability. This paper describes the concept behind ASU, the programme's functional modalities, the development of its conceptual framework and the implementation of its first and second phases. To change antibiotic prescription practices, multifaceted interventions at the individual and organizational levels were implemented; to maintain behaviour change and scale up the programme, interventions at the network and policy levels were used. The National Health Security Office has adopted ASU as a pay-for-performance criterion, a major achievement that has led to the programme's expansion nationwide. Despite limited resources, programme scale-up and sustainability have been facilitated by the promotion of local ownership and mutual recognition, which have generated pride and commitment. ASU is clearly a workable entry point for efforts to rationalize the use of medicines in Thailand. Its long-term sustainability will require continued local commitment and political support, effective auditing and integration of ASU into routine systems with appropriate financial incentives.

Binaural hearing with electrical stimulation.

PubMed

Kan, Alan; Litovsky, Ruth Y

2015-04-01

Bilateral cochlear implantation is becoming a standard of care in many clinics. While much benefit has been shown through bilateral implantation, patients who have bilateral cochlear implants (CIs) still do not perform as well as normal hearing listeners in sound localization and understanding speech in noisy environments. This difference in performance can arise from a number of different factors, including the areas of hardware and engineering, surgical precision and pathology of the auditory system in deaf persons. While surgical precision and individual pathology are factors that are beyond careful control, improvements can be made in the areas of clinical practice and the engineering of binaural speech processors. These improvements should be grounded in a good understanding of the sensitivities of bilateral CI patients to the acoustic binaural cues that are important to normal hearing listeners for sound localization and speech in noise understanding. To this end, we review the current state-of-the-art in the understanding of the sensitivities of bilateral CI patients to binaural cues in electric hearing, and highlight the important issues and challenges as they relate to clinical practice and the development of new binaural processing strategies. This article is part of a Special Issue entitled . Copyright © 2014 Elsevier B.V. All rights reserved.

Progress in analgesia for labor: focus on neuraxial blocks

PubMed Central

Ranasinghe, J Sudharma; Birnbach, David J

2010-01-01

Neuraxial analgesia is widely accepted as the most effective and the least depressant method of providing pain relief in labor. Over the last several decades neuraxial labor analgesia techniques and medications have progressed to the point now where they provide high quality pain relief with minimal side effects to both the mother and the fetus while maximizing the maternal autonomy possible for the parturient receiving neuraxial analgesia. The introduction of the combined spinal epidural technique for labor has allowed for the rapid onset of analgesia with minimal motor blockade, therefore allowing the comfortable parturient to ambulate. Patient-controlled epidural analgesia techniques have evolved to allow for more flexible analgesia that is tailored to the individual needs of the parturient and effective throughout the different phases of labor. Computer integrated systems have been studied to provide seamless analgesia from induction of neuraxial block to delivery. New adjuvant drugs that improve the effectiveness of neuraxial labor analgesia while decreasing the side effects that may occur due to high dose of a single drug are likely to be added to future labor analgesia practice. Bupivacaine still remains a popular choice of local anesthetic for labor analgesia. New local anesthetics with less cardiotoxicity have been introduced, but their cost effectiveness in the current labor analgesia practice has been questioned. PMID:21072273

Investigating underlying principles to guide health impact assessment.

PubMed

Fakhri, Ali; Maleki, Mohammadreza; Gohari, Mahmoodreza; Harris, Patrick

2014-06-01

Many countries conduct Health Impact Assessment (HIA) of their projects and policies to predict their positive and negative health impacts. In recent years many guides have been developed to inform HIA practice, largely reflecting local developments in HIA. These guides have often been designed for specific contexts and specific need, making the choice between guides difficult. The objective of the current study is to identify underlying principles in order to guide HIA practice in Iran. This study was conducted in three stages: 1) Studies comparing HIA guidelines were reviewed to identify criteria used for comparison seeking emphasized principles. 2) The HIA characteristics extracted from published papers were categorized in order to determine the principles that could guide HIA practice. 3) Finally, these principles were agreed by experts using nominal group technique. The review of the studies comparing HIA guides demonstrated there are no clear comparison criteria for reviewing HIA guides and no study mentioned HIA principles. Investigating the HIA principles from peer-reviewed papers, we found 14 issues. These were, considering of general features in planning and conducting HIAs such as HIA stream, level, timing and type, considering of the wider socio-political and economic context, considering of economic, technical and legal aspects of HIA and capacities for HIA, rationality and comprehensiveness, using appropriate evidence, elaborating on HIA relation to other forms of Impact Assessment, considering of equity, and encouraging intersectoral and interdisciplinary cooperation, involvement of stakeholders and transparency as underlying principles to guide HIA practice. The results emphasize how critical these technical as well as tactical considerations are in the early scoping step of an HIA which plans the conduct of the HIA in reponse to local contextual issues. Determining the principles of HIA from peer-reviewed papers provides an opportunity for guiding HIA practice comprehensively. It seems to be feasible to develop a universal guide that covers all principles required.

29 CFR 1601.70 - FEP agency qualifications.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) That the State or political subdivision has a fair employment practice law which makes unlawful... State or political subdivision has either established a State or local authority or authorized an...; or to institute criminal proceedings with respect to the practice. (b) Any State or local agency or...

EPA'S REGIONAL VULNERABILITY ASSESSMENT PROGRAM: USING MONITORING DATA AND MODEL RESULTS TO TARGET ACTIONS

EPA Science Inventory

Until recently, ecological studies and management practices were conducted and implemented at local scales. During the past two decades, however, it has become clear that evaluations of environmental problems and management practices cannot be considered only at local scales. Inc...

Dynamics behind the scale up of evidence-based obesity prevention: protocol for a multi-site case study of an electronic implementation monitoring system in health promotion practice.

PubMed

Conte, Kathleen P; Groen, Sisse; Loblay, Victoria; Green, Amanda; Milat, Andrew; Persson, Lina; Innes-Hughes, Christine; Mitchell, Jo; Thackway, Sarah; Williams, Mandy; Hawe, Penelope

2017-12-06

The effectiveness of many interventions to promote health and prevent disease has been well established. The imperative has therefore shifted from amassing evidence about efficacy to scale-up to maximise population-level health gains. Electronic implementation monitoring, or 'e-monitoring', systems have been designed to assist and track the delivery of preventive policies and programs. However, there is little evidence on whether e-monitoring systems improve the dissemination, adoption, and ongoing delivery of evidence-based preventive programs. Also, given considerable difficulties with e-monitoring systems in the clinical sector, scholars have called for a more sophisticated re-examination of e-monitoring's role in enhancing implementation. In the state of New South Wales (NSW), Australia, the Population Health Information Management System (PHIMS) was created to support the dissemination of obesity prevention programs to 6000 childcare centres and elementary schools across all 15 local health districts. We have established a three-way university-policymaker-practice research partnership to investigate the impact of PHIMS on practice, how PHIMS is used, and how achievement of key performance indicators of program adoption may be associated with local contextual factors. Our methods encompass ethnographic observation, key informant interviews and participatory workshops for data interpretation at a state and local level. We use an on-line social network analysis of the collaborative relationships across local health district health promotion teams to explore the relationship between PHIMS use and the organisational structure of practice. Insights will be sensitised by institutional theory, practice theory and complex adaptive system thinking, among other theories which make sense of socio-technical action. Our working hypothesis is that the science of getting evidence-based programs into practice rests on an in-depth understanding of the role they play in the on-going system of local relationships and multiple accountabilities. Data will be synthesised to produce a typology to characterise local context, PHIMS use and key performance indicator achievement (of program implementation) across the 15 local health districts. Results could be used to continuously align e-monitoring technologies within quality improvement processes to ensure that such technologies enhance practice and innovation. A partnership approach to knowledge production increases the likelihood that findings will be put into practice.

Simulation reframed.

PubMed

Kneebone, Roger L

2016-01-01

Simulation is firmly established as a mainstay of clinical education, and extensive research has demonstrated its value. Current practice uses inanimate simulators (with a range of complexity, sophistication and cost) to address the patient 'as body' and trained actors or lay people (Simulated Patients) to address the patient 'as person'. These approaches are often separate.Healthcare simulation to date has been largely for the training and assessment of clinical 'insiders', simulating current practices. A close coupling with the clinical world restricts access to the facilities and practices of simulation, often excluding patients, families and publics. Yet such perspectives are an essential component of clinical practice. This paper argues that simulation offers opportunities to move outside a clinical 'insider' frame and create connections with other individuals and groups. Simulation becomes a bridge between experts whose worlds do not usually intersect, inviting an exchange of insights around embodied practices-the 'doing' of medicine-without jeopardising the safety of actual patients.Healthcare practice and education take place within a clinical frame that often conceals parallels with other domains of expert practice. Valuable insights emerge by viewing clinical practice not only as the application of medical science but also as performance and craftsmanship.Such connections require a redefinition of simulation. Its essence is not expensive elaborate facilities. Developments such as hybrid, distributed and sequential simulation offer examples of how simulation can combine 'patient as body' with 'patient as person' at relatively low cost, democratising simulation and exerting traction beyond the clinical sphere.The essence of simulation is a purposeful design, based on an active process of selection from an originary world, abstraction of what is criterial and re - presentation in another setting for a particular purpose or audience. This may be done within traditional simulation centres, or outside in local communities, public spaces or arts and performance venues. Simulation has established a central role in clinical education but usually focuses on learning to do things as they are already done. Imaginatively designed, simulation offers untapped potential for deep engagement with patients, publics and experts outside medicine.

Assessing Ecotourism from a Multi-stakeholder Perspective: Xingkai Lake National Nature Reserve, China

NASA Astrophysics Data System (ADS)

Su, Ming Ming; Wall, Geoffrey; Ma, Zhong

2014-11-01

Ecotourism development is closely associated with the sustainability of protected natural areas. When facilitated by appropriate management, ecotourism can contribute to conservation and development, as well as the well-being of local communities. As such, ecotourism has been proposed and practiced in different forms in many places, including China. This study assesses ecotourism development at Xingkai Lake National Nature Reserve in Heilongjiang Province, China. Key informant interviews were conducted with representatives from the provincial Forestry Department, the Nature Reserve, and the local community. Observation was undertaken on three site visits and secondary data were collected. The potential for providing quality natural experiences is high and tourism development is occurring rapidly. However, current relationships between people, resources, and tourism have yet to provide mutual benefits necessary for successful ecotourism. The multi-stakeholder management style and the ambiguity of landownership within the nature reserve constitute structural difficulties for ecotourism management and operation. Although participation in ecotourism could provide a livelihood opportunity and interests in involvement in tourism have been identified among the local fishing community, current involvement is limited mainly due to the lack of mechanisms for participation. Therefore, it is recommended that management programs and government policies should be established to provide a platform for community participation in ecotourism. Then, a positive synergistic relationship between tourism, environment, and community could be developed. Planning and policy requirements are discussed for ecotourism development in protected areas in China.

Liposomal bupivacaine for regional anesthesia.

PubMed

Uskova, Anna; O'Connor, Jessica E

2015-10-01

Using a regional block in a multimodal approach to postoperative analgesia management involves addressing, which local anesthetic and how much should be used to ensure adequate pain relief to reduce related morbidity and mortality. This article will review literature surrounding the recently approved formulation of slow release liposomal bupivacaine, define its proven benefits, and identify ongoing studies to further examine the utility of this novel formulation by various routes. Recent Phase II and III clinical trials have demonstrated the ability of liposomal bupivacaine to provide prolonged analgesia, maintain a high safety profile in therapeutic doses, and decrease opioid requirements when compared with placebo in local infiltration applications for up to 24 h. Between 24 and 72 h after study drug administration, there was minimal to no difference between EXPAREL and placebo treatments on mean pain intensity. Conventional bupivacaine or ropivacaine groups (current standard practice in many hospitals in the USA) were not compared. In addition, the analgesic efficacy, cost-effectiveness, and safety profile of liposomal bupivacaine has not thoroughly been studied in various standard clinical settings such as perineural, intrathecal, and epidural administration. Current published data do not provide superior clinical results for EXPAREL over conventional bupivacaine based upon the lack of adequately powered multicentered clinical trials with comparison groups. Further investigation is necessary to identify the analgesic efficacy and safety profile of liposomal bupivacaine versus standard local anesthetics and to define the optimal clinical indication for liposomal bupivacaine administration in regional anesthesia.

Assessing ecotourism from a multi-stakeholder perspective: Xingkai Lake National Nature Reserve, China.

PubMed

Su, Ming Ming; Wall, Geoffrey; Ma, Zhong

2014-11-01

Ecotourism development is closely associated with the sustainability of protected natural areas. When facilitated by appropriate management, ecotourism can contribute to conservation and development, as well as the well-being of local communities. As such, ecotourism has been proposed and practiced in different forms in many places, including China. This study assesses ecotourism development at Xingkai Lake National Nature Reserve in Heilongjiang Province, China. Key informant interviews were conducted with representatives from the provincial Forestry Department, the Nature Reserve, and the local community. Observation was undertaken on three site visits and secondary data were collected. The potential for providing quality natural experiences is high and tourism development is occurring rapidly. However, current relationships between people, resources, and tourism have yet to provide mutual benefits necessary for successful ecotourism. The multi-stakeholder management style and the ambiguity of landownership within the nature reserve constitute structural difficulties for ecotourism management and operation. Although participation in ecotourism could provide a livelihood opportunity and interests in involvement in tourism have been identified among the local fishing community, current involvement is limited mainly due to the lack of mechanisms for participation. Therefore, it is recommended that management programs and government policies should be established to provide a platform for community participation in ecotourism. Then, a positive synergistic relationship between tourism, environment, and community could be developed. Planning and policy requirements are discussed for ecotourism development in protected areas in China.

Advances in participatory occupational health aimed at good practices in small enterprises and the informal sector.

PubMed

Kogi, Kazutaka

2006-01-01

Participatory programmes for occupational risk reduction are gaining importance particularly in small workplaces in both industrially developing and developed countries. To discuss the types of effective support, participatory steps commonly seen in our "work improvement-Asia" network are reviewed. The review covered training programmes for small enterprises, farmers, home workers and trade union members. Participatory steps commonly focusing on low-cost good practices locally achieved have led to concrete improvements in multiple technical areas including materials handling, workstation ergonomics, physical environment and work organization. These steps take advantage of positive features of small workplaces in two distinct ways. First, local key persons are ready to accept local good practices conveyed through personal, informal approaches. Second, workers and farmers are capable of understanding technical problems affecting routine work and taking flexible actions leading to solving them. This process is facilitated by the use of locally adjusted training tools such as local good examples, action checklists and group work methods. It is suggested that participatory occupational health programmes can work in small workplaces when they utilize low-cost good practices in a flexible manner. Networking of these positive experiences is essential.

Assessment of the Utility of Ictal Magnetoencephalography in the Localization of the Epileptic Seizure Onset Zone.

PubMed

Alkawadri, Rafeed; Burgess, Richard C; Kakisaka, Yosuke; Mosher, John C; Alexopoulos, Andreas V

2018-06-11

Literature on ictal magnetoencephalography (MEG) in clinical practice and the relationship to other modalities is limited because of the brevity of routine studies. To investigate the utility and reliability of ictal MEG in the localization of the epileptogenic zone. A retrospective medical record review and prospective analysis of a novel ictal rhythm analysis method was conducted at a tertiary epilepsy center with a wide base of referrals for epilepsy surgery evaluation and included consecutive cases of patients who experienced epileptic seizures during routine MEG studies from March 2008 to February 2012. A total of 377 studies screened. Data were analyzed from November 2011 to October 2015. Presurgical workup and interictal and ictal MEG data were reviewed. The localizing value of using extended-source localization of a narrow band identified visually at onset was analyzed. Of the 44 included patients, the mean (SD) age at the time of recording was 19.3 (14.9) years, and 25 (57%) were male. The mean duration of recording was 51.2 minutes. Seizures were provoked by known triggers in 3 patients and were spontaneous otherwise. Twenty-five patients (57%) had 1 seizure, 6 (14%) had 2, and 13 (30%) had 3 or more. Magnetoencephalography single equivalent current dipole analysis was possible in 29 patients (66%), of whom 8 (28%) had no clear interictal discharges. Sublobar concordance between ictal and interictal dipoles was seen in 18 of 21 patients (86%). Three patients (7%) showed clear ictal MEG patterns without electroencephalography changes. Ictal MEG dipoles correlated with the lobe of onset in 7 of 8 patients (88%) who underwent intracranial electroencephalography evaluations. Reasons for failure to identify ictal dipoles included diffuse or poor dipolar ictal patterns, no MEG changes, and movement artifact. Resection of areas containing a minimum-norm estimate of a narrow band at onset, not single equivalent current dipole, was associated with sustained seizure freedom. Ictal MEG data can provide reliable localization, including in cases that are difficult to localize by other modalities. These findings support the use of extended-source localization for seizures recorded during MEG.

Strategies for Reforestation under Uncertain Future Climates: Guidelines for Alberta, Canada

PubMed Central

Gray, Laura K.; Hamann, Andreas

2011-01-01

Background Commercial forestry programs normally use locally collected seed for reforestation under the assumption that tree populations are optimally adapted to local environments. However, in western Canada this assumption is no longer valid because of climate trends that have occurred over the last several decades. The objective of this study is to show how we can arrive at reforestation recommendations with alternative species and genotypes that are viable under a majority of climate change scenarios. Methodology/Principal Findings In a case study for commercially important tree species of Alberta, we use an ecosystem-based bioclimate envelope modeling approach for western North America to project habitat for locally adapted populations of tree species using multi-model climate projections for the 2020s, 2050s and 2080s. We find that genotypes of species that are adapted to drier climatic conditions will be the preferred planting stock over much of the boreal forest that is commercially managed. Interestingly, no alternative species that are currently not present in Alberta can be recommended with any confidence. Finally, we observe large uncertainties in projections of suitable habitat that make reforestation planning beyond the 2050s difficult for most species. Conclusion/Significance More than 50,000 hectares of forests are commercially planted every year in Alberta. Choosing alternative planting stock, suitable for expected future climates, could therefore offer an effective climate change adaptation strategy at little additional cost. Habitat projections for locally adapted tree populations under observed climate change conform well to projections for the 2020s, which suggests that it is a safe strategy to change current reforestation practices and adapt to new climatic realities through assisted migration prescriptions. PMID:21853061

Airport Financing and User Charge Systems in the USA

NASA Technical Reports Server (NTRS)

Bartle, John R.

1998-01-01

This paper examines the financing of U.S. public airports in a turbulent era of change, and projects toward the future. It begins by briefly outlining historical patterns that have changed the industry, and airport facilities in particular. It then develops basic principles of public finance as applied to public infrastructure, followed by the applicable principles of management. Following that, the current airport financing system is analyzed and contrasted with a socially optimal financing system. A concluding section suggests policy reforms and their likely benefits. The principles of finance and management discussed here are elementary. However, their implications are radical for U.S. airport policy. There is a great deal of room to improve the allocation of aviation infrastructure resources. The application of these basic principles makes it evident that in many cases, current practice is wasteful, environmentally unsound, overly costly, and inequitable. Future investments in public aviation capital will continue to be wasteful until more efficient pricing systems are instituted. Thus, problem in the U.S. is not one of insufficient investment in airport infrastructure, but investment in the wrong types of infrastructure. In the U.S., the vast majority of publically-owned airports are owned by local governments. Thus, while the federal government bad a great deal of influence in financing airports, ultimately these are local decisions. The same is true with many other public infrastructure issues. Katz and Herman (1997) report that in 1995, U.S. net public capital stock equaled almost $4.6 trillion, 72% of which ($3.9 trillion) was owned by state and local governments, most of it in buildings, highways, Streets, sewer systems, and water supply facilities. Thus, public infrastructure finance is fundamentally a local government issue, with implications for federal and state governments in the design of their aid programs.

Exploring local risk managers' use of flood hazard maps for risk communication purposes in Baden-Württemberg

NASA Astrophysics Data System (ADS)

Kjellgren, S.

2013-07-01

In response to the EU Floods Directive (2007/60/EC), flood hazard maps are currently produced all over Europe, reflecting a wider shift in focus from "flood protection" to "risk management", for which not only public authorities but also populations at risk are seen as responsible. By providing a visual image of the foreseen consequences of flooding, flood hazard maps can enhance people's knowledge about flood risk, making them more capable of an adequate response. Current literature, however, questions the maps' awareness raising capacity, arguing that their content and design are rarely adjusted to laypeople's needs. This paper wants to complement this perspective with a focus on risk communication by studying how these tools are disseminated and marketed to the public in the first place. Judging from communication theory, simply making hazard maps publicly available is unlikely to lead to attitudinal or behavioral effects, since this typically requires two-way communication and material or symbolic incentives. Consequently, it is relevant to investigate whether and how local risk managers, who are well positioned to interact with the local population, make use of flood hazard maps for risk communication purposes. A qualitative case study of this issue in the German state of Baden-Württemberg suggests that many municipalities lack a clear strategy for using this new information tool for hazard and risk communication. Four barriers in this regard are identified: perceived disinterest/sufficient awareness on behalf of the population at risk; unwillingness to cause worry or distress; lack of skills and resources; and insufficient support. These barriers are important to address - in research as well as in practice - since it is only if flood hazard maps are used to enhance local knowledge resources that they can be expected to contribute to social capacity building.

Perceived Need Versus Current Spending: Gaps in Providing Foundational Public Health Services in Communities.

PubMed

Bekemeier, Betty; Marlowe, Justin; Squires, Linda Sharee; Tebaldi, Jennifer; Park, Seungeun

Our objective was to estimate the gap between the costs for local health jurisdictions (LHJs) to provide foundational public health services (FPHS) and actual spending on FPHS and to examine factors associated with that gap. We employed resource-based cost estimation methods for this observational study and conducted multivariate analyses with measures derived from secondary administrative data. We used primary data collected from LHJ leaders that depicted 2014 spending and perceived need. We also included secondary administrative data depicting annual 2000-2013 expenditures organized into categories containing key elements of FPHS areas. We included primary data from a representative sample of 10 LHJs in Washington State and secondary data for all 35 LHJs in Washington. Participants were public health practice leaders from each sample LHJ. Our main outcome of interest was the gap identified between current spending and the perceived spending needed to provide FPHS in a jurisdiction. Actual FPHS spending was approximately 65% of spending needed to provide overall FPHS for our sample LHJs, but the size of the gap varied substantially by program. Some gaps also varied widely by LHJ, with spending gaps widest among rural and high poverty communities. Percent poverty and the metropolitan nature of a jurisdiction were factors significantly related to FPHS spending in our multivariate analyses. Actual spending lags far behind local officials' estimates of spending needed to provide FPHS and is likely influenced by local conditions. Major apparent gaps between spending and need, particularly in areas such as costly Business Competencies, underscore the need for cross-cutting capabilities to support public health system responsiveness and for attention to be paid to local conditions.

Scanning tunneling spectroscopy under large current flow through the sample.

PubMed

Maldonado, A; Guillamón, I; Suderow, H; Vieira, S

2011-07-01

We describe a method to make scanning tunneling microscopy/spectroscopy imaging at very low temperatures while driving a constant electric current up to some tens of mA through the sample. It gives a new local probe, which we term current driven scanning tunneling microscopy/spectroscopy. We show spectroscopic and topographic measurements under the application of a current in superconducting Al and NbSe(2) at 100 mK. Perspective of applications of this local imaging method includes local vortex motion experiments, and Doppler shift local density of states studies.

We Can Have It All: Improved Surveillance Outcomes and Decreased Personnel Costs Associated With Electronic Reportable Disease Surveillance, North Carolina, 2010

PubMed Central

DiBiase, Lauren; Fangman, Mary T.; Fleischauer, Aaron T.; Waller, Anna E.; MacDonald, Pia D. M.

2013-01-01

Objectives. We assessed the timeliness, accuracy, and cost of a new electronic disease surveillance system at the local health department level. We describe practices associated with lower cost and better surveillance timeliness and accuracy. Methods. Interviews conducted May through August 2010 with local health department (LHD) staff at a simple random sample of 30 of 100 North Carolina counties provided information on surveillance practices and costs; we used surveillance system data to calculate timeliness and accuracy. We identified LHDs with best timeliness and accuracy and used these categories to compare surveillance practices and costs. Results. Local health departments in the top tertiles for surveillance timeliness and accuracy had a lower cost per case reported than LHDs with lower timeliness and accuracy ($71 and $124 per case reported, respectively; P = .03). Best surveillance practices fell into 2 domains: efficient use of the electronic surveillance system and use of surveillance data for local evaluation and program management. Conclusions. Timely and accurate surveillance can be achieved in the setting of restricted funding experienced by many LHDs. Adopting best surveillance practices may improve both efficiency and public health outcomes. PMID:24134385

Global environmental crisis: is there a connection with place-based, ecosociocultural education in rural Spain?

NASA Astrophysics Data System (ADS)

Glasson, George E.

2011-06-01

Environmental educators are challenged by how to teach children about global environmental crisis such as the Gulf oil spill, which only serves to engender children's fears and apprehensions about the negative impact of humans on ecosystems. Eduardo Dopico and Eva Garcia-Vazquez's article presents an interesting context from which to analyze and reflect on the connections between local and global environmental education issues. The authors' study involves student researchers in actively learning about place-based, sustainable agricultural practices in rural Spain that are passed down through generations. These ecofriendly, culturally mediated farming practices, referred to as "traditional" by the farmers, were contrasted to "modern" practices that are used throughout market-based globalized economy. The connection between local (traditional) and global (modern) practices became very important in the reflections and learning of the student participants about sustainability and ecojustice issues associated with traditional farming. Students learned from the local farmers a positive, non-dualistic approach to sustainable agriculture in which human activity and culture is connected to ecological sustainability. Further, the students' active research of sustainable and culturally medicated agricultural practices at the local level provided a frame of reference to understand global environmental crises.

Local public health resource allocation: limited choices and strategic decisions.

PubMed

Bekemeier, Betty; Chen, Anthony L-T; Kawakyu, Nami; Yang, Youngran

2013-12-01

Local health department leaders are expected to improve the health of their populations as they "use and contribute to" the evidence base for practice, but effectively providing and utilizing data and evidence for local public health decision making has proven difficult. This study was conducted in 2011 and initiated by Washington State's public health practice-based research network to identify factors influencing local resource allocation and programmatic decisions among public health leaders facing severe funding losses. Quantitative data informed sampling for the collection of interview data. Qualitative methods were used to capture diverse insights of Washington State's local public health leaders in making decisions regarding resource allocation. Local decision-making authority was perceived as greatly restricted by what public health activities were legally mandated and the categoric nature of funding sources, even as some leaders exercised deliberate strategic approaches. One's workforce and board of health were also influential in making decisions regarding resource allocations. Challenges were expressed regarding making use of data and research evidence for decision making. Data were analyzed in 2011-2012. Programmatic mandates, funding restrictions, local stakeholders, and workforce capacity appear to trump factors such as research evidence and perceived community need in public health resource allocation. Study findings highlight tensions between the literature descriptions of what "should" influence decision making in local public health and the realities of practice. Advancements in practice-based research and evidence-based decision making, however, provide opportunities for strengthening the development of evidence and research translation for local decision making to maximize resources and promote effective service provision. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.

Associations among state and local organizational contexts: Use of evidence-based practices in the criminal justice system.

PubMed

Henderson, Craig E; Young, Douglas W; Farrell, Jill; Taxman, Faye S

2009-08-01

This study used hierarchical linear modeling (HLM) to examine the extent to which the organizational characteristics of state corrections agencies and local criminal justice facilities interacted in their associations with the extent to which local facilities are using evidence-based substance abuse treatment practices (EBPs). The study used data collected from two nationally representative surveys - one of state executives and the other of local prison wardens, justice administrators, and treatment directors - which were conducted as part of the National Criminal Justice Treatment Practices survey [NCJTP; Taxman, F.S., Young, D., Wiersema, B., Mitchell, S., Rhodes, A.G., 2007. The National Criminal Justice Treatment Practices Survey: Multi-level survey methods and procedures. J. Subst. Abuse Treat. 32, 225-238], and includes both adult criminal and juvenile justice samples. Results indicated that several state organizational characteristics were either associated with more EBP use or interacted with local organizational characteristics in associations with EBP use, including: (1) systems integration at the state level was associated with greater EBP use; (2) state staffing adequacy and stability accentuated the association between local training and resources for new programs and EBP use (i.e., in states with better staffing, the relationship between training/resources and EBP use in local facilities was stronger); and (3) state executives' attitudes regarding the missions and goals of corrections tended to diminish the extent to which corresponding local administrator attitudes were associated with EBP use. The study has implications for future research focused on EBP diffusion and implementation in correctional environments, particularly attempts to influence EBP use by working through state agencies.

The impact of patient record access on appointments and telephone calls in two English general practices: a population-based study

PubMed Central

Fitton, Caroline; Fitton, Richard; Hannan, Amir; Morgan, Lawrie; Halsall, David

2014-01-01

Background Government policy expects all patients who wish to have online record access (RA) by 2015. We currently have no knowledge of the impact of patient record access on practice workload. Setting Two urban general practices in Manchester. Question What is the impact of patient RA on telephone calls and appointments in UK general practice? Method We asked patients in two urban general practices who used RA whether it had increased or decreased their use of the practice over the previous year. Using practice data, we calculated the change in appointments, telephone calls and staff cost. We also estimated the reduction in environmental costs and patient time. Results An average of 187 clinical appointments (of which 87 were with doctors and 45 with nurses) and 290 telephone calls were saved. If 30% of patients used RA at least twice a year, these figures suggest that a 10 000-patient practice would save 4747 appointments and 8020 telephone calls per year. Assuming a consultation rate of 5.3% annually, that equates to a release of about 11% of appointments per year, with significant resource savings for patients and the environment. Discussion This is the first such study in the UK. It shows similar results to a study in the USA. We discuss the study limitations, including the issue of patient recall, nature of the practices studied and nature of early adopter patients. Strengths include combining national data, practice data and local reflection. We are confident that the savings observed are the result of RA rather than other factors. We suggest that RA can be part of continuous practice improvement, given its benefits and the support it offers for patient confidence, self-care and shared decision-making. PMID:25949705

Cultivating Composting Culture Activities among Citizens and Its Beneficial to Prolong the Landfill Lifespan

NASA Astrophysics Data System (ADS)

Azura Zakarya, Irnis; Azri Jamial, Khairul; Mat Tanda, Norazlinda

2018-03-01

Currently, the Ministry of Housing and Local Government manage solid waste in Malaysia, with the participation of the private sector. Food waste represents almost 60% of the total municipal solid waste disposed in the landfill. Material valorisation of food waste usually conducted by biological processes such as composting. Compost, an organic amendment, is the final product of the composting process. These processes are efficient, low cost and environmentally friendly alternative for managing food waste and are used extensively worldwide. Therefore, organic solid waste management practices program for the communities in Perlis was conducted. The main objective of this program was to instilling environment awareness especially among Perlis citizens. This study was investigated the impact of food waste or kitchen waste composting to the citizens in Perlis State and the beneficial of compost fertilizer to our environment especially in plant growth. Composting method was taught to the food premises owner, individuals, teachers, and students and their responses to the composting practices were then summarized. In future, we can prolong our landfill lifespan by practicing organic waste composting and can preserving our environment.

Family history in primary care: understanding GPs' resistance to clinical genetics--qualitative study.

PubMed

Mathers, Jonathan; Greenfield, Sheila; Metcalfe, Alison; Cole, Trevor; Flanagan, Sarah; Wilson, Sue

2010-05-01

National and local evaluations of clinical genetics service pilots have experienced difficulty in engaging with GPs. To understand GPs' reluctance to engage with clinical genetics service developments, via an examination of the role of family history in general practice. Qualitative study using semi-structured one-to-one interviews. The West Midlands, UK. Interviews with 21 GPs working in 15 practices, based on a stratified random sample from the Midlands Research Practices Consortium database. Thematic analysis proceeded alongside data generation. Framework grids were constructed for comparative analytical questioning. Interpretation was framed by two explanatory models: a knowledge deficit model, and practice and professional identity model. There is a clear distinction between the routine use and function of family history in GPs' clinical decision making, and contrasting conceptualisations of genetics and 'genetic conditions'. Although genetics is clearly a part of current GP practice, with acknowledgement of genetic components to multifactorial disease, this is distinguished from 'genetic conditions' which are seen as rare, complex single-gene disorders. Importantly, family history takes its place within a broader notion of the 'family doctor' that interviewees identified as a key aspect of their role. In contrast, clinical genetics was not identified as a core component of generalist practice. The likely effectiveness of educational policy interventions aimed at GPs that focus solely on knowledge deficit models, is questionable. There is a need to acknowledge how appropriate practice is constructed by GPs, within the context of accepted generalist roles and related identities.

Impact of forestry practices at a landscape scale on the dynamics of amphibian populations.

PubMed

Harper, Elizabeth B; Patrick, David A; Gibbs, James P

2015-12-01

Forest loss is a primary cause of worldwide amphibian decline. Timber harvesting in the United States has caused dramatic changes in quality and extent of forest ecosystems, and intensive forest management still occurs. Although numerous studies have documented substantial reductions in amphibian densities related to timber harvest, subsequent extinctions are rare. To better understand the population dynamics that have allowed so many amphibian species to persist in the face of widespread forest disturbance, we developed spatially explicit metapopulation models for four forest-dependent amphibian species (Lithobates sylvaticus, Ambystoma opacum, A. talpoideum, and A. maculatum) that incorporated demographic and habitat selection data derived from experiments conducted as part of the Land Use Effects on Amphibian Populations Project (LEAP). We projected local and landscape-scale population persistence under 108 different forestry practice scenarios, varying treatment (partial cut, clear-cut with coarse woody debris [CWD] removed, and clearcut with CWD retained), cut patch size (1, 10, or 50 ha), total area cut (10, 20, or 30%), and initial amphibian population size (5, 50, or 500 adult females per local breeding population). Under these scenarios, landscape-scale extinction was highly unlikely, occurring in < 1% of model runs and for only 2 of the 4 species, because landscape-scale populations were able to persist via dispersal even despite frequent local extinctions. Yet for all species, population sizes were reduced to -50% in all clear-cut scenarios, regardless of the size of harvested patches. These findings suggest that debate over timber harvesting on pool-breeding amphibian populations in the United States should focus not on questions of landscape-scale extinction but on the ecological consequences of dramatic reductions in amphibian biomass, including changes in trophic interactions, nutrient cycling, and energy transfer. Additionally, we conclude that amphibian declines and extinctions are far more likely to occur as a result of permanent habitat loss resulting from development than from the temporary degradation of habitat caused by current forestry practices.

Increasing social capital via local networks: analysis in the context of a surgical practice.

PubMed

Thakur, Anjani; Yang, Isaac; Lee, Michael Y; Goel, Arpan; Ashok, Ashwin; Fonkalsrud, Eric W

2002-09-01

The relationship between social capital (support, trust, patient awareness, and increased practice revenue) and local networks (university hospital) in communities has received little attention. The development of computer-based communication networks (social networks) has added a new dimension to the argument, posing the question of whether local networks can (re-)create social capital in local communities. This relationship is examined through a review of the literature on local networks and social capital and a surgeon's practice management from 1990 to 2001 with respect to repair of pectus chest deformities. With respect to pectus repair there was a consistent but small number of new referrals (15-20 new patients/year), lack of patient awareness (eight to 12 self-referred patients/year), and modest practice revenue. Since the inception of an Internet website (social network) dedicated to pectus repair in 1996 there has been increased social participation (n = 630 hits/year to the website); facilitation of spread of information through E-mail messages (n = 430 messages/year); and a greater participation of groups such as women, minorities, adults, and those with disability (n = 120 patients/year). The dissemination of information via the local network has also allowed an "outward movement" with increased participation by interconnecting communities (n = 698,300 global Internet participants based on statistical ratios). We conclude that local networks have enhanced social networks providing new grounds for the development of relationships based on choice and shared interest.

Local and Indigenous Knowledge Regarding the Land Use and Use of Other Natural Resources in the Aspiring Rio Coco Geopark

NASA Astrophysics Data System (ADS)

Pásková, Martina

2017-12-01

There is a limited number of studies describing the situation and importance of current or potential usage of the local and indigenous traditional environmental knowledge in the region of Northern Nicaragua. To fill this gap, the author supported by a local team conducted the participative research in this rather neglected Central American region, concretely in the northern area of the aspiring Rio Coco Geopark. The purpose of this research was to identify the local and indigenous knowledge regarding the present and traditional use of natural resources including land use and to analyse the contribution and potential of the usage of this knowledge for the local development sustainability. The practical long-term impact of this research is expected mainly in the form of enhancement of the local geotourism sustainability. The research process itself was of the same importance as its results, especially the involvement of the local and indigenous people. In this participative research, young local and indigenous people obtained training and served as co-investigators who later interviewed representatives of the local households. The other field methods included life history of elders, discussions in the focal groups involving common people from local communities as well as the mapping and photo-documentation of the identified local and indigenous traditional environmental knowledge. The participative character of the research process not only facilitated the data collection and validation but also supported the revival of the community memory and revitalization of its cultural and natural identity. The research findings point out that the more distant and more dispersed are the local settlements the better conserved local and indigenous knowledge regarding the traditional land use and other use of natural resources is. Among the best-conserved local and indigenous traditional environmental knowledge in the northern area of the aspiring Rio Coco Geopark was the usage of the earth material and plants. The local indigenous people are not expressing and transmitting the spiritual dimension of their traditional environmental knowledge (sacred times or sites, rites, rituals or taboos regarding the traditional land use and other use of natural resources) anymore because they were experiencing a continuous repression realized by the dominant (colonial) society in the past. They are not accustomed to appreciating the aesthetic values of the landscape as do visitors, but they are open to share their authentic life with them. The majority of the identified traditional land use and the use of the other natural resources as well as related traditional environmental knowledge in the researched northern region of the aspiring Rio Coco Geopark seems to be more sustainable than the present land use practices and the use of natural resources generally for agriculture, medicine, constructions etc. The local communities should dedicate much more attention and efforts to conserve, transmit and use this local and indigenous traditional environmental knowledge to enhance the sustainability of their development as well as geotourism emerging in this part of the aspiring geopark.

Overcoming limits set by scarce resources - role of local food production and food imports

NASA Astrophysics Data System (ADS)

Porkka, Miina; Guillaume, Joseph H. A.; Schaphoff, Sibyll; Siebert, Stefan; Gerten, Dieter; Kummu, Matti

2017-04-01

There is a fundamental tension between population growth and carrying capacity, i.e. the population that could potentially be supported using the resources and technologies available at a given time. This makes the assessments of resource use and agricultural productivity central to the debate on future food security. Local carrying capacity can be increased by expanding (e.g. through land conversion and irrigation infrastructure) or intensifying (e.g. through technologies and practices that increase efficiency) the resource use in agriculture. Food imports can be considered another way of overcoming current local limits and continuing growth beyond the local human-carrying capacity. Focusing on water as the key limiting resource, we performed a global assessment of the capacity for food self-sufficiency at sub-national and national scale for 1961-2009, taking into account the availability of both green and blue water as well as technology and management practices affecting water productivity at a given time, and using the hydrology and agriculture model LPJmL as our primary tool. Furthermore, we examined the use of food imports as a strategy to increase carrying capacity in regions where the potential for food self-sufficiency was limited by water availability and productivity. We found that the capacity for food self-sufficiency reduced notably during the study period due to the rapid population growth that outpaced the substantial improvements in water productivity. In 2009 more than a third (2.2 billion people) of the world's population lived in areas where sufficient food production to meet the needs of the population was not possible, and some 800 million people more were approaching this threshold. Food imports have nearly universally been used to overcome these local limits to growth, though the success of this strategy has been highly dependent on economic purchasing power. In the unsuccessful cases, increases in imports and local productivity have not kept pace with population growth, leaving 460 million people with insufficient food. Where the strategy has been successful, food security of 1.4 billion people has become dependent on imports. Whether or not this dependence on imports is considered desirable, it has policy implications that need to be taken into account.

Think Locally, Act Globally? The Transnationalization of Canadian Resource-Use Conflicts.

ERIC Educational Resources Information Center

Barker, Mary L.; Soyez, Dietrich

1994-01-01

Describes the reversal of the strategy to "think globally, act locally," whereby environmentalists and indigenous peoples of Canada, protesting environmentally unsound practices, have taken their protests to the countries most related to those practices. Issues discussed include logging in British Columbia, the James Bay hydroelectric…

A National Snapshot of Local School Wellness Policies

ERIC Educational Resources Information Center

Moag-Stahlberg, Alicia; Howley, Nora; Luscri, Lorry

2008-01-01

Background: The federal mandate for local wellness policies (LWP) provides an unprecedented opportunity to improve schools' practices that support student health, which, in turn, supports academic achievement. With a full agenda and budget challenges, districts need resources and support to turn policies into sustainable practices. The purpose of…

76 FR 47593 - Guidance for Small Business Entities on Current Good Manufacturing Practice for Positron Emission...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-05

...] Guidance for Small Business Entities on Current Good Manufacturing Practice for Positron Emission... entitled ``PET Drugs--Current Good Manufacturing Practice (CGMP); Small Entity Compliance Guide.'' FDA has... consistent with FDA's good guidance practices regulation (21 CFR 10.115). The guidance represents the Agency...

21 CFR 129.1 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 129.1 Section... Current good manufacturing practice. The applicable criteria in part 110 of this chapter, as well as the..., methods, practices, and controls used in the processing, bottling, holding, and shipping of bottled...

Situational analysis of infant and young child nutrition policies and programmatic activities in Burkina Faso.

PubMed

Wuehler, Sara E; Ouedraogo, Albertine Wendpagnagdé

2011-04-01

Progress towards reducing mortality and malnutrition among children < 5 years of age has been less than needed to achieve related Millennium Development Goals. Therefore, several international agencies joined to 'Reposition children's right to adequate nutrition in the Sahel', starting with an analysis of current activities related to infant and young child nutrition (IYCN). The objectives of the present paper are to compare relevant national policies, training materials, programmes, and monitoring and evaluation activities with internationally accepted IYCN recommendations. These findings are available to assist countries in identifying inconsistencies and filling gaps in current programming. Between August and November 2008, key informants responsible for conducting IYCN-related activities in Burkina Faso were interviewed, and 153 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, screening and treatment of acute malnutrition, prevention of mother-to-child transmission of HIV, food security and hygienic practices. National policy documents addressed nearly all of the key IYCN topics, specifically or generally. Formative research has identified some local barriers and beliefs related to general breastfeeding and complementary feeding practices, and other formative research addressed about half of the IYCN topics included in this review. However, there was little evidence that this formative research was being utilized in developing training materials and designing programme interventions. Nevertheless, the training materials that were reviewed do provide specific guidance for nearly all of the key IYCN topics. Although many of the IYCN programmes are intended for national coverage, we could only confirm with available reports that programme coverage extended to certain regions. Some programme monitoring and evaluation were conducted, but few of these provided information on whether the specific IYCN programme components were implemented as designed. Most surveys that were identified reported on general nutrition status indicators, but did not provide the detail necessary for programme impact evaluations. The policy framework is well established for optimal IYCN practices, but greater resources and capacity building are needed to: (i) conduct necessary research and adapt training materials and programme protocols to local needs; (ii) improve, carry out, and document monitoring and evaluation that highlight effective and ineffective programme components; and (iii) apply these findings in developing, expanding, and improving effective programmes. © 2011 Blackwell Publishing Ltd.

Datasets collected in general practice: an international comparison using the example of obesity.

PubMed

Sturgiss, Elizabeth; van Boven, Kees

2018-06-04

International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic? Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add? We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not be able to partake in these kinds of comparison studies. What are the implications for practitioners? Australian primary care researchers and clinicians will be at a disadvantage in any international collaboration if they are unable to accurately describe current general practice management. The Netherlands has developed an impressive dataset that requires within-consultation data collection. These datasets allow for person-centred, symptom-specific, longitudinal understanding of general practice management. The possibilities for the quasi-experimental questions that can be answered with such a dataset are limitless. It is only with the ability to answer clinically driven questions that are relevant to primary care that the clinical care of patients can be measured, developed and improved.

Developing a holistic strategy for integrated waste management within municipal planning: challenges, policies, solutions and perspectives for Hellenic municipalities in the zero-waste, low-cost direction.

PubMed

Zotos, G; Karagiannidis, A; Zampetoglou, S; Malamakis, A; Antonopoulos, I-S; Kontogianni, S; Tchobanoglous, G

2009-05-01

The present position paper addresses contemporary waste management options, weaknesses and opportunities faced by Hellenic local authorities. It focuses on state-of-the-art, tested as well as innovative, environmental management tools on a municipal scale and identifies a range of different collaboration schemes between local authorities and related service providers. Currently, a policy implementation gap is still experienced among Hellenic local authorities; it appears that administration at the local level is inadequate to manage and implement many of the general policies proposed; identify, collect, monitor and assess relevant data; and safeguard efficient and effective implementation of MSWM practices in the framework of integrated environmental management as well. This shortfall is partly due to the decentralisation of waste management issues to local authorities without a parallel substantial budgetary and capacity support, thus resulting in local activity remaining often disoriented and isolated from national strategies, therefore yielding significant planning and implementation problems and delays against pressing issues at hand as well as loss or poor use of available funds. This paper develops a systemic approach for MSWM at both the household and the non-household level, summarizes state-of-the-art available tools and compiles a set of guidelines for developing waste management master plans at the municipal level. It aims to provide a framework in the MSWM field for municipalities in Greece as well as other countries facing similar problems under often comparable socioeconomic settings.

Modeling Hydrodynamic Changes Due to Marine Hydrokinetic Power Production: Community Outreach and Education

NASA Astrophysics Data System (ADS)

James, S. C.; Jones, C.; Roberts, J.

2013-12-01

Power generation with marine hydrokinetic (MHK) turbines is receiving growing global interest. Because of reasonable investment, maintenance, reliability, and environmental friendliness, this technology can contribute to national (and global) energy markets and is worthy of research investment. Furthermore, in remote areas, small-scale MHK energy from river, tidal, or ocean currents can provide a local power supply. The power-generating capacity of MHK turbines will depend, among other factors, upon the turbine type and number and the local flow velocities. There is an urgent need for deployment of practical, accessible tools and techniques to help the industry optimize MHK array layouts while establishing best sitting and design practices that minimize environmental impacts. Sandia National Laboratories (SNL) has modified the open-source flow and transport Environmental Fluid Dynamics Code (EFDC) to include the capability of simulating the effects of MHK power production. Upon removing energy (momentum) from the system, changes to the local and far-field flow dynamics can be estimated (e.g., flow speeds, tidal ranges, flushing rates, etc.). The effects of these changes on sediment dynamics and water quality can also be simulated using this model. Moreover, the model can be used to optimize MHK array layout to maximize power capture and minimize environmental impacts. Both a self-paced tutorial and in-depth training course have been developed as part of an outreach program to train academics, technology developers, and regulators in the use and application of this software. This work outlines SNL's outreach efforts using this modeling framework as applied to two specific sites where MHK turbines have been deployed.

Political economy of decentralising HIV and AIDS treatment services to primary healthcare facilities in three Nigerian states.

PubMed

Mbachu, Chinyere; Onwujekwe, Obinna; Ezumah, Nkoli; Ajayi, Olayinka; Sanwo, Olusola; Uzochukwu, Benjamin

2016-09-01

Decentralisation is defined as the dispersion, distribution or transfer of resources, functions and decision-making power from a central authority to regional and local authorities. It is usually accompanied by assignment of accountability and responsibility for results. Fundamental to understanding decentralisation is learning what motivates central governments to give up power and resources to local governments, and the practical significance of this on their positions regarding decentralisation. This study examined key political and institutional influences on role-players' capacity to support decentralisation of HIV and AIDS treatment services to primary healthcare facilities, and implications for sustainability. In-depth interviews were conducted with 55 purposively selected key informants, drawn from three Nigerian states that were at different stages of decentralising HIV and AIDS treatment services to primary care facilities. Key informants represented different categories of role-players involved in HIV and AIDS control programmes. Thematic framework analysis of data was done. Support for decentralisation of HIV and AIDS treatment services to primary healthcare facilities was substantial among different categories of actors. Political factors such as the local and global agenda for health, political tenure and party affiliations, and institutional factors such as consolidation of decision-making power and improvements in career trajectories, influenced role-players support for decentralisation of HIV and AIDS treatment services. It is feasible and acceptable to decentralise HIV and AIDS treatment services to primary healthcare facilities, to help improve coverage. However, role-players' support largely depends on how well the reform aligns with political structures and current institutional practices.

Influence of the magnetic field profile on ITER conductor testing

NASA Astrophysics Data System (ADS)

Nijhuis, A.; Ilyin, Y.; ten Kate, H. H. J.

2006-08-01

We performed simulations with the numerical CUDI-CICC code on a typical short ITER (International Thermonuclear Experimental Reactor) conductor test sample of dual leg configuration, as usually tested in the SULTAN test facility, and made a comparison with the new EFDA-Dipole test facility offering a larger applied DC field region. The new EFDA-Dipole test facility, designed for short sample testing of conductors for ITER, has a homogeneous high field region of 1.2 m, while in the SULTAN facility this region is three times shorter. The inevitable non-uniformity of the current distribution in the cable, introduced by the joints at both ends, has a degrading effect on voltage-current (VI) and voltage-temperature (VT) characteristics, particularly for these short samples. This can easily result in an underestimation or overestimation of the actual conductor performance. A longer applied DC high field region along a conductor suppresses the current non-uniformity by increasing the overall longitudinal cable electric field when reaching the current sharing mode. The numerical interpretation study presented here gives a quantitative analysis for a relevant practical case of a test of a short sample poloidal field coil insert (PFCI) conductor in SULTAN. The simulation includes the results of current distribution analysis from self-field measurements with Hall sensor arrays, current sharing measurements and inter-petal resistance measurements. The outcome of the simulations confirms that the current uniformity improves with a longer high field region but the 'measured' VI transition is barely affected, though the local peak voltages become somewhat suppressed. It appears that the location of the high field region and voltage taps has practically no influence on the VI curve as long as the transverse voltage components are adequately cancelled. In particular, for a thin conduit wall, the voltage taps should be connected to the conduit in the form of an (open) azimuthally soldered wire, averaging the transverse conduit surface potentials initiated in the joints.

75 FR 52627 - Disenrollment Procedures

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-27

... program that has been discontinued. It also amends the regulation to reflect current VA practice and to... conform with current VA practice, which does not disenroll veterans based on their failure to file VA Form 10-10EZ. Current practice is reflected in current paragraph (d)(3)(iv). Removing paragraph (d)(5)(iii...

Non-vitamin K antagonist oral anticoagulants and atrial fibrillation guidelines in practice: barriers to and strategies for optimal implementation.

PubMed

Camm, A John; Pinto, Fausto J; Hankey, Graeme J; Andreotti, Felicita; Hobbs, F D Richard

2015-07-01

Stroke is a leading cause of morbidity and mortality worldwide. Atrial fibrillation (AF) is an independent risk factor for stroke, increasing the risk five-fold. Strokes in patients with AF are more likely than other embolic strokes to be fatal or cause severe disability and are associated with higher healthcare costs, but they are also preventable. Current guidelines recommend that all patients with AF who are at risk of stroke should receive anticoagulation. However, despite this guidance, registry data indicate that anticoagulation is still widely underused. With a focus on the 2012 update of the European Society of Cardiology (ESC) guidelines for the management of AF, the Action for Stroke Prevention alliance writing group have identified key reasons for the suboptimal implementation of the guidelines at a global, regional, and local level, with an emphasis on access restrictions to guideline-recommended therapies. Following identification of these barriers, the group has developed an expert consensus on strategies to augment the implementation of current guidelines, including practical, educational, and access-related measures. The potential impact of healthcare quality measures for stroke prevention on guideline implementation is also explored. By providing practical guidance on how to improve implementation of the ESC guidelines, or region-specific modifications of these guidelines, the aim is to reduce the potentially devastating impact that stroke can have on patients, their families and their carers. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

21 CFR 113.5 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 113.5 Section... CONTAINERS General Provisions § 113.5 Current good manufacturing practice. The criteria in §§ 113.10, 113.40..., methods, practices, and controls used by the commercial processor in the manufacture, processing, or...

Development of a microcomputer data base of manufacturing, installation, and operating experience for the NSSS designer

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

Borchers, W.A.; Markowski, E.S.

1986-01-01

Future nuclear steam supply systems (NSSSs) will be designed in an environment of powerful micro hardware and software and these systems will be linked by local area networks (LAN). With such systems, individual NSSS designers and design groups will establish and maintain local data bases to replace existing manual files and data sources. One such effort of this type in Combustion Engineering's (C-E's) NSSS engineering organization is the establishment of a data base of historical manufacturing, installation, and operating experience to provide designers with information to improve on current designs and practices. In contrast to large mainframe or minicomputer datamore » bases, which compile industry-wide data, the data base described here is implemented on a microcomputer, is design specific, and contains a level of detail that is of interest to system and component designers. DBASE III, a popular microcomputer data base management software package, is used. In addition to the immediate benefits provided by the data base, the development itself provided a vehicle for identifying procedural and control aspects that need to be addressed in the environment of local microcomputer data bases. This paper describes the data base and provides some observations on the development, use, and control of local microcomputer data bases in a design organization.« less

[Convergence of healthcare regulation in the Americas: history, development, and new challenges].

PubMed

Silva, Ana Paula Jucá; Tagliari, Patrícia Oliveira Pereira

2016-05-01

The present article describes the changing relationship among healthcare regulatory authorities in various international settings, with special emphasis on the Americas. As other sectors, healthcare also faces the need to regulate international practices, while at the same time taking into consideration the specific realities of each country. Regulatory convergence - a movement towards technical alignment to enable the adoption of local regulatory mechanisms that take into account internationally recognized standards and principles to promote a single sanitary goal - has emerged as a means to address this challenge. Organizations that already use this tool, such as the International Conference of Drug Regulatory Authorities (ICDRA), Pan American Network for Drug Regulatory Harmonization (PANDRH), International Generic Drug Regulators Programme (IGDRP), and the International Medical Device Regulators Forum (IMDRF), among others, are currently working to gather knowledge, data, and specialists from different countries to build an international technical and scientific standard that can be used for decision-making by local regulators. This would ensure convergence of national regulations despite the need to adapt international standards to local needs, structure, and capacities. The most recent resolutions issued by the World Health Organization recognize the need to bring regulatory systems closer to the reality of national healthcare systems, and underscore the advantages of using existing local guidelines as input for cooperation with regulatory authorities.

Organic fields sustain weed metacommunity dynamics in farmland landscapes.

PubMed

Henckel, Laura; Börger, Luca; Meiss, Helmut; Gaba, Sabrina; Bretagnolle, Vincent

2015-06-07

Agro-ecosystems constitute essential habitat for many organisms. Agricultural intensification, however, has caused a strong decline of farmland biodiversity. Organic farming (OF) is often presented as a more biodiversity-friendly practice, but the generality of the beneficial effects of OF is debated as the effects appear often species- and context-dependent, and current research has highlighted the need to quantify the relative effects of local- and landscape-scale management on farmland biodiversity. Yet very few studies have investigated the landscape-level effects of OF; that is to say, how the biodiversity of a field is affected by the presence or density of organically farmed fields in the surrounding landscape. We addressed this issue using the metacommunity framework, with weed species richness in winter wheat within an intensively farmed landscape in France as model system. Controlling for the effects of local and landscape structure, we showed that OF leads to higher local weed diversity and that the presence of OF in the landscape is associated with higher local weed biodiversity also for conventionally farmed fields, and may reach a similar biodiversity level to organic fields in field margins. Based on these results, we derive indications for improving the sustainable management of farming systems. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Inter-kingdom prediction certainty evaluation of protein subcellular localization tools: microbial pathogenesis approach for deciphering host microbe interaction.

PubMed

Khan, Abdul Arif; Khan, Zakir; Kalam, Mohd Abul; Khan, Azmat Ali

2018-01-01

Microbial pathogenesis involves several aspects of host-pathogen interactions, including microbial proteins targeting host subcellular compartments and subsequent effects on host physiology. Such studies are supported by experimental data, but recent detection of bacterial proteins localization through computational eukaryotic subcellular protein targeting prediction tools has also come into practice. We evaluated inter-kingdom prediction certainty of these tools. The bacterial proteins experimentally known to target host subcellular compartments were predicted with eukaryotic subcellular targeting prediction tools, and prediction certainty was assessed. The results indicate that these tools alone are not sufficient for inter-kingdom protein targeting prediction. The correct prediction of pathogen's protein subcellular targeting depends on several factors, including presence of localization signal, transmembrane domain and molecular weight, etc., in addition to approach for subcellular targeting prediction. The detection of protein targeting in endomembrane system is comparatively difficult, as the proteins in this location are channelized to different compartments. In addition, the high specificity of training data set also creates low inter-kingdom prediction accuracy. Current data can help to suggest strategy for correct prediction of bacterial protein's subcellular localization in host cell. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Ensemble Deep Learning for Biomedical Time Series Classification

PubMed Central

2016-01-01

Ensemble learning has been proved to improve the generalization ability effectively in both theory and practice. In this paper, we briefly outline the current status of research on it first. Then, a new deep neural network-based ensemble method that integrates filtering views, local views, distorted views, explicit training, implicit training, subview prediction, and Simple Average is proposed for biomedical time series classification. Finally, we validate its effectiveness on the Chinese Cardiovascular Disease Database containing a large number of electrocardiogram recordings. The experimental results show that the proposed method has certain advantages compared to some well-known ensemble methods, such as Bagging and AdaBoost. PMID:27725828

TRICARE; Revision of Nonparticipating Providers Reimbursement Rate; Removal of Cost Share for Dental Sealants; TRICARE Dental Program. Final rule.

PubMed

2016-03-07

This final rule revises the benefit payment provision for nonparticipating providers to more closely mirror industry practices by requiring TDP nonparticipating providers to be reimbursed (minus the appropriate cost-share) at the lesser of billed charges or the network maximum allowable charge for similar services in that same locality (region) or state. This rule also updates the regulatory provisions regarding dental sealants to clearly categorize them as a preventive service and, consequently, eliminate the current 20 percent cost-share applicable to sealants to conform with the language in the regulation to the statute.

[Current situation of clinical research on impacted premolars].

PubMed

Liu, Ran-Ran; Tian, Jun

2018-04-01

Teeth impaction is a common developmental malformation in oral diseases. Impacted teeth are usually the canines, third molar, central incisors, premolars, and second molars. The prevalence of impaction of maxillary canines and mandibular wisdom teeth is higher than that of other teeth. Most recent studies have focused on the canines and third molars, but research on impacted premolars is limited. In clinical practice, the majority of orthodontic patients require premolar extraction. Thus, impacted premolars play important roles in orthodontic design and prognosis. This article provides an overview of recent research on impacted premolars and summarizes epidemiological features, localizations, and treatments, with the aim of guiding practitioners on orthodontic design and therapy.

Optical protocols for terabit networks

NASA Technical Reports Server (NTRS)

Chua, P. L.; Lambert, J. L.; Morookian, J. M.; Bergman, L. A.

1991-01-01

This paper describes a new fiber-optic local area network technology providing 100X improvement over current technology, has full crossbar funtionality, and inherent data security. Based on optical code-division multiple access (CDMA), using spectral phase encoding/decoding of optical pulses, networking protocols are implemented entirely in the optical domain and thus conventional networking bottlenecks are avoided. Component and system issues for a proof-of-concept demonstration are discussed, as well as issues for a more practical and commercially exploitable system. Possible terrestrial and aerospace applications of this technology, and its impact on other technologies are explored. Some initial results toward realization of this concept are also included.

Testing Bell's inequality with cosmic photons: closing the setting-independence loophole.

PubMed

Gallicchio, Jason; Friedman, Andrew S; Kaiser, David I

2014-03-21

We propose a practical scheme to use photons from causally disconnected cosmic sources to set the detectors in an experimental test of Bell's inequality. In current experiments, with settings determined by quantum random number generators, only a small amount of correlation between detector settings and local hidden variables, established less than a millisecond before each experiment, would suffice to mimic the predictions of quantum mechanics. By setting the detectors using pairs of quasars or patches of the cosmic microwave background, observed violations of Bell's inequality would require any such coordination to have existed for billions of years-an improvement of 20 orders of magnitude.

Toward micro-scale spatial modeling of gentrification

NASA Astrophysics Data System (ADS)

O'Sullivan, David

A simple preliminary model of gentrification is presented. The model is based on an irregular cellular automaton architecture drawing on the concept of proximal space, which is well suited to the spatial externalities present in housing markets at the local scale. The rent gap hypothesis on which the model's cell transition rules are based is discussed. The model's transition rules are described in detail. Practical difficulties in configuring and initializing the model are described and its typical behavior reported. Prospects for further development of the model are discussed. The current model structure, while inadequate, is well suited to further elaboration and the incorporation of other interesting and relevant effects.

Bespoke program design for school-aged therapy disability service delivery.

PubMed

Weatherill, Pamela; Bahn, Susanne; Cooper, Trudi

2012-01-01

This article uses the evaluation of a school-aged therapy service for children with disabilities in Western Australia to investigate models of service delivery. The current literature on family-centered practice, multidisciplinary and transdisciplinary approaches, and 4 models of service are reviewed. The models include the life needs model, the relational goal-orientated model of optimal service delivery to children and families, the quality of life model, and the collaborative model of service delivery. Analysis of the data is presented together with a bespoke model of service delivery for children with disabilities, arguing that local contexts benefit from custom-made service design.

The sexual health needs of people with learning disabilities.

PubMed

Cambridge, Paul

The sexual health of people with learning disabilities raises important management and practice issues for health services, and should be examined in the context of the current policy emphasis on advocacy, person-centred services and social inclusion (Department of Health, 2001). People with learning disabilities may have limited access to mainstream health services, and sexual health and genitourinary medicine (GUM) services are no exception (DoH, 2001; 1998). They are often excluded from society, either because they are 'segregated' within specialist support services in the community or because they live in isolation with carers, and health and social care models do not always join up locally to meet their needs.

The ISB model (infrastructure, service, behaviour): a tool for waste practitioners.

PubMed

Timlett, R; Williams, I D

2011-06-01

In response to the EU Landfill Directive and the challenge of mitigating climate change, the UK government (nationally and locally) must develop strategies and policies to reduce, recycle, compost and recover waste. Best practice services that yield high recycling rates, such as alternate weekly collections, are now largely mainstream in suitable areas. However, national recycling performance is short of what is needed; policy makers must look for innovative ways to meet challenging recycling targets. Increasingly, local authorities are using behaviour change interventions to encourage the public to recycle; these tend to be based on the premise that an individuals' behaviour is predetermined by their values. In practice, this has led to a host of initiatives that attempt to change individuals' behaviour without addressing situational barriers. In this paper, we argue that that a behaviour-centric approach has limited effectiveness. Using an analysis of the literature and studies that investigated recycling participation in the city of Portsmouth, we have identified three significant clusters that can facilitate effective recycling: infrastructure, service and behaviour (ISB). We present the ISB model - a tool that can be used by waste practitioners when planning interventions to maximise recycling to better understand the situation and context for behaviour. Analysis using the ISB model suggests that current best practice, "business as usual" interventions could realistically achieve a national recycling rate of 50%. If the UK is to move towards zero waste, policy makers must look "upstream" for interventions that change the situational landscape. Copyright © 2011 Elsevier Ltd. All rights reserved.