Sample records for unintended consequences including
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Reports of unintended consequences of financial incentives to improve management of hypertension.
Hysong, Sylvia J; SoRelle, Richard; Broussard Smitham, Kristen; Petersen, Laura A
2017-01-01
Given the increase in financial-incentive programs nationwide, many physicians and physician groups are concerned about potential unintended consequences of providing financial incentives to improve quality of care. However, few studies examine whether actual unintended consequences result from providing financial incentives to physicians. We sought to document the extent to which the unintended consequences discussed in the literature were observable in a randomized clinical trial (RCT) of financial incentives. We conducted a qualitative observational study nested within a larger RCT of financial incentives to improve hypertension care. We conducted 30-minute telephone interviews with primary care personnel at facilities participating in the RCT housed at12 geographically dispersed Veterans Affairs Medical Centers nationwide. Participants answered questions about unintended effects, clinic team dynamics, organizational impact on care delivery, study participation. We employed a blend of inductive and deductive qualitative techniques for analysis. Sixty-five participants were recruited from RCT enrollees and personnel not enrolled in the larger RCT, plus one primary care leader per site. Emergent themes included possible patient harm, emphasis on documentation over improving care, reduced professional morale, and positive spillover. All discussions of unintended consequences involving patient harm were only concerns, not actual events. Several unintended consequences concerned ancillary initiatives for quality improvement (e.g., practice guidelines and performance measurement systems) rather than financial incentives. Many unintended consequences of financial incentives noted were either only concerns or attributable to ancillary quality-improvement initiatives. Actual unintended consequences included improved documentation of care without necessarily improving actual care, and positive unintended consequences. Clinicaltrials.gov Identifier: NCT00302718.
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Abraham, J.; Novak, L. L.; Reynolds, T. L.; Gettinger, A.
2016-01-01
Summary Objective To summarize recent research on unintended consequences associated with implementation and use of health information technology (health IT). Included in the review are original empirical investigations published in English between 2014 and 2015 that reported unintended effects introduced by adoption of digital interventions. Our analysis focuses on the trends of this steam of research, areas in which unintended consequences have continued to be reported, and common themes that emerge from the findings of these studies. Method Most of the papers reviewed were retrieved by searching three literature databases: MEDLINE, Embase, and CINAHL. Two rounds of searches were performed: the first round used more restrictive search terms specific to unintended consequences; the second round lifted the restrictions to include more generic health IT evaluation studies. Each paper was independently screened by at least two authors; differences were resolved through consensus development. Results The literature search identified 1,538 papers that were potentially relevant; 34 were deemed meeting our inclusion criteria after screening. Studies described in these 34 papers took place in a wide variety of care areas from emergency departments to ophthalmology clinics. Some papers reflected several previously unreported unintended consequences, such as staff attrition and patients’ withholding of information due to privacy and security concerns. A majority of these studies (71%) were quantitative investigations based on analysis of objectively recorded data. Several of them employed longitudinal or time series designs to distinguish between unintended consequences that had only transient impact, versus those that had persisting impact. Most of these unintended consequences resulted in adverse outcomes, even though instances of beneficial impact were also noted. While care areas covered were heterogeneous, over half of the studies were conducted at academic medical centers or teaching hospitals. Conclusion Recent studies published in the past two years represent significant advancement of unintended consequences research by seeking to include more types of health IT applications and to quantify the impact using objectively recorded data and longitudinal or time series designs. However, more mixed-methods studies are needed to develop deeper insights into the observed unintended adverse outcomes, including their root causes and remedies. We also encourage future research to go beyond the paradigm of simply describing unintended consequences, and to develop and test solutions that can prevent or minimize their impact. PMID:27830227
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Zheng, K; Abraham, J; Novak, L L; Reynolds, T L; Gettinger, A
2016-11-10
To summarize recent research on unintended consequences associated with implementation and use of health information technology (health IT). Included in the review are original empirical investigations published in English between 2014 and 2015 that reported unintended effects introduced by adoption of digital interventions. Our analysis focuses on the trends of this steam of research, areas in which unintended consequences have continued to be reported, and common themes that emerge from the findings of these studies. Most of the papers reviewed were retrieved by searching three literature databases: MEDLINE, Embase, and CINAHL. Two rounds of searches were performed: the first round used more restrictive search terms specific to unintended consequences; the second round lifted the restrictions to include more generic health IT evaluation studies. Each paper was independently screened by at least two authors; differences were resolved through consensus development. The literature search identified 1,538 papers that were potentially relevant; 34 were deemed meeting our inclusion criteria after screening. Studies described in these 34 papers took place in a wide variety of care areas from emergency departments to ophthalmology clinics. Some papers reflected several previously unreported unintended consequences, such as staff attrition and patients' withholding of information due to privacy and security concerns. A majority of these studies (71%) were quantitative investigations based on analysis of objectively recorded data. Several of them employed longitudinal or time series designs to distinguish between unintended consequences that had only transient impact, versus those that had persisting impact. Most of these unintended consequences resulted in adverse outcomes, even though instances of beneficial impact were also noted. While care areas covered were heterogeneous, over half of the studies were conducted at academic medical centers or teaching hospitals. Recent studies published in the past two years represent significant advancement of unintended consequences research by seeking to include more types of health IT applications and to quantify the impact using objectively recorded data and longitudinal or time series designs. However, more mixed-methods studies are needed to develop deeper insights into the observed unintended adverse outcomes, including their root causes and remedies. We also encourage future research to go beyond the paradigm of simply describing unintended consequences, and to develop and test solutions that can prevent or minimize their impact.
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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.
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Unintended Consequences: New Problems, New Solutions. Contributions From 2015.
Koppel, R; Chen, Y
2016-11-10
To select the best of the 2015 published papers on unintended consequences of healthcare information technology (HIT). Literature searches in several areas of scholarship, including IT, human factors, evaluation studies, medical errors, medical informatics, and implementation science. Also, because the specific terms "unintended consequences" were not often included in abstracts and titles, a more nuanced search algorithm was developed. We identified 754 papers that had some empirical research on unintended consequences of HIT. An initial screen of titles and abstracts reduced this to 171 papers of potential interest. We then further filtered out papers that did not meet the following criteria: 1) the paper had to report an original empirical investigation, and 2) the impact reported had to be not negligible, i.e., in quantitative studies, the results related to unintended consequences were statistically significant; and in qualitative studies the relevant themes emerged were prominent. This resulted in 33 papers of which 15 were selected as best paper candidates. Each of these 15 papers was then separately evaluated by four reviewers. The final selection of four papers was made jointly by the external reviewers and the two section editors. There is a growing awareness of the importance of HIT's unintended consequences-be they generated by the HIT vendors, the implementation process, the consultants, the users, or most probably, some combination of the above. There has also been greater creativity in use of data sources, including secondary data (e.g., medical malpractice cases and surveys) and a wider acceptance of mixed methods to identify unintended consequences. Unfortunately, the complexity of causes mitigates the value of recommendations to avoid unwanted outcomes. Suggestions are often contentious rather than obvious, setting-specific, and not universally applicable. "Lessons learned" often take on generalized-and perhaps platitudinous-forms, such as: "plan extra time," "involve all of the stakeholders," "recognize the different needs of different units or disciplines." The greater awareness of these problems, and the increased desire to identify and eliminate them is clearly reflected in the area's growing literature. We are hopeful the topic will receive additional attention and the discipline will improve its ability to identify and address these unexpected and usually adverse outcomes.
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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
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Luchters, Stanley; Bosire, Wilkister; Feng, Amy; Richter, Marlise L; King'ola, Nzioki; Ampt, Frances; Temmerman, Marleen; Chersich, Matthew F
Female sex workers (FSW) have high rates of unintended pregnancy, sexually transmitted infections including HIV, and other adverse sexual and reproductive health outcomes. Few services for FSWs include contraception. This mixed-methods study aimed to determine the rate, predictors and consequences of unintended pregnancy among FSWs in Mombasa, Kenya. A prospective cohort study of non-pregnant FSWs was conducted. Quantitative data were collected quarterly, including a structured questionnaire and testing for pregnancy and HIV. Predictors of unintended pregnancy were investigated using multivariate logistic regression. Qualitative data were gathered through focus group discussions and in-depth interviews with FSWs who became pregnant during the study, and interviews with five key informants. These data were transcribed, translated and analysed thematically. Four hundred women were enrolled, with 92% remaining in the cohort after one year. Fifty-seven percent reported using a modern contraceptive method (including condoms when used consistently). Over one-third (36%) of women were using condoms inconsistently without another method. Twenty-four percent had an unintended pregnancy during the study. Younger age, having an emotional partner and using traditional or no contraception, or condoms only, were independent predictors of unintended pregnancy. Women attributed pregnancy to forgetting to use contraception and being pressured not to by clients and emotional partners, as well as "bad luck". They described numerous negative consequences of unintended pregnancy. Modern contraceptive uptake is surprisingly low in this at-risk population, which in turn has a high rate of unintended pregnancy. The latter may result in financial hardship, social stigma, risk of abandonment, or dangerous abortion practices. FSWs face considerable barriers to the adoption of dual method contraceptive use, including low levels of control in their emotional and commercial relationships. Reproductive health services need to be incorporated into programs for sexually transmitted infections and HIV, which address the socially-determined barriers to contraceptive use.
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Luchters, Stanley; Bosire, Wilkister; Feng, Amy; Richter, Marlise L.; King’ola, Nzioki; Ampt, Frances; Temmerman, Marleen; Chersich, Matthew F.
2016-01-01
Introduction Female sex workers (FSW) have high rates of unintended pregnancy, sexually transmitted infections including HIV, and other adverse sexual and reproductive health outcomes. Few services for FSWs include contraception. This mixed-methods study aimed to determine the rate, predictors and consequences of unintended pregnancy among FSWs in Mombasa, Kenya. Methods A prospective cohort study of non-pregnant FSWs was conducted. Quantitative data were collected quarterly, including a structured questionnaire and testing for pregnancy and HIV. Predictors of unintended pregnancy were investigated using multivariate logistic regression. Qualitative data were gathered through focus group discussions and in-depth interviews with FSWs who became pregnant during the study, and interviews with five key informants. These data were transcribed, translated and analysed thematically. Results Four hundred women were enrolled, with 92% remaining in the cohort after one year. Fifty-seven percent reported using a modern contraceptive method (including condoms when used consistently). Over one-third (36%) of women were using condoms inconsistently without another method. Twenty-four percent had an unintended pregnancy during the study. Younger age, having an emotional partner and using traditional or no contraception, or condoms only, were independent predictors of unintended pregnancy. Women attributed pregnancy to forgetting to use contraception and being pressured not to by clients and emotional partners, as well as “bad luck”. They described numerous negative consequences of unintended pregnancy. Conclusion Modern contraceptive uptake is surprisingly low in this at-risk population, which in turn has a high rate of unintended pregnancy. The latter may result in financial hardship, social stigma, risk of abandonment, or dangerous abortion practices. FSWs face considerable barriers to the adoption of dual method contraceptive use, including low levels of control in their emotional and commercial relationships. Reproductive health services need to be incorporated into programs for sexually transmitted infections and HIV, which address the socially-determined barriers to contraceptive use. PMID:27689699
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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.
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Unintended Consequences of A-76 and Downsizing of the Military
2002-12-01
AIR WAR COLLEGE AIR UNIVERSITY UNINTENDED CONSEQUENCES OF A-76 AND DOWNSIZING OF THE MILITARY by Linda M. Thomas, Lt Col, USAF A Research...REPORT DATE DEC 2002 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Unintended Consequences of A-76 and Downsizing of the...of A-76. ...................................................................................15 UNINTENDED CONSEQUENCES
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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.
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Improving Evaluation to Address the Unintended Consequences of Health Information Technology:
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
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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…
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Rangachari, Pavani
2014-12-01
Despite the federal policy momentum towards "meaningful use" of Electronic Health Records, the healthcare organizational literature remains replete with reports of unintended adverse consequences of implementing Electronic Health Records, including: increased work for clinicians, unfavorable workflow changes, and unexpected changes in communication patterns & practices. In addition to being costly and unsafe, these unintended adverse consequences may pose a formidable barrier to "meaningful use" of Electronic Health Records. Correspondingly, it is essential for hospital administrators to understand and detect the causes of unintended adverse consequences, to ensure successful implementation of Electronic Health Records. The longstanding Technology-in-Practice framework emphasizes the role of human agency in enacting structures of technology use or "technologies-in-practice." Given a set of unintended adverse consequences from health information technology implementation, this framework could help trace them back to specific actions (types of technology-in-practice) and institutional conditions (social structures). On the other hand, the more recent Knowledge-in-Practice framework helps understand how information and communication technologies ( e.g. , social knowledge networking systems) could be implemented alongside existing technology systems, to create new social structures, generate new knowledge-in-practice, and transform technology-in-practice. Therefore, integrating the two literature streams could serve the dual purpose of understanding and overcoming unintended adverse consequences of Electronic Health Record implementation. This paper seeks to: (1) review the theoretical literatures on technology use & implementation, and identify a framework for understanding & overcoming unintended adverse consequences of implementing Electronic Health Records; (2) outline a broad project proposal to test the applicability of the framework in enabling "meaningful use" of Electronic Health Records in a healthcare context; and (3) identify strategies for successful implementation of Electronic Health Records in hospitals & health systems, based on the literature review and application.
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Unintended Consequences: New Problems, New Solutions Contributions From 2015
Chen, Y.
2016-01-01
Summary Objective To select the best of the 2015 published papers on unintended consequences of healthcare information technology (HIT). Method Literature searches in several areas of scholarship, including IT, human factors, evaluation studies, medical errors, medical informatics, and implementation science. Also, because the specific terms “unintended consequences” were not often included in abstracts and titles, a more nuanced search algorithm was developed. Results We identified 754 papers that had some empirical research on unintended consequences of HIT. An initial screen of titles and abstracts reduced this to 171 papers of potential interest. We then further filtered out papers that did not meet the following criteria: 1) the paper had to report an original empirical investigation, and 2) the impact reported had to be not negligible, i.e., in quantitative studies, the results related to unintended consequences were statistically significant; and in qualitative studies the relevant themes emerged were prominent. This resulted in 33 papers of which 15 were selected as best paper candidates. Each of these 15 papers was then separately evaluated by four reviewers. The final selection of four papers was made jointly by the external reviewers and the two section editors. Conclusions There is a growing awareness of the importance of HIT’s unintended consequences—be they generated by the HIT vendors, the implementation process, the consultants, the users, or most probably, some combination of the above. There has also been greater creativity in use of data sources, including secondary data (e.g., medical malpractice cases and surveys) and a wider acceptance of mixed methods to identify unintended consequences. Unfortunately, the complexity of causes mitigates the value of recommendations to avoid unwanted outcomes. Suggestions are often contentious rather than obvious, setting-specific, and not universally applicable. “Lessons learned” often take on generalized—and perhaps platitudinous—forms, such as: “plan extra time,” “involve all of the stakeholders,” “recognize the different needs of different units or disciplines.” The greater awareness of these problems, and the increased desire to identify and eliminate them is clearly reflected in the area’s growing literature. We are hopeful the topic will receive additional attention and the discipline will improve its ability to identify and address these unexpected and usually adverse outcomes. PMID:27830235
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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…
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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.
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Metric-driven harm: an exploration of unintended consequences of performance measurement.
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.
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British Military Mission (BMM) to Greece, 1942-44
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
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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.
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The Unintended Consequences of Health Information Technology Revisited.
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.
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Troubled Waters: Navigating Unintended Consequences of Health Information Technology.
Lehmann, C U; Séroussi, B; Jaulent, M-C
2016-11-10
To provide an introduction to the 2016 IMIA Yearbook of Medical Informatics by the editors. We present a brief overview of the 2016 special topic "Unintended consequences of Health IT: new problems, new solutions", we review our choice of special topic section editors, and discuss the transitions in the editorial team for next year. This edition of the Yearbook acknowledges the fact that implementation and use of Health Information Technology (HIT) may result in unintended consequences, which may lead to both adverse and sometimes beneficial outcomes. However to date, in the literature, undesired outcomes are emphasized with a focus on the complex causes and the many sources that may generate them. The growing awareness of the importance of HIT's unintended consequences and their increasing documentation reflect a wider acceptance of HIT by users (more use generating more consequences) and and a new type of users (a shift from early adopters to late adopters and laggards), whith great expectations regarding the improvement of care quality through HIT solutions. Different points of view on new problems and new solutions of unintended consequences of Health IT are presented through the keynote paper, survey papers, and the working group contributions. The regular 2016 issue of the IMIA yearbook focuses on new unintended consequences of Health IT - brought on by wider adoption and different types of users as well as solutions to addressing them.
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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.
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Unintended Consequences of Smoke-Free Bar Policies for Low-SES Women in Three California Counties
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
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Unintended consequences of smoke-free bar policies for low-SES women in three California counties.
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.
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The Unintended Consequences of Social Media in Healthcare: New Problems and New Solutions.
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.
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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
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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.
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Identifying unintended consequences of quality indicators: a qualitative study.
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.
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People, planet and profit: Unintended consequences of legacy building materials.
Zimmer, Anthony T; Ha, HakSoo
2017-12-15
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 examples where building materials were broadly deployed into society only to find that health and environmental problems resulted in unintended sustainability consequences. In the following paper, we use lead and asbestos as legacy building materials to show their similar historical trends and sustainability consequences. Our research findings show unintended consequences such as: increased remediation and litigation costs; adverse health effects; offshoring of related industries; and impediments to urban revitalization. As numerous new building materials enter today's market, another building material may have already been deployed, representing the next "asbestos." This paper also proposes an alternative methodology that can be applied in a cost-effective way into existing and upcoming building materials, to minimize and prevent potential unintended consequences and create a pathway for sustainable communities. For instance, our findings show that this proposed methodology could have prevented the unintended incurred sustainability costs of approximately $272-$359 billion by investing roughly $24 million in constant 2014 U.S. dollars on up-front research into lead and asbestos. Published by Elsevier Ltd.
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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,…
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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…
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ERIC Educational Resources Information Center
Tsai, Victoria; Khan, Nomana M.; Shi, Jianrong; Rainey, Jeanette; Gao, Hongjiang; Zheteyeva, Yenlik
2017-01-01
Background: School closure is one of the primary measures considered during severe influenza pandemics and other emergencies. However, prolonged school closures may cause unintended adverse consequences to schools, students, and their families. A better understanding of these consequences will inform prepandemic planning, and help public health…
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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...
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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.
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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/.
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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.
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The Unintended Consequences of Social Media in Healthcare: New Problems and New Solutions
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
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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.
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Unintended consequences: the social context of cancer survivors and work.
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.
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Unintended Consequences of Wearable Sensor Use in Healthcare
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
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Unintended pregnancy and unsafe abortion in the Philippines: context and consequences.
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.
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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,…
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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…
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Psychological Aspects of Contraception, Unintended Pregnancy, and Abortion.
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.
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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…
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Yu, Ping; Zhang, Yiting; Gong, Yang; Zhang, Jiajie
2013-09-01
The aim of this study was to investigate the unintended adverse consequences of introducing electronic health records (EHR) in residential aged care homes (RACHs) and to examine the causes of these unintended adverse consequences. A qualitative interview study was conducted in nine RACHs belonging to three organisations in the Australian Capital Territory (ACT), New South Wales (NSW) and Queensland, Australia. A longitudinal investigation after the implementation of the aged care EHR systems was conducted at two data points: January 2009 to December 2009 and December 2010 to February 2011. Semi-structured interviews were conducted with 110 care staff members identified through convenience sampling, representing all levels of care staff who worked in these facilities. Data analysis was guided by DeLone and McLean Information Systems Success Model, in reference with the previous studies of unintended consequences for the introduction of computerised provider order entry systems in hospitals. Eight categories of unintended adverse consequences emerged from 266 data items mentioned by the interviewees. In descending order of the number and percentage of staff mentioning them, they are: inability/difficulty in data entry and information retrieval, end user resistance to using the system, increased complexity of information management, end user concerns about access, increased documentation burden, the reduction of communication, lack of space to place enough computers in the work place and increasing difficulties in delivering care services. The unintended consequences were caused by the initial conditions, the nature of the EHR system and the way the system was implemented and used by nursing staff members. Although the benefits of the EHR systems were obvious, as found by our previous study, introducing EHR systems in RACH can also cause adverse consequences of EHR avoidance, difficulty in access, increased complexity in information management, increased documentation burden, reduction of communication and the risks of lacking care follow-up, which may cause negative effects on aged care services. Further research can focus on investigating how the unintended adverse consequences can be mitigated or eliminated by understanding more about nursing staff's work as well as the information flow in RACH. This will help to improve the design, introduction and management of EHR systems in this setting. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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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.
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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
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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…
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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…
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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…
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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…
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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...
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Unintended environmental consequences and co-benefits of economic restructuring.
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.
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Yao, Tingting; Lee, Anita H; Mao, Zhengzhong
2009-08-01
Smoke-free policies in public places have become more common in China. Little is known, however, about the potential unintended consequences of such policies on pregnant women. The study was conducted in 2006 in Chengdu, China. Nonsmoking pregnant women (N=55) whose husband were smokers participated in a study of their knowledge about secondhand smoke and smoke-free policies, their exposure to secondhand smoke, and their husbands' smoking status at home. This study presents descriptive statistics, analyses based on family income and pregnant women's education level, and the findings of focus group discussions that examined the potential unintended consequences of the smoke-free policies on pregnant women. Exposure to secondhand smoke at home was reported by 69.1% of the pregnant women. Both family income and the education level of the pregnant women had a significant (p<0.05) association with exposure to secondhand smoke. The four main potential unintended consequences of the smoke-free policies were: (1) increased exposure of pregnant women to secondhand smoke at home; (2) reduced work efficiency; (3) adverse effect on family harmony; and (4) poor air quality at home. Education is needed to increase knowledge of secondhand smoke among smokers and nonsmokers alike. When the smoking location is shifted from public places and workplaces to home, women, and in particular pregnant women, become the victims. Policymakers should recognize such potential unintended consequences and take necessary measures to increase awareness about the harms of secondhand smoke.
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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.
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Getting the lead out: understanding risks in the distribution ...
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.
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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.…
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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…
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ESTABLISHMENT OF TRANSGENIC CREEPING BENTGRASS (AGROSTIS STOLONIFERA L.) IN NON-AGRONOMIC HABITATS
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...
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Risk management and post-marketing surveillance of CNS drugs.
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.
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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…
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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…
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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…
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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…
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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
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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.
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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.
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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...
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Unintended pregnancy and abortion in Uganda.
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.
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Death and Desirability: Retrospective Reporting of Unintended Pregnancy after a Child’s Death
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
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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.
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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…
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What to consider when regulating electronic cigarettes: Pros, cons and unintended consequences.
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.
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Lessons learned from unintended consequences about erasing the stigma of mental illness.
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.
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Preventing Unintended Disclosure of Personally Identifiable Data Following Anonymisation.
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.
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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…
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The incidence of induced abortion in Kinshasa, Democratic Republic of Congo, 2016.
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.
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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…
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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.…
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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...
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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…
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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.
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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
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Freudenberg, Nicholas; Heller, Daliah
2016-01-01
In the past decade, many constituencies have questioned the efficacy, cost, and unintended consequences of mass incarceration in the United States. Although substantial evidence now demonstrates that US incarceration policies have had unintended adverse health consequences, we know less about the strategies and policies that can prevent or reduce these problems for justice-involved individuals and how the criminal justice system (CJS) can contribute to the Healthy People 2020 national goal of eliminating inequities in health. This review examines strategies that have been used to improve the health of people at various stages of CJS involvement, including diversion from jail and prison stays into community settings, improvements to the social and physical environments within correctional facilities, provision of health and other services to inmates, assistance for people leaving correctional facilities to make the transition back to the community, and systems coordination and integration.
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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.
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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…
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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…
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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…
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Lost in Translation: The Unintended Consequences of Advance Directive Law on Clinical Care
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
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Developmental Cognitive Neuroscience of Adolescent Sexual Risk and Alcohol Use
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
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The ethics of data collection: unintended consequences?
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.
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The ineffectiveness and unintended consequences of the public health war on obesity.
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.
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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
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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
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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…
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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...
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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...
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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.…
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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'…
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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.
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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.
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ERIC Educational Resources Information Center
Evans, Rhiannon; Scourfield, Jonathan; Murphy, Simon
2015-01-01
In the past twenty years there has been a proliferation of targeted school-based social and emotional learning (SEL) interventions. However, the lived experience of young peoples' participation is often elided, while the potential for interventions to confer unintended and even adverse effects remains under-theorised and empirically…
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The incidence of induced abortion in Kinshasa, Democratic Republic of Congo, 2016
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
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Robots and people with dementia: Unintended consequences and moral hazard.
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.
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Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization.
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.
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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…
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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…
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Unintended adverse consequences of a clinical decision support system: two cases.
Stone, Erin G
2018-05-01
Many institutions have implemented clinical decision support systems (CDSSs). While CDSS research papers have focused on benefits of these systems, there is a smaller body of literature showing that CDSSs may also produce unintended adverse consequences (UACs). Detailed here are 2 cases of UACs resulting from a CDSS. Both of these cases were related to external systems that fed data into the CDSS. In the first case, lack of knowledge of data categorization in an external pharmacy system produced a UAC; in the second case, the change of a clinical laboratory instrument produced the UAC. CDSSs rely on data from many external systems. These systems are dynamic and may have changes in hardware, software, vendors, or processes. Such changes can affect the accuracy of CDSSs. These cases point to the need for the CDSS team to be familiar with these external systems. This team (manager and alert builders) should include members in specific clinical specialties with deep knowledge of these external systems.
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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.
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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.
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Union women, the tobacco industry, and excise taxes: a lesson in unintended consequences.
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.
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Fracking: Unintended Consequences for Local Communities
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
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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.
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Menu labeling: the unintended consequences to the consumer.
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.
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Unintended consequences and trade-offs of fish passage
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.
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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…
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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…
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Tanning and teens: Is indoor exposure the tip of the iceberg?
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
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Missed pills: frequency, reasons, consequences and solutions.
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.
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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…
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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
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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.
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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.
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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
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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…
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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.…
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Manojlovich, Milisa; Lee, Soohee; Lauseng, Deborah
2016-12-01
This is a systematic review of the literature on unintended consequences of clinical interventions to reduce falls, catheter-related urinary tract infection, and vascular catheter-related infections in hospitalized patients. A systematic search of the literature was conducted in CINAHL and PubMed. We developed a screening tool and a two-stage screening process to identify relevant articles. Nine articles met inclusion criteria, and of those, 8 reported on interventions to reduce patient falls. Four studies reported a positive, unexpected benefit; 3 studies reported a negative, unexpected detriment; and 4 reported a perverse effect (different from what was expected). Three studies reported both positive and perverse effects arising from the intervention. In 4 of the studies, despite fall prevention interventions, patients fell while trying to get to the bathroom, suggesting that interventions to reduce one adverse outcome (i.e., CAUTI) may be associated with another outcome (i.e., patient falls). In some cases, there were positive outcomes for those who implemented and/or evaluated interventions. We encourage colleagues to collect and report data on possible unintended consequences of their interventions to allow a fuller picture of the relationship between intervention and all outcomes to emerge.
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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.
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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
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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.
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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.
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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.
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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
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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.
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Pharmaceutical reform in South Korea and the lessons it provides.
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.
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Tanning and Teens: Is Indoor Exposure the Tip of the Iceberg?
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.
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People, Planet and Profit: Unintended Consequences of Legacy Building Materials
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...
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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
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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.
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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.
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'Troubling' moments in health promotion: unpacking the ethics of empowerment.
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.
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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.
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Developing Games for Health Behavior Change: Getting Started
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
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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.
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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)
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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…
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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
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Are Hispanic Women Happier About Unintended Births?
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
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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.
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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.
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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.
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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…
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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.
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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.
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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…
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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.
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Unintended Consequences of Sensor, Signal, and Imaging Informatics: New Problems and New Solutions.
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.
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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.
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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.
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Partnership to Evaluate Alternatives to Bisphenol A in Thermal Paper
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
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Unintended Consequences of Tele Health and their Possible Solutions
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
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Effects of performance measure implementation on clinical manager and provider motivation.
Damschroder, Laura J; Robinson, Claire H; Francis, Joseph; Bentley, Douglas R; Krein, Sarah L; Rosland, Ann-Marie; Hofer, Timothy P; Kerr, Eve A
2014-12-01
Clinical performance measurement has been a key element of efforts to transform the Veterans Health Administration (VHA). However, there are a number of signs that current performance measurement systems used within and outside the VHA may be reaching the point of maximum benefit to care and in some settings, may be resulting in negative consequences to care, including overtreatment and diminished attention to patient needs and preferences. Our research group has been involved in a long-standing partnership with the office responsible for clinical performance measurement in the VHA to understand and develop potential strategies to mitigate the unintended consequences of measurement. Our aim was to understand how the implementation of diabetes performance measures (PMs) influences management actions and day-to-day clinical practice. This is a mixed methods study design based on quantitative administrative data to select study facilities and quantitative data from semi-structured interviews. Sixty-two network-level and facility-level executives, managers, front-line providers and staff participated in the study. Qualitative content analyses were guided by a team-based consensus approach using verbatim interview transcripts. A published interpretive motivation theory framework is used to describe potential contributions of local implementation strategies to unintended consequences of PMs. Implementation strategies used by management affect providers' response to PMs, which in turn potentially undermines provision of high-quality patient-centered care. These include: 1) feedback reports to providers that are dissociated from a realistic capability to address performance gaps; 2) evaluative criteria set by managers that are at odds with patient-centered care; and 3) pressure created by managers' narrow focus on gaps in PMs that is viewed as more punitive than motivating. Next steps include working with VHA leaders to develop and test implementation approaches to help ensure that the next generation of PMs motivate truly patient-centered care and are clinically meaningful.
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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)
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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
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Intended and unintended consequences of China's zero markup drug policy.
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.
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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.
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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.
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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.
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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…
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Harm Reduction Text Messages Delivered During Alcohol Drinking: Feasibility Study Protocol
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
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Unsafe abortion: a cruel way of birth control.
Shrivastava, Saurabh RamBihariLal; Shrivastava, Prateek Saurabh; Ramasamy, Jegadeesh
2014-06-01
Unsafe abortion refers to a procedure for terminating an unintended pregnancy performed either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. The objectives of the study are to assess the factors attributing to practice of unsafe abortion and to suggest feasible and cost-effective measures to counter the same. An extensive search of all materials related to the topic was made using library sources including Pubmed, Medline and World Health Organization. Keywords used in the search include unsafe abortion and unintended pregnancy. Multiple socio-demographic determinants and barriers such as illiterate women, poor socio-economic status, poor awareness about abortion services, associated stigma, and untrained health professionals have been identified resulting in restricted utilization/access of women to safe abortion services. Consequences of unsafe abortion have been alarming, seriously questioning the quality of health care delivery system. Concerted and dedicated efforts of government in collaboration with the private sector, community members and non-governmental organizations are needed to ensure that women have a better access to contraceptives, abortion services, and post-abortion care that are safe, affordable, and free from stigma.
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Hiensch, Robert; Poeran, Jashvant; Saunders-Hao, Patricia; Adams, Victoria; Powell, Charles A; Glasser, Allison; Mazumdar, Madhu; Patel, Gopi
2017-10-01
Although integrated, electronic sepsis screening and treatment protocols are thought to improve patient outcomes, less is known about their unintended consequences. We aimed to determine if the introduction of a sepsis initiative coincided with increases in broad-spectrum antibiotic use and health care facility-onset (HCFO) Clostridium difficile infection (CDI) rates. We used interrupted time series data from a large, tertiary, urban academic medical center including all adult inpatients on 4 medicine wards (June 2011-July 2014). The main exposure was implementation of the sepsis screening program; the main outcomes were the use of broad-spectrum antibiotics (including 3 that were part of an order set designed for the sepsis initiative) and HCFO CDI rates. Segmented regression analyses compared outcomes in 3 time segments: before (11 months), during (14 months), and after (12 months) implementation of a sepsis initiative. Antibiotic use and HFCO CDI rates increased during the period of implementation and the period after implementation compared with baseline; these increases were highest in the period after implementation (level change, 50.4 days of therapy per 1,000 patient days for overall antibiotic use and 10.8 HCFO CDIs per 10,000 patient days; P < .05). Remarkably, the main drivers of overall antibiotic use were not those included in the sepsis order set. The implementation of an electronic sepsis screening and treatment protocol coincided with increased broad-spectrum antibiotic use and HCFO CDIs. Because these protocols are increasingly used, further study of their unintended consequences is warranted. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
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Speaking out on safe sleep: evidence-based infant sleep recommendations.
Bartick, Melissa; Smith, Linda J
2014-11-01
The American Academy of Pediatrics (AAP) issued recommendations in 2005 and 2011 to reduce sleep-related infant death, which advise against all bedsharing for sleep. These recommendations overemphasize the risks of bedsharing, and this overemphasis has serious unintended consequences. It may result in increased deaths on sofas as tired parents try to avoid feeding their infants in bed. Current evidence shows that other risks are far more potent, such as smoking, shared sleep on sofas, sleeping next to impaired caregivers, and formula feeding. The emphasis on separate sleep is diverting resources away from addressing these critical risk factors. Recommendations to avoid bedsharing may also interfere with breastfeeding. We examine both the evidence behind the AAP recommendations and the evidence omitted from those recommendations. We conclude that the only evidence-based universal advice to date is that sofas are hazardous places for adults to sleep with infants; that exposure to smoke, both prenatal and postnatal, increases the risk of death; and that sleeping next to an impaired caregiver increases the risk of death. No sleep environment is completely safe. Public health efforts must address the reality that tired parents must feed their infants at night somewhere and that sofas are highly risky places for parents to fall asleep with their infants, especially if parents are smokers or under the influence of alcohol or drugs. All messaging must be crafted and reevaluated to avoid unintended negative consequences, including impact on breastfeeding rates, or falling asleep in more dangerous situations than parental beds. We must realign our resources to focus on the greater risk factors, and that may include greater investment in smoking cessation and doing away with aggressive formula marketing. This includes eliminating conflicts of interest between formula marketing companies and organizations dedicated to the health of children.
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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
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The Effect of Share 35 on Biliary Complications: an Interrupted Time Series Analysis.
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.
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Case histories in pharmaceutical risk management.
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).
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Masinter, Lisa M; Feinglass, Joe; Simon, Melissa A
2013-10-01
Both unintended and adolescent childbearing disproportionately impact the Hispanic population of the United States. We used the 2006-2010 National Survey of Family Growth (NSFG) to provide the most recent, nationally representative description of pregnancy, childbearing, and contraception for Hispanic females aged 15-44. We determined baseline fertility data for self-identified Hispanic female respondents. Among those reporting a pregnancy history, we calculated the proportion of pregnancies identified as unintended and their association with sociodemographic variables. We also assessed outcomes and estimates of relative risk for unintended pregnancy. Finally, we examined contraceptive use prior to self-reported unintended pregnancies. Approximately 70% of Hispanic women reported ever being pregnant, including 18% of teenagers. Over half (51%) of those pregnancies were unintended, including 81% among teenagers. The adjusted risk of unintended pregnancy was highest in women 15 to 19 years old and those with three or more pregnancies (incidence rate ratio [IRR] 1.64, 95% confidence interval [CI]: 1.44-1.88 and IRR 1.77, 95% CI: 1.53-2.06, respectively). Half of unintended pregnancies were preceded by no contraception. The most common reason for unintended pregnancy preceded by contraception was "improper use" (45%) and among pregnancies without use, the most common response (37%) was "I did not think I could get pregnant." There is a high frequency of unintended pregnancy and lack of contraceptive use among Hispanic women. These findings highlight the need for improved reproductive education and contraceptive counseling in this population.
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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...
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A Toxicological Perspective on Disinfection ByProducts
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...
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Anders, Shilo; Gadd, Cynthia S; Lorenzi, Nancy M
2012-01-01
Objective 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. Materials and methods 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. Results 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. Discussion 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.’ Conclusion 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. PMID:22634157
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Paice, Judith A
2018-06-15
Cancer pain remains a feared consequence of the disease and its treatment. Although prevalent, cancer pain can usually be managed through the skillful application of pharmacologic and nonpharmacologic interventions. Unfortunately, access to these therapies has been hampered by interventions designed to contain another serious public health problem: the opioid misuse epidemic. This epidemic and the unintended consequences of efforts to control this outbreak are leading to significant barriers to the provision of cancer pain relief. Oncologists and other professionals treating those with cancer pain will require new knowledge and tools to provide safe and effective pain control while preventing additional cases of substance use disorders (SUDs), helping patients in recovery to maintain sobriety, and guiding those not yet in recovery to seek treatment. How do these 2 serious epidemics intersect and affect oncology practice? First, oncology professionals will need to adopt practices to prevent SUDs by assessing risk and providing safe pain care. Second, oncology practices are likely to see an increased number of patients with a current or past SUD, including opioid misuse. Few guidelines exist for the direct management of pain when opioids may be indicated in these individuals. Third, modified prescribing practices along with the education of patients and families are warranted to prevent the exposure of these medications to unintended persons. Finally, advocacy on behalf of those with cancer pain is imperative to avoid losing access to essential therapies, including opioids, for those who might benefit. Cancer 2018;124:2491-7. © 2018 American Cancer Society. © 2018 American Cancer Society.
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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…
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Sometimes You Do Get a Second Chance: Emergency Contraception for Adolescents.
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.
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Shahian, David M; Jacobs, Jeffrey P; Badhwar, Vinay; D'Agostino, Richard S; Bavaria, Joseph E; Prager, Richard L
2017-12-01
Risk aversion is a potential unintended consequence of health care public reporting. In Part 1 of this review, four possible consequences of this phenomenon are discussed, including the denial of interventions to some high-risk patients, stifling of innovation, appropriate avoidance of futile interventions, and better matching of high-risk patients to more capable providers. We also summarize relevant observational clinical reports and survey results from cardiovascular medicine and surgery, the two specialties from which almost all risk aversion observations have been derived. Although these demonstrate that risk aversion does occur, the empirical data are much more consistent and compelling for interventional cardiology than for cardiac surgery. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Korlén, Sara; Amer-Wåhlin, Isis; Lindgren, Peter; von Thiele Schwarz, Ulrica
2017-08-01
Implementation of market-inspired competition and incentive models in health care is increasing worldwide, assumed to drive efficiency. However, the evidence for effects is mixed and unintended consequences have been reported. There is a need to better understand the practical consequences of such reforms. The aim of the present case study is to explore what consequences of a Swedish market-inspired patient choice reform professionals identify as relevant, and why. The study was designed as an explorative qualitative study in specialized orthopedics. Nineteen interviews were conducted with health care professionals at different providers. Data were analyzed using a hypo-deductive thematic approach. Consequences for the organization of care, patients, work environment, education and research were included in the professionals' analyses, covering both the perspective of their own organization and that of the health care system as a whole. In sum, the professionals provided multiple-level analyses that extended beyond the responsibilities of their own organization. Concluding, professionals are a valuable source of knowledge when evaluating policy reforms. Their analyses can contribute by covering a broad system perspective, serving as a guiding light to areas beyond the most obvious evaluation measures that should be included in more formal evaluations.
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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…
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CSR Cuts Bring Unintended Consequences, Prompt State Responses.
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.
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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…
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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)
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ALTERED GENE EXPRESSION OF MOUSE EMBRYO CULTURES EXPOSED TO BROMOCHLOROACETIC ACID
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 ...
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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…
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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.
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Unintended consequences of human research ethics committees: au revoir workplace studies?
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.
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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
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Feinglass, Joe; Simon, Melissa A.
2013-01-01
Abstract Background Both unintended and adolescent childbearing disproportionately impact the Hispanic population of the United States. Methods We used the 2006–2010 National Survey of Family Growth (NSFG) to provide the most recent, nationally representative description of pregnancy, childbearing, and contraception for Hispanic females aged 15–44. We determined baseline fertility data for self-identified Hispanic female respondents. Among those reporting a pregnancy history, we calculated the proportion of pregnancies identified as unintended and their association with sociodemographic variables. We also assessed outcomes and estimates of relative risk for unintended pregnancy. Finally, we examined contraceptive use prior to self-reported unintended pregnancies. Results Approximately 70% of Hispanic women reported ever being pregnant, including 18% of teenagers. Over half (51%) of those pregnancies were unintended, including 81% among teenagers. The adjusted risk of unintended pregnancy was highest in women 15 to 19 years old and those with three or more pregnancies (incidence rate ratio [IRR] 1.64, 95% confidence interval [CI]: 1.44–1.88 and IRR 1.77, 95% CI: 1.53–2.06, respectively). Half of unintended pregnancies were preceded by no contraception. The most common reason for unintended pregnancy preceded by contraception was “improper use” (45%) and among pregnancies without use, the most common response (37%) was “I did not think I could get pregnant.” Conclusions There is a high frequency of unintended pregnancy and lack of contraceptive use among Hispanic women. These findings highlight the need for improved reproductive education and contraceptive counseling in this population. PMID:24004031
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The Incidence of Abortion in Nigeria
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
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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.
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Contraception and mental health: a commentary on the evidence and principles for practice.
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.
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Mohindra, K S; Haddad, Slim
2008-01-01
Public health researchers are increasingly shifting their attention away from merely documenting those factors that determine health--a solid evidence base on health determinants now exists--to improving our understanding of how various interventions influence population health. This paper argues for greater investigations of the potential unintended health benefits associated with participation in a poverty alleviation strategy (PAS) in low-income countries. We focus on microcredit, a PAS that has been spreading across the developing world. Microcredit aims to address the "credit gap" between the poor and the better off by offering an alternative for the poor to acquire loans: small groups are formed and loans are allocated to members based on group solidarity instead of formal collateral. We argue that microcredit corresponds with activities that will help build up health capital (e.g., greater access to resources) and describe the main pathways from microcredit participation to health. We advocate that microcredit and other potential pro-health PAS be included among the range of interventions considered by public health researchers in improving the health of the poor.
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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...
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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…
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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…
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Planning for compliance: OSHA's bloodborne pathogen rule.
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.
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Disparities in long-term care: building equity into market-based reforms.
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.
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Use of psychology and behavioral economics to promote healthy eating.
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.
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McGowan, James G
2013-09-01
Unintended pregnancy is a global sexual health problem. Outcomes of unintended pregnancy include unwanted childbirth and abortion, which may be associated with negative physical and psychosocial health implications for women. In Scotland, the Scottish Sexual Health Strategy has the stated goal of improving the sexual health of the people of Scotland. One aim of the Strategy is to reduce rates of unintended pregnancy and one policy designed to achieve this is 'widening access to emergency contraception'. This paper examines the success of this policy with reference to the implicit link it makes between expanding access to emergency contraception and increasing its effective use, aiming thereby to reduce rates of unintended pregnancy. Since there is evidence that previous policies and strategies expanding access to emergency contraception have failed to reduce such rates, alternative approaches to achieve a reduction in unintended pregnancies are discussed.
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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…
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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…
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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...
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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…
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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…
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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…
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The Integrated Disinfection By-Product Mixtures Project (“4-Lab Study”): An Overview
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...
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,
2007-01-01
The U.S. Geological Survey (USGS) enhances and protects the quality of life in the United States by advancing scientific knowledge to facilitate effective management of hydrologic, biologic, and geologic resources. Results of selected USGS research and monitoring projects in agricultural landscapes are presented in this Fact Sheet. Significant environmental and social issues associated with agricultural production include changes in the hydrologic cycle; introduction of toxic chemicals, nutrients, and pathogens; reduction and alteration of wildlife habitats; and invasive species. Understanding environmental consequences of agricultural production is critical to minimize unintended environmental consequences. The preservation and enhancement of our natural resources can be achieved by measuring the success of improved management practices and by adjusting conservation policies as needed to ensure long-term protection.
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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.
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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.
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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.
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Understanding Unintended Consequences and Health Information Technology:
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
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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…
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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…
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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…
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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…
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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 âgreeningâ 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...
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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...
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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…
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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…
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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…
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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…
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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…
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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…
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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…
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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…
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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...
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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…
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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…
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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…
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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.…
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Racial/Ethnic Differences in Unintended Pregnancy: Evidence From a National Sample of U.S. Women.
Kim, Theresa Y; Dagher, Rada K; Chen, Jie
2016-04-01
Racial and ethnic minorities experience greater burden of unintended pregnancy in the U.S. This study examined the factors associated with racial and ethnic disparities in unintended pregnancy among women in the U.S. using the social ecological model. This study utilized the National Survey of Family Growth data from 2006 to 2010. Data were analyzed in Autumn 2014 and Winter 2015. Decomposition analyses examined which intrapersonal, interpersonal, institutional, community, and public policy factors explained racial and ethnic disparities in unintended pregnancy. Unadjusted analyses found that black and Hispanic women had a greater likelihood of unintended pregnancy compared with white women. Decomposition models explained 51% of the disparity in unintended pregnancy between black and white women and 73% of that between Hispanic and white women. Factors contributing to the disparity between black and white women included age, relationship status, respondent's mother's age at first birth, Federal Poverty Level, and insurance status. Between Hispanic and white women, these factors included age, U.S.-born status, education, and relationship status. Given that the results showed factors at different levels of the social ecological model contribute to racial and ethnic disparities in unintended pregnancy, interventions that aim to reduce these disparities should target at-risk groups of women such as younger, unmarried, lower-income, less-educated, non-U.S. born women and uninsured or publicly insured women. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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Cha, Susan; Masho, Saba W; Heh, Victor
2017-04-01
Intimate partner violence (IPV) is a pervasive public health problem in the U.S., affecting nearly one in every three women over their lifetimes. Using structural equation modeling, we evaluated the association between IPV and unintended pregnancy, mediated by condom use and perceived spousal/partner support among Latina and Asian women. Data came from the 2002-2003 National Latino and Asian American Study (NLAAS). The analysis was restricted to married or cohabiting female respondents aged 18+ years (n = 1,595). Dependent variables included unintended pregnancy, condom use, and perceived partner support. Independent variables included physical abuse or threats by current partner and primary decision-maker. Weighted least squares was used to fit path models to data comprising dichotomous and ordinal variables. More than 13% of women reported IPV during their relationship with their partner/spouse. Abused women were twice as likely as non-abused women to have had an unintended pregnancy. This association was partially mediated by perceived partner support. Condom use had a positive, but non-significant association with unintended pregnancy, and IPV had a negative, but non-significant association with condom use. Results highlight the importance of IPV screening for minority women. Efforts to combine family planning and violence prevention services may help reduce unintended pregnancy.
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Pérennes, Maud; Carde, Axel; Nicolas, Xavier; Dolz, Manuel; Bihannic, René; Grimont, Pauline; Chapot, Thierry; Granier, Hervé
2012-03-01
An inaccurate medication history may prevent the discovery of a pre-admission iatrogenic event or lead to interrupted drug therapy during hospitalization. Medication reconciliation is a process that ensures the transfer of medication information at admission to the hospital. The aims of this prospective study were to evaluate the interest in clinical practice of this concept and the resources needed for its implementation. We chose to include patients aged 65 years or over admitted in the internal medicine unit between June and October 2010. We obtained an accurate list of each patient's home medications. This list was then compared with medication orders. All medication variances were classified as intended or unintended. An internist and a pharmacist classified the clinical importance of each unintended variance. Sixty-one patients (mean age: 78 ± 7.4 years) were included in our study. We identified 38 unintended discrepancies. The average number of unintended discrepancies was 0.62 per patient. Twenty-five patients (41%) had one or more unintended discrepancies at admission. The contact with the community pharmacist permitted us to identify 21 (55%) unintended discrepancies. The most common errors were the omission of a regularly used medication (76%) and an incorrect dosage (16%). Our intervention resulted in order changes by the physician for 30 (79%) unintended discrepancies. Fifty percent of the unintended variances were judged by the internist and 76% by the pharmacist to be clinically significant. The admission to the hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories. Copyright © 2011 Elsevier Masson SAS. All rights reserved.
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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.
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Dermish, Amna I; Turok, David K
2013-07-01
Worldwide, 40% of all pregnancies are unintended. Widespread, over-the-counter availability of oral emergency contraception (EC) has not reduced unintended pregnancy rates. The EC visit presents an opportunity to initiate a highly effective method of contraception in a population at high risk of unintended pregnancy who are actively seeking to avoid pregnancy. The copper intrauterine device (IUD), the most effective method of EC, continues to provide contraception as effective as sterilization for up to 12 years, and it should be offered as the first-line method of EC wherever possible. Increased demand for and supply of the copper IUD for EC may have an important role in reducing rates of unintended pregnancy. The EC visit should include access to the copper IUD as optimal care but should ideally include access to all highly effective methods of contraception.
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Postpartum depression among women with unintended pregnancy
Brito, Cynthia Nunes de Oliveira; Alves, Sandra Valongueiro; Ludermir, Ana Bernarda; de Araújo, Thália Velho Barreto
2015-01-01
OBJECTIVE To analyze the association between unintended pregnancy and postpartum depression. METHODS This is a prospective cohort study conducted with 1,121 pregnant aged 18 to 49 years, who attended the prenatal program devised by the Brazilian Family Health Strategy, Recife, PE, Northeastern Brazil, between July 2005 and December 2006. We interviewed 1,121 women during pregnancy and 1,057 after childbirth. Unintended pregnancy was evaluated during the first interview and postpartum depression symptoms were assessed using the Edinburgh Postnatal Depression Screening Scale. The crude and adjusted odds ratios for the studied association were estimated using logistic regression analysis. RESULTS The frequency for unintended pregnancy was 60.2%; 25.9% presented postpartum depression symptoms. Those who had unintended pregnancies had a higher likelihood of presenting this symptoms, even after adjusting for confounding variables (OR = 1.48; 95%CI 1.09;2.01). When the Self Reporting Questionnaire (SRQ-20) variable was included, the association decreased, however, remained statistically significant (OR = 1.42; 95%CI 1.03;1.97). CONCLUSIONS Unintended pregnancy showed association with subsequent postpartum depressive symptoms. This suggests that high values in Edinburgh Postnatal Depression Screening Scale may result from unintended pregnancy. PMID:26083941
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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…
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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…
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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…
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78 FR 23872 - HIPAA Privacy Rule and the National Instant Criminal Background Check System (NICS)
Federal Register 2010, 2011, 2012, 2013, 2014
2013-04-23
... any unintended adverse consequences for individuals seeking needed mental health services that may be... Check System (NICS) to help enforce these prohibitions.\\4\\ The NICS Index, a database administered by... to the NICS. Such an amendment might produce clarity regarding the Privacy Rule and help make it as...
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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…
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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...
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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…
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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...
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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…
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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...
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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…
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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...
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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…
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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…
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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…
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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.…
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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…
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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…
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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…
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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...
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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…
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OPTIMIZATION OF A PULSED LIMESTONE BED REACTOR AT THE ARGO TUNNEL IN IDAHO SPRINGS, COLORADO
Acid Mine Drainage (AMD) is an unintended consequence of coal and metal mining that adversely affects thousands of miles of streams both in the eastern and western regions of the U.S. A novel AMD treatment process based on limestone based on limestone neutralization has been dev...
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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…
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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...
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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…
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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…
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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…
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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...
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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...
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Unintended Consequences: Potential Downsides of the Air Force’s Conversion to Biofuels
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
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Attending unintended transformations of health care infrastructure
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
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Using systems thinking in patient safety: a case study on medicines management.
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.
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Does a History of Unintended Pregnancy Lessen the Likelihood of Desire for Sterilization Reversal?
Grady, Cynthia D.; Schwarz, Eleanor Bimla; Emeremni, Chetachi A.; Yabes, Jonathan; Akers, Aletha; Zite, Nikki
2013-01-01
Abstract Background Unintended pregnancy has been significantly associated with subsequent female sterilization. Whether women who are sterilized after experiencing an unintended pregnancy are less likely to express desire for sterilization reversal is unknown. Methods This study used national, cross-sectional data collected by the 2006–2010 National Survey of Family Growth. The study sample included women ages 15–44 who were surgically sterile from a tubal sterilization at the time of interview. Multivariable logistic regression was used to examine the relationship between a history of unintended pregnancy and desire for sterilization reversal while controlling for potential confounders. Results In this nationally representative sample of 1,418 women who were sterile from a tubal sterilization, 78% had a history of at least one unintended pregnancy and 28% expressed a desire to have their sterilization reversed. In unadjusted analysis, having a prior unintended pregnancy was associated with higher odds of expressing desire for sterilization reversal (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.15–2.79). In adjusted analysis controlling for sociodemographic factors, unintended pregnancy was no longer significantly associated with desire for reversal (OR: 1.46; 95% CI: 0.91–2.34). Conclusion Among women who had undergone tubal sterilization, a prior history of unintended pregnancy did not decrease desire for sterilization reversal. PMID:23621776
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Experiences of unmarried young abortion-seekers in Bihar and Jharkhand, India.
Kalyanwala, Shveta; Jejeebhoy, Shireen J; Zavier, A J Francis; Kumar, Rajesh
2012-01-01
While several studies have documented the prevalence of unprotected pre-marital sex among young people in India, little work has explored one of its likely consequences, unintended pregnancy and abortion. This paper examines the experiences of 26 unmarried young abortion-seekers (aged 15-24) interviewed in depth as part of a larger study of unmarried abortion-seekers at clinics run by an NGO in Bihar and Jharkhand. Findings reveal that recognition of the unintended pregnancy was delayed for many and many who suspected so further delayed acknowledging it. Once recognised, most confided in the partner and, for the most part, partners were supportive; a significant minority, including those who had experienced forced sex, did not have partner support and delayed the abortion until the second trimester of pregnancy. Family support was absent in most cases; where provided, it was largely to protect the family reputation. Finally, unsuccessful attempts to terminate the pregnancy were made by several young women, often with the help of partners or family member. Findings call for programmes for young women and men, their potential partners, parents and families and the health system that will collectively enable unmarried young women to obtain safe abortions in a supportive environment.
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Matsuda, Yui; Masho, Saba; McGrath, Jacqueline M
2012-01-01
The purpose of this study is to examine the relationship between the number of unintended pregnancies and current contraceptive use. This is a secondary analysis of a cross-sectional survey, the 2006-2008 National Survey of Family Growth, which included 4,052 women between the ages of 15 and 44 years. A statistically significant association was found between the nonuse of contraceptives and repeated unintended pregnancies, as well as among those who used an effective contraceptive method and repeated unintended pregnancies. Nurses are encouraged to ask questions about intendedness of pregnancies during women's visits and help women choose appropriate contraceptive methods.
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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
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Union Women, the Tobacco Industry, and Excise Taxes
Balbach, Edith D.; Campbell, Richard B.
2009-01-01
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. PMID:19591750
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Eckel, Robert H; Borra, Susan; Lichtenstein, Alice H; Yin-Piazza, Shirley Y
2007-04-24
A 2-day forum was convened to discuss the current status and future implications of reducing trans fatty acids without increasing saturated fats in the food supply while maintaining functionality and consumer acceptance of packaged, processed, and prepared foods. Attendees represented the agriculture and oilseed industry and oil processing, food manufacturing, food service, government, food technology, and health and nutrition disciplines. Presentations included food science behind fatty acid technology, the health science of dietary fatty acids, alternatives to trans fatty acids, and the use of alternatives in food manufacturing and food service. The reduction of trans fatty acids in the food supply is a complex issue involving interdependent and interrelated stakeholders. Actions to reduce trans fatty acids need to carefully consider both intended and unintended consequences related to nutrition and public health. The unintended consequence of greatest concern is that fats and oils high in saturated fats, instead of the healthier unsaturated fats, might be used to replace fats and oils with trans fatty acids. Many different options of alternative oils and fats to replace trans fatty acids are available or in development. Decisions on the use of these alternatives need to consider availability, health effects, research and development investments, reformulated food quality and taste, supply-chain management, operational modifications, consumer acceptance, and cost. The conference demonstrated the value of collaboration between the food industry and health and nutrition professionals, and this conference model should be used to address other food development, processing, and/or technology issues.
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Turner, P; Kushniruk, A; Nohr, C
2017-08-01
Objective: To review the developments in human factors (HF) research on the challenges of health information technology (HIT) implementation and impact given the continuing incidence of usability problems and unintended consequences from HIT development and use. Methods: A search of PubMed/Medline and Web of Science® identified HF research published in 2015 and 2016. Electronic health records (EHRs) and patient-centred HIT emerged as significant foci of recent HF research. The authors selected prominent papers highlighting ongoing HF and usability challenges in these areas. This selective rather than systematic review of recent HF research highlights these key challenges and reflects on their implications on the future impact of HF research on HIT. Results: Research provides evidence of continued poor design, implementation, and usability of HIT, as well as technology-induced errors and unintended consequences. The paper highlights support for: (i) strengthening the evidence base on the benefits of HF approaches; (ii) improving knowledge translation in the implementation of HF approaches during HIT design, implementation, and evaluation; (iii) increasing transparency, governance, and enforcement of HF best practices at all stages of the HIT system development life cycle. Discussion and Conclusion: HF and usability approaches are yet to become embedded as integral components of HIT development, implementation, and impact assessment. As HIT becomes ever-more pervasive including with patients as end-users, there is a need to expand our conceptualisation of the problems to be addressed and the suite of tactics and strategies to be used to calibrate our pro-active involvement in its improvement. Georg Thieme Verlag KG Stuttgart.
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Technology and the hydra of terrorism?
DOE Office of Scientific and Technical Information (OSTI.GOV)
LePoire, D. J.; Glenn, J. C.; Environmental Assessment
2007-02-01
In the application of new technologies that address the terrorism problem, an objective is to ensure that the technology does not cause more problems than it solves. Potential new technologies, including convergences of genomics, robotics, information technology, and nanotechnology, might rapidly develop. As with any technological advance, each of these offers a mixture of benefits and risks. At first, a direct approach is reviewed by looking at how these technologies might deter the motive, means, and opportunity for terrorist activities. While there are many potential deterrence applications, other issues are identified that might cause unintended problems in the system. Somemore » of these problems include the possible contribution to terrorist motives by increasing stresses toward divisiveness in society, terrorist means through the development of dual-use technologies, or terrorist opportunities by further developing technological vulnerabilities. Next, a more systemic approach is taken by reviewing a wider range of issues, such as resource availability, management of science and technology, and general societal trends. The balance between technological change and social response is important in realizing benefits while mitigating unintended consequences such as harmful uses through terrorist actions. To explore issues concerning this balance, possible technological development scenarios are reviewed, including the possibility of accelerating or slowing technological development. Some recent recommendations are considered within this context. The need for a balance between technological and social response in this asymmetric situation suggests that the benefits of a rapid technological response against terrorism might not be as large as those observed during World War II.« less
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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
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(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,…
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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…
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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…
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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…
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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…
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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…
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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.…
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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)…
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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…
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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…
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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…
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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…
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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…
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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…
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Sustainable forestry in the balance
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...
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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…
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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…
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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…
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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…
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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…
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Long-term performance of minimum-input oak restoration plantings
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...
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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…
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Harvest intensity and competition control impacts on loblolly pine fusiform rust incidence
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...
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Controlling flooding and water pollution with upland and streamside vegetation systems
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...
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Unintended consequences of machine learning in medicine?
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.
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Patient-physician relationships in the information age.
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.
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Logic Model Checking of Unintended Acceleration Claims in Toyota Vehicles
NASA Technical Reports Server (NTRS)
Gamble, Ed
2012-01-01
Part of the US Department of Transportation investigation of Toyota sudden unintended acceleration (SUA) involved analysis of the throttle control software, JPL Laboratory for Reliable Software applied several techniques including static analysis and logic model checking, to the software; A handful of logic models were build, Some weaknesses were identified; however, no cause for SUA was found; The full NASA report includes numerous other analyses
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Wall, Kristin M; Haddad, Lisa; Vwalika, Bellington; Htee Khu, Naw; Brill, Ilene; Kilembe, William; Stephenson, Rob; Chomba, Elwyn; Vwalika, Cheswa; Tichacek, Amanda; Allen, Susan
2013-01-01
We describe rates of unintended pregnancy among HIV positive couples in Lusaka, Zambia. We also identify factors associated with unintended pregnancy among oral contraceptive pill (OCP) using couples in this cohort. Data were analyzed from couples randomized in a factorial design to two family planning intervention videos. Rates of unintended pregnancy were stratified by contraceptive method used at time of pregnancy. Predictors of time to unintended pregnancy among OCP users were determined via multivariate Cox modeling. The highest rates of unintended pregnancy were observed among couples requesting condoms only (26.4/100CY) or OCPs (20.7/100CY); these rates were not significantly different. OCP users accounted for 37% of the couple-years (CY) observed and 87% of unintended pregnancies. Rates of unintended pregnancy for injectable (0.7/100CY) and intrauterine device (1.6/100CY) users were significantly lower relative to condom only users. No pregnancies occurred among contraceptive implant users or after tubal ligation. Factors associated (p<0.05) with time to unintended pregnancy among OCP users in multivariate analysis included the man wanting more children, the woman being HIV negative versus having stage IV HIV disease, and the woman reporting: younger age, no previous OCP use, missed OCPs, or sex without a condom. Long-acting reversible contraceptive methods were effective in the context of integrated couples HIV prevention and contraceptive services. Injectable methods were also effective in this context. Given the high user failure rate of OCPs, family planning efforts should promote longer-acting methods among OCP users wishing to avoid pregnancy. Where other methods are not available or acceptable, OCP adherence counseling is needed, especially among younger and new OCP users. ClinicalTrials.gov NCT00067522.
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He, Huan; Blum, Robert W
2013-11-01
This study was conducted to determine the prevalence and the associated factors for unintended pregnancy among never-married sexually active youth (15-24 years old) in Shanghai. Using a probability sample (n = 765, including 502 males and 263 females) from 2006, we estimated prevalence of unintended pregnancy involvement for females and males by demographic factors and its associations with contextual and behavioural factors, guided by a social-ecological framework. Weighted proportion analyses estimated that 13.8% of females and 17.7% of males had been involved in an unintended pregnancy, and 99.0% and 90.5% of such pregnancies were reported to have ended in abortion by females and males, respectively. Controlling for sexual behaviour factors and residence history, multivariate hazard analyses with Weibull functions found increased hazard among older female youth (19-21 vs. 15-18 years old) but decreased hazard among older male youth (15-18 vs. 19-21/22-24 years old) as compared with the younger groups. Parallel analyses of unintended pregnancy's associations with contextual factors by sex also suggested that female unintended pregnancy involvement was more likely to be associated with family factors (family living arrangements and maternal education), while unintended pregnancy involvement among males was only associated with school factors (school climate and sex education on pregnancy) and perceived neighbourhood contraceptive services access. Sexually active and never-married youth are at considerable risk of unintended pregnancy and abortion in Shanghai. Age- and sex-specific strategies will be needed if China is going to be successful in addressing unintended pregnancy. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
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Hartnett, Caroline Sten; Lindley, Lisa L; Walsemann, Katrina M
To date, no studies have investigated whether sexual minority women (SMW) are more likely to experience unintended pregnancies compared with their heterosexual peers. The aim of this study was to explore whether adult SMW were more likely to have unintended pregnancies compared with heterosexual women, to examine the role of identity-attraction congruence in unintended pregnancy risk, and to evaluate possible mediators. Data on pregnancies to women ages 18 to 44 were drawn from the 2006 through 2013 National Survey of Family Growth (n = 25,403). Weighted logistic regression models estimated the likelihood of reporting an unintended (rather than intended) pregnancy by identity-attraction congruence and the extent to which this association was mediated by sexual experiences with men, including age at first sex and number of sexual partners. Supplementary analyses addressed the issue of abortion underreporting. Pregnancies to SMW were more likely to be unintended compared with pregnancies to heterosexual women (adjusted odds ratio, 1.26; 95% confidence interval, 1.08-1.46). This was driven by the elevated risk experienced by heterosexual-identified women with same-sex attractions, specifically (adjusted odds ratio, 1.28; 95% confidence interval, 1.08-1.51). Greater unintended pregnancy risk among these women was mediated by a greater number of male sex partners compared with heterosexual women. Unintended pregnancy risk among SMW has historically received little attention from scholars and clinicians. Future research should explore the specific conditions that put heterosexual-identified women with same sex attractions at increased risk for unintended pregnancy. Clinicians should consider these dynamics when screening patients for contraceptive counseling. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
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Lakha, Fatim; Glasier, Anna
2006-11-18
Unintended pregnancy is common. Although many unintended pregnancies end in induced abortion, up to a third of those proceeding to birth might be unplanned. Some of these pregnancies could be prevented by emergency contraception. We have sought to establish how many pregnancies ending in either childbirth or abortion are unintended, and what proportion of women use emergency contraception to try to prevent pregnancy. 2908 women who attended an Edinburgh hospital for antenatal care and 907 attending for abortion fully completed a self-administered questionnaire including a validated measure of pregnancy intention and questions about emergency contraceptive use. 814 (89.7%) of 907 pregnancies among women requesting abortion were unintended compared with only 250 (8.6%) among 2908 women who planned to continue pregnancy. However, only 1909 (65.6%) of continuing pregnancies were intended. The rest of the women were ambivalent about pregnancy intention. In women who continued with their pregnancies intendedness was related to age, with unintended pregnancy most probable in young women (p<0.0001). Emergency contraception was used by 113 (11.8%) of women who requested abortion but only 40 (1%) of those planning to continue pregnancy. In those whose pregnancy was continuing, the proportions reporting use of emergency contraception were higher in young women than in older women and in those who reported that their pregnancies were unintended than in those who meant to become pregnant (both p<0.0001). Unintended pregnancy is common, even among women planning to continue pregnancy. However, EC use is low even among women with no intention of conceiving, and is thus unlikely to reduce unintended pregnancy rates. Rather, we need to find ways to improve the use of regular contraception.
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DNA patenting: implications for public health research.
Dutfield, Graham
2006-01-01
I weigh the arguments for and against the patenting of functional DNA sequences including genes, and find the objections to be compelling. Is an outright ban on DNA patenting the right policy response? Not necessarily. Governments may wish to consider options ranging from patent law reforms to the creation of new rights. There are alternative ways to protect DNA sequences that industry may choose if DNA patenting is restricted or banned. Some of these alternatives may be more harmful than patents. Such unintended consequences of patent bans mean that we should think hard before concluding that prohibition is the only response to legitimate concerns about the appropriateness of patents in the field of human genomics. PMID:16710549
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Wasser, Tobias D; Fox, Patrick K
2013-01-01
The Silver Alert system was initially created to help protect missing persons who have cognitive impairments, particularly the elderly. The Silver Alert is modeled after the Amber Alert, created to help locate and safeguard missing children. Unlike the Amber Alert, however, in most states the Silver Alert applies to the elderly, adults with a mental impairment, or both, depending on the state. The goal of the Silver Alert system is the quick dissemination of information about missing persons to law enforcement personnel as well as to the general public. Previously, states notified law enforcement personnel of missing persons through teletype to other public safety jurisdictions to enlist their assistance in the retrieval of the missing person. Silver Alert programs substantially expand the notification to include the general public, who receive information through radio and television broadcasts as well as highway billboards. The programs serve a legitimate governmental interest by protecting a vulnerable population from possible harm. Yet, the implementation of these alerts can have unintended consequences, including the possible violation of an individual's right to privacy. Such consequences require careful consideration.
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Rottenstreich, Misgav; Grisaru-Granovsky, Sorina; Rottenstreich, Amihai
2018-06-01
Performance of urine pregnancy test in general adolescents' clinic reflects caregiver or woman's concern that there might be a pregnancy. We aimed to assess whether young-unmarried women in whom a negative urine pregnancy test was registered would be at increased risk of a future unintended pregnancy. The study cohort included consecutive women drafted by the Israeli military between 2013 and 2015. The risk of unintended pregnancy was compared between women with a negative urine pregnancy test (n = 2774), the study group, and those in whom urine pregnancy test was not carried out (n = 126,659), the control group. During the study period, 2147 (1.7%) women experienced an unintended pregnancy. The risk of unintended pregnancy was significantly higher in patients in whom a past pregnancy test was negative 4.3% (n = 118), as compared with the control group 1.6% (n = 2028) (odds ratio [OR], 2.7; 95% confidence interval [CI], 2.23-3.26). In multivariate analysis history of a negative pregnancy test results was an independent predictor for a future unintended pregnancy (adjusted OR, 2.0; 95% CI, 1.63-2.52). A history of a negative pregnancy test among young conscripted women is a significant risk indicator for a future unintended pregnancy. Directed efforts should be made in this particular vulnerable group of patients.
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NASA Astrophysics Data System (ADS)
Park, Jisun; Song, Jinwoong; Abrahams, Ian
2016-03-01
This study explored, from the perspective of intellectual passion developed by Michael Polanyi, the unintended learning that occurred in primary practical science lessons. We use the term `unintended' learning to distinguish it from `intended' learning that appears in teachers' learning objectives. Data were collected using video and audio recordings of a sample of twenty-four whole class practical science lessons, taught by five teachers, in Korean primary schools with 10- to 12-year-old students. In addition, video and audio recordings were made for each small group of students working together in order to capture their activities and intra-group discourse. Pre-lesson interviews with the teachers were undertaken and audio-recorded to ascertain their intended learning objectives. Selected key vignettes, including unintended learning, were analysed from the perspective of intellectual passion developed by Polanyi. What we found in this study is that unintended learning could occur when students got interested in something in the first place and could maintain their interest. In addition, students could get conceptual knowledge when they tried to connect their experience to their related prior knowledge. It was also found that the processes of intended learning and of unintended learning were different. Intended learning was characterized by having been planned by the teacher who then sought to generate students' interest in it. In contrast, unintended learning originated from students' spontaneous interest and curiosity as a result of unplanned opportunities. Whilst teachers' persuasive passion comes first in the process of intended learning, students' heuristic passion comes first in the process of unintended learning. Based on these findings, we argue that teachers need to be more aware that unintended learning, on the part of individual students, can occur during their lesson and to be able to better use this opportunity so that this unintended learning can be shared by the whole class. Furthermore, we argue that teachers' deliberate action and a more interactive classroom culture are necessary in order to allow students to develop, in addition to heuristic passion, persuasive passion towards their unintended learning.
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Ng, Stella L.; Lingard, Lorelei; Hibbert, Kathryn; Regan, Sandra; Phelan, Shanon; Stooke, Rosamund; Meston, Christine; Schryer, Catherine; Manamperi, Madhushani; Friesen, Farah
2015-01-01
Abstract Purpose: School settings are a common practice context for rehabilitation professionals; health advocacy is a common and challenging practice role for professionals in this context. This study explored how pediatric practitioners advocate for children with disabilities at school. Specifically, we examined everyday advocacy in the context of school-based support for children with disabilities. Method: Our theoretical framework and methodological approach were informed by institutional ethnography, which maps and makes visible hidden social coordinators of work processes with a view to improving processes and outcomes. We included families, educators, and health/rehabilitation practitioners from Ontario. Of the 37 consented informants, 27 were interviewed and 15 observed. Documents and texts were collected from the micro-level (e.g. clinician reports) and the macro-level (e.g. policies). Results: Pediatric practitioners' advocacy work included two main work processes: spotlighting invisible disabilities and orienteering the special education terrain. Practitioners advocated indirectly, by proxy, with common proxies being documents and parents. Unintended consequences of advocacy by proxy included conflict and inefficiency, which were often unknown to the practitioner. Conclusions: The findings of this study provide practice-based knowledge about advocacy for children with disabilities, which may be used to inform further development of competency frameworks and continuing education for pediatric practitioners. The findings also show how everyday practices are influenced by policies and social discourses and how rehabilitation professionals may enact change.Implications for RehabilitationRehabilitation professionals frequently perform advocacy work. They may find it beneficial to perform advocacy work that is informed by overarching professional and ethical guidelines, and a nuanced understanding of local processes and structures.Competency frameworks and education for pediatric rehabilitation professionals may be improved by: encouraging professionals to consider how their practices, including their written documents, may affect parental burden, (mis)interpretation by document recipients, and potential unintended consequences.Policies and texts, e.g. privacy legislation and the Diagnostic and Statistical Manual (DSM), influence rehabilitation professionals' actions and interactions when supporting children with disabilities at school.An awareness of the influence of policies and texts may enable practitioners to work more effectively within current systems when supporting individuals with disabilities. PMID:25738906
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"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…
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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…
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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…
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The Tao of treating weeds: Reaching for restoration in the northern Rocky Mountains
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...
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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…
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Human Trafficking in Southeast Asia: Causes and Policy Implications
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
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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…
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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…
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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…
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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…
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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…
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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…
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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…
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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…
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SPECIAL PURPOSE IT DERAILED: UNINTENDED CONSEQUENCES OF UNIVERSAL IT LAWS AND POLICIES
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
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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…
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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…
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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…
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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…
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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…
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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:…
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Future trends in the health care economy.
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.
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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…
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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…
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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...
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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…
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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…
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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...
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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…
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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…
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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…
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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…
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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...
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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.
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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.
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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
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Health Information Technology Coordination to Support Patient-centered Care Coordination.
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.
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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
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DISE: A Seed-Dependent RNAi Off-Target Effect That Kills Cancer Cells.
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.
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Health system reform in rural China: voices of healthworkers and service-users.
Zhou, Xu Dong; Li, Lu; Hesketh, Therese
2014-09-01
Like many other countries China is undergoing major health system reforms, with the aim of providing universal health coverage, and addressing problems of low efficiency and inequity. The first phase of the reforms has focused on strengthening primary care and improving health insurance coverage and benefits. The aim of the study was to explore the impacts of these reforms on healthworkers and service-users at township level, which has been the major target of the first phase of the reforms. From January to March 2013 we interviewed eight health officials, 80 township healthworkers and 80 service-users in eight counties in Zhejiang and Yunnan provinces, representing rich and poor provinces respectively. Thematic analysis identified key themes around the impacts of the health reforms. We found that some elements of the reforms may actually be undermining primary care. While the new health insurance system was popular among service-users, it was criticised for contributing to fast-growing medical costs, and for an imbalance of benefits between outpatient and inpatient services. Salary reform has guaranteed healthworkers' income, but greatly reduced their incentives. The essential drug list removed perverse incentives to overprescribe, but led to falls in income for healthworkers, and loss of autonomy for doctors. Serious problems with drug procurement also emerged. The unintended consequences have included a brain drain of experienced healthworkers from township hospitals, and patients have flowed to county hospitals at greater cost. In conclusion, in the short term resources must be found to ensure rural healthworkers feel appropriately remunerated and have more clinical autonomy, measures for containment of the medical costs must be taken, and drug procurement must show increased transparency and accountability. More importantly the study shows that all countries undergoing health reforms should elicit the views of stakeholders, including service-users, to avoid and address unintended consequences. Copyright © 2014. Published by Elsevier Ltd.
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Toma, Madalina; Davey, Peter G; Marwick, Charis A; Guthrie, Bruce
2017-12-01
Drawing on a Cochrane systematic review, this paper examines the relatively limited range of outcomes measured in published evaluations of antimicrobial stewardship interventions (ASIs) in hospitals. We describe a structured framework for considering the range of consequences that ASIs can have, in terms of their desirability and the extent to which they were expected when planning an ASI: expected, desirable consequences (intervention goals); expected, undesirable consequences (intervention trade-offs); unexpected, undesirable consequences (unpleasant surprises); and unexpected, desirable consequences (pleasant surprises). Of 49 randomized controlled trials identified by the Cochrane review, 28 (57%) pre-specified increased length of stay and/or mortality as potential trade-offs of ASI, with measurement intended to provide reassurance about safety. In actuality, some studies found unexpected decreases in length of stay (a pleasant surprise). In contrast, only 11 (10%) of 110 interrupted time series studies included any information about unintended consequences, with 10 examining unexpected, undesirable outcomes (unpleasant surprises) using case-control, qualitative or cohort designs. Overall, a large proportion of the ASIs reported in the literature only assess impact on their targeted process goals-antimicrobial prescribing-with limited examination of other potential outcomes, including microbial and clinical outcomes. Achieving a balanced accounting of the impact of an ASI requires careful consideration of expected undesirable effects (potential trade-offs) from the outset, and more consideration of unexpected effects after implementation (both pleasant and unpleasant surprises, although the latter will often be more important). The proposed framework supports the systematic consideration of all types of consequences of improvement before and after implementation. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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Defining the road ahead: thinking strategically in the new era of health care reform.
Pudlowski, Edward M
2011-01-01
Understanding the implications of the new health care reform legislation, including those provisions that do not take effect for several years, will be critical in developing a successful strategic plan under the new environment of health care reform and avoiding unintended consequences of decisions made without the benefit of long-term thinking. Although this article is not a comprehensive assessment of the challenges and opportunities that exist under health care reform, nor a layout of all of the issues, it looks at some of the key areas in order to demonstrate why employers need to identify critical pathways and the associated risks and benefits of each decision. Key health care reform areas include insurance market reforms, grandfather rules, provisions that have the potential to influence the underlying cost of health care, the individual mandate, the employer mandate (including the free-choice voucher program) and the excise tax on high-cost plans.
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Why do infants begin to talk? Language as an unintended consequence.
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.
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MacMillan, Kathleen; Mallette, Claire
2004-03-01
In the late 1960s and early '70s, two key events occurred in Ontario that greatly affected the nursing profession: the unionization of the workforce and the move of diploma-granting nursing schools out of the hospitals (first to regional schools, then to the community colleges). At the same time, university nursing programs were undergoing significant changes. A paradigm shift occurred in which baccalaureate-prepared nurses were being educated for practice as well as for roles in education and administration. While all these activities had overall positive implications, there were unintended effects that continue to influence the profession today. These include the detachment of employers from clinical nursing education; fragmentation of the profession between front-line staff and the professional elites (proletarianization); rejection by front-line practitioners and college educators of nursing scholarship in favour of experiential and technical knowledge; and rivalry between college and university educators that has hampered the development of effective collaborations. For this study, interviews were undertaken with three informants, and their recollections were considered in the context of documentation from the College of Nurses of Ontario (the regulatory body), the Ontario Nurses Association (the union) and the Registered Nurses Association of Ontario (the professional association).
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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.
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Paying hospitals for quality: can we buy better care?
Hall, Jane P; van Gool, Kees C
2016-11-21
Economic theory predicts that changing financial rewards will change behaviour. This is valid in terms of service use; higher costs reduce health care use. It should follow that paying more for quality should improve quality; however, the research evidence thus far is equivocal, particularly in terms of better health outcomes. One reason is that "financial incentives" encompass a range of payment types and sizes of reward. The design of financial incentives should take into account the desired change and the context of existing payment structures, as well as other strategies for improving quality; further, financial incentives should be fair in rewarding effort. Financial incentives may have unintended consequences, including rewarding hospitals for selecting patients with lower risks, diverting attention from the overall patient population to specific conditions, gaming, and "crowding out" or displacing intrinsic motivation. Managers and clinicians can only respond to financial incentives if they have the data, tools and skills to effect changes. Australia should not adopt widespread use of financial incentives for improving quality in health care without careful consideration of their design and context, the potential for unintended effects (particularly beyond their immediate targets), and evaluation of outcomes. The relative cost-effectiveness of financial incentives compared with, or in concert with, other strategies should also be considered.
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2012-01-01
Background Raising prices through taxation on tobacco and alcohol products is a common strategy to raise revenues and reduce consumption. However, taxation policies are product specific, focusing either on alcohol or tobacco products. Several studies document interactions between the price of cigarettes and general alcohol use and it is important to know whether increased cigarette prices are associated with varying alcohol drinking patterns among different population groups. To inform policymaking, this study investigates the association of state cigarette prices with smoking, and current, binge, and heavy drinking by age group. Methods The 2001-2006 Behavioral Risk Factor Surveillance System surveys (n = 1,323,758) were pooled and analyzed using multiple regression equations to estimate changes in smoking and drinking pattern response to an increase in cigarette price, among adults aged 18 and older. For each outcome, a multiple linear probability model was estimated which incorporated terms interacting state cigarette price with age group. State and year fixed effects were included to control for potential unobserved state-level characteristics that might influence smoking and drinking. Results Increases in state cigarette prices were associated with increases in current drinking among persons aged 65 and older, and binge and heavy drinking among persons aged 21-29. Reductions in smoking were found among persons aged 30-64, drinking among those aged 18-20, and binge drinking among those aged 65 and older. Conclusions Increases in state cigarette prices may increase or decrease smoking and harmful drinking behaviors differentially by age. Adults aged 21-29 and 65 and older are more prone to increased drinking as a result of increased cigarette prices. Researchers, practitioners, advocates, and policymakers should work together to understand and prepare for these unintended consequences of tobacco taxation policy. PMID:22784412
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Diagnosis - the limiting focus of taxonomy.
Sturmberg, Joachim P; Martin, Carmel M
2016-02-01
The focus on the diagnosis is a pivotal aspect of medical practice since antiquity. Diagnostic taxonomy helped to categorize ailments to improve medical care, and in its social sense resulted in validation of the sick role for some, but marginalization or stigmatization for others. In the medical industrial complex, diagnostic taxonomy structured health care financing, management and practitioner remuneration. However, with increasing demands from multiple agencies, there are increasing unintended and unwarranted consequences of our current taxonomies and diagnostic processes resulting from the conglomeration of underpinning concepts, theories, information and motivations. We argue that the increasing focus on the diagnosis resulted in excessive compartmentalization - 'partialism' - of medical practice, diminishing medical care and being naively simplistic in light of the emerging understanding of the interconnected nature of the diseasome. The human is a complex organic system of interconnecting dynamics and feedback loops responding to internal and external forces including genetic, epigenetic and environmental attractors, rather than the sum of multiple discrete organs which can develop isolated diseases or multiple morbidities. Solutions to these unintended consequences of many contemporary health system processes involve revisiting the nature of diagnostic taxonomies and the processes of their construction. A dynamic taxonomic framework would shift to more relevant attractors at personal, clinical and health system levels recognizing the non-linear nature of health and disease. Human health at an individual, group and population level is the ability to adapt to internal and external stressors with resilience throughout the life course, yet diagnostic taxonomies are increasingly constructed around fixed anchors. Understanding diagnosis as dissecting, pigeonholing or bean counting (learning by dividing) is no longer useful, the challenge for the future is to understand the big picture (learning by connecting). Diagnostic categorization needs to embrace a meta-learning approach open to human variability. © 2014 John Wiley & Sons, Ltd.
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Sharp, Linda; Cotton, Seonaidh; Cruickshank, Margaret; Gray, Nicola M; Harrild, Kirsten; Smart, Louise; Walker, Leslie G; Little, Julian
2014-04-01
It is well known that receipt of an initial abnormal cervical cytology test can trigger considerable anxiety among women. Less is known about the impact of follow-up by repeat cytology tests. We quantified prevalence, and identified predictors, of distress after repeat cytologic testing in women with a single low-grade test. Within the framework of the TOMBOLA randomized controlled trial of alternative managements, 844 women aged 20 to 59 years with a single routine cytology test showing borderline nuclear abnormalities (BNA; broadly equivalent to atypical squamous cells of undetermined significance) were assigned to follow-up by repeat cytology in primary care (the first test was due 6 months after the initial BNA result). Women completed sociodemographic and psychosocial questionnaires at recruitment and the Impact of Event Scale (IES) 6 weeks after their first follow-up cytology test. Factors associated with significant psychologic distress (IES ≥ 9) were identified using logistic regression. The response rate was 74% (n = 621/844). Of all the respondents, 39% scored in the range for significant distress. Distress varied by follow-up cytology result: negative, 36%; BNA or mild dyskaryosis, 42%; other (including high grade and inadequate), 55%. After adjusting for the cytology result, risk of distress was significantly raised in women who had significant anxiety at recruitment, reported experiencing pain after the follow-up cytology, had children, or were dissatisfied with support they had received after their initial BNA test. Substantial proportions of women experience surveillance-related psychologic distress after a follow-up cytology test, even when the result is negative. This is an important, albeit unintended, consequence of cervical screening. Strategies to alleviate this distress merit attention.
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2014-01-01
Background Public awareness-raising campaigns targeting alcohol use during pregnancy are an important part of preventing prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder. Despite this, there is little evidence on what specific elements contribute to campaign message effectiveness. This research evaluated three different advertising concepts addressing alcohol and pregnancy: a threat appeal, a positive appeal promoting a self-efficacy message, and a concept that combined the two appeals. The primary aim was to determine the effectiveness of these concepts in increasing women’s intentions to abstain from alcohol during pregnancy. Methods Women of childbearing age and pregnant women residing in Perth, Western Australia participated in a computer-based questionnaire where they viewed either a control or one of the three experimental concepts. Following exposure, participants’ intentions to abstain from and reduce alcohol intake during pregnancy were measured. Other measures assessed included perceived main message, message diagnostics, and potential to promote defensive responses or unintended consequences. Results The concepts containing a threat appeal were significantly more effective at increasing women’s intentions to abstain from alcohol during pregnancy than the self-efficacy message and the control. The concept that combined threat and self-efficacy is recommended for development as part of a mass-media campaign as it has good persuasive potential, provides a balance of positive and negative emotional responses, and is unlikely to result in defensive or unintended consequences. Conclusions This study provides important insights into the components that enhance the persuasiveness and effectiveness of messages aimed at preventing prenatal alcohol exposure. The recommended concept has good potential for use in a future campaign aimed at promoting women’s intentions to abstain from alcohol during pregnancy. PMID:24410764
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McLellan, Deborah L; Hodgkin, Dominic; Fagan, Pebbles; Reif, Sharon; Horgan, Constance M
2012-07-11
Raising prices through taxation on tobacco and alcohol products is a common strategy to raise revenues and reduce consumption. However, taxation policies are product specific, focusing either on alcohol or tobacco products. Several studies document interactions between the price of cigarettes and general alcohol use and it is important to know whether increased cigarette prices are associated with varying alcohol drinking patterns among different population groups. To inform policymaking, this study investigates the association of state cigarette prices with smoking, and current, binge, and heavy drinking by age group. The 2001-2006 Behavioral Risk Factor Surveillance System surveys (n = 1,323,758) were pooled and analyzed using multiple regression equations to estimate changes in smoking and drinking pattern response to an increase in cigarette price, among adults aged 18 and older. For each outcome, a multiple linear probability model was estimated which incorporated terms interacting state cigarette price with age group. State and year fixed effects were included to control for potential unobserved state-level characteristics that might influence smoking and drinking. Increases in state cigarette prices were associated with increases in current drinking among persons aged 65 and older, and binge and heavy drinking among persons aged 21-29. Reductions in smoking were found among persons aged 30-64, drinking among those aged 18-20, and binge drinking among those aged 65 and older. Increases in state cigarette prices may increase or decrease smoking and harmful drinking behaviors differentially by age. Adults aged 21-29 and 65 and older are more prone to increased drinking as a result of increased cigarette prices. Researchers, practitioners, advocates, and policymakers should work together to understand and prepare for these unintended consequences of tobacco taxation policy.
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More than a score: a qualitative study of ancillary benefits of performance measurement.
Powell, Adam A; White, Katie M; Partin, Melissa R; Halek, Krysten; Hysong, Sylvia J; Zarling, Edwin; Kirsh, Susan R; Bloomfield, Hanna E
2014-08-01
Prior research has examined clinical effects of performance measurement systems. To the extent that non-clinical effects have been researched, the focus has been on negative unintended consequences. Yet, these same systems may also have ancillary benefits for patients and providers--that is, benefits that extend beyond improvements on clinical measures. The purpose of this study is to identify and describe potential ancillary benefits of performance measures as perceived by primary care staff and facility leaders in a large US healthcare system. In-person individual semistructured interviews were conducted with 59 primary care staff and facility leaders at four Veterans Health Administration facilities. Transcribed interviews were coded and organised into thematic categories. Interviewed staff observed that local performance measurement implementation practices can result in increased patient knowledge and motivation. These effects on patients can lead to improved performance scores and additional ancillary benefits. Performance measurement implementation can also directly result in ancillary benefits for the patients and providers. Patients may experience greater satisfaction with care and psychosocial benefits associated with increased provider-patient communication. Ancillary benefits of performance measurement for providers include increased pride in individual or organisational performance and greater confidence that one's practice is grounded in evidence-based medicine. A comprehensive understanding of the effects of performance measurement systems needs to incorporate ancillary benefits as well as effects on clinical performance scores and negative unintended consequences. Although clinical performance has been the focus of most evaluations of performance measurement to date, both patient care and provider satisfaction may improve more rapidly if all three categories of effects are considered when designing and evaluating performance measurement systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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France, Kathryn E; Donovan, Robert J; Bower, Carol; Elliott, Elizabeth J; Payne, Janet M; D'Antoine, Heather; Bartu, Anne E
2014-01-13
Public awareness-raising campaigns targeting alcohol use during pregnancy are an important part of preventing prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder. Despite this, there is little evidence on what specific elements contribute to campaign message effectiveness. This research evaluated three different advertising concepts addressing alcohol and pregnancy: a threat appeal, a positive appeal promoting a self-efficacy message, and a concept that combined the two appeals. The primary aim was to determine the effectiveness of these concepts in increasing women's intentions to abstain from alcohol during pregnancy. Women of childbearing age and pregnant women residing in Perth, Western Australia participated in a computer-based questionnaire where they viewed either a control or one of the three experimental concepts. Following exposure, participants' intentions to abstain from and reduce alcohol intake during pregnancy were measured. Other measures assessed included perceived main message, message diagnostics, and potential to promote defensive responses or unintended consequences. The concepts containing a threat appeal were significantly more effective at increasing women's intentions to abstain from alcohol during pregnancy than the self-efficacy message and the control. The concept that combined threat and self-efficacy is recommended for development as part of a mass-media campaign as it has good persuasive potential, provides a balance of positive and negative emotional responses, and is unlikely to result in defensive or unintended consequences. This study provides important insights into the components that enhance the persuasiveness and effectiveness of messages aimed at preventing prenatal alcohol exposure. The recommended concept has good potential for use in a future campaign aimed at promoting women's intentions to abstain from alcohol during pregnancy.
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Intimate Partner Violence and Unintended Pregnancy among Bangladeshi Women
ERIC Educational Resources Information Center
Rahman, Mosfequr; Sasagawa, Toshiyuki; Fujii, Ryota; Tomizawa, Hideki; Makinoda, Satoru
2012-01-01
This study examined the relationship between intimate partner violence (IPV) and unintended pregnancy using data from women reporting IPV in the 2007 Bangladesh Demographic Health Survey. The analysis included 4,695 married women, aged 15 to 40 years, who had at least one birth in the last 5 years. Bivariate and multiple logistic regression…
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2015-10-01
Unintended pregnancy persists as a major public health problem in the United States. Although lowering unintended pregnancy rates requires multiple approaches, individual obstetrician-gynecologists may contribute by increasing access to contraceptive implants and intrauterine devices. Obstetrician-gynecologists should encourage consideration of implants and intrauterine devices for all appropriate candidates, including nulliparous women and adolescents. Obstetrician-gynecologists should adopt best practices for long-acting reversible contraception insertion. Obstetrician-gynecologists are encouraged to advocate for coverage and appropriate payment and reimbursement for every contraceptive method by all payers in all clinically appropriate circumstances.
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Problems in counting and paying for multidisciplinary outpatient clinics.
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.
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The plague under Commodus as an unintended consequence of Roman grain market regulation.
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.
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Iranian Azeri women's perceptions of unintended pregnancy: A qualitative study.
Mohammadi, Easa; Nourizadeh, Roghaiyeh; Simbar, Masoumeh
2015-01-01
Many women, throughout their life cycle, experience unintended pregnancy and its subsequent induced abortion. Nonetheless, women's perceptions of this phenomenon - particularly in countries prohibiting elective abortion - are poorly known. The aim of this study was to explore Iranian Azeri women's perceptions of unintended pregnancy. This was a conventional content analysis study conducted in Tabriz, Iran. The data were collected through 31 semi-structured interviews with 23 women who had recently experienced an unintended pregnancy. The study participants were recruited using the purposive sampling method. Sampling started in March 2013 and continued until reaching data saturation, i.e. till August 2013. Data analysis was carried out concurrently with data collection. MAXQDA 10.0 software was employed for managing the study data. The study data analysis process yielded the formation of three main themes including negative effects of unintended pregnancy on daily life, fear of being stigmatized with violating social norms, and abortion panic, which in turn constituted the broader overarching theme of "threat supposition." In other words, following an unintended pregnancy, the study participants had experienced different levels of fear and threat depending on their personal, family, and socio-cultural backgrounds. Women perceive unintended pregnancy as a challenging and threatening situation. An unintended pregnancy can threaten women's lives through social deprivations, growing instability, and putting both mother and baby at risk for physical and psychosocial problems. On the other hand, an unsafe illegal abortion could have potentially life-threatening complications. To cope with such a situation, women need strong social support. Healthcare providers can fulfill such women's need for support by developing pre-abortion counseling services and providing them with professional counseling. Also, strengthening women's support system by policy-makers is recommended.
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Iranian Azeri women's perceptions of unintended pregnancy: A qualitative study
Mohammadi, Easa; Nourizadeh, Roghaiyeh; Simbar, Masoumeh
2015-01-01
Background: Many women, throughout their life cycle, experience unintended pregnancy and its subsequent induced abortion. Nonetheless, women's perceptions of this phenomenon – particularly in countries prohibiting elective abortion – are poorly known. The aim of this study was to explore Iranian Azeri women's perceptions of unintended pregnancy. Materials and Methods: This was a conventional content analysis study conducted in Tabriz, Iran. The data were collected through 31 semi-structured interviews with 23 women who had recently experienced an unintended pregnancy. The study participants were recruited using the purposive sampling method. Sampling started in March 2013 and continued until reaching data saturation, i.e. till August 2013. Data analysis was carried out concurrently with data collection. MAXQDA 10.0 software was employed for managing the study data. Results: The study data analysis process yielded the formation of three main themes including negative effects of unintended pregnancy on daily life, fear of being stigmatized with violating social norms, and abortion panic, which in turn constituted the broader overarching theme of “threat supposition.” In other words, following an unintended pregnancy, the study participants had experienced different levels of fear and threat depending on their personal, family, and socio-cultural backgrounds. Conclusions: Women perceive unintended pregnancy as a challenging and threatening situation. An unintended pregnancy can threaten women's lives through social deprivations, growing instability, and putting both mother and baby at risk for physical and psychosocial problems. On the other hand, an unsafe illegal abortion could have potentially life-threatening complications. To cope with such a situation, women need strong social support. Healthcare providers can fulfill such women's need for support by developing pre-abortion counseling services and providing them with professional counseling. Also, strengthening women's support system by policy-makers is recommended. PMID:25878705
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The law of unintended (financial) consequences: the expansion of HIPAA business associate liability.
Tomes, Jonathan P
2013-01-01
The recent Omnibus Rule published by the Department of Health and Human Services greatly expanded liability for breaches of health information privacy and security under the HIPAA statute and regulations. This expansion could have dire financial consequences for the health care industry. The Rule expanded the definition of business associates to include subcontractors of business associates and made covered entities and business associates liable for breaches of the entities who perform a service for them involving the use of individually identifiable health information under the federal common law of agency. Thus, if a covered entity or its "do wnstream" business associate breaches security or privacy, the covered entity or "upstream" business associate may face HIPAA's civil money penalties or a lawsuit. Financial managers need to be aware of these changes both to protect against the greater liability and to plan for the compliance costs inherent in effectively, if not legally, making business associates into covered entities.
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Kot, Megan; Castleden, Heather; Gagnon, Graham A
2011-09-01
Studies that explore social capital and political will [corrected] in the context of safe drinking water provision in [corrected] Canada are limited. This paper presents findings from a study that examines the capacity of rural Canadian communities to attain regulatory compliance for drinking water. Interviews were conducted with water operators and managers in ten rural communities across Atlantic Canada to identify the burden of compliance arising from the implementation of, and adherence to, drinking water regulations. This research identifies the operator as being particularly burdened by regulatory compliance, often resulting in negative consequences including job stress and a strained relationship with the community they serve. Findings indicate that while regulations are vital to ensuring safe drinking water, not all communities have the resources in place to rise to the challenge of compliance. As a result, some communities are being negatively impacted by these regulations, rather than benefit from their intended positive effect. Copyright © 2011 Elsevier Ltd. All rights reserved.
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Johnson, Brian R
2013-01-01
State, county, and local governments are currently facing a myriad of economic issues, based on shrinking tax revenues combined with increased expenditures. Of these, the costs related to defined benefit pension plans are one of the most serious issues facing many public employers. Through a comprehensive review of the existing literature, this article examines how the shift from the defined benefit (DB) to defined contribution (DC) pension plan has the potential to enhance levels of labor unrest due to changes in union militancy, bargaining skills deficits, intra-organizational conflict, and issues related to economic trade-offs. Besides the capacity for immediate and deleterious ramifications in the collective bargaining process, the transition to the DC pension also presents some potentially negative consequences related to human resource management, including changes in the psychological contract, recruitment strategies, employee turnover, and changes in retirement patterns. Recommendations to improve labor relations and human resource management practices in the DC pension environment are also explored.
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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…
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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…
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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…
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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…
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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...
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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…
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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…
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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...
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The Unintended Consequences of Killing Civilians
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
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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…
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An Analytic Model for DoD Investment & Divestment Decisions (Briefing Charts)
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
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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...
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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.
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Effect of methyl bromide on Bursaphelenchus xylophilus in pine wood
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....
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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…
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"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…
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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,…
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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.
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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.
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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.
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Unintended Perioperative Hypothermia
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
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Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis
Fulop, Naomi; Protopsaltis, Gerasimos; Hutchings, Andrew; King, Annette; Allen, Pauline; Normand, Charles; Walters, Rhiannon
2002-01-01
Objective To study the processes involved in and impact of mergers between NHS trusts, including the effect on management costs. Design Cross sectional study involving in depth interviews and documentary analysis; case study to compare savings in management costs between case trusts and control trusts. Setting Nine trusts (cross sectional study) and four trusts (case study) in London. Participants 96 interviews with trust board members, other senior managers, clinicians, service managers, and representatives of health authorities, regional office, community health councils, local authorities, other trusts in the area, and primary care groups and trusts. Main outcome measures Stated and unstated drivers, and impact of merger on delivery and development of services, management structures, and staff recruitment, retention, and morale. Effects of difference in trust size before and after the merger. Savings in management costs two years after merger. Results Some important drivers for merger are not publicly stated. Mergers had a negative effect on delivery of services because of a loss of managerial focus on services. Planned developments in services were delayed by at least 18 months. Trusts' larger sizes after mergers had unintended negative consequences, as well as predicted advantages. The tendency for one trust's management team to dominate over the other resulted in tension. No improvement in recruitment or retention of clinical and managerial staff was reported. Perceived differences in organisational culture were an important barrier to bringing together two or more organisations. Two years after merger, merged trusts had not achieved the objective of saving £500 000 a year in management costs. Conclusions Important unintended consequences need to be accounted for when mergers are planned. Mergers can cause considerable disruptions to services, and require greater management support than previously acknowledged. Other organisations undergoing restructuring, such as primary care groups developing into primary care trusts and health authorities merging into strategic health authorities, should take these findings into account. What is already known on this topicResearch suggests that effectiveness increases as the amount of activity by specialised units in certain clinical specialities increasesLittle empirical research has looked at the impact of mergers; most studies focus on financial variablesMergers result in short term disruption caused by difficulties in integrating services and personnelWhat this study addsImportant drivers for NHS mergers that are not stated publicly have implications for the process and impact of mergersMergers have positive effects, as well as unintended negative consequences that disrupt services and set back developments in servicesPerceived differences in organisational culture impede bringing organisations togetherMergers do not achieve target savings in management costs in first two years after merger PMID:12153920
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Ecosystems and Land Use Change
NASA Astrophysics Data System (ADS)
DeFries, Ruth S.; Asner, Gregory P.; Houghton, Richard A.
Land use is at the center of one of the most vexing challenges for the coming decades: to provide enough food, fiber and shelter for the world's population; raise the standard of living for the billion people currently below the poverty line; and simultaneously sustain the world's ecosystems for use by humans and other species. The intended consequence of cropland expansion, urban growth, and other land use changes is to satisfy demands from the increasing appetite of the world's population. Unintended consequences, however, can alter ecological processes and have far-reaching and long-term effects that potentially compromise the basic functioning of ecosystems. Recently, the scientific community has begun to confront such issues. Several national and international programs have been at the forefront of scientific enquiry on the causes and consequences of land use change, including: the Land Use and Land Cover Change Program of the National Aeronautics and Space Administration, the Land Use program element in the interagency U.S. Climate Change Science Program, and the International Geosphere-Biosphere's Land Use and Cover Change (LUCC) core project. The result has been significant advances in understanding the complex socioeconomic, technological, and biophysical factors that drive land use change worldwide.
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NASA Astrophysics Data System (ADS)
DeFries, Ruth S.; Asner, Gregory P.; Houghton, Richard A.
Land use is at the center of one of the most vexing challenges for the coming decades: to provide enough food, fiber and shelter for the world's population; raise the standard of living for the billion people currently below the poverty line; and simultaneously sustain the world's ecosystems for use by humans and other species. The intended consequence of cropland expansion, urban growth, and other land use changes is to satisfy demands from the increasing appetite of the world's population. Unintended consequences, however, can alter ecological processes and have far-reaching and long-term effects that potentially compromise the basic functioning of ecosystems. Recently, the scientific community has begun to confront such issues. Several national and international programs have been at the forefront of scientific enquiry on the causes and consequences of land use change, including: the Land Use and Land Cover Change Program of the National Aeronautics and Space Administration, the Land Use program element in the interagency U.S. Climate Change Science Program, and the International Geosphere-Biosphere's Land Use and Cover Change (LUCC) core project. The result has been significant advances in understanding the complex socioeconomic, technological, and biophysical factors that drive land use change worldwide.
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Henry, Nathaniel; Hawes, Charlie; Lowin, Julia; Lekander, Ingrid; Filonenko, Anna; Kallner, Helena K
2015-08-01
To evaluate the cost-effectiveness of a novel intrauterine system, levonorgestrel intrauterine system 13.5 mg vs. oral contraception, in women at risk of unintended pregnancy. Cost-effectiveness model using efficacy and discontinuation data from published articles. Societal perspective including direct and indirect costs. Women at risk of unintended pregnancy using reversible contraception. An economic analysis was conducted by modeling the different health states of women using contraception over a 3-year period. Typical use efficacy rates from published articles were used to determine unintended pregnancy events. Discontinuation rates were used to account for method switching. Cost-effectiveness was evaluated in terms of the incremental cost per unintended pregnancy avoided. In addition, the incremental cost per quality-adjusted life-year was calculated. Levonorgestrel intrauterine system 13.5 mg generated costs savings of € 311,000 in a cohort of 1000 women aged 15-44 years. In addition, there were fewer unintended pregnancies (55 vs. 294) compared with women using oral contraception. Levonorgestrel intrauterine system 13.5 mg is a cost-effective method when compared with oral contraception. A shift in contraceptive use from oral contraception to long-acting reversible contraception methods could result in fewer unintended pregnancies, quality-adjusted life-year gains, as well as cost savings. © 2015 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
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ERIC Educational Resources Information Center
Brown, Michael D.
1990-01-01
This document consists of two articles on sex education programs aimed at reducing sexually transmitted diseases (STDs) and unintended pregnancies among American Indians. Both articles describe the problems of unwanted pregnancies and STDs, including acquired immune deficiency syndrome. During 1987, there were more than 3,000 live births to Native…
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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,…
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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…
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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…
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Social Movements And Social Media: Surveillance And Unintended Consequences
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
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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...
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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
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Identifying Acquisition Patterns of Failure Using Systems Archetypes
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
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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…
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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.
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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
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Biofuels: Network Analysis of the Literature Reveals Key Environmental and Economic Unknowns
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
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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.
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Finding Resolution for the Responsible Transparency of Economic Models in Health and Medicine.
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.
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Examining the relationship between medical cannabis laws and cardiovascular deaths in the US.
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.
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Implications of Prenatal Steroid Perturbations for Neurodevelopment, Behavior, and Autism
Martien, Katherine M.; Gagnidze, Khatuna; Pfaff, Donald
2014-01-01
The prenatal brain develops under the influence of an ever-changing hormonal milieu that includes endogenous fetal gonadal and adrenal hormones, placental and maternal hormones, and exogenous substances with hormonal activity that can cross the placental barrier. This review discusses the influences of endogenous fetal and maternal hormones on normal brain development and potential consequences of pathophysiological hormonal perturbations to the developing brain, with particular reference to autism. We also consider the effects of hormonal pharmaceuticals used for assisted reproduction, the maintenance of pregnancy, the prevention of congenital adrenal hypertrophy, and hormonal contraceptives continued into an unanticipated pregnancy, among others. These treatments, although in some instances life-saving, may have unintended consequences on the developing fetuses. Additional concern is raised by fetal exposures to endocrine-disrupting chemicals encountered universally by pregnant women from food/water containers, contaminated food, household chemicals, and other sources. What are the potential outcomes of prenatal steroid perturbations on neurodevelopmental and behavioral disorders, including autism-spectrum disorders? Our purposes here are 1) to summarize some consequences of steroid exposures during pregnancy for the development of brain and behavior in the offspring; 2) to summarize what is known about the relationships between exposures and behavior, including autism spectrum disorders; 3) to discuss the molecular underpinnings of such effects, especially molecular epigenetic mechanisms of prenatal steroid manipulations, a field that may explain effects of direct exposures, and even transgenerational effects; and 4) for all of these, to add cautionary notes about their interpretation in the name of scientific rigor. PMID:25211453
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Implications of prenatal steroid perturbations for neurodevelopment, behavior, and autism.
Gore, Andrea C; Martien, Katherine M; Gagnidze, Khatuna; Pfaff, Donald
2014-12-01
The prenatal brain develops under the influence of an ever-changing hormonal milieu that includes endogenous fetal gonadal and adrenal hormones, placental and maternal hormones, and exogenous substances with hormonal activity that can cross the placental barrier. This review discusses the influences of endogenous fetal and maternal hormones on normal brain development and potential consequences of pathophysiological hormonal perturbations to the developing brain, with particular reference to autism. We also consider the effects of hormonal pharmaceuticals used for assisted reproduction, the maintenance of pregnancy, the prevention of congenital adrenal hypertrophy, and hormonal contraceptives continued into an unanticipated pregnancy, among others. These treatments, although in some instances life-saving, may have unintended consequences on the developing fetuses. Additional concern is raised by fetal exposures to endocrine-disrupting chemicals encountered universally by pregnant women from food/water containers, contaminated food, household chemicals, and other sources. What are the potential outcomes of prenatal steroid perturbations on neurodevelopmental and behavioral disorders, including autism-spectrum disorders? Our purposes here are 1) to summarize some consequences of steroid exposures during pregnancy for the development of brain and behavior in the offspring; 2) to summarize what is known about the relationships between exposures and behavior, including autism spectrum disorders; 3) to discuss the molecular underpinnings of such effects, especially molecular epigenetic mechanisms of prenatal steroid manipulations, a field that may explain effects of direct exposures, and even transgenerational effects; and 4) for all of these, to add cautionary notes about their interpretation in the name of scientific rigor.
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Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay.
Tyler, Denise A; McHugh, John P; Shield, Renée R; Winblad, Ulrika; Gadbois, Emily A; Mor, Vincent
2018-06-05
To identify the challenges that reductions in length of stay (LOS) pose for skilled nursing facilities (SNFs) and their postacute care (PAC) patients. Seventy interviews with staff in 25 SNFs in eight U.S. cities, LOS data for patients in those SNFs. Data were qualitatively analyzed, and key themes were identified. Interview data from SNFs with and without reductions in median risk-adjusted LOS were compared and contrasted. We conducted 70 semistructured interviews. LOS data were derived from minimum dataset (MDS) admission records available for all patients in all U.S. SNFs from 2012 to 2014. Challenges reported regardless of reductions in LOS included frequent and more complicated re-authorization processes, patients becoming responsible for costs, and discharging patients whom staff felt were unsafe at home. Challenges related to reduced LOS included SNFs being pressured to discharge patients within certain time limits. Some SNFs reported instituting programs and processes for following up with patients after discharge. These programs helped alleviate concerns about patients, but they resulted in nonreimbursable costs for facilities. The push for shorter LOS has resulted in unexpected challenges and costs for SNFs and possible unintended consequences for PAC patients. © Health Research and Educational Trust.
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Nelson, Erica; Edmonds, Alexander; Ballesteros, Marco; Encalada Soto, Diana; Rodriguez, Octavio
2014-01-01
This paper is an ethnography of a four-year, multi-disciplinary adolescent sexual and reproductive health intervention in Bolivia, Nicaragua and Ecuador. An important goal of the intervention--and of the larger global field of adolescent sexual and reproductive health--is to create more open parent-to-teen communication. This paper analyzes the project's efforts to foster such communication and how social actors variously interpreted, responded to, and repurposed the intervention's language and practices. While the intervention emphasized the goal of 'open communication,' its participants more often used the term 'confianza' (trust). This norm was defined in ways that might--or might not--include revealing information about sexual activity. Questioning public health assumptions about parent-teen communication on sex, in and of itself, is key to healthy sexual behavior, the paper explores a pragmatics of communication on sex that includes silence, implied expectations, gendered conflicts, and temporally delayed knowledge.
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Raemer, Daniel B
2014-06-01
The story of Ignaz Semmelweis suggests a lesson to beware of unintended consequences, especially with in situ simulation. In situ simulation offers many important advantages over center-based simulation such as learning about the real setting, putting participants at ease, saving travel time, minimizing space requirements, involving patients and families. Some substantial disadvantages include frequent distractions, lack of privacy, logistics of setup, availability of technology, and supply costs. Importantly, in situ simulation amplifies some of the safety hazards of simulation itself including maintaining control of simulated medications and equipment, limiting the use of valuable hospital resources, preventing incorrect learning from simulation shortcuts, and profoundly upsetting patients and their families. Mitigating these hazards by labeling effectively, publishing policies and procedures, securing simulation supplies and equipment, educating simulation staff, and informing participants of the risks are all methods that may lessen the potential for an accident. Each requires a serious effort of analysis, design, and implementation.
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Penalizing hospitals for chronic obstructive pulmonary disease readmissions.
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.
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Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review.
Volkow, Nora D; Swanson, James M; Evins, A Eden; DeLisi, Lynn E; Meier, Madeline H; Gonzalez, Raul; Bloomfield, Michael A P; Curran, H Valerie; Baler, Ruben
2016-03-01
With a political debate about the potential risks and benefits of cannabis use as a backdrop, the wave of legalization and liberalization initiatives continues to spread. Four states (Colorado, Washington, Oregon, and Alaska) and the District of Columbia have passed laws that legalized cannabis for recreational use by adults, and 23 others plus the District of Columbia now regulate cannabis use for medical purposes. These policy changes could trigger a broad range of unintended consequences, with profound and lasting implications for the health and social systems in our country. Cannabis use is emerging as one among many interacting factors that can affect brain development and mental function. To inform the political discourse with scientific evidence, the literature was reviewed to identify what is known and not known about the effects of cannabis use on human behavior, including cognition, motivation, and psychosis.
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Unintended knowledge learnt in primary science practical lessons
NASA Astrophysics Data System (ADS)
Park, Jisun; Abrahams, Ian; Song, Jinwoong
2016-11-01
This study explored the different kinds of unintended learning in primary school practical science lessons. In this study, unintended learning has been defined as student learning that was found to occur that was not included in the teachers learning objectives for that specific lesson. A total of 22 lessons, taught by five teachers in Korean primary schools with 10- to 12-year-old students, were audio-and video recorded. Pre-lesson interviews with the teachers were conducted to ascertain their intended learning objectives. Students were asked to write short memos after the lesson about what they learnt. Post-lesson interviews with students and teachers were undertaken. What emerged was that there were three types of knowledge that students learnt unintentionally: factual knowledge gained by phenomenon-based reasoning, conceptual knowledge gained by relation- or model-based reasoning, and procedural knowledge acquired by practice. Most unintended learning found in this study fell into the factual knowledge and only a few cases of conceptual knowledge were found. Cases of both explicit procedural knowledge and implicit procedural knowledge were found. This study is significant in that it suggests how unintended learning in practical work can be facilitated as an educative opportunity for meaningful learning by exploring what and how students learnt.
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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.
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Introducing rapid tests for malaria into the retail sector: what are the unintended consequences?
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
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Fitzgerald, Niamh; Angus, Kathryn; Emslie, Carol; Shipton, Deborah; Bauld, Linda
2016-10-01
Consistent review-level evidence supports the effectiveness of population-level alcohol policies in reducing alcohol-related harms. Such policies interact with well-established social, cultural and biological differences in how men and women perceive, relate to and use alcohol, and with wider inequalities, in ways which may give rise to gender differences in policy effectiveness. This paper aimed to examine the extent to which gender-specific data and analyses were considered in, and are available from, systematic reviews of population-level alcohol policy interventions, and where possible, to conduct a narrative synthesis of relevant data. A prior systematic 'review of reviews' of population level alcohol interventions 2002-2012 was updated to May 2014, all gender-relevant data extracted, and the level and quality of gender reporting assessed. A narrative synthesis of extracted findings was conducted. Sixty-three systematic reviews, covering ten policy areas, were included. Five reviews (8%) consistently provided information on baseline participation by gender for each individual study in the review and twenty-nine (46%) reported some gender-specific information on the impact of the policies under consideration. Specific findings include evidence of possible gender differences in the impact of and exposure to alcohol marketing, and a failure to consider potential unintended consequences and harm to others in most reviews. Gender is poorly reported in systematic reviews of population-level interventions to reduce alcohol-related harm, hindering assessment of the intended and unintended effects of such policies on women and men. © 2016 Society for the Study of Addiction.
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NASA Astrophysics Data System (ADS)
Zargarzadeh, H.; Nodland, David; Thotla, V.; Jagannathan, S.; Agarwal, S.
2012-06-01
Unmanned Aerial Vehicles (UAVs) are versatile aircraft with many applications, including the potential for use to detect unintended electromagnetic emissions from electronic devices. A particular area of recent interest has been helicopter unmanned aerial vehicles. Because of the nature of these helicopters' dynamics, high-performance controller design for them presents a challenge. This paper introduces an optimal controller design via output feedback control for trajectory tracking of a helicopter UAV using a neural network (NN). The output-feedback control system utilizes the backstepping methodology, employing kinematic, virtual, and dynamic controllers and an observer. Optimal tracking is accomplished with a single NN utilized for cost function approximation. The controller positions the helicopter, which is equipped with an antenna, such that the antenna can detect unintended emissions. The overall closed-loop system stability with the proposed controller is demonstrated by using Lyapunov analysis. Finally, results are provided to demonstrate the effectiveness of the proposed control design for positioning the helicopter for unintended emissions detection.
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The Role of the Military in Counterterrorism: Unintended Consequences
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
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Mexico’s Drug War and Its Unintended Regional Consequences
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
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Unintended Consequences of the Goldwater-Nichols Act (Joint Force Quarterly, Spring 1998)
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
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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…
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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…
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Unintended Consequences of Advocating Use of Fixed-Price Contracts in Defense Acquisition Practice
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
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Afforestation and forests at the dryland edges: Lessons learned and future outlooks
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 forestsâa âGreen Great Wallââhas 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...
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The kidney allocation score: methodological problems, moral concerns and unintended consequences.
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.
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Tradeoffs for Renewable Energy Projects: Environmental, Planning, and Mission Considerations
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
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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…
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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…
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Zakar, Rubeena; Nasrullah, Muazzam; Zakar, Muhammad Z; Ali, Hussain
2016-04-01
To determine if intimate partner violence (IPV) was associated with unintended pregnancy and pregnancy loss among married women in Pakistan. A retrospective analysis was conducted using nationally representative cross-sectional secondary data from women of reproductive age who were currently married and had participated in the domestic violence module of the 2012-13 Pakistan Demographic and Heath Survey. Unintended pregnancy and pregnancy loss were defined as any mistimed or unwanted pregnancy, and any pregnancy that resulted in spontaneous abortion, induced abortion, or stillbirth, respectively. Associations with IPV were assessed by calculating adjusted odds ratios using logistic regression models. Data from 3518 individuals were included. Pregnancy loss had been experienced by 1282 (36.4%) participants and unintended pregnancy was reported by 391 (19.5%) of 2005 individuals this information was available for. In total, 1335 (37.9%) participants reported having ever experienced any form of IPV, including 919 (26.1%), 1112 (31.6%), and 697 (19.8%) participants who had experienced physical, emotional, and both emotional and physical IPV. Significant associations were observed between participants experiencing either physical or emotional IPV, emotional IPV, and both emotional and physical IPV, and unintended pregnancy (P=0.017, P<0.001, and P=0.011, respectively) and pregnancy loss (P=0.002, P=0.005, and P<0.001, respectively). There is an urgent need to develop preventive strategies to reduce intramarital IPV and its associated poor health outcomes. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
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Evaluations of Structural Interventions for HIV Prevention: A Review of Approaches and Methods.
Iskarpatyoti, Brittany S; Lebov, Jill; Hart, Lauren; Thomas, Jim; Mandal, Mahua
2018-04-01
Structural interventions alter the social, economic, legal, political, and built environments that underlie processes affecting population health. We conducted a systematic review of evaluations of structural interventions for HIV prevention in low- and middle-income countries (LMICs) to better understand methodological and other challenges and identify effective evaluation strategies. We included 27 peer-reviewed articles on interventions related to economic empowerment, education, and substance abuse in LMICs. Twenty-one evaluations included clearly articulated theories of change (TOCs); 14 of these assessed the TOC by measuring intermediary variables in the causal pathway between the intervention and HIV outcomes. Although structural interventions address complex interactions, no evaluation included methods designed to evaluate complex systems. To strengthen evaluations of structural interventions, we recommend clearly articulating a TOC and measuring intermediate variables between the predictor and outcome. We additionally recommend adapting study designs and analytic methods outside traditional epidemiology to better capture complex results, influences external to the intervention, and unintended consequences.
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Kramer, Michael R; Hogue, Carol J Rowland; Gaydos, Laura M D
2007-05-01
In the United States, 49% of all pregnancies are unintended. Part of this high rate has been attributed to the negative effects of higher levels of personal and community-level religiosity in this country. To explore the impacts of individual-level religiosity on unintended pregnancy, we used 2002 National Survey of Family Growth (NSFG) data to model the relationship between religion and noncontracepting behavior, a crucial precursor to unintended pregnancies. We tested logistic models with current and childhood religious affiliation as primary exposures and recent noncontracepting behavior as the outcome, controlling for demographic covariates, religious service importance, and attendance frequency. An estimated 32.7 million women are at risk for unintended pregnancy, 14 % of whom use no contraception. Proportions of noncontraceptors were 15.5 % among Catholics, 10.3% among mainstream Protestants, and 15.0% among fundamentalist Protestants. In multivariate modeling, religion was significantly related to not contracepting in teens, but noncontributory for women from 20 to 44 years of age. Variables associated with contraceptive behavior included marital status, age, education, and income. Among women, current and childhood religious affiliations modify odds ratio for noncontracepting behavior only among teenage girls. For adults, odds ratio vary widely by marital status, education, and income, but not by religious affiliation.
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Australia’s $40 per pack cigarette tax plans: the need to consider equity
Smith, Katherine E
2018-01-01
In May 2016, the Australian Government announced that it would implement annual increases in tobacco excise of 12.5% up to and including 2020, raising the cost of a pack of cigarettes to $A40. This increase will lead to Australia having one of the highest prices of cigarettes in the world. Increasing the cost of tobacco is considered by public health experts to be one of the most effective strategies to reduce tobacco use, and is generally well supported by the public. However, tobacco tax increases differentially impact various subgroups of the population. Based on a review of existing literature, this paper examines some of the potential (unintended) consequences of the tax to individual and family income; illicit trade; social stigma and opportunities for lobbying by the tobacco industry. In light of these considerations, we offer strategies that might be used by policymakers to mitigate potential harms. While this paper focuses on the impacts primarily on populations in Australia, the consequences and strategies offered may be useful to other countries implementing tobacco excise increases. PMID:28396484
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If you build it, they will come: unintended future uses of organised health data collections.
O'Doherty, Kieran C; Christofides, Emily; Yen, Jeffery; Bentzen, Heidi Beate; Burke, Wylie; Hallowell, Nina; Koenig, Barbara A; Willison, Donald J
2016-09-06
Health research increasingly relies on organized collections of health data and biological samples. There are many types of sample and data collections that are used for health research, though these are collected for many purposes, not all of which are health-related. These collections exist under different jurisdictional and regulatory arrangements and include: 1) Population biobanks, cohort studies, and genome databases 2) Clinical and public health data 3) Direct-to-consumer genetic testing 4) Social media 5) Fitness trackers, health apps, and biometric data sensors Ethical, legal, and social challenges of such collections are well recognized, but there has been limited attention to the broader societal implications of the existence of these collections. Although health research conducted using these collections is broadly recognized as beneficent, secondary uses of these data and samples may be controversial. We examine both documented and hypothetical scenarios of secondary uses of health data and samples. In particular, we focus on the use of health data for purposes of: Forensic investigations Civil lawsuits Identification of victims of mass casualty events Denial of entry for border security and immigration Making health resource rationing decisions Facilitating human rights abuses in autocratic regimes Current safeguards relating to the use of health data and samples include research ethics oversight and privacy laws. These safeguards have a strong focus on informed consent and anonymization, which are aimed at the protection of the individual research subject. They are not intended to address broader societal implications of health data and sample collections. As such, existing arrangements are insufficient to protect against subversion of health databases for non-sanctioned secondary uses, or to provide guidance for reasonable but controversial secondary uses. We are concerned that existing debate in the scholarly literature and beyond has not sufficiently recognized the secondary data uses we outline in this paper. Our main purpose, therefore, is to raise awareness of the potential for unforeseen and unintended consequences, in particular negative consequences, of the increased availability and development of health data collections for research, by providing a comprehensive review of documented and hypothetical non-health research uses of such data.
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Transgene flow: Facts, speculations and possible countermeasures
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
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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
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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.
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Just Say Yes: Winning the U.S. War on Drugs
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
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Green biotechnology and European competitiveness.
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.
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The Helms-Burton Act: A Strategic Critique.
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
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State of the Science Review: Potential for Beneficial Use of ...
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
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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.
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Hubacher, David; Spector, Hannah; Monteith, Charles; Chen, Pai-Lien
2018-06-01
To measure the 24-month impact on continuation, unintended pregnancy and satisfaction of trying long-acting reversible contraception (LARC) in a population seeking short-acting reversible contraception (SARC). We enrolled 916 women aged 18-29 who were seeking pills or injectables in a partially randomized patient preference trial. Women with strong preferences for pills or injectables started on those products, while others opted for randomization to LARC or SARC and received their methods gratis. We estimated continuation and unintended pregnancy rates through 24months. Intent-to-treat principles were applied after method initiation for comparing incidence of unintended pregnancy. We also examined how satisfaction levels varied by cohort and how baseline negative LARC attitudes were associated with satisfaction over time. Forty-three percent chose randomization, and 57% chose the preference option. Complete loss to follow-up was<2%. The 24-month LARC continuation probability was 64.3% [95% confidence interval (CI): 56.6-70.9], statistically higher than SARC groups [25.5% (randomized) and 40.0% (preference)]. The 24-month cumulative unintended pregnancy probabilities were 9.9% (95% CI: 7.2-12.6) (preference-SARC), 6.9% (95% CI: 3.3-10.6) (randomized-SARC) and 3.6% (95% CI: 1.8-6.4) (randomized-LARC). Statistical tests for comparing randomized groups on unintended pregnancy were mixed: binomial at 24-month time point (p=.02) and log-rank survival probabilities (p=.14 for first pregnancies and p=.07 when including second pregnancies). LARC satisfaction was high (80% happy/neutral, 73% would use LARC again, 81% would recommend to a friend). Baseline negative attitudes toward LARC (27%) were not clearly associated with satisfaction or early discontinuation. The decision to try LARC resulted in high continuation rates and substantial protection from unintended pregnancy over 24months. Despite participants' initial desires to begin short-acting regimens, they had high satisfaction with LARC. Voluntary decisions to try LARC will benefit large proportions of typical SARC users. Even women who do not necessarily view LARC as a first choice may have a highly satisfying experience and avoid unintended pregnancy if they try it. Copyright © 2018 Elsevier Inc. All rights reserved.
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DSM and the Death of Phenomenology in America: An Example of Unintended Consequences
Andreasen, Nancy C.
2007-01-01
During the 19th century and early 20th century, American psychiatry shared many intellectual traditions and values with Great Britain and Europe. These include principles derived from the Enlightenment concerning the dignity of the individual and the value of careful observation. During the 20th century, however, American psychiatry began to diverge, initially due to a much stronger emphasis on psychoanalytic principles, particularly in comparison with Great Britain. By the 1960s and 1970s, studies such as the US-UK study and the International Pilot Study of Schizophrenia demonstrated that the psychodynamic emphasis had gone too far, leading to diagnostic imprecision and inadequate evaluation of traditional evaluations of signs and symptoms of psychopathology. Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) was developed in this context, under the leadership of representatives from institutions that had retained the more traditional British-European approaches (eg, Washington University, Iowa). The goal of DSM-III was to create a comprehensive system for diagnosing and evaluating psychiatric patients that would be more reliable, more valid, and more consistent with international approaches. This goal was realized in many respects, but unfortunately it also had many unintended consequences. Although the original creators realized that DSM represented a “best effort” rather than a definitive “ground truth,” DSM began to be given total authority in training programs and health care delivery systems. Since the publication of DSM-III in 1980, there has been a steady decline in the teaching of careful clinical evaluation that is targeted to the individual person's problems and social context and that is enriched by a good general knowledge of psychopathology. Students are taught to memorize DSM rather than to learn complexities from the great psychopathologists of the past. By 2005, the decline has become so severe that it could be referred to as “the death of phenomenology in the United States.” PMID:17158191
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Supplemental feeding alters migration of a temperate ungulate.
Jones, Jennifer D; Kauffman, Matthew J; Monteith, Kevin L; Scurlock, Brandon M; Albeke, Shannon E; Cross, Paul C
Conservation of migration requires information on behavior and environmental determinants. The spatial distribution of forage resources, which migration exploits, often are altered and may have subtle, unintended consequences. Supplemental feeding is a common management practice, particularly for ungulates in North America and Europe, and carryover effects on behavior of this anthropogenic manipulation of forage are expected in theory, but have received limited empirical evaluation, particularly regarding effects on migration. We used global positioning system (GPS) data to evaluate the influence of winter feeding on migration behavior of 219 adult female elk (Cervus elaphus) from 18 fed ranges and 4 unfed ranges in western Wyoming. Principal component analysis revealed that the migratory behavior of fed and unfed elk differed in distance migrated, and the timing of arrival to, duration on, and departure from summer range. Fed elk migrated 19.2 km less, spent 11 more days on stopover sites, arrived to summer range 5 days later, resided on summer range 26 fewer days, and departed in the autumn 10 days earlier than unfed elk. Time-to-event models indicated that differences in migratory behavior between fed and unfed elk were caused by altered sensitivity to the environmental drivers of migration. In spring, unfed elk migrated following plant green-up closely, whereas fed elk departed the feedground but lingered on transitional range, thereby delaying their arrival to summer range. In autumn, fed elk were more responsive to low temperatures and precipitation events, causing earlier departure from summer range than unfed elk. Overall, supplemental feeding disconnected migration by fed elk from spring green-up and decreased time spent on summer range, thereby reducing access to quality forage. Our findings suggest that ungulate migration can be substantially altered by changes to the spatial distribution of resources, including those of anthropogenic origin, and that management practices applied in one season may have unintended behavioral consequences in subsequent seasons.
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Dixon-Woods, Mary; Redwood, Sabi; Leslie, Myles; Minion, Joel; Martin, Graham P; Coleman, Jamie J
2013-01-01
Context “Meaningful use” of electronic health records to improve quality of care has remained understudied. We evaluated an approach to improving patients’ safety and quality of care involving the secondary use of data from a hospital electronic prescribing and decision support system (ePDSS). Methods We conducted a case study of a large English acute care hospital with a well-established ePDSS. Our study was based on ethnographic observations of clinical settings (162 hours) and meetings (28 hours), informal conversations with clinical staff, semistructured interviews with ten senior executives, and the collection of relevant documents. Our data analysis was based on the constant comparative method. Findings This hospital's approach to quality and safety could be characterized as “technovigilance.” It involved treating the ePDSS as a warehouse of data on clinical activity and performance. The hospital converted the secondary data into intelligence about the performance of individuals, teams, and clinical services and used this as the basis of action for improvement. Through a combination of rapid audit, feedback to clinical teams, detailed and critical review of apparent omissions in executive-led meetings, a focus on personal professional responsibility for patients’ safety and quality care, and the correction of organizational or systems defects, technovigilance was—based on the hospital's own evidence—highly effective in improving specific indicators. Measures such as the rate of omitted doses of medication showed marked improvement. As do most interventions, however, technovigilance also had unintended consequences. These included the risk of focusing attention on aspects of patient safety made visible by the system at the expense of other, less measurable but nonetheless important, concerns. Conclusions The secondary use of electronic data can be effective for improving specific indicators of care if accompanied by a range of interventions to ensure proper interpretation and appropriate action. But care is needed to avoid unintended consequences. PMID:24028694
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Bonwitt, Jesse; Dawson, Michael; Kandeh, Martin; Ansumana, Rashid; Sahr, Foday; Brown, Hannah; Kelly, Ann H
2018-03-01
Following the 2013-2016 outbreak of Ebola virus disease (EVD) in West Africa, governments across the region imposed a ban on the hunting and consumption of meat from wild animals. This injunction was accompanied by public health messages emphasising the infectious potential of wild meat, or 'bushmeat.' Using qualitative methods, we examine the local reception and impact of these interventions. Fieldwork was focused in 9 villages in the Eastern and Southern provinces of Sierra Leone between August and December 2015. We conducted 47 semi-structured interviews, coordinated 12 informal group discussions, and conducted direct observations throughout. We also draw from research undertaken in Sierra Leone immediately before the outbreak, and from our participation in the EVD response in Guinea and Sierra Leone. Our findings underscore the social and political reverberations of hunting proscriptions. Messaging that unilaterally stressed the health risk posed by wild meat contradicted the experiences of target publics, who consume wild meat without incident. This epistemic dissonance radically undercut the effectiveness of the ban, which merely served to proliferate informal networks of wild animal trade and sale-rendering the development of acceptable, evidence-based surveillance and mitigation strategies for zoonotic spillovers almost impossible. Further, the criminalisation of wild meat consumption fuelled fears and rumours within communities under considerable strain from the health, social, and economic effects of the epidemic, entrenching distrust towards outbreak responders and exacerbating pre-existing tensions within villages. These unintended consequences are instructive for public health emergency response and preparedness. While wild meat is a risk for zoonotic infection, mitigating those risks entails interventions that fully take into account the local significances of hunting-including a communicative engagement that is designed, validated, and continually refined before emergency situations. Ultimately, our research questions the value of legal sanctions as a means of behavioural change in an emergency context. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Supplemental feeding alters migration of a temperate ungulate
Jones, Jennifer D; Kauffman, Matthew J.; Monteith, Kevin L.; Scurlock, Brandon M.; Albeke, Shannon E.; Cross, Paul C.
2014-01-01
Conservation of migration requires information on behavior and environmental determinants. The spatial distribution of forage resources, which migration exploits, often are altered and may have subtle, unintended consequences. Supplemental feeding is a common management practice, particularly for ungulates in North America and Europe, and carryover effects on behavior of this anthropogenic manipulation of forage are expected in theory, but have received limited empirical evaluation, particularly regarding effects on migration. We used global positioning system (GPS) data to evaluate the influence of winter feeding on migration behavior of 219 adult female elk (Cervus elaphus) from 18 fed ranges and 4 unfed ranges in western Wyoming. Principal component analysis revealed that the migratory behavior of fed and unfed elk differed in distance migrated, and the timing of arrival to, duration on, and departure from summer range. Fed elk migrated 19.2 km less, spent 11 more days on stopover sites, arrived to summer range 5 days later, resided on summer range 26 fewer days, and departed in the autumn 10 days earlier than unfed elk. Time-to-event models indicated that differences in migratory behavior between fed and unfed elk were caused by altered sensitivity to the environmental drivers of migration. In spring, unfed elk migrated following plant green-up closely, whereas fed elk departed the feedground but lingered on transitional range, thereby delaying their arrival to summer range. In autumn, fed elk were more responsive to low temperatures and precipitation events, causing earlier departure from summer range than unfed elk. Overall, supplemental feeding disconnected migration by fed elk from spring green-up and decreased time spent on summer range, thereby reducing access to quality forage. Our findings suggest that ungulate migration can be substantially altered by changes to the spatial distribution of resources, including those of anthropogenic origin, and that management practices applied in one season may have unintended behavioral consequences in subsequent seasons.
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Lebrun, Victoria; Muessig, Kathryn E
2016-01-01
Background Over 50% of pregnancies in the United States are unintended, meaning that the pregnancy is mistimed, unplanned, or unwanted. Unintended pregnancy increases health risks for mother and child, leads to high economic costs for society, and increases social disparities. Mobile phone ownership is rapidly increasing, providing opportunities to reach at-risk populations with reproductive health information and tailored unintended pregnancy prevention interventions through mobile phone apps. However, apps that offer support for unintended pregnancy prevention remain unevaluated. Objective To identify, describe, and evaluate mobile phone apps that purport to help users prevent unintended pregnancy. Methods We conducted an extensive search of the Apple iTunes and Android Google Play stores for apps that explicitly included or advertised pregnancy prevention or decision-making support in the context of fertility information/tracking, birth control reminders, contraceptive information, pregnancy decision-making, abortion information or counseling, sexual communication/negotiation, and pregnancy tests. We excluded apps that targeted medical professionals or that cost more than US $1.99. Eligible apps were downloaded and categorized by primary purpose. Data extraction was performed on a minimum of 143 attributes in 3 domains: (1) pregnancy prevention best practices, (2) contraceptive methods and clinical services, and (3) user interface. Apps were assigned points for their inclusion of features overall and for pregnancy prevention best practices and contraceptive information. Results Our search identified 6805 app descriptions in iTunes and Google Play. Of these, 218 unique apps met inclusion criteria and were included in the review. Apps were grouped into 9 categories: fertility trackers (n=72), centers and resources (n=38), birth control reminders (n=35), general sexual and reproductive health (SRH) information (n=17), SRH information targeted specifically to young adults (YA) (n=16), contraceptive information (n=15), service or condom locators (n=12), pregnancy tests (n=10), and games (n=3). Twelve apps scored at least 50 points (out of 94) for overall number of features and at least 15 points (out of 21) for contraceptive information and pregnancy prevention best practices. Overall, 41% of apps did not mention any modern contraceptive methods and 23% mentioned only 1 method. Of apps that did mention a modern contraceptive method, fewer than 50% of these apps provided information on how to use it. YA SRH apps had the highest percentage of pregnancy prevention best practices in each app. Demographic and interface evaluation found that most apps (72%) did not target any race and only 10% explicitly targeted youth. Communication interface features were present in fewer than 50% of apps. Conclusions This review identified several useful, evidence-based apps that support the prevention of unintended pregnancy. However, most apps miss opportunities to provide users with valuable information, interactive decision aids, and evidence-based interventions for unintended pregnancy prevention. Further, some apps in this space may increase the likelihood of unintended pregnancy due to the low effectiveness of the contraceptive methods promoted. PMID:26787311
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Mangone, Emily Rose; Lebrun, Victoria; Muessig, Kathryn E
2016-01-19
Over 50% of pregnancies in the United States are unintended, meaning that the pregnancy is mistimed, unplanned, or unwanted. Unintended pregnancy increases health risks for mother and child, leads to high economic costs for society, and increases social disparities. Mobile phone ownership is rapidly increasing, providing opportunities to reach at-risk populations with reproductive health information and tailored unintended pregnancy prevention interventions through mobile phone apps. However, apps that offer support for unintended pregnancy prevention remain unevaluated. To identify, describe, and evaluate mobile phone apps that purport to help users prevent unintended pregnancy. We conducted an extensive search of the Apple iTunes and Android Google Play stores for apps that explicitly included or advertised pregnancy prevention or decision-making support in the context of fertility information/tracking, birth control reminders, contraceptive information, pregnancy decision-making, abortion information or counseling, sexual communication/negotiation, and pregnancy tests. We excluded apps that targeted medical professionals or that cost more than US $1.99. Eligible apps were downloaded and categorized by primary purpose. Data extraction was performed on a minimum of 143 attributes in 3 domains: (1) pregnancy prevention best practices, (2) contraceptive methods and clinical services, and (3) user interface. Apps were assigned points for their inclusion of features overall and for pregnancy prevention best practices and contraceptive information. Our search identified 6805 app descriptions in iTunes and Google Play. Of these, 218 unique apps met inclusion criteria and were included in the review. Apps were grouped into 9 categories: fertility trackers (n=72), centers and resources (n=38), birth control reminders (n=35), general sexual and reproductive health (SRH) information (n=17), SRH information targeted specifically to young adults (YA) (n=16), contraceptive information (n=15), service or condom locators (n=12), pregnancy tests (n=10), and games (n=3). Twelve apps scored at least 50 points (out of 94) for overall number of features and at least 15 points (out of 21) for contraceptive information and pregnancy prevention best practices. Overall, 41% of apps did not mention any modern contraceptive methods and 23% mentioned only 1 method. Of apps that did mention a modern contraceptive method, fewer than 50% of these apps provided information on how to use it. YA SRH apps had the highest percentage of pregnancy prevention best practices in each app. Demographic and interface evaluation found that most apps (72%) did not target any race and only 10% explicitly targeted youth. Communication interface features were present in fewer than 50% of apps. This review identified several useful, evidence-based apps that support the prevention of unintended pregnancy. However, most apps miss opportunities to provide users with valuable information, interactive decision aids, and evidence-based interventions for unintended pregnancy prevention. Further, some apps in this space may increase the likelihood of unintended pregnancy due to the low effectiveness of the contraceptive methods promoted.
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Shifts in intended and unintended pregnancies in the United States, 2001-2008.
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.
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Device-tissue interactions: a collaborative communications system.
Chekan, Edward; Whelan, Richard L; Feng, Alexander H
2013-07-29
Medical devices, including surgical staplers, energy-based devices, and access enabling devices, are used routinely today in the majority of surgical procedures. Although these technically advanced devices have proved to be of immense benefit to both surgeons and patients, their rapid development and continuous improvement have had the unintended consequence of creating a knowledge gap for surgeons due to a lack of adequate training and educational programs. Thus, there is an unmet need in the surgical community to collect existing data on device-tissue interactions and subsequently develop research and educational programs to fill this gap in surgical training. Gathering data and developing these new programs will require collaboration between doctors, engineers, and scientists, from both clinical practice and industry. This paper presents a communications system to enable this unique collaboration that can potentially result in significantly improved patient care.
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Garcia, Carolyn M.; Long, Sharon K.; Lechner, Kate E.; Lust, Katherine; Eisenberg, Marla E.
2012-01-01
One provision of the 2010 Affordable Care Act is extension of dependent coverage for young adults aged up to 26 years on their parent’s private insurance plan. This change, meant to increase insurance coverage for young adults, might yield unintended consequences. Confidentiality concerns may be triggered by coverage through parental insurance, particularly regarding sexual health. The existing literature and our original research suggest that actual or perceived limits to confidentiality could influence the decisions of young adults about whether, and where, to seek care for sexual health issues. Further research is needed on the scope and outcomes of these concerns. Possible remedial actions include enhanced policies to protect confidentiality in billing and mechanisms to communicate confidentiality protections to young adults. PMID:22897544
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Antibiotic Stewardship Initiatives as Part of the UK 5-Year Antimicrobial Resistance Strategy
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
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Home and community care sector accountability.
Steele Gray, Carolyn; Berta, Whitney; Deber, Raisa B; Lum, Janet
2014-09-01
This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care. Copyright © 2014 Longwoods Publishing.
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Urban health and ecology: the promise of an avian biomonitoring tool
Pollack, Lea; Ondrasek, Naomi R.
2017-01-01
Abstract Urban-dwelling birds have the potential to serve as powerful biomonitors that reveal the impact of environmental change due to urbanization. Specifically, urban bird populations can be used to survey cities for factors that may pose both public and wildlife health concerns. Here, we review evidence supporting the use of avian biomonitors to identify threats associated with urbanization, including bioaccumulation of toxicants and the dysregulation of behavior and physiology by related stressors. In addition, we consider the use of birds to examine how factors in the urban environment can impact immunity against communicable pathogens. By studying the behavior, physiology, and ecology of urban bird populations, we can elucidate not only how avian populations are responding to environmental change, but also how unintended consequences of urbanization affect the well-being of human and non-human inhabitants. PMID:29491978
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Urban health and ecology: the promise of an avian biomonitoring tool.
Pollack, Lea; Ondrasek, Naomi R; Calisi, Rebecca
2017-04-01
Urban-dwelling birds have the potential to serve as powerful biomonitors that reveal the impact of environmental change due to urbanization. Specifically, urban bird populations can be used to survey cities for factors that may pose both public and wildlife health concerns. Here, we review evidence supporting the use of avian biomonitors to identify threats associated with urbanization, including bioaccumulation of toxicants and the dysregulation of behavior and physiology by related stressors. In addition, we consider the use of birds to examine how factors in the urban environment can impact immunity against communicable pathogens. By studying the behavior, physiology, and ecology of urban bird populations, we can elucidate not only how avian populations are responding to environmental change, but also how unintended consequences of urbanization affect the well-being of human and non-human inhabitants.
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Home and Community Care Sector Accountability
Gray, Carolyn Steele; Berta, Whitney; Deber, Raisa B.; Lum, Janet
2014-01-01
This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care. PMID:25305389
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Economic impacts of anthropogenic activities on coastlines of the United States
Magoon, Orville T.; Williams, S. Jeffress; Lent, Linda K.; Richmond, James A.; Treadwell, Donald D.; Douglass, Scott L.; Edge, Billy L.; Ewing, Lesley C.; Pratt, Anthony P.
2004-01-01
Anthropogenic activities primarily impact coasts by reducing sediment inputs, altering sediment transport processes, and accelerating sediment losses to the offshore. These activities include: sand and gravel extraction, navigation and shore protection works; non-structural shoreline management strategies such as beach nourishment, sand by-passing and beach scraping, dams and flood control works; channel and inlet dredging; subsidence caused by fluid extraction and reduction of carbonate beach material. Although many of these activities have improved the quality of life, they also have had unintended effects on the coast. The issues that arise from human alterations of the coast are common to many coastal regions around the world; this paper draws from several areas of the United States to present an overview and provisional assessment of the economic consequences of anthropogenic activities along the Pacific coast.
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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.
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Residual Inequity: Assessing the Unintended Consequences of New York City’s Clean Heat Transition
Carrión, Daniel; Lee, W. Victoria; Hernández, Diana
2018-01-01
Energy policies and public health are intimately intertwined. In New York City, a series of policies, known as the Clean Heat Program (CHP), were designed to reduce air pollution by banning residual diesel fuel oils, #6 in 2015 and #4 by 2030. This measure is expected to yield environmental and public health benefits over time. While there is near-universal compliance with the #6 ban, a substantial number of buildings still use #4. In this paper, geographic analysis and qualitative interviews with stakeholders were used to interrogate the CHP’s policy implementation in Northern Manhattan and the Bronx. A total of 1724 (53%) of all residential residual fuel burning buildings are located in this region. Stakeholders reflected mostly on the need for the program, and overall reactions to its execution. Major findings include that government partnerships with non-governmental organizations were effectively employed. However, weaknesses with the policy were also identified, including missed opportunities for more rapid transitions away from residual fuels, unsuccessful outreach efforts, cost-prohibitive conversion opportunities, and (the perception of) a volatile energy market for clean fuels. Ultimately, this analysis serves as a case study of a unique and innovative urban policy initiative to improve air quality and, consequently, public health. PMID:29324717
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Intimate partner violence and pregnancy: epidemiology and impact.
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.
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Increased Soluble Phosphorus Loads to Lake Erie: Unintended Consequences of Conservation Practices?
Jarvie, Helen P; Johnson, Laura T; Sharpley, Andrew N; Smith, Douglas R; Baker, David B; Bruulsema, Tom W; Confesor, Remegio
2017-01-01
Cumulative daily load time series show that the early 2000s marked a step-change increase in riverine soluble reactive phosphorus (SRP) loads entering the Western Lake Erie Basin from three major tributaries: the Maumee, Sandusky, and Raisin Rivers. These elevated SRP loads have been sustained over the last 12 yr. Empirical regression models were used to estimate the contributions from (i) increased runoff from changing weather and precipitation patterns and (ii) increased SRP delivery (the combined effects of increased source availability and/or increased transport efficiency of labile phosphorus [P] fractions). Approximately 65% of the SRP load increase after 2002 was attributable to increased SRP delivery, with higher runoff volumes accounting for the remaining 35%. Increased SRP delivery occurred concomitantly with declining watershed P budgets. However, within these watersheds, there have been long-term, largescale changes in land management: reduced tillage to minimize erosion and particulate P loss, and increased tile drainage to improve field operations and profitability. These practices can inadvertently increase labile P fractions at the soil surface and transmission of soluble P via subsurface drainage. Our findings suggest that changes in agricultural practices, including some conservation practices designed to reduce erosion and particulate P transport, may have had unintended, cumulative, and converging impacts contributing to the increased SRP loads, reaching a critical threshold around 2002. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.
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Health Plans' Early Response to Federal Parity Legislation for Mental Health and Addiction Services.
Horgan, Constance M; Hodgkin, Dominic; Stewart, Maureen T; Quinn, Amity; Merrick, Elizabeth L; Reif, Sharon; Garnick, Deborah W; Creedon, Timothy B
2016-02-01
In 2008, the federal Mental Health Parity and Addiction Equity Act (MHPAEA) passed, prohibiting U.S. health plans from subjecting mental health and substance use disorder (behavioral health) coverage to more restrictive limitations than those applied to general medical care. This require d some health plans to make changes in coverage and management of services. The aim of this study was to examine private health plans' early responses to MHPAEA (after its 2010 implementation), in terms of both intended and unintended effects. Data were from a nationally representative survey of commercial health plans regarding the 2010 benefit year and the preparity 2009 benefit year (weighted N=8,431 products; 89% response rate). Annual limits specific to behavioral health care were virtually eliminated between 2009 and 2010. Prevalence of behavioral health coverage was unchanged, and copayments for both behavioral and general medical services increased slightly. Prior authorization requirements for specialty medical and behavioral health outpatient services continued to decline, and the proportion of products reporting strict continuing review requirements increased slightly. Contrary to expectations, plans did not make significant changes in contracting arrangements for behavioral health services, and 80% reported an increase in size of their behavioral health provider network. The law had the intended effect of eliminating quantitative limitations that applied only to behavioral health care without unintended consequences such as eliminating behavioral health coverage. Plan decisions may also reflect other factors, including anticipation of the 2010 regulations and a continuation of trends away from requiring prior authorization.
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Deviant Globalization and the Unintended Consequences of Coca Eradication in Colombia
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
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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.
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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
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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
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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
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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
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[Psychiatric complications of abortion].
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. -
Unintended pregnancy and interpregnancy interval by maternal age, National Survey of Family Growth.
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.
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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.
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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
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Nelson, Erica; Edmonds, Alexander; Ballesteros, Marco; Encalada Soto, Diana; Rodriguez, Octavio
2014-01-01
This paper is an ethnography of a four-year, multi-disciplinary adolescent sexual and reproductive health intervention in Bolivia, Nicaragua and Ecuador. An important goal of the intervention – and of the larger global field of adolescent sexual and reproductive health – is to create more open parent-to-teen communication. This paper analyzes the project's efforts to foster such communication and how social actors variously interpreted, responded to, and repurposed the intervention's language and practices. While the intervention emphasized the goal of ‘open communication,’ its participants more often used the term ‘confianza’ (trust). This norm was defined in ways that might – or might not – include revealing information about sexual activity. Questioning public health assumptions about parent–teen communication on sex, in and of itself, is key to healthy sexual behavior, the paper explores a pragmatics of communication on sex that includes silence, implied expectations, gendered conflicts, and temporally delayed knowledge. PMID:25175294
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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.
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Quality measurement and improvement in liver transplantation.
Mathur, Amit K; Talwalkar, Jayant
2018-06-01
There is growing interest in the quality of health care delivery in liver transplantation. Multiple stakeholders, including patients, transplant providers and their hospitals, payers, and regulatory bodies have an interest in measuring and monitoring quality in the liver transplant process, and understanding differences in quality across centres. This article aims to provide an overview of quality measurement and regulatory issues in liver transplantation performed within the United States. We review how broader definitions of health care quality should be applied to liver transplant care models. We outline the status quo including the current regulatory agencies, public reporting mechanisms, and requirements around quality assurance and performance improvement (QAPI) activities. Additionally, we further discuss unintended consequences and opportunities for growth in quality measurement. Quality measurement and the integration of quality improvement strategies into liver transplant programmes hold significant promise, but multiple challenges to successful implementation must be addressed to optimise value. Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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Chersich, M F; Rees, H V
2010-01-01
South Africa has a massive burden of HIV and alcohol disease, and these pandemics are inextricably linked. Much evidence indicates that alcohol independently influences decisions around sex, and undermines skills for condom negotiation and correct use. Thus, not surprisingly, people with problem drinking in Africa have twofold higher risk for HIV than non-drinkers. Also, sexual violence incidents often coincide with heavy alcohol use, both among perpetrators and victims. Reducing alcohol harms necessitates both population- and individual-level interventions, especially raised taxation, regulation of alcohol advertising and provision of Brief Interventions. Alcohol counselling interventions must include discussion of linkages between alcohol and sex, and consequences thereof. Within positive-prevention services, alcohol reduction interventions could diminish HIV transmission. A trial is needed to definitively demonstrate that reduced drinking lowers HIV incidence. However, given available evidence, implementation of effective interventions could alleviate much alcohol-attributable disease, including unsafe sex, sexual violence, unintended pregnancy and, likely, HIV transmission.
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Interventions for preventing unintended pregnancies among adolescents.
Oringanje, Chioma; Meremikwu, Martin M; Eko, Hokehe; Esu, Ekpereonne; Meremikwu, Anne; Ehiri, John E
2016-02-03
Unintended pregnancy among adolescents represents an important public health challenge in high-income countries, as well as middle- and low-income countries. Numerous prevention strategies such as health education, skills-building and improving accessibility to contraceptives have been employed by countries across the world, in an effort to address this problem. However, there is uncertainty regarding the effects of these interventions, hence the need to review the evidence-base. To assess the effects of primary prevention interventions (school-based, community/home-based, clinic-based, and faith-based) on unintended pregnancies among adolescents. We searched all relevant studies regardless of language or publication status up to November 2015. We searched the Cochrane Fertility Regulation Group Specialised trial register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015 Issue 11), MEDLINE, EMBASE, LILACS, Social Science Citation Index and Science Citation Index, Dissertations Abstracts Online, The Gray Literature Network, HealthStar, PsycINFO, CINAHL and POPLINE and the reference lists of articles. We included both individual and cluster randomised controlled trials (RCTs) evaluating any interventions that aimed to increase knowledge and attitudes relating to risk of unintended pregnancies, promote delay in the initiation of sexual intercourse and encourage consistent use of birth control methods to reduce unintended pregnancies in adolescents aged 10 years to 19 years. Two authors independently assessed trial eligibility and risk of bias, and extracted data. Where appropriate, binary outcomes were pooled using a random-effects model with a 95% confidence interval (Cl). Where appropriate, we combined data in meta-analyses and assessed the quality of the evidence using the GRADE approach. We included 53 RCTs that enrolled 105,368 adolescents. Participants were ethnically diverse. Eighteen studies randomised individuals, 32 randomised clusters (schools (20), classrooms (6), and communities/neighbourhoods (6). Three studies were mixed (individually and cluster randomised). The length of follow up varied from three months to seven years with more than 12 months being the most common duration. Four trials were conducted in low- and middle- income countries, and all others were conducted in high-income countries. Multiple interventionsResults showed that multiple interventions (combination of educational and contraceptive-promoting interventions) lowered the risk of unintended pregnancy among adolescents significantly (RR 0.66, 95% CI 0.50 to 0.87; 4 individual RCTs, 1905 participants, moderate quality evidence. However, this reduction was not statistically significant from cluster RCTs. Evidence on the possible effects of interventions on secondary outcomes (initiation of sexual intercourse, use of birth control methods, abortion, childbirth, sexually transmitted diseases) was not conclusive.Methodological strengths included a relatively large sample size and statistical control for baseline differences, while limitations included lack of biological outcomes, possible self-report bias, analysis neglecting clustered randomisation and the use of different statistical tests in reporting outcomes. Educational interventionsEducational interventions were unlikely to significantly delay the initiation of sexual intercourse among adolescents compared to controls (RR 0.95, 95% CI 0.71 to 1.27; 2 studies, 672 participants, low quality evidence).Educational interventions significantly increased reported condom use at last sex in adolescents compared to controls who did not receive the intervention (RR 1.18, 95% CI 1.06 to 1.32; 2 studies, 1431 participants, moderate quality evidence).However, it is not clear if the educational interventions had any effect on unintended pregnancy as this was not reported by any of the included studies. Contraceptive-promoting interventionsFor adolescents who received contraceptive-promoting interventions, there was little or no difference in the risk of unintended first pregnancy compared to controls (RR 1.01, 95% CI 0.81 to 1.26; 2 studies, 3,440 participants, moderate quality evidence).The use of hormonal contraceptives was significantly higher in adolescents in the intervention group compared to those in the control group (RR 2.22, 95% CI 1.07 to 4.62; 2 studies, 3,091 participants, high quality evidence) A combination of educational and contraceptive-promoting interventions appears to reduce unintended pregnancy among adolescents. Evidence for programme effects on biological measures is limited. The variability in study populations, interventions and outcomes of included trials, and the paucity of studies directly comparing different interventions preclude a definitive conclusion regarding which type of intervention is most effective.
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Can tobacco control endgame analysis learn anything from the US experience with illegal drugs?
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.
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Epidemiological Criminology: Contextualization of HIV/AIDS Health Care for Female Inmates.
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.
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Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya.
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.