Neonatal Nurses Experience Unintended Consequences and Risks to Patient Safety With Electronic Health Records.

PubMed

Dudding, Katherine M; Gephart, Sheila M; Carrington, Jane M

2018-04-01

In this article, we examine the unintended consequences of nurses' use of electronic health records. We define these as unforeseen events, change in workflow, or an unanticipated result of implementation and use of electronic health records. Unintended consequences experienced by nurses while using electronic health records have been well researched. However, few studies have focused on neonatal nurses, and it is unclear to what extent unintended consequences threaten patient safety. A new instrument called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire has been validated, and secondary analysis using the tool explored the phenomena among neonatal nurses (N = 40). The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record, changes to the workflow, and altered communication patterns. Neonatal nurses used workarounds most often with motivation to better assist patients. Teamwork was moderately related to higher unintended consequences including patient safety risks (r = 0.427, P = .007), system design (r = 0.419, P = .009), and technology barriers (r = 0.431, P = .007). Communication about patients was reduced when patient safety risks were high (r = -0.437, P = .003). By determining the frequency with which neonatal nurses experience unintended consequences of electronic health record use, future research can be targeted to improve electronic health record design through customization, integration, and refinement to support patient safety and better outcomes.

Unintended consequences of machine learning in medicine?

PubMed

McDonald, Laura; Ramagopalan, Sreeram V; Cox, Andrew P; Oguz, Mustafa

2017-01-01

Machine learning (ML) has the potential to significantly aid medical practice. However, a recent article highlighted some negative consequences that may arise from using ML decision support in medicine. We argue here that whilst the concerns raised by the authors may be appropriate, they are not specific to ML, and thus the article may lead to an adverse perception about this technique in particular. Whilst ML is not without its limitations like any methodology, a balanced view is needed in order to not hamper its use in potentially enabling better patient care.

Prevalence and predictors of unintended pregnancy among women: an analysis of the Canadian Maternity Experiences Survey.

PubMed

Oulman, Elizaveta; Kim, Theresa H M; Yunis, Khalid; Tamim, Hala

2015-10-13

Unintended pregnancies (mistimed or unwanted during the time of conception) can result in adverse outcomes both to the mother and to her newborn. Further research on identifying the characteristics of unintended pregnant women who are at risk is warranted. The present study aims to examine the prevalence and predictors of unintended pregnancy among Canadian women. The analysis was based on the 2006 Maternity Experiences Survey targeting women who were at least 15 years of age and who had a singleton live birth, between February 15, 2006 to May 15, 2006 in the Canadian provinces and November 1, 2005 to February 1, 2006 for women in the Canadian territories. The primary outcome was the mother's pregnancy intention, where unintended pregnancy was defined as women who wanted to become pregnant later or not at all. Sociodemographic, maternal and pregnancy related variables were considered for a multivariable logistic regression. Adjusted Odds Ratios (OR) and 95% Confidence Intervals (95% CI) were reported. Overall, the prevalence of unintended pregnancy among Canadian women was 27%. The odds of experiencing an unintended pregnancy were statistically significantly increased if the mother was: under 20 years of age, immigrated to Canada, had an equivalent of a high school education or less, no partner, experienced violence or abuse and had 1 or more previous pregnancies. Additionally, mothers who reported smoking, drinking alcohol and using drugs prior to becoming pregnant, were all associated with an increased likelihood of experiencing an unintended pregnancy. The study findings constitute the basis for future research into these associations to aid in developing effective policy changes and interventions to minimize the odds of experiencing an unintended pregnancy and its associated consequences.

Digital Disturbances, Disorders, and Pathologies: A Discussion of Some Unintended Consequences of Technology in Higher Education

ERIC Educational Resources Information Center

Haughton, Noela A.; Yeh, Kuo-Chuan; Nworie, John; Romero, Liz

2013-01-01

As with any innovation, the adoption and diffusion of digital technologies in higher education have also brought unintended consequences. This article discusses the unintended misuse of these technologies in the higher education setting. Depending upon severity, these consequences discussed--distraction, addiction, academic dishonesty, and…

Pharmaceutical reform in South Korea and the lessons it provides.

PubMed

Kim, Hak-Ju; Ruger, Jennifer Prah

2008-01-01

Through implementation of its 2000 pharmaceutical reform, the South Korean government expected to reduce the cost of medications and improve service levels, medical appropriateness of care, and drug effectiveness. However, despite the reform's lofty goals, unintended consequences have distorted the supply of medical services and spending. These consequences have included increasing the use of uninsured services, prescribing high-price drugs, and a growing market share for multinational drug companies. Further reforms are needed to reduce the measure's adverse effects. This paper examines the Korean mandatory prescription system and offers an analysis of Korea's reforms.

British Military Mission (BMM) to Greece, 1942-44

DTIC Science & Technology

2009-05-21

Terrorism. Failure to take into account and accurately assess political and military actions in such environments can lead to unintended consequences ...such environments can lead to unintended consequences (potential civil war) affecting the stability of a country. Accurate assessment of the political...take into account and accurately assess political and military actions in such environments can lead to unintended consequences (potential civil war

An unintended consequence of electronic prescriptions: prevalence and impact of internal discrepancies

PubMed Central

Palchuk, Matvey B; Fang, Elizabeth A; Cygielnik, Janet M; Labreche, Matthew; Shubina, Maria; Ramelson, Harley Z; Hamann, Claus; Broverman, Carol; Einbinder, Jonathan S

2010-01-01

Many e-prescribing systems allow for both structured and free-text fields in prescriptions, making possible internal discrepancies. This study reviewed 2914 electronic prescriptions that contained free-text fields. Internal discrepancies were found in 16.1% of the prescriptions. Most (83.8%) of the discrepancies could potentially lead to adverse events and many (16.8%) to severe adverse events, involving a hospital admission or death. Discrepancies in doses, routes or complex regimens were most likely to have a potential for a severe event (p=0.0001). Discrepancies between structured and free-text fields in electronic prescriptions are common and can cause patient harm. Improvements in electronic medical record design are necessary to minimize the risk of discrepancies and resulting adverse events. PMID:20595316

The Unintended Consequences of Health Information Technology Revisited.

PubMed

Coiera, E; Ash, J; Berg, M

2016-11-10

The introduction of health information technology into clinical settings is associated with unintended negative consequences, some with the potential to lead to error and patient harm. As adoption rates soar, the impact of these hazards will increase. Over the last decade, unintended consequences have received great attention in the medical informatics literature, and this paper seeks to identify the major themes that have emerged. Rich typologies of the causes of unintended consequences have been developed, along with a number of explanatory frameworks based on socio-technical systems theory. We however still have only limited data on the frequency and impact of these events, as most studies rely on data sets from incident reporting or patient chart reviews, rather than undertaking detailed observational studies. Such data are increasingly needed as more organizations implement health information technologies. When outcome studies have been done in different organizations, they reveal different outcomes for identical systems. From a theoretical perspective, recent advances in the emerging discipline of implementation science have much to offer in explaining the origin, and variability, of unintended consequences. The dynamic nature of health care service organizations, and the rapid development and adoption of health information technologies means that unintended consequences are unlikely to disappear, and we therefore must commit to developing robust systems to detect and manage them.

Unintended Consequences in Cancer Care Delivery Created by the Medicare Part B Proposal: Is the Clinical Rationale for the Experiment Flawed?

PubMed

Gordan, Lucio; Grogg, Amy; Blazer, Marlo; Fortner, Barry

2017-02-01

Medicare currently enrolls ≥ 45 million adults, and by 2030 this is projected to increase to ≥ 80 million beneficiaries. With this growth, the Centers for Medicare & Medicaid Services (CMS) issued a proposal, the Medicare Part B Drug Payment Model, to shrink drug expenditures, a major contributor to overall health care costs. For this to not adversely affect patient outcomes, lower-cost alternative medications with equivalent efficacy and no increased toxicity must be available. This is often not true in the treatment of cancer. Herein, we examine the flaws in the rationale of the CMS and the potential unintended consequences of this experiment. We identified the top three oncology expenditures (rituximab, bevacizumab, and trastuzumab) and their vetted alternatives (per the National Comprehensive Cancer Network guidelines) to ascertain whether lower-cost equivalent alternatives are available. Drug cost was based on April 2016 average sale price. We explored both efficacy of the agents and, when applicable, toxicity to compare alternatives to these high-dollar medications. For the largest Medicare oncology drug expenditures, there is not a lower-cost option with equal efficacy for their primary indications. Without lower-cost alternatives, the unintended consequence of this CMS experiment may include curtailing access to care or an increase in patient/program costs. The CMS proposal, by simply lowering reimbursement for drugs, does not acknowledge the value of these agents and could unintentionally reduce quality of care. Alternative approaches to value-based care, such as the Oncology Care Model and similar frameworks, should be explored.

Attending unintended transformations of health care infrastructure

PubMed Central

Wentzer, Helle; Bygholm, Ann

2007-01-01

Introduction Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices. Results This paper develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT. Conclusion and discussion The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into health care practices and outcomes. PMID:18043725

Unintended consequences of information technologies in health care--an interactive sociotechnical analysis.

PubMed

Harrison, Michael I; Koppel, Ross; Bar-Lev, Shirly

2007-01-01

Many unintended and undesired consequences of Healthcare Information Technologies (HIT) flow from interactions between the HIT and the healthcare organization's sociotechnical system-its workflows, culture, social interactions, and technologies. This paper develops and illustrates a conceptual model of these processes that we call Interactive Sociotechnical Analysis (ISTA). ISTA captures common types of interaction with special emphasis on recursive processes, i.e., feedback loops that alter the newly introduced HIT and promote second-level changes in the social system. ISTA draws on prior studies of unintended consequences, along with research in sociotechnical systems, ergonomics, social informatics, technology-in-practice, and social construction of technology. We present five types of sociotechnical interaction and illustrate each with cases from published research. The ISTA model should further research on emergent and recursive processes in HIT implementation and their unintended consequences. Familiarity with the model can also foster practitioners' awareness of unanticipated consequences that only become evident during HIT implementation.

Identifying unintended consequences of quality indicators: a qualitative study.

PubMed

Lester, Helen E; Hannon, Kerin L; Campbell, Stephen M

2011-12-01

For the first 5 years of the UK primary care pay for performance scheme, the Quality and Outcomes Framework (QOF), quality indicators were introduced without piloting. However, in 2009, potential new indicators were piloted in a nationally representative sample of practices. This paper describes an in-depth exploration of family physician, nurse and other primary-care practice staff views of the value of piloting with a particular focus on unintended consequences of 13 potential new QOF indicators. Fifty-seven family-practice professionals were interviewed in 24 representative practices across England. Almost all interviewees emphasised the value of piloting in terms of an opportunity to identify unintended consequences of potential QOF indicators in 'real world' settings with staff who deliver day-to-day care to patients. Four particular types of unintended consequences were identified: measure fixation, tunnel vision, misinterpretation and potential gaming. 'Measure fixation,' an inappropriate attention on isolated aspects of care, appeared to be the key unintended consequence. In particular, if the palliative care indicator had been introduced without piloting, this might have incentivised poorer care in a minority of practices with potential harm to vulnerable patients. It is important to identify concerns and experiences about unintended consequences of indicators at an early stage when there is time to remove or adapt problem indicators. Since the UK government currently spends over £1 billion each year on QOF, the £150,000 spent on each piloting cohort (0.0005% of the total QOF budget) appears to be good value for money.

Systematic review of methods used in meta-analyses where a primary outcome is an adverse or unintended event

PubMed Central

2012-01-01

Background Adverse consequences of medical interventions are a source of concern, but clinical trials may lack power to detect elevated rates of such events, while observational studies have inherent limitations. Meta-analysis allows the combination of individual studies, which can increase power and provide stronger evidence relating to adverse events. However, meta-analysis of adverse events has associated methodological challenges. The aim of this study was to systematically identify and review the methodology used in meta-analyses where a primary outcome is an adverse or unintended event, following a therapeutic intervention. Methods Using a collection of reviews identified previously, 166 references including a meta-analysis were selected for review. At least one of the primary outcomes in each review was an adverse or unintended event. The nature of the intervention, source of funding, number of individual meta-analyses performed, number of primary studies included in the review, and use of meta-analytic methods were all recorded. Specific areas of interest relating to the methods used included the choice of outcome metric, methods of dealing with sparse events, heterogeneity, publication bias and use of individual patient data. Results The 166 included reviews were published between 1994 and 2006. Interventions included drugs and surgery among other interventions. Many of the references being reviewed included multiple meta-analyses with 44.6% (74/166) including more than ten. Randomised trials only were included in 42.2% of meta-analyses (70/166), observational studies only in 33.7% (56/166) and a mix of observational studies and trials in 15.7% (26/166). Sparse data, in the form of zero events in one or both arms where the outcome was a count of events, was found in 64 reviews of two-arm studies, of which 41 (64.1%) had zero events in both arms. Conclusions Meta-analyses of adverse events data are common and useful in terms of increasing the power to detect an association with an intervention, especially when the events are infrequent. However, with regard to existing meta-analyses, a wide variety of different methods have been employed, often with no evident rationale for using a particular approach. More specifically, the approach to dealing with zero events varies, and guidelines on this issue would be desirable. PMID:22553987

New Unintended Adverse Consequences of Electronic Health Records

PubMed Central

Wright, A.; Ash, J.; Singh, H.

2016-01-01

Summary Although the health information technology industry has made considerable progress in the design, development, implementation, and use of electronic health records (EHRs), the lofty expectations of the early pioneers have not been met. In 2006, the Provider Order Entry Team at Oregon Health & Science University described a set of unintended adverse consequences (UACs), or unpredictable, emergent problems associated with computer-based provider order entry implementation, use, and maintenance. Many of these originally identified UACs have not been completely addressed or alleviated, some have evolved over time, and some new ones have emerged as EHRs became more widely available. The rapid increase in the adoption of EHRs, coupled with the changes in the types and attitudes of clinical users, has led to several new UACs, specifically: complete clinical information unavailable at the point of care; lack of innovations to improve system usability leading to frustrating user experiences; inadvertent disclosure of large amounts of patient-specific information; increased focus on computer-based quality measurement negatively affecting clinical workflows and patient-provider interactions; information overload from marginally useful computer-generated data; and a decline in the development and use of internally-developed EHRs. While each of these new UACs poses significant challenges to EHR developers and users alike, they also offer many opportunities. The challenge for clinical informatics researchers is to continue to refine our current systems while exploring new methods of overcoming these challenges and developing innovations to improve EHR interoperability, usability, security, functionality, clinical quality measurement, and information summarization and display. PMID:27830226

The Consequences of Unintended Childbearing: A White Paper

ERIC Educational Resources Information Center

Logan, Cassandra; Holcombe, Emily; Manlove, Jennifer; Ryan, Suzanne

2007-01-01

This report provides a critical review of the current research literature on the consequences of unintended childbearing for families and children. The review addresses the following potential consequences: prenatal and perinatal risks (e.g., inadequate or delayed initiation of prenatal care, smoking/drinking/substance use during pregnancy,…

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

ERIC Educational Resources Information Center

Johnston-Goodstar, Katie; Velure Roholt, Ross

2013-01-01

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

Improving Evaluation to Address the Unintended Consequences of Health Information Technology:. a Position Paper from the Working Group on Technology Assessment & Quality Development.

PubMed

Magrabi, F; Ammenwerth, E; Hyppönen, H; de Keizer, N; Nykänen, P; Rigby, M; Scott, P; Talmon, J; Georgiou, A

2016-11-10

With growing use of IT by healthcare professionals and patients, the opportunity for any unintended effects of technology to disrupt care health processes and outcomes is intensified. The objectives of this position paper by the IMIA Working Group (WG) on Technology Assessment and Quality Development are to highlight how our ongoing initiatives to enhance evaluation are also addressing the unintended consequences of health IT. Review of WG initiatives Results: We argue that an evidence-based approach underpinned by rigorous evaluation is fundamental to the safe and effective use of IT, and for detecting and addressing its unintended consequences in a timely manner. We provide an overview of our ongoing initiatives to strengthen study design, execution and reporting by using evaluation frameworks and guidelines which can enable better characterization and monitoring of unintended consequences, including the Good Evaluation Practice Guideline in Health Informatics (GEP-HI) and the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI). Indicators to benchmark the adoption and impact of IT can similarly be used to monitor unintended effects on healthcare structures, processes and outcome. We have also developed EvalDB, a web-based database of evaluation studies to promulgate evidence about unintended effects and are developing the content for courses to improve training in health IT evaluation. Evaluation is an essential ingredient for the effective use of IT to improve healthcare quality and patient safety. WG resources and skills development initiatives can facilitate a proactive and evidence-based approach to detecting and addressing the unintended effects of health IT.

Improving Evaluation to Address the Unintended Consequences of Health Information Technology:

PubMed Central

Ammenwerth, E.; Hyppönen, H.; de Keizer, N.; Nykänen, P.; Rigby, M.; Scott, P.; Talmon, J.; Georgiou, A.

2016-01-01

Summary Background and objectives With growing use of IT by healthcare professionals and patients, the opportunity for any unintended effects of technology to disrupt care health processes and outcomes is intensified. The objectives of this position paper by the IMIA Working Group (WG) on Technology Assessment and Quality Development are to highlight how our ongoing initiatives to enhance evaluation are also addressing the unintended consequences of health IT. Methods Review of WG initiatives Results We argue that an evidence-based approach underpinned by rigorous evaluation is fundamental to the safe and effective use of IT, and for detecting and addressing its unintended consequences in a timely manner. We provide an overview of our ongoing initiatives to strengthen study design, execution and reporting by using evaluation frameworks and guidelines which can enable better characterization and monitoring of unintended consequences, including the Good Evaluation Practice Guideline in Health Informatics (GEP-HI) and the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI). Indicators to benchmark the adoption and impact of IT can similarly be used to monitor unintended effects on healthcare structures, processes and outcome. We have also developed EvalDB, a web-based database of evaluation studies to promulgate evidence about unintended effects and are developing the content for courses to improve training in health IT evaluation. Conclusion Evaluation is an essential ingredient for the effective use of IT to improve healthcare quality and patient safety. WG resources and skills development initiatives can facilitate a proactive and evidence-based approach to detecting and addressing the unintended effects of health IT. PMID:27830232

More Is Not Always Better: Intuitions About Effective Public Policy Can Lead to Unintended Consequences

PubMed Central

Peters, Ellen; Klein, William; Kaufman, Annette; Meilleur, Louise; Dixon, Anna

2013-01-01

Public policy decisions often appear based on an assumption that providing more options, more information, and greater decision-making autonomy to consumers will produce better outcomes. We examine reasons why this “more-is-better” approach exists based on the psychological literature. Although better outcomes can result from informed consumer choice, we argue that more options, information, and autonomy can also lead to unintended negative consequences. We use mostly health-related policies and guidelines from the United States and elsewhere as exemplars. We consider various psychological mechanisms that cause these unintended consequences including cognitive overload, affect, and anticipated regret, information salience and availability, and trust in governments as authoritative information providers. We also point toward potential solutions based on psychological research that may reduce the negative unintended consequences of a “more-is-better” approach. PMID:24000291

78 FR 40156 - Agency Information Collection Activities; Proposed Collection; Comment Request; Copy Testing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-03

... effectiveness and unintended consequences of advertisements designed to target general market youth ages 12-17... effectiveness and unintended consequences of advertisements designed to target general market youth ages 12-17... consequences of advertisements designed to target general market youth ages 12-15 who reside in rural areas...

Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article

PubMed Central

YAZDKHASTI, Mansureh; POURREZA, Abolghasem; PIRAK, Arezoo; ABDI, Fatemeh

2015-01-01

Abstract Unintended pregnancy is among the most troubling public health problems and a major reproductive health issue worldwide imposing appreciable socioeconomic burden on individuals and society. Governments generally plan to control growth of births (especially wanted births as well as orphans and illegitimate births) imposing extra burden on public funding of the governments which inevitably affects economic efficiency and leads to economic slowdown, too. The present narrative review focuses on socioeconomic impacts of unintended pregnancy from the health system perspective. Follow of Computerized searches of Academic, 53 scientific journals were found in various databases including PubMed, EMBASE, ISI, Iranian databases, IPPE, UNFPA (1985-2013). Original articles, review articles, published books about the purpose of the paper were used. During this search, 20 studies were found which met the inclusion criteria. Unintended pregnancy is one of the most critical challenges facing the public health system that imposes substantial financial and social costs on society. On the other hand, affecting fertility indicators, it causes reduced quality of life and workforce efficiency. Therefore lowering the incidence of intended pregnancies correlates with elevating economic growth, socio-economic development and promoting public health. Regarding recent policy changes in Iran on family planning programs and adopting a new approach in increasing population may place the country at a higher risk of increasing the rate of unintended pregnancy. Hence, all governmental plans and initiatives of public policy must be regulated intelligently and logically aiming to make saving in public spending and reduce healthcare cost inflation. PMID:26060771

Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article.

PubMed

Yazdkhasti, Mansureh; Pourreza, Abolghasem; Pirak, Arezoo; Abdi, Fatemeh

2015-01-01

Unintended pregnancy is among the most troubling public health problems and a major reproductive health issue worldwide imposing appreciable socioeconomic burden on individuals and society. Governments generally plan to control growth of births (especially wanted births as well as orphans and illegitimate births) imposing extra burden on public funding of the governments which inevitably affects economic efficiency and leads to economic slowdown, too. The present narrative review focuses on socioeconomic impacts of unintended pregnancy from the health system perspective. Follow of Computerized searches of Academic, 53 scientific journals were found in various databases including PubMed, EMBASE, ISI, Iranian databases, IPPE, UNFPA (1985-2013). Original articles, review articles, published books about the purpose of the paper were used. During this search, 20 studies were found which met the inclusion criteria. Unintended pregnancy is one of the most critical challenges facing the public health system that imposes substantial financial and social costs on society. On the other hand, affecting fertility indicators, it causes reduced quality of life and workforce efficiency. Therefore lowering the incidence of intended pregnancies correlates with elevating economic growth, socio-economic development and promoting public health. Regarding recent policy changes in Iran on family planning programs and adopting a new approach in increasing population may place the country at a higher risk of increasing the rate of unintended pregnancy. Hence, all governmental plans and initiatives of public policy must be regulated intelligently and logically aiming to make saving in public spending and reduce healthcare cost inflation.

Unintended Consequences of Wearable Sensor Use in Healthcare. Contribution of the IMIA Wearable Sensors in Healthcare WG.

PubMed

Schukat, M; McCaldin, D; Wang, K; Schreier, G; Lovell, N H; Marschollek, M; Redmond, S J

2016-11-10

As wearable sensors take the consumer market by storm, and medical device manufacturers move to make their devices wireless and appropriate for ambulatory use, this revolution brings with it some unintended consequences, which we aim to discuss in this paper. We discuss some important unintended consequences, both beneficial and unwanted, which relate to: modifications of behavior; creation and use of big data sets; new security vulnerabilities; and unforeseen challenges faced by regulatory authorities, struggling to keep pace with recent innovations. Where possible, we proposed potential solutions to unwanted consequences. Intelligent and inclusive design processes may mitigate unintended modifications in behavior. For big data, legislating access to and use of these data will be a legal and political challenge in the years ahead, as we trade the health benefits of wearable sensors against the risk to our privacy. The wireless and personal nature of wearable sensors also exposes them to a number of unique security vulnerabilities. Regulation plays an important role in managing these security risks, but also has the dual responsibility of ensuring that wearable devices are fit for purpose. However, the burden of validating the function and security of medical devices is becoming infeasible for regulators, given the many software apps and wearable sensors entering the market each year, which are only a subset of an even larger 'internet of things'. Wearable sensors may serve to improve wellbeing, but we must be vigilant against the occurrence of unintended consequences. With collaboration between device manufacturers, regulators, and end-users, we balance the risk of unintended consequences occurring against the incredible benefit that wearable sensors promise to bring to the world.

Unintended consequences: the social context of cancer survivors and work.

PubMed

Mak, Angela Ka Ying; Chaidaroon, Suwichit; Fan, Gilbert; Thalib, Fahimah

2014-06-01

This article describes the ways in which socioeconomic characteristics and workplace contexts shape the unintended consequences that cancer survivors can experience as they return to work. The study was conducted in an employment setting where there is a major focus on productivity and economic growth in the business sector. Five focus groups (N = 33 participants) were conducted in 2012 in Singapore. Questions were directed at obtaining information related to the meaning of a job and reactions to return to work as a cancer survivor completes primary cancer treatment. A thematic analysis using a two-staged analytical process was conducted to identify (1) work-related challenges faced by survivors as a result of the interplay between their self-identity as someone with a critical illness and organizational structure, and (2) unintended social consequences (USCs) related to the interaction between the workplace and cancer survivor. Eight emerging themes of work-related challenges and unintended consequences were categorized. Fear of losing out by compromising one's expectation, downplaying illness to avoid being a burden to others, working harder to meet expectations, and passive acceptance to perceived discrimination. Unintended consequences were also observed in relation to policies, procedures, and economic factors in the context of a heightened economically driven social climate. This study contributes to the understanding of how cancer survivors perceive their work situation. These findings can inform health care providers, employers, and policy makers regarding the challenges faced by cancer survivors as they return to the workplace in a culture of a rapidly growing emphasis on economic concerns. These findings offer a new perspective on the complexities that can occur when cancer survivors interact with their workplace. Awareness of the existence and types of unintended consequences in this context can help provide a more comprehensive understanding of the cancer survivor and work interface.

Unintended Consequences of Wearable Sensor Use in Healthcare

PubMed Central

McCaldin, D.; Wang, K.; Schreier, G.; Lovell, N. H.; Marschollek, M.; Redmond, S. J.

2016-01-01

Summary Objectives As wearable sensors take the consumer market by storm, and medical device manufacturers move to make their devices wireless and appropriate for ambulatory use, this revolution brings with it some unintended consequences, which we aim to discuss in this paper. Methods We discuss some important unintended consequences, both beneficial and unwanted, which relate to: modifications of behavior; creation and use of big data sets; new security vulnerabilities; and unforeseen challenges faced by regulatory authorities, struggling to keep pace with recent innovations. Where possible, we proposed potential solutions to unwanted consequences. Results Intelligent and inclusive design processes may mitigate unintended modifications in behavior. For big data, legislating access to and use of these data will be a legal and political challenge in the years ahead, as we trade the health benefits of wearable sensors against the risk to our privacy. The wireless and personal nature of wearable sensors also exposes them to a number of unique security vulnerabilities. Regulation plays an important role in managing these security risks, but also has the dual responsibility of ensuring that wearable devices are fit for purpose. However, the burden of validating the function and security of medical devices is becoming infeasible for regulators, given the many software apps and wearable sensors entering the market each year, which are only a subset of an even larger ‘internet of things’. Conclusion Wearable sensors may serve to improve wellbeing, but we must be vigilant against the occurrence of unintended consequences. With collaboration between device manufacturers, regulators, and end-users, we balance the risk of unintended consequences occurring against the incredible benefit that wearable sensors promise to bring to the world. PMID:27830234

System Safety and the Unintended Consequence

NASA Technical Reports Server (NTRS)

Watson, Clifford

2012-01-01

The analysis and identification of risks often result in design changes or modification of operational steps. This paper identifies the potential of unintended consequences as an over-looked result of these changes. Examples of societal changes such as prohibition, regulatory changes including mandating lifeboats on passenger ships, and engineering proposals or design changes to automobiles and spaceflight hardware are used to demonstrate that the System Safety Engineer must be cognizant of the potential for unintended consequences as a result of an analysis. Conclusions of the report indicate the need for additional foresight and consideration of the potential effects of analysis-driven design, processing changes, and/or operational modifications.

Unintended pregnancy and unsafe abortion in the Philippines: context and consequences.

PubMed

Hussain, Rubina; Finer, Lawrence B

2013-04-01

Despite advances in reproductive health law, many Filipino women experience unintended pregnancies, and because abortion is highly stigmatized in the country, many who seek abortion undergo unsafe procedures. This report provides a summary of reproductive health indicators in the Philippines—in particular, levels of contraceptive use, unplanned pregnancy and unsafe abortion—and describes the sociopolitical context in which services are provided, the consequences of unintended pregnancy and unsafe abortion,and recommendations for improving access to reproductive health services.

AACSB Accreditation and Possible Unintended Consequences: A Deming View

ERIC Educational Resources Information Center

Stepanovich, Paul; Mueller, James; Benson, Dan

2014-01-01

The AACSB accreditation process reflects basic quality principles, providing standards and a process for feedback for continuous improvement. However, implementation can lead to unintended negative consequences. The literature shows that while institutionalism and critical theory have been used as a theoretical base for evaluating accreditation,…

Psychological Aspects of Contraception, Unintended Pregnancy, and Abortion.

PubMed

Steinberg, Julia R; Rubin, Lisa R

2014-10-01

The knowledge of important biopsychosocial factors linking women's reproductive health and mental health is increasing. This review focuses on psychological aspects of contraception, unintended pregnancy, and abortion because these are common reproductive health experiences in U.S. women's lives. This review addresses the mental-health antecedents and consequences of these experiences, mostly focusing on depression and depressive symptoms before and after unintended pregnancy and contraception. As mental-health antecedents, depressive symptoms predict contraceptive behaviors that lead to unintended pregnancy, and mental-health disorders have been associated with having subsequent abortions. In examining the mental-health consequences, most sound research does not find abortion or contraceptive use to cause mental-health problems. Consequently, evidence does not support policies based on the notion that abortion harms women's mental health. Nevertheless, the abortion-care setting may be a place to integrate mental-health services. In contrast, women who have births resulting from unintended pregnancies may be at higher risk of postpartum depression. Social policies (e.g., paid maternity leave, subsidized child care) may protect women from mental-health problems and stress of unplanned children interrupting employment, education, and pre-existing family care responsibilities.

An Examination of the (Un)Intended Consequences of Performance Funding in Higher Education

ERIC Educational Resources Information Center

Umbricht, Mark R.; Fernandez, Frank; Ortagus, Justin C.

2017-01-01

Previous studies have shown that state performance funding policies do not increase baccalaureate degree production, but higher education scholarship lacks a rigorous, quantitative analysis of the unintended consequences of performance funding. In this article, we use difference-in-differences estimation with fixed effects to evaluate performance…

Infiltration and extravasation: update on prevention and management.

PubMed

Doellman, Darcy; Hadaway, Lynn; Bowe-Geddes, Leigh Ann; Franklin, Michelle; LeDonne, Jack; Papke-O'Donnell, Lorelei; Pettit, Janet; Schulmeister, Lisa; Stranz, Marc

2009-01-01

Infiltration and extravasation are risks of intravenous administration therapy involving unintended leakage of solution into the surrounding tissue. Consequences range from local irritation to amputation. While immediate action using appropriate measures (ie, dilution, extraction, antidotes, and supportive treatments) can decrease the need for surgical intervention, many injuries may be prevented by following established policy and procedures. However, timely surgical intervention, when necessary, can prevent more serious adverse outcomes. Clinicians should be prepared to act promptly when an event occurs. Thorough incident documentation helps determine whether infusion care meets the standard of practice and is a keystone to medicolegal defense.

Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting.

PubMed

Bloomrosen, Meryl; Starren, Justin; Lorenzi, Nancy M; Ash, Joan S; Patel, Vimla L; Shortliffe, Edward H

2011-01-01

Federal legislation (Health Information Technology for Economic and Clinical Health (HITECH) Act) has provided funds to support an unprecedented increase in health information technology (HIT) adoption for healthcare provider organizations and professionals throughout the U.S. While recognizing the promise that widespread HIT adoption and meaningful use can bring to efforts to improve the quality, safety, and efficiency of healthcare, the American Medical Informatics Association devoted its 2009 Annual Health Policy Meeting to consideration of unanticipated consequences that could result with the increased implementation of HIT. Conference participants focused on possible unintended and unanticipated, as well as undesirable, consequences of HIT implementation. They employed an input-output model to guide discussion on occurrence of these consequences in four domains: technical, human/cognitive, organizational, and fiscal/policy and regulation. The authors outline the conference's recommendations: (1) an enhanced research agenda to guide study into the causes, manifestations, and mitigation of unintended consequences resulting from HIT implementations; (2) creation of a framework to promote sharing of HIT implementation experiences and the development of best practices that minimize unintended consequences; and (3) recognition of the key role of the Federal Government in providing leadership and oversight in analyzing the effects of HIT-related implementations and policies.

Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting

PubMed Central

Starren, Justin; Lorenzi, Nancy M; Ash, Joan S; Patel, Vimla L; Shortliffe, Edward H

2010-01-01

Federal legislation (Health Information Technology for Economic and Clinical Health (HITECH) Act) has provided funds to support an unprecedented increase in health information technology (HIT) adoption for healthcare provider organizations and professionals throughout the U.S. While recognizing the promise that widespread HIT adoption and meaningful use can bring to efforts to improve the quality, safety, and efficiency of healthcare, the American Medical Informatics Association devoted its 2009 Annual Health Policy Meeting to consideration of unanticipated consequences that could result with the increased implementation of HIT. Conference participants focused on possible unintended and unanticipated, as well as undesirable, consequences of HIT implementation. They employed an input–output model to guide discussion on occurrence of these consequences in four domains: technical, human/cognitive, organizational, and fiscal/policy and regulation. The authors outline the conference's recommendations: (1) an enhanced research agenda to guide study into the causes, manifestations, and mitigation of unintended consequences resulting from HIT implementations; (2) creation of a framework to promote sharing of HIT implementation experiences and the development of best practices that minimize unintended consequences; and (3) recognition of the key role of the Federal Government in providing leadership and oversight in analyzing the effects of HIT-related implementations and policies. PMID:21169620

The Unintended Consequences of Property Tax Relief: New York's STAR Program

ERIC Educational Resources Information Center

Eom, Tae Ho; Duncombe, William; Nguyen-Hoang, Phuong; Yinger, John

2014-01-01

New York's School Tax Relief Program, STAR, provides state-funded property tax relief for homeowners. Like a matching grant, STAR changes the price of education, thereby altering the incentives of voters and school officials and leading to unintended consequences. Using data for New York State school districts before and after STAR was…

Economics: An Analysis of Unintended Consequences. Volume 1: Introduction to Microeconomics.

ERIC Educational Resources Information Center

Schenk, Robert E.

This curriculum guide introduces high school students to the basic principles of microeconomics. Chapter 1 provides a basic definition of economics, while chapter 2 introduces a number of important economic concepts and ideas and examines reasons for unintended or unexpected consequences of decision-making. Chapter 3 considers how individual…

The Policy Delphi: A Method for Identifying Intended and Unintended Consequences of Educational Policy

ERIC Educational Resources Information Center

Manley, R. Adam

2013-01-01

This article highlights a rarely utilized but effective technique for identifying intended and unintended consequences of past or current policy or policy change. The author guides the reader through the process of identifying potential participants, contacting participants, developing the policy Delphi instrument, and analyzing the findings by…

Ethics and the Unintended Consequences of Social Research: A Perspective from the Sociology of Science

ERIC Educational Resources Information Center

Studer, Kenneth E.; Chubin, Daryl E.

1977-01-01

Argues that "successful" social science requires development of a social ethic or sense of research responsibility, and suggests that an individualistic orientation is ineffective in coping with the unintended consequences of social research. Available from: Elsevier Scientific Publishing Company, Box 211, Amsterdam, the Netherlands, single copies…

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

USDA-ARS?s Scientific Manuscript database

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

Unintended environmental consequences and co-benefits of economic restructuring.

PubMed

Liang, Sai; Xu, Ming; Suh, Sangwon; Tan, Raymond R

2013-11-19

Current economic restructuring policies have ignored unintended environmental consequences and cobenefits, the understanding of which can provide foundations for effective policy decisions for green economy transformation. Using the input-output life cycle assessment model and taking China as an example, we find that household consumption, fixed capital formation, and export are main drivers to China's environmental impacts. At the product scale, major contributors to environmental impacts vary across different types of impacts. Stimulating the development of seven strategic emerging industries will cause unintended consequences, such as increasing nonferrous metal ore usage, terrestrial acidification, photochemical oxidant formation, human toxicity, and terrestrial ecotoxicity. Limiting the surplus outputs in the construction materials industry and metallurgy industry may only help mitigate some of the environmental impacts caused by China's regulated pollutants, with little effect on reducing other impacts, such as marine eutrophication, terrestrial acidification, photochemical oxidant formation, and particulate matter formation. However, it will bring cobenefits by simultaneously reducing mineral ore usage, human toxicity, marine ecotoxicity, and terrestrial ecotoxicity. Sustainable materials management and integrated policy modeling are possible ways for policy-making to avoid unintended consequences and effectively utilize cobenefits.

Examining the relationship between medical cannabis laws and cardiovascular deaths in the US.

PubMed

Abouk, Rahi; Adams, Scott

2018-03-01

Several countries and many U.S. states have allowed, for cannabis to be used as therapy to treat chronic conditions or pain., This has increased the use of cannabis, particularly among older people.Because cannabis has been linked to adverse cardiac events in the medical literature, there may be unintended consequences on increased use among older people. We analyze cardiac-related mortality data from the U.S. National Vital Statistics System for 1990-2014. We use difference-in-difference fixed-effects models to assess whether there are increased rates of cardiac-related mortality following passage of medical cannabis programs. We also analyze whether states with more liberal rules on dispensing cannabis show higher mortality rates. For men, there is a statistically significant 2.3% increase in the rate of cardiac death following passage. For women, there is a 1.3% increase that is also statistically significant. he effects increase or both men and women with age. The effects are also stronger in states with more a lax approach to cannabis dispensing. Policymakers should be aware of a potential unintended consequence of allowing broader use of cannabis, specifically for those more at risk of cardiovascular events. Copyright © 2017. Published by Elsevier B.V.

What if "Just Right" Is Just Wrong? The Unintended Consequences of Leveling Readers

ERIC Educational Resources Information Center

Hoffman, James V.

2017-01-01

The author questions the "just right" leveling of student texts as having put limitations on students and teachers in promoting literacy. The historical background for the leveling of text and readers is described. The author identifies a number of unintended consequences associated with the use of leveling and guided reading.…

Unintended Consequences: The Impact of Proposition 2½ Overrides on School Segregation in Massachusetts

ERIC Educational Resources Information Center

Zabel, Jeffrey

2014-01-01

I investigate a possible unintended consequence of Proposition 2½ override behavior--that it led to increased segregation in school districts in Massachusetts. This can occur because richer, low-minority towns tend to have more successful override votes that attract similar households with relatively high demands for public services who can afford…

Rights and great responsibilities of academic pediatricians.

PubMed

Cooper, William O

2013-01-01

Abraham Jacobi, in his first address to the newly formed American Pediatric Society over 100 years ago, stated, "Questions of public hygiene and medicine are both professional and social. Thus, every physician is by destiny a citizen of the commonwealth with many rights and great responsibilities." Accordingly, pediatricians have rights and great responsibilities to advocate for children who may be at particularly high risk for adverse outcomes. Often, well-intentioned policies or interventions can have tragic unexpected consequence for these children. In many circumstances, policies are developed by providers, policymakers, and others who may act without sufficient information to understand how a particular policy might adversely affect vulnerable populations. Thus, academic pediatricians should fulfill their great responsibilities by identifying signals from the populations they serve that may indicate unintended consequences of policies, performing the highest quality research and discovery to evaluate these signals, and disseminating the information back to the appropriate decision-makers to ensure that policies and interventions result in optimal outcomes for all children. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

It's not about pager replacement: an in-depth look at the interprofessional nature of communication in healthcare.

PubMed

Quan, Sherman D; Wu, Robert C; Rossos, Peter G; Arany, Teri; Groe, Silvi; Morra, Dante; Wong, Brian M; Cavalcanti, Rodrigo; Coke, William; Lau, Francis Y

2013-03-01

Institutions have tried to replace the use of numeric pagers for clinical communication by implementing health information technology (HIT) solutions. However, failing to account for the sociotechnical aspects of HIT or the interplay of technology with existing clinical workflow, culture, and social interactions may create other unintended consequences. To evaluate a Web-based messaging system that allows asynchronous communication between health providers and identify the unintended consequences associated with implementing such technology. Intervention-a Web-based messaging system at the University Health Network to replace numeric paging practices in May 2010. The system facilitated clinical communication on the medical wards for coordinating patient care. Study design-pre-post mixed methods utilizing both quantitative and qualitative measures. Five residents, 8 nurses, 2 pharmacists, and 2 social workers were interviewed. Pre-post interruption-15 residents from 5 clinical teams in both periods. The study compared the type of messages sent to physicians before and after implementation of the Web-based messaging system; a constant comparative analysis of semistructured interviews was used to generate key themes related to unintended consequences. Interruptions increased 233%, from 3 pages received per resident per day pre-implementation to 10 messages received per resident per day post-implementation. Key themes relating to unintended consequences that emerged from the interviews included increase in interruptions, accountability, and tactics to improve personal productivity. Meaningful improvements in clinical communication can occur but require more than just replacing pagers. Introducing HIT without addressing the sociotechnical aspects of HIT that underlie clinical communication can lead to unintended consequences. Copyright © 2013 Society of Hospital Medicine.

Using Multiple Methods to Investigate Eleven-Year-Olds' Experiences of Preparing for a High-Stakes Public Examination in Trinidad and Tobago

ERIC Educational Resources Information Center

De Lisle, Jerome; McMillan-Solomon, Sabrina

2017-01-01

This study was designed to uncover and evaluate unintended and indirect consequences of using the "Secondary Entrance Assessment" ("SEA") in Trinidad and Tobago for high-stakes selection and placement. A major argument is that the test-taker is central to consequences, both intended and unintended. Data were obtained from…

Curriculum Reform and the Displacement of Knowledge in Peruvian Rural Secondary Schools: Exploring the Unintended Local Consequences of Global Education Policies

ERIC Educational Resources Information Center

Balarin, Maria; Benavides, Martin

2010-01-01

This paper draws attention to processes of policy implementation in developing contexts, and to the unintended consequences of education policies that follow international policy scripts without enough consideration of local histories and cultures. Drawing on a study of teaching practices in Peruvian rural secondary schools after a period of…

Conflict in a Sixth-Grade Book Club: The Impact of a Rule-Driven Discourse

ERIC Educational Resources Information Center

Hill, K. Dara

2008-01-01

This study examines unintended consequences during a 6th-grade book club discussion of Bette Bao Lord's (1984) In the Year of the Boar and Jackie Robinson. The participants modeled a book club discussion, otherwise known as the fish bowl, for a newly enrolled student. Unintended consequences occurred within the realm of deviating from the rules of…

The Unintended Consequences of the Adoption of Electronic Medical Record Systems on Healthcare Costs

ERIC Educational Resources Information Center

Ganju, Kartik K.

2016-01-01

In my dissertation, I study unintended consequences of the adoption of EMR systems. In my three essays, I examine how the adoption of EMR systems affects neighboring hospitals (spillover effects), can be used by hospitals to further its objectives in an unconventional manner ("upcoding" of patient case mix data), and how EMR adoption may…

Why so many "rigorous" evaluations fail to identify unintended consequences of development programs: How mixed methods can contribute.

PubMed

Bamberger, Michael; Tarsilla, Michele; Hesse-Biber, Sharlene

2016-04-01

Many widely-used impact evaluation designs, including randomized control trials (RCTs) and quasi-experimental designs (QEDs), frequently fail to detect what are often quite serious unintended consequences of development programs. This seems surprising as experienced planners and evaluators are well aware that unintended consequences frequently occur. Most evaluation designs are intended to determine whether there is credible evidence (statistical, theory-based or narrative) that programs have achieved their intended objectives and the logic of many evaluation designs, even those that are considered the most "rigorous," does not permit the identification of outcomes that were not specified in the program design. We take the example of RCTs as they are considered by many to be the most rigorous evaluation designs. We present a numbers of cases to illustrate how infusing RCTs with a mixed-methods approach (sometimes called an "RCT+" design) can strengthen the credibility of these designs and can also capture important unintended consequences. We provide a Mixed Methods Evaluation Framework that identifies 9 ways in which UCs can occur, and we apply this framework to two of the case studies. Copyright © 2016 Elsevier Ltd. All rights reserved.

The knowledge, attitude and behaviours of nurses about pharmacovigilance, adverse drug reaction and adverse event reporting in a state hospital

PubMed Central

Vural, Fisun; Ciftci, Seval; Vural, Birol

2015-01-01

OBJECTIVE: With the use of any drug comes the possibility of unintended consequences which when harmful are referred to as adverse drug reactions (ADRs). The development of national pharmacovigilance systems is the responsibility of all health workers. The aim of this study was to investigate the knowledge of nurses about pharmacovigilance and attitudes about ADR and adverse event reporting. METHODS: This descriptive-cross sectional study was performed in 112 nurses working in a public hospital. The questionnaire was applied about pharmacovigilance and adverse drug reactions. The knowledge, attitudes and practices about adverse drug reactions were asked. RESULTS: The 74.1% of the nurses definition of “severe adverse effect” of drug therapy. The ratio of participants who knew that ADRs are reported to contact person responsible from pharmacovigilance was 34.9%. Although 70.5% of nurses knew the necessity of ADR reporting, the 8% of the nurses knew Turkish Pharmacovigilance Center (TÜFAM). Only 8% of nurses reported ADRs in their professionality. CONCLUSION: Although most of the participants knew the importance of ADR event reporting, event reporting was low. Thiese results showed that there is a lack of knowledge about pharmacovigilance. Futher studies with different settings and healthcare staff are needed to improve awareness about pharmacovigilance. PMID:28058321

Unintended pregnancy and abortion in Uganda.

PubMed

Hussain, Rubina

2013-01-01

Unintended pregnancy is common in Uganda, leading to high levels of unplanned births, unsafe abortions, and maternal injury and death. Because most pregnancies that end in abortion are unwanted, nearly all ill health and mortality resulting from unsafe abortion is preventable. This report summarizes evidence on the context and consequences of unintended pregnancy and unsafe abortion in Uganda, points out gaps in knowledge, and highlights steps that can be taken to reduce levels of unintended pregnancy and unsafe abortion, and, in turn, the high level of maternal mortality.

Contraception and mental health: a commentary on the evidence and principles for practice.

PubMed

Hall, Kelli Stidham; Steinberg, Julia R; Cwiak, Carrie A; Allen, Rebecca H; Marcus, Sheila M

2015-06-01

Among the most prevalent and disabling chronic diseases affecting reproductive-aged women worldwide, depression and anxiety can contribute to adverse reproductive health outcomes, including an increased risk of unintended pregnancy and its health and social consequences. For women with these common mental health conditions who want to avoid an unintended pregnancy, effective contraception can be an important strategy to maintain and even improve health and well-being. Reproductive health clinicians play a critical role in providing and managing contraception to help women with mental health considerations achieve their desired fertility. In this commentary, we review the literature on relationships between mental health and contraception and describe considerations for the clinical management of contraception among women with depression and anxiety. We discuss issues related to contraceptive method effectiveness and adherence concerns, mental health-specific contraceptive method safety and drug interaction considerations, and clinical counseling and management strategies. Given important gaps in current scientific knowledge of mental health and contraception, we highlight areas for future research. Copyright © 2015 Elsevier Inc. All rights reserved.

What to consider when regulating electronic cigarettes: Pros, cons and unintended consequences.

PubMed

Caponnetto, Pasquale; Saitta, Daniela; Sweanor, David; Polosa, Riccardo

2015-06-01

Many public health experts, medical research societies, large health organizations and policy makers have expressed concerns about the increased popularity of electronic cigarettes and have pushed for more restrictive measures ranging from complete bans to tight regulations of these products either as medicines or as tobacco products. But these concerns have never been adequately qualified nor quantified. Without judicious assessment and thorough evaluation, regulations may have unintended consequences that can do more damage than good in public health terms. In this article, we will appraise the existing prominent regulatory frameworks for e-cigarettes, namely, general consumer product, medicinal product and tobacco product regulation, to highlight their pros and cons. Moreover, we provide concrete examples of the unintended consequences which may arise from inappropriate regulatory action. Copyright © 2015 Elsevier B.V. All rights reserved.

Improving Children's Life Chances through Better Family Planning. CCF Brief #55

ERIC Educational Resources Information Center

Sawhill, Isabel; Venator, Joanna

2015-01-01

Non-marital childbearing is associated with many adverse outcomes for both the mother and the child. Most of these births are unintended. If these unintended births could be reduced it might improve children's prospects by enabling their mothers to get more education, earn more, and wait to have children within marriage. In this brief, the authors…

The Unintended Consequences of School Inspection: The Prevalence of Inspection Side-Effects in Austria, The Czech Republic, England, Ireland, The Netherlands, Sweden, and Switzerland

ERIC Educational Resources Information Center

Jones, Karen L.; Tymms, Peter; Kemethofer, David; O'Hara, Joe; McNamara, Gerry; Huber, Stephan; Myrberg, Eva; Skedsmo, Guri; Greger, David

2017-01-01

It has been widely documented that accountability systems, including school inspections, bring with them unintended side effects. These unintended effects are often negative and have the potential to undo the intended positive effects. However the empirical evidence is limited. Through a European comparative study we have had the rare opportunity…

The dysfunctional consequences of a performance measurement system: the case of the Iranian national hospital grading programme.

PubMed

Aryankhesal, Aidin; Sheldon, Trevor A; Mannion, Russell; Mahdipour, Saeade

2015-07-01

Performance measurement systems are increasingly used to reward and improve provider performance. However, such initiatives may also inadvertently induce a range of unintended and dysfunctional side-effects. This study explores the unintended and adverse consequences induced by the Iranian national hospital grading programme, which incorporates financial incentives for meeting nationally defined standards. We interviewed key informants across four key groups with a legitimate interest in healthcare performance: four purposively selected hospitals; four health insurance organizations; the Iranian hospital accreditation body; and one grading agency. The transcribed interviews and field notes were analysed thematically, and subsequently, member checking was conducted. Seven dysfunctional consequences were identified: misrepresentation of data by hospitals; increased anxiety and stress among hospital employees; tunnel vision; financial pressures on poorly graded hospitals; incentives to purchase unnecessary equipment; erosion of public trust; and restricting access to hospital services by patients. These were caused by the way the grading system was implemented: poor standards of audit; the way in which the audit process was conducted; and the timing of audits. The pay for performance element of the grading system and the focus on structural aspects in the standards made improvement in grading particularly difficult for those hospitals that had been assessed as under-performing. Although the Iranian hospital grading system has resulted in a significant increase in the adoption of national standards, it has nevertheless induced a range of perverse outcomes. To mitigate these requires further refinement and recalibration of the system. © The Author(s) 2015.

Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan.

PubMed

Habib, Muhammad Atif; Raynes-Greenow, Camille; Nausheen, Sidrah; Soofi, Sajid Bashir; Sajid, Muhammad; Bhutta, Zulfiqar A; Black, Kirsten I

2017-05-30

Unintended pregnancies are a global public health concern and contribute significantly to adverse maternal and neonatal health, social and economic outcomes and increase the risks of maternal deaths and neonatal mortality. In countries like Pakistan where data for the unintended pregnancies is scarce, studies are required to estimate its accurate prevalence and predictors using more specific tools such as the London Measure of Unplanned Pregnancies (LMUP). We conducted a hospital based cross sectional survey in two tertiary care hospitals in Pakistan. We used a pre tested structured questionnaire to collect the data on socio-demographic characteristics, reproductive history, awareness and past experience with contraceptives and unintended pregnancies using six item the LMUP. We used Univariate and multivariate analysis to explore the association between unintended pregnancies and predictor variables and presented the association as adjusted odds ratios. We also evaluated the psychometric properties of the Urdu version of the LMUP. Amongst 3010 pregnant women, 1150 (38.2%) pregnancies were reported as unintended. In the multivariate analysis age < 20 years (AOR 3.5 1.1-6.5), being illiterate (AOR 1.9 1.1-3.4), living in a rural setting (1.7 1.2-2.3), having a pregnancy interval of = < 12 months (AOR 1.7 1.4-2.2), having a parity of >2 (AOR 1.4 1.2-1.8), having no knowledge about contraceptive methods (AOR 3.0 1.7-5.4) and never use of contraceptive methods (AOR 2.3 1.4-5.1) remained significantly associated with unintended pregnancy. The Urdu version of the LMUP scale was found to be acceptable, valid and reliable with the Cronbach's alpha of 0.85. This study explores a high prevalence of unintended pregnancies and important factors especially those related to family planning. Integrated national family program that provides contraceptive services especially the modern methods to women during pre-conception and post-partum would be beneficial in averting unintended pregnancies and their related adverse outcomes in Pakistan.

The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals.

PubMed

Wu, Robert C; Lo, Vivian; Morra, Dante; Wong, Brian M; Sargeant, Robert; Locke, Ken; Cavalcanti, Rodrigo; Quan, Sherman D; Rossos, Peter; Tran, Kim; Cheung, Mark

2013-01-01

Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness. To describe the effects of different communication interventions and their problems. Prospective observational case study using a mixed methods approach of quantitative and qualitative methods. General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals. Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards. Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010. We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories. Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.

Geomorphology and the Law of Unintended Consequences (Locke, 1691): Lessons from coastal weathering and erosion at Prawle (UK) and Kaikoura (NZ)

NASA Astrophysics Data System (ADS)

Mottershead, Derek N.; Stephenson, Wayne J.; Hemmingsen, Maree A.

2016-07-01

The sites of two field experiments based on micro-erosion metering, one in UK the other in New Zealand, were independently revisited respectively 33 and 17 years after installation. At both sites natural weathering and erosion processes had been inadvertently interrupted by the experimental works, leading to the development of new microscale landforms. These are interpreted in the context of modifications of the controls on weathering processes, leading to enhanced understanding of the processes themselves. This has lessons for the geomorphologist in maintaining a long-term watching brief over former experimental sites, lest some unintended and potentially beneficial outcome has ensued. This theme is embraced by the Law of Unintended Consequences.

Unintended Consequences of Smoke-Free Bar Policies for Low-SES Women in Three California Counties

PubMed Central

Moore, Roland S.; Annechino, Rachelle M.; Lee, Juliet P.

2009-01-01

Background To amplify earlier studies of unintended consequences of public policies, this article illustrates both negative and positive unanticipated consequences of smoke-free workplace policies in California bars for women of low SES. Methods The article relies on thematic analysis in 2008 of qualitative data gathered between 2001 and 2007 from three mixed-method studies of tobacco use in and around bars where indoor smoking is prohibited. Results Unanticipated consequences primarily occurred when bars did comply with the law and smokers went outside the bar to smoke, particularly when smokers stood on the street outside the bar. Key negative consequences for women who smoked outside of bars included threats to their physical safety and their public image. For women living near bars, increased smoking on the street may have increased their exposure to secondhand smoke and disruptive noise. For some women, however, unanticipated negative consequences were identified with noncompliant bars. Smokers were conjectured to congregate in the smaller number of bars where smoking was still allowed, resulting in increased exposure to secondhand smoke for low-SES women working in these bars. A common positive unintended consequence of the tobacco control ordinance was increased social circulation and solidarity, as smokers gathered outside bars to smoke. Conclusions Smoke-free workplace laws in bars can have both negative and positive consequences for workers and smokers, and low-income women in particular. PMID:19591753

Unintended consequences of smoke-free bar policies for low-SES women in three California counties.

PubMed

Moore, Roland S; Annechino, Rachelle M; Lee, Juliet P

2009-08-01

To amplify earlier studies of unintended consequences of public policies, this article illustrates both negative and positive unanticipated consequences of smoke-free workplace policies in California bars for women of low SES. The article relies on thematic analysis in 2008 of qualitative data gathered between 2001 and 2007 from three mixed-method studies of tobacco use in and around bars where indoor smoking is prohibited. Unanticipated consequences primarily occurred when bars did comply with the law and smokers went outside the bar to smoke, particularly when smokers stood on the street outside the bar. Key negative consequences for women who smoked outside of bars included threats to their physical safety and their public image. For women living near bars, increased smoking on the street may have increased their exposure to secondhand smoke and disruptive noise. For some women, however, unanticipated negative consequences were identified with noncompliant bars. Smokers were conjectured to congregate in the smaller number of bars where smoking was still allowed, resulting in increased exposure to secondhand smoke for low-SES women working in these bars. A common positive unintended consequence of the tobacco control ordinance was increased social circulation and solidarity, as smokers gathered outside bars to smoke. Smoke-free workplace laws in bars can have both negative and positive consequences for workers and smokers, and low-income women in particular.

Large-scale quarantine following biological terrorism in the United States: scientific examination, logistic and legal limits, and possible consequences.

PubMed

Barbera, J; Macintyre, A; Gostin, L; Inglesby, T; O'Toole, T; DeAtley, C; Tonat, K; Layton, M

2001-12-05

Concern for potential bioterrorist attacks causing mass casualties has increased recently. Particular attention has been paid to scenarios in which a biological agent capable of person-to-person transmission, such as smallpox, is intentionally released among civilians. Multiple public health interventions are possible to effect disease containment in this context. One disease control measure that has been regularly proposed in various settings is the imposition of large-scale or geographic quarantine on the potentially exposed population. Although large-scale quarantine has not been implemented in recent US history, it has been used on a small scale in biological hoaxes, and it has been invoked in federally sponsored bioterrorism exercises. This article reviews the scientific principles that are relevant to the likely effectiveness of quarantine, the logistic barriers to its implementation, legal issues that a large-scale quarantine raises, and possible adverse consequences that might result from quarantine action. Imposition of large-scale quarantine-compulsory sequestration of groups of possibly exposed persons or human confinement within certain geographic areas to prevent spread of contagious disease-should not be considered a primary public health strategy in most imaginable circumstances. In the majority of contexts, other less extreme public health actions are likely to be more effective and create fewer unintended adverse consequences than quarantine. Actions and areas for future research, policy development, and response planning efforts are provided.

Metric-driven harm: an exploration of unintended consequences of performance measurement.

PubMed

Rambur, Betty; Vallett, Carol; Cohen, Judith A; Tarule, Jill Mattuck

2013-11-01

Performance measurement is an increasingly common element of the US health care system. Typically a proxy for high quality outcomes, there has been little systematic investigation of the potential negative unintended consequences of performance metrics, including metric-driven harm. This case study details an incidence of post-surgical metric-driven harm and offers Smith's 1995 work and a patient centered, context sensitive metric model for potential adoption by nurse researchers and clinicians. Implications for further research are discussed. © 2013.

The rationale for accelerating regionally focused climate intervention research

NASA Astrophysics Data System (ADS)

MacCracken, Michael C.

2016-12-01

Ten years ago, Paul Crutzen asked whether the time had come to consider undertaking research into intentionally intervening in the climate system so that it might be considered a policy option comparable to reducing emissions for limiting human-induced climate change. Crutzen's article pointed out how little progress had been made in reducing emissions and suggested that resurrecting decades-old ideas for imitating volcanic eruptions as a possible intervention might be needed. Today, model-based simulations, optimistically assuming that nations fulfill their commitments for future emissions reductions, project global average temperature to increase to 3-4°C above its preindustrial level by 2100, a level that Crutzen envisioned as likely to meriting active intervention. While research has begun to explore the means for intervening globally, such interventions raise challenging issues of governance, unintended consequences, intergenerational equity, and more. Initially, focusing research on potential tropospheric and surface-based approaches to altering energy flows as a means for moderating adverse regional impacts might well pose less difficult governance challenges and more regionally constrained evaluations of intended outcomes and unintended consequences. Because natural processes would tend to dissipate most types of tropospheric interventions, adjustments, and even termination, would be possible over periods of weeks to months. In addition to serving their particular purpose, regional interventions would also provide an opportunity for learning more about Earth system behavior and the potential effectiveness and risks of global-scale interventions, if such interventions might eventually be needed to counter-balance especially severe global warming.

The ineffectiveness and unintended consequences of the public health war on obesity.

PubMed

Ramos Salas, Ximena

2015-02-03

The public health war on obesity has had little impact on obesity prevalence and has resulted in unintended consequences. Its ineffectiveness has been attributed to: 1) heavy focus on individual-based approaches and lack of scaled-up socio-environmental policies and programs, 2) modest effects of interventions in reducing and preventing obesity at the population level, and 3) inappropriate focus on weight rather than health. An unintended consequence of these policies and programs is excessive weight preoccupation among the population, which can lead to stigma, body dissatisfaction, dieting, disordered eating, and even death from effects of extreme dieting, anorexia, and obesity surgery complications, or from suicide that results from weight-based bullying. Future public health approaches should: a) avoid simplistic obesity messages that focus solely on individuals' responsibility for weight and health, b) focus on health outcomes rather than weight control, and c) address the complexity of obesity and target both individual-level and system-level determinants of health.

The Medicare Policy of Payment Adjustment for Health Care-Associated Infections: Perspectives on Potential Unintended Consequences

PubMed Central

Hartmann, Christine W.; Hoff, Timothy; Palmer, Jennifer A.; Wroe, Peter; Dutta-Linn, M. Maya; Lee, Grace

2014-01-01

In 2008, the Centers for Medicare & Medicaid Services introduced a new policy to adjust payment to hospitals for health care-associated infections (HAIs) not present on admission. Interviews with 36 hospital infection preventionists across the United States explored the perspectives of these key stakeholders on the potential unintended consequences of the current policy. Responses were analyzed using an iterative coding process where themes were developed from the data. Participants’ descriptions of unintended impacts of the policy centered around three themes. Results suggest the policy has focused more attention on targeted HAIs and has affected hospital staff; relatively fewer systems changes have ensued. Some consequences of the policy, such as infection preventionists having less time to devote to HAIs other than those in the policy or having less time to implement prevention activities, may have undesirable effects on HAI rates if hospitals do not recognize and react to potential time and resource gaps. PMID:21810797

The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals

PubMed Central

Wu, Robert C; Lo, Vivian; Morra, Dante; Wong, Brian M; Sargeant, Robert; Locke, Ken; Cavalcanti, Rodrigo; Quan, Sherman D; Rossos, Peter; Tran, Kim; Cheung, Mark

2013-01-01

Background Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness. Objectives To describe the effects of different communication interventions and their problems. Design Prospective observational case study using a mixed methods approach of quantitative and qualitative methods. Setting General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals. Participants Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards. Methods Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010. Results We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories. Conclusions Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems. PMID:23355461

Unintended Consequences of Cost Recovery

ERIC Educational Resources Information Center

Piercey, David

2010-01-01

An Alberta school district that used a cost-recovery model to finance school services for 20 years is finding that the model produces unintended negative results. Some schools didn't spend this money on services but used it for other school operations. Some spent the money on external consultants. Professional relationships were damaged, and…

Global environmental health and sustainable development: the role at Rio+20.

PubMed

Furie, Gregg Lawrence; Balbus, John

2012-06-01

The Rio+20 United Nations Conference on Sustainable Development represents a crucial opportunity to place environmental health at the forefront of the sustainable development agenda. Billions of people living in low- and middle-income countries continue to be afflicted by preventable diseases due to modifiable environmental exposures, causing needless suffering and perpetuating a cycle of poverty. Current processes of economic development, while alleviating many social and health problems, are increasingly linked to environmental health threats, ranging from air pollution and physical inactivity to global climate change. Sustainable development practices attempt to reduce environmental impacts and should, in theory, reduce adverse environmental health consequences compared to traditional development. Yet these efforts could also result in unintended harm and impaired economic development if the new "Green Economy" is not carefully assessed for adverse environmental and occupational health impacts. The environmental health community has an essential role to play in underscoring these relationships as international leaders gather to craft sustainable development policies.

Nanomaterials in the construction industry: a review of their applications and environmental health and safety considerations.

PubMed

Lee, Jaesang; Mahendra, Shaily; Alvarez, Pedro J J

2010-07-27

The extraordinary chemical and physical properties of materials at the nanometer scale enable novel applications ranging from structural strength enhancement and energy conservation to antimicrobial properties and self-cleaning surfaces. Consequently, manufactured nanomaterials (MNMs) and nanocomposites are being considered for various uses in the construction and related infrastructure industries. To achieve environmentally responsible nanotechnology in construction, it is important to consider the lifecycle impacts of MNMs on the health of construction workers and dwellers, as well as unintended environmental effects at all stages of manufacturing, construction, use, demolition, and disposal. Here, we review state-of-the-art applications of MNMs that improve conventional construction materials, suggest likely environmental release scenarios, and summarize potential adverse biological and toxicological effects and their mitigation. Aligned with multidisciplinary assessment of the environmental implications of emerging technologies, this review seeks to promote awareness of potential benefits of MNMs in construction and stimulate the development of guidelines to regulate their use and disposal to mitigate potential adverse effects on human and environmental health.

Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences.

PubMed

Pomey, Marie-Pascale; Clavel, Nathalie; Amar, Claudia; Sabogale-Olarte, Juan Carlos; Sanmartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

2017-09-07

In Canada, long waiting times for core specialized services have consistently been identified as a key barrier to access. Governments and organizations have responded with strategies for better access management, notably for total joint replacement (TJR) of the hip and knee. While wait time management strategies (WTMS) are promising, the factors which influence their sustainable implementation at the organizational level are understudied. Consequently, this study examined organizational and systemic factors that made it possible to sustain waiting times for TJR within federally established limits and for at least 18 months or more. The research design is a multiple case study of WTMS implementation. Five cases were selected across five Canadian provinces. Three success levels were pre-defined: 1) the WTMS maintained compliance with requirements for more than 18 months; 2) the WTMS met requirements for 18 months but could not sustain the level thereafter; 3) the WTMS never met requirements. For each case, we collected documents and interviewed key informants. We analyzed systemic and organizational factors, with particular attention to governance and leadership, culture, resources, methods, and tools. We found that successful organizations had specific characteristics: 1) management of the whole care continuum, 2) strong clinical leadership; 3) dedicated committees to coordinate and sustain strategy; 4) a culture based on trust and innovation. All strategies led to relatively similar unintended consequences. The main negative consequence was an initial increase in waiting times for TJR and the main positive consequence was operational enhancement of other areas of specialization based on the TJR model. This study highlights important differences in factors which help to achieve and sustain waiting times. To be sustainable, a WTMS needs to generate greater synergies between contextual-level strategy (provincial or regional) and organizational objectives and constraints. Managers at the organizational level should be vigilant with regard to unintended consequences that a WTMS in one area can have for other areas of care. A more systemic approach to sustainability can help avoid or mitigate undesirable unintended consequences.

Stressful Life Events Around the Time of Unplanned Pregnancy and Women's Health: Exploratory Findings from a National Sample.

PubMed

Hall, Kelli Stidham; Dalton, Vanessa K; Zochowski, Melissa; Johnson, Timothy R B; Harris, Lisa H

2017-06-01

Objective Little is known about how women's social context of unintended pregnancy, particularly adverse social circumstances, relates to their general health and wellbeing. We explored associations between stressful life events around the time of unintended pregnancy and physical and mental health. Methods Data are drawn from a national probability study of 1078 U.S. women aged 18-55. Our internet-based survey measured 14 different stressful life events occurring at the time of unintended pregnancy (operationalized as an additive index score), chronic disease and mental health conditions, and current health and wellbeing symptoms (standardized perceived health, depression, stress, and discrimination scales). Multivariable regression modeled relationships between stressful life events and health conditions/symptoms while controlling for sociodemographic and reproductive covariates. Results Among ever-pregnant women (N = 695), stressful life events were associated with all adverse health outcomes/symptoms in unadjusted analyses. In multivariable models, higher stressful life event scores were positively associated with chronic disease (aOR 1.21, CI 1.03-1.41) and mental health (aOR 1.42, CI 1.23-1.64) conditions, higher depression (B 0.37, CI 0.19-0.55), stress (B 0.32, CI 0.22-0.42), and discrimination (B 0.74, CI 0.45-1.04) scores, and negatively associated with ≥ very good perceived health (aOR 0.84, CI 0.73-0.97). Stressful life event effects were strongest for emotional and partner-related sub-scores. Conclusion Women with adverse social circumstances surrounding their unintended pregnancy experienced poorer health. Findings suggest that reproductive health should be considered in the broader context of women's health and wellbeing and have implications for integrated models of care that address women's family planning needs, mental and physical health, and social environments.

Robots and people with dementia: Unintended consequences and moral hazard.

PubMed

O'Brolcháin, Fiachra

2017-01-01

The use of social robots in elder care is entering the mainstream as robots become more sophisticated and populations age. While there are many potential benefits to the use of social robots in care for the older people, there are ethical challenges as well. This article focuses on the societal consequences of the adoption of social robots in care for people with dementia. Making extensive use of Alasdair MacIntyre's Dependent Rational Animals to discuss issues of unintended consequences and moral hazard, we contend that in choosing to avoid the vulnerability and dependency of human existence, a society blinds itself from the animal reality of humankind. The consequence of this is that a flourishing society, in which each individual is helped to develop the virtues essential to her flourishing, becomes harder to achieve.

Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization.

PubMed

Wang, George Sam

2017-03-01

An "unintended consequence" of marijuana legalization is the impact on the pediatric population. From prenatal exposure to unintentional childhood exposures, through concerns of adolescence abuse and marijuana use for medicinal indications in children, marijuana exposure can affect pediatric patients at every stage in childhood. Regardless of the stage or reason of exposure, concerns exist about short-term and long-term consequences in a child's physical and mental health. The use of cannabidiol (CBD) may have some benefit for the treatment of epilepsy, but emphasis needs to be on rigorous clinical trials to evaluate efficacy and safety. As more states allow both medical and recreational marijuana, availability and prevalence of use will likely increase and more surveillance and research is needed to evaluate the consequences on the pediatric population.

The association and a potential pathway between gender-based violence and induced abortion in Thai Nguyen province, Vietnam.

PubMed

Nguyen, Phuong Hong; Nguyen, Son Van; Nguyen, Manh Quang; Nguyen, Nam Truong; Keithly, Sarah Colleen; Mai, Lan Tran; Luong, Loan Thi Thu; Pham, Hoa Quynh

2012-11-29

Gender-based violence (GBV) has profound adverse consequences on women's physical, mental, and reproductive health. Although Vietnam has high rates of induced abortion and GBV, literature examining this relationship is lacking. This study examines the association of GBV with induced abortion among married or partnered women of reproductive age in Thai Nguyen province, Vietnam. In addition, we explore contraceptive use and unintended pregnancy as mediators in the pathway between GBV and induced abortion. Data were drawn from a cross-sectional survey of 1,281 women aged 18-49 years in four districts of Thai Nguyen province. Bivariate and multivariate logistic regression analyses were applied to examine the associations between lifetime history of GBV, contraceptive use, unintended pregnancy, induced abortion, and repeat abortion, controlling for other covariates. One-third of respondents had undergone induced abortion in their lifetime (33.4%), and 11.5% reported having repeat abortions. The prevalence of any type of GBV was 29.1% (17.0% physical violence, 10.4% sexual violence, and 20.1% emotional violence). History of GBV was associated with induced abortion (OR=1.61, 95% CI: 1.20-2.16) and repeat abortion (OR=2.22, 95% CI: 1.48-3.32). Physical violence was significantly associated with induced abortion, and all three types of violence were associated with repeat abortion. Abused women were more likely than non-abused women to report using contraceptives and having an unintended pregnancy, and these factors were in turn associated with increased risk of induced abortion. GBV is pervasive in Thai Nguyen province and is linked to increased risks of induced abortion and repeat abortion. The findings suggest that a pathway underlying this relationship is increased risk of unintended pregnancy due in part to ineffective use of contraceptives. These findings emphasize the importance of screening and identification of GBV and incorporating women's empowerment in reproductive health and family planning programs.

The association and a potential pathway between gender-based violence and induced abortion in Thai Nguyen province, Vietnam

PubMed Central

Nguyen, Phuong Hong; Van Nguyen, Son; Nguyen, Manh Quang; Nguyen, Nam Truong; Keithly, Sarah Colleen; Tran Mai, Lan; Thi Thu Luong, Loan; Pham, Hoa Quynh

2012-01-01

Background Gender-based violence (GBV) has profound adverse consequences on women's physical, mental, and reproductive health. Although Vietnam has high rates of induced abortion and GBV, literature examining this relationship is lacking. Objective This study examines the association of GBV with induced abortion among married or partnered women of reproductive age in Thai Nguyen province, Vietnam. In addition, we explore contraceptive use and unintended pregnancy as mediators in the pathway between GBV and induced abortion. Design and methods Data were drawn from a cross-sectional survey of 1,281 women aged 18–49 years in four districts of Thai Nguyen province. Bivariate and multivariate logistic regression analyses were applied to examine the associations between lifetime history of GBV, contraceptive use, unintended pregnancy, induced abortion, and repeat abortion, controlling for other covariates. Results One-third of respondents had undergone induced abortion in their lifetime (33.4%), and 11.5% reported having repeat abortions. The prevalence of any type of GBV was 29.1% (17.0% physical violence, 10.4% sexual violence, and 20.1% emotional violence). History of GBV was associated with induced abortion (OR=1.61, 95% CI: 1.20–2.16) and repeat abortion (OR=2.22, 95% CI: 1.48–3.32). Physical violence was significantly associated with induced abortion, and all three types of violence were associated with repeat abortion. Abused women were more likely than non-abused women to report using contraceptives and having an unintended pregnancy, and these factors were in turn associated with increased risk of induced abortion. Conclusions GBV is pervasive in Thai Nguyen province and is linked to increased risks of induced abortion and repeat abortion. The findings suggest that a pathway underlying this relationship is increased risk of unintended pregnancy due in part to ineffective use of contraceptives. These findings emphasize the importance of screening and identification of GBV and incorporating women's empowerment in reproductive health and family planning programs. PMID:23195517

Public health decisions: Actions and consequences☆

PubMed Central

Pohl, H.R.; Jones, D.E.; Holler, J.S.; Murray, H.E.

2017-01-01

The goal of public health is to promote the best possible health for the whole population. Public health issues are numerous and can be unbelievably complex in form, scope, and possible consequence. Most public health decisions involve assessing several different options, weighing the respective benefits and risks of those options, and making difficult decisions that hopefully provide the greatest benefit to the affected populations. Many risk management decisions involve a variety of societal factors which modify risk assessment choices. The purpose of this paper is to point out difficulties in making decisions that impact public health. The intent of such decisions is to improve public health, but as illustrated in the paper, there can be unintended adverse consequences. Such unplanned issues require continued attention and efforts for responsible officials in the protection of environmental public health. This article presents examples of such events, when in the past, it was necessary to assess and regulate a number of potentially hazardous chemicals commonly used as insecticides, gasoline additives, and wood preservatives. PMID:25092130

["Unintended consequences of scientific discoveries" or: "Heterogeny of purposes" as phenomena of the history of science].

PubMed

Wittkau-Horgby, A

2001-01-01

This paper deals with an old observation in respect to man's action--the problem of unintended consequences of human action. It presents the scientific approaches to this phenomenon in the 18th century and focusses then on the problem of unintended consequences of scientific discoveries. Using the prominent examples of Copernicus and Darwin the author shows that the actual outcomes and final effects of scientific discoveries must not necessarily be the originally intended ones. On the contrary, especially those results of scientific discoveries which have affected the sphere of world view (Weltanschauung) like the research works of Copernicus and Darwin were originally meant to be only scientific studies. The final results in respect to the world view were on Copernicus' side not even realized and on Darwin's side neither intended nor welcomed. The conclusion of this analysis is that due to the fact that both scientists did not have the intention to change the world view they can only partly be regarded to be responsible for the fundamental changes they finally caused.

Unintended Consequences of Incentive Provision for Behaviour Change and Maintenance around Childbirth

PubMed Central

Thomson, Gill; Morgan, Heather; Crossland, Nicola; Bauld, Linda; Dykes, Fiona; Hoddinott, Pat

2014-01-01

Financial (positive or negative) and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497) including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing service delivery, but may be detrimental to other health care areas. Financial incentives are controversial and generated emotive and oppositional responses. The planning, design and delivery of future incentive interventions should evaluate unexpected consequences to inform the evidence for effectiveness, cost-effectiveness and future implementation. PMID:25357121

Unintended consequences of incentive provision for behaviour change and maintenance around childbirth.

PubMed

Thomson, Gill; Morgan, Heather; Crossland, Nicola; Bauld, Linda; Dykes, Fiona; Hoddinott, Pat; Dombrowski, Stephan; MacLennan, Graeme; Rothnie, Kieran; Stewart, Fiona; Farrar, Shelley; Yi, Deokhee; Hislop, Jenni; Ludbrook, Anne; Campbell, Marion; Moran, Victoria Hall; Sniehotta, Falko; Tappin, David

2014-01-01

Financial (positive or negative) and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497) including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing service delivery, but may be detrimental to other health care areas. Financial incentives are controversial and generated emotive and oppositional responses. The planning, design and delivery of future incentive interventions should evaluate unexpected consequences to inform the evidence for effectiveness, cost-effectiveness and future implementation.

Menu labeling: the unintended consequences to the consumer.

PubMed

Black, Ellen A

2014-01-01

The Affordable Care Act requires certain restaurants to provide nutritional information on their menus and menu boards, which is referred to as menu labeling. Menu labeling presupposes that providing consumers with the nutritional information about their food will cause them to reconsider their food choices by picking healthier food options over less healthy options, thereby reducing the nation's high obesity rate. However, several studies have shown that consumers do not make healthier food choices even when armed with menu labeling. The issue then becomes whether menu labeling provides a correlative benefit to consumers or whether there are unintended consequences that ultimately harm consumers.

Unintended consequences and trade-offs of fish passage

USGS Publications Warehouse

McLaughlin, Robert L.; Smyth, Eric R.; Castro-Santos, Theodore; Jones, Michael L.; Koops, Marten A.; Pratt, Thomas C.; Vélez-Espino, Luis-Antonio

2012-01-01

We synthesized evidence for unintended consequences and trade-offs associated with the passage of fishes. Provisioning of fish passageways at dams and dam removals are being carried out increasingly as resource managers seek ways to reduce fragmentation of migratory fish populations and restore biodiversity and nature-like ecosystem services in tributaries altered by dams. The benefits of provisioning upstream passage are highlighted widely. Possible unwanted consequences and trade-offs of upstream passage are coming to light, but remain poorly examined and underappreciated. Unintended consequences arise when passage of native and desirable introduced fishes is delayed, undone (fallback), results in patterns of movement and habitat use that reduce Darwinian fitness (e.g. ecological traps), or is highly selective taxonomically and numerically. Trade-offs arise when passage decisions intended to benefit native species interfere with management decisions intended to control the unwanted spread of non-native fishes and aquatic invertebrates, or genes, diseases and contaminants carried by hatchery and wild fishes. These consequences and trade-offs will vary in importance from system to system and can result in large economic and environmental costs. For some river systems, decisions about how to manage fish passage involve substantial risks and could benefit from use of a formal, structured process that allows transparent, objective and, where possible, quantitative evaluation of these risks. Such a process can also facilitate the design of an adaptive framework that provides valuable insights into future decisions.

Using the lessons of behavioral economics to design more effective pay-for-performance programs.

PubMed

Mehrotra, Ateev; Sorbero, Melony E S; Damberg, Cheryl L

2010-07-01

To describe improvements in the design of pay-for-performance (P4P) programs that reflect the psychology of how people respond to incentives. Investigation of the behavioral economics literature. We describe 7 ways to improve P4P program design in terms of frequency and types of incentive payments. After discussing why P4P incentives can have unintended adverse consequences, we outline potential ways to mitigate these. Although P4P incentives are increasingly popular, the healthcare literature shows that these have had minimal effect. Design improvements in P4P programs can enhance their effectiveness. Lessons from behavioral economics may greatly enhance the design and effectiveness of P4P programs in healthcare, but future work is needed to demonstrate this empirically.

Monitoring Hospitalized Adult Patients for Opioid-Induced Sedation and Respiratory Depression.

PubMed

Jungquist, Carla R; Smith, Kirsten; Nicely, Kelly L Wiltse; Polomano, Rosemary C

2017-03-01

: Opioid analgesics are commonly administered to hospitalized patients to treat acute pain, but these drugs put patients at risk for serious adverse events, such as unintended advancing sedation, respiratory depression, and death. Nurses play an important role in keeping patients safe by making clinical decisions about the frequency and intensity with which patients receiving IV and epidural opioids should be monitored. To make sound clinical judgments, nurses must be aware of the factors that place patients at elevated risk for adverse opioid-related effects and know how to screen and assess patients for these risks. The authors review the literature on unintended advancing sedation and respiratory depression associated with opioid administration and present evidence-based recommendations for clinical decision making and patient monitoring, using both nursing assessments and electronic technologies.

Missed pills: frequency, reasons, consequences and solutions.

PubMed

Chabbert-Buffet, Nathalie; Jamin, Christian; Lete, Iñaki; Lobo, Paloma; Nappi, Rossella E; Pintiaux, Axelle; Häusler, Günther; Fiala, Christian

2017-06-01

Oral hormonal contraception is an effective contraceptive method as long as regular daily intake is maintained. However, a daily routine is a constraint for many women and can lead to missed pills, pill discontinuation and/or unintended pregnancy. This article describes the frequency of inconsistent use, the consequences, the risk factors and the possible solutions. The article comprises a narrative review of the literature. Forgetting one to three pills per cycle is a frequent problem among 15-51% of users, generally adolescents. The reasons for this are age, inability to establish a routine, pill unavailability, side effects, loss of motivation and lack of involvement in the initial decision to use oral contraceptives. The consequences are 'escape ovulations' and, possibly, unintended pregnancy. Solutions are either to use a long-acting method or, for women who prefer to take oral contraceptives, use a continuous or long-cycle regimen to reduce the risks of follicular development and thus the likelihood of ovulation and unintended pregnancy. A progestogen with a long half-life can increase ovarian suppression. For women deciding to use oral contraceptives, a shortened or eliminated hormone-free interval and a progestogen with a long half-life may be an option to reduce the negative consequences of missed oral contraceptive pills.

The Unintended and Intended Academic Consequences of Educational Reforms: The Cases of Post-Soviet Estonia, Latvia and Russia

ERIC Educational Resources Information Center

Khavenson, Tatiana; Carnoy, Martin

2016-01-01

In this paper, we try to unravel some of the unintended and intended academic effects associated with post-Soviet educational reforms by focusing on three cases: Estonia, Latvia and Russia. We have chosen this comparison because a unique "natural experiment" in the three countries allows us to compare the changing academic performance on…

Beyond love: a qualitative analysis of factors associated with teenage pregnancy among young women with pregnancy experience in Bolgatanga, Ghana.

PubMed

Krugu, John Kingsley; Mevissen, Fraukje; Münkel, Meret; Ruiter, Robert

2017-03-01

Globally, an estimated 16 million young women aged 15 to 19 years give birth every year. Most teenage pregnancies are unintended and being pregnant or delivering a baby as a teenager can have serious adverse consequences. Knowledge of the environmental factors and social cognitive determinants influencing young women's failure to protect against unintended pregnancy is necessary to address the high rate of teenage pregnancies. We conducted semi-structured in-depth interviews with 21 young women, who had experience of pregnancy, in Bolgatanga, Ghana. The interview protocol included themes (relationships, sex, pregnancy, family planning) and determinants (knowledge, attitudes, self-efficacy, norms, risk perceptions) derived from empirical studies and theories related to sexuality behaviour. Findings show that young women's motivations for sexual relationships are mostly 'beyond love' and seem to focus on economic factors. The main means of sexual protection seems to be condom use. Other forms of contraception were believed to be linked to infertility. Sexuality remains a largely taboo topic for open discussion and sex education in schools seems limited to abstinence-only messages. The need for more open communication on matters of sexuality with young people and the provision of a more comprehensive sexuality education in school to address teenage pregnancies in Ghana, is discussed.

Does public reporting influence quality, patient and provider's perspective, market share and disparities? A review.

PubMed

Vukovic, Vladimir; Parente, Paolo; Campanella, Paolo; Sulejmani, Adela; Ricciardi, Walter; Specchia, Maria Lucia

2017-12-01

Public reporting (PR) of healthcare (HC) provider's quality was proposed as a public health instrument for providing transparency and accountability in HC. Our aim was to assess the impact of PR on five main domains: quality improvement; patient choice, service utilization and market share; provider's perspective; patient experience; and unintended consequences. PubMed, Scopus, ISI WOS, and EconLit databases were searched to identify studies investigating relationships between PR and five main domains, published up to April 1, 2016. Sixty-two papers published between 1988 and 2015 were included. Nineteen studies investigated quality improvement, 19 studies explored the unintended consequences of PR, 10 explored the effects on market share, 10 on patients' choice, 7 evaluated the provider's perspective, 4 economic outcome, 4 service utilization, 2 purchasers' use of PR and 2 studies explored patient experiences. The effect of PR was diverse throughout the studies-mostly positive on: patient experience (100%), quality improvement (63%), patient choice, service utilization and market share (46%); mixed on provider's perspective and economic outcome (27%) and mainly negative on unintended consequences (68%). Our research covering different outcomes and settings reported that PR is associated with changes in HC provider's behavior and can influence market share. Unintended consequences are a concern of PR and should be taken into account when allocating HC resources. The experiences collected in this paper could give a snapshot about the impact of PR on a HC user's perception of the providers' quality of care, helping them to make empowered choices. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Systematic iteration between model and methodology: A proposed approach to evaluating unintended consequences.

PubMed

Morell, Jonathan A

2018-06-01

This article argues that evaluators could better deal with unintended consequences if they improved their methods of systematically and methodically combining empirical data collection and model building over the life cycle of an evaluation. This process would be helpful because it can increase the timespan from when the need for a change in methodology is first suspected to the time when the new element of the methodology is operational. The article begins with an explanation of why logic models are so important in evaluation, and why the utility of models is limited if they are not continually revised based on empirical evaluation data. It sets the argument within the larger context of the value and limitations of models in the scientific enterprise. Following will be a discussion of various issues that are relevant to model development and revision. What is the relevance of complex system behavior for understanding predictable and unpredictable unintended consequences, and the methods needed to deal with them? How might understanding of unintended consequences be improved with an appreciation of generic patterns of change that are independent of any particular program or change effort? What are the social and organizational dynamics that make it rational and adaptive to design programs around single-outcome solutions to multi-dimensional problems? How does cognitive bias affect our ability to identify likely program outcomes? Why is it hard to discern change as a result of programs being embedded in multi-component, continually fluctuating, settings? The last part of the paper outlines a process for actualizing systematic iteration between model and methodology, and concludes with a set of research questions that speak to how the model/data process can be made efficient and effective. Copyright © 2017 Elsevier Ltd. All rights reserved.

Intended and Unintended Effects of State-Mandated High School Science and Mathematics Course Graduation Requirements on Educational Attainment

ERIC Educational Resources Information Center

Plunk, Andrew D.; Tate, William F.; Bierut, Laura J.; Grucza, Richard A.

2014-01-01

Mathematics and science course graduation requirement (CGR) increases in the 1980s and 1990s might have had both intended and unintended consequences. Using logistic regression with Census and American Community Survey (ACS) data (n = 2,892,444), we modeled CGR exposure on (a) high school dropout, (b) beginning college, and (c) obtaining any…

The Unintended Hegemonic Effects of a Limited Concession: Institutional Incorporation of Chinese Schools in Post-War Hong Kong

ERIC Educational Resources Information Center

Wong, Ting-Hong

2012-01-01

Using the case of Chinese schools in post-Second World War Hong Kong, this paper explores the unintended consequences of an incomplete hegemonic project. After World War II, anti-imperialist pressures and rising educational demands in the local setting propelled the colonial authorities to be more active in providing and funding Chinese schools.…

Telemedicine to promote patient safety: Use of phone-based interactive voice response system (IVRS) to reduce adverse safety events in predialysis CKD

PubMed Central

Weiner, Shoshana; Fink, Jeffery C.

2017-01-01

Chronic kidney disease (CKD) patients have several features conferring upon them a high risk of adverse safety events, which are defined as incidents with unintended harm related to processes of care or medications. These characteristics include impaired renal function, polypharmacy, and frequent health system encounters. The consequences of such events in CKD can include new or prolonged hospitalization, accelerated renal function loss, acute kidney injury, end-stage renal disease and death. Health information technology administered via telemedicine presents opportunities for CKD patients to remotely communicate safety-related findings to providers for the purpose of improving their care. However, many CKD patients have limitations which hinder their use of telemedicine and access to the broad capabilities of health information technology. In this review we summarize previous assessments of the pre-dialysis CKD populations’ proficiency in using telemedicine modalities and describe the use of interactive voice-response system (IVRS) to gauge the safety phenotype of the CKD patient. We discuss the potential for expanded IVRS use in CKD to address the safety threats inherent to this population. PMID:28224940

Optimising import risk mitigation: anticipating the unintended consequences and competing risks of informal trade.

PubMed

Hueston, W; Travis, D; van Klink, E

2011-04-01

The effectiveness of risk mitigation may be compromised by informal trade, including illegal activities, parallel markets and extra-legal activities. While no regulatory system is 100% effective in eliminating the risk of disease transmission through animal and animal product trade, extreme risk aversion in formal import health regulations may increase informal trade, with the unintended consequence of creating additional risks outside regulatory purview. Optimal risk mitigation on a national scale requires scientifically sound yet flexible mitigation strategies that can address the competing risks of formal and informal trade. More robust risk analysis and creative engagement of nontraditional partners provide avenues for addressing informal trade.

The Unintended Consequences of Social Media in Healthcare: New Problems and New Solutions.

PubMed

Hors-Fraile, S; Atique, S; Mayer, M A; Denecke, K; Merolli, M; Househ, M

2016-11-10

Social media is increasingly being used in conjunction with health information technology (health IT). The objective of this paper is to identify some of the undesirable outcomes that arise from this integration and to suggest solutions to these problems. After a discussion with experts to elicit the topics that should be included in the survey, we performed a narrative review based on recent literature and interviewed multidisciplinary experts from different areas. In each case, we identified and analyzed the unintended effects of social media in health IT. Each analyzed topic provided a different set of unintended consequences. Most relevant consequences include lack of privacy with ethical and legal issues, patient confusion in disease management, poor information accuracy in crowdsourcing, unclear responsibilities, misleading and biased information in the prevention and detection of epidemics, and demotivation in gamified health solutions with social components. Using social media in healthcare offers several benefits, but it is not exempt of potential problems, and not all of these problems have clear solutions. We recommend careful design of digital systems in order to minimize patient's feelings of demotivation and frustration and we recommend following specific guidelines that should be created by all stakeholders in the healthcare ecosystem.

Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy.

PubMed

Nanji, Karen C; Rothschild, Jeffrey M; Boehne, Jennifer J; Keohane, Carol A; Ash, Joan S; Poon, Eric G

2014-01-01

Electronic prescribing systems have often been promoted as a tool for reducing medication errors and adverse drug events. Recent evidence has revealed that adoption of electronic prescribing systems can lead to unintended consequences such as the introduction of new errors. The purpose of this study is to identify and characterize the unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in an outpatient pharmacy. A multidisciplinary team conducted direct observations of workflow in an independent pharmacy and semi-structured interviews with pharmacy staff members about their perceptions of the unrealized potential and residual consequences of electronic prescribing systems. We used qualitative methods to iteratively analyze text data using a grounded theory approach, and derive a list of major themes and subthemes related to the unrealized potential and residual consequences of electronic prescribing. We identified the following five themes: Communication, workflow disruption, cost, technology, and opportunity for new errors. These contained 26 unique subthemes representing different facets of our observations and the pharmacy staff's perceptions of the unrealized potential and residual consequences of electronic prescribing. We offer targeted solutions to improve electronic prescribing systems by addressing the unrealized potential and residual consequences that we identified. These recommendations may be applied not only to improve staff perceptions of electronic prescribing systems but also to improve the design and/or selection of these systems in order to optimize communication and workflow within pharmacies while minimizing both cost and the potential for the introduction of new errors.

Parents' experience of unintended childbearing: A qualitative study of factors that mitigate or exacerbate effects.

PubMed

Kavanaugh, Megan L; Kost, Kathryn; Frohwirth, Lori; Maddow-Zimet, Isaac; Gor, Vivian

2017-02-01

Births resulting from an unintended pregnancy affect individuals differentially, and some may experience more negative consequences than others. In this study, we sought to describe the mechanisms through which the severity of effects may be mitigated or exacerbated. We conducted in-depth interviews with 35 women and 30 men, all with a youngest child born resulting from an unintended pregnancy, in two urban sites in the United States. Respondents described both negative and positive effects of the child's birth in the areas of school; work and finances; partner relationships; personal health and outlook on life trajectories. Mechanisms through which unintended pregnancies mitigated or exacerbated certain effects fell at the individual (e.g. lifestyle modification), interpersonal (e.g. partner support) and structural (e.g. workplace flexibility) levels. These qualitative findings deepen understanding of the impact of unintended childbearing on the lives of women, men and families. Copyright © 2016 Elsevier Ltd. All rights reserved.

Legal and policy responses to children exposed to domestic violence: the need to evaluate intended and unintended consequences.

PubMed

Jaffe, Peter G; Crooks, Claire V; Wolfe, David A

2003-09-01

Greater training and specialization in working with children exposed to domestic violence has resulted in new policies, interagency protocols, and legislation in many states. This paper examines court-related responses in criminal, child protection, and family court custody proceedings, which highlight legislative changes and resulting systemic change. Although this legislation originated with the best of intentions to assist and protect children, some of the most striking outcomes have been negative and unintended. Laws that mandate reporting of children exposed to domestic violence can clash with inadequate training and resources, or inadvertently revictimize abused women. Similarly, child custody legislation that raises a rebuttable presumption that a violent spouse will not receive custody or joint custody of children after parental separation has resulted in greater skepticism about abuse allegations We propose that efforts at law reform can be enhanced by a more thoughtful analysis of potential intended and unintended consequences, and should be accompanied by a comprehensive evaluation plan to monitor implementation effects.

Governance of malaria prevention: How decision-makers' and pregnant women's sensemaking contribute to unintended consequences.

PubMed

Danhoundo, Georges; Wiktorowicz, Mary E; Yaya, Sanni

2017-03-01

Although malaria in pregnancy predisposes women to increased perinatal mortality and morbidity, complex issues underlie its persistence. To develop a better understanding of the factors affecting women's access to Intermittent Preventive Treatment in Benin, we used the theoretical lens of "sensemaking" to clarify policymakers', health professionals', and women's perspectives concerning preventive policies and barriers to access. Several assumptions were found to underlie Benin's malaria preventive policy that contribute to the unintended effect of deterring pregnant women in poverty from accessing preventive treatment. Health system dysfunctions including drug shortages and deficiencies in health care professionalism exacerbate the unintended effect.

Antibiotic Stewardship Initiatives as Part of the UK 5-Year Antimicrobial Resistance Strategy

PubMed Central

Johnson, Alan P.; Ashiru-Oredope, Diane; Beech, Elizabeth

2015-01-01

Antibiotic use is a major driver for the emergence and spread of antibiotic resistance. Antimicrobial stewardship programmes aim to improve antibiotic prescribing with the objectives of optimizing clinical outcomes while at the same time minimizing unintended consequences such as adverse effects and the selection of antibiotic resistance. In 2013, a five-year national strategy for tackling antimicrobial resistance was published in the UK. The overarching goal of the strategy is to slow the development and spread of resistance and to this end it has three strategic aims, namely to improve knowledge and understanding of resistance, to conserve and steward the effectiveness of existing treatments and to stimulate the development of new antibiotics, diagnostics and novel therapies. This article reviews the antimicrobial stewardship activities included in the strategy and describes their implementation and evaluation. PMID:27025636

Promises and pitfalls of data sharing in qualitative research

PubMed Central

Tsai, Alexander C.; Kohrt, Brandon A.; Matthews, Lynn T.; Betancourt, Theresa S.; Lee, Jooyoung K.; Papachristos, Andrew V.; Weiser, Sheri D.; Dworkin, Shari L.

2017-01-01

The movement for research transparency has gained irresistible momentum over the past decade. Although qualitative research is rarely published in the high-impact journals that have adopted, or are most likely to adopt, data sharing policies, qualitative researchers who publish work in these and similar venues will likely encounter questions about data sharing within the next few years. The fundamental ways in which qualitative and quantitative data differ should be considered when assessing the extent to which qualitative and mixed methods researchers should be expected to adhere to data sharing policies developed with quantitative studies in mind. We outline several of the most critical concerns below, while also suggesting possible modifications that may help to reduce the probability of unintended adverse consequences and to ensure that the sharing of qualitative data is consistent with ethical standards in research. PMID:27535900

People, Planet and Profit: Unintended Consequences of Legacy Building Materials

EPA Science Inventory

Although an explosion of new building materials are being introduced into today's market, adequate up-front research into their chemical and physical properties as well as their potential health and environmental consequences is lacking. History has provided us with several exam...

Estimating Contraceptive Needs and Increasing Access to Contraception in Response to the Zika Virus Disease Outbreak--Puerto Rico, 2016.

PubMed

Tepper, Naomi K; Goldberg, Howard I; Bernal, Manuel I Vargas; Rivera, Brenda; Frey, Meghan T; Malave, Claritsa; Renquist, Christina M; Bracero, Nabal Jose; Dominguez, Kenneth L; Sanchez, Ramon E; Shapiro-Mendoza, Carrie K; Rodriguez, Blanca R Cuevas; Simeone, Regina M; Pesik, Nicki T; Barfield, Wanda D; Ko, Jean Y; Galang, Romeo R; Perez-Padilla, Janice; Polen, Kara N D; Honein, Margaret A; Rasmussen, Sonja A; Jamieson, Denise J

2016-04-01

Zika virus is a flavivirus transmitted primarily by Aedes species mosquitoes. Increasing evidence links Zika virus infection during pregnancy to adverse pregnancy and birth outcomes, including pregnancy loss, intrauterine growth restriction, eye defects, congenital brain abnormalities, and other fetal abnormalities. The virus has also been determined to be sexually transmitted. Because of the potential risks associated with Zika virus infection during pregnancy, CDC has recommended that health care providers discuss prevention of unintended pregnancy with women and couples who reside in areas of active Zika virus transmission and do not want to become pregnant. However, limitations in access to contraception in some of these areas might affect the ability to prevent an unintended pregnancy. As of March 16, 2016, the highest number of Zika virus disease cases in the United States and U.S. territories were reported from Puerto Rico. The number of cases will likely rise with increasing mosquito activity in affected areas, resulting in increased risk for transmission to pregnant women. High rates of unintended and adolescent pregnancies in Puerto Rico suggest that, in the context of this outbreak, access to contraception might need to be improved. CDC estimates that 138,000 women of reproductive age (aged 15-44 years) in Puerto Rico do not desire pregnancy and are not using one of the most effective or moderately effective contraceptive methods, and therefore might experience an unintended pregnancy. CDC and other federal and local partners are seeking to expand access to contraception for these persons. Such efforts have the potential to increase contraceptive access and use, reduce unintended pregnancies, and lead to fewer adverse pregnancy and birth outcomes associated with Zika virus infection during pregnancy. The assessment of challenges and resources related to contraceptive access in Puerto Rico might be a useful model for other areas with active transmission of Zika virus.

Young women's education and behavioural risk trajectories: clarifying their association with unintended-pregnancy resolution.

PubMed

Gomez-Scott, Jessica; Cooney, Teresa M

2014-06-01

In the USA, most pregnancies occurring to teenage women are unplanned, making both the decisions regarding their resolution and the consequences of those decisions important topics of inquiry. Substantial debate surrounds the potential consequences for young women of either carrying an unintended pregnancy to term or voluntarily terminating it. The present study utilises data from The US National Longitudinal Study of Adolescent Health prospectively to examine the predictors of pregnancy resolution decisions in terms of young women's educational goals and their engagement in risk behaviours. Additionally, the long-term consequences of these decisions for education and risk-taking behaviours are identified. Results indicate that young women with strong educational goals have a greater likelihood of terminating an unintended pregnancy than those with low aspirations, and that pregnancy termination predicts higher educational attainment compared to motherhood. Risk behaviours did not predict pregnancy-resolution decisions, but young women who became mothers reported lower rates of subsequent substance use and fewer sexual partners post-pregnancy than those who terminated the pregnancy or who had never been pregnant. Motherhood appears to be a catalyst for lifestyle change among young women, limiting substance use and sexual partnering, in contrast to abortion, which appears to allow adolescents to continue risk-taking trajectories.

The Unintended Consequences of Social Media in Healthcare: New Problems and New Solutions

PubMed Central

Atique, S.; Mayer, M. A.; Denecke, K.; Merolli, M.; Househ, M.

2016-01-01

Summary Objectives Social media is increasingly being used in conjunction with health information technology (health IT). The objective of this paper is to identify some of the undesirable outcomes that arise from this integration and to suggest solutions to these problems. Methodology After a discussion with experts to elicit the topics that should be included in the survey, we performed a narrative review based on recent literature and interviewed multidisciplinary experts from different areas. In each case, we identified and analyzed the unintended effects of social media in health IT. Results Each analyzed topic provided a different set of unintended consequences. Most relevant consequences include lack of privacy with ethical and legal issues, patient confusion in disease management, poor information accuracy in crowdsourcing, unclear responsibilities, misleading and biased information in the prevention and detection of epidemics, and demotivation in gamified health solutions with social components. Conclusions Using social media in healthcare offers several benefits, but it is not exempt of potential problems, and not all of these problems have clear solutions. We recommend careful design of digital systems in order to minimize patient’s feelings of demotivation and frustration and we recommend following specific guidelines that should be created by all stakeholders in the healthcare ecosystem. PMID:27830230

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

PubMed

Spencer, Grace

2015-12-01

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

Health Informatics in Developing Countries: A Review of Unintended Consequences of IT Implementations, as They Affect Patient Safety and Recommendations on How to Address Them.

PubMed

Park, Hyeoun-Ae

2016-11-10

Patient safety concerns every healthcare organization. Adoption of Health information technology (HIT) appears to have the potential to address this issue, however unanticipated and undesirable consequences from implementing HIT could lead to new and more complex hazards. This could be particularly problematic in developing countries, where regulations, policies and implementations are few, less standandarized and in some cases almost non-existing. Based on the available information and our own experience, we conducted a review of unintended consequences of HIT implementations, as they affect patient safety in developing countries. We found that user dependency on the system, alert fatigue, less communications among healthcare actors and workarounds topics should be prioritize. Institution should consider existing knowledge, learn from other experiences and model their implementations to avoid known consequences. We also recommend that they monitor and communicate their own efforts to expand knowledge in the region.

System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.

PubMed

Worni, Mathias; Pietrobon, Ricardo; Zammar, Guilherme Roberto; Shah, Jatin; Yoo, Bryan; Maldonato, Mauro; Takemoto, Steven; Vail, Thomas P

2012-01-01

The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA. The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020. System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA.

The lesser of two adverse reactions.

PubMed

Chakraborti, Chayan; Egan, John

2010-01-01

Fundamental to complex systems are interconnected processes involved in providing high-quality patient care. A case study and a root cause analysis (RCA) illustrate a patient safety effort with unintended consequences. A 38-year-old woman presented to the hospital for odynophagia and vomiting. The patient developed Mobitz type 2, second-degree heart block temporally associated with the administration of intravenous ondansetron. RESPONSE TO THE EVENT: An Ishikawa, or fishbone, diagram conducted to enumerate potential contributing factors indicated that a key factor appeared to be an institutional restriction against using intravenous (i.v.) promethazine, which resulted in ondansetron being the only readily available i.v. anti-emetic on formulary. The anesthesia department requested that i.v. promethazine be removed from all operating and recovery room automated medication dispensing machines. The pharmacy department, given the realization that individual departments were taking independent action regarding promethazine, discussed the matter with the medical director, who issued a memo banning the use of i.v. promethazine. An institutional ban on i.v. anti-emetics such as promethazine may have resulted in an increase in the use of ondansetron and contributed to this adverse reaction. The reason to restrict promethazine is not well reported in the literature. In limiting the use of promethazine for patient safety concerns, the inadvertent increase in adverse reactions of the alternative medication, ondansetron, may have been overlooked. The resultant RCA underscores the need for careful cataloguing of adverse medication effects. Stakeholders should anticipate as many "downstream effects" of quality and patient safety improvements as possible. Comprehensive reporting of adverse medication effects will augment the emerging science of patient safety.

Promises and pitfalls of data sharing in qualitative research.

PubMed

Tsai, Alexander C; Kohrt, Brandon A; Matthews, Lynn T; Betancourt, Theresa S; Lee, Jooyoung K; Papachristos, Andrew V; Weiser, Sheri D; Dworkin, Shari L

2016-11-01

The movement for research transparency has gained irresistible momentum over the past decade. Although qualitative research is rarely published in the high-impact journals that have adopted, or are most likely to adopt, data sharing policies, qualitative researchers who publish work in these and similar venues will likely encounter questions about data sharing within the next few years. The fundamental ways in which qualitative and quantitative data differ should be considered when assessing the extent to which qualitative and mixed methods researchers should be expected to adhere to data sharing policies developed with quantitative studies in mind. We outline several of the most critical concerns below, while also suggesting possible modifications that may help to reduce the probability of unintended adverse consequences and to ensure that the sharing of qualitative data is consistent with ethical standards in research. Copyright © 2016 Elsevier Ltd. All rights reserved.

Treatment of Fever After Stroke: Conflicting Evidence

PubMed Central

Wrotek, Sylwia E.; Kozak, Wieslaw E.; Hess, David C.; Fagan, Susan C.

2014-01-01

Approximately 50% of patients hospitalized for stroke develop fever. In fact, experimental evidence suggests that high body temperature is significantly correlated to initial stroke severity, lesion size, mortality, and neurologic outcome. Fever occurring after stroke is associated with poor outcomes. We investigated the etiology of fever after stroke and present evidence evaluating the efficacy and safety of interventions used to treat stroke-associated fever. Oral antipyretics are only marginally effective in lowering elevated body temperature in this population and may have unintended adverse consequences. Nonpharmacologic approaches to cooling have been more effective in achieving normothermia, but whether stroke outcomes can be improved remains unclear. We recommend using body temperature as a biomarker and a catalyst for aggressive investigation for an infectious etiology. Care must be taken not to exceed the new standard of a maximum acetaminophen does of 3 g/day to avoid patient harm. PMID:22026396

Penalizing hospitals for chronic obstructive pulmonary disease readmissions.

PubMed

Feemster, Laura C; Au, David H

2014-03-15

In October 2014, the U.S. Centers for Medicare and Medicaid Services (CMS) will expand its Hospital Readmission Reduction Program (HRRP) to include chronic obstructive pulmonary disease (COPD). Under the new policy, hospitals with high risk-adjusted, 30-day all-cause unplanned readmission rates after an index hospitalization for a COPD exacerbation will be penalized with reduced reimbursement for the treatment of Medicare beneficiaries. In this perspective, we review the history of the HRRP, including the recent addition of COPD to the policy. We critically assess the use of 30-day all-cause COPD readmissions as an accountability measure, discussing potential benefits and then highlighting the substantial drawbacks and potential unintended consequences of the measure that could adversely affect providers, hospitals, and patients with COPD. We conclude by emphasizing the need to place the 30-day COPD readmission measure in the context of a reconceived model for postdischarge quality and review several frameworks that could help guide this process.

Plant reproduction is altered by simulated herbicide drift to constructed plant communities

EPA Science Inventory

Herbicide drift may have unintended impacts on native vegetation, adversely affecting structure and function of plant communities. However, these potential effects have been rarely studied or quantified. To determine potential ecological effects of herbicide drift, we construct...

Death and Desirability: Retrospective Reporting of Unintended Pregnancy after a Child’s Death

PubMed Central

Smith-Greenaway, Emily; Sennott, Christie

2016-01-01

Social scientists have long debated how to best measure pregnancy intentions. The standard measure relies on mothers’ retrospective reports of their intentions at the time of their conception. Because women have already given birth at the time of this report, the resulting children’s health—including their vital status—may influence their mothers’ responses. We hypothesize that women are less likely to report deceased children were from unintended pregnancies, and this may explain why some longitudinal studies have shown that children from unintended pregnancies have lower survival, but cross-sectional studies produce counter findings. Using Demographic and Health Survey data from 31 sub-Saharan African countries, we confirm that mothers are less likely to report deceased children resulted from unintended pregnancies compared to surviving children, although the opposite is true for unhealthy children, who mothers more commonly report were from unintended pregnancies compared to healthier children. The results suggest that mothers (1) revise their recall of intentions after the traumatic experience of child death and/or (2) alter their reports in the face-to-face interview. The study challenges the reliability of retrospective reports of pregnancy intentions in high mortality settings, and thus our current knowledge of the levels and consequences of unintended pregnancies in these contexts. PMID:27150965

The incidence of induced abortion in Kinshasa, Democratic Republic of Congo, 2016.

PubMed

Chae, Sophia; Kayembe, Patrick K; Philbin, Jesse; Mabika, Crispin; Bankole, Akinrinola

2017-01-01

In the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion. Our study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa. We applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility. In 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15-49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15-49. Increasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality.

Sexual Harassment in the Workplace. Unanticipated Consequences of Modern Social Control in Organizations.

ERIC Educational Resources Information Center

Mueller, Charles W.; De Coster, Stacy; Estes, Sarah Beth

2001-01-01

Modern organizational changes purportedly intended to increase job satisfaction and reduce turnover are actually forms of social control. Analysis of data from 6,000 employees found that an unintended yet beneficial consequence of these changes is reduced sexual harassment. (Contains 60 references.) (SK)

The Intended and Unintended Consequences of International Service-Learning

ERIC Educational Resources Information Center

Crabtree, Robbin D.

2013-01-01

Previous research on service-learning in international contexts tends to focus on the benefits and outcomes for students and educational institutions. This essay is intended to provoke further examination of issues related to university-community engagement in global contexts, particularly in terms of the consequences for host communities. In…

Prevalence and determinants of terminated and unintended pregnancies among married women: analysis of pooled cross-sectional surveys in Nigeria

PubMed Central

Amouzou, Agbessi; Uthman, Olalekan A; Ekholuenetale, Michael; Bishwajit, Ghose; Udenigwe, Ogochukwu; Hudani, Alzahra; Shah, Vaibhav

2018-01-01

Background Induced pregnancy termination and unintended pregnancy are two commonly occurring phenomena in the discipline of women’s reproductive health. In the present study, we explored cross-sectional data pooled from three rounds of Nigeria Demographic and Health Survey (NDHS) to understand the trends of prevalence of pregnancy termination and unintended pregnancy as well as the interplay of various sociodemographic and economic factors whereby these health issues occur. Methods Study participants were 79 825 currently married women aged 15–49 years. Data were collected from NDHS conducted in 2003, 2008 and 2013. Outcome variables were self-reported history of pregnancy termination and unintended pregnancy for the last birth. Data were analysed using descriptive and multivariable logistic regression methods. Results Mean (±SD) age of the respondents was 28.7 years (±9.6). The overall prevalence of pregnancy termination and unintended pregnancy were about 11%. Older women had increase in the odds of terminated pregnancies, compared with women aged 15–19 years, while the converse was true for unintended pregnancy in the adjusted model. Educated women had significant higher odds of terminated and unintended pregnancies compared with women with no formal education. Women with higher wealth index were more likely to have unintended and terminated pregnancies after adjusting for other covariates. Remarkably, women who had unintended pregnancy were 1.47 times as likely to have terminated pregnancy compared with those who had no unintended pregnancy (OR=1.47; 95% CI 1.30 to 1.65). Experience of intimate partner violence had significant association with terminated and unintended pregnancies. Conclusion The findings of this study showed that unintended and terminated pregnancies remain part of the issues to be addressed if the goal of ensuring healthy lives and promoting the well-being for all at all ages must be met. Stakeholders in Nigerian healthcare system should protect the lives of women who are vulnerable to the fatal consequences of unsafe abortion, especially in cases of rape, sexual assault, incest and where continuing a pregnancy would endanger the lives of women. PMID:29713502

Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study.

PubMed

Mozaffar, Hajar; Cresswell, Kathrin M; Williams, Robin; Bates, David W; Sheikh, Aziz

2017-09-01

Hospital electronic prescribing (ePrescribing) systems offer a wide range of patient safety benefits. Like other hospital health information technology interventions, however, they may also introduce new areas of risk. Despite recent advances in identifying these risks, the development and use of ePrescribing systems is still leading to numerous unintended consequences, which may undermine improvement and threaten patient safety. These negative consequences need to be analysed in the design, implementation and use of these systems. We therefore aimed to understand the roots of these reported threats and identify candidate avoidance/mitigation strategies. We analysed a longitudinal, qualitative study of the implementation and adoption of ePrescribing systems in six English hospitals, each being conceptualised as a case study. Data included semistructured interviews, observations of implementation meetings and system use, and a collection of relevant documents. We analysed data first within and then across the case studies. Our dataset included 214 interviews, 24 observations and 18 documents. We developed a taxonomy of factors underlying unintended safety threats in: (1) suboptimal system design, including lack of support for complex medication administration regimens, lack of effective integration between different systems, and lack of effective automated decision support tools; (2) inappropriate use of systems-in particular, too much reliance on the system and introduction of workarounds; and (3) suboptimal implementation strategies resulting from partial roll-outs/dual systems and lack of appropriate training. We have identified a number of system and organisational strategies that could potentially avoid or reduce these risks. Imperfections in the design, implementation and use of ePrescribing systems can give rise to unintended consequences, including safety threats. Hospitals and suppliers need to implement short- and long-term strategies in terms of the technology and organisation to minimise the unintended safety risks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PUTATIVE ADVERSE OUTCOME PATHWAY FOR INHIBITON ...

EPA Pesticide Factsheets

The adverse outcome pathway (AOP) provides a framework for organizing knowledge to define links between a molecular initiating event (MIE) and an adverse outcome (AO) occurring at a higher level of biological organization, such as the individual or population. The AOP framework proceeds from a general (e.g., not chemical specific) molecular mode of action, designated as a MIE, through stepwise changes in biological status, defined as key events (KEs), to a final AO that can be used in risk assessment. Because aromatase-inhibiting pharmaceuticals are widely used to treat breast cancer patients, we explored the unintended consequences that might occur in fish exposed to these chemicals through wastewater discharge into the aquatic environment. Unlike mammals, fish have two isoforms of aromatase, one that predominates in the ovary (cyp19a1a) and a second (cyp19a1b) that prevails in the brain. Aromatase activity in fish brain can be 100 to 1000 times that in mammals and is associated with reproduction. We have developed a putative AOP for inhibition of brain aromatase in fish leading to reproductive dysfunction based on review of relevant literature and reproductive experiments with the marine fish cunner (Tautogolabrus adspersus) exposed to aromatase-inhibiting pharmaceuticals in the laboratory. The first KE in this AOP is a decrease in brain aromatase activity due to exposure to an aromatase inhibitor. KEs then progress through subsequent steps including decreas

Are Hispanic Women Happier About Unintended Births?

PubMed Central

Hartnett, Caroline Sten

2014-01-01

Reducing unintended pregnancies – particularly among Hispanic and Black women, who have relatively high rates – is a key public health goal in the United States. However, descriptive literature has suggested that Hispanic women are happier about these pregnancies compared with White and Black women, which could mean that there is variation across groups in the consequences of the resulting births. The purpose of this study was to examine variations in happiness about unintended births by race-ethnicity and to assess possible explanations for these differences. Using data from the National Survey of Family Growth (n=1,462 births) I find that Hispanic women report being happier about unintended births compared with White and Black women. Higher happiness among Hispanics was particularly pronounced among a subgroup of women: those who were foreign-born and very religious. Overall, results confirm previous findings that intention status alone is incomplete for capturing pregnancy experiences. Happiness offers complementary information that is important when making comparisons by race-ethnicity and nativity. PMID:25339786

Unintended pregnancy among female sex workers in Mekelle city, northern Ethiopia: a cross-sectional study.

PubMed

Weldegebreal, Rishan; Melaku, Yohannes Adama; Alemayehu, Mussie; Gebrehiwot, Tesfay Gebregzabher

2015-01-31

Unintended pregnancy is a significant public health concern in the world. Particularly, female sex workers are exposed to the risk of unintended pregnancy, abortion and their consequences. The aim of this study was, therefore, to assess unintended pregnancy and associated factors among female sex workers in Mekelle city, northern Ethiopia. A community based cross-sectional study was conducted among 346 female sex workers from five Kebelles (smallest administrative units in Ethiopia) of Mekelle city from March-April, 2014. Sex workers were selected with simple random sampling technique using sampling frame obtained from urban health extension program. Epi-data version 3.1 was used to enter data and analysis was done using SPSS version 20. Bivariate and multivariate logistic regressions were performed to identify factors associated with unintended pregnancy using odds ratio and 95% confidence interval with P-value of 0.05. The magnitude of unintended pregnancy among female sex workers in the past two years was 28.6%. During this period, 59 women had abortion which represents three-fifths, (59.6%), of those who had unintended pregnancies, and 17.1% of all female sex workers. Female sex workers who gave birth and had history of abortion formerly had 3.1 (AOR = 3.07, 95% CI: [1.54, 6.09]) and 15.6 (AOR = 15.64 95% CI: [8.03, 30.47]) times higher odds of unintended pregnancy compared to their counterparts, respectively. Sex workers who had steady partners had 2.9 (AOR = 2.87, 95% CI: [1.47, 5.61]) times higher odds of have unintended pregnancy than those who hadn't. Drug users had 2.7 (AOR = 2.68, 95% CI: [1.30, 5.52]) times higher odds of unintended pregnancy than those who hadn't use. Sex workers who had 60-96 months of duration in sex work were 67% less likely to have unintended pregnancy than those with <12 months (AOR = 0.33, 95% CI: [0.11, 0.95]). High level of unintended pregnancy and a range of associated factors were identified among sex workers. Improving utilization of effective pregnancy prevention methods in a consistent manner can avert the existing high level of unintended pregnancy among female sex workers.

System Dynamics to Model the Unintended Consequences of Denying Payment for Venous Thromboembolism after Total Knee Arthroplasty

PubMed Central

Worni, Mathias; Pietrobon, Ricardo; Zammar, Guilherme Roberto; Shah, Jatin; Yoo, Bryan; Maldonato, Mauro; Takemoto, Steven; Vail, Thomas P.

2012-01-01

Background The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA. Methods and Findings The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020. Conclusion System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA. PMID:22536313

Human Factors for More Usable and Safer Health Information Technology: Where Are We Now and Where do We Go from Here?

PubMed

Kushniruk, A; Nohr, C; Borycki, E

2016-11-10

A wide range of human factors approaches have been developed and adapted to healthcare for detecting and mitigating negative unexpected consequences associated with technology in healthcare (i.e. technology-induced errors). However, greater knowledge and wider dissemination of human factors methods is needed to ensure more usable and safer health information technology (IT) systems. This paper reports on work done by the IMIA Human Factors Working Group and discusses some successful approaches that have been applied in using human factors to mitigate negative unintended consequences of health IT. The paper addresses challenges in bringing human factors approaches into mainstream health IT development. A framework for bringing human factors into the improvement of health IT is described that involves a multi-layered systematic approach to detecting technology-induced errors at all stages of a IT system development life cycle (SDLC). Such an approach has been shown to be needed and can lead to reduced risks associated with the release of health IT systems into live use with mitigation of risks of negative unintended consequences. Negative unintended consequences of the introduction of IT into healthcare (i.e. potential for technology-induced errors) continue to be reported. It is concluded that methods and approaches from the human factors and usability engineering literatures need to be more widely applied, both in the vendor community and in local and regional hospital and healthcare settings. This will require greater efforts at dissemination and knowledge translation, as well as greater interaction between the academic and vendor communities.

Effects of Two Endocrine-active Pharmaceuticals, Tamoxifen and Anastrozole, on Reproduction in a Marine Fish, Tautogolabrus adspersus

EPA Science Inventory

Endocrine-active pharmaceuticals entering the aquatic environment through sewage effluent may have unintended, adverse impacts on the reproduction of aquatic organisms, which in turn may affect the sustainability of exposed populations. Laboratory experiments were conducted with ...

75 FR 68972 - Medical Devices; General and Plastic Surgery Devices; Classification of Tissue Adhesive With...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-10

... running to unintended areas, etc. Wound dehiscence Bench Testing, Shelf Life Testing, Animal Testing, Clinical Studies, Labeling. Adverse tissue reaction and chemical Biocompatibility Animal burns. Testing, Clinical Studies. Infection Bench Testing, Biocompatibility Animal Testing, Clinical Studies, Sterility...

Community level effects of gender inequality on intimate partner violence and unintended pregnancy in Colombia: testing the feminist perspective.

PubMed

Pallitto, Christina C; O'Campo, Patricia

2005-05-01

Violence against women, especially by intimate partners, is a serious public health problem that is associated with physical, reproductive, and mental health consequences. The effect of intimate partner violence on women's ability to control their fertility and the mechanisms through which these phenomena are related merit further investigation. Building on findings from a previous analysis in which a statistically significant relationship between intimate partner violence and unintended pregnancy in Colombia was found, this analysis examines the effect of gender inequality on this association using data from the 2000 Colombian Demographic and Health Survey. Specifically, the objective of this analysis is to explore whether gender inequality (as measured by women's autonomy, women's status, male patriarchal control, and intimate partner violence) in municipalities partially explains the association between intimate partner violence and unintended pregnancy in Colombia. Results of logistic regression analysis with multi-level data show that living in a municipality with high rates of male patriarchal control significantly increased women's odds of having an unintended pregnancy by almost four times. Also, living in a municipality with high rates of intimate partner violence increased one's odds of unintended pregnancy by more than 2.5 times, and non-abused women living in municipalities with high rates of intimate partner violence were at a significantly increased risk of unintended pregnancy. In addition, abused women living in a municipality with high personal female decision-making autonomy had more than a fourfold increased risk of having an unintended pregnancy. These findings demonstrate the need for reproductive health programs to target areas at particularly high risk for unintended pregnancy by reducing intimate partner violence and gender inequality.

Unintended Cognitive, Affective, and Behavioral Consequences of Group Assignments

ERIC Educational Resources Information Center

Neu, Wayne A.

2012-01-01

Pedagogical strategies can be thought of as a set of stimuli placed in students' environment to influence their cognition, affect, and behavior. The design of strategies such as group assignments and a comprehensive understanding of their consequences for students should then include an analysis of all three of these elements and the…

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

ERIC Educational Resources Information Center

Speizer, Ilene S.; White, Justin S.

2008-01-01

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

Unintended pregnancy and subsequent use of modern contraceptive among slum and non-slum women in Nairobi, Kenya

PubMed Central

2014-01-01

Background In spite of major gains in contraceptive prevalence over the last few decades, many women in most parts of the developing world who would like to delay or avoid pregnancy do not use any method of contraception. This paper seeks to: a) examine whether experiencing an unintended pregnancy is associated with future use of contraception controlling for a number factors including poverty at the household and community levels; and b) investigate the mechanisms through which experiencing an unintended pregnancy leads to uptake of contraception. Methods Quantitative and qualitative data from a cross-sectional research project conducted in 2009/10 in two slum settlements and two non-slum settings of Nairobi, Kenya are used. The quantitative component of the project was based on a random sample of 1,259 women aged 15–49 years. Logistic regression models were used to assess the effect of unintended pregnancy on future contraceptive use. The qualitative component of the project successfully interviewed a total of 80 women randomly selected from survey participants who had reported having at least one unintended pregnancy. Results Women whose last pregnancy was unintended were more likely to be using a modern method of contraception, compared to their peers whose last pregnancy was intended, especially among the wealthier group as shown in the interaction model. Among poor women, unintended pregnancy was not associated with subsequent use of contraception. The qualitative investigation with women who had an unplanned pregnancy reveals that experiencing an unintended pregnancy seems to have served as a “wake-up call”, resulting in greater attention to personal risks, including increased interest in pregnancy prevention. For some women, unintended pregnancy was a consequence of strong opposition by their partners to family planning, while others reported they started using contraceptives following their unintended pregnancy, but discontinued after experiencing side effects. Conclusion This study provides quantitative and qualitative evidence that women who have had an unintended pregnancy are “ready for change”. Family planning programs may use the contacts with antenatal, delivery and post-delivery care system as an opportunity to identify women whose pregnancy is unplanned, and target them with information and services. PMID:25012817

Unintended pregnancy and subsequent use of modern contraceptive among slum and non-slum women in Nairobi, Kenya.

PubMed

Fotso, Jean Christophe; Izugbara, Chimaraoke; Saliku, Teresa; Ochako, Rhoune

2014-07-10

In spite of major gains in contraceptive prevalence over the last few decades, many women in most parts of the developing world who would like to delay or avoid pregnancy do not use any method of contraception. This paper seeks to: a) examine whether experiencing an unintended pregnancy is associated with future use of contraception controlling for a number factors including poverty at the household and community levels; and b) investigate the mechanisms through which experiencing an unintended pregnancy leads to uptake of contraception. Quantitative and qualitative data from a cross-sectional research project conducted in 2009/10 in two slum settlements and two non-slum settings of Nairobi, Kenya are used. The quantitative component of the project was based on a random sample of 1,259 women aged 15-49 years. Logistic regression models were used to assess the effect of unintended pregnancy on future contraceptive use. The qualitative component of the project successfully interviewed a total of 80 women randomly selected from survey participants who had reported having at least one unintended pregnancy. Women whose last pregnancy was unintended were more likely to be using a modern method of contraception, compared to their peers whose last pregnancy was intended, especially among the wealthier group as shown in the interaction model. Among poor women, unintended pregnancy was not associated with subsequent use of contraception. The qualitative investigation with women who had an unplanned pregnancy reveals that experiencing an unintended pregnancy seems to have served as a "wake-up call", resulting in greater attention to personal risks, including increased interest in pregnancy prevention. For some women, unintended pregnancy was a consequence of strong opposition by their partners to family planning, while others reported they started using contraceptives following their unintended pregnancy, but discontinued after experiencing side effects. This study provides quantitative and qualitative evidence that women who have had an unintended pregnancy are "ready for change". Family planning programs may use the contacts with antenatal, delivery and post-delivery care system as an opportunity to identify women whose pregnancy is unplanned, and target them with information and services.

Incidence and preventability of adverse events requiring intensive care admission: a systematic review.

PubMed

Vlayen, Annemie; Verelst, Sandra; Bekkering, Geertruida E; Schrooten, Ward; Hellings, Johan; Claes, Neree

2012-04-01

Adverse events are unintended patient injuries or complications that arise from health care management resulting in death, disability or prolonged hospital stay. Adverse events that require critical care are a considerable financial burden to the health care system, but also their global impact on patients and society is probably underestimated. The objectives of this systematic review were to synthesize the best available evidence regarding the estimates of the incidence and preventability of adverse events that necessitate intensive care admission, to determine the type and consequences [mortality, length of intensive care unit (ICU) stay and costs] of these adverse events. MEDLINE (from 1966 to present), EMBASE (from 1974 to present) and CENTRAL (version 1-2010) were searched for studies reporting on unplanned admissions on ICUs. Several other sources were searched for additional studies. Only quantitative studies that used chart review for the detection of adverse events requiring intensive care admission were considered for eligibility. For the purposes of this systematic review, ICUs were defined as specialized hospital facilities which provide continuous monitoring and intensive care for acutely ill patients. Studies that were published in the English, Dutch, German, French or Spanish language were eligible for inclusion. Two reviewers independently extracted data and assessed the methodological quality of the included studies. A total of 27 studies were reviewed. Meta-analysis of the data was not appropriate because of methodological and statistical heterogeneity between studies; therefore, results are presented in a descriptive way. The percentage of surgical and medical adverse events that required ICU admission ranged from 1.1% to 37.2%. ICU readmissions varied from 0% to 18.3%. Preventability of the adverse events varied from 17% to 76.5%. Preventable adverse events are further synthesized by type of event. Consequences of the adverse events included a mean length of ICU stay that ranged from 1.5 days to 10.4 days for the patient's first stay in ICU and mortality percentages between 0% and 58%. Adverse events are an important reason for (re)admission to the ICU and a considerable proportion of these are preventable. It was not possible to estimate an overall incidence and preventability rate of these events as we found considerable heterogeneity. To decrease adverse events that necessitate ICU admission, several systems are recommended such as early detection of patients with clinical instability on general wards and the implementation of rapid response teams. Step-down or intermediate care units could be a useful strategy for patients who require monitoring to avoid ICU readmissions. However, the effectiveness of such systems needs to be investigated. © 2011 Blackwell Publishing Ltd.

Why Do Infants Begin to Talk? Language as an Unintended Consequence.

ERIC Educational Resources Information Center

Locke, John L.

1996-01-01

This article looks into why infants learn to talk, using a series of illustrative proposals as to the short- and long-term consequences to the infant behaviors that lead to linguistic competence. The goal of the article is to encourage investigation of behavioral dispositions that nudge the child toward proficiency in the use of the spoken…

NON-TARGET AND ECOSYSTEM IMPACTS FROM GENETICALLY MODIFIED CROPS CONTAINING PLANT INCORPORATED PROTECTANTS (PIPS)

EPA Science Inventory

The risk of unintended and unexpected adverse impacts on non-target organisms and ecosystems is a key issue in environmental risk assessment of PIP crop plants. While there has been considerable examination of the effects of insect resistant crops on certain non-target organisms...

Lessons learned from unintended consequences about erasing the stigma of mental illness.

PubMed

Corrigan, Patrick W

2016-02-01

Advocates and scientists have partnered to develop and evaluate programs meant to erase the egregious effects of the different forms of stigma. Enough evidence has been collected to yield lessons about approaches to stigma change. Some of the most insightful of these lessons emerge from unintended consequences of good intentioned approaches, and are the focus of this paper. They include the limited benefits of education especially when compared to contact, beating stigma is more than changing words, beware pity as a message, understand the competing agendas of stigma change, replace ideas of normalcy with solidarity, and avoid framing self-stigma as the problem of people with mental illness and not of society. The paper ends with consideration of the back seat role that psychiatrists and other mental health providers should have in stigma change. © 2015 World Psychiatric Association.

Unintended consequences of increasing block tariffs pricing policy in urban water

NASA Astrophysics Data System (ADS)

Dahan, Momi; Nisan, Udi

2007-03-01

We exploit a unique data set to estimate the degree of economies of scale in water consumption, controlling for the standard demand factors. We found a linear Engel curve in water consumption: each additional household member consumes the same water quantity regardless of household size, except for a single-person household. Our evidence suggests that the increasing block tariffs (IBT) structure, which is indifferent to household size, has unintended consequences. Large households, which are also likely to be poor given the negative correlation between income and household size, are charged a higher price for water. The degree of economies of scale found here erodes the effectiveness of IBT price structure as a way to introduce an equity consideration. This implication is important in view of the global trend toward the use of IBT.

Unintended Consequences of Sensor, Signal, and Imaging Informatics: New Problems and New Solutions.

PubMed

Hughes, C; Voros, S; Moreau-Gaudry, A

2016-11-10

This synopsis presents a selection for the IMIA (International Medical Informatics Association) Yearbook 2016 of excellent research in the broad field of Sensor, Signal and Imaging Informatics published in the year 2015, with a focus on Unintended consequences: new problems and new solutions. We performed a systematic initial selection and a double blind peer review process to find the best papers in this domain published in 2015, from the PubMed and Web of Science databases. The set of MesH keywords used was provided by experts. The constant advances in medical technology allow ever more relevant diagnostic and therapeutic approaches to be designed. Nevertheless, there is a need to acquire expert knowledge of these innovations in order to identify precociously new associated problems for which new solutions need to be designed and developed.

Understanding Unintended Consequences and Health Information Technology:. Contribution from the IMIA Organizational and Social Issues Working Group.

PubMed

Kuziemsky, C E; Randell, R; Borycki, E M

2016-11-10

No framework exists to identify and study unintended consequences (UICs) with a focus on organizational and social issues (OSIs). To address this shortcoming, we conducted a literature review to develop a framework for considering UICs and health information technology (HIT) from the perspective of OSIs. A literature review was conducted for the period 2000- 2015 using the search terms "unintended consequences" and "health information technology". 67 papers were screened, of which 18 met inclusion criteria. Data extraction was focused on the types of technologies studied, types of UICs identified, and methods of data collection and analysis used. A thematic analysis was used to identify themes related to UICs. We identified two overarching themes. One was the definition and terminology of how people classify and discuss UICs. Second was OSIs and UICs. For the OSI theme, we also identified four sub-themes: process change and evolution, individual-collaborative interchange, context of use, and approaches to model, study, and understand UICs. While there is a wide body of research on UICs, there is a lack of overall consensus on how they should be classified and reported, limiting our ability to understand the implications of UICs and how to manage them. More mixed-methods research and better proactive identification of UICs remain priorities. Our findings and framework of OSI considerations for studying UICs and HIT extend existing work on HIT and UICs by focusing on organizational and social issues.

The ethics of data collection: unintended consequences?

PubMed

Wainwright, Delia; Sambrook, Sally

2010-01-01

The aims is to consider the political and ethical challenges involved in conducting ethnographic managerial/organisational behaviour research within the highly regulated health and social care context, in light of the emergence of more stringent "ethical approval" policies and requirements set by Local Research Ethics Committees in the United Kingdom. In the attempt and requirement to protect "vulnerable" employees, this paper aims to present an unintended paradox of consequences when participants voluntarily revealed themselves. The authors briefly review literature on research ethics and present an understanding of the ethical regulations currently existing within the British National Health Service. Within an ethnographic case study exploring the psychological contract, the authors consider the issues that arose during one stage of data collection: a qualitative questionnaire survey with 13 participants, including members of the lead author's team. Incorporating excerpts from the researcher's reflexive journal, the paper exposes the struggles of being an "insider" researcher and the tensions this raises for data analysis when participants voluntarily revealed themselves. Ethnography is at "risk" within health and social care and ethnographic "managerial" research is likely to be unduly restricted and potentially threatened. The evidence suggests that some employees either did not wish to be protected or, conversely, felt compelled to reveal their identities, raising questions of their motivation and creating a paradox of unintended consequences. This paper offers an insight into the challenges of conducting nurse-managerial ethnography in compliance with ethical guidelines, yet disrupted by participants. The findings will be useful to other nurse-researchers attempting to conduct insider research.

Risk management and post-marketing surveillance of CNS drugs.

PubMed

Henningfield, Jack E; Schuster, Charles R

2009-12-01

Drugs affecting the central nervous system span a broad range of chemical entities, dosage forms, indications, and risks. Unintended consequences include potential abuse and overdose in non-patient drug abusers, deliberate tampering of drug dosage forms, and criminal behavior associated with diversion. Regulators must consider diverse factors to find the appropriate conditions of approval to minimize unintended consequences while enabling a level of access desired by health care providers and patients. This commentary appears as part of a special issue of Drug and Alcohol Dependence that focuses on risk management and post-marketing surveillance and addresses key issues that pose real-world challenges to pharmaceutical sponsors and regulators in particular. For example, in the U.S., Controlled Substances Act drug scheduling can be considered a risk management strategy but its legal authorities and administrative processes are independent from those of risk management (including Risk Evaluation and Mitigation Strategies or REMS); better harmonization of these approaches is vital from drug development and regulatory perspectives. Risk management would ideally be implemented on a strong science foundation demonstrating that the tools employed to mitigate risks and ensure safe use are effective. In reality, research and evaluation of tools in this area is in its infancy and will necessarily be an evolutionary process; furthermore, there is little precedent for linking interventions and program evolution to unintended consequences such as regional outbreaks of abuse and diversion. How such issues are resolved has the potential to stimulate or stifle innovations in drug development and advance or imperil health care.

Preventing Unintended Disclosure of Personally Identifiable Data Following Anonymisation.

PubMed

Smith, Chris

2017-01-01

Errors and anomalies during the capture and processing of health data have the potential to place personally identifiable values into attributes of a dataset that are expected to contain non-identifiable values. Anonymisation focuses on those attributes that have been judged to enable identification of individuals. Attributes that are judged to contain non-identifiable values are not considered, but may be included in datasets that are shared by organisations. Consequently, organisations are at risk of sharing datasets that unintendedly disclose personally identifiable values through these attributes. This would have ethical and legal implications for organisations and privacy implications for individuals whose personally identifiable values are disclosed. In this paper, we formulate the problem of unintended disclosure following anonymisation, describe the necessary steps to address this problem, and discuss some key challenges to applying these steps in practice.

A blessing I can't afford: factors underlying the paradox of happiness about unintended pregnancy.

PubMed

Aiken, Abigail R A; Dillaway, Chloe; Mevs-Korff, Natasha

2015-05-01

An unresolved paradox in the measurement and interpretation of unintended pregnancy is that women frequently report feeling happy about pregnancies they also classify as unintended (i.e. they have incongruent intentions and feelings). This study explores the underlying reasons why women profess such happiness and how these relate to their motivations to avoid pregnancy. Between September 2013 and February 2014, semi-structured in-depth interviews were conducted with 27 women (8 white, 19 Latina) selected from a longitudinal study measuring prospective pregnancy intentions and feelings among 403 women in Austin, Texas. Women were selected for interview on the basis of wanting no more children and consistently professing either happiness (n = 17) or unhappiness (n = 10) at the prospect of pregnancy. Interviews were coded and analyzed following the principles of grounded theory. We found that it is possible for women to express happiness at the idea of pregnancy while simultaneously earnestly trying to prevent conception. Happiness at the idea of an unintended pregnancy was explained as the result of deep and heartfelt feelings about children taking precedence over practical considerations, the perception that the psychosocial stress resulting from another child would be low, and the ability to rationalize an unintended pregnancy as the result of fate or God's plan. The major exception to the sincerity of professed happiness was that conveyed as a result of social pressure despite truly negative feelings, predominantly expressed by foreign-born Latina women. Overall, equating incongruence with ambivalence about avoiding conception may undermine the sincerity of women's intentions and their desires for highly-effective contraception. At the same time, unintended pregnancies that are greeted with happiness may have different implications for maternal and child health outcomes compared to pregnancies that are greeted with unhappiness. Identifying which unintended pregnancies are most likely to result in adverse outcomes is a target for future research. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Blessing I Can’t Afford: Factors Underlying the Paradox of Happiness about Unintended Pregnancy

PubMed Central

Aiken, Abigail R.A.; Dillaway, Chloe; Mevs-Korff, Natasha

2015-01-01

An unresolved paradox in the measurement and interpretation of unintended pregnancy is that women frequently report feeling happy about pregnancies they also classify as unintended (i.e. they have incongruent intentions and feelings). This study explores the underlying reasons why women profess such happiness and how these relate to their motivations to avoid pregnancy. Between September 2013 and February 2014, semi-structured in-depth interviews were conducted with 27 women (8 white, 19 Latina) selected from a longitudinal study measuring prospective pregnancy intentions and feelings among 403 women in Austin, Texas. Women were selected for interview on the basis of wanting no more children and consistently professing either happiness (n=17) or unhappiness (n=10) at the prospect of pregnancy. Interviews were coded and analyzed following the principles of grounded theory. We found that it is possible for women to express happiness at the idea of pregnancy while simultaneously earnestly trying to prevent conception. Happiness at the idea of an unintended pregnancy was explained as the result of deep and heartfelt feelings about children taking precedence over practical considerations, the perception that the psychosocial stress resulting from another child would be low, and the ability to rationalize an unintended pregnancy as the result of fate or God’s plan. The major exception to the sincerity of professed happiness was that conveyed as a result of social pressure despite truly negative feelings, predominantly expressed by foreign-born Latina women. Overall, equating incongruence with ambivalence about avoiding conception may undermine the sincerity of women’s intentions and their desires for highly-effective contraception. At the same time, unintended pregnancies that are greeted with happiness may have different implications for maternal and child health outcomes compared to pregnancies that are greeted with unhappiness. Identifying which unintended pregnancies are most likely to result in adverse outcomes is a target for future research. PMID:25813729

The incidence of induced abortion in Kinshasa, Democratic Republic of Congo, 2016

PubMed Central

Kayembe, Patrick K.; Philbin, Jesse; Mabika, Crispin; Bankole, Akinrinola

2017-01-01

Background In the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion. Objectives Our study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa. Methods We applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility. Results In 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15–49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15–49. Conclusions Increasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality. PMID:28968414

Partnership to Evaluate Alternatives to Bisphenol A in Thermal Paper

EPA Pesticide Factsheets

The partnership project for alternatives assessment of alternatives to BPA in thermal paper sought to assess potential hazards for BPA and alternatives to reduce the possibility of unintended consequences of using substitutes

Maternal and fetal outcomes of intimate partner violence associated with pregnancy in the Latin American and Caribbean region.

PubMed

Han, Alice; Stewart, Donna E

2014-01-01

Very high rates of intimate partner violence during pregnancy (IPV-P) are reported in Latin America and the Caribbean (LAC) but data on prevalence and obstetric-related outcomes are limited. To conduct a literature review on risk factors, prevalence, and adverse obstetric-related outcomes of IPV-P in LAC. Systematic review of studies in MEDLINE (1946-2012) and LILACS (1982-2012), and hand searching of reference lists of included studies. Search terms were variations of partner abuse and pregnancy in LAC. Studies were excluded if they did not include IPV-P prevalence or if the perpetrator was not an intimate partner. Study quality was assessed via US Preventive Services Task Force criteria. In the 31 studies included, prevalence rates ranged from 3% to 44%. IPV-P was significantly associated with unintended pregnancies and adverse maternal (depression, pregnancy-related symptom distress, inadequate prenatal care, vaginal bleeding, spontaneous abortion, gestational weight gain, high maternal cortisol, hypertension, pre-eclampsia, STIs) and infant (prematurity, low birth weight, neonatal complications, stillbirth) outcomes (grade II-2 and 3 evidence). IPV-P is highly prevalent in LAC, with poor obstetric-related outcomes. Clinicians must identify women experiencing IPV-P and institute appropriate interventions and referrals to avoid its deleterious consequences. © 2013.

Barriers and Misperceptions Limiting Widespread Use of Intrauterine Contraception Among Canadian Women.

PubMed

Hauck, Brian; Costescu, Dustin

2015-07-01

Unintended pregnancy is a major social and public health problem with adverse effects on neonatal and developmental outcomes, as well as maternal health and wellbeing. Traditionally, family planning policies have focused on increasing contraceptive uptake in non-users; however, rates of non-use are low in many developed nations. A high proportion of unintended pregnancies are attributable to contraceptive failure, particularly when using barrier and short-acting hormonal contraceptives. Intrauterine contraceptive devices (IUCDs) are highly effective and have been shown to reduce unintended pregnancy rates. Despite this, global utilization rates are low, and IUCD uptake in Canada has been particularly low. In this review we explore why IUCDs are not more widely used, and specifically focus on barriers and misperceptions that may influence IUCD uptake, particularly in Canada. We reviewed relevant articles published in English between 1990 and 2014, through searches of PubMed and Medline, including primary studies of any design containing information on the knowledge and attitudes of health care providers and women. Providing education to care providers, women, and policy makers may help overcome misperceptions about the use of IUCDs, and may facilitate greater use. Increased support from federal and provincial health programs may also encourage the use of IUCDs in Canadian women, and help to reduce unintended pregnancy rates.

Seawater/Saline Agriculture for Energy, Warming, Water, Rainfall, Land, Food and Minerals

NASA Technical Reports Server (NTRS)

Bushnell, Dennis

2006-01-01

The combination of the incipient demise of cheap oil and increasing evidence of Global Warming due to anthropogenic fossil carbon release has reinvigorated the need for and efforts on Renewable energy sources, especially for transportation applications. Biomass/Bio-diesel appears to have many benefits compared to Hydrogen, the only other major renewable transportation fuel candidate. Biomass Production is currently limited by available arable land and fresh water. Halophyte Plants and seawater irrigation proffer a wholly new biomass production mantra using wastelands and very plentiful seawater. Such an approach addresses many-to-most of the major emerging Societal Problems including Land, Water, Food, Warming and Energy. For many reasons, including seawater agriculture, portions of the Sahara appear to be viable candidates for future Biomass Production. The apparent nonlinearity between vegetation cover and atmospheric conditions over North Africa necessitates serious coupled boundary layer Meteorology and Global Circulation Modeling to ensure that this form of Terra Forming is Favorable and to avoid adverse Unintended Consequences.

In Brief: Geoengineering draft statement

NASA Astrophysics Data System (ADS)

Showstack, Randy

2009-04-01

The American Meteorological Society (AMS) has prepared a draft policy statement on geoengineering the climate system, which the AMS Council is considering for approval. The statement notes, “Geoengineering will not substitute for either aggressive mitigation or proactive adaptation. It could contribute to a comprehensive risk management strategy to slow climate change and alleviate its negative impacts, but the potential for adverse and unintended consequences implies a need for adequate research, appropriate regulation, and transparent consideration.” The statement, if adopted, indicates that AMS recommends enhanced research on the scientific and technological potential for geoengineering the climate system; additional study of the historical, ethical, legal, political, and societal aspects of the geoengineering issues; and the development and analysis of policy options to promote transparency and international cooperation in exploring geoengineering options along with restrictions on reckless efforts to manipulate the climate system. AMS is accepting comments on the draft statement until 23 April. For more information, visit http://ametsoc.org/policy/draftstatements/index.html#draft.

Medicare’s Payment Strategy For End-Stage Renal Disease Now Embraces Bundled Payment And Pay-For-Performance To Cut Costs

PubMed Central

Swaminathan, Shailender; Mor, Vincent; Mehrotra, Rajnish; Trivedi, Amal

2013-01-01

Since 1973 Medicare has provided health insurance coverage to all people who have been diagnosed with end-stage renal disease, or kidney failure. In this article we trace the history of payment policies in Medicare’s dialysis program from 1973 to 2011, while also providing some insight into the rationale for changes made over time. Initially, Medicare adopted a fee-for-service payment policy for dialysis care, using the same reimbursement standards employed in the broader Medicare program. However, driven by rapid spending growth in this population, the dialysis program has implemented innovative payment reforms, such as prospective bundled payments and pay-for-performance incentives. It is uncertain whether these strategies can stem the increase in the total cost of dialysis to Medicare, or whether they can do so without adversely affecting the quality of care. Future research on the intended and unintended consequences of payment reform will be critical. PMID:22949455

Quantifying the effects of research band resighting activities on staging terns in comparison to other disturbances

USGS Publications Warehouse

Althouse, Melissa; Cohen, Jonathan B.; Spendelow, Jeffrey A.; Karpanty, Sarah M.; Davis, Kayla L.; Parsons, Katharine C.; Luttazi, Cristin F.

2016-01-01

Avian research that involves potential disturbance to the study species may have unintended fitness consequences and could lead to biases in measurements of interest. The effects of band resighting on the behavior of mixed-species flocks of staging waterbirds were evaluated against recreational pedestrian activity that was expected to cause flushing. We found a model with additive effects of distance (near, 0-50 m, or far, 50-200 m) and disturbance type (researcher or pedestrian) best explained flock behaviors. The proportion of staging flocks that flushed in response to pedestrians was greatest when pedestrians were within 50 m of the flock. Virtually no flushes were observed in response to researchers, regardless of distance. These results could assist in alleviating concerns that accepted protocols used for intensive band resighting studies on staging seabirds of special conservation status, such as Roseate (Sterna dougallii) and Common (S. hirundo) terns, may have adverse effects. Our framework could be used by others to test the effects of similar research on sensitive species.

The Educational-Industrial Complex.

ERIC Educational Resources Information Center

Brightman, Hank J.; Gutmore, Daniel

2002-01-01

Addresses issues of classroom commercialization, product placement, and the ethical implications of corporate influence. Discusses three policy implications: control of technology in the classroom, target marketing to children, and the unintended consequences of the first two. (Contains 39 references.) (SK)

Getting the lead out: understanding risks in the distribution ...

EPA Pesticide Factsheets

This presentation discusses the importance of the water distribution system as a component of the source-to-tap continuum in public health protection. Issues covered include: understanding source water quality changes and their impacts throughout the system; use of mitigation measures such as filters); and holistic approaches and/or strategies that could be used to avoid unintended consequences of decisions from source to tap. Invited presentation on topics indicated as of interest. With exposure to lead as the context, this presentation discusses the importance of the water distribution system as a component of the source-to-tap continuum in public health protection. Issues covered include: understanding source water quality changes and their impacts throughout the system; use of mitigation measures such as filters); and holistic approaches and/or strategies that could be used to avoid unintended consequences of decisions from source to tap.

Open research practices: unintended consequences and suggestions for averting them. (Commentary on the Peer Reviewers' Openness Initiative)

PubMed Central

2016-01-01

The Peer Reviewers' Openness Initiative (PROI) is a move to enlist reviewers in the promotion of data-sharing. In this commentary, I discuss objections that can be raised, first to the specific proposals in the PROI, and second to data-sharing in general. I argue that although many objections have strong counter-arguments, others merit more serious consideration. Regarding the PROI, I suggest that it could backfire if editors and authors feel coerced into data-sharing and so may not be the most pragmatic way of encouraging greater openness. More generally, while promoting data-sharing, we need to be sensitive to cases where sharing of data from human participants could create ethical problems. Furthermore, those interested in promoting reproducible science need to defend against an increased risk of data-dredging when large, multivariable datasets are shared. I end with some suggestions to avoid these unintended consequences. PMID:27152225

Intended and unintended consequences of China's zero markup drug policy.

PubMed

Yi, Hongmei; Miller, Grant; Zhang, Linxiu; Li, Shaoping; Rozelle, Scott

2015-08-01

Since economic liberalization in the late 1970s, China's health care providers have grown heavily reliant on revenue from drugs, which they both prescribe and sell. To curb abuse and to promote the availability, safety, and appropriate use of essential drugs, China introduced its national essential drug list in 2009 and implemented a zero markup policy designed to decouple provider compensation from drug prescription and sales. We collected and analyzed representative data from China's township health centers and their catchment-area populations both before and after the reform. We found large reductions in drug revenue, as intended by policy makers. However, we also found a doubling of inpatient care that appeared to be driven by supply, instead of demand. Thus, the reform had an important unintended consequence: China's health care providers have sought new, potentially inappropriate, forms of revenue. Project HOPE—The People-to-People Health Foundation, Inc.

Exploring the Context and Implementation of Public Health Regulations Governing Sex Work: A Qualitative Study with Migrant Sex Workers in Guatemala.

PubMed

Rocha-Jiménez, Teresita; Brouwer, Kimberly C; Silverman, Jay G; Morales-Miranda, Sonia; Goldenberg, Shira M

2017-10-01

Public health regulations practices surrounding sex work and their enforcement can have unintended consequences for HIV and sexually transmitted infection (STI) prevention and care among sex workers. This analysis was based on qualitative in-depth (n = 33) and focus groups interviews (n = 20) conducted with migrant female sex workers in Tecún Umán and Quetzaltenango, Guatemala, and explored the implementation of sex work regulations and related consequences for HIV prevention and care among migrant sex workers. Sex work regulations were found to have health-related benefits (e.g., access to HIV/STI testing) as well as negative impacts, such as abuse by police and harassment, detention/deportation of migrant sex workers. Whereas public health regulations may improve access to HIV/STI testing, their implementation may inadvertently jeopardize sex workers' health through unintended negative consequences. Non-coercive, evidence-based public health and sex work policies and programs are needed to expand access to HIV/STI prevention and care among migrant sex workers, while protecting their dignity and human rights.

The underutilization of emergency contraception.

PubMed

Devine, Kit S

2012-04-01

Despite the availability of effective contraceptive methods, unintended pregnancy continues to be a significant health problem for women throughout the world. The reasons for unplanned pregnancy include failure to use contraception, incorrect use of contraception, unplanned consensual intercourse, and rape. Emergency contraception was once heralded as a means of reducing the rates of unintended pregnancy, elective abortion, and unwanted childbirth. But more than three decades after the first oral form was introduced, the use of emergency contraception remains suboptimal-even in the United States, where it is available to most women of childbearing age without a prescription. Nurses can help narrow this clinical gap in women's health care by increasing awareness of emergency contraception, correcting common misconceptions about its mechanism of action and potential adverse effects, and facilitating patient access.

Flood Risk Management: Exploring the Impacts of the Community Rating System Program on Poverty and Income Inequality.

PubMed

Noonan, Douglas S; Sadiq, Abdul-Akeem A

2018-03-01

Flooding remains a major problem for the United States, causing numerous deaths and damaging countless properties. To reduce the impact of flooding on communities, the U.S. government established the Community Rating System (CRS) in 1990 to reduce flood damages by incentivizing communities to engage in flood risk management initiatives that surpass those required by the National Flood Insurance Program. In return, communities enjoy discounted flood insurance premiums. Despite the fact that the CRS raises concerns about the potential for unevenly distributed impacts across different income groups, no study has examined the equity implications of the CRS. This study thus investigates the possibility of unintended consequences of the CRS by answering the question: What is the effect of the CRS on poverty and income inequality? Understanding the impacts of the CRS on poverty and income inequality is useful in fully assessing the unintended consequences of the CRS. The study estimates four fixed-effects regression models using a panel data set of neighborhood-level observations from 1970 to 2010. The results indicate that median incomes are lower in CRS communities, but rise in floodplains. Also, the CRS attracts poor residents, but relocates them away from floodplains. Additionally, the CRS attracts top earners, including in floodplains. Finally, the CRS encourages income inequality, but discourages income inequality in floodplains. A better understanding of these unintended consequences of the CRS on poverty and income inequality can help to improve the design and performance of the CRS and, ultimately, increase community resilience to flood disasters. © 2017 Society for Risk Analysis.

Application of systems thinking: 12-month postintervention evaluation of a complex health system intervention in Zambia: the case of the BHOMA.

PubMed

Mutale, Wilbroad; Ayles, Helen; Bond, Virginia; Chintu, Namwinga; Chilengi, Roma; Mwanamwenge, Margaret Tembo; Taylor, Angela; Spicer, Neil; Balabanova, Dina

2017-04-01

Strong health systems are said to be paramount to achieving effective and equitable health care. The World Health Organization has been advocating for using system-wide approaches such as 'systems thinking' to guide intervention design and evaluation. In this paper we report the system-wide effects of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality. We conducted a qualitative study in three target districts. We used a systems thinking conceptual framework to guide the analysis focusing on intended and unintended consequences of the intervention. NVivo version 10 was used for data analysis. The addressed community responded positively to the BHOMA intervention. The indications were that in the short term there was increased demand for services but the health worker capacity was not severely affected. This means that the prediction that service demand would increase with implementation of BHOMA was correct and the workload also increased, but the help of clinic lay supporters meant that some of the work of clinicians was transferred to these lay workers. However, from a systems perspective, unintended consequences also occurred during the implementation of the BHOMA. We applied an innovative approach to evaluate a complex intervention in low-income settings, exploring empirically how systems thinking can be applied in the context of health system strengthening. Although the intervention had some positive outcomes by employing system-wide approaches, we also noted unintended consequences. © 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Union women, the tobacco industry, and excise taxes: a lesson in unintended consequences.

PubMed

Balbach, Edith D; Campbell, Richard B

2009-08-01

Between 1987 and 1997, the tobacco industry used the issue of cigarette excise tax increases to create a political partnership with the Coalition of Labor Union Women (CLUW), a group representing female trade unionists in the U.S. This paper documents how the industry created this relationship and the lessons tobacco-control advocates can learn from the industry's example, in order to mitigate possible unintended consequences of advocating excise tax increases. In 1998, under the terms of the Master Settlement Agreement, the tobacco industry began making documents produced in litigation available publicly. Currently, approximately 50 million pages are available online, including substantial documentation of the industry-CLUW relationship. For this study, a comprehensive search of these documents was conducted. The tobacco industry encouraged CLUW's opposition to excise tax increases by emphasizing the economic regressivity of these taxes, discussing excise taxes generically to deflect attention from cigarettes, and encouraging opposition to earmarking cigarette taxes to pay for specific programs. In addition, CLUW received at least $221,500 in financial support between 1987 and 1997 and in-kind support for its conferences, membership materials, and other services. Excise tax increases, if pursued without considering the impacts they may have on low-SES populations, may have unintended consequences. In this case, such proposals may have helped to create a relationship between CLUW and the tobacco industry. Because excise taxes are endorsed in the Framework Convention on Tobacco Control, tobacco-control advocates must understand how to build relationships with low-SES populations and mitigate potential alliances with the tobacco industry.

Houston, We Have a Problem: Studying the SAS Education Value-Added Assessment System (EVAAS) from Teachers' Perspectives in the Houston Independent School District (HISD)

ERIC Educational Resources Information Center

Collins, Clarin

2012-01-01

This study examined the intended and unintended consequences associated with the Education Value-Added Assessment System (EVAAS) as perceived and experienced by teachers in the Houston Independent School District (HISD). To evaluate teacher effectiveness, HISD is using EVAAS for high-stakes consequences more than any other district or state in the…

ESTABLISHMENT OF TRANSGENIC CREEPING BENTGRASS (AGROSTIS STOLONIFERA L.) IN NON-AGRONOMIC HABITATS

EPA Science Inventory

Concerns about genetically modified crops include transgene flow to compatible wild species and potential unintended ecological consequences associated with transgene introgression. To date, there has been little empirical documentation of the relative frequency of establishment...

[THE DISCUSSION CONCERNING THE PLACE OF LECTURES AND COMPULSORY LECTURE ATTENDANCE IN MEDICAL EDUCATION].

PubMed

Reis, Shmuel

2016-04-01

Luder shows that there is a lack of correlation between lecture attendance in medical school and examination performance, and thus draws attention to a discourse concerning the place of lectures and lecture attendance enforcement in 2015 and beyond. The paper addresses 4 questions: First, what is the current place of the traditional lecture in the education of medical students? Second, are there alternatives to this format of teaching? Third, what are the educational consequences of mandating lecture attendance; and fourth, should there be such enforcement? The author discusses these questions and concludes that lectures should be used sparingly, after a careful evaluation that they have an added value over learning away from the classroom. Furthermore, that there are clear guidelines on how to make the traditional lecture enhanced and educationally effective, as well as alternatives such as the "flipped classroom", e-learning and more to lectures. In addition, that lectures frequently drive learning negatively and enforcing attendance in Israel entails serious unintended consequences such as a need to monitor attendance, and a host of disciplinary adverse reactions. Finally, that besides lecture efficiency and economy (when having added value) one reason to consider compulsory attendance, may be when poor attendance negatively influences teachers morale.

Documenting the individual- and household-level cost of unsafe abortion in Uganda.

PubMed

Sundaram, Aparna; Vlassoff, Michael; Mugisha, Frederick; Bankole, Akinrinola; Singh, Susheela; Amanya, Leo; Onda, Tsuyoshi

2013-12-01

Although Uganda has a restrictive abortion law, illegal abortions performed under dangerous conditions are common. Data are lacking, however, on the economic impact of postabortion complications on women and their households. Data from a 2011-2012 survey of 1,338 women who received postabortion care at 27 Ugandan health facilities were used to assess the economic consequences of unsafe abortion and subsequent treatment. Information was obtained on treatment costs and on the impact of abortion complications on children in the household, on the productivity of the respondent and other household members, and on changes in their economic circumstances. Most women reported that their unsafe abortion had had one or more adverse effects, including loss of productivity (73%), negative consequences for their children (60%) and deterioration in economic circumstances (34%). Women who had spent one or more nights in a facility receiving postabortion care were more likely than those who had not needed an overnight stay to experience these three consequences (odds ratios, 1.6-2.8), and women who had incurred higher postabortion care expenses were more likely than those with lower expenses to report deterioration in economic circumstances (1.6). Wealthier women were less likely than the poorest women to report that their children had suffered negative consequences (0.4-0.5). The impact of complications of unsafe abortion and the expense of treating them are substantial for Ugandan women and their households. Strategies to reduce the number of unsafe procedures, such as by expanding access to contraceptives to prevent unintended pregnancies, are urgently needed.

Productive Spillovers of the Take-Up of Index-Based Livestock Insurance

USDA-ARS?s Scientific Manuscript database

Does the provision of livestock insurance raise the unintended consequence of stimulating excessive herd accumulation and less environmentally-sustainable herd movement patterns? The impact of insurance is theoretically ambiguous: if precautionary savings motives for holding livestock assets domina...

A Toxicological Perspective on Disinfection ByProducts

EPA Science Inventory

Disinfection of water is essential for reduction of microbes harmful to human health and chemical disinfection is considered one of the major public health triumphs of the 20th Century. An unintended consequence of disinfection with oxidizing chemicals is formation of disinfectio...

ESTABLISHMENT OF TRANSGENETIC HERBICIDE-RESISTANT CREEPING BENTGRASS (AGROSTIS STOLONIFERA L.) IN NONAGRONOMIC HABITATS

EPA Science Inventory

Concerns about genetically modified (GM) crops include transgene flow to compatible wild species and unintended ecological consequences of potential transgene introgression. However, there has been little empirical documentation of establishment and distribution of transgenic pla...

Origins of Western Literacy. Four Lectures delivered at the Ontario Institute for Studies in Education, Toronto, March 25-28, 1974. Monograph Series No. 14.

ERIC Educational Resources Information Center

Havelock, Eric A.

The four essays in this book are concerned with the cultural consequences of literacy in that they demonstrate that some forms of competence, highly valued in society, developed in large part as an unintended consequence of the Greek alphabetic writing system. The first essay, entitled "Spoken Sound and Inscribed Sign," discusses the…

Sometimes You Do Get a Second Chance: Emergency Contraception for Adolescents.

PubMed

Rome, Ellen S; Issac, Veronica

2017-04-01

Unplanned or unintended pregnancy remains a significant challenge for adolescents; many teens who plan ahead but opt not to choose long-acting reversible contraceptive methods have high failure rates with condom usage, oral contraceptives, and other less long-acting methods. Emergency contraception (EC) remains a necessity for those adolescents seeking a second chance to prevent the unintended consequences of unplanned sexual activity. At present, 5 postcoital methods remain available as EC globally: intrauterine devices, ulipristal acetate, a selective progesterone modulator, mifepristone; levonorgestrel, and ethinyl estradiol plus levonorgestrel or norgestrel (rarely used now that progestin only methods are more readily available). Copyright © 2017 Elsevier Inc. All rights reserved.

Factors associated with unintended pregnancy, poor birth outcomes and post-partum contraceptive use among HIV-positive female adolescents in Kenya

PubMed Central

2012-01-01

Background Although the experiences of unintended pregnancies and poor birth outcomes among adolescents aged 15–19 years in the general population are well documented, there is limited understanding of the same among those who are living with HIV. This paper examines the factors associated with experiencing unintended pregnancies, poor birth outcomes, and post-partum contraceptive use among HIV-positive female adolescents in Kenya. Methods Data are from a cross-sectional study that captured information on pregnancy histories of HIV-positive female adolescents in four regions of Kenya: Coast, Nairobi, Nyanza and Rift Valley provinces. Study participants were identified through HIV and AIDS programs in the four regions. Out of a total of 797 female participants, 394 had ever been pregnant with 24% of them experiencing multiple pregnancies. Analysis entails the estimation of random-effects logit models. Results Higher order pregnancies were just as likely to be unintended as lower order ones (odds ratios [OR]: 1.2; 95% confidence interval [CI]: 0.8–2.0) while pregnancies occurring within marital unions were significantly less likely to be unintended compared to those occurring outside such unions (OR: 0.1; 95% CI: 0.1–0.2). Higher order pregnancies were significantly more likely to result in poor outcomes compared to lower order ones (OR: 2.5; 95% CI: 1.6–4.0). In addition, pregnancies occurring within marital unions were significantly less likely to result in poor outcomes compared to those occurring outside such unions (OR: 0.3; 95% CI: 0.1–0.9). However, experiencing unintended pregnancy was not significantly associated with adverse birth outcomes (OR: 1.3; 95% CI: 0.5–3.3). There was also no significant difference in the likelihood of post-partum contraceptive use by whether the pregnancy was unintended (OR: 0.9; 95% CI: 0.5–1.5). Conclusions The experience of repeat unintended pregnancies among HIV-positive female adolescents in the sample is partly due to inconsistent use of contraception to prevent recurrence while poor birth outcomes among higher order pregnancies are partly due to abortion. This underscores the need for HIV and AIDS programs to provide appropriate sexual and reproductive health information and services to HIV-positive adolescent clients in order to reduce the risk of undesired reproductive health outcomes. PMID:23039966

Liberating the Learner through Self-Assessment

ERIC Educational Resources Information Center

Bourke, Roseanna

2016-01-01

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

CSR Cuts Bring Unintended Consequences, Prompt State Responses.

PubMed

Kirkner, Richard Mark

2017-12-01

Eliminating the cost-sharing payments (CSRs) to insurers to hold down out-of-pocket costs for low-income people who purchase individual health plans may wind up actually increasing overall federal spending by driving up premium subsidies to cover higher price plans.

Help Wanted.

ERIC Educational Resources Information Center

Keegan, Lisa Graham

2003-01-01

Argues that effective school leadership is key to implementing reform policies. Describes two unintended consequences of "A Nation at Risk" report: Increased resistance to change by school establishment and the proliferation of federal education programs. Sees several positive reform initiatives in No Child Left Behind Act such as…

Concluding Thoughts

ERIC Educational Resources Information Center

Palmer, James C.

2014-01-01

Community college leaders face several fundamental challenges as they work on sustaining the fiscal viability of their institutions. These include the need to anticipate the unintended consequences of performance-based funding, diversify revenue streams in ways that reduce fiscal dependence on tuition and state appropriations, control costs, and…

Some Unintended Consequences of "Top Down" Organization Development

ERIC Educational Resources Information Center

White, Bernard J.; Ramsey, V. Jean

1978-01-01

An organizational development consultant is expected to perform a thorough and unbiased diagnosis of the organization's functioning. This is an account of a case study of the effect of top management influence on the consultant's awareness and definition of problems. (Author/MLF)

ALTERED GENE EXPRESSION OF MOUSE EMBRYO CULTURES EXPOSED TO BROMOCHLOROACETIC ACID

EPA Science Inventory

An unintended consequence of chemical disinfection of municipal drinking water has been the production of disinfection by-products (DBPs) resulting from the interaction of chemical disinfectants and naturally occurring organic material present in the water. A major class of the ...

School Security Technologies

ERIC Educational Resources Information Center

Schneider, Tod

2010-01-01

Over the past decade electronic security technology has evolved from an exotic possibility into an essential safety consideration. Before resorting to high-tech security solutions, school officials should think carefully about the potential for unintended consequences. Technological fixes may be mismatched to the problems being addressed. They can…

Unintended consequences of human research ethics committees: au revoir workplace studies?

PubMed

Bamber, Greg J; Sappey, Jennifer

2007-07-01

To protect the welfare and rights of participants in research and to facilitate research that will be of benefit, as well as protect them against litigation, universities and research-funding agencies in Australia adopted the National Statement on Ethical Conduct in Research Involving Humans (NHMRC 1999). In many other countries there are similar statements. However, the ways in which such statements are often implemented by Human Research Ethics Committees (HRECs) are in conflict with an important stream of industrial sociological research. This stream seeks to deconstruct workplaces and de-layer management rhetoric to understand the realities and complexities of the social relations of production. There is a pluralist basis for much industrial sociology that challenges the unitarist view of the workplace as essentially harmonious. While views of workplaces as being conflictual and exploitative have to be tempered with an understanding of the accommodative and cooperative nature of workplace relations, there is nevertheless a general recognition of acts of resistance, as well as those of cooperation. The way in which the National Statement is typically implemented in Australia means that many HRECs require written, informed consent, which in the first instance will usually be that of management. An unintended consequence is a research focus on consensus, which is at best one-sided and at worst seriously misleading. It is unlikely that managerial consent will be granted unless there is a 'good news story' guaranteed. This article explores the ways in which HRECs may influence workplace research. The publication of the revised National Statement provides a valuable opportunity not to be missed by HRECs to implement more effective and efficient practices which would not have the unintended consequences of the earlier version. This would deserve the support of researchers in industrial sociology and other branches of the social sciences.

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

PubMed

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

2013-01-01

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

Unintended consequences of delisting routine eye exams on retinopathy screening for people with diabetes in Ontario, Canada

PubMed Central

Kiran, Tara; Kopp, Alexander; Moineddin, Rahim; Victor, J. Charles; Campbell, Robert J.; Shah, Baiju R.; Glazier, Richard H.

2013-01-01

Background: Routine eye examinations for healthy adults aged 20–64 years were delisted from the Ontario Health Insurance Plan in 2004, but they continue to be insured for people with diabetes regardless of age. We sought to assess whether the delisting of routine eye examinations for healthy adults had the unintended consequence of decreasing retinopathy screening for adults with diabetes. Methods: We used administrative data to calculate eye examinations for people with diabetes ages 40–64 years and 65 years and older in each 2-year period from 1998 to 2010. We examined differences by sex, income, rurality and type of health care provider. We used segmented linear regression to assess the change in trend before and after 2004. Results: For people with diabetes aged 65 years and older, eye examinations rose gradually from 1998 to 2010, with no substantial change between 2004 and 2006. For people with diabetes aged 40–65 years, there was an 8.7% (95% confidence interval [CI] 6.3%–11.1%) decrease in eye examinations between 2004 and 2006. Results were similar for all population subgroups. Ophthalmologic examinations decreased steadily for both age groups during the study period, and there was a decline in optometry examinations for people ages 40–65 years after 2004. Interpretation: The delisting of routine eye examinations for healthy adults in Ontario had the unintended consequence of reducing publicly funded retinopathy screening for people with diabetes. More research is needed to understand whether patients are being charged for an insured service or to what degree misunderstanding has prevented patients from seeking care. PMID:23296581

Transformations, transport, and potential unintended consequences of high sulfur inputs to Napa Valley vineyards

PubMed Central

Hinckley, Eve-Lyn S.; Matson, Pamela A.

2011-01-01

Unintended anthropogenic deposition of sulfur (S) to forest ecosystems has a range of negative consequences, identified through decades of research. There has been far less study of purposeful S use in agricultural systems around the world, including the application of elemental sulfur (S0) as a quick-reacting fungicide to prevent damage to crops. Here we report results from a three-year study of the transformations and flows of applied S0 in soils, vegetation, and hydrologic export pathways of Napa Valley, CA vineyards, documenting that all applied S is lost from the vineyard ecosystem on an annual basis. We found that S0 oxidizes rapidly to sulfate () on the soil surface where it then accumulates over the course of the growing season. Leaf and grape tissues accounted for only 7–13% of applied S whereas dormant season cover crops accounted for 4–10% of applications. Soil S inventories were largely and ester-bonded sulfates; they decreased from 1,623 ± 354 kg ha-1 during the dry growing season to 981 ± 526 kg ha-1 (0–0.5 m) during the dormant wet season. Nearly all S applied to the vineyard soils is transported offsite in dissolved oxidized forms during dormant season rainstorms. Thus, the residence time of reactive S is brief in these systems, and largely driven by hydrology. Our results provide new insight into how S use in vineyards constitutes a substantial perturbation of the S cycle in Northern California winegrowing regions and points to the unintended consequences that agricultural S use may have at larger scales. PMID:21825150

The Association between Adolescent Sexting, Psychosocial Difficulties, and Risk Behavior: Integrative Review

ERIC Educational Resources Information Center

Van Ouytsel, Joris; Walrave, Michel; Ponnet, Koen; Heirman, Wannes

2015-01-01

When a sexting message spreads to an unintended audience, it can adversely affect the victim's reputation. Sexting incidents constitute a potential school safety risk. Just as with other types of adolescent risk behavior, school nurses might have to initiate the first response when a sexting episode arises, but a school nurse's role goes…

The Incidence of Abortion in Nigeria

PubMed Central

Bankole, Akinrinola; Adewole, Isaac F.; Hussain, Rubina; Awolude, Olutosin; Singh, Susheela; Akinyemi, Joshua O.

2016-01-01

CONTEXT Because of Nigeria’s low contraceptive prevalence, a substantial number of women have unintended pregnancies, many of which are resolved through clandestine abortion, despite the country’s restrictive abortion law. Up-to-date estimates of abortion incidence are needed. METHODS A widely used indirect methodology was used to estimate the incidence of abortion and unintended pregnancy in Nigeria in 2012. Data on provision of abortion and postabortion care were collected from a nationally representative sample of 772 health facilities, and estimates of the likelihood that women who have unsafe abortions experience complications and obtain treatment were collected from 194 health care professionals with a broad understanding of the abortion context in Nigeria. RESULTS An estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15–49. The estimated unintended pregnancy rate was 59 per 1,000 women aged 15–49. Fifty-six percent of unintended pregnancies were resolved by abortion. About 212,000 women were treated for complications of unsafe abortion, representing a treatment rate of 5.6 per 1,000 women of reproductive age, and an additional 285,000 experienced serious health consequences but did not receive the treatment they needed. CONCLUSION Levels of unintended pregnancy and unsafe abortion continue to be high in Nigeria. Improvements in access to contraceptive services and in the provision of safe abortion and postabortion care services (as permitted by law) may help reduce maternal morbidity and mortality. PMID:26871725

Public Reporting of Primary Care Clinic Quality: Accounting for Sociodemographic Factors in Risk Adjustment and Performance Comparison.

PubMed

Wholey, Douglas R; Finch, Michael; Kreiger, Rob; Reeves, David

2018-01-03

Performance measurement and public reporting are increasingly being used to compare clinic performance. Intended consequences include quality improvement, value-based payment, and consumer choice. Unintended consequences include reducing access for riskier patients and inappropriately labeling some clinics as poor performers, resulting in tampering with stable care processes. Two analytic steps are used to maximize intended and minimize unintended consequences. First, risk adjustment is used to reduce the impact of factors outside providers' control. Second, performance categorization is used to compare clinic performance using risk-adjusted measures. This paper examines the effects of methodological choices, such as risk adjusting for sociodemographic factors in risk adjustment and accounting for patients clustering by clinics in performance categorization, on clinic performance comparison for diabetes care, vascular care, asthma, and colorectal cancer screening. The population includes all patients with commercial and public insurance served by clinics in Minnesota. Although risk adjusting for sociodemographic factors has a significant effect on quality, it does not explain much of the variation in quality. In contrast, taking into account the nesting of patients within clinics in performance categorization has a substantial effect on performance comparison.

The Occurrence and Comparative Toxicity of Haloacetaldehyde Disinfection Byproducts in Drinking Water

EPA Science Inventory

The introduction of drinking water disinfection greatly reduced the incidence of waterborne diseases. However, the reaction between disinfectants and natural organic matter in the source water can lead to an unintended consequence, which is the formation of drinking water disinfe...

Crossing the Rubric-Con

ERIC Educational Resources Information Center

Bailey, James R.

2014-01-01

This essay engages the prospect and peril of employing rubrics in America. It discusses how institutional independence affects the enterprise, and addresses whether rubrics will be received as salvation or subservience by educational agents. It asks how rubrics can benefit stakeholders while examining their unintended consequences. It concludes by…

Is Your Sick Leave Bank in Good Health?

ERIC Educational Resources Information Center

Hoover, James P.

2012-01-01

Sick leave banks are a common staple of teacher contracts. Although these banks may benefit employees, they expose school districts to a variety of complications and unintended consequences, including administrative complexity, potential cash flow implications, cost disparities, increased absenteeism, instructional instability, privacy issues, and…

Staying Afloat in an Information-Age Sea Change

ERIC Educational Resources Information Center

Spirduso, Waneen W.

2009-01-01

Scientific and technological advances, occurring with increasing frequency, allow for exciting opportunities for multidisciplinary research but may be accompanied by unintended consequences for kinesiology. These advances require depth of knowledge in subdisciplines and place pressures on kinesiology departments to hire experts with grants in…

Planning for compliance: OSHA's bloodborne pathogen rule.

PubMed

Bednar, B; Duke, M C

1990-11-01

Overall, the bloodborne pathogen rule constitutes a reasonable response to a significant threat to workplace safety. The risks to dialysis workers from HBV and HIV must be minimized or eliminated and the rule is generally consistent with the consensus approach. Unfortunately for dialysis providers, the rule is not exempt from the law of unintended consequences: government regulation will always have impact beyond its object. Promulgation of the final rule will immediately increase the expenses of dialysis providers. Additionally, the enormity of the HBV and HIV problem coupled with the open-ended nature of the rule's key provisions will almost certainly bring additional costs. So long as dialysis reimbursement remains flat, the unintended consequence of the bloodborne pathogen rule may be to quicken the pace of consolidation in the dialysis service market. The added burden of compliance may be too much for small independent facilities. Only large chains may have the resources to comply and survive. To forestall this effect and to provide employees with maximum protection, all dialysis providers should plan now for compliance.

Disparities in long-term care: building equity into market-based reforms.

PubMed

Konetzka, R Tamara; Werner, Rachel M

2009-10-01

A growing body of evidence documents pervasive racial, ethnic, and class disparities in long-term care in the United States. At the same time, major quality improvement initiatives are being implemented that rely on market-based incentives, many of which may have the unintended consequence of exacerbating disparities. We review existing evidence on disparities in the use and quality of long-term care services, analyze current market-based policy initiatives in terms of their potential to ameliorate or exacerbate these disparities, and suggest policies and policy modifications that may help decrease disparities. We find that racial disparities in the use of formal long-term care have decreased over time. Disparities in quality of care are more consistently documented and appear to be related to racial and socioeconomic segregation of long-term care facilities as opposed to within-provider discrimination. Market-based incentives policies should explicitly incorporate the goal of mitigating the potential unintended consequence of increased disparities.

Use of psychology and behavioral economics to promote healthy eating.

PubMed

Roberto, Christina A; Kawachi, Ichiro

2014-12-01

Understanding the psychology of how people make decisions can shed light on important factors contributing to the cause and maintenance of public health problems like obesity. This knowledge can and should inform the design of government and private-sector public health interventions. Several insights from psychology and behavioral economics that help explain why people are particularly vulnerable to the current food environment are discussed. These insights fall into the following categories: the influence of starting points (status quo bias and anchoring effects); communicating health information (simplicity and framing); and unintended consequences of policy interventions (compensation, substitution, and the peanuts effect). The paper discusses opportunities for improving the design of food policies and interventions by altering default options, providing the public with simple and meaningful nutrition information, carefully constructing the framing of public health messages, and designing food policies to minimize unintended consequences, such as compensation and substitution. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2018-07-01

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

[Psychiatric complications of abortion].

PubMed

Gurpegui, Manuel; Jurado, Dolores

2009-01-01

The psychiatric consequences of induced abortion continue to be the object of controversy. The reactions of women when they became aware of conception are very variable. Pregnancy, whether initially intended or unintended, may provoke stress; and miscarriage may bring about feelings of loss and grief reaction. Therefore, induced abortion, with its emotional implications (of relief, shame and guilt) not surprisingly is a stressful adverse life event. METHODOLOGICAL CONSIDERATIONS: There is agreement among researchers on the need to compare the mental health outcomes (or the psychiatric complications) with appropriate groups, including women with unintended pregnancies ending in live births and women with miscarriages. There is also agreement on the need to control for the potential confounding effects of multiple variables: demographic, contextual, personal development, previous or current traumatic experiences, and mental health prior to the obstetric event. Any psychiatric outcome is multi-factorial in origin and the impact of life events depend on how they are perceived, the psychological defence mechanisms (unconscious to a great extent) and the coping style. The fact of voluntarily aborting has an undeniable ethical dimension in which facts and values are interwoven. No research study has found that induced abortion is associated with a better mental health outcome, although the results of some studies are interpreted as or Some general population studies point out significant associations with alcohol or illegal drug dependence, mood disorders (including depression) and some anxiety disorders. Some of these associations have been confirmed, and nuanced, by longitudinal prospective studies which support causal relationships. With the available data, it is advisable to devote efforts to the mental health care of women who have had an induced abortion. Reasons of the woman's mental health by no means can be invoked, on empirical bases, for inducing an abortion.

Reproductive consequences of unwanted sexual debut among young adult women from Metro Cebu, Philippines.

PubMed

Wiles, Melissa; Agustin, Sonny; Narasimhan, Subasri; Gipson, Jessica D

2018-04-18

The circumstances surrounding sexual debut influence subsequent sexual and reproductive outcomes. We analysed longitudinal data from 397 women who participated in the Cebu Longitudinal Health and Nutrition Survey in Cebu, Philippines to examine associations between unwanted first sex and number of pregnancies, unintended pregnancy, and use of modern contraception. 72% of women reported unwanted first sex. Women whose first sex was unwanted had increased odds of unintended pregnancy compared to women whose first sex was wanted (aOR = 2.2, 95% CI 1.3, 3.6). Nationally-representative surveys should include culturally-relevant questions about sexual debut to inform public health programmes aimed at improving sexual/reproductive health.

Intentional Schools: Living in the Moment

ERIC Educational Resources Information Center

Van Bockern, Steve

2011-01-01

Schools with good intentions are not the same as schools being intentional. Sometimes the best intentions--a result of valuing efficiency, standard procedure (tradition), obedience, or the latest educational fad--create unintended consequences that are not necessarily in the best interest of children. Intentional schools develop a culture of…

Dollars to Discriminate: The (Un)Intended Consequences of School Vouchers

ERIC Educational Resources Information Center

Eckes, Suzanne E.; Mead, Julie; Ulm, Jessica

2016-01-01

Some private, religious schools that accept vouchers have been accused of discriminating against certain populations of students through their admissions processes. Discriminating against disfavored groups (e.g., racial minorities, LGBT students, students with disabilities, religious minorities) in voucher programs raises both legal and policy…

School-Based Condom Availability Programs

ERIC Educational Resources Information Center

Schmiedl, Renee

2004-01-01

The repercussions of sexual activity among teens continue to be a significant issue in the United States. Detrimental consequences to unprotected sexual activity among teens include unintended pregnancy and acquiring a sexually transmitted disease (STD) or human immunodeficiency virus (HIV). It is estimated that each year approximately 3 million…

Brazil: Opportunity and Crisis in Higher Education.

ERIC Educational Resources Information Center

Schwartzman, Simon

1988-01-01

The Brazilian system of higher education is discussed, including its evolution, the 1968 reform and its unintended consequences, and the recommendations of the 1985 presidential commission on higher education. Issues of interinstitutional diversity, institutional autonomy, and the influence of special interest groups on policy are addressed.…

78 FR 9865 - Air Carrier Contract Maintenance Requirements; Extension of Comment Period

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

..., RACCA believes the proposed rulemaking would result in significant unintended consequences, including greater operator cost and manpower requirements than those estimated in the NPRM, loss of efficiency, unbudgeted loss of aircraft availability, and a substantial additional workload for the FAA that would result...

High Risk Behavior among Adolescent Mothers: The Problem in Context.

ERIC Educational Resources Information Center

Kissman, Kris

1998-01-01

Discusses the particular consequences of high-risk behavior for adolescent women, including unintended pregnancies, sexually transmitted diseases, school dropout and poverty, developmental disabilities, and poor school performance. Considers the role of male partners in teenage women's high risk behavior. Describes prevention efforts such as…

Can we treat enough water to meet water quality goals

USDA-ARS?s Scientific Manuscript database

Denitrifying woodchip bioreactors are sized to treat a portion of subsurface drainage flow from a given system. Over sizing them can create conditions under which unintended consequences could occur. A potential solution for treating additional water is to use a cascading series of bioreactor cell...

Averted Vision: How Common Core May Help Struggling Readers

ERIC Educational Resources Information Center

Shanahan, Timothy

2016-01-01

In their article "Beyond the Common Core…," Cassidy, Ortlieb, and Grote-Garcia (2016), express concern that the new Common Core State Standards (CCSS; National Governors Association [NGA] Center for Best Practices & Council of Chief State School Officers [CCSSO], 2010) may have the "unintended consequence" of diverting…

Show Me the Data: Kristin Eschenfelder--University of Wisconsin-Madison

ERIC Educational Resources Information Center

Library Journal, 2005

2005-01-01

Many librarians have been concerned with the unintended consequences of new technologies, but Kristin Eschenfelder--librarian, scholar, and social scientist--gathers the data to enable rational policy decisions about technology's ramifications. As assistant professor in the School of Library and Information Studies at University of…

The Unintended Consequences of Grading Teaching

ERIC Educational Resources Information Center

Smith, Holly

2012-01-01

This article examines the possibility of a "Teaching Assessment Exercise" and attempts to quantify teaching quality as part of performance management schemes for academics. The primary sources of data are identified as student evaluation of teaching (SET) and peer observation of teaching (POT). The conceptual and empirical issues in…

The Integrated Disinfection By-Product Mixtures Project (“4-Lab Study”): An Overview

EPA Science Inventory

The intended result of chemical disinfection of drinking water is reduction of microbial contamination and a concomitant decrease in waterborne disease. The formation of a myriad of disinfection by-products (DBPs) is an unintended consequence. DBPs are present in water as high...

Reducing number entry errors: solving a widespread, serious problem.

PubMed

Thimbleby, Harold; Cairns, Paul

2010-10-06

Number entry is ubiquitous: it is required in many fields including science, healthcare, education, government, mathematics and finance. People entering numbers are to be expected to make errors, but shockingly few systems make any effort to detect, block or otherwise manage errors. Worse, errors may be ignored but processed in arbitrary ways, with unintended results. A standard class of error (defined in the paper) is an 'out by 10 error', which is easily made by miskeying a decimal point or a zero. In safety-critical domains, such as drug delivery, out by 10 errors generally have adverse consequences. Here, we expose the extent of the problem of numeric errors in a very wide range of systems. An analysis of better error management is presented: under reasonable assumptions, we show that the probability of out by 10 errors can be halved by better user interface design. We provide a demonstration user interface to show that the approach is practical.To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact. (Charles Darwin 1879 [2008], p. 229).

The impact of school suspension on student tobacco use: A longitudinal study in Victoria, Australia and Washington State, United States

PubMed Central

Hemphill, Sheryl A.; Heerde, Jessica A.; Herrenkohl, Todd I.; Toumbourou, John W.; Catalano, Richard F.

2011-01-01

Context School suspension may have unintended consequences in contributing to problem behaviors including school drop-out, substance use, and antisocial behavior. Tobacco use is an early-onset problem behavior, but prospective studies of the effects of suspension on tobacco use are lacking. Method Longitudinal school-based survey of students drawn as a 2-stage cluster sample, administered in 2002 and 2003 in Washington State, United States and Victoria, Australia. The study uses statewide representative samples of students in Grades 7 and 9 (N = 3,599). Results Rates of tobacco use were higher for Victorian than Washington State students. School suspension remained a predictor of current tobacco use at 12-month follow-up, after controlling for established risk factors including prior tobacco and other drug use for Grade 7 but not Grade 9 students. Conclusions School suspension is associated with tobacco use in early adolescence, itself an established predictor of adverse outcomes in young people. Findings suggest the need to explore process mechanisms and alternatives to school suspensions as a response to challenging student behavior in early adolescence. PMID:21586667

New Insights for Oxidative Stress and Diabetes Mellitus

PubMed Central

2015-01-01

The release of reactive oxygen species (ROS) and the generation of oxidative stress are considered critical factors for the pathogenesis of diabetes mellitus (DM), a disorder that is growing in prevalence and results in significant economic loss. New therapeutic directions that address the detrimental effects of oxidative stress may be especially warranted to develop effective care for the millions of individuals that currently suffer from DM. The mechanistic target of rapamycin (mTOR), silent mating type information regulation 2 homolog 1 (S. cerevisiae) (SIRT1), and Wnt1 inducible signaling pathway protein 1 (WISP1) are especially justified to be considered treatment targets for DM since these pathways can address the complex relationship between stem cells, trophic factors, impaired glucose tolerance, programmed cell death pathways of apoptosis and autophagy, tissue remodeling, cellular energy homeostasis, and vascular biology that greatly impact the biology and disease progression of DM. The translation and development of these pathways into viable therapies will require detailed understanding of their proliferative nature to maximize clinical efficacy and limit adverse effects that have the potential to lead to unintended consequences. PMID:26064426

RNA interference-based nanosystems for inflammatory bowel disease therapy

PubMed Central

Guo, Jian; Jiang, Xiaojing; Gui, Shuangying

2016-01-01

Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease, is a chronic, recrudescent disease that invades the gastrointestinal tract, and it requires surgery or lifelong medicinal therapy. The conventional medicinal therapies for IBD, such as anti-inflammatories, glucocorticoids, and immunosuppressants, are limited because of their systemic adverse effects and toxicity during long-term treatment. RNA interference (RNAi) precisely regulates susceptibility genes to decrease the expression of proinflammatory cytokines related to IBD, which effectively alleviates IBD progression and promotes intestinal mucosa recovery. RNAi molecules generally include short interfering RNA (siRNA) and microRNA (miRNA). However, naked RNA tends to degrade in vivo as a consequence of endogenous ribonucleases and pH variations. Furthermore, RNAi treatment may cause unintended off-target effects and immunostimulation. Therefore, nanovectors of siRNA and miRNA were introduced to circumvent these obstacles. Herein, we introduce non-viral nanosystems of RNAi molecules and discuss these systems in detail. Additionally, the delivery barriers and challenges associated with RNAi molecules will be discussed from the perspectives of developing efficient delivery systems and potential clinical use. PMID:27789943

PURPA: The spur to competition and utility restructuring

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

Hirsh, R.F.

Without discussing the merits or deficiencies of the arguments made by contesting parties, this article explores the history of PURPA and its intended and unintended consequences. The article will serve as a background for discussion of the repeal or reform of PURPA so that participants in the debate will understand the profound consequences of this important law. Most notably, PURPA helped establish the free-market, competitive principles that many people hope to extend further in the utility system.

Understanding Unintended Consequences and Health Information Technology:

PubMed Central

Randell, R.; Borycki, E. M.

2016-01-01

Summary Objective No framework exists to identify and study unintended consequences (UICs) with a focus on organizational and social issues (OSIs). To address this shortcoming, we conducted a literature review to develop a framework for considering UICs and health information technology (HIT) from the perspective of OSIs. Methods A literature review was conducted for the period 2000-2015 using the search terms “unintended consequences” and “health information technology”. 67 papers were screened, of which 18 met inclusion criteria. Data extraction was focused on the types of technologies studied, types of UICs identified, and methods of data collection and analysis used. A thematic analysis was used to identify themes related to UICs. Results We identified two overarching themes. One was the definition and terminology of how people classify and discuss UICs. Second was OSIs and UICs. For the OSI theme, we also identified four sub-themes: process change and evolution, individual-collaborative interchange, context of use, and approaches to model, study, and understand UICs. Conclusions While there is a wide body of research on UICs, there is a lack of overall consensus on how they should be classified and reported, limiting our ability to understand the implications of UICs and how to manage them. More mixed-methods research and better proactive identification of UICs remain priorities. Our findings and framework of OSI considerations for studying UICs and HIT extend existing work on HIT and UICs by focusing on organizational and social issues. PMID:27830231

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

ERIC Educational Resources Information Center

Strandler, Ola

2015-01-01

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

Unintended Consequences: Twelve Years under the DMCA

ERIC Educational Resources Information Center

Von Lohmann, Fred

2010-01-01

Since they were enacted in 1998, the "anti-circumvention" provisions of the Digital Millennium Copyright Act ("DMCA"), codified in section 1201 of the Copyright Act, have not been used as Congress envisioned. Congress meant to stop copyright infringers from defeating anti-piracy protections added to copyrighted works and to ban…

The High-Stakes Test Mess

ERIC Educational Resources Information Center

Goldberg, Mark F.

2004-01-01

Tests are a natural part of education, from the quizzes, essays, and classroom tests that teachers have traditionally administered to the high-stakes tests that states use to make decisions about graduation, promotion, and school funding and governance. In this article, the author stresses the need to learn the unintended consequences of…

One Size Fits All? A Different Perspective on University Rankings

ERIC Educational Resources Information Center

Goglio, Valentina

2016-01-01

In roughly a decade, university rankings gained the foreground in the policy arena for higher education and their influence is not going to decrease. However, several methodological shortcomings and warnings about the unintended consequences for national higher education systems have been raised. Against this background, this paper stresses that…

Waiver Culture: The Unintended Consequence of Ethics Compliance

ERIC Educational Resources Information Center

Genova, Gina L.

2008-01-01

The passage of the U.S. Sarbanes-Oxley Act (2002) spawned a series of compliance and ethics programs --the revised Principles of Federal Prosecution of Business Organizations known as the Thompson Memo (Thompson, 2003), the revised Federal Sentencing Guidelines that included the Effective Compliance and Ethics Program and the corporate…

Greening China Naturally

Treesearch

Shixiong Cao; Ge Sun; Zhiqiang Zhang; Liding Che; Qi Feng; et. al.

2011-01-01

China leads the world in afforestation, and is one of the few countries whose forested area is increasing. However, this massive “greening” effort has been less effective than expected; afforestation has sometimes produced unintended environmental, ecological, and socioeconomic consequences, and has failed to achieve the desired ecological benefits. Where afforestation...

78 FR 59029 - Information Collection Being Reviewed by the Federal Communications Commission

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-25

... Broadcast Station Antenna Patterns. Form No.: Not applicable. Type of Review: Revision of a currently... Rules Regarding AM Radio Service Directional Antenna Performance Verification, MM Docket No. 93-177, FCC... functions as the antenna. Consequently, a nearby tower may become an unintended part of the AM antenna...

The Impact of School Suspensions: A Student Wellbeing Issue

ERIC Educational Resources Information Center

Hemphill, Sheryl; Hargreaves, John

2009-01-01

School suspensions are commonly used in schools to address challenging student behaviours, often on the understanding that suspensions send a clear message to the school community about what is acceptable behaviour. However, there is a growing body of evidence that school suspensions have a range of unintended negative consequences including…

Think before You Share

ERIC Educational Resources Information Center

Read, Brock

2006-01-01

Students in the US are increasingly discovering that online socializing is far from private and that sharing personal details on social-networking Web sites, such as Facebook, can have unintended consequences. A growing number of colleges are moving to disabuse students of the notion that the Internet is their private playground and what they type…

Why Knowledge Matters: Rescuing Our Children from Failed Educational Theories

ERIC Educational Resources Information Center

Hirsch, E. D., Jr.

2016-01-01

In "Why Knowledge Matters," influential scholar E. D. Hirsch, Jr., addresses critical issues in contemporary education reform and shows how cherished truisms about education and child development have led to unintended and negative consequences. Hirsch, author of "The Knowledge Deficit," draws on recent findings in neuroscience…

Economics: An Analysis of Unintended Consequences. Volume 2: Introduction to Macroeconomics.

ERIC Educational Resources Information Center

Schenk, Robert E.

This curriculum guide emphasizes that economics is a method of thought or analysis and highlights the teaching of macroeconomic concepts. Definitions of economics, economic actions and their results, individual and group relationships, and supply and demand principles are reviewed. Macroeconomic concepts that are introduced include: (1) economic…

Community Impact Assessment Handbook.

ERIC Educational Resources Information Center

Northern Alberta Development Council, Peace River.

This handbook is intended for communities that wish to undertake their own community impact assessment (CIA). The goal is to enable communities to plan for changes before they occur, so they can cope with changes when they do occur. CIA involves forecasting and evaluating the full range of unintended consequences for the community of development…

Performativity, Propriety and Productivity: The Unintended Consequences of Investing in the Early Years

ERIC Educational Resources Information Center

Macfarlane, Kym; Lakhani, Ali

2015-01-01

This paper examines notions of childhood development in a significant Australian policy document. Using Fairclough's approaches to discourse analysis as guides, Foucault's understanding of regimes of truth and discourses as systems of power relations and Nikolas Rose's concept of "responsibilisation," the paper argues that discourses of…

Race-Ethnicity, Class and Zero Tolerance Policies: A Policy Discussion.

ERIC Educational Resources Information Center

Verdugo, Richard R.; Glenn, Beverly C.

This paper presents a history of zero tolerance policies, discusses the breadth and scope of zero tolerance policies in U.S. public schools, examines unintended consequences of zero tolerance policies (especially those conflicting with basic philosophical tenets of the public school system), and makes recommendations for creating and implementing…

Unidimensional Interpretations for Multidimensional Test Items

ERIC Educational Resources Information Center

Kahraman, Nilufer

2013-01-01

This article considers potential problems that can arise in estimating a unidimensional item response theory (IRT) model when some test items are multidimensional (i.e., show a complex factorial structure). More specifically, this study examines (1) the consequences of model misfit on IRT item parameter estimates due to unintended minor item-level…

Soviet Industrial Strategy and Reforms in Vocational Education, 1984-88: Policy Implications and Implementation.

ERIC Educational Resources Information Center

Sowtis, Dennis

1991-01-01

In 1984, Soviet educational reforms increased the number of vocational secondary schools, introduced pupils to vocational education at an earlier age, and strengthened vertical integration between local enterprises and schools. Unintended consequences may be occupational rigidity, course offerings based on obsolete manpower needs, and…

Exploring the Decision Landscape using System Sketch: Integration and Display of Ecosystem Services & Indicators Using the DPSIR Framework and Dynamic Web Application

EPA Science Inventory

Stakeholders can use the tool to accomplish their sustainability goals by: Understanding interactions and feedback loops within human-environmental systems; Identifying areas of the system not previously considered and avoiding unintended consequences; Identifying metrics, indica...

Audit Culture: Unintended Consequences of Accountability Practices in Evidence-Based Programs

ERIC Educational Resources Information Center

Owczarzak, Jill; Broaddus, Michelle; Pinkerton, Steven

2016-01-01

Evaluation has become expected within the nonprofit sector, including HIV prevention service delivery through community-based organizations (CBOs). While staff and directors at CBOs may acknowledge the potential contribution of evaluation data to the improvement of agency services, the results of evaluation are often used to demonstrate fiscal…

Knowledge Management and Higher Education: A Critical Analysis

ERIC Educational Resources Information Center

Metcalfe, Amy

2006-01-01

Rather than focusing on functional issues relating to implementation of knowledge management (KM) techniques, this book addresses the social aspects of KM. Using various social science perspectives, the volume provides critical analyses of KM in higher education, with an emphasis on unintended consequences and future implications. Fifteen chapters…

A Tale of Unintended Consequences

ERIC Educational Resources Information Center

Corn, Jennifer

2006-01-01

A teacher of Limited English Proficient elementary students in California describes how she put her students through daily timed read-aloud drills to boost their scores on a benchmark assessment of reading rate that her school district required. Corn briefly reviews the rationale behind measuring reading rate as an indicator of fluency. The reason…

Are Charitable Giving and Religious Attendance Complements or Substitutes? The Role of Measurement Error

ERIC Educational Resources Information Center

Kim, Matthew

2013-01-01

Government policies sometimes cause unintended consequences for other potentially desirable behaviors. One such policy is the charitable tax deduction, which encourages charitable giving by allowing individuals to deduct giving from taxable income. Whether charitable giving and other desirable behaviors are complements or substitutes affect the…

A New Era for Research Education in Australia?

ERIC Educational Resources Information Center

Marsh, Helene; Smith, Bradley; King, Max; Evans, Terry

2012-01-01

Use of the Australian research assessment exercise, Excellence in Research for Australia (ERA) to influence the policy and practice of research education in Australia will undoubtedly have many consequences, some of them unintended and potentially deleterious. ERA is a retrospective measure of research quality; research education is prospective.…

Intimate partner violence and pregnancy: epidemiology and impact.

PubMed

Chisholm, Christian A; Bullock, Linda; Ferguson, James E Jef

2017-08-01

Intimate partner violence is a significant public health problem in our society, affecting women disproportionately. Intimate partner violence takes many forms, including physical violence, sexual violence, stalking, and psychological aggression. While the scope of intimate partner violence is not fully documented, nearly 40% of women in the United States are victims of sexual violence in their lifetimes and 20% are victims of physical intimate partner violence. Other forms of intimate partner violence are likely particularly underreported. Intimate partner violence has a substantial impact on a woman's physical and mental health. Physical disorders include the direct consequences of injuries sustained after physical violence, such as fractures, lacerations and head trauma, sexually transmitted infections and unintended pregnancies as a consequence of sexual violence, and various pain disorders. Mental health impacts include an increased risk of depression, anxiety, posttraumatic stress disorder, and suicide. These adverse health effects are amplified in pregnancy, with an increased risk of pregnancy outcomes such as preterm birth, low birthweight, and small for gestational age. In many US localities, suicide and homicide are leading causes of pregnancy-associated mortality. We herein review the issues noted previously in greater depth and introduce the basic principles of intimate partner violence prevention. We separately address current recommendations for intimate partner violence screening and the evidence surrounding effectiveness of intimate partner violence interventions. Copyright © 2017 Elsevier Inc. All rights reserved.

Lessons Learned from the Evolution of Mandatory Adverse Event Reporting Systems

DTIC Science & Technology

2005-05-01

related to treatment, such as nosocomial infections and unintended effects of drugs and medical devices, is collected by the Centers for Disease...Nontreatment-related events (such as criminal acts, specified statutory events, and nosocomial infection outbreaks) • Treatment and procedure...1.8 Ventilator death/injury 38 1.5 Anesthesia-related event 35 1.4 Infection -related event 34 1.4 Medical equipment-related 32 1.3 Maternal death

Smoker-free workplace policies: developing a model of public health consequences of workplace policies barring employment to smokers.

PubMed

Houle, B; Siegel, M

2009-02-01

A marked shift in tobacco-related workplace health promotion intervention involves the adoption of policies barring employment to smokers. We discuss the potential public health consequences of these policies on those affected-smokers, their families, the surrounding community and society at large. We find a lack of published evidence evaluating the effectiveness and consequences of these policies. By developing a model of policy effects, we outline possible unintended consequences. With such large gaps in the evidence base and the potential for deleterious consequences, we argue for increased discussion about the use of smoker-free employment policies as a public health intervention and for increased engagement of employers by the public health community in worksite health promotion.

20 CFR 1002.194 - Can the application of the escalator principle result in adverse consequences when the employee...

Code of Federal Regulations, 2010 CFR

2010-04-01

... principle result in adverse consequences when the employee is reemployed? 1002.194 Section 1002.194... principle result in adverse consequences when the employee is reemployed? Yes. The Act does not prohibit lawful adverse job consequences that result from the employee's restoration on the seniority ladder...

Conflicts, Competition and Social Support in Female-Dominated Vocational Education--Breaking or Reaffirming Stereotypical Femininity?

ERIC Educational Resources Information Center

Hegna, Kristinn

2017-01-01

One in four upper secondary school students in Norway experience nearly single-sex classrooms, an unintended consequence of choosing certain vocational study programmes, such as "Health care, childhood and youth development" or "Building and construction". This raises a question about how female students describe their…

The Unintended Consequences of Reorganization

ERIC Educational Resources Information Center

Zeng, Jie

2009-01-01

For the last five years, the lives of New York City (NYC) public school educators have been governed by constant change. With certainty, every January or June heralded something new--restructured departments and offices, staff changes and new initiatives. One of the most interesting chapters in the history of the NYC school system unfolded in the…

Intended and Unintended Consequences of Educational Technology on Social Inequality

ERIC Educational Resources Information Center

Tawfik, Andrew A.; Reeves, Todd D.; Stich, Amy

2016-01-01

While much has been written in the field of educational technology regarding educational excellence and efficiency, less attention has been paid to issues of equity. Along these lines, the field of educational technology often does not address key equity problems such as academic achievement and attainment gaps, and inequality of educational…

76 FR 23854 - Reclassification of Motorcycles (Two and Three Wheeled Vehicles) in the Guide to Reporting...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

... and the unintended consequences of misclassification. Harley Davidson Motor Company (HDMC) stated that... concerns about the administrative, logistical and financial burdens of providing information based on the... estimated that the cost of updating their computers to process the information included in the new guidance...

Why Continuous Improvement Is a Poor Substitute for School Choice

ERIC Educational Resources Information Center

Rose, David C.; Rochester, J. Martin

2008-01-01

Efforts to introduce school choice have produced pressures on public schools to improve their performance. As a result, many public schools have embraced the total quality management principle of continuous improvement. In this article we explain that while this may be well intentioned, it may have perverse unintended consequences. A likely…

Changes in hematology and serum biochemical profiles in lambs fed sericea lespedeza

USDA-ARS?s Scientific Manuscript database

Sericea lespedeza (SL; Lespedeza cuneata) is a legume rich in condensed tannins (CT) that can be grazed or fed to small ruminants for parasite control. Condensed tannins a secondary plant compound in SL may lead to unintended consequences such as changes in production. In our preliminary research, t...

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

ERIC Educational Resources Information Center

Bjorkhaug, Hilde; Richards, Carol Ann

2008-01-01

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

Linking Air Land & Water to Examine the Vulnerability of Groundwater Nitrate Contamination from Increased Corn Production

EPA Science Inventory

The Renewable Fuel Standard (RFS) requires oil refiners to reach a target of 15 billion gallons of corn-based ethanol by 2022. However, there are concerns that the broad-scale use of corn as a source of ethanol may lead to unintended economic and environmental consequences. Thi...

Carbon Emissions Trading and Combined Heat and Power Strategies: Unintended Consequences

ERIC Educational Resources Information Center

Tysseling, John C.; Vosevich, Mary; Boersma, Benjamin R.; Zumwalt, Jefferey A.

2009-01-01

Facility professionals continuously search for projects that reduce energy consumption and operating costs so as to directly benefit their bottom line. Many institutions nationwide have contemplated or made investments in combined heat and power (CHP) projects as a life-cycle strategy to minimize operating costs. However, recent sustainability and…

78 FR 21457 - Self-Regulatory Organizations; New York Stock Exchange LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-10

..., particularly without any impact analysis, because such initiatives can have unintended consequences to the... development of ``subsystems within the national market system,'' objectives which are inconsistent with the... public interest or for the protection of investors and to facilitate the development of subsystems within...

The Social Studies are Essential to a Well-Rounded Education

ERIC Educational Resources Information Center

Duncan, Arne

2011-01-01

Social studies teachers live with the unintended consequences of the No Child Left Behind (NCLB) Act every day. They understand that the law has created flawed incentives for states and school districts to narrow their curricula to English and math. This fundamentally misguided practice leaves out core disciplines that are essential to a…

Manipulation of density of Pseudotsuga menziesii canopies: preliminary effects on understory vegetation.

Treesearch

D.R. Thysell; A.B. Carey

2001-01-01

Managing second-growth forests to conserve biodiversity has been proposed by both foresters and conservation biologists. Management, however, can have unintended consequences, including reduction in native species diversity and increased invasion by exotic species. Our goal was to determine if inducing heterogeneity in managed forest canopies could promote a diversity...

Unintended Consequences: How Science Professors Discourage Women of Color

ERIC Educational Resources Information Center

Johnson, Angela C.

2007-01-01

This study examined how 16 Black, Latina, and American Indian women science students reacted to their undergraduate science classes. I focused on the meanings they made of the common features of university science documented by Seymour and Hewitt (1997), including large, competitive, fast-paced classes, poor teaching, and an unsupportive culture.…

Parental Attitudes about Teenage Pregnancy: Impact on Sexual Risk Behaviour of African-American Youth

ERIC Educational Resources Information Center

Annang, Lucy; Lian, Brad; Fletcher, Faith E.; Jackson, Dawnyéa

2014-01-01

African-American youth suffer disproportionately from sexual risk consequences including unintended pregnancy and sexually transmitted infections. Parents educating young people about sex may be one approach to reduce sexual risk behaviour among this population. The purpose of this study was to determine young people's perceptions of parents'…

EMISSION REDUCTIONS AIMED AT IMPROVING AIR QUALITY: UNINTENDED CLIMATIC CONSEQUENCES AND THE EFFECT OF CLIMATE CHANGE ON THEIR SUCCESS

EPA Science Inventory

This work will provide improved understanding of the role of climate change, both in the recent past and future, on the success of pollutant control strategies, allowing for better planning and accountability of emission reductions. This work will also provide a quantitative a...

Class Size Reduction: Great Hopes, Great Challenges. Policy Brief.

ERIC Educational Resources Information Center

WestEd, San Francisco, CA.

This policy brief examines the benefits and the challenges that accompany class-size reduction (CSR). It suggests that when designing CSR programs, states should carefully assess specific circumstances in their schools as they adopt or modify CSR efforts to avoid the unintended consequences that some programs have experienced. Some of the…

Public Schools in Marketized Environments: Shifting Incentives and Unintended Consequences of Competition-Based Educational Reforms

ERIC Educational Resources Information Center

Lubienski, Christopher

2005-01-01

By opening the system to competition, popular school choice reforms seek to remake public education into a more consumer-oriented endeavor. While the underlying theory holds that competitive pressures will induce change and improvement in educational processes, research indicates that organizations often respond instead by developing promotional…

Student Data and Consent Policies: Avoiding Unintended Consequences. Safeguarding Data: Briefs for Policymakers

ERIC Educational Resources Information Center

Data Quality Campaign, 2014

2014-01-01

Schools use data for different purposes, which have different degrees of impact on a student's educational experience: administrative, instructional, assessment and measurement, and optional/noneducational. To the extent feasible, parental choice policies should be structured according to the use of the data in question. Parents should have more…

Visual Portrayals of Obesity in Health Media: Promoting Exercise without Perpetuating Weight Bias

ERIC Educational Resources Information Center

Pearl, R. L.; Dovidio, J. F.; Puhl, R. M.

2015-01-01

Health education campaigns for preventing and reducing obesity often contain weight-stigmatizing visual content, which may have unintended negative health consequences. The goal of the present research was to identify non-stigmatizing visual content for health education materials that can promote exercise among people of diverse weight statuses.…

On the Problem of Motor Skill Development

ERIC Educational Resources Information Center

Clark, Jane E.

2007-01-01

As a way to address the serious obesity epidemic in the United States, many physical education classes have become fitness centers designed to raise heart rates and burn calories. An unintended consequence of this emphasis on fitness, however, is the lack of attention to motor skill development. Motor skills do not develop miraculously from one…

Unintended Consequences: An Uncertain Future for Distance Learning

ERIC Educational Resources Information Center

Halfond, Jay A.

2011-01-01

While most in the academic community know about the attempt to rein in the for-profits, few are aware of its collateral damage. In October, the Department of Education (DOE) issued its Program Integrity Rules, intended to protect federal funds especially from those for-profit institutions with high student loan default rates. Well-intentioned…

Linchpins or Lost Time: Creating Effective Advisories

ERIC Educational Resources Information Center

Johnson, Bil

2009-01-01

That advisories in secondary schools are fairly pervasive around the country may be one of the great unintended consequences of the Coalition of Essential Schools (CES) reform effort. While no CES Common Principle explicitly states that advisories should exist in schools, as Coalition Schools evolved, advisories became one of the logical ways for…

Investigation of some characteristics of polyhydroxy milkweed triglycerides and their acylated derivatives in relation to lubricity

USDA-ARS?s Scientific Manuscript database

Most industrial lubricants are derived from non-renewable petroleum-based sources. As useful as these lubricants are, their unintended consequences are the pollution of our environment as a result of the very slow degradation of the spent materials. Native seed oils, on the other hand, are renewa...

Invisibility: An Unintended Consequence of Standards, Tests, and Mandates

ERIC Educational Resources Information Center

Elish-Piper, Laurie; Matthews, Mona W.; Risko, Victoria J.

2013-01-01

As elementary and middle school teachers and students face standards, high-stakes testing, accountability, and one-size-fits all curricula, concerns have arisen that these practices limit the relevance and efficacy of teaching and learning. In this paper, we argue that such practices exact personal costs on students and the teachers expected to…

Evaluating the Unintended Consequences of Assessment Practices: Construct Irrelevance and Construct Underrepresentation

ERIC Educational Resources Information Center

Spurgeon, Shawn L.

2017-01-01

Construct irrelevance (CI) and construct underrepresentation (CU) are 2 major threats to validity, yet they are rarely discussed within the counseling literature. This article provides information about the relevance of these threats to internal validity. An illustrative case example will be provided to assist counselors in understanding these…

A landscape based, systems dynamic model for assessing impacts of urban development on water quality for sustainable seagrass growth in Tampa Bay, Florida

EPA Science Inventory

We present an integrated assessment model to predict potential unintended consequences of urban development on the sustainability of seagrasses and preservation of ecosystem services, such as catchable fish, in Tampa Bay. Ecosystem services are those ecological functions and pro...

Maximal Processing, or, Archivist on a Pale Horse

ERIC Educational Resources Information Center

Cox, Robert S.

2010-01-01

With the promise of greater economy in handling an ever-increasing volume of material, minimal processing has quickly become a new orthodoxy for the archival profession despite a raft of unintended consequences for service and discovery. Taking a long-term view of the costs and benefits entailed in the process of processing, the three-stage…

Participatory Action Research and Impact: An Ecological Ripples Perspective

ERIC Educational Resources Information Center

Trickett, Edison J.; Beehler, Sarah

2017-01-01

Assessment of the impact of varied forms of participatory research is enhanced by specific attention to the ripples, such work initiates in the social context. Ripples are defined as consequences either unintended or unanticipated by those carrying out the participatory research. Following a brief documentation of the range of reported ripples in…

Visits, Hits, Caching and Counting on the World Wide Web: Old Wine in New Bottles?

ERIC Educational Resources Information Center

Berthon, Pierre; Pitt, Leyland; Prendergast, Gerard

1997-01-01

Although web browser caching speeds up retrieval, reduces network traffic, and decreases the load on servers and browser's computers, an unintended consequence for marketing research is that Web servers undercount hits. This article explores counting problems, caching, proxy servers, trawler software and presents a series of correction factors…

Exploring unintended environmental and social-equity consequences of transit oriented development : a research report from the National Center for Sustainable Transportation.

DOT National Transportation Integrated Search

2015-10-01

Communities throughout the U.S. are pursuing land use and transportation plans that locate : high density, mixed-use development near high quality rail and bus transit service. The : objective of these plans is to meet important community goals, such...

Maize, switchgrass, and ponderosa pine biochar added to soil increased herbicide sorption and decreased herbicide efficacy

USDA-ARS?s Scientific Manuscript database

Biochars, a by-product of pyrolysis conversion of a wide array of plant biomass to biofuels, are being considered as soil amendments that may provide nutrients and increase soil water holding capacity. However, there may be unintended consequences to other crop management practices. We examined her...

Unintended Consequences: Potential Downsides of the Air Force’s Conversion to Biofuels

DTIC Science & Technology

2011-01-01

Mark N. Goltz , PhD, USAF, Retired Dr. Charles A. Bleckmann Dr. Douglas M. Mackay Maj Khai Vuong, USAF Capt Jerrod P. McComb, USAF* *Lieutenant...Colonel Goltz and Dr. Bleckmann are faculty members in the environmental engineering and science program at the Air Force Institute of Technology (AFIT

Developmental interventions to address the STEM gender gap: exploring intended and unintended consequences.

PubMed

Liben, Lynn S; Coyle, Emily F

2014-01-01

Women and girls in the United States continue to be underrepresented in STEM, particularly in engineering and technology fields. This gap has been attracting recent attention from those motivated to ensure that girls and women have access to a full range of personally satisfying careers as well as from those concerned with developing a rich talent pool to meet national workforce needs. This chapter is focused on interventions that have been designed to address this STEM gender gap. We begin by documenting the STEM gender gap and then review change mechanisms emerging from theories of gender development that may be harnessed in intervention efforts. In addition, we pro vide a taxonomy of intervention goals which we then use to organize an illustrative review of sample interventions. After commenting on some of the findings and limitations of past work, we offer suggestions for enhancing the systematic evaluation of intervention programs that include careful selection of comparison groups, a broad array of STEM outcome measures, assessment of potentially unintended consequences, and meta-analyses.

Anticipating the unintended consequences of security dynamics.

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

Backus, George A.; Overfelt, James Robert; Malczynski, Leonard A.

2010-01-01

In a globalized world, dramatic changes within any one nation causes ripple or even tsunamic effects within neighbor nations and nations geographically far removed. Multinational interventions to prevent or mitigate detrimental changes can easily cause secondary unintended consequences more detrimental and enduring than the feared change instigating the intervention. This LDRD research developed the foundations for a flexible geopolitical and socioeconomic simulation capability that focuses on the dynamic national security implications of natural and man-made trauma for a nation-state and the states linked to it through trade or treaty. The model developed contains a database for simulating all 229 recognizedmore » nation-states and sovereignties with the detail of 30 economic sectors including consumers and natural resources. The model explicitly simulates the interactions among the countries and their governments. Decisions among governments and populations is based on expectation formation. In the simulation model, failed expectations are used as a key metric for tension across states, among ethnic groups, and between population factions. This document provides the foundational documentation for the model.« less

Using systems thinking in patient safety: a case study on medicines management.

PubMed

Brimble, Mandy; Jones, Aled

2017-06-29

Systems thinking is used as a way of understanding behaviours and actions in complex healthcare organisations. An important premise of the concept is that every action in a system causes a reaction elsewhere in that system. These reactions can lead to unintended consequences, sometimes long after the original action, and so are not always attributed to them. This article applies systems thinking to a medicines management case study, to highlight how quality-improvement practitioners can use the approach to underpin planning and implementation of patient-safety initiatives. The case study is specific to transcribing in children's hospices, but the strategies can be applied to other areas. The article explains that, while root cause analysis tools are useful for identifying the cause of, and possible solutions to, problems, they need to be considered carefully in terms of unintended consequences, and how the system into which the solution is implemented can be affected by the change. Analysis of problems using a systems-thinking approach can help practitioners to develop robust and well informed business cases to present to decision makers.

Adverse drug event reporting systems: a systematic review

PubMed Central

Peddie, David; Wickham, Maeve E.; Badke, Katherin; Small, Serena S.; Doyle‐Waters, Mary M.; Balka, Ellen; Hohl, Corinne M.

2016-01-01

Aim Adverse drug events (ADEs) are harmful and unintended consequences of medications. Their reporting is essential for drug safety monitoring and research, but it has not been standardized internationally. Our aim was to synthesize information about the type and variety of data collected within ADE reporting systems. Methods We developed a systematic search strategy, applied it to four electronic databases, and completed an electronic grey literature search. Two authors reviewed titles and abstracts, and all eligible full‐texts. We extracted data using a standardized form, and discussed disagreements until reaching consensus. We synthesized data by collapsing data elements, eliminating duplicate fields and identifying relationships between reporting concepts and data fields using visual analysis software. Results We identified 108 ADE reporting systems containing 1782 unique data fields. We mapped them to 33 reporting concepts describing patient information, the ADE, concomitant and suspect drugs, and the reporter. While reporting concepts were fairly consistent, we found variability in data fields and corresponding response options. Few systems clarified the terminology used, and many used multiple drug and disease dictionaries such as the Medical Dictionary for Regulatory Activities (MedDRA). Conclusion We found substantial variability in the data fields used to report ADEs, limiting the comparability of ADE data collected using different reporting systems, and undermining efforts to aggregate data across cohorts. The development of a common standardized data set that can be evaluated with regard to data quality, comparability and reporting rates is likely to optimize ADE data and drug safety surveillance. PMID:27016266

Adverse drug event reporting systems: a systematic review.

PubMed

Bailey, Chantelle; Peddie, David; Wickham, Maeve E; Badke, Katherin; Small, Serena S; Doyle-Waters, Mary M; Balka, Ellen; Hohl, Corinne M

2016-07-01

Adverse drug events (ADEs) are harmful and unintended consequences of medications. Their reporting is essential for drug safety monitoring and research, but it has not been standardized internationally. Our aim was to synthesize information about the type and variety of data collected within ADE reporting systems. We developed a systematic search strategy, applied it to four electronic databases, and completed an electronic grey literature search. Two authors reviewed titles and abstracts, and all eligible full-texts. We extracted data using a standardized form, and discussed disagreements until reaching consensus. We synthesized data by collapsing data elements, eliminating duplicate fields and identifying relationships between reporting concepts and data fields using visual analysis software. We identified 108 ADE reporting systems containing 1782 unique data fields. We mapped them to 33 reporting concepts describing patient information, the ADE, concomitant and suspect drugs, and the reporter. While reporting concepts were fairly consistent, we found variability in data fields and corresponding response options. Few systems clarified the terminology used, and many used multiple drug and disease dictionaries such as the Medical Dictionary for Regulatory Activities (MedDRA). We found substantial variability in the data fields used to report ADEs, limiting the comparability of ADE data collected using different reporting systems, and undermining efforts to aggregate data across cohorts. The development of a common standardized data set that can be evaluated with regard to data quality, comparability and reporting rates is likely to optimize ADE data and drug safety surveillance. © 2016 The British Pharmacological Society.

Unintended consequences of atmospheric injection of sulphate aerosols.

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

Brady, Patrick Vane; Kobos, Peter Holmes; Goldstein, Barry

2010-10-01

Most climate scientists believe that climate geoengineering is best considered as a potential complement to the mitigation of CO{sub 2} emissions, rather than as an alternative to it. Strong mitigation could achieve the equivalent of up to -4Wm{sup -2} radiative forcing on the century timescale, relative to a worst case scenario for rising CO{sub 2}. However, to tackle the remaining 3Wm{sup -2}, which are likely even in a best case scenario of strongly mitigated CO{sub 2} releases, a number of geoengineering options show promise. Injecting stratospheric aerosols is one of the least expensive and, potentially, most effective approaches and formore » that reason an examination of the possible unintended consequences of the implementation of atmospheric injections of sulphate aerosols was made. Chief among these are: reductions in rainfall, slowing of atmospheric ozone rebound, and differential changes in weather patterns. At the same time, there will be an increase in plant productivity. Lastly, because atmospheric sulphate injection would not mitigate ocean acidification, another side effect of fossil fuel burning, it would provide only a partial solution. Future research should aim at ameliorating the possible negative unintended consequences of atmospheric injections of sulphate injection. This might include modeling the optimum rate and particle type and size of aerosol injection, as well as the latitudinal, longitudinal and altitude of injection sites, to balance radiative forcing to decrease negative regional impacts. Similarly, future research might include modeling the optimum rate of decrease and location of injection sites to be closed to reduce or slow rapid warming upon aerosol injection cessation. A fruitful area for future research might be system modeling to enhance the possible positive increases in agricultural productivity. All such modeling must be supported by data collection and laboratory and field testing to enable iterative modeling to increase the accuracy and precision of the models, while reducing epistemic uncertainties.« less

Lost in Translation: The Unintended Consequences of Advance Directive Law on Clinical Care

PubMed Central

Castillo, Lesley S.; Williams, Brie A.; Hooper, Sarah M.; Sabatino, Charles P.; Weithorn, Lois A.; Sudore, Rebecca L.

2011-01-01

Background Advance directive law may compromise the clinical effectiveness of advance directives. Purpose To identify unintended legal consequences of advance directive law that may prevent patients from communicating end-of-life preferences. Data Sources Advance directive legal statutes for all 50 U.S. states and the District of Columbia and English-language searches of LexisNexis, Westlaw, and MEDLINE from 1966 to August 2010. Study Selection Two independent reviewers selected 51 advance directive statutes and 20 articles. Three independent legal reviewers selected 105 legal proceedings. Data Extraction Two reviewers independently assessed data sources and used critical content analysis to determine legal barriers to the clinical effectiveness of advance directives. Disagreements were resolved by consensus. Data Synthesis Legal and content-related barriers included poor readability (that is, laws in all states were written above a 12th-grade reading level), health care agent or surrogate restrictions (for example, 40 states did not include same-sex or domestic partners as default surrogates), and execution requirements needed to make forms legally valid (for example, 35 states did not allow oral advance directives, and 48 states required witness signatures, a notary public, or both). Vulnerable populations most likely to be affected by these barriers included patients with limited literacy, limited English proficiency, or both who cannot read or execute advance directives; same-sex or domestic partners who may be without legally valid and trusted surrogates; and unbefriended, institutionalized, or homeless patients who may be without witnesses and suitable surrogates. Limitation Only appellate-level legal cases were available, which may have excluded relevant cases. Conclusion Unintended negative consequences of advance directive legal restrictions may prevent all patients, and particularly vulnerable patients, from making and communicating their end-of-life wishes and having them honored. These restrictions have rendered advance directives less clinically useful. Recommendations include improving readability, allowing oral advance directives, and eliminating witness or notary requirements. Primary Funding Source U.S. Department of Veterans Affairs and the Pfizer Foundation. PMID:21242368

Smoker-Free Workplace Policies: Developing a Model of Public Health Consequences of Workplace Policies Barring Employment to Smokers

PubMed Central

Houle, Brian; Siegel, Michael

2009-01-01

A marked shift in tobacco-related workplace health promotion intervention involves the adoption of policies barring employment to smokers. We discuss the potential public health consequences of these policies on those affected – smokers, their families, the surrounding community, and society at large. We find a lack of published evidence evaluating the effectiveness and consequences of these policies. By developing a model of policy effects, we outline possible unintended consequences. With such large gaps in the evidence base and the potential for deleterious consequences, we argue for increased discussion about the use of smoker-free employment policies as a public health intervention and for increased engagement of employers by the public health community in worksite health promotion. PMID:19168490

(Un)Intended Consequences: The First-Year College Experience of Female Students with Dual Credits

ERIC Educational Resources Information Center

Tobolowsky, Barbara F.; Allen, Taryn Ozuna

2016-01-01

Using Merton's (1957) anticipatory socialization theory, this qualitative study explored how participation in dual credit in high school helped introduce 12 female students to the academic and social aspects of college to ease their first-year transitions. These students, who entered one Texas university with between 15 and 78 dual credits,…

High-Achieving Black Students, Biculturalism, and Out-of-School STEM Learning Experiences: Exploring Some Unintended Consequences

ERIC Educational Resources Information Center

McGee, Ebony O.

2013-01-01

In this article, the author discusses the complex challenges of high-achieving Black students who are successful in becoming immersed in predominately White STEM (science, technology, engineering, and mathematics) spaces and how such immersion can exacerbate their experiences of racial stereotyping and other forms of racial bias. The author…

Environmental Public Health Policy for Asbestos in Schools: Unintended Consequences.

ERIC Educational Resources Information Center

Corn, Jacqueline Karnell

This book explores the history of asbestos in schools and buildings and how this issue shaped the development of public health policy. It provides insight into past policy including how and why action was taken and who caused it to be taken; it also offers guidance for the scientific and regulatory communities in the future. While explaining…

Transparency and Accountability: "Implementing a Postsecondary Institution Rating System That Empowers Students While Avoiding Unintended Consequences"

ERIC Educational Resources Information Center

Harmon, Tim; Cielinski, Anna

2014-01-01

In an economy that increasingly demands postsecondary credentials to access high-paying jobs with the potential for career advancement, students need comprehensive and reliable information to make better college and career choices. This need has prompted a vigorous national dialogue about the best way to provide information on the performance of…

Making College More Expensive: The Unintended Consequences of Federal Tuition Aid. Policy Analysis. No. 531

ERIC Educational Resources Information Center

Wolfram, Gary

2005-01-01

As Congress debates the reauthorization of the Higher Education Act (HEA), it should heed Friedrich Hayek's warning that democracy is "peculiarly liable, if not guided by accepted common principles, to produce over-all results that nobody wanted." One result of the federal government's student financial aid programs is higher tuition…

Declining Physical Activity Levels as an Unintended Consequence of Abolishing Mandatory Campus Service Fees

ERIC Educational Resources Information Center

Jones, Sandra C.; Barrie, Lance

2011-01-01

Objective: This study investigates the effect of the introduction of voluntary student unionism and subsequent increase in campus facility fees on engagement in physical activity on campus. Participants: Participants were 1,904 students from a large regional NSW (Australia) university across 3 time periods (926 in 2005, 504 in 2006, and 474 in…

When Unintended Consequences Become the Main Effect: Evaluating the Development of a Foster Parent Training Program.

ERIC Educational Resources Information Center

Loesch-Griffin, Deborah A.; Ringstaff, Cathy

A program of education, training, and support provided to foster parents in a California county through a nonprofit agency is evaluated. The evaluators' experience indicates that: (1) evaluations are gaining in popularity; (2) role shifts by evaluators are sometimes difficult to perceive; (3) program staff are unlikely to use evaluative feedback…

Seeking Clarity in New Jersey for Leadership Preparation Program Design: Confusion, Fragility, and Unintended Consequences

ERIC Educational Resources Information Center

Doolittle, Gini

2013-01-01

In 2004, the New Jersey Department of Education issued a mandate to the 17 leadership preparation program providers to revise their leadership preparation programs after completing a critical friends review. This case study explores the challenges, programmatic, and political experiences of one preparation program as state support dwindled.…

Short vs. Long: Cognitive Load, Retention and Changing Class Structures

ERIC Educational Resources Information Center

Sheridan, Brandon; Smith, Ben; Pleggenkuhle-Miles, Erin

2017-01-01

University class structure is changing. To accommodate working students, programmes are increasing their offerings of long night classes--some lasting as long as six hours. While these long classes may be more convenient for students, they have unintended consequences as a result of cognitive load. Using a panel of 124 students (372 observations)…

Writing IEPs for the Audience of Teachers, Parents, and Students: The Case for the Communicative Individual Education Program

ERIC Educational Resources Information Center

Lucido, Richard J.

2013-01-01

Our current paradigm of Individualized Education Program (IEP) construction, the creation of a legal document or contract between parents and schools, needs rethinking. This paradigm's unintended consequences have resulted in vast inefficiencies in special education and have detracted from the core purpose of the IEP document, the communication of…

Studying the Impact of Federal and State Changes in Student Aid Policy at the Campus Level.

ERIC Educational Resources Information Center

Fenske, Robert H.; Dillon, Kathryn A.; Porter, John D.

1997-01-01

Argues that shifts in government policies can produce unintended consequences for needy students and the institutions they attend, and illustrates how campus units can cooperate to examine the impact of these changes through creation of longitudinal databases and data warehousing techniques. Describes the approach used and results of a study at…

Unintended Consequences or Testing the Integrity of Teachers and Students.

ERIC Educational Resources Information Center

Kimmel, Ernest W.

Large-scale testing programs are generally based on the assumptions that the test-takers experience standard conditions for taking the test and that everyone will do his or her own work without having prior knowledge of specific questions. These assumptions are not necessarily true. The ways students and educators use to get around standardizing…

Unintended Consequences of Tuition Discounting. New Agenda Series[TM].

ERIC Educational Resources Information Center

Davis, Jerry Sheehan

Tuition discounting, the use of institutionally funded grants to help defray students' college costs, came into vogue in the late 1970s and has since become standard practice at U.S. four-year colleges and universities. Institutions use the discounts for a variety of purposes, but generally their use is to manage or tailor enrollment in some…

Can We Protect Our Communities from Natural Disasters?

ERIC Educational Resources Information Center

Robertson, William C.

2010-01-01

There are two ways one might protect communities from natural disasters. One is to minimize the damage from disasters, and the other is to prevent the disasters in the first place. However, preventing disasters is another matter, and in trying to do so, we have to be aware of unintended consequences of our efforts. To address the issues associated…

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

ERIC Educational Resources Information Center

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

2010-01-01

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

Early Learning: Unintended Consequences of the Push to Close the Gap by Increasing Quality

ERIC Educational Resources Information Center

Sirinides, Phil

2015-01-01

Public education in the United States continues to be marked by persistent disparities in test scores, high school completion rates, and college enrollment rates based on factors such as students' household income, race/ethnicity, and gender. These achievement gaps are already in evidence before children begin school. Students that are assessed as…

Sustainable forestry in the balance

Treesearch

Stephen R. Shifley

2006-01-01

In the United States we increasingly restrict wood production in the name of sustainability while going abroad for an ever larger share of the wood we consume, even though our own forest resources per capita are greater than the rest of the Earth. The unintended consequence is we transfer impacts of harvesting and consumption elsewhere. If we believe impacts of...

Adequate (Or Adipose?) Yearly Progress: Assessing the Effect of "No Child Left Behind" on Children's Obesity

ERIC Educational Resources Information Center

Anderson, Patricia M.; Butcher, Kristin F.; Schanzenbach, Diane Whitmore

2017-01-01

This paper investigates how accountability pressures under No Child Left Behind (NCLB) may have affected students' rate of overweight. Schools facing pressure to improve academic outcomes may reallocate their efforts in ways that have unintended consequences for children's health. To examine the impact of school accountability, we create a unique…

"Cigarettes Are Priority": A Qualitative Study of How Australian Socioeconomically Disadvantaged Smokers Respond to Rising Cigarette Prices

ERIC Educational Resources Information Center

Guillaumier, Ashleigh; Bonevski, Billie; Paul, Christine

2015-01-01

Despite substantial modelling research assessing the impact of cigarette taxes on smoking rates across income groups, few studies have examined the broader financial effects and unintended consequences on very low-income smokers. This study explored how socioeconomically disadvantaged smokers in a high-income country manage smoking costs on…

Influences of the Industrial Culture on a Partnership Program, Teachers, and Curriculum.

ERIC Educational Resources Information Center

Zuga, Karen F.

As schools begin to form partnerships with industry, many of the differences in the cultural values of each institution have not been explored or considered within the partnership agreements. A lack of knowledge and preparation about cultural differences between the partners can lead to unintended consequences. As teachers begin to work in…

In the Picture or off the Wall? Ethical Regulation, Research Habitus, and Unpeopled Ethnography

ERIC Educational Resources Information Center

Hurdley, Rachel

2010-01-01

This article focuses on two unintended consequences of ethical regulation of social enquiry: the exclusion of participants and, subsequently, a transformation of research practice. An ethnography of corridor life in a large university building forms the basis of the discussion. Originally intended as a pilot for a broader study of informal…

Catholic Schools and the Common Good

ERIC Educational Resources Information Center

DeFiore, Leonard

2006-01-01

There are at least two ways to think about the Common Good. One is the intentional, direct attempt to provide benefits to those beyond oneself and those connected to oneself. The second consists of those unintended consequences of the pursuit of some other benefit, usually private but not necessarily so. Probably the best-known example is that of…

Long-term performance of minimum-input oak restoration plantings

Treesearch

Elizabeth Bernhardt; Tedmund J. Swiecki

2015-01-01

Starting in 1989, we used minimum-input methods to restore native oaks to parts of their former ranges in Vacaville, California. Each restoration site was analyzed, and only those inputs deemed necessary to overcome expected limiting factors for oak establishment were used. We avoided unnecessary inputs that added to cost and could have unintended negative consequences...

Some Latent Effects of Current Social Policies on the Elderly.

ERIC Educational Resources Information Center

Valas, Lee

Current social policies for the elderly are intended to assure a better standard of living, promote adequate medical treatment, and assure safe and clean housing, but they have unintended consequences. It is argued that these social policies serve to keep older people in a state of dependency, poverty, and segregation. Some social policies may be…

Harvest intensity and competition control impacts on loblolly pine fusiform rust incidence

Treesearch

Robert J. Eaton; Paula Spaine; Felipe G. Sanchez

2006-01-01

The Long Term Soil Productivity experiment tests the effects of soil compaction, surface organic matter removal, and understory control on net primary productivity. An unintended consequence of these treatments may be an effect on the incidence of fusiform rust [Cronartium quercuum (Berk.) Miy. ex Shirai f. sp. fusiforme Burdsall et Snow]. Loblolly pine (Pinus...

Controlling flooding and water pollution with upland and streamside vegetation systems

Treesearch

Michael Dosskey

2003-01-01

Substantial research and development effort in the U.S. is being spent on developing strategies that address flooding and water pollution problems in agricultural areas. Concerns have been raised about the costs of flood damage, degradation of productive farm land, and declining water quality that are now recognized as unintended consequences of intensive, high-yield...

Developmental Cognitive Neuroscience of Adolescent Sexual Risk and Alcohol Use

PubMed Central

Ryman, Sephira G.; Gillman, Arielle S.; Weiland, Barbara J.; Thayer, Rachel E.; Bryan, Angela D.

2018-01-01

Human adolescents engage in very high rates of unprotected sex. This behavior has a high potential for unintended, serious, and sustained health consequences including HIV/AIDS. Despite these serious health consequences, we know little about the neural and cognitive factors that influence adolescents’ decision-making around sex, and their potential overlap with behaviorally co-occurring risk behaviors, including alcohol use. Thus, in this review, we evaluate the developmental neuroscience of sexual risk and alcohol use for human adolescents with an eye to relevant prevention and intervention implications. PMID:26290051

Patient-physician relationships in the information age.

PubMed

Johnson, G L; Ramaprasad, A

2000-01-01

The ready and free availability of information that characterizes the Information Age--with health information on the Internet and direct-to-consumer advertising of prescription drugs as two of these major information sources--is bringing about significant changes in patient-physician relationships. By developing a matrix of intended and unintended consequences and desirable and undesirable consequences, it's possible to have a better understanding of the impact of the free flow of information on this traditional relationship. Ultimately, any marketing approach to these newly empowered patients must take their level of health care knowledge into consideration.

A Heuristic Decision Making Model to Mitigate Adverse Consequences in a Network Centric Warfare/Sense and Respond System

DTIC Science & Technology

2005-05-01

made. 4. Do military decision makers identify / analyze adverse consequences presently? Few do based on this research and most don’t do it effectively ...A HEURISTIC DECISION MAKING MODEL TO MITIGATE ADVERSE CONSEQUENCES IN A NETWORK CENTRIC WARFARE / SENSE AND RESPOND SYSTEM...ENS/05-01 A HEURISTIC DECISION MAKING MODEL TO MITIGATE ADVERSE CONSEQUENCES IN A NETWORK CENTRIC WARFARE / SENSE AND RESPOND SYSTEM

Episode-Based Payment for Perinatal Care in Medicaid: Implications for Practice and Policy.

PubMed

Jarlenski, Marian; Borrero, Sonya; La Charité, Trey; Zite, Nikki B

2016-06-01

Medicaid is an important source of health insurance coverage for low-income pregnant women and covers nearly half of all deliveries in the United States. In the face of budgetary pressures, several state Medicaid programs have implemented or are considering implementing episode-based payments for perinatal care. Under the episode-based payment model, Medicaid programs make a single payment for all pregnancy-related medical services provided to women with low- and medium-risk pregnancies from 40 weeks before delivery through 60 days postpartum. The health care provider who delivers a live birth is assigned responsibility for all care and must meet certain quality metrics and stay within delineated cost-per-episode parameters. Implementation of cost- and quality-dependent episode-based payments for perinatal care is notable because there is no published evidence about the effects of such initiatives on pregnancy or birth outcomes. In this article, we highlight challenges and potential adverse consequences related to defining the perinatal episode and assigning a responsible health care provider. We also describe concerns that perinatal care quality metrics may not address the most pressing health care issues that are likely to improve health outcomes and reduce costs. In their current incarnations, Medicaid programs' episode-based payments for perinatal care may not improve perinatal care delivery and subsequent health outcomes. Rigorous evaluation of the new episode-based payment initiatives is critically needed to inform policymakers about the intended and unintended consequences of implementing episode-based payments for perinatal care.

Perceived Fertility Control and Pregnancy Outcomes Among Abused Women.

PubMed

Liu, Fuqin; McFarlane, Judith; Maddoux, John A; Cesario, Sandra; Gilroy, Heidi; Nava, Angeles

2016-01-01

To describe the degree of perceived fertility control and associated likelihood of unintended pregnancy and poor pregnancy outcomes among women who report intimate partner violence. Cross-sectional cohort study design. Five domestic violence shelters and one district attorney's office in a large urban metropolis in the United States. A total of 282 women who reported intimate partner violence and reached out for the first time to a shelter or district attorney's office for assistance. This 7-year prospective longitudinal study began in 2011. Participants in the overarching study are being interviewed every 4 months. During the 32-month interview period, participants responded to a one-time, investigator-developed, fertility control questionnaire in addition to the ongoing repeated measures. Almost one third (29%) of the participants reported at least one unintended pregnancy attributed to their abusers' refusal to use birth control, and 14.3% of the participants reported at least one unintended pregnancy as a result of their abusers' refusal to allow them to use birth control. Participants were 28 times more likely to have abuse-induced miscarriages if their pregnancies resulted because their abusers did not use birth control (OR = 28.70, p < .05). Finally, participants were 8 times more likely to report premature births if they were abused because of their use of birth control (OR = 8.340, p < .05). Women in abusive relationships reported compromised fertility control associated with abuse and increased risk for unintended pregnancy as well as the adverse pregnancy outcomes of premature birth and miscarriage. Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Management of pump thrombosis in patients with left ventricular assist devices.

PubMed

Stulak, John M; Sharma, Shashank; Maltais, Simon

2015-04-01

The gradual evolution of left ventricular assist device (LVAD) therapy has resulted in a durable option for patients as either a bridge to transplantation (BTT) or a destination therapy (DT). Outcomes with current continuous-flow devices continue to demonstrate significant patient benefit, not only in enhanced survival but also in improved functional capacity and quality of life. While the lessening of adverse events through time has resulted in more widespread adoption of this therapy, there continues to be unintended consequences, including, most notably, infection, bleeding, and thrombosis. Beginning in 2011, centers and collaborative groups began to observe a significant increase in the incidence of pump thrombosis with the HeartMate II LVAD (Thoratec Corp., Pleasanton, CA, USA). However, this clinical scourge is not limited to the HeartMate II, as the HeartWare Ventricular Assist System (HVAD; HeartWare Inc., Framingham, MA, USA) has also had these same issues, which led to pump modifications and the appreciation of more strict control of blood pressure and anticoagulation with this pump design. We review the current status of the field of mechanical circulatory support in its approach to diagnosis, management, and prevention of LVAD pump thrombosis.

Current trends in pharmacy benefit designs: a threat to disease management in chronic complex diseases.

PubMed

Owens, Gary; Emons, Matthew F; Christian-Herman, Jennifer; Lawless, Grant

2007-04-01

With a focus on those patients who are candidates for treatment with biologic agents, we review the impact that current pharmacy benefit trends have on patients with chronic complex diseases and how they affect opportunities for disease management in this unique patient population. Dramatic increases in health care costs have led to a variety of strategies to manage cost. Many of these strategies either limit access to care or increase the patient's responsibility for choosing and paying for care, especially for medications. These strategies have a disproportionate impact on patients with chronic complex diseases, particularly those who require the use of biologic medications. A fundamental prerequisite of disease management has been coverage of disease-modifying therapies. If current pharmacy benefit trends continue, unintended consequences will likely occur including lost opportunities for disease management. Current pharmacy benefit trends could adversely impact disease management, particularly for patients requiring the use of biologic agents. Health plans should consider innovative benefit designs that reflect an appropriate level of cost sharing across all key stake-holders, ensuring appropriate access to needed therapies. Additional research is needed to clarify the value of newer approaches to therapies or benefit design changes.

Plant community mediation of ecosystem responses to global change factors

NASA Astrophysics Data System (ADS)

Churchill, A. C.

2017-12-01

Human alteration of the numerous environmental drivers affecting ecosystem processes is unprecedented in the last century, including changes in climate regimes and rapid increases in the availability of biologically active nitrogen (N). Plant communities may offer stabilizing or amplifying feedbacks mediating potential ecosystem responses to these alterations, and my research seeks to examine the conditions associated with when plant feedbacks are important for ecosystem change. My dissertation research focused on the unintended consequences of N deposition into natural landscapes, including alpine ecosystems which are particularly susceptible to adverse environmental impacts. In particular, I examined alpine plant and soil responses to N deposition 1) across multiple spatial scales throughout the Southern Rocky Mountains, 2) among diverse plant communities associated with unique environmental conditions common in the alpine of this region, and 3) among ecosystem pools of N contributing to stabilization of N inputs within those communities. I found that communities responded to inputs of N differently, often associated with traits of dominant plant species but these responses were intimately linked with the abiotic conditions of each independent community. Even so, statistical models predicting metrics of N processing in the alpine were improved by encompassing both abiotic and biotic components of the main community types.

Epidemiology and the Tobacco Epidemic: How Research on Tobacco and Health Shaped Epidemiology.

PubMed

Samet, Jonathan M

2016-03-01

In this article, I provide a perspective on the tobacco epidemic and epidemiology, describing the impact of the tobacco-caused disease epidemic on the field of epidemiology. Although there is an enormous body of epidemiologic evidence on the associations of smoking with health, little systematic attention has been given to how decades of research have affected epidemiology and its practice. I address the many advances that resulted from epidemiologic research on smoking and health, such as demonstration of the utility of observational designs and important parameters (the odds ratio and the population attributable risk), guidelines for causal inference, and systematic review approaches. I also cover unintended and adverse consequences for the field, including the strategy of doubt creation and the recruitment of epidemiologists by the tobacco industry to serve its mission. The paradigm of evidence-based action for addressing noncommunicable diseases began with the need to address the epidemic of tobacco-caused disease, an imperative for action documented by epidemiologic research. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

"Watch What You Teach": A First-Year Teacher Refuses to Play It Safe

ERIC Educational Resources Information Center

Sieben, Nicole; Wallowitz, Laraine

2009-01-01

In an effort to ensure that students feel "safe" and "comfortable" in the classrooms, English teachers often avoid controversial topics, particularly issues of race, gender, class, and sexuality. The insidious hidden curriculum or the unintended consequences of what they choose to say or not say--teach or not teach--can have as much or more impact…

"Go Grrrls": A Randomized Controlled Trial of a Gender-Specific Intervention to Reduce Sexual Risk Factors in Middle School Females

ERIC Educational Resources Information Center

LeCroy, Craig Winston; McCullough Cosgrove, Jenny; Cotter, Katie; Fordney, Marie

2018-01-01

Purpose: Adolescent females continue to face health consequences associated with risky sexual behaviors such as unintended pregnancies and sexually transmitted diseases. The purpose of this study was to investigate the efficacy of a gender-specific intervention targeted to early adolescent females. Method: This study used an intent to treat…

Adequate (or Adipose?) Yearly Progress: Assessing the Effect of "No Child Left Behind" on Children's Obesity. NBER Working Paper No. 16873

ERIC Educational Resources Information Center

Anderson, Patricia M.; Butcher, Kristin F.; Schanzenbach, Diane Whitmore

2011-01-01

This paper investigates how accountability pressures under No Child Left Behind (NCLB) may affect children's rate of overweight. Schools facing increased pressures to produce academic outcomes may reallocate their efforts in ways that have unintended consequences for children's health. For example, schools may cut back on recess and physical…

The Tao of treating weeds: Reaching for restoration in the northern Rocky Mountains

Treesearch

Lisa-Natalie Anjozian

2008-01-01

Noxious weeds are a serious problem that is spreading across the West. Herbicides such as Picloram have proven to be powerful tools in reducing weed invaders, although use of this tool has often produced unintended consequences. Broadleaf herbicides kill forbs, such as the noxious knapweed, but also harm native forbs such as arrowleaf balsamroot. Removing weedy forbs...

Lesbian, Gay, and Bisexual Victimization in the Military: An Unintended Consequence of "Don't Ask, Don't Tell"?

ERIC Educational Resources Information Center

Burks, Derek J.

2011-01-01

The integration of lesbian, gay, and bisexual (LGB) individuals into the U.S. military is a long-standing and politically and socially divisive issue. Exclusionary and pseudo-inclusionary policies that restrict openly LGB individuals from military service are also of long duration. Yet LGB servicemembers have continued to serve covertly in the…

Human Trafficking in Southeast Asia: Causes and Policy Implications

DTIC Science & Technology

2009-06-01

use these networks throughout the region to transport equally destabilizing material, such as drugs and arms.3 As a result of the vast number of...18 Feingold, Human Trafficking, 32. 19 Ruta Tumenaite, “Rise in human trafficking tied to poverty, international church...79 Chiyuki Aoi, Cedric de Conin, Ramesh Thakur, eds., Unintended Consequences of Peacekeeping Operations (Tokyo, Japan: United Nations University

Is the Federal Government in the Business of Improving Charter Schools? An Investigation of the Unintended Consequences of ESEA Waivers

ERIC Educational Resources Information Center

Weiner, Jennie; Dougherty, Shaun M.

2016-01-01

This study investigates how recent policies employed under states' waivers to the Elementary and Secondary Education Act (ESEA) intersect with charter schools' purpose and functioning. By collecting and analyzing all ESEA waivers granted in 2013, we find that charter schools are disproportionately represented among schools as identified in the…

Knowledge and Authority in Shift: A Linguistic Ethnography of Multilingual News Media in the Buryat Territories of Russia

ERIC Educational Resources Information Center

Graber, Kathryn Elizabeth

2012-01-01

How might institutional projects to improve the status of minority languages and publics have unintended and contradictory consequences? This dissertation examines media and language practices in order to illuminate the everyday sociocultural processes by which the value of knowledge is figured. It focuses on news media institutions in the Buryat…

Early Childhood Activism, Minor Politics and Resuscitating Vision: A Tentative Foray into the Use of "Intersections" to Influence Early Childhood Policy

ERIC Educational Resources Information Center

Press, Frances; Skattebol, Jen

2007-01-01

Many postmodern and post-structural analyses of government policies affecting early childhood education stress the hegemonic nature of neo-liberalism and subsequently primarily focus upon identifying the manifestation of neo-liberal values in such interventions. An unintended and stultifying consequence of such analyses is, at times, to close off…

The "Missing Girls" of China and the Unintended Consequences of the One Child Policy

ERIC Educational Resources Information Center

Ebenstein, Avraham

2010-01-01

High ratios of males to females in China have concerned researchers (Sen 1990, Yi et al. 1993) and the recent increase has alarmed policymakers worldwide. This paper presents an analysis of China's census data that indicates that the "missing girls" phenomenon is causally linked to enforcement of the One Child Policy. Fertility is lower…

How Does Research Evaluation Impact Educational Research? Exploring Intended and Unintended Consequences of Research Assessment in the United Kingdom, 1986-2014

ERIC Educational Resources Information Center

Marques, Marcelo; Powell, Justin J. W.; Zapp, Mike; Biesta, Gert

2017-01-01

Research evaluation systems in many countries aim to improve the quality of higher education. Among the first of such systems, the UK's Research Assessment Exercise (RAE) dating from 1986 is now the Research Excellence Framework (REF). Highly institutionalised, it transforms research to be more accountable. While numerous studies describe the…

The Law of Unintended Consequences Revisited: The Case of Ricci v. DeStefano

ERIC Educational Resources Information Center

Vedder, Richard; Denhart, Matthew; Malesick, Michael; Templeton, Jordan

2009-01-01

Deciding it necessary to review the earlier ruling of the Second Circuit court, on January 9, 2009 the U.S. Supreme Court granted certiorari in the case "Ricci v. DeStefano." The case originates from New Haven, Connecticut where a group of firefighters argue that city officials violated their Title VII rights by dismissing the results of…

Do Work Incentives Have Unintended Consequences? Measuring "Entry Effects" in the Self-Sufficiency Project.

ERIC Educational Resources Information Center

Berlin, Gordon; Bancroft, Wendy; Card, David; Lin, Winston; Robins, Philip K.

The Self-Sufficiency Project (SSP) is a Canadian social demonstration and research project designed to test an employment alternative to welfare. The SSP makes work pay by offering generous earnings supplements to long-term, single-parent welfare recipients who find full-time jobs and leave Canada's Income Assistance (IA) welfare system. The SSP's…

Inclusive Education's Promises and Trajectories: Critical Notes about Future Research on a Venerable Idea

ERIC Educational Resources Information Center

Artiles, Alfredo J.; Kozleski, Elizabeth B.

2016-01-01

The purpose of this article is to offer critical notes on inclusive education research in the U.S. We discuss issues germane to conceptual clarity and the ways in which inclusive education interacts with reforms that share equity goals, noting disruptions and unintended consequences that arise at the nexus of these reforms. In addition, we…

SPECIAL PURPOSE IT DERAILED: UNINTENDED CONSEQUENCES OF UNIVERSAL IT LAWS AND POLICIES

DTIC Science & Technology

2017-10-26

Information Services Division ........................ 3 Figure 2: iNET Instrumentation Telemetry Ground Station...consolidate local Information Technology (IT) networks into an enterprise architecture to reduce costs and to increase security. Leadership coined this...IT network was established to link Air Force and contractor sites to seamlessly share program information . So when Air Force IT leadership tried to

The Race of Nimble Fingers: Changing Patterns of Children's Work in Post-Apartheid South Africa

ERIC Educational Resources Information Center

Levine, Susan

2011-01-01

This article considers the socioeconomic changes that have impacted on the lives of poor children since the end of apartheid in South Africa. In particular, the article highlights the ways in which child labour legislation after 1994 has had the unintended consequence of deepening chronic hunger and childhood poverty on food-rich farms where…

Making Schools Safer? The Unintended Consequences of Good Intentions

ERIC Educational Resources Information Center

Tanner, Julian

2009-01-01

It is now over 10 years since the shootings at Columbine High School in April 1999. While Columbine was not the first school shooting in the United States, or the last, it remains the most important. For many people, but especially for parents, the name "Columbine" has become a one-word summation of fears and concerns about the condition…

Involving Diverse Communities of Practice to Minimize Unintended Consequences of Test-Based Accountability Systems

ERIC Educational Resources Information Center

Behizadeh, Nadia; Engelhard, George, Jr.

2015-01-01

In his focus article, Koretz (this issue) argues that accountability has become the primary function of large-scale testing in the United States. He then points out that tests being used for accountability purposes are flawed and that the high-stakes nature of these tests creates a context that encourages score inflation. Koretz is concerned about…

Latino Employment and Black Violence: The Unintended Consequence of U.S. Immigration Policy

ERIC Educational Resources Information Center

Shihadeh, Edward S.; Barranco, Raymond E.

2010-01-01

U.S. immigration policies after 1965 fueled a rise in the Latino population and, thus, increased the competition for low-skill jobs. We examine whether Latino immigration and Latino dominance of low-skill industries increases black urban violence. Using city-level data for the year 2000, we find that (1. Latino immigration is positively linked to…

Intended and Unintended Consequences of Student Use of an Online Questioning Environment

ERIC Educational Resources Information Center

Ng'ambi, Dick; Brown, Irwin

2009-01-01

While supplementation of face-to-face (F2F) teaching with online engagement is increasingly common, the educators' challenge of teaching F2F personalities and facilitating online personalities has not been widely explored. In this paper, we report on a project in which 1st-year students attended F2F sessions and engaged with an anonymous online…

A Broken Promise: Examining the Merit-Aid Policy and Implementation Gap in the Michigan Promise Scholarship

ERIC Educational Resources Information Center

Daun-Barnet, Nathan; Hermsen, Albert; Vedder, Lori; Mabry, Beth

2013-01-01

In 2006, Michigan changed their traditional merit award to a credit contingent program based upon successful completion of 60 college credits. The Michigan Promise Scholarship was crafted by state policymakers without input from the financial aid community. This case study suggests that the change in policy resulted in two unintended consequences:…

Future trends in the health care economy.

PubMed

Kajander, J; Samuels, M

1996-01-01

Most articles on the future of health care are by professionals involved in the delivery of health care services. This article is unique in that trends are examined from the perspective of the public and purchasers of care. The authors focus on 12 trends that are or will be affecting the industry, and on the sometimes unintended consequences and new conflicts that may develop.

(Un)Intended Consequences? The Impact of the Brown v. Board of Education Decision on the Employment Status of Black Educators

ERIC Educational Resources Information Center

Tillman, Linda C.

2004-01-01

The displacement of Black educators after the "Brown v. Board of Education" decision was an extraordinary social injustice. The wholesale firing of Black educators threatened the economic, social, and cultural structure of the Black community, and ultimately the social, emotional, and academic success of Black children. The author presents a…

Responses of Schools to Accountability Systems Using Multiple Measures: The Case of New York City Elementary Schools

ERIC Educational Resources Information Center

Ehren, M. C. M.; Hatch, T.

2013-01-01

Many studies point to potential unintended consequences of accountability systems such as when schools narrow their teaching to fixate on tested subjects. As a result, some states and districts in the USA have complemented the federal test-based accountability system with additional measures of educational practices to hold schools accountable on…

A new invasive species in maryland: the biology and distribution of kudzu bug, megacopta cribraria (fabricius) (femiptera: plataspidae)

USDA-ARS?s Scientific Manuscript database

The relaxation of trade restrictions in the 1960s and 70s led to an unintended exchange of invasive insect species as well as manufactured goods between the United States and its new trade partners. Consequently, the number of exotic insect pests accidently entering and taking up residence in the U...

Is the Medium Really the Message? A Comparison of Face-to-Face, Telephone, and Internet Focus Group Venues

ERIC Educational Resources Information Center

Gothberg, June; Applegate, Brooks; Reeves, Patricia; Kohler, Paula; Thurston, Linda; Peterson, Lori

2013-01-01

With increased use of technology in qualitative research, it is important to understand unintended, unanticipated, and unobvious consequences to the data. Using a side-by-side comparison of face-to-face, telephone, and Internet with video focus groups, we examined the yield differences of focus group venue (medium) to the data (message) rendered…

Emergent Cultural Change: Unintended Consequences of a Strategic Information Technology Services Implementation in a United Kingdom University

ERIC Educational Resources Information Center

Waring, Teresa; Skoumpopoulou, Dimitra

2013-01-01

Over the past 20 years, universities in the United Kingdom have been undergoing a dramatic period of transformation and change which can be attributed to the expansion of the higher education sector, the growth in student numbers and the development of an ideological approach to public service management referred to as "new…

Good Intentions and Unanticipated Effects: The Unintended Consequences of the Application of Technology in Teaching and Learning Environments

ERIC Educational Resources Information Center

Nworie, John; Haughton, Noela

2008-01-01

The nature of disruptions encountered by classroom teachers is changing. In the past, disruptions were typically students chewing gum, eating or taking naps during class, engaging in acts of incivility including the occasional brawl, and the like. These disturbances, in many ways, pale in comparison to those accompanying the use of technologies in…

Effects of picloram application on community dominants vary with initial levels of spotted knapweed (Centaurea stoebe) invasion

Treesearch

Yvete K. Ortega; Dean E. Pearson

2010-01-01

Broadleaf herbicides are commonly used to suppress exotic weeds with the intent of releasing native species from negative impacts of invasion. However, weed control measures can also have unintended consequences that should be considered along with intended effects. We conducted a controlled field experiment within bunchgrass communities of western Montana to examine...

The Unintended Consequences of World War II and the Victory Corps on Austin High School

ERIC Educational Resources Information Center

Blankenship, Whitney

2016-01-01

Within two weeks of the bombing of Pearl Harbor, the U.S. Office of Education Wartime Commission was formed to provide guidance to institutions of higher learning and public schools for the duration of the war. The goals set for the commission included: (1) facilitating the adjustment of education agencies to war needs; (2) informing government…

Student Engagement Patterns over the Duration of Level 1 and Level 3 Geography Modules: Influences on Student Attendance, Performance and Use of Online Resources

ERIC Educational Resources Information Center

Stewart, Martyn; Stott, Tim; Nuttall, Anne-Marie

2011-01-01

Greater flexibility in delivery resulting from increased use of e-learning will inevitably change the way university students approach studying. Recent studies have examined relationships between attendance, online learning and performance but findings are inconclusive. One concern is that an unintended consequence of placing lecture resources…

"Diamond in the Rough": The Impact of a Remedial Program on College Access and Opportunity for Black Males at an Historically Black Institution

ERIC Educational Resources Information Center

Palmer, Robert T.; Davis, Ryan J.

2012-01-01

Researchers, policymakers, and administrations have shown great concern over the efficacy of college remediation, which has prompted some states to eliminate remedial programs from public 4-year institutions. However, research suggests that eliminating these programs may have unintended consequences on college access and opportunity for…

What Would You Ideally Do if There Were No Targets? An Ethnographic Study of the Unintended Consequences of Top-Down Governance in Two Clinical Settings

ERIC Educational Resources Information Center

Allard, Jon; Bleakley, Alan

2016-01-01

Top-down policy directives, such as targets and their associated protocols, may be driven politically rather than clinically and can be described as macro-political texts. While targets supposedly provide incentives for healthcare services, they may unintentionally shape practices of accommodation rather than implementation, deflecting…

The Computer as an Authority Figure: Some Effects of CAI on Student Perception of Teacher Authority. Technical Report Number 29.

ERIC Educational Resources Information Center

Brod, Rodney L.

A sociological theory of authority was used to investigate some nonintellective, perhaps unintended, consequences of computer-assisted instruction (CAI) upon student's attitudes and orientations toward the organization of the school. An attitudinal questionnaire was used to survey attitudes toward the teacher and the computer in a junior high…

Can landscape-level ecological restoration influence fire risk? A spatially-explicit assessment of a northern temperate-southern boreal forest landscape

Treesearch

Douglas J. Shinneman; Brian J. Palik; Meredith W. Cornett

2012-01-01

Management strategies to restore forest landscapes are often designed to concurrently reduce fire risk. However, the compatibility of these two objectives is not always clear, and uncoordinated management among landowners may have unintended consequences. We used a forest landscape simulation model to compare the effects of contemporary management and hypothetical...

Controlled Substance Lock-In Programs: Examining An Unintended Consequence Of A Prescription Drug Abuse Policy.

PubMed

Roberts, Andrew W; Farley, Joel F; Holmes, G Mark; Oramasionwu, Christine U; Ringwalt, Chris; Sleath, Betsy; Skinner, Asheley C

2016-10-01

Controlled substance lock-in programs are garnering increased attention from payers and policy makers seeking to combat the epidemic of opioid misuse. These programs require high-risk patients to visit a single prescriber and pharmacy for coverage of controlled substance medication services. Despite high prevalence of the programs in Medicaid, we know little about their effects on patients' behavior and outcomes aside from reducing controlled substance-related claims. Our study was the first rigorous investigation of lock-in programs' effects on out-of-pocket controlled substance prescription fills, which circumvent the programs' restrictions and mitigate their potential public health benefits. We linked claims data and prescription drug monitoring program data for the period 2009-12 for 1,647 enrollees in North Carolina Medicaid's lock-in program and found that enrollment was associated with a roughly fourfold increase in the likelihood and frequency of out-of-pocket controlled substance prescription fills. This finding illuminates weaknesses of lock-in programs and highlights the need for further scrutiny of the appropriate role, optimal design, and potential unintended consequences of the programs as tools to prevent opioid abuse. Project HOPE—The People-to-People Health Foundation, Inc.

The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations.

PubMed

Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

2014-06-01

To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations

PubMed Central

Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

2014-01-01

Objective To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Data Sources/Study Setting Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Study Design Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Principal Findings Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Conclusions Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. PMID:24417309

Health Information Technology Coordination to Support Patient-centered Care Coordination.

PubMed

Steichen, O; Gregg, W

2015-08-13

To select papers published in 2014, illustrating how information technology can contribute to and improve patient-centered care coordination. The two section editors performed a literature review from Medline and Web of Science to select a list of candidate best papers on the use of information technology for patient-centered care coordination. These papers were peer-reviewed by external reviewers and three of them were selected as "best papers". The first selected paper reports a qualitative study exploring the gap between current practices of care coordination in various settings and idealized longitudinal care plans. The second selected paper illustrates several unintended consequences of HIT designed to improve care coordination. The third selected paper shows that advanced analytic techniques in medical informatics can be instrumental in studying patient-centered care coordination. The realization of true patient-centered care coordination is dependent upon a number of factors. Standardization of clinical documentation and HIT interoperability across organization and settings is a critical prerequisite for HIT to support patient-centered care coordination. Enabling patient involvement is an efficient means for goal setting and health information sharing. Additionally, unintended consequences of HIT tools (both positive and negative) must be measured and taken into account for quality improvement.

Tanning and teens: Is indoor exposure the tip of the iceberg?

PubMed Central

Hay, Jennifer L.; Riley, Kristen E.; Geller, Alan C.

2017-01-01

Due to recent state regulations and the reduced availability of free-standing tanning salons, indoor tanning prevalence is beginning to decline. This may lead to unintended consequences – increases in outdoor intentional tanning. We advance a series of research directions to track and intervene to address all forms of intentional tanning. First, we advocate for enforcement of indoor tanning regulation and encourage collection of data on tanning salon compliance and alternative indoor tanning strategies. Second, we suggest questions about outdoor and indoor tanning should be included in national surveys. Third, we need to understand the potentially complex patterns of indoor and outdoor tanning that may exist among those who tan. Fourth, research examining changing motivations for intentional tanning is needed. Finally, indoor tanning intervention studies should include outdoor tanning as an outcome to examine the effect of interventions on these related risk behaviors. These advances will ensure the development of novel interventions to address intentional tanning through multiple routes, and to avoid any unintended negative consequence of indoor tanning regulation. The promising downward direction of indoor tanning use in the United States should now lead the public health field to sharpen its focus on outdoor tanning. PMID:28765337

Intended and Unintended Effects of State-Mandated High School Science and Mathematics Course Graduation Requirements on Educational Attainment

PubMed Central

Plunk, Andrew D.; Tate, William F.; Bierut, Laura J.; Grucza, Richard A.

2014-01-01

Mathematics and science course graduation requirement (CGR) increases in the 1980s and 1990s might have had both intended and unintended consequences. Using logistic regression with Census and American Community Survey (ACS) data (n = 2,892,444), we modeled CGR exposure on (a) high school dropout, (b) beginning college, and (c) obtaining any college degree. Possible between-groups differences were also assessed. We found that higher CGRs were associated with higher odds to drop out of high school, but results for the college-level outcomes varied by group. Some were less likely to enroll, whereas others who began college were more likely to obtain a degree. Increased high school dropout was consistent across the population, but some potential benefit was also observed, primarily for those reporting Hispanic ethnicity. PMID:25541563

DISE: A Seed-Dependent RNAi Off-Target Effect That Kills Cancer Cells.

PubMed

Putzbach, William; Gao, Quan Q; Patel, Monal; Haluck-Kangas, Ashley; Murmann, Andrea E; Peter, Marcus E

2018-01-01

Off-target effects (OTEs) represent a significant caveat for RNAi caused by substantial complementarity between siRNAs and unintended mRNAs. We now discuss the existence of three types of seed-dependent OTEs (sOTEs). Type I involves unintended targeting through the guide strand seed of an siRNA. Type II is caused by the activity of the seed on the designated siRNA passenger strand when loaded into the RNA-induced silencing complex (RISC). Both type I and II sOTEs will elicit unpredictable cellular responses. By contrast, in sOTE type III the guide strand seed preferentially targets essential survival genes resulting in death induced by survival gene elimination (DISE). In this Opinion article, we discuss DISE as a consequence of RNAi that may preferentially affect cancer cells. Copyright © 2017 Elsevier Inc. All rights reserved.

Cost Effectiveness of Contraceptives in the United States

PubMed Central

Trussell, James; Lalla, Anjana M.; Doan, Quan V.; Reyes, Eileen; Pinto, Lionel; Gricar, Joseph

2013-01-01

Background The study was conducted to estimate the relative cost effectiveness of contraceptives in the United States from a payer’s perspective. Methods A Markov model was constructed to simulate costs for 16 contraceptive methods and no method over a 5-year period. Failure rates, adverse event rates, and resource utilization were derived from the literature. Sensitivity analyses were performed on costs and failure rates. Results Any contraceptive method is superior to “no method”. The three least expensive methods were the copper-T IUD ($647), vasectomy ($713) and LNG-20 IUS ($930). Results were sensitive to the cost of contraceptive methods, the cost of an unintended pregnancy, and plan disenrollment rates. Conclusion The copper-T IUD, vasectomy, and the LNG-20 IUS are the most cost-effective contraceptive methods available in the United States. Differences in method costs, the cost of an unintended pregnancy, and time horizon are influential factors that determine the overall value of a contraceptive method. PMID:19041435

Why do infants begin to talk? Language as an unintended consequence.

PubMed

Locke, J L

1996-06-01

Scholars have addressed a range of questions about language development, but for some reason have neglected to ask why infants begin to talk. Biologists often prefer 'how' to 'why' questions, but it is possible to ask about the immediate consequences of developing behaviours--an acceptable strategy for attacking causation--and psycholinguists can study the immediate consequences to the infant of behaviours that lead to linguistic competence. This process is demonstrated with a series of illustrative proposals as to the short- and long-term consequences of vocal learning and utterance storage, two developmental phases that lead to talking, as well as the act of talking itself. The goal is to encourage investigation of behavioural dispositions that nudge the child, by degrees, towards proficiency in the use of spoken language.

Mindfulness as a mediator of the association between adverse childhood experiences and alcohol use and consequences.

PubMed

Brett, Emma I; Espeleta, Hannah C; Lopez, Susanna V; Leavens, Eleanor L S; Leffingwell, Thad R

2018-09-01

One-third of college students report past-year heavy episodic drinking, making college student alcohol use an important area for continued research. Research has consistently linked early experiences of adversity to problematic substance use in adolescence and adulthood. Given the negative health consequences associated with heavy episodic drinking, it is imperative to identify mechanisms that contribute to this relation. Low levels of mindfulness have been linked to early adversity as well as impulsivity and alcohol use, therefore, the current study aims to examine the mediating role of mindfulness in the relation between early adversity and current alcohol use and consequences. Undergraduate students (N = 385) at a Midwestern university completed an online questionnaire assessing experiences of childhood adversity, trait mindfulness, and current alcohol use and related consequences. Results indicated that increased adverse experiences and lower levels of mindfulness predicted both increased alcohol consumption and consequences (ps < 0.025), with mindfulness mediating the relationships. Mindfulness is a predictor of alcohol outcomes and appears to mediate the relation between early adversity and alcohol use and consequences. Findings suggest that students with a history of adversity are more likely to exhibit lower levels of mindfulness, which may lead to an increase in alcohol consumption and consequences in early adulthood. Targeted alcohol intervention efforts that incorporate mindfulness skills may be particularly beneficial for those who have experienced early adversity. Copyright © 2018. Published by Elsevier Ltd.

Selection of nontarget arthropod taxa for field research on transgenic insecticidal crops: using empirical data and statistical power.

PubMed

Prasifka, J R; Hellmich, R L; Dively, G P; Higgins, L S; Dixon, P M; Duan, J J

2008-02-01

One of the possible adverse effects of transgenic insecticidal crops is the unintended decline in the abundance of nontarget arthropods. Field trials designed to evaluate potential nontarget effects can be more complex than expected because decisions to conduct field trials and the selection of taxa to include are not always guided by the results of laboratory tests. Also, recent studies emphasize the potential for indirect effects (adverse impacts to nontarget arthropods without feeding directly on plant tissues), which are difficult to predict because of interactions among nontarget arthropods, target pests, and transgenic crops. As a consequence, field studies may attempt to monitor expansive lists of arthropod taxa, making the design of such broad studies more difficult and reducing the likelihood of detecting any negative effects that might be present. To improve the taxonomic focus and statistical rigor of future studies, existing field data and corresponding power analysis may provide useful guidance. Analysis of control data from several nontarget field trials using repeated-measures designs suggests that while detection of small effects may require considerable increases in replication, there are taxa from different ecological roles that are sampled effectively using standard methods. The use of statistical power to guide selection of taxa for nontarget trials reflects scientists' inability to predict the complex interactions among arthropod taxa, particularly when laboratory trials fail to provide guidance on which groups are more likely to be affected. However, scientists still may exercise judgment, including taxa that are not included in or supported by power analyses.

Proposed changes to the American Psychiatric Association diagnostic criteria for autism spectrum disorder: implications for young children and their families.

PubMed

Grant, Roy; Nozyce, Molly

2013-05-01

The American Psychiatric Association has revised the diagnostic criteria for their DSM-5 manual. Important changes have been made to the diagnosis of the current (DSM-IV) category of Pervasive Developmental Disorders. This category includes Autistic Disorder (autism), Asperger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). The DSM-5 deletes Asperger's Disorder and PDD-NOS as diagnostic entities. This change may have unintended consequences, including the possibility that the new diagnostic framework will adversely affect access to developmental interventions under Individuals with Disabilities Education Act (IDEA) programs, Early Intervention (for birth to 2 years olds) and preschool special education (for 3 and 4 years olds). Changing the current diagnosis of PDD-NOS to a "Social Communication Disorder" focused on language pragmatics in the DSM-5 may restrict eligibility for IDEA programs and limit the scope of services for affected children. Young children who meet current criteria for PDD-NOS require more intensive and multi-disciplinary services than would be available with a communication domain diagnosis and possible service authorization limited to speech-language therapy. Intensive behavioral interventions, inclusive group setting placements, and family support services are typically more available for children with an autism spectrum disorder than with diagnoses reflecting speech-language delay. The diagnostic distinction reflective of the higher language and social functioning between Asperger's Disorder and autism is also undermined by eliminating the former as a categorical diagnosis and subsuming it under autism. This change may adversely affect treatment planning and misinform parents about prognosis for children who meet current criteria for Asperger's Disorder.

Reduced nicotine content cigarettes in smokers of low socioeconomic status: study protocol for a randomized control trial.

PubMed

Krebs, Nicolle M; Allen, Sophia I; Veldheer, Susan; Martinez, Diane J; Horn, Kimberly; Livelsberger, Craig; Modesto, Jennifer; Kuprewicz, Robin; Wilhelm, Ashley; Hrabovsky, Shari; Kazi, Abid; Fazzi, Alyse; Liao, Jason; Zhu, Junjia; Wasserman, Emily; Reilly, Samantha M; Reinhart, Lisa; Trushin, Neil; Moyer, Robinn E; Bascom, Rebecca; Foulds, Jonathan; Richie, John P; Muscat, Joshua E

2017-07-03

The Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration jurisdiction over the regulation of all tobacco products, including their nicotine content. Under this act, a major strategy to reduce harm from cigarette tobacco is lowering the nicotine content without causing unintended adverse consequences. Initial research on reduced nicotine content (RNC) cigarettes has shown that smokers of these cigarettes gradually decrease their smoking frequency and biomarkers of exposure. The effectiveness of this strategy needs to be demonstrated in different populations whose response to RNC cigarettes might be substantially mediated by personal or environmental factors, such as low socioeconomic status (SES) populations. This study aims to evaluate the response to a reduced nicotine intervention in low SES smokers, as defined here as those with less than 16 years of education, by switching smokers from high nicotine commercial cigarettes to RNC cigarettes. Adults (N = 280) who have smoked five cigarettes or more per day for the past year, have not made a quit attempt in the prior month, are not planning to quit, and have less than 16 years of education are recruited into a two-arm, double-blinded randomized controlled trial. First, participants smoke their usual brand of cigarettes for 1 week and SPECTRUM research cigarettes containing a usual amount of nicotine for 2 weeks. During the experimental phase, participants are randomized to continue smoking SPECTRUM research cigarettes that contain either (1) usual nicotine content (UNC) (11.6 mg/cigarette) or (2) RNC (11.6 to 0.2 mg/cigarette) over 18 weeks. During the final phase of the study, all participants are offered the choice to quit smoking with nicotine replacement therapy, continue smoking the research cigarettes, or return to their usual brand of cigarettes. The primary outcomes of the study include retention rates and compliance with using only research cigarettes and no use of other nicotine-containing products. Secondary outcomes are tobacco smoke biomarkers, nicotine dependence measures, smoking topography, stress levels, and adverse health consequences. Results from this study will provide information on whether low SES smokers can maintain a course of progressive nicotine reduction without increases in incidence of adverse effects. ClinicalTrials.gov, NCT01928719 . Registered on 21 August 2013.

Problems in counting and paying for multidisciplinary outpatient clinics.

PubMed

Jackson, T; Sevil, P

1997-01-01

Policy-makers have always found it problematic to formulate fair and consistent counting rules for public hospital outpatient activities. In the context of output-based funding, such rules have consequences which can affect patient care. This paper reviews the rationale for organising multidisciplinary clinics and reports on a series of focus groups convened in four Melbourne teaching hospitals to consider funding policy for such clinics. It discusses issues of targeting outpatient services, along with implications for payment policy. It evaluates counting rules in terms of intended and unintended consequences in the context of Victoria's introduction of output-based funding for outpatient services.

The plague under Commodus as an unintended consequence of Roman grain market regulation.

PubMed

Silver, Morris

2012-01-01

This paper begins with a review of Roman grain market policies. It is argued that policies such as forced sales and maximum prices made urban consumers hesitant to rely on the market for secure access to grain. Consequently, consumers hoarded grain in their homes. The hoarded grain formed a volatile fuel ready to be ignited by the arrival of the bubonic plague bacillus. This scenario fits events in the city of Rome under Commodus. Attested grain market interventions were followed by a severe epidemic, arguably bubonic plague, which decimated the city's population.

Unintended Consequences of State and Federal Antidiscrimination and Family Medical Leave Legislation on the Employment Rates of Persons with Disabilities

ERIC Educational Resources Information Center

Lehmann, Ilana; Crimando, William

2008-01-01

Although some writers have suggested that the Americans With Disabilities Act (ADA), contrary to its intent, was responsible for a decline in employment for persons with disabilities, there is little strong empirical support for such an assertion. This study is an attempt to demonstrate that, in fact, the dismal labor market experience following…

The Unintended Consequences of an Algebra-for-All Policy on High-Skill Students: Effects on Instructional Organization and Students' Academic Outcomes

ERIC Educational Resources Information Center

Nomi, Takako

2012-01-01

In 1997, Chicago implemented a policy that required algebra for all ninth-grade students, eliminating all remedial coursework. This policy increased opportunities to take algebra for low-skill students who had previously enrolled in remedial math. However, little is known about how schools respond to the policy in terms of organizing math…

The Hangover: Thinking about the Unintended Consequences of the Nation's Teacher Evaluation Binge. Teacher Quality 2.0. Special Report 2

ERIC Educational Resources Information Center

Mead, Sara; Rotherham, Andrew; Brown, Rachael

2012-01-01

Over the past three years, more than 20 US states have passed legislation establishing new teacher evaluation requirements and systems, and even more have committed to do so in Race to the Top or Elementary and Secondary Education Act Flexibility Waiver applications. These new evaluation systems have real potential to foster a more…

Medicaid's Role in Financing Health Care for Children with Behavioral Health Care Needs in the Special Education System: Implications of the Deficit Reduction Act

ERIC Educational Resources Information Center

Mandell, David S.; Machefsky, Aliza; Rubin, David; Feudtner, Chris; Pita, Susmita; Rosenbaum, Sara

2008-01-01

Background: Recent changes to Medicaid policy may have unintended consequences in the education system. This study estimated the potential financial impact of the Deficit Reduction Act (DRA) on school districts by calculating Medicaid-reimbursed behavioral health care expenditures for school-aged children in general and children in special…

Characterizing Predictability of Fire Occurrence in Tropical Forests and Grasslands: The Case of Puerto Rico

Treesearch

Ana Carolina Monmany; William Gould; Maria Jose Andrade-Nunez; Grizelle Gonzalez; Maya Quinones

2017-01-01

Global estimates of fire frequency indicate that over 70% of active fires occur in the tropics, and the size and frequency of fires are increasing every year. The majority of fires in the tropics are an unintended consequence of current land-use practices that promotes the establishment of grass and shrubland communities, which are more flammable and more adapted to...

Nondisclosure of Smoking Status to Health Care Providers among Current and Former Smokers in the United States

ERIC Educational Resources Information Center

Curry, Laurel Erin; Richardson, Amanda; Xiao, Haijun; Niaura, Raymond S.

2013-01-01

An unintended consequence of tobacco control's success in marginalizing smoking is that smokers may conceal their smoking from those who are best positioned to help them quit: health care providers (HCPs). The purpose of this study was to identify the prevalence of, and factors related to, nondisclosure of smoking to HCPs. Data were obtained from…

A Study of the Impact of Educational Reform on At-Risk Students in Texas: Preliminary Findings.

ERIC Educational Resources Information Center

Texas Education Agency, Austin.

A study was conducted to gain a better understanding of how the term "at-risk" is defined and applied in the schools and to assess the intended and unintended consequences of four policies: attendance, the Texas Educational Assessment of Minimum Skills exit-level examination, the no pass/no play rule, and the driver's license law on…

Historical framework to explain long-term coupled human and natural system feedbacks: application to a multiple-ownership forest landscape in the northern Great Lakes region, USA

Treesearch

Michelle M. Steen-Adams; Nancy Langston; Mark D. O. Adams; David J. Mladenoff

2015-01-01

Current and future human and forest landscape conditions are influenced by the cumulative, unfolding history of socialecological interactions. Examining past system responses, especially unintended consequences, can reveal valuable insights that promote learning and adaptation in forest policy and management. Temporal couplings are complex, however; they can be...

The Unintended Consequences of Killing Civilians

DTIC Science & Technology

2012-05-17

of the Geneva Conventions, the media invites domestic and international responses, publicizing the debate. Political leaders of America have always...the debate. Political leaders of America have always declared their commitment to protecting human rights in the many nations where the U.S. military...messaging and some activities of military units in the theater of operations. Political leaders of America have always declared their commitment to

The Nursing Home Minimum Data Set Assessment Instrument: Manifest Functions and Unintended Consequences--Past, Present, and Future

ERIC Educational Resources Information Center

Rahman, Anna N.; Applebaum, Robert A.

2009-01-01

The Minimum Data Set (MDS) is a uniform instrument used in nursing homes to assess residents. In January 2008, the Centers for Medicare and Medicaid Services published a draft of a new MDS--version 3.0. This article traces the instrument's development and the design decisions that shaped it, discusses the MDS's manifest functions--data collection…

An Analytic Model for DoD Investment & Divestment Decisions (Briefing Charts)

DTIC Science & Technology

2015-05-01

cost drives Strategic; Performance mixed; cost drives Invest Insurance Risk Mitigation √ “Making Trade-Offs in Corporate Portfolio Decisions...Effects (SE) + Insurance Intended externalities, unintended consequences Are SE measureable? Do they add/subtract so NPV is worthwhile? Deadweight...Sustainable Cost Effective Cost is supportable, LPO outsourced, or is income Advantageous NPV? Y Y Y Y either N N N N Secondary Effects+ Insurance

Fairly sustainable forestry: seven key concepts for defining local sustainability in a global ecosystem

Treesearch

Stephen R. Shifley

2008-01-01

In the U.S. we increasingly restrict wood production in the name of sustainability while going abroad for a growing share of the wood we consume, even though our own forest resources per capita are far greater than the global average. The unintended consequence is that we transfer impacts (positive and negative) of our timber harvesting and wood consumption to other...

Learning from Experience Case Studies of the Hyper-X Project

NASA Technical Reports Server (NTRS)

Peebles, Curtis

2009-01-01

The Hyper-X project (X-43A) provides a number of "lessons learned" which can be applied to other aerospace project. The specific areas examined were the selection of the goals of the Hyper-X. How the technical unknowns and assumptions were handled. The final lesson was the ambiguous nature of risk assessment, and how trying to remove a technical unknown can have unintended consequences.

Effect of methyl bromide on Bursaphelenchus xylophilus in pine wood

Treesearch

L. David Dwinell

2000-01-01

One of the unintended consequences of the globalization of trade has been an increase in the frequency of introductions and the numbers of exotic species intercepted at ports of entry. This is largely due to the increase in volume of trade and a broadening of trading partners, especially with the Pacific Rim and Asia. During the years 1985 through 1998, the U.S....

Impoverishment: An Unintended Consequence of Private Education Investment: An Atypical Case Study of a Typical Underdeveloped Chinese Village

ERIC Educational Resources Information Center

Yong, Zhong; Jie, Xie

2017-01-01

This paper presents a case study of the microeconomy of a typical underdeveloped village in southwest China and the role of elementary education in the village economy. The paper begins with a brief review of relevant theories on the economics of education and the current social conditions and state of education in the village under study, and…

"The Silence Itself Is Enough of a Statement": The Day of Silence and LGBTQ Awareness Raising

ERIC Educational Resources Information Center

Woolley, Susan W.

2012-01-01

This ethnographic study of a high school gay-straight alliance club examines unintended consequences of silence during the Day of Silence, a day of action aimed at addressing anti-LGBTQ bias in schools. While this strategy calls for students to engage in intentional silences to raise awareness of anti-LGBTQ bias, it does not necessarily lead…

The Unintended, Pernicious Consequences of "Staying the Course" on the United States' No Child Left Behind Policy

ERIC Educational Resources Information Center

Amrein-Beardsley, Audrey

2009-01-01

The phrase "no child left behind" has become a familiar expression in American education circles and in popular culture. The sentiment implied by these four words is noble. However, the effects of the top-down implementation of the high-stakes testing provisions of the law have been anything but salutary for public school children,…

Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework.

PubMed

Campbell, Stephen M; Kontopantelis, Evangelos; Hannon, Kerin; Burke, Martyn; Barber, Annette; Lester, Helen E

2011-08-10

Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP) using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF). The indicator testing protocol involved a multi-step and methodological process: 1) The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2) data extraction from patients' medical records, to test technical feasibility and reliability, 3) diaries, to test workload, 4) cost-effectiveness modelling, and 5) semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010) involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health care settings and may be of use to policy-makers and researchers worldwide to test the likely effect of implementing indicators prior to roll out. It builds on and codifies existing literature and other testing protocols to create a field testing methodology that can be used to produce country specific quality indicators for pay-for-performance or quality improvement schemes.

Forest fire management to avoid unintended consequences: a case study of Portugal using system dynamics.

PubMed

Collins, Ross D; de Neufville, Richard; Claro, João; Oliveira, Tiago; Pacheco, Abílio P

2013-11-30

Forest fires are a serious management challenge in many regions, complicating the appropriate allocation to suppression and prevention efforts. Using a System Dynamics (SD) model, this paper explores how interactions between physical and political systems in forest fire management impact the effectiveness of different allocations. A core issue is that apparently sound management can have unintended consequences. An instinctive management response to periods of worsening fire severity is to increase fire suppression capacity, an approach with immediate appeal as it directly treats the symptom of devastating fires and appeases the public. However, the SD analysis indicates that a policy emphasizing suppression can degrade the long-run effectiveness of forest fire management. By crowding out efforts to preventative fuel removal, it exacerbates fuel loads and leads to greater fires, which further balloon suppression budgets. The business management literature refers to this problem as the firefighting trap, wherein focus on fixing problems diverts attention from preventing them, and thus leads to inferior outcomes. The paper illustrates these phenomena through a case study of Portugal, showing that a balanced approach to suppression and prevention efforts can mitigate the self-reinforcing consequences of this trap, and better manage long-term fire damages. These insights can help policymakers and fire managers better appreciate the interconnected systems in which their authorities reside and the dynamics that may undermine seemingly rational management decisions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument.

PubMed

Sittig, Dean F; Ash, Joan S; Guappone, Ken P; Campbell, Emily M; Dykstra, Richard H

2008-07-01

To determine what "average" clinicians in organizations that were about to implement Computer-based Provider Order Entry (CPOE) were expecting to occur, we conducted an open-ended, semi-structured survey at three community hospitals. We created an open-ended, semi-structured, interview survey template that we customized for each organization. This interview-based survey was designed to be administered orally to clinicians and take approximately 5 min to complete, although clinicians were allowed to discuss as many advantages or disadvantages of the impending system roll-out as they wanted to. Our survey findings did not reveal any overly negative, critical, problematic, or striking sets of concerns. However, from the standpoint of unintended consequences, we found that clinicians were anticipating only a few of the events, emotions, and process changes that are likely to result from CPOE. The results of such an open-ended survey may prove useful in helping CPOE leaders to understand user perceptions and predictions about CPOE, because it can expose issues about which more communication, or discussion, is needed. Using the survey, implementation strategies and management techniques outlined in this paper, any chief information officer (CIO) or chief medical information officer (CMIO) should be able to adequately assess their organization's CPOE readiness, make the necessary mid-course corrections, and be prepared to deal with the currently identified unintended consequences of CPOE should they occur.

Unintended Perioperative Hypothermia

PubMed Central

Hart, Stuart R.; Bordes, Brianne; Hart, Jennifer; Corsino, Daniel; Harmon, Donald

2011-01-01

Background Hypothermia, defined as a core body temperature less than 36°C (96.8°F), is a relatively common occurrence in the unwarmed surgical patient. A mild degree of perioperative hypothermia can be associated with significant morbidity and mortality. A threefold increase in the frequency of surgical site infections is reported in colorectal surgery patients who experience perioperative hypothermia. As part of the Surgical Care Improvement Project, guidelines aim to decrease the incidence of this complication. Methods We review the physiology of temperature regulation, mechanisms of hypothermia, effects of anesthetics on thermoregulation, and consequences of hypothermia and summarize recent recommendations for maintaining perioperative normothermia. Results Evidence suggests that prewarming for a minimum of 30 minutes may reduce the risk of subsequent hypothermia. Conclusions Monitoring of body temperature and avoidance of unintended perioperative hypothermia through active and passive warming measures are the keys to preventing its complications. PMID:21960760

Exploring unplanned ICU admissions: a systematic review.

PubMed

Vlayen, Annemie; Verelst, Sandra; Bekkering, Geertruida E; Schrooten, Ward; Hellings, Johan; Claes, Nerée

Adverse events are unintended patient injuries or complications that arise from healthcare management resulting in death, disability or prolonged hospital stay. Adverse events that require critical care are a considerable financial burden to the healthcare system. Medical record review seems to be a reliable method for detecting adverse events. To synthesize the best available evidence regarding the estimates of the incidence and preventability of adverse events that necessitate intensive care admission; to determine the type and consequences (patient harm, mortality, length of ICU stay and direct medical costs) of these adverse events. MEDLINE (from 1966 to present), EMBASE (from 1974 to present) and CENTRAL (version 1-2010) were searched for studies reporting on unplanned admissions to intensive care units (ICUs). Databases of reports, conference proceedings, grey literature, ongoing research, relevant patient safety organizations and two journals were searched for additional studies. Reference lists of retrieved papers were searched and authors were contacted in an attempt to find any further published or unpublished work. Only quantitative studies that used chart review for the detection of adverse events requiring intensive care admission were considered for eligibility. Studies that were published in the English, Dutch, German, French or Spanish language were included. Two reviewers independently extracted data and assessed the methodological quality of the included studies. 28 studies in the English language and one study in French were included. Of these, two were considered duplicate publications and therefore 27 studies were reviewed. Meta-analysis of the data was not appropriate due to statistical heterogeneity between studies; therefore, results are presented in a descriptive way. Studies were categorized according to the population and the providers of care. 1) The majority of the included studies investigated unplanned intensive care admissions after anesthetic procedures (UIA). 2) Only a few studies examined patients on general wards being at risk for clinical deterioration. The overall incidence of surgical and medical adverse events compared with ICU admissions ranged from 1.1% to 37.2%. 3) The third category of studies examined patients that were readmitted on ICUs. ICU readmission rates varied from 0% to 18.3%. Nine studies explicitly reported on the preventability of adverse outcomes. The preventability rates of the adverse events varied from 17% to 76.5%. Preventable adverse events are further synthesized by type of event and patterns of preventability are being formulated. Consequences of the adverse events included a mean length of ICU stay that ranged from 1.5 days to 10.4 days for the patient's first stay in ICU. Mortality rates varied between 0% and 58%. Adverse events are a persistent and an important reason for admission to the ICU. However, there is relatively weak evidence to estimate an overall incidence and preventability rate of these events. In addition, estimates on preventability are prone to subjective judgments. Variability in methodology and definitions, and poor reporting in studies may be the main reasons for study heterogeneity. Unplanned intensive care admission within 24 hours of a procedure with an anesthetist in attendance (UIA) is a recommended clinical indicator in surgical patients. Several authors recommend early detection of patients with clinical instability on general wards and the implementation of rapid response teams. Step-down or intermediate care units could be a useful strategy for patients that require monitoring to avoid ICU readmissions. There is a need for further studies on the detection of adverse events. The poor quality of current research evidence and the heterogeneity across studies requires that planning of future studies should aim to standardize measures of outcomes to allow for comparisons across studies. This area of research is important in order to identify and explain failure of healthcare systems leading to patient harm, with the ultimate aim to improve the quality and safety of care.

Potential Clinical and Economic Impact of Switching Branded Medications to Generics.

PubMed

Straka, Robert J; Keohane, Denis J; Liu, Larry Z

2017-05-01

Switching branded to generic medications has become a common cost-containment measure. Although this is an important objective for health care systems worldwide, the impact of this practice on patient outcomes needs to be carefully considered. We reviewed the literature summarizing the potential clinical and economic consequences of switching from branded to generic medications on patient outcomes. A literature search of peer-reviewed articles published 2003-2013 using key words of "generic switching" or "substitution" was conducted using PubMed, OvidSP, and ScienceDirect. Of 30 articles identified and reviewed, most were related to the diseases of the central nervous system, especially epilepsy. Based on our review, potential impacts of switching fell into 3 broad categories: patient attitudes and adherence, clinical and safety outcomes, and cost and resource utilization. Although in many cases generics may represent an appropriate alternative to branded products, this may not always be the case. Specifically, several studies suggested that switching may negatively impact medication adherence, whereas other studies found that generic switching was associated with poorer clinical outcomes and more adverse events. In some instances, switching accomplished cost savings but did so at increased total cost of care because of increased physician visits or hospitalizations. Although in many cases generics may represent an appropriate alternative, mandatory generic switching may lead to unintended consequences, especially in certain therapeutic areas. Although further study is warranted, based on our review, it may be medically justifiable for physicians and patients to retain the right to request the branded product in certain cases.

Potential Clinical and Economic Impact of Switching Branded Medications to Generics

PubMed Central

Straka, Robert J.; Keohane, Denis J.; Liu, Larry Z.

2017-01-01

Switching branded to generic medications has become a common cost-containment measure. Although this is an important objective for health care systems worldwide, the impact of this practice on patient outcomes needs to be carefully considered. We reviewed the literature summarizing the potential clinical and economic consequences of switching from branded to generic medications on patient outcomes. A literature search of peer-reviewed articles published 2003–2013 using key words of “generic switching” or “substitution” was conducted using PubMed, OvidSP, and ScienceDirect. Of 30 articles identified and reviewed, most were related to the diseases of the central nervous system, especially epilepsy. Based on our review, potential impacts of switching fell into 3 broad categories: patient attitudes and adherence, clinical and safety outcomes, and cost and resource utilization. Although in many cases generics may represent an appropriate alternative to branded products, this may not always be the case. Specifically, several studies suggested that switching may negatively impact medication adherence, whereas other studies found that generic switching was associated with poorer clinical outcomes and more adverse events. In some instances, switching accomplished cost savings but did so at increased total cost of care because of increased physician visits or hospitalizations. Although in many cases generics may represent an appropriate alternative, mandatory generic switching may lead to unintended consequences, especially in certain therapeutic areas. Although further study is warranted, based on our review, it may be medically justifiable for physicians and patients to retain the right to request the branded product in certain cases. PMID:26099048

Incomes and Outcomes: Social Security Disability Benefits in First-Episode Psychosis.

PubMed

Rosenheck, Robert A; Estroff, Sue E; Sint, Kyaw; Lin, Haiqun; Mueser, Kim T; Robinson, Delbert G; Schooler, Nina R; Marcy, Patricia; Kane, John M

2017-09-01

Social Security Administration (SSA) disability benefits are an important source of income for people with psychoses and confer eligibility for health insurance. The authors examined the impact of coordinated specialty care on receipt of such benefits in first-episode psychosis, along with the correlates and consequences of receiving them. The Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, a 34-site cluster-randomized trial, compared NAVIGATE, a coordinated specialty care program, to usual community care over 2 years. Receipt of SSA benefits and clinical outcomes were assessed at program entry and every 6 months for 2 years. Piecewise regression analysis was used to identify relative change in outcome trajectories after receipt of disability benefits. Among 399 RAISE-ETP participants, 36 (9%) were receiving SSA disability benefits at baseline; of the remainder, 124 (34.1%) obtained benefits during the 2-year study period. The NAVIGATE intervention improved quality of life, symptoms, and employment but did not significantly reduce the likelihood of receiving SSA disability benefits. Obtaining benefits was predicted by more severe psychotic symptoms and greater dysfunction and was followed by increased total income but fewer days of employment, reduced motivation (e.g., sense of purpose, greater anhedonia), and fewer days of intoxication. A 2-year coordinated specialty care intervention did not reduce receipt of SSA disability benefits. There were some advantages for those who obtained SSA disability benefits over the 2-year treatment period, but there were also some unintended adverse consequences. Providing income supports without impeding recovery remains an important policy challenge.

A Comprehensive Internationalization Challenge: Learning from Failure or, When Your Best Just Isn't Good Enough

ERIC Educational Resources Information Center

Patton, Carl V.

2016-01-01

Why did our idea not work out? How did a program fail? Why did we get unintended consequences? Who is to blame? Could it be that our best just isn't good enough? There are many reasons policies, programs and projects fail. Failure can be informative if shared. This means that professionals should report on failures as well as successes. However,…

School-Based Sports Development and the Role of NSOs as 'Boundary Spanners': Benefits, Disbenefits and Unintended Consequences of the "Sporting Schools" Policy Initiative

ERIC Educational Resources Information Center

Hogan, Anna; Stylianou, Michalis

2018-01-01

The focus of this paper is on "Sporting Schools", a $100 million policy initiative intended to increase children's sport participation in Australia. Our account seeks to proffer a critical analysis of this federal policy, and the way it functions as part of the new heterarchical or networked form of sports governance in Australia. Using…

The Misplaced Math Student: Lost in Eighth-Grade Algebra. The 2008 Brown Center Report on American Education. Special Release

ERIC Educational Resources Information Center

Loveless, Tom

2008-01-01

This new study is being released as an advance excerpt of the 2008 Brown Center Report on American Education. This new report finds that the nation's push to challenge more students by placing them in advanced math classes in eighth grade has had unintended and damaging consequences, as some 120,000 middle-schoolers are now struggling in advanced…

Social Movements And Social Media: Surveillance And Unintended Consequences

DTIC Science & Technology

2017-12-01

of contentious politics: “ when ordinary people , often in league with more influential citizens, join forces in confrontations with elites...determination of that context.13 When change occurs in a society , the location, interests, and diminished relevance of existing interests facilitate the...distinguish it from previous forms of contention.21 Tarrow argues that “ when contention spreads across an entire society , as it sometimes does, we see a

Unintended Consequences: Effect of the American Jobs Creation Act Reforestation Incentives on Family Forest Owners in the South

Treesearch

John L. Greene; Thomas J. Straka

2008-01-01

Abstract: The American Jobs Creation Act of 2004 rewrote the reforestation tax incentives available to private forest owners. Owners can now deduct outright reforestation costs up to $10,000 per year for each qualified timber property and amortize any additional amount over 8 tax years. To assess the economic effect of the new incentives on forest owners, the authors...

2010 Global Maritime Information Sharing Symposium Held in Baltimore, Maryland on September 14-16, 2010

DTIC Science & Technology

2010-09-16

Fishing • Tourism • Transportation • Unintended consequences • The Devil is in the details • New layers of bureaucracy • Lack of adequate input in the...mobility administration, channel and harbor management, incident management Commercial and recreational fishing, tourism , commercial...how to provide and measure this value across the full spectrum of participants. • Governance: The IMSSE’s organizational and gover - nance structure

Identifying Acquisition Patterns of Failure Using Systems Archetypes

DTIC Science & Technology

2008-04-02

OF PAGES 18 19a. NAME OF RESPONSIBLE PERSON a. REPORT unclassified b . ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev...any but the smallest programs, complete path coverage for defect detection is impractical. Adapted from Pressman , R.S., Software Engineering: A...Firefighting” concept from “Past the Tipping Point” Fix S O B Problem Symptom R “Fixes That Fail” – Systems Archetype S Unintended Consequences S

Trust Building as a Strategy to Avoid Unintended Consequences of Education. The Case Study of International Summer Camps Designed to Promote Peace and Intercultural Dialogue among Adolescents

ERIC Educational Resources Information Center

Farini, Federico

2014-01-01

This article aims to offer both a theoretical contribution and examples of practices of trust building in peace education; the article presents an empirical analysis of videotaped interactions in the context of peace education activities in international groups of adolescents. The analysis regards two international summer camps promoted by the…

Proposed Guideline Revisions for Dental Sedation and General Anesthesia: Why Target the Safest Level of Sedation?

PubMed

Dionne, Raymond A

2016-09-01

Recently proposed revisions to the American Dental Association's Guidelines for the Use of Sedation and General Anesthesia by Dentists, aimed at improving safety in dental offices, differentiate between levels of sedation based on drug-induced changes in physiologic and behavioral states. However, the author of this op-ed is concerned the proposed revisions may have far-reaching and unintended consequences.

Fracking: Unintended Consequences for Local Communities

DTIC Science & Technology

2016-12-01

holistic impact of fracking on the environment and socioeconomics of local communities at the epicenter of shale oil production . This study included...socioeconomics of local communities at the epicenter of shale oil production . This study included an evaluation of crucial environmental issues...un ts M ill io n Ba rr el s Annual Oil Production North Dakota Annual Average Rig Count 38 biggest daily drop ever, a 6% decrease, producing 1.04

Community Notification Laws

DTIC Science & Technology

2007-12-01

vehicle to enact more stringent control on sex offenders-an innocent 7 year old girl seduced into the home of a twice convicted pedophile with the hopes...criminal justice system that permitted a repeat pedophile to plea bargain his second offense from what would have amounted to 30 years in prison, if...numerous unintended consequences for sex offenders (not just pedophiles ), sex offender family members, victims (some of whom are incest victims), and

Biofuels: Network Analysis of the Literature Reveals Key Environmental and Economic Unknowns

PubMed Central

2012-01-01

Despite rapid growth in biofuel production worldwide, it is uncertain whether decision-makers possess sufficient information to fully evaluate the impacts of the industry and avoid unintended consequences. Doing so requires rigorous peer-reviewed data and analyses across the entire range of direct and indirect effects. To assess the coverage of scientific research, we analyzed over 1600 peer-reviewed articles published between 2000 and 2009 that addressed 23 biofuels-related topics within four thematic areas: environment and human well-being, economics, technology, and geography. Greenhouse gases, fuel production, and feedstock production were well-represented in the literature, while trade, biodiversity, and human health were not. Gaps were especially striking across topics in the Southern Hemisphere, where the greatest potential socio-economic benefits, as well as environmental damages, may co-occur. There was strong asymmetry in the connectedness of research topics; greenhouse gases articles were twice as often connected to other topics as biodiversity articles. This could undermine the ability of scientific and economic analyses to adequately evaluate impacts and avoid significant unintended consequences. At the least, our review suggests caution in this developing industry and the need to pursue more interdisciplinary research to assess complex trade-offs and feedbacks inherent to an industry with wide-reaching potential impacts. PMID:22229835

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

NASA Astrophysics Data System (ADS)

Venterea, R. T.; Breuillin-Sessoms, F.; Baker, J. M.; Griffis, T. J.; Spokas, K.; Turner, P. A.

2016-12-01

The potential of agricultural soils to accumulate C as a means of removing greenhouse gases (GHGs) from the atmosphere is complicated by the inherent coupling of the C and N cycles in soil. Practices that increase soil C content can have the unintended consequence of stimulating N mineralization, nitrification and/or denitrification; which can in turn promote production of N2O as well as other forms of reactive N that can be later transformed to N2O. These effects, combined with the large global warming potential of N2O, may partially or completely offset any gains in soil C from a GHG accounting perspective. Thus, ideally, management of soil C and N must be considered together in attempts to reduce net GHG budgets. However, the knowledge base for defining practices that optimize management of soil C and N together is still quite limited. In this presentation, we will illustrate these challenges with results from several recent studies examining effects of tillage, cover crops, biochar and other practices which aim to enhance soil C. Interactions of these practices with N management, climate, and other factors and their effects on N2O will be discussed with implications for improved management and future research.

Tanning and Teens: Is Indoor Exposure the Tip of the Iceberg?

PubMed

Hay, Jennifer L; Riley, Kristen E; Geller, Alan C

2017-08-01

Because of recent state regulations and the reduced availability of free-standing tanning salons, indoor tanning (IT) prevalence is beginning to decline. This may lead to unintended consequences, such as increases in outdoor intentional tanning. We advance a series of research directions to track and intervene to address all forms of intentional tanning. First, we advocate for enforcement of IT regulation and encourage collection of data on tanning salon compliance and alternative IT strategies. Second, we suggest questions about outdoor and IT should be included in national surveys. Third, we need to understand the potentially complex patterns of indoor and outdoor tanning that may exist among those who tan. Fourth, research examining changing motivations for intentional tanning is needed. Finally, IT intervention studies should include outdoor tanning as an outcome to examine the effect of interventions on these related risk behaviors. These advances will ensure the development of novel interventions to address intentional tanning through multiple routes, and to avoid any unintended negative consequence of IT regulation. The promising downward direction of IT use in the United States should now lead the public health field to sharpen its focus on outdoor tanning. Cancer Epidemiol Biomarkers Prev; 26(8); 1170-4. ©2017 AACR . ©2017 American Association for Cancer Research.

Finding Resolution for the Responsible Transparency of Economic Models in Health and Medicine.

PubMed

Padula, William V; McQueen, Robert Brett; Pronovost, Peter J

2017-11-01

The Second Panel on Cost-Effectiveness in Health and Medicine recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses has a number of questions unanswered with respect to the implementation of transparent, open source code interface for economic models. The possibility of making economic model source code could be positive and progressive for the field; however, several unintended consequences of this system should be first considered before complete implementation of this model. First, there is the concern regarding intellectual property rights that modelers have to their analyses. Second, the open source code could make analyses more accessible to inexperienced modelers, leading to inaccurate or misinterpreted results. We propose several resolutions to these concerns. The field should establish a licensing system of open source code such that the model originators maintain control of the code use and grant permissions to other investigators who wish to use it. The field should also be more forthcoming towards the teaching of cost-effectiveness analysis in medical and health services education so that providers and other professionals are familiar with economic modeling and able to conduct analyses with open source code. These types of unintended consequences need to be fully considered before the field's preparedness to move forward into an era of model transparency with open source code.

Ambivalence, communication and past use: understanding what influences women's intentions to use contraceptives.

PubMed

Campo, Shelly; Askelson, Natoshia M; Spies, Erica L; Losch, Mary

2012-01-01

Unintended pregnancy among women in the 18-30 age group is a public health concern. The Extended Parallel Process Model (EPPM) provides a framework for exploring how women's perceptions of threat, efficacy, and fear influence intentions to use contraceptives. Past use and communication with best friends and partners were also considered. A telephone survey of 18-30-year-old women (N = 599) was completed. After univariate and bivariate analyses were conducted, the variables were entered into a hierarchal, multi-variate linear regression with three steps consistent with the EPPM to predict behavioral intention. The first step included the demographic variables of relationship status and income. The constructs for the EPPM were entered into step 2. Step 3 contained the fear measure. The model for the third step was significant, F(10,471) = 36.40, p < 0.001 and the variance explained by this complete model was 0.42. Results suggest that perceived severity of the consequences of an unintended pregnancy (p < 0.01), communication with friends (p < 0.01) and last sexual partner (p < 0.05), relationship status (p < 0.01), and past use (p < 0.001) were associated with women's intentions to use contraceptives. A woman's perception of the severity was related to her intention to use contraceptives. Half of the women (50.3%) reported ambivalence about the severity of an unintended pregnancy. In our study, talking with their last sexual partner had a positive effect on intentions to use contraceptives, while talking with friends influenced intentions in a negative direction. These results reconfirm the need for public health practitioners and health care providers to consider level of ambivalence toward unintended pregnancy, communication with partner, and relationship status when trying to improve women's contraceptive behaviors. Implications for effective communication interventions are discussed.

Event DAS-444Ø6-6 soybean grown in Brazil is compositionally equivalent to non-transgenic soybean.

PubMed

Fast, Brandon J; Galan, Maria P; Schafer, Ariane C

2016-04-02

Soybean event DAS-444Ø6-6 is tolerant to the herbicides 2,4-D, glyphosate, and glufosinate. An investigation of potential unintended adverse compositional changes in a genetically modified crop is required to meet government regulatory requirements in various geographies. A study to meet these requirements in Brazil was completed demonstrating compositional equivalency between DAS-444Ø6-6 and non-transgenic soybean. This study supplements the extensive literature supporting transgenesis as less disruptive of crop composition compared with traditional breeding methods.

The Role of Therapeutic Drugs on Acquired Mitochondrial Toxicity.

PubMed

Morén, Constanza; Juárez-Flores, Diana Luz; Cardellach, Francesc; Garrabou, Glòria

2016-01-01

Certain therapeutic drugs used in medical practice may trigger mitochondrial toxicity leading to a wide range of clinical symptoms including deafness, neuropathy, myopathy, hyperlactatemia, lactic acidosis, pancreatitis and lipodystrophy, among others, which could even compromise the life of the patient. The aim of this work is to review the potential mitochondrial toxicity derived from drugs used in health care, including anesthetics, antiepileptics, neuroleptics, antidepressants, antivirals, antibiotics, antifungals, antimalarics, antineoplastics, antidiabetics, hypolipemiants, antiarrhythmics, anti-inflammatories and nitric oxide. We herein have reviewed data from experimental and clinical studies to document the molecular mitochondrial basis, potential biomarkers and putative clinical symptoms associated to secondary effects of drugs. One hundred and forty-five articles were selected and the information was organized by means of the primary target to which pharmacologic drugs were directed. Adverse toxic events were classified depending on the mitochondrial offtarget effect and whether they had been demonstrated in the experimental or clinical setting. Since treatment of acquired mitochondriopathies remains supportive and therapeutic interventions cannot be avoided, information of molecular and clinical consequences of toxic exposure becomes fundamental to assess riskbenefit imbalance of treatment prescription. Additionally, there is a crucial need to develop less mitochondrial toxic compounds, novel biomarkers to follow up mitochondrial toxicity (or implement those already proposed) and new approaches to prevent or revert unintended mitochondrial damage.

Perceptions and experiences of using automated bolus advisors amongst people with type 1 diabetes: a longitudinal qualitative investigation.

PubMed

Lawton, J; Kirkham, J; Rankin, D; Barnard, K; Cooper, C L; Taylor, C; Heller, S; Elliott, J

2014-12-01

We explored people's reasons for, and experiences of, using bolus advisors to determine insulin doses; and, their likes/dislikes of this technology. 42 people with type 1 diabetes who had received instruction in use of bolus advisors during a structured education course were interviewed post-course and 6 months later. Data were analysed thematically. Participants who considered themselves to have poor mathematical skills highlighted a gratitude for, and heavy reliance on, advisors. Others liked and chose to use advisors because they saved time and effort calculating doses and/or had a data storage facility. Follow-up interviews highlighted that, by virtue of no longer calculating their doses, participants could become deskilled and increasingly dependent on advisors. Some forgot what their mealtime ratios were; others reported a misperception that, because they were pre-programmed during courses, these parameters never needed changing. Use of data storage facilities could hinder effective review of blood glucose data and some participants reported an adverse impact on glycaemic control. While participants liked and perceived benefits to using advisors, there may be unintended consequences to giving people access to this technology. To promote effective use, on-going input and education from trained health professionals may be necessary. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Hydrogel formulation determines cell fate of fetal and adult neural progenitor cells

PubMed Central

Wagner, Jennifer L.; Shandas, Robin; Bjugstad, Kimberly B.

2014-01-01

Hydrogels provide a unique tool for neural tissue engineering. These materials can be customized for certain functions, i.e. to provide cell/drug delivery or act as a physical scaffold. Unfortunately, hydrogel complexities can negatively impact their biocompatibility, resulting in unintended consequences. These adverse effects may be combated with a better understanding of hydrogel chemical, physical, and mechanical properties, and how these properties affect encapsulated neural cells. We defined the polymerization and degradation rates and compressive moduli of 25 hydrogels formulated from different concentrations of hyaluronic acid (HA) and poly(ethylene glycol) (PEG). Changes in compressive modulus were driven primarily by the HA concentration. The in vitro biocompatibility of fetal-derived (fNPC) and adult-derived (aNPC) neural progenitor cells was dependent on hydrogel formulation. Acute survival of fNPC benefited from hydrogel encapsulation. NPC differentiation was divergent: fNPC differentiated into mostly glial cells, compared with neuronal differentiation of aNPC. Differentiation was influenced in part by the hydrogel mechanical properties. This study indicates that there can be a wide range of HA and PEG hydrogels compatible with NPC. Additionally, this is the first study comparing hydrogel encapsulation of NPC derived from different aged sources, with data suggesting that fNPC and aNPC respond dissimilarly within the same hydrogel formulation. PMID:24141109

High-Risk Behavior and Sexually Transmitted Infections Among U.S. Active Duty Servicewomen and Veterans

PubMed Central

Mattocks, Kristin M.; Sadler, Anne G.

2012-01-01

Abstract The number of women who are active duty service members or veterans of the U.S. military is increasing. Studies among young, unmarried, active duty servicewomen who are sexually active indicate a high prevalence of risky sexual behaviors, including inconsistent condom use, multiple sexual partners, and binge drinking, that lead to unintended and unsafe sex. These high-risk sexual practices likely contribute to chlamydia infection rates that are higher than the rates in the U.S. general population. Human papillomavirus (HPV) infection and cervical dysplasia may also be higher among young, active duty servicewomen. Little is known about the sexual practices and rates of sexually transmitted infections among older servicewomen and women veterans; however, women veterans with a history of sexual assault may be at high risk for HPV infection and cervical dysplasia. To address the reproductive health needs of military women, investigations into the prevalence of unsafe sexual behaviors and consequent infection among older servicewomen and women veterans are needed. Direct comparison of military and civilian women is needed to determine if servicewomen are a truly high-risk group. Additionally, subgroups of military women at greatest risk for these adverse reproductive health outcomes need to be identified. PMID:22994983

Cancer Cachexia: Cause, Diagnosis, and Treatment.

PubMed

Mattox, Todd W

2017-10-01

Patients with cancer frequently experience unintended weight loss due to gastrointestinal (GI) dysfunction caused by the malignancy or treatment of the malignancy. However, others may present with weight loss related to other symptoms not clearly associated with identifiable GI dysfunction such as anorexia and early satiety. Cancer cachexia (CC) is a multifactorial syndrome that is generally characterized by ongoing loss of skeletal muscle mass with or without fat loss, often accompanied by anorexia, weakness, and fatigue. CC is associated with poor tolerance of antitumor treatments, reduced quality of life (QOL), and negative impact on survival. Symptoms associated with CC are thought to be caused in part by tumor-induced changes in host metabolism that result in systemic inflammation and abnormal neurohormonal responses. Unfortunately, there is no single standard treatment for CC. Nutrition consequences of oncologic treatments should be identified early with nutrition screening and assessment. Pharmacologic agents directed at improving appetite and countering metabolic abnormalities that cause inefficient nutrient utilization are currently the foundation for treating CC. Multiple agents have been investigated for their effects on weight, muscle wasting, and QOL. However, few are commercially available for use. Considerations for choosing the most appropriate treatment include effect on appetite, weight, QOL, risk of adverse effects, and cost and availability of the agent.

Mycotoxins in ethanol co-products: modeling economic impacts on the livestock industry and management strategies.

PubMed

Wu, Felicia; Munkvold, Gary P

2008-06-11

The rapidly expanding U.S. ethanol industry is generating a growing supply of co-products, mostly in the form of dried distillers' grain and solubles (DDGS) or wet distillers' grains (WDG). In the United States, 90% of the co-products of maize-based ethanol are fed to livestock. An unintended consequence is that animals are likely to be fed higher levels of mycotoxins, which are concentrated up to three times in DDGS compared to grain. The model developed in this study estimates current losses to the swine industry from weight gain reduction due to fumonisins in added DDGS at $9 million ($2-18 million) annually. If there is complete market penetration of DDGS in swine feed with 20% DDGS inclusion in swine feed and fumonisins are not controlled, losses may increase to $147 million ($29-293 million) annually. These values represent only those losses attributable to one mycotoxin on one adverse outcome on one species. The total loss due to mycotoxins in DDGS could be significantly higher due to additive or multiplicative effects of multiple mycotoxins on animal health. If mycotoxin surveillance is implemented by ethanol producers, losses are shifted among multiple stakeholders. Solutions to this problem include methods to reduce mycotoxin contamination in both pre- and postharvest maize.

Building smart cannabis policy from the science up.

PubMed

Weiss, Susan R B; Howlett, Katia D; Baler, Ruben D

2017-04-01

Social attitudes and cultural norms around the issue of substance abuse are shifting rapidly around the world, leading to complex and unpredictable consequences. On the positive side, efforts to more intensely disseminate the scientific evidence for the many connections between chronic substance use and the emergence of measurable and discrete brain dysfunctions, has ushered in an evolving climate of acceptance and a new era of improved access to more effective interventions, at least in the United States. On the negative side, there has been a steady erosion in the public perception of the harms associated with the use of popular drugs, especially cannabis. This worrisome trend has sprouted at the convergence of several forces that have combined, more or less fortuitously, to effectively change long-standing policies away from prohibition and toward decriminalization or legalization. These forces include the outsized popularity of the cannabis plant among recreational users, the unflagging campaign by corporate lobbyists and patient advocates to mainstream its medicinal use, and the honest realization in some quarters of the deleterious impact of the drug war and its draconian cannabis laws, in particular, on society's most vulnerable populations. Updating drug policies is a desirable goal, and significant changes may indeed be warranted. However, there is a real concern when policy changes are hurriedly implemented without the required input from the medical, scientific, or policy research communities. Regardless of how well intentioned, such initiatives are bound to magnify the potential for unintended adverse consequences in the form of far ranging health and social costs. To minimize this risk, science must be front and center in this important policy debate. Here, we review the state of the science on cannabis and cannabinoid health effects, both adverse and therapeutic. We focus on the prevalence of use in different populations, the mechanisms by which cannabis exerts its effects (i.e., via the endocannabinoid system), and the double-edged potential of this system to inspire new medications, on one hand, and to cause short and long term harmful effects on the other. By providing knowledge of cannabis' broad ranging effects, we hope to enable better decision making regarding cannabis legislation and policy implementation. Published by Elsevier B.V.

Building Smart Cannabis Policy from the Science Up

PubMed Central

Weiss, Susan R.B.; Howlett, Katia Delrahim; Baler, Ruben D.

2017-01-01

Social attitudes and cultural norms around the issue of substance abuse are shifting rapidly around the world, leading to complex and unpredictable consequences. On the positive side, efforts to more intensly disseminate the scientific evidence for the many connections between chronic substance use and the emergence of measurable and discrete brain dysfunctions, has ushered in an evolving climate of acceptance and a new era of improved access to more effective interventions, at least in the United States. On the negative side, there has been a steady erosion in the public perception of the harms associated with the use of popular drugs, especially cannabis. This worrisome trend has sprouted at the convergence of several forces that have combined, more or less fortuitously, to effectively change long-standing policies away from prohibition and toward decriminalization or legalization. These forces include the outsized popularity of the cannabis plant among recreational users, the unflagging campaign by corporate lobbyists and patient advocates to mainstream its medicinal use, and the honest realization in some quarters of the deleterious impact of the drug war and its draconian cannabis laws, in particular, on society’s most vulnerable populations. Updating drug policies is a desirable goal, and significant changes may indeed be warranted. However, there is a real concern when policy changes are hurriedly implemented without the required input from the medical, scientific, or policy research communities. Regardless of how well intentioned, such initiatives are bound to magnify the potential for unintended adverse consequences in the form of far ranging health and social costs. To minimize this risk, science must be front and center in this important policy debate. Here, we review the state of the science on cannabis and cannabinoid health effects, both adverse and therapeutic. We focus on the prevalence of use in different populations, the mechanisms by which cannabis exerts its effects (i.e., via the endocannabinoid system), and the double-edged potential of this system to inspire new medications, on one hand, and to cause short and long term harmful effects on the other. By providing knowledge of cannabis’ broad ranging effects, we hope to enable better decision making regarding cannabis legislation and policy implementation. PMID:28189459

What can individuals do to reduce personal health risks from air pollution?

PubMed Central

Laumbach, Robert; Meng, Qingyu

2015-01-01

In many areas of the world, concentrations of ambient air pollutants exceed levels associated with increased risk of acute and chronic health problems. While effective policies to reduce emissions at their sources are clearly preferable, some evidence supports the effectiveness of individual actions to reduce exposure and health risks. Personal exposure to ambient air pollution can be reduced on high air pollution days by staying indoors, reducing outdoor air infiltration to indoors, cleaning indoor air with air filters, and limiting physical exertion, especially outdoors and near air pollution sources. Limited evidence suggests that the use of respirators may be effective in some circumstances. Awareness of air pollution levels is facilitated by a growing number of public air quality alert systems. Avoiding exposure to air pollutants is especially important for susceptible individuals with chronic cardiovascular or pulmonary disease, children, and the elderly. Research on mechanisms underlying the adverse health effects of air pollution have suggested potential pharmaceutical or chemopreventive interventions, such as antioxidant or antithrombotic agents, but in the absence of data on health outcomes, no sound recommendations can be made for primary prevention. Health care providers and their patients should carefully consider individual circumstances related to outdoor and indoor air pollutant exposure levels and susceptibility to those air pollutants when deciding on a course of action to reduce personal exposure and health risks from ambient air pollutants. Careful consideration is especially warranted when interventions may have unintended negative consequences, such as when efforts to avoid exposure to air pollutants lead to reduced physical activity or when there is evidence that dietary supplements, such as antioxidants, have potential adverse health effects. These potential complications of partially effective personal interventions to reduce exposure or risk highlight the primary importance of reducing emissions of air pollutants at their sources. PMID:25694820

What can individuals do to reduce personal health risks from air pollution?

PubMed

Laumbach, Robert; Meng, Qingyu; Kipen, Howard

2015-01-01

In many areas of the world, concentrations of ambient air pollutants exceed levels associated with increased risk of acute and chronic health problems. While effective policies to reduce emissions at their sources are clearly preferable, some evidence supports the effectiveness of individual actions to reduce exposure and health risks. Personal exposure to ambient air pollution can be reduced on high air pollution days by staying indoors, reducing outdoor air infiltration to indoors, cleaning indoor air with air filters, and limiting physical exertion, especially outdoors and near air pollution sources. Limited evidence suggests that the use of respirators may be effective in some circumstances. Awareness of air pollution levels is facilitated by a growing number of public air quality alert systems. Avoiding exposure to air pollutants is especially important for susceptible individuals with chronic cardiovascular or pulmonary disease, children, and the elderly. Research on mechanisms underlying the adverse health effects of air pollution have suggested potential pharmaceutical or chemopreventive interventions, such as antioxidant or antithrombotic agents, but in the absence of data on health outcomes, no sound recommendations can be made for primary prevention. Health care providers and their patients should carefully consider individual circumstances related to outdoor and indoor air pollutant exposure levels and susceptibility to those air pollutants when deciding on a course of action to reduce personal exposure and health risks from ambient air pollutants. Careful consideration is especially warranted when interventions may have unintended negative consequences, such as when efforts to avoid exposure to air pollutants lead to reduced physical activity or when there is evidence that dietary supplements, such as antioxidants, have potential adverse health effects. These potential complications of partially effective personal interventions to reduce exposure or risk highlight the primary importance of reducing emissions of air pollutants at their sources.

Clinical trials bureaucracy: unintended consequences of well-intentioned policy.

PubMed

Califf, Robert M

2006-01-01

As randomized controlled trials have become the 'gold standard' for medical research, a complex regulatory structure for the conduct of clinical trials has emerged. However, this structure has not been adequately assessed to ensure that regulations governing human subjects research actually produce the desired effects. Our purpose is to identify some of the major shortcomings in the current regulatory system of human clinical trials oversight, and to propose some potential solutions to these problems. We discuss the evolution of the current US regulatory environment and its application in the context of several widely-used drug therapies. Despite numerous randomized controlled trials, performed within a structure of extensive documentation and data collection, serious shortcomings in a number of pharmaceutical therapies were not detected until after the drugs were approved and widely adopted by clinicians. The current system of regulatory bureaucracy in clinical trials has led to an extremely expensive research paradigm that, in spite of complex systems of oversight and exhaustive data collection, cannot be shown to adequately ensure the integrity of the research process and the protection of human research subjects. Some parts of the system, including Research Ethics Review Boards, may not be well-suited to carrying out their core mission of overseeing research conduct, and other aspects of clinical trials regulatory structure, such as monitoring/auditing review and adverse event reporting, may constitute a waste of money and resources. Misdirected data collection and adverse events reporting divert valuable resources and hamper development of large, simple clinical trials powered to definitively answer important research questions. Careful scrutiny of the utility of current or proposed regulatory schemes is required to ensure the integrity of human subjects research and to enhance the effectiveness of research dollars.

Pilot-testing an adverse drug event reporting form prior to its implementation in an electronic health record.

PubMed

Chruscicki, Adam; Badke, Katherin; Peddie, David; Small, Serena; Balka, Ellen; Hohl, Corinne M

2016-01-01

Adverse drug events (ADEs), harmful unintended consequences of medication use, are a leading cause of hospital admissions, yet are rarely documented in a structured format between care providers. We describe pilot-testing structured ADE documentation fields prior to integration into an electronic medical record (EMR). We completed a qualitative study at two Canadian hospitals. Using data derived from a systematic review of the literature, we developed screen mock-ups for an ADE reporting platform, iteratively revised in participatory workshops with diverse end-user groups. We designed a paper-based form reflecting the data elements contained in the mock-ups. We distributed them to a convenience sample of clinical pharmacists, and completed ethnographic workplace observations while the forms were used. We reviewed completed forms, collected feedback from pharmacists using semi-structured interviews, and coded the data in NVivo for themes related to the ADE form. We completed 25 h of clinical observations, and 24 ADEs were documented. Pharmacists perceived the form as simple and clear, with sufficient detail to capture ADEs. They identified fields for omission, and others requiring more detail. Pharmacists encountered barriers to documenting ADEs including uncertainty about what constituted a reportable ADE, inability to complete patient follow-up, the need for inter-professional communication to rule out alternative diagnoses, and concern about creating a permanent record. Paper-based pilot-testing allowed planning for important modifications in an ADE documentation form prior to implementation in an EMR. While paper-based piloting is rarely reported prior to EMR implementations, it can inform design and enhance functionality. Piloting with other groups of care providers and in different healthcare settings will likely lead to further revisions prior to broader implementations.

Introducing rapid tests for malaria into the retail sector: what are the unintended consequences?

PubMed Central

Hutchinson, Eleanor; Hutchison, Coll; Lal, Sham; Hansen, Kristian; Kayendeke, Miriam; Nabirye, Christine; Magnussen, Pascal; Mbonye, Anthony; Chandler, Clare I R

2017-01-01

The observation that many people in Africa seek care for febrile illness in the retail sector has led to a number of public health initiatives to try to improve the quality of care provided in these settings. The potential to support the introduction of rapid diagnostic tests for malaria (mRDTs) into drug shops is coming under increased scrutiny. Those in favour argue that it enables the harmonisation of policy around testing and treatment for malaria and maintains a focus on market-based solutions to healthcare. Despite the enthusiasm among many global health actors for this policy option, there is a limited understanding of the consequences of the introduction of mRDTs in the retail sector. We undertook an interpretive, mixed methods study with drug shop vendors (DSVs), their clients and local health workers to explore the uses and interpretations of mRDTs as they became part of daily practice in drug shops during a trial in Mukono District, Uganda. This paper reports the unintended consequences of their introduction. It describes how the test engendered trust in the professional competence of DSVs; was misconstrued by clients and providers as enabling a more definitive diagnosis of disease in general rather than malaria alone; that blood testing made drug shops more attractive places to seek care than they had previously been; was described as shifting treatment-seeking behaviour away from formal health centres and into drug shops; and influenced an increase in sales of medications, particularly antibiotics. Trial registration number NCT01194557; Results. PMID:28588992

Harm Reduction Text Messages Delivered During Alcohol Drinking: Feasibility Study Protocol

PubMed Central

2012-01-01

Background: Recent research using mobile phone interventions to address public health issues such as smoking, obesity, depression, and diabetes provides a basis for trialing a similar approach toward reducing the negative consequences of risky drinking. Objective: This feasibility study aims to recruit drinkers between 18–34 years to a website where they will design and enter their own personal messages (repeating or one-off) to be sent to their mobile phones when they are drinking to remind them of their pre-drinking safety intentions. Methods/Design: Participants in the treatment group will have access to the messaging function for 3 months and will be compared to a control group who will have 3 months access to a web chat site only. Data collection will occur at baseline, 3 months, and 6 months. The primary outcome is a change in unintended negative consequences from drinking at 3 months. Secondary outcomes include the acceptability of the intervention to this population, recruitment rate, participant retention, reduction in alcohol consumption, and the self-motivation discourse in participant messages. Discussion: Existing alcohol interventions in New Zealand attempt to reduce alcohol consumption in the population, but with little effect. This study aims to target unintended negative consequences resulting from drinking by empowering the drinkers themselves to deliver safety messages during the drinking session. If proven effective, this strategy could provide a cost-effective means of reducing the public health burden associated with risky drinking. Trial Registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000242921 PMID:23611773

The Role of the Military in Counterterrorism: Unintended Consequences

DTIC Science & Technology

2012-12-01

mercy or regret because their relatives were killed in front of them, their sisters were raped , their houses were destroyed…These people have nothing...soldiers for ordering his twin sisters out of their beds.46 According to the Army, the responsibility for the innocent people’s sufferings lay on the...hope of finding them sleeping in their beds peacefully. As it did in classic conventional operations, the Army Headquarters in Northern Ireland

Developing Games for Health Behavior Change: Getting Started

PubMed Central

Buday, Richard; Thompson, Debbe; Lyons, Elizabeth J.; Lu, Amy Shirong; Baranowski, Janice

2013-01-01

Abstract Many investigators are considering developing videogames for health (video-G4Hs) but have questions about how to get started. This report provides guidance for investigators considering a G4H as a behavioral intervention procedure from a team of experienced G4H developers. Thirteen commonly asked questions are answered, including defining a G4H, considerations in developing a team, considerations in G4H design, and anticipating unintended consequences. PMID:24443708

Mexico’s Drug War and Its Unintended Regional Consequences

DTIC Science & Technology

2013-03-01

multiple approaches are designed to solve the problem.9 Analysis of the current strategic environment, relying on the environmental assessment model...current environmental assessment, this paper will provide a brief description of a more desired environment and also a problem statement that depicts...the 1980s the U.S. focused its counter drug efforts in Peru and Bolivia, then the world’s leaders in coca leaf supply. In the meantime, Colombian

Unintended Consequences of the Goldwater-Nichols Act (Joint Force Quarterly, Spring 1998)

DTIC Science & Technology

1998-01-01

Armed Forces to achieve mili- tary success, the unified direction of DOD neces- sary for budgetary efficiency, and the separation of powers demanded by...its actions. The Constitution has stood for two centuries precisely because it flexibly applies simple concepts such as the separation of powers and...replaced, it has created a national military command structure that ignores the separation of powers . The amended National Security Act has consolidated

Boys as Only-Children and Girls as Only-Children--Parental Gendered Expectations of the Only-Child in the Nuclear Chinese Family in Present-Day China

ERIC Educational Resources Information Center

Liu, Fengshu

2006-01-01

Studies on the effect of only-child status on girls' education indicate that the only-child policy has had an unintended consequence of engendering a child-centered culture with a strong belief and shared interest among the urban community in educating the only-child regardless of the child's sex. As the distribution of education by sex is…

The SAS Education Value-Added Assessment System (SAS[R] EVAAS[R]) in the Houston Independent School District (HISD): Intended and Unintended Consequences

ERIC Educational Resources Information Center

Amrein-Beardsley, Audrey; Collins, Clarin

2012-01-01

The SAS Educational Value-Added Assessment System (SAS[R] EVAAS[R]) is the most widely used value-added system in the country. It is also self-proclaimed as "the most robust and reliable" system available, with its greatest benefit to help educators improve their teaching practices. This study critically examined the effects of SAS[R] EVAAS[R] as…

Unintended Consequences of Advocating Use of Fixed-Price Contracts in Defense Acquisition Practice

DTIC Science & Technology

2011-04-30

put to use and tested to determine its value . We take seriously the pernicious effects of the so-called “theory– practice” gap, which would separate...related to accounting and finance. His research fields are financial and management accounting , corporate finance, and economics. His latest research...investigates the cost efficiency issue in the context of defense contracts. Professor Wang’s work has been published in Accounting and Finance

Afforestation and forests at the dryland edges: Lessons learned and future outlooks

Treesearch

Csaba Mátyás; Ge Sun; Yaoqi Zhang

2013-01-01

In the Drylands of Northern China, such as the Loess Plateau region, a buffer zone of planted forests—a “Green Great Wall”—has been created in the last five decades. These government programs have often generated unintended environmental consequences, and have failed to achieve the desired benefits. Planted forests withhold erosion, dust storms and silting of streams...

The kidney allocation score: methodological problems, moral concerns and unintended consequences.

PubMed

Hippen, B

2009-07-01

The growing disparity between the demand for and supply of kidneys for transplantation has generated interest in alternative systems of allocating kidneys from deceased donors. This personal viewpoint focuses attention on the Kidney Allocation Score (KAS) proposal promulgated by the UNOS/OPTN Kidney Committee. I identify several methodological and moral flaws in the proposed system, concluding that any iteration of the KAS proposal should be met with more skepticism than sanguinity.

Tradeoffs for Renewable Energy Projects: Environmental, Planning, and Mission Considerations

DTIC Science & Technology

2010-04-01

lands .” Land is leased for energy projects subject to payment of royalties on commercial sales , into a Navy fund re- served for energy projects. This...their water resources, and other uses on these lands and airspaces? How do we make informed deci- sions about the tradeoffs between renewable energy...to meet their energy needs by generating renewable energy on (and off) installation lands . At the same time, unintended consequences of these new

Can Rising Instructional Time Crowd out Student Pro-Social Behaviour? Unintended Consequences of a German High School Reform. CEP Discussion Paper No. 1495

ERIC Educational Resources Information Center

Krekel, Christian

2017-01-01

We study whether raising instructional time can crowd out student pro-social behaviour. To this end, we exploit a large educational reform in Germany that has raised weekly instructional hours for high school students by 12.5% as a quasi-natural experiment. Using a difference-in-differences design, we find that this rise has a negative and…

The Misconception of Corporal Punishment: A Rejoin to Albrecht's "Drop and Give Us 20, Seifried: A Practical Response to Defending the Use of Punishment by Coaches"

ERIC Educational Resources Information Center

Seifried, Chad

2010-01-01

Dr. Rick Albrecht's article, titled "Drop and Give Us 20, Seifried: A Practical Response to Defending the Use of Punishment by Coaches," argued that I held a disregard for the unintended negative consequences of punishment and pointed out several items of concern he felt obligated to communicate to the scholarly and professional community to…

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya

PubMed Central

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-01-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility’s bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers’ motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. PMID:25920355

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya.

PubMed

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-03-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Childhood Adversity, Daily Stress, and Marital Strain in Same-Sex and Different-Sex Marriages

PubMed Central

Donnelly, Rachel; Umberson, Debra; Kroeger, Rhiannon A.

2017-01-01

Childhood adversity has enduring consequences for individuals throughout life, including increased reactivity to stress that may contribute to marital strain in adulthood. Past research on gendered experiences of heterosexual spouses raises questions about how the influence of childhood adversity might differ for men and women in same-sex marriages. We analyze dyadic diary data from 756 individuals in 106 male same-sex, 157 female same-sex, and 115 different-sex marriages to consider how childhood adversity moderates the association between daily stress and marital strain. Results suggest that the negative consequences of daily stress for marital strain are amplified by past childhood adversity with variation for men and women in same- and different-sex unions, such that women and those in same-sex marriages may experience some protection from the adverse consequences of childhood adversity.

Intimate partner violence and pregnancy spacing: results from a meta-analysis of individual participant time-to-event data from 29 low-and-middle-income countries

PubMed Central

Maxwell, Lauren; Nandi, Arijit; Benedetti, Andrea; Devries, Karen; Wagman, Jennifer; García-Moreno, Claudia

2018-01-01

Introduction Inadequately spaced pregnancies, defined as pregnancies fewer than 18 months apart, are linked to maternal, infant, and child morbidity and mortality, and adverse social, educational and economic outcomes in later life for women and children. Quantifying the relation between intimate partner violence (IPV) and women’s ability to space and time their pregnancies is an important part of understanding the burden of disease related to IPV. Methods We applied Cox proportional hazards models to monthly data from the Demographic and Health Surveys’ Reproductive Health Calendar to compare interpregnancy intervals for women who experienced physical, sexual and/or emotional IPV in 29 countries. We conducted a one-stage meta-analysis to identify the periods when women who experienced IPV were at the highest risk of unintended and incident pregnancy, and a two-stage meta-analysis to explore cross-country variations in the magnitude of the relation between women’s experience of IPV and pregnancy spacing. Results For the one-stage analysis, considering 52 959 incident pregnancies from 90 446 women, which represented 232 394 person-years at risk, women’s experience of IPV was associated with a 51% increase in the risk of pregnancy (95% CI 1.38 to 1.66), although this association decreased over time. When limiting our inference to unintended pregnancies that resulted in live births, women’s experience of IPV was associated with a 30% increase in the risk of unintended pregnancy (95% CI 1.25 to 1.34; n=13 541 pregnancies, 92 848 women, 310 319 person-years at risk). In the two-stage meta-analyses, women’s experience of IPV was associated with a 13% increase in the probability of incident pregnancy (95% CI 1.07 to 1.20) and a 28% increase in the likelihood of unintended pregnancy (95% CI 1.19 to 1.38). Conclusions Across countries, women’s experience of IPV is associated with a reduction in time between pregnancies and an increase in the risk of unintended pregnancy; the magnitude of this effect varied by country and over time. PMID:29564152

Beyond drinking: differential effects of demographic and socioeconomic factors on alcohol-related adverse consequences across European countries.

PubMed

Kuendig, Hervé; Plant, Moira L; Plant, Martin A; Kuntsche, Sandra; Miller, Patrick; Gmel, Gerhard; Ahlström, Salme; Bergmark, Karin Helmersson; Olafsdóttir, Hildigunnur; Elekes, Zsuzsanna; Csemy, Ladislav; Knibbe, Ronald

2008-01-01

Evidence underlines the importance of drinking patterns and individual characteristics in experiencing adverse alcohol-related consequences; however, little research has been conducted to explore who does and who does not experience consequences with similar drinking patterns. Using data from seven European countries, this study assesses the association between demographic and socioeconomic characteristics and six adverse consequences. Conditional logistic regression models were estimated, cases (experiencing a consequence) being matched to controls (not experiencing the consequence) by drinking patterns. In general, protective effects with increasing age and being in a partnership were consistent. Gender effects were mixed, but mainly protective for women. Educational achievement and economic status showed consistent effects across countries, but different directions of effect across consequences. Consequences mostly associated with individual drinking pattern (injury, blackout, and loss of control over drinking) exhibited similar patterns of associations, but varying ones arose for consequences additionally influenced by societal reaction to drinking (guilt, role failure, and pressure to cut down drinking). Differences in strengths and directions of effects across consequences pointed to the possibility that the reporting of adverse consequences is not only influenced by alcohol consumption, but also by attributional processes related to demographic and socioeconomic statuses. Copyright 2008 S. Karger AG, Basel.

Intendedness of pregnancy and other predictive factors for symptoms of prenatal depression in a population-based study.

PubMed

Fellenzer, Jena L; Cibula, Donald A

2014-12-01

Prenatal depression (PD) as a risk factor for adverse birth outcomes is well documented. Less is known about maternal risks for PD, which could inform preventive strategies for perinatal and interconceptional care. This exploratory study investigates associations between prenatal depression symptoms and unintended and mistimed pregnancies and other maternal risk factors for PD. A subset of birth records from the New York Statewide Perinatal Data System (n = 19,219) was used in this secondary analysis of cross-sectional data. Univariate and multivariate multinomial regression was used to identify factors that are independently associated with four self-reported levels of prenatal depression symptoms. Women with unintended pregnancies were more likely (AOR, 95 % CI) to report severe (3.6, 2.6-5.1) or moderate (2.0, 1.6-2.5) prenatal depression symptoms and less likely to report no symptoms, compared to women with intended pregnancies. Likewise, women with mistimed pregnancies were more likely to report severe (2.7, 2.2-3.5) or moderate (1.7, 1.5-2.1) prenatal depression symptoms than no symptoms, compared to women with intended pregnancies. Low education, drug use, smoking, minority race, being unmarried and having Medicaid insurance were also significant, independent predictors of PD symptoms. Results suggest that routine screening for depression, intendedness of pregnancy and other associated risk factors such as smoking and drug use during prenatal and interconceptional care visits may enable coordinated interventions that can reduce prenatal depression and unintended and mistimed pregnancies and improve pregnancy outcomes.

Transgene flow: Facts, speculations and possible countermeasures

PubMed Central

Ryffel, Gerhart U

2014-01-01

Convincing evidence has accumulated that unintended transgene escape occurs in oilseed rape, maize, cotton and creeping bentgrass. The escaped transgenes are found in variant cultivars, in wild type plants as well as in hybrids of sexually compatible species. The fact that in some cases stacked events are present that have not been planted commercially, implies unintended recombination of transgenic traits. As the consequences of this continuous transgene escape for the ecosystem cannot be reliably predicted, I propose to use more sophisticated approaches of gene technology in future. If possible GM plants should be constructed using either site-directed mutagenesis or cisgenic strategies to avoid the problem of transgene escape. In cases where a transgenic trait is needed, efficient containment should be the standard approach. Various strategies available or in development are discussed. Such a cautious approach in developing novel types of GM crops will enhance the sustainable potential of GM crops and thus increase the public trust in green gene technology. PMID:25523171

Specificity of the Acute Tryptophan and Tyrosine Plus Phenylalanine Depletion and Loading Tests I. Review of Biochemical Aspects and Poor Specificity of Current Amino Acid Formulations

PubMed Central

Badawy, Abdulla A.-B.; Dougherty, Donald M.; Richard, Dawn M.

2010-01-01

The acute tryptophan or tyrosine plus phenylalanine depletion and loading tests are powerful tools for studying the roles of serotonin, dopamine and noradrenaline in normal subjects and those with behavioural disorders. The current amino acid formulations for these tests, however, are associated with undesirable decreases in ratios of tryptophan or tyrosine plus phenylalanine to competing amino acids resulting in loss of specificity. This could confound biochemical and behavioural findings. Compositions of current formulations are reviewed, the biochemical principles underpinning the tests are revisited and examples of unintended changes in the above ratios and their impact on monoamine function and behaviour will be demonstrated from data in the literature. The presence of excessive amounts of the 3 branched-chain amino acids Leu, Ile and Val is responsible for these unintended decreases and the consequent loss of specificity. Strategies for enhancing the specificity of the different formulations are proposed. PMID:20676231

Specificity of the acute tryptophan and tyrosine plus phenylalanine depletion and loading tests I. Review of biochemical aspects and poor specificity of current amino Acid formulations.

PubMed

Badawy, Abdulla A-B; Dougherty, Donald M; Richard, Dawn M

2010-01-01

The acute tryptophan or tyrosine plus phenylalanine depletion and loading tests are powerful tools for studying the roles of serotonin, dopamine and noradrenaline in normal subjects and those with behavioural disorders. The current amino acid formulations for these tests, however, are associated with undesirable decreases in ratios of tryptophan or tyrosine plus phenylalanine to competing amino acids resulting in loss of specificity. This could confound biochemical and behavioural findings. Compositions of current formulations are reviewed, the biochemical principles underpinning the tests are revisited and examples of unintended changes in the above ratios and their impact on monoamine function and behaviour will be demonstrated from data in the literature. The presence of excessive amounts of the 3 branched-chain amino acids Leu, Ile and Val is responsible for these unintended decreases and the consequent loss of specificity. Strategies for enhancing the specificity of the different formulations are proposed.

Just Say Yes: Winning the U.S. War on Drugs

DTIC Science & Technology

2010-03-01

Prohibition Clearly the U.S. needs to find ways to prevent Mexico’s drug war from threatening the safety and security of U.S. citizens. Many of...fines and incarceration. While the goal of the U.S. policy is to prevent all illegal drug use, many negative unintended consequences result from...any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient

Green biotechnology and European competitiveness.

PubMed

Enriquez, J

2001-04-01

Europe has led many aspects of gene research and yet it has been unable to translate these discoveries into a globally dominant industrial sector. There are valid societal, political and financial reasons for its reluctance to deploy agricultural biotechnology but this reluctance might have unintended consequences. It will be hard to de-commoditize agriculture and improve farmer's lives. Research in medical biotechnology and the global environment might suffer. Europe could damage its overall economy and its global competitive standing.

The Helms-Burton Act: A Strategic Critique.

DTIC Science & Technology

1998-03-31

Sänger, "U.S.- Canadian Split on Cuba Tangles Wal-Mart’s Pajamas ," The New York Times, 6 March 1997, Sec. A, pi. An unintended consequence of the...organizational framework; without strategy, tactics, or historical perspective; without a language, library, data bank , complete intelligence...Sänger, David E. "U.S.-Canadian Split on Cuba Tangles Wal-Mart’s Pajamas ." The New York Times, Sec. A, pi. "Saying Boo to Helms-Burton." The

Problems and limitations of voluntary cleanup programs

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

Johnson, S.F.

1995-12-31

At least a dozen states have already implemented voluntary cleanup programs (VCPs). Provisions to promote state VCPs were prominent in the EPA`s 1994 proposed revisions to CERCLA and in current legislative initiatives. Under the VCP, property owners voluntarily enroll to investigate and remediate contaminated sites with the aegis of a state agency and thus avoid involvement with the federal Superfund program. When the state agency is satisfied with the condition of the site, it issues a certificate to the owner. The VCP is meant to mitigate unintended consequences of CERCLA such as the economic abandonment of urban industrial sites inmore » favor of unpolluted suburban sites. The VCP concept has been combined with other reforms including cleanup standards, financial incentives, and independent action. The effectiveness of voluntary cleanup programs is limited by the costs of investigation and cleanup relative to the value of the property in question. It is also limited when property has environmental problems outside the traditional focus of state Superfund agencies on soil and groundwater contamination. VCPs also have potential unintended consequences of their own. The VCP concept is consistent with a 15 year trend of increasing government attention and involvement with sites of diminishing health and environmental significance. VCP may reinforce the perception of liability and unwittingly raise the standard of due diligence in property assessments, especially if combined with generic cleanup standard.« less

The Effect of Share 35 on Biliary Complications: an Interrupted Time Series Analysis.

PubMed

Fleming, J N; Taber, D J; Axelrod, D; Chavin, K D

2018-05-16

The purpose of the Share 35 allocation policy was to improve liver transplant waitlist mortality, targeting high MELD waitlisted patients. However, policy changes may also have unintended consequences that must be balanced with the primary desired outcome. We performed an interrupted time series assessing the impact of Share 35 on biliary complications in a select national liver transplant population using the Vizient CDB/RM ™ database. Liver transplants that occurred between October 2012 and September 2015 were included. There was a significant change in the incident-rate of biliary complications between Pre-Share 35 (n=3,018) and Post-Share 35 (n=9,984) cohorts over time (p=0.023, r2=0.44). As a control, a subanalysis was performed throughout the same time period in Region 9 transplant centers, where a broad sharing agreement had previously been implemented. In the subanalysis, there was no change in the incident-rate of biliary complications between the two time periods. Length of stay and mean direct cost demonstrated a change after implementation of Share 35, although they did not meet statistical difference. While the target of improved waitlist mortality is of utmost importance for the equitable allocation of organs, unintended consequences of policy changes should be studied for a full assessment of a policy's impact. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

State of the Science Review: Potential for Beneficial Use of ...

EPA Pesticide Factsheets

Metal and metalloid contamination of soil and sediment is a widespread problem both in urban and rural areas throughout the United States (U.S. EPA, 2014). Beneficial use of waste by-products as amendments to remediate metal-contaminated soils and sediments can provide major economic and environmental advantages on both a site-specific and national scale. These waste by-products can also reduce our need to mine virgin materials or produce synthetic materials for amendments. Waste by-products must not be hazardous or pose unacceptable risk to human health and the environment, and should be a suitable replacement for virgin and synthetic materials. This review serves to present the state of science on in-situ remediation of metal-contaminated soil and sediment and the potential for beneficial usage of waste by-product materials. Not all unintended consequences can be fully understood or predicted prior to implementing a treatment option, however some realized, and potentially unrealized, benefits and unintended consequences are explored. The objectives of this review article are to: (1) summarize the current state of the science on in-situ treatment of metal-contaminated soils and sediments; (2) review the more recent use of non-municipal and non-hazardous waste by-products for use as soil and sediment amendments; and (3) identify physical and chemical properties that are indicative of the success or effectiveness of using a specific amendment to treat metal

The Dangers of Posthumous Diagnoses and the Unintended Consequences of Facile Associations: Jeffrey Dahmer and Autism Spectrum Disorders.

PubMed

Palermo, Mark T; Bogaerts, Stefan

2015-12-01

Posthumous diagnoses are not uncommonly given to notorious public and historical figures by applying retrospectively, and typically in the absence of the individual being diagnosed, contemporary diagnostic criteria. Although this may be relatively easy and free of consequences when it concerns clear-cut medical conditions, it may have unintended repercussions in the case of psychiatric disorders by creating myths and perpetuating stigma. The case of serial killer Jeffrey Dahmer is a typical example where a somewhat facile and almost syllogistic application of perhaps over-inclusive criteria may have contributed to the legend of solitary murderers as possibly suffering from an autism spectrum condition. Although there may be an understandable human need to explain abominable and heinous behaviors, the lack of the possibility to verify a diagnostic theory and the ill-advised attempt to make a diagnosis fit may de facto be the basis of prejudice and profiling that do not correspond to clinical reality. Although there is no doubt that the brain is the organ of behavior, the authors caution against a budding neo-Lombrosian approach to crime and criminality and against the all too common use of widely differing terms in the study of deviance, such as crime, delinquency, and aggression, the operational use of which, often used interchangeably even in association studies, often erroneously leads to further confusion. © The Author(s) 2014.

Case histories in pharmaceutical risk management.

PubMed

McCormick, Cynthia G; Henningfield, Jack E; Haddox, J David; Varughese, Sajan; Lindholm, Anders; Rosen, Susan; Wissel, Janne; Waxman, Deborah; Carter, Lawrence P; Seeger, Vickie; Johnson, Rolley E

2009-12-01

The development and implementation of programs in the U.S. to minimize risks and assess unintended consequences of new medications has been increasingly required by the Food and Drug Administration (FDA) since the mid 1990s. This paper provides four case histories of risk management and post-marketing surveillance programs utilized recently to address problems associated with possible abuse, dependence and diversion. The pharmaceutical sponsors of each of these drugs were invited to present their programs and followed a similar template for their summaries that are included in this article. The drugs and presenting companies were OxyContin, an analgesic marketed by Purdue Pharma L.P., Daytrana and Vyvanse, ADHD medications marketed by Shire Pharmaceuticals, Xyrem for narcolepsy marketed by Jazz Pharmaceuticals, and Subutex and Suboxone for opioid dependence marketed by Reckitt Benckiser Pharmaceuticals Inc. These case histories and subsequent discussions provide invaluable real-world examples and illustrate both the promise of risk management programs in providing a path to market and/or for keeping on the market drugs with serious potential risks. They also illustrate the limitations of such programs in actually controlling unintended consequences, as well as the challenge of finding the right balance of reducing risks without posing undue barriers to patient access. These experiences are highly relevant as the FDA increasingly requires pharmaceutical sponsors to develop and implement the more formalized and enforceable versions of the risk management term Risk Evaluation and Mitigation Strategies (REMS).

Unintended outcomes evaluation approach: A plausible way to evaluate unintended outcomes of social development programmes.

PubMed

Jabeen, Sumera

2018-06-01

Social development programmes are deliberate attempts to bring about change and unintended outcomes can be considered as inherent to any such intervention. There is now a solid consensus among the international evaluation community regarding the need to consider unintended outcomes as a key aspect in any evaluative study. However, this concern often equates to nothing more than false piety. Exiting evaluation theory suffers from overlap of terminology, inadequate categorisation of unintended outcomes and lack of guidance on how to study them. To advance the knowledge of evaluation theory, methods and practice, the author has developed an evaluation approach to study unintended effects using a theory building, testing and refinement process. A comprehensive classification of unintended outcomes on the basis of knowability, value, distribution and temporality helped specify various type of unintended outcomes for programme evaluation. Corresponding to this classification, a three-step evaluation process was proposed including a) outlining programme intentions b) forecasting likely unintended effects c) mapping the anticipated and understanding unanticipated unintended outcomes. This unintended outcomes evaluation approach (UOEA) was then trialled by undertaking a multi-site and multi-method case study of a poverty alleviation programme in Pakistan and refinements were made to the approach.The case study revealed that this programme was producing a number of unintended effects, mostly negative, affecting those already disadvantaged such as the poorest, women and children. The trialling process demonstrated the effectiveness of the UOEA and suggests that this can serve as a useful guide for future evaluation practice. It also provides the discipline of evaluation with an empirically-based reference point for further theoretical developments in the study of unintended outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Neonicotinoid Insecticides Alter Induced Defenses and Increase Susceptibility to Spider Mites in Distantly Related Crop Plants

PubMed Central

Szczepaniec, Adrianna; Raupp, Michael J.; Parker, Roy D.; Kerns, David; Eubanks, Micky D.

2013-01-01

Background Chemical suppression of arthropod herbivores is the most common approach to plant protection. Insecticides, however, can cause unintended, adverse consequences for non-target organisms. Previous studies focused on the effects of pesticides on target and non-target pests, predatory arthropods, and concomitant ecological disruptions. Little research, however, has focused on the direct effects of insecticides on plants. Here we demonstrate that applications of neonicotinoid insecticides, one of the most important insecticide classes worldwide, suppress expression of important plant defense genes, alter levels of phytohormones involved in plant defense, and decrease plant resistance to unsusceptible herbivores, spider mites Tetranychus urticae (Acari: Tetranychidae), in multiple, distantly related crop plants. Methodology/Principal Findings Using cotton (Gossypium hirsutum), corn (Zea mays) and tomato (Solanum lycopersicum) plants, we show that transcription of phenylalanine amonia lyase, coenzyme A ligase, trypsin protease inhibitor and chitinase are suppressed and concentrations of the phytohormone OPDA and salicylic acid were altered by neonicotinoid insecticides. Consequently, the population growth of spider mites increased from 30% to over 100% on neonicotinoid-treated plants in the greenhouse and by nearly 200% in the field experiment. Conclusions/Significance Our findings are important because applications of neonicotinoid insecticides have been associated with outbreaks of spider mites in several unrelated plant species. More importantly, this is the first study to document insecticide-mediated disruption of plant defenses and link it to increased population growth of a non-target herbivore. This study adds to growing evidence that bioactive agrochemicals can have unanticipated ecological effects and suggests that the direct effects of insecticides on plant defenses should be considered when the ecological costs of insecticides are evaluated. PMID:23658754

Severe unexpected adverse effects after permanent eye makeup and their management by Q-switched Nd:YAG laser

PubMed Central

Goldman, Alberto; Wollina, Uwe

2014-01-01

Permanent makeup is a cosmetic tattoo that is used to enhance one’s appearance, and which has become more popular among middle-aged and elderly women. A couple of benefits seem to be associated with permanent tattoos in the elderly: saving time (wake up with makeup); poor eyesight (difficult to apply makeup); and saving money. On the other hand, cosmetic tattoos bear the same risks as other tattoo procedures. We report on fading and unintended hyperpigmentation after tattooing on eyebrows and eyelids, and discuss the scientific and anatomical background behind the possible cause. Dermatochalasis may be a possible risk factor for excessive unwanted discolorations. Q-switched neodymium-doped yttrium aluminum garnet laser is an appropriate and safe therapeutic tool that can manage such adverse effects. Consumer protection warrants better information and education of the risks of cosmetic tattoos – in particular, for elderly women. PMID:25143716

Severe unexpected adverse effects after permanent eye makeup and their management by Q-switched Nd:YAG laser.

PubMed

Goldman, Alberto; Wollina, Uwe

2014-01-01

Permanent makeup is a cosmetic tattoo that is used to enhance one's appearance, and which has become more popular among middle-aged and elderly women. A couple of benefits seem to be associated with permanent tattoos in the elderly: saving time (wake up with makeup); poor eyesight (difficult to apply makeup); and saving money. On the other hand, cosmetic tattoos bear the same risks as other tattoo procedures. We report on fading and unintended hyperpigmentation after tattooing on eyebrows and eyelids, and discuss the scientific and anatomical background behind the possible cause. Dermatochalasis may be a possible risk factor for excessive unwanted discolorations. Q-switched neodymium-doped yttrium aluminum garnet laser is an appropriate and safe therapeutic tool that can manage such adverse effects. Consumer protection warrants better information and education of the risks of cosmetic tattoos - in particular, for elderly women.

Controlling Anxiety Mediates the Influence of Childhood Adversities on Risky Sexual Behaviors Among Emerging Adults.

PubMed

Wong, Janet Yuen-Ha; Choi, Edmond Pui-Hang; Chan, Claudia Kor-Yee; Fong, Daniel Yee-Tak

2017-10-01

Relatively little research has assessed the exposure-response relationship of childhood adversities on engaging in risky sexual behaviors. Also, no previous research has examined the interrelationship among childhood adversities, adult anxiety and depressive symptoms, and risky sexual behaviors. This study aimed to investigate their interrelationships. We used data from a multisite survey of emerging adults aged 18 to 29 studying at four universities in Hong Kong between September and December 2015. Structural equation modeling (SEM) was used to examine the pathways from childhood adversities to risky sexual behaviors. Participants who had higher childhood adversity scores reported more severe adult anxiety symptoms (β = 0.20, p = 0.002); and adult anxiety symptoms were associated with significantly more risky sexual behaviors (β = 0.46, p < 0.0001). The model with adult anxiety symptoms as the mediator between childhood adversities and risky sexual behaviors showed good fit (root mean square error of approximation [RMSEA] = 0.04, comparative fit index [CFI] = 0.96, Tucker-Lewis index [TLI] = 0.94 and standardized root mean square residual [SRMSR] = 0.04). However, adult depressive symptoms failed to mediate between childhood adversities and risky sexual behaviors. This study demonstrates the link between childhood adversities and risky sexual behaviors via adult anxiety but not adult depressive symptoms. It is essential to reduce anxious symptoms in dealing with emerging adults who have risky sexual behaviors to prevent sexually transmitted infections (STIs) and unintended pregnancy.

Shifts in intended and unintended pregnancies in the United States, 2001-2008.

PubMed

Finer, Lawrence B; Zolna, Mia R

2014-02-01

We monitored trends in pregnancy by intendedness and outcomes of unintended pregnancies nationally and for key subgroups between 2001 and 2008. Data on pregnancy intentions from the National Survey of Family Growth (NSFG) and a nationally representative survey of abortion patients were combined with counts of births (from the National Center for Health Statistics), counts of abortions (from a census of abortion providers), estimates of miscarriages (from the NSFG), and population denominators from the US Census Bureau to obtain pregnancy rates by intendedness. In 2008, 51% of pregnancies in the United States were unintended, and the unintended pregnancy rate was 54 per 1000 women ages 15 to 44 years. Between 2001 and 2008, intended pregnancies decreased and unintended pregnancies increased, a shift previously unobserved. Large disparities in unintended pregnancy by relationship status, income, and education increased; the percentage of unintended pregnancies ending in abortion decreased; and the rate of unintended pregnancies ending in birth increased, reaching 27 per 1000 women. Reducing unintended pregnancy likely requires addressing fundamental socioeconomic inequities, as well as increasing contraceptive use and the uptake of highly effective methods.

Progesterone for Prevention of Preterm Birth: Shortcomings and Unintended Consequences of the Orphan Drug Act.

PubMed

Gee, Rebekah E; Kuy, SreyRam; Karas, Laura O

2017-12-01

Preterm birth is a problem of major public health significance that continues to plague our country despite the existence of a therapy, 17α-hydroxyprogesterone caproate, with known efficacy in reducing the risk of spontaneous preterm birth among high-risk women. Over the past several years, the Louisiana Department of Health has undertaken a robust, multifaceted initiative to improve access to 17α-hydroxyprogesterone caproate, which resulted in a 3.5-fold increase in the percentage of eligible high-risk pregnant women in the Medicaid program who received the therapy between 2013 and 2016. Yet despite Louisiana's progress, the vast majority of the eligible population still fails to receive 17α-hydroxyprogesterone caproate. In this Current Commentary, we argue that the high price of progesterone since U.S. Food and Drug Administration approval has unnecessarily complicated access, and our nation has potentially suffered nearly 60,000 avoidable premature births as a consequence. We present the history of the orphan drug approval and manufacturer-imposed price increase for injectable progesterone, the interplay between the drug's high price and the persistence of racial and ethnic disparities in preterm birth, which are particularly germane in Louisiana, and Louisiana's broad-reaching efforts to improve progesterone coverage. The story of 17α-hydroxyprogesterone caproate highlights the durable barriers that high prices place in the way of access and helps illuminate the shortcomings and unintended consequences of the Orphan Drug Act. This case, however, is not an outlier; it is the far-too-common product of monopoly pricing in the U.S. pharmaceutical market, inadvertently bolstered by existing law, at the expense of affordability and patient access.

Deviant Globalization and the Unintended Consequences of Coca Eradication in Colombia

DTIC Science & Technology

2012-06-01

OAS) and the Colombian , U.S., and British governments. Upon official request, an in-depth study and assessment of the human health and environmental ...regarded as major players in the cocaine trade, as well as a serious threat to political stability in the country. In response, a U.S. and Colombian ...trade, as well as a serious threat to political stability in the country. In response, a U.S. and Colombian partnership known as Plan Colombia (2000

Homegrown violent extremists: A seemingly undetectable threat

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

Crawford, Justin

With today’s unlimited and instantaneous communication, it is easy for a United States citizen to easily connect with anyone in the world. There are many positives to this; however, the unintended consequences include vulnerable people being influenced by radical ideologies. This is evident with the increase in homegrown violent extremists (HVE).The challenge for law enforcement is how to work with constitutional constraints that require a criminal predicate to be present in order to allow intelligence teams to continue collecting information in a permanent file.

Barcode medication administration work-arounds: a systematic review and implications for nurse executives.

PubMed

Voshall, Barbara; Piscotty, Ronald; Lawrence, Jeanette; Targosz, Mary

2013-10-01

Safe medication administration is necessary to ensure quality healthcare. Barcode medication administration systems were developed to reduce drug administration errors and the related costs and improve patient safety. Work-arounds created by nurses in the execution of the required processes can lead to unintended consequences, including errors. This article provides a systematic review of the literature associated with barcoded medication administration and work-arounds and suggests interventions that should be adopted by nurse executives to ensure medication safety.

Accidents - Policy and Punishment Are there boundar ies to the effectiveness of cr iminal sanctions in preventing accidental conduct?

NASA Astrophysics Data System (ADS)

Fisher, Alan

This paper discusses recent and impending changes in Health and Safety law, questions the utility and supposed justification of tougher criminal sanctions and appeals for greater clarity in health and safety law as to what is truly a criminal offence. It also questions the use of the ‘reverse burden of proof’ and warns against unintended consequences if responsible people are made to feel that they are being treated unfairly.

A Relevant Risk Approach to Mental Health Inquiries in Question 21 of the Questionnaire for National Security Positions (SF-86)

DTIC Science & Technology

2015-03-24

5b. GRANT NUMBER: 5c. PROGRAM ELEMENT NUMBER: 6. AUTHOR(S): Jonathan Shedler, Eric L. Lang 5d. PROJECT NUMBER: 5e. TASK NUMBER: 5f...national security interests and represents an example of the law of unintended consequences. Inclusion of the question likely serves to undermine...certain positions. For example , a person who suffers from epilepsy and experiences uncontrolled seizures is not suited to be a pilot. He or she may

Knowledge Transfer Loss in a Base Realignment and Closure (BRAC) Environment: A Positive or Negative Acquisition Paradigm Shift

DTIC Science & Technology

2012-04-01

between 1946-1964), Gen-Xrs (born between 1965-1980), Millennials (born between 1981- 1990), and iGenerationals (born between 1991 and today). Research...generations (03 Traditionalist, 71 Generation X, 04 Millennial, and 00 iGeneration ). And there were 34 (11 percent) survey official responses where the...interesting insight into unintended consequences of “mass purge/new blood” on absorbing a short-term 0 50 100 150 200 No Response Opt-outs iGeneration

Nazi Germany and Fascist Italy: Totalitarian Menace or Monolithic Illusion? An Analysis of the Axis Coalition

DTIC Science & Technology

2004-06-17

no confidence in against Chancellor Franz von Papen . This led to new elections on 6 November which had unintended consequences--the Nazi’s lost 2...their living space and to maintain peace.1 Preamble to the Pact of Steel On 22 May 1939, the German Reich Minister for Foreign Affairs, Joachim von ...alliance and war. 5 In Germany, Hitler continued to accumulate power after January 1933. With the death of President Paul von Hindenburg, Hitler

Messaging, Missions, and Mindsets: The Unintended Consequences of National Messaging and Policy when Translated into Operations and Soldier Actions in the Second World War

DTIC Science & Technology

2013-06-23

abundant, and nearly every American had regular 6 access to radios and the cinema . For the first time, messages could reach nearly everyone in...still required for full support. On December 7th, 1941, the Japanese provided it.42 On December 11th, 1941, Hitler declared war on the U.S., without...Soviet, and anti-gypsy indoctrinating propaganda. Nazi public festivals and theater, contextually similar to the American cinema experience

"Partier" self-concept mediates the relationship between college student binge drinking and related adverse consequences.

PubMed

Reslan, Summar; Saules, Karen K; Serras, Alisha

2011-08-01

The literature suggests that identity impairments play a role in certain forms of maladaptive behavior. Thus, this study was designed to evaluate the extent to which a "Partier" self-concept confers risk for adverse drinking-related consequences, mediating the well documented relationship between college student binge drinking and adverse outcomes. Participants completed an Internet survey examining binge drinking behaviors and related consequences, "Partier" self-concept, and demographic characteristics. This sample was comprised of 251 undergraduate psychology students (M(age)=19.90, SD(age)=1.80; 83% female). Results suggest that "Partier" self-concept partially mediates the relationship between binge drinking and adverse consequences, and it contributes unique variance beyond that explained by frequency of binge drinking and duration of alcohol consumed during binge episodes. Future research should explore whether, for undergraduate college students, binge drinking prevention efforts tailored towards self-concept may fare better than those that have traditionally focused on heavy alcohol use, negative consequences, and related sanctions. Copyright © 2011 Elsevier Ltd. All rights reserved.

Unintended pregnancy and interpregnancy interval by maternal age, National Survey of Family Growth.

PubMed

Ahrens, Katherine A; Thoma, Marie E; Copen, Casey E; Frederiksen, Brittni N; Decker, Emily J; Moskosky, Susan

2018-03-01

The relationship between unintended pregnancy and interpregnancy interval (IPI) across maternal age is not clear. Using data from the National Survey of Family Growth, we estimated the percentages of pregnancies that were unintended among IPI groups (<6, 6-11, 12-17, 18-23, 24+ months) by maternal age at last live birth (15-19, 20-24, 25-29, 30-44 years). Approximately 40% of pregnancies were unintended and 36% followed an IPI<18 months. Within each maternal age group, the percentage of pregnancies that were unintended decreased as IPI increased. Unintended pregnancies are associated with shorter IPI across the reproductive age spectrum. Published by Elsevier Inc.

The Incidence, Nature and Consequences of Adverse Events in Iranian Hospitals.

PubMed

Akbari Sari, Ali; Doshmangir, Leila; Torabi, Fereshteh; Rashidian, Arash; Sedaghat, Mojtaba; Ghomi, Robabeh; Prasopa-Plaizier, Nittita

2015-12-01

Adverse events are relatively common in healthcare, leading to extensive harm to patients and a significant drain on healthcare resources. Identifying the extent, nature and consequences of adverse events is an important step in preventing adverse events and their consequences which is the subject of this study. This is a retrospective review of medical records randomly selected from patients admitted to 4 general hospitals, staying more than 24 hours and discharged between April and September 2012. We randomly selected 1200 records and completed the record review for 1162 of these records. Standard forms (RF1 and RF2) were used to review medical records in two stages by nurses and medical doctors. Eighty-five (7.3%) of the 1162 records had an adverse event during the admission; and in 43 (3.7%) of the 1162 records, the patient was admitted to the hospital due to an adverse event that occurred before the admission. Therefore, a total of 128 (11.0%) adverse events occurred in 126 (10.9) records as two patients had more than one adverse event. Forty-four (34.3%) of these 128 adverse events were considered preventable. This study confirms that adverse events, particularly adverse drug reactions, post-operative infections, bedsore and hospital acquired infections are common and potentially preventable sources of harm to patients in Iranian hospitals.

Socioeconomic inequality of unintended pregnancy in the Iranian population: a decomposition approach.

PubMed

Omani-Samani, Reza; Amini Rarani, Mostafa; Sepidarkish, Mahdi; Khedmati Morasae, Esmaeil; Maroufizadeh, Saman; Almasi-Hashiani, Amir

2018-05-09

There are several studies regarding the predictors or risk factors of unintended pregnancy, but only a small number of studies have been carried out concerning the socio-economic factors influencing the unintended pregnancy rate. This study aimed to determine the socioeconomic inequality of unintended pregnancy in Tehran, Iran, as a developing country. In this hospital based cross-sectional study, 5152 deliveries from 103 hospitals in Tehran (the capital of Iran) were included in the analysis in July 2015. Socioeconomic status (SES) was measured through an asset-based method and principal component analysis was carried out to calculate the household SES. The concentration index and curve was used to measure SES inequality in unintended pregnancy, and then decomposed into its determinants. The data was analyzed by statistical Stata software. The Wagstaff normalized concentration index of unintended pregnancy (- 0.108 (95% Confidence Interval (CI) = - 0.119 ~ - 0.054)) endorses that unintended pregnancy is more concentrated among poorer mothers. The results showed that SES accounted for 27% of unintended pregnancy inequality, followed by the mother's nationality (19%), father's age (16%), mother's age (10%), father's education level (7%) and Body Mass Index (BMI) groups (5%). Unintended pregnancy is unequally distributed among Iranian women and is more concentrated among poor women. Economic status had the most positive contribution, explaining 27% of inequality in unintended pregnancy.

Creating an impersonal NHS? Personalization, choice and the erosion of intimacy.

PubMed

Owens, John

2015-02-01

Personalization - most often understood in terms of granting patients greater opportunity to participate in, and make choices about, the services they receive - has become a key principle guiding reform of the English NHS. This study sets out to explore the relationship between two senses of the term 'personal' within the context of personalization. Firstly, much of the policy literature equates a 'personal' service with one that is responsive to the choices of individual patients. Secondly, the term 'personal' can be thought to refer to the intimate relationships between patients and medical professionals that have typified traditional models of good practice. I combine a review of the relevant academic and policy literature on personalization with a process of conceptual analysis to uncover three arguments, which suggest that personalization based on choice may adversely affect standards of care by eroding the qualities of intimacy at the heart of the care process. Thus, an unintended consequence of the drive for personalization may be the creation of an NHS that is, in an important sense, less personal than it once was. Whilst personalization may deliver many potential benefits, the tension between promoting patient choice and retaining intimate professional-patient relationships ought to be taken seriously. Thus, the task of promoting choice whilst retaining intimacy represents a key policy challenge for advocates of personalization. © 2012 John Wiley & Sons Ltd.

Health co-benefits and risks of public health adaptation strategies to climate change: a review of current literature.

PubMed

Cheng, June J; Berry, Peter

2013-04-01

Many public health adaptation strategies have been identified in response to climate change. This report reviews current literature on health co-benefits and risks of these strategies to gain a better understanding of how they may affect health. A literature review was conducted electronically using English language literature from January 2000 to March 2012. Of 812 articles identified, 22 peer-reviewed articles that directly addressed health co-benefits or risks of adaptation were included in the review. The co-benefits and risks identified in the literature most commonly relate to improvements in health associated with adaptation actions that affect social capital and urban design. Health co-benefits of improvements in social capital have positive influences on mental health, independently of other determinants. Risks included reinforcing existing misconceptions regarding health. Health co-benefits of urban design strategies included reduced obesity, cardiovascular disease and improved mental health through increased physical activity, cooling spaces (e.g., shaded areas), and social connectivity. Risks included pollen allergies with increased urban green space, and adverse health effects from heat events through the use of air conditioning. Due to the current limited understanding of the full impacts of the wide range of existing climate change adaptation strategies, further research should focus on both unintended positive and negative consequences of public health adaptation.

TIC-Tox: A preliminary discussion on identifying the forcing agents of DBP-mediated toxicity of disinfected water.

PubMed

Plewa, Michael J; Wagner, Elizabeth D; Richardson, Susan D

2017-08-01

The disinfection of drinking water is a major public health achievement; however, an unintended consequence of disinfection is the generation of disinfection by-products (DBPs). Many of the identified DBPs exhibit in vitro and in vivo toxicity, generate a diversity of adverse biological effects, and may be hazards to the public health and the environment. Only a few DBPs are regulated by several national and international agencies and it is not clear if these regulated DBPs are the forcing agents that drive the observed toxicity and their associated health effects. In this study, we combine analytical chemical and biological data to resolve the forcing agents associated with mammalian cell cytotoxicity of drinking water samples from three cities. These data suggest that the trihalomethanes (THMs) and haloacetic acids may be a small component of the overall cytotoxicity of the organic material isolated from disinfected drinking water. Chemical classes of nitrogen-containing DBPs, such as the haloacetonitriles and haloacetamides, appear to be the major forcing agents of toxicity in these samples. These findings may have important implications for the design of epidemiological studies that primarily rely on the levels of THMs to define DBP exposure among populations. The TIC-Tox approach constitutes a beginning step in the process of identifying the forcing agents of toxicity in disinfected water. Copyright © 2017. Published by Elsevier B.V.

Can tobacco control endgame analysis learn anything from the US experience with illegal drugs?

PubMed

Reuter, Peter

2013-05-01

The goals of tobacco control endgame strategies are specified in terms of the desired levels of tobacco use and/or tobacco related health consequences. Yet the strategies being considered may have other consequences beyond tobacco use prevalence, forms and related harms. Most of the proposed strategies threaten to create large black markets with potential attendant harms: corruption, high illegal earnings, violence and/or organised crime. Western societies of course have considerable experience with these problems in the context of prohibition of drugs such as cannabis, cocaine, heroin and methamphetamine. These experiences suggest that low prevalence has been achieved only by tough enforcement with damaging unintended consequences. Tobacco prohibition (total or partial) may not present the same trade-off but there is little basis for making a projection of the scale, form and harms of the attendant black markets. Nonetheless, these harms should not be ignored in analyses of the endgame proposals.

Unintended Consequences of Tele Health and their Possible Solutions

PubMed Central

Maeder, A.; Mars, M.; Hartvigsen, G.; Basu, A.; Abbott, P.

2016-01-01

Summary Objectives Assess unforeseen consequences of Telehealth and suggest solutions Methods An outline was created collecting all possible ill effects classified into Clinical considerations, Administrative concerns including interpersonal relations, Technical issues, Legal / Ethical concerns and Miscellaneous. Each topic was assigned to a particular WG member to lead, gather opinion and review existing literature. Results and Conclusion A wide array of problems have been described. Except for technical issues, literature on this topic is scant, so this article is based more on personal experience and data collected from surveys. Much can be done to prevent such problems, such as a need for standardization with related clinical studies for devices as well as processes used for telehealth is underlined, besides evaluation of outcomes of projects undertaken. PMID:27830229

Epidemiological Criminology: Contextualization of HIV/AIDS Health Care for Female Inmates.

PubMed

Lanier, Mark M; Zaitzow, Barbara H; Farrell, C Thomas

2015-04-01

Worldwide, women are increasingly being incarcerated. One unintended consequence is the increase in unhealthy female offenders. Among the more serious health concerns are HIV and AIDS. Challenges associated with caring for women with HIV/AIDS impacts not only disease management and infection control within correctional facilities but also the prisoners' home communities where they will need health care, drug and alcohol rehabilitation, housing assistance, and employment opportunities. No bridging theory has been presented that links prison and community health concerns with criminal justice policy. This article not only presents recommendations for effective HIV/AIDS policy but also suggests epidemiological criminology as a means of explicit merging of health with justice issues and consequently provides a bridging framework. © The Author(s) 2015.

Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya.

PubMed

Ikamari, Lawrence; Izugbara, Chimaraoke; Ochako, Rhoune

2013-03-19

The prevalence of unintended pregnancy in Kenya continues to be high. The 2003 Kenya Demographic and Health Survey (KDHS) showed that nearly 50% of unmarried women aged 15-19 and 45% of the married women reported their current pregnancies as mistimed or unwanted. The 2008-09 KDHS showed that 43% of married women in Kenya reported their current pregnancies were unintended. Unintended pregnancy is one of the most critical factors contributing to schoolgirl drop out in Kenya. Up to 13,000 Kenyan girls drop out of school every year as a result of unintended pregnancy. Unsafe pregnancy termination contributes immensely to maternal mortality which currently estimated at 488 deaths per 100 000 live births. In Kenya, the determinants of prevalence and determinants of unintended pregnancy among women in diverse social and economic situations, particularly in urban areas, are poorly understood due to lack of data. This paper addresses the prevalence and the determinants of unintended pregnancy among women in slum and non-slum settlements of Nairobi. This study used the data that was collected among a random sample of 1262 slum and non-slum women aged 15-49 years in Nairobi. The data was analyzed using simple percentages and logistic regression. The study found that 24 percent of all the women had unintended pregnancy. The prevalence of unintended pregnancy was 21 per cent among women in slum settlements compared to 27 per cent among those in non-slum settlements. Marital status, employment status, ethnicity and type of settlement were significantly associated with unintended pregnancy. Logistic analysis results indicate that age, marital status and type of settlement had statistically significantly effects on unintended pregnancy. Young women aged 15-19 were significantly more likely than older women to experience unintended pregnancy. Similarly, unmarried women showed elevated risk for unintended pregnancy than ever-married women. Women in non-slum settlements were significantly more likely to experience unintended pregnancy than their counterparts in slum settlements.The determinants of unintended pregnancy differed between women in each type of settlement. Among slum women, age, parity and marital status each had significant net effect on unintended pregnancy. But for non-slum women, it was marital status and ethnicity that had significant net effects. The study found a high prevalence of unintended pregnancy among the study population and indicated that young and unmarried women, irrespective of their educational attainment and household wealth status, have a higher likelihood of experiencing unintended pregnancy. Except for the results on educational attainments and household wealth, these results compared well with the results reported in the literature.The results indicate the need for effective programs and strategies to increase access to contraceptive services and related education, information and communication among the study population, particularly among the young and unmarried women. Increased access to family planning services is key to reducing unintended pregnancy among the study population. This calls for concerted efforts by all the stakeholders to improve access to family planning services among the study population. Increased access should be accompanied with improvement in the quality of care and availability of information about effective utilization of family planning methods.

[Safety profile of etonogestrel contraceptive implant (Nexplanon® and Implanon®) reported in France].

PubMed

Simon, C; Agier, M S; Béné, J; Muller, C; Vrignaud, L; Marret, H; Jonville-Bera, A P

2016-11-01

The aim of the study was to assess the incidence of adverse effects (AE) reported with etonogestrel contraceptive implant in France (Implanon ® and Nexplanon ® ). All cases of AE or unintended pregnancies reported to health authorities or to the firm were analyzed. During 10 years, 5433 AE and 789 unintended pregnancies were reported. Only 388 (7 %) were serious. There were 1137 reports of difficulties to remove, failure to locate or migration, 430 of insertion difficulties and 203 of deformation or expulsion of the implant. Among other AE, the most common were 1694 gynecological AE, 524 skin reactions and 437 metabolic AE. Since the marketing of Nexplanon ® which causes less deep insertions, the incidence of migrations, removal or insertion difficulties has decreased overall (0.92 vs. 1.31/1000 patients), particularly the incidence of removal difficulties, location failures or migrations (0.12 vs 1.01/1000). The infrequent but serious AE were infectious complications at the implant site and pregnancies. When the circumstances of the pregnancy were known, the contraceptive failure was due to the apparent inefficiency of the implant (n=224), to a technique failure (n=203) or to a drug-drug interaction (n=59). This study confirms that AE of this implant are frequent but not serious, except for the pregnancies. The incidence of complications related to insertion decreased with Nexplanon ® . Among other preventable AE, unintended pregnancies due to a drug-drug interaction would require to be better known by the practitioner. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Depression and Unmet Needs for Assistance With Daily Activities Among Community-Dwelling Older Adults.

PubMed

Xiang, Xiaoling; An, Ruopeng; Heinemann, Allen

2018-05-08

This study aims to investigate the impact of depressive symptoms on adverse consequences of unmet needs for assistance with daily activities among community-dwelling older adults. Data came from round 1 to 5 of the National Health and Aging Trends Study. Study sample consisted of 3,400 Medicare beneficiaries needing assistance with activities of daily living (ADL), instrumental activities of daily living (IADL), or mobility for any two consecutive years between 2011 and 2015. Study outcome was the number of self-reported adverse consequences of unmet needs for assistance with daily activities (e.g., went without eating, wet or soiled clothes). Mixed-effects negative binomial regression was used to estimate the association of lagged depressive symptoms and covariates in period t-1 and the number of adverse consequences of unmet needs in period t. The prevalence rates of adverse consequences of unmet needs were twice as high among older adults with elevated depressive symptoms as those without depression. After adjusting for covariates, prior wave depressive symptoms were associated with 1.24 times the rate of adverse consequences of unmet needs for assistance with ADL (Incidence Rate Ratio [IRR] = 1.24, 95% confidence interval [CI] = 1.09-1.41, p < .01) and IADL (IRR = 1.24, 95% CI = 1.06-1.44, p < .01), and 1.14 times the rate of adverse consequences of unmet needs for assistance with mobility (IRR = 1.14, 95% CI = 1.03-1.27, p < .05). Caring for older adults with mental health and long-term care needs calls for an integrated social and health services system.

The Perceived Impact of the Patient Protection and Affordable Care Act on North Carolina's Free Clinics.

PubMed

Swan, Greg A; Foley, Kristie L

2016-01-01

The Patient Protection and Affordable Care Act of 2010 (ACA) may dramatically affect the demographics of the uninsured population and the funding prospects for free health clinics. We conducted a cross-sectional survey of 64 of 80 free clinics (80.0% response rate) in North Carolina to assess free clinic directors' knowledge of the ACA and their perceptions of how the ACA would affect clinic operations. Free clinic directors were knowledgeable about well publicized aspects of the ACA (eg, lack of Medicaid expansion in North Carolina), but they were less knowledgeable about provisions such as the Federal Tort Claims Act and high-risk pools, which may have direct and indirect effects on free clinics. Directors expressed concern over the unintended consequences of the ACA, such as reduced funding and reduced volunteerism. Anticipated clinic changes as a result of the ACA include initiation of electronic medical records and, to a lesser extent, a move to become "hybrid" clinics (federally qualified health center look-alikes). This study is focused on North Carolina free clinics that are members of the North Carolina Association of Free Clinics (NCAFC). Findings cannot be generalized to non-NCAFC free clinics or to free clinic networks outside the state. Despite its effort to expand health insurance coverage, the ACA may have unintended consequences to low-cost free clinics that serve uninsured populations. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Redox-Mediated and Ionizing-Radiation-Induced Inflammatory Mediators in Prostate Cancer Development and Treatment

PubMed Central

Miao, Lu; Holley, Aaron K.; Zhao, Yanming; St. Clair, William H.

2014-01-01

Abstract Significance: Radiation therapy is widely used for treatment of prostate cancer. Radiation can directly damage biologically important molecules; however, most effects of radiation-mediated cell killing are derived from the generated free radicals that alter cellular redox status. Multiple proinflammatory mediators can also influence redox status in irradiated cells and the surrounding microenvironment, thereby affecting prostate cancer progression and radiotherapy efficiency. Recent Advances: Ionizing radiation (IR)–generated oxidative stress can regulate and be regulated by the production of proinflammatory mediators. Depending on the type and stage of the prostate cancer cells, these proinflammatory mediators may lead to different biological consequences ranging from cell death to development of radioresistance. Critical Issues: Tumors are heterogeneous and dynamic communication occurs between stromal and prostate cancer cells, and complicated redox-regulated mechanisms exist in the tumor microenvironment. Thus, antioxidant and anti-inflammatory strategies should be carefully evaluated for each patient at different stages of the disease to maximize therapeutic benefits while minimizing unintended side effects. Future Directions: Compared with normal cells, tumor cells are usually under higher oxidative stress and secrete more proinflammatory mediators. Thus, redox status is often less adaptive in tumor cells than in their normal counterparts. This difference can be exploited in a search for new cancer therapeutics and treatment regimes that selectively activate cell death pathways in tumor cells with minimal unintended consequences in terms of chemo- and radio-resistance in tumor cells and toxicity in normal tissues. Antioxid. Redox Signal. 20, 1481–1500. PMID:24093432

Mediation of adoption and use: a key strategy for mitigating unintended consequences of health IT implementation.

PubMed

Novak, Laurie L; Anders, Shilo; Gadd, Cynthia S; Lorenzi, Nancy M

2012-01-01

Without careful attention to the work of users, implementation of health IT can produce new risks and inefficiencies in care. This paper uses the technology use mediation framework to examine the work of a group of nurses who serve as mediators of the adoption and use of a barcode medication administration (BCMA) system in an inpatient setting. The study uses ethnographic methods to explore the mediators' work. Data included field notes from observations, documents, and email communications. This variety of sources enabled triangulation of findings between activities observed, discussed in meetings, and reported in emails. Mediation work integrated the BCMA tool with nursing practice, anticipating and solving implementation problems. Three themes of mediation work include: resolving challenges related to coordination, integrating the physical aspects of BCMA into everyday practice, and advocacy work. Previous work suggests the following factors impact mediation effectiveness: proximity to the context of use, understanding of users' practices and norms, credibility with users, and knowledge of the technology and users' technical abilities. We describe three additional factors observed in this case: 'influence on system developers,' 'influence on institutional authorities,' and 'understanding the network of organizational relationships that shape the users' work.' Institutionally supported clinicians who facilitate adoption and use of health IT systems can improve the safety and effectiveness of implementation through the management of unintended consequences. Additional research on technology use mediation can advance the science of implementation by providing decision-makers with theoretically durable, empirically grounded evidence for designing implementations.

Renal denervation and hypertension - The need to investigate unintended effects and neural control of the human kidney.

PubMed

Grisk, Olaf

2017-05-01

Increased renal sympathetic nerve activity (RSNA) is present in human and experimental forms of arterial hypertension. Experimental denervation studies showed that renal nerves contribute to the development of hypertension. Clinical trials provided equivocal results on the antihypertensive efficacy of renal denervation in patients spurring discussions on technical aspects of renal denervation and further research on the role of renal nerves for the regulation of kidney function as well as the pathophysiology of hypertension. This review summarizes recent findings on adrenoceptor expression and function in the human kidney, adrenoceptor-dependent regulation of sodium chloride transport in the distal nephron, experimental data on chronic RSNA and the development of high arterial pressure and consequences of renal denervation that may limit its antihypertensive efficacy. Future research needs to reduce the gap between our knowledge on neural control of renal function in animals vs. humans to facilitate translation of experimental animal data to humans. More experimental studies on the temporal relationship between RSNA and arterial pressure in the chronic setting are needed to better define the pathogenetic role of heightened RSNA in different forms of arterial hypertension in order to improve the rational basis for renal denervation in antihypertensive therapy. Finally, research on unintended consequences of renal denervation including but not limited to reinnervation and denervation supersensitivity needs to be intensified to further assess the potential of renal denervation to slow the progression of renal disease and hypertension. Copyright © 2016 Elsevier B.V. All rights reserved.

Different drinking motives, different adverse consequences? Evidence among adolescents from 10 European countries.

PubMed

Wicki, Matthias; Kuntsche, Emmanuel; Eichenberger, Yvonne; Aasvee, Katrin; Bendtsen, Pernille; Dankulincová Veselská, Zuzana; Demetrovics, Zsolt; Dzielska, Anna; Farkas, Judit; de Matos, Margarida Gaspar; Roberts, Chris; Tynjälä, Jorma; Välimaa, Raili; Vieno, Alessio

2017-11-01

This study, which builds on previous research demonstrating that drinking motives are associated with adverse consequences, investigates the associations between drinking motives and non-alcohol-attributed adverse consequences and disentangles alcohol-related and direct effects. On the basis of a sample of 22 841 alcohol-using 13- to 16-year-olds (50.6% female) from Belgium, Denmark, Estonia, Finland, Ireland, Portugal, Scotland, Slovakia, Switzerland and Wales, structural equation models were used to estimate direct and indirect effects. Additionally, differences across countries were tested in a multigroup analysis. The indirect effect (via alcohol use) was greater for injuries and academic problems than for more general outcomes such as life dissatisfaction and negative body image. For social, enhancement and coping motives, we found positive indirect effects (via alcohol use) on injuries and academic problems; the association was negative for conformity motives. The direct effect, that is, the effect above and beyond alcohol use, indicated more negative consequences among those who tended to drink more frequently for coping motives. More negative consequences, such as injuries and negative body image, were also found among those who drink for conformity motives. The pattern of association was largely comparable across countries. While the actual mean level of drinking motives, alcohol use and adverse consequence varied across countries, the consistency of association patterns implies that drinking motive-inspired health promotion efforts are likely to be beneficial across Europe. This is particularly important for coping drinkers because they are especially prone to adverse consequences over and above their alcohol use. [Wicki M, Kuntsche E, Eichenberger Y, Aasvee K, Bendtsen P, Dankulincová Veselská Z, Demetrovics Z, Dzielska A, Farkas J, de Matos MG, Roberts C, Tynjälä J, Välimaa R, Vieno A. Different drinking motives, different adverse consequences? Evidence among adolescents from 10 European countries. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Why Clinicians Don't Report Adverse Drug Events: Qualitative Study.

PubMed

Hohl, Corinne M; Small, Serena S; Peddie, David; Badke, Katherin; Bailey, Chantelle; Balka, Ellen

2018-02-27

Adverse drug events are unintended and harmful events related to medications. Adverse drug events are important for patient care, quality improvement, drug safety research, and postmarketing surveillance, but they are vastly underreported. Our objectives were to identify barriers to adverse drug event documentation and factors contributing to underreporting. This qualitative study was conducted in 1 ambulatory center, and the emergency departments and inpatient wards of 3 acute care hospitals in British Columbia between March 2014 and December 2016. We completed workplace observations and focus groups with general practitioners, hospitalists, emergency physicians, and hospital and community pharmacists. We analyzed field notes by coding and iteratively analyzing our data to identify emerging concepts, generate thematic and event summaries, and create workflow diagrams. Clinicians validated emerging concepts by applying them to cases from their clinical practice. We completed 238 hours of observations during which clinicians investigated 65 suspect adverse drug events. The observed events were often complex and diagnosed over time, requiring the input of multiple providers. Providers documented adverse drug events in charts to support continuity of care but never reported them to external agencies. Providers faced time constraints, and reporting would have required duplication of documentation. Existing reporting systems are not suited to capture the complex nature of adverse drug events or adapted to workflow and are simply not used by frontline clinicians. Systems that are integrated into electronic medical records, make use of existing data to avoid duplication of documentation, and generate alerts to improve safety may address the shortcomings of existing systems and generate robust adverse drug event data as a by-product of safer care. ©Corinne M Hohl, Serena S Small, David Peddie, Katherin Badke, Chantelle Bailey, Ellen Balka. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 27.02.2018.