Science.gov

Sample records for serving vulnerable patients

  1. Medical paternalism serves the patient best.

    PubMed

    Lim, L S

    2002-03-01

    It seems obvious that in a post-modern, constructivist world where meaning and value systems are often subjective and relative, any absolutist view is likely to be questionable. This is more so if it relates to ethics, the foundations, interpretation and application of which have been and continue to be much debated. So, in addressing the proposition, my efforts were directed at identifying a position that would mediate polarity. I examined the contention that the doctor, because he is better informed, may claim greater acuity and powers of judgment, and its defences against the charge of interfering with individual liberty and autonomy through various arguments such as the harm principle, the welfare, the principle of legal moralism and the appeal to uncertainty. While there is some validity to the arguments proposed, absolute paternalism would seem incompatible with respect for individual rights. How satisfactory, then, is the paradigm shift from paternalism to the independent choice model where the doctor presents neutral statistics as little biased as possible by his own views and judgments and leaves the decision making entirely to the patient or his/her relatives. This clearly had its limitations too. As with much of human experience, the answer would seem to rest in mediating the happy mean. Recognising a distinction between autonomy (self-determination) and independence (total freedom of choice without any interference) allows for a model of qualified independence or "enhanced autonomy" (Quill & Brody, 1996). This is predicated on doctor-patient dialogue, exchange of ideas/views, negotiation of differences, and sharing power and influence for the common purpose of serving the patient's best interest. This model would seem to be a responsible and effective approach to management of clinical dilemmas, as well as one that in its pluralistic approach is consistent with fundamental moral and philosophic propositions. It is by no means flawless, but in an

  2. Medical paternalism serves the patient best.

    PubMed

    Lim, L S

    2002-03-01

    It seems obvious that in a post-modern, constructivist world where meaning and value systems are often subjective and relative, any absolutist view is likely to be questionable. This is more so if it relates to ethics, the foundations, interpretation and application of which have been and continue to be much debated. So, in addressing the proposition, my efforts were directed at identifying a position that would mediate polarity. I examined the contention that the doctor, because he is better informed, may claim greater acuity and powers of judgment, and its defences against the charge of interfering with individual liberty and autonomy through various arguments such as the harm principle, the welfare, the principle of legal moralism and the appeal to uncertainty. While there is some validity to the arguments proposed, absolute paternalism would seem incompatible with respect for individual rights. How satisfactory, then, is the paradigm shift from paternalism to the independent choice model where the doctor presents neutral statistics as little biased as possible by his own views and judgments and leaves the decision making entirely to the patient or his/her relatives. This clearly had its limitations too. As with much of human experience, the answer would seem to rest in mediating the happy mean. Recognising a distinction between autonomy (self-determination) and independence (total freedom of choice without any interference) allows for a model of qualified independence or "enhanced autonomy" (Quill & Brody, 1996). This is predicated on doctor-patient dialogue, exchange of ideas/views, negotiation of differences, and sharing power and influence for the common purpose of serving the patient's best interest. This model would seem to be a responsible and effective approach to management of clinical dilemmas, as well as one that in its pluralistic approach is consistent with fundamental moral and philosophic propositions. It is by no means flawless, but in an

  3. Leaf size serves as a proxy for xylem vulnerability to cavitation in plantation trees.

    PubMed

    Schreiber, Stefan G; Hacke, Uwe G; Chamberland, Sabrina; Lowe, Christopher W; Kamelchuk, David; Bräutigam, Katharina; Campbell, Malcolm M; Thomas, Barb R

    2016-02-01

    Hybrid poplars are an important renewable forest resource known for their high productivity. At the same time, they are highly vulnerable to water stress. Identifying traits that can serve as indicators for growth performance remains an important task, particularly under field conditions. Understanding which trait combinations translate to improved productivity is key in order to satisfy the demand for poplar wood in an uncertain future climate. In this study, we compared hydraulic and leaf traits among five hybrid poplar clones at 10 plantations in central Alberta. We also assessed the variation of these traits between 2- to 3-year-old branches from the lower to mid-crown and current-year long shoots from the mid to upper crown. Our results showed that (1) hybrid poplars differed in key hydraulic parameters between branch type, (2) variation of hydraulic traits among clones was relatively large for some clones and less for others, and (3) strong relationships between measured hydraulic traits, such as vessel diameter, cavitation resistance, xylem-specific and leaf-specific conductivity and leaf area, were observed. Our results suggest that leaf size could serve as an additional screening tool when selecting for drought-tolerant genotypes in forest management and tree improvement programmes.

  4. Use of the NatureServe Climate Change Vulnerability Index as an Assessment Tool for Reptiles and Amphibians: Lessons Learned.

    PubMed

    Tuberville, Tracey D; Andrews, Kimberly M; Sperry, Jinelle H; Grosse, Andrew M

    2015-10-01

    Climate change threatens biodiversity globally, yet it can be challenging to predict which species may be most vulnerable. Given the scope of the problem, it is imperative to rapidly assess vulnerability and identify actions to decrease risk. Although a variety of tools have been developed to assess climate change vulnerability, few have been evaluated with regard to their suitability for certain taxonomic groups. Due to their ectothermic physiology, low vagility, and strong association with temporary wetlands, reptiles and amphibians may be particularly vulnerable relative to other groups. Here, we evaluate use of the NatureServe Climate Change Vulnerability Index (CCVI) to assess a large suite of herpetofauna from the Sand Hills Ecoregion of the southeastern United States. Although data were frequently lacking for certain variables (e.g., phenological response to climate change, genetic variation), sufficient data were available to evaluate all 117 species. Sensitivity analyses indicated that results were highly dependent on size of assessment area and climate scenario selection. In addition, several ecological traits common in, but relatively unique to, herpetofauna are likely to contribute to their vulnerability and need special consideration during the scoring process. Despite some limitations, the NatureServe CCVI was a useful tool for screening large numbers of reptile and amphibian species. We provide general recommendations as to how the CCVI tool's application to herpetofauna can be improved through more specific guidance to the user regarding how to incorporate unique physiological and behavioral traits into scoring existing sensitivity factors and through modification to the assessment tool itself.

  5. Use of the NatureServe Climate Change Vulnerability Index as an Assessment Tool for Reptiles and Amphibians: Lessons Learned

    NASA Astrophysics Data System (ADS)

    Tuberville, Tracey D.; Andrews, Kimberly M.; Sperry, Jinelle H.; Grosse, Andrew M.

    2015-10-01

    Climate change threatens biodiversity globally, yet it can be challenging to predict which species may be most vulnerable. Given the scope of the problem, it is imperative to rapidly assess vulnerability and identify actions to decrease risk. Although a variety of tools have been developed to assess climate change vulnerability, few have been evaluated with regard to their suitability for certain taxonomic groups. Due to their ectothermic physiology, low vagility, and strong association with temporary wetlands, reptiles and amphibians may be particularly vulnerable relative to other groups. Here, we evaluate use of the NatureServe Climate Change Vulnerability Index (CCVI) to assess a large suite of herpetofauna from the Sand Hills Ecoregion of the southeastern United States. Although data were frequently lacking for certain variables (e.g., phenological response to climate change, genetic variation), sufficient data were available to evaluate all 117 species. Sensitivity analyses indicated that results were highly dependent on size of assessment area and climate scenario selection. In addition, several ecological traits common in, but relatively unique to, herpetofauna are likely to contribute to their vulnerability and need special consideration during the scoring process. Despite some limitations, the NatureServe CCVI was a useful tool for screening large numbers of reptile and amphibian species. We provide general recommendations as to how the CCVI tool's application to herpetofauna can be improved through more specific guidance to the user regarding how to incorporate unique physiological and behavioral traits into scoring existing sensitivity factors and through modification to the assessment tool itself.

  6. Vulnerability

    NASA Technical Reports Server (NTRS)

    Taback, I.

    1979-01-01

    The discussion of vulnerability begins with a description of some of the electrical characteristics of fibers before definiting how vulnerability calculations are done. The vulnerability results secured to date are presented. The discussion touches on post exposure vulnerability. After a description of some shock hazard work now underway, the discussion leads into a description of the planned effort and some preliminary conclusions are presented.

  7. Are clergy serving yoked congregations more vulnerable to burnout? A study among clergy serving in The Presbyterian Church (U.S.A.).

    PubMed

    Francis, Leslie J; Robbins, Mandy; Wulff, Keith

    2013-04-01

    Pressures generated by increasing secularization and decreasing vocations to ordained ministry are resulting across denominations in a growing number of clergy serving more than one congregation. This study assesses the hypothesis that clergy serving more than one congregation are more susceptible to burnout. Data were provided by a sample of 735 clergy serving in The Presbyterian Church (USA) who completed the Francis burnout inventory together with the abbreviated Eysenck personality questionnaire revised. Among these clergy, 82% served one congregation, 13% served two congregations, and 5% served three or more congregations. After controlling for individual differences in age and personality, the data demonstrated that clergy serving yoked congregations experienced no statistically significant differences in susceptibility to burnout, either in terms of levels of emotional exhaustion or in terms of levels of satisfaction in ministry, compared with colleagues serving just one congregation.

  8. Support of vulnerable patients throughout TB treatment in the UK.

    PubMed

    Potter, J L; Inamdar, L; Okereke, E; Collinson, S; Dukes, R; Mandelbaum, M

    2016-06-01

    Despite well-established treatment regimens, tuberculosis (TB) remains a public health burden; it disproportionately affects poor and marginalized populations who may not have access to social support, including migrants, homeless people and those dependent on drugs or alcohol. There is a clearly demonstrated need for housing and other appropriate social support, as part of a package of integrated clinical and social care. However, TB prevention and control efforts in the UK often do not address the specific vulnerabilities of these groups and it can be a challenge to support the continued TB treatment of these underserved populations. This challenge is exacerbated by complex issues concerning funding, immigration and the law. In this paper, we have reviewed current UK guidance and legislation, discussed several case studies and highlighted examples of existing models of community support for TB patients. Finally, we lay out our recommendations for ensuring a co-ordinated, whole system approach to successful TB treatment.

  9. Developing Dental Students' Awareness of Health Care Disparities and Desire to Serve Vulnerable Populations Through Service-Learning.

    PubMed

    Behar-Horenstein, Linda S; Feng, Xiaoying; Roberts, Kellie W; Gibbs, Micaela; Catalanotto, Frank A; Hudson-Vassell, Charisse M

    2015-10-01

    Service-learning in dental education helps students integrate knowledge with practice in an underserved community setting. The aim of this study was to explore how a service-learning experience affected a small group of dental students' beliefs about cultural competence, professionalism, career development, desire to practice in a community service setting, and perceptions about access and disparities issues. Prior to beginning their first year of dental school, five first-year dental students at one U.S. dental school participated in a six-week service-learning program in which they interned at one of three at-risk settings in order to experience health care delivery there. After the program, 60 reflective writing assignments completed by the participants were analyzed using grounded theory methods; interviews with the students were used to corroborate the findings from that analysis. Seven themes identified in the journal reflections and interview findings showed enhanced awareness of social health care issues and patient differences, as well as a social justice orientation and desire to address disparities. Building on this study, future research should explore the curricular components of service-learning programs to ensure students receive ample opportunity to reflect upon their experiences in order to integrate previously held assumptions with their newfound knowledge. PMID:26427778

  10. Developing Dental Students' Awareness of Health Care Disparities and Desire to Serve Vulnerable Populations Through Service-Learning.

    PubMed

    Behar-Horenstein, Linda S; Feng, Xiaoying; Roberts, Kellie W; Gibbs, Micaela; Catalanotto, Frank A; Hudson-Vassell, Charisse M

    2015-10-01

    Service-learning in dental education helps students integrate knowledge with practice in an underserved community setting. The aim of this study was to explore how a service-learning experience affected a small group of dental students' beliefs about cultural competence, professionalism, career development, desire to practice in a community service setting, and perceptions about access and disparities issues. Prior to beginning their first year of dental school, five first-year dental students at one U.S. dental school participated in a six-week service-learning program in which they interned at one of three at-risk settings in order to experience health care delivery there. After the program, 60 reflective writing assignments completed by the participants were analyzed using grounded theory methods; interviews with the students were used to corroborate the findings from that analysis. Seven themes identified in the journal reflections and interview findings showed enhanced awareness of social health care issues and patient differences, as well as a social justice orientation and desire to address disparities. Building on this study, future research should explore the curricular components of service-learning programs to ensure students receive ample opportunity to reflect upon their experiences in order to integrate previously held assumptions with their newfound knowledge.

  11. Beyond autonomy: diversifying end-of-life decision-making approaches to serve patients and families.

    PubMed

    Winzelberg, Gary S; Hanson, Laura C; Tulsky, James A

    2005-06-01

    Efforts to improve end-of-life decision-making quality have emphasized the principle of individual autonomy to better ensure that patients receive care consistent with their preferences. This principle has primarily been defined through court decisions during the past 3 decades as a patient's right to refuse medical technologies and avoid life-prolonging treatments. However, autonomy as traditionally defined only serves a small segment of dying patients. Patients might not value autonomy or consider autonomy important but define it differently than decision-making self-determination. Some patients also think in terms of their care goals rather than individual treatment preferences. Patients' functional and cognitive abilities, age, racial and ethnic backgrounds, and desire to avoid burdening loved ones may influence attitudes and definitions regarding autonomy. To improve end-of-life decision-making for an increasingly multicultural and aging population, the following priorities should be set: (1) Increase the flexibility of advance care planning and decision-making strategies used with capable patients to encompass diverse perceptions of autonomy; and (2) Improve communication between physicians and patients' families when patients lack decision-making capacity to facilitate decision-making and address families' emotional burdens. The goal of these priorities is to promote understanding of patients' and families' decision-making preferences and goals and to minimize decision-making burdens on families.

  12. Development of a multivariable model to predict vulnerability in older American patients hospitalised with cardiovascular disease

    PubMed Central

    Bell, Susan P; Schnelle, John; Nwosu, Samuel K; Schildcrout, Jonathan; Goggins, Kathryn; Cawthon, Courtney; Mixon, Amanda S; Vasilevskis, Eduard E; Kripalani, Sunil

    2015-01-01

    Objectives To identify vulnerable cardiovascular patients in the hospital using a self-reported function-based screening tool. Participants Prospective observational cohort study of 445 individuals aged ≥65 years admitted to a university medical centre hospital within the USA with acute coronary syndrome and/or decompensated heart failure. Methods Participants completed an inperson interview during hospitalisation, which included vulnerable functional status using the Vulnerable Elders Survey (VES-13), sociodemographic, healthcare utilisation practices and clinical patient-specific measures. A multivariable proportional odds logistic regression model examined associations between VES-13 and prior healthcare utilisation, as well as other coincident medical and psychosocial risk factors for poor outcomes in cardiovascular disease. Results Vulnerability was highly prevalent (54%) and associated with a higher number of clinic visits, emergency room visits and hospitalisations (all p<0.001). A multivariable analysis demonstrating a 1-point increase in VES-13 (vulnerability) was independently associated with being female (OR 1.55, p=0.030), diagnosis of heart failure (OR 3.11, p<0.001), prior hospitalisations (OR 1.30, p<0.001), low social support (OR 1.42, p=0.007) and depression (p<0.001). A lower VES-13 score (lower vulnerability) was associated with increased health literacy (OR 0.70, p=0.002). Conclusions Vulnerability to functional decline is highly prevalent in hospitalised older cardiovascular patients and was associated with patient risk factors for adverse outcomes and an increased use of healthcare services. PMID:26316650

  13. Differences in Risk Factors for Suicidality between African American and White Patients Vulnerable to Suicide

    ERIC Educational Resources Information Center

    Vanderwerker, Lauren C.; Chen, Joyce H; Charpentier, Peter; Paulk, Mary Elizabeth; Michalski, Marion; Prigerson, Holly G.

    2007-01-01

    Risk factors for suicidal ideation and attempts have been shown to differ between African Americans and Whites across the lifespan. In the present study, risk factors for suicidality were examined separately by race/ethnicity in a population of 131 older adult patients considered vulnerable to suicide due to substance abuse and/or medical frailty.…

  14. Advocacy at the end of life: meeting the needs of vulnerable Latino patients.

    PubMed

    Nedjat-Haiem, Frances R; Carrion, Iraida V; Cribbs, Kristen; Lorenz, Karl

    2013-01-01

    This research explores health care professionals' understanding of the problems that arise in managing a terminal condition impacting the Latino population and conceptualizes the components of patient advocacy that address gaps in end-of-life care for patients and their family members. Limited research exists regarding patient advocacy from the perspectives of health care providers working with vulnerable Latino populations utilizing a public sector health care system. Forty-six semi-structured interviews were conducted with providers from different disciplines including medicine, nursing, social work, and chaplaincy. Although roles and responsibilities vary among health providers, it is imperative that all providers become aware of the need for patient advocacy. Doing so is not only in the best interest of vulnerable Latino populations but also has overarching financial benefits and positive outcomes for patients, administrators, and public health care systems. Social workers are the ideal professionals to assume leadership roles and share their knowledge of how to advocate effectively for the most vulnerable populations. PMID:23865972

  15. Older, vulnerable patient view: a pilot and feasibility study of the patient measure of safety (PMOS) with patients in Australia

    PubMed Central

    Taylor, Natalie; Hogden, Emily; Clay-Williams, Robyn; Li, Zhicheng; Lawton, Rebecca; Braithwaite, Jeffrey

    2016-01-01

    Objectives The UK-developed patient measure of safety (PMOS) is a validated tool which captures patient perceptions of safety in hospitals. We aimed (1) to investigate the extent to which the PMOS is appropriate for use with stroke, acute myocardial infarction (AMI) and hip fracture patients in Australian hospitals and (2) to pilot the PMOS for use in a large-scale, national study ‘Deepening our Understanding of Quality in Australia’ (DUQuA). Participants Stroke, AMI and hip fracture patients (n=34) receiving care in 3 wards in 1 large hospital. Methods 2 phases were conducted. First, a ‘think aloud’ study was used to determine the validity of PMOS with this population in an international setting, and to make amendments based on patient feedback. The second phase tested the revised measure to establish the internal consistency reliability of the revised subscales, and piloted the recruitment and administration processes to ensure feasibility of the PMOS for use in DUQuA. Results Of the 43 questions in the PMOS, 13 (30%) were amended based on issues patients highlighted for improvement in phase 1. In phase 2, a total of 34 patients were approached and 29 included, with a mean age of 71.3 years (SD=16.39). Internal consistency reliability was established using interitem correlation and Cronbach's α for all but 1 subscale. The most and least favourably rated aspects of safety differed between the 3 wards. A study log was categorised into 10 key feasibility factors, including liaising with wards to understand operational procedures and identify patterns of patient discharge. Conclusions Capturing patient perceptions of care is crucial in improving patient safety. The revised PMOS is appropriate for use with vulnerable older adult groups. The findings from this study have informed key decisions made for the deployment of this measure as part of the DUQuA study. PMID:27279478

  16. Hemodialysis patients have plasmatic hypercoagulability and decreased fibrinolytic vulnerability: role of carbon monoxide.

    PubMed

    Matika, Ryan W; Nielsen, Vance G; Steinbrenner, Evangelina B; Sussman, Amy N; Madhrira, Machaiah

    2014-01-01

    Chronic hemodialysis is associated with significant thrombophilia. Of interest, hemodialysis patients have increased carboxyhemoglobin (COHb) and exhaled carbon monoxide (CO), signs of upregulated heme oxygenase (Hmox) activity. Given that CO enhances plasmatic coagulation, we determined whether patients requiring chronic hemodialysis had an increase in endogenous CO, plasmatic hypercoagulability and decreased fibrinolytic vulnerability. Carbon monoxide was determined by noninvasive pulse oximetry measurement of COHb. Blood samples were obtained just before hemodialysis. Thrombelastographic methods to assess plasma coagulation kinetics, fibrinolytic kinetics, and formation of carboxyhemefibrinogen (COHF) were used. Hemodialysis patients (n = 45) had abnormally increased COHb concentrations of 2.2 ± 1.9%, indicative of Hmox upregulation. Coagulation and fibrinolytic parameter normal values were determined with normal individual (n = 30) plasma. Thirty-seven patients of the hemodialysis cohort had COHF formation (82.2%, [67.9%-92.0%]; mean, [95% confidence interval]), and many of this group of patients had abnormally great velocity of clot growth (73.3%, [58.1%-85.4%]) and strength (75.6%, [60.5%-87.1%]). Furthermore, over half of COHF positive patients had a hypofibrinolytic state, evidenced by an abnormally prolonged time to maximum rate of lysis (53.3%, [37.9%-68.6%]) and clot lysis time (64.4%, [48.8%-78.1%]). Carbon monoxide enhanced coagulation and diminished fibrinolytic vulnerability in hemodialysis patients. Future investigation of hemodialysis, CO-related thrombophilia is warranted.

  17. The impact of the Supreme Court judgment in Cheshire West v P on the human rights of vulnerable patients.

    PubMed

    Griffith, Richard

    2014-12-01

    The UK Supreme Court's judgment in Cheshire West and Chester Council v P [2014] has had a huge impact on the promotion of human rights of vulnerable patients. The ruling emphasises the positive duty on the state and its organisations, such as the NHS, to have in place procedures that independently confirm that the human rights of those vulnerable patients are being applied in the same way as any other human being. This article discusses the background and basis for the Supreme Court's decision in Cheshire West and its impact on vulnerable patients.

  18. Medicare home health payment reform may jeopardize access for clinically complex and socially vulnerable patients.

    PubMed

    Rosati, Robert J; Russell, David; Peng, Timothy; Brickner, Carlin; Kurowski, Daniel; Christopher, Mary Ann; Sheehan, Kathleen M

    2014-06-01

    The Affordable Care Act directed Medicare to update its home health prospective payment system to reflect more recent data on costs and use of services-an exercise known as rebasing. As a result, the Centers for Medicare and Medicaid Services will reduce home health payments 3.5 percent per year in the period 2014-17. To determine the impact that these reductions could have on beneficiaries using home health care, we examined the Medicare reimbursement margins and the use of services in a national sample of 96,621 episodes of care provided by twenty-six not-for-profit home health agencies in 2011. We found that patients with clinically complex conditions and social vulnerability factors, such as living alone, had substantially higher service delivery costs than other home health patients. Thus, the socially vulnerable patients with complex conditions represent less profit-lower-to-negative Medicare margins-for home health agencies. This financial disincentive could reduce such patients' access to care as Medicare payments decline. Policy makers should consider the unique characteristics of these patients and ensure their continued access to Medicare's home health services when planning rebasing and future adjustments to the prospective payment system.

  19. An assessment of the telehealth needs and health-care priorities of Tanna Island: a remote, under-served and vulnerable population.

    PubMed

    Khazei, Afshin; Jarvis-Selinger, Sandra; Ho, Kendall; Lee, Anna

    2005-01-01

    We surveyed eight Canadian physicians who had each provided medical care for six months on the remote and under-served island of Tanna in Vanuatu. The most frequently encountered medical problems on Tanna were infectious diseases (tuberculosis, hepatitis, abscesses, malaria, pneumonia, typhoid fever, meningitis and skin infections). When physicians were asked about the top three health-care priorities, they ranked tuberculosis control, clean water and improved health-care delivery/communication between hospital and outposts as most important. The key issues were: (1) basic public health needs and infrastructure development are higher in priority than telehealth; (2) telehealth consultants must have knowledge pertinent to local conditions and resources available to the population; (3) electronic equipment suited to tropical environments is needed; (4) projects must be developed locally rather than internationally. Understanding how telehealth can provide support to health professionals under challenging conditions may assist with the health priorities in developing countries and potentially provide access to resources both locally and internationally.

  20. Feeling “overloaded” and “shortcomings”: milieu therapists’ experiences of vulnerability in caring for severely mentally ill patients

    PubMed Central

    Bachmann, Liv; Michaelsen, Ragnhild A; Vatne, Solfrid

    2016-01-01

    Background Milieu therapists’ relationships with patients with severe mental illnesses are viewed as challenging. Elucidating vulnerability from their perspective in daily face-to-face encounters with patients might contribute to extending our knowledge about milieu therapists’ vulnerability and the dynamics of the interaction between patients in mental health services and expertise in building caring and therapeutic relationships. The aim of this project was to study educated milieu therapists’ experiences of their own vulnerability in their interactions with patients in mental health services. Materials and methods The data collection method was focus-group interviews. Thirteen part-time master’s in mental health students (eight nurses, three social workers, two social educators) participated. All participants had experience with community or specialized mental health services (2–8 years). Results The milieu therapists mainly related their experiences of vulnerability to negative feelings elicited by challenging work conditions, disclosed as two main themes: 1) “overloaded”, by the possibility of being physically and mentally hurt and the burdens of long-lasting close relationships; milieu therapists were extremely vulnerable because of their difficulty in protecting themselves; and 2) “shortcomings”, connected to feelings of despair associated with not acting in concordance with their professional standards and insecurity about their skills to handle challenging situations, which was a threat to their professional integrity. There seemed to be coherence between vulnerability and professional inauthenticity. A misunderstanding that professionalism refers to altruism seems to increase milieu therapist vulnerability. Conclusion Vulnerability in health care is of interest to multiple disciplines, and is of relevance for knowledge development in higher education. Extended knowledge and understanding about milieu therapists’ vulnerability might

  1. Vulnerability of healthy vertebrae in patients with and without previous vertebral fracture.

    PubMed

    Morosano, Mario E; Menoyo, Inés; Caferra, Digna A; Sánchez, Ariel; Tomat, María F; Bocanera, Roberto; Pezzotto, Stella M; Masoni, Ana M

    2011-04-01

    Vertebral deformities are associated with a marked increase in morbidity, mortality, and burden in terms of sanitary expenditures. Patients with vertebral fractures have a negative impact in their health, less quality of life, and loss of functional capacity and independence. The purpose of this study was to explore the vulnerability of healthy vertebrae in patients who have sustained already a compression fracture and in patients who do not have prevalent fractures in the thoracic spine; and to explore the association of the deformity in healthy vertebrae with different variables, such as bone mineral density (BMD), body mass index, age, loss of height, presence of clinical kyphosis, history of other osteoporotic fractures, and falls occurring during the last year. Clinical data and complementary studies from 175 postmenopausal outpatients were analyzed. These women (age: 69.7±11.1 years) had not received any treatment for osteoporosis. Anteroposterior and lateral radiographs of the thoracic spine and bone densitometry of the hip were obtained; morphometry was performed in 1575 thoracic vertebrae from T4 to T12. The angle of wedging of each vertebral body was calculated using a trigonometric formula. Then, the sum of wedge angles of vertebral bodies (SWA) was determined, and Cobb angle was measured. In patients with vertebral fractures, after excluding the angles of fractured vertebral bodies, the mean wedge angle of the remaining vertebrae (MWAhealthy) was calculated. The same procedure was followed in patients without vertebral fractures. MWAhealthy was considered as an indicator of the structural vulnerability of non-fractured vertebrae. Patients with prevalent fractures had lower BMD, wider Cobb angle, and higher sum of wedge angles than patients without vertebral fractures. The proportion of patients with accentuation of clinical kyphosis was higher in the group with prevalent vertebral fractures. A highly significant difference was found in the MWAhealthy

  2. Adverse reactions to aspartame: double-blind challenge in patients from a vulnerable population.

    PubMed

    Walton, R G; Hudak, R; Green-Waite, R J

    This study was designed to ascertain whether individuals with mood disorders are particularly vulnerable to adverse effects of aspartame. Although the protocol required the recruitment of 40 patients with unipolar depression and a similar number of individuals without a psychiatric history, the project was halted by the Institutional Review Board after a total of 13 individuals had completed the study because of the severity of reactions within the group of patients with a history of depression. In a crossover design, subjects received aspartame 30 mg/kg/day or placebo for 7 days. Despite the small n, there was a significant difference between aspartame and placebo in number and severity of symptoms for patients with a history of depression, whereas for individuals without such a history there was not. We conclude that individuals with mood disorders are particularly sensitive to this artificial sweetener and its use in this population should be discouraged.

  3. The Spatial Distribution of Plaque Vulnerabilities in Patients with Acute Myocardial Infarction

    PubMed Central

    Zheng, Guian; Li, Yuxin; Takayama, Tadateru; Nishida, Toshihiko; Sudo, Mitsumasa; Haruta, Hironori; Fukamachi, Daisuke; Okubo, Kimie; Higuchi, Yoshiharu; Hiro, Takafumi; Saito, Satoshi; Hirayama, Atsushi

    2016-01-01

    Objective Although the plaque characteristics have been recognized in patients with acute myocardial infarction (AMI), the plaque spatial distribution is not well clarified. Using color-mapping intravascular ultrasound (iMAP-IVUS), we examined culprit lesions to clarify plaque morphology, composition and spatial distribution of the sites of potential vulnerability. Methods Sixty-eight culprit lesions in 64 consecutive AMI patients who underwent angiography and IVUS examinations before intervention were analyzed. Plaque morphology and composition were quantified with iMAP-IVUS. The spatial distribution of the sites of potential vulnerability was assessed with longitudinal reconstruction of the consecutive IVUS images. The plaque characteristics were also compared between ruptured and non-ruptured lesions, and between totally occlusive (TO) and non-TO lesions. Results The sites with maximum necrotic area (maxNA), maximum plaque burden (maxPB) and most severely narrowed (minimal luminal area, MLA) were recognized vulnerability. In the majority of cases, maxNA sites were proximal to the maxPB sites, and MLA sites were distal to the maxNA and maxPB sites. Ruptures usually occurred close to maxNA sites and proximal to maxPB and MLA sites. The average distance from the site of rupture to the maxNA site was 0.33 ± 4.04 mm. Ruptured lesions showed significant vessel remodeling, greater plaque volume, and greater lipidic volume compared to those of non-ruptured lesions. Both the length and plaque burden (PB) of TO lesions were greater than those of non-TO lesions. Conclusions Instead of overlapping on maxPB sites, most maxNA sites are proximal to the maxPB sites and are the sites most likely to rupture. Plaque morphology and composition play critical roles in plaque rupture and coronary occlusion. PMID:27031514

  4. Specific vulnerability of face perception to noise: a similar effect in schizophrenia patients and healthy individuals.

    PubMed

    Chen, Yue; McBain, Ryan; Norton, Daniel

    2015-02-28

    Face perception plays a foundational role in the social world. This perceptual ability is deficient in schizophrenia. A noise-filtering mechanism is essential for perceptual processing. It remains unclear as to whether a specific noise-filtering mechanism is implicated in the face perception problem or a general noise-filtering mechanism is involved which also mediates non-face visual perception problems associated with this psychiatric disorder. This study examined and compared the effects of external noise on the performance of face discrimination and car discrimination in schizophrenia patients (n=25) and healthy controls (n=27). Superimposing the external visual noise on face or car stimuli elevated perceptual thresholds (i.e. degraded performance levels) for both face and car discrimination. However, the effect of noise was significantly larger on face than on car discrimination, both in patients and controls. This pattern of results suggests specific vulnerability of face processing to noise in healthy individuals and those with schizophrenia.

  5. Osteogenic Monocytes within the Coronary Circulation and their Association with Plaque Vulnerability in Patients with Early Atherosclerosis

    PubMed Central

    Collin, Julia; Gössl, Mario; Matsuo, Yoshiki; Cilluffo, Rebecca R.; Flammer, Andreas J.; Loeffler, Darrell; Lennon, Ryan J.; Simari, Robert D.; Spoon, Daniel B.; Erbel, Raimund; Lerman, Lilach O.; Khosla, Sundeep; Lerman, Amir

    2014-01-01

    Objectives This study tests the hypothesis that circulating mononuclear cells expressing osteocalcin (OCN) and bone alkaline phosphatase (BAP) are associated with distinct plaque tissue components in patients with early coronary atherosclerosis. Background Plaque characteristics implying vulnerability develop at the earliest stage of coronary atherosclerosis. Increasing evidence indicates that cells from the myeloid lineage might serve as important mediators of destabilization. Plaque burden and its components were assessed regarding their relationship to monocytes carrying both pro-inflammatory (CD14) and osteogenic surface markers OCN and BAP. Methods Twenty-three patients with angiographically non-obstructive coronary artery disease underwent coronary endothelial function assessment and virtual histology-intravascular ultrasound of the left coronary artery. Plaque composition was characterized in the total segment (TS) and in the target lesion (TL) containing the highest amount of plaque burden. Blood samples were collected simultaneously from the aorta and the coronary sinus. Circulating cell counts were then identified from each sample and a gradient across the coronary circulation was determined. Results Circulating CD14+/BAP+/OCN+ monocytes correlate with the extent of necrotic core and calcification (r=0.53, p=0.010; r=0.55, p=0.006, respectively). Importantly, coronary retention of CD14+/OCN+ cells also correlate with the amount of necrotic core and calcification (r=0.61, p=0.003; r=0.61, p=0.003) respectively. Conclusions Our study links CD14+/BAP+/OCN+ monocytes to the pathologic remodeling of the coronary circulation and therefore associates these cells with plaque destabilization in patients with early coronary atherosclerosis. PMID:25482280

  6. Library Services to Hospital Patients and Handicapped Readers Section. Libraries Serving the General Public Division. Papers.

    ERIC Educational Resources Information Center

    International Federation of Library Associations, The Hague (Netherlands).

    Papers on library services to hospital personnel, hospital patients, and housebound or handicapped persons, which were presented at the 1983 International Federation of Library Associations (IFLA) conference, include: (1) "Education and Training for Health Care Librarianship," in which Antonia J. Bunch (United Kingdom) discusses the scope of and…

  7. Implementing the Ten Steps for Successful Breastfeeding in Hospitals Serving Low-Wealth Patients

    PubMed Central

    Taylor, Emily C.; Nickel, Nathan C.

    2012-01-01

    Objectives. The Ten Steps to Successful Breastfeeding is a proven approach to support breastfeeding in maternity settings; however, scant literature exists on the relative impact and interpretation of each step on breastfeeding. We assessed the Ten Steps and their relationship with in-hospital breastfeeding rates at facilities serving low-wealth populations and explored the outcomes to identify step-specific actions. Methods. We present descriptive and nonparametric comparisons and qualitative findings to examine the relationship between the Ten Steps and breastfeeding rates from each hospital using baseline data collection. Results. Some steps (1-policy, 2-training, 4-skin-to-skin, 6-no supplements, and 9-no artificial nipples, followed by 3-prenatal counseling, 7-rooming-in) reflected differences in relative baseline breastfeeding rates between settings. Key informant interviews revealed misunderstanding of some steps. Conclusions. Self-appraisal may be less valid when not all elements of the criteria for evaluating Step implementation may be fully understood. Limited exposure and understanding may lead to self-appraisal errors, resulting in scores that are not reflective of actual practices. Nonetheless, the indication that breastfeeding rates may be better mirrored by a defined subset of steps may provide some constructive insight toward prioritizing implementation activities and simplifying assessment. These issues will be further explored in the next phase of this study. PMID:23078473

  8. HLA alleles may serve as a tool to discriminate atypical type 2 diabetic patients

    PubMed Central

    Fernández, Mariana; Fabregat, Matías; Javiel, Gerardo; Mimbacas, Adriana

    2014-01-01

    AIM: To investigate whether the presence of human leukocyte antigen (HLA) marker could add new information to discriminated atypical diabetic type 2 patients. METHODS: We analyzed 199 patients initially diagnosed as type 2 diabetes who are treated in special care diabetes clinics (3rd level). This population was classified in “atypical” (sample A) and “classic” (sample B) according to HLA typing. We consider “classic patient” when has absence of type 1 diabetes associated HLA alleles and no difficulties in their diagnosis and treatments. By the other hand, we considered “atypical patient” when show type 1 diabetes associated HLA alleles and difficulties in their diagnosis and treatments. The standard protocol Asociacion Latinoamericana de Diabetes 2006 was used for patients follow up. To analyze differences between both populations in paraclinical parameters we used unpaired t tests and contingence tables. Bivariate and multivariate analyses were carried out using the SPSS software program. In all studies we assume differences statistically significant, with a P-value < 0.05 corrected and 95%CI. RESULTS: The typing HLA in the “atypical” populations show that 92.47% patients presented at list one type 1 diabetes associated HLA alleles (DQB1*0201-0302 and DR 3-4) and 7.53% had two of its. The results showed for categorical variables (family history, presence or absence of hypertension and/or dyslipidemia, reason for initial consultation) the only difference found was at dyslipidemia (OR = 0.45, 0.243 < OD < 0.822 (P < 0.001). In relation to continuous variables we found significant differences between atypical vs classic only in cholesterol (5.07 ± 1.1 vs 5.56 ± 1.5, P < 0.05), high density lipoproteins (1.23 ± 0.3 vs 1.33 ± 0.3, P < 0.05) and low density lipoproteins (2.86 ± 0.9 vs 3.38 ± 1.7, P < 0.01). None of the variables had discriminating power when logistic regression was done. CONCLUSION: We propose an algorithm including HLA

  9. From vulnerable plaque to vulnerable patient--Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report.

    PubMed

    Naghavi, Morteza; Falk, Erling; Hecht, Harvey S; Jamieson, Michael J; Kaul, Sanjay; Berman, Daniel; Fayad, Zahi; Budoff, Matthew J; Rumberger, John; Naqvi, Tasneem Z; Shaw, Leslee J; Faergeman, Ole; Cohn, Jay; Bahr, Raymond; Koenig, Wolfgang; Demirovic, Jasenka; Arking, Dan; Herrera, Victoria L M; Badimon, Juan; Goldstein, James A; Rudy, Yoram; Airaksinen, Juhani; Schwartz, Robert S; Riley, Ward A; Mendes, Robert A; Douglas, Pamela; Shah, Prediman K

    2006-07-17

    Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no government- or healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the "vulnerable patient." These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45-75 years of age and asymptomatic women 55-75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima-media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart attack and stroke. Careful and responsible

  10. Do Clinical Standards for Diabetes Care Address Excess Risk for Hypoglycemia in Vulnerable Patients? A Systematic Review

    PubMed Central

    Berkowitz, Seth A; Aragon, Katherine; Hines, Jonas; Seligman, Hilary; Lee, Sei; Sarkar, Urmimala

    2013-01-01

    Objective To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients. Data Sources MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources. Study Design Systematic review of clinical standards (guidelines, quality metrics, or pay-for-performance programs) for glycemic control in adult diabetes patients. The primary outcome was discussion of increased risk for hypoglycemia in vulnerable populations. Data Collection/Extraction Methods Manuscripts identified were abstracted by two independent reviewers using prespecified inclusion/exclusion criteria and a standardized abstraction form. Principal Findings We screened 1,166 titles, and reviewed 220 manuscripts in full text. Forty-four guidelines, 17 quality metrics, and 8 pay-for-performance programs were included. Five (11 percent) guidelines and no quality metrics or pay-for-performance programs met the primary outcome. Conclusions Clinical standards do not substantively incorporate evidence about increased risk for hypoglycemia in vulnerable populations. PMID:23445498

  11. [Consent for the secondary use of human residual tissue: the patient is best served by an 'opting-out' procedure].

    PubMed

    Rebers, Susanne; van der Valk, Tessa; Meijer, Gerrit A; van Leeuwen, Floor E; Schmidt, Marjanka K

    2012-01-01

    In medical scientific research much use is made of human bodily material (residual tissue) which remains after treatment or diagnosis. Using this, relevant research questions can be answered. The way in which patients can consent to the secondary use of residual tissue is now formalised in a code of conduct, which allows such use unless the patient has objected to this use ('opting-out' procedure). A law is being formulated which will probably require the explicit permission of the patient for secondary use of residual tissue. It is expected that this requirement will lead to a lesser and more selective availability of residual tissue for research. Requesting explicit permission also means additional health care work. Patients demonstrate a preference for the 'opting-out' procedure, on condition that they are well informed about the use of the residual tissue. It is concluded that the interests of the patient are best served by the 'opting-out' procedure, provided that patients are well informed.

  12. Vulnerable Blood in High Risk Vascular Patients: Study Design and Methods

    PubMed Central

    McDermott, Mary M.; Greenland, Philip; Liu, Kiang; Tian, Lu; Green, David; Shah, Sanjiv J.; Huffman, Mark; Wilkins, John; Kibbe, Melina; Liao, Yihua; Huang, Chiang-Ching; Skelly, Christopher; Jacobs, Chad; McCarthy, Walter; Auerbach, Amanda; Lloyd-Jones, Donald

    2014-01-01

    BACKGROUND Basic research suggests that rapid increases in circulating inflammatory and hemostatic blood markers may trigger or indicate impending plaque rupture and coronary thrombosis, resulting in acute ischemic heart disease (IHD) events. However, these associations are not established in humans. METHODS AND RESULTS The Biomarker Risk Assessment in Vulnerable Outpatients (BRAVO) Study will determine whether levels of inflammatory and hemostatic biomarkers rapidly increase during the weeks prior to an acute IHD event in people with lower extremity peripheral artery disease (PAD). The BRAVO Study will determine whether biomarker levels measured immediately prior to an IHD event are higher than levels not preceding an IHD event; whether participants who experience an IHD event (cases) have higher biomarker levels immediately prior to the event and higher biomarker levels at each time point leading up to the IHD event than participants without an IHD event (controls); and whether case participants have greater increases in biomarkers during the months leading up to the event than controls. BRAVO enrolled 595 patients with PAD, a population at high risk for acute IHD events. After a baseline visit, participants returned every two months for blood collection, underwent an electrocardiogram to identify new silent myocardial infarctions, and were queried about new hospitalizations since their prior study visit. Mortality data were also collected. Participants were followed prospectively for up to three years. CONCLUSIONS BRAVO results will provide important information about the pathophysiology of IHD events and may lead to improved therapies for preventing IHD events in high-risk patients. PMID:24721480

  13. Serving Communities.

    ERIC Educational Resources Information Center

    Brook, Les, Ed.

    This book contains 15 articles about various aspects of community further education (FE) programs in Great Britain, including program rationales/benefits, administration, and delivery. The following articles are included: "Foreword" (Bradshaw); "Commitment to Community Is Good Business and Practical Politics" (Brook); "Can We Serve Communities in…

  14. China's new cooperative medical scheme improved finances of township health centers but not the number of patients served.

    PubMed

    Babiarz, Kimberly S; Miller, Grant; Yi, Hongmei; Zhang, Linxiu; Rozelle, Scott

    2012-05-01

    China's New Cooperative Medical Scheme, launched in 2003, was designed to protect rural households from the financial risk posed by health care costs and to increase the use of health care services. This article reports on findings from a longitudinal study of how the program affected the use of health care services, out-of-pocket spending on medical care, and the operations and financial viability of China's township health centers, which constitute a middle tier of care in between village clinics and county hospitals. We found that between 2005 and 2008 the program provided some risk protection and increased the intensity of inpatient care at township health centers. Importantly, the program appears to have improved the centers' financial status. At the same time, the program did not increase the overall number of patients served or the likelihood that a sick person would seek care at a township center. These findings serve as a benchmark of the program's early impact. The results also suggest that the composition of health care use in China has changed, with people increasingly seeking outpatient care at village clinics and inpatient care at township health centers.

  15. Serum Osteopontin Predicts Degree of Hepatic Fibrosis and Serves as a Biomarker in Patients with Hepatitis C Virus Infection

    PubMed Central

    Matsue, Yasuhiro; Tsutsumi, Mikihiro; Hayashi, Nobuhiko; Saito, Takashi; Tsuchishima, Mutsumi; Toshikuni, Nobuyuki; Arisawa, Tomiyasu; George, Joseph

    2015-01-01

    Background & Aims Osteopontin (OPN) is a matricellular protein that upregulates during pathogenesis of hepatic fibrosis. The present study was aimed to evaluate whether serum OPN could be used as a biomarker to assess the degree of hepatic fibrosis in patients with hepatitis C virus (HCV) infection. Methods Needle biopsy was performed on HCV patients and scored as zero fibrosis (F0), mild fibrosis (F1), moderate fibrosis (F2), severe fibrosis (F3) and liver cirrhosis (F4) based on Masson’s trichrome and α-smooth muscle actin (α-SMA) staining. Serum OPN levels were measured using ELISA and correlated with the degree of fibrosis. Furthermore, the OPN values were correlated and evaluated with platelets count, serum hyaluronic acid (HA), and collagen type IV and subjected to receiver operating characteristic (ROC) curve analysis. Results Serum OPN levels were remarkably increased from F0 through F4 in a progressive manner and the differences were significant (P < 0.001) between each group. The data were highly correlated with the degree of hepatic fibrosis. The ROC curve analysis depicted that serum OPN is an independent risk factor and an excellent biomarker and a prognostic index in HCV patients. Conclusions The results of the present study indicate that serum OPN levels reflect the degree of hepatic fibrosis and could be used as a biomarker to assess the stage of fibrosis in HCV patients which would help to reduce the number of liver biopsies. Furthermore, serum OPN serves as a prognostic index towards the progression of hepatic fibrosis to cirrhosis and hepatocellular carcinoma. PMID:25760884

  16. [Panaceas disseminated over the Internet and vulnerable patients: how to check a market of illusions?].

    PubMed

    Vasconcellos-Silva, Paulo R; Castiel, Luis David; Bagrichevsky, Marcos; Griep, Rosane Harter

    2011-06-01

    This article discusses the proliferation of medical quackery and fraud appearing and disappearing daily on the Internet. The customers of these scams, made vulnerable by disease or the prospect of death, use the Internet to buy products that would probably be ignored in other contexts. This vulnerability is linked to strenuous physical demands that compromise the ability to make decisions. The attempt to control the phenomenon of fraud as strictly rational, without taking into account the vulnerability of consumers who have little to lose and not considering their demands for comprehensive care, can lead to disappointing results, since these nostrums seem to be filling the gaps left by health care structures that have been insensitive to the immaterial nature of human fears.

  17. Vulnerable patients going to court: a psychiatrist's guide to special measures

    PubMed Central

    Cooper, Penny; Grace, Janet

    2016-01-01

    There have been significant changes to how vulnerable people are treated in the court system, including the introduction of special measures to support people both as witness and as accused. This paper summarises the use of special measures and their application to people with mental health diagnoses or cognitive impairment. PMID:27512594

  18. Vulnerabilities in Older Patients when Cancer Treatment is Initiated: Does a Cognitive Impairment Impact the Two-Year Survival?

    PubMed Central

    Borghgraef, Cindy; Etienne, Anne-Marie; Merckaert, Isabelle; Paesmans, Marianne; Reynaert, Christine; Roos, Myriam; Slachmuylder, Jean-Louis; Vandenbossche, Sandrine; Bron, Dominique; Razavi, Darius

    2016-01-01

    Introduction Dementia is a known predictor of shorter survival times in older cancer patients. However, no empirical evidence is available to determine how much a cognitive impairment shortens survival in older patients when cancer treatment is initiated. Purpose To longitudinally investigate how much a cognitive impairment detected at the initiation of cancer treatment influences survival of older patients during a two-year follow-up duration and to compare the predictive value of a cognitive impairment on patients survival with the predictive value of other vulnerabilities associated with older age. Methods Three hundred and fifty-seven consecutive patients (≥65 years old) admitted for breast, prostate, or colorectal cancer surgeries were prospectively recruited. A cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA<26). Socio-demographic, disease-related, and geriatric vulnerabilities were assessed using validated tools. Univariate and subsequent multivariate Cox proportional hazards models stratified for diagnosis (breast/prostate cancer versus colorectal cancer) and disease status (metastatic versus non-metastatic) were used. Results A cognitive impairment was detected in 46% (n = 163) of patients. Survival was significantly influenced by a cognitive impairment (HR = 6.13; 95% confidence interval [CI] = 2.07–18.09; p = 0.001), a loss in instrumental autonomy (IADL ≤7) (HR = 3.06; 95% CI = 1.31–7.11; p = 0.009) and fatigue (Mob-T<5) (HR = 5.98; 95% CI = 2.47–14.44; p <0.001). Conclusions During the two years following cancer treatment initiation, older patients with a cognitive impairment were up to six times more likely to die than patients without. Older patients should be screened for cognitive impairments at cancer treatment initiation to enable interventions to reduce morbidity and mortality. Further studies should address processes underlying the relationship between cognitive impairments and an increased risk of dying

  19. Circulating CD36 and fractalkine levels are associated with vulnerable plaque progression in patients with unstable angina pectoris.

    PubMed

    Li, Rui Jian; Yang, Ming; Li, Ji Fu; Xue, Li; Chen, Yu Guo; Chen, Wen Qiang

    2014-11-01

    The chemokine, fractalkine, independently enhances the vulnerability of coronary atherosclerotic plaques. The present study investigated the combined effects of CD36 and fractalkine on coronary plaque progression in patients with unstable angina pectoris. In the present study, 120 unstable angina pectoris patients undergoing coronary angiography and intravascular ultrasound were divided into two groups: an intermediate lesion group (lumen diameter stenosis 50-70%, 80 patients) and a severe lesion group (at least one lesion with lumen diameter stenosis > 70%, 40 patients). The control group consisted of 40 healthy age- and sex-matched subjects. Concentrations of CD36 and fractalkine were measured by enzyme-linked immunosorbent assay. Major adverse cardiovascular events were monitored over a 2-year follow up. Intravascular ultrasound showed that patients with severe lesions had more calcified and mixed plaques, and a larger plaque area and plaque burden than patients with intermediate lesions (P < 0.05-0.01). More patients with severe lesions underwent stent deployment (P < 0.05) than those with intermediate lesions. CD36 and fractalkine concentrations were significantly higher in the severe lesion patients (P < 0.05), and both had significant positive correlations (P < 0.05) with the plaque burden of atherosclerotic lesions. Using the matched nested case-control study, we found that CD36 and fractalkine levels were higher in patients with recurrent major adverse cardiovascular events than controls (P < 0.05). In conclusion, CD36 and fractalkine both promote, and might synergistically enhance, the progression of coronary atherosclerotic plaques.

  20. HIV-AIDS patients' evaluation of health information on the internet: the digital divide and vulnerability to fraudulent claims.

    PubMed

    Benotsch, Eric G; Kalichman, Seth; Weinhardt, Lance S

    2004-12-01

    Access to health information on the Internet has revolutionized how medical patients learn about their illnesses. Valuable information can be found online; however, many health Web sites contain inaccurate or misleading information. The authors surveyed 324 adults with HIV concerning their Internet use for obtaining health information. Health information found online was then rated for quality by participants and by medical professionals. Participants were less critical of health information found online than medical professionals and made smaller distinctions between high-quality and low-quality information. Assigning credibility to low-quality information was predicted by lower incomes and educational attainment, poorer reading comprehension, lower literacy levels, and irrational health beliefs. Results suggest that patients do not always evaluate online information critically and may be vulnerable to misinformation.

  1. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... disproportionate share of low-income patients. 412.106 Section 412.106 Public Health CENTERS FOR MEDICARE...-income patients. (a) General considerations. (1) The factors considered in determining whether a hospital qualifies for a payment adjustment include the number of beds, the number of patient days, and the...

  2. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... disproportionate share of low-income patients. 412.106 Section 412.106 Public Health CENTERS FOR MEDICARE...-income patients. (a) General considerations. (1) The factors considered in determining whether a hospital qualifies for a payment adjustment include the number of beds, the number of patient days, and the...

  3. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...-income patients. (a) General considerations. (1) The factors considered in determining whether a hospital... patients. (d) Payment adjustment factor—(1) Method of adjustment. Subject to the reduction factor set forth... patients, its DRG revenues for inpatient operating costs are increased by an adjustment factor as...

  4. Vulnerability to traumatic stress in fibromyalgia patients: 19 month follow-up after the great East Japan disaster

    PubMed Central

    2013-01-01

    Introduction The aim of this study was to investigate vulnerability and long-term influence of traumatic stress caused by the Great East Japan Disaster which occurred on March 11, 2011, in patients with fibromyalgia, which is a chronic pain syndrome probably involving central sensitization. Methods A total of 60 female patients with fibromyalgia were compared with female patients with rheumatoid arthritis (RA, n = 23) as another chronic pain disease, and with female healthy controls (HC, n = 26) in the observational study. To evaluate responses to traumatic stress, the scores of Impact of Event Scale-Revised (IES-R) were assessed one month after the disaster and every six months until 19 months after the disaster. We also evaluated levels of depression during the study period. To know the score of IES-R of patients with fibromyalgia during usual living, we assessed IES-R in another population of fibromyalgia patients without exposure to a great disaster. Results The mean score of IES-R one month after the disaster in the fibromyalgia group (24.6 [SD 18.9]) was significantly higher than that of RA group (13.4 [SD 14.5]) or HC group (9.1 [9.2]) (F = 9.96, p < 0.0001). However, the mean score of IES-R in fibromyalgia patients without exposure to a great disaster was (20.3 [SD 18.7]), which was almost the same value as the fibromyalgia group seven months after the disaster (20.2 [SD 19.5]). Repeated measures analysis of variance showed significant effect of time course in the depression-related symptoms (F = 6.68, P = 0.001), and a post-hoc test revealed that the number of depression-related symptoms one month before the disaster was significantly different from other time points until 19 months after the disaster, respectively. Conclusions Although response to acute stress induced by the great earthquake was likely to be settled within seven months after the disaster, depression-related symptoms have been increasing for more than one year after the disaster, despite

  5. Serum HMGB1 Serves as a Novel Laboratory Indicator Reflecting Disease Activity and Treatment Response in Ankylosing Spondylitis Patients

    PubMed Central

    Miao, Ye; Huang, Yishu; Sun, Mengchen; Zhu, Yingzi; Zheng, Fang

    2016-01-01

    Objective. High mobility group box 1 (HMGB1) is a late inflammatory factor participating in the pathogenesis of various autoimmune and inflammatory diseases. In the current study, we analyzed the association between serum levels of HMGB1 and clinical features of AS patients before and during treatment. Methods. Serum HMGB1 was detected in 147 AS patients and 61 healthy controls using ELISA. We evaluated the association between HMGB1 and extra-articular manifestations as well as disease severity indices. Among these AS patients, 41 patients received close follow-up at 1, 3, and 6 months after treatment. This group comprised 25 patients treated with anti-TNF-α biologics and 16 patients receiving oral NSAIDs plus sulfasalazine. Results. The serum HMGB1 of AS patients was significantly higher than in healthy controls and positively correlated with BASDAI, BASFI, ASDAS-ESR, ASDAS-CRP, ESR, and CRP, but not with HLA-B27, anterior uveitis, and recurrent diarrhea. There was no significant difference between patients with radiographic damage of hip joints and those without. We observed that serum HMGB1 paralleled disease activity after treatment. Conclusion. Serum level of HMGB1 is higher in AS patients, and to some extent, HMGB1 can reflect the activity of AS and be used as a laboratory indicator to reflect the therapeutic response. PMID:27800496

  6. Morphological and Stress Vulnerability Indices for Human Coronary Plaques and Their Correlations with Cap Thickness and Lipid Percent: An IVUS-Based Fluid-Structure Interaction Multi-patient Study

    PubMed Central

    Wang, Liang; Zheng, Jie; Maehara, Akiko; Yang, Chun; Billiar, Kristen L.; Wu, Zheyang; Bach, Richard; Muccigrosso, David; Mintz, Gary S.; Tang, Dalin

    2015-01-01

    Plaque vulnerability, defined as the likelihood that a plaque would rupture, is difficult to quantify due to lack of in vivo plaque rupture data. Morphological and stress-based plaque vulnerability indices were introduced as alternatives to obtain quantitative vulnerability assessment. Correlations between these indices and key plaque features were investigated. In vivo intravascular ultrasound (IVUS) data were acquired from 14 patients and IVUS-based 3D fluid-structure interaction (FSI) coronary plaque models with cyclic bending were constructed to obtain plaque wall stress/strain and flow shear stress for analysis. For the 617 slices from the 14 patients, lipid percentage, min cap thickness, critical plaque wall stress (CPWS), strain (CPWSn) and flow shear stress (CFSS) were recorded, and cap index, lipid index and morphological index were assigned to each slice using methods consistent with American Heart Association (AHA) plaque classification schemes. A stress index was introduced based on CPWS. Linear Mixed-Effects (LME) models were used to analyze the correlations between the mechanical and morphological indices and key morphological factors associated with plaque rupture. Our results indicated that for all 617 slices, CPWS correlated with min cap thickness, cap index, morphological index with r = -0.6414, 0.7852, and 0.7411 respectively (p<0.0001). The correlation between CPWS and lipid percentage, lipid index were weaker (r = 0.2445, r = 0.2338, p<0.0001). Stress index correlated with cap index, lipid index, morphological index positively with r = 0.8185, 0.3067, and 0.7715, respectively, all with p<0.0001. For all 617 slices, the stress index has 66.77% agreement with morphological index. Morphological and stress indices may serve as quantitative plaque vulnerability assessment supported by their strong correlations with morphological features associated with plaque rupture. Differences between the two indices may lead to better plaque assessment schemes

  7. [Experience of surgical care administration to patients with closed abdominal trauma, serving on the ships of the Navy].

    PubMed

    Pleskach, V V; Mosyagin, I G

    2016-02-01

    The analysis of surgical care administration to personnel, serving on ships of the Navy of Russia and performing different tasks in off-shore maritime and ocean zones in 2012-2013 showed that there is a requirement to create seven additional ship groups of specialized medical care: on the Northern Fleet--2, on the Pacific Fleet--2, on the Baltic Fleet--1, on the Black Sea Fleet--1, on the Caspian Flotilla--1. There is also a reasonable requirement to include anaesthesiologist and nurse anaesthetist into these groups. PMID:27263212

  8. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... qualifies for a payment adjustment include the number of beds, the number of patient days, and the hospital...) For purposes of this section, the number of patient days in a hospital includes only those days... consecutive days. (iii) The hospital's location, in an urban or rural area, is determined in accordance...

  9. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... qualifies for a payment adjustment include the number of beds, the number of patient days, and the hospital...) For purposes of this section, the number of patient days in a hospital includes only those days... within 24 hours for 30 consecutive days. (iii) The hospital's location, in an urban or rural area,...

  10. Cognitive Vulnerability in Patients with Generalized Anxiety Disorder, Dysthymic Disorder and Normal Individuals

    PubMed Central

    Al-Ghorabaie, Fateme Moin; Noferesti, Azam; Fadaee, Mahdi; Ganji, Nima

    2016-01-01

    Aim: The purpose of this study was to assess cognitive vulnerability and response style in clinical and normal individuals. Method: A sample of 90 individuals was selected for each of the 3 groups of Generalized Anxiety disorder, Dysthymic disorder and normal individuals. They completed MCQ and RSQ. Results: Results analyzed by MANOVA and post hoc showed significant differences among groups. Dysthymic group and GAD reported higher scores on cognitive confidence compared to the normal group. Individuals with GAD showed highly negative beliefs about need to control thought, compared to the other groups, but in cognitive self-consciousness they have no differences with the normal group. In regard to uncontrollability, danger and positive beliefs, GAD group had higher levels than the other groups. Although normal and GAD group didn’t show any significant differences in response style, there was a significant difference between Dysthymic group and other groups in all response styles. Discussion: Beliefs and meta-cognitive strategies can be distinguished between clinical and non clinical individuals. Also, findings support the Self-Regulatory Executive Function model. PMID:27045393

  11. Consenting of the vulnerable: the informed consent procedure in advanced cancer patients in Mexico

    PubMed Central

    Verástegui, Emma L

    2006-01-01

    Background A topic of great concern in bioethics is the medical research conducted in poor countries sponsored by wealthy nations. Western drug companies increasingly view Latin America as a proper place for clinical research trials. The region combines a large population, modern medical facilities, and low per capita incomes. Participants from developing countries may have little or non alternative means of treatment other than that offered through clinical trials. Therefore, the provision of a valid informed consent is important. Methods To gain insight about some aspects of the informed consent procedure in a major cancer centre in Mexico, we conducted a three-step evaluation process: 1) a ten point multiple choice survey questionnaires, was used to explore some aspects of the patients' experiences during the informed consent process, 2) researchers' knowledge about specific aspects of the informed consent was evaluated in this study using survey questionnaires; and 3) the comprehensibility, readability and number of pages of the consent forms were analysed. The socioeconomic and educational level of the patients, were also considered. Results were reported using a numerical scale. Results Thirty five patients, 20 doctors, and 10 individuals working at the hospital agreed to participate in the study. Eighty three percent of the patients in the study were classified as living in poverty; education level was poor or non existent, and 31% of the patients were illiterate. The consent forms were difficult to understand according to 49% of the patients, most doctors agreed that the forms were not comprehensible to the patients. The average length of the IC documents analysed was 14 pages, and the readability average score was equivalent to 8TH Grade. Conclusion The results presented in this work describe some relevant characteristics of the population seen at public health care institutions in Mexico. Poverty, limited or no education, and the complexity of the

  12. A Highly Expressed Human Protein, Apolipoprotein B-100, Serves as an Autoantigen in a Subgroup of Patients With Lyme Disease.

    PubMed

    Crowley, Jameson T; Drouin, Elise E; Pianta, Annalisa; Strle, Klemen; Wang, Qi; Costello, Catherine E; Steere, Allen C

    2015-12-01

    To discover novel autoantigens associated with Lyme arthritis (LA), we identified T-cell epitopes presented in vivo by human leukocyte antigen (HLA)-DR molecules in patients' inflamed synovial tissue or joint fluid and tested each epitope for autoreactivity. Using this approach, we identified the highly expressed human protein, apolipoprotein B-100 (apoB-100), as a target of T- and B-cell responses in a subgroup of LA patients. Additionally, the joint fluid of these patients had markedly elevated levels of apoB-100 protein, which may contribute to its autoantigenicity. In patients with antibiotic-refractory LA, the magnitude of apoB-100 antibody responses correlated with increased numbers of plasma cells in synovial tissue, greater numbers and activation of endothelial cells, and more synovial fibroblast proliferation. Thus, a subset of LA patients have high levels of apoB-100 in their joints and autoreactive T- and B-cell responses to the protein, which likely contributes to pathogenic autoimmunity in patients with antibiotic-refractory LA.

  13. Vulnerability of the Vulnerability Thesis.

    ERIC Educational Resources Information Center

    Lutz, Frank W.

    1996-01-01

    Reexamines Callahan's book, "Education and the Cult of Efficiency" (1962), and his vulnerability thesis regarding school superintendents, discussing recommendations it made and highlighting public education in the 1990s. Callahan's recommendations were well-received but not well-heeded, and the vulnerability thesis did not provide the stimulus for…

  14. Integrated Patient-Derived Models Delineate Individualized Therapeutic Vulnerabilities of Pancreatic Cancer.

    PubMed

    Witkiewicz, Agnieszka K; Balaji, Uthra; Eslinger, Cody; McMillan, Elizabeth; Conway, William; Posner, Bruce; Mills, Gordon B; O'Reilly, Eileen M; Knudsen, Erik S

    2016-08-16

    Pancreatic ductal adenocarcinoma (PDAC) harbors the worst prognosis of any common solid tumor, and multiple failed clinical trials indicate therapeutic recalcitrance. Here, we use exome sequencing of patient tumors and find multiple conserved genetic alterations. However, the majority of tumors exhibit no clearly defined therapeutic target. High-throughput drug screens using patient-derived cell lines found rare examples of sensitivity to monotherapy, with most models requiring combination therapy. Using PDX models, we confirmed the effectiveness and selectivity of the identified treatment responses. Out of more than 500 single and combination drug regimens tested, no single treatment was effective for the majority of PDAC tumors, and each case had unique sensitivity profiles that could not be predicted using genetic analyses. These data indicate a shortcoming of reliance on genetic analysis to predict efficacy of currently available agents against PDAC and suggest that sensitivity profiling of patient-derived models could inform personalized therapy design for PDAC. PMID:27498862

  15. [Improved hospital care for elderly patients: guidance on vulnerability and goal assessment].

    PubMed

    Schoon, Yvonne; van Iersel, Marianne B; Jacobsen, Didy E; Smit, Jan W A; de Boer, Menko-Jan; Olde Rikkert, Marcel G M

    2013-01-01

    Hospital care is highly disease-focused, tending towards further specialisation, and largely driven by technological innovations. Frail elderly, however, are an important and rapidly growing group of patients that is not best cared for in such a clinical environment. Case histories and the description of outcomes of an innovative programme called 'CareWell Primary Care' reveal that triage based on frailty and a global geriatric assessment of frail patients which is linked to goal-oriented hospital care and shared decision-making are the cornerstones of much needed improvement in delivering effective, safe, and sustainable hospital care to our ageing population. PMID:23965244

  16. Guidelines for Libraries Serving Hospital Patients and Disabled People in the Community. IFLA Professional Reports, No. 2.

    ERIC Educational Resources Information Center

    International Federation of Library Associations, The Hague (Netherlands).

    These guidelines are based on the experiences of a number of librarians working in the area of library services for hospital patients and disabled people in the community, as well as work done previously by a number of national library associations. The guidelines indicate the essential features of services to disabled people and suggest…

  17. How practice contributes to trolley food waste. A qualitative study among staff involved in serving meals to hospital patients.

    PubMed

    Ofei, K T; Holst, M; Rasmussen, H H; Mikkelsen, B E

    2014-12-01

    This study investigated the generation of trolley food waste at the ward level in a hospital in order to provide recommendations for how practice could be changed to reduce food waste. Three separate focus group discussions were held with four nurses, four dietitians and four service assistants engaged in food service. Furthermore, single qualitative interviews were conducted with a nurse, a dietitian and two service assistants. Observations of procedures around trolley food serving were carried out during lunch and supper for a total of 10 weekdays in two different wards. All unserved food items discarded as waste were weighed after each service. Analysis of interview and observation data revealed five key themes. The findings indicate that trolley food waste generation is a practice embedded within the limitations related to the procedures of meal ordering. This includes portion size choices and delivery, communication, tools for menu information, portioning and monitoring of food waste, as well as the use of unserved food. Considering positive changes to these can be a way forward to develop strategies to reduce trolley food waste at the ward level.

  18. Vulnerable Plaque

    MedlinePlus

    ... all vulnerable plaque ruptures, and researchers at the Texas Heart Institute are looking at ways to determine ... comments. Terms of Use and Privacy Policy © Copyright Texas Heart Institute All rights reserved.

  19. Assessing long-term health and cost outcomes of patient-centered medical homes serving adults with poor diabetes control.

    PubMed

    Pagán, José A; Carlson, Erin K

    2013-10-01

    The patient-centered medical home (PCMH) is an integrated primary care delivery model particularly suited for patients with poor diabetes control. Although PCMH models targeting adults with diabetes have shown some early success, little is known about the long-term benefits of medical homes in terms of health and cost outcomes. The performance of a PCMH model in adults with poor diabetes control was assessed using simulated controlled trial data obtained from the Archimedes model of disease progression and health care utilization. Using the Cardio-Metabolic Risk data set, we compared health and cost outcomes over a 20-year period between adults with poor diabetes control (HbA1c >9%) receiving standard care and these same adults receiving care under a PCMH model with a 49% HbA1c intervention improvement rate at a per-beneficiary per-month care management cost of $20 per month. The results suggest that the PCMH model has the potential to not only reduce the proportion of the population with bilateral blindness, foot amputations, and myocardial infarctions-and the mortality rate-but it can also do so in a cost-effective manner ($7898 per quality-adjusted life year). The PCMH model is cost saving for the population 50 to 64 years old and it is particularly cost-effective for men ($883 per quality-adjusted life year). Moreover, these effects are relatively large for adults 30 to 49 years old (lower bilateral blindness and death rates), women (lower foot amputation and death rates), and men (lower bilateral blindness and myocardial infarction rates). The PCMH model has potential long-term benefits to both patients with poor diabetes control as well as health care systems and providers willing to invest in this health care delivery approach. PMID:23799676

  20. Can hydroxyurea serve as a free radical scavenger and reduce iron overload in β-thalassemia patients?

    PubMed

    Italia, Khushnooma; Chandrakala, S; Ghosh, Kanjaksha; Colah, Roshan

    2016-09-01

    In this study, we hypothesize that hydroxyurea could provide an additional benefit as a free radical scavenger and/or iron chelator in β-thalassemia patients with iron overload. Twenty-one β-thalassemia intermedia patients who presented between 3 and 17 years but later required regular blood transfusions were enrolled for hydroxyurea therapy for a year. Fourteen patients responded to the therapy with hemoglobin levels maintained above 7.5 g/dl without transfusions. Hydroxyurea was discontinued after 6 months in seven patients who did not respond to the therapy and had to be continued on regular blood transfusions. We observed a statistically significant decrease in serum ferritin levels from 4194 ± 4850 ng/ml to 2129 ± 2380 ng/ml among the responders and from 2955 ± 2909 ng/ml to 2040 ± 2432 ng/ml among the non-responders and statistically significant decrease in labile iron pool from 18678.7 ± 10067.4 mean fluorescence intensity (MFI) to 14888.5 ± 5284.0 MFI among responders and from 17986.3 ± 9079.8 MFI to 15634.8 ± 8976.9 MFI among the non-responders after therapy. Phosphatidylserine externalization also showed a statistically significant decrease from 44.2 ± 22.2 MFI to 16.6 ± 6.7 MFI among the responders and from 46.9 ± 33.1 MFI to 39.8 ± 7.4 MFI among the non-responders along with a statistically significant decrease in the levels of reactive oxygen species from 72.8 ± 35.5 MFI to 29.0 ± 8.3 MFI among the responders and from 80.9 ± 41.4 MFI to 40.5 ± 15.8 MFI among the non-responders after therapy. A statistically significant increase in reduced glutathione levels was also observed from 430.8 ± 201.1 MFI to 715.5 ± 292.4 MFI among the responders and from 359.6 ± 165.6 MFI to 450.3 ± 279.5 MFI among the non-responders after therapy. This suggests the possible additional role of hydroxyurea as a free radical scavenger and

  1. Executive (Dys)Functioning and Impulsivity as Possible Vulnerability Factors for Aggression in Forensic Patients.

    PubMed

    Tonnaer, Franca; Cima, Maaike; Arntz, Arnoud

    2016-04-01

    This study investigated whether executive dysfunction and impulsivity are both predictors of reactive aggression and is the first to use behavioral assessment of aggression in response to provocation by means of a personalized boxing body opponent bag giving harassing feedback. Aggressive behavior, self-reported aggression, executive functioning (ie, working memory, flexibility, and divided attention), and impulsivity dimensions (i.e., Sensation Seeking, Impulsive Decision Making, and [inadequate] Response Inhibition) were measured in 44 incarcerated psychiatric patients. Results show that both executive functioning (working memory) and impulsivity (Impulsive Decision Making) predicted self-reported reactive aggression, whereas Response Inhibition was the only predictor for reactive aggressive behavioral responses. The study suggests that Response Inhibition is a stronger predictor of reactive aggressive behavior than executive capacities of working memory, flexibility, and divided attention. Therefore, future research should investigate whether (inadequate) Response Inhibition could also be a valuable predictor for violent recidivism. PMID:26894312

  2. Effects of Self-Management Support on Structure, Process, and Outcomes Among Vulnerable Patients With Diabetes

    PubMed Central

    Schillinger, Dean; Handley, Margaret; Wang, Frances; Hammer, Hali

    2009-01-01

    OBJECTIVE Despite the importance of self-management support (SMS), few studies have compared SMS interventions, involved diverse populations, or entailed implementation in safety net settings. We examined the effects of two SMS strategies across outcomes corresponding to the Chronic Care Model. RESEARCH DESIGN AND METHODS A total of 339 outpatients with poorly controlled diabetes from county-run clinics were enrolled in a three-arm trial. Participants, more than half of whom spoke limited English, were uninsured, and/or had less than a high school education, were randomly assigned to usual care, interactive weekly automated telephone self-management support with nurse follow-up (ATSM), or monthly group medical visits with physician and health educator facilitation (GMV). We measured 1-year changes in structure (Patient Assessment of Chronic Illness Care [PACIC]), communication processes (Interpersonal Processes of Care [IPC]), and outcomes (behavioral, functional, and metabolic). RESULTS Compared with the usual care group, the ATSM and GMV groups showed improvements in PACIC, with effect sizes of 0.48 and 0.50, respectively (P < 0.01). Only the ATSM group showed improvements in IPC (effect sizes 0.40 vs. usual care and 0.25 vs. GMV, P < 0.05). Both SMS arms showed improvements in self-management behavior versus the usual care arm (P < 0.05), with gains being greater for the ATSM group than for the GMV group (effect size 0.27, P = 0.02). The ATSM group had fewer bed days per month than the usual care group (−1.7 days, P = 0.05) and the GMV group (−2.3 days, P < 0.01) and less interference with daily activities than the usual care group (odds ratio 0.37, P = 0.02). We observed no differences in A1C change. CONCLUSIONS Patient-centered SMS improves certain aspects of diabetes care and positively influences self-management behavior. ATSM seems to be a more effective communication vehicle than GMV in improving behavior and quality of life. PMID:19131469

  3. Pain Treatment and Antiretroviral Medication Adherence Among Vulnerable HIV-Positive Patients

    PubMed Central

    Kurtz, Steven P.; Levi-Minzi, Maria A.; Cicero, Theodore J.; Tsuyuki, Kiyomi; O'Grady, Catherine L.

    2015-01-01

    Abstract Pain represents a significant source of morbidity, function loss, and decreased quality of life among people living with HIV. The present study examined the associations among pain, pain treatment, and ARV adherence among indigent, HIV-positive substance abusers. Participants were recruited via targeted sampling strategies, and completed a one-time computer-assisted personal interview. ANOVA and chi-square tests were used to analyze differences in demographics, health and psychological status, health behaviors, by pain and pain treatment status; a multivariate logistic regression model was constructed to examine the contribution of pain/treatment status to recent ARV adherence. Results indicated that those with untreated pain had lower odds of achieving gold-standard 95% ARV adherence as compared to the pain-free and treated pain groups; higher substance dependence symptoms were also associated with significantly lower odds of 95% ARV adherence. Findings suggest that pain management is critical to the health of people living with HIV, specifically those with high levels of co-morbid health and psychological problems. The prevalence of untreated pain was elevated among this group, and contributed to reduced ARV adherence. Providers of clinical care to disadvantaged HIV-positive patients should emphasize routine assessment and appropriate treatment of pain in order to provide comprehensive HIV care. PMID:24984142

  4. Education of Advanced Practice Nurses Serving Vulnerable Populations.

    ERIC Educational Resources Information Center

    Vezeau, Toni M.; Peterson, Jane W.; Nakao, Constance; Ersek, Mary

    1998-01-01

    The master's of science in nursing curriculum at Seattle University leads to the designation Community Health Clinical Nurse Specialist. The School of Nursing's goal is to educate leaders in nursing who advocate for those least able to speak for themselves and least able to access resources available to the majority of people. (Author/JOW)

  5. Liver steatosis replaced with non-invasive viral and host parametars can serve as negative predictive model in patients with chronic hepatitis-C.

    PubMed

    Višnjić, Ana; Ostojić, Zvonimir; Hrstić, Irena; Corić, Marijana; Premuzić, Marina

    2014-09-01

    Almost 70% of chronic hepatitis C (CHC) patients will have concomitant hepatic steatosis (HS) usually determined with invasive method. HS serve as negative predictive factor for lower sustained viral response (SVR) in CHC patients treated with standard of care (SOC) (PEG-IFN and Rib). Retrospective analysis of biochemical, virological and histological data in CHC patients treated with PEG-IFN and Ribavarin. Statistical analysis was carried out by Biometriha Healthcare Research. Level of significance was set to 95% (p < 0.05). 72 patients (43 M; 29 F; median age 41 y) with CHC (60 G1; 12 G3) with no concomitant metabolic syndrome were analyzed. HS ranged from 5 to 30% (median 15%). Overall accuracy of prediction of SVR based on the levels of HS was AUC=0.71 (95% CI=0.58-0.84; p=0.005). When HS was split regarding cut-off value of 5% significant difference was found between responders and non-responders to treatment (chi2 = 10.025; df = 1; p = 0.002). Overall sensitivity was 48% and specificity 91%. Conventional predictive variables (gender, age, fibrosis and genotype) where combined with HS (>5%) and all together achieved Nagelherke R squared of 34.0% in prediction of SVR, with accuracy rate of 75.0%. Further, invasive variables (fibrosis and HS) where replaced with vire mia and body mass index (BMI). All noninvasive variables together achieved Nagelkerke R squared of 26.5% in prediction of SVR with 74% accuracy rate of the logistic regression model. Very low HS (<5%) is negative predictor of SVR and can be replaced with noninvasive variables (gender, age, viremia and BMI) with same accuracy rate of the logistic regres- sion model. PMID:25507366

  6. Elevated hemoglobin A1c Is Associated with Carotid Plaque Vulnerability: Novel Findings from Magnetic Resonance Imaging Study in Hypertensive Stroke Patients

    PubMed Central

    Sun, Beibei; Zhao, Huilin; Liu, Xiaosheng; Lu, Qing; Zhao, Xihai; Pu, Jun; Xu, Jianrong

    2016-01-01

    The association between hemoglobin A1c (HbA1c) level and carotid plaque vulnerability has been rarely studied by magnetic resonance imaging (MRI). The present study of MRI-identified carotid atherosclerotic lesions in hypertensive patients with acute stroke therefore sought to determine the associations between HbA1c level and plaque morphological and compositional characteristics and acute cerebral infarction (ACI) severity. Eighty hypertensive patients with acute stroke were enrolled; stratified into high (≥6.5%) and low (<6.5%) HbA1c groups; and underwent carotid and brain MRI to assess carotid plaque features and ACI volume in the region supplied by the internal carotid artery (ICA) in the symptomatic side. Plaque burden [percent wall volume (PWV), max wall thickness (max-WT)] and lipid-rich necrotic core (LRNC) were larger in the high as compared to the low HbA1c group. High HbA1c was an independent risk factor for the presence of plaque (odds ratio [OR] = 3.71) and LRNC plaque (OR = 7.08). HbA1c independently correlated with ACI severity among patients with ICA region cerebral infarction and carotid plaque. Our study suggested that an elevated HbA1c may have an adverse effect on carotid plaque vulnerability especially those with larger LRNC volumes in hypertensive stroke patients, which might exacerbate the severity of ACIs. PMID:27629481

  7. The importance of negative predictive value (NPV) of vulnerable elderly survey (VES 13) as a pre-screening test in older patients with cancer.

    PubMed

    Castagneto, B; Di Pietrantonj, C; Stevani, I; Anfossi, A; Arzese, M; Giorcelli, L; Giaretto, L

    2013-12-01

    The importance of prognostic value of the comprehensive geriatric assessment (CGA) is well known in geriatric oncology, but there is no consensus on the use of alternative abbreviated screening methods for the evaluation of older patient disabilities. The participants in this study underwent vulnerable elderly survey 13 (VES 13) at first entry in Oncology Department and were later assessed by a geriatrician according to CGA. A score >3 for VES 13 identified patients as vulnerable. Aim of this study was to evaluate the specificity, sensibility, positive predictive value (PPV), and negative predictive value (NPV) of VES 13 versus cumulative illness rating scale (CIRS), activities of daily living (ADL), instrumental activities of daily living (IADL), and short portable mental status questionnaire (SPMSQ). Hundred and seventeen patients (mean age 78.8 years) entered the study. The NPV of VES was 74.6% for CIRS, 90.1% for IADL, 93.0% for ADL, and 100% for SPMSQ. As for PPV, the VES 13 showed no accuracy. We can conclude that VES 13 demonstrated sufficient accuracy as a screening test in identifying elderly "fit" patients in order to spare the more time-consuming CGA.

  8. Elevated hemoglobin A1c Is Associated with Carotid Plaque Vulnerability: Novel Findings from Magnetic Resonance Imaging Study in Hypertensive Stroke Patients.

    PubMed

    Sun, Beibei; Zhao, Huilin; Liu, Xiaosheng; Lu, Qing; Zhao, Xihai; Pu, Jun; Xu, Jianrong

    2016-01-01

    The association between hemoglobin A1c (HbA1c) level and carotid plaque vulnerability has been rarely studied by magnetic resonance imaging (MRI). The present study of MRI-identified carotid atherosclerotic lesions in hypertensive patients with acute stroke therefore sought to determine the associations between HbA1c level and plaque morphological and compositional characteristics and acute cerebral infarction (ACI) severity. Eighty hypertensive patients with acute stroke were enrolled; stratified into high (≥6.5%) and low (<6.5%) HbA1c groups; and underwent carotid and brain MRI to assess carotid plaque features and ACI volume in the region supplied by the internal carotid artery (ICA) in the symptomatic side. Plaque burden [percent wall volume (PWV), max wall thickness (max-WT)] and lipid-rich necrotic core (LRNC) were larger in the high as compared to the low HbA1c group. High HbA1c was an independent risk factor for the presence of plaque (odds ratio [OR] = 3.71) and LRNC plaque (OR = 7.08). HbA1c independently correlated with ACI severity among patients with ICA region cerebral infarction and carotid plaque. Our study suggested that an elevated HbA1c may have an adverse effect on carotid plaque vulnerability especially those with larger LRNC volumes in hypertensive stroke patients, which might exacerbate the severity of ACIs. PMID:27629481

  9. A Helpful Serving

    ERIC Educational Resources Information Center

    Rockower, David

    2006-01-01

    This article briefly describes how a fifth-grade class collaborated with a downtown diner for several months and then actually ran the restaurant for four hours. Through the Chatters Cafe, a local high school cafe that serves as a culinary arts training ground for high school students, fifth graders had the opportunity to prepare and serve dinner…

  10. Serving the Undocumented

    ERIC Educational Resources Information Center

    Pluviose, David

    2007-01-01

    Undocumented immigrant students in California are eligible to receive only private scholarships that "[aren't] enough to support a very expensive education," says CCLC CEO Scott Lay. Dr. Gerardo E. de los Santos, CEO of the League for Innovation in the Community College, calls "serving the undocumented" one of the major challenges community…

  11. Electricity Serves Our Community.

    ERIC Educational Resources Information Center

    Rakow, Steven J., Ed.

    1992-01-01

    Features a color poster entitled "Electricity Serves Our Community" and describes how the poster can be used to help teach about energy, electricity concepts, and types of electrical generation. Explains how teachers can obtain other resources such as posters, lesson plans, and kits from the National Energy Foundation. (PR)

  12. Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups--another perspective on Oregon's data.

    PubMed

    Finlay, I G; George, R

    2011-03-01

    Battin et al examined data on deaths from physician-assisted suicide (PAS) in Oregon and on PAS and voluntary euthanasia (VE) in The Netherlands. This paper reviews the methodology used in their examination and questions the conclusions drawn from it-namely, that there is for the most part 'no evidence of heightened risk' to vulnerable people from the legalisation of PAS or VE. This critique focuses on the evidence about PAS in Oregon. It suggests that vulnerability to PAS cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. It also argues, on the basis of official reports from the Oregon Health Department on the working of the Oregon Death with Dignity Act since 2008, that, contrary to the conclusions drawn by Battin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et al reported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.

  13. Primary Care Provider Perceptions of the Effectiveness of Two Self-Management Support Programs for Vulnerable Patients with Diabetes

    PubMed Central

    Ratanawongsa, Neda; Bhandari, Vijay K; Handley, Margaret; Rundall, Thomas; Hammer, Hali; Schillinger, Dean

    2012-01-01

    Background Primary care providers (PCPs) in safety net settings face barriers to optimizing care for patients with diabetes. We conducted this study to assess PCPs' perspectives on the effectiveness of two language-concordant diabetes self-management support programs. Methods One year postintervention, we surveyed PCPs whose patients with diabetes participated in a three-arm multiclinic randomized controlled trial comparing usual care (UC), weekly automated telephone self-management (ATSM) support with nurse care management, and monthly group medical visits (GMVs). We compared PCP perspectives on patient activation to create and achieve goals, quality of care, and barriers to care using regression models accounting for within-PCP clustering. Results Of 113 eligible PCPs caring for 330 enrolled patients, 87 PCPs (77%) responded to surveys about 245 (74%) enrolled patients. Intervention patients were more likely to be perceived by PCPs as activated to create and achieve goals for chronic care when compared with UC patients (standardized effect size, ATSM vs UC, +0.41, p = 0.01; GMV vs UC, +0.31, p = 0.05). Primary care providers rated quality of care as higher for patients exposed to ATSM compared to UC (odds ratio 3.6, p < 0.01). Compared with GMV patients, ATSM patients were more likely to be perceived by PCPs as overcoming barriers related to limited English proficiency (82% ATSM vs 44% GMV, p = 0.01) and managing medications (80% ATSM vs 53% GMV, p = 0.01). Conclusions Primary care providers perceived that patients receiving ATSM support had overcome barriers, participated more actively, and received higher quality diabetes care. These views of clinician stakeholders lend additional evidence for the potential to upscale ATSM more broadly to support PCPs in their care of diverse, multilinguistic populations. PMID:22401329

  14. HIV-AIDS Patients' Evaluation of Health Information on the Internet: The Digital Divide and Vulnerability to Fraudulent Claims

    ERIC Educational Resources Information Center

    Benotsch, Eric G.; Kalichman, Seth; Weinhardt, Lance S.

    2004-01-01

    Access to health information on the Internet has revolutionized how medical patients learn about their illnesses. Valuable information can be found online; however, many health Web sites contain inaccurate or misleading information. The authors surveyed 324 adults with HIV concerning their Internet use for obtaining health information. Health…

  15. Software Vulnerability Taxonomy Consolidation

    SciTech Connect

    Polepeddi, Sriram S.

    2004-12-07

    In today's environment, computers and networks are increasing exposed to a number of software vulnerabilities. Information about these vulnerabilities is collected and disseminated via various large publicly available databases such as BugTraq, OSVDB and ICAT. Each of these databases, individually, do not cover all aspects of a vulnerability and lack a standard format among them, making it difficult for end-users to easily compare various vulnerabilities. A central database of vulnerabilities has not been available until today for a number of reasons, such as the non-uniform methods by which current vulnerability database providers receive information, disagreement over which features of a particular vulnerability are important and how best to present them, and the non-utility of the information presented in many databases. The goal of this software vulnerability taxonomy consolidation project is to address the need for a universally accepted vulnerability taxonomy that classifies vulnerabilities in an unambiguous manner. A consolidated vulnerability database (CVDB) was implemented that coalesces and organizes vulnerability data from disparate data sources. Based on the work done in this paper, there is strong evidence that a consolidated taxonomy encompassing and organizing all relevant data can be achieved. However, three primary obstacles remain: lack of referencing a common ''primary key'', un-structured and free-form descriptions of necessary vulnerability data, and lack of data on all aspects of a vulnerability. This work has only considered data that can be unambiguously extracted from various data sources by straightforward parsers. It is felt that even with the use of more advanced, information mining tools, which can wade through the sea of unstructured vulnerability data, this current integration methodology would still provide repeatable, unambiguous, and exhaustive results. Though the goal of coalescing all available data, which would be of use to

  16. Identifying vulnerable patients: role of the EAT-10 and the multidisciplinary team for early intervention and comprehensive dysphagia care.

    PubMed

    Kaspar, Kala; Ekberg, Olle

    2012-01-01

    There is underdiagnosis and low awareness of dysphagia despite that the condition is modifiable and poorly managed symptoms diminish psychological well-being and overall quality of life. Frontline clinicians are in a unique position to be alert to the high prevalence of swallowing difficulty among elderly, evaluate and identify those who need intervention, and assure that individuals receive appropriate care. Proper diagnosis and treatment of oral-pharyngeal dysphagia involves a multidisciplinary healthcare team effort and starts with systematic screening of at-risk patients. The presence of a medical condition such as acute stroke, head and neck cancer, head trauma, Alzheimer's disease, Parkinson's disease, pneumonia or bronchitis is adequate basis for predicting high risk. Systematic screening of dysphagia and resulting malnutrition among at-risk older adults is justified in an effort to avoid pneumonia and is recommended by clinical practice guidelines. Systematic screening with a validated method (e.g. the 10-item Eating Assessment Tool, EAT-10) as part of a comprehensive care protocol enables multidisciplinary teams to more effectively manage the condition, reduce the economic and societal burden, and improve patient quality of life. In fact, care settings with a systematic dysphagia screening program attain significantly better patient outcomes including reduced cases of pneumonia (by 55%) and reduced hospital length of stay.

  17. Selected Cytokines Serve as Potential Biomarkers for Predicting Liver Inflammation and Fibrosis in Chronic Hepatitis B Patients With Normal to Mildly Elevated Aminotransferases

    PubMed Central

    Deng, Yong-Qiong; Zhao, Hong; Ma, An-Lin; Zhou, Ji-Yuan; Xie, Shi-Bin; Zhang, Xu-Qing; Zhang, Da-Zhi; Xie, Qing; Zhang, Guo; Shang, Jia; Cheng, Jun; Zhao, Wei-Feng; Zou, Zhi-Qiang; Zhang, Ming-Xiang; Wang, Gui-Qiang

    2015-01-01

    Abstract Previous studies of small cohorts have implicated several circulating cytokines with progression of chronic hepatitis B (CHB). However, to date there have been no reliable biomarkers for assessing histological liver damage in CHB patients with normal or mildly elevated alanine aminotransferase (ALT). The aim of the present study was to investigate the association between circulating cytokines and histological liver damage in a large cohort. Also, this study was designed to assess the utility of circulating cytokines in diagnosing liver inflammation and fibrosis in CHB patients with ALT less than 2 times the upper limit of normal range (ULN). A total of 227 CHB patients were prospectively enrolled. All patients underwent liver biopsy and staging by Ishak system. Patients with at least moderate inflammation showed significantly higher levels of CXCL-11, CXCL-10, and interleukin (IL)-2 receptor (R) than patients with less than moderate inflammation (P < 0.001). Patients with significant fibrosis had higher levels of IL-8 (P = 0.027), transforming growth factor alpha (TGF-α) (P = 0.011), IL-2R (P = 0.002), and CXCL-11 (P = 0.032) than the group without significant fibrosis. In addition, 31.8% and 29.1% of 151 patients with ALT < 2 × ULN had at least moderate inflammation and significant fibrosis, respectively. Multivariate analysis demonstrated that CXCL-11 was independently associated with at least moderate inflammation, and TGF-α and IL-2R independently correlated with significant fibrosis in patients with ALT < 2 × ULN. Based on certain cytokines and clinical parameters, an inflammation-index and fib-index were developed, which showed areas under the receiver operating characteristics curve (AUROC) of 0.75 (95% CI 0.66–0.84) for at least moderate inflammation and 0.82 (95% CI 0.75–0.90) for significant fibrosis, correspondingly. Compared to existing scores, fib-index was significantly superior to aspartate

  18. Selected Cytokines Serve as Potential Biomarkers for Predicting Liver Inflammation and Fibrosis in Chronic Hepatitis B Patients With Normal to Mildly Elevated Aminotransferases.

    PubMed

    Deng, Yong-Qiong; Zhao, Hong; Ma, An-Lin; Zhou, Ji-Yuan; Xie, Shi-Bin; Zhang, Xu-Qing; Zhang, Da-Zhi; Xie, Qing; Zhang, Guo; Shang, Jia; Cheng, Jun; Zhao, Wei-Feng; Zou, Zhi-Qiang; Zhang, Ming-Xiang; Wang, Gui-Qiang

    2015-11-01

    Previous studies of small cohorts have implicated several circulating cytokines with progression of chronic hepatitis B (CHB). However, to date there have been no reliable biomarkers for assessing histological liver damage in CHB patients with normal or mildly elevated alanine aminotransferase (ALT). The aim of the present study was to investigate the association between circulating cytokines and histological liver damage in a large cohort. Also, this study was designed to assess the utility of circulating cytokines in diagnosing liver inflammation and fibrosis in CHB patients with ALT less than 2 times the upper limit of normal range (ULN). A total of 227 CHB patients were prospectively enrolled. All patients underwent liver biopsy and staging by Ishak system. Patients with at least moderate inflammation showed significantly higher levels of CXCL-11, CXCL-10, and interleukin (IL)-2 receptor (R) than patients with less than moderate inflammation (P < 0.001). Patients with significant fibrosis had higher levels of IL-8 (P = 0.027), transforming growth factor alpha (TGF-α) (P = 0.011), IL-2R (P = 0.002), and CXCL-11 (P = 0.032) than the group without significant fibrosis. In addition, 31.8% and 29.1% of 151 patients with ALT < 2 × ULN had at least moderate inflammation and significant fibrosis, respectively. Multivariate analysis demonstrated that CXCL-11 was independently associated with at least moderate inflammation, and TGF-α and IL-2R independently correlated with significant fibrosis in patients with ALT < 2 × ULN. Based on certain cytokines and clinical parameters, an inflammation-index and fib-index were developed, which showed areas under the receiver operating characteristics curve (AUROC) of 0.75 (95% CI 0.66-0.84) for at least moderate inflammation and 0.82 (95% CI 0.75-0.90) for significant fibrosis, correspondingly. Compared to existing scores, fib-index was significantly superior to aspartate aminotransferase

  19. Depression and anxiety in patients with and without same-sex attraction: differences in clinical expression, lifestyle factors, and vulnerability indicators

    PubMed Central

    Bos, Henny M W; Boschloo, Lynn; Schoevers, Robert A; Sandfort, Theo G M

    2015-01-01

    Background The aim of this study was to compare clinical expressions (severity and loneliness), lifestyle factors (substance use), and vulnerability indicators (stressful childhood experiences) in patients with any same-sex attraction versus heterosexual patients diagnosed with depression and/or anxiety disorder. Little is known about this, even though it is now well documented that depression and anxiety are more prevalent among persons with same-sex attraction. Method Data, derived from the Netherlands Study of Depression and Anxiety (NESDA), allowed us to compare patients with a same-sex (n = 122) and an exclusively opposite-sex (n = 1658) attraction. Persons with same-sex attraction included persons who were attracted to both sexes. Data were collected by means of the Composite International Diagnostic Interview and paper-and pencil questionnaires. Results Seven percent of the patients reported any same-sex orientation. Clinical expression of depression and anxiety did not differ in relation to sexual attraction. Regarding substance use, same-sex attracted women reported more drug use than heterosexual women (drug use: 16.2% vs. 6.6%, P = 0.003). Regarding stressful childhood experiences, men with any same-sex attraction reported more sexual abuse during childhood than men with a heterosexual orientation (20.4% vs. 8.5%, P = 0.005). Conclusions For women with same-sex attraction substance use (especially illicit drug use) might be a coping mechanism to deal with existing symptoms or with the minority stressors they have to deal with; for same-sex attracted men stressful childhood experiences might reflect an aspect of etiology. PMID:26445702

  20. Modeling Coastal Vulnerability through Space and Time

    PubMed Central

    2016-01-01

    Coastal ecosystems experience a wide range of stressors including wave forces, storm surge, sea-level rise, and anthropogenic modification and are thus vulnerable to erosion. Urban coastal ecosystems are especially important due to the large populations these limited ecosystems serve. However, few studies have addressed the issue of urban coastal vulnerability at the landscape scale with spatial data that are finely resolved. The purpose of this study was to model and map coastal vulnerability and the role of natural habitats in reducing vulnerability in Jamaica Bay, New York, in terms of nine coastal vulnerability metrics (relief, wave exposure, geomorphology, natural habitats, exposure, exposure with no habitat, habitat role, erodible shoreline, and surge) under past (1609), current (2015), and future (2080) scenarios using InVEST 3.2.0. We analyzed vulnerability results both spatially and across all time periods, by stakeholder (ownership) and by distance to damage from Hurricane Sandy. We found significant differences in vulnerability metrics between past, current and future scenarios for all nine metrics except relief and wave exposure. The marsh islands in the center of the bay are currently vulnerable. In the future, these islands will likely be inundated, placing additional areas of the shoreline increasingly at risk. Significant differences in vulnerability exist between stakeholders; the Breezy Point Cooperative and Gateway National Recreation Area had the largest erodible shoreline segments. Significant correlations exist for all vulnerability (exposure/surge) and storm damage combinations except for exposure and distance to artificial debris. Coastal protective features, ranging from storm surge barriers and levees to natural features (e.g. wetlands), have been promoted to decrease future flood risk to communities in coastal areas around the world. Our methods of combining coastal vulnerability results with additional data and across multiple time

  1. Usefulness of High-Sensitive Troponin Elevation After Effort Stress to Unveil Vulnerable Myocardium in Patients With Heart Failure.

    PubMed

    Pastormerlo, Luigi Emilio; Agazio, Assunta; Benelli, Eleonora; Gabutti, Alessandra; Poletti, Roberta; Prontera, Concetta; Clerico, Aldo; Emdin, Michele; Passino, Claudio

    2015-08-15

    Elevation of resting high-sensitivity troponin (hs-Tn) holds prognostic value in heart failure (HF), but its pathophysiological meaning is unclear. We aimed to investigate hs-Tn elevation after maximal exercise in patients with systolic HF and its neurohormonal and hemodynamic correlates: 30 patients diagnosed with systolic HF (left ventricular ejection fraction 32 ± 8%, mean ± SD), on guideline-directed medical therapy and not recognized inducible ischemia, underwent maximal cardiopulmonary stress test, with assay of plasma N-terminal proB-type natriuretic peptide (NT-proBNP), norepinephrine (NE), and hs-TnT (hs-TnT) at baseline, peak, and 1 and 4 hours after exercise. Cardiac output (CO) was measured during effort, with a rebreathing technique. The natural logarithm of the ratio between percentage (%) increase in CO and NT-proBNP (ln[CO%/NT-proBNP% increase]) was evaluated, as a noninvasive estimate of Frank-Starling adaptation to effort, with NT-proBNP variation considered as a surrogate of end-diastolic left ventricular pressure variation. Hs-TnT increased during exercise with a 4-hour peak (p = 0.001); 10 patients had hs-TnT increase >20%. Patients with Hs-TnT increase >20% were more symptomatic at rest (p = 0.039) and showed greater NE at peak exercise (p = 0.003) and less ln[CO%/NT-proBNP% increase] (p = 0.034). A lower ln[CO%/NT-proBNP% increase] correlated with greater NE at peak exercise (r = -0.430, p = 0.018). In conclusion, acute troponin elevation after maximal exercise was detected in 1/3 of this series. The association of troponin release with NE, CO, and NT-proBNP changes after effort suggests a pathophysiological link among transient hemodynamic overload, adrenergic activation, and myocardial cell damage, likely identifying a clinical subset at greater risk for HF progression. PMID:26089013

  2. What Does Vulnerability Mean?

    ERIC Educational Resources Information Center

    Parley, Fiona F

    2011-01-01

    Protection of those deemed vulnerable has received increasing attention since 2000. This article reports on care staff views of vulnerability using original data from a research study (Parley. "Vulnerability and abuse: an exploration of views of care staff working with people who have learning disabilities," PhD Thesis, 2007) in which care staff…

  3. Meeting the needs of vulnerable patients: The need for team working across general practice and community nursing services.

    PubMed

    Bliss, Julie; While, Alison E

    2014-01-01

    General practitioners and district nurses have a long history of providing care outside the hospital setting. With health care increasingly moving out of the hospital setting, there are more opportunities for general practitioners and district nurses to work together to meet the health needs of the local population. However, the reduction in qualified specialist practitioner district nurses over the last decade is concerning. The need for an effective district nursing service has been recognised by the Department of Health in their own model - the nature of district nursing work, often over a long period, enables relationships to develop with the patient, family and informal carers as a basis for anticipatory care to manage long-term conditions. Communication and understanding of the role are central to enhance effective working between general practitioners and district nurses, which can be fostered by engagement in community-oriented integrated care and case management.

  4. Meeting the needs of vulnerable patients: The need for team working across general practice and community nursing services

    PubMed Central

    While, Alison E

    2014-01-01

    General practitioners and district nurses have a long history of providing care outside the hospital setting. With health care increasingly moving out of the hospital setting, there are more opportunities for general practitioners and district nurses to work together to meet the health needs of the local population. However, the reduction in qualified specialist practitioner district nurses over the last decade is concerning. The need for an effective district nursing service has been recognised by the Department of Health in their own model – the nature of district nursing work, often over a long period, enables relationships to develop with the patient, family and informal carers as a basis for anticipatory care to manage long-term conditions. Communication and understanding of the role are central to enhance effective working between general practitioners and district nurses, which can be fostered by engagement in community-oriented integrated care and case management. PMID:25949736

  5. Mitochondrial Vulnerability and Increased Susceptibility to Nutrient-Induced Cytotoxicity in Fibroblasts from Leigh Syndrome French Canadian Patients

    PubMed Central

    Burelle, Yan; Thompson Legault, Julie; Boucher, Gabrielle; Morin, Charles; Coderre, Lise; Des Rosiers, Christine

    2015-01-01

    nature of the diets, particularly excess fat intake, as well as on the use of antioxidants in patients with LSFC and, possibly, other COX defects. PMID:25835550

  6. Variation in resistance traits, phylogenetic backgrounds, and virulence genotypes among Escherichia coli clinical isolates from adjacent hospital campuses serving distinct patient populations.

    PubMed

    Drawz, Sarah M; Porter, Stephen; Kuskowski, Michael A; Johnston, Brian; Clabots, Connie; Kline, Susan; Ferrieri, Patricia; Johnson, James R

    2015-09-01

    Escherichia coli sequence type 13 (ST131), an emergent cause of multidrug-resistant extraintestinal infections, has important phylogenetic subsets, notably the H30 and H30Rx subclones, with distinctive resistance profiles and, possibly, clinical associations. To clarify the local prevalence of these ST131 subclones and their associations with antimicrobial resistance, ecological source, and virulence traits, we extensively characterized 233 consecutive E. coli clinical isolates (July and August 2013) from the University of Minnesota Medical Center-Fairview Infectious Diseases and Diagnostic Laboratory, Minneapolis, MN, which serves three adjacent facilities (a children's hospital and low- and high-acuity adult facilities). ST131 accounted for 26% of the study isolates (more than any other clonal group), was distributed similarly by facility, and was closely associated with ciprofloxacin resistance and extended-spectrum β-lactamase (ESBL) production. The H30 and H30Rx subclones accounted for most ST131 isolates and for the association of ST131 with fluoroquinolone resistance and ESBL production. Unlike ST131 per se, these subclones were distributed differentially by hospital, being most prevalent at the high-acuity adult facility and were absent from the children's hospital. The virulence gene profiles of ST131 and its subclones were distinctive and more extensive than those of other fluoroquinolone-resistant or ESBL-producing isolates. Within ST131, bla CTX-M-15 was confined to H30Rx isolates and other bla CTX-M variants to non-Rx H30 isolates. Pulsed-field gel electrophoresis documented a predominance of globally distributed pulsotypes and no local outbreak pattern. These findings help clarify the epidemiology, ecology, and bacterial correlates of the H30 and H30Rx ST131 subclones by documenting a high overall prevalence but significant segregation by facility, strong associations with fluoroquinolone resistance and specific ESBL variants, and distinctive

  7. Variation in Resistance Traits, Phylogenetic Backgrounds, and Virulence Genotypes among Escherichia coli Clinical Isolates from Adjacent Hospital Campuses Serving Distinct Patient Populations

    PubMed Central

    Porter, Stephen; Kuskowski, Michael A.; Johnston, Brian; Clabots, Connie; Kline, Susan; Ferrieri, Patricia; Johnson, James R.

    2015-01-01

    Escherichia coli sequence type 13 (ST131), an emergent cause of multidrug-resistant extraintestinal infections, has important phylogenetic subsets, notably the H30 and H30Rx subclones, with distinctive resistance profiles and, possibly, clinical associations. To clarify the local prevalence of these ST131 subclones and their associations with antimicrobial resistance, ecological source, and virulence traits, we extensively characterized 233 consecutive E. coli clinical isolates (July and August 2013) from the University of Minnesota Medical Center-Fairview Infectious Diseases and Diagnostic Laboratory, Minneapolis, MN, which serves three adjacent facilities (a children's hospital and low- and high-acuity adult facilities). ST131 accounted for 26% of the study isolates (more than any other clonal group), was distributed similarly by facility, and was closely associated with ciprofloxacin resistance and extended-spectrum β-lactamase (ESBL) production. The H30 and H30Rx subclones accounted for most ST131 isolates and for the association of ST131 with fluoroquinolone resistance and ESBL production. Unlike ST131 per se, these subclones were distributed differentially by hospital, being most prevalent at the high-acuity adult facility and were absent from the children's hospital. The virulence gene profiles of ST131 and its subclones were distinctive and more extensive than those of other fluoroquinolone-resistant or ESBL-producing isolates. Within ST131, blaCTX-M-15 was confined to H30Rx isolates and other blaCTX-M variants to non-Rx H30 isolates. Pulsed-field gel electrophoresis documented a predominance of globally distributed pulsotypes and no local outbreak pattern. These findings help clarify the epidemiology, ecology, and bacterial correlates of the H30 and H30Rx ST131 subclones by documenting a high overall prevalence but significant segregation by facility, strong associations with fluoroquinolone resistance and specific ESBL variants, and distinctive virulence

  8. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program

    PubMed Central

    Johnson, Erin E.; Aiello, Riccardo; Kane, Vincent; Pape, Lisa

    2016-01-01

    Introduction Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a “homeless medical home” initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. Methods We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services. Results More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies. Conclusion Integrating social determinants of health into clinical care can be effective for high

  9. Building Capacity for Trauma Intervention across Child-Serving Systems

    ERIC Educational Resources Information Center

    Chinitz, Susan; Stettler, Erin M.; Giammanco, Denise; Silverman, Marian; Briggs, Rahil D.; Loeb, Joanne

    2010-01-01

    Infants most vulnerable to trauma are often the least able to access interventions. Universal child-serving systems, such as primary pediatrics, early care and education, and the child welfare system, can offer a port of entry for millions of children annually for trauma-related supports and services. However, practitioners in these systems have…

  10. Pre-Exposure Prophylaxis (PrEP) for Safer Conception Among Serodifferent Couples: Findings from Healthcare Providers Serving Patients with HIV in Seven US Cities.

    PubMed

    Finocchario-Kessler, Sarah; Champassak, Sofie; Hoyt, Mary Jo; Short, William; Chakraborty, Rana; Weber, Shannon; Levison, Judy; Phillips, Joanne; Storm, Deborah; Anderson, Jean

    2016-03-01

    Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV transmission among serodifferent couples trying to conceive, yet provider knowledge, attitudes, and experience utilizing PrEP for this purpose are largely unexamined. Trained interviewers conducted phone interviews with healthcare providers treating patients with HIV in seven cities (Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco, N = 85 total). Quantitative and qualitative data were analyzed to describe experience, concerns, and perceived barriers to prescribing PrEP for safer conception. Providers (67.1% female, 43 mean years of age, 70.4% white, 10 mean years treating HIV+ patients, 56% in academic vs. community facilities, 62.2% MD) discussed both benefits and concerns of PrEP for safer conception among serodifferent couples. Only 18.8% of providers reported experience prescribing PrEP, 74.2% were willing to prescribe it under ideal circumstances, and 7.0% were not comfortable prescribing PrEP. Benefits included added protection and a greater sense of control for the HIV-negative partner. Concerns were categorized as clinical, system-level, cost, or behavioral. Significant differences in provider characteristics existed across sites, but experience with PrEP for safer conception did not, p = 0.14. Despite limited experience, most providers were open to recommending PrEP for safer conception as long as patients understood the range of concerns and could make informed decisions. Strategies to identify and link serodifferent couples to PrEP services and clinical guidance specific to PrEP for safer conception are needed.

  11. Pre-Exposure Prophylaxis (PrEP) for Safer Conception Among Serodifferent Couples: Findings from Healthcare Providers Serving Patients with HIV in Seven US Cities.

    PubMed

    Finocchario-Kessler, Sarah; Champassak, Sofie; Hoyt, Mary Jo; Short, William; Chakraborty, Rana; Weber, Shannon; Levison, Judy; Phillips, Joanne; Storm, Deborah; Anderson, Jean

    2016-03-01

    Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV transmission among serodifferent couples trying to conceive, yet provider knowledge, attitudes, and experience utilizing PrEP for this purpose are largely unexamined. Trained interviewers conducted phone interviews with healthcare providers treating patients with HIV in seven cities (Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco, N = 85 total). Quantitative and qualitative data were analyzed to describe experience, concerns, and perceived barriers to prescribing PrEP for safer conception. Providers (67.1% female, 43 mean years of age, 70.4% white, 10 mean years treating HIV+ patients, 56% in academic vs. community facilities, 62.2% MD) discussed both benefits and concerns of PrEP for safer conception among serodifferent couples. Only 18.8% of providers reported experience prescribing PrEP, 74.2% were willing to prescribe it under ideal circumstances, and 7.0% were not comfortable prescribing PrEP. Benefits included added protection and a greater sense of control for the HIV-negative partner. Concerns were categorized as clinical, system-level, cost, or behavioral. Significant differences in provider characteristics existed across sites, but experience with PrEP for safer conception did not, p = 0.14. Despite limited experience, most providers were open to recommending PrEP for safer conception as long as patients understood the range of concerns and could make informed decisions. Strategies to identify and link serodifferent couples to PrEP services and clinical guidance specific to PrEP for safer conception are needed. PMID:26824425

  12. Serving Bowl Selection Biases the Amount of Food Served

    ERIC Educational Resources Information Center

    van Kleef, Ellen; Shimizu, Mitsuru; Wansink, Brian

    2012-01-01

    Objective: To determine how common serving bowls containing food for multiple persons influence serving behavior and consumption and whether they do so independently of satiation and food evaluation. Methods: In this between-subjects experiment, 68 participants were randomly assigned to either a group serving pasta from a large-sized bowl (6.9-L…

  13. Professional attitude of health care workers toward serving HIV/AIDS patients and drug users: questionnaire design and evaluation of reliability and validity.

    PubMed

    See, Lai-Chu; Shen, Yu-Ming; Chen, Chia-Ling; Huang, Tsuei-Mi; Huang, Yi-Hua; Huang, Hui-Chun; Lin, Sheue-Rong

    2011-11-01

    The manner in which health care workers (HCWs) interact with HIV/AIDS patients and drug users during their work clearly influences the sustainability of harm reduction programs. To evaluate the professional attitudes of HCWs, we designed a questionnaire with four constructs - discrimination, acceptance of HIV/AIDS patients, acceptance of drug users, and fear - and tested its reliability and validity. Ten experts rated the questionnaire and the mean content validity index was 85.6%. Analysis of 251 anonymous questionnaires from HCWs in Taiwan yielded a composite reliability and Cronbach's α for the four constructs of >0.7. First-order and second-order confirmatory factor analysis revealed a χ(2)/degrees of freedom <3, goodness-of-fit index (GFI) >0.9, adjusted goodness-of-fit index (AGFI) >0.9, Bentler-Bonnett normal fix index >0.9, and a root mean square error of approximation between 0.00 and 0.07 indicating a good fit of the model. HCWs with training in HRPs or AIDS prevention had higher questionnaire scores than those without such training, indicating good known-group validity.

  14. How Strong Is the Primary Care Safety Net? Assessing the Ability of Federally Qualified Health Centers to Serve as Patient-Centered Medical Homes.

    PubMed

    Ryan, Jamie; Riley, Pamela; Abrams, Melinda; Nocon, Robert

    2015-09-01

    By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. Ongoing federal funding and technical support for medical home transformation will be needed to ensure that FQHCs can fulfill their mission of providing high-quality, comprehensive care to low-income and minority populations. PMID:26372972

  15. Chromodomain-helicase-DNA binding protein 5, 7 and pronecrotic mixed lineage kinase domain-like protein serve as potential prognostic biomarkers in patients with resected pancreatic adenocarcinomas

    PubMed Central

    Seldon, Crystal S; Colbert, Lauren E; Hall, William A; Fisher, Sarah B; Yu, David S; Landry, Jerome C

    2016-01-01

    Pancreatic cancer is one of the deadliest cancers with a very poor prognosis. Recently, there has been a significant increase in research directed towards identifying potential biomarkers that can be used to diagnose and provide prognostic information for pancreatic cancer. These markers can be used clinically to optimize and personalize therapy for individual patients. In this review, we focused on 3 biomarkers involved in the DNA damage response pathway and the necroptosis pathway: Chromodomain-helicase-DNA binding protein 5, chromodomain-helicase-DNA binding protein 7, and mixed lineage kinase domain-like protein. The aim of this article is to review present literature provided for these biomarkers and current studies in which their effectiveness as prognostic biomarkers are analyzed in order to determine their future use as biomarkers in clinical medicine. Based on the data presented, these biomarkers warrant further investigation, and should be validated in future studies. PMID:27096031

  16. Hispanic-Serving Community Colleges

    ERIC Educational Resources Information Center

    Waller, Lee; Glasscock, Herlinda M.; Glasscock, Ronnie L.; Fulton-Calkins, Patsy J.

    2006-01-01

    The article examines student tuition, ad valorem property taxes, and state appropriations utilizing a revenue-per-contact-hour model to identify disparities in the Texas' community college funding mechanism. Methodology is presented to identify differences between and among Caucasian-serving, African-American-serving, Hispanic-serving, and other…

  17. Lessons about vulnerability assessments.

    SciTech Connect

    Johnston, R. G.

    2004-01-01

    The Vulnerability Assessment Team (VAT) at Los Alamos National Laboratory believes that physical security can only be optimized through the use of effective vulnerability assessments. As a result of conducting vulnerability assessments on hundreds of different security devices and systems in the last few years, we have identified some of the attributes of effective assessments. These, along with our recommendations and observations about vulnerability assessments, are summarized in this paper. While our work has primarily involved physical security (in contrast to, for example, computer, network, or information security), our experiences may have applicability to other types of security as well.

  18. VEGF-B promotes cancer metastasis through a VEGF-A–independent mechanism and serves as a marker of poor prognosis for cancer patients

    PubMed Central

    Yang, Xiaojuan; Zhang, Yin; Hosaka, Kayoko; Andersson, Patrik; Wang, Jian; Tholander, Fredrik; Cao, Ziquan; Morikawa, Hiromasa; Tegnér, Jesper; Yang, Yunlong; Iwamoto, Hideki; Lim, Sharon; Cao, Yihai

    2015-01-01

    The biological functions of VEGF-B in cancer progression remain poorly understood. Here, we report that VEGF-B promotes cancer metastasis through the remodeling of tumor microvasculature. Knockdown of VEGF-B in tumors resulted in increased perivascular cell coverage and impaired pulmonary metastasis of human melanomas. In contrast, the gain of VEGF-B function in tumors led to pseudonormalized tumor vasculatures that were highly leaky and poorly perfused. Tumors expressing high levels of VEGF-B were more metastatic, although primary tumor growth was largely impaired. Similarly, VEGF-B in a VEGF-A–null tumor resulted in attenuated primary tumor growth but substantial pulmonary metastases. VEGF-B also led to highly metastatic phenotypes in Vegfr1 tk−/− mice and mice treated with anti–VEGF-A. These data indicate that VEGF-B promotes cancer metastasis through a VEGF-A–independent mechanism. High expression levels of VEGF-B in two large-cohort studies of human patients with lung squamous cell carcinoma and melanoma correlated with poor survival. Taken together, our findings demonstrate that VEGF-B is a vascular remodeling factor promoting cancer metastasis and that targeting VEGF-B may be an important therapeutic approach for cancer metastasis. PMID:25991856

  19. Vulnerable Children and Youth.

    ERIC Educational Resources Information Center

    Willms, J. Douglas

    2002-01-01

    Findings from two studies indicate that the nature of Canadian children's environments within their families, schools, neighborhoods, and communities has very strong effects on children's development and the prevalence of childhood vulnerability. Rather than stemming primarily from poverty, childhood vulnerability may arise from the environments…

  20. Superintendent Vulnerability and Mobility.

    ERIC Educational Resources Information Center

    Parker, Phyllis

    1996-01-01

    Examined Callahan's vulnerability thesis to determine its ability to explain the mobility of superintendents in Texas between 1985 and 1990. Questionnaire and interview data indicated that, at least in Texas where superintendent mobility reached 50% in that time period, vulnerability did not appear to account for much of superintendent mobility.…

  1. Students Serving Arizona. 1994 "Serve-America" Evaluation Report.

    ERIC Educational Resources Information Center

    Sandler, Linda; Vandegrift, Judith A.

    Arizona's Serve-America program, administered by the Arizona Department of Education (ADE), began in fiscal year 1992-93 under the auspices of the National and Community Service Act of 1990. Serve-America links community service projects with schools and youths in grades K-12. This second annual report documents the second year of project…

  2. Emerging Hispanic-Serving Institutions (HSIs): Serving Latino Students

    ERIC Educational Resources Information Center

    Santiago, Deborah A.; Andrade, Sally J.

    2010-01-01

    In this fifth brief in "Excelencia" in Education's series on Hispanic-Serving Institutions (HSIs) the focus is on the methods and strategies that are producing successful results in a growing sector of colleges and universities we call, "Emerging" Hispanic-Serving Institutions. These Emerging HSIs are institutions that currently do not meet the…

  3. SERVE-HF: More Questions Than Answers.

    PubMed

    Javaheri, Shahrokh; Brown, Lee K; Randerath, Winfried; Khayat, Rami

    2016-04-01

    The recent online publication of the SERVE-HF trial that evaluated the effect of treating central sleep apnea (CSA) with an adaptive servoventilation (ASV) device in patients with heart failure and reduced ejection fraction (HFrEF) has raised serious concerns about the safety of ASV in these patients. Not only was ASV ineffective but post hoc analysis found excess cardiovascular mortality in treated patients. The authors cited as one explanation an unfounded notion that CSA is a compensatory mechanism with a protective effect in HFrEF patients. We believe that there are several possible considerations that are more likely to explain the results of SERVE-HF. In this commentary, we consider methodological issues including the use of a previous-generation ASV device that constrained therapeutic settings to choices that are no longer in wide clinical use. Patient selection, data collection, and treatment adherence as well as group crossovers were not discussed in the trial as potential confounding factors. We have developed alternative reasons that could potentially explain the results and that can be explored by post hoc analysis of the SERVE-HF data. We believe that our analysis is of critical value to the field and of particular importance to clinicians treating these patients. PMID:26836904

  4. Thermal detection of vulnerable plaque.

    PubMed

    Madjid, Mohammad; Naghavi, Morteza; Malik, Basit A; Litovsky, Silvio; Willerson, James T; Casscells, Ward

    2002-11-21

    In 1996, we showed that inflamed atherosclerotic plaques give off more heat and that vulnerable plaques may be detected by measuring their temperature. Plaque temperature is correlated directly with inflammatory cell density and inversely with the distance of the cell clusters from the luminal surface. It is inversely related to the density of the smooth muscle cells. We found no significant association between temperature heterogeneity and presence of Chlamydia pneumoniae in plaque or the gross color of human atherosclerotic carotid plaques. We also found pH heterogeneity in plaques from human carotid artery and aortas of Watanabe atherosclerotic rabbits and apolipoprotein E-deficient mice. Areas with lower pH had higher temperature, and areas with a large lipid core showed lower pH with higher temperature, whereas calcified regions had lower temperature and higher pH. We also developed a thermography basket catheter and showed in vivo temperature heterogeneity in atherosclerotic lesions of atherosclerotic dogs and Watanabe rabbits. Thermal heterogeneity was later documented in human atherosclerotic coronary arteries. Temperature difference between atherosclerotic plaque and healthy vessel wall is related to clinical instability. It is correlated with systemic markers of inflammation and is a strong predictor of adverse cardiac events after percutaneous interventions. Thermography is the first in a series of novel "functional" imaging methods and is moving to clinical trials. It may be useful for a variety of clinical and research purposes, such as detection of vulnerable plaques and risk stratification of vulnerable patients.

  5. Facility Environmental Vulnerability Assessment

    SciTech Connect

    Van Hoesen, S.D.

    2001-07-09

    From mid-April through the end of June 2001, a Facility Environmental Vulnerability Assessment (FEVA) was performed at Oak Ridge National Laboratory (ORNL). The primary goal of this FEVA was to establish an environmental vulnerability baseline at ORNL that could be used to support the Laboratory planning process and place environmental vulnerabilities in perspective. The information developed during the FEVA was intended to provide the basis for management to initiate immediate, near-term, and long-term actions to respond to the identified vulnerabilities. It was expected that further evaluation of the vulnerabilities identified during the FEVA could be carried out to support a more quantitative characterization of the sources, evaluation of contaminant pathways, and definition of risks. The FEVA was modeled after the Battelle-supported response to the problems identified at the High Flux Beam Reactor at Brookhaven National Laboratory. This FEVA report satisfies Corrective Action 3A1 contained in the Corrective Action Plan in Response to Independent Review of the High Flux Isotope Reactor Tritium Leak at the Oak Ridge National Laboratory, submitted to the Department of Energy (DOE) ORNL Site Office Manager on April 16, 2001. This assessment successfully achieved its primary goal as defined by Laboratory management. The assessment team was able to develop information about sources and pathway analyses although the following factors impacted the team's ability to provide additional quantitative information: the complexity and scope of the facilities, infrastructure, and programs; the significantly degraded physical condition of the facilities and infrastructure; the large number of known environmental vulnerabilities; the scope of legacy contamination issues [not currently addressed in the Environmental Management (EM) Program]; the lack of facility process and environmental pathway analysis performed by the accountable line management or facility owner; and poor

  6. S100A9 and ORM1 serve as predictors of therapeutic response and prognostic factors in advanced extranodal NK/T cell lymphoma patients treated with pegaspargase/gemcitabine

    PubMed Central

    Zhou, Zhiyuan; Li, Zhaoming; Sun, Zhenchang; Zhang, Xudong; Lu, Lisha; Wang, Yingjun; Zhang, Mingzhi

    2016-01-01

    Pegaspargase combined with gemcitabine have greatly improved the outcomes of advanced extranodal NK/T cell lymphoma (ENKL). However, patients frequently undergo recurrent disease due to chemoresistance, and few predictive parameters are available. The present study explored potential biomarkers to predict the therapeutic response of advanced ENKL treated with pegaspargase/gemcitabine and evaluate the prognostic significance. Through serum proteomic analysis, we identified 61 upregulated and 22 downregulated proteins in nonresponders compared with responders. We further validated that patients with unfavourable treatment outcomes displayed higher levels of S100A9 and ORM1 via enzyme-linked immunosorbent assay (ELISA). Moreover, the sensitivity and specificity for detecting refractory patients were 81.5% and 71.4% for S100A9 > 62.0 ng/ml, 85.2% and 77.1% for ORM1 > 1436 ug/ml, 100% and 57.1% for S100A9 combined with ORM1. Furthermore, in multivariate analysis elevated levels of S100A9 were associated with poor 2-year OS (40.2% vs. 76.6%, RR = 2.92, p = 0.005) and 2-year PFS (33.1% vs. 61.1%, RR = 2.61 p = 0.011). High ORM1 also predicted inferior 2-year OS (38.7% vs.76.1, RR = 2.46, p = 0.023) and 2-year PFS (18.4% vs. 73.2%, RR = 2.86, p = 0.009). Our results indicated that S100A9 and ORM1 could serve as reliable predictors of therapeutic response and independent prognostic factors of survival in advanced ENKL patients treated with pegaspargase/gemcitabine. PMID:27021626

  7. Frailty and Social Vulnerability.

    PubMed

    Andrew, Melissa K

    2015-01-01

    Both intrinsic and extrinsic factors contribute to health. Intrinsic factors are familiar topics in health research and include medical conditions, medications, genetics and frailty, while extrinsic factors stem from social and physical environments. This chapter builds on others in this volume, in which a deficit accumulation approach to frailty has been described. The concept of social vulnerability is presented. Social vulnerability stems from the accumulation of multiple and varied social problems and has bidirectional importance as a risk factor for poor health outcomes and as a pragmatic consideration for health care provision and planning. Importantly, the social factors that contribute to overall social vulnerability come into play at different levels of influence (individual, family and friends, peer groups, institutions and society at large). A social ecology perspective is discussed as a useful framework for considering social vulnerability, as it allows for attention to each of these levels of influence. Tying together what we currently understand about frailty (in medical and basic science models) and social vulnerability, the scaling potential of deficit accumulation is discussed, given that deficit accumulation can be understood to occur at many levels, from the (sub-)cellular level to tissues, organisms/complex systems and societies.

  8. Could Local Dynamic Stability Serve as an Early Predictor of Falls in Patients with Moderate Neurological Gait Disorders? A Reliability and Comparison Study in Healthy Individuals and in Patients with Paresis of the Lower Extremities

    PubMed Central

    Reynard, Fabienne; Vuadens, Philippe; Deriaz, Olivier; Terrier, Philippe

    2014-01-01

    Falls while walking are frequent in patients with muscular dysfunction resulting from neurological disorders. Falls induce injuries that may lead to deconditioning and disabilities, which further increase the risk of falling. Therefore, an early gait stability index would be useful to evaluate patients in order to prevent the occurrence of future falls. Derived from chaos theory, local dynamic stability (LDS), defined by the maximal Lyapunov exponent, assesses the sensitivity of a dynamic system to small perturbations. LDS has already been used for fall risk prediction in elderly people. The aim of the present study was to provide information to facilitate future researches regarding gait stability in patients with neurological gait disorders. The main objectives were 1) to evaluate the intra-session repeatability of LDS in patients and 2) to assess the discriminative power of LDS to differentiate between healthy individuals and neurological patients. Eighty-three patients with mild to moderate neurological disorders associated with paresis of the lower extremities and 40 healthy controls participated in the study. The participants performed 2×30 s walking wearing a 3D accelerometer attached to the lower back, from which 2×35 steps were extracted. LDS was defined as the average exponential rate of divergence among trajectories in a reconstructed state-space that reflected the gait dynamics. LDS assessed along the medio-lateral axis offered the highest repeatability and discriminative power. Intra-session repeatability (intraclass correlation coefficient between the two repetitions) in the patients was 0.89 and the smallest detectable difference was 16%. LDS was substantially lower in the patients than in the controls (33% relative difference, standardized effect size 2.3). LDS measured in short over-ground walking tests seems sufficiently reliable. LDS exhibits good discriminative power to differentiate fall-prone individuals and opens up the possibility of

  9. TB in Vulnerable Populations

    PubMed Central

    Ugarte-Gil, César; Caro, Godofredo; Aylas, Rula; Castro, César; Lema, Claudia

    2016-01-01

    Abstract This article analyzes the factors associated with vulnerability of the Ashaninka, the most populous indigenous Peruvian Amazonian people, to tuberculosis (TB). By applying a human rights-based analytical framework that assesses public policy against human rights standards and principles, and by offering a step-by-step framework for a full assessment of compliance, it provides evidence of the relationship between the incidence of TB among the Ashaninka and Peru’s poor level of compliance with its human rights obligations. The article argues that one of the main reasons for the historical vulnerability of the Ashaninka to diseases such as TB is a lack of political will on the part of the national government to increase public health spending, ensure that resources reach the most vulnerable population, and adopt and invest in a culturally appropriate health system. PMID:27780999

  10. Threats and vulnerabilities

    NASA Astrophysics Data System (ADS)

    Ahonen, Pasi; Alahuhta, Petteri; Daskala, Barbara; Delaitre, Sabine; Hert, Paul De; Lindner, Ralf; Maghiros, Ioannis; Moscibroda, Anna; Schreurs, Wim; Verlinden, Michiel

    In this chapter, we present a review of threats and vulnerabilities that could afflict society and individuals in the AmI world in the context of the key policy issues of privacy, identity, trust, security and digital divide. We define a threat as the potential for one or more unwanted consequences caused by a circumstance, capability, action or event that could be harmful to a system or person. Threats can be caused naturally, accidentally or intentionally. In essence, a threat is a ubiquitous phenomenon. A vulnerability is a flaw or weakness in a system's design, its implementation, operation or management that could be exploited to violate the system and, consequently, cause a threat. Vulnerabilities may have different dimensions: technical, functional or behavioural.1

  11. Energy vulnerability relationships

    SciTech Connect

    Shaw, B.R.; Boesen, J.L.

    1998-02-01

    The US consumption of crude oil resources has been a steadily growing indicator of the vitality and strength of the US economy. At the same time import diversity has also been a rapidly developing dimension of the import picture. In the early 1970`s, embargoes of crude oil from Organization of Producing and Exporting Countries (OPEC) created economic and political havoc due to a significant lack of diversity and a unique set of economic, political and domestic regulatory circumstances. The continued rise of imports has again led to concerns over the security of our crude oil resource but threats to this system must be considered in light of the diversity and current setting of imported oil. This report develops several important issues concerning vulnerability to the disruption of oil imports: (1) The Middle East is not the major supplier of oil to the United States, (2) The US is not vulnerable to having its entire import stream disrupted, (3) Even in stable countries, there exist vulnerabilities to disruption of the export stream of oil, (4) Vulnerability reduction requires a focus on international solutions, and (5) DOE program and policy development must reflect the requirements of the diverse supply. Does this increasing proportion of imported oil create a {open_quotes}dependence{close_quotes}? Does this increasing proportion of imported oil present a vulnerability to {open_quotes}price shocks{close_quotes} and the tremendous dislocations experienced during the 1970`s? Finally, what is the vulnerability of supply disruptions from the current sources of imported oil? If oil is considered to be a finite, rapidly depleting resource, then the answers to these questions must be {open_quotes}yes.{close_quotes} However, if the supply of oil is expanding, and not limited, then dependence is relative to regional supply sources.

  12. Plutonium Vulnerability Management Plan

    SciTech Connect

    1995-03-01

    This Plutonium Vulnerability Management Plan describes the Department of Energy`s response to the vulnerabilities identified in the Plutonium Working Group Report which are a result of the cessation of nuclear weapons production. The responses contained in this document are only part of an overall, coordinated approach designed to enable the Department to accelerate conversion of all nuclear materials, including plutonium, to forms suitable for safe, interim storage. The overall actions being taken are discussed in detail in the Department`s Implementation Plan in response to the Defense Nuclear Facilities Safety Board (DNFSB) Recommendation 94-1. This is included as Attachment B.

  13. Offer Versus Serve. Training Manual.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Bureau of Health and Drug Education and Services.

    A growing awareness about food supplies, food shortages, and conservation of natural resources has resulted in public concern over food waste within the National School Lunch Program. Prior to 1976, all participating students were required to take all five items offered on a planned menu. In October 1975, the Offer v. Serve Provision was enacted…

  14. Meals Served in Public Schools.

    ERIC Educational Resources Information Center

    Vivigal, Lisa

    The Physicians Committee for Responsible Medicine (PCRM) contacted public school districts around the United States to determine if they offered low-fat, healthful meals. The PCRM ranked the schools according to whether they served low-fat and vegetarian meals daily, whether these meals varied through the week, and whether children needed to…

  15. Biological Vulnerability to Alcoholism.

    ERIC Educational Resources Information Center

    Schuckit, Marc A.

    1987-01-01

    Reviews the role of biological factors in the risk for alcoholism. Notes the importance of the definition of primary alcoholism and highlights data indicating that this disorder is genetically influenced. In studies of men at high risk for the future development of alcoholism, vulnerability shows up in reactions to ethanol brain wave amplitude and…

  16. Delinquent Recidivists: Vulnerable Children.

    ERIC Educational Resources Information Center

    Moore, Roslyn; And Others

    1984-01-01

    This study examines the relationship between vulnerability factors and recidivism of juvenile offenders. Four factors are identified which distinguish recedivists from nonrecidivists in a sample of 96 first offenders matched by age and sex. Results are discussed from an epidemiological and early intervention perspective. (Author/BS)

  17. Vulnerabilities in snakebites in Sao Paulo, Brazil

    PubMed Central

    Bertolozzi, Maria Rita; Scatena, Camila Morato da Conceição; França, Francisco Oscar de Siqueira

    2015-01-01

    ABSTRACT OBJECTIVE To describe elements of vulnerability of victims of snakebite. METHODS This qualitative, descriptive, cross-sectional study had, as theoretical framework, the concept of vulnerability in individual, social, and programmatic dimensions. We interviewed 21 patients admitted into a hospital specialized in the care of accidents caused by venomous animals. The interviews were analyzed according to a discourse analysis technique. RESULTS Patients were mainly young men, living in remote countryside areas, where health services frequently have limited resources. We found social and individual conditions of vulnerability, such as precarious schooling, low professional qualification, housing without access to piped water, no sewage treated, and no regular garbage collection, and lack of knowledge on this health problem. Regarding the programmatic dimension, we found limited accessibility to the health services that could affect the prognosis and the frequency of sequelae and deaths. CONCLUSIONS Considering such vulnerabilities evoke the need to improve the program for control the Accidents by Venomous Animals and the training of health workers, we highlight the potential use of the concept of vulnerability, which may amplify the understanding and the recommendations for the practice and education related to snakebites. PMID:26603351

  18. Optimizing health care delivery by integrating workplaces, homes, and communities: how occupational and environmental medicine can serve as a vital connecting link between accountable care organizations and the patient-centered medical home.

    PubMed

    McLellan, Robert K; Sherman, Bruce; Loeppke, Ronald R; McKenzie, Judith; Mueller, Kathryn L; Yarborough, Charles M; Grundy, Paul; Allen, Harris; Larson, Paul W

    2012-04-01

    momentum and evolving among physicians. But, the potential exists for implementation of both of these concepts across a much broader community of patients. By extending the well-conceived integrative concepts of the PCMH model and ACOs into the workforce via occupational and environmental medicine (OEM) physicians, the power of these concepts would be significantly enhanced. Occupational and environmental medicine provides a well-established infrastructure and parallel strategies that could serve as a force multiplier in achieving the fundamental goals of the PCMH model and ACOs. In this paradigm, the workplace-where millions of Americans spend a major portion of their daily lives-becomes an essential element, next to communities and homes, in an integrated system of health anchored by the PCMH and ACO concepts. To be successful, OEM physicians will need to think and work innovatively about how they can provide today's employer health services-ranging from primary care and preventive care to workers' compensation and disability management-within tomorrow's PCMH and ACO models.

  19. Vulnerability to Climate Change in Rural Nicaragua

    NASA Astrophysics Data System (ADS)

    Byrne, T. R.; Townshend, I.; Byrne, J. M.; McDaniel, S. A.

    2013-12-01

    While there is a growing recognition of the impact that climate change may have on human development, there has been a shift in focus from an impacts-led assessment approach towards a vulnerability-led assessment approach. This research operationalizes the IPCC's definition of vulnerability in a sub-national assessment to understand how different factors that shape vulnerability to climate change vary spatially across rural Nicaragua. The research utilizes the Food and Agriculture Organization of the United Nations' (FAO UN) CropWat model to evaluate how the annual yield of two of Nicaragua's staple crops may change under projected changes in temperature and precipitation. This analysis of agricultural sensitivity under exposure to climate change is then overlain with an indicator-based assessment of adaptive capacity in rural Nicaraguan farming households. Adaptive capacity was evaluated using household survey data from the 2001 National Household Survey on Living Standards Measurement, which was provided to us by the FAO UN. The result is a map representing current vulnerability to future climate change, and can serve as a basis for targeting policy interventions in rural Nicaragua.

  20. Inflammation and plaque vulnerability

    PubMed Central

    Hansson, G. K.; Libby, P.; Tabas, I.

    2016-01-01

    Atherosclerosis is a maladaptive, nonresolving chronic inflammatory disease that occurs at sites of blood flow disturbance. The disease usually remains silent until a breakdown of integrity at the arterial surface triggers the formation of a thrombus. By occluding the lumen, the thrombus or emboli detaching from it elicits ischaemic symptoms that may be life-threatening. Two types of surface damage can cause atherothrombosis: plaque rupture and endothelial erosion. Plaque rupture is thought to be caused by loss of mechanical stability, often due to reduced tensile strength of the collagen cap surrounding the plaque. Therefore, plaques with reduced collagen content are thought to be more vulnerable than those with a thick collagen cap. Endothelial erosion, on the other hand, may occur after injurious insults to the endothelium instigated by metabolic disturbance or immune insults. This review discusses the molecular mechanisms involved in plaque vulnerability and the development of atherothrombosis. PMID:26260307

  1. [Concepts of vulnerability of psychiatric diseases].

    PubMed

    Stamm, R; Bühler, K E

    2001-07-01

    Despite intensive research in recent decades, the search for the aetiopathogenesis of psychiatric diseases is just as relevant as ever. In recent years, ideas of the aetiopathogenesis of psychotic diseases based on the concept of "vulnerability" in its diverse variations and developments have been gained increasingly ground. The publications of Zubin and associates above all have contributed to a "vulnerability model". According to this descriptive model, schizophrenic disturbances develop as a result of stimuli/irritants or stress factors under modulation of the social and physical environment as well as dependent on the premorbid personality. The increased vulnerability which gives rise to this is perceived as a threshold descensus of the individual towards stimuli/irritants (with a deficit counter--irritants impulses). Apart from that, multi-causality of vulnerability is assumed as the starting point, whereby there is the possibility of several therapy approaches. Moreover, contrary to the prevailing pessimistic view that schizophrenia is a process-type progressive disease, an episodic nature of schizophrenic psychoses is postulated with a prognosis that is indeed positive in the long term. In recent years, although often not explicitly stated, Zubin's concept of vulnerability was also indubitably subjected to various further developments (the vulnerability stress model by Nuechterlein and associates as also the integrative psycho-biological schizophrenia model by Ciompi may serve as examples). Worth mentioning are also various new concepts from system sciences (such as those from cybernetics, synergetics, the chaos theory, the communication theory, structure determinism etc.), which endeavour to clarify the problem of psychosis. The evaluation of central neurophysiological function deviations with schizophrenics and their relations has so far been oriented above all towards the vulnerability model of Zubin and Nuechterlein, which differentiates temporarily

  2. Survey serves up food for thought.

    PubMed

    Baillie, Jonathan

    2011-09-01

    An independent survey into hospital food standards in England conducted earlier this year for the Soil Association saw over half of those patients surveyed admit they would not be happy serving the meals they received during a recent hospital stay to a child, while 29% said the food was so bad that, at times, they could not recognise what was on their plate. Nearly of quarter of the 1,000 indviduals questioned by OnePoll, meanwhile, had opted out of hospital catering altogether--choosing to have every meal brought in to them by visiting relatives; nor, the Soil Association says, is enough English hospital food being locally or sustainably sourced.

  3. HEPA Filter Vulnerability Assessment

    SciTech Connect

    GUSTAVSON, R.D.

    2000-05-11

    This assessment of High Efficiency Particulate Air (HEPA) filter vulnerability was requested by the USDOE Office of River Protection (ORP) to satisfy a DOE-HQ directive to evaluate the effect of filter degradation on the facility authorization basis assumptions. Within the scope of this assessment are ventilation system HEPA filters that are classified as Safety-Class (SC) or Safety-Significant (SS) components that perform an accident mitigation function. The objective of the assessment is to verify whether HEPA filters that perform a safety function during an accident are likely to perform as intended to limit release of hazardous or radioactive materials, considering factors that could degrade the filters. Filter degradation factors considered include aging, wetting of filters, exposure to high temperature, exposure to corrosive or reactive chemicals, and exposure to radiation. Screening and evaluation criteria were developed by a site-wide group of HVAC engineers and HEPA filter experts from published empirical data. For River Protection Project (RPP) filters, the only degradation factor that exceeded the screening threshold was for filter aging. Subsequent evaluation of the effect of filter aging on the filter strength was conducted, and the results were compared with required performance to meet the conditions assumed in the RPP Authorization Basis (AB). It was found that the reduction in filter strength due to aging does not affect the filter performance requirements as specified in the AB. A portion of the HEPA filter vulnerability assessment is being conducted by the ORP and is not part of the scope of this study. The ORP is conducting an assessment of the existing policies and programs relating to maintenance, testing, and change-out of HEPA filters used for SC/SS service. This document presents the results of a HEPA filter vulnerability assessment conducted for the River protection project as requested by the DOE Office of River Protection.

  4. The Role of Microvolt T-Wave Alternans to Assess Arrhythmia Vulnerability Among Patients with Heart Failure and Systolic Dysfunction: Primary Results from the TWA SCD-HeFT Substudy

    PubMed Central

    Gold, Michael R; Ip, John H; Costantini, Otto; Poole, Jeanne E; McNulty, Steven; Mark, Daniel B; Lee, Kerry L; Bardy, Gust H

    2009-01-01

    Background Sudden cardiac death remains a leading cause of mortality despite advances in medical treatment for the prevention of ischemic heart disease and heart failure. Recent studies showed a benefit of ICD implantation, but appropriate shocks for ventricular tachyarrhythmias were only noted in a minority of patients during 4-5 years of follow-up. Accordingly, better risk stratification is needed to optimize patient selection. In this regard microvolt T-wave alternans (TWA) has emerged as a potentially useful measure of arrhythmia vulnerability, but it has not been evaluated previously in a prospective randomized trial of ICD therapy. Methods and Results This investigation was a prospective substudy of the SCD-HeFT trial including 490 patients at 37 clinical sites. TWA tests were classified by blinded readers as + (37%), - (22%), or indeterminate (41%) by standard criteria. The composite primary endpoint was the first occurrence of any of the following events: sudden cardiac death, sustained ventricular tachycardia/fibrillation or appropriate ICD discharge. During a median follow-up of 30 months, there were no significant differences in event rates between TWA + or − patients (Hazard ratio 1.24, p=0.56, [CI 0.60, 2.59]), or TWA − and non − (+ and indeterminate) subjects (Hazard ratio 1.28, p=0.46, CI [0.65, 2.53]). Similar results were obtained including or excluding patients randomized to amiodarone in the analyses. Conclusions TWA testing did not predict arrhythmic events or mortality in SCD-HeFT, although a small reduction of events (20-25%) among TWA − patients cannot be excluded given the sample size of this study. Accordingly, these results suggest that TWA is not useful to help make clinical decisions regarding ICD therapy among patients with heart failure and left ventricular systolic dysfunction. PMID:18955671

  5. An Integrated Approach for Urban Earthquake Vulnerability Analyses

    NASA Astrophysics Data System (ADS)

    Düzgün, H. S.; Yücemen, M. S.; Kalaycioglu, H. S.

    2009-04-01

    -economical, structural, coastal, ground condition, organizational vulnerabilities, as well as accessibility to critical services within the framework. The proposed framework has the following eight components: Seismic hazard analysis, soil response analysis, tsunami inundation analysis, structural vulnerability analysis, socio-economic vulnerability analysis, accessibility to critical services, GIS-based integrated vulnerability assessment, and visualization of vulnerabilities in 3D virtual city model The integrated model for various vulnerabilities obtained for the urban area is developed in GIS environment by using individual vulnerability assessments for considered elements at risk and serve for establishing the backbone of the spatial decision support system. The stages followed in the model are: Determination of a common mapping unit for each aspect of urban earthquake vulnerability, formation of a geo-database for the vulnerabilities, evaluation of urban vulnerability based on multi attribute utility theory with various weighting algorithms, mapping of the evaluated integrated earthquake risk in geographic information systems (GIS) in the neighborhood scale. The framework is also applicable to larger geographical mapping scales, for example, the building scale. When illustrating the results in building scale, 3-D visualizations with remote sensing data is used so that decision-makers can easily interpret the outputs. The proposed vulnerability assessment framework is flexible and can easily be applied to urban environments at various geographical scales with different mapping units. The obtained total vulnerability maps for the urban area provide a baseline for the development of risk reduction strategies for the decision makers. Moreover, as several aspects of elements at risk for an urban area is considered through vulnerability analyses, effect on changes in vulnerability conditions on the total can easily be determined. The developed approach also enables decision makers to

  6. Reduction of Behavioral Psychological Symptoms of Dementia by Multimodal Comprehensive Care for Vulnerable Geriatric Patients in an Acute Care Hospital: A Case Series

    PubMed Central

    Honda, Miwako; Ito, Mio; Ishikawa, Shogo; Takebayashi, Yoichi; Tierney, Lawrence

    2016-01-01

    Management of Behavioral and Psychological Symptoms of Dementia (BPSD) is a key challenge in geriatric dementia care. A multimodal comprehensive care methodology, Humanitude, with eye contact, verbal communication, and touch as its elements, was provided to three geriatric dementia patients for whom conventional nursing care failed in an acute care hospital. Each episode was evaluated by video analysis. All patients had advanced dementia with BPSD. Failure of care was identified by patient's shouting, screaming, or abrupt movements of limbs. In this case series, conventional care failed for all three patients. Each element of care communication was much shorter than in Humanitude care, which was accepted by the patients. The average of the elements performed during the care was eye contact 0.6%, verbal communication 15.7%, and touch 0.1% in conventional care and 12.5%, 54.8%, and 44.5% in Humanitude care, respectively. The duration of aggressive behavior of each patient during care was 25.0%, 25.4%, and 66.3% in conventional care and 0%, 0%, and 0.3% in Humanitude, respectively. In our case series, conventional care was provided by less eye contact, verbal communication, and touch. The multimodal comprehensive care approach, Humanitude, decreased BPSD and showed success by patients' acceptance of care. PMID:27069478

  7. A Systematic Review of Patients' Experiences in Communicating with Primary Care Physicians: Intercultural Encounters and a Balance between Vulnerability and Integrity.

    PubMed

    Rocque, Rhea; Leanza, Yvan

    2015-01-01

    Communication difficulties persist between patients and physicians. In order to improve care, patients' experiences of this communication must be understood. The main objective of this study is to synthesize qualitative studies exploring patients' experiences in communicating with a primary care physician. A secondary objective is to explore specific factors pertaining to ethnic minority or majority patients and their influence on patients' experiences of communication. Pertinent health and social sciences electronic databases were searched systematically (PubMed, Cinahl, PsychNet, and IBSS). Fifty-seven articles were included in the review on the basis of being qualitative studies targeting patients' experiences of communication with a primary care physician. The meta-ethnography method for qualitative studies was used to interpret data and the COREQ checklist was used to evaluate the quality of included studies. Three concepts emerged from analyses: negative experiences, positive experiences, and outcomes of communication. Negative experiences related to being treated with disrespect, experiencing pressure due to time constraints, and feeling helpless due to the dominance of biomedical culture in the medical encounter. Positive experiences are attributed to certain relational skills, technical skills, as well as certain approaches to care privileged by the physician. Outcomes of communication depend on patients' evaluation of the consultation. Four categories of specific factors exerted mainly a negative influence on consultations for ethnic minorities: language barriers, discrimination, differing values, and acculturation. Ethnic majorities also raised specific factors influencing their experience: differing values and discrimination. Findings of this review are limited by the fact that more than half of the studies did not explore cultural aspects relating to this experience. Future research should address these aspects in more detail. In conclusion, all

  8. Vulnerability Assessment of Selected Buildings Designated as Shelters: Anguilla.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on Anguilla to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with some of the…

  9. Vulnerability Assessment of Selected Buildings Designated as Shelters: Dominica.

    ERIC Educational Resources Information Center

    Agency for International Development (IDCA), Washington, DC.

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on Dominica to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with some of the…

  10. Vulnerability Assessment of Selected Buildings Designated as Shelters: Grenada.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools, located in Grenada, to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with some of the input…

  11. Beyond 'vulnerable groups': contexts and dynamics of vulnerability.

    PubMed

    Zarowsky, Christina; Haddad, Slim; Nguyen, Vinh-Kim

    2013-03-01

    This paper reviews approaches to vulnerability in public health, introducing a series of 10 papers addressing vulnerability in health in Africa. We understand vulnerability as simultaneously a condition and a process. Social inequalities are manifest in and exacerbate three key dimensions of vulnerability: the initial level of wellbeing, the degree of exposure to risk, and the capacity to manage risk effectively. We stress the dynamic interactions linking material and social deprivation, poverty, powerlessness and ill health: risks or shocks and their health impacts are intimately interconnected and reinforce each other in a cycle which in the absence of effective interventions, increases vulnerability. An inductive process which does not begin with an a priori definition or measurement of 'vulnerability' and which does not assume the existence of fixed 'vulnerable groups' allowed us both to re-affirm core aspects of existing conceptual frameworks, and to engage in new ways with literature specifically addressing vulnerability and resilience at the population level as well as with literature - for example in ecology, and on the concept of frailty in research on aging - with which researchers on health and poverty in Africa may not be familiar. We invite conceptual and empirical work on vulnerability in complex systems frameworks. These perspectives emphasize contexts and nonlinear causality thus supporting analyses of vulnerability and resilience as both markers and emergent properties of dynamic interactions. We accept a working definition of vulnerability, and recognize that some definable groups of people are more likely than others to suffer harm from exposure to health risks. But we suggest that the real work - at both intellectual and policy/political levels - lies in understanding and responding to the dynamics, meanings and power relations underlying actual instances and processes of vulnerability and harm.

  12. Beyond 'vulnerable groups': contexts and dynamics of vulnerability.

    PubMed

    Zarowsky, Christina; Haddad, Slim; Nguyen, Vinh-Kim

    2013-03-01

    This paper reviews approaches to vulnerability in public health, introducing a series of 10 papers addressing vulnerability in health in Africa. We understand vulnerability as simultaneously a condition and a process. Social inequalities are manifest in and exacerbate three key dimensions of vulnerability: the initial level of wellbeing, the degree of exposure to risk, and the capacity to manage risk effectively. We stress the dynamic interactions linking material and social deprivation, poverty, powerlessness and ill health: risks or shocks and their health impacts are intimately interconnected and reinforce each other in a cycle which in the absence of effective interventions, increases vulnerability. An inductive process which does not begin with an a priori definition or measurement of 'vulnerability' and which does not assume the existence of fixed 'vulnerable groups' allowed us both to re-affirm core aspects of existing conceptual frameworks, and to engage in new ways with literature specifically addressing vulnerability and resilience at the population level as well as with literature - for example in ecology, and on the concept of frailty in research on aging - with which researchers on health and poverty in Africa may not be familiar. We invite conceptual and empirical work on vulnerability in complex systems frameworks. These perspectives emphasize contexts and nonlinear causality thus supporting analyses of vulnerability and resilience as both markers and emergent properties of dynamic interactions. We accept a working definition of vulnerability, and recognize that some definable groups of people are more likely than others to suffer harm from exposure to health risks. But we suggest that the real work - at both intellectual and policy/political levels - lies in understanding and responding to the dynamics, meanings and power relations underlying actual instances and processes of vulnerability and harm. PMID:23549696

  13. Reduced cardiac autonomic response to deep breathing: A heritable vulnerability trait in patients with schizophrenia and their healthy first-degree relatives.

    PubMed

    Liu, Yu-Wen; Tzeng, Nian-Sheng; Yeh, Chin-Bin; Kuo, Terry B J; Huang, San-Yuan; Chang, Chuan-Chia; Chang, Hsin-An

    2016-09-30

    Reduced resting heart rate variability (HRV) has been observed in patients with schizophrenia and their relatives, suggesting genetic predispositions. However, findings have not been consistent. We assessed cardiac autonomic response to deep breathing in first-degree relatives of patients with schizophrenia (n=45; 26 female; aged 39.69±14.82 years). Data were compared to healthy controls (n=45; 26 female; aged 38.27±9.79 years) matched for age, gender, body mass index and physical activity as well as to unmedicated patients with acute schizophrenia (n=45; 25 female; aged 37.31±12.65 years). Electrocardiograms were recorded under supine resting and deep-breathing conditions (10-12breaths/min). We measured HRV components including variance, low-frequency (LF) power, which may reflect baroreflex function, high-frequency (HF) power, which reflects cardiac parasympathetic activity, and LF/HF ratio, which may reflect sympatho-vagal balance. Patients rather than relatives exhibited lower resting-state HRV (variance, LF, and HF) than controls. As expected, deep breathing induced an increase in variance and HF-HRV in controls. However, such a response was significantly reduced in both patients and their relatives. In conclusion, the diminished cardiac autonomic reactivity to deep breathing seen in patients and their unaffected relatives indicates that this pattern of cardiac autonomic dysregulation may be regarded as a genetic trait marker for schizophrenia. PMID:27442977

  14. Reduced cardiac autonomic response to deep breathing: A heritable vulnerability trait in patients with schizophrenia and their healthy first-degree relatives.

    PubMed

    Liu, Yu-Wen; Tzeng, Nian-Sheng; Yeh, Chin-Bin; Kuo, Terry B J; Huang, San-Yuan; Chang, Chuan-Chia; Chang, Hsin-An

    2016-09-30

    Reduced resting heart rate variability (HRV) has been observed in patients with schizophrenia and their relatives, suggesting genetic predispositions. However, findings have not been consistent. We assessed cardiac autonomic response to deep breathing in first-degree relatives of patients with schizophrenia (n=45; 26 female; aged 39.69±14.82 years). Data were compared to healthy controls (n=45; 26 female; aged 38.27±9.79 years) matched for age, gender, body mass index and physical activity as well as to unmedicated patients with acute schizophrenia (n=45; 25 female; aged 37.31±12.65 years). Electrocardiograms were recorded under supine resting and deep-breathing conditions (10-12breaths/min). We measured HRV components including variance, low-frequency (LF) power, which may reflect baroreflex function, high-frequency (HF) power, which reflects cardiac parasympathetic activity, and LF/HF ratio, which may reflect sympatho-vagal balance. Patients rather than relatives exhibited lower resting-state HRV (variance, LF, and HF) than controls. As expected, deep breathing induced an increase in variance and HF-HRV in controls. However, such a response was significantly reduced in both patients and their relatives. In conclusion, the diminished cardiac autonomic reactivity to deep breathing seen in patients and their unaffected relatives indicates that this pattern of cardiac autonomic dysregulation may be regarded as a genetic trait marker for schizophrenia.

  15. Mexican doctors serve rural areas.

    PubMed

    Grossi, J

    1991-02-01

    The Mexican Foundation for Family Planning (MEXFAM) worked to solve the unemployment problems of physicians and to increase health services to underserved rural areas. In Mexico, 75% of practicing physicians were located in 16 urban areas. Mexico had a large population of 83 million, of whom many in rural areas have been deprived of family planning and medical services. MEXFAM initiated the Community Doctors Project in 1986. The aim was to help Mexican doctors set up a medical practice in marginal urban towns and small towns with low income residents. Funding to physicians was provided for conducting a market survey of the proposed region and for advertising the new medical services. Loans of furniture and medical supplies were provided, and options were provided for purchase of equipment at a later date. During the promotion, services for maternal and child health care were provided for a small fee, while family planning was provided for free. Doctors usually become self-sufficient after about two years. The MEXFAM project established 170 community doctor's offices in 30 out of 32 states. Services were provided for at least 2500 families per office. In 1990, 13 offices were opened to serve an estimated 182,000 clients. A new effort is being directed to owners of Mexican factories. MEXFAM will set up a medical and family planning clinic very close to factories for a company contribution of only $12,000. The clinic promotion is being marketed through videos. MEXFAM found two companies that agreed to support a clinic. PMID:12288711

  16. Counselor Disillusionment and Vulnerability.

    ERIC Educational Resources Information Center

    Journal of Counseling and Development, 1988

    1988-01-01

    Contains five personal accounts: (1) "Volunteers--Handle with Care" (Donna Davenport); (2) "On the Task of Letting Go: A Woman's Paradoxical Journey" (Marjorie McKelvey Isaacs); (3) "Saving Myself Versus Serving Clients" (Peggy Kinnetz); (4) "To Publish or Not to Publish: That is the Question" (Donna Walsh); and (5) "Counseling behind Closed…

  17. A preliminary analysis of quantifying computer security vulnerability data in "the wild"

    NASA Astrophysics Data System (ADS)

    Farris, Katheryn A.; McNamara, Sean R.; Goldstein, Adam; Cybenko, George

    2016-05-01

    A system of computers, networks and software has some level of vulnerability exposure that puts it at risk to criminal hackers. Presently, most vulnerability research uses data from software vendors, and the National Vulnerability Database (NVD). We propose an alternative path forward through grounding our analysis in data from the operational information security community, i.e. vulnerability data from "the wild". In this paper, we propose a vulnerability data parsing algorithm and an in-depth univariate and multivariate analysis of the vulnerability arrival and deletion process (also referred to as the vulnerability birth-death process). We find that vulnerability arrivals are best characterized by the log-normal distribution and vulnerability deletions are best characterized by the exponential distribution. These distributions can serve as prior probabilities for future Bayesian analysis. We also find that over 22% of the deleted vulnerability data have a rate of zero, and that the arrival vulnerability data is always greater than zero. Finally, we quantify and visualize the dependencies between vulnerability arrivals and deletions through a bivariate scatterplot and statistical observations.

  18. Multiscale vulnerability of complex networks.

    PubMed

    Boccaletti, Stefano; Buldú, Javier; Criado, Regino; Flores, Julio; Latora, Vito; Pello, Javier; Romance, Miguel

    2007-12-01

    We present a novel approach to quantify the vulnerability of a complex network, i.e., the capacity of a graph to maintain its functional performance under random damages or malicious attacks. The proposed measure represents a multiscale evaluation of vulnerability, and makes use of combined powers of the links' betweenness. We show that the proposed approach is able to properly describe some cases for which earlier measures of vulnerability fail. The relevant applications of our method for technological network design are outlined.

  19. Serving the world's poor, profitably.

    PubMed

    Prahalad, C K; Hammond, Allen

    2002-09-01

    By stimulating commerce and development at the bottom of the economic pyramid, multi-nationals could radically improve the lives of billions of people and help create a more stable, less dangerous world. Achieving this goal does not require MNCs to spearhead global social-development initiatives for charitable purposes. They need only act in their own self-interest. How? The authors lay out the business case for entering the world's poorest markets. Fully 65% of the world's population earns less than $2,000 per year--that's 4 billion people. But despite the vastness of this market, it remains largely untapped. The reluctance to invest is easy to understand, but it is, by and large, based on outdated assumptions of the developing world. While individual incomes may be low, the aggregate buying power of poor communities is actually quite large, representing a substantial market in many countries for what some might consider luxury goods like satellite television and phone services. Prices, and margins, are often much higher in poor neighborhoods than in their middle-class counterparts. And new technologies are already steadily reducing the effects of corruption, illiteracy, inadequate infrastructure, and other such barriers. Because these markets are in the earliest stages of economic development, revenue growth for multi-nationals entering them can be extremely rapid. MNCs can also lower costs, not only through low-cost labor but by transferring operating efficiencies and innovations developed to serve their existing operations. Certainly, succeeding in such markets requires MNCs to think creatively. The biggest change, though, has to come from executives: Unless business leaders confront their own preconceptions--particularly about the value of high-volume, low-margin businesses--companies are unlikely to master the challenges or reap the rewards of these developing markets.

  20. Markers of vulnerability in schizophrenia

    PubMed Central

    Prelipceanu, D

    2009-01-01

    Vulnerability in schizophrenia is an integrative concept, which tries to explain the development of schizophrenia as an interaction between different individual susceptibility factors and environmental risk factors. Vulnerability markers used in genetic studies include biochemical indicators, neuroanatomical, neurophysiologic, and cognitive abnormalities. Among those, the most extensive studied markers were: evoked potentials, smooth pursuit eye movements, and attentional deficits. Some of the potential indicators presented in this paper satisfy most of the criteria necessary for a vulnerability marker, but none meets all of them. Nevertheless, they represent important markers of risk to schizophrenia. Key words: vulnerability, evoked potentials, eye movements, attentional deficits PMID:20108534

  1. Common Control System Vulnerability

    SciTech Connect

    Trent Nelson

    2005-12-01

    The Control Systems Security Program and other programs within the Idaho National Laboratory have discovered a vulnerability common to control systems in all sectors that allows an attacker to penetrate most control systems, spoof the operator, and gain full control of targeted system elements. This vulnerability has been identified on several systems that have been evaluated at INL, and in each case a 100% success rate of completing the attack paths that lead to full system compromise was observed. Since these systems are employed in multiple critical infrastructure sectors, this vulnerability is deemed common to control systems in all sectors. Modern control systems architectures can be considered analogous to today's information networks, and as such are usually approached by attackers using a common attack methodology to penetrate deeper and deeper into the network. This approach often is composed of several phases, including gaining access to the control network, reconnaissance, profiling of vulnerabilities, launching attacks, escalating privilege, maintaining access, and obscuring or removing information that indicates that an intruder was on the system. With irrefutable proof that an external attack can lead to a compromise of a computing resource on the organization's business local area network (LAN), access to the control network is usually considered the first phase in the attack plan. Once the attacker gains access to the control network through direct connections and/or the business LAN, the second phase of reconnaissance begins with traffic analysis within the control domain. Thus, the communications between the workstations and the field device controllers can be monitored and evaluated, allowing an attacker to capture, analyze, and evaluate the commands sent among the control equipment. Through manipulation of the communication protocols of control systems (a process generally referred to as ''reverse engineering''), an attacker can then map out the

  2. VuWiki: An Ontology-Based Semantic Wiki for Vulnerability Assessments

    NASA Astrophysics Data System (ADS)

    Khazai, Bijan; Kunz-Plapp, Tina; Büscher, Christian; Wegner, Antje

    2014-05-01

    vulnerability assessments with the possibility for any user to retrieve assessments using specific research criteria. Furthermore, Vuwiki can serve as a collaborative knowledge platform that allows for the active participation of those generating and using the knowledge represented in the wiki.

  3. Vendor System Vulnerability Testing Test Plan

    SciTech Connect

    James R. Davidson

    2005-01-01

    The Idaho National Laboratory (INL) prepared this generic test plan to provide clients (vendors, end users, program sponsors, etc.) with a sense of the scope and depth of vulnerability testing performed at the INL’s Supervisory Control and Data Acquisition (SCADA) Test Bed and to serve as an example of such a plan. Although this test plan specifically addresses vulnerability testing of systems applied to the energy sector (electric/power transmission and distribution and oil and gas systems), it is generic enough to be applied to control systems used in other critical infrastructures such as the transportation sector, water/waste water sector, or hazardous chemical production facilities. The SCADA Test Bed is established at the INL as a testing environment to evaluate the security vulnerabilities of SCADA systems, energy management systems (EMS), and distributed control systems. It now supports multiple programs sponsored by the U.S. Department of Energy, the U.S. Department of Homeland Security, other government agencies, and private sector clients. This particular test plan applies to testing conducted on a SCADA/EMS provided by a vendor. Before performing detailed vulnerability testing of a SCADA/EMS, an as delivered baseline examination of the system is conducted, to establish a starting point for all-subsequent testing. The series of baseline tests document factory delivered defaults, system configuration, and potential configuration changes to aid in the development of a security plan for in depth vulnerability testing. The baseline test document is provided to the System Provider,a who evaluates the baseline report and provides recommendations to the system configuration to enhance the security profile of the baseline system. Vulnerability testing is then conducted at the SCADA Test Bed, which provides an in-depth security analysis of the Vendor’s system.b a. The term System Provider replaces the name of the company/organization providing the system

  4. The Naïve nurse: revisiting vulnerability for nursing

    PubMed Central

    2012-01-01

    Background Nurses in the Western world have given considerable attention to the concept of vulnerability in recent decades. However, nurses have tended to view vulnerability from an individualistic perspective, and have rarely taken into account structural or collective dimensions of the concept. As the need grows for health workers to engage in the global health agenda, nurses must broaden earlier works on vulnerability, noting that conventional conceptualizations and practical applications on the notion of vulnerability warrant extension to include more collective conceptualizations thereby making a more complete understanding of vulnerability in nursing discourse. Discussion The purpose of this paper is to examine nursing contributions to the concept of vulnerability and consider how a broader perspective that includes socio-political dimensions may assist nurses to reach beyond the immediate milieu of the patient into the dominant social, political, and economic structures that produce and sustain vulnerability. Summary By broadening nurse’s conceptualization of vulnerability, nurses can obtain the consciousness needed to move beyond a peripheral role of nursing that has been dominantly situated within institutional settings to contribute in the larger arena of social, economic, political and global affairs. PMID:22520841

  5. The Vulnerability of Elderly Consumers.

    ERIC Educational Resources Information Center

    McGhee, Jerrie L.

    1983-01-01

    Reviews research on the vulnerability of the elderly to consumer fraud. Patterns of consumption, situational characteristics, education and product knowledge, psychological losses, social isolation, and psychosocial transitions influence the elderly's vulnerability and ability to cope with consumer abuse. Higher educational attainment and greater…

  6. Depression prevalence and primary care among vulnerable patients at a free outpatient clinic in Paris, France, in 2010: results of a cross-sectional survey

    PubMed Central

    2013-01-01

    Background Data on the prevalence of depression and on how a depressive episode prompts the sufferer to seek primary care are not scarce, but the available evidence on the prevalence of depression among immigrants and poor people who frequent general practice facilities is scarce. The Baudelaire Outpatient Clinic at the Saint-Antoine Hospital in Paris provides free medical and social assistance to the poor and/or uninsured. The goal of our study was to estimate the prevalence of depression among these outpatients, to characterize this depressed population, and to analyze its demand for primary care for depressive episodes. Methods From September to December 2010, we conducted a cross-sectional, observational survey among users of the Baudelaire Outpatient Clinic. French-speaking patients attending the clinic between September 15 and December 30, 2010 who agreed to answer a questionnaire administered face-to-face before their consultation were included in the study. The chi-squared test (or Fisher’s exact test for small samples) was used for the comparisons of proportions. Logistic regression models were estimated, along with the odds ratios (OR) and their 95% confidence intervals (95% CIs), for the multivariate analysis of factors associated with depression and healthcare-seeking. Models were estimated separately for men and women, since sex was an interaction factor. The statistical analyses were performed using Stata v. 10 software (StataCorp LP, College Station, Texas, USA). Results Of the 250 patients included (mean age: 45 years), 52.0% were men and 52.4% were immigrants. Close to 40% of them reported having no supplemental health insurance. The estimated prevalence of depression in this population was 56.7%. Depression was more prevalent among the women, immigrants, and people from the poorer socioeconomic groups. Only half of these depressed patients, mostly women, reported having discussed their depression with a physician. French nationality and complete

  7. Locating and communicating with at-risk populations about emergency preparedness: the vulnerable populations outreach model.

    PubMed

    Klaiman, Tamar; Knorr, Deborah; Fitzgerald, Shannon; Demara, Philip; Thomas, Chad; Heake, George; Hausman, Alice

    2010-10-01

    Vulnerable populations tend to have the worst health outcomes during and after disasters; however, these populations are rarely included in the emergency planning process. In Philadelphia, the Department of Public Health and the Office of Emergency Management have reached out to community-based organizations that serve vulnerable populations to include these key stakeholders in emergency planning. In this article, we outline strategies for locating, engaging, and communicating with vulnerable populations about both organizational and personal emergency preparedness. Such strategies include creating a method for bidirectional communication via a free quarterly health newsletter that is distributed to community-based organizations serving vulnerable populations. We also note successes and next steps from engaging vulnerable populations in the planning process in Philadelphia.

  8. Operationalisation of physical vulnerability to natural hazards: Vulnerability curves versus vulnerability indicators

    NASA Astrophysics Data System (ADS)

    Papathoma-Koehle, Maria

    2015-04-01

    Physical vulnerability to natural hazards is often presented as a function of the intensity of the process and the degree of loss (vulnerability or fragility curves). However, a considerable amount of studies argue that physical vulnerability assessment should focus on the identification of these variables that influence the vulnerability of an element at risk (vulnerability indicators). In this study, the focus is on the comparison between the two methods and the provision of recommendations for improved operationalisation and assessment of physical vulnerability. The comparison is illustrated through a case study in South Tyrol. The two methods have been applied at the same study area that suffered significant damages due to a debris flow event in 1987. A vulnerability curve has been developed for the buildings that suffered damages, as well as a database including physical vulnerability indicators for the same set of buildings. The comparison of the results highlight the advantages and disadvantages of the two methods showing that they should complement rather than oppose each other.

  9. 5 CFR 1203.14 - Serving documents.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... to the proceeding. (b) Method of serving documents. Pleadings may be served on parties by mail, by personal delivery, by facsimile, or by commercial delivery. Service by mail is accomplished by mailing the... pleading was served, must state the method (i.e., mail, personal delivery, facsimile, or...

  10. Research with vulnerable human beings.

    PubMed

    Tangwa, Godfrey B

    2009-11-01

    Some categories of human beings are particularly vulnerable vis-à-vis medical research. Vulnerability could be considered as the liability to be harmed, exploited, deceived, cheated, wronged, or otherwise unfairly treated, in roughly that descending order of importance. Vulnerable human beings obviously include the incompetent (minors and mentally handicapped adults), the desperately poor, ill or ignorant, prisoners, refugees, pregnant women, subordinates in highly authoritarian systems, etc. Vulnerability in itself does not imply that no research whatsoever should be carried out with such categories of humans but only that it should be carried out only under very special conditions. In this paper I treat of vulnerability in research of particularly developing world populations; of the types of research which exploit such vulnerability, and of why and how research subjects should be protected. The aim in this paper is to stimulate practical reflection on the possible vulnerabilities of potential research subjects that researchers or investigators need to avoid exploiting rather than on an adequate theoretical treatment of the issue.

  11. Cultural vulnerability and professional narratives.

    PubMed

    Gunaratnam, Yasmin

    2011-01-01

    In this article the author draws upon research with palliative care professionals in the United Kingdom to discuss the value of a stance of cultural vulnerability in intercultural care. Cultural vulnerability recognizes the reality, but also the ethical value of uncertainty and not-knowing in care. Attentiveness to professional narratives is advocated as vital in the development of greater understanding of cultural vulnerability and its effects. The role of cultural identifications and the politics of racism in social work narratives is given specific attention.

  12. Cultural vulnerability and professional narratives.

    PubMed

    Gunaratnam, Yasmin

    2011-01-01

    In this article the author draws upon research with palliative care professionals in the United Kingdom to discuss the value of a stance of cultural vulnerability in intercultural care. Cultural vulnerability recognizes the reality, but also the ethical value of uncertainty and not-knowing in care. Attentiveness to professional narratives is advocated as vital in the development of greater understanding of cultural vulnerability and its effects. The role of cultural identifications and the politics of racism in social work narratives is given specific attention. PMID:22150178

  13. [Personality traits and vulnerability markers--problems of assessment].

    PubMed

    von Zerssen, D

    1994-01-01

    Personality traits play an increasing role in research on the vulnerability to mental disorders. Problems of their assessment are dealt with here with special reference to work of our own in this area. Personality inventories for self-rating or informants' rating are appropriate instruments for retrospective as well as prospective investigations. They should be short and, at the same time, suites for the assessment of the main dimensions of personality, the "Big Five". The Munich Personality Test (MPT) and the Six Factor Test (SFT) serve as examples in this context. They were already successfully applied in clinical and outpatient settings and in "high-risk" studies. In retrospective investigations, a newly developed method for the operationalized diagnosis of personality types from case history data can be used as well. On the basis of this approach, we have recently developed a Biographical Personality Interview (BPI) which, in combination with personality inventories, can be regarded an optimal device for the assessment of premorbid personality in psychiatric patients.

  14. Multimodal spectroscopy detects features of vulnerable atherosclerotic plaque

    NASA Astrophysics Data System (ADS)

    Šćepanović, Obrad R.; Fitzmaurice, Maryann; Miller, Arnold; Kong, Chae-Ryon; Volynskaya, Zoya; Dasari, Ramachandra R.; Kramer, John R.; Feld, Michael S.

    2011-01-01

    Early detection and treatment of rupture-prone vulnerable atherosclerotic plaques is critical to reducing patient mortality associated with cardiovascular disease. The combination of reflectance, fluorescence, and Raman spectroscopy-termed multimodal spectroscopy (MMS)-provides detailed biochemical information about tissue and can detect vulnerable plaque features: thin fibrous cap (TFC), necrotic core (NC), superficial foam cells (SFC), and thrombus. Ex vivo MMS spectra are collected from 12 patients that underwent carotid endarterectomy or femoral bypass surgery. Data are collected by means of a unitary MMS optical fiber probe and a portable clinical instrument. Blinded histopathological analysis is used to assess the vulnerability of each spectrally evaluated artery lesion. Modeling of the ex vivo MMS spectra produce objective parameters that correlate with the presence of vulnerable plaque features: TFC with fluorescence parameters indicative of collagen presence; NC/SFC with a combination of diffuse reflectance β-carotene/ceroid absorption and the Raman spectral signature of lipids; and thrombus with its Raman signature. Using these parameters, suspected vulnerable plaques can be detected with a sensitivity of 96% and specificity of 72%. These encouraging results warrant the continued development of MMS as a catheter-based clinical diagnostic technique for early detection of vulnerable plaques.

  15. Assessing the Agricultural Vulnerability for India under Changing Climate

    NASA Astrophysics Data System (ADS)

    Sharma, Tarul; Vardhan Murari, Harsha; Karmakar, Subhankar; Ghosh, Subimal; Singh, Jitendra

    2016-04-01

    Global climate change has proven to show majorly negative impacts for the far future. These negative impacts adversely affect almost all the fields including agriculture, water resources, tourism, and marine ecosystem. Among these, the effects on agriculture are considered to be of prime importance since its regional impacts can directly affect the global food security. Under such lines, it becomes essential to understand how climate change directs agricultural production for a region along with its vulnerability. In India, rice and wheat are considered as major staple diet and hence understanding its production loss/gain due to regional vulnerability to climate change becomes necessary. Here, an attempt has been made to understand the agricultural vulnerability for rice and wheat, considering yield as a function of temperature and precipitation during growing period. In order to accomplish this objective, the ratio of actual to potential evapo-transpiration has been considered which serves as a reliable indicator; with more this ratio towards unity, less vulnerable will be the region. The current objective needs an integration of climatic, hydrological and agricultural parameters; that can be achieved by simulating a climate data driven hydrologic (Variable Infiltration Capacity, VIC) model and a crop (Decision Support System for Agrotechnology Transfer, DSSAT) model. The proposed framework is an attempt to derive a crop vulnerability map that can facilitate in strategizing adaption practices which can reduce the adverse impacts of climate change in future.

  16. Selected items from the Charcot-Marie-Tooth (CMT) Neuropathy Score and secondary clinical outcome measures serve as sensitive clinical markers of disease severity in CMT1A patients.

    PubMed

    Mannil, Manoj; Solari, Alessandra; Leha, Andreas; Pelayo-Negro, Ana L; Berciano, José; Schlotter-Weigel, Beate; Walter, Maggie C; Rautenstrauss, Bernd; Schnizer, Tuuli J; Schenone, Angelo; Seeman, Pavel; Kadian, Chandini; Schreiber, Olivia; Angarita, Natalia G; Fabrizi, Gian Maria; Gemignani, Franco; Padua, Luca; Santoro, Lucio; Quattrone, Aldo; Vita, Giuseppe; Calabrese, Daniela; Young, Peter; Laurà, Matilde; Haberlová, Jana; Mazanec, Radim; Paulus, Walter; Beissbarth, Tim; Shy, Michael E; Reilly, Mary M; Pareyson, Davide; Sereda, Michael W

    2014-11-01

    This study evaluates primary and secondary clinical outcome measures in Charcot-Marie-Tooth disease type 1A (CMT1A) with regard to their contribution towards discrimination of disease severity. The nine components of the composite Charcot-Marie-Tooth disease Neuropathy Score and six additional secondary clinical outcome measures were assessed in 479 adult patients with genetically proven CMT1A and 126 healthy controls. Using hierarchical clustering, we identified four significant clusters of patients according to clinical severity. We then tested the impact of each of the CMTNS components and of the secondary clinical parameters with regard to their power to differentiate these four clusters. The CMTNS components ulnar sensory nerve action potential (SNAP), pin sensibility, vibration and strength of arms did not increase the discriminant value of the remaining five CMTNS components (Ulnar compound motor action potential [CMAP], leg motor symptoms, arm motor symptoms, leg strength and sensory symptoms). However, three of the six additional clinical outcome measures - the 10m-timed walking test (T10MW), 9 hole-peg test (9HPT), and foot dorsal flexion dynamometry - further improved discrimination between severely and mildly affected patients. From these findings, we identified three different composite measures as score hypotheses and compared their discriminant power with that of the CMTNS. A composite of eight components CMAP, Motor symptoms legs, Motor symptoms arms, Strength of Legs, Sensory symptoms), displayed the strongest power to discriminate between the clusters. As a conclusion, five items from the CMTNS and three secondary clinical outcome measures improve the clinical assessment of patients with CMT1A significantly and are beneficial for upcoming clinical and therapeutic trials. PMID:25085517

  17. Selected items from the Charcot-Marie-Tooth (CMT) Neuropathy Score and secondary clinical outcome measures serve as sensitive clinical markers of disease severity in CMT1A patients.

    PubMed

    Mannil, Manoj; Solari, Alessandra; Leha, Andreas; Pelayo-Negro, Ana L; Berciano, José; Schlotter-Weigel, Beate; Walter, Maggie C; Rautenstrauss, Bernd; Schnizer, Tuuli J; Schenone, Angelo; Seeman, Pavel; Kadian, Chandini; Schreiber, Olivia; Angarita, Natalia G; Fabrizi, Gian Maria; Gemignani, Franco; Padua, Luca; Santoro, Lucio; Quattrone, Aldo; Vita, Giuseppe; Calabrese, Daniela; Young, Peter; Laurà, Matilde; Haberlová, Jana; Mazanec, Radim; Paulus, Walter; Beissbarth, Tim; Shy, Michael E; Reilly, Mary M; Pareyson, Davide; Sereda, Michael W

    2014-11-01

    This study evaluates primary and secondary clinical outcome measures in Charcot-Marie-Tooth disease type 1A (CMT1A) with regard to their contribution towards discrimination of disease severity. The nine components of the composite Charcot-Marie-Tooth disease Neuropathy Score and six additional secondary clinical outcome measures were assessed in 479 adult patients with genetically proven CMT1A and 126 healthy controls. Using hierarchical clustering, we identified four significant clusters of patients according to clinical severity. We then tested the impact of each of the CMTNS components and of the secondary clinical parameters with regard to their power to differentiate these four clusters. The CMTNS components ulnar sensory nerve action potential (SNAP), pin sensibility, vibration and strength of arms did not increase the discriminant value of the remaining five CMTNS components (Ulnar compound motor action potential [CMAP], leg motor symptoms, arm motor symptoms, leg strength and sensory symptoms). However, three of the six additional clinical outcome measures - the 10m-timed walking test (T10MW), 9 hole-peg test (9HPT), and foot dorsal flexion dynamometry - further improved discrimination between severely and mildly affected patients. From these findings, we identified three different composite measures as score hypotheses and compared their discriminant power with that of the CMTNS. A composite of eight components CMAP, Motor symptoms legs, Motor symptoms arms, Strength of Legs, Sensory symptoms), displayed the strongest power to discriminate between the clusters. As a conclusion, five items from the CMTNS and three secondary clinical outcome measures improve the clinical assessment of patients with CMT1A significantly and are beneficial for upcoming clinical and therapeutic trials.

  18. Transgender youth: invisible and vulnerable.

    PubMed

    Grossman, Arnold H; D'Augelli, Anthony R

    2006-01-01

    This study used three focus groups to explore factors that affect the experiences of youth (ages 15 to 21) who identify as transgender. The focus groups were designed to probe transgender youths' experiences of vulnerability in the areas of health and mental health. This involved their exposure to risks, discrimination, marginalization, and their access to supportive resources. Three themes emerged from an analysis of the groups' conversations. The themes centered on gender identity and gender presentation, sexuality and sexual orientation, and vulnerability and health issues. Most youth reported feeling they were transgender at puberty, and they experienced negative reactions to their gender atypical behaviors, as well as confusion between their gender identity and sexual orientation. Youth noted four problems related to their vulnerability in health-related areas: the lack of safe environments, poor access to physical health services, inadequate resources to address their mental health concerns, and a lack of continuity of caregiving by their families and communities. PMID:16893828

  19. The vulnerability of elderly consumers.

    PubMed

    McGhee, J L

    1983-01-01

    Research interest in the vulnerability of the elderly to consumer fraud has increased in recent years. Consumer surveys and studies of complaint data permit the examination of hypothesized indicators of vulnerability for samples of older and younger consumers. A review of the research shows that patterns of consumption, situational characteristics, education and product knowledge, awareness of deception, psychological losses, social isolation, and psychosocial transitions influence the elderly's vulnerability and ability to cope with consumer abuse. Higher educational attainment and a greater skepticism toward business practices should improve the coping ability of future cohorts of elderly, yet the potential for fraud will remain for many transactions vitally important to their well-being. Implications of the research findings for intervention strategies are presented.

  20. Are Vulnerability Disclosure Deadlines Justified?

    SciTech Connect

    Miles McQueen; Jason L. Wright; Lawrence Wellman

    2011-09-01

    Vulnerability research organizations Rapid7, Google Security team, and Zero Day Initiative recently imposed grace periods for public disclosure of vulnerabilities. The grace periods ranged from 45 to 182 days, after which disclosure might occur with or without an effective mitigation from the affected software vendor. At this time there is indirect evidence that the shorter grace periods of 45 and 60 days may not be practical. However, there is strong evidence that the recently announced Zero Day Initiative grace period of 182 days yields benefit in speeding up the patch creation process, and may be practical for many software products. Unfortunately, there is also evidence that the 182 day grace period results in more vulnerability announcements without an available patch.

  1. A Five-miRNA Panel Identified From a Multicentric Case-control Study Serves as a Novel Diagnostic Tool for Ethnically Diverse Non-small-cell Lung Cancer Patients.

    PubMed

    Wang, Cheng; Ding, Meng; Xia, Mingde; Chen, Sidi; Van Le, Anh; Soto-Gil, Rafael; Shen, Yi; Wang, Nan; Wang, Junjun; Gu, Wanjian; Wang, Xiangdong; Zhang, Yanni; Zen, Ke; Chen, Xi; Zhang, Chunni; Zhang, Chen-Yu

    2015-10-01

    Circulating microRNAs (miRNAs) are promising biomarkers for cancer detection. However, multiethnic and multicentric studies of non-small-cell lung cancer (NSCLC) are lacking. We recruited 221 NSCLC patients, 161 controls and 56 benign nodules from both China and America. Initial miRNA screening was performed using the TaqMan Low Density Array followed by confirming individually by RT-qPCR in Chinese cohorts. Finally, we performed a blind trial from an American cohort to validate our findings. RT-qPCR confirmed that miR-483-5p, miR-193a-3p, miR-25, miR-214 and miR-7 were significantly elevated in patients compared to controls. The areas under the curve (AUCs) of the ROC curve of this five-serum miRNA panel were 0.976 (95% CI, 0.939-1.0; P < 0.0001) and 0.823 (95% CI, 0.75-0.896; P < 0.0001) for the two confirmation sets, respectively. In the blind trial, the panel correctly classified 95% NSCLC cases and 84% controls from the American cohort. Most importantly, the panel was capable of distinguishing NSCLC from benign nodules with an AUC of 0.979 (95% CI, 0.959-1.0) in the American cohort and allowed correct prediction of 86% and 95% stage I-II tumors in the Chinese and American cohorts, respectively. This serum miRNA panel holds the potential for diagnosing ethnically diverse NSCLC patients. PMID:26629532

  2. Chronic stress-induced hippocampal vulnerability: the glucocorticoid vulnerability hypothesis.

    PubMed

    Conrad, Cheryl D

    2008-01-01

    The hippocampus, a limbic structure important in learning and memory, is particularly sensitive to chronic stress and to glucocorticoids. While glucocorticoids are essential for an effective stress response, their oversecretion was originally hypothesized to contribute to age-related hippocampal degeneration. However, conflicting findings were reported on whether prolonged exposure to elevated glucocorticoids endangered the hippocampus and whether the primate hippocampus even responded to glucocorticoids as the rodent hippocampus did. This review discusses the seemingly inconsistent findings about the effects of elevated and prolonged glucocorticoids on hippocampal health and proposes that a chronic stress history, which includes repeated elevation of glucocorticoids, may make the hippocampus vulnerable to potential injury. Studies are described to show that chronic stress or prolonged exposure to glucocorticoids can compromise the hippocampus by producing dendritic retraction, a reversible form of plasticity that includes dendritic restructuring without irreversible cell death. Conditions that produce dendritic retraction are hypothesized to make the hippocampus vulnerable to neurotoxic or metabolic challenges. Of particular interest is the finding that the hippocampus can recover from dendritic retraction without any noticeable cell loss. When conditions surrounding dendritic retraction are present, the potential for harm is increased because dendritic retraction may persist for weeks, months or even years, thereby broadening the window of time during which the hippocampus is vulnerable to harm, called the 'glucocorticoid vulnerability hypothesis'. The relevance of these findings is discussed with regard to conditions exhibiting parallels in hippocampal plasticity, including Cushing's disease, major depressive disorder (MDD), and post-traumatic stress disorder (PTSD).

  3. Molecular Imaging of Plaque Vulnerability

    PubMed Central

    Tavakoli, Sina; Vashist, Aseem; Sadeghi, Mehran M.

    2014-01-01

    Over the past decade significant progress has been made in the development of novel imaging strategies focusing on the biology of the vessel wall for identification of vulnerable plaques. While the majority of these studies are still in the preclinical stage, few techniques (e.g., 18F-FDG and 18F-NaF PET imaging) have already been evaluated in clinical studies with promising results. Here, we will briefly review the pathobiology of atherosclerosis and discuss molecular imaging strategies that have been developed to target these events, with an emphasis on mechanisms that are associated with atherosclerotic plaque vulnerability. PMID:25124827

  4. Food Chain Security and Vulnerability

    NASA Astrophysics Data System (ADS)

    Brunet, Sébastien; Delvenne, Pierre; Claisse, Frédéric

    In our contemporary societies, the food chain could be defined as a macro-technical system, which depends on a wide variety of actors and risks analysis methods. In this contribution, risks related to the food chain are defined in terms of "modern risks" (Beck 1992). The whole national economic sector of food production/distribution is vulnerable to a local accident, which can affect the functioning of food chain, the export programs and even the political system. Such a complex socio-technical environment is undoubtedly vulnerable to intentional act such as terrorism.

  5. The Vulnerable Plaque: the Real Villain in Acute Coronary Syndromes

    PubMed Central

    Liang, Michael; Puri, Aniket; Devlin, Gerard

    2011-01-01

    The term "vulnerable plaque" refers to a vascular lesion that is prone to rupture and may result in life-threatening events which include myocardial infarction. It consists of thin-cap fibroatheroma and a large lipid core which is highly thrombogenic. Acute coronary syndromes often result from rupture of vulnerable plaques which frequently are only moderately stenosed and not visible by conventional angiography. Several invasive and non-invasive strategies have been developed to assess the burden of vulnerable plaques. Intravascular ultrasound provides a two-dimensional cross-sectional image of the arterial wall and can help assess the plaque burden and composition. Optical coherent tomography offers superior resolution over intravascular ultrasound. High-resolution magnetic resonance imaging provides non-invasive imaging for visualizing fibrous cap thickness and rupture in plaques. In addition, it may be of value in assessing the effects of treatments, such as lipid-lowering therapy. Technical issues however limit its clinical applicability. The role of multi-slice computed tomography, a well established screening tool for coronary artery disease, remains to be determined. Fractional flow reserve (FFR) may provide physiological functional assessment of plaque vulnerability; however, its role in the management of vulnerable plaque requires further studies. Treatment of the vulnerable patient may involve systemic therapy which currently include statins, ACE inhibitors, beta-blockers, aspirin, and calcium-channel blockers and in the future local therapeutic options such as drug-eluting stents or photodynamic therapy. PMID:21673834

  6. Calories and fat per serving (image)

    MedlinePlus

    ... and stores the rest in the form of fat. A calorie is a calorie, whether it comes ... between them is the number of calories, nutrients, fat, and other ingredients in a typical serving . Calories ...

  7. Skylab Food Heating and Serving Tray

    NASA Technical Reports Server (NTRS)

    1970-01-01

    Shown here is the Skylab food heating and serving tray in its stowed position. The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

  8. Vulnerability in research ethics: a way forward.

    PubMed

    Lange, Margaret Meek; Rogers, Wendy; Dodds, Susan

    2013-07-01

    Several foundational documents of bioethics mention the special obligation researchers have to vulnerable research participants. However, the treatment of vulnerability offered by these documents often relies on enumeration of vulnerable groups rather than an analysis of the features that make such groups vulnerable. Recent attempts in the scholarly literature to lend philosophical weight to the concept of vulnerability are offered by Luna and Hurst. Luna suggests that vulnerability is irreducibly contextual and that Institutional Review Boards (Research Ethics Committees) can only identify vulnerable participants by carefully examining the details of the proposed research. Hurst, in contrast, defines the vulnerable as those especially at risk of incurring the wrongs to which all research ethics participants are exposed. We offer a more substantive conception of vulnerability than Luna but one that gives rise to a different rubric of responsibilities from Hurst's. While we understand vulnerability to be an ontological condition of human existence, in the context of research ethics, we take the vulnerable to be research subjects who are especially prone to harm or exploitation. Our analysis rests on developing a typology of sources of vulnerability and showing how distinct sources generate distinct obligations on the part of the researcher. Our account emphasizes that the researcher's first obligation is not to make the research participant even more vulnerable than they already are. To illustrate our framework, we consider two cases: that of a vulnerable population involved in international research and that of a domestic population of people with diminished capacity.

  9. US Vulnerability to Natural Disasters

    NASA Astrophysics Data System (ADS)

    van der Vink, G.; Apgar, S.; Batchelor, A.; Carter, C.; Gail, D.; Jarrett, A.; Levine, N.; Morgan, W.; Orlikowski, M.; Pray, T.; Raymar, M.; Siebert, A.; Shawa, T. W.; Wallace, C.

    2002-05-01

    Natural disasters result from the coincidence of natural events with the built environment. Our nation's infrastructure is growing at an exponential rate in many areas of high risk, and the Federal government's liability is increasing proportionally. By superimposing population density with predicted ground motion from earthquakes, historical hurricane tracks, historical tornado locations, and areas within the flood plain, we are able to identify locations of high vulnerability within the United States. We present a comprehensive map of disaster risk for the United States that is being produced for the Senate Natural Hazards Caucus. The map allows for the geographic comparison of natural disaster risk with past disaster declarations, the expenditure of Federal dollars for disaster relief, population increase, and variations of GDP. Every state is vulnerable to natural disasters. Although their frequency varies considerably, the annualized losses for disaster relief from hurricanes, earthquakes, and floods are approximately equivalent. While fast-growing states such as California and Florida remain highly vulnerable, changes in the occurrence of natural events combined with population increases are making areas such as Texas, North Carolina, and the East Coast increasingly vulnerable.

  10. Viability of the Vulnerability Thesis.

    ERIC Educational Resources Information Center

    Lutz, Frank W.

    1996-01-01

    Summarizes the viability of the vulnerability thesis as a tool in accounting for school superintendent behavior today, suggesting how the thesis can be built on in order to better understand the political world of superintendency. The paper suggests some social and political theories that might extend the thesis, further clarifying the…

  11. REGIONAL VULNERABILITY: A CONCEPTUAL FRAMEWORK

    EPA Science Inventory

    Regional vulnerability assessment, or ReVA, is an approach to place-based ecological risk assessment that is currently under development by the Office of Research and Development of the U.S. Environmental Protection Agency (EPA). The assessment is done at the scale of EPA region...

  12. Measuring Vulnerability to Stereotype Threat

    ERIC Educational Resources Information Center

    Barnard, Lucy; Burley, Hansel; Olivarez, Arturo; Crooks, Steven

    2008-01-01

    Introduction: In this study, we examined the psychometric properties of an instrument intended to measure vulnerability to stereotype threat. Method: We revised the instrument through assessing score reliability and then examined a domain specific model using confirmatory factor analyses. After examining the responses of the total sample…

  13. Nursing Student Birth Doulas' Influence On the Childbearing Outcomes of Vulnerable Populations.

    PubMed

    Van Zandt, Shirley E; Kim, Soohyun; Erickson, Amanda

    2016-01-01

    Of 1,511 women served by nursing student birth doulas (Birth Companions) between 1998 and 2014, 34.5% were identified as vulnerable (refugees, non-English speakers, teens, low income, low education). This retrospective evaluation of the Birth Companions Program showed that vulnerable mothers had more epidurals and smaller babies, and attempted breastfeeding less frequently than nonvulnerable. There was no difference in the frequency of caesarean births, pitocin induction/augmentation, low birth weight, or preterm newborns among the vulnerable women. Birth Companion interventions may have a role in influencing these outcomes. The Birth Companions program will use this analysis to identify additional services for these populations. PMID:27383776

  14. Vulnerable Subjects: Why Does Informed Consent Matter?

    PubMed

    Goodwin, Michele

    2016-09-01

    This special issue of the Journal Law, Medicine & Ethics takes up the concern of informed consent, particularly in times of controversy. The dominant moral dilemmas that frame traditional bioethical concerns address medical experimentation on vulnerable subjects; physicians assisting their patients in suicide or euthanasia; scarce resource allocation and medical futility; human trials to develop drugs; organ and tissue donation; cloning; xenotransplantation; abortion; human enhancement; mandatory vaccination; and much more. The term "bioethics" provides a lens, language, and guideposts to the study of medical ethics. It is worth noting, however, that medical experimentation is neither new nor exclusive to one country. Authors in this issue address thorny subjects that span borders and patients: from matters dealing with children and vaccination to the language and perception of consent.

  15. Vulnerable Subjects: Why Does Informed Consent Matter?

    PubMed

    Goodwin, Michele

    2016-09-01

    This special issue of the Journal Law, Medicine & Ethics takes up the concern of informed consent, particularly in times of controversy. The dominant moral dilemmas that frame traditional bioethical concerns address medical experimentation on vulnerable subjects; physicians assisting their patients in suicide or euthanasia; scarce resource allocation and medical futility; human trials to develop drugs; organ and tissue donation; cloning; xenotransplantation; abortion; human enhancement; mandatory vaccination; and much more. The term "bioethics" provides a lens, language, and guideposts to the study of medical ethics. It is worth noting, however, that medical experimentation is neither new nor exclusive to one country. Authors in this issue address thorny subjects that span borders and patients: from matters dealing with children and vaccination to the language and perception of consent. PMID:27587443

  16. Global trends and vulnerabilities of mangrove forests

    NASA Astrophysics Data System (ADS)

    Simard, M.; Fatoyinbo, T. E.; Rivera-Monroy, V. H.; Castaneda, E.; Roy Chowdhury, R.

    2015-12-01

    Mangrove forests are located along Earth's coastlines and estuaries within tropical and subtropical latitudes. They provide numerous services functioning as an extraordinary carbon sequestration system and serving as habitat and nursery for fish, crustaceans and amphibians. To coastal populations, they provide livelihood, food, lumber and act as an effective protection against tsunamis, storm surges and hurricanes. Their vulnerability to sea level rise is strongly related to their extraordinary ability to accumulate soils, which is in part related to their productivity and therefore canopy structure. As a first step to understand their vulnerability, we seek to understand mangrove dependencies on environmental and geophysical setting. To achieve this, we mapped mangrove canopy height and above ground biomass (AGB) at the Global scale. To identify mangrove forests, existing maps derived from a collection of Landsat data around the 2000 era were used. Using the Shuttle Radar Topography Mission elevation data collected in February of 2000, we produced a Global map of mangrove canopy height. The estimated heights were validated with the ICESat/Geoscience Altimeter System (GLAS) and in situ field data. Most importantly, field data were also used to derive relationships between canopy height and AGB. While the geographical coverage of in situ data is limited, ICESat/GLAS data provided extensive geographical coverage with independent estimates of maximum canopy height. These estimates were used to calibrate SRTM-estimates of height at the Global scale. We found the difference between GLAS RH100 and SRTM resulted from several sources of uncertainty that are difficult to isolate. These include natural variations of canopy structure with time, system errors from GLAS and SRTM, geo-location errors and discrepancies in spatial resolution. The Global canopy height map was trnasormed into AGB using the field-derived allometry. Depending on the scale of analysis and geographical

  17. Childhood Cancer and Vulnerability for Significant Academic Underachievement.

    ERIC Educational Resources Information Center

    Ott, Jeanne S.; And Others

    1982-01-01

    Learning difficulties related to childhood cancer were examined by comparison of 22 oncology patients and 22 children (6 to 17 years old) referred for psychiatric/psychological evaluation. Findings demonstrated, among children undergoing treatment of cancer, some academic vulnerabilities for which psychosocial aspects may not fully account.…

  18. Osteocytes serve as a progenitor cell of osteosarcoma

    PubMed Central

    Sottnik, Joseph L; Campbell, Brittany; Mehra, Rohit; Behbahani-Nejad, Omid; Hall, Christopher L.; Keller, Evan T.

    2016-01-01

    Osteosarcoma (OSA) is the most common primary bone tumor in humans. However, the cell of origin of OSA is not clearly defined although there is evidence that osteoblasts may serve as OSA progenitors. The role of osteocytes, terminally differentiated osteoblasts, as OSA progenitors has yet to be described. Analysis of patient cDNA from publicly available microarray data revealed that patients with OSA have increased expression of dentin matrix phosphoprotein 1 (DMP1), a marker of osteocytes. Analysis of multiple murine, human, and canine OSA cell lines revealed DMP1 expression. To test the tumorigenic potential of osteocytes, MLO-Y4, an SV-40 immortalized murine osteocyte cell line, was injected into subcutaneous and orthotopic (intratibial) sites of mice. Tumor growth occurred in both locations. Orthotopic MLO-Y4 tumors produced mixed osteoblastic/osteolytic radiographic lesions; a hallmark of OSA. Together, these data demonstrate for the first time that osteocytes can serve as OSA progenitors. PMID:24700678

  19. Assessing European wild fire vulnerability

    NASA Astrophysics Data System (ADS)

    Oehler, F.; Oliveira, S.; Barredo, J. I.; Camia, A.; Ayanz, J. San Miguel; Pettenella, D.; Mavsar, R.

    2012-04-01

    Wild fire vulnerability is a measure of potential socio-economic damage caused by a fire in a specific area. As such it is an important component of long-term fire risk management, helping policy-makers take informed decisions about adequate expenditures for fire prevention and suppression, and to target those regions at highest risk. This paper presents a first approach to assess wild fire vulnerability at the European level. A conservative approach was chosen that assesses the cost of restoring the previous land cover after a potential fire. Based on the CORINE Land Cover, a restoration cost was established for each land cover class at country level, and an average restoration time was assigned according to the recovery capacity of the land cover. The damage caused by fire was then assessed by discounting the cost of restoring the previous land cover over the restoration period. Three different vulnerability scenarios were considered assuming low, medium and high fire severity causing different levels of damage. Over Europe, the potential damage of wild land fires ranges from 10 - 13, 732 Euro*ha-1*yr-1 for low fire severity, 32 - 45,772 Euro*ha-1*yr-1 for medium fire severity and 54 - 77,812 Euro*ha-1*yr-1 for high fire severity. The least vulnerable are natural grasslands, moors and heathland and sclerophyllous vegetation, while the highest cost occurs for restoring broad-leaved forest. Preliminary validation comparing these estimates with official damage assessments for past fires shows reasonable results. The restoration cost approach allows for a straightforward, data extensive assessment of fire vulnerability at European level. A disadvantage is the inherent simplification of the evaluation procedure with the underestimation of non-markets goods and services. Thus, a second approach has been developed, valuing individual wild land goods and services and assessing their annual flow which is lost for a certain period of time in case of a fire event. However

  20. Intensified tuberculosis case finding amongst vulnerable communities in southern India.

    PubMed

    Reddy, K K; Ananthakrishnan, R; Jacob, A G; Das, M; Isaakidis, P; Kumar, A M V

    2015-12-21

    India mainly uses passive case finding to detect tuberculosis (TB) patients through the Revised National Tuberculosis Control Programme (RNTCP). An intensified case finding (ICF) intervention was conducted among vulnerable communities in two districts of Karnataka during July-December 2013; 658 sputum smear-positive TB cases were detected. The number of smear-positive cases detected increased by 8.8% relative to the pre-intervention period (July-December 2012) in intervention communities as compared to an 8.6% decrease in communities without the ICF intervention. ICF activities brought TB services closer to vulnerable communities, moderately increasing TB case detection rates.

  1. Assessment of Coronary Plaque Vulnerability with Optical Coherence Tomography

    PubMed Central

    Uemura, Shiro; Soeda, Tsunenari; Sugawara, Yu; Ueda, Tomoya; Watanabe, Makoto; Saito, Yoshihiko

    2014-01-01

    Several catheter-based imaging modalities have been developed over the past 2 decades for visualizing the morphological features of coronary atherosclerotic plaques that are susceptible to future development of serious cardiovascular events. Optical coherence tomography (OCT) is a new high-resolution intracoronary imaging modality based on near-infrared interferometry, and it has been shown to be able to identify various components of atheromatous plaques. In this review, we examine the histopathology of vulnerable plaques as a target for imaging technology, and discuss the evidence of OCT in identifying vulnerable atherosclerotic lesions in patients with coronary artery disease. PMID:27122761

  2. Routing in DiffServ multicast environment

    NASA Astrophysics Data System (ADS)

    Verma, Shekhar

    2002-07-01

    QOS aware applications have propelled the development of two complementary technologies, Multicasting and Differentiated Services. To provide the required QOS on the Internet, either the bandwidth needs to be increased (Multicasting) or limited bandwidth prioritized among users (DiffServ). Although, the bandwidth on the Internet is continually increasing, the backbone is still insufficient to support QOS without resource allocations. Hence, there is a need to map multicasting in a DiffServ Environment to conserve network bandwidth and to provision this bandwidth in an appropriate fashion. In this regard, two issues have to be addressed. One, the key difference between multicast and DiffServe routing is the structure of the multicast tree. This tree is maintained in multicast aware routers whereas in DiffServe, the core routers maintain no state information regarding the flows. Second, the task of restructuring the multicast tree when members join/leave. Currently, the first issue is addressed by embedding the multicast information within the packet itself as an additional header field. In this paper, we propose a neural network based heuristic approach to address the second problem of routing in a dynamic DiffServe Multicast environment. Many dynamic multicast routing algorithms have been proposed. The greedy algorithm creates a near optimal tree when a node is added but requires many query/reply messages. The PSPT algorithm cannot construct a cost optimal tree. The VTDM algorithm requires the estimated number of nodes that will join and is not flexible. The problem of building an optimal tree to satisfy QOS requirements at minimum cost and taking minimum network resources is NP- complete and none of the above solutions give an optimal solution. We have modeled this combinatorial optimization as a nonlinear programming problem and trained an artificial neural network to solve the problem. The problem is tractable only when the QOS parameters are combined into DiffServe

  3. Vulnerabilities to misinformation in online pharmaceutical marketing.

    PubMed

    De Freitas, Julian; Falls, Brian A; Haque, Omar S; Bursztajn, Harold J

    2013-05-01

    Given the large percentage of Internet users who search for health information online, pharmaceutical companies have invested significantly in online marketing of their products. Although online pharmaceutical marketing can potentially benefit both physicians and patients, it can also harm these groups by misleading them. Indeed, some pharmaceutical companies have been guilty of undue influence, which has threatened public health and trust. We conducted a review of the available literature on online pharmaceutical marketing, undue influence and the psychology of decision-making, in order to identify factors that contribute to Internet users' vulnerability to online pharmaceutical misinformation. We find five converging factors: Internet dependence, excessive trust in the veracity of online information, unawareness of pharmaceutical company influence, social isolation and detail fixation. As the Internet continues to change, it is important that regulators keep in mind not only misinformation that surrounds new web technologies and their contents, but also the factors that make Internet users vulnerable to misinformation in the first place. Psychological components are a critical, although often neglected, risk factor for Internet users becoming misinformed upon exposure to online pharmaceutical marketing. Awareness of these psychological factors may help Internet users attentively and safely navigate an evolving web terrain.

  4. Vulnerability genes or plasticity genes?

    PubMed Central

    Belsky, J; Jonassaint, C; Pluess, M; Stanton, M; Brummett, B; Williams, R

    2009-01-01

    The classic diathesis–stress framework, which views some individuals as particularly vulnerable to adversity, informs virtually all psychiatric research on behavior–gene–environment (G × E) interaction. An alternative framework of ‘differential susceptibility' is proposed, one which regards those most susceptible to adversity because of their genetic make up as simultaneously most likely to benefit from supportive or enriching experiences—or even just the absence of adversity. Recent G × E findings consistent with this perspective and involving monoamine oxidase-A, 5-HTTLPR (5-hydroxytryptamine-linked polymorphic region polymorphism) and dopamine receptor D4 (DRD4) are reviewed for illustrative purposes. Results considered suggest that putative ‘vulnerability genes' or ‘risk alleles' might, at times, be more appropriately conceptualized as ‘plasticity genes', because they seem to make individuals more susceptible to environmental influences—for better and for worse. PMID:19455150

  5. Soil vulnerability for cesium transfer.

    PubMed

    Vandenhove, Hildegarde; Sweeck, Lieve

    2011-07-01

    The recent events at the Fukushima Daiichi nuclear power plant in Japan have raised questions about the accumulation of radionuclides in soils and the possible impacts on agriculture surrounding nuclear power plants. This article summarizes the knowledge gained after the nuclear power plant accident in Chernobyl, Ukraine, on how soil parameters influence soil vulnerability for radiocesium bioavailability, discusses some potential agrochemical countermeasures, and presents some predictions of radiocesium crop concentrations for areas affected by the Fukushima accident. PMID:21608116

  6. [Precarity, vulnerability, anticipating end-of-life care at home].

    PubMed

    Bonneval, Camille

    2016-02-01

    Many patients want to end their life at home. Care teams adapt to these wishes and organise a form of treatment which blends safety of care and the respect of the expectations of the patients and family members. When factors of precarity increase the vulnerability inherent to the end of life, caregivers anticipate and support as best as they can the difficulties encountered as testified by a hospital at home team in Dax. PMID:26861082

  7. Cotton genetic resources and crop vulnerability

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A report on the genetic vulnerability of cotton was provided to the National Genetic Resources Advisory Council. The report discussed crop vulnerabilities associated with emerging diseases, emerging pests, and a narrowing genetic base. To address these crop vulnerabilities, the report discussed the ...

  8. Reentry Preparedness among Soon-to-be-Released Inmates and the Role of Time Served

    PubMed Central

    Wolff, Nancy; Shi, Jing; Schumann, Brooke E.

    2014-01-01

    Purpose While reentry funding is flowing into states, its target efficiency and effectiveness depends on whether it goes to the right people in the right ways. The purpose of this study was to examine whether and how the amount of time incarcerated affects reentry readiness. Materials and Methods A population-based survey was conducted. Approximately 4000 soon-to-be-released male inmates were drawn from a state correctional system. Readiness is described in terms of feeling ready and material, social, and treatment resources available for reentry by time served on current conviction (episode effect) and since age 18 (cumulative effect). Generalized hierarchical linear models were used to estimate the effects of demographic, criminological, and time served variables on reentry readiness outcomes. Results Reentry vulnerability increased with time served since turning 18 (cumulative effect) but not with time served on the current conviction (episode effect). Inmates serving more than 10 years since turning 18 were at greatest reentry risk. Conclusions The findings indicate that inmates who have served more prison time over their lifetime have more pronounced needs and risks suggesting that reentry funding be targeted towards those who have served more time over the course of their lifetime. PMID:24431474

  9. Innovative Methods for Serving Rural Handicapped Children.

    ERIC Educational Resources Information Center

    Latham, Glenn; Burnham, Julia

    1985-01-01

    Some innovative methods of serving the rural handicapped population are described: volunteers; telecommunications for home instruction; SPECIALNET electronic mail; and resources for parents. Three cases involving Utah's Cooperative Extension Project for the Handicapped summarize services for handicapped and Indian students. (GDC)

  10. Getting It Together: Serving the Adult Community.

    ERIC Educational Resources Information Center

    Bakshis, Robert D.

    1979-01-01

    Describes a community needs assessment survey conducted by the College of DuPage (Illinois) which served to advertise existing programs, provide public relations for the adult education council, and obtain measures of need for existing or expanded educational and leisure activities. (MB)

  11. Serving Stakeholders at a Small Regional University

    ERIC Educational Resources Information Center

    Burrage, Sean

    2015-01-01

    The Southeastern Oklahoma State University Honors Program serves a unique role in a small, rural setting such as Durant, Oklahoma. The honors program has a traditional mission in a university that offers a nontraditional setting and history within the context of higher education. The program thus offers special rewards to its students and to the…

  12. Secondary Prevention--Serving Families at Risk.

    ERIC Educational Resources Information Center

    Thyen, Ute; And Others

    1995-01-01

    The Child Protection Center in Lubeck (Germany) offers a nonpunitive, self-help approach to prevent child abuse by encouraging families to determine their own needs. Over half of families served over a two-year period were self-reported and almost one-fifth received help to prevent violence against children before the occurrence of child abuse or…

  13. Measuring the Velocity of a Tennis Serve.

    ERIC Educational Resources Information Center

    Eng, John; Lietman, Thomas

    1994-01-01

    Presents an alternative to the use of a radar to determine how fast an individual can serve a tennis ball. Equipped with a tape recorder and a Macintosh computer, students determine the velocity of a tennis ball by analyzing the sounds and echoes heard on the court. (ZWH)

  14. Pyramid Servings Database (PSDB) for NHANES III

    Cancer.gov

    The National Cancer Institute developed a database to examine dietary data from the National Center for Health Statistics' Third National Health and Nutrition Examination Survey in terms of servings from each of United States Department of Agriculture's The Food Guide Pyramid's major and minor food groups.

  15. Making a Difference by Serving All Students

    ERIC Educational Resources Information Center

    Olley, Rivka I.

    2009-01-01

    Randi Brown came to school psychology almost as a family business. Her grandmother was a school psychologist and the first licensed psychologist in the state of New York. Randi graduated with a doctoral degree from Yeshiva University and has served students in Westchester County, New York, for 18 years. She exemplifies the dedication typical of so…

  16. How Finland Serves Gifted and Talented Pupils

    ERIC Educational Resources Information Center

    Tirri, Kirsi; Kuusisto, Elina

    2013-01-01

    The purpose of this article is to provide an overview of the ways gifted and talented pupils are served in Finland. The trend toward individualism and freedom of choice as well as national policy affecting gifted education are discussed. Empirical research on Finnish teachers' attitudes toward gifted education with respect to the national…

  17. Serving Distant Learners through Instructional Technologies.

    ERIC Educational Resources Information Center

    Drea, John T.; Armistead, L. Pendleton

    John Wood Community College (JWCC) serves a district population of approximately 90,000 in a predominantly rural section of west-central Illinois. In an effort to address the needs of the rural long-distance learner, JWCC has implemented a variety of instructional delivery techniques. Since its inception, JWCC has contracted with other area…

  18. Science To Serve the Common Good.

    ERIC Educational Resources Information Center

    Brewer, Garry D.

    1997-01-01

    Reviews "Upstream: Salmon and Society in the Pacific Northwest", a report produced by a committee of the National Research Council that offers a model of a new and better approach to addressing environmental problems that could enable science to serve the common good. Demonstrates a successful approach to doing science and contributing to society.…

  19. "Gateway" Districts Struggle to Serve Immigrant Parents

    ERIC Educational Resources Information Center

    Maxwell, Lesli A.

    2012-01-01

    As thousands of communities--especially in the South--became booming gateways for immigrant families during the 1990s and the early years of the new century, public schools struggled with the unfamiliar task of serving the large numbers of English-learners arriving in their classrooms. Instructional programs were built from scratch. Districts had…

  20. Serving Business in an Information Economy.

    ERIC Educational Resources Information Center

    The Bookmark, 1988

    1988-01-01

    The 23 articles in this theme issue focus on various aspects of library services to business in an information economy: "Serving Business in an Information Economy" (C. Bain); "New York's Resurging Economy and State Economic Development Information" (R. G. Paolino); "Department of Economic Development Library: Services to Business" (B. S.…

  1. Graduate Students Serve Extension as Evaluation Consultants

    ERIC Educational Resources Information Center

    McClure, Megan; Fuhrman, Nicholas E.

    2011-01-01

    In an effort to provide graduate students at a distance with field-based learning experiences and evaluation resources to statewide Extension programs, 24 Master's students participating in a distance-delivered program evaluation course served as evaluation consultants for Extension programs. State evaluation specialists unable to conduct…

  2. Serving up Success! Team Nutrition Days, 1997.

    ERIC Educational Resources Information Center

    Food and Nutrition Service (USDA), Washington, DC.

    This publication presents success stories and actual activities from Team Nutrition Days 1997 to serve as a starting point for other schools wanting to create their own nutrition education activities. Team Nutrition Days was a 1-week celebration that used innovative, interactive activities to teach children that nutrition is the link between…

  3. Measuring vulnerability to disaster displacement

    NASA Astrophysics Data System (ADS)

    Brink, Susan A.; Khazai, Bijan; Power, Christopher; Wenzel, Friedemann

    2015-04-01

    Large scale disasters can cause devastating impacts in terms of population displacement. Between 2008 and 2013, on average 27 million people were displaced annually by disasters (Yonetani 2014). After large events such as hurricane Katrina or the Port-au-Prince earthquake, images of inadequate public shelter and concerns about large scale and often inequitable migration have been broadcast around the world. Population displacement can often be one of the most devastating and visible impacts of a natural disaster. Despite the importance of population displacement in disaster events, measures to understand the socio-economic vulnerability of a community often use broad metrics to estimate the total socio-economic risk of an event rather than focusing on the specific impacts that a community faces in a disaster. Population displacement is complex and multi-causal with the physical impact of a disaster interacting with vulnerability arising from the response, environmental issues (e.g., weather), cultural concerns (e.g., expectations of adequate shelter), and many individual factors (e.g., mobility, risk perception). In addition to the complexity of the causes, population displacement is difficult to measure because of the wide variety of different terms and definitions and its multi-dimensional nature. When we speak of severe population displacement, we may refer to a large number of displaced people, an extended length of displacement or associated difficulties such as poor shelter quality, risk of violence and crime in shelter communities, discrimination in aid, a lack of access to employment or other difficulties that can be associated with large scale population displacement. We have completed a thorough review of the literature on disaster population displacement. Research has been conducted on historic events to understand the types of negative impacts associated with population displacement and also the vulnerability of different groups to these impacts. We

  4. Patterns of Freshwater Species Richness, Endemism, and Vulnerability in California

    PubMed Central

    Furnish, Joseph; Gardali, Thomas; Grantham, Ted; Katz, Jacob V. E.; Kupferberg, Sarah; McIntyre, Patrick; Moyle, Peter B.; Ode, Peter R.; Peek, Ryan; Quiñones, Rebecca M.; Rehn, Andrew C.; Santos, Nick; Schoenig, Steve; Serpa, Larry; Shedd, Jackson D.; Slusark, Joe; Viers, Joshua H.; Wright, Amber; Morrison, Scott A.

    2015-01-01

    The ranges and abundances of species that depend on freshwater habitats are declining worldwide. Efforts to counteract those trends are often hampered by a lack of information about species distribution and conservation status and are often strongly biased toward a few well-studied groups. We identified the 3,906 vascular plants, macroinvertebrates, and vertebrates native to California, USA, that depend on fresh water for at least one stage of their life history. We evaluated the conservation status for these taxa using existing government and non-governmental organization assessments (e.g., endangered species act, NatureServe), created a spatial database of locality observations or distribution information from ~400 data sources, and mapped patterns of richness, endemism, and vulnerability. Although nearly half of all taxa with conservation status (n = 1,939) are vulnerable to extinction, only 114 (6%) of those vulnerable taxa have a legal mandate for protection in the form of formal inclusion on a state or federal endangered species list. Endemic taxa are at greater risk than non-endemics, with 90% of the 927 endemic taxa vulnerable to extinction. Records with spatial data were available for a total of 2,276 species (61%). The patterns of species richness differ depending on the taxonomic group analyzed, but are similar across taxonomic level. No particular taxonomic group represents an umbrella for all species, but hotspots of high richness for listed species cover 40% of the hotspots for all other species and 58% of the hotspots for vulnerable freshwater species. By mapping freshwater species hotspots we show locations that represent the top priority for conservation action in the state. This study identifies opportunities to fill gaps in the evaluation of conservation status for freshwater taxa in California, to address the lack of occurrence information for nearly 40% of freshwater taxa and nearly 40% of watersheds in the state, and to implement adequate

  5. Patterns of Freshwater Species Richness, Endemism, and Vulnerability in California.

    PubMed

    Howard, Jeanette K; Klausmeyer, Kirk R; Fesenmyer, Kurt A; Furnish, Joseph; Gardali, Thomas; Grantham, Ted; Katz, Jacob V E; Kupferberg, Sarah; McIntyre, Patrick; Moyle, Peter B; Ode, Peter R; Peek, Ryan; Quiñones, Rebecca M; Rehn, Andrew C; Santos, Nick; Schoenig, Steve; Serpa, Larry; Shedd, Jackson D; Slusark, Joe; Viers, Joshua H; Wright, Amber; Morrison, Scott A

    2015-01-01

    The ranges and abundances of species that depend on freshwater habitats are declining worldwide. Efforts to counteract those trends are often hampered by a lack of information about species distribution and conservation status and are often strongly biased toward a few well-studied groups. We identified the 3,906 vascular plants, macroinvertebrates, and vertebrates native to California, USA, that depend on fresh water for at least one stage of their life history. We evaluated the conservation status for these taxa using existing government and non-governmental organization assessments (e.g., endangered species act, NatureServe), created a spatial database of locality observations or distribution information from ~400 data sources, and mapped patterns of richness, endemism, and vulnerability. Although nearly half of all taxa with conservation status (n = 1,939) are vulnerable to extinction, only 114 (6%) of those vulnerable taxa have a legal mandate for protection in the form of formal inclusion on a state or federal endangered species list. Endemic taxa are at greater risk than non-endemics, with 90% of the 927 endemic taxa vulnerable to extinction. Records with spatial data were available for a total of 2,276 species (61%). The patterns of species richness differ depending on the taxonomic group analyzed, but are similar across taxonomic level. No particular taxonomic group represents an umbrella for all species, but hotspots of high richness for listed species cover 40% of the hotspots for all other species and 58% of the hotspots for vulnerable freshwater species. By mapping freshwater species hotspots we show locations that represent the top priority for conservation action in the state. This study identifies opportunities to fill gaps in the evaluation of conservation status for freshwater taxa in California, to address the lack of occurrence information for nearly 40% of freshwater taxa and nearly 40% of watersheds in the state, and to implement adequate

  6. Acquaintance molestation and youth-serving organizations.

    PubMed

    Lanning, Kenneth V; Dietz, Park

    2014-10-01

    This article is based not only on the research literature but also on the extensive field experience of the authors in consulting with investigators, attorneys, and organizations on the prevention, investigation, prosecution, and civil litigation of molestation of children within or in connection with youth-serving organizations. Acquaintance molesters have often pursued careers or sought out paid or volunteer work with organizations through which they can meet children. To address the problem of such offenders, it is necessary for youth-serving organizations to recognize the diversity of sexual activity, the phenomena of "nice-guy" offenders and compliant child victims, and the grooming/seduction process, each of which is reviewed here. The four most important protection practices for organizations are screening; management, and supervision; response to suspicions, allegations, and complaints; and prevention and awareness programs. The authors recommend general approaches to each of these and describe the reasons many organizations resist implementing available preventive measures. PMID:24860081

  7. Culturally Relevant Practices That "Serve" Students at a Hispanic Serving Institution

    ERIC Educational Resources Information Center

    Garcia, Gina A.; Okhidoi, Otgonjargal

    2015-01-01

    As institutions not founded to "serve" Latina/o students, Hispanic Serving Institutions (HSIs) must actively change their curricula and programs to meet the needs of their diverse population, including Latina/o, low income, and first generation students. Using a case study approach, including interviews and focus groups, this study…

  8. Minority-Serving Institutions of Higher Education: Serving Communities, Revitalizing the Nation

    ERIC Educational Resources Information Center

    US Department of Housing and Urban Development, 2009

    2009-01-01

    Institutions of higher education (IHEs) that serve minority populations are unique both in their missions and in their day-to-day operations. Some of these colleges and universities are located in remote regions of the country, while others serve congested urban neighborhoods. Their constituents range from Native Americans, the country's oldest…

  9. Complicating a Latina/o-Serving Identity at a Hispanic Serving Institution

    ERIC Educational Resources Information Center

    Garcia, Gina A.

    2016-01-01

    As institutions not founded to "serve" Latina/o students, Hispanic Serving Institutions (HSIs) are criticized for solely being "Hispanic-enrolling," with access and graduation rates being hypothesized as indicators of an organizational identity for HSIs. Drawing from a case study with 88 participants, the purpose of this…

  10. Emerging Hispanic-Serving Institutions (HSIs): Serving Latino Students. Executive Summary

    ERIC Educational Resources Information Center

    Excelencia in Education (NJ1), 2010

    2010-01-01

    The invention of Hispanic-serving Institutions (HSIs) in the 1980s was grounded in the theory that institutions enrolling a large concentration of Latino students would adapt their institutional practices to serve these students better. Specifically, critical mass theory suggests once a definable group reaches a certain size within an…

  11. Equipment for Hot-to-serve Foods

    NASA Technical Reports Server (NTRS)

    Smith, D. P.

    1985-01-01

    Patented surface heating devices with a much faster air-to-solid heat transfer rate than previous air ovens were developed. The accelerated surface heating can brown, sear or crisp much more rapidly than in conventional ovens so that partially prepared food can be finished quickly and tastefully immediately before serving. The crisp, freshly browned surfaces result from the faster heat transfer which does not dry out the food. The devices are then compared to convection ovens and microwave heating processes.

  12. A Peer-to-Peer Health Education Program for Vulnerable Children in Uganda

    ERIC Educational Resources Information Center

    Falk, Diane S.; Pettet, Kristen; Mpagi, Charles

    2016-01-01

    In this paper, children attending a U.S.-sponsored private primary school serving orphaned and vulnerable children in Uganda were interviewed in focus groups about their participation in a peer-to-peer health education program in which they used music, dance, poetry, art, and drama to convey health information. The children reported enhanced…

  13. Vulnerability Assessment of Selected Buildings Designated as Shelters: Antigua and Barbuda.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on Antigua and Barbuda to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with…

  14. Vulnerability Assessment of Selected Buildings Designated as Shelters: St. Kitts--Nevis.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on St. Kitts and Nevis to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with…

  15. Rich, white, and vulnerable: rethinking oppressive socialization in the euthanasia debate.

    PubMed

    Krag, Erik

    2014-08-01

    Anita Silvers (1998) has criticized those who argue that members of marginalized groups are vulnerable to a special threat posed by physician-assisted suicide (PAS) and voluntary active euthanasia (VAE). She argues that paternalistic measures prohibiting PAS/VAE in order to protect these groups only serve to marginalize them further by characterizing them as belonging to a definitively weak class. I offer a new conception of vulnerability, one that demonstrates how rich, educated, white males, who are typically regarded as having their autonomy enhanced by their social status, are just as, if not more, vulnerable to threats posed by PAS/VAE as a result of the harmful social messages at work just below the surface of contemporary Western culture. I use this new conception of vulnerability to reinforce arguments for continued statutory prohibitions on PAS/VAE.

  16. Mountain torrents: Quantifying vulnerability and assessing uncertainties

    PubMed Central

    Totschnig, Reinhold; Fuchs, Sven

    2013-01-01

    Vulnerability assessment for elements at risk is an important component in the framework of risk assessment. The vulnerability of buildings affected by torrent processes can be quantified by vulnerability functions that express a mathematical relationship between the degree of loss of individual elements at risk and the intensity of the impacting process. Based on data from the Austrian Alps, we extended a vulnerability curve for residential buildings affected by fluvial sediment transport processes to other torrent processes and other building types. With respect to this goal to merge different data based on different processes and building types, several statistical tests were conducted. The calculation of vulnerability functions was based on a nonlinear regression approach applying cumulative distribution functions. The results suggest that there is no need to distinguish between different sediment-laden torrent processes when assessing vulnerability of residential buildings towards torrent processes. The final vulnerability functions were further validated with data from the Italian Alps and different vulnerability functions presented in the literature. This comparison showed the wider applicability of the derived vulnerability functions. The uncertainty inherent to regression functions was quantified by the calculation of confidence bands. The derived vulnerability functions may be applied within the framework of risk management for mountain hazards within the European Alps. The method is transferable to other mountain regions if the input data needed are available. PMID:27087696

  17. Vulnerable to HIV / AIDS. Migration.

    PubMed

    Fernandez, I

    1998-01-01

    This special report discusses the impact of globalization, patterns of migration in Southeast Asia, gender issues in migration, the links between migration and HIV/AIDS, and spatial mobility and social networks. Migrants are particularly marginalized in countries that blame migrants for transmission of infectious and communicable diseases and other social ills. Effective control of HIV/AIDS among migrant and native populations requires a multisectoral approach. Programs should critically review the privatization of health care services and challenge economic models that polarize the rich and the poor, men and women, North and South, and migrant and native. Programs should recognize the equality between locals and migrants in receipt of health services. Countermeasures should have input from migrants in order to reduce the conditions that increase vulnerability to HIV/AIDS. Gender-oriented research is needed to understand women's role in migration. Rapid assessment has obscured the human dimension of migrants' vulnerability to HIV. Condom promotion is not enough. Migration is a major consequence of globalization, which holds the promise, real or imagined, of prosperity for all. Mass migration can be fueled by explosive regional developments. In Southeast Asia, migration has been part of the process of economic development. The potential to emigrate increases with greater per capita income. "Tiger" economies have been labor importers. Safe sex is not practiced in many Asian countries because risk is not taken seriously. Migrants tend to be used as economic tools, without consideration of social adjustment and sex behavior among singles.

  18. Dynamics of immune system vulnerabilities

    NASA Astrophysics Data System (ADS)

    Stromberg, Sean P.

    The adaptive immune system can be viewed as a complex system, which adapts, over time, to reflect the history of infections experienced by the organism. Understanding its operation requires viewing it in terms of tradeoffs under constraints and evolutionary history. It typically displays "robust, yet fragile" behavior, meaning common tasks are robust to small changes but novel threats or changes in environment can have dire consequences. In this dissertation we use mechanistic models to study several biological processes: the immune response, the homeostasis of cells in the lymphatic system, and the process that normally prevents autoreactive cells from entering the lymphatic system. Using these models we then study the effects of these processes interacting. We show that the mechanisms that regulate the numbers of cells in the immune system, in conjunction with the immune response, can act to suppress autoreactive cells from proliferating, thus showing quantitatively how pathogenic infections can suppress autoimmune disease. We also show that over long periods of time this same effect can thin the repertoire of cells that defend against novel threats, leading to an age correlated vulnerability. This vulnerability is shown to be a consequence of system dynamics, not due to degradation of immune system components with age. Finally, modeling a specific tolerance mechanism that normally prevents autoimmune disease, in conjunction with models of the immune response and homeostasis we look at the consequences of the immune system mistakenly incorporating pathogenic molecules into its tolerizing mechanisms. The signature of this dynamic matches closely that of the dengue virus system.

  19. Scenarios for coastal vulnerability assessment

    USGS Publications Warehouse

    Nicholls, Robert J.; Woodroffe, Colin D.; Burkett, Virginia; Hay, John; Wong, Poh Poh; Nurse, Leonard; Wolanski, Eric; McLusky, Donald S.

    2011-01-01

    Coastal vulnerability assessments tend to focus mainly on climate change and especially on sea-level rise. Assessment of the influence of nonclimatic environmental change or socioeconomic change is less well developed and these drivers are often completely ignored. Given that the most profound coastal changes of the twentieth century due to nonclimate drivers are likely to continue through the twenty-first century, this is a major omission. It may result in not only overstating the importance of climate change but also overlooking significant interactions of climate change and other drivers. To support the development of policies relating to climate change and coastal management, integrated assessments of climatic change in coastal areas are required, including the effects of all the relevant drivers. This chapter explores the development of scenarios (or "plausible futures") of relevant climate and nonclimate drivers that can be used for coastal analysis, with an emphasis on the nonclimate drivers. It shows the importance of analyzing the impacts of climate change and sea-level rise in a broader context of coastal change and all its drivers. This will improve the analysis of impacts, key vulnerabilities, and adaptation needs and, hence, inform climate and coastal policy. Stakeholder engagement is important in the development of scenarios, and the underlying assumptions need to be explicit, transparent, and open to scientific debate concerning their uncertainties/realism and likelihood.

  20. Vulnerability of network of networks

    NASA Astrophysics Data System (ADS)

    Havlin, S.; Kenett, D. Y.; Bashan, A.; Gao, J.; Stanley, H. E.

    2014-10-01

    Our dependence on networks - be they infrastructure, economic, social or others - leaves us prone to crises caused by the vulnerabilities of these networks. There is a great need to develop new methods to protect infrastructure networks and prevent cascade of failures (especially in cases of coupled networks). Terrorist attacks on transportation networks have traumatized modern societies. With a single blast, it has become possible to paralyze airline traffic, electric power supply, ground transportation or Internet communication. How, and at which cost can one restructure the network such that it will become more robust against malicious attacks? The gradual increase in attacks on the networks society depends on - Internet, mobile phone, transportation, air travel, banking, etc. - emphasize the need to develop new strategies to protect and defend these crucial networks of communication and infrastructure networks. One example is the threat of liquid explosives a few years ago, which completely shut down air travel for days, and has created extreme changes in regulations. Such threats and dangers warrant the need for new tools and strategies to defend critical infrastructure. In this paper we review recent advances in the theoretical understanding of the vulnerabilities of interdependent networks with and without spatial embedding, attack strategies and their affect on such networks of networks as well as recently developed strategies to optimize and repair failures caused by such attacks.

  1. Students' vulnerability in educational research.

    PubMed

    Sykes, L M; Dullabh, H

    2012-06-01

    Dental teaching institutions in South Africa recently implemented "learner-centred" curricula and expected educators to alter their teaching styles accordingly, but perhaps without providing adequate training in this paedagogical philosophy. At the same time, the lecturers were required to conduct evidence-based research to evaluate the outcomes. Thus, clinicians/lecturers also became researchers, using their own students or student material for assessment purposes. Previously, this form of educational research, which was carried out in normal academic settings, was not subject to review by Institutional Review Boards (IRB). However, concerns have risen that learners may be a vulnerable population due to their position in the academic institution, and the power and knowledge differentials that exist between them and the lecturer/researcher. This raises ethical concerns regarding their autonomy and ability to provide free, voluntary, informed consent to be research participants. This paper questions whether educational research may lead to student vulnerability, and proposes some recommendations for educators and institutions involved in educational research.

  2. Integrated Estimation of Seismic Physical Vulnerability of Tehran Using Rule Based Granular Computing

    NASA Astrophysics Data System (ADS)

    Sheikhian, H.; Delavar, M. R.; Stein, A.

    2015-08-01

    Tehran, the capital of Iran, is surrounded by the North Tehran fault, the Mosha fault and the Rey fault. This exposes the city to possibly huge earthquakes followed by dramatic human loss and physical damage, in particular as it contains a large number of non-standard constructions and aged buildings. Estimation of the likely consequences of an earthquake facilitates mitigation of these losses. Mitigation of the earthquake fatalities may be achieved by promoting awareness of earthquake vulnerability and implementation of seismic vulnerability reduction measures. In this research, granular computing using generality and absolute support for rule extraction is applied. It uses coverage and entropy for rule prioritization. These rules are combined to form a granule tree that shows the order and relation of the extracted rules. In this way the seismic physical vulnerability is assessed, integrating the effects of the three major known faults. Effective parameters considered in the physical seismic vulnerability assessment are slope, seismic intensity, height and age of the buildings. Experts were asked to predict seismic vulnerability for 100 randomly selected samples among more than 3000 statistical units in Tehran. The integrated experts' point of views serve as input into granular computing. Non-redundant covering rules preserve the consistency in the model, which resulted in 84% accuracy in the seismic vulnerability assessment based on the validation of the predicted test data against expected vulnerability degree. The study concluded that granular computing is a useful method to assess the effects of earthquakes in an earthquake prone area.

  3. Assessing human vulnerability: Daytime residential distribution as a vulnerability indicator

    NASA Astrophysics Data System (ADS)

    Gokesch, Karin; Promper, Catrin; Papathoma-Köhle, Maria; Glade, Thomas

    2014-05-01

    Natural hazard risk management is based on detailed information on potential impacts of natural hazards. Especially concerning fast onset hazards such as flash floods, earthquakes but also debris flows and landslides, knowing potential hotspots of impact to both, assets and human lives is essential. This information is important for emergency management and decision making in the response phase of the disaster management cycle. Emergency managers are in need of information regarding not only the number of humans being potentially affected but also the respective vulnerability of the group affected based on characteristics such as age, income, health condition, mobility, etc. regarding a certain hazard. The analysis presented focuses on the distribution of the population, assuming a certain pattern of people in a certain radius of action. The method applied is based on a regular pattern of movement of different groups of people and a pattern of presence in certain units, e.g. schools, businesses or residential buildings. The distribution is calculated on a minimum of available data including the average household size, as well as information on building types. The study area is located in the Southwest of Lower Austria, Austria. The city of Waidhofen/Ybbs can be regarded as a regional center providing basic infrastructure, shops and schools. The high concentration of buildings combining shops and residential units leads to a high damage potential throughout the whole study area. The presented results indicate the population distribution within the study area on an average working day. It is clear that explicitly high numbers of people are located in specific buildings (e.g. schools and hospitals) which also include highly vulnerable groups especially to fast onset hazards. The results provide emergency services with the information that they need in order to intervene directly where large numbers of victims or people that need to be evacuated are located. In this

  4. Employee satisfactions in agencies serving retarded persons.

    PubMed

    Sarata, B P

    1975-01-01

    The work satisfactions of individuals employed by three agencies serving retarded persons were examined. The results contradicted the view held by most administrators that the individual's level of overall satisfaction is determined principally by his attitudes concerning employment in the field of mental retardation. Rather, the data suggest that satisfaction with the specific agency is the chief determinant of overall satisfaction. Extensive contact with clients and the perceived lack of client progress were found to be important sources of staff dissatisfaction. Finally, client-related dissatisfactions were often attributed to agency or staff deficiences. Implications for altering administrative practices were discussed. PMID:1115102

  5. Skylab Food Heating and Serving Tray

    NASA Technical Reports Server (NTRS)

    1970-01-01

    Shown here is the Skylab food heating and serving tray with food, drink, and utensils. The tray contained heating elements for preparing the individual food packets. The food on Skylab was a great improvement over that on earlier spaceflights. It was no longer necessary to squeeze liquified food from plastic tubes. Skylab's kitchen in the Orbital Workshop wardroom was so equipped that each crewman could select his own menu and prepare it to his own taste. The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

  6. An holistic view on aquifer vulnerability based on a distinction of different types of vulnerability

    NASA Astrophysics Data System (ADS)

    De Luca, Domenico Antonio; Lasagna, Manuela; Franchino, Elisa

    2016-04-01

    AN HOLISTIC VIEW ON AQUIFER VULNERABILITY BASED ON A DISTINCTION OF DIFFERENT TYPES OF VULNERABILITY D.A. De Luca1 , M. Lasagna1, E. Franchino1 1Department of Earth Sciences, University of Turin The concept of vulnerability is certainly useful in the field of groundwater protection. Nevertheless, within the scientific community, the definition of groundwater vulnerability is still debatable and not clear and conclusive. This is probably due to the fact that researchers often have very different experiences and education. A positive effect of it is a constant exchange of ideas, but there are also negative consequences and difficulties in deepening the issue. The different approaches are very important but they are usable only if the concept of vulnerability is standardized: thus, for the sake of clarity, a number of definitions should be laid down, based on the different types of vulnerability. These definitions can then provide the necessary holistic view for the aquifer vulnerability assessment. Nowadays vulnerability methods focus on the degree of vulnerability and the parameters needed for its evaluation, often neglecting to clarify what is the type of vulnerability the proposed methods are referred. The type of vulnerability, indeed, is both logically and hierarchically superior to the degree of vulnerability. More specifically the type of vulnerability represents the evaluation of the hydrogeological conditions considered in the vulnerability assessment and able to influence the way in which the contamination can take place. Currently the only distinction, based on of the type of vulnerability, is referred to intrinsic and specific vulnerability. Intrinsic vulnerability assesses the susceptibility of the receptor based on the natural properties of the land and subsurface; specific vulnerability also includes properties of the analyzed contaminant. This distinction is useful but not exhaustive. In addition to this, e.g., a distinction of vertical vulnerability

  7. Metadata for selecting or submitting generic seismic vulnerability functions via GEM's vulnerability database

    USGS Publications Warehouse

    Jaiswal, Kishor

    2013-01-01

    This memo lays out a procedure for the GEM software to offer an available vulnerability function for any acceptable set of attributes that the user specifies for a particular building category. The memo also provides general guidelines on how to submit the vulnerability or fragility functions to the GEM vulnerability repository, stipulating which attributes modelers must provide so that their vulnerability or fragility functions can be queried appropriately by the vulnerability database. An important objective is to provide users guidance on limitations and applicability by providing the associated modeling assumptions and applicability of each vulnerability or fragility function.

  8. Vulnerability and resilience: a critical nexus.

    PubMed

    Lotz, Mianna

    2016-02-01

    Not all forms of human fragility or vulnerability are unavoidable. Sometimes we knowingly and intentionally impose conditions of vulnerability on others; and sometimes we knowingly and intentionally enter into and assume conditions of vulnerability for ourselves (for example, when we decide to trust or forgive, enter into intimate relationships with others, become a parent, become a subject of medical or psychotherapeutic treatment, and the like). In this article, I propose a presently overlooked basis on which one might evaluate whether the imposition or assumption of vulnerability is acceptable, and on which one might ground a significant class of vulnerability-related obligations. Distinct from existing accounts of the importance of promoting autonomy in conditions of vulnerability, this article offers a preliminary exploration of the nature, role, and importance of resilience promotion, its relationship to autonomy promotion, and its prospects for improving human wellbeing in autonomy inhibiting conditions. PMID:26965682

  9. NV: Nessus Vulnerability Visualization for the Web

    SciTech Connect

    Harrison, Lane; Spahn, Riley B; Iannacone, Michael D; Downing, Evan P; Goodall, John R

    2012-01-01

    Network vulnerability is a critical component of network se- curity. Yet vulnerability analysis has received relatively lit- tle attention from the security visualization community. In this paper we describe nv, a web-based Nessus vulnerability visualization. Nv utilizes treemaps and linked histograms to allow system administrators to discover, analyze, and man- age vulnerabilities on their networks. In addition to visual- izing single Nessus scans, nv supports the analysis of sequen- tial scans by showing which vulnerabilities have been fixed, remain open, or are newly discovered. Nv was also designed to operate completely in-browser, to avoid sending sensitive data to outside servers. We discuss the design of nv, as well as provide case studies demonstrating vulnerability analysis workflows which include a multiple-node testbed and data from the 2011 VAST Challenge.

  10. Assessing the Security Vulnerabilities of Correctional Facilities

    SciTech Connect

    Morrison, G.S.; Spencer, D.S.

    1998-10-27

    The National Institute of Justice has tasked their Satellite Facility at Sandia National Laboratories and their Southeast Regional Technology Center in Charleston, South Carolina to devise new procedures and tools for helping correctional facilities to assess their security vulnerabilities. Thus, a team is visiting selected correctional facilities and performing vulnerability assessments. A vulnerability assessment helps to identi~ the easiest paths for inmate escape, for introduction of contraband such as drugs or weapons, for unexpected intrusion fi-om outside of the facility, and for the perpetration of violent acts on other inmates and correctional employees, In addition, the vulnerability assessment helps to quantify the security risks for the facility. From these initial assessments will come better procedures for performing vulnerability assessments in general at other correctional facilities, as well as the development of tools to assist with the performance of such vulnerability assessments.

  11. Vulnerability assessment of mining subsidence hazards.

    PubMed

    Deck, Olivier; Verdel, Thierry; Salmon, Romuald

    2009-10-01

    Between 1996 and 1999, five mining subsidence events occurred in the iron-ore field in Lorraine, France, and damaged several hundred buildings. Because of the thousand hectares of undermined areas, an assessment of the vulnerability of buildings and land is necessary for risk management. Risk assessment methods changed from initial risk management decisions that took place immediately after the mining subsidence to the risk assessment studies that are currently under consideration. These changes reveal much about the complexity of the vulnerability concept and about difficulties in developing simple and relevant methods for its assessment. The objective of this article is to present this process, suggest improvements on the basis of theoretical definitions of the vulnerability, and give an operational example of vulnerability assessment in the seismic field. The vulnerability is divided into three components: weakness, stakes value, and resilience. Final improvements take into account these three components and constitute an original method of assessing the vulnerability of a city to subsidence.

  12. Serving to different locations: set-up, toss, and racket kinematics of the professional tennis serve.

    PubMed

    Reid, Machar; Whiteside, David; Elliott, Bruce

    2011-11-01

    The serve, as the most important stroke in tennis, has attracted considerable biomechanical interest. Of its component parts, the swing has received disproportionate research attention and consequently, little is known regarding toss kinematics. Indeed, the age-old question of whether players serve to different parts of the court from the same toss remains unanswered. Six right-handed professionally ranked players hit first serves (FSs) and second serves (SSs) to three 2 x 1 m target areas reflecting the landing locations of T, body and wide serves, respectively, on the deuce court. A 22 camera, 250 Hz VICON MX motion analysis system captured racket, ball, foot, and h and kinematics. Repeated measures ANOVAs assessed within-player differences in foot, racket, and ball kinematics within the FS and SS as a function of landing location. The positions of the front foot, ball zenith, and ball impact were significantly different in the FS, while kinematics across all SS were consistent. Front foot position was closer to the centre mark in the T FS and players impacted the ball further left in the wide FS compared to the T FS. This study discusses the findings in the context of the development of the serve as well as potential implications for the return.

  13. Mining Bug Databases for Unidentified Software Vulnerabilities

    SciTech Connect

    Dumidu Wijayasekara; Milos Manic; Jason Wright; Miles McQueen

    2012-06-01

    Identifying software vulnerabilities is becoming more important as critical and sensitive systems increasingly rely on complex software systems. It has been suggested in previous work that some bugs are only identified as vulnerabilities long after the bug has been made public. These vulnerabilities are known as hidden impact vulnerabilities. This paper discusses the feasibility and necessity to mine common publicly available bug databases for vulnerabilities that are yet to be identified. We present bug database analysis of two well known and frequently used software packages, namely Linux kernel and MySQL. It is shown that for both Linux and MySQL, a significant portion of vulnerabilities that were discovered for the time period from January 2006 to April 2011 were hidden impact vulnerabilities. It is also shown that the percentage of hidden impact vulnerabilities has increased in the last two years, for both software packages. We then propose an improved hidden impact vulnerability identification methodology based on text mining bug databases, and conclude by discussing a few potential problems faced by such a classifier.

  14. Flood vulnerability indices at varying spatial scales.

    PubMed

    Balica, S F; Douben, N; Wright, N G

    2009-01-01

    Populations around the world are vulnerable to natural disasters. Such disasters are occurring with increased frequency as a consequence of socio-economic and land-use developments and due to increased climate variability. This paper describes a methodology for using indicators to compute a Flood Vulnerability Index which is aimed at assessing the conditions which influence flood damage at various spatial scales: river basin, sub-catchment and urban area. The methodology developed distinguishes different characteristics at each identified spatial scale, thus allowing a more in-depth analysis and interpretation of local indicators. This also pinpoints local hotspots of flood vulnerability. The final results are presented by means of a standardised number, ranging from 0 to 1, which symbolises comparatively low or high flood vulnerability between the various spatial scales. The Flood Vulnerability Index can be used by international river basin organisations to identify and develop action plans to deal with floods and flooding or on smaller scales to improve local decision-making processes by selecting measures to reduce vulnerability at local and regional levels. In this work the methodology has been applied to various case studies at different spatial scales. This leads to some interesting observations on how flood vulnerability can be reflected by quantifiable indicators across scales, e.g. the relationship between the flood vulnerability of a sub-catchment with its river basin or the weak relation between the flood vulnerability of an urban area with the sub-catchment or river basin which it belongs to.

  15. Proliferation Vulnerability Red Team report

    SciTech Connect

    Hinton, J.P.; Barnard, R.W.; Bennett, D.E.

    1996-10-01

    This report is the product of a four-month independent technical assessment of potential proliferation vulnerabilities associated with the plutonium disposition alternatives currently under review by DOE/MD. The scope of this MD-chartered/Sandia-led study was limited to technical considerations that could reduce proliferation resistance during various stages of the disposition processes below the Stored Weapon/Spent Fuel standards. Both overt and covert threats from host nation and unauthorized parties were considered. The results of this study will be integrated with complementary work by others into an overall Nonproliferation and Arms Control Assessment in support of a Secretarial Record of Decision later this year for disposition of surplus U.S. weapons plutonium.

  16. Attack Vulnerability of Network Controllability

    PubMed Central

    2016-01-01

    Controllability of complex networks has attracted much attention, and understanding the robustness of network controllability against potential attacks and failures is of practical significance. In this paper, we systematically investigate the attack vulnerability of network controllability for the canonical model networks as well as the real-world networks subject to attacks on nodes and edges. The attack strategies are selected based on degree and betweenness centralities calculated for either the initial network or the current network during the removal, among which random failure is as a comparison. It is found that the node-based strategies are often more harmful to the network controllability than the edge-based ones, and so are the recalculated strategies than their counterparts. The Barabási-Albert scale-free model, which has a highly biased structure, proves to be the most vulnerable of the tested model networks. In contrast, the Erdős-Rényi random model, which lacks structural bias, exhibits much better robustness to both node-based and edge-based attacks. We also survey the control robustness of 25 real-world networks, and the numerical results show that most real networks are control robust to random node failures, which has not been observed in the model networks. And the recalculated betweenness-based strategy is the most efficient way to harm the controllability of real-world networks. Besides, we find that the edge degree is not a good quantity to measure the importance of an edge in terms of network controllability. PMID:27588941

  17. Attack Vulnerability of Network Controllability.

    PubMed

    Lu, Zhe-Ming; Li, Xin-Feng

    2016-01-01

    Controllability of complex networks has attracted much attention, and understanding the robustness of network controllability against potential attacks and failures is of practical significance. In this paper, we systematically investigate the attack vulnerability of network controllability for the canonical model networks as well as the real-world networks subject to attacks on nodes and edges. The attack strategies are selected based on degree and betweenness centralities calculated for either the initial network or the current network during the removal, among which random failure is as a comparison. It is found that the node-based strategies are often more harmful to the network controllability than the edge-based ones, and so are the recalculated strategies than their counterparts. The Barabási-Albert scale-free model, which has a highly biased structure, proves to be the most vulnerable of the tested model networks. In contrast, the Erdős-Rényi random model, which lacks structural bias, exhibits much better robustness to both node-based and edge-based attacks. We also survey the control robustness of 25 real-world networks, and the numerical results show that most real networks are control robust to random node failures, which has not been observed in the model networks. And the recalculated betweenness-based strategy is the most efficient way to harm the controllability of real-world networks. Besides, we find that the edge degree is not a good quantity to measure the importance of an edge in terms of network controllability. PMID:27588941

  18. Effect of whiskey on atrial vulnerability and "holiday heart".

    PubMed

    Engel, T R; Luck, J C

    1983-03-01

    Vulnerability to atrial fibrillation and flutter was examined in 11 alcohol abusers who did not have cardiomyopathy or manifest heart failure. Atrial extrastimulation was done with rapid pacing (drive cycle length 500 ms) to facilitate induction of atrial vulnerability, seen in four alcohol abusers. The remaining seven were retested 30 minutes after drinking 60 to 120 ml of 86 proof whiskey (ethanol blood levels were 49 to 101 mg/100 ml but pulmonary capillary wedge pressure remained normal in all) and atrial fibrillation or flutter was induced in three of the drinkers. Three nondrinkers, symptomatic with sinus bradycardia but not in heart failure, were found not to be vulnerable to atrial fibrillation or flutter, but flutter was induced in two of the three after drinking whiskey. Whiskey did not alter atrial functional refractory periods (mean +/- standard error of the mean 297 +/- 14 to 290 +/- 12 ms) or widen the dispersion among three disparate right atrial sites (57 +/- 13 to 47 +/- 12 ms). Thus, whiskey enhanced vulnerability to atrial fibrillation and flutter in patients without heart failure or cardiomyopathy, substantiating the "holiday heart" syndrome.

  19. Vulnerabilities of children admitted to a pediatric inpatient care unit☆

    PubMed Central

    de Oliveira, Larissa Natacha; Breigeiron, Márcia Koja; Hallmann, Sofia; Witkowski, Maria Carolina

    2014-01-01

    OBJECTIVE: To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital. METHODS: Cross-sectional, descriptive study from April to September 2013 with36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and from patients, records, and analyzed by descriptive statistics. RESULTS: Of the total sample, 97.1% (n=132) of children had at least one type of vulnerability, the majority related to the caregiver's level of education, followed by caregiver's financial situation, health history of the child, caregiver's family situation, use of alcohol, tobacco, and illicit drugs by the caregiver, family's living conditions, caregiver's schooling, and bonding between the caregiver and the child. Only 2.9% (n=4) of the children did not show any criteria to be classified in a category of vulnerability. CONCLUSIONS: Most children were classified has having a social vulnerability. It is imperative to create networks of support between the hospital and the primary healthcare service to promote healthcare practices directed to the needs of the child and family. PMID:25511001

  20. Le Bistro serves up cultural change.

    PubMed

    Leggitt, Mark S; Potrepka, Virginia N; Kukolja, Teresa J

    2003-01-01

    Bristol Hospital, a 134-bed community health care system in Connecticut, has consistently been nationally ranked in the top tier of hospitals for its patient satisfaction scores. A key to this long-term distinction has been its commitment to a culture built around patient satisfaction and service excellence. Empowerment, vigilance, recognition, and celebration are the cultural cornerstones. The change has enabled the hospital to increase its market share, increase its satisfaction rankings, increase its employee retention, and enjoy consistent financial success.

  1. Proposal of a Mediterranean Diet Serving Score

    PubMed Central

    Monteagudo, Celia; Mariscal-Arcas, Miguel; Rivas, Ana; Lorenzo-Tovar, María Luisa; Tur, Josep A.; Olea-Serrano, Fátima

    2015-01-01

    Background and Aims Numerous studies have demonstrated a relationship between Mediterranean Diet (MD) adherence and the prevention of cardiovascular diseases, cancer, and diabetes, etc. The study aim was to validate a novel instrument to measure MD adherence based on the consumption of food servings and food groups, and apply it in a female population from southern Spain and determining influential factors. Methods and Results The study included 1,155 women aged 12-83 yrs, classified as adolescents, adults, and over-60-yr-olds. All completed a validated semi-quantitative food frequency questionnaire (FFQ). The Mediterranean Dietary Serving Score (MDSS) is based on the latest update of the Mediterranean Diet Pyramid, using the recommended consumption frequency of foods and food groups; the MDSS ranges from 0 to 24. The discriminative power or correct subject classification capacity of the MDSS was analyzed with the Receiver Operating Characteristic (ROC) curve, using the MDS as reference method. Predictive factors for higher MDSS adherence were determined with a logistic regression model, adjusting for age. According to ROC curve analysis, MDSS evidenced a significant discriminative capacity between adherents and non-adherents to the MD pattern (optimal cutoff point=13.50; sensitivity=74%; specificity=48%). The mean MDSS was 12.45 (2.69) and was significantly higher with older age (p<0.001). Logistic regression analysis showed highest MD adherence by over 60-year-olds with low BMI and no habit of eating between meals. Conclusions The MDSS is an updated, easy, valid, and accurate instrument to assess MD adherence based on the consumption of foods and food groups per meal, day, and week. It may be useful in future nutritional education programs to prevent the early onset of chronic non-transmittable diseases in younger populations. PMID:26035442

  2. [Health status of female soldiers serving in the Northern Fleet].

    PubMed

    Myznikov, I L; Askerko, N V; Ustimenko, L I; Miloshevich, Iu R; Volkova, L V; Sadchenko, S N; Matochkina, A A

    2013-09-01

    Authors analyzed the health status and morbidity among female soldiers serving under the contract in the Northern Fleet, age peculiarities, results of medical in-patient examination and expert assessment, put in medical records in accordance with prophylactic medical examination service and medical examination. Annual data about military troops, morbidity and medical examination among female soldiers in the period 2002-2010 (n-14,5 thousand of people) are included into analysis. 502 medical records of female soldiers approved by military physician board were analyzed. Authors presented statistic data about primary diseases and chronic pathology and considered causes of changing of the category of fitness for military service and its gender peculiarities. Authors suggest changing the recruiting concept for female soldiers and the system of medical in-patient examination.

  3. Design Vulnerability Assessments for Safeguards Sealing Systems

    SciTech Connect

    Brockman, Linda; Johnston, Roger; Kravtchenko, Victor; Undem, Halvor A.; Wishard, Bernard

    2010-08-11

    The International Atomic Energy Agency (the "Agency") engages in a rigorous equipment authorization process prior to deploying Safeguards instrumentation, including Safeguards sealing systems, for world-wide use. A positive result from a vulnerability assessment is one of the many requirements that must be met prior to instrumentation deployment. Given the long time period in the Safeguards instrumentation development cycle, the substantial Member State investments made, and the significant Agency staff time required, a negative result for the vulnerability assessment can result in the loss of time, considerable additional expense, or even the failure to deploy an instrument or sealing system at all. First suggested in 1998 by the General Physics Institute in Moscow, an approach that incorporates a design vulnerability assessment minimizes the risk of deployment failure by teaming a public sector vulnerability assessment team with the instrument or sealing system design team in order to identify, at the earliest possible design stage, inherent vulnerabilities. Involving the vulnerability assessors early and often in the design and development process avoids many of the problems inherent in evaluating security vulnerabilities only after the design is finalized. The disadvantages include increased costs and time to deployment. An improved pressure-sensitive adhesive label seal, called the "VOID-3 seal" was developed for the Agency using this design vulnerability assessment process.

  4. Infrastructure Vulnerability Assessment Model (I-VAM).

    PubMed

    Ezell, Barry Charles

    2007-06-01

    Quantifying vulnerability to critical infrastructure has not been adequately addressed in the literature. Thus, the purpose of this article is to present a model that quantifies vulnerability. Vulnerability is defined as a measure of system susceptibility to threat scenarios. This article asserts that vulnerability is a condition of the system and it can be quantified using the Infrastructure Vulnerability Assessment Model (I-VAM). The model is presented and then applied to a medium-sized clean water system. The model requires subject matter experts (SMEs) to establish value functions and weights, and to assess protection measures of the system. Simulation is used to account for uncertainty in measurement, aggregate expert assessment, and to yield a vulnerability (Omega) density function. Results demonstrate that I-VAM is useful to decisionmakers who prefer quantification to qualitative treatment of vulnerability. I-VAM can be used to quantify vulnerability to other infrastructures, supervisory control and data acquisition systems (SCADA), and distributed control systems (DCS). PMID:17640208

  5. Predicting Vulnerability Risks Using Software Characteristics

    ERIC Educational Resources Information Center

    Roumani, Yaman

    2012-01-01

    Software vulnerabilities have been regarded as one of the key reasons for computer security breaches that have resulted in billions of dollars in losses per year (Telang and Wattal 2005). With the growth of the software industry and the Internet, the number of vulnerability attacks and the ease with which an attack can be made have increased. From…

  6. Callahan's Vulnerability Thesis and "Dissatisfaction Theory."

    ERIC Educational Resources Information Center

    Iannaccone, Laurence

    1996-01-01

    In discussing school superintendent vulnerability, the paper addresses diverse meanings among scholars of Callahan's vulnerability thesis, highlighting other articles within this theme issue. The paper reflects on discussions of Callahan's "Education and the Cult of Efficacy" before its 1962 publication and investigates the relation between…

  7. Vulnerable Youth and Transitions to Adulthood

    ERIC Educational Resources Information Center

    Xie, Rongbing; Sen, Bisakha; Foster, E. Michael

    2014-01-01

    This chapter focuses on vulnerable youth, the challenges they face during their transitions to adulthood, and the adverse effects of limited support systems on those transitions. The authors offer recommendations on how adult educators can help facilitate smooth transitions into adulthood for vulnerable youth.

  8. Opportunistic Interruptions: Interactional Vulnerabilities Deriving from Linearization

    ERIC Educational Resources Information Center

    Gibson, David R.

    2005-01-01

    Speaking involves "linearizing" a message into a string of words. This process leaves us vulnerable to being interrupted in such a way that the aborted turn is a misrepresentation of the intended message. Further, because we linearize our messages in standard ways, we are recurrently vulnerable to interruptions at particular turn-construction…

  9. Issues in conducting research with vulnerable families.

    PubMed

    Demi, A S; Warren, N A

    1995-04-01

    This article explores methodological and ethical issues in the conduct of research with vulnerable families. Some methodological and ethical issues are common to all family research, regardless of the families' vulnerability; however, many research issues are more problematic in vulnerable families, and a few issues are relatively unique to vulnerable families. Vulnerable families are defined as families that are susceptible to harm because of their socioeconomic status, their minority status, or other stigmatizing status. Methodological issues include definition of family; recruitment and retention of participants; reliability and validity of instruments; and racism, classism, and sexism. Ethical issues include confidentiality, reporting abuse and neglect, conflict of research ethics and personal ethics, identifying problems nobody can fix, balancing demands and benefits, and interpretation of data. Examples of methodological and ethical issues are drawn from several research studies in which the primary author was or is currently involved.

  10. Oxytocin promotes group-serving dishonesty

    PubMed Central

    Shalvi, Shaul; De Dreu, Carsten K. W.

    2014-01-01

    To protect and promote the well-being of others, humans may bend the truth and behave unethically. Here we link such tendencies to oxytocin, a neuropeptide known to promote affiliation and cooperation with others. Using a simple coin-toss prediction task in which participants could dishonestly report their performance levels to benefit their group’s outcome, we tested the prediction that oxytocin increases group-serving dishonesty. A double-blind, placebo-controlled experiment allowing individuals to lie privately and anonymously to benefit themselves and fellow group members showed that healthy males (n = 60) receiving intranasal oxytocin, rather than placebo, lied more to benefit their group, and did so faster, yet did not necessarily do so because they expected reciprocal dishonesty from fellow group members. Treatment effects emerged when lying had financial consequences and money could be gained; when losses were at stake, individuals in placebo and oxytocin conditions lied to similar degrees. In a control condition (n = 60) in which dishonesty only benefited participants themselves, but not fellow group members, oxytocin did not influence lying. Together, these findings fit a functional perspective on morality revealing dishonesty to be plastic and rooted in evolved neurobiological circuitries, and align with work showing that oxytocin shifts the decision-maker’s focus from self to group interests. These findings highlight the role of bonding and cooperation in shaping dishonesty, providing insight into when and why collaboration turns into corruption. PMID:24706799

  11. Oxytocin promotes group-serving dishonesty.

    PubMed

    Shalvi, Shaul; De Dreu, Carsten K W

    2014-04-15

    To protect and promote the well-being of others, humans may bend the truth and behave unethically. Here we link such tendencies to oxytocin, a neuropeptide known to promote affiliation and cooperation with others. Using a simple coin-toss prediction task in which participants could dishonestly report their performance levels to benefit their group's outcome, we tested the prediction that oxytocin increases group-serving dishonesty. A double-blind, placebo-controlled experiment allowing individuals to lie privately and anonymously to benefit themselves and fellow group members showed that healthy males (n = 60) receiving intranasal oxytocin, rather than placebo, lied more to benefit their group, and did so faster, yet did not necessarily do so because they expected reciprocal dishonesty from fellow group members. Treatment effects emerged when lying had financial consequences and money could be gained; when losses were at stake, individuals in placebo and oxytocin conditions lied to similar degrees. In a control condition (n = 60) in which dishonesty only benefited participants themselves, but not fellow group members, oxytocin did not influence lying. Together, these findings fit a functional perspective on morality revealing dishonesty to be plastic and rooted in evolved neurobiological circuitries, and align with work showing that oxytocin shifts the decision-maker's focus from self to group interests. These findings highlight the role of bonding and cooperation in shaping dishonesty, providing insight into when and why collaboration turns into corruption.

  12. Biodiversity Information Serving Our Nation (BISON)

    USGS Publications Warehouse

    ,

    2013-01-01

    Researchers collect species occurrence data, records of an organism at a particular time in a particular place, as a primary or ancillary function of many biological field investigations. Presently, these data reside in numerous distributed systems and formats (including publications) and are consequently not being used to their full potential. As a step toward addressing this challenge, the Core Science Analytics and Synthesis (CSAS) program of the US Geological Survey (USGS) is developing Biodiversity Information Serving Our Nation (BISON), an integrated and permanent resource for biological occurrence data from the United States. BISON will leverage the accumulated human and infrastructural resources of the long-term USGS investment in research and information management and delivery. CSAS is also the U.S. Node of the Global Biodiversity Information Facility (GBIF), an international, government-initiated and funded effort focused on making biodiversity data freely available for scientific research, conservation and sustainable development. CSAS, with its partners at Department of Energy's Oak Ridge National Laboratory (ORNL), hosts a full mirror of the hundreds of millions of global records to which GBIF provides access. BISON has been initiated with the 110 million records GBIF makes available from the U.S. and is integrating millions more records from other sources each year.

  13. Serving Data to the GLAST Users Community

    SciTech Connect

    Stephens, Thomas E.

    2007-07-12

    The scientific community will access the public GLAST data through the website of the GLAST Science Support Center (GSSC). For most data products the GSSC website will link to the NASA High Energy Astrophysics Science Archive Research Center's (HEASARC) Browse interface, which will actually serve the data. For example, data from the GLAST Burst Monitor (GBM) from a given burst will be packaged together and accessible through Browse. However, the photon and event data produced by the Large Area Telescope (LAT), GLAST's primary instrument, will be distributed through a custom GSSC interface. These data will be collected over the LAT's large field-of-view, usually while the LAT is scanning the sky, and thus photons from a particular direction cannot be attributed to a single 'observation' in the traditional sense. Users will request all photons detected from a region on the sky over a specified time and energy range. Through its website the GSSC will also provide long and short term science timelines, spacecraft position and attitude histories, exposure maps and other scientific data products. The different data products provided by the GSSC will be described.

  14. Cogeneration plant serves Prague sewage works

    SciTech Connect

    1995-10-01

    The new cogeneration plant at the sewage works in Prague, Czech Republic, was commissioned in June of this year. The plant is based on three gas engine modules from Deutz MWM-Gastechnik, which supply power and heat from the sewage gas. Also installed was a central plant control system (CPCS) for automation of the power plant, including long-term data storage for operation optimization. The gas engines are equipped with an individual total electronic management system (TEM) that optimizes engine operation and heat transfer. The TEM system also serves for safety monitoring of the relevant modules. Data communication between the TEM system and the CPCS is realized via a serial interface. The CPCS can thus test the availability of the individual heat generators and, depending on the condition of an individual module, switch over to another. With due consideration to environmental protection, Deutz MWM-Gastechnik guarantees NO{sub x} emissions of less than 500 mg/Nm{sup 3} (at 5% O{sub 2}) and CO emissions of less than 650 mg/Nm{sup 3}. The plant operator has also encapsulated the three gas engine modules in soundproofing enclosures in order to reduce noise emissions from 105 down to 78 dB(A).

  15. Environmental Health Related Socio-Spatial Inequalities: Identifying "Hotspots" of Environmental Burdens and Social Vulnerability.

    PubMed

    Shrestha, Rehana; Flacke, Johannes; Martinez, Javier; van Maarseveen, Martin

    2016-01-01

    Differential exposure to multiple environmental burdens and benefits and their distribution across a population with varying vulnerability can contribute heavily to health inequalities. Particularly relevant are areas with high cumulative burdens and high social vulnerability termed as "hotspots". This paper develops an index-based approach to assess these multiple burdens and benefits in combination with vulnerability factors at detailed intra-urban level. The method is applied to the city of Dortmund, Germany. Using non-spatial and spatial methods we assessed inequalities and identified "hotspot" areas in the city. We found modest inequalities burdening higher vulnerable groups in Dortmund (CI = -0.020 at p < 0.05). At the detailed intra-urban level, however, inequalities showed strong geographical patterns. Large numbers of "hotspots" exist in the northern part of the city compared to the southern part. A holistic assessment, particularly at a detailed local level, considering both environmental burdens and benefits and their distribution across the population with the different vulnerability, is essential to inform environmental justice debates and to mobilize local stakeholders. Locating "hotspot" areas at this detailed spatial level can serve as a basis to develop interventions that target vulnerable groups to ensure a health conducive equal environment. PMID:27409625

  16. Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem.

    PubMed

    Williams, Patricia Ah; Woodward, Andrew J

    2015-01-01

    The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat. PMID:26229513

  17. Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem

    PubMed Central

    Williams, Patricia AH; Woodward, Andrew J

    2015-01-01

    The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat. PMID:26229513

  18. Amyotrophic lateral sclerosis: cell vulnerability or system vulnerability?

    PubMed Central

    Talbot, Kevin

    2014-01-01

    Amyotrophic lateral sclerosis (ALS) is a complex neurodegenerative disease with clinical, pathological and genetic overlap with frontotemporal dementia (FTD). No longer viewed as one disease with a single unified cause, ALS is now considered to be a clinicopathological syndrome resulting from a complex convergence of genetic susceptibility, age-related loss of cellular homeostasis, and possible environmental influences. The rapid increase in recent years of the number of genes in which mutations have been associated with ALS has led to in vitro and in vivo models that have generated a wealth of data indicating disruption of specific biochemical pathways and sub-cellular compartments. Data implicating pathways including protein misfolding, mRNA splicing, oxidative stress, proteosome and mitochondrial dysfunction in the pathogenesis of ALS reinforce a disease model based on selective age-dependent vulnerability of a specific population of cells. To the clinical neurologist, however, ALS presents as a disease of focal onset and contiguous spread. Characteristic regional patterns of involvement and progression suggest that the disease does not proceed randomly but via a restricted number of anatomical pathways. These clinical observations combined with electrophysiological and brain-imaging studies underpin the concept of ALS at the macroscopic level as a ‘system degeneration’. This dichotomy between cellular and systems neurobiology raises the fundamental questions of what initiates the disease process in a specific anatomical site and how the disease is propagated. Is the essence of ALS a cell-to-cell transmission of pathology with, for example, a ‘prion-like’ mechanism, or does the cellular pathology follow degeneration of specific synaptic networks? Elucidating the interaction between cellular degeneration and system level degeneration will aid modeling of the disease in the earliest phases, improve the development of sensitive markers of disease

  19. Serving Those Who Serve: Meeting the Complex Needs of Students Returning Home from War

    ERIC Educational Resources Information Center

    Veislind, Emili

    2013-01-01

    As community colleges across the country strive to improve completion rates and serve a growing number of students returned home from war, the need for programs that meet the unique needs of veterans--including job training, social acclimation, referral programs for mental health counseling, and academic tutoring, to name a few--is more pressing…

  20. Offer versus Serve or Serve Only: Does Service Method Affect Elementary Children's Fruit and Vegetable Consumption?

    ERIC Educational Resources Information Center

    Goggans, Margaret Harbison; Lambert, Laurel; Chang, Yunhee

    2011-01-01

    Purpose/Objectives: The purpose of this study was to determine if the use of the Offer versus Serve (OVS) provision in the National School Lunch Program would result in a significant difference in fruit and vegetable consumption by fourth and fifth grade elementary students, and in plate waste cost. Methods: Weighed and visual plate waste data…

  1. How Online Schools Serve and Fail to Serve At-Risk Students

    ERIC Educational Resources Information Center

    Figueiredo-Brown, Regina

    2013-01-01

    Purpose: Online schools were initially designed to provide access to diverse courses to advanced and homeschooled students, however, many online schools now market their programs specifically to students whose needs place them at-risk in traditional schools. The capacity of technology to address any of the needs of under-served students is largely…

  2. [Nurses' autonomy and vulnerability in the Nursing Assistance Systematization practice].

    PubMed

    Menezes, Silvia Regina Tamae; Priel, Margareth Rose; Pereira, Luciane Lucio

    2011-08-01

    The objective of this study was to recognize the autonomy and vulnerability of nurses in the implementation of the Sistema da Assistência de Enfermagem (SAE) Nursing Care System through an integrative literature review, using content analysis. A survey was conducted, and 40 articles published between 1998 and 2008 were selected based on their relevance. Results showed two main categories of meaning: Benefits associated to the SAE practice (to patients, to the profession and to the institution) and Determinants for the Implementation of SAE (nurse's competence, training and education, record-instruments, infrastructure and collective sharing-construction). From the integration of the two categories, the highlights were the autonomy in acting with freedom and responsibility, science-based decision-making, and being valued for their social work, as well as the vulnerability expressed by interpersonal relationships, the wear generated by professional stress and the risk inherent to the service. PMID:21876898

  3. [Nurses' autonomy and vulnerability in the Nursing Assistance Systematization practice].

    PubMed

    Menezes, Silvia Regina Tamae; Priel, Margareth Rose; Pereira, Luciane Lucio

    2011-08-01

    The objective of this study was to recognize the autonomy and vulnerability of nurses in the implementation of the Sistema da Assistência de Enfermagem (SAE) Nursing Care System through an integrative literature review, using content analysis. A survey was conducted, and 40 articles published between 1998 and 2008 were selected based on their relevance. Results showed two main categories of meaning: Benefits associated to the SAE practice (to patients, to the profession and to the institution) and Determinants for the Implementation of SAE (nurse's competence, training and education, record-instruments, infrastructure and collective sharing-construction). From the integration of the two categories, the highlights were the autonomy in acting with freedom and responsibility, science-based decision-making, and being valued for their social work, as well as the vulnerability expressed by interpersonal relationships, the wear generated by professional stress and the risk inherent to the service.

  4. Vulnerability, Health Agency and Capability to Health.

    PubMed

    Straehle, Christine

    2016-01-01

    One of the defining features of the capability approach (CA) to health, as developed in Venkatapuram's book Health Justice, is its aim to enable individual health agency. Furthermore, the CA to health hopes to provide a strong guideline for assessing the health-enabling content of social and political conditions. In this article, I employ the recent literature on the liberal concept of vulnerability to assess the CA. I distinguish two kinds of vulnerability. Considering circumstantial vulnerability, I argue that liberal accounts of vulnerability concerned with individual autonomy, align with the CA to health. Individuals should, as far as possible, be able to make health-enabling decisions about their lives, and their capability to do so should certainly not be hindered by public policy. The CA to health and a vulnerability-based analysis then work alongside to define moral responsibilities and designate those who hold them. Both approaches demand social policy to address circumstances that hinder individuals from taking health-enabling decisions. A background condition of vulnerability, on the other hand, even though it hampers the capability for health, does not warrant the strong moral claim proposed by the CA to health to define health as a meta-capability that should guide social policy. Nothing in our designing social policy could change the challenge to health agency when we deal with background conditions of vulnerability.

  5. Vulnerability, Health Agency and Capability to Health.

    PubMed

    Straehle, Christine

    2016-01-01

    One of the defining features of the capability approach (CA) to health, as developed in Venkatapuram's book Health Justice, is its aim to enable individual health agency. Furthermore, the CA to health hopes to provide a strong guideline for assessing the health-enabling content of social and political conditions. In this article, I employ the recent literature on the liberal concept of vulnerability to assess the CA. I distinguish two kinds of vulnerability. Considering circumstantial vulnerability, I argue that liberal accounts of vulnerability concerned with individual autonomy, align with the CA to health. Individuals should, as far as possible, be able to make health-enabling decisions about their lives, and their capability to do so should certainly not be hindered by public policy. The CA to health and a vulnerability-based analysis then work alongside to define moral responsibilities and designate those who hold them. Both approaches demand social policy to address circumstances that hinder individuals from taking health-enabling decisions. A background condition of vulnerability, on the other hand, even though it hampers the capability for health, does not warrant the strong moral claim proposed by the CA to health to define health as a meta-capability that should guide social policy. Nothing in our designing social policy could change the challenge to health agency when we deal with background conditions of vulnerability. PMID:26686329

  6. Development and implementation of a Bayesian-based aquifer vulnerability assessment in Florida

    USGS Publications Warehouse

    Arthur, J.D.; Wood, H.A.R.; Baker, A.E.; Cichon, J.R.; Raines, G.L.

    2007-01-01

    The Florida Aquifer Vulnerability Assessment (FAVA) was designed to provide a tool for environmental, regulatory, resource management, and planning professionals to facilitate protection of groundwater resources from surface sources of contamination. The FAVA project implements weights-of-evidence (WofE), a data-driven, Bayesian-probabilistic model to generate a series of maps reflecting relative aquifer vulnerability of Florida's principal aquifer systems. The vulnerability assessment process, from project design to map implementation is described herein in reference to the Floridan aquifer system (FAS). The WofE model calculates weighted relationships between hydrogeologic data layers that influence aquifer vulnerability and ambient groundwater parameters in wells that reflect relative degrees of vulnerability. Statewide model input data layers (evidential themes) include soil hydraulic conductivity, density of karst features, thickness of aquifer confinement, and hydraulic head difference between the FAS and the watertable. Wells with median dissolved nitrogen concentrations exceeding statistically established thresholds serve as training points in the WofE model. The resulting vulnerability map (response theme) reflects classified posterior probabilities based on spatial relationships between the evidential themes and training points. The response theme is subjected to extensive sensitivity and validation testing. Among the model validation techniques is calculation of a response theme based on a different water-quality indicator of relative recharge or vulnerability: dissolved oxygen. Successful implementation of the FAVA maps was facilitated by the overall project design, which included a needs assessment and iterative technical advisory committee input and review. Ongoing programs to protect Florida's springsheds have led to development of larger-scale WofE-based vulnerability assessments. Additional applications of the maps include land-use planning

  7. Determining Vulnerability Importance in Environmental Impact Assessment

    SciTech Connect

    Toro, Javier; Duarte, Oscar; Requena, Ignacio; Zamorano, Montserrat

    2012-01-15

    The concept of vulnerability has been used to describe the susceptibility of physical, biotic, and social systems to harm or hazard. In this sense, it is a tool that reduces the uncertainties of Environmental Impact Assessment (EIA) since it does not depend exclusively on the value assessments of the evaluator, but rather is based on the environmental state indicators of the site where the projects or activities are being carried out. The concept of vulnerability thus reduces the possibility that evaluators will subjectively interpret results, and be influenced by outside interests and pressures during projects. However, up until now, EIA has been hindered by a lack of effective methods. This research study analyzes the concept of vulnerability, defines Vulnerability Importance and proposes its inclusion in qualitative EIA methodology. The method used to quantify Vulnerability Importance is based on a set of environmental factors and indicators that provide a comprehensive overview of the environmental state. The results obtained in Colombia highlight the usefulness and objectivity of this method since there is a direct relation between this value and the environmental state of the departments analyzed. - Research Highlights: Black-Right-Pointing-Pointer The concept of vulnerability could be considered defining Vulnerability Importance included in qualitative EIA methodology. Black-Right-Pointing-Pointer The use of the concept of environmental vulnerability could reduce the subjectivity of qualitative methods of EIA. Black-Right-Pointing-Pointer A method to quantify the Vulnerability Importance proposed provides a comprehensive overview of the environmental state. Black-Right-Pointing-Pointer Results in Colombia highlight the usefulness and objectivity of this method.

  8. Child development: vulnerability and resilience.

    PubMed

    Engle, P L; Castle, S; Menon, P

    1996-09-01

    Many of the challenges facing children now are a function of changing times, including increase in urbanization, political violence, changing family forms, and in some areas decreased supplies of adequate food. This review focuses particularly on those changes in which children are the victims and which induce new threats for them, rather than on problems such as child disability or mental illness. The outcome variables of interest in this paper are dimensions of children's psychosocial development, including cognitive development, psychological adjustment and aggression, whereas the companion paper in this issue (Caldwell P., Child survival: vulnerability and resilience in adversity in the European past and the contemporary Third World, Soc. Sci. Med.) [1] focuses on physical aspects of children's development. The risks that are hurdles in the process of development of a young child begin from conception and carry on into later life. To address them all would be impossible; thus, in order to do justice to the issues at hand, we have chosen those risks that, in our view, are important in a child's psychosocial development in developing countries. This paper will thus provide a discussion of the concepts of risk and resilience, then apply these concepts to the analysis of three examples of risk faced by children today: nutritional threats (e.g. malnutrition due to decline in breastfeeding); family dynamics and types of family forms (e.g. child fostering and non-traditional families); and experiences of violence (domestic or political). In each case, the same four questions will be addressed: what are the consequences of the risk factor for children, what are the etiologies and conditions of risk, are there any children who seem to cope with the risk factor successfully and what are some of the protective factors, and what interventions or programs would help support these children?

  9. Early Brain Vulnerability in Wolfram Syndrome

    PubMed Central

    Hershey, Tamara; Lugar, Heather M.; Shimony, Joshua S.; Rutlin, Jerrel; Koller, Jonathan M.; Perantie, Dana C.; Paciorkowski, Alex R.; Eisenstein, Sarah A.; Permutt, M. Alan

    2012-01-01

    Wolfram Syndrome (WFS) is a rare autosomal recessive disease characterized by insulin-dependent diabetes mellitus, optic nerve atrophy, diabetes insipidus, deafness, and neurological dysfunction leading to death in mid-adulthood. WFS is caused by mutations in the WFS1 gene, which lead to endoplasmic reticulum (ER) stress-mediated cell death. Case studies have found widespread brain atrophy in late stage WFS. However, it is not known when in the disease course these brain abnormalities arise, and whether there is differential vulnerability across brain regions and tissue classes. To address this limitation, we quantified regional brain abnormalities across multiple imaging modalities in a cohort of young patients in relatively early stages of WFS. Children and young adults with WFS were evaluated with neurological, cognitive and structural magnetic resonance imaging measures. Compared to normative data, the WFS group had intact cognition, significant anxiety and depression, and gait abnormalities. Compared to healthy and type 1 diabetic control groups, the WFS group had smaller intracranial volume and preferentially affected gray matter volume and white matter microstructural integrity in the brainstem, cerebellum and optic radiations. Abnormalities were detected in even the youngest patients with mildest symptoms, and some measures did not follow the typical age-dependent developmental trajectory. These results establish that WFS is associated with smaller intracranial volume with specific abnormalities in the brainstem and cerebellum, even at the earliest stage of clinical symptoms. This pattern of abnormalities suggests that WFS has a pronounced impact on early brain development in addition to later neurodegenerative effects, representing a significant new insight into the WFS disease process. Longitudinal studies will be critical for confirming and expanding our understanding of the impact of ER stress dysregulation on brain development. PMID:22792385

  10. Individual and social vulnerabilities upon acquiring tuberculosis: a literature systematic review

    PubMed Central

    2014-01-01

    Tuberculosis is a contagious infectious disease mainly caused by the bacteria Mycobacterium tuberculosis that still meets the priority criteria - high magnitude, transcendence and vulnerability - due to the threat it poses to public health. When taking into consideration the vulnerability conditions that favor the onset of the disease, this article aimed to investigate the implications originated from individual and social vulnerability conditions in which tuberculosis patients are inserted. Databases like MEDLINE, LILACS and SciELO were searched in Portuguese, Spanish and English using the descriptors tuberculosis and vulnerability, and 183 articles were found. After the selection criterion was applied, there were 22 publications left to be discussed. Some of the aspects that characterize the vulnerability to tuberculosis are: low-income and low-education families, age, poor living conditions, chemical dependency, pre-existing conditions/aggravations like diabetes mellitus and malnutrition, indigenous communities, variables related to health professionals, intense border crossings and migration, difficulty in accessing information and health services and lack of knowledge on tuberculosis. Much as such aspects are present and favor the onset of the disease, several reports show high incidence rates of tuberculosis in low vulnerability places, suggesting that some factors related to the disease are still unclear. In conclusion, health promotion is important in order to disfavor such conditions or factors of vulnerability to tuberculosis, making them a primary target in the public health planning process and disease control. PMID:25067955

  11. Extinction vulnerability of coral reef fishes.

    PubMed

    Graham, Nicholas A J; Chabanet, Pascale; Evans, Richard D; Jennings, Simon; Letourneur, Yves; Aaron Macneil, M; McClanahan, Tim R; Ohman, Marcus C; Polunin, Nicholas V C; Wilson, Shaun K

    2011-04-01

    With rapidly increasing rates of contemporary extinction, predicting extinction vulnerability and identifying how multiple stressors drive non-random species loss have become key challenges in ecology. These assessments are crucial for avoiding the loss of key functional groups that sustain ecosystem processes and services. We developed a novel predictive framework of species extinction vulnerability and applied it to coral reef fishes. Although relatively few coral reef fishes are at risk of global extinction from climate disturbances, a negative convex relationship between fish species locally vulnerable to climate change vs. fisheries exploitation indicates that the entire community is vulnerable on the many reefs where both stressors co-occur. Fishes involved in maintaining key ecosystem functions are more at risk from fishing than climate disturbances. This finding is encouraging as local and regional commitment to fisheries management action can maintain reef ecosystem functions pending progress towards the more complex global problem of stabilizing the climate.

  12. Global health, vulnerable populations, and law.

    PubMed

    Benatar, Solomon R

    2013-01-01

    Given the fragility of individual and population wellbeing in an interdependent world threatened by many overlapping crises, the suggestion is made that new legal mechanisms have the robust potential to reduce human vulnerability locally and globally. PMID:23581656

  13. Housing concerns of vulnerable older Canadians.

    PubMed

    Weeks, Lori E; LeBlanc, Kristal

    2010-09-01

    Preparing for the future housing needs of older adults is imperative in countries with an aging population, but little is known about these issues among vulnerable older adults. This study used a qualitative approach to identify key housing concerns in this group. A total of 84 vulnerable older adults including Aboriginal elders, those with various disabilities, and ethnic minorities participated in 10 focus groups. The Canadian Mortgage and Housing Corporation's (CMHC's) standards of core housing need provided a framework for data analysis, along with the identification of additional key housing themes across and within groups of vulnerable older adults. The results provide insight into preferred housing characteristics, regardless of housing form. Additionally, the results provide insight into how to support vulnerable older adults who choose to remain in their homes and communities and how to help ensure that appropriate housing is developed that meets the needs of this diverse population. PMID:20712917

  14. Salt vulnerability assessment methodology for urban streams

    NASA Astrophysics Data System (ADS)

    Betts, A. R.; Gharabaghi, B.; McBean, E. A.

    2014-09-01

    De-icing agents such as road salts while used for winter road maintenance can cause negative effects on urban stream water quality and drinking water supplies. A new methodology using readily available spatial data to identify Salt Vulnerable Areas (SVAs) for urban streams is used to prioritize implementation of best management practices. The methodology calculates the probable chloride concentration statistics at specified points in the urban stream network and compares the results with known aquatic species exposure tolerance limits to characterize the vulnerability scores. The approach prioritizes implementation of best management practices to areas identified as vulnerable to road salt. The vulnerability assessment is performed on seven sites in four watersheds in the Greater Toronto Area and validated using the Hanlon Creek watershed in Guelph. The mean annual in-stream chloride concentration equation uses readily available spatial data - with province-wide coverage - that can be easily used in any urban watershed.

  15. [Aged woman's vulnerability related to AIDS].

    PubMed

    Silva, Carla Marins; Lopes, Fernanda Maria do Valle Martins; Vargens, Octavio Muniz da Costa

    2010-09-01

    This article is a systhematic literature review including the period from 1994 to 2009, whose objective was to discuss the aged woman's vulnerability in relation to Acquired Imunodeficiency Syndrome (Aids). The search for scientific texts was accomplished in the following databases: Biblioteca Virtual em Saúde, Scientific Eletronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE). The descriptors used were vulnerability, woman and Aids. Eighteen texts were analyzed, including articles in scientific journals, thesis and dissertations. As a conclusion, it was noted that aged women and vulnerability to Aids are directly related, through gender characteristics including submission and that were built historical and socially. We consider as fundamental the development of studies which may generate publications accessible to women, in order to help them see themselves as persons vulnerable to Aids contagion just for being women.

  16. Camana, Peru, and Tsunami Vulnerability

    NASA Technical Reports Server (NTRS)

    2002-01-01

    A tsunami washed over the low-lying coastal resort region near Camana, southern Peru, following a strong earthquake on June 23, 2001. The earthquake was one of the most powerful of the last 35 years and had a magnitude of 8.4. After the initial quake, coastal residents witnessed a sudden drawdown of the ocean and knew a tsunami was imminent. They had less than 20 minutes to reach higher ground before the tsunami hit. Waves as high as 8 m came in four destructive surges reaching as far as 1.2 km inland. The dashed line marks the approximate area of tsunami inundation. Thousands of buildings were destroyed, and the combined earthquake and tsunami killed as many as 139 people. This image (ISS004-ESC-6128) was taken by astronauts onboard the International Space Station on 10 January 2002. It shows some of the reasons that the Camana area was so vulnerable to tsunami damage. The area has a 1 km band of coastal plain that is less than 5 m in elevation. Much of the plain can be seen by the bright green fields of irrigated agriculture that contrast with the light-colored desert high ground. Many of the tsunami-related deaths were workers in the onion fields in the coastal plain that were unwilling to leave their jobs before the end of the shift. A number of lives were spared because the tsunami occurred during the resort off-season, during the daylight when people could see the ocean drawdown, and during one of the lowest tides of the year. Information on the Tsunami that hit Camana can be found in a reports on the visit by the International Tsunami Survey Team and the USC Tsunami Research Lab. Earthquake Epicenter, Peru shows another image of the area. Image provided by the Earth Sciences and Image Analysis Laboratory at Johnson Space Center. Additional images taken by astronauts and cosmonauts can be viewed at the NASA-JSC Gateway to Astronaut Photography of Earth.

  17. Physical and economic vulnerability considering alpine hazards

    NASA Astrophysics Data System (ADS)

    Totschnig, Reinhold; Keiler, Margreth; Glade, Thomas

    2010-05-01

    The obvious increase in natural disasters in the last decades, evoked by different circumstances, emphasises the necessity of dealing with these natural hazards and correlated risks. Independent of the scientific discipline, vulnerability assessment is thereby seen as a central part within risk assessment. However, the ways in which vulnerability is understood, are manifold. Based on a theoretical framework developed within the MOVE-project (Methods for the Improvement of Vulnerability Assessment in Europe), vulnerability comprises of three factors: exposure, susceptibility or fragility, and lack of resilience. To follow a multidisciplinary approach, different dimensions of susceptibility and fragility such as the physical, the social and the ecological dimensions (among others) should be considered in vulnerability assessment. Comprehensive methods and corresponding indicators (qualitative as well as quantitative) have not yet been fully developed. The aim of the MOVE-project is to close this gap, dealing with a wide range of natural hazards. The individual partner institutions within this project work in different scientific fields, dealing with different natural hazards and different vulnerability factors. The present study has its focus on alpine hazards, using data from several test sites in South Tyrol, Italy. Alpine hazards such as avalanches, landslides as well as permafrost hazards are covered. Different methods and indicators related to exposure and the physical and economic dimensions of susceptibility were studied and enhanced. Applied GIS data were improved through field studies and tools such as simulation models and data mining methods. The aim of this study was to develop vulnerability curves on a local scale and vulnerability maps on a regional scale with a high utility value for possible end users. First results, methods and indicators as well as their application will critically be discussed.

  18. Application of PRA to HEMP vulnerability analysis

    SciTech Connect

    Mensing, R.W.

    1985-09-01

    Vulnerability analyses of large systems, e.g., control and communication centers, aircraft, ships, are subject to many uncertainties. A basic source of uncertainty is the random variation inherent in the physical world. Thus, vulnerability is appropriately described by an estimate of the probability of survival (or failure). A second source of uncertainty that also needs to be recognized is the uncertainty associated with the analysis or estimation process itself. This uncertainty, often called modeling uncertainty, has many contributors. There are the approximations introduced by using mathematical models to describe reality. Also, the appropriate values of the model parameters are derived from several sources, e.g., based on experimental or test data, based on expert judgment and opinion. In any case, these values are subject to uncertainty. This uncertainty must be considered in the description of vulnerability. Thus, the estimate of the probability of survival is not a single value but a range of values. Probabilistic risk analysis (PRA) is a methodology which deals with these uncertainty issues. This report discusses the application of PRA to HEMP vulnerability analyses. Vulnerability analysis and PRA are briefly outlined and the need to distinguish between random variation and modeling uncertainty is discussed. Then a sequence of steps appropriate for applying PRA to vulnerability problems is outlined. Finally, methods for handling modeling uncertainty are identified and discussed.

  19. Global Distributions of Vulnerability to Climate Change

    SciTech Connect

    Yohe, Gary; Malone, Elizabeth L.; Brenkert, Antoinette L.; Schlesinger, Michael; Meij, Henk; Xiaoshi, Xing

    2006-12-01

    Signatories of the United Nations Framework Convention on Climate Change (UNFCCC) have committed themselves to addressing the “specific needs and special circumstances of developing country parties, especially those that are particularly vulnerable to the adverse effects of climate change”.1 The Intergovernmental Panel on Climate Change (IPCC) has since concluded with high confidence that “developing countries will be more vulnerable to climate change than developed countries”.2 In their most recent report, however, the IPCC notes that “current knowledge of adaptation and adaptive capacity is insufficient for reliable prediction of adaptations” 3 because “the capacity to adapt varies considerably among regions, countries and socioeconomic groups and will vary over time”.4 Here, we respond to the apparent contradiction in these two statements by exploring how variation in adaptive capacity and climate impacts combine to influence the global distribution of vulnerability. We find that all countries will be vulnerable to climate change, even if their adaptive capacities are enhanced. Developing nations are most vulnerable to modest climate change. Reducing greenhouse-gas emissions would diminish their vulnerabilities significantly. Developed countries would benefit most from mitigation for moderate climate change. Extreme climate change overwhelms the abilities of all countries to adapt. These findings should inform both ongoing negotiations for the next commitment period of the Kyoto Protocol and emerging plans for implementing UNFCCC-sponsored adaptation funds.

  20. Distinguishing adaptive plasticity from vulnerability in the aging hippocampus.

    PubMed

    Gray, D T; Barnes, C A

    2015-11-19

    Hippocampal circuits are among the best described networks in the mammalian brain, particularly with regard to the alterations that arise during normal aging. Decades of research indicate multiple points of vulnerability in aging neural circuits, and it has been proposed that each of these changes make a contribution to observed age-related cognitive deficits. Another view has been relatively overlooked - namely that some of these changes arise in adaptive response to protect network function in aged animals. This possibility leads to a rather different view on the biological variation of function in the brain of older individuals. Using the hippocampus as a model neural circuit we discuss how, in normally aged animals, some age-related changes may arise through processes of neural plasticity that serve to enhance network function rather than to hinder it. Conceptually disentangling the initial age-related vulnerabilities from changes that result in adaptive response will be a major challenge for the future research on brain aging. We suggest that a reformulation of how normal aging could be understood from an adaptive perspective will lead to a deeper understanding of the secrets behind successful brain aging and our recent cultural successes in facilitating these processes.

  1. Molecular Imaging of Vulnerable Atherosclerotic Plaques in Animal Models

    PubMed Central

    Gargiulo, Sara; Gramanzini, Matteo; Mancini, Marcello

    2016-01-01

    Atherosclerosis is characterized by intimal plaques of the arterial vessels that develop slowly and, in some cases, may undergo spontaneous rupture with subsequent heart attack or stroke. Currently, noninvasive diagnostic tools are inadequate to screen atherosclerotic lesions at high risk of acute complications. Therefore, the attention of the scientific community has been focused on the use of molecular imaging for identifying vulnerable plaques. Genetically engineered murine models such as ApoE−/− and ApoE−/−Fbn1C1039G+/− mice have been shown to be useful for testing new probes targeting biomarkers of relevant molecular processes for the characterization of vulnerable plaques, such as vascular endothelial growth factor receptor (VEGFR)-1, VEGFR-2, intercellular adhesion molecule (ICAM)-1, P-selectin, and integrins, and for the potential development of translational tools to identify high-risk patients who could benefit from early therapeutic interventions. This review summarizes the main animal models of vulnerable plaques, with an emphasis on genetically altered mice, and the state-of-the-art preclinical molecular imaging strategies. PMID:27618031

  2. Molecular Imaging of Vulnerable Atherosclerotic Plaques in Animal Models.

    PubMed

    Gargiulo, Sara; Gramanzini, Matteo; Mancini, Marcello

    2016-01-01

    Atherosclerosis is characterized by intimal plaques of the arterial vessels that develop slowly and, in some cases, may undergo spontaneous rupture with subsequent heart attack or stroke. Currently, noninvasive diagnostic tools are inadequate to screen atherosclerotic lesions at high risk of acute complications. Therefore, the attention of the scientific community has been focused on the use of molecular imaging for identifying vulnerable plaques. Genetically engineered murine models such as ApoE(-/-) and ApoE(-/-)Fbn1C1039G(+/-) mice have been shown to be useful for testing new probes targeting biomarkers of relevant molecular processes for the characterization of vulnerable plaques, such as vascular endothelial growth factor receptor (VEGFR)-1, VEGFR-2, intercellular adhesion molecule (ICAM)-1, P-selectin, and integrins, and for the potential development of translational tools to identify high-risk patients who could benefit from early therapeutic interventions. This review summarizes the main animal models of vulnerable plaques, with an emphasis on genetically altered mice, and the state-of-the-art preclinical molecular imaging strategies. PMID:27618031

  3. Protecting and respecting the vulnerable: existing regulations or further protections?

    PubMed

    Solomon, Stephanie R

    2013-02-01

    Scholars and policymakers continue to struggle over the meaning of the word "vulnerable" in the context of research ethics. One major reason for the stymied discussions regarding vulnerable populations is that there is no clear distinction between accounts of research vulnerabilities that exist for certain populations and discussions of research vulnerabilities that require special regulations in the context of research ethics policies. I suggest an analytic process by which to ascertain whether particular vulnerable populations should be contenders for additional regulatory protections. I apply this process to two vulnerable populations: the cognitively vulnerable and the economically vulnerable. I conclude that a subset of the cognitively vulnerable require extra protections while the economically vulnerable should be protected by implementing existing regulations more appropriately and rigorously. Unless or until the informed consent process is more adequately implemented and the distributive justice requirement of the Belmont Report is emphasized and operationalized, the economically disadvantaged will remain particularly vulnerable to the harm of exploitation in research.

  4. Drought vulnerability assesssment and mapping in Morocco

    NASA Astrophysics Data System (ADS)

    Imani, Yasmina; Lahlou, Ouiam; Bennasser Alaoui, Si; Naumann, Gustavo; Barbosa, Paulo; Vogt, Juergen

    2014-05-01

    Drought vulnerability assessment and mapping in Morocco Authors: Yasmina Imani 1, Ouiam Lahlou 1, Si Bennasser Alaoui 1 Paulo Barbosa 2, Jurgen Vogt 2, Gustavo Naumann 2 1: Institut Agronomique et Vétérinaire Hassan II (IAV Hassan II), Rabat Morocco. 2: European Commission, Joint Research Centre (JRC), Institute for Environment and Sustainability (IES), Ispra, Italy. In Morocco, nearly 50% of the population lives in rural areas. They are mostly small subsistent farmers whose production depends almost entirely on rainfall. They are therefore very sensitive to drought episodes that may dramatically affect their incomes. Although, as a consequence of the increasing frequency, length and severity of drought episodes in the late 90's, the Moroccan government decided, to move on from a crisis to a risk management approach, drought management remains in practice mainly reactive and often ineffective. The lack of effectiveness of public policy is in part a consequence of the poor understanding of drought vulnerability at the rural community level, which prevents the development of efficient mitigation actions and adaptation strategies, tailored to the needs and specificities of each rural community. Thus, the aim of this study is to assess and map drought vulnerability at the rural commune level in the Oum Er-Rbia basin which is a very heterogeneous basin, showing a big variability of climates, landscapes, cropping systems and social habits. Agricultural data collected from the provincial and local administrations of Agriculture and socio-economic data from the National Department of Statistics were used to compute a composite vulnerability index (DVI) integrating four different components: (i) the renewable natural capacity, (ii) the economic capacity, (iii) human and civic resources, and (iv) infrastructure and technology. The drought vulnerability maps that were derived from the computation of the DVI shows that except very specific areas, most of the Oum er Rbia

  5. 49 CFR 105.50 - Serving a subpoena.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... PROGRAM DEFINITIONS AND GENERAL PROCEDURES General Procedures Subpoenas § 105.50 Serving a subpoena. (a) Personal service. Anyone who is not an interested party and who is at least 18 years of age may serve...

  6. Linking local vulnerability to climatic hazard damage assessment for integrated river basin management

    NASA Astrophysics Data System (ADS)

    Hung, Hung-Chih; Liu, Yi-Chung; Chien, Sung-Ying

    2015-04-01

    1. Background Major portions of areas in Asia are expected to increase exposure and vulnerability to climate change and weather extremes due to rapid urbanization and overdevelopment in hazard-prone areas. To prepare and confront the potential impacts of climate change and related hazard risk, many countries have implemented programs of integrated river basin management. This has led to an impending challenge for the police-makers in many developing countries to build effective mechanism to assess how the vulnerability distributes over river basins, and to understand how the local vulnerability links to climatic (climate-related) hazard damages and risks. However, the related studies have received relatively little attention. This study aims to examine whether geographic localities characterized by high vulnerability experience significantly more damages owing to onset weather extreme events at the river basin level, and to explain what vulnerability factors influence these damages or losses. 2. Methods and data An indicator-based assessment framework is constructed with the goal of identifying composite indicators (including exposure, biophysical, socioeconomic, land-use and adaptive capacity factors) that could serve as proxies for attributes of local vulnerability. This framework is applied by combining geographical information system (GIS) techniques with multicriteria decision analysis (MCDA) to evaluate and map integrated vulnerability to climatic hazards across river basins. Furthermore, to explain the relationship between vulnerability factors and disaster damages, we develop a disaster damage model (DDM) based on existing disaster impact theory. We then synthesize a Zero-Inflated Poisson regression model with a Tobit regression analysis to identify and examine how the disaster impacts and vulnerability factors connect to typhoon disaster damages and losses. To illustrate the proposed methodology, the study collects data on the vulnerability attributes of

  7. Ultrasound Tissue Characterization of Vulnerable Atherosclerotic Plaque

    PubMed Central

    Picano, Eugenio; Paterni, Marco

    2015-01-01

    A thrombotic occlusion of the vessel fed by ruptured coronary atherosclerotic plaque may result in unstable angina, myocardial infarction or death, whereas embolization from a plaque in carotid arteries may result in transient ischemic attack or stroke. The atherosclerotic plaque prone to such clinical events is termed high-risk or vulnerable plaque, and its identification in humans before it becomes symptomatic has been elusive to date. Ultrasonic tissue characterization of the atherosclerotic plaque is possible with different techniques—such as vascular, transesophageal, and intravascular ultrasound—on a variety of arterial segments, including carotid, aorta, and coronary districts. The image analysis can be based on visual, video-densitometric or radiofrequency methods and identifies three distinct textural patterns: hypo-echoic (corresponding to lipid- and hemorrhage-rich plaque), iso- or moderately hyper-echoic (fibrotic or fibro-fatty plaque), and markedly hyperechoic with shadowing (calcific plaque). Hypoechoic or dishomogeneous plaques, with spotty microcalcification and large plaque burden, with plaque neovascularization and surface irregularities by contrast-enhanced ultrasound, are more prone to clinical complications than hyperechoic, extensively calcified, homogeneous plaques with limited plaque burden, smooth luminal plaque surface and absence of neovascularization. Plaque ultrasound morphology is important, along with plaque geometry, in determining the atherosclerotic prognostic burden in the individual patient. New quantitative methods beyond backscatter (to include speed of sound, attenuation, strain, temperature, and high order statistics) are under development to evaluate vascular tissues. Although not yet ready for widespread clinical use, tissue characterization is listed by the American Society of Echocardiography roadmap to 2020 as one of the most promising fields of application in cardiovascular ultrasound imaging, offering unique

  8. Institutional Vulnerability/Opportunity Audit. Preconference Seminar Proceedings of the AIR Forum (Boston, Massachusetts, May 28-31, 1995).

    ERIC Educational Resources Information Center

    Morrison, James L.

    These proceedings report on a seminar held to determine the needs and wants served by the Association for Institutional Research (AIR) in regard to products and services provided by AIR to institutions and individuals. A vulnerability/opportunity audit was conducted to identify the strengths and weaknesses of the organization. Participants listed…

  9. 27 CFR 31.42 - Restaurants serving liquors with meals.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Restaurants serving... Part Certain Organizations, Agencies, and Persons § 31.42 Restaurants serving liquors with meals. Proprietors of restaurants and other persons who serve liquors with meals to paying customers, even if...

  10. 27 CFR 31.42 - Restaurants serving liquors with meals.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Restaurants serving... Part Certain Organizations, Agencies, and Persons § 31.42 Restaurants serving liquors with meals. Proprietors of restaurants and other persons who serve liquors with meals to paying customers, even if...

  11. 27 CFR 31.42 - Restaurants serving liquors with meals.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Restaurants serving... Part Certain Organizations, Agencies, and Persons § 31.42 Restaurants serving liquors with meals. Proprietors of restaurants and other persons who serve liquors with meals to paying customers, even if...

  12. 27 CFR 31.42 - Restaurants serving liquors with meals.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Restaurants serving... Part Certain Organizations, Agencies, and Persons § 31.42 Restaurants serving liquors with meals. Proprietors of restaurants and other persons who serve liquors with meals to paying customers, even if...

  13. 27 CFR 31.42 - Restaurants serving liquors with meals.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Restaurants serving... Part Certain Organizations, Agencies, and Persons § 31.42 Restaurants serving liquors with meals. Proprietors of restaurants and other persons who serve liquors with meals to paying customers, even if...

  14. Which Stratum of Urban Elderly Is Most Vulnerable for Dementia?

    PubMed Central

    2016-01-01

    Many factors associated with a patient's lifestyle may disrupt timely access to dementia diagnosis and management. The aim of this study was to compare characteristics of lifestyle factors at the time of initial evaluation for dementia across degrees of dementia, and to identify risk factors relating to late detection of dementia, in order to understand the various lifestyle barriers to timely recognition of the disease. We reviewed medical records of 1,409 subjects who were diagnosed as dementia among 35,723 inhabitants of Gwangjin-gu. Dementia severity was divided into three degrees. Age, sex, education, income, smoking, heavy drinking, physical activity, religion, and living conditions were evaluated. There was a significantly greater proportion of individuals who were old age, female, less educated, who had never smoked or drank heavily, without physical activity, with no religious activity and living with family other than spouse in the severe dementia group. The lifestyle risks of late detection were old age, lower education, less social interactions, less physical activity or living with family. We can define this group of patients as the vulnerable stratum to dementia evaluation. Health policy or community health services might find ways to better engage patients in this vulnerable stratum to dementia. PMID:27550494

  15. Which Stratum of Urban Elderly Is Most Vulnerable for Dementia?

    PubMed

    Moon, Yeonsil; Lee, Heeyoung; Namgung, Ok Kyoung; Han, Seol Heui

    2016-10-01

    Many factors associated with a patient's lifestyle may disrupt timely access to dementia diagnosis and management. The aim of this study was to compare characteristics of lifestyle factors at the time of initial evaluation for dementia across degrees of dementia, and to identify risk factors relating to late detection of dementia, in order to understand the various lifestyle barriers to timely recognition of the disease. We reviewed medical records of 1,409 subjects who were diagnosed as dementia among 35,723 inhabitants of Gwangjin-gu. Dementia severity was divided into three degrees. Age, sex, education, income, smoking, heavy drinking, physical activity, religion, and living conditions were evaluated. There was a significantly greater proportion of individuals who were old age, female, less educated, who had never smoked or drank heavily, without physical activity, with no religious activity and living with family other than spouse in the severe dementia group. The lifestyle risks of late detection were old age, lower education, less social interactions, less physical activity or living with family. We can define this group of patients as the vulnerable stratum to dementia evaluation. Health policy or community health services might find ways to better engage patients in this vulnerable stratum to dementia. PMID:27550494

  16. Variations in serving sizes of Australian snack foods and confectionery.

    PubMed

    Watson, Wendy L; Kury, Alexandra; Wellard, Lyndal; Hughes, Clare; Dunford, Elizabeth; Chapman, Kathy

    2016-01-01

    This study examined the serving size and energy content per serving of Australian packaged snack foods and confectionery products. Nutrition Information Panel data for 23 sub-categories of packaged snack foods (n = 3481) were extracted from The George Institute for Global Health's 2013 branded food composition database. Variations in serving size and energy content per serving were examined. Energy contents per serving were compared to recommendations in the Australian Dietary Guidelines. Serving sizes varied within and between snack food categories. Mean energy content per serving varied from 320 kJ to 899 kJ. More energy per serving than the recommended 600 kJ was displayed by 22% (n = 539) of snack foods classified in the Australian Dietary Guidelines as discretionary foods. The recommendation for energy content per serving was exceeded in 60% (n = 635) of snack foods from the Five Food Groups. Only 37% (n = 377) of confectionery products displayed the industry-agreed serving size of 25 g. Energy content per serving of many packaged snack foods do not align with the Australian Dietary Guidelines and the industry agreed serving size has not been taken up widely within the confectionery category. Given the inconsistencies in serving sizes, featuring serving size in front-of-pack information may hinder the objective of a clear and simple nutrition message. Messaging to help consumers make healthier choices should consider the variation in serving sizes on packaged snack foods. PMID:26344813

  17. Vulnerability synthetic indices: a literature integrative review.

    PubMed

    Schumann, Lívia Rejane Miguel Amaral; Schumann, Lívia Amaral; Moura, Leides Baroso Azevedo

    2015-07-01

    The concept of vulnerability is delimited by dynamic social and multigenerational processes involving at least three dimensions: exposure to risk trajectories, internal and external capabilities of reaction and possibilities of adaptation based on both the intensity of risk and the resilience of people. In order to identify and describe the synthetic indices of vulnerability, there was an integrative literature review. We consulted free access articles indexed in the following databases: BioMed, Bireme, PubMed, Reldalyc, SciELO and Web of Science; and we used controlled descriptors in English and Portuguese for all time slots available with selection and analysis of 47 studies that reported results of 23 synthetic indices of vulnerability. The results showed that the synthetic indices of vulnerability address four themes: social determinants of health; environmental and climatic conditions; family and course of life; territories and specific geographic areas. It was concluded that the definition of the components and indicators, as well as the methodologies adopted for the construction of synthetic indices need to be evaluated by means of the limitations and advantages of reporting the vulnerability through summary measures in policy formulation and decision-making aimed at human development. PMID:26132249

  18. Cyber/Physical Security Vulnerability Assessment Integration

    SciTech Connect

    MacDonald, Douglas G.; Clements, Samuel L.; Patrick, Scott W.; Perkins, Casey J.; Muller, George; Lancaster, Mary J.; Hutton, William J.

    2013-02-28

    Securing high value and critical assets is one of the biggest challenges facing this nation and others around the world. In modern integrated systems, there are four potential modes of attack available to an adversary: • physical only attack, • cyber only attack, • physical-enabled cyber attack, • cyber-enabled physical attack. Blended attacks involve an adversary working in one domain to reduce system effectiveness in another domain. This enables the attacker to penetrate further into the overall layered defenses. Existing vulnerability assessment (VA) processes and software tools which predict facility vulnerabilities typically evaluate the physical and cyber domains separately. Vulnerabilities which result from the integration of cyber-physical control systems are not well characterized and are often overlooked by existing assessment approaches. In this paper, we modified modification of the timely detection methodology, used for decades in physical security VAs, to include cyber components. The Physical and Cyber Risk Analysis Tool (PACRAT) prototype illustrates an integrated vulnerability assessment that includes cyber-physical interdependencies. Information about facility layout, network topology, and emplaced safeguards is used to evaluate how well suited a facility is to detect, delay, and respond to attacks, to identify the pathways most vulnerable to attack, and to evaluate how often safeguards are compromised for a given threat or adversary type. We have tested the PACRAT prototype on critical infrastructure facilities and the results are promising. Future work includes extending the model to prescribe the recommended security improvements via an automated cost-benefit analysis.

  19. SILENCING SHARAPOVA'S GRUNT IMPROVES THE PERCEPTION OF HER SERVE SPEED.

    PubMed

    Farhead, Nader; Punt, T David

    2015-06-01

    In recent years, grunting has become a familiar although generally unwelcome element of tennis. The behavior is considered to deny opponents the benefit of receiving optimal multi-sensory information in order to plan their own shots. The ability to make accurate serve-speed judgments of identical tennis serves presented on a computer screen, and accompanied by a grunt or not, was assessed among 38 participants (19 men). Accuracy and response time were measured. Analysis compared performance for below versus above average speed serves and for the grunt versus the no grunt condition. Grunting had a disruptive effect on serve-speed perception for below average serves, with most judged incorrectly to be above average. Response times for below average serves were also slower in the grunt condition. Grunting provides a complex perceptual challenge, and greater effort may be attributed to tennis serves with an accompanying grunt. PMID:26057416

  20. Self-Serving Bias or Simply Serving the Self? Evidence for a Dimensional Approach to Narcissism

    PubMed Central

    Tamborski, Michael; Brown, Ryan P.; Chowning, Karolyn

    2012-01-01

    Previous research has suggested that narcissism can be conceptualized as a multidimensional construct consisting of the related, but unique, dimensions of grandiosity and entitlement. The current studies examined the divergent associations of grandiosity and entitlement with respect to different types of self-serving strategies. In Study 1, we found that narcissistic grandiosity, but not entitlement, was positively associated with a self-enhancing strategy of unrealistic optimism. This association was not mediated by self-esteem. In Study 2, narcissistic entitlement, but not grandiosity, was predictive of unethical decision-making, an interpersonal self-promotional strategy that advances the self at the expense of others. Together, both studies support a model of narcissism consisting of a relatively intrapersonal dimension of grandiosity and a relatively interpersonal dimension of entitlement. PMID:22773880

  1. Self-Serving Bias or Simply Serving the Self? Evidence for a Dimensional Approach to Narcissism.

    PubMed

    Tamborski, Michael; Brown, Ryan P; Chowning, Karolyn

    2012-06-01

    Previous research has suggested that narcissism can be conceptualized as a multidimensional construct consisting of the related, but unique, dimensions of grandiosity and entitlement. The current studies examined the divergent associations of grandiosity and entitlement with respect to different types of self-serving strategies. In Study 1, we found that narcissistic grandiosity, but not entitlement, was positively associated with a self-enhancing strategy of unrealistic optimism. This association was not mediated by self-esteem. In Study 2, narcissistic entitlement, but not grandiosity, was predictive of unethical decision-making, an interpersonal self-promotional strategy that advances the self at the expense of others. Together, both studies support a model of narcissism consisting of a relatively intrapersonal dimension of grandiosity and a relatively interpersonal dimension of entitlement. PMID:22773880

  2. Forensic psychiatric inpatients served in the United States: regional and system differences.

    PubMed

    Way, B B; Dvoskin, J A; Steadman, H J

    1991-01-01

    This research note presents data about regional and system variations in psychiatric inpatient services for forensic patients provided in state operated psychiatric inpatient programs in the United States in 1986. Patient census by legal status and service provision information were collected from state forensic directors. In 1986, about 5,400 patients found not guilty by reason of insanity (NGRI) and 3,200 patients found incompetent to stand trial (IST) were being served in state operated inpatient units. About 70 percent of both groups were being served in designated forensic beds. There were wide differences among the states in the volume and rates for NGRI, IST, forensic exams, and dangerous civil patients (DCP). The regional analyses revealed large variability among states within each region.

  3. Inflammatory Biomarkers in Atherosclerosis: Pentraxin 3 Can Become a Novel Marker of Plaque Vulnerability

    PubMed Central

    Shindo, Akihiro; Tanemura, Hiroshi; Yata, Kenichiro; Hamada, Kazuhide; Shibata, Masunari; Umeda, Yasuyuki; Asakura, Fumio; Toma, Naoki; Sakaida, Hiroshi; Fujisawa, Takao; Taki, Waro; Tomimoto, Hidekazu

    2014-01-01

    Inflammation is crucially involved in the development of carotid plaques. We examined the relationship between plaque vulnerability and inflammatory biomarkers using intraoperative blood and tissue specimens. We examined 58 patients with carotid stenosis. Following carotid plaque magnetic resonance imaging, 41 patients underwent carotid artery stenting (CAS) and 17 underwent carotid endarterectomy (CEA). Blood samples were obtained from the femoral artery (systemic) and common carotid artery immediately before and after CAS (local). Seventeen resected CEA tissue samples were embedded in paraffin, and histopathological and immunohistochemical analyses for IL-6, IL-10, E-selectin, adiponectin, and pentraxin 3 (PTX3) were performed. Serum levels of IL-6, IL-1β, IL-10, TNFα, E-selectin, VCAM-1, adiponectin, hs-CRP, and PTX3 were measured by multiplex bead array system and ELISA. CAS-treated patients were classified as stable plaques (n = 21) and vulnerable plaques (n = 20). The vulnerable group showed upregulation of the proinflammatory cytokines (IL-6 and TNFα), endothelial activation markers (E-selectin and VCAM-1), and inflammation markers (hs-CRP and PTX3) and downregulation of the anti-inflammatory markers (adiponectin and IL-10). PTX3 levels in both systemic and intracarotid samples before and after CAS were higher in the vulnerable group than in the stable group. Immunohistochemical analysis demonstrated that IL-6 was localized to inflammatory cells in the vulnerable plaques, and PTX3 was observed in the endothelial and perivascular cells. Our findings reveal that carotid plaque vulnerability is modulated by the upregulation and downregulation of proinflammatory and anti-inflammatory factors, respectively. PTX3 may thus be a potential predictive marker of plaque vulnerability. PMID:24936646

  4. Imaging Atherosclerosis and Vulnerable Plaque

    PubMed Central

    Sadeghi, Mehran M.; Glover, David K.; Lanza, Gregory M.; Fayad, Zahi A.; Johnson, Lynne L.

    2010-01-01

    Identifying patients at high risk for an acute cardiovascular event such as myocardial infarction or stroke and assessing the total atherosclerotic burden are clinically important. Currently available imaging modalities can delineate vascular wall anatomy and, with novel probes, target biologic processes important in plaque evolution and plaque stability. Expansion of the vessel wall involving remodeling of the extracellular matrix can be imaged, as can angiogenesis of the vasa vasorum, plaque inflammation, and fibrin deposits on early nonocclusive vascular thrombosis. Several imaging platforms are available for targeted vascular imaging to acquire information on both anatomy and pathobiology in the same imaging session using either hybrid technology (nuclear combined with CT) or MRI combined with novel probes targeting processes identified by molecular biology to be of importance. This article will discuss the current state of the art of these modalities and challenges to clinical translation. PMID:20395341

  5. Mapping Regional Drought Vulnerability: a Case Study

    NASA Astrophysics Data System (ADS)

    Karamouz, M.; Zeynolabedin, A.; Olyaei, M. A.

    2015-12-01

    Drought is among the natural disaster that causes damages and affects many people's life in many part of the world including in Iran. Recently, some factors such as climate variability and the impact of climate change have influenced drought frequency and intensity in many parts of the world. Drought can be divided into four categories of meteorological, hydrological, agricultural and social-economic. In meteorological the important feature is lack of rainfall. In hydrological drought river flows and dam storage are considered. Lack of soil moisture is the key factor in agricultural droughts while in social-economic type of drought the relation between supply and demand and social-economic damages due to water deficiency is studied. While the first three types relates to the lack of some hydrological characteristics, social-economic type of drought is actually the consequence of other types expressed in monetary values. Many indices are used in assessing drought; each has its own advantages and disadvantages and can be used for specific types of drought. Therefore knowing the types of drought can provide a better understanding of shortages and their characteristics. Drought vulnerability is a concept which shows the likelihood of damages from hazard in a particular place by focusing on the system status prior to the disaster. Drought vulnerability has been viewed as a potential for losses in the region due to water deficiency at the time of drought. In this study the application of vulnerability concept in drought management in East Azarbaijan province in Iran is investigated by providing vulnerability maps which demonstrates spatial characteristics of drought vulnerability. In the first step, certain governing parameters in drought analysis such as precipitation, temperature, land use, topography, solar radiation and ground water elevation have been investigated in the region. They are described in details and calculated in suitable time series. Vulnerabilities

  6. Creativity and psychopathology: a shared vulnerability model.

    PubMed

    Carson, Shelley H

    2011-03-01

    Creativity is considered a positive personal trait. However, highly creative people have demonstrated elevated risk for certain forms of psychopathology, including mood disorders, schizophrenia spectrum disorders, and alcoholism. A model of shared vulnerability explains the relation between creativity and psychopathology. This model, supported by recent findings from neuroscience and molecular genetics, suggests that the biological determinants conferring risk for psychopathology interact with protective cognitive factors to enhance creative ideation. Elements of shared vulnerability include cognitive disinhibition (which allows more stimuli into conscious awareness), an attentional style driven by novelty salience, and neural hyperconnectivity that may increase associations among disparate stimuli. These vulnerabilities interact with superior meta-cognitive protective factors, such as high IQ, increased working memory capacity, and enhanced cognitive flexibility, to enlarge the range and depth of stimuli available in conscious awareness to be manipulated and combined to form novel and original ideas.

  7. Regional tsunami vulnerability analysis through ASTER imagery

    NASA Astrophysics Data System (ADS)

    Dall'Osso, Filippo; Cavalletti, Alessandra; Immordino, Francesco; Gonella, Marco

    2010-05-01

    Analysis of vulnerability to natural hazards is a key issue of prevention measures within ICZM. Knowledge of susceptibility to damage and how this is distributed along the coast allows to optimize possible prevention and mitigation actions. The present study focuses on tsunami vulnerability of a large extension of coastline: the entire westerly Thailand's coast. The work is a follow up of the CRATER project (Coastal Risk Analysis for Tsunamis and Environmental Remediation) carried out on the aftermath of the 26th December 2004 Tsunami event. Vulnerability is analyzed considering an inundation scenario given by a tsunami of seismic origin, causing a maximum run-up of 25m.. An innovative methodology have been here developed and applied, based on the combined use of ASTER (Advanced Spaceborn Thermal Emission and Reflection Radiometer) satellite imagery, SRTM v-3 (Shuttle Radar Topography Mission - version #3) DEMs and GIS. Vulnerability level has been calculated combining information on coastal geomorphology, land use, topography and distance from the shoreline. Land use has been extrapolated from ASTER images through a multi-spectral analysis (a pixel-based and supervised classification process) of ASTER bands 1 to 9, plus one band for the NDVI index (Normalized Difference Vegetation Index). Coastal geomorphology has been obtained through a photo-interpretation process. Results have been organized in a set of vectorial vulnerability maps with horizontal resolution of 90m. The proposed methodology has the great advantage of being repeatable for any case of vulnerability analysis at small-medium scale (i.e. at Regional/National level) with a moderate investment in term of costs and human resources.

  8. Climate challenges, vulnerabilities, and food security.

    PubMed

    Nelson, Margaret C; Ingram, Scott E; Dugmore, Andrew J; Streeter, Richard; Peeples, Matthew A; McGovern, Thomas H; Hegmon, Michelle; Arneborg, Jette; Kintigh, Keith W; Brewington, Seth; Spielmann, Katherine A; Simpson, Ian A; Strawhacker, Colleen; Comeau, Laura E L; Torvinen, Andrea; Madsen, Christian K; Hambrecht, George; Smiarowski, Konrad

    2016-01-12

    This paper identifies rare climate challenges in the long-term history of seven areas, three in the subpolar North Atlantic Islands and four in the arid-to-semiarid deserts of the US Southwest. For each case, the vulnerability to food shortage before the climate challenge is quantified based on eight variables encompassing both environmental and social domains. These data are used to evaluate the relationship between the "weight" of vulnerability before a climate challenge and the nature of social change and food security following a challenge. The outcome of this work is directly applicable to debates about disaster management policy.

  9. Climate challenges, vulnerabilities, and food security.

    PubMed

    Nelson, Margaret C; Ingram, Scott E; Dugmore, Andrew J; Streeter, Richard; Peeples, Matthew A; McGovern, Thomas H; Hegmon, Michelle; Arneborg, Jette; Kintigh, Keith W; Brewington, Seth; Spielmann, Katherine A; Simpson, Ian A; Strawhacker, Colleen; Comeau, Laura E L; Torvinen, Andrea; Madsen, Christian K; Hambrecht, George; Smiarowski, Konrad

    2016-01-12

    This paper identifies rare climate challenges in the long-term history of seven areas, three in the subpolar North Atlantic Islands and four in the arid-to-semiarid deserts of the US Southwest. For each case, the vulnerability to food shortage before the climate challenge is quantified based on eight variables encompassing both environmental and social domains. These data are used to evaluate the relationship between the "weight" of vulnerability before a climate challenge and the nature of social change and food security following a challenge. The outcome of this work is directly applicable to debates about disaster management policy. PMID:26712017

  10. Microbiological Food Safety for Vulnerable People

    PubMed Central

    Lund, Barbara M.

    2015-01-01

    Foodborne pathogens are more likely to cause infection and to result in serious consequences in vulnerable people than in healthy adults. People with some increase in susceptibility may form nearly 20% of the population in the UK and the USA. Conditions leading to increased susceptibility are listed. The main factors leading to foodborne disease caused by major pathogens are outlined and examples are given of outbreaks resulting from these factors. Measures to prevent foodborne disease include procedures based on Hazard Analysis Critical Control Point principles and prerequisite programmes and, especially for vulnerable people, the use of lower-risk foods in place of higher-risk products. PMID:26308030

  11. Climate challenges, vulnerabilities, and food security

    PubMed Central

    Nelson, Margaret C.; Ingram, Scott E.; Dugmore, Andrew J.; Streeter, Richard; Peeples, Matthew A.; McGovern, Thomas H.; Hegmon, Michelle; Arneborg, Jette; Brewington, Seth; Spielmann, Katherine A.; Simpson, Ian A.; Strawhacker, Colleen; Comeau, Laura E. L.; Torvinen, Andrea; Madsen, Christian K.; Hambrecht, George; Smiarowski, Konrad

    2016-01-01

    This paper identifies rare climate challenges in the long-term history of seven areas, three in the subpolar North Atlantic Islands and four in the arid-to-semiarid deserts of the US Southwest. For each case, the vulnerability to food shortage before the climate challenge is quantified based on eight variables encompassing both environmental and social domains. These data are used to evaluate the relationship between the “weight” of vulnerability before a climate challenge and the nature of social change and food security following a challenge. The outcome of this work is directly applicable to debates about disaster management policy. PMID:26712017

  12. The earthquake vulnerability of a utility system

    SciTech Connect

    Burhenn, T.A.; Hawkins, H.G.; Ostrom, D.K.; Richau, E.M. )

    1992-01-01

    This paper describes a method to assess the earthquake vulnerability of a utility system and presents an example application. First, the seismic hazard of the system is modeled. Next, the damage and operational disruption to the facilities are estimated. The approach described herein formulates the problem so that the best documented and judgmental information on the earthquake performance of a utility's components can be utilized. finally, the activities and estimates of the time necessary to restore the system to different levels of service are developed. This method of analysis provides a realistic picture of the resiliency of utility service, not just vulnerabilities of various types of equipment.

  13. Assessment of Chemical and Radiological Vulnerabilities

    SciTech Connect

    SETH, S.S.

    2000-05-17

    Following the May 14, 1997 chemical explosion at Hanford's Plutonium Reclamation Facility, the Department of Energy Richland Operations Office and its prime contractor, Fluor Hanford, Inc., completed an extensive assessment to identify and address chemical and radiological safety vulnerabilities at all facilities under the Project Hanford Management Contract. This was a challenging undertaking because of the immense size of the problem, unique technical issues, and competing priorities. This paper focuses on the assessment process, including the criteria and methodology for data collection, evaluation, and risk-based scoring. It does not provide details on the facility-specific results and corrective actions, but discusses the approach taken to address the identified vulnerabilities.

  14. Earthquake resistant construction of electric transmission and telecommunication facilities serving the Federal government report

    SciTech Connect

    Yokel, F.Y.

    1990-02-01

    The vulnerability of electrical transmission and telecommunication facilities to damage in past earthquakes, as well as available standards and technologies to protect these facilities against earthquake damage are reviewed. An overview is presented of measures taken by various Federal agencies to protect electrical transmission and telecommunication facilities against earthquake hazards. It is concluded that while most new facilities which are owned and operated by Federal agencies are presently designed to provide some, though not necessarily adequate, earthquake resistance, there generally is no effort to retrofit existing facilities. No evidence was found of requirements to protect electrical transmission and communication facilities which have major contractual obligations to serve the Federal Government and only limited seismic design requirements are stipulated for electrical transmission systems constructed with Federal funding.

  15. "It's safe to ask": promoting patient safety through health literacy.

    PubMed

    Byrd, Jan; Thompson, Laurie

    2008-01-01

    The Manitoba Institute for Patient Safety launched "It's Safe to Ask" in January 2007. The communication and health literacy initiative is aimed at Manitoba's vulnerable populations and their primary care providers. Phase 1 includes a poster and brochure for patients and a toolkit for providers/organizations, pilot tested in six sites in Manitoba. Posters will serve as a symbol that dialogue is encouraged. Tools, available in 15 languages, provide patients and family members with three key questions to ask in healthcare interactions, tips on how to ask questions, and room for notes and listing of medications. The initiative will promote involvement in healthcare by patients, stronger communication between patient and provider, and reduction of risk for adverse events. "It's Safe to Ask" has been implemented in over 65 sites across Manitoba. A formal evaluation is underway. Phase 2 and 3 will enhance key tools and include interventions with specific populations. PMID:18382168

  16. Antiretroviral Drug Diversion Links Social Vulnerability to Poor Medication Adherence in Substance Abusing Populations

    PubMed Central

    Tsuyuki, Kiyomi; Surratt, Hilary L.

    2015-01-01

    Antiretroviral (ARV) medication diversion to the illicit market has been documented in South Florida, and linked to sub-optimal adherence in people living with HIV. ARV diversion reflects an unmet need for care in vulnerable populations that have difficulty engaging in consistent HIV care due to competing needs and co-morbidities. This study applies the Gelberg-Andersen Behavioral Model of Health Care Utilization for Vulnerable Populations to understand how social vulnerability is linked to ARV diversion and adherence. Cross-sectional data were collected from a targeted sample of vulnerable people living with HIV in South Florida between 2010 and 2012 (n=503). Structured interviews collected quantitative data on ARV diversion, access and utilization of care, and ARV adherence. Logistic regression was used to estimate the goodness-of-fit of additive models that test domain fit. Linear regression was used to estimate the effects of social vulnerability and ARV diversion on ARV adherence. The best fitting model to predict ARV diversion identifies having a low monthly income and unstable HIV care as salient enabling factors that promote ARV diversion. Importantly, health care need factors did not protect against ARV diversion, evidence that immediate competing needs are prioritized even in the face of poor health for this sample. We also find that ARV diversion provides a link between social vulnerability and sub-optimal ARV adherence, with ARV diversion and domains from the Behavioral Model explaining 25% of the variation in ARV adherence. Our analyses reveal great need to improve engagement in HIV care for vulnerable populations by strengthening enabling factors (e.g. patient-provider relationship) to improve retention in HIV care and ARV adherence for vulnerable populations. PMID:25893656

  17. Antiretroviral drug diversion links social vulnerability to poor medication adherence in substance abusing populations.

    PubMed

    Tsuyuki, Kiyomi; Surratt, Hilary L

    2015-05-01

    Antiretroviral (ARV) medication diversion to the illicit market has been documented in South Florida, and linked to sub-optimal adherence in people living with HIV. ARV diversion reflects an unmet need for care in vulnerable populations that have difficulty engaging in consistent HIV care due to competing needs and co-morbidities. This study applies the Gelberg-Andersen behavioral model of health care utilization for vulnerable populations to understand how social vulnerability is linked to ARV diversion and adherence. Cross-sectional data were collected from a targeted sample of vulnerable people living with HIV in South Florida between 2010 and 2012 (n = 503). Structured interviews collected quantitative data on ARV diversion, access and utilization of care, and ARV adherence. Logistic regression was used to estimate the goodness-of-fit of additive models that test domain fit. Linear regression was used to estimate the effects of social vulnerability and ARV diversion on ARV adherence. The best fitting model to predict ARV diversion identifies having a low monthly income and unstable HIV care as salient enabling factors that promote ARV diversion. Importantly, health care need factors did not protect against ARV diversion, evidence that immediate competing needs are prioritized even in the face of poor health for this sample. We also find that ARV diversion provides a link between social vulnerability and sub-optimal ARV adherence, with ARV diversion and domains from the Behavioral Model explaining 25 % of the variation in ARV adherence. Our analyses reveal great need to improve engagement in HIV care for vulnerable populations by strengthening enabling factors (e.g. patient-provider relationship) to improve retention in HIV care and ARV adherence for vulnerable populations.

  18. Climate vulnerability of drinking water supplies

    NASA Astrophysics Data System (ADS)

    Selmeczi, Pál; Homolya, Emese; Rotárné Szalkai, Ágnes

    2016-04-01

    Extreme weather conditions in Hungary led to difficulties in drinking water management on diverse occasions in the past. Due to reduced water resources and the coexisting high demand for drinking water in dry summer periods the availability of a number of water supplies became insufficient therefore causing limitations in water access. In some other cases, as a result of floods and flash floods over karstic areas evolving in consequence of excessive precipitation, several water supplies had to be excluded in order to avoid the risk of infections. More frequent occurrence of extreme weather conditions and further possible changes in the future induce the necessity for an analysis of the vulnerability of drinking water resources to climate change. Since 95% of the total drinking water supply in Hungary originates from subsurface layers, significance of groundwater resources is outstanding. The aim of our work carried out in the frames of the NAGiS (National Adaptation Geo-information System) project was to build up a methodology for the study and determination of the vulnerability of drinking water supplies to climate. The task covered analyses of climatic parameters influencing drinking water supplies principally and hydrogeological characteristics of the geological media that significantly determines vulnerability. Effects on drinking water resources and their reduction or exclusion may imply societal and economic consequences therefore we extended the analyses to the investigation of possibilities concerning the adaptation capacity to changed conditions. We applied the CIVAS (Climate Impact and Vulnerability Assessment Scheme) model developed in the frames of the international climate research project CLAVIER (Climate Change and Variability: Impact on Central and Eastern Europe) to characterize climate vulnerability of drinking water supplies. The CIVAS model, being based on the combined evaluation of exposure, sensitivity and adaptability, provides a unified

  19. Cognitive-affective assets and vulnerabilities: two factors influencing adaptation to fibromyalgia.

    PubMed

    Furlong, Lilian Velasco; Zautra, Alex; Puente, Cecilia Peñacoba; López-López, Almudena; Valero, Paloma Barjola

    2010-02-01

    This study set to explore whether variables related to cognitive-affective assets would complement measures of psychological vulnerability for the prediction of physical functioning and pain tolerance in 138 women with Fibromyalgia Syndrome (FMS). Depression, anxiety, stress response and negative affect were defined a priori as measures of vulnerability, while pain self-efficacy, internality and positive affect were identified as assets. Confirmatory factor analyses supported the validity of the hypothesised two-factor structure in FMS. A structural equation model (SEM) revealed that the two factors were associated with different outcomes in FMS as predictors. Pain and associated symptoms appeared related to psychological vulnerabilities in FMS patients, whereas physical functioning and tolerance for pain were better predicted by assets. These results are discussed with reference to current theoretical models concerning the role of psychological factors in FMS, and intervention methods designed to improve quality of life and reduce pain in FMS patients. PMID:20391215

  20. Public Health Consequences on Vulnerable Populations from Acute Chemical Releases

    PubMed Central

    Ruckart, Perri Zeitz; Orr, Maureen F.

    2008-01-01

    Data from a large, multi-state surveillance system on acute chemical releases were analyzed to describe the type of events that are potentially affecting vulnerable populations (children, elderly and hospitalized patients) in order to better prevent and plan for these types of incidents in the future. During 2003–2005, there were 231 events where vulnerable populations were within ¼ mile of the event and the area of impact was greater than 200 feet from the facility/point of release. Most events occurred on a weekday during times when day care centers or schools were likely to be in session. Equipment failure and human error caused a majority of the releases. Agencies involved in preparing for and responding to chemical emergencies should work with hospitals, nursing homes, day care centers, and schools to develop policies and procedures for initiating appropriate protective measures and managing the medical needs of patients. Chemical emergency response drills should involve the entire community to protect those that may be more susceptible to harm. PMID:21572842

  1. Vulnerable bodies: competing discourses of intimate bodily care.

    PubMed

    Grant, Barbara M; Giddings, Lynne S; Beale, Jenny E

    2005-11-01

    Nursing practices are subject to intersecting and competing discourses, which give them different, sometimes contradictory, meanings. In this article, using a case of intimate bodily care, we explore the workings of these discourses in a nursing student's account of her first experience of bathing an elderly woman. In particular we were interested in how different meanings of nursing "care" figure into the student's story. Through our analysis, we realized that a range of contradictions and tensions structured the student's experience. These contradictions were primarily produced by a collision between two discourses: the student's commonsense way of understanding the intimacy of such an act (liberal humanist discourse) and the impersonal approach characteristic of institutionalized care (scientific medical discourse). This collision caused distress and confusion, such that the student became almost as vulnerable as her patient. We argue that this type of detailed analysis of a nursing student's experience may increase our understanding of the discursive struggles that occur for students during their shifting between classrooms and clinical sites, between theory and practice, in the process of becoming professionals. Understanding these struggles and the relationships of power that produce both nursing student and patient as "vulnerable bodies" is important for nurse educators because they offer opportunities for intervention in the shaping of nursing professionals. PMID:16342631

  2. Major depression during interferon-α treatment: vulnerability and prevention

    PubMed Central

    Lotrich, Francis E.

    2009-01-01

    Major Depressive Disorder (MDD) during interferons (IFN-α) treatment can occur within a few months of therapy, and shares many homologies with other forms of MDD, Most patients are resilient to the side effect ofinterferon-induced depression (IFN-MDD), but 15% to 40% are vulnerable. Several studies have employed antidepressants to prevent the incidence of an IFN-MDD episode, and the results suggest that prophylactic antidepressants may be specifically useful in those with pre-existing subthreshold depressive symptoms andlor a history of prior MDD episodes. Several other potential markers of vulnerability for IFN-MDD have been implicated in assessments of nondepressed patients before they start IFN-α These include poor sleep quality, premorbid elevations in inflammatory cytokines, genetic polymorphisms in the serotonin system, personality, and social support. The interplay of these factors strongly predicts who is at risk for IFN-MDD, and indicates several potentially modifiable targets for the personalized prevention of IFN-MDD, PMID:20135899

  3. Optical coherence tomography for imaging the vulnerable plaque

    NASA Astrophysics Data System (ADS)

    Tearney, Guillermo J.; Jang, Ik-Kyung; Bouma, Brett E.

    2006-03-01

    While our understanding of vulnerable coronary plaque is still at an early stage, the concept that certain types of plaques predispose patients to developing an acute myocardial infarction continues to be at the forefront of cardiology research. Intracoronary optical coherence tomography (OCT) has been developed to both identify and study these lesions due to its distinct resolution advantage over other imaging modalities. We review clinical research conducted at the Massachusetts General Hospital over the past five years to develop, validate, and utilize this technology to improve our understanding of vulnerable plaque. Our results show that intracoronary OCT may be safely conducted in patients and that it provides abundant information regarding plaque microscopic morphology, which is essential to the identification and study of high-risk lesions. Even though many basic biological, clinical, and technological challenges must be addressed prior to widespread use of this technology, the unique capabilities of OCT ensure that it will have a prominent role in shaping the future of cardiology.

  4. Vulnerable bodies: competing discourses of intimate bodily care.

    PubMed

    Grant, Barbara M; Giddings, Lynne S; Beale, Jenny E

    2005-11-01

    Nursing practices are subject to intersecting and competing discourses, which give them different, sometimes contradictory, meanings. In this article, using a case of intimate bodily care, we explore the workings of these discourses in a nursing student's account of her first experience of bathing an elderly woman. In particular we were interested in how different meanings of nursing "care" figure into the student's story. Through our analysis, we realized that a range of contradictions and tensions structured the student's experience. These contradictions were primarily produced by a collision between two discourses: the student's commonsense way of understanding the intimacy of such an act (liberal humanist discourse) and the impersonal approach characteristic of institutionalized care (scientific medical discourse). This collision caused distress and confusion, such that the student became almost as vulnerable as her patient. We argue that this type of detailed analysis of a nursing student's experience may increase our understanding of the discursive struggles that occur for students during their shifting between classrooms and clinical sites, between theory and practice, in the process of becoming professionals. Understanding these struggles and the relationships of power that produce both nursing student and patient as "vulnerable bodies" is important for nurse educators because they offer opportunities for intervention in the shaping of nursing professionals.

  5. A Temporal Assessment of Barrier Island Vulnerability to Extreme Wave Events, Virginia Coast Reserve

    NASA Astrophysics Data System (ADS)

    Oster, D. J.; Moore, L. J.; Doran, K. J.; Stockdon, H. F.

    2010-12-01

    Barrier island vulnerability to storm-generated waves is directly related to interactions between shoreface morphology and surf-zone dynamics. During storms, the seaward-most dune often limits the landward extent of wave energy; however, if maximum wave run-up exceeds the elevation of the top of the dune, overwash or inundation may occur. The ‘Storm Impact Scale’ presented by Sallenger (2000) classifies barrier beach vulnerability to individual storm events based on the elevation of the frontal dune crest and toe relative to maximum wave run-up. Changes to the dune and beachface can occur over a range of time scales, altering local vulnerability to extreme waves from storms, even as a storm is occurring. As sea level continues to rise, barrier beaches will become increasingly vulnerable to overwash and inundation from a greater number of storms. Our objective is to assess temporal trends in barrier island vulnerability while also exploring island-chain-wide response and recovery from two notably different storm events (Nor’Ida and Hurricane Bonnie) along the undeveloped barrier islands of the Virginia Coast Reserve (VCR). We compare shoreline position and elevations of the frontal dune crest (DHIGH) and dune toe (DLOW) across four lidar data sets collected between 1998-2010. Observed significant wave height and period from the National Data Buoy Center and the Duck, NC Field Research Facility for the time period between 1985 and 2009 are classified to represent one-year, five-year, and ten-year storm events that serve as the basis for comparison of island vulnerability through time to a range of storm severity. Initial results reveal significant spatial and temporal variation in barrier island vulnerability to storms throughout the VCR. Despite the range of variability, all three beach features (i.e., shoreline position, DHIGH and DLOW), have moved landward indicating large-scale, widespread migration, or narrowing, of VCR barrier island landforms over the

  6. REGIONAL VULNERABILITY ASSESSMENT: A CONCEPTUAL APPROACH

    EPA Science Inventory

    EPA's Regional Vulnerability Assessment (REVA) project is developing and testing an approach to conducting comparative ecological risk assessments at the regional scale. I't seeks an objective and quantifiable answer to answer the question, "What are the greatest threaten accompa...

  7. Interrogation and false confessions: vulnerability factors.

    PubMed

    Gudjonsson, G H

    This paper reviews the psychological factors that make some individuals susceptible to making a false confession of having committed a criminal offence. A number of 'vulnerability factors' are highlighted and it is emphasized that these need to be interpreted within the context of all circumstances surrounding the case. PMID:1591561

  8. Educational and Vocational Exploration in Vulnerable Youth

    ERIC Educational Resources Information Center

    Taylor, Sarah

    2011-01-01

    Though numerous studies indicate that youth and young adults who are involved in one or more social service systems have poor educational and employment outcomes, little is known about the pathways to employment and education in this population. In this qualitative study of educational and employment exploration in vulnerable youth, 11 individuals…

  9. Criminal injuries compensation: Protecting vulnerable applicants.

    PubMed

    Guthrie, Robert

    2015-09-01

    Each year large numbers of persons sustain injury as a consequence of criminal behaviour. All Australian jurisdictions provide State-funded compensation to those harmed in this way. In the case of vulnerable applicants, the Assessor must consider not simply the appropriate and fair amount of compensation, but also how a person will be affected by the payment of compensation. Often a vulnerable applicant will apply through a guardian or a public trustee, although many apply in person. This article examines the use of legislative provisions, rules, regulations and practices in the various Australian jurisdictions in relation to how vulnerable applicants may be protected and supported once an award of compensation is made in their favour. Most jurisdictions provide for a mechanism by which compensation may be held in trust where the Assessor considers that the applicant may be unable to manage his or her financial affairs in his or her best interests. This article explores what factors are taken into account by Assessors in the absence of and pursuant to legislative directions. It considers how the approach may vary across jurisdictions and creative approaches to financial protection of vulnerable applicants.

  10. Defining and Measuring Vulnerability in Young People.

    PubMed

    Arora, Shilpa Khanna; Shah, Dheeraj; Chaturvedi, Sanjay; Gupta, Piyush

    2015-01-01

    Adolescents and youth, together addressed as "young people", form the future building blocks of any society. They being most energetic and dynamic, tend to get involved in high-risk behaviors making themselves susceptible to criminal offences, accidents, physical injuries, emotional trauma, and medical problems - some of them extremely serious like transmission of human immunodeficiency virus (HIV). The concept of vulnerability is applicable to all the people who are more exposed to risks than their peers like the young people. In order to deal with social evils like criminal offences, domestic violence, sexual abuse, HIV, etc. we need to define vulnerability and understand the factors that influence it. This review also attempts to summarize the indicators of vulnerability and the data currently available to estimate its burden in India. Measuring the magnitude of vulnerability by means of certain indicators/variables might help us in devising tools to assess this poorly defined entity. This may also evolve a conceptual framework on which targeted remedial interventions can be devised and implemented. PMID:26170545

  11. Evaluating Youth Work with Vulnerable Young People.

    ERIC Educational Resources Information Center

    Furlong, Andy; Cartmel, Fred; Powney, Janet; Hall, Stuart

    This report presents the results of an 18-month research project that studied the effectiveness of youth work with vulnerable young people. The research, representing six distinct geographical areas of Scotland characterized by disadvantage, focused on young people aged 13 to 16. In each neighborhood, the project examined the experiences of young…

  12. U.S. vulnerable to major hurricane

    NASA Astrophysics Data System (ADS)

    Bell, Peter M.

    The nation is ‘in the most vulnerable position in history’ should a major hurricane strike this year, according to James P. Walsh, acting NOAA Administrator.He warned that mushrooming coastal populations, public inexperience and apathy, and limited evacuation routes could combine to create a major catastrophe.

  13. Perceived Vulnerability to Disease Predicts Environmental Attitudes

    ERIC Educational Resources Information Center

    Prokop, Pavol; Kubiatko, Milan

    2014-01-01

    Investigating predictors of environmental attitudes may bring valuable benefits in terms of improving public awareness about biodiversity degradation and increased pro-environmental behaviour. Here we used an evolutionary approach to study environmental attitudes based on disease-threat model. We hypothesized that people vulnerable to diseases may…

  14. Configuration Fuzzing for Software Vulnerability Detection

    PubMed Central

    Dai, Huning; Murphy, Christian; Kaiser, Gail

    2010-01-01

    Many software security vulnerabilities only reveal themselves under certain conditions, i.e., particular configurations of the software together with its particular runtime environment. One approach to detecting these vulnerabilities is fuzz testing, which feeds a range of randomly modified inputs to a software application while monitoring it for failures. However, typical fuzz testing makes no guarantees regarding the syntactic and semantic validity of the input, or of how much of the input space will be explored. To address these problems, in this paper we present a new testing methodology called configuration fuzzing. Configuration fuzzing is a technique whereby the configuration of the running application is randomly modified at certain execution points, in order to check for vulnerabilities that only arise in certain conditions. As the application runs in the deployment environment, this testing technique continuously fuzzes the configuration and checks “security invariants” that, if violated, indicate a vulnerability; however, the fuzzing is performed in a duplicated copy of the original process, so that it does not affect the state of the running application. In addition to discussing the approach and describing a prototype framework for implementation, we also present the results of a case study to demonstrate the approach’s efficiency. PMID:21461049

  15. Retrieval from Memory: Vulnerable or Inviolable?

    ERIC Educational Resources Information Center

    Jones, Dylan M.; Marsh, John E.; Hughes, Robert W.

    2012-01-01

    We show that retrieval from semantic memory is vulnerable even to the mere presence of speech. Irrelevant speech impairs semantic fluency--namely, lexical retrieval cued by a semantic category name--but only if it is meaningful (forward speech compared to reversed speech or words compared to nonwords). Moreover, speech related semantically to the…

  16. Consumer Vulnerability to Fraud: Influencing Factors.

    ERIC Educational Resources Information Center

    Lee, Jinkook; Soberon-Ferrer, Horacio

    1997-01-01

    A questionnaire on market knowledge and awareness of unfair business practices was completed by 464 adults aged 18-64 and by 493 over 64. Consumers were more susceptible to fraud if they were older, poor, less educated, and/or living without spouses. Gender and race were not significant predictors of vulnerability. (SK)

  17. Vulnerability--A New View of Schizophrenia

    ERIC Educational Resources Information Center

    Zubin, Joseph; Spring, Bonnie

    1977-01-01

    Although descriptive and etiological approaches to psychopathology have made notable advances, they seem to have reached a plateau. After reviewing the six approaches to etiology that now preempt the field--ecological, developmental, learning, genetic, internal environment, and neurophysiological models--a second-order model, vulnerability, is…

  18. Who's Vulnerable in Infant Child Care Centers?

    ERIC Educational Resources Information Center

    Kendall, Earline D.; Moukaddem, Virginia E.

    1992-01-01

    Maintains that infants and toddlers, parents, and child caregivers are vulnerable to a variety of infectious diseases from infant-toddler child care centers. These diseases include infectious diarrhea; rubella; cytomeglovirus; hepatitis A, and haemophilus influenza type B. Suggests ways to prevent the spread of such diseases. (BB)

  19. Defining and Measuring Vulnerability in Young People

    PubMed Central

    Arora, Shilpa Khanna; Shah, Dheeraj; Chaturvedi, Sanjay; Gupta, Piyush

    2015-01-01

    Adolescents and youth, together addressed as “young people”, form the future building blocks of any society. They being most energetic and dynamic, tend to get involved in high-risk behaviors making themselves susceptible to criminal offences, accidents, physical injuries, emotional trauma, and medical problems — some of them extremely serious like transmission of human immunodeficiency virus (HIV). The concept of vulnerability is applicable to all the people who are more exposed to risks than their peers like the young people. In order to deal with social evils like criminal offences, domestic violence, sexual abuse, HIV, etc. we need to define vulnerability and understand the factors that influence it. This review also attempts to summarize the indicators of vulnerability and the data currently available to estimate its burden in India. Measuring the magnitude of vulnerability by means of certain indicators/variables might help us in devising tools to assess this poorly defined entity. This may also evolve a conceptual framework on which targeted remedial interventions can be devised and implemented. PMID:26170545

  20. CYBER/PHYSICAL SECURITY VULNERABILITY ASSESSMENT INTEGRATION

    SciTech Connect

    MacDonald, Douglas G.; Key, Brad; Clements, Samuel L.; Hutton, William J.; Craig, Philip A.; Patrick, Scott W.; Crawford, Cary E.

    2011-07-17

    This internally funded Laboratory-Directed R&D project by the Pacific Northwest National Laboratory, in conjunction with QinetiQ North America, is intended to identify and properly assess areas of overlap (and interaction) in the vulnerability assessment process between cyber security and physical protection. Existing vulnerability analysis (VA) processes and software tools exist, and these are heavily utilized in the determination of predicted vulnerability within the physical and cyber security domains. These determinations are normally performed independently of one another, and only interact on a superficial level. Both physical and cyber security subject matter experts have come to realize that though the various interactive elements exist, they are not currently quantified in most periodic security assessments. This endeavor aims to evaluate both physical and cyber VA techniques and provide a strategic approach to integrate the interdependent relationships of each into a single VA capability. This effort will also transform the existing suite of software currently utilized in the physical protection world to more accurately quantify the risk associated with a blended attack scenario. Performance databases will be created to support the characterization of the cyber security elements, and roll them into prototype software tools. This new methodology and software capability will enable analysts to better identify and assess the overall risk during a vulnerability analysis.

  1. Chemical Safety Vulnerability Working Group Report

    SciTech Connect

    Not Available

    1994-09-01

    This report marks the culmination of a 4-month review conducted to identify chemical safety vulnerabilities existing at DOE facilities. This review is an integral part of DOE's efforts to raise its commitment to chemical safety to the same level as that for nuclear safety.

  2. Criminal injuries compensation: Protecting vulnerable applicants.

    PubMed

    Guthrie, Robert

    2015-09-01

    Each year large numbers of persons sustain injury as a consequence of criminal behaviour. All Australian jurisdictions provide State-funded compensation to those harmed in this way. In the case of vulnerable applicants, the Assessor must consider not simply the appropriate and fair amount of compensation, but also how a person will be affected by the payment of compensation. Often a vulnerable applicant will apply through a guardian or a public trustee, although many apply in person. This article examines the use of legislative provisions, rules, regulations and practices in the various Australian jurisdictions in relation to how vulnerable applicants may be protected and supported once an award of compensation is made in their favour. Most jurisdictions provide for a mechanism by which compensation may be held in trust where the Assessor considers that the applicant may be unable to manage his or her financial affairs in his or her best interests. This article explores what factors are taken into account by Assessors in the absence of and pursuant to legislative directions. It considers how the approach may vary across jurisdictions and creative approaches to financial protection of vulnerable applicants. PMID:26554206

  3. Cosmopolitan Sensitivities, Vulnerability, and Global Englishes

    ERIC Educational Resources Information Center

    Jacobsen, Ushma Chauhan

    2015-01-01

    This paper is the outcome of an afterthought that assembles connections between three elements: the ambitions of cultivating cosmopolitan sensitivities that circulate vibrantly in connection with the internationalization of higher education, a course on Global Englishes at a Danish university and the sensation of vulnerability. It discusses the…

  4. A physical approach on flood risk vulnerability

    NASA Astrophysics Data System (ADS)

    Mazzorana, Bruno; Fuchs, Sven; Keiler, Margreth

    2013-04-01

    The design of efficient flood risk mitigation strategies and their subsequent implementation relies on a careful vulnerability analysis of the elements exposed to flood hazard. Recently, extensive research efforts were undertaken to develop and refine empirical relationships linking the structural vulnerability of buildings to the intensity of the impacting water-related hazard processes. These empirical vulnerability functions allow for an estimation of the expected direct losses as a result of the hazard scenario on the basis of a spatially explicit representation of the process patterns and the elements at risk, and improve both risk assessments and cost-benefit analyses of planned mitigation strategies. However, due to the underlying empiricism of such vulnerability functions, the physics of the damage generating mechanisms remain unveiled, and, as such, the applicability of the empirical approach for planning hazard-proof residential buildings is rather limited. Therefore, we propose a conceptual assessment scheme to close this gap. This assessment scheme comprises distinct analytical steps: (a) modelling the process intensity and (b) the impact on the element at risk exposed, (c) the physical response of the building envelope, (d) the damage accounting and (f) the economic damage valuation. This dynamic assessment supports all relevant planning activities with respect to a minimisation of flood hazard losses, and can be implemented in the operational risk assessment procedure.

  5. Seismic vulnerability assessments in risk analysis

    NASA Astrophysics Data System (ADS)

    Frolova, Nina; Larionov, Valery; Bonnin, Jean; Ugarov, Alexander

    2013-04-01

    The assessment of seismic vulnerability is a critical issue within natural and technological risk analysis. In general, there are three common types of methods used for development of vulnerability functions of different elements at risk: empirical, analytical and expert estimations. The paper addresses the empirical methods for seismic vulnerability estimation for residential buildings and industrial facilities. The results of engineering analysis of past earthquake consequences, as well as the statistical data on buildings behavior during strong earthquakes presented in the different seismic intensity scales, are used to verify the regional parameters of mathematical models in order to simulate physical and economic vulnerability for different building types classified according to seismic scale MMSK-86. Verified procedure has been used to estimate the physical and economic vulnerability of buildings and constructions against earthquakes for the Northern Caucasus Federal region of the Russian Federation and Krasnodar area, which are characterized by rather high level of seismic activity and high population density. In order to estimate expected damage states to buildings and constructions in the case of the earthquakes according to the OSR-97B (return period T=1,000 years) within big cities and towns, they were divided into unit sites and their coordinates were presented as dots located in the centers of unit sites. Then the indexes obtained for each unit site were summed up. The maps of physical vulnerability zoning for Northern Caucasus Federal region of the Russian Federation and Krasnodar area includes two elements: percent of different damage states for settlements with number of inhabitants less than 1,000 and vulnerability for cities and towns with number of inhabitants more than 1,000. The hypsometric scale is used to represent both elements on the maps. Taking into account the size of oil pipe line systems located in the highly active seismic zones in

  6. Predicting risk in space: Genetic markers for differential vulnerability to sleep restriction

    NASA Astrophysics Data System (ADS)

    Goel, Namni; Dinges, David F.

    2012-08-01

    Several laboratories have found large, highly reliable individual differences in the magnitude of cognitive performance, fatigue and sleepiness, and sleep homeostatic vulnerability to acute total sleep deprivation and to chronic sleep restriction in healthy adults. Such individual differences in neurobehavioral performance are also observed in space flight as a result of sleep loss. The reasons for these stable phenotypic differential vulnerabilities are unknown: such differences are not yet accounted for by demographic factors, IQ or sleep need, and moreover, psychometric scales do not predict those individuals cognitively vulnerable to sleep loss. The stable, trait-like (phenotypic) inter-individual differences observed in response to sleep loss—with intraclass correlation coefficients accounting for 58-92% of the variance in neurobehavioral measures—point to an underlying genetic component. To this end, we utilized multi-day highly controlled laboratory studies to investigate the role of various common candidate gene variants—each independently—in relation to cumulative neurobehavioral and sleep homeostatic responses to sleep restriction. These data suggest that common genetic variations (polymorphisms) involved in sleep-wake, circadian, and cognitive regulation may serve as markers for prediction of inter-individual differences in sleep homeostatic and neurobehavioral vulnerability to sleep restriction in healthy adults. Identification of genetic predictors of differential vulnerability to sleep restriction—as determined from candidate gene studies—will help identify astronauts most in need of fatigue countermeasures in space flight and inform medical standards for obtaining adequate sleep in space. This review summarizes individual differences in neurobehavioral vulnerability to sleep deprivation and ongoing genetic efforts to identify markers of such differences.

  7. [Customer satisfaction study in two roman hospitals: comparison between "cook & serve" and "cook & chill"].

    PubMed

    Perata, E; Ferrari, P; Tarsitani, G

    2005-01-01

    We studied patient's satisfaction rate for hospital dishes comparing "cook & chill" method with "cook & serve". As principal instrument we used a comparative questionnaire, anonymous and self-compiled, which is able to evaluate the differences of customer satisfaction's rate between the two methods. PMID:16523715

  8. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability.

    PubMed

    Brinjikji, Waleed; Huston, John; Rabinstein, Alejandro A; Kim, Gyeong-Moon; Lerman, Amir; Lanzino, Giuseppe

    2016-01-01

    Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as intraplaque hemorrhage (IPH), plaque ulceration, plaque neovascularity, fibrous cap thickness, and presence of a lipid-rich necrotic core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved patient risk stratification and outcomes. For example, a patient with a low-grade stenosis but an ulcerated plaque may benefit more from a revascularization procedure than a patient with a stable 70% asymptomatic stenosis with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying IPH, ulceration, LRNC, and inflammation. However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH. PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is

  9. Age-Related Psychophysiological Vulnerability to Phenylalanine in Phenylketonuria

    PubMed Central

    Leuzzi, Vincenzo; Mannarelli, Daniela; Manti, Filippo; Pauletti, Caterina; Locuratolo, Nicoletta; Carducci, Carla; Carducci, Claudia; Vanacore, Nicola; Fattapposta, Francesco

    2014-01-01

    Background: Phenylketonuria (PKU) is caused by the inherited defect of the phenylalanine hydroxylase enzyme, which converts phenylalanine (Phe) into tyrosine (Tyr). Neonatal screening programs and early treatment have radically changed the natural history of PKU. Nevertheless, an increased risk of neurocognitive and psychiatric problems in adulthood remains a challenging aspect of the disease. In order to assess the vulnerability of complex skills to Phe, we explored: (a) the effect of a rapid increase in blood Phe levels on event-related potentials (ERP) in PKU subjects during their second decade of life; (b) the association (if existing) between psychophysiological and neurocognitive features. Methods: Seventeen early-treated PKU subjects, aged 10–20, underwent ERP [mismatch negativity, auditory P300, contingent negative variation (CNV), and Intensity Dependence of Auditory Evoked Potentials] recording before and 2 h after an oral loading of Phe. Neurocognitive functioning, historical and concurrent biochemical values of blood Phe, Tyr, and Phe/Tyr ratio, were all included in the statistical analysis. Results: Event-related potential components were normally detected in all the subjects. In subjects younger than 13 CNV amplitude, W2-CNV area, P3b latency, and reaction times in motor responses were negatively influenced by Phe-loading. Independently from the psychophysiological vulnerability, some neurocognitive skills were more impaired in younger patients. No correlation was found between biochemical alterations and neurocognitive and psychophysiological findings. Conclusion: The vulnerability of the emerging neurocognitive functions to Phe suggests a strict metabolic control in adolescents affected by PKU and a neurodevelopmental approach in the study of neurocognitive outcome in PKU. PMID:25003100

  10. Applying Buddhist Practices to Advocacy: The Advocacy-Serving Model

    ERIC Educational Resources Information Center

    Warren, Jane; Klepper, Konja K.; Lambert, Serena; Nunez, Johnna; Williams, Susan

    2011-01-01

    Creating and retaining empathic connections with the most disenfranchised among us can take a toll on the wellness of counselor advocates. The Advocacy-Serving Model is introduced as a creative approach to strengthening the ability of advocates to serve through enhancing awareness, focusing actions, and connecting to community. The model…

  11. 34 CFR 686.12 - Agreement to serve.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) GRANT PROGRAM Application Procedures § 686.12 Agreement to serve. (a) General. A student who meets the... agreement to serve. The agreement provides that, for each TEACH Grant-eligible program for which the student... enrolled in the program for which the recipient received the TEACH Grant— (i) In a low-income school;...

  12. Long-Serving City Managers: Why Do They Stay?

    ERIC Educational Resources Information Center

    Watson, Douglas J.; Hassett, Wendy L.

    2003-01-01

    Responses from 107 city managers with more than 20 years of experience indicate that long-serving city managers are usually in smaller cities that are homogenous and politically stable. Most are white males with above-average education levels, who have support from elected officials and commitments to the cities they serve. (Contains 28…

  13. 13 CFR 142.20 - How are papers served?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false How are papers served? 142.20... ACT REGULATIONS Hearing Provisions § 142.20 How are papers served? Except for service of a complaint or a notice of hearing under §§ 142.11 and 142.14(b) respectively, service of papers must be made...

  14. 45 CFR 2554.21 - How are papers served?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false How are papers served? 2554.21 Section 2554.21... SERVICE PROGRAM FRAUD CIVIL REMEDIES ACT REGULATIONS Hearing Provisions § 2554.21 How are papers served... pleading and paper filed in the proceeding shall contain a caption setting forth the title of the...

  15. On Their Own Terms: Two-Year Minority Serving Institutions

    ERIC Educational Resources Information Center

    Nguyen, Thai-Huy; Lundy-Wagner, Valerie; Castro Samayoa, Andrés; Gasman, Marybeth; Wilson, Audrey; Diggs, Desmond; Wolff, Melanie; Dávila, Carolina; Boland, William

    2015-01-01

    This report, published by the Center for Minority Serving Institutions in collaboration with CAPSEE, looks at the role of two-year Minority Serving Institutions (MSIs) in improving postsecondary access and degree completion for disadvantaged students in the United States. In doing so, it aims to prepare the groundwork for research that considers…

  16. 40 CFR 791.34 - Serving of notice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 33 2012-07-01 2012-07-01 false Serving of notice. 791.34 Section 791.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT (CONTINUED) DATA REIMBURSEMENT Hearing Procedures § 791.34 Serving of notice. (a) Each party shall be...

  17. 40 CFR 791.34 - Serving of notice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 33 2013-07-01 2013-07-01 false Serving of notice. 791.34 Section 791.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT (CONTINUED) DATA REIMBURSEMENT Hearing Procedures § 791.34 Serving of notice. (a) Each party shall be...

  18. 76 FR 59499 - National Hispanic-Serving Institutions Week, 2011

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-26

    ... States of America the two hundred and thirty- sixth. (Presidential Sig.) [FR Doc. 2011-24888 Filed 9-23... Documents#0;#0; ] Proclamation 8718 of September 21, 2011 National Hispanic-Serving Institutions Week, 2011... National Hispanic-Serving Institutions (HSIs) Week, we renew our commitment to strengthening and...

  19. Coordination and variability in the elite female tennis serve.

    PubMed

    Whiteside, David; Elliott, Bruce Clifford; Lay, Brendan; Reid, Machar

    2015-01-01

    Enhancing the understanding of coordination and variability in the tennis serve may be of interest to coaches as they work with players to improve performance. The current study examined coordinated joint rotations and variability in the lower limbs, trunk, serving arm and ball location in the elite female tennis serve. Pre-pubescent, pubescent and adult players performed maximal effort flat serves while a 22-camera 500 Hz motion analysis system captured three-dimensional body kinematics. Coordinated joint rotations in the lower limbs and trunk appeared most consistent at the time players left the ground, suggesting that they coordinate the proximal elements of the kinematic chain to ensure that they leave the ground at a consistent time, in a consistent posture. Variability in the two degrees of freedom at the elbow became significantly greater closer to impact in adults, possibly illustrating the mechanical adjustments (compensation) these players employed to manage the changing impact location from serve to serve. Despite the variable ball toss, the temporal composition of the serve was highly consistent and supports previous assertions that players use the location of the ball to regulate their movement. Future work should consider these associations in other populations, while coaches may use the current findings to improve female serve performance. PMID:25358037

  20. Estimation of Food Guide Pyramid Serving Sizes by College Students.

    ERIC Educational Resources Information Center

    Knaust, Gretchen; Foster, Irene M.

    2000-01-01

    College students (n=158) used the Food Guide Pyramid to select serving sizes on a questionnaire (73% had been instructed in its use). Overall mean scores (31% correct) indicated they generally did not know recommended serving sizes. Those who had read about or received instruction in the pyramid had higher mean scores. (SK)

  1. The National Insurance Academy: Serving India's Insurance Professionals and Researchers

    ERIC Educational Resources Information Center

    Sane, Bhagyashree

    2011-01-01

    This article discusses how a special library can meet the needs of a specific industry. The author focuses on India's National Insurance Academy (NIA) Library, which serves the insurance industry of India and some neighboring countries. It is where the author serves as the chief librarian.

  2. 13 CFR 142.20 - How are papers served?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false How are papers served? 142.20... ACT REGULATIONS Hearing Provisions § 142.20 How are papers served? Except for service of a complaint or a notice of hearing under §§ 142.11 and 142.14(b) respectively, service of papers must be made...

  3. 45 CFR 2554.21 - How are papers served?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false How are papers served? 2554.21 Section 2554.21... SERVICE PROGRAM FRAUD CIVIL REMEDIES ACT REGULATIONS Hearing Provisions § 2554.21 How are papers served... pleading and paper filed in the proceeding shall contain a caption setting forth the title of the...

  4. 16 CFR 500.26 - Representations of servings, uses, applications.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... CFR part 10, by the Department of Commerce, quantitatively defining the meaning of the terms serving... net quantity (in terms of weight or mass, measure, or numerical count) of each such serving, use, or... to the total amount of object or objects to which the commodity may be applied or upon which or...

  5. 16 CFR 500.26 - Representations of servings, uses, applications.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... CFR part 10, by the Department of Commerce, quantitatively defining the meaning of the terms serving... net quantity (in terms of weight or mass, measure, or numerical count) of each such serving, use, or... to the total amount of object or objects to which the commodity may be applied or upon which or...

  6. Inventing Hispanic-Serving Institutions (HSIs): The Basics

    ERIC Educational Resources Information Center

    Santiago, Deborah

    2006-01-01

    HSIs (Hispanic-Serving Institutions) are important institutions for Latinos, yet little research exists on them. This brief serves as a primer on the conditions and history behind their invention, the processes for identification, and the general institutional characteristics of HSIs. It also offers an overview of how these institutions are…

  7. Mapping Hispanic-Serving Institutions: A Typology of Institutional Diversity

    ERIC Educational Resources Information Center

    Núñez, Anne-Marie; Crisp, Gloria; Elizondo, Diane

    2016-01-01

    Hispanic-Serving Institutions (HSIs), institutions that enroll at least 25% Hispanic students, are institutionally diverse, including a much wider array of institutional types than other Minority-Serving Institutions (MSIs). Furthermore, they have distinctive institutional characteristics from those typically emphasized in institutional typologies…

  8. Hispanic-Serving Institutions: What Are They? Where Are They?

    ERIC Educational Resources Information Center

    Laden, Berta Vigil

    2004-01-01

    Hispanic-serving educational institutions are receiving greater public attention as they continue to expand in number. Increasingly, more and more Latinos and other racial and ethnic students are enrolling in these institutions. Hispanic-Serving Institutions (HSIs) are public and private two- and four-year colleges and universities with Latino…

  9. School Administrator Quality in Minority-Serving Institutions

    ERIC Educational Resources Information Center

    Rodríguez, Mariela A.; Mullen, Carol A.; Allen, Tawannah G.

    2015-01-01

    This commentary brings together the topics of geographically-oriented diversity, minority-serving institutions, and educational leadership programs. The geospatial context for this discussion about school administrator quality focuses on Hispanic-serving institutions (HSIs) and historically Black colleges and universities (HBCUs) in the United…

  10. 40 CFR 791.34 - Serving of notice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 31 2010-07-01 2010-07-01 true Serving of notice. 791.34 Section 791.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT (CONTINUED) DATA REIMBURSEMENT Hearing Procedures § 791.34 Serving of notice. (a) Each party shall be...

  11. 13 CFR 142.20 - How are papers served?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false How are papers served? 142.20... ACT REGULATIONS Hearing Provisions § 142.20 How are papers served? Except for service of a complaint or a notice of hearing under §§ 142.11 and 142.14(b) respectively, service of papers must be made...

  12. 45 CFR 2554.21 - How are papers served?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false How are papers served? 2554.21 Section 2554.21... SERVICE PROGRAM FRAUD CIVIL REMEDIES ACT REGULATIONS Hearing Provisions § 2554.21 How are papers served... pleading and paper filed in the proceeding shall contain a caption setting forth the title of the...

  13. 45 CFR 2554.21 - How are papers served?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false How are papers served? 2554.21 Section 2554.21... SERVICE PROGRAM FRAUD CIVIL REMEDIES ACT REGULATIONS Hearing Provisions § 2554.21 How are papers served... pleading and paper filed in the proceeding shall contain a caption setting forth the title of the...

  14. 13 CFR 142.20 - How are papers served?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false How are papers served? 142.20... ACT REGULATIONS Hearing Provisions § 142.20 How are papers served? Except for service of a complaint or a notice of hearing under §§ 142.11 and 142.14(b) respectively, service of papers must be made...

  15. 13 CFR 142.20 - How are papers served?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false How are papers served? 142.20... ACT REGULATIONS Hearing Provisions § 142.20 How are papers served? Except for service of a complaint or a notice of hearing under §§ 142.11 and 142.14(b) respectively, service of papers must be made...

  16. 45 CFR 2554.21 - How are papers served?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 4 2013-10-01 2013-10-01 false How are papers served? 2554.21 Section 2554.21... SERVICE PROGRAM FRAUD CIVIL REMEDIES ACT REGULATIONS Hearing Provisions § 2554.21 How are papers served... pleading and paper filed in the proceeding shall contain a caption setting forth the title of the...

  17. Environmental Health Related Socio-Spatial Inequalities: Identifying “Hotspots” of Environmental Burdens and Social Vulnerability

    PubMed Central

    Shrestha, Rehana; Flacke, Johannes; Martinez, Javier; van Maarseveen, Martin

    2016-01-01

    Differential exposure to multiple environmental burdens and benefits and their distribution across a population with varying vulnerability can contribute heavily to health inequalities. Particularly relevant are areas with high cumulative burdens and high social vulnerability termed as “hotspots”. This paper develops an index-based approach to assess these multiple burdens and benefits in combination with vulnerability factors at detailed intra-urban level. The method is applied to the city of Dortmund, Germany. Using non-spatial and spatial methods we assessed inequalities and identified “hotspot” areas in the city. We found modest inequalities burdening higher vulnerable groups in Dortmund (CI = −0.020 at p < 0.05). At the detailed intra-urban level, however, inequalities showed strong geographical patterns. Large numbers of “hotspots” exist in the northern part of the city compared to the southern part. A holistic assessment, particularly at a detailed local level, considering both environmental burdens and benefits and their distribution across the population with the different vulnerability, is essential to inform environmental justice debates and to mobilize local stakeholders. Locating “hotspot” areas at this detailed spatial level can serve as a basis to develop interventions that target vulnerable groups to ensure a health conducive equal environment. PMID:27409625

  18. Aircraft vulnerability analysis by modeling and simulation

    NASA Astrophysics Data System (ADS)

    Willers, Cornelius J.; Willers, Maria S.; de Waal, Alta

    2014-10-01

    Infrared missiles pose a significant threat to civilian and military aviation. ManPADS missiles are especially dangerous in the hands of rogue and undisciplined forces. Yet, not all the launched missiles hit their targets; the miss being either attributable to misuse of the weapon or to missile performance restrictions. This paper analyses some of the factors affecting aircraft vulnerability and demonstrates a structured analysis of the risk and aircraft vulnerability problem. The aircraft-missile engagement is a complex series of events, many of which are only partially understood. Aircraft and missile designers focus on the optimal design and performance of their respective systems, often testing only in a limited set of scenarios. Most missiles react to the contrast intensity, but the variability of the background is rarely considered. Finally, the vulnerability of the aircraft depends jointly on the missile's performance and the doctrine governing the missile's launch. These factors are considered in a holistic investigation. The view direction, altitude, time of day, sun position, latitude/longitude and terrain determine the background against which the aircraft is observed. Especially high gradients in sky radiance occur around the sun and on the horizon. This paper considers uncluttered background scenes (uniform terrain and clear sky) and presents examples of background radiance at all view angles across a sphere around the sensor. A detailed geometrical and spatially distributed radiometric model is used to model the aircraft. This model provides the signature at all possible view angles across the sphere around the aircraft. The signature is determined in absolute terms (no background) and in contrast terms (with background). It is shown that the background significantly affects the contrast signature as observed by the missile sensor. A simplified missile model is constructed by defining the thrust and mass profiles, maximum seeker tracking rate, maximum

  19. Human Illness and the Experience of Vulnerability: A Summary and Reflection upon the Opening Keynote by His Grace Archbishop Emeritus Desmond Tutu

    ERIC Educational Resources Information Center

    Mazonde, Isaac N.

    2010-01-01

    In his speech, "Human Illness and the Experience of Vulnerability," Archbishop Tutu used his experience, eloquence and humour to emphasize the vulnerability of human beings during illness. The Archbishop emphasized the need for healthcare professionals to realize that patients are not simply numbers or cases, but fellow human beings who are in…

  20. Computational discovery of pathway-level genetic vulnerabilities in non-small-cell lung cancer | Office of Cancer Genomics

    Cancer.gov

    Novel approaches are needed for discovery of targeted therapies for non-small-cell lung cancer (NSCLC) that are specific to certain patients. Whole genome RNAi screening of lung cancer cell lines provides an ideal source for determining candidate drug targets. Unsupervised learning algorithms uncovered patterns of differential vulnerability across lung cancer cell lines to loss of functionally related genes. Such genetic vulnerabilities represent candidate targets for therapy and are found to be involved in splicing, translation and protein folding.

  1. Surface Vulnerability of Cerebral Cortex to Major Depressive Disorder

    PubMed Central

    Li, Gang; Fralick, Drew; Shen, Ting; Qiu, Meihui; Liu, Jun; Jiang, Kaida; Shen, Dinggang; Fang, Yiru

    2015-01-01

    Major depressive disorder (MDD) is accompanied by atypical brain structure. This study first presents the alterations in the cortical surface of patients with MDD using multidimensional structural patterns that reflect different neurodevelopment. Sixteen first-episode, untreated patients with MDD and 16 matched healthy controls underwent a magnetic resonance imaging (MRI) scan. The cortical maps of thickness, surface area, and gyrification were examined using the surface-based morphometry (SBM) approach. Increase of cortical thickness was observed in the right posterior cingulate region and the parietal cortex involving the bilateral inferior, left superior parietal and right paracentral regions, while decreased thickness was noted in the parietal cortex including bilateral pars opercularis and left precentral region, as well as the left rostral-middle frontal regions in patients with MDD. Likewise, increased or decreased surface area was found in five sub-regions of the cingulate gyrus, parietal and frontal cortices (e.g., bilateral inferior parietal and superior frontal regions). In addition, MDD patients exhibited a significant hypergyrification in the right precentral and supramarginal region. This integrated structural assessment of cortical surface suggests that MDD patients have cortical alterations of the frontal, parietal and cingulate regions, indicating a vulnerability to MDD during earlier neurodevelopmental process. PMID:25793287

  2. From intrinsic firing properties to selective neuronal vulnerability in neurodegenerative diseases.

    PubMed

    Roselli, Francesco; Caroni, Pico

    2015-03-01

    Neurodegenerative diseases (NDDs) involve years of gradual preclinical progression. It is widely anticipated that in order to be effective, treatments should target early stages of disease, but we lack conceptual frameworks to identify and treat early manifestations relevant to disease progression. Here we discuss evidence that a focus on physiological features of neuronal subpopulations most vulnerable to NDDs, and how those features are affected in disease, points to signaling pathways controlling excitation in selectively vulnerable neurons, and to mechanisms regulating calcium and energy homeostasis. These hypotheses could be tested in neuronal stress tests involving animal models or patient-derived iPS cells.

  3. Empirical Estimates and Observations of 0Day Vulnerabilities

    SciTech Connect

    Miles A. McQueen; Trevor A. McQueen; Wayne F. Boyer; May R. Chaffin

    2009-01-01

    We define a 0Day vulnerability to be any vulnerability, in deployed software, that has been discovered by at least one person but has not yet been publicly announced or patched. These 0Day vulnerabilities are of particular interest when assessing the risk to a system from exploit of vulnerabilities which are not generally known to the public or, most importantly, to the owners of the system. Using the 0Day definition given above, we analyzed the 0Day lifespans of 491 vulnerabilities and conservatively estimated that in the worst year there were on average 2500 0Day vulnerabilities in existence on any given day. Then using a small but intriguing set of 15 0Day vulnerability lifespans representing the time from actual discovery to public disclosure, we made a more aggressive estimate. In this case, we estimated that in the worst year there were, on average, 4500 0Day vulnerabilities in existence on any given day.

  4. Evaluation of Equipment Vulnerability and Potential Shock Hazards. [carbon fibers

    NASA Technical Reports Server (NTRS)

    Taback, I.

    1980-01-01

    The vulnerability of electric equipment to carbon fibers released from aircraft accidents is investigated and the parameters affecting vulnerability are discussed. The shock hazard for a hypothetical set of accidents is computed.

  5. Psychological Vulnerability to Completed Suicide: A Review of Empirical Studies.

    ERIC Educational Resources Information Center

    Conner, Kenneth R.; Duberstein, Paul R.; Conwell, Yeates; Seidlitz, Larry; Caine, Eric D.

    2001-01-01

    This article reviews empirical literature on psychological vulnerability to completed suicide. Five constructs have been consistently associated with completed suicide: impulsivity/aggression; depression; anxiety; hopelessness; and self-consciousness/social disengagement. Current knowledge of psychological vulnerability could inform social…

  6. Review of tennis serve motion analysis and the biomechanics of three serve types with implications for injury.

    PubMed

    Abrams, Geoffrey D; Sheets, Alison L; Andriacchi, Thomas P; Safran, Marc R

    2011-11-01

    The tennis serve has the potential for musculoskeletal injury as it is an overhead motion and is performed repetitively during play. Early studies evaluating the biomechanics and injury potential of the tennis serve utilized skin-based marker technologies; however, markerless motion measurement systems have recently become available and have obviated some of the problems associated with the marker-based technology. The late cocking and early acceleration phases of the kinetic chain of the service motion produce the highest internal forces and pose the greatest risk of injury during the service motion. Previous biomechanical data on the tennis serve have primarily focused on the flat serve, with some data on the kick serve, and very little published data elucidating the biomechanics of the slice serve. This review discusses the injury potential of the tennis serve with respect to the four phases of the service motion, the history, and early findings of service motion evaluation, as well as biomechanical data detailing the differences between the three types of serves and how this may relate to injury prevention, rehabilitation, and return to play. PMID:22303788

  7. Review of tennis serve motion analysis and the biomechanics of three serve types with implications for injury.

    PubMed

    Abrams, Geoffrey D; Sheets, Alison L; Andriacchi, Thomas P; Safran, Marc R

    2011-11-01

    The tennis serve has the potential for musculoskeletal injury as it is an overhead motion and is performed repetitively during play. Early studies evaluating the biomechanics and injury potential of the tennis serve utilized skin-based marker technologies; however, markerless motion measurement systems have recently become available and have obviated some of the problems associated with the marker-based technology. The late cocking and early acceleration phases of the kinetic chain of the service motion produce the highest internal forces and pose the greatest risk of injury during the service motion. Previous biomechanical data on the tennis serve have primarily focused on the flat serve, with some data on the kick serve, and very little published data elucidating the biomechanics of the slice serve. This review discusses the injury potential of the tennis serve with respect to the four phases of the service motion, the history, and early findings of service motion evaluation, as well as biomechanical data detailing the differences between the three types of serves and how this may relate to injury prevention, rehabilitation, and return to play.

  8. Vulnerability curves vs. vulnerability indicators: application of an indicator-based methodology for debris-flow hazards

    NASA Astrophysics Data System (ADS)

    Papathoma-Köhle, Maria

    2016-08-01

    The assessment of the physical vulnerability of elements at risk as part of the risk analysis is an essential aspect for the development of strategies and structural measures for risk reduction. Understanding, analysing and, if possible, quantifying physical vulnerability is a prerequisite for designing strategies and adopting tools for its reduction. The most common methods for assessing physical vulnerability are vulnerability matrices, vulnerability curves and vulnerability indicators; however, in most of the cases, these methods are used in a conflicting way rather than in combination. The article focuses on two of these methods: vulnerability curves and vulnerability indicators. Vulnerability curves express physical vulnerability as a function of the intensity of the process and the degree of loss, considering, in individual cases only, some structural characteristics of the affected buildings. However, a considerable amount of studies argue that vulnerability assessment should focus on the identification of these variables that influence the vulnerability of an element at risk (vulnerability indicators). In this study, an indicator-based methodology (IBM) for mountain hazards including debris flow (Kappes et al., 2012) is applied to a case study for debris flows in South Tyrol, where in the past a vulnerability curve has been developed. The relatively "new" indicator-based method is being scrutinised and recommendations for its improvement are outlined. The comparison of the two methodological approaches and their results is challenging since both methodological approaches deal with vulnerability in a different way. However, it is still possible to highlight their weaknesses and strengths, show clearly that both methodologies are necessary for the assessment of physical vulnerability and provide a preliminary "holistic methodological framework" for physical vulnerability assessment showing how the two approaches may be used in combination in the future.

  9. Noninvasive diagnosis of vulnerable coronary plaque

    PubMed Central

    Pozo, Eduardo; Agudo-Quilez, Pilar; Rojas-González, Antonio; Alvarado, Teresa; Olivera, María José; Jiménez-Borreguero, Luis Jesús; Alfonso, Fernando

    2016-01-01

    Myocardial infarction and sudden cardiac death are frequently the first manifestation of coronary artery disease. For this reason, screening of asymptomatic coronary atherosclerosis has become an attractive field of research in cardiovascular medicine. Necropsy studies have described histopathological changes associated with the development of acute coronary events. In this regard, thin-cap fibroatheroma has been identified as the main vulnerable coronary plaque feature. Hence, many imaging techniques, such as coronary computed tomography, cardiac magnetic resonance or positron emission tomography, have tried to detect noninvasively these histomorphological characteristics with different approaches. In this article, we review the role of these diagnostic tools in the detection of vulnerable coronary plaque with particular interest in their advantages and limitations as well as the clinical implications of the derived findings. PMID:27721935

  10. Information systems vulnerability: A systems analysis perspective

    SciTech Connect

    Wyss, G.D.; Daniel, S.L.; Schriner, H.K.; Gaylor, T.R.

    1996-07-01

    Vulnerability analyses for information systems are complicated because the systems are often geographically distributed. Sandia National Laboratories has assembled an interdisciplinary team to explore the applicability of probabilistic logic modeling (PLM) techniques (including vulnerability and vital area analysis) to examine the risks associated with networked information systems. The authors have found that the reliability and failure modes of many network technologies can be effectively assessed using fault trees and other PLM methods. The results of these models are compatible with an expanded set of vital area analysis techniques that can model both physical locations and virtual (logical) locations to identify both categories of vital areas simultaneously. These results can also be used with optimization techniques to direct the analyst toward the most cost-effective security solution.

  11. Vulnerability of community businesses to environmental disasters.

    PubMed

    Zhang, Yang; Lindell, Michael K; Prater, Carla S

    2009-03-01

    Business plays important roles in community functioning. However, disaster research has been disproportionately focused on units of analysis such as families, households and government agencies. This paper synthesises the major findings within the business development research field and the disaster research field. It constructs a framework for evaluating business vulnerability to natural disasters. Our theoretical integration of the research conducted to date addresses five major issues. First, it defines the ways in which businesses are subject to the impacts of natural disasters. Second, it identifies the factors that determine the magnitude of business impacts after a disaster. Third, it identifies how and when businesses return to their pre-disaster level in the disaster stricken community. Fourth, it describes measures that can be taken by individual firms and community planners to reduce the impacts of environmental disasters. Fifth, it identifies needs for public policy and future research to reduce business vulnerability to environmental disasters.

  12. Modernization, weather variability, and vulnerability to famine.

    PubMed

    D'Alessandro, Simone

    2011-01-01

    This paper shows that under weather variability the transformation from a rural to an incomplete market economy can increase the vulnerability of peasants to famine. This can occur even if improvements in technology have raised agricultural productivity and made production less responsive to weather variability. Indeed, negative environmental shocks can produce a drop in wages that outweighs the increase in wages due to an equivalent positive environmental shock. Consequently, the amount of grain stored increases more slowly in good seasons than it decreases in bad ones. This paper gives new insights on the catastrophic effects produced by widespread droughts in India during the second half of the 19th century. Notwithstanding the introduction of new modes of production and the modernization of infrastructures, the interaction between environmental variability and new institutional arrangements might have contributed to increase the vulnerability of peasants to famine. PMID:22164874

  13. Upper Limb Biomechanics During the Volleyball Serve and Spike

    PubMed Central

    Reeser, Jonathan C.; Fleisig, Glenn S.; Bolt, Becky; Ruan, Mianfang

    2010-01-01

    Background: The shoulder is the third-most commonly injured body part in volleyball, with the majority of shoulder problems resulting from chronic overuse. Hypothesis: Significant kinetic differences exist among specific types of volleyball serves and spikes. Study Design: Controlled laboratory study. Methods: Fourteen healthy female collegiate volleyball players performed 5 successful trials of 4 skills: 2 directional spikes, an off-speed roll shot, and the float serve. Volunteers who were competent in jump serves (n, 5) performed 5 trials of that skill. A 240-Hz 3-dimensional automatic digitizing system captured each trial. Multivariate analysis of variance and post hoc paired t tests were used to compare kinetic parameters for the shoulder and elbow across all the skills (except the jump serve). A similar statistical analysis was performed for upper extremity kinematics. Results: Forces, torques, and angular velocities at the shoulder and elbow were lowest for the roll shot and second-lowest for the float serve. No differences were detected between the cross-body and straight-ahead spikes. Although there was an insufficient number of participants to statistically analyze the jump serve, the data for it appear similar to those of the cross-body and straight-ahead spikes. Shoulder abduction at the instant of ball contact was approximately 130° for all skills, which is substantially greater than that previously reported for female athletes performing tennis serves or baseball pitches. Conclusion: Because shoulder kinetics were greatest during spiking, the volleyball player with symptoms of shoulder overuse may wish to reduce the number of repetitions performed during practice. Limiting the number of jump serves may also reduce the athlete’s risk of overuse-related shoulder dysfunction. Clinical Relevance: Volleyball-specific overhead skills, such as the spike and serve, produce considerable upper extremity force and torque, which may contribute to the risk of

  14. Space Station Program threat and vulnerability analysis

    NASA Technical Reports Server (NTRS)

    Van Meter, Steven D.; Veatch, John D.

    1987-01-01

    An examination has been made of the physical security of the Space Station Program at the Kennedy Space Center in a peacetime environment, in order to furnish facility personnel with threat/vulnerability information. A risk-management approach is used to prioritize threat-target combinations that are characterized in terms of 'insiders' and 'outsiders'. Potential targets were identified and analyzed with a view to their attractiveness to an adversary, as well as to the consequentiality of the resulting damage.

  15. Seaside, Oregon, Tsunami Vulnerability Assessment Pilot Study

    NASA Astrophysics Data System (ADS)

    Dunbar, P. K.; Dominey-Howes, D.; Varner, J.

    2006-12-01

    The results of a pilot study to assess the risk from tsunamis for the Seaside-Gearhart, Oregon region will be presented. To determine the risk from tsunamis, it is first necessary to establish the hazard or probability that a tsunami of a particular magnitude will occur within a certain period of time. Tsunami inundation maps that provide 100-year and 500-year probabilistic tsunami wave height contours for the Seaside-Gearhart, Oregon, region were developed as part of an interagency Tsunami Pilot Study(1). These maps provided the probability of the tsunami hazard. The next step in determining risk is to determine the vulnerability or degree of loss resulting from the occurrence of tsunamis due to exposure and fragility. The tsunami vulnerability assessment methodology used in this study was developed by M. Papathoma and others(2). This model incorporates multiple factors (e.g. parameters related to the natural and built environments and socio-demographics) that contribute to tsunami vulnerability. Data provided with FEMA's HAZUS loss estimation software and Clatsop County, Oregon, tax assessment data were used as input to the model. The results, presented within a geographic information system, reveal the percentage of buildings in need of reinforcement and the population density in different inundation depth zones. These results can be used for tsunami mitigation, local planning, and for determining post-tsunami disaster response by emergency services. (1)Tsunami Pilot Study Working Group, Seaside, Oregon Tsunami Pilot Study--Modernization of FEMA Flood Hazard Maps, Joint NOAA/USGS/FEMA Special Report, U.S. National Oceanic and Atmospheric Administration, U.S. Geological Survey, U.S. Federal Emergency Management Agency, 2006, Final Draft. (2)Papathoma, M., D. Dominey-Howes, D.,Y. Zong, D. Smith, Assessing Tsunami Vulnerability, an example from Herakleio, Crete, Natural Hazards and Earth System Sciences, Vol. 3, 2003, p. 377-389.

  16. NASA's Research in Aircraft Vulnerability Mitigation

    NASA Technical Reports Server (NTRS)

    Allen, Cheryl L.

    2005-01-01

    Since its inception in 1958, the National Aeronautics and Space Administration s (NASA) role in civil aeronautics has been to develop high-risk, high-payoff technologies to meet critical national aviation challenges. Following the events of Sept. 11, 2001, NASA recognized that it now shared the responsibility for improving homeland security. The NASA Strategic Plan was modified to include requirements to enable a more secure air transportation system by investing in technologies and collaborating with other agencies, industry, and academia. NASA is conducting research to develop and advance innovative and commercially viable technologies that will reduce the vulnerability of aircraft to threats or hostile actions, and identify and inform users of potential vulnerabilities in a timely manner. Presented in this paper are research plans and preliminary status for mitigating the effects of damage due to direct attacks on civil transport aircraft. The NASA approach to mitigation includes: preventing loss of an aircraft due to a hit from man-portable air defense systems; developing fuel system technologies that prevent or minimize in-flight vulnerability to small arms or other projectiles; providing protection from electromagnetic energy attacks by detecting directed energy threats to aircraft and on/off-board systems; and minimizing the damage due to high-energy attacks (explosions and fire) by developing advanced lightweight, damage-resistant composites and structural concepts. An approach to preventing aircraft from being used as weapons of mass destruction will also be discussed.

  17. Growth of Necrotic Cores in Vulnerable Plaque

    NASA Astrophysics Data System (ADS)

    Fok, Pak-Wing

    2011-03-01

    Plaques are fatty deposits that grow mainly in arteries and develop as a result of a chronic inflammatory response. Plaques are called vulnerable when they are prone to mechanical rupture. Vulnerable Plaques (VPs) are characterized by lipid-rich, necrotic cores that are heavily infiltrated with macrophages. The rupture of VPs releases thrombogenic agents into the bloodstream, usually resulting in myocardial infarctions. We propose a quantitative model to predict the development of a plaque's necrotic core. By solving coupled reaction-diffusion equations for macrophages and dead cells, we explore the joint effects of hypoxic cell death and chemo-attraction to Ox-LDL, a molecule that is strongly linked to atherosclerosis. Our model predicts cores that have approximately the right size and shape. Normal mode analysis and subsequent calculation of the smallest eigenvalues allow us to compute the times required for the system to reach its steady state. This study allows us to make quantitative predictions for how quickly vulnerable plaques develop and how their growth depends on system parameters such as chemotactic coefficients and cell death rates.

  18. Environment, vulnerability, and gender in Andean ethnomedicine.

    PubMed

    Larme, A C

    1998-10-01

    In Cuyo Cuyo, in the southern Peruvian highlands, ethnomedicine is rife with images of human vulnerability to a hostile and unpredictable environment. This is represented in the ethnomedical system by a focus on wayras, air- or wind-borne illnesses that enter through vulnerable body openings such as the head, orifices, lower back, and feet. Women are viewed to be more vulnerable, or débil, than men to illness because they have an extra orifice, the vagina, they lose copious amounts of blood, which is thought to be irreplaceable, during childbirth. and because they suffer more negative emotions, which are thought to attract wayras and other illnesses to the body. The relationship of ethnomedical beliefs to the Andean physical and political economic environment is explored within the context of social and economic change. Negative beliefs about women's bodies have negative effects on women's roles and position vis-à-vis men in present day Cuyo Cuyo. Ethnomedical beliefs reflect and reinforce gender inequalities in present day Peru and are part of a cultural ideology that in general devalues women. This case study demonstrates that power is a key dimension in the cultural construction of medical knowledge. whether in non-Western or Western societies.

  19. Strength and Vulnerability Integration (SAVI): A Model of Emotional Well-Being Across Adulthood

    PubMed Central

    Charles, Susan Turk

    2010-01-01

    The following paper presents the theoretical model of Strength and Vulnerability Integration (SAVI) to explain factors that influence emotion regulation and emotional well-being across adulthood. The model posits that trajectories of adult development are marked by age-related enhancement in the use of strategies that serve to avoid or limit exposure to negative stimuli, but age-related vulnerabilities in situations that elicit high levels of sustained emotional arousal. When older adults avoid or reduce exposure to emotional distress, they often respond better than younger adults; when they experience high levels of sustained emotional arousal, however, age-related advantages in emotional well-being are attenuated, and older adults are hypothesized to have greater difficulties returning to homeostasis. SAVI provides a testable model to understand the literature on emotion and aging and to predict trajectories of emotional experience across the adult life span. PMID:21038939

  20. Reconceptualizing Vulnerability in Personal Narrative Writing with Youths

    ERIC Educational Resources Information Center

    Johnson, Elisabeth

    2014-01-01

    Through a student/teacher classroom conflict, the author explores ways adults produce student writers as vulnerable. Drawing on post-structural concepts of adolescence, identity production, interrogation, and vulnerability, the author details how an English teacher invited students to perform vulnerability in personal narratives about issues like…

  1. An Empirical Measure of Computer Security Strength for Vulnerability Remediation

    ERIC Educational Resources Information Center

    Villegas, Rafael

    2010-01-01

    Remediating all vulnerabilities on computer systems in a timely and cost effective manner is difficult given that the window of time between the announcement of a new vulnerability and an automated attack has decreased. Hence, organizations need to prioritize the vulnerability remediation process on their computer systems. The goal of this…

  2. 6 CFR 27.215 - Security vulnerability assessments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... FACILITY ANTI-TERRORISM STANDARDS Chemical Facility Security Program § 27.215 Security vulnerability...-risk, the facility must complete a Security Vulnerability Assessment. A Security Vulnerability... in meeting the applicable Risk-Based Performance Standards; (4) Risk Assessment, including...

  3. 6 CFR 27.215 - Security vulnerability assessments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... FACILITY ANTI-TERRORISM STANDARDS Chemical Facility Security Program § 27.215 Security vulnerability...-risk, the facility must complete a Security Vulnerability Assessment. A Security Vulnerability... in meeting the applicable Risk-Based Performance Standards; (4) Risk Assessment, including...

  4. Mobile Phones and Psychosocial Therapies with Vulnerable People: a First State of the Art.

    PubMed

    Vázquez, Maria Yolanda García; Sexto, Carlos Ferrás; Rocha, Álvaro; Aguilera, Adrián

    2016-06-01

    Mobile phones are becoming a communication tool commonly used by people all over the world; and they are started to be adopted in psychosocial therapies involving vulnerable people. We are herein presenting the results of an academic literature review. We identified scientific papers published between 2006 and 2015 resorting to academic databases available on the Internet, applying a systematic selection method based on quality criteria. Secondly, we analysed contents, highlighting the scarcity of research involving vulnerable people. The available literature specialized in psychosocial therapies offers investigation results which involve mobile phones and patients in general, focusing particularly on the clinical psychology field and, to a lesser extent, on the social work field. Particularly significant are the investigation works developed in the United States. In the present paper we introduce a first "state of the art", identifying opportunities and also the limitations surrounding the use of mobile phones in psychosocial therapies targeting the vulnerable. Issues concerning privacy and data confidentiality, and the access of vulnerable people to mobile phones and how they use them, pose significant challenges; but they offer the opportunity to reach isolated or impoverished populations, or even to facilitate access to social and healthcare services. We close this paper formulating possible orientations, hypotheses and goals to design new investigation works involving vulnerable populations.

  5. Mobile Phones and Psychosocial Therapies with Vulnerable People: a First State of the Art.

    PubMed

    Vázquez, Maria Yolanda García; Sexto, Carlos Ferrás; Rocha, Álvaro; Aguilera, Adrián

    2016-06-01

    Mobile phones are becoming a communication tool commonly used by people all over the world; and they are started to be adopted in psychosocial therapies involving vulnerable people. We are herein presenting the results of an academic literature review. We identified scientific papers published between 2006 and 2015 resorting to academic databases available on the Internet, applying a systematic selection method based on quality criteria. Secondly, we analysed contents, highlighting the scarcity of research involving vulnerable people. The available literature specialized in psychosocial therapies offers investigation results which involve mobile phones and patients in general, focusing particularly on the clinical psychology field and, to a lesser extent, on the social work field. Particularly significant are the investigation works developed in the United States. In the present paper we introduce a first "state of the art", identifying opportunities and also the limitations surrounding the use of mobile phones in psychosocial therapies targeting the vulnerable. Issues concerning privacy and data confidentiality, and the access of vulnerable people to mobile phones and how they use them, pose significant challenges; but they offer the opportunity to reach isolated or impoverished populations, or even to facilitate access to social and healthcare services. We close this paper formulating possible orientations, hypotheses and goals to design new investigation works involving vulnerable populations. PMID:27194134

  6. 7 CFR 1150.134 - Nominee's agreement to serve.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE DAIRY PROMOTION PROGRAM Dairy Promotion and Research Order National Dairy Promotion and Research Board § 1150.134 Nominee's agreement to serve. Any...

  7. 7 CFR 1150.134 - Nominee's agreement to serve.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... AGREEMENTS AND ORDERS; MILK), DEPARTMENT OF AGRICULTURE DAIRY PROMOTION PROGRAM Dairy Promotion and Research Order National Dairy Promotion and Research Board § 1150.134 Nominee's agreement to serve. Any...

  8. 25 CFR 214.22 - Serving of notices.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., OKLAHOMA, FOR MINING, EXCEPT OIL AND GAS § 214.22 Serving of notices. Wherever notice is provided for in... delivery of personal notice; but where the party is outside the State of Oklahoma the officer in charge...

  9. 25 CFR 214.22 - Serving of notices.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., OKLAHOMA, FOR MINING, EXCEPT OIL AND GAS § 214.22 Serving of notices. Wherever notice is provided for in... delivery of personal notice; but where the party is outside the State of Oklahoma the officer in charge...

  10. 25 CFR 214.22 - Serving of notices.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., OKLAHOMA, FOR MINING, EXCEPT OIL AND GAS § 214.22 Serving of notices. Wherever notice is provided for in... delivery of personal notice; but where the party is outside the State of Oklahoma the officer in charge...

  11. 13. ENGINE TEST CELL BUILDING INTERIOR. EQUIPMENT ROOM SERVING CELLS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    13. ENGINE TEST CELL BUILDING INTERIOR. EQUIPMENT ROOM SERVING CELLS 2 AND 4. LOOKING SOUTHEAST. - Fairchild Air Force Base, Engine Test Cell Building, Near intersection of Arnold Street & George Avenue, Spokane, Spokane County, WA

  12. 7 CFR 1221.102 - Nominee's agreement to serve.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SORGHUM PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Sorghum... agreement to: (a) Serve on the Board if appointed; (b) Disclose any relationship with any sorghum...

  13. 7 CFR 1221.102 - Nominee's agreement to serve.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SORGHUM PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Sorghum... agreement to: (a) Serve on the Board if appointed; (b) Disclose any relationship with any sorghum...

  14. 7 CFR 1221.102 - Nominee's agreement to serve.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SORGHUM PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Sorghum... agreement to: (a) Serve on the Board if appointed; (b) Disclose any relationship with any sorghum...

  15. 7 CFR 1221.102 - Nominee's agreement to serve.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SORGHUM PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Sorghum... agreement to: (a) Serve on the Board if appointed; (b) Disclose any relationship with any sorghum...

  16. 7 CFR 1221.102 - Nominee's agreement to serve.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SORGHUM PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Sorghum... agreement to: (a) Serve on the Board if appointed; (b) Disclose any relationship with any sorghum...

  17. A private caregiver ListServ: maximum benefit for minimum cost.

    PubMed

    Lucas, Michele R

    2011-01-01

    A private ListServ was created as a psychosocial intervention for the caregivers of the brain tumor patients in a large metropolitan cancer center. Caring for someone with a brain tumor can be quite challenging, and the day-to-day responsibilities restrict the amount of discretionary time allotted the caregiver. Consequently, they can become isolated and overwhelmed. It was conceived that, for convenience sake, a ListServ might be the solution to best serve this population. The hope being that sharing with their peers would lessen the isolation and validate their own experience, decreasing their fear and anxiety. This was all possible for less than a dollar a day. PMID:21391069

  18. Neuronal vulnerability, pathogenesis and Parkinson’s disease

    PubMed Central

    Sulzer, David; Surmeier, D. James

    2012-01-01

    Although there have been significant advances, pathogenesis in Parkinson’s disease (PD) is still poorly understood. Potential clues about pathogenesis that have not been systematically pursued are suggested by the restricted pattern of neuronal pathology in the disease. In addition to dopaminergic neurons in the substantia nigra pars compacta (SNc), a significant number of other central and peripheral neuronal populations exhibit Lewy pathology (LP), phenotypic dysregulation or frank degeneration in PD patients. Drawing on this literature, there appears to be a small number of risk factors contributing to vulnerability. These include autonomous activity, broad action potentials, low intrinsic calcium buffering capacity, poorly myelinated long highly branched axons and terminal fields, and use of a monoamine neurotransmitter, often with the catecholamine-derived neuromelanin pigment. Of these phenotypic traits, only the physiological ones appear to provide a reachable therapeutic target at present. PMID:22791686

  19. Targeting LKB1 in cancer – exposing and exploiting vulnerabilities

    PubMed Central

    Momcilovic, M; Shackelford, D B

    2015-01-01

    The LKB1 tumour suppressor is a serine/threonine kinase that functions as master regulator of cell growth, metabolism, survival and polarity. LKB1 is frequently mutated in human cancers and research spanning the last two decades have begun decoding the cellular pathways deregulated following LKB1 inactivation. This work has led to the identification of vulnerabilities present in LKB1-deficient tumour cells. Pre-clinical studies have now identified therapeutic strategies targeting this subset of tumours that promise to benefit this large patient population harbouring LKB1 mutations. Here, we review the current efforts that are underway to translate pre-clinical discovery of therapeutic strategies targeting LKB1 mutant cancers into clinical practice. PMID:26196184

  20. Unified Approach to Vulnerability Analysis of Web Applications

    NASA Astrophysics Data System (ADS)

    Le, H. T.; Loh, P. K. K.

    2008-11-01

    Web vulnerabilities in web-based applications may be detected, classified and documented. Several Web scanners exist for vulnerabilities in Web applications implemented via different technologies. However, none of them provides the technology-independent, generic coverage of possible vulnerabilities. In this project that is funded by Mindef Singapore, we propose a new approach for Web application security and vulnerability analysis. The design addresses the categorization of scanner results with a generic data model and the design of a language-independent rule-based engine that detects, analyses and reports suspected vulnerabilities in web-based applications.

  1. Vulnerability of Coastal Communities from Storm Surge and Flood Disasters.

    PubMed

    Bathi, Jejal Reddy; Das, Himangshu S

    2016-02-01

    Disasters in the form of coastal storms and hurricanes can be very destructive. Preparing for anticipated effects of such disasters can help reduce the public health and economic burden. Identifying vulnerable population groups can help prioritize resources for the most needed communities. This paper presents a quantitative framework for vulnerability measurement that incorporates both socioeconomic and flood inundation vulnerability. The approach is demonstrated for three coastal communities in Mississippi with census tracts being the study unit. The vulnerability results are illustrated as thematic maps for easy usage by planners and emergency responders to assist in prioritizing their actions to vulnerable populations during storm surge and flood disasters. PMID:26907313

  2. Vulnerability of Coastal Communities from Storm Surge and Flood Disasters

    PubMed Central

    Bathi, Jejal Reddy; Das, Himangshu S.

    2016-01-01

    Disasters in the form of coastal storms and hurricanes can be very destructive. Preparing for anticipated effects of such disasters can help reduce the public health and economic burden. Identifying vulnerable population groups can help prioritize resources for the most needed communities. This paper presents a quantitative framework for vulnerability measurement that incorporates both socioeconomic and flood inundation vulnerability. The approach is demonstrated for three coastal communities in Mississippi with census tracts being the study unit. The vulnerability results are illustrated as thematic maps for easy usage by planners and emergency responders to assist in prioritizing their actions to vulnerable populations during storm surge and flood disasters. PMID:26907313

  3. Vulnerability of Coastal Communities from Storm Surge and Flood Disasters.

    PubMed

    Bathi, Jejal Reddy; Das, Himangshu S

    2016-02-19

    Disasters in the form of coastal storms and hurricanes can be very destructive. Preparing for anticipated effects of such disasters can help reduce the public health and economic burden. Identifying vulnerable population groups can help prioritize resources for the most needed communities. This paper presents a quantitative framework for vulnerability measurement that incorporates both socioeconomic and flood inundation vulnerability. The approach is demonstrated for three coastal communities in Mississippi with census tracts being the study unit. The vulnerability results are illustrated as thematic maps for easy usage by planners and emergency responders to assist in prioritizing their actions to vulnerable populations during storm surge and flood disasters.

  4. Vulnerability-based evaluation of water supply design under climate change

    NASA Astrophysics Data System (ADS)

    Umit Taner, Mehmet; Ray, Patrick; Brown, Casey

    2015-04-01

    Long-lived water supply infrastructures are strategic investments in the developing world, serving the purpose of balancing water deficits compounded by both population growth and socio-economic development. Robust infrastructure design under climate change is compelling, and often addressed by focusing on the outcomes of climate model projections ('scenario-led' planning), or by identifying design options that are less vulnerable to a wide range of plausible futures ('vulnerability-based' planning). Decision-Scaling framework combines these two approaches by first applying a climate stress test on the system to explore vulnerabilities across many traces of the future, and then employing climate projections to inform the decision-making process. In this work, we develop decision scaling's nascent risk management concepts further, directing actions on vulnerabilities identified during the climate stress test. In the process, we present a new way to inform climate vulnerability space using climate projections, and demonstrate the use of multiple decision criteria to guide to a final design recommendation. The concepts are demonstrated for a water supply project in the Mombasa Province of Kenya, planned to provide domestic and irrigation supply. Six storage design capacities (from 40 to 140 million cubic meters) are explored through a stress test, under a large number climate traces representing both natural climate variability and plausible climate changes. Design outcomes are simulated over a 40-year planning period with a coupled hydrologic-water resources systems model and using standard reservoir operation rules. Resulting performance is expressed in terms of water supply reliability and economic efficiency. Ensemble climate projections are used for assigning conditional likelihoods to the climate traces using a statistical distance measure. The final design recommendations are presented and discussed for the decision criteria of expected regret, satisficing, and

  5. Vulnerabilities in GSM technology and feasibility of selected attacks

    NASA Astrophysics Data System (ADS)

    Voznak, M.; Prokes, M.; Sevcik, L.; Frnda, J.; Toral-Cruz, Homer; Jakovlev, Sergej; Fazio, Peppino; Mehic, M.; Mikulec, M.

    2015-05-01

    Global System for Mobile communication (GSM) is the most widespread technology for mobile communications in the world and serving over 7 billion users. Since first publication of system documentation there has been notified a potential safety problem's occurrence. Selected types of attacks, based on the analysis of the technical feasibility and the degree of risk of these weaknesses, were implemented and demonstrated in laboratory of the VSB-Technical University of Ostrava, Czech Republic. These vulnerabilities were analyzed and afterwards possible attacks were described. These attacks were implemented using open-source tools, software programmable radio USRP (Universal Software RadioPeripheral) and DVB-T (Digital Video Broadcasting - Terrestrial) receiver. GSM security architecture is being scrutinized since first public releases of its specification mainly pointing out weaknesses in authentication and ciphering mechanisms. This contribution also summarizes practically proofed and used scenarios that are performed using opensource software tools and variety of scripts mostly written in Python. Main goal of this paper is in analyzing security issues in GSM network and practical demonstration of selected attacks.

  6. Determinants of choice, and vulnerability and recovery in addiction.

    PubMed

    Lamb, R J; Maguire, David R; Ginsburg, Brett C; Pinkston, Jonathan W; France, Charles P

    2016-06-01

    Addiction may be viewed as choice governed by competing contingencies. One factor impacting choice, particularly as it relates to addiction, is sensitivity to delayed rewards. Discounting of delayed rewards influences addiction vulnerability because of competition between relatively immediate gains of drug use, e.g. intoxication, versus relatively remote gains of abstinence, e.g. family stability. Factors modifying delay sensitivity can be modeled in the laboratory. For instance, increased delay sensitivity can be similarly observed in adolescent humans and non-human animals. Similarly, genetic factors influence delay sensitivity in humans and animals. Recovery from addiction may also be viewed as choice behavior. Thus, reinforcing alternative behavior facilitates recovery because reinforcing alternative behavior decreases the frequency of using drugs. How reinforcing alternative behavior influences recovery can also be modeled in the laboratory. For instance, relapse risk decreases as abstinence duration increases, and this decreasing risk can be modeled in animals using choice procedures. In summary, addiction in many respects can be conceptualized as a problem of choice. Animal models of choice disorders stand to increase our understanding of the core processes that establish and maintain addiction and serve as a proving ground for development of novel treatments.

  7. Determinants of choice, and vulnerability and recovery in addiction.

    PubMed

    Lamb, R J; Maguire, David R; Ginsburg, Brett C; Pinkston, Jonathan W; France, Charles P

    2016-06-01

    Addiction may be viewed as choice governed by competing contingencies. One factor impacting choice, particularly as it relates to addiction, is sensitivity to delayed rewards. Discounting of delayed rewards influences addiction vulnerability because of competition between relatively immediate gains of drug use, e.g. intoxication, versus relatively remote gains of abstinence, e.g. family stability. Factors modifying delay sensitivity can be modeled in the laboratory. For instance, increased delay sensitivity can be similarly observed in adolescent humans and non-human animals. Similarly, genetic factors influence delay sensitivity in humans and animals. Recovery from addiction may also be viewed as choice behavior. Thus, reinforcing alternative behavior facilitates recovery because reinforcing alternative behavior decreases the frequency of using drugs. How reinforcing alternative behavior influences recovery can also be modeled in the laboratory. For instance, relapse risk decreases as abstinence duration increases, and this decreasing risk can be modeled in animals using choice procedures. In summary, addiction in many respects can be conceptualized as a problem of choice. Animal models of choice disorders stand to increase our understanding of the core processes that establish and maintain addiction and serve as a proving ground for development of novel treatments. PMID:27083500

  8. Technological solution for vulnerable communities: How does its approach matter?

    NASA Astrophysics Data System (ADS)

    Sianipar, C. P. M.; Dowaki, K.; Yudoko, G.

    2014-06-01

    Vulnerability is an emerging term for both scientific communities and practitioners. Vulnerabilities attributed to a particular community are then aggregated to state it as a vulnerable community. Vulnerability-related study is recognized as an interdisciplinary one due to the complex characteristics of vulnerabilities in each contextual situation. In common understandings, technology is recognized as an interdisciplinary solution, making it possible for supporting any activity in eradicating vulnerability. This study aims to observe such possibilities. Literature survey is taken to investigate the interconnection between vulnerability eradication and technology. Brief comparison between several developing countries and particular focus on Indonesia become a medium of further investigation to reveal issues surrounding technology-related efforts for vulnerability eradication in vulnerable communities. The study reveals that developing countries, particularly Indonesia, tend to adopt approaches from Northern hemisphere, including transferring technologies from developed countries without proper propagation. It means that local knowledge and power are largely ignored in the pursuit of local problem solving for vulnerability eradication. These facts become a signpost to emphasize that approach in implementing technological solution for such purpose is the critical mechanism to ensure the success in every contextual situation. Then, looking at the results of this brief study, its emphasis indicates further requirements to shift the paradigm of typical community development to contextual community empowerment in order to ensure the continuity of every technological solution for a consistent eradication of local vulnerabilities, including possible changes of required approach alongside the shift.

  9. Karst morphology and groundwater vulnerability of high alpine karst plateaus

    NASA Astrophysics Data System (ADS)

    Plan, Lukas; Decker, Kurt; Faber, Robert; Wagreich, Michael; Grasemann, Bernhard

    2009-07-01

    High alpine karst plateaus are recharge areas for major drinking water resources in the Alps and many other regions. Well-established methods for the vulnerability mapping of groundwater to contamination have not been applied to such areas yet. The paper characterises this karst type and shows that two common vulnerability assessment methods (COP and PI) classify most of the areas with high vulnerability classes. In the test site on the Hochschwab plateau (Northern Calcareous Alps, Austria), overlying layers are mostly absent, not protective or even enhance point recharge, where they have aquiclude character. The COP method classifies 82% of the area as highly or extremely vulnerable. The resulting maps are reasonable, but do not differentiate vulnerabilities to the extent that the results can be used for protective measures. An extension for the upper end of the vulnerability scale is presented that allows identifying ultra vulnerable areas. The proposed enhancement of the conventional approach points out that infiltration conditions are of key importance for vulnerability. The method accounts for karst genetical and hydrologic processes using qualitative and quantitative properties of karst depressions and sinking streams including parameters calculated from digital elevations models. The method is tested on the Hochschwab plateau where 1.7% of the area is delineated as ultra vulnerable. This differentiation could not be reached by the COP and PI methods. The resulting vulnerability map highlights spots of maximum vulnerability and the combination with a hazard map enables protective measures for a manageable area and number of sites.

  10. Evaluating regional vulnerability to climate change: purposes and methods

    SciTech Connect

    Malone, Elizabeth L.; Engle, Nathan L.

    2011-03-15

    As the emphasis in climate change research, international negotiations, and developing-country activities has shifted from mitigation to adaptation, vulnerability has emerged as a bridge between impacts on one side and the need for adaptive changes on the other. Still, the term vulnerability remains abstract, its meaning changing with the scale, focus, and purpose of each assessment. Understanding regional vulnerability has advanced over the past several decades, with studies using a combination of indicators, case studies and analogues, stakeholder-driven processes, and scenario-building methodologies. As regions become increasingly relevant scales of inquiry for bridging the aggregate and local, for every analysis, it is perhaps most appropriate to ask three “what” questions: “What/who is vulnerable?,” “What is vulnerability?,” and “Vulnerable to what?” The answers to these questions will yield different definitions of vulnerability as well as different methods for assessing it.

  11. Cultural knowledge and local vulnerability in African American communities

    NASA Astrophysics Data System (ADS)

    Miller Hesed, Christine D.; Paolisso, Michael

    2015-07-01

    Policymakers need to know what factors are most important in determining local vulnerability to facilitate effective adaptation to climate change. Quantitative vulnerability indices are helpful in this endeavour but are limited in their ability to capture subtle yet important aspects of vulnerability such as social networks, knowledge and access to resources. Working with three African American communities on Maryland’s Eastern Shore, we systematically elicit local cultural knowledge on climate change and connect it with a scientific vulnerability framework. The results of this study show that: a given social-ecological factor can substantially differ in the way in which it affects local vulnerability, even among communities with similar demographics and climate-related risks; and social and political isolation inhibits access to sources of adaptive capacity, thereby exacerbating local vulnerability. These results show that employing methods for analysing cultural knowledge can yield new insights to complement those generated by quantitative vulnerability indices.

  12. Coping with seismic vulnerability: small manufacturing firms in western Athens.

    PubMed

    Sapountzaki, Kalliopi

    2005-06-01

    This paper attempts to contribute to international discourse on the responsibility of macro structures (economic and political) and private agencies for the production and distribution of vulnerability. It does so by focusing on an individual economic entity, small manufacturing firms (SMFs), in a specific location, western Athens, Greece. By evaluating the losses that SMFs sustained in the earthquake of 7 September 1999, the paper points to variations in vulnerability levels among such firms and highlights the 'sources' of vulnerability they confront. Furthermore, the SMF recovery cycle is systematically monitored in parallel with relevant public policies and state reactions to private recovery methods. The analysis illustrates processes that externalise recovery costs, alter the relationship between physical and socio-economic vulnerability and shift the vulnerability load from macro structures to individual agencies or vice versa. It is based on two methodological approaches: the division of vulnerability into three constituent components (exposure, resistance and resilience); and the conceptual split between producers and carriers of vulnerability.

  13. Extending Vulnerability Assessment to Include Life Stages Considerations

    PubMed Central

    Hodgson, Emma E.; Essington, Timothy E.; Kaplan, Isaac C.

    2016-01-01

    Species are experiencing a suite of novel stressors from anthropogenic activities that have impacts at multiple scales. Vulnerability assessment is one tool to evaluate the likely impacts that these stressors pose to species so that high-vulnerability cases can be identified and prioritized for monitoring, protection, or mitigation. Commonly used semi-quantitative methods lack a framework to explicitly account for differences in exposure to stressors and organism responses across life stages. Here we propose a modification to commonly used spatial vulnerability assessment methods that includes such an approach, using ocean acidification in the California Current as an illustrative case study. Life stage considerations were included by assessing vulnerability of each life stage to ocean acidification and were used to estimate population vulnerability in two ways. We set population vulnerability equal to: (1) the maximum stage vulnerability and (2) a weighted mean across all stages, with weights calculated using Lefkovitch matrix models. Vulnerability was found to vary across life stages for the six species explored in this case study: two krill–Euphausia pacifica and Thysanoessa spinifera, pteropod–Limacina helicina, pink shrimp–Pandalus jordani, Dungeness crab–Metacarcinus magister and Pacific hake–Merluccius productus. The maximum vulnerability estimates ranged from larval to subadult and adult stages with no consistent stage having maximum vulnerability across species. Similarly, integrated vulnerability metrics varied greatly across species. A comparison showed that some species had vulnerabilities that were similar between the two metrics, while other species’ vulnerabilities varied substantially between the two metrics. These differences primarily resulted from cases where the most vulnerable stage had a low relative weight. We compare these methods and explore circumstances where each method may be appropriate. PMID:27416031

  14. Extending Vulnerability Assessment to Include Life Stages Considerations.

    PubMed

    Hodgson, Emma E; Essington, Timothy E; Kaplan, Isaac C

    2016-01-01

    Species are experiencing a suite of novel stressors from anthropogenic activities that have impacts at multiple scales. Vulnerability assessment is one tool to evaluate the likely impacts that these stressors pose to species so that high-vulnerability cases can be identified and prioritized for monitoring, protection, or mitigation. Commonly used semi-quantitative methods lack a framework to explicitly account for differences in exposure to stressors and organism responses across life stages. Here we propose a modification to commonly used spatial vulnerability assessment methods that includes such an approach, using ocean acidification in the California Current as an illustrative case study. Life stage considerations were included by assessing vulnerability of each life stage to ocean acidification and were used to estimate population vulnerability in two ways. We set population vulnerability equal to: (1) the maximum stage vulnerability and (2) a weighted mean across all stages, with weights calculated using Lefkovitch matrix models. Vulnerability was found to vary across life stages for the six species explored in this case study: two krill-Euphausia pacifica and Thysanoessa spinifera, pteropod-Limacina helicina, pink shrimp-Pandalus jordani, Dungeness crab-Metacarcinus magister and Pacific hake-Merluccius productus. The maximum vulnerability estimates ranged from larval to subadult and adult stages with no consistent stage having maximum vulnerability across species. Similarly, integrated vulnerability metrics varied greatly across species. A comparison showed that some species had vulnerabilities that were similar between the two metrics, while other species' vulnerabilities varied substantially between the two metrics. These differences primarily resulted from cases where the most vulnerable stage had a low relative weight. We compare these methods and explore circumstances where each method may be appropriate. PMID:27416031

  15. Assessing internal biophysical vulnerability to landslide hazards - a nested catchment approach: Xiangxi Watershed / Three Gorges Reservoir

    NASA Astrophysics Data System (ADS)

    Wiegand, Matthias; Seeber, Christoph; Hartmann, Heike; Xiang, Wei; King, Lorenz

    2010-05-01

    The Three Gorges dam construction was completed in 2006. Besides the international media, also the responsible authorities and various scholarly communities pay close attention to potential and actual environmental impacts related to the impoundment and development activities. The geo-environment within the Three Gorges region is highly conducive to landslides. Consequently, a scientific monitoring and risk mitigation system was established and is still under development. Risk analysis with regard to gravity driven mass movements is highly complex and strongly site specific - several aspects hamper a universal methodology applicable for landslide risk and site assessment. The interdisciplinary Sino-German Yangtze-Project Research co-operation aims, among others, to support the sustainable cultivation of the newly developed ecosystems within the Yangtze catchments. Land use change and increasing population growth are causing severe pressure on the scarce land resources. Landslides are acknowledged as important threat, hence vulnerability of certain landscape components have to be identified, quantified and monitored. A nested quantitative approach for vulnerability analysis is developed. The applied risk and vulnerability model understands risk as the product of hazard and vulnerability. Whereas vulnerability is characterized by: mass movement intensity and susceptibility of the respective element at risk. The watershed of Xiangxi river serves as study area. In general, catchment approaches intent and proved to be a functional geographical unit for successful integrated resources management. Several limitations with regard to data accessibility, availability and accuracy have to be considered due to restrictions of feasible scales. Comprehensive large-scale site investigations are confined to training areas for model calibration and validation. Remote sensing potentials are utilised for land use/ land cover change analysis and localization of selected elements

  16. A comparison of different vulnerability functions for mountain hazard risk management

    NASA Astrophysics Data System (ADS)

    Fuchs, S.; Keiler, M.; Tsao, T.-C.

    2012-04-01

    Until now, various works have been undertaken to determine vulnerability values for elements at risk exposed to mountain hazards, in particular with respect to torrent processes and snow avalanches. Yet, many studies only provide rough estimates for vulnerability values based on proxies for process intensities. However, the vulnerability values proposed in the literature show a high range, in particular with respect to medium and high process intensities. In our study, we compare vulnerability functions for torrent processes derived from studies in test sites located in the European Alps and in Taiwan. Based on this comparison we deduce needs for future research in order to enhance mountain hazard risk management with a particular focus on the question of vulnerability on a catchment scale. The method applied is based on an ex-post approach examining recent incidences were information on both, the height of loss and the documentation of the hazardous event, were available. Vulnerability was quantified using an economic approach by establishing a quotient between the loss and the reinstatement value of every individual element at risk exposed. In a second set of calculations, this ratio obtained for every individual element at risk was attributed to the respective proxy for process intensity. The data were analysed in a spatially explicit way by using GIS. As a result, scatterplots were developed linking process intensities to vulnerability values. These data were analysed using regression approaches in order to develop vulnerability functions which served as a proxy for the structural resistance of buildings with respect to the torrent processes studied. Additionally, uncertainties were quantified by calculating confidence bands with different confidence levels (90, 95 and 99 %). The results of this study have shown that fluvial sediment transport processes due to torrent events cause similar economic damage than damage related to debris flow processes. Hence, the

  17. Ruptures of vulnerability: Linda Stein's Knight Series.

    PubMed

    Bible, Ann Vollmann

    2010-01-01

    Drawing on the work of Monique Wittig, this article understands Linda Stein's Knight Series as a lacunary writing communicating both her challenges to come to representation and her creative registration of subjectivity. The argument is grounded in an exploration of the rich interplay of power and vulnerability across the series as against the discourse of escapist fashion. Specifically, Stein's critical contradictions of inside and outside, conflated temporality, disjunctions between decoration and abstraction, and fluidity of sex and gender are examined. The discussion is elaborated through consideration of the work of Julia Kristeva, Elizabeth Grosz, and Hayao Miyazaki.

  18. Research with protected populations--vulnerable participants.

    PubMed

    Rogers, Bonnie

    2005-04-01

    Workers as study participants are a vulnerable population and additional considerations for their protection in research are needed. Issues related to invasion of privacy and coercion to participate in research studies must be carefully weighed and closely monitored. Worker autonomy must be fostered with respect to assuring that informed consent is given, meaning the information transferred is understood. Research will add to the body of knowledge and advance nursing practice, but one must always remember that risks and benefits must be balanced to achieve appropriate end results.

  19. Serve the people: understanding ideology and professional ethics of medicine in China.

    PubMed

    Yang, Jingqing

    2010-09-01

    The article explores the communist ideology that has guided the formation of professional ethics of medicine in China. It first explores the constitutions of the People's Republic of China and the Chinese Communist Party and codes of practice for medicine enforced since 1949, showing that the core of the ideology in relation to health provision and doctor-patient relationship has always been 'serving the people wholeheartedly'. The ideological undertaking, however, has never been successfully exercised. In the pre-reform era, the bureaucratisation of health professionals led to the emergence of 'bureaucratic medicine' featuring negligence of patients' interests. In the reform era, the prevailing commercialisation of health care is in fundamental conflict with the ideological commitment to serving the people. As a result, the socialist professional ethics of medicine has not been satisfactorily practiced in reality.

  20. The Cannabis Pathway to Non-Affective Psychosis may Reflect Less Neurobiological Vulnerability.

    PubMed

    Løberg, Else-Marie; Helle, Siri; Nygård, Merethe; Berle, Jan Øystein; Kroken, Rune A; Johnsen, Erik

    2014-01-01

    There is a high prevalence of cannabis use reported in non-affective psychosis. Early prospective longitudinal studies conclude that cannabis use is a risk factor for psychosis, and neurochemical studies on cannabis have suggested potential mechanisms for this effect. Recent advances in the field of neuroscience and genetics may have important implications for our understanding of this relationship. Importantly, we need to better understand the vulnerability × cannabis interaction to shed light on the mediators of cannabis as a risk factor for psychosis. Thus, the present study reviews recent literature on several variables relevant for understanding the relationship between cannabis and psychosis, including age of onset, cognition, brain functioning, family history, genetics, and neurological soft signs (NSS) in non-affective psychosis. Compared with non-using non-affective psychosis, the present review shows that there seem to be fewer stable cognitive deficits in patients with cannabis use and psychosis, in addition to fewer NSS and possibly more normalized brain functioning, indicating less neurobiological vulnerability for psychosis. There are, however, some familiar and genetic vulnerabilities present in the cannabis psychosis group, which may influence the cannabis pathway to psychosis by increasing sensitivity to cannabis. Furthermore, an earlier age of onset suggests a different pathway to psychosis in the cannabis-using patients. Two alternative vulnerability models are presented to integrate these seemingly paradoxical findings. PMID:25477825

  1. Influence of a Prolonged Tennis Match Play on Serve Biomechanics

    PubMed Central

    Martin, Caroline; Bideau, Benoit; Delamarche, Paul; Kulpa, Richard

    2016-01-01

    The aim of this study was to quantify kinematic, kinetic and performance changes that occur in the serve throughout a prolonged tennis match play. Serves of eight male advanced tennis players were recorded with a motion capture system before, at mid-match, and after a 3-hour tennis match. Before and after each match, electromyographic data of 8 upper limb muscles obtained during isometric maximal voluntary contraction were compared to determine the presence of muscular fatigue. Vertical ground reaction forces, rating of perceived exertion, ball speed, and ball impact height were measured. Kinematic and upper limb kinetic variables were computed. The results show decrease in mean power frequency values for several upper limb muscles that is an indicator of local muscular fatigue. Decreases in serve ball speed, ball impact height, maximal angular velocities and an increase in rating of perceived exertion were also observed between the beginning and the end of the match. With fatigue, the majority of the upper limb joint kinetics decreases at the end of the match. No change in timing of maximal angular velocities was observed between the beginning and the end of the match. A prolonged tennis match play may induce fatigue in upper limb muscles, which decrease performance and cause changes in serve maximal angular velocities and joint kinetics. The consistency in timing of maximal angular velocities suggests that advanced tennis players are able to maintain the temporal pattern of their serve technique, in spite of the muscular fatigue development. PMID:27532421

  2. An 8-Stage Model for Evaluating the Tennis Serve

    PubMed Central

    Kovacs, Mark; Ellenbecker, Todd

    2011-01-01

    Background: The tennis serve is a complex stroke characterized by a series of segmental rotations involving the entire kinetic chain. Many overhead athletes use a basic 6-stage throwing model; however, the tennis serve does provide some differences. Evidence Acquisition: To support the present 8-stage descriptive model, data were gathered from PubMed and SPORTDiscus databases using keywords tennis and serve for publications between 1980 and 2010. Results: An 8-stage model of analysis for the tennis serve that includes 3 distinct phases—preparation, acceleration, and follow-through—provides a more tennis-specific analysis than that previously presented in the clinical tennis literature. When a serve is evaluated, the total body perspective is just as important as the individual segments alone. Conclusion: The 8-stage model provides a more in-depth analysis that should be utilized in all tennis players to help better understand areas of weakness, potential areas of injury, as well as components that can be improved for greater performance. PMID:23016050

  3. Influence of a Prolonged Tennis Match Play on Serve Biomechanics.

    PubMed

    Martin, Caroline; Bideau, Benoit; Delamarche, Paul; Kulpa, Richard

    2016-01-01

    The aim of this study was to quantify kinematic, kinetic and performance changes that occur in the serve throughout a prolonged tennis match play. Serves of eight male advanced tennis players were recorded with a motion capture system before, at mid-match, and after a 3-hour tennis match. Before and after each match, electromyographic data of 8 upper limb muscles obtained during isometric maximal voluntary contraction were compared to determine the presence of muscular fatigue. Vertical ground reaction forces, rating of perceived exertion, ball speed, and ball impact height were measured. Kinematic and upper limb kinetic variables were computed. The results show decrease in mean power frequency values for several upper limb muscles that is an indicator of local muscular fatigue. Decreases in serve ball speed, ball impact height, maximal angular velocities and an increase in rating of perceived exertion were also observed between the beginning and the end of the match. With fatigue, the majority of the upper limb joint kinetics decreases at the end of the match. No change in timing of maximal angular velocities was observed between the beginning and the end of the match. A prolonged tennis match play may induce fatigue in upper limb muscles, which decrease performance and cause changes in serve maximal angular velocities and joint kinetics. The consistency in timing of maximal angular velocities suggests that advanced tennis players are able to maintain the temporal pattern of their serve technique, in spite of the muscular fatigue development.

  4. Modelling farm vulnerability to flooding: A step toward vulnerability mitigation policies appraisal

    NASA Astrophysics Data System (ADS)

    Brémond, P.; Abrami, G.; Blanc, C.; Grelot, F.

    2009-04-01

    Recent catastrophic flood events such as Elbe in 2002 or Rhône in 2003 have shown limits of flood management policies relying on dykes protection: worsening of flood impacts downstream, increased damage by dykes rupture. Those events, among others, contributes to radical changes on the philosophy of flood prevention, with the promotion of new orientations for mitigating flood exposition. Two new trends may have a significant impact on rural areas: floodplain restoration and vulnerability mitigation. The Rhône River program, which is an contract of objectives signed between French Government and local collectivites, is highly illustrative of these new trends and their impact on agricultural sector. In this program, it appears that areas to be concerned by floodplain restoration are agricultural ones, because their supposed vulnerability to flood is expected to be less important to urban areas. As a consequence, agricultural sector is particularly concerned by planned actions on mitigation of assets vulnerability, an important part of the program (financial support of European Union of 7.5 Million euros). Mitigation of agricultural assets vulnerability reveals particularly interesting for two following reasons. Firstly, it is a way to maintain agricultural activities in floodplains yet existing, without promoting flood protection. Secondly, in case of floodplain restoration, vulnerability mitigation is a way for local authorities to compensate over-flooding impacts. In practice, local authorities may financially support farmers for implementing measures to mitigate their farm vulnerability. On the Rhône River, an important work has already been done to identify farm vulnerability to flooding, and propose measures to mitigate it. More than 3 000 farms exposed to flood risk have been identified representing 88 690 ha of agricultural areas which is estimated to generate damage between 400 and 800 Million euros depending on the season of occurrence for a catastrophic

  5. The perils of protection: vulnerability and women in clinical research.

    PubMed

    Schonfeld, Toby

    2013-06-01

    Subpart B of 45 Code of Federal Regulations Part 46 (CFR) identifies the criteria according to which research involving pregnant women, human fetuses, and neonates can be conducted ethically in the United States. As such, pregnant women and fetuses fall into a category requiring "additional protections," often referred to as "vulnerable populations." The CFR does not define vulnerability, but merely gives examples of vulnerable groups by pointing to different categories of potential research subjects needing additional protections. In this paper, I assess critically the role of this categorization of pregnant women involved in research as "vulnerable," both as separate entities and in combination with the fetuses they carry. In particular, I do three things: (1) demonstrate that pregnant women qua pregnancy are either not "vulnerable" according to any meaningful definition of that term or that such vulnerability is irrelevant to her status as a research participant; (2) argue that while a fetus may be vulnerable in terms of dependency, this categorization does not equate to the vulnerability of the pregnant woman; and (3) suggest that any vulnerability that appends to women is precisely the result of federal regulations and dubious public perceptions about pregnant women. I conclude by demonstrating how this erroneous characterization of pregnant women as "vulnerable" and its associated protections have not only impeded vital research for pregnant women and their fetuses, but have also negatively affected the inclusion of all women in clinical research.

  6. A socioeconomic profile of vulnerable land to desertification in Italy.

    PubMed

    Salvati, Luca

    2014-01-01

    Climate changes, soil vulnerability, loss in biodiversity, and growing human pressure are threatening Mediterranean-type ecosystems which are increasingly considered as a desertification hotspot. In this region, land vulnerability to desertification strongly depends on the interplay between natural and anthropogenic factors. The present study proposes a multivariate exploratory analysis of the relationship between the spatial distribution of land vulnerability to desertification and the socioeconomic contexts found in three geographical divisions of Italy (north, center and south) based on statistical indicators. A total of 111 indicators describing different themes (demography, human settlements, labor market and human capital, rural development, income and wealth) were used to discriminate vulnerable from non-vulnerable areas. The resulting socioeconomic profile of vulnerable areas in northern and southern Italy diverged significantly, the importance of demographic and economic indicators being higher in southern Italy than in northern Italy. On the contrary, human settlement indicators were found more important to discriminate vulnerable and non-vulnerable areas in northern Italy, suggesting a role for peri-urbanization in shaping the future vulnerable areas. An in-depth knowledge of the socioeconomic characteristics of vulnerable land may contribute to scenarios' modeling and the development of more effective policies to combat desertification.

  7. Perspectives on plant vulnerabilities & other plant and containment improvements

    SciTech Connect

    LaChance, J.; Kolaczkowski, A.; Kahn, J.

    1996-01-01

    The primary goal of the Individual Plant Examination (IPE) Program was for licensees to identify plant-unique vulnerabilities and actions to address these vulnerabilities. A review of these vulnerabilities and plant improvements that were identified in the IPEs was performed as part of the IPE Insights Program sponsored by the U.S. Nuclear Regulatory Commission (NRC). The purpose of this effort was to characterize the identified vulnerabilities and the impact of suggested plant improvements. No specific definition for {open_quotes}vulnerability{close_quotes} was provided in NRC Generic Letter 88-20 or in the subsequent NRC IPE submittal guidance documented in NUREG-1335. Thus licensees were left to use their own definitions. Only 20% of the plants explicitly stated that they had vulnerabilities. However, most licensees identified other plant improvements to address issues not explicitly classified as vulnerabilities, but pertaining to areas in which overall plant safety could potentially be increased. The various definitions of {open_quotes}vulnerability{close_quotes} used by the licensees, explicitly identified vulnerabilities, proposed plant improvements to address these vulnerabilities, and other plant improvements are summarized and discussed.

  8. Perspectives on contextual vulnerability in discourses of climate conflict

    NASA Astrophysics Data System (ADS)

    Okpara, U. T.; Stringer, L. C.; Dougill, A. J.

    2015-12-01

    The science of climate security and conflict is replete with controversies. Yet the increasing vulnerability of politically fragile countries to the security consequences of climate change is widely acknowledged. Although climate conflict reflects a continuum of conditional forces that coalesce around the notion of vulnerability, how different portrayals of vulnerability influence the discursive formation of climate conflict relations remains an exceptional but under-researched issue. This paper combines a systematic discourse analysis with a vulnerability interpretation diagnostic tool to explore: (i) how discourses of climate conflict are constructed and represented, (ii) how vulnerability is communicated across discourse lines, and (iii) the strength of contextual vulnerability against a deterministic narrative of scarcity-induced conflict, such as that pertaining to land. Systematically characterising climate conflict discourses based on the central issues constructed, assumptions about mechanistic relationships, implicit normative judgements and vulnerability portrayals, provides a useful way of understanding where discourses differ. While discourses show a wide range of opinions "for" and "against" climate conflict relations, engagement with vulnerability has been less pronounced - except for the dominant context centrism discourse concerned about human security (particularly in Africa). In exploring this discourse, we observe an increasing sense of contextual vulnerability that is oriented towards a concern for complexity rather than predictability. The article concludes by illustrating that a turn towards contextual vulnerability thinking will help advance a constructivist theory-informed climate conflict scholarship that recognises historicity, specificity and variability as crucial elements of contextual totalities of any area affected by climate conflict.

  9. Perspectives on contextual vulnerability in discourses of climate conflict

    NASA Astrophysics Data System (ADS)

    Okpara, U. T.; Stringer, L. C.; Dougill, A. J.

    2016-02-01

    The science of climate security and conflict is replete with controversies. Yet the increasing vulnerability of politically fragile countries to the security consequences of climate change is widely acknowledged. Although climate conflict reflects a continuum of conditional forces that coalesce around the notion of vulnerability, how different portrayals of vulnerability influence the discursive formation of climate conflict relations remains an exceptional but under-researched issue. This paper combines a systematic discourse analysis with a vulnerability interpretation diagnostic tool to explore (i) how discourses of climate conflict are constructed and represented, (ii) how vulnerability is communicated across discourse lines, and (iii) the strength of contextual vulnerability against a deterministic narrative of scarcity-induced conflict, such as that pertaining to land. Systematically characterising climate conflict discourses based on the central issues constructed, assumptions about mechanistic relationships, implicit normative judgements and vulnerability portrayals, provides a useful way of understanding where discourses differ. While discourses show a wide range of opinions "for" and "against" climate conflict relations, engagement with vulnerability has been less pronounced - except for the dominant context centrism discourse concerned about human security (particularly in Africa). In exploring this discourse, we observe an increasing sense of contextual vulnerability that is oriented towards a concern for complexity rather than predictability. The article concludes by illustrating that a turn towards contextual vulnerability thinking will help advance a constructivist theory-informed climate conflict scholarship that recognises historicity, specificity, and variability as crucial elements of contextual totalities of any area affected by climate conflict.

  10. OutServe: an underground network stands up.

    PubMed

    Fulton, Brenda Sue

    2013-01-01

    From the perspective of an insider, this article explains how an underground network of actively-serving lesbian, gay, bisexual, and transgender (LGBT) military members was formed, and able to engage in the fight against the Don't Ask, Don't Tell policy. By providing the means to connect with one another within the constraints of the law, OutServe enabled the voices of gay and lesbian active military personnel to be heard. This new visibility informed the political debate surrounding the policy and played a role in the final days of Don't Ask, Don't Tell. PMID:23414270

  11. Framework for Vulnerability Assessment of Coastal Infrastructure

    NASA Astrophysics Data System (ADS)

    Obrien, P. S.; Moritz, H. R.; White, K. D.

    2015-12-01

    Coastal infrastructure can be highly vulnerable to changing climate, including increasing sea levels and altered frequency and intensity of coastal storms. Existing coastal infrastructure may be of a sufficient age that it is already experiencing noticeable impacts from global sea level rise, and require a variety of potential preparedness and resilience measures to adapt to changing climate. Methods to determine vulnerability to changing sea level and support planning of potential future adaptation measures are needed for application to projects having multiple purposes (e.g., navigation, coastal risk reduction). Here we describe a potential framework for assessing projects with several components typical of existing coastal infrastructure spanning a range of engineering disciplines (e.g., hydrology, geotechnical, structural, electrical, and mechanical). The US Army Corps of Engineers (USACE) Climate Preparedness and Resilience Register (CPRR) framework is currently under development. It takes a tiered approach as described in earlier USACE guidance (Engineer Technical Letter 1100-2-1) using the three scenarios prescribed by Engineer Regulation ER 1100-2-8162. Level 1 is a qualitative assessment defining the major sea level change-related impacts and ranks them in order of soonest occurrence. Level 2 is a quantitative evaluation that analyzes current and future performance of individual project components, including electrical, mechanical and structural components and functions using the sea level change scenarios prescribed by ER 1100-2-8162. Level 3 proposes adaptation measures per ETL 1100-2-1 and evaluates changes in sea level change-related impacts.

  12. Mapping of earthquakes vulnerability area in Papua

    NASA Astrophysics Data System (ADS)

    Muhammad Fawzy Ismullah, M.; Massinai, Muh. Altin

    2016-05-01

    Geohazard is a geological occurrence which may lead to a huge loss for human. A mitigation of these natural disasters is one important thing to be done properly in order to reduce the risks. One of the natural disasters that frequently occurs in the Papua Province is the earthquake. This study applies the principle of Geospatial and its application for mapping the earthquake-prone area in the Papua region. It uses earthquake data, which is recorded for 36 years (1973-2009), fault location map, and ground acceleration map of the area. The earthquakes and fault map are rearranged into an earthquake density map, as well as an earthquake depth density map and fault density map. The overlaid data of these three maps onto ground acceleration map are then (compiled) to obtain an earthquake unit map. Some districts area, such as Sarmi, Nabire, and Dogiyai, are identified by a high vulnerability index. In the other hand, Waropen, Puncak, Merauke, Asmat, Mappi, and Bouven Digoel area shows lower index. Finally, the vulnerability index in other places is detected as moderate.

  13. Market mechanisms protect the vulnerable brain

    PubMed Central

    Ramchandran, Kanchna; Nayakankuppam, Dhananjay; Berg, Joyce; Tranel, Daniel

    2011-01-01

    Markets are mechanisms of social exchange, intended to facilitate trading. However, the question remains as to whether markets would help or hurt individuals with decision-makings deficits, as is frequently encountered in the case of cognitive aging. Essential for predicting future gains and losses in monetary and social domains, the striatal nuclei in the brain undergo structural, neurochemical, and functional decline with age. We correlated the efficacy of market mechanisms with dorsal striatal decline in an aging population, by using market based trading in the context of the 2008 U.S Presidential Elections (primary cycle). Impaired decision-makers displayed higher prediction error (difference between their prediction and actual outcome). Lower in vivo caudate volume was also associated with higher prediction error. Importantly, market-based trading protected older adults with lower caudate volume to a greater extent from their own poorly calibrated predictions. Counterintuitive to the traditional public perception of the market as a fickle, risky proposition where vulnerable traders are most surely to be burned, we suggest that market-based mechanisms protect individuals with brain-based decision-making vulnerabilities. PMID:21600226

  14. Evaluating operating system vulnerability to memory errors.

    SciTech Connect

    Ferreira, Kurt Brian; Bridges, Patrick G.; Pedretti, Kevin Thomas Tauke; Mueller, Frank; Fiala, David; Brightwell, Ronald Brian

    2012-05-01

    Reliability is of great concern to the scalability of extreme-scale systems. Of particular concern are soft errors in main memory, which are a leading cause of failures on current systems and are predicted to be the leading cause on future systems. While great effort has gone into designing algorithms and applications that can continue to make progress in the presence of these errors without restarting, the most critical software running on a node, the operating system (OS), is currently left relatively unprotected. OS resiliency is of particular importance because, though this software typically represents a small footprint of a compute node's physical memory, recent studies show more memory errors in this region of memory than the remainder of the system. In this paper, we investigate the soft error vulnerability of two operating systems used in current and future high-performance computing systems: Kitten, the lightweight kernel developed at Sandia National Laboratories, and CLE, a high-performance Linux-based operating system developed by Cray. For each of these platforms, we outline major structures and subsystems that are vulnerable to soft errors and describe methods that could be used to reconstruct damaged state. Our results show the Kitten lightweight operating system may be an easier target to harden against memory errors due to its smaller memory footprint, largely deterministic state, and simpler system structure.

  15. Airport vulnerability assessment: an analytical approach

    NASA Astrophysics Data System (ADS)

    Lazarick, Richard T.

    1998-12-01

    The Airport Vulnerability Assessment Project (AVAP) is the direct result of congressional funding of recommendation 3.13 of the White House Commission on Aviation Safety and Security. This project takes a new approach to the assessment of U.S. commercial airports. AVAP uses automation, analytical methods and tools to evaluate vulnerability and risk, and to analyze cost/benefits in a more quantitative manner. This paper addresses both the process used to conduct this program, as well as a generalized look at the results, which have been achieved for the initial airport assessments. The process description covers the acquisition approach, the project structure, and a review of the various methodologies and tools being used by the sever performing organizations (Abacus Technology, Battelle, CTI, Lockwood Greene, Naval Facilities Engineering Service Center, SAIC, and Science & Engineering Associates). The tools described include ASSESS, SAM, RiskWatch, CASRAP, and AVAT. Included in the process is the utilization of an advisory panel made up predominantly of experts from the National Laboratories 9Sandia, Oak Ridge, Argonne and Brookhaven). The results portion addresses the findings and products resulting from the initial airport assessments. High level (unrestricted) summaries of the results are presented, along with initial trends in commonly recommended security improvements (countermeasures). Opportunities for the application of optics technology are identified.

  16. Reducing societal vulnerability to drought: A methodology

    SciTech Connect

    Wilhite, D.A.

    1995-12-31

    Given worldwide experience with drought during the past several decades and the magnitude of associated impacts, it is apparent that vulnerability to extended periods of water shortage is escalating. Developing a national or provincial drought policy and preparedness plan is a complicated but essential first step toward reducing societal vulnerability. Until recently, nations had devoted little effort to drought preparedness, preferring instead the reactive or crisis management approach. Presently, an increasing number of nations are pursuing a more proactive approach that emphasizes the principles of risk management and sustainable development. Because of the multitude of impacts associated with drought and the numerous governmental agencies that have responsibility for some aspect of monitoring, assessment, mitigation, and planning, developing a policy and plan must be an integrated process within and between levels of government. This paper outlines a generic process that can be adopted by governments that desire to develop a more comprehensive and long-term approach to drought management and planning. Countries and states or provincial authorities that have adopted this approach is presented as case studies. This process is timely, given the declaration of the 1990s as the International Decade for Natural Disaster Reduction and the recent International Convention to Combat Desertification and Drought (June, 1994), an offshoot of deliberations at the United Nations Conference on Environment and Development.

  17. A network approach to evaluate ecosystem vulnerability

    NASA Astrophysics Data System (ADS)

    Goodwell, Allison; Kumar, Praveen

    2016-04-01

    Ecohydrologic systems exhibit shifts in behavior due to natural or human induced perturbations or stresses. These shifts result from changes in dependencies between many interacting components. A framework that defines a system based on these shifting interactions is needed to holistically evaluate properties such as resilience, vulnerability, or health that cannot be reached through the isolated study of component behaviors. This study uses a network approach in which ecohydrologic time-series data are nodes, and information theoretic measures that capture various aspects of time dependencies are links. It has been shown that an information decomposition approach can be used to determine the relative redundant (shared by multiple source nodes to a target), synergistic (arising only from the knowledge of multiple source nodes), or unique (only provided by an individual source node) information within a given detected link. We construct networks from flux tower and ecohydrologic model output nodes and evaluate how these evolve in terms of connectivity, dominant time scales of interactions, link uniqueness, and link stability over time windows ranging from several hours to several weeks as ecosystems respond to shifting environmental conditions. We associate these network properties with simulated and observed vegetation responses, and show that a network framework can be used to detect critical interactions that dictate ecosystem vulnerabilities to extremes.

  18. The Role of Narcissistic Vulnerability in Predicting Adult Posttraumatic Symptoms from Childhood Sexual Abuse.

    PubMed

    Bachar, Eytan; Canetti, Laura; Hadar, Hilit; Baruch, Julia; Dor, Yehuda; Freedman, Sara

    2015-10-01

    The aim of the present study is to determine whether narcissistic vulnerability can aid in clarifying the debate regarding the relationship between childhood sexual abuse (CSA) and adulthood adjustment to traumatic events. 157 survivors (mean age = 31.1, SD = 10.9) of a traumatic event (war activities and road and work accidents) were assessed 1 week, 1, and 4 months following the event. Of the 157 participants, 15 reported experiencing CSA, and 26 reported experiencing childhood physical abuse (CPA). In the first-week assessment, patients were administered the Narcissistic Vulnerability Scale (NVS) and the Beck Depression Inventory (BDI). In the follow-up assessments, subjects were interviewed on the Clinician-Administered PTSD Scale. Narcissistic vulnerability was found, both in 1- and 4-month follow-ups, to increase the likelihood of participants who experienced CSA to develop PTSD symptoms later in their adult life, when exposed to other additional trauma. Narcissistic vulnerability, in both follow-ups, did not increase the likelihood of participants who experienced CPA to develop PTSD symptoms later in their life when exposed to other additional trauma. The NVS predicted the development of PTSD symptoms in the whole sample, both in the 1- and 4-month follow-ups, above and beyond the prediction of the BDI. In other words, narcissistic vulnerability can add additional information above and beyond general negative emotionality. In conclusion, it is recommended to take into consideration the interplay between CSA and the individual's narcissistic vulnerability when assessing the long term effects of CSA such as acute or chronic PTSD.

  19. The Role of Narcissistic Vulnerability in Predicting Adult Posttraumatic Symptoms from Childhood Sexual Abuse.

    PubMed

    Bachar, Eytan; Canetti, Laura; Hadar, Hilit; Baruch, Julia; Dor, Yehuda; Freedman, Sara

    2015-10-01

    The aim of the present study is to determine whether narcissistic vulnerability can aid in clarifying the debate regarding the relationship between childhood sexual abuse (CSA) and adulthood adjustment to traumatic events. 157 survivors (mean age = 31.1, SD = 10.9) of a traumatic event (war activities and road and work accidents) were assessed 1 week, 1, and 4 months following the event. Of the 157 participants, 15 reported experiencing CSA, and 26 reported experiencing childhood physical abuse (CPA). In the first-week assessment, patients were administered the Narcissistic Vulnerability Scale (NVS) and the Beck Depression Inventory (BDI). In the follow-up assessments, subjects were interviewed on the Clinician-Administered PTSD Scale. Narcissistic vulnerability was found, both in 1- and 4-month follow-ups, to increase the likelihood of participants who experienced CSA to develop PTSD symptoms later in their adult life, when exposed to other additional trauma. Narcissistic vulnerability, in both follow-ups, did not increase the likelihood of participants who experienced CPA to develop PTSD symptoms later in their life when exposed to other additional trauma. The NVS predicted the development of PTSD symptoms in the whole sample, both in the 1- and 4-month follow-ups, above and beyond the prediction of the BDI. In other words, narcissistic vulnerability can add additional information above and beyond general negative emotionality. In conclusion, it is recommended to take into consideration the interplay between CSA and the individual's narcissistic vulnerability when assessing the long term effects of CSA such as acute or chronic PTSD. PMID:25410429

  20. Vulnerability of housing buildings in Bucharest, Romania

    NASA Astrophysics Data System (ADS)

    Bostenaru, M.

    2009-04-01

    The author participates to the World Housing Encyclopedia project (www.world-housing.net), an internet based database of housing buildings in earthquake prone areas of the world. This is a voluntary project run by the Earthquake Engineering Research Institute, Oakland, California and the International Association of Earthquake Engineering, financial means being available only for the website where the information is shared. For broader dissemination in 2004 a summary publication of the reports to date was published. The database can be querried for various parameters and browsed after geographic distribution. Participation is open to any housing experts. Between 2003 and 2006 the author was also member of the editorial board. The author contributed numerous reports about building types in Romania, and each one about building types in Germany and Switzerland. This presentation will be about the contributed reports on building types in Romania. To the Encyclopedia eight reports on building types from Bucharest were contributed, while in further research of the author one more was similarly described regarding the vulnerability and the seismic retrofit. The selection of these types was done considering the historic development of the built substance in Bucharest from 1850 on, time from which a representative amount of housing buildings which can be classified in typologies can be found in Bucharest. While the structural types are not necessarily characteristic for the style, since the style has other time limits, often appearing before the type became common and then remaining being practiced also after another style gained ground, a historic succession can be seen also in this case. The nine types considered can be grouped in seven time categories: - the time 1850-1880, for a vernacular housing type with masonry load bearing walls and timber floors, - the time 1880-1920, for the type of two storey or multi-storey house with masonry walls and timber floors (in which

  1. Social vulnerability assessment: a growing practice in Europe?

    NASA Astrophysics Data System (ADS)

    Tapsell, S.; McC arthy, S.

    2012-04-01

    This paper builds upon work on social vulnerability from the CapHaz-Net consortium, an ongoing research project funded by the European Commission in its 7th Framework Programme. The project focuses on the social dimensions of natural hazards, as well as on regional practices of risk prevention and management, and aims at improving the resilience of European societies to natural hazards, paying particular attention to social capacity building. The topic of social vulnerability is one of seven themes being addressed in the project. There are various rationales for examining the relevance of social vulnerability to natural hazards. Vulnerability assessment has now been accepted as a requirement for the effective development of emergency management capability, and assessment of social vulnerability has been recognised as being integral to understanding the risk to natural hazards. The aim of our research was to examine social vulnerability, how it might be understood in the context of natural hazards in Europe, and how social vulnerability can be addressed to increase social capacity. The work comprised a review of research on social vulnerability to different natural hazards within Europe and included concepts and definitions of social vulnerability (and related concepts), the purpose of vulnerability assessment and who decides who is vulnerable, different approaches to assessing or measuring social vulnerability (such as the use of 'classical' quantitative vulnerability indicators and qualitative community-based approaches, along with the advantages and disadvantages of both), conceptual frameworks for assessing social vulnerability and three case studies of social vulnerability studies within Europe: flash floods in the Italian Alps, fluvial flooding in Germany and heat waves in Spain. The review reveals variable application of social vulnerability analysis across Europe and there are indications why this might be the case. Reasons could range from the scale of

  2. Social vulnerability indicators as a sustainable planning tool

    SciTech Connect

    Lee, Yung-Jaan

    2014-01-15

    In the face of global warming and environmental change, the conventional strategy of resource centralization will not be able to cope with a future of increasingly extreme climate events and related disasters. It may even contribute to inter-regional disparities as a result of these events. To promote sustainable development, this study offers a case study of developmental planning in Chiayi, Taiwan and a review of the relevant literature to propose a framework of social vulnerability indicators at the township level. The proposed framework can not only be used to measure the social vulnerability of individual townships in Chiayi, but also be used to capture the spatial developmental of Chiayi. Seventeen social vulnerability indicators provide information in five dimensions. Owing to limited access to relevant data, the values of only 13 indicators were calculated. By simply summarizing indicators without using weightings and by using zero-mean normalization to standardize the indicators, this study calculates social vulnerability scores for each township. To make social vulnerability indicators more useful, this study performs an overlay analysis of social vulnerability and patterns of risk associated with national disasters. The social vulnerability analysis draws on secondary data for 2012 from Taiwan's National Geographic Information System. The second layer of analysis consists of the flood potential ratings of the Taiwan Water Resources Agency as an index of biophysical vulnerability. The third layer consists of township-level administrative boundaries. Analytical results reveal that four out of the 18 townships in Chiayi not only are vulnerable to large-scale flooding during serious flood events, but also have the highest degree of social vulnerability. Administrative boundaries, on which social vulnerability is based, do not correspond precisely to “cross-administrative boundaries,” which are characteristics of the natural environment. This study adopts

  3. Susceptibility to mountain hazards in Austria - paradigms of vulnerability revisited

    NASA Astrophysics Data System (ADS)

    Fuchs, Sven

    2010-05-01

    The concept of vulnerability is pillared by multiple disciplinary theories underpinning either a technical or a social origin of the concept and resulting in a range of paradigms for either a qualitative or quantitative assessment of vulnerability. However, efforts to reduce susceptibility to hazards and to create disaster-resilient communities require intersections among these theories, since human activity cannot be seen independently from the environmental setting. Acknowledging different roots of disciplinary paradigms, issues determining structural, economic, institutional and social vulnerability are discussed with respect to mountain hazards in Austria. The underlying idea of taking such an integrative viewpoint was the cognition that human action in mountain environments affects the state of vulnerability, and the state of vulnerability in turn shapes the possibilities of human action. It is argued that structural vulnerability as originator results in considerable economic vulnerability, generated by the institutional settings of dealing with natural hazards and shaped by the overall societal framework. Hence, the vulnerability of a specific location and within a considered point of time is triggered by the hazardous event and the related physical susceptibility of structures, such as buildings located on a torrent fan. Depending on the specific institutional settings, economic vulnerability of individuals or of the society results, above all with respect to imperfect loss compensation mechanisms in the areas under investigation. While this potential for harm can be addressed as social vulnerability, the concept of institutional vulnerability has been developed with respect to the overall political settings of governmental risk management. As a result, the concept of vulnerability, as being used in natural sciences, can be extended by integration of possible reasons why such physical susceptibility of structures exists, and by integration of compensation

  4. Latinos' Economic Recovery: Postsecondary Participation and Hispanic-Serving Institutions

    ERIC Educational Resources Information Center

    Gastic, Billie; Nieto, David Gonzalez

    2010-01-01

    The majority of Latinos currently enrolled in colleges and universities attend Hispanic-serving Institutions (HSIs), or those institutions where Latino undergraduate full-time equivalent enrollment equals or exceeds 25% of the student population. While HSIs only make up 7% of colleges and universities in the U.S., they enroll more than half of all…

  5. Healthcare Leaders' Intention to Serve as Organizational Teachers

    ERIC Educational Resources Information Center

    Aggarwal, Sushma Kumari

    2014-01-01

    Today's organizational leaders are expected to actively participate and facilitate learning. A highly engaged and knowledgeable workforce, inspired by leaders, may increase the quality of service, and aid in maintaining and attracting loyal employees and customers. These leaders are now being asked to serve as organizational teachers. However,…

  6. Small Public Libraries Can Serve Big. ERIC Digest.

    ERIC Educational Resources Information Center

    Parry, Norm

    Small public libraries can deliver service like big libraries, without sacrificing hometown warmth and charm. By borrowing strategies used by successful small businesses in the private sector, defining goals and exploiting low cost technologies, small public libraries can serve customer wants as well as much larger institutions. Responding to just…

  7. Competence in Serving Children: Credentials Protectionism and Public Policy.

    ERIC Educational Resources Information Center

    Koocher, Gerald P.

    Professional competency in psychologists wishing to treat children and families is an area of considerable concern and disagreement. Three types of practitioners comprise the bulk of the problem: clinical psychologists, who lack specific child-oriented training; developmental psychologists, who wish to serve children but lack traditional clinical…

  8. Contextual Interference Effects in Learning Three Badminton Serves.

    ERIC Educational Resources Information Center

    Goode, Sinah; Magill, Richard A.

    1986-01-01

    This study was made to validate results obtained in laboratory research. Thirty female students learned three badminton serves in either a low, mixed, or high interference practice schedule and were given a retention and transfer test. Results are discussed. (Author/MT)

  9. International Organizations Serving Young Children: Part One of a Directory.

    ERIC Educational Resources Information Center

    Neugebauer, Roger

    2002-01-01

    This is part one of a directory of organizations serving children under the age of eight in more than one nation. Each entry consists of: (1) organization's name; (2) location; (3) Web site address; and (4) a description of the organization's structure, mission, and major areas of focus. (SD)

  10. Hispanic-Serving Institutions: Contributions and Challenges. Policy Brief

    ERIC Educational Resources Information Center

    Malcom-Piqueux, Lindsey E.; Lee, John Michael, Jr.

    2011-01-01

    This brief presents information about the characteristics of the nation's Hispanic-serving institutions (HSIs) and their students, as well as the HSIs' contributions to the educational attainment of the Latino population. The brief concludes by outlining some of the challenges faced by HSIs as they aim to meet their implied mission of serving…

  11. Pedagogy for Equity: Teaching in a Hispanic-Serving Institution

    ERIC Educational Resources Information Center

    Nunez, Anne-Marie; Ramalho, Elizabeth Murakami; Cuero, Kimberley K.

    2010-01-01

    Three female tenure-track faculty members at a Hispanic-Serving Institution explored how their cultural backgrounds inform their pedagogical approaches toward equity. They drew upon Mills's (1959) and Collins's (1993) frameworks to examine how their personal biographies, local social contexts, and broader systemic institutions affect their…

  12. 34 CFR 686.42 - Discharge of agreement to serve.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 4 2011-07-01 2011-07-01 false Discharge of agreement to serve. 686.42 Section 686.42 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION (CONTINUED) TEACHER EDUCATION ASSISTANCE FOR COLLEGE AND HIGHER EDUCATION (TEACH) GRANT PROGRAM Service...

  13. 36 CFR 703.22 - Where to serve demands.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false Where to serve demands. 703.22 Section 703.22 Parks, Forests, and Public Property LIBRARY OF CONGRESS DISCLOSURE OR PRODUCTION OF RECORDS OR INFORMATION Testimony by Employees and Production of Documents in Certain Legal Proceedings Where the Library Is Not a Party §...

  14. The large building to the left formerly served as open ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    The large building to the left formerly served as open hearth no. 3 steel making facility; it was erected in 1903; looking east - Bethlehem Steel Corporation, South Bethlehem Works, Open Hearth No. 3, Along Lehigh River, North of Fourth Street, West of Minsi Trail Bridge, Bethlehem, Northampton County, PA

  15. Educators as Serving Leaders in the Classroom and on Campus

    ERIC Educational Resources Information Center

    Bowman, Richard

    2014-01-01

    Counterintuitively, the more one develops as a leader, the less of a leader one becomes. What do great leaders do? Great leaders are ambitious first and foremost for the cause, the mission, the work--not themselves. Educators as "serving leaders" sense that every action they take, together with every decision that they make, either…

  16. DIRECTORY OF PUBLIC TRAINING SCHOOLS SERVING DELINQUENT CHILDREN.

    ERIC Educational Resources Information Center

    CARPENTER, KENNETH S., COMP.

    THIS EIGHTH REVISION OF THE DIRECTORY LISTS 320 STATE AND LOCAL TRAINING SCHOOLS, CAMPS, AND RECEPTION-DIAGNOSTIC CENTERS SERVING DELINQUENT CHILDREN COMMITTED BY COURT ORDER IN THE 50 STATES, THE U.S. DEPARTMENT OF JUSTICE, THE DISTRICT OF COLUMBIA, PUERTO RICO, AND THE VIRGIN ISLANDS. DATA INCLUDE RATED CAPACITIES, AVERAGE DAILY POPULATIONS,…

  17. 77 FR 58299 - National Hispanic-Serving Institutions Week, 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-19

    ... Sig.) [FR Doc. 2012-23302 Filed 9-18-12; 11:15 am] Billing code 3295-F2-P ... Documents#0;#0; ] Proclamation 8866 of September 14, 2012 National Hispanic-Serving Institutions Week, 2012... many Hispanic students and their families, and this week, we celebrate the critical role these...

  18. Kinematic analysis of the wheelchair tennis serve: Implications for classification.

    PubMed

    Cavedon, V; Zancanaro, C; Milanese, C

    2014-10-01

    The aim of the present study was to assess the validity of the classification system used in Open-class wheelchair tennis by investigating the relationship between post-impact ball velocity in the serve (measured using a sports radar gun) and the severity of impairment. Shoulder and wrist angles at the instant of ball impact were also estimated from 2D motion analysis. Forty-three nationally ranked Italian Open-class wheelchair tennis players were assigned to four groups (A–D) according to descending level of activity limitation. Ten successful flat serves (WFSs) and 10 successful kick serves (WKSs) for each player were recorded. One-way ANOVA showed that the severity of impairment significantly (P < 0.05) affected post-impact ball velocity and shoulder angle at the instant of ball impact. Furthermore, the mean value of post-impact ball velocity in WFS increased from group A to group D, i.e., with descending level of activity limitation. The results of this cross-sectional study indicate that the severity of impairment per se is associated with velocity of the wheelchair tennis serve, suggesting that the current classification is flawed in that it overlooks the impact of severity of impairment on players' performance. PMID:25371933

  19. Collaborative Project on Serving Linguistically Diverse Seniors. Final Report.

    ERIC Educational Resources Information Center

    Burt, Miriam

    In 2002, the Center for Applied Linguistics (CAL) collaborated with the Senior Service Association (SSA) and the American Society on Aging (ASA) on a two-phase project to improve the effectiveness of ASA's sub-grantees in serving linguistically and culturally diverse populations. SSA provides subsidized employment for low-income seniors and funds…

  20. Using Title XX to Serve Children and Youth.

    ERIC Educational Resources Information Center

    Twiname, John D.; And Others

    With the passage in early 1975 of the social service amendments to the Social Security Act, referred to as Title XX, a major new opportunity to serve children and youth has emerged. Seizing the opportunity will be largely dependent on the well-prepared presentation of a case for the needs of young people by dedicated advocates in every state.…

  1. 31. Tower interior, second story level, which served as tiny ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    31. Tower interior, second story level, which served as tiny bedroom for station operator; frame visible at far left originally housed cooler vented to exterior via louvers placed in window fenestration; view to northeast, 65mm lens with electronic flash illumination. - Southern Pacific Depot, 559 El Camino Real, San Carlos, San Mateo County, CA

  2. 16 CFR 500.26 - Representations of servings, uses, applications.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... CFR part 10, by the Department of Commerce, quantitatively defining the meaning of the terms serving... required statement of net contents (e.g., cupsful, tablespoonful, etc.), when such differing terms describe... the National Institute of Standards and Technology, Department of Commerce, Washington, DC 20899.)...

  3. Serving Wounded Warriors: Current Practices in Postsecondary Education

    ERIC Educational Resources Information Center

    Vance, Mary Lee; Miller, Wayne K., II

    2009-01-01

    From September to October 2009 the Association on Higher Education and Disabilities (AHEAD) invited anonymous voluntary responses from 2,500 members and affiliates to complete a 29-question online survey on current practices in postsecondary education for serving veterans with disabilities (wounded warriors). Two hundred and thirty seven complete…

  4. Meal Pattern Requirements and Offer versus Serve Manual.

    ERIC Educational Resources Information Center

    Food and Nutrition Service (USDA), Washington, DC.

    This manual contains information on federal policy regarding meal-pattern requirements for school-nutrition programs. It also describes the Offer Versus Serve (OVS) provision, which allows students to decline either one or two food items they do not intend to eat in order to reduce food waste. The manual explains food components, gives examples of…

  5. Charter Schools: Whom Do They Serve, and How Well?

    ERIC Educational Resources Information Center

    Perkins-Gough, Deborah

    1997-01-01

    To help educators assess charter schools' effects on education, this article summarizes information from two studies: the U.S. Department of Education's ongoing National Study of Charter Schools and the Hudson Institute's 1996-97 Charter Schools in Action Project. Charter schools are growing in number, serving diverse student populations, and…

  6. Handbook on Serving Private School Children with Federal Education Programs.

    ERIC Educational Resources Information Center

    Office of Private Education (ED), Washington, DC.

    This handbook provides general information about participation of private school students in federal education programs and an overview of each federal education program in which those students and their teachers can participate. The handbook includes most of the programs that serve private school students and teachers and summarizes relevant case…

  7. How Much Is 1 Serving? | Smokefree.gov

    Cancer.gov

    Feeling like following the recommendations for healthy eating will have you tackling a mountain of broccoli? Not sure what “1 cup” of cereal looks like (and measuring your cereal every morning won’t fit into your routine)? Heard the news that over-sized bagels pack a mean punch with calories? Here are some general guidelines for what 1 serving looks like:

  8. Serving and Retraining Displaced Workers in California Community Colleges.

    ERIC Educational Resources Information Center

    Thor, Linda

    In spite of funding constraints and legislatively mandated growth caps, the California community colleges, as the major provider of occupational education in the state, must play a significant role in serving and retraining workers displaced by plant shutdowns and mass layoffs. In response to these problems, a study was conducted to identify the…

  9. 34 CFR 686.12 - Agreement to serve.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 CFR part 685. (Authority: 20 U.S.C. 1070g, et seq.) ..., DEPARTMENT OF EDUCATION TEACHER EDUCATION ASSISTANCE FOR COLLEGE AND HIGHER EDUCATION (TEACH) GRANT PROGRAM... teaching service by— (1) Serving as a full-time teacher for a total of not less than four elementary...

  10. A Community College Program Serving Female Displaced Workers.

    ERIC Educational Resources Information Center

    Sherman, Ruth

    1989-01-01

    Discusses the Bunker Hill Community College program designed to draw on the experience of female dislocated workers. Discusses the types of women this program serves. Provides an example of each type of woman. Discusses the enormous employment problems of dislocated female workers and how education might help them overcome these difficulties. (JS)

  11. The Cost of Serving Infants and Toddlers under Part C

    ERIC Educational Resources Information Center

    Johnson, Jean L.; Brown, Susan; Chang, Chuan; Nelson, Dawna; Mrazek, Susan

    2011-01-01

    To identify the per-child cost of providing Part C services, the authors analyzed extensive statewide expenditure data in Hawai'i to determine the monthly and annual costs of providing early intervention services to infants and toddlers and their families. Identified were the costs of serving children with various numbers and percentages of delay,…

  12. 34 CFR 686.12 - Agreement to serve.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... serve provided by the Secretary and receives counseling in accordance with § 686.32. (b) Contents of the... enrolled in the program for which the recipient received the TEACH Grant— (i) In a low-income school; (ii... the school; and (3) Complying with the terms, conditions, and other requirements consistent...

  13. Caregivers' attitudes regarding portion size served to Head Start children

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The purpose of this study was to identify caregivers' attitudes regarding amounts and types of foods served to Head Start preschoolers using qualitative methods. Researchers conducted 8 focus groups (4 African American; 4 Hispanic) with 33 African American and 29 Hispanic Head Start caregivers. Mode...

  14. On the losses of dissolved CO(2) during champagne serving.

    PubMed

    Liger-Belair, Gérard; Bourget, Marielle; Villaume, Sandra; Jeandet, Philippe; Pron, Hervé; Polidori, Guillaume

    2010-08-11

    Pouring champagne into a glass is far from being consequenceless with regard to its dissolved CO(2) concentration. Measurements of losses of dissolved CO(2) during champagne serving were done from a bottled Champagne wine initially holding 11.4 +/- 0.1 g L(-1) of dissolved CO(2). Measurements were done at three champagne temperatures (i.e., 4, 12, and 18 degrees C) and for two different ways of serving (i.e., a champagne-like and a beer-like way of serving). The beer-like way of serving champagne was found to impact its concentration of dissolved CO(2) significantly less. Moreover, the higher the champagne temperature is, the higher its loss of dissolved CO(2) during the pouring process, which finally constitutes the first analytical proof that low temperatures prolong the drink's chill and helps it to retain its effervescence during the pouring process. The diffusion coefficient of CO(2) molecules in champagne and champagne viscosity (both strongly temperature-dependent) are suspected to be the two main parameters responsible for such differences. Besides, a recently developed dynamic-tracking technique using IR thermography was also used in order to visualize the cloud of gaseous CO(2) which flows down from champagne during the pouring process, thus visually confirming the strong influence of champagne temperature on its loss of dissolved CO(2).

  15. 16 CFR 500.26 - Representations of servings, uses, applications.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Representations of servings, uses, applications. 500.26 Section 500.26 Commercial Practices FEDERAL TRADE COMMISSION RULES, REGULATIONS, STATEMENT OF GENERAL POLICY OR INTERPRETATION AND EXEMPTIONS UNDER THE FAIR PACKAGING AND LABELING ACT REGULATIONS UNDER SECTION 4 OF THE FAIR PACKAGING...

  16. 16 CFR 500.26 - Representations of servings, uses, applications.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Representations of servings, uses, applications. 500.26 Section 500.26 Commercial Practices FEDERAL TRADE COMMISSION RULES, REGULATIONS, STATEMENT OF GENERAL POLICY OR INTERPRETATION AND EXEMPTIONS UNDER THE FAIR PACKAGING AND LABELING ACT REGULATIONS UNDER SECTION 4 OF THE FAIR PACKAGING...

  17. Using Offer versus Serve in the School Meals Initiative.

    ERIC Educational Resources Information Center

    Holliday, RoseAnna

    The goal of the Offer Versus Serve (OVS) option in the Healthy School Meals Initiative is to minimize plate waste and to encourage more food choices in school meal programs. This manual was designed for child nutrition programs as a tool in helping them meet the Healthy School Meals Initiative, in particular to assist them in identifying a…

  18. 20 CFR 639.8 - How is the notice served?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false How is the notice served? 639.8 Section 639.8 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR WORKER ADJUSTMENT AND... case of notification directly to affected employees, insertion of notice into pay envelopes is...

  19. Hispanic-Serving Institutions and the Struggle for Cognitive Justice

    ERIC Educational Resources Information Center

    Garcia, Herman S.

    2012-01-01

    Hispanic-Serving Institution (HSI) colleges and universities were initiated as an enterprise for investing in the academy as a way to provide opportunities for Latin@ students. However, HSIs in colleges and universities have had measured success in that significant numbers of Latin@ students continue to leave campuses with unfinished business. An…

  20. Staff Development While You Teach: Collaborating to Serve English Learners

    ERIC Educational Resources Information Center

    Walker, Constance; Edstam, Tina Scott

    2013-01-01

    This article examines the nature of a sustained staff development program for teachers serving English learners in elementary schools. It begins by exploring the need for learners to have optimum language and content development, and indicates that many U.S. grade-level and content area teachers have not been prepared to meet that need. Focusing…