Will this open space work?

PubMed

Vischer, J

1999-01-01

Northern Oil is moving offices, and CEO Fritz Schumacher wants to make the most of the move in this fictional case study. He believes that adopting an open-plan work space will reinvent how the company works, not to mention cut costs. Facilities manager Sasha Pasternak also supports the open plan. Her job would be easier, and her budget would stretch further, if Northern had standardized workstations and used partitions, not walls. And she likes the way the new design flattens the organization: everyone has the same amount of space and the same ergonomically sound furniture. The new building would have more conference rooms and just-in-time work spaces for employees who worked mostly off-site. And although she knew that initial meetings between the architects and Northern employees hadn't yielded much support for open space--people were attached to their private offices--she expected that people would warm to the idea. But when the new design was unveiled, employees were less than enthusiastic. They hurled questions like, How will workers concentrate if they can't shut their office doors? How will people have confidential meetings with their boss? And why would people stay at Northern when the competition offers them private offices? There was even talk of circulating a petition refusing to move to the new space. A week later, the architect presented revised plans to the project group. The new options would add costs and reduce the amount of space savings, but offering a choice to employees might make them feel less threatened. What should the project team do? Five commentators offer advice.

14 CFR 382.19 - May carriers refuse to provide transportation on the basis of disability?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false May carriers refuse to provide transportation on the basis of disability? 382.19 Section 382.19 Aeronautics and Space OFFICE OF THE SECRETARY... DISABILITY IN AIR TRAVEL Nondiscrimination and Access to Services and Information § 382.19 May carriers...

14 CFR 382.19 - May carriers refuse to provide transportation on the basis of disability?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false May carriers refuse to provide transportation on the basis of disability? 382.19 Section 382.19 Aeronautics and Space OFFICE OF THE SECRETARY... DISABILITY IN AIR TRAVEL Nondiscrimination and Access to Services and Information § 382.19 May carriers...

14 CFR 382.19 - May carriers refuse to provide transportation on the basis of disability?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false May carriers refuse to provide transportation on the basis of disability? 382.19 Section 382.19 Aeronautics and Space OFFICE OF THE SECRETARY... DISABILITY IN AIR TRAVEL Nondiscrimination and Access to Services and Information § 382.19 May carriers...

14 CFR 382.19 - May carriers refuse to provide transportation on the basis of disability?

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false May carriers refuse to provide transportation on the basis of disability? 382.19 Section 382.19 Aeronautics and Space OFFICE OF THE SECRETARY... DISABILITY IN AIR TRAVEL Nondiscrimination and Access to Services and Information § 382.19 May carriers...

14 CFR 382.19 - May carriers refuse to provide transportation on the basis of disability?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false May carriers refuse to provide transportation on the basis of disability? 382.19 Section 382.19 Aeronautics and Space OFFICE OF THE SECRETARY... DISABILITY IN AIR TRAVEL Nondiscrimination and Access to Services and Information § 382.19 May carriers...

What happens after a request for euthanasia is refused? Qualitative interviews with patients, relatives and physicians.

PubMed

Pasman, H Roeline W; Willems, Dick L; Onwuteaka-Philipsen, Bregje D

2013-09-01

Obtaining in-depth information from both patient and physician perspectives about what happens after a request for euthanasia or physician-assisted suicide (EAS) is refused. In-depth interviews with nine patients whose EAS request was refused and seven physicians of these patients, and with three relatives of patients who had died after a request was refused and four physicians of these patients. Interviews were conducted at least 6 months after the refusal. A wish to die remained in all patients after refusal, although it sometimes diminished. In most cases patient and physician stopped discussing this wish, and none of the physicians had discussed plans for the future with the patient or evaluated the patient's situation after their refusal. Physicians were aware of patients' continued wish to die. Patients who are refused EAS may subsequently be silent about a wish to die without abandoning it. Open communication about wishes to die is important, even outside the context of EAS, because if people feel unable to talk about them, their quality of life may be further diminished. Follow up appointments after refusal could give patients the opportunity to discuss their feelings and physicians to support them. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Recycling of aged refuse from a closed landfill.

PubMed

Zhao, Youcai; Song, Liyan; Huang, Renhua; Song, Lijie; Li, Xiong

2007-04-01

In this study, refuse excavated from a typical refuse landfill in Shanghai after 8-10 years of placement was characterized in terms of particle size, total nitrogen, total phosphorus, and biodegradable matter. The refuse contained a large and diverse population of micro-organisms with a high capacity for decomposing refractory organic matter present in some wastewaters, including leachate. It was found that the aged refuse was quite stable after about a decade of decomposition in the warm, humid climate of southern China. The fine fractions resembled and had the properties of black soil, a medium that is suitable for green construction, organic fertilizer, or as bioreactor media for biological treatment of organic wastewaters. Excavation of the aged refuse would make about 50% of the space available for fresh refuse. The plastics, glass, textiles, and cans can be readily mechanically separated and recycled after cleaning. It is estimated that at least 200 millions tonnes of such aged refuse are available in China alone, and at least 10 times that much is buried worldwide. Hence, the evaluation of mined landfill waste and consideration of its potential uses is of great significance.

Open air refuse burning video: Proton Dan the science man explores open air refuse burning

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

Eastburn, M.D.; Sipple, J.L.; Deramo, A.R.

The goal of this video is to educate school children to the potential hazards of open air trash burning; to demonstrate alternative ways to dispose of trash; and to motivate students to take action to change the behavior of their parents with regard to trash burning. The burning of household trash, although illegal, is still a common practice in rural areas of Delaware. Enforcement has been difficult because the practice is often performed at night and is done across a wide rural area that is difficult to patrol on a continuing basis. The prohibition on trash burning (revised Regulation 13more » of The Delaware Code of Regulations Governing The Control of Air Pollution) has been in effect since 1968, but the public has been slow to comply because trash burning has been practiced for many generations and because much of the public is unaware of the environmental impacts and/or the human health risks. This video may be valuable for other States to use as a public outreach tool regarding their problems with open air refuse burning. The focus of the video is a 7th grade science class is given various assignments relating to Earth Day and preservation of natural resources. Two children in particular are given the assignment to research and report on the hazards of open air trash burning and are asked to investigate alternative ways to dispose of refuse. Upon brainstorming how to find information on the topic, the kids decide to contact the host of a popular children's science show on broadcast television named Proton Dan the Science Man (a fictitious character and show based on Bill Nye the Science Guy). The host then invites the kids to the studio where he films his show and takes them through the topic. The TV host character takes the children to several external locations like a landfill, recycling centers, etc..« less

78 FR 9803 - Tennessee Abandoned Mine Land Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

..., dangerous impoundments, abandoned structures/equipment, open mine portals, and open mine shafts and refuse..., policy, procedural, and organizational changes that have occurred since 1984. DATES: Effective Date... procedures to manage their financial management, equipment, and procurement systems. OMB Circular A-102 was...

40 CFR 49.129 - Rule for limiting emissions of sulfur dioxide.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., incinerator, marine vessel, mobile sources, motor vehicle, nonroad engine, nonroad vehicle, open burning, process source, reference method, refuse, residual fuel oil, solid fuel, stack, standard conditions...

40 CFR 49.129 - Rule for limiting emissions of sulfur dioxide.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., incinerator, marine vessel, mobile sources, motor vehicle, nonroad engine, nonroad vehicle, open burning, process source, reference method, refuse, residual fuel oil, solid fuel, stack, standard conditions...

14 CFR 1212.401 - Filing statements of dispute.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Filing statements of dispute. 1212.401 Section 1212.401 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION PRIVACY ACT-NASA... shall: (1) Be in writing; (2) Set forth reasons for the individual's disagreement with NASA's refusal to...

14 CFR 1212.401 - Filing statements of dispute.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Filing statements of dispute. 1212.401 Section 1212.401 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION PRIVACY ACT-NASA... shall: (1) Be in writing; (2) Set forth reasons for the individual's disagreement with NASA's refusal to...

[Behavioral reactions of animals subjected in the prenatal development period to space flight conditions].

PubMed

Apanasenko, Z I; Kuznetsova, M A; Korotkova, V Iu

1986-01-01

The Wistar female rats were flown on the biosatellite Cosmos-1514 during their pregnancy days 13-18. Offspring (at the age 1 to 3 months) of four of these rats were used to investigate their behavioral reactions in the open field and mazes of different design, food attraction being applied. Control rats of matched pregnancy term were kept either in a vivarium or in a biosatellite mockup where all flight factors, except for weightlessness, were simulated. It was found that exposure to weightlessness in the above intrauterine developmental period caused no serious changes in the behavioral reactions of rats during their postnatal development. The number of refusals and errors and the latency period were similar in the rats from the flight and control groups. Changes were seen only in fine behavioral regulation. The flown animals displayed a lower research activity in the open field, a longer time of search in the maze, a far longer time or grooming and a greater number of inadequate movements, and a stronger response to external inhibiting stimuli. These changes seem to be caused by a slight attenuation of the basic nervous processes (primarily, inhibitory) and a decrease of their balance and lability. These effects may be associated with an inhibitory influence of space flight factors on the maturation of cortical structures.

Crew appliance concepts. Volume 5, appendix C: Modular space station appliances supporting engineering data

NASA Technical Reports Server (NTRS)

Proctor, B. W.; Reysa, R. P.; Russell, D. J.

1975-01-01

Housekeeping, off-duty, and medical data concerning the appliances considered for the space station are presented. Appliance functions analyzed include: cleanup, collection, processing and storage of refuse; crew entertainment and physical exercise, and the autoclaves and ergometers.

36 CFR 71.3 - Designation.

Code of Federal Regulations, 2012 CFR

2012-07-01

...: Tent or trailer spaces, drinking water, access road, refuse containers, toilet facilities, personal fee..., roads, overlook sites, visitors' centers, scenic drives, toilet facilities, picnic tables, and boat...

36 CFR 71.3 - Designation.

Code of Federal Regulations, 2013 CFR

2013-07-01

...: Tent or trailer spaces, drinking water, access road, refuse containers, toilet facilities, personal fee..., roads, overlook sites, visitors' centers, scenic drives, toilet facilities, picnic tables, and boat...

36 CFR 71.3 - Designation.

Code of Federal Regulations, 2014 CFR

2014-07-01

...: Tent or trailer spaces, drinking water, access road, refuse containers, toilet facilities, personal fee..., roads, overlook sites, visitors' centers, scenic drives, toilet facilities, picnic tables, and boat...

78 FR 38340 - Federal Acquisition Regulation; Submission for OMB Review; Right of First Refusal of Employment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-26

... DEPARTMENT OF DEFENSE GENERAL SERVICES ADMINISTRATION NATIONAL AERONAUTICS AND SPACE... Services Administration (GSA), and National Aeronautics and Space Administration (NASA). ACTION: Notice of... information gathered will be used by the Government to gain knowledge of which employees, adversely affected...

78 FR 17670 - Federal Acquisition Regulation; Information Collection; Right of First Refusal of Employment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... DEPARTMENT OF DEFENSE GENERAL SERVICES ADMINISTRATION NATIONAL AERONAUTICS AND SPACE... Services Administration (GSA), and National Aeronautics and Space Administration (NASA). ACTION: Notice of... will be used by the Government to gain knowledge of which employees, adversely affected or separated as...

75 FR 4565 - Federal Acquisition Regulation; Submission for OMB Review; Right of First Refusal of Employment

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-28

... DEPARTMENT OF DEFENSE GENERAL SERVICES ADMINISTRATION NATIONAL AERONAUTICS AND SPACE...), and National Aeronautics and Space Administration (NASA). ACTION: Notice of request for public... Government to gain knowledge of which employees, adversely affected or separated as a result of the contract...

78 FR 28218 - Appraisal Subcommittee; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-14

... reasonable security measures. The meeting space is intended to accommodate public attendees. However, if the space will not accommodate all requests, the ASC may refuse attendance on that reasonable basis. The use.... Park, Executive Director. [FR Doc. 2013-11375 Filed 5-13-13; 8:45 am] BILLING CODE P ...

A novel aerobic sulfate reduction process in landfill mineralized refuse.

PubMed

Liu, Weijia; Long, Yuyang; Fang, Yuan; Ying, Luyao; Shen, Dongsheng

2018-05-08

It is thought that mineralized refuse could be excavated from almost-full landfill sites to provide space for the increasing burden of municipal solid waste. When excavating, however, the H 2 S emissions from the mineralized waste need to be considered carefully. In an attempt to understand how H 2 S emissions might change during this excavation process, we carried out a series of tests, including exposing anaerobic mineralized refuse to oxygen, isolating and determining possible functional bacteria, and characterizing the electron donors and/or acceptors. The results showed that H 2 S would be released when landfill mineralized refuse was exposed to oxygen (O 2 ), and could reach concentrations of 6 mg m -3 , which was 3 times the concentrations of H 2 S released from anaerobic mineralized refuse. Sulfur-metabolized microorganisms accounted for only 0.5% of the microbial functional bacteria (MFB) derived from the mineralized refuse when exposed to O 2 for 60 days, and SRB were not present. The MFB maintained H 2 S production by aerobic sulfate reduction using SO 4 2- and S 2 O 3 2- as electron acceptors, and sulfate-reducing rates of 16% and 55%, respectively, were achieved. Lactate and S 2 O 3 2- were the preferred electron donor and acceptor, respectively. By enhancing the carbon source and electron transfer, MFB may undergo strong aerobic sulfate reduction even at low abundances of sulfur-metabolized microorganisms. Copyright © 2018 Elsevier B.V. All rights reserved.

Tips to Help Children through Their Medical Tests

MedlinePlus

... challenging because you have to have the child's trust. A child who is fearful and does not trust the nurse may refuse to open his or ... mouth. It is harder for the child to trust the medical personnel after an incident in which ...

78 FR 39729 - Appraisal Subcommittee Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-02

... agree to submit to reasonable security measures. The meeting space is intended to accommodate public attendees. However, if the space will not accommodate all requests, the ASC may refuse attendance on that..., 2013. James R. Park, Executive Director. [FR Doc. 2013-15850 Filed 7-1-13; 8:45 am] BILLING CODE P ...

Contamination of water due to major industries and open refuse dumping in the steel city of Orissa--a case study.

PubMed

Mishra, P C; Behera, P C; Patel, R K

2005-04-01

Contamination of ground water is common in the areas surrounded by industrial refuse dumping sites and the probability of contamination is more where dumping is done in low lying areas and the rate of percolation through the soil is high. In order to assess the ground water pollution by leachate around the refuse dumping site, eighteen wells were selected for study. Few wells are nearer to the dumps, few are far away and others are in between. Also an attempt has been made to evaluate the effect of industrial effluents on the ground and surface water due to Integrated Rourkela Steel Plant and other major industries. From the analytical data of physico-chemical parameters, it is indicated that the river water is contaminated mainly due to the industrial and municipal effluents and the ground water of some of the analyzed areas is contaminated due to municipal and industrial solid waste dumping.

Optical Measurements on Solid Specimens of Solid Rocket Motor Exhaust and Solid Rocket Motor Slag

NASA Technical Reports Server (NTRS)

Roberts, F. E., III

1991-01-01

Samples of aluminum slag were investigated to aid the Earth Science and Applications Division at the Marshall Space Flight Center (MSFC). Alumina from space motor propellant exhaust and space motor propellant slag was examined as a component of space refuse. Thermal emittance and solar absorptivity measurements were taken to support their comparison with reflectance measurements derived from actual debris. To determine the similarity between the samples and space motor exhaust or space motor slag, emittance and absorbance results were correlated with an examination of specimen morphology.

48 CFR 852.207-70 - Report of employment under commercial activities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... contracting officer with the following: (i) A list of employment openings including salaries and benefits, and... of employment; (v) The date of rejection of the offer, if applicable, and the salary and benefits... personnel exercising the right of first refusal, along with their completed job application forms. (2...

Dystrophin deficiency-induced changes in porcine skeletal muscle

USDA-ARS?s Scientific Manuscript database

A novel porcine stress syndrome was detected in the U.S. Meat Animal Research Center’s swine research population when two sibling barrows died of apparent stress symptoms (open mouth breathing, vocalization, and refusal to move or stand) after transport at 12 weeks of age. At eight weeks of age, the...

Refusing To Play the Blame Game.

ERIC Educational Resources Information Center

Dowd, JoAnne

1997-01-01

Frustrated by her ninth graders' misbehavior with a substitute teacher, a high school English teacher shelved her recriminations and engaged miscreants in a problem-solving exercise examining the incident. Establishing a protocol to talk about problems openly, without fear of retribution, made a big difference. Boys admitted to some poor choices;…

Impact of the Freedom of Information Act on the National Intelligence Agencies.

DTIC Science & Technology

1982-04-16

previously placed on the open record. This has led some courts to refuse to even consider in camera evidence until more is stated on the open record. Sworn...read an in camera affidavit and awarded summary judgement to the plaintiff because the government’s proof was not, therefore, in evidence. 5 Courts...which perceive a dilemma in these in camera procedures have been giving serious consideration to solving it by permitting plaintiffs or their attorneys

The Mark of a Dying Star

NASA Image and Video Library

2006-01-19

Six hundred and fifty light-years away in the constellation Aquarius, a dead star about the size of Earth, is refusing to fade away peacefully. NASA Hubble and Spitzer Space Telescopes have captured the complex structure of the Helix nebula.

Faculty Backlash Grows against Online Partnerships

ERIC Educational Resources Information Center

Kolowich, Steve

2013-01-01

Many professors recognize that online education is changing the landscape of academe. But faculty members at several colleges are making it clear that they will not be steamrolled. Philosophy professors at San Jose State University last week wrote an open letter saying they refused to use material from an edX course, taught by a famous Harvard…

It's Time to Consider Open Source Software

ERIC Educational Resources Information Center

Pfaffman, Jay

2007-01-01

In 1985 Richard Stallman, a computer programmer, released "The GNU Manifesto" in which he proclaimed a golden rule: One must share computer programs. Software vendors required him to agree to license agreements that forbade sharing programs with others, but he refused to "break solidarity" with other computer users whom he assumed also wanted to…

Studies find more alternatives to soil cover

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

Not Available

1984-02-01

Researchers from Southern Illinois University at Carbondale have experimented with planting forage grasses on acid coal refuse after deeply incorporating sewage sludge and limestone. Studies were conducted at Peabody Coal Co.'s Will Scarlet Mine, two miles north of Stonefort, IL. Digested liquid sewage sludge was hauled from the Chicago Sanitation District and deposited one meter deep into holding basins adjacent to the study site. The material was then dried in these basins for two years. In 1979, a specially modified cable trencher opened trenches 8 cm wide to depths of 30 cm and 60 cm for various treatments. Researchers depositedmore » the dried sludge using a silage wagon and spread the limestone by hand. Eleven different treatments of sludge and limestone were deposited at the two different incorporation depths. In March 1981 three grasses--reed canary grass, red top, and tall fescue--were seeded in a randomized complete block design within each of the eleven treatments. The deep incorporation of sewage sludge and/or limestone improved the physical and chemical properties of the coal refuse sufficiently to establish and maintain good stands of these forage grasses. Also, in spite of the high concentration of heavy metals in coal refuse amended with sewage sludge, the plant uptake was less than the maximum suggested level for feed. Analysis showed that the sewage sludge increased the organic matter of the coal refuse and decreased the bulk density. Water retention was higher in the sewage sludge amended treatments, but there were no differences in the availability of water. The pH of coal refuse increased from 2.5 to 5.0 at higher rates of sludge or limestone.« less

24 CFR 982.517 - Utility allowance schedule.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., the PHA also must provide any information or procedures used in preparation of the schedule. (b) How... services according to the following general categories: space heating; air conditioning; cooking; water heating; water; sewer; trash collection (disposal of waste and refuse); other electric; refrigerator (cost...

Battle for the Soul: Metis Children Encounter Evangelical Protestants at Mackinaw Mission, 1823-1837.

ERIC Educational Resources Information Center

Widder, Keith R.

In 1823, evangelical missionaries William and Amanda Ferry opened a boarding school for Metis children on Mackinac Island, Michigan Territory, hoping to convert and transform the Metis people through their children. Instead, they helped bring about a revival of Catholicism, and their students refused to abandon the fur trading lifestyle. Chapter 1…

The impact of competing zealots on opinion dynamics

NASA Astrophysics Data System (ADS)

Verma, Gunjan; Swami, Ananthram; Chan, Kevin

2014-02-01

An individual’s opinion on an issue is greatly impacted by others in his or her social network. Most people are open-minded and ready to change their opinion when presented evidence; however, some are zealots or inflexibles, that is, individuals who refuse to change their opinion while staunchly advocating an opinion in hopes of convincing others. Zealotry is present in opinions of significant personal investment, such as political, religious or corporate affiliation; it tends to be less commonplace in opinions involving rumors or fashion trends. In this paper, we examine the effect that zealots have in a population whose opinion dynamics obey the naming game model. We present numerical and analytical results about the number and nature of steady state solutions, demonstrating the existence of a bifurcation in the space of zealot fractions. Our analysis indicates conditions under which a minority zealot opinion ultimately prevails, and conditions under which neither opinion attains a majority. We also present numerical and simulation analysis of finite populations and on networks with partial connectivity.

Solid waste management problems in secondary schools in Ibadan, Nigeria.

PubMed

Ana, G R E E; Oloruntoba, E O; Shendell, D; Elemile, O O; Benjamin, O R; Sridhar, M K C

2011-09-01

Inappropriate solid waste management practices in schools in less-developed countries, particularly in major urban communities, constitute one of the major factors leading to declining environmental health conditions. The objective of the authors' descriptive, cross-sectional study was to assess solid waste management problems in selected urban schools in Ibadan, Nigeria. Eight secondary schools with average pupil populations not less than 500 per school were selected randomly. Four hundred questionnaires (50 per school) were administered. In addition, an observational checklist was used to assess the physical environment. Paper and plastics were the most frequently generated wastes. Common methods of solid waste disposal reported were use of dustbins for collection and open burning. Major problems perceived with current refuse disposal methods by the study students were odors, pest infestation, and spillages. Littering and spillages of solid waste were also common features reported. Data suggested inadequate waste management facilities and practices in study schools. The lack of refuse bins may have contributed to waste spillages and the burning practices. Odors may have arisen from both the decay of overstored organic waste rich in moisture and emissions from refuse burning. This scenario poses a community environmental health nuisance and may compromise school environmental quality.

Combustion products of plastics as indicators for refuse burning in the atmosphere.

PubMed

Simoneit, Bernd R T; Medeiros, Patricia M; Didyk, Borys M

2005-09-15

Despite all of the economic problems and environmental discussions on the dangers and hazards of plastic materials, plastic production worldwide is growing at a rate of about 5% per year. Increasing techniques for recycling polymeric materials have been developed during the last few years; however, a large fraction of plastics are still being discarded in landfills or subjected to intentional or incidental open-fire burning. To identify specific tracer compounds generated during such open-fire combustion, both smoke particles from burning and plastic materials from shopping bags, roadside trash, and landfill garbage were extracted for gas chromatography-mass spectrometry analyses. Samples were collected in Concón, Chile, an area frequently affected by wildfire incidents and garbage burning, and the United States for comparison. Atmospheric samples from various aerosol sampling programs are also presented as supportive data. The major components of plastic extracts were even-carbon-chain n-alkanes (C16-C40), the plasticizer di-2-ethylhexyl phthalate, and the antioxidants and lubricants/antiadhesives Irganox 1076, Irgafos 168, and its oxidation product tris(2,4-di-tertbutylphenyl) phosphate. Major compounds in smoke from burning plastics include the non-source-specific n-alkanes (mainly even predominance), terephthalic acid, phthalates, and 4-hydroxybenzoic acid, with minor amounts of polycyclic aromatic hydrocarbons (including triphenylbenzenes) and tris(2,4-di-tert-butylphenyl)phosphate. 1,3,5-Triphenylbenzene and tris(2,4-di-tert-butylphenyl)- phosphate were found in detectable amounts in atmospheric samples where plastics and refuse were burned in open fires, and thus we propose these two compounds as specific tracers for the open-burning of plastics.

The Sources of Air Pollution and Their Control.

ERIC Educational Resources Information Center

National Air Pollution Control Administration (DHEW), Arlington, VA.

The problems of air pollution and its control are discussed. Major consideration is given the sources of pollution - motor vehicles, industry, power plants, space heating, and refuse disposal. Annual emission levels of five principle pollutants - carbon monoxide, sulfur dioxide, nitrogen oxides, hydrocarbons, and particulate matter - are listed…

Alberta High School, College Elevate Learning with Rare Joint Venture

ERIC Educational Resources Information Center

Pearson, George

2012-01-01

The refusal by a group of parents in Olds, Alberta, in 2003 to accept a provincial grant to renovate their high school set in motion a remarkable collaboration that spawned an innovative learning campus for an entire community and beyond. The new Olds High School, which opened in 2010, is part of a new Community Learning Campus (CLC), a joint…

Chemical mass balance source apportionment of TSP in a lignite-burning area of Western Macedonia, Greece

NASA Astrophysics Data System (ADS)

Samara, Constantini

Total suspended particle mass concentrations (TSP) were determined in the Kozani-Ptolemais-Florina basin (western Macedonia, Greece), an area with intensive lignite burning for power generation. The study was conducted over a 1-year period (November 2000-November 2001) at 10 receptor sites located at variable distances from the power plants. Ambient TSP samples were analyzed for 27 major, minor and trace elements. Particulate emissions were also collected from a variety of sources including fly ash, lignite dust, automobile traffic, domestic heating, and open-air burning of agricultural biomass and refuse, and analyzed for the same chemical components. Ambient and source chemical profiles were used for source identification and apportionment of TSP by employing a chemical mass balance (CMB) receptor model. Diesel burning in vehicular traffic and in the power plants for generator start up was found to be the major contributor to ambient TSP levels at all 10 sites. Other sources with significant contributions were domestic coal burning, vegetative burning (wood combustion and agricultural burns) and refuse open-air burning. Fly ash escaping the electrostatic precipitators of the power plants was a minor contributor to ambient TSP.

14 CFR 13.119 - Rights of persons against self-incrimination.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Rights of persons against self... an Order of Investigation § 13.119 Rights of persons against self-incrimination. (a) Whenever a person refuses, on the basis of a privilege against self-incrimination, to testify or provide other...

The Experience of Psychiatric Care of Adolescents with Anxiety-based School Refusal and of their Parents: A Qualitative Study.

PubMed

Sibeoni, Jordan; Orri, Massimiliano; Podlipski, Marc-Antoine; Labey, Mathilde; Campredon, Sophie; Gerardin, Priscille; Revah-Levy, Anne

2018-01-01

Anxiety-based school refusal in adolescence is a complex, sometimes difficult to treat disorder that can have serious academic and psychiatric consequences. The objective of this qualitative study was to explore how teens with this problem and their parents experience the psychiatric care received. This qualitative multicenter study took place in France, where we conducted semi-structured interviews with adolescents receiving psychiatric care for anxiety-based school refusal and with their parents. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. This study included 20 adolescents aged 12 to 18 years and 21 parents. Two themes emerged from the analysis: (1) the goals of psychiatric care with two sub-themes, " self-transformation " and problem solving ; and, (2) the therapeutic levers identified as effective with two sub-themes: time and space and relationships . Our results show a divergence between parents and teens in their representations of care and especially of its goals. Therapeutic and research implications about the terms of return to school within psychiatric care and also the temporality of care are discussed.

Women's, midwives' and obstetricians' experiences of a structured process to document refusal of recommended maternity care.

PubMed

Jenkinson, Bec; Kruske, Sue; Stapleton, Helen; Beckmann, Michael; Reynolds, Maree; Kildea, Sue

2016-12-01

Ethical and professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy; the right to refuse care is well established. However, the existing literature is largely silent on the appropriate clinical responses when pregnant women refuse recommended care, and accounts of disrespectful interactions and conflict are numerous. Policies and processes to support women and maternity care providers are rare and unstudied. To document the perspectives of women, midwives and obstetricians following the introduction of a structured process (Maternity Care Plan; MCP) to document refusal of recommended maternity care in a large tertiary maternity unit. A qualitative, interpretive study involved thematic analysis of in-depth semi-structured interviews with women (n=9), midwives (n=12) and obstetricians (n=9). Four major themes were identified including: 'Reassuring and supporting clinicians'; 'Keeping the door open'; 'Varied awareness, criteria and use of the MCP process' and 'No guarantees'. Clinicians felt protected and reassured by the structured documentation and communication process and valued keeping women engaged in hospital care. This, in turn, protected women's access to maternity care. However, the process could not guarantee favourable responses from other clinicians subsequently involved in the woman's care. Ongoing discussions of risk, perceived by women and some midwives to be pressure to consent to recommended care, were still evident. These limitations may have been attributable to the absence of agreed criteria for initiating the MCP process and fragmented care. Varying awareness and use of the process also diminished women's access to it. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

14 CFR 1212.604 - Social security numbers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Social security numbers. 1212.604 Section... REGULATIONS Instructions for NASA Employees § 1212.604 Social security numbers. (a) It is unlawful for NASA to...' refusal to disclose their social security numbers, except where: (1) The disclosure is required by law; or...

14 CFR 1212.604 - Social security numbers.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Social security numbers. 1212.604 Section... REGULATIONS Instructions for NASA Employees § 1212.604 Social security numbers. (a) It is unlawful for NASA to...' refusal to disclose their social security numbers, except where: (1) The disclosure is required by law; or...

14 CFR 1212.604 - Social security numbers.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Social security numbers. 1212.604 Section... REGULATIONS Instructions for NASA Employees § 1212.604 Social security numbers. (a) It is unlawful for NASA to...' refusal to disclose their social security numbers, except where: (1) The disclosure is required by law; or...

14 CFR § 1212.604 - Social security numbers.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Social security numbers. § 1212.604... REGULATIONS Instructions for NASA Employees § 1212.604 Social security numbers. (a) It is unlawful for NASA to...' refusal to disclose their social security numbers, except where: (1) The disclosure is required by law; or...

14 CFR 1212.604 - Social security numbers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Social security numbers. 1212.604 Section... REGULATIONS Instructions for NASA Employees § 1212.604 Social security numbers. (a) It is unlawful for NASA to...' refusal to disclose their social security numbers, except where: (1) The disclosure is required by law; or...

14 CFR 13.27 - Final order of Hearing Officer in certificate of aircraft registration proceedings.

Code of Federal Regulations, 2010 CFR

2010-01-01

... certificate of aircraft registration proceedings. 13.27 Section 13.27 Aeronautics and Space FEDERAL AVIATION... Enforcement Actions § 13.27 Final order of Hearing Officer in certificate of aircraft registration proceedings... Hearing Officer determines that the holder of the Certificate of Aircraft Registration has refused or...

The politics of space - Who owns what? Earth law for space

NASA Technical Reports Server (NTRS)

Hosenball, S. N.

1983-01-01

Topics of concern in developing space law, i.e., international disagreements, the present status of space law, and requirements for future space activities, are discussed. Factors inhibiting agreements include governments that wish to control specific regions of GEO, the refusal of several countries to permit international DBS television broadcasts over their boundaries, the possibility that weapons may be placed in space, and the lack of international laws governing humans and industries in space. It is noted that any state entering an international agreement has relinquished some of its sovereignty. The Outer Space Treaty has removed celestial bodies from claims of national appropriation. States retain sovereignty over their citizens who travel in space, a problematical concept once internationally-manned settlements in space or on the moon are established. It is recommended that space law develop mainly in reaction to the implementation of new space capabilities in order to avoid hindering space activities.

[Pierre Bourdieu: sociology as a "symbolic revolution"].

PubMed

Suaud, Charles

2014-03-01

The article combines two objectives: understand the genesis and development of the sociology of Bourdieu in connection with his social and intellectual positioning. The sociology of Bourdieu is a theory of Action which reconciles the double requirement of objectification and taking account of the practical logic bound by social agents. From the character both objective and subjective of social space, he analyzes how different institutions (firstly School) are doing that mental structures match the objective structures of society. By making acceptable reality and registering it in the body, these instances contribute to reproduce social divisions and participate in the work of domination. Gradually, Bourdieu develops a general theory about Power, which leads to a sociology of State. But he refuses any sociological fatalism. Because he perceived homologies between the sociologist and the artist facing the social order, each in their own way, he devoted two researches to Flaubert and Manet, seized in the same enterprise of aesthetic subversion he described as a 'symbolic revolution'. In many aspects, the sociology of Bourdieu opens ways of looking for an objectification of caregivers and their practices.

The Experience of Psychiatric Care of Adolescents with Anxiety-based School Refusal and of their Parents: A Qualitative Study

PubMed Central

Sibeoni, Jordan; Orri, Massimiliano; Podlipski, Marc-Antoine; Labey, Mathilde; Campredon, Sophie; Gerardin, Priscille; Revah-Levy, Anne

2018-01-01

Objective Anxiety-based school refusal in adolescence is a complex, sometimes difficult to treat disorder that can have serious academic and psychiatric consequences. The objective of this qualitative study was to explore how teens with this problem and their parents experience the psychiatric care received. Methods This qualitative multicenter study took place in France, where we conducted semi-structured interviews with adolescents receiving psychiatric care for anxiety-based school refusal and with their parents. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. Results This study included 20 adolescents aged 12 to 18 years and 21 parents. Two themes emerged from the analysis: (1) the goals of psychiatric care with two sub-themes, “self-transformation” and problem solving; and, (2) the therapeutic levers identified as effective with two sub-themes: time and space and relationships. Conclusion Our results show a divergence between parents and teens in their representations of care and especially of its goals. Therapeutic and research implications about the terms of return to school within psychiatric care and also the temporality of care are discussed. PMID:29375632

Long-term effect of a single application of organic refuse on carbon sequestration and soil physical properties.

PubMed

Albaladejo, J; Lopez, J; Boix-Fayos, C; Barbera, G G; Martinez-Mena, M

2008-01-01

Restoration of degraded lands could be a way to reverse soil degradation and desertification in semiarid areas and mitigate greenhouse gases (GHG). Our objective was to evaluate the long-term effects of a single addition of organic refuse on soil physical properties and measure its carbon sequestration potential. In 1988, a set of five plots (87 m(2) each) was established in an open desert-like scrubland (2-4% cover) in Murcia, Spain, to which urban solid refuse (USR) was added in a single treatment at different rates. Soil properties were monitored over a 5-yr period. Sixteen years after the addition, three of the plots were monitored again (P0: control, P1: 13 kg m(-2), P2: 26 kg m(-2) of USR added) to assess the lasting effect of the organic addition on the soil organic carbon (SOC) pools and on the physical characteristics of the soil. The SOC content was higher in P2 (16.4 g kg(-1)) and in P1 (11.8 g kg(-1)) than in P0 (7.9 g kg(-1)). Likewise, aerial biomass increased from 0.18 kg m(-2) in P0 up to 0.27 kg m(-2) in P1 and 0.46 kg m(-2) in P2. This represents a total C sequestration of 9.5 Mg ha(-1) in P2 and 3.4 Mg ha(-1) in P1, most of the sequestered C remaining in the recalcitrant soil pool. Additionally, higher saturated hydraulic conductivity, aggregate stability, and available water content values and lower bulk density values were measured in the restored plots. Clearly, a single addition of organic refuse to the degraded soils to increase the potential for C sequestration was effective.

14 CFR § 1250.103-6 - Medical emergencies.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Medical emergencies. § 1250.103-6 Section... § 1250.103-6 Medical emergencies. Notwithstanding the provisions of §§ 1250.103 to 1250.103-5, a... through a medical institution which refuses or fails to comply with § 1250.103-1. ...

Caregivers who refuse preventive care for their children: the relationship between immunization and topical fluoride refusal.

PubMed

Chi, Donald L

2014-07-01

The aim of this study was to examine caregivers' refusal of preventive medical and dental care for children. Prevalence rates of topical fluoride refusal based on dental records and caregiver self-reports were estimated for children treated in 3 dental clinics in Washington State. A 60-item survey was administered to 1024 caregivers to evaluate the association between immunization and topical fluoride refusal. Modified Poisson regression models were used to estimate prevalence rate ratios (PRRs). The prevalence of topical fluoride refusal was 4.9% according to dental records and 12.7% according to caregiver self-reports. The rate of immunization refusal was 27.4%. In the regression models, immunization refusal was significantly associated with topical fluoride refusal (dental record PRR = 1.61; 95% confidence interval [CI] = 1.32, 1.96; P < .001; caregiver self-report PRR = 6.20; 95% CI = 3.21, 11.98; P < .001). Caregivers younger than 35 years were significantly more likely than older caregivers to refuse both immunizations and topical fluoride (P < .05). Caregiver refusal of immunizations is associated with topical fluoride refusal. Future research should identify the behavioral and social factors related to caregiver refusal of preventive care with the goal of developing multidisciplinary strategies to help caregivers make optimal preventive care decisions for children.

Refusing to Treat Sexual Dysfunction in Sex Offenders.

PubMed

Douglas, Thomas

2017-01-01

This article examines one kind of conscientious refusal: the refusal of healthcare professionals to treat sexual dysfunction in individuals with a history of sexual offending. According to what I call the orthodoxy, such refusal is invariably impermissible, whereas at least one other kind of conscientious refusal-refusal to offer abortion services-is not. I seek to put pressure on the orthodoxy by (1) motivating the view that either both kinds of conscientious refusal are permissible or neither is, and (2) critiquing two attempts to buttress it.

A narrative review of studies of refusal of psychotropic medication in acute inpatient psychiatric care.

PubMed

Owiti, J A; Bowers, L

2011-09-01

This paper offers a narrative review of the 22 studies of medication refusal in acute psychiatry. Because of varied definitions of medication refusal, diverse methodologies and few rigorous studies, it has not been possible to draw firm conclusions on the average rate of refusal of psychotropic medications in acute psychiatry. However, it is clear that medication refusal is common and leads to poor outcomes characterized by higher rates of seclusion, restraint, threats of, and actual, assaults and longer hospitalizations. There are no statistically significant differences between refusers and acceptors in gender, marital status and preadmission living arrangements. Although no firm conclusions on the influence of ethnicity, status at admission and diagnosis on refusal, the refusers are more likely to have higher number of previous hospitalizations and history of prior refusal. The review indicates that staff factors such as the use of temporary staff, lack of confidence in ward staff and ineffective ward structure are associated with higher rates of medication refusal. Comprehensive knowledge of why, and how, patients refuse medication is lacking. Research on medication refusal is still fragmented, of variable methodological quality and lacks an integrating model. © 2011 Blackwell Publishing.

Reflection on an Ethic of Officership

DTIC Science & Technology

2007-04-01

a moral commit- ment, made publicly, which we secure with our very reputation. The “Title 5 Oath” is simple and makes only three positive moral ...commissioned officers. First of all, it states that the commission is awarded based upon the President’s confidence in the officer’s patriotism, valor ...be refused. The officer then continues to be morally obliged to adhere to his or her original undertaking of service. Indeed, it is an open question

Refusal of medical treatment in the pediatric emergency service: analysis of reasons and aspects.

PubMed

Gündüz, Ramiz Coşkun; Halil, Halit; Gürsoy, Cüneyt; Çifci, Atilla; Özgün, Seher; Kodaman, Tuğba; Sönmez, Mehtap

2014-01-01

Refusal of treatment for acutely ill children is still an important problem in the emergency service. When families refuse medical treatment for their acutely ill children, healthcare professionals may attempt to provide information and negotiate with the family concerning treatment refusal and its possible adverse outcomes, and request consent for refusal of medical treatment. There is insufficient data about refusal of treatment in our country. The purpose of this study was to analyze the causes of treatment refusal in the pediatric emergency service. We collected data recorded on informed consent forms. During a 2-year-study period, 215 patients refused treatment recommended by acute health care professionals. The majorty of patients were in the 0-2 year age group. Hospitalization was the type of treatment most commonly refused; restrictions regarding family members staying with their children during hospitalization and admission to another hospital were the major reasons for refusal of treatment. Clarifying the reasons for treatment refusal may help us to overcome deficiencies, improve conditions, resolve problems and build confidence between healthcare providers and service users, increasing users' satisfaction in the future.

School refusal by patients with gender identity disorder.

PubMed

Terada, Seishi; Matsumoto, Yosuke; Sato, Toshiki; Okabe, Nobuyuki; Kishimoto, Yuki; Uchitomi, Yosuke

2012-01-01

The accumulating evidence suggests that school refusal behavior is associated with severe negative outcomes. However, previous research has not addressed school refusal by patients with gender identity disorder (GID). In this study, we tried to clarify the prevalence of school refusal among GID patients and the relationship of school refusal to demographic characteristics. A total of 579 consecutive Japanese GID patients at the outpatient GID Clinic of Okayama University Hospital between April 1997 and October 2005 were evaluated. The prevalence of school refusal was 29.2% of the total sample. School refusal was more frequent among GID patients with divorced parents than those with intact families. Multiple logistic regression analysis showed that younger age at consultation and divorce of parents were significantly associated with school refusal among the male-to-female GID patients. The rate of school refusal among GID patients is high, and school refusal is closely related with a low level of education and current unemployment. We should pay more attention to GID patients of school age to prevent their school refusal, which results in low educational achievement. Copyright © 2012 Elsevier Inc. All rights reserved.

Caregivers Who Refuse Preventive Care for Their Children: The Relationship Between Immunization and Topical Fluoride Refusal

PubMed Central

2014-01-01

Objectives. The aim of this study was to examine caregivers’ refusal of preventive medical and dental care for children. Methods. Prevalence rates of topical fluoride refusal based on dental records and caregiver self-reports were estimated for children treated in 3 dental clinics in Washington State. A 60-item survey was administered to 1024 caregivers to evaluate the association between immunization and topical fluoride refusal. Modified Poisson regression models were used to estimate prevalence rate ratios (PRRs). Results. The prevalence of topical fluoride refusal was 4.9% according to dental records and 12.7% according to caregiver self-reports. The rate of immunization refusal was 27.4%. In the regression models, immunization refusal was significantly associated with topical fluoride refusal (dental record PRR = 1.61; 95% confidence interval [CI] = 1.32, 1.96; P < .001; caregiver self-report PRR = 6.20; 95% CI = 3.21, 11.98; P < .001). Caregivers younger than 35 years were significantly more likely than older caregivers to refuse both immunizations and topical fluoride (P < .05). Conclusions. Caregiver refusal of immunizations is associated with topical fluoride refusal. Future research should identify the behavioral and social factors related to caregiver refusal of preventive care with the goal of developing multidisciplinary strategies to help caregivers make optimal preventive care decisions for children. PMID:24832428

"Sticking Together!" Policy Activism from within a UK Coal-Mining Community

ERIC Educational Resources Information Center

Bright, N. Geoffrey

2012-01-01

This article reflects on some aspects of a doctoral ethnographic study of young people disaffected from schooling in a post-industrial space of ruin in a former coal-mining community in England. It considers how their experiences of resistance and refusal of schooling can, in the relational ethos of non-school support settings, come to speak back…

Defense Industrial Base Assessment: U.S. Space Industry

DTIC Science & Technology

2007-08-31

Approved for public release; distribution is unlimited. Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection...DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release, distribution unlimited 13. SUPPLEMENTARY NOTES The original document contains color...profitability and a refusal of some foreign customers to procure equipment that requires U.S. ITAR licensing.” The BIS survey addressed

Ways to say no: refusal skill strategies among urban adolescents.

PubMed

Nichols, Tracy R; Graber, Julia A; Brooks-Gunn, Jeanne; Botvin, Gilbert J

2006-01-01

To examine associations among adolescents' generated verbal strategies (ie, Simple No, Declarative Statements, Excuse, Alternatives) and underlying nonverbal assertiveness in 2 refusal situations: smoking and shoplifting. Sixth-grade urban minority students (N = 454) participated in videotaped role-play assessments of peer refusal skills. Differences were found by situation with students demonstrating greater use of Simple No in the smoking refusal and Alternatives in the shoplifting refusal. Nonverbal assertiveness was similar across situations and was associated with Declarative Statements, but only in the smoking refusal. Prevention programs should tailor refusal skills practice to cover multiple situations.

30 CFR 77.215-4 - Refuse piles; abandonment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; abandonment. 77.215-4 Section 77... MINES Surface Installations § 77.215-4 Refuse piles; abandonment. When a refuse pile is to be abandoned... refuse pile shall be abandoned in accordance with a plan submitted by the operator and approved by the...

Factors Associated with School Refusal in Adolescents: Some Preliminary Results.

ERIC Educational Resources Information Center

Ficula, Teresa V.; And Others

School refusal, as differentiated from both school phobia and truancy, is a term used to denote emotionally-based avoidance of school. To identify factors associated with school refusal, 41 junior high and high school students (including special education school refusers, special education non-refusers, and a comparison group from a regular…

The right not to be treated or to refuse treatment.

PubMed

Deutsch, E

1989-01-01

The corollary to the right to refuse treatment is the requirement that, in general, informed consent be obtained before treatment. The Declaration of Lisbon recognises this: "The patient has the right to accept or to refuse treatment after receiving adequate information." The information to be given to the patient is of three kinds, but a special problem in relation to the doctrine of informed refusal places a special duty on the doctor to inform the patient about the possible consequences of refusing treatment. Related topics, such as refusal in part, refusal by a parent or guardian, the novus actus interveniens, the living will, and contributory negligence are touched upon.

The Refusal of Palliative Radiation in Metastatic Non-Small Cell Lung Cancer and Its Prognostic Implications.

PubMed

Stavas, Mark J; Arneson, Kyle O; Ning, Matthew S; Attia, Albert A; Phillips, Sharon E; Perkins, Stephanie M; Shinohara, Eric T

2015-06-01

Patients with metastatic non-small cell lung cancer (NSCLC) have limited survival. Population studies have evaluated the impact of radiation refusal in the curative setting; however, no data exist concerning the prognostic impact of radiation refusal in the palliative care setting. To investigate the patterns of radiation refusal in newly diagnosed patients with metastatic NSCLC. Patients with Stage IV NSCLC diagnosed between 1988 and 2010 were identified in the Surveillance, Epidemiology, and End Results database. Univariate and multivariate analyses were used to identify predictors for refusal of radiation and the impact of radiation and refusal on survival in the palliative setting. A total of 285,641 patients were initially included in the analysis. Palliative radiation was recommended in 42% and refused by 3.1% of patients. Refusal rates remained consistent across included years of study. On multivariate analysis, older, nonblack/nonwhite, unmarried females were more likely to refuse radiation (P < 0.001 in all cases). Median survival for patients refusing radiation was three months vs. five months for those receiving radiation and two months for those whom radiation was not recommended. Patients with metastatic NSCLC who refuse recommended palliative radiation have a poor survival. Radiation refusal or the recommendation against treatment can serve as a trigger for integrating palliative care services sooner and contributes greatly to prognostic awareness. Further investigation into this survival difference and the factors behind refusal are warranted. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Parental Refusal of Vitamin K and Neonatal Preventive Services: A Need for Surveillance.

PubMed

Marcewicz, Lauren H; Clayton, Joshua; Maenner, Matthew; Odom, Erika; Okoroh, Ekwutosi; Christensen, Deborah; Goodman, Alyson; Warren, Michael D; Traylor, Julie; Miller, Angela; Jones, Timothy; Dunn, John; Schaffner, William; Grant, Althea

2017-05-01

Objectives Vitamin K deficiency bleeding (VKDB) in infants is a coagulopathy preventable with a single dose of injectable vitamin K at birth. The Tennessee Department of Health (TDH) and Centers for Disease Control and Prevention (CDC) investigated vitamin K refusal among parents in 2013 after learning of four cases of VKDB associated with prophylaxis refusal. Methods Chart reviews were conducted at Nashville-area hospitals for 2011-2013 and Tennessee birthing centers for 2013 to identify parents who had refused injectable vitamin K for their infants. Contact information was obtained for parents, and they were surveyed regarding their reasons for refusing. Results At hospitals, 3.0% of infants did not receive injectable vitamin K due to parental refusal in 2013, a frequency higher than in 2011 and 2012. This percentage was much higher at birthing centers, where 31% of infants did not receive injectable vitamin K. The most common responses for refusal were a belief that the injection was unnecessary (53%) and a desire for a natural birthing process (36%). Refusal of other preventive services was common, with 66% of families refusing vitamin K, newborn eye care with erythromycin, and the neonatal dose of hepatitis B vaccine. Conclusions for Practice Refusal of injectable vitamin K was more common among families choosing to give birth at birthing centers than at hospitals, and was related to refusal of other preventive services in our study. Surveillance of vitamin K refusal rates could assist in further understanding this occurrence and tailoring effective strategies for mitigation.

A new year, a new Journal.

PubMed

Fokkens, W J

2018-03-01

Let us start this first editorial of 2018 with wishing you all a marvelous year where most of your dreams come true. In the last years, the editors of Rhinology felt often very unhappy when again we had to refuse papers send to us for Rhinology. Unfortunately, every year we can only accept around 15% of the papers we receive. With pain in our hearts, we often have to refuse papers of good quality but just not innovative enough or with slight methodological imperfections. The editorial board of Rhinology recognized this feeling and we decided to start a new journal: Rhinology Online to have space for all those papers that are good but just do not make the cut for Rhinology. Rhinology Online is a journal of the European Rhinologic Society, and will provide a platform for the dissemination of rhinologic research and reviews, as well as position papers, task force reports and guidelines, amongst an international scientific audience.

Design of landfill daily cells.

PubMed

Panagiotakopoulos, D; Dokas, I

2001-08-01

The objective of this paper is to study the behaviour of the landfill soil-to-refuse (S/R) ratio when size, geometry and operating parameters of the daily cell vary over realistic ranges. A simple procedure is presented (1) for calculating the cell parameters values which minimise the S/R ratio and (2) for studying the sensitivity of this minimum S/R ratio to variations in cell size, final refuse density, working face length, lift height and cover thickness. In countries where daily soil cover is required, savings in landfill space could be realised following this procedure. The sensitivity of minimum S/R to variations in cell dimensions decreases with cell size. Working face length and lift height affect the S/R ratio significantly. This procedure also offers the engineer an additional tool for comparing one large daily cell with two or more smaller ones, at two different working faces within the same landfill.

Refusing Curriculum as a Space of Death for Black Female Subjects: A Black Feminist Reparative Reading of Jamaica Kincaid's "Girl"

ERIC Educational Resources Information Center

Ohito, Esther Oganda

2016-01-01

The currents of elitism surging through curriculum studies in the United States have long been of chief concern to critical scholars in the field. Elements of this elitism running along racialized, gendered, classed and other such lines elide to marginalize knowledge generated by and about the "other." For this racialized, gendered,…

Refusal of postoperative radiotherapy and its association with survival in head and neck cancer.

PubMed

Schwam, Zachary G; Husain, Zain; Judson, Benjamin L

2015-11-01

Administering postoperative radiotherapy (PORT) is associated with improved survival and slower disease progression in select head and neck cancer patients. Predictive factors for PORT refusal have not been described in this population. Retrospective analysis of 6127 head and neck cancer patients who received or refused PORT in the National Cancer Database (2003-2006) was performed. Statistical analysis included Chi-square, multivariable logistic regression, Kaplan-Meier, and Cox proportional hazards analysis. In total, 247 patients (4.0%) refused PORT. Three-year overall survival was 62.8% versus 53.4% for those who received and refused PORT, respectively. PORT refusers were more likely to have negative nodes than those who underwent PORT (37.4% versus 20.1%, p<.001). In multivariate analysis, predictive factors for refusing PORT included living far from the treatment facility (OR 1.92), having negative nodes (OR 2.14), and Charlson score of ⩾ 2 (OR 2.14) (all p ⩽.001). PORT refusal was associated with increased mortality (hazard ratio 1.20, p=.044). A significant proportion of head and neck cancer patients refused PORT; this was associated with compromised overall survival. Predictive factors for PORT refusal included socioeconomic, demographic, and pathologic variables. Elucidating root causes of refusal may lead to interventions that improve long-term outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Delay and refusal of human papillomavirus vaccine for girls, national immunization survey-teen, 2010.

PubMed

Dorell, Christina; Yankey, David; Jeyarajah, Jenny; Stokley, Shannon; Fisher, Allison; Markowitz, Lauri; Smith, Philip J

2014-03-01

Human papillomavirus (HPV) vaccine coverage among girls is low. We used data reported by parents of 4103 girls, 13 to 17 years old, to assess associations with, and reasons for, delaying or refusing HPV vaccination. Sixty-nine percent of parents neither delayed nor refused vaccination, 11% delayed only, 17% refused only, and 3% both delayed and refused. Eighty-three percent of girls who delayed only, 19% who refused only, and 46% who both delayed and refused went on to initiate the vaccine series or intended to initiate it within the next 12 months. A significantly higher proportion of parents of girls who were non-Hispanic white, lived in households with higher incomes, and had mothers with higher education levels, delayed and/or refused vaccination. The most common reasons for nonvaccination were concerns about lasting health problems from the vaccine, wondering about the vaccine's effectiveness, and believing the vaccine is not needed.

Parental Refusal of Vitamin K and Neonatal Preventive Services: A Need for Surveillance

PubMed Central

Marcewicz, Lauren H.; Clayton, Joshua; Maenner, Matthew; Odom, Erika; Okoroh, Ekwutosi; Christensen, Deborah; Goodman, Alyson; Warren, Michael D.; Traylor, Julie; Miller, Angela; Jones, Timothy; Dunn, John; Schaffner, William; Grant, Althea

2017-01-01

Objectives Vitamin K deficiency bleeding (VKDB) in infants is a coagulopathy preventable with a single dose of injectable vitamin K at birth. The Tennessee Department of Health (TDH) and Centers for Disease Control and Prevention (CDC) investigated vitamin K refusal among parents in 2013 after learning of four cases of VKDB associated with prophylaxis refusal. Methods Chart reviews were conducted at Nashville-area hospitals for 2011–2013 and Tennessee birthing centers for 2013 to identify parents who had refused injectable vitamin K for their infants. Contact information was obtained for parents, and they were surveyed regarding their reasons for refusing. Results At hospitals, 3.0% of infants did not receive injectable vitamin K due to parental refusal in 2013, a frequency higher than in 2011 and 2012. This percentage was much higher at birthing centers, where 31% of infants did not receive injectable vitamin K. The most common responses for refusal were a belief that the injection was unnecessary (53%) and a desire for a natural birthing process (36%). Refusal of other preventive services was common, with 66% of families refusing vitamin K, newborn eye care with erythromycin, and the neonatal dose of hepatitis B vaccine. Conclusions for Practice Refusal of injectable vitamin K was more common among families choosing to give birth at birthing centers than at hospitals, and was related to refusal of other preventive services in our study. Surveillance of vitamin K refusal rates could assist in further understanding this occurrence and tailoring effective strategies for mitigation. PMID:28054156

Prostate Cancer Patients' Refusal of Cancer-Directed Surgery: A Statewide Analysis

PubMed Central

Islam, K. M.

2015-01-01

Introduction. Prostate cancer is the most common cancer among men in USA. The surgical outcomes of prostate cancer remain inconsistent. Barriers such as socioeconomic factors may play a role in patients' decision of refusing recommended cancer-directed surgery. Methods. The Nebraska Cancer Registry data was used to calculate the proportion of prostate cancer patients recommended the cancer-directed surgery and the surgery refusal rate. Multivariate logistic regression was applied to analyze the socioeconomic indicators that were related to the refusal of surgery. Results. From 1995 to 2012, 14,876 prostate cancer patients were recommended to undergo the cancer-directed surgery in Nebraska, and 576 of them refused the surgery. The overall refusal rate of surgery was 3.9% over the 18 years. Patients with early-stage prostate cancer were more likely to refuse the surgery. Patients who were Black, single, or covered by Medicaid/Medicare had increased odds of refusing the surgery. Conclusion. Socioeconomic factors were related to the refusal of recommended surgical treatment for prostate cancer. Such barriers should be addressed to improve the utilization of surgical treatment and patients' well-being. PMID:25973276

Risk taking and refusal assertiveness in a longitudinal model of alcohol use among inner-city adolescents.

PubMed

Epstein, J A; Griffin, K W; Botvin, G J

2001-09-01

Risk taking and refusal assertiveness have been shown to be important determinants of adolescent alcohol use. However, it remains unclear whether youth predisposed to risk taking would be less likely to assertively refuse. This study examined the relationships among risk taking, refusal assertiveness, and alcohol use in a sample of inner-city minority students (N = 1,459), using a cross-lagged longitudinal structural equation model. Data collectors administered the questionnaire to students following a standardized protocol during a 40-min class period. Based on the tested model, risk taking was more stable over time than refusal assertiveness. Furthermore, high risk takers reported less frequent subsequent refusal assertiveness, and less frequent refusal assertiveness predicted greater drinking. A predisposition toward risk taking appears to be an enduring characteristic that is associated with low refusal assertiveness and increased alcohol use. These findings suggest that alcohol prevention programs that emphasize refusal skills training may be less effective for high risk takers. But programs that focus on enhancing competence or reducing normative expectations for peer alcohol use might be more effective for high risk-taking youth.

49 CFR 219.213 - Unlawful refusals; consequences.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Unlawful refusals; consequences. 219.213 Section 219.213 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD... § 219.213 Unlawful refusals; consequences. (a) Disqualification. An employee who refuses to cooperate in...

Children of divorce: the differential diagnosis of contact refusal.

PubMed

Freeman, Bradley W

2011-07-01

Contact refusal is a common phenomenon that can occur during the course of, or after, divorce, which affects the relationship between a child and the parent. This article defines the concept of contact refusal and discusses the importance of its recognition. The concept is further narrowed to focus on the child as the one refusing contact, not the parent, which can happen as well. Various types of contact refusals are illustrated in the article through clinical vignettes, and an approach to categorizing the various types of contact refusal is presented. Copyright © 2011 Elsevier Inc. All rights reserved.

Refusal of Medical and Surgical Interventions by Older Persons with Advanced Chronic Disease

PubMed Central

Van Ness, Peter H.; O’Leary, John R.; Fried, Terri R.

2007-01-01

BACKGROUND Patients with advanced chronic disease are frequently offered medical and surgical interventions with potentially large trade-offs between benefits and burdens. Little is known about the frequency or outcomes of treatment refusal among these patients. OBJECTIVE To assess the frequency of, reasons for, factors associated with, and outcomes of treatment refusal among older persons with advanced chronic disease. DESIGN Observational cohort study. PARTICIPANTS Two hundred twenty-six community-dwelling persons with advanced cancer, chronic obstructive pulmonary disease, or congestive heart failure, interviewed at least every 4 months for up to 2 years. MEASUREMENTS Participants were asked if they had refused any treatments recommended by their physicians, and why. RESULTS Thirty-six of 226 patients (16%) reported refusing 1 or more medical or surgical treatments recommended by their physician. The most frequently refused interventions were cardiac catheterization and surgery. The most common reason for refusal was fear of side effects (41%). Treatment refusal was more frequent among patients who wanted prognostic information (10% vs 2%, p = .02) or estimated their own longevity at 2 years or less (18% vs 5%, p = .02). There was an increased risk of mortality among refusers compared with non-refusers (HR 1.98, 95% CI 1.02–3.86). CONCLUSIONS Refusal of medical and surgical interventions other than medications is common among persons with advanced chronic disease, and is associated with a greater desire for, and understanding of, prognostic information. PMID:17483977

The cost of refusing treatment and equality of outcome.

PubMed Central

Savulescu, J

1998-01-01

Patients have a right to refuse medical treatment. But what should happen after a patient has refused recommended treatment? In many cases, patients receive alternative forms of treatment. These forms of care may be less cost-effective. Does respect for autonomy extend to providing these alternatives? How for does justice constrain autonomy? I begin by providing three arguments that such alternatives should not be offered to those who refuse treatment. I argue that the best argument which refusers can appeal to is based on the egalitarian principle of equality of outcome. However, this principle does not ultimately support a right to less cost-effective alternatives. I focus on Jehovah's Witnesses refusing blood and requesting alternative treatments. However, the point applies to many patients who refuse cost-effective medical care. PMID:9752624

The fear of using tramadol for pain control (tramadolophobia) among Egyptian patients with cancer.

PubMed

Alsirafy, Samy A; Saleh, Radfan N; Fawzy, Radwa; Alnagar, Ahmed A; Hammad, Ahmed M; El-Sherief, Wessam; Farag, Dina E; Radwan, Riham H

2015-01-01

The fear of using tramadol for pain control (tramadolophobia) by Egyptian patients with cancer is a frequent problem in our practice. This study was conducted to explore the prevalence of and the reasons behind tramadolophobia among Egyptian patients with cancer. A structured interview including open-ended and closed questions. The study included 178 adult patients with cancer from two cancer centers in Cairo and Sharkia, Egypt. The source of information about tramadol was a non-healthcare-related source in 168 (94 percent) patients, mainly the media (50 percent). The believed uses of tramadol were abuse related in 94 (53 percent) patients, stimulant (physical, sexual, and to boost alertness) in 59 (33 percent), and analgesic in 55 (31 percent). Twenty-six (15 percent) patients gave history of tramadol use, largely (69 percent) as a stimulant. In case tramadol was prescribed for pain control, 90 (51 percent) patients refused to take it, 59 (33 percent) patients agreed to take it with concern about addiction, and only 29 (16 percent) patients agreed without concerns. Among those who refused taking tramadol for pain, the mentioned reason of refusal was addiction-related fears in 57 percent. The stigmatization and misconceptions about tramadol may have resulted in tramadolophobia among the majority of Egyptian patients with cancer. This further complicates the barriers to cancer pain control in Egypt. Being the only available World Health Organization step-II analgesic in Egypt, interventions to overcome tramadolophobia should be taken.

Perceived Quality of Informed Refusal Process: A Cross-Sectional Study from Iranian Patients' Perspectives.

PubMed

Farzandipour, Mehrdad; Sheikhtaheri, Abbas; Sadeqi Jabali, Monireh

2015-12-01

Patients have the right to refuse their treatment; however, this refusal should be informed. We evaluated the quality of the informed refusal process in Iranian hospitals from patients' viewpoints. To this end, we developed a questionnaire that covered four key aspects of the informed refusal process including; information disclosure, voluntariness, comprehension, and provider-patient relationship. A total of 284 patients who refused their treatment from 12 teaching hospitals in the Isfahan Province, Iran, were recruited and surveyed to produce a convenience sample. Patients' perceptions about the informed refusal process were scored and the mean scores of the four components were calculated. The findings showed that the practice of information disclosure (9.6 ± 6.4 out of 22 points) was perceived to be moderate, however, comprehension (2.3 ± 1.4 out of 4 points), voluntariness (8.7 ± 1.5 out of 12 points) and provider-patient relationship (10.2 ± 5.2 out of 16 points) were perceived to be relatively good. We found that patients, who refused their care before any treatment had commenced, reported a lower quality of information disclosure and voluntariness. Patients informed by nurses and those who had not had a previous related admission, reported lower scores for comprehension and relationship. In conclusion, the process of obtaining informed refusal was relatively satisfactory except for levels of information disclosure. To improve current practices, Iranian patients need to be better informed about; different treatment options, consequences of treatment refusal, costs of not continuing treatment and follow-ups after refusal. Developing more informative refusal forms is needed. © 2014 John Wiley & Sons Ltd.

Refusal of treatment in obstetrics - A maternal-fetal conflict.

PubMed

Ohel, Iris; Iris, Ohel; Levy, Amalia; Amalia, Levy; Mazor, Moshe; Moshe, Mazor; Wiznitzer, Arnon; Arnon, Wiznitzer; Sheiner, Eyal; Eyal, Sheiner

2009-07-01

Clinical studies about the necessity of standard obstetric interventions raise questions, making refusal by pregnant women of treatment a legitimate choice. The present study was aimed at characterising patients refusing medical treatment during pregnancy and delivery, and to examine whether refusal of treatment in obstetrics is associated with adverse perinatal outcome. A population-based study, comparing patients who refused (1898) and did not refuse (164,064) medical intervention during pregnancy and delivery, was conducted. Deliveries occurred between the years 1988 and 2002 in a tertiary medical centre. Patients refusing medical intervention tended to be older (30.5 +/- 5.0 vs. 28.4 +/- 5.9, p < 0.001) and of higher parity (above parity 5: 52.5% vs. 32.4%; parity 1: 10.2% vs. 20.0%; p < 0.001) than the controls. Parturients refusing medical treatment experienced significantly higher rates of adverse perinatal outcome including low Apgar scores (less than 7, in 1 and 5 min: 12.4% vs. 4.4%, p < 0.001 and 1.9% vs. 0.6%, p < 0.001, respectively). Moreover, higher rates of perinatal mortality in general and intra-partum death, in particular, were documented among women refusing medical treatment (3.3% vs. 1.5%, p < 0.001; 0.8% vs. 0.1%, p < 0.001). When using a multiple logistic regression model of risk factors for perinatal mortality, refuse of treatment was an independent risk factor for perinatal mortality (OR = 1.5; 95% CI = 1.1-2.0; p = 0.010). Patients refusing a medically indicated intervention have higher rates of pregnancy- and labour- related complications. Refusal of treatment is an independent risk factor for perinatal mortality.

Central Nervous System Disease, Education, and Race Impact Radiation Refusal in Pediatric Cancer Patients.

PubMed

Patel, Chirayu G; Stavas, Mark; Perkins, Stephanie; Shinohara, Eric T

2017-07-01

To investigate the determinants of radiation therapy refusal in pediatric cancer, we used the Surveillance, Epidemiology, and End Results registry to identify 24,421 patients who met the eligibility criteria, diagnosed between 1974 and 2012. Patients had any stage of cancer, were aged 0 to 19, and received radiation therapy or refused radiation therapy when it was recommended. One hundred twenty-eight patients (0.52%) refused radiation therapy when it was recommended. Thirty-two percent of patients who refused radiation therapy ultimately died from their cancer, at a median of 7 months after diagnosis (95% confidence interval, 3-11 mo), as compared with 29.0% of patients who did not refuse radiation therapy died from their cancer, at a median of 17 months after diagnosis (95% confidence interval, 17-18 mo). On multivariable analysis, central nervous system (CNS) site, education, and race were associated with radiation refusal. The odds ratio for radiation refusal for patients with CNS disease was 1.62 (P=0.009) as compared with patients without CNS disease. For patients living in a county with ≥10% residents having less than ninth grade education, the odds ratio for radiation refusal was 1.71 (P=0.008) as compared with patients living in a county with <10% residents having less than ninth grade education. Asian, Pacific Islander, Alaska Native, and American Indian races had an odds ratio of 2.12 (P=0.002) for radiation refusal as compared with black or white race. Although the radiation refusal rate in the pediatric cancer population is low, we show that CNS site, education level, and race are associated with a significant difference in radiation refusal.

Refusal of curative radiation therapy and surgery among patients with cancer.

PubMed

Aizer, Ayal A; Chen, Ming-Hui; Parekh, Arti; Choueiri, Toni K; Hoffman, Karen E; Kim, Simon P; Martin, Neil E; Hu, Jim C; Trinh, Quoc-Dien; Nguyen, Paul L

2014-07-15

Surgery and radiation therapy represent the only curative options for many patients with solid malignancies. However, despite the recommendations of their physicians, some patients refuse these therapies. This study characterized factors associated with refusal of surgical or radiation therapy as well as the impact of refusal of recommended therapy on patients with localized malignancies. We used the Surveillance, Epidemiology, and End Results program to identify a population-based sample of 925,127 patients who had diagnoses of 1 of 8 common malignancies for which surgery and/or radiation are believed to confer a survival benefit between 1995 and 2008. Refusal of oncologic therapy, as documented in the SEER database, was the primary outcome measure. Multivariable logistic regression was used to investigate factors associated with refusal. The impact of refusal of therapy on cancer-specific mortality was assessed with Fine and Gray's competing risks regression. In total, 2441 of 692,938 patients (0.4%) refused surgery, and 2113 of 232,189 patients (0.9%) refused radiation, despite the recommendations of their physicians. On multivariable analysis, advancing age, decreasing annual income, nonwhite race, and unmarried status were associated with refusal of surgery, whereas advancing age, decreasing annual income, Asian American race, and unmarried status were associated with refusal of radiation (P<.001 in all cases). Refusal of surgery and radiation were associated with increased estimates of cancer-specific mortality for all malignancies evaluated (hazard ratio [HR], 2.80, 95% confidence interval [CI], 2.59-3.03; P<.001 and HR 1.97 [95% CI, 1.78-2.18]; P<.001, respectively). Nonwhite, less affluent, and unmarried patients are more likely to refuse curative surgical and/or radiation-based oncologic therapy, raising concern that socioeconomic factors may drive some patients to forego potentially life-saving care. Copyright © 2014 Elsevier Inc. All rights reserved.

Refusal of Curative Radiation Therapy and Surgery Among Patients With Cancer

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

Aizer, Ayal A., E-mail: aaaizer@partners.org; Chen, Ming-Hui; Parekh, Arti

Purpose: Surgery and radiation therapy represent the only curative options for many patients with solid malignancies. However, despite the recommendations of their physicians, some patients refuse these therapies. This study characterized factors associated with refusal of surgical or radiation therapy as well as the impact of refusal of recommended therapy on patients with localized malignancies. Methods and Materials: We used the Surveillance, Epidemiology, and End Results program to identify a population-based sample of 925,127 patients who had diagnoses of 1 of 8 common malignancies for which surgery and/or radiation are believed to confer a survival benefit between 1995 and 2008.more » Refusal of oncologic therapy, as documented in the SEER database, was the primary outcome measure. Multivariable logistic regression was used to investigate factors associated with refusal. The impact of refusal of therapy on cancer-specific mortality was assessed with Fine and Gray's competing risks regression. Results: In total, 2441 of 692,938 patients (0.4%) refused surgery, and 2113 of 232,189 patients (0.9%) refused radiation, despite the recommendations of their physicians. On multivariable analysis, advancing age, decreasing annual income, nonwhite race, and unmarried status were associated with refusal of surgery, whereas advancing age, decreasing annual income, Asian American race, and unmarried status were associated with refusal of radiation (P<.001 in all cases). Refusal of surgery and radiation were associated with increased estimates of cancer-specific mortality for all malignancies evaluated (hazard ratio [HR], 2.80, 95% confidence interval [CI], 2.59-3.03; P<.001 and HR 1.97 [95% CI, 1.78-2.18]; P<.001, respectively). Conclusions: Nonwhite, less affluent, and unmarried patients are more likely to refuse curative surgical and/or radiation-based oncologic therapy, raising concern that socioeconomic factors may drive some patients to forego potentially life-saving care.« less

The Secret Drama at the Patient's Bedside-Refusal of Treatment Because of the Practitioner's Ethnic Identity: The Medical Staff 's Point of View.

PubMed

Popper-Giveon, Ariela; Keshet, Yael

2018-04-01

Patients' refusal of treatment based on the practitioner's ethnic identity reveals a clash of values: neutrality in medicine versus patient-centered care. Taking the Israeli-Palestinian conflict into account, this article aims at examining Israeli health care professionals' points of view concerning patients' refusal of treatment because of a practitioner's ethnic identity. Fifty in-depth interviews were conducted with 10 managers and 40 health care professionals, Jewish and Arab, employed at 11 public hospitals. Most refusal incidents recorded are unidirectional: Jewish patients refusing to be treated by Arab practitioners. Refusals are usually directed toward nurses and junior medical staff members, especially if recognizable as religious Muslims. Refusals are often initiated by the patients' relatives and occur more frequently during periods of escalation in the conflict. The structural competency approach can be applied to increase awareness of the role of social determinants in shaping patients' ethnic-based treatment refusals and to improve the handling of such incidents.

Immunofluorescence Approach to the Study of the Ecology of Thermoplasma acidophilum In Coal Refuse Material

PubMed Central

Bohlool, B. B.; Brock, T. D.

1974-01-01

Specific immunofluorescence staining was applied to the study of the localization, distribution, and growth of Thermoplasma acidophilum in its natural habitat, the coal refuse pile. Different antigenic groups of T. acidophilum could be isolated from the same refuse pile, and the same antigenic groups were isolated from piles from different geographical areas. No correlation could be established between the antigenic groups and the pH or temperature of the habitats. Brightly fluorescing cells of T. acidophilum were detected on microscope slides buried in contact with the coal refuse material or immersed in the water in the stream draining a refuse pile. T. acidophilum grew when inoculated into either coal refuse material and/or an aqueous extract of coal refuse when incubated at its optimal temperature of 55 C, but not when incubated at room temperature or 37 C. The coal refuse pile appears to be a primary habitat for T. acidophilum. PMID:4602306

A plea for uniform European definitions for organ donor potential and family refusal rates.

PubMed

Jansen, Nichon E; Haase-Kromwijk, Bernadette J J M; van Leiden, Hendrik A; Weimar, Willem; Hoitsma, Andries J

2009-11-01

Conversion of potential organ donors to actual donors is negatively influenced by family refusals. Refusal rates differ strongly among countries. Is it possible to compare refusal rates in order to be able to learn from countries with the best practices? We searched in the literature for reviews of donor potential and refusal rates for organ donation in intensive care units. We found 14 articles pertinent to this study. There is an enormous diversity among the performed studies. The definitions of potential organ donors and family refusal differed substantially. We tried to re-calculate the refusal rates. This method failed because of the influence caused by the registered will on donation in the Donor Register. We therefore calculated the total refusal rate. This strategy was also less satisfactory considering possible influence of the legal consent system on the approach of family. Because of lack of uniform definitions, we can conclude that the refusal rates for organ donation can not be used for a sound comparison among countries. To be able to learn from well-performing countries, it is necessary to establish uniform definitions regarding organ donation and registration of all intensive care deaths.

Influenza vaccine refusal in Israeli young adults.

PubMed

Balicer, Ran D; Grotto, Itamar; Huerta, Michael; Levian, Yardena; Davidovitch, Nadav

2007-10-01

The purpose of this study was to identify correlates of noncompliance with influenza immunization among young adults and to determine the reasons leading to immunization refusal. Self-administered questionnaires were distributed in 10 military bases during two consecutive annual Israel Defense Force influenza vaccination campaigns. Multivariate logistic regression was performed to identify independent correlates. Of 2,000 questionnaires distributed over two seasons, 942 were completed and returned. Of those, 401 respondents were not vaccinated either because of medical contraindication or for administrative reasons. The remaining 541 respondents who reported either receiving the vaccine or refusing to receive it were analyzed. Risk groups for vaccine refusal included older age (17.9% vs. 3.5% refusal rate) and officer rank (25.9% vs. 13.8% refusal rate). The main reasons for vaccine refusal differed significantly between officers and nonofficers (chi2 = 7.587, p = 0.023). Officers refused mainly (60%) because of fear of possible vaccine adverse effects, whereas nonofficers refused mainly (44.2%) because of disbelief in the vaccine's efficacy in preventing illness. Officers serve as a negative role model in this case, and efforts directed toward dissemination of evidence-based information regarding vaccine-related adverse effects should be introduced to increase vaccination rates in this group.

Outcomes of nighttime refusal of admission to the intensive care unit: The role of the intensivist in triage.

PubMed

Hinds, Nicholas; Borah, Amit; Yoo, Erika J

2017-06-01

To compare outcomes of patients refused medical intensive care unit (MICU) admission overnight to those refused during the day and to examine the impact of the intensivist in triage. Retrospective, observational study of patients refused MICU admission at an urban university hospital. Of 294 patients, 186 (63.3%) were refused admission overnight compared to 108 (36.7%) refused during the day. Severity-of-illness by the Mortality Probability Model was similar between the two groups (P=.20). Daytime triage refusals were more likely to be staffed by an intensivist (P=.01). After risk-adjustment, daytime refusals had a lower odds of subsequent ICU admission (OR 0.46, 95% CI 0.22-0.95, P=.04) than patients triaged at night. There was no evidence for interaction between time of triage and intensivist staffing of the patient (P=.99). Patients refused MICU admission overnight are more likely to be later admitted to an ICU than patients refused during the day. However, the mechanism for this observation does not appear to depend on the intensivist's direct evaluation of the patient. Further investigation into the clinician-specific effects of ICU triage and identification of potentially modifiable hospital triage practices will help to improve both ICU utilization and patient safety. Copyright © 2017 Elsevier Inc. All rights reserved.

Physicians' evaluations of patients' decisions to refuse oncological treatment

PubMed Central

van Kleffens, T; van Leeuwen, E

2005-01-01

Objective: To gain insight into the standards of rationality that physicians use when evaluating patients' treatment refusals. Design of the study: Qualitative design with indepth interviews. Participants: The study sample included 30 patients with cancer and 16 physicians (oncologists and general practitioners). All patients had refused a recommended oncological treatment. Results: Patients base their treatment refusals mainly on personal values and/or experience. Physicians mainly emphasise the medical perspective when evaluating patients' treatment refusals. From a medical perspective, a patient's treatment refusal based on personal values and experience is generally evaluated as irrational and difficult to accept, especially when it concerns a curative treatment. Physicians have a different attitude towards non-curative treatments and have less difficulty accepting a patient's refusal of these treatments. Thus, an important factor in the physician's evaluation of a treatment refusal is whether the treatment refused is curative or non-curative. Conclusion: Physicians mainly use goal oriented and patients mainly value oriented rationality, but in the case of non-curative treatment refusal, physicians give more emphasis to value oriented rationality. A consensus between the value oriented approaches of patient and physician may then emerge, leading to the patient's decision being understood and accepted by the physician. The physician's acceptance is crucial to his or her attitude towards the patient. It contributes to the patient's feeling free to decide, and being understood and respected, and thus to a better physician–patient relationship. PMID:15738431

Refusal of Vitamin K by Parents of Newborns: A Survey of the Better Outcomes Through Research for Newborns Network

PubMed Central

Loyal, Jaspreet; Taylor, James A.; Phillipi, Carrie A.; Goyal, Neera K.; Dhepyasuwan, Niramol; Shapiro, Eugene D.; Colson, Eve

2018-01-01

Objective To survey newborn clinicians in the United States regarding the frequency of intramuscular (IM) vitamin K refusal by a parent, reasons for refusal, and approaches of clinicians to refusals. Methods An electronic survey was administered to the clinician site representative (nursery director or designee knowledgeable about site-specific nursery policies) at all newborn nurseries in the Better Outcomes through Research for Newborns (BORN) network of newborn nurseries. Results Of 92 BORN sites, 85 (92%) respondents completed the survey. Frequency of IM vitamin K refusal during the past 5 years was reported as increased by 52% of respondents, unchanged by 42%, and 6% did not know. Reported frequencies of refusal of IM vitamin K was weekly (9%), a few times a month (31%), once a month (13%), once every 3 to 4 months (20%), once or twice a year (26%), or never (1%). The overall distribution of the reported frequencies of refusal differed among regions in the United States (higher in the West and the South; P < .05). Reported reasons for refusal by parents included perceptions of parents that the injection was unnecessary, lack of knowledge about vitamin K deficiency bleeding, and concern about preservatives. Approaches to refusal included attempts to educate parents, enlisting support from community clinicians, a state mandate, and prescription of oral vitamin K. Conclusions Respondents from a national sample of newborn nursery clinicians reported an increase in refusal of IM vitamin K in the past 5 years with regional variation. Approaches to refusals need further investigation to determine effectiveness. PMID:28277269

30 CFR 77.215-1 - Refuse piles; identification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; identification. 77.215-1 Section... COAL MINES Surface Installations § 77.215-1 Refuse piles; identification. A permanent identification marker, at least six feet high and showing the refuse pile identification number as assigned by the...

76 FR 29796 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Refuse...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-23

... for OMB Review; Comment Request; Refuse Piles and Impounding Structures, Recordkeeping and Reporting... Administration (MSHA) sponsored information collection request (ICR) titled, ``Refuse Piles and Impounding... to submit annual reports and certification on refuse piles and impoundments to the agency and to keep...

21 CFR 316.14 - Refusal to provide written recommendations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Refusal to provide written recommendations. 316.14... (CONTINUED) DRUGS FOR HUMAN USE ORPHAN DRUGS Written Recommendations for Investigations of Orphan Drugs § 316.14 Refusal to provide written recommendations. (a) FDA may refuse to provide written recommendations...

37 CFR 1.295 - Review of decision finally refusing to publish a statutory invention registration.

Code of Federal Regulations, 2010 CFR

2010-07-01

... refusing to publish a statutory invention registration. 1.295 Section 1.295 Patents, Trademarks, and... decision finally refusing to publish a statutory invention registration. (a) Any requester who is dissatisfied with the final refusal to publish a statutory invention registration for reasons other than...

22 CFR 42.81 - Procedure in refusing individual visas.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Procedure in refusing individual visas. 42.81 Section 42.81 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE... Procedure in refusing individual visas. (a) Issuance or refusal mandatory. When a visa application has been...

22 CFR 42.81 - Procedure in refusing individual visas.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Procedure in refusing individual visas. 42.81 Section 42.81 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE... Procedure in refusing individual visas. (a) Issuance or refusal mandatory. When a visa application has been...

22 CFR 41.121 - Refusal of individual visas.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Refusal of individual visas. 41.121 Section 41.121 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Refusals and Revocations § 41.121 Refusal of individual visas. (a...

22 CFR 41.121 - Refusal of individual visas.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Refusal of individual visas. 41.121 Section 41.121 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Refusals and Revocations § 41.121 Refusal of individual visas. (a...

22 CFR 42.81 - Procedure in refusing individual visas.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Procedure in refusing individual visas. 42.81 Section 42.81 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE... Procedure in refusing individual visas. (a) Issuance or refusal mandatory. When a visa application has been...

22 CFR 42.81 - Procedure in refusing individual visas.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Procedure in refusing individual visas. 42.81 Section 42.81 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE... Procedure in refusing individual visas. (a) Issuance or refusal mandatory. When a visa application has been...

22 CFR 42.81 - Procedure in refusing individual visas.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Procedure in refusing individual visas. 42.81 Section 42.81 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE... Procedure in refusing individual visas. (a) Issuance or refusal mandatory. When a visa application has been...

22 CFR 41.121 - Refusal of individual visas.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Refusal of individual visas. 41.121 Section 41.121 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Refusals and Revocations § 41.121 Refusal of individual visas. (a...

22 CFR 41.121 - Refusal of individual visas.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Refusal of individual visas. 41.121 Section 41.121 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Refusals and Revocations § 41.121 Refusal of individual visas. (a...

22 CFR 41.121 - Refusal of individual visas.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Refusal of individual visas. 41.121 Section 41.121 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Refusals and Revocations § 41.121 Refusal of individual visas. (a...

9 CFR 439.50 - Refusal of accreditation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ACCREDITATION OF NON-FEDERAL CHEMISTRY LABORATORIES § 439.50 Refusal of accreditation. Upon a determination by the Administrator, a laboratory will be refused accreditation for the following reasons: (a) A laboratory will be refused accreditation for failure to meet the requirements of § 439.5 or § 439.10 of this...

42 CFR 493.567 - Refusal to cooperate with validation inspection.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Refusal to cooperate with validation inspection... § 493.567 Refusal to cooperate with validation inspection. (a) Laboratory with a certificate of accreditation. (1) A laboratory with a certificate of accreditation that refuses to cooperate with a validation...

42 CFR 493.567 - Refusal to cooperate with validation inspection.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Refusal to cooperate with validation inspection... § 493.567 Refusal to cooperate with validation inspection. (a) Laboratory with a certificate of accreditation. (1) A laboratory with a certificate of accreditation that refuses to cooperate with a validation...

42 CFR 493.567 - Refusal to cooperate with validation inspection.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Refusal to cooperate with validation inspection... § 493.567 Refusal to cooperate with validation inspection. (a) Laboratory with a certificate of accreditation. (1) A laboratory with a certificate of accreditation that refuses to cooperate with a validation...

42 CFR 493.567 - Refusal to cooperate with validation inspection.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Refusal to cooperate with validation inspection... § 493.567 Refusal to cooperate with validation inspection. (a) Laboratory with a certificate of accreditation. (1) A laboratory with a certificate of accreditation that refuses to cooperate with a validation...

42 CFR 493.567 - Refusal to cooperate with validation inspection.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Refusal to cooperate with validation inspection... § 493.567 Refusal to cooperate with validation inspection. (a) Laboratory with a certificate of accreditation. (1) A laboratory with a certificate of accreditation that refuses to cooperate with a validation...

Method of extracting coal from a coal refuse pile

DOEpatents

Yavorsky, Paul M.

1991-01-01

A method of extracting coal from a coal refuse pile comprises soaking the coal refuse pile with an aqueous alkali solution and distributing an oxygen-containing gas throughout the coal refuse pile for a time period sufficient to effect oxidation of coal contained in the coal refuse pile. The method further comprises leaching the coal refuse pile with an aqueous alkali solution to solubilize and extract the oxidized coal as alkali salts of humic acids and collecting the resulting solution containing the alkali salts of humic acids. Calcium hydroxide may be added to the solution of alkali salts of humic acid to form precipitated humates useable as a low-ash, low-sulfur solid fuel.

Effective pine bark composting with the Dome Aeration Technology

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

Trois, Cristina; Polster, Andreas

2007-07-01

In South Africa garden refuse is primarily disposed of in domestic landfills. Due to the large quantities generated, any form of treatment would be beneficial for volume reduction, waste stabilization and resource recovery. Dome Aeration Technology (DAT) is an advanced process for aerobic biological degradation of garden refuse and general waste [Paar, S., Brummack, J., Gemende, B., 1999a. Advantages of dome aeration in mechanical-biological waste treatment. In: Proceedings of the 7th International Waste Management and Landfill Symposium, Cagliari, 4-8 October 1999; Paar, S., Brummack, J., Gemende, B., 1999b. Mechanical-biological waste stabilization by the dome aeration method. Environment Protection Engineering 25more » (3/99). Mollekopf, N., Brummack, J., Paar, S., Vorster, K., 2002. Use of the Dome Aeration Technology for biochemical stabilization of waste prior to landfilling. In: Proceedings of the Wastecon 2002, Waste Congress and Exhibition, Durban, South Africa.]. It is a non-reactor open windrow composting process, with the main advantage being that the input material needs no periodic turning. A rotting time of only 3-4 months indicates the high efficiency. Additionally, the low capital/operational costs, low energy inputs and limited plant requirements provide potential for use in aerobic refuse stabilization. The innovation in the DAT process is the passive aeration achieved by thermally driven advection through open windrows caused by temperature differences between the degrading material and the outside environment. This paper investigates the application of Dome Aeration Technology to pine bark composting as part of an integrated waste management strategy. A full-scale field experiment was performed at the Bisasar Road Landfill Site in Durban to assess the influence of climate, waste composition and operational conditions on the process. A test windrow was constructed and measurements of temperature and airflow through the material were taken. The process monitoring revealed that prevailing climatic conditions in a subtropical location do not affect the high efficiency of this technology. However, the composition of the input material can be detrimental for production of high quality compost because of a lack of nitrate.« less

Public evaluation of open space in Illinois: citizen support for natural area acquisition.

PubMed

Backlund, Erik A; Stewart, William P; McDonald, Cary; Miller, Craig

2004-11-01

Numerous studies have indicated a broad-based support for open space preservation and protection. Research also has characterized the public values and rationale that underlie the widespread support for open space. In recognition of the widespread public support for open space, various levels of government have implemented programs to provide public access to open space. There are many different types of open space, ranging from golf courses, ball parks, wildlife areas, and prairies, to name a few. This paper addresses questions related to the types of open space that should be prioritized by planners and natural resource managers. The results of this study are based on a stratified random sample of 5000 households in Illinois that were sent a questionnaire related to their support for various types of open space. Through a comparatively simple action grid analysis, the open space types that should be prioritized for public access include forest areas, stream corridors, wildlife habitat, and lakes/ponds. These were the open space types rated of the highest importance, yet were also the open space types rated the lowest in respondent satisfaction. This kind of analysis does not require the technical expertise of other options for land-use prioritizations (e.g., conjoint analysis, contingent valuation), yet provides important policy directives for planners. Although open space funds often allow for purchase of developed sites such as golf courses, ball parks, and community parks, this study indicates that undeveloped (or nature-based) open space lands are most needed in Illinois.

Parental Refusal of Childhood Vaccines and Medical Neglect Laws.

PubMed

Parasidis, Efthimios; Opel, Douglas J

2017-01-01

To examine the relation of vaccine refusal and medical neglect under child welfare laws. We used the Westlaw legal database to search court opinions from 1905 to 2016 and identified cases in which vaccine refusal was the sole or a primary reason in a neglect proceeding. We also delineated if religious or philosophical exemptions from required school immunizations were available at the time of adjudication. Our search yielded 9 cases from 5 states. Most courts (7 of 9) considered vaccine refusal to constitute neglect. In the 4 cases decided in jurisdictions that permitted religious exemptions, courts either found that vaccine refusal did not constitute neglect or considered it neglect only in the absence of a sincere religious objection to vaccination. Some states have a legal precedent for considering parental vaccine refusal as medical neglect, but this is based on a small number of cases. Each state should clarify whether, under its laws, vaccine refusal constitutes medical neglect.

Parental Vaccine Acceptance: A Logistic Regression Model Using Previsit Decisions.

PubMed

Lee, Sara; Riley-Behringer, Maureen; Rose, Jeanmarie C; Meropol, Sharon B; Lazebnik, Rina

2017-07-01

This study explores how parents' intentions regarding vaccination prior to their children's visit were associated with actual vaccine acceptance. A convenience sample of parents accompanying 6-week-old to 17-year-old children completed a written survey at 2 pediatric practices. Using hierarchical logistic regression, for hospital-based participants (n = 216), vaccine refusal history ( P < .01) and vaccine decision made before the visit ( P < .05) explained 87% of vaccine refusals. In community-based participants (n = 100), vaccine refusal history ( P < .01) explained 81% of refusals. Over 1 in 5 parents changed their minds about vaccination during the visit. Thirty parents who were previous vaccine refusers accepted current vaccines, and 37 who had intended not to vaccinate choose vaccination. Twenty-nine parents without a refusal history declined vaccines, and 32 who did not intend to refuse before the visit declined vaccination. Future research should identify key factors to nudge parent decision making in favor of vaccination.

30 CFR 77.215-2 - Refuse piles; reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; reporting requirements. 77.215-2... COAL MINES Surface Installations § 77.215-2 Refuse piles; reporting requirements. (a) The proposed location of a new refuse pile shall be reported to and acknowledged in writing by the District Manager...

38 CFR 17.100 - Refusal of treatment by unnecessarily breaking appointments.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Refusal of treatment by... VETERANS AFFAIRS MEDICAL Breaking Appointments § 17.100 Refusal of treatment by unnecessarily breaking... informed that breaking an additional appointment will be deemed to be a refusal to accept VA treatment. If...

Alternative Fuels Data Center: Renewable Natural Gas From Landfill Powers

Science.gov Websites

Refuse Vehicles Renewable Natural Gas From Landfill Powers Refuse Vehicles to someone by E-mail Share Alternative Fuels Data Center: Renewable Natural Gas From Landfill Powers Refuse Vehicles on Facebook Tweet about Alternative Fuels Data Center: Renewable Natural Gas From Landfill Powers Refuse

22 CFR 40.6 - Basis for refusal.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Basis for refusal. 40.6 Section 40.6 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH NONIMMIGRANTS AND IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED General Provisions § 40.6 Basis for refusal. A visa can be refused...

25 CFR 135.23 - Refusal of water delivery.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Refusal of water delivery. 135.23 Section 135.23 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES CONSTRUCTION ASSESSMENTS, CROW... District § 135.23 Refusal of water delivery. The right is reserved to refuse the delivery of water to any...

25 CFR 135.6 - Refusal of water delivery.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Refusal of water delivery. 135.6 Section 135.6 Indians... INDIAN IRRIGATION PROJECT Charges Assessed Against Irrigation District Lands § 135.6 Refusal of water delivery. The right is reserved to the United States to refuse the delivery of water to each of the said...

9 CFR 98.9 - Embryos refused entry.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Embryos refused entry. 98.9 Section 98... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.9 Embryos refused entry. Any embryo refused entry into the...

9 CFR 98.9 - Embryos refused entry.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Embryos refused entry. 98.9 Section 98... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.9 Embryos refused entry. Any embryo refused entry into the...

9 CFR 98.9 - Embryos refused entry.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Embryos refused entry. 98.9 Section 98... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.9 Embryos refused entry. Any embryo refused entry into the...

9 CFR 98.9 - Embryos refused entry.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Embryos refused entry. 98.9 Section 98... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.9 Embryos refused entry. Any embryo refused entry into the...

9 CFR 98.9 - Embryos refused entry.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Embryos refused entry. 98.9 Section 98... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.9 Embryos refused entry. Any embryo refused entry into the...

25 CFR 135.6 - Refusal of water delivery.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Refusal of water delivery. 135.6 Section 135.6 Indians... INDIAN IRRIGATION PROJECT Charges Assessed Against Irrigation District Lands § 135.6 Refusal of water delivery. The right is reserved to the United States to refuse the delivery of water to each of the said...

25 CFR 135.23 - Refusal of water delivery.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Refusal of water delivery. 135.23 Section 135.23 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES CONSTRUCTION ASSESSMENTS, CROW... District § 135.23 Refusal of water delivery. The right is reserved to refuse the delivery of water to any...

21 CFR 211.50 - Sewage and refuse.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Sewage and refuse. 211.50 Section 211.50 Food and... CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Buildings and Facilities § 211.50 Sewage and refuse. Sewage, trash, and other refuse in and from the building and immediate premises shall be...

25 CFR 135.6 - Refusal of water delivery.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Refusal of water delivery. 135.6 Section 135.6 Indians... INDIAN IRRIGATION PROJECT Charges Assessed Against Irrigation District Lands § 135.6 Refusal of water delivery. The right is reserved to the United States to refuse the delivery of water to each of the said...

25 CFR 135.23 - Refusal of water delivery.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Refusal of water delivery. 135.23 Section 135.23 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES CONSTRUCTION ASSESSMENTS, CROW... District § 135.23 Refusal of water delivery. The right is reserved to refuse the delivery of water to any...

25 CFR 135.6 - Refusal of water delivery.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Refusal of water delivery. 135.6 Section 135.6 Indians... INDIAN IRRIGATION PROJECT Charges Assessed Against Irrigation District Lands § 135.6 Refusal of water delivery. The right is reserved to the United States to refuse the delivery of water to each of the said...

25 CFR 135.23 - Refusal of water delivery.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Refusal of water delivery. 135.23 Section 135.23 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES CONSTRUCTION ASSESSMENTS, CROW... District § 135.23 Refusal of water delivery. The right is reserved to refuse the delivery of water to any...

Intensive (Daily) Behavior Therapy for School Refusal: A Multiple Baseline Case Series

ERIC Educational Resources Information Center

Tolin, David F.; Whiting, Sara; Maltby, Nicholas; Diefenbach, Gretchen J.; Lothstein, Mary Anne; Hardcastle, Surrey; Catalano, Amy; Gray, Krista

2009-01-01

The following multiple baseline case series examines school refusal behavior in 4 male adolescents. School refusal symptom presentation was ascertained utilizing a functional analysis from the School Refusal Assessment Scale (Kearney, 2002). For the majority of cases, treatment was conducted within a 15-session intensive format over a 3-week…

Refusal Skill Ability: An Examination of Adolescent Perceptions of Effectiveness

ERIC Educational Resources Information Center

Nichols, Tracy R.; Birnel, Sara; Graber, Julia A.; Brooks-Gunn, Jeanne; Botvin, Gilbert J.

2010-01-01

This pilot study examined whether refusal assertion as defined by a proven drug prevention program was associated with adolescent perceptions of effectiveness by comparing two sets of coded responses to adolescent videotaped refusal role-plays (N = 63). The original set of codes was defined by programmatic standards of refusal assertion and the…

Social Skills, Competence, and Drug Refusal Efficacy as Predictors of Adolescent Alcohol Use.

ERIC Educational Resources Information Center

Scheier, Lawrence M.; Botvin, Gilbert J.; Diaz, Tracy; Griffin, Kenneth W.

1999-01-01

Examines the extent to which assertiveness and related social skills, personal competence, and refusal efficacy predict alcohol involvement in adolescents. Males were at higher risk for poor refusal skills and reported higher alcohol involvement. Youth characterized by poor social skill development reported lower refusal efficacy, lower grades,…

Miami-Dade County Hydraulic Hybrid Refuse Truck Testing | Transportation

Science.gov Websites

Research | NREL Miami-Dade County Hydraulic Hybrid Refuse Truck Evaluation Miami-Dade County Hydraulic Hybrid Refuse Truck Evaluation Photo of garbage truck with view of lake and city in background. As hydraulic hybrid refuse vehicles, with 29 more on order. Photo courtesy of Parker Hannifin NREL is

Alternative Fuels Data Center: Hydraulic Hybrid Pressed into Service in

Science.gov Websites

Refuse Collection Hydraulic Hybrid Pressed into Service in Refuse Collection to someone by E -mail Share Alternative Fuels Data Center: Hydraulic Hybrid Pressed into Service in Refuse Collection on Facebook Tweet about Alternative Fuels Data Center: Hydraulic Hybrid Pressed into Service in Refuse

Persian Speakers' Use of Refusal Strategies across Politeness Systems

ERIC Educational Resources Information Center

Salmani Nodoushan, Mohammad Ali

2016-01-01

This study aimed at investigating the preferred refusal strategies in Persian. 3047 refusals collected by 108 field workers as well as 376 refusals collected through face to face interviews were analyzed and classified according to the descriptions proposed by Liao (1994) and Liao and Bresnahan (1996). The frequencies of the resulting direct and…

Clinical practice guidelines of the French Association for Supportive Care in Cancer and the French Society for Psycho-oncology: refusal of treatment by adults afflicted with cancer.

PubMed

Faivre, J C; Adam, V; Block, V; Metzger, M; Salleron, J; Dauchy, S

2017-11-01

The study's purpose was to develop practical guidelines for assessment and management of refusal of treatment by adults afflicted with cancer. The French Association for Supportive Care in Cancer and the French Society for Psycho-oncology gathered a task force that applied a consensus methodology to draft guidelines studied predisposing situations, the diagnosis, regulatory aspects, and the management of refusal of treatment by adults afflicted with cancer. We propose five guidelines: (1) be aware of the conditions/profiles of patients most often associated with refusal of treatment so as to adequately underpin the care and support measures; (2) understand the complexity of the process of refusal and knowing how to accurately identify the type and the modalities of the refused treatments; (3) apply a way to systematically analyze refusal, thereby promoting progression from a situation of disaccord toward a consensual decision; (4) devise procedures, according to the legal context, to address refusal of treatment that safeguards the stakeholders in situations of sustained disaccord; and (5) know the indications for ethical collective decision-making. The quality of the relationship between patients and health professionals, and the communication between them are essential components involved in reaching a point of consent or refusal of treatment. A process of systematic analysis of refusal is recommended as the only way to ensure that all of the physiological, psychological, and contextual elements that are potentially involved are taken into account.

A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children.

PubMed

Hubbard, Kristie L; Anderson, Sarah E; Curtin, Carol; Must, Aviva; Bandini, Linda G

2014-12-01

Parents of children with autism spectrum disorder (ASD) frequently report child food refusal based on characteristics of food. Our study sought to determine whether parent report of food refusal based on the characteristics of food was greater in children with ASD than in typically developing children, associated with a greater percentage of foods refused of those offered, and associated with fruit and vegetable intake. A modified food frequency questionnaire was used to determine overall food refusal as well as fruit and vegetable intake. Parent-reported food refusal related to characteristics of food (eg, texture/consistency, temperature, brand, color, shape, taste/smell, foods mixed together, or foods touching other foods) was compared between 53 children with ASD and 58 typically developing children aged 3 to 11 years in the Children's Activity and Meal Patterns Study (2007-2008). Children with ASD were significantly more likely to refuse foods based on texture/consistency (77.4% vs 36.2%), taste/smell (49.1% vs 5.2%), mixtures (45.3% vs 25.9%), brand (15.1% vs 1.7%), and shape (11.3% vs 1.7%). No differences between groups were found for food refusal based on temperature, foods touching other foods, or color. Irrespective of ASD status, the percentage of foods refused of those offered was associated with parent reports of food refusal based on all characteristics examined, except temperature. Food refusal based on color was inversely associated with vegetable consumption in both groups. Routine screening for food refusal among children with ASD is warranted to prevent dietary inadequacies that may be associated with selective eating habits. Future research is needed to develop effective and practical feeding approaches for children with ASD. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

46 CFR 45.149 - Machinery space openings.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 2 2014-10-01 2014-10-01 false Machinery space openings. 45.149 Section 45.149 Shipping... Assignment § 45.149 Machinery space openings. (a) Machinery space openings in position 1 or 2 must be framed... funnel or machinery space ventilator that must be kept open for the essential operations of the ship must...

46 CFR 45.149 - Machinery space openings.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 2 2013-10-01 2013-10-01 false Machinery space openings. 45.149 Section 45.149 Shipping... Assignment § 45.149 Machinery space openings. (a) Machinery space openings in position 1 or 2 must be framed... funnel or machinery space ventilator that must be kept open for the essential operations of the ship must...

46 CFR 45.149 - Machinery space openings.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false Machinery space openings. 45.149 Section 45.149 Shipping... Assignment § 45.149 Machinery space openings. (a) Machinery space openings in position 1 or 2 must be framed... funnel or machinery space ventilator that must be kept open for the essential operations of the ship must...

46 CFR 45.149 - Machinery space openings.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 2 2012-10-01 2012-10-01 false Machinery space openings. 45.149 Section 45.149 Shipping... Assignment § 45.149 Machinery space openings. (a) Machinery space openings in position 1 or 2 must be framed... funnel or machinery space ventilator that must be kept open for the essential operations of the ship must...

46 CFR 45.149 - Machinery space openings.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 2 2011-10-01 2011-10-01 false Machinery space openings. 45.149 Section 45.149 Shipping... Assignment § 45.149 Machinery space openings. (a) Machinery space openings in position 1 or 2 must be framed... funnel or machinery space ventilator that must be kept open for the essential operations of the ship must...

30 CFR 817.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 3 2013-07-01 2013-07-01 false Coal mine waste: Refuse piles. 817.83 Section... ACTIVITIES § 817.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 817.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 816.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 3 2014-07-01 2014-07-01 false Coal mine waste: Refuse piles. 816.83 Section... ACTIVITIES § 816.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 816.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 817.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 3 2014-07-01 2014-07-01 false Coal mine waste: Refuse piles. 817.83 Section... ACTIVITIES § 817.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 817.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 816.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 3 2013-07-01 2013-07-01 false Coal mine waste: Refuse piles. 816.83 Section... ACTIVITIES § 816.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 816.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 817.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 3 2012-07-01 2012-07-01 false Coal mine waste: Refuse piles. 817.83 Section... ACTIVITIES § 817.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 817.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 816.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Coal mine waste: Refuse piles. 816.83 Section... ACTIVITIES § 816.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 816.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 816.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Coal mine waste: Refuse piles. 816.83 Section... ACTIVITIES § 816.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 816.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 816.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 3 2012-07-01 2012-07-01 false Coal mine waste: Refuse piles. 816.83 Section... ACTIVITIES § 816.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 816.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 817.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Coal mine waste: Refuse piles. 817.83 Section... ACTIVITIES § 817.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 817.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 817.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Coal mine waste: Refuse piles. 817.83 Section... ACTIVITIES § 817.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 817.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

School Refusal Behavior Associated with Separation Anxiety Disorder: A Cognitive-Behavioral Approach to Treatment

ERIC Educational Resources Information Center

Doobay, Alissa F.

2008-01-01

School refusal behavior can lead to disruptions in both educational attainment and social development. One of the common causes of school refusal behavior is separation anxiety disorder (SAD). Research suggests that children with SAD and school refusal behavior show an increased rate of psychiatric consultation and a decreased likelihood of…

Alternative Fuels Data Center: Virginia Cleans up With Natural Gas Refuse

Science.gov Websites

Trucks Virginia Cleans up With Natural Gas Refuse Trucks to someone by E-mail Share Alternative Fuels Data Center: Virginia Cleans up With Natural Gas Refuse Trucks on Facebook Tweet about Alternative Fuels Data Center: Virginia Cleans up With Natural Gas Refuse Trucks on Twitter Bookmark Alternative

Academic Self-Attributions for Success and Failure in Mathematics and School Refusal

ERIC Educational Resources Information Center

Gonzálvez, Carolina; Sanmartín, Ricardo; Vicent, María; Inglés, Cándido J.; Aparicio-Flores, M. Pilar; García-Fernández, José M.

2018-01-01

The aim of this research is twofold: to analyze the mean differences scores in mathematic self-attributions based on school refusal and to verify its predictive capability on high scores in school refusal. The Sydney Attribution Scale and the School Refusal Assessment Scale-Revised were administered to 1078 Spanish students (50.8% boys) aged…

Open space and imagination

Treesearch

G. Scott Place; Bruce Hronek

2001-01-01

Open space is a necessary tool in our park system for fostering creativity and allowing for relaxation. In addition, open space areas allow people to exercise, find self-worth, and to use their imagination. This manuscript addresses the issue of what is happening in open space provided in several park settings. Do residents use open space as a place where they can play...

Public demand for preserving local open space.

Treesearch

Jeffrey D. Kline

2006-01-01

Increased development results in the loss of forest, farm, range, and other open space lands that contribute to the quality of life of U.S. residents. I describe an economic rationale for growing public support for preserving local open space, based the growing scarcity of open space lands. I test the rationale empirically by correlating the prevalence of open space...

Skeletal class III malocclusion treated using a non-surgical approach supplemented with mini-implants: a case report.

PubMed

Farret, Marcel Marchiori; Benitez Farret, Milton M

2013-09-01

We describe a 28-year-old man who sought orthodontic treatment complaining about the esthetics of his smile and difficulties associated with masticatory function. The patient had a straight facial profile, skeletal and dental class III relationship, anterior open bite and posterior crossbite. He refused orthognathic surgery and was therefore treated with camouflage orthodontics supplemented with the placement of one mini-implant in each side of the mandible to facilitate movement of the lower dentition distally, tooth-by-tooth. At the end of treatment, a class I molar relationship was obtained, with an ideal overjet and overbite and excellent intercuspation. Furthermore, the open bite and crossbite were corrected. Analysis 2 years after treatment revealed good stability of treatment outcome.

A comparison of refuse attenuation in laboratory and field scale lysimeters.

PubMed

Youcai, Zhao; Luochun, Wang; Renhua, Hua; Dimin, Xu; Guowei, Gu

2002-01-01

For this study, small and middle scale laboratory lysimeters, and a large scale field lysimeter in situ in Shanghai Refuse Landfill, with refuse weights of 187,600 and 10,800,000 kg, respectively, were created. These lysimeters are compared in terms of leachate quality (pH, concentrations of COD, BOD and NH3-N), refuse composition (biodegradable matter and volatile solid) and surface settlement for a monitoring period of 0-300 days. The objectives of this study were to explore both the similarities and disparities between laboratory and field scale lysimeters, and to compare degradation behaviors of refuse at the intensive reaction phase in the different scale lysimeters. Quantitative relationships of leachate quality and refuse composition with placement time show that degradation behaviors of refuse seem to depend heavily on the scales of the lysimeters and the parameters of concern, especially in the starting period of 0-6 months. However, some similarities exist between laboratory and field lysimeters after 4-6 months of placement because COD and BOD concentrations in leachate in the field lysimeter decrease regularly in a parallel pattern with those in the laboratory lysimeters. NH3-N, volatile solid (VS) and biodegradable matter (BDM) also gradually decrease in parallel in this intensive reaction phase for all scale lysimeters as refuse ages. Though the concrete data are different among the different scale lysimeters, it may be considered that laboratory lysimeters with sufficient scale are basically applicable for a rough simulation of a real landfill, especially for illustrating the degradation pattern and mechanism. Settlement of refuse surface is roughly proportional to the initial refuse height.

Design, recruitment outcomes, and sample characteristics of the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial.

PubMed

Krebs, Erin E; Jensen, Agnes C; Nugent, Sean; DeRonne, Beth; Rutks, Indulis; Leverty, David; Gravely, Amy; Noorbaloochi, Siamak; Bair, Matthew J; Kroenke, Kurt

2017-11-01

This manuscript describes the study protocol, recruitment outcomes, and baseline participant characteristics for the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial. SPACE is a pragmatic randomized comparative effectiveness trial conducted in multiple VA primary care clinics within one VA health care system. The objective was to compare benefits and harms of opioid therapy versus non-opioid medication therapy over 12months among patients with moderate-to-severe chronic back pain or hip/knee osteoarthritis pain despite analgesic therapy; patients already receiving regular opioid therapy were excluded. Key design features include comparing two clinically-relevant medication interventions, pragmatic eligibility criteria, and flexible treat-to-target interventions. Screening, recruitment and study enrollment were conducted over 31months. A total of 4491 patients were contacted for eligibility screening; 53.1% were ineligible, 41.0% refused, and 5.9% enrolled. The most common reasons for ineligibility were not meeting pain location and severity criteria. The most common study-specific reasons for refusal were preference for no opioid use and preference for no pain medications. Of 265 enrolled patients, 25 withdrew before randomization. Of 240 randomized patients, 87.9% were male, 84.1% were white, and age range was 21-80years. Past-year mental health diagnoses were 28.3% depression, 17% anxiety, 9.4% PTSD, 7.9% alcohol use disorder, and 2.6% drug use disorder. In conclusion, although recruitment for this trial was challenging, characteristics of enrolled participants suggest we were successful in recruiting patients similar to those prescribed opioid therapy in usual care. Published by Elsevier Inc.

The silence.

PubMed

Millenson, Michael L

2003-01-01

Despite several well-crafted Institute of Medicine (IOM) reports, there remains within health care a persistent refusal to confront providers' responsibility for severe quality problems. There is a silence of deed--failing to take corrective actions--and of word--failing to discuss openly the true consequences of that inertia. These silences distort public policy, delay change, and, by leading (albeit inadvertently) to thousands of patient deaths, undermine professionalism. The IOM quality committee, to retain its moral authority, should forgo issuing more reports and instead lead an emergency corrective-action campaign comparable to Flexner's crusade against charlatan medical schools.

9 CFR 93.806 - Animals refused entry.

Code of Federal Regulations, 2014 CFR

2014-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.806 Animals refused entry. Any elephant, hippopotamus, rhinoceros, or tapir refused entry into the...

9 CFR 93.806 - Animals refused entry.

Code of Federal Regulations, 2011 CFR

2011-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.806 Animals refused entry. Any elephant, hippopotamus, rhinoceros, or tapir refused entry into the...

9 CFR 93.806 - Animals refused entry.

Code of Federal Regulations, 2010 CFR

2010-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.806 Animals refused entry. Any elephant, hippopotamus, rhinoceros, or tapir refused entry into the...

9 CFR 93.806 - Animals refused entry.

Code of Federal Regulations, 2013 CFR

2013-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.806 Animals refused entry. Any elephant, hippopotamus, rhinoceros, or tapir refused entry into the...

9 CFR 93.806 - Animals refused entry.

Code of Federal Regulations, 2012 CFR

2012-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.806 Animals refused entry. Any elephant, hippopotamus, rhinoceros, or tapir refused entry into the...

20 CFR 229.81 - Refusal to accept vocational rehabilitation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... disabled employee refuses, without good reason, to accept vocational rehabilitation services available... in which the child refuses, without good reason, to accept such vocational rehabilitation services...

20 CFR 401.70 - Appeals of refusals to correct records or refusals to allow access to records.

Code of Federal Regulations, 2010 CFR

2010-04-01

... explaining the decision on your appeal. The time limit for making our decision after we receive your appeal... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Appeals of refusals to correct records or refusals to allow access to records. 401.70 Section 401.70 Employees' Benefits SOCIAL SECURITY...

The Legal Ethical Backbone of Conscientious Refusal.

PubMed

Munthe, Christian; Nielsen, Morten Ebbe Juul

2017-01-01

This article analyzes the idea of a legal right to conscientious refusal for healthcare professionals from a basic legal ethical standpoint, using refusal to perform tasks related to legal abortion (in cases of voluntary employment) as a case in point. The idea of a legal right to conscientious refusal is distinguished from ideas regarding moral rights or reasons related to conscientious refusal, and none of the latter are found to support the notion of a legal right. Reasons for allowing some sort of room for conscientious refusal for healthcare professionals based on the importance of cultural identity and the fostering of a critical atmosphere might provide some support, if no countervailing factors apply. One such factor is that a legal right to healthcare professionals' conscientious refusal must comply with basic legal ethical tenets regarding the rule of law and equal treatment, and this requirement is found to create serious problems for those wishing to defend the idea under consideration. We conclude that the notion of a legal right to conscientious refusal for any profession is either fundamentally incompatible with elementary legal ethical requirements, or implausible because it undermines the functioning of a related professional sector (healthcare) or even of society as a whole.

Estimates and determinants of HPV non-vaccination and vaccine refusal in girls 12 to 14 y of age in Canada: Results from the Childhood National Immunization Coverage Survey, 2013

PubMed Central

Gilbert, Nicolas L.; Gilmour, Heather; Dubé, Ève; Wilson, Sarah E.; Laroche, Julie

2016-01-01

ABSTRACT Since the introduction of HPV vaccination programs in Canada in 2007, coverage has been below public health goals in many provinces and territories. This analysis investigated the determinants of HPV non-vaccination and vaccine refusal. Data from the Childhood National Immunization Coverage Survey (CNICS) 2013 were used to estimate the prevalence of HPV non-vaccination and parental vaccine refusal in girls aged 12–14 years, for Canada and the provinces and territories. Multivariate logistic regression was used to examine factors associated with non-vaccination and vaccine refusal, after adjusting for potential confounders. An estimated 27.7% of 12–14 y old girls had not been vaccinated against HPV, and 14.4% of parents reported refusing the vaccine. The magnitude of non-vaccination and vaccine refusal varied by province or territory and also by responding parent's country of birth. In addition, higher education was associated with a higher risk of refusal of the HPV vaccine. Rates of HPV non-vaccination and of refusal of the HPV vaccine differ and are influenced by different variables. These findings warrant further investigation. PMID:26942572

Heroin refusal self-efficacy and preference for medication-assisted treatment after inpatient detoxification.

PubMed

Kenney, Shannon R; Bailey, Genie L; Anderson, Bradley J; Stein, Michael D

2017-10-01

An individual's self-efficacy to refuse using heroin in high-risk situations is believed to minimize the likelihood for relapse. However, among individuals completing inpatient heroin detoxification, perceived refusal self-efficacy may also reduce one's perceived need for medication-assisted treatment (MAT), an effective and recommended treatment for opioid use disorder. In the current study, we examined the relationship between heroin refusal self-efficacy and preference for MAT following inpatient detoxification. Participants (N=397) were interviewed at the start of brief inpatient opioid detoxification. Multiple logistic regression was used to estimate the adjusted association of background characteristics, depressed mood, and perceived heroin refusal self-efficacy with preference for MAT. Controlling for other covariates, depressed mood and lower perceived refusal self-efficacy were associated with a significantly greater likelihood of expressing preference for MAT (versus no MAT). Perceived ability to refuse heroin after leaving detox is inversely associated with a heroin user's desire for MAT. An effective continuum of care model may benefit from greater attention to patient's perceived refusal self-efficacy during detoxification which may impact preference for MAT and long-term recovery. Copyright © 2017. Published by Elsevier Ltd.

Assessment and analysis of aged refuse as ammonium-removal media for the treatment of landfill leachate.

PubMed

He, Yan; Li, Dan; Zhao, Youcai; Huang, Minsheng; Zhou, Gongming

2017-11-01

This is the first attempt to explore the sustainability of aged refuse as ammonium-removal media. Batch experiments combined with the aged-refuse-based reactor were performed to examine how the adsorption and desorption processes are involved in the ammonia removal via aged refuse media in this research. The results showed that the adsorption of ammonium by aged refuse occurred instantly and the adsorbed ammonium was stable and less exchangeable. The adsorption data fit the Freundlich isotherms well and the n value of 0.1-0.5 indicated that the adsorption of ammonium occurred easily. The maximum adsorbed ammonium occupied less than 10% of the cation exchange capacity in aged-refuse-based reactors owing to the high solid/liquid ratios (50:1-120:1). The synergistic transformations of ammonium within the aged-refuse-based reactor indicated that the cation exchange sites only provide temporary storage of ammonium, and the subsequent nitrification process can be considered the predominant restoration pathway of ammonium adsorption capacity of the reactor. It seems reasonable to assume that there is no expiry for the aged-refuse-based reactor in terms of ammonium removal owing to its bioregeneration via nitrification.

Substitution Between Privately and Publicly Supplied Urban Recreational Open Space

ERIC Educational Resources Information Center

Cordell, Harold K.

1976-01-01

Public and private open space should be considered as interrelated components of a singular open-space supply system; ignoring amounts of private space in the development of guidelines for expansion of public open-space supply may lead to inefficiencies in land allocation. (JD)

Disposable containers as larval habitats for Aedes aegypti in a city with regular refuse collection: a study in Marília, São Paulo State, Brazil.

PubMed

Mazine, C A; Macoris, M L; Andrighetti, M T; Yasumaro, S; Silva, M E; Nelson, M J; Winch, P J

1996-09-01

In Marília, Brazil, refuse is collected at least every other day, yet non-useful, non-returnable containers such as cans, plastic bottles and tires account for almost half of the container habitats found positive for the Aedes aegypti mosquito. A study was therefore conducted to investigate why these containers exist despite regular refuse collection and a high level of awareness of dengue prevention, and how the control program could most effectively respond. Differing community perceptions as to what constitutes refuse were found to lead people to store a variety of containers in their yard. Other dimensions of the problem include the presence of informal refuse collectors in search of saleable materials, and dumping of refuse in vacant lots and along roads. An intervention based on these data will involve the informal refuse collectors in implementation of a community-based recycling project.

ACOG Committee Opinion No. 306. Informed refusal.

PubMed

2004-12-01

Informed refusal is a fundamental component of the informed consent process. Informed consent laws have evolved to the "materiality or patient viewpoint" standard. A physician must disclose to the patient the risks, benefits, and alternatives that a reasonable person in the patient's position would want to know to make an informed decision. Throughout this process, the patient's autonomy, level of health literacy, and cultural background should be respected. The subsequent election by the patient to forgo an intervention that has been recommended by the physician constitutes informed refusal. Documentation of the informed refusal process is essential. It should include a notation that the need for the intervention, as well as risks, benefits, and alternatives to the intervention, and possible consequences of refusal, have been explained. The patient's reason for refusal also should be documented.

Do you feel powerless when a patient refuses medication?

PubMed

Carey, N; Jones, S L; O'Toole, A W

1990-10-01

1. Because a client legally has the right to refuse medication, the nurse can only recommend, advise, suggest, or urge the patient to comply. Consequently, it is important to understand the nurse's response to patient refusal of medication. 2. Overall, nurses were more apt to identify with indirect indicators than they were to identify words that address the concept directly (control and powerlessness). 3. The most common hazard identified in a medication refusal event was the potential for injury, and the individuals most at risk were the nurse giving the medication and other personnel on the unit. 4. The most prominent nursing response to medication refusal was counseling. Nearly all the nurse subjects believed that the medication refusal event negatively influenced nursing care, the patient/nurse interaction, and patient teaching.

A Web-based survey on students' conceptions of 'accident'.

PubMed

Blank, Danilo; Hohgraefe Neto, Guilherme; Grando, Elisa; Siqueira, Pauline Z; Lunkes, Roberta P; Pietrobeli, João Leonardo; Marzola, Norma Regina; Goldani, Marcelo Z

2009-12-01

To report the implementation of an open source web survey application and a case study of its first utilisation, particularly as to aspects of logistics and response behaviour, in a survey of Brazilian university students' conceptions about injury causing events. We developed an original application capable of recruiting respondents, sending personal e-mail invitations, storing responses and exporting data. Students of medical, law, communication and education schools were asked about personal attributes and conceptions of the term accident, as to associations and preventability. The response rate was 34.5%. Half of the subjects responded by the second day, 66.3% during the first week. Subjects around 4.2% (95% CI 3.3-5.4) refused to disclose religious persuasion, and 19.2% (95% CI 17.2-21.3) refused to disclose political persuasion, whereas only 2.8% (95% CI 2.1-3.8), on average, refused to answer questions on conceptions and attitudes. There was no significant difference between early and late respondents in respect to selected attributes and conceptions of accident (P-value varied from 0.145 to 0.971). The word accident evoked the notion of preventability to 85.1% (95% CI 83.2 to 87.0) of the subjects, foreseeability to 50.3% (95% CI 47.7-53.0), fatality to 15.1% (95% CI 13.3-17.1) and intentionality to 2.3% (95% CI 1.6-3.2). Web surveying university students' conceptions about injuries is feasible in a middle-income country setting, yielding response rates similar to those found in the literature.

Primary care pediatricians' perceptions of vaccine refusal in europe.

PubMed

Grossman, Zachi; van Esso, Diego; Del Torso, Stefano; Hadjipanayis, Adamos; Drabik, Anna; Gerber, Andreas; Miron, Dan

2011-03-01

An electronic survey assessing primary care pediatricians' estimations and practices regarding parents' vaccination refusal was sent to 395 members of the European Academy of Pediatrics Research in Ambulatory Setting network, with a response rate of 87%. Of respondents who vaccinate in the clinic, 93% estimated the total vaccine refusal rate as <1%. Of all respondents, 69% prefer a shared decision-making approach to handle refusing parents.

25 CFR 171.420 - Can I dispose of sewage, trash, or other refuse on a BIA irrigation project?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Can I dispose of sewage, trash, or other refuse on a BIA... AND WATER IRRIGATION OPERATION AND MAINTENANCE Irrigation Facilities § 171.420 Can I dispose of sewage, trash, or other refuse on a BIA irrigation project? No. Sewage, trash, or other refuse are considered...

PATIENT REFUSAL OF THROMBOLYTIC THERAPY FOR SUSPECTED ACUTE ISCHEMIC STROKE

PubMed Central

FS, Vahidy; MH, Rahbar; AP, Lal; JC, Grotta; SI, Savitz

2012-01-01

Objective To determine factors associated with patients refusing IV t-PA for suspected acute ischemic stroke (AIS), and to compare the outcomes of patients who refused t-PA (RT) with those treated with t-PA. Methods Patients who were treated with and refused t-PA at our stroke center were identified retrospectively. Demographics, clinical presentation, and outcome measures were collected and compared. Clinical outcome was defined as excellent (mRS: 0–1), good (mRS: 0–2), and poor (mRS: 3–6). Results Over 7.5 years, thirty (4.2%) patients refused t-PA. There were no demographic differences between the treated and RT groups. The rate of RT decreased over time (OR 0.63, 95% CI 0.50 – 0.79). Factors associated with refusal included a later symptom onset to emergency department presentation time (OR 1.02, 95% CI 1.01 – 1.03), lower NIHSS (OR 1.11, 95% CI 1.03 – 1.18), a higher proportion of stroke mimics (OR 17.61, 95% CI 6.20 – 50.02) and shorter hospital stay (OR 1.32, 95% CI 1.09 – 1.61). Among patients who were subsequently diagnosed with ischemic stroke, only length of stay was significantly shorter for refusal patients (OR 1.37, 95% CI 1.06 – 1.78). After controlling for mild strokes and stroke mimics, clinical outcome was not different between the groups (OR 1.61, 95% CI 0.69 – 3.73). Conclusion The incidence of patients refusing t-PA has decreased over time, yet it may be a cause for t-PA under-utilization. Patients with milder symptoms were more likely to refuse t-PA. Refusal patients presented later to the hospital and had shorter hospital stays. One out six refusal patients (16.6%) had a stroke mimic. PMID:23227830

Informed, advance refusals of treatment by people with severe mental illness in a randomised controlled trial of joint crisis plans: demand, content and correlates.

PubMed

Henderson, Claire; Farrelly, Simone; Flach, Clare; Borschmann, Rohan; Birchwood, Max; Thornicroft, Graham; Waheed, Waquas; Szmukler, George

2017-11-24

In the UK, crisis planning for mental health care should acknowledge the right to make an informed advance treatment refusal under the Mental Capacity Act 2005. Our aims were to estimate the demand for such treatment refusals within a sample of service users who had had a recent hospital admission for psychosis or bipolar disorder, and to examine the relationship between refusals, and service user characteristics. To identify refusals we conducted content analysis of Joint Crisis Plans, which are plans formulated by service users and their clinical team with involvement from an external facilitator, and routine care plans in sub-samples from a multi-centre randomised controlled trial of Joint Crisis Plans (plus routine mental health care) versus routine care alone (CRIMSON) in England. Factors hypothesised to be associated with refusals were identified using the trial data collected through baseline interviews of service users and clinicians and collection of routine clinical data. Ninety-nine of 221 (45%) of the Joint Crisis Plans contained a treatment refusal compared to 10 of 424 (2.4%) baseline routine care plans. No Joint Crisis Plans recorded disagreement with refusals on the part of clinicians. Among those with completed Joint Crisis Plans, adjusted analyses indicated a significant association between treatment refusals and perceived coercion at baseline (odds ratio = 1.21, 95% CI 1.02-1.43), but not with baseline working alliance or a past history of involuntary admission. We demonstrated significant demand for written treatment refusals in line with the Mental Capacity Act 2005, which had not previously been elicited by the process of treatment planning. Future treatment/crisis plans should incorporate the opportunity for service users to record a treatment refusal during the drafting of such plans. ISRCTN11501328 Registered 13th March 2008.

The geoarchaeology of urban wastes: from refuses to activities and towns organisation (France, 6th c. BC - 10th c. aD)

NASA Astrophysics Data System (ADS)

Borderie, Q.; Cammas, C.; Petit, C.

2012-04-01

In an urban context, geoarchaeological study of man-environment interaction is often neglected, although recent studies of urbic anthrosols and human induced processes show that it can provide a great amount of data. The sedimentary matrix of the archaeological layers, especially its organic and heavy metal contents (phosphore, organic carbon, lead…) and the pedo-sedimentary processes (such as bioturbation, percolation, decay of organic matter…), are evidence of ancient lifestyle and waste disposal habits. This data are even more useful when archaeological evidence is rare or inefficient, such as in the early medieval Dark Earth. This paper is based on several geoarchaeological studies undertaken since the 1990 in French towns ranging from the Iron Age to the early Middle Ages (Paris, Beauvais, Bayeux, Noyon, Macon, Metz, Lattara…), mainly from rescue excavations. Multi-scale, 3D and fine scale analyses of archaeological stratigraphy are combined with micromorphological studies of undisturbed samples and grain size as well as geochemical analysis of bulk samples (CaCO3, C/N, Fe, Pb, Zn, Cu…). Spatial sampling reveals complex pattern of activities in finely stratified and well defined architectural context like Lattara (Iron Age). Organic refuses were found mainly in specific urban spaces like courtyards or squares and animal housing areas could be delineate. In more undifferentiated stratigraphy (early medieval Dark Earth), bioturbation is one of the main formation process and seems to have obliterated others. Thus, we analysed the 3D pattern of macro-artefacts on field, combined with micromorphology, geochemical and semi quantitative counting of micro-artefacts on thin sections. It allowed us to characterise Dark Earth by the type of activity refuses, in relation with the pedo-sedimentary context and the uses of the areas. It also allowed us to assess the characters induced by in situ activities and those due to the local background. Moreover, in Metz, early medieval Dark Earth reveals a very high amount of lead (more than 1800 mg/kg), which could be related to air pollution due to local metal craft. The results taken from different geographical and chronological contexts show that urban sediments and soils are profoundly impacted by activities refuses and use of space. What is usually considered as "natural" processes (such as bioturbation) can be induced by human activities (organic matter inputs, anthropic pressure). In each case, the sedimentary records and their transformations have been linked with urban activities. Areas were characterised as inside (with roof) or outside (courtyard) spaces, with or without specific activities like animal housing, and the recurrence of multi-functionality. The different contexts studied allowed us to compare periods where sewage infrastructures were available or not. It showed that urban waste-disposal at the scale of the city takes a huge part in the morphology of the stratigraphy, by its content on organic matter and heavy metal pollution, which are still preserved in actual towns.

37 CFR 211.7 - Reconsideration procedure for refusals to register.

Code of Federal Regulations, 2010 CFR

2010-07-01

... CONGRESS COPYRIGHT OFFICE AND PROCEDURES MASK WORK PROTECTION § 211.7 Reconsideration procedure for... refusals to register copyright claims are applicable to requests to reconsider refusals to register mask...

Refusal bias in HIV prevalence estimates from nationally representative seroprevalence surveys.

PubMed

Reniers, Georges; Eaton, Jeffrey

2009-03-13

To assess the relationship between prior knowledge of one's HIV status and the likelihood to refuse HIV testing in populations-based surveys and explore its potential for producing bias in HIV prevalence estimates. Using longitudinal survey data from Malawi, we estimate the relationship between prior knowledge of HIV-positive status and subsequent refusal of an HIV test. We use that parameter to develop a heuristic model of refusal bias that is applied to six Demographic and Health Surveys, in which refusal by HIV status is not observed. The model only adjusts for refusal bias conditional on a completed interview. Ecologically, HIV prevalence, prior testing rates and refusal for HIV testing are highly correlated. Malawian data further suggest that amongst individuals who know their status, HIV-positive individuals are 4.62 (95% confidence interval, 2.60-8.21) times more likely to refuse testing than HIV-negative ones. On the basis of that parameter and other inputs from the Demographic and Health Surveys, our model predicts downward bias in national HIV prevalence estimates ranging from 1.5% (95% confidence interval, 0.7-2.9) for Senegal to 13.3% (95% confidence interval, 7.2-19.6) for Malawi. In absolute terms, bias in HIV prevalence estimates is negligible for Senegal but 1.6 (95% confidence interval, 0.8-2.3) percentage points for Malawi. Downward bias is more severe in urban populations. Because refusal rates are higher in men, seroprevalence surveys also tend to overestimate the female-to-male ratio of infections. Prior knowledge of HIV status informs decisions to participate in seroprevalence surveys. Informed refusals may produce bias in estimates of HIV prevalence and the sex ratio of infections.

Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.

PubMed

Garrouste-Orgeas, Maité; Montuclard, Luc; Timsit, Jean-François; Reignier, Jean; Desmettre, Thibault; Karoubi, Philippe; Moreau, Delphine; Montesino, Laurent; Duguet, Alexandre; Boussat, Sandrine; Ede, Christophe; Monseau, Yannick; Paule, Thierry; Misset, Benoit; Carlet, Jean

2005-04-01

To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. Observational, prospective, multiple-center study. Four university hospitals and seven primary-care hospitals in France. None. Age, underlying diseases (McCabe score and Knaus class), dependency, hospital mortality, and ICU characteristics were recorded. The crude ICU refusal rate was 23.8% (137/574), with variations from 7.1% to 63.1%. The reasons for refusal were too well to benefit (76/137, 55.4%), too sick to benefit (51/137, 37.2%), unit too busy (9/137, 6.5%), and refusal by the family (1/137). In logistic regression analyses, two patient-related factors were associated with ICU refusal: dependency (odds ratio [OR], 14.20; 95% confidence interval [CI], 5.27-38.25; p < .0001) and metastatic cancer (OR, 5.82; 95% CI, 2.22-15.28). Other risk factors were organizational, namely, full unit (OR, 3.16; 95% CI, 1.88-5.31), center (OR, 3.81; 95% CI, 2.27-6.39), phone admission (OR, 0.23; 95% CI, 0.14-0.40), and daytime admission (OR, 0.52; 95% CI, 0.32-0.84). The Standardized Mortality Ratio was 1.41 (95% CI, 1.19-1.69) for immediately admitted patients, 1.75 (95% CI, 1.60-1.84) for refused patients, and 1.03 (95% CI, 0.28-1.75) for later-admitted patients. ICU refusal rates varied greatly across ICUs and were dependent on both patient and organizational factors. Efforts to define ethically optimal ICU admission policies might lead to greater homogeneity in refusal rates, although case-mix variations would be expected to leave an irreducible amount of variation across ICUs.

Parents who refuse or delay HPV vaccine: Differences in vaccination behavior, beliefs, and clinical communication preferences

PubMed Central

Gilkey, Melissa B.; Calo, William A.; Marciniak, Macary W.

2017-01-01

ABSTRACT Background: We sought to estimate the national prevalence of HPV vaccine refusal and delay in a nationally-representative sample of parents of adolescents. We also compared parents who refused versus delayed HPV vaccine in terms of their vaccination beliefs and clinical communication preferences. Methods: In 2014 to 2015, we conducted an online survey of 1,484 US parents who reported on an 11- to 17-year-old child in their household. We used weighted multinomial logistic regression to assess correlates of HPV vaccine refusal and delay. Results: Overall, 28% of parents reported that they had ever “refused or decided not to get” HPV vaccine for their child, and an additional 8% of parents reported that they had “delayed or put off getting” HPV vaccine. Compared to no refusal/delay, refusal was associated with lower confidence in adolescent vaccination (relative risk ratio [RRR] = 0.66, 95% confidence interval [CI], 0.48–0.91), lower perceived HPV vaccine effectiveness (RRR = 0.68, 95% CI, 0.50–0.91), and higher perceived harms (RRR = 3.49, 95% CI, 2.65–4.60). In contrast, delay was associated with needing more information (RRR = 1.76, 95% CI, 1.08–2.85). Most parents rated physicians and information sheets as helpful for making decisions about HPV vaccination, although parents who reported refusal endorsed these resources less often. Conclusions: Our findings suggest that HPV vaccine refusal is common among parents of adolescents and may have increased relative to previous estimates. Because the vaccination beliefs and communication preferences of parents who refuse appear to differ from those who delay, targeted communication strategies may be needed to effectively address HPV vaccine hesitancy. PMID:27763818

49 CFR 219.505 - Refusals.

Code of Federal Regulations, 2013 CFR

2013-10-01

... TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Pre-Employment Tests § 219.505 Refusals. An applicant who has refused to submit to pre-employment testing under this section may not be employed in covered service...

49 CFR 219.505 - Refusals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Pre-Employment Tests § 219.505 Refusals. An applicant who has refused to submit to pre-employment testing under this section may not be employed in covered service...

49 CFR 219.505 - Refusals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Pre-Employment Tests § 219.505 Refusals. An applicant who has refused to submit to pre-employment testing under this section may not be employed in covered service...

49 CFR 219.505 - Refusals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Pre-Employment Tests § 219.505 Refusals. An applicant who has refused to submit to pre-employment testing under this section may not be employed in covered service...

49 CFR 219.505 - Refusals.

Code of Federal Regulations, 2014 CFR

2014-10-01

... TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Pre-Employment Tests § 219.505 Refusals. An applicant who has refused to submit to pre-employment testing under this section may not be employed in covered service...

Denial of service to same-sex and interracial couples: Evidence from a national survey experiment.

PubMed

Powell, Brian; Schnabel, Landon; Apgar, Lauren

2017-12-01

Legislatures and courts are debating whether businesses can deny services to same-sex couples for religious reasons. Yet, little is known about public views on this issue. In a national survey experiment, Americans ( n = 2035) responded to an experimental vignette describing a gay or interracial couple refused service. Vignettes varied the reason for refusal (religion/nonreligious) and by business type (individual/corporation). Results confirm greater support of service refusal by the self-employed than by corporations and to gay couples than to interracial couples. However, religious reasons for refusal to gay couples elicit no more support than do nonreligious reasons. In the first national study to experimentally analyze views on service refusal to sexual minorities, we demonstrate that views vary by several factors but not by whether the refusal was for religious reasons.

Relative economic values of open space provided by National Forest and military lands to surrounding communities in Colorado

Treesearch

Charlotte Ham; John B. Loomis; Patricia A. Champ

2015-01-01

Open space lands are provided by a variety of entities from private individuals to the federal government and these entities make management decisions based on a very broad range of priorities. The net benefits of additional open space depend on the number, quality, and composition of existing open space in the vicinity. In areas where open space is abundant and there...

Riding Pontic--Aesthetic Journey Aesthetic Goal.

PubMed

Rohilla, Byajit Kumar; Choudhary, Shweta; Manisha, Kukreja; Walia, Pawanjit Singh; Nafria, Anil

2015-01-01

The increasing concern for esthetics during the orthodontic treatment can be measured by the increasing popularity ofaesthetic brackets, lingual technique, smaller sized metal brackets, and clear alignment therapy. Many clients, especially adolescents, are self-conscious about their appearance in social and professional situations, and they refuse to tolerate the inevitable "black holes" of edentulous spaces during orthodontic treatment. This article describes the use, fabrication, modifications, and shortcomings of riding pontics; and illustrates how their use provides aesthetic, psychological and functional benefits.

Hydraulically-activated operating system for an electric circuit breaker

DOEpatents

Imam, Imdad; Barkan, Philip

1979-01-01

This operating system comprises a fluid motor having a piston, a breaker-opening space at one side of the piston, and a breaker-closing space at its opposite side. An accumulator freely communicates with the breaker-opening space for supplying pressurized fluid thereto during a circuit-breaker opening operation. A normally-closed valve located on the breaker-closing-side of the piston is openable to release liquid from the breaker-closing space so that pressurized liquid in the breaker-opening space can drive the piston in an opening direction. Means is provided for restoring the valve to its closed position following the circuit-breaker opening operation. An impeded passage affords communication between the accumulator and the breaker-closing space to allow pressurized liquid to flow from the accumulator to the breaker-closing space and develop a pressure therein substantially equal to accumulator pressure when the valve is restored to closed position following breaker-opening. This passage is so impeded that the flow therethrough from the accumulator into the breaker-closing space is sufficiently low during initial opening motion of the piston through a substantial portion of its opening stroke as to avoid interference with said initial opening motion of the piston.

Legislation and refusal of blood transfusion by a minor Jehovah-Witness in Belgium.

PubMed

Deneyer, M; Matthys, D; Ramet, J; Michel, L; Holsters, D; Vandenplas, Y

2011-01-01

The refusal of blood transfusion by Jehovah's Witnesses in critical situations constitutes an ethical and juridical dilemma. The refusal to receive blood products by Jehovah's Witnesses is based on biblical verses. Recurring arguments to sustain this refusal regard the right to self-determination and the right to freedom of faith. If minors are involved, the problem is rendered even more difficult as the parental authority over young children needs to be taken into account. When adolescents are concerned, the situation if even more ambiguous since adolescents might be considered as mature enough to provide autonomous consent. On the basis of three cases, the most frequent bottlenecks that can come up in paediatric emergency services are highlighted: (1) the refusal of a blood transfusion by the parents of a young child; (2) the refusal by an adolescent and (3) prior refusal based on a "No Blood"-document. Regarding minors, the law on patients' rights in Belgium contains safety mechanisms concerning the preservation of physical integrity. Therefore, a key responsibility has been assigned to the physician. A step-by-step plan and a synoptic diagram are presented.

Implied consent refusal impact

DOT National Transportation Integrated Search

1991-09-01

This report examines the extent to which persons suspected of DWI refuse to take a chemical test as required by law, describes implied consent laws in 50 States, analyzes the relation of law features to refusal rate, and analyzes the characteristics ...

Patient Experience Of Provider Refusal Of Medicaid Coverage And Its Implications.

PubMed

Bhandari, Neeraj; Shi, Yunfeng; Jung, Kyoungrae

2016-01-01

Previous studies show that many physicians do not accept new patients with Medicaid coverage, but no study has examined Medicaid enrollees' actual experience of provider refusal of their coverage and its implications. Using the 2012 National Health Interview Survey, we estimate provider refusal of health insurance coverage reported by 23,992 adults with continuous coverage for the past 12 months. We find that among Medicaid enrollees, 6.73% reported their coverage being refused by a provider in 2012, a rate higher than that in Medicare and private insurance by 4.07 (p<.01) and 3.68 (p<.001) percentage points, respectively. Refusal of Medicaid coverage is associated with delaying needed care, using emergency room (ER) as a usual source of care, and perceiving current coverage as worse than last year. In view of the Affordable Care Act's (ACA) Medicaid expansion, future studies should continue monitoring enrollees' experience of coverage refusal.

[Refusal of treatments by an adult cancer patient].

PubMed

Dauchy, Sarah; Faivre, Jean-Christophe; Block, Véronique; Metzger, Maude; Salleron, Julia; Charles, Cécile; Adam, Virginie

2018-03-01

Refusal of treatment questions the treatment's adequacy as well as the quality of the care relationship. A rigorous analysis of these situations is necessary in order to respect the patient's fundamental right to decide for him/herself while preventing a potential loss of chance. This paper proposes practical guidelines for assessment and management of the refusal of treatment by adult cancer patients. The French Association for Supportive Care in Cancer and the French Society for Psycho-Oncology formed a task force that applied a consensus methodology to draft guidelines. We propose five guidelines: (1) be informed of the conditions most often associated with refusal of treatment so as to reinforce adequate support measures; (2) understand the complexity of the process of refusal and accurately identify what is precisely refused; (3) apply an approach of systematic analysis to refusal, to try and increase the possibilities of finding an agreement while reinforcing the respect of the patient's position; (4) establish a legal procedure to address refusal of treatment that safeguards the stakeholders when no accord can be found; and (5) know the indications for ethical collective decision-making. A systematic assessment procedure of treatment refusal is necessary in order to ensure that all the physical, psychological and contextual aspects of it are taken into account, and to provide patients with the best treatment possible. The setting of good care relationship, the improvement of communication skills training and of comprehensive multidisciplinary care are all crucial elements in the prevention of these situations. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

The Role of Stakeholders Related to the Management of Ecological Function of Urban Green Open Space. Case Study: City of Depok, Indonesia

NASA Astrophysics Data System (ADS)

Mangopa Malik, Andy Anton

2017-12-01

Urban green open space is one of the assets that provide substantial benefits to the urban community. One important function of urban green open space is a function of ecology. This study will provide initial explanation on the various studies related to the ecological function of urban green open space. The study of urban space management approach related to ecological function will explain the extent of the role of stakeholders in the urban areas that will further strengthen the importance of the existence of green open space, especially in city of Depok. With so many problems related to the supply and use of green open space in the city of Depok. This approach was originally applied by the private sector and many applications made a great contribution, so it began to be used by the government in managing public assets there. This study will use descriptive method, at the beginning of the study will explain the existence of the reality of urban green open space as part of the urban space by viewing it from theoretical overview of space, function and role of the various problems that occur in it. The results of this study indicate there are six problems in the management of green open spaces in city of Depok. Using the stages in asset management will provide space for participation of existing stakeholders in the management of green open spaces in city of Depok.

Effective protection of open space: does planning matter?

PubMed

Steelman, Toddi A; Hess, George R

2009-07-01

High quality plans are considered a crucial part of good land use planning and often used as a proxy measure for success in plan implementation and goal attainment. We explored the relationship of open space plan quality to the implementation of open space plans and attainment of open space protection goals in Research Triangle, North Carolina, USA. To measure plan quality, we used a standard plan evaluation matrix that we modified to focus on open space plans. We evaluated all open space plans in the region that contained a natural resource protection element. To measure plan implementation and open space protection, we developed an online survey and administered it to open space planners charged with implementing the plans. The survey elicited each planner's perspective on aspects of open space protection in his or her organization. The empirical results (1) indicate that success in implementation and attaining goals are not related to plan quality, (2) highlight the importance of when and how stakeholders are involved in planning and implementation processes, and (3) raise questions about the relationship of planning to implementation. These results suggest that a technically excellent plan does not guarantee the long-term relationships among local land owners, political and appointed officials, and other organizations that are crucial to meeting land protection goals. A greater balance of attention to the entire decision process and building relationships might lead to more success in protecting open space.

Libretexts: a flexible online open system for disseminating educational materials relevant to geophysics at all levels

NASA Astrophysics Data System (ADS)

Halpern, J. B.

2017-12-01

Libretexts is an online open system for distributing educational materials with over 5 million page views per month. Covering geophysics, chemistry, physics and more it offers a platform for authors and users including faculty and students to access curated educational materials. Currently there are on line texts covering geology, geobiology, natural hazards and understanding the refusal to accept climate change as well as relevant materials in other sections on aquatic and atmospheric chemistry. In addition to "written" materials Libretexts provides access to simulations and demonstrations that are relevant. Most importantly the Libretext project welcomes new contributors. Faculty can use available materials to construct their own texts or supplementary materials in relatively short order. Since all material is covered by a Creative Commons Copyright, material can be added to as needed for teaching.

A quality of life quandary: a framework for navigating parental refusal of treatment for co-morbidities in infants with underlying medical conditions.

PubMed

Kunz, Sarah N; McAdams, Ryan M; Diekema, Douglas S; Opel, Douglas J

2015-01-01

Parental refusal of a recommended treatment is not an uncommon scenario in the neonatal intensive care unit. These refusals may be based upon the parents' perceptions of their child's projected quality of life. The inherent subjectivity of quality of life assessments, however, can exacerbate disagreement between parents and healthcare providers. We present a case of parental refusal of surgical intervention for necrotizing enterocolitis in an infant with Bartter syndrome and develop an ethical framework in which to consider the appropriateness of parental refusal based upon an infant's projected quality of life. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

Teaching refusal skills to sexually active adolescents.

PubMed

Warzak, W J; Page, T J

1990-06-01

Refusal skills training was extended to sexually active handicapped female adolescents who lacked an effective refusal strategy. Role-plays for assessment and training were developed using the who, what, when and where of situations which resulted in unwanted intercourse. Refusal skills were trained following the format of rationale, modeling, rehearsal, feedback, and reinforcement. Baseline rates of most target behaviors were quite low. High frequencies of target behaviors were observed as each behavior became the focus of training. Generalization across staff and time was also observed. The skillfulness and effectiveness of the subjects' refusal skills were judged to be improved as a function of training. One-year follow-up showed decreased sexual activity for each girl.

Steps in the open space planning process

Treesearch

Stephanie B. Kelly; Melissa M. Ryan

1995-01-01

This paper presents the steps involved in developing an open space plan. The steps are generic in that the methods may be applied various size communities. The intent is to provide a framework to develop an open space plan that meets Massachusetts requirements for funding of open space acquisition.

Outsourcing in the public refuse collection sector: exploiting old certainties or exploring new possibilities?

PubMed

Gustafsson, Ove; Saksvik, Per Øystein

2005-01-01

An outsourcing process in a medium-size city, by Norwegian standards, provided the background for our study. In 1996, the city council decided to contract out the refuse collection in half of its total area (the western part of the city), and to let the public refuse collection enterprise continue to collect in the other half of the area. The public enterprise also participated in the competitive tender, without success, however. The bid submitted by the public refuse collection enterprise was used as the basis for a benchmarking process performed by the chief administrative officer of the city in May 1999. The process resulted in the requirement that the public enterprise downsize its number of refuse collectors by 27 per cent. The city thus acquired a more cost-effective refuse collection system both in the western part, now run by a private company, and in the rest of the city, where the collection remained the responsibility of the public enterprise, in its newly pared-down and reorganized version. Detectable changes in the refuse collectors' health status in the three-year period immediately following the outsourcing constitute our main focus in this study. We found that the downsizing and reorganization of the public enterprise had a negative impact on the refuse collectors' health status. One year after the downsizing, six of the 27 refuse collectors remaining in the public enterprise had been diagnosed with heart problems or musculoskeletal pains that were sufficiently serious to form the basis of their individual approaches to secure a disability pension, which all six were in the process of acquiring. The registered sick leave among the refuse collectors showed a dramatic increase during the same period. We found clear indications that the refuse collectors remaining in the employment of the public enterprise had no alternatives in the labour market. Although not the focus of this study, we found that the totality of costs and benefits, not only for the enterprise in question, but also for local and national authorities, needs to be considered in any realistic assessment of the impact of public sector outsourcing of activities.

Parental Delay or Refusal of Vaccine Doses, Childhood Vaccination Coverage at 24 Months of Age, and the Health Belief Model

PubMed Central

Smith, Philip J.; Humiston, Sharon G.; Marcuse, Edgar K.; Zhao, Zhen; Dorell, Christina G.; Howes, Cynthia; Hibbs, Beth

2011-01-01

Objective We evaluated the association between parents' beliefs about vaccines, their decision to delay or refuse vaccines for their children, and vaccination coverage of children at aged 24 months. Methods We used data from 11,206 parents of children aged 24–35 months at the time of the 2009 National Immunization Survey interview and determined their vaccination status at aged 24 months. Data included parents' reports of delay and/or refusal of vaccine doses, psychosocial factors suggested by the Health Belief Model, and provider-reported up-to-date vaccination status. Results In 2009, approximately 60.2% of parents with children aged 24–35 months neither delayed nor refused vaccines, 25.8% only delayed, 8.2% only refused, and 5.8% both delayed and refused vaccines. Compared with parents who neither delayed nor refused vaccines, parents who delayed and refused vaccines were significantly less likely to believe that vaccines are necessary to protect the health of children (70.1% vs. 96.2%), that their child might get a disease if they aren't vaccinated (71.0% vs. 90.0%), and that vaccines are safe (50.4% vs. 84.9%). Children of parents who delayed and refused also had significantly lower vaccination coverage for nine of the 10 recommended childhood vaccines including diphtheria-tetanus-acellular pertussis (65.3% vs. 85.2%), polio (76.9% vs. 93.8%), and measles-mumps-rubella (68.4% vs. 92.5%). After adjusting for sociodemographic differences, we found that parents who were less likely to agree that vaccines are necessary to protect the health of children, to believe that their child might get a disease if they aren't vaccinated, or to believe that vaccines are safe had significantly lower coverage for all 10 childhood vaccines. Conclusions Parents who delayed and refused vaccine doses were more likely to have vaccine safety concerns and perceive fewer benefits associated with vaccines. Guidelines published by the American Academy of Pediatrics may assist providers in responding to parents who may delay or refuse vaccines. PMID:21812176

Refusal of Recommended Chemotherapy for Ovarian Cancer: Risk Factors and Outcomes; a National Cancer Data Base Study.

PubMed

Wallace, Sumer K; Lin, Jeff F; Cliby, William A; Leiserowitz, Gary S; Tergas, Ana I; Bristow, Robert E

2016-05-01

To identify risk factors associated with refusal of recommended chemotherapy and its impact on patients with epithelial ovarian cancer (EOC). We identified patients in the National Cancer Data Base diagnosed with EOC from January 1998 to December 2011. Patients who refused chemotherapy were identified and compared with those who received recommended, multiagent chemotherapy. Univariate and multivariable analyses were performed using chi-square test with Bonferroni correction, binary logistic regression, log-rank test, and Cox proportional hazards modeling. The threshold for statistical significance was set at a P value of less than 0.05. From a cohort of 147,713 eligible patients, 2,707 refused chemotherapy. These patients were compared with 92,212 patients who received recommended multiagent chemotherapy. Older age, more medical comorbidities, not having insurance, and later year of diagnosis were directly and significantly associated with chemotherapy refusal when analyzed using multivariable logistic regression. In addition, lower-than-expected facility adherence to NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Ovarian Cancer, treatment at low-volume center, lower grade, and higher stage were all significantly and independently associated with chemotherapy refusal. Median overall survival of patients who received multiagent chemotherapy was significantly longer than that of those who refused chemotherapy (43 vs 4.8 months; P<.0005). After controlling for known patient, facility, and disease prognostic factors, chemotherapy refusal is significantly associated with increased risk of death. Refusal of recommended chemotherapy carries significant risk of early death from ovarian cancer. Our data demonstrate that the decision to refuse chemotherapy is multifactorial and, in addition to unalterable factors (eg, stage/grade, age), involves factors that can be changed, including facility type and payor. Efforts at addressing these discrepancies in care can improve compliance with chemotherapy recommendations in the NCCN Guidelines for Ovarian Cancer and outcomes. Copyright © 2016 by the National Comprehensive Cancer Network.

Legal briefing: conscience clauses and conscientious refusal.

PubMed

Pope, Thaddeus Mason

2010-01-01

This issue's "Legal Briefing" column covers legal developments pertaining to conscience clauses and conscientious refusal. Not only has this topic been the subject of recent articles in this journal, but it has also been the subject of numerous public and professional discussions. Over the past several months, conscientious refusal disputes have had an unusually high profile not only in courthouses, but also in legislative and regulatory halls across the United States. Healthcare providers' own moral beliefs have been obstructing and are expected to increasingly obstruct patients' access to medical services. For example, some providers, on ethical or moral grounds, have denied: (1) sterilization procedures to pregnant patients, (2) pain medications in end-of-life situations, and (3) information about emergency contraception to rape victims. On the other hand, many healthcare providers have been forced to provide medical treatment that is inconsistent with their moral beliefs. There are two fundamental types of conscientious objection laws. First, there are laws that permit healthcare workers to refuse providing - on ethical, moral, or religious grounds healthcare services that they might otherwise have a legal or employer-mandated obligation to provide. Second, there are laws directed at forcing healthcare workers to provide services to which they might have ethical, moral, or religious objections. Both types of laws are rarely comprehensive, but instead target: (1) certain types of healthcare providers, (2) specific categories of healthcare services, (3) specific patient circumstances, and (4) certain conditions under which a right or obligation is triggered. For the sake of clarity, I have grouped recent legal developments concerning conscientious refusal into eight categories: 1. Abortion: right to refuse 2. Abortion: duty to provide 3. Contraception: right to refuse 4. Contraception: duty to provide 5. Sterilization: right to refuse 6. Fertility, HIV, vaccines, counseling 7. End-of-life measures: right to refuse 8. Comprehensive laws: right to refuse.

The Role of Small States in the Post-Cold War Era: The Case of Belarus

DTIC Science & Technology

2012-05-01

immediately translated its displea- sure into economic sanctions. “The conflict included Russia’s ban on importing Belarusian milk , refusal to provide a...expected some support among the states in post-Soviet space. None of them supported Moscow in this. Absolutely isolated, Mos- cow was anxious to get...the most uncompromised views of Mos- cow . Following the demise of the USSR, resentment was so high in Estonia that it might have been the only state

Investigating Plasma Motion of Magnetic Clouds at 1 AU through a Velocity-modified Cylindrical Force-free Flux Rope Model

NASA Astrophysics Data System (ADS)

Wang, Y.; Shen, C.; Liu, R.; Zhou, Z.

2014-12-01

Magnetic clouds (MCs) are the interplanetary counterparts of coronal mass ejections (CMEs). Due to the very low value of Can't connect to bucket.int.confex.com:4201 (Connection refused) LWP::Protocol::http::Socket: connect: Connection refused at /usr/local/lib/perl5/site_perl/5.8.8/LWP/Protocol/http.pm line 51. in MCs, they are believed to be in a nearly force-free state and therefore are able to be modeled by a cylindrical force-free flux rope. However, the force-free state only describes the magnetic field topology but not the plasma motion of a MC. For a MC propagating in interplanetary space, the global plasma motion has three possible components: linear propagating motion of a MC away from the Sun, expanding motion and circular motion with respect to the axis of the MC. By assuming the quasi-steady evolution and self-similar expansion, we introduced the three-component motion into the cylindrical force-free flux rope model, and developed a velocity-modified model. Then we applied the model to 73 MCs observed by Wind spacecraft to investigate the properties of the plasma motion of MCs. It is found that (1) some MCs did not propagate along the Sun-Earth line, suggesting the direct evidence of the CME's deflected propagation and/or rotation in interplanetary space, (2) the expansion speed is correlated with the radial propagation speed and 62%/17% of MCs underwent a under/over-expansion at 1 AU, and (3) the circular motion does exists though it is only on the order of 10 km s-1. These findings advance our understanding of the MC's properties at 1 AU as well as the dynamic evolution of CMEs from the Sun to interplanetary space.

Hydraulic actuator for an electric circuit breaker

DOEpatents

Imam, I.

1983-05-17

This actuator comprises a fluid motor having a piston, a breaker-opening space at one side of the piston, and a breaker-closing space at its opposite side. An accumulator freely communicates with the breaker-opening space for supplying pressurized fluid thereto during a circuit breaker opening operation. The breaker-opening space and the breaker-closing space are connected by an impeded flow passage. A pilot valve opens to allow the pressurized liquid in the breaker-closing space to flow to a back chamber of a normally closed main valve to cause the main valve to be opened during a circuit breaker opening operation to release the pressurized liquid from the breaker-closing space. An impeded passage affords communication between the back chamber and a sump located on the opposite side of the main valve from the back chamber. The pilot valve and impeded passage allow rapid opening of the main valve with pressurized liquid from the breaker closing side of the piston. 3 figs.

Hydraulic actuator for an electric circuit breaker

DOEpatents

Imam, Imdad [Colonie, NY

1983-01-01

This actuator comprises a fluid motor having a piston, a breaker-opening space at one side of the piston, and a breaker-closing space at its opposite side. An accumulator freely communicates with the breaker-opening space for supplying pressurized fluid thereto during a circuit breaker opening operation. The breaker-opening space and the breaker-closing space are connected by an impeded flow passage. A pilot valve opens to allow the pressurized liquid in the breaker-closing space to flow to a back chamber of a normally closed main valve to cause the main valve to be opened during a circuit breaker opening operation to release the pressurized liquid from the breaker-closing space. An impeded passage affords communication between the back chamber and a sump located on the opposite side of the main valve from the back chamber. The pilot valve and impeded passage allow rapid opening of the main valve with pressurized liquid from the breaker closing side of the piston.

Pragmatic Transfer in Thai EFL Refusals

ERIC Educational Resources Information Center

Wannaruk, Anchalee

2008-01-01

Communication breakdowns can occur during cross-cultural communication due to different perceptions and interpretations of appropriateness and politeness. This study investigates similarities and differences between refusals in American English and Thai and incidences of pragmatic transfer by Thai EFL learners when making refusals. The…

Breath Test Refusals and Their Effect on DWI Prosecution

DOT National Transportation Integrated Search

2012-07-01

This report describes the design and results of a project aimed at estimating the rate that drivers : refuse to submit to a legally-requested breath alcohol concentration test, and the effect of such : refusals on the prosecution of DWI cases. The st...

16 CFR 1210.18 - Refusal of importation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Refusal of importation. 1210.18 Section 1210.18 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SAFETY STANDARD FOR CIGARETTE LIGHTERS Certification Requirements § 1210.18 Refusal of importation. (a...

Limitations on human rights: are they justifiable to reduce the burden of TB in the era of MDR- and XDR-TB?

PubMed

Boggio, Andrea; Zignol, Matteo; Jaramillo, Ernesto; Nunn, Paul; Pinet, Geneviève; Raviglione, Mario

2008-01-01

Tuberculosis, in all its forms, poses a serious, demonstrable threat to the health of countless individuals as well as to health as a public good. MDR-TB and, in particular, the emergence of XDR-TB, have re-opened the debate on the importance, and nature, of treatment supervision for basic TB control and the management of drug-resistant TB. Enforcing compulsory measures regarding TB patients raises questions of respect for human rights. Yet, international law provides for rights-limiting principles, which would justify enforcing compulsory measures against TB patients who refuse to have diagnostic procedures or who refuse to be monitored and treated once disease is confirmed. This article analyzes under what circumstances compulsory measures for TB patients may be enforced under international law. Compulsory measures for TB patients may, in fact, be justified on legal grounds provided that these measures are foreseen in the law, that they are used as a last resort, and that safeguards are in place to protect affected individuals. The deadly nature of the disease, its epidemiology, the high case fatality rate, and the speed at which the disease leads to death when associated with HIV are proven.

Belief About Mandatory School Vaccinations and Vaccination Refusal Among Ohio Appalachian Parents: Do Demographic and Religious Factors, General Health, and Political Affiliation Play a Role?

PubMed

Krok-Schoen, Jessica L; Bernardo, Brittany M; Weier, Rory C; Peng, Juan; Katz, Mira L; Reiter, Paul L; Richardson, Morgan S; Pennell, Michael L; Tatum, Cathy M; Paskett, Electra D

2017-11-14

To examine how demographic, general health, religious, and political characteristics influenced beliefs about mandatory school vaccinations and history of vaccination refusal for children among Ohio Appalachian parents. In 2013 and 2014, baseline data were obtained from parents (n = 337) of girls aged 9-17 from 12 counties in rural Ohio Appalachia enrolled in the Community Awareness, Resources and Education (CARE II) Project. Multivariate logistic regression models were used to identify correlates of parental beliefs about mandatory school vaccinations and history of refusing a doctor-recommended vaccine for their child(ren). About 47% of parents agreed that parents should have the right to refuse mandatory school vaccinations for their child(ren). Participants who reported their political affiliation as Republican (OR = 2.45, 95% CI: 1.28-4.66) or Independent (OR = 3.31, 95% CI: 1.70-6.44) were more likely to agree that parents should have the right to refuse school-mandated vaccinations than parents who reported their political affiliation as Democrat. Approximately 39% of parents reported ever refusing a vaccine for their child(ren). Participants who were female (OR = 3.90, 95% CI: 1.04-14.58) and believed that parents should have the right to refuse mandatory school vaccinations (OR = 3.27, 95% CI: 1.90-5.62) were more likely to report ever refusing a vaccine for their child(ren). The study findings provide information to better understand factors related to vaccination refusal among parents in Appalachia Ohio that can be used to design interventions to improve vaccination uptake. © 2017 National Rural Health Association.

Insulin therapy refusal among type II diabetes mellitus patients in Kubang Pasu district, Kedah, Malaysia

PubMed Central

Tan, Wei Leong; Asahar, Siti Fairus; Harun, Noor Liani

2015-01-01

INTRODUCTION Diabetes mellitus is a rising non-communicable disease in Malaysia. Insulin therapy refusal is a challenge for healthcare providers, as it results in delayed insulin initiation. This study was conducted to determine the prevalence of insulin therapy refusal and its associated factors. METHODS This cross-sectional study was conducted at seven public health clinics in Kubang Pasu district of Kedah, Malaysia, from March to October 2012. A newly developed and validated questionnaire was used and participants were selected via systematic random sampling. Only patients diagnosed with type II diabetes mellitus (T2DM) and under the public health clinic care in Kubang Pasu were included in the study. Multiple logistic regression was used to study the association between insulin therapy refusal and its associated factors. RESULTS There were 461 respondents and the response rate was 100%. Among these 461 patients with T2DM, 74.2% refused insulin therapy. The most common reason given for refusal was a lack of confidence in insulin injection (85.4%). Multiple logistic regression revealed that respondents who had secondary education were 55.0% less likely to refuse insulin therapy than those who had primary education or no formal education (adjusted odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25–0.82, p = 0.009). There was also a significant inverse association between glycated haemoglobin (HbA1c) level and insulin therapy refusal (adjusted OR 0.87, 95% CI 0.76–1.00, p = 0.047). CONCLUSION Insulin therapy refusal is common in Kubang Pasu. Educational status and HbA1c level should be taken into consideration when counselling patients on insulin therapy initiation. PMID:25532511

Insulin therapy refusal among type II diabetes mellitus patients in Kubang Pasu district, the state of Kedah, Malaysia.

PubMed

Tan, Wei Leong; Asahar, Siti Fairus; Harun, Noor Liani

2015-04-01

Diabetes mellitus is a rising non-communicable disease in Malaysia. Insulin therapy refusal is a great challenge for healthcare providers, as it results in delayed insulin initiation. This study was conducted to determine the prevalence of insulin therapy refusal and its associated factors. This cross sectional study was conducted at seven public health clinics in Kubang Pasu district, Malaysia, from March to October 2012. A newly developed and validated questionnaire was used and participants were selected via systematic random sampling. Only patients diagnosed with type II diabetes mellitus (T2DM) and under the public health clinic care in Kubang Pasu were included in the study. Multiple logistic regressions were used to study the association between insulin therapy refusal and its associated factors. There were 461 respondents and the response rate was 100%. Among these 461 patients with T2DM, 74.2% refused insulin therapy. The most common reason given for refusal was a lack of confidence in insulin injection (85.4%). Multiple logistic regression revealed that respondents who had secondary education were 55.0% less likely to refuse insulin therapy than those who had primary or no formal education (p = 0.009, adjusted odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.25-0.82). There was also a significant inverse association between glycated haemoglobin (HbA1c) and insulin therapy refusal (p = 0.047, adjusted OR = 0.87, 95% CI = 0.76-1.00). Insulin therapy refusal is common in Kubang Pasu. Education status and HbA1c should be taken into consideration when counselling patients on insulin therapy initiation.

State Right to Refuse Medication Laws and Procedures: Impact on Homicide and Suicide.

PubMed

Edwards, Griffin

2016-09-01

As part of the expansive overhaul of the mental health system that occurred in the latter half of the 20th Century, many states passed laws that allow, under certain conditions, voluntary and involuntarily committed patients to refuse medication. While some predicted the consequences of these laws would be dire, the effect on violent behavior remains untested. The aim is to decipher any differences state right to refuse medication laws may have on violence. Using the homicide rate of every US state between 1972 and 2001 (N = 1,479), and the suicide rate between 1981 and 2001 (N = 1,071). The study compares the difference in homicide/suicide rates before and after a law change to that same difference in a set of control states to estimate the effect of laws aimed at extending the right to refuse medication to both voluntary and involuntarily committed mental health patients. Laws designed to allow voluntarily committed patients to refuse medication are associated with a 0.8 increase in homicides per 100,000 of the state population while laws dictating an involuntarily committed patient's right to request refusal of medication are negative but statistically insignificant using standard t test. Laws designed to allow voluntarily committed patients to refuse medication have no statistically significant effect on suicides while laws dictating an involuntarily committed patient's right to request refusal of medication, specifically when the request is reviewed by independent mental health professionals, are associated with a statistically significant reduction in suicides. Allowing voluntarily committed patients to refuse medication may entice some to enter in-patient facilities, but the brief and optional exposure to medication and their side effects may actually discourage treatment and increase violence.

Long-term monitoring and prediction for settlement and composition of refuse in Shanghai Laogang Municipal Landfill.

PubMed

Jiangying, Liu; Dimin, Xu; Youcai, Zhao; Shaowei, Chen; Guojian, Li; Qi, Zhou

2004-09-01

Parameters about composition of refuse such as mass percentage of biodegradable matter, volatile solid, organic carbon, cellulose, total sugar, and settlement were monitored and analyzed in a large-scale experimental unit. The empirical formulas between composition and refuse age were established in terms of the data obtained from the experimental unit and verified by comparing with the corresponding parameters of refuse in the closed landfill units from 1991 until 1994 in the Shanghai Laogang Municipal Landfill. Furthermore, the long-term prediction for the composition of refuse was made, and it was predicted that the half-life is 7 to 11 years for biodegradable matter, 9 to 12 years for organic carbon or volatile solid, 7 to 16 years for cellulose, and 4 to 6 years for total sugar. In addition, a mathematical model, based on the mechanism of refuse biodegradation in the landfill, was developed to simulate the relationship between the settlement and the refuse age and manifests the secondary settlement potential. The mathematical model was proved not only to be reliable but also should be accurate for predicting the settlement of the landfill. The secondary settlement, which mainly results from the slow and gradual biodegradation of refuse, is linear with respect to the exponent of refuse age. Finally, according to the settlement model and empirical biodegradation formulas, it may be predicted that, 79.4% of biodegradable matter, 92.9% of total sugar, 72.7% of volatile solid and organic carbon, and 73.1% of cellulose will be biodegraded and that 79% of the maximum secondary settlement potential will occur before the Shanghai Laogang Municipal Landfill is in a high stabilization situation, i.e., approximately 21 years after final closure.

Major surgery in an osteosarcoma patient refusing blood transfusion: case report.

PubMed

Dhanoa, Amreeta; Singh, Vivek A; Shanmugam, Rukmanikanthan; Rajendram, Raja

2010-11-08

We describe an unusual case of osteosarcoma in a Jehovah's Witness patient who underwent chemotherapy and major surgery without the need for blood transfusion. This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement. She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution. This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs.

15 CFR 760.2 - Prohibitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... refusal to do business under this section for a United States person to provide management, procurement... race, religion, sex, or national origin of any U.S. person. (d) Furnishing information about business... OR BOYCOTTS § 760.2 Prohibitions. (a) Refusals to do business. Prohibition Against Refusals To Do...

47 CFR 73.4005 - Advertising-refusal to sell.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 4 2010-10-01 2010-10-01 false Advertising-refusal to sell. 73.4005 Section 73.4005 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.4005 Advertising—refusal to sell. See 412...

47 CFR 73.4005 - Advertising-refusal to sell.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 4 2011-10-01 2011-10-01 false Advertising-refusal to sell. 73.4005 Section 73.4005 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.4005 Advertising—refusal to sell. See 412...

47 CFR 73.4005 - Advertising-refusal to sell.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 4 2012-10-01 2012-10-01 false Advertising-refusal to sell. 73.4005 Section 73.4005 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.4005 Advertising—refusal to sell. See 412...

47 CFR 73.4005 - Advertising-refusal to sell.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Advertising-refusal to sell. 73.4005 Section 73.4005 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.4005 Advertising—refusal to sell. See 412...

47 CFR 73.4005 - Advertising-refusal to sell.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 4 2013-10-01 2013-10-01 false Advertising-refusal to sell. 73.4005 Section 73.4005 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.4005 Advertising—refusal to sell. See 412...

Medication Refusal: Resident Rights, Administration Dilemma.

PubMed

Haskins, Danielle R; Wick, Jeannette Y

2017-12-01

Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

Understanding the antecedents of Korean high school students' drinking refusal self-efficacy: parental influence, peer influence, and behavior.

PubMed

Jang, Su Ahn; Cho, Namauk; Yoo, Jina

2011-12-29

The current study examined the factors that influence Korean adolescents' drinking refusal self-efficacy, which is known to be associated with alcohol use and drinking intentions. Specifically, this study considered parental monitoring, parent-child communication satisfaction, peer influence, and prior alcohol use as possible antecedents of Korean high school students' drinking refusal self-efficacy. High school students (n = 538) in South Korea responded to the current study. The data revealed that parent-child communication satisfaction facilitated parental monitoring, and these factors indirectly predicted adolescents' drinking behavior through peer influence. We also found that prior drinking, parental monitoring, and peer influence were directly associated with drinking refusal self-efficacy, and the self-efficacy, in turn, was associated with drinking intentions. These results not only suggest that drinking refusal self-efficacy are related to drinking behavior and intentions, but they also provide a theoretical explanation for how parental and peer influences are associated with adolescents' drinking refusal self-efficacy.

Understanding the Antecedents of Korean High School Students’ Drinking Refusal Self-Efficacy: Parental Influence, Peer Influence, and Behavior

PubMed Central

Jang, Su Ahn; Cho, NamAuk; Yoo, Jina

2012-01-01

The current study examined the factors that influence Korean adolescents’ drinking refusal self-efficacy, which is known to be associated with alcohol use and drinking intentions. Specifically, this study considered parental monitoring, parent-child communication satisfaction, peer influence, and prior alcohol use as possible antecedents of Korean high school students’ drinking refusal self-efficacy. High school students (n = 538) in South Korea responded to the current study. The data revealed that parent-child communication satisfaction facilitated parental monitoring, and these factors indirectly predicted adolescents’ drinking behavior through peer influence. We also found that prior drinking, parental monitoring, and peer influence were directly associated with drinking refusal self-efficacy, and the self-efficacy, in turn, was associated with drinking intentions. These results not only suggest that drinking refusal self-efficacy are related to drinking behavior and intentions, but they also provide a theoretical explanation for how parental and peer influences are associated with adolescents’ drinking refusal self-efficacy. PMID:22980099

Conscientious objection to referrals for abortion: pragmatic solution or threat to women’s rights?

PubMed Central

2014-01-01

Background Conscientious objection has spurred impassioned debate in many Western countries. Some Norwegian general practitioners (GPs) refuse to refer for abortion. Little is know about how the GPs carry out their refusals in practice, how they perceive their refusal to fit with their role as professionals, and how refusals impact patients. Empirical data can inform subsequent normative analysis. Methods Qualitative research interviews were conducted with seven GPs, all Christians. Transcripts were analysed using systematic text condensation. Results Informants displayed a marked ambivalence towards their own refusal practices. Five main topics emerged in the interviews: 1) carrying out conscientious objection in practice, 2) justification for conscientious objection, 3) challenges when relating to colleagues, 4) ambivalence and consistency, 5) effects on the doctor-patient relationship. Conclusions Norwegian GP conscientious objectors were given to consider both pros and cons when evaluating their refusal practices. They had settled on a practical compromise, the precise form of which would vary, and which was deemed an acceptable middle way between competing interests. PMID:24571955

The moderating role of risk-taking tendency and refusal assertiveness on social influences in alcohol use among inner-city adolescents.

PubMed

Epstein, Jennifer A; Botvin, Gilbert J

2002-07-01

Many etiological models of adolescent alcohol use concentrate on the main effects of risk and protective factors. This study examined the moderating influence of risk-taking tendency and refusal assertiveness on perceived friends' drinking as associated with alcohol use among inner-city adolescents. Participants (N = 2,400; 54% female) completed questionnaires that included measures of risk-taking tendency, refusal assertiveness, perceived friends' drinking and alcohol use (drinking frequency, drinking amount and drunkenness). Main effects for perceived friends' drinking, risk-taking tendency and refusal assertiveness were found for all three drinking measures, consistent with prior work. Furthermore, significant interactions were found between (1) risk-taking tendency and perceived friends' drinking and (2) refusal assertiveness and perceived friends' drinking. High risk-taking tendency and low refusal assertiveness increased the impact of perceived friends' drinking on alcohol use among inner-city adolescents. This suggests that these factors are important components in preventing alcohol use.

Open space preservation, property value, and optimal spatial configuration

Treesearch

Yong Jiang; Stephen K. Swallow

2007-01-01

The public has increasingly demonstrated a strong support for open space preservation. How to finance the socially efficient level of open space with the optimal spatial structure is of high policy relevance to local governments. In this study, we developed a spatially explicit open space model to help identify the socially optimal amount and optimal spatial...

Models of anxiety: responses of rats to novelty in an open space and an enclosed space.

PubMed

Ennaceur, A; Michalikova, S; Chazot, P L

2006-07-15

Exposure to novelty has been shown to induce anxiety responses in a variety of behavioural paradigms. The purpose of the present study was to investigate whether exposition of naïve rats to novelty would result in a comparable or a different pattern of responses in an open space versus enclosed space with or without the presence of an object in the centre of the field. Lewis and Wistar rats of both genders were used to illustrate and discuss the value and validity of these anxiety paradigms. We examined a wide range of measures, which cover several aspects of animals' responses. The results of this study revealed significant differences between the behaviour of animals in an open space and in the enclosed space. It also revealed significant differences in animal's responses to the presence and absence of an object in the open space and in the enclosed space. In the enclosed space, rats spent most of their time in the outer area with lower number of exits and avoided the object area except when there was an object, while in the open space rats displayed frequent short duration re-entries in the outer area and spent longer time in the object area in presence of an object. The time spent in the inner area (away from the outer area and the object area) was significantly longer and the number of faecal boli was significantly higher in the open space than in the enclosed space. In the present report, we will discuss the fundamental differences between enclosed space and open space models, and we will examine some methodological issues related to the current animal models of human behaviour in anxiety. In the enclosed space, animals can avoid the potential threat associated with the centre area of a box and chose the safety of walls and corners, whereas, in the open space animals have to avoid every parts of the field from which there was no safe escape. The response of animals to novelty in an open space model appears more relevant to anxiety than in an enclosed space. The present studies revealed no correlations between the measures of behaviour in enclosed space and the measures of behaviour in open space, which suggest that these two models do not involve the same construct. Our results suggest that the enclosed space model involves avoidance responses while the open space model involves anxiety responses. The open space model can be very useful in understanding the underlying neural mechanisms of anxiety responses, and in assessing the effects of potential anxiolytic drugs.

A discrete-space urban model with environmental amenities

Treesearch

Liaila Tajibaeva; Robert G. Haight; Stephen Polasky

2008-01-01

This paper analyzes the effects of providing environmental amenities associated with open space in a discrete-space urban model and characterizes optimal provision of open space across a metropolitan area. The discrete-space model assumes distinct neighborhoods in which developable land is homogeneous within a neighborhood but heterogeneous across neighborhoods. Open...

Effective Intervention for School Refusal Behaviour

ERIC Educational Resources Information Center

Nuttall, Clare; Woods, Kevin

2013-01-01

Evaluation of successful professional intervention for two case studies of female adolescents' school refusal behaviour is presented. Data gathered from the young person, professionals, and parents in each case are synthesised to propose a multi-level, ecologically situated model of intervention for school refusal behaviour. The proposed model…

Public open space, physical activity, urban design and public health: Concepts, methods and research agenda.

PubMed

Koohsari, Mohammad Javad; Mavoa, Suzanne; Villanueva, Karen; Sugiyama, Takemi; Badland, Hannah; Kaczynski, Andrew T; Owen, Neville; Giles-Corti, Billie

2015-05-01

Public open spaces such as parks and green spaces are key built environment elements within neighbourhoods for encouraging a variety of physical activity behaviours. Over the past decade, there has been a burgeoning number of active living research studies examining the influence of public open space on physical activity. However, the evidence shows mixed associations between different aspects of public open space (e.g., proximity, size, quality) and physical activity. These inconsistencies hinder the development of specific evidence-based guidelines for urban designers and policy-makers for (re)designing public open space to encourage physical activity. This paper aims to move this research agenda forward, by identifying key conceptual and methodological issues that may contribute to inconsistencies in research examining relations between public open space and physical activity. Copyright © 2015 Elsevier Ltd. All rights reserved.

The value of urban open space: meta-analyses of contingent valuation and hedonic pricing results.

PubMed

Brander, Luke M; Koetse, Mark J

2011-10-01

Urban open space provides a number of valuable services to urban populations, including recreational opportunities, aesthetic enjoyment, environmental functions, and may also be associated with existence values. In separate meta-analyses of the contingent valuation (CV) and hedonic pricing (HP) literature we examine which physical, socio-economic, and study characteristics determine the value of open space. The dependent variable in the CV meta-regression is defined as the value of open space per hectare per year in 2003 US$, and in the HP model as the percentage change in house price for a 10 m decrease in distance to open space. Using a multi-level modelling approach we find in both the CV and HP analyses that there is a positive and significant relationship between the value of urban open space and population density, indicating that scarcity and crowdedness matter, and that the value of open space does not vary significantly with income. Further, urban parks are more highly valued than other types of urban open space (forests, agricultural and undeveloped land) and methodological differences in study design have a large influence on estimated values from both CV and HP. We also find important regional differences in preferences for urban open space, which suggests that the potential for transferring estimated values between regions is likely to be limited. Copyright © 2011 Elsevier Ltd. All rights reserved.

School Refuser Child Identities

ERIC Educational Resources Information Center

Stroobant, Emma; Jones, Alison

2006-01-01

"School refuser" is an always-already negative child identity. The term is used to categorize children or adolescents who appear to dislike and fear school (or aspects of school) and persistently refuse to attend or attend very unwillingly. Given that school attendance is generally considered a necessary social good, regular and anxious…

43 CFR 8365.1-1 - Sanitation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... or petroleum products or dump refuse or waste other than wash water from any trailer or other vehicle... industrial refuse or waste brought as such from private or municipal property; (5) Pollute or contaminate water supplies or water used for human consumption; or (6) Use a refuse container or disposal facility...

28 CFR 549.65 - Refusal to accept treatment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Refusal to accept treatment. 549.65 Section 549.65 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.65 Refusal to accept treatment. (a) When, as a result of...

9 CFR 590.160 - Refusal, suspension, or withdrawal of service.

Code of Federal Regulations, 2010 CFR

2010-01-01

... INSPECTION ACT) Denial of Service § 590.160 Refusal, suspension, or withdrawal of service. (a) The... service. 590.160 Section 590.160 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE...) may refuse to provide or may withdraw inspection service under this part with respect to any plant if...

9 CFR 590.160 - Refusal, suspension, or withdrawal of service.

Code of Federal Regulations, 2011 CFR

2011-01-01

... INSPECTION ACT) Denial of Service § 590.160 Refusal, suspension, or withdrawal of service. (a) The... service. 590.160 Section 590.160 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE...) may refuse to provide or may withdraw inspection service under this part with respect to any plant if...

16 CFR § 1210.18 - Refusal of importation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Refusal of importation. § 1210.18 Section § 1210.18 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SAFETY STANDARD FOR CIGARETTE LIGHTERS Certification Requirements § 1210.18 Refusal of importation. (a...

20 CFR 702.410 - Duties of employees with respect to special examinations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... PROCEDURE Medical Care and Supervision § 702.410 Duties of employees with respect to special examinations... to submit to such examination unless circumstances justified the refusal. (c) Where an employee... of further compensation during such time as the refusal continues. Except that refusal to submit to...

20 CFR 702.410 - Duties of employees with respect to special examinations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PROCEDURE Medical Care and Supervision § 702.410 Duties of employees with respect to special examinations... to submit to such examination unless circumstances justified the refusal. (c) Where an employee... of further compensation during such time as the refusal continues. Except that refusal to submit to...

21 CFR 1316.12 - Refusal to allow inspection with an administrative warrant.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Refusal to allow inspection with an administrative warrant. 1316.12 Section 1316.12 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE ADMINISTRATIVE FUNCTIONS, PRACTICES, AND PROCEDURES Administrative Inspections § 1316.12 Refusal to allow...

Family Influences on Treatment Refusal in School-Linked Mental Health Services

ERIC Educational Resources Information Center

Keeley, Mary L.; Wiens, Brenda A.

2008-01-01

This study analyzed family influences on treatment refusal in school-linked mental health services (SLMHS). Specifically, it assessed whether levels of family cohesion, conflict, and organization were related to whether a family refused to initiate recommended treatment. Children (N = 133) referred for emotional and behavioral problems and their…

Integrated solid waste management in Japan

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

Not Available

The Japanese, through a combination of public policy, private market conditions, a geographic necessity, practice integrated municipal solid waste (MSW) management. The approach of MSW management in Japan is as follows: The basic concept of refuse treatment consists of recycling discharged refuse into usable resources, reusing such resources as much as possible, and then treating or disposing of the usable portion into a sanitary condition. Considering the difficulty of procuring land or seaside areas for such purpose as a refuse disposal site, it will be necessary to minimize the volume of refuse collected for treatment or disposal.

The right to refuse treatment: a model act.

PubMed Central

1983-01-01

Although the right to refuse medical treatment is universally recognized as a fundamental principle of liberty, this right is not always honored. A refusal can be thwarted either because a patient is unable to competently communicate or because providers insist on continuing treatment. To help enhance the patient's right to refuse treatment, many states have enacted so-called "living will" or "natural death" statutes. We believe the time has come to move beyond these current legislative models, and we therefore propose a Model Act that clearly enunciates an individual's right to refuse treatment, does not limit its exercise to the terminally ill or to heroic measures, and provides a mechanism by which individuals can set forth their wishes in advance and designate another person to enforce them. PMID:6869647

Pervasive refusal syndrome. Three German cases provide further illustration.

PubMed

Jans, Thomas; Ball, Juliane; Preiss, Maike; Haberhausen, Michael; Warnke, Andreas; Renner, Tobias J

2011-09-01

Pervasive refusal syndrome (PRS) has been proposed as a new diagnostic entity among child and adolescent psychiatric disorders. It is characterized by a cluster of life-threatening symptoms including refusal of hood intake, decreased or complete lack of mobilization, and lack of communication as well as retreat from normal life activities. Active refusal to accept help as well as neglect of personal care have been core features of PRS in the limited number of cases reported in the last decade. There have, however; been cases with predominantly passive resistance, indicating the possibility that there may be a continuum from active refusal to passive resistance within PRS. Postulating this continuum allows for the integration of "depressive devitalization" -- a refusal syndrome mainly characterized by passive resistance -- into the concept of PRS. Here, three case vignettes of adolescent patients with PRS are presented. The patients' symptomatology can be allocated on this continuum of PRS. PRS and dissociative disorders are compared in greater detail and contrasted within this discussion of differential diagnoses at the poles of such a continuum. PRS is a useful diagnosis for cases involving symptoms of predominating refusal and retreat which cannot satisfactorily be classified by existing diagnostic categories, and which can mostly clearly be separated from dissociative disorder.

Are Patients Ready for Lesbian, Gay and Bisexual Family Physicians - A Croatian Study.

PubMed

Grabovac, Igor; Mustajbegović, Jadranka; Milošević, Milan

2016-06-01

Discrimination and harassment of lesbian, gay and bisexual (LGB) physicians from their colleagues and superiors are known. However there is little knowledge about the patients’ attitudes and discrimination toward physicians. A cross sectional Internet survey was conducted in urban Croatian regions. The participants were asked to answer questions regarding their socio-demographic status, the Attitudes Towards Lesbians and Gay Men Scale (ATLG), and whether they would refuse to see a LGB physician and, if so, why. Of the 1004 participants, 8.8% said they would refuse a male GB physician while 7.9% would refuse a female LB physician, and 7.3% would refuse both. The two most common reasons for discriminating were: “disaccord with political or religious beliefs” and “fear of being sexually harassed”. A logistical regression model showed that male sex, higher ATLG score and higher age were associated with more refusals of male GB physicians. Also higher age, higher ATLG score were associated with more refusals of female LB physicians, while personal contact with LGB people was associated with less refusals of both groups. The observed prevalence of discrimination is significant. The results suggest that discrimination is based on emotional reasons and stereotypical beliefs. Educational efforts should be directed towards changing misconceptions about LGB people.

"My children and I will no longer suffer from malaria": a qualitative study of the acceptance and rejection of indoor residual spraying to prevent malaria in Tanzania.

PubMed

Kaufman, Michelle R; Rweyemamu, Datius; Koenker, Hannah; Macha, Jacob

2012-07-02

The objective of this study was to identify attitudes and misconceptions related to acceptance or refusal of indoor residual spraying (IRS) in Tanzania for both the general population and among certain groups (e.g., farmers, fishermen, community leaders, and women). This study was a series of qualitative, semi-structured, in-depth interviews and focus group discussions conducted from October 2010 to March 2011 on Mainland Tanzania and Zanzibar. Three groups of participants were targeted: acceptors of IRS (those who have already had their homes sprayed), refusers (those whose communities have been sprayed, but refused to have their individual home sprayed), and those whose houses were about to be sprayed as part of IRS scale-up. Interviews were also conducted with farmers, fishermen, women, community leaders and members of non-government organizations responsible for community mobilization around IRS. Results showed refusers are a very small percentage of the population. They tend to be more knowledgeable people such as teachers, drivers, extension workers, and other civil servants who do not simply follow the orders of the local government or the sprayers, but are skeptical about the process until they see true results. Refusal took three forms: 1) refusing partially until thorough explanation is provided; 2) accepting spray to be done in a few rooms only; and 3) refusing outright. In most of the refusal interviews, refusers justified why their houses were not sprayed, often without admitting that they had refused. Reasons for refusal included initial ignorance about the reasons for IRS, uncertainty about its effectiveness, increased prevalence of other insects, potential physical side effects, odour, rumours about the chemical affecting fertility, embarrassment about moving poor quality possessions out of the house, and belief that the spray was politically motivated. To increase IRS acceptance, participants recommended more emphasis on providing thorough public education, ensuring the sprayers themselves are more knowledgeable about IRS, and asking that community leaders encourage participation by their constituents rather than threatening punishment for noncompliance. While there are several rumours and misconceptions concerning IRS in Tanzania, acceptance is very high and continues to increase as positive results become apparent.

Factors associated with repeated refusal to participate in longitudinal population-based HIV surveillance in rural South Africa: an observational study, regression analyses

PubMed Central

Giordano, Katie; McGrath, Nuala; Snow, Rachel; Harlow, Siobán; Newell, Marie-Louise

2014-01-01

Background For many estimation purposes, individuals who repeatedly refuse to participate in longitudinal HIV surveillance pose a bigger threat to valid inferences than individuals who participate at least occasionally. We investigate the determinants of repeated refusal to consent to HIV testing in a population-based longitudinal surveillance in rural South Africa. Methods We used data from two years (2005 & 2006) of the annual HIV surveillance conducted by the Africa Centre for Health and Population Studies, linking the HIV surveillance data to demographic and socioeconomic data. The outcome for the analysis was “repeated refusal”. Demographic variables included sex, age, highest educational attainment, and place of residence. We also included a measure of wealth and the variable “ever had sex”. To compare the association of each variable with the outcome, unadjusted odds ratios and standard errors were estimated. Multivariable logistic regression was used to estimate adjusted odds ratios and their standard errors. Data were analyzed using STATA 10.0. Results Of 15,557 eligible individuals, 46% refused to test for HIV in both rounds. Males were significantly more likely than females to repeatedly refuse testing. Holding all other variables constant, individuals in the middle age groups were more likely to repeatedly refuse testing compared with younger and older age groups. The odds of repeated refusal increased with increasing level of education and relative wealth. People living in urban areas were significantly more likely to repeatedly refuse an HIV test than people living in peri-urban or rural areas. Compared to those who had ever had sex, both males and females who had not yet had sex were significantly more likely to refuse to participate. Conclusions The likelihood of repeated refusal to test for HIV in this longitudinal surveillance increases with education, wealth, urbanization, and primary sexual abstinence. Since the factors determining repeated HIV testing refusal are likely associated with HIV status, it is critical that selection effects are controlled for in the analysis of HIV surveillance data. Interventions to increase consent to HIV testing should consider targeting the relatively well educated and wealthy, people in urban areas, and individuals who have not yet sexually debuted. PMID:25621095

Personal Spaces in Public Repositories as a Facilitator for Open Educational Resource Usage

ERIC Educational Resources Information Center

Cohen, Anat; Reisman, Sorel; Sperling, Barbra Bied

2015-01-01

Learning object repositories are a shared, open and public space; however, the possibility and ability of personal expression in an open, global, public space is crucial. The aim of this study is to explore personal spaces in a big learning object repository as a facilitator for adoption of Open Educational Resources (OER) into teaching practices…

46 CFR 42.15-35 - Machinery space openings.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 2 2013-10-01 2013-10-01 false Machinery space openings. 42.15-35 Section 42.15-35... BY SEA Conditions of Assignment of Freeboard § 42.15-35 Machinery space openings. (a) Machinery space..., funnel, or machinery space ventilators in an exposed position on the freeboard or superstructure deck...

46 CFR 42.15-35 - Machinery space openings.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 2 2011-10-01 2011-10-01 false Machinery space openings. 42.15-35 Section 42.15-35... BY SEA Conditions of Assignment of Freeboard § 42.15-35 Machinery space openings. (a) Machinery space..., funnel, or machinery space ventilators in an exposed position on the freeboard or superstructure deck...

46 CFR 42.15-35 - Machinery space openings.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 2 2014-10-01 2014-10-01 false Machinery space openings. 42.15-35 Section 42.15-35... BY SEA Conditions of Assignment of Freeboard § 42.15-35 Machinery space openings. (a) Machinery space..., funnel, or machinery space ventilators in an exposed position on the freeboard or superstructure deck...

46 CFR 42.15-35 - Machinery space openings.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false Machinery space openings. 42.15-35 Section 42.15-35... BY SEA Conditions of Assignment of Freeboard § 42.15-35 Machinery space openings. (a) Machinery space..., funnel, or machinery space ventilators in an exposed position on the freeboard or superstructure deck...

46 CFR 42.15-35 - Machinery space openings.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 2 2012-10-01 2012-10-01 false Machinery space openings. 42.15-35 Section 42.15-35... BY SEA Conditions of Assignment of Freeboard § 42.15-35 Machinery space openings. (a) Machinery space..., funnel, or machinery space ventilators in an exposed position on the freeboard or superstructure deck...

Landscape Management of Public Open Space in Bogor Heritage City

NASA Astrophysics Data System (ADS)

Pusparini, F. D.; Nurhayati; Arifin, H. S.

2017-10-01

Public open space landscape plays important role in Bogor Heritage City. Although these spaces can carry various kind of public activities and enhance environment quality, they are fragile to disturbance and changing due to city development. Therefore, as an effort to maintain public open space landscape in 8 zones within Heritage City of Bogor, management of public open space landscape is necessary. Syntesys of public open space landscape management had held by using Analytical Hierarchy Process (AHP). The AHP result showed public open space landscape in Palace and Botanical Garden of Bogor zone (20%) is in high priority to be maintained. The other zone are Situ Gede (16,9%), Plan Karsten (12,3%), European Settlement (12%), Suryakencana (11,2%), Batu Tulis (10,2%), Empang (9.2%) and West Development (8,2%). Ecological function (34,8%) becomes the most important function to be maintained (34.8%) then social culture (31.2%), economic (17%), and aesthetics (17%).

Hyperconnectivity, Attribute-Space Connectivity and Path Openings: Theoretical Relationships

NASA Astrophysics Data System (ADS)

Wilkinson, Michael H. F.

In this paper the relationship of hyperconnected filters with path openings and attribute-space connected filters is studied. Using a recently developed axiomatic framework based on hyperconnectivity operators, which are the hyperconnected equivalents of connectivity openings, it is shown that path openings are a special case of hyperconnected area openings. The new axiomatics also yield insight into the relationship between hyperconnectivity and attribute-space connectivity. It is shown any hyperconnectivity is an attribute-space connectivity, but that the reverse is not true.

Factors related to treatment refusal in Taiwanese cancer patients.

PubMed

Chiang, Ting-Yu; Wang, Chao-Hui; Lin, Yu-Fen; Chou, Shu-Lan; Wang, Ching-Ting; Juang, Hsiao-Ting; Lin, Yung-Chang; Lin, Mei-Hsiang

2015-01-01

Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system. This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI). A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (p<0.001), poor performance(p<0.001), changes in medical condition (p<0.001), timing of case manager contact (p=.026), the methods by which case manager contact patients (p<0.001) and the frequency that case managers contact patients (≥10times) (p=0.016). Cancer patients who refuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.

Drink refusal training as part of a combined behavioral intervention: Effectiveness and mechanisms of change

PubMed Central

Witkiewitz, Katie; Donovan, Dennis M.; Hartzler, Bryan

2012-01-01

Objective Many trials have demonstrated the effectiveness of cognitive behavioral interventions for alcohol dependence, yet few studies have examined why particular treatments are effective. This study was designed to evaluate whether drink refusal training was an effective component of a combined behavioral intervention (CBI) and whether change in self-efficacy was a mechanism of change following drink refusal training for individuals with alcohol dependence. Method The current study is a secondary analysis of data from the COMBINE study, a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. The goal of the current study was to examine whether a drink refusal skills training module, administered as part of a 16-week CBI (n=776; 31% female, 23% non-White, average age=44) predicted changes in drinking frequency and self-efficacy during and following the CBI, and whether changes in self-efficacy following drink refusal training predicted changes in drinking frequency up to one year following treatment. Results Participants (n=302) who received drink refusal skills training had significantly fewer drinking days during treatment (d=0.50) and up to one year following treatment (d=0.23). In addition the effect of the drink refusal skills training module on drinking outcomes following treatment was significantly mediated by changes in self-efficacy, even after controlling for changes in drinking outcomes during treatment (proportion mediated = 0.47). Conclusions Drink refusal training is an effective component of CBI and some of the effectiveness may be attributed to changes in client self-efficacy. PMID:22289131

Obstetrician-gynaecologists' opinions about conscientious refusal of a request for abortion: results from a national vignette experiment.

PubMed

Rasinski, Kenneth A; Yoon, John D; Kalad, Youssef G; Curlin, Farr A

2011-12-01

Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee--whether the doctor referred and whether the doctor disclosed their objection to the abortion. 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Physicians indicated their approval for the vignette doctor's decision. Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor-patient relationship.

Neighbourhood-open space relationships in metropolitan planning: a look across four scales of concern

Treesearch

Paul H. Gobster

2001-01-01

New Urbanism and other metropolitan planning strategies may discount the importance of neighbourhood-open space relationships when dealing with some types of open spaces, particularly in city centre and urban fringe areas. In this paper I review a series of studies I have carried out over the past decade looking at people's perceptions and uses of urban open space...

How Do the Location, Size and Budget of Open Space Conservation Affect Land Values?

Treesearch

JunJie Wu; Wenchao Xu; Ralph J. Alig

2016-01-01

In this article we present a model to examine the optimal location, size, and budget of open space conservation and the resulting impact on land values and local fiscal conditions in an urban area. Results indicate that open space conservation can transform the defining features of an urban landscape. A well-designed open space conservation program can improve...

21 CFR 515.21 - Refusal to approve a medicated feed mill license application.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Refusal to approve a medicated feed mill license... SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS MEDICATED FEED MILL LICENSE Administrative Actions on Licenses § 515.21 Refusal to approve a medicated feed mill license application. (a) The...

49 CFR 382.211 - Refusal to submit to a required alcohol or controlled substances test.

Code of Federal Regulations, 2014 CFR

2014-10-01

....211 Refusal to submit to a required alcohol or controlled substances test. No driver shall refuse to submit to a pre-employment controlled substance test required under § 382.301, a post-accident alcohol or... controlled substances test. 382.211 Section 382.211 Transportation Other Regulations Relating to...

49 CFR 382.211 - Refusal to submit to a required alcohol or controlled substances test.

Code of Federal Regulations, 2012 CFR

2012-10-01

....211 Refusal to submit to a required alcohol or controlled substances test. No driver shall refuse to submit to a pre-employment controlled substance test required under § 382.301, a post-accident alcohol or... controlled substances test. 382.211 Section 382.211 Transportation Other Regulations Relating to...

49 CFR 382.211 - Refusal to submit to a required alcohol or controlled substances test.

Code of Federal Regulations, 2010 CFR

2010-10-01

....211 Refusal to submit to a required alcohol or controlled substances test. No driver shall refuse to submit to a post-accident alcohol or controlled substances test required under § 382.303, a random... controlled substances test. 382.211 Section 382.211 Transportation Other Regulations Relating to...

49 CFR 382.211 - Refusal to submit to a required alcohol or controlled substances test.

Code of Federal Regulations, 2011 CFR

2011-10-01

....211 Refusal to submit to a required alcohol or controlled substances test. No driver shall refuse to submit to a post-accident alcohol or controlled substances test required under § 382.303, a random... controlled substances test. 382.211 Section 382.211 Transportation Other Regulations Relating to...

49 CFR 219.209 - Reports of tests and refusals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Reports of tests and refusals. 219.209 Section 219... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Post-Accident Toxicological Testing § 219.209 Reports of tests and refusals. (a)(1) A railroad that has experienced one or more events for...

49 CFR 382.211 - Refusal to submit to a required alcohol or controlled substances test.

Code of Federal Regulations, 2013 CFR

2013-10-01

....211 Refusal to submit to a required alcohol or controlled substances test. No driver shall refuse to submit to a pre-employment controlled substance test required under § 382.301, a post-accident alcohol or... controlled substances test. 382.211 Section 382.211 Transportation Other Regulations Relating to...

Refusals in Chinese: How Do L1 and L2 Differ?

ERIC Educational Resources Information Center

Hong, Wei

2011-01-01

This article reports on an empirical study of refusal strategies in Chinese by native speakers (NS) and nonnative Chinese learners (NNS). Sixty subjects (perceived as "students") were to refuse an invitation by "the professor" to a Chinese New Year's party. The study found that the NS group produced 10 strategies, whereas the…

Using Descriptive Assessment in the Treatment of Bite Acceptance and Food Refusal

ERIC Educational Resources Information Center

Casey, Sean D.; Perrin, Christopher J.; Lesser, Aaron D.; Perrin, Stefanie H.; Casey, Cheryl L.; Reed, Gregory K.

2009-01-01

The feeding behaviors of two children who maintained failure to thrive diagnoses and displayed food refusal are assessed in their homes. Descriptive assessments are used to identify schedules of consequence provided by each child's care providers for bite acceptance and food refusal behaviors. Assessments reveal rich schedules of praise and access…

Obstetric Patients Who Select and Those Who Refuse Medical Students' Participation in Their Care.

ERIC Educational Resources Information Center

Magrane, Diane; And Others

1994-01-01

A survey of 222 obstetrics patients assisted by medical clerkship students from the University of Vermont and 78 who refused student participation found privacy the primary motivation for refusal and a desire to contribute to students' education a primary reason for accepting student participation. Patients frequently erroneously anticipated the…

Forms and Functions of School Refusal Behavior in Youth: An Empirical Analysis of Absenteeism Severity

ERIC Educational Resources Information Center

Kearney, Christopher A.

2007-01-01

Background: School refusal behavior is a particularly nettlesome problem for mental health and education professionals because of its symptom severity and heterogeneity as well as lack of consensus regarding inclusive classification strategies. Alternatively, a functional model of school refusal behavior may provide a particularly useful way of…

24 CFR 3282.354 - Submittal of false information or refusal to submit information.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Submittal of false information or... ENFORCEMENT REGULATIONS Primary Inspection Agencies § 3282.354 Submittal of false information or refusal to submit information. The submittal of false information or the refusal to submit information required...

Acquisition of cup drinking using previously refused foods as positive and negative reinforcement.

PubMed

Kelley, Michael E; Piazza, Cathleen C; Fisher, Wayne W; Oberdorff, Amanda J

2003-01-01

We used previously refused foods as positive and negative reinforcement in the acquisition of cup drinking. Cup drinking increased with positive and negative reinforcement, both alone and in combination (without escape extinction), indicating that treatment of food refusal can establish some foods as appetitive stimuli whereas others remain aversive.

Treatment for School Refusal among Children and Adolescents: A Systematic Review and Meta-Analysis

ERIC Educational Resources Information Center

Maynard, Brandy R.; Heyne, David; Brendel, Kristen Esposito; Bulanda, Jeffery J.; Thompson, Aaron M.; Pigott, Terri D.

2018-01-01

Objective: School refusal is a psychosocial problem associated with adverse short- and long-term consequences for children and adolescents. The authors conducted a systematic review and meta-analysis to examine the effects of psychosocial treatments for children and adolescents with school refusal. Method: A comprehensive search process was used…

22 CFR 92.9 - Refusals of requests for notarial services.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Refusals of requests for notarial services. 92.9 Section 92.9 Foreign Relations DEPARTMENT OF STATE LEGAL AND RELATED SERVICES NOTARIAL AND RELATED... services should be refused only after the most careful deliberation. [22 FR 10858, Dec. 27, 1957, as...

9 CFR 98.20 - Embryos refused entry.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Embryos refused entry. 98.20 Section... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos From Regions Where Rinderpest or Foot-and-Mouth Disease Exists § 98.20 Embryos refused entry. If any embryos are determined to be ineligible...

9 CFR 98.20 - Embryos refused entry.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Embryos refused entry. 98.20 Section... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos From Regions Where Rinderpest or Foot-and-Mouth Disease Exists § 98.20 Embryos refused entry. If any embryos are determined to be ineligible...

9 CFR 98.20 - Embryos refused entry.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Embryos refused entry. 98.20 Section... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos From Regions Where Rinderpest or Foot-and-Mouth Disease Exists § 98.20 Embryos refused entry. If any embryos are determined to be ineligible...

9 CFR 98.20 - Embryos refused entry.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Embryos refused entry. 98.20 Section... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos From Regions Where Rinderpest or Foot-and-Mouth Disease Exists § 98.20 Embryos refused entry. If any embryos are determined to be ineligible...

9 CFR 98.20 - Embryos refused entry.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Embryos refused entry. 98.20 Section... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos From Regions Where Rinderpest or Foot-and-Mouth Disease Exists § 98.20 Embryos refused entry. If any embryos are determined to be ineligible...

10 CFR 709.13 - Implications of refusal to take a polygraph examination.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Implications of refusal to take a polygraph examination. 709.13 Section 709.13 Energy DEPARTMENT OF ENERGY COUNTERINTELLIGENCE EVALUATION PROGRAM CI Evaluation Protocols and Protection of National Security § 709.13 Implications of refusal to take a polygraph...

49 CFR 219.209 - Reports of tests and refusals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Reports of tests and refusals. 219.209 Section 219.209 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Post-Accident Toxicological Testing § 219.209 Reports of tests and refusals. (...

Veterinary opinions on refusing euthanasia: justifications and philosophical frameworks.

PubMed

Yeates, J W; Main, D C J

2011-03-12

To obtain information on euthanasia decisions from practising veterinary surgeons, respondents were asked to estimate how often during their time in practice they had refused to euthanase a dog and how often they had wanted to refuse to euthanase a dog but not done so because of other pressures. For each, respondents were then asked to state their most common reasons for refusing/not refusing in free text. The responses of clinicians were considered in the light of established ethical concepts to produce an evidence-based ethical framework for decision making. In total, 58 practitioners responded. Common reasons given for decisions on whether to refuse euthanasia referred to the patient's interests, such as the possibility of treatment or rehoming, and the fear of other unacceptable outcomes for the dog. Other reasons were based on concern for owners' interests. Some respondents reported being pressured into euthanasia by clients and other veterinary surgeons. This gives insight into the ethical principles that explicitly underlie veterinary surgeons' euthanasia decisions and the resultant framework may be useful for discussing and teaching euthanasia.

Packaging's Contribution for the Effectiveness of the Space Station's Food Service Operation

NASA Technical Reports Server (NTRS)

Rausch, B. A.

1985-01-01

Storage limitations will have a major effect on space station food service. For example: foods with low bulk density such as ice cream, bread, cake, standard type potato chips and other low density snacks, flaked cereals, etc., will exacerbate the problem of space limitations; package containers are inherently volume consuming and refuse creating; and the useful observation that the optimum package is no package at all leads to the tentative conclusion that the least amount of packaging per unit of food, consistent with storage, aesthetics, preservation, cleanliness, cost and disposal criteria, is the most practical food package for the space station. A series of trade offs may have to be made to arrive at the most appropriate package design for a particular type of food taking all the criteria into account. Some of these trade offs are: single serve vs. bulk; conventional oven vs. microwave oven; nonmetallic aseptically vs. non-aseptically packaged foods; and comparison of aseptic vs. nonaseptic food packages. The advantages and disadvantages are discussed.

Soundscape of Urban Open Spaces in Hong Kong

NASA Astrophysics Data System (ADS)

Lin, Hui

This study aims to investigate the soundscape of urban open spaces in Hong Kong. Open space in densely populated cities has been considered as an important asset for urban inhabitants in that they afford opportunities for leisure, recreation and an active involvement with nature. For quite a long time, visual aesthetic was the dominant consideration in open space design and other senses were given less concern. Continuous stream of attention-demanding sounds from the noisy environment may bombard these open spaces, rendering them no longer able to satisfy the eye alone. Sound and consequently the acoustic environment are receiving increasing attention. This study used noise mapping technique supplemented by GIS spatial analysis tools to delineate quiet open spaces with traffic noise exposure less than 60 dB (A) L10, 1h and conducted field observations to determine their usages. The identified quiet open spaces are either concentrated in hilly and remote areas with low accessibility, or sporadically scattered among tall buildings. Some large urban parks and small sitting-out areas are even located in the center of the city. Larger open spaces serve group visits, such as hiking and sightseeing, while smaller ones are easily accessible to local residents for social and recreational purposes. The acoustic environment III urban open spaces varies with space and time. To characterize the acoustic quality of soundscapes in the quiet open spaces, sound walk and field recording were undertaken place in 25 selected study sites. Despite the dominance of traffic noise, soundscapes in the urban open spaces are also shaped by natural sounds. Sounds from birds and water are common and prevalent particularly in gardens and playgrounds. Soundscape approach is a human-centered point of view. How the visitors perceive and evaluate sounds and the acoustic quality has great implication for soundscape design. On-site interview of 1,610 visitors unravels human preference of individual sounds and evaluation of the acoustic quality. Sounds from bird, wind and water are most preferred, while mechanical sounds and road traffic noise are least favored. Human voice is rated in between. Brown's soundscape evaluation framework was substantiated by data collected in this study highlighting tbe importance of context and presence of wanted and unwanted sounds on subjective evaluation of the acoustic quality. Ordinal Logistic Regression models were developed with significant independent variables, including social-demographic factors, acoustic parameters, visiting habits and presence of wanted and unwanted sounds. Research findings have great implications for soundscape design of open spaces in compact cities. A properly designed open space offers a comfortable setting for relief, retreat and rejuvenation from tbe urban life. Endeavors to improve the acoustic quality in the urban open spaces will make cities more livable and sustainable.

Childhood vaccine refusal and hesitancy intentions in Croatia: insights from a population-based study.

PubMed

Repalust, Anja; Šević, Sandra; Rihtar, Stanko; Štulhofer, Aleksandar

2017-10-01

Considering that programmatic data suggest a recent rise in vaccine refusal in Croatia, this study, first of its kind in Southeast Europe, aimed to estimate the prevalence, and sociodemographic, and sociocultural determinants of childhood vaccine refusal and hesitancy (CVRH) intentions among Croatian adults. Multi-stage stratified population-based survey included 1000 individuals aged 18-88 years (M age  = 47.7, SD = 17.8), of whom 51.7% were women. The outcome, a categorical indicator, distinguished among individuals who would approve vaccinating their children (vaccine accepting), those who would approve some but not all vaccines (vaccine hesitant), and those who would refuse vaccination (vaccine refusing). A sizeable minority of participants was characterized by childhood vaccine refusal (10.6%) and hesitancy intentions (19.5%). In a multivariate assessment controlling for parenthood, the odds of vaccine hesitancy were significantly increased by a younger age (AOR = 1.96-3.03, p < .01). Religiosity (AOR = 1.12, p < .05) and the use of alternative medicine (AOR = 2.85, p < .001) increased the odds of vaccine refusal. However, individual characteristics seem to be relatively poor predictors of CVRH intentions in Croatia. Following the social contagion model, future research should move beyond individual-level approach and take into account social interaction and social network effects.

Consent and refusal in dementia research: conceptual and practical considerations.

PubMed

Cohen-Mansfield, J

2003-01-01

This article discusses types of consent refusals, rates of refusal, factors that affect consent, and methods to increase rates of consent in elderly research participants and in those with dementia in particular. Refusals can be categorized according to several types: complete refusal, refusal that is time-contingent, partial refusal, and contingent agreement. Rates of consent vary greatly across studies of persons with dementia. This variation can also be affected by different methodologies of calculating rates, in addition to differences in content of studies, populations, and procedures. To warrant consent, a study must first be scientifically sound, with a high likelihood of advancing knowledge, and must provide maximal protection to participants. Consent rates are affected by the following factors: levels of anticipated risks and benefits of the study, relationships among the different caregivers involved in the care of the potential subject, the ability of the researcher to properly identify and locate the person who needs to provide consent, characteristics and attitudes of the person providing consent, and the method of obtaining consent, including timing, location, method of presentation, and type of consent requested. An understanding of these issues can assist the researcher in tailoring research procedures so as to maximize rates of consent. It also raises ethical issues that warrant further discussion concerning the process of obtaining consent from and for persons with dementia.

Geophysical investigations of near-surface materials and groundwater quality at abandoned mine land site No. 1087, Pike County, Indiana

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

Spindler, K.M.; Olyphant, G.A.; Harper, D.

Reclamation of Abandoned Mine Land (AML) Site No. 1087 (Midwestern) includes extensive use of coal-combustion byproducts such as fly ash and fixated scrubber sludge (FSS) as fill and cover materials. Prior to reclamation, a deposit of coarse-grained pyritic refuse in the central part of the site was the primary source for acidic mine drainage. The FSS tends to have a low permeability, so it was applied over the refuse to serve as a barrier to vertical recharge and thereby inhibit generation and mobilization of additional acidity. Repeated post-reclamation measurements of soil-water content using a neutron moisture gauge provide evidence thatmore » vertical recharge is, in fact, not occurring through the FSS. However, a previously existing plume of acidic water extends beyond the area of the refuse into adjacent areas of disturbed overburden (spoil). Electrical resistivity profiles using the offset Wenner method were used to delineate the horizontal extent of the refuse and to quantify spatial variability of groundwater chemistry within the refuse and adjacent spoil. Ground penetrating radar (GPR) was used to precisely determine the thickness and extent of the FSS layer and its relation to the refuse and to the surrounding plume of acidic water. Together, these techniques provide a complete three-dimensional representation of the FSS, refuse, spoil, and plume of acidic groundwater.« less

Campus on the Hill.

ERIC Educational Resources Information Center

Martin, Frank Edgerton

2002-01-01

Details the University of Cincinnati's campus master plan, designed to overcome deans'"fiefdoms" and make the best use of the limited remaining open space. Three imperatives shaped the plan: siting new buildings to infill the campus fabric rather than taking open space, siting buildings to shape outdoor spaces, and weaving open spaces as…

A Test for Anchoring and Yea-Saying in Experimental Consumption Data.

PubMed

van Soest, Arthur; Hurd, Michael

2008-01-01

We analyze experimental survey data, with a random split into respondents who get an open-ended question on the amount of total family consumption (with follow-up unfolding brackets of the form "Is consumption $X or more?" for those who answer "don't know" or "refuse") and respondents who are immediately directed to unfolding brackets. In both cases, the entry point of the unfolding bracket sequence is randomized. Allowing for any type of selection into answering the open-ended or bracket questions, a nonparametric test is developed for errors in the answers to the first bracket question that are different from the usual reporting errors that will also affect open-ended answers. Two types of errors are considered explicitly: anchoring and yea-saying. Data are collected in the 1995 wave of the Assets and Health Dynamics survey, which is representative of the population in the United States that is 70 years and older. We reject the joint hypothesis of no anchoring and no yea-saying. Once yea-saying is taken into account, we find no evidence of anchoring at the entry point.

43 CFR 15.4 - Refuse and polluting substances.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Refuse and polluting substances. 15.4 Section 15.4 Public Lands: Interior Office of the Secretary of the Interior KEY LARGO CORAL REEF PRESERVE § 15.4 Refuse and polluting substances. No person shall dump or deposit in or on the waters of this...

43 CFR 15.4 - Refuse and polluting substances.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Refuse and polluting substances. 15.4 Section 15.4 Public Lands: Interior Office of the Secretary of the Interior KEY LARGO CORAL REEF PRESERVE § 15.4 Refuse and polluting substances. No person shall dump or deposit in or on the waters of this...

43 CFR 15.4 - Refuse and polluting substances.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Refuse and polluting substances. 15.4 Section 15.4 Public Lands: Interior Office of the Secretary of the Interior KEY LARGO CORAL REEF PRESERVE § 15.4 Refuse and polluting substances. No person shall dump or deposit in or on the waters of this...

43 CFR 15.4 - Refuse and polluting substances.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Refuse and polluting substances. 15.4 Section 15.4 Public Lands: Interior Office of the Secretary of the Interior KEY LARGO CORAL REEF PRESERVE § 15.4 Refuse and polluting substances. No person shall dump or deposit in or on the waters of this...

43 CFR 15.4 - Refuse and polluting substances.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Refuse and polluting substances. 15.4 Section 15.4 Public Lands: Interior Office of the Secretary of the Interior KEY LARGO CORAL REEF PRESERVE § 15.4 Refuse and polluting substances. No person shall dump or deposit in or on the waters of this...

New Report Compares Performance of Compressed Natural Gas Refuse Haulers to

Science.gov Websites

Diesel-Powered Trucks Report Compares Performance of Compressed Natural Gas Refuse Haulers to Diesel-Powered Trucks For more information contact: e:mail: Public Affairs A new report that compares the performance of compressed natural gas (CNG) refuse haulers in New York City to similar diesel-powered trucks

Using a Preventive Social Work Program for Reducing School Refusal

ERIC Educational Resources Information Center

Elsherbiny, Mohamed Mohamed

2017-01-01

This article describes a study aimed at solving the problem of school refusal by implementing a preventive program and raising the awareness of parents, social workers, and school personnel. The school children involved in this study were reported by their parents and school social workers to refuse to go to school, and according to the children's…

Alternative Fuels Data Center: Fleet Application for Refuse Collection

Science.gov Websites

CNG - Compressed Natural Gas 1 Electric 1 Hybrid - CNG 1 Hybrid - LNG 1 Hydraulic hybrid 9 LNG - Liquified Natural Gas icon for refuse collection vehicle application Autocar ACMD-Xpert Hybrid - CNG Hybrid - Compressed Natural Gas LNG - Liquified Natural Gas icon for refuse collection vehicle application BYD All

21 CFR 514.110 - Reasons for refusing to file applications.

Code of Federal Regulations, 2010 CFR

2010-04-01

... of the applicant and to receive communications on all matters pertaining to the application. (7) The... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Reasons for refusing to file applications. 514.110... Applications § 514.110 Reasons for refusing to file applications. (a) The date of receipt of an application for...

Thinking through Moments of Sexual Refusal in "Looking for Alibrandi" and "The Rage in Placid Lake"

ERIC Educational Resources Information Center

Clarke, Kyra

2016-01-01

This paper explores two scenarios in which young women refuse the sexual advances of young men in the films "Looking for Alibrandi" and "The Rage in Placid Lake." The paper highlights the heteronormative nature of education around refusing sex, which reinstates gendered stereotypes of masculine as active and feminine as…

9 CFR 156.8 - Refusal of service; denial or withdrawal of service.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Refusal of service; denial or withdrawal of service. 156.8 Section 156.8 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE § 156.8 Refusal of...

9 CFR 156.8 - Refusal of service; denial or withdrawal of service.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Refusal of service; denial or withdrawal of service. 156.8 Section 156.8 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE § 156.8 Refusal of...

9 CFR 156.8 - Refusal of service; denial or withdrawal of service.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Refusal of service; denial or withdrawal of service. 156.8 Section 156.8 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE § 156.8 Refusal of...

9 CFR 156.8 - Refusal of service; denial or withdrawal of service.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Refusal of service; denial or withdrawal of service. 156.8 Section 156.8 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE § 156.8 Refusal of...

The case of Ms B: suicide's slippery slope?

PubMed

Keown, J

2002-08-01

In the case of Ms B, the High Court ruled that as Ms B was a competent adult patient, her doctors acted unlawfully in overriding her refusal of life-preserving ventilation. This commentary considers whether this case supports the proposition that in English law the right to refuse treatment extends even to refusals which are clearly suicidal.

7 CFR 91.34 - When an appeal of a laboratory service may be refused.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Appeal of Laboratory Services § 91.34 When an appeal of a laboratory service may be refused. An application for an appeal of a laboratory... 7 Agriculture 3 2010-01-01 2010-01-01 false When an appeal of a laboratory service may be refused...

Self-reporting and measurement of body mass index in adolescents: refusals and validity, and the possible role of socioeconomic and health-related factors.

PubMed

Chau, Nearkasen; Chau, Kénora; Mayet, Aurélie; Baumann, Michèle; Legleye, Stéphane; Falissard, Bruno

2013-09-08

Body mass index assessment using self-reported height and weight (BMIsr) can encounter refusals and under/over-reporting while for assessment with measured data (BMIm) refusals can be more frequent. This could relate to socioeconomic and health-related factors. We explored these issues by investigating numerous potential factors: gender, age, family structure, father's occupation, income, physical/sports activity, subjective weight perception, school performance, unhealthy behaviours, physical/psychological health, social relationships, living environment, having sustained violence, sexual abuse, and involvement in violence. The sample included 1559 adolescents from middle schools in north-eastern France. They completed a questionnaire including socioeconomic and health-related data, self-reported height/weight, measured height/weight, and weight perception (participation rate 94%). Data were analysed using logistic regression models. BMIsr encountered under-reporting (with change in BMI category, 11.8%), over-reporting (6.0%), and reporting refusals (3.6%). BMIm encountered more numerous refusals (7.9%). Reporting refusal was related to living with a single parent, low school performance, lack of physical/sports activity, sustained violence, poor psychological health, and poor social relationships (gender/age-adjusted odds ratios 1.95 to 2.91). Further to these factors, measurement refusal was related to older age, having divorced/separated parents, a father being a manual worker/inactive, insufficient family income, tobacco/cannabis use, involvement in violence, poor physical health, and poor living environment (1.30 to 3.68). Under-reporting was related to male gender, involvement in violence, poor psychological health, and overweight/obesity (as assessed with BMIm) (1.52 to 11). Over-reporting was related to male gender, younger age, alcohol consumption, and underweight (1.30 to 5.35). Weight perception was linked to reporting refusals and under/over-reporting, but slightly linked to measurement refusal. The contributions of socioeconomic and health-related factors to the associations of weight perception with reporting refusal and under/over-reporting ranged from -82% to 44%. There were substantial discrepancies in the associations between socioeconomic/health-related factors and overweight/obesity assessed with BMIsr and BMIm. BMIsr and BMIm were affected by numerous biases related to vulnerability which were also obesity risk factors. BMIsr encountered under/over-reporting which were related to some socioeconomic and health-related factors, weight perception, and BMIm. BMIm was more affected by refusals than BMIsr due to socioeconomic and health-related factors. Further research is needed.

Refusal of hemodialysis by hospitalized chronic kidney disease patients in Pakistan.

PubMed

Shafi, Salman Tahir; Saleem, Mohammad; Anjum, Roshina; Abdullah, Wajid; Shafi, Tahir

2018-01-01

In Pakistan, patients with chronic kidney disease (CKD) are commonly diagnosed at a late stage. There is little information about the refusal of hemodialysis by hospitalized CKD patients who need hemodialysis (HD) and reasons for acceptance and refusal among these patients. All patients with Stage V CKD who had medical indications to undergo HD and were hospitalized at a tertiary care facility over a six-month period were invited to participate in this study. Patients were surveyed regarding acceptance or refusing of HD and reasons for their decisions. Demographic, socioeconomic, and clinical characteristics of patients were compared between patients who accepted or refused HD. A total of 125 patients were included in the study. The mean age of the patients was 47.9 ±12.1 years. The mean duration of diagnosis of CKD was 2.5 ± 0.6 months. Of all patients, 72 (57.6%) agreed to do HD and 53 (42.4%) refused HD. Patients with arteriovenous fistula in place (27.1 vs. 9.1%, P 0.02) and those in the middle- or higher-income group (64.4% vs. 38.6%, p = 0.03) were more willing to undergo HD. Trust in doctor's advice (86.1%) was the most common reason for acceptance of HD. Frequency of HD per week (52.8%), lifelong and permanent nature of HD (50.9%), advice by family members or friends (37.7%), perception of poor quality of life on HD (35.8%), and fear of HD needles and complications during HD (33.9%) were the most common reasons for refusal. Refusal of HD is common among hospitalized CKD patients with medical indications to undergo HD, especially in lower income group.

[Treatment Refusal in Pediatric Oncology].

PubMed

Špótová, A; Husáková, K; Hrašková, A; Mikesková, M; Puškáčová, J; Hederová, S; Jamárik, M; Rabenseifertová, E; Jalovecká, Z; Kolenová, A; Šubová, Z

2017-01-01

Pediatric oncologists are often faced with situations in which parents or guardians refuse recommended treatment for curable childhood cancer. Deciding how to proceed in such situations is an ethical dilemma. The aim of this article is to consider optimal approaches when parents are strongly against oncological treatment, potentially compromising their childrens rights for health care and to the chance for cure. In this paper, we report two cases of treatment refusal from our department and the impact of such decisions on the children themselves. Case no. 1 describes a child with retinoblastoma whose parents refused standard treatment in order to seek alternative treatment abroad. Case no. 2 describes a patient with a primary lymphoma of bone who received treatment by a court order after parental refusal. When parents refuse a treatment for potentially curable cancer, the medical team often focuses on the certainty of death without treatment. In the background, there is a smaller but still significant risk that - even if the treatment is eventually accepted or compelled - the child will still die from treatment-related complications or refractory disease, possibly with considerable suffering. The reasons for refusing a treatment vary. The entire medical team is tasked with trying to respectfully understand the reasoning behind the parents unwillingness to accept the treatment, in order to address all possible misunderstandings and to propose solutions that could be acceptable for the parents. In some situations however, it is necessary to resolve the dilemma by legal means in order to protect the life of the child.Key words: oncology - ethics - decision making - treatment refusal - legal guardians The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 7. 8. 2017Accepted: 7. 9. 2017.

[Refusal of initiation of dialysis by elderly patients with chronic renal failure].

PubMed

Fujimaki, Hiroshi; Kasuya, Yutaka; Kawaguchi, Sachiko; Hara, Shino; Koga, Shiro; Takahashi, Tadao; Mizuno, Shoichi

2005-07-01

Refusal of dialysis is not uncommon in elderly patients with chronic renal failure. In this study, we retrospectively inspected our dealings with patients who refused our offer to initiate dialysis. In addition, we discussed how to grasp the meaning of this phenomenon. We treated 152 patients with advanced chronic renal failure aged 60 years and over at Tokyo Metropolitan Geriatric Hospital. The patients fulfilling the following two criteria were considered to be refusal cases. The first criterion was that an acceptance of the initiation of dialysis could not be obtained in spite of repeated counseling. The second criterion was that a definite outcome was precipitated by the development of severe uremic symptoms. In every refusal case, clinical characteristics and household members were surveyed. Verbal expressions of the reasons for refusal were retrieved from medical charts. The outcome was also studied. The two criteria were fulfilled in 7 cases. The male/female ratio was 5:2. The age was 78 +/- 7 years (mean +/- standard deviation). All but one cases were ambulatory, and all cases had normal cognitive function. Four cases were married, and the other cases had lost their partners. The number of household members was 3.9 +/- 1.8. We speculated that every case could maintain a good quality of life even after the initiation of dialysis. Representative expressions of the reasons for refusal were "I have already lived fully" and "I would prefer to accept death rather than dialysis". The outcome was urgent initiation of dialysis (five cases) and death (two cases). The time between initial counseling and the outcome was 115 +/- 37 days. Accepting or refusing dialysis therapy is a selection related to life or death. We must make an effort to obtain consent to initiating dialysis if patients are assessed as suitable for dialysis.

Validation of the Vaccination Confidence Scale: A brief measure to identify parents at risk for refusing adolescent vaccines

PubMed Central

Reiter, Paul L.; Magnus, Brooke E.; McRee, Annie-Laurie; Dempsey, Amanda F.; Brewer, Noel T.

2015-01-01

Objective To support efforts to address vaccine hesitancy, we sought to validate a brief measure of vaccination confidence using a large, nationally representative sample of parents. Methods We analyzed weighted data from 9,018 parents who completed the 2010 National Immunization Survey-Teen, an annual, population-based telephone survey. Parents reported on the immunization history of a 13- to 17-year-old child in their households for vaccines including tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal, and human papillomavirus (HPV) vaccines. For each vaccine, separate logistic regression models assessed associations between parents’ mean scores on the 8-item Vaccination Confidence Scale and vaccine refusal, vaccine delay, and vaccination status. We repeated analyses for the scale’s 4-item short form. Results One quarter of parents (24%) reported refusal of any vaccine, with refusal of specific vaccines ranging from 21% for HPV to 2% for Tdap. Using the full 8-item scale, vaccination confidence was negatively associated with measures of vaccine refusal and positively associated with measures of vaccination status. For example, refusal of any vaccine was more common among parents whose scale scores were medium (odds ratio [OR] = 2.08, 95% confidence interval [CI], 1.75–2.47) or low (OR = 4.61, 95% CI, 3.51–6.05) versus high. For the 4-item short form, scores were also consistently associated with vaccine refusal and vaccination status. Vaccination confidence was inconsistently associated with vaccine delay. Conclusions The Vaccination Confidence Scale shows promise as a tool for identifying parents at risk for refusing adolescent vaccines. The scale’s short form appears to offer comparable performance. PMID:26300368

Dialysis patients refusing kidney transplantation: data from the Slovenian Renal Replacement Therapy Registry.

PubMed

Buturović-Ponikvar, Jadranka; Gubenšek, Jakob; Arnol, Miha; Bren, Andrej; Kandus, Aljoša; Ponikvar, Rafael

2011-06-01

Kidney transplantation is considered the best renal replacement therapy (RRT) for patients with end-stage renal disease; nevertheless, some dialysis patients refuse to be transplanted. The aim of our registry-based, cross-sectional study was to compare kidney transplant candidates to dialysis patients refusing transplantation. Data were collected from the Slovenian Renal Replacement Therapy Registry database, as of 31 December 2008. Demographic and some RRT data were compared between the groups. There were 1448 dialysis patients, of whom 1343 were treated by hemodialysis and 105 by peritoneal dialysis (PD); 132 (9%) were on the waiting list for transplantation, 208 (14%) were preparing for enrollment (altogether 340 [23%] dialysis patients were kidney transplant candidates); 200 (13.7%) patients were reported to refuse transplantation, all ≤ 65 years of age; 345 (24%) were not enrolled due to medical contraindications, 482 (33%) due to age, and 82 (6%) due to other or unknown reasons. No significant difference was found in age, gender, or presence of diabetes between kidney transplant candidates vs. patients refusing transplantation (mean age 50.5 ± 13.9 vs. 51.3 ± 9.6 years, males 61% vs. 63%, diabetics 18% vs. 17%). The proportion of patients ≤ 65 years old who were refusing transplantation was 28% (187/661) for hemodialysis and 17% (13/79) for PD patients (P = 0.03). There is a considerable group of dialysis patients in Slovenia refusing kidney transplantation. Compared to the kidney transplant candidates, they are similar in age, gender and prevalence of diabetes. Patients treated by peritoneal dialysis refuse kidney transplantation less often than hemodialysis patients. © 2011 The Authors. Therapeutic Apheresis and Dialysis © 2011 International Society for Apheresis.

Reconceptualizing Efficacy in Substance Use Prevention Research: Refusal Response Efficacy and Drug Resistance Self-Efficacy in Adolescent Substance Use

PubMed Central

Choi, Hye Jeong; Krieger, Janice L.; Hecht, Michael L.

2014-01-01

The purpose of this study is to utilize the Extended Parallel Process Model (EPPM) to expand the construct of efficacy in the adolescent substance use context. Using survey data collected from 2,129 seventh-grade students in 39 rural schools, we examined the construct of drug refusal efficacy and demonstrated relationships among response efficacy (RE), self-efficacy (SE), and adolescent drug use. Consistent with the hypotheses, confirmatory factor analyses of a 12-item scale yielded a three-factor solution: refusal RE, alcohol-resistance self-efficacy (ASE), and marijuana-resistance self-efficacy (MSE). Refusal RE and ASE/MSE were negatively related to alcohol use and marijuana use, whereas MSE was positively associated with alcohol use. These data demonstrate that efficacy is a broader construct than typically considered in drug prevention. Prevention programs should reinforce both refusal RE and substance-specific resistance SE. PMID:23330857

How to justify enforcing a Ulysses contract when Ulysses is competent to refuse.

PubMed

Davis, John K

2008-03-01

Sometimes the mentally ill have sufficient mental capacity to refuse treatment competently, and others have a moral duty to respect their refusal. However, those with episodic mental disorders may wish to precommit themselves to treatment, using Ulysses contracts known as "mental health advance directives." How can health care providers justify enforcing such contracts over an agent's current, competent refusal? I argue that providers respect an agent's autonomy not retrospectively--by reference to his or her past wishes-and not merely synchronically--so that the agent gets what he or she wants right now-but diachronically and prospectively, acting so that the agent can shape his or her circumstances as the agent wishes over time, for the agent will experience the consequences of providers' actions over time. Mental health directives accomplish this, so they are a way of respecting the agent's autonomy even when providers override the agent's current competent refusal.

Examining the ethico-legal aspects of the right to refuse treatment in Turkey.

PubMed

Sert, Gurkan; Guven, Tolga

2013-10-01

This paper examines the ethico-legal problems regarding the right to refuse treatment in Turkey's healthcare system. We discuss these problems in the light of a recent case that was directly reported to us. We first summarise the experience of a chronically dependent patient (as recounted by her daughter) and her family during their efforts to refuse treatment and receive palliative care only. This is followed by a summary of the legal framework governing the limits of the right to refuse treatment in Turkey. With the help of this background information on the legal framework, we re-examine the ethico-legal aspects of the case and explain the underlying reasons for the problems the family and the patient experienced. Finally, we conclude that Turkey's legal framework relating to the right to refuse treatment needs to be clarified and amended in accordance with international conventions and fundamental human rights.

Mediators of sexual revictimization risk in adult sexual assault victims.

PubMed

Ullman, Sarah E; Vasquez, Amanda L

2015-01-01

This study examined sexual risk behaviors and sexual refusal assertiveness in relationship to child sexual abuse, emotion dysregulation, and adult sexual revictimization. Path analyses of 1,094 survivors who had sex in the past year were done to examine sexual risk behavior and sexual refusal assertiveness mediational pathways by which child sexual abuse severity and emotion dysregulation may affect revictimization over one year in adult female sexual assault survivors. Exchanging sex for money and sexual refusal assertiveness were significantly associated with emotion dysregulation, whereas exchanging sex for money, and not sexual refusal assertiveness, was only significantly related to child sexual abuse severity. Both exchanging sex for money and sex refusal assertiveness mediated the relationship between emotion dysregulation and adult sexual revictimization. Exchanging sex for money mediated the child sexual abuse severity-revictimization relationship. These findings demonstrate the importance of considering both risky and protective sexual behaviors in research and prevention programming that address sexual revictimization in women.

Mediators of Sexual Revictimization Risk in Adult Sexual Assault Victims

PubMed Central

Ullman, Sarah E.; Vasquez, Amanda L.

2015-01-01

This study examined sexual risk behaviors and sexual refusal assertiveness in relationship to child sexual abuse (CSA), emotion dysregulation, and adult sexual revictimization. Path analyses of 1,094 survivors who had sex in the past year were done to examine sexual risk behavior, and sexual refusal assertiveness mediational pathways by which CSA severity and emotion dysregulation may affect revictimization over one year in adult female sexual assault survivors. Exchanging sex for money and sexual refusal assertiveness were significantly associated with emotion dysregulation, whereas exchanging sex for money, and not sexual refusal assertiveness, was only significantly related to CSA severity. Both exchanging sex for money and sex refusal assertiveness mediated the relationship between emotion dysregulation and adult sexual revictimization. Exchanging sex for money mediated the CSA severity-revictimization relationship. These findings demonstrate the importance of considering both risky and protective sexual behaviors in research and prevention programming that address sexual revictimization in women. PMID:25942287

Refusal skill ability: an examination of adolescent perceptions of effectiveness.

PubMed

Nichols, Tracy R; Birnel, Sara; Graber, Julia A; Brooks-Gunn, Jeanne; Botvin, Gilbert J

2010-06-01

This pilot study examined whether refusal assertion as defined by a proven drug prevention program was associated with adolescent perceptions of effectiveness by comparing two sets of coded responses to adolescent videotaped refusal role-plays (N = 63). The original set of codes was defined by programmatic standards of refusal assertion and the second by a group of high school interns. Consistency with programming criteria was found for interns' ratings of several indicators of verbal and non-verbal assertiveness. However, a strategy previously defined by the program as effective was perceived as ineffective by adolescents while another deemed ineffective and problematic by intervention developers was viewed as effective. Interns endorsed presenting detailed and reasonable arguments as an effective refusal strategy while short, simple statements were deemed ineffective. This study suggests the importance of including adolescent perspectives in the design, delivery, and evaluation of drug prevention strategies.

Hydraulically-actuated operating system for an electric circuit breaker

DOEpatents

Barkan, Philip; Imam, Imdad

1978-01-01

This hydraulically-actuated operating system comprises a cylinder, a piston movable therein in an opening direction to open a circuit breaker, and an accumulator for supplying pressurized liquid to a piston-actuating space within the cylinder. A normally-closed valve between the accumulator and the actuating space is openable to allow pressurized liquid from the accumulator to flow through the valve into the actuating space to drive the piston in an opening direction. A vent is located hydraulically between the actuating space and the valve for affording communication between said actuating space and a low pressure region. Flow control means is provided for restricting leakage through said vent to a rate that prevents said leakage from substantially detracting from the development of pressure within said actuatng space during the period from initial opening of the valve to the time when said piston has moved through most of its opening stroke. Following such period and while the valve is still open, said flow control means allows effective leakage through said vent. The accumulator has a limited capacity that results in the pressure within said actuating space decaying promptly to a low value as a result of effective leakage through said vent after the piston has moved through a circuit-breaker opening stroke and while the valve is in its open state. Means is provided for resetting the valve to its closed state in response to said pressure decay in the actuating space.

49 CFR 655.49 - Refusal to submit to a drug or alcohol test.

Code of Federal Regulations, 2013 CFR

2013-10-01

... IN TRANSIT OPERATIONS Types of Testing § 655.49 Refusal to submit to a drug or alcohol test. (a) Each employer shall require a covered employee to submit to a post-accident drug and alcohol test required under... 49 Transportation 7 2013-10-01 2013-10-01 false Refusal to submit to a drug or alcohol test. 655...

49 CFR 655.49 - Refusal to submit to a drug or alcohol test.

Code of Federal Regulations, 2011 CFR

2011-10-01

... IN TRANSIT OPERATIONS Types of Testing § 655.49 Refusal to submit to a drug or alcohol test. (a) Each employer shall require a covered employee to submit to a post-accident drug and alcohol test required under... 49 Transportation 7 2011-10-01 2011-10-01 false Refusal to submit to a drug or alcohol test. 655...

49 CFR 655.49 - Refusal to submit to a drug or alcohol test.

Code of Federal Regulations, 2014 CFR

2014-10-01

... IN TRANSIT OPERATIONS Types of Testing § 655.49 Refusal to submit to a drug or alcohol test. (a) Each employer shall require a covered employee to submit to a post-accident drug and alcohol test required under... 49 Transportation 7 2014-10-01 2014-10-01 false Refusal to submit to a drug or alcohol test. 655...

49 CFR 655.49 - Refusal to submit to a drug or alcohol test.

Code of Federal Regulations, 2012 CFR

2012-10-01

... IN TRANSIT OPERATIONS Types of Testing § 655.49 Refusal to submit to a drug or alcohol test. (a) Each employer shall require a covered employee to submit to a post-accident drug and alcohol test required under... 49 Transportation 7 2012-10-01 2012-10-01 false Refusal to submit to a drug or alcohol test. 655...

49 CFR 655.49 - Refusal to submit to a drug or alcohol test.

Code of Federal Regulations, 2010 CFR

2010-10-01

... IN TRANSIT OPERATIONS Types of Testing § 655.49 Refusal to submit to a drug or alcohol test. (a) Each employer shall require a covered employee to submit to a post-accident drug and alcohol test required under... 49 Transportation 7 2010-10-01 2010-10-01 false Refusal to submit to a drug or alcohol test. 655...

[Refusal of nursing care, the legal perspective].

PubMed

Fisman, Jérôme

2016-10-01

The refusal of nursing care forms part of the freedom offered to anyone wanting to refuse, consciously and knowingly, any form of nursing care such as washing, the taking of medication or hospitalisation. However, limits are fixed by law as well as by case law. Are we totally free in the expression of our will? Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Frequency and predictors of seasonal influenza vaccination and reasons for refusal among patients at a large tertiary referral hospital.

PubMed

Masnick, Max; Leekha, Surbhi

2015-07-01

We assessed frequency and predictors of seasonal influenza vaccination acceptance among inpatients at a large tertiary referral hospital, as well as reasons for vaccination refusal. Over 5 seasons, >60% of patients unvaccinated on admission refused influenza vaccination while hospitalized; "believes not at risk" was the reason most commonly given.

Graduated Exposure and Compliance Training Intervention for Blood Draw Avoidance and Refusal in a Woman with Intellectual Disability and Schizoaffective Disorder

ERIC Educational Resources Information Center

Cromartie, R. Samuel; Flood, William A.; Luiselli, James K.

2014-01-01

This case report concerns a woman with intellectual disability, schizoaffective disorder, and avoidance and refusal of having her blood drawn. She required but refused blood draws to properly monitor the therapeutic dose of a necessary psychotropic medication. During intervention at a community-based habilitation setting and under simulated…

45 CFR 400.77 - Effect of quitting employment or failing or refusing to participate in required services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 2 2011-10-01 2011-10-01 false Effect of quitting employment or failing or... Employment General Requirements § 400.77 Effect of quitting employment or failing or refusing to participate... quit employment or have refused to accept an offer of employment determined to be appropriate by the...

Making Sense of Iconic Symbols: A Study of Preschool Children Conducting a Refuse-Sorting Task

ERIC Educational Resources Information Center

Ljung-Djärf, Agneta; Åberg-Bengtsson, Lisbeth; Ottosson, Torgny; Beach, Dennis

2015-01-01

This article is part of a larger project focusing upon explanatory illustrations that children encounter in pre- and primary school education. The research questions concerned (a) how preschool children make sense of iconic symbols when placing items of refuse on illustrations of refuse bins in a sorting task and (b) what stumbling blocks they…

Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations.

PubMed

Marco, Catherine A; Brenner, Jay M; Kraus, Chadd K; McGrath, Norine A; Derse, Arthur R

2017-11-01

Informed consent is an important component of emergency medical treatment. Most emergency department patients can provide informed consent for treatment upon arrival. Informed consent should also be obtained for emergency medical interventions that may entail significant risk. A related concept to informed consent is informed refusal of treatment. Patients may refuse emergency medical treatment during their evaluation and treatment. This article addresses important considerations for patients who refuse treatment, including case studies and discussion of definitions, epidemiology, assessment of decisional capacity, information delivery, medicolegal considerations, and alternative care plans. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

[Refusal of care by a HIV-positive adolescent: role of the cross-cultural approach].

PubMed

Bouaziz, Nora; Titia Rizzi, Alice

The refusal of treatment is frequent in human immunodeficiency virus-positive adolescents. The clinical history of a teenage girl presenting severe immunodepression secondary to the virus, a depressive disorder and a refusal of treatment, illustrates the benefit of combined paediatric, child psychiatric and cross-cultural care as proposed by the Cochin-Paris Adolescent Centre. Working on the meaning of the refusal was a prerequisite for the construction of a care project forming part of a life project, as the psychopathological work could only begin once somatic care ensuring the patient's protection was in place. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Ground-Water Quality in the Vicinity of Coal-Refuse Areas Reclaimed with Biosolids in Fulton County, Illinois

USGS Publications Warehouse

Morrow, William S.

2007-01-01

The Metropolitan Water Reclamation District of Greater Chicago has applied biosolids, followed by revegetation, to reclaim three coal-refuse areas. Most of the reclamation at the three sites was done from 1989 through 1992, and included the application of lime, clay, and various loads of biosolids up to 1,000 dry tons per acre. Water samples collected from 12 monitoring wells installed in the vicinity of the three reclaimed coal-refuse areas were analyzed to better understand the hydrogeology and water-quality effects. Ground water probably flows along preferential paths in the disturbed coal-refuse areas, and is impeded by undisturbed glacial till. Most of the samples contained elevated concentrations of sulfate, iron, and manganese, constituents associated with ground water in coal-mined areas. Concentrations of aluminum, cadmium, nickel, or zinc were somewhat elevated in samples from four wells, and greatest in water samples with pH less than 5. The smaller nutrient concentrations indicate that the applied biosolids are not identifiably affecting nutrients or metal concentrations in shallow ground water near the refuse piles. The coal refuse likely is the primary influence on the chemical characterization of ground-water in the area.

Parental psychological symptoms and familial risk factors of children and adolescents who exhibit school refusal.

PubMed

Bahali, K; Tahiroglu, A Y; Avci, A; Seydaoglu, G

2011-12-01

To assess the levels of psychological symptoms in the parents of children with school refusal and determine the familial risk factors in its development. This study was performed on 55 pairs of parents who had children exhibiting school refusal and were compared with a control group. A socio-demographic data form, the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Symptom Checklist-90 revised were applied to these parents. Parents of the school refusal group had higher anxiety and depression scores than the controls. Among the risk factors for school refusal, physical punishment by the parents, a history of organic disease in the parents or children, and a history of psychiatric disorders in the parents or other relatives were found to be significant. Depending on genetic and environmental factors, parents with psychiatric disorders appeared to be associated with development of psychiatric disorders in their children. Moreover, psychiatric disorders in parents negatively affected the treatment of their children and adolescents who exhibited school refusal. It is therefore vital to treat psychiatric disorders of parents with the children having psychiatric disorders, and thus increase parent participation in their children's therapeutic process.

Distribution of green open space in Malang City based on multispectral data

NASA Astrophysics Data System (ADS)

Hasyim, A. W.; Hernawan, F. P.

2017-06-01

Green open space is one of the land that its existence is quite important in urban areas where the minimum area is set to reach 30% of the total area of the city. Malang which has an area of 110,6 square kilometers, is one of the major cities in East Java Province that is prone to over-land conversion due to development needs. In support of the green space program, calculation of green space is needed precisely so that remote sensing which has high accuracy is now used for measurement of green space. This study aims to analyze the area of green open space in Malang by using Landsat 8 image in 2015. The method used was the vegetation index that is Normalized Difference Vegetation Index (NDVI). From the study obtained the calculation of green open space was better to use the vegetation index method to avoid the occurrence of misclassification of other types of land use. The results of the calculation of green open space using NDVI found that the area of green open space in Malang City in 2015 reached 39% of the total area.

What Attracts People to Visit Community Open Spaces? A Case Study of the Overseas Chinese Town Community in Shenzhen, China

PubMed Central

Chen, Yiyong; Liu, Tao; Xie, Xiaohuan; Marušić, Barbara Goličnik

2016-01-01

A well-designed open space that encourages outdoor activity and social communication is a community asset that could potentially contribute to the health of local residents and social harmony of the community. Numerous factors may influence the use of each single space and may result in a variety of visitors. Compared with previous studies that focused on accessibility, this study highlights the relationship between the utilization and characteristics of community open spaces in China. The Overseas Chinese Town community in Shenzhen is regarded as an example. The association between the number of visitors and space characteristics is examined with multivariate regression models. Results show that large areas with accessible lawns, well-maintained footpaths, seats, commercial facilities, and water landscapes are important characteristics that could increase the use of community open spaces. However, adding green vegetation, sculptures, and landscape accessories in open spaces has limited effects on increasing the outdoor activities of residents. Thus, to increase the use of community open spaces, landscape designers should focus more on creating user-oriented spaces with facilities that encourage active use than on improving ornamental vegetation and accessories. PMID:27367713

Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons.

PubMed

Swift, Joshua K; Greenberg, Roger P; Tompkins, Kelley A; Parkin, Susannah R

2017-03-01

The purpose of this meta-analysis was to examine rates of treatment refusal and premature termination for pharmacotherapy alone, psychotherapy alone, pharmacotherapy plus psychotherapy, and psychotherapy plus pill placebo treatments. A systematic review of the literature resulted in 186 comparative trials that included a report of treatment refusal and/or premature termination for at least 2 of the 4 treatment conditions. The data from these studies were pooled using a random-effects analysis. Odds Ratio effect sizes were then calculated to compare the rates between treatment conditions, once across all studies and then again for specific client disorder categories. An average treatment refusal rate of 8.2% was found across studies. Clients who were assigned to pharmacotherapy were 1.76 times more likely to refuse treatment compared with clients who were assigned psychotherapy. Differences in refusal rates for pharmacotherapy and psychotherapy were particularly evident for depressive disorders, panic disorder, and social anxiety disorder. On average, 21.9% of clients prematurely terminated their treatment. Across studies, clients who were assigned to pharmacotherapy were 1.20 times more likely to drop out compared with clients who were assigned to psychotherapy. Pharmacotherapy clients with anorexia/bulimia and depressive disorders dropped out at higher rates compared with psychotherapy clients with these disorders. Treatment refusal and dropout are significant problems in both psychotherapy and pharmacotherapy and providers of these treatments should seek to employ strategies to reduce their occurrence. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Comparing the quality of life in insulin recipient and refusal patients with type 2 diabetes.

PubMed

Khalili, Mitra; Sabouhi, Fakhri; Abazari, Parvaneh; Aminorroaya, Ashraf

2016-01-01

Better control of blood sugar and reduction of diabetes complications through insulin therapy could convince people to choose this method. However, patients might refuse insulin therapy due to its painful injection, limitations in daily activities, and hypoglycemia. Thus, insulin therapy could have both positive and negative effects on patients' quality of life (QOL). Therefore, the aim of this study was to compare the QOL of insulin recipient and insulin refusal patients with type 2 diabetes. This study was a descriptive and comparative research conducted on 126 patients; 63 were insulin recipients and 63 had refused insulin therapy. Participants were under the care of the Endocrine and Metabolism Research Center of Isfahan, Iran. Data were gathered using the Diabetes Quality of Life (DQOL) questionnaire. In this tool, higher scores indicated lower QOL in patients. Data were analyzed using independent t-test, analysis of covariance, Mann-Whitney, Chi-square, and Pearson and Spearman's correlation. There was a significant difference (P < 0.001) between insulin recipient patients (mean = 2.02, SD = 0.31) and insulin refusal patients (mean = 1.74, SD = 0.41) in terms of mean QOL score. In addition, men and participants with higher educational levels reported a better QOL (P < 0.001). Results showed that insulin refusal patients had a better QOL. It seems that QOL is associated with the acceptance or refusal of insulin therapy. Therefore, enhancement of QOL could be related to all aspects of the disease, especially its treatment method and solving the therapeutic problems.

Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital.

PubMed

Salam, Asma Abdus; Afshan, Gauhar

2016-01-01

Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries. A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal. Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively. This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information.

Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital

PubMed Central

Salam, Asma Abdus; Afshan, Gauhar

2016-01-01

Background and Aims: Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries. Material and Methods: A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal. Results: Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively. Conclusion: This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information. PMID:27006550

An anthropological analysis of the perspectives of Somali women in the West and their obstetric care providers on caesarean birth.

PubMed

Essén, Birgitta; Binder, Pauline; Johnsdotter, Sara

2011-03-01

We explored the perceptions of 39 Somali women and 62 obstetric care providers in London in relation to caesarean birth, as borne out of a paradox we recognised from evidence-based information about the Somali group. Socio-cultural factors potentially leading to adverse obstetric outcome were identified using in-depth and focus group interviews with semi-structured, open-ended questions. A cultural anthropology model, the emic/etic model, was used for analysis. Somali women expressed fear and anxiety throughout the pregnancy and identified strategies to avoid caesarean section (CS). There was widespread, yet anecdotal, awareness among obstetric care providers about negative Somali attitudes. Caesarean avoidance and refusal were expressed as being highly stressful among providers, but also as being the responsibility of the women and families. For women, avoiding or refusing caesarean was based on a rational choice to avoid death and coping with adverse outcome relied on fatalistic attitudes. Motivation for the development of preventive actions among both groups was not described, which lends weight to the vast distinction and lack of correspondence in identified perspectives between Somali women and UK obstetric providers. Early booking and identification of women likely to avoid caesarean is proposed, as is the development of preventive strategies to address CS avoidance.

The ECOUTER methodology for stakeholder engagement in translational research.

PubMed

Murtagh, Madeleine J; Minion, Joel T; Turner, Andrew; Wilson, Rebecca C; Blell, Mwenza; Ochieng, Cynthia; Murtagh, Barnaby; Roberts, Stephanie; Butters, Oliver W; Burton, Paul R

2017-04-04

Because no single person or group holds knowledge about all aspects of research, mechanisms are needed to support knowledge exchange and engagement. Expertise in the research setting necessarily includes scientific and methodological expertise, but also expertise gained through the experience of participating in research and/or being a recipient of research outcomes (as a patient or member of the public). Engagement is, by its nature, reciprocal and relational: the process of engaging research participants, patients, citizens and others (the many 'publics' of engagement) brings them closer to the research but also brings the research closer to them. When translating research into practice, engaging the public and other stakeholders is explicitly intended to make the outcomes of translation relevant to its constituency of users. In practice, engagement faces numerous challenges and is often time-consuming, expensive and 'thorny' work. We explore the epistemic and ontological considerations and implications of four common critiques of engagement methodologies that contest: representativeness, communication and articulation, impacts and outcome, and democracy. The ECOUTER (Employing COnceptUal schema for policy and Translation Engagement in Research) methodology addresses problems of representation and epistemic foundationalism using a methodology that asks, "How could it be otherwise?" ECOUTER affords the possibility of engagement where spatial and temporal constraints are present, relying on saturation as a method of 'keeping open' the possible considerations that might emerge and including reflexive use of qualitative analytic methods. This paper describes the ECOUTER process, focusing on one worked example and detailing lessons learned from four other pilots. ECOUTER uses mind-mapping techniques to 'open up' engagement, iteratively and organically. ECOUTER aims to balance the breadth, accessibility and user-determination of the scope of engagement. An ECOUTER exercise comprises four stages: (1) engagement and knowledge exchange; (2) analysis of mindmap contributions; (3) development of a conceptual schema (i.e. a map of concepts and their relationship); and (4) feedback, refinement and development of recommendations. ECOUTER refuses fixed truths but also refuses a fixed nature. Its promise lies in its flexibility, adaptability and openness. ECOUTER will be formed and re-formed by the needs and creativity of those who use it.

Recreational benefits of residual open space: A case study of four communities in northeastern New Jersey

NASA Astrophysics Data System (ADS)

Airola, Teuvo M.; Wilson, David

1982-11-01

Numerous undeveloped and ecologically diverse tracts of land within urban communities in the United States are presently being utilized for a variety of unsupervised recreational activities. The present use and perceived value of residual open spaces adjacent to the Palisades to residents of four communities in northeastern New Jersey was assessed. The results of our survey suggest that parks and open space represent a city service that is not as highly valued as other more visible services, that respondents desire a diversity of recreational experiences, that existing parks and open space provide a narrow range of recreational benefits to users, that benefits of existing parks extend primarily to the provision of active pursuits, and that undeveloped residual open spaces are valued for and provide opportunities for a variety of passive pursuits. Residual open spaces are a resource that contributes towards meeting the aesthetic and recreational needs of city residents. Failure by planners and decision-makers to recognize the value and utility of such tracts of land may result in their destruction and in the loss of a resource which provides a range of recreational opportunities that is not adequately provided by formal parks and open spaces.

[Rejection of the preventive discussion and at-risk sexual behavior: a qualitative study among gay men in Portugal].

PubMed

Maia, Marta

2010-01-01

The dominant preventive discourse imposed on sexual minorities is one that orders and prescribes condom use and an adjusted lifestyle. High-risk sexual behaviors seem to express, in part, the rejection of this dominant discourse. The objective of this study is to better understand the links between the risky sexual behaviors of gays and the socio-cultural context that leads to the rejection of preventive practices. An ethnological study was carried out in Portugal This study included seven gay men aged between 19 and 64 years old. The study also included accounts from interviews of three lesbian and bisexual women. The results show that the social pressure of a hetero-normative environment can result in the refusal or denial of prevention practices. Thus, risky sexual behaviors can reflect desire and aspirations for more rights and freedoms. New and alternative spaces for meeting gays, namely on the Internet, also seem to create more opportunities for sexual liberation and open the way for relaxed prevention practices and engaging in risky sexual behavior. However, preventive practices are not entirely absent; the reduction of risks is being expressed by the choice of sexual partners and the avoidance of certain sexual practices when a condom is not used. Through this study, the importance of peer groups in the acceptance and internalization of the preventive discourse is re-affirmed.

45 CFR 400.77 - Effect of quitting employment or failing or refusing to participate in required services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Effect of quitting employment or failing or... Employment General Requirements § 400.77 Effect of quitting employment or failing or refusing to participate... employment or fail or refuse to meet the requirements of § 400.75(a). [54 FR 5477, Feb. 3, 1989, as amended...

45 CFR 400.77 - Effect of quitting employment or failing or refusing to participate in required services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 2 2014-10-01 2012-10-01 true Effect of quitting employment or failing or... Employment General Requirements § 400.77 Effect of quitting employment or failing or refusing to participate... employment or fail or refuse to meet the requirements of § 400.75(a). [54 FR 5477, Feb. 3, 1989, as amended...

The impact of municipal refuse utilization on energy and our environment

NASA Technical Reports Server (NTRS)

1978-01-01

The incinerator/boiler configuration is stressed as the most reliable method of waste utilization. It is also pointed out that the high cost of refuse disposal and the ever increasing cost of energy, have made this method attractive. A plan is outlined for operating a waste utilization plant. Community participation is encouraged in investigating the feasibility of refuse to energy facilities in their area.

Ethnic Identity, Neighborhood Risk, and Adolescent Drug and Sex Attitudes and Refusal Efficacy: The Urban African American Girls' Experience

ERIC Educational Resources Information Center

Corneille, Maya A.; Belgrave, Faye Z.

2007-01-01

This study examined the impact of ethnic identity and neighborhood risk on drug and sex attitudes and refusal efficacy among early adolescent urban African American females (n = 175). The model also predicted a moderating relationship of ethnic identity on neighborhood risk for drug and sex attitudes and refusal efficacy. Data were collected as…

49 CFR 199.103 - Use of persons who fail or refuse a drug test.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SAFETY DRUG AND ALCOHOL TESTING Drug Testing § 199.103 Use of persons who fail or refuse a drug test. (a) An operator may not knowingly use as an employee any person who— (1) Fails a drug test required by... 49 Transportation 3 2013-10-01 2013-10-01 false Use of persons who fail or refuse a drug test. 199...

49 CFR 199.103 - Use of persons who fail or refuse a drug test.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SAFETY DRUG AND ALCOHOL TESTING Drug Testing § 199.103 Use of persons who fail or refuse a drug test. (a) An operator may not knowingly use as an employee any person who— (1) Fails a drug test required by... 49 Transportation 3 2014-10-01 2014-10-01 false Use of persons who fail or refuse a drug test. 199...

49 CFR 199.103 - Use of persons who fail or refuse a drug test.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SAFETY DRUG AND ALCOHOL TESTING Drug Testing § 199.103 Use of persons who fail or refuse a drug test. (a) An operator may not knowingly use as an employee any person who— (1) Fails a drug test required by... 49 Transportation 3 2011-10-01 2011-10-01 false Use of persons who fail or refuse a drug test. 199...

49 CFR 199.103 - Use of persons who fail or refuse a drug test.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SAFETY DRUG AND ALCOHOL TESTING Drug Testing § 199.103 Use of persons who fail or refuse a drug test. (a) An operator may not knowingly use as an employee any person who— (1) Fails a drug test required by... 49 Transportation 3 2012-10-01 2012-10-01 false Use of persons who fail or refuse a drug test. 199...

49 CFR 199.103 - Use of persons who fail or refuse a drug test.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SAFETY DRUG AND ALCOHOL TESTING Drug Testing § 199.103 Use of persons who fail or refuse a drug test. (a) An operator may not knowingly use as an employee any person who— (1) Fails a drug test required by... 49 Transportation 3 2010-10-01 2010-10-01 false Use of persons who fail or refuse a drug test. 199...

Realization of Speech Acts of Refusals and Pragmatic Competence by Turkish EFL Learners

ERIC Educational Resources Information Center

Han, Turgay; Burgucu-Tazegül, Assiye

2016-01-01

The purpose of the present study is to examine a) how lower-intermediate and upper-intermediate level Turkish learners of English-as-a-foreign language (EFL) realize refusals in English, b) the differences between native and non-native speakers of English in the use of refusals, and c) if L2 proficiency affects possible pragmatic transfer or not.…

Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet

PubMed Central

Lammert, Sara M.; Rao, Sowmya R.; Jentes, Emily S.; Fairley, Jessica K.; Erskine, Stefanie; Walker, Allison T.; Hagmann, Stefan H.; Sotir, Mark J.; Ryan, Edward T.

2017-01-01

Background: International travellers are at risk of travel-related, vaccine-preventable diseases. More data are needed on the proportion of travellers who refuse vaccines during a pre-travel health consultation and their reasons for refusing vaccines. Methods: We analyzed data on travellers seen for a pre-travel health consultation from July 2012 through June 2014 in the Global TravEpiNet (GTEN) consortium. Providers were required to indicate one of three reasons for a traveller refusing a recommended vaccine: (1) cost concerns, (2) safety concerns or (3) not concerned with the illness. We calculated refusal rates among travellers eligible for each vaccine based on CDC recommendations current at the time of travel. We used multivariable logistic regression models to examine the effect of individual variables on the likelihood of accepting all recommended vaccines. Results: Of 24 478 travellers, 23 768 (97%) were eligible for at least one vaccine. Travellers were most frequently eligible for typhoid (N = 20 092), hepatitis A (N = 12 990) and influenza vaccines (N = 10 539). Of 23 768 eligible travellers, 6573 (25%) refused one or more recommended vaccine(s). Of those eligible, more than one-third refused the following vaccines: meningococcal: 2232 (44%) of 5029; rabies: 1155 (44%) of 2650; Japanese encephalitis: 761 (41%) of 1846; and influenza: 3527 (33%) of 10 539. The most common reason for declining vaccines was that the traveller was not concerned about the illness. In multivariable analysis, travellers visiting friends and relatives (VFR) in low or medium human development countries were less likely to accept all recommended vaccines, compared with non-VFR travellers (OR = 0.74 (0.59–0.95)). Conclusions: Travellers who sought pre-travel health care refused recommended vaccines at varying rates. A lack of concern about the associated illness was the most commonly cited reason for all refused vaccines. Our data suggest more effective education about disease risk is needed for international travellers, even those who seek pre-travel advice. PMID:27799502

Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet.

PubMed

Lammert, Sara M; Rao, Sowmya R; Jentes, Emily S; Fairley, Jessica K; Erskine, Stefanie; Walker, Allison T; Hagmann, Stefan H; Sotir, Mark J; Ryan, Edward T; LaRocque, Regina C

2016-07-01

International travellers are at risk of travel-related, vaccine-preventable diseases. More data are needed on the proportion of travellers who refuse vaccines during a pre-travel health consultation and their reasons for refusing vaccines. We analyzed data on travellers seen for a pre-travel health consultation from July 2012 through June 2014 in the Global TravEpiNet (GTEN) consortium. Providers were required to indicate one of three reasons for a traveller refusing a recommended vaccine: (1) cost concerns, (2) safety concerns or (3) not concerned with the illness. We calculated refusal rates among travellers eligible for each vaccine based on CDC recommendations current at the time of travel. We used multivariable logistic regression models to examine the effect of individual variables on the likelihood of accepting all recommended vaccines. Of 24 478 travellers, 23 768 (97%) were eligible for at least one vaccine. Travellers were most frequently eligible for typhoid (N = 20 092), hepatitis A (N = 12 990) and influenza vaccines (N = 10 539). Of 23 768 eligible travellers, 6573 (25%) refused one or more recommended vaccine(s). Of those eligible, more than one-third refused the following vaccines: meningococcal: 2232 (44%) of 5029; rabies: 1155 (44%) of 2650; Japanese encephalitis: 761 (41%) of 1846; and influenza: 3527 (33%) of 10 539. The most common reason for declining vaccines was that the traveller was not concerned about the illness. In multivariable analysis, travellers visiting friends and relatives (VFR) in low or medium human development countries were less likely to accept all recommended vaccines, compared with non-VFR travellers (OR = 0.74 (0.59-0.95)). Travellers who sought pre-travel health care refused recommended vaccines at varying rates. A lack of concern about the associated illness was the most commonly cited reason for all refused vaccines. Our data suggest more effective education about disease risk is needed for international travellers, even those who seek pre-travel advice. © International Society of Travel Medicine, 2016. Published by Oxford University Press.

Factors Associated with Participation, Active Refusals and Reasons for Not Taking Part in a Mortality Followback Survey Evaluating End-of-Life Care

PubMed Central

Calanzani, Natalia; Higginson, Irene J; Koffman, Jonathan; Gomes, Barbara

2016-01-01

Background Examination of factors independently associated with participation in mortality followback surveys is rare, even though these surveys are frequently used to evaluate end-of-life care. We aimed to identify factors associated with 1) participation versus non-participation and 2) provision of an active refusal versus a silent refusal; and systematically examine reasons for refusal in a population-based mortality followback survey. Methods Postal survey about the end-of-life care received by 1516 people who died from cancer (aged ≥18), identified through death registrations in London, England (response rate 39.3%). The informant of death (a relative in 95.3% of cases) was contacted 4–10 months after the patient died. We used multivariate logistic regression to identify factors associated with participation/active refusals and content analysis to examine refusal reasons provided by 205 nonparticipants. Findings The odds of partaking were higher for patients aged 90+ (AOR 3.48, 95%CI: 1.52–8.00, ref: 20–49yrs) and female informants (AOR 1.70, 95%CI: 1.33–2.16). Odds were lower for hospital deaths (AOR 0.62, 95%CI: 0.46–0.84, ref: home) and proxies other than spouses/partners (AORs 0.28 to 0.57). Proxies of patients born overseas were less likely to provide an active refusal (AOR 0.49; 95% CI: 0.32–0.77). Refusal reasons were often multidimensional, most commonly study-related (36.0%), proxy-related and grief-related (25.1% each). One limitation of this analysis is the large number of nonparticipants who did not provide reasons for refusal (715/920). Conclusions Our survey better reached proxies of older patients while those dying in hospitals were underrepresented. Proxy characteristics played a role, with higher participation from women and spouses/partners. More information is needed about the care received by underrepresented groups. Study design improvements may guide future questionnaire development and help develop strategies to increase response rates. PMID:26745379

Criteria for Public Open Space Enhancement to Achieve Social Interaction: a Review Paper

NASA Astrophysics Data System (ADS)

Salih, S. A.; Ismail, S.

2017-12-01

A This paper presents a various literatures, studies, transcripts and papers aiming to provide an overview of some theories and existing research on the significance of natural environments and green open spaces to achieve social interaction and outdoor recreation. The main objective of the paper is to identify the factors that affecting social interaction in green open spaces, through proving that an appropriate open spaces is important to enhance social interaction and community. This study employs (qualitative) summarizing content analysis method which mainly focused on collect and summarizing of documentation such as transcripts, articles, papers, and books from more than 25 source, regarding the importance of public open spaces for the community. The summarizing content analysis of this paper is the fundament for a qualitative oriented procedure of text interpretation used to analyse the information gathered. Results of this study confirms that sound social interaction need an appropriate physical space including criteria of: design, activities, access and linkage, administration and maintenance, place attachment and users’ characteristics, also previous studies in this area have a health perspective with measures of physical activity of open spaces in general.

14 CFR 1203.401 - Effect of open publication.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Effect of open publication. 1203.401 Section 1203.401 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM Guides for Original Classification § 1203.401 Effect of open publication. Public disclosure...

14 CFR 1203.401 - Effect of open publication.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Effect of open publication. 1203.401 Section 1203.401 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM Guides for Original Classification § 1203.401 Effect of open publication. Public disclosure...

14 CFR 1203.401 - Effect of open publication.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Effect of open publication. 1203.401 Section 1203.401 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM Guides for Original Classification § 1203.401 Effect of open publication. Public disclosure...

14 CFR 1203.401 - Effect of open publication.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Effect of open publication. 1203.401 Section 1203.401 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM Guides for Original Classification § 1203.401 Effect of open publication. Public disclosure...

Topology of actions and homogeneous spaces

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

Kozlov, Konstantin L

2013-04-30

Topologization of a group of homeomorphisms and its action provide additional possibilities for studying the topological space, the group of homeomorphisms, and their interconnections. The subject of the paper is the use of the property of d-openness of an action (introduced by Ancel under the name of weak micro-transitivity) in the study of spaces with various forms of homogeneity. It is proved that a d-open action of a Cech-complete group is open. A characterization of Polish SLH spaces using d-openness is given, and it is established that any separable metrizable SLH space has an SLH completion that is a Polishmore » space. Furthermore, the completion is realized in coordination with the completion of the acting group with respect to the two-sided uniformity. A sufficient condition is given for extension of a d-open action to the completion of the space with respect to the maximal equiuniformity with preservation of d-openness. A result of van Mill is generalized, namely, it is proved that any homogeneous CDH metrizable compactum is the only G-compactification of the space of rational numbers for the action of some Polish group. Bibliography: 39 titles.« less

Hardened, environmentally disposable composite granules of coal cleaning refuse, coal combustion waste, and other wastes, and method preparing the same

DOEpatents

Burnet, George; Gokhale, Ashok J.

1990-07-10

A hardened, environmentally inert and disposable composite granule of coal cleaning refuse and coal combustion waste, and method for producing the same, wherein the coal combustion waste is first granulated. The coal cleaning refuse is pulverized into fine particles and is then bound, as an outer layer, to the granulated coal combustion waste granules. This combination is then combusted and sintered. After cooling, the combination results in hardened, environmentally inert and disposable composite granules having cores of coal combustion waste, and outer shells of coal cleaning refuse. The composite particles are durable and extremely resistant to environmental and chemical forces.

Hardened, environmentally disposable composite granules of coal cleaning refuse, coal combustion waste, and other wastes, and method preparing the same

DOEpatents

Burnet, G.; Gokhale, A.J.

1990-07-10

A hardened, environmentally inert and disposable composite granule of coal cleaning refuse and coal combustion waste and method for producing the same are disclosed, wherein the coal combustion waste is first granulated. The coal cleaning refuse is pulverized into fine particles and is then bound, as an outer layer, to the granulated coal combustion waste granules. This combination is then combusted and sintered. After cooling, the combination results in hardened, environmentally inert and disposable composite granules having cores of coal combustion waste, and outer shells of coal cleaning refuse. The composite particles are durable and extremely resistant to environmental and chemical forces. 3 figs.

Microbial ecology studies at two coal mine refuse sites in Illinois

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

Miller, R. M.; Cameron, R. E.

An investigation was made of the microflora associated with coal refuse at two abandoned mines in the midwestern United States. Information was gathered for both the edaphic and the biotic composition of the refuse material. Emphasis was placed on heterotrophic and autotrophic components as to numbers, kinds, and physiological groups. The presence of chemolithotrophs was also investigated. The relationship between abiotic and biotic components in regard to distribution of bacteria, fungi, and algae is discussed. Information presented in this report will be utilized in assessing trends and changes in microbial numbers and composition related to manipulations of the edaphic andmore » biotic ecosystem components associated with reclamation of the refuse piles.« less

The Role of Relational Harmony in the Use of Drug-Refusal Strategies of Rural Native Hawaiian Youths

PubMed Central

Bills, Kaycee; Okamoto, Scott K.; Helm, Susana

2016-01-01

This study examined the role of maintaining relational harmony among family members in the use of drug refusal strategies for rural Hawaiian youth. Youth focus groups were conducted to validate refusal strategies used in realistic, hypothetical drug-related problem situations. The findings suggested gender-specific motivations for maintaining relational harmony among family members when faced with drug offers from them. Specifically, boys described instrumental concerns when using refusal strategies (i.e., not wanting to get into trouble), while girls described holistic relational concerns (i.e., not wanting family members to be upset with each other). Implications for prevention and social work practice are discussed. PMID:28133439

Intrepid Space Shuttle Pavilion Opening

NASA Image and Video Library

2012-07-19

The space shuttle Enterprise is seen shortly after the grand opening of the Space Shuttle Pavilion at the Intrepid Sea, Air & Space Museum on Thursday, July 19, 2012 in New York. Photo Credit: (NASA/Bill Ingalls)

Urban greenspace for resilient city in the future: Case study of Yogyakarta City

NASA Astrophysics Data System (ADS)

Ni'mah, N. M.; Lenonb, S.

2017-06-01

The capacity of adaptation is essential elements towards urban resilience. One adaptation that can be done is to consider the provision of open space and public space in the city. Yogyakarta City development which focused on the built area and negates the open space has blurred the characteristics of the city. Efforts in increasing the availability of public space is one of the seven priorities of the programs included in the environmental and the utilization of space in Yogyakarta City. An understanding of the provision of public green open spaces in Yogyakarta is important because the products and processes that take place in a development will determine the successful implementation of the development plan. The objectives of this study are as follows: (1) to identify the provision green space in Yogyakarta City from the aspects of product and procedure; and (2) to identify the role of green space to build resilient city. This study is used descriptive qualitative approach with in-depth interview, literature review, and triangulation as the method for data collection. Yogyakarta has had instruments for public green open spaces provision called Masterplan Ruang Terbuka Hijau (RTH) Up-Scaling Yogyakarta 2013-2032 which govern the typologies and criteria for green open space development in the city.Public green open spaces development mechanism can be grouped into the planning phase, the utilization phase, and the control phase of each consisting of legal and regulatory aspects, institutional aspects, financial aspects, and technical aspects. The mechanism of green open space provision should regard the need of advocacy for “urban green commons” (UGCs) development as a systematic approach of collective-participatory for urban land management.

Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust

PubMed Central

Umotong, Eno

2016-01-01

Abstract The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability. PMID:27893528

Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust: Audit.

PubMed

Umotong, Eno

2016-12-01

The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability.

A defense of compulsory vaccination.

PubMed

Flanigan, Jessica

2014-03-01

Vaccine refusal harms and risks harming innocent bystanders. People are not entitled to harm innocents or to impose deadly risks on others, so in these cases there is nothing to be said for the right to refuse vaccination. Compulsory vaccination is therefore justified because non-vaccination can rightly be prohibited, just as other kinds of harmful and risky conduct are rightly prohibited. I develop an analogy to random gunfire to illustrate this point. Vaccine refusal, I argue, is morally similar to firing a weapon into the air and endangering innocent bystanders. By re-framing vaccine refusal as harmful and reckless conduct my aim is to shift the focus of the vaccine debate from non-vaccinators' religious and refusal rights to everyone else's rights against being infected with contagious illnesses. Religious freedom and rights of informed consent do not entitle non-vaccinators to harm innocent bystanders, and so coercive vaccination requirements are permissible for the sake of the potential victims of the anti-vaccine movement.

Performing coolness: smoking refusal and adolescent identities.

PubMed

Plumridge, E W; Fitzgerald, L J; Abel, G M

2002-04-01

The implications of smoking refusal for personal identity style were studied through conversations in six small focus groups or dyads of 13- and 14-year-old non-smokers from an urban New Zealand secondary school. The approach to analyzing their talk was informed by notions of 'performativity' and 'social space' to focus on the connections between identity and social relations. Smoking emerged as a key signifier of power and status. It was salient at both top and bottom ends of the social hierarchy depending upon the competence displayed in smoking as part of a larger ensemble of personal deportment and behavior. Being a non-smoker therefore inevitably carried connotations of being 'average' or 'in the middle', presenting non-smoking adolescents with the problem of accrediting themselves against superior 'smoker cool' groups. A discourse analytic approach was used to examine the resources and strategies participants brought to bear on this 'problem', which was then seen to be solved differently by boys and girls. Boys could establish alternatives to 'smoker cool' through physical activity, girls had little recourse but to accept their inferior status. The implications of this for health education and promotion are discussed.

Lime retention in anthracite coal-breaker refuse

Treesearch

Miroslaw M. Czapowskyj; Edward A. Sowa

1973-01-01

Hydrated lime was applied to extremely acid anthracite coal-breaker refuse at rates of 2.5 and 5.0 tons per acre. The lime raised the pH to neutral range, and this range was still in evidence 7 years after treatment. The pH readings decreased with the depth of the refuse profile, and below 9 inches they approximated those of the control plots. The 2.5-tons-of-lime-per-...

Bacteria and Acidic Drainage from Coal Refuse: Inhibition by Sodium Lauryl Sulfate and Sodium Benzoate

PubMed Central

Dugan, Patrick R.; Apel, William A.

1983-01-01

The application of an aqueous solution of sodium lauryl sulfate and sodium benzoate to the surface of high-sulfur coal refuse resulted in the inhibition of iron-and sulfur-oxidizing chemoautotrophic bacteria and in the decrease of acidic drainage from the refuse, suggesting that acid drainage can be abated in the field by inhibiting iron- and sulfur-oxidizing bacteria. PMID:16346347

[The parents' experience of school refusal in adolescence].

PubMed

Bussard, Dewi; Harf, Aurélie; Sibeoni, Jordan; Radjack, Rahmeth; Benoit, Jean Pierre; Moro, Marie Rose

2015-01-01

While today's society places considerable importance on schooling and performances, school absenteeism is currently very high. One of the causes is anxiety-based school refusal. This phenomenon affects the adolescent but also has an impact on their family. Exploring the experience of the parents of teenagers presenting anxiety-based school refusal enables these families to be given better support. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Refusal Strategies of Iranian University English as a Foreign Language and Non-English Learners in Native Language: A Comparative Study

ERIC Educational Resources Information Center

Sa'd, Seyyed Hatam Tamimi; Qadermazi, Zohre

2014-01-01

This study is an attempt to examine the possible effect that exposure to English has had on the use of refusal strategies in English as a Foreign Language (EFL) learners compared with those of non-English learners when refusing in their native language, Persian. The sample included 12 EFL learners and 12 learners of other academic majors including…

49 CFR 40.191 - What is a refusal to take a DOT drug test, and what are the consequences?

Code of Federal Regulations, 2011 CFR

2011-10-01

..., you have refused to take a drug test if you: (1) Fail to appear for any test (except a pre-employment... the testing site before the testing process commences (see § 40.63 (c)) for a pre-employment test is... pre-employment test is not deemed to have refused to test; (4) In the case of a directly observed or...

49 CFR 40.191 - What is a refusal to take a DOT drug test, and what are the consequences?

Code of Federal Regulations, 2013 CFR

2013-10-01

..., you have refused to take a drug test if you: (1) Fail to appear for any test (except a pre-employment... the testing site before the testing process commences (see § 40.63 (c)) for a pre-employment test is... pre-employment test is not deemed to have refused to test; (4) In the case of a directly observed or...

49 CFR 40.191 - What is a refusal to take a DOT drug test, and what are the consequences?

Code of Federal Regulations, 2012 CFR

2012-10-01

..., you have refused to take a drug test if you: (1) Fail to appear for any test (except a pre-employment... the testing site before the testing process commences (see § 40.63 (c)) for a pre-employment test is... pre-employment test is not deemed to have refused to test; (4) In the case of a directly observed or...

49 CFR 40.191 - What is a refusal to take a DOT drug test, and what are the consequences?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 1 2014-10-01 2014-10-01 false What is a refusal to take a DOT drug test, and... Transportation PROCEDURES FOR TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Problems in Drug Tests § 40.191 What is a refusal to take a DOT drug test, and what are the consequences? (a) As an employee...

49 CFR 40.191 - What is a refusal to take a DOT drug test, and what are the consequences?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false What is a refusal to take a DOT drug test, and... Transportation PROCEDURES FOR TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Problems in Drug Tests § 40.191 What is a refusal to take a DOT drug test, and what are the consequences? (a) As an employee...

[Novel resources utilization technique for rural domestic refuse].

PubMed

Qiu, Cai-Di; He, Ruo; Chen, Song-Mei; Lou, Bin; Shen, Dong-Sheng

2009-03-15

In order to speed up rural domestic refuse resources utilization, intermittent aeration and continuous aeration were applied to treat rural domestic refuse after anaerobic fermentation. Three kinds of refuse were selected on base of fermentative age, i.e. three months, five months and seven months. Results showed that aeration could remove water and organic materials of the refuse effectively. Points of view on aeration, continuous aeration was better than intermittent aeration, and on the other side, water removal rate increased with ventilation and decreased with fermentative age in the condition of intermittent aeration. On organic materials removal point, it was affected by fermentative age significantly, i. e. increase of fermentative age could resulted in decrease in the removal efficiency. In conclusion, intermittent aeration of 0.06 m3/(min x m3) was considered to be feasible for treatment. The water removal efficiency of three months, five months and seven months fermentative age refuse could be up to 49.1%, 45.3% and 44.0%, and organic compound removal efficiency was 41.9%, 24.8% and 13.1%, respectively, after intermittent aeration for 21 d. Moreover, concentrated effect was presented on major nutrient ingredients, such as total nitrogen, phosphorus, and potassium during the aeration, which realized for resources utilization.

Application of electromagnetic techniques in survey of contaminated groundwater at an abandoned mine complex in southwestern Indiana, U.S.A.

USGS Publications Warehouse

Brooks, G.A.; Olyphant, G.A.; Harper, D.

1991-01-01

In part of a large abandoned mining complex, electromagnetic geophysical surveys were used along with data derived from cores and monitoring wells to infer sources of contamination and subsurface hydrologic connections between acidic refuse deposits and adjacent undisturbed geologic materials. Electrical resistivity increases sharply along the boundary of an elevated deposit of pyritic coarse refuse, which is highly contaminated and electrically conductive, indicating poor subsurface hydrologic connections with surrounding deposits of fine refuse and undisturbed glacial material. Groundwater chemistry, as reflected in values of specific conductance, also differs markedly across the deposit's boundary, indicating that a widespread contaminant plume has not developed around the coarse refuse in more than 40 yr since the deposit was created. Most acidic drainage from the coarse refuse is by surface runoff and is concentrated around stream channels. Although most of the contaminated groundwater within the study area is concentrated within the surficial refuse deposits, transects of apparent resistivity and phase angle indicate the existence of an anomalous conductive layer at depth (>4 m) in thick alluvial sediments along the northern boundary of the mining complex. Based on knowledge of local geology, the anomaly is interpreted to represent a subsurface connection between the alluvium and a flooded abandoned underground mine. ?? 1991 Springer-Verlag New York Inc.

Application of electromagnetic techniques in survey of contaminated groundwater at an abandoned mine complex in southwestern Indiana, U.S.A.

NASA Astrophysics Data System (ADS)

Brooks, Glenn A.; Olyphant, Greg A.; Harper, Denver

1991-07-01

In part of a large abandoned mining complex, electromagnetic geophysical surveys were used along with data derived from cores and monitoring wells to infer sources of contamination and subsurface hydrologic connections between acidic refuse deposits and adjacent undisturbed geologic materials. Electrical resistivity increases sharply along the boundary of an elevated deposit of pyritic coarse refuse, which is highly contaminated and electrically conductive, indicating poor subsurface hydrologic connections with surrounding deposits of fine refuse and undisturbed glacial material. Groundwater chemistry, as reflected in values of specific conductance, also differs markedly across the deposit's boundary, indicating that a widespread contaminant plume has not developed around the coarse refuse in more than 40 yr since the deposit was created. Most acidic drainage from the coarse refuse is by surface runoff and is concentrated around stream channels. Although most of the contaminated groundwater within the study area is concentrated within the surficial refuse deposits, transects of apparent resistivity and phase angle indicate the existence of an anomalous conductive layer at depth (>4 m) in thick alluvial sediments along the northern boundary of the mining complex. Based on knowledge of local geology, the anomaly is interpreted to represent a subsurface connection between the alluvium and a flooded abandoned underground mine.

Clinical Characteristics of the Suicide Attempters Who Refused to Participate in a Suicide Prevention Case Management Program.

PubMed

Park, Soyoung; Choi, Kyoung Ho; Oh, Youngmin; Lee, Hae-Kook; Kweon, Yong-Sil; Lee, Chung Tai; Lee, Kyoung-Uk

2015-10-01

Case management interventions for suicide attempters aimed at helping adjust their social life to prevent reattempts have high nonparticipation and dropout rates. We analyzed the clinical characteristics of the group who refused to participate in the suicide prevention program in Korea. A total of 489 patients with a suicide attempt who visited Uijeongbu St. Mary's Hospital, the Catholic University of Korea, from December 2009 to December 2013 were analyzed. All patients were divided into the participation group (n = 262) and the refusal group (n = 227) according to their participation in the case management program. Demographic and clinical characteristics of each group were examined. Results showed that the refusal group had low risks for suicide in terms of risk factors related with psychopathologies and presenting suicide behavior. That is, the refusal group had less patients with co-morbid medical illnesses and more patients with mild severity of depression compared to the participation group. However, the refusal group had more interpersonal conflict, more isolation of social integrity, and more impaired insight about suicide attempt. The results suggest that nonparticipation in the case management program may depend upon the patient's impaired insight about the riskiness of suicide and lack of social support.

[Hygiene problems in inland and sea navigation].

PubMed

Goethe, H

1983-09-01

Both waste and sewage disposal are ubiquitous problems which have also affected navigation. Shipping is a very important transport carrier on a worldwide basis which together with the fishing industry employs roughly two million people. The problems associated with waste and sewage disposal obviously present a severe hazard to the coastal areas, narrow sea basins and, in particular, to inland and open-sea waterways. These problems are particularly alarming in large sea-ports, docks without outfall etc. The reduction of the crews aboard the ships operated by the industialised countries has helped to quantitatively ease the problem of waste and sewage disposal caused by the crews. However, passenger steamers with high waste and sewage volumes cause considerable nuisance in small harbours and the same holds for the disposal of technical waste products from ships such as dunnage packing material, ropes, plastic material, oil, etc. The quantity of waste water aboard a sea-going vessel including that from the toilets, washrooms, galley, and cleaning is rather considerable and is estimated at 300 litres per person and day under tropical climates. The volume of waste varies greatly and depends mainly on the type of material used aboard as mentioned above. Passenger liners with a very high volume of kitchen refuse and other solid waste give rise to specially insidious problems. In the past, sea-going vessels as well as ships employed in inland navigation used to throw overboard any type of refuse and sewage. However, during the last few decades the port authorities and also governments have introduced local and national regulations ruling that waste may no longer be thrown into harbour basins, but must be collected and disposed of on shore. Most ships have complied with these provisions, but some of them kept the collected refuse aboard and disposed of it on the open sea outside the harbours. International agreements on the prohibition of emptying oil and oil-containing waste into the sea were reached as early as 1954. The first rigorous provisions on the strict prohibition of discharging sewage and throwing spoilage overboard on the sea were promulgated around 1960 for the Great Lakes (USA and Canada) as well as for some Baltic Sea and Black Sea harbours (USSR). This legislation has been increasingly tightened. The international agreement on the prevention of sea pollution by ships, submitted by the International Maritime Consultative Organization (IMCO) in 1973 and 1978, strictly bans the throwing overboard or discharging of oil, plastic material, stowing and packing materials etc. as well as unperishable substances.(ABSTRACT TRUNCATED AT 400 WORDS)

Geographic clusters in underimmunization and vaccine refusal.

PubMed

Lieu, Tracy A; Ray, G Thomas; Klein, Nicola P; Chung, Cindy; Kulldorff, Martin

2015-02-01

Parental refusal and delay of childhood vaccines has increased in recent years and is believed to cluster in some communities. Such clusters could pose public health risks and barriers to achieving immunization quality benchmarks. Our aims were to (1) describe geographic clusters of underimmunization and vaccine refusal, (2) compare clusters of underimmunization with different vaccines, and (3) evaluate whether vaccine refusal clusters may pose barriers to achieving high immunization rates. We analyzed electronic health records among children born between 2000 and 2011 with membership in Kaiser Permanente Northern California. The study population included 154,424 children in 13 counties with continuous membership from birth to 36 months of age. We used spatial scan statistics to identify clusters of underimmunization (having missed 1 or more vaccines by 36 months of age) and vaccine refusal (based on International Classification of Diseases, Ninth Revision, Clinical Modification codes). We identified 5 statistically significant clusters of underimmunization among children who turned 36 months old during 2010-2012. The underimmunization rate within clusters ranged from 18% to 23%, and the rate outside them was 11%. Children in the most statistically significant cluster had 1.58 (P < .001) times the rate of underimmunization as others. Underimmunization with measles, mumps, rubella vaccine and varicella vaccines clustered in similar geographic areas. Vaccine refusal also clustered, with rates of 5.5% to 13.5% within clusters, compared with 2.6% outside them. Underimmunization and vaccine refusal cluster geographically. Spatial scan statistics may be a useful tool to identify locations with challenges to achieving high immunization rates, which deserve focused intervention. Copyright © 2015 by the American Academy of Pediatrics.

Expedited Partner Therapy: Pharmacist Refusal of Legal Prescriptions.

PubMed

Borchardt, Lauren N; Pickett, Michelle L; Tan, Kevin T; Visotcky, Alexis M; Drendel, Amy L

2018-05-01

Expedited partner therapy (EPT) is an effective strategy for partner management of sexually transmitted infections. Some states, including Wisconsin, allow EPT prescriptions to be filled without a patient name. This study determined the refusal rates of nameless EPT prescriptions in Milwaukee pharmacies. In this cross-sectional study, 3 trained research assistants of different age, sex, and race posed as "patients" and visited 50 pharmacy locations from one pharmacy chain in Milwaukee County, WI, to fill nameless EPT prescriptions. A χ test was used to compare demographics of patients, pharmacists, and pharmacies. Multiple logistic regression was used to identify factors associated with prescription refusal. Twenty-nine (58%) of 50 nameless EPT prescriptions were refused. Univariate analysis showed that prescriptions were more likely to be refused if the pharmacy was in the suburbs (77%) compared with Milwaukee city (43%; P = 0.01), if the pharmacist was older than the patient (82%) compared with being younger (46%) or within the same age group (33%; P = 0.01 for both), and if the patient was white (78%) compared with nonwhite (47%; P = 0.03). Multivariable regression revealed significantly higher refusals for pharmacies located in the suburbs compared with the city (odds ratio, 5.3; 95% confidence interval, 1.4-20.3; P = 0.03) and in patients who were white compared with nonwhite (odds ratio: 4.8; 95% confidence interval, 1.2-19.8; P = 0.01). More than half of nameless EPT prescriptions were refused in Milwaukee county pharmacies, more frequently at suburban pharmacies and for white patients. Increased pharmacist education regarding EPT is essential to help combat the sexually transmitted infection crisis.

The role of positive/negative outcome expectancy and refusal self-efficacy of Internet use on Internet addiction among college students in Taiwan.

PubMed

Lin, Min-Pei; Ko, Huei-Chen; Wu, Jo Yung-Wei

2008-08-01

Based on Bandura's social cognitive theory, this study was designed to examine positive and negative outcome expectancy and refusal self-efficacy of Internet use and their contribution to Internet addiction among college students by using hierarchical multiple regression analyses in a cross-sectional study design. Schools were first stratified into technical or nontechnical colleges and then into seven majors. A cluster random sampling by department was further applied to randomly choose participants from each major. A representative sample of 4,456 college students participated in this study. The Outcome Expectancy and Refusal Self-Efficacy of Internet Use Questionnaire and the Chen Internet Addiction Scale were used to assess the cognitive factors and the levels of Internet addiction. Results showed that both positive outcome expectancy and negative outcome expectancy were significantly and positively correlated with Internet addiction, and refusal self-efficacy of Internet use was significantly and negatively related to Internet addiction. Further analyses revealed that refusal self-efficacy of Internet use directly and negatively predicted Internet addiction. Moreover, we discovered that positive outcome expectancy positively predicted Internet addiction via refusal self-efficacy of Internet use; however, surprisingly, negative outcome expectancy had both a direct and indirect positive relationship in predicting Internet addiction via the refusal self-efficacy of Internet use. These results give empirical evidence to verify the theoretical effectiveness of the three cognitive factors to Internet addiction and should be incorporated when designing prevention programs and strategies for Internet addicted college students.

Refusal to participate in heart failure studies: do age and gender matter?

PubMed Central

Harrison, Jordan M; Jung, Miyeon; Lennie, Terry A; Moser, Debra K; Smith, Dean G; Dunbar, Sandra B; Ronis, David L; Koelling, Todd M; Giordani, Bruno; Riley, Penny L; Pressler, Susan J

2018-01-01

Aims and objectives The objective of this retrospective study was to evaluate reasons heart failure patients decline study participation, to inform interventions to improve enrollment. Background Failure to enrol older heart failure patients (age > 65) and women in studies may lead to sampling bias, threatening study validity. Design This study was a retrospective analysis of refusal data from four heart failure studies that enrolled 788 patients in four states. Methods Chi-Square and a pooled t-test were computed to analyse refusal data (n = 300) obtained from heart failure patients who were invited to participate in one of the four studies but declined. Results Refusal reasons from 300 patients (66% men, mean age 65 33) included: not interested (n = 163), too busy (n = 64), travel burden (n = 50), too sick (n = 38), family problems (n = 14), too much commitment (n = 13) and privacy concerns (n = 4). Chi-Square analyses showed no differences in frequency of reasons (p > 0 05) between men and women. Patients who refused were older, on average, than study participants. Conclusions Some reasons were patient-dependent; others were study-dependent. With ‘not interested’ as the most common reason, cited by over 50% of patients who declined, recruitment measures should be targeted at stimulating patients’ interest. Additional efforts may be needed to recruit older participants. However, reasons for refusal were consistent regardless of gender. Relevance to clinical practice Heart failure researchers should proactively approach a greater proportion of women and patients over age 65. With no gender differences in type of reasons for refusal, similar recruitment strategies can be used for men and women. However, enrolment of a representative proportion of women in heart failure studies has proven elusive and may require significant effort from researchers. Employing strategies to stimulate interest in studies is essential for recruiting heart failure patients, who overwhelmingly cited lack of interest as the top reason for refusal. PMID:26914834

Situation testing: the case of health care refusal.

PubMed

Després, C; Couralet, P-E

2011-04-01

Situation testing to assess physicians' refusal to provide healthcare is increasingly used in research studies. This paper aims to explain the relevance and limits of this method. Conducted in 2008-2009, this study was designed to assess the rate of healthcare refusal among several categories of private practitioners toward patients covered by the French public means-tested complementary health insurance (CMUc) when they requested a first appointment by phone. The other objectives were to study the determinants of healthcare refusal and assess the method. The study was conducted on a representative sample of Paris-based dentists and physicians in five categories: general practitioners, medical gynecologists, ophthalmologists, radiologists, and dentists. The method was based on two protocols. In the first scenario, an actor pretended to be a CMUc beneficiary and, in the second one, he did not give information about his health coverage but hinted at a low socioeconomic status. The two protocols were compared and procedures checking the relation between refusal and CMUc coverage were implemented in each of them. In the scenario in which the patient declared being a CMUc beneficiary, the results showed different refusal rates depending on the type of practitioner, physician, or dentist, their specialty, and whether or not, they charge more than the standard set fee. In the second scenario, refusal rates were much lower. The comparison of the two protocols seems to confirm the existence of discrimination based on CMUc affiliation rather than patients' socioeconomic status. The discussion presents the limits of situation testing, which remains an experimental instrument because it does not observe reality but reveals behaviors in situation. The findings cannot be extrapolated and are limited in time. The statistical analysis is only valid if the procedure followed is precise and applied consistently using a preset scenario. In addition, the discriminatory nature of the refusal (CMUc coverage) must be confirmed by a validation procedure (unless clearly stated by the interlocutor). Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Individual- and regional-level determinants of human papillomavirus (HPV) vaccine refusal: the Ontario Grade 8 HPV vaccine cohort study.

PubMed

Remes, Olivia; Smith, Leah M; Alvarado-Llano, Beatriz E; Colley, Lindsey; Lévesque, Linda E

2014-10-08

Studies on the determinants of human papillomavirus (HPV) vaccine use have generally focused on individual-level characteristics, despite the potentially important influence of regional-level characteristics. Therefore, we undertook a population-based, retrospective cohort study to identify individual- and regional-level determinants of HPV vaccine refusal (non-receipt) in Ontario's (Canada) Grade 8 HPV Immunization Program. Ontario's administrative health and immunization databases were used to identify girls eligible for free HPV vaccination in 2007-2011 and to ascertain individual-level characteristics of cohort members (socio-demographics, vaccination history, health care utilization, medical history). The social and material characteristics of the girl's region (health unit) were derived from the 2006 Canadian Census. Generalized estimating equations (binomial distribution, logit link) were used to estimate the population-average effects of individual- and regional-level characteristics on HPV vaccine refusal. Our cohort consisted of 144,047 girls, 49.3% of whom refused HPV vaccination. Factors associated with refusal included a previous diagnosis of Down's syndrome (OR = 1.37, 95% CI 1.16-1.63) or autism (OR = 1.60, 95% CI 1.34-1.90), few physician visits (OR = 1.45, 95% CI 1.35-1.55), and previous refusal of mandatory (OR = 2.23, 95% CI 2.07-2.40) and optional (OR = 3.96, 95% CI 3.87-4.05) vaccines. Refusal was highest among the lowest and highest income levels. Finally, a previous diagnosis of obesity and living in an area of high deprivation were associated with lower refusal (OR = 0.87, 95% CI 0.83-0.92 and OR = 0.82 95%, CI 0.79-0.86, respectively). Studies on HPV vaccine determinants should consider regional-level factors. Efforts to increase HPV vaccine acceptance should include vulnerable populations (such as girls of low income) and girls with limited contact with the healthcare system.

The Influence of Green Infrastructure on Urban Resilience in Greater London

NASA Astrophysics Data System (ADS)

Oh, Yukyung

2017-04-01

High population densities and diverse economic activities in urban areas create social issues as well as a range of environmental impacts including air pollution, soil contamination, loss of biodiversity and health problems (Alberti et al., 2003; Dobbs, Escobedo, & Zipperer, 2011; Grimm et al., 2008). The concept of urban resilience has been used for increasing the capacity of the entities and players to adapt to rapid changes, and urban green spaces play a crucial role in increasing urban resilience. Greater London has a good case for increasing urban green spaces and resilience under the London Plan. The relevance of urban open spaces and several socioeconomic indicators would provide researchers and policy makers with the information for managing green coverage. The correlation analysis of two quantitative data such as open space and socioeconomic data of Greater London was conducted with SPSS. The data for open spaces in Greater London was gained through Greenspace Information for Greater London. The data was converted from vector to raster in Geographic Information System (GIS), so as to calculate landscape metrics for open spaces in Greater London through a spatial pattern analysis program, FRAGSTATS 4.2. The socioeconomic data was obtained from "London Borough Profile", London Datastore. In addition, data on total carbon emissions from Industry and Commercial, Domestic, Transport, LULUCF Net Emissions, and per capita emissions were gained from UK local authority and regional carbon dioxide emissions national statistics: 2005-2014 released from Department of Energy and Climate Change. The indicators from open spaces are total area of open space and patch density or contagion of open spaces. The latter indicator allows to figure out the level of fragmentation of open spaces. The socioeconomic indicators cover number of jobs by workplace, jobs density, crime rates per thousand population, and several wellbeing indicators such as life satisfaction, worthwhileness, happiness and anxiety. The correlation analysis outcomes can be divided into three levels such as Greater London as a whole, and Inner and Outer London. In Greater London, total area of green spaces has a strong relation with crime rates, and a less strong relation with number of jobs. Both socioeconomic indicators showed a negative trend along with the increase of open spaces. In terms of wellbeing indicators, the positive trend of life satisfaction, worthwhileness and happiness, and the negative trend of anxiety can be found in accordance with the increase of green coverage. In Inner London, job density and crime rates show a negative trend in accordance with the increase of total open space areas. And as contagion of open spaces is higher, the indicators of number of jobs, jobs density, and crime rates also showed an increase tendency. As for worthwhileness and happiness, it also showed a substantial correlation with contagion of open spaces. In Outer London, the correlation between job density and crime rates, and open space cannot be found, but the wellbeing indicators such as life satisfaction and worthwhileness show an increase trend along with larger green coverage.

Using Open Space Technology for School Improvement.

ERIC Educational Resources Information Center

Cox, David

2002-01-01

Describes a theory referred to as Open Space Technology (OST), which holds that the most productive learning in conference settings takes place in the open space between formally scheduled conference sessions. Argues that OST can be applied to staff development days and other educational development programs. (Contains 10 references.) (NB)

14 CFR § 1203.401 - Effect of open publication.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Effect of open publication. § 1203.401 Section § 1203.401 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM Guides for Original Classification § 1203.401 Effect of open publication. Public...

Open Space Communities

Treesearch

Rachel Kaplan; Maureen E. Austin; Stephen Kaplan; Stephen Kaplan

2004-01-01

Though the concept is often left undefined, "open space" in residential areas is generally viewed as an asset. Duany et al. (2000), for example, suggest that "the generous provision of open space" offers the "main advantage" of suburbs over the city (p. 31). With forest, field, and farm steadily giving way to development, many communities...

SCHOOLS WITHOUT WALLS. PROFILES OF SIGNIFICANT SCHOOLS.

ERIC Educational Resources Information Center

Educational Facilities Labs., Inc., New York, NY.

A SUCCESSFUL APPROACH TO SCHOOL HOUSING FOR THE ELEMENTARY GRADES HAS BEEN MADE IN OPEN SPACE SCHOOLS. DURING THE LAST THREE YEARS IN CALIFORNIA, 75 PERCENT OF ALL SCHOOL CONSTRUCTION INCLUDES SOME OPEN TEACHING SPACE, 20 PERCENT CONTAINS NOTHING BUT. OPEN SPACE SCHOOLS PROVIDE AN ENVIRONMENT WHICH ENCOURAGES INNOVATION AND INTERACTION. PROBLEMS…

High speed hydraulically-actuated operating system for an electric circuit breaker

DOEpatents

Iman, I.

1983-06-07

This hydraulically-actuated operating system comprises a cylinder, a piston movable therein in an opening direction to open a circuit breaker, and an accumulator for supplying pressurized liquid to a breaker-opening piston-actuating space within the cylinder. A normally-closed valve between the accumulator and the actuating space is openable to allow pressurized liquid from the accumulator to flow through the valve into the actuating space to drive the piston in an opening direction. A dashpotting mechanism operating separately from the hydraulic actuating system is provided, thereby reducing flow restriction interference with breaker opening. 3 figs.

High speed hydraulically-actuated operating system for an electric circuit breaker

DOEpatents

Iman, Imdad

1983-06-07

This hydraulically-actuated operating system comprises a cylinder, a piston movable therein in an opening direction to open a circuit breaker, and an accumulator for supplying pressurized liquid to a breaker-opening piston-actuating space within the cylinder. A normally-closed valve between the accumulator and the actuating space is openable to allow pressurized liquid from the accumulator to flow through the valve into the actuating space to drive the piston in an opening direction. A dashpotting mechanism operating separately from the hydraulic actuating system is provided, thereby reducing flow restriction interference with breaker opening.

A randomised controlled trial to assess the effectiveness of a nurse-led palliative care intervention for HIV positive patients on antiretroviral therapy: recruitment, refusal, randomisation and missing data.

PubMed

Lowther, Keira; Higginson, Irene J; Simms, Victoria; Gikaara, Nancy; Ahmed, Aabid; Ali, Zipporah; Afuande, Gaudencia; Kariuki, Hellen; Sherr, Lorraine; Jenkins, Rachel; Selman, Lucy; Harding, Richard

2014-09-03

Despite the life threatening nature of an HIV diagnosis and the multidimensional problems experienced by this patient population during antiretroviral therapy, the effectiveness of a palliative care approach for HIV positive patients on ART is as yet unknown. A randomised controlled trial (RCT) was conducted in a sample of 120 HIV positive patients on ART in an urban clinic in Mombasa, Kenya. The intervention was a minimum of seven sessions of multidimensional, person-centred care, given by HIV nurses trained in the palliative care approach over a period of 5 months. Rates of recruitment and refusal, the effectiveness of the randomisation procedure, trial follow-up and attrition and extent of missing data are reported.120 patients (60 randomised to control arm, 60 randomised to intervention arm) were recruited over 5.5 months, with a refusal rate of 55.7%. During the study period, three participants died from cancer, three withdrew (two moved away and one withdrew due to time constraints). All of these patients were in the intervention arm: details are reported. There were five additional missing monthly interviews in both the control and intervention study arm, bringing the total of missing data to 26 data points (4.3%). The quality and implications of these data are discussed extensively and openly, including the effect of full and ethical consent procedures, respondent burden, HIV stigma, accurate randomisation, patient safety and the impact of the intervention. Data on recruitment randomisation, attrition and missing data in clinical trials should be routinely reported, in conjunction with the now established practice of publishing study protocols to enhance research integrity, transparency and quality. Transparency is especially important in cross cultural settings, in which the sources of funding and trial design are often not based in the country of data collection. Findings reported can be used to inform future RCTs in this area. Clinicaltrials.gov NCT01608802.

Patterns and sources of particle-phase aliphatic and polycyclic aromatic hydrocarbons in urban and rural sites of western Greece

NASA Astrophysics Data System (ADS)

Kalaitzoglou, Maria; Terzi, Eleni; Samara, Constantini

Particle-bound aliphatic and polycyclic aromatic hydrocarbons (AHs and PAHs, respectively) were determined in the ambient air of the Eordea basin, in western Greece, where intensive coal burning for power generation takes place. Thirteen PAHs, n-alkanes (C 14-C 35), hopanes, and isoprenoid hydrocarbons (pristane and phytane) were determined in the total suspended particles collected from the atmosphere of four sites within the basin receiving potential impacts from various sources, such as fly ash, coal mining, automobile traffic, domestic heating, and agricultural or refuse burning. The same organic species were also determined in the fly ash generated in power stations, and in particulate emissions from open burning of biomass (dry corn leaves) and refuse burning. Organic particle sources were resolved using concentration diagnostic ratios and factor analysis (FA). A multivariate statistical receptor model (Absolute Principal Component Analysis, APCA) was finally employed to estimate the contribution of identified sources to the measured concentrations of organic pollutants. Four major sources for ambient PAHs and AHs were identified displaying variable contribution in different sites: (a) fossil fuel combustion, (b) biogenic emissions, (c) refuse burning, and (d) oil residues. Fuel combustion was the major source of ambient PAHs and an important source of n-alkanes in the range C 21-C 28. Oil residues were found to be the major source of low molecular weight n-alkanes (particularly the C 14-C 16), and an important source of pristane, phytane and UCM. Biogenic sources were primarily responsible for the high molecular weight n-alkanes explaining almost the entire concentration levels of homologues >C 32. Biomass burning was particularly important for the C 23-C 26n-alkanes. Despite the vicinity of certain sampling sites to power stations, coal fly ash was not identifiable as a source for ambient PAHs and AHs.

45 CFR 261.15 - Can a family be penalized if a parent refuses to work because he or she cannot find child care?

Code of Federal Regulations, 2011 CFR

2011-10-01

... Provisions Addressing Individual Responsibility? § 261.15 Can a family be penalized if a parent refuses to... parent caring for a child under age six who has a demonstrated inability to obtain needed child care, as... 45 Public Welfare 2 2011-10-01 2011-10-01 false Can a family be penalized if a parent refuses to...

45 CFR 261.15 - Can a family be penalized if a parent refuses to work because he or she cannot find child care?

Code of Federal Regulations, 2013 CFR

2013-10-01

... Provisions Addressing Individual Responsibility? § 261.15 Can a family be penalized if a parent refuses to... parent caring for a child under age six who has a demonstrated inability to obtain needed child care, as... 45 Public Welfare 2 2013-10-01 2012-10-01 true Can a family be penalized if a parent refuses to...

45 CFR 261.15 - Can a family be penalized if a parent refuses to work because he or she cannot find child care?

Code of Federal Regulations, 2012 CFR

2012-10-01

... Provisions Addressing Individual Responsibility? § 261.15 Can a family be penalized if a parent refuses to... parent caring for a child under age six who has a demonstrated inability to obtain needed child care, as... 45 Public Welfare 2 2012-10-01 2012-10-01 false Can a family be penalized if a parent refuses to...

45 CFR 261.15 - Can a family be penalized if a parent refuses to work because he or she cannot find child care?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Provisions Addressing Individual Responsibility? § 261.15 Can a family be penalized if a parent refuses to... parent caring for a child under age six who has a demonstrated inability to obtain needed child care, as... 45 Public Welfare 2 2010-10-01 2010-10-01 false Can a family be penalized if a parent refuses to...

45 CFR 261.15 - Can a family be penalized if a parent refuses to work because he or she cannot find child care?

Code of Federal Regulations, 2014 CFR

2014-10-01

... Provisions Addressing Individual Responsibility? § 261.15 Can a family be penalized if a parent refuses to... parent caring for a child under age six who has a demonstrated inability to obtain needed child care, as... 45 Public Welfare 2 2014-10-01 2012-10-01 true Can a family be penalized if a parent refuses to...

[The refusal of nursing care by the families].

PubMed

Curchod, Claude; Fisher, Marion

2016-10-01

Caregiving is complex. While it is not easy to admit that the process can be refused by the patient, it is no easier when it is refused by the patient's family. Accepting this fact is however an essential stage in the relational and care processes. The family must therefore be supported by professionals in order to be able to make an enlightened choice. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

45 CFR 286.150 - Can a family, with a child under age 6, be penalized because a parent refuses to work because (s...

Code of Federal Regulations, 2010 CFR

2010-10-01

... penalized because a parent refuses to work because (s)he cannot find child care? 286.150 Section 286.150... a parent refuses to work because (s)he cannot find child care? (a) If the individual is a single custodial parent caring for a child under age six, the Tribe may not reduce or terminate assistance based on...

45 CFR 286.150 - Can a family, with a child under age 6, be penalized because a parent refuses to work because (s...

Code of Federal Regulations, 2013 CFR

2013-10-01

... penalized because a parent refuses to work because (s)he cannot find child care? 286.150 Section 286.150... a parent refuses to work because (s)he cannot find child care? (a) If the individual is a single custodial parent caring for a child under age six, the Tribe may not reduce or terminate assistance based on...

45 CFR 286.150 - Can a family, with a child under age 6, be penalized because a parent refuses to work because (s...

Code of Federal Regulations, 2011 CFR

2011-10-01

... penalized because a parent refuses to work because (s)he cannot find child care? 286.150 Section 286.150... a parent refuses to work because (s)he cannot find child care? (a) If the individual is a single custodial parent caring for a child under age six, the Tribe may not reduce or terminate assistance based on...

45 CFR 286.150 - Can a family, with a child under age 6, be penalized because a parent refuses to work because (s...

Code of Federal Regulations, 2014 CFR

2014-10-01

... penalized because a parent refuses to work because (s)he cannot find child care? 286.150 Section 286.150... a parent refuses to work because (s)he cannot find child care? (a) If the individual is a single custodial parent caring for a child under age six, the Tribe may not reduce or terminate assistance based on...

45 CFR 286.150 - Can a family, with a child under age 6, be penalized because a parent refuses to work because (s...

Code of Federal Regulations, 2012 CFR

2012-10-01

... penalized because a parent refuses to work because (s)he cannot find child care? 286.150 Section 286.150... a parent refuses to work because (s)he cannot find child care? (a) If the individual is a single custodial parent caring for a child under age six, the Tribe may not reduce or terminate assistance based on...

Parent Refusal of Topical Fluoride for Their Children: Clinical Strategies and Future Research Priorities to Improve Evidence-Based Pediatric Dental Practice.

PubMed

Chi, Donald L

2017-07-01

A growing number of parents are refusing topical fluoride for their children during preventive dental and medical visits. This nascent clinical and public health problem warrants attention from dental professionals and the scientific community. Clinical and community-based strategies are available to improve fluoride-related communications with parents and the public. In terms of future research priorities, there is a need to develop screening tools to identify parents who are likely to refuse topical fluoride and diagnostic instruments to uncover the reasons for topical fluoride refusal. This knowledge will lead to evidence-based strategies that can be widely disseminated into clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

The geography of recreational open space: influence of neighborhood racial composition and neighborhood poverty.

PubMed

Duncan, Dustin T; Kawachi, Ichiro; White, Kellee; Williams, David R

2013-08-01

The geography of recreational open space might be inequitable in terms of minority neighborhood racial/ethnic composition and neighborhood poverty, perhaps due in part to residential segregation. This study evaluated the association between minority neighborhood racial/ethnic composition, neighborhood poverty, and recreational open space in Boston, Massachusetts (US). Across Boston census tracts, we computed percent non-Hispanic Black, percent Hispanic, and percent families in poverty as well as recreational open space density. We evaluated spatial autocorrelation in study variables and in the ordinary least squares (OLS) regression residuals via the Global Moran's I. We then computed Spearman correlations between the census tract socio-demographic characteristics and recreational open space density, including correlations adjusted for spatial autocorrelation. After this, we computed OLS regressions or spatial regressions as appropriate. Significant positive spatial autocorrelation was found for neighborhood socio-demographic characteristics (all p value = 0.001). We found marginally significant positive spatial autocorrelation in recreational open space (Global Moran's I = 0.082; p value = 0.053). However, we found no spatial autocorrelation in the OLS regression residuals, which indicated that spatial models were not appropriate. There was a negative correlation between census tract percent non-Hispanic Black and recreational open space density (r S = -0.22; conventional p value = 0.005; spatially adjusted p value = 0.019) as well as a negative correlation between predominantly non-Hispanic Black census tracts (>60 % non-Hispanic Black in a census tract) and recreational open space density (r S = -0.23; conventional p value = 0.003; spatially adjusted p value = 0.007). In bivariate and multivariate OLS models, percent non-Hispanic Black in a census tract and predominantly Black census tracts were associated with decreased density of recreational open space (p value < 0.001). Consistent with several previous studies in other geographic locales, we found that Black neighborhoods in Boston were less likely to have recreational open spaces, indicating the need for policy interventions promoting equitable access. Such interventions may contribute to reductions and disparities in obesity.

a Spatial Analysis on Gis-Hedonic Pricing Model on the Influence of Public Open Space and House Price in Klang Valley, Malaysia

NASA Astrophysics Data System (ADS)

Zainora, A. M.; Norzailawati, M. N.; Tuminah, P.

2016-06-01

Presently, it is noticeable that there is a significant influence of public open space about house price, especially in many developed nations. Literature suggests the relationship between the two aspects give impact on the housing market, however not many studies undertaken in Malaysia. Thus, this research was initiated to analyse the relationship of open space and house price via the techniques of GIS-Hedonic Pricing Model. In this regards, the GIS tool indicates the pattern of the relationship between open space and house price spatially. Meanwhile, Hedonic Pricing Model demonstrates the index of the selected criteria in determining the housing price. This research is a perceptual study of 200 respondents who were the house owners of double-storey terrace houses in four townships, namely Bandar Baru Bangi, Taman Melawati, Subang Jaya and Shah Alam, in Klang Valley. The key research question is whether the relationship between open space and house price exists and the nature of its pattern and intensity. The findings indicate that there is a positive correlation between open space and house price. Correlation analysis reveals that a weak relationship (rs < 0.1) established between the variable of open space and house price (rs = 0.91, N = 200, p = 0.2). Consequently, the rate of house price change is rather small. In overall, this research has achieved its research aims and thus, offers the value added in applying the GIS-Hedonic pricing model in analysing the influence of open space to the house price in the form of spatially and textually.

Cigarette advertising and media coverage of smoking and health.

PubMed

Warner, K E

1985-02-07

In the US, media coverage of the health hazards of cigarette smoking is consored by the tobacco industry. Tobacco companies, which in 1983 alone spent US$2.5 billion on smoking promtion, are a major source of advertising revenue for many media organizations. As a result media organizations frequently refuse to publish antismoking information, tent to tone down coverage of antismoking news events, and often refuse to accept antismoking advertisements. In a 1983 "Newsweek" supplement on personal health, prepared by the American Medical Association, only 4 sentences were devoted to the negative effects of smoking. A spokesman for the association reported that "Newsweek" editors refused to allow the association to use the forum to present a strong antismoking message. In 1984 a similar type of health supplement, published by "Time," failed to mention smoking at all. An examination of 10 major women's magazines revealed that between 1967-79, 4 of the magazines published no articles about the hazards of smoking and only 8 such articles appeared in the other 6 magazines. All of these magazines carried smoking advertisements. During the same time period, 2 magazines, which refused to publish cigarette ads, published a total of 16 articles on the hazards of smoking. Small magazines which publish antismoking articles are especially vulnerable to pressure from the tobacco industry. For example, the tobacco industry canceled all its ads in "Mother Jones" after the magazine printed 2 antismoking articles. 22 out of 36 magazines refused to run antismoking advertisements when they were requested to do so. Due to poor media coverage, th public's knowledge of the hazards of smoking is deficient. Recent surveys found that 2/3 of the public did not know that smoking could cause heart attacks, and 1/2 of the respondents did not know that smoking is the major cause of lung cancer. An analysis of time trends in cigarette smoking indicates that the public does respond to antismoking information when such information is presented. Major declines in smoking occurred 1) in the early 1950s, following the publication of a major antismoking article by "Reader's Digest;" 2) in 1964, following the publicizing of the Surgeon General's report on smoking; and 3) in 1967-70, in response to the antismoking fairness doctrine messages carried by the broadcasting media. Suggested responses to counter the censorship power of the tobacco industry include 1) banning all cigarette advertisement, 2) requiring the medial to allocate equal space and time to tobacco industry and antismoking advertisements, 3) encouraging the media to develop advertising standards, 4) boycotting magazines which carry tobacco industry advertisement, and 5) legally restricting the style and content of cigarette ads. Finally journalists themselves should respond to the tobacco industry's attempt to erode freedom of the press.

The economic benefits of parks and open space : how land conservation helps communities grow smart and protect the bottom line

DOT National Transportation Integrated Search

1999-01-01

Open space is an investment that produces important economic benefits. It does not have to be an expense. This document relates examples and data that can help concerned citizens and leaders make the economic case for open space and parks conservatio...

Associations between recreational walking and attractiveness, size, and proximity of neighborhood open spaces.

PubMed

Sugiyama, Takemi; Francis, Jacinta; Middleton, Nicholas J; Owen, Neville; Giles-Corti, Billie

2010-09-01

We examined associations of attractiveness, size, and proximity of multiple neighborhood open spaces (NOSs) with recreational walking. Adults participating in the Residential Environments (RESIDE) study (n=1366) in Perth, Australia, reported time spent engaging in recreational walking within their neighborhoods. Park audit data and geographic information systems were used to identify the most attractive, largest, and nearest NOS within a 1.6-km radius from each participant's residential location. Regression analysis was used to examine attributes (attractiveness, size, and proximity) of these open spaces and their associations with participants' recreational walking. Shorter distance to attractive open spaces was associated with doing any recreational walking, but adults with larger attractive open spaces within 1.6 km of their home were more likely to walk 150 minutes or more in a week. For adults, the presence of a large, high-quality park within walking distance of one's home may be more important in promoting sufficient amounts of walking for health benefits than is the presence of an open space within a shorter distance.

Associations Between Recreational Walking and Attractiveness, Size, and Proximity of Neighborhood Open Spaces

PubMed Central

Francis, Jacinta; Middleton, Nicholas J.; Owen, Neville; Giles-Corti, Billie

2010-01-01

Objectives. We examined associations of attractiveness, size, and proximity of multiple neighborhood open spaces (NOSs) with recreational walking. Methods. Adults participating in the Residential Environments (RESIDE) study (n = 1366) in Perth, Australia, reported time spent engaging in recreational walking within their neighborhoods. Park audit data and geographic information systems were used to identify the most attractive, largest, and nearest NOS within a 1.6-km radius from each participant's residential location. Regression analysis was used to examine attributes (attractiveness, size, and proximity) of these open spaces and their associations with participants’ recreational walking. Results. Shorter distance to attractive open spaces was associated with doing any recreational walking, but adults with larger attractive open spaces within 1.6 km of their home were more likely to walk 150 minutes or more in a week. Conclusions. For adults, the presence of a large, high-quality park within walking distance of one's home may be more important in promoting sufficient amounts of walking for health benefits than is the presence of an open space within a shorter distance. PMID:20634455

Influences on Immunization Decision-Making among US Parents of Young Children.

PubMed

Chung, Yunmi; Schamel, Jay; Fisher, Allison; Frew, Paula M

2017-12-01

Objectives This study assessed influences on vaccination decisions among parents of young children and examined common vaccination information and advice sources. Methods Using panel samples of parents of children under 7 years, web-based surveys were conducted in 2012 (n = 2603) and 2014 (n = 2518). A vaccine decision-making typology (non-hesitant acceptors, hesitant acceptors, delayers, and refusers) was established and weighted population estimates of potential factors influencing parental vaccination decision (e.g., provider influence, source of information and advice) were computed by year and decision type. Results Delayers and refusers were more likely than acceptors to know someone whose child experienced a severe reaction to a vaccine or delayed/refused vaccine(s). High proportions of delayers (2012: 33.4%, 2014: 33.9%) and refusers (2012: 49.6%, 2014: 58.6%) reported selecting their healthcare provider based on whether the provider would allow them to delay/refuse vaccines. Providers were the most frequently reported trusted vaccine information source among all parents, though more often by acceptors than refusers (2012, 2014: p < 0.01). We found differing patterns of provider advice-seeking and internet as a reliable vaccine information source by group. Among those who had considered delay/refusal, trust in their healthcare provider's advice was the most common reason cited for their decision reversal. Conclusions for Practice Provider trust and communication along with varying degrees of personal-network influences likely contribute to immunization decisions of parents. Vaccine hesitant parents often seek providers amenable to accommodating their vaccine beliefs. Providers may benefit from vaccine communication training as their recommendations may influence hesitant parents to immunize their children.

A novel silica alumina-based backfill material composed of coal refuse and fly ash.

PubMed

Yao, Yuan; Sun, Henghu

2012-04-30

In this paper, a systematic study was conducted to investigate a novel silica alumina-based backfill material composed of coal refuse and fly ash. The coal refuse and fly ash had different properties under various thermal activation temperatures (20 °C, 150 °C, 350 °C, 550 °C, 750 °C and 950 °C). It is known that a thermal activation temperature ranging from 20 °C to 950 °C significantly increases the flowability and pozzolanic properties of the coal refuse; however, the flowability of fly ash decreases when the activation temperature is higher than 550 °C because of a severe agglomeration phenomenon on its surface. An optimal design for this backfill material was determined to include an activated portion composed of 5% coal refuse at 750 °C and 15% fly ash at 20 °C. This combination yields the best performance with excellent flowability, a high compressive strength and a low bleeding rate. The microanalysis results corresponded well with the performance tests at different activation conditions. In the coal refuse, kaolinite peaks began to decrease because of their transformation into metakaolin at 550 °C. Chlorite peaks disappeared at 750 °C. Muscovite peaks decreased at 750 °C and disappeared at 950 °C. During this process, muscovite 2M(1) gradually dehydroxylated to muscovite HT. Furthermore, this paper examined the environmental acceptance and economic feasibility of this technology and found that this silica alumina-based backfill material composed of coal refuse and fly ash not only meets EPA requirements but also has several advantages in industry feasibility when compared with hydraulic backfill, rock backfill and paste backfill. Published by Elsevier B.V.

Why do some women refuse to allow male residents to perform pelvic exams?

PubMed

Rifkin, Julie I; Shapiro, Howard; Regensteiner, Judith G; Stotler, Jeanne K; Schmidt, Betty

2002-10-01

Many women who receive medical care in residency training clinics refuse to allow male residents to perform their pelvic exams. This study was conducted to identify which women were most likely to refuse and to learn their reasons for refusing. From January to March 1997, a questionnaire was given to all women entering a Tri-County Health office and a Planned Parenthood clinic, both in the Denver, Colorado, metropolitan area, who consented to participate in the study. Data from the questionnaire were analyzed using a statistical software package. A total of 1,437 women entered the clinics during the study period. Of these patients, 1,078 consented to complete the questionnaire. Seven of these 1,078 women did not complete the questionnaire. Women who did not know the training level of the resident performing the pelvic exam were more likely to refuse than were women who knew the training level of the resident (p =.001), but many women preferred a female physician regardless of the physician's training level. Fifty-eight percent said they would allow a male resident to observe a female attending physician perform the exam, compared with 36% who said they would allow a male resident to observe if the attending physician was a man. Common statements from those who would refuse were: "I am just more comfortable with a female," "Women do not want men to examine their private body parts," and "Women explain things better." A woman's knowledge of the resident's training level correlates with her willingness to have a pelvic exam performed by a male resident. Women who said they would refuse a pelvic exam performed by a male resident gave specific reasons for their decision.

Potential bias in the bank: what distinguishes refusers, nonresponders and participants in a clinic-based biobank?

PubMed

Ridgeway, J L; Han, L C; Olson, J E; Lackore, K A; Koenig, B A; Beebe, T J; Ziegenfuss, J Y

2013-01-01

Biobanks are an important resource for genetic and epidemiologic research, but bias may be introduced if those who accept the recruitment invitation differ systematically from those who do not in terms of attributes important to health-related investigations. To understand potential bias in a clinic-based biobank of biological samples, including genetic data linked to electronic health record information, we compared patient characteristics and self-reported information among participants, nonresponders and refusers. We also compared reasons for nonparticipation between refusers and nonresponders to elucidate potential pathways to reduce nonparticipation and any uncovered bias. We mailed recruitment packets to 1,600 adult patients with upcoming appointments at Mayo Clinic (Rochester, Minn., USA) and recorded their participation status. Administrative data were used to compare characteristics across groups. We used phone interviews with 26 nonresponders and 26 refusers to collect self-reported information, including reasons for nonparticipation. Participants were asked to complete a mailed questionnaire. We achieved 26.2% participation (n=419) with 12.1% refusing (n=193) and 61.8% nonresponse (n=988). In multivariate analyses, sex, age, region of residence, and race/ethnicity were significantly associated with participation. The groups differed in information-seeking behaviors and research experience. Refusers more often cited privacy concerns, while nonresponders more often identified time constraints as the reason for nonparticipation. For genomic medicine to advance, large, representative biobanks are required. Significant associations between patient characteristics and nonresponse, as well as systematic differences between refusers and nonresponders, could introduce bias. Oversampling or recruitment changes, including heightened attention to privacy protection and participation burden, may be necessary to increase participation among less-represented groups. Copyright © 2013 S. Karger AG, Basel.

Potential Bias in the Bank: What Distinguishes Refusers, Non-responders and Participants in a Clinic-based Biobank?

PubMed Central

Ridgeway, Jennifer L; Han, Leona C; Olson, Janet E; Lackore, Kandace A; Koenig, Barbara A; Beebe, Timothy J; Ziegenfuss, Jeanette Y

2013-01-01

Background Biobanks are an important resource for genetic and epidemiologic research, but bias may be introduced if those who accept the recruitment invitation differ systematically from those who do not in attributes important to health-related investigations. To understand potential bias in a clinic-based biobank of biological samples, including genetic data linked to Electronic Medical Record information, we compared patient characteristics and self-reported information among participants, non-responders, and refusers. We also compared reasons for non-participation between refusers and non-responders to elucidate potential pathways to reduce non-participation and any uncovered bias. Methods We mailed recruitment packets to 1600 adult patients with upcoming appointments at Mayo Clinic (Rochester, MN) and recorded their participation status. Administrative data were used to compare characteristics across groups. We used phone interviews with 26 non-responders and 26 refusers to collect self-reported information, including reasons for non-participation. Participants were asked to complete a mailed questionnaire. Results We achieved 26.2% participation (n=419) with 12.1% refusing (n=193) and 61.8% non-response (n=988). In multivariate analyses, sex, age, region of residence, and race/ethnicity were significantly associated with participation. The groups differed in information-seeking behaviors and research experience. Refusers more often cited privacy concerns while non-responders more often identified time constraints as the reason for non-participation. Conclusion For genomic medicine to advance, large, representative biobanks are required. Significant associations between patient characteristics and nonresponse, as well as systematic differences between refusers and nonresponders, could introduce bias. Oversampling or recruitment changes, including heightened attention to privacy protection and participation burden, may be necessary to increase participation among less-represented groups. PMID:23595106

Arab dentists' refusal to treat HIV positive patients: a survey of recently graduated dentists from three Arab dental schools.

PubMed

Arheiam, Arheiam; El Tantawi, Maha; Al-Ansari, Asim; Ingafou, Mohamed; El-Howiti, Asma; Gaballah, Kamis; AbdelAziz, Wafaa

2017-07-01

To assess intended refusal of recent graduates from three Arab dental schools to treat HIV + patients and factors associated with this intention. In 2015, convenience samples of recent dental graduates were included from Libya, Egypt and the United Arab Emirates. Participants responded to a questionnaire assessing personal background, knowledge of oral manifestations and fluids transmitting HIV, perceived adequacy of training and self-efficacy to manage blood exposures, attitude to risk of infection, moral beliefs and willingness to treat HIV + patients. Logistic regression assessed factors associated with intended refusal to treat HIV + patients. The overall response rate was 552/710 (77.8%), mean age = 23.7 years with 41.8% males. The mean (SD) scores for knowledge of oral manifestations and fluids transmitting HIV were 5.5 (1.3)/8 and 4.2 (1.7)/7. The mean (SD) scores for attitude to risk of infection and moral beliefs were 2.9 (1.0)/4 and 2 (0.9)/3, respectively. One-third of respondents indicated intention to refuse treating HIV + patients. Knowledge of body fluids transmitting HIV and moral beliefs were associated with lower odds of refusing to treat HIV + patients (OR = 0.86 and 0.38) whereas attitude indicating greater concern for risk of infection was associated with higher odds (OR = 1.54). One third of dentists from three Arab dental schools indicated they would refuse to treat HIV + patients. Adequate knowledge and moral beliefs reflecting professional ethics were associated with lower odds of refusal counterbalancing the association with attitude indicating increased concern for risk of infection with implications for dentist education and training.

[Nursing ethics in the face of the refusal of nursing care].

PubMed

Dauchy, Sarah; Charles, Cécile; Vérotte, Nelly; Block, Véronique; Adam, Virginie

2016-10-01

Caregivers can find themselves faced with a refusal of nursing care. A number of questions are then raised. While it is firstly important to understand the reasons for this refusal and what is at stake for the patient, there are a number of nursing strategies in place, not least of all dialogue and analysis. The role of the multi-disciplinary team is essential in such situations. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Refusal of care: the physician-patient relationship and decisionmaking capacity.

PubMed

Simon, Jeremy R

2007-10-01

Problems of refusal of care, among the most common ethical dilemmas in the emergency department, are also often the most difficult to resolve, pitting 2 conflicting duties, that of helping patients and that of respecting their autonomy, against each other. Using a case presentation as a backdrop, this article offers a practical approach to patients who refuse treatment, including assessment of decisionmaking capacity but emphasizing the role of trust, communication, and compromise in these cases.

Jehovah's Witnesses and autonomy: honouring the refusal of blood transfusions.

PubMed

Bock, Gregory L

2012-11-01

This paper explores the scriptural and theological reasons given by Jehovah's Witnesses (JWs) to refuse blood transfusions. Julian Savulescu and Richard W Momeyer argue that informed consent should be based on rational beliefs and that the refusal of blood transfusions by JWs is irrational, but after examining the reasons given by JWs, I challenge the claim that JW beliefs are irrational. I also question whether we should give up the traditional notion of informed consent.

[Refusal of care faced by case manager from elderly persons in complex situation: cross perspectives].

PubMed

Corvol, A; Balard, F; Moutel, G; Somme, D

2014-01-01

Case management is a new professional field in France. It is addressed to elderly persons living in community whose situation is regarded as particularly complex. Case managers have to assess needs and coordinate necessary services. One common criteria of complexity is refusal of care. The objective of this study is to compare the words of users with those of case managers about refusal of care, in order to understand its meaning, professionals' attitudes and ethical challenges. Two researchers have cooperated on this qualitative research: the first one, anthropologist, interviewed 19 individuals, and 11 of their caregivers. The second one, geriatrician and researcher in medical ethics, lead four focus groups gathering a total of 18 case managers. Refusal of care often is the result of the will of preserving one's identity, compromised by illness. Individuals seek control on their life. Facing this behaviour, case managers try to secure the individual, by establishing a personal relationship that respects their choices, even if care has to be delayed. Refusal of care may sometimes disclose a desire to vanish, in front of which professionals meet their own limits. To recognise an elderly person that refuses care as a unique individual who can make choices secure his identity, and allow him to change. Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Transitional paternalism: how shared normative powers give rise to the asymmetry of adolescent consent and refusal.

PubMed

Manson, Neil C

2015-02-01

In many jurisdictions, adolescents acquire the right to consent to treatment; but in some cases their refusals - e.g. of life-saving treatment - may not be respected. This asymmetry of adolescent consent and refusal seems puzzling, even incoherent. The aim here is to offer an original explanation, and a justification, of this asymmetry. Rather than trying to explain the asymmetry in terms of a variable standard of competence - where the adolescent is competent to consent to, but not refuse, certain interventions - the account offered here focuses more closely on the normative power to render actions permissible. Where normative powers are shared they can readily give rise to an asymmetry between consent and refusal. We then turn to why it is justifiable that normative powers be shared in adolescence. Transitional paternalism holds that the acquisition of normative powers by competent adolescents should not be an instant one, achieved in a single step, but that there should be a transitional period where paternalistic protection is rolled back, but not entirely withdrawn until a later date. Transitional paternalism could be implemented without generating the asymmetry between consent and refusal but, it is argued, the asymmetric version of transitional paternalism is to be preferred insofar as it offers a greater respect for the adolescent's decisions than the symmetrical alternative. © 2014 John Wiley & Sons Ltd.

[Analysis of the refusal of the flu vaccination (REGRIVI study)].

PubMed

Méijome-Blanco, S; González-Cristobo, G; Regueiro-Martínez, A Á

2018-02-10

The objective of this study is to determine the reasons for refusing the flu vaccination in the Primary Care Health Centre of Vilanova de Arousa, Spain, as well as to evaluate the flu vaccination coverage after an educational intervention. A quasi-experimental before and after study was conducted after an educational intervention on a total of 73 people that included those Primary Care Health Centre patients from Vilanova de Arousa who had refused the flu vaccination in 2014, and who did not meet the exclusion criteria (death during 2014 and 2015 campaigns, non-acceptance of participation, vaccine registration mistakes, contraindication or no indication for the vaccine, inability to contact). After a brief educational intervention, vaccination data from those patients in the 2015 and 2016 campaigns were checked. A descriptive analysis of the variables under study was then carried out. Of the 73 patients initially included, 72 completed the study. The main reasons for refusing a vaccination were the concerns about the adverse effects and patient perception of good health. Vaccination coverage was 50.7% in 2015, and 48.6% in 2016. The reasons for refusing vaccination are approachable with a brief intervention since the refusal decreases by half in the long-term. Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

77 FR 52108 - Commercial Space Transportation Advisory Committee; Open Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-28

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Commercial Space Transportation... Commercial Space Transportation Advisory Committee Open Meeting. SUMMARY: Pursuant to Section 10(a)(2) of the... the Commercial Space Transportation Advisory Committee (COMSTAC). The meeting will take place on...

78 FR 18416 - Commercial Space Transportation Advisory Committee; Open Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Commercial Space Transportation... Commercial Space Transportation Advisory Committee Open Meeting. SUMMARY: Pursuant to Section 10(a)(2) of the... the Commercial Space Transportation Advisory Committee (COMSTAC). The meeting will take place on...

75 FR 16901 - Commercial Space Transportation Advisory Committee-Open Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-02

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Commercial Space Transportation... Commercial Space Transportation Advisory Committee Open meeting. SUMMARY: Pursuant to section 10(a)(2) of the... of the Commercial Space Transportation Advisory Committee (COMSTAC). The meetings will take place on...

76 FR 17474 - Commercial Space Transportation Advisory Committee-Open Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-29

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Commercial Space Transportation... Commercial Space Transportation Advisory Committee Open Meeting. SUMMARY: Pursuant to Section 10(a)(2) of the... the Commercial Space Transportation Advisory Committee (COMSTAC). The meeting will take place on...

75 FR 54002 - Commercial Space Transportation Advisory Committee-Open Meeting

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2010-09-02

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Commercial Space Transportation... Commercial Space Transportation Advisory Committee Open Meeting. SUMMARY: Pursuant to Section 10(a)(2) of the... the Commercial Space Transportation Advisory Committee (COMSTAC). The meeting will take place on...

78 FR 53496 - Commercial Space Transportation Advisory Committee; Open Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-29

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Commercial Space Transportation... Commercial Space Transportation Advisory Committee Open Meeting. SUMMARY: Pursuant to Section 10(a)(2) of the... the Commercial Space Transportation Advisory Committee (COMSTAC). The meeting will take place on...

76 FR 51461 - Commercial Space Transportation Advisory Committee-Open Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-18

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Commercial Space Transportation... Commercial Space Transportation Advisory Committee open meeting. SUMMARY: Pursuant to Section 10(a)(2) of the... the Commercial Space Transportation Advisory Committee (COMSTAC). The meeting will take place on...

Open-Source RTOS Space Qualification: An RTEMS Case Study

NASA Technical Reports Server (NTRS)

Zemerick, Scott

2017-01-01

NASA space-qualification of reusable off-the-shelf real-time operating systems (RTOSs) remains elusive due to several factors notably (1) The diverse nature of RTOSs utilized across NASA, (2) No single NASA space-qualification criteria, lack of verification and validation (V&V) analysis, or test beds, and (3) different RTOS heritages, specifically open-source RTOSs and closed vendor-provided RTOSs. As a leader in simulation test beds, the NASA IV&V Program is poised to help jump-start and lead the space-qualification effort of the open source Real-Time Executive for Multiprocessor Systems (RTEMS) RTOS. RTEMS, as a case-study, can be utilized as an example of how to qualify all RTOSs, particularly the reusable non-commercial (open-source) ones that are gaining usage and popularity across NASA. Qualification will improve the overall safety and mission assurance of RTOSs for NASA-agency wide usage. NASA's involvement in space-qualification of an open-source RTOS such as RTEMS will drive the RTOS industry toward a more qualified and mature open-source RTOS product.

Social Cohesion Among Sex Workers and Client Condom Refusal in a Canadian Setting: Implications for Structural and Community-Led Interventions.

PubMed

Argento, Elena; Duff, Putu; Bingham, Brittany; Chapman, Jules; Nguyen, Paul; Strathdee, Steffanie A; Shannon, Kate

2016-06-01

Community empowerment can be a powerful determinant of HIV risk among sex workers (SWs). This study modeled the impact of social cohesion on client condom refusal among SWs in Vancouver. Longitudinal data were drawn from a prospective cohort of SWs (2010-2013). Lippman and colleagues' Social Cohesion Scale measured SWs' connectedness (i.e., perception of mutual aid, trust, support). Multivariable logistic regression examined the independent effect of social cohesion on client condom refusal. Of 654 SWs, 22 % reported baseline client condom refusal and 34 % over 3 years. The baseline median social cohesion score was 24 (IQR 20-29, range 4-45). In the final confounding model, for every one-point increase in the social cohesion score, average odds of condom refusal decreased by 3 % (AOR 0.97; 95 % CI 0.95-0.99). Community empowerment can have a direct protective effect on HIV risk. These findings highlight the need for a legal framework that enables collectivization and SW-led efforts in the HIV response.

Advance decisions and the Mental Capacity Act.

PubMed

Halliday, Samantha

This article considers the requirements set out in the Mental Capacity Act 2005 for valid advance decisions. The Act recognizes that an adult with capacity may refuse treatment, including life-sustaining treatment, in advance of losing capacity. If that advance decision is valid and applicable, it will bind health-care professionals, taking effect as if the patient had contemporaneously refused the treatment. However, in cases where the advance decision does not relate to treatment for a progressive disease, it will be extremely difficult for the patient to meet the dual specificity requirement - specifying the treatment to be refused and the circumstances in which that refusal should operate. Moreover, while a patient may explicitly revoke an advance decision while she retains the capacity to do so, the continuing validity of an advance decision may be called into question by the patient implicitly revoking her advance refusal or by a change of circumstance. This article concludes that the key to enabling patients to exercise precedent autonomy will be full and frank discussion of the scope and intentions underlying advance decisions between patients and their health-care professionals.

African-American adolescent females' predictors of having sex.

PubMed

Dancy, Barbara L; Crittenden, Kathleen S; Freels, Sally

2006-12-01

African-American adolescent females are at high risk for HIV infection, acquired primarily as a result of heterosexual intercourse. Multiple regression analyses was used to describe the correlates of the outcome variable, ever having had sex, for low-income African-American adolescent females in a cross-sectional study of 322 (N = 322) mother/daughter pairs. The results revealed that while the daughters' age was positively associated with the outcome variable, the daughters' perceptions of strictness of curfew and maternal monitoring, and the daughters'self-efficacy to refuse sex and their intention to refuse sex were negatively associated with the outcome variable. Mothers tended to report significantly more maternal monitoring and stricter curfews than what their daughters perceived them to be. The daughters'intention to refuse sex mediated the effects of age and self-efficacy to refuse sex on the outcome variable. These results suggest that health-care providers should promote clearer communication between mothers and daughters in order to reduce divergent perceptions and to help mothers facilitate their daughters' self-efficacy and their intention to refuse sex.

Blood Transfusion in Children: The Refusal of Jehovah's Witness Parents'.

PubMed

Conti, Adelaide; Capasso, Emanuele; Casella, Claudia; Fedeli, Piergiorgio; Salzano, Francesco Antonio; Policino, Fabio; Terracciano, Lucia; Delbon, Paola

2018-01-01

In Italy, both parents have parental responsibility; as a general principle they have the power to give or withhold consent to medical procedures on their children, including consent for blood transfusion; however these rights are not absolute and exist only to promote the welfare of children. The Authors discuss ethical and legal framework for Jehovah's Witness parents' refusal of blood transfusion in Italy. They searched national judgments concerning Jehovah's Witness parents' refusal of blood transfusion - and related comments - in national legal databases and national legal journals, and literature on medical literature databases. In the case of Jehovah's Witness parents' refusal of blood transfusion for their child, Italian Courts adopt measures that prevents the parents from exercise their parental responsibility not in the child's best interest. In the event that refusal by the parents, outside of emergency situations, exposes the child's health to serious risk, health workers must proceed by notifying the competent authority, according also to the Italian Code of Medical Ethics. When the patient is a minor, the child's best interest always come first.

[Tuberculosis and refusal of treatment: resorting to legislation on serious health threats].

PubMed

Bouvet, R; Le Gueut, M

2013-06-01

Clinicians are regularly confronted with the question of refusal of treatment from patients with tuberculosis. For several years, the French public health authorities have been studying the possibility of compelling treatment or isolation, but no plan has been implemented even though European and American experiences have shown the effectiveness of restrictive measures. Neither the statutory exceptions to the principle of consent to medical treatment nor the conditions of implementation of "required care" allow legally binding measures against patients refusing care or isolation. The legislation on serious health threats has recently been applied to the situation of a refusal of treatment in the context of tuberculosis. It allowed the patient to be ordered to observe prescribed care and the possibility of forced isolation in the event of breach of this order. The legislation on serious health threats is a response to the question of refusal of treatment from patients with tuberculosis. However the opinion of the legal authority as to its necessity and proportionality to the risk remains unknown. Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Solid Waste Management Practices in the Eastern Province of Saudi Arabia

NASA Astrophysics Data System (ADS)

Khan, Hasin U.; Husain, Tahir; Khan, Suhail M.

1987-11-01

Solid waste management practices in the Eastern Province of Saudi Arabia are reviewed. The officials of various municipalities and agencies responsible for collecting and disposing of municipal waste were interviewed. The refuse generation rate found is in the range of 1.61 2.72 kg per capita per day. The refuse composition data indicate a high percentage of glass, metals, and wood. For storage purposes, 0.2-m3 barrels are used in residential areas and 0.75 to 1.50 m3-capacity containers are used in commerical areas. The present solid-waste collection system is labor-intensive, and a significant part of the budget is spent on collection and haul operations. The unit collection and haul cost is much higher than the unit disposal cost of refuse. The direct haul of refuse is the common practice, and the use of transfer stations has not yet been considered. It is also observed that the disposal methods used at these sites are not in line with modern techniques for refuse disposal. Landfilling and combined burning and landfilling are the common disposal methods at all the sites.

[Participation refusal by probands in an epidemiologic long-term study--sociodemographic, clinical and psychometric findings].

PubMed

Franz, M; Schepank, H; Wirth, T; Schellberg, D

1992-11-01

Usually little is known about probands who participated in an epidemiological longitudinal field survey but refused participation in follow-up investigations. For reasons of data protection and on account of the fact that investigative instruments used in longterm field surveys or panel studies are more focused on well defined issues (opinions, attitudes, assessment of behaviors) and less on personality variables, differentiated statements on probands who explicitly refused cooperation can hardly be made. In our epidemiological longitudinal field study on prevalence and course of psychogenic disorders we have a different situation. Within the limits of our study we had the unique opportunity to gain far-reaching information on probands who refused to participate in preceding investigations in regard to sociodemographic, psychometric and clinical variables. The clientele of refusers we present in our paper mainly comprises elderly, married, rather obsessive-compulsive structured, lower-class females. According to our data interactive aspects are equally responsible for reduced cooperativeness. The significance of our findings for the planning and carrying out of epidemiological longitudinal field surveys is discussed.

Media resistance skills and drug skill refusal techniques: What is their relationship with alcohol use among inner-city adolescents?

PubMed

Epstein, Jennifer A; Botvin, Gilbert J

2008-04-01

Past research related to alcohol advertising examined whether underage adolescents were targets of the alcohol industry and what impact such advertising had on adolescent drinking. The purpose of this study was to longitudinally examine the impact of media resistance skills on subsequent drinking among adolescents residing in inner-city regions of New York City. The study also tested whether drug skill refusal techniques (knowing how to say no to alcohol and other drugs) mediated the relationship between media resistance skills and adolescent drinking. A panel sample of baseline, one-year and two-year follow-ups (N=1318) from the control group of a longitudinal drug abuse prevention trial participated. A series of structural equations models showed that media resistance skills directly negatively predicted alcohol use 2 years later and that drug skill refusal techniques mediated this effect. Baseline media resistance skills were associated with one-year drug skill refusal techniques, which in turn negatively predicted two-year alcohol use. These findings provided empirical support for including media resistance skills and drug skill refusal techniques in alcohol prevention programs.

Media Resistance Skills and Drug Skill Refusal Techniques: What is Their Relationship with Alcohol Use Among Inner-City Adolescents?

PubMed Central

Epstein, Jennifer A.; Botvin, Gilbert J.

2008-01-01

Past research related to alcohol advertising examined whether underage adolescents were targets of the alcohol industry and what impact such adverting had on adolescent drinking. The purpose of this study was to longitudinally examine the impact of media resistance skills on subsequent drinking among adolescents residing in inner-city regions of New York City. The study also tested whether drug skill refusal techniques (knowing how to say no to alcohol and other drugs) mediated the relationship between media resistance skills and adolescent drinking. A panel sample of baseline, 1-year and 2-year follow-ups (N = 1318) from the control group of a longitudinal drug abuse prevention trial participated. A series of structural equations models showed that media resistance skills directly negatively predicted alcohol use two years later and that drug skill refusal techniques mediated this effect. Baseline media resistance skills were associated with 1-year drug skill refusal techniques, which in turn negatively predicted 2-year alcohol use. These findings provided empirical support for including media resistance skills and drug skill refusal techniques in alcohol prevention programs. PMID:18164827

Social Cohesion Among Sex Workers and Client Condom Refusal in a Canadian Setting: Implications for Structural and Community-Led Interventions

PubMed Central

Argento, Elena; Duff, Putu; Bingham, Brittany; Chapman, Jules; Nguyen, Paul; Strathdee, Steffanie A.

2015-01-01

Community empowerment can be a powerful determinant of HIV risk among sex workers (SWs). This study modeled the impact of social cohesion on client condom refusal among SWs in Vancouver. Longitudinal data were drawn from a prospective cohort of SWs (2010–2013). Lippman and colleagues’ Social Cohesion Scale measured SWs’ connectedness (i.e., perception of mutual aid, trust, support). Multivariable logistic regression examined the independent effect of social cohesion on client condom refusal. Of 654 SWs, 22 % reported baseline client condom refusal and 34 % over 3 years. The baseline median social cohesion score was 24 (IQR 20–29, range 4–45). In the final confounding model, for every one-point increase in the social cohesion score, average odds of condom refusal decreased by 3 % (AOR 0.97; 95 % CI 0.95–0.99). Community empowerment can have a direct protective effect on HIV risk. These findings highlight the need for a legal framework that enables collectivization and SW-led efforts in the HIV response. PMID:26499335

Children and refusal of medical treatment: in urgent need of reform.

PubMed

Lennings, Nicholas

2013-09-01

The ability of children to refuse medical treatment is far from certain. The New South Wales Law Reform Commission report on this topic, released in 2008, addressed a number of key concerns. As yet, no action on that report has been taken. Neither the present statutory nor common law regime provides sufficient guidance on this issue. The case of Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112, while important, is not as far-reaching as it first appeared and has been subject to substantial limitations regarding refusals of treatment. Specifically, the position in relation to the assessment of competency, and the weight of a competent decision, remains outstanding. The ability of children to refuse medical treatment is in urgent need of attention and rectification.

When is it permissible to dismiss a family who refuses vaccines? Legal, ethical and public health perspectives.

PubMed

Halperin, Beth; Melnychuk, Ryan; Downie, Jocelyn; Macdonald, Noni

2007-12-01

Although immunization is one of the most important health interventions of the 20th century, cases of infectious disease continue to occur. There are parents who refuse immunization for their children, creating a dilemma for the primary care physician who must consider the best interest of the individual child as well as that of the community. Some physicians, when faced with parents who refuse immunization on behalf of their children, choose to dismiss these families from their practice. Given the existing shortage of primary care physicians across Canada, this decision to dismiss families based on vaccine refusal has far-reaching implications. The present article explores this issue in the Canadian context from a legal, ethical and public health perspective.

A Comparison of Selective Auditory Attention Abilities in Open-Space Versus Closed Classroom Students.

ERIC Educational Resources Information Center

Reinertsen, Gloria M.

A study compared performances on a test of selective auditory attention between students educated in open-space versus closed classroom environments. An open-space classroom environment was defined as having no walls separating it from hallways or other classrooms. It was hypothesized that the incidence of auditory figure-ground (ability to focus…

The Impact of The Open-Space School Upon Teacher Influence and Autonomy: The Effects of an Organizational Innovation.

ERIC Educational Resources Information Center

Meyer, John; And Others

This study compares teachers in open-space and traditional schools with respect to variables including the teacher's sense of influence, job satisfaction, and attitude toward being evaluated by colleges. Questionnaires were administered to 110 teachers from nine open-space elementary schools and 120 teachers from eight traditional elementary…

76 FR 37874 - Notice of Intent To Rule on Request To Release Airport Property at Lehigh Valley International...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-28

... Acres as open space dedication to meet the conditions of an existing zone change (Resolution 07-08), and...--to Hanover Township for Current & Advance Open Space Dedication Purposes A certain lot, piece or... existing zone change (Resolution 07-08), and the open space dedication requirements of the Subdivision and...

Pakistani Children in Sheffield and Their Perception and Use of Public Open Spaces.

ERIC Educational Resources Information Center

Woolley, Helen; ul Amin, Noor

1995-01-01

Examines urban public open spaces used by Pakistani children in Sheffield, United Kingdom. Results reveal that most children visit open spaces on a daily or weekly basis and that parks and playgrounds are preferred. Lists activities engaged in by the majority of children as well as reasons for not undertaking activities. (AIM)

KENNEDY SPACE CENTER, FLA. - Daniel LeBlanc, chief operating officer of Delaware North Companies Parks and Resorts at KSC, makes the opening remarks to hundreds of guests and media representatives attending a ribbon cutting ceremony officially opening the U.S. Astronaut Hall of Fame as part of the Kennedy Space Center Visitor Complex. The ceremony was held in conjunction with the induction of four Space Shuttle astronauts into the Hall of Fame including Daniel Brandenstein, Robert "Hoot" Gibson, Story Musgrave, and Sally Ride. Conceived by six of the Mercury Program astronauts, the U.S. Astronaut Hall of Fame opened in 1990 to provide a place where space travelers could be remembered for their participation and accomplishments in the U.S. space program. The four new inductees join 48 previously honored astronauts from the ranks of the Gemini, Apollo, Skylab, Apollo-Soyuz, and Space Shuttle programs.

NASA Image and Video Library

2003-06-20

KENNEDY SPACE CENTER, FLA. - Daniel LeBlanc, chief operating officer of Delaware North Companies Parks and Resorts at KSC, makes the opening remarks to hundreds of guests and media representatives attending a ribbon cutting ceremony officially opening the U.S. Astronaut Hall of Fame as part of the Kennedy Space Center Visitor Complex. The ceremony was held in conjunction with the induction of four Space Shuttle astronauts into the Hall of Fame including Daniel Brandenstein, Robert "Hoot" Gibson, Story Musgrave, and Sally Ride. Conceived by six of the Mercury Program astronauts, the U.S. Astronaut Hall of Fame opened in 1990 to provide a place where space travelers could be remembered for their participation and accomplishments in the U.S. space program. The four new inductees join 48 previously honored astronauts from the ranks of the Gemini, Apollo, Skylab, Apollo-Soyuz, and Space Shuttle programs.

Dangerous Spaces: Threatening Sites for Social Justice

ERIC Educational Resources Information Center

Schostak, John

2012-01-01

There is nothing natural about space as it is understood here. Spacing is an act that constructs relationships, intervals, separations and thus boundaries. The earth has no territories other than those imagined and enforced through acts of territorialisation. A city has its private spaces closed to open access and open spaces that are inscribed…

Open source IPSEC software in manned and unmanned space missions

NASA Astrophysics Data System (ADS)

Edwards, Jacob

Network security is a major topic of research because cyber attackers pose a threat to national security. Securing ground-space communications for NASA missions is important because attackers could endanger mission success and human lives. This thesis describes how an open source IPsec software package was used to create a secure and reliable channel for ground-space communications. A cost efficient, reproducible hardware testbed was also created to simulate ground-space communications. The testbed enables simulation of low-bandwidth and high latency communications links to experiment how the open source IPsec software reacts to these network constraints. Test cases were built that allowed for validation of the testbed and the open source IPsec software. The test cases also simulate using an IPsec connection from mission control ground routers to points of interest in outer space. Tested open source IPsec software did not meet all the requirements. Software changes were suggested to meet requirements.

Harm or Mere Inconvenience? Denying Women Emergency Contraception

PubMed Central

McLeod, Carolyn

2010-01-01

This paper addresses the likely impact on women of being denied emergency contraception (EC) by pharmacists who conscientiously refuse to provide it. A common view—defended by Elizabeth Fenton and Loren Lomasky, among others—is that these refusals inconvenience rather than harm women so long as the women can easily get EC somewhere else close by. I argue from a feminist perspective that the refusals harm women even when they can easily get EC somewhere else close by. PMID:20706565