A cognitive developmental approach to variability in the psychotherapeutic process with adolescents.

PubMed

Gunning, C; Verheij, F

1990-01-01

Formulated from a cognitive frame of reference, psychodynamic therapy can be viewed as acting on one of the three aspects (feeling, thought, action) in order to influence or change the client's action and thought schemes. In this paper the consequences of the interaction of cognition and emotion for psychotherapeutic practice with adolescents are explored. Knowledge of cognitive development is supposed to be important for the therapist because, from Piaget's viewpoint, the structures of affect are cognitive structures. Moreover a great variability exists in cognitive development between adolescents. This variability is due to individual, family and social variables. The cognitive structural developmental model, the relation between emotional and cognitive development and the afore-mentioned variables are discussed. Consequences are psychotherapeutic practice with adolescents are described and short case histories are given. The authors conclude that in psychotherapeutic practice psychodynamic theory and cognitive structural theory can complete each other.

Trading legitimacy: everyday corruption and its consequences for medical regulation in southern Vietnam.

PubMed

Lê, Gillian

2013-09-01

Government regulation of health professionals is believed to ensure the efficacy and expertise of practitioners for and on behalf of patients. Certification and licensing are two common means to do so, legalizing a physician to practice medicine. However, ethnography from Ho Chi Minh City (HCMC) suggests that in corrupt socioeconomic environments, certification and licensing can alternatively produce a trade in legitimacy. Drawing on participant observations during 15 months of fieldwork with 25 medical acupuncturists in private practice in HCMC, southern Vietnam, and their patients, I argue that everyday practices of corruption and the importance of personal networks meant that legality, efficacy, and expertise separated. Certificates and licenses did not unproblematically validate expertise and efficacy. Consequently, compliance and enforcement of regulations as solutions to inadequate medical care may not achieve the effects intended. © 2013 by the American Anthropological Association.

A feminist approach to family therapy.

PubMed

Hare-Mustin, R T

1978-06-01

Although family therapy recognizes the importance of the social context as a determiner of behavior, family therapists have not examined the consequences of traditional socialization practices that primarily disadvantage women. The unquestioned reinforcement of stereotyped sex roles takes place in much of family therapy. A feminist therapy orientation that considers the consequences of stereotyped sex roles and the statuses prescribed by society for females and males should be part of family therapy practice. This paper describes the ways in which family therapists who are aware of their own biases and those of the family can change sexist patterns through applying feminist principles to such areas as the contract, shifting tasks in the family, communication, generational boundaries, relabeling deviance, modeling, and therapeutic alliances.

Societal Consequences of the g Factor in Employment.

ERIC Educational Resources Information Center

Gottfredson, Linda S.

1986-01-01

Reviews and rebuts seven common arguments that intelligence (g) is of little or no practical importance in employment. Illustrates in several ways the profound effect that differences in intelligence in a work force may have on the structure and functioning of whole societies. (Author/ABB)

Are Zeros Your Ultimate Weapon?

ERIC Educational Resources Information Center

Guskey, Thomas R.

2004-01-01

Grading is one of a teacher's greatest challenges and most important professional responsibilities. However, few teachers have any formal training in grading methods, and most teachers have limited knowledge about the effectiveness of various grading practices. As a consequence, when teachers develop their grading policies, they typically reflect…

Practical Consequences of Item Response Theory Model Misfit in the Context of Test Equating with Mixed-Format Test Data

PubMed Central

Zhao, Yue; Hambleton, Ronald K.

2017-01-01

In item response theory (IRT) models, assessing model-data fit is an essential step in IRT calibration. While no general agreement has ever been reached on the best methods or approaches to use for detecting misfit, perhaps the more important comment based upon the research findings is that rarely does the research evaluate IRT misfit by focusing on the practical consequences of misfit. The study investigated the practical consequences of IRT model misfit in examining the equating performance and the classification of examinees into performance categories in a simulation study that mimics a typical large-scale statewide assessment program with mixed-format test data. The simulation study was implemented by varying three factors, including choice of IRT model, amount of growth/change of examinees’ abilities between two adjacent administration years, and choice of IRT scaling methods. Findings indicated that the extent of significant consequences of model misfit varied over the choice of model and IRT scaling methods. In comparison with mean/sigma (MS) and Stocking and Lord characteristic curve (SL) methods, separate calibration with linking and fixed common item parameter (FCIP) procedure was more sensitive to model misfit and more robust against various amounts of ability shifts between two adjacent administrations regardless of model fit. SL was generally the least sensitive to model misfit in recovering equating conversion and MS was the least robust against ability shifts in recovering the equating conversion when a substantial degree of misfit was present. The key messages from the study are that practical ways are available to study model fit, and, model fit or misfit can have consequences that should be considered when choosing an IRT model. Not only does the study address the consequences of IRT model misfit, but also it is our hope to help researchers and practitioners find practical ways to study model fit and to investigate the validity of particular IRT models for achieving a specified purpose, to assure that the successful use of the IRT models are realized, and to improve the applications of IRT models with educational and psychological test data. PMID:28421011

Towards a practical framework for managing the risks of selecting technology to support independent living.

PubMed

Monk, Andrew; Hone, Kate; Lines, Lorna; Dowdall, Alan; Baxter, Gordon; Blythe, Mark; Wright, Peter

2006-09-01

Information and communication technology applications can help increase the independence and quality of life of older people, or people with disabilities who live in their own homes. A risk management framework is proposed to assist in selecting applications that match the needs and wishes of particular individuals. Risk comprises two components: the likelihood of the occurrence of harm and the consequences of that harm. In the home, the social and psychological harms are as important as the physical ones. The importance of the harm (e.g., injury) is conditioned by its consequences (e.g., distress, costly medical treatment). We identify six generic types of harm (including dependency, loneliness, fear and debt) and four generic consequences (including distress and loss of confidence in ability to live independently). The resultant client-centred framework offers a systematic basis for selecting and evaluating technology for independent living.

Teacher Leader Model Standards: Implications for Preparation, Policy, and Practice

ERIC Educational Resources Information Center

Berg, Jill Harrison; Carver, Cynthia L.; Mangin, Melinda M.

2014-01-01

Teacher leadership is increasingly recognized as a resource for instructional improvement. Consequently, teacher leader initiatives have expanded rapidly despite limited knowledge about how to prepare and support teacher leaders. In this context, the "Teacher Leader Model Standards" represent an important development in the field. In…

Leadership Challenges in Addressing Changing Demographics in Schools

ERIC Educational Resources Information Center

Madsen, Jean; Mabokela, Reitumetse

2014-01-01

Principals who lead demographically diverse schools play an important role in changing the dynamics that often occur in these contexts. Consequently, principals must have the leadership skills to revolutionize teachers' belief systems. Their energies are consumed with reshaping teachers' instructional practices and focusing on improving…

Child Abuse: An Emerging Social Priority

ERIC Educational Resources Information Center

Antler, Stephen

1978-01-01

In recent years, child abuse has emerged as a social priority of national importance, largely through physicians' efforts to make it so. Grafting a medical approach onto what has been a social work concern has had serious, perhaps unfortunate, consequences for social work policy, practice, and education. (Author)

Postdefoliation ecosystem carbon and water flux and canopy growth dynamics in sagebrush steppe bunchgrass

USDA-ARS?s Scientific Manuscript database

Developing land-use practices that lead to sustainable net primary productivity in rangelands are important, but understanding their consequences to population and community processes is not often accounted for in basic ecosystem studies. Grazed and ungrazed upland ecosystems generally do not diffe...

Cosmic Education: Linking the Human to the Universe.

ERIC Educational Resources Information Center

Gebhardt-Seele, Peter

2002-01-01

Describes cosmic education as the Montessori guide for educating 6- to 12-year-olds. Discusses practical consequences of Montessori's ideas, including the selection of the "great story," the need for physics at the elementary level to teach the laws of nature, the citizen's responsibility for the earth's survival, the importance of…

Lifelong Learning Strategies and Practice in Latvia and Thailand

ERIC Educational Resources Information Center

Luka, Ineta; Sungsri, Sumalee

2015-01-01

The importance of lifelong learning has been recognized for many years and consequently many countries, disregarding their geographical location, differences in education systems and traditions, have adopted their lifelong learning policies to develop the lifelong learning system. The goal of the present comparative research is to study the…

Emotion Metaphors and Emotional Labor in Science Teaching

ERIC Educational Resources Information Center

Zembylas, Michalinos

2004-01-01

An understanding of the importance of metaphors and beliefs in the development of teachers' practical knowledge has already been explored in science education research. However, the significance of "emotion metaphors" and the consequences of "emotional labor" as part of being a science teacher have been little addressed. This study describes the…

No Brain Left Behind: Consequences of Neuroscience Discourse for Education

ERIC Educational Resources Information Center

Busso, Daniel S.; Pollack, Courtney

2015-01-01

Educational neuroscience represents a concerted interdisciplinary effort to bring the fields of cognitive science, neuroscience and education to bear on classroom practice. This article draws attention to the current and potential implications of importing biological ideas, language and imagery into education. By analysing examples of brain-based…

Networks: A Route to Improving Performance in Manufacturing SMEs

ERIC Educational Resources Information Center

Coleman, J.

2003-01-01

Perceived as important contributors to economic growth, network and cluster groups are currently receiving much attention. The same may be said of SMEs. But practical and theoretical perspectives indicate that SMEs, and particularly the owner-managers, place little value on networks and have only limited networking resources. Consequently, they do…

Estimating costs of quality improvement for outpatient healthcare organisations: a practical methodology.

PubMed

Brown, Sydney E S; Chin, Marshall H; Huang, Elbert S

2007-08-01

Outpatient healthcare organisations worldwide participate in quality improvement (QI) programmes. Despite the importance of understanding the financial impact of such programmes, there are no established standard methods for empirically assessing QI programme costs and their consequences for small outpatient healthcare organisations. The costs and cost consequences were evaluated for a diabetes QI programme implemented throughout the USA in federally qualified community health centres. For five case study centres, survey instruments and methods for data analysis were developed. Two types of cost/revenue were evaluated. Direct costs/revenues, such as personnel time, items purchased and grants received, were evaluated using self-administered surveys. Cost/revenue consequences, which were cost/revenue changes that may have occurred due to changes in patient utilisation or physician behaviour, were evaluated using electronic billing data. Other methods for evaluating cost/revenue consequences if electronic billing data are not available are also discussed. This paper describes a practical taxonomy and method for assessing the costs and revenues of QI programmes for outpatient organisations. Results of such analyses will be useful for healthcare organisations implementing QI programmes and also for policy makers designing incentives for QI participation.

[Complications of termination of pregnancy].

PubMed

Faucher, P

2016-12-01

The legalization of abortion in France allowed to disappear almost maternal deaths caused by induced abortions. Nevertheless, the practice of abortion in a medical framework is encumbered with a number of immediate complications. Similarly, the late consequences of the practice of surgical abortion have generated an abundant literature, which it is important to analyse, both to meet the legitimate concerns of patients as to prevent any spread of false ideas under the influence of movements opposed to abortion. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The costs and consequences of assisted reproductive technology: an economic perspective.

PubMed

Connolly, Mark P; Hoorens, Stijn; Chambers, Georgina M

2010-01-01

Despite the growing use of assisted reproductive technologies (ART) worldwide, there is only a limited understanding of the economics of ART to inform policy about effective, safe and equitable financing of ART treatment. A review was undertaken of key studies regarding the costs and consequences of ART treatment, specifically examining the direct and indirect costs of treatment, economic drivers of utilization and clinical practice and broader economic consequences of ART-conceived children. The direct costs of ART treatment vary substantially between countries, with the USA standing out as the most expensive. The direct costs generally reflect the costliness of the underlying healthcare system. If unsubsidized, direct costs represent a significant economic burden to patients. The level of affordability of ART treatment is an important driver of utilization, treatment choices, embryo transfer practices and ultimately multiple birth rates. The costs associated with caring for multiple-birth ART infants and their mothers are substantial, reflecting the underlying morbidity associated with such pregnancies. Investment analysis of ART treatment and ART-conceived children indicates that appropriate funding of ART services appears to represent sound fiscal policy. The complex interaction between the cost of ART treatment and how treatments are subsidized in different healthcare settings and for different patient groups has far-reaching consequences for ART utilization, clinical practice and infant outcomes. A greater understanding of the economics of ART is needed to inform policy decisions and to ensure the best possible outcomes from ART treatment.

Elementary Students' Use of Dialect and Reading Achievement: Examining Students with Disabilities

ERIC Educational Resources Information Center

Gatlin, Brandy; Wanzek, Jeanne

2017-01-01

Nonmainstream American English, or dialect, among children may have important implications for reading research and practice. However, much of the research involving relations between dialect and literacy has analyzed dialect use in only one context and has omitted students with speech, language, and learning disabilities. Consequently, we…

Teachers Get Personal about Teaching to Survive NCLB

ERIC Educational Resources Information Center

Bunting, Carolyn

2007-01-01

So much of teaching is now driven by data (i.e., test scores) and dictated by "best practices" that teachers are losing confidence in their own creativity. Yet, despite these unfortunate consequences of No Child Left Behind (NCLB), the important work of teachers remains unchanged. That work is the work of connecting personally and…

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

ERIC Educational Resources Information Center

Bjorkhaug, Hilde; Richards, Carol Ann

2008-01-01

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

Relationship between Work Interference with Family and Parent-Child Interactive Behavior: Can Guilt Help?

ERIC Educational Resources Information Center

Cho, Eunae; Allen, Tammy D.

2012-01-01

Despite its theoretical and practical importance, behavioral consequences of work-family conflict that reside in the family domain rarely have been examined. Based on two studies, the current research investigated the relationship of work-interference-with-family (WIF) with parent-child interactive behavior (i.e., educational, recreational, and…

Student and Teacher Perception of Disciplinary Practices: Types, Reasons, Consequences and Alternatives

ERIC Educational Resources Information Center

Mumthas, N. S.; Munavvir, Jouhar; Abdul Gafoor, K.

2014-01-01

Inculcating self-discipline is important for systematic pursuit of learning, development of interest and potential in the child. Punishments involve employing a noxious or painful stimulus that generates a variety of problems and negative side effects to the child. Corporal punishments severely affect the human dignity of children. This study…

Implicit Theories of Ability in Physical Education: Current Issues and Future Directions

ERIC Educational Resources Information Center

Warburton, Victoria Emily; Spray, Christopher Mark

2017-01-01

Purpose: In light of the extensive empirical evidence that implicit theories have important motivational consequences for young people across a range of educational settings we seek to provide a summary of, and personal reflection on, implicit theory research and practice in physical education (PE). Overview: We first provide an introduction to…

Changing the Environmental Behaviour of Small Business Owners: The Business Case

ERIC Educational Resources Information Center

Walker, Beth; Redmond, Janice

2014-01-01

The importance of the environment is something of a cracked record to many small business owners, as historically any calls to business to change or improve their practices or behaviours were from the "environmental" or "green" perspective, rather than from a business perspective. As a consequence, many small businesses have…

A systematic review of medical practice variation in OECD countries.

PubMed

Corallo, Ashley N; Croxford, Ruth; Goodman, David C; Bryan, Elisabeth L; Srivastava, Divya; Stukel, Therese A

2014-01-01

Major variations in medical practice have been documented internationally. Variations raise questions about the quality, equity, and efficiency of resource allocation and use, and have important implications for health care and health policy. To perform a systematic review of the peer-reviewed literature on medical practice variations in OECD countries. We searched MEDLINE to find publications on medical practice variations in OECD countries published between 2000 and 2011. We present an overview of the characteristics of published studies as well as the magnitude of variations for select high impact conditions. A total of 836 studies were included. Consistent with the gray literature, there were large variations across regions, hospitals and physician practices for almost every condition and procedure studied. Many studies focused on high-impact conditions, but very few looked at the causes or outcomes of medical practice variations. While there were an overwhelming number of publications on medical practice variations the coverage was broad and not often based on a theoretical construct. Future studies should focus on conditions and procedures that are clinically important, policy relevant, resource intensive, and have high levels of public awareness. Further study of the causes and consequences of variations is important. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

[Knowledge and practices of the community health agent in the universe of mental disorder].

PubMed

de Barros, Márcia Maria Mont'alverne; Chagas, Maristela Inês Osawa; Dias, Maria Socorro de Araújo

2009-01-01

This qualitative investigation aimed at collecting information about the knowledge and practices of the community health agents related to the universe of mental disorders. Fourteen agents working in the Family Health Program in Sobral, Ceará were interviewed. We deduced that the concepts of mental disorder are constructed in a process influenced by subjective and socio-cultural aspects and in connection with concrete experiences. The community health agents judge mentally disturbed persons on the basis of different criteria such as normal or abnormal behavior standards and the capacity to make judgments. Social isolation emerged as an important factor, considered by the different research subjects as the cause, the consequence and even as the mental disorder itself. Fear, as a consequence of the strange behavior of people with mental disorders, was identified as an important obstacle for the performance of the community health agents. The strategies adopted by these professionals, fundamentally based on dialogue, reveal concern with social inclusion and the need to involve the families in the care of people with mental disorders.

[Evidence-based medicine--method, critical appraisal and usefulness for professionalized business practice in medical].

PubMed

Portwich, P

2005-05-01

The concept of evidence-based medicine (EBM) describes 5 steps that lead to a scientifically based solution of clinical problems. EBM is often reduced to the search for the best evidence (randomised controlled trials, meta-analyses) or the introduction of guidelines. This causes criticism and may have consequences for medicine. But EBM also emphasizes the so-called clinical expertise of the doctor, which is important for reference to the individual patient. This point of EBM is being developed further. Connected with the theory of professionalization by U. Oevermann, stressing the importance of hermeneutical competence, EBM turns out to be a sophisticated model of professional medical practice.

Methods for comparing drug policies--the utility of composite drug harm indexes.

PubMed

Ritter, Alison

2009-11-01

One of the challenges for drug policy research is being able to compare policy options and outcomes. The development of indexes, such as the UK Drug Harm Index or the UNODC Illicit Drug Index is a way to systematically enable such comparisons. An Index is a single common metric that represents the diverse outcomes or consequences of drug use. An Index may be used for performance monitoring within one country/region over time; to establish societal benefit of drug policies as expressed in social costs saved; to compare countries or regions; or for comparative policy analysis. Clarity of purpose is important in how an Index is used. The consequences or outcomes that can be combined into a single Index include health consequences, crime consequences, public amenity, pain and suffering, labour market outcomes, and drug manufacture and trafficking activity. The choice of outcomes for inclusion is driven by the purpose but also often by practical considerations, such as data availability. The weighting of the consequences is an important consideration in translating the outcomes into a common metric. A monetary unit has a number of advantages: it is a unit that can be measured across diverse impacts; it gives implicit "weighting" of harms; and it is intuitive for policy makers and community. On the other hand, it represents an economic perspective. No one Index will be regarded as suitable and appropriate by every stakeholder and ongoing research effort on Indexes is an important foundational research activity to advance illicit drug policy.

Soil structural stability assessment with the fluidized bed, aggregate stability, and rainfall simulation on long-term tillage and crop rotation systems

USDA-ARS?s Scientific Manuscript database

The formation of stable soil aggregates is an important indicator of soil susceptibility to erosion and a factor defining soil health. On cropland, tillage practices and crop rotations have shown to control soil biophysical properties with potential consequences on erosion susceptibility. Thus, the ...

The Need for a Principled Approach for Examining Indirect Effects of Test Use

ERIC Educational Resources Information Center

Lane, Suzanne

2013-01-01

In Shepard's (1997) discussion on the importance of test use and consequences in a validity argument for educational assessments, she reflected on Cronbach and Meehl's (1955) perspective on the role of test developers in providing consequential evidence. In the following year, a special issue in "Educational Measurement: Issues and Practice"…

Development and Psychometric Evaluation of the Index of Dental Anxiety and Fear (IDAF-4C[superscript +])

ERIC Educational Resources Information Center

Armfield, Jason M.

2010-01-01

The measurement of dental fear is important due to its high prevalence and appreciable individual, clinical, and public health consequences. However, existing measures of dental anxiety and fear (DAF) have theoretical or practical limitations. This study describes the development and subsequent assessment of the reliability and validity of test…

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

ERIC Educational Resources Information Center

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

2010-01-01

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

The good, the bad, and the unknown about telecommuting: meta-analysis of psychological mediators and individual consequences.

PubMed

Gajendran, Ravi S; Harrison, David A

2007-11-01

What are the positive and negative consequences of telecommuting? How do these consequences come about? When are these consequences more or less potent? The authors answer these questions through construction of a theoretical framework and meta-analysis of 46 studies in natural settings involving 12,883 employees. Telecommuting had small but mainly beneficial effects on proximal outcomes, such as perceived autonomy and (lower) work-family conflict. Importantly, telecommuting had no generally detrimental effects on the quality of workplace relationships. Telecommuting also had beneficial effects on more distal outcomes, such as job satisfaction, performance, turnover intent, and role stress. These beneficial consequences appeared to be at least partially mediated by perceived autonomy. Also, high-intensity telecommuting (more than 2.5 days a week) accentuated telecommuting's beneficial effects on work-family conflict but harmed relationships with coworkers. Results provide building blocks for a more complete theoretical and practical treatment of telecommuting. (c) 2007 APA

Best practices in OR suite layout and equipment choices to reduce slips, trips, and falls.

PubMed

Brogmus, George; Leone, William; Butler, Lorraine; Hernandez, Edward

2007-09-01

Slips, trips, and falls (STFs) account for about 20% of lost-time injuries for health care personnel. Although the effect that OR layout and equipment choices have on STF risk has not been specifically addressed in the literature, STFs in the perioperative suite are of particular concern because of their potential to cause adverse patient consequences. Increased renovation of ORs to include equipment for minimally invasive procedures intensifies the importance of examining best practices in OR layout and equipment choices to reduce the potential for STFs.

The relationship among mathematics anxiety, beliefs about mathematics, mathematics self-efficacy, and mathematics performance in associate degree nursing students.

PubMed

Walsh, Kathleen A

2008-01-01

This research explored nursing students' mathematics anxiety, beliefs about mathematics, and mathematics self-efficacy in relation to performance on a medication mathematics test. Results revealed that the participants experienced some mathematics anxiety and had positive beliefs about mathematics and mathematics self-efficacy. Qualitative responses indicated that participants worried about the consequences of failing the medication mathematics test and that practice helped reduce this anxiety. In addition, participants acknowledged the importance of correct dosage calculations for nursing practice. Implications for nursing education are discussed.

Evaluation of Practice Trials to Increase Self-Drinking in a Child with a Feeding Disorder.

PubMed

Peterson, Kathryn M; Volkert, Valerie M; Milnes, Suzanne M

2017-06-01

Self-drinking is an important skill for children to acquire as they transition from infancy to early childhood; however, the literature is limited (e.g., Collins, Gast, Wolery, Holcombe, & Leatherby, 1991; Peterson, Volkert, & Zeleny, 2015). We manipulated the consequences associated with self-drinking relative to those associated with being fed along the dimension of response effort. Results demonstrated that self-drinking increased when the child could either choose to self-feed one drink or be fed one drink and 5 practice trials with an empty cup.

Translational research: a concept analysis.

PubMed

Wendler, M Cecilia; Kirkbride, Geri; Wade, Kristen; Ferrell, Lynne

2013-01-01

BACKGROUND/CONCEPTUAL FRAMEWORK: Little is known about which approaches facilitate adoption and sustainment of evidence-based practice change in the highly complex care environments that constitute clinical practice today. The purpose of this article was to complete a concept analysis of translational research using a modified Walker and Avant approach. DESIGN/DATA COLLECTION: Using a rigorous and thorough review of the recent health care literature generated by a deep electronic search from 2004-2011, 85 appropriate documents were retrieved. Close reading of the articles by three coresearchers yielded an analysis of the emerging concept of translational research. Using the iterative process described by Walker and Avant, a tentative definition of the concept of translational research, along with antecedents and consequences were identified. Implications for health care professionals in education, practice, and research are offered. Further research is needed to determine the adequacy of the definition, to identify empirical referents, and to guide theory development. The study resulted in a theoretical definition of the concept of translational research, along with identification of antecedents and consequences and a description of an ideal or model case to illustrate the definition. Implications for practice and education include the importance of focusing on translational research approaches that may reduce the research-practice gap in health care, thereby improving patient care delivery. Research is needed to determine the usefulness of the definition in health care clinical practice.

Rethinking McKeown: The Relationship Between Public Health and Social Change

PubMed Central

Szreter, Simon

2002-01-01

Thomas McKeown was a rhetorically powerful critic, from the inside, of the medical profession's mid-20th-century love affair with curative and scientific medicine. He emphasized instead the importance of economic growth, rising living standards, and improved nutrition as the primary sources of most historical improvements in the health of developed nations. This interpretation failed to emphasize the simultaneous historical importance of an accompanying redistributive social philosophy and practical politics, which has characterized the public health movement from its 19th-century origins. Consequently, the current generation of public health practitioners are having to reconstruct such a politics and practice following its virtual dismantlement during the last 2 decades of the 20th century. PMID:11988434

Practice environment and its association with professional competence and work-related factors: perception of newly graduated nurses.

PubMed

Numminen, Olivia; Ruoppa, Eija; Leino-Kilpi, Helena; Isoaho, Hannu; Hupli, Maija; Meretoja, Riitta

2016-01-01

To explore newly graduated nurses' (NGN) perception of their practice environment and its association with their self-assessed competence, turnover intentions and job satisfaction as work-related factors. The impact of practice environment on nurses' work is important. Positive practice environments are associated with positive organisational, nurse and patient outcomes. How this applies to NGNs needs further exploration. A cross-sectional descriptive correlation design was used. Data were collected with PES-NWI and NCS instruments from 318 Finnish registered nurses, and analysed statistically. Newly graduated nurses' perception of their practice environment was mainly positive. Most positive perceptions related to collegial nurse-physician relations, and the least positive to staffing and resource adequacy. Positive perceptions were also associated with higher professional competence, higher perceptions of quality of care and lower intentions to leave the job or profession. The findings revealed strong and significant associations between practice environment and work-related factors. Practice environment is an important element in supporting NGNs' competence, retention and job satisfaction. Nursing management should pay attention to NGNs' perceptions of their practice environment. Management's ability to create and maintain positive practice environments can foster NGNs' professional development and job satisfaction, and consequently retain them in the workforce. © 2015 John Wiley & Sons Ltd.

How to assess vision.

PubMed

Marsden, Janet

2016-09-21

Rationale and key points An objective assessment of the patient's vision is important to assess variation from 'normal' vision in acute and community settings, to establish a baseline before examination and treatment in the emergency department, and to assess any changes during ophthalmic outpatient appointments. » Vision is one of the essential senses that permits people to make sense of the world. » Visual assessment does not only involve measuring central visual acuity, it also involves assessing the consequences of reduced vision. » Assessment of vision in children is crucial to identify issues that might affect vision and visual development, and to optimise lifelong vision. » Untreatable loss of vision is not an inevitable consequence of ageing. » Timely and repeated assessment of vision over life can reduce the incidence of falls, prevent injury and optimise independence. Reflective activity 'How to' articles can help update you practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice when assessing people holistically. 2. How you could use this article to educate your colleagues in the assessment of vision.

Why Has High-Stakes Testing So Easily Slipped into Contemporary American Life?

ERIC Educational Resources Information Center

Nichols, Sharon L.; Berliner, David C.

2008-01-01

High-stakes testing is the practice of attaching important consequences to standardized test scores, and it is the engine that drives the No Child Left Behind (NCLB) Act. The rationale for high-stakes testing is that the promise of rewards and the threat of punishments will cause teachers to work more effectively, students to be more motivated,…

Knowledge, Attitude, and Practice of Upper-middle Class toward the Importance of a Pediatric Dentist.

PubMed

Sadana, Gunmeen; Walia, Satinder; Rai, Hashmit Kaur; Aggarwal, Neha; Bhargava, Ankita

2017-10-01

This study was carried out to assess the knowledge, attitude, and practice of upper middle class toward the importance of a pediatric dentist in the city of Amritsar, Punjab. A cross-sectional study was carried out among the parents of children belonging to upper middle class in the city of Amritsar. This proposed study was assessed by the Institutional Ethical Committee (531/IDSR/2016) and their clearance was attained. A total of 950 parents were selected using a convenient sampling technique, and a self-made questionnaire was presented to them. Responses from the parents were evaluated in terms of numbers and percentages and were statistically analyzed using SPSS for Windows release 14.0 (SPSS Inc., Chicago, IL, USA). Differences at the 5% level were accepted as being statistically significant. The results of the study show limited knowledge about a pediatric dentist among the well-educated, well-placed, and economically sound citizens of Amritsar city. Consequently, the attitude and practices among this socioeconomic group are unconstructive and unprepared, respectively. Although the importance of taking a child to a pediatrician is a common practice among the upper and upper-middle classes of the society, it is clear that they do not give the same importance to a pediatric dentist, who is the pediatrician of dentistry.

An Opportunity to Bridge the Gap Between Clinical Research and Clinical Practice: Implications for Clinical Training

PubMed Central

Hershenberg, Rachel; Drabick, Deborah A. G.; Vivian, Dina

2013-01-01

Clinical researchers and clinical practitioners share a goal of increasing the integration of research and clinical practice, which is reflected in an evidence-based practice (EBP) approach to psychology. The EBP framework involves the integration of research findings with clinical expertise and client characteristics, values, and preferences, and consequently provides an important foundation for conducting clinically relevant research, as well as empirically based and clinically sensitive practice. Given the critical role that early training can play in the integration of science and practice and in promoting the future of the field, the present article addresses predoctoral training programs as a context for adopting an EBP approach to clinical work. We address training in the three components of EBP and provide suggestions for curriculum development and practicum training that we hope will contribute to bridging the gap between research and practice. PMID:22642520

Examining pedagogical practices in family systems nursing: intentionality, complexity, and doing well by families.

PubMed

Moules, Nancy J; Bell, Janice M; Paton, Brenda I; Morck, Angela C

2012-05-01

Teaching graduate family nursing students the important and delicate practice of entering into and mitigating families' illness suffering signifies an educational practice that is rigorous, intense, and contextual, yet not articulated as expounded knowledge. This study examined the pedagogical practices of the advanced practice of Family Systems Nursing (FSN) as taught to master's and doctoral nursing students at the Family Nursing Unit, University of Calgary, using observation of expert and novice clinical practice, live supervision, videotape review, presession hypothesizing, clinical documentation, and the writing of therapeutic letters to families. A triangulation of research methods and data collection strategies, interpretive ethnography, autoethnography, and hermeneutics, were used. Students reported an intensity of learning that had both useful and limiting consequences as they developed skills in therapeutic conversations with families experiencing illness. Faculty used an intentional pedagogical process to encourage growth in perceptual, conceptual, and executive knowledge and skills of working with families.

Non-conscious processes in changing health-related behaviour: a conceptual analysis and framework

PubMed Central

Hollands, Gareth J.; Marteau, Theresa M.; Fletcher, Paul C.

2016-01-01

ABSTRACT Much of the global burden of non-communicable disease is caused by unhealthy behaviours that individuals enact even when informed of their health-harming consequences. A key insight is that these behaviours are not predominantly driven by deliberative conscious decisions, but occur directly in response to environmental cues and without necessary representation of their consequences. Consequently, interventions that target non-conscious rather than conscious processes to change health behaviour may have significant potential, but this important premise remains largely untested. This is in part due to the lack of a practicable conceptual framework that can be applied to better describe and assess these interventions. We propose a framework for describing or categorising interventions to change health behaviour by the degree to which their effects may be considered non-conscious. Potential practical issues with applying such a framework are discussed, as are the implications for further research to inform the testing and development of interventions. A pragmatic means of conceptualising interventions targeted at non-conscious processes is a necessary prelude to testing the potency of such interventions. This can ultimately inform the development of interventions with the potential to shape healthier behaviours across populations. PMID:26745243

Non-conscious processes in changing health-related behaviour: a conceptual analysis and framework.

PubMed

Hollands, Gareth J; Marteau, Theresa M; Fletcher, Paul C

2016-12-01

Much of the global burden of non-communicable disease is caused by unhealthy behaviours that individuals enact even when informed of their health-harming consequences. A key insight is that these behaviours are not predominantly driven by deliberative conscious decisions, but occur directly in response to environmental cues and without necessary representation of their consequences. Consequently, interventions that target non-conscious rather than conscious processes to change health behaviour may have significant potential, but this important premise remains largely untested. This is in part due to the lack of a practicable conceptual framework that can be applied to better describe and assess these interventions. We propose a framework for describing or categorising interventions to change health behaviour by the degree to which their effects may be considered non-conscious. Potential practical issues with applying such a framework are discussed, as are the implications for further research to inform the testing and development of interventions. A pragmatic means of conceptualising interventions targeted at non-conscious processes is a necessary prelude to testing the potency of such interventions. This can ultimately inform the development of interventions with the potential to shape healthier behaviours across populations.

Promoting teacher quality and retention in special education.

PubMed

Billingsley, Bonnie S

2004-01-01

Qualified special educators are needed to carry out research-based practices in schools. The shortage of special educators, the high numbers of uncertified teachers, and high attrition rates threaten the practice of science in the schoolhouse and, consequently, the education that students with disabilities receive. If teachers are to use research-based practices to benefit students with disabilities, care must be directed toward teachers, what they do, and the complex conditions in which their practice occurs. In this discussion, I focus on four factors that are important to special education teacher retention--responsive induction programs, deliberate role design, positive work conditions and supports, and professional development. These retention-enhancing factors also serve to cultivate qualified special educators by providing the conditions in which they can thrive and grow professionally.

The acquisition of problem behavior in individuals with developmental disabilities as a behavioral cusp.

PubMed

Robertson, Rachel E

2015-07-01

A behavioral cusp has been defined as a behavior change that produces contact with new contingencies with important and far-reaching consequences. The concept of behavioral cusps has most frequently been used to select target skills taught to learners and to evaluate the importance of those skills; however, the concept is equally applicable to behavior changes that bring about important and far-reaching negative consequences. Although it has been acknowledged that socially undesirable behavior change can also qualify as a behavioral cusp, this area of the cusp concept has been under-examined. In this article, an undesirable behavior change, the acquisition of problem behavior in individuals with developmental disabilities, is compared with criteria for behavioral cusps previously identified in the literature. The advantages of viewing problem behavior as a behavioral cusp are outlined, and implications for practice and research from a behavioral cusp approach to problem behavior are provided. © The Author(s) 2015.

China: Unfolding the Paper Dragon

DTIC Science & Technology

2011-03-23

accompanied Chinese economic prosperity. In the following decade, China has devalued its currency , purchased debt around the world, and used coercive...partners.79 Nations protest China‟s currency devaluation practice, because it makes China‟s exports cheaper and foreign imports more expensive...as the IMF . Consequently, Nigeria ‟s late president Umaru Yar‟Adua canceled a number of the projects.90 The seeds of corruption have grown into

Marital Processes, Arranged Marriage, and Contraception to Limit Fertility

PubMed Central

Ghimire, Dirgha J.; Axinn, William G.

2013-01-01

An international transition away from familially-arranged marriages toward participation in spouse choice has endured for decades and continues to spread through rural Asia today. Though we know this transformation has important consequences for childbearing early in marriage, we know much less about longer-term consequences of this marital revolution. This study draws upon theories of family and fertility change and a rural Asian panel study designed to investigate changes in both marital and childbearing behaviors to investigate these long-term consequences. Controlling for social changes that shape both marital practices and childbearing behaviors, and explicitly considering multiple dimensions of marital processes, we find evidence consistent with an independent, long-standing association of participation in spouse choice with higher rates of contraception to terminate childbearing. These results add a new dimension to the evidence linking revolutions in marital behavior to long-term declines in fertility, but also motivate new research to consider a broader range of long-term consequences of changing marital processes. PMID:23709184

The uses and implications of standards in general practice consultations.

PubMed

Lippert, Maria Laura; Reventlow, Susanne; Kousgaard, Marius Brostrøm

2017-01-01

Quality standards play an increasingly important role in primary care through their inscription in various technologies for improving professional practice. While 'hard' biomedical standards have been the most common and debated, current quality development initiatives increasingly seek to include standards for the 'softer' aspects of care. This article explores the consequences of both kinds of quality standards for chronic care consultations. The article presents findings from an explorative qualitative field study in Danish general practice where a standardized technology for quality development has been introduced. Data from semi-structured interviews and observations among 17 general practitioners were analysed using an iterative analytical approach, which served to identify important variations in the uses and impacts of the technology. The most pronounced impact of the technology was observed among general practitioners who strictly adhered to the procedural standards on the interactional aspects of care. Thus, when allowed to function as an overall frame for consultations, those standards supported adherence to general recommendations regarding which elements to be included in chronic disease consultations. However, at the same time, adherence to those standards was observed to narrow the focus of doctor-patient dialogues and to divert general practitioners' attention from patients' personal concerns. Similar consequences of quality standards have previously been framed as manifestations of an inherent conflict between principles of patient-centredness and formal biomedical quality standards. However, this study suggests that standards on the 'softer' aspects of care may just as well interfere with a clinical approach relying on situated and attentive interactions with patients.

Land surface water cycles observed with satellite sensors

NASA Technical Reports Server (NTRS)

Nghiem, Son V.; Njoku, E. G.; Brakenridge, G. R.; Kim, Y.

2005-01-01

Acceleration of the global water cycle may lead to increased global precipitation, faster evaporation and a consequent exacerbation of hydrologic extreme. In the U.S. national assessment of the potential consequences of climate variability and change, two GCMs (CGCM1 and HadCM2) show a large increase in precipitation in the future over the southwestern U.S. particularly during winter (Felzer and Heard, 1999). Increased precipitation potentially has important impacts on agricultural and water use in the southeast U.S. (Hatch et al., 1999) and in the central Great Plains (Nielsen, 1997). A hurricane model predicts a 40% precipitation increase for severe hurricanes affecting southeastern Florida, which provokes substantially greater flooding that could negate most of the benefits of present water-management practices in this basin (Gutowski et al., 1994). Thus, it is important to observe the hydroclimate on a continuous longterm basis to address the question of increased precipitation in the enhanced water cycle.

Domestic Minor Sex Trafficking: Medical Follow-up for Victimized and High-Risk Youth.

PubMed

Kaplan, Dana M; Moore, Jessica L; Barron, Christine E; Goldberg, Amy P

2018-05-01

Domestic minor sex trafficking (DMST) has become an increasingly recognized issue associated with both immediate and long-term physical and mental health consequences. Guidelines have focused on potential risk factors, recruitment practices, and health consequences for these youth assisting in identification and intervention efforts. However, recommendations have not been established for continuous medical intervention and follow-up for this vulnerable patient population that includes both patients involved in and at high risk for DMST. Our goal is to highlight preliminary recommendations for and the importance of medical visits for these youth. A comprehensive physical examination, STI testing and treatment, and pregnancy prevention options are important to address the patients' concerns for their body and identify acute and chronic injuries. Further, collaborating with other medical and non-medical providers can provide essential resources for the multifaceted needs of DMST patients. [Full article available at http://rimed.org/rimedicaljournal-2018-05.asp].

An empirical analysis of public and private medical practice in Australia.

PubMed

Cheng, Terence C; Joyce, Catherine M; Scott, Anthony

2013-06-01

The combination of public and private medical practice is widespread in many health systems and has important consequences for health care cost and quality. However, its forms and prevalence vary widely and are poorly understood. This paper examines factors associated with public and private sector work by medical specialists using a nationally representative sample of Australian doctors. We find considerable variations in the practice patterns, remuneration contracts and professional arrangements across doctors in different work sectors. Both specialists in mixed practice and private practice differ from public sector specialists with regard to their annual earnings, sources of income, maternity and other leave taken and number of practice locations. Public sector specialists are likely to be younger, to be international medical graduates, devote a higher percentage of time to education and research, and are more likely to do after hours and on-call work compared with private sector specialists. Gender and total hours worked do not differ between doctors across the different practice types. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Ecological models supporting environmental decision making: a strategy for the future

USGS Publications Warehouse

Schmolke, Amelie; Thorbek, Pernille; DeAngelis, Donald L.; Grimm, Volker

2010-01-01

Ecological models are important for environmental decision support because they allow the consequences of alternative policies and management scenarios to be explored. However, current modeling practice is unsatisfactory. A literature review shows that the elements of good modeling practice have long been identified but are widely ignored. The reasons for this might include lack of involvement of decision makers, lack of incentives for modelers to follow good practice, and the use of inconsistent terminologies. As a strategy for the future, we propose a standard format for documenting models and their analyses: transparent and comprehensive ecological modeling (TRACE) documentation. This standard format will disclose all parts of the modeling process to scrutiny and make modeling itself more efficient and coherent.

Critical Essay: Building new management theories on sound data? The case of neuroscience

PubMed Central

Lindebaum, Dirk

2015-01-01

In this critical essay, I contend that accelerating demands for novel theories in management studies imply that new methodologies and data are sometimes accepted prematurely as supply of these novel theories. This point is illustrated with reference to how neuroscience can inform management research. I propose two demand forces that foster the increased focus on neuroscience in management studies, these being (i) the direction of public research funding, and (ii) publication bias as a boost for journal impact factor. Looking at the supply side, I note that (i) the statistical power of studies using functional magnetic resonance imaging (or fMRI, the ‘gold’ standard) is unacceptably low, (ii) the use of imprecise ‘motherhood’ statements, and (iii) the dismissal of ethical concerns in the formulation of management theories and practice informed by neuroscience. I then briefly outline the bad consequences of this for management theory and practice, emphasize why it is important to prevent these consequences, and offer some methodological suggestions for future research. PMID:27041766

The Challenges of Using Horses for Practical Teaching Purposes in Veterinary Programmes

PubMed Central

Gronqvist, Gabriella; Rogers, Chris; Gee, Erica; Bolwell, Charlotte; Gordon, Stuart

2016-01-01

Simple Summary Veterinary students often lack previous experience in handling horses and other large animals. This article discusses the challenges of using horses for veterinary teaching purposes and the potential consequences to student and equine welfare. The article proposes a conceptual model to optimise equine welfare, and subsequently student safety, during practical equine handling classes. Abstract Students enrolled in veterinary degrees often come from an urban background with little previous experience in handling horses and other large animals. Many veterinary degree programmes place importance on the teaching of appropriate equine handling skills, yet within the literature it is commonly reported that time allocated for practical classes often suffers due to time constraint pressure from other elements of the curriculum. The effect of this pressure on animal handling teaching time is reflected in the self-reported low level of animal handling competency, particularly equine, in students with limited prior experience with horses. This is a concern as a naive student is potentially at higher risk of injury to themselves when interacting with horses. Additionally, a naive student with limited understanding of equine behaviour may, through inconsistent or improper handling, increase the anxiety and compromise the welfare of these horses. There is a lack of literature investigating the welfare of horses in university teaching facilities, appropriate handling procedures, and student safety. This article focuses on the importance for students to be able to interpret equine behaviour and the potential consequences of poor handling skills to equine and student welfare. Lastly, the authors suggest a conceptual model to optimise equine welfare, and subsequently student safety, during practical equine handling classes. PMID:27845702

New social tasks for cognitive psychology; or, new cognitive tasks for social psychology.

PubMed

Wettersten, John

2014-01-01

To elucidate how differing theories of rationality lead to differing practices, their social rules must be analyzed. This is true not merely in science but also in society at large. This analysis of social thinking requires both the identification of innate cognitive social psychological processes and explanations of their relations with differing rules of rational practice. These new tasks can enable social psychologists to contribute to the study of how social situations facilitate or inhibit rational practice and enable cognitive psychologists to improve social psychological theory. In contrast to dominant current research strategies, social and cognitive psychologists can integrate social studies of rational practices and their consequences with studies of underlying cognitive psychological processes. In this article I do not attempt to carry out these tasks but rather point to both their lack of recognition and their importance.

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

PubMed

Rangachari, Pavani

2014-12-01

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

Healthcare managers in negative media focus: a qualitative study of personification processes and their personal consequences

PubMed Central

2014-01-01

Background Over the last decade healthcare management and managers have increasingly been in focus in public debate. The purpose of the present study was to gain a deeper understanding of how prolonged, unfavorable media focus can influence both the individual as a person and his or her managerial practice in the healthcare organization. Methods In-depth interviews (n = 49) with 24 managers and their superiors, or subordinate human resources/information professionals, and partners were analyzed using a grounded theory approach. Results The conceptual model explains how perceived uncertainties related to the managerial role influence personification and its negative consequences. The role ambiguities comprised challenges regarding the separation of individual identity from the professional function, the interaction with intra-organizational support and political play, and the understanding and acceptance of roles in society. A higher degree of uncertainty in role ambiguity increased both personification and the personal reaction to intense media pressure. Three types of reactions were related to the feeling of being infringed: avoidance and narrow-mindedness; being hard on self, on subordinates, and/or family members; and resignation and dejection. The results are discussed so as to elucidate the importance of support from others within the organization when under media scrutiny. Conclusions The degree of personification seems to determine the personal consequences as well as the consequences for their managerial practice. Organizational support for managers appearing in the media would probably be beneficial for both the manager and the organization. PMID:24397306

Learning from Lessons: studying the structure and construction of mathematics teacher knowledge in Australia, China and Germany

NASA Astrophysics Data System (ADS)

Chan, Man Ching Esther; Clarke, David J.; Clarke, Doug M.; Roche, Anne; Cao, Yiming; Peter-Koop, Andrea

2018-03-01

The major premise of this project is that teachers learn from the act of teaching a lesson. Rather than asking "What must a teacher already know in order to practice effectively?", this project asks "What might a teacher learn through their activities in the classroom and how might this learning be optimised?" In this project, controlled conditions are created utilising purposefully designed and trialled lesson plans to investigate the process of teacher knowledge construction, with teacher selective attention proposed as a key mediating variable. In order to investigate teacher learning through classroom practice, the project addresses the following questions: To what classroom objects, actions and events do teachers attend and with what consequence for their learning? Do teachers in different countries attend to different classroom events and consequently derive different learning benefits from teaching a lesson? This international project combines focused case studies with an online survey of mathematics teachers' selective attention and consequent learning in Australia, China and Germany. Data include the teacher's adaptation of a pre-designed lesson, the teacher's actions during the lesson, the teacher's reflective thoughts about the lesson and, most importantly, the consequences for the planning and delivery of a second lesson. The combination of fine-grained, culturally situated case studies and large-scale online survey provides mutually informing benefits from each research approach. The research design, so constituted, offers the means to a new and scalable vision of teacher learning and its promotion.

Risk practices for HIV infection and other STDs amongst female prostitutes working in legalized brothels.

PubMed

Pyett, P M; Haste, B R; Snow, J

1996-02-01

Most research investigating risk practices for HIV infection and other STDs amongst sex workers has focused on street prostitutes to the exclusion of those prostitutes who work in different sections of the industry. This is largely a consequence of methodological difficulties in accessing prostitutes other than those who work on the streets. HIV prevention research and interventions must address the fact that risk practices may vary according to the type of prostitution engaged in. This paper reports on risk practices for HIV infection and other STDs amongst prostitutes working in legalized brothels in Victoria, Australia. A self-administered questionnaire was distributed by representatives of a sex worker organization whose collaboration was an important factor in obtaining a large sample of prostitutes. The study found low levels of risk practices for prostitutes working in legal brothels in Victoria. The major risk practices indentified were injecting drug use and condom non-use with non-paying partners.

Associations between women's autonomy and child nutritional status: a review of the literature.

PubMed

Carlson, Gwen J; Kordas, Katarzyna; Murray-Kolb, Laura E

2015-10-01

Around the world, many women continue to experience low levels of autonomy. Recent literature has reported that the health consequences of low maternal autonomy extend beyond mothers and translate into health consequences for their children, and may be an important causal factor in child malnutrition. This review summarises the current knowledge of the relationship between maternal autonomy and children's nutritional status (defined as any measure that reflects the nutritional state of the body, such as birthweight or anthropometric scores) and child-feeding practices. The review also includes both discussion of the limitations found in the literature and directions for future research. A systematic review of the literature was conducted. Results of the studies included in the review strongly suggest that raising maternal autonomy is an important goal for improving children's nutritional status, yet gaps in the current knowledge exist, further confounded by issues with how autonomy is measured and limitations of cross-cultural comparability. A thorough understanding of the consequences of restricting women's autonomy will inform programmes and policy worldwide, and speed progress towards both empowering women and alleviating the global burden of child malnutrition. © 2014 John Wiley & Sons Ltd.

Promising behavior change techniques in a multicomponent intervention to reduce concerns about falls in old age: a Delphi study.

PubMed

Vestjens, Lotte; Kempen, Gertrudis I J M; Crutzen, Rik; Kok, Gerjo; Zijlstra, G A Rixt

2015-04-01

Complex behavior change interventions need evidence regarding the effectiveness of individual components to understand how these interventions work. The objective of this study was to identify the least and most promising behavior change techniques (BCTs) within the Dutch intervention 'A Matter of Balance' (AMB-NL) aimed at concerns about falls in old age as an example. After the identification of 27 BCTs within AMB-NL, an online two-round Delphi survey among 16 international experts was conducted to reach consensus on the least and most promising BCTs. The level of consensus and the level of importance of BCTs were determined. In total, 23 of the 27 (>85%) BCTs identified reached consensus. Most promising BCTs were goal setting (behavior), graded tasks and behavioral practice/rehearsal. Information about health consequences, salience of consequences and information about emotional consequences were considered least promising. These outcomes provide a first but important step in the evidence building process regarding the effectiveness of BCTs in a complex intervention. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Representations of Disability: School and Its Cultural Effects

NASA Astrophysics Data System (ADS)

Medeghini, Roberto; Fornasa, Walter; Vadalà, Giuseppe

School plays a significant role in cultural production where representations of difference and disability are very important: educational and pedagogical practices (implicit and explicit) help to form cultural and social representations of the world and, consequently, to confirm some stereotypes too. In this regard the study of social representations linked in with disability assumes some importance: in fact disability becomes a difference excluded from educational and social dynamics as well as from full participation in citizenship. This research will try to draw some dominant social representations about differences and disability, through analysis of young university students stories and memories.

Addressing the “Risk Environment” for Injection Drug Users: The Mysterious Case of the Missing Cop

PubMed Central

Burris, Scott; Blankenship, Kim M; Donoghoe, Martin; Sherman, Susan; Vernick, Jon S; Case, Patricia; Lazzarini, Zita; Koester, Stephen

2004-01-01

Ecological models of the determinants of health and the consequent importance of structural interventions have been widely accepted, but using these models in research and practice has been challenging. Examining the role of criminal law enforcement in the “risk environment” of injection drug users (IDUs) provides an opportunity to apply structural thinking to the health problems associated with drug use. This article reviews international evidence that laws and law enforcement practices influence IDU risk. It argues that more research is needed at four levels—laws; management of law enforcement agencies; knowledge, attitudes, beliefs, and practices of frontline officers; and attitudes and experiences of IDUs—and that such research can be the basis of interventions within law enforcement to enhance IDU health. PMID:15016246

Helping nurses cope with grief and compassion fatigue: an educational intervention.

PubMed

Houck, Dereen

2014-08-01

Oncology nurses may experience intense physical and emotional exhaustion, identified in the literature as symptoms of cumulative grief and compassion fatigue, with significant consequences for both nurses and organizations. The first step in preventing these consequences is recognition. Organizations should provide nurses with resources including education, counseling, and opportunities to grieve. Nurses need to learn the importance of work-life balance, self-care strategies, and communication skills. Using recommendations from the literature, an educational intervention was designed with the purpose of providing nurses with knowledge, skills, and resources to practice effective self-care and recognize when assistance is needed. The program's objective was to help nurses develop the coping skills and inner resources necessary to maintain their emotional and physical health.

Patient safety in out-of-hours primary care: a review of patient records.

PubMed

Smits, Marleen; Huibers, Linda; Kerssemeijer, Brian; de Feijter, Eimert; Wensing, Michel; Giesen, Paul

2010-12-10

Most patients receive healthcare in primary care settings, but relatively little is known about patient safety. Out-of-hours contacts are of particular importance to patient safety. Our aim was to examine the incidence, types, causes, and consequences of patient safety incidents at general practice cooperatives for out-of-hours primary care and to examine which factors were associated with the occurrence of patient safety incidents. A retrospective study of 1,145 medical records concerning patient contacts with four general practice cooperatives. Reviewers identified records with evidence of a potential patient safety incident; a physician panel determined whether a patient safety incident had indeed occurred. In addition, the panel determined the type, causes, and consequences of the incidents. Factors associated with incidents were examined in a random coefficient logistic regression analysis. In 1,145 patient records, 27 patient safety incidents were identified, an incident rate of 2.4% (95% CI: 1.5% to 3.2%). The most frequent incident type was treatment (56%). All incidents had at least partly been caused by failures in clinical reasoning. The majority of incidents did not result in patient harm (70%). Eight incidents had consequences for the patient, such as additional interventions or hospitalisation. The panel assessed that most incidents were unlikely to result in patient harm in the long term (89%). Logistic regression analysis showed that age was significantly related to incident occurrence: the likelihood of an incident increased with 1.03 for each year increase in age (95% CI: 1.01 to 1.04). Patient safety incidents occur in out-of-hours primary care, but most do not result in harm to patients. As clinical reasoning played an important part in these incidents, a better understanding of clinical reasoning and guideline adherence at GP cooperatives could contribute to patient safety.

Student debt amongst junior doctors in New Zealand; part 2: effects on intentions and workforce.

PubMed

Moore, James; Gale, Jesse; Dew, Kevin; Simmers, Don

2006-02-17

To assess the effects of student debt on the intentions of first-year house officers in relation to location of practice and vocation, and to evaluate the relative importance of incentives to remain practising in New Zealand (NZ). A questionnaire sent to all 296 New Zealand-graduate first-year house officers practicing in New Zealand. The response rate was 53%. Eighty percent of respondents intended to practice in New Zealand for the bulk of their careers; however, 65% of respondents intended to leave New Zealand within 3 years of graduating. The most important factors influencing the decision to leave NZ were overseas travel, financial opportunities, and job/training opportunities. Fifty-five percent of respondents had considered leaving the country, specifically because of the student loan debt. The most important factors influencing vocational intentions were interest, lifestyle, and intellectual challenge. Forty-three percent of respondents stated that their student debt had influenced their intended specialty, and only 9% of respondents indicated their intention to pursue a career in general practice. The highest rated incentives for staying in New Zealand were increased salaries, employer contributions towards student loans, and training opportunities within New Zealand. Student debt influences both emigration and specialty choice intentions of junior doctors in New Zealand. This effect is an unintended but important consequence of our current tertiary education system in New Zealand. These results paint a worrying picture for the junior doctor and general practitioner workforce in New Zealand's future.

Lessons Learned about Best Practices for Communicating Earthquake Forecasting and Early Warning to Non-Scientific Publics

NASA Astrophysics Data System (ADS)

Sellnow, D. D.; Sellnow, T. L.

2017-12-01

Earthquake scientists are without doubt experts in understanding earthquake probabilities, magnitudes, and intensities, as well as the potential consequences of them to community infrastructures and inhabitants. One critical challenge these scientific experts face, however, rests with communicating what they know to the people they want to help. Helping scientists translate scientific information to non-scientists is something Drs. Tim and Deanna Sellnow have been committed to for decades. As such, they have compiled a host of data-driven best practices for communicating effectively to non-scientific publics about earthquake forecasting, probabilities, and warnings. In this session, they will summarize what they have learned as it may help earthquake scientists, emergency managers, and other key spokespersons share these important messages to disparate publics in ways that result in positive outcomes, the most important of which is saving lives.

The eco-evolutionary impacts of domestication and agricultural practices on wild species.

PubMed

Turcotte, Martin M; Araki, Hitoshi; Karp, Daniel S; Poveda, Katja; Whitehead, Susan R

2017-01-19

Agriculture is a dominant evolutionary force that drives the evolution of both domesticated and wild species. However, the various mechanisms of agriculture-induced evolution and their socio-ecological consequences are not often synthetically discussed. Here, we explore how agricultural practices and evolutionary changes in domesticated species cause evolution in wild species. We do so by examining three processes by which agriculture drives evolution. First, differences in the traits of domesticated species, compared with their wild ancestors, alter the selective environment and create opportunities for wild species to specialize. Second, selection caused by agricultural practices, including both those meant to maximize productivity and those meant to control pest species, can lead to pest adaptation. Third, agriculture can cause non-selective changes in patterns of gene flow in wild species. We review evidence for these processes and then discuss their ecological and sociological impacts. We finish by identifying important knowledge gaps and future directions related to the eco-evolutionary impacts of agriculture including their extent, how to prevent the detrimental evolution of wild species, and finally, how to use evolution to minimize the ecological impacts of agriculture.This article is part of the themed issue 'Human influences on evolution, and the ecological and societal consequences'. © 2016 The Author(s).

Discipline with Dignity.

ERIC Educational Resources Information Center

Curwin, Richard L.; Mendler, Allen N.

Theoretically and practically, this book helps teachers develop a repertoire of practical consequences to use when students forget or do not know how to perform the behaviors agreed upon in their social contracts. A range of strategies are suggested for creating additional consequences and encouraging treating students in fair, dignified, and…

Female genital mutilation: a systematic review of research on its economic and social impacts across four decades.

PubMed

Mpinga, Emmanuel Kabengele; Macias, Aurélie; Hasselgard-Rowe, Jennifer; Kandala, Ngianga-Bakwin; Félicien, Tshimungu Kandolo; Verloo, Henk; Bukonda, Ngoyi K Zacharie; Chastonay, Philippe

2016-01-01

Global efforts to end female genital mutilation (FGM) have intensified in recent decades because of the rising awareness that such a practice is an act of extreme violence against women and girls. Articles on FGM have been published highlighting the combined efforts of international and non-governmental organizations, governments, as well as religious and civil society groups to end the practice. However, the consequences of this research are not well known, and it seems that the socioeconomic aspects of the practice are underreported. This review aims to characterize over a 40-year period the scientific output on the consequences of FGM in African countries, the most affected region known for the high prevalence of FGM, and review data on the socioeconomic consequences of the practice. A systematic review of literature was done, looking at the following databases: PubMed, Embase, CINAHL, BDSP, Web of Science, PsycINFO, FRANCIS, Sociological Abstracts, WHOLIS, RERO, and SAPHIR. The analysis was limited to articles concerning the African continent, published in English and French, from January 1, 1972, to December 31, 2011. One hundred ninety-eight articles were reviewed. More than half of the articles were published during the last decade of the study period. The majority of papers were published in biomedical journals (64.1%). Most studies looked at Africa as a region (33.3%). Nigeria was the single country most investigated (19.2%), followed by Egypt (10.6%). Most first authors were affiliated to non-African countries (60.6%): among them 21.2% were US-based, 4% were from African institutions, and 16.2% from Nigeria.The medical and psychological consequences (51.5%) and the prevalence and ethics of the practice (34.4%) were the most frequently investigated topics. The socioeconomic consequences were addressed in a minority of the papers (14.1%): they were classified into direct economic consequences (2.5%), school attendance (1%), marriageability (2%), sexual and marital consequences (3.5%), fertility (2.5%), domestic violence (1%), and discrimination (1.5%). The publication of articles on the consequences of FGM is increasing, but there is little research on the socioeconomic consequences of the practice. More scientific data focusing on this dimension is necessary to strengthen prevention, advocacy, and intervention campaigns.

Female genital mutilation: a systematic review of research on its economic and social impacts across four decades

PubMed Central

Mpinga, Emmanuel Kabengele; Macias, Aurélie; Hasselgard-Rowe, Jennifer; Kandala, Ngianga-Bakwin; Félicien, Tshimungu Kandolo; Verloo, Henk; Bukonda, Ngoyi K. Zacharie; Chastonay, Philippe

2016-01-01

Background Global efforts to end female genital mutilation (FGM) have intensified in recent decades because of the rising awareness that such a practice is an act of extreme violence against women and girls. Articles on FGM have been published highlighting the combined efforts of international and non-governmental organizations, governments, as well as religious and civil society groups to end the practice. However, the consequences of this research are not well known, and it seems that the socioeconomic aspects of the practice are underreported. Objective This review aims to characterize over a 40-year period the scientific output on the consequences of FGM in African countries, the most affected region known for the high prevalence of FGM, and review data on the socioeconomic consequences of the practice. Design A systematic review of literature was done, looking at the following databases: PubMed, Embase, CINAHL, BDSP, Web of Science, PsycINFO, FRANCIS, Sociological Abstracts, WHOLIS, RERO, and SAPHIR. The analysis was limited to articles concerning the African continent, published in English and French, from January 1, 1972, to December 31, 2011. Results One hundred ninety-eight articles were reviewed. More than half of the articles were published during the last decade of the study period. The majority of papers were published in biomedical journals (64.1%). Most studies looked at Africa as a region (33.3%). Nigeria was the single country most investigated (19.2%), followed by Egypt (10.6%). Most first authors were affiliated to non-African countries (60.6%): among them 21.2% were US-based, 4% were from African institutions, and 16.2% from Nigeria. The medical and psychological consequences (51.5%) and the prevalence and ethics of the practice (34.4%) were the most frequently investigated topics. The socioeconomic consequences were addressed in a minority of the papers (14.1%): they were classified into direct economic consequences (2.5%), school attendance (1%), marriageability (2%), sexual and marital consequences (3.5%), fertility (2.5%), domestic violence (1%), and discrimination (1.5%). Conclusions The publication of articles on the consequences of FGM is increasing, but there is little research on the socioeconomic consequences of the practice. More scientific data focusing on this dimension is necessary to strengthen prevention, advocacy, and intervention campaigns. PMID:27707452

"Asia's missing women" as a problem in applied evolutionary psychology?

PubMed

Brooks, Robert

2012-12-20

In many parts of Asia, the Middle East and North Africa, women and children are so undervalued, neglected, abused, and so often killed, that sex ratios are now strongly male biased. In recent decades, sex-biased abortion has exacerbated the problem. In this article I highlight several important insights from evolutionary biology into both the origin and the severe societal consequences of "Asia's missing women", paying particular attention to interactions between evolution, economics and culture. Son preferences and associated cultural practices like patrilineal inheritance, patrilocality and the Indian Hindu dowry system arise among the wealthy and powerful elites for reasons consistent with models of sex-biased parental investment. Those practices then spread via imitation as technology gets cheaper and economic development allows the middle class to grow rapidly. I will consider evidence from India, China and elsewhere that grossly male-biased sex ratios lead to increased crime, violence, local warfare, political instability, drug abuse, prostitution and trafficking of women. The problem of Asia's missing women presents a challenge for applied evolutionary psychology to help us understand and ameliorate sex ratio biases and their most severe consequences.

Seeking trust and transcendence: sexual risk-taking among Vietnamese youth.

PubMed

Gammeltoft, Tine

2002-08-01

This paper contends that sexuality research has paid far too limited attention to the phenomenology of sexual experience, thus failing to recognize the importance of embodied sensory experience for sexual perceptions and practices in general and for sexual risk-taking in particular. In order to comprehend the cultural rationales of sexual risk-taking among urban Vietnamese youth, the author presents an analysis which combines a detailed attention to the phenomenology of sexual experience with a social analysis of the wider socio-economic contexts within which sexual practices are embedded. It is demonstrated that the sexual encounters of Vietnamese youth involve much more than strivings for intimacy and pleasure: at stake are also fundamental questions of the moral integrity of the self and the socio-political shaping of intimate relations. Moreover, obstacles to safer sex stem not only from individual choices or intimate interpersonal interactions, but also from larger systems of moral meaning and social constraint. While the acknowledgement of individual capacities for action in the sexual sphere is important, it is equally important to recognize the responsibility of communities and political systems for the shaping of sexual interactions. Current limitations in the understanding of sexual experience and practice have consequences which seriously affect health interventions and education programmes targeting high-risk sexual behaviour. In order to develop more appropriate sexual health interventions, cultural transformations at the levels of both individual practice and societal organization are needed.

Transcultural Endocrinology: Adapting Type-2 Diabetes Guidelines on a Global Scale.

PubMed

Nieto-Martínez, Ramfis; González-Rivas, Juan P; Florez, Hermes; Mechanick, Jeffrey I

2016-12-01

Type-2 diabetes (T2D) needs to be prevented and treated effectively to reduce its burden and consequences. White papers, such as evidence-based clinical practice guidelines (CPG) and their more portable versions, clinical practice algorithms and clinical checklists, may improve clinical decision-making and diabetes outcomes. However, CPG are underused and poorly validated. Protocols that translate and implement these CPG are needed. This review presents the global dimension of T2D, details the importance of white papers in the transculturalization process, compares relevant international CPG, analyzes cultural variables, and summarizes translation strategies that can improve care. Specific protocols and algorithmic tools are provided. Copyright © 2016 Elsevier Inc. All rights reserved.

Child feeding practices and household food insecurity among low-income mothers in Buenos Aires, Argentina.

PubMed

Lindsay, Ana Cristina; Ferarro, Mabel; Franchello, Alejandra; Barrera, Raul de La; Machado, Marcia Maria Tavares; Pfeiffer, Martha Erin; Peterson, Karen Eileen

2012-03-01

This qualitative study of low-income mothers in Buenos Aires, Argentina, examines the influence of socio-economic conditions, organizational structures, family relationships, and food insecurity on child feeding practices and weight status. Thirty-eight mothers of preschool children living in urban Buenos Aires participated in four focus group discussions. The results indicated that many mothers were aware that obesity may be detrimental to the child's health, but most of them are unclear about the specific consequences. Maternal employment, family pressures, food insecurity and financial worries seem to influence child feeding practices. These findings have important implications for developing strategies for nutritional assistance that could benefit the health of children and provide opportunities for educational programs that are directed to nutritional awareness in Buenos Aires, Argentina. The right to eat regularly and properly is an obligation of the State and must be implemented taking into account the notion of food sovereignty and respecting the importance of preserving the culture and eating habits of a country and its diverse population groups.

Characterisation of Liquefaction Effects for Beyond-Design Basis Safety Assessment of Nuclear Power Plants

NASA Astrophysics Data System (ADS)

Bán, Zoltán; Győri, Erzsébet; János Katona, Tamás; Tóth, László

2015-04-01

Preparedness of nuclear power plants to beyond design base external effects became high importance after 11th of March 2011 Great Tohoku Earthquakes. In case of some nuclear power plants constructed at the soft soil sites, liquefaction should be considered as a beyond design basis hazard. The consequences of liquefaction have to be analysed with the aim of definition of post-event plant condition, identification of plant vulnerabilities and planning the necessary measures for accident management. In the paper, the methodology of the analysis of liquefaction effects for nuclear power plants is outlined. The case of Nuclear Power Plant at Paks, Hungary is used as an example for demonstration of practical importance of the presented results and considerations. Contrary to the design, conservatism of the methodology for the evaluation of beyond design basis liquefaction effects for an operating plant has to be limited to a reasonable level. Consequently, applicability of all existing methods has to be considered for the best estimation. The adequacy and conclusiveness of the results is mainly limited by the epistemic uncertainty of the methods used for liquefaction hazard definition and definition of engineering parameters characterizing the consequences of liquefaction. The methods have to comply with controversial requirements. They have to be consistent and widely accepted and used in the practice. They have to be based on the comprehensive database. They have to provide basis for the evaluation of dominating engineering parameters that control the post-liquefaction response of the plant structures. Experience of Kashiwazaki-Kariwa plant hit by Niigata-ken Chuetsu-oki earthquake of 16 July 2007 and analysis of site conditions and plant layout at Paks plant have shown that the differential settlement is found to be the dominating effect in case considered. They have to be based on the probabilistic seismic hazard assessment and allow the integration into logic-tree procedure. Earlier studies have shown that the potentially liquefiable layer at Paks Nuclear Power Plant is situated in relatively large depth. Therefore the applicability and adequacy of the methods at high overburden pressure is important. In case of existing facilities, the geotechnical data gained before construction aren't sufficient for the comprehensive liquefaction analysis. Performance of new geotechnical survey is limited. Consequently, the availability of the data has to be accounted while selection the analysis methods. Considerations have to be made for dealing with aleatory uncertainty related to the knowledge of the soil conditions. It is shown in the paper, a careful comparison and analysis of the results obtained by different methodologies provides the basis of the selection of practicable methods for the safety analysis of nuclear power plant for beyond design basis liquefaction hazard.

Work satisfaction, intent to stay, desires of nurses, and financial knowledge among bedside and advanced practice nurses.

PubMed

Hill, Karen S

2011-05-01

To better understand factors that may contribute to retention of experienced nurses, a study examined differences and relationships among work satisfaction, intent to stay in the nursing profession, and financial knowledge of retirement consequences related to income between clinical bedside nurses (CBNs) and advanced practice nurses (APNs) and described the importance of 7 workforce desires of nurses. Overall, nurses are not informed regarding the financial implications of transitioning from the workforce into retirement. In addition, little is known about the workforce desires and intent to stay among experienced nurses. A cross-sectional, descriptive, comparative design was used. Data were collected from a convenience sample (n = 176) of CBNs employed by a 371-bed, acute care, Magnet-designated hospital, who worked in telemetry and medical-surgical care, and APNs employed by the hospital or employed by a credentialed physicians within the facility in a variety of care settings and roles. Findings from the Work Satisfaction and Intent to Stay scales suggest that relationships in the workplace are important. Data related to the 7 workforce desire questions show that nurses in this organization support the characteristics of caring in the work environment as identified by Watson. The financial knowledge of the consequences of retirement related to income was low among both groups but slightly higher for the APNs. Implications of this study for nurse leaders include the importance of strengthening relationships among nursing colleagues and between the nurse and the supervisor particularly in the constructs of caring. Data support a need for increased education about finances and retirement for RNs in the workplace.

Pacemaker syndrome with sub-acute left ventricular systolic dysfunction in a patient with a dual-chamber pacemaker: consequence of lead switch at the header.

PubMed

Khurwolah, Mohammad Reeaze; Vezi, Brian Zwelethini

In the daily practice of pacemaker insertion, the occurrence of atrial and ventricular lead switch at the pacemaker box header is a rare and unintentional phenomenon, with less than five cases reported in the literature. The lead switch may have dire consequences, depending on the indication for the pacemaker. One of these consequences is pacemaker syndrome, in which the normal sequence of atrial and ventricular activation is impaired, leading to sub-optimal ventricular filling and cardiac output. It is important for the attending physician to recognise any worsening of symptoms in a patient who has recently had a permanent pacemaker inserted. In the case of a dual-chamber pacemaker, switching of the atrial and ventricular leads at the pacemaker box header should be strongly suspected. We present an unusual case of pacemaker syndrome and right ventricular-only pacinginduced left ventricular systolic dysfunction in a patient with a dual-chamber pacemaker.

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.

Klamath Basin: A Watershed Approach to Support Habitat Restoration, Species Recovery, and Water Resource Planning

USGS Publications Warehouse

VanderKooi, S.P.; Thorsteinson, L.

2007-01-01

Water allocation among human and natural resource uses in the American West is challenging. Western rivers have been largely managed for hydropower, irrigation, drinking water, and navigation. Today land and water use practices have gained importance, particularly as aging dams are faced with re-licensing requirements and provisions of the Endangered Species and Clean Water Acts. Rising demand for scarce water heightens the need for scientific research to predict consequences of management actions on habitats, human resource use, and fish and wildlife. Climate change, introduction of invasive species, or restoration of fish passage can have large, landscape-scaled consequences - research must expand to encompass the appropriate scale and by applying multiple scientific disciplines to complex ecosystem challenges improve the adaptive management framework for decision-making.

The economic and environmental consequences of implementing nitrogen-efficient technologies and management practices in agriculture.

PubMed

Zhang, Xin; Mauzerall, Denise L; Davidson, Eric A; Kanter, David R; Cai, Ruohong

2015-03-01

Technologies and management practices (TMPs) that reduce the application of nitrogen (N) fertilizer while maintaining crop yields can improve N use efficiency (NUE) and are important tools for meeting the dual challenges of increasing food production and reducing N pollution. However, because farmers operate to maximize their profits, incentives to implement TMPs are limited, and TMP implementation will not always reduce N pollution. Therefore, we have developed the NUE Economic and Environmental impact analytical framework (NUE) to examine the economic and environmental consequences of implementing TMPs in agriculture, with a specific focus on farmer profits, N fertilizer consumption, N losses, and cropland demand. Our analytical analyses show that impact of TMPs on farmers' economic decision-making and the environment is affected by how TMPs change the yield ceiling and the N fertilization rate at the ceiling and by how the prices of TMPs, fertilizer, and crops vary. Technologies and management practices that increase the yield ceiling appear to create a greater economic incentive for farmers than TMPs that do not but may result in higher N application rates and excess N losses. Nevertheless, the negative environmental impacts of certain TMPs could be avoided if their price stays within a range determined by TMP yield response, fertilizer price, and crop price. We use a case study on corn production in the midwestern United States to demonstrate how NUE can be applied to farmers' economic decision-making and policy analysis. Our NUE framework provides an important tool for policymakers to understand how combinations of fertilizer, crop, and TMP prices affect the possibility of achieving win-win outcomes for farmers and the environment. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Addressing the Philosophical Confusion Regarding Constructivism in Chemical Education

NASA Astrophysics Data System (ADS)

Bernal, Pedro J.

2006-02-01

In the Chemical Education Today section of the May 2003 issue of this Journal , Eric Scerri wrote about the consequences of what he regards as a philosophical confusion in the work of constructivist chemical education researchers. This issue has important implications for both the teaching and practice of science. I offer a view of the confusion that places the emphasis on the careless use of philosophical terms that Scerri noted and on the tendency of psychological constructivists to go from psychological premises to unwarranted epistemological conclusions.

Occupational health, cognitive disorders and occupational neuropsychology

PubMed Central

Caixeta, Leonardo; da Silva Júnior, George Martins Ney; Caixeta, Victor de Melo; Reimer, Cláudio Henrique Ribeiro; Azevedo, Paulo Verlaine Borges e

2012-01-01

Work can be an important etiologic factor in the genesis of some mental disorders including cognitive disability. Occupational neuropsychology constitutes an intriguing new but neglected area of research and clinical practice which deals with the neurocognitive consequences of the work environment and work habits. Neuropsychological knowledge is fundamental to understand cognitive requirements of work competence. Work can impact sleep patterns and mental energy, which in turn can cause neuropsychological symptoms. This report presents relevant evidence to illustrate the relationship between work and cognitive dysfunction. PMID:29213798

[Sponsorship, conflict of interest and corruption: promoting science in discussion of medical ethics].

PubMed

Frewer, A

2002-01-01

Even in health care systems corruption is an increasing problem. Since the German Anti-Corruption-Law (1997) the areas of financial support, sponsoring and corruption in medicine are analyzed much more intensively. This article sketches the crucial points of the debate on medical funding and shows the consequences of the new jurisdiction. Most important is the balance between a transparent documentation and a too-far-reaching bureaucracy, which hinders medical research. Finally, this article presents core principles as helpful rules in practice.

Practical aspects of bacterial skin infections in children.

PubMed

Tunnessen, W W

1985-07-01

Bacterial skin infections are a common reason for children to be examined by a pediatrician. Streptococci and staphylococci are responsible for the great majority of the infections. Because of the variety of lesions produced by these bacteria, there is support for dividing impetigo into "traditional" crusted and bullous forms. Two important forms of cellulitis--facial and periorbital--have potential for serious systemic consequences. The bacterial etiology and treatment of cellulitis, animal bites, and puncture wounds of the foot require special attention for successful outcome.

Technology Assessment of Field Portable Instrumentation for Use at Rocky Mountain Arsenal

DTIC Science & Technology

1988-07-01

masking the original valence state of the element. In cases where the valence state is important to the relative toxicity of the species, ( chromium VI vs... chromium III, or metallic mercury vs. organo alkyl mercury), this is an unfortunate consequence. However, there are some practical reasons as to why...interest or co-precipitate them with an added metal ion with a suitable reagent. If chromium and arsenic were adjusted to a valance of +3, then it should

Redundancy relations and robust failure detection

NASA Technical Reports Server (NTRS)

Chow, E. Y.; Lou, X. C.; Verghese, G. C.; Willsky, A. S.

1984-01-01

All failure detection methods are based on the use of redundancy, that is on (possible dynamic) relations among the measured variables. Consequently the robustness of the failure detection process depends to a great degree on the reliability of the redundancy relations given the inevitable presence of model uncertainties. The problem of determining redundancy relations which are optimally robust in a sense which includes the major issues of importance in practical failure detection is addressed. A significant amount of intuition concerning the geometry of robust failure detection is provided.

[The correlation between motivation, emotions land learning].

PubMed

Holm, Ellen; Jørsboe, Hanne Blæhr; Holm, Kirsten; Sørensen, Jette Led

2017-07-03

This article explores the importance of emotions as conditional for motivation in medical education. The main principles in self-determination theory and in control-value theory are outlined, and practical consequences which may be drawn from these theories are discussed. Based on the literature we hypothesize that human need for autonomy and competence may be violated by strict regulations and detailed plans for medical education, and that constructive feedback may modify these potential negative effects and support feelings of competence and autonomy.

Practice assistants in primary care in Germany - associations with organizational attributes on job satisfaction.

PubMed

Gavartina, Amina; Zaroti, Stavria; Szecsenyi, Joachim; Miksch, Antje; Ose, Dominik; Campbell, Stephen M; Goetz, Katja

2013-08-05

Job satisfaction and organizational attributes in primary care teams are important issues as they affect clinical outcomes and the quality of health care provided. As practice assistants are an integral part of these teams it is important to gain insight into their views on job satisfaction and organizational attributes. The aim of this study was to evaluate the job satisfaction of practice assistants and the organizational attributes within their general practices in Germany and to explore the existence of possible associations. This observational study was based on a job satisfaction survey and measurement of organizational attributes in general practices in the German federal state of Baden-Wuerttemberg. Job satisfaction was measured with the 10-item 'Warr-Cook-Wall job satisfaction scale'. Organizational attributes were evaluated with the 21-items 'survey of organizational attributes for primary care' (SOAPC). Linear regression analyses were performed in which each of SOAPC scales and the overall score of SOAPC was treated as outcome variables. 586 practice assistants out of 794 respondents (73.8%) from 234 general practices completed the questionnaire. Practice assistants were mostly satisfied with their colleagues and least of all satisfied with their income and recognition for their work. The regression analysis showed that 'freedom of working method' and 'recognition of work', the employment status of practice assistants and the mode of practice were almost always significantly associated with each subscale and overall score of SOAPC. Job satisfaction is highly associated with different aspects of organizational attributes for primary care ('communication', 'decision-making' and 'stress'). Consequently, improved job satisfaction could lead to a better-organized primary care team. This implication should be investigated directly in further intervention studies with a special focus on improving the recognition for work and income.

Control-value theory: using achievement emotions to improve understanding of motivation, learning, and performance in medical education: AMEE Guide No. 64.

PubMed

Artino, Anthony R; Holmboe, Eric S; Durning, Steven J

2012-01-01

In this AMEE Guide, we consider the emergent theoretical and empirical work on human emotion and how this work can inform the theory, research, and practice of medical education. In the Guide, we define emotion, in general, and achievement emotions, more specifically. We describe one of the leading contemporary theories of achievement emotions, control-value theory (Pekrun 2006), and we distinguish between different types of achievement emotions, their proximal antecedents, and their consequences for motivation, learning, and performance. Next, we review the empirical support for control-value theory from non-medical fields and suggest several important implications for educational practice. In this section, we highlight the importance of designing learning environments that foster a high degree of control and value for students. Finally, we end with a discussion of the need for more research on achievement emotions in medical education, and we propose several key research questions we believe will facilitate our understanding of achievement emotions and their impact on important educational outcomes.

Causes, consequences and countermeasures to driver fatigue in the rail industry: The train driver perspective.

PubMed

Filtness, A J; Naweed, A

2017-04-01

Fatigue is an important workplace risk management issue. Within the rail industry, the passing of a stop signal (signal passed at danger; SPAD) is considered to be one of the most major safety breaches which can occur. Train drivers are very aware of the negative consequences associated with a SPAD. Therefore, SPADs provide a practical and applied safety relevant context within which to structure a discussion on fatigue. Focus groups discussing contributing factors to SPADs were undertaken at eight passenger rail organisations across Australia and New Zealand (n = 28 drivers). Data relating to fatigue was extracted and inductively analysed identifying three themes: causes, consequences, and countermeasures (to fatigue). Drivers experienced negative consequences of fatigue, despite existing countermeasures to mitigate it. Organisational culture was a barrier to effective fatigue management. A fatigue assessment tool consistently informed rostering, however, shift swapping was commonplace and often unregulated, reducing any potential positive impact. In discussing fatigue countermeasure strategies, drivers talked interchangeably about mitigating task related fatigue (e.g. increasing cognitive load) and sleepiness (e.g. caffeine). Ensuring the concepts of fatigue and sleepiness are properly understood has the potential to maximise safety. Copyright © 2016 Elsevier Ltd. All rights reserved.

Contrasting approaches to the response-contingent learning of young children with significant delays and their social-emotional consequences.

PubMed

Dunst, Carl J; Raab, Melinda; Hamby, Deborah W

2017-04-01

The purpose of the analyses described in this paper was to evaluate the direct and indirect effects of two different approaches to child response-contingent learning on rates of child learning and both concomitant and collateral child social-emotional behaviour. The participants were 71 children with significant developmental delays or multiple disabilities randomly assigned to either of the two contrasting approaches to interventions. Findings showed that an intervention which employed practices that built on existing child behaviour (asset-based practices) was more effective than an intervention focusing on teaching children missing skills (needs-based practices) for influencing changes in the rates of child learning as well as rates of child social-emotional behaviour mediated by differences in rates of child learning. Both the theoretical and practical importance of the results are described in terms of the extended social-emotional benefits of asset-based response-contingent learning games. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Neuroethics and fMRI: Mapping a Fledgling Relationship

PubMed Central

Garnett, Alex; Whiteley, Louise; Piwowar, Heather; Rasmussen, Edie; Illes, Judy

2011-01-01

Human functional magnetic resonance imaging (fMRI) informs the understanding of the neural basis of mental function and is a key domain of ethical enquiry. It raises questions about the practice and implications of research, and reflexively informs ethics through the empirical investigation of moral judgments. It is at the centre of debate surrounding the importance of neuroscience findings for concepts such as personhood and free will, and the extent of their practical consequences. Here, we map the landscape of fMRI and neuroethics, using citation analysis to uncover salient topics. We find that this landscape is sparsely populated: despite previous calls for debate, there are few articles that discuss both fMRI and ethical, legal, or social implications (ELSI), and even fewer direct citations between the two literatures. Recognizing that practical barriers exist to integrating ELSI discussion into the research literature, we argue nonetheless that the ethical challenges of fMRI, and controversy over its conceptual and practical implications, make this essential. PMID:21526115

Problematizing the Practicum to Integrate Practical Knowledge

NASA Astrophysics Data System (ADS)

Melville, Wayne; Campbell, Todd; Fazio, Xavier; Stefanile, Antonio; Tkaczyk, Nicholas

2014-10-01

This article examines the influence of a practicum teaching experience on two pre-service science teachers. The research is focused on examining a practicum in a secondary science department that actively promotes the teaching and learning of science as inquiry. We investigated the process through which the pre-service science teachers integrated their practical knowledge, and examined this in the context of the quantified reformed instruction they enacted. Using a mixed methods design, we have quantified these pre-service science teachers' practice using the Reformed Teaching Observation Protocol (Piburn et al. 2000), in concert with a narrative methodology drawn from in-depth interviews. Our analysis of the data indicates two important conclusions. The first is the importance of a consistently reformed image of science education being presented and practiced by both science teacher educators and cooperating teachers. The second is the recognition that a consistently reformed image may not be sufficient, of itself, to challenge pre-service teachers' views of science education. Pre-service teachers appear to be heavily influenced by their biographies and own science education. Consequently, it appears the extent to which a pre-service teacher identifies problems of teaching and learning, and then works toward possible resolution, influences their progress in shaping reformed views of science education.

Urinary urgency - translating the evidence base into daily clinical practice.

PubMed

Cardozo, L; Chapple, C R; Dmochowski, R; Fitzgerald, M P; Hanno, P; Michel, M C; Staskin, D; Van Kerrebroeck, P; Wyndaele, J-J; Yamaguchi, O; Yoshida, M

2009-12-01

To consider the currently available knowledge and understanding of the symptom of urgency. Each faculty member reviewed the literature base of a different aspect of urgency and along with their personal clinical experience provided a base of evidence for discussion. This overview summarises relevant published literature and the current clinical experience of the authors. Whilst the mechanisms producing the sensation of urgency are still not fully understood and we are working within a definition that may complicate measurement and treatment, our pressing need is to effectively manage our patients for whom the practical nature of urgency can be all too apparent. Health care professionals have an important role to play today in helping to alleviate the widespread problem of urgency and its consequences.

The Case for Intervention Bias in the Practice of Medicine

PubMed Central

Foy, Andrew J.; Filippone, Edward J.

2013-01-01

Bias is an inclination to present or hold a partial perspective at the expense of possibly equal or more valid alternatives. In this paper, we present a series of conditional arguments to prove that intervention bias exists in the practice of medicine. We then explore its potential causes, consequences, and criticisms. We use the term to describe the bias on the part of physicians and the medical community to intervene, whether it is with drugs, diagnostic tests, non-invasive procedures, or surgeries, when not intervening would be a reasonable alternative. The recognition of intervention bias in medicine is critically important given today’s emphasis on providing high-value care and reducing unnecessary and potentially harmful interventions. PMID:23766747

Cigarettes, social reinforcement, and culture: a commentary on "Tobacco as a social currency: cigarette gifting and sharing in China".

PubMed

Ding, Ding; Hovell, Melbourne F

2012-03-01

As Rich and Xiao suggested, cigarette sharing and gifting play an important role in China's smoking epidemic. Understanding the cultural roots, history, and impacts of such practices should be emphasized in tobacco control efforts. "Tobacco as a social currency" is a consequence of the tobacco industry usurping traditional values and cultural customs to make cigarette gifting acceptable, desirable, and socially reinforcing. The cigarettes-social reinforcement link created by the tobacco industry can be broken by deglamorizing smoking and cigarette gifting and by reinforcing alternative healthful behaviors. A behavioral ecological perspective, with an emphasis of understanding and engineering cultures, should guide future health promotion efforts to reduce smoking and other risk practices in China.

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

Time for a change to assess and evaluate body temperature in clinical practice.

PubMed

Sund-Levander, Märtha; Grodzinsky, Ewa

2009-08-01

The definition of normal body temperature as 37 degrees C still is considered the norm worldwide, but in practice there is a widespread confusion of the evaluation of body temperature, especially in elderly individuals. In this paper, we discuss the relevance of normal body temperature as 37 degrees C and consequences in clinical practice. Our conclusion is that body temperature should be evaluated in relation to the individual variability and that the best approach is to use the same site, and an unadjusted mode without adjustments to other sites. If the baseline value is not known, it is important to notice that frail elderly individuals are at risk of a low body temperature. In addition, what should be regarded as fever is closely related to what is considered as normal body temperature. That is, as normal body temperature shows individual variations, it is reasonable that the same should hold true for the febrile range.

An assessment of finite-element modeling techniques for thick-solid/thin-shell joints analysis

NASA Technical Reports Server (NTRS)

Min, J. B.; Androlake, S. G.

1993-01-01

The subject of finite-element modeling has long been of critical importance to the practicing designer/analyst who is often faced with obtaining an accurate and cost-effective structural analysis of a particular design. Typically, these two goals are in conflict. The purpose is to discuss the topic of finite-element modeling for solid/shell connections (joints) which are significant for the practicing modeler. Several approaches are currently in use, but frequently various assumptions restrict their use. Such techniques currently used in practical applications were tested, especially to see which technique is the most ideally suited for the computer aided design (CAD) environment. Some basic thoughts regarding each technique are also discussed. As a consequence, some suggestions based on the results are given to lead reliable results in geometrically complex joints where the deformation and stress behavior are complicated.

Next generation sequencing--implications for clinical practice.

PubMed

Raffan, Eleanor; Semple, Robert K

2011-01-01

Genetic testing in inherited disease has traditionally relied upon recognition of the presenting clinical syndrome and targeted analysis of genes known to be linked to that syndrome. Consequently, many patients with genetic syndromes remain without a specific diagnosis. New 'next-generation' sequencing (NGS) techniques permit simultaneous sequencing of enormous amounts of DNA. A slew of research publications have recently demonstrated the tremendous power of these technologies in increasing understanding of human genetic disease. These approaches are likely to be increasingly employed in routine diagnostic practice, but the scale of the genetic information yielded about individuals means that caution must be exercised to avoid net harm in this setting. Use of NGS in a research setting will increasingly have a major but indirect beneficial impact on clinical practice. However, important technical, ethical and social challenges need to be addressed through informed professional and public dialogue before it finds its mature niche as a direct tool in the clinical diagnostic armoury.

Child neurology practice guidelines: past, present, and future.

PubMed

Hurwitz, Benjamin A; Hurwitz, Kathleen Bretzius; Ashwal, Stephen

2015-03-01

Practice guidelines have been developed in child neurology during the last fifteen years to address important clinical questions and provide evidence-based recommendations for patient care. This review describes the guideline development process and how it has evolved to meet the needs of child neurologists. Several current child neurology guidelines are reviewed and the advantages and disadvantages of guidelines, as well as the legal consequences of using them to determine a standard of care are discussed. The future of guidelines and of their influence on integrated support systems also is considered. Child neurology practice guidelines are a helpful resource for clinicians, families and institutions as they provide evidence-based recommendations concerning the diagnosis and management of common neurological conditions affecting children. Incorporating consensus processes has allowed expansion of clinically relevant recommendations that has increased the utility of guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

Can achievement emotions be used to better understand motivation, learning, and performance in medical education?

PubMed

Artino, Anthony R; Holmboe, Eric S; Durning, Steven J

2012-01-01

In this article, we consider an emergent theory of human emotion. The overarching purpose of the article is to introduce medical education researchers to the notion of achievement emotions and provide a brief overview of how this work can inform the theory, research, and practice of medical education. First, we define achievement emotions and describe one of the leading contemporary theories of achievement emotions, control-value theory (Pekrun R. 2006. The control-value theory of achievement emotions: Assumptions, corollaries, and implications for educational research and practice. Educ Psychol Rev 18:315-341.). Next, we distinguish between different types of achievement emotions, their proximal causes, and their consequences for motivation, learning, and performance, and we discuss several implications for educational practice. Finally, we end with a call for more research on achievement emotions in medical education to facilitate our understanding of emotions and their impact on important educational outcomes.

Physician Dual Practice: A Descriptive Mapping Review of Literature.

PubMed

Moghri, Javad; Arab, Mohammad; Rashidian, Arash; Akbari Sari, Ali

2016-03-01

Physician dual practice is a common phenomenon in almost all countries throughout the world, which could potential impacts on access, equity and quality of services. This paper aims to review studies in physician dual practice and categorize them in order to their main objectives and purposes. Comprehensive literature searches were undertaken in order to obtain main papers and documents in the field of physician dual practice. Systematic searches in Medline and Embase from 1960 to 2013, and general searches in some popular search engines were carried out in this way. After that, descriptive mapping review methods were utilized to categorize eligible studies in this area. The searches obtained 404 titles, of which 81 full texts were assessed. Finally, 24 studies were eligible for inclusion in our review. These studies were categorized into four groups - "motivation and forces behind dual practice", "consequences of dual practice", "dual practice Policies and their impacts", and "other studies" - based on their main objectives. Our findings showed a dearth of scientifically reliable literature in some areas of dual practice, like the prevalence of the phenomenon, the real consequences of it, and the impacts of the implemented policy measures. Rigorous empirical and evaluative studies should be designed to detect the real consequences of DP and assess the effects of interventions and regulations, which governments have implemented in this field.

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

PubMed

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

2018-07-01

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

Phage Therapy: Various Perspectives on How to Improve the Art.

PubMed

Abedon, Stephen T

2018-01-01

Use of phages as antibacterial agents has a long and, even, storied history. During that time much has been learned but, to a degree, also forgotten. As a consequence, today we experience a largely preclinical development of a field which already has been subject to substantial clinical practice. This development, as well, is now occurring within a much more rigorously regulated environment than previously had been the case. The consequence is not only a need to reinvent standards of practice but to do so within a more explicitly pharmacological context. Of particular concern is that the application of phages to bacterial infections does not always result in control of the latter, necessitating ongoing thought on how to refine treatment protocols. Here I consider a number of issues relevant to such refinement, focusing on areas which, in my opinion, phage therapy researchers-perhaps especially those new to the field-might struggle with. In order of presentation, I consider how best to describe phage therapy within publications toward achieving a more coherent literature, the importance of Poisson distributions along with killing titers toward understanding phage dosing, the associated importance of establishing sufficient phage numbers in situ to achieve adequate bacteria killing, various problems with the use of multiplicity of infection (MOI) as a description of phage dosing, how to anticipate the basic kinetics of phage-bacteria absorptive interactions, how to distinguish passive from active treatments, and basic approaches toward addressing disappointing efficacy outcomes.

Evaluating health service quality: using importance performance analysis.

PubMed

Izadi, Azar; Jahani, Younes; Rafiei, Sima; Masoud, Ali; Vali, Leila

2017-08-14

Purpose Measuring healthcare service quality provides an objective guide for managers and policy makers to improve their services and patient satisfaction. Consequently, the purpose of this paper is to measure service quality provided to surgical and medical inpatients at Kerman Medical Sciences University (KUMS) in 2015. Design/methodology/approach A descriptive-analytic study, using a cross-sectional method in the KUMS training hospitals, was implemented between October 2 and March 15, 2015. Using stratified random sampling, 268 patients were selected. Data were collected using an importance-performance analysis (IPA) questionnaire, which measures current performance and determines each item's importance from the patients' perspectives. These data indicate overall satisfaction and appropriate practical strategies for managers to plan accordingly. Findings Findings revealed a significant gap between service importance and performance. From the patients' viewpoint, tangibility was the highest priority (mean=3.54), while reliability was given the highest performance (mean=3.02). The least important and lowest performance level was social accountability (mean=1.91 and 1.98, respectively). Practical implications Healthcare managers should focus on patient viewpoints and apply patient comments to solve problems, improve service quality and patient satisfaction. Originality/value The authors applied an IPA questionnaire to measure service quality provided to surgical and medical ward patients. This method identifies and corrects service quality shortcomings and improving service recipient perceptions.

Emotional consequences of collective action participation: differentiating self-directed and outgroup-directed emotions.

PubMed

Becker, Julia C; Tausch, Nicole; Wagner, Ulrich

2011-12-01

The present research examines the emotional and behavioral consequences of collective action participation. It demonstrates that "positive" and "negative" emotions can be experienced simultaneously as a result of collective action participation, yet it is important to distinguish outgroup-directed from self-directed emotions. Results of two experiments (N = 71 and N = 101) that manipulated participation in collective action illustrate that whereas collective action participants experience more outgroup-directed anger and contempt, they feel more self-directed positive affect. Furthermore, collective action participation predicted willingness to engage in moderate and radical collective actions in the future. These relations were mediated by outgroup-directed, but not by self-directed, emotions, suggesting that outgroup-directed rather than self-directed emotions play a crucial role in the maintenance of protest behavior. Theoretical and practical implications of these findings are discussed.

Climate Change Perceptions of NY State Farmers: The Role of Risk Perceptions and Adaptive Capacity.

PubMed

Takahashi, Bruno; Burnham, Morey; Terracina-Hartman, Carol; Sopchak, Amanda R; Selfa, Theresa

2016-12-01

Climate change is expected to severely impact agricultural practices in many important food-producing regions, including the Northeast United States. Changing climate conditions, such as increases in the amount of rainfall, will require farmers to adapt. Yet, little is known with regard to farmers' perceptions and understandings about climate change, especially in the industrialized country context. This paper aims at overcoming this research limitation, as well as determining the existing contextual, cognitive, and psychological barriers that can prevent adoption of sustainable practices of farmers in New York State. The study is framed within the adaptive capacity and risk perception literature, and is based on a qualitative analysis of in-depth interviews with farmers in 21 farms in two counties in Central New York. The results reveal diverging views about the long-term consequences of climate change. Results also reveal that past experience remains as the most important source of information that influences beliefs and perceptions about climate change, confirming previous research.

Mechanisms of Antibiotic Resistance

PubMed Central

Munita, Jose M.; Arias, Cesar A.

2015-01-01

Emergence of resistance among the most important bacterial pathogens is recognized as a major public health threat affecting humans worldwide. Multidrug-resistant organisms have emerged not only in the hospital environment but are now often identified in community settings, suggesting that reservoirs of antibiotic-resistant bacteria are present outside the hospital. The bacterial response to the antibiotic “attack” is the prime example of bacterial adaptation and the pinnacle of evolution. “Survival of the fittest” is a consequence of an immense genetic plasticity of bacterial pathogens that trigger specific responses that result in mutational adaptations, acquisition of genetic material or alteration of gene expression producing resistance to virtually all antibiotics currently available in clinical practice. Therefore, understanding the biochemical and genetic basis of resistance is of paramount importance to design strategies to curtail the emergence and spread of resistance and devise innovative therapeutic approaches against multidrug-resistant organisms. In this chapter, we will describe in detail the major mechanisms of antibiotic resistance encountered in clinical practice providing specific examples in relevant bacterial pathogens. PMID:27227291

A practical guide to surveys and questionnaires.

PubMed

Slattery, Eric L; Voelker, Courtney C J; Nussenbaum, Brian; Rich, Jason T; Paniello, Randal C; Neely, J Gail

2011-06-01

Surveys with questionnaires play a vital role in decision and policy making in society. Within medicine, including otolaryngology, surveys with questionnaires may be the only method for gathering data on rare or unusual events. In addition, questionnaires can be developed and validated to be used as outcome measures in clinical trials and other clinical research architecture. Consequently, it is fundamentally important that such tools be properly developed and validated. Just asking questions that have not gone through rigorous design and development may be misleading and unfair at best; at worst, they can result in under- or overtreatment and unnecessary expense. Furthermore, it is important that consumers of the data produced by these instruments understand the principles of questionnaire design to interpret results in an optimal and meaningful way. This article presents a practical guide for understanding the methodologies of survey and questionnaire design, including the concepts of validity and reliability, how surveys are administered and implemented, and, finally, biases and pitfalls of surveys.

Climate Change Perceptions of NY State Farmers: The Role of Risk Perceptions and Adaptive Capacity

NASA Astrophysics Data System (ADS)

Takahashi, Bruno; Burnham, Morey; Terracina-Hartman, Carol; Sopchak, Amanda R.; Selfa, Theresa

2016-12-01

Climate change is expected to severely impact agricultural practices in many important food-producing regions, including the Northeast United States. Changing climate conditions, such as increases in the amount of rainfall, will require farmers to adapt. Yet, little is known with regard to farmers' perceptions and understandings about climate change, especially in the industrialized country context. This paper aims at overcoming this research limitation, as well as determining the existing contextual, cognitive, and psychological barriers that can prevent adoption of sustainable practices of farmers in New York State. The study is framed within the adaptive capacity and risk perception literature, and is based on a qualitative analysis of in-depth interviews with farmers in 21 farms in two counties in Central New York. The results reveal diverging views about the long-term consequences of climate change. Results also reveal that past experience remains as the most important source of information that influences beliefs and perceptions about climate change, confirming previous research.

Conserving genetic diversity in the honeybee: comments on Harpur et al. (2012).

PubMed

De la Rúa, Pilar; Jaffé, Rodolfo; Muñoz, Irene; Serrano, José; Moritz, Robin F A; Kraus, F Bernhard

2013-06-01

The article by Harpur et al. (2012) 'Management increases genetic diversity of honey bees via admixture' concludes that '…honey bees do not suffer from reduced genetic diversity caused by management and, consequently, that reduced genetic diversity is probably not contributing to declines of managed Apis mellifera populations'. In the light of current honeybee and beekeeping declines and their consequences for honeybee conservation and the pollination services they provide, we would like to express our concern about the conclusions drawn from the results of Harpur et al. (2012). While many honeybee management practices do not imply admixture, we are convinced that the large-scale genetic homogenization of admixed populations could drive the loss of valuable local adaptations. We also point out that the authors did not account for the extensive gene flow that occurs between managed and wild/feral honeybee populations and raise concerns about the data set used. Finally, we caution against underestimating the importance of genetic diversity for honeybee colonies and highlight the importance of promoting the use of endemic honeybee subspecies in apiculture. © 2013 John Wiley & Sons Ltd.

Equine metabolic syndrome

PubMed Central

Morgan, R.; Keen, J.; McGowan, C.

2015-01-01

Laminitis is one of the most common and frustrating clinical presentations in equine practice. While the principles of treatment for laminitis have not changed for several decades, there have been some important paradigm shifts in our understanding of laminitis. Most importantly, it is essential to consider laminitis as a clinical sign of disease and not as a disease in its own right. Once this shift in thinking has occurred, it is logical to then question what disease caused the laminitis. More than 90 per cent of horses presented with laminitis as their primary clinical sign will have developed it as a consequence of endocrine disease; most commonly equine metabolic syndrome (EMS). Given the fact that many horses will have painful protracted and/or chronic recurrent disease, a good understanding of the predisposing factors and how to diagnose and manage them is crucial. Current evidence suggests that early diagnosis and effective management of EMS should be a key aim for practising veterinary surgeons to prevent the devastating consequences of laminitis. This review will focus on EMS, its diagnosis and management. PMID:26273009

Positioning of Weight Bias: Moving towards Social Justice

PubMed Central

Alberga, Angela S.; Kassan, Anusha; Sesma-Vazquez, Monica

2016-01-01

Weight bias is a form of stigma with detrimental effects on the health and wellness of individuals with large bodies. Researchers from various disciplines have recognized weight bias as an important topic for public health and for professional practice. To date, researchers from various areas have approached weight bias from independent perspectives and from differing theoretical orientations. In this paper, we examined the similarities and differences between three perspectives (i.e., weight-centric, non-weight-centric (health-centric), and health at every size) used to understand weight bias and approach weight bias research with regard to (a) language about people with large bodies, (b) theoretical position, (c) identified consequences of weight bias, and (d) identified influences on weight-based social inequity. We suggest that, despite differences, each perspective acknowledges the negative influences that position weight as being within individual control and the negative consequences of weight bias. We call for recognition and discussion of weight bias as a social justice issue in order to change the discourse and professional practices extended towards individuals with large bodies. We advocate for an emphasis on social justice as a uniting framework for interdisciplinary research on weight bias. PMID:27747099

Avoiding burnout in an orthopaedic trauma practice.

PubMed

Marsh, J Lawrence

2012-09-01

Burnout is characterized by emotional exhaustion, depersonalization, and decreased sense of personal accomplishment, and burnout has been very tightly linked with career dissatisfaction and other associated negative personal and professional consequences. Recently published studies indicate that among surgeons and surgical specialists, burnout is common, and that at least in some groups of surgeons, it has significant negative consequences for their practice and career. It is concerning that studies have found younger surgeons were at greater risk for burnout. There is no data on rates of, or risk for, burnout specifically for orthopaedic trauma surgeons. However, there are several reasons to expect the risk may be significant, including demanding call schedules and difficult to control work schedules. There are some common-sense guidelines to minimize the chances of burnout in the early stages of an orthopaedic trauma career. One of the most important is to set up a work schedule that allows personal pursuits, including time with significant other and family away from work. Achieving and maintaining a balance between work and home will optimize the chances of achieving the tremendous satisfaction possible in an orthopaedic trauma career and minimize the chances of burnout.

Blood transfusion reactions; evaluation of 462 transfusions at a tertiary hospital in Nigeria.

PubMed

Arewa, O P; Akinola, N O; Salawu, L

2009-06-01

The immuno-haematological safety of blood remains an important and recurring issue in blood transfusion practice. Data concerning morbidity and mortality from blood transfusion is sparse in Nigeria however and while the current efforts at reduction in the incidence of adverse consequence of blood transfusion is encapsulated in the concept of Haemovigilance, the Nigerian blood transfusion service is yet to institute the practice. A prospective study of 462 transfusions at the Obafemi Awolowo University Teaching Hospital was done to evaluate the incidence and pattern of transfusion reactions in the hospital. The overall incidence of transfusion reactions is 8.7% (40 cases), with febrile nonhaemolytic transfusion reactions (FNHTR) constituting 65% of these. The incidence of adverse reaction is significantly related to a positive history of previous transfusion (p = 0.0039). Efforts must be sustained at evolving a system to minimize the incidence and consequences. The development of a haemovigilance system in which data regarding all transfusions carried out in Nigerian hospitals is collated and analyzed is necessary. The advent of the National Blood Transfusion Service (N.B.T.S) in Nigeria with Zonal centres in the six geopolitical zones of the country offers an opportunity for setting up a national haemovigilance programme.

Rocking the boat - nursing students' stories of moral courage: A qualitative descriptive study.

PubMed

Bickhoff, Laurie; Levett-Jones, Tracy; Sinclair, Peter M

2016-07-01

This paper profiles a qualitative study that examined how undergraduate nursing students demonstrate moral courage when confronted with clinical situations that negatively impact the quality of patient care and/or patient experience and the factors that encouraged or inhibited their willingness to speak up when they identified poor practice. Clinical placements are an essential component of nursing programmes. However, placements are a reported source of stress for students, with many witnessing, or feeling compelled to participate in, poor practice. In these instances, nursing students require the moral courage to raise concerns in order to protect patient safety and dignity. This was a qualitative descriptive study. Nine nursing students and one nursing graduate from one semi-metropolitan university in Australia were interviewed and the data were thematically analysed. Four key themes emerged: (1) patient advocate identity, which had two sub-themes of knowing one's own moral code and previous life experiences; (2) consequences to the patient and to the participant; (3) the impact of key individuals; and (4) picking your battles. This study demonstrates the importance of undergraduate nursing students identifying as patient advocates, the multitude of consequences students face when questioning the practice of a registered nurse, and the influence supervising nurses and clinical facilitators have on a student's decisions to intervene to protect patient safety. Further research is required to examine the factors, both intrinsic and extrinsic, that influence nursing students' moral courage and their decisions to intervene when poor practice is witnessed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Integrating Bioethics into Clinical and Translational Science Research: A Roadmap

PubMed Central

Shapiro, Robyn S.; Layde, Peter M.

2008-01-01

Abstract Recent initiatives to improve human health emphasize the need to effectively and appropriately translate new knowledge gleaned from basic biomedical and behavioral research to clinical and community application. To maximize the beneficial impact of scientific advances in clinical practice and community health, and to guard against potential deleterious medical and societal consequences of such advances, incorporation of bioethics at each stage of clinical and translational science research is essential. At the earliest stage, bioethics input is critical to address issues such as whether to limit certain areas of scientific inquiry. Subsequently, bioethics input is important to assure not only that human subjects trials are conducted and reported responsibly, but also that results are incorporated into clinical and community practices in a way that promotes and protects bioethical principles. At the final stage of clinical and translational science research, bioethics helps to identify the need and approach for refining clinical practices when safety or other concerns arise. The framework we present depicts how bioethics interfaces with each stage of clinical and translational science research, and suggests an important research agenda for systematically and comprehensively assuring bioethics input into clinical and translational science initiatives. PMID:20443821

Consequences of calcium decline on the embryogenesis and life history of Daphnia magna.

PubMed

Giardini, Jamie-Lee; Yan, Norman D; Heyland, Andreas

2015-07-01

Ambient calcium is declining in thousands of soft-water lake habitats in temperate regions as a consequence of unsustainable forestry practices, decreased atmospheric calcium deposition and acidic deposition. As their exoskeleton is heavily reinforced with calcium, freshwater crustaceans have a high specific calcium requirement relative to other aquatic organisms. Daphnia, in particular, is an ideal crustacean for investigating the consequences of calcium decline because it is an abundant and important member of freshwater zooplankton communities. Although it has been established that adult and juvenile Daphnia have different tolerances to low ambient calcium as a result of their different life stage-specific calcium requirements, the consequences of declining calcium on embryonic development have never been investigated. Here, we describe the distribution of calcium in embryonic stages of D. magna and introduce a novel and easy to use staging scheme. We tested whether calcium can be traced from mothers to their offspring. Finally, we assessed the fitness consequences of maternal provisioning in limiting calcium environments. We found that while embryos require calcium for their development and moulting, they do not equilibrate with environmental calcium levels. Instead, we were able to trace calcium from mothers to their offspring. Furthermore, our data strongly suggest that females are faced with an allocation trade-off between providing calcium to their offspring and using it for growth and moulting. Together, these data provide novel insights into the consequences of calcium decline for freshwater zooplankton. © 2015. Published by The Company of Biologists Ltd.

Promoting survival: A grounded theory study of consequences of modern health practices in Ouramanat region of Iranian Kurdistan

PubMed Central

Mohammadpur, Ahmad; Rezaei, Mehdi; Sadeghi, Rasoul

2010-01-01

The aim of this qualitative study is to explore the way people using modern health care perceive its consequences in Ouraman-e-Takht region of Iranian Kurdistan. Ouraman-e-Takht is a rural, highly mountainous and dry region located in the southwest Kurdistan province of Iran. Recently, modern health practices have been introduced to the region. The purpose of this study was to investigate, from the Ouramains' point of view, the impact that modern health services and practices have had on the Ouraman traditional way of life. Interview data from respondents were analyzed by using grounded theory. Promoting survival was the core category that explained the impact that modern health practices have had on the Ouraman region. The people of Ouraman interpreted modern health practices as increasing their quality of life and promoting their survival. Results are organized around this core category in a paradigm model consisting of conditions, interactions, and consequences. This model can be used to understand the impact of change from the introduction of modern health on a traditional society. PMID:20640020

Promoting survival: A grounded theory study of consequences of modern health practices in Ouramanat region of Iranian Kurdistan.

PubMed

Mohammadpur, Ahmad; Rezaei, Mehdi; Sadeghi, Rasoul

2010-05-14

The aim of this qualitative study is to explore the way people using modern health care perceive its consequences in Ouraman-e-Takht region of Iranian Kurdistan. Ouraman-e-Takht is a rural, highly mountainous and dry region located in the southwest Kurdistan province of Iran. Recently, modern health practices have been introduced to the region. The purpose of this study was to investigate, from the Ouramains' point of view, the impact that modern health services and practices have had on the Ouraman traditional way of life. Interview data from respondents were analyzed by using grounded theory. Promoting survival was the core category that explained the impact that modern health practices have had on the Ouraman region. The people of Ouraman interpreted modern health practices as increasing their quality of life and promoting their survival. Results are organized around this core category in a paradigm model consisting of conditions, interactions, and consequences. This model can be used to understand the impact of change from the introduction of modern health on a traditional society.

Face-to-Face versus Distance Learning: Psychological Consequences and Practical Implications.

ERIC Educational Resources Information Center

Kahl, Thomas N.; Cropley, Arthur J.

1986-01-01

Summarizes differences between face-to-face and distance learners at Fernuniversitat (West Germany) in terms of demographics, motivation, study conditions, and personal consequences, in order to provide some empirically derived insights into the psychological consequences of distance learning for learners. (MBR)

Whither British general practice after the 2004 GMS contract? Stories and realities of change in four UK general practices.

PubMed

Huby, Guro; Guthrie, Bruce; Grant, Suzanne; Watkins, Francis; Checkland, Kath; McDonald, Ruth; Davies, Huw

2008-01-01

The purpose of this article is to provide answers to two questions: what has been the impact of nGMS on practice organisation and teamwork; and how do general practice staff perceive the impact? The article is based on comparative in-depth case studies of four UK practices. There was a discrepancy between changes observed and the way practice staff described the impact of the contract. Similar patterns of organisational change were apparent in all practices. Decision-making became concentrated in fewer hands. Formally or informally constituted "elite" multidisciplinary groups monitored and controlled colleagues' behaviour for maximum performance and remuneration. This convergence of organisational form was not reflected in the dominant "story" each practice constructed about its unique ethos and style. The "stories" also failed to detect negative consequences to the practice flowing from its adaptation to the contract. The paper highlights how collective "sensemaking" in practices may fail to detect and address key organisational consequences from the nGMS.

Electro-encephalogram based brain-computer interface: improved performance by mental practice and concentration skills.

PubMed

Mahmoudi, Babak; Erfanian, Abbas

2006-11-01

Mental imagination is the essential part of the most EEG-based communication systems. Thus, the quality of mental rehearsal, the degree of imagined effort, and mind controllability should have a major effect on the performance of electro-encephalogram (EEG) based brain-computer interface (BCI). It is now well established that mental practice using motor imagery improves motor skills. The effects of mental practice on motor skill learning are the result of practice on central motor programming. According to this view, it seems logical that mental practice should modify the neuronal activity in the primary sensorimotor areas and consequently change the performance of EEG-based BCI. For developing a practical BCI system, recognizing the resting state with eyes opened and the imagined voluntary movement is important. For this purpose, the mind should be able to focus on a single goal for a period of time, without deviation to another context. In this work, we are going to examine the role of mental practice and concentration skills on the EEG control during imaginative hand movements. The results show that the mental practice and concentration can generally improve the classification accuracy of the EEG patterns. It is found that mental training has a significant effect on the classification accuracy over the primary motor cortex and frontal area.

The practical skills of newly qualified nurses.

PubMed

Danbjørg, Dorthe Boe; Birkelund, Regner

2011-02-01

This paper reports the findings from a study of newly qualified nurses and which subjects the nurses regarded as the most important in order to be able to live up to the requirements of clinical practice, and how they experience their potential for developing practical and moral skills, after the decrease in practical training. A qualitative approach guided the research process and the analysis of the data. The data was collected by participant observation and qualitative interviews with four nurses as informants. The conclusions made in this study are based on the statements and the observations of the newly qualified nurses. Our findings are discussed in relation to the Aristotelian concept and other relevant literature. The main message is that the newly qualified nurses did not feel equipped when they finished their training. This could be interpreted as a direct consequence of the decrease in practical training. Our study also underlines that the way nursing theory is perceived and taught is problematic. The interviews revealed that the nurses think that nursing theories should be applied directly in practice. This misunderstanding is probably also applicable to the teachers of the theories. Copyright © 2010 Elsevier Ltd. All rights reserved.

Northwest Climate Risk Assessment

NASA Astrophysics Data System (ADS)

Mote, P.; Dalton, M. M.; Snover, A. K.

2012-12-01

As part of the US National Climate Assessment, the Northwest region undertook a process of climate risk assessment. This process included an expert evaluation of previously identified impacts, their likelihoods, and consequences, and engaged experts from both academia and natural resource management practice (federal, tribal, state, local, private, and non-profit) in a workshop setting. An important input was a list of 11 risks compiled by state agencies in Oregon and similar adaptation efforts in Washington. By considering jointly the likelihoods, consequences, and adaptive capacity, participants arrived at an approximately ranked list of risks which was further assessed and prioritized through a series of risk scoring exercises to arrive at the top three climate risks facing the Northwest: 1) changes in amount and timing of streamflow related to snowmelt, causing far-reaching ecological and socioeconomic consequences; 2) coastal erosion and inundation, and changing ocean acidity, combined with low adaptive capacity in the coastal zone to create large risks; and 3) the combined effects of wildfire, insect outbreaks, and diseases will cause large areas of forest mortality and long-term transformation of forest landscapes.

Exploring bullying: Implications for nurse educators.

PubMed

Edwards, Sharon L; O'Connell, Claire Frances

2007-01-01

This article examines briefly the issue of workplace violence and bullying in the hospital environment, but more importantly how the same and different styles of bullying and intra-staff bullying are emerging in nurse education. The content describes the aetiology of violence and bullying and their place in the National Health Service (NHS) including nursing. It explores bullying as the principle form of intimidation in nurse education, the different types and subtle forms of bullying, why individuals become bullies, dealing with and the consequences of bullying. The legislation, guidelines, policies are part of the recommendations for practice.

[Bipolar disorders and self-stigma].

PubMed

Richard-Lepouriel, H

2015-09-16

Despite wide media coverage in recent years, the stigmatization of people with bipolar disorder still exists. Bipolar people also have their own tendency to self-stigmatize that is to integrate their beliefs, prejudices and stigmatizing behaviors. The consequences are important: shame, guilt, withdrawal and renunciation to lead one's own life according to personal values increasing therefore the risk of mood relapses. Self-stigma is rarely assessed in clinical practice and few strategies have been designed to face them efficiently. Recognizing self-stigmatizing beliefs and challenging them are the first steps of this vast endeavour.

Psychological Trauma in the Context of Familial Relationships: A Concept Analysis.

PubMed

Isobel, Sophie; Goodyear, Melinda; Foster, Kim

2017-01-01

Many forms of psychological trauma are known to develop interpersonally within important relationships, particularly familial. Within the varying theoretical constructs of psychological traumas, and distinct from the processes of diagnosis, there is a need to refine the scope and definitions of psychological traumas that occur within important familial relationships to ensure a cohesive evidence base and fidelity of the concept in application to practice. This review used a philosophical inquiry methodology of concept analysis to identify the definitions, antecedents, characteristics, and consequences of the varying conceptualizations of psychological trauma occurring within important relationships. Interactions between concepts of interpersonal trauma, relational trauma, betrayal trauma, attachment trauma, developmental trauma, complex trauma, cumulative trauma, and intergenerational trauma are presented. Understanding of the discrete forms and pathways of transmission of psychological trauma between individuals, including transgenerationally within families, creates opportunities for prevention and early intervention within trauma-focused practice. This review found that concepts of psychological trauma occurring within familial relationships are not exclusive of each other but overlap in their encompassment of events and circumstances as well as the effect on individuals of events in the short term and long term. These traumas develop and are transmitted in the space between people, both purposefully and incidentally, and have particularly profound effects when they involve a dependent infant or child. Linguistic and conceptual clarity is paramount for trauma research and practice.

Honeybees Increase Fruit Set in Native Plant Species Important for Wildlife Conservation

NASA Astrophysics Data System (ADS)

Cayuela, Luis; Ruiz-Arriaga, Sarah; Ozers, Christian P.

2011-11-01

Honeybee colonies are declining in some parts of the world. This may have important consequences for the pollination of crops and native plant species. In Spain, as in other parts of Europe, land abandonment has led to a decrease in the number of non professional beekeepers, which aggravates the problem of honeybee decline as a result of bee diseases In this study, we investigated the effects of honeybees on the pollination of three native plant species in northern Spain, namely wildcherry Prunus avium L., hawthorn Crataegus monogyna Jacq., and bilberry Vaccinium myrtillus L. We quantified fruit set of individuals from the target species along transects established from an apiary outwards. Half the samples were bagged in a nylon mesh to avoid insect pollination. Mixed-effects models were used to test the effect of distance to the apiary on fruit set in non-bagged samples. The results showed a negative significant effect of distance from the apiary on fruit set for hawthorn and bilberry, but no significant effects were detected for wildcherry. This suggests that the use of honeybees under traditional farming practices might be a good instrument to increase fruit production of some native plants. This may have important consequences for wildlife conservation, since fruits, and bilberries in particular, constitute an important feeding resource for endangered species, such as the brown bear Ursus arctos L. or the capercaillie Tetrao urogallus cantabricus L.

Honeybees increase fruit set in native plant species important for wildlife conservation.

PubMed

Cayuela, Luis; Ruiz-Arriaga, Sarah; Ozers, Christian P

2011-11-01

Honeybee colonies are declining in some parts of the world. This may have important consequences for the pollination of crops and native plant species. In Spain, as in other parts of Europe, land abandonment has led to a decrease in the number of non professional beekeepers, which aggravates the problem of honeybee decline as a result of bee diseases In this study, we investigated the effects of honeybees on the pollination of three native plant species in northern Spain, namely wildcherry Prunus avium L., hawthorn Crataegus monogyna Jacq., and bilberry Vaccinium myrtillus L. We quantified fruit set of individuals from the target species along transects established from an apiary outwards. Half the samples were bagged in a nylon mesh to avoid insect pollination. Mixed-effects models were used to test the effect of distance to the apiary on fruit set in non-bagged samples. The results showed a negative significant effect of distance from the apiary on fruit set for hawthorn and bilberry, but no significant effects were detected for wild cherry. This suggests that the use of honeybees under traditional farming practices might be a good instrument to increase fruit production of some native plants. This may have important consequences for wildlife conservation, since fruits, and bilberries in particular, constitute an important feeding resource for endangered species, such as the brown bear Ursus arctos L. or the capercaillie Tetrao urogallus cantabricus L.

Developing an interdisciplinary community-based sports concussion management program.

PubMed

LoGalbo, Anthony; Salinas, Christine M; Dougherty, Michael; Field, Mel

2014-01-01

The increasing incidence and associated consequences of sport-related concussion have been at the forefront of public health concerns in recent years, prompting the need for safe and effective management guidelines and availability of appropriately trained healthcare providers. In this report we provide practical and user-friendly information regarding several important factors to consider when developing a sports concussion program, including how to select relevant team members, assess community needs and available resources, provide concussion education, secure and nurture partnerships with athletic programs, implement management strategies that align with current practice standards, and cater to athletes' unique needs in terms of program accessibility. It is hoped that the knowledge shared and proposed recommendations will be beneficial for guiding both newly developing and established concussion programs alike. © 2014 S. Karger AG, Basel.

Business continuity 2014: From traditional to integrated Business Continuity Management.

PubMed

Ee, Henry

As global change continues to generate new challenges and potential threats to businesses, traditional business continuity management (BCM) slowly reveals its limitations and weak points to ensuring 'business resiliency' today. Consequently, BCM professionals also face the challenge of re-evaluating traditional concepts and introducing new strategies and industry best practices. This paper points to why traditional BCM is no longer sufficient in terms of enabling businesses to survive in today's high-risk environment. It also looks into some of the misconceptions about BCM and other stumbling blocks to establishing effective BCM today. Most importantly, however, this paper provides tips based on the Business Continuity Institute's (BCI) Good Practices Guideline (GPG) and the latest international BCM standard ISO 22301 on how to overcome the issues and challenges presented.

Corporate Externalities: A Challenge to the Further Success of Prevention Science

PubMed Central

2011-01-01

The full benefit of prevention science will not be realized until we learn how to influence organizational practices. The marketing of tobacco, alcohol, and food and corporate advocacy for economic policies that maintain family poverty are examples of practices we must influence. This paper analyzes the evolution of such practices in terms of their selection by economic consequences. A strategy for addressing these critical risk factors should include: (a) systematic research on the impact of corporate practices on each of the most common and costly psychological and behavior problems; (b) empirical analyses of the consequences that select harmful corporate practices; (c) assessment of the impact of policies that could affect problematic corporate practices; and (d) research on advocacy organizations to understand the factors that influence their growth and to help them develop effective strategies for influencing corporate externalities. PMID:21225461

Repeat prescribing of medications: A system‐centred risk management model for primary care organisations

PubMed Central

Price, Julie; Man, Shu Ling; Bartlett, Stephen; Taylor, Kate; Dinwoodie, Mark

2017-01-01

Abstract Rationale, aims and objectives Reducing preventable harm from repeat medication prescriptions is a patient safety priority worldwide. In the United Kingdom, repeat prescriptions items issued has doubled in the last 20 years from 5.8 to 13.3 items per patient per annum. This has significant resource implications and consequences for avoidable patient harms. Consequently, we aimed to test a risk management model to identify, measure, and reduce repeat prescribing system risks in primary care. Methods All 48 general medical practices in National Health Service (NHS) Lambeth Clinical Commissioning Group (an inner city area of south London in England) were recruited. Multiple interventions were implemented, including educational workshops, a web‐based risk monitoring system, and external reviews of repeat prescribing system risks by clinicians. Data were collected via documentation reviews and interviews and subject to basic thematic and descriptive statistical analyses. Results Across the 48 participating general practices, 62 unique repeat prescribing risks were identified on 505 occasions (eg, practices frequently experiencing difficulty interpreting medication changes on hospital discharge summaries), equating to a mean of 8.1 risks per practice (range: 1‐33; SD = 7.13). Seven hundred sixty‐seven system improvement actions were recommended across 96 categories (eg, alerting hospitals to illegible writing and delays with discharge summaries) with a mean of 15.6 actions per practice (range: 0‐34; SD = 8.0). Conclusions The risk management model tested uncovered important safety concerns and facilitated the development and communication of related improvement recommendations. System‐wide information on hazardous repeat prescribing and how this could be mitigated is very limited. The approach reported may have potential to close this gap and improve the reliability of general practice systems and patient safety, which should be of high interest to primary care organisations internationally. PMID:28370904

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

ERIC Educational Resources Information Center

Johnston-Goodstar, Katie; Velure Roholt, Ross

2013-01-01

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

Using classification tree modelling to investigate drug prescription practices at health facilities in rural Tanzania.

PubMed

Kajungu, Dan K; Selemani, Majige; Masanja, Irene; Baraka, Amuri; Njozi, Mustafa; Khatib, Rashid; Dodoo, Alexander N; Binka, Fred; Macq, Jean; D'Alessandro, Umberto; Speybroeck, Niko

2012-09-05

Drug prescription practices depend on several factors related to the patient, health worker and health facilities. A better understanding of the factors influencing prescription patterns is essential to develop strategies to mitigate the negative consequences associated with poor practices in both the public and private sectors. A cross-sectional study was conducted in rural Tanzania among patients attending health facilities, and health workers. Patients, health workers and health facilities-related factors with the potential to influence drug prescription patterns were used to build a model of key predictors. Standard data mining methodology of classification tree analysis was used to define the importance of the different factors on prescription patterns. This analysis included 1,470 patients and 71 health workers practicing in 30 health facilities. Patients were mostly treated in dispensaries. Twenty two variables were used to construct two classification tree models: one for polypharmacy (prescription of ≥3 drugs) on a single clinic visit and one for co-prescription of artemether-lumefantrine (AL) with antibiotics. The most important predictor of polypharmacy was the diagnosis of several illnesses. Polypharmacy was also associated with little or no supervision of the health workers, administration of AL and private facilities. Co-prescription of AL with antibiotics was more frequent in children under five years of age and the other important predictors were transmission season, mode of diagnosis and the location of the health facility. Standard data mining methodology is an easy-to-implement analytical approach that can be useful for decision-making. Polypharmacy is mainly due to the diagnosis of multiple illnesses.

Burnout Syndrome and Demotivation Among Health Care Personnel. Managing Stressful Situations: The Importance of Teamwork.

PubMed

García-Campayo, J; Puebla-Guedea, M; Herrera-Mercadal, P; Daudén, E

2016-06-01

Almost one-third of our lives is spent in the workplace, where much of our interaction with others takes place and where we are exposed to stressful situations. Work-related stress has consequences for the individual's physical and mental health. Stress and professional burnout syndrome are the main consequences of work situations characterized by a constant state of tension. Stress is the second leading cause of absenteeism in the European Union, and around 12% of European workers are currently affected by burnout syndrome. It is therefore vital to identify demotivated and stressed staff in both large organizations (hospitals and clinics) and smaller centers (private practices) so as to facilitate preventive measures and ensure early intervention in situations of stress, with a view to improving the performance of work teams. Copyright © 2015 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

Do we need a threshold conception of competence?

PubMed

den Hartogh, Govert

2016-03-01

On the standard view we assess a person's competence by considering her relevant abilities without reference to the actual decision she is about to make. If she is deemed to satisfy certain threshold conditions of competence, it is still an open question whether her decision could ever be overruled on account of its harmful consequences for her ('hard paternalism'). In practice, however, one normally uses a variable, risk dependent conception of competence, which really means that in considering whether or not to respect a person's decision-making authority we weigh her decision on several relevant dimensions at the same time: its harmful consequences, its importance in terms of the person's own relevant values, the infringement of her autonomy involved in overruling it, and her decision-making abilities. I argue that we should openly recognize the multi-dimensional nature of this judgment. This implies rejecting both the threshold conception of competence and the categorical distinction between hard and soft paternalism.

Insufficient sleep in adolescents and young adults: an update on causes and consequences.

PubMed

Owens, Judith

2014-09-01

Chronic sleep loss and associated sleepiness and daytime impairments in adolescence are a serious threat to the academic success, health, and safety of our nation's youth and an important public health issue. Understanding the extent and potential short- and long-term repercussions of sleep restriction, as well as the unhealthy sleep practices and environmental factors that contribute to sleep loss in adolescents, is key in setting public policies to mitigate these effects and in counseling patients and families in the clinical setting. This report reviews the current literature on sleep patterns in adolescents, factors contributing to chronic sleep loss (ie, electronic media use, caffeine consumption), and health-related consequences, such as depression, increased obesity risk, and higher rates of drowsy driving accidents. The report also discusses the potential role of later school start times as a means of reducing adolescent sleepiness. Copyright © 2014 by the American Academy of Pediatrics.

Differential Consequences of Tramadol in Overdosing: Dilemma of a Polymorphic Cytochrome P450 2D6-Mediated Substrate.

PubMed

Srinivas, Nuggehally R

2015-09-01

Tramadol is a centrally acting opioid analgesic that is prone to polymorphic metabolism via cytochrome P450 (CYP) 2D6. The generation of the active metabolite, O-desmethyltramadol, which occurs through the CYP 2D6 pathway, significantly contributes to the drug's activity. However, dosage adjustments of tramadol are typically not practiced in the clinic when treating patients who are homozygous extensive metabolizers, heterozygous extensive metabolizers, or poor metabolizers. In the event of a tramadol overdose, the consequences may be influenced importantly by the genotype or phenotype status of the subject. Depending on the individual subject's CYP 2D6 status, one may see excessive miotic-related toxicity driven by the excessive availability of O-desmethyltramadol or one may manifest mydriatic-related toxicity driven by the excessive availability of tramadol. This report provides pharmacokinetic perspectives in situations of tramadol overdosing.

Diagnosing dementia in Dutch general practice: a qualitative study of GPs’ practices and views

PubMed Central

Prins, Agnes; Hemke, Feia; Pols, Jeannette; van Charante, Eric P Moll

2016-01-01

Background GPs play an important role in recognising the symptoms of dementia; however, little is known about how they perceive their actual and future role in diagnosing dementia. Aim To explore Dutch GPs’ perceptions of their current position in diagnosing dementia, their reasons for referral to secondary care, and views on the future diagnostic role of GPs. Design and setting A qualitative study among Dutch GPs. Method Eighteen GPs participated in a semi-structured interview that ranged from 20 to 60 minutes. Interviews were transcribed verbatim and thematic analysis was performed. Results GPs reported that their role in the diagnostic phase of identifying people with suspected dementia is limited to recognising cognitive problems and deciding whether a patient needs to be referred for further investigation, or whether care could be organised without specialist diagnosis. GPs indicated that they were likely to refer patients if patients/caregivers or dementia case managers requested it, or if they thought it could have consequences for treatment. Typically, GPs do not see the need for referral when their patients are very old and declining slowly. GPs would welcome a more prominent role in diagnosing dementia in their own practice. Conclusion Diagnosing dementia involves a complex balance between patient and carer preferences, the consequences for treatment and care, and the burden of referral. Dutch GPs favour a stronger involvement in diagnosing dementia provided that both resources and diagnostic algorithms are improved. PMID:27114209

An exploration of jealousy in nursing: a Kleinian analysis.

PubMed

Evans, Alicia M; Traynor, Michael; Glass, Nel

2014-06-01

It is well established that nursing practice produces considerable anxiety, and it can also give rise to envy and jealousy. While envy in nursing was identified in the literature more than 50 years ago, there remains a paucity of articles addressing either envy or jealousy for nurses. In a recent research study on current experiences of clinical practice, we analysed a fragment of nurses' speech via Klein's theory of jealousy. The results revealed that the nurses expressed jealousy at the privilege afforded to doctors. We argue that it is important to acknowledge jealousy in nursing practice because it has the potential for 'spoiling' effective care delivery and as such, can have detrimental ramifications in the health system. Also, jealousy may keep the nurse from fully focusing on their nursing practice in that it divides the nurse's attention and so limits the nurse's treatment of the patient. Nurses' jealousy of doctors is a taboo topic in nursing, and yet it warrants serious consideration due to the potential deleterious consequences that can arise when this dynamic is present. © 2013 John Wiley & Sons Ltd.

Female Genital Mutilation Is a Violation of Reproductive Rights of Women: Implications for Health Workers.

PubMed

Jungari, Suresh Banayya

2016-02-01

Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for nonmedical reasons. This coercive practice is still prevalent in many parts of the world, in both developed and developing countries. However, FGM is more prevalent in African countries and some Asian countries. In this study, an attempt has been made to understand the prevalence and practice of FGM worldwide and its adverse effects on women's reproductive health. To fulfill the study objectives, the author collected evidence from various studies conducted by international agencies. Many studies found that FGM has no health benefits; is mostly carried out on girls before they reach the age of 15 years; can cause severe bleeding, infections, psychological illness, and infertility; and, most important, can have serious consequences during childbirth. The practice is mainly governed by the traditions and cultures of the communities without having any scientific or medical benefit. In conclusion, FGM is a practice that violates the human and reproductive rights of women.

Parenting style and practices in stepfamilies

PubMed Central

Cassoni, Cynthia; Caldana, Regina HL

2012-01-01

There are several studies on the best way to raise a child, ie, what would be the consequences of our actions for our children. We tend to think of how to educate children in a traditional family, but society has undergone many changes and, hence, family structures have undergone changes too. Today, we find a large number of stepfamilies facing the same issues concerning how to educate a child. Stepfamily configuration often entails more than just the addition of a new parent figure. The objective of this study was to shed some light on how these stepfamilies deal with issues of parenting style and practices. We reviewed the Brazilian and international literature concerning parenting styles and practices in stepfamilies. The papers identified were organized and submitted to analysis. We identified very few papers addressing parenting styles and practices, pointing to an important but unaddressed social change as reflected in new family structures. There is a need for longitudinal studies aimed at understanding not only a particular moment in time, but also moments within a context, ie, an analysis with a holistic approach without preconceived ideas. PMID:22977315

Effects of plough pan development on surface hydrology and on soil physical properties in Southeastern Brazilian plateau

NASA Astrophysics Data System (ADS)

Bertolino, Ana V. F. A.; Fernandes, Nelson F.; Miranda, João P. L.; Souza, Andréa P.; Lopes, Marcel R. S.; Palmieri, Francesco

2010-10-01

SummaryConventional tillage may impose changes in soil physical properties that lead to a decrease in soil physical quality. Although plough pan formation is considered to be an important consequence of conventional tillage practices in Southeastern Brazil, few studies have focused on its hydrological consequences. Detailed investigations in two experimental plots located in the hilly landscape of Serra do Mar close to Rio de Janeiro city were carried out to characterize the changes in soil physical properties and in soil hydrology due to plough pan formation. Conventional (CT) and minimum tillage (MT) practices were implemented in two plots for 3 years and soil matric potential (SMP) was monitored in each plot via nests of tensiometers and Watermark® sensors installed at different depths. Undisturbed soil blocks were collected for micromorphological analyses to quantify the total pore space in soils under CT and MT systems, and in soils under natural tropical forest. Results suggest that soils under the CT system developed a plough pan layer at about 20 cm depth that had 44% less total porosity as compared to surface conditions. It is shown that soils under the CT system tended to stay saturated for longer periods of time after each rainfall event. Besides, during intense rainy periods soils under the CT system may develop hydrologic conditions that favor lateral flows while soils under the MT system were still draining. Such hydrological responses may explain why average soil erosion rates measured for individual rainfall events under the CT system were about 2.5 times greater than the ones observed at MT. The results attested that conventional tillage in this area generated modifications in soil fabric, especially in pore-size distribution and connectivity, which induced important changes in soil hydrology and soil erosion. The agricultural practices used in this area, associated with the local steep hillslopes and intense rainfall events, are definitely not adequate and require the introduction of soil and water conservation practices in order to become sustainable.

Engaging and supporting fathers to promote breast feeding: a concept analysis.

PubMed

Sherriff, Nigel; Hall, Valerie; Panton, Christina

2014-06-01

Empirical evidence demonstrates that fathers have a strong influence on a mother's decision to initiate and continue breast feeding. However, no clear delineation of what behaviours and attributes constitute father support or differentiate it from other kinds of support is provided in the current literature. The purpose of this study was to analyse the concept of 'father support' in relation to maternity services and broader health settings, thereby clarifying meaning to enable comprehension and application in practice, education, and research. A concept analysis combining the evolutionary model of concept development with the inter-related theoretical, fieldwork and analytical phases of the hybrid model of concept development. Children's Centres in East and West Sussex in Southern England. Repeated qualitative research over two phases with 16 parents of breast fed infants through seven focus groups and five telephone interviews. CINAHL, PsycINFO, AMED, MEDLINE, OVID and EMBASE databases were searched for articles published in English between 1999 and 2013 using the keywords breast feeding, father, and support. Seven same-sex focus groups and five individual interviews were also conducted over two research phases with the parents of breast fed infants to expand and exemplify, and then validate the analysis of the literature search. Five main attributes of father support in relation to breast feeding were identified: (1) knowledge about breast feeding; (2) positive attitude to breast feeding; (3) involvement in the decision-making process; (4) practical support; and (5) emotional support. Multiple antecedents and consequences to these attributes were also identified. This study has contributed to clarifying the meaning of father support in relation to breast feeding and provides an important starting point for the development of a theoretical and practical model of optimal breast feeding that takes into account father support. Identification of attributes, antecedents, and consequences of father support may assist practitioners to reflect on current working practices and service delivery models, and offer important educational opportunities for the training of student midwives and other health professionals. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

SEA screening of voluntary climate change plans: A story of non-compliant discretion

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

Kørnøv, Lone, E-mail: lonek@plan.aau.dk; Wejs, Anja

Screening within Strategic Environmental Assessment (SEA) is the first critical stage involving considerations on whether an assessment is carried out or not. Although legislation and guidance offer practitioners a legal and logical approach to the screening process, it is inevitable that discretionary judgement takes place and will impact on the screening decision. This article examines the results of discretion involved in screening of climate change plans (CCPs) in a Danish context. These years voluntary CCPs are developed as a response to the global and local emergence of both mitigation and adaptation, and the voluntary commitment by the local authorities ismore » an indication of an emerging norm of climate change as an important issue. This article takes its point of departure in the observation that SEA is not undertaken for these voluntary CCPs. The critical analysis of this phenomenon rests upon a documentary study of Danish CCPs, interviews with a lawyer and ministerial key person and informal discussions between researchers, practitioners and lawyers on whether climate change plans are covered by SEA legislation and underlying reasons for the present practice. Based on a critical analysis of mandatory SEA and/or obligation to screen CCPs according to significance criteria, the authors find that 18 out of the 48 CCPs are mandatory to SEA and 9 would require a screening of significance and thereby potentially be followed by a SEA. In practice only one plan was screened and one was environmentally assessed. The legal, democratic and environmental consequences of this SEA practice are critically discussed. Hereunder is the missed opportunity to use the broad environmental scope of SEA to avoid a narrow focus on energy and CO{sub 2} in CCPs, and the question whether this practice in Denmark complies with the EU Directive. -- Highlights: ► It is inevitable that discretionary judgement takes place and will impact on the screening decision. ► The article hereby calls for greater awareness of the discretion and judgement involved in SEA screening. ► Practice seemingly reveals a lack of application of SEA within climate change planning and a lack of explicit screening. ► Absence of SEAs of voluntary plans such as CCPs, have legal consequences, as well as democratic and environmental consequences. ► The vague definition of ‘administrative provision’ seems to impose the lacking SEA.« less

Practice assistants in primary care in Germany – associations with organizational attributes on job satisfaction

PubMed Central

2013-01-01

Background Job satisfaction and organizational attributes in primary care teams are important issues as they affect clinical outcomes and the quality of health care provided. As practice assistants are an integral part of these teams it is important to gain insight into their views on job satisfaction and organizational attributes. The aim of this study was to evaluate the job satisfaction of practice assistants and the organizational attributes within their general practices in Germany and to explore the existence of possible associations. Methods This observational study was based on a job satisfaction survey and measurement of organizational attributes in general practices in the German federal state of Baden-Wuerttemberg. Job satisfaction was measured with the 10-item ‘Warr-Cook-Wall job satisfaction scale’. Organizational attributes were evaluated with the 21-items ‘survey of organizational attributes for primary care’ (SOAPC). Linear regression analyses were performed in which each of SOAPC scales and the overall score of SOAPC was treated as outcome variables. Results 586 practice assistants out of 794 respondents (73.8%) from 234 general practices completed the questionnaire. Practice assistants were mostly satisfied with their colleagues and least of all satisfied with their income and recognition for their work. The regression analysis showed that ‘freedom of working method’ and ‘recognition of work’, the employment status of practice assistants and the mode of practice were almost always significantly associated with each subscale and overall score of SOAPC. Conclusions Job satisfaction is highly associated with different aspects of organizational attributes for primary care (‘communication’, ‘decision-making’ and ‘stress’). Consequently, improved job satisfaction could lead to a better-organized primary care team. This implication should be investigated directly in further intervention studies with a special focus on improving the recognition for work and income. PMID:23915225

A Practical Approach to Address Uncertainty in Stakeholder Deliberations.

PubMed

Gregory, Robin; Keeney, Ralph L

2017-03-01

This article addresses the difficulties of incorporating uncertainty about consequence estimates as part of stakeholder deliberations involving multiple alternatives. Although every prediction of future consequences necessarily involves uncertainty, a large gap exists between common practices for addressing uncertainty in stakeholder deliberations and the procedures of prescriptive decision-aiding models advanced by risk and decision analysts. We review the treatment of uncertainty at four main phases of the deliberative process: with experts asked to describe possible consequences of competing alternatives, with stakeholders who function both as individuals and as members of coalitions, with the stakeholder committee composed of all stakeholders, and with decisionmakers. We develop and recommend a model that uses certainty equivalents as a theoretically robust and practical approach for helping diverse stakeholders to incorporate uncertainties when evaluating multiple-objective alternatives as part of public policy decisions. © 2017 Society for Risk Analysis.

Sexual Difficulties after Pelvic Radiotherapy: Improving Clinical Management.

PubMed

White, I D

2015-11-01

Modern multimodality cancer treatment has led to more than 2 million people living with and beyond cancer in the UK, an impressive survival statistic on which clinicians and services continue to build. However, what is less readily acknowledged by health professionals and patients alike are the 500,000 people whose daily lives are adversely affected by the longer term consequences of cancer treatment. Macmillan Cancer Support estimate as many as 350,000 people in the UK experience sexual consequences of cancer and its treatment, an aspect of survivorship and rehabilitation that receives relatively scant attention in service provision, policy development and research terms. This overview addresses the sexual impact of radical pelvic radiotherapy for the more common (prostate, ano-rectal, cervical and endometrial) adult malignancies. Through discussion of the clinical assessment and management of desire, arousal, orgasmic and sexual pain difficulties that arise after pelvic radiotherapy, this overview offers an integrated biopsychosocial model of practice that incorporates the physical, psychological and relationship elements of these treatment sequelae. It is important that clinicians raise the profile of the sexual consequences of cancer treatment as a legitimate aspect of survivorship and service provision. Only in this way can the identification and management of treatment-induced sexual difficulties, frequently experienced by patients and their partners, be better understood and managed. Increased focus on the sexual consequences of treatment and cancer survivorship more broadly may, in time, lead to greater clinical recognition, service development and, most importantly, increased research devoted to the effective management of what remains a neglected aspect of cancer care. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Using mass media within health-promoting practice: a nursing perspective.

PubMed

Whitehead, D

2000-10-01

For some time health professionals have recognized the growing importance of utilizing mass media strategies as part of their health-promoting practice. The ever-evolving climate of technology and increasing reliance on mass communications has further reinforced the position of mass media initiatives. The enormous potential for mass media resources to reach certain audiences and influence their health-related behaviours has become particularly well established. Despite these facts, however, it is argued that the nursing profession has been less than pro-active in acknowledging, accommodating and adopting such practices. Consequently, the incorporation of health-related mass media initiatives into nursing's health-promotional role remains an elusive exercise. The maintenance of such a position, it is claimed, is potentially damaging for the profession as a whole. In light of this state of affairs, this paper seeks to review the literature surrounding the nature and processes of mass media strategies, their relevance to health promotion and nursing, how they are currently utilized and how they can be incorporated further into nursing practice. In conclusion, it is argued that nursing should seek to become a more active user of mass communication/media technology--especially in relation to its health-promotional practices.

Elder Abuse: Systematic Review and Implications for Practice.

PubMed

Dong, Xin Qi

2015-06-01

This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem. Evidence suggests that elder abuse is prevalent, predictable, costly, and sometimes fatal. This review will highlight the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences in community populations. The global literature in PubMed, MEDLINE, PsycINFO, BIOSIS, Science Direct, and Cochrane Central was searched. Search terms included elder abuse, elder mistreatment, elder maltreatment, prevalence, incidence, risk factors, protective factors, outcomes, and consequences. Studies that existed only as abstracts, case series, or case reports or recruited individuals younger than 60; qualitative studies; and non-English publications were excluded. Tables and figures were created to highlight the findings: the most-detailed analyses to date of the prevalence of elder abuse according to continent, risk and protective factors, graphic presentation of odds ratios and confidence intervals for major risk factors, consequences, and practical suggestions for health professionals in addressing elder abuse. Elder abuse is common in community-dwelling older adults, especially minority older adults. This review identifies important knowledge gaps, such as a lack of consistency in definitions of elder abuse; insufficient research with regard to screening; and etiological, intervention, and prevention research. Concerted efforts from researchers, community organizations, healthcare and legal professionals, social service providers, and policy-makers should be promoted to address the global problem of elder abuse. © 2015, Copyright the Author Journal compilation © 2015, The American Geriatrics Society.

The role of land use changes in the distribution of shallow landslides.

PubMed

Persichillo, Maria Giuseppina; Bordoni, Massimiliano; Meisina, Claudia

2017-01-01

The role of land use dynamics on shallow landslide susceptibility remains an unresolved problem. Thus, this work aims to assess the influence of land use changes on shallow landslide susceptibility. Three shallow landslide-prone areas that are representative of peculiar land use settings in the Oltrepò Pavese (North Apennines) are analysed: the Rio Frate, Versa and Alta Val Tidone catchments. These areas were affected by widespread land abandonment and modifications in agricultural practices from 1954 to 2012 and relevant shallow landslide phenomena in 2009, 2013 and 2014. A multi-temporal land use change analysis allows us to evaluate the degree of transformation in the three investigated areas and the influence of these changes on the susceptibility to shallow landslides. The results show that the three catchments were characterised by pronounced land abandonment and important changes in agricultural practices. In particular, abandoned cultivated lands that gradually recovered through natural grasses, shrubs and woods were identified as the land use change classes that were most prone to shallow landslides. Additionally, the negative qualities of the agricultural maintenance practices increased the surface water runoff and consequently intensified erosion processes and instability phenomena. Although the land use was identified as the most important predisposing factor in all the study areas, some cases existed in which the predisposition of certain areas to shallow landslides was influenced by the combined effect of land use changes and the geological conditions, as highlighted by the high susceptibility of slopes that are characterised by adverse local geological (thick soils derived from clayey-marly bedrocks) and geomorphological (slope angle higher than 25°) conditions. Thus, the achieved results are particularly useful to understand the best land conservation strategies to be adopted to reduce instability phenomena and the consequent economic losses in areas that are strongly linked to agricultural land use in these territories. Copyright © 2016 Elsevier B.V. All rights reserved.

Self-reported body weight perception and dieting practices in community-dwelling patients with schizophrenia.

PubMed

Strassnig, Martin; Brar, Jaspreet S; Ganguli, Rohan

2005-06-15

Many patients with schizophrenia are exposed to serious health risks associated with their excess body weight. Evidence exists that even a moderate amount of weight loss may have significant health benefits. Thus, weight control in schizophrenia patients has become an important treatment goal. Although studies in the general population show that satisfaction with body weight is an important predictor for engagement in various weight loss measures, the perspective of schizophrenia patients has not been assessed. Information on self-reported weight perception, desire to lose weight as well as weight loss attempts was obtained according to methods employed in the National Health and Nutrition Examination Survey, Cycle III (NHANES III). Body weight and height were measured and body mass index (BMI) was calculated. Perception of body weight and desire to lose weight were correlated to BMI. Both obese female and male subjects (BMI30) were aware of their weight status. However, whereas overweight females (BMI>25< or =29.9) accurately perceived themselves so, males in this category had difficulties perceiving themselves overweight, and consequently neither wanted to lose weight, nor tried to lose weight. As means of weight loss, caloric restriction (diet) was most frequently employed (by more than 80% of study subjects); yet only a third of study subjects (34.4%) engaged in the recommended combination of diet and exercise to lose weight. Questionable weight loss practices were also frequently employed, especially among women. Obese patients (BMI> or =30) were generally aware of their excess body weight and wanted to lose weight. Only non-obese, yet overweight males (BMI>25< or =29.9) did not perceive themselves as overweight and consequently did not try to lose weight. Weight loss practices did not always follow established recommendations. Especially women were likely to approach weight loss with questionably appropriate and unsafe methods.

ACVIM small animal consensus statement on safe use of cytotoxic chemotherapeutics in veterinary practice

PubMed Central

Klahn, Shawna; Phillips, Brenda; Parshley, Lisa; Bennett, Peter; Flory, Andi; Calderon, Rosemary

2018-01-01

The purpose of this report is to offer a consensus opinion of ACVIM oncology diplomates and technicians on the safe use of cytotoxic chemotherapeutics in veterinary practice. The focus is on minimizing harm to the personnel exposed to the drugs: veterinary practitioners, veterinary technicians, veterinary staff, and pet owners. The safety of the patient receiving these drugs is also of paramount importance, but is not addressed in this statement. Much of the information presented is based on national recommendations by Occupational Safety and Health Administration, National Institute for Occupational Safety and Health, United States Pharmacopeia, and other published regulations. These directives reflect an abundance of caution to minimize exposure to medical personnel, but large‐scale studies about the consequences of long‐term occupational exposure are not available in veterinary medicine. Challenges in the delivery of optimal treatment safely and economically to veterinary patients in general practice without access to a veterinary oncologist or other specialist, because of costs or proximity, remain. PMID:29603372

Genetics of Movement Disorders and the Practicing Clinician; Who and What to Test for?

PubMed

Di Fonzo, Alessio; Monfrini, Edoardo; Erro, Roberto

2018-05-23

This review aims to provide the basic knowledge on the genetics of hypokinetic and hyperkinetic movement disorders to guide clinicians in the decision of "who and what to test for?" In recent years, the identification of various genetic causes of hypokinetic and hyperkinetic movement disorders has had a great impact on a better definition of different clinical syndromes. Indeed, the advent of next-generation sequencing (NGS) techniques has provided an impressive step forward in the easy identification of genetic forms. However, this increased availability of genetic testing has challenges, including the ethical issue of genetic testing in unaffected family members, "commercially" available home testing kits and the increasing number and relevance of "variants of unknown significance." The emergent role of genetic factors has important implications on clinical practice and counseling. As a consequence, it is fundamental that practicing neurologists have a proper knowledge of the genetic background of the diseases and perform an accurate selection of who has to be tested and for which gene mutations.

Practices and Policies of Clinical Exome Sequencing Providers: Analysis and Implications

PubMed Central

Jamal, Seema M.; Yu, Joon-Ho; Chong, Jessica X.; Dent, Karin M.; Conta, Jessie H.; Tabor, Holly K.; Bamshad, Michael J.

2013-01-01

Exome and whole genome sequencing (ES/WGS) offer potential advantages over traditional approaches to diagnostic genetic testing. Consequently, use of ES/WGS in clinical settings is rapidly becoming commonplace. Yet there are myriad moral, ethical, and perhaps legal implications attached to the use of ES and health care professionals and institutions will need to consider these implications in the context of the varied practices and policies of ES service providers. We developed “core elements” of content and procedures for informed consent, data sharing, and results management and a quantitative scale to assess the extent to which research protocols met the standards established by these core elements. We then used these tools to evaluate the practices and policies of each of the 6 U.S. CLIA-certified labs offering clinical ES. Approaches toward informed consent, data sharing, and results return vary widely among ES providers as do the overall potential merits and disadvantages of each, and more importantly, the balance between the two. PMID:23610049

Retrieval practice makes procedure from remembering: An automatization account of the testing effect.

PubMed

Racsmány, Mihály; Szőllősi, Ágnes; Bencze, Dorottya

2018-01-01

The "testing effect" refers to the striking phenomenon that repeated retrieval practice is one of the most effective learning strategies, and certainly more advantageous for long-term learning, than additional restudying of the same information. How retrieval can boost the retention of memories is still without unanimous explanation. In 3 experiments, focusing on the reaction time (RT) of retrieval, we showed that RT of retrieval during retrieval practice followed a power function speed up that typically characterizes automaticity and skill learning. More important, it was found that the measure of goodness of fit to this power function was associated with long-term recall success. Here we suggest that the automatization of retrieval is an explanatory component of the testing effect. As a consequence, retrieval-based learning has the properties characteristic of skill learning: diminishing involvement of attentional processes, faster processing, resistance to interference effects, and lower forgetting rate. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Female genital mutilation among Iraqi Kurdish women: a cross-sectional study from Erbil city.

PubMed

Yasin, Berivan A; Al-Tawil, Namir G; Shabila, Nazar P; Al-Hadithi, Tariq S

2013-09-08

Iraqi Kurdistan region is one of the areas where female genital mutilation is reportedly widely practiced but inadequately studied. The aim of this study was to determine (i) the prevalence of female genital mutilation among Muslim Kurdish women in Erbil city, (ii) the patterns and types of female genital mutilation, (iii) the factors associated with this practice and (iv) women's knowledge and attitudes towards this practice. A cross-sectional study was conducted in the primary health care centers and the Maternity Teaching Hospital in Erbil city, involving 1987 women aged 15-49 years. Data were obtained about female genital mutilation status and knowledge and perception towards this practice. The participants were clinically examined to verify the self-reported female genital mutilation status. The self-reported prevalence of female genital mutilation was 70.3%, while it was 58.6% according to clinical examination of the women's genitalia. The most common type of female genital mutilation was type I (99.6%) and the most common age at which mutilation was performed was 4-7 years (60.2%). This practice was mostly performed by traditional birth attendants (72.5%). Only 6.4% of mutilated women reported having complications after mutilation, most commonly bleeding (3.6%). The practice was more reported among housewives (OR = 3.3), those women whose mothers were mutilated (OR = 15.1) or with unknown mutilation status (OR = 7.3) and those women whose fathers were illiterate (OR = 1.4) or could only read and write (OR = 1.6). The common reasons for practicing female genital mutilation were cultural tradition (46.7%) and dictate of religion (38.9%). Only 30% of the participants were aware about the health consequences of female genital mutilation. More than one third (36.6%) of the women support the practice and 34.5% have intention to mutilate their daughters. Prevalence of female genital mutilation among Muslim Kurdish women in Erbil city is very high; although, most cases are of type I. There is clear lack of knowledge about the health consequences of female genital mutilation and a relatively important segment of women support this practice. Custom or tradition and dictate of religion are the main reasons for this practice that need further in-depth exploration.

Female genital mutilation among Iraqi Kurdish women: a cross-sectional study from Erbil city

PubMed Central

2013-01-01

Background Iraqi Kurdistan region is one of the areas where female genital mutilation is reportedly widely practiced but inadequately studied. The aim of this study was to determine (i) the prevalence of female genital mutilation among Muslim Kurdish women in Erbil city, (ii) the patterns and types of female genital mutilation, (iii) the factors associated with this practice and (iv) women’s knowledge and attitudes towards this practice. Methods A cross-sectional study was conducted in the primary health care centers and the Maternity Teaching Hospital in Erbil city, involving 1987 women aged 15–49 years. Data were obtained about female genital mutilation status and knowledge and perception towards this practice. The participants were clinically examined to verify the self-reported female genital mutilation status. Results The self-reported prevalence of female genital mutilation was 70.3%, while it was 58.6% according to clinical examination of the women’s genitalia. The most common type of female genital mutilation was type I (99.6%) and the most common age at which mutilation was performed was 4–7 years (60.2%). This practice was mostly performed by traditional birth attendants (72.5%). Only 6.4% of mutilated women reported having complications after mutilation, most commonly bleeding (3.6%). The practice was more reported among housewives (OR = 3.3), those women whose mothers were mutilated (OR = 15.1) or with unknown mutilation status (OR = 7.3) and those women whose fathers were illiterate (OR = 1.4) or could only read and write (OR = 1.6). The common reasons for practicing female genital mutilation were cultural tradition (46.7%) and dictate of religion (38.9%). Only 30% of the participants were aware about the health consequences of female genital mutilation. More than one third (36.6%) of the women support the practice and 34.5% have intention to mutilate their daughters. Conclusions Prevalence of female genital mutilation among Muslim Kurdish women in Erbil city is very high; although, most cases are of type I. There is clear lack of knowledge about the health consequences of female genital mutilation and a relatively important segment of women support this practice. Custom or tradition and dictate of religion are the main reasons for this practice that need further in-depth exploration. PMID:24010850

Moral competence among nurses in Malawi: A concept analysis approach.

PubMed

Maluwa, Veronica Mary; Gwaza, Elizabeth; Sakala, Betty; Kapito, Esnath; Mwale, Ruth; Haruzivishe, Clara; Chirwa, Ellen

2018-01-01

Nurses are expected to provide comprehensive, holistic and ethically accepted care according to their code of ethics and practice. However, in Malawi, this is not always the case. This article analyses moral competence concept using the Walker and Avant's strategy of concept analysis. The aim of this article is to analyse moral competence concept in relation to nursing practice and determine defining attributes, antecedents and consequences of moral competence in nursing practice. Analysis of moral competence concept was done using Walker and Avant's strategy of concept analysis. Deductive analysis was used to find the defining attributes of moral competence, which were kindness, compassion, caring, critical thinking, ethical decision making ability, problem solving, responsibility, discipline, accountability, communication, solidarity, honesty, and respect for human values, dignity and rights. The identified antecedents were personal, cultural and religious values; nursing ethics training, environment and guidance. The consequences of moral competence are team work spirit, effective communication, improved performance and positive attitudes in providing nursing care. Moral competence can therefore be used as a tool to improve care in nursing practice to meet patients' problems and needs and consequently increase public's satisfaction in Malawi.

Pharmacy practice department chairs' perspectives on part-time faculty members.

PubMed

Fjortoft, Nancy; Winkler, Susan R; Mai, Thy

2012-05-10

To identify the benefits and consequences of having part-time faculty members in departments of pharmacy practice from the department chair's perspective. A stratified purposive sample of 12 pharmacy practice department chairs was selected. Eleven telephone interviews were conducted. Two investigators independently read interview notes and categorized and enumerated responses to determine major themes using content analysis. The investigators jointly reviewed the data and came to consensus on major themes. Benefits of allowing full-time faculty members to reduce their position to part-time included faculty retention and improved individual faculty work/life balance. Consequences of allowing part-time faculty positions included the challenges of managing individual and departmental workloads, the risk of marginalizing part-time faculty members, and the challenges of promotion and tenure issues. All requests to switch to part-time status were faculty-driven and most were approved. There are a variety of benefits and consequences of having part-time faculty in pharmacy practice departments from the chair's perspective. Clear faculty and departmental expectations of part-time faculty members need to be established to ensure optimal success of this working arrangement.

Potential consequences of clinical application of artificial gametes: a systematic review of stakeholder views.

PubMed

Hendriks, Saskia; Dondorp, Wybo; de Wert, Guido; Hamer, Geert; Repping, Sjoerd; Dancet, Eline A F

2015-01-01

Recent progress in the formation of artificial gametes, i.e. gametes generated from progenitors or somatic cells, has led to scientific and societal discussion about their use in medically assisted reproduction. In animals, live births have already been achieved using artificial gametes of varying (cell type) sources and biological research seems to be progressing steadily toward clinical application in humans. Artificial gametes could potentially help not only infertile heterosexual couples of reproductive age of which one or both partners lacks functional gametes, but also post-menopausal women and same-sex couples, to conceive a child who will be genetically related to them. But as clinical application of these new technologies may have wider societal consequences, a proactive consideration of the possible impact seems timely and important. This review aims to contribute to this by providing a systematic overview of the potential consequences of clinical application of artificial gametes anticipated by different stakeholders. The electronic database 'Medline/Pubmed' was systematically searched with medical subject heading terms (MesH) for articles published in English between January 1970 and December 2013. Articles were selected based on eligibility and reference lists of eligible studies were hand searched. The reported potential consequences of clinical application of artificial gametes were extracted from the articles and were grouped into categories by content analysis. Per category, we noted which stakeholders referred to which potential consequences, based on author affiliations and, if applicable, study participants. The systematic search yielded 2424 articles, and 84 studies were included after screening. Nine positive consequences, 21 specific consequences requiring consideration and 22 recommendations referring to clinical application of artificial gametes were documented. All positive consequences, consequences requiring consideration and recommendations could be categorized under the following eight objectives to be safeguarded during clinical application of artificial gametes: (i) timing the implementation of new treatments correctly, (ii) meeting 'plausible demands of patients', (iii) improving and safeguarding public health, (iv) promoting the progress of medical science in the interest of future patients, (v) providing treatments that are morally acceptable for the general public, (vi) controlling medical practice, (vii) offering treatments that allow acquisition of informed consent and (viii) funding treatments fairly. Professionals specialized in biomedical science, science journalists and professionals specialized in ethics all addressed these eight objectives on artificial gametes, whereas professionals specialized in law or political science addressed seven objectives. Although one study reported on the perspective of parents of under-aged patients on three objectives, the perspectives of patients themselves were not reported by the reviewed literature. Of course, clinical introduction of artificial gametes should only be considered on the basis of reassuring outcomes of appropriate preclinical effectiveness and safety studies. In addition, potential users' views on the desirability and acceptability of artificial gametes should be studied before clinical introduction. A societal debate including all stakeholders is needed to determine the relative importance of all arguments in favor of and against the introduction of artificial gametes into clinical practice. More broadly, establishing pre-implementation processes for new medical techniques is relevant for all fields of medicine. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

How does the culture of medical group practices influence the types of programs used to assure quality of care?

PubMed

Kaissi, Amer; Kralewski, John; Curoe, Ann; Dowd, Bryan; Silversmith, Janet

2004-01-01

It is widely acknowledged that the culture of medical group practices greatly influences the quality of care, but little is known about how cultures are translated into specific types of programs focused on quality. This study explores this issue by assessing the influence of the organizational culture on these types of programs in medical group practices in the upper Midwest. Data were obtained from two surveys of medical group practices. The first survey was designed to assess the culture of the practice using a nine-dimension instrument developed previously. The second survey was designed to obtain organizational structure data including the programs identified by the literature as important to the quality of care in medical practices. Completed surveys were obtained from eighty-eight medical groups. The relationship of the group practice culture to structural programs focused on quality of care was analyzed using logistic regression equations. Several interesting patterns emerged. As expected, practices with a strong information culture favor electronic data systems and formal programs that provide comparative or evidence-based data to enhance their clinical practices. However, those with a quality-centered culture appear to prefer patient satisfaction surveys to assess the quality of their care, while practices that are more business-oriented rely on bureaucratic strategies such as benchmarking and physician profiling. Cultures that emphasize the autonomy of physician practice were negatively (but not at a statistically significant level) associated with all the programs studied. Practices with a highly collegial culture appear to rely on informal peer review mechanisms to assure quality rather than any of the structural programs included in this analysis. This study suggests that the types of quality programs that group practices develop differ according to their cultures. Consequently, it is important for practice administrators and medical directors to develop quality assurance programs that fit their cultures if they are to gain buy-in by their clinicians. Future research should assess the effect of culture-structure fit on quality and safety outcomes.

[Summary of the practice guideline 'Viral hepatitis and other liver diseases' (second revision) from the Dutch College of General Practitioners].

PubMed

Bouma, M; van Geldrop, W J; Numans, M E; Wiersma, Tj; Goudswaard, A N

2008-12-06

The revised Dutch College of General Practitioners' practice guideline 'Viral hepatitis and other liver diseases' offers advice in the diagnosis and management of viral hepatitis A, B and C and other liver diseases. The guideline is important for general practitioners as well as specialists in internal medicine and gastroenterology. The emphasis is on the management of chronic hepatitis B en C, because the prevalence of these diseases has increased in the Netherlands and, in addition, the treatment options for chronic hepatitis have improved. Consequently, timely recognition and adequate referral of patients with chronic hepatitis B or hepatitis C have become more important. However, many patients with a chronic liver disease have no symptoms. Therefore, the general practitioner should be aware that a patient visiting the practice with fatigue and malaise could have a liver disease if he or she belongs to a high-risk group or has had high-risk contacts. If the general practitioner repeatedly finds increased liver transaminase values during routine examination of asymptomatic patients, additional diagnostic tests should be performed. Further tests should focus on viral hepatitis as well as on non-alcoholic fatty liver disease and non-alcoholic steatohepatitis or, depending on the history-taking, liver damage due to excessive alcohol, medication or drug use.

Mental health consequences of stress and trauma: allostatic load markers for practice and policy with a focus on Indigenous health.

PubMed

Berger, Maximus; Juster, Robert-Paul; Sarnyai, Zoltán

2015-12-01

Mental health, well-being, and social life are intimately related as is evident from the higher incidence of psychiatric illness in individuals exposed to social stress and adversity. Several biological pathways linking social adversity to health outcomes are heavily investigated in the aims of facilitating early identification and prevention of adverse health outcomes. We provide a practice-orientated overview of the allostatic load model and how it relates to metabolic and cardiovascular comorbidity in psychiatric disorders. Allostatic load brings together a set of neuroendocrine, metabolic, immune and cardiovascular biomarkers that are elevated in individuals with adverse early life experiences and are predictive of cardiovascular and metabolic risk in psychiatric illness of critical importance for Indigenous Australians. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Demography and Public Health Emergency Preparedness: Making the Connection

PubMed Central

Katz, Rebecca

2009-01-01

The tools and techniques of population sciences are extremely relevant to the discipline of public health emergency preparedness: protecting and securing the population’s health requires information about that population. While related fields such as security studies have successfully integrated demographic tools into their research and literature, the theoretical and practical connection between the methods of demography and the practice of public health emergency preparedness is weak. This article suggests the need to further the interdisciplinary use of demography by examining the need for a systematic use of population science techniques in public health emergency preparedness. Ultimately, we demonstrate how public health emergency preparedness can incorporate demography to develop more effective preparedness plans. Important policy implications emerge: demographers and preparedness experts need to collaborate more formally in order to facilitate community resilience and mitigate the consequences of public health emergencies. PMID:20694030

Nonequivalent lanthanide defects: Energy level modeling

NASA Astrophysics Data System (ADS)

Joos, Jonas J.; Poelman, Dirk; Smet, Philippe F.

2016-11-01

Empirical charge-state transition level schemes are popular tools to model the properties of lanthanide-doped materials and their construction has become standard practice. Typically, it is implicitly assumed that all lanthanide ions form isostructural defects. However, in practice, multiple nonequivalent defects related to the same lanthanide can occur or different lanthanides can even incorporate in different ways. The consequences of these complications on the impurity energy levels are discussed in this article. It seems that small structural differences around the lanthanide dopant can give rise to important spectral differences in its emission. These are not always clearly reproduced by the charge-state transition level schemes. Improvements to the existing procedure are suggested and applied to the lanthanide ions in the well-studied host crystals SrAl2O4, Sr2Si5N8 and SrGa2S4.

Why eyewitnesses fail

PubMed Central

Albright, Thomas D.

2017-01-01

Eyewitness identifications play an important role in the investigation and prosecution of crimes, but it is well known that eyewitnesses make mistakes, often with serious consequences. In light of these concerns, the National Academy of Sciences recently convened a panel of experts to undertake a comprehensive study of current practice and use of eyewitness testimony, with an eye toward understanding why identification errors occur and what can be done to prevent them. The work of this committee led to key findings and recommendations for reform, detailed in a consensus report entitled Identifying the Culprit: Assessing Eyewitness Identification. In this review, I focus on the scientific issues that emerged from this study, along with brief discussions of how these issues led to specific recommendations for additional research, best practices for law enforcement, and use of eyewitness evidence by the courts. PMID:28739937

The open black box: The role of the end-user in GIS integration

USGS Publications Warehouse

Poore, B.S.

2003-01-01

Formalist theories of knowledge that underpin GIS scholarship on integration neglect the importance and creativity of end-users in knowledge construction. This has practical consequences for the success of large distributed databases that contribute to spatial-data infrastructures. Spatial-data infrastructures depend on participation at local levels, such as counties and watersheds, and they must be developed to support feedback from local users. Looking carefully at the work of scientists in a watershed in Puget Sound, Washington, USA during the salmon crisis reveals that the work of these end-users articulates different worlds of knowledge. This view of the user is consonant with recent work in science and technology studies and research into computer-supported cooperative work. GIS theory will be enhanced when it makes room for these users and supports their practical work. ?? / Canadian Association of Geographers.

The role of socio-technical principles in leveraging meaningful benefits from IT investments.

PubMed

Doherty, Neil F

2014-03-01

In recent years there has been a great deal of academic and practitioner interest in the role of 'benefits realisation management' [BRM] approaches, as a means of proactively leveraging value from IT investments. This growing body of work owes a very considerable, but as yet unacknowledged, debt to the work of Ken Eason, and other early socio-technical theorists. Consequently, the aim of this paper is to demonstrate, using the literature, how many of the principles, practices and techniques of BRM have evolved either directly or indirectly from socio-technical approaches to systems design. In so doing, this article makes a further important contribution to the literature by explicitly identifying the underlying principles and key practices of benefits realisation management. Copyright © 2012 Elsevier Ltd and The Ergonomics Society. All rights reserved.

eLearning, knowledge brokering, and nursing: strengthening collaborative practice in long-term care.

PubMed

Halabisky, Brenda; Humbert, Jennie; Stodel, Emma J; MacDonald, Colla J; Chambers, Larry W; Doucette, Suzanne; Dalziel, William B; Conklin, James

2010-01-01

Interprofessional collaboration is vital to the delivery of quality care in long-term care settings; however, caregivers in long-term care face barriers to participating in training programs to improve collaborative practices. Consequently, eLearning can be used to create an environment that combines convenient, individual learning with collaborative experiential learning. Findings of this study revealed that learners enjoyed the flexibility of the Working Together learning resource. They acquired new knowledge and skills that they were able to use in their practice setting to achieve higher levels of collaborative practice. Nurses were identified as team leaders because of their pivotal role in the long-term care home and collaboration with all patient care providers. Nurses are ideal as knowledge brokers for the collaborative practice team. Quantitative findings showed no change in learner's attitudes regarding collaborative practice; however, interviews provided examples of positive changes experienced. Face-to-face collaboration was found to be a challenge, and changes to organizations, systems, and technology need to be made to facilitate this process. The Working Together learning resource is an important first step toward strengthening collaboration in long-term care, and the pilot implementation provides insights that further our understanding of both interprofessional collaboration and effective eLearning.

The Practice of Respect in the ICU.

PubMed

Brown, Samuel M; Azoulay, Elie; Benoit, Dominique; Butler, Terri Payne; Folcarelli, Patricia; Geller, Gail; Rozenblum, Ronen; Sands, Ken; Sokol-Hessner, Lauge; Talmor, Daniel; Turner, Kathleen; Howell, Michael D

2018-06-01

Although "respect" and "dignity" are intuitive concepts, little formal work has addressed their systematic application in the ICU setting. After convening a multidisciplinary group of relevant experts, we undertook a review of relevant literature and collaborative discussions focused on the practice of respect in the ICU. We report the output of this process, including a summary of current knowledge, a conceptual framework, and a research program for understanding and improving the practice of respect and dignity in the ICU. We separate our report into findings and proposals. Findings include the following: 1) dignity and respect are interrelated; 2) ICU patients and families are vulnerable to disrespect; 3) violations of respect and dignity appear to be common in the ICU and overlap substantially with dehumanization; 4) disrespect may be associated with both primary and secondary harms; and 5) systemic barriers complicate understanding and the reliable practice of respect in the ICU. Proposals include: 1) initiating and/or expanding a field of research on the practice of respect in the ICU; 2) treating "failures of respect" as analogous to patient safety events and using existing quality and safety mechanisms for improvement; and 3) identifying both benefits and potential unintended consequences of efforts to improve the practice of respect. Respect and dignity are important considerations in the ICU, even as substantial additional research remains to be done.

The importance of cultural competency in general pediatrics.

PubMed

Brotanek, Jane M; Seeley, Christina E; Flores, Glenn

2008-12-01

There is a growing awareness of the importance of cultural competency in pediatrics. The authors review the most recent studies that examine the impact of cultural competency on general pediatric care, explore cultural beliefs and practices affecting clinical care, and describe culturally sensitive interventions designed to address racial/ethnic health disparities. The beneficial effects of cultural competency embrace health outcomes, quality of care, and patient satisfaction, while failure to consider language and culture can have serious adverse consequences for clinical care, including patient safety and healthcare access. A five-component model of cultural competency has been developed, and a growing literature details an array of normative cultural values, folk illnesses, parent beliefs/practices, and provider behaviors that can have a profound impact on pediatric care. Culturally sensitive interventions are being developed to lessen racial/ethnic health disparities. A goal for the pediatrician is to provide culturally competent healthcare by using trained medical interpreters with limited English-proficient families, being familiar with normative cultural values that affect the healthcare of commonly encountered racial/ethnic groups, and asking about folk illness beliefs and ethnomedical treatments.

Psychological stress in sarcoidosis.

PubMed

Wilsher, Margaret L

2012-09-01

Sarcoidosis is a chronic illness associated with emotional and physical consequences which impact on quality of life. Although the impact of fatigue is well understood, emotional impacts of sarcoidosis are less commonly recognized and addressed in routine clinical practice. The purpose of this review is to highlight that sarcoidosis can result in considerable psychological distress. Not only is there a high prevalence of depressive symptoms in sarcoidosis, but clinical depressive and anxiety disorders are more common than seen in the general population. Patients with sarcoidosis have perceptions and beliefs about their disease that may impact on their willingness to engage in recommended therapies. They may also exhibit a disordered perception of their disease and a personality profile of neuroticism. Understanding the minimally important clinical difference in the Fatigue Assessment Scale (FAS) and validation of the Sarcoidosis Health Questionnaire (SHQ) across different populations supports the use of these tools in routine clinical practice and clinical trials. Understanding the global impact of sarcoidosis is important for patients and clinicians, and use of validated instruments, such as the SHQ and FAS, allows for more comprehensive assessment of the disease and the impact of any interventions.

Substance Use among Youth with Currently and Formerly Incarcerated Parents

PubMed Central

Davis, Laurel; Shlafer, Rebecca J.

2017-01-01

Parental incarceration impacts millions of children in the U.S. and has important consequences for youths’ adjustment. Children of incarcerated parents are at risk for a host of negative psychosocial outcomes, including substance abuse problems. Using data from a statewide survey of youth behavior, the effect of both present and past parental incarceration on youths’ report of their substance use behaviors was examined. Both present and past parental incarceration was significantly associated with use of alcohol, tobacco, marijuana, and prescription drugs, as well as substance abuse and dependence. Implications for practice and research are discussed. PMID:29170570

Telephone Medicine for Internists

PubMed Central

Elnicki, D Michael; Ogden, Paul; Flannery, Michael; Hannis, Mark; Cykert, Sam

2000-01-01

The role of the telephone in medical practice is important, but often problematic. Mistakes in telephone diagnosis and triage can have severe consequences. An effective office system can reduce liability risks, and in some cases telephone contact can substitute for office visits. Internists feel unprepared to provide telephone care. Therefore, residency education needs to focus on documentation, consultant availability, and performance feedback. Research should focus on improving outcomes, reimbursement issues, and technologic advances. This article describes internists' telephone interactions with ambulatory patients, preparation for telephone medicine, and aspects of office telephone systems and makes comparisons with other primary care fields. PMID:10840269

Body piercing with fatal consequences.

PubMed

Ranga, N; Jeffery, A J

2011-01-25

Body modifications such as piercings, tattoos and surgery have increased in popularity in recent times and have become more socially acceptable. The common complications of piercing different parts of the human anatomy are well-documented, including sepsis, allergic reactions and, more rarely, endocarditis and ischaemia. Deaths related to piercing complications are primarily septic in origin. In this case, a man in his 50s died due to complications of his multiple umbilical piercings. The cause of death was unusually linked to body modification; the umbilical piercings had ultimately led to a mesenteric infarction. Cases such as these are forensically important due to potential manslaughter charges that could be brought against a piercing establishment. More importantly, this case highlights another extreme complication of body modification. Fashion statements are always changing and impact upon many lives. It is important to highlight to people the potentially life-threatening complications of common piercing practices.

Representing Practice: Practice Models, Patterns, Bundles

ERIC Educational Resources Information Center

Falconer, Isobel; Finlay, Janet; Fincher, Sally

2011-01-01

This article critiques learning design as a representation for sharing and developing practice, based on synthesis of three projects. Starting with the findings of the Mod4L Models of Practice project, it argues that the technical origins of learning design, and the consequent focus on structure and sequence, limit its usefulness for sharing…

A review of transfusion practice before, during, and after hematopoietic progenitor cell transplantation

PubMed Central

Johnson, Viviana V.; Sandler, S. Gerald; Sayegh, Antoine; Klumpp, Thomas R.

2008-01-01

The increased use of hematopoietic progenitor cell (HPC) transplantation has implications and consequences for transfusion services: not only in hospitals where HPC transplantations are performed, but also in hospitals that do not perform HPC transplantations but manage patients before or after transplantation. Candidates for HPC transplantation have specific and specialized transfusion requirements before, during, and after transplantation that are necessary to avert the adverse consequences of alloimmunization to human leukocyte antigens, immunohematologic consequences of ABO-mismatched transplantations, or immunosuppression. Decisions concerning blood transfusions during any of these times may compromise the outcome of an otherwise successful transplantation. Years after an HPC transplantation, and even during clinical remission, recipients may continue to be immunosuppressed and may have critically important, special transfusion requirements. Without a thorough understanding of these special requirements, provision of compatible blood components may be delayed and often urgent transfusion needs prohibit appropriate consultation with the patient's transplantation specialist. To optimize the relevance of issues and communication between clinical hematologists, transplantation physicians, and transfusion medicine physicians, the data and opinions presented in this review are organized by sequence of patient presentation, namely, before, during, and after transplantation. PMID:18583566

Food insecurity: consequences for the household and broader social implications.

PubMed

Hamelin, A M; Habicht, J P; Beaudry, M

1999-02-01

A conceptual framework showing the household and social implications of food insecurity was elicited from a qualitative and quantitative study of 98 households from a heterogeneous low income population of Quebec city and rural surroundings; the study was designed to increase understanding of the experience of food insecurity in order to contribute to its prevention. According to the respondents' description, the experience of food insecurity is characterized by two categories of manifestations, i.e., the core characteristics of the phenomenon and a related set of actions and reactions by the household. This second category of manifestations is considered here as a first level of consequences of food insecurity. These consequences at the household level often interact with the larger environment to which the household belongs. On a chronic basis, the resulting interactions have certain implications that are tentatively labeled "social implications" in this paper. Their examination suggests that important aspects of human development depend on food security. It also raises questions concerning the nature of socially acceptable practices of food acquisition and food management, and how such acceptability can be assessed. Guidelines to that effect are proposed. Findings underline the relevance and urgency of working toward the realization of the right to food.

The alcohol hangover research group consensus statement on best practice in alcohol hangover research.

PubMed

Verster, Joris C; Stephens, Richard; Penning, Renske; Rohsenow, Damaris; McGeary, John; Levy, Dan; McKinney, Adele; Finnigan, Frances; Piasecki, Thomas M; Adan, Ana; Batty, G David; Fliervoet, Lies A L; Heffernan, Thomas; Howland, Jonathan; Kim, Dai-Jin; Kruisselbrink, L Darren; Ling, Jonathan; McGregor, Neil; Murphy, René J L; van Nuland, Merel; Oudelaar, Marieke; Parkes, Andrew; Prat, Gemma; Reed, Nick; Slutske, Wendy S; Smith, Gordon; Young, Mark

2010-06-01

Alcohol-induced hangover, defined by a series of symptoms, is the most commonly reported consequence of excessive alcohol consumption. Alcohol hangovers contribute to workplace absenteeism, impaired job performance, reduced productivity, poor academic achievement, and may compromise potentially dangerous daily activities such as driving a car or operating heavy machinery. These socioeconomic consequences and health risks of alcohol hangover are much higher when compared to various common diseases and other health risk factors. Nevertheless, unlike alcohol intoxication the hangover has received very little scientific attention and studies have often yielded inconclusive results. Systematic research is important to increase our knowledge on alcohol hangover and its consequences. This consensus paper of the Alcohol Hangover Research Group discusses methodological issues that should be taken into account when performing future alcohol hangover research. Future research should aim to (1) further determine the pathology of alcohol hangover, (2) examine the role of genetics, (3) determine the economic costs of alcohol hangover, (4) examine sex and age differences, (5) develop common research tools and methodologies to study hangover effects, (6) focus on factor that aggravate hangover severity (e.g., congeners), and (7) develop effective hangover remedies.

[Male perceptions of sequelae associated with female genital mutilation].

PubMed

Jiménez-Ruiz, Ismael; Almansa Martínez, Pilar; Pastor Bravo, María Del Mar

2016-01-01

To explore men's knowledge of the negative consequences of female genital mutilation (FGM) to women's health in countries where this practice is performed. A qualitative methodology was used with an ethnomethodological approach. Both individual and group semi-structured interviews concerning FGM were conducted with 25 men, selected by triple sampling. A study presentation letter was provided to participants, together with an informed consent declaration. Permission was also procured to record the interviews in audio format. Data analysis was performed using the Atlas Ti7 software. Those participants against FGM are aware of the range of complications this practice can cause, being able to identify physical, obstetric, psychological, sexuality and social consequences in women subjected to FGM. However, those men who are in favour display a general ignorance of the problems resulting from this practice. Participants from countries where FGM is performed who are against this practice are more aware of the negative consequences than those who claim to be in favour. The design of awareness-raising programmes and other tools to combat female genital mutilation must highlight the implications for women's and girls' health, and include family-targeted campaigns which involve men in the process of eradicating this practice. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Multiple Causality: Consequences for Medical Practice

PubMed Central

Nydegger, Corinne N.

1983-01-01

When a scientifically trained health professional is called upon to deal with patients holding differing causal views of illness, the resulting lack of communication is frustrating to both. This discussion traces some implications for medical practice of significant cultural differences in two aspects of causal paradigms of illness: (1) terms accepted and (2) dimension or level of causality typically sought. The second is the more pervasive and intractable problem, having distinctive consequences for the role of curer, symptomatology, diagnosis and treatment. PMID:6858133

Review of Environmental Consequences of Waterway Design and Construction Practices as of 1979.

DTIC Science & Technology

1982-04-01

AD-A118 07Th VANDERISILT UNIV NASHVILLE I TN F/ ,2 REVIEW OF ENVIRONMENTAL CONSEQUENCES OF WATERWAY DESIGN AND CON-ETC(U U CLASSIFIED APR 82 E L... DESIGN AND CONSTRUCTION PRACTICES AS OF 1979 8. PERFORMING ORG. REPORT NUMEER 7. AUTHOR(q) S. CONTRACT OR GRANT NUMUER(t) Edward L. Thackston...numF*-" a I~mOlPi lt block ninr) >. Waterway projects designed and constructed by the Corps of Engineers (CE) include dikes, revetments, levees, and

Current Jewish perspectives on maternal identity.

PubMed

Wolowelsky, Joel B; Grazi, Richard V

2014-01-01

Infertility counseling is a specialized field that will continue to grow in coming years as the impact of infertility and its treatment is documented more in terms of emotional, physical, social and life consequences. We report here on more recent developments in halakha (Jewish law and ethics) that are of importance to Orthodox Jewish infertile couple considering donor gametes or surrogacy. Counselors should anticipate issues that may arise in the future and assist couples in their efforts to address them. Good medical practice values the importance of understanding the patient's individual concerns and values, including the complex psychological, sociological and cultural context in which they experience their infertility. Good counseling anticipates and addresses future problems about which patients might not currently be aware, and requires up-to-date authoritative information.

Should informed consent be based on rational beliefs?

PubMed Central

Savulescu, J; Momeyer, R W

1997-01-01

Our aim is to expand the regulative ideal governing consent. We argue that consent should not only be informed but also based on rational beliefs. We argue that holding true beliefs promotes autonomy. Information is important insofar as it helps a person to hold the relevant true beliefs. But in order to hold the relevant true beliefs, competent people must also think rationally. Insofar as information is important, rational deliberation is important. Just as physicians should aim to provide relevant information regarding the medical procedures prior to patients consenting to have those procedures, they should also assist patients to think more rationally. We distinguish between rational choice/action and rational belief. While autonomous choice need not necessarily be rational, it should be based on rational belief. The implication for the doctrine of informed consent and the practice of medicine is that, if physicians are to respect patient autonomy and help patients to choose and act more rationally, not only must they provide information, but they should care more about the theoretical rationality of their patients. They should not abandon their patients to irrationality. They should help their patients to deliberate more effectively and to care more about thinking rationally. We illustrate these arguments in the context of Jehovah's Witnesses refusing life-saving blood transfusions. Insofar as Jehovah's Witnesses should be informed of the consequences of their actions, they should also deliberate rationally about these consequences. PMID:9358347

Should informed consent be based on rational beliefs?

PubMed

Savulescu, J; Momeyer, R W

1997-10-01

Our aim is to expand the regulative ideal governing consent. We argue that consent should not only be informed but also based on rational beliefs. We argue that holding true beliefs promotes autonomy. Information is important insofar as it helps a person to hold the relevant true beliefs. But in order to hold the relevant true beliefs, competent people must also think rationally. Insofar as information is important, rational deliberation is important. Just as physicians should aim to provide relevant information regarding the medical procedures prior to patients consenting to have those procedures, they should also assist patients to think more rationally. We distinguish between rational choice/action and rational belief. While autonomous choice need not necessarily be rational, it should be based on rational belief. The implication for the doctrine of informed consent and the practice of medicine is that, if physicians are to respect patient autonomy and help patients to choose and act more rationally, not only must they provide information, but they should care more about the theoretical rationality of their patients. They should not abandon their patients to irrationality. They should help their patients to deliberate more effectively and to care more about thinking rationally. We illustrate these arguments in the context of Jehovah's Witnesses refusing life-saving blood transfusions. Insofar as Jehovah's Witnesses should be informed of the consequences of their actions, they should also deliberate rationally about these consequences.

Cardiovascular consequences of childhood obesity.

PubMed

McCrindle, Brian W

2015-02-01

Childhood and adolescent overweight and obesity is an important and increasingly prevalent public health problem in Canada and worldwide. High adiposity in youth is indicated in clinical practice by plotting body mass index on appropriate percentile charts normed for age and sex, although waist measures might be a further tool. High adiposity can lead to adiposopathy in youth, with associated increases in inflammation and oxidative stress, changes in adipokines, and endocrinopathy. This is manifest as cardiometabolic risk factors in similar patterns to those in noted in obese adults. Obesity and cardiometabolic risk factors have been shown to be associated with vascular changes indicative of early atherosclerosis, and ventricular hypertrophy, dilation, and dysfunction. These cardiovascular consequences are evident in youth, but childhood obesity is also predictive of similar consequences in adulthood. Childhood obesity and risk factors have been shown to track into adulthood and worsen in most individuals. The result is an exponential acceleration of atherosclerosis, which can be predicted to translate into an epidemic of premature cardiovascular disease and events. A change in paradigm is needed toward preventing and curing atherosclerosis and not just preventing cardiovascular disease. This would necessarily create an imperative for preventing and treating childhood obesity. Urgent attention, policy, and action are needed to avoid the enormous future social and health care costs associated with the cardiovascular consequences of obesity in youth. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Neurosurgical Practice in Transition: A Review.

PubMed

Kim, Dong H; Dagi, T Forcht; Bean, James R

2017-04-01

Neurosurgery is experiencing a period of acute change driven by 2 forces: (1) the perception that the healthcare system in the United States is wasteful and that patients are receiving low "value" care, (2) the belief that quality and long-term outcomes can be measured accurately. We believe 3 important shifts will emerge as a result of these forces. First, payment models will change. They will become anchored to a concept of population health, with capitation payments on a per-patient basis going to provider entities that undertake financial risk. Second, fee-for-service payments will be tied increasingly to administrative and clinical quality measures. Finally, out-of-pocket costs for patients will increase and affect both treatment decisions and willingness to participate in restrictive health care networks. In this review, we describe these changes and discuss possible consequences. We note the changing demographics of neurosurgical practices. Overall, independent private practices, managed by the neurosurgeons, will decline. The proportion of fee-for-service cases will decrease while cases reimbursed through capitation will increase. Physician integration with provider organizations, whether via full employment, a "lease," or some other arrangement, will also increase. We note the increasing importance of quality measures, and how they are likely to affect neurosurgical practices and reimbursement. We describe the advantages and disadvantages of fee-for-service and population health; describe opportunities and risks arising from these transitions; and outline strategies to thrive in a changing environment. Copyright © 2016 by the Congress of Neurological Surgeons.

Brazilian mothers' beliefs, attitudes and practices related to child weight status and early feeding within the context of nutrition transition.

PubMed

Lindsay, Ana Cristina; Machado, Marcia Tavares; Sussner, Katarina M; Hardwick, Cary K; Kerr, Ligia Regina Franco Sansigolo; Peterson, Karen E

2009-01-01

With the rapid pace of the nutrition transition worldwide, understanding influences of child feeding practices within a context characterized by the co-existence of overweight and undernutrition in the same population has increasing importance. This qualitative study describes Brazilian mothers' child feeding practices and their perceptions of their association with child weight status and explores the role of socioeconomic, cultural and organizational factors on these relationships. Forty-one women enrolled in the Family Health/Community Health Workers Programme were selected from rural, urban, coastal and indigenous areas in Ceara State, north-east Brazil, to participate in four focus group discussions. Content analysis identified fourteen emergent themes showing mothers' child feeding practices in this setting were influenced by economic resources, mothers' immediate social support networks (e.g. neighbours and family members) and participation in nutrition assistance programmes. Child malnutrition was the most common nutritional concern; nevertheless, mothers were aware of the negative health consequences of obesity but misunderstood its causes (e.g. foods filled with fat would make a person fat; others thought that birth control pills and stimulants given to children were causes of obesity); several reported their own struggles with overweight. Food assistance programmes emerged as an important influence on children's dietary adequacy, especially among mothers describing dire economic situations. The findings have implications for targeting food assistance as well as health and nutrition education strategies in low-income families undergoing the nutrition transition in north-east Brazil.

The Consequences of Glasnost.

ERIC Educational Resources Information Center

Zilper, Nadia

1991-01-01

Offers an overview of Soviet and Eastern European publishing practices. The history of communist publishing practices and the dramatic effect which Glasnost has had upon these practices are summarized. It is observed that highly unstable conditions in the USSR have severely jeopardized bibliographic control and hindered collection development in…

The Carrot and the Stick: A Cross-Sectional Study of the Influences on Responsible Merchant Practices to Reduce Underage Drinking.

PubMed

Ebener, Patricia; Malone, Patrick; Imm, Pamela; Osilla, Karen Chan; Paddock, Susan M; Wright, Patricia Ann; Burkhart, Q

2013-05-01

Alcohol merchants (N=331) completed a cross-sectional survey assessing their attitudes and beliefs about underage drinking, its likely consequences, requirements for responsible beverage service (RBS) training, and performance of RBS practices and checking IDs. Merchants requiring more rigorous RBS training (i.e., state-approved versus in-house or none) have stronger beliefs that outlets who sell to minors will get cited and that their employees know RBS practices. Also, merchants who engage in more RBS practices require more rigorous RBS training, and believe more strongly that outlets who sell to minors are more likely to face, and deserve, stricter sanctions. Merchants who check IDs more strictly conduct more RBS practices and believe more strongly that underage drinking is serious and will result in stronger consequences if caught selling to minors. These findings about the attitudes, practices, and enforcement of alcohol merchants suggests ways communities can better target their limited resources to prevent underage drinking.

Health economic evaluation of treatments for Alzheimer's disease: impact of new diagnostic criteria.

PubMed

Wimo, A; Ballard, C; Brayne, C; Gauthier, S; Handels, R; Jones, R W; Jonsson, L; Khachaturian, A S; Kramberger, M

2014-03-01

The socio-economic impact of Alzheimer's disease (AD) and other dementias is enormous, and the potential economic challenges ahead are clear given the projected future numbers of individuals with these conditions. Because of the high prevalence and cost of dementia, it is very important to assess any intervention from a cost-effectiveness viewpoint. The diagnostic criteria for preclinical AD suggested by the National Institute on Aging and Alzheimer's Association workgroups in combination with the goal of effective disease-modifying treatment (DMT) are, however, a challenge for clinical practice and for the design of clinical trials. Key issues for future cost-effectiveness studies include the following: (i) the consequences for patients if diagnosis is shifted from AD-dementia to predementia states, (ii) bridging the gap between clinical trial populations and patients treated in clinical practice, (iii) translation of clinical trial end-points into measures that are meaningful to patients and policymakers/payers and (iv) how to measure long-term effects. To improve cost-effectiveness studies, long-term population-based data on disease progression, costs and outcomes in clinical practice are needed not only in dementia but also in predementia states. Reliable surrogate end-points in clinical trials that are sensitive to detect effects even in predementia states are also essential as well as robust and validated modelling methods from predementia states that also take into account comorbidities and age. Finally, the ethical consequences of early diagnosis should be considered. © 2014 The Association for the Publication of the Journal of Internal Medicine.

Chronic morbidities after traumatic brain injury: an update for the advanced practice nurse.

PubMed

Bay, Esther H; Chartier, Kattlynn S

2014-06-01

Emerging data suggest that traumatic brain injury (TBI) is a disease process with considerable long-range morbidities requiring lifelong monitoring and treatment. Multiple chronic morbidities develop across the life span after TBI, including mental health disorders, headaches, seizures, and neuroendocrine imbalances as well as chronic diseases. Still, there has been limited focus on effective guides and strategies for helping persons with TBI meet their chronic health needs as they live with the consequences of TBI. The advanced practice nurse is well positioned to participate collaboratively in practices that promote health screening and chronic disease management after TBI to ameliorate distress and enhance quality of life as persons with TBI live with lifelong consequences.

[Carry forward the successes].

PubMed

1983-02-27

Achievements of the National Publicity Month on Family Planning in China came about for the following reasons: the Party Central Committee and the State Council formulated correct principles and policies and party committees and governments at all levels strengthened their leadership; the people, particularly the peasants, responded enthusiastically to the calls and actively began to practice family planning; and all relevant departments along with the staff in family planning and medical units actively participated in the work. Recognizing the achievements of the publicity month, it is necessary to acknowledge the fact that work in family planning continues to be a longterm and arduous effort. China is entering a 15-year period of peak fertility. Each year 20 million couples will be entering the marriage and fertility age, and the slightest relaxation in birth planning will result in great swells in population and irrevocable consequences. Efforts cannot be relaxed. It is essential to keep up the momentum generated by the publicity month and to expand achievements. An important experience gained in the publicity month is that all localities should form 3 contingents of people: a publicity contingent; a technical contingent; and an activist continent. Their efforts are the guarantee to success in family planning. Thus far, China has trained 15 million publicity workers and 750,000 technical personnel. Large numbers of activists have also emerged from among the people. It is important to continue to educate the people. Experience shows that an effective method is to demonstrate possible results with specific calculations and make comparisons. Explaining Chinese realities and possible consequences without family planning should help the peasants to understand the relationship between family planning and the future of China. Publicity and education must be integrated with implementation of birth control measures. Specific guidance on how to practice birth control must be provided.

Succession in the petroleum reservoir microbiome through an oil field production lifecycle.

PubMed

Vigneron, Adrien; Alsop, Eric B; Lomans, Bartholomeus P; Kyrpides, Nikos C; Head, Ian M; Tsesmetzis, Nicolas

2017-09-01

Subsurface petroleum reservoirs are an important component of the deep biosphere where indigenous microorganisms live under extreme conditions and in isolation from the Earth's surface for millions of years. However, unlike the bulk of the deep biosphere, the petroleum reservoir deep biosphere is subject to extreme anthropogenic perturbation, with the introduction of new electron acceptors, donors and exogenous microbes during oil exploration and production. Despite the fundamental and practical significance of this perturbation, there has never been a systematic evaluation of the ecological changes that occur over the production lifetime of an active offshore petroleum production system. Analysis of the entire Halfdan oil field in the North Sea (32 producing wells in production for 1-15 years) using quantitative PCR, multigenic sequencing, comparative metagenomic and genomic bins reconstruction revealed systematic shifts in microbial community composition and metabolic potential, as well as changing ecological strategies in response to anthropogenic perturbation of the oil field ecosystem, related to length of time in production. The microbial communities were initially dominated by slow growing anaerobes such as members of the Thermotogales and Clostridiales adapted to living on hydrocarbons and complex refractory organic matter. However, as seawater and nitrate injection (used for secondary oil production) delivered oxidants, the microbial community composition progressively changed to fast growing opportunists such as members of the Deferribacteres, Delta-, Epsilon- and Gammaproteobacteria, with energetically more favorable metabolism (for example, nitrate reduction, H 2 S, sulfide and sulfur oxidation). This perturbation has profound consequences for understanding the microbial ecology of the system and is of considerable practical importance as it promotes detrimental processes such as reservoir souring and metal corrosion. These findings provide a new conceptual framework for understanding the petroleum reservoir biosphere and have consequences for developing strategies to manage microbiological problems in the oil industry.

Pharmacy Practice Department Chairs’ Perspectives on Part-Time Faculty Members

PubMed Central

Winkler, Susan R.; Mai, Thy

2012-01-01

Objective. To identify the benefits and consequences of having part-time faculty members in departments of pharmacy practice from the department chair’s perspective. Methods. A stratified purposive sample of 12 pharmacy practice department chairs was selected. Eleven telephone interviews were conducted. Two investigators independently read interview notes and categorized and enumerated responses to determine major themes using content analysis. The investigators jointly reviewed the data and came to consensus on major themes. Results. Benefits of allowing full-time faculty members to reduce their position to part-time included faculty retention and improved individual faculty work/life balance. Consequences of allowing part-time faculty positions included the challenges of managing individual and departmental workloads, the risk of marginalizing part-time faculty members, and the challenges of promotion and tenure issues. All requests to switch to part-time status were faculty-driven and most were approved. Conclusions. There are a variety of benefits and consequences of having part-time faculty in pharmacy practice departments from the chair’s perspective. Clear faculty and departmental expectations of part-time faculty members need to be established to ensure optimal success of this working arrangement. PMID:22611268

"The Eyes of the Power Company": Workplace Information Practices of a Vault Inspector

ERIC Educational Resources Information Center

Veinot, Tiffany C.

2007-01-01

To date, LIS studies of workplace information practices have primarily focused on occupations that require a university education, and, consequently, little is known about the information practices of blue-collar workers. This study uses a qualitative case study approach to examine the workplace information practices of a blue-collar worker--a…

More than a message: framing public health advocacy to change corporate practices.

PubMed

Dorfman, Lori; Wallack, Lawrence; Woodruff, Katie

2005-06-01

Framing battles in public health illustrate the tension in our society between individual freedom and collective responsibility. This article describes how two frames, market justice and social justice, first articulated in a public health context by Dan Beauchamp, influence public dialogue on the health consequences of corporate practices. The authors argue that public health advocates must articulate the social justice values motivating the changes they seek in specific policy battles that will be debated in the context of news coverage. The authors conclude with lessons for health education practitioners who need to frame public health issues in contentious and controversial policy contexts. Specific lessons include the importance of understanding the existing values and beliefs motivating the public health change being sought, the benefits of articulating core messages that correspond to shared values, and the necessity of developing media skills to compete effectively with adversaries in public debate.

Analytical solutions for coagulation and condensation kinetics of composite particles

NASA Astrophysics Data System (ADS)

Piskunov, Vladimir N.

2013-04-01

The processes of composite particles formation consisting of a mixture of different materials are essential for many practical problems: for analysis of the consequences of accidental releases in atmosphere; for simulation of precipitation formation in clouds; for description of multi-phase processes in chemical reactors and industrial facilities. Computer codes developed for numerical simulation of these processes require optimization of computational methods and verification of numerical programs. Kinetic equations of composite particle formation are given in this work in a concise form (impurity integrated). Coagulation, condensation and external sources associated with nucleation are taken into account. Analytical solutions were obtained in a number of model cases. The general laws for fraction redistribution of impurities were defined. The results can be applied to develop numerical algorithms considerably reducing the simulation effort, as well as to verify the numerical programs for calculation of the formation kinetics of composite particles in the problems of practical importance.

Assessing admixture by multivariate analyses of phenotypic differentiation in the Algerian goat livestock.

PubMed

Ouchene-Khelifi, Nadjet-Amina; Ouchene, Nassim; Maftah, Abderrahman; Da Silva, Anne Blondeau; Lafri, Mohamed

2015-10-01

In Algeria, goat research has been largely neglected, in spite of the economic importance of this domestic species for rural livelihoods. Goat farming is traditional and cross-breeding practices are current. The phenotypic variability of the four main native breeds (Arabia, Makatia, M'zabite and Kabyle), and of two exotic breeds (Alpine and Saanen), was investigated for the first time, using multivariate discriminant analysis. A total of 892 females were sampled in a large area, including the cradle of the native breeds, and phenotyped with 23 quantitative measures and 10 qualitative traits. Our results suggested that cross-breeding practices have ever led to critical consequences, particularly for Makatia and M'zabite. The information reported in this study has to be carefully considered in order to establish governmental plan able to prevent the genetic dilution of the Algerian goat livestock.

Motivational Influences on the Safer Sex Behavior of Agency-based Male Sex Workers

PubMed Central

Smith, Michael D.; Seal, David W.

2017-01-01

Although indoor male sex workers (MSWs) have been found to engage in lower rates of HIV risk behavior with clients than street-based MSWs, few studies have examined the motivations behind such practices. We interviewed 30 MSWs working for the same escort agency regarding their safer sex practices with clients and their reasons for these. As in other research, MSWs reported little risk behavior with clients. Five motivational themes related to safer sex on the job emerged: health concerns, emotional intimacy, client attractiveness, relationships, and structural work factors. Results suggest that participants engaged in rational decision-making relative to sex with clients, facilitated by reduced economic incentive for riskier behavior and a supportive social context. MSWs desired a safe sexual work place, personal integrity, and minimal negative consequences to personal relationships. Collaborating with sex work employers to study their role in encouraging a safer workplace may be important to future research. PMID:18288599

Cyber security: a critical examination of information sharing versus data sensitivity issues for organisations at risk of cyber attack.

PubMed

Mallinder, Jason; Drabwell, Peter

Cyber threats are growing and evolving at an unprecedented rate.Consequently, it is becoming vitally important that organisations share information internally and externally before, during and after incidents they encounter so that lessons can be learned, good practice identified and new cyber resilience capabilities developed. Many organisations are reluctant to share such information for fear of divulging sensitive information or because it may be vague or incomplete. This provides organisations with a complex dilemma: how to share information as openly as possibly about cyber incidents, while protecting their confidentiality and focusing on service recovery from such incidents. This paper explores the dilemma of information sharing versus sensitivity and provides a practical overview of considerations every business continuity plan should address to plan effectively for information sharing in the event of a cyber incident.

Motivational influences on the safer sex behavior of agency-based male sex workers.

PubMed

Smith, Michael D; Seal, David W

2008-10-01

Although indoor male sex workers (MSWs) have been found to engage in lower rates of HIV risk behavior with clients than street-based MSWs, few studies have examined the motivations behind such practices. We interviewed 30 MSWs working for the same escort agency regarding their safer sex practices with clients and their reasons for these. As in other research, MSWs reported little risk behavior with clients. Five motivational themes related to safer sex on the job emerged: health concerns, emotional intimacy, client attractiveness, relationships, and structural work factors. Results suggest that participants engaged in rational decision-making relative to sex with clients, facilitated by reduced economic incentive for riskier behavior and a supportive social context. MSWs desired a safe sexual work place, personal integrity, and minimal negative consequences to personal relationships. Collaborating with sex work employers to study their role in encouraging a safer workplace may be important to future research.

Evaluation of the Quality of Occupational Health and Safety Management Systems Based on Key Performance Indicators in Certified Organizations.

PubMed

Mohammadfam, Iraj; Kamalinia, Mojtaba; Momeni, Mansour; Golmohammadi, Rostam; Hamidi, Yadollah; Soltanian, Alireza

2017-06-01

Occupational Health and Safety Management Systems are becoming more widespread in organizations. Consequently, their effectiveness has become a core topic for researchers. This paper evaluates the performance of the Occupational Health and Safety Assessment Series 18001 specification in certified companies in Iran. The evaluation is based on a comparison of specific criteria and indictors related to occupational health and safety management practices in three certified and three noncertified companies. Findings indicate that the performance of certified companies with respect to occupational health and safety management practices is significantly better than that of noncertified companies. Occupational Health and Safety Assessment Series 18001-certified companies have a better level of occupational health and safety; this supports the argument that Occupational Health and Safety Management Systems play an important strategic role in health and safety in the workplace.

Ethics in age estimation of unaccompanied minors.

PubMed

Thevissen, P W; Kvaal, S I; Willems, G

2012-11-30

Children absconding from countries of conflict and war are often not able to document their age. When an age is given, it is frequently untraceable or poorly documented and therefore questioned by immigration authorities. Consequently many countries perform age estimations on these children. Provision of ethical practice during the age estimation investigation of unaccompanied minors is considered from different angles: (1) The UN convention on children's rights, formulating specific rights, protection, support, healthcare and education for unaccompanied minors. (2) Since most age estimation investigations are based on medical examination, the four basic principles of biomedical ethics, namely autonomy, beneficence, non-malevolence, justice. (3) The use of medicine for non treatment purposes. (4) How age estimates with highest accuracy in age prediction can be obtained. Ethical practice in age estimation of unaccompanied minors is achieved when different but related aspects are searched, evaluated, weighted in importance and subsequently combined. However this is not always feasible and unanswered questions remain.

Using patient values and preferences to inform the importance of health outcomes in practice guideline development following the GRADE approach.

PubMed

Zhang, Yuan; Coello, Pablo Alonso; Brożek, Jan; Wiercioch, Wojtek; Etxeandia-Ikobaltzeta, Itziar; Akl, Elie A; Meerpohl, Joerg J; Alhazzani, Waleed; Carrasco-Labra, Alonso; Morgan, Rebecca L; Mustafa, Reem A; Riva, John J; Moore, Ainsley; Yepes-Nuñez, Juan José; Cuello-Garcia, Carlos; AlRayees, Zulfa; Manja, Veena; Falavigna, Maicon; Neumann, Ignacio; Brignardello-Petersen, Romina; Santesso, Nancy; Rochwerg, Bram; Darzi, Andrea; Rojas, Maria Ximena; Adi, Yaser; Bollig, Claudia; Waziry, Reem; Schünemann, Holger J

2017-05-02

There are diverse opinions and confusion about defining and including patient values and preferences (i.e. the importance people place on the health outcomes) in the guideline development processes. This article aims to provide an overview of a process for systematically incorporating values and preferences in guideline development. In 2013 and 2014, we followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to adopt, adapt and develop 226 recommendations in 22 guidelines for the Ministry of Health of the Kingdom of Saudi Arabia. To collect context-specific values and preferences for each recommendation, we performed systematic reviews, asked clinical experts to provide feedback according to their clinical experience, and consulted patient representatives. We found several types of studies addressing the importance of outcomes, including those reporting utilities, non-utility measures of health states based on structured questionnaires or scales, and qualitative studies. Guideline panels used the relative importance of outcomes based on values and preferences to weigh the balance of desirable and undesirable consequences of alternative intervention options. However, we found few studies addressing local values and preferences. Currently there are different but no firmly established processes for integrating patient values and preferences in healthcare decision-making of practice guideline development. With GRADE Evidence-to-Decision (EtD) frameworks, we provide an empirical strategy to find and incorporate values and preferences in guidelines by performing systematic reviews and eliciting information from guideline panel members and patient representatives. However, more research and practical guidance are needed on how to search for relevant studies and grey literature, assess the certainty of this evidence, and best summarize and present the findings.

Information literacy skills and training of licensed practical nurses in Alberta, Canada: results of a survey.

PubMed

Wadson, Kelley; Phillips, Leah Adeline

2018-06-01

Although information literacy skills are recognized as important to the curriculum and professional outcomes of two-year nursing programs, there is a lack of research on the information literacy skills and support needed by graduates. To identify the information literacy skills and consequent training and support required of Licensed Practical Nurses (LPNs) in Alberta, Canada. An online survey using a random sample of new graduates (graduated within 5 years) from the registration database of the College of Practical Nurses of Alberta (CLPNA). There was a 43% response rate. Approximately 25-38% of LPNs felt they were only moderately or to a small extent prepared to use evidence effectively in their professional practice. LPNs use the internet and websites most frequently, in contrast to library resources that are used least frequently. Developing lifelong learning skills, using information collaboratively, and locating and retrieving information are areas where LPNs desire more effective or increased training. The results suggest there are significant gaps in the preparedness and ability of LPNs to access and apply research evidence effectively in the workplace. There are several areas in which the training provided by Librarians appears either misaligned or ineffective. © 2018 Health Libraries Group.

A gut feeling? Intuition and critical care nursing.

PubMed

Hams, S P

2000-10-01

As nurses, we are knowledgeable about nursing and able, immediately and intuitively, to identify the needs and demands of a given situation. Experienced nurses practise intuitively by virtue of having developed, through critical thought, a deeply grounded knowledge base that can be applied in daily practice. Each gains knowledge about nursing practice in such a way that every clinical experience becomes a lesson which informs the next experience. There is continued debate over the domain of nursing knowledge, where it originates and to whom it belongs. Much of nursing knowledge has emerged from the practice of other professions. There now appears to be an increasing focus within today's modern healthcare environment on the importance of measurable outcomes and the need to predict the consequences of all interventions. The strength of our intuition often urges us to do something more for the patient. When we as nurses report our intuitions, subjective feelings are often at odds with the objective signs and symptoms. Nurses have made great strides in recognizing, analysing and teaching concepts related to logical, rational decision-making. It is imperative, however, also to recognize and teach the concepts related to the intuitive and precognitive components of making decisions in clinical practice.

Drug reimportation practices in the United States

PubMed Central

Bhosle, Monali J; Balkrishnan, Rajesh

2007-01-01

Background Drug reimportation is perceived as a costs-cutting strategy by Americans. Nonetheless, issues such as drug safety and efficacy prevent legalization of the practice. With the contradictory views from supporters and opponents, debate on drug reimportation continues to snowball. The objective of this commentary is to discuss issues regarding drug reimportation practices in the United States (US). It also examines policy implications and potential solutions of the controversy. Findings Comparatively inexpensive drugs available across the border help Americans relieve the burden of medication costs. Consequently, the volume of reimported drugs entering the US has considerably increased. However, these practices are illegal and legalization of drug reimportation is a political debate. While safety is the most important barrier for legalization, this concern does not seem to affect growing number of Americans who are getting their prescriptions filled from across the border. Canadians oppose legalization of reimportation in the US as it could exacerbate the problem of medication shortage in Canada. Summary Currently, legalization of dug reimportation has wedged between the arguments by different groups. Until the US government finds a solution to reduce medication costs, it seems to be impossible to stop Americans from buying the comparatively inexpensive medications available across the border. PMID:18360614

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

PubMed

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

2013-01-01

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

The pedagogy of argumentation in science education: science teachers' instructional practices

NASA Astrophysics Data System (ADS)

Özdem Yilmaz, Yasemin; Cakiroglu, Jale; Ertepinar, Hamide; Erduran, Sibel

2017-07-01

Argumentation has been a prominent concern in science education research and a common goal in science curriculum in many countries over the past decade. With reference to this goal, policy documents burden responsibilities on science teachers, such as involving students in dialogues and being guides in students' spoken or written argumentation. Consequently, teachers' pedagogical practices regarding argumentation gain importance due to their impact on how they incorporate this practice into their classrooms. In this study, therefore, we investigated the instructional strategies adopted by science teachers for their argumentation-based science teaching. Participants were one elementary science teacher, two chemistry teachers, and four graduate students, who have a background in science education. The study took place during a graduate course, which was aimed at developing science teachers' theory and pedagogy of argumentation. Data sources included the participants' video-recorded classroom practices, audio-recorded reflections, post-interviews, and participants' written materials. The findings revealed three typologies of instructional strategies towards argumentation. They are named as Basic Instructional Strategies for Argumentation, Meta-level Instructional ‌St‌‌rategies for ‌Argumentation, and Meta-strategic Instructional ‌St‌‌rategies for ‌Argumentation. In conclusion, the study provided a detailed coding framework for the exploration of science teachers' instructional practices while they are implementing argumentation-based lessons.

Consequences count: against absolutism at the end of life.

PubMed

Snelling, Paul C

2004-05-01

There has been a considerable amount of debate in the nursing literature about euthanasia, and especially the distinctions between acts and omissions, and killing and letting die. These distinctions are required by opponents of euthanasia to justify allowing some cases of passive euthanasia while forbidding all cases of active euthanasia. This paper adds to the debate by arguing that the position that absolutely forbids euthanasia is theoretically inconsistent. The paper first considers the place of moral theory in analysing moral problems, within the framework of the principles of biomedical ethics. It is argued that despite a moral pluralism that operates in many areas, the legal status of euthanasia is based upon an absolute deontological position against deliberate killing, which cannot be overridden by appeals to favourable consequences. In order that certain forms of passive euthanasia can be allowed, this position allows distinctions within three pairs of concepts--acts and omissions, killing and letting die, and ordinary and extraordinary means. A further method of justifying certain actions near the end of life is the doctrine of double effect. These paired concepts and the doctrine of double effect are analysed with special reference to their consequences. The application of the doctrine of double effect and the three distinctions relies on consideration of their consequences, allowing in practice what in theory is denied. This is important because it weakens the absolute case against euthanasia, which disallows any direct consequentialist appeal. If consequences count in the application of the doctrine and the distinctions, then they should also count directly prior to their application. This strengthens the argument for active euthanasia in certain cases.

An Investigation of Tertiary-Level Learning in Some Practical Physics Courses

ERIC Educational Resources Information Center

Wang, Weili; Coll, Richard K.

2005-01-01

Experimental physics is seen as an essential part of tertiary physics education. Students are supposed to develop practical skills and advance from closed "cookbook" experiments to open experiment and design experiment procedures independently. As a consequence tertiary practical physics courses increase in the level of challenge…

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

ERIC Educational Resources Information Center

Strandler, Ola

2015-01-01

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

The New Racism in Education.

ERIC Educational Resources Information Center

Pressman, Harvey; Gartner, Alan

1986-01-01

Discusses the current practice in the U.S. of standardized testing of teachers as a response to the perceived failures of public schools. Focuses on the position that this practice reduces the already low percentage of minority teachers in the schools. Reviews testing practices in various states and the consequences encountered. (SA)

Evidence-Based Practice: Integrating Classroom Curriculum and Field Education

ERIC Educational Resources Information Center

Tuchman, Ellen; Lalane, Monique

2011-01-01

This article describes the use of problem-based learning to teach the scope and consequences of evidence-based practices in mental health through an innovative assignment that integrates classroom and field learning. The authors illustrate the planning and implementation of the Evidence-Based Practice: Integrating Classroom Curriculum and Field…

Identifying and Extinguishing Dysfunctional and Deadly Organizational Practices

ERIC Educational Resources Information Center

Mawhinney, Thomas C.

2009-01-01

It is possible to define an organization's culture in terms of its dominant behavioral practices and their molar consequences, from the shop floor to the executive suite (Redmon & Mason, 2001). Dysfunctional and potentially deadly practices (for the organization as a whole) can be "latent." They often go undetected until their…

Risk factors for dental problems: Recommendations for oral health in infancy.

PubMed

Wagner, Yvonne; Heinrich-Weltzien, Roswitha

2017-11-01

Primary care providers, gynaecologists and paediatricians have to be aware of the importance of oral health in infancy and possible consequences for child's development, growth, health and quality of life. Oral diseases, particularly dental caries, developmental defects of the dental tissues and periodontal or orthodontic issues have a complex and interrelated aetiology with common, primarily behavioral based risk factors. A sugar-rich diet is the key risk factor with detrimental consequences for general and oral health, particularly in combination with an insufficient oral hygiene. Therefore, daily tooth brushing with fluoride toothpaste and reducing of sugar intake are the key pillars to prevent oral diseases, including a positive effect on numerous chronic diseases. Future preventive approaches should focus on pregnant women and mothers of infants with a common vision of health and a shared responsibility for children's oral health care to promote healthy lifestyles and self-care practices in families. Copyright © 2017 Elsevier B.V. All rights reserved.

An investigation into the socioeconomic aspects of two major earthquakes in Iran.

PubMed

Amini Hosseini, Kambod; Hosseinioon, Solmaz; Pooyan, Zhila

2013-07-01

An evaluation of the socioeconomic consequences of earthquakes is an essential part of the development of risk reduction and disaster management plans. However, these variables are not normally addressed sufficiently after strong earthquakes; researchers and relevant stakeholders focus primarily on the physical damage and casualties. The importance of the socioeconomic consequences of seismic events became clearer in Iran after the Bam earthquake on 26 December 2003, as demonstrated by the formulation and approval of various laws and ordinances. This paper reviews the country's regulatory framework in the light of the socioeconomic aspects of two major and destructive earthquakes: in Manjil-Rudbar in 1990, and in Bam in 2003. The results take the form of recommendations and practical strategies for incorporating the socioeconomic dimensions of earthquakes in disaster risk management planning. The results presented here can be applied in other countries with similar conditions to those of Iran in order to improve public preparedness and risk reduction. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

Core values versus common sense: consequentialist views appear less rooted in morality.

PubMed

Kreps, Tamar A; Monin, Benoît

2014-11-01

When a speaker presents an opinion, an important factor in audiences' reactions is whether the speaker seems to be basing his or her decision on ethical (as opposed to more pragmatic) concerns. We argue that, despite a consequentialist philosophical tradition that views utilitarian consequences as the basis for moral reasoning, lay perceivers think that speakers using arguments based on consequences do not construe the issue as a moral one. Five experiments show that, for both political views (including real State of the Union quotations) and organizational policies, consequentialist views are seen to express less moralization than deontological views, and even sometimes than views presented with no explicit justification. We also demonstrate that perceived moralization in turn affects speakers' perceived commitment to the issue and authenticity. These findings shed light on lay conceptions of morality and have practical implications for people considering how to express moral opinions publicly. © 2014 by the Society for Personality and Social Psychology, Inc.

Evidence-based policy responses to strengthen health, community and legislative systems that care for women in Australia with female genital mutilation / cutting.

PubMed

Varol, Nesrin; Hall, John J; Black, Kirsten; Turkmani, Sabera; Dawson, Angela

2017-05-18

The physical and psychological impact of female genital mutilation / cutting (FGM/C) can be substantial, long term, and irreversible. Parts of the health sector in Australia have developed guidelines in the management of FGM/C, but large gaps exist in community and professional knowledge of the consequences and treatment of FGM/C. The prevalence of FGM/C amongst Australian women is unknown. Our article reviews the literature on research on FGM/C in Australia, which focuses on health system response to women and girls with FGM/C. Recommendations are made for policy reform in health, legislation, and community programs to provide the best healthcare, protect children, and help communities abandon this harmful practice. Midwives and doctors in Australia acknowledged a lack of knowledge on FGM/C, clinical guidelines and consequences for maternity care. In a metropolitan Australian hospital with specialised FGM/C care, women with FGM/C had similar obstetric outcomes as women without FGM/C, underlining the importance of holistic FGM/C clinics. Greater focus on integration of refugee and migrant populations into their new cultures may be an important way of facilitating the abandonment of this practice, as is education of communities that practise FGM/C, and experts involved in the care and protection of children. Men could be important advocates for protecting women and girls from violence and FGM/C through a man-to-man strategy with programs focussing on men's health and other personal issues, education, and communication. The Australian Government has identified gender-based violence as an area of priority and has been implementing a National plan to reduce violence against women and their children 2010-2022. A multidisciplinary network of experts on FGM/C could be established within this taskforce to develop well-defined and rapid referral pathways to care for and protect these children, as well as coordinate education and prevention programs to help communities abandon this harmful practice. Countries of migration can be part of the solution for abandonment of FGM/C through community interventions and implementation of national and coordinated training in FGM/C of experts involved in the care and protection of children and women. The global focus on collaboration on research, training and prevention programs should be fostered between countries of FGM/C prevalence and migration.

Trade-offs and spatial dependency of rice production and environmental consequences at community level in Southeastern China

NASA Astrophysics Data System (ADS)

Xu, Hui; Liu, Zhong; Wang, Lihua; Wan, Haibo; Jing, Changwei; Jiang, Jingang; Wu, Jiaping; Qi, Jiaguo

2018-02-01

Over the past three decades, farmers in China have increasingly used fertilizers to increase paddy rice production. While this approach has eased the rising demand for food, it is unclear whether it pays off in the long-run when costs associated with environmental consequences are considered. Using two case studies in Zhejiang Province, China, this paper analyzed field-based rice yields, fertilizer inputs, nitrogen leaching and greenhouse emissions and their socioeconomic values of different farm practices. The objective was to assess the trade-offs among economic gains from increased yield and environmental consequences of different paddy rice management practices. The results indicated short-term economic gains to farmers outweigh the environmental cost concerns. However, considering the lasting environmental effects, there is a significant imbalance toward a conservative farming practice. The results further indicated that synergies can be achieved if precision management practices are adopted. It was also indicated that a large spatial variation exists in yields and environmental impacts, suggesting ‘one-size fits all’ policies will likely be ineffective in reducing environmental impacts. Although only two case studies were demonstrated in this study, the approach may be generalized to other geographic regions to help guide paddy farmers in similar climatic and land use environments such as those in the subtropical regions of Southeast Asia, to achieve synergic environment practices.

Longitudinal Health Consequences of Socioeconomic Disadvantage: Examining Perceived Discrimination as a Mediator

PubMed Central

Fuller-Rowell, Thomas E.; Curtis, David S.; Chae, David H.; Ryff, Carol D.

2018-01-01

Objective Foundational theoretical perspectives suggest that socioeconomic disadvantage (SED) increases an individual’s risk of being exposed to unfair treatment or discrimination. However, little empirical attention has been given to the role of perceived discrimination in the SED-health gradient. Addressing this knowledge gap, the current study examined the mediating role of discrimination in the longitudinal association between SED and self-rated health. Methods Participants in the Midlife in the United States (MIDUS) study were followed over three waves covering a 17–19 year period (N = 6286; 53% female; 91% White; Mean Age at baseline = 47 years, SD = 13). SED was assessed from education, occupational prestige, income, and assets; self-rated health was measured at baseline and follow-up assessments. Two measures of discrimination—perceived inequality in work and everyday discrimination—were considered as mediators. Results Both measures of discrimination emerged as important explanatory variables in the link between SED and health. SED at the baseline assessment was associated with changes in self-rated health over the 17–19 year period (B = −.15, p < .001). Measures of discrimination partially mediated this longitudinal association, explaining 22% of the total effect. Exposure to discrimination and its health consequences were also more pronounced at younger ages. Conclusion Additional research is needed to replicate the findings of this study using objective health measures and to examine possible interventions. Challenging the ideologies and practices that underlie social class-related discrimination, or mitigating its harmful consequences, will both be important approaches to consider. PMID:29698020

Can new doctors be prepared for practice? A review.

PubMed

Alexander, Cameron; Cameron, Alexander; Millar, James; Szmidt, Natasha; Hanlon, Katie; Cleland, Jennifer

2014-06-01

The transition from medical student to junior doctor is an important period of change. Research shows junior doctors often experience high levels of stress, and consequently burnout. Understanding how to prepare for the transition may allow individuals who are likely to struggle to be identified and assisted. The aim of this paper is to systematically review the literature on preparedness for practice in newly qualified junior doctors. This was a systematic review of literature concerning the transition from student to junior doctor, published in the last 10 years, and that measured or explored one or more factors affecting preparedness. Nine papers were included in this review. These varied in design and methodological quality. Most used survey methodology (n = 7). Six found knowledge and skills, particularly deficiencies in prescribing and practical procedures, relevant in terms of preparedness. Five looked at personal traits, with high levels of neuroticism and low confidence deemed to be important. Medical school and workplace factors, including early clinical experience and shadowing, positively affected preparedness. A lack of senior support proved detrimental. The influence of demographics was inconclusive. The studies reviewed indicate that both personal and organisational factors are pertinent to managing the transition from student to junior doctor. Further prospective studies, both qualitative and quantitative, drawing on theories of change, are required to identify what precise factors would make a difference to this transition. © 2014 John Wiley & Sons Ltd.

'I expected just to walk in, get my tablets and then walk out': on framing new community pharmacy services in the English healthcare system.

PubMed

Latif, Asam; Waring, Justin; Watmough, Deborah; Boyd, Matthew J; Elliott, Rachel A

2018-04-19

Reconfiguration of the healthcare division of labour is becoming increasingly attractive in the context of increased patient demand and resource constraints. One example is the introduction of extended roles for pharmacists to provide patients additional support to manage their medicines, while also reducing work pressures experienced by other health professionals. Understanding how such policies are framed by those delivering and receiving care has been under-theorised. Using Goffman's frame theory, we examine one newly introduced community pharmacy service (New Medicines Service (NMS)) to illustrate how a policy intended to support patient medicine-taking through the extended roles of pharmacists is framed and where this deviates from its proposed aims. Three themes emerged: (i) the spatial-material artefacts; (ii) existing discursive culture and practice around medicine-taking; and (iii) the NMS interactions that shape and govern framing and subsequent interpretation of the NMS. Our study offers an explanatory and dynamic view of the framing process with important lessons for reconfiguring medicine management policy and practice. As well as illustrating framing as being variegated, complementary or conflicting, it also shows how this plurality and fragility had consequences for patient engagement and sense-making. The consequences for engagement and recommendations for implementing future initiatives are discussed. © 2018 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.

Nursing Fatigue: An Evidence-Based Practice Review for Oncology Nurses
.

PubMed

Ferris, Jordan

2015-12-01

Nursing fatigue is a current and well-researched topic. Many negative outcomes and consequences exist for patients and nurses that have been linked to nursing fatigue. Medical errors are one such consequence, and these errors have become one of the top three preventable deaths in the United States. Oncology nurses are not immune to fatigue, and the consequences of their fatigue can be much more harmful to patients.

[Teaching practices and the position concerning medical education].

PubMed

Medina-Figueroa, Alda María; Espinosa-Alarcón, Patricia Atzimba; Viniegra-Velázquez, Leonardo

2008-01-01

Estimate the degree of development of a position concerning medical education, in a phisician population. We carried out a cross-sectional study at with 1580 physicians; we selected 395 participants by non-proportional stratified sampling of an IMSS health facility; 244 (62 %) was medical professors, included 15 physicians responsible for education. A previously validated instrument was applied to these participants. Three indicators were evaluated: agreement in general, most popular trend, and consequence. Group grading was done blindly. Kuder-Richardson test was utilized to calculate the value of internal instrument consistency and nonparametric statistics < 0.05. Answering tendency in agreement were similar among physicians; heads or managers were statistically significant. The most popular trend was participative. In terms of consequence in physicians, there were some without consequent sentences in pair. The most popular trend was participative, although it would appear that this has not been pondered, in that on exploring the indicator, that of consequence. Teaching practices do not have any significant influence on the development of a position concerning medical education.

The influence of father's child feeding knowledge and practices on children's dietary diversity: a study in urban and rural districts of Northern Ethiopia, 2013.

PubMed

Bilal, Selamawit M; Dinant, GeertJan; Blanco, Roman; Crutzen, Rik; Mulugeta, Afework; Spigt, Mark

2016-07-01

Infant and young child feeding has been recognised as an essential element to improve growth of children, especially in developing countries where malnutrition among children and its dire consequences are very prevalent. However, little attention has been paid on the influence of fathers on child feeding practices, although fathers are very important in raising well-adjusted, happy and successful children. Therefore, this study aimed to assess the influence of fathers' child feeding knowledge and practice on children's dietary diversity. A community-based comparative cross-sectional study was conducted among 850 eligible urban and rural households with children of 6-23 months. The father and mother of the child were interviewed on children's dietary diversity and fathers' knowledge and practice of child feeding. Nearly half (46%) of the children in the rural district did not meet the minimum dietary diversity, and in the urban district, the rate was even worse (72%). Grains were the common food group given to the children in both districts, whereas flesh food was the least commonly consumed food group. Additionally, low vitamin A-rich food and other fruit and vegetable consumption seem to be a problem in both districts. Almost all dimensions of fathers' knowledge and practice were significantly related to children's minimum dietary diversity; especially, fathers' knowledge of food groups was an important predictor (P-value < 0.001) in both districts. Interventions that focus on the fathers' knowledge of child feeding, especially about food groups, are recommended to improve children's dietary diversity in the study communities. © 2014 John Wiley & Sons Ltd.

Understanding work contextual factors: a short-cut to evidence-based practice?

PubMed

Wallin, Lars; Ewald, Uwe; Wikblad, Karin; Scott-Findlay, Shannon; Arnetz, Bengt B

2006-01-01

It has become increasingly clear that workplace contextual factors make an important contribution to provider and patient outcomes. The potential for health care professionals of using research in practice is also linked to such factors, although the exact factors or mechanisms for enhancing this potential are not understood. From a perspective of implementing evidence-based nursing practice, the authors of this article report on a study examining contextual factors. The objective of this study was to identify predictors of organizational improvement by measuring staff perceptions of work contextual factors. The Quality Work Competence questionnaire was used in a repeated measurement survey with a 1-year break between the two periods of data collection. The sample consisted of 134 employees from four neonatal units in Sweden. Over the study period significant changes occurred among staff perceptions, both within and between units, on various factors. Changes in staff perceptions on skills development and participatory management were the major predictors of enhanced potential of overall organizational improvement. Perceived improvement in skills development and performance feedback predicted improvement in leadership. Change in commitment was predicted by perceived decreases in work tempo and work-related exhaustion. These findings indicate the potential for organizational improvement by developing a learning and supportive professional environment as well as by involving staff in decision-making at the unit level. Such initiatives are also likely to be of importance for enhanced use of research in practice and evidence-based nursing. On the other hand, high levels of work tempo and burnout appear to have negative consequences on staff commitment for improving care and the work environment. A better understanding of workplace contextual factors is necessary for improving the organizational potential of getting research into practice and should be considered in future implementation projects.

Movement patterns of exhibition swine and associations of influenza A virus infection with swine management practices.

PubMed

Bliss, Nola; Stull, Jason W; Moeller, Steven J; Rajala-Schultz, Päivi J; Bowman, Andrew S

2017-09-15

OBJECTIVE To identify the geographic distribution of exhibition swine in the Midwestern United States, characterize management practices used for exhibition swine, and identify associations between those practices and influenza A virus (IAV) detection in exhibition swine arriving at county or state agricultural fairs. DESIGN Cross-sectional survey. SAMPLE 480 swine exhibitors and 641 exhibition swine. PROCEDURES Inventories of swine exhibited at fairs in 6 selected Midwestern states during 2013 and of the total swine population (including commercial swine) in these regions in 2012 were obtained and mapped. In 2014, snout wipe samples were collected from swine on arrival at 9 selected fairs in Indiana (n = 5) and Ohio (4) and tested for the presence of IAV. Also at fair arrival, swine exhibitors completed a survey regarding swine management practices. RESULTS Contrary to the total swine population, the exhibition swine population was heavily concentrated in Indiana and Ohio. Many swine exhibitors reported attending multiple exhibitions within a season (median number, 2; range, 0 to 50), with exhibited swine often returned to their farm of origin. Rearing of commercial and exhibition swine on the same premises was reported by 13.3% (56/422) of exhibitors. Hosting an on-farm open house or sale was associated with an increased odds of IAV detection in snout wipe samples. CONCLUSIONS AND CLINICAL RELEVANCE The exhibition swine population was highly variable and differed from the commercial swine population in terms of pig density across geographic locations, population integrity, and on-farm management practices. Exhibition swine may be important in IAV transmission, and identified biosecurity deficiencies may have important public and animal health consequences.

Litigations and the Obstetrician in Clinical Practice

PubMed Central

Adinma, JIB

2016-01-01

The expectation of obstetrics is a perfect outcome. Obstetrics malpractice can cause morbidity and mortality that may engender litigation. Globally, increasing trend to litigation in obstetrics practice has resulted in high indemnity cost to the obstetrician with consequent frustration and overall danger to the future of obstetrics practice. The objective was to review litigations and the Obstetrician in Clinical Practice, highlighting medical ethics, federation of gynecology and obstetrics (FIGO’s) ethical responsibility guideline on women's sexual and reproductive health and right; examine the relationship between medical ethics and medical laws; X-ray medical negligence and litigable obstetrics malpractices; and make recommendation towards the improvement of obstetrics practices to avert misconduct that would lead to litigation. Review involves a literature search on the internet in relevant journals, textbooks, and monographs. Knowledge and application of medical ethics are important to the obstetricians to avert medical negligence that will lead to litigation. A medical negligence can occur in any of the three triads of medicare viz: Diagnosis, advice/counseling, and treatment. Lawsuits in obstetrics generally center on errors of omission or commission especially in relation to the failure to perform caesarean section or to perform the operation early enough. Fear of litigation, high indemnity cost, and long working hours are among the main reasons given by obstetricians for ceasing obstetrics practice. Increasing global trend in litigation with high indemnity cost to the obstetrician is likely to jeopardize the future of obstetrics care especially in countries without medical insurance coverage for health practitioners. Litigation in obstetrics can be prevented through the Obstetrician's mindfulness of its possibility; acquainting themselves of the medical laws and guidelines related to their practice; ensuring adequate communication with, and consent of patients during treatment together with proper and correct documentation of cases. The supervision of resident-in-training, development and implementation of obstetrics protocol, and continuing medical education of obstetricians are also important factors to the prevention of litigation in obstetrics. PMID:27213088

Regulation of health information processing in an outsourcing environment.

PubMed

2004-06-01

Policy makers must consider the work force, technology, cost, and legal implications of their legislative proposals. AHIMA, AAMT, CHIA, and MTIA urge lawmakers to craft regulatory solutions that enforce HIPAA and support advancements in modern health information processing practices that improve the quality and cost of healthcare. We also urge increased investment in health information work force development and implementation of new technologies to advance critical healthcare outcomes--timely, accurate, accessible, and secure information to support patient care. It is essential that state legislatures reinforce the importance of improving information processing solutions for healthcare and not take actions that will produce unintended and detrimental consequences.

CoS supersedes Pt as efficient electrocatalyst for triiodide reduction in dye-sensitized solar cells.

PubMed

Wang, Mingkui; Anghel, Alina M; Marsan, Benoît; Cevey Ha, Ngoc-Le; Pootrakulchote, Nuttapol; Zakeeruddin, Shaik M; Grätzel, Michael

2009-11-11

We report an efficient nonplatinized flexible counter electrode for dye-sensitized solar cells. In combination with a solvent-free ionic liquid electrolyte, we have demonstrated a approximately 6.5% cell with an amphiphilic ruthenium polypyridyl photosensitizer showing excellent stability measured under prolonged light soaking at 60 degrees C. Compared to the Pt deposited PEN film, the CoS deposited PEN film shows higher electrocatalytic activity for the reduction of triiodide. This is expected to have an important practical consequence on the production of flexible low-cost and lightweight thin film DSC devices based on the plastic matrix.

Arranged matches and mental illness: therapists' dilemmas.

PubMed

Greenberg, David; Buchbinder, Jacob Tuvia; Witztum, Eliezer

2012-01-01

Traditional societies place especial value on marriage and having children, and marriages are often arranged. A series of situations and dilemmas associated with arranged matches and their consequences are described in the course of mental health work with ultra-orthodox Jewish people with severe mental illness. Issues of confidentiality may arise with parents and matchmakers; on the other hand, respectful cooperation with religious authorities, counselors in the community, and family members is important. Information on genetic counseling, contraception, medication during pregnancy, and breastfeeding are considered and interact with communal structures and practices. There is a need for close support and evaluation during the process of marriage, childbearing, and parenthood.

Self-awareness: a review and analysis of a basic nursing concept.

PubMed

Eckroth-Bucher, Margie

2010-01-01

Self-awareness has long been addressed as fundamental for the professional nurse with the accepted view that self-awareness will lead to greater competence. Therefore, it is important to understand the historical evolution of the concept, attributes, antecedents, and consequences. Rodgers' evolutionary method was used for critical analysis of nursing, social sciences, and education literature. Analysis indicates that self-awareness is a dynamic, transformative process of self. Ultimately, self-awareness is the use of self-insights and presence knowingly to guide behavior that is genuine and authentic to create a healing interpersonal environment. Future research areas within practice and education are identified.

Solar transformation: Sun on the reservation

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

Epstein, R.T.

1994-01-01

To most Americans, the simple act of flicking on the light is as taken for granted as breathing air-without so much as a thought about its possible environmental consequences. But to Sylvia Brownskill and hundreds on the New Mexico Navajo Indian reservation, accessing electricity without harming the environment is of the utmost importance-and until recently, virtually impossible. Four years ago, however, practical technology for producing {open_quotes}clean{close_quotes} energy became available, and now even in the most remote locations of the reservation can flick on a light switch, knowing that the electricity generated is produced in its entirety by the power ofmore » the sun.« less

Developmental dysplasia of the hip: a history of innovation.

PubMed

Tarpada, Sandip P; Girdler, Steven J; Morris, Matthew T

2018-05-01

Developmental dysplasia of the hip (DDH) is a relatively common malady that has profound consequences in the infant if left untreated. Effective and early treatment of DDH has been praised as one of the most successful ventures of modern pediatric orthopedics. Yet, before the modern management of DDH came into existence, there were extensive technological developments in the field of harnesses, casts, and traction methods. This paper aims to identify the centuries-old history of advancement in DDH treatment and the many important people involved. Their devices, thoughts, and ideas continue to have a profound impact on the current practice of orthopedic surgery.

Hyperthyroidism and cerebral venous thrombosis.

PubMed

Mouton, S; Nighoghossian, N; Berruyer, M; Derex, L; Philippeau, F; Cakmak, S; Honnorat, J; Hermier, M; Trouillas, P

2005-01-01

The demonstration of an underlying prothrombotic condition in cerebral venous thrombosis (CVT) may have important practical consequences in terms of prevention. Thyrotoxicosis through a hypercoagulable state may be a predisposing factor for CVT. The authors present the cases of 4 patients who developed CVT and hyperthyroidism. At the acute stage, hyperthyroidism was associated with an increase in factor VIII (FVIII). At follow-up, FVIII level remained increased in 2 patients. Hyperthyroidism may have an impact on FVIII level. Accordingly in patients with hyperthyroidism and neurological symptoms, the diagnosis of CVT should be considered and an exhaustive coagulation screening may be appropriate. (c) 2005 S. Karger AG, Basel.

The sexuality of young women with intellectual and developmental disabilities: A neglected focus in the American foster care system.

PubMed

Ballan, Michelle S; Freyer, Molly Burke

2017-07-01

Youths with intellectual and developmental disabilities (ID/DD) are overrepresented in the American foster care system and experience heightened rates of pregnancy compared to their nondisabled peers. Yet limited information is known about sexually active or pregnant young women with ID/DD in foster care. Consequently, important healthcare needs of this population are not adequately addressed. This article explores sexuality education and sexual healthcare for female adolescents in foster care with ID/DD and recommends practice guidelines to support and prepare their emergent sexual development. Copyright © 2017 Elsevier Inc. All rights reserved.

Green Chemistry: An Introductory Text (Mike Lancaster)

NASA Astrophysics Data System (ADS)

Rosan, Alan M.

2003-10-01

With the unrealistic and irreconcilable choice of either technical or environmental performance still dominating the consumer view, the need for green teaching, green thinking, and green practice is paramount. Replete with extensive and varied examples, detailed analyses, and critical comparisons, this text is an important contribution to the training of future chemists and chemical engineers who will need to work together to plan and conduct syntheses requiring atom economy, energy efficiency, waste minimization, safe reactor design and operation all linked by an overarching environmental ethic. If these laudable goals are ever attained it will be as a consequence of the insightful knowledge and forthright teachings of texts like this one.

Patient influences on satisfaction and loyalty for GP services.

PubMed

Rundle-Thiele, Sharyn; Russell-Bennett, Rebekah

2010-04-01

Little is known about the influence that patients themselves have on their loyalty to a general practitioner (GP). Consequently, a theoretical framework that draws on diverse literature is proposed to suggest that along with satisfaction, patient loyalty is an important outcome for GPs. Comprising 174 Australian patients, this study identified that knowledgeable patients reported lower levels of loyalty while older patients and patients visiting a GP more frequently reported higher levels of loyalty. The results suggest that extending patient-centered care practices to encompass all patients may be warranted in order to improve patient satisfaction and loyalty. Further, future research opportunities abound, with intervention and dyadic research methodologies recommended.

[Current legislation in the healthcare system 2015/2016].

PubMed

Martenstein, I; Wienke, A

2016-03-01

The energy of the legislator in the healthcare system was barely stoppable in 2015. Many new laws have been brought into force and legal initiatives have also been implemented. The Hospital Structure Act, the Treatment Enhancement Act, amendments of the official medical fee schedules for physicians, the Prevention Act, the E-Health Act, the Anti-corruption Act, the hospital admission guidelines and amendments of the model specialty training regulations are just some of the essential alterations that lie ahead of the medical community. This article gives a review of the most important new legislative regulations in the healthcare system and presents the fundamental consequences for the practice.

Controlling extreme events on complex networks

NASA Astrophysics Data System (ADS)

Chen, Yu-Zhong; Huang, Zi-Gang; Lai, Ying-Cheng

2014-08-01

Extreme events, a type of collective behavior in complex networked dynamical systems, often can have catastrophic consequences. To develop effective strategies to control extreme events is of fundamental importance and practical interest. Utilizing transportation dynamics on complex networks as a prototypical setting, we find that making the network ``mobile'' can effectively suppress extreme events. A striking, resonance-like phenomenon is uncovered, where an optimal degree of mobility exists for which the probability of extreme events is minimized. We derive an analytic theory to understand the mechanism of control at a detailed and quantitative level, and validate the theory numerically. Implications of our finding to current areas such as cybersecurity are discussed.

[Current legislation in the healthcare system 2015/2016].

PubMed

Martenstein, I; Wienke, A

2016-05-01

The energy of the legislator in the healthcare system was barely stoppable in 2015. Many new laws have been brought into force and legal initiatives have also been implemented. The Hospital Structure Act, the Treatment Enhancement Act, amendments of the official medical fee schedules for physicians, the Prevention Act, the E-Health Act, the Anti-corruption Act, the hospital admission guidelines and amendments of the model specialty training regulations are just some of the essential alterations that lie ahead of the medical community. This article gives a review of the most important new legislative regulations in the healthcare system and presents the fundamental consequences for the practice.

[The development of the ethical thinking in children and the teaching of ethics in pediatrics].

PubMed

Lejarraga, Horacio

2008-10-01

The child's ethical thinking is not installed in his mind as a single act, but as a consequence of an evolving process. Kohlberg, based on Piaget's studies, described three main developmental stages: preconventional, conventional and post conventional. However, Vigostky and others emphasized the importance of the environment for the moral sculpture of children. Three models can be recognised for teaching ethics in children: the deontological way, the descriptive way, and the only one morally acceptable: the one used by Socrates, by which ethics becomes not merely an adjective, but an institutionalised social practice built on axiological basis.

Adrenaline overdose in pediatric anaphylaxis: a case report.

PubMed

Liew, Pui Yi Lily; Craven, John Andrew

2017-05-08

Adrenaline is the standard treatment for anaphylaxis but appropriate administration remains challenging, and iatrogenic overdose is easily overlooked. Despite the established importance of pediatric blood pressure measurement, its use remains inconsistent in clinical practice. We report a case of adrenaline overdose in a 9-year-old white boy with anaphylaxis, where signs of adrenaline overdose were indistinguishable from progressive shock until blood pressure measurement was taken. The consequences of under-dosing adrenaline in anaphylaxis are well-recognized, but the converse is less so. Blood pressure measurement should be a routine part of pediatric assessment as it is key to differentiating adrenaline overdose from anaphylactic shock.

Defining Peer-to-Peer Accountability From the Nurse's Perspective.

PubMed

Lockett, Jacqueline Jansen; Barkley, Leslie; Stichler, Jaynelle; Palomo, Jeanne; Kik, Bozena; Walker, Christopher; Donnelly, Janet; Willon, Judy; Sanborn, Julie; O'Byrne, Noeleen

2015-11-01

The aim of this study was to define and create a conceptual model for peer-to-peer accountability (P to PA). Many organizations cite the importance of peer accountability (PA) as essential in ensuring patient safety. Professionalism in nursing requires self-regulation of practice and PA. Although discussed in the literature, P to PA is not conceptually defined. A grounded theory study design with constant comparative data collection and analysis was used to explore nurses' definitions of P to PA and their perceptions of motivators and barriers to engaging in P to PA. Transcripts of digital recordings of all interviews were analyzed using line-by-line coding until identified themes emerged. P to PA was defined as the act of speaking up when one observes a peer not practicing to acceptable standards. A conceptual model illustrates the antecedents, attributes, and consequences of P to PA. P to PA is the professional responsibility of every nurse and healthcare provider and is essential for safe patient care. The conceptual definition facilitates actualization of P to PA in practice.

[The doctrine of free and informed consent: its ethical and legal foundations and its applications in research and practice of psychiatry].

PubMed

Grunberg, F

1990-06-01

This article briefly examines the ethical and legal foundations for the doctrine of informed consent in medical research and practice. The doctrine is based upon the importance of respecting the individual's autonomy and his right to self-determination. The article also reviews the development of the doctrine of informed consent based on its recent application. The authors cite the Nuremburg Code and the Helsinki Declarations and particularly the media denunication of several scandals in the United States during the late 1960s, when Henri Beecher's name figured prominently. The effects of informed consent in psychiatry are examined specifically, as well as the consequences for psychiatric research, on subjects who are able to give their consent, as well as those who are unable to do so. As for its effects on clinical practice, the paper discusses the right of the hospitalized patient to refuse treatment, and informed consent and the risks for patients treated with neuroleptics of developing tardive dyskinesia. The authors conclude that in psychotherapy the concept of informed consent cannot be taken for granted.

Medical examiner/death investigator training requirements in state medical examiner systems.

PubMed

Prahlow, J A; Lantz, P E

1995-01-01

Comprehensive and properly performed investigation of suspicious, unusual, unnatural, and various natural deaths is necessary to maintain the health, safety, and well-being of society as a whole. Adequate investigation requires the combined efforts and cooperation of law-enforcement and other public-service agencies, medical professionals, and those within the forensic community. As such, the "death investigator" plays a crucial role in the investigation process. These front-line investigators, whether they be coroners, medical examiners, physicians, other medical professionals, or lay-people, are required to make important decisions which have far-reaching consequences on how death investigation cases proceed. Death investigation practices vary greatly among medico-legal jurisdictions. A recent publication has categorized state death investigation systems by type of system. In an attempt to better delineate death investigation practices with specific regard to investigators' training and continuing education requirements, we surveyed the 20 systems categorized as state medical examiner systems and the five states with combined state medical examiner and county coroner/medical examiner systems. We present our findings and make recommendations which address the attributes and deficiencies of current death investigation practices.

Disclosure of Adverse Events in the United States and Canada: An Update, and a Proposed Framework for Improvement

PubMed Central

Wu, Albert W.; Boyle, Dennis J.; Wallace, Gordon; Mazor, Kathleen M.

2013-01-01

There is consensus that physicians, health professionals and health care organizations should discuss harm that results from health care delivery (adverse events), including the reasons for harm, with patients and their families. Thought leaders and policy makers in the USA and Canada support this goal. However, there are gaps in both countries between patients and physicians in their attitudes about how errors should be handled, and between disclosure policies and their implementation in practice. This paper reviews the state of disclosure policy and practice in the two countries, and the barriers to full disclosure. Important barriers include fear of consequences, attitudes about disclosure, lack of skill and role models, and lack of peer and institutional support. The paper also describes the problem of the second victim, a corollary of disclosure whereby health care workers are also traumatized by the same events that harm patients. The presence of multiple practical and personal barriers to disclosure suggests the need for a comprehensive solution directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support. At the local level, implementation could be based on a translating-evidence-into-practice framework. Applying this framework would involve the formation of teams, training, measurement and identification of local barriers to achieving universal disclosure of adverse events. Significance for public health It is inevitable that some patients will be harmed rather than helped by health care. There is consensus that patients and their families must be told about these harmful events. However, there are gaps between patient and physician attitudes about how errors should be handled, and between disclosure policies and their implementation. There are important barriers that impede disclosure, including fear of consequences, attitudes about disclosure, lack of skill, and lack of institutional support. A related problem is that of the second victim, whereby health care workers are traumatized by the same harmful events. This can impair their performance and further compromise safety. The problem is unlikely to be solved by focusing solely on increasing disclosure. A comprehensive solution is needed, directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support. PMID:25170503

Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke

PubMed Central

2013-01-01

Background Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training) affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences. Method Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP) and HYBRID (combined FTP and power training) in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome), upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed. Results Primary outcome: Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p = .049), regardless of treatment order. These functional improvements were retained 6-months post-intervention (p = .03). Secondary outcomes: A greater proportion of participants achieved minimally important differences (MID) following HYBRID vs. FTP (p = .03). MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p > .05). Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p < .05) and effects were retained 6-months post-intervention (p’s < .05). EMG position threshold and burst duration were significantly reduced at fast speeds (≥120º/s) (p’s < 0.05) and passive torque was reduced post-washout (p < .05) following HYBRID. Conclusions Functional and neuromechanical gains were greater following HYBRID vs. FPT. Improved stretch reflex modulation and increased neuromuscular activation indicate potent neural adaptations. Importantly, no deleterious consequences, including exacerbation of spasticity or musculoskeletal complaints, were associated with HYBRID. These results contribute to an evolving body of contemporary evidence regarding the efficacy of high-intensity training in neurorehabilitation and the physiological mechanisms that mediate neural recovery. PMID:23336711

Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke.

PubMed

Patten, Carolynn; Condliffe, Elizabeth G; Dairaghi, Christine A; Lum, Peter S

2013-01-21

Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training) affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences. Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP) and HYBRID (combined FTP and power training) in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome), upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed. Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p = .049), regardless of treatment order. These functional improvements were retained 6-months post-intervention (p = .03). A greater proportion of participants achieved minimally important differences (MID) following HYBRID vs. FTP (p = .03). MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p > .05). Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p < .05) and effects were retained 6-months post-intervention (p's < .05). EMG position threshold and burst duration were significantly reduced at fast speeds (≥120º/s) (p's < 0.05) and passive torque was reduced post-washout (p < .05) following HYBRID. Functional and neuromechanical gains were greater following HYBRID vs. FPT. Improved stretch reflex modulation and increased neuromuscular activation indicate potent neural adaptations. Importantly, no deleterious consequences, including exacerbation of spasticity or musculoskeletal complaints, were associated with HYBRID. These results contribute to an evolving body of contemporary evidence regarding the efficacy of high-intensity training in neurorehabilitation and the physiological mechanisms that mediate neural recovery.

Understanding practice: the factors that influence management of mild traumatic brain injury in the emergency department--a qualitative study using the Theoretical Domains Framework.

PubMed

Tavender, Emma J; Bosch, Marije; Gruen, Russell L; Green, Sally E; Knott, Jonathan; Francis, Jill J; Michie, Susan; O'Connor, Denise A

2014-01-13

Mild traumatic brain injury is a frequent cause of presentation to emergency departments. Despite the availability of clinical practice guidelines in this area, there is variation in practice. One of the aims of the Neurotrauma Evidence Translation program is to develop and evaluate a targeted, theory- and evidence-informed intervention to improve the management of mild traumatic brain injury in Australian emergency departments. This study is the first step in the intervention development process and uses the Theoretical Domains Framework to explore the factors perceived to influence the uptake of four key evidence-based recommended practices for managing mild traumatic brain injury. Semi-structured interviews were conducted with emergency staff in the Australian state of Victoria. The interview guide was developed using the Theoretical Domains Framework to explore current practice and to identify the factors perceived to influence practice. Two researchers coded the interview transcripts using thematic content analysis. A total of 42 participants (9 Directors, 20 doctors and 13 nurses) were interviewed over a seven-month period. The results suggested that (i) the prospective assessment of post-traumatic amnesia was influenced by: knowledge; beliefs about consequences; environmental context and resources; skills; social/professional role and identity; and beliefs about capabilities; (ii) the use of guideline-developed criteria or decision rules to inform the appropriate use of a CT scan was influenced by: knowledge; beliefs about consequences; environmental context and resources; memory, attention and decision processes; beliefs about capabilities; social influences; skills and behavioral regulation; (iii) providing verbal and written patient information on discharge was influenced by: beliefs about consequences; environmental context and resources; memory, attention and decision processes; social/professional role and identity; and knowledge; (iv) the practice of providing brief, routine follow-up on discharge was influenced by: environmental context and resources; social/professional role and identity; knowledge; beliefs about consequences; and motivation and goals. Using the Theoretical Domains Framework, factors thought to influence the management of mild traumatic brain injury in the emergency department were identified. These factors present theoretically based targets for a future intervention.

Non-target effects of fungicides on nectar-inhabiting fungi of almond flowers.

PubMed

Schaeffer, Robert N; Vannette, Rachel L; Brittain, Claire; Williams, Neal M; Fukami, Tadashi

2017-04-01

Nectar mediates interactions between plants and pollinators in natural and agricultural systems. Specialized microorganisms are common nectar inhabitants, and potentially important mediators of plant-pollinator interactions. However, their diversity and role in mediating pollination services in agricultural systems are poorly characterized. Moreover, agrochemicals are commonly applied to minimize crop damage, but may present ecological consequences for non-target organisms. Assessment of ecological risk has tended to focus on beneficial macroorganisms such as pollinators, with less attention paid to microorganisms. Here, using culture-independent methods, we assess the impact of two widely-used fungicides on nectar microbial community structure in the mass-flowering crop almond (Prunus dulcis). We predicted that fungicide application would reduce fungal richness and diversity, whereas competing bacterial richness would increase, benefitting from negative effects on fungi. We found that fungicides reduced fungal richness and diversity in exposed flowers, but did not significantly affect bacterial richness, diversity, or community composition. The relative abundance of Metschnikowia OTUs, nectar specialists that can impact pollination, was reduced by both fungicides. Given growing recognition of the importance of nectar microorganisms as mediators of plant-pollinator mutualisms, future research should consider the impact of management practices on plant-associated microorganisms and consequences for pollination services in agricultural landscapes. © 2016 Society for Applied Microbiology and John Wiley & Sons Ltd.

Is the current public health message on UV exposure correct?

PubMed Central

Lucas, Robyn M.; Repacholi, Mike H.; McMichael, Anthony J.

2006-01-01

Current sun safety messages stress the importance of sun protection in avoiding the consequences of excessive exposure to ultraviolet radiation (UVR), such as skin cancers, cataracts and other eye diseases, and viral infections caused by UV-induced immunosuppression. However, adequate exposure to UVR has an important role in human health, primarily through UV-induced production of vitamin D, a hormone essential to bone health. Vitamin D insufficiency may be associated with increased risks of some cancers, autoimmune diseases and mental health disorders such as schizophrenia. Here, we review the evolution of current sun exposure practices and sun-safe messages and consider not only the benefits, but also the detrimental effects that such messages may have. UVR-induced vitamin D production can be inhibited by factors such as deep skin pigmentation, indoor lifestyles, older age, sun avoidance behaviours and clothing habits that limit skin exposure, with deleterious consequences for health. There is some early evidence that sun-safe messages are beginning to cause a decrease in skin cancer rates in young people. After the widespread promotion of sun safety, it may now be appropriate to refine public health messages to take better account of variations between groups and their susceptibility to the dangers and benefits of sun exposure. PMID:16799733

How similar can co-occurring species be in the presence of competition and ecological drift?

PubMed

Capitán, José A; Cuenda, Sara; Alonso, David

2015-09-06

If two species live on a single resource, the one with a slight advantage will out-compete the other: complete competitors cannot coexist. This is known as the competitive exclusion principle. If no extinction occurs, it is because evolutionary adaptation to slightly different niches takes place. Therefore, it is widely accepted that ecological communities are assembled by evolutionary differentiation and progressive adaptation of species to different niches. However, some ecologists have recently challenged this classic paradigm highlighting the importance of chance and stochasticity. Using a synthetic framework for community dynamics, here we show that, while deterministic descriptors predict coexistence, species similarity is limited in a more restrictive way in the presence of stochasticity. We analyse the stochastic extinction phenomenon, showing that extinction occurs as competitive overlap increases above a certain threshold well below its deterministic counterpart. We also prove that the extinction threshold cannot be ascribed only to demographic fluctuations around small population sizes. The more restrictive limit to species similarity is, therefore, a consequence of the complex interplay between competitive interactions and ecological drift. As a practical implication, we show that the existence of a stochastic limit to similarity has important consequences in the recovery of fragmented habitats. © 2015 The Author(s).

How similar can co-occurring species be in the presence of competition and ecological drift?

PubMed Central

Capitán, José A.; Cuenda, Sara; Alonso, David

2015-01-01

If two species live on a single resource, the one with a slight advantage will out-compete the other: complete competitors cannot coexist. This is known as the competitive exclusion principle. If no extinction occurs, it is because evolutionary adaptation to slightly different niches takes place. Therefore, it is widely accepted that ecological communities are assembled by evolutionary differentiation and progressive adaptation of species to different niches. However, some ecologists have recently challenged this classic paradigm highlighting the importance of chance and stochasticity. Using a synthetic framework for community dynamics, here we show that, while deterministic descriptors predict coexistence, species similarity is limited in a more restrictive way in the presence of stochasticity. We analyse the stochastic extinction phenomenon, showing that extinction occurs as competitive overlap increases above a certain threshold well below its deterministic counterpart. We also prove that the extinction threshold cannot be ascribed only to demographic fluctuations around small population sizes. The more restrictive limit to species similarity is, therefore, a consequence of the complex interplay between competitive interactions and ecological drift. As a practical implication, we show that the existence of a stochastic limit to similarity has important consequences in the recovery of fragmented habitats. PMID:26269234

Smokeless tobacco: a major public health problem in the SEA region: a review.

PubMed

Gupta, Prakash C; Ray, Cecily S; Sinha, Dhirendra N; Singh, Poonam K

2011-01-01

Smokeless tobacco use is on the upswing in some parts of the world, including parts of SEAR. It is therefore important to monitor this problem and understand the possible consequences on public health. Material for this review was obtained from documents and data of the World Health Organization, co-authors, colleagues, and searches on key words in PubMed and on Google. Smokeless tobacco use in SEAR, as betel quid with tobacco, declined with increased marketing of cigarettes from the early twentieth century. Smokeless tobacco use began to increase in the 1970s in South Asia, with the marketing of new products made from areca nut and tobacco and convenient packaging. As a consequence, oral precancerous conditions and cancer incidence in young adults have increased significantly. Thailand's successful policies in reducing betel quid use through school health education from the 1920s and in preventing imports of smokeless tobacco products from 1992 are worth emulating by many SEAR countries. India, the largest manufacturing country of smokeless tobacco in the Region, is considering ways to regulate its production. Best practices require the simultaneous control of smokeless and smoking forms of tobacco. Governments in SEAR would do well to adopt strong measures now to control this problem.

Methodology of selecting dozers for lignite open pit mines in Serbia

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

Stojanovic, D.; Ignjatovic, D.; Kovacevic, S.

1996-12-31

Apart from the main production processes (coal and overburden mining, rail conveyors transportation and storage of excavated masses) performed by great-capacity mechanization at open pit mines, numerous and different auxiliary works, that often have crucial influence on both the work efficiency of main equipment and the maintenance of optimum technical conditions of machines and plants covering technological system of open pit, are present. Successful realization of work indispensably requires a proper and adequate selection of auxiliary machines according to their type quantity, capacity, power etc. thus highly respecting specific conditions existing at each and every open pit mine. A dozermore » is certainly the most important and representative auxiliary machine at single open pit mine. It is widely used in numerous works that, in fact, are preconditions for successful work of the main mechanization and consequently the very selection of a dozer ranges among the most important operations when selecting mechanization. This paper presents the methodology of dozers selection when lignite open pit mines are concerned. A mathematical model defining the volume of work required for dozers to perform at open pit mines and consequently the number of necessary dozers was designed. The model underwent testing in practice at big open pit mines and can be used in design of future open pits mines.« less

Dementia resulting from traumatic brain injury

PubMed Central

Ramalho, Joana; Castillo, Mauricio

2015-01-01

Traumatic brain injury (TBI) represents a significant public health problem in modern societies. It is primarily a consequence of traffic-related accidents and falls. Other recently recognized causes include sports injuries and indirect forces such as shock waves from battlefield explosions. TBI is an important cause of death and lifelong disability and represents the most well-established environmental risk factor for dementia. With the growing recognition that even mild head injury can lead to neurocognitive deficits, imaging of brain injury has assumed greater importance. However, there is no single imaging modality capable of characterizing TBI. Current advances, particularly in MR imaging, enable visualization and quantification of structural and functional brain changes not hitherto possible. In this review, we summarize data linking TBI with dementia, emphasizing the imaging techniques currently available in clinical practice along with some advances in medical knowledge. PMID:29213985

Facilitators and barriers in expanding scope of practice: findings from a national survey of Irish nurses and midwives.

PubMed

Fealy, Gerard M; Rohde, Daniela; Casey, Mary; Brady, Anne-Marie; Hegarty, Josephine; Kennedy, Catriona; McNamara, Martin; O'Reilly, Pauline; Prizeman, Geraldine

2015-12-01

The aim was to examine current scope of practice among nurses and midwives in Ireland. The objectives were to describe practitioners' self-reported facilitators and barriers to expanding scope of practice and to develop a scope of practice barriers scale. Regulatory authorities permit practice expansion, so long as it falls within accepted parameters of scope of practice. Enduring difficulties in relation to scope of practice include the difficulty of balancing practice restriction with practice expansion. A postal survey design was used to examine registered nurses' and midwives' current scope of practice, including their experiences of facilitators and barriers to expanding practice. A stratified random sample of registered nurses and midwives in Ireland was surveyed using the Scope-QB, a 19-item self-report scope of practice barriers scale. Based on a sample of 1010 respondents, the self-reported perceived barriers to practice expansion included fear of legal consequences, time restrictions and lack of remuneration. Professional satisfaction, patients' needs, organisational support and having access to continuing professional education were perceived as facilitators of practice expansion. Older nurses and midwives as well as nurses and midwives holding more senior promotional grades, such as clinical nurse manager grades, perceived fewer barriers than their younger and more junior counterparts. Nurses and midwives continue to experience difficulties in relation to expanding their practice. Practitioners can operate to optimal scope of practice when practitioner-centred and workplace-based circumstances are optimal. The optimal circumstances for practice expansion exist when the facilitators of practice expansion outweigh the barriers. Given the critical role that nurses and midwives play in modern health services, it is important that they are empowered and enabled to expand their practice and to work to full scope of practice when patient needs and service requirements warrant it. © 2015 John Wiley & Sons Ltd.

NATIONAL ALCOHOL SURVEY (NAS)

EPA Science Inventory

National Alcohol Survey (NAS) is designed to assess the trends in drinking practices and problems in the national population, including attitudes, norms, treatment and experiences and adverse consequences. It also studies the effects of public policy on drinking practices (i.e., ...

Whistleblowing: what influences nurses' decisions on whether to report poor practice?

PubMed

Gallagher, Ann

Several recent high profile examples demonstrate that nurses fear and have reason to fear the consequences of reporting poor practice. This article examines the ethical issues surrounding whistleblowing, discussing in detail the reasons for and against reporting concerns about poor practice, and how nurses can be supported to do this.

Early Childhood Practice and Refrains of Complexity

ERIC Educational Resources Information Center

Cumming, Tamara; Sumsion, Jennifer; Wong, Sandie

2015-01-01

Early childhood practice has often been described as complex in both policy documents and research literature; however, less attention has been given to exploring the nature and consequences of complexity in early childhood practice. At a time of intense policy attention in many national contexts, there is the potential for closing down, as well…

Diabetes Treatment as "Homework": Consequences for Household Knowledge and Health Practices in Rural Uganda

ERIC Educational Resources Information Center

Nielsen, Jannie; Bahendeka, Silver K.; Bygbjerg, Ib C.; Meyrowitsch, Dan W.; Whyte, Susan R.

2016-01-01

Background: Health professionals assign diabetes patients "homework" in that they give them instructions on how to manage diabetes, recognizing that most diabetes care takes place in the home setting. We studied how homework is practiced and whether knowledge and behavioral practices related to diabetes self-management diffuse from…

Image/Music/Voice: Song Dubbing in Hollywood Musicals.

ERIC Educational Resources Information Center

Siefert, Marsha

1995-01-01

Uses the practice of song dubbing in the Hollywood film musical to explore the implications and consequences of the singing voice for imaging practices in the 1930s through 1960s. Discusses the ideological, technological, and socioeconomic basis for song dubbing. Discusses gender, race, and ethnicity patterns of image-sound practices. (SR)

Educational Assessment Policy and Practice: A Matter of Ethics

ERIC Educational Resources Information Center

Elwood, Jannette

2013-01-01

Long-standing concerns within the field of educational assessment consider the impact of assessment policy and practice as matters of equity, inequality and social justice. Yet educational assessment policy and practice continues to have powerful social consequences for key users such as children and young people. This paper re-positions these…

Using an intervention mapping approach to develop a discharge protocol for intensive care patients.

PubMed

van Mol, Margo; Nijkamp, Marjan; Markham, Christine; Ista, Erwin

2017-12-19

Admission into an intensive care unit (ICU) may result in long-term physical, cognitive, and emotional consequences for patients and their relatives. The care of the critically ill patient does not end upon ICU discharge; therefore, integrated and ongoing care during and after transition to the follow-up ward is pivotal. This study described the development of an intervention that responds to this need. Intervention Mapping (IM), a six-step theory- and evidence-based approach, was used to guide intervention development. The first step, a problem analysis, comprised a literature review, six semi-structured telephone interviews with former ICU-patients and their relatives, and seven qualitative roundtable meetings for all eligible nurses (i.e., 135 specialized and 105 general ward nurses). Performance and change objectives were formulated in step two. In step three, theory-based methods and practical applications were selected and directed at the desired behaviors and the identified barriers. Step four designed a revised discharge protocol taking into account existing interventions. Adoption, implementation and evaluation of the new discharge protocol (IM steps five and six) are in progress and were not included in this study. Four former ICU patients and two relatives underlined the importance of the need for effective discharge information and supportive written material. They also reported a lack of knowledge regarding the consequences of ICU admission. 42 ICU and 19 general ward nurses identified benefits and barriers regarding discharge procedures using three vignettes framed by literature. Some discrepancies were found. For example, ICU nurses were skeptical about the impact of writing a lay summary despite extensive evidence of the known benefits for the patients. ICU nurses anticipated having insufficient skills, not knowing the patient well enough, and fearing legal consequences of their writings. The intervention was designed to target the knowledge, attitudes, self-efficacy, and perceived social influence. Building upon IM steps one to three, a concept discharge protocol was developed that is relevant and feasible within current daily practice. Intervention mapping provided a comprehensive framework to improve ICU discharge by guiding the development process of a theory- and empirically-based discharge protocol that is robust and useful in practice.

Reconceptualizing 'extremism' and 'moderation': from categories of analysis to categories of practice in the construction of collective identity.

PubMed

Hopkins, Nick; Kahani-Hopkins, Vered

2009-03-01

Much psychological research employs the categories of extremism and moderation as categories of analysis (e.g. to identify the psychological bases for, and consequences of, holding certain positions). This paper argues these categorizations inevitably reflect one's values and taken-for-granted assumptions about social reality and that their use as analytic categories limits our ability to explore what is really important: social actors' own constructions of social reality. In turn we argue that if we are to focus on this latter, there may be merit in exploring how social actors themselves use the categories of moderation and extremism to construct their own terms of reference. That is we propose to re-conceptualize the categories of moderation and extremism as categories of practice rather than analysis. The utility of this approach is illustrated with qualitative data. We argue that these data illustrate the importance of respecting social actors' own constructions of social reality (rather than imposing our own). Moreover, we argue that categories of moderation and extremism may be employed by social actors in diverse ways to construct different terms of reference and so recruit support for different identity-related projects.

Astronomy and its role in ancient Mesoamerica

NASA Astrophysics Data System (ADS)

Šprajc, Ivan

2011-06-01

The observation of the sky had an important rôle among the Maya, Aztecs and other prehispanic peoples of Mesoamerica. Their familiarity with the regularities of the apparent motion of the Sun, the Moon and bright planets is attested in a large amount of astronomical data contained in codices and monumental hieroglyphic inscriptions, as well as in their sophisticated calendrical system. On the other hand, the study of architectural alignments has disclosed that civic and ceremonial buildings were largely oriented on astronomical grounds, mostly to sunrises and sunsets on certain dates, allowing the use of observational calendars that facilitated a proper scheduling of agricultural and the associated ritual activities in the yearly cycle. Both accurate knowledge and other astronomically-derived concepts reveal that the significance attributed to certain celestial events by the ancient Mesoamericans can be explained in terms of the relationship of these phenomena with specific environmental and cultural facts, such as seasonal climatic changes and subsistence strategies. It was particularly due to its practical utility that astronomy, intertwined with religious ideas and practices, had such an important place in the worldview and, consequently, in the cosmologically substantiated political ideology of Mesoamerican societies

The impact of new forms of large-scale general practice provider collaborations on England's NHS: a systematic review.

PubMed

Pettigrew, Luisa M; Kumpunen, Stephanie; Mays, Nicholas; Rosen, Rebecca; Posaner, Rachel

2018-03-01

Over the past decade, collaboration between general practices in England to form new provider networks and large-scale organisations has been driven largely by grassroots action among GPs. However, it is now being increasingly advocated for by national policymakers. Expectations of what scaling up general practice in England will achieve are significant. To review the evidence of the impact of new forms of large-scale general practice provider collaborations in England. Systematic review. Embase, MEDLINE, Health Management Information Consortium, and Social Sciences Citation Index were searched for studies reporting the impact on clinical processes and outcomes, patient experience, workforce satisfaction, or costs of new forms of provider collaborations between general practices in England. A total of 1782 publications were screened. Five studies met the inclusion criteria and four examined the same general practice networks, limiting generalisability. Substantial financial investment was required to establish the networks and the associated interventions that were targeted at four clinical areas. Quality improvements were achieved through standardised processes, incentives at network level, information technology-enabled performance dashboards, and local network management. The fifth study of a large-scale multisite general practice organisation showed that it may be better placed to implement safety and quality processes than conventional practices. However, unintended consequences may arise, such as perceptions of disenfranchisement among staff and reductions in continuity of care. Good-quality evidence of the impacts of scaling up general practice provider organisations in England is scarce. As more general practice collaborations emerge, evaluation of their impacts will be important to understand which work, in which settings, how, and why. © British Journal of General Practice 2018.

Recognition-induced forgetting is not due to category-based set size.

PubMed

Maxcey, Ashleigh M

2016-01-01

What are the consequences of accessing a visual long-term memory representation? Previous work has shown that accessing a long-term memory representation via retrieval improves memory for the targeted item and hurts memory for related items, a phenomenon called retrieval-induced forgetting. Recently we found a similar forgetting phenomenon with recognition of visual objects. Recognition-induced forgetting occurs when practice recognizing an object during a two-alternative forced-choice task, from a group of objects learned at the same time, leads to worse memory for objects from that group that were not practiced. An alternative explanation of this effect is that category-based set size is inducing forgetting, not recognition practice as claimed by some researchers. This alternative explanation is possible because during recognition practice subjects make old-new judgments in a two-alternative forced-choice task, and are thus exposed to more objects from practiced categories, potentially inducing forgetting due to set-size. Herein I pitted the category-based set size hypothesis against the recognition-induced forgetting hypothesis. To this end, I parametrically manipulated the amount of practice objects received in the recognition-induced forgetting paradigm. If forgetting is due to category-based set size, then the magnitude of forgetting of related objects will increase as the number of practice trials increases. If forgetting is recognition induced, the set size of exemplars from any given category should not be predictive of memory for practiced objects. Consistent with this latter hypothesis, additional practice systematically improved memory for practiced objects, but did not systematically affect forgetting of related objects. These results firmly establish that recognition practice induces forgetting of related memories. Future directions and important real-world applications of using recognition to access our visual memories of previously encountered objects are discussed.

Priority setting in clinical nursing practice: literature review.

PubMed

Hendry, Charles; Walker, Anne

2004-08-01

Time is a valuable resource. When nurses experience demands on their services which exceed their available time, then 'rationing' must occur. In clinical practice such rationing requires practitioners to set priorities for care. The aim of this paper is establish what is currently known about priority setting in nursing, including how nurses set priorities and what factors influence this. CINAHL, Medline, ASSIA, and PsychLit databases for the years 1982-2002 were searched, using the terms (clinical decision-making or problem-solving or planning) and (setting priorities or prioriti*). The publications found were used in a selective, descriptive review. Priority setting is an important skill in nursing, and a skill deficit can have serious consequences for patients. Recent studies have suggested that it is a difficult skill for newly qualified nurses to acquire and may not be given sufficient attention in nurse education. Priority setting can be defined as the ordering of nursing problems using notions of urgency and/or importance, in order to establish a preferential order for nursing actions. A number of factors that may impact on priority setting have been identified in the literature. These include: the expertise of the nurse; the patient's condition; the availability of resources; ward organization; philosophies and models of care; the nurse-patient relationship; and the cognitive strategy used by the nurse to set priorities. However, very little empirical work has been conducted in this area. Further study of priority setting in a range of clinical practice settings is necessary. This could inform both practice and education, promote better use of limited resources and maximize patient outcomes.

Sustainable biosolids--welcomed practice through community partnership and the consequential economic benefits.

PubMed

Evans, T; Lowe, N; Matthews, P

2004-01-01

Technically, most people agree that conserving soil organic matter and completing nutrient cycles by applying animal manures, treated organic wastes and biosolids to land is the most sustainable option in the majority of situations. It is also generally the least expensive. There has been a huge amount of research into the hazards, and this has concluded that the risks can be managed to acceptable levels. But there has been insufficient attention to communicating this knowledge, as so often in the scientific and technological arena. Perception is reality. Nowadays compliance with regulations (whilst essential) is not enough; public and stakeholder attitudes can be of decisive importance. Sometimes policy-makers speculate what public attitudes might be without really asking them. This paper will describe an initiative to create a partnership open to anybody with an interest in the use of organic materials on land to develop consensus on good practice and to share knowledge. It summarises an attitude survey of more than 140 organisations, which was then debated at a workshop in July 2002. The conclusion from this study was that all parties considered a partnership is essential to share knowledge, build mutual trust and agree practices that are welcomed by all in the food chain. The paper will describe the steps to establishing a partnership organisation, its aims and objectives, the work to date and the plans for the future. The Environment Agency considers this very important and has largely funded the work to date. The consequences of failing to establish welcomed practices would be loss of the facility to use organic resources on land.

A risk-based approach to sanitary sewer pipe asset management.

PubMed

Baah, Kelly; Dubey, Brajesh; Harvey, Richard; McBean, Edward

2015-02-01

Wastewater collection systems are an important component of proper management of wastewater to prevent environmental and human health implications from mismanagement of anthropogenic waste. Due to aging and inadequate asset management practices, the wastewater collection assets of many cities around the globe are in a state of rapid decline and in need of urgent attention. Risk management is a tool which can help prioritize resources to better manage and rehabilitate wastewater collection systems. In this study, a risk matrix and a weighted sum multi-criteria decision-matrix are used to assess the consequence and risk of sewer pipe failure for a mid-sized city, using ArcGIS. The methodology shows that six percent of the uninspected sewer pipe assets of the case study have a high consequence of failure while four percent of the assets have a high risk of failure and hence provide priorities for inspection. A map incorporating risk of sewer pipe failure and consequence is developed to facilitate future planning, rehabilitation and maintenance programs. The consequence of failure assessment also includes a novel failure impact factor which captures the effect of structurally defective stormwater pipes on the failure assessment. The methodology recommended in this study can serve as a basis for future planning and decision making and has the potential to be universally applied by municipal sewer pipe asset managers globally to effectively manage the sanitary sewer pipe infrastructure within their jurisdiction. Copyright © 2014 Elsevier B.V. All rights reserved.

Prioritising drug and therapeutics committee (DTC) decisions: a national survey.

PubMed

Tan, Ee Lyn; Day, Richard O; Brien, Jo-anne E

2007-04-01

A national survey was conducted to explore stakeholder opinions about: (1) the domains of activity and criteria used to determine "important" decisions; (2) the "importance" of Drug and Therapeutics Committee (DTC) decisions as an appropriate approach for prioritising implementation and actions and (3) how DTC decisions could be prioritised for action. This is a study of DTCs conducted in the Australian health care setting. A semi-structured questionnaire was sent to Directors of Pharmacies or Chief Pharmacists in Australian hospitals. Questionnaires could be returned by email or by fax. Two weeks after initial mail-out, non-responders were followed-up. Responses were collated and analysed using descriptive statistics. Free-text responses were collated. QSR NVivo was used as a data management tool. The response rate was 61%. All respondents indicated that "patient safety" was a domain of importance for a decision. Other domains of important DTC decisions include: "ensuring the practice of evidence based medicine within their institution" (94%), "cost" (93%), "ensure practice according to legislative requirements" (87%). Most respondents agreed that some DTC decisions were more important than others. Given constraints on time and resources, the majority agreed that DTC decisions should be prioritised for implementation, although most had no suggestions about how this could be done. Some suggested that the domains of importance could be the basis for priority assignment. Currently DTC decisions and policies are implemented in an ad hoc manner. As a result implementation may be incomplete and ineffective, and may pose a risk of serious consequences in patient care. This study identifies the domains or criteria of DTC decisions so that DTCs may allocate scarce resources to the systematic implementation of important decisions.

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

PubMed

Spencer, Grace

2015-12-01

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

Challenges of medicines management in the public and private sector under Ghana's National Health Insurance Scheme - A qualitative study.

PubMed

Ashigbie, Paul G; Azameti, Devine; Wirtz, Veronika J

2016-01-01

Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring more equitable financing of health care to improve access to health services. This qualitative study examines the challenges and consequences of medicines management policies and practices under the NHIS as perceived by public and private service providers. This study was conducted in health facilities in the Eastern, Greater Accra and Volta regions of Ghana between July and August 2014. We interviewed 26 Key Informants (KIs) from a purposively selected sample of public and private sector providers (government and mission hospitals, private hospitals and private standalone pharmacies), pharmaceutical suppliers and NHIS district offices. Data was collected using semi-structured interview guides which covered facility accreditation, reimbursement practices, medicines selection, purchasing and pricing of medicines, and utilization of medicines. Codes for data analysis were developed based on the study questions and also in response to themes that emerged from the transcripts and notes. Most KIs agreed that the introduction of the NHIS has increased access to and utilization of medicines by removing cost barriers for patients; however, some pointed out the increased utilization could also be corollary to moral hazard. Common concerns across all facilities were the delays in receiving NHIS reimbursements, and low reimbursement rates for medicines which result in providers asking patients to pay supplementary fees. KIs reported important differences between private and public sectors including weak separation of prescribing and dispensing and limited use of drugs and therapeutic committees in the private sector, the disproportionate effects of unfavorable reimbursement prices for medicines, and inadequate participation of the private sector providers (especially pharmacies and licensed chemical sellers) in the NHIS. Health providers generally perceive the NHIS to have had a largely positive impact on access to medicines. However, concerns remain about equity in access to medicines and the differences in quality of pharmaceutical care delivered by private and public providers. Routine monitoring of medicines use during the implementation of health insurance schemes is important to identify and address the potential consequences of medicines policies and practices under the scheme.

Computational design of a pH stable enzyme: understanding molecular mechanism of penicillin acylase's adaptation to alkaline conditions.

PubMed

Suplatov, Dmitry; Panin, Nikolay; Kirilin, Evgeny; Shcherbakova, Tatyana; Kudryavtsev, Pavel; Svedas, Vytas

2014-01-01

Protein stability provides advantageous development of novel properties and can be crucial in affording tolerance to mutations that introduce functionally preferential phenotypes. Consequently, understanding the determining factors for protein stability is important for the study of structure-function relationship and design of novel protein functions. Thermal stability has been extensively studied in connection with practical application of biocatalysts. However, little work has been done to explore the mechanism of pH-dependent inactivation. In this study, bioinformatic analysis of the Ntn-hydrolase superfamily was performed to identify functionally important subfamily-specific positions in protein structures. Furthermore, the involvement of these positions in pH-induced inactivation was studied. The conformational mobility of penicillin acylase in Escherichia coli was analyzed through molecular modeling in neutral and alkaline conditions. Two functionally important subfamily-specific residues, Gluβ482 and Aspβ484, were found. Ionization of these residues at alkaline pH promoted the collapse of a buried network of stabilizing interactions that consequently disrupted the functional protein conformation. The subfamily-specific position Aspβ484 was selected as a hotspot for mutation to engineer enzyme variant tolerant to alkaline medium. The corresponding Dβ484N mutant was produced and showed 9-fold increase in stability at alkaline conditions. Bioinformatic analysis of subfamily-specific positions can be further explored to study mechanisms of protein inactivation and to design more stable variants for the engineering of homologous Ntn-hydrolases with improved catalytic properties.

Computational Design of a pH Stable Enzyme: Understanding Molecular Mechanism of Penicillin Acylase's Adaptation to Alkaline Conditions

PubMed Central

Suplatov, Dmitry; Panin, Nikolay; Kirilin, Evgeny; Shcherbakova, Tatyana; Kudryavtsev, Pavel; Švedas, Vytas

2014-01-01

Protein stability provides advantageous development of novel properties and can be crucial in affording tolerance to mutations that introduce functionally preferential phenotypes. Consequently, understanding the determining factors for protein stability is important for the study of structure-function relationship and design of novel protein functions. Thermal stability has been extensively studied in connection with practical application of biocatalysts. However, little work has been done to explore the mechanism of pH-dependent inactivation. In this study, bioinformatic analysis of the Ntn-hydrolase superfamily was performed to identify functionally important subfamily-specific positions in protein structures. Furthermore, the involvement of these positions in pH-induced inactivation was studied. The conformational mobility of penicillin acylase in Escherichia coli was analyzed through molecular modeling in neutral and alkaline conditions. Two functionally important subfamily-specific residues, Gluβ482 and Aspβ484, were found. Ionization of these residues at alkaline pH promoted the collapse of a buried network of stabilizing interactions that consequently disrupted the functional protein conformation. The subfamily-specific position Aspβ484 was selected as a hotspot for mutation to engineer enzyme variant tolerant to alkaline medium. The corresponding Dβ484N mutant was produced and showed 9-fold increase in stability at alkaline conditions. Bioinformatic analysis of subfamily-specific positions can be further explored to study mechanisms of protein inactivation and to design more stable variants for the engineering of homologous Ntn-hydrolases with improved catalytic properties. PMID:24959852

Curriculum for neurogastroenterology and motility training: A report from the joint ANMS-ESNM task force.

PubMed

Gyawali, C P; Savarino, E; Lazarescu, A; Bor, S; Patel, A; Dickman, R; Pressman, A; Drewes, A M; Rosen, J; Drug, V; Saps, M; Novais, L; Vazquez-Roque, M; Pohl, D; van Tilburg, M A L; Smout, A; Yoon, S; Pandolfino, J; Farrugia, G; Barbara, G; Roman, S

2018-03-25

Although neurogastroenterology and motility (NGM) disorders are some of the most frequent disorders encountered by practicing gastroenterologists, a structured competency-based training curriculum developed by NGM experts is lacking. The American Neurogastroenterology and Motility Society (ANMS) and the European Society of Neurogastroenterology and Motility (ESNM) jointly evaluated the components of NGM training in North America and Europe. Eleven training domains were identified within NGM, consisting of functional gastrointestinal disorders, visceral hypersensitivity and pain pathways, motor disorders within anatomic areas (esophagus, stomach, small bowel and colon, anorectum), mucosal disorders (gastro-esophageal reflux disease, other mucosal disorders), consequences of systemic disease, consequences of therapy (surgery, endoscopic intervention, medications, other therapy), and transition of pediatric patients into adult practice. A 3-tiered training curriculum covering these domains is proposed here and endorsed by all NGM societies. Tier 1 NGM knowledge and training is expected of all gastroenterology trainees and practicing gastroenterologists. Tier 2 knowledge and training is appropriate for trainees who anticipate NGM disorder management and NGM function test interpretation being an important part of their careers, which may require competency assessment and credentialing of test interpretation skills. Tier 3 knowledge and training is undertaken by trainees interested in a dedicated NGM career and may be restricted to specific domains within the broad NGM field. The joint ANMS and ESNM task force anticipates that the NGM curriculum will streamline NGM training in North America and Europe and will lead to better identification of centers of excellence where Tier 2 and Tier 3 training can be accomplished. © 2018 The Authors. Neurogastroenterology & Motility Published by John Wiley & Sons, Ltd.

Self-medication practices and rational drug use habits among university students: a cross-sectional study from Kahramanmaraş, Turkey.

PubMed

Okyay, Ramazan Azim; Erdoğan, Ayşegül

2017-01-01

Self-medication refers to the use of medicines to treat self-diagnosed diseases without consulting any healthcare professionals. Irrational drug use and self-medication have serious negative consequences both on health and economy. Therefore, the aim of this study is to assess the habits related to rational use of drugs (RUD) and to estimate the prevalence of self-medication practices among university students. This cross-sectional study was conducted on university students in Kahramanmaraş. From May 2017 to June 2017 a total of 960 students filled a "Rational Use of Drugs Questionnaire". The prevalence of practicing self-medication in students was 63.4%. The most common medicines that the students had consumed without prescription were analgesics by 39.5%, antibiotics by 36.9% and cold remedies by 24.0%. The rate of students who declared that they were familiar with RUD and "rational use of antibiotics" (RUA) was 45.9%. Reading/checking the instructions in the prospectus (OR = 1.529, 95% CI [1.176-1.990]), understanding the context of the prospectus (OR = 1.893, 95% CI [1.387-2.584]), compliance with the duration of antibiotic treatment (OR = 1.597, 95% CI [1.231-2.071]) and consulting a physician in case of a side effect (OR = 1.350, 95% CI [1.037-1.757]) were significantly higher among students who were familiar with RUD as compared to who were not. Since the awareness of RUD among university students was found to be inadequate, it has critical importance to hold educational activities with the cooperation of physicians, health organizations, universities, non-governmental organizations and media to avoid negative consequences of irrational drug use and self-medication.

Voicing Solidarity: Linguistic Hospitality and Poststructuralism in the Real World

ERIC Educational Resources Information Center

Phipps, Alison

2012-01-01

Structuralism has dominated the field of applied linguistics, which has consequences for the positioning of applied linguistics "vis-a-vis" policy makers, educational practice, and also theoretical and methodological innovations. These consequences pertain to how the field advocates, takes sides, balances its descriptive modes with its discursive…

Filtering beyond CIPA: Consequences of and Alternatives to Overfiltering in Schools

ERIC Educational Resources Information Center

Batch, Kristen R.; Magi, Trina; Luhtala, Michelle

2015-01-01

The article is divided into three sections. The main section, "Filtering beyond CIPA: Consequences of and Alternatives to Overfiltering in Schools" (Kristen Batch) describes factors that contribute to the overimplementation of CIPA. Internet filtering is a routine practice in public schools and libraries. The Children's Internet…

Enhancing Learning and Retarding Forgetting: Choices and Consequences

ERIC Educational Resources Information Center

Pashler, Harold; Rohrer, Doug; Cepeda, Nicholas J.; Carpenter, Shana K.

2007-01-01

Our research on learning enhancement has been focusing on the consequences for learning and forgetting of some of the more obvious and concrete choices that arise in instruction, including: How does spacing of practice affect retention of information over significant retention intervals (up to two years)? Do spacing effects generalize beyond…

Recent advances in collisional effects on spectra of molecular gases and their practical consequences

NASA Astrophysics Data System (ADS)

Hartmann, Jean-Michel; Tran, Ha; Armante, Raymond; Boulet, Christian; Campargue, Alain; Forget, François; Gianfrani, Livio; Gordon, Iouli; Guerlet, Sandrine; Gustafsson, Magnus; Hodges, Joseph T.; Kassi, Samir; Lisak, Daniel; Thibault, Franck; Toon, Geoffrey C.

2018-07-01

We review progress, since publication of the book ``Collisional effects on molecular spectra: Laboratory experiments and models, consequences for applications" (Elsevier, Amsterdam, 2008), on measuring, modeling and predicting the influence of pressure (ie of intermolecular collisions) on the spectra of gas molecules. We first introduce recently developed experimental techniques of high accuracy and sensitivity. We then complement the aforementioned book by presenting the theoretical approaches, results and data proposed (mostly) in the last decade on the topics of isolated line shapes, line-broadening and -shifting, line-mixing, the far wings and associated continua, and collision-induced absorption. Examples of recently demonstrated consequences of the progress in the description of spectral shapes for some practical applications (metrology, probing of gas media, climate predictions) are then given. Remaining issues and directions for future research are finally discussed.

Between trust and accountability: different perspectives on the modernization of postgraduate medical training in the Netherlands.

PubMed

Wallenburg, Iris; van Exel, Job; Stolk, Elly; Scheele, Fedde; de Bont, Antoinette; Meurs, Pauline

2010-06-01

Postgraduate medical training was reformed to be more responsive to changing societal needs. In the Netherlands, as in various other Western countries, a competency-based curriculum was introduced reflecting the clinical and nonclinical roles a modern doctor should fulfill. It is still unclear, however, what this modernization process exactly comprises and what its consequences might be for clinical practice and medical work. The authors conducted a Q methodological study to investigate which different perspectives exist on the modernization of postgraduate medical training among actors involved. The authors found four distinct perspectives, reflecting the different features of medical training. The accountability perspective stresses the importance of formal regulations within medical training and the monitoring of results in order to be more transparent and accountable to society. According to the educational perspective, medical training should be more formalized and directed at the educational process. The work-life balance perspective stresses the balance between a working life and a private life, as well as the changing professional relationship between staff members and residents. The trust-based perspective reflects the classic view of medical training in which role modeling and trust are considered most important. The four perspectives on the modernization of postgraduate medical training show that various aspects of the modernization process are valued differently by stakeholders, highlighting important sources of agreement and disagreement between them. An important source of disagreement is diverging expectations of the role of physicians in modern medical practice.

Silvicultural Practices in Forests of the Southern United States: Insect and Disease Considerations

Treesearch

T. Evan Nebeker; Theodor D. Leininger; James S. Meadows

1999-01-01

The relationship between silvicultural practices, e.g. thinning, and pest organisms (insects and diseases) has been investigated extensively in pine species but to a lesser degree in hardwoods. Of critical interest is the potential negative impact to the residual stand resulting from insect damage and diseases that develop as a consequence of silvicultural practices....

A Qualitative Study of Immigration Policy and Practice Dilemmas for Social Work Students

ERIC Educational Resources Information Center

Furman, Rich; Langer, Carol L.; Sanchez, Thomas Wayne; Negi, Nalini Junko

2007-01-01

Social policy shapes the infrastructure wherein social work is practiced. However, what happens when a particular social policy is seemingly incongruent with the social work code of ethics? How do social work students conceive and resolve potential practice dilemmas that may arise as a consequence? In this study, the authors explored potential…

The Classroom Observation Protocol for Undergraduate STEM (COPUS): A New Instrument to Characterize University STEM Classroom Practices

ERIC Educational Resources Information Center

Smith, Michelle K.; Jones, Francis H. M.; Gilbert, Sarah L.; Wieman, Carl E.

2013-01-01

Instructors and the teaching practices they employ play a critical role in improving student learning in college science, technology, engineering, and mathematics (STEM) courses. Consequently, there is increasing interest in collecting information on the range and frequency of teaching practices at department-wide and institution-wide scales. To…

[The importance of relationship satisfaction and the questionnaire techniques of its measurement].

PubMed

Vajda, Dóra; Sz Makó, Hajnalka

2014-01-01

The quality of marriage or partnership has an impact on many areas of life. Consequently, a good working relationship can be a significant resource to cope with difficult life situations and stress, and may contribute to partners' well-being and healthy lifestyle. Therefore, its investigation has particular relevance. Relationship satisfaction is a complex concept which is confirmed by both diversity and multidimensionality of its definition. The aim of this study is to provide an overview of the importance of relationship satisfaction, inter- and intrapersonal factors influencing its development, its changes over family life cycles and the gender differences that may manifest in relationship satisfaction. In addition, this review summarizes the questionnaire techniques of measuring relationship satisfaction which are also reflected within the complexity and the diversity of the concept. Given the fact that the degree of relationship satisfaction plays a salient role in many aspects of life, the empirical research findings which emphasize the importance of this conception can serve as an alternative to aim the mobilization of its practical work.

Programming of Urban Revitalization

NASA Astrophysics Data System (ADS)

Biliński, Tadeusz

2016-12-01

The planning stage of the investment-construction process is of a crucial importance. Its overall impact on the costs, construction time and the quality of design solutions is huge. However, in practice, little attention is given to this pre-design stage, except for public buildings or other buildings of particular importance. In consequence, the results of investment and construction activities are unsatisfactory. Therefore, the issue has been given careful consideration in this paper. The paper discusses the issue of programming urban revitalization, emphasizing its socio-economic importance. To illustrate the complexity of revitalization projects planning, the author draws attention to social, economic, technical and organisational factors, such as public participation, reorganization and revaluation of land use planning, rationalization of energy use, organization and management of revitalization processes, as well as technical progress. Summarising the paper, the author concludes that in order to improve the quality of life of town residents and to protect material national heritage, it is indispensable to continuously revitalize subsequent town areas.

Building inhabitant feedback: Creating a reflective practice for environmental design using activity theory

NASA Astrophysics Data System (ADS)

Cunningham, Dara Suzanne

The way buildings are designed now, there is little feedback from use involved in the design process. Attempts to correct this problem have been made in the form of Post Occupancy Evaluations (POEs) for 50-years but have largely failed. POEs are the accepted method for environmental designers to collect feedback about buildings in use. They are infrequently conducted, after the building is built, in a one-time only evaluation, and not funded as part of the build process. Other products receive feedback about the design in use from online critiques. Online critiques could provide a platform for feedback from actors engaged with buildings in use for environmental designers to utilize in developing reflective design rationale to avoid adverse consequences in future designs or correct consequences in past and current designs. Since buildings constitute such a large part of the human environment, it's important to research the effects of buildings on their inhabitants. In order for environmental designers to act on feedback from situated use, designers need to have access to that feedback and all actors interacting with the building design need to have an easy, inexpensive, and accessible method to submit feedback. These needs can be addressed by utilizing modern networked and mobile computing to collect and access building feedback. The analysis presented in this dissertation is informed by a thorough evaluation of the theory of reflective practice, activity theory, environmental design, and cognitive science research. From this analysis, I developed the following contributions. First, I expanded Schon's reflective practice by combining his theory with a modified version of activity theory, using activity theory to enrich reflective practice and create Reflective Activity Systems Theory (RAST), which provides a new framework to develop design rationale based on feedback from use and a focus on the activity. Second, I suggest the design of an activity information system, Socio-Technical Environments for Evolutionary Design (STEED), which provides an interactive platform for actor and artifact feedback from the use situation. Third, I discuss implications for practice by discussing how the feedback from actors and artifacts in situated use can be used to create reflective design rationale.

The Personal Emergency Response System as a Technology Innovation in Primary Health Care Services: An Integrative Review.

PubMed

Stokke, Randi

2016-07-14

Most western countries are experiencing greater pressure on community care services due to increased life expectancy and changes in policy toward prioritizing independent living. This has led to a demand for change and innovation in caring practices with an expected increased use of technology. Despite numerous attempts, it has proven surprisingly difficult to implement and adopt technological innovations. The main established technological innovation in home care services for older people is the personal emergency response system (PERS), which is widely adopted and used throughout most western countries aiming to support "aging safely in place." This integrative review examines how research literature describes use of the PERS focusing on the users' perspective, thus exploring how different actors experience the technology in use and how it affects the complex interactions between multiple actors in caring practices. The review presents an overview of the body of research on this well-established telecare solution, indicating what is important for different actors in regard to accepting and using this technology in community care services. An integrative review, recognized by a systematic search in major databases followed by a review process, was conducted. The search resulted in 33 included studies describing different actors' experiences with the PERS in use. The overall focus was on the end users' experiences and the consequences of having and using the alarm, and how the technology changes caring practices and interactions between the actors. The PERS contributes to safety and independent living for users of the alarm, but there are also unforeseen consequences and possible improvements in the device and the integrated service. This rather simple and well-established telecare technology in use interacts with the actors involved, creating changes in daily living and even affecting their identities. This review argues for an approach to telecare in which the complexity of practice is accounted for and shows how the plug-and-play expectations producers tend to generate is a simplification of the reality. This calls for a recognition that place and actors matter, as does a sensitivity to technology as an integrated part of complex caring practices.

The Personal Emergency Response System as a Technology Innovation in Primary Health Care Services: An Integrative Review

PubMed Central

2016-01-01

Background Most western countries are experiencing greater pressure on community care services due to increased life expectancy and changes in policy toward prioritizing independent living. This has led to a demand for change and innovation in caring practices with an expected increased use of technology. Despite numerous attempts, it has proven surprisingly difficult to implement and adopt technological innovations. The main established technological innovation in home care services for older people is the personal emergency response system (PERS), which is widely adopted and used throughout most western countries aiming to support “aging safely in place.” Objective This integrative review examines how research literature describes use of the PERS focusing on the users’ perspective, thus exploring how different actors experience the technology in use and how it affects the complex interactions between multiple actors in caring practices. Methods The review presents an overview of the body of research on this well-established telecare solution, indicating what is important for different actors in regard to accepting and using this technology in community care services. An integrative review, recognized by a systematic search in major databases followed by a review process, was conducted. Results The search resulted in 33 included studies describing different actors’ experiences with the PERS in use. The overall focus was on the end users’ experiences and the consequences of having and using the alarm, and how the technology changes caring practices and interactions between the actors. Conclusions The PERS contributes to safety and independent living for users of the alarm, but there are also unforeseen consequences and possible improvements in the device and the integrated service. This rather simple and well-established telecare technology in use interacts with the actors involved, creating changes in daily living and even affecting their identities. This review argues for an approach to telecare in which the complexity of practice is accounted for and shows how the plug-and-play expectations producers tend to generate is a simplification of the reality. This calls for a recognition that place and actors matter, as does a sensitivity to technology as an integrated part of complex caring practices. PMID:27417422

Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine.

PubMed

Sanders, Gillian D; Neumann, Peter J; Basu, Anirban; Brock, Dan W; Feeny, David; Krahn, Murray; Kuntz, Karen M; Meltzer, David O; Owens, Douglas K; Prosser, Lisa A; Salomon, Joshua A; Sculpher, Mark J; Trikalinos, Thomas A; Russell, Louise B; Siegel, Joanna E; Ganiats, Theodore G

2016-09-13

Since publication of the report by the Panel on Cost-Effectiveness in Health and Medicine in 1996, researchers have advanced the methods of cost-effectiveness analysis, and policy makers have experimented with its application. The need to deliver health care efficiently and the importance of using analytic techniques to understand the clinical and economic consequences of strategies to improve health have increased in recent years. To review the state of the field and provide recommendations to improve the quality of cost-effectiveness analyses. The intended audiences include researchers, government policy makers, public health officials, health care administrators, payers, businesses, clinicians, patients, and consumers. In 2012, the Second Panel on Cost-Effectiveness in Health and Medicine was formed and included 2 co-chairs, 13 members, and 3 additional members of a leadership group. These members were selected on the basis of their experience in the field to provide broad expertise in the design, conduct, and use of cost-effectiveness analyses. Over the next 3.5 years, the panel developed recommendations by consensus. These recommendations were then reviewed by invited external reviewers and through a public posting process. The concept of a "reference case" and a set of standard methodological practices that all cost-effectiveness analyses should follow to improve quality and comparability are recommended. All cost-effectiveness analyses should report 2 reference case analyses: one based on a health care sector perspective and another based on a societal perspective. The use of an "impact inventory," which is a structured table that contains consequences (both inside and outside the formal health care sector), intended to clarify the scope and boundaries of the 2 reference case analyses is also recommended. This special communication reviews these recommendations and others concerning the estimation of the consequences of interventions, the valuation of health outcomes, and the reporting of cost-effectiveness analyses. The Second Panel reviewed the current status of the field of cost-effectiveness analysis and developed a new set of recommendations. Major changes include the recommendation to perform analyses from 2 reference case perspectives and to provide an impact inventory to clarify included consequences.

The practice of physical medicine and rehabilitation in subSaharan Africa and Antarctica: A white paper or a black mark?

PubMed

Haig, Andrew J; Im, Jonathan; Adewole, Ayodeji; Nelson, Virgina S; Krabak, Brian

2009-05-01

The medical specialty of physical medicine and rehabilitation (PM&R) has had a proven impact on persons with disability and on health care systems. Documents such as The White Book on Physical and Rehabilitation Medicine in Europe have been important in defining the scope of practice within various regions. However, on some continents, the practice has not been well defined. To explore the practice of PM&R in subSaharan Africa and Antarctica. Medline searches, membership data searches, fax survey of medical schools, Internet searches, and interviews with experts. The continents are dissimilar in terms of climate and government. However both Antarctica and subSaharan Africa have no PM&R training programs, no professional organizations, no specialty board requirements, and no practicing physicians in the field. Because there are no known disabled children on Antarctica and adults are airlifted to world-class health care, the consequences of this deficit are minimal there. However, the 788,000,000 permanent residents of subSaharan Africa, including approximately 78 million persons with disability, are left unserved. Antarctica is doing fine. Africa is in a crisis. Local medical schools, hospitals doctors, and persons with disability; along with foreign volunteers, aid groups, and policymakers can impact the crisis. However government-specifically national ministries of health-is ultimately responsible for the health and wellbeing of citizens.

The practice of physical medicine and rehabilitation in sub-Saharan Africa and Antarctica: a white paper or a black mark?

PubMed

Haig, Andrew J; Im, Jonathan; Adewole, Adodeji; Nelson, Virginia S; Krabek, Brian

2009-01-01

The medical specialty of Physical Medicine and Rehabilitation (PM&R) has had a proven impact on persons with disability and on healthcare systems. Documents such as The White Book on Physical and Rehabilitation Medicine in Europe have been important in defining the scope of practice within various regions. However in some continents the practice has not been well defined. To explore the practice of PM&R in sub-Saharan Africa and Antarctica. Medline searches, membership data searches, fax survey of medical schools, Internet searches and interviews with experts. The continents are dissimilar in terms of climate and government. However both Antarctica and sub-Saharan Africa have no PM&R training programs, no professional organisations, no specialty board requirements and no practicing physicians in the field. Since there are no known disabled children in Antarctica and adults are airlifted to world-class health care, the consequences of this deficit are minimal there. However, the 788,000,000 permanent residents of sub-Saharan Africa including approximately 78 million persons with disability are left unserved. Antarctica is doing fine. Africa is in a crisis. Local medical schools, hospitals doctors, and persons with disability; along with foreign volunteers, aid groups and policymakers can impact the crisis. However government--specifically national ministries of health--is ultimately responsible for the health and well-being of citizens.

The practice of physical medicine and rehabilitation in subSaharan Africa and Antarctica: a white paper or a black mark?

PubMed

Haig, A J; Im, J; Adewole, A; Nelson, V S; Krabak, B

2009-06-01

The medical specialty of physical medicine and rehabilitation (PM&R) has had a proven impact on persons with disability and on healthcare systems. Documents such as The White Book on Physical and Rehabilitation Medicine in Europe have been important in defining the scope of practice within various regions. However on some continents the practice has not been well defined. The aim of this paper was to explore the practice of PM&R in subSaharan Africa and Antarctica. Medline searches, membership data searches, fax survey of medical schools, Internet searches, and interviews with experts. The continents are dissimilar in terms of climate and government; However, both Antarctica and subSaharan Africa have no PM&R training programs, no professional organizations, no specialty board requirements, and no practicing physicians in the field. Since there are no known disabled children on Antarctica and adults are airlifted to world-class health care, the consequences of this deficit are minimal there. However the 788,000,000 permanent residents of subSaharan Africa including approximately 78 million persons with disability are left unserved. Antarctica is doing fine. Africa is in a crisis. Local medical schools, hospitals doctors, and persons with disability; along with foreign volunteers, aid groups, and policymakers can impact the crisis. However government specifically national ministries of health is ultimately responsible for the health and wellbeing of citizens.

Female genital mutilation/cutting: changes and trends in knowledge, attitudes, and practices among health care professionals in The Gambia

PubMed Central

Kaplan Marcusán, Adriana; Riba Singla, Laura; Laye, Mass; Secka, Dodou M; Utzet, Mireia; Le Charles, Marie-Alix

2016-01-01

Background Female genital mutilation/cutting (FGM/C) is a harmful traditional practice that affects two out of three girls in The Gambia, seriously threatening their life and well-being with severe health consequences. By tracking the reference values established in former research conducted between 2009 and 2011, the objectives of this study are to explore trends and to measure and assess changes in knowledge, attitudes, and practices regarding FGM/C among health care professionals (HCPs) in The Gambia. Methods A cross-sectional descriptive study was designed to collect and analyze data from an overall stratified sample consisting of 1,288 HCPs including health professionals and students throughout the six regions of The Gambia. Data were collected by the implementation of a self-administered written knowledge, attitudes, and practices questionnaire between 2012 and 2014. Results The results of this study showed that 76.4% of HCPs are eager to abandon FGM/C, and 71.6% of them regard it as a harmful practice with negative consequences on life and health. HCPs reported more knowledge and favorable attitudes towards FGM/C abandonment, being better able to identify the practice, more aware of its health complications, and more concerned in their essential role as social agents of change. However, 25.4% of HCPs still embraced the continuation of the practice, 24.4% expressed intention of subjecting their own daughters to it, and 10.5% declared to have performed it within their professional praxis. Conclusion Findings confirm progress in knowledge and attitudes regarding FGM/C among HCPs, who are better skilled to understand and manage the consequences. Nevertheless, discrepancies between information, intention, and behavior unveil resistance in practice and proves that FGM/C medicalization is increasing. Thus, there is an urgent need to support HCPs in the integration of FGM/C preventive interventions within the public health system, to address arguments favoring medicalization, and to use data to design appropriate strategies. PMID:27110140

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

PubMed Central

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

2018-01-01

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

SOARCA Peach Bottom Atomic Power Station Long-Term Station Blackout Uncertainty Analysis: Knowledge Advancement.

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

Gauntt, Randall O.; Mattie, Patrick D.; Bixler, Nathan E.

2014-02-01

This paper describes the knowledge advancements from the uncertainty analysis for the State-of- the-Art Reactor Consequence Analyses (SOARCA) unmitigated long-term station blackout accident scenario at the Peach Bottom Atomic Power Station. This work assessed key MELCOR and MELCOR Accident Consequence Code System, Version 2 (MACCS2) modeling uncertainties in an integrated fashion to quantify the relative importance of each uncertain input on potential accident progression, radiological releases, and off-site consequences. This quantitative uncertainty analysis provides measures of the effects on consequences, of each of the selected uncertain parameters both individually and in interaction with other parameters. The results measure the modelmore » response (e.g., variance in the output) to uncertainty in the selected input. Investigation into the important uncertain parameters in turn yields insights into important phenomena for accident progression and off-site consequences. This uncertainty analysis confirmed the known importance of some parameters, such as failure rate of the Safety Relief Valve in accident progression modeling and the dry deposition velocity in off-site consequence modeling. The analysis also revealed some new insights, such as dependent effect of cesium chemical form for different accident progressions. (auth)« less

Improved Perceptions and Practices Related to Schistosomiasis and Intestinal Worm Infections Following PHAST Intervention on Kome Island, North-Western Tanzania.

PubMed

Mwanga, Joseph R; Kaatano, Godfrey M; Siza, Julius E; Chang, Su Young; Ko, Yunsuk; Kullaya, Cyril M; Nsabo, Jackson; Eom, Keeseon S; Yong, Tai-Soon; Chai, Jong-Yil; Min, Duk-Young; Rim, Han-Jong; Changalucha, John M

2015-10-01

Schistosomiasis and intestinal worm infections are widespread diseases of public health importance in Tanzania. A study on perceptions and practices related to schistosomiasis and intestinal worm infections was undertaken among a community population of Kome Island in Sengerema District, north-western Tanzania, where intestinal schistosomiasis and intestinal worm infections are endemic. Schistosomiasis and intestinal worm-related perceptions and practices were assessed before and 3 years after implementation of a participatory hygiene and sanitation transformation (PHAST) intervention as a control measure. Data were obtained from baseline and post-intervention knowledge, attitudes, and practices (KAP) questionnaire surveys conducted twice in 2009 and 2012 among 82 individuals aged ≥15 years. We found significant increases in respondents' knowledge of the cause, transmission, symptoms, health consequences, and prevention of schistosomiasis and intestinal worm infections after PHAST intervention. The increase in respondents' knowledge on almost all aspects of the said infections was translated into actions to control schistosomiasis and intestinal worm infections. This has not been achieved by chance, but due to well-designed and locally-adapted PHAST intervention. We conclude that despite criticisms, PHAST approach is still useful in empowering communities to control water, sanitation, and hygiene related infectious diseases such as schistosomiasis and intestinal worm infections.

Testing for Accountability: A Balancing Act That Challenges Current Testing Practices and Theories

ERIC Educational Resources Information Center

Brennan, Robert L.

2015-01-01

Koretz, in his article published in this issue, provides compelling arguments that the high stakes currently associated with accountability testing lead to behavioral changes in students, teachers, and other stakeholders that often have negative consequences, such as inflated scores. Koretz goes on to argue that these negative consequences require…

Academic Crime and Punishment: Faculty Members' Perceptions of and Responses to Plagiarism

ERIC Educational Resources Information Center

Robinson-Zanartu, Carol; Pena, Elizabeth D.; Cook-Morales, Valerie; Pena, Anna M.; Afshani, Rosalyn; Nguyen, Lynda

2005-01-01

Academic dishonesty and its consequences have become increasingly complex. Highly accessible electronic media, profound consequences for misconduct and reporting, and lack of standard practice intensify the issues. We surveyed 270 faculty members to determine whether they had been confronted with plagiarism and if they felt prepared to deal with…

Potential Psychosocial and Instructional Consequences of the Common Core State Standards: Implications for Research and Practice

ERIC Educational Resources Information Center

Saeki, Elina; Pendergast, Laura; Segool, Natasha K.; von der Embse, Nathaniel P.

2015-01-01

Despite the recent rollout of the Common Core State Standards (CCSS), CCSS-aligned assessments, and test-based teacher evaluation systems, questions remain regarding the impact that these accountability policies will have on teachers and students. This article discusses the psychosocial and instructional consequences of test-based accountability…

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

USDA-ARS?s Scientific Manuscript database

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

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

ERIC Educational Resources Information Center

Speizer, Ilene S.; White, Justin S.

2008-01-01

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

Liberating the Learner through Self-Assessment

ERIC Educational Resources Information Center

Bourke, Roseanna

2016-01-01

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

33 CFR 238.5 - Comprehensive planning.

Code of Federal Regulations, 2010 CFR

2010-07-01

... to be urbanized in the future. Changes in land use may result in major alterations of the runoff... projected land uses and expected practices for collection and conveyance of runoff over the period of... about water related consequences of alternative land uses and drainage practices. ...

Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses

PubMed Central

Gutmanis, Iris; Beynon, Charlene; Tutty, Leslie; Wathen, C Nadine; MacMillan, Harriet L

2007-01-01

Background Intimate partner violence against women (IPV) has been identified as a serious public health problem. Although the health care system is an important site for identification and intervention, there have been challenges in determining how health care professionals can best address this issue in practice. We surveyed nurses and physicians in 2004 regarding their attitudes and behaviours with respect to IPV, including whether they routinely inquire about IPV, as well as potentially relevant barriers, facilitators, experiential, and practice-related factors. Methods A modified Dillman Tailored Design approach was used to survey 1000 nurses and 1000 physicians by mail in Ontario, Canada. Respondents were randomly selected from professional directories and represented practice areas pre-identified from the literature as those most likely to care for women at the point of initial IPV disclosure: family practice, obstetrics and gynecology, emergency care, maternal/newborn care, and public health. The survey instrument had a case-based scenario followed by 43 questions asking about behaviours and resources specific to woman abuse. Results In total, 931 questionnaires were returned; 597 by nurses (59.7% response rate) and 328 by physicians (32.8% response rate). Overall, 32% of nurses and 42% of physicians reported routinely initiating the topic of IPV in practice. Principal components analysis identified eight constructs related to whether routine inquiry was conducted: preparedness, self-confidence, professional supports, abuse inquiry, practitioner consequences of asking, comfort following disclosure, practitioner lack of control, and practice pressures. Each construct was analyzed according to a number of related issues, including clinician training and experience with woman abuse, area of practice, and type of health care provider. Preparedness emerged as a key construct related to whether respondents routinely initiated the topic of IPV. Conclusion The present study provides new insight into the factors that facilitate and impede clinicians' decisions to address the issue of IPV with their female patients. Inadequate preparation, both educational and experiential, emerged as a key barrier to routine inquiry, as did the importance of the "real world" pressures associated with the daily context of primary care practice. PMID:17250771

Case Studies in Modelling, Control in Food Processes.

PubMed

Glassey, J; Barone, A; Montague, G A; Sabou, V

This chapter discusses the importance of modelling and control in increasing food process efficiency and ensuring product quality. Various approaches to both modelling and control in food processing are set in the context of the specific challenges in this industrial sector and latest developments in each area are discussed. Three industrial case studies are used to demonstrate the benefits of advanced measurement, modelling and control in food processes. The first case study illustrates the use of knowledge elicitation from expert operators in the process for the manufacture of potato chips (French fries) and the consequent improvements in process control to increase the consistency of the resulting product. The second case study highlights the economic benefits of tighter control of an important process parameter, moisture content, in potato crisp (chips) manufacture. The final case study describes the use of NIR spectroscopy in ensuring effective mixing of dry multicomponent mixtures and pastes. Practical implementation tips and infrastructure requirements are also discussed.

A Computer Model of Insect Traps in a Landscape

NASA Astrophysics Data System (ADS)

Manoukis, Nicholas C.; Hall, Brian; Geib, Scott M.

2014-11-01

Attractant-based trap networks are important elements of invasive insect detection, pest control, and basic research programs. We present a landscape-level, spatially explicit model of trap networks, focused on detection, that incorporates variable attractiveness of traps and a movement model for insect dispersion. We describe the model and validate its behavior using field trap data on networks targeting two species, Ceratitis capitata and Anoplophora glabripennis. Our model will assist efforts to optimize trap networks by 1) introducing an accessible and realistic mathematical characterization of the operation of a single trap that lends itself easily to parametrization via field experiments and 2) allowing direct quantification and comparison of sensitivity between trap networks. Results from the two case studies indicate that the relationship between number of traps and their spatial distribution and capture probability under the model is qualitatively dependent on the attractiveness of the traps, a result with important practical consequences.

Choice of wound care in diabetic foot ulcer: A practical approach

PubMed Central

Kavitha, Karakkattu Vijayan; Tiwari, Shalbha; Purandare, Vedavati Bharat; Khedkar, Sudam; Bhosale, Shilpa Sameer; Unnikrishnan, Ambika Gopalakrishnan

2014-01-01

Diabetic foot ulcers are the consequence of multiple factors including peripheral neuropathy, decreased blood supply, high plantar pressures, etc., and pose a significant risk for morbidity, limb loss and mortality. The critical aspects of the wound healing mechanism and host physiological status in patients with diabetes necessitate the selection of an appropriate treatment strategy based on the complexity and type of wound. In addition to systemic antibiotics and surgical intervention, wound care is considered to be an important component of diabetic foot ulcer management. This article will focus on the use of different wound care materials in diabetic foot. From a clinical perspective, it is important to decide on the wound care material depending on the type and grade of the ulcer. This article will also provide clinicians with a simple approach to the choice of wound care materials in diabetic foot ulcer. PMID:25126400

Beyond motivation: job and work design for development, health, ambidexterity, and more.

PubMed

Parker, Sharon K

2014-01-01

Much research shows it is possible to design motivating work, which has positive consequences for individuals and their organizations. This article reviews research that adopts this motivational perspective on work design, and it emphasizes that it is important to continue to refine motivational theories. In light of continued large numbers of poor-quality jobs, attention must also be given to influencing practice and policy to promote the effective implementation of enriched work designs. Nevertheless, current and future work-based challenges mean that designing work for motivation is necessary but insufficient. This review argues that work design can be a powerful vehicle for learning and development, for maintaining and enhancing employees' physical and mental health, and for achieving control and flexibility simultaneously (for example, in the form of ambidexterity); all these outcomes are important given the challenges in today's workplaces. The review concludes by suggesting methodological directions.

[Helminths of carnivores relevant to veterinary practice].

PubMed

Hasslinger, M A

1986-01-01

Especially in an urban environment man and carnivores live closely together, whereby one has to pay attention not only to animal parasites, but also to human pathogenic connections regarding these parasites. Because of the infection risk the animal owner has to be competently informed by his veterinarian. While some cestodes make great demands on hygiene, with others the cycle can be interrupted by consequent diet restrictions. Of all nematodes the stomach worm of the cat is of greater importance as it is easily overlooked because of its small size, is difficult to diagnose and is occurring in our regions with an infestation rate of about 40%. "Larva migrans visceralis" and "Larva migrans cutanea" caused by ascaride and hookworm larvae are important in human medicine and demand therapeutic measures. The contamination of parks, playgrounds and beaches with these parasites caused by carnivores requires a critical evaluation of the human pathogen interests.

Editorial: Research Domain Criteria (RDoC): a new psychiatric nosology whose time has not yet come.

PubMed

Peterson, Bradley S

2015-07-01

In developing new ways of classifying mental disorders, RDoC is developing a new nosology, a new way of dividing nature at its seams. Given the NIMH influence on research agendas across the world, this scientific agenda will have important consequences for researchers and clinicians worldwide. Defining discrete neural systems and the behavioral and cognitive functions they subserve is scientifically important. Understanding how these systems relate to clinical problems, patient suffering, and improved treatments has immense potential practical value for clinical care worldwide. This Editorial places the RDoC framework in context and then sets out a series of conceptual, empirical, and developmental challenges for RDoC. Together these challenges suggest that RDoC is premature as a nosology and, as currently implemented, risks being reified and overly rigid in its application. © 2015 Association for Child and Adolescent Mental Health.

Quantifying randomness in real networks

NASA Astrophysics Data System (ADS)

Orsini, Chiara; Dankulov, Marija M.; Colomer-de-Simón, Pol; Jamakovic, Almerima; Mahadevan, Priya; Vahdat, Amin; Bassler, Kevin E.; Toroczkai, Zoltán; Boguñá, Marián; Caldarelli, Guido; Fortunato, Santo; Krioukov, Dmitri

2015-10-01

Represented as graphs, real networks are intricate combinations of order and disorder. Fixing some of the structural properties of network models to their values observed in real networks, many other properties appear as statistical consequences of these fixed observables, plus randomness in other respects. Here we employ the dk-series, a complete set of basic characteristics of the network structure, to study the statistical dependencies between different network properties. We consider six real networks--the Internet, US airport network, human protein interactions, technosocial web of trust, English word network, and an fMRI map of the human brain--and find that many important local and global structural properties of these networks are closely reproduced by dk-random graphs whose degree distributions, degree correlations and clustering are as in the corresponding real network. We discuss important conceptual, methodological, and practical implications of this evaluation of network randomness, and release software to generate dk-random graphs.

Cheques and challenges: business performance in New Zealand general practice.

PubMed

Greatbanks, Richard; Doolan-Noble, Fiona; McKenna, Alex

2017-09-01

INTRODUCTION New Zealand general practice mainly functions as small businesses, usually owned by a single or small group of doctors. Consequently, owners often have to balance the provision of patient care with varying funding priorities, changing patient needs and the pressures of running a sustainable business. Such balancing inevitably leads to tensions developing between these factors. AIM To explore and understand these tensions and responses to them, by examining the business performance measurements used by general practice. METHODS For this study, the unit of analysis and focus were individual practices, but qualitative semi-structured interviews with general practitioners (GPs) and practice managers were used to gather the data. RESULTS All participating practices had some form of governance or board review, where high-level aggregated business performance data were presented. More sophisticated business performance measures were evident in the larger, more developed practices and in practices functioning as community trusts. Examples of such measures included doctor utilisation and efficiency, appraisal of risk, patient satisfaction with services and responses to changes in patient demand. DISCUSSION As the number of general practices based on the traditional model decrease, a corresponding increase is likely in the establishment and development of 'super practices' based on a corporatized, multi-service, single-location model. Consequently, service delivery will become increasingly complex and will drive a need for increased sophistication in how general practice measures its business performance, thus ensuring a balance between high-quality, safe patient care and the maintenance of a sustainable business.

Online information seeking practices of biology teachers and the perceived influences on instructional planning

NASA Astrophysics Data System (ADS)

Perrault, Anne Marie

The purpose of this study was to examine biology teachers' perceptions of how their online information seeking practices influence their instructional planning. When teachers engage in activities to locate, evaluate, and use online information and resources, a myriad of inter-related and often inseparable consequences follows. These influences may be any combination of direct/indirect, desirable/undesirable, or anticipated/unanticipated (Rogers, 2003). This exploratory study collected baseline data regarding teachers' online practices and its influence on their practice. There were two phases of data collection in this study. Phase I was an online survey of more than seventy New York State biology teachers. The survey was intended to capture (1) a snapshot of the biology teachers' online information seeking practices during the summer and fall 2004, and (2) their perceptions regarding how their online practices influenced their instructional planning. In Phase II, ten study participants were interviewed in order to explore in greater detail the consequences of their online information seeking practices on their instructional planning. Four themes reflecting the consequences of teachers' information seeking practices emerged from the data analysis: Currency of Information; Sparking of Ideas and Gaining Personal Knowledge; Resource Management and the Role of Time; and Webs of Sharing. Each theme encompassed both the purposeful and the indirect actions by teachers to access knowledge and resources to refine and improve their instructional planning. This study's findings show that teachers are using a greater number and wider range of current and multi-modal resources than pre-Internet and they perceive this as an advantage in creating authentic, inquiry-based learning experiences. A notable discovery was of the under-use by teachers of educational online resources specifically designed to support teaching and learning activities (e.g., digital libraries, online databases, and listservs). This study's findings point to a recursive process in which teachers are engaged in ongoing online information seeking practices; continually learning and fostering new knowledge; integrating the learning into their instructional planning practices; changing their teaching strategies; and going back online to search for information and resources and begin the cycle again.

Association of acculturation with drinking games among Hispanic college students.

PubMed

Schwartz, Seth J; Zamboanga, Byron L; Tomaso, Cara C; Kondo, Karli K; Unger, Jennifer B; Weisskirch, Robert S; Ham, Lindsay S; Meca, Alan; Cano, Miguel Ángel; Whitbourne, Susan Krauss; Brittian, Aerika S; Des Rosiers, Sabrina E; Hurley, Eric A; Vazsonyi, Alexander T; Ravert, Russell D

2014-09-01

This cross-sectional study was conducted to investigate which components of acculturation relate to drinking games participation among Hispanic college students. We also sought to examine whether the relationships between acculturation and drinking games would differ from the associations between acculturation and other alcohol-related outcomes. A sample of 1,397 Hispanic students aged 18-25 (75% women; 77% US-born) from 30 US colleges and universities completed a confidential online survey. Associations among acculturative processes, drinking games participation, general alcohol consumption, and negative drinking consequences differed across gender. Most significant findings emerged in the domain of cultural practices. For women, US cultural practices were associated with greater general alcohol consumption, drinking games frequency, and amount of alcohol consumed while gaming, whereas for men, US cultural practices were associated with general alcohol consumption and negative drinking consequences. Hispanic and US cultural practices, values, and identifications were differentially associated with drinking games participation, and these associations differed by gender. It is therefore essential for college student alcohol research to examine US culture acquisition and Hispanic culture retention separately and within the domains of cultural practices, values, and identifications.

Un regard international sur la sécurité nucléaire

NASA Astrophysics Data System (ADS)

Birkhofer, Adolf

2002-10-01

Safety has always been an important objective in nuclear technology. Starting with a set of sound physical principles and prudent design approaches, safety concepts have gradually been refined and cover now a wide range of provisions related to design, quality and operation. Research, the evaluation of operating experiences and probabilistic risk assessments constitute an essential basis and international co-operation plays a significant role in that context. Concerning future developments a major objective for new reactor concepts, such as the EPR, is to practically exclude a severe core damage accident with large scale consequences outside the plant. To cite this article: A. Birkhofer, C. R. Physique 3 (2002) 1059-1065.

Nurses and requests for female genital mutilation: cultural rights versus human rights.

PubMed

Sala, R; Manara, D

2001-05-01

In this article we focus on female genital mutilation. We analyse this problem as one of the most important issues of multiculturalism, which is also coming to the attention of the public in Italy as a consequence of the growing number of immigrants from African countries. The fundamental problem is about the acceptability of this practice: can female genital mutilation be permitted and, if so, on what basis? We will try to cope with this as a genuine conflict between culture-relative values and universal values, such as human rights. Some attention will be drawn to Italian law. Finally, the impact on nurses of requests for genital mutilation will be described.

Lessons learned from the dog genome.

PubMed

Wayne, Robert K; Ostrander, Elaine A

2007-11-01

Extensive genetic resources and a high-quality genome sequence position the dog as an important model species for understanding genome evolution, population genetics and genes underlying complex phenotypic traits. Newly developed genomic resources have expanded our understanding of canine evolutionary history and dog origins. Domestication involved genetic contributions from multiple populations of gray wolves probably through backcrossing. More recently, the advent of controlled breeding practices has segregated genetic variability into distinct dog breeds that possess specific phenotypic traits. Consequently, genome-wide association and selective sweep scans now allow the discovery of genes underlying breed-specific characteristics. The dog is finally emerging as a novel resource for studying the genetic basis of complex traits, including behavior.

Genetics and molecular biology in laboratory medicine, 1963-2013.

PubMed

Whitfield, John B

2013-01-01

The past 50 years have seen many changes in laboratory medicine, either as causes or consequences of increases in productivity and expansion of the range of information which can be provided. The drivers and facilitators of change in relation to clinical applications of molecular biology included the need for diagnostic tools for genetic diseases and technical advances such as PCR and sequencing. However, molecular biology techniques have proved to have far wider applications, from detection of infectious agents to molecular characterization of tumors. Journals such as Clinical Chemistry and Laboratory Medicine play an important role in communication of these advances to the laboratory medicine community and in publishing evaluations of their practical value.

A review of nursing strategies to reduce patient anxiety in coronary care. Part 2.

PubMed

Elliott, D

1992-09-01

Illness and associated hospitalisation are stressful events for any individual. The stress associated with an admission to a coronary care unit may be related to the severity and acuteness of the illness, the effects of hospitalisation on the individual, their family, their job and financial position, and often manifests itself as anxiety, fear or depression. This paper highlights the use of anxiety reduction strategies such as muscle relaxation, music, education and counseling. The literature reviewed does not provide any clear messages regarding the effectiveness of these strategies in the coronary care unit setting. As a consequence, there is a need to continue researching this important area of nursing practice.

Dipolar induced para-hydrogen-induced polarization.

PubMed

Buntkowsky, Gerd; Gutmann, Torsten; Petrova, Marina V; Ivanov, Konstantin L; Bommerich, Ute; Plaumann, Markus; Bernarding, Johannes

2014-01-01

Analytical expressions for the signal enhancement in solid-state PHIP NMR spectroscopy mediated by homonuclear dipolar interactions and single pulse or spin-echo excitation are developed and simulated numerically. It is shown that an efficient enhancement of the proton NMR signal in solid-state NMR studies of chemisorbed hydrogen on surfaces is possible. Employing typical reaction efficacy, enhancement-factors of ca. 30-40 can be expected both under ALTADENA and under PASADENA conditions. This result has important consequences for the practical application of the method, since it potentially allows the design of an in-situ flow setup, where the para-hydrogen is adsorbed and desorbed from catalyst surfaces inside the NMR magnet. Copyright © 2014 Elsevier Inc. All rights reserved.

Stepwise approach to establishing multiple outreach laboratory information system-electronic medical record interfaces.

PubMed

Pantanowitz, Liron; Labranche, Wayne; Lareau, William

2010-05-26

Clinical laboratory outreach business is changing as more physician practices adopt an electronic medical record (EMR). Physician connectivity with the laboratory information system (LIS) is consequently becoming more important. However, there are no reports available to assist the informatician with establishing and maintaining outreach LIS-EMR connectivity. A four-stage scheme is presented that was successfully employed to establish unidirectional and bidirectional interfaces with multiple physician EMRs. This approach involves planning (step 1), followed by interface building (step 2) with subsequent testing (step 3), and finally ongoing maintenance (step 4). The role of organized project management, software as a service (SAAS), and alternate solutions for outreach connectivity are discussed.

Stepwise approach to establishing multiple outreach laboratory information system-electronic medical record interfaces

PubMed Central

Pantanowitz, Liron; LaBranche, Wayne; Lareau, William

2010-01-01

Clinical laboratory outreach business is changing as more physician practices adopt an electronic medical record (EMR). Physician connectivity with the laboratory information system (LIS) is consequently becoming more important. However, there are no reports available to assist the informatician with establishing and maintaining outreach LIS–EMR connectivity. A four-stage scheme is presented that was successfully employed to establish unidirectional and bidirectional interfaces with multiple physician EMRs. This approach involves planning (step 1), followed by interface building (step 2) with subsequent testing (step 3), and finally ongoing maintenance (step 4). The role of organized project management, software as a service (SAAS), and alternate solutions for outreach connectivity are discussed. PMID:20805958

Preparing disabled students for professional practice: managing risk through a principles-based approach.

PubMed

Hargreaves, Janet; Walker, Lizzie

2014-08-01

A discussion exploring the ways disabled students are managed in practice settings. It proposes and argues for morally and legally viable principles to guide risk assessment and inclusive decision-making in practice. Equality law means that universities are bound not to discriminate against students on the basis, amongst other things, of disability. As a consequence in the UK, there is a perceived increase in numbers of disabled people applying for and succeeding as health professionals. Whilst placement providers are equally obliged by the law to have inclusive policies, competing needs including patient safety, public confidence and professional regulations mean that adjustments that can be made in an educational environment to appropriately support student learning may prove to be more difficult in placements that provide direct care to the public. This discussion is an outcome of recommendations from published research by the authors and their research partners. It is supported by related literature, critical debate amongst academics, disabled students and disabled and non-disabled practitioners. Ensuring a nursing workforce that mirrors the diversity of the population it serves is of universal importance. Effective management of disabled students can contribute to achieving this goal and to promoting a positive view of disabled practitioners. Legislation is necessary to protect disabled people from discrimination. To respect this legislation, when preparing nurses and other health professions, a clear understanding of the law and a principles-based approach to guiding risk is important. © 2014 John Wiley & Sons Ltd.

Workplace social capital in nursing: an evolutionary concept analysis.

PubMed

Read, Emily A

2014-05-01

To report an analysis of the concept of nurses' workplace social capital. Workplace social capital is an emerging concept in nursing with potential to illuminate the value of social relationships at work. A common definition is needed. Concept analysis. The Cumulative Index to Nursing and Allied Health Literature, PubMed, PsychINFO and ProQuest Nursing. Databases were systematically searched using the keywords: workplace social capital, employee social capital, work environment, social capital and nursing. Sources published between January 1937-November 2012 in English that described or studied social capital of nurses at work were included. A total of 668 resources were found. After removing 241 duplicates, literature was screened in two phases: (1) titles and abstracts were reviewed (n = 427); and (2) remaining data sources were retrieved and read (n = 70). Eight sources were included in the final analysis. Attributes of nurses' workplace social capital included networks of social relationships at work, shared assets and shared ways of knowing and being. Antecedents were communication, trust and positive leadership practices. Nurses' workplace social capital was associated with positive consequences for nurses, their patients and healthcare organizations. Nurses' workplace social capital is defined as nurses' shared assets and ways of being and knowing that are evident in, and available through, nurses' networks of social relationships at work. Future studies should examine and test relationships between antecedents and consequences of nurses' workplace social capital to understand this important aspect of healthy professional practice environments better. © 2013 John Wiley & Sons Ltd.

Sedentary Behavior and Health: Broadening the Knowledge Base and Strengthening the Science.

PubMed

Hadgraft, Nyssa; Owen, Neville

2017-06-01

We provide an overview of a recently published, edited book in a rapidly emerging field of research, policy, and practice for physical activity: Sedentary Behavior and Health. In this commentary, we highlight the broad perspectives provided in the 27 chapters of Sedentary Behavior and Health and suggest a research strategy to move the field forward-not only with scientific rigor, but also with breadth of scholarship. The book's chapters provide an overview of the background to and contexts for sedentary behavior and health. They then highlight the importance of understanding health consequences and underlying mechanisms; introduce key measurement technology and analytic strategies; consider sedentary behavior in subpopulations; describe conceptual models and theories to guide sedentary behavior interventions; and explain what is known about interventions in different settings. Considering the breadth of perspectives brought to bear on the field and the plethora of opportunities for research, policy, and practice, we suggest 3 elements of an interdisciplinary research strategy drawing upon the primary knowledge bases of physical activity and health: through the experimental methods of exercise science, through the observational tools of epidemiology, and through the conceptual approaches and methods of behavioral science. A better understanding of the health consequences of sedentary behavior and how they may be influenced can be encompassed by 3 key questions: What changes are needed to most effectively influence sedentary behaviors? What elements of sedentary behavior should be changed to improve health outcomes? What are the feasibility of and the benefits from changing sedentary behavior?

Trust and memory: organizational strategies, institutional conditions and trust negotiations in specialty clinics for Alzheimer's disease.

PubMed

Beard, Renée L

2008-03-01

Clinicians aim to establish trust during medical encounters because, without it, health consumers may not seek medical care, consider their diagnoses legitimate, or adhere to treatment regimens. This paper examines the identification and treatment of memory loss within two specialty clinics to understand how cultural dynamics, such as organizational ethos and work practices, influence the social fabric of cognitive evaluations. Ethnographic data suggest important historical and cultural differences in the approaches to Alzheimer's disease (AD). Organizational routines, however, support a common goal, that of moving individuals from "potential patients" to patients, and ultimately research subjects, through establishing trust. Although the processes through which trust is potentially achieved, or the social conditions of trust, were similar at the sites, the object of trust was different. Whereas one clinic encouraged trust in collective medical expertise, the other focused on trust in specific clinicians. These conditions affect the clinical consequences of trust, particularly how and when the diagnosis is delivered, use of the AD label and other terminology, and the level of standardization. The individual consequences include perceptions of patients and depictions of the prognosis. Whether cognitive impairment is viewed as a scientific puzzle to be solved or is seen as a chronic illness significantly shapes the organizational processes of clinical evaluation. Alzheimer's disease, as a cultural object, is a particularly salient exemplar of the clinical negotiation of ambiguous diagnostic categorizations and the unpredictable patient in daily biomedical practice.

The assessment and measurement of adult life stress: Basic premises, operational principles, and design requirements.

PubMed

Harkness, Kate L; Monroe, Scott M

2016-07-01

Life stress is a central factor in the onset and course of a wide range of medical and psychiatric conditions. Determining the precise etiological and pathological consequences of stress, though, has been hindered by weaknesses in prevailing definitional and measurement practices. The purpose of the current paper is to evaluate the primary strategies for defining and measuring major and minor acute life events, chronic stressors, and daily hassles as informed by 3 basic scientific premises. The first premise concerns the manner in which stress is conceptualized and operationally defined, and specifically we assert that stress measures must not conflate the stress exposure with the stress response. The second premise concerns how stress exposures are measured, and we provide guidelines for optimizing standardized and sensitive indicators of life stress. The third premise addresses the consequences of variations in the procedures for life event measurement with regard to the validity of the research designs employed. We show that life stress measures are susceptible to several sources of bias, and if these potential sources of bias are not controlled in the design of the research, spurious findings may result. Our goal is to provide a useful guide for researchers who consider life stress to be an important factor in their theoretical models of disease, wish to incorporate measures of life stress in their research, and seek to avoid the common pitfalls of past measurement practices. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Benefits of Multilingualism in Education

ERIC Educational Resources Information Center

Okal, Benard Odoyo

2014-01-01

The article gives a brief analytical survey of multilingualism practices, its consequences, its benefits in education and discussions on the appropriate ways towards its achievement in education. Multilingualism refers to speaking more than one language competently. Generally there are both the official and unofficial multilingualism practices. A…

Where's the Race in Culturally Relevant Pedagogy?

ERIC Educational Resources Information Center

Milner, H. Richard, IV

2017-01-01

Background/Context: When Ladson-Billings described the pedagogical practices of successful teachers of African American children and consequently conceptualized culturally relevant pedagogy as an analytic resource to describe and make sense of pedagogical practices of teachers, her discussion was situated in a frame that examined instructional…

Steps to overcome the North-South divide in research relevant to climate change policy and practice

NASA Astrophysics Data System (ADS)

Blicharska, Malgorzata; Smithers, Richard J.; Kuchler, Magdalena; Agrawal, Ganesh K.; Gutiérrez, José M.; Hassanali, Ahmed; Huq, Saleemul; Koller, Silvia H.; Marjit, Sugata; Mshinda, Hassan M.; Masjuki, Hj Hassan; Solomons, Noel W.; Staden, Johannes Van; Mikusiński, Grzegorz

2017-01-01

A global North-South divide in research, and its negative consequences, has been highlighted in various scientific disciplines. Northern domination of science relevant to climate change policy and practice, and limited research led by Southern researchers in Southern countries, may hinder further development and implementation of global climate change agreements and nationally appropriate actions. Despite efforts to address the North-South divide, progress has been slow. In this Perspective, we illustrate the extent of the divide, review underlying issues and analyse their consequences for climate change policy development and implementation. We propose a set of practical steps in both Northern and Southern countries that a wide range of actors should take at global, regional and national scales to span the North-South divide, with examples of some actions already being implemented.

Musculoskeletal physiotherapists' use of psychological interventions: a systematic review of therapists' perceptions and practice.

PubMed

Alexanders, Jenny; Anderson, Anna; Henderson, Sarah

2015-06-01

Research has demonstrated that incorporating psychological interventions within physiotherapy practice has numerous potential benefits. Despite this physiotherapists have reported feeling inadequately trained to confidently use such interventions in their day-to-day practice. To systematically review musculoskeletal physiotherapists' perceptions regarding the use of psychological interventions within physiotherapy practice. Eligible studies were identified through a rigorous search of AMED, CINAHL, EMBASE, MEDLINE and PsychINFO from January 2002 until August 2013. Full text qualitative, quantitative and mixed methodology studies published in English language investigating musculoskeletal physiotherapists' perceptions regarding their use of psychological interventions within physiotherapy practice. Included studies were appraised for risk of bias using the Critical Appraisal Skills Programme qualitative checklist. Meta-analysis was not possible due to study heterogeneity. Six studies, all with a low risk of bias, met the inclusion criteria. These studies highlighted that physiotherapists appreciate the importance of using psychological interventions within their practice, but report inadequate understanding and consequent underutilisation of these interventions. These results should be noted with some degree of caution due to various limitations associated with the included studies and with this review, including the use of a qualitative appraisal tool for mixed methodology/quantitative studies. These findings suggest that musculoskeletal physiotherapists are aware of the potential benefits of incorporating psychological interventions within their practice but feel insufficiently trained to optimise their use of such interventions; hence highlighting a need for further research in this area and a review of physiotherapist training. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Implementing the Next Generation Science Standards: How Instructional Coaches Mediate Standards-Based Educational Reform to Teacher Practice

NASA Astrophysics Data System (ADS)

Laxton, Katherine E.

This dissertation takes a close look at how district-level instructional coaches support teachers in learning to shifting their instructional practice, related to the Next Generation Science Standards. This dissertation aims to address how re-structuring professional development to a job-embedded coaching model supports individual teacher learning of new reform-related instructional practice. Implementing the NGSS is a problem of supporting professional learning in a way that will enable educators to make fundamental changes to their teaching practice. However, there are few examples in the literature that explain how coaches interact with teachers to improve teacher learning of reform-related instructional practice. There are also few examples in the literature that specifically address how supporting teachers with extended professional learning opportunities, aligned with high-leverage practices, tools and curriculum, impacts how teachers make sense of new standards-based educational reforms and what manifests in classroom instruction. This dissertation proposes four conceptual categories of sense-making that influence how instructional coaches interpret the nature of reform, their roles and in instructional improvement and how to work with teachers. It is important to understand how coaches interpret reform because their interpretations may have unintended consequences related to privileging certain views about instruction, or establishing priorities for how to work with teachers. In this dissertation, we found that re-structuring professional development to a job-embedded coaching model supported teachers in learning new reform-related instructional practice. However, individual teacher interpretations of reform emerged and seemed to be linked to how instructional coaches supported teacher learning.

A study about the existence of the leverage effect in stochastic volatility models

NASA Astrophysics Data System (ADS)

Florescu, Ionuţ; Pãsãricã, Cristian Gabriel

2009-02-01

The empirical relationship between the return of an asset and the volatility of the asset has been well documented in the financial literature. Named the leverage effect or sometimes risk-premium effect, it is observed in real data that, when the return of the asset decreases, the volatility increases and vice versa. Consequently, it is important to demonstrate that any formulated model for the asset price is capable of generating this effect observed in practice. Furthermore, we need to understand the conditions on the parameters present in the model that guarantee the apparition of the leverage effect. In this paper we analyze two general specifications of stochastic volatility models and their capability of generating the perceived leverage effect. We derive conditions for the apparition of leverage effect in both of these stochastic volatility models. We exemplify using stochastic volatility models used in practice and we explicitly state the conditions for the existence of the leverage effect in these examples.

The issue of mental health in occupational health surveillance.

PubMed

Leão, Luís Henrique da Costa; Gomez, Carlos Minayo

2014-12-01

This paper addresses the issue of mental health in the Occupational Health Surveillance (VISAT) context. It seeks to present theoretical aspects and institutional policies contributing to the incorporation of mental health dimensions into the VISAT process, in view of the pressing need to attend to this demand that is becoming increasingly important in the occupational health area, especially within the scope of the National Comprehensive Occupational Healthcare Network (RENAST). Some theoretical approaches and practical experiences in mental health and work are systematically presented and discussed in this essay. A survey is also conducted of potential strategies to integrate mental health into VISAT actions. It is our view that the origins of illnesses and ensuing harm are closely linked to the elements involved in work organization and management. Consequently, surveillance practices should include and identify generating components of these negative aspects. The diversity of illnesses caused by work processes and conditions calls for major investment to ascertain and change the situations that give rise to such illnesses.

Issues with data and analyses: Errors, underlying themes, and potential solutions

PubMed Central

Allison, David B.

2018-01-01

Some aspects of science, taken at the broadest level, are universal in empirical research. These include collecting, analyzing, and reporting data. In each of these aspects, errors can and do occur. In this work, we first discuss the importance of focusing on statistical and data errors to continually improve the practice of science. We then describe underlying themes of the types of errors and postulate contributing factors. To do so, we describe a case series of relatively severe data and statistical errors coupled with surveys of some types of errors to better characterize the magnitude, frequency, and trends. Having examined these errors, we then discuss the consequences of specific errors or classes of errors. Finally, given the extracted themes, we discuss methodological, cultural, and system-level approaches to reducing the frequency of commonly observed errors. These approaches will plausibly contribute to the self-critical, self-correcting, ever-evolving practice of science, and ultimately to furthering knowledge. PMID:29531079

‘On the Perimeter of the Lawful’: Enduring Illegality in the Irish Family Planning Movement, 1972-1985

PubMed Central

Cloatre, Emilie; Enright, Máiréad

2017-01-01

Between 1935 and 1985, Irish law criminalized the sale and importation of condoms. Activists established illegal markets to challenge the law and alleviate its social consequences. They distributed condoms through postal services, shops, stalls, clinics, and machines. Though they largely operated in the open, their activities attracted little direct punishment from the state, and they were able to build a stable network of medical and commercial family planning services. We use 30 interviews conducted with former activists to explore this history. In doing so, we also examine the limits of ‘illegality’ in describing acts of everyday resistance to law, arguing that the boundaries between legal and illegal, in the discourses and practices of those who sought to challenge the state, were shifting and uncertain. In turn, we revisit ‘illegality’, characterizing it as an assemblage of varying selectively-performed political practices, shaped by complex choreographies of negotiation between state and non-state actors. PMID:29307949

Female Genital Mutilation: A Visual Reference and Learning Tool for Health Care Professionals.

PubMed

Abdulcadir, Jasmine; Catania, Lucrezia; Hindin, Michelle Jane; Say, Lale; Petignat, Patrick; Abdulcadir, Omar

2016-11-01

Female genital mutilation comprises all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs for nonmedical reasons. Health care providers for women and girls living with female genital mutilation have reported difficulties in recognizing, classifying, and recording female genital mutilation, which can adversely affect treatment of complications and discussions of the prevention of the practice in future generations. According to the World Health Organization, female genital mutilation is classified into four types, subdivided into subtypes. An agreed-upon classification of female genital mutilation is important for clinical practice, management, recording, and reporting, as well as for research on prevalence, trends, and consequences of female genital mutilation. We provide a visual reference and learning tool for health care professionals. The tool can be consulted by caregivers when unsure on the type of female genital mutilation diagnosed and used for training and surveys for monitoring the prevalence of female genital mutilation types and subtypes.

Sleep Medicine in Saudi Arabia.

PubMed

Almeneessier, Aljohara S; BaHammam, Ahmed S

2017-04-15

The practice of sleep medicine in Saudi Arabia began in the mid to late 1990s. Since its establishment, this specialty has grown, and the number of specialists has increased. Based on the available data, sleep disorders are prevalent among the Saudi population, and the demand for sleep medicine services is expected to increase significantly. Currently, two training programs are providing structured training and certification in sleep medicine in this country. Recently, clear guidelines for accrediting sleep medicine specialists and technologists were approved. Nevertheless, numerous obstacles hamper the progress of this specialty, including the lack of trained technicians, specialists, and funding. Increasing the awareness of sleep disorders and their serious consequences among health care workers, health care authorities, and insurance companies is another challenge. Future plans should address the medical educational system at all levels to demonstrate the importance of early detection and the treatment of sleep disorders. This review discusses the current position of and barriers to sleep medicine practice and education in Saudi Arabia. © 2017 American Academy of Sleep Medicine

Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments.

PubMed

Landi, Francesco; Calvani, Riccardo; Tosato, Matteo; Martone, Anna Maria; Ortolani, Elena; Savera, Giulia; Sisto, Alex; Marzetti, Emanuele

2016-01-27

Older people frequently fail to ingest adequate amount of food to meet their essential energy and nutrient requirements. Anorexia of aging, defined by decrease in appetite and/or food intake in old age, is a major contributing factor to under-nutrition and adverse health outcomes in the geriatric population. This disorder is indeed highly prevalent and is recognized as an independent predictor of morbidity and mortality in different clinical settings. Even though anorexia is not an unavoidable consequence of aging, advancing age often promotes its development through various mechanisms. Age-related changes in life-style, disease conditions, as well as social and environmental factors have the potential to directly affect dietary behaviors and nutritional status. In spite of their importance, problems related to food intake and, more generally, nutritional status are seldom attended to in clinical practice. While this may be the result of an "ageist" approach, it should be acknowledged that simple interventions, such as oral nutritional supplementation or modified diets, could meaningfully improve the health status and quality of life of older persons.

Plague epizootic cycles in Central Asia.

PubMed

Reijniers, Jonas; Begon, Mike; Ageyev, Vladimir S; Leirs, Herwig

2014-06-01

Infection thresholds, widely used in disease epidemiology, may operate on host abundance and, if present, on vector abundance. For wildlife populations, host and vector abundances often vary greatly across years and consequently the threshold may be crossed regularly, both up- and downward. Moreover, vector and host abundances may be interdependent, which may affect the infection dynamics. Theory predicts that if the relevant abundance, or combination of abundances, is above the threshold, then the infection is able to spread; if not, it is bound to fade out. In practice, though, the observed level of infection may depend more on past than on current abundances. Here, we study the temporal dynamics of plague (Yersinia pestis infection), its vector (flea) and its host (great gerbil) in the PreBalkhash region in Kazakhstan. We describe how host and vector abundances interact over time and how this interaction drives the dynamics of the system around the infection threshold, consequently affecting the proportion of plague-infected sectors. We also explore the importance of the interplay between biological and detectability delays in generating the observed dynamics.

"There is soccer but we have to watch": the embodied consequences of rhetorics of inclusion for South African children with cerebral palsy.

PubMed

Bantjes, Jason; Swartz, Leslie; Conchar, Lauren; Derman, Wayne

2015-01-01

Twenty years after the advent of democracy in South Africa (SA), there have been some successes in the achievement of greater equality, access and inclusion for many persons with disabilities. The move towards inclusive education may, however, have had unanticipated embodied consequences for people positioned discursively as included, but who in fact may in some respects be further marginalised than they had been under apartheid. We describe ethnographic research conducted in a special needs school in SA to explore the lived experiences of children with cerebral palsy and their involvement in physical activity. Our study shows how inclusive educational practices in SA have impeded involvement in sport for some children with motor impairments because of resource limitations and other historic reasons. This paper raises important questions about the role of community psychology in recognising, naming and contributing to action around injustices, which may be hard to see but which can have profound effects on the lives and bodies of those who experience exclusion.

“There is soccer but we have to watch”: the embodied consequences of rhetorics of inclusion for South African children with cerebral palsy

PubMed Central

Bantjes, Jason; Swartz, Leslie; Conchar, Lauren; Derman, Wayne

2016-01-01

Twenty years after the advent of democracy in South Africa (SA), there have been some successes in the achievement of greater equality, access and inclusion for many persons with disabilities. The move towards inclusive education may, however, have had unanticipated embodied consequences for people positioned discursively as included, but who in fact may in some respects be further marginalised than they had been under apartheid. We describe ethnographic research conducted in a special needs school in SA to explore the lived experiences of children with cerebral palsy and their involvement in physical activity. Our study shows how inclusive educational practices in SA have impeded involvement in sport for some children with motor impairments because of resource limitations and other historic reasons. This paper raises important questions about the role of community psychology in recognising, naming and contributing to action around injustices, which may be hard to see but which can have profound effects on the lives and bodies of those who experience exclusion. PMID:28003729

Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments

PubMed Central

Landi, Francesco; Calvani, Riccardo; Tosato, Matteo; Martone, Anna Maria; Ortolani, Elena; Savera, Giulia; Sisto, Alex; Marzetti, Emanuele

2016-01-01

Older people frequently fail to ingest adequate amount of food to meet their essential energy and nutrient requirements. Anorexia of aging, defined by decrease in appetite and/or food intake in old age, is a major contributing factor to under-nutrition and adverse health outcomes in the geriatric population. This disorder is indeed highly prevalent and is recognized as an independent predictor of morbidity and mortality in different clinical settings. Even though anorexia is not an unavoidable consequence of aging, advancing age often promotes its development through various mechanisms. Age-related changes in life-style, disease conditions, as well as social and environmental factors have the potential to directly affect dietary behaviors and nutritional status. In spite of their importance, problems related to food intake and, more generally, nutritional status are seldom attended to in clinical practice. While this may be the result of an “ageist” approach, it should be acknowledged that simple interventions, such as oral nutritional supplementation or modified diets, could meaningfully improve the health status and quality of life of older persons. PMID:26828516

Providing preimplantation genetic diagnosis in the United Kingdom, The Netherlands and Germany: a comparative in-depth analysis of health-care access.

PubMed

Aarden, Erik; Van Hoyweghen, Ine; Vos, Rein; Horstman, Klasien

2009-07-01

In recent years, preimplantation genetic diagnosis (PGD) has developed into a routine diagnostic procedure in health care. Although during this process, several initiatives have been employed to regulate the procedure, access to PGD may be hampered by the diversity in health-care arrangements or therapeutic cultures in different countries. This article demonstrates how PGD provision practices depend on much more than regulation alone, by providing an in-depth comparative analysis of the provision of PGD in Britain, the Netherlands and Germany. In analysing regulation, organization, selection of indications, and mechanisms and criteria for reimbursement, differences between these countries can be identified. This is important, since differences in PGD provision can have enormous consequences for the access of individual patients in different countries. Somewhat paradoxically, this article concludes that even though differences in access do have serious consequences, they also serve the establishment of PGD. Developing access to PGD in national 'therapeutic cultures' can contribute to making PGD routine health care in a way that may not be achievable by harmonizing regulation.

[Evidential value of dental materials identification by infrared spectroscopy in forensic medicine opinionating].

PubMed

Wachowiak, Roman; Strach, Bogna

2007-01-01

The potential for a release of dental restoration material or a spontaneous loss of a tooth structure fragment in the course of mastication frequently requires a reliable identification of the lost fragment in order to confirm its origin. The consequences of incidental mechanical injuries -- in view of the presence of dangerous solid fragments -- become particularly important in cases of using a chewing gum. The problem involves distinguishing between the structure of a fragment of restoration or a broken tooth structure and incidental contaminants of chewing gum produced in the process of gum manufacturing. The consequences of mechanical injuries or exposure to potential structural tooth damage in the course of gum chewing provide a subject for numerous litigations against manufacturer of chewing gum and require appropriate identification of the material. The studies were conducted using solid phase infrared spectroscopy in the range of 500-4000 wavelength (cm(-1)) for a quick identification of dental materials used in the dental practice. A database of infrared transmission spectra characteristic of commonly employed dental filling materials was prepared to provide a systemic reference system, useful in controversial interpretation cases.

Quality of life returns from basic research.

PubMed

Cozzens, Susan E

2010-06-07

Assessing the consequences of research is an increasingly important task in research and innovation policy. This paper takes a broader view of those consequences than the conventional economic approach, placing researchers and their activities in the centre of the assessment process and examining results for professional practice and general education as well as contributions to knowledge. The paper uses historical and documentary analysis to illustrate the approach, focusing on U.S. biomedicine over the past century. At aggregate level, the analysis attributes portions of the change in aggregate health indicators to research and research-based institutions, through several available types of logic: either through correlations between timing of institutional changes and changes in the indicators or through direct or indirect causal connections. The analysis shows that while biomedical research has certainly contributed to improved health in the United States, other factors have also contributed. In some ways the institutional structure of science-based medicine has worked against creating benefits for some groups in U.S. society. The paper concludes with a call for more strategic attention to dimensions of impact other than knowledge outcomes and for participatory planning for research.

Pig empire under infectious threat: risk of African swine fever introduction into the People's Republic of China.

PubMed

Vergne, Timothée; Chen-Fu, Cao; Li, Shuo; Cappelle, Julien; Edwards, John; Martin, Vincent; Pfeiffer, Dirk Udo; Fusheng, Guo; Roger, Francois Louis

2017-07-29

Pig production and pork consumption are very important to the People's Republic of China for both economic and cultural reasons. The incursion and spread of a disease such as African swine fever (ASF), which emerged in Eastern Europe in 2007, could have devastating socioeconomic consequences for both the Chinese and the global pig industry. The Chinese government consequently attributes a very high priority to ASF and is actively seeking to improve its preparedness. This paper discusses different drivers and pathways of potential emergence of ASF in China in light of the country's specificities, including international movements of people, pigs and pig products, swill feeding practices and wild boar populations. It suggests that effective ASF risk management in China will require a comprehensive and integrated approach linking science and policy and will need to involve all relevant stakeholders to develop realistic policies. © British Veterinary Association (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Use of ineffective practices in Primary Health Care: professional opinions].

PubMed

Domínguez Bustillo, L; Barrasa Villar, J I; Castán Ruíz, S; Moliner Lahoz, F J; Aibar Remón, C

2014-01-01

To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD]=1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

It Won't Happen to Me: The Role of Optimistic Bias in African-American Teens' Risky Sexual Practices.

ERIC Educational Resources Information Center

Chapin, John

Discovering why adolescents take sexual risks, despite knowledge of consequences, is a vital first step in combating the problem. Optimistic bias, the misperception that one is less likely than others to experience negative consequences from health behaviors, offers a promising explanation for adolescents' sexual risk-taking. Unfortunately,…

Cognitive Learning Theory Takes a Backseat: Consequences of a Management Development Program for Work Practice

ERIC Educational Resources Information Center

Moesby-Jensen, Cecilie K.

2008-01-01

This paper describes the consequences of a cognitive management development program for middle managers in a public organization. The objective was to teach transformational leadership and teamwork but it occasioned a very limited improved articulation of transformational leadership and teamwork and only a modest change in the managers' actions in…

Characterizing High School Students Who Play Drinking Games Using Latent Class Analysis

PubMed Central

Borsari, Brian; Zamboanga, Byron L.; Correia, Christopher; Olthuis, Janine V.; Van Tyne, Kathryne; Zadworny, Zoe; Grossbard, Joel R.; Horton, Nicholas J.

2013-01-01

Heavy alcohol use and its associated negative consequences continue to be an important health issue among adolescents. Of particular concern are risky drinking practices such as playing drinking games. Although retrospective accounts indicate that drinking game participation is common among high school students, it has yet to be assessed in current high school students. Utilizing data from high school students who reported current drinking game participation (n = 178), we used latent class analysis to investigate the negative consequences resulting from gaming and examined underlying demographic and alcohol-related behavioral characteristics of students as a function of the resultant classes. Three classes of “gamers” emerged: (1) a “lower-risk” group who had a lower probability of endorsing negative consequences compared to the other groups, (2) a “higher-risk” group who reported that they experienced hangovers and difficulties limiting their drinking, got physically sick, and became rude, obnoxious, or insulting, and (3) a “sexual regret” group who reported that they experienced poor recall and unplanned sexual activity that they later regretted. Although the frequency of participating in drinking games did not differ between these three groups, results indicated that the “lower-risk” group consumed fewer drinks in a typical gaming session compared to the other two groups. The present findings suggest that drinking games are common among high school students, but that mere participation and frequency of play is not necessarily the best indicator of risk. Instead, examination of other constructs such as game-related alcohol consumption, consequences, or psychosocial variables such as impulsivity may be more useful. PMID:23778317

Characterizing high school students who play drinking games using latent class analysis.

PubMed

Borsari, Brian; Zamboanga, Byron L; Correia, Christopher; Olthuis, Janine V; Van Tyne, Kathryne; Zadworny, Zoe; Grossbard, Joel R; Horton, Nicholas J

2013-10-01

Heavy alcohol use and its associated negative consequences continue to be an important health issue among adolescents. Of particular concern are risky drinking practices such as playing drinking games. Although retrospective accounts indicate that drinking game participation is common among high school students, it has yet to be assessed in current high school students. Utilizing data from high school students who reported current drinking game participation (n=178), we used latent class analysis to investigate the negative consequences resulting from gaming and examined underlying demographic and alcohol-related behavioral characteristics of students as a function of the resultant classes. Three classes of "gamers" emerged: (1) a "lower-risk" group who had a lower probability of endorsing negative consequences compared to the other groups, (2) a "higher-risk" group who reported that they experienced hangovers and difficulties limiting their drinking, got physically sick, and became rude, obnoxious, or insulting, and (3) a "sexual regret" group who reported that they experienced poor recall and unplanned sexual activity that they later regretted. Although the frequency of participating in drinking games did not differ between these three groups, results indicated that the "lower-risk" group consumed fewer drinks in a typical gaming session compared to the other two groups. The present findings suggest that drinking games are common among high school students, but that mere participation and frequency of play are not necessarily the best indicators of risk. Instead, examination of other constructs such as game-related alcohol consumption, consequences, or psychosocial variables such as impulsivity may be more useful. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Mediating Effect of Kaizen between Total Quality Management (TQM) and Business Performance

NASA Astrophysics Data System (ADS)

Shan, Ang Wei; Fauzi Ahmad, Mohd; Hisyamudin Muhd Nor, Nik

2016-11-01

Every customer preference is different but yet important. The global market is shifting rapidly, organizations are needed to continuously identify new opportunity to obtain competitive advantages. Literature suggested that manufacturing companies are needed to differentiate themselves through emphasize on quality and continuous improvement in product and services as a crucial part to secure and success in the future. The Total Quality Management (TQM) practices has developed a strong bearing on growth and competitiveness in market. Therefore, a proper continuous improvement (Kaizen) practice is needed to eliminate waste and value added in production to remain competitiveness and retained the potential customer. However, based on the previous study it had indicated an inconsistent result between TQM and BP. Besides that, researcher also less emphasized on mediator in previous work. Therefore, the purpose of this paper is to recommend the relationship between TQM and business performance with a mediator's effect of Kaizen. This proposed model attempt to create knowledge to both academician and company players to acquire a better understanding among the TQM and Kaizen practices. Consequently, the Structural Equation Modelling (SEM) techniques is applying to identify and evaluate the relationship among TQM, Kaizen, and business performance in developing a new TQM model.

Harnessing information and communication technologies to leverage scarce resources for cancer education, research and practice in developing countries

PubMed Central

Andela, Valentine B

2006-01-01

In developing countries, low levels of awareness, cost and organizational constraints on access to specialized care contribute to inadequate patient help-seeking behavior. As much as 95% of cancer patients in developing countries are diagnosed at late to end stage disease. Consequently, treatment outcome is dismally poor and a vicious cycle sets in, with public mystification of cancer and the admonishment of cancer medicine as a futile effort, all, to the further detriment of patient help-seeking behavior and treatment engagement. The situation spirals down, when the practice of cancer medicine is not gratifying to the medical practitioner and does not appeal as a medical specialty to those in training. The future of cancer medicine in developing countries thus hinges on the demystification of cancer through positive information, coupled to an effective organization that allows for the optimal use of available resources, facilitates access to specialized care and promotes the flow of knowledge and technology amongst various stakeholders. This paper strives to make a cogent argument and highlight the capital importance of information and communication technologies in organizing and leveraging scarce resources for cancer education, research and practice in developing countries. PMID:16390555

Re-orienting discussions of scientific explanation: A functional perspective.

PubMed

Woody, Andrea I

2015-08-01

Philosophy of science offers a rich lineage of analysis concerning the nature of scientific explanation, but the vast majority of this work, aiming to provide an analysis of the relation that binds a given explanans to its corresponding explanandum, presumes the proper analytic focus rests at the level of individual explanations. There are, however, other questions we could ask about explanation in science, such as: What role(s) does explanatory practice play in science? Shifting focus away from explanations, as achievements, toward explaining, as a coordinated activity of communities, the functional perspective aims to reveal how the practice of explanatory discourse functions within scientific communities given their more comprehensive aims and practices. In this paper, I outline the functional perspective, argue that taking the functional perspective can reveal important methodological roles for explanation in science, and consequently, that beginning here provides resources for developing more adequate responses to traditional concerns. In particular, through an examination of the ideal gas law, I emphasize the normative status of explanations within scientific communities and discuss how such status underwrites a compelling rationale for explanatory power as a theoretical virtue. Copyright © 2015 Elsevier Ltd. All rights reserved.

Concept Analysis: Music Therapy.

PubMed

Murrock, Carolyn J; Bekhet, Abir K

2016-01-01

Down through the ages, music has been universally valued for its therapeutic properties based on the psychological and physiological responses in humans. However, the underlying mechanisms of the psychological and physiological responses to music have been poorly identified and defined. Without clarification, a concept can be misused, thereby diminishing its importance for application to nursing research and practice. The purpose of this article was for the clarification of the concept of music therapy based on Walker and Avant's concept analysis strategy. A review of recent nursing and health-related literature covering the years 2007-2014 was performed on the concepts of music, music therapy, preferred music, and individualized music. As a result of the search, the attributes, antecedents, and consequences of music therapy were identified, defined, and used to develop a conceptual model of music therapy. The conceptual model of music therapy provides direction for developing music interventions for nursing research and practice to be tested in various settings to improve various patient outcomes. Based on Walker and Avant's concept analysis strategy, model and contrary cases are included. Implications for future nursing research and practice to use the psychological and physiological responses to music therapy are discussed.

ICRP publication 112. A report of preventing accidental exposures from new external beam radiation therapy technologies.

PubMed

Ortiz López, P; Cosset, J M; Dunscombe, P; Holmberg, O; Rosenwald, J C; Pinillos Ashton, L; Vilaragut Llanes, J J; Vatnitsky, S

2009-08-01

Disseminating the knowledge and lessons learned from accidental exposures is crucial in preventing re-occurrence. This is particularly important in radiation therapy; the only application of radiation in which very high radiation doses are deliberately given to patients to achieve cure or palliation of disease. Lessons from accidental exposures are, therefore, an invaluable resource for revealing vulnerable aspects of the practice of radiotherapy, and for providing guidance for the prevention of future occurrences. These lessons have successfully been applied to avoid catastrophic events with conventional technologies and techniques. Recommendations, for example, include the independent verification of beam calibration and independent calculation of the treatment times and monitor units for external beam radiotherapy, and the monitoring of patients and their clothes immediately after brachytherapy. New technologies are meant to bring substantial improvement to radiation therapy. However, this is often achieved with a considerable increase in complexity, which in turn brings opportunities for new types of human error and problems with equipment. Dissemination of information on these errors or mistakes as soon as it becomes available is crucial in radiation therapy with new technologies. In addition, information on circumstances that almost resulted in serious consequences (near-misses) is also important, as the same type of events may occur elsewhere. Sharing information about near-misses is thus a complementary important aspect of prevention. Lessons from retrospective information are provided in Sections 2 and 4 of this report. Disseminating lessons learned for serious incidents is necessary but not sufficient when dealing with new technologies. It is of utmost importance to be proactive and continually strive to answer questions such as 'What else can go wrong', 'How likely is it?' and 'What kind of cost-effective choices do I have for prevention?'. These questions are addressed in Sections 3 and 5 of this report. Section 6 contains the conclusions and recommendations. This report is expected to be a valuable resource for radiation oncologists, hospital administrators, medical physicists, technologists, dosimetrists, maintenance engineers, radiation safety specialists, and regulators. While the report applies specifically to new external beam therapies, the general principles for prevention are applicable to the broad range of radiotherapy practices where mistakes could result in serious consequences for the patient and practitioner.

Network Framing of Pest Management Knowledge and Practice

ERIC Educational Resources Information Center

Moore, Keith M.

2008-01-01

Conventional technology transfer is based on the assumption that autonomous individuals independently make behavioral decisions. In contrast, Actor-Network Theory (ANT) suggests that people and technologies are interconnected in ways that reinforce and reproduce some types of knowledge and consequent behavioral practices, but not others. Research…

NIPF Landowner's view of regulation.

Treesearch

Rebecca L. Johnson; Ralph J. Alig; Eric Moore; Robert J. Moulton

1997-01-01

As awareness and concern regarding the environmental consequences of forest practices have increased, new or amended forest regulations have been placed on nonindustrial private forestlands (NIPF) in the Pacific Northwest (Salazar and Cubbage 1990; Quigley 1992). Debates over whether forest practice regulations are providing public benefits or preventing public harm...

Identifying economic hurdles to early adoption of trunk disease preventative practices in California winegrape vineyards

USDA-ARS?s Scientific Manuscript database

Trunk diseases poses a serious threat to winegrape growers. Despite high prevalence and substantial consequences, growers routinely wait to adopt field-tested, preventative practices (delayed pruning, double pruning, or application of pruning wound protectant) until symptomatic vines appear (~10 yea...

Discipline of Students with Disabilities: An Update.

ERIC Educational Resources Information Center

Sorensen, Gail

1995-01-01

Practical guidelines are presented for implementing a discipline policy at the local level for students with disabilities, with suggestions for distinguishing policies affecting students in general and students with disabilities. Emphasis is placed on emerging issues and practical consequences. Relevant federal and state court decisions are cited,…

Using So-Called Mind-Body Practices to Promote Youths' Well-Being: Reflections on Therapeutic Outcomes, Strategies, and Processes

ERIC Educational Resources Information Center

Renshaw, Tyler L.

2016-01-01

The present article provides commentary on this pioneering special issue covering the usefulness of so-called mind-body practices with youth and in schools. I begin by addressing the way we talk about this approach to practice, describing a few undesirable consequences that can follow from using the mind-body moniker adopted from the world of…

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

PubMed

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

2018-02-01

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

Measuring Infant and Young Child Complementary Feeding Practices: Indicators, Current Practice, and Research Gaps.

PubMed

Ruel, Marie T

2017-01-01

The publication of the WHO Infant and Young Child Feeding (IYCF) indicators in 2008 equipped the nutrition and broader development community with an invaluable tool for measuring, documenting, and advocating for faster progress in improving these practices in low- and middle-income countries (LMICs). The indicators, with 5 of them focusing on complementary feeding (CF) practices, were originally designed for population level assessment, targeting, monitoring, and evaluation. This chapter takes stock of where we are with the existing CF indicators: it reviews how the indicators have been used, what we have learned, and what their strengths and limitations are, and it suggests a way forward. We find that the indicators have been used extensively for population level assessments and country comparisons, and to track progress. They have also been adopted by researchers in program impact evaluations and in research seeking to understand the determinants and consequences of poor CF practices for child growth and development outcomes. In addition to generating a wealth of knowledge and unveiling the severity of the global problem of poor CF practices in LMICs, the indicators have been an invaluable tool to raise awareness and call for urgent action on improving CF practices at scale. The indicators have strengths and limitations, which are summarized in this chapter. Although enormous progress has been achieved since the indicators were released in 2008, we feel it is time to reflect and revisit the CF indicators, improve them, develop new ones, and promote their appropriate use. Better indicators are critically important to stimulate action and investments in improving CF practices at scale. © 2017 Nestec Ltd., Vevey/S. Karger AG, Basel.

Succession in the petroleum reservoir microbiome through an oil field production lifecycle

DOE PAGES

Vigneron, Adrien; Alsop, Eric B.; Lomans, Bartholomeus P.; ...

2017-05-19

Subsurface petroleum reservoirs are an important component of the deep biosphere where indigenous microorganisms live under extreme conditions and in isolation from the Earth's surface for millions of years. However, unlike the bulk of the deep biosphere, the petroleum reservoir deep biosphere is subject to extreme anthropogenic perturbation, with the introduction of new electron acceptors, donors and exogenous microbes during oil exploration and production. Despite the fundamental and practical significance of this perturbation, there has never been a systematic evaluation of the ecological changes that occur over the production lifetime of an active offshore petroleum production system. Analysis of themore » entire Halfdan oil field in the North Sea (32 producing wells in production for 1-15 years) using quantitative PCR, multigenic sequencing, comparative metagenomic and genomic bins reconstruction revealed systematic shifts in microbial community composition and metabolic potential, as well as changing ecological strategies in response to anthropogenic perturbation of the oil field ecosystem, related to length of time in production. The microbial communities were initially dominated by slow growing anaerobes such as members of the Thermotogales and Clostridiales adapted to living on hydrocarbons and complex refractory organic matter. However, as seawater and nitrate injection (used for secondary oil production) delivered oxidants, the microbial community composition progressively changed to fast growing opportunists such as members of the Deferribacteres, Delta-, Epsilon- and Gammaproteobacteria, with energetically more favorable metabolism (for example, nitrate reduction, H2S, sulfide and sulfur oxidation). This perturbation has profound consequences for understanding the microbial ecology of the system and is of considerable practical importance as it promotes detrimental processes such as reservoir souring and metal corrosion. These findings provide a new conceptual framework for understanding the petroleum reservoir biosphere and have consequences for developing strategies to manage microbiological problems in the oil industry.« less

Succession in the petroleum reservoir microbiome through an oil field production lifecycle

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

Vigneron, Adrien; Alsop, Eric B.; Lomans, Bartholomeus P.

Subsurface petroleum reservoirs are an important component of the deep biosphere where indigenous microorganisms live under extreme conditions and in isolation from the Earth's surface for millions of years. However, unlike the bulk of the deep biosphere, the petroleum reservoir deep biosphere is subject to extreme anthropogenic perturbation, with the introduction of new electron acceptors, donors and exogenous microbes during oil exploration and production. Despite the fundamental and practical significance of this perturbation, there has never been a systematic evaluation of the ecological changes that occur over the production lifetime of an active offshore petroleum production system. Analysis of themore » entire Halfdan oil field in the North Sea (32 producing wells in production for 1-15 years) using quantitative PCR, multigenic sequencing, comparative metagenomic and genomic bins reconstruction revealed systematic shifts in microbial community composition and metabolic potential, as well as changing ecological strategies in response to anthropogenic perturbation of the oil field ecosystem, related to length of time in production. The microbial communities were initially dominated by slow growing anaerobes such as members of the Thermotogales and Clostridiales adapted to living on hydrocarbons and complex refractory organic matter. However, as seawater and nitrate injection (used for secondary oil production) delivered oxidants, the microbial community composition progressively changed to fast growing opportunists such as members of the Deferribacteres, Delta-, Epsilon- and Gammaproteobacteria, with energetically more favorable metabolism (for example, nitrate reduction, H2S, sulfide and sulfur oxidation). This perturbation has profound consequences for understanding the microbial ecology of the system and is of considerable practical importance as it promotes detrimental processes such as reservoir souring and metal corrosion. These findings provide a new conceptual framework for understanding the petroleum reservoir biosphere and have consequences for developing strategies to manage microbiological problems in the oil industry.« less

After Fukushima: managing the consequences of a radiological release.

PubMed

Fitzgerald, Joe; Wollner, Samuel B; Adalja, Amesh A; Morhard, Ryan; Cicero, Anita; Inglesby, Thomas V

2012-06-01

Even amidst the devastation following the earthquake and tsunami in Japan that killed more than 20,000 people, it was the accident at the Fukushima Daiichi nuclear power plant that led the country's prime minister, Naoto Kan, to fear for "the very existence of the Japanese nation." While accidents that result in mass radiological releases have been rare throughout the operating histories of existing nuclear power plants, the growing number of plants worldwide increases the likelihood that such releases will occur again in the future. Nuclear power is an important source of energy in the U.S. and will be for the foreseeable future. Accidents far smaller in scale than the one in Fukushima could have major societal consequences. Given the extensive, ongoing Nuclear Regulatory Commission (NRC) and industry assessment of nuclear power plant safety and preparedness issues, the Center for Biosecurity of UPMC focused on offsite policies and plans intended to reduce radiation exposure to the public in the aftermath of an accident. This report provides an assessment of Japan's efforts at nuclear consequence management; identifies concerns with current U.S. policies and practices for "outside the fence" management of such an event in the U.S.; and makes recommendations for steps that can be taken to strengthen U.S. government, industry, and community response to large-scale accidents at nuclear power plants.

Moored offshore structures - evaluation of forces in elastic mooring lines

NASA Astrophysics Data System (ADS)

Crudu, L.; Obreja, D. C.; Marcu, O.

2016-08-01

In most situations, the high frequency motions of the floating structure induce important effects in the mooring lines which affect also the motions of the structure. The experience accumulated during systematic experimental tests and calculations, carried out for different moored floating structures, showed a complex influence of various parameters on the dynamic effects. Therefore, it was considered that a systematic investigation is necessary. Due to the complexity of hydrodynamics aspects of offshore structures behaviour, experimental tests are practically compulsory in order to be able to properly evaluate and then to validate their behaviour in real sea. Moreover the necessity to carry out hydrodynamic tests is often required by customers, classification societies and other regulatory bodies. Consequently, the correct simulation of physical properties of the complex scaled models becomes a very important issue. The paper is investigating such kind of problems identifying the possible simplification, generating different approaches. One of the bases of the evaluation has been found consideringtheresults of systematic experimental tests on the dynamic behaviour of a mooring chain reproduced at five different scales. Dynamic effects as well as the influences of the elasticity simulation for 5 different scales are evaluated together. The paper presents systematic diagrams and practical results for a typical moored floating structure operating as pipe layer based on motion evaluations and accelerations in waves.

The role of surgeons in identifying emerging technologies for health technology assessment.

PubMed

Stafinski, Tania; Topfer, Leigh-Ann; Zakariasen, Ken; Menon, Devidas

2010-04-01

Health technology assessment (HTA) is a tool intended to help policy-makers decide which technologies to fund. However, given the proliferation of new technologies, it is not possible to undertake an HTA of each one before it becomes funded. Consequently, "horizon-scanning" processes have been developed to identify emerging technologies that are likely to have a substantial impact on clinical practice. Although the importance of physicians in the adoption of new technologies is well recognized, their role in horizon scanning in Canada has been limited. The purpose of this project was to pilot an approach to engage physicians, specifically surgeons, in provincial horizon-scanning activities. We invited 18 surgeons from Alberta's 2 medical schools to a horizon-scanning workshop to solicit their views on emerging technologies expected to impact surgical practice within the next 5 years and/or the importance of different attributes or characteristics of new technologies. Surgeons, regardless of specialty, identified developments designed to enhance existing minimally invasive surgical techniques, such as endoscopic, robotic and image-guided surgery. Several nonsurgical areas, including molecular genetics and nano technology, were also identified. Of the 13 technology attributes discussed, safety or risk, effectiveness and feasibility were rated as most important. Lastly, participating surgeons expressed an interest in becoming further involved in local HTA initiatives. Surgeons, as adopters and users of health technologies, represent an important and accessible information source for identifying emerging technologies for HTA. A more formal, ongoing relationship between the government, HTA and surgeons may help to optimize the use of HTA resources.

The role of surgeons in identifying emerging technologies for health technology assessment

PubMed Central

Stafinski, Tania; Topfer, Leigh-Ann; Zakariasen, Ken; Menon, Devidas

2010-01-01

Background Health technology assessment (HTA) is a tool intended to help policy-makers decide which technologies to fund. However, given the proliferation of new technologies, it is not possible to undertake an HTA of each one before it becomes funded. Consequently, “horizon-scanning” processes have been developed to identify emerging technologies that are likely to have a substantial impact on clinical practice. Although the importance of physicians in the adoption of new technologies is well recognized, their role in horizon scanning in Canada has been limited. The purpose of this project was to pilot an approach to engage physicians, specifically surgeons, in provincial horizon-scanning activities. Methods We invited 18 surgeons from Alberta’s 2 medical schools to a horizon-scanning workshop to solicit their views on emerging technologies expected to impact surgical practice within the next 5 years and/or the importance of different attributes or characteristics of new technologies. Results Surgeons, regardless of specialty, identified developments designed to enhance existing minimally invasive surgical techniques, such as endoscopic, robotic and image-guided surgery. Several nonsurgical areas, including molecular genetics and nanotechnology, were also identified. Of the 13 technology attributes discussed, safety or risk, effectiveness and feasibility were rated as most important. Lastly, participating surgeons expressed an interest in becoming further involved in local HTA initiatives. Conclusion Surgeons, as adopters and users of health technologies, represent an important and accessible information source for identifying emerging technologies for HTA. A more formal, ongoing relationship between the government, HTA and surgeons may help to optimize the use of HTA resources. PMID:20334740

Assessment of Nature, Reasons, and Consequences of Self-medication Practice among General Population of Ras Al-Khaimah, UAE.

PubMed

Sridhar, Sathvik B; Shariff, Atiqulla; Dallah, Lana; Anas, Doaa; Ayman, Maryam; Rao, Padma Gm

2018-01-01

The aim of this study is to assess the nature, reasons, and consequences of self-medication practice among the general population of Ras Al-Khaimah, UAE. This was a prospective, cross-sectional, survey-based study. Data with respect to knowledge, awareness, and practices regarding self-medication were collected through an interviewer-assisted questionnaire answered by the study participants. Thus, collected data from 413 survey respondents were analyzed using SPSS version 24.0. The prevalence of self-medication practices among our study respondents was 52.1%. A headache (155 [37.5%]) was the most common clinical condition treated through self-medication practice. Familiarity with the treatment/medication (198 [48%]) was the most common cited reasons, whereas the advertisement and friend's advice were the most (182 [44%]) cited sources of information for self-medication usage. The majority (265 [64.1%]) of the respondents were considered self-medication practice as safe. However, 19 respondents reported side-effects or complications during the due course of self-medication. It was observed that there is a statistically significant association ( P < 0.05) between age and employment status of this study participants with self-medication practices. The data from this study show that the self-medication practice is very common among the study population. Variables such as younger age group and occupation status were significantly associated with self-medication practice. We emphasize the role of pharmacist in educating the community regarding safe medication practices such as harmful effects of self-medicating and inappropriate practices such as sharing the medications among family members and friends.

Practical and emotional consequences of parental divorce.

PubMed

Emery, R E; Laumann-Billings, L

1998-06-01

This review explores divorce as a risk factor for psychological problems among children and adolescents and the difficult emotional and practical transitions it creates for them. The authors provide helpful suggestions for primary care pediatricians on how best to assist their adolescent patients and their families in dealing with the transition.

School Social Work in Louisiana: A Model of Practice

ERIC Educational Resources Information Center

Richard, Laura A.; Villarreal Sosa, Leticia

2014-01-01

Although the role of the school social worker has historically been inconsistent, fragmented, and contextual, concerns about the need to advocate for school social work positions, demonstrate the effectiveness of school social work practice, understand the consequences of role ambiguity, and respond in a proactive way to policy changes has…

Decreasing Mattress Ripping Using Forced Practice.

ERIC Educational Resources Information Center

Bluestone, Michael A.

A deaf, profoundly retarded institutionalized 20-year-old, who engaged in mattress ripping, was required to participate in forced practice behavioral training. Repeatedly physically guided through ripping mattresses, he was given the aversive consequence of a squirt of tabasco sauce solution. After 5 weeks of intensive behavioral training and a 3…

Anti-Bullying Practices in American Schools: Perspectives of School Psychologists

ERIC Educational Resources Information Center

Sherer, Yiping C.; Nickerson, Amanda B.

2010-01-01

A random sample of 213 school psychologists working in a school setting completed a survey on their schools' current anti-bullying practices. Talking with bullies following bullying incidents, disciplinary consequences for bullies, and increasing adult supervision were the three most frequently used strategies. Peer juries/court, an anti-bullying…

How Implementation of Bibliometric Practice Affects the Role of Academic Libraries

ERIC Educational Resources Information Center

Åström, Fredrik; Hansson, Joacim

2013-01-01

This article discusses potential consequences of implementing bibliometrics as an institutionalized practice in academic libraries. Results are reported from a survey among libraries in Sweden with organized bibliometric activities. Incorporating bibliometric activities is one way of redefining and widening the role of the library. Implementation…

"Open" Philosophy or Down the Rabbit Hole?

ERIC Educational Resources Information Center

Bowman, Wayne

2017-01-01

In this essay, I challenge the open-closed dualism at the heart of Allsup's project and question the very possibility of an "open" philosophy. I propose an account of music, musical instruction, and philosophy as ethically guided practices, discussing a number of practical and philosophical consequences that follow from such a view.

Parental Practices and Educational Achievement: Social Class, Race, and "Habitus"

ERIC Educational Resources Information Center

Bodovski, Katerina

2010-01-01

A large, nationally representative database of American elementary school students was used to quantitatively assess the complex ways in which race intersects with social class, affecting parenting strategies that in turn produce various educational outcomes among children. The determinants and consequences of parental practices associated with…

Normative perceptions and past-year consequences as predictors of subjective evaluations and weekly drinking behavior.

PubMed

Merrill, Jennifer E; Read, Jennifer P; Colder, Craig R

2013-11-01

Problem drinking during the college years continues to be an important area of study. Subjective evaluations of consequences have recently been demonstrated to predict future drinking behavior; however, what predicts those evaluations is yet unknown. Social Learning Theory (SLT) provides a guiding framework in this study. Primary aims are to investigate whether individual differences in past experience with alcohol consequences and normative perceptions of alcohol consequences predict subjective evaluations (i.e., the extent to which consequences are perceived as negative, aversive, or severe) and weekly drinking behavior. We also test whether evaluations mediate the influence of past consequences and norms on weekly drinking behavior. Following a baseline assessment, participants (N = 96 regularly drinking college students, 52% female) completed ten weekly web-based surveys on previous week alcohol use, consequences, and subjective evaluations of those consequences. A series of hierarchical linear models were used to test hypotheses. Most mediational pathways were not supported - weekly level evaluations do not appear to fully explain the effect of norms or past experience on weekly level drinking behavior. However, results demonstrated that normative perceptions of and past experience with consequences were associated with both weekly drinking behavior and subjective evaluations, and evaluations remained significant predictors of alcohol use behavior after accounting for these important between-person influences. Findings support the importance placed by SLT on cognition in drinking behavior, and suggest that norms for consequences and subjective evaluations may be appropriate targets of intervention in college students. © 2013 Elsevier Ltd. All rights reserved.

Normative Perceptions and Past-year Consequences as Predictors of Subjective Evaluations and Weekly Drinking Behavior

PubMed Central

Merrill, Jennifer E.; Read, Jennifer P.; Colder, Craig R.

2013-01-01

Problem drinking during the college years continues to be an important area of study. Subjective evaluations of consequences have recently been demonstrated to predict future drinking behavior; however, what predicts those evaluations is yet unknown. Social Learning Theory (SLT) provides a guiding framework in this study with primary aims to investigate whether individual differences in past experience with and normative perceptions of alcohol consequences predict subjective evaluations (i.e., the extent to which consequences are perceived as negative, aversive, or severe) and weekly drinking behavior. We also test whether evaluations mediate the influence of past consequences and norms on weekly drinking behavior. Following a baseline assessment, participants (N=96 regularly drinking college students, 52% female) completed ten weekly web-based surveys on previous week alcohol use, consequences, and subjective evaluations of those consequences. A series of hierarchical linear models were used to test hypotheses. Most mediational pathways were not supported – weekly level evaluations do not appear to fully explain the effect of norms or past experience on weekly level drinking behavior. However, results demonstrated that normative perceptions of and past experience with consequences were associated with both weekly drinking behavior and subjective evaluations, and evaluations remained significant predictors of alcohol use behavior after accounting for these important between-person influences. Findings support the importance placed by SLT on cognition in drinking behavior, and suggest that norms for consequences and subjective evaluations may be appropriate targets of intervention in college students. PMID:23899424

Female genital mutilation: when a cultural practice generates clinical and ethical dilemmas.

PubMed

Gibeau, A M

1998-01-01

Female genital mutilation (FGM) is of growing concern to health care providers in the United States and Canada as more women from countries where the procedure is practiced emigrate to North America. An introduction to the demographics of FGM, including prevalence rates, is a necessary antecedent for understanding the cultural rationales for this widespread practice. Considering the health consequences of this practice promotes questions about legal and ethical aspects of care as North Americans approach FGM from their own individual cultural frameworks.

Personnel Recovery in Space

DTIC Science & Technology

2016-07-13

adequate security testing , and segment their networks and systems into separate defended enclaves. Finally, cyber defenders should posi- tion themselves...explicitly tied to following security practices, and there should be consequences for security failures that are regularly tested via a continuing testing ...program. Users should be routinely tested and probed, and those who do not perform well should face escalating consequences. For example, cyber

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

ERIC Educational Resources Information Center

Balarin, Maria; Benavides, Martin

2010-01-01

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

Combating Terrorism: Issues in Managing Counterterrorist Programs

DTIC Science & Technology

2000-04-06

major effort to develop a national strategy, to date the strategy does not include a clear desired outcome to be achieved. Resources to combat...Federal exercises, in contrast to earlier years, are now practicing crisis and consequence management simultaneously and including state and local...categories—crisis management and consequence management. Crisis management includes efforts to stop a terrorist attack, arrest terrorists, and gather

["Handle with care": about the potential unintended consequences of oracular artificial intelligence systems in medicine.

PubMed

Cabitza, Federico; Alderighi, Camilla; Rasoini, Raffaele; Gensini, Gian Franco

2017-10-01

Decisional support systems based on machine learning (ML) in medicine are gaining a growing interest as some recent articles have highlighted the high diagnostic accuracy exhibited by these systems in specific medical contexts. However, it is implausible that any potential advantage can be obtained without some potential drawbacks. In light of the current gaps in medical research about the side effects of the application of these new AI systems in medical practice, in this article we summarize the main unexpected consequences that may result from the widespread application of "oracular" systems, that is highly accurate systems that cannot give reasonable explanations of their advice as those endowed with predictive models developed with ML techniques usually are. These consequences range from the intrinsic uncertainty in the data that are used to train and feed these systems, to the inadequate explainability of their output; through the risk of overreliance, deskilling and context desensitization of their end-users. Although some of these issues may be currently hard to evaluate due to the still scarce adoption of these decisional systems in medical practice, we advocate the study of these potential consequences also for a more informed policy of approval beyond hype and disenchantment.

The Effect of Water Management and Land Use Practices on the Restoration of Lee Vining and Rush Creeks

Treesearch

Peter Vorster; G. Mathias Kondolf

1989-01-01

This paper describes water management and land use practices in the Rush and Lee Vining Creek watersheds and evaluates the effect they have had on the stream environment. The management practices will continue to have effects on the flow regime and consequently habitat conditions on lower Lee Vining and Rush Creeks. The implications of existing and potential management...

Nursing on the medical ward.

PubMed

Parker, Judith M

2004-12-01

This paper considers some issues confronting contemporary medical nursing and draws upon psychoanalytic theories to investigate some seemingly straightforward and taken-for-granted areas of medical nursing work. I am arguing that the everyday work of medical nurses in caring for patients is concerned with bringing order to and placing boundaries around inherently unsettled and destabilized circumstances. I am also arguing that how nurses manage and organize their work in this regard stems from traditional practices that tend to be taken for granted and not explicitly thought about. It is therefore difficult for nurses to consider changing these practices that often have negative consequences for the nurses. I want to examine the impact upon nurses of the consequences of three taken-for-granted nursing practices: (i) the tendency of nurses to confine their reactions to what is going on so as to present a caring self; (ii) the tendency of nurses in their everyday talk to patients to confine, limit and minimize meaning; and (iii) the tensions and ambiguities that emerge for nurses in the policing function they perform in confining patients to the bed or the ward. Negative consequences on nurses of these practices potentially include stress and confusion regarding their ability to care for patients; an undervaluing of nursing skills; and a deterioration in the nurse-patient relationship. Clinical supervision for medical nurses is proposed as a means of facilitating greater understanding of the nature of nurses' relationships with patients and the complex dimensions of their medical nursing role.

End-of-Life Care in the Intensive Care Unit

PubMed Central

Engelberg, Ruth A.; Bensink, Mark E.; Ramsey, Scott D.

2012-01-01

The incidence and costs of critical illness are increasing in the United States at a time when there is a focus both on limiting the rising costs of healthcare and improving the quality of end-of-life care. More than 25% of healthcare costs are spent in the last year of life, and approximately 20% of deaths occur in the intensive care unit (ICU). Consequently, there has been speculation that end-of-life care in the ICU represents an important target for cost savings. It is unclear whether efforts to improve end-of-life care in the ICU could significantly reduce healthcare costs. Here, we summarize recent studies suggesting that important opportunities may exist to improve quality and reduce costs through two mechanisms: advance care planning for patients with life-limiting illness and use of time-limited trials of ICU care for critically ill patients. The goal of these approaches is to ensure patients receive the intensity of care that they would choose at the end of life, given the opportunity to make an informed decision. Although these mechanisms hold promise for increasing quality and reducing costs, there are few clearly described, effective methods to implement these mechanisms in routine clinical practice. We believe basic science in communication and decision making, implementation research, and demonstration projects are critically important if we are to translate these approaches into practice and, in so doing, provide high-quality and patient-centered care while limiting rising healthcare costs. PMID:22859524

Skin Bleaching and Dermatologic Health of African and Afro-Caribbean Populations in the US: New Directions for Methodologically Rigorous, Multidisciplinary, and Culturally Sensitive Research.

PubMed

Benn, Emma K T; Alexis, Andrew; Mohamed, Nihal; Wang, Yan-Hong; Khan, Ikhlas A; Liu, Bian

2016-12-01

Skin-bleaching practices, such as using skin creams and soaps to achieve a lighter skin tone, are common throughout the world and are triggered by cosmetic reasons that oftentimes have deep historical, economic, sociocultural, and psychosocial roots. Exposure to chemicals in the bleaching products, notably, mercury (Hg), hydroquinone, and steroids, has been associated with a variety of adverse health effects, such as Hg poisoning and exogenous ochronosis. In New York City (NYC), skin care product use has been identified as an important route of Hg exposure, especially among Caribbean-born blacks and Dominicans. However, surprisingly sparse information is available on the epidemiology of the health impacts of skin-bleaching practices among these populations. We highlight the dearth of large-scale, comprehensive, community-based, clinical, and translational research in this area, especially the limited skin-bleaching-related research among non-White populations in the US. We offer five new research directions, including investigating the known and under-studied health consequences among populations for which the skin bleach practice is newly emerging at an alarming rate using innovative laboratory and statistical methods. We call for conducting methodologically rigorous, multidisciplinary, and culturally sensitive research in order to provide insights into the root and the epidemiological status of the practice and provide evidence of exposure-outcome associations, with an ultimate goal of developing potential intervention strategies to reduce the health burdens of skin-bleaching practice.

Development of a novel, multilayered presentation format for clinical practice guidelines.

PubMed

Kristiansen, Annette; Brandt, Linn; Alonso-Coello, Pablo; Agoritsas, Thomas; Akl, Elie A; Conboy, Tara; Elbarbary, Mahmoud; Ferwana, Mazen; Medani, Wedad; Murad, Mohammad Hassan; Rigau, David; Rosenbaum, Sarah; Spencer, Frederick A; Treweek, Shaun; Guyatt, Gordon; Vandvik, Per Olav

2015-03-01

Bridging the gap between clinical research and everyday health-care practice requires effective communication strategies. To address current shortcomings in conveying practice recommendations and supporting evidence, we are creating and testing presentation formats for clinical practice guidelines (CPGs). We carried out multiple cycles of brainstorming and sketching, developing a prototype. Physicians participating in the user testing viewed CPG formats linked to clinical scenarios and engaged in semistructured interviews applying a think-aloud method for exploring important aspects of user experience. We developed a multilayered presentation format that allows clinicians to successively view more in-depth information. Starting with the recommendations, clinicians can, on demand, access a rationale and a key information section containing statements on quality of the evidence, balance between desirable and undesirable consequences, values and preferences, and resource considerations. We collected feedback from 27 stakeholders and performed user testing with 47 practicing physicians from six countries. Advisory group feedback and user testing of the first version revealed problems with conceptual understanding of underlying CPG methodology, as well as difficulties with the complexity of the layout and content. Extensive revisions made before the second round of user testing resulted in most participants expressing overall satisfaction with the final presentation format. We have developed an electronic, multilayered, CPG format that enhances the usability of CPGs for frontline clinicians. We have implemented the format in electronic guideline tools that guideline organizations can now use when authoring and publishing their guidelines.

PUFA and LC-PUFA intake during the first year of life: can dietary practice achieve a guideline diet?

PubMed

Schwartz, J; Dube, K; Alexy, U; Kalhoff, H; Kersting, M

2010-02-01

An appropriate supply of n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) during early childhood may enhance cognitive development. Little attention is paid to the fatty acid (FA) supply during the complementary feeding period. We examined the polyunsaturated fatty acids (PUFAs) and LC-PUFAs pattern in dietary practice of two study groups and evaluated the results against the present Dietary Guidelines in Germany. The food consumption and FA pattern of dietary practice in subjects from two prospective studies (n=102 and n=184, respectively) at the age of 3, 6 and 9 months was assessed by weighed diet records, and changes during the first year of life were compared with the food-based dietary guidelines for the first year of life. Dietary practice in the complementary feeding period was clearly dominated by commercial food products. The FA composition in dietary practice was different from the Guideline Diet and the ratio of n-6/n-3 PUFAs was less favorable. Consumption of breast milk or formula was still of major importance for the intake of LC-PUFAs in the complementary feeding period. LC-PUFAs are predominantly provided by breast milk and formula during the first year of life and consequently decrease when milk consumption decreases. For compensation, commercial complementary food might come closer to the Guideline Diet by lowering the n-6/n-3 PUFA ratio through appropriate vegetable oil along with an increase in total fat content up to the legal limit.

Challenging tradition in Nigeria.

PubMed

Supriya, K E

1991-01-01

In Nigeria since 1987, the National Association of Nigeria Nurses and Midwives (NSNNM) has used traditional medial and traditional health care workers to curtail the practice of female circumcision. Other harmful traditions are being changed also, such as early marriage, taboos of pregnancy and childbirth, and scarification. 30,000 member of NANNM are involved in this effort to halt the harmful practices themselves and to change community opinion. The program involved national and state level workshops on harmful health consequences of traditional practices and instruction on how to conduct focus group discussions to assess women's beliefs and practices. The focus groups were found to be a particularly successful method of opening up discussion of taboo topics and expressing deep emotions. The response to the knowledge that circumcision was not necessary was rage and anger, which was channeled into advocacy roles or change in the practice. The result was the channeled into advocacy roles for change in the practice. The result was the development of books, leaflets and videos. One community group designed a dress with a decorative motif of tatoos and bodily cuts to symbolize circumcision and scarring. Plays and songs were written and performed. Artists provided models of female genitalia both before and after circumcision. The campaign has been successful in bringing this issue to the public attention in prominent ways, such a national television, health talk shows, and women;s magazines. One of the most important results of the effort has been the demonstration that culture and tradition can be changed from within, rather than from outside imposition of values and beliefs.

The impact of funding changes on the implementation of primary health care policy.

PubMed

Finlayson, Mary P; Sheridan, Nicolette F; Cumming, Jacqueline M; Fowler, Sandra

2012-04-01

To ascertain how new funding arrangements, introduced in New Zealand's 2001 Primary Health Care (PHC) Strategy, have impacted on the expansion of nurses' role in general practice. Nurses are central to the new policy that was designed to improve the health status of New Zealanders and reduce inequalities in health. Nurses were to be a crucial part of the PHC team, expanding their current roles to provide increased access to appropriate services. This paper investigates how the new funding arrangements, introduced as part of the policy, have impacted on the expansion of nurses' roles and consequently the realisation of the policy goals. Semi-structured interviews were undertaken with 128 key stakeholders five years after the introduction of the PHC Strategy, and surveys were completed by practice nurses, general practitioners and practice managers in purposively selected practices within the 20 participating Primary Health Organisations. There has been substantial growth in the development of nursing roles for some nurses in general practice; however, this expansion has not been universal and one of the main reasons for this is the way funding devolves at the practice level. One of the consequences of the policymakers not taking into account the business model of the majority of general practices, is the resulting overarching goal of the strategy not being realised, and inequalities in health status remaining.

The consequences of task delegation for the process of care: Female patients seem to benefit more.

PubMed

Noordman, Janneke; van Dulmen, Sandra

2016-01-01

The shift of tasks from primary care physicians to practice nurses and the continuing incease in the numbers of women involved in medical care may have consequences for the provision of health care and communication. The aim of the present study was to examine potential differences in female practice nurses' application of communication skills, practice guidelines, and motivational interviewing skills during consultations with female and male patients. Nineteen female practice nurses and their patients (n = 181) agreed to have their consultations videotaped (during 2010-2011). The videotaped consultations were rated using two validated instruments: the Maas-Global (to assess generic communication skills and practice guidelines) and the Behaviour Change Counselling Index (to assess motivational interviewing skills). Multilevel linear and logistic regression analyses were performed. Female practice nurses provided significantly more comprehensive information during consultations with female patients (p = .03) and talked more about management with male patients (p = .04). Furthermore, nurses applied motivational interviewing skills more clearly during consultations with female than with male patients (p < .01). The shift in tasks from primary care physicians toward practice nurses may have implications for clinical and patient outcomes as patients will no longer be counseled by male professionals. Conceivably, female patients are motivated more by nurses to change their behavior, while male patients receive more concrete management information or advice.

Practising family history: 'identity' as a category of social practice.

PubMed

Bottero, Wendy

2015-09-01

Research on family history argues it performs the task of anchoring a sense of 'self' through tracing ancestral connection and cultural belonging, seeing it as a form of storied 'identity-work'. This paper draws on a small-scale qualitative study to think further on the identity-work of family history. Using practice theory, and a disaggregated notion of 'identity', it explores how the storying of family histories relates to genealogy as a leisure hobby, a form of historical research, and an information-processing activity; and examines the social organization of that narrativity, where various practical engagements render certain kinds of genealogical information more, or less, 'storyable'. Key features of 'identity-work' in family history, such as the construction of genealogy as a personal journey of discovery and identification with particular ancestors, emerge as a consequence of the procedures of family history, organized as a set of practical tasks. The paper explores 'identity-work' as a consequence of people's engagement in specific social practices which provide an internal logic to their actions, with various components of 'identity' emerging as categories of practice shaped within, and for, use. Focusing on 'identity' as something produced when we are engaged in doing other things, the paper examines how the practical organization of 'doing other things' helps produce 'identity' in particular ways. © London School of Economics and Political Science 2015.

Knowledge, attitudes and practices of female genital mutilation/cutting among health care professionals in The Gambia: a multiethnic study.

PubMed

Kaplan, Adriana; Hechavarría, Suiberto; Bernal, Mariola; Bonhoure, Isabelle

2013-09-16

Female genital mutilation/cutting (FGM/C) is a harmful traditional practice with severe consequences for the health and well-being of girls and women. Health care professionals (HCPs) are therefore expected to be aware of how to identify and manage these consequences in order to ensure that those affected by the practice receive quality health care. Moreover, their integration and legitimacy within the communities allow them to play a key role in the prevention of the practice. Nevertheless, the perception of HCPs on FGM/C has been barely explored in African contexts. This study seeks to contribute to this field of knowledge by examining the knowledge, attitudes, and practices regarding FGM/C among HCPs working in rural settings in The Gambia. A cross-sectional descriptive study was designed through a quantitative methodology, following a multiethnic approach. A pre-tested questionnaire with open and closed-ended questions was created. Forty medical students from the Community-based Medical Programme were trained to administer the questionnaire, face to face, at village health facilities in rural areas of The Gambia. A final sample of 468 HCPs included all nurse cadres and midwives. A significant proportion of Gambian HCPs working in rural areas embraced the continuation of FGM/C (42.5%), intended to subject their own daughters to it (47.2%), and reported having already performed it during their medical practice (7.6%). However, their knowledge, attitudes, and practices were shaped by sex and ethnic identity. Women showed less approval for continuation of FGM/C and higher endorsement of the proposed strategies to prevent it than men. However, it was among ethnic groups that differences were more substantial. HCPs belonging to traditionally practicing groups were more favourable to the perpetuation and medicalisation of FGM/C, suggesting that ethnicity prevails over professional identity. These findings demonstrate an urgent need to build HCP's capacities for FGM/C-related complications, through strategies adapted to their specific characteristics in terms of sex and ethnicity. A culturally and gender sensitive training programme might contribute to social change, promoting the abandonment of FGM/C, avoiding medicalisation, and ensuring accurate management of its health consequences.

Symmetry breaking in drop bouncing on curved surfaces

PubMed Central

Liu, Yahua; Andrew, Matthew; Li, Jing; Yeomans, Julia M.; Wang, Zuankai

2015-01-01

The impact of liquid drops on solid surfaces is ubiquitous in nature, and of practical importance in many industrial processes. A drop hitting a flat surface retains a circular symmetry throughout the impact process. Here we show that a drop impinging on Echevaria leaves exhibits asymmetric bouncing dynamics with distinct spreading and retraction along two perpendicular directions. This is a direct consequence of the cylindrical leaves that have a convex/concave architecture of size comparable to the drop. Systematic experimental investigations on mimetic surfaces and lattice Boltzmann simulations reveal that this novel phenomenon results from an asymmetric momentum and mass distribution that allows for preferential fluid pumping around the drop rim. The asymmetry of the bouncing leads to ∼40% reduction in contact time. PMID:26602170

From a black-box to a glass-box system: the attempt towards a plant-wide automation concept for full-scale biogas plants.

PubMed

Wiese, J; König, R

2009-01-01

Biogas plants gain worldwide increasing importance due to several advantages. However, concerning the equipment most of the existing biogas plants are low-tech plants. E.g., from the point of view of instrumentation, control and automation (ICA) most plants are black-box systems. Consequently, practice shows that many biogas plants are operated sub-optimally and/or in critical (load) ranges. To solve these problems, some new biogas plants have been equipped with modern machines and ICA equipment. In this paper, the authors will show details and discuss operational results of a modern agricultural biogas plant and the resultant opportunities for the implementation of a plant-wide automation.

Maternal and congenital toxoplasmosis, currently available and novel therapies in horizon

PubMed Central

Oz, Helieh S.

2014-01-01

Over one billion people worldwide are predicted to harbor Toxoplasma infection frequently with unknown lifelong health consequences. Toxoplasmosis is an important cause of foodborne, inflammatory illnesses, as well as congenital abnormalities. Ubiquitous Toxoplasma has a unique tropism for central nervous system with a mind-bugging effect and is transmitted sexually through semen. Currently available therapies are ineffective for persistent chronic disease and congenital toxoplasmosis or have severe side effects which may result in life-threatening complications. There is an urgent need for safe and effective therapies to eliminate or treat this cosmopolitan infectious and inflammatory disease. This investigation discusses pathogenesis of maternal and congenital toxoplasmosis, the currently available therapies in practice, and the experimental therapeutic modalities for promising future trials. PMID:25104952

Myopathy in hyperthyroidism as a consequence of rapid reduction of thyroid hormone: A case report.

PubMed

Li, Qianrui; Liu, Yuping; Zhang, Qianying; Tian, Haoming; Li, Jianwei; Li, Sheyu

2017-07-01

Myalgia and elevated creatine kinase (CK) are occasionally observed during the treatment of hyperthyroid patients. Relative hypothyroidism resulted from rapid thyroid hormone reduction had been promoted as a plausible cause of these myopathic changes, however rarely reported. We hereby presented a 20-year-old female with Grave's disease, who developed myopathy and elevated CK during rapid correction of thyroid hormone. Relative hypothyroidism-induced myopathy. Antithyroid drug (ATD) dosage was reduced without levothyroxine replacement. The muscular symptoms were recovered with CK level returned to normal after adoption of the euthyroid status. Differentiation of relative hypothyroidism from other causes of myopathy, especially with the effect of ATD, is important for clinical practice, although difficult in many cases.

Gender differences in liver disease and the drug-dose gender gap.

PubMed

Buzzetti, Elena; Parikh, Pathik M; Gerussi, Alessio; Tsochatzis, Emmanuel

2017-06-01

Although gender-based medicine is a relatively recent concept, it is now emerging as an important field of research, supported by the finding that many diseases manifest differently in men and women and therefore, might require a different treatment. Sex-related differences regarding the epidemiology, progression and treatment strategies of certain liver diseases have long been known, but most of the epidemiological and clinical trials still report results only about one sex, with consequent different rate of response and adverse reactions to treatment between men and women in clinical practice. This review reports the data found in the literature concerning the gender-related differences for the most representative hepatic diseases. Copyright © 2017 Elsevier Ltd. All rights reserved.

Statistical methods for conducting agreement (comparison of clinical tests) and precision (repeatability or reproducibility) studies in optometry and ophthalmology.

PubMed

McAlinden, Colm; Khadka, Jyoti; Pesudovs, Konrad

2011-07-01

The ever-expanding choice of ocular metrology and imaging equipment has driven research into the validity of their measurements. Consequently, studies of the agreement between two instruments or clinical tests have proliferated in the ophthalmic literature. It is important that researchers apply the appropriate statistical tests in agreement studies. Correlation coefficients are hazardous and should be avoided. The 'limits of agreement' method originally proposed by Altman and Bland in 1983 is the statistical procedure of choice. Its step-by-step use and practical considerations in relation to optometry and ophthalmology are detailed in addition to sample size considerations and statistical approaches to precision (repeatability or reproducibility) estimates. Ophthalmic & Physiological Optics © 2011 The College of Optometrists.

The search for equality: representations of the smoking act among adolescent women.

PubMed

Sánchez Martínez, J Adriana; Ribeiro, Cléa Regina de Oliveira

2008-01-01

This study aimed to discover the representations of the smoking habit in both non-smoking and smoking female adolescents from a high school in Querétaro, Mexico. It is a qualitative research, carried out with 14 female adolescents in 2005. A semi-structured interview and a socioeconomic survey were used to collect data. Results evidenced adolescents know the biomedical discourse, which proposes that smoking causes serious consequences to health. However, there are other symbolic reasons that influence its use such as the search for equality and image, since they think men find smoking women more attractive and mature. Peer pressure represents an important factor for women to smoke by validating its practice and minimizing its effects to the body.

Assessment of a Bayesian Belief Network-GIS framework as a practical tool to support marine planning.

PubMed

Stelzenmüller, V; Lee, J; Garnacho, E; Rogers, S I

2010-10-01

For the UK continental shelf we developed a Bayesian Belief Network-GIS framework to visualise relationships between cumulative human pressures, sensitive marine landscapes and landscape vulnerability, to assess the consequences of potential marine planning objectives, and to map uncertainty-related changes in management measures. Results revealed that the spatial assessment of footprints and intensities of human activities had more influence on landscape vulnerabilities than the type of landscape sensitivity measure used. We addressed questions regarding consequences of potential planning targets, and necessary management measures with spatially-explicit assessment of their consequences. We conclude that the BN-GIS framework is a practical tool allowing for the visualisation of relationships, the spatial assessment of uncertainty related to spatial management scenarios, the engagement of different stakeholder views, and enables a quick update of new spatial data and relationships. Ultimately, such BN-GIS based tools can support the decision-making process used in adaptive marine management. Copyright © 2010 Elsevier Ltd. All rights reserved.

[Proxy decision in health questions and advance designations by patients. A practice-oriented review of the legal and ethical problems in treating the incompetent patient].

PubMed

Strätling, M; Scharf, V E; Wulf, H; Eisenbart, B; Simon, A

2000-07-01

Except in emergencies, the medical treatment of incompetent patients also has to be based upon an informed consent between the physician and a legitimate legal representative (durable power of attorney). Consequently, the German 'Betreuungsrecht' advices persons to designate in advance such a proxy or surrogate. However, an additional court-decision is demanded, if a medical measure poses significant risks for the future health or the life of the incompetent patient. On the base of the available epidemiologic data we illustrate that neither our medical nor our legal system could realistically cope with the practical consequences of this legislation: The vast majority of our present decisions in such cases is not covered by a legally valid informed consent, which implies possible forensic consequences. This article provides relevant clinical and legal advice on how to protect the legitimate interests of all concerned within the present framework, which should urgently be revised.

Patchwork diagnoses: the production of coherence, uncertainty, and manageable bodies.

PubMed

Gardner, John; Dew, Kevin; Stubbe, Maria; Dowell, Tony; Macdonald, Lindsay

2011-09-01

Using a material semiotics methodology, this paper explores the link between diagnostic practices, patient awareness of the body, and biopolitical governance. We collected video and audio recordings of a patient with chest pain involved in three medical interactions (a general practitioner [GP] consultation, an electrocardiogram stress test and a consultation with a cardiologist) in Wellington, New Zealand. Following the work of Annemarie Mol, we argue that each of these diagnostics interactions bring together a range of material and non-material entities that enact the body and disease. Consequently, we note how the diagnostic practices associated with cardiovascular medicine enable and prompt an awareness of the body based on uncertainty, and thus promotes the self-management of cardiac health and risk. This paper illustrates that a material semiotics methodology makes important contributions to the sociology of diagnosis. Firstly, it draws attention to the relationship between humans and material entities in rendering the body intelligible. Secondly, it illustrates that different diagnostic procedures can produce multiple, potentially conflicting, forms of self-awareness. Alongside these practices generating multiplicity, however, are those that presuppose and produce singularity and coherence. We illustrate how the cardiologist "patches" two potentially conflicting diagnoses together in order to provide a sense of coherence to the interactions. Thirdly, material semiotics illustrates how various diagnostic practices can reify risk, and produce bodies that lend themselves to particular forms of governance. Copyright © 2011 Elsevier Ltd. All rights reserved.

A Qualitative Study of Medical Oncologists’ Experiences of Their Profession and Workforce Sustainability

PubMed Central

Broom, Alex; Wong, W. K. Tim; Kirby, Emma; Sibbritt, David; Karikios, Deme; Harrup, Rosemary; Lwin, Zarnie

2016-01-01

Background Medical oncology is a steadily evolving field of medical practice and professional pathway for doctors, offering value, opportunity and challenge to those who chose this medical specialty. This study examines the experiences of a group of Australian medical oncologists, with an emphasis on their professional practice, career experiences, and existing and emerging challenges across career stages. Methods In-depth qualitative interviews were conducted with 22 medical oncologists, including advanced trainees, early-career consultants and senior consultants, focusing on: professional values and experiences; career prospects and pathways; and, the nexus of the characteristics of the profession and delivery of care. Results The following themes were emergent from the interviews: the need for professional reinvention and the pressure to perform; the importance, and often absence, of mentoring and feedback loops; the emotional labour of oncology; and, the impact of cascading workload volume on practice sustainability. Conclusions Understanding professional experiences, career trajectories and challenges at the workforce level are crucial for understanding what drives the oncological care day-to-day. The results indicate that there are considerable potential tensions between the realities of professional, workforce demands and expectations for patient care. Such tensions have real and significant consequences on individual medical oncologists with respect to their futures, aspirations, satisfaction with work, caring practices, interactions with patients and potentially therapeutic outcomes. PMID:27902706

The publication strategies of Jöns Jacob Berzelius (1779-1848): negotiating national and linguistic boundaries in chemistry.

PubMed

Beckman, Jenny

2016-04-01

This article follows the publication strategies of the Swedish chemist Jöns Jacob Berzelius (1779-1848). It focuses on the role of language and translation in Berzelius' efforts to strengthen his own reputation, and that of Swedish science. As an author and editor, Berzelius encouraged the translation of his own works into several languages, while endeavouring to preserve the status of Swedish as a language of scientific publication in the face of French, and increasingly German and English, dominance. Reforming the Transactions of the Royal Swedish Academy of Sciences and launching several new scientific periodicals, Berzelius also attempted to influence the publication practices in other countries. Recent scholarship on the history of scientific publication has drawn attention to the practical difficulties of determining and getting hold of the relevant publications in one's field, the 'malleability' of the journal medium, and the common practice of reprinting and summarising papers published elsewhere. Berzelius' publication strategies highlight translation - time-consuming, unreliable and problematic in terms of authorisation and ownership - as one aspect of the wider problem of communicating across national and linguistic boundaries. Berzelius' struggles with the practicalities of communicating across borders in times of war, the choice of language and its consequences, and national standards of publication, demonstrate the importance of a transnational perspective on the history of scientific publication.

Traditional beliefs about pregnancy and child birth among women from Chiang Mai, Northern Thailand.

PubMed

Liamputtong, Pranee; Yimyam, Susanha; Parisunyakul, Sukanya; Baosoung, Chavee; Sansiriphun, Nantaporn

2005-06-01

To examine women's embodied knowledge of pregnancy and birth, women's explanations of precautions during pregnancy and birth and preparations for easy birth and the role of a traditional midwife in a Thai birthing care. In-depth interviews relating to traditional and changed beliefs and practices of pregnancy and childbirth with Thai women in Northern Thailand. Chiang Mai city and Mae On sub-district in Chiang Mai province, Northern Thailand. 30 Thai women living in Chiang Mai in Thailand. The social meaning of childbirth in Thai culture is part of the larger social system, which involves the woman, her family, the community, society and the supernatural world. Traditional beliefs and practices in Thai culture clearly aim to preserve the life and well-being of a new mother and her baby. It seems that traditional childbirth practices have not totally disappeared in northern Thailand, but have gradually diminished. Women's social backgrounds influence traditional beliefs and practices. The traditions are followed by most rural and some urban poor women in Chiang Mai. The findings of this study may assist health professionals to better understand women from different cultures. It is important to recognise many factors discussed in this paper within the context of Thai lives and traditions. This will prevent misunderstanding and, consequently, encourage more sensitive pregnancy and birthing care for pregnant women.

Responses of Aquatic Saproxylic Macroinvertebrates to Reduced-Impact Logging in Central Amazonia.

PubMed

Roque, F O; Escarpinati, S C; Valente-Neto, F; Hamada, N

2015-08-01

Reduced-impact logging (RIL) is an alternative land use because it reduces damage to forest cover in comparison with clear-cut practices. However, management practices adopted in RIL can affect wood availability and, consequently, fauna associated with dead wood during part of their life cycle (saproxylic). In this study, we evaluated whether aquatic saproxylic macroinvertebrates are affected by reduced-impact logging in Central Amazonia. We selected six streams in areas under reduced-impacted logging and six in primary forest areas and collected submerged woody debris. We did not find any differences in water pH, conductivity, and wood availability between reduced-impacted forest and primary forest streams. We found 248 saproxylic aquatic macroinvertebrates belonging to 37 taxa. We found five wood specialist (Dryops, Lutrochus, Stenochironomus, Oukuriella, and Endotribelos) and 32 generalists, totalling 98 and 150 individuals, respectively. In general, our results show that reduced-impact logging does not affect richness, abundance, and composition of saproxylic macroinvertebrates. The main explanation for this pattern is that management practices do not change important macroinvertebrate niche dimensions, including wood availability and the water's chemical and physical variables. Thus, controlled logging, such as applied in the area of the Central Amazonian streams studied, opens a new prospect for insect conservation and commercial exploitation of wood, which is not possible when clear-cut practices are adopted.

Contradictions and dilemmas within the practice of immigration medicine.

PubMed

Bisaillon, Laura

2013-01-08

To identify, explore and critique features of how practices associated with immigration medicine are socially organized. Specifically, how the work of designated medical practitioners (DMP) - physicians who conduct immigration medical examinations of prospective immigrants to Canada as contractors to the Canadian government department of Citizenship and Immigration Canada - is organized to occur in interactions with applicants who are diagnosed with the human immunodeficiency virus during the immigration medical examination. Findings from a theoretically informed empirical study using institutional and political activist ethnography inform this article. Data collection and analytic activities spanning 18 months included observational work in institutional settings, textual review, 61 interviews, and 2 focus groups in three Canadian cities. The medical examination of prospective immigrants to Canada is not organized as a therapeutic relation of care and has little to do with medicine per se. The rationale structuring the work of DMPs is actually administrative responsibilities. The work achieved by the DMP positions her/him as a key figure and important decision-maker within the Canadian immigration system. The work of doctors who practice immigration medicine gives rise to contradictions and ethical problems. These are largely unresolvable because of the way in which the labour process in which the DMP is implicated is coordinated. The social organization of immigration doctoring practices has serious consequences for prospective immigrants to Canada, for doctors themselves, and for the Canadian immigration system more broadly.

Consanguineous marriage in Oman: understanding the community awareness about congenital effects of and attitude towards consanguineous marriage.

PubMed

Mazharul Islam, M

2017-05-01

Although consanguinity is widely practiced in Oman, the attitude of community towards consanguinity and the awareness of its health consequences to offspring remain largely unexplored. To analyse the levels and trends of consanguineous marriage and examine community awareness about congenital anomaly associated with consanguinity and attitude towards consanguinity in Oman. The data come from a nationally representative survey on Omani adults of age 18 years and above, irrespective of their marital status. Data were analysed using both descriptive and multivariate statistical techniques. The survey results indicate a very high rate (49%) of consanguineous marriage in Oman. There is a declining trend in consanguinity which may be attributed to decline in first cousin marriage. Omani adults have moderately high knowledge (69%) about health consequences of consanguineous marriage. There is a high positive attitude towards consanguineous marriage (75%) which appeared as a significant predictor of current practice of consanguineous marriage in Oman. The positive attitude of the Omani community towards consanguinity outweighs the negative health consequences of consanguinity, and the practice is likely to remain high in the near future. Strong educational and motivational programmes are needed to bring further changes in attitude towards consanguinity and, thus, reduce the burden of congenital anomalies associated with consanguinity in Oman.

Reputation management on facebook: awareness is key to protecting yourself, your practice, and the veterinary profession.

PubMed

Weijs, Cynthia A; Coe, Jason B; Muise, Amy; Christofides, Emily; Desmarais, Serge

2014-01-01

From the Social media use by health professionals occurs in a digital environment where etiquette has yet to be solidly defined. The objectives of this study were to explore veterinarians' personal use of Facebook, knowledge of privacy settings, and factors related to sharing personal information online. All American Animal Hospital Association member veterinarians with a valid e-mail address (9469) were invited to complete an online survey about Facebook (e.g., time spent on Facebook, awareness of consequences, types of information posted). Questions assessing personality dimensions including trust, popularity, self-esteem and professional identity were included. The response rate was 17% (1594 of 9469); 72% of respondents (1148 of 1594) had a personal Facebook profile. Veterinarians were more likely to share information on Facebook than they would in general. Trust, need for popularity, and more time spent on Facebook predicted more disclosure of personal information on Facebook. Awareness of consequences and increased veterinary experience predicted lesser disclosure. As veterinary practices use Facebook to improve client services, they need also to manage risks associated with online disclosure by staff. Raising awareness of reputation management and consequences of posting certain types of information to Facebook is integral to protecting the individual, the practice, and the veterinary profession.

A methodology for overall consequence modeling in chemical industry.

PubMed

Arunraj, N S; Maiti, J

2009-09-30

Risk assessment in chemical process industry is a very important issue for safeguarding human and the ecosystem from damages caused to them. Consequence assessment is an integral part of risk assessment. However, the commonly used consequence estimation methods involve time-consuming complex mathematical models and simple assimilation of losses without considering all the consequence factors. This lead to the deterioration of quality of estimated risk value. So, the consequence modeling has to be performed in detail considering all major losses with optimal time to improve the decisive value of risk. The losses can be broadly categorized into production loss, assets loss, human health and safety loss, and environment loss. In this paper, a conceptual framework is developed to assess the overall consequence considering all the important components of major losses. Secondly, a methodology is developed for the calculation of all the major losses, which are normalized to yield the overall consequence. Finally, as an illustration, the proposed methodology is applied to a case study plant involving benzene extraction. The case study result using the proposed consequence assessment scheme is compared with that from the existing methodologies.

The Governance of Organizational Learning: Empirical Evidence from Best-Practice Universities in Germany

ERIC Educational Resources Information Center

Lauer, Sabine; Wilkesmann, Uwe

2017-01-01

Purpose: The purpose of this paper is to link two modes of governance (transactional and transformational) to organizational learning by examining the example of academic teaching. Consequently, the "transformational" strategies of best practices that have been used by German universities to achieve teaching excellence are interpreted as…

Culturally Adapted Psychotherapy and the Legitimacy of Myth: A Direct-Comparison Meta-Analysis

ERIC Educational Resources Information Center

Benish, Steven G.; Quintana, Stephen; Wampold, Bruce E.

2011-01-01

Psychotherapy is a culturally encapsulated healing practice that is created from and dedicated to specific cultural contexts (Frank & Frank, 1993; Wampold, 2007; Wrenn, 1962). Consequently, conventional psychotherapy is a practice most suitable for dominant cultural groups within North America and Western Europe but may be culturally incongruent…

The Practices of Student Network as Cooperative Learning in Ethiopia

ERIC Educational Resources Information Center

Reda, Weldemariam Nigusse; Hagos, Girmay Tsegay

2015-01-01

Student network is a teaching strategy introduced as cooperative learning to all educational levels above the upper primary schools (grade 5 and above) in Ethiopia. The study was, therefore, aimed at investigating to what extent the student network in Ethiopia is actually practiced in line with the principles of cooperative learning. Consequently,…

The Doctoral Education of Professional Marriage and Family Therapists

ERIC Educational Resources Information Center

Lee, Robert E., III; Nichols, William C.

2010-01-01

The professional practice of marriage and family therapy (MFT) scholarship is regulated at the master's level in the United States. Consequently, contemporary curricular issues have largely been focused on what is to be achieved within the master's degree, with an emphasis on clinical practice. We consider here what value may and should be added…

Adlerian Counseling: A Practitioner's Approach. Fourth Edition.

ERIC Educational Resources Information Center

Sweeney, Thomas J.

Written with the practitioner in mind, this overview of the theory and practice of Alfred Adler's Individual Psychology explains the dimensions and uses of natural and logical consequences--the twin bases of Adlerian/Individual Psychology. The text takes a practical approach to the topic, and covers a variety of settings (school, home, community,…

Aristotle's Definition of Rhetoric in the "Rhetoric": The Metaphors and Their Message.

ERIC Educational Resources Information Center

Newman, Sara J.

2001-01-01

Investigates Aristotle's metaphorical definitions of rhetoric in book 1 of his "Rhetoric," using his own theory of metaphor as a measure of his practice in these definitions. Indicates that Aristotle's practice in the situation does not match his theory, a circumstance that has consequences for one's reading of the "Rhetoric."…

Intersections of Accountability and Special Education: The Social Justice Implications of Policy and Practice

ERIC Educational Resources Information Center

Castro-Villarreal, Felicia; Nichols, Sharon L.

2016-01-01

High-stakes testing accountability has wreaked havoc on America's public schools. Since the passage of NCLB in 2001, virtually every public school student has experienced the pressures of preparing for, practicing, and taking standardized state exams, the results of which have had significant consequences for their schools, teachers, and…

Alignment in Teacher Education and Distribution of Leadership: An Example Concerning Learning Study

ERIC Educational Resources Information Center

Nilsson, Ingrid

2008-01-01

The critical aspects distribution of professional leadership, alignment in learning and research close to practices, were lifted forward in order to exemplify a research project with learning study as an approach for alignment between teacher education and practice, and as consequence an instrument for distribution of power. The results showed…

Dangers in the Use of Staplers in Liver Surgery

PubMed Central

Riga, Angela; Karanjia, Nariman

2007-01-01

The use of endoscopic vascular staplers has become common practice in recent years both in open and minimally invasive surgery. The technological advances, however, are not free of problems. In our practice, we have come across two cases where the Endopath ETS Flex 45 Endoscopic Articulating Linear Cutter failed with dangerous consequences. PMID:17999829

Training for Efficiency: Work, Time, and Systems-Based Practice in Medical Residency

ERIC Educational Resources Information Center

Szymczak, Julia E.; Bosk, Charles L.

2012-01-01

Medical residency is a period of intense socialization with a heavy workload. Previous sociological studies have identified efficiency as a practical skill necessary for success. However, many contextual features of the training environment have undergone dramatic change since these studies were conducted. What are the consequences of these…

More than a Message: Framing Public Health Advocacy to Change Corporate Practices

ERIC Educational Resources Information Center

Dorfman, Lori; Wallack, Lawrence; Woodruff, Katie

2005-01-01

Framing battles in public health illustrate the tension in our society between individual freedom and collective responsibility. This article describes how two frames, market justice and social justice, first articulated in a public health context by Dan Beauchamp, influence public dialogue on the health consequences of corporate practices. The…

Will a Clinical Approach Make Education Research More Relevant for Practice?

ERIC Educational Resources Information Center

Bulterman-Bos, Jacquelien A.

2008-01-01

The way in which researchers view education differs fundamentally from the way in which teachers view education. These different outlooks are (partly) a consequence of the different work roles of researchers and teachers. This article explores the question of whether it is really inevitable that research and practice each establish different views…

An Assessment of the Theoretical Underpinnings of Practical Participatory Evaluation

ERIC Educational Resources Information Center

Smits, Pernelle A.; Champagne, Francois

2008-01-01

This article is concerned with the underpinnings of practical participatory evaluation (PPE). Evaluation approaches have long been criticized because their results are often not used. It is believed that PPE addresses this drawback. The article focuses on the mechanisms underlying the links between activities and consequences in PPE. A PPE theory…

Globalisation and Its Consequences for Scholarship in Philosophy of Education

ERIC Educational Resources Information Center

Haynes, Bruce

2002-01-01

A manifestation of globalisation as an economic imperative has occurred at the national level in Australia. This manifestation is in the form of political policies, administrative practices and funding distribution ostensibly aimed at creating a more competitive national economy. Philosophy of Education, as a practice and product of some employees…

Visualisation for System Learning in Supply Chains

ERIC Educational Resources Information Center

Lindskog, Magnus; Abrahamsson, Mats; Aronsson, Hakan

2007-01-01

Contemporary supply chains are vastly complex, and decisions made by actors have system-wide consequences that these might not be able to foresee. There are gaps between "best practice"-founded theory and actual practice in supply chains. To remedy this, we argue, the supply chain actors need to enhance systems knowledge. There is a need to…

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

ERIC Educational Resources Information Center

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

2013-01-01

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

Educators' Self-Reported Training, Use, and Perceived Effectiveness of Evidence-Based Classroom Management Practices

ERIC Educational Resources Information Center

Cooper, Justin T.; Gage, Nicholas A.; Alter, Peter J.; LaPolla, Stefanie; MacSuga-Gage, Ashley S.; Scott, Terrance M.

2018-01-01

A survey study of 248 educators in four states was conducted to identify respondents' formal training, use, and perceived effectiveness of 37 evidence-based classroom management practices within four general categories: (a) antecedent-based, (b) instructionally based, (c) consequence-based, and (d) self-management. Results indicated that, on…

Position Statement on Motivations, Methodologies, and Practical Implications of Educational Neuroscience Research: fMRI Studies of the Neural Correlates of Creative Intelligence

ERIC Educational Resources Information Center

Geake, John

2011-01-01

In this position statement it is argued that educational neuroscience must necessarily be relevant to, and therefore have implications for, both educational theory and practice. Consequently, educational neuroscientific research necessarily must embrace educational research questions in its remit.

Curriculum Making as Novice Professional Development: Practical Risk Taking as Learning in High-Stakes Times

ERIC Educational Resources Information Center

Clayton, Christine D.

2007-01-01

This qualitative case study presents three novices in urban schools who enacted curricular projects as participants in a university-based professional development program. This experience created an opportunity for practical risk taking, enabling them to consider the consequences of curricular choices in personal terms. Such professional…

76 FR 71276 - Common Crop Insurance Regulations; Pecan Revenue Crop Insurance Provisions

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-17

... CFR part 400, subpart J for the informal administrative review process of good farming practices as... farming operation. For instance, all producers are required to submit an application and acreage report to... and discourages good management practices. Language in sections 3(d)(3) and 6(b) provides consequences...

Encouraging Good Writing Practice in First-Year Psychology Students: An Intervention Using Turnitin

ERIC Educational Resources Information Center

Betts, Lucy R.; Bostock, Stephen J.; Elder, Tracey J.; Trueman, Mark

2012-01-01

There is growing concern among many regarding plagiarism within student writing. This has promoted investigation into both the factors that predict plagiarism and potential methods of reducing plagiarism. Consequently, we developed and evaluated an intervention to enhance good practice within academic writing through the use of the plagiarism…

Working with Creativity of Gifted Students through Ludic Teaching

ERIC Educational Resources Information Center

Piske, Fernanda Hellen Ribeiro; Stoltz, Tania; Machado, Jarci Maria; Vestena, Carla Luciane Blum; de Oliveira, Carla Sant'ana; de Freitas, Samarah Perszel; Machado, Cristiana Lopes

2016-01-01

Educational practices that develop creativity depend on good teacher training. Teachers should be able to value the potential of their students. Teacher can promote a work with creative educational practices for this which it is necessary to develop in their students the ability to think in terms of possibility to explore various consequences and…

Procalcitonin Biomarker Algorithm Reduces Antibiotic Prescriptions, Duration of Therapy, and Costs in Chronic Obstructive Pulmonary Disease: A Comparison in the Netherlands, Germany, and the United Kingdom.

PubMed

van der Maas, Marloes E; Mantjes, Gertjan; Steuten, Lotte M G

2017-04-01

Antibiotics are often recommended as treatment for patients with chronic obstructive pulmonary disease (COPD) exacerbations. However, not all COPD exacerbations are caused by bacterial infections and there is consequently considerable misuse and overuse of antibiotics among patients with COPD. This poses a severe burden on healthcare resources such as increased risk of developing antibiotic resistance. The biomarker procalcitonin (PCT) displays specificity to distinguish bacterial inflammations from nonbacterial inflammations and may therefore help to rationalize antibiotic prescriptions. We report in this study, a three-country comparison of the health and economic consequences of a PCT biomarker-guided prescription and clinical decision-making strategy compared to current practice in hospitalized patients with COPD exacerbations. A decision tree was developed, comparing the expected costs and effects of the PCT algorithm to current practice in the Netherlands, Germany, and the United Kingdom. The time horizon of the model captured the length of hospital stay and a societal perspective was also adopted. The primary health outcome was the duration of antibiotic therapy. The incremental cost-effectiveness ratio was defined as the incremental costs per antibiotic day avoided. The incremental cost savings per day on antibiotic therapy avoided were (in Euros) €90 in the Netherlands, €125 in Germany, and €52 in the United Kingdom. Probabilistic sensitivity analyses showed that in the majority of simulations, the PCT biomarker strategy was superior to current practice (the Netherlands: 58%, Germany: 58%, and the United Kingdom: 57%). In conclusion, the PCT biomarker algorithm to optimize antibiotic prescriptions in COPD is likely to be cost-effective compared to current practice. Both the percentage of patients who start with antibiotic treatment as well as the duration of antibiotic therapy are reduced with the PCT decision algorithm, leading to a decrease in total costs per patient. Economic analysis based on real-life data is recommended for further research. Biomarker-driven prescription algorithms are important instruments for personalized medicine in COPD. This also attests to the emerging convergence of biomarker innovations and the broader field of Health Technology Assessment (HTA).

Are we failing to prepare nursing and midwifery students to deal with domestic abuse? Findings from a qualitative study.

PubMed

Bradbury-Jones, Caroline; Broadhurst, Karen

2015-09-01

To investigate student nurses' and midwives' knowledge, confidence and educational needs regarding recognition and responses to domestic abuse. Domestic abuse is a serious global problem and has greater, negative effects on long-term health than more obvious diseases, such as diabetes. Nurses and midwives are well-placed to recognize and respond to domestic abuse but many lack confidence in this area. There is firm evidence that training can increase the confidence of Registered Nurses and midwives in responding to domestic abuse. But the issue of undergraduate preparation is significantly under-investigated. A qualitative study. Nursing and midwifery students were recruited using purposive sampling. We facilitated eight focus groups with a total of 55 students (student midwives N = 32; student nurses n = 23). Data were collected between May-November 2014. Students in the study viewed the issue of domestic abuse as important and they possessed sound theoretical knowledge of its nature and consequences. However, they lacked confidence in recognizing and responding to abuse and were concerned about the implications of this for their future practice as registered practitioners. Interactive learning opportunities that engaged with service users and involved experts from practice were viewed as important educational requirements. Most students in the study felt insufficiently prepared to deal with the issue of domestic abuse. They perceived this as a cyclical state of disempowerment that would impact negatively on their practice and on their own ability to support nursing and midwifery students of the future. © 2015 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.

Comparative effects of oil palm and selective logging on erosion, river channels and water chemistry in Malaysian steeplands

NASA Astrophysics Data System (ADS)

Walsh, Rory; Nainar, Anand; Nurhidayu, Siti; Higton, Sam; Annammala, Kogilavani; Wall, Katy; Bidin, Kawi; Blake, William; Darling, Isabella

2017-04-01

Oil palm land-use has expanded greatly in recent decades in SE Asia and other parts of the wet tropics, including to steepland areas, where bench-terraced landscaping is involved. Retaining (and sometimes restoring) riparian forest strips and rainforest fragments on the steepest slopes have been adopted as elements of strategies designed to reduce adverse effects on runoff generation, erosion, downstream sedimentation, flooding and pollutional problems - as well as biodiversity and emissions. Results of catchment monitoring, soil erosion and sediment fingerprinting research in oil palm and selectively logged steeplands of eastern Sabah and Peninsular Malaysia are presented. The evidence indicates the greater scale and temporal persistence of effects that oil palm land-use (compared with selective logging) has had on suspended sediment dynamics, soil erosion, downstream sedimentation, channel geometry and dynamics and river pollution. The importance of (1) high densities of roads and tracks and (2) relatively impermeable bench-terraced terrain in enhancing runoff, sediment and nutrient outputs in storm events is stressed. Influences of oil palm management practices including riparian forest strips in increasing or reducing these effects are critically reviewed and ways of increasing the effectiveness of riparian forest strips are proposed. The design and rationale of current projects exploring and testing consequences of existing and proposed improved land management practices are briefly described. The key importance of involvement of people from the oil palm industry (including multinational companies, smallholders and their organizations) and Government bodies that are responsible for land-use policies and land management practices is stressed.

The Consequences of Consequential Validity.

ERIC Educational Resources Information Center

Mehrens, William A.

1997-01-01

There is no agreement at present about the importance or meaning of the term "consequential validity." It is important that the authors of revisions to the "Standards for Educational and Psychological Testing" recognize the debate and relegate discussion of consequences to a context separate from the discussion of validity.…

Assessment of Nature, Reasons, and Consequences of Self-medication Practice among General Population of Ras Al-Khaimah, UAE

PubMed Central

Sridhar, Sathvik B; Shariff, Atiqulla; Dallah, Lana; Anas, Doaa; Ayman, Maryam; Rao, Padma GM

2018-01-01

Aim: The aim of this study is to assess the nature, reasons, and consequences of self-medication practice among the general population of Ras Al-Khaimah, UAE. Materials and Methods: This was a prospective, cross-sectional, survey-based study. Data with respect to knowledge, awareness, and practices regarding self-medication were collected through an interviewer-assisted questionnaire answered by the study participants. Thus, collected data from 413 survey respondents were analyzed using SPSS version 24.0. Results: The prevalence of self-medication practices among our study respondents was 52.1%. A headache (155 [37.5%]) was the most common clinical condition treated through self-medication practice. Familiarity with the treatment/medication (198 [48%]) was the most common cited reasons, whereas the advertisement and friend's advice were the most (182 [44%]) cited sources of information for self-medication usage. The majority (265 [64.1%]) of the respondents were considered self-medication practice as safe. However, 19 respondents reported side-effects or complications during the due course of self-medication. It was observed that there is a statistically significant association (P < 0.05) between age and employment status of this study participants with self-medication practices. Conclusion: The data from this study show that the self-medication practice is very common among the study population. Variables such as younger age group and occupation status were significantly associated with self-medication practice. We emphasize the role of pharmacist in educating the community regarding safe medication practices such as harmful effects of self-medicating and inappropriate practices such as sharing the medications among family members and friends. PMID:29552527

A 25-Year Single Institution Analysis of Health, Practice, and Fate of General Surgeons

PubMed Central

Harms, Bruce A.; Heise, Charles P.; Gould, Jon C.; Starling, James R.

2005-01-01

Objective: The objective of this study was to analyze nearly 3 decades of surgical residents from an established training program to carefully define individual outcomes on personal and professional health and practice satisfaction. Summary Background Data: A paucity of data exists regarding the health and related practice issues of surgeons postresidency training. Despite several studies examining surgeon burnout and alcohol dependency problems, there have been no detailed reports defining health problems in practicing surgeons or preventive health patterns in this physician population. Important practice factors, including family and practice stress, that may impact on surgical career longevity and satisfaction have similarly received minimal focused examination. Methods: All former surgery residents at the University of Wisconsin from 1978 to 2002 were contacted. Detailed direct interview or phone contact was made to ensure confidentiality and to obtain reliable data. Interviews concentrated on serious health and practice issues since residency completion. Results: One hundred ten of 114 (97%) former residents were contacted. There were 100 males and 14 females with 2 deaths (accident, suicide). Including deaths and those lost to follow up, 15 (13.2%) were nonpracticing; 5 voluntarily (3 planned, 1 accident, 1 arthritis) and 4 involuntarily (alcohol/substance dependency). Eighty-nine percent were married or remarried with a 21.4% divorce rate postresidency. Major health issues occurred in 32% of all surveyed and in 50% of those ages ≥50. Only 10% reported complete lack of weekly exercise activity with 62% exercising at least 3 times per week. Body mass index increased from 23.9 ± 1.5 kg/m2 (age <40) to 26.6 ± 3.0 kg/m2 (P = 0.009) by age ≥50. Alcohol dependency was confirmed in 7.3%. Overall, 75% of surgeons surveyed were satisfied with their practice/career. Conclusion: Despite a high job satisfaction rate, surgeon health may be compromised in up to 50% by age ≥50, with a 20% voluntary or involuntary retirement rate. Alcohol dependency occurred in up to 7.3% of surgeons, which contributed to the practice attrition rate. The success and length of a career in surgery is defined by postresidency factors rarely examined during training and include major and minor health issues, preventive health patterns/exercise, alcohol use or dependency, family life, and practice satisfaction. Surgeons mentoring during the course of surgical training should be improved to inform of important health and practice issues and consequences. PMID:16192812

Anticipating the Social Consequences of AIDS: A Position Paper.

ERIC Educational Resources Information Center

Berk, Richard A.; And Others

1981-01-01

Focuses on the social consequences of the AIDS epidemic, arguing that sociologists have an important contribution to make in planning for the long-range social consequences of AIDS. Concludes with three different commentaries on Berk's article. (Author/BSR)

Coupling Satellite Data with Species Distribution and Connectivity Models as a Tool for Environmental Management and Planning in Matrix-Sensitive Species.

PubMed

Rödder, Dennis; Nekum, Sven; Cord, Anna F; Engler, Jan O

2016-07-01

Climate change and anthropogenic habitat fragmentation are considered major threats for global biodiversity. As a direct consequence, connectivity is increasingly disrupted in many species, which might have serious consequences that could ultimately lead to the extinction of populations. Although a large number of reserves and conservation sites are designated and protected by law, potential habitats acting as inter-population connectivity corridors are, however, mostly ignored in the common practice of environmental planning. In most cases, this is mainly caused by a lack of quantitative measures of functional connectivity available for the planning process. In this study, we highlight the use of fine-scale potential connectivity models (PCMs) derived from multispectral satellite data for the quantification of spatially explicit habitat corridors for matrix-sensitive species of conservation concern. This framework couples a species distribution model with a connectivity model in a two-step framework, where suitability maps from step 1 are transformed into maps of landscape resistance in step 2 filtered by fragmentation thresholds. We illustrate the approach using the sand lizard (Lacerta agilis L.) in the metropolitan area of Cologne, Germany, as a case study. Our model proved to be well suited to identify connected as well as completely isolated populations within the study area. Furthermore, due to its fine resolution, the PCM was also able to detect small linear structures known to be important for sand lizards' inter-population connectivity such as railroad embankments. We discuss the applicability and possible implementation of PCMs to overcome shortcomings in the common practice of environmental impact assessments.

Pathology in the Medical Profession?: Taking the Pulse of Physician Wellness and Burnout.

PubMed

Schrijver, Iris

2016-09-01

-In the past decades, physician wellness has diminished in every aspect of professional life. Burnout symptoms in the United States affect 30% to 68% of physicians overall-exceeding the levels of any other professional group. The ramifications of burnout present an underrecognized crisis in the health care system that carries the consequences of personal, professional, institutional, and societal costs. -To bring to light the elements of current medical practice that contribute to physician professional fulfillment and burnout. Intervention measures, steps toward burnout prevention, and the present limitations thereof are also addressed. -This narrative literature review was performed by using studies in PubMed (National Center for Biotechnology Information) and large online physician surveys, published through December 2015. Because of geographic differences, the review is primarily concentrated on physicians across specialties in the United States. Small studies and those of single disciplines were excluded. -Many physicians learn to tolerate burnout symptoms despite negative personal consequences. Long-term work-related stress, however, may lead to the potential for negative effects on the quality of patient care, and to attrition. Interestingly, the factors that enhance physician fulfillment and those that may precipitate burnout symptoms are distinct. Optimization of physician well-being, therefore, requires tailored approaches in each of these 2 dimensions and is most likely to succeed if it includes approaches that are customized to career phase, physician specialty, and practice setting. Importantly, organization leaders must prioritize this issue and provide sustained support for wellness initiatives, to foster a culture that is conducive to physician well-being.

Are you talking to ME? The importance of ethnicity and culture in childhood obesity prevention and management.

PubMed

Peña, Michelle-Marie; Dixon, Brittany; Taveras, Elsie M

2012-02-01

Childhood obesity is prevalent, is of consequence, and disproportionately affects racial/ethnic minority populations. By the preschool years, racial/ethnic disparities in obesity prevalence and substantial differences in many risk factors for obesity are already present, suggesting that disparities in obesity prevalence have their origins in the earliest stages of life. The reasons for racial/ethnic variation in obesity are complex and may include differences in cultural beliefs and practices, level of acculturation, ethnicity-based differences in body image, and perceptions of media, sleep, and physical activity. In addition, racial/ethnic differences in obesity may evolve as a consequence of the socio- and environmental context in which families live. The primary care setting offers unique opportunities to intervene and alter the subsequent course of health and disease for children at risk for obesity. Regular visits during childhood allow both detection of elevated weight status and offer opportunities for prevention and treatment. Greater awareness of the behavioral, social–cultural, and environmental determinants of obesity among ethnic minority populations could assist clinicians in the treatment of obesity among diverse pediatric populations. Specific strategies include beginning prevention efforts early in life before obesity is present and recognizing and querying about ethnic- and culturally specific beliefs and practices, the role of the extended family in the household, and parents' beliefs of the causative factors related to their child's obesity. Efforts to provide culturally and linguistically appropriate care, family-based treatment programs, and support services that aim to uncouple socioeconomic factors from adverse health outcomes could improve obesity care for racial/ethnic minority children.

Coupling Satellite Data with Species Distribution and Connectivity Models as a Tool for Environmental Management and Planning in Matrix-Sensitive Species

NASA Astrophysics Data System (ADS)

Rödder, Dennis; Nekum, Sven; Cord, Anna F.; Engler, Jan O.

2016-07-01

Climate change and anthropogenic habitat fragmentation are considered major threats for global biodiversity. As a direct consequence, connectivity is increasingly disrupted in many species, which might have serious consequences that could ultimately lead to the extinction of populations. Although a large number of reserves and conservation sites are designated and protected by law, potential habitats acting as inter-population connectivity corridors are, however, mostly ignored in the common practice of environmental planning. In most cases, this is mainly caused by a lack of quantitative measures of functional connectivity available for the planning process. In this study, we highlight the use of fine-scale potential connectivity models (PCMs) derived from multispectral satellite data for the quantification of spatially explicit habitat corridors for matrix-sensitive species of conservation concern. This framework couples a species distribution model with a connectivity model in a two-step framework, where suitability maps from step 1 are transformed into maps of landscape resistance in step 2 filtered by fragmentation thresholds. We illustrate the approach using the sand lizard ( Lacerta agilis L.) in the metropolitan area of Cologne, Germany, as a case study. Our model proved to be well suited to identify connected as well as completely isolated populations within the study area. Furthermore, due to its fine resolution, the PCM was also able to detect small linear structures known to be important for sand lizards' inter-population connectivity such as railroad embankments. We discuss the applicability and possible implementation of PCMs to overcome shortcomings in the common practice of environmental impact assessments.

Are You Talking to ME? The Importance of Ethnicity and Culture in Childhood Obesity Prevention and Management

PubMed Central

Peña, Michelle-Marie; Dixon, Brittany

2012-01-01

Abstract Childhood obesity is prevalent, is of consequence, and disproportionately affects racial/ethnic minority populations. By the preschool years, racial/ethnic disparities in obesity prevalence and substantial differences in many risk factors for obesity are already present, suggesting that disparities in obesity prevalence have their origins in the earliest stages of life. The reasons for racial/ethnic variation in obesity are complex and may include differences in cultural beliefs and practices, level of acculturation, ethnicity-based differences in body image, and perceptions of media, sleep, and physical activity. In addition, racial/ethnic differences in obesity may evolve as a consequence of the socio- and environmental context in which families live. The primary care setting offers unique opportunities to intervene and alter the subsequent course of health and disease for children at risk for obesity. Regular visits during childhood allow both detection of elevated weight status and offer opportunities for prevention and treatment. Greater awareness of the behavioral, social–cultural, and environmental determinants of obesity among ethnic minority populations could assist clinicians in the treatment of obesity among diverse pediatric populations. Specific strategies include beginning prevention efforts early in life before obesity is present and recognizing and querying about ethnic- and culturally specific beliefs and practices, the role of the extended family in the household, and parents' beliefs of the causative factors related to their child's obesity. Efforts to provide culturally and linguistically appropriate care, family-based treatment programs, and support services that aim to uncouple socioeconomic factors from adverse health outcomes could improve obesity care for racial/ethnic minority children. PMID:22799474

Gender matters: the relationship between social anxiety and alcohol-related consequences.

PubMed

Schry, Amie R; Norberg, Melissa M; Maddox, Brenna B; White, Susan W

2014-01-01

Identification of risk factors for alcohol-related consequences is an important public health concern. Both gender and social anxiety have been associated with alcohol-related consequences broadly, but it is unknown whether these variables are differentially related to specific types of alcohol-related consequences for American college students. In the present study, 573 undergraduate students (M(age) = 19.86 years, SD = 1.40; range 18 to 25; 68.9% female) completed an on-line assessment of social anxiety, alcohol use, and four types of alcohol-related consequences (personal, social, physical, and role). Poisson regressions were run to examine social anxiety, gender, and the interaction between social anxiety and gender as predictors of each type of alcohol-related consequences. After controlling for alcohol use, social anxiety was positively associated with all four types of consequences, and females endorsed higher rates of physical, personal, and role consequences. The interaction between social anxiety and gender was statistically significant only for physical consequences, with social anxiety having a stronger effect for males. These findings, which diverge somewhat from those of a prior study with Australian college students, are discussed in the context of a biopsychosocial model of social anxiety and substance use problems. This study highlights the importance of further investigating cultural differences in the relationships among social anxiety, gender, and alcohol-related consequences.

A qualitative study using the Theoretical Domains Framework to investigate why patients were or were not assessed for rehabilitation after stroke.

PubMed

Lynch, Elizabeth A; Luker, Julie A; Cadilhac, Dominique A; Fryer, Caroline E; Hillier, Susan L

2017-07-01

To explore the factors perceived to affect rehabilitation assessment and referral practices for patients with stroke. Qualitative study using data from focus groups analysed thematically and then mapped to the Theoretical Domains Framework. Eight acute stroke units in two states of Australia. Health professionals working in acute stroke units. Health professionals at all sites had participated in interventions to improve rehabilitation assessment and referral practices, which included provision of copies of an evidence-based decision-making rehabilitation Assessment Tool and pathway. Eight focus groups were conducted (32 total participants). Reported rehabilitation assessment and referral practices varied markedly between units. Continence and mood were not routinely assessed (4 units), and people with stroke symptoms were not consistently referred to rehabilitation (4 units). Key factors influencing practice were identified and included whether health professionals perceived that use of the Assessment Tool would improve rehabilitation assessment practices (theoretical domain 'social and professional role'); beliefs about outcomes from changing practice such as increased equity for patients or conversely that changing rehabilitation referral patterns would not affect access to rehabilitation ('belief about consequences'); the influence of the unit's relationships with other groups including rehabilitation teams ('social influences' domain) and understanding within the acute stroke unit team of the purpose of changing assessment practices ('knowledge' domain). This study has identified that health professionals' perceived roles, beliefs about consequences from changing practice and relationships with rehabilitation service providers were perceived to influence rehabilitation assessment and referral practices on Australian acute stroke units.

Analysing and exemplifying forensic conclusion criteria in terms of Bayesian decision theory.

PubMed

Biedermann, A; Bozza, S; Taroni, F

2018-03-01

There is ongoing discussion in forensic science and the law about the nature of the conclusions reached based on scientific evidence, and on how such conclusions - and conclusion criteria - may be justified by rational argument. Examples, among others, are encountered in fields such as fingermarks (e.g., 'this fingermark comes from Mr. A's left thumb'), handwriting examinations (e.g., 'the questioned signature is that of Mr. A'), kinship analyses (e.g., 'Mr. A is the father of child C') or anthropology (e.g., 'these are human remains'). Considerable developments using formal methods of reasoning based on, for example (Bayesian) decision theory, are available in literature, but currently such reference principles are not explicitly used in operational forensic reporting and ensuing decision-making. Moreover, applied examples, illustrating the principles, are scarce. A potential consequence of this in practical proceedings, and hence a cause of concern, is that underlying ingredients of decision criteria (such as losses quantifying the undesirability of adverse decision consequences), are not properly dealt with. There is merit, thus, in pursuing the study and discussion of practical examples, demonstrating that formal decision-theoretic principles are not merely conceptual considerations. Actually, these principles can be shown to underpin practical decision-making procedures and existing legal decision criteria, though often not explicitly apparent as such. In this paper, we will present such examples and discuss their properties from a Bayesian decision-theoretic perspective. We will argue that these are essential concepts for an informed discourse on decision-making across forensic disciplines and the development of a coherent view on this topic. We will also emphasize that these principles are of normative nature in the sense that they provide standards against which actual judgment and decision-making may be compared. Most importantly, these standards are justified independently of peoples' observable decision behaviour, and of whether or not one endorses these formal methods of reasoning. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Child sexual abuse: consequences and implications.

PubMed

Hornor, Gail

2010-01-01

Sexual abuse is a problem of epidemic proportions in the United States. Given the sheer numbers of sexually abused children, it is vital for pediatric nurse practitioners to understand both short-term and long-term consequences of sexual abuse. Understanding consequences of sexual abuse can assist the pediatric nurse practitioner in anticipating the physical and mental health needs of patients and also may assist in the identification of sexual abuse victims. Sexual abuse typically does not occur in isolation. Implications for practice will be discussed. Copyright © 2010 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Farmers' preferences for automatic lameness-detection systems in dairy cattle.

PubMed

Van De Gucht, T; Saeys, W; Van Nuffel, A; Pluym, L; Piccart, K; Lauwers, L; Vangeyte, J; Van Weyenberg, S

2017-07-01

As lameness is a major health problem in dairy herds, a lot of attention goes to the development of automated lameness-detection systems. Few systems have made it to the market, as most are currently still in development. To get these systems ready for practice, developers need to define which system characteristics are important for the farmers as end users. In this study, farmers' preferences for the different characteristics of proposed lameness-detection systems were investigated. In addition, the influence of sociodemographic and farm characteristics on farmers' preferences was assessed. The third aim was to find out if preferences change after the farmer receives extra information on lameness and its consequences. Therefore, a discrete choice experiment was designed with 3 alternative lameness-detection systems: a system attached to the cow, a walkover system, and a camera system. Each system was defined by 4 characteristics: the percentage missed lame cows, the percentage false alarms, the system cost, and the ability to indicate which leg is lame. The choice experiment was embedded in an online survey. After answering general questions and choosing their preferred option in 4 choice sets, extra information on lameness was provided. Consecutively, farmers were shown a second block of 4 choice sets. Results from 135 responses showed that farmers' preferences were influenced by the 4 system characteristics. The importance a farmer attaches to lameness, the interval between calving and first insemination, and the presence of an estrus-detection system contributed significantly to the value a farmer attaches to lameness-detection systems. Farmers who already use an estrus detection system were more willing to use automatic detection systems instead of visual lameness detection. Similarly, farmers who achieve shorter intervals between calving and first insemination and farmers who find lameness highly important had a higher tendency to choose for automatic lameness detection. A sensor attached to the cow was preferred, followed by a walkover system and a camera system. In general, visual lameness detection was preferred over automatic detection systems, but this preference changed after informing farmers about the consequences of lameness. To conclude, the system cost and performance were important features, but dairy farmers should be sensitized on the consequences of lameness and its effect on farm profitability. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

The potential role of regret in the physician-patient relationship: insights from neuroeconomics.

PubMed

Coricelli, Giorgio

2008-01-01

The aim of the chapter is to show how two important facts of physicians' behavior, (i) their tendency to "create" the demand for medical practices, and (ii) their delay and reluctance in using new treatments and therapies, can be explained with the lens of the neuroeconomics research on the neural and behavioral basis of regret. This chapter adopts a neuroeconomics perspective on decision-making, asking how the brain represents values and generates emotional states, which consequently influence choices. In the line of recent work on emotion-based decision-making, we expect to be able to characterize the brain areas underlying the studied processes and to specify the functional relationship between rational decision-making and the emotional influences that modulate these decisional processes. Neurobiological approaches can contribute significantly to a better understanding of the cognitive and emotional underpinnings of medical decision-making, from how physicians might evaluate and anticipate the effect of alternative therapies, to how patients might anticipate future consequences of their health choice. This can explain some features of the doctor-patient relationship which are not consistent with simple maximization models. Our findings suggest that physicians' behavior can be often explained by regret avoidance. Likewise, they suggest that physicians play as actual agents when they make medical decisions that will affect the future well-being of their patients. We limited our analysis to the potential role of anticipated regret; therefore, this chapter neglects many important factors of the health sector.

Women's status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory.

PubMed

Sudhinaraset, May; Treleaven, Emily; Melo, Jason; Singh, Kanksha; Diamond-Smith, Nadia

2016-10-28

Mistreatment of women in healthcare settings during childbirth has been gaining attention globally. Mistreatment during childbirth directly and indirectly affects health outcomes, patient satisfaction, and the likelihood of delivering in a facility currently or in the future. It is important that we study patients' reports of mistreatment and abuse to develop a deeper understanding of how it is perpetrated, its consequences, and to identify potential points of intervention. Patients' perception of the quality of care is dependent, not only on the content of care, but importantly, on women's expectations of care. This study uses rich, mixed-methods data to explore women's characteristics and experiences of mistreatment during childbirth among slum-resident women in Uttar Pradesh, India. To understand the ways in which women's social and cultural factors influence their expectations of care and consequently their perceptions of respectful care, we adopt a Cultural Health Capital (CHC) framework. The quantitative sample includes 392 women, and the qualitative sample includes 26 women. Quantitative results suggest high levels of mistreatment (over 57 % of women reported any form of mistreatment). Qualitative findings suggest that lack of cultural health capital disadvantages patients in their patient-provider relationships, and that women use resources to improve care they receive. Participants articulated how providers set expectations and norms regarding behaviors in facilities; patients with lower social standing may not always understand standard practices and are likely to suffer poor health outcomes as a result. Of importance, however, patients also blame themselves for their own lack of knowledge. Lack of cultural health capital disadvantages women during delivery care in India. Providers set expectations and norms around behaviors during delivery, while women are often misinformed and may have low expectations of care.

Friends of friends: are indirect connections in social networks important to animal behaviour?

PubMed

Brent, Lauren J N

2015-05-01

Friend of a friend relationships, or the indirect connections between people, influence our health, well-being, financial success and reproductive output. As with humans, social behaviours in other animals often occur within a broad interconnected network of social ties. Yet studies of animal social behaviour tend to focus on associations between pairs of individuals. With the increase in popularity of social network analysis, researchers have started to look beyond the dyad to examine the role of indirect connections in animal societies. Here, I provide an overview of the new knowledge that has been uncovered by these studies. I focus on research that has addressed both the causes of social behaviours, i.e. the cognitive and genetic basis of indirect connections, as well as their consequences, i.e. the impact of indirect connections on social cohesion, information transfer, cultural practices and fitness. From these studies, it is apparent that indirect connections play an important role in animal behaviour, although future research is needed to clarify their contribution.

Chemical composition and bioactive compounds of garlic (Allium sativum L.) as affected by pre- and post-harvest conditions: A review.

PubMed

Martins, Natália; Petropoulos, Spyridon; Ferreira, Isabel C F R

2016-11-15

Garlic (Allium sativum L.) is considered one of the twenty most important vegetables, with various uses throughout the world, either as a raw vegetable for culinary purposes, or as an ingredient of traditional and modern medicine. Furthermore, it has also been proposed as one of the richest sources of total phenolic compounds, among the usually consumed vegetables, and has been highly ranked regarding its contribution of phenolic compounds to human diet. This review aims to examine all the aspects related with garlic chemical composition and quality, focusing on its bioactive properties. A particular emphasis is given on the organosulfur compounds content, since they highly contribute to the effective bioactive properties of garlic, including its derived products. The important effects of pre-harvest (genotype and various cultivation practices) and post-harvest conditions (storage conditions and processing treatments) on chemical composition and, consequently, bioactive potency of garlic are also discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Counting surface-kernel epimorphisms from a co-compact Fuchsian group to a cyclic group with motivations from string theory and QFT

NASA Astrophysics Data System (ADS)

Bibak, Khodakhast; Kapron, Bruce M.; Srinivasan, Venkatesh

2016-09-01

Graphs embedded into surfaces have many important applications, in particular, in combinatorics, geometry, and physics. For example, ribbon graphs and their counting is of great interest in string theory and quantum field theory (QFT). Recently, Koch et al. (2013) [12] gave a refined formula for counting ribbon graphs and discussed its applications to several physics problems. An important factor in this formula is the number of surface-kernel epimorphisms from a co-compact Fuchsian group to a cyclic group. The aim of this paper is to give an explicit and practical formula for the number of such epimorphisms. As a consequence, we obtain an 'equivalent' form of Harvey's famous theorem on the cyclic groups of automorphisms of compact Riemann surfaces. Our main tool is an explicit formula for the number of solutions of restricted linear congruence recently proved by Bibak et al. using properties of Ramanujan sums and of the finite Fourier transform of arithmetic functions.

The long-term psychiatric and medical prognosis of perinatal mental illness.

PubMed

Meltzer-Brody, Samantha; Stuebe, Alison

2014-01-01

The perinatal period provides an important window into a woman's long-term health. Perinatal mental illness is a common condition conferring potential serious long-term psychiatric and medical consequences for the mother and family. It is known that childbirth acts as a powerful trigger for depressive episodes in some women, and that women with histories of a mood disorder are particularly vulnerable. Some evidence links perinatal mental illness with obstetrical complications and reduced lactation initiation and duration. Therefore, perinatal mental illness may be a marker for long-term risk, and may contribute directly to subsequent cardiometabolic disease through both neuroendocrine mechanisms and the effects of mental illness on health behaviours. In clinical practice, these associations underscore the importance of screening and treating women with perinatal mental illness to ensure best possible long-term outcomes. Early screening and treatment may both mitigate the primary disease process and reduce the risk of comorbid medical conditions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Alcohol marketing, drunkenness, and problem drinking among Zambian youth: findings from the 2004 Global School-Based Student Health Survey.

PubMed

Swahn, Monica H; Ali, Bina; Palmier, Jane B; Sikazwe, George; Mayeya, John

2011-01-01

This study examines the associations between alcohol marketing strategies, alcohol education including knowledge about dangers of alcohol and refusal of alcohol, and drinking prevalence, problem drinking, and drunkenness. Analyses are based on the Global School-Based Student Health Survey (GSHS) conducted in Zambia (2004) of students primarily 11 to 16 years of age (N = 2257). Four statistical models were computed to test the associations between alcohol marketing and education and alcohol use, while controlling for possible confounding factors. Alcohol marketing, specifically through providing free alcohol through a company representative, was associated with drunkenness (AOR = 1.49; 95% CI: 1.09-2.02) and problem drinking (AOR = 1.41; 95% CI: 1.06-1.87) among youth after controlling for demographic characteristics, risky behaviors, and alcohol education. However, alcohol education was not associated with drunkenness or problem drinking. These findings underscore the importance of restricting alcohol marketing practices as an important policy strategy for reducing alcohol use and its dire consequences among vulnerable youth.

Friends of friends: are indirect connections in social networks important to animal behaviour?

PubMed Central

Brent, Lauren J. N.

2015-01-01

Friend of a friend relationships, or the indirect connections between people, influence our health, well-being, financial success and reproductive output. As with humans, social behaviours in other animals often occur within a broad interconnected network of social ties. Yet studies of animal social behaviour tend to focus on associations between pairs of individuals. With the increase in popularity of social network analysis, researchers have started to look beyond the dyad to examine the role of indirect connections in animal societies. Here, I provide an overview of the new knowledge that has been uncovered by these studies. I focus on research that has addressed both the causes of social behaviours, i.e. the cognitive and genetic basis of indirect connections, as well as their consequences, i.e. the impact of indirect connections on social cohesion, information transfer, cultural practices and fitness. From these studies, it is apparent that indirect connections play an important role in animal behaviour, although future research is needed to clarify their contribution. PMID:25937639

Isolation and Suffering Related to Serious and Terminal Illness: Metaphors and Lessons From Albert Camus' Novel, The Plague.

PubMed

Tuffuor, Akosua N; Payne, Richard

2017-09-01

Health care providers have much to learn from Albert Camus' great novel, The Plague. The Plague tells the story of a bubonic plague epidemic through the lens of doctor-narrator Rieux. In addition to Rieux, this essay also focuses on the perspective of Father Paneloux, a Jesuit priest, who provides important religious commentary on the epidemic, before falling victim to it and dying. Camus' masterful engagement of the metaphor of isolation and its profound impact on suffering emphasizes the important role of community and spiritual perspectives of patients and providers in coping with serious illness, death, and dying. The Plague is relevant today, particularly given the challenges of distancing, alienation, and isolation imposed by not only disease but also by technology and clinical and administrative practices that have unintended consequences of incentivizing separation between patient and healer, thus engendering greater stress and suffering in both. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Dietary sodium in chronic kidney disease: a comprehensive approach.

PubMed

Wright, Julie A; Cavanaugh, Kerri L

2010-01-01

Despite existing guidelines, dietary sodium intake among people worldwide often exceeds recommended limits. Research evidence is growing in both animal and human studies showing indirect and direct adverse consequences of high dietary sodium on the kidney. In patients with kidney disease, dietary sodium may have important effects on proteinuria, efficacy of antiproteinuric pharmacologic therapy, hypertension control, maintaining an optimal volume status, and immunosuppressant therapy. Dietary sodium intake is an important consideration in patients with all stages of chronic kidney disease, including those receiving dialysis therapy or those who have received a kidney transplant. We review in detail the dietary sodium recommendations suggested by various organizations for patients with kidney disease. Potential barriers to successfully translating current sodium intake guidelines into practice include poor knowledge about the sodium content of food among both patients and providers, complex labeling information, patient preferences related to taste, and limited support for modifications in public policy. Finally, we offer existing and potential solutions that may assist providers in educating and empowering patients to effectively manage their dietary sodium intake.