WorldWideScience

Sample records for previous approaches needed

  1. Need for a multidisciplinary approach

    International Nuclear Information System (INIS)

    Foersund, Hans Martin; Kristoffersen, Lasse; Skaatun, Helge; Dragsund, Egil

    2004-01-01

    Transportation of oil poses significant environmental risks. Effective reduction of those risks require an integrated approach, including the legal and institutional aspects, waste reception facilities in ports, navigational risk assessment, oil spill modelling, environmental sensitivity mapping and oil spill contingency planning. Proper management starts with an integrated study of oil pollution risk management, covering both oil pollution as a consequence of operational discharges and as a consequence of accidents. However, as the two areas of oil pollution management are different, they therefore require separate approaches

  2. A Survey of Patients' Preoperative Need for Information About Postoperative Pain-Effect of Previous Surgery Experience.

    Science.gov (United States)

    Mavridou, Paraskevi; Manataki, Adamantia; Arnaoutoglou, Elena; Damigos, Dimitrios

    2017-10-01

    The aim of this study was to determine the kind of information patients need preoperatively about postoperative pain (POP) and whether this is affected by previous surgery experience. A descriptive study design using preoperative questionnaires. Questionnaires with fixed questions related to POP and its management were distributed preoperatively to consenting, consecutive surgical patients. Patients were divided into two groups: patients with previous surgery experience (group A) and patients without previous surgery experience (group B). Of the patients who participated in the study, 94.2% wanted information about POP and 77.8% of them believe that they will feel calmer if they get the information they need. The patients' biggest concern relates to pain management issues after discharge. Next, in order of preference is information about the analgesics that they need to take. The patients want to be informed primarily with a personal interview (59.4%). Previous surgery experience has no effect on patients' needs for information. Most of the patients want to be informed about the management of the POP after being discharged. It is remarkable that patients who had previous surgery experience need the same information with those who had no previous surgery. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  3. A website evaluation model by integration of previous evaluation models using a quantitative approach

    Directory of Open Access Journals (Sweden)

    Ali Moeini

    2015-01-01

    Full Text Available Regarding the ecommerce growth, websites play an essential role in business success. Therefore, many authors have offered website evaluation models since 1995. Although, the multiplicity and diversity of evaluation models make it difficult to integrate them into a single comprehensive model. In this paper a quantitative method has been used to integrate previous models into a comprehensive model that is compatible with them. In this approach the researcher judgment has no role in integration of models and the new model takes its validity from 93 previous models and systematic quantitative approach.

  4. The Role of Birth/Previously Adopted Children in Families Choosing to Adopt Children with Special Needs.

    Science.gov (United States)

    Mullin, Ellen Steele; Johnson, LeAnne

    1999-01-01

    Notes that successful child placement depends on engaging birth or previously adopted children during the adoption process, yet other children are often overlooked when parents are adopting a special-needs child. Presents a model which recognizes dynamics of strength and vulnerability and applies that model to preparing and supporting the adoptive…

  5. Sleep need in adolescents: a longitudinal approach.

    Science.gov (United States)

    Strauch, I; Meier, B

    1988-08-01

    A sample of 190 male and female "high school" students completed a sleep questionnaire for the first time when they were 10 to 14 years old. The survey was repeated five times at 2 year intervals. Ninety-three subjects answered the questionnaire each time. Subjective sleep need was assessed by the indicated wish for more sleep. The wish for more sleep was very pronounced, varying between 54.3% and 74.5% across the years. Individual consistency, however, was low since only 14.5% of the adolescents indicated the wish for more sleep in each survey, emphasizing the state dependency of this variable. Within each total sample, subjects with the wish for more sleep (MSL) and with sufficient sleep (SSL) were compared. Subjective sleep need was consistently validated by a syndrome of morning-tiredness. In the last two surveys, there was reduced time in bed (TIB) on weekdays in MSL subjects and longer TIB during vacation in surveys 2 through 5. Furthermore, MSL subjects more often showed irregular sleep habits. The previous sleep history of the MSL subjects in the last survey indicated that concomitants of the wish for more sleep were already experienced earlier in adolescence. The desired sleep duration of these subjects was 1.7 h longer than their current sleep on weekdays, an amount they had not obtained on weekdays since early adolescence. It is concluded that a substantial proportion of the adolescents seem to have had difficulties adapting to the general sleep time reduction occurring in adolescence.

  6. Sustainable development, tourism and territory. Previous elements towards a systemic approach

    Directory of Open Access Journals (Sweden)

    Pierre TORRENTE

    2009-01-01

    Full Text Available Today, tourism is one of the major challenges for many countries and territories. The balance of payments, an ever-increasing number of visitors and the significant development of the tourism offer clearly illustrate the booming trend in this sector. This macro-economic approach is often used by the organizations in charge of tourism, WTO for instance. Quantitative assessments which consider the satisfaction of customers’ needs as an end in itself have prevailed both in tourism development schemes and in prospective approaches since the sixties.

  7. Comprehensive Approach Training Toolkit: Training Needs Analysis

    Science.gov (United States)

    2013-03-01

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  8. Accessibility patterns and community integration among previously homeless adults: a Geographic Information Systems (GIS) approach.

    Science.gov (United States)

    Chan, Dara V; Gopal, Sucharita; Helfrich, Christine A

    2014-11-01

    Although a desired rehabilitation goal, research continues to document that community integration significantly lags behind housing stability success rates for people of a variety of ages who used to be homeless. While accessibility to resources is an environmental factor that may promote or impede integration activity, there has been little empirical investigation into the impact of proximity of community features on resource use and integration. Using a Geographic Information Systems (GIS) approach, the current study examines how accessibility or proximity to community features in Boston, United States related to the types of locations used and the size of an individual's "activity space," or spatial presence in the community. Significant findings include an inverse relationship between activity space size and proximity to the number and type of community features in one's immediate area. Specifically, larger activity spaces were associated with neighborhoods with less community features, and smaller activity spaces corresponded with greater availability of resources within one's immediate area. Activity space size also varied, however, based on proximity to different types of resources, namely transportation and health care. Greater community function, or the ability to navigate and use community resources, was associated with better accessibility and feeling part of the community. Finally, proximity to a greater number of individual identified preferred community features was associated with better social integration. The current study suggests the ongoing challenges of successful integration may vary not just based on accessibility to, but relative importance of, specific community features and affinity with one's surroundings. Community integration researchers and housing providers may need to attend to the meaning attached to resources, not just presence or use in the community. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Correlation between coronary artery calcification and the need for revascularization in patients with no previous diagnosis of arterial coronary disease

    Energy Technology Data Exchange (ETDEWEB)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Bello, Juliana Hiromi Silva Matsumoto [Instituto do Coracao (InCor/FM/USP), Sao paulo, SP (Brazil); Magalhaes, Tiago Augusto [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil); Moreira, Valeria de Melo; Carlos Eduardo Rochitte, E-mail: rochitte@gmail.com, E-mail: crochitte@hcor.com.br [Hospital do Coracao (HCOR), Sao Paulo, SP (Brazil)

    2012-10-15

    Introduction: about half of deaths from coronary heart disease (CHD) are not preceded by cardiac symptoms or previous diagnosis. Quantification of coronary artery calcification (CAC) by computed tomography is a strong predictor of events and improves the stratification the Framingham Risk Score. Objective: to evaluate the ability of the calcium score to predict the necessity invasive treatment (bypass (CABG) or intervention coronary percutaneous (ICP)) with no previous CAD. Method: retrospective study in pts without prior CAD and with quantification of CAC during 2009. The CAC was obtained in 64 multislice CT without contrast, with synchronized ECG acquisition, 120kV, 80-100mA, radiation <1mSv, and measured by the Agatston calcium score (CS) (threshold of 130 HU). Mean, median, and diagnostic tests were used. Results: We evaluated 263 pts (171 men), 59±13 years, BMI = 27.7 kg/m2, and mean follow up of 18±3 months. The total CS was 199.5±24.39. In patients with diabetes (DM), the CS was 320.5±67.56 and 166±24.47 in non-DM. The 23 patients who underwent invasive treatment had an average CS of 692 ± 72.3 versus 134.7 ± 21.35 in patients not treated (p <0.001). Of the 47 pts with CS ≥ 400, 17 were treated (CABG or ICP). Of the 216 pts with CS <400, 6 underwent treatment. Of the treated pts, 15 without diabetes had average CS 672.7 ± 92.04 versus 728.3 ± 11 of DM (8pts). In pts without DM who not underwent invasive treatment (191 pts), only 18 pts had SC ≥ 400. Conclusion: CS ≥ 400 was a strong predictor of revascularization (CABG or ICP) with good diagnostic performance in patients without prior diagnosis of CAD in the following 18 months. (author)

  10. Need for multiple approaches in collaborative software development

    International Nuclear Information System (INIS)

    LePoire, D. J.

    2002-01-01

    The need to share software and reintegrate it into new applications presents a difficult but important challenge. Component-based development as an approach to this problem is receiving much attention in professional journals and academic curricula. However, there are many other approaches to collaborative software development that might be more appropriate. This paper reviews a few of these approaches and discusses criteria for the conditions and contexts in which these alternative approaches might be more appropriate. This paper complements the discussion of context-based development team organizations and processes. Examples from a small development team that interacts with a larger professional community are analyzed

  11. Treatment response in psychotic patients classified according to social and clinical needs, drug side effects, and previous treatment; a method to identify functional remission.

    Science.gov (United States)

    Alenius, Malin; Hammarlund-Udenaes, Margareta; Hartvig, Per; Sundquist, Staffan; Lindström, Leif

    2009-01-01

    Various approaches have been made over the years to classify psychotic patients according to inadequate treatment response, using terms such as treatment resistant or treatment refractory. Existing classifications have been criticized for overestimating positive symptoms; underestimating residual symptoms, negative symptoms, and side effects; or being to open for individual interpretation. The aim of this study was to present and evaluate a new method of classification according to treatment response and, thus, to identify patients in functional remission. A naturalistic, cross-sectional study was performed using patient interviews and information from patient files. The new classification method CANSEPT, which combines the Camberwell Assessment of Need rating scale, the Udvalg for Kliniske Undersøgelser side effect rating scale (SE), and the patient's previous treatment history (PT), was used to group the patients according to treatment response. CANSEPT was evaluated by comparison of expected and observed results. In the patient population (n = 123), the patients in functional remission, as defined by CANSEPT, had higher quality of life, fewer hospitalizations, fewer psychotic symptoms, and higher rate of workers than those with the worst treatment outcome. In the evaluation, CANSEPT showed validity in discriminating the patients of interest and was well tolerated by the patients. CANSEPT could secure inclusion of correct patients in the clinic or in research.

  12. Negative Measures Are Not Enough, A Constructive Approach Is Needed

    International Nuclear Information System (INIS)

    Broda, E.

    1983-01-01

    This text is Broda’s contribution to the Pugwash Symposium 1983 in Bucharest. In this document Broda analyses the paramount problem of his time: peace and especially the avoidance of atomic war. He explains further that ‘negative measures’ like the demands for an atomic freeze and disarmament are not sufficient, but a constructive approach is needed. For this constructive approach Broda assigns an important role to international organizations like IAEA a.o. (nowak)

  13. Human Needs as an Approach to Designed Landscapes

    Directory of Open Access Journals (Sweden)

    Dalia Aly

    2018-03-01

    Full Text Available The traditional approach of landscape architecture has always focused on the aesthetic and visual aspects of landscapes while giving less attention to other aspects. This view has limited the benefits that can be derived from designed landscapes, despite the wide-ranging potential they carry for humans; socially, environmentally and economically. As a result, many researchers and practitioners are currently challenging this view to develop a more holistic and multidimensional approach. The present research therefore aims at proposing a new perspective for public designed landscapes based on fundamental human needs. The study methodology was comprised of critical content analysis for three main domains: sustainable development, human needs in specific relation to public landscapes, and significant approaches to fundamental human needs. Reconciliation among these domains was achieved based on a modified version of Max-Neef’s matrix of fundamental human needs. Human needs in public landscapes were merged into the matrix to reach a comprehensive yet specific perspective. The study concluded with a conceptual framework that can provide a wider perspective to human needs in designed landscapes. It proposes a new tool for the analysis of the benefits of public landscapes and their value for humans, which can be further used in various applications.

  14. The effects of informal carers' characteristics on their information needs: The information needs state approach.

    Science.gov (United States)

    Alzougool, Basil; Chang, Shanton; Gray, Kathleen

    2017-09-01

    There has been little research that provides a comprehensive account of the nature and aspects of information needs of informal carers. The authors have previously developed and validated a framework that accounts for major underlying states of information need. This paper aims to apply this framework to explore whether there are common demographic and socioeconomic characteristics that affect the information needs states of carers. A questionnaire about the information needs states was completed by 198 carers above 18 years old. We use statistical methods to look for similarities and differences in respondents' information needs states, in terms of the demographic and socioeconomic variables. At least one information needs state varies among carers, in terms of seven demographic and socioeconomic variables: the age of the patient(s) that they are caring for; the condition(s) of the patient(s) that they are caring for; the number of patients that they are caring for; their length of time as a carer; their gender; the country that they live in; and the population of the area that they live in. The findings demonstrate the utility of the information needs state framework. We outline some practical implications of the framework.

  15. A systematic approach to training: A training needs assessment

    Science.gov (United States)

    Manning, Margaret H.

    1989-01-01

    In an effort to determine the gap between the actual performance and the necessary performance of employees for the effective and efficient accomplishment of an organization's mission and goals, an organization-wide Training Needs Assessment must be conducted. The purpose of this work was to conduct a training needs analysis and prepare a NASA Langley Catalog of On-Site Training programs. The work included developing a Training Needs Assessment Survey, implementing the survey, analyzing and researching the training needs, identifying the courses to meet the needs, and preparing and designing an On-Site Training Catalog. This needs analysis attempted to identify performance weaknesses and deficits; seek out and provide opportunities for improved performance; anticipate and avoid future problems; enhance and create new strengths. The end product is a user-friendly catalog of on-site training available. The results include: top-down approach to needs assessment; improved communication with training coordinators; 98 percent return rate of the Training Needs Assessment survey; complete, newly designed, user-friendly catalog; 167 catalog descriptions advertised; 82 new courses advertised; training logo; and request for the training application form.

  16. The neural correlates of consciousness: new experimental approaches needed?

    Science.gov (United States)

    Hohwy, Jakob

    2009-06-01

    It appears that consciousness science is progressing soundly, in particular in its search for the neural correlates of consciousness. There are two main approaches to this search, one is content-based (focusing on the contrast between conscious perception of, e.g., faces vs. houses), the other is state-based (focusing on overall conscious states, e.g., the contrast between dreamless sleep vs. the awake state). Methodological and conceptual considerations of a number of concrete studies show that both approaches are problematic: the content-based approach seems to set aside crucial aspects of consciousness; and the state-based approach seems over-inclusive in a way that is hard to rectify without losing sight of the crucial conscious-unconscious contrast. Consequently, the search for the neural correlates of consciousness is in need of new experimental paradigms.

  17. Translational research-the need of a new bioethics approach.

    Science.gov (United States)

    Hostiuc, Sorin; Moldoveanu, Alin; Dascălu, Maria-Iuliana; Unnthorsson, Runar; Jóhannesson, Ómar I; Marcus, Ioan

    2016-01-15

    Translational research tries to apply findings from basic science to enhance human health and well-being. Many phases of the translational research may include non-medical tasks (information technology, engineering, nanotechnology, biochemistry, animal research, economy, sociology, psychology, politics, and so on). Using common bioethics principles to these areas might sometimes be not feasible, or even impossible. However, the whole process must respect some fundamental, moral principles. The purpose of this paper is to argument the need for a different approach to the morality in translational bioethics, and to suggest some directions that might be followed when constructing such a bioethics. We will show that a new approach is needed and present a few ethical issues that are specific to the translational research.

  18. Determining organizational information needs: the Critical Success Factors approach.

    Directory of Open Access Journals (Sweden)

    2001-01-01

    Full Text Available Reports on a series of investigations in the UK and Finland, in both academic and business institutions. The Critical Success Factors approach is defined and explored as a means of determining the information needs of organizations, rather than of individuals. Concludes that such use is appropriate and productive, enabling the identification of types of information that may aid the organization in its strategic policy making to achieve competitive advantage.

  19. Complex Needs or Simplistic Approaches? Homelessness Services and People with Complex Needs in Edinburgh

    Directory of Open Access Journals (Sweden)

    Manuel Macias Balda

    2016-10-01

    Full Text Available This research addresses how homelessness services from the statutory and voluntary sector are working for people with complex needs in the City of Edinburgh. Using a qualitative approach, it analyses the service providers’ perspectives on the concept, challenges and what works when dealing with this group of people. It also explores the opinions of a sample of service users, categorised as having complex needs, regarding the accommodation and support they are receiving. After analysing the data, it is argued that homelessness agencies do not have an appropriate cognitive nor institutional framework that facilitates an effective approach to work with people with complex needs. The lack of a sophisticated understanding that recognises the relational difficulties of individuals and the presence of structural, organisational, professional and interpersonal barriers hinder the development of positive long-term relationships which is considered as the key factor of change. For this reason, it is recommended to address a set of factors that go beyond simplistic and linear approaches and move towards complex responses in order to tackle homelessness from a broader perspective and, ultimately, achieve social inclusion.

  20. Endovascular approach to treat ascending aortic pseudoaneurysm in a patient with previous CABG and very high surgical risk.

    Science.gov (United States)

    Zago, Alexandre C; Saadi, Eduardo K; Zago, Alcides J

    2011-10-01

    Pseudoaneurysm of the ascending aorta is an uncommon pathology and a challenge in high-risk patients who undergo conventional surgery because of high operative morbidity and mortality. Endovascular exclusion of an aortic pseudoaneurysm using an endoprosthesis is a less invasive approach, but few such cases have been reported. Moreover, the use of this approach poses unique therapeutic challenges because there is no specific endoprosthesis for ascending aortic repair, particularly to treat patients with previous coronary artery bypass graft (CABG). We describe the case of a 74-year-old patient who had undergone CABG and later presented with an iatrogenic ascending aortic pseudoaneurysm that occurred during an angiography. This patient was at very high risk for surgical treatment and, therefore, an endovascular approach was adopted: percutaneous coronary intervention for the left main coronary artery, left anterior descending and left circumflex native coronary arteries followed by endovascular endoprosthesis deployment in the ascending aorta to exclude the pseudoaneurysm. Both procedures were successfully performed, and the patient was discharged without complications 4 days later. At 5 months' clinical follow-up, his clinical condition was good and he had no complications. Copyright © 2011 Wiley-Liss, Inc.

  1. Struggling against suicide: the need for an integrative approach.

    Science.gov (United States)

    De Leo, Diego

    2002-01-01

    Transcultural comparisons would be beneficial for both our understanding of suicide phenomena and the setting up of preventative strategies. Changes in attitude throughout history, gender and age differences, socio-economic factors, influence of race and ethnicity, and the impact of religion are among the aspects mentioned in this article. All of them can actually have a considerable effect on suicide rates, and all of them should be taken into account when interpreting suicide trends and designing antisuicide strategies. In fact, both risk and protective factors may vary remarkably in different cultures. The need for an integrative approach is evident today more than ever, and this fact calls for more concerted and coordinated, multidisciplinary approaches to suicide prevention.

  2. Diversity Management Change Projects: In Need of Alternative Conceptual Approaches?

    Directory of Open Access Journals (Sweden)

    Christina Evans

    2012-09-01

    Full Text Available Drawing on a meta-analysis of an evaluation of a European Social Fund project aimed at enhancing employment opportunities for women in Information Technology, Electronic and Computing (ITEC, this paper critically debates how effectual a diversity management approach alone is as an underpinning rationale for change in the complex area of diversity. The paper draws on the experiences of ‘partner organizations’, gathered through interviews conducted during the evaluation stage of the project. The paper discusses some of the tensions experienced by partner organizations, thus providing new insights into why such projects are not as effectual as they might be. The paper concludes by presenting a case for the need to re-conceptualise how change as part of a wider diversity management approach might best be conceptualized. We suggest that a ‘systems approach’ could prove a more fruitful way of conceptualizing change of this nature given the inter-dependences between different organizations and institutions.

  3. Ecosystem approach to inland fisheries: research needs and implementation strategies

    Science.gov (United States)

    Beard, T. Douglas; Arlinghaus, Robert; Cooke, Steven J.; McIntyre, Peter B.; De Silva, Sena; Bartley, Devin M.; Cowx, Ian G.

    2011-01-01

    Inland fisheries are a vital component in the livelihoods and food security of people throughout the world, as well as contributing huge recreational and economic benefits. These valuable assets are jeopardized by lack of research-based understanding of the impacts of fisheries on inland ecosystems, and similarly the impact of human activities associated with inland waters on fisheries and aquatic biodiversity. To explore this topic, an international workshop was organized in order to examine strategies to incorporate fisheries into ecosystem approaches for management of inland waters. To achieve this goal, a new research agenda is needed that focuses on: quantifying the ecosystem services provided by fresh waters; quantifying the economic, social and nutritional benefits of inland fisheries; improving assessments designed to evaluate fisheries exploitation potential; and examining feedbacks between fisheries, ecosystem productivity and aquatic biodiversity. Accomplishing these objectives will require merging natural and social science approaches to address coupled social–ecological system dynamics.

  4. Swedish approach to information needs in severe accident situations

    Energy Technology Data Exchange (ETDEWEB)

    Soederman, E. (ES-Konsult AB, Stockholm (Sweden)); Karnik, P. (ES-Konsult AB, Stockholm (Sweden))

    1992-07-01

    In Sweden, systems for mitigating severe accidents have been installed at all plants and procedures have been implemented for accident management. This work has included the assessment of needs of information and the survivability of existing instrumentation during the various phases of an accident scenario. The approach has been pragmatic and based on existing knowledge of accident phenomenology and MAAP code calculations together with plant staff experience of detailed plant design and installation. During the early phases of accidents, which is defined to remain up to maximum fuel temperatures in the order of 800 C, the ordinary instrumentation is to a great extent useful. The reactor vessel level measurement is however identified to be weak in BWRs as soon as the core is partly uncovered. This has lead to the development of a Core Cooling Monitor. In later phases of accident scenarios, the general basis has been that no intrumentation inside the containment can survive. It has been analysed what information is strictly needed. It has been found that detailed information of the status inside the pressure vessel is of little importance after vessel penetration. Certain important information needs have been identified, that was not safely accessible from existing instrumentation. This had lead to complementary installations, using instruments inserted into the containment through protected guide tubes. Also for sampling of gas and water complementary installations have been made. (orig.)

  5. Swedish approach to information needs in severe accident situations

    International Nuclear Information System (INIS)

    Soederman, E.; Karnik, P.

    1992-01-01

    In Sweden, systems for mitigating severe accidents have been installed at all plants and procedures have been implemented for accident management. This work has included the assessment of needs of information and the survivability of existing instrumentation during the various phases of an accident scenario. The approach has been pragmatic and based on existing knowledge of accident phenomenology and MAAP code calculations together with plant staff experience of detailed plant design and installation. During the early phases of accidents, which is defined to remain up to maximum fuel temperatures in the order of 800 C, the ordinary instrumentation is to a great extent useful. The reactor vessel level measurement is however identified to be weak in BWRs as soon as the core is partly uncovered. This has lead to the development of a Core Cooling Monitor. In later phases of accident scenarios, the general basis has been that no intrumentation inside the containment can survive. It has been analysed what information is strictly needed. It has been found that detailed information of the status inside the pressure vessel is of little importance after vessel penetration. Certain important information needs have been identified, that was not safely accessible from existing instrumentation. This had lead to complementary installations, using instruments inserted into the containment through protected guide tubes. Also for sampling of gas and water complementary installations have been made. (orig.)

  6. Designing sustainable work systems: the need for a systems approach.

    Science.gov (United States)

    Zink, Klaus J

    2014-01-01

    There is a growing discussion concerning sustainability. While this discussion was at first mainly focused on a society level--and sometimes regarding especially environmental problems, one can now see that this topic is of increasing relevance for companies worldwide and even the social dimension of this three pillar approach is gaining more and more importance. This leads to some questions: Is sustainability already a part of human factors thinking or do we have to further develop our discipline? How can we define sustainable work systems? What are the topics we have to consider? Do we need a new systems ergonomics perspective regarding whole value creation chains and a life-cycle perspective concerning products (and work systems)? How can we deal with potential contradictions about social, ecological, and economic goals? Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  7. The Need for an Informational Systems Approach to Security

    Directory of Open Access Journals (Sweden)

    José María Díaz Nafría

    2011-03-01

    Full Text Available Different senses of security and its related assumptions, methodologies and contexts are analyzed by first reviewing the liberalistic notions of security and trust, unveiling, on the one hand, the contradictions exhibited between discourse and practice; on the other hand, the historical strategy of concentration of power behind the liberalistic doctrines. The weakness, limits and implications of the liberalistic notions and methods on security and trust are inquired, and subsequently a genuine horizon of security as sustainable and general procurement of positive freedom is advocated. The CyberSyn project successfully implemented in Chile, but tragically and prematurely ending under the hard power in the 9/11 of 1973, serves as model of the posed system approach to security. However, the system model is actualized and completed with elements of the general theory of information in virtue of: the increased complexity of societal systems, its ultimate global dimension, its biospherical closure, the increase of information assets and processes, and some epistemological boundaries. These reasons also set the need of keeping – beside the system approach – a critical and ethical stance.

  8. Distributed Electrical Energy Systems: Needs, Concepts, Approaches and Vision

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Yingchen [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Zhang, Jun [University of Denver; Gao, Wenzhong [University of Denver; Zheng, Xinhu [University of Minnesota; Yang, Liuqing [Colorado State University; Hao, Jun [University of Denver; Dai, Xiaoxiao [University of Denver

    2017-09-01

    Intelligent distributed electrical energy systems (IDEES) are featured by vast system components, diversifled component types, and difficulties in operation and management, which results in that the traditional centralized power system management approach no longer flts the operation. Thus, it is believed that the blockchain technology is one of the important feasible technical paths for building future large-scale distributed electrical energy systems. An IDEES is inherently with both social and technical characteristics, as a result, a distributed electrical energy system needs to be divided into multiple layers, and at each layer, a blockchain is utilized to model and manage its logic and physical functionalities. The blockchains at difierent layers coordinate with each other and achieve successful operation of the IDEES. Speciflcally, the multi-layer blockchains, named 'blockchain group', consist of distributed data access and service blockchain, intelligent property management blockchain, power system analysis blockchain, intelligent contract operation blockchain, and intelligent electricity trading blockchain. It is expected that the blockchain group can be self-organized into a complex, autonomous and distributed IDEES. In this complex system, frequent and in-depth interactions and computing will derive intelligence, and it is expected that such intelligence can bring stable, reliable and efficient electrical energy production, transmission and consumption.

  9. Comparative efficacy of tadalafil once daily in men with erectile dysfunction who demonstrated previous partial responses to as-needed sildenafil, tadalafil, or vardenafil.

    Science.gov (United States)

    Kim, Edward; Seftel, Allen; Goldfischer, Evan; Baygani, Simin; Burns, Patrick

    2015-02-01

    Phosphodiesterase type-5 inhibitors (PDE5Is) are first-line therapies for erectile dysfunction (ED). Sildenafil (SIL) and vardenafil (VAR) are approved for as-needed (PRN) dosing; tadalafil (TAD) is approved for both PRN and once-a-day (OaD) dosing for ED. Recent evidence suggests that TAD-OaD may be effective as therapy in men with an incomplete response to PRN-PDE5I therapy. This study evaluated whether TAD-OaD provides similar efficacy in men with ED who had previously demonstrated a partial response to PRN-PDE5I therapy. In this randomized, double-blind, placebo-controlled trial, men with a ≥3 month ED history received SIL 100 mg, TAD 20 mg, or VAR 20 mg during a 4 week open-label lead-in period. Those with International Index of Erectile Function - Erectile Function (IIEF-EF) domain scores TAD 2.5 mg up-titrated to 5 mg, TAD 5 mg, or placebo (PBO) OaD for 12 weeks. MAIN OUTCOME MEASURES obtained from patients treated with TAD-OaD were compared to PBO-treated patients. Additionally, results of treatment with TAD-OaD were compared to results obtained from 4 week PRN-PDE5I therapy to determine whether OaD and PRN regimens provided comparable efficacy. NCT01130532. International Index of Erectile Function (IIEF) domain scores; Sexual Encounter Profile (SEP) questions 2-5. Endpoint data was obtained from 590 men (391 TAD; 199 PBO). RESULTS for all IIEF and SEP measures were significantly better for TAD-OaD (p TAD 2.5 mg and TAD 5 mg OaD therapy were safe and generally well tolerated. Tadalafil once daily is a viable alternative to as-needed PDE5I therapy in men with ED. Key limitations include the lack of a PRN PDE5I study group during the double-blind period, and that many more patients took tadalafil than sildenafil or vardenafil during the PRN period.

  10. Unmet belongingness needs but not high belongingness needs alone predict adverse well-being; A response surface modeling approach

    NARCIS (Netherlands)

    Verhagen, M.; Lodder, G.M.A.; Baumeister, R.F.

    2018-01-01

    Objective: Previous work has linked high levels of belongingness needs to low well-being, suggesting that high desire for social connection causes problems. Against that view, we hypothesized that problems stem especially from unmet belongingness needs. To examine this, discrepancies between

  11. Assessing Language Needs Within an Institutional Context: An Ethnographic Approach.

    Science.gov (United States)

    Holliday, Adrian

    1995-01-01

    This article describes an analysis of English-language needs of an oil company in the Middle East, exploring the role of ethnography in carrying out the holistic research necessary to obtain a clear picture of the company's needs. It includes a discussion of the project's findings and recommendations for language training. (11 references) (MDM)

  12. The Power of Behavioural Approaches--We Need a Revival

    Science.gov (United States)

    Buckley, Sue

    2008-01-01

    Behavioural approaches can be used effectively to teach new skills and to change behaviours that are challenging and not socially adaptive. The behaviour modification approach--now called applied behaviour analysis--is based on the assumption that all behaviours are learned, both the useful ones (new skills) and the ones that are not so useful…

  13. "The Maasai Need Cows and the Cows Need Maasai," the Use of a Photovoice Approach to Assess Animal Health Needs.

    Science.gov (United States)

    van der Meer, Frank; Clancy, Eoin; Thomas, Adam; Kutz, Susan; Hatfield, Jennifer; Orsel, Karin

    2015-01-01

    The Maasai pastoralists in sub-Saharan Africa depend on their livestock for income and food. Livestock production can be significantly improved by addressing animal health concerns. We explored the use of photovoice, a participatory action research method, to strengthen our understanding of the Maasai's animal health needs. Nine interviewees, representing warriors, elders, and women, identified animal, social, and human health themes. The use of photography provided a new medium for Maasai to express their needs and a focus for researcher-participant communications, thereby facilitating new insights across language and cultural barriers.

  14. Collaborative Approaches Needed to Close the Big Data Skills Gap

    Directory of Open Access Journals (Sweden)

    Steven Miller

    2014-04-01

    Full Text Available The big data and analytics talent discussion has largely focused on a single role – the data scientist. However, the need is much broader than data scientists. Data has become a strategic business asset. Every professional occupation must adapt to this new mindset. Universities in partnership with industry must move quickly to ensure that the graduates they produce have the required skills for the age of big data. Existing curricula should be reviewed and adapted to ensure relevance. New curricula and degree programs are needed to meet the needs of industry.

  15. A new approach to assessing skill needs of senior managers.

    Science.gov (United States)

    Griffith, John R; Warden, Gail L; Neighbors, Kamilah; Shim, Beth

    2002-01-01

    Management of health care organizations must improve to meet the well-documented challenges of quality improvement and cost control. Other industries have developed the tools--entry education, mentoring, planned mid-career formal education and experience, and special programs for senior management. The purpose of this paper is to pilot test an alternative method to identify competencies and performance of health care executives. We propose using formal lists of technical, interpersonal, and strategic competencies and specific real events chosen by the respondent to identify and prioritize competencies. Results of a trial with 30 large health care system CEOs and 15 early careerists demonstrate that the method reveals useful depth and detail about managers' educational needs. The results suggest that current thinking about managerial education and learning patterns may be seriously inadequate in several respects. The continued improvement of U.S. health care is a pressing national concern. Quality of care is highly variable and substantially deficient in many institutions (Chassin and Galvin 1998; Committee on Quality of Health Care in America 2001). "Quality improvement should be the essential business strategy for healthcare in the 21st century (Kizer 2001)." Productivity improvements will be essential to balance cost pressures from an aging population and growing technology (Heffler, et al. 2002). Skillful management is necessary to improve quality and productivity. Teams of dozens of caregivers are often required to improve a patient's health. The organizations that provide care have grown larger in response to the greater cost, complexity of operation and finance, and evidence of the success of scale in other industries. While many small professional practices, hospitals, and nursing homes remain, consolidation has created a few dozen provider and intermediary organizations exceeding a billion dollars a year in expenditures. These large health care

  16. We need theoretical physics approaches to study living systems

    Science.gov (United States)

    Blagoev, Krastan B.; Shukla, Kamal; affil="3" >Herbert Levine,

    2013-08-01

    , nor collect data on the kinetics of the many complex reactions. Instead, the focus was on formulating two- or three-component reaction-diffusion equations (e.g. the Oregonator), which could explain such generic features as the existence of rotating spiral waves (and their instability), the transition to chaos, the control of the reaction by light etc. By stressing mechanism instead of meticulous detail, one could understand the system even if there were still components and interactions waiting to be cataloged and quantified. In living systems, this way of thinking is even more crucial. A leading biologist once remarked to one of us that a calculation of in vivo cytoskeletal dynamics that did not take into account the fact that the particular cell in question had more than ten isoforms of actin could not possibly be correct. We need to counter that any calculation which takes into account all these isoforms is overwhelmingly likely to be vastly under-constrained and ultimately not useful. Adding more details can often bring us further from reality. Of course, the challenge for models is then falsification, i.e., finding robust predictions which can be directly tested experimentally. The most severe criticism, to quote Pauli, remains that 'your model is not even wrong.' Is this approach proving successful? In many cases it is too early to tell, but simple models have already proved useful in understanding protein folding, directed cell motility, gene expression variability and even laboratory-scale Darwinian evolution. One could argue as well that the extremely influential Hodgkin-Huxley approach to the action potential in neurons is a vastly oversimplified description and that is why it is tractable and compelling. There are other cases, however, where the model was too simple—the simple Turing instability does not account for Drosophila segment formation [2] and the binary state relaxational dynamics of the Hopfield model may prove incapable of explaining memory

  17. A Theoretical Approach to Information Needs Across Different Healthcare Stakeholders

    Science.gov (United States)

    Raitoharju, Reetta; Aarnio, Eeva

    Increased access to medical information can lead to information overload among both the employees in the healthcare sector as well as among healthcare consumers. Moreover, medical information can be hard to understand for consumers who have no prerequisites for interpreting and understanding it. Information systems (e.g. electronic patient records) are normally designed to meet the demands of one professional group, for instance those of physicians. Therefore, the same information in the same form is presented to all the users of the systems regardless of the actual need or prerequisites. The purpose of this article is to illustrate the differences in information needs across different stakeholders in healthcare. A literature review was conducted to collect examples of these different information needs. Based on the findings the role of more user specific information systems is discussed.

  18. Training Needs Analysis: Weaknesses in the Conventional Approach.

    Science.gov (United States)

    Leat, Michael James; Lovel, Murray Jack

    1997-01-01

    Identification of the training and development needs of administrative support staff is not aided by conventional performance appraisal, which measures summary or comparative effectiveness. Meaningful diagnostic evaluation integrates three levels of analysis (organization, task, and individual), using behavioral expectation scales. (SK)

  19. Prioritizing the refactoring need for critical component using combined approach

    Directory of Open Access Journals (Sweden)

    Rajni Sehgal

    2018-10-01

    Full Text Available One of the most promising strategies that will smooth out the maintainability issues of the software is refactoring. Due to lack of proper design approach, the code often inherits some bad smells which may lead to improper functioning of the code, especially when it is subject to change and requires some maintenance. A lot of studies have been performed to optimize the refactoring strategy which is also a very expensive process. In this paper, a component based system is considered, and a Fuzzy Multi Criteria Decision Making (FMCDM model is proposed by combining subjective and objective weights to rank the components as per their urgency of refactoring. Jdeodorant tool is used to detect the code smells from the individual components of a software system. The objective method uses the Entropy approach to rank the component having the code smell. The subjective method uses the Fuzzy TOPSIS approach based on decision makers’ judgement, to identify the critically and dependency of these code smells on the overall software. The suggested approach is implemented on component-based software having 15 components. The constitute components are ranked based on refactoring requirements.

  20. Respiratory sensitization and allergy: Current research approaches and needs

    International Nuclear Information System (INIS)

    Boverhof, Darrell R.; Billington, Richard; Gollapudi, B. Bhaskar; Hotchkiss, John A.; Krieger, Shannon M.; Poole, Alan; Wiescinski, Connie M.; Woolhiser, Michael R.

    2008-01-01

    There are currently no accepted regulatory models for assessing the potential of a substance to cause respiratory sensitization and allergy. In contrast, a number of models exist for the assessment of contact sensitization and allergic contact dermatitis (ACD). Research indicates that respiratory sensitizers may be identified through contact sensitization assays such as the local lymph node assay, although only a small subset of the compounds that yield positive results in these assays are actually respiratory sensitizers. Due to the increasing health concerns associated with occupational asthma and the impending directives on the regulation of respiratory sensitizers and allergens, an approach which can identify these compounds and distinguish them from contact sensitizers is required. This report discusses some of the important contrasts between respiratory allergy and ACD, and highlights several prominent in vivo, in vitro and in silico approaches that are being applied or could be further developed to identify compounds capable of causing respiratory allergy. Although a number of animal models have been used for researching respiratory sensitization and allergy, protocols and endpoints for these approaches are often inconsistent, costly and difficult to reproduce, thereby limiting meaningful comparisons of data between laboratories and development of a consensus approach. A number of emerging in vitro and in silico models show promise for use in the characterization of contact sensitization potential and should be further explored for their ability to identify and differentiate contact and respiratory sensitizers. Ultimately, the development of a consistent, accurate and cost-effective model will likely incorporate a number of these approaches and will require effective communication, collaboration and consensus among all stakeholders

  1. THE NEED FOR STATE IN THE ECONOMY- EPISTEMOLOGICAL APPROACH

    Directory of Open Access Journals (Sweden)

    ANCA-ŞTEFANIA SAVA

    2010-01-01

    Full Text Available The aim of this paper is to discuss the need for state in the economy, in an epistemological viewpoint. It presents in a critical manner the ideas on the state of the mercantilism and physiocracy representatives, of the classical and Keynesian economists and of the so-called current „the new liberal orthodoxy”. It is noticed that the need for a minimal state, as a condition of proper functioning of the society, has been justified even by those who have criticized it (classical liberals, being recognized that a society can not be conceived anarchic and utopian. If during ’29-’33s, the philosophy of laisser-faire was replaced by the Keynesian doctrine, and ’70s have placed the welfare state in a crisis of legitimacy, starting from 2008 we can talk of a resurgence of the Keynesian paradigm, according to which government intervention is seen as a way to stimulate the economic recovery.

  2. Systems approach to chemical spill response information needs

    Energy Technology Data Exchange (ETDEWEB)

    Parnarouskis, M.C.; Flessner, M.F.; Potts, R.G.

    1980-01-01

    The Chemical Hazards Response Information System (CHRIS) has been specifically designed to meet the emergency needs of US Coast Guard field personnel, currently providing them with information on 900 hazardous chemicals, with methods of predicting hazards resulting from accidental discharges, and with procedures for selecting and implementing response to accident discharges. The major components of CHRIS and the computerized hazard assessment models within the Hazard Assessment Computer System are described in detail.

  3. Solving public passenger transportation problems: a need for policy reorientation. [Brokerage or consumer-oriented approach needed

    Energy Technology Data Exchange (ETDEWEB)

    Davis, F.W. Jr.; Oen, K.

    1977-01-01

    Public transportation has declined because policymakers and outdated regulations have restricted the evolution of transportation systems which more closely reflect the mobility and lifestyles of today. Public policy needs to take a consumer-oriented approach to public transportation by recognizing that all consumers do not have the same transportation needs and that one or two modes of transportation cannot satisfy these needs. This report argues that if public transportation is to become an efficient method of satisfying the transportation needs of a community, a brokerage or consumer-oriented approach should be adopted. The transportation broker will match specific individual needs with a broad array of transportation services, and overcome institutional, legal, and operational barriers to the development of new forms of transportation service. 51 references or footnotes.

  4. Why health care corruption needs a new approach.

    Science.gov (United States)

    Radin, Dagmar

    2016-07-01

    While corruption has been at the center of academic studies and on the agenda of international organizations for a couple of decades, in the health care sector corruption has not generated much interest or progress. At the centre of this issue is the lack of an interdisciplinary approach, which is warranted given the complexity of the issue and the lack of cooperation between STET scientifically rigorous academics and policy-makers, leaving room for more cooperation and progress. © The Author(s) 2015.

  5. The Need for Integrated Approaches in Metabolic Engineering

    Energy Technology Data Exchange (ETDEWEB)

    Lechner, Anna; Brunk, Elizabeth; Keasling, Jay D.

    2016-08-15

    This review highlights state-of-the-art procedures for heterologous small-molecule biosynthesis, the associated bottlenecks, and new strategies that have the potential to accelerate future accomplishments in metabolic engineering. We emphasize that a combination of different approaches over multiple time and size scales must b e considered for successful pathway engineering in a heterologous host. We have classified these optimization procedures based on the "system" that is being manipulated: transcriptome, translatome, proteome, or reactome. By bridging multiple disciplines, including molecular biology, biochemistry, biophysics, and computational sciences, we can create an integral framework for the discovery and implementation of novel biosynthetic production routes.

  6. The Need for New Dosimetric Approach in CT Dosimetry

    International Nuclear Information System (INIS)

    Ben-Shlomo, A.; Iacobovici, E.

    2004-01-01

    Three decades after the invention of the first CT in 1972, it became a major tool in diagnostic radiology. The use of CT for various applications is getting wider every year. The quantity of CT procedures performed in Israel every year is estimated as 500,000. About 10% of those are pediatric procedures, for children under age 10. CT procedures increase is estimated at 5-10 % per annum. In spite the fact that CT contributes to about 1/8 of the total number of diagnostic X-ray procedures in Israel, the CT collective dosage is about 40% of the total collective dosage in the said procedures (about 3,500 Man*Sv per year). Medical radiation dosage is the first contributor to population dosage, resulting from artificial radiation sources. Diagnostic X-ray radiation dosage is the first contributor to medical radiation dose (including radiation dose from diagnostic X-ray, nuclear medicine and radiotherapy with exclusion of the target organ dose). Among medical X-ray different applications, CT procedure is the first cause to radiation dose of the population according to X-ray diagnostic procedures. The above facts emphasize the need to focus on CT in order to reduce the medical collective dose of the public. Several dosimetric units have appeared in recent years in order to comply with the need for CT Dosimetry. The CTDI Unit that served so well during the first CT years is no longer sufficient, as is, for modern instruments. This basic unit has become a complex concept that covers new units: CTDI W , CTDI VOL , CTDI 100 , MSAD and DLP. The search for a simple way to apply these units in order to calculate effective dosage during CT examinations is not straightforward. Modern equipment is simultaneously using 4 and 16 slices. Manufacturers are endeavoring to develop the next generation equipment with 256 slices used simultaneously (expected on the market in the next 1-2 years). This situation sets technology one step forward regarding the dosimetry methods used for organ

  7. Targeting the unmet medical need: the Abbott Laboratories oncology approach.

    Science.gov (United States)

    Carlson, Dawn M; Steinberg, Joyce L; Gordon, Gary

    2005-09-01

    While significant advances in the treatment of cancer occured during the last half of the twentieth century, parallel decreases in overall cancer death rates were not observed. Cancer therapy remains an area of significant unmet medical need. Abbott's oncology research programs are focused on pioneering trageted, less toxic therapies, aimed at different aspects of tumor growth and development. Oncology drugs in development at Abbott target several mechanisms of cancer progression by interfering with multiple processes necessary for tumor growth: recruitment of a blood supply, cell proliferation, and the development of metastases. They include a selective endothelin A-receptor antagonist (atrasentan/Xinlay), 3 angiogenesis inhibitors (ABT 510, a thrombospondin mimetic: ABT-869, a multitargeted receptor tyrosine kinase inhibitor; and ABT 828, recombinant human plasminogen kringle 5), a cell proliferation inhibitor (ABT-751, an antimitotic agent), an apoptosis inducer (ABT 737, a Bcl-2 family inhibitor), and a poly(ADP-ribose)polymerase inhibitor.

  8. Estimating the Need for Palliative Radiation Therapy: A Benchmarking Approach

    Energy Technology Data Exchange (ETDEWEB)

    Mackillop, William J., E-mail: william.mackillop@krcc.on.ca [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Queen' s University, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Department of Oncology, Queen' s University, Kingston, Ontario (Canada); Kong, Weidong [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Queen' s University, Kingston, Ontario (Canada)

    2016-01-01

    Purpose: Palliative radiation therapy (PRT) benefits many patients with incurable cancer, but the overall need for PRT is unknown. Our primary objective was to estimate the appropriate rate of use of PRT in Ontario. Methods and Materials: The Ontario Cancer Registry identified patients who died of cancer in Ontario between 2006 and 2010. Comprehensive RT records were linked to the registry. Multivariate analysis identified social and health system-related factors affecting the use of PRT, enabling us to define a benchmark population of patients with unimpeded access to PRT. The proportion of cases treated at any time (PRT{sub lifetime}), the proportion of cases treated in the last 2 years of life (PRT{sub 2y}), and number of courses of PRT per thousand cancer deaths were measured in the benchmark population. These benchmarks were standardized to the characteristics of the overall population, and province-wide PRT rates were then compared to benchmarks. Results: Cases diagnosed at hospitals with no RT on-site and residents of poorer communities and those who lived farther from an RT center, were significantly less likely than others to receive PRT. However, availability of RT at the diagnosing hospital was the dominant factor. Neither socioeconomic status nor distance from home to nearest RT center had a significant effect on the use of PRT in patients diagnosed at a hospital with RT facilities. The benchmark population therefore consisted of patients diagnosed at a hospital with RT facilities. The standardized benchmark for PRT{sub lifetime} was 33.9%, and the corresponding province-wide rate was 28.5%. The standardized benchmark for PRT{sub 2y} was 32.4%, and the corresponding province-wide rate was 27.0%. The standardized benchmark for the number of courses of PRT per thousand cancer deaths was 652, and the corresponding province-wide rate was 542. Conclusions: Approximately one-third of patients who die of cancer in Ontario need PRT, but many of them are never

  9. Protecting nuclear material and facilities: Is a new approach needed?

    International Nuclear Information System (INIS)

    Steinhausler, F.; Bunn, G.

    2002-01-01

    Full text: The main reason why national physical protection (PP) systems for nuclear and other radioactive material need to be strengthened further is that, after the attacks on the US on 11 September 2001, the threat of dangerous, suicidal radiological and nuclear terrorism can no longer be excluded as a possibility. Existing PP systems were not designed to deal with the threat of suicidal terrorists having the numbers, skills, training, and resources available to the commandos attacking on 11 September. Moreover, there are no mandatory international standards for domestic PP systems for nuclear or radioactive material, and this has produced great variation in protection provided from country to country. IAEA recommended standards, while useful, were not designed with the new terrorist threat in mind. Moreover, they are often not followed in practice. The result is inadequate protection against the new form of terrorism in most countries. The Director General of the IAEA expressed a similar view after 11 September, but achieving a consensus to amend the Convention on the Physical Protection of Nuclear Material (CPPNM) to require specific standards of protection for different amounts and kinds of nuclear material used or stored domestically (not in international transport) has been impossible in the year since 11 September. In the case of radiological materials, a new effort to provide required international standards for protection against the new form of terrorism has not begun. In the summer of 2001, leaders of the G-8 countries agreed to a Global Partnership to prevent the new terrorists from acquiring nuclear and radiological as well as other materials related to weapons of mass destruction. Perhaps in part because of the failure to date to achieve agreement on an effective amendment to the CPPNM, the first principle of this partnership is to strengthen 'multilateral treaties and other instruments whose aim is to prevent the proliferation or illicit

  10. Novel approaches are needed to develop tomorrow's antibacterial therapies.

    Science.gov (United States)

    Spellberg, Brad; Bartlett, John; Wunderink, Rich; Gilbert, David N

    2015-01-15

    Society faces a crisis of rising antibiotic resistance even as the pipeline of new antibiotics has been drying up. Antibiotics are a public trust; every individual's use of antibiotics affects their efficacy for everyone else. As such, responses to the antibiotic crisis must take a societal perspective. The market failure of antibiotics is due to a combination of scientific challenges to discovering and developing new antibiotics, unfavorable economics, and a hostile regulatory environment. Scientific solutions include changing the way we screen for new antibiotics. More transformationally, developing new treatments that seek to disarm pathogens without killing them, or that modulate the host inflammatory response to infection, will reduce selective pressure and hence minimize resistance emergence. Economic transformation will require new business models to support antibiotic development. Finally, regulatory reform is needed so that clinical development programs are feasible, rigorous, and clinically relevant. Pulmonary and critical care specialists can have tremendous impact on the continued availability of effective antibiotics. Encouraging use of molecular diagnostic tests to allow pathogen-targeted, narrow-spectrum antibiotic therapy, using short rather than unnecessarily long course therapy, reducing inappropriate antibiotic use for probable viral infections, and reducing infection rates will help preserve the antibiotics we have for future generations.

  11. Sociotechnical approaches to workplace safety: Research needs and opportunities

    Science.gov (United States)

    Robertson, Michelle M.; Hettinger, Lawrence J.; Waterson, Patrick E.; Ian Noy, Y.; Dainoff, Marvin J.; Leveson, Nancy G.; Carayon, Pascale; Courtney, Theodore K.

    2015-01-01

    The sociotechnical systems perspective offers intriguing and potentially valuable insights into problems associated with workplace safety. While formal sociotechnical systems thinking originated in the 1950s, its application to the analysis and design of sustainable, safe working environments has not been fully developed. To that end, a Hopkinton Conference was organised to review and summarise the state of knowledge in the area and to identify research priorities. A group of 26 international experts produced collaborative articles for this special issue of Ergonomics, and each focused on examining a key conceptual, methodological and/or theoretical issue associated with sociotechnical systems and safety. In this concluding paper, we describe the major conference themes and recommendations. These are organised into six topic areas: (1) Concepts, definitions and frameworks, (2) defining research methodologies, (3) modelling and simulation, (4) communications and decision-making, (5) sociotechnical attributes of safe and unsafe systems and (6) potential future research directions for sociotechnical systems research. Practitioner Summary: Sociotechnical complexity, a characteristic of many contemporary work environments, presents potential safety risks that traditional approaches to workplace safety may not adequately address. In this paper, we summarise the investigations of a group of international researchers into questions associated with the application of sociotechnical systems thinking to improve worker safety. PMID:25728246

  12. The need for a new approach to reactor safety

    International Nuclear Information System (INIS)

    Cave, L.; Holmes, R.E.; Holmes, P.J.

    1981-01-01

    The public's acceptance of nuclear power appears to be decreasing in many countries, partly owing to fears about the safety of reactors. In the paper the usefulness of an approach based on comparative risks is examined in the light of the view, expressed by behavioural scientists, that the public find the concept of risk difficult to understand and are more concerned with the possible consequences and benefits of nuclear power. On the premise that this view is correct, its implications in relation to reactor siting, reactor design, choice of reactor system and the economics of nuclear power are examined. This examination leads to some specific suggestions for future action in relation to the reduction of the possible consequences of nuclear accidents. It leads also to the view that there appears to be a close correlation between the public's perception of the strength of the national economy, the extent of its indigenous fuel resources and the degree of public hostility to nuclear power in any one country, although this concept requires further detailed study. (author)

  13. Treatment response in psychotic patients classified according to social and clinical needs, drug side effects, and previous treatment; a method to identify functional remission

    DEFF Research Database (Denmark)

    Alenius, Malin; Hammarlund-Udenaes, Margareta; Honoré, Per Gustaf Hartvig

    2009-01-01

    , fewer psychotic symptoms, and higher rate of workers than those with the worst treatment outcome. CONCLUSION: In the evaluation, CANSEPT showed validity in discriminating the patients of interest and was well tolerated by the patients. CANSEPT could secure inclusion of correct patients in the clinic......BACKGROUND: Various approaches have been made over the years to classify psychotic patients according to inadequate treatment response, using terms such as treatment resistant or treatment refractory. Existing classifications have been criticized for overestimating positive symptoms......; underestimating residual symptoms, negative symptoms, and side effects; or being to open for individual interpretation. The aim of this study was to present and evaluate a new method of classification according to treatment response and, thus, to identify patients in functional remission. METHOD: A naturalistic...

  14. Development and Initial Validation of the Need Satisfaction and Need Support at Work Scales: A Validity-Focused Approach

    Directory of Open Access Journals (Sweden)

    Susanne Tafvelin

    2018-01-01

    Full Text Available Although the relevance of employee need satisfaction and manager need support have been examined, the integration of self-determination theory (SDT into work and organizational psychology has been hampered by the lack of validated measures. The purpose of the current study was to develop and validate measures of employees’ perception of need satisfaction (NSa-WS and need support (NSu-WS at work that were grounded in SDT. We used three Swedish samples (total 'N' = 1,430 to develop and validate our scales. We used a confirmatory approach including expert panels to assess item content relevance, confirmatory factor analysis for factorial validity, and associations with theoretically warranted outcomes to assess criterion-related validity. Scale reliability was also assessed. We found evidence of content, factorial, and criterion-related validity of our two scales of need satisfaction and need support at work. Further, the scales demonstrated high internal consistency. Our newly developed scales may be used in research and practice to further our understanding regarding how satisfaction and support of employee basic needs influence employee motivation, performance, and well-being. Our study makes a contribution to the current literature by providing (1 scales that are specifically designed for the work context, (2 an example of how expert panels can be used to assess content validity, and (3 testing of theoretically derived hypotheses that, although SDT is built on them, have not been examined before.

  15. Approaches to learning, need for cognition, and strategic flexibility among university students.

    Science.gov (United States)

    Evans, Christina J; Kirby, John R; Fabrigar, Leandre R

    2003-12-01

    Considerable research has described students' deep and surface approaches to learning. Other research has described individuals' self-regulated learning and need for cognition. There is a need for research examining the relationships among these constructs. This study explored relationships among approaches to learning (deep, surface), need for cognition, and three types of control of learning (adaptive, inflexible, irresolute). Theory suggested similarities among the deep approach, need for cognition, and adaptive control (aspects of self-regulated learning); and among surface, inflexible, and irresolute control (aspects of an ineffective approach to learning). One-factor and two-factor models were proposed. Participants were 226 Canadian military college students. Participants completed the following questionnaires: the Study Process Questionnaire (Biggs, 1978), the Need for Cognition Scale (Cacioppo & Petty, 1982), and the Strategic Flexibility Questionnaire (Cantwell & Moore, 1996). Confirmatory factor analysis supported the identification of the six scale factors. Second order confirmatory factor analysis indicated three factors representing constructs underlying these factors. Neither the one- nor two-factor models accounted adequately for the data. Self-regulated learning was defined by measures of the deep approach to learning, need for cognition, and adaptive control of learning. The second factor divided into one factor consisting of irresolute control, the surface approach, and negative need for cognition; and another consisting of inflexible and negative adaptive control. Substantial relationships among scales support the need for further theory development.

  16. Social use of alcohol among adolescent offenders: a fundamental approach toward human needs

    Directory of Open Access Journals (Sweden)

    Gustavo D?Andrea

    2014-02-01

    Full Text Available This study examined some basic health care approaches toward human needs, with a particular focus on nursing. We aimed to incorporate these approaches into the discussion of the mental health of adolescent offenders who consume alcohol. We discuss specific needs of the delinquent group, critique policies that prioritize coercion of adolescent offenders, and the role that nurses could play in the sphere of juvenile delinquency.

  17. The TEACH Method: An Interactive Approach for Teaching the Needs-Based Theories Of Motivation

    Science.gov (United States)

    Moorer, Cleamon, Jr.

    2014-01-01

    This paper describes an interactive approach for explaining and teaching the Needs-Based Theories of Motivation. The acronym TEACH stands for Theory, Example, Application, Collaboration, and Having Discussion. This method can help business students to better understand and distinguish the implications of Maslow's Hierarchy of Needs,…

  18. REACH, non-testing approaches and the urgent need for a change in mind set

    NARCIS (Netherlands)

    Schaafsma, G.; Kroese, E.D.; Tielemans, E.L.J.P.; Sandt, J.J.M. van de; Leeuwen, C.J. van

    2009-01-01

    The objectives of REACH cannot be achieved under the current risk assessment approach. A change in mind set among all the relevant stakeholders is needed: risk assessment should move away from a labor-intensive and animal-consuming approach to intelligent and pragmatic testing, by combining exposure

  19. Malaria Vaccine Development: The Need for Novel Approach-es: A Review Article

    Directory of Open Access Journals (Sweden)

    Shima MAHMOUDI

    2018-03-01

    Full Text Available Background: Although rigorous efforts have substantially decreased the malaria burden through decades, it still threatens the lives of millions of children. Development of an effective vaccine can provide important approach in malaria control strategies. Unfortunately, development of an effective vaccine for falciparum malaria has been hindered by the extreme complexity of malaria parasite biology, complex and diverse parasite genomes, and immune evasion by the parasites as well as the intricate nature of the parasites infection cycle. The aim of this review was to discuss the different approaches to malaria vaccine development until now.Methods: Scientific databases, including MEDLINE (via PubMed and SCOPUS were searched up to 30 Jan 2017 and the articles regarding malaria vaccine development were taken into examination.Results: Several strategies for malaria vaccine development including pre-erythrocytic vaccines, antibody-based subunit vaccines, vectored vaccines, whole sporozoite vaccines, genetically Attenuated parasites and sporozoite subunit vaccine, erythrocytic vaccines, sexual stage vaccine, transmission-blocking vaccine as well as synthetic peptides and conjugate vaccine has been introduced. However, the success has been limited thus far.Conclusion: Although development of malaria vaccine over the past 70 year has been continued, the discovery, development, and licensing of a malaria vaccine formulation, which meets safety, affordability, accessibility, applicability, and efficacy has not yet been achieved.

  20. Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach.

    Science.gov (United States)

    Wikman, Anna; Kukkola, Laura; Börjesson, Helene; Cernvall, Martin; Woodford, Joanne; Grönqvist, Helena; von Essen, Louise

    2018-04-18

    Parenting a child through cancer is a distressing experience, and a subgroup of parents report negative long-term psychological consequences years after treatment completion. However, there is a lack of evidence-based psychological interventions for parents who experience distress in relation to a child's cancer disease after end of treatment. One aim of this study was to develop an internet-administered, cognitive behavior therapy-based, psychological, guided, self-help intervention (ENGAGE) for parents of children previously treated for cancer. Another aim was to identify acceptable procedures for future feasibility and efficacy studies testing and evaluating the intervention. Participatory action research methodology was used. The study included face-to-face workshops and related Web-based exercises. A total of 6 parents (4 mothers, 2 fathers) of children previously treated for cancer were involved as parent research partners. Moreover, 2 clinical psychologists were involved as expert research partners. Research partners and research group members worked collaboratively throughout the study. Data were analyzed iteratively using written summaries of the workshops and Web-based exercises parallel to data collection. A 10-week, internet-administered, cognitive behavior therapy-based, psychological, guided, self-help intervention (ENGAGE) was developed in collaboration with parent research partners and expert research partners. The content of the intervention, mode and frequency of e-therapist support, and the individualized approach for feedback were modified based on the research partner input. Shared solutions were reached regarding the type and timing of support from an e-therapist (eg, initial video or telephone call, multiple methods of e-therapist contact), duration and timing of intervention (eg, 10 weeks, 30-min assessments), and the removal of unnecessary support functions (eg, removal of chat and forum functions). Preferences for study procedures in

  1. Needs assessments in palliative care: an appraisal of definitions and approaches used.

    Science.gov (United States)

    Higginson, Irene J; Hart, Sam; Koffman, Jonathan; Selman, Lucy; Harding, Richard

    2007-05-01

    We report a systematic appraisal of definitions and approaches to needs assessment in palliative care. Electronic databases were searched, and relevant individuals and organizations were contacted to identify needs assessments in palliative care. Over 200 articles were identified giving general information on needs assessment, and 77 articles comprised palliative care-related needs assessment reports. The reports originated from Africa (37), Australia (1), Europe (including former central/eastern European states) (35), USA (1), Latin America (5), and Asia (7). Two underpinning definitions of need were identified, that of Maslow from the field of psychology, and that of Bradshaw from sociology. However, in conducting needs assessments, these definitions were operationalized, and here the National Health Service Executive definition of need as "the ability to benefit from health care" is helpful. We identified three main categories of approach to needs assessment--epidemiological, corporate, and comparative--that can be used in combination. Careful consideration must be paid to any needs assessment data to ensure that the assessment is implemented.

  2. A quality approach for conducting training needs assessments in the Ministry of Health, State of Bahrain.

    Science.gov (United States)

    Benjamin, S; al-Darazi, F

    2000-01-01

    In health care organizations around the world, Training Needs Assessments (TNAs) have generally followed a professions-based approach. For example, the training needs of doctors, nurses, each allied health profession, and distinct support staff have been analyzed separately--individualized TNAs conducted for each speciality and functional area. Although a professions-based TNA model can provide useful information to human resource development (HRD) professionals, there are two major drawbacks: (1) it is possible that important training needs might be overlooked because of lack of information sharing among professions and (2) such an approach does not encourage an interdisciplinary, team orientation to service provision. This paper proposes an improved method of conceptualizing TNAs, using an approach that builds on the quality management literature (TQM, CQI, etc.) which stresses the importance of customer- and service-orientations to organizing and measuring organizational and individual performance.

  3. Comparing three different approaches to the measurement of needs concerning fatigue in patients with advanced cancer

    DEFF Research Database (Denmark)

    Madsen, Ulla Riis; Groenvold, Mogens; Petersen, Morten Aagaard

    2015-01-01

    PURPOSE: To identify patients having fatigue, it is necessary to assess the patients fatigue systematically. This study investigates three different approaches to the assessment of needs concerning fatigue in patients with advanced cancer and addresses the following questions. METHODS: In a cross......-sectional nationwide survey, patients were asked about their needs concerning fatigue in three different ways: Fatigue intensity was measured with the European Organisation for Research and Treatment of Cancer quality of life questionnaire, fatigue burden (the extent fatigue was a problem) and fatigue felt need...

  4. TwitterNEED: a hybrid approach for named entity extraction and disambiguation for tweets

    NARCIS (Netherlands)

    Habib, Mena Badieh; van Keulen, Maurice

    Twitter is a rich source of continuously and instantly updated information. Shortness and informality of tweets are challenges for Natural Language Processing tasks. In this paper, we present TwitterNEED, a hybrid approach for Named Entity Extraction and Named Entity Disambiguation for tweets. We

  5. The need for affect: individual differences in the motivation to approach or avoid emotions.

    Science.gov (United States)

    Maio, G R; Esses, V M

    2001-08-01

    The present research developed and tested a new individual-difference measure of the need for affect, which is the motivation to approach or avoid emotion-inducing situations. The first phase of the research developed the need for affect scale. The second phase revealed that the need for affect is related to a number of individual differences in cognitive processes (e.g., need for cognition, need for closure), emotional processes (e.g., affect intensity, repression-sensitization), behavioral inhibition and activation (e.g., sensation seeking), and aspects of personality (Big Five dimensions) in the expected directions, while not being redundant with them. The third phase of the research indicated that, compared to people low in the need for affect, people high in the need for affect are more likely to (a) possess extreme attitudes across a variety of issues, (b) choose to view emotional movies, and (c) become involved in an emotion-inducing event (the death of Princess Diana). Overall, the results indicate that the need for affect is an important construct in understanding emotion-related processes.

  6. Retrosternal goiter: The need for thoracic approach based on CT findings: Surgeon’s view

    International Nuclear Information System (INIS)

    Sakkary, M.A.; Abdelrahman, A.M.; Mostafa, A.M.; Abbas, A.A.; Zedan, M.H.

    2012-01-01

    Background and purpose: The incidence of retrosternal goiter (Rg) varies from 2% to 26% of all thyroidectomies, depending on the defining criteria . There are no clear guidelines to identify patients that require an intrathoracic approach. So, we tried to correlate, between the size and/ or anatomical site of the RSG based on preoperative CT findings and the surgical approaches used, aiming at defining those patients with RSG who are in need for thoracic approach. Patients and methods: Out of 1481 patients underwent thyroidectomy at the National Cancer Institute (NCI), Cairo University, between January 2000 and December 2009, only 73 (4.93%) of them had retrosternal extension. Demographic, clinical, operative, anatomical, and pathological data of patients with RSG were recorded and analyzed. Results: The intraoperative extension of the goiter correlated with the extension seen in the CT in all except two patients. Laterality and longitudinal extension found in preoperative CT, correlated well with the surgical findings. The approach used was cervical in 66 cases (90.4%); combined approach in six patients (8.2%). Pure thoracic (full sternotomy) was used alone in one case (1.4%). Extension of the RSG down to or below the arch was associated with an increased risk of using a thoracic approach p< 0.0001. Conclusion: Preoperative CT, can be used effectively to guide the indications for using a thoracic approach. Reaching the aortic arch or beyond and loss of fat planes in CT, recurrent and malignant disease, are significant risk factors for using a thoracic approach.

  7. Individualising Chronic Care Management by Analysing Patients' Needs - A Mixed Method Approach.

    Science.gov (United States)

    Timpel, P; Lang, C; Wens, J; Contel, J C; Gilis-Januszewska, A; Kemple, K; Schwarz, P E

    2017-11-13

    Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and

  8. Estimating the financial resources needed for local public health departments in Minnesota: a multimethod approach.

    Science.gov (United States)

    Riley, William; Briggs, Jill; McCullough, Mac

    2011-01-01

    This study presents a model for determining total funding needed for individual local health departments. The aim is to determine the financial resources needed to provide services for statewide local public health departments in Minnesota based on a gaps analysis done to estimate the funding needs. We used a multimethod analysis consisting of 3 approaches to estimate gaps in local public health funding consisting of (1) interviews of selected local public health leaders, (2) a Delphi panel, and (3) a Nominal Group Technique. On the basis of these 3 approaches, a consensus estimate of funding gaps was generated for statewide projections. The study includes an analysis of cost, performance, and outcomes from 2005 to 2007 for all 87 local governmental health departments in Minnesota. For each of the methods, we selected a panel to represent a profile of Minnesota health departments. The 2 main outcome measures were local-level gaps in financial resources and total resources needed to provide public health services at the local level. The total public health expenditure in Minnesota for local governmental public health departments was $302 million in 2007 ($58.92 per person). The consensus estimate of the financial gaps in local public health departments indicates that an additional $32.5 million (a 10.7% increase or $6.32 per person) is needed to adequately serve public health needs in the local communities. It is possible to make informed estimates of funding gaps for public health activities on the basis of a combination of quantitative methods. There is a wide variation in public health expenditure at the local levels, and methods are needed to establish minimum baseline expenditure levels to adequately treat a population. The gaps analysis can be used by stakeholders to inform policy makers of the need for improved funding of the public health system.

  9. Meeting water needs for sustainable development: an overview of approaches, measures and data sources

    Science.gov (United States)

    Lissner, Tabea; Reusser, Dominik E.; Sullivan, Caroline A.; Kropp, Jürgen P.

    2013-04-01

    An essential part of a global transition towards sustainability is the Millennium Development Goals (MDG), providing a blueprint of goals to meet human needs. Water is an essential resource in itself, but also a vital factor of production for food, energy and other industrial products. Access to sufficient water has only recently been recognized as a human right. One central MDG is halving the population without access to safe drinking water and sanitation. To adequately assess the state of development and the potential for a transition towards sustainability, consistent and meaningful measures of water availability and adequate access are thus fundamental. Much work has been done to identify thresholds and definitions to measure water scarcity. This includes some work on defining basic water needs of different sectors. A range of data and approaches has been made available from a variety of sources, but all of these approaches differ in their underlying assumptions, the nature of the data used, and consequently in the final results. We review and compare approaches, methods and data sources on human water use and human water needs. This data review enables identifying levels of consumption in different countries and different sectors. Further comparison is made between actual water needs (based on human and ecological requirements), and recognised levels of water abstraction. The results of our review highlight the differences between different accounts of water use and needs, and reflect the importance of standardised approaches to data definitions and measurements, making studies more comparable across space and time. The comparison of different use and allocation patterns in countries enables levels of water use to be identified which allow for an adequate level of human wellbeing to be maintained within sustainable water abstraction limits. Recommendations are provided of how data can be defined more clearly to make comparisons of water use more meaningful and

  10. High school teachers' perspectives on effective approaches for teaching biology to students with special needs

    Science.gov (United States)

    Kos, Agnieszka

    The demands of national educational reforms require high school biology teachers to provide high quality instruction to students with and without special needs. The reforms, however, do not provide teachers with adequate teaching strategies to meet the needs of all students in the same context. The purpose of this grounded theory study was to understand high school biology teachers' perspectives, practices, and challenges in relation to teaching students with special needs. This approach was used to develop a substantive model for high school biology teachers who are challenged with teaching students with and without special needs. Data were collected via in-depth interviews with 15 high school teachers in a Midwestern school district. The data were analyzed using open coding, axial coding, and selective coding procedures in accordance with the grounded theory approach. Essential model components included skills and training for teachers, classroom management strategies, teaching strategies, and student skills. The emergent substantive theory indicated that that teacher preparation and acquired skills greatly influence the effectiveness of inclusion implementation. Key findings also indicated the importance of using of a variety of instructional strategies and classroom management strategies that address students' special needs and their learning styles. This study contributes to social change by providing a model for teaching students and effectively implementing inclusion in regular science classrooms. Following further study, this model may be used to support teacher professional development and improve teaching practices that in turn may improve science literacy supported by the national educational reforms.

  11. Managing forests in a changing world: the need for a systemic approach. A review

    International Nuclear Information System (INIS)

    Nocentini, S.; Buttoud, G.; Ciancio, O.; Corona, P.

    2017-01-01

    Aim of study: The paper is a scientific commented discussion with the aim of defining a framework which allows both a comprehensive vision of forest dynamics, as well as an adaptive management approach and policy procedures more suited to a changing and inherently unpredictable world. Main results: We identify the main challenges facing forestry in relation to recent developments in forestry thinking, i.e. the paradox of aiming at sustainability in a changing environment, a shifting perception of the relationship between ecological and social systems, the recognition of forest ecosystems as complex adaptive systems, the need for integrating the social and ecological dimensions of forestry into a single framework, and the growing awareness of the importance of the ethical approach to the forest. We propose the concept of “systemic forestry” as a paradigm for better understanding forest dynamics and for guiding management and public actions at various levels. We compare the systemic approach with different silvicultural and forest management approaches which have been proposed in the last decades. Research highlights: Our analysis shows that a systemic approach to forestry has five main consequences: 1. forestry is viewed as a part of landscape dynamics through a multi-sectoral coordination, 2. the logic of action changes from norm to process, 3. conservation is a dynamic search for resilience, 4. multi-functionality is achieved through a multi-entries approach integrating ecological, social and economic components of sustainability, 5. forestry institutions are reframed to address the issue of changing interactions among actors, 6. a change in the ethical approach to the forest is needed.

  12. Managing forests in a changing world: the need for a systemic approach. A review

    Energy Technology Data Exchange (ETDEWEB)

    Nocentini, S.; Buttoud, G.; Ciancio, O.; Corona, P.

    2017-11-01

    Aim of study: The paper is a scientific commented discussion with the aim of defining a framework which allows both a comprehensive vision of forest dynamics, as well as an adaptive management approach and policy procedures more suited to a changing and inherently unpredictable world. Main results: We identify the main challenges facing forestry in relation to recent developments in forestry thinking, i.e. the paradox of aiming at sustainability in a changing environment, a shifting perception of the relationship between ecological and social systems, the recognition of forest ecosystems as complex adaptive systems, the need for integrating the social and ecological dimensions of forestry into a single framework, and the growing awareness of the importance of the ethical approach to the forest. We propose the concept of “systemic forestry” as a paradigm for better understanding forest dynamics and for guiding management and public actions at various levels. We compare the systemic approach with different silvicultural and forest management approaches which have been proposed in the last decades. Research highlights: Our analysis shows that a systemic approach to forestry has five main consequences: 1. forestry is viewed as a part of landscape dynamics through a multi-sectoral coordination, 2. the logic of action changes from norm to process, 3. conservation is a dynamic search for resilience, 4. multi-functionality is achieved through a multi-entries approach integrating ecological, social and economic components of sustainability, 5. forestry institutions are reframed to address the issue of changing interactions among actors, 6. a change in the ethical approach to the forest is needed.

  13. Managing forests in a changing world: the need for a systemic approach. A review

    Directory of Open Access Journals (Sweden)

    Susanna Nocentini

    2017-05-01

    Full Text Available Aim of study: The paper is a scientific commented discussion with the aim of defining a framework which allows both a comprehensive vision of forest dynamics, as well as an adaptive management approach and policy procedures more suited to a changing and inherently unpredictable world. Main results: We identify the main challenges facing forestry in relation to recent developments in forestry thinking, i.e. the paradox of aiming at sustainability in a changing environment, a shifting perception of the relationship between ecological and social systems, the recognition of forest ecosystems as complex adaptive systems, the need for integrating the social and ecological dimensions of forestry into a single framework, and the growing awareness of the importance of the ethical approach to the forest. We propose the concept of “systemic forestry” as a paradigm for better understanding forest dynamics and for guiding management and public actions at various levels. We compare the systemic approach with different silvicultural and forest management approaches which have been proposed in the last decades. Research highlights: Our analysis shows that a systemic approach to forestry has five main consequences: 1. forestry is viewed as a part of landscape dynamics through a multi-sectoral coordination, 2. the logic of action changes from norm to process, 3. conservation is a dynamic search for resilience, 4. multi-functionality is achieved through a multi-entries approach integrating ecological, social and economic components of sustainability, 5. forestry institutions are reframed to address the issue of changing interactions among actors, 6. a change in the ethical approach to the forest is needed.

  14. Anybody Hear Us? Attempting to Meet the Psychological Care Needs of Older People: an Ethnographic Approach

    Directory of Open Access Journals (Sweden)

    Seyed Zia Tabatabaei

    2016-07-01

    Full Text Available Older people who live in residential settings need some psychological support because of vicissitudes of life they faced with. The aim of this study is to explore psychological care needs of older people in a residential home. We used an ethnographic approach from May 2011 till January 2012. Through purposeful sampling, 14 knowledgeable participants were selected. Data were gathered from participant observations, in-depth interviews, review of related documents and field notes. Thematic analysis revealed three key themes including: (a Feelings of sadness (b Emotional desires and (c Choice and control. Findings of current study provided rich and useful information that is useful in charting new guideline for policy makers and care providers in order to support elderly residents' psychological care needs.

  15. A Toolkit Modeling Approach for Sustainable Forest Management Planning: Achieving Balance between Science and Local Needs

    Directory of Open Access Journals (Sweden)

    Brian R. Sturtevant

    2007-12-01

    Full Text Available To assist forest managers in balancing an increasing diversity of resource objectives, we developed a toolkit modeling approach for sustainable forest management (SFM. The approach inserts a meta-modeling strategy into a collaborative modeling framework grounded in adaptive management philosophy that facilitates participation among stakeholders, decision makers, and local domain experts in the meta-model building process. The modeling team works iteratively with each of these groups to define essential questions, identify data resources, and then determine whether available tools can be applied or adapted, or whether new tools can be rapidly created to fit the need. The desired goal of the process is a linked series of domain-specific models (tools that balances generalized "top-down" models (i.e., scientific models developed without input from the local system with case-specific customized "bottom-up" models that are driven primarily by local needs. Information flow between models is organized according to vertical (i.e., between scale and horizontal (i.e., within scale dimensions. We illustrate our approach within a 2.1 million hectare forest planning district in central Labrador, a forested landscape where social and ecological values receive a higher priority than economic values. However, the focus of this paper is on the process of how SFM modeling tools and concepts can be rapidly assembled and applied in new locations, balancing efficient transfer of science with adaptation to local needs. We use the Labrador case study to illustrate strengths and challenges uniquely associated with a meta-modeling approach to integrated modeling as it fits within the broader collaborative modeling framework. Principle advantages of the approach include the scientific rigor introduced by peer-reviewed models, combined with the adaptability of meta-modeling. A key challenge is the limited transparency of scientific models to different participatory groups

  16. Individualising Chronic Care Management by Analysing Patients’ Needs – A Mixed Method Approach

    Directory of Open Access Journals (Sweden)

    P. Timpel

    2017-11-01

    Full Text Available Background: Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. Method: A mixed method study was conducted. A standardised survey (n = 92 of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22 of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650. Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. Results: The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. Conclusion: The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care

  17. Taking health needs seriously: against a luck egalitarian approach to justice in health.

    Science.gov (United States)

    Nielsen, Lasse

    2013-08-01

    In recent works, Shlomi Segall suggests and defends a luck egalitarian approach to justice in health. Concurring with G. A. Cohen's mature position he defends the idea that people should be compensated for "brute luck", i.e. the outcome of actions that it would be unreasonable to expect them to avoid. In his defense of the luck egalitarian approach he seeks to rebut the criticism raised by Norman Daniels that luck egalitarianism is in some way too narrow and in another too wide to uphold justice in health and health care distribution. He points out that a pluralistic outline of luck egalitarianism taking into account the moral requirement of meeting everyone's basic needs can avoid this line of criticism. In this article I argue against the application of such pluralistic luck egalitarianism in matters of health distribution. First of all, Segall has not shown that luck egalitarianism handles well health distributions above a threshold of basic needs. Secondly, his way of avoiding Elizabeth Anderson's abandonment objection is theoretically problematic. Finally, I argue that luck egalitarianism in general fails to acknowledge the moral foundation of health and health care as a basic human entitlement. Thus I conclude that luck egalitarianism fails to take health needs seriously and that it cannot therefore uphold justice in health.

  18. Reference Data Layers for Earth and Environmental Science: History, Frameworks, Science Needs, Approaches, and New Technologies

    Science.gov (United States)

    Lenhardt, W. C.

    2015-12-01

    Global Mapping Project, Web-enabled Landsat Data (WELD), International Satellite Land Surface Climatology Project (ISLSCP), hydrology, solid earth dynamics, sedimentary geology, climate modeling, integrated assessments and so on all have needs for or have worked to develop consistently integrated data layers for Earth and environmental science. This paper will present an overview of an abstract notion of data layers of this types, what we are referring to as reference data layers for Earth and environmental science, highlight some historical examples, and delve into new approaches. The concept of reference data layers in this context combines data availability, cyberinfrastructure and data science, as well as domain science drivers. We argue that current advances in cyberinfrastructure such as iPython notebooks and integrated science processing environments such as iPlant's Discovery Environment coupled with vast arrays of new data sources warrant another look at the how to create, maintain, and provide reference data layers. The goal is to provide a context for understanding science needs for reference data layers to conduct their research. In addition, to the topics described above this presentation will also outline some of the challenges to and present some ideas for new approaches to addressing these needs. Promoting the idea of reference data layers is relevant to a number of existing related activities such as EarthCube, RDA, ESIP, the nascent NSF Regional Big Data Innovation Hubs and others.

  19. Towards Current Profile Control in ITER: Potential Approaches and Research Needs

    Science.gov (United States)

    Schuster, E.; Barton, J. E.; Wehner, W. P.

    2014-10-01

    Many challenging plasma control problems still need to be addressed in order for the ITER Plasma Control System (PCS) to be able to successfully achieve the ITER project goals. For instance, setting up a suitable toroidal current density profile is key for one possible advanced scenario characterized by noninductive sustainment of the plasma current and steady-state operation. The nonlinearity and high dimensionality exhibited by the plasma demand a model-based current-profile control synthesis procedure that can accommodate this complexity through embedding the known physics within the design. The development of a model capturing the dynamics of the plasma relevant for control design enables not only the design of feedback controllers for regulation or tracking but also the design of optimal feedforward controllers for a systematic model-based approach to scenario planning, the design of state estimators for a reliable real-time reconstruction of the plasma internal profiles based on limited and noisy diagnostics, and the development of a fast predictive simulation code for closed-loop performance evaluation before implementation. Progress towards control-oriented modeling of the current profile evolution and associated control design has been reported following both data-driven and first-principles-driven approaches. An overview of these two approaches will be provided, as well as a discussion on research needs associated with each one of the model applications described above. Supported by the US Department of Energy under DE-SC0001334 and DE-SC0010661.

  20. Policies for friendly cities: the need for a new approach by governments and the donor community

    Science.gov (United States)

    Puccioni, V.

    2018-03-01

    Since the 1990s, the major issues in the world’s cities of Developing and Emerging Economy Countries have in some few cases improved in terms of the percentage of urban population living without appropriate housing and access to essential services- but in terms of numbers such population has severely increased. The theory by which economic development would automatically produce a trickle down effect that would take care of the needs of the poor has proved ineffective, and while the middle-lower classes have seen their lot improved, the lowest income groups are more destitute then ever- and more and more vulnerable to natural disasters. The approach of Governments and the donor community needs to be radically revisited, with a new urban policy agenda that should put emphasis on support to the lowest income groups, and relying on the informal sector as the main actor in implementing such support. The impacts of Climate Change and the increased frequency and severity of natural catastrophes also call for such a revised approach. The two-step approach to interventions in disasters situations – i.e. providing temporary shelters and only subsequently reconstructing homes- is ineffective and wasteful.

  1. Critical review of forensic trace evidence analysis and the need for a new approach.

    Science.gov (United States)

    Stoney, David A; Stoney, Paul L

    2015-06-01

    The historical development, contributions and limitations of the two traditional approaches to trace evidence analysis are reviewed. The first approach was as generalist practitioner, looking broadly at an assemblage of many different particle types. The second was that of specialist practitioner, with attention focused on one specific particle type. Four factors have significantly impacted the effectiveness of these approaches: (1) increasing technological capabilities, (2) increasing complexity in the character of manufactured materials, (3) changes in forensic laboratory management, and (4) changing scientific and legal expectations. The effectiveness of each approach is assessed within the context of these changes. More recently, new technologies have been applied to some trace evidence problems, intended to address one or more limitations. This has led to a third approach founded on discrete, highly technical methods addressing specific analytical problems. After evaluating the contributions and limitations of this third approach, we consider the different ways that technologies could be developed to address unmet needs in forensic trace evidence analysis. The route toward effective use of new technologies is contrasted with how forensic science laboratories are currently choosing and employing them. The conclusion is that although new technologies are contributing, we are not on a path that will result in their most effective and appropriate use. A new approach is required. Based on an analysis of the contributions of each of the three exisiting approaches, seven characteristics of an effective trace evidence analysis capability were determined: (1) particle traces should be a major problem-solving tool, (2) there should be readily available, straightforward methods to enable their use, (3) all available and potentially useful particle types should be considered, (4) decisions to use them should be made in the context of each case, guided by what they can

  2. Is drug-resistant Mycobacterium leprae a real cause for concern?: First approach to molecular monitoring of multibacillary Colombian patients with and without previous leprosy treatment.

    Science.gov (United States)

    Guerrero, Martha Inírida; Colorado, Claudia Lucía; Torres, José Fernando; León, Clara Inés

    2014-04-01

    There is no information in Colombia on Mycobacterium leprae primary and secondary drug resistance in regards to the WHO-multidrug therapy regime. On the other hand, public health authorities around the world have issued various recommendations, one of which prompts for the immediate organization of resistance surveillance through simple molecular methods. To determine the prevalence of Mycobacterium leprae drug resistance to rifampicin, ofloxacin and dapsone in untreated and previously treated patients at the Centro Dermatológico Federico Lleras Acosta during the 1985-2004 period. We conducted a retrospective study which included multibacillary patient biopsies through elective sampling: 381 of them from new patients and 560 from previously treated patients. Using a microtome, we obtained six slides from each skin biopsy preserved in paraffin, and we extracted M. leprae DNA. We amplified three molecular targets through PCR and obtained the patterns of drug resistance to dapsone, rifampicin and ofloxacin by reverse hybridization. Finally, we collected epidemiological, clinical and demographical data for analyses. From 941 samples under study, 4.14% of them were resistant to one or more drugs, and 5.77 and 3.04% had resistant genotypes in new and previously treated patients, respectively. Total resistance for each drug was 0.43% for dapsone, 3.19% for rifampicin and 1.17% for ofloxacin. We found statistically significant differences for rifampicin and for the total population when comparing the results from untreated versus previously treated patients. Two thirds of the resistant samples were resistant to rifampicin alone or combined. The standard multidrug therapy schemes continue being effective for leprosy cases; however, it is necessary to guarantee adherence and regularity. Surveillance to drug resistance in new and previously treated leprosy cases should be established.

  3. Cooperative learning in 'Special Needs in Dentistry' for undergraduate students using the Jigsaw approach.

    Science.gov (United States)

    Suárez-Cunqueiro, M M; Gándara-Lorenzo, D; Mariño-Pérez, R; Piñeiro-Abalo, S; Pérez-López, D; Tomás, I

    2017-11-01

    The goals of this study were to (i) describe the use of the Jigsaw approach for the resolution of clinical cases by undergraduate students in the subject 'Special Needs in Dentistry' and (ii) assess the impact of its implementation on academic performance and the students' perception. The Jigsaw approach was applied to the fifth-year in the subject 'Special Needs in Dentistry', as part of the Dentistry degree curriculum of the University of Santiago de Compostela, during the academic years 2012/2013 and 2013/2014. A total of 109 dental students were enrolled in the study, and the final marks of the Jigsaw (n = 55) and the non-Jigsaw groups (n = 54) were compared. Students' perceptions on the Jigsaw technique were assessed using a 13-question questionnaire. Academic performance based on the final examination mark for the Jigsaw and non-Jigsaw groups was 6.45 ± 1.49 and 6.13 ± 1.50, respectively. There were not students in the Jigsaw group who failed to attend the mandatory examination (0% vs. 12.96% in the non-Jigsaw group, P = 0.006). The questionnaire's internal consistency was 0.90. The mean value for all the questionnaire items was 3.80, with the highest response score of 4.35 for the statement 'I have seen the complexity that the resolution of a clinical case can involve'. Based on the students' perceptions, the Jigsaw approach could contribute to a better understanding of the complexity of solving clinical cases in the subject 'Special Needs in Dentistry'. However, further investigations should be conducted to analyse the influence of this technique on students' academic performance in the field of clinical dentistry. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Forecasting the global shortage of physicians: an economic- and needs-based approach

    Science.gov (United States)

    Liu, Jenny X; Kinfu, Yohannes; Dal Poz, Mario R

    2008-01-01

    Abstract Objective Global achievements in health may be limited by critical shortages of health-care workers. To help guide workforce policy, we estimate the future demand for, need for and supply of physicians, by WHO region, to determine where likely shortages will occur by 2015, the target date of the Millennium Development Goals. Methods Using World Bank and WHO data on physicians per capita from 1980 to 2001 for 158 countries, we employ two modelling approaches for estimating the future global requirement for physicians. A needs-based model determines the number of physicians per capita required to achieve 80% coverage of live births by a skilled health-care attendant. In contrast, our economic model identifies the number of physicians per capita that are likely to be demanded, given each country’s economic growth. These estimates are compared to the future supply of physicians projected by extrapolating the historical rate of increase in physicians per capita for each country. Findings By 2015, the global supply of physicians appears to be in balance with projected economic demand. Because our measure of need reflects the minimum level of workforce density required to provide a basic health service that is met in all but the least developed countries, the needs-based estimates predict a global surplus of physicians. However, on a regional basis, both models predict shortages for many countries in the WHO African Region in 2015, with some countries experiencing a needs-based shortage, a demand-based shortage, or both. Conclusion The type of policy intervention needed to alleviate projected shortages, such as increasing health-care training or adopting measures to discourage migration, depends on the type of shortage projected. PMID:18670663

  5. The need to disentangle key concepts from ecosystem-approach jargon.

    Science.gov (United States)

    Waylen, K A; Hastings, E J; Banks, E A; Holstead, K L; Irvine, R J; Blackstock, K L

    2014-10-01

    The ecosystem approach--as endorsed by the Convention on Biological Diversity (CDB) in 2000-is a strategy for holistic, sustainable, and equitable natural resource management, to be implemented via the 12 Malawi Principles. These principles describe the need to manage nature in terms of dynamic ecosystems, while fully engaging with local peoples. It is an ambitious concept. Today, the term is common throughout the research and policy literature on environmental management. However, multiple meanings have been attached to the term, resulting in confusion. We reviewed references to the ecosystem approach from 1957 to 2012 and identified 3 primary uses: as an alternative to ecosystem management or ecosystem-based management; in reference to an integrated and equitable approach to resource management as per the CBD; and as a term signifying a focus on understanding and valuing ecosystem services. Although uses of this term and its variants may overlap in meaning, typically, they do not entirely reflect the ethos of the ecosystem approach as defined by the CBD. For example, there is presently an increasing emphasis on ecosystem services, but focusing on these alone does not promote decentralization of management or use of all forms of knowledge, both of which are integral to the CBD's concept. We highlight that the Malawi Principles are at risk of being forgotten. To better understand these principles, more effort to implement them is required. Such efforts should be evaluated, ideally with comparative approaches, before allowing the CBD's concept of holistic and socially engaged management to be abandoned or superseded. It is possible that attempts to implement all 12 principles together will face many challenges, but they may also offer a unique way to promote holistic and equitable governance of natural resources. Therefore, we believe that the CBD's concept of the ecosystem approach demands more attention. © 2014 Society for Conservation Biology.

  6. Taking Health Needs Seriously: Against a Luck Egalitarian Approach to Justice in Health

    DEFF Research Database (Denmark)

    Nielsen, Lasse

    2013-01-01

    In recent works, Shlomi Segall suggests and defends a luck egalitarian approach to justice in health. Concurring with G. A. Cohen’s mature position he defends the idea that people should be compensated for “brute luck”, i.e. the outcome of actions that it would be unreasonable to expect them...... to avoid. In his defense of the luck egalitarian approach he seeks to rebut the criticism raised by Norman Daniels that luck egalitarianism is in some way too narrow and in another too wide to uphold justice in health and health care distribution. He points out that a pluralistic outline of luck...... egalitarianism taking into account the moral requirement of meeting everyone’s basic needs can avoid this line of criticism. In this article I argue against the application of such pluralistic luck egalitarianism in matters of health distribution. First of all, Segall has not shown that luck egalitarianism...

  7. “The Maasai Need Cows and the Cows Need Maasai,” the Use of a Photovoice Approach to Assess Animal Health Needs

    Science.gov (United States)

    van der Meer, Frank; Clancy, Eoin; Thomas, Adam; Kutz, Susan; Hatfield, Jennifer; Orsel, Karin

    2015-01-01

    The Maasai pastoralists in sub-Saharan Africa depend on their livestock for income and food. Livestock production can be significantly improved by addressing animal health concerns. We explored the use of photovoice, a participatory action research method, to strengthen our understanding of the Maasai’s animal health needs. Nine interviewees, representing warriors, elders, and women, identified animal, social, and human health themes. The use of photography provided a new medium for Maasai to express their needs and a focus for researcher–participant communications, thereby facilitating new insights across language and cultural barriers. PMID:26664973

  8. Trends and needs in regulatory approaches for future reactors. Annex 16

    International Nuclear Information System (INIS)

    Kress, T.S.

    2002-01-01

    For nuclear power to be the future alternative of choice for electric generation capacity, there are two essential elements: (1) cost competitiveness, and (2) an acceptable level of safety. To meet these perhaps conflicting elements, there will need to be significant risk-informed modifications to the regulatory approaches for the licensing and oversight of reactors. This paper discusses some of the trends in the U.S. in this direction and identifies what the author believes will be technical and policy issues that stand in the way. (author)

  9. Paediatric and perinatal postmortem imaging: the need for a subspecialty approach

    Energy Technology Data Exchange (ETDEWEB)

    Arthurs, Owen J. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom); Rijn, Rick R. van [Emma Children' s Hospital - Academic Medical Centre, Department of Radiology, Amsterdam (Netherlands); Taylor, Andrew M. [Great Ormond Street Hospital for Children, Cardiorespiratory Unit, London (United Kingdom); UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London (United Kingdom); Sebire, Neil J. [Great Ormond Street Hospital for Children, Department of Pathology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom)

    2015-04-01

    Paediatric postmortem imaging is distinct and different from adult postmortem imaging due to differences in disease aetiology, pathology and imaging approaches, which require a particular skill set to maximise its yield and clinical utility. Practitioners need to have expertise in several aspects of radiology, including both plain radiographs and cross-sectional imaging modalities, knowledge of specialist techniques, and familiarity with the unique range of pathologies in this patient population, including perinatal pathology. Here we outline the training requirements that should be considered to establish such a service. (orig.)

  10. Quantitative Risk reduction estimation Tool For Control Systems, Suggested Approach and Research Needs

    Energy Technology Data Exchange (ETDEWEB)

    Miles McQueen; Wayne Boyer; Mark Flynn; Sam Alessi

    2006-03-01

    For the past year we have applied a variety of risk assessment technologies to evaluate the risk to critical infrastructure from cyber attacks on control systems. More recently, we identified the need for a stand alone control system risk reduction estimation tool to provide owners and operators of control systems with a more useable, reliable, and credible method for managing the risks from cyber attack. Risk is defined as the probability of a successful attack times the value of the resulting loss, typically measured in lives and dollars. Qualitative and ad hoc techniques for measuring risk do not provide sufficient support for cost benefit analyses associated with cyber security mitigation actions. To address the need for better quantitative risk reduction models we surveyed previous quantitative risk assessment research; evaluated currently available tools; developed new quantitative techniques [17] [18]; implemented a prototype analysis tool to demonstrate how such a tool might be used; used the prototype to test a variety of underlying risk calculational engines (e.g. attack tree, attack graph); and identified technical and research needs. We concluded that significant gaps still exist and difficult research problems remain for quantitatively assessing the risk to control system components and networks, but that a useable quantitative risk reduction estimation tool is not beyond reach.

  11. MAKING THE NEIGHBOURHOOD A BETTER PLACE TO LIVE. A SWB APPROACH IMPLEMENTING FUNDAMENTAL HUMAN NEEDS

    Directory of Open Access Journals (Sweden)

    Ioanna Anna Papachristou

    2015-10-01

    Full Text Available Subjective well-being (SWB studies have been at the centre of researchers’ attention during the last years. With the majority of people now living in cities, the necessity for a more anthropocentric approach for the study and betterment of urban environments is constantly increasing. In this sense, defining and measuring SWB in urban contexts can be of particular benefit in urban design and planning processes. In this article, a method for measuring SWB for urban places based on the accomplishment of the fundamental human needs is presented and applied at a neighbourhood of Barcelona; that of Vila de Gràcia. For the measurement, a survey was constructed based on the specific geographical and socio-economic characteristics of the study case. Retrieved from Max-Neef’s Human Scale Development Paradigm (Max-Neef et al. 1991, human needs correspond to the domains of study of the suggested method. The matching of the survey’s questions to each need is the outcome of two consecutive processes: a first qualitative one, involving the work of an expert group, and a second quantitative one, involving the definition of weights among the questions that affect the same need. Although the final result is positive (although low for this study case, results for each need show considerable differences in their level of accomplishment. At the same time people seem to truly believe that most of their feelings are affected by their living environment, with stress and calmness leading the list. In summary, the method defines and applies a simple tool to quantify and evaluate current levels of SWB at different urban scales and to determine more holistic urban indexes in order to improve decision making processes, policies and plans. The classification of the questions per need favours the identification of a potential problem at the urban grid and consequently can be used as a process for implementing related measures of improvement. The method can also be seen

  12. A True Delphi Approach: Developing a Tailored Curriculum in Response to Local Agriscience Need

    Energy Technology Data Exchange (ETDEWEB)

    Rubenstein, Eric; Thoron, Andrew; Burleson, Sarah

    2012-02-07

    The Delphi approach is a structured communication technique, developed as a systematic, interactive forecasting method which relies on a panel of experts. In this specific case experts from Industry, Education and Extension fields addressed needs for educational programs in a traditional agriculturally-based community, environmentally conscious practices in order to restore environmental integrity and multi-disciplinary approach to solve sustainability problems facing the agricultural industry. The experts were divided into two main groups, (A) Secondary and (B) Post-secondary, and answered questionnaires in three rounds: • 1st Round – Participants generated a list of knowledge, skills, and competencies followed • 2nd Round – Panelists rated each item • 3rd Round – Panelists were given the opportunity to combine and add additional items As a result, top six items from both groups were not found similar, secondary panelists centralized around employment skills and post-secondary panelists focused on content areas. Implications include a need for content-based curriculum for post-secondary graduates, utilization of true-Delphi technique for future curriculum development research and further examination of students that complete secondary and post-secondary programs in biofuels/sustainable agriculture.

  13. Meeting the Late-Career Needs of Faculty Transitioning Through Retirement: One Institution's Approach.

    Science.gov (United States)

    Cain, Joanna M; Felice, Marianne E; Ockene, Judith K; Milner, Robert J; Congdon, John L; Tosi, Stephen; Thorndyke, Luanne E

    2018-03-01

    Medical school faculty are aging, but few academic health centers are adequately prepared with policies, programs, and resources (PPR) to assist late-career faculty. The authors sought to examine cultural barriers to successful retirement and create alignment between individual and institutional needs and tasks through PPR that embrace the contributions of senior faculty while enabling retirement transitions at the University of Massachusetts Medical School, 2013-2017. Faculty 50 or older were surveyed, programs at other institutions and from the literature (multiple fields) were reviewed, and senior faculty and leaders, including retired faculty, were engaged to develop and implement PPR. Cultural barriers were found to be significant, and a multipronged, multiyear strategy to address these barriers, which sequentially added PPR to support faculty, was put in place. A comprehensive framework of sequenced PPR was developed to address the needs and tasks of late-career transitions within three distinct phases: pre-retirement, retirement, and post-retirement. This sequential introduction approach has led to important outcomes for all three of the retirement phases, including reduction of cultural barriers, a policy that has been useful in assessing viability of proposed phased retirement plans, transparent and realistic discussions about financial issues, and consideration of roles that retired faculty can provide. The authors are tracking the issues mentioned in consultations and efficacy of succession planning, and will be resurveying faculty to further refine their work. This framework approach could serve as a template for other academic health centers to address late-career faculty development.

  14. Process-outcome interrelationship and standard setting in medical education: the need for a comprehensive approach.

    Science.gov (United States)

    Christensen, Leif; Karle, Hans; Nystrup, Jørgen

    2007-09-01

    An outcome-based approach to medical education compared to a process/content orientation is currently being discussed intensively. In this article, the process and outcome interrelationship in medical education is discussed, with specific emphasis on the relation to the definition of standards in basic medical education. Perceptions of outcome have always been an integrated element of curricular planning. The present debate underlines the need for stronger focus on learning objectives and outcome assessment in many medical schools around the world. The need to maintain an integrated approach of process/content and outcome is underlined in this paper. A worry is expressed about the taxonomy of learning in pure outcome-based medical education, in which student assessment can be a major determinant for the learning process, leaving the control of the medical curriculum to medical examiners. Moreover, curricula which favour reductionism by stating everything in terms of instrumental outcomes or competences, do face a risk of lowering quality and do become a prey for political interference. Standards based on outcome alone rise unclarified problems in relationship to licensure requirements of medical doctors. It is argued that the alleged dichotomy between process/content and outcome seems artificial, and that formulation of standards in medical education must follow a comprehensive line in curricular planning.

  15. A Hybrid Approach to Finding Relevant Social Media Content for Complex Domain Specific Information Needs.

    Science.gov (United States)

    Cameron, Delroy; Sheth, Amit P; Jaykumar, Nishita; Thirunarayan, Krishnaprasad; Anand, Gaurish; Smith, Gary A

    2014-12-01

    While contemporary semantic search systems offer to improve classical keyword-based search, they are not always adequate for complex domain specific information needs. The domain of prescription drug abuse, for example, requires knowledge of both ontological concepts and "intelligible constructs" not typically modeled in ontologies. These intelligible constructs convey essential information that include notions of intensity, frequency, interval, dosage and sentiments, which could be important to the holistic needs of the information seeker. In this paper, we present a hybrid approach to domain specific information retrieval that integrates ontology-driven query interpretation with synonym-based query expansion and domain specific rules, to facilitate search in social media on prescription drug abuse. Our framework is based on a context-free grammar (CFG) that defines the query language of constructs interpretable by the search system. The grammar provides two levels of semantic interpretation: 1) a top-level CFG that facilitates retrieval of diverse textual patterns, which belong to broad templates and 2) a low-level CFG that enables interpretation of specific expressions belonging to such textual patterns. These low-level expressions occur as concepts from four different categories of data: 1) ontological concepts, 2) concepts in lexicons (such as emotions and sentiments), 3) concepts in lexicons with only partial ontology representation, called lexico-ontology concepts (such as side effects and routes of administration (ROA)), and 4) domain specific expressions (such as date, time, interval, frequency and dosage) derived solely through rules. Our approach is embodied in a novel Semantic Web platform called PREDOSE, which provides search support for complex domain specific information needs in prescription drug abuse epidemiology. When applied to a corpus of over 1 million drug abuse-related web forum posts, our search framework proved effective in retrieving

  16. Mental health research in the criminal justice system: The need for common approaches and international perspectives.

    Science.gov (United States)

    Roesch, R; Ogloff, J R; Eaves, D

    1995-01-01

    There is a need for researchers and policy makers in the area of mental health and law to collaborate and develop common methods of approach to research. Although we have learned a great deal about the prevalence and needs of mentally ill offenders in jails and prisons, there are a number of research questions that remain. If the "second generation" of research is to be fruitful--and useful to policy makers--we need to be sure that the methods we employ are valid and that the findings we obtain are reliable. By collaborating with colleagues in other jurisdictions, we can begin to learn whether some of the existing findings are of a general nature, or dependent upon the system in which they were found. Similarly, while the first-generation research has alerted us to the needs of mentally ill offenders in jails and prisons, second-generation research is needed to help identify factors that may help prevent the "revolving door phenomenon," which results in mentally ill people being volleyed among mental health, criminal justice, and community settings. One area that has received embarrassingly little attention has been the need for considering the relationship between substance abuse and mental disorders. In our own work, we have found an alarmingly high degree of substance abuse among offenders, including mentally ill offenders. We have come to realize the importance of considering the role that substance abuse coupled with other mental disorders may play in the criminal justice system. As a result of this concern, the Surrey Mental Health Project recently hired a full-time drug and alcohol counselor whose job it is to work with inmates with substance abuse disorders while in the jail, and to help arrange continuing treatment resources upon their release. As Wilson et al. (1995) discuss, intensive case management projects may be particularly useful at targeting the unique needs of mentally ill offenders with multiple problems. Much of the research conducted with

  17. Overview of tracheal tissue engineering: clinical need drives the laboratory approach.

    Science.gov (United States)

    Ott, Lindsey M; Weatherly, Robert A; Detamore, Michael S

    2011-08-01

    Breathing is a natural function that most of us do not even think about, but for those who suffer from disease or damage of the trachea, the obstruction of breathing can mean severe restrictions to quality of life or may even be fatal. Replacement and reconstruction of the trachea is one of the most difficult procedures in otolaryngology/head and neck surgery, and also one of the most vital. Previous reviews have focused primarily on clinical perspectives or instead on engineering strategies. However, the current review endeavors to bridge this gap by evaluating engineering approaches in a practical clinical context. For example, although contemporary approaches often include in vitro bioreactor pre-culture, or sub-cutaneous in vivo conditioning, the limitations they present in terms of regulatory approval, cost, additional surgery, and/or risk of infection challenge engineers to develop the next generation of biodegradable/resorbable biomaterials that can be directly implanted in situ. Essentially, the functionality of the replacement is the most important requirement. It must be the correct shape and size, achieve an airtight fit, resist collapse as it is replaced by new tissue, and be non-immunogenic. As we look to the future, there will be no one-size-fits-all solution.

  18. Nematode parasite control of livestock in the tropics/subtropics: the need for novel approaches.

    Science.gov (United States)

    Waller, P J

    1997-10-01

    Because parasites are more abundant, small ruminants in the tropical/subtropical regions of the world experience much greater ravages from internal parasitic disease than those in the temperate regions. In the tropics/subtropics, the limiting ecological factor influencing the severity of parasitism is rainfall, as temperatures almost always favour hatching and development of the free-living stages. Attempts to expand sheep and goat production by replacing traditional village production systems, which rarely involve anthelmintic treatment, with large-scale intensive commercial enterprises invariably induce complete reliance on anthelmintics to control nematode parasites. This has led to the widespread development of high level, multiple anthelmintic resistance throughout the tropics/subtropics, and in certain regions this has reached the ultimate disastrous scenario of total chemotherapeutic failure. Immediate concerted efforts are needed to resolve this crisis. Significant benefits are likely to emerge from research into non-chemotherapeutic approaches to nematode parasite control, such as grazing management, worm vaccines, breed selection and biological control. However, it is likely that none, in isolation or collectively, will completely replace the need for effective anthelmintics. What is needed is the integration of all methods of parasite control as they come to hand, with the underlying aim of reducing the use and thus preserving the effectiveness of anthelmintics. Although cheap and simple procedures, based on sound epidemiological principles, can achieve dramatic benefits in worm control, they have been poorly adopted by livestock owners. Clearly then, the greatest need is for technology transfer and education programmes, but these activities are generally found to be chronically under-resourced.

  19. Marketing Management Relational Approaches Focused on Consumer’s and Customer’s Needs and Desires

    Directory of Open Access Journals (Sweden)

    Gheorghe MINCULETE

    2014-12-01

    Full Text Available Currently, because of the evolution in the knowledge-based society, the marketing reveals another dimension, the one of relational marketing, which represents the special relationship established between the company and its consumers, with win-win advantages over a long period. In these circumstances, the managerial approach of marketing has new connotations for a more efficient managerial approach of the new national and international business environment. Within the marketing management process of a company, consumers or customers play a very critical role as these are the people who finally buy the goods and services of the organization, and the firm is always on the move to make them buy so as to earn revenue.This article presents the managerial approach of marketing management concept toward the strategic planning of a company and the marketing planning focused on needs and desires of consumers and customers. Therefore, consumers are the beneficiaries of the general and marketing strategy of the company while customers are those who respond to the loyalty process established by the firm. In this context, the purpose of this analysis is to highlight the strategic planning process of a company by integrating the strategic and operational marketing.In addition, we also consider important the issues related to Michael Porter’s generic strategies, which are thus presented in the context of relational knowledge within the process of marketing management. All these approaches are related to winning customers’ loyalty and obviously to customers' value that determines the company to achieve a value chain in the business process. Hence, the consumers and customers are the most important people for any organization. They are the resources which trigger the success of the business.

  20. A genomic and transcriptomic approach for a differential diagnosis between primary and secondary ovarian carcinomas in patients with a previous history of breast cancer

    International Nuclear Information System (INIS)

    Meyniel, Jean-Philippe; Alran, Séverine; Rapinat, Audrey; Gentien, David; Roman-Roman, Sergio; Mignot, Laurent; Sastre-Garau, Xavier; Cottu, Paul H; Decraene, Charles; Stern, Marc-Henri; Couturier, Jérôme; Lebigot, Ingrid; Nicolas, André; Weber, Nina; Fourchotte, Virginie

    2010-01-01

    The distinction between primary and secondary ovarian tumors may be challenging for pathologists. The purpose of the present work was to develop genomic and transcriptomic tools to further refine the pathological diagnosis of ovarian tumors after a previous history of breast cancer. Sixteen paired breast-ovary tumors from patients with a former diagnosis of breast cancer were collected. The genomic profiles of paired tumors were analyzed using the Affymetrix GeneChip ® Mapping 50 K Xba Array or Genome-Wide Human SNP Array 6.0 (for one pair), and the data were normalized with ITALICS (ITerative and Alternative normaLIzation and Copy number calling for affymetrix Snp arrays) algorithm or Partek Genomic Suite, respectively. The transcriptome of paired samples was analyzed using Affymetrix GeneChip ® Human Genome U133 Plus 2.0 Arrays, and the data were normalized with gc-Robust Multi-array Average (gcRMA) algorithm. A hierarchical clustering of these samples was performed, combined with a dataset of well-identified primary and secondary ovarian tumors. In 12 of the 16 paired tumors analyzed, the comparison of genomic profiles confirmed the pathological diagnosis of primary ovarian tumor (n = 5) or metastasis of breast cancer (n = 7). Among four cases with uncertain pathological diagnosis, genomic profiles were clearly distinct between the ovarian and breast tumors in two pairs, thus indicating primary ovarian carcinomas, and showed common patterns in the two others, indicating metastases from breast cancer. In all pairs, the result of the transcriptomic analysis was concordant with that of the genomic analysis. In patients with ovarian carcinoma and a previous history of breast cancer, SNP array analysis can be used to distinguish primary and secondary ovarian tumors. Transcriptomic analysis may be used when primary breast tissue specimen is not available

  1. Critical infrastructures at risk: A need for a new conceptual approach and extended analytical tools

    International Nuclear Information System (INIS)

    Kroeger, Wolfgang

    2008-01-01

    Recent decades have witnessed on the one hand a much greater and tighter integration of goods or services supply systems and growing interconnectedness as well as changing organizational and operational factors, and on the other hand an increased social vulnerability in the face of accidental or intentional disruption. The work of the International Risk Governance Council (IRGC) in the field of critical infrastructures has focused on both the risks associated with five individual infrastructures and the issues associated with the increasing interdependence between them. This paper presents a selection of system weaknesses and a number of policy options that have been identified and highlights issues for further investigation and dialogue with stakeholders. Furthermore, the need to extend current modeling and simulation techniques in order to cope with the increasing system complexity is elaborated. An object-oriented, hybrid modeling approach promising to overcome some of the shortcomings of traditional methods is presented

  2. Oncology Education in Medical Schools: Towards an Approach that Reflects Australia's Health Care Needs.

    Science.gov (United States)

    McRae, Robert J

    2016-12-01

    Cancer has recently overtaken heart disease to become the number 1 cause of mortality both globally and in Australia. As such, adequate oncology education must be an integral component of medical school if students are to achieve learning outcomes that meet the needs of the population. The aim of this review is to evaluate the current state of undergraduate oncology education and identify how Australian medical schools can improve oncology learning outcomes for students and, by derivative, improve healthcare outcomes for Australians with cancer. The review shows that oncology is generally not well represented in medical school curricula, that few medical schools offer mandatory oncology or palliative care rotations, and that junior doctors are exhibiting declining oncology knowledge and skills. To address these issues, Australian medical schools should implement the Oncology Education Committee's Ideal Oncology Curriculum, enact mandatory oncology and palliative care clinical rotations for students, and in doing so, appreciate the importance of students' differing approaches to learning.

  3. A comprehensive approach to handle the dynamics of customer’s needs in Quality Function Deployment based on linguistic variables

    Directory of Open Access Journals (Sweden)

    Zohreh Bostaki

    2014-04-01

    Full Text Available In the contexture of a customer-driven goods or service design process, a well-timed update of customer’s requirements may not only serve as a necessity indicator to observe how things change over time, but also it incorporates the firms a better ground to interoperate different strategies to meet the future needs of its customer. This paper proposes a systematic methodology to deal with the customer needs’ dynamics, in terms of their relative weights, in the QFD. Compared with previous research, the contribution of this paper is fourfold. First, it applies some linguistic variables to get preferences of customers and experts to determine the relative importance of customer requirements (CRs and the relationships between customer requirements and engineering characteristics (ECs. Second, it proposes the implementation of a forecasting technique. Third, it describes more comprehensively on how future uncertainty in the weights of customer’s needs could be estimated and transmitted into the design attributes. Fourth, it proposes the implementation of a quantitative approach, which takes into account the decision maker’s attitude towards risk to optimize the QFD decision making analysis. Finally, a real-world application of QFD is provided to demonstrate the practical applicability of the proposed methodology.

  4. Experiences of parents of children with special needs at school entry: a mixed method approach.

    Science.gov (United States)

    Siddiqua, A; Janus, M

    2017-07-01

    The transition from pre-school to kindergarten can be complex for children who need special assistance due to mental or physical disabilities (children with 'special needs'). We used a convergent mixed method approach to explore parents' experiences with service provision as their children transitioned to school. Parents (including one grandparent) of 37 children aged 4 to 6 years completed measures assessing their perceptions of and satisfaction with services. Semi-structured interviews were also conducted with 10 parents to understand their experience with services. Post transition, parents reported lower perceptions of services and decreased satisfaction than pre-transition. The following themes emerged from the qualitative data: qualities of services and service providers, communication and information transfer, parent advocacy, uncertainty about services, and contrasts and contradictions in satisfaction. The qualitative findings indicate that parents were both satisfied and concerned with aspects of the post-transition service provision. While the quantitative results suggested that parents' experience with services became less positive after their children entered school, the qualitative findings illustrated the variability in parents' experiences and components of service provision that require improvements to facilitate a successful school entry. © 2017 John Wiley & Sons Ltd.

  5. A systematic approach to the training in the nuclear power industry: The need for standard

    International Nuclear Information System (INIS)

    Wilkinson, J.D.

    1995-01-01

    The five elements of a open-quotes Systematic Approach to Trainingclose quotes (SAT) are analysis, design, development, implementation and evaluation. These elements are also present in the effective application of basic process control. The fundamental negative feedback process control loop is therefore an excellent model for a successful, systematic approach to training in the nuclear power industry. Just as standards are required in today's manufacturing and service industries, eg ISO 9000, so too are control standards needed in the training industry and in particular in the training of nuclear power plant staff. The International Atomic Energy Agency (IAEA) produced its TECDOC 525 on open-quotes Training to Establish and Maintain the Qualification and Competence of Nuclear Power Plant Operations Personnelclose quotes in 1989 and the American Nuclear Society published its open-quotes Selection, Qualification, and Training of Personnel for Nuclear Power Plants, an American National Standardclose quotes in 1993. It is important that community colleges, training vendors and organizations such as the Instrument Society of America (ISA), who may be supplying basic or prerequisite training to the nuclear power industry, become aware of these and other standards relating to training in the nuclear power industry

  6. Atomic and Molecular Data Needs for Radiation Damage Modeling: Multiscale Approach

    International Nuclear Information System (INIS)

    Yakubovich, Alexander V.; Solov'yov, Andrey V.; Surdutovich, Eugene

    2011-01-01

    We present a brief overview of the multiscale approach towards understanding of the processes responsible for the radiation damage caused by energetic ions. This knowledge is very important, because it can be utilized in the ion-beam cancer therapy, which is one of the most advanced modern techniques to cure certain type of cancer. The central element of the multiscale approach is the theoretical evaluation and quantification of the DNA damage within cell environment. To achieve this goal one needs a significant amount of data on various atomic and molecular processes involved into the cascade of events starting with the ion entering and propagation in the biological medium and resulting in the DNA damage. The discussion of the follow up biological processes are beyond the scope of this brief overview. We consider different paths of the DNA damage and focus on the the illustration of the thermo-mechanical effects caused by the propagation of ions through the biological environment and in particular on the possibility of the creation of the shock waves in the vicinity of the ion tracks. We demonstrate that at the initial stages after ion's passage the shock wave is so strong that it can contribute to the DNA damage due to large pressure gradients developed at the distances of a few nanometers from the ionic tracks. This novel mechanism of the DNA damage provides an important contribution to the cumulative biodamage caused by low-energy secondary electrons, holes and free radicals.

  7. From computer-assisted intervention research to clinical impact: The need for a holistic approach.

    Science.gov (United States)

    Ourselin, Sébastien; Emberton, Mark; Vercauteren, Tom

    2016-10-01

    The early days of the field of medical image computing (MIC) and computer-assisted intervention (CAI), when publishing a strong self-contained methodological algorithm was enough to produce impact, are over. As a community, we now have substantial responsibility to translate our scientific progresses into improved patient care. In the field of computer-assisted interventions, the emphasis is also shifting from the mere use of well-known established imaging modalities and position trackers to the design and combination of innovative sensing, elaborate computational models and fine-grained clinical workflow analysis to create devices with unprecedented capabilities. The barriers to translating such devices in the complex and understandably heavily regulated surgical and interventional environment can seem daunting. Whether we leave the translation task mostly to our industrial partners or welcome, as researchers, an important share of it is up to us. We argue that embracing the complexity of surgical and interventional sciences is mandatory to the evolution of the field. Being able to do so requires large-scale infrastructure and a critical mass of expertise that very few research centres have. In this paper, we emphasise the need for a holistic approach to computer-assisted interventions where clinical, scientific, engineering and regulatory expertise are combined as a means of moving towards clinical impact. To ensure that the breadth of infrastructure and expertise required for translational computer-assisted intervention research does not lead to a situation where the field advances only thanks to a handful of exceptionally large research centres, we also advocate that solutions need to be designed to lower the barriers to entry. Inspired by fields such as particle physics and astronomy, we claim that centralised very large innovation centres with state of the art technology and health technology assessment capabilities backed by core support staff and open

  8. Health status transitions in community-living elderly with complex care needs: a latent class approach.

    Science.gov (United States)

    Lafortune, Louise; Béland, François; Bergman, Howard; Ankri, Joël

    2009-02-03

    For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164), we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles) based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability) Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical information for the planning of longitudinal studies of aging

  9. Health status transitions in community-living elderly with complex care needs: a latent class approach

    Directory of Open Access Journals (Sweden)

    Béland François

    2009-02-01

    Full Text Available Abstract Background For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. Methods Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164, we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. Results We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. Conclusion Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical

  10. Need to use probabilistic risk approach in performance assessment of waste disposal facilities

    International Nuclear Information System (INIS)

    Bonano, E.J.; Gallegos, D.P.

    1991-01-01

    Regulations governing the disposal of radioactive, hazardous, and/or mixed wastes will likely require, either directly or indirectly, that the performance of disposal facilities be assessed quantitatively. Such analyses, commonly called ''performance assessments,'' rely on the use of predictive models to arrive at a quantitative estimate of the potential impact of disposal on the environment and the safety and health of the public. It has been recognized that a suite of uncertainties affect the results of a performance assessment. These uncertainties are conventionally categorized as (1) uncertainty in the future state of the disposal system (facility and surrounding medium), (2) uncertainty in models (including conceptual models, mathematical models, and computer codes), and (3) uncertainty in data and parameters. Decisions regarding the suitability of a waste disposal facility must be made in light of these uncertainties. Hence, an approach is needed that would allow the explicit consideration of these uncertainties so that their impact on the estimated consequences of disposal can be evaluated. While most regulations for waste disposal do not prescribe the consideration of uncertainties, it is proposed that, even in such cases, a meaningful decision regarding the suitability of a waste disposal facility cannot be made without considering the impact of the attendant uncertainties. A probabilistic risk assessment (PRA) approach provides the formalism for considering the uncertainties and the technical basis that the decision makers can use in discharging their duties. A PRA methodology developed and demonstrated for the disposal of high-level radioactive waste provides a general framework for assessing the disposal of all types of wastes (radioactive, hazardous, and mixed). 15 refs., 1 fig., 1 tab

  11. Laparoscopy After Previous Laparotomy

    Directory of Open Access Journals (Sweden)

    Zulfo Godinjak

    2006-11-01

    Full Text Available Following the abdominal surgery, extensive adhesions often occur and they can cause difficulties during laparoscopic operations. However, previous laparotomy is not considered to be a contraindication for laparoscopy. The aim of this study is to present that an insertion of Veres needle in the region of umbilicus is a safe method for creating a pneumoperitoneum for laparoscopic operations after previous laparotomy. In the last three years, we have performed 144 laparoscopic operations in patients that previously underwent one or two laparotomies. Pathology of digestive system, genital organs, Cesarean Section or abdominal war injuries were the most common causes of previouslaparotomy. During those operations or during entering into abdominal cavity we have not experienced any complications, while in 7 patients we performed conversion to laparotomy following the diagnostic laparoscopy. In all patients an insertion of Veres needle and trocar insertion in the umbilical region was performed, namely a technique of closed laparoscopy. Not even in one patient adhesions in the region of umbilicus were found, and no abdominal organs were injured.

  12. Clinical roundtable monograph: unmet needs in the treatment of chronic lymphocytic leukemia: integrating a targeted approach.

    Science.gov (United States)

    O'Brien, Susan M; Furman, Richard R; Byrd, John C; Smith, Ashbel

    2014-01-01

    Chronic lymphocytic leukemia (CLL) is the most frequently diagnosed hematologic malignancy in the United States. Although several features can be useful in the diagnosis of CLL, the most important is the immunophenotype.Two staging systems--the Binet system and the Rai classification--are used to assess risk. After diagnosis, the first major therapeutic decision is when to initiate therapy, as a watchful waiting approach is often appropriate for patients with asymptomatic disease. Once a patient has met the criteria for treatment, the choice of therapy is the next major decision. Younger patients (<65 years) often receive more aggressive treatment that typically consists of cytotoxic chemotherapy. There is a great unmet need concerning treatment of older patients with CLL, who often present with more comorbid conditions that can decrease their ability to tolerate particular regimens. The current standard of care for older patients with CLL is rituximab plus chlorambucil. The concept of targeted agents is currently an area of intense interest in CLL. The Bruton’s tyrosine kinase inhibitor ibrutinib is the targeted agent that is furthest along in clinical development. It is associated with an overall survival rate of 83%. Idelalisib targets the phosphatidyl inositol 3-kinase and is under evaluation in pivotal trials. Targeted agents offer much promise in terms of efficacy, toxicity, and oral availability. They will change the management of patients with CLL.

  13. The History of Petroleum Pollution in Malaysia; Urgent Need for Integrated Prevention Approach

    Directory of Open Access Journals (Sweden)

    Mahyar Sakari

    2010-01-01

    Full Text Available Petroleum pollution is known as point and non-point source of contaminations in the environment. A major class of petroleum contaminant is groups of compounds consist of two or more fused benzene rings called polycyclic aromatic hydrocarbons (PAHs that are carcinogenic, mutagenic and toxic. Source identification of petroleum pollution is necessary to prevent pollution entry into the environment. Eight sedimentary cores were obtained from developed and developing areas around Peninsular Malaysia to investigate the historical profile of PAHs, their characteristics and its possible origins. The results showed that the PAHs concentrations varied from very minimum to 2400 ng/g d. w. in average quarter century intervals. Most of the studied locations showed high contribution of PAHs from combusted fuel, coal, biomasses and wood materials except for the southern part of Peninsular Malaysia in which revealed dominance of petroleum products. The findings indicate that PAHs are delivered from different intermediate materials such as asphalt, street dust, vehicular emission and crankcase oil. However, there has been a decline of PAHs input into the marine environment in recent years; petroleum is shown to be a significant cause of marine pollution since the second quarter of 20th century. An overview on sourced materials of petroleum pollution indicates multi-approach necessity toward pollution control, regardless of concentration and possible degradation processes. Various sectors both governmental and non-governmental are needed for prevention and control of petroleum pollution where different sources apparently contribute to the pollution generation process.

  14. Priority Setting in Indigenous Health: Why We Need an Explicit Decision Making Approach

    Directory of Open Access Journals (Sweden)

    Michael E. Otim

    2015-06-01

    Full Text Available Indigenous Australians have significantly poorer health outcomes than the non-Indigenous population worldwide. The Australian government has increased its investment in Indigenous health through the "Closing the Health Gap" initiative. Deciding where to invest scarce resources so as to maximize health outcomes for Indigenous peoples may require improved priority setting processes. Current government practice involves a mix of implicit and explicit processes to varying degrees at the macro and meso decision making levels. In this article, we argue that explicit priority setting should be emphasized in Indigenous health, as it can ensure that the decision making process is accountable, systematic, and transparent. Following a review of the literature, we outline four key issues that need to be considered for explicit priority setting: developing an Indigenous health "constitution," strengthening the evidence base, selecting mechanisms for priority setting, and establishing appropriate incentives and institutional structure. We then summarize our findings into a checklist that can help a decision makers ensure that explicit priority setting is undertaken in Indigenous health. By addressing these key issues, the benefits of an explicit approach, which include increased efficiency, equity, and use of evidence, can be realized, thereby maximizing Indigenous health outcomes.

  15. New EDF approach to the mentification of NPP personnel training needs

    International Nuclear Information System (INIS)

    Hazet, Jean-Christophe

    2003-01-01

    The EDF ambition today is to be among the best electricity producers in the world. To do so, we have to take more responsibilities, to motivate and to give our employees a better level of competence, and to make them more involved in the culture and the success of our company. In order to reach these objectives a deeper analysis of the NPP training needs must be completed. Our answer, named 'Local Competencies Development System' (LCDS) consists in implementing a large decentralisation of the competencies management, done by the EDF Production Department in conjunction with the EDF Training Department. It takes place in a logical approach bound up with the historical development of our nuclear program. In addition to this LCDS a new organization of training centers instructors, in dedicated training teams, has been implemented in order to co-ordinate the different actions directly with the NPP. The purpose of this presentation is to take into account the LCDS on the operation personnel training side, a similar organization has been implemented for the maintenance side

  16. Assessing basic needs in frail older persons calls for aesthetic nursing skills – an ethnographic approach

    DEFF Research Database (Denmark)

    Kollerup, Mette Geil; Angel, Sanne

    2015-01-01

    Background: Despite research on caring for older persons' basic needs, a number of hospital admissions occur which had been preventable, given the proper attention to caring for the basic needs. Literature show that caring for the basic needs of frail older persons can be complicated if they are ......Background: Despite research on caring for older persons' basic needs, a number of hospital admissions occur which had been preventable, given the proper attention to caring for the basic needs. Literature show that caring for the basic needs of frail older persons can be complicated...

  17. Managing the language and learning needs of the communication-impaired preschool child. A proactive approach.

    Science.gov (United States)

    Prelock, P A

    1993-01-01

    If a proactive approach to assessment and intervention had been used in the case study presented at the beginning of this article, the following might have occurred: The SLP would have asked the parents and brother of the 3 1/2-year-old child referred for a communication evaluation to participate in the assessment activities. The parents would have been asked to prioritize their expectations for their daughter's communication, behavior, and school success. They would have been told the SLP would do the same based on her knowledge of performance expectations in these areas for a 3 1/2-year old. Both the parents and the SLP would have agreed to consider describing the child's communication, behavior, and potential for school success in more than a single setting or context. The child would have been seen in her home as well as in a preschool setting. The clinician would have observed the child's play with both familiar and unfamiliar children and adults. The parents would have kept a log of their child's communication successes and failures for one week. The clinician would have used those situations the parents identified as successful and unsuccessful to specify the child's strengths and weaknesses. The parents would have been asked to write down ideas they had on the type of intervention, if any, they felt their daughter needed to meet the expectations they set. The clinician would do the same and would have consulted with an educational specialist and a psychologist to obtain their perspective on the educational and cognitive needs of a preschooler. The speech-language pathologist would have asked other professionals to assist in assessment of this child. The psychologist would have completed some testing in the home with the SLP providing help in interpreting the child's responses. The educational specialist would have invited the SLP to observe the child in a diagnostic preschool setting to assess the child's ability to understand and communicate in an

  18. Negative Emissions Technologies, the Paris Agreement, and the Need for a Human-Rights Based Approach

    Science.gov (United States)

    Burns, W. C. G.

    2016-12-01

    The new Paris Agreement under the United Nations Framework Convention on Climate Change contemplates that its prospective Parties will balance emissions and sinks by 2050 as a means to effectuate the goal of holding temperature increases to well below 2°C from pre-industrial levels, as well as the more aspirational goal of holding temperature increases to 1.5°C. Most of the IPCC's AR5 scenarios that achieve these objectives contemplate the large-scale deployment of so-called "negative emissions technologies," with an emphasis on bioenergy and carbon capture and storage (BECCS), and to a lesser degree afforestation. BECCS could assuredly help society avoid passing critical climatic thresholds, or address overshoot scenarios in this century and beyond. However, it could also profound implications for food production, the status of forests, access to lands for livelihoods by vulnerable populations, and the integrity of critical ecosystems. This, in turn could have serious ramifications for human rights of some of the world's most vulnerable populations, including the rights to food, water, livelihoods and the benefits of biodiversity. The Preamble to the Paris Agreement acknowledges the need to take into consideration the potential impact of responses to climate change, providing that "Parties should, when taking action to address climate change, respect, promote and consider their respective obligations on human rights." This presentation will outline how application of a human rights-based approach to assessing such options could help to reconcile the objectives of ameliorating potential climatic impacts while protecting the human rights of potentially affected individuals and groups. This will include the potential role of Human Rights Impacts Assessments and potential configuration of HRIAs at the national and international level. It will also briefly suggest how to operationalize this approach within the Paris Agreement framework, including institutional

  19. Do we need an integrative approach to food safety at the country level?

    Energy Technology Data Exchange (ETDEWEB)

    Ristic, G E-mail:risticg@eunet yu [Department of Nutrition, Medical Faculty, Belgrade (Yugoslavia)

    2002-05-01

    Scientific data show increasing evidence of relationship between food safety and food standards on one hand and public health concern on the other hand. In FR Yugoslavia in 1989 the system of reporting on food safety issues on federal and republic level was established. The system provides data on laboratory analysis of 22 food items (bread, milk, meat and meat products, vegetables, processed vegetables etc). Those items were and still are tested on food quality and safety parameters such as microbiological, chemical and radio nuclides. Seldom all required testing on chemical and radio nuclides are performed, so we lack exact risk assessment for those contaminants. Further, during war conflict in FR Yugoslavia and also due to industrial hazards in neighbouring countries (Rumania, Hungary) high quantities of PCBs, dioxins, heavy metals, arsenic compounds and other toxic compounds contaminated the environment. In the soil and in some food products (animal fats predominantly) radionuclides originating from Chernobyl hazard can still be detected. In order to identify the level of exposure to chemical and radio nuclide contaminants in the food chain it is essential to test intensively and systematically food from animal and from plant origin. In order to prevent entering the contaminants to the food chain new recommendations from WHO, FAO and EU suggest implementation of integrative approach to food safety and control over the whole chain of food production from 'farm to table'. This approach provides control of the contaminants in soil, water, air, control over primary food production (covering animal feed too), intensive control over processing with implementation of HACCP system, but also, over transportation, retail trade, street food and home made food too. In our country creation of the map of the polluted areas, and actions in order to treat the pollution should accompany implementation of this new food safety system. The need for assessment of the level of

  20. Do we need an integrative approach to food safety at the country level?

    International Nuclear Information System (INIS)

    Ristic, G.

    2002-01-01

    Scientific data show increasing evidence of relationship between food safety and food standards on one hand and public health concern on the other hand. In FR Yugoslavia in 1989 the system of reporting on food safety issues on federal and republic level was established. The system provides data on laboratory analysis of 22 food items (bread, milk, meat and meat products, vegetables, processed vegetables etc). Those items were and still are tested on food quality and safety parameters such as microbiological, chemical and radio nuclides. Seldom all required testing on chemical and radio nuclides are performed, so we lack exact risk assessment for those contaminants. Further, during war conflict in FR Yugoslavia and also due to industrial hazards in neighbouring countries (Rumania, Hungary) high quantities of PCBs, dioxins, heavy metals, arsenic compounds and other toxic compounds contaminated the environment. In the soil and in some food products (animal fats predominantly) radionuclides originating from Chernobyl hazard can still be detected. In order to identify the level of exposure to chemical and radio nuclide contaminants in the food chain it is essential to test intensively and systematically food from animal and from plant origin. In order to prevent entering the contaminants to the food chain new recommendations from WHO, FAO and EU suggest implementation of integrative approach to food safety and control over the whole chain of food production from 'farm to table'. This approach provides control of the contaminants in soil, water, air, control over primary food production (covering animal feed too), intensive control over processing with implementation of HACCP system, but also, over transportation, retail trade, street food and home made food too. In our country creation of the map of the polluted areas, and actions in order to treat the pollution should accompany implementation of this new food safety system. The need for assessment of the level of

  1. 8 Different approaches needed to manage ED demand among different age-groups.

    Science.gov (United States)

    Rimmer, Melanie; Ablard, Suzanne; O'Keeffe, Colin; Mason, Suzanne

    2017-12-01

    including patient education, co-location of other services with ED ('ED hubs'), and extending community-based services. ED staff attribute distinctly different patterns of ED attendance to patients of different age groups, including reasons for attending ED, the route to the ED, and the rate of non-urgent attendance. Given this variation, proposed demand management interventions are likely to impact differently on different age groups, and one solution is unlikely to be optimal for all ages. Therefore a number of different approaches will be needed to manage ED demand among different age groups. © 2017, 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.

  2. Employees older than 50 on Croatian labour market – need for a new approach

    Directory of Open Access Journals (Sweden)

    Srecko Goic

    2017-10-01

    Full Text Available Croatia has reached demographic maturity, with ever lower cohorts of youngers (and younger labour force numbers, longer life expectations, and rapidly growing share of older population. In such situation, working population older than 50 becomes more and more significant, not only by number, but also as an important pool of knowledge and experiences. 28,36% of total employed in Croatia in 2014 were 50+ years old. That same year (2014 27,7% of total unemployed in Croatia were 50+ years old. The share of persons 50+ in total number of unemployed grew to 29,6% in 2015, and 31,7% in 2016. Long duration of unemployment is especially accentuated among persons older than 50: in 2016 older persons made 41,91% among those with unemployment duration between 2 and 3 years, 44,00% among those with unemployment duration between 4 and 5 years, 53,23% among those with unemployment duration between 6 and 8 years, and even 70,04% among those with unemployment duration over 8 years. Although Croatian governments for almost quarter of century were devising different “active labour market policies” directed to older persons, their results are questionable. With growing problems to acquire and retain necessary workforce in Croatian enterprises, there is obviously strong need to develop new approach (es towards people older than 50. This paper is trying to shed new light on this problem and offer new ideas in the field of labour market policies, and human resources management oriented towards older employees in Croatia. The Croatian example (changes, problems, and experiences may be of interest to other, particularly European, countries in a similar situation.

  3. The need for multisectoral food chain approaches to reduce trans fat consumption in India.

    Science.gov (United States)

    Downs, Shauna M; Singh, Archna; Gupta, Vidhu; Lock, Karen; Ghosh-Jerath, Suparna

    2015-07-22

    The World Health Organization (WHO) recommends virtually eliminating trans fat from the global food supply. Although several high-income countries have successfully reduced trans fat levels in foods, low- and middle-income countries such as India face additional challenges to its removal from the food supply. This study provides a systems analysis of the Indian food chain to assess intervention options for reducing trans fat intake in low-income consumers. Data were collected at the manufacturer, retailer and consumer levels. Qualitative interviews were conducted with vanaspati manufacturers (n = 13) and local food vendors (n = 44). Laboratory analyses (n = 39) of street foods/snacks sold by the vendors were also conducted. Trans fat and snack intakes were also examined in low-income consumers in two rural villages (n = 260) and an urban slum (n = 261). Manufacturers of vanaspati described reducing trans fat levels as feasible but identified challenges in using healthier oils. The fat content of sampled oils from street vendors contained high levels of saturated fat (24.7-69.3 % of total fat) and trans fat (0.1-29.9 % of total fat). Households were consuming snacks high in trans fat as part of daily diets (31 % village and 84.3 % of slum households) and 4 % of rural and 13 % of urban households exceeded WHO recommendations for trans fat intakes. A multisectoral food chain approach to reducing trans fat is needed in India and likely in other low- and middle-income countries worldwide. This will require investment in development of competitively priced bakery shortenings and economic incentives for manufacturing foods using healthier oils. Increased production of healthier oils will also be required alongside these investments, which will become increasingly important as more and more countries begin investing in palm oil production.

  4. IITET and shadow TT: an innovative approach to training at the point of need

    Science.gov (United States)

    Gross, Andrew; Lopez, Favio; Dirkse, James; Anderson, Darran; Berglie, Stephen; May, Christopher; Harkrider, Susan

    2014-06-01

    The Image Intensification and Thermal Equipment Training (IITET) project is a joint effort between Night Vision and Electronics Sensors Directorate (NVESD) Modeling and Simulation Division (MSD) and the Army Research Institute (ARI) Fort Benning Research Unit. The IITET effort develops a reusable and extensible training architecture that supports the Army Learning Model and trains Manned-Unmanned Teaming (MUM-T) concepts to Shadow Unmanned Aerial Systems (UAS) payload operators. The training challenge of MUM-T during aviation operations is that UAS payload operators traditionally learn few of the scout-reconnaissance skills and coordination appropriate to MUM-T at the schoolhouse. The IITET effort leveraged the simulation experience and capabilities at NVESD and ARI's research to develop a novel payload operator training approach consistent with the Army Learning Model. Based on the training and system requirements, the team researched and identified candidate capabilities in several distinct technology areas. The training capability will support a variety of training missions as well as a full campaign. Data from these missions will be captured in a fully integrated AAR capability, which will provide objective feedback to the user in near-real-time. IITET will be delivered via a combination of browser and video streaming technologies, eliminating the requirement for a client download and reducing user computer system requirements. The result is a novel UAS Payload Operator training capability, nested within an architecture capable of supporting a wide variety of training needs for air and ground tactical platforms and sensors, and potentially several other areas requiring vignette-based serious games training.

  5. Methodological approaches and magnitude of the clinical unmet need associated with amotivation in mood disorders.

    Science.gov (United States)

    Calabrese, Joseph R; Fava, Maurizio; Garibaldi, George; Grunze, Heinz; Krystal, Andrew D; Laughren, Thomas; Macfadden, Wayne; Marin, Robert; Nierenberg, Andrew A; Tohen, Mauricio

    2014-10-01

    There is growing research interest in studying motivational deficits in different neuropsychiatric disorders because these symptoms appear to be more common than originally reported and negatively impact long-term functional outcomes. However, there is considerable ambiguity in the terminology used to describe motivational deficits in the scientific literature. For the purposes of this manuscript, the term "amotivation" will be utilised in the context of mood disorders, since this is considered a more inclusive/appropriate term for this patient population. Other challenges impacting the study of amotivation in mood disorders, include: appropriate patient population selection; managing or controlling for potential confounding factors; the lack of gold-standard diagnostic criteria and assessment scales; and determination of the most appropriate study duration. This paper summarises the search for a consensus by a group of experts in the optimal approach to studying amotivation in mood disorders. The consensus of this group is that amotivation in mood disorders is a legitimate therapeutic target, given the magnitude of the associated unmet needs, and that proof-of-concept studies should be conducted in order to facilitate subsequent larger investigations. The focus of this manuscript is to consider the study of amotivation, as a residual symptom of major depressive disorder (MDD) or bipolar depression (BD), following adequate treatment with a typical antidepressant or mood stabiliser/antipsychotic, respectively. There is a paucity of data studying amotivation in mood disorders. This manuscript provides general guidance on the most appropriate study design(s) and methodology to assess potential therapeutic options for the management of residual amotivation in mood disorders. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. “Health in the Mirror”: An Unconventional Approach to Unmet Psychological Needs in Oncology

    Directory of Open Access Journals (Sweden)

    Valentina E. Di Mattei

    2017-09-01

    Full Text Available Background: The introduction of aesthetic care programs for cancer patients inside hospitals could help patients cope with the side effects of both disease and treatment. The specific objective of this study is to evaluate whether a complementary and supportive program, called “Health in the Mirror,” has a positive effect on participants by analyzing certain psychological variables.Methods: Eighty-eight female cancer patients were included in this analysis. The support program is composed of three group aesthetic interventions that address both physical and psychological aspects that accompany cancer and its treatment. Patients were asked to complete a battery of tests in order to measure the impact of the program on certain psychological variables including anxiety, depression, body image, self-esteem, and quality of life. Outcome variables were measured at three different time-points: prior to participation, on the last day of the program, and after a 3-month follow-up.Results: Participating in the psychosocial support program “Health in the Mirror” determines an improvement in the psychological variables measured. Results revealed a significant reduction in depressive symptoms, anxiety and body image issues, as well as an improvement in self-esteem levels; this suggests that participating in this program could facilitate better adjustment to disease and treatment.Discussion: This study legitimizes the importance of implementing supportive and complementary therapies together with conventional therapies; the therapeutic approach to cancer cannot be restricted solely to medical care, but it must consider the patient as a whole person with needs that are not only physical or medical, but also psychological, social, and existential.

  7. Effectively Serving the Needs of Today's Business Student: The Product Life Cycle Approach to Class Organization

    Science.gov (United States)

    Eastman, Jacqueline K.; Aviles, Maria; Hanna, Mark

    2012-01-01

    We illustrate a class organization process utilizing the concept of the Product Life Cycle to meet the needs of today's millennial student. In the Introduction stage of a business course, professors need to build structure to encourage commitment. In the Growth stage, professors need to promote the structure through multiple, brief activities that…

  8. Approaching an Extended Role for Meeting Special Educational Needs in High Schools.

    Science.gov (United States)

    Mills, Keith

    1988-01-01

    The paper looks at staffing issues in meeting special educational needs in high schools in Manchester, United Kingdom. The concerns of Heads of Departments (N=26) included improved training and inservice, their extended roles within their schools, the support role of special needs staff, and the need for more planning and evaluation. (Author/DB)

  9. Superior transseptal approach to mitral valve is associated with a higher need for pacemaker implantation than the left atrial approach

    DEFF Research Database (Denmark)

    Lukac, Peter; Hjortdal, Vibeke E; Pedersen, Anders K

    2006-01-01

    retrospectively evaluated. The surgeons used either the superior transseptal (group A) or left atrial approach (group B). The risk of pacemaker implantation associated with the superior transseptal approach as compared with the left atrial approach was estimated using the multivariate Cox regression analysis...... to adjust for possible confounders. RESULTS: We included 577 patients, 150 in group A and 427 in group B. Forty-four patients had a pacemaker implanted after the surgery; 17 in group A and 27 in group B (p = 0.010). The superior transseptal approach was an independent risk factor of pacemaker implantation...... in multivariate analysis (hazard ratio 2.2 [1.2 to 4.1], p = 0.014). Nineteen patients had a pacemaker implanted because of sinus node dysfunction; 9 in group A and 10 in group B (p = 0.017). Group A was an independent predictor of pacemaker implantation because of sinus node dysfunction in bivariate analyses...

  10. The Need to Disentangle Key Concepts from Ecosystem-Approach Jargon

    Science.gov (United States)

    WAYLEN, K A; HASTINGS, E J; BANKS, E A; HOLSTEAD, K L; IRVINE, R J; BLACKSTOCK, K L

    2014-01-01

    The ecosystem approach—as endorsed by the Convention on Biological Diversity (CDB) in 2000—is a strategy for holistic, sustainable, and equitable natural resource management, to be implemented via the 12 Malawi Principles. These principles describe the need to manage nature in terms of dynamic ecosystems, while fully engaging with local peoples. It is an ambitious concept. Today, the term is common throughout the research and policy literature on environmental management. However, multiple meanings have been attached to the term, resulting in confusion. We reviewed references to the ecosystem approach from 1957 to 2012 and identified 3 primary uses: as an alternative to ecosystem management or ecosystem-based management; in reference to an integrated and equitable approach to resource management as per the CBD; and as a term signifying a focus on understanding and valuing ecosystem services. Although uses of this term and its variants may overlap in meaning, typically, they do not entirely reflect the ethos of the ecosystem approach as defined by the CBD. For example, there is presently an increasing emphasis on ecosystem services, but focusing on these alone does not promote decentralization of management or use of all forms of knowledge, both of which are integral to the CBD’s concept. We highlight that the Malawi Principles are at risk of being forgotten. To better understand these principles, more effort to implement them is required. Such efforts should be evaluated, ideally with comparative approaches, before allowing the CBD’s concept of holistic and socially engaged management to be abandoned or superseded. It is possible that attempts to implement all 12 principles together will face many challenges, but they may also offer a unique way to promote holistic and equitable governance of natural resources. Therefore, we believe that the CBD’s concept of the ecosystem approach demands more attention. La Necesidad de Desenredar Conceptos Clave del

  11. Application of Database Approaches to the Study of Earth's Aeolian Environments: Community Needs and Goals

    Science.gov (United States)

    Scuderi, Louis A.; Weissmann, Gary S.; Hartley, Adrian J.; Yang, Xiaoping; Lancaster, Nicholas

    2017-08-01

    Aeolian science is faced with significant challenges that impact its ability to benefit from recent advances in information technology. The discipline deals with high-end systems in the form of ground and satellite based sensors, computer modeling and simulation, and wind tunnel experiments. Aeolian scientists also collect field data manually with observational methods that may differ significantly between studies with little agreement on even basic morphometric parameters and terminology. Data produced from these studies, while forming the core of research papers and reports, is rarely available to the community at large. Recent advances are also superimposed on an underlying semantic structure that dates to the 1800's or earlier that is confusing, with ambiguously defined, and at times even contradictory, meanings. The aeolian "world-view" does not always fit within neat increments nor is defined by crisp objects. Instead change is continuous and features are fuzzy. Development of an ontological framework to guide spatiotemporal research is the fundamental starting point for organizing data in aeolian science. This requires a "rethinking" of how we define, collect, process, store and share data along with the development of a community-wide collaborative approach designed to bring the discipline into a data rich future. There is also a pressing need to develop efficient methods to integrate, analyze and manage spatial and temporal data and to promote data produced by aeolian scientists so it is available for preparing diagnostic studies, as input into a range of environmental models, and for advising national and international bodies that drive research agendas. This requires the establishment of working groups within the discipline to deal with content, format, processing pipelines, knowledge discovery tools and database access issues unique to aeolian science. Achieving this goal requires the development of comprehensive and highly-organized databases, tools

  12. Photoemission in strongly correlated crystalline f-electron systems: A need for a new approach

    International Nuclear Information System (INIS)

    Arko, A.J.; Joyce, J.J.; Sarrao, J.

    1998-01-01

    The unusual properties of heavy fermion (or heavy electron) materials have sparked an avalanche of research over the last two decades in order to understand the basic phenomena responsible for these properties. Photoelectron spectroscopy (often referred to as PES in the following sections), the most direct measurement of the electronic structure of a material, should in principle be able to shed considerable light on this matter. In general the distinction between a localized and a band-like state is trivially observed in band dispersion. Much of the past work was performed on poly-crystalline samples, scraped in-situ to expose a clean surface for PES. There have since been considerable advances both in the quality of specimens as well as experimental resolution, which raise questions regarding these conclusions. Much of the past work on poly-crystalline samples has been reported in several review articles, most notably Allen et al., and it is not necessary here to review those efforts again, with the exception of subsequent work performed at high resolution. The primary focus of the present review will be on new measurements obtained on single crystals, cleaved or prepared in situ and measured at high resolution, which seem to suggest that agreement with the GS and NCA approximations is less than perfect, and that perhaps the starting models need to be modified, or that even an entirely new approach is called for. Of the promising new models the Periodic Anderson Model is most closely related to the SIM. Indeed, at high temperatures it reverts to the SIM. However, the charge polaron model of Liu (1997) as well as the two-electron band model of Sheng and Cooper (1995) cannot yet be ruled out. Inasmuch as the bulk of the single crystal work was performed by the Los Alamos group, this review will draw heavily on those results. Moreover, since the GS and NCA approximations represent the most comprehensive and widely accepted treatment of heavy fermion PES, it is only

  13. Service Approaches to Young People with Complex Needs Leaving Out-of-Home Care

    Science.gov (United States)

    Malvaso, Catia; Delfabbro, Paul; Hackett, Louisa; Mills, Hayley

    2016-01-01

    Although leaving statutory out-of-home care can be a challenging time for many young people, it is recognised that young people who have multiple or complex needs find this transition particularly difficult. This study aims to gain a deeper understanding of the challenges faced by care leavers who have complex needs, as well as to identify some of…

  14. Teaching Music to Students with Special Needs: A Label-Free Approach

    Science.gov (United States)

    Hammel, Alice; Hourigan, Ryan

    2011-01-01

    A practical guide & reference manual, "Teaching Music to Students with Special Needs" addresses special needs in the broadest possible sense to equip teachers with proven, research-based curricular strategies that are grounded in both best practice and current special education law. Chapters address the full range of topics and issues music…

  15. A basic need theory approach to problematic Internet use and the mediating effect of psychological distress.

    Science.gov (United States)

    Wong, Ting Yat; Yuen, Kenneth S L; Li, Wang On

    2014-01-01

    The Internet provides an easily accessible way to meet certain needs. Over-reliance on it leads to problematic use, which studies show can be predicted by psychological distress. Self-determination theory proposes that we all have the basic need for autonomy, competency, and relatedness. This has been shown to explain the motivations behind problematic Internet use. This study hypothesizes that individuals who are psychologically disturbed because their basic needs are not being met are more vulnerable to becoming reliant on the Internet when they seek such needs satisfaction from online activities, and tests a model in which basic needs predict problematic Internet use, fully mediated by psychological distress. Problematic Internet use, psychological distress, and basic needs satisfaction were psychometrically measured in a sample of 229 Hong Kong University students and structural equation modeling was used to test the hypothesized model. All indices showed the model has a good fit. Further, statistical testing supported a mediation effect for psychological distress between needs satisfaction and problematic Internet use. The results extend our understanding of the development and prevention of problematic Internet use based on the framework of self-determination theory. Psychological distress could be used as an early predictor, while preventing and treating problematic Internet use should emphasize the fulfillment of unmet needs.

  16. Strengthening the Focus on Business Results: The Need for Systems Approaches in Organizational Behavior Management

    Science.gov (United States)

    Hyten, Cloyd

    2009-01-01

    Current Organizational Behavior Management (OBM) research and practice may be characterized as either behavior focused or results focused. These two approaches stem from different origins and have different characteristics. The behavior-focused approach stems from applied behavior analysis (ABA) methods and emphasizes direct observation of and…

  17. Sounding the warning bells: the need for a systems approach to understanding behaviour at rail level crossings.

    Science.gov (United States)

    Read, Gemma J M; Salmon, Paul M; Lenné, Michael G

    2013-09-01

    Collisions at rail level crossings are an international safety concern and have been the subject of considerable research effort. Modern human factors practice advocates a systems approach to investigating safety issues in complex systems. This paper describes the results of a structured review of the level crossing literature to determine the extent to which a systems approach has been applied. The measures used to determine if previous research was underpinned by a systems approach were: the type of analysis method utilised, the number of component relationships considered, the number of user groups considered, the number of system levels considered and the type of model described in the research. None of research reviewed was found to be consistent with a systems approach. It is recommended that further research utilise a systems approach to the study of the level crossing system to enable the identification of effective design improvements. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  18. Masculinities and young men's sex education needs in Ireland: problematizing client-centred health promotion approaches.

    Science.gov (United States)

    Hyde, Abbey; Howlett, Etaoine; Drennan, Jonathan; Brady, Dympna

    2005-12-01

    In recent decades, dominant discourses in health promotion have emphasized empowerment, client participation and the notion of people identifying and being facilitated to meet their own health needs. However, there has been little analysis of the concept of 'need' and the possibility, at least, that the fulfillment of some such self-defined needs are not in the interest of social justice and equality. In this article, we present an account of the sex education needs of secondary school pupils from their own perspectives, and problematize the concept of self-identified needs in health education. Twenty-nine focus group interviews were conducted with 226 secondary school pupils in Ireland, and data were subjected to a qualitative analysis. Findings suggested that young men tended to prioritize practical guidance that would provide them with the skills and confidence to take the lead in sexual encounters, and display competence in the act of penetrative sex. We argue that these self-defined sex education needs emanate from a culture of traditional masculinity where, for a male, one's place in the pecking order is derived from one's capacity to conquer, lead and display mastery with regard to sex. In the discussion, we attempt to unpack the notion of clients identifying their own needs and the concept of empowerment as it relates to our data, in the context of gender-based structural inequalities.

  19. FOREIGN LANGUAGES: Human Capital Approach Needed to Correct Staffing and Proficiency Shortfalls

    National Research Council Canada - National Science Library

    2002-01-01

    Although more than 70 federal agencies have foreign language needs, some of the largest programs are concentrated in the Army, the State Department, the Central Intelligence Agency, and the Federal...

  20. Needs assessment in health research projects: a new approach to project management in iran.

    Science.gov (United States)

    Peykari, Niloofar; Owlia, Parviz; Malekafzali, Hossein; Ghanei, Mostafa; Babamahmoodi, Abdolreza; Djalalinia, Shirin

    2013-01-01

    The science and technology health plan has defined the outline of health research to the national vision of Iran by 2025. The aim of this study was to focus on the process of needs assessment of health research projects also health research priority setting in Iran. THE PROJECT MANAGEMENT LIFE CYCLE HAS FOUR PHASES: Initiation, Planning, Execution and Closure. Based on abovementioned points we conducted the study. Focusing on the needs assessment led to systematic implementation of needs assessment of health project in all of the medical sciences universities. Parallel with this achieved strategies health research priority setting was followed through specific process from empowerment to implementation. We should adopt with more systematic progressive methods of health project managements for both our national convenience as well as our international health research programs.

  1. Do we need sustainability as a new approach in human factors and ergonomics?

    Science.gov (United States)

    Zink, Klaus J; Fischer, Klaus

    2013-01-01

    The International Ergonomics Association Technical Committee 'Human Factors and Sustainable Development' was established to contribute to a broad discourse about opportunities and risks resulting from current societal 'mega-trends' and their impacts on the interactions among humans and other elements of a system, e.g. in work systems. This paper focuses on the underlying key issues: how do the sustainability paradigm and human factors/ergonomics interplay and interact, and is sustainability necessary as a new approach for our discipline? Based on a discussion of the sustainability concept, some general principles for designing new and enhancing existent approaches of human factors and ergonomics regarding their orientation towards sustainability are proposed. The increasing profile of sustainability on the international stage presents new opportunities for human factors/ergonomics. Positioning of the sustainability paradigm within human factors/ergonomics is discussed. Approaches to incorporating sustainability in the design of work systems are considered.

  2. Radiation protection/shield design: a need for a systems approach

    International Nuclear Information System (INIS)

    Disney, R.K.

    1977-01-01

    Radiation protection/shielding design of a nuclear facility requires a coordinated effort of many engineering disciplines to meet the requirements imposed by regulations. The system approach to Clinch River Breeder Reactor Plant (CRBRP) radiation protection is described, and the program developed to implement this approach is defined. In addition, the principal shielding design problems for LMFBR nuclear reactor systems are discussed in relation to LWR nuclear reactor system shielding designs. The methodology used to analyze these problems in the U.S. LMFBR program, the resultant design solutions, and the experimental verification of these designs and/or methods are discussed

  3. 76 FR 12963 - Request for Information (NOT-ES-11-007): Needs and Approaches for Assessing the Human Health...

    Science.gov (United States)

    2011-03-09

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Request for Information (NOT-ES-11-007): Needs and Approaches for Assessing the Human Health Impacts of Exposure to Mixtures AGENCY: National Institutes of... analyzes its findings to assess potential hazards to human health from exposure to environmental substances...

  4. Implementing a Public Health Approach to Addressing Mental Health Needs in a University Setting: Lessons and Challenges

    Science.gov (United States)

    Parcover, Jason; Mays, Sally; McCarthy, Amy

    2015-01-01

    The mental health needs of college students are placing increasing demands on counseling center resources, and traditional outreach efforts may be outdated or incomplete. The public health model provides an approach for reaching more students, decreasing stigma, and addressing mental health concerns before they reach crisis levels. Implementing a…

  5. 78 FR 20672 - Literature Review Approach “Identifying Research Needs for Assessing Safe Use of High Intakes of...

    Science.gov (United States)

    2013-04-05

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Literature Review Approach... Needs for Assessing Safe Use of High Intakes of Folic Acid,'' for review of the pertinent literature... folate and folic acid, screening of the literature was undertaken to identify the potential adverse...

  6. Addressing tuberculosis patients' medical and socio-economic needs: a comprehensive programmatic approach.

    Science.gov (United States)

    Contreras, Carmen C; Millones, Ana K; Santa Cruz, Janeth; Aguilar, Margot; Clendenes, Martin; Toranzo, Miguel; Llaro, Karim; Lecca, Leonid; Becerra, Mercedes C; Yuen, Courtney M

    2017-04-01

    For a cohort of patients with tuberculosis in Carabayllo, Peru, we describe the prevalence of medical comorbidities and socio-economic needs, the efforts required by a comprehensive support programme ('TB Cero') to address them and the success of this programme in linking patients to care. Patients diagnosed with tuberculosis in Carabayllo underwent evaluations for HIV, diabetes, mental health and unmet basic needs. For patients initiating treatment during 14 September, 2015-15 May, 2016, we abstracted data from evaluation forms and a support request system. We calculated the prevalence of medical comorbidities and the need for socio-economic support at the time of tuberculosis diagnosis, as well as the proportion of patients successfully linked to care or support. Of 192 patients, 83 (43%) had at least one medical comorbidity other than tuberculosis. These included eight (4%) patients with HIV, 12 (6%) with diabetes and 62 (32%) deemed at risk for a mental health condition. Of patients who required follow-up for a comorbidity, 100% initiated antiretroviral therapy, 71% attended endocrinology consultations and 66% attended psychology consultations. Of 126 (65%) patients who completed the socio-economic evaluation, 58 (46%) reported already receiving food baskets from the municipality, and 79 (63%) were given additional support, most commonly food vouchers and assistance in accessing health care. Carabayllo tuberculosis patients face many challenges in addition to tuberculosis. A collaborative, comprehensive treatment support programme can achieve high rates of linkage to care for these needs. © 2017 John Wiley & Sons Ltd.

  7. A Needs Analysis Approach to the Evaluation of Iranian Third-Grade High School English Textbook

    Directory of Open Access Journals (Sweden)

    Nasser Rashidi

    2014-09-01

    Full Text Available Needs analysis as an integral part of evaluative review of English materials, mainly textbooks, requires giving sufficient attention in all English language learning contexts. This issue seems to be more demanding in English as a Foreign Language (EFL contexts where the textbooks are the main sources of input for the learners. However, in some cases, this important factor is excluded entirely or at least limited to the ideas of major stakeholders. This article reports on the findings of a study conducted to evaluate an English textbook (the third-grade high school English book, which is being used in all state high schools in Iran by using a needs analysis framework. First, the needs analysis questionnaires were administered among 180 third-grade female high school students for whom the textbook was designed. Having investigated the students’ perceived foreign language needs, the researcher then used it as the basis for evaluating the textbook. The results of the textbook evaluation revealed that although all language skills and components were almost important for the majority of the students, the textbook could not fully support all of them together. Finally, it was suggested that the textbook be revised or at least supplemented by other instructional materials, so that it could be more effective for the aforementioned learners.

  8. An Empirical Study on Business English Teaching and Development in China--A Needs Analysis Approach

    Science.gov (United States)

    Guiyu, Dai; Yang, Liu

    2016-01-01

    This paper first reviews the developmental history and status quo of Business English Program in China. Then based on the theory of needs analysis, it researches on 226 questionnaires from Business English Program students from Guangdong University of Foreign Studies to investigate the problems encountered and current situation of Business English…

  9. On the need for phylogenetic ‘corrections’ in functional trait-based approaches

    NARCIS (Netherlands)

    de Bello, F.; Berg, M.P.; Dias, A.T.C.; Diniz-Filho, J.A.F.; Götzenberger, L.; Hortal, J.; Ladle, R.J.; Lepš, J.

    2015-01-01

    There is considerable uncertainty about if, and when, phylogenetic information is needed to answer various ecological questions about trait-based ecological studies. It has been recommended that both functional and phylogenetic information should be combined, and some researchers have even suggested

  10. "Trees and Things That Live in Trees": Three Children with Special Needs Experience the Project Approach

    Science.gov (United States)

    Griebling, Susan; Elgas, Peg; Konerman, Rachel

    2015-01-01

    The authors report on research conducted during a project investigation undertaken with preschool children, ages 3-5. The report focuses on three children with special needs and the positive outcomes for each child as they engaged in the project Trees and Things That Live in Trees. Two of the children were diagnosed with developmental delays, and…

  11. A need for non-tokamak approaches to magnetic fusion energy

    International Nuclear Information System (INIS)

    Bathke, C.G.; Krakowski, R.A.; Miller, R.L.

    1992-01-01

    Focusing exclusively on conventional tokamak physics in the quest for commercial fusion power is premature, and the options for both advanced-tokamak and non-tokamak concepts need continued investigation. The basis for this claim is developed, and promising advanced-tokamak and non-tokamak options are suggested

  12. "But, We Don't Have a Library": Exploring Approaches to Addressing Branch Campuses' Library Needs

    Science.gov (United States)

    Hostetler, Kirsten; DeSilva, Michele

    2016-01-01

    Librarians at Central Oregon Community College's Barber Library explored how to best serve the needs of three satellite campuses across a large geographic region. While initially intending to start an embedded librarianship program, a pair of surveys showed the relationships and awareness necessary for the foundation of such a program were…

  13. Exploring Reading Comprehension Needs of Iranian EAP Students of Health Information Management (HIM): A Triangulated Approach

    Science.gov (United States)

    Atai, Mahmood Reza; Nazari, Ogholgol

    2011-01-01

    Discipline-based English for Academic Purposes (EAP) reading programs in Iran are designed to fill the gap between the students' general English reading competence and their ability to read authentic discipline-specific texts. This study attempted to assess target and present reading comprehension needs of EAP students of Health Information…

  14. Deltalink, Socio-Technical Development in the Delta : An Experimental Approach to Water Related Needs

    NARCIS (Netherlands)

    Rammelt, C.; Alibux, F.; Sutjahjo, D.; Wong Yee Kwan, S.

    2006-01-01

    Bangladesh is one of the poorest and densely populated deltas in the world. Due to institutional and financial limitations of the central government as well as past failures of the conventional top-down approach we suggest bottom-up strategies to increase the communities' ability to manage their own

  15. The Nigerian System of Education and the Need for Pragmatic Approach

    Science.gov (United States)

    Oyebamiji, M. A.

    2011-01-01

    This paper attempted to reveal some inadequacies inherent in the Nigerian system of education and, how the pragmatic approach to education can help solve the problems of disfunctionality of the system. It does this by explaining the aims and features of the pragmatic philosophy of education. Furthermore, the paper gave answers to two basic…

  16. Social Justice, Children's Needs and Rights: An Approach to Planning

    Science.gov (United States)

    Sims, Margaret

    2015-01-01

    Commonly, planning for children involves comparing what they know against a curriculum or learning framework which identifies what they should know. Early childhood educators are then expected to create learning opportunities to help fill the gap between these two extremes. In this paper I argue that such an approach does not honour the…

  17. The crisis is homemade. Why we need a playful approach in teaching and practising strategic preparedness

    Directory of Open Access Journals (Sweden)

    Reinhard Ematinger

    2012-01-01

    Full Text Available Although the research on how to develop strategic preparedness, or resilience, has generated a great deal of interest among organizational theorists, many of the empirical studies conducted share important methodological limitations. When investigating how educational experiences boosting the participants’ capacities to learn, adapt, and apply can create sustainable value for organizations – be it non-profit-organizations or international enterprises – it becomes obvious that applied systematic creativity like playful construction, improvisation, and imagination, as well as making use of design thinking approaches, will benefit the organizations’ strategic preparedness for future scenarios.The first chapter will be on a relevant framework and the theories which fuel the value of playful and design-led approaches when it comes to corporate strategy, service development, and team identity. The framework will be illustrated in the second chapter with a proven approach designed for this very purpose. The third chapter will reflect on how to utilize this approach for teaching purposes and will elaborate on a draft for educators who want to move in this direction.

  18. Towards an Agile Approach to Adapting Dynamic Collaboration Support to Student Needs

    Science.gov (United States)

    Adamson, David; Dyke, Gregory; Jang, Hyeju; Rosé, Carolyn Penstein

    2014-01-01

    This paper investigates the use of conversational agents to scaffold on-line collaborative learning discussions through an approach called Academically Productive Talk (APT). In contrast to past work on dynamic support for collaborative learning, where agents were used to elevate conceptual depth by leading students through directed lines of…

  19. Training and Developing an Age Diverse Workforce in SMEs: The Need for a Strategic Approach

    Science.gov (United States)

    Beaver, Graham; Hutchings, Kate

    2005-01-01

    Purpose: The purpose of this paper is to examine the importance of strategic human resource development (HRD) in small and medium-sized enterprises (SMEs) with specific reference to key issues around training, development and education as well as an emerging issue of significance, age diversity management. Design/Methodology/Approach: The approach…

  20. Subsequent childbirth after a previous traumatic birth.

    Science.gov (United States)

    Beck, Cheryl Tatano; Watson, Sue

    2010-01-01

    Nine percent of new mothers in the United States who participated in the Listening to Mothers II Postpartum Survey screened positive for meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for posttraumatic stress disorder after childbirth. Women who have had a traumatic birth experience report fewer subsequent children and a longer length of time before their second baby. Childbirth-related posttraumatic stress disorder impacts couples' physical relationship, communication, conflict, emotions, and bonding with their children. The purpose of this study was to describe the meaning of women's experiences of a subsequent childbirth after a previous traumatic birth. Phenomenology was the research design used. An international sample of 35 women participated in this Internet study. Women were asked, "Please describe in as much detail as you can remember your subsequent pregnancy, labor, and delivery following your previous traumatic birth." Colaizzi's phenomenological data analysis approach was used to analyze the stories of the 35 women. Data analysis yielded four themes: (a) riding the turbulent wave of panic during pregnancy; (b) strategizing: attempts to reclaim their body and complete the journey to motherhood; (c) bringing reverence to the birthing process and empowering women; and (d) still elusive: the longed-for healing birth experience. Subsequent childbirth after a previous birth trauma has the potential to either heal or retraumatize women. During pregnancy, women need permission and encouragement to grieve their prior traumatic births to help remove the burden of their invisible pain.

  1. Junk-food enhances conditioned food cup approach to a previously established food cue, but does not alter cue potentiated feeding; implications for the effects of palatable diets on incentive motivation.

    Science.gov (United States)

    Derman, Rifka C; Ferrario, Carrie R

    2018-03-16

    Efforts to stem the global rise in obesity have been minimally effective, perhaps in part because our understanding of the psychological and behavioral drivers of obesity is limited. It is well established that stimuli that are paired with palatable foods can powerfully influence food-seeking and feeding behaviors. However, how consumption of sugary, fatty "junk-foods" affects these motivational responses to food cues is poorly understood. Here, we determined the effects of short- and long-term "junk-food" consumption on the expression of cue potentiated feeding and conditioned food cup approach to Pavlovian conditioned stimuli (CS). Further, to determine the degree to which effects of "junk-food" were selective to Pavlovian motivational processes, we varied the predictive validity of the CS by including training groups conditioned with unique CS-US contingencies ranging from -1.0 to +1.0. "Junk-food" did not enhance cue potentiated feeding in any group, but expression of this potentiation effect varied with the CS-US contingency independent of diet. In contrast, "junk-food" consistently enhanced conditioned approach to the food cup; this effect was dependent on the previously established CS-US contingency. That is, consumption of "junk-food" following training enhanced approach to the food cup only in response to CSs with previously positive CS-US contingencies. This was accompanied by reduced motivation for the US itself. Together these data show that "junk-food" consumption selectively enhances incentive motivational responses to previously established food CSs, without altering cue potentiated feeding induced by these same CSs, and in the absence of enhanced motivation for food itself. Copyright © 2018 Elsevier Inc. All rights reserved.

  2. Political economy of Central Asia: Initial reflections on the need for a new approach

    Directory of Open Access Journals (Sweden)

    Assel Rustemova

    2011-01-01

    I argue that post-structuralist approaches and specifically, the framework of “governmentality” – a term coined by Michel Foucault, allows for more fruitful heuristic exercise. Governmentality as an analytical approach looks at the way the state positions itself in its society and determines the type of governing rationale it adopts. Particularly, it incorporates both discursive and structural-technological conditions of each state into analysis by augmenting the data before constructing the theory to argue what rationale drives government activities in the state. Governmentality speaks to both “resource curse” and the “varieties of capitalism” by enriching and complicating them while allowing identification of how rationales of governing evolve and change over time.

  3. The need and approach for characterization - U.S. air force perspectives on materials state awareness

    Science.gov (United States)

    Aldrin, John C.; Lindgren, Eric A.

    2018-04-01

    This paper expands on the objective and motivation for NDE-based characterization and includes a discussion of the current approach using model-assisted inversion being pursued within the Air Force Research Laboratory (AFRL). This includes a discussion of the multiple model-based methods that can be used, including physics-based models, deep machine learning, and heuristic approaches. The benefits and drawbacks of each method is reviewed and the potential to integrate multiple methods is discussed. Initial successes are included to highlight the ability to obtain quantitative values of damage. Additional steps remaining to realize this capability with statistical metrics of accuracy are discussed, and how these results can be used to enable probabilistic life management are addressed. The outcome of this initiative will realize the long-term desired capability of NDE methods to provide quantitative characterization to accelerate certification of new materials and enhance life management of engineered systems.

  4. A Statistical Approach for Selecting Buildings for Experimental Measurement of HVAC Needs

    Directory of Open Access Journals (Sweden)

    Malinowski Paweł

    2017-03-01

    Full Text Available This article presents a statistical methodology for selecting representative buildings for experimentally evaluating the performance of HVAC systems, especially in terms of energy consumption. The proposed approach is based on the k-means method. The algorithm for this method is conceptually simple, allowing it to be easily implemented. The method can be applied to large quantities of data with unknown distributions. The method was tested using numerical experiments to determine the hourly, daily, and yearly heat values and the domestic hot water demands of residential buildings in Poland. Due to its simplicity, the proposed approach is very promising for use in engineering applications and is applicable to testing the performance of many HVAC systems.

  5. A CRITICAL NEEDS PLAN FOR GENERAL MOTORS: A CULTURAL PLURALISM APPROACH

    OpenAIRE

    Gregory W. Goussak; Jon K. Webber; Elliot M. Ser

    2012-01-01

    The purpose of this paper is to create a critical needs plan for General Motors Corporation in the 21st century. General Motors (GM), once the most dominant manufacturer in the automotive industry, finds itself in financial crisis with a Chapter 11 bankruptcy and a necessary government infusion of capital. The foundation of this paper applies the Supportive Model as an effective strategy for creating a new corporate culture and focusing GM as a competitive manufacturer in the global automotiv...

  6. A New Approach for Assessing the Needs of Service Members and Their Families

    Science.gov (United States)

    2011-01-01

    their families. Nothing that I do as the Secretary of the Army is more important than this [emphasis added] ( Harvey , 2009). According to the Army...to address the physical, material, mental and spiritual needs of each member of the Total Army Family [emphasis added] ( Harvey and Schoomaker, 2006...Laurie Weinstein and Christie C. White, eds., Wives and Warriors: Women and the Military in the United States and Canada, Westport, Conn.: Greenwood

  7. Open Scenario Study, Phase II Report: Assessment and Development of Approaches for Satisfying Unclassified Scenario Needs

    Science.gov (United States)

    2010-01-01

    Oracle) • Mysql (Open Source) • Other What application server software will be needed? • Application Server • CGI PHP /Perl (Open Source...CGI PHP /Perl (Other Open Source software) • ColdFusion (Adobe) • OAS Application Server (Oracle) • .ASP/.NET (Microsoft) • Inmagic DB/textworks I...developers around the world. 9 • Ms Windows® – Microsoft Windows operating system for personal computers • MySQL (Open Source) - the most reliable

  8. SOFTWARE DEFINED NETWORKS (SDN): APPROACHES NEEDED FOR UP-GRADATION OF SDN'S

    OpenAIRE

    Deepak Kumar*, Manu Sood

    2017-01-01

    SDN has changed the way of thinking about networks. SDN networks are flexible, scalable and easily manageable. Application that runs on the management plane actually utilize the network efficiency, So application developed should be capable of handling the controllers functionality. Each of the application that runs should be free from viruses, so that it does not affect the controller. Also we need to increase the level of security in all layers of the SDN architecture. SDN is growing faster...

  9. The Northridge earthquake: community-based approaches to unmet recovery needs.

    Science.gov (United States)

    Bolin, R; Stanford, L

    1998-03-01

    The 1994 Northridge, California earthquake has proven to be one of the most costly disasters in United States history. Federal and state assistance programmes received some 681,000 applications from victims for various forms of relief. In spite of the flow of US$11 billion in federal assistance into Los Angeles and Ventura counties, many victims have failed to obtain adequate relief. These unmet needs relate to the vulnerability of particular class and ethnic groups. In response to unmet needs, a number of non-governmental organisations (NGOs) have become involved in the recovery process. This paper, based on evidence collected from hundreds of in-depth interviews with the people involved, examines the activities of several community-based organisations (CBOs) and other NGOs as they have attempted to assist vulnerable people with unmet post-disaster needs. We discuss two small ethnically diverse communities in Ventura County, on the periphery of the Los Angeles metropolitan region. The earthquake and resultant disaster declaration provided an opportunity for local government and NGOs to acquire federal resources not normally available for economic development. At the same time the earthquake created political openings in which longer-term issues of community development could be addressed by various local stakeholders. A key issue in recovery has been the availability of affordable housing for those on low incomes, particularly Latinos, the elderly and farm workers. We discuss the successes and limitations of CBOs and NGOs as mechanisms for dealing with vulnerable populations, unmet needs and recovery issues in the two communities.

  10. A Needs Analysis Approach to the Evaluation of Iranian Third-Grade High School English Textbook

    OpenAIRE

    Nasser Rashidi; Roghaye Kehtarfard

    2014-01-01

    Needs analysis as an integral part of evaluative review of English materials, mainly textbooks, requires giving sufficient attention in all English language learning contexts. This issue seems to be more demanding in English as a Foreign Language (EFL) contexts where the textbooks are the main sources of input for the learners. However, in some cases, this important factor is excluded entirely or at least limited to th...

  11. MAKING THE NEIGHBOURHOOD A BETTER PLACE TO LIVE. A SWB APPROACH IMPLEMENTING FUNDAMENTAL HUMAN NEEDS

    OpenAIRE

    Papachristou, Ioanna Anna; Rosas-Casals, Martí

    2015-01-01

    Subjective well-being (SWB) studies have been at the centre of researchers’ attention during the last years. With the majority of people now living in cities, the necessity for a more anthropocentric approach for the study and betterment of urban environments is constantly increasing. In this sense, defining and measuring SWB in urban contexts can be of particular benefit in urban design and planning processes. In this article, a method for measuring SWB for urban places based on the accompli...

  12. How Older Persons Perceive the Loss of Independence: The Need of a Holistic Approach to Frailty.

    Science.gov (United States)

    Escourrou, E; Cesari, M; Chicoulaa, B; Fougère, B; Vellas, B; Andrieu, S; Oustric, S

    2017-01-01

    Since 2004, the definition of the frailty syndrome has shifted from purely physical criteria to a more comprehensive consideration of the individual, including their psychosocial criteria. In this study, qualitative research methods were used as a complementary approach in order to enrich the existing quantitative results in this area. To understand the views of older persons on the risk of loss of independence. The study population comprised people over 75 years of age who were living at home in the south-west of France and were considered to be at risk of losing their independence. Data were collected using individual semi-structured in-depth interviews, accompanied by observations. Inductive analysis was carried out according to grounded theory methods. Fifteen individual interviews were conducted to achieve theoretical data saturation. Analysis of the content of the interviews revealed seven risk factors for the loss of independence: poor mental health, poor physical health, social isolation, no longer leaving the home, an unsuitable environment, unsuitable living conditions, and few resources. These results complement the purely physical approach to screening for the frailty syndrome and lead us to reconsider our screening approach to include a more holistic view of the older person and their circumstances.

  13. Use of comparative genomics approaches to characterize interspecies differences in response to environmental chemicals: Challenges, opportunities, and research needs

    International Nuclear Information System (INIS)

    Burgess-Herbert, Sarah L.; Euling, Susan Y.

    2013-01-01

    A critical challenge for environmental chemical risk assessment is the characterization and reduction of uncertainties introduced when extrapolating inferences from one species to another. The purpose of this article is to explore the challenges, opportunities, and research needs surrounding the issue of how genomics data and computational and systems level approaches can be applied to inform differences in response to environmental chemical exposure across species. We propose that the data, tools, and evolutionary framework of comparative genomics be adapted to inform interspecies differences in chemical mechanisms of action. We compare and contrast existing approaches, from disciplines as varied as evolutionary biology, systems biology, mathematics, and computer science, that can be used, modified, and combined in new ways to discover and characterize interspecies differences in chemical mechanism of action which, in turn, can be explored for application to risk assessment. We consider how genetic, protein, pathway, and network information can be interrogated from an evolutionary biology perspective to effectively characterize variations in biological processes of toxicological relevance among organisms. We conclude that comparative genomics approaches show promise for characterizing interspecies differences in mechanisms of action, and further, for improving our understanding of the uncertainties inherent in extrapolating inferences across species in both ecological and human health risk assessment. To achieve long-term relevance and consistent use in environmental chemical risk assessment, improved bioinformatics tools, computational methods robust to data gaps, and quantitative approaches for conducting extrapolations across species are critically needed. Specific areas ripe for research to address these needs are recommended

  14. Changing physician perspectives on complementary and alternative medicine: the need for a top-down approach

    Directory of Open Access Journals (Sweden)

    MacKinnon TS

    2017-09-01

    Full Text Available Thomas S MacKinnon,1 Norbert F Banhidy,1 Daniel R Tuite21School of Medicine, Imperial College London, London, 2Faculty of Medicine, Brighton and Sussex Medical School, Brighton, UKWe read with great interest the article by Patel et al1 discussing the changing perspectives towards complementary and alternative medicine (CAM, and an impetus for additional physician knowledge of the strengths and drawbacks of CAM. These findings are indeed relevant in the UK, with an estimated 41.1% one-year prevalence of CAM use, responsible for an annual out-of-pocket expenditure of £1.6 billion.2 We agree that improved training and education in medical school and residencies – which can be thought of as a “bottom-up” approach – are fundamental in preparing the health care system for improved integration of CAM. However, we also suggest that “top-down” changes are required to optimize patient care.Authors' reply Sejal J Patel,1 Kathi J Kemper,2 Joseph P Kitzmiller31College of Public Health, The Ohio State University, 2Center for Integrative Health and Wellness, The Ohio State Wexner University Medical Center, 3Department of Biological Chemistry and Pharmacology, College of Medicine, The Ohio State University, Columbus, OH, USAWe agree the letter is worthy of publication but have a little to add: a top-down approach (as suggested and described by the authors of the letter certainly complements the bottom-up approach (described in our article.1View the original paper by Patel et al.

  15. Screening for chronic comorbid diseases in people with HIV: the need for a strategic approach.

    Science.gov (United States)

    Peters, B; Post, F; Wierzbicki, A S; Phillips, A; Power, L; Das, S; Johnson, M; Moyle, G; Hughes, L; Wilkins, E; McCloskey, E; Compston, J; Di Angelantonio, E

    2013-01-01

    Among people living with HIV, the proportion of deaths attributed to chronic noninfectious comorbid diseases has increased over the past 15 years. This is partly a result of increased longevity in the era of highly active antiretroviral therapy (HAART), and also because HIV infection is related, causally or otherwise, to several chronic conditions. These comorbidities include conditions that are strongly associated with modifiable risk factors, such as cardiovascular disease (CVD), diabetes, and renal and bone diseases, and increasingly management guidelines for HIV recommend risk evaluation for these conditions. The uptake of these screening approaches is often limited by the resources required for their application, and hence the management of risk reduction in most HIV-infected populations falls below a reasonable standard. The situation is compounded by the fact that few risk calculators have been adjusted for specific use in HIV infection. There is substantial overlap of risk factors for the four common comorbid diseases listed above that are especially relevant in HIV infection, and this offers an opportunity to develop a simple screening approach that encompasses the key risk factors for lifestyle-related chronic disease in people with HIV infection. This would identify those patients who require more in-depth investigation, and facilitate a stepwise approach to targeted management. Such a tool could improve communication between patient and clinician. A significant proportion of people with HIV are sufficiently engaged with their care to participate in health promotion and take the lead in using patient-centric screening measures. Health-based social networking offers a mechanism for dissemination of such a tool and is able to embed educational messages and support within the process. © 2012 British HIV Association.

  16. Investigating the management information needs of academic Heads of Department: a Critical Success Factors approach

    Directory of Open Access Journals (Sweden)

    Francis Green

    1996-01-01

    Full Text Available This paper describes a research project in the Department of Information Studies at the University of Sheffield. With funding from the British Library Research and Development Department a critical success factors-based investigation of the management information needs of academic Heads of Department in an number of English universities was undertaken in 1994/1995, following publication of the results of a pilot study byPellow and Wilson (1993. Senior academic staff, university administrators and librarians in sixteen universities were interviewed between December, 1994 and March, 1995. Collation of data and analysis of results have been completed

  17. Europe needs to take clear, analytical approach in considering future of nuclear energy

    Energy Technology Data Exchange (ETDEWEB)

    Shepherd, John [nuclear 24, Redditch (United Kingdom)

    2016-11-15

    Europe's political leaders have been accused of failing to offer a clear and comprehensive approach to the future of nuclear power in Europe. The criticism came in an opinion adopted recently by the European Economic and Social Committee (EESC). According to the EESC, the European Commission should propose ''a clear analytical process and methodology which can offer a consistent, voluntary framework for national decision-making about the role - if any - of nuclear power in the energy mix''.

  18. Dhat syndrome: Evolution of concept, current understanding, and need of an integrated approach

    Directory of Open Access Journals (Sweden)

    Sujita Kumar Kar

    2015-01-01

    Full Text Available Dhat syndrome has often been construed as a culture-bound sexual neurosis of the Indian subcontinent. Symptoms similar to that of Dhat syndrome has been described in other cultures across different time periods. The present paper looks at the evolution of the concept of Dhat syndrome in India. The review also takes an overview of the current understanding of this syndrome in terms of nosological status as a distinct entity and its "culture-bound" status. The narrative finally attempts to discuss the integrated approach for the treatment of this disorder.

  19. Why We Need Evidence-Based, Community-Wide Approaches for Prevention of Teen Pregnancy.

    Science.gov (United States)

    Barfield, Wanda D; Warner, Lee; Kappeler, Evelyn

    2017-03-01

    Teen pregnancy and childbearing have declined over the past two decades to historic lows. The most recent declines have occurred during a time of coordinated national efforts focused on teen pregnancy. This article highlights a federal partnership to reduce teen pregnancy through the implementation of innovative, evidence-based approaches in affected communities, with a focus on reaching African-American and Latino/Hispanic youth. This initiative has the potential to transform the design and implementation of future teen pregnancy prevention efforts and provide a model that can be replicated in communities across the nation. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  20. Europe needs to take clear, analytical approach in considering future of nuclear energy

    International Nuclear Information System (INIS)

    Shepherd, John

    2016-01-01

    Europe's political leaders have been accused of failing to offer a clear and comprehensive approach to the future of nuclear power in Europe. The criticism came in an opinion adopted recently by the European Economic and Social Committee (EESC). According to the EESC, the European Commission should propose ''a clear analytical process and methodology which can offer a consistent, voluntary framework for national decision-making about the role - if any - of nuclear power in the energy mix''.

  1. [The future of clinical research: why do we need an ecological approach?].

    Science.gov (United States)

    Liberati, Alessandro; Moja, Lorenzo P; Moschetti, Ivan

    2006-11-01

    In this paper we try to define the future goals of the clinical research, with particular reference to methodological and policy issues. There is an increasing tension between the real drivers of clinical research and its scientific and ethical aims. To consumers the goal is to strengthen the relevance and usefulness of clinical research. This is possible only if consumers are empowered and actively involved. For the health care systems it is mandatory to re-engineer the process, enforcing national and international legislation. This should help to fill the research-clinical practice gap and to balance the research agenda, better reflecting health priorities. Finally the scientific community should reflect on its own conflicts of interests and analyse the causes of the ethical divide between the needs and the market. Scientists too often seem to loose sight of the original cumulative nature of research and of the idea of research as a collective good. More non-commercial research is needed, integrated with the health care systems, to support a transparent, more realistic and valid information useful for patient care, scientific information.

  2. Update on impact effects in nuclear plants Part I--overview and need for integrated approach

    International Nuclear Information System (INIS)

    Sliter, G.E.; Ravindra, M.K.

    1984-01-01

    In this paper, an ASCE working group on impact effects in nuclear plants updates the review of this technology contained in a five-yearold ASCE report. In Part I, an overview is given of the impact conditions addressed in nuclear plant design against missiles generated by such postulated extreme events as tornados, turbine failures, pipe ruptures, aircraft crashes, and drops of heavy objects from lifting devices. The conclusion of a brief evaluation of the state of the art in predicting structural response for the various missile impact types is that two of them--pipe whip and heavy object drop--would benefit most by further development of design and analysis methods. Parts II and III of this paper review current practice and identify its limitations for these two impact types. Part I continues with a discussion of the general characteristics of impacts and the structural response they produce and concludes with a recommendation for and brief description of an ''integrated approach'' for treating impact effects. The adoption of this systematic approach in future development of impact technology would guide engineers in the use of the most appropriate and accurate available techniques for designing against a particular impact event

  3. A mosaic-based approach is needed to conserve biodiversity in disturbed freshwater ecosystems

    Science.gov (United States)

    Hitchman, Sean M.; Mather, Martha E.; Smith, Joseph M.; Fencl, Jane S.

    2017-01-01

    Conserving native biodiversity in the face of human‐ and climate‐related impacts is a challenging and globally important ecological problem that requires an understanding of spatially connected, organismal‐habitat relationships. Globally, a suite of disturbances (e.g., agriculture, urbanization, climate change) degrades habitats and threatens biodiversity. A mosaic approach (in which connected, interacting collections of juxtaposed habitat patches are examined) provides a scientific foundation for addressing many disturbance‐related, ecologically based conservation problems. For example, if specific habitat types disproportionately increase biodiversity, these keystones should be incorporated into research and management plans. Our sampling of fish biodiversity and aquatic habitat along ten 3‐km sites within the Upper Neosho River subdrainage, KS, from June‐August 2013 yielded three generalizable ecological insights. First, specific types of mesohabitat patches (i.e., pool, riffle, run, and glide) were physically distinct and created unique mosaics of mesohabitats that varied across sites. Second, species richness was higher in riffle mesohabitats when mesohabitat size reflected field availability. Furthermore, habitat mosaics that included more riffles had greater habitat diversity and more fish species. Thus, riffles (<5% of sampled area) acted as keystone habitats. Third, additional conceptual development, which we initiate here, can broaden the identification of keystone habitats across ecosystems and further operationalize this concept for research and conservation. Thus, adopting a mosaic approach can increase scientific understanding of organismal‐habitat relationships, maintain natural biodiversity, advance spatial ecology, and facilitate effective conservation of native biodiversity in human‐altered ecosystems.

  4. The hierarchy-by-interval approach to identifying important models that need improvement in severe-accident simulation codes

    International Nuclear Information System (INIS)

    Heames, T.J.; Khatib-Rahbar, M.; Kelly, J.E.

    1995-01-01

    The hierarchy-by-interval (HBI) methodology was developed to determine an appropriate phenomena identification and ranking table for an independent peer review of severe-accident computer codes. The methodology is described, and the results of a specific code review are presented. Use of this systematic and structured approach ensures that important code models that need improvement are identified and prioritized, which allows code sponsors to more effectively direct limited resources in future code development. In addition, critical phenomenological areas that need more fundamental work, such as experimentation, are identified

  5. Determinants of childhood obesity: need for a trans-sectoral convergent approach.

    Science.gov (United States)

    Kiranmala, Naorem; Das, Manoja K; Arora, Narendra K

    2013-03-01

    The emerging burden of non communicable diseases is likely to erode the "Demographic-Dividend" of India and compromise the national growth and development. Increasing rates of childhood obesity globally and in India is a cause for serious public health concern. It is becoming increasingly apparent that obesity is result of complex interplay between multiple genes, environmental factors and human behavior. Clear comprehension of this interaction and pathway is still not clear, making the prevention and management of obesity especially challenging. Globalization and rapid economic growth has led to dramatic changes in the life style of the population including food intake, physical activity, market, environmental factors and social structures. A growing economy, urbanization and motorized transport have increased physical inactivity. A systematic multi-sectoral approach with population health as the center of discourse and attention is the only key to tackle this problem.

  6. Global warming and environmental contaminants in aquatic organisms: the need of the etho-toxicology approach.

    Science.gov (United States)

    Manciocco, Arianna; Calamandrei, Gemma; Alleva, Enrico

    2014-04-01

    Environmental contaminants are associated with a wide spectrum of pathological effects. Temperature increase affects ambient distribution and toxicity of these chemicals in the water environment, representing a potentially emerging problem for aquatic species with short-, medium- and long-term repercussions on human health through the food chain. We assessed peer-reviewed literature, including primary studies, review articles and organizational reports available. We focused on studies concerning toxicity of environmental pollutants within a global warming scenario. Existing knowledge on the effects that the increase of water temperature in a contaminated situation has on physiological mechanisms of aquatic organisms is presented. Altogether we consider the potential consequences for the human beings due to fish and shellfish consumption. Finally, we propose an etho-toxicological approach to study the effects of toxicants in conditions of thermal increase, using aquatic organisms as experimental models under laboratory controlled conditions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. [Pain and fear of movement in the elderly : the need for an interdisciplinary approach].

    Science.gov (United States)

    Leonhardt, C; Laekeman, M

    2010-12-01

    According to evidence-based guidelines a physically activating therapy approach in older chronic pain patients is necessary for the preservation of autonomy. Often the elderly are not easy to motivate for this because of inappropriate attitudes, low self-efficacy, fear of pain and fear of falling. The latter might be more important for self-induced restriction of activity in older pain patients than fear avoidance beliefs known from pain research. The fear of caregivers concerning pain and falls can also lead to physical restrictions in the elderly. The underlying diseases and drug effects have to be borne in mind in exercise-oriented therapy. It seems necessary to design special therapy elements for all national care sectors using age-specific motivation strategies and to assure an interdisciplinary cooperation.

  8. People for sale: the need for a multidisciplinary approach towards human trafficking.

    Science.gov (United States)

    Van Impe, K

    2000-01-01

    The article addresses the question of how to develop appropriate measures to tackle trafficking in women, based on the findings of a study of trafficking between the Philippines and Belgium. It argues that there is no easy or unidimensional solution to human trafficking, since it is influenced by a complex set of factors, often working in combination with one another. It concludes that control measures alone cannot stop the flow of trafficking in women and that a legal approach which relies solely on one type of legislation would be too narrow. An effective strategy must combine and balance punitive measures with protection of human rights, stricter border control and the removal of the root causes of irregular movements. Measures must be agreed and coordinated between origin, transit and receiving countries.

  9. Risk analysis for U.S. offshore wind farms: the need for an integrated approach.

    Science.gov (United States)

    Staid, Andrea; Guikema, Seth D

    2015-04-01

    Wind power is becoming an increasingly important part of the global energy portfolio, and there is growing interest in developing offshore wind farms in the United States to better utilize this resource. Wind farms have certain environmental benefits, notably near-zero emissions of greenhouse gases, particulates, and other contaminants of concern. However, there are significant challenges ahead in achieving large-scale integration of wind power in the United States, particularly offshore wind. Environmental impacts from wind farms are a concern, and these are subject to a number of on-going studies focused on risks to the environment. However, once a wind farm is built, the farm itself will face a number of risks from a variety of hazards, and managing these risks is critical to the ultimate achievement of long-term reductions in pollutant emissions from clean energy sources such as wind. No integrated framework currently exists for assessing risks to offshore wind farms in the United States, which poses a challenge for wind farm risk management. In this "Perspective", we provide an overview of the risks faced by an offshore wind farm, argue that an integrated framework is needed, and give a preliminary starting point for such a framework to illustrate what it might look like. This is not a final framework; substantial work remains. Our intention here is to highlight the research need in this area in the hope of spurring additional research about the risks to wind farms to complement the substantial amount of on-going research on the risks from wind farms. © 2015 Society for Risk Analysis.

  10. The need for a better approach to business energy management: engaging decision makers

    Energy Technology Data Exchange (ETDEWEB)

    Jutsen, Jonathan [EnVinta Corporation, Chicago, IL (United States); Feldman, Shel [Shel Feldman Management Consulting, Middleton, WI (United States)

    2003-07-01

    Many programs have achieved success in stimulating companies to increase their purchase, installation, and use of energy-efficient equipment (e.g., fluorescent lighting, premium efficient motors). However, few can claim having moved companies to manage energy efficiency as an ongoing part of their practices, procedures, and culture. Recently, a program has been developed and implemented in the UK, Australia, Canada, and the U.S. that is aimed specifically at educating and motivating corporate decision-makers in this direction. This program targets senior management; it not only engages their interest and concern with energy-related issues, but also guides them to set priorities based on a structured gap analysis, and to establish and commit to a plan of action. By focusing on the business needs of the target companies and gaining executive commitment to a structured, systematic implementation plan, it motivates these companies both to seek immediate savings and to a process for continuous improvement that includes sustainable long-term energy efficiency. This paper illustrates specific aspects of the program, the way it helps drive outcomes in participating companies, and its implementation by government and utilities. In addition, the paper discusses needed changes in program evaluation methods to systematically monitor and value the cost-efficiency of this type of intervention which a) does not focus on equipment efficiencies, b) directs clients to other providers of energy efficiency services, c) helps build the infrastructure for such services, and d) motivates long-term energy reductions through the adoption of a sustainable energy-savings ethic in ongoing corporate planning and decisions.

  11. A Consortium Approach to Surgical Education in a Developing Country: Educational Needs Assessment.

    Science.gov (United States)

    Cook, Mackenzie; Howard, Benjamin M; Yu, Angela; Grey, Douglas; Hofmann, Paul B; Moren, Alexis M; Mchembe, Mabula; Essajee, Abbas; Mndeme, Omari; Peck, James; Schecter, William P

    2015-11-01

    Surgical disease is a global health priority, and improving surgical care requires local capacity building. Single-institution partnerships and surgical missions are logistically limited. The Alliance for Global Clinical Training (hereafter the Alliance) is a consortium of US surgical departments that aims to provide continuous educational support at the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS). To our knowledge, the Alliance is the first multi-institutional international surgical collaboration to be described in the literature. To assess if the Alliance is effectively responding to the educational needs of MUHAS and Muhimbili National Hospital surgeons. During an initial 13-month program (July 1, 2013, to August 31, 2014), faculty and resident teams from 3 US academic surgical programs rotated at MUHAS as physicians and teachers for 1 month each. To assess the value of the project, we administered anonymous surveys. Anonymous surveys were analyzed on a 5-point Likert-type scale. Free-text answers were analyzed for common themes. During the study period, Alliance members were present at MUHAS for 8 months (1 month each). At the conclusion of the first year of collaboration, 15 MUHAS faculty and 22 MUHAS residents completed the survey. The following 6 areas of educational needs were identified: formal didactics, increased clinical mentorship, longer-term Alliance presence, equitable distribution of teaching time, improved coordination and language skills, and reciprocal exchange rotations at US hospitals. The MUHAS faculty and residents agreed that Alliance members contributed to improved patient care and resident education. A multi-institutional international surgical partnership is possible and leads to perceived improvements in patient care and resident learning. Alliance surgeons must continue to focus on training Tanzanian surgeons. Improving the volunteer surgeons' Swahili-language skills would be an asset. Future

  12. The need for a better approach to business energy management: engaging decision makers

    International Nuclear Information System (INIS)

    Jutsen, Jonathan; Feldman, Shel

    2003-01-01

    Many programs have achieved success in stimulating companies to increase their purchase, installation, and use of energy-efficient equipment (e.g., fluorescent lighting, premium efficient motors). However, few can claim having moved companies to manage energy efficiency as an ongoing part of their practices, procedures, and culture. Recently, a program has been developed and implemented in the UK, Australia, Canada, and the U.S. that is aimed specifically at educating and motivating corporate decision-makers in this direction. This program targets senior management; it not only engages their interest and concern with energy-related issues, but also guides them to set priorities based on a structured gap analysis, and to establish and commit to a plan of action. By focusing on the business needs of the target companies and gaining executive commitment to a structured, systematic implementation plan, it motivates these companies both to seek immediate savings and to a process for continuous improvement that includes sustainable long-term energy efficiency. This paper illustrates specific aspects of the program, the way it helps drive outcomes in participating companies, and its implementation by government and utilities. In addition, the paper discusses needed changes in program evaluation methods to systematically monitor and value the cost-efficiency of this type of intervention which a) does not focus on equipment efficiencies, b) directs clients to other providers of energy efficiency services, c) helps build the infrastructure for such services, and d) motivates long-term energy reductions through the adoption of a sustainable energy-savings ethic in ongoing corporate planning and decisions

  13. Why we need new approaches to low-dose risk modeling

    International Nuclear Information System (INIS)

    Alvarez, J.L.; Seiler, F.A.

    1996-01-01

    The linear no-threshold model for radiation effects was introduced as a conservative model for the design of radiation protection programs. The model has persisted not only as the basis for such programs, but has come to be treated as a dogma and is often confused with scientific fact. In this examination a number of serious problems with the linear no-threshold model of radiation carcinogenesis were demonstrated, many of them invalidating the hypothesis. It was shown that the relative risk formalism did not approach 1 as the dose approaches zero. When morality ratios were used instead, the data in the region below 0.3 Sv were systematically below the predictions of the linear model. It was also shown that the data above 0.3 Sv were of little use in formulating a model at low doses. In addition, these data are valid only for doses accumulated at high dose rates, and there is no scientific justification for using the model in low-dose, low-dose-rate extrapolations for purposes of radiation protection. Further examination of model fits to the Japanese survivor data were attempted. Several such models were fit to the data including an unconstrained linear, linear-square root, and Weibull, all of which fit the data better than the relative risk, linear no-threshold model. These fits were used to demonstrate that the linear model systematically over estimates the risk at low doses in the Japanese survivor data set. It is recommended here that an unbiased re-analysis of the data be undertaken and the results used to construct a new model, based on all pertinent data. This model could then form the basis for managing radiation risks in the appropriate regions of dose and dose rate

  14. Evaluation of secretion prediction highlights differing approaches needed for oomycete and fungal effectors

    Directory of Open Access Journals (Sweden)

    Jana eSperschneider

    2015-12-01

    Full Text Available The steadily increasing number of sequenced fungal and oomycete genomes has enabled detailed studies of how these eukaryotic microbes infect plants and cause devastating losses in food crops. During infection, fungal and oomycete pathogens secrete effector molecules which manipulate host plant cell processes to the pathogen’s advantage. Proteinaceous effectors are synthesised intracellularly and must be externalised to interact with host cells. Computational prediction of secreted proteins from genomic sequences is an important technique to narrow down the candidate effector repertoire for subsequent experimental validation. In this study, we benchmark secretion prediction tools on experimentally validated fungal and oomycete effectors. We observe that for a set of fungal SwissProt protein sequences, SignalP 4 and the neural network predictors of SignalP 3 (D-score and SignalP 2 perform best. For effector prediction in particular, the use of a sensitive method can be desirable to obtain the most complete candidate effector set. We show that the neural network predictors of SignalP 2 and 3, as well as TargetP were the most sensitive tools for fungal effector secretion prediction, whereas the hidden Markov model predictors of SignalP 2 and 3 were the most sensitive tools for oomycete effectors. Thus, previous versions of SignalP retain value for oomycete effector prediction, as the current version, SignalP 4, was unable to reliably predict the signal peptide of the oomycete Crinkler effectors in the test set. Our assessment of subcellular localisation predictors shows that cytoplasmic effectors are often predicted as not extracellular. This limits the reliability of secretion predictions that depend on these tools. We present our assessment with a view to informing future pathogenomics studies and suggest revised pipelines for secretion prediction to obtain optimal effector predictions in fungi and oomycetes.

  15. Municipal solid waste management in Lebanon: the need for an integrated approach

    International Nuclear Information System (INIS)

    Khoury, R.; El-Fadel, M.

    2000-01-01

    Full text.This study focuses on the management of municipal solid waste (MSW) in Lebanon. It addresses the current status of MSW management in Lebanon in terms of collection, transport and disposal, infers the associated impacts of such practices and discusses mitigation measures and finally proposes basic guidelines for a national strategy for solid waste management in the country. The study is based on available previous investigations and on a field survey of 113 villages in four different countries. The study revealed the absence of an effective environmental policy and poor collection and disposal methods throughout the country, except for the Greater Beirut Area (G A), where better solid waste management practices are employed. Although collection of MSW outside GBA was found to be acceptable by local authorities, resources (labor and equipment) were not used efficiently. Furthermore, treatment of collected waste is almost not available. Waste collected is invariably open dumped and /or open burned outside GBA. The poor quality of the services were reflected by the low budgets available in the solid waste sanitation departments of most surveyed villages. Unlike the situation outside the GBA a solid waste management component can be identified in the GBA. However, until recently, nearly 90 percent of the total waste generated in the GBA is being ultimately disposed of at the landfill. This raises into question the purpose of the sorting-processing-composting facilities as well as the recycling program. Apparently, the current waste management activities, particularly source reduction and recycling have not measured up favorably with the steps outlined in an integrated solid waste management system. The study concludes with a series of policy measures that can constitute the framework for a long-term strategy in order to implement an effective solid waste master plan in Lebanon

  16. Participative approach to elicit water quality monitoring needs from stakeholder groups - An application of integrated watershed management.

    Science.gov (United States)

    Behmel, S; Damour, M; Ludwig, R; Rodriguez, M J

    2018-07-15

    Water quality monitoring programs (WQMPs) must be based on monitoring objectives originating from the real knowledge needs of all stakeholders in a watershed and users of the resource. This paper proposes a participative approach to elicit knowledge needs and preferred modes of communication from citizens and representatives of organized stakeholders (ROS) on water quality and quantity issues. The participative approach includes six steps and is adaptable and transferable to different types of watersheds. These steps are: (1) perform a stakeholder analysis; (2) conduct an adaptable survey accompanied by a user-friendly public participation geographical information system (PPGIS); (3) hold workshops to meet with ROS to inform them of the results of the survey and PPGIS; discuss attainment of past monitoring objectives; exchange views on new knowledge needs and concerns on water quality and quantity; (4) meet with citizens to obtain the same type of input (as from ROS); (5) analyze the data and information collected to identify new knowledge needs and modes of communication and (6) identify, in collaboration with the individuals in charge of the WQMPs, the short-, medium- and long-term monitoring objectives and communication strategies to be pursued. The participative approach was tested on two distinct watersheds in the province of Quebec, Canada. It resulted in a series of optimization objectives of the existing WQMPs, new monitoring objectives and recommendations regarding communication strategies of the WQMPs' results. The results of this study show that the proposed methodology is appreciated by all parties and that the outcomes and monitoring objectives are acceptable. We also conclude that successful integrated watershed management is a question of scale, and that every aspect of integrated watershed management needs to be adapted to the surface watershed, the groundwater watershed (aquifers) and the human catchment area. Copyright © 2018 Elsevier Ltd. All

  17. Information Technology and the Need for Clear Communication for Effective User’s Approach

    Directory of Open Access Journals (Sweden)

    Adriane Setti

    2014-09-01

    Full Text Available The present study addresses the communication between professionals of information technology (IT and its users in the corporate environment of Curitiba (Brazil. The main aim was to analyze communication problems and implications for management and marketing. Empirical research examined responses from a sample of IT professionals with some professional experience in the area and academic level, as well as responses from a sample of IT users (making use of technology in that corporate environment. The questionnaires were available online, and the SPSS software was used for data processing. Results allow us to infer that, in the sample studied, problems in communication between IT professionals and the services’ users do exist. Data obtained reflect a need for formal training by the professionals to serve customers, manage their careers and use technology on behalf of users in order to improve business management practice. Professionals must be clear with users, to create confidence. Also, it was evident that respondent users consider technology as a basic tool, and they expect professionals to share and explain their actions toward the machine or system. This research makes some implications obvious in relation to communication processes in the IT field for management and marketing.

  18. Four key reasons why climate change adaptation and mitigation need a gendered approach

    Directory of Open Access Journals (Sweden)

    Carla Sarrouy

    2014-09-01

    Full Text Available Climate change is having a growing impact on every human activity, especially on agriculture with altered rainfall patterns and an increased number and intensity of extreme weather events. This article argues that efforts to mitigate and adapt to climate change must consider whole food systems – rather than the sole production of food – whilst embracing a conscious gendered approach. Women are the main victims of hunger, but they are also the main actors of global food systems, they greatly contribute to their household’s and community’s wellbeing and detain a rich and often untapped knowledge of food systems. Promoting the role of women in our global food systems enhances the inclusion of criteria mainly valued by women such as resilience, diversity and nutrition, which are paramount for climate change mitigation and adaptation.   Photo credit: By OxFam East Africa [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0], via Wikimedia Commons

  19. Need for an integrated approach towards the assessment of radon, thoron and their progeny exposures

    International Nuclear Information System (INIS)

    Mayya, Y.S.

    2008-01-01

    Recent publications dealing with epidemiological studies on North American and European populations have indicated statistically significant lung cancer risk coefficients attributable to residential radon exposures. These are essentially based on radon gas itself as the quantitative measure of exposures. However, considering that true exposures depend upon the intricate mechanisms of decay product deposition in the lung, it is necessary to go for the assessment of decay products including their size distributions and deposition velocities. This approach is essential for assessing the risks of thoron and its decay products which is of considerable importance in the public domain and in the thorium fuel cycle. The recent development of deposition based progeny concentration measurement techniques appear to be best suited for radiological risk assessments both among occupational workers and general study populations. These provide an easy to wear alternative for radon inhalation dosimetry similar to TLDs for external gamma radiations. It is urgently required to characterize their performance under a variety of residential indoor and workplace conditions. This may be achieved through an integrated multi-parametric study programme involving measurements of radon, thoron and their progeny concentrations along with fine and coarse fractions and indoor source terms. This will not only in delineate the true exposure profiles and indoor parameters (e.g. deposition velocities and air exchange rates) in the country, but also will help in establishing deposition dosimetry as a basic technique for inhalation exposure estimations for occupational workers and subjects living in high background radiation areas

  20. Remediation strategies for sustainable development of contaminated environments - a need for an integrated approach

    International Nuclear Information System (INIS)

    Voigt, G.

    2005-01-01

    The risk of radiation exposures can result from different nuclear but also non-nuclear origins such as routine or accidental releases during operation of nuclear power plants, releases due to war actions, industrial production and manufacturing, mining and milling activities as well as nuclear weapons' production and testing resulting in increased natural or artificial radioactivity. In the consequence of releases of radionuclides into the environment, efforts have been made to assess and reduce their impact on human health and more recently on biota in the most effective way. Countermeasures for a variety of radionuclides have been developed and tested and finally implemented in contaminated areas to reduce the transfer of radionuclides in the ecosystems, and especially in the food chain to humans, and to reduce the direct radiation and thus exposures to humans and biota. However, especially in regards to the long-term, which will require the involvement of local stakeholders and the local population into the post-release decision making process, few attempts have been made in the past to consider a more holistic approach taking into account not only the effectiveness of the countermeasure itself but also its environmental and social-economic side effects as well as some ethical aspects. Examples of different efforts in this field are presented. (authors)

  1. Management of pregnancy-related issues in multiple sclerosis patients: the need for an interdisciplinary approach.

    Science.gov (United States)

    Amato, Maria Pia; Bertolotto, Antonio; Brunelli, Roberto; Cavalla, Paola; Goretti, Benedetta; Marrosu, Maria Giovanna; Patti, Francesco; Pozzilli, Carlo; Provinciali, Leandro; Rizzo, Nicola; Strobelt, Nicola; Tedeschi, Gioacchino; Trojano, Maria; Comi, Giancarlo

    2017-10-01

    Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system (CNS), most probably autoimmune in origin, usually occurring in young adults with a female/male prevalence of approximately 3:1. Women with MS in the reproductive age may face challenging issues in reconciling the desire for parenthood with their condition, owing to the possible influence both on the ongoing or planned treatment with the possible consequences on the disease course and on the potential negative effects of treatments on foetal and pregnancy outcomes. At MS diagnosis, timely counselling should promote informed parenthood, while disease evolution should be assessed before making therapeutic decisions. Current guidelines advise the discontinuation of any treatment during pregnancy, with possible exceptions for some treatments in patients with very active disease. Relapses decline during pregnancy but are more frequent during puerperium, when MS therapy should be promptly resumed in most of the cases. First-line immunomodulatory agents, such as interferon-β (IFN-β) and glatiramer acetate (GA), significantly reduce the post-partum risk of relapse. Due to substantial evidence of safety with the use of GA during pregnancy, a recent change in European marketing authorization removed the pregnancy contraindication for GA. This paper reports a consensus of Italian experts involved in MS management, including neurologists, gynaecologists and psychologists. This consensus, based on a review of the available scientific evidence, promoted an interdisciplinary approach to the management of pregnancy in MS women.

  2. Humanization in healthcare arises from the need for a holistic approach to illness.

    Science.gov (United States)

    de la Fuente-Martos, C; Rojas-Amezcua, M; Gómez-Espejo, M R; Lara-Aguayo, P; Morán-Fernandez, E; Aguilar-Alonso, E

    2018-03-01

    Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  3. Biodiesel exhaust: the need for a systematic approach to health effects research.

    Science.gov (United States)

    Larcombe, Alexander N; Kicic, Anthony; Mullins, Benjamin J; Knothe, Gerhard

    2015-10-01

    Biodiesel is a generic term for fuel that can be made from virtually any plant or animal oil via transesterification of triglycerides with an alcohol (and usually a catalyst). Biodiesel has received considerable scientific attention in recent years, as it is a renewable resource that is directly able to replace mineral diesel in many engines. Additionally, some countries have mandated a minimum biodiesel content in all diesel fuel sold on environmental grounds. When combusted, biodiesel produces exhaust emissions containing particulate matter, adsorbed chemicals and a range of gases. In many cases, absolute amounts of these pollutants are lower in biodiesel exhaust compared with mineral diesel exhaust, leading to speculation that biodiesel exhaust may be less harmful to health. Additionally, engine performance studies show that the concentrations of these pollutants vary significantly depending on the renewable oil used to make the biodiesel and the ratio of biodiesel to mineral diesel in the fuel mix. Given the strategic and legislative push towards the use of biodiesel in many countries, a concerning possibility is that certain biodiesels may produce exhaust emissions that are more harmful to health than others. This variation suggests that a comprehensive, systematic and comparative approach to assessing the potential for a range of different biodiesel exhausts to affect health is urgently required. Such an assessment could inform biodiesel production priorities, drive research and development into new exhaust treatment technologies, and ultimately minimize the health impacts of biodiesel exhaust exposure. © 2015 Asian Pacific Society of Respirology.

  4. A triangulation approach to the identification of acute sector nurses' training needs for formal nurse practitioner status.

    Science.gov (United States)

    Hicks, C; Hennessy, D

    1998-01-01

    The current confusion surrounding the definition and role function of the nurse practitioner (NP) has created a situation in which advanced clinical practice is delivered in a variety of ways and at many levels. Not surprisingly, this has led to difficulties in regulating educational provision for NPs. This study reports a survey of the perceptions of the role definitions and training needs of all nurses working at advanced clinical levels within an acute sector Trust. Although this concept is not a novel one in advanced nursing practice, the procedure adopted differed from previous studies in two fundamental ways: firstly, a unique training needs assessment instrument was used, which because of its validity and opacity, was capable of yielding a highly reliable data-base, comprising a prioritized profile of real training needs as opposed to the standard wish-list typically elicited. Secondly, it did not rely simply on the self-reported needs of the nurse sample, but also included the perceptions of the sample's immediate medical and managerial colleagues. In this way, a triangulation paradigm was adopted. The results indicated that overall, there was high agreement between the nurses and their managers, regarding both the definition of the NP role and the essential training requirements, with somewhat different opinions being offered by the medical staff. When the raw scores were standardized to correct for response bias, the data provided an operational definition of the role of the NP and a prioritized profile of training needs for nurses who wished to train to this level.

  5. The need for an organized approach for Government Medical Insurance Programs in the Commonwealth of Virginia.

    Science.gov (United States)

    Edlich, Richard F

    2005-01-01

    The Commonwealth of Virginia has a disorganized approach to enrolling their retired faculty in Medicare Supplement Insurance Programs. An organized approach to establishing Medicare Supplemental Insurance for retired University faculty should include the following administrative changes to correct this potential health-care crisis for retired state faculty members. First, the ombudsman for human resources for the state universities must receive educational programs that prepare the retired faculty members over the age of 65 to select the corporate insurance policy from Anthem Blue Cross/Blue Shield Insurance Company. Included in this educational program should be a review of the Advantage 65 Member Handbook. Second, they must point out to the faculty member that they are receiving a CORPORATE insurance policy rather than an individual insurance policy from Anthem Blue Cross/Blue Shield Insurance Company. They must provide the telephone numbers of the Anthem Blue Cross/Blue Shield offices in Roanoke, Virginia. Concomitantly, they must send the name and address of the faculty member to the Commonwealth of Virginia Department of Human Resource Management. They should inform the faculty member that the Commonwealth of Virginia Department of Human Resource Management will be sending them newsletters that outline any changes in the corporate insurance policy that they coordinate with the Anthem Blue Cross/Blue Shield Insurance Company. The Commonwealth of Virginia Department of Human Resource Management must take on some new responsibilities in their efforts to coordinate health-care coverage of the retired faculty over the age of 65. First, they must have a computer registry of all corporate health-care policies of the individual faculty members to ensure that newsletters are being sent to them. Ideally, this agency should have a computerized system that allows it to send out its newsletter update by email to those retired faculty members who have computers. They should

  6. Paradigm change in ocean studies: multi-platform observing and forecasting integrated approach in response to science and society needs

    Science.gov (United States)

    Tintoré, Joaquín

    2017-04-01

    -platform approach in ocean observation. Three examples from the integration capabilities of SOCIB facilities will be presented and discussed. First the quasi-continuous high frequency glider monitoring of the Ibiza Channel since 2011, an important biodiversity hot spot and a 'choke' point in the Western Mediterranean circulation, has allowed us to reveal a high frequency variability in the North-South exchanges, with very significant changes (0.8 - 0.9 Sv) occurring over periods of days to week of the same order as the previously known seasonal cycle. HF radar data and model results have also contributed more recently to better describe and understand the variability at small scales. Second, the Alborex/Perseus project multi-platform experiment (e.g., RV catamaran, 2 gliders, 25 drifters, 3 Argo type profilers & satellite data) that focused on submesoscale processes and ecosystem response and carried out in the Alborán Sea in May 2014. Glider results showed significant chlorophyll subduction in areas adjacent to the steep density front with patterns related to vertical motion. Initial dynamical interpretations will be presented. Third and final, I will discuss the key relevance of the data centre to guarantee data interoperability, quality control, availability and distribution for this new approach to ocean observation and forecasting to be really efficient in responding to key scientific state of the art priorities, enhancing technology development and responding to society needs.

  7. One Health approach to identify research needs in bovine and human babesioses: workshop report

    Directory of Open Access Journals (Sweden)

    McElwain Terry F

    2010-04-01

    Full Text Available Abstract Background Babesia are emerging health threats to humans and animals in the United States. A collaborative effort of multiple disciplines to attain optimal health for people, animals and our environment, otherwise known as the One Health concept, was taken during a research workshop held in April 2009 to identify gaps in scientific knowledge regarding babesioses. The impetus for this analysis was the increased risk for outbreaks of bovine babesiosis, also known as Texas cattle fever, associated with the re-infestation of the U.S. by cattle fever ticks. Results The involvement of wildlife in the ecology of cattle fever ticks jeopardizes the ability of state and federal agencies to keep the national herd free of Texas cattle fever. Similarly, there has been a progressive increase in the number of cases of human babesiosis over the past 25 years due to an increase in the white-tailed deer population. Human babesiosis due to cattle-associated Babesia divergens and Babesia divergens-like organisms have begun to appear in residents of the United States. Research needs for human and bovine babesioses were identified and are presented herein. Conclusions The translation of this research is expected to provide veterinary and public health systems with the tools to mitigate the impact of bovine and human babesioses. However, economic, political, and social commitments are urgently required, including increased national funding for animal and human Babesia research, to prevent the re-establishment of cattle fever ticks and the increasing problem of human babesiosis in the United States.

  8. Filovirus Research: The Need for an Integrated Approach in Time and Space

    Science.gov (United States)

    Pinzon, Jorge E.

    2010-01-01

    The episodic appearance of Ebola virus (EBOV) and Marburg virus (MARV) across central Africa over the last 15 years not only underscores the importance of filoviruses as uniquely virulent agents to both human and wildlife communities but also implies a very complex transmission scenario that must be understood if we are to prevent or mitigate filovirus outbreaks in the future. Efforts of a global network of scientists and healthcare workers have expanded our knowledge of filoviruses to meet the growing threat of Ebola and Marburg hemorrhagic fevers in Africa. In recent decades, several newly emerging diseases have resulted in major threats to both affected communities and global public health. Viruses from wildlife hosts in particular, have exhibited a capability for cross-species transmission (CST), and have caused high-impact diseases in humans Such as Ebola and Marburg hemorrhagic fevers, Nipah and severe acute respiratory syndrome (SAILS). It has been estimated that about 60.3% (Jones et al. 2008) of human infectious diseases are of animal origin (zoonoses) and even some important viral diseases that are traditionally considered of human origin, for example measles and smallpox, may very well have their prehistoric origins in wildlife (Wolfe et al 2007). It maybe logical and prudent therefore, to anticipate that there are other, new filoviruses out there that will cross into humans at some point in time. If we anticipate that these will happen and wish to be prepared for and mitigate this potential, then an understanding of filoviruses as a biologic system in the environment will be essential to that process. We will need to know how the ecological dynamic of CST interacts with a 'new' viruse's evolutionary factors to overcome environmental, demographic and host-specific barriers to transmission and infectivity to humans.

  9. A holistic approach to chronic pain management that involves all stakeholders: change is needed.

    Science.gov (United States)

    Kress, Hans-Georg; Aldington, Dominic; Alon, Eli; Coaccioli, Stefano; Collett, Beverly; Coluzzi, Flaminia; Huygen, Frank; Jaksch, Wolfgang; Kalso, Eija; Kocot-Kępska, Magdalena; Mangas, Ana Cristina; Ferri, Cesar Margarit; Mavrocordatos, Philippe; Morlion, Bart; Müller-Schwefe, Gerhard; Nicolaou, Andrew; Hernández, Concepción Pérez; Sichère, Patrick

    2015-01-01

    Chronic pain affects a large proportion of the population, imposing significant individual distress and a considerable burden on society, yet treatment is not always instituted and/or adequate. Comprehensive multidisciplinary management based on the biopsychosocial model of pain has been shown to be clinically effective and cost-efficient, but is not widely available. A literature review of stakeholder groups revealed many reasons for this, including: i) many patients believe healthcare professionals lack relevant knowledge, and consultations are rushed, ii) general practitioners consider that pain management has a low priority and is under-resourced, iii) pain specialists cite non-adherence to evidence-based treatment, sub-optimal prescribing, and chronic pain not being regarded as a disease in its own right, iv) nurses', pharmacists' and physiotherapists' skills are not fully utilized, and v) psychological therapy is employed infrequently and often too late. Many of the issues relating to physicians could be addressed by improving medical training, both at undergraduate and postgraduate levels - for example, by making pain medicine a compulsory core subject of the undergraduate medical curriculum. This would improve physician/patient communication, increase the use of standardized pain assessment tools, and allow more patients to participate in treatment decisions. Patient care would also benefit from improved training for other multidisciplinary team members; for example, nurses could provide counseling and follow-up support, psychologists offer coping skills training, and physiotherapists have a greater role in rehabilitation. Equally important measures include the widespread adoption of a patient-centered approach, chronic pain being recognized as a disease in its own right, and the development of universal guidelines for managing chronic non-cancer pain. Perhaps the greatest barrier to improvement is lack of political will at both national and international

  10. Supporting culturally and linguistically diverse children with speech, language and communication needs: Overarching principles, individual approaches.

    Science.gov (United States)

    Verdon, Sarah; McLeod, Sharynne; Wong, Sandie

    2015-01-01

    Speech-language pathologists (SLPs) are working with an increasing number of families from culturally and linguistically diverse backgrounds as the world's population continues to become more internationally mobile. The heterogeneity of these diverse populations makes it impossible to identify and document a one size fits all strategy for working with culturally and linguistically diverse families. This paper explores approaches to practice by SLPs identified as specialising in multilingual and multicultural practice in culturally and linguistically diverse contexts from around the world. Data were obtained from ethnographic observation of 14 sites in 5 countries on 4 continents. The sites included hospital settings, university clinics, school-based settings, private practices and Indigenous community-based services. There were 652 individual artefacts collected from the sites which included interview transcripts, photographs, videos, narrative reflections, informal and formal field notes. The data were analysed using Cultural-Historical Activity Theory (Engeström, 1987). From the analysis six overarching Principles of Culturally Competent Practice (PCCP) were identified. These were: (1) identification of culturally appropriate and mutually motivating therapy goals, (2) knowledge of languages and culture, (3) use of culturally appropriate resources, (4) consideration of the cultural, social and political context, (5) consultation with families and communities, and (6) collaboration between professionals. These overarching principles align with the six position statements developed by the International Expert Panel on Multilingual Children's Speech (2012) which aim to enhance the cultural competence of speech pathologists and their practice. The international examples provided in the current study demonstrate the individualised ways that these overarching principles are enacted in a range of different organisational, social, cultural and political contexts

  11. Evaluations of Factors Predicting the Need for an Extra-Cervical Approach for Intra-Thoracic Goiter

    Directory of Open Access Journals (Sweden)

    Ali Sadrizadeh

    2015-11-01

    Full Text Available Introduction: Intra-thoracic goiter refers to the extension of enlarged thyroid tissue into the thoracic inlet. This condition can produce symptoms of compression on adjacent organs and can sometimes be accompanied by malignant transformation. Therefore surgical treatment is almost always necessary. In order to remove the pathology with the fewest post-operative complications, selection of the appropriate surgical approach is essential. In this study we aimed to detect the criteria which help us select the best therapeutic approach.   Materials and Methods: In this retrospective study, 82 patients with intra-thoracic goiter were investigated. Their data were extracted from medical records and analyzed using SPSS software.   Results: Overall 82 patients, 18 (21% males and 64 (78% females with mean age of 56.38 years were studied. The most common clinical symptoms were mass (95% and dyspnea (73%. In most patients, the surgical approach was cervical (90.2%, while 9.8% of patients required an extra-cervical approach. Post-operation complications were observed in 17.1% of patients; the most common being transient recurrent laryngeal nerve paralysis (4.9%. Malignancy was reported in the histopathology of seven patients (8.5%. The most common malignant histopathology was papillary thyroid carcinoma (7.3%. Extension of the thyroid tissue below the uppermost level of the aortic arch was significantly correlated with the need for an extra-cervical approach to surgery (P

  12. Student identification of the need for complementary medicine education in Australian medical curricula: a constructivist grounded theory approach.

    Science.gov (United States)

    Templeman, Kate; Robinson, Anske; McKenna, Lisa

    2015-04-01

    Across the Western world, including Australia, growing popularity of complementary medicines (CMs) mandates their implementation into medical education (ME). Medical students in international contexts have expressed a need to learn about CMs. In Australia, little is known about the student-specific need for CM education. The objective of this paper was to assess the self-reported need for CM education among Australian medical students. Thirty second-year to final-year medical students participated in semi-structured interviews. A constructivist grounded theory methodological approach was used to generate, construct and analyse data. Medical school education faculties in Australian universities. Medical students generally held favourable attitudes toward CMs but had knowledge deficits and did not feel adept at counselling patients about CMs. All students were supportive of CM education in ME, noting its importance in relation to the doctor-patient encounter, specifically with regard to interactions with medical management. As future practitioners, students recognised the need to be able to effectively communicate about CMs and advise patients regarding safe and effective CM use. Australian medical students expressed interest in, and the need for, CM education in ME regardless of their opinion of it, and were supportive of evidence-based CMs being part of their armamentarium. However, current levels of CM education in medical schools do not adequately enable this. This level of receptivity suggests the need for CM education with firm recommendations and competencies to assist CM education development required. Identifying this need may help medical educators to respond more effectively. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Challenging empowerment: AIDS-affected South African children and the need for a multi-level relational approach.

    Science.gov (United States)

    Ansell, Nicola

    2014-01-01

    Critics of empowerment have highlighted the concept's mutability, focus on individual transformation, one-dimensionality and challenges of operationalisation. Relating these critiques to children's empowerment raises new challenges. Drawing on scholarship on children's subjecthood and exercise of power, alongside empirical research with children affected by AIDS, I argue that empowerment envisaged as individual self-transformation and increased capacity to act independently offers little basis for progressive change. Rather it is essential to adopt a relational approach that recognises the need to transform power relationships at multiple levels. This analysis has implications for our wider understanding of empowerment in the 21st century.

  14. Computing and information services at the Jet Propulsion Laboratory - A management approach to a diversity of needs

    Science.gov (United States)

    Felberg, F. H.

    1984-01-01

    The Jet Propulsion Laboratory, a research and development organization with about 5,000 employees, presents a complicated set of requirements for an institutional system of computing and informational services. The approach taken by JPL in meeting this challenge is one of controlled flexibility. A central communications network is provided, together with selected computing facilities for common use. At the same time, staff members are given considerable discretion in choosing the mini- and microcomputers that they believe will best serve their needs. Consultation services, computer education, and other support functions are also provided.

  15. Household level domestic fuel consumption and forest resource in relation to agroforestry adoption: Evidence against need-based approach

    Energy Technology Data Exchange (ETDEWEB)

    Sood, Kamal Kishor [Division of Agroforestry, Shere-Kashmir University of Agricultural Sciences and Technology of Jammu Main Campus-Chatha, Jammu (J and K) 180 009 (India); Mitchell, C. Paul [Institute of Energy Technologies, Fraser Noble Building, University of Aberdeen, Aberdeen AB24 3UE (United Kingdom)

    2011-01-15

    The need-based approach (assuming that higher consumption of tree products would motivate farmers to adopt agroforestry) has led to uneven success, in many cases failure, of many agroforestry projects. Current study investigated the association between fuelwood and forest resource use, and agroforestry adoption based on a survey of 401 households in the Indian Western Himalaya. Data on household domestic fuel utilisation and forest resource use were collected using a questionnaire in personal interviews. Agroforestry adoption increased significantly with increase in distance of nearest State forest from the house, distance travelled to collect fuelwood, and consumption of cattle dung, crop residues, charcoal, kerosene and liquid petroleum gas as domestic fuels by the household. Agroforestry adoption was also significantly higher in households with non-forest than those with State forests as primary source of fuelwood and timber. The proportion of adopters decreased significantly with increase in quantity of fuelwood used for domestic consumption, frequency of collection from State forests, total domestic energy consumption, fuelwood dependency, timber consumption and availability of timber through rights of households on State forests. Logistic regression analysis revealed that none of the factors related to need (quantity of fuelwood and timber used) appeared in the model but primary source of fuelwood, distance travelled to collect fuelwood and availability of timber through rights on the State forests appeared as important factors. This implies that need of the tree products is not a necessary condition to motivate farmers to adopt agroforestry, rather, it is accessibility of tree products which influence agroforestry adoption. (author)

  16. Policy needs and options for a common transatlantic approach towards measuring adoption, usage and benefits of eHealth.

    Science.gov (United States)

    Stroetmann, Karl A; Middleton, Blackford

    2011-01-01

    The European Union (EU) sponsored ARGOS project analysed current eHealth policy thinking in both the EU and the USA, compared strategic challenges and outcomes in selected fields, and drafted roadmaps towards developing advanced global approaches for these issues. This policy brief focuses on better understanding the benefits and costs of eHealth investments, assessing their overall socio-economic impact, identifying challenges and success factors, as well as measuring and globally benchmarking the concrete usage of eHealth solutions. These are by now key policy priorities not only of national governments and the European Commission, but also of international institutions like WHO or OECD. There is a strong felt transatlantic need for stocktaking, identifying lessons learned, sharing of experience, and working together to advance these issues for the benefit of health systems. A growing number of national and international activities can be taken advantage of. Recommendations on how to proceed with such transatlantic activities are proposed.

  17. Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach.

    Science.gov (United States)

    Jordan, Joanne E; Briggs, Andrew M; Brand, Caroline A; Osborne, Richard H

    2008-11-17

    Although emphasis on the prevention of chronic disease is important, governments in Australia need to balance this with continued assistance to the 77% of Australians reported to have at least one long-term medical condition. Self-management support is provided by health care and community services to enhance patients' ability to care for their chronic conditions in a cooperative framework. In Australia, there is a range of self-management support initiatives that have targeted patients (most notably, chronic disease self-management education programs) and health professionals (financial incentives, education and training). To date, there has been little coordination or integration of these self-management initiatives to enhance the patient-health professional clinical encounter. If self-management support is to work, there is a need to better understand the infrastructure, systems and training that are required to engage the key stakeholders - patients, carers, health professionals, and health care organisations. A coordinated approach is required in implementing these elements within existing and new health service models to enhance uptake and sustainability.

  18. Comparison of different approaches applied in Analytic Hierarchy Process - an example of information needs of patients with rare diseases.

    Science.gov (United States)

    Pauer, Frédéric; Schmidt, Katharina; Babac, Ana; Damm, Kathrin; Frank, Martin; von der Schulenburg, J-Matthias Graf

    2016-09-09

    The Analytic Hierarchy Process (AHP) is increasingly used to measure patient priorities. Studies have shown that there are several different approaches to data acquisition and data aggregation. The aim of this study was to measure the information needs of patients having a rare disease and to analyze the effects of these different AHP approaches. The ranking of information needs is then used to display information categories on a web-based information portal about rare diseases according to the patient's priorities. The information needs of patients suffering from rare diseases were identified by an Internet research study and a preliminary qualitative study. Hence, we designed a three-level hierarchy containing 13 criteria. For data acquisition, the differences in outcomes were investigated using individual versus group judgements separately. Furthermore, we analyzed the different effects when using the median and arithmetic and geometric means for data aggregation. A consistency ratio ≤0.2 was determined to represent an acceptable consistency level. Forty individual and three group judgements were collected from patients suffering from a rare disease and their close relatives. The consistency ratio of 31 individual and three group judgements was acceptable and thus these judgements were included in the study. To a large extent, the local ranks for individual and group judgements were similar. Interestingly, group judgements were in a significantly smaller range than individual judgements. According to our data, the ranks of the criteria differed slightly according to the data aggregation method used. It is important to explain and justify the choice of an appropriate method for data acquisition because response behaviors differ according to the method. We conclude that researchers should select a suitable method based on the thematic perspective or investigated topics in the study. Because the arithmetic mean is very vulnerable to outliers, the geometric mean

  19. Health care providers' perceived barriers to and need for the implementation of a national integrated health care standard on childhood obesity in the Netherlands - a mixed methods approach.

    Science.gov (United States)

    Schalkwijk, Annemarie A H; Nijpels, Giel; Bot, Sandra D M; Elders, Petra J M

    2016-03-08

    In 2010, a national integrated health care standard for (childhood) obesity was published and disseminated in the Netherlands. The aim of this study is to gain insight into the needs of health care providers and the barriers they face in terms of implementing this integrated health care standard. A mixed-methods approach was applied using focus groups, semi-structured, face-to-face interviews and an e-mail-based internet survey. The study's participants included: general practitioners (GPs) (focus groups); health care providers in different professions (face-to-face interviews) and health care providers, including GPs; youth health care workers; pediatricians; dieticians; psychologists and physiotherapists (survey). First, the transcripts from the focus groups were analyzed thematically. The themes identified in this process were then used to analyze the interviews. The results of the analysis of the qualitative data were used to construct the statements used in the e-mail-based internet survey. Responses to items were measured on a 5-point Likert scale and were categorized into three outcomes: 'agree' or 'important' (response categories 1 and 2), 'disagree' or 'not important'. Twenty-seven of the GPs that were invited (51 %) participated in four focus groups. Seven of the nine health care professionals that were invited (78 %) participated in the interviews and 222 questionnaires (17 %) were returned and included in the analysis. The following key barriers were identified with regard to the implementation of the integrated health care standard: reluctance to raise the subject; perceived lack of motivation and knowledge on the part of the parents; previous negative experiences with lifestyle programs; financial constraints and the lack of a structured multidisciplinary approach. The main needs identified were: increased knowledge and awareness on the part of both health care providers and parents/children; a social map of effective intervention; structural

  20. A Patient-centered Approach to Evaluate the Information Needs of Women With Ductal Carcinoma In Situ.

    Science.gov (United States)

    Lo, Andrea C; Olson, Robert; Feldman-Stewart, Deb; Truong, Pauline T; Aquino-Parsons, Christina; Bottorff, Joan L; Carolan, Hannah

    2017-12-01

    To evaluate the information needs of ductal carcinoma in situ (DCIS) patients. Four focus groups involving 24 previously treated DCIS patients were conducted to develop a comprehensive list of questions they felt were important to have answered at the time of diagnosis. Using a survey, a separate group of patients treated for DCIS then rated the importance of having each of these questions addressed before treatment decision making. Response options were "essential," "desired," "not important," "no opinion," and "avoid." For each essential/desired question, respondents specified how addressing it would help them: "understand," "decide," "plan," "not sure," or "other." Focus group participants generated 117 questions used in the survey. Fifty-seven patients completed the survey (55% response rate). Respondents rated a median of 66 questions as essential. The most commonly cited reason for rating a question essential was to "understand," followed by to "decide." The top questions women deemed essential to help them understand were disease specific, whereas the top questions deemed essential to help women decide were predominantly treatment specific, pertaining to available options, recurrence and survival outcomes, and timelines to decide and start treatment. DCIS patients want a large number of questions answered, mostly for understanding, and also for deciding and planning. A core set of questions that most patients consider essential for decision making has been formulated and may be used in the clinical setting and in research to develop educational resources and decision-making tools specific to DCIS.

  1. Research needs

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    Research needs were identified during working sessions for several potential separation options. These options include sequestering agents, solvent extraction, membranes, solid sorbents, novel approaches, organic separation and destruction methods, and radiation and chemical stability of separation materials

  2. A rational approach to estimating the surgical demand elasticity needed to guide manpower reallocation during contagious outbreaks.

    Science.gov (United States)

    Tsao, Hsiao-Mei; Sun, Ying-Chou; Liou, Der-Ming

    2015-01-01

    Emerging infectious diseases continue to pose serious threats to global public health. So far, however, few published study has addressed the need for manpower reallocation needed in hospitals when such a serious contagious outbreak occurs. To quantify the demand elasticity of the major surgery types in order to guide future manpower reallocation during contagious outbreaks. Based on a nationwide research database in Taiwan, we extracted the monthly volumes of major surgery types for the period 1998-2003, which covered the SARS period, in order to carry out a time series analysis. The demand elasticity of each surgery type was then estimated by autoregressive integrated moving average (ARIMA) analysis. During the study period, the surgical volumes of most selected surgery types either increased or remained steady. We categorized these surgery types into low-, moderate- and high-elastic groups according to their demand elasticity. Appendectomy, 'open reduction of fracture with internal fixation' and 'free skin graft' were in the low demand elasticity group. Transurethral prostatectomy and extracorporeal shockwave lithotripsy (ESWL) were in the high demand elasticity group. The manpower of the departments carrying out the surgeries with low demand elasticity should be maintained during outbreaks. In contrast, departments in charge of surgeries mainly with high demand elasticity, like urology departments, may be in a position to have part of their staff reallocated. Taking advantage of the demand variation during the SARS period in 2003, we adopted the concept of demand elasticity and used a time series approach to figure out an effective index of demand elasticity for various types of surgery that could be used as a rational reference to carry out manpower reallocation during contagious outbreak situations.

  3. Clinician–Investigator Training and the Need to Pilot New Approaches to Recruiting and Retaining This Workforce

    Science.gov (United States)

    Hall, Alison K.; Lund, P. Kay

    2017-01-01

    Clinician–investigators, also called physician–scientists, offer critical knowledge and perspectives that benefit research on basic science mechanisms, improved diagnostic and therapeutic approaches, population and outcomes medicine, health policy, and health services, yet few clinically trained health professionals pursue a research career. Sustaining this workforce requires attention to the unique challenges faced by investigators who must achieve clinical and research competence during training and their careers. These challenges include the duration of required clinical training, limited or discontinuous research opportunities, high levels of educational debt, balancing the dual obligations and rewards of clinical care and research, competition for research funding, and the need for leadership development after training. Women and individuals from underrepresented racial and ethnic groups comprise a small percentage of this workforce. The authors summarize the recent literature on training for clinician–investigators, emphasizing approaches with encouraging outcomes that warrant broader implementation. Using this overview as background, they convened three workshops at the National Institutes of Health in 2016 to identify and refine key priorities for potential new pilot programs to recruit and retain the clinician–investigator workforce. From these workshops emerged three priorities for future pilot programs: (1) support for research in residency, (2) new research on-ramps for health professionals at multiple career stages, and (3) national networks to diversify and sustain clinician–investigator faculty. Implementation of any pilot program will require coordinated commitment from academic health centers, medical licensing/certification boards, professional societies, and clinician–investigators themselves, in addition to support from the National Institutes of Health. PMID:28767499

  4. Clinician-Investigator Training and the Need to Pilot New Approaches to Recruiting and Retaining This Workforce.

    Science.gov (United States)

    Hall, Alison K; Mills, Sherry L; Lund, P Kay

    2017-10-01

    Clinician-investigators, also called physician-scientists, offer critical knowledge and perspectives that benefit research on basic science mechanisms, improved diagnostic and therapeutic approaches, population and outcomes medicine, health policy, and health services, yet few clinically trained health professionals pursue a research career. Sustaining this workforce requires attention to the unique challenges faced by investigators who must achieve clinical and research competence during training and their careers. These challenges include the duration of required clinical training, limited or discontinuous research opportunities, high levels of educational debt, balancing the dual obligations and rewards of clinical care and research, competition for research funding, and the need for leadership development after training. Women and individuals from underrepresented racial and ethnic groups comprise a small percentage of this workforce.The authors summarize the recent literature on training for clinician-investigators, emphasizing approaches with encouraging outcomes that warrant broader implementation. Using this overview as background, they convened three workshops at the National Institutes of Health in 2016 to identify and refine key priorities for potential new pilot programs to recruit and retain the clinician-investigator workforce. From these workshops emerged three priorities for future pilot programs: (1) support for research in residency, (2) new research on-ramps for health professionals at multiple career stages, and (3) national networks to diversify and sustain clinician-investigator faculty. Implementation of any pilot program will require coordinated commitment from academic health centers, medical licensing/certification boards, professional societies, and clinician-investigators themselves, in addition to support from the National Institutes of Health.

  5. The role of duplications in the evolution of genomes highlights the need for evolutionary-based approaches in comparative genomics

    Directory of Open Access Journals (Sweden)

    Levasseur Anthony

    2011-02-01

    Full Text Available Abstract Understanding the evolutionary plasticity of the genome requires a global, comparative approach in which genetic events are considered both in a phylogenetic framework and with regard to population genetics and environmental variables. In the mechanisms that generate adaptive and non-adaptive changes in genomes, segmental duplications (duplication of individual genes or genomic regions and polyploidization (whole genome duplications are well-known driving forces. The probability of fixation and maintenance of duplicates depends on many variables, including population sizes and selection regimes experienced by the corresponding genes: a combination of stochastic and adaptive mechanisms has shaped all genomes. A survey of experimental work shows that the distinction made between fixation and maintenance of duplicates still needs to be conceptualized and mathematically modeled. Here we review the mechanisms that increase or decrease the probability of fixation or maintenance of duplicated genes, and examine the outcome of these events on the adaptation of the organisms. Reviewers This article was reviewed by Dr. Etienne Joly, Dr. Lutz Walter and Dr. W. Ford Doolittle.

  6. Too Much or Not Enough? An Examination of Special Education Provision and School District Leaders' Perceptions of Current Needs and Common Approaches

    Science.gov (United States)

    Cameron, David Lansing

    2016-01-01

    The purpose of this study was to examine the relationship between special education provision in Norway and school district leaders' perspectives regarding (a) the need for special education and (b) the importance and prevalence of integrated and segregated approaches. Findings indicate that the percentage of students perceived as being in need of…

  7. Improvements in Hudson River Water Quality Create the Need for a new Approach to Monitoring and Management

    Science.gov (United States)

    O'Mullan, G. D.; Juhl, A.; Sambrotto, R.; Lipscomb, J.; Brown, T.

    2008-12-01

    localized events, demonstrate that a new approach is needed to monitor and manage the lower Hudson River Estuary. One important component of this new approach is consideration of local and extreme conditions, rather than just spatial and temporal means. Another aspect is increased public dissemination of available water quality data. A new Hudson River water quality web site has been launched as an example of this type of public outreach.

  8. Pattern and outcome of infertility in Enugu: the need to improve diagnostic facilities and approaches to management.

    Science.gov (United States)

    Ugwu, E O; Onwuka, C I; Okezie, O A

    2012-01-01

    In Nigeria, infertility is a social for the childless couple due to the high premium placed on propagating oneself. To determine the pattern of infertility among women attending the gynaecological clinic of university of Nigeria Teaching Hospital, Enugu and to examine the outcome of management. A descriptive retrospective design study based on findings from the folders of infertile couples presenting at the gynaecological clinic of University of Nigeria Teaching Hospital over a five year period (2004 - 2008). The data were collected from all documented and laboratory findings. The data extracted from the case records were the socio-demographic characteristics of the patients, the type of infertility whether primary or secondary, the causes, and the treatment in the years under review. The outcome of management was also evaluated. These were analyzed using SPSS 12.0.1 for window version. The mean age of the women was 34.1 +/- 4.9 range 21 - 46) years. The prevalence of infertility was 5.5% of all outpatient gynaecological consultations. The cause of infertility could not be determined in 39.4% of cases, female factors were identified as the sole causes in 28.7% of cases, male factors as sole causes in 11.5% of cases, and combined male/female factors in 20.4% of cases. Secondary infertility accounted for 76.8% of infertility and primary infertility 23.2%. The age of the women and the educational level did not significantly influence the type of infertility the women presented with (P > 0.05). Tubal factor was identified in majority of cases and pregnancy was recorded in only 17.0% of the women. Secondary infertility is more prevalent in Enugu with tubal factor accounting for majority of the cases with identifiable causes. The outcome of treatment of infertility is poor. There is need to improve infertility diagnostic and treatment facilities and approaches in Enugu, Nigeria.

  9. Previously unknown species of Aspergillus.

    Science.gov (United States)

    Gautier, M; Normand, A-C; Ranque, S

    2016-08-01

    The use of multi-locus DNA sequence analysis has led to the description of previously unknown 'cryptic' Aspergillus species, whereas classical morphology-based identification of Aspergillus remains limited to the section or species-complex level. The current literature highlights two main features concerning these 'cryptic' Aspergillus species. First, the prevalence of such species in clinical samples is relatively high compared with emergent filamentous fungal taxa such as Mucorales, Scedosporium or Fusarium. Second, it is clearly important to identify these species in the clinical laboratory because of the high frequency of antifungal drug-resistant isolates of such Aspergillus species. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) has recently been shown to enable the identification of filamentous fungi with an accuracy similar to that of DNA sequence-based methods. As MALDI-TOF MS is well suited to the routine clinical laboratory workflow, it facilitates the identification of these 'cryptic' Aspergillus species at the routine mycology bench. The rapid establishment of enhanced filamentous fungi identification facilities will lead to a better understanding of the epidemiology and clinical importance of these emerging Aspergillus species. Based on routine MALDI-TOF MS-based identification results, we provide original insights into the key interpretation issues of a positive Aspergillus culture from a clinical sample. Which ubiquitous species that are frequently isolated from air samples are rarely involved in human invasive disease? Can both the species and the type of biological sample indicate Aspergillus carriage, colonization or infection in a patient? Highly accurate routine filamentous fungi identification is central to enhance the understanding of these previously unknown Aspergillus species, with a vital impact on further improved patient care. Copyright © 2016 European Society of Clinical Microbiology and

  10. Identifying consumer's needs of health information technology through an innovative participatory design approach among English- and Spanish-speaking urban older adults.

    Science.gov (United States)

    Lucero, R; Sheehan, B; Yen, P; Velez, O; Nobile-Hernandez, D; Tiase, V

    2014-01-01

    We describe an innovative community-centered participatory design approach, Consumer-centered Participatory Design (C2PD), and the results of applying C2PD to design and develop a web-based fall prevention system. We conducted focus groups and design sessions with English- and Spanish-speaking community-dwelling older adults. Focus group data were summarized and used to inform the context of the design sessions. Descriptive content analysis methods were used to develop categorical descriptions of design session informant's needs related to information technology. The C2PD approach enabled the assessment and identification of informant's needs of health information technology (HIT) that informed the development of a falls prevention system. We learned that our informants needed a system that provides variation in functions/content; differentiates between actionable/non-actionable information/structures; and contains sensory cues that support wide-ranging and complex tasks in a varied, simple, and clear interface to facilitate self-management. The C2PD approach provides community-based organizations, academic researchers, and commercial entities with a systematic theoretically informed approach to develop HIT innovations. Our community-centered participatory design approach focuses on consumer's technology needs while taking into account core public health functions.

  11. A knowledge management and need-capacity matching approach for community-based disaster management and recovery

    NARCIS (Netherlands)

    Palomares, I.; Galway, L.; Haran, M.; Neef, M.; Woods, C.; Wang, H.

    2015-01-01

    Post-crisis response and recovery necessitates the identification and prioritization of the needs and capacities of the affected community in order to provide efficient and wellcoordinated humanitarian assistance. The Community Based Comprehensive Recovery platform aims to facilitate enhanced

  12. Work schedule manager gap analysis : assessing the future training needs of work schedule managers using a strategic job analysis approach

    Science.gov (United States)

    2010-05-01

    This report documents the results of a strategic job analysis that examined the job tasks and knowledge, skills, abilities, and other characteristics (KSAOs) needed to perform the job of a work schedule manager. The strategic job analysis compared in...

  13. A Rational Approach to Estimating the Surgical Demand Elasticity Needed to Guide Manpower Reallocation during Contagious Outbreaks

    OpenAIRE

    Tsao, Hsiao-Mei; Sun, Ying-Chou; Liou, Der-Ming

    2015-01-01

    Background Emerging infectious diseases continue to pose serious threats to global public health. So far, however, few published study has addressed the need for manpower reallocation needed in hospitals when such a serious contagious outbreak occurs. Aim To quantify the demand elasticity of the major surgery types in order to guide future manpower reallocation during contagious outbreaks. Materials and Methods Based on a nationwide research database in Taiwan, we extracted the monthly volume...

  14. Needs for R and D and innovations to address challenges of nuclear facility decommissioning after its normal shutdown versus advanced approaches required for Fukushima Daiichi NPS decommissioning. Needs and emergency technologies for decommissioning

    International Nuclear Information System (INIS)

    Laurent, G.

    2017-01-01

    Taking into account several attempts to address variety of needs for R and D related to the decommissioning challenges such as: - Characterisation and survey prior to dismantling, - Technologies for dismantling, - Decontamination and on-site remediation, - Material and waste management, - Site characterisation and environmental monitoring. This presentation will give an update of approaches in several countries for R and D to aim at more efficient and effective decommissioning and, above all, to reduce current labour intensive needs to implement this kind of work. The evidence of the particular needs to coordinate efforts both for 'normal decommissioning' and accident cases like Fukushima Daiichi will be offered by demonstrating that, for a large part, that needs might be considered as similar. Some examples of particular interest will be given and it will be emphasized the need to adapt existing and/or new technologies from 'non-nuclear' areas to use them for nuclear decommissioning. The global interest to evaluate and to coordinate R and D efforts will be demonstrated. Consequently there might be a large international interest to increase the consensus where R and D can be better directed. The more comprehensive coordination should support improvement of the overview of future decommissioning needs to implement the decommissioning activities more effectively in terms of time and finance, not compromising safety. (author)

  15. User-driven health care - answering multidimensional information needs in individual patients utilizing post-EBM approaches: a conceptual model.

    Science.gov (United States)

    Biswas, Rakesh; Martin, Carmel M; Sturmberg, Joachim; Shanker, Ravi; Umakanth, Shashikiran; Shanker, Shiv; Kasturi, A S

    2008-10-01

    Evidence based on average patient data, which occupies most of our present day information databases, does not fulfil the needs of individual patient-centred health care. In spite of the unprecedented expansion in medical information we still do not have the types of information required to allow us to tailor optimal care for a given individual patient. As our current information is chiefly provided in disconnected silos, we need an information system that can seamlessly integrate different types of information to meet diverse user group needs. Groups of certain individual medical learners namely patients, medical students and health professionals share the patient's need to increasingly interact with and seek knowledge and solutions offered by others (individual medical learners) who have the lived experiences that they would benefit to access and learn from. A web-based user-driven learning solution may be a stepping-stone to address the present problem of information oversupply in medicine that mostly remains underutilized, as it doesn't meet the needs of the individual patient and health professional user. The key to its success would be to relax central control and make local trust and strategic health workers feel more engaged in the project such that it is truly user-driven.

  16. What Drives Students' Loyalty-Formation in Social Media Learning within a Personal Learning Environment Approach? The Moderating Role of Need for Cognition

    Science.gov (United States)

    Arquero, José L.; del Barrio-García, Salvador; Romero-Frías, Esteban

    2017-01-01

    Our study analyzes an educational experience based on the integrated use of social media within a higher education course under a personal learning environment approach and investigates the factors that determine students' loyalty to social media learning. We examined the moderating role of need for cognition (NFC) in students' formation of…

  17. The Development of Ethnobotany Curriculum for Students in Rural Schools: An Approach that Incorporates the Needs and Insights of Local Communities

    Science.gov (United States)

    Kraipeerapun, Kittima; Thongthew, Sumlee

    2007-01-01

    In this paper, an ethnobotany curriculum is used as a case example of one approach to incorporating the insights and needs of the local community into the curriculum development process. This curriculum development was carried out in the "Kiriwong Community" in Nakornsrithammarat Province, Southern Thailand. The ethnobotany curriculum…

  18. Social-Emotional Needs: A School-Based Approach to Preventing Suicide among Students with Gifts and Talents

    Science.gov (United States)

    Cross, Tracy L.

    2012-01-01

    This article provides a succinct primer on some of the basic constructs that adults need to know to help keep students with gifts and talents from completing suicide. It focuses on the school as the primary context to look out for potentially suicidal gifted students. This makes sense, as students spend a considerable amount of time in school,…

  19. Teachers' Voice vs. Students' Voice: A Needs Analysis Approach to English for Acadmic Purposes (EAP) in Iran

    Science.gov (United States)

    Eslami, Zohreh R.

    2010-01-01

    EAP plays a highly important role in countries where English is used mainly for academic purposes. However, EAP programs have been developed without conducting a systematic needs analysis from both the students' and instructors' perspective. The purpose of this study is to describe the perception that EAP students and instructors have of the…

  20. Science of learning is learning of science: why we need a dialectical approach to science education research

    Science.gov (United States)

    Roth, Wolff-Michael

    2012-06-01

    Research on learning science in informal settings and the formal (sometimes experimental) study of learning in classrooms or psychological laboratories tend to be separate domains, even drawing on different theories and methods. These differences make it difficult to compare knowing and learning observed in one paradigm/context with those observed in the other. Even more interestingly, the scientists studying science learning rarely consider their own learning in relation to the phenomena they study. A dialectical, reflexive approach to learning, however, would theorize the movement of an educational science (its learning and development) as a special and general case—subject matter and method—of the phenomenon of learning (in/of) science. In the dialectical approach to the study of science learning, therefore, subject matter, method, and theory fall together. This allows for a perspective in which not only disparate fields of study—school science learning and learning in everyday life—are integrated but also where the progress in the science of science learning coincides with its topic. Following the articulation of a contradictory situation on comparing learning in different settings, I describe the dialectical approach. As a way of providing a concrete example, I then trace the historical movement of my own research group as it simultaneously and alternately studied science learning in formal and informal settings. I conclude by recommending cultural-historical, dialectical approaches to learning and interaction analysis as a context for fruitful interdisciplinary research on science learning within and across different settings.

  1. Transsphenoidal Approach in Endoscopic Endonasal Surgery for Skull Base Lesions: What Radiologists and Surgeons Need to Know.

    Science.gov (United States)

    García-Garrigós, Elena; Arenas-Jiménez, Juan José; Monjas-Cánovas, Irene; Abarca-Olivas, Javier; Cortés-Vela, Jesús Julián; De La Hoz-Rosa, Javier; Guirau-Rubio, Maria Dolores

    2015-01-01

    In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and the pituitary gland above. More recently, extended approaches have expanded the indications for transsphenoidal surgery by using different corridors leading to specific target areas, from the crista galli to the spinomedullary junction. Computer-assisted surgery is an evolving technology that allows real-time anatomic navigation during endoscopic surgery by linking preoperative triplanar radiologic images and intraoperative endoscopic views, thus helping the surgeon avoid damage to vital structures. Preoperative computed tomography is the preferred modality to show bone landmarks and vascular structures. Radiologists play an important role in surgical planning by reporting extension of sphenoid pneumatization, recesses and septations of the sinus, and other relevant anatomic variants. Radiologists should understand the relationships of the sphenoid bone and skull base structures, anatomic variants, and image-guided neuronavigation techniques to prevent surgical complications and allow effective treatment of skull base lesions with the endoscopic endonasal transsphenoidal approach. ©RSNA, 2015.

  2. Psychological Needs, Engagement, and Work Intentions: A Bayesian Multi-Measurement Mediation Approach and Implications for HRD

    Science.gov (United States)

    Shuck, Brad; Zigarmi, Drea; Owen, Jesse

    2015-01-01

    Purpose: The purpose of this study was to empirically examine the utility of self-determination theory (SDT) within the engagement-performance linkage. Design/methodology/approach: Bayesian multi-measurement mediation modeling was used to estimate the relation between SDT, engagement and a proxy measure of performance (e.g. work intentions) (N =…

  3. Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience.

    Science.gov (United States)

    Asadi-Lari, M; Farshad, A A; Assaei, S E; Vaez Mahdavi, M R; Akbari, M E; Ameri, A; Salimi, Z; Gray, D

    2005-06-01

    Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development. Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities. A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development

  4. Is there Needed an Industry Approach on Corporate Default Risk? Case Study on Companies Listed on Romanian Stock Exchange

    Directory of Open Access Journals (Sweden)

    Cristina Maria Triandafil

    2009-02-01

    Full Text Available This paper focuses on applying Black and Scholes structural approach on credit risk in the case of the companies listed on Romanian Stock Exchange. We conduct a case-study on 35 companies belonging to five industries (energetic, materials, chemistry, pharmaceuticals, equipments during a period of 10 years in order to highlight out default point/threshold and its essential factors evolution across industries. Research approach is concentrated also on the specific characteristics of the Romanian capital market (especially in terms of illiquidity and lack of transparency additional costs, macroeconomic environment and corporate finance decision process. We compute default point from the perspective of the arbitrage between assets and leverage; in accordance with the most recent theories on specific features corporate default within emerging countries (Galytskyy, 2006, a key element will be represented by the assets volatility which will be correlated with the country risk premium in order to highlight out a potential macroeconomic impact on corporate failure.

  5. Trans-palpebral illumination: an approach for wide-angle fundus photography without the need for pupil dilation

    OpenAIRE

    Toslak, Devrim; Thapa, Damber; Chen, Yanjun; Erol, Muhammet Kazim; Paul Chan, R. V.; Yao, Xincheng

    2016-01-01

    It is technically difficult to construct wide-angle fundus imaging devices due to the complexity of conventional transpupillary illumination and imaging mechanisms. We report here a new method, i.e., trans-palpebral illumination, for wide-angle fundus photography without the need for pupil dilation. By constructing a smartphone-based prototype imaging device, we demonstrated a 152° view in a single-shot image. The unique combination of low-cost smartphone design and automatic illumination opt...

  6. The Future of Character Education and Social-Emotional Learning: "The Need for Whole School and Community-Linked Approaches"

    Science.gov (United States)

    Elias, Maurice J.

    2014-01-01

    In an era of change, preparing our youth for an uncertain future is akin to building the airplane while it is in flight. Since we do not have the luxury of putting development on hold until we figure out the destination and the kind of plane we need to get there, we must fly anyway. This article employs an airplane analogy to illustrate the fact…

  7. Multiple risk factors during pregnancy in South Africa: the need for a horizontal approach to perinatal care.

    Science.gov (United States)

    Tomlinson, Mark; O'Connor, Mary J; le Roux, Ingrid M; Stewart, Jacqueline; Mbewu, Nokwanele; Harwood, Jessica; Rotheram-Borus, Mary Jane

    2014-06-01

    South African children's long-term health and well-being is jeopardized during their mothers' pregnancies by the intersecting epidemics of HIV, alcohol use, low birth weight (LBW; alcohol prior to knowing that they were pregnant, and 15 % had a previous childbirth with a LBW infant. Approximately 27 % of women had more than one risk factor: depressed mood was significantly associated with alcohol use and LBW, with a trend to significance with HIV+. In addition, alcohol use was significantly related to HIV+. These results suggest the importance of intervening across multiple risks to maternal and child health, and particularly with depression and alcohol use, to positively impact multiple maternal and infant outcomes.

  8. Hospital discharge: What are the problems, information needs and objectives of community pharmacists? A mixed method approach

    Directory of Open Access Journals (Sweden)

    Brühwiler LD

    2017-09-01

    Full Text Available Background: After hospital discharge, community pharmacists are often the first health care professionals the discharged patient encounters. They reconcile and dispense prescribed medicines and provide pharmaceutical care. Compared to the roles of general practitioners, the pharmacists’ needs to perform these tasks are not well known. Objective: This study aims to a Identify community pharmacists’ current problems and roles at hospital discharge, b Assess their information needs, specifically the availability and usefulness of information, and c Gain insight into pharmacists’ objectives and ideas for discharge optimisation. Methods: A focus group was conducted with a sample of six community pharmacists from different Swiss regions. Based on these qualitative results, a nationwide online-questionnaire was sent to 1348 Swiss pharmacies. Results: The focus group participants were concerned about their extensive workload with discharge prescriptions and about gaps in therapy. They emphasised the importance of more extensive information transfer. This applied especially to medication changes, unclear prescriptions, and information about a patient's care. Participants identified treatment continuity as a main objective when it comes to discharge optimisation. There were 194 questionnaires returned (response rate 14.4%. The majority of respondents reported to fulfil their role as defined by the Joint-FIP/WHO Guideline on Good Pharmacy Practice (rather badly. They reported many unavailable but useful information items, like therapy changes, allergies, specifications for “off-label” medication use or contact information. Information should be delivered in a structured way, but no clear preference for one particular transfer method was found. Pharmacists requested this information in order to improve treatment continuity and patient safety, and to be able to provide better pharmaceutical care services. Conclusion: Surveyed Swiss community

  9. Eyeworm infections in dogs and in a human patient in Serbia: A One Health approach is needed.

    Science.gov (United States)

    Tasić-Otašević, Suzana; Gabrielli, Simona; Trenkić-Božinović, Marija; Petrović, Aleksandar; Gajić, Bojan; Colella, Vito; Momčilović, Stefan; Cancrini, Gabriella; Otranto, Domenico

    2016-04-01

    Thelazia callipaeda eyeworm has been frequently reported parasitizing humans in Asia. In Europe, the parasite is endemic in wild and domestic carnivores and only eight cases have been reported in humans so far. We describe the first case of human thelaziosis in Serbia, along with two cases in dogs from the same area. A One Health approach, based on cooperation amongst veterinarians and physicians, is strongly advised for this emerging infection in order to assess the risk for and prevent of the zoonotic infection. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Contrasting motivational orientation and evaluative coding accounts: On the need to differentiate the effectors of approach/avoidance responses

    Directory of Open Access Journals (Sweden)

    Julia eKozlik

    2015-05-01

    Full Text Available Several emotion theorists suggest that valenced stimuli automatically trigger motivational orientations and thereby facilitate corresponding behavior. Positive stimuli were thought to activate approach motivational circuits which in turn primed approach-related behavioral tendencies whereas negative stimuli were supposed to activate avoidance motivational circuits so that avoidance-related behavioral tendencies were primed (motivational orientation account. However, recent research suggests that typically observed affective stimulus–response compatibility phenomena might be entirely explained in terms of theories accounting for mechanisms of general action control instead of assuming motivational orientations to mediate the effects (evaluative coding account. In what follows, we explore to what extent this notion is applicable. We present literature suggesting that evaluative coding mechanisms indeed influence a wide variety of affective stimulus–response compatibility phenomena. However, the evaluative coding account does not seem to be sufficient to explain affective S–R compatibility effects. Instead, several studies provide clear evidence in favor of the motivational orientation account that seems to operate independently of evaluative coding mechanisms. Implications for theoretical developments and future research designs are discussed.

  11. Contrasting motivational orientation and evaluative coding accounts: on the need to differentiate the effectors of approach/avoidance responses.

    Science.gov (United States)

    Kozlik, Julia; Neumann, Roland; Lozo, Ljubica

    2015-01-01

    Several emotion theorists suggest that valenced stimuli automatically trigger motivational orientations and thereby facilitate corresponding behavior. Positive stimuli were thought to activate approach motivational circuits which in turn primed approach-related behavioral tendencies whereas negative stimuli were supposed to activate avoidance motivational circuits so that avoidance-related behavioral tendencies were primed (motivational orientation account). However, recent research suggests that typically observed affective stimulus-response compatibility phenomena might be entirely explained in terms of theories accounting for mechanisms of general action control instead of assuming motivational orientations to mediate the effects (evaluative coding account). In what follows, we explore to what extent this notion is applicable. We present literature suggesting that evaluative coding mechanisms indeed influence a wide variety of affective stimulus-response compatibility phenomena. However, the evaluative coding account does not seem to be sufficient to explain affective S-R compatibility effects. Instead, several studies provide clear evidence in favor of the motivational orientation account that seems to operate independently of evaluative coding mechanisms. Implications for theoretical developments and future research designs are discussed.

  12. Using a distribution and conservation status weighted hotspot approach to identify areas in need of conservation action to benefit Idaho bird species

    Science.gov (United States)

    Haines, Aaron M.; Leu, Matthias; Svancara, Leona K.; Wilson, Gina; Scott, J. Michael

    2010-01-01

    Identification of biodiversity hotspots (hereafter, hotspots) has become a common strategy to delineate important areas for wildlife conservation. However, the use of hotspots has not often incorporated important habitat types, ecosystem services, anthropogenic activity, or consistency in identifying important conservation areas. The purpose of this study was to identify hotspots to improve avian conservation efforts for Species of Greatest Conservation Need (SGCN) in the state of Idaho, United States. We evaluated multiple approaches to define hotspots and used a unique approach based on weighting species by their distribution size and conservation status to identify hotspot areas. All hotspot approaches identified bodies of water (Bear Lake, Grays Lake, and American Falls Reservoir) as important hotspots for Idaho avian SGCN, but we found that the weighted approach produced more congruent hotspot areas when compared to other hotspot approaches. To incorporate anthropogenic activity into hotspot analysis, we grouped species based on their sensitivity to specific human threats (i.e., urban development, agriculture, fire suppression, grazing, roads, and logging) and identified ecological sections within Idaho that may require specific conservation actions to address these human threats using the weighted approach. The Snake River Basalts and Overthrust Mountains ecological sections were important areas for potential implementation of conservation actions to conserve biodiversity. Our approach to identifying hotspots may be useful as part of a larger conservation strategy to aid land managers or local governments in applying conservation actions on the ground.

  13. User-driven health care: answering multidimensional information needs in individual patients utilizing post-EBM approaches: an operational model.

    Science.gov (United States)

    Biswas, Rakesh; Maniam, Jayanthy; Lee, Edwin Wen Huo; Gopal, Premalatha; Umakanth, Shashikiran; Dahiya, Sumit; Ahmed, Sayeed

    2008-10-01

    The hypothesis in the conceptual model was that a user-driven innovation in presently available information and communication technology infrastructure would be able to meet patient and health professional users information needs and help them attain better health outcomes. An operational model was created to plan a trial on a sample diabetic population utilizing a randomized control trial design, assigning one randomly selected group of diabetics to receive electronic information intervention and analyse if it would improve their health outcomes in comparison with a matched diabetic population who would only receive regular medical intervention. Diabetes was chosen for this particular trial, as it is a major chronic illness in Malaysia as elsewhere in the world. It is in essence a position paper for how the study concept should be organized to stimulate wider discussion prior to beginning the study.

  14. Approach to a case of multiple irregular red cell antibodies in a liver transplant recipient: Need for developing competence.

    Science.gov (United States)

    Dara, Ravi C; Tiwari, Aseem K; Pandey, Prashant; Arora, Dinesh

    2015-01-01

    Liver transplant procedure acts as a challenge for transfusion services in terms of specialized blood components, serologic problems, and immunologic effects of transfusion. Red cell alloimmunization in patients awaiting a liver transplant complicate the process by undue delay or unavailability of compatible red blood cell units. Compatible blood units can be provided by well-equipped immunohematology laboratory, which has expertise in resolving these serological problems. This report illustrates resolution of a case with multiple alloantibodies using standard techniques, particularly rare antisera. Our case re-emphasizes the need for universal antibody screening in all patients as part of pretransfusion testing, which helps to identify atypical antibodies and plan for appropriate transfusion support well in time. We recommend that the centers, especially the ones that perform complex procedures like solid organ transplants and hematological transplants should have the necessary immunohematological reagents including rare antisera to resolve complex cases of multiple antibodies as illustrated in this case.

  15. Approach to a case of multiple irregular red cell antibodies in a liver transplant recipient: Need for developing competence

    Directory of Open Access Journals (Sweden)

    Ravi C Dara

    2015-01-01

    Full Text Available Liver transplant procedure acts as a challenge for transfusion services in terms of specialized blood components, serologic problems, and immunologic effects of transfusion. Red cell alloimmunization in patients awaiting a liver transplant complicate the process by undue delay or unavailability of compatible red blood cell units. Compatible blood units can be provided by well-equipped immunohematology laboratory, which has expertise in resolving these serological problems. This report illustrates resolution of a case with multiple alloantibodies using standard techniques, particularly rare antisera. Our case re-emphasizes the need for universal antibody screening in all patients as part of pretransfusion testing, which helps to identify atypical antibodies and plan for appropriate transfusion support well in time. We recommend that the centers, especially the ones that perform complex procedures like solid organ transplants and hematological transplants should have the necessary immunohematological reagents including rare antisera to resolve complex cases of multiple antibodies as illustrated in this case.

  16. Air pollution and detrimental effects on children's brain. The need for a multidisciplinary approach to the issue complexity and challenges.

    Science.gov (United States)

    Calderón-Garcidueñas, Lilian; Torres-Jardón, Ricardo; Kulesza, Randy J; Park, Su-Bin; D'Angiulli, Amedeo

    2014-01-01

    Millions of children in polluted cities are showing brain detrimental effects. Urban children exhibit brain structural and volumetric abnormalities, systemic inflammation, olfactory, auditory, vestibular and cognitive deficits v low-pollution controls. Neuroinflammation and blood-brain-barrier (BBB) breakdown target the olfactory bulb, prefrontal cortex and brainstem, but are diffusely present throughout the brain. Urban adolescent Apolipoprotein E4 carriers significantly accelerate Alzheimer pathology. Neurocognitive effects of air pollution are substantial, apparent across all populations, and potentially clinically relevant as early evidence of evolving neurodegenerative changes. The diffuse nature of the neuroinflammation and neurodegeneration forces to employ a weight of evidence approach incorporating current clinical, cognitive, neurophysiological, radiological and epidemiological research. Pediatric air pollution research requires extensive multidisciplinary collaborations to accomplish a critical goal: to protect exposed children through multidimensional interventions having both broad impact and reach. Protecting children and teens from neural effects of air pollution should be of pressing importance for public health.

  17. Terrestrial liming to promote Atlantic Salmon recovery in Nova Scotia - approaches needed and knowledge gained after a trial application

    Science.gov (United States)

    Sterling, S. M.; Angelidis, C.; Armstrong, M.; Biagi, K. M.; Clair, T. A.; Jackson, N.; Breen, A.

    2014-09-01

    Populations of Atlantic salmon (Salmo salar) in Southwest Nova Scotia (SWNS) have plummeted since the 1980s. Acidification is considered a main threat to this population. The lakes and streams of SWNS were among the most heavily acidified in North America during the last century and calcium levels are predicted to continue to fall in coming decades. One of the most promising mitigation options to reduce the risk of extirpation of the SWNS Salmo salar is terrestrial liming; however, both the chemistry of SWNS rivers, and effective strategies for terrestrial liming in SWNS are poorly understood. Here we have launched the first terrestrial liming study in Nova Scotia, employing a test hydrologic source area liming strategy in a 5 ha experimental catchment in SWNS, Maria Brook; we apply an average local application rate of 13 t ha-1 to 10% of the 47 ha catchment. We employ high frequency stream monitoring to complement grab sampling to identify which constituents pose a threat to Salmo salar and to identify strategies for larger scale terrestrial liming that would fit the local conditions. Results indicate that the water chemistry conditions are currently at toxic levels for Salmo salar throughout the year, with levels of ionic aluminium exceeding toxic thresholds almost 100% of the time. The stream chemistry in Maria Brook is remarkably similar to pre-recovery conditions in other heavily acidified watersheds, such as Birkenes in Norway. Our results support the hypothesis that there has been no recovery from acidification in SWNS. Results from the first year of post-liming do not show an improvement in stream chemistry levels, and further lime application is needed to improve the water chemistry conditions to needed levels for the recovery of Salmo salar.

  18. Anthropogenic pollutants affect ecosystem services of freshwater sediments. The need for a 'triad plus x' approach

    Energy Technology Data Exchange (ETDEWEB)

    Gerbersdorf, Sabine Ulrike; Wieprecht, Silke [Stuttgart Univ. (Germany). Dept. of Hydraulic Engineering and Water Resources Management; Hollert, Henner; Brinkmann, Markus [RWTH Aachen Univ. (Germany). Dept. of Ecosystem Analysis; Schuettrumpf, Holger [RWTH Aachen Univ. (Germany). Inst. of Hydraulic Engineering and Water Resources Management; Manz, Werner [Koblenz-Landau Univ., Koblenz (Germany). Inst. for Integrated Natural Sciences

    2011-09-15

    Purpose: Freshwater sediments and their attached microbial communities (biofilms) are essential features of rivers and lakes, providing valuable ecosystem services such as nutrient recycling or self-purification which extend beyond the aquatic environment. Anthropogenic pollutants, whether from the industrial era or as a result of our contemporary lifestyles, can negatively affect these functions with hitherto unknown consequences on ecology, the economy and human health. Thus far, the singular view of the involved disciplines such as ecotoxicology, environmental microbiology, hydrology and geomorphology has prevented a deeper understanding of this emerging issue. Main features: This paper discusses briefly the progressions and the state-of-the-art methods within the disciplines of concern related to contaminated sediments, ranging from ecotoxicological test systems, microbiological/molecular approaches to unravel changes of microbial ecosystems, up to the modelling of sediment transport and sorption/desorption of associated pollutants. The first bilateral research efforts on contaminated sediments include efforts to assess ecotoxicological sediment risk including sediment mobility (i.e. ecotoxicology and engineering), enhance bioremediation potential (i.e. microbiology and ecotoxicology) or to understand biostabilisation processes of sediments by microbial assemblages (i.e. microbiology and engineering). Conclusions and perspectives: In freshwater habitats, acute, chronic and mechanism-specific toxic effects on organisms, shifts in composition, structure and functionality of benthic microbial communities, as well as the obstruction of important ecosystem services by continuously discharged and long-deposited pollutants, should be related to the in situ sediment dynamics. To achieve an improved understanding of the ecology of freshwater sediments and the impairment of their important ecosystem functions by human-derived pollutants, we suggest a 'triad plus x

  19. Information Needs of Textile Industry: Methodological Approach Tekstil Endüstrisinin Enformasyon Gereksinimleri: Metodolojik Yaklaşım

    Directory of Open Access Journals (Sweden)

    Oya Gürdal

    1998-03-01

    Full Text Available Up till now various user studies were made to show the information needs and the information use habits of the industrial firms. With the same objective, a user survey is realized in the Turkish textile industry. The research that has been done in Turkey and other world countries show that users does not know the presence of information sources and I or channels and the information needed is retrieved randomely or with difficulty. However, there is a very important relationship between the comprehension of the importance of information for the fulfilment of industrial activities and establishment and use of information sources / channels and/or information centers. Endüstriyel işletmelerin enformasyon gereksinimlerini ve bu kesimin bilgi merkezlerini kullanma alışkanlıklarını belirlemek üzere çeşitli "kullanıcı incelemeleri" (survey çalışmaları yapılmaktadır. Bu çalışmada da aynı amaçla, Türk tekstil sektörü baz alınarak endüstriyel survey araştırması gerçekleştirilmiştir. Dünyada ve bizde yapılan çalışmalar göstermektedir ki mevcut olan enformasyon kaynakları ve / veya kanallarının varlığı kullanıcılar tarafından bilinmemekte, bu nedenle de gereksinilen enformasyona güçlükle ya da rastlantısal biçimde erişilmektedir. Bununla birlikte endüstriyel aktiviteler için enformasyonun öneminin kavranması ile enformasyon kaynakları/kanalları ve / veya bilgi merkezlerinin oluşumu ve kullanımı arasında önemli bir bağ bulunmaktadır.

  20. Using a digital story format: a contemporary approach to meeting the workforce needs of public health laboratories.

    Science.gov (United States)

    Walkner, Laurie; Fife, Dena; Bedet, Jennifer; DeMartino, Mary

    2014-01-01

    Public health laboratories are an integral partner in preparedness and emergency response. The Upper Midwest Preparedness and Emergency Response Learning Center (UMPERLC) and the State Hygienic Laboratory at the University of Iowa have a long history of working together to identify and meet the preparedness training needs of the laboratory workforce. The training, Anatomy of a Foodborne Outbreak, which uses a digital story format, provides an example of this partnership. The State Hygienic Laboratory expressed the need for training programs targeted at enhancing early detection and investigation of outbreaks. Clinical laboratory staff play a significant role in identifying patient samples that may represent the effects of foodborne illness. Given that foodborne illnesses are on the increase nationally, it is critical that laboratory staff be prepared to deal with these outbreaks. UMPERLC collaborated with State Hygienic Laboratory content experts in the design and development of a digital story, using a foodborne outbreak that focuses on testing to detect Shiga toxin-producing Escherichia coli. This narrative format was selected because seeing and hearing a story about the training content provide the learner with a deeper interaction and richer learning experience, allowing the learner to better see the bigger picture. Anatomy of a Foodborne Outbreak is available on UMPERLC's Learning Management System, Training Source (http://training-source.org). Evaluation data indicate positive learning experiences overall. The digital story format, which is a video that uses a blend of images, text, and audio narration, was an appropriate method for the content and learning outcomes of the Anatomy of a Foodborne Outbreak training. This format requires more active learning, which increases retention and transfer of knowledge. Training that is easily accessed and user-friendly is an important resource for laboratory staff. When reviewing the course completion data, the highest

  1. Moving from theory to practice: A participatory social network mapping approach to address unmet need for family planning in Benin.

    Science.gov (United States)

    Igras, Susan; Diakité, Mariam; Lundgren, Rebecka

    2017-07-01

    In West Africa, social factors influence whether couples with unmet need for family planning act on birth-spacing desires. Tékponon Jikuagou is testing a social network-based intervention to reduce social barriers by diffusing new ideas. Individuals and groups judged socially influential by their communities provide entrée to networks. A participatory social network mapping methodology was designed to identify these diffusion actors. Analysis of monitoring data, in-depth interviews, and evaluation reports assessed the methodology's acceptability to communities and staff and whether it produced valid, reliable data to identify influential individuals and groups who diffuse new ideas through their networks. Results indicated the methodology's acceptability. Communities were actively and equitably engaged. Staff appreciated its ability to yield timely, actionable information. The mapping methodology also provided valid and reliable information by enabling communities to identify highly connected and influential network actors. Consistent with social network theory, this methodology resulted in the selection of informal groups and individuals in both informal and formal positions. In-depth interview data suggest these actors were diffusing new ideas, further confirming their influence/connectivity. The participatory methodology generated insider knowledge of who has social influence, challenging commonly held assumptions. Collecting and displaying information fostered staff and community learning, laying groundwork for social change.

  2. Meeting physicians' needs: a bottom-up approach for improving the implementation of medical knowledge into practice.

    Science.gov (United States)

    Vaucher, Carla; Bovet, Emilie; Bengough, Theresa; Pidoux, Vincent; Grossen, Michèle; Panese, Francesco; Burnand, Bernard

    2016-07-18

    Multiple barriers to knowledge translation in medicine have been identified (ranging from information overload to abstraction of models), leading to important implementation gaps. This study aimed at assessing the suggestions of practicing physicians for possible improvements of knowledge translation (KT) effectiveness into clinical practice. We used a mixed methods design. French- German- and Italian-speaking general practitioners, psychiatrists, orthopaedic surgeons, cardiologists, and diabetologists practicing in Switzerland were interrogated through semi-structured interviews, focus group discussions, and an online survey. A total of 985 physicians from three regions of Switzerland participated in the online survey, whereas 39 participated in focus group discussions and 14 in face-to-face interviews. Physicians expressed limitations and difficulties related to KT into their daily practice. Several barriers were identified, including influence and pressure of pharmaceutical companies, non-publication of negative results, mismatch between guidelines and practice, education gaps, and insufficient collaboration between research and practice. Suggestions to overcome barriers were improving education concerning the evaluation of scientific publications, expanding applicability of guidelines, having free and easy access to independent journals, developing collaborations between research and practice, and creating tools to facilitate access to medical information. Our study provides suggestions for improving KT into daily medical practice, matching the views, needs and preferences of practicing physicians. Responding to suggestions for improvements brought up by physicians may lead to better knowledge translation, higher professional satisfaction, and better healthcare outcomes.

  3. An outcome-based approach for the creation of fetal growth standards: do singletons and twins need separate standards?

    Science.gov (United States)

    Joseph, K S; Fahey, John; Platt, Robert W; Liston, Robert M; Lee, Shoo K; Sauve, Reg; Liu, Shiliang; Allen, Alexander C; Kramer, Michael S

    2009-03-01

    Contemporary fetal growth standards are created by using theoretical properties (percentiles) of birth weight (for gestational age) distributions. The authors used a clinically relevant, outcome-based methodology to determine if separate fetal growth standards are required for singletons and twins. All singleton and twin livebirths between 36 and 42 weeks' gestation in the United States (1995-2002) were included, after exclusions for missing information and other factors (n = 17,811,922). A birth weight range was identified, at each gestational age, over which serious neonatal morbidity and neonatal mortality rates were lowest. Among singleton males at 40 weeks, serious neonatal morbidity/mortality rates were lowest between 3,012 g (95% confidence interval (CI): 3,008, 3,018) and 3,978 g (95% CI: 3,976, 3,980). The low end of this optimal birth weight range for females was 37 g (95% CI: 21, 53) less. The low optimal birth weight was 152 g (95% CI: 121, 183) less for twins compared with singletons. No differences were observed in low optimal birth weight by period (1999-2002 vs. 1995-1998), but small differences were observed for maternal education, race, parity, age, and smoking status. Patterns of birth weight-specific serious neonatal morbidity/neonatal mortality support the need for plurality-specific fetal growth standards.

  4. Understanding the contamination of food with mineral oil: the need for a confirmatory analytical and procedural approach.

    Science.gov (United States)

    Spack, Lionel W; Leszczyk, Gabriela; Varela, Jesus; Simian, Hervé; Gude, Thomas; Stadler, Richard H

    2017-06-01

    The contamination of food by mineral oil hydrocarbons (MOHs) found in packaging is a long-running concern. A main source of MOHs in foods is the migration of mineral oil from recycled board into the packed food products. Consequently, the majority of food manufacturers have taken protective measures, e.g., by using virgin board instead of recycled fibres and, where feasible, introducing functional barriers to mitigate migration. Despite these protective measures, MOHs may still be observed in low amounts in certain food products, albeit due to different entry points across the food supply chain. In this study, we successfully apply gas chromatography coupled to mass spectrometry (GC-MS) to demonstrate, through marker compounds and the profile of the hydrocarbon response, the possible source of contamination using mainly chocolate and cereals as food matrices. The conventional liquid chromatography-one-dimensional GC coupled to a flame ionisation detector (LC-GC-FID) is a useful screening method, but in cases of positive samples it must be complemented by a confirmatory method such as, for example, GC-MS, allowing a verification of mineral oil contamination. The procedural approach proposed in this study entails profile analysis, marker identification, and interpretation and final quantification.

  5. Implementation of Safe-by-Design for Nanomaterial Development and Safe Innovation: Why We Need a Comprehensive Approach.

    Science.gov (United States)

    Kraegeloh, Annette; Suarez-Merino, Blanca; Sluijters, Teun; Micheletti, Christian

    2018-04-14

    Manufactured nanomaterials (MNMs) are regarded as key components of innovations in various fields with high potential impact (e.g., energy generation and storage, electronics, photonics, diagnostics, theranostics, or drug delivery agents). Widespread use of MNMs raises concerns about their safety for humans and the environment, possibly limiting the impact of the nanotechnology-based innovation. The development of safe MNMs and nanoproducts has to result in a safe as well as functional material or product. Its safe use, and disposal at the end of its life cycle must be taken into account too. However, not all MNMs are similarly useful for all applications, some might bear a higher hazard potential than others, and use scenarios could lead to different exposure probabilities. To improve both safety and efficacy of nanotechnology, we think that a new proactive approach is necessary, based on pre-regulatory safety assessment and dialogue between stakeholders. On the basis of the work carried out in different European Union (EU) initiatives, developing and integrating MNMs Safe-by-Design and Trusted Environments (NANoREG, ProSafe, and NanoReg2), we present our point of view here. This concept, when fully developed, will allow for cost effective industrial innovation, and an exchange of key information between regulators and innovators. Regulators are thus informed about incoming innovations in good time, supporting a proactive regulatory action. The final goal is to contribute to the nanotechnology governance, having faster, cheaper, effective, and safer nano-products on the market.

  6. Controlling Eutrophication in A Mediterranean Shallow Reservoir by Phosphorus Loading Reduction: The Need for an Integrated Management Approach

    Science.gov (United States)

    Zaragüeta, Mikel; Acebes, Pablo

    2017-04-01

    Increased nutrient enrichment in Mediterranean standing waters has enhanced the risk of being affected by cyanobacterial blooms. Because phosphorus abatement is shaped as a crucial strategy for controlling eutrophication, this study introduces a structural thinking, experiential learning laboratory with animation dynamic model elaborated for Cazalegas Reservoir (Spain) to assess the feasibility of implementing a set of internal and external control measures and hydromorphological adjustments to meet the goal of oligotrophication. This shallow reservoir is another case where recurrent eutrophication has led to reach annual mean total phosphorus concentrations (0.16 ± 0.08 mg total phosphorus/L) over the threshold of current water policies, triggering cyanobacterial growth up to undesirable levels in summer time (approximately 50,000 cells/mL). Modeling results showed that (i) after upgrading water treatment in the main tributary, (ii) applying a lanthanum-modified bentonite into the water column and sediment, and (iii) increasing reservoir water level, in-lake P concentrations and cyanobacterial abundance decreased in an 88% (below 0.01 mg total phosphorus/L) and 84% (below 6000 cells/mL), respectively in the most critical periods. However, the constraints of the proposed management strategies are associated with their costs of implementation and the time span for a stable trophic recovery of the reservoir. In that end, integrated management approaches are aimed to be adopted by water managers to reach adequate ecological status of freshwater bodies.

  7. The assessment of math learning difficulties in a primary grade-4 child with high support needs: Mixed methods approach

    Directory of Open Access Journals (Sweden)

    Lawrence Mundia

    2012-03-01

    Full Text Available This mixed-methods study incorporated elements of survey, case study and action research approaches in investigating an at-risk child. Using an in-take interview, a diagnostic test, an error analysis, and a think-aloud clinical interview, the study identified the child’s major presenting difficulties. These included: inability to use the four arithmetic operations (addition, subtraction, multiplication, division efficiently; not understanding the relationship between units, tens and hundreds; using any two of the four arithmetic processes (+, - , x, ÷ in combination within one operation; treating each column as a separate problem; place value problems / wrong alignment of numbers; poor eye-hand coordination leading to dysgraphia; and memory lapses. The other problems that became apparent through this investigation and implied in the findings include possible causal factors such as dyscalculia, dyslexia, low self-esteem, low self-efficacy, and math anxiety. Further assessment, intervention and research are recommended to address problems of this vulnerable child.

  8. A transnational and holistic breeding approach is needed for sustainable wheat production in the Baltic Sea region.

    Science.gov (United States)

    Chawade, Aakash; Armoniené, Rita; Berg, Gunilla; Brazauskas, Gintaras; Frostgård, Gunilla; Geleta, Mulatu; Gorash, Andrii; Henriksson, Tina; Himanen, Kristiina; Ingver, Anne; Johansson, Eva; Jørgensen, Lise Nistrup; Koppel, Mati; Koppel, Reine; Makela, Pirjo; Ortiz, Rodomiro; Podyma, Wieslaw; Roitsch, Thomas; Ronis, Antanas; Svensson, Jan T; Vallenback, Pernilla; Weih, Martin

    2018-03-14

    The Baltic Sea is one of the largest brackish water bodies in the world. Eutrophication is a major concern in the Baltic Sea due to the leakage of nutrients to the sea with agriculture being the primary source. Wheat (Triticum aestivum L.) is the most widely grown crop in the countries surrounding the Baltic Sea and thus promoting sustainable agriculture practices for wheat cultivation will have a major impact on reducing pollution in the Baltic Sea. This approach requires identifying and addressing key challenges for sustainable wheat production in the region. Implementing new technologies for climate-friendly breeding and digital farming across all surrounding countries should promote sustainable intensification of agriculture in the region. In this review, we highlight major challenges for wheat cultivation in the Baltic Sea region and discuss various solutions integrating transnational collaboration for pre-breeding and technology sharing to accelerate development of low input wheat cultivars with improved host plant resistance to pathogen and enhanced adaptability to the changing climate. © 2018 The Authors. Physiologia Plantarum published by John Wiley & Sons Ltd on behalf of Scandinavian Plant Physiology Society.

  9. The Assessment of Math Learning Difficulties in a Primary Grade-4 Child with High Support Needs: Mixed Methods Approach

    Directory of Open Access Journals (Sweden)

    Lawrence Mundia

    2012-03-01

    Full Text Available This mixed-methods study incorporated elements of survey, case study and action research approaches in investigating an at-risk child. Using an in-take interview, a diagnostic test, an error analysis, and a think-aloud clinical interview, the study identified the child’s major presenting difficulties. These included: inability to use the four arithmetic operations (addition, subtraction, multiplication, division efficiently; not understanding the relationship between units, tens and hundreds; using any two of the four arithmetic processes (+, - , x, ÷ in combination within one operation; treating each column as a separate problem; place value problems / wrong alignment of numbers; poor eye-hand coordination leading to dysgraphia; and memory lapses. The other problems that became apparent through this investigation and implied in the findings include possible causal factors such as dyscalculia, dyslexia, low self-esteem, low self-efficacy, and math anxiety. Further assessment, intervention and research are recommended to address problems of this vulnerable child.

  10. Timing of Surgery for Spinal Fractures Associated with Systemic Trauma: A Need for a Strategic and Systemic Approach.

    Science.gov (United States)

    Koksal, Ismet; Alagoz, Fatih; Celik, Haydar; Yildirim, Ali Erdem; Akin, Tezcan; Guvenc, Yahya; Karatay, Mete; Erdem, Yavuz

    An underestimated evaluation of systemic organs in cases with spinal fractures might jeopardize the intervention for treatment and future complications with an increased morbidity and mortality are almost warranted. In the present study, a retrospective analysis of spinal fracture cases associated with systemic trauma was performed to assess surgical success. A retrospective analysis of patients with thoracolumbar fractures who were admitted to the emergency unit between September 2012 and September 2014 was used for the study. The cases were categorized according to age, sex, reason of trauma, associated trauma, neurological condition and treatment details and results were analysed using SPSS 14.0 for Windows. The most common reason of trauma is detected as falls in 101 cases (64.3%). Radiological evaluation of spinal fractures revealed a compression fracture in 106 cases (67.5%) and other fractures in 51 cases (32.5%). Surgical treatment for spinal fracture was performed in 60.5% of the cases and conservative approach was preferred in 39.5% cases. In non-compressive spinal fractures, an associated pathology like head trauma, lower extremity fracture or neurological deficit was found to be higher in incidence (p systemic condition which might be associated with decreased morbidity and mortality.

  11. Modeling the determinants of Medicaid home care payments for children with special health care needs: A structural equation model approach.

    Science.gov (United States)

    Adepoju, Omolola E; Zhang, Yichen; Phillips, Charles D

    2014-10-01

    The management of children with special needs can be very challenging and expensive. To examine direct and indirect cost drivers of home care expenditures for this vulnerable and expensive population. We retrospectively assessed secondary data on children, ages 4-20, receiving Medicaid Personal Care Services (PCS) (n = 2760). A structural equation model assessed direct and indirect effects of several child characteristics, clinical conditions and functional measures on Medicaid home care payments. The mean age of children was 12.1 years and approximately 60% were female. Almost half of all subjects reported mild, moderate or severe ID diagnosis. The mean ADL score was 5.27 and about 60% of subjects received some type of rehabilitation services. Caseworkers authorized an average of 25.5 h of PCS support per week. The SEM revealed three groups of costs drivers: indirect, direct and direct + indirect. Cognitive problems, health impairments, and age affect expenditures, but they operate completely through other variables. Other elements accumulate effects (externalizing behaviors, PCS hours, and rehabilitation) and send them on a single path to the dependent variable. A few elements exhibit a relatively complex position in the model by having both significant direct and indirect effects on home care expenditures - medical conditions, intellectual disability, region, and ADL function. The most important drivers of home care expenditures are variables that have both meaningful direct and indirect effects. The only one of these factors that may be within the sphere of policy change is the difference among costs in different regions. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Dabigatran – a case history demonstrating the need for comprehensive approaches to optimize the use of new drugs

    Science.gov (United States)

    Malmström, Rickard E.; Godman, Brian B.; Diogene, Eduard; Baumgärtel, Christoph; Bennie, Marion; Bishop, Iain; Brzezinska, Anna; Bucsics, Anna; Campbell, Stephen; Ferrario, Alessandra; Finlayson, Alexander E.; Fürst, Jurij; Garuoliene, Kristina; Gomes, Miguel; Gutiérrez-Ibarluzea, Iñaki; Haycox, Alan; Hviding, Krystyna; Herholz, Harald; Hoffmann, Mikael; Jan, Saira; Jones, Jan; Joppi, Roberta; Kalaba, Marija; Kvalheim, Christina; Laius, Ott; Langner, Irene; Lonsdale, Julie; Lööv, Sven-Äke; Malinowska, Kamila; McCullagh, Laura; Paterson, Ken; Markovic-Pekovic, Vanda; Martin, Andrew; Piessnegger, Jutta; Selke, Gisbert; Sermet, Catherine; Simoens, Steven; Tulunay, Cankat; Tomek, Dominik; Vončina, Luka; Vlahovic-Palcevski, Vera; Wale, Janet; Wilcock, Michael; Wladysiuk, Magdalena; van Woerkom, Menno; Zara, Corrine; Gustafsson, Lars L.

    2013-01-01

    Background: There are potential conflicts between authorities and companies to fund new premium priced drugs especially where there are safety and/or budget concerns. Dabigatran, a new oral anticoagulant for the prevention of stroke in patients with non-valvular atrial fibrillation (AF), exemplifies this issue. Whilst new effective treatments are needed, there are issues in the elderly with dabigatran due to variable drug concentrations, no known antidote and dependence on renal elimination. Published studies have shown dabigatran to be cost-effective but there are budget concerns given the prevalence of AF. There are also issues with potentially re-designing anticoagulant services. This has resulted in activities across countries to better manage its use. Objective: To (i) review authority activities in over 30 countries and regions, (ii) use the findings to develop new models to better manage the entry of new drugs, and (iii) review the implications for all major stakeholder groups. Methodology: Descriptive review and appraisal of activities regarding dabigatran and the development of guidance for groups through an iterative process. Results: There has been a plethora of activities among authorities to manage the prescribing of dabigatran including extensive pre-launch activities, risk sharing arrangements, prescribing restrictions, and monitoring of prescribing post-launch. Reimbursement has been denied in some countries due to concerns with its budget impact and/or excessive bleeding. Development of a new model and future guidance is proposed to better manage the entry of new drugs, centering on three pillars of pre-, peri-, and post-launch activities. Conclusion: Models for introducing new drugs are essential to optimize their prescribing especially where there are concerns. Without such models, new drugs may be withdrawn prematurely and/or struggle for funding. PMID:23717279

  13. Dabigatran - a case history demonstrating the need for comprehensive approaches to optimise the use of new drugs

    Directory of Open Access Journals (Sweden)

    Rickard eMalmstrom

    2013-05-01

    Full Text Available Background: There are potential conflicts between authorities and companies to fund new premium priced drugs especially where there are safety and/ or budget concerns. Dabigatran, a new oral anticoagulant for the prevention of stroke in patients with non-valvular AF, exemplifies this issue. Whilst new effective treatments are needed, there are issues in the elderly with dabigatran due to variable drug concentrations, no known antidote and dependence on renal elimination. Published studies have shown dabigatran to be cost-effective but there are budget concerns given the prevalence of atrial fibrillation. There are also issues with potentially re-designing anticoagulant services. This has resulted in activities across countries to better manage its use. Objective: To (i review authority activities in over 30 countries and regions, (ii use the findings to develop new models to better manage the entry of new drugs , and (iii review the implications for all major stakeholder groups. Methodology: Descriptive review and appraisal of activities regarding dabigatran and the development of guidance for groups through an iterative process. Results: There has been a plethora of activities to manage dabigatran including extensive pre-launch activities, risk sharing arrangements, prescribing restrictions and monitoring of prescribing post launch. Reimbursement has been denied in some countries due to concerns with its budget impact and/or excessive bleeding. Development of a new model and future guidance is proposed to better manage the entry of new drugs, centring on three pillars of pre-, peri- and post-launch activities. Conclusion: Models for introducing new drugs are essential to optimise their prescribing especially where there are concerns. Without such models, new drugs may be withdrawn prematurely and/ or struggle for funding.

  14. Developing effective educational approaches for Liaison Old Age Psychiatry teams: a literature review of the learning needs of hospital staff in relation to managing the confused older patient.

    Science.gov (United States)

    Teodorczuk, Andrew; Welfare, Mark; Corbett, Sally; Mukaetova-Ladinska, Elizabeta

    2010-09-01

    Deficiencies in the knowledge, skills and attitudes of all healthcare professionals working within the general hospital contribute towards the suboptimal care of older hospitalized patients with confusion. In the U.K., policy dictates that Liaison Old Age Psychiatry teams deliver effective education to general hospital clinical staff. The purpose of this paper is to review the literature concerning the learning needs of healthcare professionals in relation to managing confusion in the older patient in order to inform effective educational approaches for Liaison Old Age Psychiatry teams. A broad range of medical and educational databases were searched. Identified English language studies were selected for further analysis if they had a specific educational focus in the hospital setting and then further subdivided into intervention and naturalistic studies. The impact of intervention studies was evaluated by Kirkpatrick's system. Learning needs, as determined from the naturalistic studies, were mapped to identify themes. 13 intervention studies were identified. Despite a high level of effectiveness for educational interventions, it was unclear what the active components were. A further 23 naturalistic studies were identified; their findings focused on knowledge gaps, diagnostic behaviors and experiences, attitudes and training issues. Few studies specifically researched learning needs or the educational role of liaison teams. Conspicuous by its absence was reference to relevant educational theories. The findings of this review can be incorporated in the planning of local curricula by Liaison Teams in order to design educational strategies. There is a need for further research, especially studies exploring the learning needs of all healthcare professionals.

  15. Technical Approach for Determining Key Parameters Needed for Modeling the Performance of Cast Stone for the Integrated Disposal Facility Performance Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Yabusaki, Steven B. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Serne, R. Jeffrey [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rockhold, Mark L. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Wang, Guohui [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Westsik, Joseph H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-03-30

    Washington River Protection Solutions (WRPS) and its contractors at Pacific Northwest National Laboratory (PNNL) and Savannah River National Laboratory (SRNL) are conducting a development program to develop / refine the cementitious waste form for the wastes treated at the ETF and to provide the data needed to support the IDF PA. This technical approach document is intended to provide guidance to the cementitious waste form development program with respect to the waste form characterization and testing information needed to support the IDF PA. At the time of the preparation of this technical approach document, the IDF PA effort is just getting started and the approach to analyze the performance of the cementitious waste form has not been determined. Therefore, this document looks at a number of different approaches for evaluating the waste form performance and describes the testing needed to provide data for each approach. Though the approach addresses a cementitious secondary aqueous waste form, it is applicable to other waste forms such as Cast Stone for supplemental immobilization of Hanford LAW. The performance of Cast Stone as a physical and chemical barrier to the release of contaminants of concern (COCs) from solidification of Hanford liquid low activity waste (LAW) and secondary wastes processed through the Effluent Treatment Facility (ETF) is of critical importance to the Hanford Integrated Disposal Facility (IDF) total system performance assessment (TSPA). The effectiveness of cementitious waste forms as a barrier to COC release is expected to evolve with time. PA modeling must therefore anticipate and address processes, properties, and conditions that alter the physical and chemical controls on COC transport in the cementitious waste forms over time. Most organizations responsible for disposal facility operation and their regulators support an iterative hierarchical safety/performance assessment approach with a general philosophy that modeling provides

  16. Enhancing participatory approach in water resources management: development of a survey to evaluate stakeholders needs and priorities related to software capabilities

    Science.gov (United States)

    Foglia, L.; Rossetto, R.; Borsi, I.; Josef, S.; Boukalova, Z.; Triana, F.; Ghetta, M.; Sabbatini, T.; Bonari, E.; Cannata, M.; De Filippis, G.

    2016-12-01

    The EU H2020 FREEWAT project (FREE and open source software tools for WATer resource management) aims at simplifying the application of EU-water related Directives, by developing an open source and public domain, GIS-integrated platform for planning and management of ground- and surface-water resources. The FREEWAT platform is conceived as a canvas, where several distributed and physically-based simulation codes are virtually integrated. The choice of such codes was supported by the result of a survey performed by means of questionnaires distributed to 14 case study FREEWAT project partners and several stakeholders. This was performed in the first phase of the project within the WP 6 (Enhanced science and participatory approach evidence-based decision making), Task 6.1 (Definition of a "needs/tools" evaluation grid). About 30% among all the invited entities and institutions from several EU and non-EU Countries expressed their interest in contributing to the survey. Most of them were research institutions, government and geoenvironmental companies and river basin authorities.The result of the questionnaire provided a spectrum of needs and priorities of partners/stakeholders, which were addressed during the development phase of the FREEWAT platform. The main needs identified were related to ground- and surface-water quality, sustainable water management, interaction between groundwater/surface-water bodies, and design and management of Managed Aquifer Recharge schemes. Needs and priorities were then connected to the specific EU Directives and Regulations to be addressed.One of the main goals of the questionnaires was to collect information and suggestions regarding the use of existing commercial/open-source software tools to address needs and priorities, and regarding the needs to address specific water-related processes/problems.

  17. Accountable priority setting for trust in health systems--the need for research into a new approach for strengthening sustainable health action in developing countries

    DEFF Research Database (Denmark)

    Byskov, Jens; Bloch, Paul; Blystad, Astrid

    2009-01-01

    Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived...... from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability...... and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed.Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must...

  18. IAS 12 needs methodical approach

    NARCIS (Netherlands)

    Hafkenscheid, R.P.F.M.; Janssen, C.M.L.

    2009-01-01

    The article describes a methodology used to establish the expected value of uncertain tax positions. The Project Update on Income Taxes released by the International Accounting Standards Board (IASB) in September 2008 aims to reduce the differences between IAS 12 Income Taxes and the SFAS 109

  19. A mixed-methods approach to conducting Internal Revenue Service-compliant community health needs assessments: a case example for nonprofit hospital leaders

    Directory of Open Access Journals (Sweden)

    Oglesby WH

    2014-10-01

    Full Text Available Willie H Oglesby, Ken Slenkovich Department of Health Policy and Management, College of Public Health, Kent State University, Kent, OH, USA Background: The Patient Protection and Affordable Care Act created new requirements for nonprofit hospitals to conduct a Community Health Needs Assessment (CHNA at least once every 3 years, with a significant tax penalty for noncompliance. While some resources exist to help nonprofit hospital leaders conduct various aspects of a CHNA, few reflect the new Internal Revenue Service requirements. Methods: Many different models of CHNAs have emerged over the years. Although each has its unique features, the essential elements of a CHNA include engaging stakeholders, defining the community, gathering sufficient representative data, prioritizing information, and reporting results. In this paper, we expand upon this basic approach by offering a practical step-by-step guide to conducting CHNAs that meets new Internal Revenue Service regulations. Results: We developed and tested this methodology in partnership with several nonprofit hospital systems in Northeast Ohio, USA. In this paper, we discuss our use of the methodology and identify recommendations for other nonprofit hospital leaders. Conclusion: The methodology presented in this paper is a cost-effective approach to satisfying new CHNA requirements and nonprofit hospital leaders should consider using it or modifying it to fit their unique needs. Keywords: Affordable Care Act, CHNA, community benefit, community hospital

  20. Are Current Physical Match Performance Metrics in Elite Soccer Fit for Purpose or is the Adoption of an Integrated Approach Needed?

    Science.gov (United States)

    Bradley, Paul S; Ade, Jack D

    2018-01-18

    Time-motion analysis is a valuable data-collection technique used to quantify the physical match performance of elite soccer players. For over 40 years researchers have adopted a 'traditional' approach when evaluating match demands by simply reporting the distance covered or time spent along a motion continuum of walking through to sprinting. This methodology quantifies physical metrics in isolation without integrating other factors and this ultimately leads to a one-dimensional insight into match performance. Thus, this commentary proposes a novel 'integrated' approach that focuses on a sensitive physical metric such as high-intensity running but contextualizes this in relation to key tactical activities for each position and collectively for the team. In the example presented, the 'integrated' model clearly unveils the unique high-intensity profile that exists due to distinct tactical roles, rather than one-dimensional 'blind' distances produced by 'traditional' models. Intuitively this innovative concept may aid the coaches understanding of the physical performance in relation to the tactical roles and instructions given to the players. Additionally, it will enable practitioners to more effectively translate match metrics into training and testing protocols. This innovative model may well aid advances in other team sports that incorporate similar intermittent movements with tactical purpose. Evidence of the merits and application of this new concept are needed before the scientific community accepts this model as it may well add complexity to an area that conceivably needs simplicity.

  1. Endoscopic "step-up approach" using a dedicated biflanged metal stent reduces the need for direct necrosectomy in walled-off necrosis (with videos).

    Science.gov (United States)

    Lakhtakia, Sundeep; Basha, Jahangeer; Talukdar, Rupjyoti; Gupta, Rajesh; Nabi, Zaheer; Ramchandani, Mohan; Kumar, B V N; Pal, Partha; Kalpala, Rakesh; Reddy, P Manohar; Pradeep, R; Singh, Jagadish R; Rao, G V; Reddy, D Nageshwar

    2017-06-01

    EUS-guided drainage using plastic stents may be inadequate for treatment of walled-off necrosis (WON). Recent studies report variable outcomes even when using covered metal stents. The aim of this study was to evaluate the efficacy of a dedicated covered biflanged metal stent (BFMS) when adopting an endoscopic "step-up approach" for drainage of symptomatic WON. We retrospectively evaluated consecutive patients with symptomatic WON who underwent EUS-guided drainage using BFMSs over a 3-year period. Reassessment was done between 48 and 72 hours for resolution. Endoscopic reinterventions were tailored in nonresponders in a stepwise manner. Step 1 encompassed declogging the blocked lumen of the BFMS. In step 2, a nasocystic tube was placed via BFMSs with intermittent irrigation. Step 3 involved direct endoscopic necrosectomy (DEN). BFMSs were removed between 4 and 8 weeks of follow-up. The main outcome measures were technical success, clinical success, adverse events, and need for DEN. Two hundred five WON patients underwent EUS-guided drainage using BFMSs. Technical success was achieved in 203 patients (99%). Periprocedure adverse events occurred in 8 patients (bleeding in 6, perforation in 2). Clinical success with BFMSs alone was seen in 153 patients (74.6%). Reintervention adopting the step-up approach was required in 49 patients (23.9%). Incremental success was achieved in 10 patients with step 1, 16 patients with step 2, and 19 patients with step 3. Overall clinical success was achieved in 198 patients (96.5%), with DEN required in 9.2%. Four patients failed treatment and required surgery (2) or percutaneous drainage (2). The endoscopic step-up approach using BFMSs was safe, effective, and yielded successful outcomes in most patients, reducing the need for DEN. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  2. Public and patient involvement in needs assessment and social innovation: a people-centred approach to care and research for congenital disorders of glycosylation.

    Science.gov (United States)

    de Freitas, Cláudia; Dos Reis, Vanessa; Silva, Susana; Videira, Paula A; Morava, Eva; Jaeken, Jaak

    2017-09-26

    Public and patient involvement in the design of people-centred care and research is vital for communities whose needs are underserved, as are people with rare diseases. Innovations devised collectively by patients, caregivers, professionals and other members of the public can foster transformative change toward more responsive services and research. However, attempts to involve lay and professional stakeholders in devising community-framed strategies to address the unmet needs of rare diseases are lacking. In this study, we engaged with the community of Congenital Disorders of Glycosylation (CDG) to assess its needs and elicit social innovations to promote people-centred care and research. Drawing on a qualitative study, we conducted three think tanks in France with a total of 48 participants, including patients/family members (n = 18), health care professionals (n = 7), researchers (n = 7) and people combining several of these roles (n = 16). Participants came from 20 countries across five continents. They were selected from the registry of the Second World Conference on CDG through heterogeneity and simple random sampling. Inductive and deductive approaches were employed to conduct interpretational analysis using open, axial and selective coding, and the constant-comparison method to facilitate the emergence of categories and core themes. The CDG community has unmet needs for information, quality health care, psychosocial support and representation in decision-making concerned with care and research. According to participants, these needs can be addressed through a range of social innovations, including peer-support communities, web-based information resources and a CDG expertise platform. This is one of the few studies to engage lay and professional experts in needs assessment and innovation for CDG at a global level. Implementing the innovations proposed by the CDG community is likely to have ethical, legal and social implications associated with the

  3. Doll therapy: a therapeutic means to meet past attachment needs and diminish behaviours of concern in a person living with dementia--a case study approach.

    Science.gov (United States)

    Bisiani, Leah; Angus, Jocelyn

    2013-07-01

    The aim of this research study was to examine the impact of the provision of a lifelike baby doll as a therapeutic tool on the behaviour of a person living with dementia. Specifically, this single case study assessed the potential benefits, if any, of the use of doll therapy in reducing behaviours of concern such as anxiety and agitation that may be associated with observed attachment needs of a person living with dementia. A single case study of a female participant, with moderately advanced Alzheimer's disease, was the subject of this research. The case study used both qualitative and quantitative research design and methodology in data collection and analysis. Demonstrated that doll therapy was a positive intervention for the person living with dementia who was the participant in this research. The findings indicate a reduction in behaviours of concern related to the need for attachment and a considerable decline in levels of anxiety and agitation. There was extensive ongoing improvement in social interaction and communication. This research supports doll therapy as a therapeutic intervention that may be utilized within the ongoing care of some persons with dementia to meet needs for attachment and to reduce behaviours of concern. Despite some controversy on this topic, doll therapy should be considered as a therapeutic approach to further dementia care in light of this positive outcome.

  4. The Iowa K-12 Climate Science Education Initiative: a comprehensive approach to meeting in-service teachers' stated needs for teaching climate literacy with NGSS

    Science.gov (United States)

    Stanier, C. O.; Spak, S.; Neal, T. A.; Herder, S.; Malek, A.; Miller, Z.

    2017-12-01

    The Iowa Board of Education voted unanimously in 2015 to adopt NGSS performance standards. The CGRER - College of Education Iowa K-12 Climate Science Education Initiative was established in 2016 to work directly with Iowa inservice teachers to provide what teachers need most to teach climate literacy and climate science content through investigational learning aligned with NGSS. Here we present teachers' requests for teaching climate with NGSS, and an approach to provide resources for place-based authentic inquiry on climate, developed, tested, and refined in partnership with inservice and preservice teachers. A survey of inservice middle school and high school science teachers was conducted at the 2016 Iowa Council of Teachers of Mathematics/Iowa Academy of Sciences - Iowa Science Teaching Section Fall Conference and online in fall 2016. Participants (n=383) were asked about their prior experience and education, the resources they use and need, their level of comfort in teaching climate science, perceived barriers, and how they address potential controversy. Teachers indicated preference for professional development on climate content and complete curricula packaged with lessons and interactive models aligned to Iowa standards, as well as training on instructional strategies to enhance students' ability to interpret scientific evidence. We identify trends in responses by teaching experience, climate content knowledge and its source, grade level, and urban and rural districts. Less than 20% of respondents reported controversy or negativity in teaching climate to date, and a majority were comfortable teaching climate science and climate change, with equal confidence in teaching climate and other STEM content through investigational activities. We present an approach and materials to meet these stated needs, created and tested in collaboration with Iowa teachers. We combine professional development and modular curricula with bundled standards, concepts, models, data

  5. Energy needs

    International Nuclear Information System (INIS)

    Chateau, Bertrand

    2014-05-01

    The author first discusses the various concepts and definitions associated with energy needs, and then the difference between actual needs and energy needs by distinguishing personal needs, needs of the productive sector, energetic needs and services. In the next part, he discusses how energy needs are assessed. He discusses the relationship between energy needs and energy consumption, how energy consumptions can be analysed and interpreted. He comments how energy needs can be assessed and analysed in time and in space. He notices and explains why economy and climate are the main causes of spatial differences for energy needs per habitant, and comments the evolution of energy consumption over long periods

  6. Needs assessment for adapting TB directly observed treatment intervention programme in Limpopo Province, South Africa: A community-based participatory research approach

    Directory of Open Access Journals (Sweden)

    Jabu T. Mabunda

    2016-07-01

    Full Text Available Background: Limpopo Province is one of the hardest hit by tuberculosis and human immune virus infections in the country. The province has been implementing directly observed treatment strategy since 1996. However, the cure rate was 64% in 2015 and remains far from the set target by the World Health Organization of 85%. Poor health-care seeking and adherence behaviours were identified as major risk behaviours. Aim: To apply a community-based participatory research approach in identifying barriers and facilitators to health-care seeking and adherence to treatment, and to determine strategies and messages in order to inform the design of an adapted intervention programme. Setting: This study was conducted in three districts in the Limpopo Province, Capricorn, Mopani and Sekhukhune districts. Methods: Community participatory research approach was applied. Purposive sampling was used to sample participants. Focus group discussions were used to collect data. Participatory analysis was used comparing findings within and across all the participants. Results: A total of 161 participated in the study. Participants included coordinators, professional nurses, supporters and patients. Major modifiable behavioural-related barriers were lack of knowledge about tuberculosis, misinformation and misperceptions cultural beliefs, stigma and refusal of treatment support. Environment-related barriers were attitudes of health workers, lack of support by family and community, lack of food and use of alcohol and drugs. Strategies and messages included persuasive and motivational messages to promote healthy behaviour. Conclusion: Joint programmatic collaboration between the community and academic researchers is really needed for interventions to address the needs of the community. Keywords: Health seeking, Adherence, Community based participatory research, Tuberculosis

  7. Health professionals' views on health literacy issues for culturally and linguistically diverse women in maternity care: barriers, enablers and the need for an integrated approach.

    Science.gov (United States)

    Hughson, Jo-Anne; Marshall, Fiona; Daly, Justin Oliver; Woodward-Kron, Robyn; Hajek, John; Story, David

    2018-02-01

    Objective To identify health literacy issues when providing maternity care to culturally and linguistically diverse (CALD) women, and the strategies needed for health professionals to collaboratively address these issues. Methods A qualitative case study design was undertaken at one large metropolitan Australian hospital serving a highly CALD population. Semistructured interviews were conducted with a range of maternity healthcare staff. The data were analysed thematically. The study is informed by a framework of cultural competence education interventions for health professionals and a health literacy framework. Results Eighteen clinicians participated in the interviews (seven midwives, five obstetricians, five physiotherapists, one social worker, and one occupational therapist). Emergent themes of health literacy-related issues were: patient-based factors (communication and cultural barriers, access issues); provider-based factors (time constraints, interpreter issues); and enablers (cultural awareness among staff, technology). Conclusions There are significant health literacy and systemic issues affecting the hospital's provision of maternity care for CALD women. These findings, mapped onto the four domains of cultural competence education interventions will inform a technology-delivered health literacy intervention for CALD maternity patients. This approach may be applied to other culturally diverse healthcare settings to foster patient health literacy. What is known about the topic? There are health inequities for pregnant women of culturally and linguistically diverse (CALD) backgrounds. Low health literacy compounded by language and cultural factors contribute to these inequities and access to interpreters in pregnancy care remains an ongoing issue. Pregnancy smart phone applications are a popular source of health information for pregnant women yet these apps are not tailored for CALD women nor are they part of a regulated industry. What does this paper add

  8. Social Interaction Needs and Entertainment Approaches to Pregnancy Well-Being in mHealth Technology Design for Low-Income Transmigrant Women: Qualitative Codesign Study.

    Science.gov (United States)

    AlJaberi, Hana

    2018-04-13

    Low-income Caribbean transmigrant women face unique health challenges during pregnancy that set forth multidimensional implications for the design of mobile health (mHealth). Acknowledgment of the unique health needs of low-income Caribbean immigrant women in the United States and what that entails regarding technology design remains rarely examined in the literature of mHealth technologies. The goal of this study was to reveal the needs and gaps in mHealth interventions for pregnant immigrant women not yet realized in this field. These understandings reveal design opportunities for mHealth. The use of the qualitative participatory action research approach of codesign workshops in this study resulted in design solutions by the participants after reflecting on their earlier focus group discussions. The highlights are not the resulting designs per se but rather the inferences derived from the researcher reflecting on these designs. The designs exposed two themes relevant to this paper. First, the participants desired the inclusion and rebuilding of social and organizational relationships in mHealth. The resulting designs formulate an understanding of the women's health-related social support needs and how technology can facilitate them. Second, the participants wanted entertainment with an element of social participation incorporated in mHealth pregnancy management interventions. This brings attention to the role entertainment can add to the impact mHealth can deliver for pregnancy well-being. The study concluded with an examination of social and entertainment design implications that reveal pregnant immigrant women's virtual health-related sharing habits, choice of sharing interaction scenarios during pregnancy (eg, local, long distance, one-way, two-way, and many-many), and choice of sharing media (eg, text, voice, and video). Additionally, the study revealed exclusions to social sharing capabilities in health technologies for these women. ©Hana Al

  9. Preoperative screening: value of previous tests.

    Science.gov (United States)

    Macpherson, D S; Snow, R; Lofgren, R P

    1990-12-15

    To determine the frequency of tests done in the year before elective surgery that might substitute for preoperative screening tests and to determine the frequency of test results that change from a normal value to a value likely to alter perioperative management. Retrospective cohort analysis of computerized laboratory data (complete blood count, sodium, potassium, and creatinine levels, prothrombin time, and partial thromboplastin time). Urban tertiary care Veterans Affairs Hospital. Consecutive sample of 1109 patients who had elective surgery in 1988. At admission, 7549 preoperative tests were done, 47% of which duplicated tests performed in the previous year. Of 3096 previous results that were normal as defined by hospital reference range and done closest to the time of but before admission (median interval, 2 months), 13 (0.4%; 95% CI, 0.2% to 0.7%), repeat values were outside a range considered acceptable for surgery. Most of the abnormalities were predictable from the patient's history, and most were not noted in the medical record. Of 461 previous tests that were abnormal, 78 (17%; CI, 13% to 20%) repeat values at admission were outside a range considered acceptable for surgery (P less than 0.001, frequency of clinically important abnormalities of patients with normal previous results with those with abnormal previous results). Physicians evaluating patients preoperatively could safely substitute the previous test results analyzed in this study for preoperative screening tests if the previous tests are normal and no obvious indication for retesting is present.

  10. Accountable priority setting for trust in health systems - the need for research into a new approach for strengthening sustainable health action in developing countries

    Directory of Open Access Journals (Sweden)

    Olsen Øystein E

    2009-10-01

    Full Text Available Abstract Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed. Accountability for Reasonableness (AFR is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must identify and consider the full range of relevant values. AFR consists of four conditions: i relevance to the local setting, decided by agreed criteria; ii publicizing priority-setting decisions and the reasons behind them; iii the establishment of revisions/appeal mechanisms for challenging and revising decisions; iv the provision of leadership to ensure that the first three conditions are met. REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study started in 2006, which is testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. The objectives of REACT are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by AFR and to measure their effect on quality, equity and trust indicators. Effects are monitored within selected disease and programme interventions and services and within human resources and health systems management. Qualitative and quantitative methods are being

  11. Accountable priority setting for trust in health systems--the need for research into a new approach for strengthening sustainable health action in developing countries.

    Science.gov (United States)

    Byskov, Jens; Bloch, Paul; Blystad, Astrid; Hurtig, Anna-Karin; Fylkesnes, Knut; Kamuzora, Peter; Kombe, Yeri; Kvåle, Gunnar; Marchal, Bruno; Martin, Douglas K; Michelo, Charles; Ndawi, Benedict; Ngulube, Thabale J; Nyamongo, Isaac; Olsen, Oystein E; Onyango-Ouma, Washington; Sandøy, Ingvild F; Shayo, Elizabeth H; Silwamba, Gavin; Songstad, Nils Gunnar; Tuba, Mary

    2009-10-24

    Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed.Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must identify and consider the full range of relevant values. AFR consists of four conditions: i) relevance to the local setting, decided by agreed criteria; ii) publicizing priority-setting decisions and the reasons behind them; iii) the establishment of revisions/appeal mechanisms for challenging and revising decisions; iv) the provision of leadership to ensure that the first three conditions are met.REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study started in 2006, which is testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. The objectives of REACT are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by AFR and to measure their effect on quality, equity and trust indicators. Effects are monitored within selected disease and programme interventions and services and within human resources and health systems management. Qualitative and quantitative methods are being applied in an action research

  12. Implant breast reconstruction after salvage mastectomy in previously irradiated patients.

    Science.gov (United States)

    Persichetti, Paolo; Cagli, Barbara; Simone, Pierfranco; Cogliandro, Annalisa; Fortunato, Lucio; Altomare, Vittorio; Trodella, Lucio

    2009-04-01

    The most common surgical approach in case of local tumor recurrence after quadrantectomy and radiotherapy is salvage mastectomy. Breast reconstruction is the subsequent phase of the treatment and the plastic surgeon has to operate on previously irradiated and manipulated tissues. The medical literature highlights that breast reconstruction with tissue expanders is not a pursuable option, considering previous radiotherapy a contraindication. The purpose of this retrospective study is to evaluate the influence of previous radiotherapy on 2-stage breast reconstruction (tissue expander/implant). Only patients with analogous timing of radiation therapy and the same demolitive and reconstructive procedures were recruited. The results of this study prove that, after salvage mastectomy in previously irradiated patients, implant reconstruction is still possible. Further comparative studies are, of course, advisable to draw any conclusion on the possibility to perform implant reconstruction in previously irradiated patients.

  13. Automatic electromagnetic valve for previous vacuum

    International Nuclear Information System (INIS)

    Granados, C. E.; Martin, F.

    1959-01-01

    A valve which permits the maintenance of an installation vacuum when electric current fails is described. It also lets the air in the previous vacuum bomb to prevent the oil ascending in the vacuum tubes. (Author)

  14. Do we need cross border education?: A Case of Pilot Course Multi-professional Approaches to Substance Abuse Care and Working with Addicts

    Directory of Open Access Journals (Sweden)

    Tarja Orjasniemi

    2017-04-01

    Full Text Available The aim of this article is to examine studentsʼ experiences of cross-border education based on a single course carried out in collaboration between two networks, Barents Cross-Border University (BCBU and the Thematic Network of Social Work (TNSWUA, as well as the experiences of teachers in the course. The course was a part of the curriculum for the Master’s Degree Programme (BCBU in Comparative Social Work. Most of the students were studying in this Master’s Programme, some of them were exchange students at the University of Lapland (UL and the rest were social work students at UL and the University of Iceland (UI.  The course ran for two weeks in April 2015, and included lectures, discussions and workshops; parts of the course were delivered electronically, while other sections were delivered by teachers on-site. This course provided a broad multi-professional introduction to the field of addiction and substance abuse care. Students learned about screening the alcohol culture and the relationship between society, addiction, gender, family, life phases, ageing, maternity and substance use. The data for this study was collected through focus group discussion, with students reflecting on one question: ‘Do we need cross-border education?’ Data from instructors was collected through discussions during the planning and post-course discussions. Overall, the experiences of students and instructors were positive. The collaboration did not face insuperable challenges. The findings highlighted four main themes: globalization, networking, comparing theory and practice, and using technology. Globalization has set new demands for social work and its professionals. Experts in cultural diversity and international social issues, as well as people with a comparative approach to different societies, are needed the world over. Regarding implications for cross-border education, we would recommend collaboration in the particular field of social work

  15. How is shrimp aquaculture transforming coastal livelihoods and lagoons in Estero Real, Nicaragua? The need to integrate social-ecological research and ecosystem-based approaches.

    Science.gov (United States)

    Benessaiah, Karina; Sengupta, Raja

    2014-08-01

    Ecosystem-based approaches to aquaculture integrate environmental concerns into planning. Social-ecological systems research can improve this approach by explicitly relating ecological and social dynamics of change at multiple scales. Doing so requires not only addressing direct effects of aquaculture but also considering indirect factors such as changes in livelihood strategies, governance dynamics, and power relations. We selected the community of Puerto Morazán, Nicaragua as a case study to demonstrate how the introduction of small-scale aquaculture radically transformed another key livelihood activity, lagoon shrimp fishing, and the effects that these changes have had on lagoons and the people that depend on them. We find that shrimp aquaculture played a key role in the collapse, in the 1990s, of an existing lagoon common-property management. Shrimp aquaculture-related capital enabled the adoption of a new fishing technique that not only degraded lagoons but also led to their gradual privatization. The existence of social ties between small-scale shrimp farmers and other community members mitigated the impacts of privatization, illustrating the importance of social capital. Since 2008, community members are seeking to communally manage the lagoons once again, in response to degraded environmental conditions and a consolidation of the shrimp industry at the expense of smaller actors. This research shows that shrimp aquaculture intersects with a complex set of drivers, affecting not only how ecosystems are managed but also how they are perceived and valued. Understanding these social-ecological dynamics is essential to implement realistic policies and management of mangrove ecosystems and address the needs of resource-dependent people.

  16. HEALTH NEEDS

    Directory of Open Access Journals (Sweden)

    Olivera Radulovic

    2007-01-01

    Full Text Available Human needs are of great interest to different scientific fields: sociology, anthropology, psychology, medicine, economy… Malinowski, Maslow, Adler and From have largely contributed to studying the needs. While trying to define the need concept, not only one definition is acceptable. In psychology, need is defined as a lack or disorder, i.e. the necessity to dislodge this lack. It was Maslow who gave the fullest classification and explanation of human needs. If we start from the fact that need represents the lack or deficit of something, in this context health needs would indicate the lack of health, and the measurement of health needs would be the same as the measurement of health. Therefore, almost all human needs can be enumerated as health needs, i.e. those which, after being satisfied, can lead to physical, psychical and social welfare. According to WHO, health needs can be defined as scientifically settled evasions from health which require preventive, curative and probably regulative and eradicative measurements. According to the medical method used by the health service while regarding the needs, the emphasis is on morbidity, mortality, incidence, prevalence, inability, etc. Usually, when we have very low level of health culture, and the responsibility for personal health is in most of the cases unacceptable, for the health service user the curative services will have priority over preventive ones. The measurement of health needs is a complex task. The needs can be regarded through medical documentation and by perception of the needs by people in the community.

  17. Need for Orientation, Media Uses and Gratifications, and Media Effects.

    Science.gov (United States)

    Weaver, David

    In order to study the influence of need for orientation and media gratifications on media use and media effects in political communication, two previous surveys were studied to compare the causal modeling approach and the contingent conditions approach. In the first study, 339 personal interviews were conducted with registered voters during a…

  18. Strategic needs of water on the Yukon: an interdisciplinary approach to studying hydrology and climate change in the Lower Yukon River Basin

    Science.gov (United States)

    Herman-Mercer, Nicole M.; Schuster, Paul F.

    2014-01-01

    Strategic Needs of Water on the Yukon (SNOWY) is an interdisciplinary research project funded by the National Science Foundation (NSF; http://www.nsf.gov/). The SNOWY team is made up of a diverse group of researchers from different backgrounds and organizations. This partnership between scientists from different disciplines (hydrology, geography, and social science), government agencies, nonprofit organizations, universities, and Lower Yukon River Basin (LYRB) and Yukon-Kuskokwim (YK) Delta communities provided an opportunity to study the effects of climate change using a holistic approach. The Arctic and Subarctic are experiencing environmental change at a rate faster than the rest of the world, and the lack of historical baseline data in these often remote locations makes understanding and predicting regional climate change difficult. This project focused on collecting data to fill in these gaps by using both quantitative and qualitative methodologies to tell the story of environmental change in this region as told by the physical data and the people who rely on this landscape.

  19. Preemie abandonment? Multidisciplinary experts consider how to best meet preemies needs at "preterm infants: a collaborative approach to specialized care" roundtable.

    Science.gov (United States)

    Als, Heidelise; Behrman, Richard; Checchia, Paul; Denne, Scott; Dennery, Phyllis; Hall, Caroline B; Martin, Richard; Panitch, Howard; Schmidt, Barbara; Stevenson, David K; Vila, Linda

    2007-06-04

    In June 2006, the Institute of Medicine (LoM), released a comprehensive study, Preterm Birth: Causes, Consequences, and Prevention. The report was a result of the IoM's efforts, in particular the Committee on Understanding Premature Birth and Assuring Healthy Outcomes, to better understand and prevent preterm birth and improve care for babies born prematurely. After its publication, a group of health care professionals came together in a roundtable session, "Preterm Infants: A Collaborative Approach to Specialized Care," to discuss the implications of the report. The following article captures the group's April 2007 discussion about the clinical and societal problems of preterm birth. It should be of interest to hospital administrators, pediatricians, third-party payers, policy makers, public health officials, academic researchers, funding agencies, allied health professionals, and others with a vested interest in curbing healthcare costs as well as what needs to be understood and done to safeguard the short- and long-term health of a most vulnerable population.

  20. 77 FR 70176 - Previous Participation Certification

    Science.gov (United States)

    2012-11-23

    ... participants' previous participation in government programs and ensure that the past record is acceptable prior... information is designed to be 100 percent automated and digital submission of all data and certifications is... government programs and ensure that the past record is acceptable prior to granting approval to participate...

  1. On the Tengiz petroleum deposit previous study

    International Nuclear Information System (INIS)

    Nysangaliev, A.N.; Kuspangaliev, T.K.

    1997-01-01

    Tengiz petroleum deposit previous study is described. Some consideration about structure of productive formation, specific characteristic properties of petroleum-bearing collectors are presented. Recommendation on their detail study and using of experience on exploration and development of petroleum deposit which have analogy on most important geological and industrial parameters are given. (author)

  2. Subsequent pregnancy outcome after previous foetal death

    NARCIS (Netherlands)

    Nijkamp, J. W.; Korteweg, F. J.; Holm, J. P.; Timmer, A.; Erwich, J. J. H. M.; van Pampus, M. G.

    Objective: A history of foetal death is a risk factor for complications and foetal death in subsequent pregnancies as most previous risk factors remain present and an underlying cause of death may recur. The purpose of this study was to evaluate subsequent pregnancy outcome after foetal death and to

  3. INTRODUCTION Previous reports have documented a high ...

    African Journals Online (AJOL)

    Conclusion: The positive effect of education on oral hygiene practices is highlighted in this study. However there is still need for proper health enlightenment in this population with regards to use of the available oral health care facilities. Keywords: Oral hygiene, Pregnancy, Nigeria. Annals of Ibadan Postgraduate Medicine.

  4. The Need of Interdisciplinary Approach for the Treatment of Children with Down Syndrome with Severe Caries Unintentionally Facilitated by Hypotonia Therapy.

    Science.gov (United States)

    Bimstein, Enrique; Miskovich, Camilla

    2018-05-11

    This manuscript describes a case of a 4-year-old child with Down syndrome involving hypotonia in which the use of sweets to induce oral muscular function contributed to the need to extract all the primary teeth due to extensive caries. The need for interdisciplinary education and practice targeted to the treatment of children with special health care needs is emphasized.

  5. Previous Experience a Model of Practice UNAE

    OpenAIRE

    Ormary Barberi Ruiz; María Dolores Pesántez Palacios

    2017-01-01

    The statements presented in this article represents a preliminary version of the proposed model of pre-professional practices (PPP) of the National University of Education (UNAE) of Ecuador, an urgent institutional necessity is revealed in the descriptive analyzes conducted from technical support - administrative (reports, interviews, testimonials), pedagogical foundations of UNAE (curricular directionality, transverse axes in practice, career plan, approach and diagnostic examination as subj...

  6. Erlotinib-induced rash spares previously irradiated skin

    International Nuclear Information System (INIS)

    Lips, Irene M.; Vonk, Ernest J.A.; Koster, Mariska E.Y.; Houwing, Ronald H.

    2011-01-01

    Erlotinib is an epidermal growth factor receptor inhibitor prescribed to patients with locally advanced or metastasized non-small cell lung carcinoma after failure of at least one earlier chemotherapy treatment. Approximately 75% of the patients treated with erlotinib develop acneiform skin rashes. A patient treated with erlotinib 3 months after finishing concomitant treatment with chemotherapy and radiotherapy for non-small cell lung cancer is presented. Unexpectedly, the part of the skin that had been included in his previously radiotherapy field was completely spared from the erlotinib-induced acneiform skin rash. The exact mechanism of erlotinib-induced rash sparing in previously irradiated skin is unclear. The underlying mechanism of this phenomenon needs to be explored further, because the number of patients being treated with a combination of both therapeutic modalities is increasing. The therapeutic effect of erlotinib in the area of the previously irradiated lesion should be assessed. (orig.)

  7. Reasoning with Previous Decisions: Beyond the Doctrine of Precedent

    DEFF Research Database (Denmark)

    Komárek, Jan

    2013-01-01

    in different jurisdictions use previous judicial decisions in their argument, we need to move beyond the concept of precedent to a wider notion, which would embrace practices and theories in legal systems outside the Common law tradition. This article presents the concept of ‘reasoning with previous decisions...... law method’, but they are no less rational and intellectually sophisticated. The reason for the rather conceited attitude of some comparatists is in the dominance of the common law paradigm of precedent and the accompanying ‘case law method’. If we want to understand how courts and lawyers......’ as such an alternative and develops its basic models. The article first points out several shortcomings inherent in limiting the inquiry into reasoning with previous decisions by the common law paradigm (1). On the basis of numerous examples provided in section (1), I will present two basic models of reasoning...

  8. Books average previous decade of economic misery.

    Science.gov (United States)

    Bentley, R Alexander; Acerbi, Alberto; Ormerod, Paul; Lampos, Vasileios

    2014-01-01

    For the 20(th) century since the Depression, we find a strong correlation between a 'literary misery index' derived from English language books and a moving average of the previous decade of the annual U.S. economic misery index, which is the sum of inflation and unemployment rates. We find a peak in the goodness of fit at 11 years for the moving average. The fit between the two misery indices holds when using different techniques to measure the literary misery index, and this fit is significantly better than other possible correlations with different emotion indices. To check the robustness of the results, we also analysed books written in German language and obtained very similar correlations with the German economic misery index. The results suggest that millions of books published every year average the authors' shared economic experiences over the past decade.

  9. Books Average Previous Decade of Economic Misery

    Science.gov (United States)

    Bentley, R. Alexander; Acerbi, Alberto; Ormerod, Paul; Lampos, Vasileios

    2014-01-01

    For the 20th century since the Depression, we find a strong correlation between a ‘literary misery index’ derived from English language books and a moving average of the previous decade of the annual U.S. economic misery index, which is the sum of inflation and unemployment rates. We find a peak in the goodness of fit at 11 years for the moving average. The fit between the two misery indices holds when using different techniques to measure the literary misery index, and this fit is significantly better than other possible correlations with different emotion indices. To check the robustness of the results, we also analysed books written in German language and obtained very similar correlations with the German economic misery index. The results suggest that millions of books published every year average the authors' shared economic experiences over the past decade. PMID:24416159

  10. Underestimation of Severity of Previous Whiplash Injuries

    Science.gov (United States)

    Naqui, SZH; Lovell, SJ; Lovell, ME

    2008-01-01

    INTRODUCTION We noted a report that more significant symptoms may be expressed after second whiplash injuries by a suggested cumulative effect, including degeneration. We wondered if patients were underestimating the severity of their earlier injury. PATIENTS AND METHODS We studied recent medicolegal reports, to assess subjects with a second whiplash injury. They had been asked whether their earlier injury was worse, the same or lesser in severity. RESULTS From the study cohort, 101 patients (87%) felt that they had fully recovered from their first injury and 15 (13%) had not. Seventy-six subjects considered their first injury of lesser severity, 24 worse and 16 the same. Of the 24 that felt the violence of their first accident was worse, only 8 had worse symptoms, and 16 felt their symptoms were mainly the same or less than their symptoms from their second injury. Statistical analysis of the data revealed that the proportion of those claiming a difference who said the previous injury was lesser was 76% (95% CI 66–84%). The observed proportion with a lesser injury was considerably higher than the 50% anticipated. CONCLUSIONS We feel that subjects may underestimate the severity of an earlier injury and associated symptoms. Reasons for this may include secondary gain rather than any proposed cumulative effect. PMID:18201501

  11. [Electronic cigarettes - effects on health. Previous reports].

    Science.gov (United States)

    Napierała, Marta; Kulza, Maksymilian; Wachowiak, Anna; Jabłecka, Katarzyna; Florek, Ewa

    2014-01-01

    Currently very popular in the market of tobacco products have gained electronic cigarettes (ang. E-cigarettes). These products are considered to be potentially less harmful in compared to traditional tobacco products. However, current reports indicate that the statements of the producers regarding to the composition of the e- liquids not always are sufficient, and consumers often do not have reliable information on the quality of the product used by them. This paper contain a review of previous reports on the composition of e-cigarettes and their impact on health. Most of the observed health effects was related to symptoms of the respiratory tract, mouth, throat, neurological complications and sensory organs. Particularly hazardous effects of the e-cigarettes were: pneumonia, congestive heart failure, confusion, convulsions, hypotension, aspiration pneumonia, face second-degree burns, blindness, chest pain and rapid heartbeat. In the literature there is no information relating to passive exposure by the aerosols released during e-cigarette smoking. Furthermore, the information regarding to the use of these products in the long term are not also available.

  12. The pattern of moderate acute malnutrition in a rural area of Sri Lanka: Integrated approach is needed to address the problem

    International Nuclear Information System (INIS)

    Peiris, Dilka; Nandasena, Sumal

    2014-01-01

    8.8% have initiated the solid/semi-solid food during the first 6 months. Highest weight for age percentage of <-2SD reported from the children age 49 - 60 months (33.3% (CI = 21- 48.5)). Highest percentage of MAM was reported in the age group of 49-60 months. About 10% of children had presumed pneumonia with in the 2 weeks prior to the survey. A wide disparity was noticed in underweight proportions over the geographical localities. Majority of the children had haemoglobin levels less than 11.0 g/dl (n = 78, 65.0%). Conclusions and recommendations: Weight for age percentage of <-2SD is higher than the national average while weight for height percentage of -2SD is lesser than the National average. Multiple factors such as high levels of respiratory tract infections, poverty, lack awareness etc. may contribute to the low nutritional status of children. Integrated approach is needed to address the malnutrition in this area. A short term targeted interventions should be designed for the MAM child. (author)

  13. Local recurrence risk after previous salvage mastectomy.

    Science.gov (United States)

    Tanabe, M; Iwase, T; Okumura, Y; Yoshida, A; Masuda, N; Nakatsukasa, K; Shien, T; Tanaka, S; Komoike, Y; Taguchi, T; Arima, N; Nishimura, R; Inaji, H; Ishitobi, M

    2016-07-01

    Breast-conserving surgery is a standard treatment for early breast cancer. For ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery, salvage mastectomy is the current standard surgical procedure. However, it is not rare for patients with IBTR who have received salvage mastectomy to develop local recurrence. In this study, we examined the risk factors of local recurrence after salvage mastectomy for IBTR. A total of 118 consecutive patients who had histologically confirmed IBTR without distant metastases and underwent salvage mastectomy without irradiation for IBTR between 1989 and 2008 were included from eight institutions in Japan. The risk factors of local recurrence were assessed. The median follow-up period from salvage mastectomy for IBTR was 4.6 years. Patients with pN2 or higher on diagnosis of the primary tumor showed significantly poorer local recurrence-free survival than those with pN0 or pN1 at primary tumor (p mastectomy for IBTR. Further research and validation studies are needed. (UMIN-CTR number UMIN000008136). Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Previous Experience a Model of Practice UNAE

    Directory of Open Access Journals (Sweden)

    Ormary Barberi Ruiz

    2017-02-01

    Full Text Available The statements presented in this article represents a preliminary version of the proposed model of pre-professional practices (PPP of the National University of Education (UNAE of Ecuador, an urgent institutional necessity is revealed in the descriptive analyzes conducted from technical support - administrative (reports, interviews, testimonials, pedagogical foundations of UNAE (curricular directionality, transverse axes in practice, career plan, approach and diagnostic examination as subject nature of the pre professional practice and the demand of socio educational contexts where the practices have been emerging to resize them. By relating these elements allowed conceiving the modeling of the processes of the pre-professional practices for the development of professional skills of future teachers through four components: contextual projective, implementation (tutoring, accompaniment (teaching couple and monitoring (meetings at the beginning, during and end of practice. The initial training of teachers is inherent to teaching (academic and professional training, research and links with the community, these are fundamental pillars of Ecuadorian higher education.

  15. Energy needs

    International Nuclear Information System (INIS)

    Maxey, M.N.

    1982-06-01

    There seems to be a trend towards expecting energy conservation to be a panacea for the world's ills. In fact, a global perspective on energy needs shows that more, not less, energy is needed and technological innovation in energy sources is essential in order to meet the needs of more than just the developed countries. Energy-intensive technology is the amplification of our natural resources rather than their depletion. A fundamental bioethical principle must be established if we are to analyze and organize scientific evidence about hazards from currently feasible energy resources, and separate genuine from counterfeit claims to credibility. In particular, public fears about radiation hazards and radioactive waste disposal are influenced too much by rhetorical cleverness and forensic skills of a vociferous minority. Potential hazard management is ethically equitable only if it is proportioned to actual basic harm that can be identified and reduced by expenditures of human effort, time and money

  16. The Green, Amber, Red Delineation of Risk and Need (GARDIAN) management system: a pragmatic approach to optimizing heart health from primary prevention to chronic disease management.

    Science.gov (United States)

    Carrington, Melinda J; Kok, Simone; Jansen, Kiki; Stewart, Simon

    2013-08-01

    A sustained epidemic of cardiovascular disease and related risk factors is a global phenomenon contributing significantly to premature deaths and costly morbidity. Preventative strategies across the full continuum of life, from a population to individual perspective, are not optimally applied. This paper describes a simple and adaptable 'traffic-light' system we have developed to systematically perform individual risk and need delineation in order to 'titrate' the intensity and frequency of healthcare intervention in a cost-effective manner. The GARDIAN (Green Amber Red Delineation of Risk and Need) system is an individual assessment of risk and need that modulates the frequency and intensity of future healthcare intervention. Individual assessment of risk and need for ongoing intervention and support is determined with reference to three domains: (1) clinical stability, (2) gold-standard management, and (3) a broader, holistic assessment of individual circumstance. This can be applied from a primary prevention, secondary prevention, or chronic disease management perspective. Our experience with applying and validating GARDIAN to titrate healthcare resources according to need has been extensive to date, with >5000 individuals profiled in a host of clinical settings. A series of clinical randomized trials will determine the impact of the GARDIAN system on important indices of healthcare utilization and health status. The GARDIAN model to delineating risk and need for varied intensity of management shows strong potential to cost effectively improve health outcomes for both individuals at risk of heart disease and those with established heart disease.

  17. Need theory

    NARCIS (Netherlands)

    R. Veenhoven (Ruut)

    2014-01-01

    markdownabstract__Abstract__ Need theory of happiness is linked to affect theory, which holds that happiness is a reflection of how well we feel generally. In this view, we do not "calculate" happiness but rather "infer" it, the typical heuristic being "I feel good most of the time, hence

  18. Response to health insurance by previously uninsured rural children.

    Science.gov (United States)

    Tilford, J M; Robbins, J M; Shema, S J; Farmer, F L

    1999-08-01

    To examine the healthcare utilization and costs of previously uninsured rural children. Four years of claims data from a school-based health insurance program located in the Mississippi Delta. All children who were not Medicaid-eligible or were uninsured, were eligible for limited benefits under the program. The 1987 National Medical Expenditure Survey (NMES) was used to compare utilization of services. The study represents a natural experiment in the provision of insurance benefits to a previously uninsured population. Premiums for the claims cost were set with little or no information on expected use of services. Claims from the insurer were used to form a panel data set. Mixed model logistic and linear regressions were estimated to determine the response to insurance for several categories of health services. The use of services increased over time and approached the level of utilization in the NMES. Conditional medical expenditures also increased over time. Actuarial estimates of claims cost greatly exceeded actual claims cost. The provision of a limited medical, dental, and optical benefit package cost approximately $20-$24 per member per month in claims paid. An important uncertainty in providing health insurance to previously uninsured populations is whether a pent-up demand exists for health services. Evidence of a pent-up demand for medical services was not supported in this study of rural school-age children. States considering partnerships with private insurers to implement the State Children's Health Insurance Program could lower premium costs by assembling basic data on previously uninsured children.

  19. Research Paper: Determination of the Needs of Mothering Handling Training for Family Caregiving of Children and Youth With Cerebral Palsy at Home Based on a Family- Centered Approach

    Directory of Open Access Journals (Sweden)

    Hamid Dalvand

    2016-11-01

    Conclusion The results showed that the highest priority of needs of mothering handling training was self-care, feeding, toileting, and functional mobility. However, the needs of mothering handling training enhanced with increasing severity of fine motor function lesions and age. The simultaneous relationships between age and MACS levels in children with CP have no effect on the priorities of mothering handling training. Organized training of families and caregivers about needs of mothering handling training and proper care of their children are facilitating steps in promoting the education of mothers of children with CP. It seems that the understanding and education of mothering handling for therapists responsible for managing children with CP and the education of their parents can open the way to effective caring and treatment.

  20. The risk-benefit task of research ethics committees: An evaluation of current approaches and the need to incorporate decision studies methods

    Directory of Open Access Journals (Sweden)

    Bernabe Rosemarie D L C

    2012-04-01

    Full Text Available Abstract Background Research ethics committees (RECs are tasked to assess the risks and the benefits of a trial. Currently, two procedure-level approaches are predominant, the Net Risk Test and the Component Analysis. Discussion By looking at decision studies, we see that both procedure-level approaches conflate the various risk-benefit tasks, i.e., risk-benefit assessment, risk-benefit evaluation, risk treatment, and decision making. This conflation makes the RECs’ risk-benefit task confusing, if not impossible. We further realize that RECs are not meant to do all the risk-benefit tasks; instead, RECs are meant to evaluate risks and benefits, appraise risk treatment suggestions, and make the final decision. Conclusion As such, research ethics would benefit from looking beyond the procedure-level approaches and allowing disciplines like decision studies to be involved in the discourse on RECs’ risk-benefit task.

  1. A Tailored Approach for Incarcerated Boys : Q Study into the Needs of Incarcerated Boys in the Interaction with Group Workers in a Juvenile Correctional Institution

    NARCIS (Netherlands)

    Marie-José Geenen

    2017-01-01

    Behavioral change of incarcerated boys is influenced by the alliance with the group workers who support them. This alliance is partly determined by the extent to which both the needs of group workers and boys are being fulfilled. The objective of this research was to explore the views of

  2. The Need for an Ecological Approach to Parental Stress in Autism Spectrum Disorders: The Combined Role of Individual and Environmental Factors

    Science.gov (United States)

    Derguy, C.; M'Bailara, K.; Michel, G.; Roux, S.; Bouvard, M.

    2016-01-01

    This study aimed to identify parental stress predictors in ASD by considering individual and environmental factors in an ecological approach. Participants were 115 parents of children with ASD aged from 3 to 10 years. Multiple regression analyses were conducted to determine the best predictors of parental stress among child-related, parent-related…

  3. TEACHER NEEDED

    CERN Multimedia

    2002-01-01

    Part-time teacher of primary English needed from 1st December 2002 to teach English National Curriculum (KS2) and NLS to mother tongue or good second language English-speakers aged 7-10. 4 hours contact time per week, team planning, marking and meetings. Candidates should be English mother tongue qualified teachers, confident, flexible classroom practitioners and team players. For further details and how to apply: engnat@hotmail.com or 04 50 40 82 66. Apply as soon as possible, and in any case before November 20th. English National Programme - Lycée International, Ferney-Voltaire

  4. Sustainable Development Goals (SDGs), and their implementation: A national global framework for health, development and equity needs a systems approach at every level.

    Science.gov (United States)

    Morton, Stephen; Pencheon, David; Squires, Neil

    2017-12-01

    The Sustainable Development Goals (SDGs) are a set of global goals for fair and sustainable health at every level: from planetary biosphere to local community. The aim is to end poverty, protect the planet and ensure that all people enjoy peace and prosperity, now and in the future. The UN has established web-sites to inform the implementation of the SDGs and an Inter-Agency and Expert Group on an Indicator Framework. We have searched for independent commentaries and analysis. The goals represent a framework that is scientifically robust, and widely intuitive intended to build upon the progress established by the Millennium Development Goals (MDGs). There is a need for system wide strategic planning to integrate the economic, social and environmental dimensions into policy and actions. Many countries have yet to understand the difference between the MDGs and the SDGs, particularly their universality, the huge potential of new data methods to help with their implementation, and the systems thinking that is needed to deliver the vision. The danger is that individual goals may be prioritized without an understanding of the potential positive interactions between goals. There is an increasing understanding that sustainable development needs a paradigm shift in our understanding of the interaction between the real economy and quality of life. There would be many social, environmental and economic benefits in changing our current model. We need to develop systems wide understanding of what supports a healthy environment and the art and science of making change. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  5. A museum-based urban teacher residency program's approach to strengthening the STEM pipeline: Channeling highly qualified Earth Science teachers into high needs schools

    Science.gov (United States)

    Ustunisik, G. K.; Zirakparvar, N. A.

    2015-12-01

    Channeling better prepared Earth Science teachers into secondary schools with low achievement rates in STEM subjects is essential to ensuring that the students attending these schools are ultimately afforded the opportunity to take advantage of projected growth in the global geoscience workforce. Here, a museum-based urban teacher residency (UTR) program's approach to building subject specific content knowledge and research experience in Earth Science teacher candidates is described. In the museum-based program, graduate-level science courses and research experiences are designed and implemented specifically for the UTR by active Earth and Space research scientists that account for almost half of the program's faculty. Because these courses and research experiences are designed specifically for the teacher candidates, they are different than many science courses and research experiences available to pre-service teachers in a university setting. At the same time, the museum-based program is the only UTR to incorporate such a rigorous science curriculum, and some possible advantages and disadvantages of the program's approach are also considered here. While the impact of the program's approach on student achievement rates has yet to be evaluated, there is promise in the well documented links between a teacher's own experience with the practice of science and that teacher's ability to leverage effective pedagogical content knowledge in the teaching of science. Because the museum-based program's science curriculum is balanced against the educational coursework and teaching residencies that necessarily form the program's backbone, the museum's approach to strengthening the teacher candidate's science background may also inform the faculty and administration of other UTRs in cases where one of their program goals is to further expand their teacher candidate's content knowledge and practical subject matter experience.

  6. The Global Dimension of Water Governance: Why the River Basin Approach Is No Longer Sufficient and Why Cooperative Action at Global Level Is Needed

    Directory of Open Access Journals (Sweden)

    Arjen Y. Hoekstra

    2010-12-01

    Full Text Available When water problems extend beyond the borders of local communities, the river basin is generally seen as the most appropriate unit for analysis, planning, and institutional arrangements. In this paper it is argued that addressing water problems at the river basin level is not always sufficient. Many of today’s seemingly local water issues carry a (subcontinental or even global dimension, which urges for a governance approach that comprises institutional arrangements at a level beyond that of the river basin. This paper examines a number of arguments for the thesis that good water governance requires a global approach complementary to the river basin approach. Subsequently, it identifies four major issues to be addressed at global scale: Efficiency, equity, sustainability and security of water supply in a globalised world. Finally, the paper raises the question of what kind of institutional arrangements could be developed to cope with the global dimension of water issues. A few possible directions are explored, ranging from an international protocol on full-cost water pricing and a water label for water-intensive products to the implementation of water footprint quotas and the water-neutral concept.

  7. TEACHERS NEEDED

    CERN Multimedia

    2001-01-01

    The English Language Programme of the Lycée International de Ferney-Voltaire has two teaching posts available for la rentrée 2001. 1. Part-time teacher of Primary-level English Candidates for the post need to be mother-tongue English speakers. They should have a relevant degree and teaching qualification. The post involves teaching the English curriculum to pupils who are within the French educational system. Classes take place on Tuesday afternoons at the Lycée. Team spirit necessary as teachers work as a team. Induction & training are offered. 2. Part-time teacher of Secondary-level history-geography Candididates for the post need to be mother-tongue English speakers. They should have a relevant degree in history or geography and also a strong interest in the other subject. They should have a relevant teaching qualification and be confident classroom practioners. For more information on either of these posts please contact the school office on 04.50.40.82...

  8. Analysis of previous screening examinations for patients with breast cancer

    International Nuclear Information System (INIS)

    Lee, Eun Hye; Cha, Joo Hee; Han, Dae Hee; Choi, Young Ho; Hwang, Ki Tae; Ryu, Dae Sik; Kwak, Jin Ho; Moon, Woo Kyung

    2007-01-01

    We wanted to improve the quality of subsequent screening by reviewing the previous screening of breast cancer patients. Twenty-four breast cancer patients who underwent previous screening were enrolled. All 24 took mammograms and 15 patients also took sonograms. We reviewed the screening retrospectively according to the BI-RADS criteria and we categorized the results into false negative, true negative, true positive and occult cancers. We also categorized the causes of false negative cancers into misperception, misinterpretation and technical factors and then we analyzed the attributing factors. Review of the previous screening revealed 66.7% (16/24) false negative, 25.0% (6/24) true negative, and 8.3% (2/24) true positive cancers. False negative cancers were caused by the mammogram in 56.3% (9/16) and by the sonogram in 43.7% (7/16). For the false negative cases, all of misperception were related with mammograms and this was attributed to dense breast, a lesion located at the edge of glandular tissue or the image, and findings seen on one view only. Almost all misinterpretations were related with sonograms and attributed to loose application of the final assessment. To improve the quality of breast screening, it is essential to overcome the main causes of false negative examinations, including misperception and misinterpretation. We need systematic education and strict application of final assessment categories of BI-RADS. For effective communication among physicians, it is also necessary to properly educate them about BI-RADS

  9. Design of pulsed perforated-plate columns for industrial scale mass transfer applications - present experience and the need for a model based approach

    International Nuclear Information System (INIS)

    Roy, Amitava

    2010-01-01

    Mass transfer is a vital unit operation in the processing of spent nuclear fuel in the backend of closed fuel cycle and Pulsed perforated plate extraction columns are used as mass transfer device for more than five decades. The pulsed perforated plate column is an agitated differential contactor, which has wide applicability due to its simplicity, high mass transfer efficiency, high through put, suitability for maintenance free remote operation, ease of cleaning/decontamination and cost effectiveness. Design of pulsed columns are based on a model proposed to describe the hydrodynamics and mass transfer. In equilibrium stage model, the HETS values are obtained from pilot plant experiments and then scaled empirically to design columns for industrial application. The dispersion model accounts for mass transfer kinetics and back-mixing. The drop population balance model can describe complex hydrodynamics of dispersed phase, that is, drop formation, break-up and drop-to-drop interactions. In recent years, significant progress has been made to model pulsed columns using CFD, which provides complete mathematical description of hydrodynamics in terms of spatial distribution of flow fields and 3D visualization. Under the condition of pulsation, the poly-dispersed nature of turbulent droplet swarm renders modeling difficult. In the absence of industry acceptance of proposed models, the conventional chemical engineering practice is to use HETS-NTS concept or HTU-NTU approach to design extraction columns. The practicability of HTU-NTU approach has some limitations due to the lack of experimental data on individual film mass transfer coefficients. Presently, the HETS-NTS concept has been used for designing the columns, which has given satisfactory performance. The design objective is mainly to arrive at the diameter and height of the mass transfer section for a specific plate geometry, fluid properties and pulsing condition to meet the intended throughput (capacity) and mass

  10. The SPICE concept - An approach to providing geometric and other ancillary information needed for interpretation of data returned from space science instruments

    Science.gov (United States)

    Acton, Charles H., Jr.

    1990-01-01

    The Navigation Ancillary Information Facility (NAIF), acting under the direction of NASA's Office of Space Science and Applications, and with substantial participation of the planetary science community, is designing and implementing an ancillary data system - called SPICE - to assist scientists in planning and interpreting scientific observations taken from spaceborne instruments. The principal objective of the implemented SPICE system is that it will hold the essential geometric and related ancillary information needed to recover the full value of science instrument data, and that it will facilitate correlations of individual instrument datasets with data obtained from other instruments on the same or other spacecraft.

  11. STAFF NEEDED

    CERN Multimedia

    2001-01-01

    The English National Programme, part of the Lycée International de Ferney-Voltaire (France) needs the following staff for September 2001: A part-time teacher of primary English The post involves teaching the English curriculum to pupils who are within the French educational system: Classes take place on Tuesday afternoons at the Lycée, Team spirit necessary as teachers work as a team, Induction & training are offered. A part time teacher of senior secondary history-geography in English A part time teacher of secondary mathematics in English Teachers must be mother-tongue English speakers and have a relevant degree and/or teaching qualification. For the history-geography post, either history or geography degrees are acceptable. Please send your c.v. and a letter of application to Peter Woodburn, Head, English National Programme, Lycée International, 01216 Ferney-Voltaire, France. (Email: engnat@hotmail.com) Telephone 04 50 40 82 66 for further details of posts. Ple...

  12. A User-Centered Approach: Understanding Client and Caregiver Needs and Preferences in the Development of mHealth Apps for Self-Management.

    Science.gov (United States)

    Bendixen, Roxanna M; Fairman, Andrea D; Karavolis, Meredith; Sullivan, Carly; Parmanto, Bambang

    2017-09-26

    Many adolescents and young adults with chronic illness or disability often fail to develop the self-management skills necessary to independently handle medical and self-management routines. In light of these needs, we are developing iMHere 2.0 (Interactive Mobile Health and Rehabilitation), a mobile health (mHealth) system to support a self-management program. Our objective was to gather data from persons with brain and spinal cord anomalies (BSA) and their caregivers to better understand how mHealth would be most helpful in supporting them to proactively manage daily self-care routines and to access medical care as needed. The specific purpose was not only to gather feedback and to gain increased insight into the design of the new version of iMHere, but also to gather perspectives of new groups, namely adolescents as young as 12 years and their parents and/or caregivers. Our project employed focus group sessions and surveys to collect data from participants with BSA, as well as their caregivers. A total of six focus group sessions were conducted on four separate occasions until the data gathered reached saturation. The objectives of our focus group sessions were to better understand ways to develop mHealth systems to support self-management, to promote independence, to motivate long-term system use, and to prevent medical problems that lead to hospitalizations and emergency room visits for youth and young adults with BSA. A total of 16 youth and young adults with BSA and 11 caregivers participated in the sessions. Within and among our groups, the following five overarching themes emerged from the data: (1) make it easy, (2) engage, (3) educate and prepare, (4) motivate and support, and (5) personalize. Participants shared their perspectives and detailed information about mHealth apps that would be important for independence in self-care and self-management. Our findings suggest that most individuals keep their mobile phones with them at all times and typically use

  13. Path-oriented early reaction to approaching disruptions in ASDEX Upgrade and TCV in view of the future needs for ITER and DEMO

    Science.gov (United States)

    Maraschek, M.; Gude, A.; Igochine, V.; Zohm, H.; Alessi, E.; Bernert, M.; Cianfarani, C.; Coda, S.; Duval, B.; Esposito, B.; Fietz, S.; Fontana, M.; Galperti, C.; Giannone, L.; Goodman, T.; Granucci, G.; Marelli, L.; Novak, S.; Paccagnella, R.; Pautasso, G.; Piovesan, P.; Porte, L.; Potzel, S.; Rapson, C.; Reich, M.; Sauter, O.; Sheikh, U.; Sozzi, C.; Spizzo, G.; Stober, J.; Treutterer, W.; ZancaP; ASDEX Upgrade Team; TCV Team; the EUROfusion MST1 Team

    2018-01-01

    Routine reaction to approaching disruptions in tokamaks is currently largely limited to machine protection by mitigating an ongoing disruption, which remains a basic requirement for ITER and DEMO [1]. Nevertheless, a mitigated disruption still generates stress to the device. Additionally, in future fusion devices, high-performance discharge time itself will be very valuable. Instead of reacting only on generic features, occurring shortly before the disruption, the ultimate goal is to actively avoid approaching disruptions at an early stage, sustain the discharges whenever possible and restrict mitigated disruptions to major failures. Knowledge of the most relevant root causes and the corresponding chain of events leading to disruption, the disruption path, is a prerequisite. For each disruption path, physics-based sensors and adequate actuators must be defined and their limitations considered. Early reaction facilitates the efficiency of the actuators and enhances the probability of a full recovery. Thus, sensors that detect potential disruptions in time are to be identified. Once the entrance into a disruption path is detected, we propose a hierarchy of actions consisting of (I) recovery of the discharge to full performance or at least continuation with a less disruption-prone backup scenario, (II) complete avoidance of disruption to sustain the discharge or at least delay it for a controlled termination and, (III), only as last resort, a disruption mitigation. Based on the understanding of disruption paths, a hierarchical and path-specific handling strategy must be developed. Such schemes, testable in present devices, could serve as guidelines for ITER and DEMO operation. For some disruption paths, experiments have been performed at ASDEX Upgrade and TCV. Disruptions were provoked in TCV by impurity injection into ELMy H-mode discharges and in ASDEX Upgrade by forcing a density limit in H-mode discharges. The new approach proposed in this paper is discussed for

  14. Policy needs and options for a common approach towards modelling and simulation of human physiology and diseases with a focus on the virtual physiological human.

    Science.gov (United States)

    Viceconti, Marco; McCulloch, Andrew D

    2011-01-01

    Life is the result of an intricate systemic interaction between many processes occurring at radically different spatial and temporal scales. Every day, worldwide biomedical research and clinical practice produce a huge amount of information on such processes. However, this information being highly fragmented, its integration is largely left to the human actors who find this task increasingly and ever more demanding in a context where the information available continues to increase exponentially. Investments in the Virtual Physiological Human (VPH) research are largely motivated by the need for integration in healthcare. As all health information becomes digital, the complexity of health care will continue to evolve, translating into an ever increasing pressure which will result from a growing demand in parallel to limited budgets. Hence, the best way to achieve the dream of personalised, preventive, and participative medicine at sustainable costs will be through the integration of all available data, information and knowledge.

  15. Use of an holistic approach for effective adoption of User-Centred-Design techniques in diabetes disease management: Experiences in user need elicitation.

    Science.gov (United States)

    Fico, Giuseppe; Arredondo, Maria Teresa

    2015-01-01

    One of the most important challenges of designing eHealth tools for Chronic Disease Management is to understand how transforming cutting-edge innovations in something that can impact the current clinical practice and improve the performance of the health care systems. The adoption of User Centered Design techniques is fundamental in order to integrate these systems in an effective and successful way. The work presented in this paper describe the methodologies used in the context of two multidisciplinary research projects, METABO and MOSAIC. The adoption of the methodologies have been driven by the CeHRes Roamap, a holistic framework that support participatory development of eHealth. The work reported in this paper describes the results of the first two (out of the five) phases in eliciting user needs.

  16. The Need for an Alternative Narrative to the History of Ideas or To Pay a Debt to Women: A Feminist Approach to Ricœur's Thought

    Directory of Open Access Journals (Sweden)

    Fernanda Henriques

    2013-06-01

    Full Text Available This paper explores the thought of Paul Ricœur from a feminist point of view. My goal is to show that it is necessary to narrate differently the history of our culture – in particular, the history of philosophy – in order for wommen to attain a self-representation that is equal to that of men. I seek to show that Ricoeur’s philosophy – especially his approach to the topics of memory and history, on the one hand, and the human capacity for initiative, on the other hand– can support the idea that it is possible and legitimate to tell our history otherwise by envisioning a more accurate truth about ourselves. 

  17. The significance of recruiting underrepresented minorities in medicine: an examination of the need for effective approaches used in admissions by higher education institutions

    Directory of Open Access Journals (Sweden)

    Obed Figueroa

    2014-09-01

    Full Text Available The purpose of this paper is to examine the significance of recruiting underrepresented minorities in medicine (URM. This would include African Americans, Hispanics, and Native Americans. The research findings support the belief that URMs, upon graduating, are more likely to become practitioners in underserved communities, thereby becoming a resource that prompts us to find effective ways to help increase their college enrollments statewide. This paper analyzes the recruitment challenges for institutions, followed by a review of creative and effective approaches used by organizations and universities. The results have shown positive outcomes averaging a 50% increase in minority enrollments and retention. In other areas, such as cognitive development, modest gains were achieved in programs that were shorter in duration. The results nevertheless indicated steps in the right direction inspiring further program developments.

  18. A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach?

    Science.gov (United States)

    Claudet, Isabelle; Le Breton, Mathilde; Bréhin, Camille; Franchitto, Nicolas

    2017-04-01

    Pediatricians working in an emergency environment are confronted with children admitted to emergency departments for intoxication on a daily basis. We carried out a retrospective cohort study of children admitted to a pediatric emergency department due to unintentional cannabis exposure over a 10-year period from 2004 to 2014. Twenty-nine children under the age of 3 were admitted with a positive cannabis urine test. Eighty-seven percent of intoxications occurred at the family home. Resin was the main form of ingested cannabis (69%). The mean age was 16.5 ± 5.2 months, and mean weight was 11.1 ± 2.1 Kg. Sixty percent of admissions occurred between 2012 and 2014. More severe presentations, based on Poisoning Severity Score, occurred over the past 2 years. Four children experienced seizures before admission. Ten children (34%) had a decreased level of consciousness (GCS cannabis consumption. This study supports the impression that accidental child poisonings with cannabis have been more serious than previously thought for 2 years. This observation may be explained by (1) the increased THC concentration in cannabis and (2) the widespread use in young adults, even after they become parents. Introducing an addiction team inside the PED could help to improve the care links with these parents. What is Known: • Cases of unintentional cannabis intoxication in children have been increasing for many years due to an increase of potency. What is New: • We highlight an increase in more severe presentations in children under the age of 3 occurring over the past 2 years, which will indicate the importance of assessing cannabis abuse in parents by a specialized addiction team.

  19. Does Quantitative Research in Child Maltreatment Tell the Whole Story? The Need for Mixed-Methods Approaches to Explore the Effects of Maltreatment in Infancy.

    Science.gov (United States)

    Glass, Samuel; Gajwani, Ruchika; Turner-Halliday, Fiona

    Background and Aims. Research on child maltreatment has largely overlooked the under-five age group and focuses primarily on quantitative measurement. This mixed-methods study of maltreated children (N = 92) entering care (age 6-60 months) combines a quantitative focus on the associations between care journey characteristics and mental health outcomes with a qualitative exploration of maltreatment in four different families. Methods. Care journey data was obtained from social care records; mental health and attachment assessments were carried out following entry to care; qualitative data comprised semistructured interviews with professionals, foster carers, and parents. Results. Significant associations were found between suspected sexual abuse and increased DAI inhibited attachment symptoms (p = 0.001) and between reported domestic violence and decreased DAI inhibited (p = 0.016) and disinhibited (p = 0.004) attachment symptoms. Qualitative results: two themes demonstrate the complexity of assessing maltreatment: (1) overlapping maltreatment factors occur in most cases and (2) maltreatment effects may be particularly challenging to isolate. Conclusions. Qualitative exploration has underscored the complexity of assessing maltreatment, indicating why expected associations were not found in this study and posing questions for the quantitative measurement of maltreatment in general. We therefore suggest a new categorisation of maltreatment and call for the complimentary research lenses of further mixed-methods approaches.

  20. Does Quantitative Research in Child Maltreatment Tell the Whole Story? The Need for Mixed-Methods Approaches to Explore the Effects of Maltreatment in Infancy

    Directory of Open Access Journals (Sweden)

    Samuel Glass

    2016-01-01

    Full Text Available Background and Aims. Research on child maltreatment has largely overlooked the under-five age group and focuses primarily on quantitative measurement. This mixed-methods study of maltreated children (N=92 entering care (age 6–60 months combines a quantitative focus on the associations between care journey characteristics and mental health outcomes with a qualitative exploration of maltreatment in four different families. Methods. Care journey data was obtained from social care records; mental health and attachment assessments were carried out following entry to care; qualitative data comprised semistructured interviews with professionals, foster carers, and parents. Results. Significant associations were found between suspected sexual abuse and increased DAI inhibited attachment symptoms (p=0.001 and between reported domestic violence and decreased DAI inhibited (p=0.016 and disinhibited (p=0.004 attachment symptoms. Qualitative results: two themes demonstrate the complexity of assessing maltreatment: (1 overlapping maltreatment factors occur in most cases and (2 maltreatment effects may be particularly challenging to isolate. Conclusions. Qualitative exploration has underscored the complexity of assessing maltreatment, indicating why expected associations were not found in this study and posing questions for the quantitative measurement of maltreatment in general. We therefore suggest a new categorisation of maltreatment and call for the complimentary research lenses of further mixed-methods approaches.

  1. What good is legislation--or planning--if we can't make it work? The need for a comprehensive approach to health and welfare.

    Science.gov (United States)

    Snoke, A W

    1982-09-01

    Health and welfare programs continue to be developed and implemented on a piecemeal basis in this country. There is difficulty in recognizing not only that health and social affairs are intimately related, but that the system must be dealt with as a whole of its interrelated problems are to be solved. Increasing costs for health and social programs are becoming of even greater concern, and cost containment (voluntary or regulatory) preoccupies both the payers and the recipients. Complicating the current situation is uncertainty of the role of financing and regulation on the part of the federal government and the states (the New Federalism), and the fragmentation and uncertainty of the private delivery sector and its third party reimbursement agencies. Questions are raised as to whether viable solutions can be obtained until all components (governmental and private) can work together in a partnership rather than an adversarial relationship in the development of an overall strategy with understandable objectives. Of basic importance is consideration of matters of organization, administration, and leadership at all levels so that whatever program may be developed or evolved can be successfully implemented. The subject is of such magnitude and is so complicated that it deserves a major coordinated effort of the federal government, the state governments, and the diverse private sector components to ensure a coordinated and systematic approach to any realistic solution.

  2. 'Vague Oviedo': autonomy, culture and the case of previously competent patients.

    Science.gov (United States)

    Pascalev, Assya; Vidalis, Takis

    2010-03-01

    The paper examines the ethical and legal challenges of making decisions for previously competent patients and the role of advance directives and legal representatives in light of the Oviedo Convention. The paper identifies gaps in the Convention that result in conflicting instructions in cases of a disagreement between the expressed prior wishes of a patient, and the legal representative. The authors also examine the legal and moral status of informally expressed prior wishes of patients unable to consent. The authors argue that positivist legal reasoning is insufficient for a consistent interpretation of the relevant provisions of the Convention and argue that ethical argumentation is needed to provide guidance in such cases. Based on the ethical arguments, the authors propose a way of reconciling the apparent inconsistencies in the Oviedo Convention. They advance a culturally sensitive approach to the application of the Convention at the national level. This approach understands autonomy as a broader, relational consent and emphasizes the social and cultural embeddedness of the individual. Based on their approach, the authors argue that there exists a moral obligation to respect the prior wishes of the patient even in countries without advance directives. Yet it should be left to the national legislations to determine the extent of this obligation and its concrete forms.

  3. Community Engagement to Optimize the Use of Web-Based and Wearable Technology in a Cardiovascular Health and Needs Assessment Study: A Mixed Methods Approach.

    Science.gov (United States)

    Yingling, Leah R; Brooks, Alyssa T; Wallen, Gwenyth R; Peters-Lawrence, Marlene; McClurkin, Michael; Cooper-McCann, Rebecca; Wiley, Kenneth L; Mitchell, Valerie; Saygbe, Johnetta N; Johnson, Twanda D; Curry, Rev Kendrick E; Johnson, Allan A; Graham, Avis P; Graham, Lennox A; Powell-Wiley, Tiffany M

    2016-04-25

    Resource-limited communities in Washington, D.C. have high rates of obesity-related cardiovascular disease in addition to inadequate physical activity (PA) facilities and limited Internet access. Engaging community members in the design and implementation of studies to address these health disparities is essential to the success of community-based PA interventions. The objective of the study was to use qualitative and quantitative methods to evaluate the feasibility and acceptability of PA-monitoring wristbands and Web-based technology by predominantly African American, church-based populations in resource-limited Washington, D.C. neighborhoods. To address cardiovascular health in at-risk populations in Washington, D.C., we joined community leaders to establish a community advisory board, the D.C. Cardiovascular Health and Obesity Collaborative (D.C. CHOC). As their first initiative, the Washington, D.C. Cardiovascular Health and Needs Assessment intends to evaluate cardiovascular health, social determinants of health, and PA-monitoring technologies. At the recommendation of D.C. CHOC members, we conducted a focus group and piloted the proposed PA-monitoring system with community members representing churches that would be targeted by the Cardiovascular Health and Needs Assessment. Participants (n=8) agreed to wear a PA-monitoring wristband for two weeks and to log cardiovascular health factors on a secure Internet account. Wristbands collected accelerometer-based data that participants uploaded to a wireless hub at their church. Participants agreed to return after two weeks to participate in a moderated focus group to share experiences using this technology. Feasibility was measured by Internet account usage, wristband utilization, and objective PA data. Acceptability was evaluated through thematic analysis of verbatim focus group transcripts. Study participants (5 males, 3 females) were African American and age 28-70 years. Participant wristbands recorded data on

  4. “İhtiyaç” Kavramı Ekseninde Sosyal Koruma: Temel İhtiyaçlar Yaklaşımı / Social Protection on the Base of “Needs”: Basic Needs Approach

    Directory of Open Access Journals (Sweden)

    Doğa Başar SARIİPEK

    2017-05-01

    Full Text Available İhtiyaç, somutlaştırılması ve tanımlanması güç bir kavramdır. Bu bağlamda, ihtiyaçların hangi ölçütlere göre belirleneceği, temel ve ileri ihtiyaçların neler olduğu, ihtiyaç içinde olanlarla olmayanların neye göre ve nasıl kesin olarak ayrılacağı gibi sorular sosyal refah ve koruma politikaları tasarlanırken sürekli sorulan ve tartışılan sorulardır. İhtiyaç temelli yaklaşım bu sorulara cevap olarak geliştirilmiş bir sosyal koruma yaklaşımıdır. Ancak genel anlamda ihtiyaç kavramının özünde bulunan sübjektif nitelikler ve içerdiği belirsizlikler nedeniyle, uygulaması kolay bir yöntem değildir. Bu nedenle, uygulamada herkesi kapsayabilmek adına “temel ihtiyaçlar” şeklinde bir daraltmaya gidilmiştir. Temel ihtiyaçlar yaklaşımının amacı, bireyin tam gelişimi için gereken fırsatları sağlamak ve bu amaçla belli gruplar için belli kaynakları tahsis etmektir. Temel ihtiyaçlar yaklaşımının özü, gerçek yaşam düzeyiyle ihtiyaçlar arasındaki boşluğun diğer alternatif yaklaşımlara göre çok daha kısa sürede ve mümkün olan en az miktarda kaynak kullanılarak doldurulmasıdır. Ancak bu yaklaşım, teoriden kaynaklanan ciddi eksiklikleri nedeniyle hak temelli yaklaşımın sağladığı sosyal koruma güvence düzeyini sağlamaktan uzak görünmektedir. / Needs are not easy to define. In this sense, the questions of which criteria are applied to determine needs, what the basic and further needs are, how the ones who are in need are distinguished from the others etc. are constantly asked while designing policies of social welfare and protection. Needs based approach is a social protection mechanism which was introduced as a response for these questions. Yet, it is not an easy measure to take due to the subjective features and uncertainties in the very nature of the concept of need itself. Therefore, a conceptual restriction, in the form of “basic needs”, was

  5. Proteomics Analysis Reveals Previously Uncharacterized Virulence Factors in Vibrio proteolyticus

    Directory of Open Access Journals (Sweden)

    Ann Ray

    2016-07-01

    Full Text Available Members of the genus Vibrio include many pathogens of humans and marine animals that share genetic information via horizontal gene transfer. Hence, the Vibrio pan-genome carries the potential to establish new pathogenic strains by sharing virulence determinants, many of which have yet to be characterized. Here, we investigated the virulence properties of Vibrio proteolyticus, a Gram-negative marine bacterium previously identified as part of the Vibrio consortium isolated from diseased corals. We found that V. proteolyticus causes actin cytoskeleton rearrangements followed by cell lysis in HeLa cells in a contact-independent manner. In search of the responsible virulence factor involved, we determined the V. proteolyticus secretome. This proteomics approach revealed various putative virulence factors, including active type VI secretion systems and effectors with virulence toxin domains; however, these type VI secretion systems were not responsible for the observed cytotoxic effects. Further examination of the V. proteolyticus secretome led us to hypothesize and subsequently demonstrate that a secreted hemolysin, belonging to a previously uncharacterized clan of the leukocidin superfamily, was the toxin responsible for the V. proteolyticus-mediated cytotoxicity in both HeLa cells and macrophages. Clearly, there remains an armory of yet-to-be-discovered virulence factors in the Vibrio pan-genome that will undoubtedly provide a wealth of knowledge on how a pathogen can manipulate host cells.

  6. Complicated diverticular disease of the colon, do we need to change the classical approach, a retrospective study of 110 patients in southeast England

    Directory of Open Access Journals (Sweden)

    Subhas Gokulakkrishna

    2008-01-01

    Full Text Available Abstract Background Complicated diverticular disease of the colon imposes a serious risk to patient's life, challenge to surgeons and has cost implications for health authority. The aim of this study is to evaluate the management outcome of complicated colonic diverticular disease in a district hospital and to explore the current strategies of treatment. Methods This is a retrospective study of all patients who were admitted to the surgical ward between May 2002 and November 2006 with a diagnosis of complicated diverticular disease. A proforma of patients' details, admission date, ITU admission, management outcomes and the follow up were recorded from the patients case notes and analyzed. The mean follow-up was 34 months (range 6–60 months Results The mean age of patients was 72.7 years (range 39–87 years. Thirty-one men (28.18 % and Seventy-nine women (71.81% were included in this study. Male: female ratio was 1:2.5. Sixty-eight percent of patients had one or more co-morbidities. Forty-one patients (37.27% had two or more episodes of diverticulitis while 41.8% of them had no history of diverticular disease. Eighty-six percent of patients presented with acute abdominal pain while bleeding per rectum was the main presentation in 14%. Constipation and erratic bowel habit were the commonest chronic symptoms in patients with history of diverticular disease. Generalized tenderness was reported in 64.28% while 35.71% have left iliac fossa tenderness. Leukocytosis was reported in 58 patients (52.72%. The mean time from the admission until the start of operative intervention was 20.57 hours (range 4–96 hours. Perforation was confirmed in 59.52%. Mortality was 10.90%. Another 4 (3.63% died during follow up for other reasons. Conclusion Complicated diverticular disease carries significant morbidity and mortality. These influenced by patient-related factors. Because of high mortality and morbidities, we suggest the need to target a specific group of

  7. Assessment of radiation damage - the need for a multi-parametric and integrative approach with the help of both clinical and biological dosimetry

    International Nuclear Information System (INIS)

    Meineke, Viktor

    2008-01-01

    provide the best basis for triage and planning and providing of medical treatment after accidental radiation exposure always different and independent diagnostic procedures integrating all clinical aspects as well as different biological indicators have to be applied. Up to now this multi parametric approach is missing in medical radiation accident management. A new integrative concept is shown and discussed. (author)

  8. Nutrition training in medical and other health professional schools in West Africa: the need to improve current approaches and enhance training effectiveness

    Directory of Open Access Journals (Sweden)

    Roger Sodjinou

    2014-07-01

    surveyed institutions had a dedicated nutrition faculty. The majority (55% of the respondents rated nutrition instruction in their institutions as insufficient. Conclusions: The results of our study reveal important gaps in current approaches to nutrition training in health professional schools in West Africa. Addressing these gaps is critical for the development of a skilled nutrition workforce in the region. Nutrition curricula that provide opportunities to obtain more insights about the basic principles of human nutrition and their application to public health and clinical practice are recommended.

  9. Risks/Needs of Children/Youth with Behavior Disorders in Correctional Institutions in Croatia

    Science.gov (United States)

    Ratkajec, Gabrijela; Jedud, Ivana

    2010-01-01

    Previous research and experience in Croatia show that interventions are not matched with the risk level and intervention needs of children with behavior disorders. As a result of that, the situation in Croatia requires actuarial approach to the risks and needs assessment of children and youth. The purpose of the current research is to put stronger…

  10. HEART TRANSPLANTATION IN PATIENTS WITH PREVIOUS OPEN HEART SURGERY

    Directory of Open Access Journals (Sweden)

    R. Sh. Saitgareev

    2016-01-01

    cited in the review may have important clinical applications, because they outline the range of problems and possible solutions in the performance of the HTx in recipients previously operated on open heart. This knowledge can facilitate the decision making process with regard to the opportunities and risks of the implementation of HTx. Given the uniqueness of each of the recipient and the donor, it is required to make a personalized approach to the question of the possible risks and to the preventive measures to reduce those risks in any given clinical situation. 

  11. Operating plant safety analysis needs

    International Nuclear Information System (INIS)

    Young, M.Y.; Love, D.S.

    1992-01-01

    The primary objective for nuclear power station owners is to operate and manage their plants safely. However, there is also a need to provide economical electric power, which requires that the unit be operated as efficiently as possible, consistent with the safety requirements. The objectives cited above can be achieved through the identification and use of available margins inherent in the plant design. As a result of conservative licensing and analytical approaches taken in the past, many of these margins may be found in the safety analysis limits within which plants currently operate. Improvements in the accuracy of the safety analysis, and a more realistic treatment of plant initial and boundary conditions, can make this margin available for a variety of uses which enhance plant performance, help to reduce O and M costs, and may help to extend licensed operation. Opportunities for improvement exist in several areas in the accident analysis normally performed for Chapter 15 of the FSAR. For example, recent modifications to the ECCS rule, 10CFR50.46 and Appendix K, allow use of margins previously unavailable in the analysis of the Loss of Coolant Accident (LOCA). To take advantage of this regulatory change, new methods are being developed to analyze both the large and small break loss of coolant accident (LOCA). As this margin is used, enhancements in the analysis of other transients will become necessary. The paper discusses accident analysis methods, future development needs, and analysis margin utilization in specific accident scenarios

  12. SONOGRAPHIC PREDICTION OF SCAR DEHISCENCE IN WOMEN WITH PREVIOUS CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Shubhada Suhas Jajoo

    2018-01-01

    Full Text Available BACKGROUND Caesarean section (Sectio Caesarea is a surgical method for the completion of delivery. After various historical modifications of operative techniques, modern approach consists in the transverse dissection of the anterior wall of the uterus. The rate of vaginal birth after caesarean section was significantly reduced from year to year and the rate of repeated caesarean section is increased during the past 10 years. Evaluation of scar thickness is done by ultrasound, but it is still debatable size of thick scar that would be guiding “cut-off value” for the completion of the delivery method. To better assess the risk of uterine rupture, some authors have proposed sonographic measurement of lower uterine segment thickness near term assuming that there is an inverse correlation between LUS thickness and the risk of uterine scar defect. Therefore, this assessment for the management of women with prior CS may increase safety during labour by selecting women with the lowest risk of uterine rupture. The aim of the study is to study the diagnostic accuracy of sonographic measurements of the Lower Uterine Segment (LUS thickness near term in predicting uterine scar defects in women with prior Caesarean Section (CS. We aim to ascertain the best cut-off values for predicting uterine rupture. MATERIALS AND METHODS 100 antenatal women with history of previous one LSCS who come to attend antenatal clinic will be assessed for scar thickness by transabdominal ultrasonography and its correlation with intraoperative findings. This prospective longitudinal study was conducted for 1 year after IEC approval with inclusion criteria previous one LSCS. Exclusion criteria- 1 Previous myomectomy scar; 2 Previous 2 LSCS; 3 Previous hysterotomy scar. RESULTS Our findings indicate that there is a strong association between degree of LUS thinning measured near term and the risk of uterine scar defect at birth. In our study, optimal cut-off value for predicting

  13. Who cares for the carers at hospital discharge at the end of life? A qualitative study of current practice in discharge planning and the potential value of using The Carer Support Needs Assessment Tool (CSNAT) Approach.

    Science.gov (United States)

    Ewing, Gail; Austin, Lynn; Jones, Debra; Grande, Gunn

    2018-05-01

    Carer factors prevent patients achieving timely and appropriate hospital discharge. There is a lack of research into interventions to support carers at hospital discharge. To explore whether and how family carers are currently supported during patient discharge at end of life; to assess perceived benefits, acceptability and feasibility of using The Carer Support Needs Assessment Tool (CSNAT) Approach in the hospital setting to support carers. Qualitative. Three National Health Service Trusts in England: focus groups with 40 hospital and community-based practitioners and 22 carer interviews about experiences of carer support during hospital discharge and views of The CSNAT Approach. Two workshops brought together 14 practitioners and five carers to discuss implementation issues. Framework analysis was conducted. Current barriers to supporting carers at hospital discharge were an organisational focus on patients' needs, what practitioners perceived as carers' often 'unrealistic expectations' of end-of-life caregiving at home and lack of awareness of patients' end-of-life situation. The CSNAT Approach was viewed as enabling carer support and addressing difficulties of discussing the realities of supporting someone at home towards end of life. Implementation in hospital required organisational considerations of practitioner workload and training. To enhance carer support, a two-stage process of assessment and support (hospital with community follow-up) was suggested using the CSNAT as a carer-held record to manage the transition. This study identifies a novel intervention, which expands the focus of discharge planning to include assessment of carers' support needs at transition, potentially preventing breakdown of care at home and patient readmissions to hospital.

  14. Typing DNA profiles from previously enhanced fingerprints using direct PCR.

    Science.gov (United States)

    Templeton, Jennifer E L; Taylor, Duncan; Handt, Oliva; Linacre, Adrian

    2017-07-01

    Fingermarks are a source of human identification both through the ridge patterns and DNA profiling. Typing nuclear STR DNA markers from previously enhanced fingermarks provides an alternative method of utilising the limited fingermark deposit that can be left behind during a criminal act. Dusting with fingerprint powders is a standard method used in classical fingermark enhancement and can affect DNA data. The ability to generate informative DNA profiles from powdered fingerprints using direct PCR swabs was investigated. Direct PCR was used as the opportunity to generate usable DNA profiles after performing any of the standard DNA extraction processes is minimal. Omitting the extraction step will, for many samples, be the key to success if there is limited sample DNA. DNA profiles were generated by direct PCR from 160 fingermarks after treatment with one of the following dactyloscopic fingerprint powders: white hadonite; silver aluminium; HiFi Volcano silk black; or black magnetic fingerprint powder. This was achieved by a combination of an optimised double-swabbing technique and swab media, omission of the extraction step to minimise loss of critical low-template DNA, and additional AmpliTaq Gold ® DNA polymerase to boost the PCR. Ninety eight out of 160 samples (61%) were considered 'up-loadable' to the Australian National Criminal Investigation DNA Database (NCIDD). The method described required a minimum of working steps, equipment and reagents, and was completed within 4h. Direct PCR allows the generation of DNA profiles from enhanced prints without the need to increase PCR cycle numbers beyond manufacturer's recommendations. Particular emphasis was placed on preventing contamination by applying strict protocols and avoiding the use of previously used fingerprint brushes. Based on this extensive survey, the data provided indicate minimal effects of any of these four powders on the chance of obtaining DNA profiles from enhanced fingermarks. Copyright © 2017

  15. Urethrotomy has a much lower success rate than previously reported.

    Science.gov (United States)

    Santucci, Richard; Eisenberg, Lauren

    2010-05-01

    We evaluated the success rate of direct vision internal urethrotomy as a treatment for simple male urethral strictures. A retrospective chart review was performed on 136 patients who underwent urethrotomy from January 1994 through March 2009. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, third, fourth and fifth urethrotomy. Patients with complex strictures (36) were excluded from the study for reasons including previous urethroplasty, neophallus or previous radiation, and 24 patients were lost to followup. Data were available for 76 patients. The stricture-free rate after the first urethrotomy was 8% with a median time to recurrence of 7 months. For the second urethrotomy stricture-free rate was 6% with a median time to recurrence of 9 months. For the third urethrotomy stricture-free rate was 9% with a median time to recurrence of 3 months. For procedures 4 and 5 stricture-free rate was 0% with a median time to recurrence of 20 and 8 months, respectively. Urethrotomy is a popular treatment for male urethral strictures. However, the performance characteristics are poor. Success rates were no higher than 9% in this series for first or subsequent urethrotomy during the observation period. Most of the patients in this series will be expected to experience failure with longer followup and the expected long-term success rate from any (1 through 5) urethrotomy approach is 0%. Urethrotomy should be considered a temporizing measure until definitive curative reconstruction can be planned. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. Previous Repeated Exposure to Food Limitation Enables Rats to Spare Lipid Stores during Prolonged Starvation.

    Science.gov (United States)

    McCue, Marshall D; Albach, Audrey; Salazar, Giovanni

    The risk of food limitation and, ultimately, starvation dates back to the dawn of heterotrophy in animals, yet starvation remains a major factor in the regulation of modern animal populations. Researchers studying starvation more than a century ago suggested that animals subjected to sublethal periods of food limitation are somehow more tolerant of subsequent starvation events. This possibility has received little attention over the past decades, yet it is highly relevant to modern science for two reasons. First, animals in natural populations are likely to be exposed to bouts of food limitation once or more before they face prolonged starvation, during which the risk of mortality becomes imminent. Second, our current approach to studying starvation physiology in the laboratory focuses on nourished animals with no previous exposure to nutritional stress. We examined the relationship between previous exposure to food limitation and potentially adaptive physiological responses to starvation in adult rats and found several significant differences. On two occasions, rats were fasted until they lost 20% of their body mass maintained lower body temperatures, and had presumably lower energy requirements when subjected to prolonged starvation than their naive cohort that never experienced food limitation. These rats that were trained in starvation also had lower plasma glucose set -points and reduced their reliance on endogenous lipid oxidation. These findings underscore (1) the need for biologists to revisit the classic hypothesis that animals can become habituated to starvation, using a modern set of research tools; and (2) the need to design controlled experiments of starvation physiology that more closely resemble the dynamic nature of food availability.

  17. Sacrococcygeal pilonidal disease: analysis of previously proposed risk factors

    Directory of Open Access Journals (Sweden)

    Ali Harlak

    2010-01-01

    Full Text Available PURPOSE: Sacrococcygeal pilonidal disease is a source of one of the most common surgical problems among young adults. While male gender, obesity, occupations requiring sitting, deep natal clefts, excessive body hair, poor body hygiene and excessive sweating are described as the main risk factors for this disease, most of these need to be verified with a clinical trial. The present study aimed to evaluate the value and effect of these factors on pilonidal disease. METHOD: Previously proposed main risk factors were evaluated in a prospective case control study that included 587 patients with pilonidal disease and 2,780 healthy control patients. RESULTS: Stiffness of body hair, number of baths and time spent seated per day were the three most predictive risk factors. Adjusted odds ratios were 9.23, 6.33 and 4.03, respectively (p<0.001. With an adjusted odds ratio of 1.3 (p<.001, body mass index was another risk factor. Family history was not statistically different between the groups and there was no specific occupation associated with the disease. CONCLUSIONS: Hairy people who sit down for more than six hours a day and those who take a bath two or less times per week are at a 219-fold increased risk for sacrococcygeal pilonidal disease than those without these risk factors. For people with a great deal of hair, there is a greater need for them to clean their intergluteal sulcus. People who engage in work that requires sitting in a seat for long periods of time should choose more comfortable seats and should also try to stand whenever possible.

  18. Previously unidentified changes in renal cell carcinoma gene expression identified by parametric analysis of microarray data

    International Nuclear Information System (INIS)

    Lenburg, Marc E; Liou, Louis S; Gerry, Norman P; Frampton, Garrett M; Cohen, Herbert T; Christman, Michael F

    2003-01-01

    carcinogenesis. This highlights the need for rigorous statistical approaches in microarray studies

  19. Influence of Previous Knowledge in Torrance Tests of Creative Thinking

    Directory of Open Access Journals (Sweden)

    María Aranguren

    2015-07-01

    Full Text Available The aim of this work is to analyze the influence of study field, expertise and recreational activities participation in Torrance Tests of Creative Thinking (TTCT, 1974 performance. Several hypotheses were postulated to explore the possible effects of previous knowledge in TTCT verbal and TTCT figural university students’ outcomes. Participants in this study included 418 students from five study fields: Psychology;Philosophy and Literature, Music; Engineering; and Journalism and Advertising (Communication Sciences. Results found in this research seem to indicate that there in none influence of the study field, expertise and recreational activities participation in neither of the TTCT tests. Instead, the findings seem to suggest some kind of interaction between certain skills needed to succeed in specific studies fields and performance on creativity tests, such as the TTCT. These results imply that TTCT is a useful and valid instrument to measure creativity and that some cognitive process involved in innovative thinking can be promoted using different intervention programs in schools and universities regardless the students study field.

  20. Impact of previously disadvantaged land-users on sustainable ...

    African Journals Online (AJOL)

    Impact of previously disadvantaged land-users on sustainable agricultural ... about previously disadvantaged land users involved in communal farming systems ... of input, capital, marketing, information and land use planning, with effect on ...

  1. 22 CFR 40.91 - Certain aliens previously removed.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Certain aliens previously removed. 40.91... IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Aliens Previously Removed § 40.91 Certain aliens previously removed. (a) 5-year bar. An alien who has been found inadmissible, whether as a result...

  2. Determining root correspondence between previously and newly detected objects

    Science.gov (United States)

    Paglieroni, David W.; Beer, N Reginald

    2014-06-17

    A system that applies attribute and topology based change detection to networks of objects that were detected on previous scans of a structure, roadway, or area of interest. The attributes capture properties or characteristics of the previously detected objects, such as location, time of detection, size, elongation, orientation, etc. The topology of the network of previously detected objects is maintained in a constellation database that stores attributes of previously detected objects and implicitly captures the geometrical structure of the network. A change detection system detects change by comparing the attributes and topology of new objects detected on the latest scan to the constellation database of previously detected objects.

  3. An in-depth mixed-methods approach to Ryan White HIV/AIDS care program comprehensive needs assessment from the Northeast Georgia Public Health District: the significance of patient privacy, psychological health, and social stigma to care.

    Science.gov (United States)

    Huff, Amber; Chumbler, Neale; Cherry, Colleen O'Brien; Hill, Miranda; Veguilla, Vic

    2015-04-01

    We apply a social-ecological interpretive framework to understanding relationships among patient privacy, psychological health, social stigma, and continuity in care in the HIV treatment cascade in the rural southeastern US. This research was conducted as part of the 2013 comprehensive needs assessment for the Northeast Georgia Ryan White Consortium using an anthropologically informed mixed-methods design, and a deductive-inductive approach to thematic analysis of qualitative data obtained in interviews and focus groups with service providers and service utilizers. Our comprehensive needs assessment yielded two key components. First, we identified salient phenomena influencing introduction to, retention among, and satisfaction of patients in the Ryan White-coordinated treatment cascade in NE-GA. Second, we formulated actionable recommendations around leverage points identified in the current district-wide system of care. Results highlight spatial, institutional, and interpersonal aspects of the system of care that intersect around issues of patient privacy, psychological health, and social stigma. These intersections constitute pathways by which persons living with HIV are exposed to stigma and other negative social signals regarding their health status without sufficient access to behavioral health services. These negative issues, in turn, can erect significant barriers to long-term continuity in care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Successive Research: A Strategy for Building on Previous Research.

    Science.gov (United States)

    Noble, Mary Anne

    1979-01-01

    Describes an approach to clinical research used by the author in teaching graduate nursing students, involving replication and expansion of a primary study of hospital intensive care units. This approach provided valuable experience as well as validated data about clinical practice. Discusses advantages and disadvantages in the approach. (MF)

  5. 49 CFR 173.23 - Previously authorized packaging.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Previously authorized packaging. 173.23 Section... REQUIREMENTS FOR SHIPMENTS AND PACKAGINGS Preparation of Hazardous Materials for Transportation § 173.23 Previously authorized packaging. (a) When the regulations specify a packaging with a specification marking...

  6. 28 CFR 10.5 - Incorporation of papers previously filed.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Incorporation of papers previously filed... CARRYING ON ACTIVITIES WITHIN THE UNITED STATES Registration Statement § 10.5 Incorporation of papers previously filed. Papers and documents already filed with the Attorney General pursuant to the said act and...

  7. 75 FR 76056 - FEDERAL REGISTER CITATION OF PREVIOUS ANNOUNCEMENT:

    Science.gov (United States)

    2010-12-07

    ... SECURITIES AND EXCHANGE COMMISSION Sunshine Act Meeting FEDERAL REGISTER CITATION OF PREVIOUS ANNOUNCEMENT: STATUS: Closed meeting. PLACE: 100 F Street, NE., Washington, DC. DATE AND TIME OF PREVIOUSLY ANNOUNCED MEETING: Thursday, December 9, 2010 at 2 p.m. CHANGE IN THE MEETING: Time change. The closed...

  8. No discrimination against previous mates in a sexually cannibalistic spider

    Science.gov (United States)

    Fromhage, Lutz; Schneider, Jutta M.

    2005-09-01

    In several animal species, females discriminate against previous mates in subsequent mating decisions, increasing the potential for multiple paternity. In spiders, female choice may take the form of selective sexual cannibalism, which has been shown to bias paternity in favor of particular males. If cannibalistic attacks function to restrict a male's paternity, females may have little interest to remate with males having survived such an attack. We therefore studied the possibility of female discrimination against previous mates in sexually cannibalistic Argiope bruennichi, where females almost always attack their mate at the onset of copulation. We compared mating latency and copulation duration of males having experienced a previous copulation either with the same or with a different female, but found no evidence for discrimination against previous mates. However, males copulated significantly shorter when inserting into a used, compared to a previously unused, genital pore of the female.

  9. 78 FR 70888 - Need for Agency Approval of a Railroad's Use of Certain Technology That Has Been Previously...

    Science.gov (United States)

    2013-11-27

    ... . Follow the Web site's online instructions for submitting comments. Fax: 202-493-2251. Mail: Docket... components thereof, developed under the terms and conditions of that subpart. See 70 FR 11095 (Mar. 7, 2005...

  10. New energy carriers in vehicles and their impact on confined infrastructures Overview of previous research and research needs

    OpenAIRE

    Salvi , Olivier; Lonnermark , Anders; Ingason , Haukur; Truchot , Benjamin; Leucker , Roland; Amberg , Félix; Molenaar , Dirk-Jan; Hejny , Horst

    2010-01-01

    International audience; The global warming debate forces the vehicle industry to come up with new environmentally friendly solutions. In 10 years time, or even faster depending on the pressure from different governments in particular in Europe, vehicles will not only use gasoline, diesel and LPG, but also CNG, Hydrogen, ethanol, DME and other bio-fuels, as well as batteries and fuel cells. This quick development and the diversity of new energy carriers can jeopardize the safety in underground...

  11. Accident management information needs

    International Nuclear Information System (INIS)

    Hanson, D.J.; Ward, L.W.; Nelson, W.R.; Meyer, O.R.

    1990-04-01

    In support of the US Nuclear Regulatory Commission (NRC) Accident Management Research Program, a methodology has been developed for identifying the plant information needs necessary for personnel involved in the management of an accident to diagnose that an accident is in progress, select and implement strategies to prevent or mitigate the accident, and monitor the effectiveness of these strategies. This report describes the methodology and presents an application of this methodology to a Pressurized Water Reactor (PWR) with a large dry containment. A risk-important severe accident sequence for a PWR is used to examine the capability of the existing measurements to supply the necessary information. The method includes an assessment of the effects of the sequence on the measurement availability including the effects of environmental conditions. The information needs and capabilities identified using this approach are also intended to form the basis for more comprehensive information needs assessment performed during the analyses and development of specific strategies for use in accident management prevention and mitigation. 3 refs., 16 figs., 7 tabs

  12. Accident management information needs

    Energy Technology Data Exchange (ETDEWEB)

    Hanson, D.J.; Ward, L.W.; Nelson, W.R.; Meyer, O.R. (EG and G Idaho, Inc., Idaho Falls, ID (USA))

    1990-04-01

    In support of the US Nuclear Regulatory Commission (NRC) Accident Management Research Program, a methodology has been developed for identifying the plant information needs necessary for personnel involved in the management of an accident to diagnose that an accident is in progress, select and implement strategies to prevent or mitigate the accident, and monitor the effectiveness of these strategies. This report describes the methodology and presents an application of this methodology to a Pressurized Water Reactor (PWR) with a large dry containment. A risk-important severe accident sequence for a PWR is used to examine the capability of the existing measurements to supply the necessary information. The method includes an assessment of the effects of the sequence on the measurement availability including the effects of environmental conditions. The information needs and capabilities identified using this approach are also intended to form the basis for more comprehensive information needs assessment performed during the analyses and development of specific strategies for use in accident management prevention and mitigation. 3 refs., 16 figs., 7 tabs.

  13. Current and previous eating practices among women recovered from anorexia nervosa: a qualitative approach

    Directory of Open Access Journals (Sweden)

    Mariana Dimitrov Ulian

    2013-12-01

    Full Text Available OBJECTIVE: The aim of this study was to analyze qualitatively how women, who have recovered from anorexia nervosa, perceive and describe their current eating practices, as well as the ones developed during the eating disorder period. METHODS: Seven women were interviewed individually with the objective of investigating their eating practices, transition phases and all relevant aspects that somewhat contributed to the habit-forming; experiences, feelings and perceptions related to mealtime and the influence that food has had over the present subjects' life. The interviews were analyzed by the discourse of the collective subject method. RESULTS: The results brought up the following topics: a control; b concerns and feelings; c deprivation d beauty dictatorship; e eating competence; f importance of food; g food cacophony. CONCLUSIONS: What stands out is a multiplicity of eating practices, which during the eating disorder were similar to and characterized by restriction; however, after recovery, part of the subjects seem to have developed a higher eating competence, whereas others show a practice similar to the one acquired during the anorexia nervosa, such as the difficulty in realizing when they are satisfied and a feeling of discomfort when facing social interactions.

  14. Personality disorders in previously detained adolescent females: a prospective study

    NARCIS (Netherlands)

    Krabbendam, A.; Colins, O.F.; Doreleijers, T.A.H.; van der Molen, E.; Beekman, A.T.F.; Vermeiren, R.R.J.M.

    2015-01-01

    This longitudinal study investigated the predictive value of trauma and mental health problems for the development of antisocial personality disorder (ASPD) and borderline personality disorder (BPD) in previously detained women. The participants were 229 detained adolescent females who were assessed

  15. Payload specialist Reinhard Furrer show evidence of previous blood sampling

    Science.gov (United States)

    1985-01-01

    Payload specialist Reinhard Furrer shows evidence of previous blood sampling while Wubbo J. Ockels, Dutch payload specialist (only partially visible), extends his right arm after a sample has been taken. Both men show bruises on their arms.

  16. Choice of contraception after previous operative delivery at a family ...

    African Journals Online (AJOL)

    Choice of contraception after previous operative delivery at a family planning clinic in Northern Nigeria. Amina Mohammed‑Durosinlorun, Joel Adze, Stephen Bature, Caleb Mohammed, Matthew Taingson, Amina Abubakar, Austin Ojabo, Lydia Airede ...

  17. Previous utilization of service does not improve timely booking in ...

    African Journals Online (AJOL)

    Previous utilization of service does not improve timely booking in antenatal care: Cross sectional study ... Journal Home > Vol 24, No 3 (2010) > ... Results: Past experience on antenatal care service utilization did not come out as a predictor for ...

  18. A previous hamstring injury affects kicking mechanics in soccer players.

    Science.gov (United States)

    Navandar, Archit; Veiga, Santiago; Torres, Gonzalo; Chorro, David; Navarro, Enrique

    2018-01-10

    Although the kicking skill is influenced by limb dominance and sex, how a previous hamstring injury affects kicking has not been studied in detail. Thus, the objective of this study was to evaluate the effect of sex and limb dominance on kicking in limbs with and without a previous hamstring injury. 45 professional players (males: n=19, previously injured players=4, age=21.16 ± 2.00 years; females: n=19, previously injured players=10, age=22.15 ± 4.50 years) performed 5 kicks each with their preferred and non-preferred limb at a target 7m away, which were recorded with a three-dimensional motion capture system. Kinematic and kinetic variables were extracted for the backswing, leg cocking, leg acceleration and follow through phases. A shorter backswing (20.20 ± 3.49% vs 25.64 ± 4.57%), and differences in knee flexion angle (58 ± 10o vs 72 ± 14o) and hip flexion velocity (8 ± 0rad/s vs 10 ± 2rad/s) were observed in previously injured, non-preferred limb kicks for females. A lower peak hip linear velocity (3.50 ± 0.84m/s vs 4.10 ± 0.45m/s) was observed in previously injured, preferred limb kicks of females. These differences occurred in the backswing and leg-cocking phases where the hamstring muscles were the most active. A variation in the functioning of the hamstring muscles and that of the gluteus maximus and iliopsoas in the case of a previous injury could account for the differences observed in the kicking pattern. Therefore, the effects of a previous hamstring injury must be considered while designing rehabilitation programs to re-educate kicking movement.

  19. A total market approach for condoms in Myanmar: the need for the private, public and socially marketed sectors to work together for a sustainable condom market for HIV prevention.

    Science.gov (United States)

    Htat, Han Win; Longfield, Kim; Mundy, Gary; Win, Zaw; Montagu, Dominic

    2015-03-01

    Concerns about appropriate pricing strategies and the high market share of subsidized condoms prompted Population Services International (PSI)/Myanmar to adopt a total market approach (TMA). This article presents data on the size and composition of the Myanmar condom market, identifies inefficiencies and recommends methods for better targeting public subsidy. Data on condom need and condom use came from PSI/Myanmar's (PSI/M's) behavioural surveys; data for key populations' socioeconomic status profiles came from the same surveys and the National Tuberculosis Prevalence Survey. Data on market share, volumes, value and number of condoms were from PSI/M's quarterly retail audits and Joint United Nations Programme on HIV/AIDS (UNAIDS). Between 2008 and 2010, the universal need for condoms decreased from 112.9 to 98.2 million while condom use increased from 32 to 46%. Free and socially marketed condoms dominated the market (94%) in 2009-11 with an increase in the proportion of free condoms over time. The retail price of socially marketed condoms was artificially low at 44 kyats ($0.05 USD) in 2011 while the price for commercial condoms was 119-399 kyats ($0.15-$0.49 USD). Equity analyses demonstrated an equal distribution of female sex workers across national wealth quintiles, but 54% of men who have sex with men and 55% of male clients were in the highest two quintiles. Donor subsidies for condoms increased over time; from $434,000 USD in 2009 to $577,000 USD in 2011. The market for male condoms was stagnant in Myanmar due to: limited demand for condoms among key populations, the dominance of free and socially marketed condoms on the market and a neglected commercial sector. Subsidies for socially marketed and free condoms have prevented the growth of the private sector, an unintended consequence. A TMA is needed to grow and sustain the condom market in Myanmar, which requires close co-ordination between the public, socially marketed and commercial sectors. Published

  20. A total market approach for condoms in Myanmar: the need for the private, public and socially marketed sectors to work together for a sustainable condom market for HIV prevention

    Science.gov (United States)

    Longfield, Kim; Mundy, Gary; Win, Zaw; Montagu, Dominic

    2015-01-01

    Background Concerns about appropriate pricing strategies and the high market share of subsidized condoms prompted Population Services International (PSI)/Myanmar to adopt a total market approach (TMA). This article presents data on the size and composition of the Myanmar condom market, identifies inefficiencies and recommends methods for better targeting public subsidy. Methodology Data on condom need and condom use came from PSI/Myanmar’s (PSI/M’s) behavioural surveys; data for key populations’ socioeconomic status profiles came from the same surveys and the National Tuberculosis Prevalence Survey. Data on market share, volumes, value and number of condoms were from PSI/M’s quarterly retail audits and Joint United Nations Programme on HIV/AIDS (UNAIDS). Results Between 2008 and 2010, the universal need for condoms decreased from 112.9 to 98.2 million while condom use increased from 32 to 46%. Free and socially marketed condoms dominated the market (94%) in 2009–11 with an increase in the proportion of free condoms over time. The retail price of socially marketed condoms was artificially low at 44 kyats ($0.05 USD) in 2011 while the price for commercial condoms was 119–399 kyats ($0.15–$0.49 USD). Equity analyses demonstrated an equal distribution of female sex workers across national wealth quintiles, but 54% of men who have sex with men and 55% of male clients were in the highest two quintiles. Donor subsidies for condoms increased over time; from $434 000 USD in 2009 to $577 000 USD in 2011. Conclusion The market for male condoms was stagnant in Myanmar due to: limited demand for condoms among key populations, the dominance of free and socially marketed condoms on the market and a neglected commercial sector. Subsidies for socially marketed and free condoms have prevented the growth of the private sector, an unintended consequence. A TMA is needed to grow and sustain the condom market in Myanmar, which requires close co-ordination between the

  1. Secondary recurrent miscarriage is associated with previous male birth.

    LENUS (Irish Health Repository)

    Ooi, Poh Veh

    2012-01-31

    Secondary recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses after delivery of a viable infant. Previous reports suggest that a firstborn male child is associated with less favourable subsequent reproductive potential, possibly due to maternal immunisation against male-specific minor histocompatibility antigens. In a retrospective cohort study of 85 cases of secondary RM we aimed to determine if secondary RM was associated with (i) gender of previous child, maternal age, or duration of miscarriage history, and (ii) increased risk of pregnancy complications. Fifty-three women (62.0%; 53\\/85) gave birth to a male child prior to RM compared to 32 (38.0%; 32\\/85) who gave birth to a female child (p=0.002). The majority (91.7%; 78\\/85) had uncomplicated, term deliveries and normal birth weight neonates, with one quarter of the women previously delivered by Caesarean section. All had routine RM investigations and 19.0% (16\\/85) had an abnormal result. Fifty-seven women conceived again and 33.3% (19\\/57) miscarried, but there was no significant difference in failure rates between those with a previous male or female child (13\\/32 vs. 6\\/25, p=0.2). When patients with abnormal results were excluded, or when women with only one previous child were considered, there was still no difference in these rates. A previous male birth may be associated with an increased risk of secondary RM but numbers preclude concluding whether this increases recurrence risk. The suggested association with previous male birth provides a basis for further investigations at a molecular level.

  2. Secondary recurrent miscarriage is associated with previous male birth.

    LENUS (Irish Health Repository)

    Ooi, Poh Veh

    2011-01-01

    Secondary recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses after delivery of a viable infant. Previous reports suggest that a firstborn male child is associated with less favourable subsequent reproductive potential, possibly due to maternal immunisation against male-specific minor histocompatibility antigens. In a retrospective cohort study of 85 cases of secondary RM we aimed to determine if secondary RM was associated with (i) gender of previous child, maternal age, or duration of miscarriage history, and (ii) increased risk of pregnancy complications. Fifty-three women (62.0%; 53\\/85) gave birth to a male child prior to RM compared to 32 (38.0%; 32\\/85) who gave birth to a female child (p=0.002). The majority (91.7%; 78\\/85) had uncomplicated, term deliveries and normal birth weight neonates, with one quarter of the women previously delivered by Caesarean section. All had routine RM investigations and 19.0% (16\\/85) had an abnormal result. Fifty-seven women conceived again and 33.3% (19\\/57) miscarried, but there was no significant difference in failure rates between those with a previous male or female child (13\\/32 vs. 6\\/25, p=0.2). When patients with abnormal results were excluded, or when women with only one previous child were considered, there was still no difference in these rates. A previous male birth may be associated with an increased risk of secondary RM but numbers preclude concluding whether this increases recurrence risk. The suggested association with previous male birth provides a basis for further investigations at a molecular level.

  3. Envisioning a smart home that can learn and negotiate the needs of multiple users

    NARCIS (Netherlands)

    Chuang, Y.; Chen, L.; Lee, Y-H.

    2015-01-01

    Most of the previous smart home researches were primarily concerned for single-user scenarios. However, our homes are usually full with social interactions. In order to explore the research challenge, we applied need-finding approaches to envision the possibilities. We visited ten families to prove

  4. Medical-legal partnerships: the role of mental health providers and legal authorities in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural settings.

    Science.gov (United States)

    Speldewinde, Christopher A; Parsons, Ian

    2015-01-01

    Medical-legal partnerships (MLP) are a model in which medical and legal practitioners are co-located and work together to support the health and wellbeing of individuals by identifying and resolving legal issues that impact patients' health and wellbeing. The aim of this article is to analyse the benefits of this model, which has proliferated in the USA, and its applicability in the context of rural and remote Australia. This review was undertaken with three research questions in mind: What is an MLP? Is service provision for individuals with mental health concerns being adequately addressed by current service models particularly in the rural context? Are MLPs a service delivery channel that would benefit individuals experiencing mental health issues? The combined searches from all EBSCO Host databases resulted in 462 citations. This search aggregated academic journals, newspapers, book reviews, magazines and trade publications. After several reviews 38 papers were selected for the final review based on their relevance to this review question: How do MLPs support mental health providers and legal service providers in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural Australia? There is considerable merit in pursuing the development of MLPs in rural and remote Australia particularly as individuals living in rural and remote areas have far fewer opportunities to access support services than those people living in regional and metropolitan locations. MLPS are important channels of service delivery to assist in early invention of legal problems that can exacerbate mental health problems.

  5. High levels of unprotected anal intercourse and never testing for HIV among men who have sex with men in Nigeria: evidence from a cross-sectional survey for the need for innovative approaches to HIV prevention.

    Science.gov (United States)

    Vu, Lung; Andrinopoulos, Katherine; Tun, Waimar; Adebajo, Sylvia

    2013-12-01

    To describe sexual risk behaviour, correlates of unprotected anal intercourse (UAI) and never testing for HIV and its implications for HIV prevention interventions among men who have sex with men (MSM) in Nigeria and other similar contexts. A cross-sectional survey was administered to 712 MSM in Abuja, Ibadan and Lagos, recruited through respondent-driven sampling (RDS). Levels of sexual risk behaviour and never having tested for HIV prior to the survey were calculated using weighted data for each city and unweighted data for the pooled sample. Correlates of UAI and never testing for HIV were determined using multiple logistic regression. The risk for HIV and STI among MSM in Nigeria is high, with 43.4% reporting UAI at last sex, 45.1% never having been tested for HIV and 53.9% reporting exchange of sex for resources in the past 6 months. Correlates of UAI in multivariate analysis included living in Ibadan, marriage or cohabitation with a woman, identification as bisexual, not having tested for HIV and being HIV-positive. Correlates of not having tested for HIV in multivariate analysis included living in Ibadan, young age, less education, unemployment and report of UAI. HIV testing is low and associated with UAI. Findings merit targeted and innovative approaches for HIV prevention for MSM, especially access to HIV self-testing. Attention to social and structural determinants of health-seeking and sexual risk behaviour is also needed, including the criminalisation of homosexuality and social marginalisation of MSM.

  6. Study of some physical aspects previous to design of an exponential experiment

    International Nuclear Information System (INIS)

    Caro, R.; Francisco, J. L. de

    1961-01-01

    This report presents the theoretical study of some physical aspects previous to the design of an exponential facility. The are: Fast and slow flux distribution in the multiplicative medium and in the thermal column, slowing down in the thermal column, geometrical distribution and minimum needed intensity of sources access channels and perturbations produced by possible variations in its position and intensity. (Author) 4 refs

  7. Predicting fruit consumption: the role of habits, previous behavior and mediation effects

    NARCIS (Netherlands)

    de Vries, H.; Eggers, S.M.; Lechner, L.; van Osch, L.; van Stralen, M.M.

    2014-01-01

    Background: This study assessed the role of habits and previous behavior in predicting fruit consumption as well as their additional predictive contribution besides socio-demographic and motivational factors. In the literature, habits are proposed as a stable construct that needs to be controlled

  8. The need for a hydromorphological approach to Chilean river management La necesidad de un enfoque hidromorfológico para la gestión de los ríos chilenos

    Directory of Open Access Journals (Sweden)

    ANDREA ANDREOLI

    2012-09-01

    Full Text Available The manuscript reflects the opinion of the authors about the need for a hydromorphological approach for the management of Chilean rivers. A brief state-of-the-art of the recent scientific advances on hydromorphological approach to river management is presented, as well as a general overview of the conditions of Chilean rivers and the mayor disturbances they suffer. Moreover, the need to take into account both direct and indirect services provided by rivers in the decision making process on river management is underlined. Hydromorphology is claimed to be a main element to be considered while assessing the ecological state of rivers. Understanding how the hydrological and morphological variables interact dynamically is indeed key to assess the presence or absence of dynamic equilibrium, a condition that, in turn, promotes both habitat diversity and self-sustainable aquatic and riparian ecosystems. The authors also emphasized the need for a change of paradigm in current Chilean rivers management practices, by developing a unified framework to assess hydromorphological and ecological river conditions. In addition, the implementation of specific legislation aimed at promoting ecological and geomorphological standards in river management practice, and the strengthening and widening of the academic teaching of fluvial ecology and geomorphology is suggested.El manuscrito refleja la opinión de los autores acerca de la necesidad de aplicar un enfoque hidromorfológico para la gestión de los ríos chilenos. Se presenta una breve reseña de los últimos avances científicos sobre el enfoque hidromorfológico en la gestión de ríos, así como una visión general de las condiciones de los ríos chilenos y sus mayores perturbaciones. Por otra parte, se hace énfasis en la necesidad de incluir en la toma de decisiones los servicios directos como los indirectos proporcionados por los ríos. Se afirma que la hidromorfología es un elemento fundamental a

  9. [Prevalence of previously diagnosed diabetes mellitus in Mexico.

    Science.gov (United States)

    Rojas-Martínez, Rosalba; Basto-Abreu, Ana; Aguilar-Salinas, Carlos A; Zárate-Rojas, Emiliano; Villalpando, Salvador; Barrientos-Gutiérrez, Tonatiuh

    2018-01-01

    To compare the prevalence of previously diagnosed diabetes in 2016 with previous national surveys and to describe treatment and its complications. Mexico's national surveys Ensa 2000, Ensanut 2006, 2012 and 2016 were used. For 2016, logistic regression models and measures of central tendency and dispersion were obtained. The prevalence of previously diagnosed diabetes in 2016 was 9.4%. The increase of 2.2% relative to 2012 was not significant and only observed in patients older than 60 years. While preventive measures have increased, the access to medical treatment and lifestyle has not changed. The treatment has been modified, with an increase in insulin and decrease in hypoglycaemic agents. Population aging, lack of screening actions and the increase in diabetes complications will lead to an increase on the burden of disease. Policy measures targeting primary and secondary prevention of diabetes are crucial.

  10. Cardiovascular magnetic resonance in adults with previous cardiovascular surgery.

    Science.gov (United States)

    von Knobelsdorff-Brenkenhoff, Florian; Trauzeddel, Ralf Felix; Schulz-Menger, Jeanette

    2014-03-01

    Cardiovascular magnetic resonance (CMR) is a versatile non-invasive imaging modality that serves a broad spectrum of indications in clinical cardiology and has proven evidence. Most of the numerous applications are appropriate in patients with previous cardiovascular surgery in the same manner as in non-surgical subjects. However, some specifics have to be considered. This review article is intended to provide information about the application of CMR in adults with previous cardiovascular surgery. In particular, the two main scenarios, i.e. following coronary artery bypass surgery and following heart valve surgery, are highlighted. Furthermore, several pictorial descriptions of other potential indications for CMR after cardiovascular surgery are given.

  11. SCIENCE NEEDS AFRICA AS MUCH AS AFRICA NEEDS ...

    African Journals Online (AJOL)

    Preferred Customer

    their study on the needs of science education in Tanzania (2, p. 12): ... qualified teachers of mathematics and science at the primary- and secondary-school level, inadequate ... perform competently in the classroom. Second ... knowledge nor adequate knowledge/application of the competency based approaches that are the ...

  12. Squamous cell carcinoma arising in previously burned or irradiated skin

    International Nuclear Information System (INIS)

    Edwards, M.J.; Hirsch, R.M.; Broadwater, J.R.; Netscher, D.T.; Ames, F.C.

    1989-01-01

    Squamous cell carcinoma (SCC) arising in previously burned or irradiated skin was reviewed in 66 patients treated between 1944 and 1986. Healing of the initial injury was complicated in 70% of patients. Mean interval from initial injury to diagnosis of SCC was 37 years. The overwhelming majority of patients presented with a chronic intractable ulcer in previously injured skin. The regional relapse rate after surgical excision was very high, 58% of all patients. Predominant patterns of recurrence were in local skin and regional lymph nodes (93% of recurrences). Survival rates at 5, 10, and 20 years were 52%, 34%, and 23%, respectively. Five-year survival rates in previously burned and irradiated patients were not significantly different (53% and 50%, respectively). This review, one of the largest reported series, better defines SCC arising in previously burned or irradiated skin as a locally aggressive disease that is distinct from SCC arising in sunlight-damaged skin. An increased awareness of the significance of chronic ulceration in scar tissue may allow earlier diagnosis. Regional disease control and survival depend on surgical resection of all known disease and may require radical lymph node dissection or amputation

  13. Outcome Of Pregnancy Following A Previous Lower Segment ...

    African Journals Online (AJOL)

    Background: A previous ceasarean section is an important variable that influences patient management in subsequent pregnancies. A trial of vaginal delivery in such patients is a feasible alternative to a secondary section, thus aiding to reduce the ceasarean section rate and its associated co-morbidities. Objective: To ...

  14. 24 CFR 1710.552 - Previously accepted state filings.

    Science.gov (United States)

    2010-04-01

    ... of Substantially Equivalent State Law § 1710.552 Previously accepted state filings. (a) Materials... and contracts or agreements contain notice of purchaser's revocation rights. In addition see § 1715.15..., unless the developer is obligated to do so in the contract. (b) If any such filing becomes inactive or...

  15. The job satisfaction of principals of previously disadvantaged schools

    African Journals Online (AJOL)

    The aim of this study was to identify influences on the job satisfaction of previously disadvantaged ..... I am still riding the cloud … I hope it lasts. .... as a way of creating a climate and culture in schools where individuals are willing to explore.

  16. Haemophilus influenzae type f meningitis in a previously healthy boy

    DEFF Research Database (Denmark)

    Ronit, Andreas; Berg, Ronan M G; Bruunsgaard, Helle

    2013-01-01

    Non-serotype b strains of Haemophilus influenzae are extremely rare causes of acute bacterial meningitis in immunocompetent individuals. We report a case of acute bacterial meningitis in a 14-year-old boy, who was previously healthy and had been immunised against H influenzae serotype b (Hib...

  17. Research Note Effects of previous cultivation on regeneration of ...

    African Journals Online (AJOL)

    We investigated the effects of previous cultivation on regeneration potential under miombo woodlands in a resettlement area, a spatial product of Zimbabwe's land reforms. We predicted that cultivation would affect population structure, regeneration, recruitment and potential grazing capacity of rangelands. Plant attributes ...

  18. Cryptococcal meningitis in a previously healthy child | Chimowa ...

    African Journals Online (AJOL)

    An 8-year-old previously healthy female presented with a 3 weeks history of headache, neck stiffness, deafness, fever and vomiting and was diagnosed with cryptococcal meningitis. She had documented hearing loss and was referred to tertiary-level care after treatment with fluconazole did not improve her neurological ...

  19. Investigation of previously derived Hyades, Coma, and M67 reddenings

    International Nuclear Information System (INIS)

    Taylor, B.J.

    1980-01-01

    New Hyades polarimetry and field star photometry have been obtained to check the Hyades reddening, which was found to be nonzero in a previous paper. The new Hyades polarimetry implies essentially zero reddening; this is also true of polarimetry published by Behr (which was incorrectly interpreted in the previous paper). Four photometric techniques which are presumed to be insensitive to blanketing are used to compare the Hyades to nearby field stars; these four techniques also yield essentially zero reddening. When all of these results are combined with others which the author has previously published and a simultaneous solution for the Hyades, Coma, and M67 reddenings is made, the results are E (B-V) =3 +- 2 (sigma) mmag, -1 +- 3 (sigma) mmag, and 46 +- 6 (sigma) mmag, respectively. No support for a nonzero Hyades reddening is offered by the new results. When the newly obtained reddenings for the Hyades, Coma, and M67 are compared with results from techniques given by Crawford and by users of the David Dunlap Observatory photometric system, no differences between the new and other reddenings are found which are larger than about 2 sigma. The author had previously found that the M67 main-sequence stars have about the same blanketing as that of Coma and less blanketing than the Hyades; this conclusion is essentially unchanged by the revised reddenings

  20. Rapid fish stock depletion in previously unexploited seamounts: the ...

    African Journals Online (AJOL)

    Rapid fish stock depletion in previously unexploited seamounts: the case of Beryx splendens from the Sierra Leone Rise (Gulf of Guinea) ... A spectral analysis and red-noise spectra procedure (REDFIT) algorithm was used to identify the red-noise spectrum from the gaps in the observed time-series of catch per unit effort by ...

  1. 18 CFR 154.302 - Previously submitted material.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Previously submitted material. 154.302 Section 154.302 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... concurrently with the rate change filing. There must be furnished to the Director, Office of Energy Market...

  2. Process cells dismantling of EUREX pant: previous activities

    International Nuclear Information System (INIS)

    Gili, M.

    1998-01-01

    In the '98-'99 period some process cells of the EUREX pant will be dismantled, in order to place there the liquid wastes conditioning plant 'CORA'. This report resumes the previous activities (plant rinsing campaigns and inactive Cell 014 dismantling), run in the past three years and the drawn experience [it

  3. The job satisfaction of principals of previously disadvantaged schools

    African Journals Online (AJOL)

    The aim of this study was to identify influences on the job satisfaction of previously disadvantaged school principals in North-West Province. Evans's theory of job satisfaction, morale and motivation was useful as a conceptual framework. A mixedmethods explanatory research design was important in discovering issues with ...

  4. Obstructive pulmonary disease in patients with previous tuberculosis ...

    African Journals Online (AJOL)

    Obstructive pulmonary disease in patients with previous tuberculosis: Pathophysiology of a community-based cohort. B.W. Allwood, R Gillespie, M Galperin-Aizenberg, M Bateman, H Olckers, L Taborda-Barata, G.L. Calligaro, Q Said-Hartley, R van Zyl-Smit, C.B. Cooper, E van Rikxoort, J Goldin, N Beyers, E.D. Bateman ...

  5. Abiraterone in metastatic prostate cancer without previous chemotherapy

    NARCIS (Netherlands)

    Ryan, Charles J.; Smith, Matthew R.; de Bono, Johann S.; Molina, Arturo; Logothetis, Christopher J.; de Souza, Paul; Fizazi, Karim; Mainwaring, Paul; Piulats, Josep M.; Ng, Siobhan; Carles, Joan; Mulders, Peter F. A.; Basch, Ethan; Small, Eric J.; Saad, Fred; Schrijvers, Dirk; van Poppel, Hendrik; Mukherjee, Som D.; Suttmann, Henrik; Gerritsen, Winald R.; Flaig, Thomas W.; George, Daniel J.; Yu, Evan Y.; Efstathiou, Eleni; Pantuck, Allan; Winquist, Eric; Higano, Celestia S.; Taplin, Mary-Ellen; Park, Youn; Kheoh, Thian; Griffin, Thomas; Scher, Howard I.; Rathkopf, Dana E.; Boyce, A.; Costello, A.; Davis, I.; Ganju, V.; Horvath, L.; Lynch, R.; Marx, G.; Parnis, F.; Shapiro, J.; Singhal, N.; Slancar, M.; van Hazel, G.; Wong, S.; Yip, D.; Carpentier, P.; Luyten, D.; de Reijke, T.

    2013-01-01

    Abiraterone acetate, an androgen biosynthesis inhibitor, improves overall survival in patients with metastatic castration-resistant prostate cancer after chemotherapy. We evaluated this agent in patients who had not received previous chemotherapy. In this double-blind study, we randomly assigned

  6. Training industry needs & Technology Industry needs

    NARCIS (Netherlands)

    Klemke, Roland; Kuula, Timo; Helin, Kaj; Wild, Fridolin

    2017-01-01

    This deliverable joins D1.1 (User Industry Needs) and D1.2 (Technology Industry Needs and Affordances) and reports on the outcomes of Tasks T1.1 (Training Industry Assessment) and T1.2 (Technology Industry Assessment). We merged the deliverables for the following reasons: For readability ease we

  7. Reoperative sentinel lymph node biopsy after previous mastectomy.

    Science.gov (United States)

    Karam, Amer; Stempel, Michelle; Cody, Hiram S; Port, Elisa R

    2008-10-01

    Sentinel lymph node (SLN) biopsy is the standard of care for axillary staging in breast cancer, but many clinical scenarios questioning the validity of SLN biopsy remain. Here we describe our experience with reoperative-SLN (re-SLN) biopsy after previous mastectomy. Review of the SLN database from September 1996 to December 2007 yielded 20 procedures done in the setting of previous mastectomy. SLN biopsy was performed using radioisotope with or without blue dye injection superior to the mastectomy incision, in the skin flap in all patients. In 17 of 20 patients (85%), re-SLN biopsy was performed for local or regional recurrence after mastectomy. Re-SLN biopsy was successful in 13 of 20 patients (65%) after previous mastectomy. Of the 13 patients, 2 had positive re-SLN, and completion axillary dissection was performed, with 1 having additional positive nodes. In the 11 patients with negative re-SLN, 2 patients underwent completion axillary dissection demonstrating additional negative nodes. One patient with a negative re-SLN experienced chest wall recurrence combined with axillary recurrence 11 months after re-SLN biopsy. All others remained free of local or axillary recurrence. Re-SLN biopsy was unsuccessful in 7 of 20 patients (35%). In three of seven patients, axillary dissection was performed, yielding positive nodes in two of the three. The remaining four of seven patients all had previous modified radical mastectomy, so underwent no additional axillary surgery. In this small series, re-SLN was successful after previous mastectomy, and this procedure may play some role when axillary staging is warranted after mastectomy.

  8. O complexo industrial da saúde e a necessidade de um enfoque dinâmico na economia da saúde The health industrial complex and the need of a dynamic approach on health economics

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Grabois Gadelha

    2003-01-01

    article analyzes the interaction between the health system and the economical-industrial system, explaining how it has been succeeding a dichotomy on the relation between both of them, which is expressed by the deterioration of the innovation potential of the country and on a growing and worrying external vulnerability of health politics. It is suggested that the traditional neoclassical approach of health economics is not sufficient to attend health industrial complex, due to the intensity of the process of structural change, and the need of a theoretical alternative approach incorporating the dynamics of economic and institutional transformation, of accumulation and innovation.

  9. [Fatal amnioinfusion with previous choriocarcinoma in a parturient woman].

    Science.gov (United States)

    Hrgović, Z; Bukovic, D; Mrcela, M; Hrgović, I; Siebzehnrübl, E; Karelovic, D

    2004-04-01

    The case of 36-year-old tercipare is described who developed choriocharcinoma in a previous pregnancy. During the first term labour the patient developed cardiac arrest, so reanimation and sectio cesarea was performed. A male new-born was delivered in good condition, but even after intensive therapy and reanimation occurred death of parturient woman with picture of disseminate intravascular coagulopathia (DIK). On autopsy and on histology there was no sign of malignant disease, so it was not possible to connect previous choricarcinoma with amniotic fluid embolism. Maybe was place of choriocarcinoma "locus minoris resistentiae" which later resulted with failure in placentation what was hard to prove. On autopsy we found embolia of lung with a microthrombosis of terminal circulation with punctiformis bleeding in mucous, what stands for DIK.

  10. Challenging previous conceptions of vegetarianism and eating disorders.

    Science.gov (United States)

    Fisak, B; Peterson, R D; Tantleff-Dunn, S; Molnar, J M

    2006-12-01

    The purpose of this study was to replicate and expand upon previous research that has examined the potential association between vegetarianism and disordered eating. Limitations of previous research studies are addressed, including possible low reliability of measures of eating pathology within vegetarian samples, use of only a few dietary restraint measures, and a paucity of research examining potential differences in body image and food choice motives of vegetarians versus nonvegetarians. Two hundred and fifty-six college students completed a number of measures of eating pathology and body image, and a food choice motives questionnaire. Interestingly, no significant differences were found between vegetarians and nonvegetarians in measures of eating pathology or body image. However, significant differences in food choice motives were found. Implications for both researchers and clinicians are discussed.

  11. Previously unreported abnormalities in Wolfram Syndrome Type 2.

    Science.gov (United States)

    Akturk, Halis Kaan; Yasa, Seda

    2017-01-01

    Wolfram syndrome (WFS) is a rare autosomal recessive disease with non-autoimmune childhood onset insulin dependent diabetes and optic atrophy. WFS type 2 (WFS2) differs from WFS type 1 (WFS1) with upper intestinal ulcers, bleeding tendency and the lack ofdiabetes insipidus. Li-fespan is short due to related comorbidities. Only a few familieshave been reported with this syndrome with the CISD2 mutation. Here we report two siblings with a clinical diagnosis of WFS2, previously misdiagnosed with type 1 diabetes mellitus and diabetic retinopathy-related blindness. We report possible additional clinical and laboratory findings that have not been pre-viously reported, such as asymptomatic hypoparathyroidism, osteomalacia, growth hormone (GH) deficiency and hepatomegaly. Even though not a requirement for the diagnosis of WFS2 currently, our case series confirm hypogonadotropic hypogonadism to be also a feature of this syndrome, as reported before. © Polish Society for Pediatric Endocrinology and Diabetology.

  12. Previous climatic alterations are caused by the sun

    International Nuclear Information System (INIS)

    Groenaas, Sigbjoern

    2003-01-01

    The article surveys the scientific results of previous research into the contribution of the sun to climatic alterations. The author concludes that there is evidence of eight cold periods after the last ice age and that the alterations largely were due to climate effects from the sun. However, these effects are only causing a fraction of the registered global warming. It is assumed that the human activities are contributing to the rest of the greenhouse effect

  13. Influence of previous knowledge in Torrance tests of creative thinking

    OpenAIRE

    Aranguren, María; Consejo Nacional de Investigaciones Científicas y Técnicas CONICET

    2015-01-01

    The aim of this work is to analyze the influence of study field, expertise and recreational activities participation in Torrance Tests of Creative Thinking (TTCT, 1974) performance. Several hypotheses were postulated to explore the possible effects of previous knowledge in TTCT verbal and TTCT figural university students’ outcomes. Participants in this study included 418 students from five study fields: Psychology;Philosophy and Literature, Music; Engineering; and Journalism and Advertisin...

  14. Mobility needs and wireless solutions

    DEFF Research Database (Denmark)

    Saugstrup, Dan; Henten, Anders

    The main purpose of this report is to spell out a methodological approach to the analysis of user needs with respect to mobility. Furthermore, this methodological approach is used in an exemplary analysis of the relationship between user needs and technology solutions offered by different wireless...... technologies. The report is based on a research approach, emphasizing important aspects in relation to developing more user oriented mobile services and applications in a heterogeneous network environment. As a staring point, Scandinavian research within the field of social science concerning mobility...... is described and discussed. Furthermore different wireless technologies are briefly described and discussed in relation to possible transmission capacities and coverage areas. In addition to this, a preliminary framework regarding the implications of mobility on the use and development of mobile services...

  15. National Needs Drivers for Nanotechnology

    Energy Technology Data Exchange (ETDEWEB)

    Yonas, G.; Picraux, S.T.

    2000-10-09

    Societal needs related to demographics, resources, and human behavior will drive technological advances over the next 20 years. Nanotechnology is anticipated to be an important enabler of these advances, and thus maybe anticipated to have significant influence on new systems approaches to solving societal problems as well as on extending current science and technology-based applications. To examine the potential implications of nanotechnology a societal needs-driven approach is taken. Thus the methodology is to present the definition of the problem, and then examine system concepts, technology issues, and promising future directions. We approach the problem definition from a national and global security perspective and identify three key areas involving the condition of the planet, the human condition, and global security. In anticipating societal issues in the context of revolutionary technologies, such as maybe enabled by nanoscience, the importance of working on the entire life cycle of any technological solution is stressed.

  16. Severe radiation morbidity in carcinoma of the cervix: impact of pretherapy surgical staging and previous surgery

    International Nuclear Information System (INIS)

    Fine, Bruce A.; Hempling, Ronald E.; Piver, M. Steven; Baker, Trudy R.; McAuley, Michael; Driscoll, Deborah

    1995-01-01

    Purpose: The purpose of this study is to delineate the factors which (a) contribute to an increase in the severe, radiation induced complication rate and (b) have a significant effect on survival in patients with International Federation of Gynecologists and Obstetricians (FIGO) Stage I-IVA cervical cancer undergoing pretherapy surgical staging. Methods and Materials: From 1971-1991, 189 patients underwent pretherapy surgical staging via a retroperitoneal approach (67) or transperitoneal approach (122). Seventy-nine patients had previously experienced a laparotomy. Patients subsequently received a median of 85 Gy to point A. In patients receiving paraaortic radiation, a median of 45 Gy was administered. One hundred and thirty-two (69.8%) patients received hydroxyurea as a radiation sensitizer. Results: Pretherapy surgical evaluation revealed that 21 of 89 (23.6%) Stage II patients and 32 of 85 (37.6%) Stage III patients had paraaortic lymph node metastases. Multivariate logistic regression analysis detailed the significant factors favorably influencing the radiation-induced complication rate to be a retroperitoneal approach of pretherapy surgical staging and no previous laparotomy. Survival was significantly prolonged in patients receiving hydroxyurea, evaluated via a retroperitoneal incision, with negative paraaortic lymph nodes, and with an early stage of disease. Conclusion: A retroperitoneal approach to pretherapy surgical staging and absence of previous surgery reduced the incidence of subsequent radiation-induced complications. Despite improvements in the detection of occult disease, prolonged survival is impaired when the therapeutic measures currently available are used

  17. Moyamoya disease in a child with previous acute necrotizing encephalopathy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Taik-Kun; Cha, Sang Hoon; Chung, Kyoo Byung; Kim, Jung Hyuck; Kim, Baek Hyun; Chung, Hwan Hoon [Department of Diagnostic Radiology, Korea University College of Medicine, Ansan Hospital, 516 Kojan-Dong, Ansan City, Kyungki-Do 425-020 (Korea); Eun, Baik-Lin [Department of Pediatrics, Korea University College of Medicine, Seoul (Korea)

    2003-09-01

    A previously healthy 24-day-old boy presented with a 2-day history of fever and had a convulsion on the day of admission. MRI showed abnormal signal in the thalami, caudate nuclei and central white matter. Acute necrotising encephalopathy was diagnosed, other causes having been excluded after biochemical and haematological analysis of blood, urine and CSF. He recovered, but with spastic quadriparesis. At the age of 28 months, he suffered sudden deterioration of consciousness and motor weakness of his right limbs. MRI was consistent with an acute cerebrovascular accident. Angiography showed bilateral middle cerebral artery stenosis or frank occlusion with numerous lenticulostriate collateral vessels consistent with moyamoya disease. (orig.)

  18. MCNP HPGe detector benchmark with previously validated Cyltran model.

    Science.gov (United States)

    Hau, I D; Russ, W R; Bronson, F

    2009-05-01

    An exact copy of the detector model generated for Cyltran was reproduced as an MCNP input file and the detection efficiency was calculated similarly with the methodology used in previous experimental measurements and simulation of a 280 cm(3) HPGe detector. Below 1000 keV the MCNP data correlated to the Cyltran results within 0.5% while above this energy the difference between MCNP and Cyltran increased to about 6% at 4800 keV, depending on the electron cut-off energy.

  19. Understanding mobile information needs

    OpenAIRE

    Church, Karen; Smyth, Barry

    2008-01-01

    In this paper we describe the results of a four-week diary study of mobile information needs, focusing on the intent behind mobile needs and the importance on context on such needs. We identified three key intents among diary entries: informational, geographical and personal information management (PIM). Furthermore, we found many of these information needs have high temporal and location dependencies.

  20. Fontan Surgical Planning: Previous Accomplishments, Current Challenges, and Future Directions.

    Science.gov (United States)

    Trusty, Phillip M; Slesnick, Timothy C; Wei, Zhenglun Alan; Rossignac, Jarek; Kanter, Kirk R; Fogel, Mark A; Yoganathan, Ajit P

    2018-04-01

    The ultimate goal of Fontan surgical planning is to provide additional insights into the clinical decision-making process. In its current state, surgical planning offers an accurate hemodynamic assessment of the pre-operative condition, provides anatomical constraints for potential surgical options, and produces decent post-operative predictions if boundary conditions are similar enough between the pre-operative and post-operative states. Moving forward, validation with post-operative data is a necessary step in order to assess the accuracy of surgical planning and determine which methodological improvements are needed. Future efforts to automate the surgical planning process will reduce the individual expertise needed and encourage use in the clinic by clinicians. As post-operative physiologic predictions improve, Fontan surgical planning will become an more effective tool to accurately model patient-specific hemodynamics.

  1. Frontal Mucocele following Previous Facial Trauma with Hardware Reconstruction

    Directory of Open Access Journals (Sweden)

    Megan EuDaly

    2016-01-01

    Full Text Available Mucoceles are cysts that can develop after facial bone fractures, especially those involving the frontal sinuses. Despite being rare, mucoceles can result in serious delayed sequelae. We present a case of a frontal mucocele that developed two years after extensive facial trauma following a motor vehicle crash (MVC and review the emergency department (ED evaluation and treatment of mucocele. Early recognition, appropriate imaging, and an interdisciplinary approach are essential for managing these rare sequelae of facial trauma.

  2. Frontal Mucocele following Previous Facial Trauma with Hardware Reconstruction

    OpenAIRE

    EuDaly, Megan; Kraus, Chadd K.

    2016-01-01

    Mucoceles are cysts that can develop after facial bone fractures, especially those involving the frontal sinuses. Despite being rare, mucoceles can result in serious delayed sequelae. We present a case of a frontal mucocele that developed two years after extensive facial trauma following a motor vehicle crash (MVC) and review the emergency department (ED) evaluation and treatment of mucocele. Early recognition, appropriate imaging, and an interdisciplinary approach are essential for managing ...

  3. Incidence of Acneform Lesions in Previously Chemically Damaged Persons-2004

    Directory of Open Access Journals (Sweden)

    N Dabiri

    2008-04-01

    Full Text Available ABSTRACT: Introduction & Objective: Chemical gas weapons especially nitrogen mustard which was used in Iraq-Iran war against Iranian troops have several harmful effects on skin. Some other chemical agents also can cause acne form lesions on skin. The purpose of this study was to compare the incidence of acneform in previously chemically damaged soldiers and non chemically damaged persons. Materials & Methods: In this descriptive and analytical study, 180 chemically damaged soldiers, who have been referred to dermatology clinic between 2000 – 2004, and forty non-chemically damaged people, were chosen randomly and examined for acneform lesions. SPSS software was used for statistic analysis of the data. Results: The mean age of the experimental group was 37.5 ± 5.2 and that of the control group was 38.7 ± 5.9 years. The mean percentage of chemical damage in cases was 31 percent and the time after the chemical damage was 15.2 ± 1.1 years. Ninety seven cases (53.9 percent of the subjects and 19 people (47.5 percent of the control group had some degree of acne. No significant correlation was found in incidence, degree of lesions, site of lesions and age of subjects between two groups. No significant correlation was noted between percentage of chemical damage and incidence and degree of lesions in case group. Conclusion: Incidence of acneform lesions among previously chemically injured peoples was not higher than the normal cases.

  4. Relationship of deer and moose populations to previous winters' snow

    Science.gov (United States)

    Mech, L.D.; McRoberts, R.E.; Peterson, R.O.; Page, R.E.

    1987-01-01

    (1) Linear regression was used to relate snow accumulation during single and consecutive winters with white-tailed deer (Odocoileus virginianus) fawn:doe ratios, mosse (Alces alces) twinning rates and calf:cow ratios, and annual changes in deer and moose populations. Significant relationships were found between snow accumulation during individual winters and these dependent variables during the following year. However, the strongest relationships were between the dependent variables and the sums of the snow accumulations over the previous three winters. The percentage of the variability explained was 36 to 51. (2) Significant relationships were also found between winter vulnerability of moose calves and the sum of the snow accumulations in the current, and up to seven previous, winters, with about 49% of the variability explained. (3) No relationship was found between wolf numbers and the above dependent variables. (4) These relationships imply that winter influences on maternal nutrition can accumulate for several years and that this cumulative effect strongly determines fecundity and/or calf and fawn survivability. Although wolf (Canis lupus L.) predation is the main direct mortality agent on fawns and calves, wolf density itself appears to be secondary to winter weather in influencing the deer and moose populations.

  5. Kidnapping Detection and Recognition in Previous Unknown Environment

    Directory of Open Access Journals (Sweden)

    Yang Tian

    2017-01-01

    Full Text Available An unaware event referred to as kidnapping makes the estimation result of localization incorrect. In a previous unknown environment, incorrect localization result causes incorrect mapping result in Simultaneous Localization and Mapping (SLAM by kidnapping. In this situation, the explored area and unexplored area are divided to make the kidnapping recovery difficult. To provide sufficient information on kidnapping, a framework to judge whether kidnapping has occurred and to identify the type of kidnapping with filter-based SLAM is proposed. The framework is called double kidnapping detection and recognition (DKDR by performing two checks before and after the “update” process with different metrics in real time. To explain one of the principles of DKDR, we describe a property of filter-based SLAM that corrects the mapping result of the environment using the current observations after the “update” process. Two classical filter-based SLAM algorithms, Extend Kalman Filter (EKF SLAM and Particle Filter (PF SLAM, are modified to show that DKDR can be simply and widely applied in existing filter-based SLAM algorithms. Furthermore, a technique to determine the adapted thresholds of metrics in real time without previous data is presented. Both simulated and experimental results demonstrate the validity and accuracy of the proposed method.

  6. [ANTITHROMBOTIC MEDICATION IN PREGNANT WOMEN WITH PREVIOUS INTRAUTERINE GROWTH RESTRICTION].

    Science.gov (United States)

    Neykova, K; Dimitrova, V; Dimitrov, R; Vakrilova, L

    2016-01-01

    To analyze pregnancy outcome in patients who were on antithrombotic medication (AM) because of previous pregnancy with fetal intrauterine growth restriction (IUGR). The studied group (SG) included 21 pregnancies in 15 women with history of previous IUGR. The patients were on low dose aspirin (LDA) and/or low molecular weight heparin (LMWH). Pregnancy outcome was compared to the one in two more groups: 1) primary group (PG) including the previous 15 pregnancies with IUGR of the same women; 2) control group (CG) including 45 pregnancies of women matched for parity with the ones in the SG, with no history of IUGR and without medication. The SG, PG and CG were compared for the following: mean gestational age (g.a.) at birth, mean birth weight (BW), proportion of cases with early preeclampsia (PE), IUGR (total, moderate, and severe), intrauterine fetal death (IUFD), neonatal death (NND), admission to NICU, cesarean section (CS) because of chronic or acute fetal distress (FD) related to IUGR, PE or placental abruption. Student's t-test was applied to assess differences between the groups. P values < 0.05 were considered statistically significant. The differences between the SG and the PG regarding mean g. a. at delivery (33.7 and 29.8 w.g. respectively) and the proportion of babies admitted to NICU (66.7% vs. 71.4%) were not statistically significant. The mean BW in the SG (2114,7 g.) was significantly higher than in the PG (1090.8 g.). In the SG compared with the PG there were significantly less cases of IUFD (14.3% and 53.3% respectively), early PE (9.5% vs. 46.7%) moderate and severe IUGR (10.5% and 36.8% vs. 41.7% and 58.3%). Neonatal mortality in the SG (5.6%) was significantly lower than in the PG (57.1%), The proportion of CS for FD was not significantly different--53.3% in the SG and 57.1% in the PG. On the other hand, comparison between the SG and the CG demonstrated significantly lower g.a. at delivery in the SG (33.7 vs. 38 w.g.) an lower BW (2114 vs. 3094 g

  7. Relationship between the public's belief in recovery, level of mental illness stigma, and previous contact.

    Science.gov (United States)

    Barczyk, Amanda N

    2015-01-01

    Disbelief exits that individuals who have a mental health condition are able to recover and fully function in life. This study analyzed 1,437 adults from the 2006 General Social Survey. Structural equation modeling (1) examined the relationship between respondents' level of prejudicial attitudes and social distance (i.e., stigma) toward individuals who have a mental health condition and their belief in the potential of recovery (2) tested whether previous contact with an individual who received treatment was a mediator. Findings indicated that the belief in recovery led to lower levels of social distance. Prejudicial attitudes were found to be a predictor of one's level of social distance. Previous contact was not a mediator however; males, minorities and those with less education were less likely to have had previous contact. Results indicated a need to emphasize the probability of recovering from a mental health condition when developing target-specific stigma reducing strategies.

  8. Health care need

    DEFF Research Database (Denmark)

    Hasman, Andreas; Hope, Tony; Østerdal, Lars Peter

    2006-01-01

    The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precis......The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can...... be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need...

  9. Deepwater Gulf of Mexico more profitable than previously thought

    International Nuclear Information System (INIS)

    Craig, M.J.K.; Hyde, S.T.

    1997-01-01

    Economic evaluations and recent experience show that the deepwater Gulf of Mexico (GOM) is much more profitable than previously thought. Four factors contributing to the changed viewpoint are: First, deepwater reservoirs have proved to have excellent productive capacity, distribution, and continuity when compared to correlative-age shelf deltaic sands. Second, improved technologies and lower perceived risks have lowered the cost of floating production systems (FPSs). Third, projects now get on-line quicker. Fourth, a collection of other important factors are: Reduced geologic risk and associated high success rates for deepwater GOM wells due primarily to improved seismic imaging and processing tools (3D, AVO, etc.); absence of any political risk in the deepwater GOM (common overseas, and very significant in some international areas); and positive impact of deepwater federal royalty relief. This article uses hypothetical reserve distributions and price forecasts to illustrate indicative economics of deepwater prospects. Economics of Shell Oil Co.'s three deepwater projects are also discussed

  10. Corneal perforation after conductive keratoplasty with previous refractive surgery.

    Science.gov (United States)

    Kymionis, George D; Titze, Patrik; Markomanolakis, Marinos M; Aslanides, Ioannis M; Pallikaris, Ioannis G

    2003-12-01

    A 56-year-old woman had conductive keratoplasty (CK) for residual hyperopia and astigmatism. Three years before the procedure, the patient had arcuate keratotomy, followed by laser in situ keratomileusis 2 years later for high astigmatism correction in both eyes. During CK, a corneal perforation occurred in the right eye; during the postoperative examination, an iris perforation and anterior subcapsule opacification were seen beneath the perforation site. The perforation was managed with a bandage contact lens and an antibiotic-steroid ointment; it had a negative Seidel sign by the third day. The surgery in the left eye was uneventful. Three months after the procedure, the uncorrected visual acuity was 20/32 and the best corrected visual acuity 20/20 in both eyes with a significant improvement in corneal topography. Care must be taken to prevent CK-treated spots from coinciding with areas in the corneal stroma that might have been altered by previous refractive procedures.

  11. Interference from previous distraction disrupts older adults' memory.

    Science.gov (United States)

    Biss, Renée K; Campbell, Karen L; Hasher, Lynn

    2013-07-01

    Previously relevant information can disrupt the ability of older adults to remember new information. Here, the researchers examined whether prior irrelevant information, or distraction, can also interfere with older adults' memory for new information. Younger and older adults first completed a 1-back task on pictures that were superimposed with distracting words. After a delay, participants learned picture-word paired associates and memory was tested using picture-cued recall. In 1 condition (high interference), some pairs included pictures from the 1-back task now paired with new words. In a low-interference condition, the transfer list used all new items. Older adults had substantially lower cued-recall performance in the high- compared with the low-interference condition. In contrast, younger adults' performance did not vary across conditions. These findings suggest that even never-relevant information from the past can disrupt older adults' memory for new associations.

  12. The long-term consequences of previous hyperthyroidism

    DEFF Research Database (Denmark)

    Hjelm Brandt Kristensen, Frans

    2015-01-01

    Thyroid hormones affect every cell in the human body, and the cardiovascular changes associated with increased levels of thyroid hormones are especially well described. As an example, short-term hyperthyroidism has positive chronotropic and inotropic effects on the heart, leading to a hyperdynamic...... with CVD, LD and DM both before and after the diagnosis of hyperthyroidism. Although the design used does not allow a stringent distinction between cause and effect, the findings indicate a possible direct association between hyperthyroidism and these morbidities, or vice versa....... vascular state. While it is biologically plausible that these changes may induce long-term consequences, the insight into morbidity as well as mortality in patients with previous hyperthyroidism is limited. The reasons for this are a combination of inadequately powered studies, varying definitions...

  13. Is Previous Respiratory Disease a Risk Factor for Lung Cancer?

    Science.gov (United States)

    Denholm, Rachel; Schüz, Joachim; Straif, Kurt; Stücker, Isabelle; Jöckel, Karl-Heinz; Brenner, Darren R.; De Matteis, Sara; Boffetta, Paolo; Guida, Florence; Brüske, Irene; Wichmann, Heinz-Erich; Landi, Maria Teresa; Caporaso, Neil; Siemiatycki, Jack; Ahrens, Wolfgang; Pohlabeln, Hermann; Zaridze, David; Field, John K.; McLaughlin, John; Demers, Paul; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Rudnai, Peter; Fabianova, Eleonora; Dumitru, Rodica Stanescu; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Kendzia, Benjamin; Peters, Susan; Behrens, Thomas; Vermeulen, Roel; Brüning, Thomas; Kromhout, Hans

    2014-01-01

    Rationale: Previous respiratory diseases have been associated with increased risk of lung cancer. Respiratory conditions often co-occur and few studies have investigated multiple conditions simultaneously. Objectives: Investigate lung cancer risk associated with chronic bronchitis, emphysema, tuberculosis, pneumonia, and asthma. Methods: The SYNERGY project pooled information on previous respiratory diseases from 12,739 case subjects and 14,945 control subjects from 7 case–control studies conducted in Europe and Canada. Multivariate logistic regression models were used to investigate the relationship between individual diseases adjusting for co-occurring conditions, and patterns of respiratory disease diagnoses and lung cancer. Analyses were stratified by sex, and adjusted for age, center, ever-employed in a high-risk occupation, education, smoking status, cigarette pack-years, and time since quitting smoking. Measurements and Main Results: Chronic bronchitis and emphysema were positively associated with lung cancer, after accounting for other respiratory diseases and smoking (e.g., in men: odds ratio [OR], 1.33; 95% confidence interval [CI], 1.20–1.48 and OR, 1.50; 95% CI, 1.21–1.87, respectively). A positive relationship was observed between lung cancer and pneumonia diagnosed 2 years or less before lung cancer (OR, 3.31; 95% CI, 2.33–4.70 for men), but not longer. Co-occurrence of chronic bronchitis and emphysema and/or pneumonia had a stronger positive association with lung cancer than chronic bronchitis “only.” Asthma had an inverse association with lung cancer, the association being stronger with an asthma diagnosis 5 years or more before lung cancer compared with shorter. Conclusions: Findings from this large international case–control consortium indicate that after accounting for co-occurring respiratory diseases, chronic bronchitis and emphysema continue to have a positive association with lung cancer. PMID:25054566

  14. Twelve previously unknown phage genera are ubiquitous in global oceans.

    Science.gov (United States)

    Holmfeldt, Karin; Solonenko, Natalie; Shah, Manesh; Corrier, Kristen; Riemann, Lasse; Verberkmoes, Nathan C; Sullivan, Matthew B

    2013-07-30

    Viruses are fundamental to ecosystems ranging from oceans to humans, yet our ability to study them is bottlenecked by the lack of ecologically relevant isolates, resulting in "unknowns" dominating culture-independent surveys. Here we present genomes from 31 phages infecting multiple strains of the aquatic bacterium Cellulophaga baltica (Bacteroidetes) to provide data for an underrepresented and environmentally abundant bacterial lineage. Comparative genomics delineated 12 phage groups that (i) each represent a new genus, and (ii) represent one novel and four well-known viral families. This diversity contrasts the few well-studied marine phage systems, but parallels the diversity of phages infecting human-associated bacteria. Although all 12 Cellulophaga phages represent new genera, the podoviruses and icosahedral, nontailed ssDNA phages were exceptional, with genomes up to twice as large as those previously observed for each phage type. Structural novelty was also substantial, requiring experimental phage proteomics to identify 83% of the structural proteins. The presence of uncommon nucleotide metabolism genes in four genera likely underscores the importance of scavenging nutrient-rich molecules as previously seen for phages in marine environments. Metagenomic recruitment analyses suggest that these particular Cellulophaga phages are rare and may represent a first glimpse into the phage side of the rare biosphere. However, these analyses also revealed that these phage genera are widespread, occurring in 94% of 137 investigated metagenomes. Together, this diverse and novel collection of phages identifies a small but ubiquitous fraction of unknown marine viral diversity and provides numerous environmentally relevant phage-host systems for experimental hypothesis testing.

  15. Who Needs Replication?

    Science.gov (United States)

    Porte, Graeme

    2013-01-01

    In this paper, the editor of a recent Cambridge University Press book on research methods discusses replicating previous key studies to throw more light on their reliability and generalizability. Replication research is presented as an accepted method of validating previous research by providing comparability between the original and replicated…

  16. Radon anomalies prior to earthquakes (1). Review of previous studies

    International Nuclear Information System (INIS)

    Ishikawa, Tetsuo; Tokonami, Shinji; Yasuoka, Yumi; Shinogi, Masaki; Nagahama, Hiroyuki; Omori, Yasutaka; Kawada, Yusuke

    2008-01-01

    The relationship between radon anomalies and earthquakes has been studied for more than 30 years. However, most of the studies dealt with radon in soil gas or in groundwater. Before the 1995 Hyogoken-Nanbu earthquake, an anomalous increase of atmospheric radon was observed at Kobe Pharmaceutical University. The increase was well fitted with a mathematical model related to earthquake fault dynamics. This paper reports the significance of this observation, reviewing previous studies on radon anomaly before earthquakes. Groundwater/soil radon measurements for earthquake prediction began in 1970's in Japan as well as foreign countries. One of the most famous studies in Japan is groundwater radon anomaly before the 1978 Izu-Oshima-kinkai earthquake. We have recognized the significance of radon in earthquake prediction research, but recently its limitation was also pointed out. Some researchers are looking for a better indicator for precursors; simultaneous measurements of radon and other gases are new trials in recent studies. Contrary to soil/groundwater radon, we have not paid much attention to atmospheric radon before earthquakes. However, it might be possible to detect precursors in atmospheric radon before a large earthquake. In the next issues, we will discuss the details of the anomalous atmospheric radon data observed before the Hyogoken-Nanbu earthquake. (author)

  17. Mediastinal involvement in lymphangiomatosis: a previously unreported MRI sign

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Vikas; Shah, Sachit; Barnacle, Alex; McHugh, Kieran [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); Sebire, Neil J. [Great Ormond Street Hospital for Children, Department of Histopathology, London (United Kingdom); Brock, Penelope [Great Ormond Street Hospital for Children, Department of Oncology, London (United Kingdom); Harper, John I. [Great Ormond Street Hospital for Children, Department of Dermatology, London (United Kingdom)

    2011-08-15

    Multifocal lymphangiomatosis is a rare systemic disorder affecting children. Due to its rarity and wide spectrum of clinical, histological and imaging features, establishing the diagnosis of multifocal lymphangiomatosis can be challenging. The purpose of this study was to describe a new imaging sign in this disorder: paraspinal soft tissue and signal abnormality at MRI. We retrospectively reviewed the imaging, clinical and histopathological findings in a cohort of eight children with thoracic involvement from this condition. Evidence of paraspinal chest disease was identified at MRI and CT in all eight of these children. The changes comprise heterogeneous intermediate-to-high signal parallel to the thoracic vertebrae on T2-weighted sequences at MRI, with abnormal paraspinal soft tissue at CT and plain radiography. Multifocal lymphangiomatosis is a rare disorder with a broad range of clinicopathological and imaging features. MRI allows complete evaluation of disease extent without the use of ionising radiation and has allowed us to describe a previously unreported imaging sign in this disorder, namely, heterogeneous hyperintense signal in abnormal paraspinal tissue on T2-weighted images. (orig.)

  18. Cerebral Metastasis from a Previously Undiagnosed Appendiceal Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Antonio Biroli

    2012-01-01

    Full Text Available Brain metastases arise in 10%–40% of all cancer patients. Up to one third of the patients do not have previous cancer history. We report a case of a 67-years-old male patient who presented with confusion, tremor, and apraxia. A brain MRI revealed an isolated right temporal lobe lesion. A thorax-abdomen-pelvis CT scan showed no primary lesion. The patient underwent a craniotomy with gross-total resection. Histopathology revealed an intestinal-type adenocarcinoma. A colonoscopy found no primary lesion, but a PET-CT scan showed elevated FDG uptake in the appendiceal nodule. A right hemicolectomy was performed, and the specimen showed a moderately differentiated mucinous appendiceal adenocarcinoma. Whole brain radiotherapy was administrated. A subsequent thorax-abdomen CT scan revealed multiple lung and hepatic metastasis. Seven months later, the patient died of disease progression. In cases of undiagnosed primary lesions, patients present in better general condition, but overall survival does not change. Eventual identification of the primary tumor does not affect survival. PET/CT might be a helpful tool in detecting lesions of the appendiceal region. To the best of our knowledge, such a case was never reported in the literature, and an appendiceal malignancy should be suspected in patients with brain metastasis from an undiagnosed primary tumor.

  19. Coronary collateral vessels in patients with previous myocardial infarction

    International Nuclear Information System (INIS)

    Nakatsuka, M.; Matsuda, Y.; Ozaki, M.

    1987-01-01

    To assess the degree of collateral vessels after myocardial infarction, coronary angiograms, left ventriculograms, and exercise thallium-201 myocardial scintigrams of 36 patients with previous myocardial infarction were reviewed. All 36 patients had total occlusion of infarct-related coronary artery and no more than 70% stenosis in other coronary arteries. In 19 of 36 patients with transient reduction of thallium-201 uptake in the infarcted area during exercise (Group A), good collaterals were observed in 10 patients, intermediate collaterals in 7 patients, and poor collaterals in 2 patients. In 17 of 36 patients without transient reduction of thallium-201 uptake in the infarcted area during exercise (Group B), good collaterals were seen in 2 patients, intermediate collaterals in 7 patients, and poor collaterals in 8 patients (p less than 0.025). Left ventricular contractions in the infarcted area were normal or hypokinetic in 10 patients and akinetic or dyskinetic in 9 patients in Group A. In Group B, 1 patient had hypokinetic contraction and 16 patients had akinetic or dyskinetic contraction (p less than 0.005). Thus, patients with transient reduction of thallium-201 uptake in the infarcted area during exercise had well developed collaterals and preserved left ventricular contraction, compared to those in patients without transient reduction of thallium-201 uptake in the infarcted area during exercise. These results suggest that the presence of viable myocardium in the infarcted area might be related to the degree of collateral vessels

  20. High-Grade Leiomyosarcoma Arising in a Previously Replanted Limb

    Directory of Open Access Journals (Sweden)

    Tiffany J. Pan

    2015-01-01

    Full Text Available Sarcoma development has been associated with genetics, irradiation, viral infections, and immunodeficiency. Reports of sarcomas arising in the setting of prior trauma, as in burn scars or fracture sites, are rare. We report a case of a leiomyosarcoma arising in an arm that had previously been replanted at the level of the elbow joint following traumatic amputation when the patient was eight years old. He presented twenty-four years later with a 10.8 cm mass in the replanted arm located on the volar forearm. The tumor was completely resected and pathology examination showed a high-grade, subfascial spindle cell sarcoma diagnosed as a grade 3 leiomyosarcoma with stage pT2bNxMx. The patient underwent treatment with brachytherapy, reconstruction with a free flap, and subsequently chemotherapy. To the best of our knowledge, this is the first case report of leiomyosarcoma developing in a replanted extremity. Development of leiomyosarcoma in this case could be related to revascularization, scar formation, or chronic injury after replantation. The patient remains healthy without signs of recurrence at three-year follow-up.

  1. Global functional atlas of Escherichia coli encompassing previously uncharacterized proteins.

    Directory of Open Access Journals (Sweden)

    Pingzhao Hu

    2009-04-01

    Full Text Available One-third of the 4,225 protein-coding genes of Escherichia coli K-12 remain functionally unannotated (orphans. Many map to distant clades such as Archaea, suggesting involvement in basic prokaryotic traits, whereas others appear restricted to E. coli, including pathogenic strains. To elucidate the orphans' biological roles, we performed an extensive proteomic survey using affinity-tagged E. coli strains and generated comprehensive genomic context inferences to derive a high-confidence compendium for virtually the entire proteome consisting of 5,993 putative physical interactions and 74,776 putative functional associations, most of which are novel. Clustering of the respective probabilistic networks revealed putative orphan membership in discrete multiprotein complexes and functional modules together with annotated gene products, whereas a machine-learning strategy based on network integration implicated the orphans in specific biological processes. We provide additional experimental evidence supporting orphan participation in protein synthesis, amino acid metabolism, biofilm formation, motility, and assembly of the bacterial cell envelope. This resource provides a "systems-wide" functional blueprint of a model microbe, with insights into the biological and evolutionary significance of previously uncharacterized proteins.

  2. Global functional atlas of Escherichia coli encompassing previously uncharacterized proteins.

    Science.gov (United States)

    Hu, Pingzhao; Janga, Sarath Chandra; Babu, Mohan; Díaz-Mejía, J Javier; Butland, Gareth; Yang, Wenhong; Pogoutse, Oxana; Guo, Xinghua; Phanse, Sadhna; Wong, Peter; Chandran, Shamanta; Christopoulos, Constantine; Nazarians-Armavil, Anaies; Nasseri, Negin Karimi; Musso, Gabriel; Ali, Mehrab; Nazemof, Nazila; Eroukova, Veronika; Golshani, Ashkan; Paccanaro, Alberto; Greenblatt, Jack F; Moreno-Hagelsieb, Gabriel; Emili, Andrew

    2009-04-28

    One-third of the 4,225 protein-coding genes of Escherichia coli K-12 remain functionally unannotated (orphans). Many map to distant clades such as Archaea, suggesting involvement in basic prokaryotic traits, whereas others appear restricted to E. coli, including pathogenic strains. To elucidate the orphans' biological roles, we performed an extensive proteomic survey using affinity-tagged E. coli strains and generated comprehensive genomic context inferences to derive a high-confidence compendium for virtually the entire proteome consisting of 5,993 putative physical interactions and 74,776 putative functional associations, most of which are novel. Clustering of the respective probabilistic networks revealed putative orphan membership in discrete multiprotein complexes and functional modules together with annotated gene products, whereas a machine-learning strategy based on network integration implicated the orphans in specific biological processes. We provide additional experimental evidence supporting orphan participation in protein synthesis, amino acid metabolism, biofilm formation, motility, and assembly of the bacterial cell envelope. This resource provides a "systems-wide" functional blueprint of a model microbe, with insights into the biological and evolutionary significance of previously uncharacterized proteins.

  3. Gastrointestinal tolerability with ibandronate after previous weekly bisphosphonate treatment.

    Science.gov (United States)

    Derman, Richard; Kohles, Joseph D; Babbitt, Ann

    2009-01-01

    Data from two open-label trials (PRIOR and CURRENT) of women with postmenopausal osteoporosis or osteopenia were evaluated to assess whether monthly oral and quarterly intravenous (IV) ibandronate dosing improved self-reported gastrointestinal (GI) tolerability for patients who had previously experienced GI irritation with bisphosphonate (BP) use. In PRIOR, women who had discontinued daily or weekly BP treatment due to GI intolerance received monthly oral or quarterly IV ibandronate for 12 months. The CURRENT subanalysis included women receiving weekly BP treatment who switched to monthly oral ibandronate for six months. GI symptom severity and frequency were assessed using the Osteoporosis Patient Satisfaction Questionnaire. In PRIOR, mean GI tolerability scores increased significantly at month 1 from screening for both treatment groups (oral: 79.3 versus 54.1; IV: 84.4 versus 51.0; p 90% at Month 10). In the CURRENT subanalysis >60% of patients reported improvements in heartburn or acid reflux and >70% indicated improvement in other stomach upset at month 6. Postmenopausal women with GI irritability with daily or weekly BPs experienced improvement in symptoms with extended dosing monthly or quarterly ibandronate compared with baseline.

  4. Pertussis-associated persistent cough in previously vaccinated children.

    Science.gov (United States)

    Principi, Nicola; Litt, David; Terranova, Leonardo; Picca, Marina; Malvaso, Concetta; Vitale, Cettina; Fry, Norman K; Esposito, Susanna

    2017-11-01

    To evaluate the role of Bordetella pertussis infection, 96 otherwise healthy 7- to 17-year-old subjects who were suffering from a cough lasting from 2 to 8 weeks were prospectively recruited. At enrolment, a nasopharyngeal swab and an oral fluid sample were obtained to search for pertussis infection by the detection of B. pertussis DNA and/or an elevated titre of anti-pertussis toxin IgG. Evidence of pertussis infection was found in 18 (18.7 %; 95 % confidence interval, 11.5-28.0) cases. In 15 cases, the disease occurred despite booster administration. In two cases, pertussis was diagnosed less than 2 years after the booster injection, whereas in the other cases it was diagnosed between 2 and 9 years after the booster dose. This study used non-invasive testing to show that pertussis is one of the most important causes of long-lasting cough in school-age subjects. Moreover, the protection offered by acellular pertussis vaccines currently wanes more rapidly than previously thought.

  5. Multispecies Coevolution Particle Swarm Optimization Based on Previous Search History

    Directory of Open Access Journals (Sweden)

    Danping Wang

    2017-01-01

    Full Text Available A hybrid coevolution particle swarm optimization algorithm with dynamic multispecies strategy based on K-means clustering and nonrevisit strategy based on Binary Space Partitioning fitness tree (called MCPSO-PSH is proposed. Previous search history memorized into the Binary Space Partitioning fitness tree can effectively restrain the individuals’ revisit phenomenon. The whole population is partitioned into several subspecies and cooperative coevolution is realized by an information communication mechanism between subspecies, which can enhance the global search ability of particles and avoid premature convergence to local optimum. To demonstrate the power of the method, comparisons between the proposed algorithm and state-of-the-art algorithms are grouped into two categories: 10 basic benchmark functions (10-dimensional and 30-dimensional, 10 CEC2005 benchmark functions (30-dimensional, and a real-world problem (multilevel image segmentation problems. Experimental results show that MCPSO-PSH displays a competitive performance compared to the other swarm-based or evolutionary algorithms in terms of solution accuracy and statistical tests.

  6. The urgent need to change the current medical approach on tobacco cessation in Latin America Urge cambiar el abordaje de la cesación del tabaquismo por los médicos en América Latina

    Directory of Open Access Journals (Sweden)

    Guadalupe Ponciano-Rodríguez

    2010-01-01

    Full Text Available Despite of the accumulation of scientific evidence confirming the health consequences of smoking and the new paradigm of smoking as a disease where nicotine is the drug that modifies the functional and morphological characteristics of the brain in dependent smokers, tobacco smoking continues as an important public health problem in many Latin American countries. In contrast with big advances in the tobacco control area, as an example the Framework Convention on Tobacco Control signed by 168 countries, the role of health professional in the fight against tobacco is still less than ideal. In many Latin American schools of medicine, deficiencies in medical education has led to insecure physicians when they have to motivate their patients to stop smoking or to prevent young people to begin tobacco consumption. If each general practitioner or specialist during their daily medical assistance could talk to their smoker patients about the big benefits of stop smoking and support them to get free of tobacco, we would be winning a battle against smoking. Also if we could achieve generations of young non smoking doctors, who could be a real example for patients, this could also impact the prevalence of smokers. In this article we analyze the neurobiological bases of nicotine addiction, which we think are missing in the medical curriculum and could help doctors to understand tobacco smoking as a disease rather than a risk factor, and discuss the main reasons supporting an urgent change in the medical approach of tobacco cessation in Latin America as well as the need to actualize the medical curriculum in order to give physicians the skills needed to intervene successfully with their smoker patients and to be themselves non smokers.A pesar de que actualmente contamos con una gran cantidad de evidencias científicas que confirman que el tabaquismo es una enfermedad con graves consecuencias para la salud y que la nicotina es una droga o sustancia psicoactiva

  7. Mentoring to develop research selfefficacy, with particular reference to previously disadvantaged individuals

    Directory of Open Access Journals (Sweden)

    S. Schulze

    2010-07-01

    Full Text Available The development of inexperienced researchers is crucial. In response to the lack of research self-efficacy of many previously disadvantaged individuals, the article examines how mentoring can enhance the research self-efficacy of mentees. The study is grounded in the self-efficacy theory (SET – an aspect of the social cognitive theory (SCT. Insights were gained from an in-depth study of SCT, SET and mentoring, and from a completed mentoring project. This led to the formulation of three basic principles. Firstly, institutions need to provide supportive environmental conditions that facilitate research selfefficacy. This implies a supportive and efficient collective system. The possible effects of performance ratings and reward systems at the institution also need to be considered. Secondly, mentoring needs to create opportunities for young researchers to experience successful learning as a result of appropriate action. To this end, mentees need to be involved in actual research projects in small groups. At the same time the mentor needs to facilitate skills development by coaching and encouragement. Thirdly, mentors need to encourage mentees to believe in their ability to successfully complete research projects. This implies encouraging positive emotional states, stimulating self-reflection and self-comparison with others in the group, giving positive evaluative feedback and being an intentional role model.

  8. Impact of Students’ Class Attendance on Recalling Previously Acquired Information

    Directory of Open Access Journals (Sweden)

    Camellia Hemyari

    2018-03-01

    Full Text Available Background: In recent years, availability of class material including typed lectures, the professor’s Power Point slides, sound recordings, and even videos made a group of students feel that it is unnecessary to attend the classes. These students usually read and memorize typed lectures within two or three days prior to the exams and usually pass the tests even with low attendance rate. Thus, the question is how effective is this learning system and how long the one-night memorized lessons may last.Methods: A group of medical students (62 out of 106 students, with their class attendance and educational achievements in the Medical Mycology and Parasitology course being recorded since two years ago, was selected and their knowledge about this course was tested by multiple choice questions (MCQ designed based on the previous lectures.Results: Although the mean re-exam score of the students at the end of the externship was lower than the corresponding final score, a significant association was found between the scores of the students in these two exams (r=0.48, P=0.01. Moreover, a significant negative association was predicted between the number of absences and re-exam scores (r=-0.26, P=0.037.Conclusion: As our findings show, the phenomenon of recalling the acquired lessons is preserved for a long period of time and it is associated with the students’ attendance. Many factors including generation effect (by taking notes and cued-recall (via slide picture might play a significant role in the better recalling of the learned information in students with good class attendance.Keywords: STUDENT, MEMORY, LONG-TERM, RECALL, ABSENTEEISM, LEARNING

  9. Repeat immigration: A previously unobserved source of heterogeneity?

    Science.gov (United States)

    Aradhya, Siddartha; Scott, Kirk; Smith, Christopher D

    2017-07-01

    Register data allow for nuanced analyses of heterogeneities between sub-groups which are not observable in other data sources. One heterogeneity for which register data is particularly useful is in identifying unique migration histories of immigrant populations, a group of interest across disciplines. Years since migration is a commonly used measure of integration in studies seeking to understand the outcomes of immigrants. This study constructs detailed migration histories to test whether misclassified migrations may mask important heterogeneities. In doing so, we identify a previously understudied group of migrants called repeat immigrants, and show that they differ systematically from permanent immigrants. In addition, we quantify the degree to which migration information is misreported in the registers. The analysis is carried out in two steps. First, we estimate income trajectories for repeat immigrants and permanent immigrants to understand the degree to which they differ. Second, we test data validity by cross-referencing migration information with changes in income to determine whether there are inconsistencies indicating misreporting. From the first part of the analysis, the results indicate that repeat immigrants systematically differ from permanent immigrants in terms of income trajectories. Furthermore, income trajectories differ based on the way in which years since migration is calculated. The second part of the analysis suggests that misreported migration events, while present, are negligible. Repeat immigrants differ in terms of income trajectories, and may differ in terms of other outcomes as well. Furthermore, this study underlines that Swedish registers provide a reliable data source to analyze groups which are unidentifiable in other data sources.

  10. Gastrointestinal tolerability with ibandronate after previous weekly bisphosphonate treatment

    Directory of Open Access Journals (Sweden)

    Richard Derman

    2009-09-01

    Full Text Available Richard Derman1, Joseph D Kohles2, Ann Babbitt31Department of Obstetrics and Gynecology, Christiana Hospital, Newark, DE, USA; 2Roche, Nutley, NJ, USA; 3Greater Portland Bone and Joint Specialists, Portland, ME, USAAbstract: Data from two open-label trials (PRIOR and CURRENT of women with postmenopausal osteoporosis or osteopenia were evaluated to assess whether monthly oral and quarterly intravenous (IV ibandronate dosing improved self-reported gastrointestinal (GI tolerability for patients who had previously experienced GI irritation with bisphosphonate (BP use. In PRIOR, women who had discontinued daily or weekly BP treatment due to GI intolerance received monthly oral or quarterly IV ibandronate for 12 months. The CURRENT subanalysis included women receiving weekly BP treatment who switched to monthly oral ibandronate for six months. GI symptom severity and frequency were assessed using the Osteoporosis Patient Satisfaction Questionnaire™. In PRIOR, mean GI tolerability scores increased significantly at month 1 from screening for both treatment groups (oral: 79.3 versus 54.1; IV: 84.4 versus 51.0; p < 0.001 for both. Most patients reported improvement in GI symptom severity and frequency from baseline at all post-screening assessments (>90% at Month 10. In the CURRENT subanalysis >60% of patients reported improvements in heartburn or acid reflux and >70% indicated improvement in other stomach upset at month 6. Postmenopausal women with GI irritability with daily or weekly BPs experienced improvement in symptoms with extended dosing monthly or quarterly ibandronate compared with baseline.Keywords: ibandronate, osteoporosis, bisphosphonate, gastrointestinal

  11. Parental anxiety associated with Kawasaki disease in previously healthy children.

    Science.gov (United States)

    Chahal, Nita; Clarizia, Nadia A; McCrindle, Brian W; Boydell, Katherine M; Obadia, Maya; Manlhiot, Cedric; Dillenburg, Rejane; Yeung, Rae S M

    2010-01-01

    The objective of this study was to explore the lived experience of parents of children diagnosed with Kawasaki disease (KD) and to identify factors associated with increased levels of parental anxiety. Three focus groups were conducted including 25 parents of 17 patients with KD, seven (41%) of whom had coronary artery complications. A conceptual model was developed to depict parental experiences and illustrate the key issues related to heightened anxiety. Themes identified included anxiety related to the child's sudden illness and delay in obtaining a correct diagnosis because of the lack of health care providers' awareness and knowledge regarding KD. Parents were frustrated by the lack of information available in lay language and the limited scientific knowledge regarding the long-term consequences of the disease. Parents also reported positive transformations and different perspective toward challenges in life. However, the parents of children with coronary artery complications expressed persistent anxiety even years after the acute phase of the illness due to the uncertainty of the long-term prognosis. There remains a critical need for richly textured research data on the perspective and experience of families of children with KD. Copyright 2010 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

  12. Lung cancer in Hodgkin's disease: association with previous radiotherapy

    International Nuclear Information System (INIS)

    List, A.F.; Doll, D.C.; Greco, F.A.

    1985-01-01

    Seven cases of lung cancer were observed in patients with Hodgkin's disease (HD) since 1970. The risk ratio for the development of lung cancer among HD patients was 5.6 times that expected in the general population. The pertinent clinical data from these patients are described and compared to 28 additional patients reported from other institutions. Small-cell lung cancer represented the predominant histologic type of lung cancer encountered in both smoking and nonsmoking patients with HD, accounting for 42% of cases overall and greater than 55% of cases reported in reviews of second malignancies. Tobacco use was noted in only 53% of patients. Twenty-eight (94%) of 30 patients developing metachronous lung cancer received supradiaphragmatic irradiation as primary therapy for HD. Nineteen (68%) of these patients received subsequent chemotherapy salvage. The median age at diagnosis of HD and lung cancer was 39 and 45 years, respectively. The interval between diagnosis of HD and metachronous lung cancer averaged seven years but appeared to vary inversely with age. HD patients treated with supradiaphragmatic irradiation or combined modality therapy may be at increased risk for developing lung cancer. The high frequency of in-field malignancies that the authors observed and the prevalence of small-cell lung cancer in both smoking and nonsmoking patients suggests that chest irradiation may influence the development of metachronous lung cancer in these patients. The finding of a mean latent interval in excess of seven years emphasizes the need for close long-term observation

  13. Climbing the Needs Pyramids

    Directory of Open Access Journals (Sweden)

    J. C. Lomas

    2013-08-01

    Full Text Available Abraham Maslow’s theory of human adult motivation is often represented by a pyramid image showing two proposals: First, the five needs stages in emergent order of hierarchical ascension and second, a percentage of the adult population suggested to occupy each needs tier. Specifically, Maslow proposed that adults would be motivated to satisfy their unfilled needs until they reached the hierarchy’s apex and achieved self-transcendence. Yet how adults can purposefully ascend Maslow’s pyramid through satisfying unfilled needs remains elusive. This brief article challenges this on the theory’s 70th anniversary by presenting a new image of the needs hierarchy, based on ecological design principles to support adults’ purposeful endeavors to climb the needs pyramid.

  14. The incidence of congenital heart disease: Previous findings and perspectives

    Directory of Open Access Journals (Sweden)

    Miranović Vesna

    2014-01-01

    Full Text Available Congenital heart defects (CHD are the most common of all congenital anomalies, and represent a significant global health problem. Involvement of medical professionals of different profiles has led to drastic changes in survival and quality of life of children with CHD. The motivation for the implementation of the first large population studies on this subject was not only to obtain answers to the question on the level of incidence of CHD, but the harmonization of criteria and protocols for monitoring and treatment of certain defects as well as the planning of medical staff dealing with children with CHD. Data on the incidence varies from 4-10/1000 live births. Fetal echocardiography can have potential impact on decrease of CHD incidence. The increase in incidence may be due to the possibility that children with CHD will grow up and have offsprings. Owing to the progress that has been made, an increasing number of patients experiences adulthood, creating an entirely new and growing population of patients: patients with “adult” CHD. Survivors suffer morbidity resulting from their circulatory abnormalities as well as from medical and surgical therapies they have been subjected to. Application of the achievements of human genome projects will in time lead to drastic changes in the approach to the patients with CHD. Until the time when it is possible, the goal will be further improvement of the existing system of service: networking in a unique, multicenter clinical registry of patients with CHD, as well as upgrading of technical and non-technical conditions for the treatment of patients with CHD. We are in an unprecedented time of change, but are actually at the end of the beginning of making pediatric cardiac care a highly reliable institution.

  15. Climbing the Needs Pyramids

    OpenAIRE

    J. C. Lomas

    2013-01-01

    Abraham Maslow’s theory of human adult motivation is often represented by a pyramid image showing two proposals: First, the five needs stages in emergent order of hierarchical ascension and second, a percentage of the adult population suggested to occupy each needs tier. Specifically, Maslow proposed that adults would be motivated to satisfy their unfilled needs until they reached the hierarchy’s apex and achieved self...

  16. Information Needs/Relevance

    OpenAIRE

    Wildemuth, Barbara M.

    2009-01-01

    A user's interaction with a DL is often initiated as the result of the user experiencing an information need of some kind. Aspects of that experience and how it might affect the user's interactions with the DL are discussed in this module. In addition, users continuously make decisions about and evaluations of the materials retrieved from a DL, relative to their information needs. Relevance judgments, and their relationship to the user's information needs, are discussed in this module. Draft

  17. Priority knowledge needs. Summary

    International Nuclear Information System (INIS)

    2012-01-01

    This report gives an overview of the knowledge needs identified during the work on the scientific basis for the management plan. The overview includes knowledge needs identified in: the impact assessments for various sectors; the reports on the vulnerability of particularly valuable areas; proposed indicators for a monitoring system; cumulative environmental effects; conflicting interests and the need for coordination; and the report on analysis of population and, economic activity and ecosystem services. In addition, the working group has identified several additional knowledge needs. The present report summarises the 2010 status report and describes new developments since its publication.(Author)

  18. Priority knowledge needs. Summary

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-01

    This report gives an overview of the knowledge needs identified during the work on the scientific basis for the management plan. The overview includes knowledge needs identified in: the impact assessments for various sectors; the reports on the vulnerability of particularly valuable areas; proposed indicators for a monitoring system; cumulative environmental effects; conflicting interests and the need for coordination; and the report on analysis of population and, economic activity and ecosystem services. In addition, the working group has identified several additional knowledge needs. The present report summarises the 2010 status report and describes new developments since its publication.(Author)

  19. Trephine Transverse Colostomy Is Effective for Patients Who Have Previously Undergone Rectal Surgery

    Science.gov (United States)

    Yeom, Seung-Seop; Jung, Sung Woo; Oh, Se Heon; Lee, Jong Lyul; Yoon, Yong Sik; Park, In Ja; Lim, Seok-Byung; Yu, Chang Sik; Kim, Jin Cheon

    2018-01-01

    Purpose Colostomy creation is an essential procedure for colorectal surgeons, but the preferred method of colostomy varies by surgeon. We compared the outcomes of trephine colostomy creation with open those for the (laparotomy) and laparoscopic methods and evaluated appropriate indications for a trephine colostomy and the advantages of the technique. Methods We retrospectively evaluated 263 patients who had undergone colostomy creation by trephine, open and laparoscopic approaches between April 2006 and March 2016. We compared the clinical features and the operative and postoperative outcomes according to the approach used for stoma creation. Results One hundred sixty-three patients (62%) underwent colostomy surgery for obstructive causes and 100 (38%) for fistulous problems. The mean operative time was significantly shorter with the trephine approach (trephine, 46.0 ± 1.9 minutes; open, 78.7 ± 3.9 minutes; laparoscopic, 63.5 ± 5.0 minutes; P colostomy was feasible for a diversion colostomy (P colostomy is safe and can be implemented quickly in various situations, and compared to other colostomy procedures, the patient’s recovery is faster. Previous laparotomy history was not a contraindication for a trephine colostomy, and a trephine transverse colostomy is feasible for patients who have undergone previous rectal surgery. PMID:29742862

  20. Additional user needs

    International Nuclear Information System (INIS)

    Rorschach, H.E.; Hayter, J.B.

    1986-01-01

    This paper summarizes the conclusions of a discussion group on users' needs held at the Workshop on an Advanced Steady-State Neutron Facility. The discussion was devoted to reactor characteristics, special facilities and siting considerations suggested by user needs. (orig.)

  1. Health physics instrumentation needs

    International Nuclear Information System (INIS)

    Selby, J.M.; Swinth, K.L.; Kenoyer, J.L.

    1984-10-01

    Deficiencies and desirable improvements can be identified in every technical area in which health physics instruments are employed. The needed improvements cover the full spectrum including long-term reliability, human factors, accuracy, ruggedness, ease of calibration, improved radiation response, and improved mixed field response. Some specific areas of deficiency noted along with needed improvements. 17 references

  2. Training Needs Identification: A Turning Point.

    Science.gov (United States)

    Thomas, Edwin A.

    1982-01-01

    Describes a systematic approach to training needs identification that is directly tied to changing organizational events and performance requirements. The discussion includes nine questions which address performance expectations. (JJD)

  3. Accident management information needs

    International Nuclear Information System (INIS)

    Hanson, D.J.; Ward, L.W.; Nelson, W.R.; Meyer, O.R.

    1990-04-01

    The tables contained in this Appendix A describe the information needs for a pressurized water reactor (PWR) with a large, dry containment. To identify these information needs, the branch points in the safety objective trees were examined to decide what information is necessary to (a) determine the status of the safety functions in the plant, i.e., whether the safety functions are being adequately maintained within predetermined limits, (b) identify plant behavior (mechanisms) or precursors to this behavior which indicate that a challenge to plant safety is occurring or is imminent, and (c) select strategies that will prevent or mitigate this plant behavior and monitor the implementation and effectiveness of these strategies. The information needs for the challenges to the safety functions are not examined since the summation of the information needs for all mechanisms associated with a challenge comprise the information needs for the challenge itself

  4. Accident management information needs

    Energy Technology Data Exchange (ETDEWEB)

    Hanson, D.J.; Ward, L.W.; Nelson, W.R.; Meyer, O.R. (EG and G Idaho, Inc., Idaho Falls, ID (USA))

    1990-04-01

    The tables contained in this Appendix A describe the information needs for a pressurized water reactor (PWR) with a large, dry containment. To identify these information needs, the branch points in the safety objective trees were examined to decide what information is necessary to (a) determine the status of the safety functions in the plant, i.e., whether the safety functions are being adequately maintained within predetermined limits, (b) identify plant behavior (mechanisms) or precursors to this behavior which indicate that a challenge to plant safety is occurring or is imminent, and (c) select strategies that will prevent or mitigate this plant behavior and monitor the implementation and effectiveness of these strategies. The information needs for the challenges to the safety functions are not examined since the summation of the information needs for all mechanisms associated with a challenge comprise the information needs for the challenge itself.

  5. Personal anticipated information need

    Directory of Open Access Journals (Sweden)

    H. Bruce

    2005-01-01

    Full Text Available Background. The role of personal information collections is a well known feature of personal information management. The World Wide Web has introduced to such collections ideas such as filing Web pages or noting their existence in 'Bookmarks' and 'Favourites'. Argument. It is suggested that personal information collections are created in anticipation of some future need for that information-personal, anticipated information need, which also underlies the design of formal information systems. Elaboration. Examination of the literature of information needs and information seeking behaviour leads to the formulation of five propositions that elaborate the concept of personal, anticipated information need. These propositions draw upon concepts such as uncertainty, predictability, sensitivity and the valuation of information sources. Conclusion. An individual's understanding of personal, anticipated information need and how this understanding guides the acquisition and management of personal information will determine the effectiveness of that collection.

  6. Milky Way Past Was More Turbulent Than Previously Known

    Science.gov (United States)

    2004-04-01

    Results of 1001 observing nights shed new light on our Galaxy [1] Summary A team of astronomers from Denmark, Switzerland and Sweden [2] has achieved a major breakthrough in our understanding of the Milky Way, the galaxy in which we live. After more than 1,000 nights of observations spread over 15 years, they have determined the spatial motions of more than 14,000 solar-like stars residing in the neighbourhood of the Sun. For the first time, the changing dynamics of the Milky Way since its birth can now be studied in detail and with a stellar sample sufficiently large to allow a sound analysis. The astronomers find that our home galaxy has led a much more turbulent and chaotic life than previously assumed. PR Photo 10a/04: Distribution on the sky of the observed stars. PR Photo 10b/04: Stars in the solar neigbourhood and the Milky Way galaxy (artist's view). PR Video Clip 04/04: The motions of the observed stars during the past 250 million years. Unknown history Home is the place we know best. But not so in the Milky Way - the galaxy in which we live. Our knowledge of our nearest stellar neighbours has long been seriously incomplete and - worse - skewed by prejudice concerning their behaviour. Stars were generally selected for observation because they were thought to be "interesting" in some sense, not because they were typical. This has resulted in a biased view of the evolution of our Galaxy. The Milky Way started out just after the Big Bang as one or more diffuse blobs of gas of almost pure hydrogen and helium. With time, it assembled into the flattened spiral galaxy which we inhabit today. Meanwhile, generation after generation of stars were formed, including our Sun some 4,700 million years ago. But how did all this really happen? Was it a rapid process? Was it violent or calm? When were all the heavier elements formed? How did the Milky Way change its composition and shape with time? Answers to these and many other questions are 'hot' topics for the

  7. Poverty, Socio-Political Factors and Degradation of the Environment in Sub-Saharan Africa: The Need For a Holistic Approach to the Protection of the Environment and Realisation of the Right to Environment

    Directory of Open Access Journals (Sweden)

    Emeka Polycarp Amechi

    2009-09-01

    Full Text Available The right to environment is a recognised human right in Africa. However, despite the legal and institutional frameworks designed to respect, promote, protect and fulfil the right, its enjoyment is still a mirage to majority of African citizens as a result of environmental degradation. This article aims to proffer a holistic or integrated approach to tackling the problem of environmental degradation in sub-Saharan Africa in order to enhance the protection of the environment and the realisation of this right in the region. It recognises that the problem of environmental degradation in the region is not due to lack of regulatory frameworks, but rather due to other factors that are mainly socio-economic and political in nature. It argues that to enhance the protection of the environment and realisation of this right in sub-Saharan Africa, African governments must adopt a holistic approach towards the protection of the environment, and proposes the promotion of good governance and socio-economic reform in the region as an integral core of such approach.

  8. Congenital costo-vertebral fibrous band and congenital kyphoscoliosis: a previously unreported combination.

    Science.gov (United States)

    Eid, Tony; Ghostine, Bachir; Kreichaty, Gaby; Daher, Paul; Ghanem, Ismat

    2013-05-01

    Congenital kyphoscoliosis (CKS) results from abnormal vertebral chondrification. Congenital fibrous bands occur in several locations with variable impact on vertebral development. We report a previously unreported case of a female infant with CKS presenting with an L2 hypoplastic vertebra and a costo-vertebral fibrous band extending to the skin in the form of a dimple. We also describe the therapeutic approach, consisting of surgical excision of the fibrous band and postoperative fulltime bracing, with a 7-year follow-up. We recommend a high index of suspicion in any unusual presentation of CKS and insist on case by case management in such cases.

  9. Sex ratio at birth in India, its relation to birth order, sex of previous children and use of indigenous medicine.

    Directory of Open Access Journals (Sweden)

    Samiksha Manchanda

    Full Text Available OBJECTIVE: Sex-ratio at birth in families with previous girls is worse than those with a boy. Our aim was to prospectively study in a large maternal and child unit sex-ratio against previous birth sex and use of traditional medicines for sex selection. MAIN OUTCOME MEASURES: Sex-ratio among mothers in families with a previous girl and in those with a previous boy, prevalence of indigenous medicine use and sex-ratio in those using medicines for sex selection. RESULTS: Overall there were 806 girls to 1000 boys. The sex-ratio was 720:1000 if there was one previous girl and 178:1000 if there were two previous girls. In second children of families with a previous boy 1017 girls were born per 1000 boys. Sex-ratio in those with one previous girl, who were taking traditional medicines for sex selection, was 928:1000. CONCLUSION: Evidence from the second children clearly shows the sex-ratio is being manipulated by human interventions. More mothers with previous girls tend to use traditional medicines for sex selection, in their subsequent pregnancies. Those taking such medication do not seem to be helped according to expectations. They seem to rely on this method and so are less likely use more definitive methods like sex selective abortions. This is the first such prospective investigation of sex ratio in second children looked at against the sex of previous children. More studies are needed to confirm the findings.

  10. Accident information needs

    International Nuclear Information System (INIS)

    Hanson, D.J.; Arcieri, W.C.; Ward, L.W.

    1992-01-01

    A Five-step methodology has been developed to evaluate information needs for nuclear power plants under accident conditions and the availability of plant instrumentation during severe accidents. Step 1 examines the credible accidents and their relationships to plant safety functions. Step 2 determines the information personnel involved in accident management will need to understand plant behavior. Step 3 determines the capability of the instrumentation to function properly under severe accident conditions. Step 4 determines the conditions expected during the identified severe accidents. Step 5 compares the instrument capabilities and the severe accident conditions to evaluate the availability of the instrumentation to supply needed plant information

  11. Accident information needs

    Energy Technology Data Exchange (ETDEWEB)

    Hanson, D.J.; Arcieri, W.C.; Ward, L.W.

    1992-12-31

    A Five-step methodology has been developed to evaluate information needs for nuclear power plants under accident conditions and the availability of plant instrumentation during severe accidents. Step 1 examines the credible accidents and their relationships to plant safety functions. Step 2 determines the information personnel involved in accident management will need to understand plant behavior. Step 3 determines the capability of the instrumentation to function properly under severe accident conditions. Step 4 determines the conditions expected during the identified severe accidents. Step 5 compares the instrument capabilities and the severe accident conditions to evaluate the availability of the instrumentation to supply needed plant information.

  12. Accident information needs

    Energy Technology Data Exchange (ETDEWEB)

    Hanson, D.J.; Arcieri, W.C.; Ward, L.W.

    1992-01-01

    A Five-step methodology has been developed to evaluate information needs for nuclear power plants under accident conditions and the availability of plant instrumentation during severe accidents. Step 1 examines the credible accidents and their relationships to plant safety functions. Step 2 determines the information personnel involved in accident management will need to understand plant behavior. Step 3 determines the capability of the instrumentation to function properly under severe accident conditions. Step 4 determines the conditions expected during the identified severe accidents. Step 5 compares the instrument capabilities and the severe accident conditions to evaluate the availability of the instrumentation to supply needed plant information.

  13. Analysis of current research addressing complementary use of life-cycle assessment and risk assessment for engineered nanomaterials: have lessons been learned from previous experience with chemicals?

    International Nuclear Information System (INIS)

    Grieger, Khara D.; Laurent, Alexis; Miseljic, Mirko; Christensen, Frans; Baun, Anders; Olsen, Stig I.

    2012-01-01

    While it is generally agreed that successful strategies to address the health and environmental impacts of engineered nanomaterials (NM) should consider the well-established frameworks for conducting life-cycle assessment (LCA) and risk assessment (RA), scientific research, and specific guidance on how to practically apply these methods are still very much under development. This paper evaluates how research efforts have applied LCA and RA together for NM, particularly reflecting on previous experiences with applying these methods to chemicals. Through a literature review and a separate analysis of research focused on applying LCA and RA together for NM, it appears that current research efforts have taken into account some key “lessons learned” from previous experience with chemicals while many key challenges remain for practically applying these methods to NM. We identified two main approaches for using these methods together for NM: “LC-based RA” (traditional RA applied in a life-cycle perspective) and “RA-complemented LCA” (conventional LCA supplemented by RA in specific life-cycle steps). Hence, the latter is the only identified approach which genuinely combines LC- and RA-based methods for NM-risk research efforts to date as the former is rather a continuation of normal RA according to standard assessment procedures (e.g., REACH). Both these approaches along with recommendations for using LCA and RA together for NM are similar to those made previously for chemicals, and thus, there does not appear to be much progress made specific for NM. We have identified one issue in particular that may be specific for NM when applying LCA and RA at this time: the need to establish proper dose metrics within both methods.

  14. Effects of previous ovarian surgery for endometriosis on the outcome of assisted reproduction treatment.

    Science.gov (United States)

    Geber, Selmo; Ferreira, Daniela Parreiras; Spyer Prates, Luis Felipe Víctor; Sales, Liana; Sampaio, Marcos

    2002-01-01

    Endometriosis affects 2-50% of women at reproductive age. Surgery is an option for treatment, but there is no convincing evidence that it promotes a significant improvement in fertility. Also, the removal of ovarian endometrioma might lead to a reduction in the follicular reserve and response to stimulation. Therefore, the aim of this study was to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. A total of 61 women, with primary infertility and previously having undergone ovarian surgery for endometriosis, who had received 74 IVF/intracytoplasmic sperm injection (ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within#10; the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as a control group. Patients were matched for age and treatment performed. Patients 35 years with previous ovarian surgery needed more ampoules for ovulation induction (P = 0.017) and had fewer follicles and oocytes than women in the control group (P = 0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Although a lower pregnancy rate was observed in patients who had undergone previous ovarian surgery, this difference was not statistically significant (P = 0.424). In conclusion, ovarian surgery for the treatment of endometriosis reduces the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, for infertile patients, non-surgical treatment might be a better option to avoid reduction of the ovarian response.

  15. Babies Need Tummy Time

    Science.gov (United States)

    ... sharing on social media links Babies Need Tummy Time! Page Content Tummy Time is not only an ... of your baby’s normal growth. What Is Tummy Time? Tummy Time describes the times when you place ...

  16. College Information Needs.

    Science.gov (United States)

    Cibik, Margaret A.

    1982-01-01

    A survey of a sampling of college-bound high school seniors in Arizona was undertaken to determine students' information needs for college choice. Items, including institutional, student, and program characteristics, are ranked in order of perceived importance. (MSE)

  17. Why We Need Marketing.

    Science.gov (United States)

    Harper, Nancy

    1984-01-01

    An interview with Philip Kotler, the Harold T. Martin Professor of Marketing at Northwestern University, is presented. Three approaches to marketing are identified: product-oriented, hard-sell, and building satisfaction in a long-term clientele. (MLW)

  18. Elicitation of Unstated Needs

    Science.gov (United States)

    2014-09-17

    have a lot of new people that need to come up to speed on laptops soon.” “We have 40 new account reps that need to be able to create and manage ...SERVICE HAS STRESSED OUR CAPABILITY TO DELIVER DELAYS DURING RESERVATION INQUIRIES RESULT IN ABOUT 9% OF DROPPED CALLS MOST PURCHASING MANAGERS ...CUSTOMER WHO “COULDN’T FIND HER WAITER FOR 10 MINUTES” DECIDED NOT TO BOOK A MAJOR CONFERENCE HERE CUSTOMERS EXPECT FASTER ACCESS TO

  19. Irradiation - who needs it?

    International Nuclear Information System (INIS)

    Scoular, C.

    1994-01-01

    In this paper the public's attitudes to the irradiation of food to ensure it is bacteria free and to prolong shelf-life are considered. The need to label irradiated food and to educate the public about its implications are emphasised. The opinions of the large food retailers who maintain that high standards in food processing, hygiene and refrigeration eliminate the need for food irradiation are discussed. (UK)

  20. Maslow, Needs, and War

    Science.gov (United States)

    2012-02-28

    for individual‟s remains equally true for groups and nations.ŗ Abraham H. Maslow did groundbreaking work on a hierarchy of needs; he identified five...Penguin Press, 1991), 48. 3 Ibid, 49. 4 Abraham H. Maslow , Motivation and Personality, Second Edition. (New York: Harper and Row, 1970), 35-58. 5... Maslow , Needs, and War by Lieutenant Colonel John P. Baker United States Air Force United States Army War College

  1. Personal anticipated information need

    OpenAIRE

    H. Bruce

    2005-01-01

    Background. The role of personal information collections is a well known feature of personal information management. The World Wide Web has introduced to such collections ideas such as filing Web pages or noting their existence in 'Bookmarks' and 'Favourites'. Argument. It is suggested that personal information collections are created in anticipation of some future need for that information-personal, anticipated information need, which also underlies the design of formal information systems. ...

  2. Human Needs Theory: Applications for Music Education

    Science.gov (United States)

    Bates, Vincent C.

    2009-01-01

    In this article the author reviews needs theory as a field of research and scholarship, examines seven needs theories (including Nussbaum's capabilities approach), and synthesizes elements of all of these into a list he used tentatively and speculatively to analyze two common instructional practices in music education. The author's intent is to…

  3. Low-dose computed tomography image restoration using previous normal-dose scan

    International Nuclear Information System (INIS)

    Ma, Jianhua; Huang, Jing; Feng, Qianjin; Zhang, Hua; Lu, Hongbing; Liang, Zhengrong; Chen, Wufan

    2011-01-01

    of the previous normal-dose scan via the presented ndiNLM algorithm is noticeable as compared to a similar approach without using the previous normal-dose scan. Conclusions: For low-dose CT image restoration, the presented ndiNLM method is robust in preserving the spatial resolution and identifying the low-contrast structure. The authors can draw the conclusion that the presented ndiNLM algorithm may be useful for some clinical applications such as in perfusion imaging, radiotherapy, tumor surveillance, etc.

  4. Response to deep TMS in depressive patients with previous electroconvulsive treatment.

    Science.gov (United States)

    Rosenberg, Oded; Zangen, Abraham; Stryjer, Rafael; Kotler, Moshe; Dannon, Pinhas N

    2010-10-01

    The efficacy of transcranial magnetic stimulation (TMS) in the treatment of major depression has already been shown. Novel TMS coils allowing stimulation of deeper brain regions have recently been developed and studied. Our study is aimed at exploring the possible efficacy of deep TMS in patients with resistant depression, who previously underwent electroconvalsive therapy (ECT). Using Brainsway's deep TMS H1 coil, six patients who previously underwent ECT, were treated with 120% power of the motor threshold at a frequency of 20 Hz. Patients underwent five sessions per week, up to 4 weeks. Before the study, patients were evaluated using the Hamilton depression rating scale (HDRS, 24 items), the Hamilton anxiety scale, and the Beck depression inventory and were again evaluated after 5, 10, 15, and 20 daily treatments. Response to treatment was considered a reduction in the HDRS of at least 50%, and remission was considered a reduction of the HDRS-24 below 10 points. Two of six patients responded to the treatment with deep TMS, including one who achieved full remission. Our results suggest the possibility of a subpopulation of depressed patients who may benefit from deep TMS treatment, including patients who did not respond to ECT previously. However, the power of the study is small and similar larger samples are needed. Copyright © 2010 Elsevier Inc. All rights reserved.

  5. Dietary self-efficacy predicts AHEI diet quality in women with previous gestational diabetes.

    Science.gov (United States)

    Ferranti, Erin Poe; Narayan, K M Venkat; Reilly, Carolyn M; Foster, Jennifer; McCullough, Marjorie; Ziegler, Thomas R; Guo, Ying; Dunbar, Sandra B

    2014-01-01

    The purpose of this study was to examine the association of intrapersonal influences of diet quality as defined by the Health Belief Model constructs in women with recent histories of gestational diabetes. A descriptive, correlational, cross-sectional design was used to analyze relationships between diet quality and intrapersonal variables, including perceptions of threat of type 2 diabetes mellitus development, benefits and barriers of healthy eating, and dietary self-efficacy, in a convenience sample of 75 community-dwelling women (55% minority; mean age, 35.5 years; SD, 5.5 years) with previous gestational diabetes mellitus. Diet quality was defined by the Alternative Healthy Eating Index (AHEI). Multiple regression was used to identify predictors of AHEI diet quality. Women had moderate AHEI diet quality (mean score, 47.6; SD, 14.3). Only higher levels of education and self-efficacy significantly predicted better AHEI diet quality, controlling for other contributing variables. There is a significant opportunity to improve diet quality in women with previous gestational diabetes mellitus. Improving self-efficacy may be an important component to include in nutrition interventions. In addition to identifying other important individual components, future studies of diet quality in women with previous gestational diabetes mellitus are needed to investigate the scope of influence beyond the individual to potential family, social, and environmental factors. © 2014 The Author(s).

  6. Impact of vocational interests, previous academic experience, gender and age on Situational Judgement Test performance.

    Science.gov (United States)

    Schripsema, Nienke R; van Trigt, Anke M; Borleffs, Jan C C; Cohen-Schotanus, Janke

    2017-05-01

    Situational Judgement Tests (SJTs) are increasingly implemented in medical school admissions. In this paper, we investigate the effects of vocational interests, previous academic experience, gender and age on SJT performance. The SJT was part of the selection process for the Bachelor's degree programme in Medicine at University of Groningen, the Netherlands. All applicants for the academic year 2015-2016 were included and had to choose between learning communities Global Health (n = 126), Sustainable Care (n = 149), Intramural Care (n = 225), or Molecular Medicine (n = 116). This choice was used as a proxy for vocational interest. In addition, all graduate-entry applicants for academic year 2015-2016 (n = 213) were included to examine the effect of previous academic experience on performance. We used MANCOVA analyses with Bonferroni post hoc multiple comparisons tests for applicant performance on a six-scenario SJT. The MANCOVA analyses showed that for all scenarios, the independent variables were significantly related to performance (Pillai's Trace: 0.02-0.47, p performance on three scenarios (p performance on two scenarios (p performance, as was previous academic experience. Gender and age were related to performance on SJT scenarios in different settings. Especially the first effect might be helpful in selecting appropriate candidates for areas of health care in which more professionals are needed.

  7. Outcomes of Ahmed glaucoma valve implantation in advanced primary congenital glaucoma with previous surgical failure

    Science.gov (United States)

    Huang, Jingjing; Lin, Jialiu; Wu, Ziqiang; Xu, Hongzhi; Zuo, Chengguo; Ge, Jian

    2015-01-01

    Purpose The purpose of this study was to evaluate the intermediate surgical results of Ahmed glaucoma valve (AGV) implantation in patients less than 7 years of age, with advanced primary congenital glaucoma who have failed previous surgeries. Patients and methods Consecutive patients with advanced primary congenital glaucoma that failed previous operations and had undergone subsequent AGV implantation were evaluated retrospectively. Surgical success was defined as 1) intraocular pressure (IOP) ≥6 and ≤21 mmHg; 2) IOP reduction of at least 30% relative to preoperative values; and 3) without the need for additional surgical intervention for IOP control, loss of light perception, or serious complications. Results Fourteen eyes of eleven patients were studied. Preoperatively, the average axial length was 27.71±1.52 (25.56–30.80) mm, corneal diameter was 14.71±1.07 (13.0–16.0) mm, cup-to-disc ratio was 0.95±0.04 (0.9–1.0), and IOP was 39.5±5.7 (30–55) mmHg. The mean follow-up time was 18.29±10.96 (5–44, median 18) months. There were significant reductions in IOPs and the number of glaucoma medications (Pglaucoma unresponsive to previous surgical intervention, despite a relatively high incidence of severe surgical complications. PMID:26082610

  8. Differences between previously married and never married 'gay' men: family background, childhood experiences and current attitudes.

    Science.gov (United States)

    Higgins, Daryl J

    2004-01-01

    Despite a large body of literature on the development of sexual orientation, little is known about why some gay men have been (or remain) married to a woman. In the current study, a self-selected sample of 43 never married gay men ('never married') and 26 gay men who were married to a woman ('previously married') completed a self-report questionnaire. Hypotheses were based on five possible explanations for gay men's marriages: (a) differences in sexual orientation (i.e., bisexuality); (b) internalized homophobia; (c) religious intolerance; (d) confusion created because of childhood/adolescent sexual experiences; and/or (e) poor psychological adjustment. Previously married described their families' religious beliefs as more fundamentalist than never married. No differences were found between married' and never married' ratings of their sexual orientation and identity, and levels of homophobia and self-depreciation. Family adaptability and family cohesion and the degree to which respondents reported having experienced child maltreatment did not distinguish between previously married and never married. The results highlight how little is understood of the reasons why gay men marry, and the need to develop an adequate theoretical model.

  9. Effectiveness of sound therapy in patients with tinnitus resistant to previous treatments: importance of adjustments

    Directory of Open Access Journals (Sweden)

    Flavia Alencar de Barros Suzuki

    Full Text Available ABSTRACT INTRODUCTION: The difficulty in choosing the appropriate therapy for chronic tinnitus relates to the variable impact on the quality of life of affected patients and, thus, requires individualization of treatment. OBJECTIVE: To evaluate the effectiveness of using sound generators with individual adjustments to relieve tinnitus in patients unresponsive to previous treatments. METHODS: A prospective study of 10 patients with chronic tinnitus who were unresponsive to previous drug treatments, five males and five females, with ages ranging from 41 to 78 years. Bilateral sound generators (Reach 62 or Mind 9 models were used daily for at least 6 h during 18 months. The patients were evaluated at the beginning, after 1 month and at each 3 months until 18 months through acuphenometry, minimum masking level, the Tinnitus Handicap Inventory, visual analog scale, and the Hospital Anxiety and Depression Scale. The sound generators were adjusted at each visit. RESULTS: There was a reduction of Tinnitus Handicap Inventory in nine patients using a protocol with a customized approach, independent of psychoacoustic characteristics of tinnitus. The best response to treatment occurred in those with whistle-type tinnitus. A correlation among the adjustments and tinnitus loudness and minimum masking level was found. Only one patient, who had indication of depression by Hospital Anxiety and Depression Scale, did not respond to sound therapy. CONCLUSION: There was improvement in quality of life (Tinnitus Handicap Inventory, with good response to sound therapy using customized settings in patients who did not respond to previous treatments for tinnitus.

  10. Natural gas and bio methane in the future fuel mix. Need of action and solution approaches for an accelerated etablishment in the traffic; Erdgas und Biomethan im kuenftigen Kraftstoffmix. Handlungsbedarf und Loesungsansaetze fuer eine beschleunigte Etablierung im Verkehr

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-01-15

    The contribution under consideration reports on the need of action and on solution attempts for an accelerated establishment of natural gas and bio methane in the future fuel mix. The authors come to the following conclusions: The energy situation and climatic situation require a stronger diversification of fuels and drives. The targets for the amount of natural gas and bio methane as a fuel are not reached yet. The characteristics of natural gas speak for an accelerated establishment in the traffic sector. The admixture of bio methane can increase the climatic, environmental and resources advantages. In order to penetrate the market all participants involved must commit themselves to a concrete 'roadmap'. The contribution shows which measures must be converted by the participants involved in order to be able to utilize fully the potentials of the employment of natural gas and bio methane in the traffic sector.

  11. Pimonidazole labelling and response to fractionated irradiation of five human squamous cell carcinoma (hSCC) lines in nude mice: The need for a multivariate approach in biomarker studies

    International Nuclear Information System (INIS)

    Yaromina, Ala; Zips, Daniel; Thames, Howard D.; Eicheler, Wolfgang; Krause, Mechthild; Rosner, Andrea; Haase, Michael; Petersen, Cordula; Raleigh, James A.; Quennet, Verena; Walenta, Stefan; Mueller-Klieser, Wolfgang; Baumann, Michael

    2006-01-01

    Objective: To investigate the influence on local control after fractionated radiotherapy of hypoxia measured in unirradiated tumours using the hypoxic marker Pimonidazole, using multivariate approaches. Material and methods: Five human squamous cell carcinoma lines (FaDu, UT-SCC-15, UT-SCC-14, XF354, and UT-SCC-5) were transplanted subcutaneously into the right hind-leg of NMRI nude mice. Histological material was collected from 60 unirradiated tumours after injection of Pimonidazole. The relative hypoxic area within the viable tumour area (Pimonidazole hypoxic fraction, pHF) was determined in seven serial 10 μm cross-sections per tumour by fluorescence microscopy and computerized image analysis. Local tumour control was evaluated in a total of 399 irradiated tumours at 120 days after 30 fractions given within 6 weeks with total doses between 30 and 115 Gy. Results: Tumour lines showed pronounced heterogeneity in both pHF and TCD 5 . Mean pHF values varied between 5% and 37%, TCD 5 values between 47 and 130 Gy. A Cox Proportional Hazards model of time to recurrence with two covariates, dose and pHF, yielded significant contributions of both parameters on local control (p < 0.005) but violated the proportional hazards assumption, suggesting that other factors also influence tumour control. Introduction of histological grade as an example of a confounding factor into the model improved the fit significantly. Local control rates decreased with increasing pHF and this effect was more pronounced at higher doses. Conclusions: This study confirms that tumour hypoxia measured using Pimonidazole in untreated tumours is a significant determinant of local control after fractionated irradiation. The data support the use of multivariate approaches for the evaluation of a single prognostic biomarker such as Pimonidazole, and more generally, suggest that they are required to establish accurate prognostic factors for tumour response

  12. Value, utility and needs

    DEFF Research Database (Denmark)

    Ravn, Ib

    Positive Psychology and Self-Determination Theory (SDT, Deci & Ryan, 2000) share an ambition to identify the sources of value and human flourishing. In the 19th century, the emerging science of economics similarly investigated the nature of social value in a capitalist society that placed a price...... in SDT have gathered extensive evidence that needs for autonomy, competence and relatedness must be met for human flourishing and eudaimonia to occur (Ryan, Huta and Deci, 2013). There is a short step to arguing that what is valuable in life is what satisfies human needs. As has been established by SDT...... on every commodity. In this conceptual paper, SDTs’ mini-theory of Basic Psychological Needs is applied to solve the “paradox of value” in economics (Weisskopf, 1956): Why are some things that are practically free, such as oxygen, water and fellowship, so valuable to people, while others, often craved...

  13. Visual memory needs categories

    OpenAIRE

    Olsson, Henrik; Poom, Leo

    2005-01-01

    Capacity limitations in the way humans store and process information in working memory have been extensively studied, and several memory systems have been distinguished. In line with previous capacity estimates for verbal memory and memory for spatial information, recent studies suggest that it is possible to retain up to four objects in visual working memory. The objects used have typically been categorically different colors and shapes. Because knowledge about categories is stored in long-t...

  14. Who needs us?

    DEFF Research Database (Denmark)

    Salgado, Mariana; Saad-Sulonen, Joanna

    In this paper we look at participatory activities as practiced by others, meaning practitioners not from the participatory design fields, and address the question whether we, as participatory design researchers and practitioners are still needed. By understanding what others do, we aim to better ...... understand and articulate our own participatory practice and our own future role. The results of our inquiry show that participatory designers are needed, even in contexts where other participatory practitioners prevail, but that we should learn from them and collaborate with them....

  15. Who needs intervention?

    DEFF Research Database (Denmark)

    Jørgensen, Line Dahl

    2015-01-01

    Who needs intervention? A phonological screening tool for children with cleft palate Children with cleft palate +/- cleft lip (CP) are at risk of speech and language delay. It is important to identify children with difficulties as early as possible in order to offer appropriate intervention. Conv....... Lieberman, M., & Lohmander, A. (2014). Observation is a valid way of assessing common variables in typical babbling and identifies infants who need further support. Acta Paediatrica, 103(12), 1251–1257. doi:10.1111/apa.12776...

  16. 75 FR 39143 - Airworthiness Directives; Arrow Falcon Exporters, Inc. (previously Utah State University); AST...

    Science.gov (United States)

    2010-07-08

    ... (previously Precision Helicopters, LLC); Robinson Air Crane, Inc.; San Joaquin Helicopters (previously Hawkins... (Previously Hawkins & Powers Aviation); S.M. &T. Aircraft (Previously Us Helicopter Inc., UNC Helicopters, Inc...

  17. 75 FR 66009 - Airworthiness Directives; Cessna Aircraft Company (Type Certificate Previously Held by Columbia...

    Science.gov (United States)

    2010-10-27

    ... Company (Type Certificate Previously Held by Columbia Aircraft Manufacturing (Previously the Lancair... Company (Type Certificate Previously Held by Columbia Aircraft Manufacturing (Previously The Lancair...-15895. Applicability (c) This AD applies to the following Cessna Aircraft Company (type certificate...

  18. Antirandom Testing: A Distance-Based Approach

    Directory of Open Access Journals (Sweden)

    Shen Hui Wu

    2008-01-01

    Full Text Available Random testing requires each test to be selected randomly regardless of the tests previously applied. This paper introduces the concept of antirandom testing where each test applied is chosen such that its total distance from all previous tests is maximum. This spans the test vector space to the maximum extent possible for a given number of vectors. An algorithm for generating antirandom tests is presented. Compared with traditional pseudorandom testing, antirandom testing is found to be very effective when a high-fault coverage needs to be achieved with a limited number of test vectors. The superiority of the new approach is even more significant for testing bridging faults.

  19. Economic impact of feeding a phenylalanine-restricted diet to adults with previously untreated phenylketonuria.

    Science.gov (United States)

    Brown, M C; Guest, J F

    1999-02-01

    The aim of the present study was to estimate the direct healthcare cost of managing adults with previously untreated phenylketonuria (PKU) for one year before any dietary restrictions and for the first year after a phenylalanine- (PHE-) restricted diet was introduced. The resource use and corresponding costs were estimated from medical records and interviews with health care professionals experienced in caring for adults with previously untreated PKU. The mean annual cost of caring for a client being fed an unrestricted diet was estimated to be 83 996 pound silver. In the first year after introducing a PHE-restricted diet, the mean annual cost was reduced by 20 647 pound silver to 63 348 pound silver as a result of a reduction in nursing time, hospitalizations, outpatient clinic visits and medications. However, the economic benefit of the diet depended on whether the clients were previously high or low users of nursing care. Nursing time was the key cost-driver, accounting for 79% of the cost of managing high users and 31% of the management cost for low users. In contrast, the acquisition cost of a PHE-restricted diet accounted for up to 6% of the cost for managing high users and 15% of the management cost for low users. Sensitivity analyses showed that introducing a PHE-restricted diet reduces the annual cost of care, provided that annual nursing time was reduced by more than 8% or more than 5% of clients respond to the diet. The clients showed fewer negative behaviours when being fed a PHE-restricted diet, which may account for the observed reduction in nursing time needed to care for these clients. In conclusion, feeding a PHE-restricted diet to adults with previously untreated PKU leads to economic benefits to the UK's National Health Service and society in general.

  20. Antimetabolites in cataract surgery to prevent failure of a previous trabeculectomy.

    Science.gov (United States)

    Thomas, Roger E; Crichton, Andrew; Thomas, Bennett C

    2014-07-28

    Patients having cataract surgery have often earlier undergone a trabeculectomy for glaucoma. However, cataract surgery may be associated with failure of the previous glaucoma surgery and antimetabolites may be used with cataract surgery to prevent such failure. There is no systematic review on whether antimetabolites with cataract surgery prevent failure of a previous trabeculectomy. To assess the effects of antimetabolites with cataract surgery on functioning of a previous trabeculectomy. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2014), EMBASE (January 1980 to June 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to June 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 10 June 2014. We also searched the Science Citation Index database (July 2013) and reference lists of potentially relevant studies. Randomised controlled trials (RCTs) of antimetabolites with cataract surgery in people with a functioning trabeculectomy. Two review authors independently reviewed the titles and abstracts from the electronic searches. Two review authors independently assessed relevant full-text articles and entered data. We identified no RCTs to test the effectiveness of antimetabolites with cataract surgery in individuals with the intention of preventing failure of a previous trabeculectomy. There are no RCTs of antimetabolites with cataract surgery in people with a functioning trabeculectomy. Appropriately powered RCTs