Ayurveda formulations: A roadmap to address the safety concerns

Directory of Open Access Journals (Sweden)

Kishor Patwardhan

2017-10-01

Full Text Available It is a matter of serious concern that the number of case reports pointing at a possible association between the clinical toxicity and the use of Ayurveda formulations is increasing significantly over the years in scientific medical literature. Though most of these cases are connected with the presence of heavy metals such as lead, mercury and arsenic in these formulations, there are also reports suggesting toxicity due to the presence of toxic chemicals of herbal origin. In the year 2008, the Government of India took an initiative of establishing the National Pharmacovigilance Programme for Ayurveda, Siddha and Unani drugs in a structured way. However, due to lack of sustained support, this program has now become defunct. This issue is of vital importance and needs to be addressed effectively on a priority basis. In this communication, we propose the following crucial policy interventions to be introduced at different levels: a. Amendments to Drug and Cosmetic Act, b. Issuing consumer guidelines, c. Issuing prescription guidelines, d. Issuing clinical monitoring guidelines, e. Implementation of good manufacturing guidelines, f. Promoting documentation of clinical safety, g. Identifying the sources of contamination, and, h. Provision for stringent punishment. If these policy interventions are taken up and implemented, a significant positive change in the scenario can be expected in the near future.

Addressing competitiveness and leakage concerns in climate policy: An analysis of border adjustment measures in the US and the EU

International Nuclear Information System (INIS)

Asselt, Harro van; Brewer, Thomas

2010-01-01

The implementation of climate policies in the US and EU in light of uncertainties about future international climate policy has shifted attention to two interrelated concerns, namely competitiveness and carbon leakage. Although various policy measures are available to address these concerns, there has been much discussion about one such measure in particular: the use of offsetting measures at the border. This article compares policy discussions in the US and the EU on how to address competitiveness and carbon leakage concerns, with a focus on the role of import-related border adjustment measures. It analyses the kinds of measures that so far have been put forward with a view to addressing competitiveness and carbon leakage; compares the approaches to the problems in the US and the EU; and provides a preliminary discussion of international cooperation on border adjustment measures. It concludes that two kinds of cooperation are needed between the EU and the US - not only cooperation through formal international negotiations, but also cooperation through international learning processes, in which the EU and the US learn from each other about design and implementation issues as they develop their respective cap-and-trade systems.

Privacy concerns of patients and nurse practitioners in primary care--an APRNet study.

Science.gov (United States)

Olsen, Douglas P; Dixon, Jane Karpe; Grey, Margaret; Deshefy-Longhi, Terry; Demarest, Jo Cecille

2005-12-01

This study explores and compares the privacy concerns of primary care nurse practitioners (NPs) and their patients. Privacy concerns were identified in separate focus groups of NPs and patients, and then parallel survey instruments were designed and administered to 27 NPs and 185 of their patients. All subjects were recruited through APRNet, a regional practice-based research network of NPs in southern New England encompassing 58 practices. Both groups demonstrated high levels of concern regarding privacy. While NPs and patients had similar levels of concern about most issues, there were some notable differences regarding breeches because of carelessness, disclosures for research, and which disorders require the most care in maintaining privacy. These results allow NPs to anticipate patient privacy concerns and to enhance trust in the clinical relationship. These results also indicate the need to educate patients regarding privacy rights and expectations.

Special nutritional concerns for the female athlete.

Science.gov (United States)

Gabel, Kathe A

2006-06-01

Inadequate dietary intake is the primary nutritional concern of today's female athlete. As these athletes fail to consume enough energy to support the physical demands of training, they become at risk for disordered eating, amenorrhea, and osteoporosis, conditions collectively identified as the female athlete triad. This review addresses nutritional concerns of the female athlete, identification of those at risk, relationship of energy intake to menstrual irregularities, and recently identified chronic diseases associated with the female athlete triad. Strategies are offered to prevent harmful behaviors leading to the comorbidities associated with inadequate dietary intakes.

Addressing domestic violence in primary care: what the physician needs to know

Science.gov (United States)

Usta, Jinan; Taleb, Rim

2014-01-01

Domestic violence (DV) is quite prevalent and negatively impacts the health and mental wellbeing of those affected. Victims of DV are frequent users of health service, yet they are infrequently recognized. Physicians tend to treat the presenting complaints without addressing the root cause of the problem. Lack of knowledge on adequately managing cases of DV and on appropriate ways to help survivors is commonly presented as a barrier. This article presents the magnitude of the problem of DV in the Arab world, highlights the role of the primary care physician in addressing this problem, and provides practical steps that can guide the clinician in the Arab world in giving a comprehensive and culturally sensitive service to the survivors of DV. PMID:24647277

Communication between office-based primary care providers and nurses working within patients' homes: an analysis of process data from CAPABLE.

Science.gov (United States)

Smith, Patrick D; Boyd, Cynthia; Bellantoni, Julia; Roth, Jill; Becker, Kathleen L; Savage, Jessica; Nkimbeng, Manka; Szanton, Sarah L

2016-02-01

To examine themes of communication between office-based primary care providers and nurses working in private residences; to assess which methods of communication elicit fruitful responses to nurses' concerns. Lack of effective communication between home health care nurses and primary care providers contributes to clinical errors, inefficient care delivery and decreased patient safety. Few studies have described best practices related to frequency, methods and reasons for communication between community-based nurses and primary care providers. Secondary analysis of process data from 'Community Aging in Place: Advancing Better Living for Elders (CAPABLE)'. Independent reviewers analysed nurse documentation of communication (phone calls, letters and client coaching) initiated for 70 patients and analysed 45 letters to primary care providers to identify common concerns and recommendations raised by CAPABLE nurses. Primary care providers responded to 86% of phone calls, 56% of letters and 50% of client coaching efforts. Primary care providers addressed 86% of concerns communicated by phone, 34% of concerns communicated by letter and 41% of client-raised concerns. Nurses' letters addressed five key concerns: medication safety, pain, change in activities of daily living, fall safety and mental health. In letters, CAPABLE nurses recommended 58 interventions: medication change; referral to a specialist; patient education; and further diagnostic evaluation. Effective communication between home-based nurses and primary care providers enhances care coordination and improves outcomes for home-dwelling elders. Various methods of contact show promise for addressing specific communication needs. Nurses practicing within patients' homes can improve care coordination by using phone calls to address minor matters and written letters for detailed communication. Future research should explore implementation of Situation, Background, Assessment and Recommendation in home care to promote

Clinical strategies to address patients' concerns in osteoporosis management with bisphosphonates.

Science.gov (United States)

Cole, Raymond E

2011-03-01

Approximately 44 million Americans either have, or are at risk of developing, osteoporosis, a disease associated with an increased risk of fracture and, consequently, morbidity and mortality. Osteoporosis affects 20% to 30% of postmenopausal women, and resulting fractures pose a major economic burden, with estimated annual direct costs ranging from $17 billion to $19 billion. Hip fractures account for the majority of costs (~60%) because they often require costly long-term follow-up care in addition to the direct costs of initial treatment. Screening, diagnosis, and disease management are of paramount importance when treating patients at risk for osteoporosis. The National Osteoporosis Foundation recommends that all postmenopausal women be evaluated for osteoporosis risk factors and that all women aged ≥ 65 years undergo bone mineral density testing. Once the primary care physician has identified a patient at risk for osteoporosis-related fracture, the physician must decide whether and how to treat the patient (ie, nonpharmacologic or pharmacologic options). Bisphosphonates are the first-line pharmacologic treatment for women aged ≥ 50 years with postmenopausal osteoporosis. Bisphosphonates-which have a favorable safety and tolerability profile in clinical trials-have shown efficacy in reducing fractures. However, achieved real world effectiveness is very much dependent on good treatment adherence by the patient. Media attention to rare adverse events has motivated some patients to deliberate nonadherence. Physicians should screen patients for contraindications and adverse event risk factors, educate them on the risks of fracture and benefits and risks of treatment, and monitor them during therapy. To assist primary care physicians in clinical decision making for women at risk for or with confirmed osteoporosis, this article presents a review of the guidelines for the diagnosis and treatment of postmenopausal osteoporosis, recent long-term efficacy data for

Addressing employee concerns about welding in a nuclear power plant

International Nuclear Information System (INIS)

Danko, J.C.; Hansen, D.D.; O'Leary, P.D.

1988-01-01

A leading utility contracted with EG and G Idaho to perform a comprehensive, independent evaluation of the utility's welding program with respect to the safety-related welds made at one of its nuclear power plants. The purpose of this paper is to review a number of the employee concerns and the technical basis for the disposition of these concerns. In addition, recommendations are presented that may help to prevent the recurrence of employee concerns in future nuclear power plant construction, and thereby costly delays may be avoided and welding productivity and quality improved

Understanding technology use and constructivist strategies when addressing Saudi primary students' mathematics difficulties.

OpenAIRE

Alabdulaziz, M.; Higgins, S.

2017-01-01

This paper will investigate the relationship between technology use and the use of constructivist strategies when addressing Saudi primary students' mathematics difficulties. Semi-structured interviews and observations were used for the purpose of this research, which were undertaken with three mathematics teachers from school A which used technology, and the other three from school B, which did not use technology. We found that technology can support constructivist approach when teaching and...

Part of the green plan : suppliers are helping the coal and oil sands industries to address environmental concerns

Energy Technology Data Exchange (ETDEWEB)

Sabourin, M.

2009-09-15

The Canadian coal and oil sands industries operate in one of the most stringent environmental regulatory frameworks found in the world. The purpose of the strict regulations is to ensure that Canadian energy resources are developed safely, responsibly and efficiently. Their primary objectives involve the protection of water supplies and aquatic life. This article discussed how suppliers are helping the coal and oil sands industries address environmental concerns. Several examples were provided. In terms of water protection and management, EBA Engineering Consultants has helped mining companies comply with strict environmental regulations and has assisted them in obtaining the necessary permits and establishing monitoring programs. In terms of containment, the Layfield Group's silt and sediment control products has helped prevent fine soil particles from running off into and clouding local water courses. In terms of land reclamation and remediation, IW Kuhn Environmental Ltd., has provided soil remediation services, including re-vegetation using hydroseeding which involves the sowing of seeds with a hosed jet of water. This article also discussed the many green technology products that have been developed and commercialized by EarthRenew for application in coal and oil sands projects. Their patented waste renew facilities can process and cook manures, biosolids or green wastes into organic fertilizers that could be used in land repair applications. 5 figs.

76 FR 72756 - Finding That the Islamic Republic of Iran Is a Jurisdiction of Primary Money Laundering Concern

Science.gov (United States)

2011-11-25

... Money Laundering Concern AGENCY: The Financial Crimes Enforcement Network (``FinCEN''), Treasury. ACTION... that the Islamic Republic of Iran is a jurisdiction of primary money laundering concern. DATES: The... PATRIOT Act''), Public Law 107-56. Title III of the USA PATRIOT Act amends the anti- money laundering...

A Conceptual Framework to Address Stress-Associated Human Health Effects of Ecosystem Services Degraded by Disasters

Science.gov (United States)

Chronic stress leads to a variety of mental and physiological disorders, and stress effects are the primary concern after traumatic injury and exposure to infectious diseases or toxic agents from disaster events. We developed a conceptual model to address the question of whether...

Unilateral Measures addressing Non-Trade Concerns. A Study on WTO Consistency, Relevance of other International Agreements, Economic Effectiveness and Impact on Developing Countries of Measures concerning Non-Product-Related Processes and Production Methods

International Nuclear Information System (INIS)

Van den Bossche, P.; Schrijver, N.; Faber, G.

2007-01-01

Over the last two years, the debate in the Netherlands on trade measures addressing non-trade concerns has focused on two important and politically sensitive issues, namely: (1) the sustainability of the large-scale production of biomass as an alternative source of energy; and (2) the production of livestock products in a manner that is consistent with animal welfare requirements. In February 2007 a report was issued on the 'Toetsingskader voor Duurzame Biomassa', the so-called Cramer Report. This report discusses the risks associated with large-scale biomass production and establishes a list of criteria for the sustainable production of biomass. These criteria reflect a broad range of non-trade concerns, including environmental protection, global warming, food security, biodiversity, economic prosperity and social welfare. The report recognizes that the implementation of the criteria (including the establishment of a certification system) will require careful consideration of the obligations of the Netherlands under EU and WTO law. Governments called upon to address non-trade concerns may do so by using different types of measures. Prominent among these are measures concerning processes and production methods of products. In the present study, these issues are examined primarily with regard to existing, proposed or still purely hypothetical measures for implementing the Cramer criteria for the sustainable production of biomass. Several other, non-energy-related issues are discussed in this report

The Influence of RSG-GAS Primary Pump Operation Concerning the Rise Water Level of Reactor Pool in 15 MW Reactor Power

International Nuclear Information System (INIS)

Djunaidi

2004-01-01

The expansion of air volume in the delay chamber shows in rise water level of reactor pool during the operation. The rises of water level in the reactor pool is not quite from the expansion of air volume in the delay chamber, but some influence the primary pump operation. The purpose evaluated of influence primary pump is to know the influence primary pump power concerning the rise water level during the reactor operation. From the data collection during 15 MW power operation in the last core 42 the influence of primary pump operation concerning the rise water level in the reactor pool is 34.48 % from the total increased after operation during 12 days. (author)

Primary data collection in health technology assessment.

Science.gov (United States)

McIsaac, Michelle L; Goeree, Ron; Brophy, James M

2007-01-01

This study discusses the value of primary data collection as part of health technology assessment (HTA). Primary data collection can help reduce uncertainty in HTA and better inform evidence-based decision making. However, methodological issues such as choosing appropriate study design and practical concerns such as the value of collecting additional information need to be addressed. The authors emphasize the conditions required for successful primary data collection in HTA: experienced researchers, sufficient funding, and coordination among stakeholders, government, and researchers. The authors conclude that, under specific conditions, primary data collection is a worthwhile endeavor in the HTA process.

Primary cultures of astrocytes

DEFF Research Database (Denmark)

Lange, Sofie C; Bak, Lasse Kristoffer; Waagepetersen, Helle S

2012-01-01

During the past few decades of astrocyte research it has become increasingly clear that astrocytes have taken a central position in all central nervous system activities. Much of our new understanding of astrocytes has been derived from studies conducted with primary cultures of astrocytes...... subsequently found in vivo. Nevertheless, primary cultures of astrocytes are an in vitro model that does not fully mimic the complex events occurring in vivo. Here we present an overview of the numerous contributions generated by the use of primary astrocyte cultures to uncover the diverse functions...... of astrocytes. Many of these discoveries would not have been possible to achieve without the use of astrocyte cultures. Additionally, we address and discuss the concerns that have been raised regarding the use of primary cultures of astrocytes as an experimental model system....

A history of the working group to address Los Alamos community health concerns - A case study of community involvement and risk communication

Energy Technology Data Exchange (ETDEWEB)

Harry Otway; Jon Johnson

2000-01-01

In May 1991, at a Department of Energy (DOE) public hearing at Los Alamos, New Mexico, a local artist claimed there had been a recent brain tumor cluster in a small Los Alamos neighborhood. He suggested the cause was radiation from past operations of Los Alamos National Laboratory. Data from the Laboratory's extensive environmental monitoring program gave no reason to believe this charge to be true but also could not prove it false. These allegations, reported in the local and regional media, alarmed the community and revealed an unsuspected lack of trust in the Laboratory. Having no immediate and definitive response, the Laboratory offered to collaborate with the community to address this concern. The Los Alamos community accepted this offer and a joint Community-Laboratory Working Group met for the first time 29 days later. The working group set as its primary goal the search for possible carcinogens in the local environment. Meanwhile, the DOE announced its intention to fund the New Mexico Department of Health to perform a separate and independent epidemiological study of all Los Alamos cancer rates. In early 1994, after commissioning 17 environmental studies and meeting 34 times, the working group decided that the public health concerns had been resolved to the satisfaction of the community and voted to disband. This paper tells the story of the artist and the working group, and how the media covered their story. It summarizes the environmental studies directed by the working group and briefly reviews the main findings of the epidemiology study. An epilogue records the present-day recollections of some of the key players in this environmental drama.

A history of the working group to address Los Alamos community health concerns. A case study of community involvement and risk communication

International Nuclear Information System (INIS)

Harry Otway; Jon Johnson

2000-01-01

In May 1991, at a Department of Energy (DOE) public hearing at Los Alamos, New Mexico, a local artist claimed there had been a recent brain tumor cluster in a small Los Alamos neighborhood. He suggested the cause was radiation from past operations of Los Alamos National Laboratory. Data from the Laboratory's extensive environmental monitoring program gave no reason to believe this charge to be true but also could not prove it false. These allegations, reported in the local and regional media, alarmed the community and revealed an unsuspected lack of trust in the Laboratory. Having no immediate and definitive response, the Laboratory offered to collaborate with the community to address this concern. The Los Alamos community accepted this offer and a joint Community-Laboratory Working Group met for the first time 29 days later. The working group set as its primary goal the search for possible carcinogens in the local environment. Meanwhile, the DOE announced its intention to fund the New Mexico Department of Health to perform a separate and independent epidemiological study of all Los Alamos cancer rates. In early 1994, after commissioning 17 environmental studies and meeting 34 times, the working group decided that the public health concerns had been resolved to the satisfaction of the community and voted to disband. This paper tells the story of the artist and the working group, and how the media covered their story. It summarizes the environmental studies directed by the working group and briefly reviews the main findings of the epidemiology study. An epilogue records the present-day recollections of some of the key players in this environmental drama

Parental concerns in parents of children attending pre- and primary school: analysis of the Portuguese population by District

Directory of Open Access Journals (Sweden)

Susana Algarvio

Full Text Available Objective: In this study, our aim was to assess and analyze parental concerns by Portuguese District. Methods: The participants were 3842 parents of children between 3 and 10 years old, attending preschool and primary school, from 820 public schools in 18 Portuguese Districts. Parents completed a sociodemographic questionnaire, and a Parental Concerns Scale, composed by 5 subscales, family and school problems; feeding, sleep and physical complaints; preparation; fears; and negative behaviors. Results: Portuguese parents concerned about all the dimensions considered in this study. The highest level of concern was obtained in family and school problems, and the lowest level of concern about their children’s fears. There were significant differences between Districts, parents from Porto and Bragança showed the highest levels of concern. Parents from Coimbra, Évora, Beja e Portalegre, presented the lowest levels of concern. Conclusion: Parental concerns are an aspect of general parenting and must be considered by health professionals to promote healthier parents-children relationships. Geographic differences should be further investigated.

Exploring Intercultural Awareness in the Primary Modern Language Classroom: The Potential of the New Model of European Language Portfolio Developed by the Irish Modern Languages in Primary Schools Initiative (MLPSI)

Science.gov (United States)

Rantz, Frederique; Horan, Pascaline

2005-01-01

This paper reflects a key concern for teacher trainers: how can primary language teachers promote the development of intercultural awareness among their pupils? It addresses the concept of intercultural awareness as it applies to young learners and refers more specifically to the context of the Irish primary classroom and its curriculum. It argues…

How do Australian palliative care nurses address existential and spiritual concerns? Facilitators, barriers and strategies.

Science.gov (United States)

Keall, Robyn; Clayton, Josephine M; Butow, Phyllis

2014-11-01

To investigate the facilitators, barriers and strategies that Australian palliative care nurses identify in providing existential and spiritual care for patients with life-limiting illnesses. Palliative care aims to be holistic, incorporating all domains of personhood, but spiritual/existential domain issues are often undertreated. Lack of time and skills and concerns for what you may uncover hamper care provision. A qualitative study through semistructured interviews. We interviewed 20 palliative care nurses from a cross section of area of work, place of work, years of experience, spiritual beliefs and importance of those beliefs within their lives. Questions focused on their current practices of existential and spiritual care, identification of facilitators of, barriers to and strategies for provision of that care. Their responses were transcribed and subjected to thematic analysis. The nurses' interviews yielded several themes including development of the nurse-patient relationship (14/20 nurses), good communication skills and examples of questions they use to 'create openings' to facilitate care. Barriers were identified as follows: lack of time (11/20 nurses), skills, privacy and fear of what you may uncover, unresolved symptoms and differences in culture or belief. Novel to our study, the nurses offered strategies that included the following: undertaking further education in this area, being self-aware and ensuring the setting is conducive to in-depth conversations and interactions and documentation and/or interdisciplinary sharing for continuity of care. Palliative care nurses are well placed to provide existential and spiritual care to patients with the primary facilitator being the nurse-patient relationship, the primary barrier being lack of time and the primary strategy being undertaking further education in this area. These findings could be used for nurse-support programmes, undergraduate or graduate studies or communication workshop for nurses.

Overvaluation of shape and weight in adolescents with anorexia nervosa: does shape concern or weight concern matter more for treatment outcome?

Science.gov (United States)

Byrne, Catherine E; Kass, Andrea E; Accurso, Erin C; Fischer, Sarah; O'Brien, Setareh; Goodyear, Alexandria; Lock, James; Le Grange, Daniel

2015-01-01

Overvaluation of shape and weight is a key diagnostic feature of anorexia nervosa (AN); however, limited research has evaluated the clinical utility of differentiating between weight versus shape concerns. Understanding differences in these constructs may have important implications for AN treatment given the focus on weight regain. This study examined differences in treatment outcome between individuals whose primary concern was weight versus those whose primary concern was shape in a randomized controlled trial of treatment for adolescent AN. Data were drawn from a two-site randomized controlled trial that compared family-based treatment and adolescent focused therapy for AN. Chi-square tests and logistic regression analyses were conducted. Thirty percent of participants presented with primary weight concern (n = 36; defined as endorsing higher Eating Disorder Examination (EDE) Weight Concern than Shape Concern subscale scores); 60 % presented with primary shape concern (n = 72; defined as endorsing higher EDE Shape Concern than Weight Concern scores). There were no significant differences between the two groups in remission status at the end of treatment. Treatment did not moderate the effect of group status on achieving remission. Results suggest that treatment outcomes are comparable between adolescents who enter treatment for AN with greater weight concerns and those who enter treatment with greater shape concerns. Therefore, treatment need not be adjusted based on primary weight or primary shape concerns.

77 FR 31434 - Finding That JSC CredexBank Is a Financial Institution of Primary Money Laundering Concern

Science.gov (United States)

2012-05-25

... CredexBank is a financial institution of primary money laundering concern. DATES: The finding made in... Law 107-56. Title III of the USA PATRIOT Act amends the anti- money laundering provisions of the Bank..., to promote prevention, detection, and prosecution of international money laundering and the financing...

inaugral address

African Journals Online (AJOL)

While political reorientation and economic redress were of immediate concern, ... South African context, where widespread changes have been proposed for education at all ... education at school and other levels and needs to be addressed so as to ..... the major national curriculum intervention in environmental education.

A national probability survey of American Medical Association gynecologists and primary care physicians concerning menopause.

Science.gov (United States)

Singh, Betsy; Liu, Xiao-Dong; Der-Martirosian, Claudia; Hardy, Mary; Singh, Vijay; Shepard, Neil; Gandhi, Sonal; Khorsan, Raheleh

2005-09-01

This survey intended to clarify physicians' understanding of the issues surrounding women, menopause, alternative medicine, and drug therapy for the treatment of menopause. This study was designed as a national probability sample survey of primary care physicians and gynecologists nationwide. Its focus was to identify major concerns and issues identified by patients about menopause and perceived communication with effectiveness how to communicate with their patients. Physicians were also asked to rate their comfort level in recommending the use of herbal remedies and which herbal remedy they felt comfortable recommending to interested patients. Data indicated that a patient's complaint about menopausal symptoms was the most common factor leading to discussion of menopausal issues with physicians (91%) and that the primary concern to the patient was management of menopausal symptoms. Other factors were controversies about hormone replacement therapy, long-term health implications of menopause, and hormone replacement therapy. Eighty percent of the physician found confusing messages with regard to menopause to be the most challenging aspect in patient communication. The second most challenging issue is "inconclusive data about hormone replacement therapy" (56%). Seventy-six percent of the physicians found "showing sympathy" to be the most important factor for the physicians to communicate effectively with patients, whereas "being honest and open" was the most important patient attitude cited for the same purpose. When it comes to herbal therapy for menopause symptom control, only 4% of the physicians indicated that none of their patients take any remedies. Only 18% were not very comfortable in discussing or recommending herbal therapies, whereas the rest ranged from fairly comfortable to completely comfortable. This study has provided data with regard to physician understanding of menopause treatment options and their primary interaction with patients on this issue

Qualitative interview study of parents' perspectives, concerns and experiences of the management of lower respiratory tract infections in children in primary care

NARCIS (Netherlands)

Halls, Amy; Van'T Hoff, Catherine; Little, Paul; Verheij, Theo; Leydon, Geraldine M.

2017-01-01

Objective To explore parents' perspectives, concerns and experiences of the management of lower respiratory tract infections (LRTIs) in children in primary care. Design Qualitative semistructured interview study. Setting UK primary care. Participants 23 parents of children aged 6 months to 10 years

An Agent-Based Model for Addressing the Impact of a Disaster on Access to Primary Care Services.

Science.gov (United States)

Guclu, Hasan; Kumar, Supriya; Galloway, David; Krauland, Mary; Sood, Rishi; Bocour, Angelica; Hershey, Tina Batra; van Nostrand, Elizabeth; Potter, Margaret

2016-06-01

Hurricane Sandy in the Rockaways, Queens, forced residents to evacuate and primary care providers to close or curtail operations. A large deficit in primary care access was apparent in the immediate aftermath of the storm. Our objective was to build a computational model to aid responders in planning to situate primary care services in a disaster-affected area. Using an agent-based modeling platform, HAZEL, we simulated the Rockaways population, its evacuation behavior, and primary care providers' availability in the aftermath of Hurricane Sandy. Data sources for this model included post-storm and community health surveys from New York City, a survey of the Rockaways primary care providers, and research literature. The model then tested geospatially specific interventions to address storm-related access deficits. The model revealed that areas of high primary care access deficit were concentrated in the eastern part of the Rockaways. Placing mobile health clinics in the most populous census tracts reduced the access deficit significantly, whereas increasing providers' capacity by 50% reduced the deficit to a lesser degree. An agent-based model may be a useful tool to have in place so that policy makers can conduct scenario-based analyses to plan interventions optimally in the event of a disaster. (Disaster Med Public Health Preparedness. 2016;10:386-393).

Addressing the nuclear misconception

International Nuclear Information System (INIS)

Taylor, J.J.

1998-01-01

There is a perception, fostered and encouraged by the anti-nuclear groups, that the nuclear industry generates large quantities of waste with no idea how to deal with it, that it is unsafe, uneconomic, and environmentally damaging. The task is to change these perceptions, by demonstrating that the industry is not a problem in itself, but in fact provides solutions to problems. This paper, while primarily concerned with waste, addresses all of these issues as each has a bearing on the perception of the industry and therefore must be considered when addressing the issue of waste. The paper concludes that evidence exists to support the industry view, but that the mission of the industry should be to change the perception of the industry, by influencing and working together with its stake holders to address their concerns, rather than merely presenting more and more facts. (author)

Securities Operations: Update on Actions Taken to Address Day Trading Concerns

National Research Council Canada - National Science Library

2001-01-01

In 1999, day trading 1 began to receive intense scrutiny from state and federal regulators and the Congress because of concerns that it posed significant investor protection and market integrity issues...

Securities Operations: Update on Actions Taken to Address Day Trading Concerns

National Research Council Canada - National Science Library

2001-01-01

.... In particular there was concern that broker-dealers promoting day trading as a strategy (day trading firms) sometimes used questionable advertising to attract customers without fully disclosing or by downplaying the risks involved...

Primary care patients reporting concerns about their gambling frequently have other co-occurring lifestyle and mental health issues

Directory of Open Access Journals (Sweden)

Shepherd Robin

2006-04-01

Full Text Available Abstract Background Problem gambling often goes undetected by family physicians but may be associated with stress-related medical problems as well as mental disorders and substance abuse. Family physicians are often first in line to identify these problems and to provide a proper referral. The aim of this study was to compare a group of primary care patients who identified concerns with their gambling behavior with the total population of screened patients in relation to co-morbidity of other lifestyle risk factors or mental health issues. Methods This is a cross sectional study comparing patients identified as worrying about their gambling behavior with the total screened patient population for co morbidity. The setting was 51 urban and rural New Zealand practices. Participants were consecutive adult patients per practice (N = 2,536 who completed a brief multi-item tool screening primary care patients for lifestyle risk factors and mental health problems (smoking, alcohol and drug misuse, problem gambling, depression, anxiety, abuse, anger. Data analysis used descriptive statistics and non-parametric binomial tests with adjusting for clustering by practitioner using STATA survey analysis. Results Approximately 3/100 (3% answered yes to the gambling question. Those worried about gambling more likely to be male OR 1.85 (95% CI 1.1 to 3.1. Increasing age reduced likelihood of gambling concerns – logistic regression for complex survey data OR = 0.99 (CI 95% 0.97 to 0.99 p = 0.04 for each year older. Patients concerned about gambling were significantly more likely (all p Conclusion Our questionnaire identifies patients who express a need for help with gambling and other lifestyle and mental health issues. Screening for gambling in primary care has the potential to identify individuals with multiple co-occurring disorders.

Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study.

Science.gov (United States)

Javanparast, Sara; Coveney, John; Saikia, Udoy

2009-02-23

Due to the multifaceted aspect of child malnutrition, a comprehensive approach, taking social factors into account, has been frequently recommended in health literature. The Alma-Ata declaration explicitly outlined comprehensive primary health care as an approach that addresses the social, economic and political causes of poor health and nutrition. Iran as a signatory country to the Alma Ata Declaration has established primary health care since 1979 with significant progress on many health indicators during the last three decades. However, the primary health care system is still challenged to reduce inequity in conditions such as child malnutrition which trace back to social factors. This study aimed to explore the perceptions of the Iranian health stakeholders with respect to the Iranian primary health care performance and actions to move towards a comprehensive approach in addressing childhood malnutrition. Health stakeholders are defined as those who affect or can be affected by health system, for example health policy-makers, health providers or health service recipients. Stakeholder analysis approach was undertaken using a qualitative research method. Different levels of stakeholders, including health policy-makers, health providers and community members were interviewed as either individuals or focus groups. Qualitative content analysis was used to interpret and compare/contrast the viewpoints of the study participants. The results demonstrated that fundamental differences exist in the perceptions of different health stakeholders in the understanding of comprehensive notion and action. Health policy-makers mainly believed in the need for a secure health management environment and the necessity for a whole of the government approach to enhance collaborative action. Community health workers, on the other hand, indicated that staff motivation, advocacy and involvement are the main challenges need to be addressed. Turning to community stakeholders, greater

Addressing adherence to treatment: a longstanding concern. The patients’ perspective

OpenAIRE

Mahmoud Hadipour Dehshal

2014-01-01

Adherence to treatment is a great concern for patients who need long-life treatment. Thalassaemia is an inherited disease for whose treatment team-working is of a considerable importance. To logically face the problem of poor compliance patients, all members of the team ought to be aware of the causing factors and the ways to handle the problem. The factors which cause the lack of compliance among patients could be stratified into economic and structural facto. Furthermore, patient-related fa...

Addressing Gender Violence among Children in the Early Years of Schooling: Insights from Teachers in a South African Primary School

Science.gov (United States)

Mayeza, Emmanuel; Bhana, Deevia

2016-01-01

This paper explores how teachers in a poor township primary school in South Africa construct meaning regarding gender violence among children, and how they talk about addressing that violence. The paper argues that major influences on the endemic violence include complex societal structures that are inscribed with cultures of violent…

Emotions in primary care: Are there cultural differences in the expression of cues and concerns?

Science.gov (United States)

Schouten, Barbara C; Schinkel, Sanne

2015-11-01

This study compared native-Dutch and Turkish-Dutch patients' expressions of emotional cues/concerns and GPs' responses to these cues/concerns. Relations between patient's cues/concerns and GPs' perceptions of the patient's health complaint were examined too. 82 audiotaped encounters with native-Dutch and 38 with Turkish-Dutch GP patients were coded using the VR-CoDES and VR-CoDES-P. Patients filled out a survey before each consultation to assess their cultural identification, Dutch language proficiency and health-related variables. GPs filled out a survey after each consultation to assess their perceptions of the patient's health complaint. Turkish-Dutch patients expressed more cues than native-Dutch patients, which was explained by higher worries about their health and worse perceived general health. GPs responded more often with space-providing responses to Turkish-Dutch patients compared to native-Dutch patients. Turkish-Dutch patients' cue expression strongly influenced GPs' perceptions about the presence of psychosocial problems. Migrant patient-related factors influence the amount of emotional cue expression in primary care. GPs perceive these cues as indicating the presence of psychosocial problems and provide space for patients to elaborate on their emotional distress. GPs should be trained in using more affective communication techniques to enhance elicitation of the underlying reasons for migrant patients' enhanced emotional cue expression. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Addressing concerns about the agricultural impacts of siting a nuclear waste repository in Texas

International Nuclear Information System (INIS)

Boryczka, M.; Darrough, B.

1986-01-01

Public concerns related to the siting of a nuclear repository have included the potential impacts to specific economic sectors. In Texas, local residents have expressed concern about how a repository will affect agriculture. Several major questions have arisen with respect to this issue including: 1) how will a repository's requirements for land and water affect agriculture, 2) how will a repository affect agricultural land values, and 3) how will actual or perceived contamination of locally grown products affect their marketability? This paper describes the concerns raised by local residents and discusses the approach to analyzing the concerns identified. An evaluation of agricultural impacts has been prepared for the Department of Energy's Enviromental Assessment (EA) documents. In addition, activities needed to further evaluate these impacts are planned for site characterization. Both the current analysis and planned activities are described

Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

Science.gov (United States)

Beers, Lee; Southammakosane, Cathy; Lewin, Amy

2014-01-01

Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents’ engagement in mental health treatment. PMID:24298010

Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study

Directory of Open Access Journals (Sweden)

Saikia Udoy

2009-02-01

Full Text Available Abstract Background Due to the multifaceted aspect of child malnutrition, a comprehensive approach, taking social factors into account, has been frequently recommended in health literature. The Alma-Ata declaration explicitly outlined comprehensive primary health care as an approach that addresses the social, economic and political causes of poor health and nutrition. Iran as a signatory country to the Alma Ata Declaration has established primary health care since 1979 with significant progress on many health indicators during the last three decades. However, the primary health care system is still challenged to reduce inequity in conditions such as child malnutrition which trace back to social factors. This study aimed to explore the perceptions of the Iranian health stakeholders with respect to the Iranian primary health care performance and actions to move towards a comprehensive approach in addressing childhood malnutrition. Health stakeholders are defined as those who affect or can be affected by health system, for example health policy-makers, health providers or health service recipients. Methods Stakeholder analysis approach was undertaken using a qualitative research method. Different levels of stakeholders, including health policy-makers, health providers and community members were interviewed as either individuals or focus groups. Qualitative content analysis was used to interpret and compare/contrast the viewpoints of the study participants. Results The results demonstrated that fundamental differences exist in the perceptions of different health stakeholders in the understanding of comprehensive notion and action. Health policy-makers mainly believed in the need for a secure health management environment and the necessity for a whole of the government approach to enhance collaborative action. Community health workers, on the other hand, indicated that staff motivation, advocacy and involvement are the main challenges need to be

Public concern for decommissioning - why it must be addressed

International Nuclear Information System (INIS)

Kay, Martin.

1997-01-01

To demonstrate its responsible approach, the nuclear industry in the United Kingdom must recognise the benefits of satisfying and gaining the consent of the stakeholder society in the pursuit of its legitimate goals. Public acceptance can be achieved only by establishing and maintaining trust through two-way communication. Stakeholder audiences still perceive that waste management and decommissioning are the industry's ''achilles heel''. The simple message to be delivered is that waste and decommissioning are being managed safely, sensibly and ecnomically. An exemplar of how public consent may be gained is the consultation carried out by Magnox Electric with local stakeholders on the decommissioning strategy for the Trawsfyndd nuclear power plant. The basic strategy was confirmed but details were changed to take account of local concerns. Some valuable lessons learned were: communications should be integrated into the planning process as a strategic issue; openess is a cornerstone of good communication; gaining public trust and respect is fundamental; key stake holders need to be identified carefully. (UK)

Academic retainer medicine: an innovative business model for cross-subsidizing primary care.

Science.gov (United States)

Lucier, David J; Frisch, Nicholas B; Cohen, Brian J; Wagner, Michael; Salem, Deeb; Fairchild, David G

2010-06-01

Retainer-medicine primary care practices, commonly referred to as "luxury" or "concierge" practices, provide enhanced services to patients beyond those available in traditional practices for a yearly retainer fee. Adoption of retainer practices has been largely absent in academic health centers (AHCs). Reasons for this trend stem primarily from ethical concerns, such as the potential for patient abandonment when physicians downsize from larger, traditional practices to smaller, retainer-medicine practices.In 2004, the Department of Medicine at Tufts Medical Center developed an academic retainer-medicine primary care practice within the Division of General Medicine that not only generates financial support for the division but also incorporates a clinical and business model that is aligned with the mission and ethics of an academic institution.In contrast to private retainer-medicine practices, this unique business model addresses several of the ethical issues associated with traditional retainer practices-it does not restrict net access to care and it neutralizes concerns about patient abandonment. Addressing the growing primary care shortage, the model also presents the opportunity for a retainer practice to cross-subsidize the expansion of general medicine in an academic medical setting. The authors elucidate the benefits, as well as the inherent challenges, of embedding an academic retainer-medicine practice within an AHC.

Child oral health concerns amongst parents and primary care givers in a Sure Start local programme.

Science.gov (United States)

Daly, B; Clarke, W; McEvoy, W; Periam, K; Zoitopoulos, L

2010-09-01

To conduct an oral health promotion needs assessment amongst parents and primary care givers of pre-school children in a South East London Sure Start Local Programme (SSLP). To explore the oral health concerns and oral health literacy with regard to children's oral health amongst parents and primary care givers in a South East London SSLP. A qualitative study using four in-depth focus groups with a purposive sample of 20 participants. Data were analysed using the framework method. The SSLP was identified as an important source of information, support and social interaction for participants. Participants rated the informal networks of the programme as equally authoritative as other formal sources of information. Oral health concerns included: introducing healthy eating, establishing tooth brushing, teething and access to dental care. While participants had adequate knowledge of how to prevent oral disease they cited many barriers to acting on their knowledge which included: parents' tiredness, lack of confidence in parenting skills, confusing information, widespread availability of sugary foods and drinks, and lack of local child friendly dentists. Parenting skills and the social support provided by the SSLP appeared to be integral to the introduction of positive oral health behaviours. SSLPs were seen as a trusted source of support and information for carers of pre-school children. Integration of oral health promotion into SSLPs has the potential to tap into early interventions which tackle the wider support needs of carers of pre-school children while also supporting the development of positive oral health behaviours.

Attitudes towards domestic violence in Lebanon: a qualitative study of primary care practitioners

Science.gov (United States)

Usta, Jinan; Feder, Gene; Antoun, Jumana

2014-01-01

Background Domestic violence (DV) is highly prevalent in the developing and developed world. Healthcare systems internationally are still not adequately addressing the needs of patients experiencing violence. Aim To explore physicians’ attitudes about responding to DV, their perception of the physician’s role, and the factors that influence their response. Design and setting Qualitative study using individual interviews among primary care practitioners working in Lebanon. Method Primary care clinicians practising for >5 years and with >100 patient consultations a week were interviewed. Physicians were asked about their practice when encountering women disclosing abuse, their opinion about the engagement of the health services with DV, their potential role, and the anticipated reaction of patients and society to this extended role. Results Physicians felt that they were well positioned to play a pivotal role in addressing DV; yet they had concerns related to personal safety, worry about losing patients, and opposing the norms of a largely conservative society. Several physicians justified DV or blamed the survivor rather than the perpetrator for triggering the violent behaviour. Moreover, religion was perceived as sanctioning DV. Conclusion Perceived cultural norms and religious beliefs seem to be major barriers to physicians responding to DV in Lebanon, and possibly in the Arab world more generally. Financial concerns also need to be addressed to encourage physicians to address DV. PMID:24868068

Attitudes towards domestic violence in Lebanon: a qualitative study of primary care practitioners.

Science.gov (United States)

Usta, Jinan; Feder, Gene; Antoun, Jumana

2014-06-01

Domestic violence (DV) is highly prevalent in the developing and developed world. Healthcare systems internationally are still not adequately addressing the needs of patients experiencing violence. To explore physicians' attitudes about responding to DV, their perception of the physician's role, and the factors that influence their response. Qualitative study using individual interviews among primary care practitioners working in Lebanon. Primary care clinicians practising for >5 years and with >100 patient consultations a week were interviewed. Physicians were asked about their practice when encountering women disclosing abuse, their opinion about the engagement of the health services with DV, their potential role, and the anticipated reaction of patients and society to this extended role. Physicians felt that they were well positioned to play a pivotal role in addressing DV; yet they had concerns related to personal safety, worry about losing patients, and opposing the norms of a largely conservative society. Several physicians justified DV or blamed the survivor rather than the perpetrator for triggering the violent behaviour. Moreover, religion was perceived as sanctioning DV. Perceived cultural norms and religious beliefs seem to be major barriers to physicians responding to DV in Lebanon, and possibly in the Arab world more generally. Financial concerns also need to be addressed to encourage physicians to address DV. © British Journal of General Practice 2014.

Mental Health Concerns: Veterans & Active Duty

Science.gov (United States)

... dialing 1-800-273-8255 and pressing 1. Mental Health Concerns There are three primary mental health concerns ... care or call 911. How Will Asking for Mental Health Treatment Affect My Career? Military personnel have always ...

Risk communication concerning welding fumes for the primary preventive care of welding apprentices in southern Brazil.

Science.gov (United States)

Cezar-Vaz, Marta Regina; Bonow, Clarice Alves; Vaz, Joana Cezar

2015-01-19

This study's aim was to assess the perceptions of welding apprentices concerning welding fumes being associated with respiratory and cardiovascular disorders and assess the implementation of risk communication as a primary prevention tool in the welding training process. This quasi-experimental, non-randomized study with before-and-after design was conducted with 84 welding apprentices in Southern Brazil. Poisson Regression analysis was used. Relative Risk was the measure used with a 95% confidence interval and 5% (p ≤ 0.05) significance level. Significant association was found between perceptions of worsened symptoms of respiratory disorders caused by welding fumes and educational level (p = 0.049), the use of goggles to protect against ultraviolet rays (p = 0.023), and access to services in private health facilities without insurance coverage (p = 0.001). Apprentices younger than 25 years old were 4.9 times more likely to perceive worsened cardiovascular symptoms caused by welding fumes after risk communication (RR = 4.91; CI 95%: 1.09 to 22.2). The conclusion is that risk communication as a primary preventive measure in continuing education processes implemented among apprentices, who are future welders, was efficacious. Thus, this study confirms that risk communication can be implemented as a primary prevention tool in welding apprenticeships.

Knowledge, attitudes, and practices of 1,985 Buddhist monks in Thailand concerning family planning, sterilization and primary health care.

Science.gov (United States)

Muangman, D; Hirunraks, A

1983-12-01

Pretested questionnaires were used with 2000 Buddhist monks in 4 regions of Thailand to learn about the monks' characteristics and background, their attitudes on family planning and primary health care, and their knowledge, attitudes, and practices concerning sterilization with a focus on vasectomy. Randomly selected, the monks were individually interviewed using well trained local teachers with the staff from the Faculty of Public Health, Mohidol University acting as field supervisors. There were completed data on 1985 monks. 95% of the monks were single whith the average age of 28. The majority had only 4 years of education and an agriculture background. The mass media channels of radio and newspapers could reach about half of them. The majority were well informed about population problems and gave strong backing to the family planning policy of the Thai government. 79% stated that family planning practices are not sinful. They also had positive attitudes toward small families and the spacing of childred in the 1st year of marriage and after delivery of the 1st child. The majority wanted to be trained in primary health care and were willing to use their wats as health depots. The monks were well informed about oral contraceptives (OCs), the IUD, condoms, and male and female sterilization methods. Vasectomy cases were very small. This might be due to their large number being single. A large number had nevative attitudes toward vasectomy. The monks thought men were afraid of sexual impotence post-vasectomy. During monkhood might be the best time to give these young men more correct information concerning family planning and primary health care, for they would have enough time to learn and think positively. After 3 months are over, about 2/3 of these monks will leave their priesthood and probably marry and have childred. If they have had short training in family planning and primary health care, they will be prepared to provide primary health care services to their

Reclaiming unused IPv4 addresses

CERN Multimedia

IT Department

2016-01-01

As many people might know, the number of IPv4 addresses is limited and almost all have been allocated (see here and here for more information).   Although CERN has been allocated some 340,000 addresses, the way these are allocated across the site is not as efficient as we would like. As we face an increasing demand for IPv4 addresses with the growth in virtual machines, the IT Department’s Communication Systems Group will be reorganising address allocation during 2016 to make more efficient use of the IPv4 address ranges that have been allocated to CERN. We aim, wherever possible, to avoid giving out fixed IP addresses, and have all devices connected to the campus network obtain an address dynamically each time they connect. As a first stage, starting in February, IP addresses that have not been used for more than 9 months will be reclaimed. No information about the devices concerned will be deleted from LANDB, but a new IP address will have to be requested if they are ever reconnected to t...

Modern Languages and Interculturality in the Primary Sector in England, Greece, Italy and Spain.

Science.gov (United States)

Cerezal, Fernando

1997-01-01

Addresses concerns and issues regarding modern language teaching and learning at primary schools in Greece, Italy, Spain, and England. It focuses on the optimal age for learning and acquiring languages and to the educational reforms which have been undertaken in each country relating to early modern language teaching and learning and…

Opening address

International Nuclear Information System (INIS)

Ianko, L.

1993-01-01

This short talk was the opening remarks to the attendees at this conference, presented by the Scientific Secretary, IWG-LMNPP, of the IAEA. This meeting is an effort to aid research on problems related to the general area of nuclear plant aging and life management. In particular it addresses fracture properties of reactor materials and components, both as installed, and at end of service condition. A major concern is relating measurements made on laboratory samples to properties displayed by actual reactor components

Behavioral medicine interventions for adult primary care settings: A review.

Science.gov (United States)

Funderburk, Jennifer S; Shepardson, Robyn L; Wray, Jennifer; Acker, John; Beehler, Gregory P; Possemato, Kyle; Wray, Laura O; Maisto, Stephen A

2018-06-07

Health care organizations are embracing integrated primary care (IPC), in which mental health and behavioral health are addressed as part of routine care within primary care settings. Behavioral medicine concerns, which include health behavior change and coping with medical conditions, are common in primary care populations. Although there are evidence-based behavioral interventions that target a variety of behavioral medicine concerns, integrated behavioral health providers need interventions that are sufficiently brief (i.e., ≤6 appointments) to be compatible with IPC. We conducted a literature review of published studies examining behavioral interventions that target prevalent behavioral medicine concerns and can feasibly be employed by IPC providers in adult primary care settings. A total of 67 published articles representing 63 original studies met eligibility criteria. We extracted data on the behavioral interventions employed, results comparing the active intervention to a comparison group, general fit with IPC, and methodological quality. The vast majority of studies examined brief interventions targeting sleep difficulties and physical activity. The most commonly employed interventions were derived from cognitive-behavioral therapy and motivational interviewing. Outcomes were generally statistically significantly in favor of the active intervention relative to comparison, with highly variable methodological quality ratings (range = 0-5; M = 2.0). Results are discussed in relation to the need for further evidence for brief behavioral interventions targeting other behavioral medicine concerns beyond sleep and physical activity, as well as for more specificity regarding the compatibility of such interventions with IPC practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Local address and emergency contact details

CERN Multimedia

2013-01-01

The HR Department would like to remind members of the personnel that they are responsible for ensuring that their personal data concerning local address and preferred emergency contact details remains valid and up-to-date.   Both are easily accessible via the links below: Local address: https://edh.cern.ch/Document/Personnel/LocalAddressChange   Emergency contacts: https://edh.cern.ch/Document/Personnel/EC   Please take a few minutes to check your details and modify if necessary. Thank you in advance. HR Department Head Office

Health care voluntourism: addressing ethical concerns of undergraduate student participation in global health volunteer work.

Science.gov (United States)

McCall, Daniel; Iltis, Ana S

2014-12-01

The popularity and availability of global health experiences has increased, with organizations helping groups plan service trips and companies specializing in "voluntourism," health care professionals volunteering their services through different organizations, and medical students participating in global health electives. Much has been written about global health experiences in resource poor settings, but the literature focuses primarily on the work of health care professionals and medical students. This paper focuses on undergraduate student involvement in short term medical volunteer work in resource poor countries, a practice that has become popular among pre-health professions students. We argue that the participation of undergraduate students in global health experiences raises many of the ethical concerns associated with voluntourism and global health experiences for medical students. Some of these may be exacerbated by or emerge in unique ways when undergraduates volunteer. Guidelines and curricula for medical student engagement in global health experiences have been developed. Guidelines specific to undergraduate involvement in such trips and pre-departure curricula to prepare students should be developed and such training should be required of volunteers. We propose a framework for such guidelines and curricula, argue that universities should be the primary point of delivery even when universities are not organizing the trips, and recommend that curricula should be developed in light of additional data.

A Framework for Integrating Environmental and Occupational Health and Primary Care in a Postdisaster Context.

Science.gov (United States)

Kirkland, Katherine; Sherman, Mya; Covert, Hannah; Barlet, Grace; Lichtveld, Maureen

Integration of environmental and occupational health (EOH) into primary care settings is a critical step to addressing the EOH concerns of a community, particularly in a postdisaster context. Several barriers to EOH integration exist at the physician, patient, and health care system levels. This article presents a framework for improving the health system's capacity to address EOH after the Deepwater Horizon oil spill and illustrates its application in the Environmental and Occupational Health Education and Referral (EOHER) program. This program worked with 11 Federally Qualified Health Center systems in the Gulf Coast region to try to address the EOH concerns of community members and to assist primary care providers to better understand the impact of EOH factors on their patients' health. The framework uses a 3-pronged approach to (1) foster coordination between primary care and EOH facilities through a referral network and peer consultations, (2) increase physician capacity in EOH issues through continuing education and training, and (3) conduct outreach to community members about EOH issues. The EOHER program highlighted the importance of building strong partnerships with community members and other relevant organizations, as well as high organizational capacity and effective leadership to enable EOH integration into primary care settings. Physicians in the EOHER program were constrained in their ability to engage with EOH issues due to competing patient needs and time constraints, indicating the need to improve physicians' ability to assess which patients are at high risk for EOH exposures and to efficiently take environmental and occupational histories. This article highlights the importance of addressing EOH barriers at multiple levels and provides a model that can be applied to promote community health, particularly in the context of future natural or technological disasters.

Reflections on Ways Forward for Addressing Ethical Concerns in Mobile Learning Research

Science.gov (United States)

Wishart, Jocelyn

2016-01-01

This paper reflects on a decade of discussions about the range of ethical issues arising in mobile learning research. Research into the educational potential of mobile, handheld technologies to enhance teaching and learning has been regularly frustrated by lecturers' and teachers' concerns about how their students might use such devices. At other…

Existential concerns about death

DEFF Research Database (Denmark)

Moestrup, Lene

2014-01-01

Background Research suggests that addressing dying patients’ existential concerns can help improve their quality of life. Common existential conditions, such as a search for meaning and considerations about faith, are probably intensified in a palliative setting and existential concerns about death...... are likewise intensified when patients face their impending death. Knowledge of modern, secular existential concerns about death is under-researched, and therefore, it is difficult to develop and implement specifically targeted support to dying patients. Aim The aim of this paper is to present the results from...... a qualitative field study illuminating the variety of dying patients´ existential concerns about their impending death. Method Data was generated through ethnographic fieldwork comprising 17 semi-structured interviews with dying patients and 38 days of participant observation at three Danish hospices. Results...

Addressing Geriatric Oral Health Concerns through National Oral Health Policy in India

Directory of Open Access Journals (Sweden)

Abhinav Singh

2015-01-01

Full Text Available There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the world’s elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries

Addressing industrial competitiveness concerns in the 2030 EU Climate and Energy Package

International Nuclear Information System (INIS)

Sartor, Oliver; Colombier, Michel; Spencer, Thomas

2014-01-01

In the current sombre economic context, the issue of industrial competitiveness has become highly salient. Europe's industrial challenges need to be understood to be addressed. Europe like other major economies has gone through the resource intensive phase of building its capital stock. At Europe's level of development, high incomes tend to be spent on high value added services and manufactures. These factors mean that Europe's industry has been undergoing a long-term transition since the early 70's. In addition, European industry has been hit by a deep cyclical downturn as a result of the crisis. This long-term structural trend and current conjectural situation have nothing to do with energy policy. However, it would be wrong to suggest that energy prices do not play a role for certain industries. For a few highly energy and trade intensive industries, energy prices are a significant factor of comparative advantage. These industries will need protection in the 2030 climate and energy package, especially if a meaningful CO 2 price is to emerge. The current mechanisms to address competitiveness involve a number of drawbacks, notably the distortions and windfall profits that they entail due to variations of production levels from the historical reference used for free allocation. They also do not effectively address electricity intensive industries. Finding a solution to these issues is important for negotiating a meaningful future framework. Options that could be considered include moving to output based allocation for energy intensive, trade exposed industries, or considering temporary opt-outs for these industries. Given the potential risks around temporary opt-outs, output based allocation could be a way forward, combined with a much tighter focus on the energy intensive, trade exposed industries and a harmonized system for dealing with electricity intensive industries. (authors)

Response to ONS/EH-OA concerns

International Nuclear Information System (INIS)

Rice, P.D.

1991-01-01

The DOE's independent Office of Nuclear Safety (ONS) conducted an independent assessment of WSRC's readiness for K-Reactor restart. DOE-ONS identified six areas of concern, with specific findings in each area. The six concerns deal with: (1) Technical Specification surveillance, (2) human factors issues, (3) emergency lighting, (4) fire protection issues, (5) the Unreviewed Safety Question process, and (6) the critique process. This report addresses each of these six concerns and Westinghouse's actions to resolve them

Senior military officers' educational concerns, motivators and barriers for healthful eating and regular exercise.

Science.gov (United States)

Sigrist, Lori D; Anderson, Jennifer E; Auld, Garry W

2005-10-01

The increasing trend of overweight in the military, the high cost of health care associated with overweight, and the failure to meet some Healthy People 2000 objectives related to diet identify the need for more appropriate nutrition and fitness education for military personnel. The purpose of this study was to assess senior military officers' concerns on various health topics, educational preferences for nutrition and health topics, eating habits, and barriers and motivators for eating healthfully and exercising regularly. The survey was completed by 52 resident students at the U.S. Army War College. Fitness, weight, and blood cholesterol were top health concerns, and respondents wanted to know more about eating healthfully on the run. The primary barrier to eating healthfully and exercising regularly was lack of time, whereas health and appearance were top motivators. Health interventions for this population should include their topics of concern and should address perceived barriers and motivators.

Qualitative interview study of parents' perspectives, concerns and experiences of the management of lower respiratory tract infections in children in primary care.

Science.gov (United States)

Halls, Amy; Van't Hoff, Catherine; Little, Paul; Verheij, Theo; Leydon, Geraldine M

2017-09-15

To explore parents' perspectives, concerns and experiences of the management of lower respiratory tract infections (LRTIs) in children in primary care. Qualitative semistructured interview study. UK primary care. 23 parents of children aged 6 months to 10 years presenting with LRTI in primary care. Thematic analysis of semistructured interviews (either in person or by telephone) conducted with parents to explore their experiences and views on their children being prescribed antibiotics for LRTI. Four major themes were identified and these are perspectives on: (1) infection, (2) antibiotic use, (3) the general practitioner (GP) appointment and (4) decision making around prescribing. Symptomatic relief was a key concern: the most troublesome symptoms were cough, breathing difficulty, fever and malaise. Many parents were reluctant to use self-care medication, tended to support antibiotic use and believed they are effective for symptoms, illness duration and for preventing complications. However, parental expectations varied from a desire for reassurance and advice to an explicit preference for an antibiotic prescription. These preferences were shaped by: (1) the age of the child, with younger children perceived as more vulnerable because of their greater difficulty in communicating, and concerns about rapid deterioration; (2) the perceived severity of the illness; and (3) disruption to daily routine. When there was disagreement with the GP, parents described feeling dismissed, and they were critical of inconsistent prescribing when they reconsult. When agreement between the parent and the doctor featured, parents described a feeling of relief and legitimation for consulting, feeling reassured that the illness did indeed warrant a doctor's attention. Symptomatic relief is a major concern for parents. Careful exploration of expectations, and eliciting worries about key symptoms and impact on daily life will be needed to help parents understand when a no antibiotic

Changing concerns of beginning Dutch university teachers

NARCIS (Netherlands)

van den Bos, Paul

2017-01-01

Purpose: The purpose of this paper is to address the concerns of beginning university teachers about learning to teach in the context of an induction programme. Design/methodology/approach: The author asked 162 beginning teachers at Dutch universities of applied sciences to express their concerns

“Is it still safe to eat traditional food?” Addressing traditional food safety concerns in aboriginal communities

Energy Technology Data Exchange (ETDEWEB)

Bordeleau, Serge, E-mail: Serge.Bordeleau@uqat.ca [Chaire de Recherche du Canada en Foresterie Autochtone, Université du Québec en Abitibi-Témiscamingue, 445 boul. de l' Université, Rouyn-Noranda, Québec J9X 5E4 (Canada); Chaire Industrielle CRSNG-UQAT-UQÀM en Aménagement Forestier Durable, Université du Québec en Abitibi-Témiscamingue, 445 boul. de l' Université, Rouyn-Noranda, Québec J9X 5E4 (Canada); Asselin, Hugo, E-mail: Hugo.Asselin@uqat.ca [Chaire de Recherche du Canada en Foresterie Autochtone, Université du Québec en Abitibi-Témiscamingue, 445 boul. de l' Université, Rouyn-Noranda, Québec J9X 5E4 (Canada); Chaire Industrielle CRSNG-UQAT-UQÀM en Aménagement Forestier Durable, Université du Québec en Abitibi-Témiscamingue, 445 boul. de l' Université, Rouyn-Noranda, Québec J9X 5E4 (Canada); and others

2016-09-15

Food insecurity is a growing concern for indigenous communities worldwide. While the risk of heavy metal contamination associated to wild food consumption has been extensively studied in the Arctic, data are scarce for the Boreal zone. This study addressed the concerns over possible heavy metal exposure through consumption of traditional food in four Anishnaabeg communities living in the Eastern North American boreal forest. Liver and meat samples were obtained from 196 snowshoe hares (Lepus americanus) trapped during winter 2012 across the traditional lands of the participating communities and within 56–156 km of a copper smelter. Interviews were conducted with 78 household heads to assess traditional food habits, focusing on snowshoe hare consumption. Concentrations in most meat and liver samples were below the detection limit for As, Co, Cr, Ni and Pb. Very few meat samples had detectable Cd and Hg concentrations, but liver samples had mean dry weight concentrations of 3.79 mg/kg and 0.15 mg/kg respectively. Distance and orientation from the smelter did not explain the variability between samples, but percent deciduous and mixed forest cover had a marginal negative effect on liver Cd, Cu and Zn concentrations. The estimated exposition risk from snowshoe hare consumption was low, although heavy consumers could slightly exceed recommended Hg doses. In accordance with the holistic perspective commonly adopted by indigenous people, the nutritional and sociocultural importance of traditional food must be considered in risk assessment. Traditional food plays a significant role in reducing and preventing serious health issues disproportionately affecting First Nations, such as obesity, diabetes, and cardiovascular diseases. Traditional consumption of snowshoe hare (Lepus americanus) entails low risk of heavy metal exposure if animals are tapped > 50 km from a point emission source (such as a copper smelter in the present study), if risk-increasing behaviours are

“Is it still safe to eat traditional food?” Addressing traditional food safety concerns in aboriginal communities

International Nuclear Information System (INIS)

Bordeleau, Serge; Asselin, Hugo

2016-01-01

Food insecurity is a growing concern for indigenous communities worldwide. While the risk of heavy metal contamination associated to wild food consumption has been extensively studied in the Arctic, data are scarce for the Boreal zone. This study addressed the concerns over possible heavy metal exposure through consumption of traditional food in four Anishnaabeg communities living in the Eastern North American boreal forest. Liver and meat samples were obtained from 196 snowshoe hares (Lepus americanus) trapped during winter 2012 across the traditional lands of the participating communities and within 56–156 km of a copper smelter. Interviews were conducted with 78 household heads to assess traditional food habits, focusing on snowshoe hare consumption. Concentrations in most meat and liver samples were below the detection limit for As, Co, Cr, Ni and Pb. Very few meat samples had detectable Cd and Hg concentrations, but liver samples had mean dry weight concentrations of 3.79 mg/kg and 0.15 mg/kg respectively. Distance and orientation from the smelter did not explain the variability between samples, but percent deciduous and mixed forest cover had a marginal negative effect on liver Cd, Cu and Zn concentrations. The estimated exposition risk from snowshoe hare consumption was low, although heavy consumers could slightly exceed recommended Hg doses. In accordance with the holistic perspective commonly adopted by indigenous people, the nutritional and sociocultural importance of traditional food must be considered in risk assessment. Traditional food plays a significant role in reducing and preventing serious health issues disproportionately affecting First Nations, such as obesity, diabetes, and cardiovascular diseases. Traditional consumption of snowshoe hare (Lepus americanus) entails low risk of heavy metal exposure if animals are tapped > 50 km from a point emission source (such as a copper smelter in the present study), if risk-increasing behaviours are

Addressing domestic violence in primary care: what the physician ...

African Journals Online (AJOL)

Domestic violence (DV) is quite prevalent and negatively impacts the health and mental wellbeing of those affected. Victims of DV are frequent users of health service, yet they are infrequently recognized. Physicians tend to treat the presenting complaints without addressing the root cause of the problem. Lack of knowledge ...

Investigation of Problems of Implementing Curriculum in Primary Schools in Somalia. African Studies in Curriculum Development & Evaluation.

Science.gov (United States)

Mohamed, Ibrahim Jeylani

The aim of this study was to investigate the implementation of modern mathematics in the primary schools of Somalia. In particular, three concerns were addressed: (1) teachers' confidence and ability in teaching mathematics; (2) students' interest in mathematics; and (3) students' examination performance in mathematics. Subjects were 30 teachers…

How can clinician-educator training programs be optimized to match clinician motivations and concerns?

Science.gov (United States)

McCullough, Brendan; Marton, Gregory E; Ramnanan, Christopher J

2015-01-01

Several medical schools have implemented programs aimed at supporting clinician-educators with formal mentoring, training, and experience in undergraduate medical teaching. However, consensus program design has yet to be established, and the effectiveness of these programs in terms of producing quality clinician-educator teaching remains unclear. The goal of this study was to review the literature to identify motivations and perceived barriers to clinician-educators, which in turn will improve clinician-educator training programs to better align with clinician-educator needs and concerns. Review of medical education literature using the terms "attitudes", "motivations", "physicians", "teaching", and "undergraduate medical education" resulted in identification of key themes revealing the primary motivations and barriers involved in physicians teaching undergraduate medical students. A synthesis of articles revealed that physicians are primarily motivated to teach undergraduate students for intrinsic reasons. To a lesser extent, physicians are motivated to teach for extrinsic reasons, such as rewards or recognition. The key barriers deterring physicians from teaching medical students included: decreased productivity, lack of compensation, increased length of the working day, patient concerns/ethical issues, and lack of confidence in their own ability. Our findings suggest that optimization of clinician-educator training programs should address, amongst other factors, time management concerns, appropriate academic recognition for teaching service, and confidence in teaching ability. Addressing these issues may increase the retention of clinicians who are active and proficient in medical education.

Medical Students Raising Concerns.

Science.gov (United States)

Druce, Maralyn R; Hickey, Andrea; Warrens, Anthony N; Westwood, Olwyn M R

2016-09-16

After a number of high-profile incidents and national reports, it has become clear that all health professionals and all medical students must be able to raise concerns about a colleague's behavior if this behavior puts patients, colleagues, or themselves at risk.Detailed evidence from medical students about their confidence to raise concerns is limited, together with examples of barriers, which impair their ability to do so. We describe a questionnaire survey of medical students in a single-center, examining self-reported confidence about raising concerns in a number of possible scenarios. Thematic analysis was applied to comments about barriers identified.Although 80% of respondents felt confident to report a patient safety issue, students were less confident around issues of probity, attitude, and conduct. This needs to be addressed to create clear mechanisms to raise concerns, as well as support for students during the process.

A primary care-based health needs assessment in inner city Dublin.

LENUS (Irish Health Repository)

O'Kelly, C M

2012-02-01

BACKGROUND: In 2001, a primary care-based health needs assessment (HNA) in South Inner City of Dublin identified high levels of morbidity and widespread and frequent use of primary care and specialist hospital services as particular concerns. AIMS: This study aims to determine the primary care health needs of a local community, from the perspective of service users and service providers. METHODS: A similar methodology to our 2001 HNA was adopted, involving semi-structured interviews with a convenience sample of patients attending two general practices and key informants regarding local health issues and health service utilisation. RESULTS: High levels of morbidity and chronic illness were found. A correlation between the local environment and ill-health was identified, as well as high utilisation of primary care services in the area. CONCLUSION: The establishment of a Primary Care Team would begin to address the health needs of the community.

What fosters concern for inequality among American adolescents?

Science.gov (United States)

Cech, Erin A

2017-01-01

Understanding cultural beliefs about social and economic inequality is vital to discerning the roadblocks and pathways to addressing that inequality. The foundation of concern for inequality is laid during adolescence, yet scholars understand little about the factors that influence whether and how adolescents come to express such concern. Arguing that structural and cultural contexts are just as consequential as whether adolescents themselves are members of disadvantaged groups, I draw on four theoretical perspectives to identify factors that influence adolescents' concern for addressing inequality: the underdog thesis, intergroup contact theory, the education enlightens thesis, and ideological buttressing. Using representative restricted-use Educational Longitudinal Survey data, I find that 12th-graders' beliefs are indeed influenced by more than their own demography: the diversity of their social milieu, the content of education in and out of the classroom, and ideological buttressing via political region and entertainment all influence whether they express concern for addressing inequality. These findings suggest extensions and amendments to the four theoretical perspectives and underscore the importance of studying structural and cultural factors that shape beliefs about inequality. The results also point to several interventions that may increase students' concern for inequality: involvement in civic-oriented extracurricular activities, more education in academic subjects that consider inequality, nurturing of cross-race friendships, and increased leisure reading. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison between Primary Teacher Educators' and Primary School Teachers' Beliefs of Primary Geography Education Quality

Science.gov (United States)

Bent, Gert Jan; Bakx, Anouke; den Brok, Perry

2016-01-01

In this study teacher educators' beliefs concerning primary geography education have been investigated and compared with primary school teachers' beliefs. In this study 45 teacher educators and 489 primary school teachers completed a questionnaire, and nine teacher educators have been interviewed as well. It has been found that teacher educators…

Addressing domestic violence in primary care: what the physician ...

African Journals Online (AJOL)

2014-03-14

Mar 14, 2014 ... stance abuse, suicidal behavior, somatizing disorders, eating disorders, and ... anxiety disorders, and PTSD are at a higher risk of experiencing adult ... reported by mental health and primary care professionals. (29) included ... about the nature and course of DV and assessing the level of readiness to ...

Rising to the challenge: addressing the concerns of people working in the sex industry.

Science.gov (United States)

Shaver, Frances M; Lewis, Jacqueline; Maticka-Tyndale, Eleanor

2011-02-01

In September 2010, three Canadian Criminal Code provisions related to prostitution were ruled unconstitutional because they increase the risk of harm to people working in the sex industry (PWSI). Using data from studies with PWSI and key informants conducted in several Canadian cities, we examine three domains related to worker health and safety: occupational health and safety, perceptions of and behaviors toward workers, and access to essential services. Addressing these issues necessitates moving beyond decriminalization. We conclude that using a harm reduction/labor rights framework would enhance our ability to address issues related to the physical, social, and mental well-being as well as rights of PWSI.

Convocation address.

Science.gov (United States)

Zakaria, R

1996-07-01

By means of this graduation address at the International Institute for Population Sciences (IIPS) in Bombay, the Chancellor of Urdu University voiced his concerns about overpopulation in India. During the speaker's tenure as Health Minister of Maharashtra, he implemented a sterilization incentive program that resulted in the state's having the best family planning (FP) statistics in India for almost 10 years. The incentive program, however, was misused by overenthusiastic officials in other states, with the result that the FP program was renamed the Family Welfare Programme. Population is growing in India because of improvements in health care, but the population education necessary to change fertility will require more time than the seriousness of the population problem allows. In the longterm, poverty and illiteracy must be addressed to control population. In the meanwhile, the graduate program at the IIPS should be expanded to include an undergraduate program, marriage age laws should be enforced, and misconceptions about religious objections to FP must be addressed. India can not afford to use the measures forwarded by developed countries to control population growth. India must integrate population control efforts with the provision of health care because if population continues to grow in the face of reduced infant mortality and longer life expectancy, future generations will be forced to live in a state of poverty and economic degradation.

Addressing Concerns Related to the Use of Ethanol-Blended Fuels in Marine Vehicles

Directory of Open Access Journals (Sweden)

Gregory W. Davis

2017-12-01

Full Text Available Ethanol blended fuels have become increasingly prevalent in the on-road transportation sector due to the benefits they provide in energy security, sustainability and reduced environmental impact. However, ethanol usage has led to material compatibility concerns causing corrosion and degradation in materials that are commonly used in engines and fuel storage/delivery systems. The on-road transportation sector continues to study and develop alternatives to minimize potential material challenges. Although, marine vehicles represent a smaller segment of the transportation sector, they represent many vehicles, particularly in the United States. Concerns related to the use of ethanol blended fuels in the marine environment have been expressed by many individuals and groups. Unfortunately, relatively little work has gone into the study of gasoline mixed with approximately 10% ethanol usage and potential material incompatibilities in marine engines. The objective of this article is to provide some factual answers to these concerns. In order to understand the extent of material incompatibilities, a literature survey of published material compatibility data and marine engine manufacturer recommendations was conducted. Next field samples of marine fuels were gathered to estimate the extent of ethanol usage in marine gasoline. Finally, samples of new and in-use marine components were exposed to either gasoline mixed with approximately 10% ethanol or gasoline with 0% ethanol for 1,960 hours to determine whether gasoline mixed with approximately 10% ethanol presented degradation beyond that seen with gasoline (gasoline with 0% ethanol alone. This work has shown that many marine engine manufacturers have used ethanol compatible materials in current products and that exposure of older marine engine components to gasoline mixed with approximately 10% ethanol by did not reveal any significant degradation. Finally, marine fuel samples gathered in 2013, reveal that

Aliens in the promised land? Keynote address for the 1986 National Gathering of the United Church of Christ's Coalition for Lesbian/Gay Concerns.

Science.gov (United States)

Comstock, G D

The following article is a condensed version of the keynote address given at the 1986 National Gathering of the Lesbian/Gay Coalition of the United Church of Christ (UCC). Problems encountered by lesbians and gay men in organized religion, especially within the liberal tradition, are identified by a method of inquiry developed by Christian educator John Westerhoff for assessing egalitarianism within institutions. The story of Queen Vashti from the Book of Esther in Hebrew scripture, and the emerging tradition of coming-out experiences by lesbians and gay men; provide the norm and model for declaring independence from denominations that neglect the concerns of lesbians and gay men and for constructing religious alternatives.

Radioactive waste below regulatory concern

International Nuclear Information System (INIS)

Neuder, S.M.

1987-01-01

The U.S. Nuclear Regulatory Commission (NRC) published two notices in the Federal Register concerning radioactive waste below regulatory concern. The first, a Commission Policy Statement and Implementation Plan published August 29, 1986, concerns petition to exempt specific radioactive waste streams from the regulations. The second, an Advanced Notice of Proposed Rulemaking published Decemger 2, 1986, addresses the concept of generic rulemaking by the NRC on radioactive wastes that are below regulatory concern. Radioactive waste determined to be below regulatory concern would not be subject to regulatory control and would not need to go to a licensed low-level radioactive waste disposal site. The Policy Statement and Implementation Plan describe (1) the information a petitioner should file in support of a petition to exempt a specific waste stream, (2) the decision criteria the Commission intends to use for judging the petition, and (3) the internal administrative procedures to use be followed in order to permit the Commission to act upon the petition in an expedited manner

Dear Critics: Addressing Concerns and Justifying the Benefits of Photography as a Research Method

Directory of Open Access Journals (Sweden)

Kyle Elizabeth Miller

2015-08-01

Full Text Available Photography serves as an important tool for researchers to learn about the contextualized lives of individuals. This article explores the process of integrating photo elicitation interviews (PEI into research involving children and families. Much literature is dedicated to the general debate surrounding the ethics of visual methods in research, with little attention directed at the actual process of gaining study approval and publishing one's findings. There are two main critiques that researchers must face in order to conduct and disseminate studies involving visual images—ethics committees and peer reviewers. In this article, I identify and discuss some of the challenges that emerged across gaining protocol approval from an ethics committee in the United States. Ethical concerns and restrictions related to the use of photography can delay data collection and create barriers to research designs. Similarly, I describe the process of responding to reviewers' concerns as part of the publication process. Peer reviewers' lack of familiarity with the use of photography as a research tool may lead to misunderstandings and inappropriate requests for manuscript changes. While many concerns are sound, the range of benefits stemming from the use of visual data help to justify the time and energy required to defend this type of research. Implications are discussed for researchers using visual methods in their work. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1503274

Childhood obesity policies - mighty concerns, meek reactions

DEFF Research Database (Denmark)

Vallgårda, Signild

2018-01-01

Background: The increasing number of children defined as overweight or obeseis causing concern among politicians and health advocates; several countries havelaunched policies addressing the issue.Method: The paper presents an analysis of how the childhood obesity is defined,explained and suggested...... policies to address the problem from the WHO, the EU,Canada, England and New Zealand.Results: Considering the dramatic language used when describing childhood obe-sity, the proposed interventions are modest. Either the politicians do not considerthe problem that great after all, or other concerns...... by evidence, and the evidence cited is sometimesmisinterpreted or disregarded.Conclusion: There is a discrepancy between how the problem of childhood obe-sity is presented as alarming and the modest measures suggested....

Environmental remediation: Addressing public concerns through effective community relations

International Nuclear Information System (INIS)

Davis, S.; Heywood, J.; Wood, M.B.; Arellano, M.; Pfister, S.

1998-01-01

The public's perception of risk drives their response to any potential environmental remediation project. Even if the actual environmental and health risks may be relatively low, public perception of high risk may doom the project to an uphill struggle characterized by heated public meetings, negative media coverage, reluctant regulators, project delays and increased costs. The ultimate Catch 22 in such a case is that the contamination remains in-place until the public drama is concluded. This paper explores the development and implementation of a Community Relations Plan for the clean up of a Manufactured Gas Plant (MGP) site owned and operated by corporate predecessors of Arizona Public Service Company (APS) near the turn of the century. The unique challenges associated with this project were that the former MGP was located in downtown Phoenix at the site of a future federal courthouse. Although the MGP site had been under investigation for some time, the clean-up schedule was driven by a tight courthouse construction schedule. Compounding these challenges were the logistics associated with conducting a large-scale cleanup in a congested, highly visible downtown location. An effective Community Relations Plan can mean the difference between the success and failure of an environmental remediation project. Elements of an effective plan are: identifying key stakeholders and involving them in the project from the beginning; providing timely information and being open and honest about the potential environmental and health risks; involving your company's community relations and media staff; and educating affected company employees. The Community Relations Plan developed for this project was designed to alleviate public concern about potential risks (perceived or real) associated with the project by keeping key stakeholders informed of all activities well in advance

NARCISSISM AND CONCERN: THE RELATIONSHIP OF SELF-OBJECT NEEDS AND NARCISSISTIC SYMPTOMS WITH HEALTHY AND PATHOLOGICAL CONCERN.

Science.gov (United States)

Friedemann, Yael; Tolmacz, Rami; Doron, Yonit

2016-03-01

While concern and narcissism seem to be contradictory in nature, clinical evidence and theoretical writings on pathological forms of concern--tracing their origin to deficiencies in early relationships with primary caretakers--suggest that the actual relationship between these two characteristics might be much more complicated. We respond to a study aimed to add empirical data to the clinical and theoretical knowledge examined the relationships between self-object functions, types of narcissism and pathological concern. The findings of the study showed that pathological concern was positively associated with self-object needs and that this association was mediated by covert narcissism. Our discussion focuses on the developmental and psychodynamic sources of pathological concern, as well as its significance in the intrapersonal and interpersonal domains.

Impact of a primary care based intervention on breast cancer knowledge, risk perception and concern: A randomized, controlled trial.

Science.gov (United States)

Livaudais-Toman, Jennifer; Karliner, Leah S; Tice, Jeffrey A; Kerlikowske, Karla; Gregorich, Steven; Pérez-Stable, Eliseo J; Pasick, Rena J; Chen, Alice; Quinn, Jessica; Kaplan, Celia P

2015-12-01

To estimate the effects of a tablet-based, breast cancer risk education intervention for use in primary care settings (BreastCARE) on patients' breast cancer knowledge, risk perception and concern. From June 2011-August 2012, we enrolled women from two clinics, aged 40-74 years with no personal breast cancer history, and randomized them to the BreastCARE intervention group or to the control group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). All women were categorized as high or average risk based on the Referral Screening Tool, the Gail model or the Breast Cancer Surveillance Consortium model. Intervention patients and their physicians received an individualized risk report to discuss during the visit. All women completed a follow-up telephone survey 1-2 weeks after risk assessment. Post-test comparisons estimated differences at follow-up in breast cancer knowledge, risk perception and concern. 580 intervention and 655 control women completed follow-up interviews. Mean age was 56 years (SD = 9). At follow-up, 73% of controls and 71% of intervention women correctly perceived their breast cancer risk and 22% of controls and 24% of intervention women were very concerned about breast cancer. Intervention patients had greater knowledge (≥75% correct answers) of breast cancer risk factors at follow-up (24% vs. 16%; p = 0.002). In multivariable analysis, there were no differences in correct risk perception or concern, but intervention patients had greater knowledge ([OR] = 1.62; 95% [CI] = 1.19-2.23). A simple, practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern. ClinicalTrials.gov identifier NCT01830933. Copyright © 2015 Elsevier Ltd. All rights reserved.

Impact of a primary care based intervention on breast cancer knowledge, risk perception and concern: A randomized, controlled trial

Science.gov (United States)

Livaudais-Toman, Jennifer; Karliner, Leah S.; Tice, Jeffrey A.; Kerlikowske, Karla; Gregorich, Steven; Pérez-Stable, Eliseo J.; Pasick, Rena J.; Chen, Alice; Quinn, Jessica; Kaplan, Celia P.

2015-01-01

Purpose To estimate the effects of a tablet-based, breast cancer risk education intervention for use in primary care settings (BreastCARE) on patients' breast cancer knowledge, risk perception and concern. Methods From June 2011–August 2012, we enrolled women from two clinics, aged 40–74 years with no personal breast cancer history, and randomized them to the BreastCARE intervention group or to the control group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). All women were categorized as high or average risk based on the Referral Screening Tool, the Gail model or the Breast Cancer Surveillance Consortium model. Intervention patients and their physicians received an individualized risk report to discuss during the visit. All women completed a follow-up telephone survey 1–2 weeks after risk assessment. Post-test comparisons estimated differences at follow-up in breast cancer knowledge, risk perception and concern. Results 580 intervention and 655 control women completed follow-up interviews. Mean age was 56 years (SD = 9). At follow-up, 73% of controls and 71% of intervention women correctly perceived their breast cancer risk and 22% of controls and 24% of intervention women were very concerned about breast cancer. Intervention patients had greater knowledge (≥75% correct answers) of breast cancer risk factors at follow-up (24% vs. 16%; p = 0.002). In multivariable analysis, there were no differences in correct risk perception or concern, but intervention patients had greater knowledge ([OR] = 1.62; 95% [CI] = 1.19–2.23). Conclusions A simple, practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern. Trial Registration ClinicalTrials.gov identifier NCT01830933. PMID:26476466

Addressing Student Debt in the Classroom

Science.gov (United States)

Perkins, David; Johnston, Tim; Lytle, Rick

2016-01-01

Student debt is a national concern. The authors address debt in the classroom to enhance students' understanding of the consequences of debt and the need for caution when financing their education. However, student feedback indicates this understanding has a delayed effect on borrowing behavior and underscores the importance of making difficult…

The dire need for primary care specialization in India: Concerns and challenges

Directory of Open Access Journals (Sweden)

Nafis Faizi

2016-01-01

Full Text Available Primary health care is an evidence-based priority, but it is still inadequately supported in many countries. Ironically, on one hand, India is a popular destination for medical tourism due to the affordability of high quality of health care and, on the other hand, ill health and health care are the main reasons for becoming poor through medical poverty traps. Surprisingly, this is despite the fact that India was committed to 'Health for All by 2000' in the past, and is committed to 'Universal Health Coverage' by 2022! Clearly, these commitments are destined to fail unless something is done to improve the present state of affairs. This study argues for the need to develop primary care as a specialization in India as a remedial measure to reform its health care in order to truly commit to the commitments. Three critical issues for this specialization are discussed in this review: (1 The dynamic and distinct nature of primary care as opposed to other medical specializations, (2 the intersection of primary care and public health which can be facilitated by such a specialization, and (3 research in primary care including the development of screening and referral tools for early diagnosis of cancers, researches for evidence-based interventions via health programs, and primary care epidemiology. Despite the potential challenges and difficulties, India is a country in dire need for primary care specialization. India's experience in providing low-cost and high quality healthcare for medical tourism presages a more cost-effective and efficient primary care with due attention and specialization.

The dire need for primary care specialization in India: Concerns and challenges.

Science.gov (United States)

Faizi, Nafis; Khalique, Najam; Ahmad, Anees; Shah, Mohammad Salman

2016-01-01

Primary health care is an evidence-based priority, but it is still inadequately supported in many countries. Ironically, on one hand, India is a popular destination for medical tourism due to the affordability of high quality of health care and, on the other hand, ill health and health care are the main reasons for becoming poor through medical poverty traps. Surprisingly, this is despite the fact that India was committed to 'Health for All by 2000' in the past, and is committed to 'Universal Health Coverage' by 2022! Clearly, these commitments are destined to fail unless something is done to improve the present state of affairs. This study argues for the need to develop primary care as a specialization in India as a remedial measure to reform its health care in order to truly commit to the commitments. Three critical issues for this specialization are discussed in this review: (1) The dynamic and distinct nature of primary care as opposed to other medical specializations, (2) the intersection of primary care and public health which can be facilitated by such a specialization, and (3) research in primary care including the development of screening and referral tools for early diagnosis of cancers, researches for evidence-based interventions via health programs, and primary care epidemiology. Despite the potential challenges and difficulties, India is a country in dire need for primary care specialization. India's experience in providing low-cost and high quality healthcare for medical tourism presages a more cost-effective and efficient primary care with due attention and specialization.

Gender bias in primary education a theoretical analysis

Directory of Open Access Journals (Sweden)

Róbert Osaďan

2013-11-01

Full Text Available For decades, gender bias and inequity have remained extensive issues in nearly all societies in the world. During the past years, the effects of these issues have extended to one of the most important facets in our society - the education sector. Although this may not be immediately shocking, a lot of researchers as well as concerned educators and parents believe otherwise. As a matter of fact, a myriad of studies and research projects have already proven that gender discrimination, bias, and other related issues in sexuality actually exist in most primary schools throughout the globe. These literary materials present vital points that provide the initiative for primary school educators, school administrators, and other parents to become aware of the gender issues, which significantly affect the school performance and achievement of the concerned students, most of them being girls. Also, a number of studies have identified gender bias agents and their contributions in the worsening of the problem. Obviously, this problem needs to be addressed by the people most empowered - the educators. There is no question whether or not primary school teachers possess the knowledge to circumvent this bias inside their classrooms. The true concern is when they will actually start to apply crucial measures to resolve and get rid of gender bias. Once they eliminate their own prejudices about their students in terms of gender- related issues, they will be able to provide each of their pupils the right and proper education that the children deserve to get. And if all students obtain fair educational treatment, academic excellence and competence will merely be two of the countless benefits they can get.

Public concerns and alternative nuclear power systems

International Nuclear Information System (INIS)

Mayo, L.H.

1980-02-01

The basic task undertaken in this study was to assess the relative public acceptability of three general types of nuclear power systems as alternatives to the existing Light Water Reactor (LWR) system. Concerns registered toward nuclear power constituted the basic data for this assessment. The primary measure adopted for determining the significance of concerns was the degree of difficulty posed by the concern to the nuclear power decisional structure in the establishment and maintenance of norms to control risks or to advance intended energy objectives. Alleviations or exacerbations of concern resulting from particular attributes of alternative systems were measured from an LWR baseline

Addressing the determinants of child mental health: intersectionality as a guide to primary health care renewal.

Science.gov (United States)

McPherson, Charmaine M; McGibbon, Elizabeth A

2010-09-01

Primary health care (PHC) renewal was designed explicitly to attend to the multidimensional factors impacting on health, including the social determinants of health. These determinants are central considerations in the development of integrated, cross-sectoral, and multi-jurisdictional policies such as those that inform models of shared mental health care for children. However, there are complex theoretical challenges in translating these multidimensional issues into policy. One of these is the rarely discussed interrelationships among the social determinants of health and identities such as race, gender, age, sexuality, and social class within the added confluence of geographic contexts. An intersectionality lens is used to examine the complex interrelationships among the factors affecting child mental health and the associated policy challenges surrounding PHC renewal. The authors argue that an understanding of the intersections of social determinants of health, identity, and geography is pivotal in guiding policy-makers as they address child mental health inequities using a PHC renewal agenda.

Engineering Hematopoietic Cells for Cancer Immunotherapy: Strategies to Address Safety and Toxicity Concerns.

Science.gov (United States)

Resetca, Diana; Neschadim, Anton; Medin, Jeffrey A

2016-09-01

Advances in cancer immunotherapies utilizing engineered hematopoietic cells have recently generated significant clinical successes. Of great promise are immunotherapies based on chimeric antigen receptor-engineered T (CAR-T) cells that are targeted toward malignant cells expressing defined tumor-associated antigens. CAR-T cells harness the effector function of the adaptive arm of the immune system and redirect it against cancer cells, overcoming the major challenges of immunotherapy, such as breaking tolerance to self-antigens and beating cancer immune system-evasion mechanisms. In early clinical trials, CAR-T cell-based therapies achieved complete and durable responses in a significant proportion of patients. Despite clinical successes and given the side effect profiles of immunotherapies based on engineered cells, potential concerns with the safety and toxicity of various therapeutic modalities remain. We discuss the concerns associated with the safety and stability of the gene delivery vehicles for cell engineering and with toxicities due to off-target and on-target, off-tumor effector functions of the engineered cells. We then overview the various strategies aimed at improving the safety of and resolving toxicities associated with cell-based immunotherapies. Integrating failsafe switches based on different suicide gene therapy systems into engineered cells engenders promising strategies toward ensuring the safety of cancer immunotherapies in the clinic.

Towards a feminist global bioethics: addressing women's health concerns worldwide.

Science.gov (United States)

Tong, R

2001-01-01

In this paper I argue that a global bioethics is possible. Specifically, I present the view that there are within feminist approaches to bioethics some conceptual and methodological tools necessary to forge a bioethics that embraces the health-related concerns of both developing and developed nations equally. To support my argument I discuss some of the challenges that have historically confronted feminists. If feminists accept the idea that women are entirely the same, then feminists present as fact the fiction of the essential "Woman." Not only does "Woman" not exist, -she" obscures important racial, ethnic, cultural, and class differences among women. However, if feminists stress women's differences too much, feminists lose the power to speak coherently and cogently about gender justice, women's rights, and sexual equality in general. Analyzing the ways in which the idea of difference as well as the idea of sameness have led feminists astray, I ask whether it is possible to avoid the Scylla of absolutism (imperialism, colonialism, hegemony) on the one hand and the Charybdis of relativism (postmodernism, fragmentation, Balkanization) on the other. Finally, after reflecting upon the work of Uma Narayan, Susan Muller Okin, and Martha Nussbaum, I conclude that there is a way out of this ethical bind. By focusing on women's, children's, and men's common human needs, it is possible to lay the foundation for a just and caring global bioethics.

Zirconia crowns for rehabilitation of decayed primary incisors: an esthetic alternative.

Science.gov (United States)

Ashima, G; Sarabjot, K Bhatia; Gauba, K; Mittal, H C

2014-01-01

Esthetic management of extensively decayed primary maxillary anterior teeth requiring full coronal coverage restoration is usually challenging to the pediatric dentists especially in very young children. Many esthetic options have been tried over the years each having its own advantages, disadvantages and associated technical, functional or esthetic limitations. Zirconia crowns have provided a treatment alternative to address the esthetic concerns and ease of placement of extra-coronal restorations on primary anterior teeth. The present article presents a case where grossly decayed maxillary primary incisors were restored esthetically and functionally with ready made zirconia crowns (ZIRKIZ, HASS Corp; Korea). After endodontic treatment the decayed teeth were restored with zirconia crowns. Over a 30 months period, the crowns have demonstrated good retention and esthetic results. Dealing with esthetic needs in children with extensive loss of tooth structure, using Zirconia crowns would be practical and successful. The treatment described is simple and effective and represents a promising alternative for rehabilitation of decayed primary teeth.

Esthetic Concerns and Acceptability of Treatment Modalities in Primary Teeth: A Comparison between Children and Their Parents

Science.gov (United States)

Saffan, Abdulrahman Al; AlHobail, Sultan; Bin Salem, Fares; AlFuraih, AlBara; AlTamimi, Mohammad

2016-01-01

Background and Aim. Esthetic concerns in primary teeth have been studied mainly from the point of view of parents. The aim of this study was to study compare the opinions of children aged 5–8 years to have an opinion regarding the changes in appearance of their teeth due to dental caries and the materials used to restore those teeth. Methodology. A total of 107 children and both of their parents (n = 321), who were seeking dental treatment, were included in this study. A tool comprising a questionnaire and pictures of carious lesions and their treatment arranged in the form of a presentation was validated and tested on 20 children and their parents. The validated tool was then tested on all participants. Results. Children had acceptable validity statistics for the tool suggesting that they were able to make informed decisions regarding esthetic restorations. There was no difference between the responses of the children and their parents on most points. Zirconia crowns appeared to be the most acceptable full coverage restoration for primary anterior teeth among both children and their parents. Conclusion. Within the limitations of the study it can be concluded that children in their sixth year of life are capable of appreciating the esthetics of the restorations for their anterior teeth. PMID:27446212

Addressing concerns and achieving expectations

Energy Technology Data Exchange (ETDEWEB)

Miller, C.L. [Dept. of Energy, Washington, DC (United States)

1995-12-01

Approximately 2-1/2 years ago many of us were gathered here in Prague at a similar conference with a similar name, {open_quotes}Energy and Environment: Transitions in Eastern Europe.{close_quotes} Over 300 professionals from 26 nations attended. The objective of the conference was to: Facilitate the Solution of Long and Short Term Energy and Environmental Problems in Eastern Europe by Bringing Together People, ideas and technologies which could be applied to specific problems in a logical step-by-step manner. It was conceded at the time that the long term solution would consist of thoughtfully integrated steps and that the conference was the first step. We are here in the Czech Republic again this week to continue what was started. As before, this conference continues to: (1) Provide a forum to identify and discuss cost-effective environmentally acceptable energy and environmental technology options and their associated socioeconomic issues. (2) Stimulate the Formation of business partnerships (3) Identify key barrier issues hindering technology applications and identify implementation pathways that eliminate or avoid obstacles to progress.

Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns

Directory of Open Access Journals (Sweden)

Maziar Moradi-Lakeh

2015-10-01

Full Text Available In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP, was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016. It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME affiliated hospitals, reduce out-of-pocket (OOP payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers’ concerns (as powerful and influential stakeholders potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes should be addressed through proper revision(s while nontechnical concerns (which are derived from conflicting interests must be responded through clarification and providing transparent information. The

Addressing the Global Burden of Breast Cancer

Science.gov (United States)

The US National Cancer Institute’s Center for Global Health (CGH) has been a key partner in a multi-institutional expert team that has developed a set of publications to address foundational concerns in breast cancer care across the cancer care continuum and within limited resource settings.

Epistemological beliefs in introductory biology: Addressing measurement concerns and exploring the relationship with strategy use

Science.gov (United States)

Holschuh, Jodi Lynn

This study had two main purposes: to address measurement concerns about assessing students' epistemological beliefs and to explore the relationship between epistemological beliefs and deep and surface strategy use in an introductory biology classroom. The following research questions guided the study: (a) Are epistemological beliefs multidimensional? (b) Are the measures of epistemological beliefs correlated? (c) Are the measures of strategy use correlated? (d) Are epistemological beliefs correlated with deep and surface strategy use? (e) How much of the unique variance in Scholastic Aptitude Test (SAT) scores, grade point average (GPA), and course grade is accounted for by epistemological beliefs and strategy use? (f) To what extent does the content analysis of the open-ended questionnaire data support or refute the role of mature epistemological beliefs? and (g) To what extent does the content analysis of the open-ended questionnaire data support or refute the role of deep strategies? Participants (N = 518) were recruited from two sections of an introductory biology course. All participants completed five assessments including the Epistemological Questionnaire, the Epistemological Scenario, the Self-Regulated Learning Inventory, two strategy checklists, and an open-ended questionnaire. The factor analysis, which was used to answer the first question, indicated no clear loading of the hypothesized dimensions underlying epistemological beliefs as measured by the Epistemological Questionnaire. However, the factor analysis of the Epistemological Scenario indicated four factors underlying epistemological beliefs (i.e., certain knowledge, innate ability, quick learning, and simple knowledge). In addition, the correlation analyses, which were used to answer the second, third, and fourth questions, indicated a significant relationship between epistemological beliefs and strategy use. The multiple regression commonality analysis, which was used to answer the fifth

30 CFR 250.302 - Definitions concerning air quality.

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Definitions concerning air quality. 250.302... Definitions concerning air quality. For purposes of §§ 250.303 and 250.304 of this part: Air pollutant means..., pursuant to section 109 of the Clean Air Act, national primary or secondary ambient air quality standards...

Deployment Models: Towards Eliminating Security Concerns From Cloud Computing

OpenAIRE

Zhao, Gansen; Chunming, Rong; Jaatun, Martin Gilje; Sandnes, Frode Eika

2010-01-01

Cloud computing has become a popular choice as an alternative to investing new IT systems. When making decisions on adopting cloud computing related solutions, security has always been a major concern. This article summarizes security concerns in cloud computing and proposes five service deployment models to ease these concerns. The proposed models provide different security related features to address different requirements and scenarios and can serve as reference models for deployment. D...

Addressing adherence to treatment: a longstanding concern. The patients’ perspective

Directory of Open Access Journals (Sweden)

Mahmoud Hadipour Dehshal

2014-12-01

Full Text Available Adherence to treatment is a great concern for patients who need long-life treatment. Thalassaemia is an inherited disease for whose treatment team-working is of a considerable importance. To logically face the problem of poor compliance patients, all members of the team ought to be aware of the causing factors and the ways to handle the problem. The factors which cause the lack of compliance among patients could be stratified into economic and structural facto. Furthermore, patient-related factors including ethnicity, gender, age, and regimen complexity such as dosing are also noteworthy. The supportive relationship between the health providers and the patients should be also established such as patients’ trust in their doctors. Last but not least, the pattern of health care delivery including the availability of health care requisites and operation of flexible hours and floating working hours. From the patients’ point of view, it is important to be aware of the significance of the adherence to treatment and the importance of providing prompt-routine reminders to patients to understand the consequence of incomplete treatment. Trained and motivated staffs play an effective role to enhance patients’ tendency to pursue the determined treatment. Health decision makers would be better to reinterpret the concept of health to “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The patients’ role in self-management should not be ignored and “medicalization” has to be altered by the patient centered care.

Fairness and nanotechnology concern.

Science.gov (United States)

McComas, Katherine A; Besley, John C

2011-11-01

Research suggests that fairness perceptions matter to people who are asked to evaluate the acceptability of risks or risk management. Two separate national random surveys (n = 305 and n = 529) addressed Americans' concerns about and acceptance of nanotechnology risk management in the context of the degree to which they view scientists and risk managers as fair. The first survey investigated general views about scientists across four proposed dimensions of fairness (distributional, procedural, interpersonal, and informational). The results show that respondents who believe that the outcomes of scientific research tend to result in unequal benefits (distributional fairness) and that the procedures meant to protect the public from scientific research are biased (procedural fairness) were more concerned about nanotechnology. Believing scientists would treat them with respect (interpersonal fairness) and ensure access to information (informational fairness) were not significant predictors of concern. The second study also looked at these four dimensions of fairness but focused on perceptions of risk managers working for government, universities, and major companies. In addition to concern, it also examined acceptance of nanotechnology risk management. Study 2 results were similar to those of study 1 for concern; however, only perceived informational fairness consistently predicted acceptance of nanotechnology risk management. Overall, the study points to the value of considering fairness perceptions in the study of public perceptions of nanotechnology. © 2011 Society for Risk Analysis.

Maternal Concern for Child Undereating.

Science.gov (United States)

Brown, Callie L; Pesch, Megan H; Perrin, Eliana M; Appugliese, Danielle P; Miller, Alison L; Rosenblum, Katherine; Lumeng, Julie C

To describe features of maternal concern for her child undereating; examine maternal and child correlates of maternal concern for undereating; and determine whether maternal concern for undereating is associated with feeding practices. This was a cross-sectional analysis of an observational study with 286 mother-child dyads (mean child age, 71 months). Maternal concern for undereating was assessed using a semistructured interview. Mothers completed questionnaires to assess picky eating, food neophobia, and feeding practices. Feeding practices were further assessed using videotaped mealtime observations. Logistic regression was used to assess the association of maternal and child characteristics with maternal concern for undereating. Regression was used to assess the association of maternal concern for undereating with feeding practices, controlling for covariates. Over a third of mothers (36.5%) expressed concern that their child does not eat enough. Correlates of concern for undereating included child body mass index z-score (BMIz; odds ratio [OR] = 0.58; 95% confidence interval [CI], 0.43-0.77) and picky eating (OR = 2.41; 95% CI, 1.26-4.59). Maternal concern for undereating was associated with greater reported pressure to eat (relative risk [RR] = 1.97; 95% CI, 1.55-2.50), greater observed bribery (OR = 2.63; 95% CI, 1.50-4.60), and higher observed pressure (OR = 1.90; 95% CI, 1.08-3.36) during mealtimes. Mothers of children who are picky eaters and have a lower BMIz are more likely to be concerned that their children do not eat enough, and maternal concern for undereating is associated with pressuring and bribing children to eat. Pediatricians might address maternal concern for undereating by advising feeding practices that do not involve pressure and bribery, particularly among healthy weight children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

STRUCTURAL AND HIDDEN BARRIERS TO A LOCAL PRIMARY HEALTH CARE INFRASTRUCTURE: AUTONOMY, DECISIONS ABOUT PRIMARY HEALTH CARE, AND THE CENTRALITY AND SIGNIFICANCE OF POWER.

Science.gov (United States)

Freed, Christopher R; Hansberry, Shantisha T; Arrieta, Martha I

2013-09-01

To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States. Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach. Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers. Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power. This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

Sexual concerns among kidney transplant recipients.

Science.gov (United States)

Muehrer, Rebecca J; Lanuza, Dorothy M; Brown, Roger L; Djamali, Arjang

2014-11-01

Little is known about the specific sexual concerns of kidney transplant (KTx) recipients. The primary objectives of this study were to: (i) describe the importance of sexuality to KTx recipients; (ii) investigate the sexual concerns of KTx recipients; and (iii) examine the relationship between sexual concerns and quality of life (QOL). A secondary objective was to examine potential sexual concern differences by gender, pre-transplant dialysis status, and donor type. This study employed a cross-sectional, descriptive, correlational design. Sexual concerns were identified using the Sexual Concerns Questionnaire, which contains seven subscales. QOL was measured with the SF-8 and the QOL Uniscale. Nearly 73% of subjects rated sexuality as important. Subscales indicating highest area of sexual concerns were communication with healthcare providers about sexuality (Mean (M) = 2.70) and sexual pleasure concerns (M = 2.45). Higher concern ratings regarding health consequences of sexual activity, quality of sexual relationship, sexual pleasure, sexual functioning problems, and pessimistic beliefs about treatment were significantly, inversely related to QOL. Women had significantly higher scores on the Sexual Pleasure and Communication with Healthcare Providers subscales than men. This study reports the sexual concerns of KTx recipients' who are an average of four yr since surgery, and the relationship of these concerns to QOL. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Ethical issues in bipolar disorders pedigree research: privacy concerns, informed consent, and grounds for waiver.

Science.gov (United States)

Parker, Lisa S

2002-02-01

Focusing on bipolar disorders research, this article considers ethical issues of informed consent and privacy arising in genetic pedigree research at two stages: the construction of tentative pedigrees to determine family eligibility for study and, subsequently, the enrollment of subjects in and conduct of the family study. Increasing concern to protect the privacy of family members of primary subjects or probands, following ethical controversy over a survey study at Virginia Commonwealth University, has led some researchers and Institutional Review Boards (IRBs) to apply informed consent requirements to those represented on a tentative pedigree at the initial stage of research. This article analyzes the possible benefits, risks, and burdens to prospective subjects of seeking prospective consent for pedigree construction at this initial stage. It argues that the likely risk-benefit ratio favors granting a waiver of consent requirements for this stage of pedigree research and presents grounds for IRBs to grant such a waiver. The article closes by considering particular ethical concerns that should be addressed in the informed consent discussion when enrolling subjects in pedigree studies of bipolar disorder, including concerns about subjects' competence to consent, management of interim and incidental findings, and issues particular to psychiatric research.

How can clinician-educator training programs be optimized to match clinician motivations and concerns?

Directory of Open Access Journals (Sweden)

McCullough B

2015-01-01

Full Text Available Brendan McCullough, Gregory E Marton, Christopher J Ramnanan Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada Background: Several medical schools have implemented programs aimed at supporting clinician-educators with formal mentoring, training, and experience in undergraduate medical teaching. However, consensus program design has yet to be established, and the effectiveness of these programs in terms of producing quality clinician-educator teaching remains unclear. The goal of this study was to review the literature to identify motivations and perceived barriers to clinician-educators, which in turn will improve clinician-educator training programs to better align with clinician-educator needs and concerns. Methods: Review of medical education literature using the terms “attitudes”, “motivations”, “physicians”, “teaching”, and “undergraduate medical education” resulted in identification of key themes revealing the primary motivations and barriers involved in physicians teaching undergraduate medical students. Results: A synthesis of articles revealed that physicians are primarily motivated to teach undergraduate students for intrinsic reasons. To a lesser extent, physicians are motivated to teach for extrinsic reasons, such as rewards or recognition. The key barriers deterring physicians from teaching medical students included: decreased productivity, lack of compensation, increased length of the working day, patient concerns/ethical issues, and lack of confidence in their own ability. Conclusion: Our findings suggest that optimization of clinician-educator training programs should address, amongst other factors, time management concerns, appropriate academic recognition for teaching service, and confidence in teaching ability. Addressing these issues may increase the retention of clinicians who are active and proficient in medical education. Keywords: clinician-educators, teaching, undergraduate medical

Understanding community traits - understanding public concerns

International Nuclear Information System (INIS)

Wlodarczyk, T.

2003-01-01

No two communities are alike. Therefore, one should not expect that public concerns and socio-economic effects of a proposed undertaking would be the same everywhere. Public concerns and the potential for social and economic effects of nuclear waste management facilities in one community will be different from those in another because communities differ in their fundamental sociological and economic traits. Research and experience with various types of nuclear and hazardous waste management facilities, generating stations and other energy developments across Canada and the United States indicate that an analysis of only a few key community traits can yield a more thorough understanding of the ways in which a community might perceive and respond to a project, the kinds of concerns that might dominate the public agenda, and the types of socio-economic effects that will be of primary concern. (author)

A Simulation Model that Decreases Faculty Concerns about Adopting Web-Based Instruction

Science.gov (United States)

Song, Hae-Deok; Wang, Wei-Tsong; Liu, Chao-Yueh

2011-01-01

Faculty members have different concerns as they integrate new technology into their teaching practices. The integration of Web-Based Instruction in higher-education settings will not be successful if these faculty concerns are not addressed. Four main stages of faculty concern (information, personal, management, and impact) were identified based…

Acute and regressive scleroderma concomitant to an acute CMV primary infection.

Science.gov (United States)

Goulabchand, Radjiv; Khellaf, Lakhdar; Forestier, Amandine; Costes, Valerie; Foulongne, Vincent; le Quellec, Alain; Guilpain, Philippe

2014-12-01

To describe the pathophysiological mechanisms involving cytomegalovirus (CMV) primary infection and natural killer (NK) cell expansion in the development of localized scleroderma. A 43-year-old woman presented acute erythematous discoloration and skin thickening concerning face, neck, trunk, abdomen, and the four limbs, predominantly in proximal areas. Our case did not respond to systemic sclerosis criteria diagnosis. However, skin and muscle biopsy revealed early scleroderma associated with capillary thrombi, and tissue infiltration with NK cells (CD56+/Granzyme B). Scleroderma was attributed to CMV primary infection responsible for cytolytic hepatitis (7-fold over the limit) and circulating NK cell excess. After 6 months of prednisone and a 2-year follow-up, a complete resolution of symptoms was observed. Our observation suggests a potential triggering role of CMV primary infection in the development of scleroderma. Histological features from our observation addresses the role of CMV and NK cells in the development of endothelial damage and fibrotic process. Copyright © 2014 Elsevier B.V. All rights reserved.

Oral health knowledge and attitudes of primary school teachers toward school-based oral health programs in Abha-Khamis, Saudi Arabia

Directory of Open Access Journals (Sweden)

Shreyas Tikare

2017-01-01

Conclusions: The oral health knowledge among primary school teachers was found to be good with positive attitudes toward school-based oral health programs. The most significant barriers in implementing a school oral health program were administrative barriers. There is a need for concerned school authorities and health policy makers to address these barriers and to promote oral health in the community.

Effects of Recreation Participation and Tildenian Interpretation on Tourists' Environmental Concern

Science.gov (United States)

Satchabut, Thitikan

2013-01-01

Evidence from correlational studies suggests outdoor recreation may enhance participants' environmental concern, but findings are inconclusive. Also, previous research has not systematically addressed the influence of interpretation services on environmental concern, and little research has been conducted in developing Eastern countries. Thus,…

Regulatory approaches for addressing dissolved oxygen concerns at hydropower facilities

Energy Technology Data Exchange (ETDEWEB)

Peterson, Mark J. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Cada, Glenn F. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Sale, Michael J. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Eddlemon, Gerald K. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

2003-03-01

Low dissolved oxygen (DO) concentrations are a common water quality problem downstream of hydropower facilities. At some facilities, structural improvements (e.g. installation of weir dams or aerating turbines) or operational changes (e.g., spilling water over the dam) can be made to improve DO levels. In other cases, structural and operational approaches are too costly for the project to implement or are likely to be of limited effectiveness. Despite improvements in overall water quality below dams in recent years, many hydropower projects are unable to meet state water quality standards for DO. Regulatory agencies in the U.S. are considering or implementing dramatic changes in their approach to protecting the quality of the Nation’s waters. New policies and initiatives have emphasized flexibility, increased collaboration and shared responsibility among all parties, and market-based, economic incentives. The use of new regulatory approaches may now be a viable option for addressing the DO problem at some hydropower facilities. This report summarizes some of the regulatory-related options available to hydropower projects, including negotiation of site-specific water quality criteria, use of biological monitoring, watershed-based strategies for the management of water quality, and watershed-based trading. Key decision points center on the health of the local biological communities and whether there are contributing impacts (i.e., other sources of low DO effluents) in the watershed. If the biological communities downstream of the hydropower project are healthy, negotiation for site-specific water quality standards or biocriteria (discharge performance criteria based on characteristics of the aquatic biota) might be pursued. If there are other effluent dischargers in the watershed that contribute to low DO problems, watershed-scale strategies and effluent trading may be effective. This report examines the value of regulatory approaches by reviewing their use in

Parental concerns and control in feeding of 9 to 12-year-old children in a primary school in Kuala Lumpur, Malaysia.

Science.gov (United States)

Noor, Azimah M; Leelavathi, M; Shamsul, Azhar S; Hizlinda, T; Khairani, O; Fatimah, A

2012-04-01

Body weight of children is affected by many factors including food habits which are influenced by their parents. Studies in the West have shown that parents tend to control child feeding in response to their child's weight status. The aim of this study was to assess Malaysian parental concerns about child weight and the control they exert on child feeding. This cross-sectional study was conducted on parents and their children aged 9 to 12 years from a primary school in Kuala Lumpur. The weight status of the children was classified according to the body mass index-for-age growth chart. Parental concerns about child weight and control in child feeding was assessed using the adapted Malay version of Child Feeding Questionnaire. A total of 204 parents participated in this study. The study found that being a female served as a protective factor against becoming overweight (OR: 0.28, CI: 0.13-0.62). Parents with overweight children were significantly older (OR: 1.08, CI: 1.01-1.15), concerned about their child's weight (OR: 2.77, CI: 1.49-5.12) and controlled their child's feeding by restricting food intake (OR: 2.70, CI: 1.30-5.60). They were less likely to pressure their children to eat (OR: 0.32, CI: 0.19-0.56). Parents from the low income group were more likely to have underweight children (OR: 4.15, CI: 1.28-13.47). There was significant difference in level of parental concern across differing child weight status. Parents with overweight children were likely to be more concerned about their child's weight, tending to control their feeding. In contrast, parents with underweight children did not exert control on their feeding.

78 FR 45910 - Proposed Information Collection; Comment Request; Current Population Survey (CPS) Email Address...

Science.gov (United States)

2013-07-30

... Population Survey (CPS) Email Address Collection Test Supplement AGENCY: U.S. Census Bureau, Commerce. ACTION... request clearance for the collection of data concerning the November 2013 Email Address Collection Test... tool to help increase response rates. We foresee that in the future, we could collect email addresses...

Investigating Power System Primary and Secondary Reserve Interaction under High Wind Power Penetration

Energy Technology Data Exchange (ETDEWEB)

Zhang, Yingchen [National Renewable Energy Lab. (NREL), Golden, CO (United States); Tan, Jin [National Renewable Energy Lab. (NREL), Golden, CO (United States); Krad, Ibrahim [National Renewable Energy Lab. (NREL), Golden, CO (United States); Yang, Rui [National Renewable Energy Lab. (NREL), Golden, CO (United States); Gevorgian, Vahan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Ela, Erik [Electric Power Research Inst. (EPRI), Knoxville, TN (United States)

2016-12-01

Power system frequency needs to be maintained close to its nominal value at all times to successfully balance load and generation and maintain system reliability. Adequate primary frequency response and secondary frequency response are the primary forces to correct an energy imbalance at the second-to-minute level. As wind energy becomes a larger portion of the world's energy portfolio, there is an increased need for wind to provide frequency response. This paper addresses one of the major concerns about using wind for frequency regulation: the unknown factor of the interaction between primary and secondary reserves. The lack of a commercially available tool to model this has limited the energy industry's understanding of when the depletion of primary reserves will impact the performance of secondary response or vice versa. This paper investigates the issue by developing a multi-area frequency response integration tool with combined primary and secondary capabilities. The simulation is conducted in close coordination with economical energy scheduling scenarios to ensure credible simulation results.

Behavior Analytic Consultation for Academic Referral Concerns

Science.gov (United States)

Dufrene, Brad A.; Zoder-Martell, Kimberly A.; Dieringe, Shannon Titus; Labrot, Zachary

2016-01-01

Applied behavior analysis provides a technology of human behavior that demonstrates great potential for improving socially important outcomes for individuals. School-based consultation may provide a vehicle for delivering applied behavior analysis services in schools to address academic referral concerns. In this article, we propose that…

Emotions in primary care: are there cultural differences in the expression of cues and concerns?

NARCIS (Netherlands)

Schouten, B.C.; Schinkel, S.

2015-01-01

OBJECTIVE: This study compared native-Dutch and Turkish-Dutch patients' expressions of emotional cues/concerns and GPs' responses to these cues/concerns. Relations between patient's cues/concerns and GPs' perceptions of the patient's health complaint were examined too. METHODS: 82 audiotaped

Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.

Science.gov (United States)

Baer, Heather J; Wee, Christina C; DeVito, Katerina; Orav, E John; Frolkis, Joseph P; Williams, Deborah H; Wright, Adam; Bates, David W

2015-08-01

a follow-up appointment about their weight or were prescribed weight loss medication. We encountered challenges in our development of an intervention within the existing structure of an electronic health record. For example, although we decided to randomize clinics within primary care practices, this decision may have introduced contamination and led to some imbalance of patient characteristics between the intervention and control practices. Using the electronic health record as the primary data source reduced the cost of the study, but not all desired data were recorded for every participant. Despite the challenges, this study should provide valuable information about the effectiveness of electronic health record-based tools for addressing overweight and obesity in primary care. © The Author(s) 2015.

Acquisition: Allegations Concerning Mismanagement of the Aerial Targets Program

National Research Council Canada - National Science Library

Jolliffe, Richard B; Burton, Bruce A; Pearson, Dianna J; Hilliard, Thomas J; Miller, Timothy; McKay, Celeste; Silver, Kiana; Bobbio, Jaime A; Chang, Wei K

2006-01-01

.... The Hotline allegations were submitted in three letters by an anonymous complainant and addressed concerns about the lack of participation and support by the Air Force Aerial Targets Systems Program...

Border carbon adjustments: Addressing emissions embodied in trade

International Nuclear Information System (INIS)

Sakai, Marco; Barrett, John

2016-01-01

Approximately one fourth of global emissions are embodied in international trade and a significant portion flows from non-carbon-priced to carbon-priced economies. Border carbon adjustments (BCAs) figure prominently as instruments to address concerns arising from unilateral climate policy. Estimating the volume of emissions that could be potentially taxed under a BCA scheme has received little attention until now. This paper examines how a number of issues involved in the implementation of BCAs can affect their ability to cover emissions embodied in trade and thus address carbon leakage. These issues range from ensuring compliance with trade provisions and assumptions on the carbon intensity of imports, to determining which countries are included and whether intermediate and final demand are considered. Here we show that the volume of CO_2 captured by a scheme that involved all Annex B countries could be significantly reduced due to these issues, particularly by trade provisions, such as the principle of ‘best available technology’ (BAT). As a consequence, the tariff burdens faced by non-Annex B parties could dwindle considerably. These findings have important policy implications, as they question the effectiveness and practicalities of BCAs to reduce carbon leakage and alleviate competitiveness concerns, adding further arguments against their implementation. - Highlights: •We estimate the volume of emissions that could be potentially taxed by BCAs. •We study the effects of trade provisions and country and sectoral coverage on BCAs. •Trade provisions can significantly reduce the scope and effectiveness of BCAs. •Best available technology and exclusion of electricity reduce tariffs considerably. •BCAs are not optimal policy tools to address carbon leakage concerns.

Quality Education for the Pastoralist in Public Primary Schools in Kajiado County, Kenya: Case Study of Dupoto-E-Maa Education Project in Kajiado Central District

Science.gov (United States)

Ouda, James Bill; Opiyo, Rose Atieno; Wambiya, Pascal

2015-01-01

Conditions of learning are critical in determining quality of education. There have been real concerns raised by stakeholders regarding the quality of education for pastoralists in public primary schools in Kajiado Central District in Kenya. Interventions have been put in place to address the issue of quality education. One such intervention is…

Stereotype confirmation concerns predict dropout from cognitive behavioral therapy for social anxiety disorder.

Science.gov (United States)

Johnson, Suzanne; Price, Matthew; Mehta, Natasha; Anderson, Page L

2014-08-19

There are high attrition rates observed in efficacy studies for social anxiety disorder, and research has not identified consistent nor theoretically meaningful predictors of dropout. Pre-treatment symptom severity and demographic factors, such as age and gender, are sometimes predictive of dropout. The current study examines a theoretically meaningful predictor of attrition based on experiences associated with social group membership rather than differences between social group categories--fear of confirming stereotypes. This is a secondary data analysis of a randomized controlled trial comparing two cognitive behavioral treatments for social anxiety disorder: virtual reality exposure therapy and exposure group therapy. Participants (N = 74) with a primary diagnosis of social anxiety disorder who were eligible to participate in the parent study and who self-identified as either "African American" (n = 31) or "Caucasian" (n = 43) completed standardized self-report measures of stereotype confirmation concerns (SCC) and social anxiety symptoms as part of a pre-treatment assessment battery. Hierarchical logistic regression showed that greater stereotype confirmation concerns were associated with higher dropout from therapy--race, age, gender, and pre-treatment symptom severity were not. Group treatment also was associated with higher dropout. These findings urge further research on theoretically meaningful predictors of attrition and highlight the importance of addressing cultural variables, such as the experience of stereotype confirmation concerns, during treatment of social anxiety to minimize dropout from therapy.

Going Concern Disclosure for Local Governments

Directory of Open Access Journals (Sweden)

Nancy Chun Feng

2017-07-01

Full Text Available Going concern opinions (GCOs indicate that auditors have significant doubt about an entity’s ability to continue operation one year after the financial statement date. This study addresses the following research questions: What are the factors that motivate auditors to issue GCOs to governmental entities? Does a governmental entity disclose going concern uncertainty in the footnotes or the MD&A section of annual financial reports (AFRs either the year before or the year when the entity receives a GCO? To what extent does the entity disclose the GCO factors used by auditors? We find that auditors most often cited two reasons, “Deficiency in Funds” and “Losses or Revenue Declines,” accounting for the majority of reasons given for a going concern opinion. Further, the disclosure is most likely to be in the notes to the AFRs. In addition, we find that going concern reporting varies by auditor type (state auditors vs. public accounting firms, government size, and government type. We also find some evidence that going concern disclosures improve after the enactment of GASB No. 56. The results of our study should be of interest to stakeholders’ interested in lead indicators of fiscal distress.

Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns.

Science.gov (United States)

Moradi-Lakeh, Maziar; Vosoogh-Moghaddam, Abbas

2015-08-31

In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of

Options to address concerns regarding EU ETS induced increases in power prices and generators' profits. The case of carbon cost pass-through in Germany and the Netherlands

International Nuclear Information System (INIS)

Sijm, J.P.M.; Hers, J.S.; Wetzelaer, B.J.H.W.

2008-02-01

Power prices in EU countries have increased significantly since the European Emissions Trading Scheme (EU ETS) became effective on 1 January 2005. This suggests that these increases in power prices are due to this scheme, in particular the pass-through of the costs of EU allowances (EUAs) to cover the CO2 emissions of eligible installations. In all sectors, however - including the power sector - eligible installations have usually received almost all of their needed allowances for free during the first phase of the EU ETS (2005-07). In several EU countries, the coincidence of the increases in power prices and the implementation of the EU ETS has raised questions, and sometimes fierce political debate, on whether power producers have indeed passed through the costs of freely allocated CO2 allowances to electricity prices, and to what extent the increase in these prices can be attributed to this pass-through or to other factors. In addition, it has raised discussions on whether - and to what extent - the supposed passing through of these costs has led to additional profits for power producers, that is, the so-called 'windfall profits' induced by the EU ETS. Finally, the supposed ETSinduced increases in power prices and generators' profits has raised concerns affecting the legitimacy of the present EU ETS, including concerns regarding its impact on the international competitiveness of some powerintensive industries, the purchasing power of electricity end-users such as small households or, more generally, the distribution of social welfare among power producers and consumers. As a result, in several countries policy makers and stakeholders have suggested a variety of options to address these concerns, including changing the emissions trading allocation system, taxing windfall profits or controlling market prices of EU carbon allowances, electricity or both. Against this background, the objectives of this chapter include: (a) To analyse empirically the trends in power

Interventions to address sexual problems in people with cancer.

Science.gov (United States)

Barbera, L; Zwaal, C; Elterman, D; McPherson, K; Wolfman, W; Katz, A; Matthew, A

2017-06-01

Sexual dysfunction in people with cancer is a significant problem. The present clinical practice guideline makes recommendations to improve sexual function in people with cancer. This guideline was undertaken by the Interventions to Address Sexual Problems in People with Cancer Expert Panel, a group organized by the Program in Evidence-Based Care (pebc). Consistent with the pebc standardized approach, a systematic search was conducted for existing guidelines, and the literature in medline and embase for the years 2003-2015 was systematically searched for both systematic reviews and primary literature. Evidence found for men and for women was evaluated separately, and no restrictions were placed on cancer type or study design. Content and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. The search identified 4 existing guidelines, 13 systematic reviews, and 103 studies with relevance to the topic. The present guideline provides one overarching recommendation concerning the discussion of sexual health and dysfunction, which is aimed at all people with cancer. Eleven additional recommendations made separately for men and women deal with issues such as sexual response, body image, intimacy and relationships, overall sexual functioning and satisfaction, and vasomotor and genital symptoms. To our knowledge this clinical practice guideline is the first to comprehensively evaluate interventions for the improvement of sexual problems in people with cancer. The guideline will be a valuable resource to support practitioners and clinics in addressing sexuality in cancer survivors.

Infections are a global issue: infection addresses global issues.

Science.gov (United States)

Grobusch, M P; Calleri, G; Bogner, J R

2012-12-01

Infections are of unifying global concern, despite regional differences in disease epidemiology, clinical appearance and the instruments to tackle them. The primary aim of Infection is "to be a forum for the presentation and discussion of clinically relevant information on infectious diseases… from all over the world". To that end, and as a reflection of the global burden of infectious diseases, we intend to increase the number of high-quality contributions from authors addressing the aetiology, pathogenesis, diagnosis and treatment of infectious diseases from outside Europe and the affluent North (Chang et al. Infection 40:359-365, 2012; Misra et al. Infection 40:125-130, 2012). The Editorial Board of Infection envisages the journal as an interface between where infectious diseases meet and mix between "North and South"--i.e., the field of travel medicine--frequently functioning as a sentinel for altered/novel disease activities that are encountered as imported conditions. With the change in generation on the Editorial Board, Infection aims to expand the areas of tropical medicine, travel medicine and global health with its own section editors (GC and MPG). Contributions from outside Europe are actively encouraged.

Inquiry of Pre-Service Teachers' Concern about Integrating Web 2.0 into Instruction

Science.gov (United States)

Hao, Yungwei; Lee, Kathryn S.

2017-01-01

To promote technology integration, it is essential to address pre-service teacher (PST) concerns about facilitating technology-enhanced learning environments. This study adopted the Concerns-Based Adoption Model to investigate PST concern on Web 2.0 integration. Four hundred and eighty-nine PSTs in a teacher education university in north Taiwan…

The Growing Concerns Regarding School Resource Officers

Science.gov (United States)

Ryan, Joseph B.; Katsiyannis, Antonis; Counts, Jennifer M.; Shelnut, Jill C.

2018-01-01

There have been an increasing number of incidents in which school resource officers (SRO) have been used to manage student disciplinary issues with disastrous results. Court cases brought by parents and advocacy groups claim SROs have traumatized and injured students. This article addresses several critical issues concerning SROs being used to…

Addressing the evidence to practice gap for complex interventions in primary care: a systematic review of reviews protocol.

Science.gov (United States)

Lau, Rosa; Stevenson, Fiona; Ong, Bie Nio; Dziedzic, Krysia; Eldridge, Sandra; Everitt, Hazel; Kennedy, Anne; Kontopantelis, Evangelos; Little, Paul; Qureshi, Nadeem; Rogers, Anne; Treweek, Shaun; Peacock, Richard; Murray, Elizabeth

2014-06-23

Getting the results of research implemented into routine healthcare is often a challenge. The disconnect between the development and implementation of evidence into practice is called the 'second translational gap' and is particularly apparent in primary care. To address this gap, we plan to identify, summarise and synthesise currently available evidence by undertaking a systematic review of reviews to: (1) explore barriers and facilitators of implementation of research evidence or complex interventions, and (2) assess the effectiveness of strategies in facilitating implementation of complex interventions in primary care. This is a protocol for a systematic review of reviews. We will search MEDLINE, EMBASE, the Cochrane Library, CINAHL and PsycINFO up until December 2013. We will check reference lists of included studies for further studies. Two authors will independently screen the titles and abstracts identified from the search; any discrepancies will be resolved by discussion and consensus. Full-text papers will be obtained and relevant reviews will be selected against inclusion criteria. Eligible reviews have to be based on predominantly primary care in developed countries and examine either factors to implementation or, the effectiveness of strategies to optimise implementation. Data from eligible reviews will be extracted using standardised data abstraction forms. For barriers and facilitators, data will be synthesised using an interpretative meta-synthesis approach. For implementation strategies, findings will be summarised and described narratively and synthesised using a framework approach. All findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ethical approval is not required. The review findings will inform the work of the design and implementation of future studies and will be of interest to a wide audience including health professionals, researchers, health service or

A Conceptual Framework to Address Stress-Associated ...

Science.gov (United States)

Chronic stress leads to a variety of mental and physiological disorders, and stress effects are the primary concern after traumatic injury and exposure to infectious diseases or toxic agents from disaster events. We developed a conceptual model to address the question of whether degradation of ecosystem services (ES) by disasters such as recent hurricanes and the Deepwater Horizon oil catastrophe produce acute and chronic stress that ultimately result in short- and long-term negative health outcomes in people. An interdisciplinary team with expertise in data mining, ecology, ecosystem services, ecotoxicology, landscape ecology, mental health, psychiatry, and stress physiology utilized the Driver-Pressure-State-Ecosystem Service model of Kelble et al. (2013), the mental health framework of Palinkas (2012) and McEwen’s (1993) allostatic load model of chronic stress as starting points. Initial modeling results were augmented via expert workshops and peer review. Our conceptual model connects effects of disasters to changes in specific ecosystem components (e.g., water quality, biodiversity, fishery populations) with resulting degradation of multiple ES such as commercial and recreational fishing, tourism, and sense of place. The model shows how the degraded ES produce acute and chronic stress in people and how such stress may lead to a variety of negative mental, physical and behavioral health outcomes. Using this framework, one can trace potential for str

INEL studies concerning solidification of low-level waste in cement

International Nuclear Information System (INIS)

Mandler, J.W.

1989-01-01

The Idaho National Engineering Laboratory (INEL) has performed numerous studies addressing issues concerning the solidification of low-level radioactive waste in cement. These studies have been performed for both the Nuclear Regulatory Commission (NRC) and the Department of Energy (DOE). This short presentation will only outline the major topics addressed in some of these studies, present a few conclusions, and identify some of the technical concerns we have. More details of the work and pertinent results will be given in the Working Group sessions. The topics that have been addressed at the INEL which are relevant to this Workshop include (1) solidification of ion-exchange resins and evaporator waste in cement at commercial nuclear power plants, (2) leachability and compressive strength of power plant waste solidified in cement, (3) suggested guidelines for preparation of a solid waste process control program (PCP), (4) cement solidification of EPICOR-II resin wastes, and (5) performance testing of cement-solidified EPICOR-II resin wastes

Glaucoma Patient-Reported Concerns and Associated Factors.

Science.gov (United States)

Mogil, Rachel S; Tirsi, Andrew; Lee, Jung Min; Tello, Celso; Park, Sung Chul

2017-06-01

To assess the character and degree of concerns of glaucoma patients and identify demographic/clinical factors affecting the concerns. Prospective cross-sectional study. A questionnaire that addressed patients' concerns was administered to consecutive glaucoma patients. Severity of concern was scored with a scale of 0-5 in order of increasing severity. Age, sex, intraocular pressure, visual field (VF) mean deviation (MD), number of antiglaucoma medications, history of glaucoma surgery, and employment status were recorded. Questionnaire results of 152 patients (mean VF MD, -8.03 ± 7.86 dB [better eye] and -16.06 ± 10.22 dB [worse eye]; mean age, 69 ± 14 years) were analyzed. Severity of concern was greatest for general eyesight (2.92/5.00) and visual symptoms (2.78/5.00), followed by activities (2.20/5.00) and socioeconomic factors (2.13/5.00), and then ocular symptoms (1.69/5.00) (P factors correlated with VF MD of the better eye (r = -0.245; P = .003) and age (r = -0.260; P = .001). Glaucoma patients reported varied degrees of concern regarding items associated with quality of life. Certain items may be more concerning than others. Severity of some concerns increased with more severe VF loss, prior glaucoma surgery, or younger age. Copyright © 2017 Elsevier Inc. All rights reserved.

Attitudes of Arab and Jewish patients toward integration of complementary medicine in primary care clinics in Israel: a cross-cultural study.

Science.gov (United States)

Ben-Arye, Eran; Karkabi, Khaled; Karkabi, Sonia; Keshet, Yael; Haddad, Maria; Frenkel, Moshe

2009-01-01

The purpose of this cross-cultural study was to evaluate patient perspectives on complementary and alternative medicine (CAM) integration within primary care clinics. It is one of the first multiethnic studies to explore patients' perspectives on the best model for integrating CAM into the conventional care setting. We developed a 13-item questionnaire that addresses issues of CAM use, expectations from the primary care physicians concerning CAM, and attitudes toward CAM integration within a patient's primary care clinic. We constructed the questionnaire with cross-cultural sensitivity concerning the core concepts of CAM and traditional medicine in both the Arab and Jewish communities in northern Israel. Data for statistical analysis were obtained from 3840 patients attending seven primary care clinics. Of the 3713 respondents who were willing to identify their religion, 2184 defined themselves as Muslims, Christians, or Druze and 1529 as Jews. Respondents in the two groups were equally distributed by sex but differed significantly by age, education, self-rated religiosity, and self-reported chronic diseases in their medical background. Respondents in the two groups reported comparable overall CAM use during the previous year, but the Arab respondents reported more use of herbs and traditional medicine. Respondents in both groups stated that their primary expectation from a family physician concerning CAM was to refer them appropriately and safely to a CAM practitioner. Respondents in both groups greatly supported a theoretical scenario of CAM integration into primary medical care. However, Arab respondents were more supportive of the option that non-physician CAM practitioners would provide CAM rather than physicians.

Transition from specialist to primary diabetes care: A qualitative study of perspectives of primary care physicians

Directory of Open Access Journals (Sweden)

Liddy Clare

2009-06-01

Full Text Available Abstract Background The growing prevalence of diabetes and heightened awareness of the benefits of early and intensive disease management have increased service demands and expectations not only of primary care physicians but also of diabetes specialists. While research has addressed issues related to referral into specialist care, much less has been published about the transition from diabetes specialists back to primary care. Understanding the concerns of family physicians related to discharge of diabetes care from specialist centers can support the development of strategies that facilitate this transition and result in broader access to limited specialist services. This study was undertaken to explore primary care physician (PCP perspectives and concerns related to reassuming responsibility for diabetes care after referral to a specialized diabetes center. Methods Qualitative data were collected through three focus groups. Sessions were audio-taped and transcribed verbatim. Data were coded and sorted with themes identified using a constant comparison method. The study was undertaken through the regional academic referral center for adult diabetes care in Ottawa, Canada. Participants included 22 primary care physicians representing a variety of referral frequencies, practice types and settings. Results Participants described facilitators and barriers to successful transition of diabetes care at the provider, patient and systems level. Major facilitators included clear communication of a detailed, structured plan of care, ongoing access to specialist services for advice or re-referral, continuing education and mentoring for PCPs. Identified provider barriers were gaps in PCP knowledge and confidence related to diabetes treatment, excessive workload and competing time demands. Systems deterrents included reimbursement policies for health professionals and inadequate funding for diabetes medications and supplies. At the PCP-patient interface

Toward a More Responsive Consumable Materiel Supply Chain: Leveraging New Metrics to Identify and Classify Items of Concern

Science.gov (United States)

2016-06-01

MATERIEL SUPPLY CHAIN: LEVERAGING NEW METRICS TO IDENTIFY AND CLASSIFY ITEMS OF CONCERN by Andrew R. Haley June 2016 Thesis Advisor: Robert...IDENTIFY AND CLASSIFY ITEMS OF CONCERN 5. FUNDING NUMBERS 6. AUTHOR(S) Andrew R. Haley 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Naval...Supply Systems Command (NAVSUP), logistics, inventory, consumable, NSNs at Risk, Bad Actors, Bad Actors with Trend, items of concern , customer time

Beyond sustainability criteria and principles in palm oil production: addressing consumer concerns through insetting

Directory of Open Access Journals (Sweden)

Faisal M. Mohd Noor

2017-06-01

Full Text Available Palm oil is one of the most controversial agricultural commodities of our time. To its supporters, it is the golden crop that catalyzes smallholders out of poverty and brings salvation to the global food and energy crisis. For its critics, it is the single biggest threat driving the wholesale destruction of peatlands and rainforests as well as adding to greenhouse gas emissions. Hailed as a turning point in 2004, the Roundtable on Sustainable Palm Oil (RSPO has been widely criticized as being unable to change the industry fast enough. We argue that certification, although certainly important, will not be able to deliver expected environmental and social benefits because of (1 an uneven distribution of incentives along the value chain, (2 traceability issues, (3 difficulties associated with an expanding market, and (4 alternative low standard markets to the standard large Organisation for Economic Co-operation and Development (OECD markets. We argue that the sustainability debate has actually failed to address the fact that oil palm landscape as a whole would be more sustainable if smallholders for whom palm oil is not an economic viable avenue would engage in other forms of land use. An important starting point for change is to move beyond narrow business interests of satisfying customers and shareholders interests only and tackle the implicit contract between palm oil marketers and importers and the smallholder agricultural communities in palm oil producing areas. We introduce the concept of livelihood "insetting" that goes beyond the pure sustainability aspect by also addressing the issue of mutuality along the global value chain.

Medical and pharmacy student concerns about participating on international service-learning trips.

Science.gov (United States)

Chuang, Chih; Khatri, Siddique H; Gill, Manpal S; Trehan, Naveen; Masineni, Silpa; Chikkam, Vineela; Farah, Guillaume G; Khan, Amber; Levine, Diane L

2015-12-23

International Service Learning Trips (ISLT) provide health professional students the opportunity to provide healthcare, under the direction of trained faculty, to underserved populations in developing countries. Despite recent increases in international service learning trips, there is scant literature addressing concerns students have prior to attending such trips. This study focuses on identifying concerns before and after attending an ISLT and their impact on students. A survey comprised of closed and open-ended questions was developed to elucidate student concerns prior to attending an ISLT and experiences which might influence concerns. A five-point Likert-scale (extremely concerned = 1, minimally concerned = 5) was used to rate apprehension and satisfaction. Paired t-test was used to compare pre- and post-trip concerns; Chi-Square test was used to compare groups. Thirty-five students (27 medical, 8 pharmacy) attended ISLTs in December 2013. All completed pre and post-trip surveys. Significant decreases were seen in concerns related to cultural barriers (4.14 vs 4.46, P = .047), disease/epidemics (3.34 vs 4.60, P travel (3.86 vs 4.51, P food (3.83 vs 4.60, P students described benefits of attending an ISLT. Students had multiple concerns prior to attending an ISLT. Most decreased upon return. Addressing concerns has the potential to decrease student apprehension. The results of this study highlight the benefits of providing ISLTs and supporting development of a curriculum incorporating trip-related concerns.

Nuclear techniques to address HAB concerns

International Nuclear Information System (INIS)

Vu Nhu Ngoc; Phan Son Hai; Chu Van Thuoc; Nguyen Thi Thu; Nguyen Minh Huyen

2003-01-01

The paper presents results of determination of Co, Fe, Mn, Zn, Mg and K in sediment samples taken from some bays of Vietnam, and of sediment dating using radioisotope 210 Pb. It also reveals preliminary results of study on dinoflagellate cyst in Halong Bay. (NHA)

New safety valve addresses environmental concerns

International Nuclear Information System (INIS)

Taylor, J.; Austin, R.

1992-01-01

This paper reports that Conoco Pipeline is using a unique relief valve to reduce costs while improving environmental protection at its facilities. Conoco Pipeline Co. Inc. began testing new relief valves in 1987 to present over-pressuring its pipelines while enhancing the safety, environmental integrity and profitability of its pipelines. Conoco worked jointly with Rupture Pin Technology Inc., Oklahoma City, to seek a solution to a series of safety, environmental, and operational risks in the transportation of crude oil and refined products through pipelines. Several of the identified problems were traced to a single equipment source: the reliability of rupture discs used at pipeline stations to relieve pressure by diverting flow to tanks during over-pressure conditions. Conoco's corporate safety and environmental policies requires solving problems that deal with exposure to hydrocarbon vapors, chemical spills or the atmospheric release of fugitive emissions, such as during rupture disc maintenance. The company had used rupture pin valves as vent relief devices in conjunction with development by Rick Austin of inert gas methods to protect the inner casing wall and outer carrier pipeline wall in pipeline road crossings. The design relies on rupture pin valves set at 5 psi to isolate vent openings from the atmosphere prior to purging the annular space between the pipeline and casing with inert gas to prevent corrosion. Speciality Pipeline Inspection and Engineering Inc., Houston, is licensed to distribute the equipment for the new cased-crossing procedure

Infections are a global issue: Infection addresses global issues

NARCIS (Netherlands)

Grobusch, M. P.; Calleri, G.; Bogner, J. R.

2012-01-01

Infections are of unifying global concern, despite regional differences in disease epidemiology, clinical appearance and the instruments to tackle them. The primary aim of Infection is "to be a forum for the presentation and discussion of clinically relevant information on infectious diseasesaEuro

Usability requirements for buildings: a case study on primary schools.

Science.gov (United States)

Duca, Gabriella

2012-01-01

This paper concerns an applied research aimed at applying the concept of usability, as derived form the standard ISO 9241/11, in the filed of building design, namely primary schools. Starting from the concept that space characteristics play a very relevant role in learning performances, the study presented here developed an original methodology for the assessment of effectiveness, efficiency and satisfaction of buildings hosting primary schools, in order to create a school environment better supporting users in their tasks. Research core is the framework of usability requirements and their related markers, indicators and technical specification that has been formulated in order to check compliance of urban area, building, rooms and architectural details with users needs. Therefore, a detailed task analysis of pupils and teacher tasks has been carried out and two questionnaires addressed to a significant users panel have been formulated for satisfaction survey. Lastly, a matrix for an overall reading of gathered data has been set-up and criteria for usability assessment based on that data has been defined. The whole study has been developed within the case study of a primary school in the Naples city centre, whose contents and results are discussed.

EPRI PWR primary water chemistry guidelines revision

International Nuclear Information System (INIS)

McElrath, Joel; Fruzzetti, Keith

2014-01-01

EPRI periodically updates the PWR Primary Water Chemistry Guidelines as new information becomes available and as required by NEI 97-06 (Steam Generator Program Guidelines) and NEI 03-08 (Guideline for the Management of Materials Issues). The last revision of the PWR water chemistry guidelines identified an optimum primary water chemistry program based on then-current understanding of research and field information. This new revision provides further details with regard to primary water stress corrosion cracking (PWSCC), fuel integrity, and shutdown dose rates. A committee of industry experts, including utility specialists, nuclear steam supply system (NSSS) and fuel vendor representatives, Institute of Nuclear Power Operations (INPO) representatives, consultants, and EPRI staff collaborated in reviewing the available data on primary water chemistry, reactor water coolant system materials issues, fuel integrity and performance issues, and radiation dose rate issues. From the data, the committee updated the water chemistry guidelines that all PWR nuclear plants should adopt. The committee revised guidance with regard to optimization to reflect industry experience gained since the publication of Revision 6. Among the changes, the technical information regarding the impact of zinc injection on PWSCC initiation and dose rate reduction has been updated to reflect the current level of knowledge within the industry. Similarly, industry experience with elevated lithium concentrations with regard to fuel performance and radiation dose rates has been updated to reflect data collected to date. Recognizing that each nuclear plant owner has a unique set of design, operating, and corporate concerns, the guidelines committee has retained a method for plant-specific optimization. Revision 7 of the Pressurized Water Reactor Primary Water Chemistry Guidelines provides guidance for PWR primary systems of all manufacture and design. The guidelines continue to emphasize plant

Do primary health care nurses address cardiovascular risk in diabetes patients?

Science.gov (United States)

Daly, Barbara; Kenealy, Timothy; Arroll, Bruce; Sheridan, Nicolette; Scragg, Robert

2014-11-01

To identify factors associated with assessment and nursing management of blood pressure, smoking and other major cardiovascular risk factors by primary health care nurses in Auckland, New Zealand. Primary health care nurses (n = 287) were randomly sampled from the total (n=1091) identified throughout the Auckland region and completed a self-administered questionnaire (n = 284) and telephone interview. Nurses provided details for 86% (n =265) of all diabetes patients they consulted on a randomly selected day. The response rate for nurses was 86%. Of the patients sampled, 183 (69%) patients had their blood pressure measured, particularly if consulted by specialist (83%) and practice (77%) nurses compared with district (23%, p = 0.0003). After controlling for demographic variables, multivariate analyses showed patients consulted by nurses who had identified stroke as a major diabetes-related complication were more likely to have their blood pressure measured, and those consulted by district nurses less likely. Sixteen percent of patients were current smokers. Patients consulted by district nurses were more likely to smoke while, those >66 years less likely. Of those who wished to stop, only 50% were offered nicotine replacement therapy. Patients were significantly more likely to be advised on diet and physical activity if they had their blood pressure measured (p workforce is essential to ensure cardiovascular risk management becomes integrated into diabetes management. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Driving and dementia: Efficient approach to driving safety concerns in family practice.

Science.gov (United States)

Lee, Linda; Molnar, Frank

2017-01-01

To provide primary care physicians with an approach to driving safety concerns when older persons present with memory difficulties. The approach is based on an accredited memory clinic training program developed by the Centre for Family Medicine Primary Care Collaborative Memory Clinic. One of the most challenging aspects of dementia care is the assessment of driving safety. Drivers with dementia are at higher risk of motor vehicle collisions, yet many drivers with mild dementia might be safely able to continue driving for several years. Because safe driving is dependent on multiple cognitive and functional skills, clinicians should carefully consider many factors when determining if cognitive concerns affect driving safety. Specific findings on corroborated history and office-based cognitive testing might aid in the physician's decisions to refer for comprehensive on-road driving evaluation and whether to notify transportation authorities in accordance with provincial reporting requirements. Sensitive communication and a person-centred approach are essential. Primary care physicians must consider many factors when determining if cognitive concerns might affect driving safety in older drivers. Copyright© the College of Family Physicians of Canada.

Globalization and new policy concerns

DEFF Research Database (Denmark)

Daugbjerg, Carsten; Swinbank, Alan

2015-01-01

The transfer of some decision-making authority from the domestic to the supranational arena as a result of the establishment of the World Trade Organization (WTO) in 1995 potentially changed domestic policy dynamics. The WTO agreements reflect the trade policy concerns addressed in the Uruguay...... Round in the late 1980s and early 1990s. This article applies and adapts historical institutionalism to explain how international organizations may constrain and facilitate certain domestic policy options. It demonstrates that, while the WTO legal framework has become more receptive of environmental...

Going Concern Opinions and Management's Forward Looking Disclosures: Evidence from the MD&A

NARCIS (Netherlands)

Enev, M.; Geiger, Marshall; Gold, A.H.; Wallage, P.

In this study we examine the relationship between the auditor’s going concern opinion and management’s forward-looking disclosures in the Management’s Discussion and Analysis (MD&A) section of 10-K filings. The research objective is two-fold and addresses whether the presence of a going concern

Physical Protection of Spent Fuel Shipments: Resolution of Stakeholder Concerns Through Rulemaking - 12284

Energy Technology Data Exchange (ETDEWEB)

Ballard, James D. [Department of Sociology, California State University, Northridge, Northridge, CA 91330 (United States); Halstead, Robert J. [State of Nevada Agency for Nuclear Projects Carson City, NV 89706 (United States); Dilger, Fred [Black Mountain Research, Henderson, NV 81012 (United States)

2012-07-01

In 1999, the State of Nevada brought its concerns about physical protection of current spent nuclear fuel (SNF) shipments, and future SNF shipments to a federal repository, before the NRC in a 1999 petition for rulemaking (PRM-73-10). In October 2010, the NRC published a rulemaking decision which would significantly strengthen physical protection of SNF in transit. The newest articulation of the rule (10 CFR 73.37) incorporates regulatory clarifications and security enhancements requested in Nevada's 1999 petition for rulemaking, codifies the findings of the Nuclear NRC and DOE consequence analyses into policy guidance documents and brings forward into regulations the agency and licensee experience gained since the terrorist attacks of September 11, 2001. Although at present DOE SNF shipments would continue to be exempt from these NRC regulations, Nevada considers the rule to constitute a largely satisfactory resolution to stakeholder concerns raised in the original petition and in subsequent comments submitted to the NRC. This paper reviews the process of regulatory changes, assesses the specific improvements contained in the new rules and briefly describes the significance of the new rule in the context of a future national nuclear waste management program. Nevada's petition for rulemaking led to a generally satisfactory resolution of the State's concerns. The decade plus timeframe from petition to rulemaking conclusion saw a sea change in many aspects of the relevant issues - perhaps most importantly the attacks on 9/11 led to the recognition by regulatory bodies that a new threat environment exists wherein shipments of SNF and HLW pose a viable target for human initiated events. The State of Nevada has always considered security a critical concern for the transport of these highly radioactive materials. This was one of the primary reasons for the original rulemaking petition and subsequent advocacy by Nevada on related issues. NRC decisions on

76 FR 42055 - Data Availability Concerning Transport Rule Allowance Allocations to Existing Units

Science.gov (United States)

2011-07-18

... concerning this action should be addressed to Brian Fisher, telephone (202) 343-9633, and e- mail [email protected] , Michael Cohen, telephone (202) 343-9497 and e-mail [email protected] , or Robert Miller, telephone (202) 343.9077, and e-mail [email protected] . The mailing address for the...

An Overview of the EPRI PWR Primary Chemistry Program

International Nuclear Information System (INIS)

Perkins, David; Fruzzetti, Keith; Haas, Carey; Wells, Dan

2012-09-01

Primary chemistry controls continue to evolve, impacting long term equipment reliability goals, optimized core designs, and radiation dose management practices. Chemistry initiatives include increased primary system pH (T) , zinc injection, and optimization of primary system hydrogen concentration. Nevertheless, utilities are faced with ever changing challenges as fuel vendors continue to optimize core power densities coupled with longer operating cycles and material replacement efforts. These challenges must be collaboratively addressed by the plant chemists, engineers, and operators. Operational chemistry has changed dramatically over the years with increased primary pH (T) programs requiring some utilities to operate with up to 6 ppm lithium or slightly higher. Coupled with primary pH (T) program optimization, are ongoing EPRI research efforts attempting to develop an optimized hydrogen control program balancing material issues associated with primary water stress corrosion cracking (PWSCC) crack growth rate against fuel concerns associated with increased hydrogen concentrations. One of the most significant primary chemistry changes that effectively balances the demands of materials, fuels, chemistry and dose management strategies is zinc injection into the primary coolant. Since 1994 when Farley initiated zinc injection, zinc injection has been successfully injected at over 70 pressurized water reactors world-wide. Combining operational chemistry with shutdown chemistry controls provides the plant chemist with a technically based and balanced approach to fuel and material integrity as well as dose management strategies. Shutdown chemistry has continually evolved since the 1970's when the chemist was primarily concerned with fission products. Now the chemist must manage corrosion product release, and support Outage Management and Radiation Protection through the performance of a controlled shutdown. In part, this change was driven as plant materials evolved

role of altruistic behavior, empathetic concern, and social responsibility motivation in blood donation behavior.

Science.gov (United States)

Steele, Whitney Randolph; Schreiber, George B; Guiltinan, Anne; Nass, Catharie; Glynn, Simone A; Wright, David J; Kessler, Debra; Schlumpf, Karen S; Tu, Yongling; Smith, James W; Garratty, George

2008-01-01

Blood donation can be described as a prosocial behavior, and donors often cite prosocial reasons such as altruism, empathy, or social responsibility for their willingness to donate. Previous studies have not quantitatively evaluated these characteristics in donors or examined how they relate to donation frequency. As part of a donor motivation study, 12,064 current and lapsed donors answered questions used to create an altruistic behavior, empathetic concern, and social responsibility motivation score for each donor. Analysis of variance was used to compare mean scores by demographics and donor status and to determine the influence of each variable on the mean number of donations in the past 5 years. The mean score for each prosocial characteristic appeared high, with lower scores in male and younger donors. Higher altruistic behavior and social responsibility motivation scores were associated with increased past donation frequency, but the effects were minor. Empathetic concern was not associated with prior donation. The largest differences in prior donations were by age and donor status, with older and current donors having given more frequently. Most blood donors appear to have high levels of the primary prosocial characteristics (altruism, empathy, and social responsibility) commonly thought to be the main motivators for donation, but these factors do not appear to be the ones most strongly related to donation frequency. Traditional donor appeals based on these characteristics may need to be supplemented by approaches that address practical concerns like convenience, community safety, or personal benefit.

Online access to doctors' notes: patient concerns about privacy.

Science.gov (United States)

Vodicka, Elisabeth; Mejilla, Roanne; Leveille, Suzanne G; Ralston, James D; Darer, Jonathan D; Delbanco, Tom; Walker, Jan; Elmore, Joann G

2013-09-26

Offering patients online access to medical records, including doctors' visit notes, holds considerable potential to improve care. However, patients may worry about loss of privacy when accessing personal health information through Internet-based patient portals. The OpenNotes study provided patients at three US health care institutions with online access to their primary care doctors' notes and then collected survey data about their experiences, including their concerns about privacy before and after participation in the intervention. To identify patients' attitudes toward privacy when given electronic access to their medical records, including visit notes. The design used a nested cohort study of patients surveyed at baseline and after a 1-year period during which they were invited to read their visit notes through secure patient portals. Participants consisted of 3874 primary care patients from Beth Israel Deaconess Medical Center (Boston, MA), Geisinger Health System (Danville, PA), and Harborview Medical Center (Seattle, WA) who completed surveys before and after the OpenNotes intervention. The measures were patient-reported levels of concern regarding privacy associated with online access to visit notes. 32.91% of patients (1275/3874 respondents) reported concerns about privacy at baseline versus 36.63% (1419/3874 respondents) post-intervention. Baseline concerns were associated with non-white race/ethnicity and lower confidence in communicating with doctors, but were not associated with choosing to read notes or desire for continued online access post-intervention (nearly all patients with notes available chose to read them and wanted continued access). While the level of concern among most participants did not change during the intervention, 15.54% (602/3874 respondents, excluding participants who responded "don't know") reported more concern post-intervention, and 12.73% (493/3874 respondents, excluding participants who responded "don't know") reported less

The Surgical Nosology In Primary-care Settings (SNIPS): a simple bridging classification for the interface between primary and specialist care

Science.gov (United States)

Gruen, Russell L; Knox, Stephanie; Britt, Helena; Bailie, Ross S

2004-01-01

Background The interface between primary care and specialist medical services is an important domain for health services research and policy. Of particular concern is optimising specialist services and the organisation of the specialist workforce to meet the needs and demands for specialist care, particularly those generated by referral from primary care. However, differences in the disease classification and reporting of the work of primary and specialist surgical sectors hamper such research. This paper describes the development of a bridging classification for use in the study of potential surgical problems in primary care settings, and for classifying referrals to surgical specialties. Methods A three stage process was undertaken, which involved: (1) defining the categories of surgical disorders from a specialist perspective that were relevant to the specialist-primary care interface; (2) classifying the 'terms' in the International Classification of Primary Care Version 2-Plus (ICPC-2 Plus) to the surgical categories; and (3) using referral data from 303,000 patient encounters in the BEACH study of general practice activity in Australia to define a core set of surgical conditions. Inclusion of terms was based on the probability of specialist referral of patients with such problems, and specialists' perception that they constitute part of normal surgical practice. Results A four-level hierarchy was developed, containing 8, 27 and 79 categories in the first, second and third levels, respectively. These categories classified 2050 ICPC-2 Plus terms that constituted the fourth level, and which covered the spectrum of problems that were managed in primary care and referred to surgical specialists. Conclusion Our method of classifying terms from a primary care classification system to categories delineated by specialists should be applicable to research addressing the interface between primary and specialist care. By describing the process and putting the bridging

Informed consent: attitudes, knowledge and information concerning prenatal examination

DEFF Research Database (Denmark)

Dahl, Katja; Kesmodel, Ulrik; hvidman, lone

2006-01-01

Background: Providing women with information enabling an informed consent to prenatal examinations has been widely recommended. Objective: The primary purpose of this review is to summarise current knowledge of the pregnant woman's expectations and attitudes concerning prenatal examinations, as w...

Contextual influences on environmental concerns cross-nationally: A multilevel investigation.

Science.gov (United States)

Marquart-Pyatt, Sandra T

2012-09-01

Environmental issues continue to grow in international prominence, as environmental conditions are recognized as some of the most important problems facing the world. Research examining this globalization of environmental concern shown in public opinion surveys emphasizes the importance of context yet is currently underspecified. To address this gap, this research uses a multi-level, cross-national study to examine individual-level and country-level influences on three measures of environmental concern: environmental threat awareness, environmental efficacy, and willingness to pay. At the individual level, education, age, and gender affect environmental concerns. At the national level, economic, political, and environmental factors affect environmental concerns. Importantly, contextual factors differ in their effects depending on the dimension of environmental concern measured. Results from cross-level interactions for education confirm these complexities across these measures, supporting a dimensionality argument. The importance of the measurement of environmental concern shown in this research is emphasized for future cross-national scholarship. Copyright © 2012 Elsevier Inc. All rights reserved.

Addressing Climate Change and the Role of Technological Solutions

Directory of Open Access Journals (Sweden)

Stephen Axon

2010-05-01

Full Text Available As far as sustainability is concerned, the role of technology has always been contested. With regard to environmental degradation, technology is either perceived to be part of the problem or part of the solution. To combat the complex issues of the present time, technological solutions are expected to play a key role towards mitigating and adapting to the negative impacts of climate change. The paper also discusses the role of the 2009 Copenhagen Conference towards addressing climate change. Although the Copenhagen Accord is not a legally binding agreement, it is seen as a necessary first step towards a protocol that will effectively address the issue of climate change.

Societal concerns about pork and pork production and their relationships on the production system

NARCIS (Netherlands)

Kanis, E.; Groen, A.F.; Greef, de K.H.

2003-01-01

Pork producers in Western Europe more and more encounter a variety of societal concerns about pork and pork production. So far, however, producers predominantly focused on low consumer prices, therewith addressing just one concern. This resulted in an intensive and large-scale production system,

Depressive Disorders in Primary Health Care

OpenAIRE

Vuorilehto, Maria

2008-01-01

The Vantaa Primary Care Depression Study (PC-VDS) is a naturalistic and prospective cohort study concerning primary care patients with depressive disorders. It forms a collaborative research project between the Department of Mental and Alcohol Research of the National Public Health Institute, and the Primary Health Care Organization of the City of Vantaa. The aim is to obtain a comprehensive view on clinically significant depression in primary care, and to compare depressive patients in prima...

Bioethicists Can and Should Contribute to Addressing Racism

Science.gov (United States)

Danis, Marion; Wilson, Yolonda; White, Amina

2016-01-01

The problems of racism and racially-motivated violence in predominantly African American communities in the US are complex, multifactorial and historically rooted. While these problems are also deeply morally troubling, bioethicists have not contributed substantially to addressing them. Concern for justice has been one of the core commitments of bioethics. For this and other reasons, bioethicists should contribute to addressing these problems. We consider how bioethicists can offer meaningful contributions to the public discourse, research, teaching, training, policy development and academic scholarship in response to the alarming and persistent patterns of racism and implicit biases associated with it. To make any useful contribution, bioethicists will require preparation and should expect to play a significant role through collaborative action with others. PMID:26982911

Bioethicists Can and Should Contribute to Addressing Racism.

Science.gov (United States)

Danis, Marion; Wilson, Yolonda; White, Amina

2016-01-01

The problems of racism and racially motivated violence in predominantly African American communities in the United States are complex, multifactorial, and historically rooted. While these problems are also deeply morally troubling, bioethicists have not contributed substantially to addressing them. Concern for justice has been one of the core commitments of bioethics. For this and other reasons, bioethicists should contribute to addressing these problems. We consider how bioethicists can offer meaningful contributions to the public discourse, research, teaching, training, policy development, and academic scholarship in response to the alarming and persistent patterns of racism and implicit biases associated with it. To make any useful contribution, bioethicists will require preparation and should expect to play a significant role through collaborative action with others.

Low levels of empathic concern predict utilitarian moral judgment.

Science.gov (United States)

Gleichgerrcht, Ezequiel; Young, Liane

2013-01-01

Is it permissible to harm one to save many? Classic moral dilemmas are often defined by the conflict between a putatively rational response to maximize aggregate welfare (i.e., the utilitarian judgment) and an emotional aversion to harm (i.e., the non-utilitarian judgment). Here, we address two questions. First, what specific aspect of emotional responding is relevant for these judgments? Second, is this aspect of emotional responding selectively reduced in utilitarians or enhanced in non-utilitarians? The results reveal a key relationship between moral judgment and empathic concern in particular (i.e., feelings of warmth and compassion in response to someone in distress). Utilitarian participants showed significantly reduced empathic concern on an independent empathy measure. These findings therefore reveal diminished empathic concern in utilitarian moral judges.

Why Aren't More Primary Care Residents Going into Primary Care? A Qualitative Study.

Science.gov (United States)

Long, Theodore; Chaiyachati, Krisda; Bosu, Olatunde; Sircar, Sohini; Richards, Bradley; Garg, Megha; McGarry, Kelly; Solomon, Sonja; Berman, Rebecca; Curry, Leslie; Moriarty, John; Huot, Stephen

2016-12-01

Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine. We aimed to explore contextual and programmatic factors within primary care residency training environments that may influence career choices. This was a qualitative study based on semi-structured, in-person interviews. Three primary care internal medicine residency programs were purposefully selected to represent a diversity of training environments. Second and third year residents were interviewed. We used a survey guide developed from pilot interviews and existing literature. Three members of the research team independently coded the transcripts and developed the code structure based on the constant comparative method. The research team identified emerging themes and refined codes. ATLAS.ti was used for the analysis. We completed 24 interviews (12 second-year residents, and 12 third-year residents). The age range was 27-39 years. Four recurrent themes characterized contextual and programmatic factors contributing to residents' decision-making: resident expectations of a career in primary care, navigation of the boundary between social needs and medical needs, mentorship and perceptions of primary care, and structural features of the training program. Addressing aspects of training that may discourage residents from careers in primary care such as lack of diversity in outpatient experiences and resident frustration with their inability to address social needs of patients, and strengthening aspects of training that may encourage interests in careers in primary care such as mentorship and protected time away from inpatient responsibilities during primary care rotations, may increase the proportion of residents enrolled in primary care training programs who pursue

Drinking water quality concerns and water vending machines

International Nuclear Information System (INIS)

McSwane, D.Z.; Oleckno, W.A.; Eils, L.M.

1994-01-01

Drinking water quality is a vital public health concern to consumers and regulators alike. This article describes some of the current microbiological, chemical, and radiological concerns about drinking water and the evolution of water vending machines. Also addressed are the typical treatment processes used in water vending machines and their effectiveness, as well as a brief examination of a certification program sponsored by the National Automatic Merchandising Association (NAMA), which provides a uniform standard for the design and construction of food and beverage vending machines. For some consumers, the water dispensed from vending machines is an attractive alternative to residential tap water which may be objectionable for aesthetic or other reasons

Whittling Down the Wait Time: Exploring Models to Minimize the Delay from Initial Concern to Diagnosis and Treatment of Autism Spectrum Disorder.

Science.gov (United States)

Gordon-Lipkin, Eliza; Foster, Jessica; Peacock, Georgina

2016-10-01

The process from initial concerns to diagnosis of autism spectrum disorder (ASD) can be a long and complicated process. The traditional model for evaluation and diagnosis of ASD often consists of long wait-lists and evaluations that result in a 2-year difference between the earliest signs of ASD and mean age of diagnosis. Multiple factors contribute to this diagnostic bottleneck, including time-consuming evaluations, cost of care, lack of providers, and lack of comfort of primary care providers to diagnose autism. This article explores innovative clinical models that have been implemented to address this as well as future directions and opportunities. Copyright © 2016 Elsevier Inc. All rights reserved.

The regulation for enforcing the law concerning indemnification of nuclear damage

International Nuclear Information System (INIS)

1978-01-01

These provisions are established on the basis of and to enforce the ''Law concerning the indemnification of nuclear damage''. Atomic energy enterprises who want to get the approval in connection with the Law shall file the applications to the Director General of Science and Technology Agency, in which the name and the address of the applicant, kinds of the operation of nuclear reactors, the name and the address of the factory or the establishment concerning the operation of nuclear reactors, the thermal output of the reactors, the kinds and quantities of nuclear fuel materials or the things contaminated by such materials to be transported, and the time of starting and the expected time of ending the operation of the reactors, etc. To such applications, shall be attached actually surveyed maps indicating the area of the factory or the establishment concerning the operation of the reactors and the documents certifying the conclusion of obligatory insurances and indemnification contracts, etc. The securities which can be deposited and recovering of such securities are prescribed. (Okada, K.)

Multiple Primary Tumors

African Journals Online (AJOL)

2018-02-07

Feb 7, 2018 ... breast and ascending colon. KEYWORDS: Carcinoid, colorectal cancer, metachronous, synchronous. Multiple Primary Tumors. MA Adeyanju, AA Ilori. Address for correspondence: Dr. MA Adeyanju,. Department of Surgery, Federal Medical Centre, Ebute Metta,. Lagos, Nigeria. E-mail: mbadeyanju@yahoo.

Patients' and parents' concerns and decisions about orthodontic treatment.

Science.gov (United States)

Kazancı, Fatih; Aydoğan, Cihan; Alkan, Özer

2016-01-01

Patients' and parents' expectations are important in orthodontic treatment decision making. The literature generally demonstrates the perceived benefits of orthodontic treatment, but patients' and their parents' concerns about orthodontic treatment have not been investigated comprehensively. The aim of this study was to identify patients' and parents' concerns about orthodontic treatment and compare them according to sex, age, and treatment demand level. One hundred and eighty-nine children and their parents were interviewed about concerns related to orthodontic treatment. Patients and parents were asked about orthodontic treatment decisions. Answers were recorded as "yes," "no," or "don't know." Chi-squared and Fisher's exact tests were used to compare concerns between age groups, sexes, and treatment demand levels. Kappa statistics were used to assess agreement between patients and their parents. Concerns about orthodontic treatment were gathered under 10 items as follows: "feeling pain," "the appearance of braces," "being teased," "avoiding smiling," "speech problems," "dietary changes," "problems with transportation," "economic problems," "long treatment duration," and "missing school." There was no statistically significant difference in concerns between the sexes or age groups. Some concern items and treatment demand were inversely related in patients. The results of this study demonstrate patients' and parents' concerns about orthodontic treatment. Differences between the concerns of patients with different treatment demands imply that children might reject orthodontic treatment because of their concerns. Appropriate consultation of patients addressing their concerns may help reduce anxiety and improve the acceptance of treatment.

76 FR 14896 - Multi-Agency Informational Meeting Concerning Compliance With the Federal Select Agent Program...

Science.gov (United States)

2011-03-18

... specific regulatory guidance and information on standards concerning biosafety and biosecurity issues... assessments, biosafety requirements, and security measures. DATES: The meeting will be held on May 10, 2011... meeting to address questions and concerns. Entity registration, security risk assessments, biosafety...

Tailwater concerns and the history of turbine aeration

International Nuclear Information System (INIS)

Bohac, C.E.; Ruane, R.J.

1991-01-01

All new proposals for hydropower development and many of the almost 300 hydroelectric projects which will be relicensed before 2000 will have to address the issue of minimum dissolved oxygen concentrations. This paper highlights some of the causes and concerns of low dissolved oxygen concentrations in releases from hydropower projects and describes the history of hydroturbine aeration for reaerating these releases

Mothers' Concerns for Personal Safety and Privacy While Breastfeeding: An Unexplored Phenomenon.

Science.gov (United States)

Rosen-Carole, Casey; Allen, Katherine; Fagnano, Maria; Dozier, Ann; Halterman, Jill

2018-04-01

Preliminary qualitative research in upstate NY shows new mothers are worried about safety while breastfeeding. Little is known regarding prevalence of these concerns and their effect on breastfeeding outcomes. (1) Determine frequency of breastfeeding safety and privacy concerns; (2) Explore their association with breastfeeding outcomes. Mothers were surveyed immediately and 1-month postpartum about breastfeeding goals; both surveys addressed privacy and safety concerns at home, work, and in public. Outcome data included breastfeeding intent, exclusivity, and duration. Breastfeeding/non-breastfeeding mothers were compared using Chi-square and multivariate analyses. A total of 279 women enrolled. Of these 82.8% initiated breastfeeding; at 1-month 72% provided any breast milk, and 44% were exclusively breastfeeding. About 99% felt safe breastfeeding at home; 25% reported privacy concerns; and 5% felt "vulnerable or unsafe" while breastfeeding. At 1-month, 49% agreed there was a safe place to breastfeed/express milk at work (20% unsure). Non-breastfeeding mothers expressed more safety concerns outside home/at work: 18% breastfeeding versus 28% non-breastfeeding outside home; 27% breastfeeding versus 40% non-breastfeeding at work. Nearly 54% who reported feeling vulnerable/unsafe with breastfeeding initiated breastfeeding, compared with 86% not reporting this concern (p = 0.008). Fewer women initiating breastfeeding reported vulnerability/safety (3% breastfeeding versus 14% non-breastfeeding, p = 0.008) or privacy (22% breastfeeding versus 40% non-breastfeeding, p = 0.19) concerns. Associations held after controlling for age, race, parity, insurance, geography, and marital-status. Significant associations between initiation, privacy, and safety concerns did not extend to duration or exclusivity. Many breastfeeding women reported safety and privacy concerns, especially outside the home and at work, which may influence breastfeeding initiation. Further study

Medical and pharmacy student concerns about participating on international service-learning trips

OpenAIRE

Chuang, Chih; Khatri, Siddique H.; Gill, Manpal S.; Trehan, Naveen; Masineni, Silpa; Chikkam, Vineela; Farah, Guillaume G.; Khan, Amber; Levine, Diane L.

2015-01-01

Background International Service Learning Trips (ISLT) provide health professional students the opportunity to provide healthcare, under the direction of trained faculty, to underserved populations in developing countries. Despite recent increases in international service learning trips, there is scant literature addressing concerns students have prior to attending such trips. This study focuses on identifying concerns before and after attending an ISLT and their impact on students. Methods A...

When Others' Performance Just Isn't Good Enough: Educational Leaders' Framing of Concerns in Private and Public

Science.gov (United States)

Sinnema, Claire E. L.; Le Fevre, Deidre; Robinson, Viviane M. J.; Pope, Denyse

2013-01-01

Effective instructional leadership demands that leaders address the inevitable problems and concerns that exist in any educational organization. Unfortunately, much evidence suggests that many important concerns, including teacher performance issues, continue to be unaddressed and unresolved. This article portrays the nature of concerns facing 77…

Multisite Testing of the Discrete Address Beacon System (DABS).

Science.gov (United States)

1981-07-01

discrete address would the new DABS/ATCRBS environment, thus, allow individual interrogation of each allowing for an economical transition aircraft so...Traffic used. These changes were primarily Advisory and Resolution Service ( ATARS ) concerned with ATCRBS performance and function and ATC en route...the zenith cones and potential ATARS list of "assigned" sensors; i.e., those conflicts with the stationary Mizpah being used for redundant surveillance

Low levels of empathic concern predict utilitarian moral judgment.

Directory of Open Access Journals (Sweden)

Ezequiel Gleichgerrcht

Full Text Available Is it permissible to harm one to save many? Classic moral dilemmas are often defined by the conflict between a putatively rational response to maximize aggregate welfare (i.e., the utilitarian judgment and an emotional aversion to harm (i.e., the non-utilitarian judgment. Here, we address two questions. First, what specific aspect of emotional responding is relevant for these judgments? Second, is this aspect of emotional responding selectively reduced in utilitarians or enhanced in non-utilitarians? The results reveal a key relationship between moral judgment and empathic concern in particular (i.e., feelings of warmth and compassion in response to someone in distress. Utilitarian participants showed significantly reduced empathic concern on an independent empathy measure. These findings therefore reveal diminished empathic concern in utilitarian moral judges.

Counting addressing method: Command addressable element and extinguishing module

Directory of Open Access Journals (Sweden)

Ristić Jovan D.

2009-01-01

Full Text Available The specific requirements that appear in addressable fire detection and alarm systems and the shortcomings of the existing addressing methods were discussed. A new method of addressing of detectors was proposed. The basic principles of addressing and responding of a called element are stated. Extinguishing module is specific subsystem in classic fire detection and alarm systems. Appearing of addressable fire detection and alarm systems didn't caused essential change in the concept of extinguishing module because of long calling period of such systems. Addressable fire security system based on counting addressing method reaches high calling rates and enables integrating of the extinguishing module in addressable system. Solutions for command addressable element and integrated extinguishing module are given in this paper. The counting addressing method was developed for specific requirements in fire detection and alarm systems, yet its speed and reliability justifies its use in the acquisition of data on slowly variable parameters under industrial conditions. .

Status report on NRC's current below regulatory concern activities

International Nuclear Information System (INIS)

Dragonette, K.S.

1988-01-01

The concept of below regulatory concern (BRC) is not new to the Nuclear Regulatory Commission (NRC) or its predecessor agency, the Atomic Energy Commission. The regulations and licensing decisions have involved limited and de facto decisions on BRC since the beginning. For example, consumer products containing radioactive materials have been approved for distribution to persons exempt from licensing for some time and procedures for survey and release of equipment have traditionally been a part of many licensees' radiation safety programs. However, these actions have generally been ad hoc decisions in response to specific needs and have not been necessarily consistent. The need to deal with this regulatory matter has been receiving attention from both Congress and the NRC Commissioners. NRC response has grown from addressing specific waste streams, to generic rulemaking for wastes, and finally to efforts to develop a broad generic BRC policy. Section 10 of the Low-Level Radioactive Waste Policy Amendments Act of 1985 addressed NRC actions on specific waste streams. In response, NRC issued guidance on rulemaking petitions for specific wastes. NRC also issued an advance notice of proposed rulemaking indicating consideration of Commission initiated regulations to address BRC wastes in a generic manner. The Commissioners have directed staff to develop an umbrella policy for all agency decisions concerning levels of risk or dose that do not require government regulation

Veterans’ Health Care: Limited Progress Made to Address Concerns That Led to High Risk Designation

Science.gov (United States)

2017-03-15

Women Veterans. GAO-17-52. Washington , D.C.: December 2, 2016. Veterans Health Care: Improvements Needed in Operationalizing Strategic Goals and...Access to Primary Care. GAO-16-328. Washington , D.C.: March 18, 2016. DOD and VA Health Care: Actions Needed to Help Ensure Appropriate Medication...ET Wednesday, March 15, 2017 GAO-17-473T United States Government Accountability Office United States Government Accountability Office

Incorporating Primary and Secondary Prevention Approaches To Address Childhood Obesity Prevention and Treatment in a Low-Income, Ethnically Diverse Population: Study Design and Demographic Data from the Texas Childhood Obesity Research Demonstration (TX CORD) Study

Science.gov (United States)

Butte, Nancy F.; Barlow, Sarah; Vandewater, Elizabeth A.; Sharma, Shreela V.; Huang, Terry; Finkelstein, Eric; Pont, Stephen; Sacher, Paul; Byrd-Williams, Courtney; Oluyomi, Abiodun O.; Durand, Casey; Li, Linlin; Kelder, Steven H.

2015-01-01

Abstract Background: There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2–12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone. Methods: Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented. Results: Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3–83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables. Conclusions: Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity. PMID:25555188

Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) study.

Science.gov (United States)

Hoelscher, Deanna M; Butte, Nancy F; Barlow, Sarah; Vandewater, Elizabeth A; Sharma, Shreela V; Huang, Terry; Finkelstein, Eric; Pont, Stephen; Sacher, Paul; Byrd-Williams, Courtney; Oluyomi, Abiodun O; Durand, Casey; Li, Linlin; Kelder, Steven H

2015-02-01

There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2-12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone. Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented. Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3-83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables. Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity.

Staff Concerns in Schools Planning for and Implementing School-Wide Positive Behavior Interventions and Supports

Science.gov (United States)

Tyre, Ashli D.; Feuerborn, Laura L.; Woods, Leslie

2018-01-01

Understanding staff concerns about a systemic change effort allows leadership teams to better anticipate and address staff needs for professional development and support. In this study, staff concerns in nine schools planning for or implementing School-Wide Positive Behavior Interventions and Supports (SWPBIS) were explored using the…

Alternative energy and environmental concerns

International Nuclear Information System (INIS)

2002-01-01

The New Brunswick Market Design Committee will address environmental concerns within the context of the new energy policy and market rules for the newly restructured electric power industry. The new rules that come with power restructuring will in some ways facilitate environmental protection but they can also complicate it. With open access markets, it will be possible to coordinate evolving energy frameworks with current environmental objectives. Restructuring provides an opportunity to create incentives and guidelines to operate in an environmentally sustainable manner, as suggested in the New Brunswick Energy Policy, White Paper which outlines green pricing, the development of a provincial Climate Change Action Plan, and promotion of alternative energy. The Market Design Committee examined the environmental concerns listed within the White Paper that pertain to the generation and transmission of electricity. These include the integration of energy and environmental policy. Other issues addressed in this report were trans-boundary and global air emissions, the development of a provincial climate change action plan, and a federal-provincial climate change framework agreement. New Brunswick will encourage the development of pilot studies that demonstrate the benefits of renewable and alternative technologies and that help promote the market to manufacture, sell and maintain renewable and alternative technologies in small-scale on-site power generation. This report also discussed the 4 key air pollutants for which specific treatment has been defined, including sulphur dioxide, nitrogen oxides, mercury and carbon dioxide. Recommendations for reducing these emissions include the use of renewable energy sources, the use of lower carbon fuels, increased efficiency of power transmission/generation/distribution systems, reducing power demand by the industrial sector, and promoting energy efficient building codes. 34 refs., 1 tab

Primary Immune Deficiency Treatment Consortium (PIDTC) report

NARCIS (Netherlands)

L.M. Griffith (Linda); M. Cowan (Morton); L.D. Notarangelo (Luigi Daniele); R. Kohn (Robert); J. Puck (Jennifer); S.-Y. Pai (Sung-Yun); B. Ballard (Barbara); S.C. Bauer (Sarah); J. Bleesing (Jack); M. Boyle (Marcia); R.W. Brower (Ronald); R.H. Buckley (Rebecca); M. van der Burg (Mirjam); L.M. Burroughs (Lauri); F. Candotti (Fabio); A. Cant (Andrew); T. Chatila (Talal); C. Cunningham-Rundles (Charlotte); M.C. Dinauer (Mary); J. Dvorak (Jennie); A. Filipovich (Alexandra); L.A. Fleisher (Lee); H.B. Gaspar (Bobby); T. Gungor (Tayfun); E. Haddad (Elie); E. Hovermale (Emily); F. Huang (Faith); A. Hurley (Alan); M. Hurley (Mary); S.K. Iyengar (Sudha); E.M. Kang (Elizabeth); B.R. Logan (Brent); J.R. Long-Boyle (Janel); H. Malech (Harry); S.A. McGhee (Sean); S. Modell (Sieglinde); S. Modell (Sieglinde); H.D. Ochs (Hans); R.J. O'Reilly (Richard); R. Parkman (Robertson); D. Rawlings (D.); J.M. Routes (John); P. Shearer (P.); T.N. Small (Trudy); H. Smith (H.); K.E. Sullivan (Kathleen); P. Szabolcs (Paul); A.J. Thrasher (Adrian); D. Torgerson; P. Veys (Paul); K. Weinberg (Kenneth); J.C. Zuniga-Pflucker (Juan Carlos)

2014-01-01

textabstractThe Primary Immune Deficiency Treatment Consortium (PIDTC) is a network of 33 centers in North America that study the treatment of rare and severe primary immunodeficiency diseases. Current protocols address the natural history of patients treated for severe combined immunodeficiency

Concerns about Breast Cancer, Pain, and Fatigue in Non-Metastatic Breast Cancer Patients Undergoing Primary Treatment

Directory of Open Access Journals (Sweden)

Chelsea R. Amiel

2016-08-01

Full Text Available Women diagnosed with breast cancer often endorse psychosocial concerns prior to treatment, which may influence symptom experiences. Among these, low perceived social support relates to elevated fatigue. Those with low social support perceptions may also experience a greater sense of rejection. We sought to determine if social rejection concerns post-surgery predict fatigue interference 12 months later in women with non-metastatic breast cancer. Depressive symptoms and pain severity after completion of adjuvant therapy (six months post-surgery were examined as potential mediators. Women (N = 240 with non-metastatic breast cancer were recruited 2–10 weeks post-surgery. Multiple regression analyses examined relationships among variables adjusting for relevant covariates. Greater rejection concerns at study entry predicted greater fatigue interference 12 months later (p < 0.01. Pain severity after adjuvant therapy partially mediated the relationship between social rejection concerns and fatigue interference, with significant indirect (β = 0.06, 95% CI (0.009, 0.176 and direct effects (β = 0.18, SE = 0.07, t(146 = 2.78, p < 0.01, 95% CI (0.053, 0.311. Therefore, pain levels post-treatment may affect how concerns of social rejection relate to subsequent fatigue interference. Interventions targeting fears of social rejection and interpersonal skills early in treatment may reduce physical symptom burden during treatment and into survivorship.

It Starts With Me: Privacy concerns and stigma in the evaluation of a Facebook health promotion intervention.

Science.gov (United States)

Witzel, T Charles; Guise, Andy; Nutland, Will; Bourne, Adam

2016-06-01

Background As efforts continue to increase rates of HIV testing and condom use among at-risk communities in England, organisations have sought use social media for health promotion interventions. As part of a wider evaluation of It Starts With Me (ISWM), a sexual health promotion intervention in England targeting gay and bisexual men and African people through Facebook, this study sought to explore how the online environment shapes end user engagement with sexual health interventions. A primary objective was to explore how privacy concerns can act as a barrier to engagement for the audience of ISWM. A purposive sample of 40 individuals were recruited, who were targeted by the intervention for in-depth interviews. Data collection was in two phases. In the first phase, individuals were sampled based on engagement with online health interventions in general, while in the second phase, all individuals were sampled on the basis of engagement with the intervention. Privacy concerns related to the ecology of social networking sites, issues with implied disclosure and discrimination, as well as uncertainty over control of data. These concerns limited the organic reach of the intervention by confining the intervention to those who already held the norms diffused through it, and by discouraging participants from sharing and commenting on content. Care should be taken to address concerns when designing interventions delivered through social media. Gated interventions may be more beneficial for marginalised communities, while large-scale interventions such as ISWM may provide a useful backdrop for face-to-face interventions.

Primary care research conducted in networks: getting down to business.

Science.gov (United States)

Mold, James W

2012-01-01

This seventh annual practice-based research theme issue of the Journal of the American Board of Family Medicine highlights primary care research conducted in practice-based research networks (PBRNs). The issue includes discussion of (1) theoretical and methodological research, (2) health care research (studies addressing primary care processes), (3) clinical research (studies addressing the impact of primary care on patients), and (4) health systems research (studies of health system issues impacting primary care including the quality improvement process). We had a noticeable increase in submissions from PBRN collaborations, that is, studies that involved multiple networks. As PBRNs cooperate to recruit larger and more diverse patient samples, greater generalizability and applicability of findings lead to improved primary care processes.

The African diaspora’s public participation in policy-making concerning Africa

NARCIS (Netherlands)

Norglo, Benhardt Edem Kofi; Goris, Margriet; Lie, Rico; Ong’ayo, Antony Otieno

2016-01-01

This paper examines the involvement of African diaspora organizations in Dutch and European policy-making concerning Africa. It addresses the extent to which their inclusion or exclusion in public policy processes in their destination countries is likely to impact (development) policies relating to

Synthesis of common management concerns associated with dam removal

Science.gov (United States)

Tullos, Desiree D.; Collins, Mathias J.; Bellmore, J. Ryan; Bountry, Jennifer A.; Connolly, Patrick J.; Shafroth, Patrick B.; Wilcox, Andrew C.

2016-01-01

Managers make decisions regarding if and how to remove dams in spite of uncertainty surrounding physical and ecological responses, and stakeholders often raise concerns about certain negative effects, regardless of whether or not these concerns are warranted at a particular site. We used a dam-removal science database supplemented with other information sources to explore seven frequently-raised concerns, herein Common Management Concerns (CMCs). We investigate the occurrence of these concerns and the contributing biophysical controls. The CMCs addressed are: degree and rate of reservoir sediment erosion, excessive channel incision upstream of reservoirs, downstream sediment aggradation, elevated downstream turbidity, drawdown impacts on local water infrastructure, colonization of reservoir sediments by non-native plants, and expansion of invasive fish. Biophysical controls emerged for some of the concerns, providing managers with information to assess whether a given concern is likely to occur at a site. To fully assess CMC risk, managers should concurrently evaluate site conditions and identify the ecosystem or human uses that will be negatively affected if the biophysical phenomenon producing the CMC occurs. We show how many CMCs have one or more controls in common, facilitating the identification of multiple risks at a site, and demonstrate why CMC risks should be considered in the context of other factors like natural watershed variability and disturbance history.

'We are doing our best': African and African-Caribbean fatherhood, health and preventive primary care services, in England.

Science.gov (United States)

Williams, Robert; Hewison, Alistair; Stewart, Mel; Liles, Clive; Wildman, Stuart

2012-03-01

Recent policy pronouncements emphasise the importance of engaging fathers with preventive primary care services. However, in England, there is a paucity of literature which examines African and African-Caribbean fathers' experiences of service provision. This paper reports a study that investigated African and African-Caribbean fathers' beliefs about fatherhood, health and preventive primary care services, with the aim of addressing the deficit in the literature. Nine focus groups involving 46 African and African-Caribbean fathers, recruited using purposive sampling, were undertaken between October 2008-January 2009. Fatherhood was seen as a core aspect of the participants' identities. The fathers enacted these identities in a number of ways, such as caring for and protecting children, which were influenced by spirituality, relationships with women, paid work and racism. The fathers had concerns about their bodies, medical conditions, physical activity and forms of consumption. However, their primary focus was on maintaining and improving the well-being of their children. This resulted in them neglecting their own health needs as they had to meet the obligations of family life and paid work. The fathers reported limited contact with preventive primary care services and were unaware of their purpose, function and availability. They identified ethnicity as a positive asset, and felt their families and communities had particular strengths. However they acknowledged that structural constraints, including racism, influenced their perceptions of and access to local health services. The engagement of African and African-Caribbean fathers needs to be addressed more specifically in policy as part of a broader programme of action to tackle health inequalities. In addition, child health services could build on fathers' commitment to children's well-being through practice that addresses fathers' as well as mothers' needs in families. © 2011 Blackwell Publishing Ltd.

Sun protection and low levels of vitamin D: are people concerned?

Science.gov (United States)

Janda, Monika; Kimlin, Michael; Whiteman, David; Aitken, Joanne; Neale, Rachel

2007-11-01

Recent reports on the association between low serum vitamin D and increased risk of cancer raised concerns about possible adverse effects of primary prevention strategies for skin cancer. To evaluate if these reports may influence peoples' sun protective behavior, knowledge, and attitudes to the impact of sun protection on vitamin D. Within a population-based survey in Queensland, Australia (5,611 participants, mean age 50.7 years (range 20-75); 48.2% men), agreement with the statement that sun protection may result in not having enough vitamin D as well as factors associated with agreement were assessed. Overall, 837 (15.0%) participants agreed that sun protection may result in not having enough vitamin D, 2,163 (38.7%) neither agreed nor disagreed, and 2,591 (46.3%) disagreed with this statement. Factors associated with agreement included older age, darker skin color, and attempt to develop a suntan within the past year. These results suggest that future sun protection campaigns may need to address the issue of vitamin D and present ways to achieve sufficient vitamin D levels without increasing sun exposure at least in countries with high UV radiation throughout the year.

Studies and research concerning BNFP: transportation of radioactive material by water

International Nuclear Information System (INIS)

Anderson, R.T.

1980-11-01

Currently there are many limitations imposed on the shipment of radioactive material from nuclear power plants. In this regard, many questions have arisen related to the feasibility of substituting water transportation of these materials as a backup or supplement to the highway and rail modes which are now in use. This study addresses the results of studies performed by Allied-General Nuclear Services concerning the water transportation of spent nuclear fuel and radwaste materials. The report presents both an overview of the possible applications, problems, and means of solution, and specific information related to one particular site. In particular, a detailed case study of a nuclear plant site located on a navigable waterway (Chesapeake Bay) was made. The study concludes that there are some real advantages in using water transport, which are particularly evident if a site is not served by rail or its primary transport route lies near populous areas. Whereas, water transport has been used extensively in Europe and Japan, it has been virtually bypassed in the United States. A recommendation is made to continue examination of water transport, including the development of necessary standards for possible future operations

Keynote Addresses from the Horace Mann Lecture Series and the Paul Masoner International Lecture Series 1972-1978.

Science.gov (United States)

Bender, Mary, Ed.

The document contains eight lectures addressing a variety of educational trends, issues, and concerns. The objective is to heighten the awareness of educational challenges that must be met and to promote continued professional renewal activities. Lecture I discusses fundamental problems concerning world education, concentrating on hunger and…

Farmers' Concerns: A Qualitative Assessment to Plan Rural Medical Education

Science.gov (United States)

Anderson, Brittney T.; Johnson, Gwendolyn J.; Wheat, John R.; Wofford, Amina S.; Wiggins, O. Sam; Downey, Laura H.

2012-01-01

Abstract Context: Limited research suggests that translational approaches are needed to decrease the distance, physical and cultural, between farmers and health care. Purpose: This study seeks to identify special concerns of farmers in Alabama and explore the need for a medical education program tailored to prepare physicians to address those…

Functioning of primary health care in opinion of managers of primary health care units.

Science.gov (United States)

Bojar, I; Wdowiak, L; Kwiatosz-Muc, M

2006-01-01

The aim of the research is to get to know opinions of primary health care managers concerning working of primary health care and concerning quality of medical services offered by family doctors out-patient clinics. The research among managers of primary health care units took place in all out-patient clinics in Lublin province. Research instrument was survey questionnaire of authors own construction. Results were statistically analyzed. From 460 surveys sent, 108 questionnaires were accepted to analysis. Majority of managers of out-patient clinics of primary health care is satisfied with the way and the quality of work of employed staff. In opinion of 71.3% of managers access to family doctor services is very good. Availability of primary health care services is better estimated by managers of not public units. The occupied local provide comfortable work for the staff in opinion of 78.5% of surveyed managers of out-patient clinics. Managers estimate the level of their services as very good (37.96%) and good (37.96%) comparing to other such a subjects present in the market. Internal program of improving quality is run in 22% of out-patient clinics, which were investigated. Managers of primary health care units assess the quality of their services as good and very good. They estimate positively the comfort and politeness in serving patients as well as technical status of equipment and the lodging. They assess availability of their services as very good. Large group of managers of family doctors practices recognizes neighborhood practices as a competitors.

Elderly patients' and GPs' perspectives of patient-GP communication concerning polypharmacy: a qualitative interview study.

Science.gov (United States)

Schöpf, Andrea C; von Hirschhausen, Maike; Farin, Erik; Maun, Andy

2017-12-26

Aim The aim of this study was to explore elderly patients' and general practitioners' (GPs') perceptions of communication about polypharmacy, medication safety and approaches for empowerment. To manage polypharmacy, GPs need to know patients' real medication consumption. However, previous research has shown that patients do not always volunteer all information about their medication regimen, for example, such as the intake of over-the-counter medication or the alteration or discontinuation of prescribed medication. A qualitative interview study including patients of at least 65 years old with polypharmacy (⩾5 medications) and their GPs in a German Primary Healthcare Centre. The transcripts from the semi-structured interviews (n=6 with patients; n=3 with GPs) were analysed using a framework analytical approach. Findings We identified three themes: differing medication plans: causes?; dialogue concerning medication: whose responsibility?; supporting patients' engagement: how? While GPs stated that patients do not always report or might even conceal information, all patients reported that they could speak openly about everything with their GPs. In this context, trust might act as a double-edged sword, as it can promote open communication but also prevent patients from asking questions. Both GPs and patients could name very few ways in which patients could be supported to become more informed and active in communication concerning polypharmacy and medication safety. This study shows that patients' awareness of the significance of their active role in addressing polypharmacy needs to be increased. This includes understanding that trusting the doctor does not preclude asking questions or seeking more information. Thus, interventions which improve patients' communication skills and address specific issues of polypharmacy, particularly in elderly patients, should be designed. GPs might support patients by 'inviting' their contribution.

Monitoring quality in Israeli primary care: The primary care physicians' perspective

Directory of Open Access Journals (Sweden)

Nissanholtz-Gannot Rachel

2012-06-01

program was widespread even among physicians who are young, board-certified in family medicine, and salaried. Many physicians also reported that various problems had emerged to a great or very great extent: a heavier workload (65%, over-competitiveness (60%, excessive managerial pressure (48%, and distraction from other clinical issues (35%. In addition, there was some criticism of the quality of the measures themselves. Respondents also identified approaches to addressing these problems. Conclusions The findings provide perspective on the anecdotal reports of physician opposition to the monitoring program; they may well accurately reflect the views of the small number of physicians directly involved, but they do not reflect the views of primary care physicians as a whole, who are generally quite supportive of the program. At the same time, the study confirms the existence of several perceived problems. Some of these problems, such as excess managerial pressure, can probably best be addressed by the health plans themselves; while others, such as the need to refine the quality indicators, are probably best addressed at the national level. Cooperation between primary care physicians and health plan managers, which has been an essential component of the program's success thus far, can also play an important role in addressing the problems identified.

Characteristics of Sissi primary beam

International Nuclear Information System (INIS)

Nghiem, P.; Payet, J.; Tkatchenko, A.

1994-01-01

This study concerns the definition of the Sissi primary beam characteristics. The calculations have been carried out in two steps : -a study of primary and secondary order with the help of BETA matrix code -a study of superior orders with the help of ZGOUBI code which is able to take into consideration the measured fields and in which the movement equations are integrated numerically. (O.L.). 9 figs., 3 tabs

ED accreditation update. Physicians, medical staff may report safety concerns without fear of disciplinary action.

Science.gov (United States)

2007-11-01

Educating your staff about The Joint Commission's requirements for concerns about hospital safety and quality of care requires the ED manager to set a tone of openness and cooperation, while at the same time emphasizing your department's role in addressing such concerns: * The ED should be the first place that staff members communicate quality and safety concerns. It is only when a problem is not addressed that they should take the issue to hospital administration and, if necessary, The Joint Commission. * A single event should not trigger a report to The Joint Commission, unless it is unusually serious. Otherwise, only a series of events should trigger a report. * Reassure your staff that you care about what is reported and will act quickly on it. Educate your staff about the reporting forms, and follow up with random audits to ensure compliance.

Can We Identify Parents Who Do Not Verbally Share Concerns for Their Children's Development?

Science.gov (United States)

Eremita, Matthew; Semancik, Eileen; Lerer, Trudy; Dworkin, Paul H

2017-04-01

We aimed to identify characteristics of parents who do not voice developmental concerns when prompted by their children's nurse and/or primary care provider (PCP), despite reporting concerns on parent-completed questionnaires. We reviewed 376 medical records of children seen for a 9-month well-child visit in an urban pediatric clinic between September 2011 and December 2012 for sociodemographic variables hypothesized to affect parents' sharing of developmental concerns: the child's birth order and gender; parents' education level, employment, relationship status, and primary language; and family size and racial/ethnic background. The target population was parents who reported concerns on the Parents' Evaluation of Developmental Status (PEDS), a routinely administered, parent-completed screening questionnaire. We subdivided parents who reported concerns on the PEDS (N = 86) based on whether they voiced developmental concerns when prompted by their children's nurse and/or PCP. Two-sided Fisher's exact tests and logistic regression evaluated the relationship between sociodemographic variables and parents' voicing of developmental concerns. Only parent education approached significance, as parents with less than a high school education (children's development than parents with at least a high school degree or equivalent (≥HS) (63% compared to 35%, p = .056). Univariate logistic regression analysis showed that parents with Parents with low educational attainment may be more likely to not verbally share their developmental concerns. For children of such parents, early detection of developmental delay may be strengthened by use of written questionnaires.

Models of Students' Thinking Concerning the Greenhouse Effect and Teaching Implications.

Science.gov (United States)

Koulaidis, Vasilis; Christidou, Vasilia

1999-01-01

Primary school students (n=40) ages 11 and 12 years were interviewed concerning their conceptions of the greenhouse effect. Analysis of the data led to the formation of seven distinct models of thinking regarding this phenomenon. (Author/CCM)

Public attitudes toward health information exchange: perceived benefits and concerns.

Science.gov (United States)

Dimitropoulos, Linda; Patel, Vaishali; Scheffler, Scott A; Posnack, Steve

2011-12-01

To characterize consumers' attitudes regarding the perceived benefits of electronic health information exchange (HIE), potential HIE privacy and security concerns, and to analyze the intersection of these concerns with perceived benefits. A cross-sectional study. A random-digit-dial telephone survey of English-speaking adults was conducted in 2010. Multivariate logistic regression models examined the association between consumer characteristics and concerns related to the security of electronic health records (EHRs) and HIE. A majority of the 1847 respondents reported they were either "very" or "somewhat" concerned about privacy of HIE (70%), security of HIE (75%), or security of EHRs (82%). Concerns were significantly higher (P security, and 60% would permit HIE for treatment purposes even if the physician might not be able to protect their privacy all of the time. Over half (52%) wanted to choose which providers access and share their data. Greater participation by consumers in determining how HIE takes place could engender a higher degree of trust among all demographic groups, regardless of their varying levels of privacy and security concerns. Addressing the specific privacy and security concerns of minorities, individuals 40 to 64 years old, and employed individuals will be critical to ensuring widespread consumer participation in HIE.

Concerns of patients actively contemplating total knee replacement: differences by race and gender.

Science.gov (United States)

Chang, Huan J; Mehta, Priya S; Rosenberg, Aaron; Scrimshaw, Susan C

2004-02-15

To examine differences by race/ethnicity and gender in patients' concerns regarding total knee replacement (TKR). Focus groups of patients actively considering TKR were conducted. Discussion included patients' questions and concerns regarding TKR. The software ATLAS.ti was used to tabulate themes by race/ethnicity and gender. Concerns raised by focus group participants were compared with thematic content from patient joint replacement information materials. This comparison used patient literature from 3 high-volume academic TKR centers, the Arthritis Foundation, and the American Academy of Orthopedic Surgeons. All groups shared similar concerns. However, some issues were more prevalent among certain gender and racial groups. For instance, concerns regarding anesthesia were more important to white Americans and concerns regarding recovery were more important to women. Some of these concerns were not addressed in the available patient literature. Different gender and racial subgroups focus on different concerns when considering TKR. These differences may contribute to gender and race/ethnicity disparity seen in TKR use.

Addressing Special Education Inequity through Systemic Change: Contributions of Ecologically Based Organizational Consultation

Science.gov (United States)

Sullivan, Amanda L.; Artiles, Alfredo J.; Hernandez-Saca, David I.

2015-01-01

Since the inception of special education, scholars and practitioners have been concerned about the disproportionate representation of students from culturally and linguistically diverse backgrounds among students identified with disabilities. Professional efforts to address this disproportionality have encompassed a range of targets, but scholars…

Study of environmental concerns: offshore oil and gas drilling and production

Energy Technology Data Exchange (ETDEWEB)

Baker, R

1978-01-01

Material on the environmental concerns associated with offshore drilling and production activities has been synthesized with Department of Fisheries and Environment files on specific projects, these being the primary information source. Recommendations to resolve these concerns have also been provided. Most of the environmental concerns identified in this study are traceable to specific weaknesses in offshore drilling and production procedures and management systems. Hardware weaknesses are seldom of central importance. Areas of concern include the gradual deposition of pollutants from rigs, underwater pipelines and onshore ancillary structures, and the quality of the following: action plans to deal with oil spills, standards for safety and anti-pollution equipment, information provided on the environmental hazards in offshore drilling and production areas, environmental impact assessments, and communication links between those having environmental concerns and expertise (including the public-at-large) and those who make the decisions regarding offshore oil and gas development.

A transition program to primary health care for new graduate nurses: a strategy towards building a sustainable primary health care nurse workforce?

Science.gov (United States)

Gordon, Christopher J; Aggar, Christina; Williams, Anna M; Walker, Lynne; Willcock, Simon M; Bloomfield, Jacqueline

2014-01-01

This debate discusses the potential merits of a New Graduate Nurse Transition to Primary Health Care Program as an untested but potential nursing workforce development and sustainability strategy. Increasingly in Australia, health policy is focusing on the role of general practice and multidisciplinary teams in meeting the service needs of ageing populations in the community. Primary health care nurses who work in general practice are integral members of the multidisciplinary team - but this workforce is ageing and predicted to face increasing shortages in the future. At the same time, Australia is currently experiencing a surplus of and a corresponding lack of employment opportunities for new graduate nurses. This situation is likely to compound workforce shortages in the future. A national nursing workforce plan that addresses supply and demand issues of primary health care nurses is required. Innovative solutions are required to support and retain the current primary health care nursing workforce, whilst building a skilled and sustainable workforce for the future. This debate article discusses the primary health care nursing workforce dilemma currently facing policy makers in Australia and presents an argument for the potential value of a New Graduate Transition to Primary Health Care Program as a workforce development and sustainability strategy. An exploration of factors that may contribute or hinder transition program for new graduates in primary health care implementation is considered. A graduate transition program to primary health care may play an important role in addressing primary health care workforce shortages in the future. There are, however, a number of factors that need to be simultaneously addressed if a skilled and sustainable workforce for the future is to be realised. The development of a transition program to primary health care should be based on a number of core principles and be subjected to both a summative and cost

French experience concerning expansion compensating devices on the primary systems of nuclear reactors

International Nuclear Information System (INIS)

Vrillon, B.; Raynal, A.

1980-01-01

French experience in the use of large expansion bellows in the presence of hot sodium is extremely limited. This stems from the 'pool' structure of the primary circuit, adopted in France to eliminate the need to solve expansion problems affecting the primary piping of loop reactors. Furthermore, until the present time, the use of bellows on secondary circuits has neither been implemented nor considered. A few bellows nevertheless exist on the Phenix and Super-Phenix reactors, and these perform separation functions, for example, between sodium at different temperature and/or pressures, or tightness functions in gaseous environment at the component penetrations in the slabs. The dimension criteria applied to these bellows are the general rules for structural dimensioning. Since they do not form part of a circuit wall, they do not need to be discussed. Note, however, that these components have not raised any particular problems thus far. Expansion bellows exist in France on the primary circuits of certain nuclear reactors of the natural uranium/graphite/gas type. These reactors have been in operation for many years, and some lessons can be drawn from this experience in the use of bellows in representative conditions on power reactor circuits. Liquid sodium raises specific problems with respect to circuit operation and material behavior. However, many problems in the use of bellows are independent of the fluid conveyed in the circuits. This is why the experience gained with gas type power reactors appears to be useful in considering the possible future use of bellows on sodium reactor circuits

Environmental Concerns, Environmental Policy and Green Investment.

Science.gov (United States)

Gao, Xuexian; Zheng, Haidong

2017-12-13

Environmental regulators often use environmental policy to induce green investment by firms. However, if an environmental policy fails to exert a long-run effect on regulating the economic agents' behavior, it may be more reasonable to think of the firm as the leader in the game, since the investment in green technology is usually a strategic decision. In this paper, we consider a three-stage Stackelberg game to address the interaction between a profit-maximizing firm (Stackelberg leader) facing emission-dependent demand, and the environmental regulator (Stackelberg follower). The firm decides on the green technology level in the first stage of the game based on its understanding of the regulator's profits function, especially an environmental concern that is introduced as an exogenous variable. In the current research, we show that high levels of the regulator's environmental concerns do not necessarily lead to the choice of green technology by the firm, and green investment level depends on the combined effects of the market and operational factors for a given level of the regulator's environmental concerns. The result also shows that increasing environmental awareness amongst the consumers is an effective way to drive the firm's green investment.

Towards the concerned study of religion: Exploring the double power-play disparity

NARCIS (Netherlands)

Droogers, A.F.

2010-01-01

Increasing numbers of students of religion, from various disciplines, address issues of public interest, going beyond documentation and analysis, taking the quality of human life in religion and society as a criterion for their recommendations. Accordingly, systematic reflection on the concerned

Providing cell phone numbers and email addresses to Patients: the physician's perspective

Science.gov (United States)

2011-01-01

Background The provision of cell phone numbers and email addresses enhances the accessibility of medical consultations, but can add to the burden of physicians' routine clinical practice and affect their free time. The objective was to assess the attitudes of physicians to providing their telephone number or email address to patients. Methods Primary care physicians in the southern region of Israel completed a structured questionnaire that related to the study objective. Results The study population included 120 primary care physicians with a mean age of 41.2 ± 8.5, 88 of them women (73.3%). Physicians preferred to provide their cell phone number rather than their email address (P = 0.0007). They preferred to answer their cell phones only during the daytime and at predetermined times, but would answer email most hours of the day, including weekends and holidays (P = 0.001). More physicians (79.7%) would have preferred allotted time for email communication than allotted time for cell phone communication (50%). However, they felt that email communication was more likely to lead to miscommunication than telephone calls (P = 0.0001). There were no differences between male and female physicians on the provision of cell phone numbers or email addresses to patients. Older physicians were more prepared to provide cell phone numbers that younger ones (P = 0.039). Conclusions The attitude of participating physicians was to provide their cell phone number or email address to some of their patients, but most of them preferred to give out their cell phone number. PMID:21426591

Providing cell phone numbers and email addresses to Patients: the physician's perspective

Directory of Open Access Journals (Sweden)

Freud Tamar

2011-03-01

Full Text Available Abstract Background The provision of cell phone numbers and email addresses enhances the accessibility of medical consultations, but can add to the burden of physicians' routine clinical practice and affect their free time. The objective was to assess the attitudes of physicians to providing their telephone number or email address to patients. Methods Primary care physicians in the southern region of Israel completed a structured questionnaire that related to the study objective. Results The study population included 120 primary care physicians with a mean age of 41.2 ± 8.5, 88 of them women (73.3%. Physicians preferred to provide their cell phone number rather than their email address (P = 0.0007. They preferred to answer their cell phones only during the daytime and at predetermined times, but would answer email most hours of the day, including weekends and holidays (P = 0.001. More physicians (79.7% would have preferred allotted time for email communication than allotted time for cell phone communication (50%. However, they felt that email communication was more likely to lead to miscommunication than telephone calls (P = 0.0001. There were no differences between male and female physicians on the provision of cell phone numbers or email addresses to patients. Older physicians were more prepared to provide cell phone numbers that younger ones (P = 0.039. Conclusions The attitude of participating physicians was to provide their cell phone number or email address to some of their patients, but most of them preferred to give out their cell phone number.

LGBTQ Youth's Perceptions of Primary Care.

Science.gov (United States)

Snyder, Barbara K; Burack, Gail D; Petrova, Anna

2017-05-01

Despite published guidelines on the need to provide comprehensive care to lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) youth, there has been limited research related to the deliverance of primary health care to this population. The goals of this study were to learn about LGBTQ youth's experiences with their primary care physicians and to identify areas for improvement. Youth attending 1 of 5 community-based programs completed a written questionnaire and participated in a focus group discussion regarding experiences at primary care visits, including topics discussed, counselling received, and physician communication. Most of the youth did not feel their health care needs were well met. The majority acknowledged poor patient-provider communication, disrespect, and lack of discussions about important topics such as sexual and emotional health. Participants cited concerns about confidentiality and inappropriate comments as barriers to care. Youth expressed a strong desire to have physicians be more aware of their needs and concerns.

The development of hazardous waste management as a state policy concern

International Nuclear Information System (INIS)

Herzik, E.B.

1992-01-01

Hazardous waste management has become a primary concern of state governments. This concern is relatively recent, with state governments assuming a leading role in hazardous waste policy development and implementation only in the past decade. This article outlines the scope of the hazardous waste problem to which state governments must respond. The scope of the problem is then linked to changing public perceptions and intergovernmental relationships to explain the expanding state government policy role in hazardous waste management. 15 refs., 1 tab

WMPO project issues and public concerns

International Nuclear Information System (INIS)

Vieth, D.L.

1984-01-01

The Governor of Nevada was notified in 1983 that the Yucca Mountain site is a potentially acceptable site for a nuclear waste storage site. A series of public hearings held produced nearly 400 comments on issues concerning the site nomination. Areas of primary public concern are the impact of the proposed nuclear site on tourism, transportation, and socioeconomic impact on adjacent communities. Results of recent studies showed no impact of high-level waste transport on tourism in the Las Vegas area and on analysis of data accumulated over the 25 to 30 years that high-level radioactive wastes have been transported on Nevada highways showed that no one has been evacuated from their home as the result of an accident involving radioactive waste. A comparison of the possible effects of construction of a nuclear waste storage facility at the Yucca mountain site with the effects of Nevada Test Site indicate that the impact on communities will be minimal

Beyond the Dialectics and Polemics: Canadian Catholic Schools Addressing LGBT Youth Issues

Science.gov (United States)

Liboro, Renato M.; Travers, Robb; St. John, Alex

2015-01-01

In 2012, Canadian media coverage on Bill 13--an Ontario legislative proposal to require all publicly funded schools to support Gay-Straight Alliances as a means of addressing issues concerning bullied lesbian, gay, bisexual, and transgender (LGBT) students--instigated a divisive exchange among representatives of the Ontario Catholic school sector.…

Challenges in interdisciplinary weight management in primary care: lessons learned from the 5As Team study.

Science.gov (United States)

Asselin, J; Osunlana, A M; Ogunleye, A A; Sharma, A M; Campbell-Scherer, D

2016-04-01

Increasingly, research is directed at advancing methods to address obesity management in primary care. In this paper we describe the role of interdisciplinary collaboration, or lack thereof, in patient weight management within 12 teams in a large primary care network in Alberta, Canada. Qualitative data for the present analysis were derived from the 5As Team (5AsT) trial, a mixed-method randomized control trial of a 6-month participatory, team-based educational intervention aimed at improving the quality and quantity of obesity management encounters in primary care practice. Participants (n = 29) included in this analysis are healthcare providers supporting chronic disease management in 12 family practice clinics randomized to the intervention arm of the 5AsT trial including mental healthcare workers (n = 7), registered dietitians (n = 7), registered nurses or nurse practitioners (n = 15). Participants were part of a 6-month intervention consisting of 12 biweekly learning sessions aimed at increasing provider knowledge and confidence in addressing patient weight management. Qualitative methods included interviews, structured field notes and logs. Four common themes of importance in the ability of healthcare providers to address weight with patients within an interdisciplinary care team emerged, (i) Availability; (ii) Referrals; (iii) Role perception and (iv) Messaging. However, we find that what was key to our participants was not that these issues be uniformly agreed upon by all team members, but rather that communication and clinic relationships support their continued negotiation. Our study shows that firm clinic relationships and deliberate communication strategies are the foundation of interdisciplinary care in weight management. Furthermore, there is a clear need for shared messaging concerning obesity and its treatment between members of interdisciplinary teams. © 2016 World Obesity.

Faculty Attitudes toward Addressing Mental Health Conditions and Substance Abuse among College Students

Science.gov (United States)

O'Connor-Merrigan, Mary L.

2013-01-01

The continued prevalence of mental health conditions and substance abuse among students enrolled in institutions of higher education is a significant and progressing concern, with marked impact on retention, academic success, graduation rate, and alarming personal consequences. Yet, many institutions struggle with successfully addressing these…

Trends in public health policies addressing violence against women

Directory of Open Access Journals (Sweden)

Kattia Rojas Loría

2014-08-01

Full Text Available OBJECTIVE To analyze the content of policies and action plans within the public healthcare system that addresses the issue of violence against women. METHODS A descriptive and comparative study was conducted on the health policies and plans in Catalonia and Costa Rica from 2005 to 2011. It uses a qualitative methodology with documentary analysis. It is classified by topics that describe and interpret the contents. We considered dimensions, such as principles, strategies, concepts concerning violence against women, health trends, and evaluations. RESULTS Thirteen public policy documents were analyzed. In both countries’ contexts, we have provided an overview of violence against women as a problem whose roots are in gender inequality. The strategies of gender policies that address violence against women are cultural exchange and institutional action within the public healthcare system. The actions of the healthcare sector are expanded into specific plans. The priorities and specificity of actions in healthcare plans were the distinguishing features between the two countries. CONCLUSIONS The common features of the healthcare plans in both the counties include violence against women, use of protocols, detection tasks, care and recovery for women, and professional self-care. Catalonia does not consider healthcare actions with aggressors. Costa Rica has a lower specificity in conceptualization and protocol patterns, as well as a lack of updates concerning health standards in Catalonia.

Trends in public health policies addressing violence against women

Science.gov (United States)

Loría, Kattia Rojas; Rosado, Teresa Gutiérrez; Espinosa, Leonor María Cantera; Marrochi, Leda María Marenco; Sánchez, Anna Fernández

2014-01-01

OBJECTIVE To analyze the content of policies and action plans within the public healthcare system that addresses the issue of violence against women. METHODS A descriptive and comparative study was conducted on the health policies and plans in Catalonia and Costa Rica from 2005 to 2011. It uses a qualitative methodology with documentary analysis. It is classified by topics that describe and interpret the contents. We considered dimensions, such as principles, strategies, concepts concerning violence against women, health trends, and evaluations. RESULTS Thirteen public policy documents were analyzed. In both countries’ contexts, we have provided an overview of violence against women as a problem whose roots are in gender inequality. The strategies of gender policies that address violence against women are cultural exchange and institutional action within the public healthcare system. The actions of the healthcare sector are expanded into specific plans. The priorities and specificity of actions in healthcare plans were the distinguishing features between the two countries. CONCLUSIONS The common features of the healthcare plans in both the counties include violence against women, use of protocols, detection tasks, care and recovery for women, and professional self-care. Catalonia does not consider healthcare actions with aggressors. Costa Rica has a lower specificity in conceptualization and protocol patterns, as well as a lack of updates concerning health standards in Catalonia. PMID:25210820

Primary decomposition of torsion R[X]-modules

Directory of Open Access Journals (Sweden)

William A. Adkins

1994-01-01

Full Text Available This paper is concerned with studying hereditary properties of primary decompositions of torsion R[X]-modules M which are torsion free as R-modules. Specifically, if an R[X]-submodule of M is pure as an R-submodule, then the primary decomposition of M determines a primary decomposition of the submodule. This is a generalization of the classical fact from linear algebra that a diagonalizable linear transformation on a vector space restricts to a diagonalizable linear transformation of any invariant subspace. Additionally, primary decompositions are considered under direct sums and tensor product.

Below regulatory concern - or simply exempt?

International Nuclear Information System (INIS)

Brodsky, A.

1991-01-01

The US Nuclear Regulatory Commission published a policy statement last summer on ''below regulatory concern'' (BRC), which exempted small quantities of radioactive material from regulatory control and would allow the deregulated disposal of some low level waste. The policy drew opposition from several groups. NRC is not planning to revise its BRC policy statement, but wants to develop a concensus on how to implement the policy. Although the Commission's publication of a long needed policy framework for guiding exemption decisions should be welcomed by those of us who have been concerned with making such decisions, there is an urgent need for further consensus building. The policy statement offers only broad guidelines, some of which could be confusing and seem contradictory. The policy statement by itself could further erode public confidence in the NRC's commitment to specific limits of risk, and the ability of its staff to independently evaluate the risks. Another reason why it is appropriate and urgent to embark upon consensus building involving all parties and the public, is that the risks of low level radioactive waste disposal as practiced and proposed in the United States have long been exaggerated in biased reports that receive most media attention. A consensus process needs to be established so that the public can have confidence that its concerns have been properly addressed. (author)

Zika virus: Current concerns in India

Directory of Open Access Journals (Sweden)

Sumit Bhardwaj

2017-01-01

Full Text Available With confirmation of Zika virus (ZIKV presence in India, screening of a large number of febrile illness samples yielded only four positive cases. In this review, we address the current concern with context to India. The possible reasons for low level of Zika prevalence in India have been discussed, by extracting some probable explanations from previous experience of chikungunya virus-vector model/studies. In the current context, it is hypothesized that Indian mosquito strains have lower susceptibility gradient/threshold for ZIKV. The very low positivity in the humans also indicates low levels of mosquito-human-mosquito transmission cycle. There is also a need to look for the existence of any such animal cycle/sylvatic involvement in India. The recently detected four cases in India show local transmission of ZIKV suggesting that ZIKV might have been present in India since long time. The earlier vector-virus relationship studies with chikungunya suggested that in due course of time, ZIKV might become a major public health concern in the future.

[Use of indicators of geographical accessibility to primary health care centers in addressing inequities].

Science.gov (United States)

De Pietri, Diana; Dietrich, Patricia; Mayo, Patricia; Carcagno, Alejandro; de Titto, Ernesto

2013-12-01

Characterize geographical indicators in relation to their usefulness in measuring regional inequities, identify and describe areas according to their degree of geographical accessibility to primary health care centers (PHCCs), and detect populations at risk from the perspective of access to primary care. Analysis of spatial accessibility using geographic information systems (GIS) involved three aspects: population without medical coverage, distribution of PHCCs, and the public transportation network connecting them. The development of indicators of demand (real, potential, and differential) and analysis of territorial factors affecting population mobility enabled the characterization of PHCCs with regard to their environment, thereby contributing to local and regional analysis and to the detection of different zones according to regional connectivity levels. Indicators developed in a GIS environment were very useful in analyzing accessibility to PHCCs by vulnerable populations. Zoning the region helped identify inequities by differentiating areas of unmet demand and fragmentation of spatial connectivity between PHCCs and public transportation.

The 'Green' concern in e-learning development findings from a university case study in the UK

DEFF Research Database (Denmark)

Lin, Chih-Cheng; Ma, Zheng; Gerstlberger, Wolfgang

2012-01-01

Purpose: the paper tries to address the question of whether universities concern 'Green' during e-learning development. Methodology: acase study approach is chosen for establishing empirical evidence and describing the phenomenon. Findings: the paper found that the green concern did not appear...... at the initial stage of e-learning strategy although there is green output - reusable resource at the e-learning delivery stage. However, the diversity of cost is still a critical concern for the e-learning adoption. Originality/value: this paper shows the missing awareness of green concern in the e...

A concern about the crack propagation rate of PWSCC which obtained from the investigation on primary coolant leakage portion of the reactor vessel head in Ohi 3

International Nuclear Information System (INIS)

Totsuka, Nobuo; Fukumura, Takuya

2010-01-01

There will be some concern about the content presented in the paper entitled 'Primary Coolant Leakage Path Research of Reactor Vessel Head Penetration' published in INSS JOURNAL of 2008, which may lead to misunderstanding about the PWSCC crack propagation rate, that is, the rate written in the paper seems to be faster than those reported by the previous studies. It is considered that such misunderstanding will be due to a sentence in the abstract of the paper. Therefore, we will revise a part of the abstract and explain about the outline of the paper again. (author)

Primary Criteria for Near Surface Disposal Facility in Egypt Proposal approach

International Nuclear Information System (INIS)

Abdellatif, M.M.

2013-01-01

The objective of radioactive waste disposal is to isolate waste from the surrounding media to protect human health and environment from the harmful effect of the ionizing radiation. The required degree of isolation can be obtained by implementing various disposal methods, of which near surface disposal represents an option commonly used and demonstrated in several countries. Near surface disposal has been practiced for some decades, with a wide variation in sites, types and amounts of wastes, and facility designs employed. Experience has shown that the effective and safe isolation of waste depends on the performance of the overall disposal system, which is formed by three major components or barriers: the site, the disposal facility and the waste form. The site selection process for low-level and intermediate level radioactive waste disposal facility addressed a wide range of public health, safety, environmental, social and economic factors. The primary goal of the sitting process is to identify a site that is capable of protecting public health, safety and the environment. This paper is concerning a proposal approach for the primary criteria for near surface disposal facility that could be applicable in Egypt.

Teachers' Stages of Concern for Media Literacy Education and the Integration of MLE in Chinese Primary Schools

Science.gov (United States)

Zhang, Hui; Zhu, Chang; Sang, Guoyuan

2014-01-01

Media literacy is an essential skill for living in the twenty-first century. School-based instruction is a critical part of media literacy education (MLE), while research on teachers' concerns and integration of MLE is not sufficient. The objective of this study is to investigate teachers' stages of concern (SoC), perceived need, school context,…

HEPA filter concerns - an overview

Energy Technology Data Exchange (ETDEWEB)

Leonard, J.F. [Department of Energy, Washington, DC (United States)

1995-02-01

The U.S. Department of Energy (DOE) recently initiated a complete review of the DOE High Efficiency Particulate Air (HEPA) Filter Program to identify areas for improvement. Although this process is currently ongoing, various issues and problems have already been identified for action that not only impacts the DOE HEPA filter program, but potentially the national and international air cleaning community as well. This paper briefly reviews a few of those concerns that may be of interest, and discusses actions initiated by the DOE to address the associated issues and problems. Issues discussed include: guidance standards, in-place testing, specifications, Test Facilities, portable units, vacuum cleaners, substitute aerosols, filter efficiencies, aging/shelf life/service life, fire suppression, handbook, Quality Products List (QPL), QA testing, and evaluations.

Elder Abuse and Neglect Intervention in the Clinical Setting: Perceptions and Barriers Faced by Primary Care Physicians in Malaysia.

Science.gov (United States)

Mohd Mydin, Fadzilah Hanum; Othman, Sajaratulnisah

2017-08-01

This qualitative study attempts to explore the definition, perceptions, practice experience, and barriers of primary care physicians (PCPs) in identifying and intervening in cases of elder abuse and neglect at the primary care level. Semistructured in-depth interview was conducted among 10 PCPs. Participants were selected by purposive sampling. The interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. In general, PCPs showed consistency in defining elder abuse and neglect. PCPs considered that they were optimally positioned to intervene in cases of elder abuse and neglect, but indicated the potential of overlooking such problems. The hurdles faced by PCPs in the identification and intervention of elder abuse were determined to be occurring at three levels: clinical, organizational, and policy. At the clinical level, PCPs recognize that they are lacking both the confidence and knowledge of elder abuse and neglect intervention. PCPs' conflicting personal and professional beliefs create barriers during the clinical practice. Time constraints, patients' other clinical problems, and, in addition, the preservation of a good doctor-patient relationship overshadow the importance of addressing and intervening in elder abuse and neglect issues during the consultation. This is further exacerbated by the barriers perceived by the patients: their nondisclosure and reluctance to accept outside intervention. At the organizational level, the lack of efficient interagency networks or support for the health system poses barriers. At the policy level, the absence of legislation specifically addressing elder abuse also creates considerable difficulties. However, PCPs gave differing responses when asked about a law concerning the elderly and mandatory reporting. Addressing these multilevel barriers is critical for ensuring that opportunities arising at the primary care level for elder maltreatment intervention are correctly utilized.

Changes in Aleut concerns following the stakeholder-driven Amchitka independent science assessment.

Science.gov (United States)

Burger, Joanna; Gochfeld, Michael

2009-08-01

There is widespread agreement that stakeholders should be included in the problem-formulation phase of addressing environment problems and, more recently, there have been attempts to include stakeholders in other phases of environmental research. However, there are few studies that evaluate the effects of including stakeholders in all phases of research aimed at solving environmental problems. Three underground nuclear blasts were detonated on Amchitka Island from 1965 to 1971. Considerable controversy developed when the Department of Energy (DOE) decided to "close" Amchitka. Concerns were voiced by subsistence Aleuts living in the region, resource trustees, and the State of Alaska, among others. This article evaluates perceptions of residents of three Aleutian village before (2003) and after (2005) the Consortium for Risk Evaluation with Stakeholder Participation's (CRESP) Amchitka Independent Science Assessment (AISA). The CRESP AISA provided technical information on radionuclide levels in biota to inform questions of seafood safety and food chain health. CRESP used the questions asked at public meetings in the Aleut communities of Atka, Nikolski, and Unalaska to evaluate attitudes and perceptions before and after the AISA. Major concerns before the AISA were credibility/trust of CRESP and the DOE, and information about biological methodology of the study. Following the AISA, people were most concerned about health effects and risk reduction, and trust issues with CRESP declined while those for the DOE remained stable. People's relative concerns about radionuclides declined, while their concerns about mercury (not addressed in the AISA) increased, and interest in ecological issues (population changes of local species) and the future (continued biomonitoring) increased from 2003 to 2005. These results suggest that questions posed at public meetings can be used to evaluate changes in attitudes and perceptions following environmental research, and the results are

Going Concern eller Concerned Going

DEFF Research Database (Denmark)

Haraszuk, Anni; Hartmann, Stig

2012-01-01

Højsæsonen for revision af årsrapporter 2011 er på trapperne; men hvordan håndterer revisorer egentlig going concern i praksis - i en tid præget af stejle op- og nedture?......Højsæsonen for revision af årsrapporter 2011 er på trapperne; men hvordan håndterer revisorer egentlig going concern i praksis - i en tid præget af stejle op- og nedture?...

Environmental Concerns, Environmental Policy and Green Investment

Directory of Open Access Journals (Sweden)

Xuexian Gao

2017-12-01

Full Text Available Environmental regulators often use environmental policy to induce green investment by firms. However, if an environmental policy fails to exert a long-run effect on regulating the economic agents’ behavior, it may be more reasonable to think of the firm as the leader in the game, since the investment in green technology is usually a strategic decision. In this paper, we consider a three-stage Stackelberg game to address the interaction between a profit-maximizing firm (Stackelberg leader facing emission-dependent demand, and the environmental regulator (Stackelberg follower. The firm decides on the green technology level in the first stage of the game based on its understanding of the regulator’s profits function, especially an environmental concern that is introduced as an exogenous variable. In the current research, we show that high levels of the regulator’s environmental concerns do not necessarily lead to the choice of green technology by the firm, and green investment level depends on the combined effects of the market and operational factors for a given level of the regulator’s environmental concerns. The result also shows that increasing environmental awareness amongst the consumers is an effective way to drive the firm’s green investment.

A systematic review of sexual concerns reported by gynecological cancer survivors.

Science.gov (United States)

Abbott-Anderson, Kristen; Kwekkeboom, Kristine L

2012-03-01

To identify physical, psychological and social sexual concerns reported by gynecological (GYN) cancer survivors. A systematic review of the literature was conducted using CINAHL, PubMed and PsycInfo databases. Reference lists from articles provided additional relevant literature. Only research articles from peer-reviewed journals were included. A total of 37 articles were located; 34 explored women's sexual concerns following gynecological cancer diagnosis and treatment and 3 tested interventions for sexual concerns in women with gynecological cancer. Sexual concerns were identified across all dimensions of sexuality. Common concerns in the physical dimension were dyspareunia, changes in the vagina, and decreased sexual activity. In the psychological dimension, common concerns were decreased libido, alterations in body image, and anxiety related to sexual performance. And in the social dimension, common concerns were difficulty maintaining previous sexual roles, emotional distancing from the partner, and perceived change in the partner's level of sexual interest. Of the three psychoeducational intervention studies, two reported improvements in physical aspects of sexual function, and one reported improved knowledge, but without resolution of sexual concerns. Gynecological cancer survivors experience a broad range of sexual concerns after diagnosis and treatment, but the majority of studies emphasized physical aspects of sexuality, and may not adequately represent women's psychological and social sexual concerns. Health care providers should remain mindful of psychological and social sexual concerns when caring for gynecologic cancer survivors. Future research should systematically evaluate the full range of sexual concerns in large, representative samples of GYN cancer survivors and develop and test interventions to address those concerns. Copyright © 2011 Elsevier Inc. All rights reserved.

Concerned with Computer Games: A Collective Analysis of Being and Becoming Gamer in Denmark

DEFF Research Database (Denmark)

Andersen, Mads Lund; Chimirri, Niklas Alexander; Jensen, Tine

2018-01-01

of effective and exact operationalization of variables gain prevalence over questions of conceptual clarity and conceptual development. The complexity of video game concerns, for instance in terms of their digital-analogue entanglements and how these co-enact the effects and meaning of violent video gaming......This paper suggests a collectively developed qualitative approach into inquiring and thereby shedding unexpected light on common concerns as expressed in psychological research on video gaming. For years, “The Video Game War” has been reproducing polarized debates on whether games are harmful......, is neither conceptually debated nor of concern. In DGS, on the other hand, such specificities and entanglements are not considered and issue of concern, leaving yet another conceptual void. This chapter therefore addresses video game concerns from psychological traditions that cross disciplinary boundaries...

Cosmic-ray antimatter - A primary origin hypothesis

Science.gov (United States)

Stecker, F. W.; Protheroe, R. J.; Kazanas, D.

1983-01-01

The present investigation is concerned with the possibility that the observed cosmic-ray protons are of primary extragalactic origin, taking into account the significance of the current antiproton data. Attention is given to questions regarding primary antiprotons, antihelium fluxes, and the propagation of extragalactic cosmic rays. It is concluded that the primary origin hypothesis should be considered as a serious alternative explanation for the cosmic-ray antiproton fluxes. Such extragalactic primary origin can be considered in the context of a baryon symmetric domain cosmology. The fluxes and propagation characteristics suggested are found to be in rough agreement with the present antiproton data.

Introducing quality improvement management methods into primary health care services in Uganda.

Science.gov (United States)

Omaswa, F; Burnham, G; Baingana, G; Mwebesa, H; Morrow, R

1996-01-01

Uganda's National Quality Assurance Program was established in 1994 to monitor the process of decentralization of primary health care services. Guidelines were developed to address problems (e.g., in obtaining health funds channeled through local government) identified at district meetings. Bringing together District Health Teams with local administrators and political leaders to share responsibility for strengthening health services has been a significant program achievement. A smoother functioning referral system from health units to district hospitals has resulted. The response to a measles outbreak in the Arua district in 1993-94 confirmed the utility of the quality management approach. Weaknesses in the district cold chain, problems with diagnostic accuracy, and a poorly functioning information system were identified as key causative factors, and corrective action in these areas led to a subsequent decline in measles cases. Patient dissatisfaction with long waiting times at Masaka Hospital was another concern addressed through the quality assurance approach. Five salient areas were identified for action: low health worker morale, supply shortages, inadequate supervision by hospital management, poor patient flow, and inefficient drug dispensing. As a result, long delays were eliminated and utilization of hospital outpatient services increased by 28%.

"Out of Fear and into Peace" President Eisenhower's Address of the United Nations.

Science.gov (United States)

Mueller, Jean West; Schamel, Wynell Burroughs

1990-01-01

Presents a section of President Dwight D. Eisenhower's, "Atoms for Peace," 1953 address to the United Nations General Assembly. Suggests using the document for classroom discussions of nuclear proliferation, emphasizing that using primary sources develops research skills, activates classroom discussions, citizenship, and creative…

Concerns for Skills Shortages in the 21st Century: A Review into the Construction Industry, Australia

Directory of Open Access Journals (Sweden)

Michelle Watson

2012-11-01

Full Text Available The Australian Construction Industry is now facing skills shortages in all trades. As an industry focused on the skill of its workforce, there is now concern the Australian standard in quality, workmanship, and productivity will inhibit both at national and international level.This research paper addresses the underlying, influential factors concerning skills shortages in the Australian construction industry. The influential factors addressed include funding, training statistics, employer expectations, financial limitations, Industrial Relations and immigration. Given the reference to skills shortages within the industry, and documented in related literature, if skills shortages are to continue to exist, their effect will impact upon the overall performance of construction companies throughout Australia.

Will you accept the government's friend request? Social networks and privacy concerns.

Science.gov (United States)

Siegel, David A

2013-01-01

Participating in social network websites entails voluntarily sharing private information, and the explosive growth of social network websites over the last decade suggests shifting views on privacy. Concurrently, new anti-terrorism laws, such as the USA Patriot Act, ask citizens to surrender substantial claim to privacy in the name of greater security. I address two important questions regarding individuals' views on privacy raised by these trends. First, how does prompting individuals to consider security concerns affect their views on government actions that jeopardize privacy? Second, does the use of social network websites alter the effect of prompted security concerns? I posit that prompting individuals to consider security concerns does lead to an increased willingness to accept government actions that jeopardize privacy, but that frequent users of websites like Facebook are less likely to be swayed by prompted security concerns. An embedded survey experiment provides support for both parts of my claim.

Persistence of Latino Students in Community Colleges: An Empowerment Model Addressing Acculturative Stress

Science.gov (United States)

Wilson, Judy C.

2012-01-01

College student persistence has been a concern of researchers and practitioners since the early 1960s. Traditional models have addressed the need for students to be integrated into the academic and social domains of the college campus. Recently, critical theorists and researchers have been questioning the relevance of the traditional models for…

Raising the topic of weight in general practice: perspectives of GPs and primary care nurses.

Science.gov (United States)

Blackburn, Maxine; Stathi, Afroditi; Keogh, Edmund; Eccleston, Christopher

2015-08-07

To explore general practitioners' (GPs) and primary care nurses' perceived barriers to raising the topic of weight in general practice. A qualitative study using the Theoretical Domains Framework (TDF). 34 semistructured interviews were conducted to explore views, opinions and experiences of initiating a discussion about weight. Content and thematic analyses were used to analyse the interview transcripts. General practices located in one primary care trust in the South West of England. 17 GPs and 17 nurses aged between 32 and 66 years. The modal age range for GPs was 30-39 years and for nurses, 40-49 years. Barriers were synthesised into three main themes: (1) limited understanding about obesity care, (2) concern about negative consequences, and (3) having time and resources to raise a sensitive topic. Most barriers were related to raising the topic in more routine settings, rather than when dealing with an associated medical condition. GPs were particularly worried about damaging their relationship with patients and emphasised the need to follow their patient's agenda. Uncertainty about obesity, concerns about alienating patients and feeling unable to raise the topic within the constraints of a 10 min consultation, is adding to the reluctance of GPs and nurses to broach the topic of weight. Addressing these concerns through training or by providing evidence of effective interventions that are feasible to deliver within consultations may lead to greater practitioner engagement and willingness to raise the topic. 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.

Addressing the Concerns Surrounding Continuous Deep Sedation in Singapore and Southeast Asia: A Palliative Care Approach.

Science.gov (United States)

Krishna, Lalit Kumar Radha

2015-09-01

The application of continuous deep sedation (CDS) in the treatment of intractable suffering at the end of life continues to be tied to a number of concerns that have negated its use in palliative care. Part of the resistance towards use of this treatment option of last resort has been the continued association of CDS with physician-associated suicide and/or euthanasia (PAS/E), which is compounded by a lack clinical guidelines and a failure to cite this treatment under the aegis of a palliative care approach. I argue that reinstituting a palliative care-inspired approach that includes a holistic review of the patient's situation and the engagement of a multidisciplinary team (MDT) guided by clearly defined practice requirements that have been lacking amongst many prevailing guidelines will overcome prevailing objections to this practice and allow for the legitimization of this process.

Some Behaviorial Science Measurement Concerns and Proposals.

Science.gov (United States)

Nesselroade, John R; Molenaar, Peter C M

2016-01-01

Primarily from a measurement standpoint, we question some basic beliefs and procedures characterizing the scientific study of human behavior. The relations between observed and unobserved variables are key to an empirical approach to building explanatory theories and we are especially concerned about how the former are used as proxies for the latter. We believe that behavioral science can profitably reconsider the prevailing version of this arrangement because of its vulnerability to limiting idiosyncratic aspects of observed/unobserved variable relations. We describe a general measurement approach that takes into account idiosyncrasies that should be irrelevant to the measurement process but can intrude and may invalidate it in ways that distort and weaken relations among theoretically important variables. To clarify further our major concerns, we briefly describe one version of the measurement approach that fundamentally supports the individual as the primary unit of analysis orientation that we believe should be preeminent in the scientific study of human behavior.

Primary care in a new era: disillusion and dissolution?.

Science.gov (United States)

Sandy, Lewis G; Schroeder, Steven A

2003-02-04

The current dilemmas in primary care stem from 1) the unintended consequences of forces thought to promote primary care and 2) the "disruptive technologies of care" that attack the very function and concept of primary care itself. This paper suggests that these forces, in combination with "tiering" in the health insurance market, could lead to the dissolution of primary care as a single concept, to be replaced by alignment of clinicians by economic niche. Evidence already exists in the marketplace for both tiering of health insurance benefits and corresponding practice changes within primary care. In the future, primary care for the top tier will cater to the affluent as "full-service brokers" and will be delivered by a wide variety of clinicians. The middle tier will continue to grapple with tensions created by patient demand and bureaucratic systems but will remain most closely aligned to primary care as a concept. The lower tier will become increasingly concerned with community health and social justice. Each primary care specialty will adapt in a unique way to a tiered world, with general internal medicine facing the most challenges. Given this forecast for the future, those concerned about primary care should focus less on workforce issues and more on macro health care financing and organization issues (such as Medicare reform); appropriate training models; and the development of a conception of primary care that emphasizes values and ethos, not just function.

Employment status, employment functioning, and barriers to employment among VA primary care patients.

Science.gov (United States)

Zivin, Kara; Yosef, Matheos; Levine, Debra S; Abraham, Kristen M; Miller, Erin M; Henry, Jennifer; Nelson, C Beau; Pfeiffer, Paul N; Sripada, Rebecca K; Harrod, Molly; Valenstein, Marcia

2016-03-15

Prior research found lower employment rates among working-aged patients who use the VA than among non-Veterans or Veterans who do not use the VA, with the lowest reported employment rates among VA patients with mental disorders. This study assessed employment status, employment functioning, and barriers to employment among VA patients treated in primary care settings, and examined how depression and anxiety were associated with these outcomes. The sample included 287 VA patients treated in primary care in a large Midwestern VA Medical Center. Bivariate and multivariable analyses were conducted examining associations between socio-demographic and clinical predictors of six employment domains, including: employment status, job search self-efficacy, work performance, concerns about job loss among employed Veterans, and employment barriers and likelihood of job seeking among not employed Veterans. 54% of respondents were employed, 36% were not employed, and 10% were economically inactive. In adjusted analyses, participants with depression or anxiety (43%) were less likely to be employed, had lower job search self-efficacy, had lower levels of work performance, and reported more employment barriers. Depression and anxiety were not associated with perceived likelihood of job loss among employed or likelihood of job seeking among not employed. Single VA primary care clinic; cross-sectional study. Employment rates are low among working-aged VA primary care patients, particularly those with mental health conditions. Offering primary care interventions to patients that address mental health issues, job search self-efficacy, and work performance may be important in improving health, work, and economic outcomes. Published by Elsevier B.V.

Assessment of Patient Safety Culture in Primary Health Care Settings in Kuwait

Directory of Open Access Journals (Sweden)

Maha Mohamed Ghobashi

2014-01-01

Full Text Available Background Patient safety is critical component of health care quality. We aimed to assess the awareness of primary healthcare staff members about patient safety culture and explore the areas of deficiency and opportunities for improvement concerning this issue.Methods: This descriptive cross sectional study surveyed 369 staff members in four primary healthcare centers in Kuwait using self-administered “Hospital Survey on Patient Safety Culture” adopted questionnaire. The total number of respondents was 276 participants (response rate = 74.79%.Results: Five safety dimensions with lowest positivity (less than 50% were identified and these are; the non – punitive response to errors, frequency of event reporting, staffing, communication openness, center handoffs and transitions with the following percentages of positivity 24%, 32%, 41%, 45% and 47% respectively. The dimensions of highest positivity were teamwork within the center’s units (82% and organizational learning (75%.Conclusion: Patient safety culture in primary healthcare settings in Kuwait is not as strong as improvements for the provision of safe health care. Well-designed patient safety initiatives are needed to be integrated with organizational policies, particularly the pressing need to address the bioethical component of medical errors and their disclosure, communication openness and emotional issues related to them and investing the bright areas of skillful organizational learning and strong team working attitudes.    

Patients' Aesthetic Concerns After Horizontally Placed Abdominal Free Flap Breast Reconstruction.

Science.gov (United States)

Kim, Eun Key; Suh, Young Chul; Maldonado, Andrés A; Yun, Jiyoung; Lee, Taik Jong

2015-10-01

The present study aimed to analyze patients' aesthetic concerns after breast reconstruction with abdominal free flap by reporting secondary cosmetic procedures performed based on the patients' request, and analyzed the effect of adjuvant therapies and other variables on such outcomes. All patients who underwent unilateral immediate reconstruction were enrolled prospectively. Free abdominal flaps were placed horizontally with little manipulation. Secondary procedures were actively recommended during the follow-up period to meet the patients' aesthetic concerns. The numbers and types of the secondary procedures and the effects of various factors were analyzed. 150 patients met the eligibility criteria. The average number of overall secondary surgeries per patient was 1.25. Patients with skin-sparing mastectomy required significantly higher number of secondary surgeries compared with those who underwent nipple-areolar skin-sparing mastectomy. When confined to the cosmetic procedures, 58 (38.7 %) patients underwent 75 operations. The most common procedures were flank dog ear revision, fat injection of the reconstructed breast, and breast liposuction. None of the radiated patients underwent liposuction of the flap. Most commonly liposuctioned regions were the central-lateral and lower-lateral, while fat was most commonly injected to the upper-medial and upper-central part of the breast. The present study delineated the numbers and types of the secondary operations after horizontally placed abdominal free flap transfer with analysis of the influence of various factors. Addressing such issues during the primary reconstruction would help to reduce the need and extent of the secondary operations and to maximize aesthetic outcome. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Barriers to primary care responsiveness to poverty as a risk factor for health.

Science.gov (United States)

Bloch, Gary; Rozmovits, Linda; Giambrone, Broden

2011-06-29

Poverty is widely recognized as a major determinant of poor health, and this link has been extensively studied and verified. Despite the strong evidentiary link, little work has been done to determine what primary care health providers can do to address their patients' income as a risk to their health. This qualitative study explores the barriers to primary care responsiveness to poverty as a health issue in a well-resourced jurisdiction with near-universal health care insurance coverage. One to one interviews were conducted with twelve experts on poverty and health in primary care in Ontario, Canada. Participants included family physicians, specialist physicians, nurse practitioners, community workers, advocates, policy experts and researchers. The interviews were analysed for anticipated and emergent themes. This study reveals provider- and patient-centred structural, attitudinal, and knowledge-based barriers to addressing poverty as a risk to health. While many of its findings reinforce previous work in this area, this study's findings point to a number of areas front line primary care providers could target to address their patients' poverty. These include a lack of provider understanding of the lived reality of poverty, leading to a failure to collect adequate data about patients' social circumstances, and to the development of inappropriate care plans. Participants also pointed to prejudicial attitudes among providers, a failure of primary care disciplines to incorporate approaches to poverty as a standard of care, and a lack of knowledge of concrete steps providers can take to address patients' poverty. While this study reinforces, in a well-resourced jurisdiction such as Ontario, the previously reported existence of significant barriers to addressing income as a health issue within primary care, the findings point to the possibility of front line primary care providers taking direct steps to address the health risks posed by poverty. The consistent

Biomass stakeholder views and concerns: Environmental groups and some trade association

Energy Technology Data Exchange (ETDEWEB)

Peelle, E.

2000-01-01

This exploratory study of the views and concerns of 25 environmental organizations found high interest and concern about which biomass feedstocks would be used and how these biomass materials would be converted to energy. While all favored renewable energy over fossil or nuclear energy, opinion diverged over whether energy crops, residues, or both should be the primary source of a biomass/bioenergy fuel cycle. About half of the discussants favored biomass ``in general'' as a renewable energy source, while the others were distributed about equally over five categories, from favor-with-conditions, uncertain, skeptical, opposed, to ``no organizational policy.''

Biomass stakeholder views and concerns: Environmental groups and some trade associations

International Nuclear Information System (INIS)

Peelle, E.

2000-01-01

This exploratory study of the views and concerns of 25 environmental organizations found high interest and concern about which biomass feedstocks would be used and how these biomass materials would be converted to energy. While all favored renewable energy over fossil or nuclear energy, opinion diverged over whether energy crops, residues, or both should be the primary source of a biomass/bioenergy fuel cycle. About half of the discussants favored biomass ''in general'' as a renewable energy source, while the others were distributed about equally over five categories, from favor-with-conditions, uncertain, skeptical, opposed, to ''no organizational policy.''

Strengthening "the Foundations" of the Primary School Curriculum

Science.gov (United States)

Duncombe, Rebecca; Cale, Lorraine; Harris, Jo

2018-01-01

The low status of the foundation subjects (e.g. Music and Physical Education (PE)) in English primary schools is well documented. Using PE as an illustrative example, a thematic analysis of 51 PE trainee students' assignments, based on their perceptions of a two-week experience in a primary school, highlighted a number of areas of concern (e.g.…

Adherence to best practice guidelines in dyspepsia: a survey comparing dyspepsia experts, community gastroenterologists and primary-care providers.

Science.gov (United States)

Spiegel, B M R; Farid, M; van Oijen, M G H; Laine, L; Howden, C W; Esrailian, E

2009-04-15

Although 'best practice' guidelines for dyspepsia management have been disseminated, it remains unclear whether providers adhere to these guidelines. To compare adherence to 'best practice' guidelines among dyspepsia experts, community gastroenterologists and primary-care providers (PCPs). We administered a vignette survey to elicit knowledge and beliefs about dyspepsia including a set of 16 best practices, to three groups: (i) dyspepsia experts; (ii) community gastroenterologists and (iii) PCPs. The expert, community gastroenterologist and PCP groups endorsed 75%, 73% and 57% of best practices respectively. Gastroenterologists were more likely to adhere with guidelines than PCPs (P guideline adherence (P = 0.04). Gastroenterologists are more likely than PCPs to comply with best practices in dyspepsia, although compliance remains incomplete in both groups. PCPs harbour more concerns regarding long-term PPI use and these concerns may affect therapeutic decision making. This suggests that best practices have not been uniformly adopted and persistent guideline-practice disconnects should be addressed.

Searching for resilience: addressing the impacts of changing disturbance regimes on forest ecosystem services

Science.gov (United States)

Rupert Seidl; Thomas A. Spies; David L. Peterson; Scott L. Stephens; Jeffrey A. Hicke

2015-01-01

Summary 1. The provisioning of ecosystem services to society is increasingly under pressure from global change. Changing disturbance regimes are of particular concern in this context due to their high potential impact on ecosystem structure, function and composition. Resiliencebased stewardship is advocated to address these changes in ecosystem management,...

Comic Relief: Graduate Students Address Multiple Meanings for Technology Integration with Digital Comic Creation

Science.gov (United States)

Sockman, Beth Rajan; Sutton, Rhonda; Herrmann, Michele

2016-01-01

This study determined the usefulness of digital comic creation with 77 graduate students in a teacher technology course. Students completed an assigned reading and created digital comics that addressed technology integration concerns in the schools and society. Using practical action research, 77 student-created comics were analyzed. The findings…

Concerns about identity and services among people with autism and Asperger's regarding DSM-5 changes.

Science.gov (United States)

Spillers, Jessica L H; Sensui, Leonard M; Linton, Kristen F

2014-01-01

The Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2012 ) now includes a new autism spectrum diagnosis (ASD) with previous separate diagnoses of autism removed. This study explores the concerns of people with Asperger's syndrome (AS) and autistic disorder (AD). Discussion forum data of people with AS and AD (N = 76) were analyzed using phenomenological, inductive-content analysis to gather qualitative data about the concerns of people with AS and AD regarding the changes in the DSM-5. People with AS and AD were concerned about identity, community, the cure movement, and services. They also discussed using advocacy and solidarity to address their concerns.

Nuclear Education and training: addressing a global need

International Nuclear Information System (INIS)

Dunn Lee, Janice

2008-01-01

There is growing concern about the difficulties nuclear institutions in many OECD/NEA member countries are experiencing in recruiting qualified specialists. Recent studies have also shown that nuclear education and training have been suffering declines of various degrees. If no action is taken on this issue, the nuclear sector risks facing a shortage of qualified human resources to ensure the appropriate regulation and operation of existing nuclear facilities as well as the construction of new ones in those countries wishing to do so. The NEA Steering Committee for Nuclear Energy issued a statement on this subject in October 2007, the complete text of which is available at: www.nea.fr/html/general/press/2007/2007-05.html. The NEA has for many years been involved in efforts to define and address the need for qualified human resources. In this regard, the Agency: 1- carries out assessments of requirements and availability of qualified human resources in the nuclear field, 2- enhances nuclear education programmes, such as the International School of Nuclear Law, and 3- encourages large, high-profile international research and development programmes. These areas are addressed in the NEA Strategic Plan as well as in the specific NEA programmes discussed below. The presentation will focus on ways to address the issue of qualified human resources, share information about what others are doing, and discuss what we might do collectively. (author)

[Detection of intimate partner violence in primary care and related factors].

Science.gov (United States)

Rodríguez-Blanes, Gloria M; Vives-Cases, Carmen; Miralles-Bueno, Juan José; San Sebastián, Miguel; Goicolea, Isabel

Intimate partner violence (IPV) against women is a significant public health and human rights problem. Primary care professionals play a key role in detecting and addressing this issue. The aim of this study is to determine the frequency of IPV and its associated factors in primary care by means of a screening questionnaire and to describe the main actions taken in identified cases. Cross-sectional study in 15 health centres in four autonomous regions of Spain with a total of 265 health professionals. The information was collected through the self-administered PREMIS questionnaire (Physician Readiness to Manage Intimate Partner Violence Survey), which includes variables concerning screening questions, sociodemographic factors, level of training/knowledge about IPV, perceptions and actions. A descriptive and analytical study was conducted. 67.2% of participants said they ask about IPV during consultations. The most frequent actions were: referring patients to other departments, individual counselling and information delivery. ≥21hours of training, an advanced training level, knowledge of policies and programmes and the implementation of an appropriate protocol and reference resources were all factors that increased the likelihood of investigating IPV. The asking of questions increases in line with professionals' perceived level of training in IPV and the provision of a case management protocol. Two thirds of health professional respondents said they inquire about IPV. Given the influence of training in IPV and awareness of the resources to address the issue, it is essential to continue investing in the IPV training of healthcare personnel. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care.

Science.gov (United States)

Coxeter, Peter; Del Mar, Chris B; McGregor, Leanne; Beller, Elaine M; Hoffmann, Tammy C

2015-11-12

Shared decision making is an important component of patient-centred care. It is a set of communication and evidence-based practice skills that elicits patients' expectations, clarifies any misperceptions and discusses the best available evidence for benefits and harms of treatment. Acute respiratory infections (ARIs) are one of the most common reasons for consulting in primary care and obtaining prescriptions for antibiotics. However, antibiotics offer few benefits for ARIs, and their excessive use contributes to antibiotic resistance - an evolving public health crisis. Greater explicit consideration of the benefit-harm trade-off within shared decision making may reduce antibiotic prescribing for ARIs in primary care. To assess whether interventions that aim to facilitate shared decision making increase or reduce antibiotic prescribing for ARIs in primary care. We searched CENTRAL (2014, Issue 11), MEDLINE (1946 to November week 3, 2014), EMBASE (2010 to December 2014) and Web of Science (1985 to December 2014). We searched for other published, unpublished or ongoing trials by searching bibliographies of published articles, personal communication with key trial authors and content experts, and by searching trial registries at the National Institutes of Health and the World Health Organization. Randomised controlled trials (RCTs) (individual level or cluster-randomised), which evaluated the effectiveness of interventions that promote shared decision making (as the focus or a component of the intervention) about antibiotic prescribing for ARIs in primary care. Two review authors independently extracted and collected data. Antibiotic prescribing was the primary outcome, and secondary outcomes included clinically important adverse endpoints (e.g. re-consultations, hospital admissions, mortality) and process measures (e.g. patient satisfaction). We assessed the risk of bias of all included trials and the quality of evidence. We contacted trial authors to obtain missing

Will you accept the government's friend request? Social networks and privacy concerns.

Directory of Open Access Journals (Sweden)

David A Siegel

Full Text Available Participating in social network websites entails voluntarily sharing private information, and the explosive growth of social network websites over the last decade suggests shifting views on privacy. Concurrently, new anti-terrorism laws, such as the USA Patriot Act, ask citizens to surrender substantial claim to privacy in the name of greater security. I address two important questions regarding individuals' views on privacy raised by these trends. First, how does prompting individuals to consider security concerns affect their views on government actions that jeopardize privacy? Second, does the use of social network websites alter the effect of prompted security concerns? I posit that prompting individuals to consider security concerns does lead to an increased willingness to accept government actions that jeopardize privacy, but that frequent users of websites like Facebook are less likely to be swayed by prompted security concerns. An embedded survey experiment provides support for both parts of my claim.

A New Method of Chinese Address Extraction Based on Address Tree Model

Directory of Open Access Journals (Sweden)

KANG Mengjun

2015-01-01

Full Text Available Address is a spatial location encoding method of individual geographical area. In China, address planning is relatively backward due to the rapid development of the city, resulting in the presence of large number of non-standard address. The space constrain relationship of standard address model is analyzed in this paper and a new method of standard address extraction based on the tree model is proposed, which regards topological relationship as consistent criteria of space constraints. With this method, standard address can be extracted and errors can be excluded from non-standard address. Results indicate that higher math rate can be obtained with this method.

National survey addressing the information needs of primary care physicians: Side effect management of patients on androgen deprivation therapy.

Science.gov (United States)

Soeyonggo, Tony; Locke, Jennifer; Giudice, Maria Elizabeth Del; Alibhai, Shabbir; Fleshner, Neil Eric; Warde, Padraig

2014-03-01

Androgen deprivation therapy (ADT) is a common treatment for prostate cancer with numerous side effects. We assess primary care physicians' (PCPs) knowledge of ADT side effects and their interest in increasing their knowledge in this area. A list of active Canadian PCPs was obtained using the Canadian Medical Directory. A cross-sectional survey was distributed to 600 randomly selected physicians. We collected PCPs' demographic information, experience with ADT management, knowledge regarding ADT side effects and desired sources for obtaining knowledge on ADT management. In total, we received 103 completed questionnaires. Of these, 89% of PCPs had patients on ADT. One-third of respondents prescribed ADT and over half of them administered ADT annually. Thirty-eight percent felt their knowledge of ADT side effects was inadequate and 50% felt uncomfortable counselling patients on ADT. Many PCPs were less familiar with the incidence of functional side effects of ADT (i.e., hot flashes, fatigue and erectile dysfunction) compared to life-threatening side effects (i.e., cardiovascular events, metabolic syndrome, fractures). In terms of increasing their knowledge of ADT side effects, 82% of PCPs would use educational resources if they were available (52% and 32% preferred continued medical education [CME] events and educational pamphlets, respectively). PCPs play an important role in managing ADT side effects. There is poor awareness of the prevalence of ADT side effects, and many are uncomfortable in managing these side effects. These areas may be addressed through CME programs and educational pamphlets.

Primary mental health prevention themes in published research and academic programs in Israel.

Science.gov (United States)

Nakash, Ora; Razon, Liat; Levav, Itzhak

2015-01-01

The World Health Organization Comprehensive Mental Health Action Plan (CMHAP) 2013-2020 proposes the implementation of primary prevention strategies to reduce the mental health burden of disease. The extent to which Israeli academic programs and published research adhere to the principles spelled out by the CMHAP is unknown. To investigate the presence of mental health primary prevention themes in published research and academic programs in Israel. We searched for mental health primary prevention themes in: (1) three major journals of psychiatry and social sciences during the years 2001-2012; (2) university graduate programs in psychology, social work and medicine in leading universities for the academic year of 2011-2012; and (3) doctoral and master's theses approved in psychology and social work departments in five universities between the years 2007-2012. We used a liberal definition of primary prevention to guide the above identification of themes, including those related to theory, methods or research information of direct or indirect application in practice. Of the 934 articles published in the three journals, 7.2%, n = 67, addressed primary prevention. Of the 899 courses in the 19 graduate programs 5.2%, n = 47, elective courses addressed primary prevention. Of the 1960 approved doctoral and master's theses 6.2%, n = 123, addressed primary prevention. Only 11 (4.7%) articles, 5 (0.6%) courses, and 5 (0.3%) doctoral and master's theses addressed primary prevention directly. The psychiatric reform currently implemented in Israel and WHO CMHAP call for novel policies and course of action in all levels of prevention, including primary prevention. Yet, the latter is rarely a component of mental health education and research activities. The baseline we drew could serve to evaluate future progress in the field.

Reply by the Federal Government to a question concerning new primary energy sources raised in the Bundestag

Energy Technology Data Exchange (ETDEWEB)

Matthoefer, H [Bundesministerium fuer Forschung und Technologie, Bonn (F.R. Germany)

1976-06-01

A question raised in the Bundestag concerning new primary energy sources was answered by the Federal Minister for Science and Technology in his letter dated June 2, 1976; the letter called attention to the Federal Government's energy program of September 1973 which, instead of promoting research almost exclusively on the nuclear sector as used to be the case, aims at a purposeful and comprehensive promotion by the state of non-nuclear energy research as well in the FRG. Solar energy seems to have the best chance in the FRG of being utilized in an industrial way, applying low-temperature collectors to recover heat for heating and hot water preparation; 28 million DM have been invested so far. Despite the fact that the technical potential of wind power in the FRG would cover almost 75% of the present electricity demand, only plants with a small kW range are being developed at the moment as the question of energy storage is still open; 0.3 million DM have been granted so far. The utilization of geothermal power can only be of interest for the FRG on the basis of the hot-dry-rock method; drilling work is carried out in the Eifel district investigating geothermal gradients: 1.25 million DM have been granted so far. In 1976 the projects mentioned above have been allotted research funds amounting to 20 million DM. Energy from running/tidal waters is utilized in the FRG to 90% so far, but this only accounts for 6.7% of the gross electricity generation. Therefore, its importance for the energy supply of the FRG will decrease when the energy demand increases.

Primary optic nerve sheath meningioma

Energy Technology Data Exchange (ETDEWEB)

Jeremic, Branislav [International Atomic Energy Agency, Vienna (Austria); Pitz, Susanne (eds.) [University Eye Hospital, Mainz (Germany)

2008-07-01

Optic nerve sheath meningioma (ONSM) is a rare tumour. Cases are usually separated into primary ONSM, which arises either intraorbitally or, less commonly, intracanalicularly, and secondary ONSM, which arises intracranially and subsequently invades the optic canal and orbit. This is the first book to cover all important aspects of the diagnosis and treatment of primary ONSM. After a general introduction, individual chapters discuss the clinical presentation, clinical examination and diagnosis, imaging, and histology. Treatment options are then addressed in detail, with special emphasis on external beam radiation therapy, and in particular stereotactic fractionated radiation therapy. The latter has recently produced consistently good results and is now considered the emerging treatment of choice for the vast majority of patients with primary ONSM. This well-illustrated book will prove invaluable to all practitioners who encounter primary ONSM in their clinical work. (orig.)

What factors mediate the relationship between global self-worth and weight and shape concerns?

Science.gov (United States)

Murphy, Edel; Dooley, Barbara; Menton, Aoife; Dolphin, Louise

2016-04-01

The primary aim of this study was to investigate whether the relationship between global self-worth and weight concerns and global self-worth and shape concerns was mediated by pertinent body image factors, while controlling for gender and estimated BMI. Participants were 775 adolescents (56% male) aged 12-18years (M=14.6; SD=1.50). Mediation analysis revealed a direct and a mediated effect between global self-worth and two body image models: 1) weight concerns and 2) shape concerns. The strongest mediators in both models were physical appearance, restrained eating, and depression. Partial mediation was observed for both models, indicating that body image factors which span cognitive, affective, and behavioral constructs, explain the association between global self-worth and weight and shape concerns. Implications for future research, weight and shape concern prevention and global self-worth enhancement programs are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

THE PRAGMATIC MEANINGS OF ADDRESS TERMS SAMPEYAN AND ANDA

Directory of Open Access Journals (Sweden)

Djoko Susanto

2014-07-01

Full Text Available Abstract: This research investigates the use of sampeyan and anda by the students from Pasuruan and Probolinggo. Address terms is one of important tools in communication in Javanese society as it is used, for example, to designate the person they are talking to or to show the possession of formal and informal manners. However, the use of this address terms may have different interpretation across regions. This research is undertaken to find out (1 factors that influence the choice of address terms sampeyan and anda in Pasuruan and Probolinggo and (2 situations in which the interlocutors use the address terms sampeyan and anda. Several theories are used to help analyze the data, which include address terms (Wardhaugh, 2002, sampeyan and anda (Wolf & Poedjosoedarmo, 1982, Politeness theory (Brown & Levinson, 1987, and Power and Solidarity (Brown & Gilman, 1960. The data were obtained from the results of observations, questionnaires and interviews with the participants. The results of the study show that both sampeyan and anda were found to be commonly used by the participants to address their lecturer, instead of using Bapak. This is, of course, uncommon from either the perspective of standard usage of Javanese or Indonesian language. This study also indicates that the participants used sampeyan to lecturer/teacher, kyai, parent, and older sibling because they wanted to express (1 express politeness and (2 to indicate informality. Concerning to the use of anda, this study reveals that the participants use this address term because of (1 more formal and appropriate manners in environmental education, (2 respecting person of higher social status and older person, (3 more polite and more appropriate than sampeyan, and (4 the use of Indonesian as a formal language. In some respect, however, the participants use anda to lecturer/teacher, which is not appropriate because they were not socially equal to the lecturer/teacher.  This study provide

Long-term criticality safety concerns associated with surplus fissile material disposition

International Nuclear Information System (INIS)

Choi, J.S.

1995-01-01

A substantial inventory of surplus fissile material would result from ongoing and planned dismantlement of US and Russian nuclear weapons. This surplus fissile material could be dispositioned by irradiation in nuclear reactors, and the resulting spent MOx fuel would be similar in radiation characteristics to regular LWR spent UO2 fuel. The surplus fissile material could also be immobilized into high-level waste forms, such as borosilicate glass, synroc, or metal-alloy matrix. The MOx spent fuel, or the immobilized waste forms, could then be directly disposed of in a geologic repository. Long-term criticality safety concerns arise because the fissile contents (i.e., Pu-239 and its decay daughter U-235) in these waste forms are higher than in LWR spent UO2 fuel. MOx spent fuel could contain 3 to 4 wt% of reactor-grade plutonium, compared to only 0.9 wt% of plutonium in LWR spent UO2 fuel. At some future time (tens of thousand of years), when the waste forms had deteriorated due to intruding groundwater, the water could mix with the long-lived fissile materials to form into a critical system. If the critical system is self-sustaining, somewhat like the natural-occurring reactor in OKLO, fission products produced could readily be available for dissolution and release out to the accessible environment, adversely affecting public health and safety. This paper will address ongoing activities to evaluate long-term criticality safety concerns associated with disposition of fissile material in a geologic setting. Issues to be addressed include the identification of a worst-case water-intrusion scenario and waste-form geometries which present the most concern for long-term criticality safety; and suggests of technical solutions for such concerns

Army Biometric Applications. Identifying and Addressing Sociocultural Concerns

National Research Council Canada - National Science Library

Woodward, John

2001-01-01

... information, depends on fast and accurate identification. The Army also operates a vast set of human resource services involving health care, retiree and dependent benefits, and troop support services. These services create the need for positive identification to prevent fraud and abuse.

Health technology assessment and primary data collection for reducing uncertainty in decision making.

Science.gov (United States)

Goeree, Ron; Levin, Les; Chandra, Kiran; Bowen, James M; Blackhouse, Gord; Tarride, Jean-Eric; Burke, Natasha; Bischof, Matthias; Xie, Feng; O'Reilly, Daria

2009-05-01

Health care expenditures continue to escalate, and pressures for increased spending will continue. Health care decision makers from publicly financed systems, private insurance companies, or even from individual health care institutions, will continue to be faced with making difficult purchasing, access, and reimbursement decisions. As a result, decision makers are increasingly turning to evidence-based platforms to help control costs and make the most efficient use of existing resources. Most tools used to assist with evidence-based decision making focus on clinical outcomes. Health technology assessment (HTA) is increasing in popularity because it also considers other factors important for decision making, such as cost, social and ethical values, legal issues, and factors such as the feasibility of implementation. In some jurisdictions, HTAs have also been supplemented with primary data collection to help address uncertainty that may still exist after conducting a traditional HTA. The HTA process adopted in Ontario, Canada, is unique in that assessments are also made to determine what primary data research should be conducted and what should be collected in these studies. In this article, concerns with the traditional HTA process are discussed, followed by a description of the HTA process that has been established in Ontario, with a particular focus on the data collection program followed by the Programs for Assessment of Technology in Health Research Institute. An illustrative example is used to show how the Ontario HTA process works and the role value of information analyses plays in addressing decision uncertainty, determining research feasibility, and determining study data collection needs.

Primary-care based participatory rehabilitation: users' views of a horticultural and arts project.

Science.gov (United States)

Barley, Elizabeth A; Robinson, Susan; Sikorski, Jim

2012-02-01

Participation in horticulture and arts may improve wellbeing in those with mental and physical illness. To conduct an in-depth exploration of the views and experience of participants of a primary-care-based horticultural and participatory arts rehabilitation project (Sydenham Garden). Qualitative interview study of a primary-care-based horticultural and participatory arts rehabilitation project in South London. Semi-structured interviews were conducted with 16 participants (referred to as 'coworkers') of Sydenham Garden. Seven were female. Participants were aged between 38 and 91 years and had a range of severe mental and physical health problems; most had depression. The interviews were analysed using constant comparison and thematic analysis. Data were overwhelmingly positive concerning participation. Coworkers considered participation in the project to promote wellbeing by providing purposeful and enjoyable activity and interest, improving mood and self-perceptions, and providing an escape from life's pressures. Being outdoors was considered therapeutic. The most-valued aspect of participation was the social contact derived as a result of it. Many of the coworkers who were interviewed developed transferable skills, including nationally recognised qualifications, which they valued highly. Delivery of horticultural therapy and participatory arts is a feasible model for improving wellbeing in patients in primary care who have serious illness. Longer-term studies are needed to address what happens to people after leaving such projects.

Concerning the primary and secondary objectives in robot task definition - the "learn from humans" principle

NARCIS (Netherlands)

Potkonjak, V.; Tzafestas, S.; Kostic, D.

2000-01-01

This paper is concerned with the trajectory definition in robot tasks. Although very often ignored, the specification of robot motion is not the first step in the definition of a robot task. The task definition starts with the description of the final outcome, i.e. with the specification of the job

External Quality Assurance in Higher Education: How Can It Address Corruption and Other Malpractices?

Science.gov (United States)

Martin, Michaela

2016-01-01

Corruption and malpractices in higher education are today a major concern in nearly all higher education systems worldwide. It is a multifaceted phenomenon and has become particularly visible in the academic domain. This paper represents an exploration of the possible role that quality assurance can play in addressing corruption and malpractices.…

Factors shaping intersectoral action in primary health care services.

Science.gov (United States)

Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael

2014-12-01

To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.

Do systematic reviews address community healthcare professionals' wound care uncertainties? Results from evidence mapping in wound care.

Science.gov (United States)

Christie, Janice; Gray, Trish A; Dumville, Jo C; Cullum, Nicky A

2018-01-01

Complex wounds such as leg and foot ulcers are common, resource intensive and have negative impacts on patients' wellbeing. Evidence-based decision-making, substantiated by high quality evidence such as from systematic reviews, is widely advocated for improving patient care and healthcare efficiency. Consequently, we set out to classify and map the extent to which up-to-date systematic reviews containing robust evidence exist for wound care uncertainties prioritised by community-based healthcare professionals. We asked healthcare professionals to prioritise uncertainties based on complex wound care decisions, and then classified 28 uncertainties according to the type and level of decision. For each uncertainty, we searched for relevant systematic reviews. Two independent reviewers screened abstracts and full texts of reviews against the following criteria: meeting an a priori definition of a systematic review, sufficiently addressing the uncertainty, published during or after 2012, and identifying high quality research evidence. The most common uncertainty type was 'interventions' 24/28 (85%); the majority concerned wound level decisions 15/28 (53%) however, service delivery level decisions (10/28) were given highest priority. Overall, we found 162 potentially relevant reviews of which 57 (35%) were not systematic reviews. Of 106 systematic reviews, only 28 were relevant to an uncertainty and 18 of these were published within the preceding five years; none identified high quality research evidence. Despite the growing volume of published primary research, healthcare professionals delivering wound care have important clinical uncertainties which are not addressed by up-to-date systematic reviews containing high certainty evidence. These are high priority topics requiring new research and systematic reviews which are regularly updated. To reduce clinical and research waste, we recommend systematic reviewers and researchers make greater efforts to ensure that research

Incidence and significance of Multiple Primary Malignant Neoplasms

International Nuclear Information System (INIS)

Choi, Eun Kyung; Cho, Moon June; Ha, Sung Whan; Park, Charn Il; Bang, Young Ju; Kim, Noe Kyung

1986-01-01

To know the three questions about multiple primary cancers: 1) what are the characteristics of persons having multiple primary cancer? 2) Dose presence of a single primary concern after the susceptibility to multiple primary cancers? 3) Dose the location of one multiple primary cancer influence the site of others?, we analysed 121 cases of multiple primary malignant neoplasms registered in Seoul National University Hospital during 8years from July 1978 to August 1986. Of 121 cases, double primary malignant neoplasms were 119 cases and triple were 2 cases. The incidence of multiple primary malignant neoplasms was 0.7%. The metachronous tumor(> 6 months) was found in 70 cases and the median time between the first and the second was 32 months. The most commonly associated tumors were stomach and primary liver carcinoma. Cervix and Lung cancer, Stomach and Rectal cancer, Stomach and Esophagus cancer were also commonly associated

(18)F-Fluorodeoxyglucose PET/Computed Tomography for Primary Brain Tumors

DEFF Research Database (Denmark)

Antonsen Segtnan, Eivind; Hess, Søren; Grupe, Peter

2015-01-01

Structural imaging with computed tomography (CT) and MR imaging is the mainstay in primary diagnosis of primary brain tumors, but these modalities depend on morphologic appearance and an intact blood-brain barrier, and important aspects of tumor biology are not addressed. Such issues may...

A strategic stakeholder approach for addressing further analysis requests in whole genome sequencing research.

Science.gov (United States)

Thornock, Bradley Steven O

2016-01-01

Whole genome sequencing (WGS) can be a cost-effective and efficient means of diagnosis for some children, but it also raises a number of ethical concerns. One such concern is how researchers derive and communicate results from WGS, including future requests for further analysis of stored sequences. The purpose of this paper is to think about what is at stake, and for whom, in any solution that is developed to deal with such requests. To accomplish this task, this paper will utilize stakeholder theory, a common method used in business ethics. Several scenarios that connect stakeholder concerns and WGS will also posited and analyzed. This paper concludes by developing criteria composed of a series of questions that researchers can answer in order to more effectively address requests for further analysis of stored sequences.

Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence

OpenAIRE

Sadler, Michelle; Santos, Mário JDS; Ruiz-Berdún, Dolores; Rojas, Gonzalo Leiva; Skoko, Elena; Gillen, Patricia; Clausen, Jette A

2016-01-01

WOS:000389012500006 (Nº de Acesso Web of Science) During recent decades, a growing and preoccupying excess of medical interventions during childbirth, even in physiological and uncomplicated births, together with a concerning spread of abusive and disrespectful practices towards women during childbirth across the world, have been reported. Despite research and policy-making to address these problems, changing childbirth practices has proved to be difficult. We argue that the excessive rate...

Ethical Concerns About Human Genetic Enhancement in the Malay Science Fiction Novels.

Science.gov (United States)

Isa, Noor Munirah; Hj Safian Shuri, Muhammad Fakhruddin

2018-02-01

Advancements in science and technology have not only brought hope to humankind to produce disease-free offspring, but also offer possibilities to genetically enhance the next generation's traits and capacities. Human genetic enhancement, however, raises complex ethical questions, such as to what extent should it be allowed? It has been a great challenge for humankind to develop robust ethical guidelines for human genetic enhancement that address both public concerns and needs. We believe that research about public concerns is necessary prior to developing such guidelines, yet the issues have not been thoroughly investigated in many countries, including Malaysia. Since the novel often functions as a medium for the public to express their concerns, this paper explores ethical concerns about human genetic enhancement expressed in four Malay science fiction novels namely Klon, Leksikon Ledang, Transgenesis Bisikan Rimba and Transgenik Sifar. Religion has a strong influence on the worldview of the Malays therefore some concerns such as playing God are obviously religious. Association of the negative image of scientists as well as the private research companies with the research on human genetic enhancement reflects the authors' concerns about the main motivations for conducting such research and the extent to which such research will benefit society.

Addressing the Security Concerns of Locals and Visitors for the Sustainable Development of Tourist Destinations

Directory of Open Access Journals (Sweden)

Rob I. Mawby

2016-05-01

Full Text Available Tourism has long been recognized as a crime generator. This poses a dilemma in the sustainable development context: is continued tourist expansion sustainable if it generates increased law and order problems? Using the example of Brașov, Romania, this article considers the ways in which criminal justice agencies and the tourism sector have operated in partnership to ensure the security of both local residents and visitors. We argue that the success of the initiative depends on multi-agency working at the local level, but that the involvement of local residents is also crucial. This commitment may be tested as the nature of tourism changes. The research consists of an analysis of primary and secondary data. The results revealed that among the main security issues mentioned by tourists are not only robberies and other social and situational features that contributed to tourists feeling anxious or unsafe, but also the need to have access to good health services and easy access to money changing facilities, information centers, etc. Some improvements are suggested for the local Sustainable Development Strategy of Brașov.

Staff perceptions of addressing lifestyle in primary health care: a qualitative evaluation 2 years after the introduction of a lifestyle intervention tool

Directory of Open Access Journals (Sweden)

Carlfjord Siw

2012-10-01

Full Text Available Abstract Background Preventive services and health promotion in terms of lifestyle counselling provided through primary health care (PHC has the potential to reduce morbidity and mortality in the population. Health professionals in general are positive about and willing to develop a health-promoting and/or preventive role. A number of obstacles hindering PHC staff from addressing lifestyle issues have been identified, and one facilitator is the use of modern technology. When a computer-based tool for lifestyle intervention (CLT was introduced at a number of PHC units in Sweden, this provided an opportunity to study staff perspectives on the subject. The aim of this study was to explore PHC staff’s perceptions of handling lifestyle issues, including the consultation situation as well as the perceived usefulness of the CLT. Methods A qualitative study was conducted after the CLT had been in operation for 2 years. Six focus group interviews, one at each participating unit, including a total of 30 staff members with different professions participated. The interviews were designed to capture perceptions of addressing lifestyle issues, and of using the CLT. Interview data were analysed using manifest content analysis. Results Two main themes emerged from the interviews: a challenging task and confidence in handling lifestyle issues. The first theme covered the categories responsibilities and emotions, and the second theme covered the categories first contact, existing tools, and role of the CLT. Staff at the units showed commitment to health promotion/prevention, and saw that patients, caregivers, managers and politicians all have responsibilities regarding the issue. They expressed confidence in handling lifestyle-related conditions, but to a lesser extent had routines for general screening of lifestyle habits, and found addressing alcohol the most problematic issue. The CLT, intended to facilitate screening, was viewed as a complement, but was not

Advancing primary care to promote equitable health: implications for China

Directory of Open Access Journals (Sweden)

Hung Li-Mei

2012-01-01

Full Text Available Abstract China is a country with vast regional differences and uneven economic development, which have led to widening gaps between the rich and poor in terms of access to healthcare, quality of care, and health outcomes. China's healthcare reform efforts must be tailored to the needs and resources of each region and community. Building and strengthening primary care within the Chinese health care system is one way to effectively address health challenges. This paper begins by outlining the concept of primary care, including key definitions and measurements. Next, results from a number of studies will demonstrate that primary care characteristics are associated with savings in medical costs, improvements in health outcomes and reductions in health disparities. This paper concludes with recommendations for China on successfully incorporating a primary care model into its national health policy, including bolstering the primary care workforce, addressing medical financing structures, recognizing the importance of evidence-based medicine, and looking to case studies from countries that have successfully implemented health reform.

Experiencing reproductive concerns as a female cancer survivor is associated with depression.

Science.gov (United States)

Gorman, Jessica R; Su, H Irene; Roberts, Samantha C; Dominick, Sally A; Malcarne, Vanessa L

2015-03-15

Young adult female cancer survivors have unmet reproductive concerns and informational needs that are associated with poorer quality of life. The purpose of this study was to examine the association between current reproductive concerns and moderate to severe depression among young survivors. This cross-sectional study included 200 female cancer survivors between the ages of 18 and 35 years who completed a Web-based survey measuring reproductive history, parenthood desires, reproductive concerns after cancer, and quality-of-life indicators. The mean age of the participants was 28 years (standard deviation, 4.4 years), and almost two-thirds were diagnosed within 5 years of survey completion. A multivariate logistic regression analysis controlling for education, duration of survivorship, and social support revealed an association between experiencing reproductive concerns and moderate to severe depression (odds ratio for each 5-unit increase in the Reproductive Concerns After Cancer [RCAC] score, 1.30; 95% confidence interval, 1.06-1.60). Among those with moderate to severe depression, 23% had high RCAC scores, whereas 6% of those with minimal to mild depression did (P reproductive concerns was associated with greater odds of experiencing moderate to severe depression. Almost a quarter of survivors in this sample reported moderate to severe depression, and addressing reproductive concerns represents one potential area of intervention for improving the psychosocial health of young survivors. © 2014 American Cancer Society.

Second Languages in Primary Education.

Science.gov (United States)

Donoghue, Mildred R.; Kunkle, John F.

A book on second languages in primary education, designed to assist both classroom teachers and language specialists, is presented. The following topics are addressed: (1) reasons for studying a second language; (2) reasons for children to learn a second language; (3) language choices; (4) qualifications of teachers; (5) FLES, bilingual education,…

Exploring the relationship between parental concern and the management of childhood obesity.

Science.gov (United States)

Moore, Lucas C; Harris, Carole V; Bradlyn, Andrew S

2012-05-01

Parental concern about child weight has been identified as a factor in parental monitoring and regulation of child diet. However, little is known about factors that influence parental concern or about how concern may influence parent management of child physical activity. The objectives of the current study were to identify the factors associated with parental concern about child weight and determine if parental concern is associated with specific actions to improve diet and increase physical activity. A stratified random sample of 1,500 parents of children in kindergarten, 2nd, 4th, 5th, 7th, and 9th grade were interviewed. Interviews addressed: (a) child and parent physical activity, (b) child and family nutrition, (c) child and parent BMI weight category, (d) interactions with health care providers, (e) parent obesity knowledge, (f) school assessment of BMI, and (g) parent perception of and concern about child weight. Child gender, weight status, and parent perception of child weight were significant predictors of parental concern. Parents were significantly more likely to report concern if their child was female, they believed their child to be overweight/obese, or their child was overweight/obese as indicated by BMI percentile. Concerned parents were significantly more likely to limit child screen time, take steps to improve child diet, and increase child physical activity than were parents who reported no concern. Treatment and prevention efforts should emphasize parental concern and awareness about child weight by providing accurate feedback on child weight status and education regarding the health risks associated with childhood overweight and obesity. Schools can play an important role in this process through the incorporation of BMI screenings.

Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study.

Science.gov (United States)

Hernan, Andrea L; Giles, Sally J; Fuller, Jeffrey; Johnson, Julie K; Walker, Christine; Dunbar, James A

2015-09-01

Patients can have an important role in reducing harm in primary-care settings. Learning from patient experience and feedback could improve patient safety. Evidence that captures patients' views of the various contributory factors to creating safe primary care is largely absent. The aim of this study was to address this evidence gap. Four focus groups and eight semistructured interviews were conducted with 34 patients and carers from south-east Australia. Participants were asked to describe their experiences of primary care. Audio recordings were transcribed verbatim and specific factors that contribute to safety incidents were identified in the analysis using the Yorkshire Contributory Factors Framework (YCFF). Other factors emerging from the data were also ascertained and added to the analytical framework. Thirteen factors that contribute to safety incidents in primary care were ascertained. Five unique factors for the primary-care setting were discovered in conjunction with eight factors present in the YCFF from hospital settings. The five unique primary care contributing factors to safety incidents represented a range of levels within the primary-care system from local working conditions to the upstream organisational level and the external policy context. The 13 factors included communication, access, patient factors, external policy context, dignity and respect, primary-secondary interface, continuity of care, task performance, task characteristics, time in the consultation, safety culture, team factors and the physical environment. Patient and carer feedback of this type could help primary-care professionals better understand and identify potential safety concerns and make appropriate service improvements. The comprehensive range of factors identified provides the groundwork for developing tools that systematically capture the multiple contributory factors to patient safety. Published by the BMJ Publishing Group Limited. For permission to use (where not

WhatsApp in Stroke Systems: Current Use and Regulatory Concerns.

Science.gov (United States)

Calleja-Castillo, Juan M; Gonzalez-Calderon, Gina

2018-01-01

Smartphone use is extremely common. Applications such as WhatsApp have billions of users and physicians are no exception. Stroke Medicine is a field where instant communication among fairly large groups is essential. In developing countries, economic limitations preclude the possibility of acquiring proper communication platforms. Thus, WhatsApp has been used as an organizational tool, for sharing clinical data, and for real time guidance of clinical care decisions. It has evolved into a cheap, accessible tool for telemedicine. Nevertheless, regulatory and privacy issues must be addressed. Some countries have implemented legislation to address this issue, while others lag behind. In this article, we present an overview on the different roles WhatsApp has acquired as a clinical tool in stroke systems and the potential privacy concerns of its use.

WhatsApp in Stroke Systems: Current Use and Regulatory Concerns

Directory of Open Access Journals (Sweden)

Juan M. Calleja-Castillo

2018-05-01

Full Text Available Smartphone use is extremely common. Applications such as WhatsApp have billions of users and physicians are no exception. Stroke Medicine is a field where instant communication among fairly large groups is essential. In developing countries, economic limitations preclude the possibility of acquiring proper communication platforms. Thus, WhatsApp has been used as an organizational tool, for sharing clinical data, and for real time guidance of clinical care decisions. It has evolved into a cheap, accessible tool for telemedicine. Nevertheless, regulatory and privacy issues must be addressed. Some countries have implemented legislation to address this issue, while others lag behind. In this article, we present an overview on the different roles WhatsApp has acquired as a clinical tool in stroke systems and the potential privacy concerns of its use.

Primary caregivers of schizophrenia outpatients: burden and predictor variables.

Science.gov (United States)

Grandón, Pamela; Jenaro, Cristina; Lemos, Serafín

2008-04-15

This article explores family burden in relation to relatives' coping strategies and social networks, as well as in relation to the patients' severity of positive and negative symptoms. Data on the severity of symptoms (Positive and Negative Syndrome Scale for Schizophrenia [PANSS]), social functioning (Social Functioning Scale [SFS]), caregivers burden (Interview on Objective and Subjective Family Burden or Entrevista de Carga Familiar Objetiva y Subjetiva [ECFOS]), coping skills (Family Coping Questionnaire [FCQ]), and social support (Social Network Questionnaire [SNQ]) were gathered from a randomized sample of 101 Chilean outpatients and their primary caregivers, mostly mothers. Low levels of burden were typically found, with the exception of moderate levels on general concerns for the ill relative. A hierarchical regression analysis with four blocks showed that clinical characteristics, such as higher frequency of relapses, more positive symptoms and lower independence-performance, together with lower self-control attributed to the patient, decrease in social interests, and less affective support, predict burden. The results support the relevance of psychoeducational interventions where families' needs are addressed.

Systematic reviews addressing identified health policy priorities in Eastern Mediterranean countries: a situational analysis.

Science.gov (United States)

El-Jardali, Fadi; Akl, Elie A; Karroum, Lama Bou; Kdouh, Ola; Akik, Chaza; Fadlallah, Racha; Hammoud, Rawan

2014-08-20

Systematic reviews can offer policymakers and stakeholders concise, transparent, and relevant evidence pertaining to pressing policy priorities to help inform the decision-making process. The production and the use of systematic reviews are specifically limited in the Eastern Mediterranean region. The extent to which published systematic reviews address policy priorities in the region is still unknown. This situational analysis exercise aims at assessing the extent to which published systematic reviews address policy priorities identified by policymakers and stakeholders in Eastern Mediterranean region countries. It also provides an overview about the state of systematic review production in the region and identifies knowledge gaps. We conducted a systematic search of the Health System Evidence database to identify published systematic reviews on policy-relevant priorities pertaining to the following themes: human resources for health, health financing, the role of the non-state sector, and access to medicine. Priorities were identified from two priority-setting exercises conducted in the region. We described the distribution of these systematic reviews across themes, sub-themes, authors' affiliations, and countries where included primary studies were conducted. Out of the 1,045 systematic reviews identified in Health System Evidence on selected themes, a total of 200 systematic reviews (19.1%) addressed the priorities from the Eastern Mediterranean region. The theme with the largest number of systematic reviews included was human resources for health (115) followed by health financing (33), access to medicine (27), and role of the non-state sector (25). Authors based in the region produced only three systematic reviews addressing regional priorities (1.5%). Furthermore, no systematic review focused on the Eastern Mediterranean region. Primary studies from the region had limited contribution to systematic reviews; 17 systematic reviews (8.5%) included primary

Systematic reviews addressing identified health policy priorities in Eastern Mediterranean countries: a situational analysis

Science.gov (United States)

2014-01-01

Background Systematic reviews can offer policymakers and stakeholders concise, transparent, and relevant evidence pertaining to pressing policy priorities to help inform the decision-making process. The production and the use of systematic reviews are specifically limited in the Eastern Mediterranean region. The extent to which published systematic reviews address policy priorities in the region is still unknown. This situational analysis exercise aims at assessing the extent to which published systematic reviews address policy priorities identified by policymakers and stakeholders in Eastern Mediterranean region countries. It also provides an overview about the state of systematic review production in the region and identifies knowledge gaps. Methods We conducted a systematic search of the Health System Evidence database to identify published systematic reviews on policy-relevant priorities pertaining to the following themes: human resources for health, health financing, the role of the non-state sector, and access to medicine. Priorities were identified from two priority-setting exercises conducted in the region. We described the distribution of these systematic reviews across themes, sub-themes, authors’ affiliations, and countries where included primary studies were conducted. Results Out of the 1,045 systematic reviews identified in Health System Evidence on selected themes, a total of 200 systematic reviews (19.1%) addressed the priorities from the Eastern Mediterranean region. The theme with the largest number of systematic reviews included was human resources for health (115) followed by health financing (33), access to medicine (27), and role of the non-state sector (25). Authors based in the region produced only three systematic reviews addressing regional priorities (1.5%). Furthermore, no systematic review focused on the Eastern Mediterranean region. Primary studies from the region had limited contribution to systematic reviews; 17 systematic reviews

Primary hypertension and special aspects of hypertension in older children and adolescents

Directory of Open Access Journals (Sweden)

Ellis D

2011-07-01

Full Text Available Demetrius Ellis, Yosuke MiyashitaChildren’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, PA, USAAbstract: The prevalence of hypertension has increased at an accelerated rate in older children and adolescents. This has raised great concern about premature development of cardiovascular disease, which has major long-term health and financial implications. While obesity and sedentary habits largely explain this phenomenon, there are other social and cultural influences that may unmask genetic susceptibility to hypertension in the pediatric population. While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review. Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents. Besides primary hypertension and obesity-related hypertension, emphasis is given to epidemiology, measurement of blood pressure, including ambulatory blood pressure monitoring, hypertension associated with drug use, teenage pregnancy, and video and computer games. Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed.Keywords: hypertension, adolescents, obesity, drugs, pregnancy, athletes

Teachers' Understanding of and Concerns about Mathematical Modeling in the Common Core Standards

Science.gov (United States)

Wolf, Nancy Butler

2013-01-01

Educational reform is most likely to be successful when teachers are knowledgeable about the intended reform, and when their concerns about the reform are understood and addressed. The Common Core State Standards (CCSS) is an effort to establish a set of nationwide expectations for students and teachers. This study examined teacher understanding…

Teaching Design in Middle-School: Instructors' Concerns and Scaffolding Strategies

Science.gov (United States)

Bamberger, Yael M.; Cahill, Clara S.

2013-04-01

This study deals with engineering education in the middle-school level. Its focus is instructors' concerns in teaching design, as well as scaffolding strategies that can help teachers deal with these concerns. Through participatory action research, nine instructors engaged in a process of development and instruction of a curriculum about energy along with engineering design. A 50-h curriculum was piloted during a summer camp for 38 middle-school students. Data was collected through instructors' materials: observation field notes, daily reflections and post-camp discussions. In addition, students' artifacts and planning graphical models were collected in order to explore how instructors' concerns were aligned with students' learning. Findings indicate three main tensions that reflect instructors' main concerns: how to provide sufficient scaffolding yet encourage creativity, how to scaffold hands-on experiences that promote mindful planning, and how to scaffold students' modeling practices. Pedagogical strategies for teaching design that developed through this work are described, as well as the ways they address the National Research Council (A framework for K-12 science education: practices, crosscutting concepts, and core ideas. National Academies Press, Washington, DC, 2011) core ideas of engineering education and the International Technological Literacy standards (ITEA in Standards for technological literacy, 3rd edn. International Technology education Association, Reston, VA, 2007).

Performance concerns for high duty fuel cycle

International Nuclear Information System (INIS)

Esposito, V.J.; Gutierrez, J.E.

1999-01-01

One of the goals of the nuclear industry is to achieve economic performance such that nuclear power plants are competitive in a de-regulated market. The manner in which nuclear fuel is designed and operated lies at the heart of economic viability. In this sense reliability, operating flexibility and low costs are the three major requirements of the NPP today. The translation of these three requirements to the design is part of our work. The challenge today is to produce a fuel design which will operate with long operating cycles, high discharge burnup, power up-rating and while still maintaining all design and safety margins. European Fuel Group (EFG) understands that to achieve the required performance high duty/energy fuel designs are needed. The concerns for high duty design includes, among other items, core design methods, advanced Safety Analysis methodologies, performance models, advanced material and operational strategies. The operational aspects require the trade-off and evaluation of various parameters including coolant chemistry control, material corrosion, boiling duty, boron level impacts, etc. In this environment MAEF is the design that EFG is now offering based on ZIRLO alloy and a robust skeleton. This new design is able to achieve 70 GWd/tU and Lead Test Programs are being executed to demonstrate this capability. A number of performance issues which have been a concern with current designs have been resolved such as cladding corrosion and incomplete RCCA insertion (IRI). As the core duty becomes more aggressive other new issues need to be addressed such as Axial Offset Anomaly. These new issues are being addressed by combination of the new design in concert with advanced methodologies to meet the demanding needs of NPP. The ability and strategy to meet high duty core requirements, flexibility of operation and maintain acceptable balance of all technical issues is the discussion in this paper. (authors)

76 FR 9409 - National Emission Standards for Hazardous Air Pollutants: Primary Lead Smelting

Science.gov (United States)

2011-02-17

... National Emission Standards for Hazardous Air Pollutants: Primary Lead Smelting; Proposed Rule #0;#0... Emission Standards for Hazardous Air Pollutants: Primary Lead Smelting AGENCY: Environmental Protection... standards for hazardous air pollutants (NESHAP) for Primary Lead Smelting to address the results of the...

The regulations concerning the uses of nuclear fuel materials

International Nuclear Information System (INIS)

1978-01-01

The Regulations are established on the basis of ''The law for the regulations of nuclear source materials, nuclear fuel materials and reactors'' and the ''Provisions concerning the usage of nuclear fuel materials'' in the Enforcement Ordinance of the Law, to enforce such provisions. Terms are explained, such as exposure radiation dose, cumulative dose, control area, surrounding inspection area, persons engaging in works, area for incoming and outgoing of materials, batch, real stocks, effective value and main measuring points. In the applications for the permission to use nuclear fuel materials, the expected period and quantity of usage of each kind of such materials and the other party and the method of selling, lending and returning spent fuel or the process of disposal of such fuel must be written. Explanations concerning the technical ability required for the usage of nuclear fuel materials shall be attached to the applications. Applications shall be filed for the inspection of facilities for use, in which the name and the address of the applicant, the name and the address of the factory or the establishment, the range of the facilities for use, the maximum quantity of nuclear fuel materials to be used or stocked, and the date, the place and the kind of the expected inspection are written. Prescriptions cover the records to be held, safety regulations, the technical standards for usage, the disposal, transport and storage of nuclear fuel materials and the reports to be filed. (Okada, K.)

Facebook and body image concern in adolescent girls: A prospective study.

Science.gov (United States)

Tiggemann, Marika; Slater, Amy

2017-01-01

The primary aim of the study was to examine the relationship across time between Facebook use and body image concern in adolescent girls. A sample of 438 girls in the first two years (Years 8 and 9) of high school (aged 13-15 years) at Time 1 completed questionnaire measures of Facebook consumption and body image concerns, and again two years later (Time 2). Facebook involvement increased substantially over the two year time period. Body image concerns also increased. Number of Facebook friends was found to prospectively predict the observed increase in drive for thinness. On the other hand, internalization and body surveillance prospectively predicted the observed increase in number of Facebook friends. It was concluded that Facebook "friendships" represent a potent sociocultural force in the body image of adolescent girls. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:80-83). © 2016 Wiley Periodicals, Inc.

primary prevention of mental, neurological and psychosocial

African Journals Online (AJOL)

92-4-. 154516X. This well written book addresses the primary prevention of ... a broad, public health perspective. ... suicide include gun control, gas detoxification and responsible ... It will be most useful for policy makers, and professionals and.

78 FR 24584 - Imposition of Special Measures Against Halawi Exchange Co. as a Financial Institution of Primary...

Science.gov (United States)

2013-04-25

... financial institution operating outside of the United States that is of primary money laundering concern... international money laundering and the financing of terrorism. Regulations implementing the BSA appear at 31 CFR..., class of transaction, or type of account is of ``primary money laundering concern,'' to require domestic...

Counselling low-back-pain patients in secondary healthcare: a randomised trial addressing experienced workplace barriers and physical activity.

Science.gov (United States)

Jensen, Lone Donbæk; Maribo, Thomas; Schiøttz-Christensen, Berit; Madsen, Finn Hjorth; Gonge, Bigitte; Christensen, Michael; Frost, Poul

2012-01-01

To assess if counselling by an occupational physician (OP) addressing experienced workplace barriers and physical activity integrated as a part of low-back pain (LBP) outpatient treatment influences pain, function and sick leave. Randomised controlled trial in the secondary healthcare sector with 3 months' follow-up. The participants were LBP patients who, independently of sick-leave status, expressed concerns about the ability to maintain their current job. Patients referred for surgery were excluded. The intervention consisted of two counselling sessions conducted by an OP addressing both workplace barriers and leisure-time physical activity. A workplace visit was performed if required. Pain, function and duration of sick leave due to LBP were primary outcomes. A reduction in bodily pain and improvement in physical function both measured by the 36-item short-form health survey questionnaire in favour of the intervention group was found. The change in pain score was found to be clinically relevant. The risk of sick leave for at least 8 weeks due to LBP was significantly reduced in the intervention group. Two secondary outcomes, Fear Avoidance Beliefs about physical activity and maximum oxygen uptake, supported compliance and adherence to the part of the intervention focusing on enhanced physical activity. Two short counselling sessions by an OP combining advice on meeting workplace barriers and enhancing physical activity had a substantial effect on important prognostic factors for LBP patients with moderate to severe symptoms diagnosed in outpatient rheumatological clinics. Current Controlled Trials ISRCTN13071157.

Providing reliable energy in a time of constraints : a North American concern

International Nuclear Information System (INIS)

Egan, T.; Turk, E.

2008-04-01

The reliability of the North American electricity grid was discussed. Government initiatives designed to control carbon dioxide (CO 2 ) and other emissions in some regions of Canada may lead to electricity supply constraints in other regions. A lack of investment in transmission infrastructure has resulted in constraints within the North American transmission grid, and the growth of smaller projects is now raising concerns about transmission capacity. Labour supply shortages in the electricity industry are also creating concerns about the long-term security of the electricity market. Measures to address constraints must be considered in the current context of the North American electricity system. The extensive transmission interconnects and integration between the United States and Canada will provide a framework for greater trade and market opportunities between the 2 countries. Coordinated actions and increased integration will enable Canada and the United States to increase the reliability of electricity supply. However, both countries must work cooperatively to increase generation supply using both mature and emerging technologies. The cross-border transmission grid must be enhanced by increasing transmission capacity as well as by implementing new reliability rules, building new infrastructure, and ensuring infrastructure protection. Barriers to cross-border electricity trade must be identified and avoided. Demand-side and energy efficiency measures must also be implemented. It was concluded that both countries must focus on developing strategies for addressing the environmental concerns related to electricity production. 6 figs

Addressing Escape-Maintained Behavior for Students with Developmental Disabilities: A Systematic Review of School-Based Interventions

Science.gov (United States)

Dart, Evan H.; Radley, Keith C.; Mason, Benjamin A.; Allen, Justin P.

2018-01-01

Students with developmental disabilities have been found to exhibit higher rates of problem behavior in the classroom than their typically developing peers. Effectively addressing these students' behavior concerns requires the identification of interventions that can be implemented in an educational setting. Furthermore, matching intervention…

Hospital burden of road traffic injury: major concern in primary and secondary level hospitals in Bangladesh.

Science.gov (United States)

Mashreky, S R; Rahman, A; Khan, T F; Faruque, M; Svanström, L; Rahman, F

2010-04-01

To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. Cross-sectional study. The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact. 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Victimisation and psychosocial difficulties associated with sexual orientation concerns: a school-based study of adolescents.

LENUS (Irish Health Repository)

Cotter, P

2014-11-01

This study examined victimisation, substance misuse, relationships, sexual activity, mental health difficulties and suicidal behaviour among adolescents with sexual orientation concerns in comparison to those without such concerns. 1112 Irish students (mean age 14 yrs) in 17 mixed-gender secondary schools completed a self-report questionnaire with standardised scales and measures of psychosocial difficulties. 58 students (5%) reported having concerns regarding their sexual orientation. Compared with their peers, they had higher levels of mental health difficulties and a markedly-increased prevalence of attempted suicide (29% vs. 2%), physical assault (40% vs. 8%), sexual assault (16%vs. 1%) and substance misuse. Almost all those (90%) with sexual orientation concerns reported having had sex compared to just 4% of their peers. These results highlight the significant difficulties associated with sexual orientation concerns in adolescents in Ireland. Early and targeted interventions are essential to address their needs.

Quality of life concerns and depression among hematopoietic stem cell transplant survivors.

Science.gov (United States)

Mosher, Catherine E; DuHamel, Katherine N; Rini, Christine; Corner, Geoffrey; Lam, Joanne; Redd, William H

2011-09-01

This study examined quality of life, transplant-related concerns, and depressive symptoms and their demographic and medical correlates at 1 to 3 years following hematopoietic stem cell transplantation (HSCT). HSCT survivors (N=406) completed telephone-administered questionnaires that assessed demographic variables, functional status, quality of life, transplant-related concerns, and depressive symptoms. The most prevalent concerns among HSCT survivors included physical symptoms (e.g., fatigue and pain), maintaining current health status and employment, changes in appearance, and lack of sexual interest and satisfaction. In addition, almost one-third (32%) of survivors age 40 years and younger reported concern about their ability to have children. Unemployed survivors and those with lower incomes and worse functional status were more likely to experience poorer quality of life in multiple domains. Fifteen percent of the sample reported moderate to severe depressive symptoms, and these symptoms were higher among allogeneic transplant recipients and those with lower functional status. Results suggest that interventions are needed to address physical symptoms, coping with an uncertain future, infertility, and sexual issues during the early phase of HSCT survivorship.

Natural gas reserves/total energy consumption: a useful new ratio for addressing global climate change concerns

International Nuclear Information System (INIS)

Siddiqi, T.A.

2002-01-01

Energy analysts have used the reserves/production ratios for oil and natural gas for decades as indicators of the ability of countries to maintain or increase their production of those fuels. The global community is now faced with the challenge of reducing carbon dioxide emissions from a variety of sources, with the energy sector being the largest contributor to the anthropogenic emissions of greenhouse gases. Natural gas has emerged as a highly desirable fuel, since it produces lower emissions of carbon dioxide than coal or oil for equivalent amounts of energy supplied. The ratio of a country's proven natural gas reserves to its total energy consumption is a good indicator of its ability to improve its air quality situation or address greenhouse gas reduction targets from domestic natural gas sources. This paper provides the ratio for several countries at different stages of development, and discusses some of the implications. In countries where exploration for natural gas has been limited, the estimated resources in place may sometimes be a more useful indicator than proven reserves, and could be used instead. (author)

Addressing the intersection between alcohol consumption and antiretroviral treatment: needs assessment and design of interventions for primary healthcare workers, the Western Cape, South Africa.

Science.gov (United States)

Schneider, M; Chersich, M; Temmerman, M; Parry, C D

2016-10-26

At the points where an infectious disease and risk factors for poor health intersect, while health problems may be compounded, there is also an opportunity to provide health services. Where human immunodeficiency virus (HIV) infection and alcohol consumption intersect include infection with HIV, onward transmission of HIV, impact on HIV and acquired immunodeficiency syndrome (AIDS) disease progression, and premature death. The levels of knowledge and attitudes relating to the health and treatment outcomes of HIV and AIDS and the concurrent consumption of alcohol need to be determined. This study aimed to ascertain the knowledge, attitudes and practices of primary healthcare workers concerning the concurrent consumption of alcohol of clinic attendees who are prescribed antiretroviral drugs. An assessment of the exchange of information on the subject between clinic attendees and primary healthcare providers forms an important aspect of the research. A further objective of this study is an assessment of the level of alcohol consumption of people living with HIV and AIDS attending public health facilities in the Western Cape Province in South Africa, to which end, the study reviewed health workers' perceptions of the problem's extent. A final objective is to contribute to the development of evidence-based guidelines for AIDS patients who consume alcohol when on ARVs. The overall study purpose is to optimise antiretroviral health outcomes for all people living with HIV and AIDS, but with specific reference to the clinic attendees studied in this research. Overall the research study utilised mixed methods. Three group-specific questionnaires were administered between September 2013 and May 2014. The resulting qualitative data presented here supplements the results of the quantitative data questionnaires for HIV and AIDS clinic attendees, which have been analysed and written up separately. This arm of the research study comprised two, separate, semi-structured sets of

Security and Health Research Databases: The Stakeholders and Questions to Be Addressed

OpenAIRE

Stewart, Sara

2006-01-01

Health research database security issues abound. Issues include subject confidentiality, data ownership, data integrity and data accessibility. There are also various stakeholders in database security. Each of these stakeholders has a different set of concerns and responsibilities when dealing with security issues. There is an obvious need for training in security issues, so that these issues may be addressed and health research will move on without added obstacles based on misunderstanding s...

Security and health research databases: the stakeholders and questions to be addressed.

Science.gov (United States)

Stewart, Sara

2006-01-01

Health research database security issues abound. Issues include subject confidentiality, data ownership, data integrity and data accessibility. There are also various stakeholders in database security. Each of these stakeholders has a different set of concerns and responsibilities when dealing with security issues. There is an obvious need for training in security issues, so that these issues may be addressed and health research will move on without added obstacles based on misunderstanding security methods and technologies.

76 FR 9403 - Finding That the Lebanese Canadian Bank SAL Is a Financial Institution of Primary Money...

Science.gov (United States)

2011-02-17

... Bank SAL Is a Financial Institution of Primary Money Laundering Concern AGENCY: Financial Crimes...'') is a financial institution of primary money laundering concern. DATES: The finding made in this... Law 107-56. Title III of the USA PATRIOT Act amended the anti- money laundering provisions of the Bank...

The security concern on internet banking adoption among Malaysian banking customers.

Science.gov (United States)

Sudha, Raju; Thiagarajan, A S; Seetharaman, A

2007-01-01

The existing literatures highlights that the security is the primary factor which determines the adoption of Internet banking technology. The secondary information on Internet banking development in Malaysia shows a very slow growth rate. Hence, this study aims to study the banking customers perception towards security concern and Internet banking adoption through the information collected from 150 sample respondents. The data analysis reveals that the customers have much concern about security and privacy issue in adoption of Internet banking, whether the customers are adopted Internet banking or not. Hence, it infers that to popularize Internet banking system there is a need for improvement in security and privacy issue among the banking customers.

The Coming Primary Care Revolution.

Science.gov (United States)

Ellner, Andrew L; Phillips, Russell S

2017-04-01

The United States has the most expensive, technologically advanced, and sub-specialized healthcare system in the world, yet it has worse population health status than any other high-income country. Rising healthcare costs, high rates of waste, the continued trend towards chronic non-communicable disease, and the growth of new market entrants that compete with primary care services have set the stage for fundamental change in all of healthcare, driven by a revolution in primary care. We believe that the coming primary care revolution ought to be guided by the following design principles: 1) Payment must adequately support primary care and reward value, including non-visit-based care. 2) Relationships will serve as the bedrock of value in primary care, and will increasingly be fostered by teams, improved clinical operations, and technology, with patients and non-physicians assuming an ever-increasing role in most aspects of healthcare. 3) Generalist physicians will increasingly focus on high-acuity and high-complexity presentations, and primary care teams will increasingly manage conditions that specialists managed in the past. 4) Primary care will refocus on whole-person care, and address health behaviors as well as vision, hearing, dental, and social services. Design based on these principles should lead to higher-value healthcare, but will require new approaches to workforce training.

Convocation address.

Science.gov (United States)

Swaminathan, M S

1998-07-01

This address delivered to the 40th convocation of the International Institute for Population Sciences in India in 1998 opens by noting that a shortage of jobs for youth is India's most urgent problem but that the problems that attend the increasing numbers of elderly also require serious attention. The address then notes that the Earth's population is growing at an unsustainable rate while economic inequities among countries are increasing, so that, while intellectual property is becoming the most important asset in developed countries, nutritional anemia among pregnant women causes their offspring to be unable to achieve their full intellectual potential from birth. Next, the address uses a discussion of the 18th-century work on population of the Marquis de Condorcet and of Thomas Malthus to lead into a consideration of estimated increased needs of countries like India and China to import food grains in the near future. Next, the progress of demographic transition in Indian states is covered and applied to Mahbub ul Haq's measure of human deprivation developed for and applied to the region of the South Asian Association for Regional Cooperation (India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and the Maldives). The address continues by reiterating some of the major recommendations forwarded by a government of India committee charged in 1995 with drafting a national population policy. Finally, the address suggests specific actions that could be important components of the Hunger-Free India Programme and concludes that all success rests on the successful implementation of appropriate population policies.

Using vignettes to assess contributions to the work of addressing child mental health problems in primary care.

Science.gov (United States)

Wissow, Lawrence S; Zafar, Waleed; Fothergill, Kate; Ruble, Anne; Slade, Eric

2016-01-22

To further efforts to integrate mental health and primary care, this study develops a novel approach to quantifying the amount and sources of work involved in shifting care for common mental health problems to pediatric primary care providers. Email/web-based survey of a convenience sample (n = 58) of Maryland pediatricians (77% female, 58% at their site 10 or more years; 44% in private practice, 52 % urban, 48 % practicing with a co-located mental health provider). Participants were asked to review 11 vignettes, which described primary care management of child/youth mental health problems, and rate them on an integer-based ordinal scale for the overall amount of work involved compared to a 12th reference vignette describing an uncomplicated case of ADHD. Respondents were also asked to indicate factors (time, effort, stress) accounting for their ratings. Vignettes presented combinations of three diagnoses (ADHD, anxiety, and depression) and three factors (medical co-morbidity, psychiatric co-morbidity, and difficult families) reported to complicate mental health care. The reference case was pre-assigned a work value of 2. Estimates of the relationship of diagnosis and complicating factors with workload were obtained using linear regression, with random effects at the respondent level. The 58 pediatricians gave 593 vignette responses. Depression was associated with a 1.09 unit (about 50%) increase in work (95% CL .94, 1.25), while anxiety did not differ significantly from the reference case of uncomplicated ADHD (p = .28). Although all three complicating factors increased work ratings compared with the reference case, family complexity and psychiatric co-morbidity did so the most (.87 and 1.07 units, respectively, P work were physician time, physician mental effort, and stress; those least strongly associated were staff time, physician physical effort, and malpractice risk. Pediatricians working with co-located mental health providers gave higher work

Opportunities in the integration of primary care and public health nursing: Two case exemplars on physical activity and nutrition.

Science.gov (United States)

Evans-Agnew, Robin A; Mayer, Kala A; Miller, Lori L L

2018-01-01

The integration of primary care and public health nursing may provide new opportunities for transforming nursing practice that addresses population health. Effective programs emphasize multilevel approaches that include both downstream (education) and upstream (policy change) actions. The purpose of this article is to identify downstream and upstream nursing actions that integrate public health and primary care practice through two case exemplars concerning disparities in physical activity and nutrition. Describe two research case exemplars: (1) a secondary analysis of school physical activity policy for female adolescents in 36 public middle schools and (2) a focus group study of African American adults in a community kitchen program. In exemplar 1, school policies lacked population-based standards and presented structural disadvantages to African American girls who were already obese. In exemplar 2, participants found the community kitchen program to be more effective than the federally funded nutrition program. Integrating primary care and public health nursing could improve the tailoring of physical activity and nutrition programs to local populations by following core principles of community engagement, infrastructural sustainability, aligned leadership, and data sharing for population health improvement. © 2017 Wiley Periodicals, Inc.

The regulation for enforcing the law concerning indemnification of nuclear damage

International Nuclear Information System (INIS)

1980-01-01

The regulation is set up under the provisions of the law concerning the indemnification for atomic energy damages, to enforce them. An atomic energy business enterpriser who intends to get the approval of indemnification measures specified under the law shall file an application to the General Director of the Science Technology Agency, attaching particular documents and writing the following matters: his name and address; the kinds of operation of reactors; the names and addresses of works or places of business where reactors are operated; the thermal output of reactors; the kinds and quantities of nuclear fuel materials processed or employed; the kinds and quantities of nuclear fuel materials or contaminated materials to be transported; the kinds and quantities of nuclear fuel materials or contaminated materials to be disposed; beginning dates and expected ending dates of the operation of reactors; and other items stipulated concerning liability insurance and indemnification contracts. The negotiable securities qualified to be trusted include government bonds; municipal bonds; bonds issued by particular legal persons; bonds issued by banks, Central Cooperative Bank for Agriculture and Forestry, or Bank for Commerce and Industrial Cooperatives, and secured debentures under the secured debenture trust law. The recovering of trusted securities and identification cards are defined, respectively. (Okada, K.)

Animating Research with Counseling Values: A Training Model to Address the Research-to-Practice Gap

Science.gov (United States)

Lee, Kristi A.; Dewell, John A.; Holmes, Courtney M.

2014-01-01

The persistent research-to-practice gap poses a problem for counselor education. The gap may be caused by conflicts between the humanistic values that guide much of counseling and the values that guide research training. In this article, the authors address historical concerns regarding research training for students and the conducting of research…

Overview of an address and purpose of the workshop [ISO Workshop on address standards: Considering the issues related to an international address standard

CSIR Research Space (South Africa)

Cooper, Antony K

2008-05-01

Full Text Available ) (ISO 19112) Precision Redirectable Standards Postal address Street delivery address Y N N Y N Y Fine Y UPU S42 PO Box or Private Bag Y N N Y Fine to Coarse Y UPU S42 Post Restante Y N N Y N Y Coarse Y UPU S42 Delivery address... (for goods, etc) Street address Y N N Y N Y Fine N Intersection address Y N N Y N Y Fine N Landmark address Y N N Y N Y Fine to Moderate N Building address Y N N Y N Y Fine N Site address Y N N Y N Y Fine to Coarse N Farm...

Maternal concerns about children overeating among low-income children.

Science.gov (United States)

Pesch, Megan H; Rizk, Monika; Appugliese, Danielle P; Rosenblum, Katherine L; Miller, Alison; Lumeng, Julie C

2016-04-01

Addressing overeating is essential to obesity treatment and prevention. The objectives of this study were to investigate maternal concern for child overeating, to identify associated participant characteristics and to determine if concern for child overeating is associated with maternal feeding practices. Low-income mothers (N=289) of children (mean age 70.8months) participated in a semi-structured interview. Themes of maternal concern for child overeating were identified and a coding scheme was reliably applied. Maternal feeding practices were measured by questionnaire and videotaped eating interactions. Logistic regressions were used to test the associations of participant characteristics with the presence of each theme, and bivariate analyses were used to test the associations of the presence of each theme with feeding practices. Three themes were identified: 1) mothers worry that their child does overeat, 2) mothers acknowledge that their child may overeat but indicate that it is not problematic because they manage their child's eating behavior, and 3) mothers acknowledge that their child may overeat but indicate that it is not problematic because of characteristics inherent to the child. Child obesity predicted the themes; mothers of obese and overweight children are more likely to be concerned about overeating. Themes were associated with lower levels of observed pressure to eat. Only Theme 2 was associated with greater restrictive feeding practices. Interventions that provide parents' practical, healthy ways to prevent child overeating may be helpful. Copyright © 2016. Published by Elsevier Ltd.

Traumatic Dental Injuries in the primary dentition: a 15-year bibliometric analysis of Dental Traumatology.

Science.gov (United States)

Kramer, Paulo Floriani; Onetto, Juan; Flores, Marie Therese; Borges, Tássia Silvana; Feldens, Carlos Alberto

2016-10-01

To explore the profile of articles on traumatic dental injuries (TDI) in the primary dentition published in Dental Traumatology in the last 15 years using bibliometric analysis. Three researchers read all titles and abstracts of articles published in Dental Traumatology between 2000 and 2014 (excluding editorials and letters) and selected all articles on TDI in the primary dentition. The articles were categorized according to year of publication, country in which the study was conducted, study design, and topics addressed. Divergences were resolved by consensus between the researchers. Among a total of 1257 articles published, 98 were initially excluded. Among the remaining 1159 articles, 152 (13.1%) focused on TDI in the primary dentition. The articles were conducted in 29 countries, with Brazil (38.8%) and Turkey (11.8%) accounting for the largest numbers. Cross-sectional studies (36.2%) and case report/case series (33.6%) were the most frequent study designs. Only two systematic reviews were published. The most commonly addressed topics were frequency/etiology/associated factors (36.8%), treatment (30.9%), and prognosis (19.7%). Among the articles addressing treatment, two-thirds were case reports or case series. The effects of TDI in primary teeth on their permanent successors were addressed in 20.4% of the articles (31/152). The number of articles on TDI in the primary dentition has increased, but remains low. The evaluation of study designs and topics addressed identified gaps that could contribute to the development of new studies on TDI in the primary dentition, especially cohort studies that evaluate risk factors, prognosis, and treatment. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Exploring primary care activities in ACT teams.

Science.gov (United States)

Vanderlip, Erik R; Williams, Nancy A; Fiedorowicz, Jess G; Katon, Wayne

2014-05-01

People with serious mental illness often receive inadequate primary and preventive care services. Federal healthcare reform endorses team-based care that provides high quality primary and preventive care to at risk populations. Assertive community treatment (ACT) teams offer a proven, standardized treatment approach effective in improving mental health outcomes for the seriously mentally ill. Much is known about the effectiveness of ACT teams in improving mental health outcomes, but the degree to which medical care needs are addressed is not established. The purpose of this study was to explore the extent to which ACT teams address the physical health of the population they serve. ACT team leaders were invited to complete an anonymous, web-based survey to explore attitudes and activities involving the primary care needs of their clients. Information was collected regarding the use of health screening tools, physical health assessments, provision of medical care and collaboration with primary care systems. Data was analyzed from 127 team leaders across the country, of which 55 completed the entire survey. Nearly every ACT team leader believed ACT teams have a role in identifying and managing the medical co-morbidities of their clientele. ACT teams report participation in many primary care activities. ACT teams are providing a substantial amount of primary and preventive services to their population. The survey suggests standardization of physical health identification, management or referral processes within ACT teams may result in improved quality of medical care. ACT teams are in a unique position to improve physical health care by virtue of having medically trained staff and frequent, close contact with their clients.

License Address List

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Address list generated from National Saltwater Angler Registry. Used in conjunction with an address-based sample as per survey design.

Children's Behavioral Adjustment in Pre-Primary Schools in Tanzania : A Multilevel Approach

NARCIS (Netherlands)

Shavega, Theresia J.; Brugman, Daniel; van Tuijl, Cathy

2014-01-01

Research Findings: The present study concerns children's behavioral adjustment in the context of pre-primary schools in Tanzania. Twenty teachers and 320 children from 20 pre-primary schools participated in the study. Teacher-child relationships, children's behavioral adjustment, and teachers'

Psychological treatment of social anxiety disorder improves body dysmorphic concerns.

Science.gov (United States)

Fang, Angela; Sawyer, Alice T; Aderka, Idan M; Hofmann, Stefan G

2013-10-01

Social anxiety disorder and body dysmorphic disorder are considered nosologically distinct disorders. In contrast, some cognitive models suggest that social anxiety disorder and body dysmorphic disorder share similar cognitive maintenance factors. The aim of this study was to examine the effects of psychological treatments for social anxiety disorder on body dysmorphic disorder concerns. In Study 1, we found that 12 weekly group sessions of cognitive-behavioral therapy led to significant decreases in body dysmorphic symptom severity. In Study 2, we found that an attention retraining intervention for social anxiety disorder was associated with a reduction in body dysmorphic concerns, compared to a placebo control condition. These findings support the notion that psychological treatments for individuals with primary social anxiety disorder improve co-occurring body dysmorphic disorder symptoms. Copyright © 2013 Elsevier Ltd. All rights reserved.

Parental concerns towards children and adolescents with epilepsy in Sri Lanka--Qualitative study.

Science.gov (United States)

Murugupillai, Roshini; Wanigasinghe, Jithangi; Muniyandi, Ravi; Arambepola, Carukshi

2016-01-01

Social, cultural, psychological and many other factors significantly impact the lives of epileptic children and their families. Parental concerns towards their children are less known in south Asian children with epilepsy. We aimed to identify the parental concerns regarding their children and adolescents with epilepsy in Sri Lanka. We carried out qualitative study in 3 districts of Sri Lanka, comprising 16 in-depth interviews with parents of children and adolescents with epilepsy and 3 focus group discussions with primary caregivers of epileptic children and key informants (schoolteachers, public health staffs). Content analysis of the interview data was performed. Parental concerns were spread among seven themes that emerged from the content analysis. These concerns were about the child's functioning in areas such as physical, behavioural, psychological and social, education, concerns related to anti-epileptic therapy and epilepsy as a disease. Parents were more concerned about their child's safety, educational achievements and future prospects in terms of employment and marriage. Unpredictability of seizures, fear of stigma and unawareness of epilepsy were the main reasons voiced by the parents for having such concerns. Increased concern and perception of vulnerability was seen among parents whose children had epilepsy and co-morbid illness. Parental concerns towards their children and adolescents show a multidimensional construct. Unpredictability of seizures, fear of stigma and unawareness of epilepsy were identified as key influential factors in moulding the parental concerns. Copyright © 2015. Published by Elsevier Ltd.

Experiencing reproductive concerns as a female cancer survivor is associated with depression

Science.gov (United States)

Gorman, Jessica R.; Su, H. Irene; Roberts, Samantha C.; Dominick, Sally A.; Malcarne, Vanessa L.

2014-01-01

Background Young adult female cancer survivors have unmet reproductive concerns and informational needs that are associated with poorer quality of life. The purpose of this study was to examine the association between current reproductive concerns and moderate to severe depression among young survivors. Methods This cross-sectional study includes 200 female cancer survivors between the ages of 18 and 35 years who completed a web-based survey measuring reproductive history, parenthood desires, reproductive concerns after cancer, and quality of life indicators. Results The mean age of participants was 28 years (SD = 4.4) and almost two-thirds were diagnosed within 5 years of completing the survey. Multivariable logistic regression analysis controlling for education, duration of survivorship, and social support revealed an association between experiencing reproductive concerns and moderate to severe depression (OR = 1.30, 95% CI = 1.06–1.60 for each 5 unit increase in RCAC score). Of those with moderate to severe depression, 23% had high RCAC scores as compared to 6% of those with minimal to mild depression (p < 0.001). Conclusion A higher level of reproductive concerns was associated with greater odds of experiencing moderate to severe depression. Almost a quarter of survivors in this sample reported moderate to severe depression, and addressing reproductive concerns represents one potential area of intervention to improve the psychosocial health of young survivors. PMID:25377593

Potential of low-temperature anaerobic digestion to address current environmental concerns on swine production.

Science.gov (United States)

Massé, D I; Masse, L; Xia, Y; Gilbert, Y

2010-04-01

Environmental issues associated with swine production are becoming a major concern among the general public and are thus an important challenge for the swine industry. There is now a renewed interest in environmental biotechnologies that can minimize the impact of swine production and add value to livestock by-products. An anaerobic biotechnology called psychrophilic anaerobic digestion (PAD) in sequencing batch reactors (SBR) has been developed at Agriculture and Agri-Food Canada. This very stable biotechnology recovers usable energy, stabilizes and deodorizes manure, and increases the availability of plant nutrients. Experimental results indicated that PAD of swine manure slurry at 15 to 25 degrees C in intermittently fed SBR reduces the pollution potential of manure by removing up to 90% of the soluble chemical oxygen demand. The process performs well under intermittent feeding, once to 3 times a week, and without external mixing. Bioreactor feeding activities can thus be easily integrated into the routine manure removal procedures in the barn, with minimal interference with other farm operations and use of existing manure-handling equipment. Process stability was not affected by the presence of antibiotics in manure. The PAD process was efficient in eliminating populations of zoonotic pathogens and parasites present in raw livestock manure slurries. Psychrophilic anaerobic digestion in SBR could also be used for swine mortality disposal. The addition of swine carcasses, at loading rates representing up to 8 times the normal mortality rates on commercial farms, did not affect the stability of SBR. No operational problems were related to the formation of foam and scum. The biotechnology was successfully operated at semi-industrial and full commercial scales. Biogas production rate exceeded 0.20 L of methane per gram of total chemical oxygen demand fed to the SBR. The biogas was of excellent quality, with a methane concentration ranging from 70 to 80%. The

Moral accounts and membership categorization in primary care medical interviews.

Science.gov (United States)

Dillon, Patrick J

2011-01-01

Although the link between health and morality has been well established, few studies have examined how issues of morality emerge and are addressed in primary care medical encounters. This paper addresses the need to examine morality as it is (re) constructed in everyday health care interactions. A Membership Categorization Analysis of 96 medical interviews reveals how patients orient to particular membership categories and distance themselves from others as a means of accounting (Buttny 1993; Scott and Lyman 1968) for morally questionable health behaviours. More specifically, this paper examines how patients use membership categorizations in order to achieve specific social identity(ies) (Schubert et al. 2009) through two primary strategies: defensive detailing and prioritizing alternative membership categories. Thus, this analysis tracks the emergence of cultural and moral knowledge about social life as it takes place in primary care medical encounters.

Life-cycle studies of biodiesel in Europe: A review addressing the variability of results and modeling issues

International Nuclear Information System (INIS)

Malca, Joao; Freire, Fausto

2011-01-01

Renewable energy sources, and particularly biofuels, are being promoted as possible solutions to address global warming and the depletion of petroleum resources. Nevertheless, significant disagreement and controversies exist regarding the actual benefits of biofuels displacing fossil fuels, as shown by a large number of life-cycle studies that have varying and sometimes contradictory conclusions. This article presents a comprehensive review of life-cycle studies of biodiesel in Europe. Studies have been compared in terms of nonrenewable primary energy requirement and GHG intensity of biodiesel. Recently published studies negate the definite and deterministic advantages for biodiesel presented in former studies. A high variability of results, particularly for biodiesel GHG intensity, with emissions ranging from 15 to 170 gCO 2 eq MJ f -1 has been observed. A detailed assessment of relevant aspects, including major assumptions, modeling choices and results, has been performed. The main causes for this high variability have been investigated, with emphasis on modeling choices. Key issues found are treatment of co-product and land use modeling, including high uncertainty associated with N 2 O and carbon emissions from cultivated soil. Furthermore, a direct correlation between how soil emissions were modeled and increasing values for calculated GHG emission has been found. A robust biodiesel life-cycle modeling has been implemented and the main sources of uncertainty have been investigated to show how uncertainty can be addressed to improve the transparency and reliability of results. Recommendations for further research work concerning the improvement of biofuel life cycle modeling are also presented. (author)

Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence.

Science.gov (United States)

Sadler, Michelle; Santos, Mário Jds; Ruiz-Berdún, Dolores; Rojas, Gonzalo Leiva; Skoko, Elena; Gillen, Patricia; Clausen, Jette A

2016-05-01

During recent decades, a growing and preoccupying excess of medical interventions during childbirth, even in physiological and uncomplicated births, together with a concerning spread of abusive and disrespectful practices towards women during childbirth across the world, have been reported. Despite research and policy-making to address these problems, changing childbirth practices has proved to be difficult. We argue that the excessive rates of medical interventions and disrespect towards women during childbirth should be analysed as a consequence of structural violence, and that the concept of obstetric violence, as it is being used in Latin American childbirth activism and legal documents, might prove to be a useful tool for addressing structural violence in maternity care such as high intervention rates, non-consented care, disrespect and other abusive practices. Copyright © 2016 Elsevier Inc. All rights reserved.

Modelling categorical data to identify factors influencing concern for the natural environment in Iran.

Science.gov (United States)

Parizanganeh, Abdolhossein; Lakhan, V Chris; Yazdani, Mahmoud; Ahmad, Sajid R

2011-10-01

Loglinear modelling techniques were used to identify the interactions and interrelationships underlying categorical environmental concern data collected from 9062 respondents in Iran. After fitting various loglinear models to the data, the most parsimonious model highlighted that a combination of interacting factors, namely educational attainment, age, gender, and residential location were responsible for influencing personal concern for the environment. Although high educational attainment had a close correspondence with high concern for the environment the loglinear results, when visualized with a geographical information system, demonstrated wide spatial variations in educational attainment and concern for the environment. Nearly two-thirds of the respondents were not highly educated, and were therefore not highly concerned for the environment. The finding that both rural and urban male and female respondents in the 15-24 years age category, with 10-12 years of education, had the strongest interaction with personal concern for the environment could be beneficial for policy planners to utilize education as the primary instrument to enhance environmental governance and prospects for sustainable development. Copyright © 2011 Elsevier Ltd. All rights reserved.

What are the social concerns? round table discussions during session 1 of the Fsc workshop in Canada

International Nuclear Information System (INIS)

Mays, C.

2003-01-01

The first session of the Ottawa Workshop addressed the identification of social concerns regarding the management of low-level radioactive waste and nuclear fuel waste. The Forum on Stakeholder Confidence recognizes that concerns about e.g., equity, lifestyle, culture and economy are intrinsically important. These concerns also form the context of radioactive waste management, and so institutional frameworks must address them. Canadian legislation sets up assurance that due consideration will be given to social concerns. The Canadian Environmental Assessment Act requires that proposed large infrastructure projects be assessed for adverse effects on the environment, including social and economic impacts (Ferch, this volume). The requirements on social impact assessment have recently been reinforced. The new Canadian Nuclear Fuel Waste Act (NFWA) was voted in Summer 2002 and brought into force in November 2002. It directs the nuclear energy corporations to establish a waste management organisation. This organisation must propose at least three approaches for the management of fuel waste, and then implement the approach that is selected or approved by the Governor in Council. The NWFA explicitly requires the study of ethical, social and economic considerations, as well as relative benefits, risks and costs associated with each proposed management approach. (author)

78 FR 34169 - Notice of Finding That Liberty Reserve S.A. Is a Financial Institution of Primary Money...

Science.gov (United States)

2013-06-06

... Reserve S.A. Is a Financial Institution of Primary Money Laundering Concern AGENCY: Financial Crimes... is of primary money laundering concern. DATES: The finding referred to in this notice was effective... money laundering and the financing of terrorism. Regulations implementing the BSA appear at 31 CFR...

The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review.

Science.gov (United States)

Demarzo, Marcelo M P; Montero-Marin, Jesús; Cuijpers, Pim; Zabaleta-del-Olmo, Edurne; Mahtani, Kamal R; Vellinga, Akke; Vicens, Caterina; López-del-Hoyo, Yolanda; García-Campayo, Javier

2015-11-01

Positive effects have been reported after mindfulness-based interventions (MBIs) in diverse clinical and nonclinical populations. Primary care is a key health care setting for addressing common chronic conditions, and an effective MBI designed for this setting could benefit countless people worldwide. Meta-analyses of MBIs have become popular, but little is known about their efficacy in primary care. Our aim was to investigate the application and efficacy of MBIs that address primary care patients. We performed a meta-analytic review of randomized controlled trials addressing the effect of MBIs in adult patients recruited from primary care settings. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines were followed. Effect sizes were calculated with the Hedges g in random effects models. The meta-analyses were based on 6 trials having a total of 553 patients. The overall effect size of MBI compared with a control condition for improving general health was moderate (g = 0.48; P = .002), with moderate heterogeneity (I(2) = 59; P .05). Although the number of randomized controlled trials applying MBIs in primary care is still limited, our results suggest that these interventions are promising for the mental health and quality of life of primary care patients. We discuss innovative approaches for implementing MBIs, such as complex intervention and stepped care. © 2015 Annals of Family Medicine, Inc.

Family-centered depression treatment for older men in primary care: a qualitative study of stakeholder perspectives.

Science.gov (United States)

Hinton, Ladson; Sciolla, Andrés F; Unützer, Jürgen; Elizarraras, Edward; Kravitz, Richard L; Apesoa-Varano, Ester Carolina

2017-09-29

Family members often play important roles in the lives of depressed older men and frequently attend primary care visits with their loved ones, yet surprisingly little is known about how to most effectively engage and include family members in depression treatment. However, including family in depression treatment may be difficult due to several factors, such as depression stigma and family conflicts. The objective of this study was to describe challenges in engaging family members in older men's depression treatment and potential strategies to overcome those challenges. A cross-sectional, qualitative descriptive interview study was conducted in a safety-net, Federally Qualified Health Center in California's Central Valley. A total of 37 stakeholders were recruited, including 15 depressed older (i.e. age ≥ 60) men, 12 family members, and 10 clinic staff. Depressed men were identified through mail outreach, waiting room screening, and referral. Depressed men identified family members who were later approached to participate. We also recruited a purposeful sample of clinic staff. Interviews explored stakeholder perspectives on family involvement in men's depression treatment as part of a primary care intervention. Interviews were conducted using a semi-structured interview guide, tape-recorded, transcribed verbatim, and translated if the interview was conducted in Spanish. Four themes were identified representing core challenges: engaging men at the right time; preserving men's sense of autonomy; managing privacy concerns; and navigating family tensions. Stakeholders also provided practical suggestions and advice about how each of these challenges might be addressed. While engaging family is a promising approach to strengthen depression care for older men in primary care settings, several potential challenges exist. Family- centered depression intervention development and clinical practice need to anticipate these challenges and to develop approaches and

Culture X: addressing barriers to physical activity in Samoa.

Science.gov (United States)

Heard, Emma Marie; Auvaa, Leveti; Conway, Brooke A

2017-08-01

There is an urgent need to address the epidemic rates of non-communicable diseases globally, and the Pacific Island region is of particular concern. Increasing physical activity participation plays an important role in reducing some of the key risk factors for non-communicable diseases including obesity and being overweight. In order to address low levels of physical activity, it is essential to understand the key barriers and facilitating factors experienced by specific population groups. The purpose of this study is to investigate key facilitating factors for participation in a dance aerobic initiative, Culture X, developed in the Pacific Island country, Samoa. The study further aims to understand ways in which the programme assists participants in addressing barriers to physical activity. Face-to-face interviews running from 10 to 20 min were conducted with 28 Culture X participants in order to gain a deep understanding of participants' personal perspectives with regard to barriers and facilitating factors to physical activity. Findings suggest the inclusion of key cultural components (including, traditional dance moves and music, prayer, community orientation and family inclusiveness) were integral for supporting ongoing participation in Culture X. These components further assisted participants in addressing important personal and social barriers to physical activity (including lack of motivation and enjoyment, lack of confidence, time management, family and social commitments and lack of support). This study highlights creative ways that health promotion in the Pacific Island region can encourage physical activity and informs health promotion literature regarding the importance of placing local culture at the heart of behaviour change initiatives. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Addresses

Data.gov (United States)

Town of Chapel Hill, North Carolina — Point features representing locations of all street addresses in Orange County, NC including Chapel Hill, NC. Data maintained by Orange County, the Town of Chapel...

Selected international efforts to address climate change

Energy Technology Data Exchange (ETDEWEB)

Seki, M.; Christ, R. [Atmosphere Unit, United Nations Environment Programme UNEP, Nairobi (Kenya)

1995-12-31

Over the past two decades, concern about human-induced climate change has become an increasingly important item on the environmental and political agenda. The signing of the United Nations Framework Convention on Climate Change and the adoption of Agenda 21 at the United Nations Conference on Environment and Development in Rio de Janeiro in 1992 provided international organizations and the nations of the world with a new focus for climate-related activities. Although there remains considerable scientific uncertainty about the extent, magnitude, and rate of climate change and the impacts of such change, actions to address climate change have been initiated both internationally and nationally. Major international activities include the World Climate Programme, the Intergovernmental Panel on Climate Change, the United Nations Framework Convention on Climate Change. and the United Nations Environment Program me. 16 refs.

Applying organizational behavior theory to primary care.

Science.gov (United States)

Mullangi, Samyukta; Saint, Sanjay

2017-03-01

Addressing the mounting primary care shortage in the United States has been a focus of educators and policy makers, especially with the passage of the Affordable Care Act in 2010 and the Medicare Access and CHIP Reauthorization Act in 2015, placing increased pressure on the system. The Association of American Medical Colleges recently projected a shortage of as many as 65,000 primary care physicians by 2025, in part because fewer than 20% of medical students are picking primary care for a career. We examined the issue of attracting medical students to primary care through the lens of organizational behavior theory. Assuming there are reasons other than lower income potential for why students are inclined against primary care, we applied various principles of the Herzberg 2-factor theory to reimagine the operational flow and design of primary care. We conclude by proposing several solutions to enrich the job, such as decreasing documentation requirements, reducing the emphasis on specialty consultations, and elevating physicians to a supervisory role.

Addressing challenges in scaling up TB and HIV treatment integration in rural primary healthcare clinics in South Africa (SUTHI): a cluster randomized controlled trial protocol.

Science.gov (United States)

Naidoo, Kogieleum; Gengiah, Santhanalakshmi; Yende-Zuma, Nonhlanhla; Padayatchi, Nesri; Barker, Pierre; Nunn, Andrew; Subrayen, Priashni; Abdool Karim, Salim S

2017-11-13

A large and compelling clinical evidence base has shown that integrated TB and HIV services leads to reduction in human immunodeficiency virus (HIV)- and tuberculosis (TB)-associated mortality and morbidity. Despite official policies and guidelines recommending TB and HIV care integration, its poor implementation has resulted in TB and HIV remaining the commonest causes of death in several countries in sub-Saharan Africa, including South Africa. This study aims to reduce mortality due to TB-HIV co-infection through a quality improvement strategy for scaling up of TB and HIV treatment integration in rural primary healthcare clinics in South Africa. The study is designed as an open-label cluster randomized controlled trial. Sixteen clinic supervisors who oversee 40 primary health care (PHC) clinics in two rural districts of KwaZulu-Natal, South Africa will be randomized to either the control group (provision of standard government guidance for TB-HIV integration) or the intervention group (provision of standard government guidance with active enhancement of TB-HIV care integration through a quality improvement approach). The primary outcome is all-cause mortality among TB-HIV patients. Secondary outcomes include time to antiretroviral therapy (ART) initiation among TB-HIV co-infected patients, as well as TB and HIV treatment outcomes at 12 months. In addition, factors that may affect the intervention, such as conditions in the clinic and staff availability, will be closely monitored and documented. This study has the potential to address the gap between the establishment of TB-HIV care integration policies and guidelines and their implementation in the provision of integrated care in PHC clinics. If successful, an evidence-based intervention comprising change ideas, tools, and approaches for quality improvement could inform the future rapid scale up, implementation, and sustainability of improved TB-HIV integration across sub-Sahara Africa and other resource

Enter your email-address: how German internet users manage their email addresses

NARCIS (Netherlands)

Utz, S.

2004-01-01

Writing E-mail is the most popular Internet activity. Meanwhile, many people have more than one E-mail address. The question how people manage their E-mail addresses, more specifically, whether they use them deliberately for different purposes, is the central question of this paper. E-mail addresses

Primary and secondary patient data in contrast: the use of observational studies like RABBIT.

Science.gov (United States)

Richter, Adrian; Meißner, Yvette; Strangfeld, Anja; Zink, Angela

2016-01-01

The study of secondary patient data, particularly represented by claims data, has increased in recent years. The strength of this approach involves easy access to data that have been generated for administrative purposes. By contrast, collection of primary data for research is time-consuming and may therefore appear outdated. Both administrative data and data collected prospectively in clinical care can address similar research questions concerning effectiveness and safety of treatments. Therefore, why should we invest the precious time of rheumatologists to generate primary patient data? This article will outline some features of primary patient data collection illustrated by the German biologics register RABBIT (Rheumatoid arthritis: observation of biologic therapy). RABBIT is a long-term observational cohort study that was initiated more than 15 years ago. We will discuss as quality indicators: (i) study design, (ii) type of documentation, standardisation of (iii) clinical and (iv) safety data, (v) monitoring of the longitudinal follow-up, (vi) losses to follow-up as well as (vii) the possibilities to link the data base. The impact of these features on interpretation and validity of results is illustrated using recent publications. We conclude that high quality and completeness of data prospectively-collected offers many advantages over large quantities of non-standardised data collected in an unsupervised manner. We expect the enthusiasm about the use of secondary patient data to decline with more awareness of their methodological limitations while studies with primary patient data like RABBIT will maintain and broaden their impact on daily clinical practice.

Primary-care based participatory rehabilitation: users’ views of a horticultural and arts project

Science.gov (United States)

Barley, Elizabeth A; Robinson, Susan; Sikorski, Jim

2012-01-01

Background Participation in horticulture and arts may improve wellbeing in those with mental and physical illness. Aim To conduct an in-depth exploration of the views and experience of participants of a primary-care-based horticultural and participatory arts rehabilitation project (Sydenham Garden). Design and setting Qualitative interview study of a primary-care-based horticultural and participatory arts rehabilitation project in South London. Method Semi-structured interviews were conducted with 16 participants (referred to as ‘coworkers’) of Sydenham Garden. Seven were female. Participants were aged between 38 and 91 years and had a range of severe mental and physical health problems; most had depression. The interviews were analysed using constant comparison and thematic analysis. Results Data were overwhelmingly positive concerning participation. Coworkers considered participation in the project to promote wellbeing by providing purposeful and enjoyable activity and interest, improving mood and self-perceptions, and providing an escape from life’s pressures. Being outdoors was considered therapeutic. The most-valued aspect of participation was the social contact derived as a result of it. Many of the coworkers who were interviewed developed transferable skills, including nationally recognised qualifications, which they valued highly. Conclusion Delivery of horticultural therapy and participatory arts is a feasible model for improving wellbeing in patients in primary care who have serious illness. Longer-term studies are needed to address what happens to people after leaving such projects. PMID:22520790

Allegheny County Addressing Landmarks

Data.gov (United States)

Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains address points which represent physical address locations assigned by the Allegheny County addressing authority. Data is updated by County...

Allegheny County Address Points

Data.gov (United States)

Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains address points which represent physical address locations assigned by the Allegheny County addressing authority. Data is updated by County...

Health concerns associated with unconventional gas mining in rural Australia.

Science.gov (United States)

Haswell, Melissa R; Bethmont, Anna

2016-01-01

Many governments globally are investigating the benefits and risks associated with unconventional gas mining for shale, tight and coal seam gas (coalbed methane) to determine whether the industry should proceed in their jurisdiction. Most locations likely to be developed are in rural areas, with potential impact on farmers and small communities. Despite significant health concerns, public health knowledge and growing evidence are often overlooked in decision-making. It is difficult to gain a broad but accurate understanding of the health concerns for rural communities because the evidence has grown very recently and rapidly, is complex and largely based in the USA, where the industry is advanced. In 2016, a concerned South Australian beef and lamb farmer in an area targeted for potential unconventional gas development organised visits to homes in developed unconventional gas areas of Pennsylvania and forums with leading researchers and lawyers in Pennsylvania and New York. Guided by priorities identified during this trip, this communication concisely distils the research evidence on these key concerns, highlighting the Australian situation where evidence exists. It summarises key information of particular concern to rural regions, using Australia as an example, to assist rural health professionals to be better prepared to engage in decision-making and address the challenges associated with this new industry. Discussions with communities and experts, supported by the expanding research from the USA and Australia, revealed increasing health concerns in six key areas. These are absence of a safe solution to the toxic wastewater management problems, air pollution, land and water competition, mental health and psychosocial wellbeing risks, fugitive methane emissions and lack of proven regulatory regimes. Emerging epidemiological studies suggesting interference with foetal development and birth outcomes, and exacerbation of asthma conditions, are particularly concerning

A rural/urban comparison of privacy and confidentiality concerns associated with providing sensitive location information in epidemiologic research involving persons who use drugs.

Science.gov (United States)

Rudolph, Abby E; Young, April M; Havens, Jennifer R

2017-11-01

Analyses that link contextual factors with individual-level data can improve our understanding of the "risk environment"; however, the accuracy of information provided by participants about locations where illegal/stigmatized behaviors occur may be influenced by privacy/confidentiality concerns that may vary by setting and/or data collection approach. We recruited thirty-five persons who use drugs from a rural Appalachian town and a Mid-Atlantic city to participate in in-depth interviews. Through thematic analyses, we identified and compared privacy/confidentiality concerns associated with two survey methods that (1) collect self-reported addresses/cross-streets and (2) use an interactive web-based map to find/confirm locations in rural and urban settings. Concerns differed more by setting than between methods. For example, (1) rural participants valued interviewer rapport and protections provided by the Certificate of Confidentiality more; (2) locations considered to be sensitive differed in rural (i.e., others' homes) and urban (i.e., where drugs were used) settings; and (3) urban participants were more likely to view providing cross-streets as an acceptable alternative to providing exact addresses for sensitive locations and to prefer the web-based map approach. Rural-urban differences in privacy/confidentiality concerns reflect contextual differences (i.e., where drugs are used/purchased, population density, and prior drug-related arrests). Strategies to alleviate concerns include: (1) obtain a Certificate of Confidentiality, (2) collect geographic data at the scale necessary for proposed analyses, and (3) permit participants to provide intersections/landmarks in close proximity to actual locations rather than exact addresses or to skip questions where providing an intersection/landmark would not obfuscate the actual address. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effect of age, education and health status on community dwelling older men's health concerns.

Science.gov (United States)

Tannenbaum, Cara

2012-06-01

A significant gap in evidence characterizes the process of establishing patient-centered health priorities for older men. A cross-sectional postal survey of 2325 Canadian community dwelling men aged 55-97 years old was conducted in 2008 to gauge older men's level of concern for 24 different health items, to determine the impact of age, education and health status on these perceptions, and to ascertain whether men perceive that their health concerns are being attended to. Health issues of greatest concern to men were mobility impairment (64% of respondents), memory loss (64%), and medication side effects (63%). Respondents with lower educational attainment expressed greater concern about their health and were almost 2-fold times more likely to report being concerned about stroke, heart disease and prostate disorders in analyses that controlled for age and health status. Physical and mental health were independently associated with various concerns about health, but old age was not a reliable predictor, with only younger men (erectile dysfunction. Health items of greatest concern to men tended to be those with the lowest screening or counseling rates: these included incontinence, osteoporosis, mobility impairment, falls, anxiety issues, memory loss and depression. An improved consumer-guided agenda for addressing older men's health in the coming decade is urgently required.

Scoping review of health promotion and disease prevention interventions addressed to elderly people.

Science.gov (United States)

Duplaga, Mariusz; Grysztar, Marcin; Rodzinka, Marcin; Kopec, Agnieszka

2016-09-05

The ageing of modern societies remains one of the greatest challenges for health and social systems. To respond to this challenge, we need effective strategies assuring healthy active life for elderly people. Health promotion and related activities are perceived as a key intervention, which can improve wellbeing in later life. The main aim of this study is the identification and classification of such interventions addressed to older adults and elderly. Therefore, the strategy based on the scoping review as a feasible tool for exploring this domain, summarizing research findings and identifying gaps of evidence, was applied. The scoping review relies on the analysis of previous reviews of interventions aimed at older adults (55-64 years old) and elderly persons (65 years and above) assessed for their effectiveness in the framework of a systematic review and/or meta-analysis. The search strategy was based on the identification of interventions reported as health promotion, primary disease prevention, screening or social support. In the analysis, the reviews published from January 2000 to April 2015 were included. The search strategy yielded 334 systematic reviews and/or meta-analyses addressed to target groups of interest, 182 of them assessed interventions belonging to health promotion, 219 to primary prevention, 34 to screening and 35 to social support. The studies focused on elderly (65 years and above) made up 40.4 % of all retrieved reviews and those addressing population of 55 years and above accounted for 24.0 %. Interventions focused on health maintenance and improvement in elderly and older adults represent frequently combined health promotion and disease prevention actions. Many interventions of this type are not addressed exclusively to elderly populations and/or older adults but are designed for the general population. The most common types of interventions addressed to elderly and older adults in the area of health promotion include health

South African address standard and initiatives towards an international address standard

CSIR Research Space (South Africa)

Cooper, Antony K

2008-10-01

Full Text Available ; visiting friends; and providing a reference context for presenting other information. The benefits of an international address standards include: enabling address interoperability across boundaries; reducing service delivery costs; enabling development...

78 FR 24593 - Notice of Finding That Kassem Rmeiti & Co. For Exchange Is a Financial Institution of Primary...

Science.gov (United States)

2013-04-25

.... For Exchange Is a Financial Institution of Primary Money Laundering Concern AGENCY: Financial Crimes... United States that is of primary money laundering concern. DATES: The finding referred to in this notice... the anti- money laundering provisions of the Bank Secrecy Act (``BSA''), codified at 12 U.S.C. 1829b...

Keynote address

International Nuclear Information System (INIS)

Davis, J.M.

1991-01-01

DOE biomass R ampersand D programs have the potential to provide America with both plentiful, clean-burning domestic transportation fuels and cost-competitive industrial and utility fuels, benefiting energy security in the United States. Biofuels developed under our programs will also help improve air quality, reduce greenhouse gases, reduce the large daily quantities of waste we produce, and revitalize rural America. These research motivations have been documented in the National Energy Strategy. DOE looks forward to expanding its biofuels research program and to forging a partnership with private sector for cost-shared commercialization of new fuels and vehicle technologies. Many alternative fuels (e.g., ethanol, methanol, compressed natural gas, propane, or electricity) are candidates for gaining market share. Indeed, there may be significant regional variation in the future fuel mix. Alcohol fuels from biomass, particularly ethanol, have the potential to make a major contribution. Currently, ethanol in the United States is almost entirely made from corn; and the limitations of that process are well known (e.g., costly feedstock, end product requiring subsidy to be competitive, use of fossil fuels in renewable feedstock production and processing, and potential adverse impact of corn ethanol production on the price of food). To address these concerns, the DOE biofuels program is pursuing an ambitious research program to develop the technologies needed to convert these crops into alternative transportation fuels, primarily cellulose-based ethanol and methanol. Program R ampersand D has reduced the estimated cost per gallon of cellulose-based ethanol from $3.60 in 1980 to the current $1.35, with a program goal of $0.60 by the year 2000. DOE is also investigating the thermochemical conversion of biomass to methanol. The program goal is to achieve commercial production of methanol (like ethanol) at the gasoline equivalent of $0.90 per gallon by the year 2000. 4 figs

Learning experiences of physiotherapy students during primary ...

African Journals Online (AJOL)

Background. Primary healthcare (PHC) is necessary to address the health needs of communities. It creates the opportunity for the attainment of curricular outcomes through community-based education. Appropriate learning opportunities are needed to enable students to develop the necessary skills to attain these outcomes ...

The Relation Between Policies concerning Corporate Social Responsibility and Philosophical Moral Theories

OpenAIRE

Frederiksen, Claus S.

2009-01-01

This paper examines the relation between policies concerning Corporate Social Responsibility (CSR) and philosophical moral theories. The objective is to determine which moral theories form the basis for CSR policies. Are they based on ethical egoism, libertarianism, utilitarianism or some kind of common-sense morality? To address this issue, I conducted an empirical investigation examining the relation between moral theories and CSR policies, in companies engaged in CSR. Based ...

HANFORD DOUBLE SHELL TANK THERMAL AND SEISMIC PROJECT BUCKLING EVALUATION METHODS AND RESULTS FOR THE PRIMARY TANKS

Energy Technology Data Exchange (ETDEWEB)

MACKEY TC; JOHNSON KI; DEIBLER JE; PILLI SP; RINKER MW; KARRI NK

2009-01-14

This report documents a detailed buckling evaluation of the primary tanks in the Hanford double-shell waste tanks (DSTs), which is part of a comprehensive structural review for the Double-Shell Tank Integrity Project. This work also provides information on tank integrity that specifically responds to concerns raised by the Office of Environment, Safety, and Health (ES&H) Oversight (EH-22) during a review of work performed on the double-shell tank farms and the operation of the aging waste facility (AWF) primary tank ventilation system. The current buckling review focuses on the following tasks: (1) Evaluate the potential for progressive anchor bolt failure and the appropriateness of the safety factors that were used for evaluating local and global buckling. The analysis will specifically answer the following questions: (a) Can the EH-22 scenario develop if the vacuum is limited to -6.6-inch water gage (w.g.) by a relief valve? (b) What is the appropriate factor of safety required to protect against buckling if the EH-22 scenario can develop? (c) What is the appropriate factor of safety required to protect against buckling if the EH-22 scenario cannot develop? (2) Develop influence functions to estimate the axial stresses in the primary tanks for all reasonable combinations of tank loads based on detailed finite element analysis. The analysis must account for the variation in design details and operating conditions between the different DSTs. The analysis must also address the imperfection sensitivity of the primary tank to buckling. (3) Perform a detailed buckling analysis to determine the maximum allowable differential pressure for each of the DST primary tanks at the current specified limits on waste temperature, height, and specific gravity. Based on the concrete anchor bolt loads analysis and the small deformations that are predicted at the unfactored limits on vacuum and axial loads, it is very unlikely that the EH-22 scenario (i.e., progressive anchor bolt

HANFORD DOUBLE-SHELL TANK THERMAL AND SEISMIC PROJECT-BUCKLING EVALUATION METHODS AND RESULTS FOR THE PRIMARY TANKS

International Nuclear Information System (INIS)

Mackey, T.C.; Johnson, K.I.; Deibler, J.E.; Pilli, S.P.; Rinker, M.W.; Karri, N.K.

2009-01-01

This report documents a detailed buckling evaluation of the primary tanks in the Hanford double-shell waste tanks (DSTs), which is part of a comprehensive structural review for the Double-Shell Tank Integrity Project. This work also provides information on tank integrity that specifically responds to concerns raised by the Office of Environment, Safety, and Health (ES and H) Oversight (EH-22) during a review of work performed on the double-shell tank farms and the operation of the aging waste facility (AWF) primary tank ventilation system. The current buckling review focuses on the following tasks: (1) Evaluate the potential for progressive anchor bolt failure and the appropriateness of the safety factors that were used for evaluating local and global buckling. The analysis will specifically answer the following questions: (a) Can the EH-22 scenario develop if the vacuum is limited to -6.6-inch water gage (w.g.) by a relief valve? (b) What is the appropriate factor of safety required to protect against buckling if the EH-22 scenario can develop? (c) What is the appropriate factor of safety required to protect against buckling if the EH-22 scenario cannot develop? (2) Develop influence functions to estimate the axial stresses in the primary tanks for all reasonable combinations of tank loads based on detailed finite element analysis. The analysis must account for the variation in design details and operating conditions between the different DSTs. The analysis must also address the imperfection sensitivity of the primary tank to buckling. (3) Perform a detailed buckling analysis to determine the maximum allowable differential pressure for each of the DST primary tanks at the current specified limits on waste temperature, height, and specific gravity. Based on the concrete anchor bolt loads analysis and the small deformations that are predicted at the unfactored limits on vacuum and axial loads, it is very unlikely that the EH-22 scenario (i.e., progressive anchor

Public Concern with Farm-Animal Welfare: Religion, Politics, and Human Disadvantage in the Food Sector

Science.gov (United States)

Deemer, Danielle R.; Lobao, Linda M.

2011-01-01

The welfare of farm animals has become a continuing source of controversy as states seek greater regulation over the livestock industry. However, empirical studies addressing the determinants of public concern for farm-animal welfare are limited. Religion and politics, two institutional bases of attitudes, are rarely explored. Nor have…

Grade Repetition and Primary School Dropout in Uganda

Science.gov (United States)

Kabay, Sarah

2016-01-01

Research on education in low-income countries rarely focuses on grade repetition. When addressed, repetition is typically presented along with early school dropout as the "wasting" of educational resources. Simplifying grade repetition in this way often fails to recognize significant methodological concerns and also overlooks the unique…

US Approaches to Physician Payment: The Deconstruction of Primary Care

OpenAIRE

Berenson, Robert A.; Rich, Eugene C.

2010-01-01

The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary ...

Addressing water quality issues on a watershed basis: a comprehensive approach for utilizing chapter 20 of the Michigan drain code

International Nuclear Information System (INIS)

McCulloch, J.P.

2002-01-01

There are five major watersheds in Oakland County. They are the Clinton, Flint, Huron, Rouge and Shiawassee. Included in these watersheds are 61 individual cities, villages and townships. Actions taken by one community within the watershed have a significant impact on other communities in the watershed. Consequently, a multi-community approach needs to be identified and utilized to comprehensively address public health and water quality issues. Some of the issues faced by these communities individually include stormwater management, flooding, drainage, and river and stream management. Failing septic systems, illicit connections causing groundwater contamination, and habitat and wetland degradation are also primary concerns. Finally, wastewater treatment capacity and sanitary sewer service also are regularly dealt with by these communities. Traditionally, short-term solutions to these often urgent problems required the construction of relief sewers or temporary retention structures. Unfortunately, solving the problem in one area often meant the creation of new problems downstream. Coordinating efforts among these 61 individual communities is difficult. These difficult challenges are best met with a coordinated, comprehensive plan. (author)

Assessing primary care in Austria: room for improvement.

Science.gov (United States)

Stigler, Florian L; Starfield, Barbara; Sprenger, Martin; Salzer, Helmut J F; Campbell, Stephen M

2013-04-01

There is emerging evidence that strong primary care achieves better health at lower costs. Although primary care can be measured, in many countries, including Austria, there is little understanding of primary care development. Assessing the primary care development in Austria. A primary care assessment tool developed by Barbara Starfield in 1998 was implemented in Austria. This tool defines 15 primary care characteristics and distinguishes between system and practice characteristics. Each characteristic was evaluated by six Austrian primary care experts and rated as 2 (high), 1 (intermediate) or 0 (low) points, respectively, to their primary care strength (maximum score: n = 30). Austria received 7 out of 30 points; no characteristic was rated as '2' but 8 were rated as '0'. Compared with the 13 previously assessed countries, Austria ranks 10th of 14 countries and is classified as a 'low primary care' country. This study provides the first evidence concerning primary care in Austria, benchmarking it as weak and in need of development. The practicable application of an existing assessment tool can be encouraging for other countries to generate evidence about their primary care system as well.

Forms of Address as Discrete Modal Operators

Directory of Open Access Journals (Sweden)

Wojciech Paweł Sosnowski

2016-12-01

Full Text Available Forms of Address as Discrete Modal Operators The category of expressions of politeness includes, among others, forms of address. Forms of address express honorification. Honorification can be defined as a special type of meaning that consists of information about the social and interpersonal relations between the speaker and the addressee, the speaker and the hearer, and the speaker and the protagonist of the predication. As far as their place in the syntactic structure is concerned, forms of address can either be integrated with the other elements of a predication or not. However, they are always part of a predication’s semantic structure. Moreover, forms of address convey the speaker’s attitude to the meaning of the predicate that they want to convey, which consequently means that forms of address also carry a modal element. Modality can be defined as a situation in which an individual is in a particular mental state, i.e. exhibits some kind of attitude to a situation or a type of situations. Forms of address can be categorised as modal operators conveying imperatives, requests, suppositions, etc. The term "operator" can be used for a unit of language when it changes the semantic structure of the predication. My research on honorification is mainly based on contemporary corpora, both monolingual and multilingual. In the present study, I analyse forms of address which carry imperative and optative meanings.   Formy adresatywne jako dyskretne operatory modalne W obrębie wyrażeń realizujących funkcje grzecznościowe znajduje się grupa form adresatywnych. Są one częścią kategorii honoryfikatywności rozumianej jako szczególny rodzaj znaczenia zawartego w treści wypowiedzi, informację o towarzysko-społecznej relacji między nadawcą a odbiorcą, nadawcą a słuchaczem oraz nadawcą a bohaterem wypowiedzi. Gramatycznie formy adresatywne mogą być zarówno zintegrowane, jak i niezintegrowane syntaktycznie z resztą wypowiedzi, ale

Concerns in Marine Renewable Energy Projects

Energy Technology Data Exchange (ETDEWEB)

Kramer, Sharon; Previsic, Mirko; Nelson, Peter; Woo, Sheri

2010-06-17

To accelerate the adoption of these emerging marine hydrokinetic technologies, navigational and environmental issues and concerns must be identified and addressed. As hydrokinetic projects move forward, various stakeholders will need to be engaged; one of the key issues that project proponents face as they engage stakeholders is that many conflicting uses and environmental issues are not well-understood. Much of this lack of understanding comes from a limited understanding of the technologies themselves. To address this issue, in September 2008, RE Vision consulting, LLC, was selected by the Department of Energy, under their market acceleration program, to apply a scenario-based assessment approach to the emerging hydrokinetic technology sector. The goal was to improve understanding of potential environmental and navigation impacts of these technologies and focus stakeholders on the critical issues. To meet this goal, the study established baseline scenarios for wave and tidal power conversion at potential future deployment sites. The scenarios captured variations in technical approaches and deployment scales and thus grounded the analysis in realistic constraints. The work conducted under this award provides an important foundation to other market acceleration activities carried out by the DOE and other stakeholders in this sector. The scenarios were then evaluated using a framework developed by H.T. Harvey & Associates to identify and characterize key environmental concerns and uncertainties. In collaboration with PCCI and the U.S. Coast Guard, navigation issues were assessed and guidelines developed to assure the safe operation of these systems. Finally, the work highlights “next steps” to take to continue development and adoption of marine hydrokinetic energy. Throughout the project, close collaboration with device developers, project developers and regulatory stakeholders was pursued to ensure that assumptions and constraints are realistic. Results concur

Identifying veterinary students' capacity for moral behavior concerning animal ethics issues.

Science.gov (United States)

Verrinder, Joy M; Phillips, Clive J C

2014-01-01

Veterinarians face unique animal ethics challenges as practitioners and policy advisors to government and industry. Changing societal attitudes, cultural diversity, and the often conflicting needs and interests of patients and clients contribute to moral distress. Yet little has been done to identify veterinarians' capacity to address these animal ethics issues. In this study, first-year and final-year veterinary students in an Australian university were surveyed to explore moral sensitivity, moral motivation, and moral character and their relationship with moral reasoning. The majority of students were concerned about animal ethics issues and had experienced moral distress in relation to the treatment of animals. Most believed that veterinarians should address the wider social issues of animal protection and that veterinary medicine should require a commitment to animals' interests over owners'/caregivers' interests. There was less agreement that the veterinary profession was sufficiently involved in addressing animal ethics issues. The principal motivators for studying veterinary medicine were, in declining importance, enjoyment in working with animals, helping sick and injured animals, and improving the way animals are treated. However, most students had taken little or no action to address animal ethics issues. These results suggest that both first- and fifth-year veterinary students are sensitive to animal ethics issues and are motivated to prioritize the interests of animals but have little experience in taking action to address these issues. Further research is needed to determine ways to identify and assess these moral behavior components in veterinary education to develop veterinarians' capacity to address animal ethics issues.

'Hesitant compliers': Qualitative analysis of concerned fully-vaccinating parents.

Science.gov (United States)

Enkel, Stephanie L; Attwell, Katie; Snelling, Thomas L; Christian, Hayley E

2017-10-11

Some parents are hesitant about vaccines and yet still vaccinate their children. Vaccine behaviours are not fixed and parents who are concerned but nonetheless adherent to standard schedules could switch to an unconventional schedule, delaying or cherry-picking vaccines. There is a need to better understand vaccine hesitancy in specific contexts, acknowledging cultural and geographical variation, to ensure interventions targeting hesitancy are well directed and received. To identify the behaviours, knowledge and attitudes of 'hesitant compliers' in Perth, Western Australia, nine one-on-one in-depth interviews were conducted with vaccinating parents of children (vaccination as important for themselves and their community, despite their limited knowledge of vaccine preventable diseases. Parents reported concerns about potential side effects, and worried about the safety of the measles-mumps-rubella (MMR) and seasonal influenza vaccines. Concerned about the role of anti-vaccination information in the community, some sought to isolate themselves from parents who did not vaccinate, although others were concerned that this could entrench non-vaccinators' behaviours. Parents' views were all underlaid by two pivotal 'vaccine-related events' that had occurred in the community: the severe injury of a baby from seasonal influenza vaccination in 2010, and the death of a baby from whooping cough in 2015. Parents interpreted pivotal vaccine-related events in the community as requiring them to take personal responsibility for vaccine decisions. Their reports of continued vaccine fears (evident in international studies in recent decades) demonstrate that vaccine scares have long lasting effects. With vaccine rates high and stable, current strategies appear to be have little impact on addressing parental vaccine concerns. Further research is required to determine the prevalence of hesitancy amongst vaccinating parents and identify critical points for intervention. Copyright © 2017

[Multiple primary colorectal cancer: Clinical aspects].

Science.gov (United States)

Soldatkina, N V; Kit, O I; Gevorkyan, Yu A; Milakin, A G

to define some clinical characteristics of synchronous and metachronous colorectal cancer (CRC). The investigation was concerned with the data of 150 patients with T1-4N0-2M0-1 multiple primary CRC. The clinical, biological, and morphological characteristics of synchronous and metachronous tumors were analyzed. Multiple primary tumors were 6.01% of all the cases of CRC. There was a preponderance of synchronous CRC (63.75%) with the tumor localized in the sigmoid colon and rectum. In women, synchronous colorectal tumors were more often concurrent with breast tumors; metachronous ones were detected after treatment for genital tumors. In men, synchronous colorectal tumors were more frequently concurrent with kidney cancer; metachronous ones were identified after treatment for gastric cancer. The found characteristics of multiple primary colorectal tumors may be taken in account in programs for both primary diagnosis and follow-up after treatment for malignant tumors, which will be able to improve the early detection of cancer patients and their treatment results.

Concerned consumption. Global warming changing household domestication of energy

International Nuclear Information System (INIS)

Aune, Margrethe; Godbolt, Åsne Lund; Sørensen, Knut H.; Ryghaug, Marianne; Karlstrøm, Henrik; Næss, Robert

2016-01-01

This paper addresses possible effects of the growing focus on global warming on households’ domestication of energy and the dynamics of energy consumption by comparing data pertaining to the domestication of energy within Norwegian households from two time periods: first, 1991–1995, when climate change was given little public attention, and, second, 2006–2009, after climate change became a major public concern. In the first period, we observed that the domestication of energy resulted in an energy culture emphasizing comfort and convenience with respect to everyday life and the abundant supply of clean hydropower. In the second period, this culture seemed to have changed, making households more concerned about their energy consumption. Consumption of energy was linked to climate change, and many interviewees claimed to save energy. However, the dominant expectation was still to be able to manage everyday life in a convenient and comfortable way. Thus, climate change concerns produced some but not very radical changes in the practical domestication of energy, including energy saving. A main effect was feelings of guilt, tempered by arguments regarding why change is difficult and complaints about political inaction. Thus, public engagement with climate change issues may facilitate energy efficiency policy but to succeed, wider climate policy measures seem to be needed. - Highlights: • Increased climate change focus has affected household domestication of energy. • The changes produced concerns about energy consumption. • Some energy saving activities were reported. • Household energy cultures are less stable than anticipated. • Suggests wider climate policy measures to motivate for energy efficiency.

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...

Addressing land use change and uncertainty in the life-cycle assessment of wheat-based bioethanol

International Nuclear Information System (INIS)

Malça, João; Freire, Fausto

2012-01-01

Despite the significant growth in the number of published life-cycle assessments of biofuels, important aspects have not captured sufficient attention, namely soil carbon emissions from land use change (LUC) and uncertainty analysis. The main goal of this article is to evaluate the implications of different LUC scenarios and uncertainty in the life-cycle energy renewability efficiency and GHG (greenhouse gases) intensity of wheat-based bioethanol replacing gasoline. A comprehensive assessment of different LUC scenarios (grassland or cropland converted to wheat cultivation) and agricultural practices is conducted, which results in different carbon stock change values. The types of uncertainty addressed include parameter uncertainty (propagated into LC (life-cycle) results using Monte-Carlo simulation) and uncertainty concerning how bioethanol co-product credits are accounted for. Results show that GHG emissions have considerably higher uncertainty than energy efficiency values, mainly due to soil carbon emissions from direct LUC and N 2 O release from cultivated soil. Moreover, LUC dominates the GHG intensity of bioethanol. Very different GHG emissions are calculated depending on the LUC scenario considered. Conversion of full- or low-tillage croplands to wheat cultivation results in bioethanol GHG emissions lower than gasoline emissions, whereas conversion of grassland does not contribute to bioethanol GHG savings over gasoline in the short- to mid-term. -- Highlights: ► We address different LUC scenarios and uncertainty in the LCA of wheat bioethanol. ► GHG emissions have considerably higher uncertainty than energy efficiency values. ► Bioethanol contributes to primary energy savings over gasoline. ► Very different life-cycle GHG emissions are calculated depending on the LUC scenario. ► GHG savings over gasoline are only achieved if cropland is the reference land use.

Skin cancer concerns and genetic risk information-seeking in primary care.

Science.gov (United States)

Hay, J; Kaphingst, K A; Baser, R; Li, Y; Hensley-Alford, S; McBride, C M

2012-01-01

Genomic testing for common genetic variants associated with skin cancer risk could enable personalized risk feedback to motivate skin cancer screening and sun protection. In a cross-sectional study, we investigated whether skin cancer cognitions and behavioral factors, sociodemographics, family factors, and health information-seeking were related to perceived importance of learning about how (a) genes and (b) health habits affect personal health risks using classification and regression trees (CART). The sample (n = 1,772) was collected in a large health maintenance organization as part of the Multiplex Initiative, ranged in age from 25-40, was 53% female, 41% Caucasian, and 59% African-American. Most reported that they placed somewhat to very high importance on learning about how genes (79%) and health habits (88%) affect their health risks. Social influence actors were associated with information-seeking about genes and health habits. Awareness of family history was associated with importance of health habit, but not genetic, information-seeking. The investment of family and friends in health promotion may be a primary motivator for prioritizing information-seeking about how genes and health habits affect personal health risks and may contribute to the personal value, or personal utility, of risk information. Individuals who seek such risk information may be receptive to interventions aimed to maximize the social implications of healthy lifestyle change to reduce their health risks. Copyright © 2011 S. Karger AG, Basel.

Human Rights and International Labour Law issues concerning Migrant Women Working as Domestic Helpers in China

NARCIS (Netherlands)

Peng, Q.|info:eu-repo/dai/nl/375803998

2017-01-01

This book addresses the human rights and international labour law issues concerning rural migrant women workers as domestic helpers in China and offers several legislative suggestions to the Chinese government. By describing the current de facto and de jure condition of rural migrant women working

Cost-effectiveness of primary prevention of paediatric asthma: a decision-analytic model

NARCIS (Netherlands)

Ramos, G. Feljandro P.; van Asselt, Antoinette D. I.; Kuiper, Sandra; Severens, Johan L.; Maas, Tanja; Dompeling, Edward; Knottnerus, J. André; van Schayck, Onno C. P.

2013-01-01

Background: Many children stand to benefit from being asthma-free for life with primary (i.e., prenatally started) prevention addressing one environmental exposure in a unifaceted (UF) approach or at least two in a multifaceted (MF) approach. We assessed the cost-effectiveness of primary prevention

32 CFR 37.875 - Should my TIA include a provision concerning foreign access to technology?

Science.gov (United States)

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Should my TIA include a provision concerning... Related to Other Administrative Matters Intellectual Property § 37.875 Should my TIA include a provision... provision in the TIA that addresses foreign access to technology developed under the TIA. (b) The provision...

Perceived risk of mental health problems in primary care

Directory of Open Access Journals (Sweden)

Constança ePaúl

2015-11-01

Full Text Available In the face of limited resources and an ageing population with increasingly care needs, healthcare systems must identify community-dwelling older adults with mental health problems at higher risk of adverse outcomes such as institutionalisation, hospitalisation and death, in order to deliver timely and efficient care. The objectives of this study were to assess the prevalence of mental health concerns and the associated perceived risk of adverse outcomes in a large sample of older patients in primary care. We trained general practitioners and nurses to use the Risk Instrument for Screening in the Community (RISC to rank perceived risk of mental health concerns (including neurocognitive and mood disorders from 1 (mild to 3 (Severe. The mean age of the 4499 people assessed was 76.3 years (sd=7.3 and 2645 (58.8% were female. According to the primary care team 1616 (35.9% were perceived to have mental health concerns of whom 847 (52.4% were mild, 559 (34.6% were moderate and 210 (13% were severe. Patients with mental health concerns had higher odds of perceived risk of adverse outcomes (OR=2.22, 95% CI 1.83-2.69 for institutionalisation; OR=1.66, 95% CI 1.41-1.94 for hospitalisation; OR=1.69, 95% CI 1.42-2.01 for death. These results suggest a high prevalence of mental health concerns among older adults and supports the need for early identification of patients at high-risk of adverse healthcare outcomes.

Addressing inequalities in health--what is the contribution of health trainers?

Science.gov (United States)

White, Judy; Woodward, Jenny; South, Jane

2013-07-01

The role that members of the public (non-professional lay people) can play in improving health is being increasingly recognised in research and policy. This paper explores what contribution lay people employed as health trainers are making to addressing health inequalities in England. Data from eight local evaluations of health trainer services were synthesised using a data-extraction framework to find out about client populations, any lifestyle changes made, health trainers' background and community engagement activities. These data were compared with national data to assess how findings relating to addressing inequalities compared with the national picture. Local data largely matched national data and showed that health trainers are reaching people living with disadvantage and enabling them to make lifestyle changes. The data suggest that they do this by engaging with communities and taking a person-centred approach. Being non-clinical peers is also important. However, no evidence was found that health trainers were impacting on health inequalities at a population level. Health trainers are contributing to addressing health inequalities but the services evaluated were small and had been operating for a limited time, so to expect reductions in inequalities at a population level within districts would be unrealistic. The findings of this synthesis present a challenge to primary care and public health to employ health trainers in order to engage marginalised communities as one element of plans to address health inequalities.

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…

Commissioning and equity in primary care in Australia: Views from Primary Health Networks.

Science.gov (United States)

Henderson, Julie; Javanparast, Sara; MacKean, Tamara; Freeman, Toby; Baum, Fran; Ziersch, Anna

2018-01-01

This paper reports findings from 55 stakeholder interviews undertaken in six Primary Health Networks (PHNs) in Australia as part of a study of the impact of population health planning in regional primary health organisations on service access and equity. Primary healthcare planning is currently undertaken by PHNs which were established in 2015 as commissioning organisations. This was a departure from the role of Medicare Locals, the previous regional primary health organisations which frequently provided services. This paper addresses perceptions of 23 senior staff, 11 board members and 21 members of clinical and community advisory councils or health priority groups from six case study PHNs on the impact of commissioning on equity. Participants view the collection of population health data as facilitating service access through redistributing services on the basis of need and through bringing objectivity to decision-making about services. Conversely, participants question the impact of the political and geographical context and population profile on capacity to improve service access and equity through service commissioning. Service delivery was seen as fragmented, the model is at odds with the manner in which Aboriginal Community Controlled Health Organisations (ACCHOs) operate and rural regions lack services to commission. As a consequence, reliance upon commissioning of services may not be appropriate for the Australian primary healthcare context. © 2017 John Wiley & Sons Ltd.

Radiation Protection Aspects of Primary Water Chemistry and Source-term Management Report

International Nuclear Information System (INIS)

2014-04-01

Since the beginning of the 1990's, occupational exposures in nuclear power plant has strongly decreased, outlining efforts achieved by worldwide nuclear operators in order to reach and maintain occupational exposure as low as reasonably achievable (ALARA) in accordance with international recommendations and national regulations. These efforts have focused on both technical and organisational aspects. According to many radiation protection experts, one of the key features to reach this goal is the management of the primary system water chemistry and the ability to avoid dissemination of radioactivity within the system. It outlines the importance for radiation protection staff to work closely with chemistry staff (as well as operation staff) and thus to have sufficient knowledge to understand the links between chemistry and the generation of radiation field. This report was prepared with the primary objective to provide such knowledge to 'non-chemist'. The publication primarily focuses on three topics dealing with water chemistry, source term management and remediation techniques. One key objective of the report is to provide current knowledge regarding these topics and to address clearly related radiation protection issues. In that mind, the report prepared by the EGWC was also reviewed by radiation protection experts. In order to address various designs, PWRs, VVERs, PHWRs and BWRs are addressed within the document. Additionally, available information addressing current operating units and lessons learnt is outlined with choices that have been made for the design of new plants. Chapter 3 of this report addresses current practices regarding primary chemistry management for different designs, 'how to limit activity in the primary circuit and to minimise contamination'. General information is provided regarding activation, corrosion and transport of activated materials in the primary circuit (background on radiation field generation). Primary chemistry aspects that

Online conversations among Ontario university students: environmental concerns.

Science.gov (United States)

Martinello, Novella; Donelle, Lorie

2012-09-01

As the 'next generation' guardians of the environment, there appears to be limited inquiry into young Canadians' environmental concerns. At the same time, online social networking is a predominant method of communication among young adults. This research explored online conversations regarding environmental concerns among young Canadian adults targeting the university student population. A qualitative content analysis was conducted using posted conversations from the online social media network Facebook. Conversations addressing environmental issues were summarized into four major themes. The first theme, 'Built Environment' (127 postings) centred on housing and transportation. The second theme, 'Natural Environment' (55 postings) accounted for issues of air quality, pollution and water quality. The third theme, 'Environmental Restoration' (52 postings) highlighted young Canadian adults' plans for environmental recovery. The fourth theme, 'Engagement and Activism' (31 postings) underscored students' use of the online social networking site for environmental advocacy. Young adults appeared to be environmentally conscious and, through the use of social networking, exchanged knowledge and opinions, and advocated for environmental change. Online social networking sites, such as Facebook, can serve as a communication channel that facilitates health information sharing and more importantly cultivates community capacity focused on environmental health promotion among young adult users.

NetGirls: the Internet, Facebook, and body image concern in adolescent girls.

Science.gov (United States)

Tiggemann, Marika; Slater, Amy

2013-09-01

The primary aim of the study was to examine the relationship between Internet exposure and body image concern in adolescent girls, with a particular focus on the social networking site of Facebook. A sample of 1,087 girls in the first two years (Years 8 and 9) of high school (aged 13-15 years) completed questionnaire measures of Internet consumption and body image concerns. The overwhelming majority of girls (95.9%) had access to the Internet in their home. Time spent on the Internet was significantly related to internalization of the thin ideal, body surveillance, and drive for thinness. Further, 75% of the girls had a Facebook profile, and spent an average of 1.5 hours there daily. Facebook users scored significantly more highly on all body image concern measures than non-users. It was concluded that the Internet represents a potent socio-cultural medium of relevance to the body image of adolescent girls. Copyright © 2013 Wiley Periodicals, Inc.

Radiation Safety in the Neonatal Intensive Care Unit: Too Little or Too Much Concern?

Directory of Open Access Journals (Sweden)

Cheng-Chung Yu

2010-12-01

Full Text Available With rising numbers of extremely premature infants in the neonatal intensive care unit (NICU who require multiple radiologic examinations for their complex medical conditions, concerns the risk of radiation exposure become a more prevalent issue. The biological effects from cumulative doses of both primary and secondary radiation can be particularly troubling for very premature babies due to their inherent sensitivity to both iatrogenic and environmental insults. Similarly, radiologic studies performed in the NICU pose potentially significant exposure risks to caretakers and to the families of patients often present in the NICU during these examinations. The purpose of this article is to critically review the available literature regarding current exposure rates in the NICU, address the validity of radiation exposure concerns, and suggest areas for improvement. With few exceptions, studies reveal that there were only low doses of radiation derived from any single radiographic examination in standard NICUs and that the radiation dosage used was in compliance with recommendations made by the Commission of European Communities (EC and International Commission on Radiological Protection (ICRP. However, there were wide variations in the radiation dose per single examination (mean entrance skin doses ranged from 15 to 73.6 μGy and in the frequency (mean ranged from 3.2 to 31 examinations per infant of those examinations. Studies also reported low secondary exposure rates from scatter radiation to others present in the NICU during radiographic examinations. Key to limiting unnecessary radiation exposure in the NICU is the employment of proper radiation techniques and safety measures. Thus, adhering to recommendations made by the EC and ICRP can help to reduce the anxiety of patients' families and medical staff regarding their risks from the effects of ionizing radiation in the NICU.

Concerns about aging and caregiving among middle-aged and older lesbian and gay adults.

Science.gov (United States)

Czaja, Sara J; Sabbag, Samir; Lee, Chin Chin; Schulz, Richard; Lang, Samantha; Vlahovic, Tatiana; Jaret, Adrienne; Thurston, Catherine

2016-11-01

Despite the increasing number of lesbian and gay older adults, research geared towards health and well-being of this population is limited. Many lesbian and gay seniors experience health disparities and are at risk for poor health outcomes. The aims of this study were to gather in-depth information on the concerns of lesbian and gay elders with respect to aging and care needs. The sample included 124 gay men and lesbian women aged 50+ years. Data were gathered via focus groups and questionnaires. The focus groups addressed: (1) concerns about aging in the LGBT community, (2) barriers to needed support and services, (3) concerns about caregiving and (4) needed programs for lesbian and gay seniors. Concerns expressed about aging included: lack of financial security, lack of family or social support, fears about the lack of someone to provide needed care, and discrimination in healthcare or service communities. Participants also indicated concerns about being alone and vulnerable and a need for resources and support programs, specifically for lesbian and gay older adults and for lesbian and gay caregivers. These findings suggest needed areas of support and programs for older gay men and lesbian women. They also suggest that healthcare professionals might need more training regarding the particular needs and concerns of this community.

Do Online Privacy Concerns Predict Selfie Behavior among Adolescents, Young Adults and Adults?

Science.gov (United States)

Dhir, Amandeep; Torsheim, Torbjørn; Pallesen, Ståle; Andreassen, Cecilie S.

2017-01-01

Selfies, or self-portraits, are often taken and shared on social media for online self-presentation reasons, which are considered essential for the psychosocial development and well-being of people in today’s culture. Despite the growing popularity and widespread sharing of selfies in the online space, little is known about how privacy concerns moderate selfie behavior. In addition to this, it is also not known whether privacy concerns across age and gender groups influence selfie behavior. To address this timely issue, a survey assessing common selfie behaviors, that is, frequency of taking (individual and group selfies), editing (cropping and filtering), and posting selfies online, and social media privacy concerns (over personal data being accessed and misused by third parties) was conducted. The web-survey was administered to 3,763 Norwegian social media users, ranging from 13 to 50 years, with a preponderance of women (n = 2,509, 66.7%). The present study investigated the impact of privacy concerns on selfie behaviors across gender and age groups (adolescent, young adult, and adult) by use of the structural equation modeling approach. The results suggest that young adults have greater privacy concerns compared to adolescents and adults. Females have greater privacy concerns than males. Greater privacy concerns among female social media users were linked to lower engagement in selfie behavior, but privacy concerns did not influence selfie behavior in the case of male adolescents and young adults. Overall, privacy concerns were more consistently and inversely related to selfie behavior (taking and posting) among females than males. The study results have theoretical as well as practical implications for both researchers and policy makers. PMID:28588530

Do Online Privacy Concerns Predict Selfie Behavior among Adolescents, Young Adults and Adults?

Science.gov (United States)

Dhir, Amandeep; Torsheim, Torbjørn; Pallesen, Ståle; Andreassen, Cecilie S

2017-01-01

Selfies, or self-portraits, are often taken and shared on social media for online self-presentation reasons, which are considered essential for the psychosocial development and well-being of people in today's culture. Despite the growing popularity and widespread sharing of selfies in the online space, little is known about how privacy concerns moderate selfie behavior. In addition to this, it is also not known whether privacy concerns across age and gender groups influence selfie behavior. To address this timely issue, a survey assessing common selfie behaviors, that is, frequency of taking (individual and group selfies), editing (cropping and filtering), and posting selfies online, and social media privacy concerns (over personal data being accessed and misused by third parties) was conducted. The web-survey was administered to 3,763 Norwegian social media users, ranging from 13 to 50 years, with a preponderance of women ( n = 2,509, 66.7%). The present study investigated the impact of privacy concerns on selfie behaviors across gender and age groups (adolescent, young adult, and adult) by use of the structural equation modeling approach. The results suggest that young adults have greater privacy concerns compared to adolescents and adults. Females have greater privacy concerns than males. Greater privacy concerns among female social media users were linked to lower engagement in selfie behavior, but privacy concerns did not influence selfie behavior in the case of male adolescents and young adults. Overall, privacy concerns were more consistently and inversely related to selfie behavior (taking and posting) among females than males. The study results have theoretical as well as practical implications for both researchers and policy makers.

Do Online Privacy Concerns Predict Selfie Behavior among Adolescents, Young Adults and Adults?

Directory of Open Access Journals (Sweden)

Amandeep Dhir

2017-05-01

Full Text Available Selfies, or self-portraits, are often taken and shared on social media for online self-presentation reasons, which are considered essential for the psychosocial development and well-being of people in today’s culture. Despite the growing popularity and widespread sharing of selfies in the online space, little is known about how privacy concerns moderate selfie behavior. In addition to this, it is also not known whether privacy concerns across age and gender groups influence selfie behavior. To address this timely issue, a survey assessing common selfie behaviors, that is, frequency of taking (individual and group selfies, editing (cropping and filtering, and posting selfies online, and social media privacy concerns (over personal data being accessed and misused by third parties was conducted. The web-survey was administered to 3,763 Norwegian social media users, ranging from 13 to 50 years, with a preponderance of women (n = 2,509, 66.7%. The present study investigated the impact of privacy concerns on selfie behaviors across gender and age groups (adolescent, young adult, and adult by use of the structural equation modeling approach. The results suggest that young adults have greater privacy concerns compared to adolescents and adults. Females have greater privacy concerns than males. Greater privacy concerns among female social media users were linked to lower engagement in selfie behavior, but privacy concerns did not influence selfie behavior in the case of male adolescents and young adults. Overall, privacy concerns were more consistently and inversely related to selfie behavior (taking and posting among females than males. The study results have theoretical as well as practical implications for both researchers and policy makers.

Primary Mathematics. A Saxon Teacher's Resource Booklet.

Science.gov (United States)

1997

Saxon's primary mathematics series is a "hands-on," success-oriented program which emphasizes manipulatives and mental math. The series addresses the multisensory approach to teaching. Its use enables all children to develop a solid foundation in the language and basic concepts of mathematics. Concepts are presented in carefully…

The differing privacy concerns regarding exchanging electronic medical records of internet users in Taiwan.

Science.gov (United States)

Hwang, Hsin-Ginn; Han, Hwai-En; Kuo, Kuang-Ming; Liu, Chung-Feng

2012-12-01

This study explores whether Internet users have different privacy concerns regarding the information contained in electronic medical records (EMRs) according to gender, age, occupation, education, and EMR awareness. Based on the Concern for Information Privacy (CFIP) scale developed by Smith and colleagues in 1996, we conducted an online survey using 15 items in four dimensions, namely, collection, unauthorized access, secondary use, and errors, to investigate Internet users' concerns regarding the privacy of EMRs under health information exchanges (HIE). We retrieved 213 valid questionnaires. The results indicate that the respondents had substantial privacy concerns regarding EMRs and their educational level and EMR awareness significantly influenced their privacy concerns regarding unauthorized access and secondary use of EMRs. This study recommends that the Taiwanese government organizes a comprehensive EMR awareness campaign, emphasizing unauthorized access and secondary use of EMRs. Additionally, to cultivate the public's understanding of EMRs, the government should employ various media, especially Internet channels, to promote EMR awareness, thereby enabling the public to accept the concept and use of EMRs. People who are highly educated and have superior EMR awareness should be given a comprehensive explanation of how hospitals protect patients' EMRs from unauthorized access and secondary use to address their concerns. Thus, the public can comprehend, trust, and accept the use of EMRs, reducing their privacy concerns, which should facilitate the future implementation of HIE.

Mandibular unilateral fusion in primary dentition

Directory of Open Access Journals (Sweden)

Neena Eregowda

2017-01-01

Full Text Available Fusion is a developmental anomaly which occurs due to a union of one or more adjacent teeth during morphodifferentiation of the dental germs. The prevalence of tooth fusion is estimated at 0.5%–2.5% in the primary dentition. These anomalies may be unilateral or bilateral and may affect either dentition although the deciduous teeth are more commonly affected. Early diagnosis of such condition is important because it may cause clinical problems, such as esthetic concerns, and caries. This report describes a case of unilateral fusion of the primary mandibular lateral incisor and canine and aims to evaluate any associated pathology.

Sleep concerns in children and young people with cerebral palsy in their home setting.

Science.gov (United States)

McCabe, Susan M; Blackmore, A Marie; Abbiss, Chris R; Langdon, Katherine; Elliott, Catherine

2015-12-01

The aims were to identify in-home concerns about sleep in children and young people with cerebral palsy (CP) across age and Gross Motor Function Classification Scale (GMFCS) levels. This was a retrospective review of clinical notes of 154 children and young people with CP, aged 1-18 years (M = 7.8; standard deviation = 5.4) who received a home-based sleep service. Reported concerns were synthesised, for analysis according to age groups (1-5, 6-13, 14-18) and GMFCS levels. Sixteen factors of concern were derived from the home-based assessment reports. Most children and young people had multiple factors of concern. These varied across age groups and GMFCS levels. Body position was of concern across all age groups, for over 90% at GMFCS levels IV and V, and for 10% at GMFCS level I. Settling routines were of concern for more than 90% at GMFCS levels I and II, but for less than 50% at GMFCS levels IV and V. Settling routines were of concern to over 65% of those under 6 years but less than 25% of those over 14 years. Conversely, pain and pressure care concerned less than 10% of children under 6, and more than 35% of those over 14 years. Concerns about sleep vary across ages and GMFCS levels of children and young people with CP. Concerns relate to impairment of body structure and function, activity, environment, and personal supports. Multi-disciplinary, home-based assessment and interventions are recommended to address these concerns. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Health and fracking: should the medical profession be concerned?

Science.gov (United States)

Mash, Rachel; Minnaar, Jolynn; Mash, Bob

2014-02-26

The use of natural gas that is obtained from high-volume hydraulic fracturing (fracking) may reduce carbon emissions relative to the use of coal and have substantial economic benefits for South Africa. However, concerns have been raised regarding the health and environmental impacts. The drilling and fracking processes use hundreds of chemicals as well as silica sand. Additional elements are either released from or formed in the shale during drilling. These substances can enter the environment in various ways: through failures in the well casing; via alternative underground pathways; as wastewater, spills and leaks on the wellpad; through transportation accidents; and as air pollution. Although many of these chemicals and elements have known adverse health effects, there is little evidence available on the health impacts of fracking. These health concerns have not yet been fully addressed in policy making, and the authors recommend that the voice of health professionals should be part of the public debate on fracking and that a full health impact assessment be required before companies are given the go-ahead to drill. 

Forms of address in Isizulu

OpenAIRE

2014-01-01

M.A. (African Studies) The study deals with forms of address in isiZulu. Therefore, the various aspects of speech that play roles when addressing a person, the factors affecting forms of address in isiZulu and the effect of languages such as English, Afrikaans and other African languages on the forms of address in isiZulu are of interest. Research was conducted on forms of address in isiZulu in parts of Soweto and it was discovered that form of address are determined by different factors i...

Shared care between specialised psychiatric services and primary care: The experiences and expectations of General Practitioners in Ireland.

LENUS (Irish Health Repository)

Agyapong, Vincent Israel Opoku

2012-04-17

Objective. The study aims to explore the views of General Practitioners in Ireland on shared care between specialised psychiatric services and primary care. Method. A self-administered questionnaire was designed and posted to 400 randomly selected General Practitioners working in Ireland. Results. Of the respondents, 189 (94%) reported that they would support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their treatment. However, 124 (61.4%) reported that they foresaw difficulties for patients in implementing such a policy including: a concern that primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (113, 53.2%); a concern this would result in increased financial burden on some patients (89, 48.8%); a lack of adequate cooperation between primary care and specialised mental health services (84, 41.8%); a concern that some patients may lack confidence in GP care (55, 27.4%); and that primary care providers are not adequately trained to provide psychiatric care (29, 14.4% ). Conclusion. The majority of GPs in Ireland would support a policy of shared care of psychiatric patients; however they raise significant concerns regarding practical implications of such a policy in Ireland.

Primary production in the Kattegat - past and present

DEFF Research Database (Denmark)

Richardson, K.; Heilmann, Jens

1995-01-01

data collected during the period 1984-1993 are calculated using the method employed in the 1950s. It is concluded that primary production in the Kattegat has increased from less than 100 g C m(-2) y(- 1) to about 200 g C m(-2) y(-1) since the 1950s. This increase is not seen during the winter months...... to be responses to increases in primary production. However, for most areas, there are insufficient data to demonstrate whether or not increases in primary production have actually occurred. In this study, the evidence for increased primary production in the Kattegat is examined by comparing primary production...... measurements from the 1950s and measurements made in the period 1984-1993. The methods employed during the two periods differ considerably. These differences and how they may affect the validity of a comparison of the results from the studies carried out in two periods are addressed. The primary production...

Impact of primary care provider knowledge, attitudes, and beliefs about cancer clinical trials: implications for referral, education and advocacy.

Science.gov (United States)

Michaels, Margo; D'Agostino, Thomas A; Blakeney, Natasha; Weiss, Elisa S; Binz-Scharf, Maria C; Golant, Mitch; Bylund, Carma L

2015-03-01

Primary Care Providers (PCPs) can be instrumental in helping to prepare patients for referral to cancer treatment. It has been suggested that PCPs can have an important impact on priming patients about the possibility of receiving care within a cancer treatment clinical trial (CCT). However, little is understood about how to effectively engage primary care providers in educating patients about trials. Data were collected as part of two qualitative research projects about primary care providers' role in referral to treatment and to CCTs. Participants were 27 PCPs who agreed to take part in qualitative face-to-face or telephone interviews and serve predominantly underserved, minority populations. Interviews identified a number of factors influencing referral to oncologists, including patients' insurance coverage, location and proximity to treatment facilities, and the strength of ongoing relationships with and/or previous experience with a specialist. PCPs overwhelmingly expressed disinterest in discussing any treatment options, including CCTs. Misconceptions about quality of care received through trials were also common, presenting a deterrent to discussion. PCPs need targeted, evidence-based educational interventions to appropriately address their concerns about cancer clinical trials, enhance provider communication skills, and alter patient referral behavior. Steps must also be taken to strengthen communication between oncologists and referring PCPs.

The best and brightest. Concern over tomorrow's workforce opens new doors for education and training in nuclear fields

International Nuclear Information System (INIS)

Wedekind, Lothar

2001-01-01

The article discusses the results of a study by the Nuclear Energy Agency to address concerns about downward trends in nuclear education and training at universities. The implications of a shortage of trained nuclear energy specialists are discussed

Radioisotopes in the primary circuit of a fast reactor

International Nuclear Information System (INIS)

Berlin, M.; Cauvin, M.

1976-01-01

In the frame of the research performed to understand the behaviour of the radioactive isotopes of iodine in the primary coolant circuit of fast reactor, a simple theoretical model is proposed. Results concerning PHENIX and RAPSODIE are given

Family History, Gender, and Eating and Body Image Concerns in University Students Seeking Counseling Services

Science.gov (United States)

Cavallini, Adriane Q.; Erekson, David M.; Steinberg, Rachel M.; Clayson, Rachelle A.; Albright, Dallin D.

2018-01-01

Family history events have been shown to be reliable predictors of eating and body image concerns; however, little is known regarding how family history events compare in a clinical sample, or if these events differ by gender. The current study addresses this paucity, focusing on 3,129 university students seeking clinical services. Having a family…

Position paper on flammability concerns associated with TRU waste destined for WIPP

International Nuclear Information System (INIS)

1991-04-01

The Waste Isolation Pilot Plant (WIPP), in southeastern New Mexico,is an underground repository, designed for the safe geologic disposal of transuranic (TRU) wastes generated from defense-related activities of the US Department of Energy (DOE). The WIPP storage rooms are mined in a bedded salt (halite) formation, and are located 2150 feet below the surface. After the disposal of waste in the storage rooms, closure of the repository is expected to occur by creep (plastic flow) of the salt formation, with the waste being permanently isolated from the surrounding environment. This paper has evaluated the issue of flammability concerns associated with TRU waste to be shipped to WIPP, including a review of possible scenarios that can potentially contribute to the flammability. The paper discusses existing regulations that address potential flammability concerns, presents an analysis of previous flammability-related incidents at DOE sites with respect to the current regulations, and finally, examines the degree of assurance these regulations provide in safeguarding against flammability concerns during transportation and waste handling. 50 refs., 7 figs., 7 tabs

Economic performance and public concerns about social class in twentieth-century books.

Science.gov (United States)

Chen, Yunsong; Yan, Fei

2016-09-01

What is the association between macroeconomic conditions and public perceptions of social class? Applying a novel approach based on the Google Books N-gram corpus, this study addresses the relationship between public concerns about social class and economic conditions throughout the twentieth century. The usage of class-related words/phrases, or "literary references to class," in American English-language books is related to US economic performance and income inequality. The findings of this study demonstrate that economic conditions play a significant role in literary references to class throughout the century, whereas income inequality does not. Similar results are obtained from further analyses using alternative measures of class concerns as well as different corpora of English Fiction and the New York Times. We add to the social class literature by showing that the long-term temporal dynamics of an economy can be exhibited by aggregate class concerns. The application of massive culture-wide content analysis using data of unprecedented size also represents a contribution to the literature. Copyright © 2016 Elsevier Inc. All rights reserved.

Framework for Identifying Key Environmental Concerns in Marine Renewable Energy Projects- Appendices

Energy Technology Data Exchange (ETDEWEB)

Kramer, Sharon; Previsic, Mirko; Nelson, Peter; Woo, Sheri

2010-06-17

Marine wave and tidal energy technology could interact with marine resources in ways that are not well understood. As wave and tidal energy conversion projects are planned, tested, and deployed, a wide range of stakeholders will be engaged; these include developers, state and federal regulatory agencies, environmental groups, tribal governments, recreational and commercial fishermen, and local communities. Identifying stakeholders’ environmental concerns in the early stages of the industry’s development will help developers address and minimize potential environmental effects. Identifying important concerns will also assist with streamlining siting and associated permitting processes, which are considered key hurdles by the industry in the U.S. today. In September 2008, RE Vision consulting, LLC was selected by the Department of Energy (DoE) to conduct a scenario-based evaluation of emerging hydrokinetic technologies. The purpose of this evaluation is to identify and characterize environmental impacts that are likely to occur, demonstrate a process for analyzing these impacts, identify the “key” environmental concerns for each scenario, identify areas of uncertainty, and describe studies that could address that uncertainty. This process is intended to provide an objective and transparent tool to assist in decision-making for siting and selection of technology for wave and tidal energy development. RE Vision worked with H. T. Harvey & Associates, to develop a framework for identifying key environmental concerns with marine renewable technology. This report describes the results of this study. This framework was applied to varying wave and tidal power conversion technologies, scales, and locations. The following wave and tidal energy scenarios were considered: 4 wave energy generation technologies 3 tidal energy generation technologies 3 sites: Humboldt coast, California (wave); Makapu’u Point, Oahu, Hawaii (wave); and the Tacoma Narrows, Washington (tidal

So you've got IPv6 address space. Can you defend it?

OpenAIRE

Sande, Mikal

2014-01-01

Internet Protocol version 6 (IPv6) is the successor of Internet Protocol version 4 (IPv4). IPv6 will become the next standard networking protocol on the Internet. It brings with it a great increase in address space, changes to network operations, and new network security concerns. In this thesis we examine IPv6 from a security perspective. The security of IPv6 is important to all protocols that use IPv6 on the Internet. The goal of this thesis is to introduce the reader to existing IPv6 secur...

Addressing the challenges of improving primary care quality in Uzbekistan: a qualitative study of chronic heart failure management.

Science.gov (United States)

Ahmedov, Mohir; Green, Judith; Azimov, Ravshan; Avezova, Guloyim; Inakov, Sherzod; Mamatkulov, Bahrom

2013-08-01

Uzbekistan has a well-developed primary care system, with universal access to care, but faces challenges in improving the quality of clinical care provided. This study aimed to identify barriers to quality improvement by focusing on one common condition, Chronic Heart Failure (CHF), for which there are evidence-based international guidelines for management. To identify the challenges to improving the quality of care for CHF in line with such guidelines we took a qualitative approach, interviewing 15 physicians and 30 patients in detail about their experiences of CHF management. Despite recent improvements to the training of primary care physicians, their access to up-to-date information was limited, and they were disproportionately reliant on information from pharmaceutical companies. The main barriers to implementing international standards of care were: reluctance of physicians (and patients) to abandon ineffective interventions; enduring, system-wide incentives for clinically unnecessary hospitalization; and the lack of structural support for evidence-based health services improvement. Patients were in general positive about adherence to medications, but faced some problems in affording drugs and hospital care. Future interventions to strengthen primary care should be implemented with evaluations of their impact on the processes and outcomes of care for chronic conditions.

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative

Science.gov (United States)

Kaplan, Sue A.; Ruddock, Charmaine; Golub, Maxine; Davis, Joyce; Foley, Robert; Devia, Carlos; Rosen, Rosa; Berry, Carolyn; Barretto, Brenda; Carter, Toni; Irish-Spencer, Evalina; Marchena, Maria; Purcaro, Ellenrita; Calman, Neil

2011-01-01

This case study provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation. The study uses qualitative methods to identify lessons learned and to reflect on the benefits and challenges of using a community-based participatory approach for the development and evaluation of a faith-based program designed to address health disparities. Key findings concern the role of pastoral leadership, the importance of providing a religious context for health promotion and health equality messages, the challenges of creating a bilingual/bi-cultural program, and the need to provide management support to the lay program coordinators. The study also identifies lessons learned about community-based evaluation and the importance of addressing community concern about the balance between evaluation and program. Finally, the study identifies the challenges that lie ahead, including issues of program institution-alization and sustainability. PMID:20168022

Data concerning the development of the energy economy of the Federal Republic of Germany in 1981

Energy Technology Data Exchange (ETDEWEB)

1982-07-01

After an introductory survey concerning international and national energy policy in 1981 there follow statistics, tables and graphs concerning the balance of primary energy, the structure of energy consumption, the import and export of energy sources, as well as the development of the market (amount produced, utilisation, prices) especially for black coal, brown coal, mineral oil, electricity and gas. To extend these data referring to the Federal Republic of Germany and to compare them the most important energy data of the world are represented.

Addressing health workforce distribution concerns: a discrete choice experiment to develop rural retention strategies in Cameroon.

Science.gov (United States)

Robyn, Paul Jacob; Shroff, Zubin; Zang, Omer Ramses; Kingue, Samuel; Djienouassi, Sebastien; Kouontchou, Christian; Sorgho, Gaston

2015-03-01

Nearly every nation in the world faces shortages of health workers in remote areas. Cameroon is no exception to this. The Ministry of Public Health (MoPH) is currently considering several rural retention strategies to motivate qualified health personnel to practice in remote rural areas. To better calibrate these mechanisms and to develop evidence-based retention strategies that are attractive and motivating to health workers, a Discrete Choice Experiment (DCE) was conducted to examine what job attributes are most attractive and important to health workers when considering postings in remote areas. The study was carried out between July and August 2012 among 351 medical students, nursing students and health workers in Cameroon. Mixed logit models were used to analyze the data. Among medical and nursing students a rural retention bonus of 75% of base salary (aOR= 8.27, 95% CI: 5.28-12.96, Pimpact measurements were also estimated to identify combination of incentives that health workers would find most attractive. Based on these findings, the study recommends the introduction of a system of substantial monetary bonuses for rural service along with ensuring adequate and functional equipment and uninterrupted supplies. By focusing on the analysis of locally relevant, actionable incentives, generated through the involvement of policy-makers at the design stage, this study provides an example of research directly linked to policy action to address a vitally important issue in global health.

Health concern, food choice motives, and attitudes toward healthy eating: the mediating role of food choice motives.

Science.gov (United States)

Sun, Yu-Hua Christine

2008-07-01

This study addresses how various health concerns might influence not only consumers' food choice motives but also consumers' subsequent attitudes toward healthy eating. This study expects that those consumers with greater health concerns would have different food choice motives and better attitudes toward healthy eating. A self-completion questionnaire was used to gather information. Participants, a random sample of 500 undergraduate students from a national university in Taipei, Taiwan, provided a total of 456 usable questionnaires, representing a valid response rate of 91%. The average age of the respondents at the time of the survey was 21 years and 63% of respondents were females. The relationship between health concern and healthy eating attitudes was confirmed. The relationship between health concern of developing diseases and attitudes toward healthy eating was fully mediated by food choice motives. However, the relationship between calorie consumption health concern and healthy eating attitudes was only partially mediated by food choice motives. Implications of these findings are discussed.

Ethnic differences in ecological concerns: Spanish-speaking Hispanics are more concerned than others

International Nuclear Information System (INIS)

Burger, Joanna; Greenberg, Michael

2006-01-01

We postulated that environmental concern encompasses a wide range of different issues, often lumping pollution with habitat loss (or land use) and ecological resources (fish and wildlife). In this paper, we compare perceptions about a range of environmental and ecological resource issues, and explore ethnic/racial differences. We surveyed 1513 residents of New Jersey about 'environmental concerns', using both general environmental questions (two questions: How serious are environmental problems in New Jersey? Are you concerned about the loss of open space?) and ecological resource questions (12 questions: e.g., how important is planting trees in your neighborhood, how concerned are you about loss of breeding and feeding habitat for fish and birds?) in New Jersey. Not all concerns were rated equally. For the ecological questions, there were no ethnic differences in concerns over preserving areas around water supplies, loss of places to hunt and fish, and loss of places for quiet walks and cycling, but there were for the other 9 ecological concerns. For eight of these nine concerns, Spanish-speaking Hispanics were more concerned than others (including English-speaking Hispanics). We divided the ecological resources into three categories: ecological services (clean water and safety), ecological resources (fish and wildlife), and recreational services. The strongest correlates of people's association with enlarging and enhancing recreational services were Spanish-speaking Hispanics, who are supportive of regulations and believe local government is not doing enough for environmental problems. People concerned about the loss of ecological resources and open space believe the federal government and the state are not doing enough for the environment, were non-Hispanic White, want continued environmental regulations, were longer-term residents, were high school graduates, and were older (45-54 years). People interested in ecological services were college-educated, non

Concerned with computer games

DEFF Research Database (Denmark)

Chimiri, Niklas Alexander; Andersen, Mads Lund; Jensen, Tine

2018-01-01

In this chapter, we focus on a particular matter of concern within computer gaming practices: the concern of being or not being a gamer. This matter of concern emerged from within our collective investigations of gaming practices across various age groups. The empirical material under scrutiny...... was generated across a multiplicity of research projects, predominantly conducted in Denmark. The question of being versus not being a gamer, we argue, exemplifies interesting enactments of how computer game players become both concerned with and concerned about their gaming practices. As a collective...... of researchers writing from the field of psychology and inspired by neo-materialist theories, we are particularly concerned with (human) subjectivity and processes of social and subjective becoming. Our empirical examples show that conerns/worries about computer games and being engaged with computer game...

Implementing the Comprehensive Unit-Based Safety Program (CUSP) to Improve Patient Safety in an Academic Primary Care Practice.

Science.gov (United States)

Pitts, Samantha I; Maruthur, Nisa M; Luu, Ngoc-Phuong; Curreri, Kimberly; Grimes, Renee; Nigrin, Candace; Sateia, Heather F; Sawyer, Melinda D; Pronovost, Peter J; Clark, Jeanne M; Peairs, Kimberly S

2017-11-01

While there is growing awareness of the risk of harm in ambulatory health care, most patient safety efforts have focused on the inpatient setting. The Comprehensive Unit-based Safety Program (CUSP) has been an integral part of highly successful safety efforts in inpatient settings. In 2014 CUSP was implemented in an academic primary care practice. As part of CUSP implementation, staff and clinicians underwent training on the science of safety and completed a two-question safety assessment survey to identify safety concerns in the practice. The concerns identified by team members were used to select two initial safety priorities. The impact of CUSP on safety climate and teamwork was assessed through a pre-post comparison of results on the validated Safety Attitudes Questionnaire. Ninety-six percent of staff completed science of safety training as part of CUSP implementation, and 100% of staff completed the two-question safety assessment. The most frequently identified safety concerns were related to medications (n = 11, 28.2), diagnostic testing (n = 9, 25), and communication (n = 5, 14). The CUSP team initially prioritized communication and infection control, which led to standardization of work flows within the practice. Six months following CUSP implementation, large but nonstatistically significant increases were found for the percentage of survey respondents who reported knowledge of the proper channels for questions about patient safety, felt encouraged to report safety concerns, and believed that the work setting made it easy to learn from the errors of others. CUSP is a promising tool to improve safety climate and to identify and address safety concerns within ambulatory health care. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Access to essential medicines in Pakistan: policy and health systems research concerns.

Directory of Open Access Journals (Sweden)

Shehla Zaidi

Full Text Available INTRODUCTION: Inadequate access to essential medicines is a common issue within developing countries. Policy response is constrained, amongst other factors, by a dearth of in-depth country level evidence. We share here i gaps related to access to essential medicine in Pakistan; and ii prioritization of emerging policy and research concerns. METHODS: An exploratory research was carried out using a health systems perspective and applying the WHO Framework for Equitable Access to Essential Medicine. Methods involved key informant interviews with policy makers, providers, industry, NGOs, experts and development partners, review of published and grey literature, and consultative prioritization in stakeholder's Roundtable. FINDINGS: A synthesis of evidence found major gaps in essential medicine access in Pakistan driven by weaknesses in the health care system as well as weak pharmaceutical regulation. 7 major policy concerns and 11 emerging research concerns were identified through consultative Roundtable. These related to weaknesses in medicine registration and quality assurance systems, unclear and counterproductive pricing policies, irrational prescribing and sub-optimal drug availability. Available research, both locally and globally, fails to target most of the identified policy concerns, tending to concentrate on irrational prescriptions. It overlooks trans-disciplinary areas of policy effectiveness surveillance, consumer behavior, operational pilots and pricing interventions review. CONCLUSION: Experience from Pakistan shows that policy concerns related to essential medicine access need integrated responses across various components of the health systems, are poorly addressed by existing evidence, and require an expanded health systems research agenda.

Industry petition for rulemaking on the disposal of below-regulatory-concern wastes

International Nuclear Information System (INIS)

Tipton, T.E.

1989-01-01

The Nuclear Management and Resources Council, Inc., in conjunction with the Edison Electric Institute, plans to submit a petition for rulemaking entitled Petition for Rulemaking Regarding Disposal of Below Regulatory Concern Wastes from commercial Nuclear Power Plants to the U.S. Nuclear Regulatory Commission (NRC). This petition for rulemaking, which is being filed pursuant to 10CFR2.802 and 10CFR2, Appendix B of the Code of Federal Regulations, requests the NRC to promulgate a rule authorizing the treatment and disposal of low-level radioactive wastes (LLW) determined to be below regulatory concern (BRC) in other than licensed LLW disposal facilities. The proposed rule will apply only to LLW generated at commercial nuclear power plants. The petition is based on detailed scientific and technical data derived through an extensive research program conducted by the Electric Power Research Institute, Inc. It addresses the 14 decision criteria that the NRC will employ in judging whether to grant the petition. The petition also provides an environmental assessment and finding of no significant impact and regulatory analysis. The purpose of the environmental assessment is to discuss alternatives, consequences, and impacts analyzed to support the recommendation of the proposed rule. The regulatory analysis addresses the need for and consequences of the proposed regulatory action as it relates to the protection of public health and safety

Concern about the Expanding Prescription Drug Epidemic: A Survey of Licensed Prescribers and Dispensers.

Science.gov (United States)

Wright, R Eric; Reed, Nia; Carnes, Neal; Kooreman, Harold E

2016-01-01

Prescription drug misuse and abuse has reached epidemic levels in the U.S., and stands as a leading cause of death. As the primary gatekeepers to the medications contributing to this epidemic, it is critical to understand the views of licensed health care professionals. In this study, we examine health care professionals' concern regarding prescription drug abuse in their communities and the impact their concern has had on their prescribing and dispensing practices. An online survey of licensed health care providers. Conducted in Indiana. This study was a state-wide evaluation of Indiana's prescription drug monitoring program. The questionnaire asked respondents how concerned they were about prescription drug abuse in their community. Variation in the level of concern was examined using ordinary least squares regression and information about the respondents' demographic background and clinical experience. In addition, we used logistic regression to examine whether concern was associated with changing prescribing and/or dispensing behavior. The majority of providers indicated they were "moderately" or "extremely concerned" about prescription drug abuse in their communities. The level of concern, however, varied significantly by profession, with pharmacists, physicians, nurse practitioners/physician assistants being more concerned than dentists. Additional analyses indicate that providers with higher levels of concern were those who also reported recently changing their prescribing and/or dispensing behavior. The voluntary nature and geographical focus of the study limits the generalizability of the findings. Concern about prescription drug abuse is generally high across the major health care professions; however, a significant minority of providers, particularly among dentists, expressed little or no concern about the epidemic. Increasing health care providers' general level of concern about prescription drug abuse may be an effective public health tool for

Treatment-seeking college students with disabilities: Presenting concerns, protective factors, and academic distress.

Science.gov (United States)

Fleming, Allison R; Edwin, Mary; Hayes, Jeffrey A; Locke, Benjamin D; Lockard, Allison J

2018-02-01

Students with disabilities are a growing population on college campuses and have unique challenges that put them at risk for early departure, creating complexity in efforts to address their personal and academic needs. The purpose was to explore academic and other sources of distress among college students with disabilities to identify possible areas where enhanced supports might benefit this population. Research Method and Design: Researchers analyzed cross-sectional data from the Center for Collegiate Mental Health to compare subsamples of students with (n = 1,774) and without disabilities (n = 1,774) on presenting concerns, and to determine significant predictors of academic distress among students with disabilities. Results indicated that students with disabilities have many similar treatment concerns with their peers, but showed greater concerns in depression and self-harm; academic performance; anxiety and obsessions/compulsions; and fewer concerns in relationship problems. Significant predictors of academic distress for students with disabilities included attention deficit-hyperactivity disorder (ADHD), depression and self-harm, trauma or victimization, stress and academic performance, and social support from family and peers. These results suggest the importance of several factors in understanding the presenting concerns of treatment-seeking students with disabilities and mitigating academic distress for this population. Additional areas for research are presented. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

75 FR 41790 - Address Management Services-Elimination of the Manual Card Option for Address Sequencing Services

Science.gov (United States)

2010-07-19

.... The authority citation for 39 CFR Part 111 continues to read as follows: Authority: 5 U.S.C. 552(a... addresses (including rural address conversions to city-style addressing). For each 5-digit ZIP Code grouping... customer includes a rural-style address (RR/box number) in an address file submitted for sequencing, and a...

Reach Address Database (RAD)

Data.gov (United States)

U.S. Environmental Protection Agency — The Reach Address Database (RAD) stores the reach address of each Water Program feature that has been linked to the underlying surface water features (streams,...

Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

Science.gov (United States)

Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

2014-01-01

Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

Addressing Adolescent Substance Abuse: An Evaluation of Washington's Prevention and Intervention Services Program. 2001-03 Final Report.

Science.gov (United States)

Deck, Dennis D.

2004-01-01

To directly address the state of Washington's concerns regarding student alcohol and other drug use, in 1989 the state Legislature passed the Omnibus Alcohol and Controlled Substances Act (ESSHB 1793). One part of this act called for the creation of a school-based alcohol and other dug abuse prevention and early intervention program. The Office of…

Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study.

Science.gov (United States)

O'Donnell, Patrick; Tierney, Edel; O'Carroll, Austin; Nurse, Diane; MacFarlane, Anne

2016-12-03

The involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally. Many benefits of involving these groups in primary care planning have been reported. However, these benefits are rarely felt by those considered marginalised in society and they are often excluded from participating in the process of planning primary care. It has been recommended to employ suitable approaches, such as co-operative and participatory initiatives, to enable marginalised groups to highlight their priorities for care. This Participatory Learning and Action (PLA) research study involved 21 members of various marginalised groups who contributed their views about access to primary care. Using a series of PLA techniques for data generation and co-analysis, we explored barriers and facilitators to primary healthcare access from the perspective of migrants, Irish Travellers, homeless people, drug users, sex workers and people living in deprivation, and identified their priorities for action with regard to primary care provision. Four overarching themes were identified: the home environment, the effects of the 'two-tier' healthcare system on engagement, healthcare encounters, and the complex health needs of many in those groups. The study demonstrates that there are many complicated personal and structural barriers to accessing primary healthcare for marginalised groups. There were shared and differential experiences across the groups. Participants also expressed shared priorities for action in the planning and running of primary care services. Members of marginalised groups have shared priorities for action to improve their access to primary care. If steps are taken to address these, there is scope to impact on more than one marginalised group and to address the existing health inequities.

Addressing Risk Assessment for Patient Safety in Hospitals through Information Extraction in Medical Reports

Science.gov (United States)

Proux, Denys; Segond, Frédérique; Gerbier, Solweig; Metzger, Marie Hélène

Hospital Acquired Infections (HAI) is a real burden for doctors and risk surveillance experts. The impact on patients' health and related healthcare cost is very significant and a major concern even for rich countries. Furthermore required data to evaluate the threat is generally not available to experts and that prevents from fast reaction. However, recent advances in Computational Intelligence Techniques such as Information Extraction, Risk Patterns Detection in documents and Decision Support Systems allow now to address this problem.

Evaluation of primary coolant leaks and assessment of detection methods

International Nuclear Information System (INIS)

Cassette, P.; Giroux, C.; Roche, H.; Seveon, J.J.

1986-01-01

A review of the French PWR situation concerning primary coolant leaks is presented, including a description of operating technical specifications, of the collecting system of primary coolant leakage into the containment and of the detection methods. It is mainly based on a compilation over three years, 1981 to 1983, of almost all actual leaks, their natures, causes, consequences and methods used for their detection. By analysing these data it is possible to evaluate the efficiency of the primary coolant leak detection system and the problems raised by compliance with the criteria defined in the operating technical specifications

Evaluation of primary coolant leaks and assessment of detection methods

International Nuclear Information System (INIS)

Cassette, P.; Giroux, C.; Roche, H.; Seveon, J.J.

1984-11-01

A review of French PWR situation concerning primary coolant leaks is presented, including a description of operating technical specifications, of the collecting system of primary coolant leakage into the containment and of the detection methods. It is mainly based on a compilation over three years, 1981 to 1983, of almost all occurred leaks, their natures, causes, consequences and methods used for their detection. By analysing these data it is possible to evaluate the efficiency of the primary coolant leak detection system and the problems raised by the compliance with the criteria defined in the operating technical specifications

Effective recruitment strategies in primary care research: a systematic review.

Science.gov (United States)

Ngune, Irene; Jiwa, Moyez; Dadich, Ann; Lotriet, Jaco; Sriram, Deepa

2012-01-01

Patient recruitment in primary care research is often a protracted and frustrating process, affecting project timeframes, budget and the dissemination of research findings. Yet, clear guidance on patient recruitment strategies in primary care research is limited. This paper addresses this issue through a systematic review. Articles were sourced from five academic databases - AustHealth, CINAHL, the Cochrane Methodology Group, EMBASE and PubMed/Medline; grey literature was also sourced from an academic library and the Primary Healthcare Research & Information Service (PHCRIS) website. Two reviewers independently screened the articles using the following criteria: (1) published in English, (2) reported empirical research, (3) focused on interventions designed to increase patient recruitment in primary care settings, and (4) reported patient recruitment in primary care settings. Sixty-six articles met the inclusion criteria. Of these, 23 specifically focused on recruitment strategies and included randomised trials (n = 7), systematic reviews (n = 8) and qualitative studies (n = 8). Of the remaining articles, 30 evaluated recruitment strategies, while 13 addressed the value of recruitment strategies using descriptive statistics and/or qualitative data. Among the 66 articles, primary care chiefly included general practice (n = 30); nursing and allied health services, multiple settings, as well as other community settings (n = 30); and pharmacy (n = 6). Effective recruitment strategies included the involvement of a discipline champion, simple patient eligibility criteria, patient incentives and organisational strategies that reduce practitioner workload. The most effective recruitment in primary care research requires practitioner involvement. The active participation of primary care practitioners in both the design and conduct of research helps to identify strategies that are congruent with the context in which patient care is delivered. This is reported to be the

Midwives' experiences of performing maternal observations and escalating concerns: a focus group study.

Science.gov (United States)

Jeffery, Justine; Hewison, Alistair; Goodwin, Laura; Kenyon, Sara

2017-09-02

For the past decade, Maternal Mortality Reports, published in the United Kingdom every three years, have consistently raised concerns about maternal observations in maternity care. The reports identify that observations are not being done, not being completed fully, are not recorded on Early Warning Score systems, and/or are not escalated appropriately. This has resulted in delays in referral, intervention and increases the risk of maternal morbidity or mortality. However there has been little exploration of the possible reasons for non-completion of maternal observations. The aim of this study was to explore midwives' experiences of performing maternal observations and escalating concerns in rural and urban maternity settings in the West Midlands of England. A qualitative design involving a series of six focus groups with midwives and Supervisors of Midwives was employed to investigate the facilitators of, and barriers to the completion of maternal observations. Eighteen Midwives and 8 Supervisors of Midwives participated in a total of 6 focus groups. Three key themes emerged from the data: (1) Organisation of Maternal Observations (including delegation of tasks to Midwifery Support Workers, variation in their training, the care model used e.g. one to one care, and staffing issues); (2) Prioritisation of Maternal Observations (including the role of professional judgement and concerns expressed by midwives that they did not feel equipped to care for women with complex clinical needs; and (3) Negotiated Escalation (including the inappropriate response from senior staff to use of Modified Early Warning Score systems, and the emotional impact of escalation). A number of organisational and cultural barriers exist to the completion of maternal observations and the escalation of concerns. In order to address these the following actions are recommended: standardised training for Midwifery Support Workers, review of training of midwives to ensure it addresses the

Addressing refugee health through evidence-based policies: a case study.

Science.gov (United States)

Thiel de Bocanegra, Heike; Carter-Pokras, Olivia; Ingleby, J David; Pottie, Kevin; Tchangalova, Nedelina; Allen, Sophia I; Smith-Gagen, Julie; Hidalgo, Bertha

2017-05-12

The cumulative total of persons forced to leave their country for fear of persecution or organized violence reached an unprecedented 24.5 million by the end of 2015. Providing equitable access to appropriate health services for these highly diverse newcomers poses challenges for receiving countries. In this case study, we illustrate the importance of translating epidemiology into policy to address the health needs of refugees by highlighting examples of what works as well as identifying important policy-relevant gaps in knowledge. First, we formed an international working group of epidemiologists and health services researchers to identify available literature on the intersection of epidemiology, policy, and refugee health. Second, we created a synopsis of findings to inform a recommendation for integration of policy and epidemiology to support refugee health in the United States and other high-income receiving countries. Third, we identified eight key areas to guide the involvement of epidemiologists in addressing refugee health concerns. The complexity and uniqueness of refugee health issues, and the need to develop sustainable management information systems, require epidemiologists to expand their repertoire of skills to identify health patterns among arriving refugees, monitor access to appropriately designed health services, address inequities, and communicate with policy makers and multidisciplinary teams. Copyright © 2017. Published by Elsevier Inc.

Persisting rise in referrals during labor in primary midwife-led care in The Netherlands

NARCIS (Netherlands)

Offerhaus, P.M.; Hukkelhoven, C.W.P.M.; Jonge, A. de; Pal-de Bruin, K.M. van der; Scheepers, P.L.H.; Lagro-Janssen, A.L.M.

2013-01-01

Background: There are concerns about the Dutch maternity care system, characterized by a strict role division between primary and secondary care. The objective of this study was to describe trends in referrals and in perinatal outcomes among labors that started in primary midwife-led care. Methods:

Non-melanoma Skin Cancer in Canada Chapter 2: Primary Prevention of Non-melanoma Skin Cancer.

Science.gov (United States)

Barber, Kirk; Searles, Gordon E; Vender, Ronald; Teoh, Hwee; Ashkenas, John

2015-01-01

Non-melanoma skin cancer (NMSC), including basal and squamous cell carcinoma (BCC and SCC), represents the most common malignancy. To provide guidance to Canadian health care practitioners regarding primary prevention of NMSC. Structured literature searches were conducted, using search terms including prevention, sunscreen, and sun prevention factor. All recommendations concern guidance that physicians should regularly discuss with their patients to help establish photoprotection habits. The GRADE system was used to assign strength to each recommendation. Ultraviolet exposure is the major modifiable risk factor for NMSC. Aspects of photoprotection, including effective sunscreen use and avoidance of both the midday sun and artificial tanning, are discussed. Several widespread misunderstandings that undermine responsible public health measures related to sun safety are addressed. Photoprotection represents both an individual priority and a public health imperative. By providing accurate information during routine patient visits, physicians reinforce the need for ongoing skin cancer prevention. © The Author(s) 2015.

Regulation concerning installation and operation of reactors for power generation

International Nuclear Information System (INIS)

1987-01-01

This report shows the Ordinance of the Ministry of International Trade and Industry No.77 of December 28, 1978. The ordinance consists of provisions covering application for permission for construction of nuclear reactor (concerning continuous maximum thermal output, location, structure, reactor core, fuel material, moderator, reflector, cooling system, measurement control system, safety circuit, control system, emergency system, radioactive waste proposal facilities, construction plan, meteorology and other environmental conditions, etc.), operation plan (to be submitted every year), application for approval of joint management (name, address, facilities location, conditions for joint management, etc.), cancellation of permission (in five years from the date of permission), record keeping (density and temperature of neutron, temperature and pressure of coolant, purity of mederator, etc.), restriction on access to areas under management (measures to be taken in such areas), measures concerning exposure to radioactive rays (allowable dosage, etc.), patrol and checking in nuclear reactor facilities, self-imposed regular inspection of nuclear reactor facilities, operation of nuclear reactor, transport within plant or business establishment, storage (storing facilities, etc.), waste disposal, etc. (Nogami, K.)

Leadership practices and inclusive education reform in primary schools in Bangladesh

OpenAIRE

Mullick, Jahirul

2017-01-01

This study was undertaken to investigate leadership practices for Inclusive Education (IE) reform in primary schools in Bangladesh. Specifically, the study investigated leadership practice structures, views of school leaders about the accountability approach in primary schools, school leaders’ opinions on challenges to implementing IE and possible strategies to address the identified challenges. The study also explored the relationships between school variables, teachers’ demographic variabl...

Using MPAs to address regional-scale ecological objectives in the North Sea: modelling the effects of fishing effort displacement

NARCIS (Netherlands)

Greenstreet, S.P.R.; Fraser, H.M.; Piet, G.J.

2009-01-01

The use of Marine Protected Areas (MPAs) to address regional-scale objectives as part of an ecosystem approach to management in the North Sea is examined. Ensuring that displacement of fishing activity does not negate the ecological benefits gained from MPAs is a major concern. Two scenarios are

The primary processes by impact of ionizing radiations with water

International Nuclear Information System (INIS)

Znamirovschi, V.; Mastan, I.; Cozar, O.

1976-01-01

The problem concerning primary processes in radiolysis of water is discussed. The results on the excitation and ionization of water molecule, dissociation of the parent-molecular ion of water and dissociation of excited molecule of water are presented. (author)

Hydrocomplexity: Addressing water security and emergent environmental risks

Science.gov (United States)

Kumar, Praveen

2015-07-01

Water security and emergent environmental risks are among the most significant societal concerns. They are highly interlinked to other global risks such as those related to climate, human health, food, human migration, biodiversity loss, urban sustainability, etc. Emergent risks result from the confluence of unanticipated interactions from evolving interdependencies between complex systems, such as those embedded in the water cycle. They are associated with the novelty of dynamical possibilities that have significant potential consequences to human and ecological systems, and not with probabilities based on historical precedence. To ensure water security we need to be able to anticipate the likelihood of risk possibilities as they present the prospect of the most impact through cascade of vulnerabilities. They arise due to a confluence of nonstationary drivers that include growing population, climate change, demographic shifts, urban growth, and economic expansion, among others, which create novel interdependencies leading to a potential of cascading network effects. Hydrocomplexity aims to address water security and emergent risks through the development of science, methods, and practices with the potential to foster a "Blue Revolution" akin to the Green revolution for food security. It blends both hard infrastructure based solution with soft knowledge driven solutions to increase the range of planning and design, management, mitigation and adaptation strategies. It provides a conceptual and synthetic framework to enable us to integrate discovery science and engineering, observational and information science, computational and communication systems, and social and institutional approaches to address consequential water and environmental challenges.

PRIMARY SCHOOL TEACHER

CERN Multimedia

Madeleine Dittus

2002-01-01

For January 2003, the A.P.E.G. has an opening for a primary school teacher in the German national language program. The position requires one afternoon of teaching (13:30 till 16:30) every Tuesday at the Collège in Prévessin. The candidate should be a native speaker of German and have some knowledge of French. If you are interested, please send your CV, a copy of your diploma, and a short letter of motivation, until December 9th, to the following address. Madeleine Dittus Présidente A.P.E.G. 5, La vie Destraz 01630 St. Genis-Pouilly (France)

PRIMARY SCHOOL TEACHER

CERN Multimedia

Madeleine Dittus

2002-01-01

For the beginning of the school year 2002/2003, the A.P.E.G. has an opening for a primary school teacher in the German national language program. The position requires one afternoon of teaching (13:30 till 16:30) every Tuesday at the Collège in Prévessin. The candidate should be a native speaker of German and have some knowledge of French. If you are interested, please send your CV, a copy of your diploma, and a short letter of motivation, until March 10th, to the following address. Madeleine Dittus - Présidente A.P.E.G. 5, La vie Destraz 01630 St. Genis-Pouilly - France

Improving eye care in the primary health care setting

Directory of Open Access Journals (Sweden)

M de Wet

2000-09-01

Full Text Available One of the challenges facing primary health care in South Africa is the delivery of quality eye care to all South Africans. In this regard the role of the primary health care worker, as the first point of contact, is crucial. This paper reports on the problems primary health care workers experience in providing quality eye care in Region B of the Free State. Problems identified by those involved in the study include the cumbersome referral system, the unavailability of appropriate medicine at clinics, the insufficient knowledge of primary health care workers regarding eye conditions and the lack of communication between the various eye care service providers. Suggestions to address the problems identified included more in-service training of primary health care workers regarding eye conditions, liaison with NGO’s providing eye care, decentralisation of services and the establishment of an eye care committee in the region.

Toward interdependence: Implementation of cooperative learning in primary schools

NARCIS (Netherlands)

Krol-Pot, K.

2005-01-01

The present dissertation concerns the implementation of cooperative learning in Dutch primary schools. The focus was on the process of implementation in four experimental schools and on the outcomes at the levels of the school, the teacher and the student. Chapters 1, 2, and 3 constitute the

Speaker Introductions at Internal Medicine Grand Rounds: Forms of Address Reveal Gender Bias.

Science.gov (United States)

Files, Julia A; Mayer, Anita P; Ko, Marcia G; Friedrich, Patricia; Jenkins, Marjorie; Bryan, Michael J; Vegunta, Suneela; Wittich, Christopher M; Lyle, Melissa A; Melikian, Ryan; Duston, Trevor; Chang, Yu-Hui H; Hayes, Sharonne N

2017-05-01

Gender bias has been identified as one of the drivers of gender disparity in academic medicine. Bias may be reinforced by gender subordinating language or differential use of formality in forms of address. Professional titles may influence the perceived expertise and authority of the referenced individual. The objective of this study is to examine how professional titles were used in the same and mixed-gender speaker introductions at Internal Medicine Grand Rounds (IMGR). A retrospective observational study of video-archived speaker introductions at consecutive IMGR was conducted at two different locations (Arizona, Minnesota) of an academic medical center. Introducers and speakers at IMGR were physician and scientist peers holding MD, PhD, or MD/PhD degrees. The primary outcome was whether or not a speaker's professional title was used during the first form of address during speaker introductions at IMGR. As secondary outcomes, we evaluated whether or not the speakers professional title was used in any form of address during the introduction. Three hundred twenty-one forms of address were analyzed. Female introducers were more likely to use professional titles when introducing any speaker during the first form of address compared with male introducers (96.2% [102/106] vs. 65.6% [141/215]; p form of address 97.8% (45/46) compared with male dyads who utilized a formal title 72.4% (110/152) of the time (p = 0.007). In mixed-gender dyads, where the introducer was female and speaker male, formal titles were used 95.0% (57/60) of the time. Male introducers of female speakers utilized professional titles 49.2% (31/63) of the time (p addressed by professional title than were men introduced by men. Differential formality in speaker introductions may amplify isolation, marginalization, and professional discomfiture expressed by women faculty in academic medicine.

On the Path to SunShot - Utility Regulatory Business Model Reforms forAddressing the Financial Impacts of Distributed Solar on Utilities

Energy Technology Data Exchange (ETDEWEB)

None, None

2016-05-01

Net-energy metering (NEM) with volumetric retail electricity pricing has enabled rapid proliferation of distributed photovoltaics (DPV) in the United States. However, this transformation is raising concerns about the potential for higher electricity rates and cost-shifting to non-solar customers, reduced utility shareholder profitability, reduced utility earnings opportunities, and inefficient resource allocation. Although DPV deployment in most utility territories remains too low to produce significant impacts, these concerns have motivated real and proposed reforms to utility regulatory and business models, with profound implications for future DPV deployment. This report explores the challenges and opportunities associated with such reforms in the context of the U.S. Department of Energy’s SunShot Initiative. As such, the report focuses on a subset of a broader range of reforms underway in the electric utility sector. Drawing on original analysis and existing literature, we analyze the significance of DPV’s financial impacts on utilities and non-solar ratepayers under current NEM rules and rate designs, the projected effects of proposed NEM and rate reforms on DPV deployment, and alternative reforms that could address utility and ratepayer concerns while supporting continued DPV growth. We categorize reforms into one or more of four conceptual strategies. Understanding how specific reforms map onto these general strategies can help decision makers identify and prioritize options for addressing specific DPV concerns that balance stakeholder interests.

The Changing Roles of Science Specialists during a Capacity Building Program for Primary School Science

Science.gov (United States)

Herbert, Sandra; Xu, Lihua; Kelly, Leissa

2017-01-01

Science education starts at primary school. Yet, recent research shows primary school teachers lack confidence and competence in teaching science (Prinsley & Johnston, 2015). A Victorian state government science specialist initiative responded to this concern by providing professional learning programs to schools across Victoria. Drawing on…

Depression in obese patients with primary fibromyalgia: the mediating role of poor sleep and eating disorder features.

Science.gov (United States)

Senna, Mohammed K; Ahmad, Hamada S; Fathi, Warda

2013-03-01

Depression is a prominent feature in fibromyalgia syndrome. Patients with fibromyalgia syndrome who are obese, with poor sleep quality, and those who have recurrent episodes of binge eating are at greater risk to develop depression. The aim of this cross-sectional study was to examine the hypothesis that the relationship between obesity and depression in patients with primary fibromyalgia syndrome is mediated by poor sleep, binge eating disorder (BED), and weight and shape concern. This study included 131 patients with primary fibromyalgia syndrome. Participants completed the following questionnaires: Pittsburgh Sleep Quality Index, Beck Depression Inventory-II, Eating Disorder questionnaire, and Fibromyalgia Impact Questionnaire. Body mass index (BMI) provided the primary indicator of obesity. Sobel test showed that the conditions for complete mediation were satisfied on the weight and shape concern as mediator between BMI and depression because the association between BMI and depression score became insignificant after controlling of weight and shape concern. However, since the association between BMI and depression remained significant after BED and poor sleep score were controlled, thus for both mediators, the conditions for partial mediation on the depression were satisfied. The findings suggest that in patients with primary fibromyalgia syndrome, weight and shape concern, BED, and poor sleep quality are important mediators of the relationship between obesity and depression. We suggest that a greater focus on these mediators in depression treatment may be indicated.

Parents' concerns regarding the growth characteristics of their adolescents: a qualitative inquiry in Iran.

Science.gov (United States)

Cheraghi, Mohammad Ali; Rezasoltani, Parvaneh; Vedadhir, AbouAli; Taghizadeh, Ziba; Samadanifard, Seyyed Hossein

2018-12-01

In recent times, parents have become increasingly concerned, both subjectively and objectively, about their adolescents' body height/weight growth. Parent-adolescent interactions about this issue and the potential socio-psychological consequences of such interactions should be considered as an important influencing factor on the future of adolescents' sexual and reproductive health. To achieve a greater understanding of such concerns, it is necessary to further elucidate parents' experiences on this topic, so as to expand the existing literature. This study aimed to explain the perceptions of parents' concerns regarding their adolescents' growth characteristics in the socio-cultural context of Iran as a transitional society. This paper is part of a larger qualitative study designed using the Constructivist Grounded Theory Methodology (CGTM). We conducted open-ended intensive interviews with eleven parents individually and recruited them through purposeful and theoretical sampling from a teaching hospital, community, and a primary school in Tehran with theoretical sampling variation in terms of teenagers' age, sex, and birth order, place of residence, parents' occupation and education, and the self-reported socio-economic status. Using the analytical procedures of the CGTM, we performed analyses. In the findings, the concept of 'living with constant sense of uncertainty' emerged from the subcategories including 'feeling existing and potential concern about expected minimum and maximum bio-positions of growth,' 'feeling potential concern about biological health consequences,' 'feeling potential concern about the emergence of early/late maturity signs,' 'feeling potential concern about adolescent's emotional threat,' 'feeling concerned about future employment, education, marriage, and fertility,' and 'feeling potential concern about the society's view'. These findings suggest that parents are living with a constant sense of uncertainty about their teens' growth

Retrospection concerning the sugar beet protection on Fundulea zone, district Calarasi, Romania

Directory of Open Access Journals (Sweden)

Doncila Anton I.

2006-01-01

Full Text Available The paper represents a synthesis concerning sugar beet protection in the specific conditions (soil and climatic of Fundulea zone. The presented aspects refer to the beet diseases, pests and weeds (primary and secondary concerning economic importance since these organisms are continually limiting root and sugar yields. At the same time, it refers to the present control possibilities, the aim being the efficiancy and environmental demands. The basis of the synthesis are main data and results obtained at the Institute (in experimental fields and demonstration plots, during 1982-2003 (the Institute was founded in 1981 about natural infections and infestations without treatments. It contains three parts (pathogens, pests, weeds and has original pictures enclosed in the annex: some symptoms of pathogen and pests attacks, weed control and other aspects such as herbicides fitotoxity strangled roots, Cuscuta as a parasitic plant etc.

South African Teachers' Perceptions of the Primary Geography Curriculum: An Exploratory Study

Science.gov (United States)

Wilmot, Di; Irwin, Pat

2015-01-01

There is a dearth of research on primary school Geography in South Africa. With no Annual National Assessments (ANAs) being done in the subject, little is known about the quality of geographical learning and teaching in South African primary schools. This article begins to address this shortcoming. More specifically, it responds to the need for…

A novel income security intervention to address poverty in a primary care setting: a retrospective chart review.

Science.gov (United States)

Jones, Marcella K; Bloch, Gary; Pinto, Andrew D

2017-08-17

To examine the development and implementation of a novel income security intervention in primary care. A retrospective, descriptive chart review of all patients referred to the Income Security Heath Promotion service during the first year of the service (December 2013-December 2014). A multisite interdisciplinary primary care organisation in inner city Toronto, Canada, serving over 40 000 patients. The study population included 181 patients (53% female, mean age 48 years) who were referred to the Income Security Health Promotion service and engaged in care. The Income Security Health Promotion service consists of a trained health promoter who provides a mixture of expert advice and case management to patients to improve income security. An advisory group, made up of physicians, social workers, a community engagement specialist and a clinical manager, supports the service. Sociodemographic information, health status, referral information and encounter details were collected from patient charts. Encounters focused on helping patients with increasing their income (77.4%), reducing their expenses (58.6%) and improving their financial literacy (26.5%). The health promoter provided an array of services to patients, including assistance with taxes, connecting to community services, budgeting and accessing free services. The service could be improved with more specific goal setting, better links to other members of the healthcare team and implementing routine follow-up with each patient after discharge. Income Security Health Promotion is a novel service within primary care to assist vulnerable patients with a key social determinant of health. This study is a preliminary look at understanding the functioning of the service. Future research will examine the impact of the Income Security Health Promotion service on income security, financial literacy, engagement with health services and health outcomes. © Article author(s) (or their employer(s) unless otherwise stated in

AN EVALUATION OF PRIMARY DATA-COLLECTION MODES IN AN ADDRESS-BASED SAMPLING DESIGN.

Science.gov (United States)

Amaya, Ashley; Leclere, Felicia; Carris, Kari; Liao, Youlian

2015-01-01

As address-based sampling becomes increasingly popular for multimode surveys, researchers continue to refine data-collection best practices. While much work has been conducted to improve efficiency within a given mode, additional research is needed on how multimode designs can be optimized across modes. Previous research has not evaluated the consequences of mode sequencing on multimode mail and phone surveys, nor has significant research been conducted to evaluate mode sequencing on a variety of indicators beyond response rates. We conducted an experiment within the Racial and Ethnic Approaches to Community Health across the U.S. Risk Factor Survey (REACH U.S.) to evaluate two multimode case-flow designs: (1) phone followed by mail (phone-first) and (2) mail followed by phone (mail-first). We compared response rates, cost, timeliness, and data quality to identify differences across case-flow design. Because surveys often differ on the rarity of the target population, we also examined whether changes in the eligibility rate altered the choice of optimal case flow. Our results suggested that, on most metrics, the mail-first design was superior to the phone-first design. Compared with phone-first, mail-first achieved a higher yield rate at a lower cost with equivalent data quality. While the phone-first design initially achieved more interviews compared to the mail-first design, over time the mail-first design surpassed it and obtained the greatest number of interviews.

Address Points - COUNTY_ADDRESS_POINTS_IDHS_IN: Address Points Maintained by County Agencies in Indiana (Indiana Department of Homeland Security, Point feature class)

Data.gov (United States)

NSGIC State | GIS Inventory — COUNTY_ADDRESS_POINTS_IDHS_IN is an ESRI Geodatabase point feature class that contains address points maintained by county agencies in Indiana, provided by personnel...

Substance abuse and HIV risk behaviours amongst primary health ...

African Journals Online (AJOL)

Substance abuse and HIV risk behaviours amongst primary health care service users in Cape Town. ... African Journal of Psychiatry ... We assessed substance use with the Alcohol, Smoking and Substance Involvement Screening Test, and HIV risk with items addressing injection drug use, blood-sharing rituals, and sexual ...

Emissions of volatile organic compounds during the ship-loading of petroleum products: Dispersion modelling and environmental concerns.

Science.gov (United States)

Milazzo, Maria Francesca; Ancione, Giuseppa; Lisi, Roberto

2017-12-15

Emissions due to ship-loading of hydrocarbons are currently not addressed neither by the Directive on the integrated pollution prevention or by other environmental regulations. The scope of this study is to point towards the environmental and safety concerns associated with such emissions, even if proper attention has not been given to this issue until now. In order to achieve this goal, the modelling of the emission volatile organic compounds (VOC), due to ship-load operations at refineries has been made by means of the definition of a simulation procedure which includes a proper treatment of the hours of calm. Afterwards, a quantitative analysis of VOC dispersion for an Italian case-study is presented with the primary aims: (i) to develop and verify the validity of the approach for the modelling of the emission sources and of the diffusion of these contaminants into the atmosphere by a proper treatment of the hours of calm and (ii) to identify their contribution to the total VOC emitted in a typical refinery. The calculated iso-concentration contours have also been drawn on a map and allowed the identification of critical areas for people protecting by the adoption of abatement solutions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Addressing issues raised by stakeholders: experiences of eight organisations

International Nuclear Information System (INIS)

Vari, Anna

2004-01-01

Demand for stakeholder involvement has become imperative in the field of radioactive waste management. Providing for fair and competent stakeholder involvement, however, raises several questions of practice, for example: How to address issues raised by stakeholders? How to take stakeholders' views into consideration if they are divergent or conflicting? This paper reviews eight case studies prepared for the Topical Session on Addressing Issues Raised by Stakeholders, aimed at analysing the impacts of stakeholder involvement on decisions in RWM organisations. The studies outline the experiences of the following organisations: Canadian Nuclear Safety Commission (CNSC); Canadian Nuclear Waste Management Organization (NWMO); Nuclear Waste Management Organisation of Japan (NUMO); Posiva, Finland; Radioactive Waste Repository Authority, Czech Republic (RAWRA); Swedish Radiation Protection Authority (SSI); United Kingdom Environment Agency; United States Environmental Protection Agency (EPA). Case study reports are included in the Annex of this volume. The paper outlines the main trends and lessons learned from the above case studies. The first section focuses on impacts of stakeholder involvement on specific RWM decisions regarding policy and process. Examples presented in the second section illustrate how stakeholders' concerns may influence general decision-making practices and organisational behaviour. In the third section various approaches to handling divergent stakeholder views are introduced. The paper concludes with recommendations extracted and derived from the eight reports. (author)

Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study

Science.gov (United States)

Blakeman, Tom; Protheroe, Joanne; Chew-Graham, Carolyn; Rogers, Anne; Kennedy, Anne

2012-01-01

Background Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management. Aim To explore processes underpinning the implementation of CKD management in primary care. Design and setting Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester. Method Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation and analysis of the data. Results A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was shaped by, the organisation of care for people with CKD and associated long-term conditions. Conclusion Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney injury, improve self-management of vascular conditions, and improve the management of multimorbidity. PMID:22520910

Quality Control in Survey Design: Evaluating a Survey of Educators’ Attitudes Concerning Differentiated Compensation

OpenAIRE

Kelly D. Bradley; Michael Peabody; Shannon O. Sampson

2015-01-01

This study utilized the Rasch model to assess the quality of a survey instrument designed to measure attitudes of administrators and teachers concerning a differentiated teacher compensation program piloted in Kentucky.  Researchers addressing potentially contentious issues should ensure their methods stand up to rigorous criticism.  The results indicate that the rating scale does not function as expected, with items being too easy to endorse.  Future iterations of this survey should be revis...

Addressing Criticisms of Large-Scale Marine Protected Areas

Science.gov (United States)

Ban, Natalie C; Fernandez, Miriam; Friedlander, Alan M; García-Borboroglu, Pablo; Golbuu, Yimnang; Guidetti, Paolo; Harris, Jean M; Hawkins, Julie P; Langlois, Tim; McCauley, Douglas J; Pikitch, Ellen K; Richmond, Robert H; Roberts, Callum M

2018-01-01

Abstract Designated large-scale marine protected areas (LSMPAs, 100,000 or more square kilometers) constitute over two-thirds of the approximately 6.6% of the ocean and approximately 14.5% of the exclusive economic zones within marine protected areas. Although LSMPAs have received support among scientists and conservation bodies for wilderness protection, regional ecological connectivity, and improving resilience to climate change, there are also concerns. We identified 10 common criticisms of LSMPAs along three themes: (1) placement, governance, and management; (2) political expediency; and (3) social–ecological value and cost. Through critical evaluation of scientific evidence, we discuss the value, achievements, challenges, and potential of LSMPAs in these arenas. We conclude that although some criticisms are valid and need addressing, none pertain exclusively to LSMPAs, and many involve challenges ubiquitous in management. We argue that LSMPAs are an important component of a diversified management portfolio that tempers potential losses, hedges against uncertainty, and enhances the probability of achieving sustainably managed oceans. PMID:29731514

48 CFR 752.219-8 - Utilization of small business concerns and small disadvantaged business concerns.

Science.gov (United States)

2010-10-01

... business concerns and small disadvantaged business concerns. 752.219-8 Section 752.219-8 Federal... AND CONTRACT CLAUSES Texts of Provisions and Clauses 752.219-8 Utilization of small business concerns and small disadvantaged business concerns. The Foreign Assistance Act calls for USAID to give small...

Using imputation to provide location information for nongeocoded addresses.

Directory of Open Access Journals (Sweden)

Frank C Curriero

2010-02-01

Full Text Available The importance of geography as a source of variation in health research continues to receive sustained attention in the literature. The inclusion of geographic information in such research often begins by adding data to a map which is predicated by some knowledge of location. A precise level of spatial information is conventionally achieved through geocoding, the geographic information system (GIS process of translating mailing address information to coordinates on a map. The geocoding process is not without its limitations, though, since there is always a percentage of addresses which cannot be converted successfully (nongeocodable. This raises concerns regarding bias since traditionally the practice has been to exclude nongeocoded data records from analysis.In this manuscript we develop and evaluate a set of imputation strategies for dealing with missing spatial information from nongeocoded addresses. The strategies are developed assuming a known zip code with increasing use of collateral information, namely the spatial distribution of the population at risk. Strategies are evaluated using prostate cancer data obtained from the Maryland Cancer Registry. We consider total case enumerations at the Census county, tract, and block group level as the outcome of interest when applying and evaluating the methods. Multiple imputation is used to provide estimated total case counts based on complete data (geocodes plus imputed nongeocodes with a measure of uncertainty. Results indicate that the imputation strategy based on using available population-based age, gender, and race information performed the best overall at the county, tract, and block group levels.The procedure allows for the potentially biased and likely under reported outcome, case enumerations based on only the geocoded records, to be presented with a statistically adjusted count (imputed count with a measure of uncertainty that are based on all the case data, the geocodes and imputed

Port virtual addressing for PC

International Nuclear Information System (INIS)