Planting sites in the Northeast

Treesearch

Northeastern Forest Experiment Station

1961-01-01

Tree planting involves many considerations - site classification, selection of species, planting practices, and protection from fire, insects, and diseases. The information about many of these aspects of planting is scattered and fragmentary.

Primary School Leadership Practice: How the Subject Matters

ERIC Educational Resources Information Center

Spillane, James P.

2005-01-01

Teaching is a critical consideration in investigations of primary school leadership and not just as an outcome variable. Factoring in instruction as an explanatory variable in scholarship on school leadership involves moving away from views of teaching as a monolithic or unitary practice. When it comes to leadership in primary schools, the subject…

Tree planting in the Allegheny section

Treesearch

Northeastern Forest Experiment Station

1961-01-01

Tree planting involves many considerations - site classification, selection of species, planting practices, and protection from fire, insects, and diseases. The information about many of these aspects of planting is scattered and fragmentary.

Ethics in clinical drug trial research in private practice.

PubMed

Beran, R G; Beran, M E

2006-09-01

Private clinics and clinicians have been involved in clinical drug trials for approximately two decades. This paper reviews the ethical consideration inherent in this process. Involvement of a single community based, private, Australian neurological clinic in the conduct of trials was audited. Changes in ethical considerations were analysed. The clinic previously audited its clinical trial involvement, starting with pharmaceutical company orchestrated trials. These were vetted by hospital based ethics committees (ECs) which then refused to review private research. A private EC accommodating NH & MRC standards was formed to assess private research. Indemnity concerns forced return to institutional ECs with government guaranteed indemnification. Trials evolved to investigator initiated, company sponsored studies thence a company asking the clinic to devise, sponsor and manage a trial. The latter relegated trial co-ordination to the clinic which would control publication thereby creating new ethical standards. Private practice trial involvement evolved from reluctant inclusion to a pivotal role in privately sponsored studies. Access to ECs is government endorsed and publication is independent for investigator-sponsored trials. There has been modification of standard operating procedures and enhanced ethical standards.

Some effects of external stores on the static stability of fighter airplanes

NASA Technical Reports Server (NTRS)

Spearman, M. L.

1972-01-01

Fighter airplanes may have a seemingly limitless number of external store arrangements. Some practical considerations and some aerodynamic considerations must be taken into account in the arrangements of the external stores. The nature of the problems concerning the type of store arrangement involved and the type of airplane on which the stores are installed are reported.

[Micro and Macro Social Work Practice in the Context of Tuberculosis].

PubMed

Moya, Eva M; Chavez-Baray, Silvia M; Martínez, Omar

2017-07-01

The study of tuberculosis (TB) in the U.S.-Mexico border involves the consideration of three key components, which are complex and interrelated: the difficulty tracking and providing appropriate TB care due to the epidemiological and pathological characteristics of TB; the border itself is a geographical and epidemiological area that interweaves two nations, two cultures, two health systems and different laws; and the need for prevention and treatment approaches to TB that involve comprehensive clinical care and prevention while also taking into consideration stigma, social context and knowledge. This manuscript describes the work of ten studies conducted in Mexico and in the U.S.-Mexico border region from 2006 to 2013. It also provides an understanding of the social and public health implications of TB, the environment and communities, as well as the identification and application of advocacy and social mobilization practices. The work presented provides an understanding of different interventions related to adherence, stigma reduction, person-centered approaches, and effective micro and macro practices in social work.

Advance directives in the UK: legal, ethical, and practical considerations for doctors.

PubMed

Kessel, A S; Meran, J

1998-05-01

In the United Kingdom (UK), advance directives have recently received considerable attention from professional and voluntary organizations as well as medical journals and the media. However, despite such exposure, many doctors remain uncertain of the importance or relevance of advance directives with regard to their own clinical practice. This paper addresses these uncertainties by first explaining what advance directives are and then describing the current legal status of such directives in the UK. Examination of the cases underpinning this status reveals several key elements: competence, information, anticipation, applicability, and freedom from duress. Each is discussed. Although this paper focuses on legal issues, it is important that medical law does not dominate medical ethics. Accordingly, the paper also discusses some important philosophical and sociological considerations that have remained largely unexplored in the medical press. Finally, the paper deals with practical matters, including how the general practitioner might be involved.

41 CFR 109-42.1102-51 - Suspect personal property.

Code of Federal Regulations, 2011 CFR

2011-01-01

... excess. (b) With due consideration to the economic factors involved, every effort shall be made to reduce the level of contamination of excess or surplus personal property to the lowest practicable level...

Setting up recovery clinics and promoting service user involvement.

PubMed

John, Thomas

2017-06-22

Service user involvement in mental health has gained considerable momentum. Evidence from the literature suggests that it remains largely theoretical rather than being put into practice. The current nature of acute inpatient mental health units creates various challenges for nurses to put this concept into practice. Recovery clinics were introduced to bridge this gap and to promote service user involvement practice within the current care delivery model at Kent and Medway NHS and Social Care Partnership Trust. It has shaped new ways of working for nurses with a person-centred approach as its philosophy. Service users and nurses were involved in implementing a needs-led and bottom-up initiative using Kotter's change model. Initial results suggest that it has been successful in meeting its objectives evidenced through increased meaningful interactions and involvement in care by service users and carers. The clinics have gained wide recognition and have highlighted a need for further research into care delivery models to promote service user involvement in these units.

Barriers to Parental Involvement in Education: An Explanatory Model

ERIC Educational Resources Information Center

Hornby, Garry; Lafaele, Rayleen

2011-01-01

The issue of parental involvement (PI) in education is notable for the extensive rhetoric supporting it and considerable variation in the reality of its practice. It is proposed that the gap between rhetoric and reality in PI has come about because of the influence of factors at the parent and family, child, parent-teacher and societal levels…

Integrating counselling into general practice.

PubMed

Stone, L; Blashki, G

2000-03-01

General practice counselling has many significant differences to counselling in other settings. General practitioners have long term relationships with their patients involving physical as well as mental health care. General practitioners are often the first point of contact for distressed patients who may not perceive their problem to have a psychological basis. There are barriers to counselling including time management and cultural expectations of the consultation. To outline a practical biopsychosocial model for counselling in the general practice setting using the knowledge and skills unique to each GP. Theoretical and practical barriers to counselling commonly encountered in general practice are discussed. Assessing the problem in a biopsychosocial format highlights strengths and skills the patient already possesses and involves consideration of physical sensations, emotions, behaviours, key relationships, family, social roles and resources. Counselling in general practice requires flexibility and an ability to adapt available resources to address patient needs in an individually appropriate way.

Prevalence and sport-related predictors of disturbed eating attitudes and behaviors: Moderating effects of sex and age.

PubMed

Lanfranchi, M-C; Maïano, C; Morin, A J S; Therme, P

2014-08-01

Very few studies examined the prevalence and sport-related predictors of disturbed eating attitudes and behaviors (DEABs) among adolescents involved in sport practice, and their results are mixed and inconclusive. These inconsistencies are most likely due to their methodological heterogeneity and to the fact that none of these studies took into consideration the potentially relevant characteristics of the sport practice context. This study attempts to answer this limitation among French adolescents not involved or involved in various sports contexts defined based on their organization, leanness-centration, and competitive level. Participants were 335 adolescents involved in sport practice, and 435 adolescents not involved in any form of regular sport practice. The DEABs were measured using the Eating Attitudes Test-26. Global results do not showed any significant association between the status of the participants and DEAB. However, these results drastically changed when we considered the potential moderating role of sex and age on these relations. Indeed, sports involvement in general, and involvement in leanness and competitive sports were found to exert sex- and age-differentiated effects on the risks of presenting clinically significant levels of DEAB. This study suggests the importance of monitoring, preventive, and early intervention mechanisms within the context of practice, particularly for adolescent girls. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Normative dimensions of nursing practice--the ethical relevance of the body].

PubMed

Remmers, H

1997-10-01

A combination of preliminary considerations concerning a theory of action and a philosophy of science illustrates the determining influence of the scientific preconception of the subject matter, and of the approach which is presupposed by this preconception, on the normative orientation of nursing practice. The specific physical nearness involved in nursing practice ("body to body") holds problems with regard to an appropriate theoretical frame of reference and corresponding practical convictions. This background provides the context for a concluding critical examination of several representative nursing theories with regard to their implicit, normative premises.

Involving users with learning difficulties in health improvement: lessons from inclusive learning disability research.

PubMed

Walmsley, Jan

2004-03-01

In this paper the author considers the lessons to be drawn from what is termed "inclusive" learning disability research for user involvement around health improvement. Inclusive learning disability research refers to research where people with learning difficulties (intellectual disability) are involved as active participants, as opposed to passive subjects. There is by now a considerable body of such research, developed over the past 25 years. From the review, the author draws attention to areas which can inform practice in involvement of users in a way that adds value.

49 CFR 1106.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR SURFACE TRANSPORTATION BOARD CONSIDERATION OF SAFETY INTEGRATION... the agency within the Department of Transportation responsible for railroad safety. Safety Integration... involved in a manner that would maintain safety at every step of the integration process, in the event the...

Educational Neuroscience: Neuroethical Considerations

ERIC Educational Resources Information Center

Lalancette, Helene; Campbell, Stephen R.

2012-01-01

Research design and methods in educational neuroscience involve using neuroscientific tools such as brain image technologies to investigate cognitive functions and inform educational practices. The ethical challenges raised by research in social neuroscience have become the focus of neuroethics, a sub-discipline of bioethics. More specifically…

Ethical Issues Involving Research Conducted with Homebound Older Adults

ERIC Educational Resources Information Center

Locher, Julie L.; Bronstein, Janet; Robinson, Caroline O.; Williams, Charlotte; Ritchie, Christine S.

2006-01-01

Conducting research in the home setting with homebound older adults presents distinct ethical and practical challenges that require special consideration. This article describes the methodological issues that make studying homebound older adults especially vulnerable to therapeutic misconception and researcher role conflict and offers practical…

Pastoral Care and Mindfulness: A Teaching Practice

ERIC Educational Resources Information Center

Strongman, Luke

2017-01-01

From the earliest modern academic literature of industrial organization, supervision education and training, managerial considerations involve leveraging to improve the work of the supervisor and supervisee, and accentuating the value added opportunities for work improvement (Dawson, 1926, pp. 293-295). Reflecting the incorporation of the…

Information in general medical practices: the information processing model.

PubMed

Crowe, Sarah; Tully, Mary P; Cantrill, Judith A

2010-04-01

The need for effective communication and handling of secondary care information in general practices is paramount. To explore practice processes on receiving secondary care correspondence in a way that integrates the information needs and perceptions of practice staff both clinical and administrative. Qualitative study using semi-structured interviews with a wide range of practice staff (n = 36) in nine practices in the Northwest of England. Analysis was based on the framework approach using N-Vivo software and involved transcription, familiarization, coding, charting, mapping and interpretation. The 'information processing model' was developed to describe the six stages involved in practice processing of secondary care information. These included the amendment or updating of practice records whilst simultaneously or separately actioning secondary care recommendations, using either a 'one-step' or 'two-step' approach, respectively. Many factors were found to influence each stage and impact on the continuum of patient care. The primary purpose of processing secondary care information is to support patient care; this study raises the profile of information flow and usage within practices as an issue requiring further consideration.

Some Legal Aspects of Campus Housing.

ERIC Educational Resources Information Center

Moore, Donald R.

Legal aspects and implications affecting college and university housing administration are unpredictable, unsettled, and subject to change. The complete practical guide to the everyday legal answers for campus housing simply does not exist. This document presents some specific legal considerations involved in housing that may affect the management…

Medical Considerations for Multiple-Handicapped Children in the Public Schools

ERIC Educational Resources Information Center

Bryan, Elizabeth; And Others

1978-01-01

The authors discuss concerns and practical suggestions involved in the education of multiply handicapped children in the following problem areas: first aid, emergency care and disaster planning; sanitation; environment; safety in routine and supplemental activities; therapy procedures; and staff protection, training, orientation, and special…

Bookshelf. Seize the Moment.

ERIC Educational Resources Information Center

Wilde, Susie

1997-01-01

Optimal classroom read-aloud sessions result from teachers' planning and practice. Important considerations include choosing the right book, prereading, reading dramatically, and choosing authors who have written several books. Books that are sure to go over well include those that let the students get involved, stories that start discussions, and…

Mathematics, Modelling and Students in Transition

ERIC Educational Resources Information Center

Wake, Geoff

2016-01-01

This article is based on data from two major research projects that investigated students involved in mathematically demanding courses during their transition through college and into university. It explores the nature of modelling as a mathematical practice in this important transition phase for students. Theoretical considerations are informed…

Interleaved concatenated codes: new perspectives on approaching the Shannon limit.

PubMed

Viterbi, A J; Viterbi, A M; Sindhushayana, N T

1997-09-02

The last few years have witnessed a significant decrease in the gap between the Shannon channel capacity limit and what is practically achievable. Progress has resulted from novel extensions of previously known coding techniques involving interleaved concatenated codes. A considerable body of simulation results is now available, supported by an important but limited theoretical basis. This paper presents a computational technique which further ties simulation results to the known theory and reveals a considerable reduction in the complexity required to approach the Shannon limit.

Equine Assisted Interventions (EAIs): Methodological Considerations for Stress Assessment in Horses

PubMed Central

Cirulli, Francesca; Luzi, Fabio; Stefani, Annalisa; Toson, Marica; Odore, Rosangela; Farina, Luca

2017-01-01

Equine assisted interventions (EAIs) are recently facing an increasing popularity, and are characterized by a wide diversity of practices. However, information on the welfare of animals involved in this kind of activity is often lacking. Horses are highly susceptible to work stressors related to physical constraints and/or to the need to control emotions while interacting with humans. Considerations of the emotional state of horses involved in EAIs have multiple valences: for the safety of humans and animals involved, for the quality and efficacy of interventions, as well as for ethical reasons. The aim of this unsystematic narrative review is to summarize the different approaches used for the evaluation of horses’ stress responses, investigate their application in the context of EAIs, and discuss some methodological considerations for researchers and practitioners involved in EAI. The sources of information are mostly based on electronic databases (i.e., Medline, Scopus and Google scholar), as well as on hand searches of the references of retrieved literature, and discussions with experts in the field. At present, a few studies have investigated horses’ stress responses during EAIs, and further studies are recommended, with the final aim to derive a reliable multidimensional method for assessing a horse’s reaction during therapeutic programs, ultimately helping professionals to better develop interventions by taking into consideration the animal’s perspective. PMID:29056702

Design Development Test and Evaluation (DDT and E) Considerations for Safe and Reliable Human Rated Spacecraft Systems

NASA Technical Reports Server (NTRS)

Miller, James; Leggett, Jay; Kramer-White, Julie

2008-01-01

A team directed by the NASA Engineering and Safety Center (NESC) collected methodologies for how best to develop safe and reliable human rated systems and how to identify the drivers that provide the basis for assessing safety and reliability. The team also identified techniques, methodologies, and best practices to assure that NASA can develop safe and reliable human rated systems. The results are drawn from a wide variety of resources, from experts involved with the space program since its inception to the best-practices espoused in contemporary engineering doctrine. This report focuses on safety and reliability considerations and does not duplicate or update any existing references. Neither does it intend to replace existing standards and policy.

How Should We Respond to Non-Dominant Healing Practices, the Example of Homeopathy.

PubMed

Gray, Ben

2017-03-01

The debate around the ethics of homeopathy in recent issues of the journal has been approached as a binary question; is homeopathy ethical or not? This paper suggests that this is an unhelpful question and instead discusses a framework to establish the extent to which the dominant (medical) culture should tolerate non-dominant health practices such as homeopathy. This requires a sophisticated understanding of the placebo effect, a critical evaluation of what evidence is available, a consideration of the harm that the non-dominant practice might cause, and a consideration of how this might be affected by the culture of the patient. This is presented as a matter of cultural competence. At a clinical level clinicians need to respect the values and beliefs of their patients and communicate with all the practitioners involved in a patient's care. At a societal level there are a number of factors to be considered when a community decides which practices to tolerate and to what extent.

Elections: Secondary Teaching Activities in the Participation Series.

ERIC Educational Resources Information Center

Schultz, John; Taft-Morales, Hugh

One of a series of teacher-developed curriculum guides designed to encourage student participation and involvement in important social issues, this secondary level guide helps 7th through 12th grade English and social studies educators teach about the election process. An introductory section suggests practical considerations, means of enlisting…

Developing clinical practice guidelines for Chinese herbal treatment of polycystic ovary syndrome: A mixed-methods modified Delphi study.

PubMed

Lai, Lily; Flower, Andrew; Moore, Michael; Lewith, George

2015-06-01

Preliminary evidence suggests Chinese herbal medicine (CHM) could be a viable treatment option for polycystic ovary syndrome (PCOS). Prior to conducting a clinical trial it is important to consider the characteristics of good clinical practice. This study aims to use professional consensus to establish good clinical practice guidelines for the CHM treatment of PCOS. CHM practitioners participated in a mixed-methods modified Delphi study involving three rounds of structured group communication. Round 1 involved qualitative interviews with practitioners to generate statements regarding good clinical practice. In round 2, these statements were distributed online to the same practitioners to rate their agreement using a 7-point Likert scale, where group consensus was defined as a median rating of ≥5. Statements reaching consensus were accepted for consideration onto the guideline whilst those not reaching consensus were re-distributed for consideration in round 3. Statements presented in the guidelines were graded from A (strong consensus) to D (no consensus) determined by median score and interquartile range. 11 CHM practitioners in the UK were recruited. After three Delphi rounds, 91 statement items in total had been considered, of which 89 (97.8%) reached consensus and 2 (2.2%) did not. The concluding set of guidelines consists of 85 items representing key features of CHM prescribing for PCOS. These guidelines can be viewed as an initial framework that captures fundamental principles of good clinical practice for CHM. Copyright © 2015 Elsevier Ltd. All rights reserved.

Transformative learning and research utilization in nursing practice: a missing link?

PubMed

Matthew-Maich, Nancy; Ploeg, Jenny; Jack, Susan; Dobbins, Maureen

2010-03-01

Poor or inconsistent research utilization into clinical practice is a recurrent theme across study contexts, rendering leaders disillusioned with how best to foster the uptake of research into nursing practice. This makes it imperative to look to new approaches. Research utilization involves a learning process engaging attitudes, beliefs, and behaviors; yet, this is often overlooked in approaches and models used to facilitate research use. This oversight may offer some explanation to the limited progress in research utilization to date. Transformation Theory offers an explanatory theory and specific strategies (critical reflection and critical discourse) to explore attitudes, beliefs, and behaviors so that they are understood, validated, and can better guide actions. The purpose of this article was to explore what Transformation Theory can contribute to research utilization initiatives in nursing practice. Transformation Theory and transformative learning strategies are discussed and critically analyzed in consideration of their potential roles in fostering research utilization in clinical nursing practice. (1) Research utilization is a learning process that involves knowledge, skills, feelings, attitudes, and beliefs. (2) Transformative learning strategies of critical reflection and discourse can facilitate insight into experiences, finding shared meanings among groups of people, and understanding/validating beliefs, attitudes, and feelings so they can more consciously guide future actions. This dimension is frequently neglected in research utilization efforts. (3) In combination with research utilization theories, Transformation Theory may be a missing link to make research utilization initiatives more effective in rendering and sustaining nursing practice change, thus enhancing client care and well-being. (4) Research and further consideration are both warranted and needed.

Nursing and genetic biobanks.

PubMed

Sanner, Jennifer E; Yu, Erica; Udtha, Malini; Williams, Pamela Holtzclaw

2013-12-01

Biobanks function as vital components in genetic research, which often requires large disease-based or population-based biospecimens and clinical data to study complex or rare diseases. Genetic biobanks aim to provide resources for translational research focusing on rapidly moving scientific findings from the laboratory into health care practice. The nursing profession must evolve as genetic biobanking practices advance. Nursing involvement in genetic biobanking practices comes with a distinct set of educational, ethical, and practice competencies. In response to these growing competency standards, nursing science developed a conceptual framework and continues to study ethical considerations to guide genetic biobanking initiatives. Copyright © 2013 Elsevier Inc. All rights reserved.

Social Work's Role in Medicaid Reform: A Qualitative Study.

PubMed

Bachman, Sara S; Wachman, Madeline; Manning, Leticia; Cohen, Alexander M; Seifert, Robert W; Jones, David K; Fitzgerald, Therese; Nuzum, Rachel; Riley, Patricia

2017-12-01

To critically analyze social work's role in Medicaid reform. We conducted semistructured interviews with 46 stakeholders from 10 US states that use a range of Medicaid reform approaches. We identified participants using snowball and purposive sampling. We gathered data in 2016 and analyzed them using qualitative methods. Multiple themes emerged: (1) social work participates in Medicaid reform through clinical practice, including care coordination and case management; (2) there is a gap between social work's practice-level and systems-level involvement in Medicaid innovations; (3) factors hindering social work's involvement in systems-level practice include lack of visibility, insufficient clarity on social work's role and impact, and too few resources within professional organizations; and (4) social workers need more training in health transformation payment models and policy. Social workers have unique skills that are valuable to building health systems that promote population health and reduce health inequities. Although there is considerable opportunity for social work to increase its role in Medicaid reform, there is little social work involvement at the systems level.

Practical Considerations for Conducting Delphi Studies: The Oracle Enters a New Age.

ERIC Educational Resources Information Center

Eggers, Renee M.; Jones, Charles M.

1998-01-01

In addition to giving an overview of Delphi methodology and describing the methodology used by the researchers in two Delphi studies, the authors provide information about electronic communication in Delphi studies. Also provided are suggestions that can be used in a Delphi study involving any form of communication. (SLD)

Weaving a Syllaweb: Consideration before Constructing an On-line Syllabus.

ERIC Educational Resources Information Center

Johnston, Joyce P.

This paper explores the practical and philosophical issues involved in Web site construction so that the finished site truly reflects its creator. The author uses the term "syllaweb" for a hyperlinked syllabus and declares that it was an outgrowth of Vannevar Bush's original description of computerized graphical communication as a web,…

Health Lifestyle Theory and the Convergence of Agency and Structure

ERIC Educational Resources Information Center

Cockerham, William C.

2005-01-01

This article utilizes the agency-structure debate as a framework for constructing a health lifestyle theory. No such theory currently exists, yet the need for one is underscored by the fact that many daily lifestyle practices involve considerations of health outcomes. An individualist paradigm has influenced concepts of health lifestyles in…

From Instructional Leadership to Leadership Capabilities: Empirical Findings and Methodological Challenges

ERIC Educational Resources Information Center

Robinson, Viviane M. J.

2010-01-01

While there is considerable evidence about the impact of instructional leadership on student outcomes, there is far less known about the leadership capabilities that are required to confidently engage in the practices involved. This article uses the limited available evidence, combined with relevant theoretical analyses, to propose a tentative…

Collaboration in Academic R&D: A Decade of Growth in Pass-Through Funding. InfoBrief. NSF 12-325

ERIC Educational Resources Information Center

Hale, Katherine

2012-01-01

Research collaboration involving multiple institutions is a growing trend. Contributing to this growth are federal initiatives as well as practical considerations, such as technological advances that facilitate communication and opportunities for division of labor, risk sharing, and increased research credibility. One measure of this research…

Evidence-Based Professional Development Considerations along the School-to-Prison Pipeline

ERIC Educational Resources Information Center

Houchins, David E.; Shippen, Margaret E.; Murphy, Kristin M.

2012-01-01

This article addresses professional development (PD) issues for those who provide services to students in the school-to-prison pipeline (STPP). Emphasis is on implementing evidence-based practices. The authors use a modified version of Desimone's PD framework for the structure of this article involving (a) collective participation and common…

Interleaved concatenated codes: New perspectives on approaching the Shannon limit

PubMed Central

Viterbi, A. J.; Viterbi, A. M.; Sindhushayana, N. T.

1997-01-01

The last few years have witnessed a significant decrease in the gap between the Shannon channel capacity limit and what is practically achievable. Progress has resulted from novel extensions of previously known coding techniques involving interleaved concatenated codes. A considerable body of simulation results is now available, supported by an important but limited theoretical basis. This paper presents a computational technique which further ties simulation results to the known theory and reveals a considerable reduction in the complexity required to approach the Shannon limit. PMID:11038568

Practical considerations for bicarbonate loading and sports performance.

PubMed

Burke, Louise M

2013-01-01

Consumption of sodium bicarbonate (300 mg/kg 1-2 h before exercise) can temporarily increase blood bicarbonate concentrations, enhancing extracellular buffering of hydrogen ions which accumulate and efflux from the working muscle. Such 'bicarbonate loading' provides an ergogenic strategy for sporting events involving high rates of anaerobic glycolysis which are otherwise limited by the body's capacity to manage the progressive increase in intracellular acidity. Studies show that bicarbonate loading strategies have a moderate positive effect on the performance of sports involving 1-7 min of sustained strenuous exercise, and may also be useful for prolonged sports involving intermittent or sustained periods of high-intensity work rates. This potential to enhance sports performance requires further investigation using appropriate research design, but may be limited by practical considerations such as gut discomfort or the logistics of the event. The effect of chronic use of bicarbonate supplementation prior to high-intensity workouts to promote better training performance and adaptations is worthy of further investigation. While this relatively simple dietary strategy has been studied and used by sports people for over 80 years, it is likely that there are still ways in which further benefits from bicarbonate supplementation can be developed and individualized for specific athletes or specific events. Copyright © 2013 Nestec Ltd., Vevey/S. Karger AG, Basel.

Nurse and resident satisfaction in magnet long-term care organizations: do high involvement approaches matter?

PubMed

Rondeau, Kent V; Wagar, Terry H

2006-04-01

This study examines the association of high involvement nursing work practices with employer-of-choice (magnet) status in a sample of Canadian nursing homes. In response to a severe shortage of registered nursing personnel, it is imperative for health care organizations to more effectively recruit and retain nursing personnel. Some long-term care organizations are developing employee-centred cultures that allow them to effectively enhance nurse and resident satisfaction. At the same time, many nursing homes have adopted progressive nursing workplace practices (high involvement work practices) that emphasize greater employee empowerment, participation and commitment. A mail survey was sent to the director of nursing in 300 nursing homes in western Canada. In total, 125 useable questionnaires were returned and constituted the data set for this study. Separate ordinary least squares regressions are performed with magnet strength, nurse satisfaction and resident satisfaction used as dependent variables. Nursing homes that demonstrate strong magnet (employer-of-choice) characteristics are more likely to have higher levels of nurse and patient satisfaction, even after controlling for a number of significant factors at the establishment level. Magnet nursing homes are more likely to have progressive participatory decision-making cultures and much more likely to spend considerable resources on job-related training for their nursing staff. The presence of high involvement work practices is not found to be a significant predictor in magnet strength, nurse or resident satisfaction. Merely adopting more high involvement nursing work practices may be insufficient for nursing homes, which desire to become 'employers-of-choice' in their marketplaces, especially if these practices are adopted without a concomitant investment in nurse training or an enhanced commitment to establishing a more democratic and participatory decision-making style involving all nursing staff.

Integrating postgraduate and undergraduate general practice education: qualitative study.

PubMed

O'Regan, Andrew; Culhane, Aidan; Dunne, Colum; Griffin, Michael; McGrath, Deirdre; Meagher, David; O'Dwyer, Pat; Cullen, Walter

2013-05-01

Educational activity in general practice has increased considerably in the past 20 years. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' capacity to fulfil this role. To explore the potential for vertical integration in undergraduate and postgraduate education in general practice, by describing the experience of (and attitudes towards) 'vertical integration in general practice education' among key stakeholder groups. Qualitative study of GPs, practice staff, GPs-in-training and medical students involving focus groups which were thematically analysed. We identified four overarching themes: (1) Important practical features of vertical integration are interaction between learners at different stages, active involvement in clinical teams and interagency collaboration; (2) Vertical integration may benefit GPs/practices, students and patients through improved practice systems, exposure to team-working and multi-morbidity and opportunistic health promotion, respectively; (3) Capacity issues may challenge its implementation; (4) Strategies such as recognising and addressing diverse learner needs and inter-agency collaboration can promote vertical integration. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' teaching capacity. Recognising the diverse educational needs of learners at different stages and collaboration between agencies responsible for the planning and delivery of specialist training and medical degree programmes would appear to be important.

'Seeking authorization': a grounded theory exploration of mentors' experiences of assessing nursing students on the borderline of achievement of competence in clinical practice.

PubMed

Cassidy, Simon; Coffey, Michael; Murphy, Fiona

2017-09-01

To develop a substantive theoretical explanation of how mentors make sense of their experiences where nursing students are on the borderline of achievement of competence in clinical practice. The reluctance of Registered Nurse mentors to fail nursing students in clinical practice despite concerns about competence remains a contemporary issue in international healthcare education. Mentors' assessment decisions have considerable impact for a variety of key stakeholders, not least for students in these circumstances. Grounded theory qualitative study. Phase one involved 20 individual semi-structured interviews with nurse mentors in one United Kingdom National Health Service Health Board (July-October 2009). Phase two included eight individual semi-structured interviews and seven focus groups with mentors and practice educators (n = 38) in four further Health Boards (June 2011-February 2012). Data were analysed using open, axial and selective coding consistent with grounded theory method. Three categories 'the conundrum of practice competence,' 'the intensity of nurturing hopefulness,' and 'managing assessment impasse,' led to the study's substantive theoretical explanation - 'Seeking authorization: Establishing collective accountability for mentorship.' This demonstrates how mentors are dependent on key sources of support and feedback to validate their assessment decision-making, notwithstanding substantial personal, professional and organizational pressures. We conclude that management of borderline assessment situations is considerably developed by recognition of the authorizing effects of a wider community of assessors. Consequently, we identify the personal, professional and organizational implications involved in the preparation, support and regulation of mentors specifically during borderline assessment circumstances. © 2017 John Wiley & Sons Ltd.

Letter to the editor concerning the article "Performance of gymnastics skill benefits from an external focus of attention" by Abdollahipour, Wulf, Psotta & Nieto (2015).

PubMed

Collins, Dave; Carson, Howie J; Toner, John

2016-01-01

Abdollahipour, Wulf, Psotta, and Nieto (2015) recently published data in the Journal of Sports Sciences to show that an external focus of attention promotes superior performance effects (gymnastics jump height and judged movement form score) when compared to internal or control foci during skill execution without an implement involved. While we do not contest the veracity of findings reported, nor others that have been used to support beneficial effects of an external focus of attention, in this Letter to the Editor we comment on considerable methodological limitations associated with this and previous studies that, we suggest, have resulted in serious theoretical oversights regarding the control of movement and, most crucially from our practitioner perspective, suboptimal recommendations for applied coaching practice. Specifically, we discuss the lack of consideration towards translational research in this area, the problematic nature of attentional focus cues employed, interpretation of findings in relation to other applied recommendations and coherence with mechanistic underpinning and, finally, the representative nature of task involved. In summary, while (laboratory) research evidence may appear to be conclusive, we suggest that the focus of attention effects are in need of more ecologically valid and rigorous testing as well as consideration of current coaching practices if it is to optimally serve the applied sporting domain that it purportedly aims to.

Complexities of Providing Dental Hygiene Services in Community Care Settings.

PubMed

Zarkowski, Pamela; Aksu, Mert N

2016-06-01

Direct access care provided by dental hygienists can reduce oral health disparities for the underserved, yet legal, regulatory, and ethical considerations create complexities and limits. Individual state dental practice acts regulate the scope of practice and level of supervision required when dental hygienists deliver care. Yet, inconsistent state practice act regulations contribute to ethical and legal limitations and dilemmas for practitioners. The dental hygienist is positioned to assume an increasingly larger role in the management of oral health disparities. However, there are several legal and ethical considerations that impact both dental hygienists and dentists providing care in complex community settings. This article informs dental hygienists and other related constituencies about conundrums that are encountered when providing care 'beyond the operatory.' An evidence-based view of ways in which dental hygienists are reducing oral health disparities illustrates the complex issues involved in providing such care. Potential scenarios that can occur during care provision in underserved settings provide the basis for a discussion of legal and other associated issues impacting dental hygiene practice. Copyright © 2016 Elsevier Inc. All rights reserved.

End-of-life practices at a Lebanese hospital: courage or knowledge?

PubMed

Gebara, Jouhayna; Tashjian, Hera

2006-10-01

End-of-life care requires knowledgeable and culturally sensitive clinicians to assist patients and families dealing with the difficult journey of death. The authors present important end-of-life considerations for health care providers dealing with culturally diversified patients. A case study approach is used illustrating two case vignettes derived from the practice of an intensive care setting of a tertiary teaching facility in a large urban area in Lebanon. In a multidisciplinary fashion, practices of end of life were explored and a protocol developed to guide health care providers. Special cultural values were identified such as importance of family involvement and religious beliefs. Implications for practice are described.

Some practical considerations in restoration of wilderness geodiversity: Insights from Lake Pedder, Tasmania

Treesearch

Kevin Kiernan

2007-01-01

Geodiversity values involve aspects of the abiotic environment that are sometimes the dominant element that imparts scenic and wilderness value, are scientifically important in their own right, and almost invariably form the essential habitat for the biodiversity that is often the main target of modern conservation policies. Given this dominance of the physical...

Reforestation by seed sowing in the northern Rocky Mountains

Treesearch

W. G. Wahlenberg

1925-01-01

Planting denuded forest lands with nursery stock is the dependable and established way to get new forest crops started. The fact, however, that it is in many places an operation involving heavy expenditures has led the American forester to try out other methods to a considerable extent. His characteristic discontent with established practice as such, and his constant...

Some observations on precipitation measurement on forested experimental watersheds

Treesearch

Raymond E. Leonard; Kenneth G. Reinhart

1963-01-01

Measurement of precipitation on forested experimental watersheds presents difficulties other than those associated with access to and from the gages in all kinds of weather. For instance, the tree canopy must be cleared above the gage. The accepted practice of keeping an unobstructed sky view of 45" around the gage involves considerable tree cutting. On a level...

Bowel obstruction: Differential diagnosis and clinical management

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

Welch, J.P.

1987-01-01

This book presents a practical guide to the diagnosis and management of obstruction, both mechanical and organic, of the large and small bowel. Obstruction is a common problem for surgeons, and this text emphasizes differential diagnosis and the use of all radiologic modalities. It presents the surgical and medical considerations involved with gallstones, bezoars, parasites, tumors, inflammation, trauma, intussusception, more.

Participatory Educational Design: How to Improve Mutual Learning and the Quality and Usability of the Design?

ERIC Educational Resources Information Center

Janssen, Fred J. J. M.; Könings, Karen D.; van Merriënboer, Jeroen J. G.

2017-01-01

Many educational change proposals, designed to improve student learning, fail to be implemented in classrooms, which is a threat to the impact of educational policy on educational practice. This has led to a call for participatory educational design in which different stakeholders are involved in the generation and consideration of alternative…

Nuevas Tendencias en la Ensenanza de las Ciencias (New Trends in Science Education).

ERIC Educational Resources Information Center

Oficina Regional de Educacion de la Unesco para America Latina y el Caribe, Santiago (Chile).

The concern for improving science education in Latin America is reflected in this document compiled by UNESCO offices in Chile, Uruguay, and Paris with financial support from UNICEF, and directed to Latin American science teachers. The first part deals with planning the reforms needed in science education and the practical considerations involved.…

Novel low-risk commercial sex practices in the parks of Vietnam.

PubMed

Walters, I

2003-06-01

This is a paper about a novel form of commercial sex practice recorded in Vietnam, and its implications for HIV/AIDS prevention strategies. Female commercial sex workers occupy urban parks in the evenings, offering on-site masturbation services to clients at cheap prices even by local standards. All sex acts are performed in public by workers who sit on benches, path edges or stools,often behind bicycles or open umbrellas in the quest for some semblance of privacy. Clients are local men, with only an occasional foreigner involved Many sex workers were involved, some having 15 to 20 or more clients a night. Sex workers and clients in Vietnam, a s elsewhere, operate at high risk of HIV/AIDS infection. As a service which minimizes risks, this form of commercial sex practice should perhaps be given serious consideration by policy makers and authorities for formal deployment in the fight against AIDS.

Continuity of care through medical records--an explorative study on GPs' management considerations.

PubMed

Schers, Henk; van den Hoogen, Henk; Grol, Richard; van den Bosch, Wil

2006-06-01

The growing complexity of care with more professionals involved is a threat to the delivery of coherent and consistent care. Excellent exchange of information between professionals may be a way to maintain continuity of care. Relevant information to be passed over includes thoughts about future management for individual patients. To explore the nature of GPs' thoughts about future management, and to determine the extent to which such thoughts are actually recorded in medical records. Cross-sectional study of 5741 consultations. Thirty GPs from 17 practices in a region in the eastern part of The Netherlands. The GPs responded to an electronic questionnaire, directly after 200 successive consultations. The questionnaire included items on management considerations, consultation characteristics and personal continuity. We compared the data from the questionnaire to the actual recording of management considerations in the patient records. The GPs had management considerations in 66.4% of the consultations, involving mainly considerations about additional testing (15.5%), adjustment of medication (22.5%), alternative treatment plans (18.6%), possible referral (11.8%) and coping behaviour (18.0%). These considerations were seldom recorded in the electronic patient record; additional testing (3.0%) adjustment of medication (2.9%) and alternative treatment plans (4.1%). Surprisingly however, GPs rarely found that management considerations from earlier consultations were lacking in the medical record. GPs often have thoughts on how to deal with this patient, but hardly ever record such considerations. We recommend the development of tools that facilitate the recording of management considerations in electronic patient records.

Neonatal euthanasia: moral considerations and criminal liability

PubMed Central

Sklansky, M.

2001-01-01

Despite tremendous advances in medical care for critically ill newborn infants, caregivers in neonatal intensive care units still struggle with how to approach those patients whose prognoses appear to be the most grim, and whose treatments appear to be the most futile. Although the practice of passive neonatal euthanasia, from a moral perspective, has been widely (albeit quietly) condoned, those clinicians and families involved in such cases may still be found legally guilty of child abuse or even manslaughter. Passive neonatal euthanasia remains both a moral dilemma and a legal ambiguity. Even the definition of passive euthanasia remains unclear. This manuscript reviews the basic moral and legal considerations raised by the current practice of neonatal euthanasia, and examines the formal position statements of the American Medical Association and the American Academy of Pediatrics. The paper concludes by emphasising the need, at least in the United States, to clarify the legal status of this relatively common medical practice. Key Words: Euthanasia • neonatal intensive care • defective newborns PMID:11233379

Recommendations for toxicological investigation of drug-impaired driving and motor vehicle fatalities.

PubMed

Logan, Barry K; Lowrie, Kayla J; Turri, Jennifer L; Yeakel, Jillian K; Limoges, Jennifer F; Miles, Amy K; Scarneo, Colleen E; Kerrigan, Sarah; Farrell, Laurel J

2013-10-01

This report describes the review and update of a set of minimum recommendations for the toxicological investigation of suspected alcohol and drug-impaired driving cases and motor vehicle fatalities involving drugs or alcohol. The recommendations have the goal of ensuring that a consistent set of data regarding the most frequently encountered drugs linked to driving impairment is collected for practical application in the investigation of these cases and to allow epidemiological monitoring and the development of evidence-based public policy on this important public safety issue. The recommendations are based on a survey of practices in US laboratories performing this kind of analysis, consideration of existing epidemiological crash and arrest data and practical considerations of widely available technology platforms in laboratories performing this work. The final recommendations were derived from a consensus meeting of experts recruited from survey respondents and the membership of the National Safety Council's Alcohol, Drug and Impairment Division (formerly known as the Committee on Alcohol and Other Drugs, CAOD).

[Variables involved in the individual and collective practice of healthy habits].

PubMed

García-Ubaque, Juan C; García-Ubaque, César A; Vaca-Bohórquez, Martha L

2014-01-01

To conduct a descriptive review of the concepts related to the practice of healthy habits by identifying the main variables associated with their managment in terms of health promotion actions. In consultation with groups working in health promotion in the city of performed by consulting databases and documentary sources. The strategy and criteria for the selection of documents was previously defined. Finally, we proceeded to organizing and structuring the information. It was established that, to promote healthy habits, four groups of behavior are involved: a) consumption, b) phyisical activity and hygiene, c) safety, and d) social participation. All of these are reviewed in order to point out the main concepts contained in each. The promotion of healthy habits must involve not only the transmission of behaviors associated with them. It must also involve understanding and adapting these habits to the environments of life in which people operate, with consideration for the different roles that they perform and the psychological and cultural demands that each space implies.

Healthcare decisions: a review of children's involvement.

PubMed

Baston, Jenny

2008-04-01

Children's rights, their ability to consent to treatment and their involvement in healthcare decisions have received considerable attention in recent years. There is some evidence to suggest that when children are involved in the decision-making process, they retain a sense of control over their situation. However there are still unresolved issues related to a child's right to decide and nurses may be confused about the extent to which children can and should be involved in decision-making. A code of practice for involving children in decisions was first suggested in 2001 and there is still a need for a consistent, structured and robust method of ensuring that children are included in the decision-making process at all stages of their health care.

Practical photochemistry: General considerations

NASA Astrophysics Data System (ADS)

Hutchison, J.

1986-05-01

Practical aspects of laboratory scale preparative photochemistry are discussed under the headings of: (1) lamps: dimensions, power ratings, spectral distributions and output intensities of different lamp types; (2) the reaction mixture: factors involved in establishing the most suitable wavelength region to use to carry out a particular reaction; the selection of the appropriate solvents, filters, and glassware; concentration of the photoactive component; (3) preparative photoreactions: immersion well, falling film, external irradiation and elliptical configurations; (4) apparatus for quantitative work: carousel and optical bench arrangements; (5) hazards: effects of ultraviolet radiation on eyes and skin and precautions to be taken.

Social Work’s Role in Medicaid Reform: A Qualitative Study

PubMed Central

Wachman, Madeline; Manning, Leticia; Cohen, Alexander M.; Seifert, Robert W.; Jones, David K.; Fitzgerald, Therese; Nuzum, Rachel; Riley, Patricia

2017-01-01

Objectives. To critically analyze social work’s role in Medicaid reform. Methods. We conducted semistructured interviews with 46 stakeholders from 10 US states that use a range of Medicaid reform approaches. We identified participants using snowball and purposive sampling. We gathered data in 2016 and analyzed them using qualitative methods. Results. Multiple themes emerged: (1) social work participates in Medicaid reform through clinical practice, including care coordination and case management; (2) there is a gap between social work’s practice-level and systems-level involvement in Medicaid innovations; (3) factors hindering social work’s involvement in systems-level practice include lack of visibility, insufficient clarity on social work’s role and impact, and too few resources within professional organizations; and (4) social workers need more training in health transformation payment models and policy. Conclusions. Social workers have unique skills that are valuable to building health systems that promote population health and reduce health inequities. Although there is considerable opportunity for social work to increase its role in Medicaid reform, there is little social work involvement at the systems level. PMID:29236537

User involvement in clinical governance

PubMed Central

Pickard, Susan; Marshall, Martin; Rogers, Anne; Sheaff, Rod; Sibbald, Bonnie; Campbell, Stephen; Halliwell, Shirley; Roland, Martin

2002-01-01

Objectives To investigate the involvement of users in clinical governance activities within Primary Care Groups (PCGs) and Trusts (PCTs). Drawing on policy and guidance published since 1997, the paper sets out a framework for how users are involved in this agenda, evaluates practice against this standard and suggests why current practice for user involvement in clinical governance is flawed and why this reflects a flaw in the policy design as much as its implementation. Design Qualitative data comprising semi‐structured interviews, reviews of documentary evidence and relevant literature. Setting Twelve PCGs/PCTs in England purposively selected to provide variation in size, rurality and group or trust status. Participants Key stakeholders including Lay Board members (n=12), Chief Executives (CEs) (n= 12), Clinical Governance Leads (CG leads) (n= 14), Mental Health Leads (MH leads) (n= 9), Board Chairs (n=2) and one Executive Committee Lead. Results Despite an acknowledgement of an organizational commitment to lay involvement, in practice very little has occurred. The role of lay Board members in setting priorities and implementing and monitoring clinical governance remains low. Beyond Board level, involvement of users, patients of GP practices and the general public is patchy and superficial. The PCGs/PCTs continue to rely heavily on Community Health Councils (CHCs) as a conduit or substitute for user involvement; although their abolition is planned, their role to be fulfilled by new organizations called Voices, which will have an expanded remit in addition to replacing CHCs. Conclusions Clarity is required about the role of lay members in the committees and subcommittees of PCGs and PCTs. Involvement of the wider public should spring naturally from the questions under consideration, rather than be regarded as an end in itself. PMID:12199658

Students learning medicine in general practice in Canada and Australia.

PubMed

Strasser, Roger

2016-01-01

Over the past 20 years, there has been increasing focus on general practice and the role of general practitioners (GPs) in undergraduate medical education. This article explores the experiences in Australia and Canada of students learning medicine in the general practice setting, drawing on general practice and medical education literature in both countries and beyond. In Canada and Australia, there is substantial and growing evidence that students learning medicine in general practice has positive value for all involved, including the students, patients, wider community, academic institutions and GPs. The space, time and financial aspects of GP-based medical education require further study. Nevertheless, there is considerable potential to develop and implement a national plan for GP-based medical education with targeted government investment and commitment from academic institutions.

Examining the Beliefs and Practices of Four Effective Australian Primary Science Teachers

NASA Astrophysics Data System (ADS)

Fitzgerald, Angela; Dawson, Vaille; Hackling, Mark

2013-06-01

With trends across many countries still indicating the decline of student interest in school science and diminishing numbers of students studying science beyond the compulsory years, it seems that the field remains in crisis. To address these unfortunate trends, there needs to be a greater emphasis on science education research that highlights the good news stories. For example, what are science teachers actually doing in their classrooms to increase student interest and understanding in science? This article focuses on the science teaching beliefs and practices of four Western Australian primary school teachers. The teachers were nominated by a professional colleague as effective practitioners. The study involved gathering information from classroom observations and teacher interviews to provide background information to assist in developing understandings of these teachers and their science teaching. This article reports on the initial findings drawn from Deanne A, Kate B, Lisa C and Rebecca D. Their practices were organised into the following six categories: classroom environment; conceptual knowledge and procedural skills; teaching strategies and approaches; student-specific considerations; teacher-specific considerations; and context-specific considerations. In examining the components contributing to these categories, it was evident that the teachers' beliefs, as well as the contextual factors inherent in each classroom environment, influenced how and why they teach science in the ways they do.

70,489 primary care encounters: retrospective analysis of morbidity at a primary care centre in Ireland.

PubMed

Molony, D; Beame, C; Behan, W; Crowley, J; Dennehy, T; Quinlan, M; Cullen, W

2016-11-01

While considerable changes are happening in primary care in Ireland and considerable potential exists in intelligence derived from practice-based data to inform these changes, relatively few large-scale general morbidity surveys have been published. To examine the most common reasons why people attend primary care, specifically 'reasons for encounter' (RFEs) among the general practice population and among specific demographic groups (i.e., young children and older adults). We retrospectively examined clinical encounters (which had a diagnostic code) over a 4-year time period. Descriptive analyses were conducted on anonymised data. 70,489 RFEs consultations were recorded (mean 13.53 recorded RFEs per person per annum) and consultations involving multiple RFEs were common. RFE categories for which codes were most commonly recorded were: 'general/unspecified' (31.6 %), 'respiratory' (15.4 %) and 'musculoskeletal' (12.6 %). Most commonly recorded codes were: 'medication renewal' (6.8 %), 'cough' (6.6 %), and 'health maintenance/prevention' (5.8 %). There was considerable variation in the number of RFEs recorded per age group. 6239 RFEs (8.9 %) were recorded by children under 6 years and 15,295 RFEs (21.7 %) were recorded by adults aged over 70. RFEs recorded per calendar month increased consistently through the study period and there was a marked seasonal and temporal variation in the number of RFEs recorded. Practice databases can generate intelligence on morbidity and health service utilisation in the community. Future research to optimise diagnostic coding at a practice level and to promote this activity in a more representative sample of practices is a priority.

The use of anaesthetic agents to provide anxiolysis and sedation in dentistry and oral surgery.

PubMed

O'Halloran, Michael

2013-12-31

Throughout the world there is considerable variation in the techniques used to manage anxious dental patients requiring treatment. Traditionally anxious or phobic dental patients may have been sent for general anaesthesia to allow dental treatment be undertaken. While this is still the case for the more invasive oral surgical procedures, such as wisdom teeth extraction, sedation in general dentistry is becoming more popular. Various sedation techniques using many different anaesthetic agents have gained considerable popularity over the past 30 years. While the practice of sedating patients for dental procedures is invaluable in the management of suitably assessed patients, patient safety must always be the primary concern. Medical, dental and psychosocial considerations must be taken into account when evaluating the patient need and the patient suitability for sedation or general anaesthesia. The regulations that govern the practice of dental sedation vary throughout the world, in particular regarding the techniques used and the training necessary for dental practitioners to sedate patients. It is necessary for medical and dental practitioners to be up to date on current practice to ensure standards of practice, competence and safety throughout our profession. This article, the first in a two-part series, will provide information to practitioners on the practice of sedation in dentistry, the circumstances where it may be appropriate instead of general anaesthesia and the risks involved with sedation. It will also discuss the specific training and qualifications required for dental practitioners to provide sedation. The second article in this series will outline the different techniques used to administer inhalation, oral and intravenous sedation in dentistry and will focus on specific methods that are practiced.

Measuring a Journey without Goal: Meditation, Spirituality, and Physiology

PubMed Central

2015-01-01

The secular practice of meditation is associated with a range of physiological and cognitive effects, including lower blood pressure, lower cortisol, cortical thickening, and activation of areas of the brain associated with attention and emotion regulation. However, in the context of spiritual practice, these benefits are secondary gains, as the primary aim is spiritual transformation. Despite obvious difficulties in trying to measure a journey without goal, spiritual aspects involved in the practice of meditation should also be addressed by experimental study. This review starts by considering meditation in the form of the relaxation response (a counterpart to the stress response), before contrasting mindfulness research that emphasizes the role of attention and alertness in meditation. This contrast demonstrates how reference to traditional spiritual texts (in this case Buddhist) can be used to guide research questions involving meditation. Further considerations are detailed, along with the proposal that research should triangulate spiritual textual sources, first person accounts (i.e., neurophenomenology), and physiological/cognitive measures in order to aid our understanding of meditation, not only in the secular context of health benefits, but also in the context of spiritual practice. PMID:26137495

Security Standards and Best Practice Considerations for Quantum Key Distribution (QKD)

DTIC Science & Technology

2012-03-01

SECURITY STANDARDS AND BEST PRACTICE CONSIDERATIONS FOR QUANTUM KEY DISTRIBUTION (QKD) THESIS...protection in the United States. AFIT/GSE/ENV/12-M05 SECURITY STANDARDS AND BEST PRACTICE CONSIDERATIONS FOR QUANTUM KEY DISTRIBUTION (QKD...FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED. AFIT/GSE/ENV/12-M05 SECURITY STANDARDS AND BEST PRACTICE CONSIDERATIONS FOR QUANTUM KEY

Gender differences in the reasons for participation in spouse sharing among the Okun in Nigeria.

PubMed

Osagbemi, M O; Adepetu, A A

2001-08-01

This report examines the reasons for participation in spouse sharing among the Okun with a view to identifying some factors that may present particular obstacles to women and enhance their vulnerability to the practice. A total of 1029 sexually active respondents in 5 settlements where spouse sharing is being practiced participated in the questionnaire survey aspect of the study, while 82 respondents participated in the focus group discussions. About 65% of respondents reported having ale or alase and were involved in the practice of spouse sharing. Reasons for involvement in spouse sharing include the need for economic support, sexual satisfaction, increased social status, procreation, the problems of separation/divorce and widowhood. The focus group discussions revealed a possible exploitation of the gender-based economic weakness of the women by the men in the initiation and sustenance of the practice in the Okun communities. It is recommended that for any program to achieve a considerable reduction in the practice, differences in the reasons for participation in spouse sharing among the men and women must be documented with a view to solving those problems that compel women to participate.

Managing caries: the need to close the gap between the evidence base and current practice.

PubMed

Schwendicke, F; Doméjean, S; Ricketts, D; Peters, M

2015-11-13

Underpinned by a changing knowledge of the aetiology of caries and its sequelae, and assisted by established and advancing dental materials, there is growing evidence supporting less invasive management of dental caries based on the principles of minimal intervention dentistry. This narrative review assesses both the evidence and the adoption of less invasive caries management strategies and describes ways in which the gap between evidence and practice might be overcome. While there is increasing data supporting less invasive management of carious lesions, these are not standard in most dental practices worldwide. Usually, clinical studies focused on efficacy as outcome, and did not take into consideration the views and priorities of other stakeholders, such as primary care dentists, educators, patients and those financing services. Involving these stakeholders into study design and demonstrating the broader advantages of new management strategies might improve translation of research into practice. In theory, clinical dentists can rely on a growing evidence in cariology regarding less invasive management options. In practice, further factors seem to impede adoption of these strategies. Future research should address these factors by involving major stakeholders and investigating their prioritised outcomes to narrow or close the evidence gap.

[A framework for evaluating ethical issues of public health initiatives: practical aspects and theoretical implications].

PubMed

Petrini, Carlo

2015-01-01

The "Framework for the Ethical Conduct of Public Health Initiatives", developed by Public Health Ontario, is a practical guide for assessing the ethical implications of evidence-generating public health initiatives, whether research or non-research activities, involving people, their biological materials or their personal information. The Framework is useful not only to those responsible for determining the ethical acceptability of an initiative, but also to investigators planning new public health initiatives. It is informed by a theoretical approach that draws on widely shared bioethical principles. Two considerations emerge from both the theoretical framework and its practical application: the line between practice and research is often blurred; public health ethics and biomedical research ethics are based on the same common heritage of values.

Health research involving First Nations, Inuit and Métis children and their communities

PubMed Central

Starkes, Jill M; Baydala, Lola T

2014-01-01

Canadian and international guidelines address the ethical conduct of health research in general and the issues affecting Indigenous populations in particular. This statement summarizes, for clinicians and researchers, relevant ethical and practical considerations for health research involving Aboriginal children and youth. While not intended to duplicate findings arising from lengthy collaborative processes, it does highlight ‘wise practices’ that have successfully generated knowledge relevant to, respectful of and useful for Aboriginal children, youth and their communities. Further research on current health issues and inequities should lead to practical, effective and culturally relevant applications. Expanding our knowledge of ways to address the health disparities facing Canada’s Aboriginal children and youth can inform health policy and the provision of services. Community-based participatory research is proposed as a means to achieve this goal. PMID:24596485

Putting patient participation into practice in pediatrics-results from a qualitative study in pediatric oncology.

PubMed

Ruhe, Katharina Maria; Wangmo, Tenzin; De Clercq, Eva; Badarau, Domnita Oana; Ansari, Marc; Kühne, Thomas; Niggli, Felix; Elger, Bernice Simone

2016-09-01

Adequate participation of children and adolescents in their healthcare is a value underlined by several professional associations. However, little guidance exists as to how this principle can be successfully translated into practice. A total of 52 semi-structured interviews were carried out with 19 parents, 17 children, and 16 pediatric oncologists. Questions pertained to participants' experiences with patient participation in communication and decision-making. Applied thematic analysis was used to identify themes with regard to participation. Three main themes were identified: (a) modes of participation that captured the different ways in which children and adolescents were involved in their healthcare; (b) regulating participation, that is, regulatory mechanisms that allowed children, parents, and oncologists to adapt patient involvement in communication and decision-making; and (c) other factors that influenced patient participation. This last theme included aspects that had an overall impact on how children participated. Patient participation in pediatrics is a complex issue and physicians face considerable challenges in facilitating adequate involvement of children and adolescents in this setting. Nonetheless, they occupy a central role in creating room for choice and guiding parents in involving their child. Adequate training of professionals to successfully translate the principle of patient participation into practice is required. •Adequate participation of pediatric patients in communication and decision-making is recommended by professional guidelines but little guidance exists as to how to translate it into practice. What is New: •The strategies used by physicians, parents, and patients to achieve participation are complex and serve to both enable and restrict children's and adolescents' involvement.

Aesthetic concepts, perceptual learning, and linguistic enculturation: considerations from Wittgenstein, language, and music.

PubMed

Croom, Adam M

2012-03-01

Aesthetic non-cognitivists deny that aesthetic statements express genuinely aesthetic beliefs and instead hold that they work primarily to express something non-cognitive, such as attitudes of approval or disapproval, or desire. Non-cognitivists deny that aesthetic statements express aesthetic beliefs because they deny that there are aesthetic features in the world for aesthetic beliefs to represent. Their assumption, shared by scientists and theorists of mind alike, was that language-users possess cognitive mechanisms with which to objectively grasp abstract rules fixed independently of human responses, and that cognizers are thereby capable of grasping rules for the correct application of aesthetic concepts without relying on evaluation or enculturation. However, in this article I use Wittgenstein's rule-following considerations to argue that psychological theories grounded upon this so-called objective model of rule-following fail to adequately account for concept acquisition and mastery. I argue that this is because linguistic enculturation, and the perceptual learning that's often involved, influences and enables the mastery of aesthetic concepts. I argue that part of what's involved in speaking aesthetically is to belong to a cultural practice of making sense of things aesthetically, and that it's within a socio-linguistic community, and that community's practices, that such aesthetic sense can be made intelligible.

Accountability in action?: the case of a database purchasing decision.

PubMed

Neyland, Daniel; Woolgar, Steve

2002-06-01

The increasing prevalence of audit in university settings has raised concerns about the potentially adverse effects of invasive measures of performance upon the conduct of research and generation of knowledge. What sustains the current commitment to audit? It is argued that in order to address this question we need to understand how and to what extent notions of accountability are played out in practice. This is illustrated through the analysis of materials from an ethnographic study of 'good management practice' in the deployment of technologies in university settings. The paper examines the ways in which ideas of accountability - involving considerations such as 'value for money' - inform the practical processes of deciding about the purchase of a new database technology.

A conceptual framework for transferring research to practice.

PubMed

Simpson, D Dwayne

2002-06-01

Systematic evaluations of efforts to transfer research-based interventions and procedures into general practice at community drug treatment programs have been limited. However, practical experiences as well as results from studies of technology transfer and organizational behavior in related fields provide a basis for proposing a heuristic model of key factors that influence this process. The successful completion of four stages of activity typically involved in program change (exposure, adoption, implementation, and practice of new interventions) appears to be influenced by several organizational considerations (e.g., institutional readiness for change, resources, and climate) as well as staff attributes. Assessment instruments for measuring organizational functioning (based on ratings aggregated for staff and patients in a program) are introduced, along with preliminary evidence for their validity. A better conceptual understanding of the process of program change and common barriers that may be encountered is needed for effectively transferring research to practice.

Web-based assessments of physical activity in youth: considerations for design and scale calibration.

PubMed

Saint-Maurice, Pedro F; Welk, Gregory J

2014-12-01

This paper describes the design and methods involved in calibrating a Web-based self-report instrument to estimate physical activity behavior. The limitations of self-report measures are well known, but calibration methods enable the reported information to be equated to estimates obtained from objective data. This paper summarizes design considerations for effective development and calibration of physical activity self-report measures. Each of the design considerations is put into context and followed by a practical application based on our ongoing calibration research with a promising online self-report tool called the Youth Activity Profile (YAP). We first describe the overall concept of calibration and how this influences the selection of appropriate self-report tools for this population. We point out the advantages and disadvantages of different monitoring devices since the choice of the criterion measure and the strategies used to minimize error in the measure can dramatically improve the quality of the data. We summarize strategies to ensure quality control in data collection and discuss analytical considerations involved in group- vs individual-level inference. For cross-validation procedures, we describe the advantages of equivalence testing procedures that directly test and quantify agreement. Lastly, we introduce the unique challenges encountered when transitioning from paper to a Web-based tool. The Web offers considerable potential for broad adoption but an iterative calibration approach focused on continued refinement is needed to ensure that estimates are generalizable across individuals, regions, seasons and countries.

Workplace Violence: Practical Considerations for Mental Health Professionals in Consultation, Assessment, and Management of Risk.

PubMed

Saragoza, Philip; White, Stephen G

2016-12-01

Workplace predatory violence has been the focus of increased study over the past 30 years, leading to a more sophisticated understanding of the factors that contribute to it, and important considerations for its assessment and management. Risk assessment professionals involved in workplace violence consultations should be mindful of issues specific to the workplace context and the principles of threat assessment to provide a more precise opinion of risk, to inform and enhance critical decisions regarding the employment status of the individual of concern, security measures, possible treatment options, and other management responses, while being mindful of the employee's certain rights. Copyright © 2016 Elsevier Inc. All rights reserved.

Homosexual foot fetishism.

PubMed

Weinberg, M S; Williams, C J; Calhan, C

1994-12-01

262 respondents from an organization for homosexual foot fetishists provide information from a broader sample than clinical cases and allow examination of the effects of sexual preference on fetishism. Data show a wide range of feet/footwear objects to be arousing. Such interests were often associated with particular types of men, yet interests were subject to change over time. Fetishistic arousal rested on both sensual and symbolic aspects of the fetish. Symbolically, it was the theme of "masculinity" that made male feet/footwear arousing, showing parallels to "femininity" evoked by female feet/footwear for male heterosexual fetishists. For many of the respondents, fetishism did not seem to be a substitute for living persons. Respondents had intimate relationships and were able to incorporate their fetish interests into stable relationships and less intimate ones. Considerable involvement in sadomasochistic practices was also found as was involvement in the gay world. Finally, nothing about a fetishistic interest seemed to preclude the development of subcultural forms around the practice.

Ambulatory surgery center joint ventures involving tax-exempt entities.

PubMed

Becker, S; Pristave, R J; McConnell, W

1999-01-01

This article provides an overview of the tax-exempt related issues for ambulatory surgery center joint ventures involving tax-exempt entities. The article analyzes the key points of analysis of the guidance released by the IRS, in particular General Counsel Memorandum 39862, Revenue Ruling 98-15, and Redlands Surgical Services v. Commissioner of the Internal Revenue Service. These key points include whether the venture results in private inurement to insiders and whether the venture furthers the charitable purposes of the tax-exempt entity. The article also provides practical guidance to analyze the documents and structure of the joint venture to ensure compliance with the IRS guidance. These practical considerations include, among other things, whether the charitable purposes of the tax-exempt entity are clearly expressed in the documents and whether the tax-exempt entity has sufficient control over the joint venture to ensure the charitable purposes are being adhered to.

"Generality of mis-fit"? The real-life difficulty of matching scales in an interconnected world.

PubMed

Keskitalo, E Carina H; Horstkotte, Tim; Kivinen, Sonja; Forbes, Bruce; Käyhkö, Jukka

2016-10-01

A clear understanding of processes at multiple scales and levels is of special significance when conceiving strategies for human-environment interactions. However, understanding and application of the scale concept often differ between administrative-political and ecological disciplines. These mirror major differences in potential solutions whether and how scales can, at all, be made congruent. As a result, opportunities of seeking "goodness-of-fit" between different concepts of governance should perhaps be reconsidered in the light of a potential "generality of mis-fit." This article reviews the interdisciplinary considerations inherent in the concept of scale in its ecological, as well as administrative-political, significance and argues that issues of how to manage "mis-fit" should be awarded more emphasis in social-ecological research and management practices. These considerations are exemplified by the case of reindeer husbandry in Fennoscandia. Whilst an indigenous small-scale practice, reindeer husbandry involves multi-level ecological and administrative-political complexities-complexities that we argue may arise in any multi-level system.

Asking good clinical research questions and choosing the right study design.

PubMed

Bragge, P

2010-07-01

Clinicians and researchers seek answers to clinical research questions, primarily by accessing the results of clinical research studies. This paper moves the focus of research enquiry from getting answers to developing good clinical research questions. Using worked examples, the steps involved in refining questions drawn from various sources to create 'answerable' clinical research questions using the 'PICO' principle are described. Issues to consider in prioritising clinical research questions are also identified. Theoretical and practical considerations involved in choosing the right study design for a clinical research question are then discussed using the worked examples. These include: Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Utilization of the Arkansas Prescription Monitoring Program to combat prescription drug abuse

PubMed Central

Rittenhouse, Rebecca; Wei, Feifei; Robertson, Denise; Ryan, Kevin

2015-01-01

Objective The Arkansas Prescription Monitoring Program (AR PMP) was implemented in 2013 to combat prescription drug abuse. All enrollees were invited to participate in a user survey available in February 2014, to identify makeup of users, utilization of the program, and changes made to health care practices after implementation of the program. Methods Of the 3694 individual enrollees invited to participate, 1541 (41.7%) completed the survey. Data collected were analyzed to identify changes in health care practices by program frequency of use and user profession. Results Medical doctors, advanced practice nurses, and pharmacists are the professions who use the program most frequently. Daily AR PMP users are considerably more likely than infrequent users to be prompted to access the program by the involvement of a controlled substance (CS) prescription or by office/facility policy requirements. Increased frequency of use of the AR PMP results in positive impacts on CS prescribing and dispensing practices. Conclusion Compelling more users of the AR PMP to be prompted to access the program by the involvement of a CS prescription or by requirements per office/facility policy may increase frequency of use of the program and thereby changes in health care practices to combat prescription drug abuse. PMID:26191489

EANM 2012 guidelines for radionuclide imaging of phaeochromocytoma and paraganglioma

PubMed Central

Timmers, Henri J.; Hindié, Elif; Guillet, Benjamin A.; Neumann, Hartmut P.; Walz, Martin K.; Opocher, Giuseppe; de Herder, Wouter W.; Boedeker, Carsten C.; de Krijger, Ronald R.; Chiti, Arturo; Al-Nahhas, Adil; Pacak, Karel

2016-01-01

Purpose Radionuclide imaging of phaeochromocytomas (PCCs) and paragangliomas (PGLs) involves various functional imaging techniques and approaches for accurate diagnosis, staging and tumour characterization. The purpose of the present guidelines is to assist nuclear medicine practitioners in performing, interpreting and reporting the results of the currently available SPECT and PET imaging approaches. These guidelines are intended to present information specifically adapted to European practice. Methods Guidelines from related fields, issued by the European Association of Nuclear Medicine and the Society of Nuclear Medicine, were taken into consideration and are partially integrated within this text. The same was applied to the relevant literature, and the final result was discussed with leading experts involved in the management of patients with PCC/PGL. The information provided should be viewed in the context of local conditions, laws and regulations. Conclusion Although several radionuclide imaging modalities are considered herein, considerable focus is given to PET imaging which offers high sensitivity targeted molecular imaging approaches. PMID:22926712

Mixing methodology, nursing theory and research design for a practice model of district nursing advocacy.

PubMed

Reed, Frances M; Fitzgerald, Les; Rae, Melanie

2016-01-01

To highlight philosophical and theoretical considerations for planning a mixed methods research design that can inform a practice model to guide rural district nursing end of life care. Conceptual models of nursing in the community are general and lack guidance for rural district nursing care. A combination of pragmatism and nurse agency theory can provide a framework for ethical considerations in mixed methods research in the private world of rural district end of life care. Reflection on experience gathered in a two-stage qualitative research phase, involving rural district nurses who use advocacy successfully, can inform a quantitative phase for testing and complementing the data. Ongoing data analysis and integration result in generalisable inferences to achieve the research objective. Mixed methods research that creatively combines philosophical and theoretical elements to guide design in the particular ethical situation of community end of life care can be used to explore an emerging field of interest and test the findings for evidence to guide quality nursing practice. Combining philosophy and nursing theory to guide mixed methods research design increases the opportunity for sound research outcomes that can inform a nursing model of care.

Safety considerations for outpatient electroconvulsive therapy.

PubMed

Reti, Irving M; Walker, Melinda; Pulia, Kathy; Gallegos, Jesus; Jayaram, Geetha; Vaidya, Punit

2012-03-01

As electroconvulsive therapy (ECT) requires general anesthesia and is associated with both cognitive and non-cognitive side effects, careful consideration must be given to the safety aspects of providing ECT on an outpatient basis. Drawing upon published literature and their clinical experience administering outpatient ECT, the authors propose best practices for safely providing ECT to outpatients. They review criteria for selecting patients for outpatient ECT as well as treatment and programmatic issues. The authors highlight the importance of educating referring clinicians as well as patients and their families about factors involved in the safe delivery of ECT for outpatients. Fiscal considerations and the drive toward reduced length of stay are prompting insurers and caregivers to choose outpatient over inpatient ECT. For each patient, such a choice merits a careful analysis of the risks of outpatient ECT, as well as the implementation of measures to ensure patient safety.

Private rural health providers in Haryana, India: profile and practices.

PubMed

Jarhyan, P; Singh, B; Rai, S K; Nongkynrih, B

2012-01-01

Despite a widespread public health system, the private healthcare sector is the major provider of health care in rural India. This study describes the profile and medical practices of private rural health providers (PRHPs) in rural Haryana, India. A cross-sectional study was conducted among PRHPs practicing in the villages of Comprehensive Rural Health Services Project (CRHSP) at Ballabgarh block located in the Faridabad district of Haryana State. The CRHSP is an Intensive Field Practice Area (IFPA) of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. Eighty PRHPs participated in this study (response rate 93%). The majority (96%) did not possess a qualification in any formal system of medicine. Half of the PRHPs had a separate space (private area) for the examination of patients. Almost all had stethoscopes, thermometers and blood pressure apparatus. The PRHPs were involved in a wide range of practices, such as dispensing medicines (98.7%), providing injections (98.7%) and intravenous fluids (98.7%), and conducting minor surgery (78.5%). Dumping biomedical waste was a common practice among these practitioners. Some PRHPs (8.7%) were involved in national health programs. Unqualified PRHPs provide substantial outpatient healthcare services in rural Ballabgarh, India. Their biomedical waste disposal practices are inadequate. There is a need for training in waste disposal practices and monitoring of safe injection techniques among PRHPs. Consideration should be given to utilising PRHPs in important public health programs such as disease surveillance.

Thinking in clinical nursing practice: a study of critical care nurses' thinking applying the think-aloud, protocol analysis method.

PubMed

Han, Kyung-Ja; Kim, Hesook Suzie; Kim, Mae-Ja; Hong, Kyung-Ja; Park, Sungae; Yun, Soon-Nyoung; Song, Misoon; Jung, Yoenyi; Kim, Haewon; Kim, Dong-Oak Debbie; Choi, Heejung; Kim, Kyungae

2007-06-01

The purpose of the paper is to discover the patterns and processes of decision-making in clinical nursing practice. A set of think-aloud data from five critical care nurses during 40 to 50 minutes of caregiving in intensive care units were obtained and analyzed by applying the procedures recommended by Ericsson and Simon for protocol analysis. Four thinking processes before acting were identified to constitute various sorts of thoughts in which the nurses were engaged during patient care: reviewing, validation, consideration, rationalization, and action. In addition, three patterns of sequential streaming of thinking (short, intermediate, long) were identified to reveal various ways the nurses dealt with clinical situations involving nursing tasks and responsibilities. This study specifies the initial categories of thoughts for each of the processes and various patterns with which these processes are sequentially combined, providing insights into the ways nurses think about problems and address their concerns. The findings suggest that the thinking in clinical practice involves more than focused decision-making and reasoning, and needs to be examined from a broader perspective.

Consideration of climate change impacts and adaptation in EIA practice — Perspectives of actors in Austria and Germany

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

Jiricka, Alexandra, E-mail: alexandra.jiricka@boku.ac.at; Department of Landscape, Spatial and Infrastructure Sciences, Institute for Landscape Development, Recreation and Conservation Planning, Peter-Jordan-Straße 82, 1190 Vienna; Formayer, Herbert

Current political discussions and developments indicate the importance and urgency of incorporating climate change considerations into EIA processes. The recent revision of the EU Directive 2014/52/EU on Environmental Impact Assessment (EIA) requires changes in the EIA practice of the EU member states. This paper investigates the extent to which the Environmental Impact Assessment (EIA) can contribute to an early consideration of climate change consequences in planning processes. In particular the roles of different actors in order to incorporate climate change impacts and adaptation into project planning subject to EIA at the appropriate levels are a core topic. Semi-structured expert interviewsmore » were carried out with representatives of the main infrastructure companies and institutions responsible in these sectors in Austria, which have to carry out EIA regularly. In a second step expert interviews were conducted with EIA assessors and EIA authorities in Austria and Germany, in order to examine the extent to which climate-based changes are already considered in EIA processes. This paper aims to discuss the different perspectives in the current EIA practice with regard to integrating climate change impacts as well as barriers and solutions identified by the groups of actors involved, namely project developers, environmental competent authorities and consultants (EIA assessors/practitioners). The interviews show that different groups of actors consider the topic to different degrees. Downscaling of climate change scenarios is in this context both, a critical issue with regards to availability of data and costs. Furthermore, assistance for the interpretation of relevant impacts, to be deducted from climate change scenarios, on the specific environmental issues in the area is needed. The main barriers identified by the EIA experts therefore include a lack of data as well as general uncertainty as to how far climate change should be considered in the process without reliable data but in the presence of knowledge about possible consequences at an abstract level. A joint strategy on how to cope with uncertain prognoses about main impacts on environmental issues for areas without reliable data requires a discussion and cooperation between EIA consultants and environmental authorities. - Highlights: • The consideration of climate change impacts in EIA practice in Austria and Germany was analysed through expert interviews. • Barriers as well as possible solutions were indentified by the different groups of actors involved in EIA. • The main challenges regard the investigation of specific entry points. • Limits of feasibility need to be discussed amongst the different groups of actors.« less

Health sector involvement in the management of female genital mutilation/cutting in 30 countries.

PubMed

Johansen, R Elise B; Ziyada, Mai Mahgoub; Shell-Duncan, Bettina; Kaplan, Adriana Marcusàn; Leye, Els

2018-04-04

For the last decades, the international community has emphasised the importance of a multisectoral approach to tackle female genital mutilation (FGM/C). While considerable improvement concerning legislations and community involvement is reported, little is known about the involvement of the health sector. A mixed methods approach was employed to map the involvement of the health sector in the management of FGM/C both in countries where FGM/C is a traditional practice (countries of origin), and countries where FGM/C is practiced mainly by migrant populations (countries of migration). Data was collected in 2016 using a pilot-tested questionnaire from 30 countries (11 countries of origin and 19 countries of migration). In 2017, interviews were conducted to check for data accuracy and to request relevant explanations. Qualitative data was used to elucidate the quantitative data. A total of 24 countries had a policy on FGM/C, of which 19 had assigned coordination bodies and 20 had partially or fully implemented the plans. Nevertheless, allocation of funding and incorporation of monitoring and evaluation systems was lacking in 11 and 13 of these countries respectively. The level of the health sectors' involvement varied considerably across and within countries. Systematic training of healthcare providers (HCP) was more prevalent in countries of origin, whereas involvement of HCP in the prevention of FGM/C was more prevalent in countries of migration. Most countries reported to forbid HCP from conducting FGM/C on both minors and adults, but not consistently forbidding re-infibulation. Availability of healthcare services for girls and women with FGM/C related complications also varied between countries dependent on the type of services. Deinfibulation was available in almost all countries, while clitoral reconstruction and psychological and sexual counselling were available predominantly in countries of migration and then in less than half the countries. Finally, systematic recording of FGM/C in medical records was completely lacking in countries of origin and very limited in countries of migration. Substantial progress has been made in the involvement of the health sector in both the treatment and prevention of FGM/C. Still, there are several areas in need for improvement, particularly monitoring and evaluation.

Organizing a Collaborative Development of Technological Design Requirements Using a Constructive Dialogue on Value Profiles: A Case in Automated Vehicle Development.

PubMed

Flipse, Steven M; Puylaert, Steven

2018-02-01

Following societal and policy pressures for responsible innovation, innovators are more and more expected to consider the broader socio-ethical context of their work, and more importantly, to integrate such considerations into their daily practices. This may require the involvement of 'outsiders' in innovation trajectories, including e.g. societal and governmental actors. However, methods on how to functionally organize such integration in light of responsible innovation have only recently started to emerge. We present an approach to do just that, in which we first develop value profiles of the involved actors, and second, design a workshop setting that allows innovators to develop design requirements in collaboration with representatives of parties that are not usually involved in such innovation design practices. Using a case study in automated vehicle development, we positively demonstrate the possibility and utility of our approach. We stress that in this study we wish to demonstrate the functionality of our developed method, and did not search for scientifically valid outcomes regarding this technical field.

Strategic planning: today's hot buttons.

PubMed

Bohlmann, R C

1998-01-01

The first generation of mergers and managed care hasn't slowed down group practices' need for strategic planning. Even groups that already went through one merger are asking about new mergers or ownership possibilities, the future of managed care, performance standards and physician unhappiness. Strategic planning, including consideration of bench-marking, production of ancillary services and physician involvement, can help. Even if only a short, general look at the future, strategic planning shows the proactive leadership needed in today's environment.

Implant retention systems for implant-retained overdentures.

PubMed

Laverty, D P; Green, D; Marrison, D; Addy, L; Thomas, M B M

2017-03-10

Implant retained overdentures are being increasingly utilised in both general and specialist practice to rehabilitate patients with missing teeth, particularly those that are edentate. This article aims to inform the reader of a variety of retention systems that are available to retain an implant overdenture and to understand how these systems work, their advantages and disadvantages and to outline some of the clinical and treatment planning considerations involved in selecting the most appropriate retention system for patients.

Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

PubMed

Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

2007-08-01

Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

The early career researcher's toolkit: translating tissue engineering, regenerative medicine and cell therapy products.

PubMed

Rafiq, Qasim A; Ortega, Ilida; Jenkins, Stuart I; Wilson, Samantha L; Patel, Asha K; Barnes, Amanda L; Adams, Christopher F; Delcassian, Derfogail; Smith, David

2015-11-01

Although the importance of translation for the development of tissue engineering, regenerative medicine and cell-based therapies is widely recognized, the process of translation is less well understood. This is particularly the case among some early career researchers who may not appreciate the intricacies of translational research or make decisions early in development which later hinders effective translation. Based on our own research and experiences as early career researchers involved in tissue engineering and regenerative medicine translation, we discuss common pitfalls associated with translational research, providing practical solutions and important considerations which will aid process and product development. Suggestions range from effective project management, consideration of key manufacturing, clinical and regulatory matters and means of exploiting research for successful commercialization.

Good practices and health policy analysis in European sports stadia: results from the 'Healthy Stadia' project.

PubMed

Drygas, Wojciech; Ruszkowska, Joanna; Philpott, Matthew; Björkström, Olav; Parker, Mike; Ireland, Robin; Roncarolo, Federico; Tenconi, Maria

2013-06-01

Sport plays an important role within society and sports stadia provide significant settings for public health strategies. In addition to being places of mass gathering, stadia are often located in less affluent areas and are traditionally attended by 'harder to reach' communities. Unfortunately sports stadia and the clubs they host are rarely perceived as places that promote healthy lifestyles. Fast food, alcohol and tobacco are commonly advertized, served and consumed during sports games giving the spectators and TV fans contradictory messages concerning healthy choices. As part of a wider programme of work part-funded by the European Union, a study was therefore designed to explore current 'good practice' relating to positive health interventions in sports stadia across a number of European countries. Using a specially designed questionnaire, information about health policies and good practices relating to food offerings in stadia, physical activity promotion among local communities, tobacco policy, positive mental health initiatives, environmental sustainability practices and social responsibility policies were collected in 10 European countries (England and Northern Ireland, Finland, Georgia, Greece, Ireland, Italy, Latvia, Poland, Spain and Sweden) involving 88 stadia. The audit results show that stadia health policies differ considerably between specific countries and sports. Based on the literature analysed, the examples of good practices collected through the study, and the subsequent instigation of a European Healthy Stadia Network, it shows that there is considerable potential for stadia to become health promoting settings.

The doctor's dilemma.

PubMed

Irvine, D H; Donaldson, L J

1995-10-01

The close relationship between expenditure on health care and the countless individual judgements made by doctors for their patients means that any discussion about rationing must involve the process of clinical decision-making. Increasingly, doctors are being drawn into rationing by two powerful forces. Firstly, through the corporate responsibilities of those working within a managed health care system in which organisational objectives and budgetary constraints are agreed and specified in a much more explicit way than ever before. Secondly, by the professionally-led movement towards more clinically effective practice. These, in combination, are leading towards a fundamental review of the nature and ethical basis of clinical practice in which the duty of doctors to individual patients must be balanced against the wider considerations.

Career changers: dentists who choose to leave private practice.

PubMed

Rice, C D; Hayden, W J; Glaros, A G; Thein, D J

1997-01-01

Some dentists have voluntarily chosen to leave the dental profession despite the considerable time, effort, and financial expenditures involved in their educations. The purpose of this study was to survey the entire population of dentists who had identified themselves as being principally employed in a career outside of clinical practice in the American Dental Association's 1991 Census. A four-page survey was mailed to 654 former dentists, with a total of 237 usable responses (36%). Analysis of major demographic variables showed no significant difference between the survey respondents and the 1992 ADA Survey of Dentists. Major reasons cited by respondents for entering dentistry included professional, financial, and independence factors. Respondents as a group rated their dental school experience as average in degree of difficulty. Clinical dental experience was varied, with a substantially smaller percentage (37%) choosing solo clinical positions than the 1992 ADA Survey of Dentists reported (69%). Reasons for leaving practice included financial, stress, and external regulation concerns. Current careers varied widely, with business, teaching, medicine, and investing being the most common. Respondents ranked their current careers as considerably more favorable on measures of perceived creativity, freedom, belonging, and whether they would choose the same career again. These findings indicate that there was a difference between the perception of a dental career and the reality of clinical practice for the study sample.

A survey of UK practice patterns in the delivery of intravitreal injections.

PubMed

Samia-Aly, Emma; Cassels-Brown, Andrew; Morris, Daniel S; Stancliffe, Rachel; Somner, John E A

2015-07-01

To assess UK practice patterns related to the prescription of antibiotics before, during and after intravitreal injections, the location where injections are carried out and the qualifications of those administering the injections. Every ophthalmology unit featured in the Royal College of Ophthalmologists (UK) training directory was contacted. A healthcare professional involved in giving intravitreal injections at each institution completed a questionnaire regarding local practice patterns. A response rate of 85% (115/136) was achieved. Seventy four percent of hospitals (85/115) gave take home antibiotics post intravitreal injection. Twenty three percent (26/115) of hospitals employed non-medical healthcare professionals to administer injections and 83% (96/115) administered intravitreal injections in a dedicated clean room as opposed to an operating theatre. Practice patterns for intravitreal injection vary considerably. Guidelines alone do not appear to be effective in reducing practices which are considered wasteful and other approaches need to be developed. © 2015 The Authors Ophthalmic & Physiological Optics © 2015 The College of Optometrists.

SUMMARY REPORT OF A PEER INVOLVEMENT ...

EPA Pesticide Factsheets

EPA has released the final workshop report, Summary Report of a Peer Involvement Workshop on the Development of an Exposure Factors Handbook for the Aging. This report provides an overview of a meeting held February 14-15, 2007 which was organized to discuss factors affecting exposures of older adults to environmental chemicals, as well as issues related to the development of an exposure factors handbook for the aging. To address these issues and discuss practical considerations of the utility of an Exposure Factors Handbook for the Aging in conducting exposure assessments, a panel of experts in the fields of exposure assessment, risk assessment, physiology, and behavioral science were convened at a national workshop in February of 2007.

Reflective practice in speech-language pathology: a scoping review.

PubMed

Caty, Marie-Ève; Kinsella, Elizabeth Anne; Doyle, Philip C

2015-01-01

Within the profession of speech-language pathology, there is limited information related to both conceptual and empirical perspectives of reflective practice. This review considers the key concepts and approaches to reflection and reflective practice that have been published in the speech-language pathology literature in order to identify potential research gaps. A scoping review was conducted using Arksey and O'Malley's (2005) framework. A total of 42 relevant publications were selected for review. The resulting literature mapping revealed that scholarship on reflection and reflective practice in speech-language pathology is limited. Our conceptual mapping pointed to the use of both multiple and generic terms and a lack of conceptual clarity about reflection and reflective practice in speech-language pathology. Two predominant approaches to reflection and reflective practice were identified: written reflection and reflective discussion. Both educational and clinical practice contexts were associated with reflection and reflective practice. Publications reviewed were primarily concerned with reflection and reflective practice by novices and expert practitioners. Based on this review, we posit that there is considerable need for conceptual and empirical work with a goal to support university- and work-based educational initiatives involving reflection and reflective practice in speech-language pathology.

Effective public involvement in the HoST-D Programme for dementia home care support: From proposal and design to methods of data collection (innovative practice).

PubMed

Giebel, Clarissa; Roe, Brenda; Hodgson, Anthony; Britt, David; Clarkson, Paul

2017-01-01

Public involvement is an important element in health and social care research. However, it is little evaluated in research. This paper discusses the utility and impact of public involvement of carers and people with dementia in a five-year programme on effective home support in dementia, from proposal and design to methods of data collection, and provides a useful guide for future research on how to effectively involve the public. The Home SupporT in Dementia (HoST-D) Programme comprises two elements of public involvement, a small reference group and a virtual lay advisory group. Involving carers and people with dementia is based on the six key values of involvement - respect, support, transparency, responsiveness, fairness of opportunity, and accountability. Carers and people with dementia gave opinions on study information, methods of data collection, an economic model, case vignettes, and a memory aid booklet, which were all taken into account. Public involvement has provided benefits to the programme whilst being considerate of the time constraints and geographical locations of members.

Peer volunteer perspectives following a complex social cognitive intervention: a qualitative investigation.

PubMed

McHugh, J E; Lee, O; Aspell, N; Connolly, L; Lawlor, B A; Brennan, S

2016-09-01

Peer volunteers can be key to delivering effective social cognitive interventions due to increased potential for social modeling. We consulted peer volunteers who had just taken part in an 8-week social and nutritional mealtime intervention with older adults living alone, to seek their evaluation of the intervention. Semi-structured focus groups were used with a total of 21 volunteers (17 female) and two facilitators. Thematic analysis was used to interrogate the data. Six themes (16 sub-themes) are discussed. Peer volunteers described the importance of the socializing aspect of the intervention, of pairing considerations and compatibility in peer interventions, of considering the needs of the participant, of benefits to the volunteers, and of the practical considerations of conducting an intervention. Volunteers also discussed considerations for future research and services for older adults living alone. Volunteers found their involvement in the intervention to be personally beneficial, and revealed some valuable considerations for the researchers to take forward to future research. Results are pertinent to intervention design and could inform future social cognitive and other peer-oriented interventions for older adults living alone.

Psychological Issues Relevant to Astronaut Selection for Long-Duration Space Flight: A Review of the Literature

DTIC Science & Technology

1985-04-01

orbital bases in the future involving 10 to 20 people (Schlitz, 1983). Subject availability and other practical considerations have discouraged...InA By NDaniel L. Collins, Capt, USAF MANPOWER AND PERSONNEL DIVISION Brooks Air Force Base , Texas 78235-5601 R DTICAELECTE11 E MrDAY 2 2 05 S April...SYSTEMS COMMAND BROOKS AIR FORCE BASE , TEXAS 78235-5000 8 s 04 29 1o4 NOTICE When Government drawings, specifications, or other data are used for any

Evaluation of Consideration and Incorporation of Green and Sustainable Remediation (GSR) Practices in Army Environmental Remediation. Volume 2. Pilot Project GSR Evaluation Reports

DTIC Science & Technology

2012-08-27

Project Team. This option involves the use of on-site wind turbines to provide all of the approximately 73,800 MWh of the electricity estimated to...and improves the GSR parameter for percentage of energy from renewable resources. Footprint for constructing the wind turbines is not considered...the potential for wind turbines at the site, and an FS is currently being conducted. The National Guard may also be interested in sustainable

Device for data-acquisition from transient signals: kinetic considerations

PubMed Central

Sampedro, A. Sanchez; Vives, S. Sagrado

1990-01-01

This paper reports on the evaluation and testing of a home-made device. Data-acquisition, treatment of transient signals and the hardware and software involved are discussed. Some practical aspects are developed in order to power the autonomy of procedures using the device. Kinetic and multi-signal calculations are considered in order to cover the actual tendencies in continuous-flow analysis. Somepractical advantages versus the use of classical chart recorders or commercial computerized-instrument devices are pointed out. PMID:18925275

An exploration of the roles of nurse managers in evidence-based practice implementation.

PubMed

Wilkinson, Joyce E; Nutley, Sandra M; Davies, Huw T O

2011-12-01

Internationally, nurses face ongoing difficulties in making a reality of evidence-based practice. Existing studies suggest that nurse managers (NMs) should play a key role in leading and facilitating evidence-based practice, but the nature of this role has not yet been fully explored or articulated. This is one of the first studies to investigate the roles of NMs in evidence-based practice implementation. METHODOLOGY AND METHODS: Using a case study approach the study explores five propositions in relation to the NMs' potential evidence-based practice role and the extent to which their attitudes, knowledge, and skills support such a role. In doing so, it draws on interviews (n= 51), documentary analysis and observational data. Data analysis reveals that the role of NMs in facilitating evidence-based practice is under-articulated, largely passive and currently limited by competing demands. Progress in implementing evidence-based practice in the case study sites is largely explained by factors other than the role played by NMs. As such, the findings expose significant discrepancies between NMs' actual roles and those espoused in the literature as being necessary. Contextual factors are important and it is clear that the role of the contemporary NM places considerable emphasis on management and administration to the detriment of clinical practice concerns. The study reveals that NMs are only involved in evidence-based practice implementation in a passive role, not the full engagement described in the literature as being necessary. This study adds previously lacking detail of the roles of NMs. It elucidates why exhortations to NMs to become more involved in evidence-based practice implementation are ineffective without action to address the problems identified. Copyright ©2011 Sigma Theta Tau International.

A person-centered approach to study intimacy and sexuality in residential care facility (RCF) clients with dementia: Methodological considerations and a guide to study design.

PubMed

Roelofs, Tineke S M; Luijkx, Katrien G; Embregts, Petri J C M

2017-01-01

The person-centered perspective of residential care facility (RCF) residents with dementia with regard to their intimate and sexual lives is largely neglected in research. We aim to provide methodological considerations and reflections on a performed qualitative study. Recommendations and a guide to study design are provided to inform and encourage future research on the inclusion of people with dementia as participants. Methodological recommendations and reflections are described in chronological order of the procedure. Fragments of interviews are included for further illustration and clarification. Considering preparation, close involvement of clinical practice, and extensive deliberation regarding study design tended to be important. Considering procedure, investment in contacts with clinical practice and authorized representatives; an introduction meeting; person-centered inclusion and consent; profound skills in interviewing participants with dementia; and flexibility in data collection were proven of importance. Considering data analysis and study quality, including field notes and aiming at a balance between study quality and practicability to enhance study 'rigor' were found important. Including the person-centered perspective in research on intimacy and sexuality of RCF residents with dementia, is challenging and takes a flexible and creative approach. It is, however, worthwhile to close the gap in literature.

An additional study and implementation of tone calibrated technique of modulation

NASA Technical Reports Server (NTRS)

Rafferty, W.; Bechtel, L. K.; Lay, N. E.

1985-01-01

The Tone Calibrated Technique (TCT) was shown to be theoretically free from an error floor, and is only limited, in practice, by implementation constraints. The concept of the TCT transmission scheme along with a baseband implementation of a suitable demodulator is introduced. Two techniques for the generation of the TCT signal are considered: a Manchester source encoding scheme (MTCT) and a subcarrier based technique (STCT). The results are summarized for the TCT link computer simulation. The hardware implementation of the MTCT system is addressed and the digital signal processing design considerations involved in satisfying the modulator/demodulator requirements are outlined. The program findings are discussed and future direction are suggested based on conclusions made regarding the suitability of the TCT system for the transmission channel presently under consideration.

A preprocessing strategy for helioseismic inversions

NASA Astrophysics Data System (ADS)

Christensen-Dalsgaard, J.; Thompson, M. J.

1993-05-01

Helioseismic inversion in general involves considerable computational expense, due to the large number of modes that is typically considered. This is true in particular of the widely used optimally localized averages (OLA) inversion methods, which require the inversion of one or more matrices whose order is the number of modes in the set. However, the number of practically independent pieces of information that a large helioseismic mode set contains is very much less than the number of modes, suggesting that the set might first be reduced before the expensive inversion is performed. We demonstrate with a model problem that by first performing a singular value decomposition the original problem may be transformed into a much smaller one, reducing considerably the cost of the OLA inversion and with no significant loss of information.

Health lifestyle theory and the convergence of agency and structure.

PubMed

Cockerham, William C

2005-03-01

This article utilizes the agency-structure debate as a framework for constructing a health lifestyle theory. No such theory currently exists, yet the need for one is underscored by the fact that many daily lifestyle practices involve considerations of health outcomes. An individualist paradigm has influenced concepts of health lifestyles in several disciplines, but this approach neglects the structural dimensions of such lifestyles and has limited applicability to the empirical world. The direction of this article is to present a theory of health lifestyles that includes considerations of both agency and structure, with an emphasis upon restoring structure to its appropriate position. The article begins by defining agency and structure, followed by presentation of a health lifestyle model and the theoretical and empirical studies that support it.

The non-medical use of antibiotics and the risk of causing microbial drug-resistance*

PubMed Central

Manten, A.

1963-01-01

One of the hazards involved in the use of antibiotics in animal feeds is that it may lead to the development of bacterial drug-resistance. An analysis of the phenomenon shows that this possibility largely depends on the size of the bacterial populations involved and on the possibility of selective multiplication of the resistant mutants that may be present. Additional factors involved in the development of resistance are the type of drug applied and the time during which the bacteria are in contact with it. Animal experiments and general practical experience show that resistance, especially in E. coli, Salm. typhimurium and Staph. aureus, may considerably increase as higher doses are added to the feed. Therefore, the lowest effective level for growth promotion (5-20 p.p.m. of penicillin or tetracycline) is to be preferred over higher levels. As to the practice of food preservation by means of antibiotics, a dangerous situation may arise if two factors combine: emergence of bacterial resistance in Salmonella and perhaps other pathogenic bacteria in the animal as a result of the addition of a certain antibiotic to feeds, and subsequent use of the same substance for preservation of the meat. PMID:14058230

Rethinking Value in the Bio-economy

PubMed Central

2016-01-01

Current debates in science and technology studies emphasize that the bio-economy—or, the articulation of capitalism and biotechnology—is built on notions of commodity production, commodification, and materiality, emphasizing that it is possible to derive value from body parts, molecular and cellular tissues, biological processes, and so on. What is missing from these perspectives, however, is consideration of the political-economic actors, knowledges, and practices involved in the creation and management of value. As part of a rethinking of value in the bio-economy, this article analyzes three key political-economic processes: financialization, capitalization, and assetization. In doing so, it argues that value is managed as part of a series of valuation practices, it is not inherent in biological materialities. PMID:28458406

Treatment of Chronic Inflammatory Demyelinating Polyneuropathy: From Molecular Bases to Practical Considerations

PubMed Central

Ripellino, Paolo; Fleetwood, Thomas; Cantello, Roberto; Comi, Cristoforo

2014-01-01

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease of the peripheral nervous system, in which both cellular and humoral immune responses are involved. The disease is clinically heterogeneous with some patients displaying pure motor form and others also showing a variable degree of sensory dysfunction; disease evolution may also differ from patient to patient, since monophasic, progressive, and relapsing forms are reported. Underlying such clinical variability there is probably a broad spectrum of molecular dysfunctions that are and will be the target of therapeutic strategies. In this review we first explore the biological bases of current treatments and subsequently we focus on the practical management that must also take into account pharmacoeconomic issues. PMID:24527207

Ethics and Childhood Vaccination Policy in the United States

PubMed Central

Sturm, Lynne A.; Zimet, Gregory D.; Meslin, Eric M.

2016-01-01

Childhood immunization involves a balance between parents’ autonomy in deciding whether to immunize their children and the benefits to public health from mandating vaccines. Ethical concerns about pediatric vaccination span several public health domains, including those of policymakers, clinicians, and other professionals. In light of ongoing developments and debates, we discuss several key ethical issues concerning childhood immunization in the United States and describe how they affect policy development and clinical practice. We focus on ethical considerations pertaining to herd immunity as a community good, vaccine communication, dismissal of vaccine-refusing families from practice, and vaccine mandates. Clinicians and policymakers need to consider the nature and timing of vaccine-related discussions and invoke deliberative approaches to policymaking. PMID:26691123

An ethical framework for nursing service administration.

PubMed

Christensen, P J

1988-04-01

Nurses as administrators are responsible for creating an ethical work environment in which nurses' human welfare is promoted. Bureaucratic organizations can dehumanize people, wherein human welfare suffers in the midst of institutional constraints. Amid these conditions nurses' ethical competence cannot develop nor can nurses maintain a sense of personal integrity. Applying concepts from nursing and general ethics to administrative practice provides a basis for developing an ethical framework for management. The proposed framework involves ethical awareness, principled reasoning, moral commitment to the profession and to one another, and primary consideration for human welfare with strategies to promote it. Use of these components when making decisions in daily practice and on a policy level enhances the well-being of nurses working in organizations.

Rethinking Value in the Bio-economy: Finance, Assetization, and the Management of Value.

PubMed

Birch, Kean

2017-05-01

Current debates in science and technology studies emphasize that the bio-economy-or, the articulation of capitalism and biotechnology-is built on notions of commodity production, commodification, and materiality, emphasizing that it is possible to derive value from body parts, molecular and cellular tissues, biological processes, and so on. What is missing from these perspectives, however, is consideration of the political-economic actors, knowledges, and practices involved in the creation and management of value. As part of a rethinking of value in the bio-economy, this article analyzes three key political-economic processes: financialization, capitalization, and assetization. In doing so, it argues that value is managed as part of a series of valuation practices, it is not inherent in biological materialities.

Effects of Callous-Unemotional Traits on the Association Between Parenting and Child Conduct Problems.

PubMed

Crum, Kathleen I; Waschbusch, Daniel A; Bagner, Daniel M; Coxe, Stefany

2015-12-01

The current study investigated whether and how callous-unemotional traits (CU) moderated the association between specific parenting practices and child conduct problems (CP) with a special consideration of informant patterns. Associations between CU, ODD and CD symptom severity, and the parenting practices of deficient monitoring, positive involvement, and negative/ineffective discipline were examined across parent and teacher reports on 851 elementary-school students. Relative to children with low CU, in children with high CU: (1) positive parenting was associated with lower CD, but increased ODD; (2) negative/ineffective discipline was associated with increased ODD; (3) deficient monitoring was associated with increased CD. Results were not robust across informants. These findings suggest that in the context of CU, the associations between parenting and CP differ based on parenting characteristics, CP dimensions, and informant, and that families may benefit from treatment targeting specific parenting practices based on CP symptom profiles.

Discussion of Extinction-Based Behavioral Sleep Interventions for Young Children and Reasons Why Parents May Find Them Difficult.

PubMed

Etherton, Hayley; Blunden, Sarah; Hauck, Yvonne

2016-11-15

The majority of behavioral sleep interventions for young children involve extinction procedures where parents must ignore their child's cries for a period. Many parents have difficulties with this, contributing to attrition, non-compliance, and treatment avoidance. Yet why these methods are difficult to implement has rarely been addressed in the literature. This paper discusses seven potential reasons why parents may find extinction sleep interventions difficult: enduring crying, practical considerations, fear of repercussions, misinformation, incongruence with personal beliefs, different cultural practices, and parent wellness. These reasons are discussed in relation to the current literature. Practicing health professionals and sleep researchers could benefit from an awareness of these issues when suggesting extinction interventions and offering alternatives which may be more appropriate for family circumstances and facilitate parental informed choice. © 2016 American Academy of Sleep Medicine

International adoption among families in the United States: considerations of social justice.

PubMed

Hollingsworth, Leslie Doty

2003-04-01

The practice of international adoption of children is critiqued, using Rawls' egalitarian concept of a distributive method of social justice. From this perspective, international adoption may be perceived as contradictory to principles of social justice by ignoring the social context within which it occurs. Social contexts that frequently surround international adoption are severe poverty and the disenfranchisement of the adopted child's biological family; the disenfranchisement of certain children because of their lower social status; gender oppression and discrimination against female children; risk to children's rights to the knowledge of their birth history and parentage; risk to children's rights to identification with their ethnic, cultural, and national group; and practices that may involve abduction, deceit, and trafficking in children. The article presents alternate views, including libertarian and utilitarian perspectives. Solutions from two international conventions are critiqued and implications are discussed for social work policy advocacy, practice, and research.

The influence of experiential learning on medical equipment adoption in general practices.

PubMed

Bourke, Jane; Roper, Stephen

2014-10-01

The benefits of the availability and use of medical equipment for medical outcomes are understood by physicians and policymakers alike. However, there is limited understanding of the decision-making processes involved in adopting and using new technologies in health care organisations. Our study focuses on the adoption of medical equipment in Irish general practices which are marked by considerable autonomy in terms of commercial practice and the range of medical services they provide. We examine the adoption of six items of medical equipment taking into account commercial, informational and experiential stimuli. Our analysis is based on primary survey data collected from a sample of 601 general practices in Ireland on practice characteristics and medical equipment use. We use a multivariate Probit to identify commonalities in the determinants of the adoption. Many factors, such as GP and practice characteristics, influence medical equipment adoption. In addition, we find significant and consistent evidence of the influence of learning-by-using effects on the adoption of medical equipment in a general practice setting. Knowledge generated by experiential or applied learning can have commercial, organisational and health care provision benefits in small health care organisations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Review of palliative sedation and its distinction from euthanasia and lethal injection.

PubMed

Hahn, Michael P

2012-01-01

Palliative sedation evolved from within the practice of palliative medicine and has become adopted by other areas of medicine, such as within intensive care practice. Clinician's usually come across this practice for dying patients who are foregoing or having life support terminated. A number of intolerable and intractable symptom burdens can occur during the end of life period that may require the use of palliative sedation. Furthermore, when patients receive palliative sedation, the continued use of hydration and nutrition becomes an issue of consideration and there are contentious bioethical issues involved in using or withholding these life-sustaining provisions. A general understanding of biomedical ethics helps prevent abuse in the practice of palliative sedation. Various sedative drugs can be employed in the provision of palliative sedation that can produce any desired effect, from light sedation to complete unconsciousness. Although there are some similarities in the pharmacotherapy of palliative sedation, euthanasia, physician-assisted suicide, and lethal injection, there is a difference in how the drugs are administered with each practice. There are some published guidelines about how palliative sedation should be practiced, but currently there is not any universally accepted standard of practice.

Challenges of safe medication practice in paediatric care--a nursing perspective.

PubMed

Star, Kristina; Nordin, Karin; Pöder, Ulrika; Edwards, I Ralph

2013-05-01

To explore nurses' experiences of handling medications in paediatric clinical practice, with a focus on factors that hinder and facilitate safe medication practices. Twenty nurses (registered nurses) from four paediatric wards at two hospitals in Sweden were interviewed in focus groups. The interviews were analysed using content analysis. Six themes emerged from the analysed interviews: the complexity specific for nurses working on paediatric wards is a hindrance to safe medication practices; nurses' concerns about medication errors cause a considerable psychological burden; the individual nurse works hard for safe medication practices and values support from other nurse colleagues; circumstances out of the ordinary are perceived as critical challenges for maintaining patient safety; nurses value clear instructions, guidelines and routines, but these are often missing, variable or changeable; management, other medical professionals, the pharmacy, the pharmaceutical industry and informatics support need to respond to the requirements of the nurses' working situations to improve safe medication practices. Weaknesses were apparent in the long chain of the medication-delivery process. A joint effort by different professions involved in that delivery process, and a nationwide collaboration between hospitals is recommended to increase safe medication practices in paediatric care. ©2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

Electrical characterization of organic thin film transistors and alternative device architectures

NASA Astrophysics Data System (ADS)

Newman, Christopher R.

In the last 10--15 years, organic semiconductors have evolved from experimental curiosities into viable alternatives for practical applications involving large-area and low-cost electronics such as display backplanes, electronic paper, radio frequency identification (RFID) tags, and solar cells. Many of the initially-stated goals in this field have been achieved; organic semconductors have demonstrated performance comparable to or greater than amorphous silicon (a-Si), the entrenched technology for most of the applications listed above. At present, the major obstacles remaining to commercialization of devices based on organic semiconductors involve material stability, processing considerations and optimization of the other device components (e.g. metal contacts and dielectric materials). Despite these technical achievements, significant gaps remain in our understanding of the underlying transport physics in these devices. This thesis summarizes experiments performed on organic field-effect transistors (OFETs) in an attempt to address some of these knowledge gaps. The FET, in addition to being a very useful device for practical applications (such as the driving elements in pixel backplanes), is also a very flexible architecture from an experimental standpoint. The presence of a capacitively-coupled gate electrode allows the investigation of transport physics as a function of carrier concentration. For devices in which non-idealities (i.e. carrier traps) largely dictate the observed characteristics, this is a very useful feature. Although practical OFETs are fabricated as conventional single-gate structures on an organic thin film (OTFTs), more exotic structures can often provide insights that standard OTFTs cannot. Specifically, single-crystal OFETs allow the investigation of carrier transport in the absence of grain boundaries, and double-gated OTFTs facilitate the investigation and comparison of properties across two discrete interfaces. One of the remaining challenges in terms of achieving stability inorganic semiconductors involves understanding, and hopefully minimizing, the bias stress effect of operating OTFTs. Largely ignored during the years in which research groups sought to optimize the standard device metrics of field-effect mobility, current on/off ratio, and threshold voltage, operational stability is emerging as a dominant consideration in these materials. Experiments performed with the goal of quantifying and understanding the bias-stress effect in organic semiconductors are described at the end of this thesis.

A toolkit for incorporating genetics into mainstream medical services: Learning from service development pilots in England

PubMed Central

2010-01-01

Background As advances in genetics are becoming increasingly relevant to mainstream healthcare, a major challenge is to ensure that these are integrated appropriately into mainstream medical services. In 2003, the Department of Health for England announced the availability of start-up funding for ten 'Mainstreaming Genetics' pilot services to develop models to achieve this. Methods Multiple methods were used to explore the pilots' experiences of incorporating genetics which might inform the development of new services in the future. A workshop with project staff, an email questionnaire, interviews and a thematic analysis of pilot final reports were carried out. Results Seven themes relating to the integration of genetics into mainstream medical services were identified: planning services to incorporate genetics; the involvement of genetics departments; the establishment of roles incorporating genetic activities; identifying and involving stakeholders; the challenges of working across specialty boundaries; working with multiple healthcare organisations; and the importance of cultural awareness of genetic conditions. Pilots found that the planning phase often included the need to raise awareness of genetic conditions and services and that early consideration of organisational issues such as clinic location was essential. The formal involvement of genetics departments was crucial to success; benefits included provision of clinical and educational support for staff in new roles. Recruitment and retention for new roles outside usual career pathways sometimes proved difficult. Differences in specialties' working practices and working with multiple healthcare organisations also brought challenges such as the 'genetic approach' of working with families, incompatible record systems and different approaches to health professionals' autonomous practice. 'Practice points' have been collated into a Toolkit which includes resources from the pilots, including job descriptions and clinical tools. These can be customised for reuse by other services. Conclusions Healthcare services need to translate advances in genetics into benefits for patients. Consideration of the issues presented here when incorporating genetics into mainstream medical services will help ensure that new service developments build on the body of experience gained by the pilots, to provide high quality services for patients with or at risk of genetic conditions. PMID:20470377

A toolkit for incorporating genetics into mainstream medical services: Learning from service development pilots in England.

PubMed

Bennett, Catherine L; Burke, Sarah E; Burton, Hilary; Farndon, Peter A

2010-05-14

As advances in genetics are becoming increasingly relevant to mainstream healthcare, a major challenge is to ensure that these are integrated appropriately into mainstream medical services. In 2003, the Department of Health for England announced the availability of start-up funding for ten 'Mainstreaming Genetics' pilot services to develop models to achieve this. Multiple methods were used to explore the pilots' experiences of incorporating genetics which might inform the development of new services in the future. A workshop with project staff, an email questionnaire, interviews and a thematic analysis of pilot final reports were carried out. Seven themes relating to the integration of genetics into mainstream medical services were identified: planning services to incorporate genetics; the involvement of genetics departments; the establishment of roles incorporating genetic activities; identifying and involving stakeholders; the challenges of working across specialty boundaries; working with multiple healthcare organisations; and the importance of cultural awareness of genetic conditions. Pilots found that the planning phase often included the need to raise awareness of genetic conditions and services and that early consideration of organisational issues such as clinic location was essential. The formal involvement of genetics departments was crucial to success; benefits included provision of clinical and educational support for staff in new roles. Recruitment and retention for new roles outside usual career pathways sometimes proved difficult. Differences in specialties' working practices and working with multiple healthcare organisations also brought challenges such as the 'genetic approach' of working with families, incompatible record systems and different approaches to health professionals' autonomous practice. 'Practice points' have been collated into a Toolkit which includes resources from the pilots, including job descriptions and clinical tools. These can be customised for reuse by other services. Healthcare services need to translate advances in genetics into benefits for patients. Consideration of the issues presented here when incorporating genetics into mainstream medical services will help ensure that new service developments build on the body of experience gained by the pilots, to provide high quality services for patients with or at risk of genetic conditions.

Analysis of the UCSF Symptom Management Theory: Implications for Pediatric Oncology Nursing

PubMed Central

Linder, Lauri

2015-01-01

Symptom management research is a priority for both children and adults with cancer. The UCSF Symptom Management Theory (SMT) is a middle range theory depicting symptom management as a multidimensional process. A theory analysis using the process described by Walker and Avant evaluated the SMT with attention to application in research involving children with cancer. Application of the SMT in studies involving children has been limited to descriptive studies testing only portions of the theory. Findings of these studies have provided empiric support for the relationships proposed within the SMT. Considerations for future research involving children include attention to measurement of symptoms and clarity regarding the location of the parents and family within the model. With additional testing and refinement, the SMT has the potential to guide nursing research and practice to improve symptoms for children with cancer. PMID:20639345

Implementing Machine Learning in Radiology Practice and Research.

PubMed

Kohli, Marc; Prevedello, Luciano M; Filice, Ross W; Geis, J Raymond

2017-04-01

The purposes of this article are to describe concepts that radiologists should understand to evaluate machine learning projects, including common algorithms, supervised as opposed to unsupervised techniques, statistical pitfalls, and data considerations for training and evaluation, and to briefly describe ethical dilemmas and legal risk. Machine learning includes a broad class of computer programs that improve with experience. The complexity of creating, training, and monitoring machine learning indicates that the success of the algorithms will require radiologist involvement for years to come, leading to engagement rather than replacement.

Von den Flitterwochen zur distanzierten Partnerschaft. Deutsche Manager in internationalen M&A

NASA Astrophysics Data System (ADS)

Fuchs, Martina; Schalljo, Martin

2017-04-01

Cross-border mergers and acquisitions (M&A) require considerable intercultural openness on the part of the managers involved. A recent wave of takeovers by private equity investors and foreign investors from emerging economies has challenged German executives. In cases of friendly takeovers, as described in this study, managers at first appear to extend a cosmopolitan welcome to the new owners. However, further analysis of structural hermeneutics reveals latent normative professional ethics of managers which lead to practices of distancing, in particular from young investors from China, India, and Russia.

Data Processing And Machine Learning Methods For Multi-Modal Operator State Classification Systems

NASA Technical Reports Server (NTRS)

Hearn, Tristan A.

2015-01-01

This document is intended as an introduction to a set of common signal processing learning methods that may be used in the software portion of a functional crew state monitoring system. This includes overviews of both the theory of the methods involved, as well as examples of implementation. Practical considerations are discussed for implementing modular, flexible, and scalable processing and classification software for a multi-modal, multi-channel monitoring system. Example source code is also given for all of the discussed processing and classification methods.

Design of arbitrarily homogeneous permanent magnet systems for NMR and MRI: theory and experimental developments of a simple portable magnet.

PubMed

Hugon, Cedric; D'Amico, Francesca; Aubert, Guy; Sakellariou, Dimitris

2010-07-01

Starting from general results of magnetostatics, we give fundamental considerations on the design and characterization of permanent magnets for NMR based on harmonic analysis and symmetry. We then propose a simple geometry that takes advantage of some of these considerations and discuss the practical aspects of the assembly of a real magnet based on this geometry, involving the characterization of its elements, the optimization of the layout and the correction of residual inhomogeneities due to material and geometry imperfections. We report with this low-cost, light-weight magnet (100 euros and 1.8 kg including the aluminum frame) a field of 120 mT (5.1 MHz proton) with a 10 ppm natural homogeneity over a sphere of 1.5 mm in diameter. Copyright (c) 2010 Elsevier Inc. All rights reserved.

[Delegation of GP Work to Qualified Medical Staff in Germany - An Overview].

PubMed

Mergenthal, K; Leifermann, M; Beyer, M; Gerlach, F M; Güthlin, C

2016-09-01

To assure nationwide provision of family medical care, a greater involvement of non-physician healthcare professionals has been discussed in Germany for some time. Currently, there are various delegation models. The aim of this study is to provide an overview of existing delegation models in a German family practice setting and to investigate to what extent they are implemented in practice. Internet search was made for delegation models for non-physician healthcare staff, and various experts were contacted in April 2014. Models that explicitly addressed family practice, involved continuing education of more than 80 h, and for which health insurance funds bore the costs, were taken into consideration. The models were judged in accordance with the PDCA implementation cycle (Plan-Do-Check-Act). 6 delegation models used in family practice were identified for which only 4 qualifications were still available in 2014. The duration, content and aims of the training courses differed markedly. Since 2015, training to become a NäPA non-physician practice assistant (or a VERAH healthcare assistant in the family practice if the necessary supplementary qualification is achieved) is the basic qualification for which costs are reimbursed. However, one important quality criterion for its broad implementation, namely evaluation, is missing in NäPA training. Only the VERAH qualification fulfills all quality criteria. In order to fully implement the delegation models and to strengthen and promote the healthcare assistant profession, the delegation models for which training costs are generally reimbursable should satisfy all quality criteria and also be subject to continual evaluation. © Georg Thieme Verlag KG Stuttgart · New York.

PATIENT-CENTERED DECISION MAKING: LESSONS FROM MULTI-CRITERIA DECISION ANALYSIS FOR QUANTIFYING PATIENT PREFERENCES.

PubMed

Marsh, Kevin; Caro, J Jaime; Zaiser, Erica; Heywood, James; Hamed, Alaa

2018-01-01

Patient preferences should be a central consideration in healthcare decision making. However, stories of patients challenging regulatory and reimbursement decisions has led to questions on whether patient voices are being considered sufficiently during those decision making processes. This has led some to argue that it is necessary to quantify patient preferences before they can be adequately considered. This study considers the lessons from the use of multi-criteria decision analysis (MCDA) for efforts to quantify patient preferences. It defines MCDA and summarizes the benefits it can provide to decision makers, identifies examples of MCDAs that have involved patients, and summarizes good practice guidelines as they relate to quantifying patient preferences. The guidance developed to support the use of MCDA in healthcare provide some useful considerations for the quantification of patient preferences, namely that researchers should give appropriate consideration to: the heterogeneity of patient preferences, and its relevance to decision makers; the cognitive challenges posed by different elicitation methods; and validity of the results they produce. Furthermore, it is important to consider how the relevance of these considerations varies with the decision being supported. The MCDA literature holds important lessons for how patient preferences should be quantified to support healthcare decision making.

Ensuring continuing fitness to practice in the pharmacy workforce: Understanding the challenges of revalidation.

PubMed

Schafheutle, Ellen Ingrid; Hassell, Karen; Noyce, Peter R

2013-01-01

Revalidation is about assuring that health practitioners remain up to date and fit to practice, and demonstrating that they continue to meet the requirements of their professional regulator. To critically discuss issues that need to be considered when designing a system of revalidation for pharmacy professionals. Although providing international context, the article focuses in particular on Great Britain (GB), where both pharmacists (Phs) and pharmacy technicians (PTs) are regulated. Following a brief historical overview, the article draws on emerging evidence in context. Revalidation may involve discrete periodic assessment or a continuous process of assessment against clearly identified standards. The evolving scope of pharmacy practice involves increasingly clinical roles and also practitioners in nonpatient-facing roles. The potential risk to patients and the public may require consideration. Although revalidation, or systems for recertification/relicensure, exist in numerous jurisdictions, most center on the collection of continuing education credits; continuous professional development and reflective practice are increasingly found. Revalidation may involve assessment of other sources, such as appraisals or monitoring visits. Existing revalidation systems are coordinated centrally, but particularly in larger jurisdictions, like GB, where approximately 67,000 pharmacy professionals are regulated, some responsibility may need to be devolved. This would require engagement with employers and contracting organizations to ensure suitability and consistency. Existing systems, such as company appraisals, are unfit for the assessment of fitness to practice owing to a focus on organizational/business targets. Certain groups of pharmacy professionals may pose particular challenges, such as self-employed locums, pharmacy owners, those working in different sectors, or returning after a break. To ensure proportionality, it must be considered whether the same standards and/or sources of evidence should apply to all pharmacy professionals, either dependent on whether they are patient facing, their scope of practice, or whether Phs and PTs should be treated differently. Copyright © 2013 Elsevier Inc. All rights reserved.

Practical Stereochemistry.

PubMed

Kellogg, Richard M

2017-04-18

The relationship between fundamental and applied is often uneasy, particularly in modern political climates. A familiar political view, aimed negatively at the scientific community, is that the former is a waste of money whereas the latter gives value for investment. The answer that fundamental is required as the basis for practical suffers from the fact that the timelines between fundamental and practical are often long and the routes contorted and unexpected. This has been my experience. In this Account, examples are given from the research in which I have been involved wherein quite fundamental considerations have led to various applications. The longer the time, the clearer and broader the relationship. Fundamental can and does lead to application. They need and depend on each other. I have seen this both from the side of academia and from small companies. In the course of the past 40 plus years, I have been involved in various aspects of stereochemistry and, in particular, chirality. It has been rewarding to see that several of the developments, most originally grounded in fundamental research considerations, have been used in the chemical community and given new dimensions and often practical applications by others. In this Account, a path-not planned deliberately by me-from orbital symmetry and Woodward-Hoffmann rules through crown ethers to conformational analysis to diastereomeric resolutions to deracemizations powered by Ostwald ripening and the Gibbs-Thomson effect to nucleation to helicenes is described. In order of discussion, the orbital symmetry aspects have via an unusual and unpredicted path has resulted in, among other things, a synthesis of hindered alkenes useful for the production of molecular motors. The crown ether aspects led to discovery of the utility of cesium salts particularly for racemization sensitive nucleophilic substitutions. Work on diastereomeric resolutions has concentrated on the mechanistic as well as practical/commercial aspects of the use of multiple resolving agents (Dutch resolution). During this work the complex relationship between nucleation and chirality in diastereomeric resolutions began to reveal itself. In general, nucleation, especially with involvement of chirality, is a topical challenge that has attracted the attention of many groups. The contribution of this knowledge to the development of attrition driven deracemizations of racemizable conglomerates is described. This remarkable technology allows, without intervention of chiral aids, conversion of certain racemates in quantitative yield and absolute enantiomeric excess to a single enantiomer. From a practical standpoint, this methodology has been used for the production in enantiomerically pure form of commercially interesting compounds like naproxen and clopidogrel (Plavix). Finally an STM investigation of the nucleation behavior of a helicene, prepared via a remarkably short and efficient route, on a metal surface is described.

"Alcohol and nicotine"--Concept and evaluation of an interdisciplinary elective course with OSPE in preclinical medical education.

PubMed

Bergelt, Corinna; Lauke, Heidrun; Petersen-Ewert, Corinna; Jücker, Manfred; Bauer, Christiane K

2014-01-01

In the last decade, increasing interest has been paid to interdisciplinary and practical courses in the medical education in Germany. This report describes the implementation and outcome of a preclinical interdisciplinary elective course with a team-teaching concept developed by lecturers in medical psychology, anatomy, physiology and biochemistry. The practical orientation of the course led to the implementation of a final interdisciplinary OSPE to ensure fair consideration of the different disciplines involved in grading. Individual OSPE results correlate well with the fact that different skills are required in medical psychology compared to those required in anatomy, physiology and biochemistry. Student course evaluation and lecturers` experience indicate the success of this elective course. Its concept can be well adapted to other interdisciplinary courses.

Practical Considerations Informing Teachers' Technology Integration Decisions: The Case of Tablet PCs

ERIC Educational Resources Information Center

Pareja Roblin, Natalie; Tondeur, Jo; Voogt, Joke; Bruggeman, Bram; Mathieu, Griet; van Braak, Johan

2018-01-01

The unique characteristics of tablet PCs promise important benefits for education. Yet, little is known about the rationale underlying teachers' decisions concerning their educational uses within the constraints of daily classroom practice. The current multiple case study investigated the practical considerations informing nine secondary school…

Practical considerations for obtaining high quality quantitative computed tomography data of the skeletal system.

PubMed

Troy, Karen L; Edwards, W Brent

2018-05-01

Quantitative CT (QCT) analysis involves the calculation of specific parameters such as bone volume and density from CT image data, and can be a powerful tool for understanding bone quality and quantity. However, without careful attention to detail during all steps of the acquisition and analysis process, data can be of poor- to unusable-quality. Good quality QCT for research requires meticulous attention to detail and standardization of all aspects of data collection and analysis to a degree that is uncommon in a clinical setting. Here, we review the literature to summarize practical and technical considerations for obtaining high quality QCT data, and provide examples of how each recommendation affects calculated variables. We also provide an overview of the QCT analysis technique to illustrate additional opportunities to improve data reproducibility and reliability. Key recommendations include: standardizing the scanner and data acquisition settings, minimizing image artifacts, selecting an appropriate reconstruction algorithm, and maximizing repeatability and objectivity during QCT analysis. The goal of the recommendations is to reduce potential sources of error throughout the analysis, from scan acquisition to the interpretation of results. Copyright © 2018 Elsevier Inc. All rights reserved.

Enacting Pedagogy in Curricula: On the Vital Role of Governance in Medical Education.

PubMed

Casiro, Oscar; Regehr, Glenn

2018-02-01

Managing curricula and curricular change involves both a complex set of decisions and effective enactment of those decisions. The means by which decisions are made, implemented, and monitored constitute the governance of a program. Thus, effective academic governance is critical to effective curriculum delivery. Medical educators and medical education researchers have been invested heavily in issues of educational content, pedagogy, and design. However, relatively little consideration has been paid to the governance processes that ensure fidelity of implementation and ongoing refinements that will bring curricular practices increasingly in line with the pedagogical intent. In this article, the authors reflect on the importance of governance in medical schools and argue that, in an age of rapid advances in knowledge and medical practices, educational renewal will be inhibited if discussions of content and pedagogy are not complemented by consideration of a governance framework capable of enabling change. They explore the unique properties of medical curricula that complicate academic governance, review the definition and properties of good governance, offer mechanisms to evaluate the extent to which governance is operating effectively within a medical program, and put forward a potential research agenda for increasing the collective understanding of effective governance in medical education.

The case for mandatory inclusion of ethics within the zoological sciences curriculum.

PubMed

Buckeridge, John S

2006-03-01

Traditionally, undergraduate science curricula include little or no "ethics," either as theory or practice. However, zoologists are currently enjoying considerable media exposure: some of it positive (as in conservation practice), but more often negative (pertaining to issues such as the use of animals for testing of drugs, and genetic engineering). More than ever before, zoologists are being asked to make value judgments, and many of these involve moral assessment; if we accept that zoologists (along with other scientists) are professionals, then we must accept that they are responsible for any decisions they make, and it then follows that they are accountable, which can have serious ramifications in cases of malpractice. Ethics involves the application of morality in a professional setting. In light of this, teaching ethics is mandatory in degree programs such as engineering and medicine. This paper contends that a key output of zoological education is the undergraduate who is cognizant of the ethical framework and constructs within which he/she must function. The paper concludes with comment on the nature and style of delivery of ethics education.

An Overview of Interrater Agreement on Likert Scales for Researchers and Practitioners

PubMed Central

O'Neill, Thomas A.

2017-01-01

Applications of interrater agreement (IRA) statistics for Likert scales are plentiful in research and practice. IRA may be implicated in job analysis, performance appraisal, panel interviews, and any other approach to gathering systematic observations. Any rating system involving subject-matter experts can also benefit from IRA as a measure of consensus. Further, IRA is fundamental to aggregation in multilevel research, which is becoming increasingly common in order to address nesting. Although, several technical descriptions of a few specific IRA statistics exist, this paper aims to provide a tractable orientation to common IRA indices to support application. The introductory overview is written with the intent of facilitating contrasts among IRA statistics by critically reviewing equations, interpretations, strengths, and weaknesses. Statistics considered include rwg, rwg*, r′wg, rwg(p), average deviation (AD), awg, standard deviation (Swg), and the coefficient of variation (CVwg). Equations support quick calculation and contrasting of different agreement indices. The article also includes a “quick reference” table and three figures in order to help readers identify how IRA statistics differ and how interpretations of IRA will depend strongly on the statistic employed. A brief consideration of recommended practices involving statistical and practical cutoff standards is presented, and conclusions are offered in light of the current literature. PMID:28553257

The effect of non traditional teaching methods in entrepreneurship education on students entrepreneurial interest and business startups: A data article.

PubMed

Olokundun, Maxwell; Moses, Chinonye Love; Iyiola, Oluwole; Ibidunni, Stephen; Ogbari, Mercy; Peter, Fred; Borishade, Taiye

2018-08-01

Traditional methods of teaching entrepreneurship in universities involves more theoretical approaches which are less effective in motivating considerations for an entrepreneurship career. This owes to the fact that such techniques essentially make students develop a dormant attitude rather than active participation. Expert views suggest that experiential entrepreneurship teaching methods in universities which involve practical activities and active participation can be considered salient to students' development of entrepreneurial interest an business startup potentials. This present study presents data on the extent to which experiential teaching methods in entrepreneurship adopted by Nigerian universities stimulate students' entrepreneurial interest and business startups. Data have been gathered following a descriptive cross-sectional quantitative survey conducted among university students ( N = 600) of four selected institutions in Nigeria offering a degree programme in entrepreneurship. Hierarchical Multiple Regression Analysis was used in confirming the hypothesis proposed in the study using the Statistical Package for Social Sciences (SPSS) version 22.The findings from the analysis showed that the adoption of experiential practical activities considered as best practices in entrepreneurship teaching in Nigerian universities can stimulate students' interest and drive for engaging in business start-up activities even as undergraduates. The field data set is made extensively available to allow for critical investigation.

Clinical use of indium-111 labeled blood products

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

Loken, M.K.; Clay, M.E.; Carpenter, R.T.

1985-12-01

Following the introduction of In-111 oxine as a label for blood cells by McAffee and Thakur in 1976, these procedures have become increasingly important in the practice of nuclear medicine. Of particular interest are studies involving the use of labeled leukocytes for the detection of focal infection. The clinical utility of labeled platelets is less well developed, although the use of platelets to detect the formation of thrombi in blood vessels and on vascular grafts and prostheses is gaining prominence. This report summarizes the techniques presently employed at the University of Minnesota for the labeling of blood products, and theirmore » clinical use. Consideration also is given to the desired expertise and cost factors involved in the labeling of leukocytes and platelets.43 references.« less

Community participation in superfund practice and policy

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

Gossett, L.B.

1995-12-01

Superfund has several statutory and regulatory provisions that provide vehicles for community involvement at Superfund sites including community relations plans, information repositories, public comment periods, and technical assistance grants to community organizations. There has been considerable debate about the effectiveness of these programs. The community participation requirement of the Superfund process are in a state of transition. The proposed Superfund Reform Act of 1994 contained additional community participation provisions. EPA appears to be incorporating some of these proposed changes and improvements learned from prior experiences into its current community relations practices. This study examines the status of community relations inmore » Superfund and the effectiveness of the community information and public participation programs in meeting legislative objectives. In addition to addressing current requirements and practices, the study looks at proposals to amend the community participation provisions as well as alternative approaches used by the EPA, potentially responsible parties, and citizens to address or resolve community concerns. While the focus will be on the overall program, a few brief selected case studies, representing a diversity of experiences, will be included. The resulting paper will discuss successes and shortcomings of community involvement in Superfund. It will address the sometimes competing goals of the various players in the Superfund process, bringing in not only the community perspective, but also concerns for decreased complexity and cost and increased efficiency. The conclusion will evaluate alternatives to improve procedures for community involvement in the Superfund program. Superfund reform, public and stakeholder involvement, and dispute resolution are addressed in this study. These are prominent, contemporary issues as the nation seeks to constructively solve its environmental problems.« less

Pathways from Autism Spectrum Disorder (ASD) Diagnosis to Genetic Testing

PubMed Central

Barton, Krysta S.; Tabor, Holly K.; Starks, Helene; Garrison, Nanibaa’ A.; Laurino, Mercy; Burke, Wylie

2017-01-01

Purpose This study examines challenges faced by families and health providers related to genetic testing for autism spectrum disorder (ASD). Methods This qualitative study of 14 parents and 15 health providers identified an unstandardized three-step process for families who pursue ASD genetic testing. Results Step 1 is the clinical diagnosis of ASD, confirmed by providers practicing alone or in a team. Step 2 is the offer of genetic testing to find an etiology. For those offered testing, step 3 involves the parents’ decision whether to pursue testing. Despite professional guidelines and recommendations, interviews describe considerable variability in approaches to genetic testing for ASD, a lack of consensus among providers, and questions about clinical utility. Many families in our study were unaware of the option for genetic testing; testing decisions by parents appear to be influenced by both provider recommendations and insurance coverage. Conclusion Consideration of genetic testing for ASD should take into account different views about the clinical utility of testing and variability in insurance coverage. Ideally, policy makers from the range of clinical specialties involved in ASD care should revisit policies to clarify the purpose of genetic testing for ASD and promote consensus about its appropriate use. PMID:29048417

Telework rationale and implementation for people with disabilities: considerations for employer policymaking.

PubMed

Moon, Nathan W; Linden, Maureen A; Bricout, John C; Baker, Paul M A

2014-01-01

Telework has been promoted as a viable workplace accommodation for people with disabilities since the 1990s, when information and communication technologies (ICT) had developed sufficiently to facilitate its widespread adoption. This initial research and accompanying policy recommendations were prescriptive in nature and frequently aimed at employers. This article adds to existing policy models for facilitating successful telework outcomes for people with disabilities. Drawing upon two studies by the Rehabilitation Engineering Research Center on Workplace Accommodations, we expound on employee-side considerations in the implementation of telework. Our policy model utilizes established typologies for policy evaluation to develop a process model that considers rationales and implementation factors for telework among people with physical disabilities. Telework may be used as an accommodation for disability, but employee rationales for telework are more complex, involving work-life balance, strategies for pain and fatigue not formally recognized as disability, and expediency in travel and transportation. Implementation of telework as a component of workplace operations is similarly multifaceted, involving non-technology accommodations to realize job restructuring left incomplete by telework. Our model grounds new empirical research in this area. We also renew our call for additional research on effective telework practices for people with disabilities.

Technical challenges in designing post-marketing eCRFs to address clinical safety and pharmacovigilance needs.

PubMed

Lu, Zhengwu

2010-01-01

To identify key challenges and propose technical considerations in designing electronic case report form (eCRF) for post-marketing studies, the author undertakes a comprehensive literature review of peer reviewed and grey literature to assess the key aspects, processes, standards, recommendations, and best practices in designing eCRFs based on industry experience in designing and supporting electronic data capture (EDC) studies. Literature search using strings on MEDLINE and PUBMED returned few papers directly related to CRF design. Health informatics and general practice journals were searched and results reviewed. Many conference, government commission, health professional and special interests group websites provide relevant information from practical experience - summarization of this information is presented. Further, we presented a list of concrete technical considerations in dealing with EDC technology/system limitations based on literature assessment and industry implementation experience. It is recognized that cross-functional teams be involved in eCRF design process and decision making. To summarize the keys in designing eCRFs to address post-market study safety and pharmacovigilance needs, the first is to identify required data elements from the study protocol supporting data analyses and reporting requirements. Secondly, accepted best practices, CDASH & CDISC guidelines, and company internal or therapeutic unit standard should be considered and applied. Coding (MedDRA & WHODD) mapping should be managed and implemented as well when possible. Finally, we need to be on top of the EDC technologies, challenge the technologies, drive EDC improvement via working with vendors, and utilize the technologies to drive clinical effectiveness. Copyright (c) 2009 Elsevier Inc. All rights reserved.

Researching the psychological therapies in prison: considerations and future recommendations.

PubMed

Gee, Joanna; Bertrand-Godfrey, Betty

2014-01-01

The psychological therapies are widely considered within the forensic literature as holding a useful role in the prison system, however, despite this, very little research into the psychological therapies has taken place. Further, where research is carried out, it is often associated with the need for evidence-based practice (EBP), involving quantification and randomization. The paper aims to discuss these issues. This paper will initially introduce the importance of research into the psychological therapies in prison, followed by a consideration of EBP which can be thought of as the current movement governing research in the psychological therapies in the UK. However, in providing a focused critique of EBP, particularly within prisons, this paper will attempt to pave the way for a consideration of alternative research methodologies and resultant methods in researching the psychological therapies in prisons in the UK. Through this it is argued that research within the prison setting should act not to promote interventions and create an evidence-based as such, but to provide an accessible body of knowledge for the psychological therapists working in prisons in the UK.

Integration of research and practice to improve public health and healthcare delivery through a collaborative 'Health Integration Team' model - a qualitative investigation.

PubMed

Redwood, Sabi; Brangan, Emer; Leach, Verity; Horwood, Jeremy; Donovan, Jenny L

2016-06-22

Economic considerations and the requirement to ensure the quality, safety and integration of research with health and social care provision have given rise to local developments of collaborative organisational forms and strategies to span the translational gaps. One such model - the Health Integration Team (HIT) model in Bristol in the United Kingdom (UK) - brings together National Health Service (NHS) organisations, universities, local authorities, patients and the public to facilitate the systematic application of evidence to promote integration across healthcare pathways. This study aimed to (1) provide empirical evidence documenting the evolution of the model; (2) to identify the social and organisational processes and theory of change underlying healthcare knowledge and practice; and (3) elucidate the key aspects of the HIT model for future development and translation to other localities. Contemporaneous documents were analysed, using procedures associated with Framework Analysis to produce summarised data for descriptive accounts. In-depth interviews were undertaken with key informants and analysed thematically. Comparative methods were applied to further analyse the two data sets. One hundred forty documents were analysed and 10 interviews conducted with individuals in leadership positions in the universities, NHS commissioning and provider organisations involved in the design and implementation of the HIT model. Data coalesced around four overarching themes: 'Whole system' engagement, requiring the active recruitment of all those who have a stake in the area of practice being considered, and 'collaboration' to enable coproduction were identified as 'process' themes. System-level integration and innovation were identified as potential 'outcomes' with far-reaching impacts on population health and service delivery. The HIT model emerged as a particular response to the perceived need for integration of research and practice to improve public health and healthcare delivery at a time of considerable organisational turmoil and financial constraints. The concept gained momentum and will likely be of interest to those involved in setting up similar arrangements, and researchers in the social and implementation sciences with an interest in their evaluation.

Voices from Left of the Dial:* Reflections of Practice-Based Researchers

PubMed Central

Fagnan, Lyle J.; Handley, Margaret A.; Rollins, Nancy; Mold, James

2010-01-01

Background Purpose Practice-Based Research Networks (PBRNs) provide an important approach to implementing primary care research at the community level, thus increasing the relevance and utility of research findings for routine primary care practices. PBRNs expend considerable time and energy in the recruitment, engagement, and retention of network clinicians and practices to establish this community-based primary care research laboratory. This study assessed factors motivating PBRN clinicians to participate and stay involved in practice-based research in their primary care office setting. Methods We invited practicing clinicians across the United States who are affiliated with a PBRN to share their stories regarding motivations to participate in practice-based research. Using qualitative methods, we categorized the stories into the main motivation for participation and the perceived impact of participation. Results We collected 37 stories from clinicians affiliated with 12 PBRNS located in 14 states. Motivations for participation in practice-based research included themes associated with personal satisfaction, improving local clinic-based care, and contributing to community and system level improvements. Sources of personal satisfaction corresponded to the three psychological needs postulated by Deci's and Ryan's Self-Determination Theory: competence, autonomy, and relatedness. Conclusions These PBRN clinician stories describe the values, motivations and unique paths that clinicians took as they chose to participate and stay active in a practice-based research network. Their voices have the potential to influence others to participate in practice-based research. PMID:20616286

Characterization of Vacuum Facility Background Gas Through Simulation and Considerations for Electric Propulsion Ground Testing

NASA Technical Reports Server (NTRS)

Yim, John T.; Burt, Jonathan M.

2015-01-01

The background gas in a vacuum facility for electric propulsion ground testing is examined in detail through a series of cold flow simulations using a direct simulation Monte Carlo (DSMC) code. The focus here is on the background gas itself, its structure and characteristics, rather than assessing its interaction and impact on thruster operation. The background gas, which is often incorrectly characterized as uniform, is found to have a notable velocity within a test facility. The gas velocity has an impact on the proper measurement of pressure and the calculation of ingestion flux to a thruster. There are also considerations for best practices for tests that involve the introduction of supplemental gas flows to artificially increase the background pressure. All of these effects need to be accounted for to properly characterize the operation of electric propulsion thrusters across different ground test vacuum facilities.

Philosophy, medicine and its technologies.

PubMed Central

Almond, B

1988-01-01

There is a need to bring ethics and medical practice closer together, despite the risk and problems this may involve. Deontological ethics may promote sanctity of life considerations against the quality of life considerations favoured by consequentialists or utilitarians; while talk of respect for life and the value of life may point to more qualified ethical positions. This paper argues for a respect-for-life position, dismissing a utilitarian cost-benefit outlook as too simplistic; but an unqualified fixed principles approach is also ruled out, both because of its unacceptable consequences in individual cases and also because of its reliance on the slippery slope argument which, it is argued, is logically and psychologically deficient. The case of genetic engineering provides an example in which the notion of respect may operate, but in which broad general principles also apply. A cautious conservatism towards accepted principles is recommended in the development of medical technologies. PMID:3236344

Philosophy, medicine and its technologies.

PubMed

Almond, B

1988-12-01

There is a need to bring ethics and medical practice closer together, despite the risk and problems this may involve. Deontological ethics may promote sanctity of life considerations against the quality of life considerations favoured by consequentialists or utilitarians; while talk of respect for life and the value of life may point to more qualified ethical positions. This paper argues for a respect-for-life position, dismissing a utilitarian cost-benefit outlook as too simplistic; but an unqualified fixed principles approach is also ruled out, both because of its unacceptable consequences in individual cases and also because of its reliance on the slippery slope argument which, it is argued, is logically and psychologically deficient. The case of genetic engineering provides an example in which the notion of respect may operate, but in which broad general principles also apply. A cautious conservatism towards accepted principles is recommended in the development of medical technologies.

Prevention of school bullying: the important role of autonomy-supportive teaching and internalization of pro-social values.

PubMed

Roth, Guy; Kanat-Maymon, Yaniv; Bibi, Uri

2011-12-01

This study examined students' perceptions of autonomy-supportive teaching (AST) and its relations to internalization of pro-social values and bullying in class. We hypothesized that: (1) teachers' AST, which involves provision of rationale and taking the student's perspective, would relate positively to students' identified internalization of considerateness towards classmates, and would relate negatively to external regulation (considerateness to obtain rewards or avoid punishments); (2) students' identified regulation would relate negatively to self-reported bullying in class, whereas external regulation would relate positively to bullying; and (3) the relation between teachers' AST and student bullying would be mediated by students' identification with the value of considerateness towards others. The sample consisted of 725 junior high school students (50% females) in Grades 7 and 8 from 27 classes in four schools serving students from lower-middle to middle-class socioeconomic backgrounds.   The participants completed questionnaires assessing the variables of interest. Correlational analysis supported the hypotheses. Moreover, mediational analyses using hierarchical linear modelling (HLM) demonstrated that identified regulation mediates the negative relation between AST and self-reported bullying in class. The mediational hypothesis was supported at the between-class level and at the within-class level.   The findings suggest that school policy aimed at bullying reduction should go beyond external control that involves external rewards and sanctions and should help teachers acquire autonomy-supportive practices focusing on students' meaningful internalization. ©2010 The British Psychological Society.

The impact of regulations, safety considerations and physical limitations on research progress at maximum biocontainment.

PubMed

Shurtleff, Amy C; Garza, Nicole; Lackemeyer, Matthew; Carrion, Ricardo; Griffiths, Anthony; Patterson, Jean; Edwin, Samuel S; Bavari, Sina

2012-12-01

We describe herein, limitations on research at biosafety level 4 (BSL-4) containment laboratories, with regard to biosecurity regulations, safety considerations, research space limitations, and physical constraints in executing experimental procedures. These limitations can severely impact the number of collaborations and size of research projects investigating microbial pathogens of biodefense concern. Acquisition, use, storage, and transfer of biological select agents and toxins (BSAT) are highly regulated due to their potential to pose a severe threat to public health and safety. All federal, state, city, and local regulations must be followed to obtain and maintain registration for the institution to conduct research involving BSAT. These include initial screening and continuous monitoring of personnel, controlled access to containment laboratories, accurate and current BSAT inventory records. Safety considerations are paramount in BSL-4 containment laboratories while considering the types of research tools, workflow and time required for conducting both in vivo and in vitro experiments in limited space. Required use of a positive-pressure encapsulating suit imposes tremendous physical limitations on the researcher. Successful mitigation of these constraints requires additional time, effort, good communication, and creative solutions. Test and evaluation of novel vaccines and therapeutics conducted under good laboratory practice (GLP) conditions for FDA approval are prioritized and frequently share the same physical space with important ongoing basic research studies. The possibilities and limitations of biomedical research involving microbial pathogens of biodefense concern in BSL-4 containment laboratories are explored in this review.

The Impact of Regulations, Safety Considerations and Physical Limitations on Research Progress at Maximum Biocontainment

PubMed Central

Shurtleff, Amy C.; Garza, Nicole; Lackemeyer, Matthew; Carrion, Ricardo; Griffiths, Anthony; Patterson, Jean; Edwin, Samuel S.; Bavari, Sina

2012-01-01

We describe herein, limitations on research at biosafety level 4 (BSL-4) containment laboratories, with regard to biosecurity regulations, safety considerations, research space limitations, and physical constraints in executing experimental procedures. These limitations can severely impact the number of collaborations and size of research projects investigating microbial pathogens of biodefense concern. Acquisition, use, storage, and transfer of biological select agents and toxins (BSAT) are highly regulated due to their potential to pose a severe threat to public health and safety. All federal, state, city, and local regulations must be followed to obtain and maintain registration for the institution to conduct research involving BSAT. These include initial screening and continuous monitoring of personnel, controlled access to containment laboratories, accurate and current BSAT inventory records. Safety considerations are paramount in BSL-4 containment laboratories while considering the types of research tools, workflow and time required for conducting both in vivo and in vitro experiments in limited space. Required use of a positive-pressure encapsulating suit imposes tremendous physical limitations on the researcher. Successful mitigation of these constraints requires additional time, effort, good communication, and creative solutions. Test and evaluation of novel vaccines and therapeutics conducted under good laboratory practice (GLP) conditions for FDA approval are prioritized and frequently share the same physical space with important ongoing basic research studies. The possibilities and limitations of biomedical research involving microbial pathogens of biodefense concern in BSL-4 containment laboratories are explored in this review. PMID:23342380

Service user involvement in preregistration general nurse education: a systematic review.

PubMed

Scammell, Janet; Heaslip, Vanessa; Crowley, Emma

2016-01-01

A systematic review of published studies on service user involvement in undergraduate, preregistration general nursing education (excluding mental health-specific programmes). The objective is to examine how students are exposed to engagement with service users. The requirement of service user involvement in all nurse education is policy expectation of health professional education providers, in response to the increased public and political expectations. Previous literature reviews have focused solely on mental health. Systematic review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines; timeframe 1997-2014; published in English. Search of CINAHL, Cochrane Review, Education Research Complete, Internurse, MEDLINE, PsychINFO, Scopus, SocINDEX and Web of Science yielded 229 citations; 11 studies met the review eligibility criteria. Seven studies used qualitative methodology, two quantitative and two mixed methods. Studies from the United Kingdom dominated (n = 9), the remainder from South Africa and Turkey. The results are described using four themes: benefits and limitations of service user involvement; nursing student selection; education delivery; practice-based learning and assessment. Most studies were small scale; nine had less than 30 participants. Overall the evidence suggests that student, lecturers and service users valued service user involvement in nurse education, to provide an authentic insight into the illness experience. Logistical considerations around support and student cohort size emerged. This is the first systematic review to focus on service user involvement in general nurse education. It reveals that service user involvement commenced later and is more limited in general programmes as compared to equivalent mental health education provision. Most of the evidence focuses on perceptions of the value of involvement. Further research is required to more clearly establish impact on learning and clinical practice. Service user involvement in nurse education is valued by stakeholders but preparation and support for those involved, including mentors is underestimated. © 2015 John Wiley & Sons Ltd.

Imagining Moral Bioenhancement Practices: Drawing Inspiration from Moral Education, Public Health Ethics, and Forensic Psychiatry.

PubMed

Specker, Jona; Schermer, Maartje H N

2017-07-01

In this article, we consider contexts or domains in which (future) moral bioenhancement interventions possibly or most likely will be implemented. By looking closely at similar or related existing practices and their relevant ethical frameworks, we hope to identify ethical considerations that are relevant for evaluating potential moral bioenhancement interventions. We examine, first, debates on the proper scope of moral education; second, proposals for identifying early risk factors for antisocial behaviour; and third, the difficult balancing of individual freedom and third party concerns in (forensic) psychiatry. In imagining moral bioenhancement in practice, we observe that unlike other forms of enhancement, moral enhancement fundamentally asks how the interests and preferences of the individual and the interests of others should be weighed (in view of public safety and managing public risk). Highly diverse domains such as education, mental health, and the judicial domain might be involved, and moral bioenhancement might challenge existing institutional settings. Given these highly varied contexts and domains, it appears unlikely that there will be a distinct set of practices that will be referred to as "moral bioenhancement."

Engaging patients in primary care practice transformation: theory, evidence and practice.

PubMed

Sharma, Anjana E; Grumbach, Kevin

2017-06-01

Patient engagement is a fundamental strategy for achieving patient centred care and is receiving increasing attention in primary care reform efforts such as the patient-centred medical home and related care models. Much of the prior published theory and evidence supporting patient engagement has focused on improving engagement in individual care. Much less is understood about engaging patients as partners in practice improvement at the primary care clinic or practice level. We review the historical and policy context for the growing interest in the USA and UK in patient engagement at the primary care practice level, highlight findings from systematic reviews of the research evidence on practice-level patient engagement and discuss practical considerations for implementing patient engagement. We conclude that while there are persuasive ethical and social justice reasons for empowering patient involvement in practice improvement at the clinic level, research conducted to date in primary care provides suggestive but not yet resounding evidence in support of the instrumental triple aim benefit of practice-level patient engagement. We propose a research agenda to better understand the process and outcomes of practice-level patient engagement and its potential advantages to both the practice and the patients and communities served. Better evidence as well as resources to support and incentivize effective and feasible engagement methods are needed to catalyse greater diffusion of practice-level patient engagement in primary care practices. © The Author 2016. Published by Oxford University Press.

Deriving consensus on the characteristics of advanced practice nursing: meta-summary of more than 2 decades of research.

PubMed

Hutchinson, Marie; East, Leah; Stasa, Helen; Jackson, Debra

2014-01-01

Over recent decades, there has been considerable research and debate about essential features of advanced nursing practice and differences among various categories of advanced practice nurses. This study aimed to derive an integrative description of the defining characteristics of advanced practice nursing through a meta-summary of the existing literature. A three-phase approach involved (a) systematic review of the literature to identify the specific activities characterized as advanced practice nursing, (b) qualitative meta-summary of practice characteristics extracted from manuscripts meeting inclusion criteria; and (c) statistical analysis of domains across advanced practice categories and country in which the study was completed. A descriptive framework was distilled using qualitative and quantitative results. Fifty manuscripts met inclusion criteria and were retained for analysis. Seven domains of advanced nursing practice were identified: (a) autonomous or nurse-led extended clinical practice; (b) improving systems of care; (c) developing the practice of others; (d) developing/delivering educational programs/activities; (e) nursing research/scholarship; (f) leadership external to the organization; and (g) administering programs, budgets, and personnel. Domains were similar across categories of advanced nursing practice; the domain of developing/delivering educational programs/activities was more common in Australia than in the United States or United Kingdom. Similarity at the domain level was sufficient to suggest that advanced practice role categories are less distinct than often argued. There is merit in adopting a more integrated and consistent interpretation of advanced practice nursing.

Exploring staff perceptions and experiences of volunteers and visitors on the hospital ward at mealtimes using an ethnographic approach.

PubMed

Ottrey, Ella; Palermo, Claire; Huggins, Catherine E; Porter, Judi

2018-04-01

To explore multiple perspectives and experiences of volunteer and visitor involvement and interactions at hospital mealtimes. In addition, to understand how the volunteer and visitor role at mealtimes is perceived within the hospital system. Mealtime assistance can improve patients' food intake and mealtime experience. Barriers to providing mealtime assistance include time pressures, staff availability and inadequate communication. Volunteers and visitors can encourage and assist patients at mealtimes. There is a lack of evidence on the relationship between hospital staff, volunteers and visitors. A qualitative, ethnographic approach. Sixty-seven hours of fieldwork were conducted on two subacute wards within an Australian healthcare network in 2015. Mealtime practices and interactions of hospital staff, volunteers and visitors were observed. Sixty-one staff, volunteers and visitors were interviewed in 75 ethnographic and semi-structured interviews. Data were inductively and thematically analysed. Three key themes emerged as follows: "help"-volunteers and visitors were considered helpful when they assisted patients at mealtimes, supported well-being and aided staff-patient communication; "hindrance"-staff perceived visitors as negative presences when they inhibited patient progress and impacted staff work practices; and "reality of practice"-visiting hours, visitor engagement in patient therapy and communication between staff, volunteers and visitors were important practical considerations of mealtime involvement. The findings show how and why volunteers and visitors can be helpful and unhelpful at hospital mealtimes on subacute wards. More research on the role and contribution of volunteers and visitors on hospital wards will inform future practice in healthcare settings. This healthcare organisation should continue to encourage volunteer and visitor involvement at hospital mealtimes. More effort is needed to educate visitors about patients' therapeutic goals and the importance of nutrition. The working relationship between hospital staff, volunteers and visitors should be strengthened to improve nutritional care. © 2018 John Wiley & Sons Ltd.

The status of anencephalic babies: should their bodies be used as donor banks?

PubMed Central

Davis, A

1988-01-01

In recent months there has been considerable discussion on the ethics of using organs from anencephalic babies for transplantation purposes. The heart of an anencephalic in Ireland was so used, but the recipient died very soon after the operation. Since this case came to light the Royal College of Physicians has imposed a ban on the use of these babies as donors while a working party investigates the issues involved.* This article attempts to examine the problem and reaches the conclusion that in practice it is not ethical to use the organs of anencephalics for transplants. PMID:3184137

The acceptance of in silico models for REACH: Requirements, barriers, and perspectives

PubMed Central

2011-01-01

In silico models have prompted considerable interest and debate because of their potential value in predicting the properties of chemical substances for regulatory purposes. The European REACH legislation promotes innovation and encourages the use of alternative methods, but in practice the use of in silico models is still very limited. There are many stakeholders influencing the regulatory trajectory of quantitative structure-activity relationships (QSAR) models, including regulators, industry, model developers and consultants. Here we outline some of the issues and challenges involved in the acceptance of these methods for regulatory purposes. PMID:21982269

Generating high Reynolds-number flows.

NASA Technical Reports Server (NTRS)

Russell, D. A.

1972-01-01

Present test facilities are seriously limited regarding investigations involving high Reynolds numbers due to financial considerations. Quasi-steady testing facilities offer a practical immediate solution to the problem of high-Re testing. A familiar example is the blowdown wind tunnel, but even more flexibility and economy may be provided by using shock-tube devices. The Ludwieg tube is the shock-tube device most often proposed as a means of generating high-Re flows. Two-stage nozzles may be used with a Ludwieg tube. Quasi-steady facilities will be useful only if the available test time exceeds that required to establish steady flow.

Medicare's Drug Discount Card Program: Beneficiaries' Experience with Choice

PubMed Central

Hassol, Andrea; Wrobel, Marian V.; Doksum, Teresa

2007-01-01

This article describes Medicare beneficiaries' experience with the choice among Medicare drug discount cards and is based primarily on surveys and focus groups with beneficiaries as well as interviews with other stakeholders. Although competition and choice have the potential to reduce cost and enhance quality in the Medicare Program, our findings highlight some of the challenges involved in making choice work in practice. Despite the unique and temporary nature of the drug discount card program, these findings have considerable relevance to the Part D drug benefit and to other Medicare initiatives that rely on choice. PMID:17722747

A queer-theoretical approach to community health psychology.

PubMed

Easpaig, Bróna R Nic Giolla; Fryer, David M; Linn, Seònaid E; Humphrey, Rhianna H

2014-01-01

Queer-theoretical resources offer ways of productively rethinking how central concepts such as 'person-context', 'identity' and 'difference' may be understood for community health psychologists. This would require going beyond consideration of the problems with which queer theory is popularly associated to cautiously engage with the aspects of this work relevant to the promotion of collective practice and engaging with processes of marginalisation. In this article, we will draw upon and illustrate the queer-theoretical concepts of 'performativity' and 'cultural intelligibility' before moving towards a preliminary mapping of what a queer-informed approach to community health psychology might involve.

Ethical issues and accountability in pressure ulcer prevention.

PubMed

Welsh, Lynn

2014-10-28

Pressure ulcers represent a considerable cost, both in terms of healthcare spending and quality of life. They are increasingly viewed in terms of patient harm. For clinicians involved in pressure ulcer prevention, ethical issues surrounding accountability may arise from both policy and practice perspectives. It may be useful for clinicians to refer to ethical theories and principles to create frameworks when addressing ethical dilemmas. However, such theories and principles have been criticised for their simplicity and over-generalisation. Alternative theories, for example, virtue ethics and experiential learning, can provide more comprehensive guidance and promote a pluralistic approach to tackling ethical dilemmas.

Challenges of drug risk communications in the Philippines.

PubMed

Hartigan-Go, Kenneth

2012-11-01

Risk communication in the context of patient care is about conveying balanced information on benefit and risk of medical products and procedures and developments in health. It is an integral part of pharmacovigilance and healthcare communications and involves stakeholders such as regulators, industry, health professionals and patients. In the Philippines, many factors can interfere with effective risk communication and affect the safety of patients when medicinal products are used: poverty, literacy, age, social media, practice and behaviour of health professionals, industry marketing, patient expectations and product quality. These factors must be taken into consideration when formulating effective risk communications to ensure patient safety.

[New business model for medical specialists].

PubMed

Houwen, L G H J Louis

2013-01-01

The reforms in the field of medical specialist care have important implications for the professional practice of medical specialists and their working relationship with the hospital. This leads to a considerable amount of pressure placed upon the way physicians have traditionally practiced their liberal professions, which is by forming partnerships and practicing from within the hospitals based on an admission agreement. As of 2015, the tax benefits for entrepreneurs will be abolished and the formation of regional partnerships will be discouraged. These developments not only pose threats but also offer opportunities for both the entrepreneurial medical specialist and the innovative hospital. In this article, the prospect of a future business model for specialist medical care will be outlined and explored by proposing three new organizational forms. The central vision of this model is that physicians who wish to retain their status of liberal professional practitioners in the twenty-first century should be more involved in the ownership structure of hospitals. The social importance of responsible patient care remains paramount.

Discussion of Extinction-Based Behavioral Sleep Interventions for Young Children and Reasons Why Parents May Find Them Difficult

PubMed Central

Etherton, Hayley; Blunden, Sarah; Hauck, Yvonne

2016-01-01

The majority of behavioral sleep interventions for young children involve extinction procedures where parents must ignore their child's cries for a period. Many parents have difficulties with this, contributing to attrition, non-compliance, and treatment avoidance. Yet why these methods are difficult to implement has rarely been addressed in the literature. This paper discusses seven potential reasons why parents may find extinction sleep interventions difficult: enduring crying, practical considerations, fear of repercussions, misinformation, incongruence with personal beliefs, different cultural practices, and parent wellness. These reasons are discussed in relation to the current literature. Practicing health professionals and sleep researchers could benefit from an awareness of these issues when suggesting extinction interventions and offering alternatives which may be more appropriate for family circumstances and facilitate parental informed choice. Citation: Etherton H, Blunden S, Hauck Y. Discussion of extinction-based behavioral sleep interventions for young children and reasons why parents may find them difficult. J Clin Sleep Med 2016;12(11):1535–1543. PMID:27655457

Learning science as a potential new source of understanding and improvement for continuing education and continuing professional development.

PubMed

Van Hoof, Thomas J; Doyle, Terrence J

2018-01-15

Learning science is an emerging interdisciplinary field that offers educators key insights about what happens in the brain when learning occurs. In addition to explanations about the learning process, which includes memory and involves different parts of the brain, learning science offers effective strategies to inform the planning and implementation of activities and programs in continuing education and continuing professional development. This article provides a brief description of learning, including the three key steps of encoding, consolidation and retrieval. The article also introduces four major learning-science strategies, known as distributed learning, retrieval practice, interleaving, and elaboration, which share the importance of considerable practice. Finally, the article describes how learning science aligns with the general findings from the most recent synthesis of systematic reviews about the effectiveness of continuing medical education.

A qualitative metasynthesis: family involvement in decision making for people with dementia in residential aged care.

PubMed

Petriwskyj, Andrea; Gibson, Alexandra; Parker, Deborah; Banks, Susan; Andrews, Sharon; Robinson, Andrew

2014-06-01

Involving people in decisions about their care is good practice and ensures optimal outcomes. Despite considerable research, in practice family involvement in decision making can be challenging for both care staff and families. The aim of this review was to identify and appraise existing knowledge about family involvement in decision making for people with dementia living in residential aged care. The present Joanna Briggs Institute meta-synthesis considered studies that investigate involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this article presents the qualitative findings. A comprehensive search of studies was conducted in 15 electronic databases. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as relevant for this review; 16 were qualitative papers reporting on 15 studies. Two independent reviewers assessed the studies for methodological validity and extracted the data using the standardized Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). The findings were synthesized using JBI-QARI. The findings related to the decisions encountered and made by family surrogates, family perceptions of, and preferences for, their role/s, factors regarding treatment decisions and the collaborative decision-making process, and outcomes for family decision makers. Results indicate varied and complex experiences and multiple factors influencing decision making. Communication and contacts between staff and families and the support available for families should be addressed, as well as the role of different stakeholders in decisions.

The Humble Leader: Association of Discrepancies in Leader and Follower Ratings of Implementation Leadership with Organizational Climate in Mental Health

PubMed Central

Aarons, Gregory A.; Ehrhart, Mark G.; Torres, Elisa M.; Finn, Natalie K.; Beidas, Rinad

2017-01-01

Objectives Discrepancies between leaders' self-ratings and follower ratings of the leader are common but usually go unrecognized. Research on discrepancies is limited but there is evidence that discrepancies are associated with organizational context. This study examined the association of leader-follower discrepancies in Implementation Leadership Scale (ILS) ratings of mental health clinic leaders, and the association of those discrepancies with organizational climate for involvement and performance feedback. Both involvement and performance feedback may be important for evidence-based practice implementation in mental health. Methods A total of 593 supervisors (i.e., leaders, n=80) and clinical service providers (i.e., followers, n=513) completed surveys including ratings of implementation leadership and organizational climate. Polynomial regression and response surface analyses were conducted to examine the associations of discrepancies in leader-follower ILS ratings with organizational involvement climate and performance feedback climate, aspects of climate likely to support EBP implementation. Results Both involvement climate and performance feedback climate were highest where leaders rated themselves low on the ILS and their followers rated those leaders high on the ILS (i.e., “humble leaders”). Conclusions Teams with “humble leaders” showed more positive organizational climate for involvement and for performance feedback, contextual factors important during EBP implementation and sustainment. Discrepancy in leader and follower ratings of implementation leadership should be a consideration in understanding and improving leadership and organizational climate for mental health services and for evidence-based practice implementation and sustainment in mental health and other allied health settings. PMID:27691380

Consideration of climate change on environmental impact assessment in Spain

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

Enríquez-de-Salamanca, Álvaro, E-mail: aenriquez@draba.org; Martín-Aranda, Rosa M., E-mail: rmartin@ccia.uned.es; Díaz-Sierra, Rubén, E-mail: sierra@dfmf.uned.es

Most of the projects subject to environmental impact assessment (EIA) are closely related to climate change, as they contribute to or are affected by it. The growing certainty about climate change and its impacts makes its consideration an essential part of the EIA process, as well as in strategic environmental assessment (SEA). This paper examines how climate change (CC) has been taken into account in EIA in Spain through the analysis of 1713 environmental records of decision (RODs) of projects submitted for EIA. In 2013 Spain approved one of the most advanced laws in terms of CC consideration in environmentalmore » assessment, although it had not yet accumulated extensive practice on the issue. This contrasts with the situation of countries like Canada or the USA, which have a significant body of experience without specific legal requirements. Only 14% of the RODs analysed included references to CC, and in more than half of the cases it was a mere citation. Thermal power plants, which are subject to specific GHG regulations, show the highest consideration, while transport infrastructures, which are important contributors to CC, show a very low consideration. Almost all the references are related to their contribution to CC, while consideration of the effects of CC is minimal. The increasingly common incorporation of CC into SEA, should not imply its exclusion from EIA, because both processes have different aims and uses. Including the obligation to consider CC in the EIA regulations is highly desirable, but probably not enough without other measures, such as practical guidance, training and motivational programmes for practitioners and evaluators. But even these actions cannot ensure effective and adequate assessments of CC. Probably more resources should be spent on creating greater awareness in all the agents involved in EIA. - Highlights: • We analyse how the climate change is considered in EIA in Spain. • Few projects seriously assess climate change. • Transport infrastructure projects barely consider climate change. • Assessing climate change in SEA should not imply that it is excluded from EIA.« less

Family involvement in decision making for people with dementia in residential aged care: a systematic review of quantitative literature.

PubMed

Petriwskyj, Andrea; Gibson, Alexandra; Parker, Deborah; Banks, Susan; Andrews, Sharon; Robinson, Andrew

2014-06-01

Ensuring older adults' involvement in their care is accepted as good practice and is vital, particularly for people with dementia, whose care and treatment needs change considerably over the course of the illness. However, involving family members in decision making on people's behalf is still practically difficult for staff and family. The aim of this review was to identify and appraise the existing quantitative evidence about family involvement in decision making for people with dementia living in residential aged care. The present Joanna Briggs Institute (JBI) metasynthesis assessed studies that investigated involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this paper presents the quantitative findings. A comprehensive search of 15 electronic databases was performed. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as being relevant; 10 were quantitative, with 1 mixed method study. Two independent reviewers assessed the studies for methodological validity and extracted the data using the JBI Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). The findings were synthesized and presented in narrative form. The findings related to decisions encountered and made by family surrogates, variables associated with decisions, surrogates' perceptions of, and preferences for, their roles, as well as outcomes for people with dementia and their families. The results identified patterns within, and variables associated with, surrogate decision making, all of which highlight the complexity and variation regarding family involvement. Attention needs to be paid to supporting family members in decision making in collaboration with staff.

Physician shadowing: a review of the literature and proposal for guidelines.

PubMed

Kitsis, Elizabeth A; Goldsammler, Michelle

2013-01-01

Premedical students commonly shadow physicians to gain an understanding of what careers in medicine entail. The authors reviewed the literature to explore (1) whether shadowing achieves this goal consistently and effectively, (2) the ethical issues involved, and (3) other reasons that individuals shadow physicians. The authors searched the MEDLINE database via Ovid for English-language articles published from 1948 to March 2011. Eligible articles described physician shadowing programs and/or assessed the value of physician shadowing independently or in comparison with other educational methods. Of 770 articles identified, 13 articles about physician shadowing programs met inclusion criteria. Two of the 13 programs involved shadowing only, whereas 11 included other educational initiatives. Participants varied; shadowers included students (high school, college, medical school), recent medical school graduates, or international medical graduates. Few studies addressed shadowing by premedical students. Most studies involved programs outside the United States. Shadowing program objectives and characteristics differed. Data reported from focus groups, interviews, and surveys suggest that shadowing experiences generally increased participants' interest in medicine (or a specialty) or improved participants' confidence in transitioning to a new position. Some articles raised ethical and practical concerns related to shadowing. The few shadowing programs described in the literature were heterogeneous and often involved other activities. Further research is warranted; objective outcomes measures would be useful. The authors propose developing guidelines and introducing a code of conduct for premedical students, to enhance the consistency of shadowing experiences and address ethical and practical considerations.

A collaborative approach to supporting communication in the assessment of decision-making capacity.

PubMed

Zuscak, Simon John; Peisah, Carmelle; Ferguson, Alison

2016-01-01

This paper explores the clinical implications of acquired communication disorders in decisional capacity. Discipline-specific contributions are discussed in a multidisciplinary context, with a specific focus on the role of speech and language pathologists (SLPs). Key rehabilitation issues in determining decisional capacity are identified. The impact of communication impairment on capacity is discussed in light of the research literature relating to supportive communication and collaborative practice that respects human rights. Guidelines are presented for professionals involved in the assessment of the decisional capacity of individuals with communication disorders of neurological origin. They guide an assessor through: assessing cognition, language and speech; determining preferred communication domains; and practical strategies and considerations for maximising communication. There is a dearth of guidelines available that deal with augmenting and supporting communication of individuals with acquired communication disorders of neurological origin when it comes to assessing legal decision-making capacity. Capacity assessment is a multidisciplinary realm, and the involvement of SLPs is key to maximising the decision-making capacity of these individuals. All clinicians have an obligation to maximise client autonomy and participation in decision-making. Assessments of capacity should involve a general cognitive ability assessment, followed by a decision-specific assessment tool or question set for the decision facing the patient. The involvement of speech and language pathologists (SLPs) is key to assess and facilitate capacity determinations in instances of cognitive-communication disorder. Impairments in different aspects of auditory comprehension require different accommodations.

Need for an "integrated safety assessment" of GMOs, linking food safety and environmental considerations.

PubMed

Haslberger, Alexander G

2006-05-03

Evidence for substantial environmental influences on health and food safety comes from work with environmental health indicators which show that agroenvironmental practices have direct and indirect effects on human health, concluding that "the quality of the environment influences the quality and safety of foods" [Fennema, O. Environ. Health Perspect. 1990, 86, 229-232). In the field of genetically modified organisms (GMOs), Codex principles have been established for the assessment of GM food safety and the Cartagena Protocol on Biosafety outlines international principles for an environmental assessment of living modified organisms. Both concepts also contain starting points for an assessment of health/food safety effects of GMOs in cases when the environment is involved in the chain of events that could lead to hazards. The environment can act as a route of unintentional entry of GMOs into the food supply, such as in the case of gene flow via pollen or seeds from GM crops, but the environment can also be involved in changes of GMO-induced agricultural practices with relevance for health/food safety. Examples for this include potential regional changes of pesticide uses and reduction in pesticide poisonings resulting from the use of Bt crops or influences on immune responses via cross-reactivity. Clearly, modern methods of biotechnology in breeding are involved in the reasons behind the rapid reduction of local varieties in agrodiversity, which constitute an identified hazard for food safety and food security. The health/food safety assessment of GM foods in cases when the environment is involved needs to be informed by data from environmental assessment. Such data might be especially important for hazard identification and exposure assessment. International organizations working in these areas will very likely be needed to initiate and enable cooperation between those institutions responsible for the different assessments, as well as for exchange and analysis of information. An integrated assessment might help to focus and save capacities in highly technical areas such as molecular characterization or profiling, which are often necessary for both assessments. In the area of establishing international standards for traded foods, such as for the newly created Standards in Trade and Development Facility (STDF), an integrated assessment might help in the consideration of important environmental aspects involved in health and food safety. Furthermore, an established integrated view on GMOs may create greater consumer confidence in the technology.

Articles on Practical Cybernetics. Computer-Developed Computers; Heuristics and Modern Sciences; Linguistics and Practice; Cybernetics and Moral-Ethical Considerations; and Men and Machines at the Chessboard.

ERIC Educational Resources Information Center

Berg, A. I.; And Others

Five articles which were selected from a Russian language book on cybernetics and then translated are presented here. They deal with the topics of: computer-developed computers, heuristics and modern sciences, linguistics and practice, cybernetics and moral-ethical considerations, and computer chess programs. (Author/JY)

Opinion paper: scientific, philosophical and legal consideration of doping in sports.

PubMed

Negro, Massimo; Marzullo, Natale; Caso, Francesca; Calanni, Luca; D'Antona, Giuseppe

2018-04-01

The term doping is generally used to indicate practices based on the use of performance-enhancing drugs (PEDs) or the abuse of medical therapies. Mostly analysed by doctors and officials, doping nevertheless also requires a philosophical consideration to avoid being simplistically portrayed as an isolated practice. To do this, we need to pay attention to the contradictions and paradoxes in the modern approach to doping in sport. In this context, doping is not only relevant to the health of an individual involved in the violation of World Anti-Doping Agency (WADA) criteria, but it actually represents a double-edged phenomenon containing ethical and legal points of view. Several philosophical items affect the ethics of doping. While, indeed, through a deontological vision it is easy to morally condemn an athlete who takes the decision to turn to doping, the same condemnation becomes difficult when the practice of doping is compared with the strong social demand of winners in every field of life. This point must be considered to prevent doping from becoming accepted as a daily practice to excel at all costs and regarded not only as normal but as a necessity for those participating in sport at both an amateur and professional level. Furthermore, a complete discussion on doping has to consider not only the philosophy of performance-enhancing drug abuse, but also the widespread practice of an inappropriate and excessive intake of certain dietary supplements with the unique and obsessive purpose (similar to doping) of increasing physical or mental performance. Based on the above, the aim of this paper is to provide a critical opinion of the doping problem and its related practices and analyze possible solutions considering issues that go beyond the impact of doping on health and reflect on whether it is right or not that an athlete does all he can to improve his performance.

Review of the International Society for Heart and Lung Transplantation Practice guidelines for management of heart failure in children.

PubMed

Colan, Steven D

2015-08-01

In 2004, practice guidelines for the management of heart failure in children by Rosenthal and colleagues were published in conjunction with the International Society for Heart and Lung Transplantation. These guidelines have not been updated or reviewed since that time. In general, there has been considerable controversy as to the utility and purpose of clinical practice guidelines, but there is general recognition that the relentless progress of medicine leads to the progressive irrelevance of clinical practice guidelines that do not undergo periodic review and updating. Paediatrics and paediatric cardiology, in particular, have had comparatively minimal participation in the clinical practice guidelines realm. As a result, most clinical practice guidelines either specifically exclude paediatrics from consideration, as has been the case for the guidelines related to cardiac failure in adults, or else involve clinical practice guidelines committees that include one or two paediatric cardiologists and produce guidelines that cannot reasonably be considered a consensus paediatric opinion. These circumstances raise a legitimate question as to whether the International Society for Heart and Lung Transplantation paediatric heart failure guidelines should be re-reviewed. The time, effort, and expense involved in producing clinical practice guidelines should be considered before recommending an update to the International Society for Heart and Lung Transplantation Paediatric Heart Failure guidelines. There are specific areas of rapid change in the evaluation and management of heart failure in children that are undoubtedly worthy of updating. These domains include areas such as use of serum and imaging biomarkers, wearable and implantable monitoring devices, and acute heart failure management and mechanical circulatory support. At the time the International Society for Heart and Lung Transplantation guidelines were published, echocardiographic tissue Doppler, 3 dimensional imaging, and strain and strain rate were either novel or non-existent and have now moved into the main stream. Cardiac magnetic resonance imaging (MRI) had very limited availability, and since that time imaging and assessment of myocardial iron content, delayed gadolinium enhancement, and extracellular volume have moved into the mainstream. The only devices discussed in the International Society for Heart and Lung Transplantation guidelines were extracorporeal membrane oxygenators, pacemakers, and defibrillators. Since that time, ventricular assist devices have become mainstream. Despite the relative lack of randomised controlled trials in paediatric heart failure, advances continue to occur. These advances warrant implementation of an update and review process, something that is best done under the auspices of the national and international cardiology societies. A joint activity that includes the International Society for Heart and Lung Transplantation, American College of Cardiology/American Heart Association, the Association for European Paediatric and Congenital Cardiology (AEPC), European Society of Cardiology, Canadian Cardiovascular Society, and others will have more credibility than independent efforts by any of these organisations.

Developing a 'critical' approach to patient and public involvement in patient safety in the NHS: learning lessons from other parts of the public sector?

PubMed

Ocloo, Josephine E; Fulop, Naomi J

2012-12-01

There has been considerable momentum within the NHS over the last 10 years to develop greater patient and public involvement (PPI). This commitment has been reflected in numerous policy initiatives. In patient safety, the drive to increase involvement has increasingly been seen as an important way of building a safety culture. Evidence suggests, however, that progress has been slow and even more variable than in health care generally. Given this context, the paper analyses some of the key underlying drivers for involvement in the wider context of health and social care and makes some suggestions on what lessons can be learned for developing the PPI agenda in patient safety. To develop PPI further, it is argued that a greater understanding is needed of the contested nature of involvement in patient safety and how this has similarities to the emergence of user involvement in other parts of the public services. This understanding has led to the development of a range of critical theories to guide involvement that also make more explicit the underlying factors that support and hinder involvement processes, often related to power inequities and control. Achieving greater PPI in patient safety is therefore seen to require a more critical framework for understanding processes of involvement that can also help guide and evaluate involvement practices. © 2011 Blackwell Publishing Ltd.

How do health service professionals consider human factors when purchasing interactive medical devices? A qualitative interview study.

PubMed

Vincent, Christopher James; Blandford, Ann

2017-03-01

We present findings of a UK study into how those involved in purchasing interactive medical devices go about evaluating usability, the challenges that arise, and opportunities for improvement. The study focused on procurement of infusion devices because these are used by various professionals across healthcare. A semi-structured interview study was carried out involving a range of stakeholders (20 in total) involved in or impacted by medical device procurement. Data was analysed using thematic analysis, a qualitative method designed to support the identification, analysis and reporting of patterns. In principle, health service purchasing was found to accommodate consideration of equipment usability. In practice, the evaluation process was driven primarily by engineering standards; assessment of local needs did not accommodate substantive assessment of usability; and choice was limited by the availability of equipment on the marketplace. We discuss ways in which purchasing could be improved through techniques that account for social circumstances. Copyright © 2016 Elsevier Ltd. All rights reserved.

Compliance revisited: pharmaceutical drug trials in the era of the contract research organization.

PubMed

Jonvallen, Petra

2009-12-01

Over the past decade, the management of clinical trials of pharmaceuticals has become a veritable industry, as evidenced by the emergence and proliferation of contract research organizations (CROs) that co-ordinate and monitor trials. This article focuses on work performed by one CRO involved in the introduction of new software, modelled on industrial production processes, into clinical trial practices. It investigates how this new management technique relates to the work performed in the clinic to ensure that trial participants comply with the protocol. Using an analytical distinction between 'classical' management work and invisible work, the article contextualizes the meaning of compliance in the clinic and suggests that the work involved in producing compliance should be taken into consideration by those concerned with validity of trials, as clinical trials are put under private industrial management. The article builds on participant observation at a Swedish university hospital and interviews the nurses, dieticians, doctors and a software engineer, all part of a team involved in pharmaceutical drug trials on a potential obesity drug.

'Calling executives and clinicians to account': user involvement in commissioning cancer services.

PubMed

Evans, David H; Bacon, Roger J; Greer, Elizabeth; Stagg, Angela M; Turton, Pat

2015-08-01

English NHS guidance emphasizes the importance of involving users in commissioning cancer services. There has been considerable previous research on involving users in service improvement, but not on involvement in commissioning cancer services. To identify how users were involved as local cancer service commissioning projects sought to implement good practice and what has been learned. Participatory evaluation with four qualitative case studies based on semi-structured interviews with project stakeholders, observation and documentary analysis. Users were involved in every stage from design to analysis and reporting. Four English cancer network user involvement in commissioning projects, with 22 stakeholders interviewed. Thematic analysis identified nine themes: initial involvement, preparation for the role, ability to exercise voice, consistency and continuity, where decisions are made, closing the feedback loop, assessing impact, value of experience and diversity. Our findings on the impact of user involvement in commissioning cancer services are consistent with other findings on user involvement in service improvement, but highlight the specific issues for involvement in commissioning. Key points include the different perspectives users and professionals may have on the impact of user involvement in commissioning, the time necessary for meaningful involvement, the importance of involving users from the beginning and the value of senior management and PPI facilitator support and training. Users can play an important role in commissioning cancer services, but their ability to do so is contingent on resources being available to support them. © 2013 John Wiley & Sons Ltd.

Practical Considerations in Pediatric Surgery

PubMed Central

Louis, Matthew R.; Meaike, Jesse D.; Chamata, Edward; Hollier, Larry H.

2016-01-01

The care of pediatric patients requires special considerations that are often not addressed in the literature. Relatively straightforward tasks such as clinical evaluation, antibiotic use, splinting, wound closure, and care of simple burns become complicated in the pediatric population for several reasons. The authors seek to demystify some of these topics using the senior author's years of clinical experience treating pediatric patients by giving practical advice and general considerations when treating children. PMID:27895539

16 CFR 1012.1 - General policy considerations; scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Policy, sets forth requirements for advance public notice, public attendance, and recordkeeping for... 16 Commercial Practices 2 2010-01-01 2010-01-01 false General policy considerations; scope. 1012.1 Section 1012.1 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL MEETINGS POLICY-MEETINGS...

Advancing practice relating to SEA alternatives

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

González, Ainhoa, E-mail: agonzal@tcd.ie; Thérivel, Riki, E-mail: levett-therivel@phonecoop.coop; Fry, John, E-mail: john.fry@ucd.ie

Developing and assessing alternatives is a key and central stage to Strategic Environmental Assessment (SEA). However, research has repeatedly reported this stage as one of the most poorly undertaken aspects of the SEA process. Current practice limitations include belated consideration of reasonable alternatives, narrow scope of alternatives that often include unrealistic or retrofitted options, limited stakeholder and public involvement in their identification, assessment and selection, lack of systematic approaches to their assessment and comparison, and inadequate reporting of the ‘storyline’ on how they were identified, what the potential impacts are and why the preferred alternative was selected. These issues havemore » resulted in objections and judicial reviews. On the positive side, a number of good practice case studies enable extraction of key lessons and formulation of a set of general recommendations to advance practice in SEA alternatives. In this paper, practical guidance on the identification and development of alternatives, their assessment and comparison, selection of the preferred option, and documentation of the process and the reasons for selection is provided and discussed to frame good practice approaches. - Highlights: • Alternatives are one of the most poorly completed aspects of Strategic Environmental Assessment. • Current practice limitations need to be addressed to enhance SEA effectiveness. • A set of recommendations are extracted from good practice case studies. • These recommendations can be applied across jurisdictions and sectors and tailored as necessary.« less

Professional roles in physiotherapy practice: Educating for self-management, relational matching, and coaching for everyday life.

PubMed

Solvang, Per Koren; Fougner, Marit

2016-11-01

The patient's active participation in treatment and rehabilitation represents a cultural change in clinical practice as well as a major change in physiotherapist and patient roles. This article presents findings from a study aimed at gaining a better understanding of how physiotherapists in actual practice understand their interactions with patients during the treatment process. This article reports on the findings from focus-group interviews with physiotherapists working in three different settings. Analyses of the interview data identified three modes of physiotherapy practice. In one, physiotherapists educate their patients to be self-managing in conducting exercise programs based on sound evidence. Educational films available on the Internet are included in these efforts to teach patients. In another, physiotherapists emphasize the importance of a close relationship to the patient. A good personal chemistry is believed to improve the treatment process. And finally, what physiotherapists learn about the living conditions and the biographies of their patients was shown to be very important. Understanding the importance of the life-world and taking this into consideration in the treatment process were factors considered to be central to good practice. The article concludes with a discussion linking these findings to those of other studies identifying those factors contributing to our knowledge of what is involved in biopsychosocial practice in physiotherapy.

Use of mobile devices in community health care: barriers and solutions to implementation.

PubMed

Turner, Christopher

2016-02-01

Mobile devices allow clinicians to access electronic clinical systems away from traditional base locations. They have contributed to increased productivity and efficiency, and clinical staff also cite benefits to patient care. A selection of NHS trusts have participated in a national pilot to explore the benefits and drawbacks of this technology. Clinical engagement with frontline staff is essential to ensure the staff feel valued, listened to, and fully involved to ensure any change to existing practice is successful. Moreover, the training needs of the workforce require careful consideration. The provision of information technology (IT) support services is fundamental to ensure that staff receive the necessary assistance with any functionality issues they may experience with mobile devices to minimise the effect on clinical practice. Variability in internet connectivity may present as a challenge to clinical staff, and the benefits of complimentary offline working solutions should be considered. Barriers to the successful use of mobile devices should be reported as this may have a negative clinical effect on the safe delivery of patient care. Clinical staff need to be mindful of their obligations in relation to information governance, and should appreciate that the same consideration needs to be given to both paper and electronic records.

Prospective-pricing strategies for hospital and departmental effectiveness: the physician's response.

PubMed

Shapleigh, C

1985-10-01

Physician-practice patterns are discussed, and programs of decentralization designed to reduce ancillary use are described. The New England Medical Center (NEMC) conducted a study with two other major hospitals in Boston comparing physician-practice patterns for patients who had had carotid endarterectomies. The indications for surgery for these patients did not appear to be different among the hospitals; however, average charges and length of stay varied considerably. Operating-room time and postoperative management also varied substantially. Strategies to change physician-practice patterns must address the issues of incentives to physicians and hospitals. At NEMC, a program of decentralization is being implemented that involves physician participation in budgeting hospital resources. A program of product pricing has been developed, whereby the NEMC offers an HMO a fixed price for certain kinds of cases upon admission. A daily use report was started to report resource use for specific cases compared with annual medians for that type of case. Case types from many different surgical specialties are involved. The reports show physicians the difference between the actual and expected costs in terms of variances. The NEMC has reoriented its budgeting process to include clinical divisions. Clinical services are planning to budget the use of intermediate products across different cost centers. The clinical budgeting program makes the planning process more objective, lowers the use of ancillary services, and reduces costs.

16 CFR 1061.12 - Commission consideration on merits.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Commission consideration on merits. 1061.12 Section 1061.12 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL APPLICATIONS FOR EXEMPTION... available and relevant information on the proposal. (c) The Commission's evaluation will focus on: (1...

STORMWATER BEST MANAGEMENT PRACTICES DESIGN GUIDE VOLUME 1 - GENERAL CONSIDERATIONS

EPA Science Inventory

This document is Volume 1 of a three volume series that provides guidance on the selection and design of stormwater management Best Management Practices (BMPs). This first volume provides general considerations associated with the selection and design of BMPs.
Volume I provi...

Students who are deaf and hard of hearing and use sign language: considerations and strategies for developing spoken language and literacy skills.

PubMed

Nussbaum, Debra; Waddy-Smith, Bettie; Doyle, Jane

2012-11-01

There is a core body of knowledge, experience, and skills integral to facilitating auditory, speech, and spoken language development when working with the general population of students who are deaf and hard of hearing. There are additional issues, strategies, and challenges inherent in speech habilitation/rehabilitation practices essential to the population of deaf and hard of hearing students who also use sign language. This article will highlight philosophical and practical considerations related to practices used to facilitate spoken language development and associated literacy skills for children and adolescents who sign. It will discuss considerations for planning and implementing practices that acknowledge and utilize a student's abilities in sign language, and address how to link these skills to developing and using spoken language. Included will be considerations for children from early childhood through high school with a broad range of auditory access, language, and communication characteristics. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Mental Capacity Act 2005: implications for dietetic practice.

PubMed

Lyons, C; Brotherton, A; Stanley, N; Carrahar, M; Manthorpe, J

2007-08-01

The Mental Capacity Act (MCA) 2005 will be implemented in England and Wales in 2007 and have consequences for dietitians who work with people who may lack capacity to make specific decisions. This paper will explore issues arising from the introduction of the Act and considers the implications for dietitians involved in the delivery of clinical care, using enteral feeding as an illustrative example. If patients lack capacity to make specific decisions, dietitians will be required to record if, how and why they reached a decision, how they are involved in the decision making process and need to be able to justify their actions in relation to those decisions. This paper discusses the importance of dietitians' involvement in best interests decision making and considers the implications of decision making where people have drawn up a Lasting Power of Attorney. The role of such advance decisions is discussed and consideration is given to the potential compatibility of perspectives between the patient and family that may give rise to disputes. Dietitians may be well placed within multidisciplinary team working to ensure patients and their carers are part of the decision making process through effective communication and support for patients. Dietitians in England and Wales must consider the implications of the MCA upon their clinical practice and others outside these jurisdictions may like to reflect on the relevance of such developments in their own contexts.

The Essential Elements of a Risk Governance Framework for Current and Future Nanotechnologies.

PubMed

Stone, Vicki; Führ, Martin; Feindt, Peter H; Bouwmeester, Hans; Linkov, Igor; Sabella, Stefania; Murphy, Finbarr; Bizer, Kilian; Tran, Lang; Ågerstrand, Marlene; Fito, Carlos; Andersen, Torben; Anderson, Diana; Bergamaschi, Enrico; Cherrie, John W; Cowan, Sue; Dalemcourt, Jean-Francois; Faure, Michael; Gabbert, Silke; Gajewicz, Agnieszka; Fernandes, Teresa F; Hristozov, Danail; Johnston, Helinor J; Lansdown, Terry C; Linder, Stefan; Marvin, Hans J P; Mullins, Martin; Purnhagen, Kai; Puzyn, Tomasz; Sanchez Jimenez, Araceli; Scott-Fordsmand, Janeck J; Streftaris, George; van Tongeren, Martie; Voelcker, Nicolas H; Voyiatzis, George; Yannopoulos, Spyros N; Poortvliet, P Marijn

2017-12-14

Societies worldwide are investing considerable resources into the safe development and use of nanomaterials. Although each of these protective efforts is crucial for governing the risks of nanomaterials, they are insufficient in isolation. What is missing is a more integrative governance approach that goes beyond legislation. Development of this approach must be evidence based and involve key stakeholders to ensure acceptance by end users. The challenge is to develop a framework that coordinates the variety of actors involved in nanotechnology and civil society to facilitate consideration of the complex issues that occur in this rapidly evolving research and development area. Here, we propose three sets of essential elements required to generate an effective risk governance framework for nanomaterials. (1) Advanced tools to facilitate risk-based decision making, including an assessment of the needs of users regarding risk assessment, mitigation, and transfer. (2) An integrated model of predicted human behavior and decision making concerning nanomaterial risks. (3) Legal and other (nano-specific and general) regulatory requirements to ensure compliance and to stimulate proactive approaches to safety. The implementation of such an approach should facilitate and motivate good practice for the various stakeholders to allow the safe and sustainable future development of nanotechnology. © 2017 Society for Risk Analysis.

The Unexpected in Primary Care: A Multicenter Study on the Emergence of Unvoiced Patient Agenda

PubMed Central

Peltenburg, Michael; Fischer, Joachim E.; Bahrs, Ottomar; van Dulmen, Sandra; van den Brink-Muinen, Atie

2004-01-01

PURPOSE Within the time constraints of a typical physician-patient encounter, the full patient agenda will rarely be voiced. Unexpectedly revealed issues that were neither on the patient’s list of items for discussion nor anticipated by the physician constitute an emerging agenda. We aimed to quantify the occurrence rate of emerging agendas in primary care practices and to explain the variation between patients and practices. METHODS This observational cross-sectional study involved 182 primary care practices in 9 European cultural regions. Consecutive primary care consultations were videotaped and rated. Patients completed preconsultation and postconsultation questionnaires assessing their expectations and perceived care. Emerging agenda, determined by using 11-item preconsultation and postconsultation questionnaires, was defined as care perceived by the patient to be in addition to expected care, after adjustment for cultural variations of patient expectations. RESULTS For consultations involving 2,243 patients (mean age, 44.8 years, 58.4% women), every sixth (15.8%) consultation revealed emerging psychosocial agenda. Biomedical agenda emerged in14.5% of the consultations. Rates for unmet expectations were 13.6% and 10.3%, respectively, for psychosocial and biomedical problems. Practices showed considerable heterogeneity of occurrence of emerging agenda (biomedical, median 13%, range 0%–67%; psychosocial, median 14%, range 0%–53%). After controlling for region and patient baseline characteristics, variables significantly related to emerging agenda were patient expectations and biomedical or psychosocial discourse content, but not consultation time or sex of the patient. A large proportion of the variance attributable to physicians remained concealed in a practice dummy variable (explaining up to 8% of the variance). CONCLUSION Unexpected agenda emerges in every sixth to seventh consultation in outpatient primary care visits. PMID:15576537

Ethical Considerations and Planetary Protection for Future Space Exploration - Starting with the Basics

NASA Astrophysics Data System (ADS)

Race, Margaret

2012-07-01

As COSPAR scientists deliberate what types of frameworks and policy approaches may be applicable to future activities by various sectors in space exploration, it also needs to consider the challenging question of what ethical values and foundations should be used in dealing with life, objects and activities in outer space. A 2010 COSPAR Workshop Report on Ethical Considerations for Planetary Protection in Space Exploration recommended that it is appropriate to maintain the existing PP policy aimed at scientific concerns even as we begin to explore various practical approaches to future contamination avoidance policies. It is also appropriate to examine in parallel the ethical considerations applicable to potential indigenous extraterrestrial life, non-living extraterrestrial features and environments, and planned uses and activities involving diverse life from Earth. Since numerous sectors have begun to propose activities raising varied ethical concerns (e.g., protection and management on the moon, strip mining, space synthetic biology, space code of conduct, and commercial space transport), it is timely to initiate serious international discussions about the appropriate ethical foundations and questions applicable to future space exploration. Plans are underway for convening interdisciplinary work groups to explore and deliberate on the values (e.g., intrinsic and instrumental) and ethical foundations that are appropriate for use in deliberations involving potential indigenous extraterrestrial life and the different classes of target objects and environments in our solar system. More than ever, information on bioethics, environmental ethics and geoethics will provide helpful guidance and foundational approaches of relevance to future policy deliberations that seek to go beyond science protection per se.

Public participation in decision-making on the coverage of new antivirals for hepatitis C.

PubMed

Kieslich, Katharina; Ahn, Jeonghoon; Badano, Gabriele; Chalkidou, Kalipso; Cubillos, Leonardo; Hauegen, Renata Curi; Henshall, Chris; Krubiner, Carleigh B; Littlejohns, Peter; Lu, Lanting; Pearson, Steven D; Rid, Annette; Whitty, Jennifer A; Wilson, James

2016-08-15

Purpose - New hepatitis C medicines such as sofosbuvir underline the need to balance considerations of innovation, clinical evidence, budget impact and equity in health priority-setting. The purpose of this paper is to examine the role of public participation in addressing these considerations. Design/methodology/approach - The paper employs a comparative case study approach. It explores the experience of four countries - Brazil, England, South Korea and the USA - in making coverage decisions about the antiviral sofosbuvir and involving the public and patients in these decision-making processes. Findings - Issues emerging from public participation ac tivities include the role of the universal right to health in Brazil, the balance between innovation and budget impact in England, the effect of unethical medical practices on public perception in South Korea and the legitimacy of priority-setting processes in the USA. Providing policymakers are receptive to these issues, public participation activities may be re-conceptualized as processes that illuminate policy problems relevant to a particular context, thereby promoting an agenda-setting role for the public. Originality/value - The paper offers an empirical analysis of public involvement in the case of sofosbuvir, where the relevant considerations that bear on priority-setting decisions have been particularly stark. The perspectives that emerge suggest that public participation contributes to raising attention to issues that need to be addressed by policymakers. Public participation activities can thus contribute to setting policy agendas, even if that is not their explicit purpose. However, the actualization of this contribution is contingent on the receptiveness of policymakers.

Legal approaches regarding health-care decisions involving minors: implications for next-generation sequencing

PubMed Central

Sénécal, Karine; Thys, Kristof; Vears, Danya F; Van Assche, Kristof; Knoppers, Bartha M; Borry, Pascal

2016-01-01

The development of next-generation sequencing (NGS) technologies are revolutionizing medical practice, facilitating more accurate, sophisticated and cost-effective genetic testing. NGS is already being implemented in the clinic assisting diagnosis and management of disorders with a strong heritable component. Although considerable attention has been paid to issues regarding return of incidental or secondary findings, matters of consent are less well explored. This is particularly important for the use of NGS in minors. Recent guidelines addressing genomic testing and screening of children and adolescents have suggested that as ‘young children' lack decision-making capacity, decisions about testing must be conducted by a surrogate, namely their parents. This prompts consideration of the age at which minors can provide lawful consent to health-care interventions, and consequently NGS performed for diagnostic purposes. Here, we describe the existing legal approaches regarding the rights of minors to consent to health-care interventions, including how laws in the 28 Member States of the European Union and in Canada consider competent minors, and then apply this to the context of NGS. There is considerable variation in the rights afforded to minors across countries. Many legal systems determine that minors would be allowed, or may even be required, to make decisions about interventions such as NGS. However, minors are often considered as one single homogeneous population who always require parental consent, rather than recognizing there are different categories of ‘minors' and that capacity to consent or to be involved in discussions and decision-making process is a spectrum rather than a hurdle. PMID:27302841

Legal approaches regarding health-care decisions involving minors: implications for next-generation sequencing.

PubMed

Sénécal, Karine; Thys, Kristof; Vears, Danya F; Van Assche, Kristof; Knoppers, Bartha M; Borry, Pascal

2016-11-01

The development of next-generation sequencing (NGS) technologies are revolutionizing medical practice, facilitating more accurate, sophisticated and cost-effective genetic testing. NGS is already being implemented in the clinic assisting diagnosis and management of disorders with a strong heritable component. Although considerable attention has been paid to issues regarding return of incidental or secondary findings, matters of consent are less well explored. This is particularly important for the use of NGS in minors. Recent guidelines addressing genomic testing and screening of children and adolescents have suggested that as 'young children' lack decision-making capacity, decisions about testing must be conducted by a surrogate, namely their parents. This prompts consideration of the age at which minors can provide lawful consent to health-care interventions, and consequently NGS performed for diagnostic purposes. Here, we describe the existing legal approaches regarding the rights of minors to consent to health-care interventions, including how laws in the 28 Member States of the European Union and in Canada consider competent minors, and then apply this to the context of NGS. There is considerable variation in the rights afforded to minors across countries. Many legal systems determine that minors would be allowed, or may even be required, to make decisions about interventions such as NGS. However, minors are often considered as one single homogeneous population who always require parental consent, rather than recognizing there are different categories of 'minors' and that capacity to consent or to be involved in discussions and decision-making process is a spectrum rather than a hurdle.

What is the role of procedural justice in civil commitment?

PubMed

McKenna, B G; Simpson, A I; Coverdale, J H

2000-08-01

To determine best practice management strategies in the clinical application of civil commitment. All relevant literature on the topics of 'civil commitment', 'coercion' and 'procedural justice' were located on MEDLINE and PsychLIT databases and reviewed. Literature on the use of Ulysses contracts and advance directives in mental health treatment was integrated into the findings. Best practice evidence that guides management strategies is limited to the time of enactment of civil commitment. Management strategies involve enhancing the principles of procedural justice as a means of limiting negative patient perception of commitment. In the absence of evidence-based research beyond this point of enactment, grounds for the application of the principles of procedural justice are supported by reference to ethical considerations. Ulysses contracts provide an additional method for strengthening procedural justice. Procedural justice principles should be routinely applied throughout the processes of civil commitment in order to enhance longer term therapeutic outcomes and to blunt paternalism.

The Torsion of Members Having Sections Common in Aircraft Construction

NASA Technical Reports Server (NTRS)

Trayer, George W; March, H W

1930-01-01

Within recent years a great variety of approximate torsion formulas and drafting-room processes have been advocated. In some of these, especially where mathematical considerations are involved, the results are extremely complex and are not generally intelligible to engineers. The principal object of this investigation was to determine by experiment and theoretical investigation how accurate the more common of these formulas are and on what assumptions they are founded and, if none of the proposed methods proved to be reasonable accurate in practice, to produce simple, practical formulas from reasonably correct assumptions, backed by experiment. A second object was to collect in readily accessible form the most useful of known results for the more common sections. Formulas for all the important solid sections that have yielded to mathematical treatment are listed. Then follows a discussion of the torsion of tubular rods with formulas both rigorous and approximate.

Describing spatial pattern in stream networks: A practical approach

USGS Publications Warehouse

Ganio, L.M.; Torgersen, C.E.; Gresswell, R.E.

2005-01-01

The shape and configuration of branched networks influence ecological patterns and processes. Recent investigations of network influences in riverine ecology stress the need to quantify spatial structure not only in a two-dimensional plane, but also in networks. An initial step in understanding data from stream networks is discerning non-random patterns along the network. On the other hand, data collected in the network may be spatially autocorrelated and thus not suitable for traditional statistical analyses. Here we provide a method that uses commercially available software to construct an empirical variogram to describe spatial pattern in the relative abundance of coastal cutthroat trout in headwater stream networks. We describe the mathematical and practical considerations involved in calculating a variogram using a non-Euclidean distance metric to incorporate the network pathway structure in the analysis of spatial variability, and use a non-parametric technique to ascertain if the pattern in the empirical variogram is non-random.

Design of energy harvesting systems for harnessing vibrational motion from human and vehicular motion

NASA Astrophysics Data System (ADS)

Wickenheiser, Adam; Garcia, Ephrahim

2010-04-01

In much of the vibration-based energy harvesting literature, devices are modeled, designed, and tested for dissipating energy across a resistive load at a single base excitation frequency. This paper presents several practical scenarios germane to tracking, sensing, and wireless communication on humans and land vehicles. Measured vibrational data from these platforms are used to provide a time-varying, broadband input to the energy harvesting system. Optimal power considerations are given for several circuit topologies, including a passive rectifier circuit and active, switching methods. Under various size and mass constraints, the optimal design is presented for two scenarios: walking and idling a car. The frequency response functions are given alongside time histories of the power harvested using the experimental base accelerations recorded. The issues involved in designing an energy harvester for practical (i.e. timevarying, non-sinusoidal) applications are discussed.

Critical appraisal of clinical practice guidelines in pediatric infectious diseases.

PubMed

Wilby, Kyle John; Black, Emily Kathleen; MacLeod, Claire; Wiens, Matthew; Lau, Tim T Y; Paiva, Maria A; Gorman, Sean

2015-10-01

There is a need to critically appraise clinical practice guidelines in order to ensure safe and effective practices are being implemented to optimize patient care. Appraising guidelines within one therapeutic area enable recommendations for improvement during guideline creation and dissemination. Study objectives were to systematically appraise selected published guidelines used in the treatment of pediatric infectious diseases and to make recommendations for improvement throughout the development and dissemination processes. The study occurred between collaborative academic and practice-based institutions located in Canada and Qatar. A literature search identified guidelines for management of pediatric infectious diseases from 1997 to 2013. Each guideline was appraised by four independent assessors, according to the appraisal of guidelines for research and evaluation II (AGREE II) instrument. Standardized domain scores were calculated for each guideline and pooled. Final endorsements for use in clinical practice were also determined. Inter-rater reliability was assessed using intraclass correlation coefficients. Standardized domain scores according to the AGREE II instrument. Twenty guidelines met inclusion criteria and were appraised. Pooled domain scores were: scope and purpose (69.9), stakeholder involvement (40.1), rigour of development (47.1), clarity of presentation (73.4), applicability (23.7), editorial independence (46.7), and overall assessment (55.8). Two (10%) guidelines were recommended for use without revision, 13 (65%) guidelines were recommended with modifications, and 5 (25%) guidelines were not recommended for implementation into practice. Inter-rater reliability was moderate to good with intra-class correlations of 0.65-0.93 per guideline. The majority of appraised guidelines were moderately rated, with a 25% of guidelines not recommended for use. Strategies for improvement require the involvement of all key stakeholders (caregivers, patients, and allied health professionals), and consideration of facilitators, barriers and resource implications during implementation. Additionally, critical appraisal of guidelines should become standard practice prior to adoption into clinical settings.

Pharmacy technician self-efficacies: Insight to aid future education, staff development, and workforce planning.

PubMed

Desselle, Shane P; Hoh, Ryan; Holmes, Erin R; Gill, Amanpreet; Zamora, Lemuel

2017-07-15

The roles of pharmacy technicians are increasingly prominent given pharmacy's transition to patient-centered activities and evolving scopes of practice in many U.S. states and throughout the world. The aims of this study were to assess U.S. pharmacy technicians' self-efficacies for and attitudes toward performing current and emerging roles in hospital and in community pharmacy and to identify factors related to pharmacy technician self-efficacies in these roles. A total of 5000 pharmacy technicians from 8 U.S. states were sent an electronic survey eliciting data on current involvement, self-efficacies, and attitudes for practicing in an expansive list of practice activities. The 8 states from which the sample was drawn were selected from a stratified randomized procedure using U.S. Census Bureau geographically defined regions. Pre-notification and response reminders were employed. Data were analyzed descriptively and with univariate, inferential tests, as appropriate, to determine associations with commitment, practice environment, experience level, and other variables. Of the 612 participants who responded, 494 were currently working as a technician and not enrolled in a PharmD program of study. Participants reported various activities in which they were highly engaged. Overall, attitudes toward performing most of the activities and self-efficacies were quite favorable, even for those activities in which technicians were currently less involved. There were some notable differences between technicians practicing in community versus hospital settings. Years of experience, profession commitment, and advanced employee ranking were associated with higher levels of self-efficacy, overall. This initial examination of pharmacy technician self-efficacies identified areas that along with other factors could help employers with further expanding technician practice activities and vocational institutions with considerations for education and development of these key members of the workforce. The results would suggest technicians to be ready for continued evolution in their practice. Copyright © 2017 Elsevier Inc. All rights reserved.

Conducting a qualitative child interview: methodological considerations.

PubMed

Kortesluoma, Riitta-Liisa; Hentinen, Maija; Nikkonen, Merja

2003-06-01

Studies of children have a long history, but the literature related to young children consists for the most part of studies on rather than with children and taking little account of what is regarded as significant and meaningful by children themselves. Researchers have relied almost exclusively on adults when collecting data about children's thoughts, feelings and experiences. Interviewing children, however, gives an opportunity to gain information about their subjective experiences. The purpose of this article is to illustrate the theoretical premises of child interviewing, as well as to describe some practical methodological solutions used during interviews. Factors that influence data gathered from children and strategies for taking these factors into consideration during the interview are also described. This paper is based on literature and the experience of one of the authors in interviewing children aged from 4 to 11 years about their experiences of pain. A consideration of literature dealing with the principles of child interviewing shows that there is surprisingly little guidance available on conversational methods involving children. The empirical and conceptual foundation for child interviewing is not very clear. Novice researchers especially may need recommendations about how to conduct a qualitative child interview. The method must suit both the purpose and the context.

Practitioner consensus on the determinants of capacity building practice in high-income countries.

PubMed

Swanepoel, Elizabeth; Fox, Ann; Hughes, Roger

2015-07-01

To assess and develop consensus among experienced public health nutrition practitioners from high-income countries regarding conceptualisation of capacity building in practice, and to test the content validity of a previously published conceptual framework for capacity building in public health nutrition practice. A Delphi study involving three iterations of email-delivered questionnaires testing a range of capacity determinants derived from the literature. Consensus was set at >50% of panellists ranking items as 'very important' on a five-point Likert scale across three survey rounds. Public health nutrition practice in Australia, the UK, Canada and the USA. Public health nutrition practitioners and academics. Result A total of thirty expert panellists (68% of an initial panel of forty-four participants) completed all three rounds of Delphi questionnaires. Consensus identified determinants of capacity building in practice including partnerships, resourcing, community development, leadership, workforce development, intelligence and quality of project management. The findings from the study suggest there is broad agreement among public health nutritionists from high-income countries about how they conceptualise capacity building in public health nutrition practice. This agreement suggests considerable content validity for a capacity building conceptual framework proposed by Baillie et al. (Public Health Nutr 12, 1031-1038). More research is needed to apply the conceptual framework to the implementation and evaluation of strategies that enhance the practice of capacity building approaches by public health nutrition professionals.

Nutrition research in the military.

PubMed

Hill, Neil E; Fallowfield, J L; Delves, S K; Wilson, D R

2014-06-01

Military research performed in an operational environment involves mission-specific considerations. The Institute of Naval Medicine was tasked in 2008 by the Surgeon General to investigate the nutritional status of deployed British military personnel, and how this might affect body composition, physical fitness and operational capability. This paper briefly describes the logistic and technical issues specific to military research that were encountered by the study team, how these issues were overcome and how this research has influenced military practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Testimony and interrogation of minors: assumptions about maturity and morality.

PubMed

Owen-Kostelnik, Jessica; Reppucci, N Dickon; Meyer, Jessica R

2006-01-01

This article examines the legal histories and social contexts of testimony and interrogation involving minors, developmental research on suggestibility and judgment, interactions between development and legal/sociological contexts, and the reasoning behind how minors are treated in different legal contexts. The authors argue (a) that young witnesses, victims, and suspects alike possess youthful characteristics that influence their ability to validly inform legal processes, some of which were recently recognized by the Supreme Court as they apply to the juvenile death penalty, and (b) that consideration should be given to reforming current practices in the context of juvenile interrogation. ((c) 2006 APA, all rights reserved).

Tiered Systems of Support: Practical Considerations for School Districts. Issue Focus

ERIC Educational Resources Information Center

MDRC, 2017

2017-01-01

Students learn or progress at their own paces. How can schools make sure that they get the help they need--and only the help they need? Many are turning to multi-tiered systems of support. This brief provides some practical considerations for schools contemplating tiered approaches.

17 CFR 201.411 - Commission consideration of initial decisions by hearing officers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Commission consideration of initial decisions by hearing officers. 201.411 Section 201.411 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION RULES OF PRACTICE Rules of Practice Appeal to the Commission and...

Working with women experiencing mid-trimester termination of pregnancy: the integration of nursing and feminist knowledge in the gynaecological setting.

PubMed

Huntington, Annette D

2002-03-01

1. Working with women experiencing a mid-trimester termination of pregnancy is part of clinical practice in many gynaecological services. In this paper recent research with nurses working in the gynaecological area is drawn on to explore the issues for nurses working with women experiencing mid-trimester termination. Mid-trimester terminations are those carried out between approximately 12 and 20 weeks. 2. Mid-trimester termination results in the delivery of a fetus and this event requires sensitive management as it is has the potential to cause distress for the women due to the psychological and physical impact of the procedure. However, health professionals involved can also find this a distressing clinical event due to the complex nature of the management and care required. 3. Consideration of this clinical event from a feminist perspective led to my exploring the way in which feminist theory could be applied in the situation of mid-trimester termination. Using notions from feminist theory can assist in the management of this process, and feminist concepts related to the centrality of women's experience can be integrated into actual practice. 4. A series of recommendations are provided in this paper to show the way in which feminist concepts can be integrated into clinical practice. Integrating feminist principles into practice can support both the woman experiencing the abortion and the nurse whose role in the event is sustained and intimate, and result in positive outcomes for both women. This can result in an environment that is safe and supportive for all women involved in mid-trimester terminations.

How does an increase in undergraduate teaching load affect GP teacher motivation? A grounded theory study using data from a new medical school.

PubMed

Harding, Alex; Sweeney, Grace

2013-07-01

The opening of a new medical school is a cause for celebration. Starting with a clean slate often gives the opportunity to adopt more modern teaching practices. However, encouraging large numbers of clinicians to start teaching and to adopt these new methods brings its own set of challenges. During the expansion phase of a new medical school, it was often noted that new teachers seemed to have considerable difficulties, and often expressed these as negativity towards student placements. This did not chime with much of the work from established schools, which seemed to evaluate expansion of teaching more positively. We wanted to better understand the issues involved. Semi-structured interviews were conducted involving GPs who had received medical students over the first four years of a newly established medical school. The aims were to assess the impact of the students on the new teachers, and to try to better understand why some teachers were experiencing difficulties. We collected qualitative and quantitative data at the interviews. The qualitative data were analysed using grounded theory which aims to link emerging themes together. The findings suggest that as the quantity of teaching medical students increases, the enjoyment and commitment to teaching may decrease. Concerns over the administration of teaching may begin to predominate. Two factors may help to reduce this: 1 Adequate investment in manpower and premises to reduce time and space constraints on teaching. 2 Practices considering themselves as teaching practices where education is a part of the practice identity.

"Dad - a practical guy in the shadow": Fathers' experiences of their paternal role as a father during early discharge after birth and readmission of their newborns.

PubMed

Feenstra, Maria Monberg; Nilsson, Ingrid; Danbjørg, Dorthe Boe

2018-03-01

The aim is to explore how new fathers experience early discharge after birth and readmission of their newborn in relation to their role and involvement as a father. Fathers of today are active participants during pregnancy, birth and in the care of the newborn. Still studies demonstrate that health care professionals are unsuccessful at involving fathers in ante- and postnatal care. How fathers experience their paternal role in the early postnatal period may affect the well-being of the new family. A qualitative study inspired by the hermeneutic approach. Data was collected through telephone interviews. The study was conducted in the Region of Southern Denmark in a University Hospital setting. Convenience sampling was applied. Eight fathers were included from November 2015 till February 2016 and six were interviewed. The data analysis revealed three categories: Early discharge - ups and downs, Readmission -waiting but being in good hands, and Practical guy in the shadow. Our study points at fathers being comfortable with being discharged early, but experienced insecurity when at home. The fathers experienced to be categorized by health care professionals as the practical guy, who had to assist the mother. Yet fathers saw themselves as equal to the mothers. Fathers also saw themselves in the shadow of the mother and showed greater considerations for the mother's feelings than their own. Fathers can be insecure in their paternal role when being met as just the practical guy. Copyright © 2017 Elsevier B.V. All rights reserved.

Interpersonal Privacy Management in Distributed Collaboration: Situational Characteristics and Interpretive Influences

NASA Astrophysics Data System (ADS)

Patil, Sameer; Kobsa, Alfred; John, Ajita; Brotman, Lynne S.; Seligmann, Doree

To understand how collaborators reconcile the often conflicting needs of awareness and privacy, we studied a large software development project in a multinational corporation involving individuals at sites in the U.S. and India. We present a theoretical framework describing privacy management practices and their determinants that emerged from field visits, interviews, and questionnaire responses. The framework identifies five relevant situational characteristics: issue(s) under consideration, physical place(s) involved in interaction(s), temporal aspects, affordances and limitations presented by technology, and nature of relationships among parties. Each actor, in turn, interprets the situation based on several simultaneous influences: self, team, work site, organization, and cultural environment. This interpretation guides privacy management action(s). Past actions form a feedback loop refining and/or reinforcing the interpretive influences. The framework suggests that effective support for privacy management will require that designers follow a socio-technical approach incorporating a wider scope of situational and interpretive differences.

Universality Results for Multi-Layer Hele-Shaw and Porous Media Flows

NASA Astrophysics Data System (ADS)

Daripa, Prabir

2012-11-01

Saffman-Taylor instability is a well known viscosity driven instability of an interface. Motivated by a need to understand the effect of various injection policies currently in practice for chemical enhanced oil recovery, we study linear stability of displacement processes in a Hele-Shaw cell involving injection of an arbitrary number of immiscible fluid phases in succession. This is a problem involving many interfaces. Universal stability results have been obtained for this multi-layer (multi-region) flow in the sense that the results hold with arbitrary number of interfaces. These stability results have been applied to design injection policies that are considerably less unstable than the pure Saffman-Taylor case. In particular, we determine specific values of the viscosity of the fluid layers corresponding to smallest unstable band. Moreover, we discuss universal selection principle of optimal viscous profiles. The talk is based on following papers. Qatar National Fund (a member of the Qatar Foundation).

Optimization of Operations Resources via Discrete Event Simulation Modeling

NASA Technical Reports Server (NTRS)

Joshi, B.; Morris, D.; White, N.; Unal, R.

1996-01-01

The resource levels required for operation and support of reusable launch vehicles are typically defined through discrete event simulation modeling. Minimizing these resources constitutes an optimization problem involving discrete variables and simulation. Conventional approaches to solve such optimization problems involving integer valued decision variables are the pattern search and statistical methods. However, in a simulation environment that is characterized by search spaces of unknown topology and stochastic measures, these optimization approaches often prove inadequate. In this paper, we have explored the applicability of genetic algorithms to the simulation domain. Genetic algorithms provide a robust search strategy that does not require continuity and differentiability of the problem domain. The genetic algorithm successfully minimized the operation and support activities for a space vehicle, through a discrete event simulation model. The practical issues associated with simulation optimization, such as stochastic variables and constraints, were also taken into consideration.

New Developments of Computational Fluid Dynamics and Their Applications to Practical Engineering Problems

NASA Astrophysics Data System (ADS)

Chen, Hudong

2001-06-01

There have been considerable advances in Lattice Boltzmann (LB) based methods in the last decade. By now, the fundamental concept of using the approach as an alternative tool for computational fluid dynamics (CFD) has been substantially appreciated and validated in mainstream scientific research and in industrial engineering communities. Lattice Boltzmann based methods possess several major advantages: a) less numerical dissipation due to the linear Lagrange type advection operator in the Boltzmann equation; b) local dynamic interactions suitable for highly parallel processing; c) physical handling of boundary conditions for complicated geometries and accurate control of fluxes; d) microscopically consistent modeling of thermodynamics and of interface properties in complex multiphase flows. It provides a great opportunity to apply the method to practical engineering problems encountered in a wide range of industries from automotive, aerospace to chemical, biomedical, petroleum, nuclear, and others. One of the key challenges is to extend the applicability of this alternative approach to regimes of highly turbulent flows commonly encountered in practical engineering situations involving high Reynolds numbers. Over the past ten years, significant efforts have been made on this front at Exa Corporation in developing a lattice Boltzmann based commercial CFD software, PowerFLOW. It has become a useful computational tool for the simulation of turbulent aerodynamics in practical engineering problems involving extremely complex geometries and flow situations, such as in new automotive vehicle designs world wide. In this talk, we present an overall LB based algorithm concept along with certain key extensions in order to accurately handle turbulent flows involving extremely complex geometries. To demonstrate the accuracy of turbulent flow simulations, we provide a set of validation results for some well known academic benchmarks. These include straight channels, backward-facing steps, flows over a curved hill and typical NACA airfoils at various angles of attack including prediction of stall angle. We further provide numerous engineering cases, ranging from external aerodynamics around various car bodies to internal flows involved in various industrial devices. We conclude with a discussion of certain future extensions for complex fluids.

Benefits, challenges, and best practices for involving audiences in the development of interactive coastal risk communication tools: Professional communicators' experiences

NASA Astrophysics Data System (ADS)

Stephens, S. H.; DeLorme, D.

2017-12-01

To make scientific information useful and usable to audiences, communicators must understand audience needs, expectations, and future applications. This presentation synthesizes benefits, challenges, and best practices resulting from a qualitative social science interview study of nine professionals on their experiences developing interactive visualization tools for communicating about coastal environmental risks. Online interactive risk visualization tools, such as flooding maps, are used to provide scientific information about the impacts of coastal hazards. These tools have a wide range of audiences and purposes, including time-sensitive emergency communication, infrastructure and natural resource planning, and simply starting a community conversation about risks. Thus, the science, purposes, and audiences of these tools require a multifaceted communication strategy. In order to make these tools useable and accepted by their audiences, many professional development teams solicit target end-user input or incorporate formal user-centered design into the development process. This presentation will share results of seven interviews with developers of U.S. interactive coastal risk communication tools, ranging from state-level to international in scope. Specific techniques and procedures for audience input that were used in these projects will be discussed, including ad-hoc conversations with users, iterative usability testing with project stakeholder groups, and other participatory mechanisms. The presentation will then focus on benefits, challenges, and recommendations for best practice that the interviewees disclosed about including audiences in their development projects. Presentation attendees will gain an understanding of different procedures and techniques that professionals employ to involve end-users in risk tool development projects, as well as important considerations and recommendations for effectively involving audiences in science communication design.

ELSI practices in genomic research in East Asia: implications for research collaboration and public participation

PubMed Central

2014-01-01

Common infrastructures and platforms are required for international collaborations in large-scale human genomic research and policy development, such as the Global Alliance for Genomics and Health and the ‘ELSI 2.0’ initiative. Such initiatives may require international harmonization of ethical and regulatory requirements. To enable this, however, a greater understanding of issues and practices that relate to the ethical, legal and social implications (ELSI) of genomic research will be needed for the different countries and global regions involved in such research. Here, we review the ELSI practices and regulations for genomic research in six East Asian countries (China, Indonesia, Japan, Singapore, South Korea and Taiwan), highlighting the main similarities and differences between these countries, and more generally, in relation to Western countries. While there are significant differences in ELSI practices among these East Asian countries, there is a consistent emphasis on advancing genomic science and technology. In addition, considerable emphasis is placed on informed consent for participation in research, whether through the contribution of tissue samples or personal information. However, a higher level of engagement with interested stakeholders and the public will be needed in some countries. PMID:24944586

Aggression and Agitation in Dementia.

PubMed

Wolf, M Uri; Goldberg, Yael; Freedman, Morris

2018-06-01

This article reviews the treatment of aggression and agitation in dementia. Both nonpharmacologic and pharmacologic approaches to responsive behaviors are discussed. Practical treatment strategies are applied to common behavioral symptoms. Aggressive and agitated behavior is common in dementia. Behavioral symptoms lead to reduced quality of life and distress for both patients and caregivers. They can also lead to poor outcomes and are associated with significant financial implications for the individual and health care system. A wide range of difficult behaviors exists, with limited evidence for deciding on treatment. Clinicians should integrate the available evidence with practical and commonsense strategies to target these difficult-to-treat behaviors. Treating aggression and agitation in dementia is challenging. Viewing behaviors as a response to either internal or external stimuli can help guide treatment. Treatment should emphasize nonpharmacologic approaches as an initial step, using practical and commonsense strategies. Caregivers and family should be actively involved in the planning and implementation of behavioral plans. It is essential to minimize both medical and nonmedical factors that may be contributing to behaviors. When pharmacologic options are required, it is important to choose medications that will target specific behavioral goals, having both practical consideration and the best evidence in mind.

Philanthropy as a source of funding for nursing initiatives.

PubMed

Kleinpell, Ruth M; Start, Rachel; McIntosh, Erik; Worobec, Sophia; Llewellyn, Jane

2014-01-01

Nurse leaders are challenged with ensuring that research and evidence-based practices are being integrated into clinical care. Initiatives such as the Magnet Recognition Program have helped reinforce the importance of advancing nursing practices to integrate best practices, conduct quality improvement initiatives, improve performance metrics, and involve bedside nurses in conducting research and evidence-based practice projects. While seeking research funding is an option for some initiatives, other strategies such as seeking funding from grateful patients or from philanthropic resources are becoming important options for nurse leaders to pursue, as the availability of funding from traditional sources such as professional organizations or federal funding becomes more limited. In addition, more institutions are seeking and applying for funding, increasing the pool of candidates who are vying for existing funding. Seeking alternative sources of funding, such as through philanthropy, becomes a viable option. This article reviews important considerations in seeking funding from philanthropic sources for nursing initiatives. Examples from a multiyear project that focused on promoting a healthy work environment and improving nursing morale are used to highlight strategies that were used to solicit, obtain, and secure extension funding from private foundation funding to support the initiative.

Ask not what personalized medicine can do for you--ask what you can do for personalized medicine.

PubMed

Budin-Ljøsne, Isabelle; Harris, Jennifer R

2015-01-01

Personalized medicine (PM) aims to offer tailored health care to individuals on the basis of their genetic profile. This paper explores the types of behaviors and practices that citizens are expected to adopt under PM, examines whether such expectations are realistic, and proposes strategies that could support citizens in the adoption of these behaviors. Recent reports from national and international medical organizations and funders of PM are reviewed to investigate the types of behaviors and practices that citizens are expected to adopt under PM. These behaviors are examined in light of the current knowledge regarding citizen involvement in health care. Under PM, citizens are expected to be much more educated, proactive, and engaged in their health care than under conventional medical models. Actualizing such behaviors and practices may, however, be difficult or even unattainable for some groups of citizens. Educating citizens in PM, as proposed in the reports, is important but may not suffice for the adoption of new behaviors and practices by a majority of citizens. Approaches taking into consideration the heterogeneity of backgrounds, abilities, and resources among citizens are needed and include modifying reimbursement and pricing mechanisms, diversifying research, and developing low-cost PM programs.

Time management strategies in nursing practice.

PubMed

Waterworth, Susan

2003-09-01

With the increasing emphasis on efficiency and effectiveness in health care, how a nurse manages her time is an important consideration. Whilst time management is recognized as an important component of work performance and professional nursing practice, the reality of this process in nursing practice has been subject to scant empirical investigation. To explore how nurses organize and manage their time. A qualitative study was carried out, incorporating narratives (22 nurses), focus groups (24 nurses) and semi-structured interviews (22 nurses). In my role as practitioner researcher I undertook observation and had informal conversations, which provided further data. Study sites were five health care organizations in the United Kingdom during 1995-1999. Time management is complex, with nurses using a range of time management strategies and a repertoire of actions. Two of these strategies, namely routinization and prioritizing, are discussed, including their implications for understanding time management by nurses in clinical practice. Ignoring the influence of 'others', the team and the organization perpetuates a rather individualistic and self-critical perspective of time management. This may lead to a failure to address problems in the organizing of work, and the co-ordinating of care involving other health care workers.

Assisted or Hastened Death: The Healthcare Practitioner’s Dilemma

PubMed Central

MacLeod, Rod D; Wilson, Donna M; Malpas, Phillipa

2012-01-01

Assisting or hastening death is a dilemma with many ethical as well as practical issues facing healthcare practitioners in most countries worldwide now. Various arguments for and against assisted dying have been made over time but the call from the public for the legalisation of euthanasia and assisted suicide has never been stronger. While some studies have documented the reluctance of medical and other healthcare professionals to be involved in the practice of assisted dying or euthanasia, there is still much open debate in the public domain. Those who have the most experience of palliative care are strongest in their opposition to hastening death. This paper explores salient practical and ethical considerations for healthcare practitioners associated with assisting death, including a focus on examining the concepts of autonomy for patients and healthcare practitioners. The role of the healthcare practitioner has clearly and undoubtedly changed over time with advances in healthcare practices but the duty of care has not changed. The dilemmas for healthcare practitioners thus who have competent patients requesting hastened death extends far beyond acting within a country’s laws as they go to the very heart of the relationship between the practitioner and patient. PMID:23121745

Evaluation of the AHRQ Patient Safety Initiative: Synthesis of Findings

PubMed Central

Farley, Donna O; Damberg, Cheryl L

2009-01-01

Objective To present overall findings from the 4-year evaluation of the national patient safety initiative operated by the Agency for Healthcare Research and Quality (AHRQ). Data Sources Interviews with AHRQ staff, grantees, and other patient safety stakeholders; published materials; and internal AHRQ documents. Study Design The evaluation was structured to address a system framework of five components involved in improving safety. The initiative's contributions to improving each system component were assessed qualitatively, comparing results from three separate analyses—AHRQ's achievement of its patient safety goals, our own assessment of the initiative's activities, and independent stakeholder ratings of AHRQ's contributions. Findings and Conclusions AHRQ has faced a daunting challenge for improving patient safety, given the complex problems of the U.S. health care system and the limited resources AHRQ has had to address them. The patient safety initiative achieved strongest progress for its contributions to knowledge of patient safety epidemiology and effective practices, where AHRQ has considerable experience, and to strengthening infrastructure to support adoption of safe practices. Progress was slower in establishing a national monitoring capability and dissemination of safe practices for adoption. AHRQ needs to expand efforts to apply new knowledge for stimulating use of safe practices in the field. PMID:21456115

Breast cancer risk from different mammography screening practices.

PubMed

Bijwaard, Harmen; Brenner, Alina; Dekkers, Fieke; van Dillen, Teun; Land, Charles E; Boice, John D

2010-09-01

Mammography screening is an accepted procedure for early detection of breast tumors among asymptomatic women. Since this procedure involves the use of X rays, it is itself potentially carcinogenic. Although there is general consensus about the benefit of screening for older women, screening practices differ between countries. In this paper radiation risks for these different practices are estimated using a new approach. We model breast cancer induction by ionizing radiation in a cohort of patients exposed to frequent X-ray examinations. The biologically based, mechanistic model provides a better foundation for the extrapolation of risks to different mammography screening practices than empirical models do. The model predicts that the excess relative risk (ERR) doubles when screening starts at age 40 instead of 50 and that a continuation of screening at ages 75 and higher carries little extra risk. The number of induced fatal breast cancers is estimated to be considerably lower than derived from epidemiological studies and from internationally accepted radiation protection risks. The present findings, if used in a risk-benefit analysis for mammography screening, would be more favorable to screening than estimates currently recommended for radiation protection. This has implications for the screening ages that are currently being reconsidered in several countries.

Lessons learned from England's Health Checks Programme: using qualitative research to identify and share best practice.

PubMed

Ismail, Hanif; Kelly, Shona

2015-10-20

This study aimed to explore the challenges and barriers faced by staff involved in the delivery of the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program in primary care. Data have been derived from three qualitative evaluations that were conducted in 25 General Practices and involved in depth interviews with 58 staff involved all levels of the delivery of the Health Checks. Analysis of the data was undertaken using the framework approach and findings are reported within the context of research and practice considerations. Findings indicated that there is no 'one size fits all' blueprint for maximising uptake although success factors were identified: evolution of the programme over time in response to local needs to suit the particular characteristics of the patient population; individual staff characteristics such as being proactive, enthusiastic and having specific responsibility; a supportive team. Training was clearly identified as an area that needed addressing and practitioners would benefit from CVD specific baseline training and refresher courses to keep them up to date with recent developments in the area. However there were other external factors that impinged on an individual's ability to provide an effective service, some of these were outside the control of individuals and included cutbacks in referral services, insufficient space to run clinics or general awareness of the Health Checks amongst patients. The everyday experiences of practitioners who participated in this study suggest that overall, Health Check is perceived as a worthwhile exercise. But, organisational and structural barriers need to be addressed. We also recommend that clear referral pathways be in place so staff can refer patients to appropriate services (healthy eating sessions, smoking cessation, and exercise referrals). Local authorities need to support initiatives that enable data sharing and linkage so that GP Practices are informed when patients take up services such as smoking cessation or alcohol harm reduction programmes run by social services.

Regulatory considerations in the design of comparative observational studies using propensity scores.

PubMed

Yue, Lilly Q

2012-01-01

In the evaluation of medical products, including drugs, biological products, and medical devices, comparative observational studies could play an important role when properly conducted randomized, well-controlled clinical trials are infeasible due to ethical or practical reasons. However, various biases could be introduced at every stage and into every aspect of the observational study, and consequently the interpretation of the resulting statistical inference would be of concern. While there do exist statistical techniques for addressing some of the challenging issues, often based on propensity score methodology, these statistical tools probably have not been as widely employed in prospectively designing observational studies as they should be. There are also times when they are implemented in an unscientific manner, such as performing propensity score model selection for a dataset involving outcome data in the same dataset, so that the integrity of observational study design and the interpretability of outcome analysis results could be compromised. In this paper, regulatory considerations on prospective study design using propensity scores are shared and illustrated with hypothetical examples.

Pediatric sample inclusion in an opt-out biorepository linking DNA to de-identified medical records: Pediatric BioVU

PubMed Central

McGregor, Tracy L.; Van Driest, Sara L.; Brothers, Kyle B.; Bowton, Erica A.; Muglia, Louis J.; Roden, Dan M.

2013-01-01

The Vanderbilt DNA repository, BioVU, links DNA from leftover clinical blood samples to de-identified electronic medical records. After initiating adult sample collection, pediatric extension required consideration of ethical concerns specific to pediatrics and implementation of specialized DNA extraction methods. In the first year of pediatric sample collection, over 11,000 samples were included from individuals younger than 18 years. We compared the pediatric BioVU cohort to the overall Vanderbilt University Medical Center pediatric population and found similar demographic characteristics; however, the BioVU cohort has higher rates of select diseases, medication exposures, and laboratory testing, demonstrating enriched representation of severe or chronic disease. This unbalanced sample accumulation may accelerate research of some cohorts, but also may limit study of relatively benign conditions and the accrual of unaffected and unbiased control samples. BioVU represents a feasible model for pediatric DNA biobanking but involves both ethical and practical considerations specific to the pediatric population. PMID:23281421

Ethics of Social Media Research: Common Concerns and Practical Considerations

PubMed Central

Goniu, Natalie; Moreno, Peter S.; Diekema, Douglas

2013-01-01

Abstract Social media Websites (SMWs) are increasingly popular research tools. These sites provide new opportunities for researchers, but raise new challenges for Institutional Review Boards (IRBs) that review these research protocols. As of yet, there is little-to-no guidance regarding how an IRB should review the studies involving SMWs. The purpose of this article was to review the common risks inherent in social media research and consider how researchers can consider these risks when writing research protocols. We focused this article on three common research approaches: observational research, interactive research, and survey/interview research. Concomitant with these research approaches, we gave particular attention to the issues pertinent to SMW research, including privacy, consent, and confidentiality. After considering these challenges, we outlined key considerations for both researchers and reviewers when creating or reviewing SMW IRB protocols. Our goal in this article was to provide a detailed examination of relevant ethics and regulatory issues for both researchers and those who review their protocols. PMID:23679571

Ethics of social media research: common concerns and practical considerations.

PubMed

Moreno, Megan A; Goniu, Natalie; Moreno, Peter S; Diekema, Douglas

2013-09-01

Social media Websites (SMWs) are increasingly popular research tools. These sites provide new opportunities for researchers, but raise new challenges for Institutional Review Boards (IRBs) that review these research protocols. As of yet, there is little-to-no guidance regarding how an IRB should review the studies involving SMWs. The purpose of this article was to review the common risks inherent in social media research and consider how researchers can consider these risks when writing research protocols. We focused this article on three common research approaches: observational research, interactive research, and survey/interview research. Concomitant with these research approaches, we gave particular attention to the issues pertinent to SMW research, including privacy, consent, and confidentiality. After considering these challenges, we outlined key considerations for both researchers and reviewers when creating or reviewing SMW IRB protocols. Our goal in this article was to provide a detailed examination of relevant ethics and regulatory issues for both researchers and those who review their protocols.

Components and Quality Measures of DIME (Devitalized Tissue, Infection/Inflammation, Moisture Balance, and Edge Preparation) in Wound Care

PubMed Central

Snyder, Robert J.; Fife, Caroline; Moore, Zena

2016-01-01

ABSTRACT OBJECTIVES: To discuss how patient considerations and the initial wound environment can affect wound treatment and summarize the way in which the initial US Wound Registry measures capture aspects of the DIME (Debridement/devitalized tissue, Infection or inflammation, Moisture balance, and wound Edge preparation/wound depth) principles. DISCUSSION: The treatment of chronic wounds often involves extended hospital stays and long-term outpatient follow-up visits with costly advanced therapeutic interventions. As complex care is required for chronic wounds, treatment guidelines such as DIME have evolved to include consideration of patient-centered concerns and etiology, as well as features of wound bed preparation. The US healthcare system is in the midst of transitioning to a quality-based system. However, as wound care is not yet a recognized specialty, it is poorly represented in the current approved quality-based measures. CONCLUSION: This article helps to identify the practice guidelines that are not currently represented by quality metrics. PMID:27089149

Scabies: Advances in Noninvasive Diagnosis.

PubMed

Micali, Giuseppe; Lacarrubba, Francesco; Verzì, Anna Elisa; Chosidow, Olivier; Schwartz, Robert A

2016-06-01

Scabies is a common, highly contagious skin parasitosis caused by Sarcoptes scabiei var. hominis. Early identification and prompt treatment of infested subjects is essential, as missed diagnosis may result in outbreaks, considerable morbidity, and significantly increased economic burden. The standard diagnostic technique consists of mites' identification by microscopic examination of scales obtained by skin scraping. This is a time-consuming and risk-associated procedure that is also not suitable to a busy practice. In recent years, some advanced and noninvasive techniques such as videodermatoscopy, dermatoscopy, reflectance confocal microscopy, and optical coherence tomography have demonstrated improved efficacy in the diagnosis of scabies. Their advantages include rapid, noninvasive mass screening and post-therapeutic follow-up, with no physical risk. A greater knowledge of these techniques among general practitioners and other specialists involved in the intake care of overcrowded populations vulnerable to scabies infestations is now viewed as urgent and important in the management of outbreaks, as well as in consideration of the recent growing inflow of migrants in Europe from North Africa.

Scabies: Advances in Noninvasive Diagnosis

PubMed Central

Lacarrubba, Francesco; Verzì, Anna Elisa; Chosidow, Olivier; Schwartz, Robert A.

2016-01-01

Scabies is a common, highly contagious skin parasitosis caused by Sarcoptes scabiei var. hominis. Early identification and prompt treatment of infested subjects is essential, as missed diagnosis may result in outbreaks, considerable morbidity, and significantly increased economic burden. The standard diagnostic technique consists of mites’ identification by microscopic examination of scales obtained by skin scraping. This is a time-consuming and risk-associated procedure that is also not suitable to a busy practice. In recent years, some advanced and noninvasive techniques such as videodermatoscopy, dermatoscopy, reflectance confocal microscopy, and optical coherence tomography have demonstrated improved efficacy in the diagnosis of scabies. Their advantages include rapid, noninvasive mass screening and post-therapeutic follow-up, with no physical risk. A greater knowledge of these techniques among general practitioners and other specialists involved in the intake care of overcrowded populations vulnerable to scabies infestations is now viewed as urgent and important in the management of outbreaks, as well as in consideration of the recent growing inflow of migrants in Europe from North Africa. PMID:27311065

Stepping up, stepping back, stepping forward: Student nurses' experiences as peer mentors in a pre-nursing scholarship.

PubMed

Smith, Annetta; Beattie, Michelle; Kyle, Richard G

2015-11-01

Mentorship is an essential part of the registered nurse's role, yet few opportunities exist for student nurses to mentor others during pre-registration programmes. This paper reports student nurses' experiences of mentoring school pupils during a pre-nursing scholarship. Focus groups were conducted with fifteen final year student nurses (14 female, 1 male) in two university campuses in Scotland. Discussions were audio recorded and transcribed verbatim, and data analysed thematically. Three interconnected themes emerged: 1) stepping up; 2) stepping back; 3) stepping forward. 'Stepping up' was a process through which student nurses rapidly assumed responsibility for mentoring pupils, facilitated through the attitudes and actions of students' mentors and students' control over pupils' practice experiences. 'Stepping back' encapsulated attitudes and behaviours that enabled student nurses to mentor pupils that involved considerable judgement around how unfolding events in practice could provide learning and development opportunities, and emotional acuity to support pupils through, sometimes challenging, practice situations. 'Stepping forward' described how students' mentoring experience allowed them to appraise and affirm nursing knowledge and skills, and gain greater appreciation of the reality and complexity of mentorship in clinical practice. Peer mentoring may prepare student nurses for future mentoring roles and aid their transition into clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Partnerships for better mental health worldwide: WPA recommendations on best practices in working with service users and family carers

PubMed Central

WALLCRAFT, JAN; AMERING, MICHAELA; FREIDIN, JULIAN; DAVAR, BHARGAVI; FROGGATT, DIANE; JAFRI, HUSSAIN; JAVED, AFZAL; KATONTOKA, SYLVESTER; RAJA, SHOBA; RATAEMANE, SOLOMON; STEFFEN, SIGRID; TYANO, SAM; UNDERHILL, CHRISTPHER; WAHLBERG, HENRIK; WARNER, RICHARD; HERRMAN, HELEN

2011-01-01

WPA President M. Maj established the Task Force on Best Practice in Working with Service Users and Carers in 2008, chaired by H. Herrman. The Task Force had the remit to create recommendations for the international mental health community on how to develop successful partnership working. The work began with a review of literature on service user and carer involvement and partnership. This set out a range of considerations for good practice, including choice of appropriate terminology, clarifying the partnership process and identifying and reducing barriers to partnership working. Based on the literature review and on the shared knowledge in the Task Force, a set of ten recommendations for good practice was developed. These recommendations were the basis for a worldwide consultation of stakeholders with expertise as service users, families and carers, and the WPA Board and Council. The results showed a strong consensus across the international mental health community on the ten recommendations, with the strongest agreement coming from service users and carers. This general consensus gives a basis for Task Force plans to seek support for activities to promote shared work worldwide to identify best practice examples and create a resource to assist others to begin successful collaboration. PMID:21991284

Toxic red tides and harmful algal blooms: A practical challenge in coastal oceanography

NASA Astrophysics Data System (ADS)

Anderson, Donald M.

1995-07-01

The debate over the relative value of practical or applied versus fundamental research has heated up considerably in recent years, and oceanography has not been spared this re-evaluation of science funding policy. Some federal agencies with marine interests have always focused their resources on practical problems, but those with a traditional commitment to basic research such as the National Science Foundation have increasingly had to fight to maintain their freedom to fund quality science without regard to practical or commercial applications. Within this context, it is instructive to highlight the extent to which certain scientific programs can satisfy both sides of this policy dilemma—i.e. address important societal issues through advances in fundamental or basic research. One clear oceanographic example of such a program involves the phenomena called "red tides" or "harmful algal blooms". This paper describes the nature and extent of the problems caused by these outbreaks, emphasizing the alarming expansion in their incidence and their impacts in recent years, both in the U.S. and worldwide. The objective is to highlight fundamental physical, biological, and chemical oceanographic question that must be addressed if we are to achieve the practical goal of scientifically based management of fisheries resources, public health, and ecosystem health in regions threatened by toxic and harmful algae.

Nitrogen Cycling Considerations for Low-Disturbance, High-Carbon Soil Management in Climate-Adaptive Agriculture

NASA Astrophysics Data System (ADS)

Bruns, M. A.; Dell, C. J.; Karsten, H.; Bhowmik, A.; Regan, J. M.

2016-12-01

Agriculturists are responding to climate change concerns by reducing tillage and increasing organic carbon inputs to soils. Although these management practices are intended to enhance soil carbon sequestration and improve water retention, resulting soil conditions (moister, lower redox, higher carbon) are likely to alter nitrogen cycling and net greenhouse gas (GHG) emissions. Soils are particularly susceptible to denitrification losses of N2O when soils are recently fertilized and wet. It is paradoxical that higher N2O emissions may occur when farmers apply practices intended to make soils more resilient to climate change. As an example, the application of animal manures to increase soil organic matter and replace fossil fuel-based fertilizers could either increase or decrease GHGs. The challenges involved with incorporating manures in reduced-tillage soils often result in N2O emission spikes immediately following manure application. On the other hand, manures enrich soils with bacteria capable of dissimilatory nitrate reduction to ammonium (DNRA), a process that could counter N2O production by denitrification. Since bacterial DNRA activity is enhanced by labile forms of carbon, the forms of carbon in soils may play a role in determining the predominant N cycling processes and the extent and duration of DNRA activity. A key question is how management can address the tradeoff of higher N2O emissions from systems employing climate-adaptive practices. Management factors such as timing and quality of carbon inputs therefore may be critical considerations in minimizing GHG emissions from low-disturbance, high-carbon cropping systems.

Best practices for implementing, testing and using a cloud-based communication system in a disaster situation.

PubMed

Makowski, Dale

2016-01-01

This paper sets out the basics for approaching the selection and implementation of a cloud-based communication system to support a business continuity programme, including: • consideration for how a cloud-based communication system can enhance a business continuity programme; • descriptions of some of the more popular features of a cloud-based communication system; • options to evaluate when selecting a cloud-based communication system; • considerations for how to design a system to be most effective for an organisation; • best practices for how to conduct the initial load of data to a cloud-based communication system; • best practices for how to conduct an initial validation of the data loaded to a cloud-based communication system; • considerations for how to keep contact information in the cloud-based communication system current and accurate; • best practices for conducting ongoing system testing; • considerations for how to conduct user training; • review of other potential uses of a cloud-based communication system; and • review of other tools and features many cloud-based communication systems may offer.

The Australian response: pandemic influenza preparedness.

PubMed

Horvath, John S; McKinnon, Moira; Roberts, Leslee

2006-11-20

Australia's preparedness for a potential influenza pandemic involves many players, from individual health carers to interdepartmental government committees. It embraces a wide number of strategies from the management of the disease to facilitating business continuity. The key strategy underlying Australia's planned response is an intensive effort to reduce transmission of the virus. This includes actions to reduce the likelihood of entry of the virus into the country and to contain outbreaks when they occur. Containment will provide time to allow production of a matched vaccine. The health strategies are outlined in the Australian health management plan for pandemic influenza. The plan is accompanied by technical annexes setting out key considerations and guidelines in the areas of clinical management and infection control. National plans present overall strategies and guidance, but the operational details can only be determined by individual states and territories, regions, and the services themselves. Primary health care practices will be on the frontline of an influenza pandemic. Every practice needs a plan that defines the roles of staff, incorporates infection control and staff protection measures, and considers business continuity. Most importantly, a practice needs to know how to implement that plan.

The affective (re)production of refugee representations through educational policies and practices: Reconceptualising the role of emotion for peace education in a divided country

NASA Astrophysics Data System (ADS)

Zembylas, Michalinos

2012-08-01

Drawing into a discussion of the politicisation of emotion, this paper develops a framework to analyse some of the processes and strategies by which educational policies and pedagogical practices "emotionalise" the representation of refugees in conflict-ridden societies such as Cyprus and explores the implications for peace education. In particular, this paper aims to refine our understanding of how emotions affect the ways in which educational policies and practices reproduce self-other dichotomies through certain representations of the refugee experience. It is argued that these dichotomies are relevant to the emotional reactions against peace education initiatives. Second, this paper examines alternative possibilities of promoting peaceful coexistence, while taking into consideration the affective (re)production of refugee representations yet without undermining the refugee experience. Better understanding of how emotion is involved will help educational policymakers and teachers in divided societies to take into account the hitherto poorly developed aspects of the ways in which emotions, the refugee experience and peace education are inextricably intertwined.

The development, evolution, and status of Holland's theory of vocational personalities: Reflections and future directions for counseling psychology.

PubMed

Nauta, Margaret M

2010-01-01

This article celebrates the 50th anniversary of the introduction of John L. Holland's (1959) theory of vocational personalities and work environments by describing the theory's development and evolution, its instrumentation, and its current status. Hallmarks of Holland's theory are its empirical testability and its user-friendliness. By constructing measures for operationalizing the theory's constructs, Holland and his colleagues helped ensure that the theory could be implemented in practice on a widespread basis. Empirical data offer considerable support for the existence of Holland's RIASEC types and their ordering among persons and environments. Although Holland's congruence hypotheses have received empirical support, congruence appears to have modest predictive power. Mixed support exists for Holland's hypotheses involving the secondary constructs of differentiation, consistency, and vocational identity. Evidence of the continued impact of Holland's theory on the field of counseling psychology, particularly in the area of interest assessment, can be seen from its frequent implementation in practice and its use by scholars. Ideas for future research and practice using Holland's theory are suggested.

The potential of palliative care for patients with respiratory diseases

PubMed Central

Narsavage, Georgia L.; Chen, Yea-Jyh; Korn, Bettina; Elk, Ronit

2017-01-01

Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears. A practical checklist of activities based on the domains of palliative care can assist clinicians to integrate palliative care into their practice. Clinical management of patients receiving palliative care requires consideration of human factors and related organisational characteristics that involve cultural, educational and motivational aspects of the patient/family and clinicians. Educational aims To explain the basic domains of palliative care applicable to chronic respiratory diseases. To review palliative care interventions for patients with chronic respiratory diseases. To outline a checklist for clinicians to use in practice, based on the domains of palliative care. To propose recommendations for clinical management of patients receiving palliative care for chronic respiratory diseases. PMID:29209422

Advances in computer imaging/applications in facial plastic surgery.

PubMed

Papel, I D; Jiannetto, D F

1999-01-01

Rapidly progressing computer technology, ever-increasing expectations of patients, and a confusing medicolegal environment requires a clarification of the role of computer imaging/applications. Advances in computer technology and its applications are reviewed. A brief historical discussion is included for perspective. Improvements in both hardware and software with the advent of digital imaging have allowed great increases in speed and accuracy in patient imaging. This facilitates doctor-patient communication and possibly realistic patient expectations. Patients seeking cosmetic surgery now often expect preoperative imaging. Although society in general has become more litigious, a literature search up to 1998 reveals no lawsuits directly involving computer imaging. It appears that conservative utilization of computer imaging by the facial plastic surgeon may actually reduce liability and promote communication. Recent advances have significantly enhanced the value of computer imaging in the practice of facial plastic surgery. These technological advances in computer imaging appear to contribute a useful technique for the practice of facial plastic surgery. Inclusion of computer imaging should be given serious consideration as an adjunct to clinical practice.

Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices.

PubMed

Byrnes, Matthew C; Schuerer, Douglas J E; Schallom, Marilyn E; Sona, Carrie S; Mazuski, John E; Taylor, Beth E; McKenzie, Wendi; Thomas, James M; Emerson, Jeffrey S; Nemeth, Jennifer L; Bailey, Ruth A; Boyle, Walter A; Buchman, Timothy G; Coopersmith, Craig M

2009-10-01

To determine a) if a checklist covering a diverse group of intensive care unit protocols and objectives would improve clinician consideration of these domains and b) if improved consideration would change practice patterns. Pre- and post observational study. A 24-bed surgical/burn/trauma intensive care unit in a teaching hospital. A total of 1399 patients admitted between June 2006 and May 2007. The first component of the study evaluated whether mandating verbal review of a checklist covering 14 intensive care unit best practices altered verbal consideration of these domains. Evaluation was performed using real-time bedside audits on morning rounds. The second component evaluated whether the checklist altered implementation of these domains by changing practice patterns. Evaluation was performed by analyzing data from the Project IMPACT database after patients left the intensive care unit. Verbal consideration of evaluable domains improved from 90.9% (530/583) to 99.7% (669/671, p < .0001) after verbal review of the checklist was mandated. Bedside consideration improved on the use of deep venous thrombosis prophylaxis (p < .05), stress ulcer prophylaxis (p < .01), oral care for ventilated patients (p < 0.01), electrolyte repletion (p < .01), initiation of physical therapy (p < .05), and documentation of restraint orders (p < .0001). Mandatory verbal review of the checklist resulted in a greater than two-fold increase in transferring patients out of the intensive care unit on telemetry (16% vs. 35%, p < .0001) and initiation of physical therapy (28% vs. 42%, p < .0001) compared with baseline practice. A mandatory verbal review of a checklist covering a wide range of objectives and goals at each patient's bedside is an effective method to improve both consideration and implementation of intensive care unit best practices. A bedside checklist is a simple, cost-effective method to prevent errors of omission in basic domains of intensive care unit management that might otherwise be forgotten in the setting of more urgent care requirements.

National implementation of standards of practice for non-prescription medicines in Australia.

PubMed

Benrimoj, Shalom I; Gilbert, Andrew L; de Almeida Neto, Abilio C; Kelly, Fiona

2009-04-01

In Australia, there are two categories of non-prescription medicines: pharmacy medicines and pharmacist only medicines. Standards were developed to define and describe the professional activities required for the provision of these medicines at a consistent and measurable level of practice. Our objective was to implement nationally a quality improvement package in relation to the Standards of Practice for the Provision of Non-Prescription Medicines. Approximately 50% of Australian pharmacies (n = 2,706) were randomly selected by local registering authorities. Trained pharmacy educators audited each community pharmacy in the study three times, 7 weeks apart on Standards of Practice for the Provision of Non-Prescription Medicines, Visit 1 involved the educator explaining the project and conducting an assessment of the pharmacy's level of compliance. Behaviour of community pharmacists and their staff in relation to these standards was measured by conducting pseudo-patron visits. Pseudopatron visits were conducted at Visit 2, with the educator providing immediate feedback and coaching and a compliance assessment. Visit 3 involved a compliance assessment, and a second pseudo-patron visit for those pharmacies that had performed poorly at the first visit. At Visit 1, the lowest levels of compliance were to the standards relating to the documentation process (44%) and customer care and advice (46%). By Visit 2, more than 80% of pharmacies had met most criteria. At Visit 3, compliance had significantly improved compared to Visits 1 and 2 (P < 0.001). The lowest levels of compliance were to criteria which required written operating procedures for specific tasks, but these also improved significantly over time (P < 0.001). Professional practice in relation to the handling of pharmacist only and pharmacy medicines improved considerably as measured by the auditing process, and the results indicate that Australian pharmacies are well-equipped to provide high quality service to consumers of these medicines. The acceptability of national implementation of these standards of practice in Australia indicates that such an approach could be taken internationally.

The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: screening and diagnosis recommendations.

PubMed

Mehta, S; Guy, S D; Bryce, T N; Craven, B C; Finnerup, N B; Hitzig, S L; Orenczuk, S; Siddall, P J; Widerström-Noga, E; Casalino, A; Côté, I; Harvey, D; Kras-Dupuis, A; Lau, B; Middleton, J W; Moulin, D E; O'Connell, C; Parrent, A G; Potter, P; Short, C; Teasell, R; Townson, A; Truchon, C; Wolfe, D; Bradbury, C L; Loh, E

2016-08-01

Clinical practice guidelines. To develop the first Canadian clinical practice guidelines for screening and diagnosis of neuropathic pain in people with spinal cord injury (SCI). The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada. The CanPainSCI Working Group reviewed evidence to address clinical questions regarding screening and diagnosis of neuropathic pain after SCI. A consensus process was followed to achieve agreement on recommendations and clinical considerations. Twelve recommendations, based on expert consensus, were developed for the screening and diagnosis of neuropathic pain after SCI. The recommendations address methods for assessment, documentation tools, team member accountability, frequency of screening and considerations for diagnostic investigation. Important clinical considerations accompany each recommendation. The expert Working Group developed recommendations for the screening and diagnosis of neuropathic pain after SCI that should be used to inform practice.

A researcher's journey: Exploring a sensitive topic with vulnerable women.

PubMed

Marsh, Christine A; Browne, Jenny; Taylor, Jan; Davis, Deborah

2017-02-01

The conduct of research regardless of the subject or methods employed brings responsibilities and challenges. These are greater when dealing with sensitive topics and vulnerable groups and therefore researchers must navigate a range of complex issues and make choices in relation to practical, ethical and philosophical concerns. While literature dealing with research methodologies and research design may assist to some degree, it cannot provide a clear pathway or template as each research project must respond to a unique set of circumstances. We can however, also learn from sharing our stories and critical reflections on our research processes. The purpose of this article is to highlight the practical and methodological issues arising from researching a sensitive topic with vulnerable women experiencing an Assumption of Care. Research involving topics that are deeply personal and private combined with a vulnerable population can be complex and challenging for the researcher. Although some issues were anticipated from the literature, others encountered in this study were unexpected. Special considerations and prerequisites were necessary to build mutual trust and share power with women who had experienced an Assumption of Care at birth. Narrative Inquiry was a good methodological fit for this study as it privileged the voices of women and insisted that their experiences be considered within the context of their lives. Although Narrative Inquiry is a suitable choice for researching sensitive topics with vulnerable women specific considerations are still required to ensure the benefits of this research for both participants and researchers. Family and Community Service (FACS) have now replaced the formerly known Department of Community Services (DoCS) and in consideration of the timing of this study this article uses the terminology as DoCS. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Towards an integrated flood management approach to address trade-offs between ecosystem services: Insights from the Dutch and German Rhine, Hungarian Tisza, and Chinese Yangtze basins

NASA Astrophysics Data System (ADS)

Halbe, Johannes; Knüppe, Kathrin; Knieper, Christian; Pahl-Wostl, Claudia

2018-04-01

The utilization of ecosystem services in flood management is challenged by the complexity of human-nature interactions and practical implementation barriers towards more ecosystem-based solutions, such as riverine urban areas or technical infrastructure. This paper analyses how flood management has dealt with trade-offs between ecosystem services and practical constrains towards more ecosystem-based solutions. To this end, we study the evolution of flood management in four case studies in the Dutch and German Rhine, the Hungarian Tisza, and the Chinese Yangtze basins during the last decades, focusing on the development and implementation of institutions and their link to ecosystem services. The complexity of human-nature interactions is addressed by exploring the impacts on ecosystem services through the lens of three management paradigms: (1) the control paradigm, (2) the ecosystem-based paradigm, and (3) the stakeholder involvement paradigm. Case study data from expert interviews and a literature search were structured using a database approach prior to qualitative interpretation. Results show the growing importance of the ecosystem-based and stakeholder involvement paradigms which has led to the consideration of a range of regulating and cultural ecosystem services that had previously been neglected. We detected a trend in flood management practice towards the combination of the different paradigms under the umbrella of integrated flood management, which aims at finding the most suitable solution depending on the respective regional conditions.

A dimensional analysis of patient-centered care.

PubMed

Hobbs, Jennifer Lynn

2009-01-01

Patient-centered care (PCC) is a poorly conceptualized phenomenon and can indicate anything from soothing room design, emotional support of patients, customization of meals, to support of patient decision making. This inconsistency across the clinical and research literature makes the application of PCC difficult. The objective of this study was to identify dimensions of PCC as found in the literature. A dimensional analysis of PCC was conducted from 69 clinical and research articles published from 2000 to 2006. Coding of the literature for the perspective, context, conditions, process, and consequences of PCC was completed. These codes were used to determine literature selected for inclusion, organize article content, and frame the delineation of PCC. Alleviating vulnerabilities, consisting of both compromised physiological states and threats to individual identity, was constant throughout the literature. Therapeutic engagement was the process sustaining the patient during an illness episode that necessitated service use and involved allocating time, carrying out information practices, knowing the patient, and developing a relationship. This process occurs during nurse-patient interaction, sustained during successive interactions, and reinforced by the information practices of a particular setting. The interaction between nurse and patient is central to the effective study and application of PCC. Appropriate use of PCC can improve study outcomes and measurements by clarifying the variables involved, and PCC holds great promise to frame patient outcome and satisfaction research by analyzing how and with what effect nurses alleviate patient vulnerability. Moreover, consideration of information practices as a critical supporting structure of nurse-patient interaction can be explored.

Choice is not the issue. The misrepresentation of healthcare in bioethical discourse

PubMed Central

Førde, Reidun; Wifstad, Åge

2010-01-01

The principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary medical practice reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion. PMID:21131609

Assessment and d/Deaf and Hard of Hearing Multilingual Learners: Considerations and Promising Practices

ERIC Educational Resources Information Center

Pizzo, Lianna; Chilvers, Amanda

2016-01-01

The authors address considerations and promising practices relating to assessment of d/Deaf and Hard of Hearing Multilingual Learners. DMLs' unique culture(s), language(s), and learning needs must be considered when assessments of this population are being planned, conducted, and interpreted. The authors address theory and research on (a) general…

Practical, Ethical, and Legal Considerations regarding Videocounseling in College and University Counseling Centers: A Response to Quarto's "Influencing College Students' Perceptions of Videocounseling"

ERIC Educational Resources Information Center

Menzano, Silvestro; Goodwin, Alan; Rockett, Geraldine; Morris, Kathy

2011-01-01

There are numerous factors and concerns to take into consideration when implementing new technology into a counseling center's practice. These factors--informed consent, confidentiality, record-keeping, licensure, technical issues, eligibility, emergencies, and staff perceptions--are legitimate and must be addressed and resolved before…

Well-Being and Happiness: Critical, Practical and Philosophical Considerations for Policies and Practices in Lifelong Learning

ERIC Educational Resources Information Center

Gouthro, Patricia A.

2010-01-01

This paper argues that while the Inquiry into the Future of Lifelong Learning that was commissioned by NIACE makes some helpful recommendations for broadening the scope of lifelong learning to include considerations around well-being and happiness, the reports do not provide a sufficiently critical or philosophical analysis of the challenges…

Secondary Students' Considerations of Variability in Measurement Activities Based on Authentic Practices

ERIC Educational Resources Information Center

Dierdorp, Adri; Bakker, Arthur; Ben-Zvi, Dani; Makar, Katie

2017-01-01

Measurement activities were designed in this study on the basis of authentic professional practices in which linear regression is used, to study considerations of variability by students in Grade 12 (aged 17-18). The question addressed in this article is: In what ways do secondary students consider variability within these measurement activities?…

Early community-based family practice elective positively influences medical students' career considerations--a pre-post-comparison.

PubMed

Deutsch, Tobias; Hönigschmid, Petra; Frese, Thomas; Sandholzer, Hagen

2013-02-21

Demographic change and recruitment problems in family practice are increasingly threatening an adequate primary care workforce in many countries. Thus, it is important to attract young physicians to the field. The purpose of the present study was to examine the effect of an early community-based 28-h family practice elective with one-to-one mentoring on medical students' consideration of family practice as a career option, their interest in working office-based, and several perceptions with regard to specific aspects of a family physician's work. First- and second-year medical students completed questionnaires before and after a short community-based family practice elective, consisting of a preparatory course and a community-based practical experience with one-to-one mentoring by trained family physicians. We found a significantly higher rate of students favoring family practice as a career option after the elective (32.7% vs. 26.0%, p = 0.039). Furthermore, the ranking of family practice among other considered career options improved (p = 0.002). Considerations to work office-based in the future did not change significantly. Perceptions regarding a family physician's job changed positively with regard to the possibility of long-term doctor-patient relationships and treatment of complex disease patterns. The majority of the students described identification with the respective family physician tutor as a professional role model and an increased interest in the specialty. Our results indicate that a short community-based family practice elective early in medical education may positively influence medical students' considerations of a career in family practice. Furthermore, perceptions regarding the specialty with significant impact on its attractiveness may be positively adjusted. Further research is needed to evaluate the influence of different components of a family practice curriculum on the de facto career decisions of young physicians after graduation.

Infusing and sustaining aging content in social work education: findings from GeroRich projects.

PubMed

Hash, Kristina M; Gottlieb, Jody; Harper-Dorton, Karen V; Crawley-Woods, Geraldine; Shelek-Furbee, Katherine; Smith, John David; Brown, Rita

2007-01-01

This article presents findings from experiences of 67 projects involved in GeroRich, an initiative funded by the John A. Hartford Foundation designed to infuse, enrich and sustain aging content in BSW and MSW curricula. Thematic qualitative analysis was used to uncover themes in answers to open-ended questions contained in End-of-Year 2 project reports. Content areas addressed by open-ended answers were: (1) successes and innovations, and (2) challenges requiring responses. Primary successes and innovations identified were as follows: curriculum enrichment, faculty and student involvement, student-learning activities and community. Challenges to be responded to were identified as lack of faculty involvement, competing demands on faculty and programs, and sustainability of project efforts. Examples of strategies implemented to overcome these obstacles include providing teaching resources, instituting financial and other supports, and developing strategic plans for sustaining content infusion post-funding. Experiences of the GeroRich projects offer practical considerations for other social work programs that accept the challenge of attracting and preparing students to work with the increasing population of older adults.

47 CFR 101.55 - Considerations involving transfer or assignment applications.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... (d) If a proposed transfer of radio facilities is incidental to a sale or other facilities or merger... SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Applications and Licenses License Transfers, Modifications, Conditions and Forfeitures § 101.55 Considerations involving transfer or assignment applications. (a) Except...

47 CFR 101.55 - Considerations involving transfer or assignment applications.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... (d) If a proposed transfer of radio facilities is incidental to a sale or other facilities or merger... SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Applications and Licenses License Transfers, Modifications, Conditions and Forfeitures § 101.55 Considerations involving transfer or assignment applications. (a) Except...

47 CFR 101.55 - Considerations involving transfer or assignment applications.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... (d) If a proposed transfer of radio facilities is incidental to a sale or other facilities or merger... SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Applications and Licenses License Transfers, Modifications, Conditions and Forfeitures § 101.55 Considerations involving transfer or assignment applications. (a) Except...

47 CFR 101.55 - Considerations involving transfer or assignment applications.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... (d) If a proposed transfer of radio facilities is incidental to a sale or other facilities or merger... SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Applications and Licenses License Transfers, Modifications, Conditions and Forfeitures § 101.55 Considerations involving transfer or assignment applications. (a) Except...

47 CFR 101.55 - Considerations involving transfer or assignment applications.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... (d) If a proposed transfer of radio facilities is incidental to a sale or other facilities or merger... SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES Applications and Licenses License Transfers, Modifications, Conditions and Forfeitures § 101.55 Considerations involving transfer or assignment applications. (a) Except...

Supporting youth grieving the dying or death of a sibling or parent: considerations for parents, professionals, and communities.

PubMed

Warnick, Andrea L

2015-03-01

The aim of this article is to highlight considerations for parents, professionals, and communities regarding supporting children and adolescents who are grieving the dying or death of a parent or sibling. Current research is directly engaging the voices of youth who have experienced a parent or sibling's death. Although there continues to be much evidence about the distressing effect of such deaths on children and adolescents, there is a welcome emerging tendency to distinguish between adaptive and maladaptive grief. Although the literature strongly encourages parents to take an open and honest approach to supporting youth prior to a death, many barriers remain to them doing so. The literature identifies healthcare providers as being ideally positioned to provide guidance to families around best practice in the area of preparing youth for the death of a parent or sibling. Following a death, there is now encouraging evidence regarding the efficacy of certain interventions for bereaved youth, both in the short and long term, which is an important development in the field. Youth benefit from being involved in open and honest conversations about a family member's cancer diagnosis, treatment, prognosis, and end-of-life care. Although advances are being made with regard to understanding the grief experience of youth, there remains a wide gap between the current theoretical knowledge and the availability of practical well informed support for grieving youth.

Implementation of Duchenne Muscular Dystrophy Care Considerations.

PubMed

Andrews, Jennifer G; Conway, Kristin; Westfield, Christina; Trout, Christina; Meaney, F John; Mathews, Katherine; Ciafaloni, Emma; Cunniff, Christopher; Fox, Deborah J; Matthews, Dennis; Pandya, Shree

2018-06-20

Duchenne muscular dystrophy (DMD) is an X-linked disorder characterized by progressive muscle weakness and multisystem involvement. Recent advances in management of individuals with DMD have prolonged survival. Lack of standardized care spurred an international collaboration to develop consensus-based care considerations for diagnosis and management. In this study, we evaluate adherence to considerations at selected sites. We collaborated with the Muscular Dystrophy Surveillance, Tracking, and Research Network. Our sample included males with DMD and Becker muscular dystrophy <21 years as of December 31, 2010, with 1 health care encounter on or after January 1, 2012. We collected data from medical records on encounters occurring January 1, 2012, through December 31, 2014. Adherence was determined when frequency of visits or assessments were at or above recommendations for selected care considerations. Our analytic sample included 299 individuals, 7% of whom (20/299) were classified as childhood-onset Becker muscular dystrophy. Adherence for neuromuscular and respiratory clinician visits was 65% for the cohort; neuromuscular assessments and corticosteroid side effect monitoring measures ranged from 16% to 68%. Adherence was 83% for forced vital capacity and ≤58% for other respiratory diagnostics. Cardiologist assessments and echocardiograms were found for at least 84%. Transition planning for education or health care was documented for 31% of eligible males. Medical records data were used to identify areas in which practice aligns with the care considerations. However, there remains inconsistency across domains and insufficiency in critical areas. More research is needed to explain this variability and identify reliable methods to measure outcomes. Copyright © 2018 by the American Academy of Pediatrics.

Educational Video Recording and Editing for The Hand Surgeon

PubMed Central

Rehim, Shady A.; Chung, Kevin C.

2016-01-01

Digital video recordings are increasingly used across various medical and surgical disciplines including hand surgery for documentation of patient care, resident education, scientific presentations and publications. In recent years, the introduction of sophisticated computer hardware and software technology has simplified the process of digital video production and improved means of disseminating large digital data files. However, the creation of high quality surgical video footage requires basic understanding of key technical considerations, together with creativity and sound aesthetic judgment of the videographer. In this article we outline the practical steps involved with equipment preparation, video recording, editing and archiving as well as guidance for the choice of suitable hardware and software equipment. PMID:25911212

Contemplating cognitive enhancement in medical students and residents.

PubMed

Webb, Jadon R; Thomas, John W; Valasek, Mark A

2010-01-01

Medical school and residency can be stressful times, involving years of intensive academic study and pressure to earn high grades. Students and residents must learn to care for the sick, a task requiring long work hours and sleep deprivation. In such an environment, it is important to monitor the mental health of trainees and the factors that influence it. This essay examines a relatively unexplored facet of physician mental health: the use of pharmacological stimulants by students and residents to study better, earn higher grades, stay awake longer, and take better care of patients. Practical and ethical considerations of stimulant use in the medical profession, along with future directions for medical student mental health, are discussed.

Impact of Cardiac Rehabilitation and Exercise Training on Psychological Risk Factors and Subsequent Prognosis in Patients With Cardiovascular Disease.

PubMed

Lavie, Carl J; Menezes, Arthur R; De Schutter, Alban; Milani, Richard V; Blumenthal, James A

2016-10-01

The role of psychological risk factors has been under-recognized in most subspecialties of medicine, as well as in general medicine practices. However, considerable evidence indicates that psychosocial factors are involved in the pathogenesis and progression of cardiovascular disease (CVD). Emerging data from cardiac rehabilitation (CR) settings and CR exercise training (CRET) programs have demonstrated the value of comprehensive CRET to improve psychological functioning and reduce all-cause mortality. Recent evidence also supports the role of CRET and the added value of stress management training in the secondary prevention of CVD. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Civil society? What deliberative democrats can tell advocates about how to build public commitment to the health promotion agenda.

PubMed

Evoy, Brian E; McDonald, Michael; Frankish, C James

2008-01-01

Closing the health inequity gap can be seen as an issue of justice, however what concretely best serves the interest of justice is in dispute. It is argued that standard policy-making mechanisms are inadequate to address this issue, and therefore more and better public dialogue is required. Drawing on deliberative democratic theory and practice, three public organizing considerations are offered: organizing within the state sphere, organizing within the public sphere, and using cross strategies. It is recommended that public resources be provided to involve the public in deliberations about population health promotion issues related to the wicked problem of health inequities.

[The treatment of scientific knowledge in the framework of CITES].

PubMed

Lanfranchi, Marie-Pierre

2014-03-01

Access to scientific knowledge in the context of CITES is a crucial issue. The effectiveness of the text is indeed largely based on adequate scientific knowledge of CITES species. This is a major challenge: more than 30,000 species and 178 member states are involved. The issue of expertise, however, is not really addressed by the Convention. The question was left to the consideration of the COP. Therefore, the COP has created two ad hoc scientific committees: the Plants Committee and the Animals Committee, conferring upon them an ambitious mandate. The article addresses some important issues at stake which are linked to institutional questions, as well as the mixed record after twenty-five years of practice.

Mechanics of ultrasound elastography

PubMed Central

Li, Guo-Yang

2017-01-01

Ultrasound elastography enables in vivo measurement of the mechanical properties of living soft tissues in a non-destructive and non-invasive manner and has attracted considerable interest for clinical use in recent years. Continuum mechanics plays an essential role in understanding and improving ultrasound-based elastography methods and is the main focus of this review. In particular, the mechanics theories involved in both static and dynamic elastography methods are surveyed. They may help understand the challenges in and opportunities for the practical applications of various ultrasound elastography methods to characterize the linear elastic, viscoelastic, anisotropic elastic and hyperelastic properties of both bulk and thin-walled soft materials, especially the in vivo characterization of biological soft tissues. PMID:28413350

Is self-sufficiency financially viable and ethically justifiable?--a commercial viewpoint.

PubMed

Christie, R B

1994-12-01

Manufacturers of blood products have to maintain the highest possible standards for plasma screening and good manufacturing practices to ensure maximum purity and viral safety. The private sector companies have much experience in implementing and complying with national and international regulations. These requirements involve considerable cost in the areas of (1) plasma collection facilities, (2) research and clinical research, (3) manufacture, and (4) quality control. Total self-sufficiency would mean the loss of many existing resources. An alternative would be a collaboration between the public and private sectors to meet the needs of all patients who require plasma derived products. The current definition of self-sufficiency suggests that it is not financially viable.

Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice

PubMed Central

2015-01-01

A step toward the development of optimally effective, efficient, and feasible implementation strategies that increase evidence-based treatment integration in mental health services involves identification of the multilevel mechanisms through which these strategies influence implementation outcomes. This article (a) provides an orientation to, and rationale for, consideration of multilevel mediating mechanisms in implementation trials, and (b) systematically reviews randomized controlled trials that examined mediators of implementation strategies in mental health. Nine trials were located. Mediation-related methodological deficiencies were prevalent and no trials supported a hypothesized mediator. The most common reason was failure to engage the mediation target. Discussion focuses on directions to accelerate implementation strategy development in mental health. PMID:26474761

Physical Health Care for People with Severe Mental Illness: the Attitudes, Practices, and Training Needs of Nurses in Three Asian Countries.

PubMed

Bressington, Daniel; Badnapurkar, Ashish; Inoue, Sachiko; Ma, Hin Yeung; Chien, Wai Tong; Nelson, Deborah; Gray, Richard

2018-02-15

People with severe mental illness (SMI) have considerable unmet physical health needs and an increased risk of early mortality. This cross-sectional survey utilized the Physical Health Attitude Scale (PHASe) to examine the attitudes, practices, and training needs of nurses towards physical health care of people with SMI in three Asian countries (Hong Kong, Japan, Qatar). Cross-country differences were explored and linear regression was used to investigate if nurses' attitudes and confidence were associated with their level of involvement in physical health care. A total of 481 questionnaires were returned. Hong Kong nurses were less involved in physical health care than those from Japan and Qatar. Nurses' attitudes and confidence were significant predictors of their participation in managing physical health. Compared with western countries, more nurses in this study felt that mental illness was a barrier to improving physical health. Three-quarters reported that they needed additional training in promoting cardiometabolic health. The perceived need for additional training in physical health care was held by Mental Health Nurses (MHN) irrespective of their type of nursing registration and nationality. Nurse educators and service providers should reconsider the physical health care training requirements of nurses working in mental health settings in order to improve the physical health of people with SMI.

The political abuse of medicine and the challenge of opposing it.

PubMed

Zwi, A B

1987-01-01

A fundamental aim of medicine is to protect and promote health. The practice of medicine has, however, been used to promote political aims which may be detrimental to health. The article attempts to isolate the ways in which political abuses may interfere with good medical practice: by allowing health policies to be influenced by undemocratic political considerations; by using health services to reward or punish political supporters or opponents; by direct medical involvement in political acts which contradict accepted medical ethics; and by the support which conventional medical practises give to perpetuating inequalities in health and social services. Each of these is examined with the use of a number of examples. The ways in which medical personnel have opposed the political abuse of medicine is explored by a brief review of the opposition of Chilean doctors to torture, the involvement of South African doctors in opposing the abuse of health services in perpetuating apartheid, and the growing medical movement in opposition to nuclear war. Some comments concerning the monitoring of a multitude of medical disciplines which are open to political abuse are made. The purpose of the paper is primarily to stimulate debate around this important issue and it does not attempt to provide a comprehensive review of the political abuse of medicine.

Disclosing incidental findings in brain research: the rights of minors in decision-making.

PubMed

Di Pietro, Nina C; Illes, Judy

2013-11-01

MRI is used routinely in research with children to generate new knowledge about brain development. The detection of unexpected brain abnormalities (incidental findings; IFs) in these studies presents unique challenges. While key issues surrounding incidence and significance, duty of care, and burden of disclosure have been addressed substantially for adults, less empirical data and normative analyses exist for minors who participate in minimal risk research. To identify ethical concerns and fill existing gaps, we conducted a comprehensive review of papers that focused explicitly on the discovery of IFs in minors. The discourse in the 21 papers retrieved for this analysis amply covered practical issues such as informed consent and screening, difficulties in ascertaining clinical significance, the economic costs and burden of responsibility on researchers, and risks (physical or psychological). However, we found little discussion about the involvement of minors in decisions about disclosure of IFs in the brain, especially for IFs of low clinical significance. In response, we propose a framework for managing IFs that integrates practical considerations with explicit appreciation of rights along the continuum of maturity. This capacity-adjusted framework emphasizes the importance of involving competent minors and respecting their right to make decisions about disclosure. Copyright © 2013 Wiley Periodicals, Inc.

Fundamental Considerations for Biobank Legacy Planning

PubMed Central

Fombonne, Benjamin; Watson, Peter Hamilton; Moore, Helen Marie

2016-01-01

Biobanking in its various forms is an activity involving the collection of biospecimens and associated data and their storage for differing lengths of time before use. In some cases, biospecimens are immediately used, but in others, they are stored typically for the term of a specified project or in perpetuity until the materials are used up or declared to be of little scientific value. Legacy planning involves preparing for the phase that follows either biobank closure or a significant change at an operational level. In the case of a classical finite collection, this may be brought about by the completion of the initial scientific goals of a project, a loss of funding, or loss of or change in leadership. Ultimately, this may require making a decision about when and where to transfer materials or whether to destroy them. Because biobanking in its entirety is a complex endeavour, legacy planning touches on biobank operations as well as ethical, legal, financial, and governance parameters. Given the expense and time that goes into setting up and maintaining biobanks, coupled with the ethical imperative to appropriately utilize precious resources donated to research, legacy planning is an activity that every biobanking entity should think about. This article describes some of the fundamental considerations for preparing and executing a legacy plan, and we envisage that this article will facilitate dialogue to help inform best practices and policy development in the future. PMID:26890981

Transitional polytherapy: tricks of the trade for monotherapy to monotherapy AED conversions.

PubMed

Garnett, William R; St Louis, Erik K; Henry, Thomas R; Bramley, Thomas

2009-06-01

The goal of epilepsy therapy is to help patients achieve seizure freedom without adverse effects. While monotherapy is preferable in epilepsy treatment, many patients fail a first drug due to lack of efficacy or failure to tolerate an initial medication, necessitating an alteration in therapy. Sudden changes between monotherapies are rarely feasible and sometimes deleterious given potential hazards of acute seizure exacerbation or intolerable adverse effects. The preferred method for converting between monotherapies is transitional polytherapy, a process involving initiation of a new antiepileptic drug (AED) and adjusting it toward a target dose while maintaining or reducing the dose of the baseline medication. A fixed-dose titration strategy of maintaining the baseline drug dose while titrating the new medication is preferable when breakthrough seizures are occurring and no adverse effects are present. However, a flexible titration strategy involving reduction of the baseline drug dose to ensure adequate tolerability of the new adjunctive medication is preferred when patients are already experiencing adverse effects. This article reviews pharmacokinetic considerations pertinent for ensuring successful transitional polytherapy with the standard and newer antiepileptic drugs. Practical consensus recommendations "from an expect panel (SPECTRA, Study by a Panel of Experts Considerations for Therapy Replacement and Antiepileptics) for a successful monotherapy" AED conversions are then summarized. Transitional polytherapy is most successful when clinicians appropriately manage the titration strategy and consider pharmacokinetic factors germane to the baseline and new adjunctive medication.

Blueprint for a deliberative public forum on biobanking policy: were theoretical principles achievable in practice?

PubMed

Molster, Caron; Maxwell, Susannah; Youngs, Leanne; Kyne, Gaenor; Hope, Fiona; Dawkins, Hugh; O'Leary, Peter

2013-06-01

Public deliberation is recommended for obtaining citizen input to policy development when policies involve contested ethical dimensions, diverse perspectives on how to trade-off competing public interests and low public awareness of these perspectives. Several norms have been proposed for the design of deliberative methods. Evidence is scarce regarding whether such norms are achievable in practice. This paper refers to principles of deliberative democracy theory to describe a deliberative public forum on biobanking. Practical challenges and contextual facilitators of achieving deliberative ideals are discussed, along with factors that influenced use of the forum output in policy development. The forum ran for 4 days over two weekends in Perth, Western Australia. Key methodological features were socio-demographic stratification to randomly recruit a mini-public of citizens for discursive representation, provision of information inclusive of diverse perspectives and framed for difference, provision of a fair way for reasoning and collective decision making and adoption of processes to achieve publicity, accountability and independence from undue institutional influence. Most design principles were achieved in practice, with the fundamental exception of representativeness. Factors influencing these outcomes, and the use of deliberated outputs to develop policy, included institutional characteristics, the design involvement of deliberative experts and quality of the outputs when compared to other consultation methods. Public deliberations can achieve design ideals and influence (ethics-based) public health policy. The representation of 'hard to reach' citizens and their views needs further consideration, particularly as this relates to the procedural legitimacy of ethical analyses and the just inclusion of deliberative citizen advice within the broader policy-making process. © 2011 John Wiley & Sons Ltd.

Blueprint for a deliberative public forum on biobanking policy: were theoretical principles achievable in practice?

PubMed Central

Molster, Caron; Maxwell, Susannah; Youngs, Leanne; Kyne, Gaenor; Hope, Fiona; Dawkins, Hugh; O’Leary, Peter

2011-01-01

Abstract Background:  Public deliberation is recommended for obtaining citizen input to policy development when policies involve contested ethical dimensions, diverse perspectives on how to trade‐off competing public interests and low public awareness of these perspectives. Several norms have been proposed for the design of deliberative methods. Evidence is scarce regarding whether such norms are achievable in practice. Purpose:  This paper refers to principles of deliberative democracy theory to describe a deliberative public forum on biobanking. Practical challenges and contextual facilitators of achieving deliberative ideals are discussed, along with factors that influenced use of the forum output in policy development. Method:  The forum ran for 4 days over two weekends in Perth, Western Australia. Key methodological features were socio‐demographic stratification to randomly recruit a mini‐public of citizens for discursive representation, provision of information inclusive of diverse perspectives and framed for difference, provision of a fair way for reasoning and collective decision making and adoption of processes to achieve publicity, accountability and independence from undue institutional influence. Results:  Most design principles were achieved in practice, with the fundamental exception of representativeness. Factors influencing these outcomes, and the use of deliberated outputs to develop policy, included institutional characteristics, the design involvement of deliberative experts and quality of the outputs when compared to other consultation methods. Conclusions:  Public deliberations can achieve design ideals and influence (ethics‐based) public health policy. The representation of ‘hard to reach’ citizens and their views needs further consideration, particularly as this relates to the procedural legitimacy of ethical analyses and the just inclusion of deliberative citizen advice within the broader policy‐making process. PMID:21645188

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations

PubMed Central

Dakkuri, Adnan; Abrons, Jeanine P.; Williams, Dennis; Ombengi, David N.; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O’Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

2016-01-01

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education. PMID:27170809

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

PubMed

Alsharif, Naser Z; Dakkuri, Adnan; Abrons, Jeanine P; Williams, Dennis; Ombengi, David N; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O'Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

2016-04-25

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

Current Practices in Hosting Non-US Pharmacy Students at US Pharmacy Schools in Experiential Clerkships

PubMed Central

Al-Dahir, Sara; Alsharif, Naser Z.; Gleason, Shaun E.; Tofade, Toyin; Flores, Emily K.; Katz, Michael; Dornblaser, Emily K.

2017-01-01

Objective: To provide specific considerations for hosting non-U.S. pharmacy students at U.S.-based colleges/schools of pharmacy (C/SOP) for experiential clerkships and training. Findings: A literature review (2000-2016) in PubMed, Google Scholar and IPA databases was conducted using specific keywords. Recommendations and future directions for development of experiential rotations for non-U.S. students in U.S. experiential rotations are presented for both the home and host country. Summary articles and best practices across the disciplines, as well as expert opinion, were found across U.S. models for hosting non-U.S. students in advanced practice rotations in the medical disciplines. Consistent themes regarding legal agreements, acculturation, standardized calendars and social and safety considerations were considered for inclusion in the final document. Conclusion: Development of a successful experiential rotation/training for non-U.S. students requires consideration for well-developed objectives, qualified preceptors, multitude of legal and cultural considerations and recommendations for longevity and sustainability. PMID:29302084

Safety and security of radioactive sources in industrial radiography in Bangladesh

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

Mollah, A. S.; Nazrul, M. Abdullah

2013-07-01

Malicious use of radioactive sources can involve dispersal of that material through an explosive device. There has been recognition of the threat posed by the potential malicious misuse of NDT radioactive source by terrorists. The dispersal of radioactive material using conventional explosives, referred to as a 'dirty bomb', could create considerable panic, disruption and area access denial in an urban environment. However, as it is still a relatively new topic among regulators, users, and transport and storage operators worldwide, international assistance and cooperation in developing the necessary regulatory and security infrastructure is required. The most important action in reducing themore » risk of radiological terrorism is to increase the security of radioactive sources. This paper presents safety and security considerations for the transport and site storage of the industrial radiography sources as per national regulations entitled 'Nuclear Safety and Radiation Control Rules-1997'.The main emphasis was put on the stages of some safety and security actions in order to prevent theft, sabotage or other malicious acts during the transport of the packages. As a conclusion it must be mentioned that both safety and security considerations are very important aspects that must be taking in account for the transport and site storage of radioactive sources used in the practice of industrial radiography. (authors)« less

The sequence of disease-modifying therapies in relapsing multiple sclerosis: safety and immunologic considerations.

PubMed

Pardo, Gabriel; Jones, David E

2017-12-01

The treatment landscape for relapsing forms of multiple sclerosis (RMS) has expanded considerably over the last 10 years with the approval of multiple new disease-modifying therapies (DMTs), and others in late-stage clinical development. All DMTs for RMS are believed to reduce central nervous system immune-mediated inflammatory processes, which translate into demonstrable improvement in clinical and radiologic outcomes. However, some DMTs are associated with long-lasting effects on the immune system and/or serious adverse events, both of which may complicate the use of subsequent therapies. When customizing a treatment program, a benefit-risk assessment must consider multiple factors, including the efficacy of the DMT to reduce disease activity, the short- and long-term safety and immunologic profiles of each DMT, the criteria used to define switching treatment, and the risk tolerance of each patient. A comprehensive benefit-risk assessment can only be achieved by evaluating the immunologic, safety, and efficacy data for DMTs in the controlled clinical trial environment and the postmarketing clinical practice setting. This review is intended to help neurologists make informed decisions when treating RMS by summarizing the known data for each DMT and raising awareness of the multiple considerations involved in treating people with RMS throughout the entire course of their disease.

Let's talk about death: data collection for verbal autopsies in a demographic and health surveillance site in Malaysia.

PubMed

Allotey, Pascale A; Reidpath, Daniel D; Evans, Natalie C; Devarajan, Nirmala; Rajagobal, Kanason; Bachok, Ruhaida; Komahan, Kridaraan

2015-01-01

Verbal autopsies have gained considerable ground as an acceptable alternative to medically determined cause of death. Unlike with clinical or more administrative settings for data collection, verbal autopsies require significant involvement of families and communities, which introduces important social and cultural considerations. However, there is very little clear guidance about the methodological issues in data collection. The objectives of this case study were: to explore the range of bereavement rituals within the multi-ethnic, multi-faith population of the district; to investigate the preparedness of communities to talk about death; to describe the verbal autopsy process; to assess the effects of collecting verbal autopsy data on data collectors; and to determine the most accurate sources of information about deaths in the community. A case study approach was used, using focus group discussions, indepth interviews and field notes. Thematic analyses were undertaken using NVivo. Consideration of cultural bereavement practices is importance to acceptance and response rates to verbal autopsies. They are also important to the timing of verbal autopsy interviews. Well trained data collectors, regardless of health qualifications are able to collect good quality data, but debriefing is important to their health and well being. This article contributes to guidance on the data collection procedures for verbal autopsies within community settings.

Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning.

PubMed

Grundy, A C; Walker, L; Meade, O; Fraser, C; Cree, L; Bee, P; Lovell, K; Callaghan, P

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: There is consistent evidence that service users and carers feel marginalized in the process of mental health care planning. Mental health professionals have identified ongoing training needs in relation to involving service users and carers in care planning. There is limited research on the acceptability of training packages for mental health professionals which involve service users and carers as co-facilitators. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A co-produced and co-delivered training package on service user- and carer-involved care planning was acceptable to mental health professionals. Aspects of the training that were particularly valued were the co-production model, small group discussion and the opportunity for reflective practice. The organizational context of care planning may need more consideration in future training models. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses using co-production models of delivering training to other mental health professionals can be confident that such initiatives will be warmly welcomed, acceptable and engaging. On the basis of the results reported here, we encourage mental health nurses to use co-production approaches more often. Further research will show how clinically effective this training is in improving outcomes for service users and carers. Background There is limited evidence for the acceptability of training for mental health professionals on service user- and carer-involved care planning. Aim To investigate the acceptability of a co-delivered, two-day training intervention on service user- and carer-involved care planning. Methods Community mental health professionals were invited to complete the Training Acceptability Rating Scale post-training. Responses to the quantitative items were summarized using descriptive statistics (Miles, ), and qualitative responses were coded using content analysis (Weber, ). Results Of 350 trainees, 310 completed the questionnaire. The trainees rated the training favourably (median overall TARS scores = 56/63; median 'acceptability' score = 34/36; median 'perceived impact' score = 22/27). There were six qualitative themes: the value of the co-production model; time to reflect on practice; delivery preferences; comprehensiveness of content; need to consider organizational context; and emotional response. Discussion The training was found to be acceptable and comprehensive with participants valuing the co-production model. Individual differences were apparent in terms of delivery preferences and emotional reactions. There may be a need to further address the organizational context of care planning in future training. Implications for practice Mental health nurses should use co-production models of continuing professional development training that involve service users and carers as co-facilitators. © 2017 The Authors. Journal of Psychiatric and Mental Health Nursing Published by John Wiley & Sons Ltd.

Eleven essential steps to purchasing or selling a medical practice.

PubMed

Barrett, William

2014-01-01

Based on our experience in representing more than 100 doctors and medical specialists in practice sales and acquisitions, we have identified 11 key considerations important to a deal. There are several issues to consider while going through the process of buying or selling a practice including the implementation of a "letter of intent" as a first step rather than drafting a contract, securing a lease, and verifying the property is not in violation of the local zoning requirements. There are also considerations with regard to the patients, which range from how will the accounts receivable at the time of the closing be handled to who is responsible for the handling of continued treatment in an ongoing case after a deal is finalized. This article details these considerations and more.

Assessment and d/Deaf and Hard of Hearing Multilingual Learners: Considerations and Promising Practices.

PubMed

Pizzo, Lianna; Chilvers, Amanda

2016-01-01

The authors address considerations and promising practices relating to assessment of d/Deaf and Hard of Hearing Multilingual Learners. DMLs' unique culture(s), language(s), and learning needs must be considered when assessments of this population are being planned, conducted, and interpreted. The authors address theory and research on (a) general considerations for the overarching assessment process, (b) specific assessment approaches used to assess DMLs, and (c) assessment of language proficiency for diverse language learners. In addition, basic recommendations for the assessment of DMLs are made, including increased availability of assessments in various languages, use of multiple sources of individual and family data, assessment of all languages, and incorporation of a strong assessment component (that includes nondiscrimination practices) into teacher preparation programs.

49 CFR 604.21 - Special considerations for advisory opinions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Desist Orders § 604.21 Special considerations for advisory opinions. Based on new facts involving significant financial considerations, the Chief Counsel may take appropriate enforcement action contrary to an... 49 Transportation 7 2010-10-01 2010-10-01 false Special considerations for advisory opinions. 604...

What are GPs' preferences for financial and non-financial incentives in cancer screening? Evidence for breast, cervical, and colorectal cancers.

PubMed

Sicsic, Jonathan; Krucien, Nicolas; Franc, Carine

2016-10-01

General practitioners (GPs) play a key role in the delivery of preventive and screening services for breast, cervical, and colorectal cancers. In practice, GPs' involvement varies considerably across types of cancer and among GPs, raising important questions about the determinants of GPs' implication in screening activities: what is the relative impact of financial and non-financial incentives? Are GPs' preferences for financial and non-financial incentives cancer-specific? Is there preference heterogeneity and how much does it differ according to the screening context? This study investigates the determinants of GPs' involvement in cancer screening activities using the discrete choice experiment (DCE) methodology. A representative sample of 402 GPs' was recruited in France between March and April 2014. Marginal rates of substitution were used to compare GPs' preferences for being involved in screening activities across three types of cancers: breast, cervical, and colorectal. Variability of preferences was investigated using Hierarchical Bayes mixed logit models. The results indicate that GPs are sensitive to both financial and non-financial incentives, such as a compensated training and systematic transmission of information about screened patients, aimed to facilitate communication between doctors and patients. There is also evidence that the level and variability of preferences differ across screening contexts, although the variations are not statistically significant on average. GPs appear to be relatively more sensitive to financial incentives for being involved in colorectal cancer screening, whereas they have higher and more heterogeneous preferences for non-financial incentives in breast and cervical cancers. Our study provides new findings for policymakers interested in prioritizing levers to increase the supply of cancer screening services in general practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Couple based family planning education: changes in male involvement and contraceptive use among married couples in Jimma Zone, Ethiopia.

PubMed

Tilahun, Tizta; Coene, Gily; Temmerman, Marleen; Degomme, Olivier

2015-07-21

Family planning contributes substantially in achieving the Millennium Development Goals. Recently, male involvement has gained considerable attention in family planning programs but the implementation thereof remains a challenge. In that context, our study aimed at measuring the effect of a six-month-long family planning education program on male involvement in family planning, as well as on couples' contraceptive practice. We conducted a quasi-experimental research among 811 married couples in Jimma Zone, southwest Ethiopia. Our study consisted of an intervention and a control group for comparative purpose; and surveyed before and after the implementation of the intervention. The intervention consisted of family planning education, given to both men and women at the household level in the intervention arm, in addition to monthly community gatherings. During the intervention period, households in the control group were not subject to particular activities but had access to routine health care services. We obtained follow-up data from 760 out of 786 (96.7%) couples who were originally enrolled in the survey. Findings were compared within and between groups before and after intervention surveys. At the baseline, contraceptive use in both control and intervention households were similar. After the intervention, we observed among men in the intervention arm a significantly higher level of willingness to be actively involved in family planning compared to the men in the control arm (p < 0.001). In addition, the difference between spouses that discussed family planning issues was less reported within the control group, both in the case of men and women ((p = 0.031) and (p < 0.001)) respectively. In general, a significant, positive difference in male involvement was observed. Concerning contraceptive use, there was change observed among the intervention group who were not using contraception at baseline. This study showed that family planning educational intervention, which includes both spouses and promotes spousal communication, might be useful to foster contraceptive practice among couples. The results also offer practical information on the benefits of male involvement in family planning as a best means to increase contraceptive use. Thus, providing opportunities to reinforce family planning education may strengthen the existing family planning service delivery system.

Quasi-experimental designs in practice-based research settings: design and implementation considerations.

PubMed

Handley, Margaret A; Schillinger, Dean; Shiboski, Stephen

2011-01-01

Although randomized controlled trials are often a gold standard for determining intervention effects, in the area of practice-based research (PBR), there are many situations in which individual randomization is not possible. Alternative approaches to evaluating interventions have received increased attention, particularly those that can retain elements of randomization such that they can be considered "controlled" trials. Methodological design elements and practical implementation considerations for two quasi-experimental design approaches that have considerable promise in PBR settings--the stepped-wedge design, and a variant of this design, a wait-list cross-over design, are presented along with a case study from a recent PBR intervention for patients with diabetes. PBR-relevant design features include: creation of a cohort over time that collects control data but allows all participants (clusters or patients) to receive the intervention; staggered introduction of clusters; multiple data collection points; and one-way cross-over into the intervention arm. Practical considerations include: randomization versus stratification, training run in phases; and extended time period for overall study completion. Several design features of practice based research studies can be adapted to local circumstances yet retain elements to improve methodological rigor. Studies that utilize these methods, such as the stepped-wedge design and the wait-list cross-over design, can increase the evidence base for controlled studies conducted within the complex environment of PBR.

Physician to investigator: clinical practice to clinical research--ethical, operational, and financial considerations.

PubMed

Pierre, Christine

2008-01-01

Physicians who participate in clinical research studies gain benefits for themselves, their practice, and their patients. Historically, private practice physicians have chosen to defer to their counterparts in academic medicine when it comes to contributing to scientific advancement through clinical studies. A growing number of private practice physicians are now taking a serious second look and deciding that there are unique benefits for both the practice and the patient. Physicians who decide to participate in clinical research should give serious consideration to the time and resources that are required to meet both federal regulations and industry standards. In addition, ethical and scientific principles for assuring the protection of human research subjects must be a paramount commitment.

Medicaid Consent to Sterilization forms: historical, practical, ethical, and advocacy considerations.

PubMed

Block-Abraham, Dana; Arora, Kavita S; Tate, Danielle; Gee, Rebekah E

2015-06-01

The US government developed a Medicaid Consent to Sterilization form in the mid-1970s to protect vulnerable populations from coerced sterilization. US health care practices have evolved significantly since that time. The form, however, has not changed, and may be preventing access to desired services for the same vulnerable populations it was originally created to protect. This paper discusses the relevant historical, practical use, ethical, and advocacy considerations of the Medicaid sterilization consent form and proposes changes to make the form more pertinent to today's medical environment.

Special considerations--Induction of labor in low-resource settings.

PubMed

Smid, Marcela; Ahmed, Yusuf; Ivester, Thomas

2015-10-01

Induction of labor in resource-limited settings has the potential to significantly improve health outcomes for both mothers and infants. However, there are relatively little context-specific data to guide practice, and few specific guidelines. Also, there may be considerable issues regarding the facilities and organizational capacities necessary to support safe practices in many aspects of obstetrical practice, and for induction of labor in particular. Herein we describe the various opportunities as well as challenges presented by induction of labor in these settings. Copyright © 2015 Elsevier Inc. All rights reserved.

[Psychotherapy institutions and their patients].

PubMed

Rudolf, G; von Essen, C; Porsch, U; Grande, T

1988-01-01

This article investigates a number of institutions and private practices involved in the Berlin psychotherapy study from the point of view of their patients and their offerings in the area of therapy. Certain similarities have been found to exist between the institutions in the sex and age structure of the patients as well as in terms of the high level of previous experience with psychotherapy and psychoanalysis and previous medical measures. None of the institutions or practices saw primarily socially privileged patients, as is sometimes maintained. To a considerable degree the people they see live in a destabilized situation or one that is not yet stabilized and enjoy little social certainty (ca. 50%). The rate of the indication for psychotherapy and its actual initiation varies considerably from one institution to another. It runs the spectrum from the municipal counseling services, whose little motivated patients are only open to psychotherapy at all at a rate of 50% (actual therapy 22%) to patients in private psychotherapeutic practices who have gone through a long motivational process and who begin therapy at a rate of 70%. Study of the relationship between the location of the institution and the area in which the patients live shows on the one hand a tendency toward regionalism insofar as institutions are preferred by the patients who live near by. On the other hand, these special institutions are also sought out by patients from more distant locations and from differently structured areas; these patients are represented to the same degree as patients from the immediate area. Although psychotherapeutic institutions are often situated in the "better" residential areas, their patients are by no means only from such privileged areas but from all regions, including those that are socially weak.

A focused ethnographic assessment of Middle Eastern mothers' infant feeding practices in Canada.

PubMed

Jessri, Mahsa; Farmer, Anna P; Olson, Karin

2015-10-01

The aim of this study was to examine the barriers to following complementary feeding guidelines among Middle Eastern mothers and the cultural considerations of practitioners from an emic perspective. This is a two-phase focused ethnographic assessment of infant feeding among 22 Middle Eastern mothers in Western Canada who had healthy infants aged <1 year. Data were collected through four focus groups conducted in Arabic/Farsi, and were further complemented by comprehensive survey data collected in the second phase of study. Mothers' main criterion for choosing infant foods was whether or not foods were Halal, while food allergens were not causes for concern. Vitamin D supplements were not fed to 18/22 of infants, and mashed dates (Halawi), rice pudding (Muhallabia/Ferni) and sugared water/tea were the first complementary foods commonly consumed. Through constant comparison of qualitative data, three layers of influence emerged, which described mothers' process of infant feeding: socio-cultural, health care system and personal factors. Culture was an umbrella theme influencing all aspects of infant feeding decisions. Mothers cited health care professionals' lack of cultural considerations and lack of relevance and practicality of infant feeding guidelines as the main reasons for ignoring infant feeding recommendations. Early introduction of pre-lacteal feeds and inappropriate types of foods fed to infants among immigrant/refugee Middle Eastern mothers in Canada is cause of concern. Involving trained language interpreters in health teams and educating health care staff on cultural competency may potentially increase maternal trust in the health care system and eventually lead to increased awareness of and adherence to best practices with infant feeding recommendations. © 2013 John Wiley & Sons Ltd.

The decision to adopt evidence-based and other innovative mental health practices: risky business?

PubMed

Panzano, Phyllis C; Roth, Dee

2006-08-01

A risk-based decision-making framework was used to examine the decision to adopt innovative mental health practices, including both evidence-based and other research-guided practices. Seventy-eight projects involving decisions to adopt one of four innovative mental health practices were the focus of this study. Key informants with direct knowledge about the adoption decision provided data for hypothesis testing. As predicted, the propensity to adopt an innovative practice-as measured by decision stage-was negatively related to the perceived risk of adopting the practice, positively related to expected capacity to manage risk, and positively related to an organization's past propensity to take risks. Further, perceived risk, anticipated resource availability, and exposure to field-based evidence explained a substantial part of what differentiated adopters from nonadopters. Finally, several features of innovations known to influence innovation adoption decisions were found to be related in expected ways to perceived risk, capacity to manage risk, and risk propensity. This research supports the view that the decision to adopt an innovative mental health practice is a decision made in consideration of risk. Contrary to popular views that early adopters of innovations are willing to take enormous risks, these data offer the novel idea that early adopters act because they see the risks associated with adopting as lower than their nonadopter counterparts, partly because the risks are seen as more manageable. Implications of results are discussed for organizations considering adoption of innovative health care practices and for state or local mental health authorities hoping for a higher level of adoption in their areas.

Toward Dynamic Adaptation of Psychological Interventions for Child and Adolescent Development and Mental Health.

PubMed

Malti, Tina; Noam, Gil G; Beelmann, Andreas; Sommer, Simon

2016-01-01

Children's and adolescents' mental health needs emphasize the necessity of a new era of translational research to enhance development and yield better lives for children, families, and communities. Developmental, clinical, and translational research serves as a powerful tool for managing the inevitable complexities in pursuit of these goals. This article proposes key ideas that will strengthen current evidence-based intervention practices by creating stronger links between research, practice, and complex systems contexts, with the potential of extending applicability, replicability, and impact. As exemplified in some of the articles throughout this special issue, new research and innovative implementation models will likely contribute to better ways of assessing and dynamically adapting structure and intervention practice within mental health systems. We contend that future models for effective interventions with children and adolescents will involve increased attention to (a) the connection of research on the developmental needs of children and adolescents to practice models; (b) consideration of informed contextual and cultural adaptation in implementation; and (c) a rational model of evidence-based planning, using a dynamic, inclusive approach with high support for adaptation, flexibility, and implementation fidelity. We discuss future directions for translational research for researchers, practitioners, and administrators in the field to continue and transform these ideas and their illustrations.

Online interprofessional health sciences education: From theory to practice.

PubMed

Luke, Robert; Solomon, Patty; Baptiste, Sue; Hall, Pippa; Orchard, Carole; Rukholm, Ellen; Carter, Lorraine

2009-01-01

Online learning (e-learning) has a nascent but established history. Its application to interprofessional education (IPE), however, is relatively new. Over the past 2 decades the Internet has been used increasingly to mediate education. We have come past the point of "should we use the Internet for education" to "how should we use the Internet for education." Research has begun on the optimal development of online learning environments to support IPE. Developing online IPE should follow best practices in e-learning generally, though there are some special considerations for acknowledging the interprofessional context and clinical environments that online IPE is designed to support. The design, development, and deployment of effective online IPE must therefore pay special attention to the particular constraints of the health care worker educational matrix, both pre- and postlicensure. In this article we outline the design of online, interprofessional health sciences education. Our work has involved 4 educational and 4 clinical service institutions. We establish the context in which we situate our development activities that created learning modules designed to support IPE and its transfer into new interprofessional health care practices. We illustrate some best practices for the design of effective online IPE, and show how this design can create effective learning for IPE. Challenges exist regarding the full implementation of interprofessional clinical practice that are beginning to be met by coordinated efforts of multiple health care education silos.

Theoretical and practical knowledge of Nursing professionals on indirect blood pressure measurement at a coronary care unit

PubMed Central

Machado, Juliana Pereira; Veiga, Eugenia Velludo; Ferreira, Paulo Alexandre Camargo; Martins, José Carlos Amado; Daniel, Ana Carolina Queiroz Godoy; Oliveira, Amanda dos Santos; da Silva, Patrícia Costa dos Santos

2014-01-01

Objective To determine and to analyze the theoretical and practical knowledge of Nursing professionals on indirect blood pressure measurement. Methods This cross-sectional study included 31 professionals of a coronary care unit (86% of the Nursing staff in the unit). Of these, 38.7% of professionals were nurses and 61.3% nurse technicians. A validated questionnaire was used to theoretical evaluation and for practice assessment the auscultatory technique was applied in a simulation environment, under a non-participant observation. Results To the theoretical knowledge of the stages of preparation of patient and environment, 12.9% mentioned 5-minute of rest, 48.4% checked calibration, and 29.0% chose adequate cuff width. A total of 64.5% of professionals avoided rounding values, and 22.6% mentioned the 6-month deadline period for the equipment calibration. On average, in practice assessment, 65% of the steps were followed. Lacks in knowledge were primary concerning lack of checking the device calibration and stethoscope, measurement of arm circumference to choose the cuff size, and the record of arm used in blood pressure measurement. Conclusion Knowledge was poor and had disparities between theory and practice with evidence of steps taken without proper awareness and lack of consideration of important knowledge during implementation of blood pressure measurement. Educational and operational interventions should be applied systematically with institutional involvement to ensure safe care with reliable values. PMID:25295455

42 CFR 409.35 - Criteria for “practical matter”.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Criteria for “practical matter”. (a) General considerations. In making a “practical matter” determination...) Examples of circumstances that meet practical matter criteria—(1) Beneficiary's condition. Inpatient care would be required “as a practical matter” if transporting the beneficiary to and from the nearest...

42 CFR 409.35 - Criteria for “practical matter”.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Criteria for “practical matter”. (a) General considerations. In making a “practical matter” determination...) Examples of circumstances that meet practical matter criteria—(1) Beneficiary's condition. Inpatient care would be required “as a practical matter” if transporting the beneficiary to and from the nearest...

42 CFR 409.35 - Criteria for “practical matter”.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Criteria for “practical matter”. (a) General considerations. In making a “practical matter” determination...) Examples of circumstances that meet practical matter criteria—(1) Beneficiary's condition. Inpatient care would be required “as a practical matter” if transporting the beneficiary to and from the nearest...

42 CFR 409.35 - Criteria for “practical matter”.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Criteria for “practical matter”. (a) General considerations. In making a “practical matter” determination...) Examples of circumstances that meet practical matter criteria—(1) Beneficiary's condition. Inpatient care would be required “as a practical matter” if transporting the beneficiary to and from the nearest...

Religion, spirituality and mental health in the West and the Middle East.

PubMed

Koenig, Harold G; Zaben, Faten Al; Khalifa, Doaa Ahmed

2012-06-01

Research on religion, spirituality and mental health has been rapidly accumulating from Western countries and now increasingly from the Middle East. We review here the latest research on this topic from these two areas of the world, one largely Christian and the other largely Muslim, after discussing similarities and differences in these faith traditions. Contrary to popular thought, there is considerable overlap between these religious groups in beliefs, practices of worship, moral beliefs and values, and emphasis on family life (although also some distinct differences). Because of the similarity in belief and practice, it is not surprising that research on mental health and devout religious involvement in both these religious traditions has tended to produce similar results. Religious psychotherapies within these faith traditions have been developed and are now being refined and used in clinical trials to determine if integrating patients' religious resources into therapy is more or less effective than conventional therapies in relieving the symptoms of depression and anxiety. Copyright © 2012 Elsevier B.V. All rights reserved.

[The ethic dimension of daily tasks in the formation process of nurses].

PubMed

Fernandes, Josicélia Dumêt; Rosa, Darci de Oliveira Santa; Vieira, Therezinha Teixeira; Sadigursky, Dora

2008-06-01

This theoretical article had as its object of study the ethic dimension of the formation process of nurses taking in consideration the National Curricular Directives for Nursing Courses. It was based on the presuppositions of ethics and their relationship with the implementation of changes in the formation process of nurses, using as reference elements of ethical behavior in the formation and attempting to bring the reflection to current times and thus contribute to define a direction to Nursing education. It was concluded that the ethical dimension in the formation of nurses involves values that permeate the relations between the subjects of this process and nature itself. The study points out the need to transform the practices of students and teachers and change the current curriculum framework, highlighting elements that indicate that the concern with ethics when developing the curriculum framework is not limited to how a discipline is taught, but pass through as practices that take place in the education process.

Environmental practices for biomedical research facilities.

PubMed Central

Medlin, E L; Grupenhoff, J T

2000-01-01

As a result of the Leadership Conference on Biomedical Research and the Environment, the Facilities Committee focused its work on the development of best environmental practices at biomedical research facilities at the university and independent research facility level as well as consideration of potential involvement of for-profit companies and government agencies. The designation "facilities" includes all related buildings and grounds, "green auditing" of buildings and programs, purchasing of furnishings and sources, energy efficiency, and engineering services (lighting, heating, air conditioning), among other activities. The committee made a number of recommendations, including development of a national council for environmental stewardship in biomedical research, development of a system of green auditing of such research facilities, and creation of programs for sustainable building and use. In addition, the committee recommended extension of education and training programs for environmental stewardship, in cooperation with facilities managers, for all research administrators and researchers. These programs would focus especially on graduate fellows and other students, as well as on science labs at levels K--12. PMID:11121360

Time to Redefine Organic Agriculture: Can’t GM Crops Be Certified as Organics?

PubMed Central

Husaini, Amjad M.; Sohail, Muhammad

2018-01-01

The challenges of sustainable food production without damaging the environment for a growing human population have increased considerably. The current agricultural practices involving chemical fertilizers and even organic farming are not sustainable in the long run and can have deleterious effects on the environment. Thus, new, innovative solutions need to be identified and propagated for tackling this. Among such innovations, that can complement conventional as well as organic farming methods, are genetic modification (GM) and aquaculture. Yet, GM technologies often face resistance from civil groups owing to an ‘unknown’ fear, akin to Frankenstein’s monster. How real is this fear? Our discussion rests on basic questions like, why can’t ‘organics’ include GM crops that do not require chemical inputs for cultivation, and can GM crops like Golden rice qualify to be ‘organic’ if cultivated through organic practices? Do we need to rethink organic agriculture in the context of the present and future challenges of 21st century? PMID:29692789

Time to Redefine Organic Agriculture: Can't GM Crops Be Certified as Organics?

PubMed

Husaini, Amjad M; Sohail, Muhammad

2018-01-01

The challenges of sustainable food production without damaging the environment for a growing human population have increased considerably. The current agricultural practices involving chemical fertilizers and even organic farming are not sustainable in the long run and can have deleterious effects on the environment. Thus, new, innovative solutions need to be identified and propagated for tackling this. Among such innovations, that can complement conventional as well as organic farming methods, are genetic modification (GM) and aquaculture. Yet, GM technologies often face resistance from civil groups owing to an 'unknown' fear, akin to Frankenstein's monster. How real is this fear? Our discussion rests on basic questions like, why can't 'organics' include GM crops that do not require chemical inputs for cultivation, and can GM crops like Golden rice qualify to be 'organic' if cultivated through organic practices? Do we need to rethink organic agriculture in the context of the present and future challenges of 21st century?

Economic and practical challenges to the formulation of vaccines against endemic infectious diseases such as malaria.

PubMed

Plebanski, Magdalena; Lopez, Ester; Proudfoot, Owen; Cooke, Brian M; Itzstein, Mark von; Coppel, Ross L

2006-09-01

Herein, we analyze in general the current vaccine market and identify potential factors driving and modulating supply and demand for vaccines. An emphasis is placed on changes in regulation in the last 20 years which have led to increased indirect costs of production, and which can create a barrier against the timely use of technological advances to reduce direct costs. Other defining industry characteristics, such as firm numbers and sizes, cost and pricing strategies, nature extent and impact of Government involvement and international regulation are noted. These considerations, far from being removed from basic vaccine research, influence its ability to achieve aims that can be then progressed into effective vaccine products. We discuss specifically the development of particulate vaccines against malaria, a major lethal disease and health problem prevalent in Africa, including some key economic and methodological challenges and opportunities. We note some practical issues blocking the development of effective particulate vaccines for the Third World, mainly driven by the regulatory spiral noted above.

The skin as a window to the blood: Cutaneous manifestations of myeloid malignancies.

PubMed

Li, Alvin W; Yin, Emily S; Stahl, Maximilian; Kim, Tae Kon; Panse, Gauri; Zeidan, Amer M; Leventhal, Jonathan S

2017-11-01

Cutaneous manifestations of myeloid malignancies are common and have a broad range of presentations. These skin findings are classified as specific, due to direct infiltration by malignant hematopoietic cells, or non-specific. Early recognition and diagnosis can have significant clinical implications, as skin manifestations may be the first indication of underlying hematologic malignancy, can reflect the immune status and stage of disease, and cutaneous reactions may occur from conventional and targeted agents used to treat myeloid disease. In addition, infections with cutaneous involvement are common in immunocompromised patients with myeloid disease. Given the varying presentations, dermatologic findings associated with myeloid malignancies can pose diagnostic challenges for hematologists and dermatologists. In this clinical review intended for the practicing hematologist/oncologist, we discuss the presentation, diagnosis, treatment, and prognostic value of the most common cutaneous manifestations associated with myeloid malignancies using illustrative macro- and microscopic figures and with a special emphasis on practical considerations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Impact of a population based intervention to increase the adoption of multiple physical activity practices in centre based childcare services: a quasi experimental, effectiveness study

PubMed Central

2012-01-01

Background There is considerable scope to improve the delivery of practices that increase the physical activity of children in centre based childcare services. Few studies have reported the effectiveness of interventions to address this, particularly at a population level. The primary aim of this study was to describe the impact of an intervention to increase the adoption of multiple policies and practices to promote physical activity in centre based childcare services. Methods A quasi experimental study was conducted in centre based childcare services (n =228) in New South Wales (NSW), Australia and involved a three month intervention to increase the adoption of eight practices within childcare services that have been suggested to promote child physical activity. Intervention strategies to support the adoption of practices included staff training, resources, incentives, follow-up support and performance monitoring and feedback. Randomly selected childcare services in the remainder of NSW acted as a comparison group (n = 164) and did not receive the intervention but may have been exposed to a concurrent NSW government healthy eating and physical activity initiative. Self reported information on physical activity policies, fundamental movement skills sessions, structured physical activity opportunities, staff involvement in active play and provision of verbal prompts to encourage physical activity, small screen recreation opportunities, sedentary time, and staff trained in physical activity were collected by telephone survey with childcare service managers at baseline and 18 months later. Results Compared with the comparison area, the study found significantly greater increases in the prevalence of intervention services with a written physical activity policy, with policy referring to placing limits on small screen recreation, and with staff trained in physical activity. In addition, non-significant trends towards a greater increase in the proportion of intervention services conducting daily fundamental movement skill sessions, and such services having a physical activity policy supporting physical activity training for staff were also evident. Conclusion The intervention was effective in improving a number of centre based childcare service policies and practices associated with promoting child physical activity. Adoption of a broader range of practices may require more intensive and prolonged intervention support. PMID:22929434

The Psychological Benefits from Reconceptualizing Music-Making as Mindfulness Practice.

PubMed

Steinfeld, Matthew; Brewer, Judson

2015-06-01

While the music psychology and education literatures have devoted considerable attention to how musical instrumentalists practice their instruments, less formal scholarly attention has been given in consideration of what it means to maintain a musical "practice" over time and across context. In this paper, the practice of mindfulness meditation is used as heuristic, arguing for a view of mindfulness meditation as a formalized de-specialization of the infinite number of other activities with which people can achieve mindfulness. Sitting meditation, requiring of one to observe the contents of their mind unmediated, can serve as a useful model for the musician in understanding the phenomenology of the music-making process and the "flow" states that can result from an embodied musical practice. Finally, reconceptualizing music-making as a mindfulness practice is considered with psychological and pedagogical implications relevant for developing musicians.

Postoperative Stereotactic Body Radiation Therapy (SBRT) for Spine Metastases: A Critical Review to Guide Practice

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

Redmond, Kristin J., E-mail: kjanson3@jhmi.edu; Lo, Simon S.; Fisher, Charles

Postoperative stereotactic body radiation therapy (SBRT) for metastatic spinal tumors is increasingly being performed in clinical practice. Whereas the fundamentals of SBRT practice for intact spinal metastases are established, there are as yet no comprehensive practice guidelines for the postoperative indications. In particular, there are unique considerations for patient selection and treatment planning specific to postoperative spine SBRT that are critical for safe and effective management. The purpose of this critical review is to discuss the rationale for treatment, describe those factors affecting surgical decision making, introduce modern surgical trends, and summarize treatment outcomes for both conventional postoperative external beammore » radiation therapy and postoperative spine SBRT. Lastly, an in-depth practical discussion with respect to treatment planning and delivery considerations is provided to help guide optimal practice.« less

A Situated Practice of Ethics for Participatory Visual and Digital Methods in Public Health Research and Practice: A Focus on Digital Storytelling

PubMed Central

Hill, Amy L.; Flicker, Sarah

2014-01-01

This article explores ethical considerations related to participatory visual and digital methods for public health research and practice, through the lens of an approach known as “digital storytelling.” We begin by briefly describing the digital storytelling process and its applications to public health research and practice. Next, we explore 6 common challenges: fuzzy boundaries, recruitment and consent to participate, power of shaping, representation and harm, confidentiality, and release of materials. We discuss their complexities and offer some considerations for ethical practice. We hope this article serves as a catalyst for expanded dialogue about the need for high standards of integrity and a situated practice of ethics wherein researchers and practitioners reflexively consider ethical decision-making as part of the ongoing work of public health. PMID:23948015

A situated practice of ethics for participatory visual and digital methods in public health research and practice: a focus on digital storytelling.

PubMed

Gubrium, Aline C; Hill, Amy L; Flicker, Sarah

2014-09-01

This article explores ethical considerations related to participatory visual and digital methods for public health research and practice, through the lens of an approach known as "digital storytelling." We begin by briefly describing the digital storytelling process and its applications to public health research and practice. Next, we explore 6 common challenges: fuzzy boundaries, recruitment and consent to participate, power of shaping, representation and harm, confidentiality, and release of materials. We discuss their complexities and offer some considerations for ethical practice. We hope this article serves as a catalyst for expanded dialogue about the need for high standards of integrity and a situated practice of ethics wherein researchers and practitioners reflexively consider ethical decision-making as part of the ongoing work of public health.

Practice-Informed Approaches to Addressing Substance Abuse and Trauma Exposure in Urban Native Families Involved with Child Welfare.

PubMed

Lucero, Nancy M; Bussey, Marian

2015-01-01

Similar to families from other groups, urban-based American Indian and Alaska Native ("Native") family members involved with the child welfare system due to substance abuse issues are also often challenged by untreated trauma exposure. The link between these conditions and the history of genocidal policies aimed at destroying Native family ties, as well as experiences of ongoing discrimination, bring added dimensions for consideration when pro- viding services to these families. Practice-based evidence indicates that the trauma-informed and culturally responsive model developed by the Denver Indian Family Resource Center (DIFRC) shows promise in reducing out-of-home placements and re-referrals in urban Native families with substance abuse and child welfare concerns, while also increasing caregiver capabilities, family safety, and child well-being. This article provides strategies from the DIFRC approach that non-Native caseworkers and supervisors can utilize to create an environment in their own agencies that supports culturally based practice with Native families while incorporating a trauma-informed understanding of service needs of these families. Casework consistent with this approach demonstrates actions that meet the Active Efforts requirement of the Indian Child Welfare Act (ICWA) as well as sound clinical practice. Intensive and proactive case management designed specifically for families with high levels of service needs is a key strategy when combined with utilizing a caseworker brief screening tool for trauma exposure; training caseworkers to recognize trauma symptoms, making timely referrals to trauma treatment by behavioral health specialists experienced in working with Native clients, and providing a consistent service environment that focuses on client safety and worker trustworthiness. Finally, suggestions are put forth for agencies seeking to enhance their cultural responsiveness and include increasing workers' understanding of cultural values, worldview, and historical issues; working from a relational perspective; listening deeply to families' experiences; and being open to incorporating traditional healing and cultural practice into service plans.

Critical considerations for the practical utility of health equity tools: a concept mapping study.

PubMed

Pauly, Bernadette; Martin, Wanda; Perkin, Kathleen; van Roode, Thea; Kwan, Albert; Patterson, Tobie; Tong, Samantha; Prescott, Cheryl; Wallace, Bruce; Hancock, Trevor; MacDonald, Marjorie

2018-04-23

Promoting health equity within health systems is a priority and challenge worldwide. Health equity tools have been identified as one strategy for integrating health equity considerations into health systems. Although there has been a proliferation of health equity tools, there has been limited attention to evaluating these tools for their practicality and thus their likelihood for uptake. Within the context of a large program of research, the Equity Lens in Public Health (ELPH), we conducted a concept mapping study to identify key elements and themes related to public health leaders and practitioners' views about what makes a health equity tool practical and useful. Concept mapping is a participatory mixed-method approach to generating ideas and concepts to address a common concern. Participants brainstormed responses to the prompt "To be useful, a health equity tool should…" After participants sorted responses into groups based on similarity and rated them for importance and feasibility, the statements were analyzed using multidimensional scaling, then grouped using cluster analysis. Pattern matching graphs were constructed to illustrate the relationship between the importance and feasibility of statements, and go-zone maps were created to guide subsequent action. The process resulted in 67 unique statements that were grouped into six clusters: 1) Evaluation for Improvement; 2) User Friendliness; 3) Explicit Theoretical Background; 4) Templates and Tools 5) Equity Competencies; and 6) Nothing about Me without Me- Client Engaged. The result was a set of concepts and themes describing participants' views of the practicality and usefulness of health equity tools. These thematic clusters highlight the importance of user friendliness and having user guides, templates and resources to enhance use of equity tools. Furthermore, participants' indicated that practicality was not enough for a tool to be useful. In addition to practical characteristics of the tool, a useful tool is one that encourages and supports the development of practitioner competencies to engage in equity work including critical reflections on power and institutional culture as well as strategies for the involvement of community members impacted by health inequities in program planning and delivery. The results of this study will be used to inform the development of practical criteria to assess health equity tools for application in public health.

How can Doctors Improve their Communication Skills?

PubMed Central

Kumari, Archana; Chakrawarty, Avinash

2015-01-01

The process of curing a patient requires a holistic approach which involves considerations beyond treating a disease. It warrants several skills in a doctor along with technical expertise. Studies have shown that good communication skill in a doctor improve patient’s compliance and overall satisfaction. There are certain basic principles of practicing good communication. Patient listening, empathy, and paying attention to the paraverbal and non verbal components of the communication are the important ones that are frequently neglected. Proper information about the nature, course and prognosis of the disease is important. Besides, patients and attendants should always be explained about the necessity and yield of expensive investigations and risks/benefits involved in invasive procedures. One should be extremely cautious while managing difficult encounters and breaking bad news. Formal training of the doctors in improving communication skills is necessary and has proven to improve overall outcome. The authors recommend inclusion of formal training in communication skills in medical curriculum and training of practising doctors in the form of CMEs and CPEs. PMID:25954636

[Cancer prevention in France: Implication of health professionals].

PubMed

Lasserre, Andrea; Gaillot, Julie; Deutsch, Antoine; Chauvet, Claire; Bessette, Dominique; Ancellin, Raphaëlle

2017-03-01

Almost 40% of cancers are attributable to preventable cancer risk factors related to behavior. Health professionals must take into account the respective weight of the different causes of cancer to enforce effective cancer prevention. Their involvement is needed on several levels. In primary prevention, not only for vaccinations, detection and support the withdrawal of addiction, but also by a greater consideration in their patients of all cancer risk behavioral factors. This involvement is essential in the care and monitoring of patients with cancer. Thus, enhancing patient compliance with cancer prevention tips (stopping smoking, reducing alcohol consumption, practice physical activity, physical inactivity reduction, reduction of overweight, adopting a diversified and balanced diet) appears as a new challenge of personalized care in oncology that not only aims to reduce the incidence of cancer but also to reduce the risks of morbidity and long-term mortality. Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Currency arbitrage detection using a binary integer programming model

NASA Astrophysics Data System (ADS)

Soon, Wanmei; Ye, Heng-Qing

2011-04-01

In this article, we examine the use of a new binary integer programming (BIP) model to detect arbitrage opportunities in currency exchanges. This model showcases an excellent application of mathematics to the real world. The concepts involved are easily accessible to undergraduate students with basic knowledge in Operations Research. Through this work, students can learn to link several types of basic optimization models, namely linear programming, integer programming and network models, and apply the well-known sensitivity analysis procedure to accommodate realistic changes in the exchange rates. Beginning with a BIP model, we discuss how it can be reduced to an equivalent but considerably simpler model, where an efficient algorithm can be applied to find the arbitrages and incorporate the sensitivity analysis procedure. A simple comparison is then made with a different arbitrage detection model. This exercise helps students learn to apply basic Operations Research concepts to a practical real-life example, and provides insights into the processes involved in Operations Research model formulations.

School-based smoking prevention programmes: ethical aspects.

PubMed

Lotrean, Lucia Maria; Trofor, Antigona; Mihălţan, Florin; Santillan, Edna Arillo

2011-01-01

School-based health education has the potential to inform and educate young people, in order to promote healthy behaviours among them, which will help to prevent diseases and social problems. The present study gives an overview of several ethical issues which must be considered in different phases of school-based smoking prevention programs. This will help health educators, public health professionals and researchers in their activity of health education in schools. The ethical issues must be taken into consideration during all the activities and refer to the involvement of officials, schools, parents, young people who participate into the program, authors and persons/institutions responsible with the implementation, evaluation or funding of the programs. The application into practice of these ethical principles, influence the quality of the health education, its acceptability BY the target group and the correctness of results. Also, it prevents possible problems and misunderstandings between persons and institutions involved in the health education and smoking prevention process, which could seriously affect and even destroy implementation of such health education activities.

Legal, Social, Ethical, and Medical Perspectives on the Care of the Statutory Rape Adolescent in the Emergency Department.

PubMed

Tsai, Shiu-Lin; Acosta, Elvira; Cardenas, Toni; Sigall, Jeremy K; Van Geem, Kevin

2017-07-01

Rapes involving adolescents who present to the emergency department (ED) are fraught with ethical and legal complexities and are often emotionally turbulent for patients, their families, and medical providers. Management requires a thoughtful approach from multiple standpoints, including legal, psychosocial, ethical, and medical ones. However, there is no standardized sexual assault education for emergency medicine residents, and management practices vary widely. 1,2 We present a hypothetical statutory rape case based on real cases that occurred in New York City and bring together the perspectives of an attorney on the legal parameters, two social workers on the psychosocial issues, an ethicist on the moral considerations, and a pediatric emergency physician-who is also a sexual assault forensic examiner-on the medical treatments. We aim to provide a framework for physicians to navigate issues of patient-physician privilege involving minors, privacy rules, and mandatory reporting laws. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Prediction of child performance on a parent-child behavioral approach test with animal phobic children.

PubMed

Ollendick, Thomas H; Lewis, Krystal M; Cowart, Maria J W; Davis, Thompson

2012-07-01

A host of factors including genetic influences, temperament characteristics, learning experiences, information processing biases, parental psychopathology, and specific parenting practices have been hypothesized to contribute to the development and expression of children's phobias. In the present study, the authors focused on parental psychopathology (phobic anxiety) and parenting behaviors (warmth, involvement) in the prediction of child performance on a behavioral approach test (BAT). All children (n = 44) experienced a phobia of animals and were clinic referred. The youth completed two BATs: the first alone and the second one with a parent present. Overall, performance was greater on the parent-present BAT (58% of steps completed) than on the child-alone BAT (38% of steps completed), although considerable variability was present. Performance on the parent-present BAT was associated with parental warmth and involvement but not parental phobic anxiety. Implications of these findings were discussed, and their implications for the use of behavioral analogues tests were explored.

Paying the piper: additional considerations of the theoretical, ethical and moral basis of financial incentives for health behaviour change.

PubMed

Stephens, Christine

2014-02-01

Lynagh, Sanson-Fisher and Bonevski's article entitled "What's good for the goose is good for the gander. Guiding principles for the use of financial incentives in health behaviour change" (Int J Behav Med 20:114-120, 2012) reviews evidence for the use of financial incentives for encouraging health behaviour change. Their discussion of the practical and moral issues involved is a timely contribution which will encourage consideration of the implications of such interventions. In this response to their paper, I suggest that there are also broader aspects that we must consider before developing principles for public policy intervention. First, we must include good theories that explain in a great deal more depth what we mean by health-related behaviours, and secondly, we need to understand the location of these behaviours in social life and within structural inequalities. To ignore these fundamental aspects of health is to risk increasing social injustice and worsening health inequalities, a facet of the morality of health promotion activities which is not touched upon by the Lynagh et al. paper.

Environmental health implications of global climate change.

PubMed

Watson, Robert T; Patz, Jonathan; Gubler, Duane J; Parson, Edward A; Vincent, James H

2005-09-01

This paper reviews the background that has led to the now almost-universally held opinion in the scientific community that global climate change is occurring and is inescapably linked with anthropogenic activity. The potential implications to human health are considerable and very diverse. These include, for example, the increased direct impacts of heat and of rises in sea level, exacerbated air and water-borne harmful agents, and--associated with all the preceding--the emergence of environmental refugees. Vector-borne diseases, in particular those associated with blood-sucking arthropods such as mosquitoes, may be significantly impacted, including redistribution of some of those diseases to areas not previously affected. Responses to possible impending environmental and public health crises must involve political and socio-economic considerations, adding even greater complexity to what is already a difficult challenge. In some areas, adjustments to national and international public health practices and policies may be effective, at least in the short and medium terms. But in others, more drastic measures will be required. Environmental monitoring, in its widest sense, will play a significant role in the future management of the problem.

Tiered analytics for purity assessment of macrocyclic peptides in drug discovery: Analytical consideration and method development.

PubMed

Qian Cutrone, Jingfang Jenny; Huang, Xiaohua Stella; Kozlowski, Edward S; Bao, Ye; Wang, Yingzi; Poronsky, Christopher S; Drexler, Dieter M; Tymiak, Adrienne A

2017-05-10

Synthetic macrocyclic peptides with natural and unnatural amino acids have gained considerable attention from a number of pharmaceutical/biopharmaceutical companies in recent years as a promising approach to drug discovery, particularly for targets involving protein-protein or protein-peptide interactions. Analytical scientists charged with characterizing these leads face multiple challenges including dealing with a class of complex molecules with the potential for multiple isomers and variable charge states and no established standards for acceptable analytical characterization of materials used in drug discovery. In addition, due to the lack of intermediate purification during solid phase peptide synthesis, the final products usually contain a complex profile of impurities. In this paper, practical analytical strategies and methodologies were developed to address these challenges, including a tiered approach to assessing the purity of macrocyclic peptides at different stages of drug discovery. Our results also showed that successful progression and characterization of a new drug discovery modality benefited from active analytical engagement, focusing on fit-for-purpose analyses and leveraging a broad palette of analytical technologies and resources. Copyright © 2017. Published by Elsevier B.V.

Canine and feline blood transfusions: controversies and recent advances in administration practices.

PubMed

Kisielewicz, Caroline; Self, Ian A

2014-05-01

To discuss and review blood transfusion practices in dogs and cats including collection and storage of blood and administration of products. To report new developments, controversial practices, less conventional blood product administration techniques and where applicable, describe the relevance to anaesthetists and anaesthesia. PubMed and Google Scholar using dog, cat, blood transfusion, packed red blood cells and whole blood as keywords. Blood transfusions improve oxygen carrying capacity and the clinical signs of anaemia. However there are numerous potential risks and complications possible with transfusions, which may outweigh their benefits. Storage of blood products has improved considerably over time but whilst extended storage times may improve their availability, a phenomenon known as the storage lesion has been identified which affects erythrocyte viability and survival. Leukoreduction involves removing leukocytes and platelets thereby preventing their release of cytokines and bioactive compounds which also contribute to storage lesions and certain transfusion reactions. Newer transfusion techniques are being explored such as cell salvage in surgical patients and subsequent autologous transfusion. Xenotransfusions, using blood and blood products between different species, provide an alternative to conventional blood products. © 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

Adaptive trials for tuberculosis: early reflections on theory and practice.

PubMed

Montgomery, C M

2016-08-01

Adaptive designs (ADs) have been proposed for anti-tuberculosis treatment trials. This call for innovation occurs against the backdrop of fundamental changes in the acceptable evidence base in anti-tuberculosis treatment. To contextualise ADs for tuberculosis (TB) and explore early responses from those working in the field. In this qualitative study investigating processes of theoretical and practical change in randomised controlled trials, 24 interviews were conducted with professionals involved in AD trials, half of whom worked in the TB field. Clinical trialists working on AD trials in TB are positive about the efficiency these designs offer, but remain cautious about their suitability. In addition to technical concerns, informants discussed the challenges of implementing AD in developing countries, including limited regulatory capacity to evaluate proposals, investments needed in infrastructure and site capacity, and challenges regarding informed consent. Respondents identified funding, interdisciplinary communication and regulatory and policy responses as additional concerns potentially affecting the success of AD for TB. Empirical research is needed into patient experiences of AD, including informed consent. Further consideration of the contexts of innovation in trial design is needed. These are fundamental to the successful translation of theory into practice.

Using a communication audit to improve communication on clinical placement in pre-registration nursing.

PubMed

Hogard, Elaine; Ellis, Roger; Ellis, Jackie; Barker, Chris

2005-02-01

This article describes a novel communication audit conducted with those concerned with the practice placements of pre-registration Nursing students. The study, uniquely, addressed all who were involved in communication concerning placement in what is described as an organisational analysis. The aim of the audit was to identify levels of satisfaction and dissatisfaction with present communication processes and to identify points for improvement. The audit used the Hogard-Barker Communication Audit of Practice a customized version of a well established tool, devised to cover issues relevant to practice placements. A key feature of the tool is the opportunity for participants to identify the amount of communication they are receiving on particular topics and issues against the amount they would like to receive. Participants in the audit included students, assessor mentors, ward managers, clinical facilitators and link tutors. Overall there was considerable dissatisfaction with what was perceived to be the insufficient amount of communication received on a number of topics including allocations, the curriculum, students' learning outcomes and commitments in terms of college work. In addition to identifying points for improvement the audit provides a baseline against which progress can be assessed through a future audit.

Planning for life after orthopaedics.

PubMed

Barr, Joseph S; McCaslin, Michael J; Hinds, Cynthia K

2014-01-01

The word retirement is going out of fashion. Many orthopaedic surgeons want to work in some capacity when they stop performing surgery. Making a smooth transition from a busy orthopaedic practice to alternative work demands advanced planning. The surgeon must consider personal issues that involve how to use human capital (his or her accumulated knowledge and experience). New ventures, hobbies, travel, and spending time with family and friends are some possibilities. Plans for slowing down or leaving the practice should be discussed and agreed on well ahead of time. Agreements for buyouts may be difficult to work out and will require creative thinking. The solo practitioner can close the practice or hire a successor. Financial planning is perhaps the most important consideration and should be started by approximately age 40. It is recommended that the surgeon develop a portfolio of secure investments and annuities to provide adequate income for as long as is needed and then to turn the residual income to one's family, favorite charities, or other desired cause. A team of competent advisors is needed to help develop and achieve one's goals, create financial security, and provide the discipline to carry out the needed planning for life after orthopaedics.

Ethically-based clinical decision-making in physical therapy: process and issues.

PubMed

Finch, Elspeth; Geddes, E Lynne; Larin, Hélène

2005-01-01

The identification and consideration of relevant ethical issues in clinical decision-making, and the education of health care professionals (HCPs) in these skills are key factors in providing quality health care. This qualitative study explores the way in which physical therapists (PTs) integrate ethical issues into clinical practice decisions and identifies ethical themes used by PTs. A purposive sample of eight PTs was asked to describe a recent ethically-based clinical decision. Transcribed interviews were coded and themes identified related to the following categories: 1) the integration of ethical issues in the clinical decision-making process, 2) patient welfare, 3) professional ethos of the PT, and 4) health care economics and business practices. Participants readily described clinical situations involving ethical issues but rarely identified specific conflicting ethical issues in their description. Ethical dilemmas were more frequently resolved when there were fewer emotional sequelae associated with the dilemma, and the PT had a clear understanding of professional ethos, valued patient autonomy, and explored a variety of alternative actions before implementing one. HCP students need to develop a clear professional ethos and an increased understanding of the economic factors that will present ethical issues in practice.

Advancing Psychologically Informed Practice for Patients With Persistent Musculoskeletal Pain: Promise, Pitfalls, and Solutions.

PubMed

Keefe, Francis J; Main, Chris J; George, Steven Z

2018-05-01

There has been growing interest in psychologically oriented pain management over the past 3 to 4 decades, including a 2011 description of psychologically informed practice (PIP) for low back pain. PIP requires a broader focus than traditional biomechanical and pathology-based approaches that have been traditionally used to manage musculoskeletal pain. A major focus of PIP is addressing the behavioral aspects of pain (ie, peoples' responses to pain) by identifying individual expectations, beliefs, and feelings as prognostic factors for clinical and occupational outcomes indicating progression to chronicity. Since 2011, the interest in PIP seems to be growing, as evidenced by its use in large trials, inclusion in scientific conferences, increasing evidence base, and expansion to other musculoskeletal pain conditions. Primary care physicians and physical therapists have delivered PIP as part of a stratified care approach involving screening and targeting of treatment for people at high risk for continued pain-associated disability. Furthermore, PIP is consistent with recent national priorities emphasizing nonpharmacological pain management options. In this perspective, PIP techniques that range in complexity are described, considerations for implementation in clinical practice are offered, and future directions that will advance the understanding of PIP are outlined.

Occupational safety and health, green chemistry, and sustainability: a review of areas of convergence

PubMed Central

2013-01-01

With increasing numbers and quantities of chemicals in commerce and use, scientific attention continues to focus on the environmental and public health consequences of chemical production processes and exposures. Concerns about environmental stewardship have been gaining broader traction through emphases on sustainability and “green chemistry” principles. Occupational safety and health has not been fully promoted as a component of environmental sustainability. However, there is a natural convergence of green chemistry/sustainability and occupational safety and health efforts. Addressing both together can have a synergistic effect. Failure to promote this convergence could lead to increasing worker hazards and lack of support for sustainability efforts. The National Institute for Occupational Safety and Health has made a concerted effort involving multiple stakeholders to anticipate and identify potential hazards associated with sustainable practices and green jobs for workers. Examples of potential hazards are presented in case studies with suggested solutions such as implementing the hierarchy of controls and prevention through design principles in green chemistry and green building practices. Practical considerations and strategies for green chemistry, and environmental stewardship could benefit from the incorporation of occupational safety and health concepts which in turn protect affected workers. PMID:23587312

Ways of thinking about and teaching ethical problem solving: microethics and macroethics in engineering.

PubMed

Herkert, Joseph R

2005-07-01

Engineering ethics entails three frames of reference: individual, professional, and social. "Microethics" considers individuals and internal relations of the engineering profession; "macroethics" applies to the collective social responsibility of the profession and to societal decisions about technology. Most research and teaching in engineering ethics, including online resources, has had a "micro" focus. Mechanisms for incorporating macroethical perspectives include: integrating engineering ethics and science, technology and society (STS); closer integration of engineering ethics and computer ethics; and consideration of the influence of professional engineering societies and corporate social responsibility programs on ethical engineering practice. Integrating macroethical issues and concerns in engineering ethics involves broadening the context of ethical problem solving. This in turn implies: developing courses emphasizing both micro and macro perspectives, providing faculty development that includes training in both STS and practical ethics; and revision of curriculum materials, including online resources. Multidisciplinary collaboration is recommended 1) to create online case studies emphasizing ethical decision making in individual, professional, and societal contexts; 2) to leverage existing online computer ethics resources with relevance to engineering education and practice; and 3) to create transparent linkages between public policy positions advocated by professional societies and codes of ethics.

Occupational safety and health, green chemistry, and sustainability: a review of areas of convergence.

PubMed

Schulte, Paul A; McKernan, Lauralynn T; Heidel, Donna S; Okun, Andrea H; Dotson, Gary Scott; Lentz, Thomas J; Geraci, Charles L; Heckel, Pamela E; Branche, Christine M

2013-04-15

With increasing numbers and quantities of chemicals in commerce and use, scientific attention continues to focus on the environmental and public health consequences of chemical production processes and exposures. Concerns about environmental stewardship have been gaining broader traction through emphases on sustainability and "green chemistry" principles. Occupational safety and health has not been fully promoted as a component of environmental sustainability. However, there is a natural convergence of green chemistry/sustainability and occupational safety and health efforts. Addressing both together can have a synergistic effect. Failure to promote this convergence could lead to increasing worker hazards and lack of support for sustainability efforts. The National Institute for Occupational Safety and Health has made a concerted effort involving multiple stakeholders to anticipate and identify potential hazards associated with sustainable practices and green jobs for workers. Examples of potential hazards are presented in case studies with suggested solutions such as implementing the hierarchy of controls and prevention through design principles in green chemistry and green building practices. Practical considerations and strategies for green chemistry, and environmental stewardship could benefit from the incorporation of occupational safety and health concepts which in turn protect affected workers.

Astronomical Heritage and Aboriginal People: Conflicts and Possibilities

NASA Astrophysics Data System (ADS)

Martín López, Alejandro

2015-08-01

In this presentation we will address the issues relating to the astronomical heritage of contemporary aboriginal groups and othe minorities. We will deal specially with the intangible astronomical heritage and their particularities. We will study (from the ethnographic experience with Aboriginal groups, Creoles and Europeans in the Argentine Chaco) the conflicts referring to the different ways, in which the native's knowledge and practice are categorized by the natives themselves, by the scientists, the state politicians, the professional artists and NGOs. We will address several cases to illustrate this kind of conflicts. We will analyze the complexities of patrimonial policies when it are applied to practices and representations of contemporary communities involved in power relations with national states and the global system. The essentialization of identities, the folklorization of representations and practices, the fossilization of aboriginal peoples are some of the risks of give the label of "cultural heritage" without a careful consideration of each specific case.In particular we will suggest possible forms by which he international scientific community could collaborate to improve the agenda of national states instead of reproducing colonial prejudices. In this way we will contribute to promote the respect for ethnic and religious minorities.

Astronomical Heritage and Aboriginal People: Conflicts and Possibilities

NASA Astrophysics Data System (ADS)

López, Alejandro Martín

2016-10-01

In this presentation we address issues relating to the astronomical heritage of contemporary aboriginal groups and other minorities. We deal specially with intangible astronomical heritage and its particularities. Also, we study (from ethnographic experience with Aboriginal groups, Creoles and Europeans in the Argentine Chaco) the conflicts referring to the different ways in which the natives' knowledge and practice are categorized by the natives themselves, by scientists, state politicians, professional artists and NGOs. Furthermore, we address several cases that illustrate these kinds of conflicts. We aim to analyze the complexities of patrimonial policies when they are applied to practices and representations of contemporary communities involved in power relations with national states and the global system. The essentialization of identities, the folklorization of representations and practices, and the fossilization of aboriginal peoples are some of the risks of applying the label ``cultural heritage'' without a careful consideration of each specific case. In particular we suggest possible ways in which the international scientific community could collaborate to improve the agenda of national states instead of reproducing colonial prejudices. In this way, we aim to contribute to the promotion of respect for ethnic and religious minorities.

Education, practical training and professional development for public health practitioners: a scoping review of the literature and insights for sustainable food system capacity-building.

PubMed

Wegener, Jessica; Fong, Debbie; Rocha, Cecilia

2018-06-01

Noting the upstream positioning of sustainable food systems (SFS) to multiple global crises, the present review described examples of emerging and promising practices to support SFS-oriented education, practical training (PT) and continuing professional development (CPD) among trainees and public health practitioners (PHP). A secondary objective was to compile the evidence into practical considerations for educators, supervising practitioners and professional associations. A scoping review of the literature published between 2007 and 2017 was conducted in May 2017 using four databases: CINAHL, MEDLINE, Scopus and HSSA, along with bibliography hand-searching and expert consultation. Articles were screened for relevance and specificity by independent raters. Nineteen articles were included for analysis. Two-thirds of the articles related to dietitians and public health nutritionists. Emerging practices included curriculum-based considerations, incorporation of 'sustainability' within professional competencies and self-reflection related to SFS. Descriptions of SFS-related education, PT and CPD practices appeared largely in the literature from developed countries. Articles converged on the need for ecosystems, food systems and sustainability considerations within and across practice to support current and future practitioners. There is growing interest in SFS but guidance to support educators and preceptors is lacking. Updates to dietary guidelines to reflect issues of sustainability are a timely prompt to examine the education, training and development needs of trainees and PHP. Practical examples of emerging practices can empower PHP to promote SFS in all areas of practice. More research is needed to address identified gaps in the literature and to improve SFS-specific education, PT and CPD.

Afterword: Considerations for Future Practice of Assessment and Accountability

ERIC Educational Resources Information Center

Bresciani, Marilee J.

2013-01-01

This afterword offers challenges and considerations as the assessment movement continues to develop. The author offers some simple considerations for readers to ponder as they advance their evidence-based decision making processes, and encourages others to use these methods within the context of recent neuroscientific evidence that learning and…

Male involvement during pregnancy and childbirth: men’s perceptions, practices and experiences during the care for women who developed childbirth complications in Mulago Hospital, Uganda

PubMed Central

2014-01-01

Background Development of appropriate interventions to increase male involvement in pregnancy and childbirth is vital to strategies for improving health outcomes of women with obstetric complications. The objective was to gain a deeper understanding of their experiences of male involvement in their partners’ healthcare during pregnancy and childbirth. The findings might inform interventions for increasing men’s involvement in reproductive health issues. Methods We conducted 16 in-depth interviews with men who came to the hospital to attend to their spouses/partners admitted to Mulago National Referral Hospital. All the spouses/partners had developed severe obstetric complications and were admitted in the high dependency unit. We sought to obtain detailed descriptions of men’s experiences, their perception of an ideal “father” and the challenges in achieving this ideal status. We also assessed perceived strategies for increasing male participation in their partners’ healthcare during pregnancy and childbirth. Data was analyzed by content analysis. Results The identified themes were: Men have different descriptions of their relationships; responsibility was an obligation; ideal fathers provide support to mothers during childbirth; the health system limits male involvement in childbirth; men have no clear roles during childbirth, and exclusion and alienation in the hospital environment. The men described qualities of the ideal father as one who was available, easily reached, accessible and considerate. Most men were willing to learn about their expected roles during childbirth and were eager to support their partners/wives/spouses during this time. However, they identified personal, relationship, family and community factors as barriers to their involvement. They found the health system unwelcoming, intimidating and unsupportive. Suggestions to improve men’s involvement include creating more awareness for fathers, male-targeted antenatal education and support, and changing provider attitudes. Conclusions This study generates information on perceived roles, expectations, experiences and challenges faced by men who wish to be involved in maternal health issues, particularly during pregnancy and childbirth. There is discord between the policy and practice on male involvement in pregnancy and childbirth. Health system factors that are critical to promoting male involvement in women’s health issues during pregnancy and childbirth need to be addressed. PMID:24479421

Thinking about Practical Work in Chemistry: Teachers' Considerations of Selected Practices for the Macroscopic Experience

ERIC Educational Resources Information Center

Lewthwaite, Brian

2014-01-01

This study explores teachers' thinking about practical work, especially in regards to the types of practical work they privilege in their teaching of chemistry to support students in their learning. It seeks to investigate the view that practical work, especially the type of practical work selected, is "unthinkingly" and…

Men's Knowledge About Maternal Serum Screening for Down Syndrome and their Attitude Towards Amniocentesis.

PubMed

Brajenović-Milić, Bojana; Dorčić, Tamara Martinac

2017-02-01

The present study aimed to assess (i) the impact of screening consultation on male partner's knowledge about second trimester maternal serum screening for Down syndrome and on their attitudes toward amniocentesis, and (ii) the concomitant effect of men's involvement in pregnancy on both knowledge and attitudes. The study included 164 men who accompanied their partners to the screening appointment. Knowledge Questionnaire and Partner's Involvement in Pregnancy Scale with two dimensions, support and distance, were administered. Involvement in pregnancy was determined using two factors; support and distance. Findings revealed a significant post-consultation improvement in men's knowledge about the test, but less-educated men and those who were more distanced from partner and pregnancy were less knowledgeable even post-consultation. Compared to before the consultation, most men had a positive attitude toward amniocentesis and were willing to suggest it to their partners in case of positive test results (77 % and 42 %, respectively). The remainder would either leave the decision to their partners (20 %) or were undecided (3 %). Higher perception of distance was associated with men's unwillingness to be involved in amniocentesis decisions, particularly before consultation. However, the consultation had considerable potential to engage men with this attitude in the decision-making process. The study highlights the need to change woman-oriented prenatal screening practices for Down syndrome to involve their male partners in the consultation.

Assessment: Examining Practice in Entrepreneurship Education

ERIC Educational Resources Information Center

Pittaway, Luke; Edwards, Corina

2012-01-01

Purpose: The purpose of this paper is to develop knowledge about the nature of student assessment practice in entrepreneurship education. Design/methodology/approach: This paper introduces general assessment practice issues and highlights key considerations. It explains prior research on assessment practice in entrepreneurship education and argues…

Reducing physical size limits for low-frequency horn loudspeaker systems

NASA Astrophysics Data System (ADS)

Honeycutt, Richard Allison

From 1881 until the present day, many excellent scholars have studied acoustic horns. This dissertation begins by discussing over eighty results of such study. Next, the methods of modeling horn behavior are examined with an emphasis on the prediction of throat impedance. Because of the time constraints in a product-design environment, in which the results of this study may be used, boundary-element and cascaded-section types of analysis were not considered due to their time intensiveness. Of the methods studied, an analytical process based upon Olson's adaptation of Webster's analysis is selected as the most accurate of the rapid methods, although other good methods exist. Reasons and extent of inaccuracy are discussed. The concept of interleaved horn loading is introduced: it involves using two horns of different parameters, fed by a single driver, with a view toward interleaving and thus smoothing the impedance peaks of the separate horns to produce a smoother response. The validity of the technique is demonstrated both theoretically and practically. Then the reactance annulling technique is explained and tested experimentally. It is found to work well, but the exact parameter values involved are not found to be critical. Finally, the considerations involved in building a practical working system are discussed, and a preliminary working model reviewed. Future work could be directed toward finding the optimum parameter values for the two "parallel horns" whose impedances are to be interleaved, as well as the system parameters that determine these optimum values. Also, further experimental investigation or ported loading of the back air chamber would be useful.

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations.

PubMed

Dornblaser, Emily K; Ratka, Anna; Gleason, Shaun E; Ombengi, David N; Tofade, Toyin; Wigle, Patricia R; Zapantis, Antonia; Ryan, Melody; Connor, Sharon; Jonkman, Lauren J; Ochs, Leslie; Jungnickel, Paul W; Abrons, Jeanine P; Alsharif, Naser Z

2016-04-25

The objective of this article is to describe the key areas of consideration for global/international advanced pharmacy practice experience (G/I APPE) preceptors, students and learning objectives. At the 2013 Annual Meeting of the American Association of Colleges of Pharmacy (AACP), the GPE SIG prepared and presented an initial report on the G/IAPPE initiatives. Round table discussions were conducted at the 2014 AACP Annual Meeting to document GPE SIG member input on key areas in the report. Literature search of PubMed, Google Scholar and EMBASE with keywords was conducted to expand this report. In this paper, considerations related to preceptors and students and learning outcomes are described. Preceptors for G/I APPEs may vary based on the learning outcomes of the experience. Student learning outcomes for G/I APPEs may vary based on the type of experiential site. Recommendations and future directions for development of G/IAPPEs are presented. Development of a successful G/I APPE requires significant planning and consideration of appropriate qualifications for preceptors and students.

Knowledge, Attitude and Practice Regarding Cervical Cancer Screening Among Women Attending a Teaching Hospital, Bharatpur, Chitwan.

PubMed

Shrestha, Smita; Dhakal, Prativa

2017-03-01

Objective: To find out the knowledge, attitude and practice regarding cervical cancer screening among women. Materials and methods: A descriptive cross-sectional study design was used to collect data from 96 women. Each woman was selected alternately from Gynae Out-Patient Department of Teaching Hospital. Data was collected by using semi-structured interview schedule to find out knowledge and practice and Likert scale to find out the attitude regarding cervical cancer screening. Data was analyzed by using SPSS version 20.0 and interpreted in terms of descriptive and inferential statistics. Results: Out of 96 women, mean age was 38.83 ± 6.57 and 90.6% respondents followed Hinduism. More than three fourth (85.4%) were literate and 59.4% were housewife. Only 9.4% were involved in cervical cancer prevention and screening awareness programme and 2.1% had family history of cervical cancer. As per the findings, only 34.4% and 27.8% had adequate knowledge and practice respectively whereas cent percent women had favorable attitude. Only education level of women was statistically significant with level of knowledge regarding cervical cancer screening (p = 0.041). There was strong negative correlation between knowledge score and practice score regarding cervical cancer screening among women (r = -0.194). Conclusion: Considerable proportions of women have inadequate knowledge and practice regarding cervical cancer screening. Therefore cervical cancer screening health camps and awareness program should be conducted at community level for women to increase the level of knowledge and practice regarding cervical cancer screening.

Knowledge, Attitude and Practice Regarding Cervical Cancer Screening Among Women Attending a Teaching Hospital, Bharatpur, Chitwan

PubMed Central

Shrestha, Smita; Dhakal, Prativa

2017-01-01

Objective: To find out the knowledge, attitude and practice regarding cervical cancer screening among women. Materials and methods: A descriptive cross-sectional study design was used to collect data from 96 women. Each woman was selected alternately from Gynae Out-Patient Department of Teaching Hospital. Data was collected by using semi-structured interview schedule to find out knowledge and practice and Likert scale to find out the attitude regarding cervical cancer screening. Data was analyzed by using SPSS version 20.0 and interpreted in terms of descriptive and inferential statistics. Results: Out of 96 women, mean age was 38.83 ± 6.57 and 90.6% respondents followed Hinduism. More than three fourth (85.4%) were literate and 59.4% were housewife. Only 9.4% were involved in cervical cancer prevention and screening awareness programme and 2.1% had family history of cervical cancer. As per the findings, only 34.4% and 27.8% had adequate knowledge and practice respectively whereas cent percent women had favorable attitude. Only education level of women was statistically significant with level of knowledge regarding cervical cancer screening (p = 0.041). There was strong negative correlation between knowledge score and practice score regarding cervical cancer screening among women (r = -0.194). Conclusion: Considerable proportions of women have inadequate knowledge and practice regarding cervical cancer screening. Therefore cervical cancer screening health camps and awareness program should be conducted at community level for women to increase the level of knowledge and practice regarding cervical cancer screening. PMID:29114264

Transition to Office-based Obstetric and Gynecologic Procedures: Safety, Technical, and Financial Considerations.

PubMed

Peacock, Lisa M; Thomassee, May E; Williams, Valerie L; Young, Amy E

2015-06-01

Office-based surgery is increasingly desired by patients and providers due to ease of access, overall efficiency, reimbursement, and satisfaction. The adoption of office-based surgery requires careful consideration of safety, efficacy, cost, and feasibility within a providers practice. This article reviews the currently available data regarding patient and provider satisfaction as well as practical considerations of staffing, equipment, and supplies. To aid the practitioner, issues of office-based anesthesia and safety with references to currently available national guidelines and protocols are provided. Included is a brief review of billing, coding, and reimbursement. Technical procedural aspects with information and recommendations are summarized.

Medication Therapy Management in community pharmacy practice: core elements of an MTM service (version 1.0).

PubMed

2005-01-01

To develop a model framework of Medication Therapy Management (MTM) in community pharmacy designed to improve care, enhance communication among patients and providers, improve collaboration among providers, and optimize medication use that leads to improved patient outcomes. Peer-reviewed literature, structured discussions with community pharmacy leaders and representatives from pharmacy benefit providers and health plans, and input from pharmacists and pharmacy associations. Building on an MTM consensus definition adopted by 11 national pharmacy organizations in July 2004, this model describes core elements of an MTM service that can be provided by pharmacists across the spectrum of community pharmacy. The model is structured for pharmacists to use with all patients in need of MTM services, both in the private and public sector. The model describes five core elements of MTM in the community pharmacy setting: medication therapy review (MTR), a personal medication record (PMR), a medication action plan (MAP), intervention and referral, and documentation and follow-up. The MTR can be comprehensive or targeted, depending onthe needs of the patient. The PMR and MAP are patient-centered documents intended to be used by the patient to improve medication self-management. A collaborative approach to patient care involving patients, pharmacists, and physicians and other health care providers is advocated in the model. General patient eligibility considerations are also described. A model framework for consideration by community pharmacists in developing MTM services is described. The model consists of five core elements for MTM service delivery in community pharmacy practice.

Natura 2000 as a platform balancing socio-economic and environmental objectives - theory and practice

NASA Astrophysics Data System (ADS)

Wołoszyn, Witold; Kałamucka, Wioletta; Kozieł, Marcin; Stanicka, Małgorzata; Ziółek, Marta; Czubla, Paweł

2012-01-01

This paper concerns problems of possible use of Natura 2000 areas in Poland for economic purposes. In this context creation and functioning of the Natura 2000 network are characterised as well as public participation in the process of development and management of Natura 2000 areas is presented. A special attention is paid to the possibility of forestry and tourism development on Natura 2000 areas taking into consideration formal requirements in this context. In conclusions matters of proper recognition of Natura 2000 areas are underlined and an importance of correlation of the Natura 2000 network with local land use plans is indicated. It is acknowledged that essential role in realisation of the Natura 2000 programme plays public involvement.

Using mobile location data in biomedical research while preserving privacy.

PubMed

Goldenholz, Daniel M; Goldenholz, Shira R; Krishnamurthy, Kaarkuzhali B; Halamka, John; Karp, Barbara; Tyburski, Matthew; Wendler, David; Moss, Robert; Preston, Kenzie L; Theodore, William

2018-06-07

Location data are becoming easier to obtain and are now bundled with other metadata in a variety of biomedical research applications. At the same time, the level of sophistication required to protect patient privacy is also increasing. In this article, we provide guidance for institutional review boards (IRBs) to make informed decisions about privacy protections in protocols involving location data. We provide an overview of some of the major categories of technical algorithms and medical-legal tools at the disposal of investigators, as well as the shortcomings of each. Although there is no "one size fits all" approach to privacy protection, this article attempts to describe a set of practical considerations that can be used by investigators, journal editors, and IRBs.

Passive and active adaptive management: Approaches and an example

USGS Publications Warehouse

Williams, B.K.

2011-01-01

Adaptive management is a framework for resource conservation that promotes iterative learning-based decision making. Yet there remains considerable confusion about what adaptive management entails, and how to actually make resource decisions adaptively. A key but somewhat ambiguous distinction in adaptive management is between active and passive forms of adaptive decision making. The objective of this paper is to illustrate some approaches to active and passive adaptive management with a simple example involving the drawdown of water impoundments on a wildlife refuge. The approaches are illustrated for the drawdown example, and contrasted in terms of objectives, costs, and potential learning rates. Some key challenges to the actual practice of AM are discussed, and tradeoffs between implementation costs and long-term benefits are highlighted. ?? 2010 Elsevier Ltd.

Anatomic features involved in technical complexity of partial nephrectomy.

PubMed

Hou, Weibin; Yan, Weigang; Ji, Zhigang

2015-01-01

Nephrometry score systems, including RENAL nephrometry, preoperative aspects and dimensions used for an anatomical classification system, C-index, diameter-axial-polar nephrometry, contact surface area score, calculating resected and ischemized volume, renal tumor invasion index, surgical approach renal ranking score, zonal NePhRO score, and renal pelvic score, have been reviewed. Moreover, salient anatomic features like the perinephric fat and vascular variants also have been discussed. We then extract 7 anatomic characteristics, namely tumor size, spatial location, adjacency, exophytic/endophytic extension, vascular variants, pelvic anatomy, and perinephric fat as important features for partial nephrectomy. For novice surgeons, comprehensive and adequate anatomic consideration may help them in their early clinical practice. Copyright © 2015 Elsevier Inc. All rights reserved.

Lidar Remote Sensing

NASA Technical Reports Server (NTRS)

McGill, Matthew J.; Starr, David OC. (Technical Monitor)

2002-01-01

The laser radar, or lidar (for light detection and ranging) is an important tool for atmospheric studies. Lidar provides a unique and powerful method for unobtrusively profiling aerosols, wind, water vapor, temperature, and other atmospheric parameters. This brief overview of lidar remote sensing is focused on atmospheric applications involving pulsed lasers. The level of technical detail is aimed at the educated non-lidar expert and references are provided for further investigation of specific topics. The article is divided into three main sections. The first describes atmospheric scattering processes and the physics behind laser-atmosphere interactions. The second section highlights some of the primary lidar applications, with brief descriptions of each measurement capability. The third section describes the practical aspects of lidar operation, including the governing equation and operational considerations.

Enhanced supercapacitor performances using C-doped porous TiO2 electrodes

NASA Astrophysics Data System (ADS)

Chen, Juanrong; Qiu, Fengxian; Zhang, Ying; Liang, Jianzheng; Zhu, Huijun; Cao, Shunsheng

2015-11-01

Considerable efforts have been paid to develop electrochemical capacitors with energy storage capability in order to meet the demands of multifunctional electronics. Here we report a facile method to fabricate C-doped porous anatase TiO2. This technique involves the preparation of monodisperse cationic polystyrene nanoparticles (CPN), following sequential deposition of tetrabutylorthotitanate (TBT), and directly carbonizing of CPN. Interestingly, during the process of carbonizing CPN, a phase transition of TiO2 will be happened and whist C-doped porous anatase TiO2 is in situ formed. When this porous C-doped TiO2 is used as electrode material to prepare electrochemical capacitor, it manifests a higher capacitance than the commercial P25, effectively broadening it potential for many practical applications.

Satellite cell therapy – from mice to men

PubMed Central

2013-01-01

Satellite cells are rare mononuclear skeletal muscle-resident cells that are the chief contributors to regenerative myogenesis following muscle injury. Although first identified more than 50 years ago, it is only recently that the murine satellite cell has become molecularly defined with the ability to prospectively isolate these cells from their niche. Human satellite cells are considerably less well understood with relatively few studies having been performed on them. In this review, a critical evaluation of this literature is provided along with a discussion of the practical and methodological issues involved with research on human satellite cells. The therapeutic potential of these and other cells types is also discussed, and the various challenges that face satellite cell therapy are addressed. PMID:23369649

Longitudinal cystic fibrosis care.

PubMed

Antunovic, S S; Lukac, M; Vujovic, D

2013-01-01

Cystic fibrosis is a complex disease entity that presents considerable lifelong challenges. Implementation of medical and surgical treatment options involves multisystem interventions to prevent and treat lung and gastrointestinal manifestations of cystic fibrosis and associated comorbidities. From birth through adulthood, cystic fibrosis care entails a longitudinal regimen aimed at achieving relief of disease symptoms and enhanced life expectancy. With increased knowledge of the molecular behavior of the cystic fibrosis transmembrane conductance regulator (CFTR) in health and disease, clinical practice has been enriched by the prospect of novel strategies, including mutation-specific drug and gene therapy targeting restoration of corrupted transepithelial ion transport. Emerging paradigms of comprehensive care increasingly enable personalized solutions to address the root cause of disease-transforming management options for individuals with cystic fibrosis.

Gaseous Environment Considerations and Evaluation Programs Leading to Spacecraft Atmosphere Selection

NASA Technical Reports Server (NTRS)

Johnston, Richard S.; Michel, Edward L.; Smith, George B., Jr.

1965-01-01

The NASA Manned Spacecraft Center has been actively involved in the direction and support of programs leading to the selection and validations of the atmosphere for forthcoming Gemini and Apollo missions. This paper discusses the engineering and physiologic considerations involved, describes the investigations to validate spacecraft atmospheres, and discusses the implications derived from the results of these investigations.

Optimum Design of High Speed Prop-Rotors

NASA Technical Reports Server (NTRS)

Chattopadhyay, Aditi

1992-01-01

The objective of this research is to develop optimization procedures to provide design trends in high speed prop-rotors. The necessary disciplinary couplings are all considered within a closed loop optimization process. The procedures involve the consideration of blade aeroelastic, aerodynamic performance, structural and dynamic design requirements. Further, since the design involves consideration of several different objectives, multiobjective function formulation techniques are developed.

Ethical Considerations in Technology Transfer.

ERIC Educational Resources Information Center

Froehlich, Thomas J.

1991-01-01

Examines ethical considerations involved in the transfer of appropriate information technology to less developed countries. Approaches to technology are considered; two philosophical frameworks for studying ethical considerations are discussed, i.e., the Kantian approach and the utilitarian perspective by John Stuart Mill; and integration of the…

Engaging the oldest old in research: lessons from the Newcastle 85+ study.

PubMed

Davies, Karen; Collerton, Joanna C; Jagger, Carol; Bond, John; Barker, Sally A H; Edwards, June; Hughes, Joan; Hunt, Judith M; Robinson, Louise

2010-09-17

Those aged 85 and over, the oldest old, are now the fastest growing sector of the population. Information on their health is essential to inform future planning; however, there is a paucity of up-to-date information on the oldest old, who are often excluded from research. The aim of the Newcastle 85+ Study is to investigate the health of a cohort of 85-year-olds from a biological, medical and psychosocial perspective. This paper describes the methods employed for the successful recruitment, retention and evaluation of this cohort. Participants were all individuals born in 1921 and registered with a participating general practice in Newcastle and North Tyneside, UK. Involvement comprised detailed health assessments, by a nurse, in their usual place of residence and/or review of their general practice medical records. Of the 1453 individuals eligible to participate, 72% (n = 1042) were recruited; 59% (n = 851) consented to both health assessment and review of general practice records. Key factors for successful involvement included protected time to engage with family and other key gatekeepers, minimising participant burden, through for example home based assessment, and flexibility of approach. Cognitive impairment is a significant issue; due consideration should be given to the ethical and legal issues of capacity and consent. Interim withdrawal rates at phase 2 (18 month post baseline), show 88 out of 854 participants (10%) had withdrawn with approval for continued use of data and materials and a further 2 participants (0.2%) had withdrawn and requested that all data be destroyed. Attrition due to death of participants within this same time frame was 135 (16%). Our recruitment rates were good and compared favourably with other similar UK and international longitudinal studies of the oldest old. The challenges of and successful strategies for involving, recruiting and retaining the oldest old in research, including those in institutions, are described to facilitate adequate representation of this growing population in future research into ageing.

Alcohol brief interventions in Scottish antenatal care: a qualitative study of midwives' attitudes and practices.

PubMed

Doi, Lawrence; Cheyne, Helen; Jepson, Ruth

2014-05-21

Infants exposed to alcohol in the womb are at increased risk of experiencing health problems. However, mixed messages about the consequences of prenatal alcohol consumption have resulted in inconsistent attitudes and practices amongst some healthcare practitioners. Screening and alcohol brief interventions (ABIs) can reduce risky drinking in various clinical settings. Recently, a program of screening and ABIs have been implemented in antenatal care settings in Scotland. However, current evidence suggests that midwives' involvement in alcohol brief interventions activities is patchy. This study explored midwives' attitudes and practices regarding alcohol screening and ABIs in order to understand why they are relatively underutilized in antenatal care settings compared to other clinical settings. This was a qualitative study, involving semi-structured interviews with 15 midwives and a focus group with a further six midwifery team leaders (21 participants in total) in Scotland. Interview transcripts were analysed using thematic analysis. Midwives were positive about their involvement in the screening and ABI program. However, they were not completely convinced about the purpose and value of the screening and ABIs in antenatal care. In the midst of competing priorities, the program was seen as having a low priority in their workload. Midwives felt that the rapport between them and pregnant women was not sufficiently established at the first antenatal appointment to allow them to discuss alcohol issues appropriately. They reported that many women had already given up drinking or were drinking minimal amounts prior to the first antenatal appointment. Midwives recognised the important role they could play in alcohol intervention activities in antenatal care. As the majority of women stop consuming alcohol in pregnancy, many will not need an ABI. Those who have not stopped are likely to need an ABI, but midwives were concerned that it was this group that they were most likely to alienate by discussing such concerns. Further consideration should be given to pre-pregnancy preventative measures as they are more likely to reduce alcohol-exposed pregnancies.

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

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

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

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

Parents' Perceptions and Practices in Homework: Implications for School-Teacher-Parent Partnerships

ERIC Educational Resources Information Center

Fan, Qian

2012-01-01

This study examined parents' perceptions and practices of parental involvement in their children's homework process to explore how variations in parents' perceptions might explain differences in their practices. Understanding parents' perceptions and practices of involvement is essential to increasing the effectiveness of parental involvement in…

Evaluation of Different Normalization and Analysis Procedures for Illumina Gene Expression Microarray Data Involving Small Changes

PubMed Central

Johnstone, Daniel M.; Riveros, Carlos; Heidari, Moones; Graham, Ross M.; Trinder, Debbie; Berretta, Regina; Olynyk, John K.; Scott, Rodney J.; Moscato, Pablo; Milward, Elizabeth A.

2013-01-01

While Illumina microarrays can be used successfully for detecting small gene expression changes due to their high degree of technical replicability, there is little information on how different normalization and differential expression analysis strategies affect outcomes. To evaluate this, we assessed concordance across gene lists generated by applying different combinations of normalization strategy and analytical approach to two Illumina datasets with modest expression changes. In addition to using traditional statistical approaches, we also tested an approach based on combinatorial optimization. We found that the choice of both normalization strategy and analytical approach considerably affected outcomes, in some cases leading to substantial differences in gene lists and subsequent pathway analysis results. Our findings suggest that important biological phenomena may be overlooked when there is a routine practice of using only one approach to investigate all microarray datasets. Analytical artefacts of this kind are likely to be especially relevant for datasets involving small fold changes, where inherent technical variation—if not adequately minimized by effective normalization—may overshadow true biological variation. This report provides some basic guidelines for optimizing outcomes when working with Illumina datasets involving small expression changes. PMID:27605185

Art and theatre for health in rural Cambodia.

PubMed

Nguon, Chea; Dysoley, Lek; Davoeung, Chan; Sovann, Yok; Sanann, Nou; Sareth, Ma; Kunthea, Pich; Vuth, San; Sovann, Kem; Kol, Kayna; Heng, Chhouen; Sary, Rouen; Peto, Thomas J; Tripura, Rupam; Lim, Renly; Cheah, Phaik Yeong

2018-01-01

This article describes our experience using art and theatre to engage rural communities in western Cambodia to understand malaria and support malaria control and elimination. The project was a pilot science-arts initiative to supplement existing engagement activities conducted by local authorities. In 2016, the project was conducted in 20 villages, involved 300 community members and was attended by more than 8000 people. Key health messages were to use insecticide-treated bed-nets and repellents, febrile people should attend village malaria workers, and to raise awareness about the risk of forest-acquired malaria. Building on the experience and lessons learnt in the year prior, the 2017 project which was conducted in 15 villages involved 600 community members and attracted more than 12,000 people. In addition to the malaria theme, upon discussion with local health authorities, secondary theme (infant vaccination) was added to the 2017 project. We learnt the following lessons from our experience in Cambodia: involving local people including children from the beginning of the project and throughout the process is important; messages should be kept simple; it is necessary to take into consideration practical issues such as location and timing of the activities; and that the project should offer something unique to communities.

Comparative Analysis: Potential Barriers to Career Participation by North American Physicians in Global Health

PubMed Central

Rhee, Daniel S.; Heckman, Jennifer E.

2014-01-01

Physician interest in global health, particularly among family physicians, is reflected by an increasing proliferation of field training and service experiences. However, translating initial training involvement into a defined and sustainable global health career remains difficult and beset by numerous barriers. Existing global health literature has largely examined training experiences and related ethical considerations while neglecting the role of career development in global health. To explore this, this paper extrapolates potential barriers to global health career involvement from existing literature and compares these to salary and skills requirements for archetypal physician positions in global health, presenting a framework of possible barriers to sustained physician participation in global health work. Notable barriers identified include financial limitations, scheduling conflicts, security/family concerns, skills limitations, limited awareness of opportunities, and specialty choice, with family practice often closely aligned with global health experience. Proposed solutions include financial support, protected time, family relocation support, and additional training. This framework delineates barriers to career involvement in global health by physicians. Further research regarding these barriers as well as potential solutions may help direct policy and initiatives to better utilize physicians, particularly family physicians, as a valuable global health human resource. PMID:25405030

Effects of Antismoking Advertising–Based Beliefs on Adult Smokers’ Consideration of Quitting

PubMed Central

Netemeyer, Richard G.; Andrews, J. Craig; Burton, Scot

2005-01-01

Objectives. We examined whether specific antismoking advertising–based beliefs regarding the addictiveness of smoking, the dangers of environmental tobacco smoke, and the tobacco industry’s use of deceptive advertising practices are associated with adult smokers’ consideration of quitting. We also assessed whether interactions between such beliefs and having children living in the home were associated with consideration of quitting. Methods. We used analyses of smokers’ responses to a telephone survey conducted after completion of the Wisconsin Anti-Tobacco Media Campaign to test hypotheses associated with our study objectives. Results. Results indicated that advertising-based beliefs regarding smoking addictiveness and the dangers of environmental tobacco smoke were associated with consideration of quitting. The findings also showed that consideration of quitting was positively affected by the interaction between number of children living at home and advertising-based beliefs about deceptive tobacco industry advertising practices designed to induce people to smoke. Conclusions. Creating advertisements that target specific antismoking beliefs may be the most effective approach to enhancing consideration of quitting among adult smokers, particularly those with children living at home. PMID:15914834

Effects of antismoking advertising--based beliefs on adult smokers' consideration of quitting.

PubMed

Netemeyer, Richard G; Andrews, J Craig; Burton, Scot

2005-06-01

We examined whether specific antismoking advertising-based beliefs regarding the addictiveness of smoking, the dangers of environmental tobacco smoke, and the tobacco industry's use of deceptive advertising practices are associated with adult smokers' consideration of quitting. We also assessed whether interactions between such beliefs and having children living in the home were associated with consideration of quitting. We used analyses of smokers' responses to a telephone survey conducted after completion of the Wisconsin Anti-Tobacco Media Campaign to test hypotheses associated with our study objectives. Results indicated that advertising-based beliefs regarding smoking addictiveness and the dangers of environmental tobacco smoke were associated with consideration of quitting. The findings also showed that consideration of quitting was positively affected by the interaction between number of children living at home and advertising-based beliefs about deceptive tobacco industry advertising practices designed to induce people to smoke. Creating advertisements that target specific antismoking beliefs may be the most effective approach to enhancing consideration of quitting among adult smokers, particularly those with children living at home.

Physical Health Care for People with Severe Mental Illness: the Attitudes, Practices, and Training Needs of Nurses in Three Asian Countries

PubMed Central

Badnapurkar, Ashish; Ma, Hin Yeung; Nelson, Deborah

2018-01-01

People with severe mental illness (SMI) have considerable unmet physical health needs and an increased risk of early mortality. This cross-sectional survey utilized the Physical Health Attitude Scale (PHASe) to examine the attitudes, practices, and training needs of nurses towards physical health care of people with SMI in three Asian countries (Hong Kong, Japan, Qatar). Cross-country differences were explored and linear regression was used to investigate if nurses’ attitudes and confidence were associated with their level of involvement in physical health care. A total of 481 questionnaires were returned. Hong Kong nurses were less involved in physical health care than those from Japan and Qatar. Nurses’ attitudes and confidence were significant predictors of their participation in managing physical health. Compared with western countries, more nurses in this study felt that mental illness was a barrier to improving physical health. Three-quarters reported that they needed additional training in promoting cardiometabolic health. The perceived need for additional training in physical health care was held by Mental Health Nurses (MHN) irrespective of their type of nursing registration and nationality. Nurse educators and service providers should reconsider the physical health care training requirements of nurses working in mental health settings in order to improve the physical health of people with SMI. PMID:29462859

Swamps, Alligators, and Adult Educators.

ERIC Educational Resources Information Center

Burnham, Byron R.

1990-01-01

Choice taking is a personal matter that results from consideration of the issues and beliefs about the nature of reality, humans, and social context. Systematic consideration of these elements forms the foundation of professional practice. (Author)

Hydrotherapy in burn care: a survey of hydrotherapy practices in the UK and Ireland and literature review.

PubMed

Langschmidt, Jenna; Caine, Paul L; Wearn, Christopher M; Bamford, Amy; Wilson, Yvonne T; Moiemen, Naiem S

2014-08-01

Hydrotherapy is widely used in burns management however there are risks associated with its use, in particular cross-infection. Data regarding indications and techniques in common use is deficient. This study aimed to investigate hydrotherapy practices in the UK and Ireland. A survey of the hydrotherapy practice of major burn care providers was performed by e mail and where necessary, follow up telephone contact. The survey included 28 burn care providers. 27 reported using hydrotherapy. Only 11 (41%) had defined indication criteria with 4 (15%) implementing a specific protocol. Variations in hydrotherapy practice were seen. Hydrotherapy is used nationwide, however considerable variation in practice exists. One area worthy of further consideration is the need for appropriate standards of infection control. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Chinese L2 Literacy Practices: Material and Sociocultural Considerations

ERIC Educational Resources Information Center

Lo-Philip, Stephanie Wingyan

2014-01-01

Although there has been research on literacy as a sociocultural practice, L2 literacy researchers have yet to incorporate and consider how the material characteristics of a writing system interact with sociocultural factors in shaping literacy practices. Drawing on conceptions of literacy as a sociocultural practice, psycholinguistic and…

Let's talk about death: data collection for verbal autopsies in a demographic and health surveillance site in Malaysia

PubMed Central

Allotey, Pascale A.; Reidpath, Daniel D.; Evans, Natalie C.; Devarajan, Nirmala; Rajagobal, Kanason; Bachok, Ruhaida; Komahan, Kridaraan

2015-01-01

Background Verbal autopsies have gained considerable ground as an acceptable alternative to medically determined cause of death. Unlike with clinical or more administrative settings for data collection, verbal autopsies require significant involvement of families and communities, which introduces important social and cultural considerations. However, there is very little clear guidance about the methodological issues in data collection. The objectives of this case study were: to explore the range of bereavement rituals within the multi-ethnic, multi-faith population of the district; to investigate the preparedness of communities to talk about death; to describe the verbal autopsy process; to assess the effects of collecting verbal autopsy data on data collectors; and to determine the most accurate sources of information about deaths in the community. Methods A case study approach was used, using focus group discussions, indepth interviews and field notes. Thematic analyses were undertaken using NVivo. Results Consideration of cultural bereavement practices is importance to acceptance and response rates to verbal autopsies. They are also important to the timing of verbal autopsy interviews. Well trained data collectors, regardless of health qualifications are able to collect good quality data, but debriefing is important to their health and well being. This article contributes to guidance on the data collection procedures for verbal autopsies within community settings. PMID:26140728

The role of husbands in maternal health and safe childbirth in rural Nepal: a qualitative study.

PubMed

Lewis, Sarah; Lee, Andrew; Simkhada, Padam

2015-08-04

The role of husbands in maternal health is often overlooked by health programmes in developing countries and is an under-researched area of study globally. This study examines the role of husbands in maternity care and safe childbirth, their perceptions of the needs of women and children, the factors which influence or discourage their participation, and how women feel about male involvement around childbirth. It also identifies considerations that should be taken into account in the development of health education for husbands. This qualitative study was conducted in four rural hill villages in the Gorkha district of Nepal. Semi-structured, in-depth interviews were conducted with husbands (n = 17), wives (n = 15), mothers-in-law (n = 3), and health workers (n = 7) in Nepali through a translator. Interviews were transcribed and analysed using axial coding. We found that, in rural Nepal, male involvement in maternal health and safe childbirth is complex and related to gradual and evolving changes in attitudes taking place. Traditional beliefs are upheld which influence male involvement, including the central role of women in the domain of pregnancy and childbirth that cannot be ignored. That said, husbands do have a role to play in maternity care. For example, they may be the only person available when a woman goes into labour. Considerable interest for the involvement of husbands was also expressed by both expectant mothers and fathers. However, it is important to recognise that the husbands' role is shaped by many factors, including their availability, cultural beliefs, and traditions. This study shows that, although complex, expectant fathers do have an important role in maternal health and safe childbirth. Male involvement needs to be recognised and addressed in health education due to the potential benefits it may bring to both maternal and child health outcomes. This has important implications for health policy and practice, as there is a need for health systems and maternal health interventions to adapt in order to ensure the appropriate and effective inclusion of expectant fathers.

Cannabinergic pain medicine: a concise clinical primer and survey of randomized-controlled trial results.

PubMed

Aggarwal, Sunil K

2013-02-01

This article attempts to cover pragmatic clinical considerations involved in the use of cannabinergic medicines in pain practice, including geographical and historical considerations, pharmacokinetics, pharmacodynamics, adverse effects, drug interactions, indications, and contraindications. Topics include molecular considerations such as the 10-fold greater abundance of cannabinoid type 1 receptors compared to µ-opioid receptors in the central nervous system and anatomic distributions of cannabinoid receptors in pain circuits. The article uses a narrative review methodology drawing from authoritative textbooks and journals of cannabinoid medicine, Food and Drug Administration-approved cannabinoid drug labels, and current and historical pain medicine literature to address core clinical considerations. To survey the current evidence base for pain management with cannabinergic medicines, a targeted PubMed search was performed to survey the percentage of positive and negative published randomized-controlled trial (RCT) results with this class of pain medicines, using appropriate search limit parameters and the keyword search string "cannabinoid OR cannabis-based AND pain." Of the 56 hits generated, 38 published RCTs met the survey criteria. Of these, 71% (27) concluded that cannabinoids had empirically demonstrable and statistically significant pain-relieving effects, whereas 29% (11) did not. Cannabis and other cannabinergic medicines' efficacies for relieving pain have been studied in RCTs, most of which have demonstrated a beneficial effect for this indication, although most trials are short-term. Adverse effects are generally nonserious and well tolerated. Incorporating cannabinergic medicine topics into pain medicine education seems warranted and continuing clinical research and empiric treatment trials are appropriate.

32 CFR 187.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... considerable importance involving substantial expenditures of time, money, and resources, that affects the... consideration may be associated. Deployment of ships, aircraft, or other mobile military equipment is not a...

32 CFR 187.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... considerable importance involving substantial expenditures of time, money, and resources, that affects the... consideration may be associated. Deployment of ships, aircraft, or other mobile military equipment is not a...

32 CFR 187.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... considerable importance involving substantial expenditures of time, money, and resources, that affects the... consideration may be associated. Deployment of ships, aircraft, or other mobile military equipment is not a...

32 CFR 187.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... considerable importance involving substantial expenditures of time, money, and resources, that affects the... consideration may be associated. Deployment of ships, aircraft, or other mobile military equipment is not a...

Considerations for safe glucocorticoid therapy

PubMed

2018-06-01

Synthetic glucocorticoids have innumerable therapeutic applications and are frequently used in medical practice. Changes in the wide variety of synthetic molecules and the different routes of administration cause differences in anti-inflammatory action, therapeutic action and mineralocorticoid effects. Endocrinologists are generally consulted to evaluate the gradual decline in treatment, rather than to indicate it. We present general information and practical advice to the pediatrician to minimize the adverse effects and considerations to be taken into account for the suspension of treatment.

Consumers' purchase of organic food products. A matter of convenience and reflexive practices.

PubMed

Hjelmar, Ulf

2011-04-01

The aim of this study was to gain insight into the purchase of organic food products by consumers and to explore the main factors driving this process. This paper uses evidence from 16 in-depth interviews with consumers in Denmark carried out in 2008-2009. On the basis of the analysis two broad concepts are suggested: convenience behaviours and reflexive practices. Convenience behaviours are characteristic of pragmatic organic consumers. This type of shopping behaviour requires organic foods to be available in the local supermarket, they have to be clearly visible (preferably with an eco-label), and the price differential vis-à-vis conventional products have to be minimal. The analysis also showed that politically/ethically minded consumers have reflexive practices when purchasing organic food products: health considerations, ethical considerations (animal welfare), political considerations (environmentalism) and quality considerations (taste) play an important part for these consumers. Reflexive shopping practices can be sparked by life events (e.g. having children), "shocking" news about conventional food products and similar events, and news capable of creating a "cognitive dissonance" among consumers. The Danish case illustrates that the government needs to actively implement reforms and promote activities which make organic products a convenient choice for the pragmatic oriented consumer if their market share is to increase substantially. Copyright © 2011 Elsevier Ltd. All rights reserved.

Nutrition Considerations in the Pediatric Cardiac Intensive Care Unit Patient.

PubMed

Justice, Lindsey; Buckley, Jason R; Floh, Alejandro; Horsley, Megan; Alten, Jeffrey; Anand, Vijay; Schwartz, Steven M

2018-05-01

Adequate caloric intake plays a vital role in the course of illness and the recovery of critically ill patients. Nutritional status and nutrient delivery during critical illness have been linked to clinical outcomes such as mortality, incidence of infection, and length of stay. However, feeding practices with critically ill pediatric patients after cardiac surgery are variable. The Pediatric Cardiac Intensive Care Society sought to provide an expert review on provision of nutrition to pediatric cardiac intensive care patients, including caloric requirements, practical considerations for providing nutrition, safety of enteral nutrition in controversial populations, feeding considerations with chylothorax, and the benefits of feeding beyond nutrition. This article addresses these areas of concern and controversy.

Caring for Women Who Have Experienced Female Genital Cutting.

PubMed

Little, Cindy M

2015-01-01

Female genital cutting/mutilation (FGC/M) is a procedure that involves physically altering a woman's/girl's genitals for no health benefits. This is a practice that is deeply rooted in culture, religion, and social tradition primarily in some African and Middle East countries. It is performed by a midwife, barber, traditional healer with no surgical training, or a physician. The practice of FGC/M has been gaining increased attention as women from those countries have been migrating to the United States and Western Europe. The World Health Organization (WHO) has estimated that 125 million women worldwide have undergone FGC/M. The practice has serious short-term and long-term physical, obstetric, and psychological complications. It has been proposed by some healthcare professionals that physicians or other healthcare providers should perform the cutting because it would be done under more sanitary conditions that would reduce complications. However, the WHO and other organizations have condemned the practice by any medical professional. The FGC/M procedure is a human rights violation and has been banned by WHO and other organizations and governments. This article provides an overview of the current issues related to FGC/M and addresses important cultural considerations for nurses caring for women with FGC/M. Nurses are in a unique position to provide holistic, culturally competent care in a respectful, nonjudgmental atmosphere. Nurses have a role in educating women with FGC/M about the complications and care, as education is necessary in the challenge to eradicate the practice of FGC/M.

Dentist-Perceived Barriers and Attractors to Cognitive-Behavioral Treatment Provided by Mental Health Providers in Dental Practices.

PubMed

Heyman, R E; Wojda, A K; Eddy, J M; Haydt, N C; Geiger, J F; Slep, A M Smith

2018-02-01

Over 1 in 5 dental patients report moderate to severe dental fear. Although the efficacy of cognitive-behavioral treatment (CBT) for dental fear has been examined in over 20 randomized controlled trials-with 2 meta-analyses finding strong average effect sizes ( d > 1)-CBT has received almost no dissemination beyond the specialty clinics that tested it. The challenge, then, is not how to treat dental fear but how to disseminate and implement such an evidence-based treatment in a way that recognizes the rewards and barriers in the US health care system. This mixed-method study investigated the potential of disseminating CBT through care from a mental health provider from within the dental home, a practice known as evidence-based collaborative care (EBCC). Two preadoption studies were conducted with practicing dentists drawn from a self-organized Practice-Based Research Network in the New York City metropolitan area. The first comprised 3 focus groups ( N = 17), and the second involved the administration of a survey ( N = 46). Focus group participants agreed that CBT for dental fear is worthy of consideration but identified several concerns regarding its appeal, feasibility, and application in community dental practices. Survey participants indicated endorsement of factors promoting the use of EBCC as a mechanism for CBT dissemination, with no factors receiving less than 50% support. Taken together, these findings indicate that EBCC may be a useful framework through which an evidence-based treatment for dental fear treatment can be delivered.

Special Consideration in Post-Secondary Institutions: Trends at a Canadian University

ERIC Educational Resources Information Center

Zimmermann, Joelle; Kamenetsky, Stuart B.; Pongracic, Syb

2015-01-01

This study examined trends in the practice of granting special consideration for missed tests and late papers in colleges and universities. We analyzed a database of 4,183 special consideration requests at a large Canadian university between 1998 and 2008. Results show a growing rate of requests per enrolment between 2001 and 2007. Although…

Interventions to improve outpatient referrals from primary care to secondary care.

PubMed

Akbari, Ayub; Mayhew, Alain; Al-Alawi, Manal Alawi; Grimshaw, Jeremy; Winkens, Ron; Glidewell, Elizabeth; Pritchard, Chanie; Thomas, Ruth; Fraser, Cynthia

2008-10-08

The primary care specialist interface is a key organisational feature of many health care systems. Patients are referred to specialist care when investigation or therapeutic options are exhausted in primary care and more specialised care is needed. Referral has considerable implications for patients, the health care system and health care costs. There is considerable evidence that the referral processes can be improved. To estimate the effectiveness and efficiency of interventions to change outpatient referral rates or improve outpatient referral appropriateness. We conducted electronic searches of the Cochrane Effective Practice and Organisation of Care (EPOC) group specialised register (developed through extensive searches of MEDLINE, EMBASE, Healthstar and the Cochrane Library) (February 2002) and the National Research Register. Updated searches were conducted in MEDLINE and the EPOC specialised register up to October 2007. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of interventions to change or improve outpatient referrals. Participants were primary care physicians. The outcomes were objectively measured provider performance or health outcomes. A minimum of two reviewers independently extracted data and assessed study quality. Seventeen studies involving 23 separate comparisons were included. Nine studies (14 comparisons) evaluated professional educational interventions. Ineffective strategies included: passive dissemination of local referral guidelines (two studies), feedback of referral rates (one study) and discussion with an independent medical adviser (one study). Generally effective strategies included dissemination of guidelines with structured referral sheets (four out of five studies) and involvement of consultants in educational activities (two out of three studies). Four studies evaluated organisational interventions (patient management by family physicians compared to general internists, attachment of a physiotherapist to general practices, a new slot system for referrals and requiring a second 'in-house' opinion prior to referral), all of which were effective. Four studies (five comparisons) evaluated financial interventions. One study evaluating change from a capitation based to mixed capitation and fee-for-service system and from a fee-for-service to a capitation based system (with an element of risk sharing for secondary care services) observed a reduction in referral rates. Modest reductions in referral rates of uncertain significance were observed following the introduction of the general practice fundholding scheme in the United Kingdom (UK). One study evaluating the effect of providing access to private specialists demonstrated an increase in the proportion of patients referred to specialist services but no overall effect on referral rates. There are a limited number of rigorous evaluations to base policy on. Active local educational interventions involving secondary care specialists and structured referral sheets are the only interventions shown to impact on referral rates based on current evidence. The effects of 'in-house' second opinion and other intermediate primary care based alternatives to outpatient referral appear promising.

Oocyte cryopreservation beyond cancer: tools for ethical reflection.

PubMed

Linkeviciute, Alma; Peccatori, Fedro A; Sanchini, Virginia; Boniolo, Giovanni

2015-08-01

This article offers physicians a tool for structured ethical reflection on challenging situations surrounding oocyte cryopreservation in young healthy women. A systematic literature review offers a comprehensive overview of the ethical debate surrounding the practice. Ethical Counseling Methodology (ECM) offers a practical approach for addressing ethical uncertainties. ECM consists of seven steps: (i) case presentation; (ii) analysis of possible implications; (iii) presentation of ethical question(s); (iv) explanation of ethical terms; (v) presentation of the ethical arguments in favor of and against the procedure; (vi) examination of the individual patient's beliefs and wishes; and (vii) conclusive summary. The most problematic aspects in the ethical debate include the distinction between medical and non-medical use of oocyte cryopreservation, safety and efficiency of the procedure, and marketing practices aimed at healthy women. Female empowerment and enhanced reproductive choices (granted oocyte cryopreservation is a safe and efficient technique) are presented as ethical arguments supporting the practice, while ethical reservations towards oocyte cryopreservation are based on concerns about maternal and fetal safety and wider societal implications. Oocyte cryopreservation is gaining popularity among healthy reproductive age women. However, despite promised benefits it also involves risks that are not always properly communicated in commercialized settings. ECM offers clinicians a tool for structured ethical analysis taking into consideration a wide range of implications, various ethical standpoints, and patients' perceptions and beliefs.

Neighborhood geographical factors and the presence of advanced community pharmacy practice sites in Greater Chicago.

PubMed

Johnson, Charisse L; Crawford, Stephanie Y; Lin, Swu-Jane; Salmon, J Warren; Smith, Miriam Mobley

2009-02-19

To determine the availability of experiential learning opportunities in culturally diverse areas and to identify opportunities and barriers to attract and sustain sites for the University of Illinois at Chicago College of Pharmacy. Utilizing variables of census tract income, racial/ethnicity composition and crime index, data analyses included descriptive statistics and multivariate logistic regression. Faculty members involved in experiential education were interviewed to identify other factors influencing site placement and selection for community-based advanced pharmacy practice experiences (APPEs). Median family income and Asian population were significantly higher and black population was significantly lower in census tracts with community APPE sites than in census tracts without APPE sites (p < 0.05). No significant differences were found in the population variables of white and Latino populations and crime index. The Asian population variable was the only significant predictor of an APPE site (p = 0.0148) when controlling for other variables. Distance from the College, pharmacy staffing issues, goodwill, influence of district and corporate managers, and strategic initiatives were critical considerations in site establishment and overall sustainability. Advanced community pharmacy practice sites were fairly well distributed across metropolitan Chicago, indicating that exposure to diverse populations during the advanced community practice experiences parallels with strategic College objectives of expanding and diversifying experiential sites to enhance pharmacy students' abilities to meet emerging patient care challenges and opportunities.

Ethnic groups' knowledge, attitude and practices and Rift Valley fever exposure in Isiolo County of Kenya.

PubMed

Affognon, Hippolyte; Mburu, Peter; Hassan, Osama Ahmed; Kingori, Sarah; Ahlm, Clas; Sang, Rosemary; Evander, Magnus

2017-03-01

Rift Valley fever (RVF) is an emerging mosquito-borne viral hemorrhagic fever in Africa and the Arabian Peninsula, affecting humans and livestock. For spread of infectious diseases, including RVF, knowledge, attitude and practices play an important role, and the understanding of the influence of behavior is crucial to improve prevention and control efforts. The objective of the study was to assess RVF exposure, in a multiethnic region in Kenya known to experience RVF outbreaks, from the behavior perspective. We investigated how communities in Isiolo County, Kenya were affected, in relation to their knowledge, attitude and practices, by the RVF outbreak of 2006/2007. A cross-sectional study was conducted involving 698 households selected randomly from three different ethnic communities. Data were collected using a structured questionnaire regarding knowledge, attitudes and practices that could affect the spread of RVF. In addition, information was collected from the communities regarding the number of humans and livestock affected during the RVF outbreak. This study found that better knowledge about a specific disease does not always translate to better practices to avoid exposure to the disease. However, the high knowledge, attitude and practice score measured as a single index of the Maasai community may explain why they were less affected, compared to other investigated communities (Borana and Turkana), by RVF during the 2006/2007 outbreak. We conclude that RVF exposure in Isiolo County, Kenya during the outbreak was likely determined by the behavioral differences of different resident community groups. We then recommend that strategies to combat RVF should take into consideration behavioral differences among communities.

Ethnic groups’ knowledge, attitude and practices and Rift Valley fever exposure in Isiolo County of Kenya

PubMed Central

Affognon, Hippolyte; Mburu, Peter; Hassan, Osama Ahmed; Kingori, Sarah; Ahlm, Clas; Sang, Rosemary; Evander, Magnus

2017-01-01

Rift Valley fever (RVF) is an emerging mosquito-borne viral hemorrhagic fever in Africa and the Arabian Peninsula, affecting humans and livestock. For spread of infectious diseases, including RVF, knowledge, attitude and practices play an important role, and the understanding of the influence of behavior is crucial to improve prevention and control efforts. The objective of the study was to assess RVF exposure, in a multiethnic region in Kenya known to experience RVF outbreaks, from the behavior perspective. We investigated how communities in Isiolo County, Kenya were affected, in relation to their knowledge, attitude and practices, by the RVF outbreak of 2006/2007. A cross-sectional study was conducted involving 698 households selected randomly from three different ethnic communities. Data were collected using a structured questionnaire regarding knowledge, attitudes and practices that could affect the spread of RVF. In addition, information was collected from the communities regarding the number of humans and livestock affected during the RVF outbreak. This study found that better knowledge about a specific disease does not always translate to better practices to avoid exposure to the disease. However, the high knowledge, attitude and practice score measured as a single index of the Maasai community may explain why they were less affected, compared to other investigated communities (Borana and Turkana), by RVF during the 2006/2007 outbreak. We conclude that RVF exposure in Isiolo County, Kenya during the outbreak was likely determined by the behavioral differences of different resident community groups. We then recommend that strategies to combat RVF should take into consideration behavioral differences among communities. PMID:28273071

Balancing health care evidence and art to meet clinical needs: policymakers' perspectives.

PubMed

Parker, Louise E; Ritchie, Mona J; Kirchner, Joann E; Owen, Richard R

2009-12-01

Rationale, aims and objectives Although many believe that evidence-based practice (EBP) has great potential, critics have identified limitations including a focus on randomized clinical trial (RCT) evidence to the exclusion of other evidence types and a disregard for the art of medicine. Others have argued, however, that proper application of EBP involves reasoned consideration of a wide variety of information; thus, the dichotomy between medical science and art may be false. We explore the views of executive-level policymakers from the Veterans Health Administration, a leader in the EBP movement, regarding what constitutes evidence and the relative importance of evidence versus practical needs when determining clinical policy. Method We conducted 26 semi-structured qualitative interviews and performed a content analysis. Results Although informants generally believed in the value of EBP and the role of RCTs within it, they also valued other types of evidence. Further, they had concerns that were sometimes antithetical with strict adherence to an evidence-based approach. These included practical concerns, fit with organizational values and with local circumstances, resources, political pressures and patient needs. They were especially concerned about how to address medical conditions that affect many individuals or high-risk populations that have no evidence-based treatment. Conclusion When possible, health care practice should be evidence-based. When this is not possible, health care providers must turn to the art of medicine by using consensus-based best practices. Further, it is important for policymakers and researchers to work in concert to develop EBPs that are practical and meet needs.

Design control considerations for biologic-device combination products.

PubMed

Anderson, Dave; Liu, Roger; Anand Subramony, J; Cammack, Jon

2017-03-01

Combination products are therapeutic and diagnostic medical products that combine drugs, devices, and/or biological products with one another. Historically, biologics development involved identifying efficacious doses administered to patients intravenously or perhaps by a syringe. Until fairly recently, there has been limited focus on developing an accompanying medical device, such as a prefilled syringe or auto-injector, to enable easy and more efficient delivery. For the last several years, and looking forward, where there may be little to distinguish biologics medicines with relatively similar efficacy profiles, the biotechnology market is beginning to differentiate products by patient-focused, biologic-device based combination products. As innovative as biologic-device combination products are, they can pose considerable development, regulatory, and commercialization challenges due to unique physicochemical properties and special clinical considerations (e.g., dosing volumes, frequency, co-medications, etc.) of the biologic medicine. A biologic-device combination product is a marriage between two partners with "cultural differences," so to speak. There are clear differences in the development, review, and commercialization processes of the biologic and the device. When these two cultures come together in a combination product, developers and reviewers must find ways to address the design controls and risk management processes of both the biologic and device, and knit them into a single entity with supporting product approval documentation. Moreover, digital medicine and connected health trends are pushing the boundaries of combination product development and regulations even further. Despite an admirable cooperation between industry and FDA in recent years, unique product configurations and design features have resulted in review challenges. These challenges have prompted agency reviewers to modernize consultation processes, while at the same time, promoting development of innovative, safe and effective combination products. It remains the manufacturer's responsibility to comply with the relevant requirements and regulations, and develop good business practices that clearly describe how these practices comply with FDA's final rule (21 CFR Part 4) and aligns with the company's already established quality system. Copyright © 2017 Elsevier B.V. All rights reserved.

Commentary: Moving from Practice to Research, and Back

ERIC Educational Resources Information Center

Yohalem, Nicole; Tseng, Vivian

2015-01-01

It is a widely accepted idea that knowledge from research needs to be better integrated into practice. Considerable energy is dedicated to strengthening the flow of research to practice. Less attention, however, has been paid to strengthening the ways researchers can learn from practice to improve their work. In this commentary, we draw on our…

Closing the Gap between Research Evidence and Clinical Practice: Jordanian Nurses' Perceived Barriers to Research Utilisation

ERIC Educational Resources Information Center

Al Khalaileh, Murad; Al Qadire, Mohammad; Musa, Ahmad S.; Al-Khawaldeh, Omar A.; Al Qudah, Hani; Alhabahbeh, Atalla

2016-01-01

Background: The nursing profession is a combination of theory and practical skill, and nurses are required to generate and develop knowledge through implementing research into clinical practice. Considerable number of barriers could hind implementing research findings into practice. Barriers to research utilisation are not identified in the…

Team Deliberate Practice in Medicine and Related Domains: A Consideration of the Issues

ERIC Educational Resources Information Center

Harris, Kevin R.; Eccles, David W.; Shatzer, John H.

2017-01-01

A better understanding of the factors influencing medical team performance and accounting for expert medical team performance should benefit medical practice. Therefore, the aim here is to highlight key issues with using deliberate practice to improve medical team performance, especially given the success of deliberate practice for developing…

A framework for developing rural academic general practices: a qualitative case study in rural Victoria.

PubMed

Brown, J B; Morrison, Tracy; Bryant, Melanie; Kassell, Lisa; Nestel, Debra

2015-01-01

There is increasing pressure for Australian rural general practices to engage in educational delivery as a means of addressing workforce issues and accommodating substantial increases in learners. For practices that have now developed a strong focus on education, there is the challenge to complement this by engaging in research activity. This study develops a rural academic general practice framework to assist rural practices in developing both comprehensive educational activity and a strong research focus thus moving towards functioning as mature academic units. A case study research design was used with the unit of analysis at the level of the rural general practice. Purposively sampled practices were recruited and individual interviews conducted with staff (supervisors, practice managers, nurses), learners (medical students, interns and registrars) and patients. Three practices hosted 'multi-level learners', two practices hosted one learner group and one had no learners. Forty-four individual interviews were conducted with staff, learners and patients. Audio recordings were transcribed for thematic analysis. After initial inductive coding, deductive analysis was undertaken with reference to recent literature and the expertise of the research team resulting in the rural academic general practice framework. Three key themes emerged with embedded subthemes. For the first theme, organisational considerations, subthemes were values/vision/culture, patient population and clinical services, staffing, physical infrastructure/equipment, funding streams and governance. For the second theme, educational considerations, subthemes were processes, clinical supervision, educational networks and learner presence. Third, for research considerations, there were the subthemes of attitude to research and research activity. The framework maps the development of a rural academic practice across these themes in four progressive stages: beginning, emerging, consolidating and established. The data enabled a framework to be constructed to map rural general practice activity with respect to activity characteristic of an academic general practice. The framework offers guidance to practices seeking to transition towards becoming a mature academic practice. The framework also offers guidance to educational institutions and funding bodies to support the development of academic activity in rural general practices. The strengths and limitations of the study design are outlined.

Online interviewing with interpreters in humanitarian contexts

PubMed Central

Chiumento, Anna; Rahman, Atif; Frith, Lucy

2018-01-01

ABSTRACT Purpose: Recognising that one way to address the logistical and safety considerations of research conducted in humanitarian emergencies is to use internet communication technologies to facilitate interviews online, this article explores some practical and methodological considerations inherent to qualitative online interviewing. Method: Reflections from a case study of a multi-site research project conducted in post-conflict countries are presented.  Synchronous online cross-language qualitative interviews were conducted in one country.  Although only a small proportion of interviews were conducted online (six out of 35), it remains important to critically consider the impact upon data produced in this way. Results: A range of practical and methodological considerations are discussed, illustrated with examples.  Results suggest that whilst online interviewing has methodological and ethical potential and versatility, there are inherent practical challenges in settings with poor internet and electricity infrastructure.  Notable methodological limitations include barriers to building rapport due to partial visual and non-visual cues, and difficulties interpreting pauses or silences. Conclusions: Drawing upon experiences in this case study, strategies for managing the practical and methodological limitations of online interviewing are suggested, alongside recommendations for supporting future research practice.  These are intended to act as a springboard for further reflection, and operate alongside other conceptual frameworks for online interviewing. PMID:29532739

Online interviewing with interpreters in humanitarian contexts.

PubMed

Chiumento, Anna; Machin, Laura; Rahman, Atif; Frith, Lucy

2018-12-01

Recognising that one way to address the logistical and safety considerations of research conducted in humanitarian emergencies is to use internet communication technologies to facilitate interviews online, this article explores some practical and methodological considerations inherent to qualitative online interviewing. Reflections from a case study of a multi-site research project conducted in post-conflict countries are presented.  Synchronous online cross-language qualitative interviews were conducted in one country.  Although only a small proportion of interviews were conducted online (six out of 35), it remains important to critically consider the impact upon data produced in this way. A range of practical and methodological considerations are discussed, illustrated with examples.  Results suggest that whilst online interviewing has methodological and ethical potential and versatility, there are inherent practical challenges in settings with poor internet and electricity infrastructure.  Notable methodological limitations include barriers to building rapport due to partial visual and non-visual cues, and difficulties interpreting pauses or silences. Drawing upon experiences in this case study, strategies for managing the practical and methodological limitations of online interviewing are suggested, alongside recommendations for supporting future research practice.  These are intended to act as a springboard for further reflection, and operate alongside other conceptual frameworks for online interviewing.

Integrating musculoskeletal sonography into rehabilitation: Therapists’ experiences with training and implementation

PubMed Central

Gray, Julie McLaughlin; Frank, Gelya; Roll, Shawn C.

2018-01-01

Musculoskeletal sonography is rapidly extending beyond radiology; however, best practices for successful integration into new practice contexts are unknown. This study explored non-physician experiences with the processes of training and integration of musculoskeletal sonography into rehabilitation. Qualitative data were captured through multiple sources and iterative thematic analysis was used to describe two occupational therapists’ experiences. The dominant emerging theme was competency, in three domains: technical, procedural and analytical. Additionally, three practice considerations were illuminated: (1) understanding imaging within the dynamics of rehabilitation, (2) navigating nuances of interprofessional care, and (3) implications for post-professional training. Findings indicate that sonography training for rehabilitation providers requires multi-level competency development and consideration of practice complexities. These data lay a foundation on which to explore and develop best practices for incorporating sonographic imaging into the clinic as a means for engaging clients as active participants in the rehabilitation process to improve health and rehabilitation outcomes. PMID:28830315

EJ IWG Promising Practices for EJ Methodologies in NEPA Reviews

EPA Pesticide Factsheets

Report of methodologies gleaned from current agency practices identified by the NEPA Committee. These methodologies are concerning the interface of environmental justice considerations through NEPA processes.

Korean older intimate partner violence survivors in North America: cultural considerations and practice recommendations.

PubMed

Shim, Woochan S; Nelson-Becker, Holly

2009-01-01

While literature on elder abuse has expanded, elder abuse by intimate partners has been less investigated. Even less is known about intimate partner violence among older Koreans living in North America. This article identifies important cultural considerations for individuals helping the Korean older adult community, beginning with the definition of intimate partner violence in this community and barriers to leaving that include traditional views of the East Asian self. Current practice interventions are discussed and recommendations for future practice such as healing han, the accumulated suffering from years of abuse, are suggested. The ultimate goal of this paper is to expand awareness in order to develop the best culturally competent prevention and intervention practice for Korean older intimate partner violence survivors in North America.

Practice considerations in providing cancer risk assessment and genetic testing in women's health.

PubMed

Mahon, Suzanne M; Crecelius, Mary E

2013-01-01

Providers of women's health services are often confronted with questions about cancer genetic testing. The provision of these services is complex. The process begins with accurate risk assessment and identification of individuals who might benefit from genetic testing services. There are practice, administrative, legal, and ethical considerations that should be considered when developing policies for the referral of at-risk individuals or before deciding to provide genetic services. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Understanding the Lomb–Scargle Periodogram

NASA Astrophysics Data System (ADS)

VanderPlas, Jacob T.

2018-05-01

The Lomb–Scargle periodogram is a well-known algorithm for detecting and characterizing periodic signals in unevenly sampled data. This paper presents a conceptual introduction to the Lomb–Scargle periodogram and important practical considerations for its use. Rather than a rigorous mathematical treatment, the goal of this paper is to build intuition about what assumptions are implicit in the use of the Lomb–Scargle periodogram and related estimators of periodicity, so as to motivate important practical considerations required in its proper application and interpretation.

Telerehabilitation store and forward applications: a review of applications and privacy considerations in physical and occupational therapy practice.

PubMed

Peterson, Christopher; Watzlaf, Valerie

2014-01-01

An overview of store and forward applications commonly used in physical and occupational therapy practice is reviewed with respect to regulation, privacy, security, and clinical applications. A privacy and security checklist provides a clear reference of pertinent regulatory issues regarding these software applications. A case study format is used to highlight clinical applications of store and forward software features. Important considerations of successful implementation of store and forward applications are also identified and discussed.

Religious involvement and health-related behaviors among Black Seventh-Day Adventists in Canada.

PubMed

McKenzie, Monica M; Modeste, Naomi N; Marshak, Helen Hopp; Wilson, Colwick

2015-03-01

Most studies that involve Black Seventh-Day Adventists (SDAs) have been conducted in the United States. We sought to examine the association between religious involvement and lifestyle practices among Black SDAs in Canada. A convenience sample of 509 Black SDA church members 18 years and older completed a self-administered questionnaire, assessing religious involvement and seven lifestyle practices promoted by the SDA church: diet, physical activity, water intake, exposure to sunlight, alcohol use, caffeine and tobacco use, and rest. Compliance with lifestyle practices ranged from a low of 10% meeting fitness guidelines to a high of 99% abstaining from tobacco products. Religious involvement and lifestyle were positively related (rs = .11, p < .05). Multivariate analyses indicated that private religious practice (β = .16, p =.003), importance of the health principles (β = .17, p = .003), and acceptance of health principles (β = .65, p = .00001) significantly predicted the number of behaviors practiced. Greater religious involvement is associated with positive lifestyle practices but is not an independent predictor of lifestyle practices for Black Canadian SDAs. © 2014 Society for Public Health Education.

Nurses' care practices at the end of life in intensive care units in Bahrain.

PubMed

O'Neill, Catherine S; Yaqoob, Maryam; Faraj, Sumaya; O'Neill, Carla L

2017-12-01

The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. This study explored nurses' care practices at the end of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Despite the avoidance of death talk and nurses' lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values.

[Professional practices and perceptions about job retention systems for the chronically ill: a qualitative study in south-eastern France].

PubMed

Saliba, M-L; Arnaud, S; Souville, M; Viau, A; François, G; Verger, P

2013-04-01

Continued employment of people with health problems that reduce their ability to work is a major social issue. The French measures to optimize job retention are characterized by a multiplicity of participants, and their efficacy depends largely on the capacity of these different participants to work together. The objective of this study was to document the perceived role, attitudes and practices of participants involved in these job retention measures and of general practitioners, as well as their difficulties in this domain. In 2009, 15 semi-directive interviews were conducted in the region of Provence-Alpes-Côte d'Azur (PACA) of occupational physicians, general practitioners, and other participants involved in the occupational reclassification of workers no longer completely fit for their job. The data collected were analyzed from a thematic perspective. The different groups of professionals questioned agreed on the primacy of the role of the occupational physician, on the importance of early consideration of each worker's case, and on the need to work together as partners to optimize the prospects of job retention. This study nonetheless showed numerous communication difficulties between the various professionals: although informal exchanges have developed over time, the efficacy of the system seems to be limited by a lack of clarity about the role of each institution, divergences of opinions on some key points including the role of the physicians caring for the patient, and, more largely, lack of information about the tools for job retention. The distribution of homogeneous knowledge, the development of multidisciplinary collaborative practices and the pooling of the lessons of experience between the different groups of participants are essential for the success of job retention procedures. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Research priorities on diarrhoeal diseases to support the Control of Diarrhoeal Diseases (CDD) programme in Indonesia.

PubMed

Sunoto

1986-01-01

A comprehensive program review of Indonesia's Control of Diarrheal Diseases (CDD) program conducted in 1983 indicated that considerable success has been achieved in this area. Oral rehydration solution (ORS) is widely available, there has been community involvement, a strong managerial structure has developed, baseline data on diarrhea morbidity and mortality are being collected, and staff have received adequate training. At the same time, there have been some problems: inadequate use of ORS, a lack of coordination among CDD programs, insufficient surveillance, budgetary problems, and a lack of laboratory support. During the last 10 years, diarrhea mortality in Indonesia has been reduced by 50-70%, to about 20,000 (20% of child mortality). The Government has established the goal of reducing mortality from diarrhea to less than 1% of child deaths by the year 2000. A major strategy for achieving this goal is integrating family planning, nutrition, maternal-child health, immunization, and CDD programs. Another strategy involves improving research in this area. Areas for further research include: epidemiologic studies, rehydration treatment, antidiarrheal agents, social aspects, immunity and vaccine development, and laboratory examination. The cause of diarrheal diseases is not only enteric infection, it is indirectly caused by acute respiratory infection, malnutrition, measles and other systemic infection as well as the health knowledge and education of the mother. Priority is to be given to 7 areas of research: 1) the use of home-prepared rehydration fluids, 2) feeding practices during acute diarrhea that can prevent chronic diarrhea and malnutrition, 3) the determinants of progression to chronic diarrhea, 4) the impact of simple health information on hygienic and feeding practices on mortality, 5) the potential of using traditional birth attendants in ORS campaigns, 6) traditional attitudes and practices, and 7) the effectiveness of traditional medicines in diarrhea treatment.

Factors Affecting Adolescents' Involvement in Cyberbullying: What Divides the 20% from the 80%?

PubMed

Shin, Namin; Ahn, Hwasil

2015-07-01

Despite some variations among cyberbullying studies, about 20% of the youth population surveyed appears to be involved in cyberbullying. Coincidentally, the current study found that exactly 20% of the students surveyed were involved in cyberbullying as bullies (7.8%), victims (7.5%), and bully/victims (4.7%). What divides those 20% from the 80% of noninvolved students? This study aimed to produce a parsimonious and accurate model that can predict the occurrence of involvement in cyberbullying among youth. Data were collected from a questionnaire survey administered to 1,036 students enrolled in secondary schools in South Korea. Stepwise logistic regression (SLR) was carried out to predict the dichotomous dependent variable (involved/noninvolved) with 10 independent variables grouped into three categories: (a) demographic, (b) media-related, and (c) school and psychology factors. The result of the SLR analysis yielded a four-step model including the variables of cyber-confidence, weekday game time, mobile activities, and age as being significant in explaining the 20/80 division (model χ(2)=34.306, df=4, p<0.001, Nagelkerke R(2)=0.071). This finding suggests that younger students who spend more time playing games on weekdays while being more confident in cyberspace and active in using mobile phones are more likely to be involved in cyberbullying than other students. In particular, the construct of cyber-confidence calls for further elaboration and research, given its controversial function with respect to adolescents' involvement in cyberbullying. Also, this study may bring about insights into practical considerations needed for concerned researchers, teachers, and parents to identify who is inside the group involved in cyberbullying so as to help the participating adolescents escape from the circle of cyberbullying.

Guidance, Navigation and Control (GN&C): Best Practices for Human-Rated Spacecraft Systems

NASA Technical Reports Server (NTRS)

Lebsock, Ken; West, John

2008-01-01

In 2007 the NESC completed an in-depth assessment to identify, define and document engineering considerations for the Design Development Test and Evaluation (DDT&E) of human-rated spacecraft systems. This study had been requested by the Astronaut Office at JSC to help them to better understand what is required to ensure safe, robust, and reliable human-rated spacecraft systems. The 22 GN&C engineering Best Practices described in this paper are a condensed version of what appears in the NESC Technical Report. These Best Practices cover a broad range from fundamental system architectural considerations to more specific aspects (e.g., stability margin recommendations) of GN&C system design and development. 15 of the Best Practices address the early phases of a GN&C System development project and the remaining 7 deal with the later phases. Some of these Best Practices will cross-over between both phases. We recognize that this set of GN&C Best Practices will not be universally applicable to all projects and mission applications.

Operationalising a model framework for consumer and community participation in health and medical research

PubMed Central

Saunders, Carla; Crossing, Sally; Girgis, Afaf; Butow, Phyllis; Penman, Andrew

2007-01-01

The Consumers' Health Forum of Australia and the National Health and Medical Research Council has recently developed a Model Framework for Consumer and Community Participation in Health and Medical Research in order to better align health and medical research with community need, and improve the impact of research. Model frameworks may have little impact on what goes on in practice unless relevant organisations actively make use of them. Philanthropic and government bodies have reported involving consumers in more meaningful or collaborative ways of late. This paper describes how a large charity organisation, which funds a significant proportion of Australian cancer research, operationalised the model framework using a unique approach demonstrating that it is both possible and reasonable for research to be considerate of public values. PMID:17592651

Legal considerations and cooperative opportunities for space commercial activities

NASA Technical Reports Server (NTRS)

Hosenball, S. N.

1984-01-01

It is a national policy to make the capabilities of the Space Transportation System available to a wide range of potential users. This includes its availability as a space manufacturing facility for commercial activities, which may be carried out on a reimbursable basis or as a joint endeavor with NASA, but with substantial private investment. In any high risk, long lead-time research and development activity directed towards commercialization, the protection afforded the results of the research and development under the laws relating to intellectual property rights may provide an important incentive for private investment. The policies and practices of NASA directed towards the protection of privately-established intellectual property rights involved in STS use are reviewed with particular emphasis on reimbursable launch agreements and joint endeavor agreements.

Decision support methods for the detection of adverse events in post-marketing data.

PubMed

Hauben, M; Bate, A

2009-04-01

Spontaneous reporting is a crucial component of post-marketing drug safety surveillance despite its significant limitations. The size and complexity of some spontaneous reporting system databases represent a challenge for drug safety professionals who traditionally have relied heavily on the scientific and clinical acumen of the prepared mind. Computer algorithms that calculate statistical measures of reporting frequency for huge numbers of drug-event combinations are increasingly used to support pharamcovigilance analysts screening large spontaneous reporting system databases. After an overview of pharmacovigilance and spontaneous reporting systems, we discuss the theory and application of contemporary computer algorithms in regular use, those under development, and the practical considerations involved in the implementation of computer algorithms within a comprehensive and holistic drug safety signal detection program.

Assessing clinical competency in medical senior house officers: how and why should we do it?

PubMed Central

Carr, S

2004-01-01

Most consultants are involved in the training and assessment of several grades of doctors in training especially senior house officers (SHOs) and specialist registrars. In the medical and other specialties there is an increasing trend towards assessing junior doctors' competency using the record of in-training assessment process for specialist registrars and using the Royal College of Physicians folder to record competences of medical SHOs. It is necessary to consider why there is a need to assess competency, how it may be done practically, and the advantages and disadvantages of this system of assessment. There are considerable hurdles to the implementation of this system in the medical specialties within today's NHS and the organisation may need to undergo fairly radical change to facilitate this system. PMID:14970290

Polycystic ovary syndrome and adverse pregnancy outcomes: Current state of knowledge, challenges and potential implications for practice.

PubMed

Bahri Khomami, Mahnaz; Boyle, Jacqueline A; Tay, Chau T; Vanky, Eszter; Teede, Helena J; Joham, Anju E; Moran, Lisa J

2018-06-01

Although there is a growing body of literature reporting that pregnancies in women with polycystic ovary syndrome (PCOS) are associated with greater complications than those without PCOS, methodological differences across studies make these results difficult to consolidate. This narrative review outlines potential mechanisms involved in adverse pregnancy outcomes in PCOS and the nature of the complications. It covers limitations of current evidence and future research directions. Future research should include prospective studies with phenotypic stratification of PCOS and matching or consideration of specific PCOS manifestations and risk factors specific to each pregnancy complication. This review also emphasizes the importance of following a healthy lifestyle for women with PCOS and of individualized care according to overall risk factors for pregnancy complications. © 2018 John Wiley & Sons Ltd.

A review of the effects of vitamins and other dietary supplements on seizure activity.

PubMed

Lee, Susan W; Chung, Steve S

2010-07-01

The role of pharmacological and surgical management of epilepsy continues to expand, but these treatments are often associated with significant side effects and morbidity. As a result, many patients with epilepsy and their physicians alike have gained interest in the role of vitamins and other dietary supplements for seizure management. In this review, we examine the potential anticonvulsant and proconvulsant effects of commonly used dietary supplements, as well as their potential effects on cognition or behavior. Our review was conducted through a literature search focusing on clinical trials involving patients with epilepsy and their seizure response to dietary supplementation. We summarize findings from previous clinical studies and comment on practical considerations regarding dietary supplementation for patients with epilepsy. Copyright 2010 Elsevier Inc. All rights reserved.

Quality of life and patients' expectations in soft tissue sarcoma.

PubMed

Jones, Robin L; Cesne, Axel Le

2018-05-01

Assessment of health-related quality of life (HRQoL) is essential for holistic care. Greater efforts are required to incorporate HRQoL measures into clinical trials and daily practice. Considerable HRQoL data are available for localized soft tissue sarcomas (STS), particularly in the orthopedic setting. In future, HRQoL is expected to become increasingly important in the evaluation of palliative therapy in advanced STS. A patient-centric approach is advocated for STS management. Greater awareness of STS by nonspecialist clinicians, and timely referral to specialized sarcoma reference centers, is crucial for patient welfare. The patient is central to shared decision-making during consultations and during case review in tumor boards. The management approach to STS should be collaborative, involving a multidisciplinary team, multiple centers and patient advocacy groups.

Spatially explicit data: stewardship and ethical challenges in science.

PubMed

Hartter, Joel; Ryan, Sadie J; Mackenzie, Catrina A; Parker, John N; Strasser, Carly A

2013-09-01

Scholarly communication is at an unprecedented turning point created in part by the increasing saliency of data stewardship and data sharing. Formal data management plans represent a new emphasis in research, enabling access to data at higher volumes and more quickly, and the potential for replication and augmentation of existing research. Data sharing has recently transformed the practice, scope, content, and applicability of research in several disciplines, in particular in relation to spatially specific data. This lends exciting potentiality, but the most effective ways in which to implement such changes, particularly for disciplines involving human subjects and other sensitive information, demand consideration. Data management plans, stewardship, and sharing, impart distinctive technical, sociological, and ethical challenges that remain to be adequately identified and remedied. Here, we consider these and propose potential solutions for their amelioration.

Establishing a master's degree programme in bioinformatics: challenges and opportunities.

PubMed

Sahinidis, N V; Harandi, M T; Heath, M T; Murphy, L; Snir, M; Wheeler, R P; Zukoski, C F

2005-12-01

The development of the Bioinformatics MS degree program at the University of Illinois, the challenges and opportunities associated with such a process, and the current structure of the program is described. This program has departed from earlier University practice in significant ways. Despite the existence of several interdisciplinary programs at the University, a few of which grant degrees, this is the first interdisciplinary program that grants degrees and formally recognises departmental specialisation areas. The program, which is not owned by any particular department but by the Graduate College itself, is operated in a franchise-like fashion via several departmental concentrations. With four different colleges and many more departments involved in establishing and operating the program, the logistics of the operation are of considerable complexity but result in significant interactions across the entire campus.

Practical Lessons From the First Decade of EPO Partnership Between NIRCam/JWST and the GSUSA

NASA Astrophysics Data System (ADS)

McCarthy, D.; Lebofsky, L. A.; Schlingman, W. M.; Higgins, M. L.

2013-04-01

Ten years ago the NIRCam science team proposed to conduct “Train the Trainer” workshops for adult leaders from all Girl Scout Councils in the U.S. with an aim to improving basic astronomy materials and to conveying mission-specific information about the science and technologies associated with the James Webb Space Telescope (JWST). To date we have conducted 20 workshops involving 225 adult leaders (41 U.S. states, Guam, Japan). During this time, the infrastructure of the GSUSA has evolved considerably, as has its approach to STEM education. Here we discuss how our ongoing workshops, educational activities, and our network of trained leaders have evolved to meet the continuing needs of girls and young women within the GSUSA's new framework of Journeys.

Variation in Perfusion Strategies for Neonatal and Infant Aortic Arch Repair: Contemporary Practice in the STS Congenital Heart Surgery Database.

PubMed

Meyer, David B; Jacobs, Jeffrey P; Hill, Kevin; Wallace, Amelia S; Bateson, Brian; Jacobs, Marshall L

2016-09-01

Regional cerebral perfusion (RCP) is used as an adjunct or alternative to deep hypothermic circulatory arrest (DHCA) for neonates and infants undergoing aortic arch repair. Clinical studies have not demonstrated clear superiority of either strategy, and multicenter data regarding current use of these strategies are lacking. We sought to describe the variability in contemporary practice patterns for use of these techniques. The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010-2013) was queried to identify neonates and infants whose index operation involved aortic arch repair with cardiopulmonary bypass. Perfusion strategy was classified as isolated DHCA, RCP (with less than or equal to ten minutes of DHCA), or mixed (RCP with more than ten minutes of DHCA). Data were analyzed for the entire cohort and stratified by operation subgroups. Overall, 4,523 patients (105 centers) were identified; median age seven days (interquartile range: 5.0-13.0). The most prevalent perfusion strategy was RCP (43%). Deep hypothermic circulatory arrest and mixed perfusion accounted for 32% and 16% of cases, respectively. In all, 59% of operations involved some period of RCP. Regional cerebral perfusion was the most prevalent perfusion strategy for each operation subgroup. Neither age nor weight was associated with perfusion strategy, but reoperations were less likely to use RCP (31% vs 45%, P < .001). The combined duration of RCP and DHCA in the RCP group was longer than the DHCA time in the DHCA group (45 vs 36 minutes, P < .001). There is considerable variability in practice regarding perfusion strategies for arch repair in neonates and infants. In contemporary practice, RCP is the most prevalent perfusion strategy for these procedures. Use of DHCA is also common. Further investigation is warranted to ascertain possible relative merits of the various perfusion techniques. © The Author(s) 2016.

Primary care-led commissioning: applying lessons from the past to the early development of clinical commissioning groups in England.

PubMed

Checkland, Kath; Coleman, Anna; McDermott, Imelda; Segar, Julia; Miller, Rosalind; Petsoulas, Christina; Wallace, Andrew; Harrison, Stephen; Peckham, Stephen

2013-09-01

The current reorganisation of the English NHS is one of the most comprehensive ever seen. This study reports early evidence from the development of clinical commissioning groups (CCGs), a key element in the new structures. To explore the development of CCGs in the context of what is known from previous studies of GP involvement in commissioning. Case study analysis from sites chosen to provide maximum variety across a number of dimensions, from September 2011 to June 2012. A case study analysis was conducted using eight detailed qualitative case studies supplemented by descriptive information from web surveys at two points in time. Data collection involved observation of a variety of meetings, and interviews with key participants. Previous research shows that clinical involvement in commissioning is most effective when GPs feel able to act autonomously. Complicated internal structures, alongside developing external accountability relationships mean that CCGs' freedom to act may be subject to considerable constraint. Effective GP engagement is also important in determining outcomes of clinical commissioning, and there are a number of outstanding issues for CCGs, including: who feels 'ownership' of the CCG; how internal communication is conceptualised and realised; and the role and remit of locality groups. Previous incarnations of GP-led commissioning have tended to focus on local and primary care services. CCGs are keen to act to improve quality in their constituent practices, using approaches that many developed under practice-based commissioning. Constrained managerial support and the need to maintain GP engagement may have an impact. CCGs are new organisations, faced with significant new responsibilities. This study provides early evidence of issues that CCGs and those responsible for CCG development may wish to address.

Primary care-led commissioning: applying lessons from the past to the early development of clinical commissioning groups in England

PubMed Central

Checkland, Kath; Coleman, Anna; McDermott, Imelda; Segar, Julia; Miller, Rosalind; Petsoulas, Christina; Wallace, Andrew; Harrison, Stephen; Peckham, Stephen

2013-01-01

Background The current reorganisation of the English NHS is one of the most comprehensive ever seen. This study reports early evidence from the development of clinical commissioning groups (CCGs), a key element in the new structures. Aim To explore the development of CCGs in the context of what is known from previous studies of GP involvement in commissioning. Design and setting Case study analysis from sites chosen to provide maximum variety across a number of dimensions, from September 2011 to June 2012. Method A case study analysis was conducted using eight detailed qualitative case studies supplemented by descriptive information from web surveys at two points in time. Data collection involved observation of a variety of meetings, and interviews with key participants. Results Previous research shows that clinical involvement in commissioning is most effective when GPs feel able to act autonomously. Complicated internal structures, alongside developing external accountability relationships mean that CCGs’ freedom to act may be subject to considerable constraint. Effective GP engagement is also important in determining outcomes of clinical commissioning, and there are a number of outstanding issues for CCGs, including: who feels ‘ownership’ of the CCG; how internal communication is conceptualised and realised; and the role and remit of locality groups. Previous incarnations of GP-led commissioning have tended to focus on local and primary care services. CCGs are keen to act to improve quality in their constituent practices, using approaches that many developed under practice-based commissioning. Constrained managerial support and the need to maintain GP engagement may have an impact. Conclusion CCGs are new organisations, faced with significant new responsibilities. This study provides early evidence of issues that CCGs and those responsible for CCG development may wish to address. PMID:23998841

Speech pathologists' experience of involving people with stroke-induced aphasia in clinical decision making during rehabilitation.

PubMed

Berg, Karianne; Rise, Marit By; Balandin, Susan; Armstrong, Elizabeth; Askim, Torunn

2016-01-01

Although client participation has been part of legislation and clinical guidelines for several years, the evidence of these recommendations being implemented into clinical practice is scarce, especially for people with communication disorders. The aim of this study was to investigate how speech pathologists experienced client participation during the process of goal-setting and clinical decision making for people with aphasia. Twenty speech pathologists participated in four focus group interviews. A qualitative analysis using Systematic Text Condensation was undertaken. Analysis revealed three different approaches to client participation: (1) client-oriented, (2) next of kin-oriented and (3) professional-oriented participation. Participants perceived client-oriented participation as the gold standard. The three approaches were described as overlapping, with each having individual characteristics incorporating different facilitators and barriers. There is a need for greater emphasis on how to involve people with severe aphasia in goal setting and treatment planning, and frameworks made to enhance collaboration could preferably be used. Participants reported use of next of kin as proxies in goal-setting and clinical decision making for people with moderate-to-severe aphasia, indicating the need for awareness towards maintaining the clients' autonomy and addressing the goals of next of kin. Speech pathologists, and most likely other professionals, should place greater emphasis on client participation to ensure active involvement of people with severe aphasia. To achieve this, existing tools and techniques made to enhance collaborative goal setting and clinical decision making have to be better incorporated into clinical rehabilitation practice. To ensure the autonomy of the person with aphasia, as well as to respect next of kin's own goals, professionals need to make ethical considerations when next of kin are used as proxies in collaborative goal setting and clinical decision making.

An international survey of the public engagement practices of health technology assessment organizations.

PubMed

Whitty, Jennifer A

2013-01-01

Many jurisdictions are moving toward greater public involvement in health technology assessment (HTA) processes. This study aims to provide a broad, cross-sectional indication of the extent and methods of public engagement in HTA, with a focus on which public are engaged, by what mechanisms, and the purpose of public engagement. An international Web-based survey of 217 organizations involved in HTA was undertaken. Contact e-mail addresses for targeted organizations were identified from the Internet. Individuals from 39 (18%) of the contacted organizations completed a survey. The majority (67%) of responding HTA organizations undertake public engagement activities, predominantly involving lay representatives of organized groups (81%), and to a lesser extent individual patients/consumers (54%) or citizens/community members (54%). For organizations undertaking public engagement, mechanisms based on communication or consultation were the most common, although some organizations have used or intend to use participatory approaches, particularly the Citizens' Jury (8%) or Consensus Council (20%) methods. Respondents identified with a number of rationales and barriers for undertaking public engagement. This survey provides further insight into the public engagement approaches that are used by HTA organizations in practice. In particular, it suggests a limited adoption of participatory methods to date, and interest in the use of social media. Study findings require further confirmation, due to limitations related to survey response. There is considerable opportunity for further research into pragmatic, robust, and meaningful approaches to public engagement to strengthen HTA policy and decision-making frameworks. An agenda for future research evolving from the survey responses is proposed. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The Humble Leader: Association of Discrepancies in Leader and Follower Ratings of Implementation Leadership With Organizational Climate in Mental Health.

PubMed

Aarons, Gregory A; Ehrhart, Mark G; Torres, Elisa M; Finn, Natalie K; Beidas, Rinad S

2017-02-01

Discrepancies, or perceptual distance, between leaders' self-ratings and followers' ratings of the leader are common but usually go unrecognized. Research on discrepancies is limited, but there is evidence that discrepancies are associated with organizational context. This study examined the association of leader-follower discrepancies in Implementation Leadership Scale (ILS) ratings of mental health clinic leaders and the association of those discrepancies with organizational climate for involvement and performance feedback. Both involvement and performance feedback are important for evidence-based practice (EBP) implementation in mental health. A total of 593 individuals-supervisors (leaders, N=80) and clinical service providers (followers, N=513)-completed surveys that included ratings of implementation leadership and organizational climate. Polynomial regression and response surface analyses were conducted to examine the associations of discrepancies in leader-follower ILS ratings with organizational involvement climate and performance feedback climate, aspects of climate likely to support EBP implementation. Both involvement climate and performance feedback climate were highest where leaders rated themselves low on the ILS and their followers rated those leaders high on the ILS ("humble leaders"). Teams with "humble leaders" showed more positive organizational climate for involvement and for performance feedback, contextual factors important during EBP implementation and sustainment. Discrepancy in leader and follower ratings of implementation leadership should be a consideration in understanding and improving leadership and organizational climate for mental health services and for EBP implementation and sustainment in mental health and other allied health settings.

The undergraduate research fellows program: a unique model to promote engagement in research.

PubMed

Vessey, Judith A; DeMarco, Rosanna F

2008-01-01

Well-educated nurses with research expertise are needed to advance evidence-based nursing practice. A primary goal of undergraduate nursing curricula is to create meaningful participatory experiences to help students develop a research skill set that articulates with rapid career advancement of gifted, young graduates interested in nursing research and faculty careers. Three research enrichment models-undergraduate honors programs, research assistant work-for-hire programs, and research work/mentorship programs-to be in conjunction with standard research content are reviewed. The development and implementation of one research work/mentorship program, the Boston College undergraduate research fellows program (UGRF), is explicated. This process included surveying previous UGRFs followed by creating a retreat and seminars to address specific research skill sets. The research skill sets included (a) how to develop a research team, (b) accurate data retrieval, (c) ethical considerations, (d) the research process, (e) data management, (f) successful writing of abstracts, and (g) creating effective poster presentations. Outcomes include evidence of involvement in research productivity and valuing of evidenced-based practice through the UGRF mentorship process with faculty partners.

A discontinuous Galerkin approach for conservative modeling of fully nonlinear and weakly dispersive wave transformations

NASA Astrophysics Data System (ADS)

Sharifian, Mohammad Kazem; Kesserwani, Georges; Hassanzadeh, Yousef

2018-05-01

This work extends a robust second-order Runge-Kutta Discontinuous Galerkin (RKDG2) method to solve the fully nonlinear and weakly dispersive flows, within a scope to simultaneously address accuracy, conservativeness, cost-efficiency and practical needs. The mathematical model governing such flows is based on a variant form of the Green-Naghdi (GN) equations decomposed as a hyperbolic shallow water system with an elliptic source term. Practical features of relevance (i.e. conservative modeling over irregular terrain with wetting and drying and local slope limiting) have been restored from an RKDG2 solver to the Nonlinear Shallow Water (NSW) equations, alongside new considerations to integrate elliptic source terms (i.e. via a fourth-order local discretization of the topography) and to enable local capturing of breaking waves (i.e. via adding a detector for switching off the dispersive terms). Numerical results are presented, demonstrating the overall capability of the proposed approach in achieving realistic prediction of nearshore wave processes involving both nonlinearity and dispersion effects within a single model.

A Neurophysiological and Neuropsychological Consideration of Mindful Movement: Clinical and Research Implications

PubMed Central

Russell, Tamara Anne; Arcuri, Silvia Maria

2015-01-01

In this article, we present ideas related to three key aspects of mindfulness training: the regulation of attention via noradrenaline, the importance of working memory and its various components (particularly the central executive and episodic buffer), and the relationship of both of these to mind-wandering. These same aspects of mindfulness training are also involved in the preparation and execution of movement and implicated in the pathophysiology of psychosis. We argue that by moving in a mindful way, there may be an additive effect of training as the two elements of the practice (mindfulness and movement) independently, and perhaps synergistically, engage common underlying systems (the default mode network). We discuss how working with mindful movement may be one route to mindfulness training for individuals who would struggle to sit still to complete the more commonly taught mindfulness practices. Drawing on our clinical experience working with individuals with severe and enduring mental health conditions, we show the real world application of these ideas and how they can be used to help those who are suffering and for whom current treatments are still far from adequate. PMID:26074800

Best practice management strategies for mental health nurses during the clinical application of civil commitment: an overview.

PubMed

McKenna, Brian G; Simpson, Alexander I F; Coverdale, John H

2006-01-01

The aim of this article is to outline best practice management strategies for nurses during the clinical application of civil commitment of mentally ill persons. A thorough literature search on 'coercion' and 'civil commitment' was undertaken using MEDLINE, CINAHL and PSYCHINFO. Published and unpublished research undertaken by the authors in New Zealand on this topic was drawn upon. This research considered the use of civil commitment during admission to acute mental health services, acute forensic mental health services and community mental health services. The experience of coercion by service users coincides with the degree of restriction associated with the service they are involved in. Socio-demographic factors, clinical factors and the experience of coercive events have little bearing on the amount of coercion experienced. Rather it is the pattern of communication and the use of 'procedural justice' that has the potential to ameliorate the amount of perceived coercion. 'Procedural justice' aligns with the emphasis placed on the therapeutic relationship in mental health nursing and is an important consideration for nurses during the clinical application of civil commitment.

Reviewing the quality of strategic environmental assessment reports for English spatial plan core strategies

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

Fischer, Thomas B., E-mail: fischer@liverpool.ac.u

This paper summarises the results of a research project from early 2008, involving the author of this paper, as well as 18 post-graduate University of Liverpool students, in which the quality of European Directive based strategic environmental assessment (SEA) reports of English spatial plan core strategies (conducted within the context of the spatial planning sustainability appraisal-SA-regime) was reviewed. The project aimed at establishing the extensiveness of emerging spatial plan related SEA practice, as well as highlighting shortcomings and problems. Overall, it was found that whilst some aspects of assessment were done well, others were not of a satisfactory quality. Shortcomingsmore » were connected particularly with the practice of listing potentially relevant baseline documents and data without distinguishing sufficiently between those that are important in terms of significant impacts and those that are not. Problems were also found to exist with the evaluation of options and impacts, the consideration of substantive aspects, such as health, as well as regarding the formulation of final recommendations and monitoring.« less

Hormones and the Bolsheviks: from organotherapy to experimental endocrinology, 1918-1929.

PubMed

Krementsov, Nikolai

2008-09-01

The discipline of endocrinology emerged over roughly the same period in Britain, France, Germany, Russia, the United States, and elsewhere, and its practitioners across the world shared research practices and agendas to a considerable degree. Yet the discipline's institutions, networks, and social practices were firmly embedded in the particular social fabric of concrete locales, and they were built on specific local traditions, resources, and patronage. Through analysis of the origins and early progress of Soviet endocrinology, this essay uncovers numerous factors and multiple actors involved with the institutional development of the discipline in the first decade of Bolshevik rule. As elsewhere in the world, the medicinal use of animal tissue extracts--organotherapy--paved the way for wide acceptance of the ideas of the nascent science of endocrinology by both the Soviet medical community and the general public. Organotherapy also supplied the new discipline with "seed" institutions, technologies, and personnel--the veterinarian Iakov Tobolkin and the therapist Vasilii Shervinskii. But the specific institutional, political, economic, and ideological landscape of Soviet Russia shaped the discipline in a particular way.

Changing our minds: a commentary on `Conceptual change: a discussion of theoretical, methodological and practical challenges for science education'

NASA Astrophysics Data System (ADS)

Mercer, Neil

2008-07-01

This paper begins with a consideration of some important themes dealt with in the paper by Treagust and Duit. These include the relationship between research on conceptual change and educational practice, the significance of emotion and identity in the process of conceptual change, and role of cognitive conflict in motivating change. I then argue that the authors implicitly assert the importance of spoken dialogue as a motor for conceptual change, but do not give it the proper, explicit recognition that it deserves. I first use their own data of transcribed talk to make this point, and then go on to elaborate my case by drawing on other research. Talk amongst students and teacher-student talk are both considered. My conclusion is that while more empirical research is needed to understand how dialogue is involved in conceptual change, available evidence shows very clearly that the role of talk and social interaction is so significant that it cannot be ignored. It is therefore necessary for theoretical accounts to deal with both social (i.e. communicative) and cognitive aspects of conceptual change.

Integrating molecular and morphological approaches for characterizing parasite cryptic species: implications for parasitology.

PubMed

Nadler, Steven A; DE León, Gerardo Pérez-Ponce

2011-11-01

Herein we review theoretical and methodological considerations important for finding and delimiting cryptic species of parasites (species that are difficult to recognize using traditional systematic methods). Applications of molecular data in empirical investigations of cryptic species are discussed from an historical perspective, and we evaluate advantages and disadvantages of approaches that have been used to date. Developments concerning the theory and practice of species delimitation are emphasized because theory is critical to interpretation of data. The advantages and disadvantages of different molecular methodologies, including the number and kind of loci, are discussed relative to tree-based approaches for detecting and delimiting cryptic species. We conclude by discussing some implications that cryptic species have for research programmes in parasitology, emphasizing that careful attention to the theory and operational practices involved in finding, delimiting, and describing new species (including cryptic species) is essential, not only for fully characterizing parasite biodiversity and broader aspects of comparative biology such as systematics, evolution, ecology and biogeography, but to applied research efforts that strive to improve development and understanding of epidemiology, diagnostics, control and potential eradication of parasitic diseases.

Incorporating Mobile Phone Technologies to Expand Evidence-Based Care

PubMed Central

Jones, Deborah J.; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin

2014-01-01

Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach. PMID:26213458

Incorporating Mobile Phone Technologies to Expand Evidence-Based Care.

PubMed

Jones, Deborah J; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin

2015-08-01

Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach.

Swiss clinical practice guidelines on field cancerization of the skin.

PubMed

Hofbauer, Günther; Anliker, Mark; Boehncke, Wolf-Henning; Brand, Christoph; Braun, Ralph; Gaide, Olivier; Hafner, Jürg; Hunger, Robert; Itin, Peter; Kaeuper, Gina; Lautenschlager, Stephan; Mainetti, Carlo; Streit, Markus

2014-01-01

Actinic keratosis (AK) affects millions of people worldwide, and its prevalence continues to increase. AK lesions are caused by chronic ultraviolet radiation exposure, and the presence of two or more AK lesions along with photodamage should raise the consideration of a diagnosis of field cancerization. Effective treatment of individual lesions as well as field cancerization is essential for good long-term outcomes. The Swiss Registry of Actinic Keratosis Treatment (REAKT) Working Group has developed clinical practice guidelines for the treatment of field cancerization in patients who present with AK. These guidelines are intended to serve as a resource for physicians as to the most appropriate treatment and management of AK and field cancerization based on current evidence and the combined practical experience of the authors. Treatment of AK and field cancerization should be driven by consideration of relevant patient, disease, and treatment factors, and appropriate treatment decisions will differ from patient to patient. Prevention measures and screening recommendations are discussed, and special considerations related to management of immunocompromised patients are provided.

The mesmerists inquire about "Oriental mind powers": West meets East in the search for the universal trance.

PubMed

Schmit, David T

2010-01-01

Contemporary interest in Asian meditation raises questions about when Westerners began investigating these practices. A synopsis of Western-originating scientific meditation research is followed by a brief introduction to mesmerism. Next, the unappreciated ways the mesmerists explored Oriental mind powers is recounted. How the mesmerists' cultural positioning, philosophy, and interest in mind-body practices facilitated their inquiries of Oriental medicine and Hindu contemplative practices is explored, followed by a consideration of why these investigations were unique for the era. The way this work subverted Western cultural imperialism is examined. A consideration of the historical continuities and discontinuities between the mesmerists' inquiries and twentieth-century meditation research concludes the article.

An integrated optimum design approach for high speed prop-rotors including acoustic constraints

NASA Technical Reports Server (NTRS)

Chattopadhyay, Aditi; Wells, Valana; Mccarthy, Thomas; Han, Arris

1993-01-01

The objective of this research is to develop optimization procedures to provide design trends in high speed prop-rotors. The necessary disciplinary couplings are all considered within a closed loop multilevel decomposition optimization process. The procedures involve the consideration of blade-aeroelastic aerodynamic performance, structural-dynamic design requirements, and acoustics. Further, since the design involves consideration of several different objective functions, multiobjective function formulation techniques are developed.

From Research to Practice: Lessons Learned

ERIC Educational Resources Information Center

Toth, Sheree L.; Manly, Jody Todd; Nilsen, Wendy J.

2008-01-01

Research has informed practice since the origins of developmental psychology, but only recently has basic science and practice begun to be consistently integrated with one another. In addition, considerable research documents the utility of empirically-supported interventions, yet it has been difficult to implement such interventions outside of…

The Value of Literacy Practices

ERIC Educational Resources Information Center

Esposito, Lucio; Kebede, Bereket; Maddox, Bryan

2015-01-01

The concepts of literacy events and practices have received considerable attention in educational research and policy. In comparison, the question of value, that is, "which literacy practices do people most value?" has been neglected. With the current trend of cross-cultural adult literacy assessment, it is increasingly important to…

Environmental Education: Practice and Possibility.

ERIC Educational Resources Information Center

Robottom, Ian, Ed.

This collection of essays describes practices in environmental education and points to possibilities in the field. The intention is to appraise selected practices in order to prepare the ground for a consideration of alternative images of environmental education that may shape future action. The following articles are included: (1) "A…

Parental feeding behaviours and motivations: a qualitative study in mothers of UK pre-schoolers

PubMed Central

Carnell, S; Cooke, L; Cheng, R; Robbins, A; Wardle, J

2011-01-01

Parental feeding behaviours are considered major influences on children’s eating behaviour. However, many questionnaire studies of feeding neglect subtle distinctions between specific feeding strategies and practices in favour of eliciting general feeding goals, and do not take account of the context provided by parents’ motivations. These factors may be critical to understanding child outcomes and engaging parents in child obesity prevention. The present study obtained interview and diary data on specific feeding behaviours and underlying motivations from 22 mothers of predominantly healthy weight 3–5 y olds in the UK. Parents described a wide range of efforts to promote or restrict intake that were largely motivated by practical and health considerations and only rarely by concern about weight. There was also evidence for instrumental feeding, rules surrounding meal-time, child involvement, and parental flexibility in relation to feeding. Almost all parents described responding to children’s appetitive traits, consistent with growing evidence for genetically-influenced individual differences in children’s appetite. These findings suggest that in order to engage parents of currently healthy weight children, obesity prevention advice should aim to satisfy their primary motivations (practicality, health), and be framed as helping parents to respond sensitively and appropriately to different children’s characteristics. PMID:21884741

Teaching nurses teamwork: Integrative review of competency-based team training in nursing education.

PubMed

Barton, Glenn; Bruce, Anne; Schreiber, Rita

2017-12-20

Widespread demands for high reliability healthcare teamwork have given rise to many educational initiatives aimed at building team competence. Most effort has focused on interprofessional team training however; Registered Nursing teams comprise the largest human resource delivering direct patient care in hospitals. Nurses also influence many other health team outcomes, yet little is known about the team training curricula they receive, and furthermore what specific factors help translate teamwork competency to nursing practice. The aim of this review is to critically analyse empirical published work reporting on teamwork education interventions in nursing, and identify key educational considerations enabling teamwork competency in this group. CINAHL, Web of Science, Academic Search Complete, and ERIC databases were searched and detailed inclusion-exclusion criteria applied. Studies (n = 19) were selected and evaluated using established qualitative-quantitative appraisal tools and a systematic constant comparative approach. Nursing teamwork knowledge is rooted in High Reliability Teams theory and Crew or Crisis Resource Management sources. Constructivist pedagogy is used to teach, practice, and refine teamwork competency. Nursing teamwork assessment is complex; involving integrated yet individualized determinations of knowledge, skills, and attitudes. Future initiatives need consider frontline leadership, supportive followership and skilled communication emphasis. Collective stakeholder support is required to translate teamwork competency into nursing practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

Doctors and torture: the police surgeon.

PubMed

Burges, S H

1980-09-01

Much has been written by many distinguished persons about the philosophical, religious and ethical considerations of doctors and their involvement with torture. What follows will not have the erudition or authority of the likes of St Augustine, Mahatma Gandi, Schopenhauer or Thomas Paine. It represents the views of a very ordinary person; a presumption defended by the submission that many very ordinary persons have been, and will be, instruments for effecting, assisting or condoning the physical or mental anguish of others. As practitioners of medicine, we are particularly vulnerable, since our particular knowledge and our privileged position may be so easily abused--to the detriment of others. Those of us who practice clinical forensic medicine have even greater responsibility by virtue of our daily contact with the enforcement of law, criminal procedure, and the machinations of the judiciary. We are thus particularly well placed to monitor, encourage or discourage the occurrence of evil practices within the community. It is imperative, therefore, that the ordinary doctor should be cognisant of, and be party to, a code of conduct formulated by his peers and having reference to his obligations as a citizen, and doctor, and to his ability to manipulate human activity. Forensic physicians have further discretionary powers as arbiters in the marriage of the art and ethics of healing with the principles and practice of justice.

Self-Assessment of competence during post-graduate training in general medicine: A preliminary study to develop a portfolio for further education

PubMed Central

Huenges, Bert; Woestmann, Barbara; Ruff-Dietrich, Susanne; Rusche, Herbert

2017-01-01

Awareness of one’s own strengths and weaknesses is a key qualification for the specialist physician. We examined how physicians undergoing specialist training in general medicine rate themselves in different areas. For this purpose, 139 participants receiving post-graduate training in general practice offered by the Medical Association of Westfalen-Lippe assessed themselves regarding their subjective confidence in 20 core competencies and 47 situations involving patient counseling in general practice. Their self-assessments were recorded on a five-point Likert scale. The study questions addressed acceptance and practicability of self-assessment, mean values, reliability, stratification and plausibility of the results in group comparison. On average participants rated their subjective confidence with 3.4 out of 5 points. The results are self-consistent (Cronbach’s alpha >0.8), although there are considerable differences among competencies and among participants. The latter can be explained partly by biographical data, which supports the plausibility of the data. Participants stated that regularly gathering data on subjective learning needs and the discussion of these needs with mentors and trainers contributes to improving their specialist training. Elements for self-assessment are suitable for integration into a postgraduate training portfolio. These should be supplemented by formative assessment procedures. PMID:29226236

'Outside the Original Remit': Co-production in UK mental health research, lessons from the field.

PubMed

Lambert, Nicky; Carr, Sarah

2018-06-19

The aim of this discursive paper was to explore the development of co-production and service user involvement in UK university-based mental health research and to offer practical recommendations for practitioners co-producing research with service users and survivors, informed by an overview of the key literature on co-production in mental health and from a critical reflection on applied research through the medium of a case study. The paper is co-written by a mental health nurse academic and a service user/survivor researcher academic. The authors argue that the implications of co-production for mental health research remain underexplored, but that both the practitioner and service user/survivor researcher experience and perspective of co-production in research can provide practical reflections to inform developing research practice. The theories and values of emancipatory research can provide a framework from which both practitioners and service users can work together on a research project, in a way that requires reflection on process and power dynamics. The authors conclude that whilst co-produced investigations can offer unique opportunities for advancing emancipatory and applied research in mental health, practitioner researchers need to be more radical in their consideration of power in the research process. © 2018 Australian College of Mental Health Nurses Inc.

Self-Assessment of competence during post-graduate training in general medicine: A preliminary study to develop a portfolio for further education.

PubMed

Huenges, Bert; Woestmann, Barbara; Ruff-Dietrich, Susanne; Rusche, Herbert

2017-01-01

Awareness of one's own strengths and weaknesses is a key qualification for the specialist physician. We examined how physicians undergoing specialist training in general medicine rate themselves in different areas. For this purpose, 139 participants receiving post-graduate training in general practice offered by the Medical Association of Westfalen-Lippe assessed themselves regarding their subjective confidence in 20 core competencies and 47 situations involving patient counseling in general practice. Their self-assessments were recorded on a five-point Likert scale. The study questions addressed acceptance and practicability of self-assessment, mean values, reliability, stratification and plausibility of the results in group comparison. On average participants rated their subjective confidence with 3.4 out of 5 points. The results are self-consistent (Cronbach's alpha >0.8), although there are considerable differences among competencies and among participants. The latter can be explained partly by biographical data, which supports the plausibility of the data. Participants stated that regularly gathering data on subjective learning needs and the discussion of these needs with mentors and trainers contributes to improving their specialist training. Elements for self-assessment are suitable for integration into a postgraduate training portfolio. These should be supplemented by formative assessment procedures.

Channel coding and data compression system considerations for efficient communication of planetary imaging data

NASA Technical Reports Server (NTRS)

Rice, R. F.

1974-01-01

End-to-end system considerations involving channel coding and data compression which could drastically improve the efficiency in communicating pictorial information from future planetary spacecraft are presented.

The Safe and Effective Use of Shared Data Underpinned by Stakeholder Engagement and Evaluation Practice.

PubMed

Georgiou, Andrew; Magrabi, Farah; Hypponen, Hannele; Wong, Zoie Shui-Yee; Nykänen, Pirkko; Scott, Philip J; Ammenwerth, Elske; Rigby, Michael

2018-04-22

 The paper draws attention to: i) key considerations involving the confidentiality, privacy, and security of shared data; and ii) the requirements needed to build collaborative arrangements encompassing all stakeholders with the goal of ensuring safe, secure, and quality use of shared data.  A narrative review of existing research and policy approaches along with expert perspectives drawn from the International Medical Informatics Association (IMIA) Working Group on Technology Assessment and Quality Development in Health Care and the European Federation for Medical Informatics (EFMI) Working Group for Assessment of Health Information Systems.  The technological ability to merge, link, re-use, and exchange data has outpaced the establishment of policies, procedures, and processes to monitor the ethics and legality of shared use of data. Questions remain about how to guarantee the security of shared data, and how to establish and maintain public trust across large-scale shared data enterprises. This paper identifies the importance of data governance frameworks (incorporating engagement with all stakeholders) to underpin the management of the ethics and legality of shared data use. The paper also provides some key considerations for the establishment of national approaches and measures to monitor compliance with best practice. Data sharing endeavours can help to underpin new collaborative models of health care which provide shared information, engagement, and accountability amongst all stakeholders. We believe that commitment to rigorous evaluation and stakeholder engagement will be critical to delivering health data benefits and the establishment of collaborative models of health care into the future. Georg Thieme Verlag KG Stuttgart.

Controversies in juvenile idiopathic arthritis-associated uveitis.

PubMed

Zierhut, Manfred; Heiligenhaus, Arnd; deBoer, Joke; Cunningham, Emmett T; Tugal-Tutkun, Ilknur

2013-06-01

Abstract Juvenile idiopathic arthritis-associated uveitis (JIAU) accounts for a sizable proportion of uveitis cases in children and is an important cause of ocular morbidity in uveitis patients in this age group. The authors present the results of a survey conducted to obtain a better understanding of the current views and practices of ophthalmologists involved in the care of children with JIAU. A detailed questionnaire consisting of 54 questions addressing epidemiology, diagnosis, and therapy of JIAU was distributed to 67 uveitis specialists. The responses from 37 completed questionnaires were tabulated for this report. While the experts often agreed on aspects of the epidemiologic and clinical features of JIAU and its complications, considerable diversity of responses was noted-particularly with regard to practice patterns. Regarding diagnostics and disease monitoring, all experts favored ANA testing, whereas two-thirds also suggested HLA-B27 typing. Laser flare photometry was available to and routinely used by almost one-third of the experts. Optical coherence tomography (OCT) was used by more than half. The survey revealed an overall consensus on therapeutic strategies, including the use of both conventional immunosuppressive and biologic agents. Methotrexate was the initial choice for immunosuppression by most respondents. Most would add an anti-TNF-alpha agent following failure of traditional immunosuppressive therapy, and adalimumab was favored by almost half of the experts. Questions addressing the management of individual situations, such as the treatment of macular edema and perioperative management, revealed considerable differences in therapeutic approaches. The results of this survey support the development of international guidelines for the management of JIAU.

The Investigation of Research-Based Home Parental Involvement Practices, Parental Style, and Student Achievement

ERIC Educational Resources Information Center

Colson, Myron Jamal

2010-01-01

The purpose of the study was to investigate the relationship of home parental involvement practices, parental style and student achievement. Dimensions of parental involvement practices are parental instruction, parental reinforcement, parental modeling, and parental encouragement. Dimensions of parental style are authoritarian, permissive, and…

77 FR 29345 - Sunshine Act Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-17

... of the Currency), Director Richard Cordray (Director, Consumer Financial Protection Bureau) and Acting Chairman Martin J. Gruenberg, that Corporation business required its consideration of the matters... earlier notice of the meeting was practicable; that the public interest did not require consideration of...

49 CFR 1106.1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR SURFACE TRANSPORTATION BOARD CONSIDERATION OF SAFETY INTEGRATION.... This part is designed to ensure adequate and coordinated consideration of safety integration issues, by... subject to the Board's jurisdiction. It establishes the procedures by which the Board will consider safety...

49 CFR 1106.1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR SURFACE TRANSPORTATION BOARD CONSIDERATION OF SAFETY INTEGRATION.... This part is designed to ensure adequate and coordinated consideration of safety integration issues, by... subject to the Board's jurisdiction. It establishes the procedures by which the Board will consider safety...

49 CFR 1106.1 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR SURFACE TRANSPORTATION BOARD CONSIDERATION OF SAFETY INTEGRATION.... This part is designed to ensure adequate and coordinated consideration of safety integration issues, by... subject to the Board's jurisdiction. It establishes the procedures by which the Board will consider safety...

49 CFR 1106.1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR SURFACE TRANSPORTATION BOARD CONSIDERATION OF SAFETY INTEGRATION.... This part is designed to ensure adequate and coordinated consideration of safety integration issues, by... subject to the Board's jurisdiction. It establishes the procedures by which the Board will consider safety...

49 CFR 1106.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR SURFACE TRANSPORTATION BOARD CONSIDERATION OF SAFETY INTEGRATION.... This part is designed to ensure adequate and coordinated consideration of safety integration issues, by... integration plans in connection with its approval and authorization of transactions for which the Board has...

Theoretical considerations on the optogalvanic detection of laser induced fluorescence in atmospheric pressure atomizers

NASA Astrophysics Data System (ADS)

Omenetto, N.; Smith, B. W.; Winefordner, J. D.

1989-01-01

Several theoretical considerations are given on the potential and practical capabilities of a detector of fluorescence radiation whose operating principle is based on a multi-step excitation-ionization scheme involving the fluorescence photons as the first excitation step. This detection technique, which was first proposed by MATVEEVet al. [ Zh. Anal Khim.34, 846 (1979)], combines two independent atomizers, one analytical cell for the excitation of the sample fluorescence and one cell, filled with pure analyte atomic vapor, acting as the ionization detector. One laser beam excites the analyte fluorescence in the analytical cell and one (or two) laser beams are used to ionize the excited atoms in the detector. Several different causes of signal and noise are evaluated, together with a discussion on possible analytical atom reservoirs (flames, furnaces) and laser sources which could be used with this approach. For properly devised conditions, i.e. optical saturation of the fluorescence and unity ionization efficiency, detection limits well below pg/ml in solution and well below femtograms as absolute amounts in furnaces can be predicted. However, scattering problems, which are absent in a conventional laser-enhanced ionization set-up, may be important in this approach.

U.S. Public Health Service Commissioned Corps pharmacists: making a difference in advancing the nation's health.

PubMed

Flowers, Louis; Wick, Jeannette; Figg, William Douglas; McClelland, Robert H; Shiber, Michael; Britton, James E; Ngo, Diem-Kieu H; Borders-Hemphill, Vicky; Mead, Christina; Zee, Jerry; Huntzinger, Paul

2009-01-01

To describe how U.S. Public Health Service (PHS) pharmacists serving in jobs that are normal for them, but considerably different than those found in the private sector, are making a difference in advancing the nation's health. Pharmacists who serve in the Commissioned Corps of PHS fill roles that are considerably different than their counterparts in the private sector. Their work takes them out from behind the counter and into the world. Pharmacy officers advance the health and safety of the nation by their involvement in the delivery of direct patient care to medically underserved people, national security, drug vigilance, research, and policy-making endeavors. PHS pharmacists fill essential public health leadership and service roles throughout the U.S. Department of Health and Human Services (HHS) and certain non-HHS federal agencies and programs. The Health Resources and Services Administration, National Institutes of Health, Federal Bureau of Prisons, Indian Health Service, Food and Drug Administration, and U.S. Coast Guard are among the many federal agencies in which pharmacy officers are assigned. In each setting, PHS pharmacists find traditional roles augmented with assignments and challenges that broaden the scope of their practice.

MOMENTS OF UNCERTAINTY: ETHICAL CONSIDERATIONS AND EMERGING CONTAMINANTS

PubMed Central

Cordner, Alissa; Brown, Phil

2013-01-01

Science on emerging environmental health threats involves numerous ethical concerns related to scientific uncertainty about conducting, interpreting, communicating, and acting upon research findings, but the connections between ethical decision making and scientific uncertainty are under-studied in sociology. Under conditions of scientific uncertainty, researcher conduct is not fully prescribed by formal ethical codes of conduct, increasing the importance of ethical reflection by researchers, conflicts over research conduct, and reliance on informal ethical standards. This paper draws on in-depth interviews with scientists, regulators, activists, industry representatives, and fire safety experts to explore ethical considerations of moments of uncertainty using a case study of flame retardants, chemicals widely used in consumer products with potential negative health and environmental impacts. We focus on the uncertainty that arises in measuring people’s exposure to these chemicals through testing of their personal environments or bodies. We identify four sources of ethical concerns relevant to scientific uncertainty: 1) choosing research questions or methods, 2) interpreting scientific results, 3) communicating results to multiple publics, and 4) applying results for policy-making. This research offers lessons about professional conduct under conditions of uncertainty, ethical research practice, democratization of scientific knowledge, and science’s impact on policy. PMID:24249964

The Stakeholder Model of voice research: Acknowledging barriers to human rights of all stakeholders in a communicative exchange.

PubMed

Madill, Catherine; Warhurst, Samantha; McCabe, Patricia

2018-02-01

The act of communication is a complex, transient and often abstract phenomenon that involves many stakeholders, each of whom has their own perspective: the speaker, the listener, the observer and the researcher. Current research practices in voice disorder are frequently framed through a single lens - that of the researcher/clinician or their participant/patient. This single lens approach risks overlooking significant barriers to the basic human right of freedom of expression for those with a voice disorder as it omits consideration of the impact of voice disorder on the listener, and consideration of the wider impact of the voice in the occupational context. Recent research in the area of voice has developed a multiple lens and subsequent Stakeholder Model that acknowledges the experience and reality of multiple stakeholders viewing the same phenomenon, the voice. This research paradigm is built on Article 19 of the Universal Declaration of Human Rights as it considers the realities of all stakeholders in forming a deeper understanding of the causality, impact and aspects of communication disorder. The Stakeholder Model will be presented as a suggestion for future investigations of communication disorders more widely.

Fortuitously discovered liver lesions.

PubMed

Dietrich, Christoph F; Sharma, Malay; Gibson, Robert N; Schreiber-Dietrich, Dagmar; Jenssen, Christian

2013-06-07

The fortuitously discovered liver lesion is a common problem. Consensus might be expected in terms of its work-up, and yet there is none. This stems in part from the fact that there is no preventive campaign involving the early detection of liver tumors other than for patients with known liver cirrhosis and oncological patients. The work-up (detection and differential diagnosis) of liver tumors comprises theoretical considerations, history, physical examination, laboratory tests, standard ultrasound, Doppler ultrasound techniques, contrast-enhanced ultrasound (CEUS), computed tomography and magnetic resonance imaging, as well as image-guided biopsy. CEUS techniques have proved to be the most pertinent method; these techniques became part of the clinical routine about 10 years ago in Europe and Asia and are used for a variety of indications in daily clinical practice. CEUS is in many cases the first and also decisive technical intervention for detecting and characterizing liver tumors. This development is reflected in many CEUS guidelines, e.g., in the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines 2004, 2008 and 2012 as well as the recently published World Federation for Ultrasound in Medicine and Biology-EFSUMB guidelines 2012. This article sets out considerations for making a structured work-up of incidental liver tumors feasible.

Language barriers and qualitative nursing research: methodological considerations.

PubMed

Squires, A

2008-09-01

This review of the literature synthesizes methodological recommendations for the use of translators and interpreters in cross-language qualitative research. Cross-language qualitative research involves the use of interpreters and translators to mediate a language barrier between researchers and participants. Qualitative nurse researchers successfully address language barriers between themselves and their participants when they systematically plan for how they will use interpreters and translators throughout the research process. Experienced qualitative researchers recognize that translators can generate qualitative data through translation processes and by participating in data analysis. Failure to address language barriers and the methodological challenges they present threatens the credibility, transferability, dependability and confirmability of cross-language qualitative nursing research. Through a synthesis of the cross-language qualitative methods literature, this article reviews the basics of language competence, translator and interpreter qualifications, and roles for each kind of qualitative research approach. Methodological and ethical considerations are also provided. By systematically addressing the methodological challenges cross-language research presents, nurse researchers can produce better evidence for nursing practice and policy making when working across different language groups. Findings from qualitative studies will also accurately represent the experiences of the participants without concern that the meaning was lost in translation.

Language barriers and qualitative nursing research: methodological considerations

PubMed Central

Squires, A.

2009-01-01

Aim This review of the literature synthesizes methodological recommendations for the use of translators and interpreters in cross-language qualitative research. Background Cross-language qualitative research involves the use of interpreters and translators to mediate a language barrier between researchers and participants. Qualitative nurse researchers successfully address language barriers between themselves and their participants when they systematically plan for how they will use interpreters and translators throughout the research process. Experienced qualitative researchers recognize that translators can generate qualitative data through translation processes and by participating in data analysis. Failure to address language barriers and the methodological challenges they present threatens the credibility, transferability, dependability and confirmability of cross-language qualitative nursing research. Through a synthesis of the cross-language qualitative methods literature, this article reviews the basics of language competence, translator and interpreter qualifications, and roles for each kind of qualitative research approach. Methodological and ethical considerations are also provided. Conclusion By systematically addressing the methodological challenges cross-language research presents, nurse researchers can produce better evidence for nursing practice and policy making when working across different language groups. Findings from qualitative studies will also accurately represent the experiences of the participants without concern that the meaning was lost in translation. PMID:19522941

Ethics of the electrified mind: Defining issues and perspectives on the principled use of brain stimulation in medical research and clinical care

PubMed Central

Cabrera, Laura Y.; Evans, Emily L.; Hamilton, Roy H.

2013-01-01

In recent years, non-pharmacologic approaches to modifying human neural activity have gained increasing attention. One of these approaches is brain stimulation, which involves either the direct application of electrical current to structures in the nervous system or the indirect application of current by means of electromagnetic induction. Interventions that manipulate the brain have generally been regarded as having both the potential to alleviate devastating brain-related conditions and the capacity to create unforeseen and unwanted consequences. Hence, although brain stimulation techniques offer considerable benefits to society, they also raise a number of ethical concerns. In this paper we will address various dilemmas related to brain stimulation in the context of clinical practice and biomedical research. We will survey current work involving deep brain stimulation (DBS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). We will reflect upon relevant similarities and differences between them, and consider some potentially problematic issues that may arise within the framework of established principles of medical ethics: nonmaleficence and beneficence, autonomy, and justice. PMID:23733209

Plant intelligence

PubMed Central

Lipavská, Helena; Žárský, Viktor

2009-01-01

The concept of plant intelligence, as proposed by Anthony Trewavas, has raised considerable discussion. However, plant intelligence remains loosely defined; often it is either perceived as practically synonymous to Darwinian fitness, or reduced to a mere decorative metaphor. A more strict view can be taken, emphasizing necessary prerequisites such as memory and learning, which requires clarifying the definition of memory itself. To qualify as memories, traces of past events have to be not only stored, but also actively accessed. We propose a criterion for eliminating false candidates of possible plant intelligence phenomena in this stricter sense: an “intelligent” behavior must involve a component that can be approximated by a plausible algorithmic model involving recourse to stored information about past states of the individual or its environment. Re-evaluation of previously presented examples of plant intelligence shows that only some of them pass our test. “You were hurt?” Kumiko said, looking at the scar. Sally looked down. “Yeah.” “Why didn't you have it removed?” “Sometimes it's good to remember.” “Being hurt?” “Being stupid.”—(W. Gibson: Mona Lisa Overdrive) PMID:19816094

Extending the Reach of Evidence-Based Medicine: A Proposed Categorization of Lower-Level Evidence.

PubMed

Detterbeck, Frank C; Gould, Michael K; Lewis, Sandra Zelman; Patel, Sheena

2018-02-01

Clinical practice involves making many treatment decisions for which only limited formal evidence exists. While the methodology of evidence-based medicine (EBM) has evolved tremendously, there is a need to better characterize lower-level evidence. This should enhance the ability to appropriately weigh the evidence against other considerations, and counter the temptation to think it is more robust than it actually is. A framework to categorize lower-level evidence is proposed, consisting of nonrandomized comparisons, extrapolation using indirect evidence, rationale, and clinical experience (ie, an accumulated general impression). Subtypes are recognized within these categories, based on the degree of confounding in nonrandomized comparisons, the uncertainty involved in extrapolation from indirect evidence, and the plausibility of a rationale. Categorizing the available evidence in this way can promote a better understanding of the strengths and limitations of using such evidence as the basis for treatment decisions in clinically relevant areas that are devoid of higher-level evidence. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Evolution of trends in risk management.

PubMed

Aziz, Farah; Khalil, Alizan; Hall, John C

2005-07-01

In the past, the detection and response to adverse clinical events were viewed as an inherent part of professionalism; and, if perceived problems were not sorted out at that level, the ultimate expression of dissatisfaction was litigation. There are now demands for the adoption of more transparent and effective processes for risk management. Reviews of surgical practice have highlighted the presence of unacceptable levels of avoidable adverse events. This is being resolved in two ways. First, attention is being directed to the extent that training and experience have on outcomes after surgery, and both appear to be important. Second, a greater appreciation of human factors engineering has promoted a greater involvement of surgeons in processes involving teamwork and non-technical skills. The community wants surgeons who are competent and health-care systems that minimize risk. In recent times attention has been focused on the turmoil associated with change; but, when events are viewed over a period of several decades, there has been considerable progress towards these ideals. Further advancement would be aided by removing the adversarial nature of malpractice systems that have failed to maintain standards.

Planning for robust reserve networks using uncertainty analysis

USGS Publications Warehouse

Moilanen, A.; Runge, M.C.; Elith, Jane; Tyre, A.; Carmel, Y.; Fegraus, E.; Wintle, B.A.; Burgman, M.; Ben-Haim, Y.

2006-01-01

Planning land-use for biodiversity conservation frequently involves computer-assisted reserve selection algorithms. Typically such algorithms operate on matrices of species presence?absence in sites, or on species-specific distributions of model predicted probabilities of occurrence in grid cells. There are practically always errors in input data?erroneous species presence?absence data, structural and parametric uncertainty in predictive habitat models, and lack of correspondence between temporal presence and long-run persistence. Despite these uncertainties, typical reserve selection methods proceed as if there is no uncertainty in the data or models. Having two conservation options of apparently equal biological value, one would prefer the option whose value is relatively insensitive to errors in planning inputs. In this work we show how uncertainty analysis for reserve planning can be implemented within a framework of information-gap decision theory, generating reserve designs that are robust to uncertainty. Consideration of uncertainty involves modifications to the typical objective functions used in reserve selection. Search for robust-optimal reserve structures can still be implemented via typical reserve selection optimization techniques, including stepwise heuristics, integer-programming and stochastic global search.

Exploring hypersexual behavior in men with Parkinson's disease: is it compulsive sexual behavior?

PubMed

Bronner, Gila; Hassin-Baer, Sharon

2012-01-01

A range of impulse control disorders has been described in Parkinson's disease, including compulsive sexual behavior. Excessive sexual demands of parkinsonian men can lead to considerable tension within the couple. Thorough sexual interviews reveal that these cases may reflect various types of sexual dysfunctions that present as hypersexuality. This study aims to analyze cases of presumed and true compulsive male sexual behavior, and to propose a practical tool for clinicians, assisting them with the diagnosis and management of compulsive sexual behavior and other sexual dysfunctions in parkinsonian patients. We describe four male patients with Parkinson's disease from the movement disorders clinic, which were referred to the sex therapist as suspected hypersexuality. The sexual assessment revealed that only one of the cases involved true hypersexuality due to compulsive sexual behavior. The other three presented with erectile dysfunction, difficulties reaching orgasm (delayed ejaculation), and a gap in desire within the couple. Complaints about hypersexual behavior in patients with Parkinson's disease must be carefully evaluated, involving a multidisciplinary team. A comprehensive diagnostic and therapeutic algorithm is suggested.

Requirement Generation for Space Infrastructure Systems

NASA Astrophysics Data System (ADS)

Hempsell, M.

Despite heavy investment, in the half-century period between 1970 and 2020 there will almost no progress in the capability provided by the space infrastructure. It is argued that this is due to a failure during the requirement generation phase of the infrastructure's elements, a failure that is primarily due to following the accepted good practice of involving stakeholders while establishing a mission based set of technical requirements. This argument is supported by both a consideration of the history of the requirement generation phase of past space infrastructure projects, in particular the Space Shuttle, and an analysis of the interactions of the stakeholders during this phase. Traditional stakeholder involvement only works well in mature infrastructures where investment aims to make minor improvements, whereas space activity is still in the early experimental stages and is open to major new initiatives that aim to radically change the way we work in space. A new approach to requirement generation is proposed, which is more appropriate to these current circumstances. This uses a methodology centred on the basic functions the system is intended to perform rather than its expected missions.

An approach to evaluating drug-nutrient interactions.

PubMed

Santos, Cristina A; Boullata, Joseph I

2005-12-01

Although the significance of interactions between drugs is widely appreciated, little attention has been given to interactions between drugs and nutrients. Pharmacists are challenged to remember documented interactions involving available drugs, and they face the possibility that each newly approved therapeutic agent may be involved not only in unrecognized drug-drug interactions but in drug-nutrient interactions as well. A more consistent approach to evaluating drug-nutrient interactions is needed. The approach must be systematic in order to assess the influence of nutritional status, food, or specific nutrients on a drug's pharmacokinetics and pharmacodynamics, as well as the influence of a drug on overall nutritional status or on the status of a specific nutrient. We provide such a process, using several recently approved drugs as working examples. Risk factors and clinical relevance are described, with distinctions made between documented and potential interactions. Application of this process by the pharmacist to any drug will help increase their expertise. Furthermore, full consideration by pharmacists of all possible interactions of the drug regimens used in practice can allow for improved patient care.

The Curriculum and Pedagogic Properties of Practice-Based Experiences: The Case of Midwifery Students

ERIC Educational Resources Information Center

Billett, Stephen; Sweet, Linda; Glover, Pauline

2013-01-01

This paper outlines curriculum considerations for the ordering, enactment and experiencing of practice-based experiences (e.g. practicums) in tertiary education programs developing occupational specific capacities. Increasingly, these programs are engaging students in practicum experiences (i.e. those in the circumstances of practice). These…

Disseminating Evidence-Based Practice For Children & Adolescents: A Systems Approach to Enhancing Care

ERIC Educational Resources Information Center

American Psychological Association (APA), 2008

2008-01-01

This report focuses on psychological practice with children and adolescents, concurring with a previous task force report that integrating science and practice must be a priority. In addition, the report advocates that developmental considerations and cultural/contextual factors warrant specific, distinctive attention by researchers and…