WorldWideScience

Sample records for refuse

  1. School Refusal

    Science.gov (United States)

    Wimmer, Mary

    2008-01-01

    School attendance is an ongoing concern for administrators, particularly in middle level and high school. Frequent absences affect student learning, test scores, and social development. Absenteeism is often the result of emotional disorders, such as anxiety or depression. Administrators who understand the causes of school refusal behavior and are…

  2. Coal refuse reclamation project

    Energy Technology Data Exchange (ETDEWEB)

    Zellmer, S.D.

    1979-04-06

    A 13.8 ha abandoned coal refuse site in southwestern Illinois was reclaimed by recontouring the refuse material and covering it with a minimum 30 cm of soil. The reclamation procedure included determination of the site's final land use, collection of preconstruction environmental data, and development and implementation of engineering plans. The project is demonstrating methods that can be used to reclaim abandoned coal refuse sites, and a multidisciplinary approach is being used to evaluate postconstruction environmental and economic effects of the reclamation effort. Surface water quality has shown significant improvement and plant cover is becoming established on the site. Soil microbial populations are developing and wildlife habitats are forming. The economic value of the site and adjacent properties has increased substantially and the area's aesthetic value has been enhanced. This project is providing valuable design data for future reclamation efforts of this type.

  3. Refusal to medical interventions.

    Science.gov (United States)

    Palacios, G; Herreros, B; Pacho, E

    2014-10-01

    Refusal to medical interventions is the not acceptance, voluntary and free, of an indicated medical intervention. What the physician should do in case of refusal? It is understandable that the rejection of a validated medical intervention is difficult to accept by the responsible physician when raises the conflict protection of life versus freedom of choice. Therefore it is important to follow some steps to incorporate the most relevant aspects of the conflict. These steps include: 1) Give complete information to patients, informing on possible alternatives, 2) determine whether the patient can decide (age, competency and level of capacity), 3) to ascertain whether the decision is free, 4) analyze the decision with the patient, 5) to persuade, 6) if the patient kept in the rejection decision, consider conscientious objection, 7) take the decision based on the named criteria, 8) finally, if the rejection is accepted, offer available alternatives. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  4. Children with pervasive refusal.

    OpenAIRE

    Lask, B; Britten, C; Kroll, L; Magagna, J; Tranter, M

    1991-01-01

    Four children are described with a potentially life threatening condition manifested by profound and pervasive refusal to eat, drink, walk, talk, or care for themselves in any way over a period of several months. The multiplicity and severity of the symptoms in these children do not fit comfortably into any existing diagnostic category. Long term and highly skilled nursing and psychiatric care is required to help these children to recover. The possible causes of this syndrome are discussed.

  5. Identification and characteristics of vaccine refusers

    OpenAIRE

    Wei, Feifei; Mullooly, John P; Goodman, Mike; McCarty, Maribet C; Hanson, Ann M; Crane, Bradley; Nordin, James D

    2009-01-01

    Abstract Background This study evaluated the utility of immunization registries in identifying vaccine refusals among children. Among refusers, we studied their socioeconomic characteristics and health care utilization patterns. Methods Medical records were reviewed to validate refusal status in the immunization registries of two health plans. Racial, education, and income characteristics of children claiming refusal were collected based on the census tract of each child. Health care utilizat...

  6. 33 CFR 401.89 - Transit refused.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Transit refused. 401.89 Section... TRANSPORTATION SEAWAY REGULATIONS AND RULES Regulations General § 401.89 Transit refused. (a) An officer may refuse to allow a vessel to transit when, (1) The vessel is not equipped in accordance with §§ 401.5 to...

  7. School Refusal: Clinical Features, Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Kayhan Bahali

    2010-12-01

    Full Text Available Children regularly and voluntarily go to school in order to fulfill the expectations of society from them to continue their education or schooling. School continuation has been made compulsory by laws. Nonetheless, contrary to popular belief, for some children it is distressing to go to school. These children have difficulty continuing school and/or refuse to go to school. Today school refusal is defined as a child’s inability to continue school for reasons, such as anxiety and depression. The prevalence of school refusal has been reported to be approximately 1% in school-age children and 5% in child psychiatry samples. The prevalence of school refusal is similar among boys and girls. School refusal can occur at any time throughout the child’s academic life and at all socio-economic levels. School refusal is considered a symptom rather than a clinical diagnosis and can manifest itself as a sign of many psychiatric disorders, with anxiety disorders predominant. Separation anxiety disorder, generalized anxiety disorder, social phobia, specific phobia, and adjustment disorder with anxiety symptoms are the most common disorders co-occurring with school refusal. While separation anxiety disorder is associated with school refusal in younger children, other anxiety disorders, especially phobias, are associated with school refusal in adolescents. Children who have parents with psychiatric disorders have a higher incidence of school refusal, and psychiatric disorders are more frequently seen in adult relatives of children with school refusal, which supports a significant role of genetic and environmental factors in th etiology of school refusal. School refusal is a emergency state for child mental health. As it leads to detrimental effects in the short term and the long term, it should be regarded as a serious problem. The long-lasting follow-up studies of school refusing children have revealed that these children have a higher incidence of

  8. The Legal Ethical Backbone of Conscientious Refusal

    DEFF Research Database (Denmark)

    Munthe, Christian; Nielsen, Morten Ebbe Juul

    2017-01-01

    This article analyzes the idea of a legal right to conscientious refusal for healthcare professionals from a basic legal ethical standpoint, using refusal to perform tasks related to legal abortion (in cases of voluntary employment) as a case in point. The idea of a legal right to conscientious...... refusal is distinguished from ideas regarding moral rights or reasons related to conscientious refusal, and none of the latter are found to support the notion of a legal right. Reasons for allowing some sort of room for conscientious refusal for healthcare professionals based on the importance of cultural...... identity and the fostering of a critical atmosphere might provide some support, if no countervailing factors apply. One such factor is that a legal right to healthcare professionals’ conscientious refusal must comply with basic legal ethical tenets regarding the rule of law and equal treatment...

  9. 30 CFR 816.83 - Coal mine waste: Refuse piles.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Coal mine waste: Refuse piles. 816.83 Section... ACTIVITIES § 816.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 816.81, the... drainage may not be diverted over the outslope of the refuse piles. Runoff from the areas above the refuse...

  10. 30 CFR 817.83 - Coal mine waste: Refuse piles.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Coal mine waste: Refuse piles. 817.83 Section... ACTIVITIES § 817.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 817.81, the... drainage may not be diverted over the outslope of the refuse pile. Runoff from areas above the refuse pile...

  11. Personal values and cancer treatment refusal

    NARCIS (Netherlands)

    Evert van Leeuwen; Marli Huijer

    2000-01-01

    This pilot study explores the reasons patients have for refusing chemotherapy, and the ways oncologists respond to them. Our hypothesis, generated from interviews with patients and oncologists, is that an ethical approach that views a refusal as an autonomous choice, in which patients are informed

  12. [Refusal of nursing care, the legal perspective].

    Science.gov (United States)

    Fisman, Jérôme

    2016-10-01

    The refusal of nursing care forms part of the freedom offered to anyone wanting to refuse, consciously and knowingly, any form of nursing care such as washing, the taking of medication or hospitalisation. However, limits are fixed by law as well as by case law. Are we totally free in the expression of our will? Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. Caregivers who refuse preventive care for their children: the relationship between immunization and topical fluoride refusal.

    Science.gov (United States)

    Chi, Donald L

    2014-07-01

    The aim of this study was to examine caregivers' refusal of preventive medical and dental care for children. Prevalence rates of topical fluoride refusal based on dental records and caregiver self-reports were estimated for children treated in 3 dental clinics in Washington State. A 60-item survey was administered to 1024 caregivers to evaluate the association between immunization and topical fluoride refusal. Modified Poisson regression models were used to estimate prevalence rate ratios (PRRs). The prevalence of topical fluoride refusal was 4.9% according to dental records and 12.7% according to caregiver self-reports. The rate of immunization refusal was 27.4%. In the regression models, immunization refusal was significantly associated with topical fluoride refusal (dental record PRR = 1.61; 95% confidence interval [CI] = 1.32, 1.96; P refuse both immunizations and topical fluoride (P refusal of immunizations is associated with topical fluoride refusal. Future research should identify the behavioral and social factors related to caregiver refusal of preventive care with the goal of developing multidisciplinary strategies to help caregivers make optimal preventive care decisions for children.

  14. The Legal Ethical Backbone of Conscientious Refusal.

    Science.gov (United States)

    Munthe, Christian; Nielsen, Morten Ebbe Juul

    2017-01-01

    This article analyzes the idea of a legal right to conscientious refusal for healthcare professionals from a basic legal ethical standpoint, using refusal to perform tasks related to legal abortion (in cases of voluntary employment) as a case in point. The idea of a legal right to conscientious refusal is distinguished from ideas regarding moral rights or reasons related to conscientious refusal, and none of the latter are found to support the notion of a legal right. Reasons for allowing some sort of room for conscientious refusal for healthcare professionals based on the importance of cultural identity and the fostering of a critical atmosphere might provide some support, if no countervailing factors apply. One such factor is that a legal right to healthcare professionals' conscientious refusal must comply with basic legal ethical tenets regarding the rule of law and equal treatment, and this requirement is found to create serious problems for those wishing to defend the idea under consideration. We conclude that the notion of a legal right to conscientious refusal for any profession is either fundamentally incompatible with elementary legal ethical requirements, or implausible because it undermines the functioning of a related professional sector (healthcare) or even of society as a whole.

  15. Legal briefing: conscience clauses and conscientious refusal.

    Science.gov (United States)

    Pope, Thaddeus Mason

    2010-01-01

    This issue's "Legal Briefing" column covers legal developments pertaining to conscience clauses and conscientious refusal. Not only has this topic been the subject of recent articles in this journal, but it has also been the subject of numerous public and professional discussions. Over the past several months, conscientious refusal disputes have had an unusually high profile not only in courthouses, but also in legislative and regulatory halls across the United States. Healthcare providers' own moral beliefs have been obstructing and are expected to increasingly obstruct patients' access to medical services. For example, some providers, on ethical or moral grounds, have denied: (1) sterilization procedures to pregnant patients, (2) pain medications in end-of-life situations, and (3) information about emergency contraception to rape victims. On the other hand, many healthcare providers have been forced to provide medical treatment that is inconsistent with their moral beliefs. There are two fundamental types of conscientious objection laws. First, there are laws that permit healthcare workers to refuse providing - on ethical, moral, or religious grounds healthcare services that they might otherwise have a legal or employer-mandated obligation to provide. Second, there are laws directed at forcing healthcare workers to provide services to which they might have ethical, moral, or religious objections. Both types of laws are rarely comprehensive, but instead target: (1) certain types of healthcare providers, (2) specific categories of healthcare services, (3) specific patient circumstances, and (4) certain conditions under which a right or obligation is triggered. For the sake of clarity, I have grouped recent legal developments concerning conscientious refusal into eight categories: 1. Abortion: right to refuse 2. Abortion: duty to provide 3. Contraception: right to refuse 4. Contraception: duty to provide 5. Sterilization: right to refuse 6. Fertility, HIV, vaccines

  16. Chemical reagent and process for refuse disposal

    International Nuclear Information System (INIS)

    Somerville, R.B.; Fan, L.T.

    1989-01-01

    A process for treating refuse by mixing them with a reactive chemical and a puzzolana-type material. Said chemical includes a retarding agent which modifies the viscosity and an accelerating agent. (author)

  17. Using a Nonaversive Procedure to Decrease Refusals.

    Science.gov (United States)

    Spooner, Fred; And Others

    1990-01-01

    A nonaversive technique was used to teach a severely handicapped woman to decrease her refusals. The technique employed precision teaching via precise daily measurement strategies, environmental analysis, and a focus on building appropriate behavior. (JDD)

  18. When does food refusal require professional intervention?

    OpenAIRE

    Dovey, Terence M.; Farrow, Claire V.; Martin, Clarissa I.; Isherwood, Elaine; Halford, Jason C.G.

    2009-01-01

    Food refusal can have the potential to lead to nutritional deficiencies, which increases the risk of a variety of communicable and non-communicable diseases. Deciding when food refusal requires professional intervention is complicated by the fact that there is a natural and appropriate stage in a child's development that is characterised by increased levels of rejection of both previously accepted and novel food items. Therefore, choosing to intervene is difficult, which if handled badly can ...

  19. 30 CFR 77.215-4 - Refuse piles; abandonment.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; abandonment. 77.215-4 Section 77... MINES Surface Installations § 77.215-4 Refuse piles; abandonment. When a refuse pile is to be abandoned... refuse pile shall be abandoned in accordance with a plan submitted by the operator and approved by the...

  20. Medication Refusal: Resident Rights, Administration Dilemma.

    Science.gov (United States)

    Haskins, Danielle R; Wick, Jeannette Y

    2017-12-01

    Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

  1. Cubicle Refusal in Norwegian Dairy Herds

    Directory of Open Access Journals (Sweden)

    Myren HJ

    2001-03-01

    Full Text Available In order to survey the behaviour of choosing the alley area instead of a cubicle as a lying place (cubicle refusal, a questionnaire was sent to the 273 dairy farms in Norway known to keep cows in cubicle housing systems. Sixty-six percent of the farmers contacted were included in the study. The median herd size was 18 cows (range 7–118. More than 85% of the herds had sheds providing one or more cubicles per cow. The mean herd occurrence of cubicle refusal was 6%, but showed great variation (range 0–55%. Regression analysis showed a significant association between rearing heifers in slatted floor pens and an increased cubicle refusal occurrence (p = 0.02, R2 = 0.05, while herd size, use of litter, or cubicle-to-animal ratio were not found to be associated with cubicle refusal. The practice of rearing heifers in slatted floor pens accounted for about one half of the observed cubicle refusal (etiologic fraction = 0.51.

  2. Current status of research on school refusal

    Directory of Open Access Journals (Sweden)

    Cándido J. Inglés

    2015-06-01

    Full Text Available School refusal behavior refers to the avoidance of a child attending school and/or persistent difficulty staying in the classroom throughout the school day. Based on a review of the scientific literature, the aim of this study is to describe the current state of research on school refusal, differentiating between the findings and progress made in Spain from those achieved in the international field. For this purpose, the significance of this phenomenon, in addition to associated risk factors and variables, will be reviewed in the child and youth population. In turn, the commonly used assessment methods and most recommended treatment proposals, mainly based on cognitive behavioral therapy, are discussed. The results reveal several gaps and subjects for debate in some areas of knowledge about school refusal behavior, with differences being found between Spanish and international studies. In conclusion, future studies and challenges in this field are required.

  3. Refusing The Choice: Balancing Life and Work

    Science.gov (United States)

    Brooks, J.

    2012-12-01

    The Choice The intellect of man is forced to choose perfection of the life, or of the work, And if it take the second must refuse A heavenly mansion, raging in the dark. When all that story's finished, what's the news? In luck or out the toil has left its mark: That old perplexity an empty purse, Or the day's vanity, the night's remorse. William Butler Yeats William Yeats put forward The Choice that I feel too many scientists feel they must make. Too often, many choose to leave science. How do we refuse this choice and find balance between life and our careers? While I don't know the answer, I will share choices that have lead to not perfection but satisfaction in science careers and lives. The role of mentors, supportive spouses, the luck of the job, and flexibility in research directions have all contributed to being able to refuse to choose.

  4. 8. European sewage and refuse symposium. Documentation

    International Nuclear Information System (INIS)

    1990-01-01

    The subject of the 8. European Sewage and Refuse Symposium is covered under the following headings: collection and control in sewers, industrial waste water management, pretreatment, combined treatment, special cases, industrial waste water sludges disposal and the European waste business. (orig./BBR)

  5. [Professionals' training and refusal of nursing care].

    Science.gov (United States)

    Bay, Corinne

    2016-10-01

    A patient's refusal of nursing care concerns the caregivers. Future professionals must be prepared for it and student nurses are trained to deal with such situations. It is also important to empower patients and support them in their choice. This article presents the example of the Haute École Robert Schuman in Libramont, Belgium. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. Analysis of fouling in refuse waste incinerators

    NARCIS (Netherlands)

    Beek, van M.C.; Rindt, C.C.M.; Wijers, J.G.; Steenhoven, van A.A.

    2001-01-01

    Gas-side fouling of waste-heat-recovery boilers, caused mainly by the deposition of particulate matter, reduces the heat transfer in the boiler. The fouling as observed on the tube bundles in the boiler of a Dutch refuse waste incinerator varied from thin and powdery for the economizer to thick and

  7. Process for producing a fuel suitable for degassing from refuse

    Energy Technology Data Exchange (ETDEWEB)

    Sulzberger, J

    1975-11-20

    Utilization of the heat energy of refuse in waste incineration plants is time-consuming and expensive due to high investment and operation costs. The inventor recommends to process the refuse to a sterile, handy and storable fuel. For this propose the refuse should be crushed, kneaded and pressed. The briquettes produced in this way should be dried.

  8. 30 CFR 77.214 - Refuse piles; general.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; general. 77.214 Section 77.214... Installations § 77.214 Refuse piles; general. (a) Refuse piles constructed on or after July 1, 1971, shall be..., tipples, or other surface installations and such piles shall not be located over abandoned openings or...

  9. 30 CFR 77.215-3 - Refuse piles: certification.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles: certification. 77.215-3 Section... COAL MINES Surface Installations § 77.215-3 Refuse piles: certification. (a) Within 180 days following written notification by the District Manager that a refuse pile can present a hazard, the person owning...

  10. 30 CFR 77.215-1 - Refuse piles; identification.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; identification. 77.215-1 Section... COAL MINES Surface Installations § 77.215-1 Refuse piles; identification. A permanent identification marker, at least six feet high and showing the refuse pile identification number as assigned by the...

  11. 30 CFR 77.215-2 - Refuse piles; reporting requirements.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; reporting requirements. 77.215-2... COAL MINES Surface Installations § 77.215-2 Refuse piles; reporting requirements. (a) The proposed location of a new refuse pile shall be reported to and acknowledged in writing by the District Manager...

  12. 30 CFR 77.215 - Refuse piles; construction requirements.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; construction requirements. 77.215... COAL MINES Surface Installations § 77.215 Refuse piles; construction requirements. (a) Refuse deposited on a pile shall be spread in layers and compacted in such a manner so as to minimize the flow of air...

  13. 25 CFR 135.6 - Refusal of water delivery.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Refusal of water delivery. 135.6 Section 135.6 Indians... INDIAN IRRIGATION PROJECT Charges Assessed Against Irrigation District Lands § 135.6 Refusal of water delivery. The right is reserved to the United States to refuse the delivery of water to each of the said...

  14. Refusal Skill Ability: An Examination of Adolescent Perceptions of Effectiveness

    Science.gov (United States)

    Nichols, Tracy R.; Birnel, Sara; Graber, Julia A.; Brooks-Gunn, Jeanne; Botvin, Gilbert J.

    2010-01-01

    This pilot study examined whether refusal assertion as defined by a proven drug prevention program was associated with adolescent perceptions of effectiveness by comparing two sets of coded responses to adolescent videotaped refusal role-plays (N = 63). The original set of codes was defined by programmatic standards of refusal assertion and the…

  15. Persian Speakers' Use of Refusal Strategies across Politeness Systems

    Science.gov (United States)

    Salmani Nodoushan, Mohammad Ali

    2016-01-01

    This study aimed at investigating the preferred refusal strategies in Persian. 3047 refusals collected by 108 field workers as well as 376 refusals collected through face to face interviews were analyzed and classified according to the descriptions proposed by Liao (1994) and Liao and Bresnahan (1996). The frequencies of the resulting direct and…

  16. Primary care pediatricians' perceptions of vaccine refusal in europe.

    Science.gov (United States)

    Grossman, Zachi; van Esso, Diego; Del Torso, Stefano; Hadjipanayis, Adamos; Drabik, Anna; Gerber, Andreas; Miron, Dan

    2011-03-01

    An electronic survey assessing primary care pediatricians' estimations and practices regarding parents' vaccination refusal was sent to 395 members of the European Academy of Pediatrics Research in Ambulatory Setting network, with a response rate of 87%. Of respondents who vaccinate in the clinic, 93% estimated the total vaccine refusal rate as refusing parents.

  17. 21 CFR 211.50 - Sewage and refuse.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Sewage and refuse. 211.50 Section 211.50 Food and... CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Buildings and Facilities § 211.50 Sewage and refuse. Sewage, trash, and other refuse in and from the building and immediate premises shall be...

  18. 25 CFR 135.23 - Refusal of water delivery.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Refusal of water delivery. 135.23 Section 135.23 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES CONSTRUCTION ASSESSMENTS, CROW... District § 135.23 Refusal of water delivery. The right is reserved to refuse the delivery of water to any...

  19. 19 CFR 12.114 - Release or refusal of delivery.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Release or refusal of delivery. 12.114 Section 12... delivery. If the completed Notice of Arrival directs the port director to release the shipment of... directs the port director to refuse delivery of the shipment, the shipment shall be refused delivery and...

  20. Use for refuse of shale carbonization

    Energy Technology Data Exchange (ETDEWEB)

    1917-09-25

    A process is disclosed for using the refuse from the carbonization of bituminous shales in the preparation of light building material, characterized in that the pulverized material is mixed wet with a light filler, formed in a mold, and burned with or without the addition of clay or with the addition of binding and preserving material, preparing the mold from the pulverized material in the cold.

  1. Assessment of musculoskeletal load in refuse collectors

    Directory of Open Access Journals (Sweden)

    Zbigniew W. Jóźwiak

    2013-08-01

    Full Text Available Background: The aim of this work was to assess the load on the musculoskeletal system and its effects in the collectors of solid refuse. The rationale behind this study was to formulate proposals how to reduce excessive musculoskeletal load in this group of workers. Material and Methods: The study group comprised 15 refuse collectors aged 25 to 50 years. Data about the workplace characteristics and subjective complaints of workers were collected by the free interview and questionnaire. During the survey the photorecording of the workpostures, the distance and velocity by GPS recorders, measurements of forces necessary to move containers, energy expenditure (lung ventilation method, workload estimation using the Firstbeat system and REBA method and stadiometry were done. Results: The distance walked daily by the collectors operating in terms of 2 to 3 in urban areas was about 15 km, and in rural areas about 18 km. The most frequent musculoskeletal complaints concerned the feet (60% subjects, knees, wrists and shoulders (over 40% subjects. After work-shift all examined workers had vertebral column shorter by 10 to 14 mm (11.4 mm mean. Conclusions: The results of our study show that the refuse collectors are subjected to a very high physical load because of the work organization and the way it is performed. To avoid adverse health effects and overload it is necessary to undertake ergonomic interventions, involving training of workers to improve the way of their job performance, active and passive leisure, technical control of the equipment and refuse containers, as well as the renegotiation of contracts with clients, especially those concerning non-standard containers. Med Pr 2013;64(4:507–519

  2. Microbial ecology of coal mine refuse

    Energy Technology Data Exchange (ETDEWEB)

    Cameron, R. E.; Miller, R. M.

    1977-01-01

    Baseline microbial and ecological studies of samples obtained from two abandoned coal mine refuse sites in the State of Illinois indicate that the unfavorable nature of refuse materials can be a very limiting factor for survival and growth of organisms. Despite the ''foothold'' obtained by some microorganisms, especially acidophilic fungi and some acidotolerant algae, the refuse materials should be amended or ameliorated to raise the pH, provide needed nutrients, especially nitrogen, and provide biodegradable organic matter, both for physical and biological purposes. Finally, the role of microbial populations, responses, and interactions in acid mine wastes must be put into larger perspective. Acid mine drainage amounts to over 4 million tons per year of acidity from active and abandoned mines. Microorganisms appear to be significantly responsible for this problem, but they also can play a beneficial and significant role in the amelioration or alleviation of this detrimental effect as abandoned mines are reclaimed and returned to useful productivity.

  3. Geomorphic reclmation of a coal refuse pile

    Science.gov (United States)

    Hopkinson, L. C.; Quaranta, J.

    2017-12-01

    Geomorphic reclamation is a technique that may offer opportunities to improve mine reclamation in Central Appalachia. The design approach is based on constructing a steady-state, mature landform condition and takes into account the long-term climatic conditions, soil types, terrain grade, and vegetation. Geomorphic reclamation has been applied successfully in semi-arid regions but has not yet been applied in Central Appalachia. This work describes a demonstration study where geomorphic landforming techniques are being applied to a coarse coal refuse pile in southern West Virginia, USA. The reclamation design includes four geomorphic watersheds that radially drain runoff from the pile. Each watershed has one central draining channel and incorporates compound slope profiles similarly to naturally eroded slopes. Planar slopes were also included to maintain the impacted area. The intent is to alter the hydrology to decrease water quality treatment costs. The excavation cut and fill volumes are comparable to those of more conventional refuse pile reclamation designs. If proven successful then this technique can be part of a cost-effective solution to improve water quality at active and future refuse facilities, abandoned mine lands, bond forfeiture sites, landfills, and major earthmoving activities within the region.

  4. Vaccine refusal - what we need to know.

    Science.gov (United States)

    Succi, Regina Célia de Menezes

    2018-04-12

    Opposition to vaccines is not a new event, and appeared soon after the introduction of the smallpox vaccine in the late 18th century. The purpose of this review is to educate healthcare professionals about vaccine hesitancy and refusal, its causes and consequences, and make suggestions to address this challenge. A comprehensive and non-systematic search was carried out in the PubMed, LILACS, and ScieLo databases from 1980 to the present day, using the terms "vaccine refusal," "vaccine hesitancy," and "vaccine confidence." The publications considered as the most relevant by the author were critically selected. The beliefs and arguments of the anti-vaccine movements have remained unchanged in the past two centuries, but new social media has facilitated the dissemination of information against vaccines. Studies on the subject have intensified after 2010, but the author did not retrieve any published studies to quantify this behavior in Brazil. The nomenclature on the subject (vaccine hesitancy) was standardized by the World Health Organization in 2012. Discussions have been carried out on the possible causes of vaccine hesitancy and refusal, as well as on the behavior of families and health professionals. Proposals for interventions to decrease public doubts, clarify myths, and improve confidence in vaccines have been made. Guides for the health care professional to face the problem are emerging. The healthcare professional is a key element to transmit information, resolve doubts and increase confidence in vaccines. They must be prepared to face this new challenge. Copyright © 2018 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  5. Conscientious refusals and reason-giving.

    Science.gov (United States)

    Marsh, Jason

    2014-07-01

    Some philosophers have argued for what I call the reason-giving requirement for conscientious refusal in reproductive healthcare. According to this requirement, healthcare practitioners who conscientiously object to administering standard forms of treatment must have arguments to back up their conscience, arguments that are purely public in character. I argue that such a requirement, though attractive in some ways, faces an overlooked epistemic problem: it is either too easy or too difficult to satisfy in standard cases. I close by briefly considering whether a version of the reason-giving requirement can be salvaged despite this important difficulty. © 2013 John Wiley & Sons Ltd.

  6. Utilization of washery dirt and mine refuse

    Energy Technology Data Exchange (ETDEWEB)

    Leininger, D; Schieder, T

    1975-10-02

    Washery dirt and mine refuse may be used without processing as road ballast, embankments and dykes, and for filling gravel pits and subsidence areas. The properties required in road ballast are outlined. For the top portions of embankments and for frost protection layers, washery dirt must be processed to remove particles of the wrong size. Methods of heat treatment are listed, and the chemical composition of the dirt is discussed. Because of its different chemical composition, large particles are preferable to fine dirt for some applications, even if they have to be crushed. Tree planting experiments on spoilbanks are described.

  7. Differences between "refusers" and "non-refusers" in a psychological study.

    NARCIS (Netherlands)

    Hoogstraten, J.; Vorst, H.C.M.

    1972-01-01

    Administered the ABV (Amsterdam Biographical Questionnaire) and the LOS (Leadership Concept Scale) to 98 students. The directions indicated that the Ss need not comply with the requirement to complete the LOS. 21 Ss failed to avail themselves of this permission and were labeled "refusers" (A). Their

  8. Autonomy, religious values, and refusal of lifesaving medical treatment.

    OpenAIRE

    Wreen, M J

    1991-01-01

    The principal question of this paper is: Why are religious values special in refusal of lifesaving medical treatment? This question is approached through a critical examination of a common kind of refusal of treatment case, one involving a rational adult. The central value cited in defence of honouring such a patient's refusal is autonomy. Once autonomy is isolated from other justificatory factors, however, possible cases can be imagined which cast doubt on the great valuational weight assign...

  9. Marketization of refuse collection in Denmark

    DEFF Research Database (Denmark)

    Busck, Ole Gunni

    2006-01-01

      Danish municipalities' outsourcing and contracting of refuse collection are framed by a complex set of ideologies and objectives, besides regulation. Both at EU-level and at national level extreme demands for marketization of the public sector are counter-weighed by demands for social and envir......  Danish municipalities' outsourcing and contracting of refuse collection are framed by a complex set of ideologies and objectives, besides regulation. Both at EU-level and at national level extreme demands for marketization of the public sector are counter-weighed by demands for social...... and environmental considerations associated with the superior goal of sustainable development. In the EU regulative complex developments in normative and legal regulation of social and environmental requirements to member-states' performance have co-existed with tough requirements to ensure open competition...... in public authorities contracting. In the latest edition of the procurement directive it has been clarified that public authorities' commitment of private service-providers to social and environmental requirements by contracting is perfectly legitimate. At national level the municipalities when contracting...

  10. Refusal to pay electricity bill is illegal

    International Nuclear Information System (INIS)

    Hermann, H.P.

    1979-01-01

    Pursuant to a judgement passed by the Lower Court of Hamburg, the author discusses probable legal arguments justifying the refusal to pay one's electricity bill, the so-called electricity bill boycott. Following an analysis of the power supply contract and of the content and the limits of the fundamental right of freedom of conscience, as well as of the concept of free enterprise and of the legal effect of licenses under the nuclear law, his point of view stated in the article is to agree with the decision of the court saying that the operation of a nuclear power plant licensed under the nuclear law does not mean an infringement of the right of freedom of conscience. It can further not be accepted to let people refuse to pay their electricity bill by referring to the right of freedom of speech, by alleging conduct against public policy on the part of the public utilities, or by referring to the right of opposition. (HSCH) [de

  11. Hospital wastes management containing in radioactive refusals

    International Nuclear Information System (INIS)

    Campi, F.

    1999-01-01

    In large hospitals, featuring a nuclear medicine department, diagnostic examinations and metabolic therapies are performed using an amount of radio drugs per day averaging around some hundreds mCi. Part of these drugs are disposed in the conventional patient related waste and collected within the hospital itself. Before directing the wastes to the disposal, it is necessary verify that they do not contain radioactive materials. This article refers a study on the possibility to perform this verification by means of an automatic radio-metric system, in order to improve the efficiency, the speed and the safety of the control. Measures devoted to determined the minimum detectable activities for the main radionuclides used in the hospitals have been executed, and it has been designed a comprehensive device able to operate automatically, and unattended by any operator, the selection of radioactive refusals [it

  12. 14 CFR 121.586 - Authority to refuse transportation.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Authority to refuse transportation. 121.586 Section 121.586 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... transportation. (a) No certificate holder may refuse transportation to a passenger on the basis that, because the...

  13. School Refusal: Assessment and Intervention within School Settings.

    Science.gov (United States)

    Wimmer, Mary B.

    Anxiety-based school refusal occurs in 2% of school-age children. The reasons why they refuse to go school range from mental illness and learning problems to general defiance and a desire for attention. Early identification and multi-faceted assessment and interventions are critical to addressing the problem. This book offers concise, practical…

  14. 36 CFR 1002.14 - Sanitation and refuse.

    Science.gov (United States)

    2010-07-01

    ... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Sanitation and refuse. 1002.14 Section 1002.14 Parks, Forests, and Public Property PRESIDIO TRUST RESOURCE PROTECTION, PUBLIC USE AND RECREATION § 1002.14 Sanitation and refuse. (a) The following are prohibited: (1) Disposing of...

  15. 36 CFR 2.14 - Sanitation and refuse.

    Science.gov (United States)

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Sanitation and refuse. 2.14 Section 2.14 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR RESOURCE PROTECTION, PUBLIC USE AND RECREATION § 2.14 Sanitation and refuse. (a) The following are...

  16. 47 CFR 73.4005 - Advertising-refusal to sell.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Advertising-refusal to sell. 73.4005 Section 73.4005 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.4005 Advertising—refusal to sell. See 412...

  17. 20 CFR 401.70 - Appeals of refusals to correct records or refusals to allow access to records.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Appeals of refusals to correct records or refusals to allow access to records. 401.70 Section 401.70 Employees' Benefits SOCIAL SECURITY... also inform you that you have a right to file a statement of disagreement with the decision. Your...

  18. Characteristics and Outcomes of Elderly Patients Refused to ICU

    Directory of Open Access Journals (Sweden)

    María-Consuelo Pintado

    2013-01-01

    Full Text Available Background. There are few data regarding the process of deciding which elderly patients are refused to ICU admission, their characteristics, and outcome. Methods. Prospective longitudinal observational cohort study. We included all consecutive patients older than 75 years, who were evaluated for admission to but were refused to treatment in ICU, during 18 months, with 12-month followup. We collected demographic data, ICU admission/refusal reasons, previous functional and cognitive status, comorbidity, severity of illness, and hospital and 12-month mortality. Results. 338 elderly patients were evaluated for ICU admission and 88 were refused to ICU (26%. Patients refused because they were “too ill to benefit” had more comorbidity and worse functional and mental situation than those admitted to ICU; there were no differences in illness severity. Hospital mortality rate of the whole study cohort was 36.3%, higher in patients “too ill to benefit” (55.6% versus 35.8%, P<0.01, which also have higher 1-year mortality (73.7% versus 42.5%, P<0.01. High comorbidity, low functional status, unavailable ICU beds, and age were associated with refusal decision on multivariate analysis. Conclusions. Prior functional status and comorbidity, not only the age or severity of illness, can help us more to make the right decision of admitting or refusing to ICU patients older than 75 years.

  19. Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations.

    Science.gov (United States)

    Marco, Catherine A; Brenner, Jay M; Kraus, Chadd K; McGrath, Norine A; Derse, Arthur R

    2017-11-01

    Informed consent is an important component of emergency medical treatment. Most emergency department patients can provide informed consent for treatment upon arrival. Informed consent should also be obtained for emergency medical interventions that may entail significant risk. A related concept to informed consent is informed refusal of treatment. Patients may refuse emergency medical treatment during their evaluation and treatment. This article addresses important considerations for patients who refuse treatment, including case studies and discussion of definitions, epidemiology, assessment of decisional capacity, information delivery, medicolegal considerations, and alternative care plans. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  20. Performing coolness: smoking refusal and adolescent identities.

    Science.gov (United States)

    Plumridge, E W; Fitzgerald, L J; Abel, G M

    2002-04-01

    The implications of smoking refusal for personal identity style were studied through conversations in six small focus groups or dyads of 13- and 14-year-old non-smokers from an urban New Zealand secondary school. The approach to analyzing their talk was informed by notions of 'performativity' and 'social space' to focus on the connections between identity and social relations. Smoking emerged as a key signifier of power and status. It was salient at both top and bottom ends of the social hierarchy depending upon the competence displayed in smoking as part of a larger ensemble of personal deportment and behavior. Being a non-smoker therefore inevitably carried connotations of being 'average' or 'in the middle', presenting non-smoking adolescents with the problem of accrediting themselves against superior 'smoker cool' groups. A discourse analytic approach was used to examine the resources and strategies participants brought to bear on this 'problem', which was then seen to be solved differently by boys and girls. Boys could establish alternatives to 'smoker cool' through physical activity, girls had little recourse but to accept their inferior status. The implications of this for health education and promotion are discussed.

  1. Refuse derived fuel potential in DKI Jakarta

    Science.gov (United States)

    Widyatmoko, H.

    2018-01-01

    Combustible waste fractions of municipal solid waste (MSW) which can not be easily separated or sorted, reused or recycled, may have a high calorifiv value (CV) that can be used in a fuel for energy recovery. The objective of this study was to explore the Refuse Derived Fuel (RDF) potential of municipal solid waste from DKI Jakarta to produce electricity and to promote it to be socially and politically acceptable. For this purpose, 24 sampels of RDF were taken from Bantargebang, cabonized, molded and pressed to be briquette. All samples were analized for moisture, ash, and calorific value in the physical and chemistry Laboratory of ITB Bandung. The analysis of calorific value (CV) shows the CV difference of 1815.8 cal/g between the briquettes (8051.25 cal/g) and the RDF (9867.12 cal/g. The total waste DKI which can be used as briquettes 5253 ton / day or equivalent with 49154115 kWh / day. If the efficiency of electricity production from RDF was 25%, then Jakarta is able to generate electricity from RDF of 12288529 kWh / day or as much as energy needed by 573,480 middle-class households with energy needs of 642.84 kWh/month.

  2. 49 CFR 219.213 - Unlawful refusals; consequences.

    Science.gov (United States)

    2010-10-01

    ... inconsistent with the employee's health, whether such refusal was made in good faith and based on medical..., as appropriate, also consider the following: (1) Whether the railroad made a good faith determination...

  3. Elemental composition of suspended particles released in refuse incineration

    International Nuclear Information System (INIS)

    Mamuro, Tetsuo; Mizohata, Akira

    1979-01-01

    Suspended particles released in refuse incineration were subjected to multielement analysis by means of instrumental neutron activation method and energy dispersive X-ray fluorescence spectrometry. The analytical results were compared with the elemental concentrations observed in the urban atmosphere, and the contribution of the refuse incineration to the urban atmosphere was roughly estimated. Greenberg et al. pointed out on the basis of their analyses that the refuse incineration can account for major portions of the Zn, Cd and Sb observed on urban aerosols. According to our results, the contribution of the refuse incineration for Zn, Cd and Sb is not negligible, but not so serious as in U.S.A. big cities. In Japan big cities there must be other more important sources of these elements. (author)

  4. Clean Cities Niche Market Overview: Refuse Haulers (Brochure)

    Energy Technology Data Exchange (ETDEWEB)

    Shea, S.

    2011-09-01

    Refuse haulers are ideal for the adoption of alternative fuels and advanced vehicle technologies. By using fuels like natural gas, propane, or biodiesel, and technologies like hybrid electric and hydraulic hybrid systems, the refuse-hauling sector could substantially decrease its petroleum use and greenhouse gas emissions. Fleet managers should explore the benefits of the fuels and technologies available, as well as the individual fleet needs, before adoption.

  5. Jehovah's Witnesses and autonomy: honouring the refusal of blood transfusions.

    Science.gov (United States)

    Bock, Gregory L

    2012-11-01

    This paper explores the scriptural and theological reasons given by Jehovah's Witnesses (JWs) to refuse blood transfusions. Julian Savulescu and Richard W Momeyer argue that informed consent should be based on rational beliefs and that the refusal of blood transfusions by JWs is irrational, but after examining the reasons given by JWs, I challenge the claim that JW beliefs are irrational. I also question whether we should give up the traditional notion of informed consent.

  6. [The refusal of nursing care by the families].

    Science.gov (United States)

    Curchod, Claude; Fisher, Marion

    2016-10-01

    Caregiving is complex. While it is not easy to admit that the process can be refused by the patient, it is no easier when it is refused by the patient's family. Accepting this fact is however an essential stage in the relational and care processes. The family must therefore be supported by professionals in order to be able to make an enlightened choice. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. [Refusal of treatments by an adult cancer patient].

    Science.gov (United States)

    Dauchy, Sarah; Faivre, Jean-Christophe; Block, Véronique; Metzger, Maude; Salleron, Julia; Charles, Cécile; Adam, Virginie

    2018-03-01

    Refusal of treatment questions the treatment's adequacy as well as the quality of the care relationship. A rigorous analysis of these situations is necessary in order to respect the patient's fundamental right to decide for him/herself while preventing a potential loss of chance. This paper proposes practical guidelines for assessment and management of the refusal of treatment by adult cancer patients. The French Association for Supportive Care in Cancer and the French Society for Psycho-Oncology formed a task force that applied a consensus methodology to draft guidelines. We propose five guidelines: (1) be informed of the conditions most often associated with refusal of treatment so as to reinforce adequate support measures; (2) understand the complexity of the process of refusal and accurately identify what is precisely refused; (3) apply an approach of systematic analysis to refusal, to try and increase the possibilities of finding an agreement while reinforcing the respect of the patient's position; (4) establish a legal procedure to address refusal of treatment that safeguards the stakeholders when no accord can be found; and (5) know the indications for ethical collective decision-making. A systematic assessment procedure of treatment refusal is necessary in order to ensure that all the physical, psychological and contextual aspects of it are taken into account, and to provide patients with the best treatment possible. The setting of good care relationship, the improvement of communication skills training and of comprehensive multidisciplinary care are all crucial elements in the prevention of these situations. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  8. Arsenic burden survey among refuse incinerator workers

    Directory of Open Access Journals (Sweden)

    Chao Chung-Liang

    2005-01-01

    Full Text Available Background: Incinerator workers are not considered to have arsenic overexposure although they have the risk of overexposure to other heavy metals. Aim: To examine the relationship between arsenic burden and risk of occupational exposure in employees working at a municipal refuse incinerator by determining the concentrations of arsenic in the blood and urine. Settings and Design: The workers were divided into three groups based on their probability of contact with combustion-generated residues, namely Group 1: indirect contact, Group 2: direct contact and Group 3: no contact. Healthy age- and sex-matched residents living in the vicinity were enrolled as the control group. Materials and Methods: Heavy metal concentrations were measured by atomic absorption spectrophotometer. Downstream rivers and drinking water of the residents were examined for environmental arsenic pollution. A questionnaire survey concerning the contact history of arsenic was simultaneously conducted. Statistical analysis: Non-parametric tests, cross-tabulation and multinomial logistic regression. Results: This study recruited 122 incinerator workers. The urine and blood arsenic concentrations as well as incidences of overexposure were significantly higher in the workers than in control subjects. The workers who had indirect or no contact with combustion-generated residues had significantly higher blood arsenic level. Arsenic contact history could not explain the difference. Airborne and waterborne arsenic pollution were not detected. Conclusion: Incinerator workers run the risk of being exposed to arsenic pollution, especially those who have incomplete protection in the workplace even though they only have indirect or no contact with combustion-generated pollutants.

  9. Power generation from refuse derived fuel

    International Nuclear Information System (INIS)

    Surroop, Dinesh; Mohee, Romeela

    2010-01-01

    Full text: The beginning of the third millennium has been characterized by a progressive increase in the demand for fossil fuels, which has caused a steep rise in oil price. At the same time, several environmental disasters have increased the sensitivity of world-wide public opinion towards the effect that environmental pollution has on human health and climate change. These conditions have fostered a renewed interest in renewable energy like solar energy, wind energy, biomass and solid wastes. In addition, the disposal of municipal solid waste (MSW) has become a critical and costly problem. The traditional landfill method requires large amounts of land and contaminates air, water and soil. The increase in socio-economic condition during the past ten years has also significantly increased the amount of solid waste generated. There are around 1200 tons of municipal solid waste (MSW) generated daily, of which the combustibles namely plastics, paper and textile waste represent 28%, and with the present generation rate, the landfill will be filled by 2012. The study was, therefore, initiated to assess the potential of power generation from refused derived fuels (RDF) from municipal solid waste (MSW) in order to reduce the dependency on fossil fuels. There are 336 tons which is equivalent to 12 tons/ h of RDF that can be generated daily from the MSW and this would generate 19.2 MW power. There will be 312 kg/ h of ash that would be generated and the NO x and SO 2 concentration were found to be 395.5 and 43.3 mg/ Nm 3 respectively. It was also found that the amount of non-biogenic CO 2 produced was 471 g/ kWhe. (author)

  10. Factors related to treatment refusal in Taiwanese cancer patients.

    Science.gov (United States)

    Chiang, Ting-Yu; Wang, Chao-Hui; Lin, Yu-Fen; Chou, Shu-Lan; Wang, Ching-Ting; Juang, Hsiao-Ting; Lin, Yung-Chang; Lin, Mei-Hsiang

    2015-01-01

    Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system. This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI). A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (prefuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.

  11. Pervasive refusal syndrome. Three German cases provide further illustration.

    Science.gov (United States)

    Jans, Thomas; Ball, Juliane; Preiss, Maike; Haberhausen, Michael; Warnke, Andreas; Renner, Tobias J

    2011-09-01

    Pervasive refusal syndrome (PRS) has been proposed as a new diagnostic entity among child and adolescent psychiatric disorders. It is characterized by a cluster of life-threatening symptoms including refusal of hood intake, decreased or complete lack of mobilization, and lack of communication as well as retreat from normal life activities. Active refusal to accept help as well as neglect of personal care have been core features of PRS in the limited number of cases reported in the last decade. There have, however; been cases with predominantly passive resistance, indicating the possibility that there may be a continuum from active refusal to passive resistance within PRS. Postulating this continuum allows for the integration of "depressive devitalization" -- a refusal syndrome mainly characterized by passive resistance -- into the concept of PRS. Here, three case vignettes of adolescent patients with PRS are presented. The patients' symptomatology can be allocated on this continuum of PRS. PRS and dissociative disorders are compared in greater detail and contrasted within this discussion of differential diagnoses at the poles of such a continuum. PRS is a useful diagnosis for cases involving symptoms of predominating refusal and retreat which cannot satisfactorily be classified by existing diagnostic categories, and which can mostly clearly be separated from dissociative disorder.

  12. Refusal of emergency caesarean section in Ireland: a relational approach.

    Science.gov (United States)

    Wade, Katherine

    2014-01-01

    This article examines the issue of emergency caesarean section refusal. This raises complex legal and ethical issues surrounding autonomy, capacity, and the right to refuse treatment. In Ireland, the situation is complicated further by the constitutional right to life of the unborn. While cases involving caesarean section refusal have occurred in other jurisdictions, a case of this nature has yet to be reported in Ireland. This article examines possible ways in which the interaction of a woman's right to refuse treatment and the right to life of the unborn could be approached in Ireland in the context of caesarean section refusal. The central argument of the article is that the liberal individualistic approach to autonomy evident in the caesarean section cases in England and Wales is difficult to apply in the Irish context, due to the conflicting constitutional rights of the woman and foetus. Thus, alternative visions of autonomy which take the interests and rights of others into account in medical decision-making are examined. In particular, this article focuses on the concept of relational consent, as developed by Alasdair Maclean and examines how such an approach could be applied in the context of caesarean section refusal in Ireland. The article explains why this approach is particularly appropriate and identifies mechanisms through which such a theory of consent could be applied. It is argued that this approach enhances a woman's right to autonomy, while at the same time allows the right to life of the unborn to be defended.

  13. Ignition processes in the refuse bed of a refuse incineration plant. Gomi shokyakuro ni okeru gomi sonai no chakka katei

    Energy Technology Data Exchange (ETDEWEB)

    Goromaru, T; Onishi, K; Iwakawa, N; Yoshikuni, N [Fukuoka Univ., Fukuoka, (Japan)

    1990-03-01

    The ignition process was studied in this paper, which was particularly connected with the drying process of refuse in the statical characteristics of refuse incinerators. Because of variety in refuse forms to be supplied to the incinerators, a physical model was composed, assuming that refuse was the layers of piled up refuse elements with uniform forms, and the ignition curves of the layers were drawn on the basis of the above model after a mathematical model was formed. The upper part of the curves was altered so that it suits to actual endothermic and heat velocity distribution on the assumption of temperature distribution in the incinerators at their inlet side. No particular alteration was made in their middle part, then the ignition curves were changed to almost straight lines inclined downward. Unburnt and refuse under firing were wrapped by ash and uncombustibles, so the lower part of the curves was only studied as a imaginary solid model by the two methods of finite element method and simple analytical one, and conversion was made into equivalent reduction in combustion temperature. 15 refs., 7 figs., 2 tabs.

  14. Situation testing: the case of health care refusal.

    Science.gov (United States)

    Després, C; Couralet, P-E

    2011-04-01

    Situation testing to assess physicians' refusal to provide healthcare is increasingly used in research studies. This paper aims to explain the relevance and limits of this method. Conducted in 2008-2009, this study was designed to assess the rate of healthcare refusal among several categories of private practitioners toward patients covered by the French public means-tested complementary health insurance (CMUc) when they requested a first appointment by phone. The other objectives were to study the determinants of healthcare refusal and assess the method. The study was conducted on a representative sample of Paris-based dentists and physicians in five categories: general practitioners, medical gynecologists, ophthalmologists, radiologists, and dentists. The method was based on two protocols. In the first scenario, an actor pretended to be a CMUc beneficiary and, in the second one, he did not give information about his health coverage but hinted at a low socioeconomic status. The two protocols were compared and procedures checking the relation between refusal and CMUc coverage were implemented in each of them. In the scenario in which the patient declared being a CMUc beneficiary, the results showed different refusal rates depending on the type of practitioner, physician, or dentist, their specialty, and whether or not, they charge more than the standard set fee. In the second scenario, refusal rates were much lower. The comparison of the two protocols seems to confirm the existence of discrimination based on CMUc affiliation rather than patients' socioeconomic status. The discussion presents the limits of situation testing, which remains an experimental instrument because it does not observe reality but reveals behaviors in situation. The findings cannot be extrapolated and are limited in time. The statistical analysis is only valid if the procedure followed is precise and applied consistently using a preset scenario. In addition, the discriminatory nature of the

  15. Risk factors associated with treatment refusal in lung cancer.

    Science.gov (United States)

    Suh, Won Na; Kong, Kyoung Ae; Han, Yeji; Kim, Soo Jung; Lee, Su Hwan; Ryu, Yon Ju; Lee, Jin Hwa; Shim, Sung Shine; Kim, Yookyung; Chang, Jung Hyun

    2017-09-01

    The incidence of lung cancer is increasing with longer life expectancy. Refusal of active treatment for cancer is prone to cause patients to experience more severe symptoms and shorten survival. The purpose of this study was to define the factors related to refusal or abandonment of active therapy in lung cancer. We retrospectively reviewed the data of 617 patients from medical records from 2010 to 2014. Two groups were formed: 149 patients who refused anti-cancer treatment and allowed only palliative care were classified into the non-treatment group, while the remaining 468 who received anti-cancer treatment were classified into the treatment group. The groups differed significantly in age, employment, relationship status, number of offspring, educational status, body mass index, presence of chest and systemic symptoms, Charlson Comorbidity Index, Eastern Cooperative Oncology Group score, and tumor node metastasis stage ( P refusal of cancer treatment. Individual factors, such as old age, low educational status, low weight, and poor performance status can influence refusal of cancer treatment in patients with lung cancer, and should be considered prior to consultation with patients. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

  16. Knowledge-based fault diagnosis system for refuse collection vehicle

    International Nuclear Information System (INIS)

    Tan, CheeFai; Juffrizal, K.; Khalil, S. N.; Nidzamuddin, M. Y.

    2015-01-01

    The refuse collection vehicle is manufactured by local vehicle body manufacturer. Currently; the company supplied six model of the waste compactor truck to the local authority as well as waste management company. The company is facing difficulty to acquire the knowledge from the expert when the expert is absence. To solve the problem, the knowledge from the expert can be stored in the expert system. The expert system is able to provide necessary support to the company when the expert is not available. The implementation of the process and tool is able to be standardize and more accurate. The knowledge that input to the expert system is based on design guidelines and experience from the expert. This project highlighted another application on knowledge-based system (KBS) approached in trouble shooting of the refuse collection vehicle production process. The main aim of the research is to develop a novel expert fault diagnosis system framework for the refuse collection vehicle

  17. Knowledge-based fault diagnosis system for refuse collection vehicle

    Energy Technology Data Exchange (ETDEWEB)

    Tan, CheeFai; Juffrizal, K.; Khalil, S. N.; Nidzamuddin, M. Y. [Centre of Advanced Research on Energy, Universiti Teknikal Malaysia Melaka, Hang Tuah Jaya, Durian Tunggal, Melaka (Malaysia)

    2015-05-15

    The refuse collection vehicle is manufactured by local vehicle body manufacturer. Currently; the company supplied six model of the waste compactor truck to the local authority as well as waste management company. The company is facing difficulty to acquire the knowledge from the expert when the expert is absence. To solve the problem, the knowledge from the expert can be stored in the expert system. The expert system is able to provide necessary support to the company when the expert is not available. The implementation of the process and tool is able to be standardize and more accurate. The knowledge that input to the expert system is based on design guidelines and experience from the expert. This project highlighted another application on knowledge-based system (KBS) approached in trouble shooting of the refuse collection vehicle production process. The main aim of the research is to develop a novel expert fault diagnosis system framework for the refuse collection vehicle.

  18. Responding to the refusal of care in the emergency department.

    Science.gov (United States)

    Nelson, Jennifer; Venkat, Arvind; Davenport, Moira

    2014-01-01

    The emergency department (ED) serves as the primary gateway for acute care and the source of health care of last resort. Emergency physicians are commonly expected to rapidly assess and treat patients with a variety of life-threatening conditions. However, patients do refuse recommended therapy, even when the consequences are significant morbidity and even mortality. This raises the ethical dilemma of how emergency physicians and ED staff can rapidly determine whether patient refusal of treatment recommendations is based on intact decision-making capacity and how to respond in an appropriate manner when the declining of necessary care by the patient is lacking a basis in informed judgment. This article presents a case that illustrates the ethical tensions raised by the refusal of life-sustaining care in the ED and how such situations can be approached in an ethically appropriate manner.

  19. Sodium bicarbonate effects on the anaerobic digestion of refuse

    Energy Technology Data Exchange (ETDEWEB)

    Kasali, G.B.; Senior, E.; Watson-Craik, I.A. (Strathclyde Univ., Glasgow (UK). Dept. of Applied Physics)

    1989-01-01

    Laboratory column and bottle cultures were used to examine the efficacy of NaHCO{sub 3}additions (1%, 2.5% and 5% w/v) to promote the solid-state refuse fermentation. Buffering capacity increase, by addition of 2.5% NaHCO{sub 3}, equivalent to 84 mg NaHCO{sub 3} g dry weight refuse{sup -1}, promoted both acidogenesis and methanogenesis, with the latter accelerating by a factor of six, compared with glass-distilled water controls. Increased addition, with 5% NaHCO{sub 3}, however, mediated partial suppression of methanogenesis and acidogenesis with cation toxicity the most likely cause. Promotion of the refuse fermentation by NaHCO{sub 3} addition, therefore, necessitates careful control of the concentration applied. (author).

  20. [Maternal refusal to consent to a cesarean delivery, stillbirth].

    Science.gov (United States)

    Defline, A; Obadia, M; El Djerbi, A; Plevy, P; Lepercq, J

    2014-01-01

    The doctor-lawyer perspective that we discuss is a maternal refusal to consent to a cesarean delivery for a fetal indication in June 2011. Despite repeated information of the risks during a three-week hospitalization for pre-eclampsia, after being assured of the proper understanding of the seriousness of the situation by the patient and spouse, and after consideration to transfer to another hospital, the reiterated refusal led to a late fetal extraction resulting in term stillbirth. Copyright © 2013. Published by Elsevier Masson SAS.. All rights reserved.

  1. 7 CFR 319.8-26 - Material refused entry.

    Science.gov (United States)

    2010-01-01

    ... Plant Protection Act (7 U.S.C. 7714 and 7731). Neither the Department of Agriculture nor the inspector... 7 Agriculture 5 2010-01-01 2010-01-01 false Material refused entry. 319.8-26 Section 319.8-26 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION...

  2. 9 CFR 93.806 - Animals refused entry.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Animals refused entry. 93.806 Section 93.806 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE EXPORTATION AND IMPORTATION OF ANIMALS (INCLUDING POULTRY) AND ANIMAL PRODUCTS IMPORTATION OF...

  3. Magnetometric Studies of Catalyst Refuses in Nanocarbon Materials

    Directory of Open Access Journals (Sweden)

    Eklund Peter

    2008-01-01

    Full Text Available AbstractIt is shown that magnetometry can be employed as an effective tool to control the content of a ferromagnetic constituent in nanocarbon materials. We propose a thermochemical treatment protocol to achieve extensive cleaning of the source nanocarbon materials from ferromagnetic refuses.

  4. [Refusal of personal hygiene care and nursing responsibility].

    Science.gov (United States)

    Peyé, Anne

    2013-03-01

    Situations of patients refusing personal hygiene care are frequent. Sources of difficulties and questioning for caregivers, they can lead to maltreatment. In order to avoid this pitfall, it is essential to support the teams in their approach around representations of caregiving and nursing responsibility.

  5. the development of new generation of solid waste refuse incinerators

    African Journals Online (AJOL)

    Apart from town refuse, there are wastes from agriculturally based industries especially ... depends on careful control of the 3T's (time, temperature and turbulence). ... These activities cause serious public health risks ... The modifications to the old bottle incinerators were developed by carefully assessing the failure modes.

  6. Ways to Say No: Refusal Skill Strategies among Urban Adolescents

    Science.gov (United States)

    Nichols, Tracy R.; Graber, Julia A.; Brooks-Gunn, Jeanne; Botvin, Gilbert J.

    2006-01-01

    Objectives: To examine associations among adolescents' generated verbal strategies (ie, Simple No, Declarative Statements, Excuse, Alternatives) and underlying nonverbal assertiveness in 2 refusal situations: smoking and shoplifting. Methods: Sixth-grade urban minority students (N = 454) participated in videotaped role-play assessments of peer…

  7. Autonomy, religious values, and refusal of lifesaving medical treatment.

    Science.gov (United States)

    Wreen, M J

    1991-09-01

    The principal question of this paper is: Why are religious values special in refusal of lifesaving medical treatment? This question is approached through a critical examination of a common kind of refusal of treatment case, one involving a rational adult. The central value cited in defence of honouring such a patient's refusal is autonomy. Once autonomy is isolated from other justificatory factors, however, possible cases can be imagined which cast doubt on the great valuational weight assigned it by strong anti-paternalists. This weight is sufficient, in their estimation, to justify honouring the patient's refusal. There is thus a tension between the strong anti-paternalist's commitment to the sufficiency of autonomy and our intuitions respecting such cases. Attempts can be made to relieve this tension, such as arguing that patients aren't really rational in the circumstances envisaged, or that other values, such as privacy or bodily integrity, if added to autonomy, are sufficient to justify an anti-paternalistic stance. All such attempts fail, however. But what does not fail is the addition of religious freedom, freedom respecting a patient's religious beliefs and values. Why religious freedom reduces the tension is then explained, and the specialness of religious beliefs and values examined.

  8. Problems and prospects of refuse disposal in nigerian urban centres ...

    African Journals Online (AJOL)

    Refuse disposal is one of the major environmental problems that developing ... The problem of waste management has two parts, that of collection and that of disposal. ... Disposal methods such as dumping sites, incineration, recycling, shipping ... citizenry has roles to play in adopting more suitable solutions to this problem.

  9. [Refusal of care in the intensive care: how makes decision?].

    OpenAIRE

    Borel , Marie; Veber , Benoit; Villette-Baron , Karen; Hariri , S.; Dureuil , Bertrand; Hervé , Christian

    2009-01-01

    International audience; It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.

  10. [Refusal of care and respect of the body].

    Science.gov (United States)

    Bernard, Marie-Fleur

    Patients receive numerous care procedures which they may refuse for physical and/or psychological reasons, even if, sometimes, the consequences for them can be dramatic. Faced with this situation, caregivers are helpless. Only ethical reflection centred on their responsibility and their humanity can guide them towards the suitable attitude to adopt. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Invitation Refusals in Cameroon French and Hexagonal French

    Science.gov (United States)

    Farenkia, Bernard Mulo

    2015-01-01

    Descriptions of regional pragmatic variation in French are lacking to date the focus has been on a limited range of speech acts, including apologies, requests, compliments and responses to compliments. The present paper, a systematic analysis of invitation refusals across regional varieties of French, is designed to add to the research on…

  12. Refuse Dumps And The Environment: A Case Study Of Some ...

    African Journals Online (AJOL)

    Refuse Dumps And The Environment: A Case Study Of Some Selected Cities In Nigeria. ... International Journal of Emotional Psychology and Sport Ethics ... This study assessed the level of environmental pollution in the nation by focusing on the degree of accumulation of house – hold wastes, industrial scraps or wastes, ...

  13. Refuse derived fuel incineration: Fuel gas monitoring and analysis

    International Nuclear Information System (INIS)

    Ranaldi, E.; Coronidi, M.; De Stefanis, P.; Di Palo, C.; Zagaroli, M.

    1993-11-01

    Experience and results on refuse derived fuel (selected from municipal solid wastes) incineration are reported. The study involved the investigation of inorganic compounds (heavy metals, acids and toxic gases) emissions, and included feeding materials and incineration residues characterization and mass balance

  14. Bioethics and religious bodies: refusal of blood transfusions in Germany.

    Science.gov (United States)

    Rajtar, Małgorzata

    2013-12-01

    The refusal of medical treatment is a recurrent topic in bioethical debates and Jehovah's Witnesses often constitute an exemplary case in this regard. The refusal of a potentially life-saving blood transfusion is a controversial choice that challenges the basic medical principle of acting in patients' best interests and often leads physicians to adopt paternalistic attitudes toward patients who refuse transfusion. However, neither existing bioethical nor historical and social sciences scholarship sufficiently addresses experiences of rank-and-file Witnesses in their dealings with the health care system. This article draws on results of a nine-month (2010, 2011-2012) ethnographic research on the relationship between religious, legal, ethical, and emotional issues emerging from the refusal of blood transfusions by Jehovah's Witnesses in Germany (mainly in Berlin). It shows how bioethical challenges are solved in practice by some German physicians and what they perceive to be the main goal of biomedicine: promoting the health or broadly understood well-being of patients. I argue that two different understandings of the concept of autonomy are at work here: autonomy based on reason and autonomy based on choice. The first is privileged by German physicians in line with a Kantian philosophical tradition and constitutional law; the second, paradoxically, is utilized by Jehovah's Witnesses in their version of the Anglo-Saxon Millian approach. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Understanding Excessive School Absenteeism as School Refusal Behavior

    Science.gov (United States)

    Dube, Shanta R.; Orpinas, Pamela

    2009-01-01

    Understanding excessive absenteeism is important to ameliorating the negative outcomes associated with the behavior. The present study examined behavioral reinforcement profiles of school refusal behavior: negative reinforcement (avoidance) and positive reinforcement (gaining parental attention or receiving tangible benefits from not attending…

  16. Othermotherwork: "Testimonio" and the Refusal of Historical Trauma

    Science.gov (United States)

    Vega, Christine

    2018-01-01

    This paper is an "ofrenda" (offering), a "testimonio" (testimony) of the healing power of reconstituting severed relationships and reconstructing agentic creation stories in the pathology of soul-wounds where pictures and "cuentos" serve to mend genealogical traumas. This paper is a refusal of neglecting traumas, it…

  17. School Refusal Behavior: Classification, Assessment, and Treatment Issues.

    Science.gov (United States)

    Lee, Marcella I.; Miltenberger, Raymond G.

    1996-01-01

    Discusses diagnostic and functional classification, assessment, and treatment approaches for school refusal behavior. Diagnostic classification focuses on separation anxiety disorder, specific phobia, social phobia, depression, and truancy. Functional classification focuses on the maintaining consequences of the behavior, such as avoidance of…

  18. Impact of interventions for patients refusing emergency medical services transport.

    Science.gov (United States)

    Alicandro, J; Hollander, J E; Henry, M C; Sciammarella, J; Stapleton, E; Gentile, D

    1995-06-01

    To evaluate the effect of a documentation checklist and on-line medical control contact on ambulance transport of out-of-hospital patients refusing medical assistance. Consecutive patients served by four suburban ambulance services who initially refused emergency medical services (EMS) transport to the hospital were prospectively enrolled. In phase 1 (control phase), all patients who initially refused medical attention or transport had an identifying data card completed. In phase 2 (documentation phase), out-of-hospital providers completed a similar data card that contained a checklist of high-risk criteria for a poor outcome if not transported. In phase 3 (intervention phase), a data card similar to that used in phase 2 was completed, and on-line medical control was contacted for all patients with high-risk criteria who refused transport. The primary endpoint was the percentage of patients transported to the hospital. A total of 361 patients were enrolled. Transport rate varied by phase: control, 17 of 144 (12%); documentation, 11 of 150 (7%); and intervention, 12 of 67 (18%) (chi-square, p = 0.023). Transport of high-risk patients improved with each intervention: control, two of 60 (3%); documentation, seven of 70 (10%); and intervention, 12 of 34 (35%) (chi-square, p = 0.00003). Transport of patients without high-risk criteria decreased with each intervention: control, 15 of 84 (18%); documentation, four of 80 (5%); and intervention, 0 of 33 (0%) (p = 0.0025). Of the 28 patients for whom medical control was contacted, 12 (43%) were transported to the hospital, and only three of these 12 patients (25%) were released from the ED. Contact with on-line medical control increased the likelihood of transport of high-risk patients who initially refused medical assistance. The appropriateness of the decreased transport rate of patients not meeting high-risk criteria needs further evaluation.

  19. Refusal of dialysis amongst patients of chronic kidney disease (CKD)

    International Nuclear Information System (INIS)

    Anees, M.; Khan, J.A.

    2014-01-01

    This study was conducted to determine the refusal of dialysis amongst patients of chronic kidney disease presenting for the first time for dialysis in uremic condition. Study Design: Cross sectional Study. Place and Duration of the Study: Outpatient department of Nephrology, Mayo Hospital, Lahore from 1 st Jan 2012 to 31 st December 2012. Patients and Methods: Patients of CKD due to any cause presenting with uremia for the first time for dialysis were included in the study. History and physical examination was done and demographic data was collected in pre designed form. Patients were offered for dialysis while explaining to them the advantages of getting and disadvantages of not getting dialysis. Patient's response on the offer was recorded and the reason for the refusal were noted. Results: According to the criteria 150 patients were included in the study. Most of the patients were male 92 (61.3%) and illiterate 78 (52.0%). Major cause of CKD was diabetes mellitus 58 (38.7%) followed by hypertension 38 (25.3%). Mean age of the patients was 42.59 ± 13.72 year and income of themost of the patients 126 (84%) was less than US$100/-month. Most of the patients 126 (77.0%) were asked about the need of dialysis in less than three months, 61 (41.3%) offered for the first time and amongst them 85 (54.0%) were offered dialysis already. Majority of the patients 101 (67.3%) refused dialysis when it was offered to them for the first time. Major reason of the refusal was fear of dialysis procedure in 76 (76%) patients followed by treatment by spiritual 14 (14%) and alternative ways and others 11 (11 %). Middle age persons refused dialysis significantly. (author)

  20. 76 FR 29796 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Refuse...

    Science.gov (United States)

    2011-05-23

    ... for OMB Review; Comment Request; Refuse Piles and Impounding Structures, Recordkeeping and Reporting... Administration (MSHA) sponsored information collection request (ICR) titled, ``Refuse Piles and Impounding... to submit annual reports and certification on refuse piles and impoundments to the agency and to keep...

  1. Social Skills, Competence, and Drug Refusal Efficacy as Predictors of Adolescent Alcohol Use.

    Science.gov (United States)

    Scheier, Lawrence M.; Botvin, Gilbert J.; Diaz, Tracy; Griffin, Kenneth W.

    1999-01-01

    Examines the extent to which assertiveness and related social skills, personal competence, and refusal efficacy predict alcohol involvement in adolescents. Males were at higher risk for poor refusal skills and reported higher alcohol involvement. Youth characterized by poor social skill development reported lower refusal efficacy, lower grades,…

  2. A plea for uniform European definitions for organ donor potential and family refusal rates.

    NARCIS (Netherlands)

    Jansen, N.E.; Haase-Kromwijk, B.J.; Leiden, H.A. van; Weimar, W.; Hoitsma, A.J.

    2009-01-01

    Conversion of potential organ donors to actual donors is negatively influenced by family refusals. Refusal rates differ strongly among countries. Is it possible to compare refusal rates in order to be able to learn from countries with the best practices? We searched in the literature for reviews of

  3. Alternative Fuels Data Center: Virginia Cleans up With Natural Gas Refuse

    Science.gov (United States)

    Trucks Virginia Cleans up With Natural Gas Refuse Trucks to someone by E-mail Share Alternative Fuels Data Center: Virginia Cleans up With Natural Gas Refuse Trucks on Facebook Tweet about Alternative Fuels Data Center: Virginia Cleans up With Natural Gas Refuse Trucks on Twitter Bookmark Alternative

  4. 37 CFR 1.295 - Review of decision finally refusing to publish a statutory invention registration.

    Science.gov (United States)

    2010-07-01

    ... dissatisfied with the final refusal to publish a statutory invention registration for reasons other than... refunded if the final refusal to publish a statutory invention registration for reasons other than... refusing to publish a statutory invention registration. 1.295 Section 1.295 Patents, Trademarks, and...

  5. Academic Self-Attributions for Success and Failure in Mathematics and School Refusal

    Science.gov (United States)

    Gonzálvez, Carolina; Sanmartín, Ricardo; Vicent, María; Inglés, Cándido J.; Aparicio-Flores, M. Pilar; García-Fernández, José M.

    2018-01-01

    The aim of this research is twofold: to analyze the mean differences scores in mathematic self-attributions based on school refusal and to verify its predictive capability on high scores in school refusal. The Sydney Attribution Scale and the School Refusal Assessment Scale-Revised were administered to 1078 Spanish students (50.8% boys) aged…

  6. Emissions from co-combustion of wood and household refuse

    International Nuclear Information System (INIS)

    Zhang, X.J.; Peterson, F.

    1996-01-01

    An investigation was carried out on the emissions produced in a 20 kW experimental boiler burning a combination of wood and household refuse. The wood content ranged form 10 to 50%. Direct sampling with Tenax adsorbent was used to cover a range of volatile organic compounds (VOCs). The measurements also included unburned hydrocarbons, carbon monoxide, carbon dioxide, oxygen and flue gas temperature. Combustion and emission parameters were recorded continuously with a multi-point data logger. VOCs were analyzed by gas chromatography and mass spectrometer (GC/MS). The main emphasis was placed on the effect of wood on VOC emissions. The results showed that as the wood content increased from 10 to 50%, there was a roughly linear increase in emissions of total VOCs. Carbon monoxide and unburned hydrocarbon emissions also increased. These results suggest that household refuse is a good substitute for wood as a boiler fuel, as it has a similar calorific value but fewer emissions. (Author)

  7. Project Startup: Evaluating the Performance of Hydraulic Hybrid Refuse Vehicles

    Energy Technology Data Exchange (ETDEWEB)

    2015-09-01

    The Fleet Test and Evaluation Team at the National Renewable Energy Laboratory (NREL) is evaluating the in-service performance of 10 next-generation hydraulic hybrid refuse vehicles (HHVs), 8 previous-generation HHVs, and 8 comparable conventional diesel vehicles operated by Miami-Dade County's Public Works and Waste Management Department in southern Florida. The HHVs under study - Autocar E3 refuse trucks equipped with Parker Hannifin's RunWise Advanced Series Hybrid Drive systems - can recover as much as 70 percent of the energy typically lost during braking and reuse it to power the vehicle. NREL's evaluation will assess the performance of this technology in commercial operation and help Miami-Dade County determine the ideal routes for maximizing the fuel-saving potential of its HHVs.

  8. [Anorexia and refusal to eat in the elderly].

    Science.gov (United States)

    Hazif-Thomas, Cyril; Thomas, Philippe

    2016-01-01

    The question of the links between anorexia and the refusal to eat in the elderly is often the cause of major difficulties with regard to therapeutic strategies within caregiving teams. Likewise, few studies have been carried out into the diachronic links between teenage anorexia and that of the elderly. The role of the multi-disciplinary team is essential. Copyright © 2015. Published by Elsevier Masson SAS.

  9. Lime helps establish crownvetch on coal-breaker refuse

    Science.gov (United States)

    Miroslaw M. Czapowskyj; Edward A. Sowa

    1976-01-01

    A study was begun in 1965 to determine the effect of lime fertilizer, and mulch on the establishment and growth of crownvetch crowns planted on anthracite coal-breaker refuse. After 7 years the lime application had by far the strongest effect. Both 2.5 and 5.0 tons per acre increased survival and ground cover manyfold, and both treatments were equally beneficial from...

  10. [Refusal of care in the intensive care: how makes decision?].

    Science.gov (United States)

    Borel, M; Veber, B; Villette-Baron, K; Hariri, S; Dureuil, B; Hervé, C

    2009-11-01

    Decision-making bringing to an admission or not in intensive care is complex. The aim of this study is to analyze with an ethical point of view the making decision process leading to the refusal and its consequences. It is proposed a setting in prospect through the principles of beneficence, non-maleficience, respect for autonomy, justice, and the Leonetti law. Prospective study in surgical reanimation at the University Hospital of Rouen over 9 months (November 2007-September 2008). Systematic collection for each non-admitted patient of the general characters, the methods of decision making, immediate becoming and within 48 h Constitution of two groups: patients for whom an admission in intensive care could be an unreasonable situation of obstinacy, and patients for whom an admission in reanimation would not be about unreasonable if it occurred. One hundred and fifty situations were analyzed. The potentially unreasonable character of an admission does not involve necessarily a refusal of care in intensive care. The question of the lack of place and equity in the access to the care is real but relative according to the typology of the patients. The research of the respect of the autonomy of the patient is difficult but could be facilitated. The Leonetti law does not appear to be able to be a framework with the situation of refusal of care in intensive care. It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.

  11. A narrative review of studies of refusal of psychotropic medication in acute inpatient psychiatric care.

    Science.gov (United States)

    Owiti, J A; Bowers, L

    2011-09-01

    This paper offers a narrative review of the 22 studies of medication refusal in acute psychiatry. Because of varied definitions of medication refusal, diverse methodologies and few rigorous studies, it has not been possible to draw firm conclusions on the average rate of refusal of psychotropic medications in acute psychiatry. However, it is clear that medication refusal is common and leads to poor outcomes characterized by higher rates of seclusion, restraint, threats of, and actual, assaults and longer hospitalizations. There are no statistically significant differences between refusers and acceptors in gender, marital status and preadmission living arrangements. Although no firm conclusions on the influence of ethnicity, status at admission and diagnosis on refusal, the refusers are more likely to have higher number of previous hospitalizations and history of prior refusal. The review indicates that staff factors such as the use of temporary staff, lack of confidence in ward staff and ineffective ward structure are associated with higher rates of medication refusal. Comprehensive knowledge of why, and how, patients refuse medication is lacking. Research on medication refusal is still fragmented, of variable methodological quality and lacks an integrating model. © 2011 Blackwell Publishing.

  12. Mental health consequences of abortion and refused abortion.

    Science.gov (United States)

    Watter, W W

    1980-02-01

    There is no scientific evidence to support the hypothesis put forth by Dr. Philip Ney in a recent article published in the Canadian Journal of Psychiatry that induced abortion is associated with an increase in child abuse. There are, however, numerous studies which support the contention that mandatory motherhood adversely affects the mental health of both the mother and the offspring. Studies conducted in Sweden, Scotland, and Czechoslovakia revealed that women who were refused abortions frequently experienced serious psychosocial difficulties for long periods of time following abortion refusal. Case controlled follow-up studies, conducted in Sweden and Czechoslovakia, of offspring born to women who were refused abortions demonstrated that a higher proportion of the unwanted children required psychiatric services, engaged in criminal behavior, and did less well in school than the controlled children. These studies have implications for the current Canadian law which permits a woman to obtain an abortion if pregnancy continuation will endanger her health. In view of the above statistical evidence, and the fact that mortality and morbidity are known to be lower for abortion than for childbirth, any person who denies a woman the right to have an abortion is increasing the risk that the health of the woman will be endangered. By law, therefore, all abortion requests should be honored.

  13. Consent and assessment of capacity to decide or refuse treatment.

    Science.gov (United States)

    Simpson, Owena

    Consent protects the right of patients to decide what happens to them. Before any medical intervention, adults must give valid consent, which must be voluntary, informed and given free of undue influence. When consent is being obtained, patients must be informed about the intervention, why it is being done and its risks; information they are given must be recorded. Every effort should be made to explain the issues in terms that the patient can understand and by providing support and aids to communicate. Consent can be expressed, where patients say they consent or put it in writing, or implied, where a healthcare professional infers from their behaviour that they consent. While different types of consent are valid, some are evidence of stronger proof in court that valid consent has been given. Competent adults have the right to refuse treatment, regardless of the reasons they give for refusal and even if the refusal will result in death; clinicians must respect their decision. In some circumstances-such as when an unconscious person is admitted as an emergency-healthcare professionals can make decisions on behalf of patients, and must do so in patients' best interests.

  14. Delay and refusal of human papillomavirus vaccine for girls, national immunization survey-teen, 2010.

    Science.gov (United States)

    Dorell, Christina; Yankey, David; Jeyarajah, Jenny; Stokley, Shannon; Fisher, Allison; Markowitz, Lauri; Smith, Philip J

    2014-03-01

    Human papillomavirus (HPV) vaccine coverage among girls is low. We used data reported by parents of 4103 girls, 13 to 17 years old, to assess associations with, and reasons for, delaying or refusing HPV vaccination. Sixty-nine percent of parents neither delayed nor refused vaccination, 11% delayed only, 17% refused only, and 3% both delayed and refused. Eighty-three percent of girls who delayed only, 19% who refused only, and 46% who both delayed and refused went on to initiate the vaccine series or intended to initiate it within the next 12 months. A significantly higher proportion of parents of girls who were non-Hispanic white, lived in households with higher incomes, and had mothers with higher education levels, delayed and/or refused vaccination. The most common reasons for nonvaccination were concerns about lasting health problems from the vaccine, wondering about the vaccine's effectiveness, and believing the vaccine is not needed.

  15. Refusal of medical treatment in the pediatric emergency service: analysis of reasons and aspects.

    Science.gov (United States)

    Gündüz, Ramiz Coşkun; Halil, Halit; Gürsoy, Cüneyt; Çifci, Atilla; Özgün, Seher; Kodaman, Tuğba; Sönmez, Mehtap

    2014-01-01

    Refusal of treatment for acutely ill children is still an important problem in the emergency service. When families refuse medical treatment for their acutely ill children, healthcare professionals may attempt to provide information and negotiate with the family concerning treatment refusal and its possible adverse outcomes, and request consent for refusal of medical treatment. There is insufficient data about refusal of treatment in our country. The purpose of this study was to analyze the causes of treatment refusal in the pediatric emergency service. We collected data recorded on informed consent forms. During a 2-year-study period, 215 patients refused treatment recommended by acute health care professionals. The majorty of patients were in the 0-2 year age group. Hospitalization was the type of treatment most commonly refused; restrictions regarding family members staying with their children during hospitalization and admission to another hospital were the major reasons for refusal of treatment. Clarifying the reasons for treatment refusal may help us to overcome deficiencies, improve conditions, resolve problems and build confidence between healthcare providers and service users, increasing users' satisfaction in the future.

  16. NREL Evaluates Performance of Hydraulic Hybrid Refuse Vehicles

    Energy Technology Data Exchange (ETDEWEB)

    2015-09-01

    This highlight describes NREL's evaluation of the in-service performance of 10 next-generation hydraulic hybrid refuse vehicles (HHVs), 8 previous-generation (model year 2013) HHVs, and 8 comparable conventional diesel vehicles operated by Miami-Dade County's Public Works and Waste Management Department in southern Florida. Launched in March 2015, the on-road portion of this 12-month evaluation focuses on collecting and analyzing vehicle performance data - fuel economy, maintenance costs, and drive cycles - from the HHVs and the conventional diesel vehicles. The fuel economy of heavy-duty vehicles, such as refuse trucks, is largely dependent on the load carried and the drive cycles on which they operate. In the right applications, HHVs offer a potential fuel-cost advantage over their conventional counterparts. This advantage is contingent, however, on driving behavior and drive cycles with high kinetic intensity that take advantage of regenerative braking. NREL's evaluation will assess the performance of this technology in commercial operation and help Miami-Dade County determine the ideal routes for maximizing the fuel-saving potential of its HHVs. Based on the field data, NREL will develop a validated vehicle model using the Future Automotive Systems Technology Simulator, also known as FASTSim, to study the impacts of route selection and other vehicle parameters. NREL is also analyzing fueling and maintenance data to support total-cost-of-ownership estimations and forecasts. The study aims to improve understanding of the overall usage and effectiveness of HHVs in refuse operation compared to similar conventional vehicles and to provide unbiased technical information to interested stakeholders.

  17. Stop on construction of fast breeder at Kalkar refused

    International Nuclear Information System (INIS)

    Anon.

    1978-01-01

    The application of a plaintiff was refused by the verdict of the High Court for North Rhine-Westphalia of 16.6.1978, which would have restored the delaying effect of his application against the defendant Minister of the Land (his opponent) on the first part licence of the Kalkar nuclear power station. The plaintiff had to bear the costs of the proceedings, including extra legal costs of the co-defendant nuclear power company. The value of the object of the case was set at DM 10,000. This means that construction can continue. The most important reasons for turning down the application are given. (orig./HP) [de

  18. Vaccination refusal: ethics, individual rights, and the common good.

    Science.gov (United States)

    Schwartz, Jason L; Caplan, Arthur L

    2011-12-01

    Among the obstacles to the success of vaccination programs is the apparent recent increase in hesitancy and outright resistance to the recommended vaccination schedule by some parents and patients. This article reviews the spectrum of patient or parental attitudes that may be described as vaccine refusal, explores related ethical considerations in the context of the doctor-patient relationship and public health, and evaluates the possible responses of physicians when encountering resistance to vaccination recommendations. Health care providers should view individuals hesitant about or opposed to vaccines not as frustrations or threats to public health, but as opportunities to educate and inform. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Psychotropic Medication Refusal: Reasons and Patients′ Perception at a Secure Forensic Psychiatric Treatment Centre

    Directory of Open Access Journals (Sweden)

    Olajide O Adelugba

    2016-01-01

    Full Text Available Poor adherence to prescribed medication regimens can undermine the effectiveness of medications. This study was conducted to determine the demographic profile of forensic psychiatric inpatients refusing medications and to identify the reasons for refusal. Data were collected through interviews using a questionnaire including Drug Attitude Inventory-10. Medication refusal was more common among Aboriginals (68%, n = 34 than Caucasians (32%, n = 16 and was highest among the patients 21-30 years of age (44%, n = 22. Antisocial personality disorder and substance use disorder featured prominently among patients refusing medications. The main reasons for medication refusal were inconvenience (34%, n = 17 followed by side effects (22%, n = 11, ineffective medication (20%, n = 10, illness-related (16%, n = 8, and no reasons (8%, n = 6. Antipsychotic medications topped the list of the major classes of medications refused followed by Antidepressants and Mood Stabilizers.

  20. Refusal of Curative Radiation Therapy and Surgery Among Patients With Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Aizer, Ayal A., E-mail: aaaizer@partners.org [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Chen, Ming-Hui [Department of Statistics, University of Connecticut, Storrs, Connecticut (United States); Parekh, Arti [Boston University School of Medicine, Boston, Massachusetts (United States); Choueiri, Toni K. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Hoffman, Karen E. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kim, Simon P. [Department of Urology, Mayo Clinic, Rochester, Minnesota (United States); Martin, Neil E. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Hu, Jim C. [Department of Urology, University of California, Los Angeles, California (United States); Trinh, Quoc-Dien [Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec (Canada); Nguyen, Paul L. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute/Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States)

    2014-07-15

    Purpose: Surgery and radiation therapy represent the only curative options for many patients with solid malignancies. However, despite the recommendations of their physicians, some patients refuse these therapies. This study characterized factors associated with refusal of surgical or radiation therapy as well as the impact of refusal of recommended therapy on patients with localized malignancies. Methods and Materials: We used the Surveillance, Epidemiology, and End Results program to identify a population-based sample of 925,127 patients who had diagnoses of 1 of 8 common malignancies for which surgery and/or radiation are believed to confer a survival benefit between 1995 and 2008. Refusal of oncologic therapy, as documented in the SEER database, was the primary outcome measure. Multivariable logistic regression was used to investigate factors associated with refusal. The impact of refusal of therapy on cancer-specific mortality was assessed with Fine and Gray's competing risks regression. Results: In total, 2441 of 692,938 patients (0.4%) refused surgery, and 2113 of 232,189 patients (0.9%) refused radiation, despite the recommendations of their physicians. On multivariable analysis, advancing age, decreasing annual income, nonwhite race, and unmarried status were associated with refusal of surgery, whereas advancing age, decreasing annual income, Asian American race, and unmarried status were associated with refusal of radiation (P<.001 in all cases). Refusal of surgery and radiation were associated with increased estimates of cancer-specific mortality for all malignancies evaluated (hazard ratio [HR], 2.80, 95% confidence interval [CI], 2.59-3.03; P<.001 and HR 1.97 [95% CI, 1.78-2.18]; P<.001, respectively). Conclusions: Nonwhite, less affluent, and unmarried patients are more likely to refuse curative surgical and/or radiation-based oncologic therapy, raising concern that socioeconomic factors may drive some patients to forego potentially life

  1. Refusal of Curative Radiation Therapy and Surgery Among Patients With Cancer

    International Nuclear Information System (INIS)

    Aizer, Ayal A.; Chen, Ming-Hui; Parekh, Arti; Choueiri, Toni K.; Hoffman, Karen E.; Kim, Simon P.; Martin, Neil E.; Hu, Jim C.; Trinh, Quoc-Dien; Nguyen, Paul L.

    2014-01-01

    Purpose: Surgery and radiation therapy represent the only curative options for many patients with solid malignancies. However, despite the recommendations of their physicians, some patients refuse these therapies. This study characterized factors associated with refusal of surgical or radiation therapy as well as the impact of refusal of recommended therapy on patients with localized malignancies. Methods and Materials: We used the Surveillance, Epidemiology, and End Results program to identify a population-based sample of 925,127 patients who had diagnoses of 1 of 8 common malignancies for which surgery and/or radiation are believed to confer a survival benefit between 1995 and 2008. Refusal of oncologic therapy, as documented in the SEER database, was the primary outcome measure. Multivariable logistic regression was used to investigate factors associated with refusal. The impact of refusal of therapy on cancer-specific mortality was assessed with Fine and Gray's competing risks regression. Results: In total, 2441 of 692,938 patients (0.4%) refused surgery, and 2113 of 232,189 patients (0.9%) refused radiation, despite the recommendations of their physicians. On multivariable analysis, advancing age, decreasing annual income, nonwhite race, and unmarried status were associated with refusal of surgery, whereas advancing age, decreasing annual income, Asian American race, and unmarried status were associated with refusal of radiation (P<.001 in all cases). Refusal of surgery and radiation were associated with increased estimates of cancer-specific mortality for all malignancies evaluated (hazard ratio [HR], 2.80, 95% confidence interval [CI], 2.59-3.03; P<.001 and HR 1.97 [95% CI, 1.78-2.18]; P<.001, respectively). Conclusions: Nonwhite, less affluent, and unmarried patients are more likely to refuse curative surgical and/or radiation-based oncologic therapy, raising concern that socioeconomic factors may drive some patients to forego potentially life

  2. Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.

    Science.gov (United States)

    Garrouste-Orgeas, Maité; Montuclard, Luc; Timsit, Jean-François; Reignier, Jean; Desmettre, Thibault; Karoubi, Philippe; Moreau, Delphine; Montesino, Laurent; Duguet, Alexandre; Boussat, Sandrine; Ede, Christophe; Monseau, Yannick; Paule, Thierry; Misset, Benoit; Carlet, Jean

    2005-04-01

    To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. Observational, prospective, multiple-center study. Four university hospitals and seven primary-care hospitals in France. None. Age, underlying diseases (McCabe score and Knaus class), dependency, hospital mortality, and ICU characteristics were recorded. The crude ICU refusal rate was 23.8% (137/574), with variations from 7.1% to 63.1%. The reasons for refusal were too well to benefit (76/137, 55.4%), too sick to benefit (51/137, 37.2%), unit too busy (9/137, 6.5%), and refusal by the family (1/137). In logistic regression analyses, two patient-related factors were associated with ICU refusal: dependency (odds ratio [OR], 14.20; 95% confidence interval [CI], 5.27-38.25; p refused patients, and 1.03 (95% CI, 0.28-1.75) for later-admitted patients. ICU refusal rates varied greatly across ICUs and were dependent on both patient and organizational factors. Efforts to define ethically optimal ICU admission policies might lead to greater homogeneity in refusal rates, although case-mix variations would be expected to leave an irreducible amount of variation across ICUs.

  3. Toilet refusal syndrome in preschool children: do different subtypes exist?

    Science.gov (United States)

    Niemczyk, Justine; Equit, Monika; El Khatib, Diana; von Gontard, Alexander

    2014-03-01

    Toilet refusal syndrome (TRS) is a common, benign disorder in toddlers defined by the use of diapers and refusal of toilet for defaecation, but has not been described systematically in preschool children yet. The aim of the study was to analyse and identify possible subgroups of TRS. Retrospective analysis of all of the consecutive children with TRS presented as outpatients in a clinic for elimination disorders. Patients had received a detailed paediatric and child psychiatric assessment, including the Child Behavior Checklist questionnaire. Three typical case vignettes are presented of TRS with constipation, oppositional defiant disorder, and sibling rivalry. Twenty-five children (10 boys) with a mean age of 5.2 (3.4-7.3) years were included-representing 2.5% of all of the children (n = 1001) presented. They had high rates of constipation (60%) and elimination disorders (24%-44%). Child psychiatric International Classification of Diseases-10th Edition disorders were common (40%) and heterogeneous, with significantly more boys affected, but no differences between children with and without constipation. This study shows that TRS occurs also in older preschool (and even school) children. At this later age, it is associated with constipation and behavioural disorders. The case vignettes show differences in therapy and may represent different subgroups of TRS. TRS is associated with constipation, elimination disorders, and psychiatric disorders. Owing to this variety of comorbid disorders, different therapeutic approaches are needed. A general screening for behavioural symptoms is recommended.

  4. Energy from refuse by bioconversion, fermentation and residue disposal processes

    Energy Technology Data Exchange (ETDEWEB)

    Pfeffer, J T; Liebman, J C

    1976-01-01

    Bioconversion of organic refuse to CH/sub 4/ by anaerobic fermentation is 1 mechanism by which the energy in urban waste can be reclaimed. Laboratory studies were made to determine the rate and amount of gas production at various operating temperatures. The dewatering characteristics of the spent fermentation slurry were evaluated. The spent solids can be dewatered to a sufficiently low moisture content such that incineration is self-sustaining. The incineration system was evaluated to determine the possible energy recovery from the spent cake. A process for treating the liquid blowdown from the system was developed. A mathematical simulation of the total system was constructed to evaluate performance under various operating conditions. A plant processing 908 tons of refuse/day will produce 3905 m/sup 3/ CH/sub 4//hr. Recovery of just CH/sub 4/ provides a 32.6% efficiency of energy recovery. This efficiency can be increased to 63.4% if steam from the incinerator can be sold.

  5. Constructive and Destructive Aspects of Refusal from Communication

    Directory of Open Access Journals (Sweden)

    Marianna A. Gulyaeva

    2016-12-01

    Full Text Available The article investigates the phenomenon of refusal from communication in terms of its positive and negative impact, both on the communicative process, and interpersonal relationships in general. It has been analyzed several aspects of the failure to communicate with positive communication position. The identification of constructive or destructive potential was carried out on the basis of three parameters such as productivity/ unproductive conflict resolution with the help of avoiding communication, the choice of an optimum way of non-communication and its role in the communication process on the basis of the functions performed by them. Failure to communicate is often perceived negatively and is considered an inefficient form of communication, so it does not allow to solve interpersonal conflicts. This article discusses the circumstances where refusal from communication advocates an effective way to avoid conflict. In situations where the termination of communication is inevitable, a fundamental factor for the positive, harmonious form of communication acts interrupting the communication process. Functioning in the communicative space, failure to communicate can either destroy an interaction and relationship between the partners, and regulate the communication process by guiding in the right direction, coordinating the behavior of communication.

  6. Abandoned coal mine refuse areas: their reclamation and use

    Energy Technology Data Exchange (ETDEWEB)

    Zellmer, S. D.; Carter, R. P.

    1977-01-01

    There are over 4,000 abandoned deep coal mine refuse areas in Illinois ranging in size from a few acres to as large as 160 acres. These sites produce quantities of pollutants which affect the environment, have no real land value, and are a scar on the landscape. The Staunton 1 Site Reclamation Demonstration Project addressess these problems. It also is developing and evaluating new cost-effective methods for reclaiming refuse areas of this type. The program involved determining the final land use for the site, development of detailed engineering plans and specifications for the reclamation effort, a prereclamation environmental inventory, and implementation. Post-construction evaluation is now in process to determine the effectiveness of the reclamation effort. Detailed investigations are being conducted to determine surface water quality improvement, the amount of suitable surface cover and amendments required for revegetation, and field evaluation of candidate vegetation species for revegetation. Other research is examining soil microbial populations, soil fauna reactions, and changes in surface material characteristics at the reclamation site. Surveys are being conducted on groundwater quality, effects on the aquatic ecosystem, and wildlife use of the area. An economic evaluation is underway to determine the cost effectiveness of the total effort and of individual reclamation procedures. Preliminary results from the first year's environmental evaluation of various method tested will be described in detail. An economic assessment, including cost effectiveness, of the first year's work is given.

  7. Refusal of implant supported mandibular overdentures by elderly patients.

    Science.gov (United States)

    Ellis, Janice S; Levine, Alissa; Bedos, Christophe; Mojon, Phillippe; Rosberger, Zeer; Feine, Jocelyne; Thomason, J Mark

    2011-03-01

      The aim of this study was to gain greater in-depth understanding of why elderly patients who are currently dissatisfied with conventional dentures decline implant treatment.   There is strong evidence from high-quality randomised controlled trials to support the use of implant-supported overdentures for the restoration of the edentulous mandible. However, whilst recruiting for randomised clinical trials, researchers have found that a high proportion of potential subjects decline participation, despite the removal of financial constraints.   The study adopted a qualitative approach to provide a rich and deep understanding of people's reasons for refusal. Data were collected through focus group interviews in a two-centre study based in Montreal, Canada and Newcastle, UK. A semi-structured interview schedule was used and iteratively developed as analysis identified themes from previous focus groups. Transcripts of focus groups were coded and emergent themes determined.   Two main themes emerged; patients' fear and anxiety (relating to the pain of surgery, complications of the procedure and immediate post-surgical denture use), and the appropriateness of the procedure in an elderly person.   Fears of pain, complications and social embarrassment, exacerbated by age, are important factors that help explain refusal of implants by elderly patients. © 2010 The Gerodontology Society and John Wiley & Sons A/S.

  8. Rationality, religion and refusal of treatment in an ambulance revisited.

    Science.gov (United States)

    McMahon-Parkes, Kate

    2013-09-01

    In their recent article, Erbay et al considered whether a seriously injured patient should be able to refuse treatment if the refusal was based on a (mis)interpretation of religious doctrine. They argued that in such a case 'what is important…is whether the teaching or philosophy used as a reference point has been in fact correctly perceived' (p 653). If it has not been, they asserted that this eroded the patient's capacity to make an autonomous decision and that therefore, in such cases, it is the role of the healthcare professional (HCP) to 'assist patients to think more clearly and rationally' (p 653). There are, however, a number of problems with the reasons why Erbay et al suggest we should help patients to rationalise their decisions and how HCPs should go about this. In this article, the author explores some of their main arguments regarding consent and rationality (particularly in relation to religious beliefs), as well as Erbay et al's normative claim that HCPs have an obligation to promote autonomy by helping patients to come to a 'rational' decision. Ultimately, the author agrees that the (temporary) solution to the dilemma presented in this scenario (which was to insert an intravenous cannula into the patient in order to allow an infusion of fluids in the event that he changed his mind) seemed both pragmatic and ethically permissible. However, it is suggested that the arguments which underpin this conclusion in Erbay et al's article are largely unsound.

  9. Central Nervous System Disease, Education, and Race Impact Radiation Refusal in Pediatric Cancer Patients.

    Science.gov (United States)

    Patel, Chirayu G; Stavas, Mark; Perkins, Stephanie; Shinohara, Eric T

    2017-07-01

    To investigate the determinants of radiation therapy refusal in pediatric cancer, we used the Surveillance, Epidemiology, and End Results registry to identify 24,421 patients who met the eligibility criteria, diagnosed between 1974 and 2012. Patients had any stage of cancer, were aged 0 to 19, and received radiation therapy or refused radiation therapy when it was recommended. One hundred twenty-eight patients (0.52%) refused radiation therapy when it was recommended. Thirty-two percent of patients who refused radiation therapy ultimately died from their cancer, at a median of 7 months after diagnosis (95% confidence interval, 3-11 mo), as compared with 29.0% of patients who did not refuse radiation therapy died from their cancer, at a median of 17 months after diagnosis (95% confidence interval, 17-18 mo). On multivariable analysis, central nervous system (CNS) site, education, and race were associated with radiation refusal. The odds ratio for radiation refusal for patients with CNS disease was 1.62 (P=0.009) as compared with patients without CNS disease. For patients living in a county with ≥10% residents having less than ninth grade education, the odds ratio for radiation refusal was 1.71 (P=0.008) as compared with patients living in a county with education. Asian, Pacific Islander, Alaska Native, and American Indian races had an odds ratio of 2.12 (P=0.002) for radiation refusal as compared with black or white race. Although the radiation refusal rate in the pediatric cancer population is low, we show that CNS site, education level, and race are associated with a significant difference in radiation refusal.

  10. Perceived Quality of Informed Refusal Process: A Cross-Sectional Study from Iranian Patients' Perspectives.

    Science.gov (United States)

    Farzandipour, Mehrdad; Sheikhtaheri, Abbas; Sadeqi Jabali, Monireh

    2015-12-01

    Patients have the right to refuse their treatment; however, this refusal should be informed. We evaluated the quality of the informed refusal process in Iranian hospitals from patients' viewpoints. To this end, we developed a questionnaire that covered four key aspects of the informed refusal process including; information disclosure, voluntariness, comprehension, and provider-patient relationship. A total of 284 patients who refused their treatment from 12 teaching hospitals in the Isfahan Province, Iran, were recruited and surveyed to produce a convenience sample. Patients' perceptions about the informed refusal process were scored and the mean scores of the four components were calculated. The findings showed that the practice of information disclosure (9.6 ± 6.4 out of 22 points) was perceived to be moderate, however, comprehension (2.3 ± 1.4 out of 4 points), voluntariness (8.7 ± 1.5 out of 12 points) and provider-patient relationship (10.2 ± 5.2 out of 16 points) were perceived to be relatively good. We found that patients, who refused their care before any treatment had commenced, reported a lower quality of information disclosure and voluntariness. Patients informed by nurses and those who had not had a previous related admission, reported lower scores for comprehension and relationship. In conclusion, the process of obtaining informed refusal was relatively satisfactory except for levels of information disclosure. To improve current practices, Iranian patients need to be better informed about; different treatment options, consequences of treatment refusal, costs of not continuing treatment and follow-ups after refusal. Developing more informative refusal forms is needed. © 2014 John Wiley & Sons Ltd.

  11. Adsorption of phenolic compound by aged-refuse

    Energy Technology Data Exchange (ETDEWEB)

    Chai Xiaoli [State Key Laboratory of Pollution Control and Resource Reuse, School of Enviromental Science and Engineering, Tongji University, Siping Road 1239, Shanghai 200092 (China)]. E-mail: xlchai@mail.tongji.edu.cn; Zhao Youcai [State Key Laboratory of Pollution Control and Resource Reuse, School of Enviromental Science and Engineering, Tongji University, Siping Road 1239, Shanghai 200092 (China)

    2006-09-01

    The adsorption of phenol, 2-chlorophenol, 4-chlorophenol and 2,4-dichlorophenol by aged-refuse has been studied. Adsorption isotherms have been determined for phenol, 2-chlorophenol, 4-chlorophenol and 2,4-dichlorophenol and the data fits well to the Freundlich equation. The chlorinated phenols are absorbed more strongly than the phenol and the adsorption capacity has an oblivious relationship with the numbers and the position of chlorine subsistent. The experiment data suggests that both the partition function and the chemical adsorption involve in the adsorption process. Pseudo-first-order and pseudo-second-order model were applied to investigate the kinetics of the adsorption and the results show that it fit the pseudo-second-order model. More than one step involves in the adsorption process and the overall rate of the adsorption process appears to be controlled by the chemical reaction. The thermodynamic analysis indicates that the adsorption is spontaneous and endothermic.

  12. Transfusion Refusal and the Shifting Limits of Multicultural Accommodation.

    Science.gov (United States)

    DeMichelis, Carey

    2017-12-01

    The refusal of blood products by Jehovah's Witness patients has provoked court proceedings, social science research, and contemporary fiction, all of which emphasize a seemingly intractable conflict between religious and secular ways of being. This article takes a different approach, focusing instead on the space that Witness patients have carved out for their accommodation in a major pediatric research hospital. Using discourse analysis and interview data, I map the way moralizing discourses surrounding Witness families have shifted over the past 70 years alongside advancements in bloodless medicine. I argue that Witnesses have helped to enable their present accommodation and recognition by marshaling particular forms of economic, human, and social capital, and consider whether their success might be attainable by other treatment-resisting patient groups. Thus, this article explores the shifting limits of multicultural accommodation and the conditions that make understanding, collaboration, and compromise possible.

  13. A case of pervasive refusal syndrome: a diagnostic conundrum.

    LENUS (Irish Health Repository)

    McNicholas, Fiona

    2013-01-01

    A case is presented of an 11-year-old girl with pervasive refusal syndrome (PRS) who ultimately recovered acutely and completely after an 18-month paediatric hospitalisation. There was an apparent absence of previously proposed important aetiological factors in PRS, such as family pathology and markedly traumatic or abusive experiences, and her recovery was sudden and complete. The authors consider the differential diagnoses of PRS paying particular attention to the possibility of a conversion disorder or catatonia, given the absence of PRS in the North American literature. Consideration of catatonia is important as it has a diagnostic test and responds rapidly to appropriate treatment, in contrast to conventional treatment for PRS and conversion disorder.

  14. Renouncement of renal replacement therapy: withdrawal and refusal

    Directory of Open Access Journals (Sweden)

    José Andrade Moura Neto

    Full Text Available Abstract Renouncement of renal replacement therapy (RRT is a medical dilemma. This review covers the concept, the magnitude, the prognosis, and discusses strategies and management approaches about this subject in patients with CKD and AKI. Evidence suggests that refusal is more frequent and carries a more guarded prognosis than withdrawal of RRT. When RRT is not expected to be beneficial in terms of survival or quality of life, conservative treatment and palliative care are alternatives. We review the historical evolution of guidelines about renouncement of RRT and palliative care, and highlight the absence of specific recommendations in Brazil. However renouncement of RRT may be ethically and legally accepted in Brazil, as the right to a dignified death. Longer life expectancy, economic pressures, and greater awareness will require a more detailed discussion about indications and sustainable use of RRT, and possibly the elaboration of national guidelines.

  15. System for manufacturing ash products and energy from refuse waste

    Energy Technology Data Exchange (ETDEWEB)

    Sutin, G.L.; Mahoney, P.F.

    1996-01-04

    The present invention provides a system of manufacturing energy and ash products from solid waste. The system includes apparatus for receiving solid waste for processing, apparatus for shredding the received solid waste, apparatus for removing ferrous material from the shredded solid waste to create processed refuse fuel (PRF) and apparatus for efficiently combusting the PRF. A conveyor transfers the PRF to the combusting apparatus such that the density of the PRF is always controlled for continuous non-problematic flow. Apparatus for recovering residual combustion particulate from the combustion residual gases and for recovering solid ash residue provides the system with the ability to generate steam and electrical energy, and to recover for reuse and recycling valuable materials from the solid ash residue. (author) figs.

  16. Social and legal dimensions discussion of conscientious refusal in Turkey

    Directory of Open Access Journals (Sweden)

    Şeniz ANBARLI BOZATAY

    2011-12-01

    Full Text Available Even though the discussion of conscientious objection, the refusal of military service due to individual’s moral values or religious beliefs, is new in Turkey, the subject has become the focus of intense interest. The discussion of conscientious objection in Turkey has come the to the fore with the heated debates between the glorification of the dynamics of Turkish social structure towards military service and the critique of militarism and conscientious objection’s legal dimensions, as well. Since the reduction of discussions in this context in Turkey to the legal dimension is the ignorance of social reality constituting basis to the legal dimension, the subject is examined with reference to the social and historical outlook on this issue and the study is built on dimensions.

  17. Treatment guidelines for primary nonretentive encopresis and stool toileting refusal.

    Science.gov (United States)

    Kuhn, B R; Marcus, B A; Pitner, S L

    1999-04-15

    Nonretentive encopresis refers to inappropriate soiling without evidence of fecal constipation and retention. This form of encopresis accounts for up to 20 percent of all cases. Characteristics include soiling accompanied by daily bowel movements that are normal in size and consistency. An organic cause for nonretentive encopresis is rarely identified. The medical assessment is usually normal, and signs of constipation are noticeably absent. A full developmental and behavioral assessment should be made to establish that the child is ready for intervention to correct encopresis and to identify any barriers to success, particularly disruptive behavior problems. Successful interventions depend on the presence of soft, comfortable bowel movements and addressing toilet refusal behavior. Daily scheduled positive toilet sits are recommended. Incentives may be used to reinforce successful defecation during these sits. A plan for management of stool withholding should be agreed on by the parents/caretakers and the family physician before intervention.

  18. Adsorption of phenolic compound by aged-refuse

    International Nuclear Information System (INIS)

    Chai Xiaoli; Zhao Youcai

    2006-01-01

    The adsorption of phenol, 2-chlorophenol, 4-chlorophenol and 2,4-dichlorophenol by aged-refuse has been studied. Adsorption isotherms have been determined for phenol, 2-chlorophenol, 4-chlorophenol and 2,4-dichlorophenol and the data fits well to the Freundlich equation. The chlorinated phenols are absorbed more strongly than the phenol and the adsorption capacity has an oblivious relationship with the numbers and the position of chlorine subsistent. The experiment data suggests that both the partition function and the chemical adsorption involve in the adsorption process. Pseudo-first-order and pseudo-second-order model were applied to investigate the kinetics of the adsorption and the results show that it fit the pseudo-second-order model. More than one step involves in the adsorption process and the overall rate of the adsorption process appears to be controlled by the chemical reaction. The thermodynamic analysis indicates that the adsorption is spontaneous and endothermic

  19. Treatment for School Refusal among Children and Adolescents: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Maynard, Brandy R.; Heyne, David; Brendel, Kristen Esposito; Bulanda, Jeffery J.; Thompson, Aaron M.; Pigott, Terri D.

    2018-01-01

    Objective: School refusal is a psychosocial problem associated with adverse short- and long-term consequences for children and adolescents. The authors conducted a systematic review and meta-analysis to examine the effects of psychosocial treatments for children and adolescents with school refusal. Method: A comprehensive search process was used…

  20. 49 CFR 655.49 - Refusal to submit to a drug or alcohol test.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Refusal to submit to a drug or alcohol test. 655... TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT OPERATIONS Types of Testing § 655.49 Refusal to submit to a drug or alcohol test. (a) Each...

  1. 24 CFR 3282.354 - Submittal of false information or refusal to submit information.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Submittal of false information or... ENFORCEMENT REGULATIONS Primary Inspection Agencies § 3282.354 Submittal of false information or refusal to submit information. The submittal of false information or the refusal to submit information required...

  2. Making Sense of Iconic Symbols: A Study of Preschool Children Conducting a Refuse-Sorting Task

    Science.gov (United States)

    Ljung-Djärf, Agneta; Åberg-Bengtsson, Lisbeth; Ottosson, Torgny; Beach, Dennis

    2015-01-01

    This article is part of a larger project focusing upon explanatory illustrations that children encounter in pre- and primary school education. The research questions concerned (a) how preschool children make sense of iconic symbols when placing items of refuse on illustrations of refuse bins in a sorting task and (b) what stumbling blocks they…

  3. Bacteria and Acidic Drainage from Coal Refuse: Inhibition by Sodium Lauryl Sulfate and Sodium Benzoate

    OpenAIRE

    Dugan, Patrick R.; Apel, William A.

    1983-01-01

    The application of an aqueous solution of sodium lauryl sulfate and sodium benzoate to the surface of high-sulfur coal refuse resulted in the inhibition of iron-and sulfur-oxidizing chemoautotrophic bacteria and in the decrease of acidic drainage from the refuse, suggesting that acid drainage can be abated in the field by inhibiting iron- and sulfur-oxidizing bacteria.

  4. Thinking through Moments of Sexual Refusal in "Looking for Alibrandi" and "The Rage in Placid Lake"

    Science.gov (United States)

    Clarke, Kyra

    2016-01-01

    This paper explores two scenarios in which young women refuse the sexual advances of young men in the films "Looking for Alibrandi" and "The Rage in Placid Lake." The paper highlights the heteronormative nature of education around refusing sex, which reinstates gendered stereotypes of masculine as active and feminine as…

  5. Learned Helplessness and Learning Goals: Role played in School Refusal. A Study on Italian Students.

    Directory of Open Access Journals (Sweden)

    Luana Sorrenti

    2016-08-01

    Full Text Available Literature on school refusal has shown a link between school refusal and poor school performance. However, there has been little investigation into the individual underlying factors, and specifically factors directly related to the learning process, such as the learning goals of students and their expectations of success and/or failure. The main purpose of the present study is to investigate the influence of Learned Helplessness (LH and learning goals on school refusal. We hypothesized that LH and learning goals exert a unique role in predicting school refusal above and beyond the roles of academic achievement, age, and gender. The sample consisted of 201 Italian students with an average age of 11.93, with both low (57.2 % of students and high (42.8 % academic achievement. School refusal, LH, and learning goals were measured by means of questionnaires. The results confirm the hypothesis of this study; in fact, we found that learning goals and, above all, LH play a more predictive role of school refusal than academic achievement. These results extend previous studies on school refusal and, for the first time, they provide additional knowledge about this problem, analyzing the relationship between school refusal, learning goals, and LH, still neglected in the literature. Implications on the psychological well-being of students are discussed.

  6. The Impact of Refuse Dump sites on the Physico-chemical and ...

    African Journals Online (AJOL)

    The Impact of Refuse Dump sites on the Physico-chemical and Microbial Properties of ground Water in some selected areas. ... Journal of Agricultural Research and Development. Journal Home ... The pollution effect of refuse dumps on the quality of wells at Ojota, Lagos, Apete, Ibadan and Odopetu, Akure were studied.

  7. What happens after a request for euthanasia is refused? Qualitative interviews with patients, relatives and physicians.

    Science.gov (United States)

    Pasman, H Roeline W; Willems, Dick L; Onwuteaka-Philipsen, Bregje D

    2013-09-01

    Obtaining in-depth information from both patient and physician perspectives about what happens after a request for euthanasia or physician-assisted suicide (EAS) is refused. In-depth interviews with nine patients whose EAS request was refused and seven physicians of these patients, and with three relatives of patients who had died after a request was refused and four physicians of these patients. Interviews were conducted at least 6 months after the refusal. A wish to die remained in all patients after refusal, although it sometimes diminished. In most cases patient and physician stopped discussing this wish, and none of the physicians had discussed plans for the future with the patient or evaluated the patient's situation after their refusal. Physicians were aware of patients' continued wish to die. Patients who are refused EAS may subsequently be silent about a wish to die without abandoning it. Open communication about wishes to die is important, even outside the context of EAS, because if people feel unable to talk about them, their quality of life may be further diminished. Follow up appointments after refusal could give patients the opportunity to discuss their feelings and physicians to support them. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Can children aged 12 years or more refuse life-saving treatment ...

    African Journals Online (AJOL)

    The best interests of the child are paramount, and should the child unreasonably refuse to consent to life-saving treatment, the Minister of Social Development may give consent for such treatment in terms of the Children's Act. Otherwise, should a parent, guardian, caregiver or healthcare provider believe that such a refusal ...

  9. Behavioural treatment of severe food refusal in five toddlers with developmental disabilities

    NARCIS (Netherlands)

    Moor, J.M.H. de; Didden, H.C.M.; Korzilius, H.P.L.M.

    2007-01-01

    BACKGROUND: Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake. METHODS: A behavioural treatment package was

  10. Behavioral treatment of severe food refusal in five toddlers with developmental disabilities

    NARCIS (Netherlands)

    Moor, J.M.H. de; Didden, H.C.M.; Korzilius, H.P.L.M.

    2007-01-01

    Background Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake. Methods A behavioural treatment package was

  11. Behavioural treatment of severe food refusal in five toddlers with developmental disabilities.

    NARCIS (Netherlands)

    Moor, J.M.H. de; Didden, R.; Korzilius, H.P.L.M.

    2007-01-01

    BACKGROUND: Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake. METHODS: A behavioural treatment package was

  12. What happens after a request for euthanasia is refused? Qualitative interviews with patients, relatives and physicians

    NARCIS (Netherlands)

    Pasman, H.R.W.; Willems, D.L.; Onwuteaka-Philipsen, B.D.

    2013-01-01

    Objective: Obtaining in-depth information from both patient and physician perspectives about what happens after a request for euthanasia or physician-assisted suicide (EAS) is refused. Methods: In-depth interviews with nine patients whose EAS request was refused and seven physicians of these

  13. Comparing the quality of life in insulin recipient and refusal patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Mitra Khalili

    2016-01-01

    Conclusions: Results showed that insulin refusal patients had a better QOL. It seems that QOL is associated with the acceptance or refusal of insulin therapy. Therefore, enhancement of QOL could be related to all aspects of the disease, especially its treatment method and solving the therapeutic problems.

  14. Using Descriptive Assessment in the Treatment of Bite Acceptance and Food Refusal

    Science.gov (United States)

    Casey, Sean D.; Perrin, Christopher J.; Lesser, Aaron D.; Perrin, Stefanie H.; Casey, Cheryl L.; Reed, Gregory K.

    2009-01-01

    The feeding behaviors of two children who maintained failure to thrive diagnoses and displayed food refusal are assessed in their homes. Descriptive assessments are used to identify schedules of consequence provided by each child's care providers for bite acceptance and food refusal behaviors. Assessments reveal rich schedules of praise and access…

  15. A plea for uniform European definitions for organ donor potential and family refusal rates.

    Science.gov (United States)

    Jansen, Nichon E; Haase-Kromwijk, Bernadette J J M; van Leiden, Hendrik A; Weimar, Willem; Hoitsma, Andries J

    2009-11-01

    Conversion of potential organ donors to actual donors is negatively influenced by family refusals. Refusal rates differ strongly among countries. Is it possible to compare refusal rates in order to be able to learn from countries with the best practices? We searched in the literature for reviews of donor potential and refusal rates for organ donation in intensive care units. We found 14 articles pertinent to this study. There is an enormous diversity among the performed studies. The definitions of potential organ donors and family refusal differed substantially. We tried to re-calculate the refusal rates. This method failed because of the influence caused by the registered will on donation in the Donor Register. We therefore calculated the total refusal rate. This strategy was also less satisfactory considering possible influence of the legal consent system on the approach of family. Because of lack of uniform definitions, we can conclude that the refusal rates for organ donation can not be used for a sound comparison among countries. To be able to learn from well-performing countries, it is necessary to establish uniform definitions regarding organ donation and registration of all intensive care deaths.

  16. Obstetric Patients Who Select and Those Who Refuse Medical Students' Participation in Their Care.

    Science.gov (United States)

    Magrane, Diane; And Others

    1994-01-01

    A survey of 222 obstetrics patients assisted by medical clerkship students from the University of Vermont and 78 who refused student participation found privacy the primary motivation for refusal and a desire to contribute to students' education a primary reason for accepting student participation. Patients frequently erroneously anticipated the…

  17. 21 CFR 515.21 - Refusal to approve a medicated feed mill license application.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Refusal to approve a medicated feed mill license... SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS MEDICATED FEED MILL LICENSE Administrative Actions on Licenses § 515.21 Refusal to approve a medicated feed mill license application. (a) The...

  18. Strategie di rifuto in Italiano: uno studio etnografico (Refusal Strategies in Italian: An Ethnographic Study).

    Science.gov (United States)

    Frescura, Marina

    1997-01-01

    After reviewing previous research on speech acts, this article describes a study that analyzed the behavior of speakers of standard Italian in refusing an offer of food. The importance of "face" is explained, and the refusal strategies are classified into four categories: explicit, tactical, decisive, and conclusive. (CFM)

  19. 13 CFR 115.18 - Refusal to issue further guarantees; suspension and termination of PSB status.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Refusal to issue further guarantees; suspension and termination of PSB status. 115.18 Section 115.18 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SURETY BOND GUARANTEE Provisions for All Surety Bond Guarantees § 115.18 Refusal to issue further guarantees; suspension...

  20. 75 FR 4565 - Federal Acquisition Regulation; Submission for OMB Review; Right of First Refusal of Employment

    Science.gov (United States)

    2010-01-28

    .... Please cite OMB Control No. 9000-0114, Right of First Refusal of Employment, in all correspondence. Dated... ADMINISTRATION [OMB Control No. 9000-0114] Federal Acquisition Regulation; Submission for OMB Review; Right of... previously approved information collection requirement concerning right of first refusal of employment. A...

  1. 29 CFR 1977.22 - Employee refusal to comply with safety rules.

    Science.gov (United States)

    2010-07-01

    ... WILLIAMS-STEIGER OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Some Specific Subjects § 1977.22 Employee refusal to comply with safety rules. Employees who refuse to comply with occupational safety and health... Section 1977.22 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH...

  2. 30 CFR 253.50 - How can MMS refuse or invalidate my OSFR evidence?

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false How can MMS refuse or invalidate my OSFR... can MMS refuse or invalidate my OSFR evidence? (a) If MMS determines that any OSFR evidence you submit... acceptable evidence without being subject to civil penalty under § 253.51. (b) MMS may immediately and...

  3. Denitrification capacity of bioreactors filled with refuse at different landfill ages

    International Nuclear Information System (INIS)

    Chen Yingxu; Wu Songwei; Wu Weixiang; Sun Hua; Ding Ying

    2009-01-01

    The denitrification capacity of refuse at different landfill ages in bioreactor landfill system was studied. Three reactors filled with 1-year-old refuse (R1), 6-year-old refuse (R6) and 11-year-old refuse (R11), respectively, were operated in the experiment. Nitrate solution (1000 mg NO 3 - -N L -1 ) was added into each reactor. The results showed that the reactors were all able to consume nitrate. However, 1-year-old refuse in R1 had both a higher nitrate reduction rate and concentration of N 2 . In addition, vertical differences in nitrate removal along the depth of R1 were observed. The bottom-layer refuse and the middle-layer refuse both showed higher efficiency in nitrate depletion than the top layer. Furthermore, N 2 O accumulation was found in R11 with the concentration up to 19.3% of the released gas. These results suggested that 1-year-old refuse, which was partly degraded, was more suitable to use as denitrification medium.

  4. Patient Experience Of Provider Refusal Of Medicaid Coverage And Its Implications.

    Science.gov (United States)

    Bhandari, Neeraj; Shi, Yunfeng; Jung, Kyoungrae

    2016-01-01

    Previous studies show that many physicians do not accept new patients with Medicaid coverage, but no study has examined Medicaid enrollees' actual experience of provider refusal of their coverage and its implications. Using the 2012 National Health Interview Survey, we estimate provider refusal of health insurance coverage reported by 23,992 adults with continuous coverage for the past 12 months. We find that among Medicaid enrollees, 6.73% reported their coverage being refused by a provider in 2012, a rate higher than that in Medicare and private insurance by 4.07 (p<.01) and 3.68 (p<.001) percentage points, respectively. Refusal of Medicaid coverage is associated with delaying needed care, using emergency room (ER) as a usual source of care, and perceiving current coverage as worse than last year. In view of the Affordable Care Act's (ACA) Medicaid expansion, future studies should continue monitoring enrollees' experience of coverage refusal.

  5. Refusal of curative radiation therapy and surgery among patients with cancer.

    Science.gov (United States)

    Aizer, Ayal A; Chen, Ming-Hui; Parekh, Arti; Choueiri, Toni K; Hoffman, Karen E; Kim, Simon P; Martin, Neil E; Hu, Jim C; Trinh, Quoc-Dien; Nguyen, Paul L

    2014-07-15

    Surgery and radiation therapy represent the only curative options for many patients with solid malignancies. However, despite the recommendations of their physicians, some patients refuse these therapies. This study characterized factors associated with refusal of surgical or radiation therapy as well as the impact of refusal of recommended therapy on patients with localized malignancies. We used the Surveillance, Epidemiology, and End Results program to identify a population-based sample of 925,127 patients who had diagnoses of 1 of 8 common malignancies for which surgery and/or radiation are believed to confer a survival benefit between 1995 and 2008. Refusal of oncologic therapy, as documented in the SEER database, was the primary outcome measure. Multivariable logistic regression was used to investigate factors associated with refusal. The impact of refusal of therapy on cancer-specific mortality was assessed with Fine and Gray's competing risks regression. In total, 2441 of 692,938 patients (0.4%) refused surgery, and 2113 of 232,189 patients (0.9%) refused radiation, despite the recommendations of their physicians. On multivariable analysis, advancing age, decreasing annual income, nonwhite race, and unmarried status were associated with refusal of surgery, whereas advancing age, decreasing annual income, Asian American race, and unmarried status were associated with refusal of radiation (PRefusal of surgery and radiation were associated with increased estimates of cancer-specific mortality for all malignancies evaluated (hazard ratio [HR], 2.80, 95% confidence interval [CI], 2.59-3.03; Prefuse curative surgical and/or radiation-based oncologic therapy, raising concern that socioeconomic factors may drive some patients to forego potentially life-saving care. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. The Refusal of Palliative Radiation in Metastatic Non-Small Cell Lung Cancer and Its Prognostic Implications.

    Science.gov (United States)

    Stavas, Mark J; Arneson, Kyle O; Ning, Matthew S; Attia, Albert A; Phillips, Sharon E; Perkins, Stephanie M; Shinohara, Eric T

    2015-06-01

    Patients with metastatic non-small cell lung cancer (NSCLC) have limited survival. Population studies have evaluated the impact of radiation refusal in the curative setting; however, no data exist concerning the prognostic impact of radiation refusal in the palliative care setting. To investigate the patterns of radiation refusal in newly diagnosed patients with metastatic NSCLC. Patients with Stage IV NSCLC diagnosed between 1988 and 2010 were identified in the Surveillance, Epidemiology, and End Results database. Univariate and multivariate analyses were used to identify predictors for refusal of radiation and the impact of radiation and refusal on survival in the palliative setting. A total of 285,641 patients were initially included in the analysis. Palliative radiation was recommended in 42% and refused by 3.1% of patients. Refusal rates remained consistent across included years of study. On multivariate analysis, older, nonblack/nonwhite, unmarried females were more likely to refuse radiation (P refusing radiation was three months vs. five months for those receiving radiation and two months for those whom radiation was not recommended. Patients with metastatic NSCLC who refuse recommended palliative radiation have a poor survival. Radiation refusal or the recommendation against treatment can serve as a trigger for integrating palliative care services sooner and contributes greatly to prognostic awareness. Further investigation into this survival difference and the factors behind refusal are warranted. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  7. 25 CFR 171.420 - Can I dispose of sewage, trash, or other refuse on a BIA irrigation project?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Can I dispose of sewage, trash, or other refuse on a BIA... AND WATER IRRIGATION OPERATION AND MAINTENANCE Irrigation Facilities § 171.420 Can I dispose of sewage, trash, or other refuse on a BIA irrigation project? No. Sewage, trash, or other refuse are considered...

  8. Heroin refusal self-efficacy and preference for medication-assisted treatment after inpatient detoxification.

    Science.gov (United States)

    Kenney, Shannon R; Bailey, Genie L; Anderson, Bradley J; Stein, Michael D

    2017-10-01

    An individual's self-efficacy to refuse using heroin in high-risk situations is believed to minimize the likelihood for relapse. However, among individuals completing inpatient heroin detoxification, perceived refusal self-efficacy may also reduce one's perceived need for medication-assisted treatment (MAT), an effective and recommended treatment for opioid use disorder. In the current study, we examined the relationship between heroin refusal self-efficacy and preference for MAT following inpatient detoxification. Participants (N=397) were interviewed at the start of brief inpatient opioid detoxification. Multiple logistic regression was used to estimate the adjusted association of background characteristics, depressed mood, and perceived heroin refusal self-efficacy with preference for MAT. Controlling for other covariates, depressed mood and lower perceived refusal self-efficacy were associated with a significantly greater likelihood of expressing preference for MAT (versus no MAT). Perceived ability to refuse heroin after leaving detox is inversely associated with a heroin user's desire for MAT. An effective continuum of care model may benefit from greater attention to patient's perceived refusal self-efficacy during detoxification which may impact preference for MAT and long-term recovery. Copyright © 2017. Published by Elsevier Ltd.

  9. The right to physical integrity and informed refusal: Just how far does a patient’s right to refuse medical treatment go?

    Directory of Open Access Journals (Sweden)

    Annelize Nienaber

    2016-11-01

    Full Text Available The article presents a legal analysis of the right to physical integrity as guaranteed by the South African Constitution, 1996, and the subsequent right of a competent adult person to refuse medical treatment under South African law. We consider whether the right to refuse treatment is an absolute right and very briefly reflect on the application of the constitutional limitations clause to this right. Instances in which patients’ right to physical integrity is limited by factors, which detract from (patient autonomy, are considered: these represent a limitation of their right to refuse medical treatment. We conclude that forced medical interventions, for the most part, are not desirable but, indeed, necessary in some narrowly defined circumstances. When a person makes a decision to refuse a medical intervention, which may seem unusual or may be perceived as irrational, it does not mean that person does not warrant the protection of the constitution and the courts. Provided that the patient makes an informed refusal while of sound mind, generally there is no reason to discredit his/her decision, difficult as it may be for others to accept. At all times the right to bodily integrity is pivotal in any health-related context and should not be lightly disregarded.

  10. Microbial ecology studies at two coal mine refuse sites in Illinois

    Energy Technology Data Exchange (ETDEWEB)

    Miller, R. M.; Cameron, R. E.

    1978-01-01

    An investigation was made of the microflora associated with coal refuse at two abandoned mines in the midwestern United States. Information was gathered for both the edaphic and the biotic composition of the refuse material. Emphasis was placed on heterotrophic and autotrophic components as to numbers, kinds, and physiological groups. The presence of chemolithotrophs was also investigated. The relationship between abiotic and biotic components in regard to distribution of bacteria, fungi, and algae is discussed. Information presented in this report will be utilized in assessing trends and changes in microbial numbers and composition related to manipulations of the edaphic and biotic ecosystem components associated with reclamation of the refuse piles.

  11. [Refusal of care by a HIV-positive adolescent: role of the cross-cultural approach].

    Science.gov (United States)

    Bouaziz, Nora; Titia Rizzi, Alice

    The refusal of treatment is frequent in human immunodeficiency virus-positive adolescents. The clinical history of a teenage girl presenting severe immunodepression secondary to the virus, a depressive disorder and a refusal of treatment, illustrates the benefit of combined paediatric, child psychiatric and cross-cultural care as proposed by the Cochin-Paris Adolescent Centre. Working on the meaning of the refusal was a prerequisite for the construction of a care project forming part of a life project, as the psychopathological work could only begin once somatic care ensuring the patient's protection was in place. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  12. Turning refuse plastic into multi-walled carbon nanotube forest

    Science.gov (United States)

    Oh, Eugene; Lee, Jaegeun; Jung, Seung-Ho; Cho, Seungho; Kim, Hye-Jin; Lee, Sung-Hyun; Lee, Kun-Hong; Song, Kyong-Hwa; Choi, Chi-Hoon; Han, Do Suck

    2012-01-01

    A novel and effective method was devised for synthesizing a vertically aligned carbon nanotube (CNT) forest on a substrate using waste plastic obtained from commercially available water bottles. The advantages of the proposed method are the speed of processing and the use of waste as a raw material. A mechanism for the CNT growth was also proposed. The growth rate of the CNT forest was ∼2.5 μm min−1. Transmission electron microscopy images indicated that the outer diameters of the CNTs were 20–30 nm on average. The intensity ratio of the G and D Raman bands was 1.27 for the vertically aligned CNT forest. The Raman spectrum showed that the wall graphitization of the CNTs, synthesized via the proposed method was slightly higher than that of commercially available multi-walled carbon nanotubes (MWCNTs). We expect that the proposed method can be easily adapted to the disposal of other refuse materials and applied to MWCNT production industries. PMID:27877482

  13. Hygiene tests in the anaerobic digestion of household refuse

    Energy Technology Data Exchange (ETDEWEB)

    Maier, H.; Philipp, W.; Wekerle, J.; Strauch, D.

    In a pilot plant the disinfecting effect of composting the effluent of an anaerobic mesophilic digestion process of the organic fraction of household refuse was investigated. The dewatered effluent was mixed with straw as bulking material, put in not aerated windrows and aerobically composted. It was further investigated whether the influent of the digester could be disinfected with lime milk prior to the anaerobic mesophilic digestion process. For the evaluation of the disinfection salmonellas, enterococci, klebsiellas, parvo-, polio- and rotavirus were used as test agents. Temperature, total aerobic germ count, enterobacteriaceae and coliforms were also considered. The effect of lime milk in the influent on the digestion process, survival of the test bacteria and gas production was also studied. Both treatments can result in a hygienically safe product. But composting under the conditions given should not be operated during the winter period. Lime treatment of the influent results in a disinfection of the effluent which immediately can be utilized as liquid sludge in agriculture. (orig.)

  14. Turning refuse plastic into multi-walled carbon nanotube forest

    Directory of Open Access Journals (Sweden)

    Eugene Oh, Jaegeun Lee, Seung-Ho Jung, Seungho Cho, Hye-Jin Kim, Sung-Hyun Lee, Kun-Hong Lee, Kyong-Hwa Song, Chi-Hoon Choi and Do Suck Han

    2012-01-01

    Full Text Available A novel and effective method was devised for synthesizing a vertically aligned carbon nanotube (CNT forest on a substrate using waste plastic obtained from commercially available water bottles. The advantages of the proposed method are the speed of processing and the use of waste as a raw material. A mechanism for the CNT growth was also proposed. The growth rate of the CNT forest was ~2.5 μm min−1. Transmission electron microscopy images indicated that the outer diameters of the CNTs were 20–30 nm on average. The intensity ratio of the G and D Raman bands was 1.27 for the vertically aligned CNT forest. The Raman spectrum showed that the wall graphitization of the CNTs, synthesized via the proposed method was slightly higher than that of commercially available multi-walled carbon nanotubes (MWCNTs. We expect that the proposed method can be easily adapted to the disposal of other refuse materials and applied to MWCNT production industries.

  15. Negotiating refusal in primary care consultations: a qualitative study.

    Science.gov (United States)

    Walter, Alex; Chew-Graham, Carolyn; Harrison, Stephen

    2012-08-01

    How GPs negotiate patient requests is vital to their gatekeeper role but also a source of potential conflict, practitioner stress and patient dissatisfaction. Difficulties may arise when demands of shared decision-making conflict with resource allocation, which may be exacerbated by new commissioning arrangements, with GPs responsible for available services. To explore GPs' accounts of negotiating refusal of patient requests and their negotiation strategies. A qualitative design was employed with two focus groups of GPs and GP registrars followed by 20 semi-structured interviews. Participants were sampled by gender, experience, training/non-training, principal versus salaried or locum. Thematic content analysis proceeded in parallel with interviews and further sampling. The setting was GP practices within an English urban primary care trust. Sickness certification, antibiotics and benzodiazepines were cited most frequently as problematic patient requests. GP trainees reported more conflict within interactions than experienced GPs. Negotiation strategies, such as blaming distant third parties such as the primary care organization, were designed to prevent conflict and preserve the doctor-patient relationship. GPs reported patients' expectations being strongly influenced by previous encounters with other health care professionals. The findings reiterate the prominence of the doctor-patient relationship in GPs' accounts. GPs' relationships with colleagues and the wider National Health Service (NHS) are particular of relevance in light of provisions in the Health and Social Care Bill for clinical commissioning consortia. The ability of GPs to offset blame for rationing decisions to third parties will be undermined if the same GPs commission services.

  16. Production, quality and quality assurance of Refuse Derived Fuels (RDFs).

    Science.gov (United States)

    Sarc, R; Lorber, K E

    2013-09-01

    This contribution describes characterization, classification, production, application and quality assurance of Refuse Derived Fuels (RDFs) that are increasingly used in a wide range of co-incineration plants. It is shown in this paper, that the fuel-parameter, i.e. net calorific value [MJ/kg(OS)], particle size d(90) or d(95) [mm], impurities [w%], chlorine content [w%], sulfur content [w%], fluorine content [w%], ash content [w%], moisture [w%] and heavy metals content [mg/kg(DM)], can be preferentially used for the classification of different types of RDF applied for co-incineration and substitution of fossil-fuel in different industial sectors. Describing the external production of RDF by processing and confectioning of wastes as well as internal processing of waste at the incineration plant, a case study is reported on the application of RDF made out of different household waste fractions in a 120,000t/yr Waste to Energy (WtE) circulating fluidized bed (CFB) incinerator. For that purpose, delivered wastes, as well as incinerator feedstock material (i.e. after internal waste processing) are extensively investigated. Starting with elaboration of sampling plan in accordance with the relevant guidelines and standards, waste from different suppliers was sampled. Moreover, manual sorting analyses and chemical analyses were carried out. Finally, results of investigations are presented and discussed in the paper. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. How to justify enforcing a Ulysses contract when Ulysses is competent to refuse.

    Science.gov (United States)

    Davis, John K

    2008-03-01

    Sometimes the mentally ill have sufficient mental capacity to refuse treatment competently, and others have a moral duty to respect their refusal. However, those with episodic mental disorders may wish to precommit themselves to treatment, using Ulysses contracts known as "mental health advance directives." How can health care providers justify enforcing such contracts over an agent's current, competent refusal? I argue that providers respect an agent's autonomy not retrospectively--by reference to his or her past wishes-and not merely synchronically--so that the agent gets what he or she wants right now-but diachronically and prospectively, acting so that the agent can shape his or her circumstances as the agent wishes over time, for the agent will experience the consequences of providers' actions over time. Mental health directives accomplish this, so they are a way of respecting the agent's autonomy even when providers override the agent's current competent refusal.

  18. Biometric identification with high frequency electrocardiogram: Unregistered user refusal method and performance evaluation.

    Science.gov (United States)

    Kyoso, Masaki

    2015-08-01

    As a new modality for biometric identification, electrocardiogram-based identification technique has been developed. We proposed a technique with high frequency component of electrocardiogram (HFECG) in QRS segment. In this report, an unregistered user refusal algorithm was combined with the artificial neural network based waveform classifier. The refusal function was realized by simple thresholding technique. HFECGs from twenty collaborators were used for supervised learning. Twenty HFECGs from the same collaborators were tested and false acceptance rate (FAR) and false rejection rate (FRR) were evaluated. Ten HFECGs from other collaborators were also tested to find unregistered user refusal performance. The results show that FAR and FRR in the registrants can be kept within 1%, however, unregistered user refusal performance was not acceptable under the same condition.

  19. PATIENT’S CONSCIOUS REFUSAL OF TREATMENT AND REQUEST FOR ACTIVETREATMENT WHEN RECOVERY IS NOT POSSIBLE

    Directory of Open Access Journals (Sweden)

    Peter Černoga

    2008-01-01

    General practitioner and a specialist doctor are faced with difficult dilemma when there isa case of a competent but unwilling to consent patient refusing the timely treatment inspite of the predicted fatal consequences

  20. The right to physical integrity and informed refusal: Just how far does ...

    African Journals Online (AJOL)

    Provided that the patient makes an informed refusal while of sound mind, generally ... At all times the right to bodily integrity is pivotal in any health-related context and should ... choices regarding the body in an autonomous and independent.

  1. Right of a patient to refuse medical treatment: justification for judicial ...

    African Journals Online (AJOL)

    Nnamdi Azikiwe University Journal of International Law and Jurisprudence ... This paper discusses the right of a patient to refuse medical treatment and juxtaposes ... This is achieved by an expository review of relevant case law and scholarly ...

  2. Bacteria and Acidic Drainage from Coal Refuse: Inhibition by Sodium Lauryl Sulfate and Sodium Benzoate

    Science.gov (United States)

    Dugan, Patrick R.; Apel, William A.

    1983-01-01

    The application of an aqueous solution of sodium lauryl sulfate and sodium benzoate to the surface of high-sulfur coal refuse resulted in the inhibition of iron-and sulfur-oxidizing chemoautotrophic bacteria and in the decrease of acidic drainage from the refuse, suggesting that acid drainage can be abated in the field by inhibiting iron- and sulfur-oxidizing bacteria. PMID:16346347

  3. School refusal associated with separation anxiety disorder; an adolescent case report

    Directory of Open Access Journals (Sweden)

    Mustafa Yasin Irmak

    2016-12-01

    Full Text Available In literature, there are lots of studies about separation anxiety disorder (SAD and school refusal. Of the patients in these studies, it is generally known to child age group. In this paper, we aimed to draw attention to an adolescent patient with SAD who admitted to our clinic with complaint of school refusal and there is SAD under his unwillingness to go to school. [J Contemp Med 2016; 6(4.000: 357-360

  4. [Nursing ethics in the face of the refusal of nursing care].

    Science.gov (United States)

    Dauchy, Sarah; Charles, Cécile; Vérotte, Nelly; Block, Véronique; Adam, Virginie

    2016-10-01

    Caregivers can find themselves faced with a refusal of nursing care. A number of questions are then raised. While it is firstly important to understand the reasons for this refusal and what is at stake for the patient, there are a number of nursing strategies in place, not least of all dialogue and analysis. The role of the multi-disciplinary team is essential in such situations. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. Insulin therapy refusal among type II diabetes mellitus patients in Kubang Pasu district, Kedah, Malaysia

    Science.gov (United States)

    Tan, Wei Leong; Asahar, Siti Fairus; Harun, Noor Liani

    2015-01-01

    INTRODUCTION Diabetes mellitus is a rising non-communicable disease in Malaysia. Insulin therapy refusal is a challenge for healthcare providers, as it results in delayed insulin initiation. This study was conducted to determine the prevalence of insulin therapy refusal and its associated factors. METHODS This cross-sectional study was conducted at seven public health clinics in Kubang Pasu district of Kedah, Malaysia, from March to October 2012. A newly developed and validated questionnaire was used and participants were selected via systematic random sampling. Only patients diagnosed with type II diabetes mellitus (T2DM) and under the public health clinic care in Kubang Pasu were included in the study. Multiple logistic regression was used to study the association between insulin therapy refusal and its associated factors. RESULTS There were 461 respondents and the response rate was 100%. Among these 461 patients with T2DM, 74.2% refused insulin therapy. The most common reason given for refusal was a lack of confidence in insulin injection (85.4%). Multiple logistic regression revealed that respondents who had secondary education were 55.0% less likely to refuse insulin therapy than those who had primary education or no formal education (adjusted odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25–0.82, p = 0.009). There was also a significant inverse association between glycated haemoglobin (HbA1c) level and insulin therapy refusal (adjusted OR 0.87, 95% CI 0.76–1.00, p = 0.047). CONCLUSION Insulin therapy refusal is common in Kubang Pasu. Educational status and HbA1c level should be taken into consideration when counselling patients on insulin therapy initiation. PMID:25532511

  6. Aged refuse enhances anaerobic digestion of waste activated sludge.

    Science.gov (United States)

    Zhao, Jianwei; Gui, Lin; Wang, Qilin; Liu, Yiwen; Wang, Dongbo; Ni, Bing-Jie; Li, Xiaoming; Xu, Rui; Zeng, Guangming; Yang, Qi

    2017-10-15

    In this work, a low-cost alternative approach (i.e., adding aged refuse (AR) into waste activated sludge) to significantly enhance anaerobic digestion of sludge was reported. Experimental results showed that with the addition dosage of AR increasing from 0 to 400 mg/g dry sludge soluble chemical oxygen demand (COD) increased from 1150 to 5240 mg/L at the digestion time of 5 d, while the maximal production of volatile fatty acids (VFA) increased from 82.6 to 183.9 mg COD/g volatile suspended solids. Although further increase of AR addition decreased the concentrations of both soluble COD and VFA, their contents in these systems with AR addition at any concentration investigated were still higher than those in the blank, which resulted in higher methane yields in these systems. Mechanism studies revealed that pertinent addition of AR promoted solubilization, hydrolysis, and acidogenesis processes and did not affect methanogenesis significantly. It was found that varieties of enzymes and anaerobes in AR were primary reason for the enhancement of anaerobic digestion. Humic substances in AR benefited hydrolysis and acidogenesis but inhibited methanogenesis. The effect of heavy metals in AR on sludge anaerobic digestion was dosage dependent. Sludge anaerobic digestion was enhanced by appropriate amounts of heavy metals but inhibited by excessive amounts of heavy metals. The relative abundances of microorganisms responsible for sludge hydrolysis and acidogenesis were also observed to be improved in the system with AR addition, which was consistent with the performance of anaerobic digestion. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Informed consent for the administration of an intravenous contrast agent: importance and determinants of patient refusal

    International Nuclear Information System (INIS)

    Martel, J.; Garcia-Diaz, J. D.

    1999-01-01

    We proposed to determine the proportion of patients who refuse to undergo intravenous contrast administration and the factors that influence their refusal. Our series consisted of 442 patients who were supposed to undergo imaging studies involving the intravenous injection of an iodine contrast. In a personal interview, the patients were issued a questionnaire specifically designed for this study. The following parameters were recorded: sex, age, inpatient or outpatient status, medical history available, person who informed them about the procedure, person signing the informed consent (patient or other) , highest academic degree, attitude toward receiving the information and degree of concern after reading and signing the consent form. In our series 8.6% of the patients (95% confidence interval: 6-11.2) refused to sign the informed consent form. In addition, there were a number of patients who delayed the procedure or hindered the daily work schedule by some other means. When the relationship between each of the variables studied and refusal to sign the consent form was assessed, significant associations were observed between the latter and the academic level of the patient, his or her degree of concern and having received the information from a trained person. There was also a nearly significant trend toward the association between refusal and the patient's background. Relatively few patients refuse to sign the informed consent to receive intravenous contrast administration but this negative decision interferes with the health care practice. It is possible to identify certain correctable factors that influence the patient in this respect. (Author) 13 refs

  8. Comparing the quality of life in insulin recipient and refusal patients with type 2 diabetes.

    Science.gov (United States)

    Khalili, Mitra; Sabouhi, Fakhri; Abazari, Parvaneh; Aminorroaya, Ashraf

    2016-01-01

    Better control of blood sugar and reduction of diabetes complications through insulin therapy could convince people to choose this method. However, patients might refuse insulin therapy due to its painful injection, limitations in daily activities, and hypoglycemia. Thus, insulin therapy could have both positive and negative effects on patients' quality of life (QOL). Therefore, the aim of this study was to compare the QOL of insulin recipient and insulin refusal patients with type 2 diabetes. This study was a descriptive and comparative research conducted on 126 patients; 63 were insulin recipients and 63 had refused insulin therapy. Participants were under the care of the Endocrine and Metabolism Research Center of Isfahan, Iran. Data were gathered using the Diabetes Quality of Life (DQOL) questionnaire. In this tool, higher scores indicated lower QOL in patients. Data were analyzed using independent t-test, analysis of covariance, Mann-Whitney, Chi-square, and Pearson and Spearman's correlation. There was a significant difference (P refusal patients (mean = 1.74, SD = 0.41) in terms of mean QOL score. In addition, men and participants with higher educational levels reported a better QOL (P refusal patients had a better QOL. It seems that QOL is associated with the acceptance or refusal of insulin therapy. Therefore, enhancement of QOL could be related to all aspects of the disease, especially its treatment method and solving the therapeutic problems.

  9. Legislation and refusal of blood transfusion by a minor Jehovah-Witness in Belgium.

    Science.gov (United States)

    Deneyer, M; Matthys, D; Ramet, J; Michel, L; Holsters, D; Vandenplas, Y

    2011-01-01

    The refusal of blood transfusion by Jehovah's Witnesses in critical situations constitutes an ethical and juridical dilemma. The refusal to receive blood products by Jehovah's Witnesses is based on biblical verses. Recurring arguments to sustain this refusal regard the right to self-determination and the right to freedom of faith. If minors are involved, the problem is rendered even more difficult as the parental authority over young children needs to be taken into account. When adolescents are concerned, the situation if even more ambiguous since adolescents might be considered as mature enough to provide autonomous consent. On the basis of three cases, the most frequent bottlenecks that can come up in paediatric emergency services are highlighted: (1) the refusal of a blood transfusion by the parents of a young child; (2) the refusal by an adolescent and (3) prior refusal based on a "No Blood"-document. Regarding minors, the law on patients' rights in Belgium contains safety mechanisms concerning the preservation of physical integrity. Therefore, a key responsibility has been assigned to the physician. A step-by-step plan and a synoptic diagram are presented.

  10. Effect of bio-column composed of aged refuse on methane abatement--a novel configuration of biological oxidation in refuse landfill.

    Science.gov (United States)

    Han, Dan; Zhao, Youcai; Xue, Binjie; Chai, Xiaoli

    2010-01-01

    An experimental bio-column composed of aged refuse was installed around the exhaust pipe as a new way to mitigate methane in refuse landfill. One of the objectives of this work was to assess the effect of aged refuse thickness in bio-column on reducing CH4 emissions. Over the study period, methane oxidation was observed at various thicknesses, 5 cm (small size), 10 cm (middle size) and 15 cm (large size), representing one to three times of pipeline diameters. The middle and large size both showed over 90% methane conversion, and the highest methane conversion rate of above 95% occurred in the middle-size column cell. Michaelis-Menten equation addressed the methanotrophs diffusion in different layers of the bio-columns. Maximum methanotrophic activity (Vmax) measured at the three thicknesses ranged from 6.4 x 10(-3) to 15.6 x 10(-3) units, and the half-saturation value (K(M)) ranged from 0.85% to 1.67%. Both the highest Vmax and K(M) were observed at the middle-size of the bio-column, as well as the largest methanotrophs population, suggesting a significant efficiency of methane mitigation happened in the optimum zone with greatest affinity and methanotrophic bacteria activities. Therefore, bio-column is a potential style for methane abatement in landfill, and the aged refuse both naturally formed and artificially placed in the column plays a critical role in CH4 emission.

  11. Predictors of condom use and refusal among the population of Free State province in South Africa.

    Science.gov (United States)

    Chandran, Thoovakkunon Moorkoth; Berkvens, Dirk; Chikobvu, Perpetual; Nöstlinger, Christiana; Colebunders, Robert; Williams, Brian Gerard; Speybroeck, Niko

    2012-05-28

    This study investigated the extent and predictors of condom use and condom refusal in the Free State province in South Africa. Through a household survey conducted in the Free Sate province of South Africa, 5,837 adults were interviewed. Univariate and multivariate survey logistic regressions and classification trees (CT) were used for analysing two response variables 'ever used condom' and 'ever refused condom'. Eighty-three per cent of the respondents had ever used condoms, of which 38% always used them; 61% used them during the last sexual intercourse and 9% had ever refused to use them. The univariate logistic regression models and CT analysis indicated that a strong predictor of condom use was its perceived need. In the CT analysis, this variable was followed in importance by 'knowledge of correct use of condom', condom availability, young age, being single and higher education. 'Perceived need' for condoms did not remain significant in the multivariate analysis after controlling for other variables. The strongest predictor of condom refusal, as shown by the CT, was shame associated with condoms followed by the presence of sexual risk behaviour, knowing one's HIV status, older age and lacking knowledge of condoms (i.e., ability to prevent sexually transmitted diseases and pregnancy, availability, correct and consistent use and existence of female condoms). In the multivariate logistic regression, age was not significant for condom refusal while affordability and perceived need were additional significant variables. The use of complementary modelling techniques such as CT in addition to logistic regressions adds to a better understanding of condom use and refusal. Further improvement in correct and consistent use of condoms will require targeted interventions. In addition to existing social marketing campaigns, tailored approaches should focus on establishing the perceived need for condom-use and improving skills for correct use. They should also incorporate

  12. An audit of consent refusals in clinical research at a tertiary care center in India

    Directory of Open Access Journals (Sweden)

    S J Thaker

    2015-01-01

    Full Text Available Background and Rationale: Ensuring research participants′ autonomy is one of the core ethical obligations of researchers. This fundamental principle confers on every participant the right to refuse to take part in clinical research, and the measure of the number of consent refusals could be an important metric to evaluate the quality of the informed consent process. This audit examined consent refusals among Indian participants in clinical studies done at our center. Materials and Methods: The number of consent refusals and their reasons in 10 studies done at our center over a 5-year period were assessed. The studies were classified by the authors according to the type of participant (healthy vs patients, type of sponsor (investigator-initiated vs pharmaceutical industry, type of study (observational vs interventional, level of risk [based on the Indian Council of Medical Research (ICMR "Ethical Guidelines for Biomedical Research on Human Participants"], available knowledge of the intervention being studied, and each patient′s disease condition. Results: The overall consent refusal rate was 21%. This rate was higher among patient participants [23.8% vs. healthy people (14.9%; P = 0.002], in interventional studies [33.6% vs observational studies (7.5%; P < 0.0001], in pharmaceutical industry-sponsored studies [34.7% vs investigator-initiated studies (7.2%; P < 0.0001], and in studies with greater risk (P < 0.0001. The most common reasons for consent refusals were multiple blood collections (28%, inability to comply with the study protocol (20%, and the risks involved (20%. Conclusion: Our audit suggests the adequacy and reasonable quality of the informed consent process using consent refusals as a metric.

  13. Refusal of hemodialysis by hospitalized chronic kidney disease patients in Pakistan.

    Science.gov (United States)

    Shafi, Salman Tahir; Saleem, Mohammad; Anjum, Roshina; Abdullah, Wajid; Shafi, Tahir

    2018-01-01

    In Pakistan, patients with chronic kidney disease (CKD) are commonly diagnosed at a late stage. There is little information about the refusal of hemodialysis by hospitalized CKD patients who need hemodialysis (HD) and reasons for acceptance and refusal among these patients. All patients with Stage V CKD who had medical indications to undergo HD and were hospitalized at a tertiary care facility over a six-month period were invited to participate in this study. Patients were surveyed regarding acceptance or refusing of HD and reasons for their decisions. Demographic, socioeconomic, and clinical characteristics of patients were compared between patients who accepted or refused HD. A total of 125 patients were included in the study. The mean age of the patients was 47.9 ±12.1 years. The mean duration of diagnosis of CKD was 2.5 ± 0.6 months. Of all patients, 72 (57.6%) agreed to do HD and 53 (42.4%) refused HD. Patients with arteriovenous fistula in place (27.1 vs. 9.1%, P 0.02) and those in the middle- or higher-income group (64.4% vs. 38.6%, p = 0.03) were more willing to undergo HD. Trust in doctor's advice (86.1%) was the most common reason for acceptance of HD. Frequency of HD per week (52.8%), lifelong and permanent nature of HD (50.9%), advice by family members or friends (37.7%), perception of poor quality of life on HD (35.8%), and fear of HD needles and complications during HD (33.9%) were the most common reasons for refusal. Refusal of HD is common among hospitalized CKD patients with medical indications to undergo HD, especially in lower income group.

  14. Use of wet FGD material for revegetation of an abandoned acidic coal refuse pile

    International Nuclear Information System (INIS)

    Mafi, S.; Stehouwer, R.C.

    1996-01-01

    Wet FGD material has a neutralizing potential of 15% CaCO 3 . These properties may make it a beneficial amendment for revegetation of hyper-acidic coal refuse. In greenhouse and field experiments, coal refuse (pH = 2.5) was amended with wet FGD (300, 500, and 700 tons/acre). Amendment with FGD was as effective as agricultural lime (AL) in increasing refuse pH and decreasing soluble Al and Fe. Addition of compost to the FGD further increased pH and decreased soluble Al and Fe. Downward transport of Ca was greater with FGD than AL, but FGD did not increase leachate concentrations of S. Amendment with FGD increased refuse, leachate and plant tissue concentrations of B. Other trace elements were not increased by FGD. In the greenhouse, plant growth was similar with AL and FGD except during the first three months when AL produced more growth than FGD. The initial growth suppression by FGD was likely due to high soluble salts, and possibly by high B concentrations. During the first year of the field experiment plant growth was greater with FGD than with AL. In both the field and greenhouse experiments compost increased plant growth when combined with FGD. These experiments show revegetation of toxic coal refuse and improvement in drainage water quality is possible by amendment with FGD. Revegetation success will be improved by combined amendment with FGD and compost

  15. Parental psychological symptoms and familial risk factors of children and adolescents who exhibit school refusal.

    Science.gov (United States)

    Bahali, K; Tahiroglu, A Y; Avci, A; Seydaoglu, G

    2011-12-01

    To assess the levels of psychological symptoms in the parents of children with school refusal and determine the familial risk factors in its development. This study was performed on 55 pairs of parents who had children exhibiting school refusal and were compared with a control group. A socio-demographic data form, the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Symptom Checklist-90 revised were applied to these parents. Parents of the school refusal group had higher anxiety and depression scores than the controls. Among the risk factors for school refusal, physical punishment by the parents, a history of organic disease in the parents or children, and a history of psychiatric disorders in the parents or other relatives were found to be significant. Depending on genetic and environmental factors, parents with psychiatric disorders appeared to be associated with development of psychiatric disorders in their children. Moreover, psychiatric disorders in parents negatively affected the treatment of their children and adolescents who exhibited school refusal. It is therefore vital to treat psychiatric disorders of parents with the children having psychiatric disorders, and thus increase parent participation in their children's therapeutic process.

  16. Childhood vaccine refusal and hesitancy intentions in Croatia: insights from a population-based study.

    Science.gov (United States)

    Repalust, Anja; Šević, Sandra; Rihtar, Stanko; Štulhofer, Aleksandar

    2017-10-01

    Considering that programmatic data suggest a recent rise in vaccine refusal in Croatia, this study, first of its kind in Southeast Europe, aimed to estimate the prevalence, and sociodemographic, and sociocultural determinants of childhood vaccine refusal and hesitancy (CVRH) intentions among Croatian adults. Multi-stage stratified population-based survey included 1000 individuals aged 18-88 years (M age  = 47.7, SD = 17.8), of whom 51.7% were women. The outcome, a categorical indicator, distinguished among individuals who would approve vaccinating their children (vaccine accepting), those who would approve some but not all vaccines (vaccine hesitant), and those who would refuse vaccination (vaccine refusing). A sizeable minority of participants was characterized by childhood vaccine refusal (10.6%) and hesitancy intentions (19.5%). In a multivariate assessment controlling for parenthood, the odds of vaccine hesitancy were significantly increased by a younger age (AOR = 1.96-3.03, p Croatia. Following the social contagion model, future research should move beyond individual-level approach and take into account social interaction and social network effects.

  17. Transitional paternalism: how shared normative powers give rise to the asymmetry of adolescent consent and refusal.

    Science.gov (United States)

    Manson, Neil C

    2015-02-01

    In many jurisdictions, adolescents acquire the right to consent to treatment; but in some cases their refusals - e.g. of life-saving treatment - may not be respected. This asymmetry of adolescent consent and refusal seems puzzling, even incoherent. The aim here is to offer an original explanation, and a justification, of this asymmetry. Rather than trying to explain the asymmetry in terms of a variable standard of competence - where the adolescent is competent to consent to, but not refuse, certain interventions - the account offered here focuses more closely on the normative power to render actions permissible. Where normative powers are shared they can readily give rise to an asymmetry between consent and refusal. We then turn to why it is justifiable that normative powers be shared in adolescence. Transitional paternalism holds that the acquisition of normative powers by competent adolescents should not be an instant one, achieved in a single step, but that there should be a transitional period where paternalistic protection is rolled back, but not entirely withdrawn until a later date. Transitional paternalism could be implemented without generating the asymmetry between consent and refusal but, it is argued, the asymmetric version of transitional paternalism is to be preferred insofar as it offers a greater respect for the adolescent's decisions than the symmetrical alternative. © 2014 John Wiley & Sons Ltd.

  18. Are they really refusing to travel? A qualitative study of prehospital records

    Directory of Open Access Journals (Sweden)

    Christopher Sarah

    2006-09-01

    Full Text Available Abstract Background Refusal by the patient to travel after calling an emergency ambulance may lead to a preventable waste of scarce resources if it can be shown that an alternative more appropriate response could be employed. A greater understanding is required of the reasons behind 'refusal to travel' (RTT in order to find appropriate solutions to address this issue. We sought to investigate the reasons why patients refuse to travel following emergency call-out in a rural county. Methods Written records made by ambulance crews for patients (n = 397 who were not transported to hospital following an emergency call-out during October 2004 were retrospectively analysed. Results Twelve main themes emerged for RTT which included non injury or minor injury, falls and recovery after treatment on scene; other themes included alternative supervision, follow-up and treatment arrangements or patients arranging their own transport. Importantly, only 8% of the sample was recorded by ambulance crews as truly refusing to travel against advice. Conclusion A system that facilitates standardised recording of RTT information including social reasons for non-transportation needs to be designed. 'Refused to travel' disclaimers need to reflect instances when crew and patient are satisfied that not going to hospital is the right outcome. These recommendations should be considered within the context of the plans for widening the role of ambulance services.

  19. [Refusal of care faced by case manager from elderly persons in complex situation: cross perspectives].

    Science.gov (United States)

    Corvol, A; Balard, F; Moutel, G; Somme, D

    2014-01-01

    Case management is a new professional field in France. It is addressed to elderly persons living in community whose situation is regarded as particularly complex. Case managers have to assess needs and coordinate necessary services. One common criteria of complexity is refusal of care. The objective of this study is to compare the words of users with those of case managers about refusal of care, in order to understand its meaning, professionals' attitudes and ethical challenges. Two researchers have cooperated on this qualitative research: the first one, anthropologist, interviewed 19 individuals, and 11 of their caregivers. The second one, geriatrician and researcher in medical ethics, lead four focus groups gathering a total of 18 case managers. Refusal of care often is the result of the will of preserving one's identity, compromised by illness. Individuals seek control on their life. Facing this behaviour, case managers try to secure the individual, by establishing a personal relationship that respects their choices, even if care has to be delayed. Refusal of care may sometimes disclose a desire to vanish, in front of which professionals meet their own limits. To recognise an elderly person that refuses care as a unique individual who can make choices secure his identity, and allow him to change. Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  20. Outcomes of nighttime refusal of admission to the intensive care unit: The role of the intensivist in triage.

    Science.gov (United States)

    Hinds, Nicholas; Borah, Amit; Yoo, Erika J

    2017-06-01

    To compare outcomes of patients refused medical intensive care unit (MICU) admission overnight to those refused during the day and to examine the impact of the intensivist in triage. Retrospective, observational study of patients refused MICU admission at an urban university hospital. Of 294 patients, 186 (63.3%) were refused admission overnight compared to 108 (36.7%) refused during the day. Severity-of-illness by the Mortality Probability Model was similar between the two groups (P=.20). Daytime triage refusals were more likely to be staffed by an intensivist (P=.01). After risk-adjustment, daytime refusals had a lower odds of subsequent ICU admission (OR 0.46, 95% CI 0.22-0.95, P=.04) than patients triaged at night. There was no evidence for interaction between time of triage and intensivist staffing of the patient (P=.99). Patients refused MICU admission overnight are more likely to be later admitted to an ICU than patients refused during the day. However, the mechanism for this observation does not appear to depend on the intensivist's direct evaluation of the patient. Further investigation into the clinician-specific effects of ICU triage and identification of potentially modifiable hospital triage practices will help to improve both ICU utilization and patient safety. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Confusing criminal and civil law: when may a hospital refuse to release a dead body?

    Science.gov (United States)

    Gallagher, Steven B

    2014-12-01

    A United Kingdom bereavement advice group has expressed concern that hospitals in Britain may be acting "illegally" in refusing to release dead bodies to relatives unless they provide evidence that funeral arrangements have been made. In some cases, hospitals may have refused to release a body to anyone other than an undertaker. The charity argues that this behaviour constitutes the common law offence of preventing the lawful burial of a body. This article considers the confusion that may occur between this offence and interference with the right to possession of a body for lawful burial. The conclusion is that it is extremely unlikely a hospital or its employees would fall foul of the criminal law in refusing to release a dead body and may be liable in the civil courts if they release a body to someone who does not have the duty and consequent right to possession of the body for lawful burial.

  2. Review of the potential for utilizing washery refuse in N. S. W. and Queensland

    Energy Technology Data Exchange (ETDEWEB)

    Sullivan, K M

    1977-06-01

    The growing importance attached to the environment, coupled with the increasing quantities of coal refuse resulting from expanded coal production has highlighted the problem of coal refuse disposal and provided the necessary impetus to find uses for the by-product, which will eventually be regarded as a fuel and engineering material rather than a waste. Potential areas of use will be as a fuel; as a potential fuel replacement and raw material additive for brick manufacture; as a raw material for lightweight aggregate manufacture; as a construction material; for agricultural purposes, or a number of other areas of special use. The successful marketing of coal refuse will depend on an in-depth technical market analysis being carried out, followed by practical research and a comprehensive product examination and identification program being undertaken.

  3. Fundamental aspects of municipal refuse generated in Beirut and Tripoli: field studies 1994-1996

    International Nuclear Information System (INIS)

    Ayoub, G.M.; Acra, A.; Abdallah, R.; Merhebi, F.

    1996-01-01

    This study presents socio-economic survey on collection and analysis of data pertaining to the municipal refuse generated in Beirut and Tripoli, Two big cities of Lebanon.Although the collection process applied in Beirut has progressed immensely in the past two years, the unsatisfactory methods of disposal that have been employed until now has an impact on the environment:marine environment as well as the air pollution becoming problems in the city of Beirut. In this respect, solid wastes characterization and generation rates in both cities of Beirut and Tripoli are presented. Mapping of refuse collection and disposal services in the two cities is described. Sources of refuse like hospitals, industries, household,...are enumerated. Recycling potentials of plastics, paper and cardboard, glass wastes, metallic wastes, textile wastes are described

  4. The impacts of coal refuse/fly ash bulk bends on water quality and plant growth

    Energy Technology Data Exchange (ETDEWEB)

    Stewar, B.R.; Daniels, W.L. [Virginia Polytechnic Institute and State Univ., Blacksburg, VA (United States)

    1995-09-01

    There is considerable interest in the beneficial reuse of coal fly ash as a soil amendment on coal refuse piles. One method of application would be to blend the coal refuse and the fly ash before deposition in a refuse pile. A field experiment was initiated to measure the effects of bulk blending fly ash with coal refuse on water quality and plant growth parameters. Fly ash (class F) from three sources were used in the experiment. Two of the fly ashes were acidic and the third was alkaline. Trenches were excavated in a coal refuse pile to a depth of 2 m and the refuse was blended with fly ash and then returned to the trench. In other plots the ash was applied as a surface amendment. A treatment of a bulk blend of 5% (w/w) rock phosphate was also included in the experiment. Large volume lysimeters were installed in some trenches to collect the leachates. The fly ash treatments appear to improve the quality of the leachates when compared to the leachates from the untreated plots. The fly ash amended treatments have lower leachate concentrations of Fe and Al. Initially the fly ash treatments showed high levels of leachate B, however those levels have decreased with time. Millet (Setaria italica) yields from the first year of the experiment were highest n the alkaline fly ash and rock phosphate blended plots. In the second growing season, the two bulk blends with alkaline fly ash had the highest yields. In the third growing season all treatments had higher yield levels than the untreated control plots. The positive effects of the fly ash on leachate quality were attributed to the alkalinity of the ash, and the increase in yield was attributed to the increases in water holding capacity due to fly ash treatments.

  5. The Impact of Age and Sex on the Refusal Strategies Used by Iranian EFL Learners

    Directory of Open Access Journals (Sweden)

    Shohreh Shahpouri Arani

    2013-05-01

    Full Text Available One major problem for non-native speakers is using refusals and because of this, second language teachers and others who communicate in that language should have the cultural differences in mind. When the interlocutors say “no” to a request or invitation, either directly or indirectly, they use speech act of refusalRefusal is considered a face threatening act, as there exists a kind of contradiction in it and is always realized indirectly. Thus, a high level of pragmatic competence is needed to realize it. The aim of this study is to find out whether the age and sex of Iranian learners have any effect on their used refusal strategies and if the existence of such an effect was demonstrated which group is more native like in terms of content and form of used strategies. To achieve this end, graduated students (male/female of different age, sex and different fields of study were selected. Three groups of participants participated in this study. The first group includes 30 American English Speakers (A.E.S. The second group consists of participants whose ages were between 22-29 and the third group was a group of 30 participants of both sexes who speak English as a second language (sex is the only variable under study in this group. Using a Discourse Completion Test (DCT, a number of refusal situations were collected, responded by participants and analyzed. The results revealed that the age and sex of EFL learners does not have any significant effect on using refusal strategies.

  6. Why do some women refuse to allow male residents to perform pelvic exams?

    Science.gov (United States)

    Rifkin, Julie I; Shapiro, Howard; Regensteiner, Judith G; Stotler, Jeanne K; Schmidt, Betty

    2002-10-01

    Many women who receive medical care in residency training clinics refuse to allow male residents to perform their pelvic exams. This study was conducted to identify which women were most likely to refuse and to learn their reasons for refusing. From January to March 1997, a questionnaire was given to all women entering a Tri-County Health office and a Planned Parenthood clinic, both in the Denver, Colorado, metropolitan area, who consented to participate in the study. Data from the questionnaire were analyzed using a statistical software package. A total of 1,437 women entered the clinics during the study period. Of these patients, 1,078 consented to complete the questionnaire. Seven of these 1,078 women did not complete the questionnaire. Women who did not know the training level of the resident performing the pelvic exam were more likely to refuse than were women who knew the training level of the resident (p =.001), but many women preferred a female physician regardless of the physician's training level. Fifty-eight percent said they would allow a male resident to observe a female attending physician perform the exam, compared with 36% who said they would allow a male resident to observe if the attending physician was a man. Common statements from those who would refuse were: "I am just more comfortable with a female," "Women do not want men to examine their private body parts," and "Women explain things better." A woman's knowledge of the resident's training level correlates with her willingness to have a pelvic exam performed by a male resident. Women who said they would refuse a pelvic exam performed by a male resident gave specific reasons for their decision.

  7. Pediatric Depression: When Does Parental Refusal for Treatment Constitute Medical Neglect?

    Science.gov (United States)

    Shapiro, Michael

    2018-06-01

    Depression is a common disorder in youth, and 10% to 15% of individuals have a lifetime prevalence by 18 years of age. Youth who receive treatment typically have a positive outcome, but many remain undiagnosed and untreated. 1 There is a dearth of literature on parental refusal to consent to treatment for pediatric depression and the circumstances under which such refusal could be considered medical neglect. In general, it appears that mental health diagnoses are rarely reported in cases of medical neglect. 2 . Copyright © 2018 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  8. [Remaining a caregiver in the face of a refusal of nursing care].

    Science.gov (United States)

    Blanchard, Karine; Ménard, Rachel; Corvol, Aline

    2016-10-01

    Caregivers working with elderly people often find themselves in a difficult position when faced with the refusal of nursing care, whether or not the patient presents cognitive disorders. The nurses from the mobile geriatrics team of Rennes university hospital are regularly asked to help the caregiving teams in such situations. Refusals may concern washing, medication, eating, moving to an armchair, the organisation of physical aids or human assistance after discharge or transfer to a nursing home. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  9. 14 CFR 120.11 - Refusal to submit to a drug or alcohol test by a Part 61 certificate holder.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Refusal to submit to a drug or alcohol test...: CERTIFICATION AND OPERATIONS DRUG AND ALCOHOL TESTING PROGRAM Individuals Certificated Under Parts 61, 63, and 65 § 120.11 Refusal to submit to a drug or alcohol test by a Part 61 certificate holder. (a) This...

  10. 14 CFR 120.15 - Refusal to submit to a drug or alcohol test by a Part 65 certificate holder.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Refusal to submit to a drug or alcohol test...: CERTIFICATION AND OPERATIONS DRUG AND ALCOHOL TESTING PROGRAM Individuals Certificated Under Parts 61, 63, and 65 § 120.15 Refusal to submit to a drug or alcohol test by a Part 65 certificate holder. (a) This...

  11. 14 CFR 120.13 - Refusal to submit to a drug or alcohol test by a Part 63 certificate holder.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Refusal to submit to a drug or alcohol test...: CERTIFICATION AND OPERATIONS DRUG AND ALCOHOL TESTING PROGRAM Individuals Certificated Under Parts 61, 63, and 65 § 120.13 Refusal to submit to a drug or alcohol test by a Part 63 certificate holder. (a) This...

  12. Risk taking and refusal assertiveness in a longitudinal model of alcohol use among inner-city adolescents.

    Science.gov (United States)

    Epstein, J A; Griffin, K W; Botvin, G J

    2001-09-01

    Risk taking and refusal assertiveness have been shown to be important determinants of adolescent alcohol use. However, it remains unclear whether youth predisposed to risk taking would be less likely to assertively refuse. This study examined the relationships among risk taking, refusal assertiveness, and alcohol use in a sample of inner-city minority students (N = 1,459), using a cross-lagged longitudinal structural equation model. Data collectors administered the questionnaire to students following a standardized protocol during a 40-min class period. Based on the tested model, risk taking was more stable over time than refusal assertiveness. Furthermore, high risk takers reported less frequent subsequent refusal assertiveness, and less frequent refusal assertiveness predicted greater drinking. A predisposition toward risk taking appears to be an enduring characteristic that is associated with low refusal assertiveness and increased alcohol use. These findings suggest that alcohol prevention programs that emphasize refusal skills training may be less effective for high risk takers. But programs that focus on enhancing competence or reducing normative expectations for peer alcohol use might be more effective for high risk-taking youth.

  13. Risky procedures by nurses in hospitals: problems and (contemplated) refusals of orders by physicians, and views of physicians and nurses

    NARCIS (Netherlands)

    de Bie, J.; Cuperus-Bosma, J.M.; van der Jagt, M.A.; Gevers, J.K.M.; van der Wal, G.

    2005-01-01

    Occurrence of problems with, refusals of orders and contemplated refusals of orders for risky procedures by nurses in Dutch hospitals and views on the safety of performance was studied using postal questionnaires (600 physicians and 3200 nurses, response 60-71%). Of the respondents, 11-30%

  14. Higher refusal rates for organ donation among older potential donors in the Netherlands: impact of the donor register and relatives.

    NARCIS (Netherlands)

    Leiden, H.A. van; Jansen, N.E.; Haase-Kromwijk, B.J.; Hoitsma, A.J.

    2010-01-01

    BACKGROUND: The availability of donor organs is considerably reduced by relatives refusing donation after death. There is no previous large-scale evaluation of the influence of the Donor Register (DR) consultation and the potential donor's age on this refusal in The Netherlands. METHODS: This study

  15. Predicting risk of school refusal: Examining the incremental role of trait EI beyond personality and emotion regulation

    Directory of Open Access Journals (Sweden)

    Filippello Pina

    2018-01-01

    Full Text Available Research has not yet been deepened in the link between personality factors and risk of school refusal. Furthermore, previous studies fail to verify the direct relation between trait EI and the risk of school refusal. The present study examined personality traits, emotion regulation and trait EI for the contributory role they may play in predicting the risk of school refusal. The sample consisted of 311 participants, 112 males (36% and 199 females (64% with an average age of 14.19 (SD = .60, from a high school in the city of Messina (Sicily, Italy. Results show that the risk of school refusal is positively related to neuroticism and maladaptive emotion regulation strategies, while it is negatively related to the extroversion, agreeableness and conscientiousness and trait EI. Moreover, trait EI can be considered as a strong incremental negative predictor of risk of school refusal over and above personality traits and emotion regulation.

  16. 9 CFR 351.19 - Refusal of certification for specific lots.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Refusal of certification for specific lots. 351.19 Section 351.19 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION...

  17. Psychological Factors behind Truancy, School Phobia, and School Refusal: A Literature Study

    Science.gov (United States)

    Ek, Hans; Eriksson, Rikard

    2013-01-01

    Truancy is a problem that normally leads to treatment interventions within different organizations. Within these organizations different perspectives on the causes and consequences of the above problem can be found. The purpose of this literature study is to map out and describe the current state of research within the fields of school refusal,…

  18. Mothers' reasons for refusing to give consent to HIV testing and the ...

    African Journals Online (AJOL)

    under-five mortality rate by more than half since 1990. ... children in sub-Saharan Africa. ... In Limpopo Province, South Africa, the prevention of mother-to-child ... had attended antenatal care, 28 (93%) stated that their HIV results were negative ... (16%) mothers signed refusal of hospital treatment, three (12%) started ARV ...

  19. An investigation on the fuel savings potential of hybrid hydraulic refuse collection vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Bender, Frank A., E-mail: bender@isys.uni-stuttgart.de; Bosse, Thomas; Sawodny, Oliver

    2014-09-15

    Highlights: • Driving cycle acquisition in a refuse collection vehicle. • Vehicle modeling and validation for numerical simulations based on the measured driving cycle. • Fuel consumption analysis for a conventional diesel vehicle and a hybrid hydraulic vehicle. - Abstract: Refuse trucks play an important role in the waste collection process. Due to their typical driving cycle, these vehicles are characterized by large fuel consumption, which strongly affects the overall waste disposal costs. Hybrid hydraulic refuse vehicles offer an interesting alternative to conventional diesel trucks, because they are able to recuperate, store and reuse braking energy. However, the expected fuel savings can vary strongly depending on the driving cycle and the operational mode. Therefore, in order to assess the possible fuel savings, a typical driving cycle was measured in a conventional vehicle run by the waste authority of the City of Stuttgart, and a dynamical model of the considered vehicle was built up. Based on the measured driving cycle and the vehicle model including the hybrid powertrain components, simulations for both the conventional and the hybrid vehicle were performed. Fuel consumption results that indicate savings of about 20% are presented and analyzed in order to evaluate the benefit of hybrid hydraulic vehicles used for refuse collection.

  20. An investigation on the fuel savings potential of hybrid hydraulic refuse collection vehicles

    International Nuclear Information System (INIS)

    Bender, Frank A.; Bosse, Thomas; Sawodny, Oliver

    2014-01-01

    Highlights: • Driving cycle acquisition in a refuse collection vehicle. • Vehicle modeling and validation for numerical simulations based on the measured driving cycle. • Fuel consumption analysis for a conventional diesel vehicle and a hybrid hydraulic vehicle. - Abstract: Refuse trucks play an important role in the waste collection process. Due to their typical driving cycle, these vehicles are characterized by large fuel consumption, which strongly affects the overall waste disposal costs. Hybrid hydraulic refuse vehicles offer an interesting alternative to conventional diesel trucks, because they are able to recuperate, store and reuse braking energy. However, the expected fuel savings can vary strongly depending on the driving cycle and the operational mode. Therefore, in order to assess the possible fuel savings, a typical driving cycle was measured in a conventional vehicle run by the waste authority of the City of Stuttgart, and a dynamical model of the considered vehicle was built up. Based on the measured driving cycle and the vehicle model including the hybrid powertrain components, simulations for both the conventional and the hybrid vehicle were performed. Fuel consumption results that indicate savings of about 20% are presented and analyzed in order to evaluate the benefit of hybrid hydraulic vehicles used for refuse collection

  1. Electric equipment for Koto Refuse Incineration Plant; Tokyoto Koto seiso kojo muke denki setsubi

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-03-10

    Meidensha Corporation, intending to enter into refuse disposal business, delivered electric equipment to a Koto Refuse Incineration Plant, Koto Ward, Tokyo, and the facilities came into operation in October, 1998. The plant is the largest in Japan in terms of refuse processing capacity (1800t/day), and efforts are exerted to harmonize the plant with the surroundings, which involve pollution measures and a building that images a cruising yacht. The power receiving facility consists of a 66kV nominal two-circuit gas insulated switch and gas insulated transformer arranged in a space saving design. Heat from refuse incineration is fed to a steam turbine generator (yielding 50MW, the largest in Japan, with the surplus offered for sale after 15MW fed to loads in the site) and to neighboring facilities. For the suppression of fluctuations in voltage at the power receiving point, reactive power is subjected to control which is done by controlling the generator magnetic field system. An 11kV distribution system is provided to match the steam turbine generator voltage, and the voltage is stepped down to 6.6kV with the intermediary of a 23MVA gas insulated transformer. The power is fed to high voltage motors such as the one used for the induced draft fan, electric equipment in the buildings, power facilities in the plant, etc. A power monitoring board is provided in the central control room for general supervision over the power related facilities. (NEDO)

  2. 37 CFR 1.47 - Filing when an inventor refuses to sign or cannot be reached.

    Science.gov (United States)

    2010-07-01

    ... reached. (a) If a joint inventor refuses to join in an application for patent or cannot be found or reached after diligent effort, the application may be made by the other inventor on behalf of himself or... PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE GENERAL RULES OF PRACTICE IN PATENT CASES National...

  3. Refuse derived soluble bio-organics enhancing tomato plant growth and productivity

    Energy Technology Data Exchange (ETDEWEB)

    Sortino, Orazio [Dipartimento di Scienze Agronomiche Agrochimiche e delle Produzioni Animali, Universita degli Studi di Catania, Via Valdisavoia 5, 95123 Catania (Italy); Dipasquale, Mauro [Dipartimento di Chimica, Universita di Torino, Via P. Giuria 7, 10125 Torino (Italy); Montoneri, Enzo, E-mail: enzo.montoneri@unito.it [Dipartimento di Chimica, Universita di Torino, Via P. Giuria 7, 10125 Torino (Italy); Tomasso, Lorenzo; Perrone, Daniele G. [Dipartimento di Chimica, Universita di Torino, Via P. Giuria 7, 10125 Torino (Italy); Vindrola, Daniela; Negre, Michele; Piccone, Giuseppe [Dipartimento di Valorizzazione e Protezione delle Risorse Agroforestali, Universita di Torino, Via L. da Vinci 44, 10095 Grugliasco (Italy)

    2012-10-15

    Highlights: Black-Right-Pointing-Pointer Municipal bio-wastes are a sustainable source of bio-based products. Black-Right-Pointing-Pointer Refuse derived soluble bio-organics promote chlorophyll synthesis. Black-Right-Pointing-Pointer Refuse derived soluble bio-organics enhance plant growth and fruit ripening rate. Black-Right-Pointing-Pointer Sustainable chemistry exploiting urban refuse allows sustainable development. Black-Right-Pointing-Pointer Chemistry, agriculture and the environment benefit from biowaste technology. - Abstract: Municipal bio-refuse (CVD), containing kitchen wastes, home gardening residues and public park trimmings, was treated with alkali to yield a soluble bio-organic fraction (SBO) and an insoluble residue. These materials were characterized using elemental analysis, potentiometric titration, and 13C NMR spectroscopy, and then applied as organic fertilizers to soil for tomato greenhouse cultivation. Their performance was compared with a commercial product obtained from animal residues. Plant growth, fruit yield and quality, and soil and leaf chemical composition were the selected performance indicators. The SBO exhibited the best performance by enhancing leaf chlorophyll content, improving plant growth and fruit ripening rate and yield. No product performance-chemical composition relationship could be assessed. Solubility could be one reason for the superior performance of SBO as a tomato growth promoter. The enhancement of leaf chlorophyll content is discussed to identify a possible link with the SBO photosensitizing properties that have been demonstrated in other work, and thus with photosynthetic performance.

  4. Refusing in a Foreign Language: An Investigation of Problems Encountered by Chinese Learners of English

    Science.gov (United States)

    Chang, Yuh-Fang

    2011-01-01

    Whereas the speech act of refusal is universal across language, the politeness value and the types of linguistic forms used to perform it vary across language and culture. The majority of the comparative pragmatic research findings were derived from one single source of data (i.e., either production data or perception data). Few attempts have been…

  5. Influence of Refuse Sites on the Prevalence of Campylobacter spp. and Salmonella Serovars in Seagulls▿

    OpenAIRE

    Ramos, Raül; Cerdà-Cuéllar, Marta; Ramírez, Francisco; Jover, Lluís; Ruiz, Xavier

    2010-01-01

    Wild animals are well-known reservoirs of Campylobacter and Salmonella. We investigated the influence of insalubrious diets on the prevalence of both enterobacteria in seagulls. Campylobacter occurrence in gull chicks sampled along the northeastern Iberian coast was directly related to the degree of refuse consumption. High Salmonella values from the sampling sites did not reflect any dietary relationship.

  6. Influence of Refuse Sites on the Prevalence of Campylobacter spp. and Salmonella Serovars in Seagulls▿

    Science.gov (United States)

    Ramos, Raül; Cerdà-Cuéllar, Marta; Ramírez, Francisco; Jover, Lluís; Ruiz, Xavier

    2010-01-01

    Wild animals are well-known reservoirs of Campylobacter and Salmonella. We investigated the influence of insalubrious diets on the prevalence of both enterobacteria in seagulls. Campylobacter occurrence in gull chicks sampled along the northeastern Iberian coast was directly related to the degree of refuse consumption. High Salmonella values from the sampling sites did not reflect any dietary relationship. PMID:20208027

  7. Influence of refuse sites on the prevalence of Campylobacter spp. and Salmonella serovars in seagulls.

    Science.gov (United States)

    Ramos, Raül; Cerdà-Cuéllar, Marta; Ramírez, Francisco; Jover, Lluís; Ruiz, Xavier

    2010-05-01

    Wild animals are well-known reservoirs of Campylobacter and Salmonella. We investigated the influence of insalubrious diets on the prevalence of both enterobacteria in seagulls. Campylobacter occurrence in gull chicks sampled along the northeastern Iberian coast was directly related to the degree of refuse consumption. High Salmonella values from the sampling sites did not reflect any dietary relationship.

  8. Blood Transfusion in Children: The Refusal of Jehovah’s Witness Parents’

    Science.gov (United States)

    Conti, Adelaide; Capasso, Emanuele; Casella, Claudia; Fedeli, Piergiorgio; Salzano, Francesco Antonio; Policino, Fabio; Terracciano, Lucia; Delbon, Paola

    2018-01-01

    Abstract In Italy, both parents have parental responsibility; as a general principle they have the power to give or withhold consent to medical procedures on their children, including consent for blood transfusion; however these rights are not absolute and exist only to promote the welfare of children. Methods The Authors discuss ethical and legal framework for Jehovah’s Witness parents’ refusal of blood transfusion in Italy. They searched national judgments concerning Jehovah’s Witness parents’ refusal of blood transfusion – and related comments – in national legal databases and national legal journals, and literature on medical literature databases. Results In the case of Jehovah’s Witness parents’ refusal of blood transfusion for their child, Italian Courts adopt measures that prevents the parents from exercise their parental responsibility not in the child’s best interest. Discussion In the event that refusal by the parents, outside of emergency situations, exposes the child’s health to serious risk, health workers must proceed by notifying the competent authority, according also to the Italian Code of Medical Ethics. Conclusion When the patient is a minor, the child’s best interest always come first. PMID:29666843

  9. Rape myth acceptance and rape acknowledgment: The mediating role of sexual refusal assertiveness.

    Science.gov (United States)

    Newins, Amie R; Wilson, Laura C; White, Susan W

    2018-05-01

    Unacknowledged rape, defined as when an individual experiences an event that meets a legal or empirical definition of rape but the individual does not label it as such, is prevalent. Research examining predictors of rape acknowledgment is needed. Sexual assertiveness may be an important variable to consider, as an individual's typical behavior during sexual situations may influence rape acknowledgment. To assess the indirect effect of rape myth acceptance on rape acknowledgment through sexual refusal assertiveness, an online survey of 181 female rape survivors was conducted. The indirect effects of two types of rape myths (He didn't mean to and Rape is a deviant event) were significant and positive. Specifically, acceptance of these two rape myths was negatively related to sexual refusal assertiveness, which was negatively associated with likelihood of rape acknowledgment. The results of this study indicate that sexual refusal assertiveness is associated with lower likelihood of rape acknowledgment among rape survivors. As a result, it appears that, under certain circumstances, women high in rape myth acceptance may be more likely to acknowledge rape when it results in decreased sexual refusal assertiveness. Copyright © 2018 Elsevier B.V. All rights reserved.

  10. "To My Relations": Writing and Refusal toward an Indigenous Epistolary Methodology

    Science.gov (United States)

    Cisneros, Nora Alba

    2018-01-01

    In this article, the author presents an Indigenous Epistolary Methodology (IEM) to reflect on what it means for Indigenous women to engage the notion of refusal in traditional writing methods and qualitative research. The author proposes that an IEM, nestled within her familial genealogies, Indigenous Knowledges and Chicana Feminist Epistemology…

  11. Why parents refuse childhood vaccination: a qualitative study using online focus groups

    Science.gov (United States)

    2013-01-01

    Background In high income countries, vaccine-preventable diseases have been greatly reduced through routine vaccination programs. Despite this success, many parents question, and a small proportion even refuse vaccination for their children. As no qualitative studies have explored the factors behind these decisions among Dutch parents, we performed a study using online focus groups. Methods In total, eight online focus groups (n = 60) which included Dutch parents with at least one child, aged 0–4 years, for whom they refused all or part of the vaccinations within the National Immunization Program (NIP). A thematic analysis was performed to explore factors that influenced the parents’ decisions to refuse vaccination. Results Refusal of vaccination was found to reflect multiple factors including family lifestyle; perceptions about the child’s body and immune system; perceived risks of disease, vaccine efficacy, and side effects; perceived advantages of experiencing the disease; prior negative experience with vaccination; and social environment. The use of online focus groups proved to be an effective qualitative research method providing meaningful data. Conclusion Information provided by the NIP turned out to be insufficient for this group of parents. More trust in the NIP and deliberate decisions might result from increased parental understanding of lifestyle and disease susceptibility, the impact of vaccinations on the immune system, and the relative risks of diseases and their vaccines. The public health institute should also inform parents that the NIP is recommended but non-mandatory. PMID:24341406

  12. [A patient who refused treatment after self-poisoning with paracetamol

    NARCIS (Netherlands)

    Kramers, C.; Jansman, F.G.A.; Droogleever Fortuyn, H.A.

    2006-01-01

    Two patients, a 20-year-old man and a 33-year-old woman, were admitted with paracetamol poisoning. Both patients refused treatment initially but eventually complied. The man had a paracetamol concentration of 47.5 mg/l 2.5-5.0 h after ingestion, so antidote treatment was not considered necessary.

  13. 38 CFR 17.100 - Refusal of treatment by unnecessarily breaking appointments.

    Science.gov (United States)

    2010-07-01

    ... and satisfactory reasons are advanced for breaking the appointment and circumstances were such that... unnecessarily breaking appointments. 17.100 Section 17.100 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Breaking Appointments § 17.100 Refusal of treatment by unnecessarily breaking...

  14. Determinants for refusal of HIV testing among women attending for antenatal care in Gambella Region, Ethiopia.

    Science.gov (United States)

    Fanta, Wondimagegn; Worku, Alemayehu

    2012-07-26

    In Gambella region, inhabitants owe socio-cultural factors that might favor refusal for HIV testing service utilization among Antenatal Care attendees. To assess determinants for refusal of HIV testing service utilization among ANC attendees in Gambella Region. A comparative cross sectional study was conducted among ANC attendees from March 2008 to May 2008 in four selected health facilities of Gambella region. Sample size of 332 participants (83 who refused HIV testing and 249 who accepted HIV testing) were taken for the study. The study was supplemented with four focus group discussions. Multivariate binary logistic regression was employed to control for confounding factors. When adjusted with other factors pregnant women with 2-3 live births in the past; who claimed divorce as a perceived response of their husband following HIV positive test result; who had not sought agreement from their husband for testing; disclosure of test for husband and being from certain ethnic group (E.g. Mejenger) were independent predictors for refusal of HIV testing among ANC attendees. Based on the findings, the following recommendations were forwarded: Provision of innovative information and education on the pre-test session for those pregnant women having two or more children; community involvement to tackle stigma; women empowerment; designing couple friendly counseling service; and fighting harmful traditional practices related with decision of HIV testing.

  15. [Tuberculosis and refusal of treatment: resorting to legislation on serious health threats].

    Science.gov (United States)

    Bouvet, R; Le Gueut, M

    2013-06-01

    Clinicians are regularly confronted with the question of refusal of treatment from patients with tuberculosis. For several years, the French public health authorities have been studying the possibility of compelling treatment or isolation, but no plan has been implemented even though European and American experiences have shown the effectiveness of restrictive measures. Neither the statutory exceptions to the principle of consent to medical treatment nor the conditions of implementation of "required care" allow legally binding measures against patients refusing care or isolation. The legislation on serious health threats has recently been applied to the situation of a refusal of treatment in the context of tuberculosis. It allowed the patient to be ordered to observe prescribed care and the possibility of forced isolation in the event of breach of this order. The legislation on serious health threats is a response to the question of refusal of treatment from patients with tuberculosis. However the opinion of the legal authority as to its necessity and proportionality to the risk remains unknown. Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  16. Correlates of HIV testing refusal among emergency department patients in the opt-out testing era.

    Science.gov (United States)

    Setse, Rosanna W; Maxwell, Celia J

    2014-05-01

    Opt-out HIV screening is recommended by the CDC for patients in all healthcare settings. We examined correlates of HIV testing refusal among urban emergency department (ED) patients. Confidential free HIV screening was offered to 32,633 ED patients in an urban tertiary care facility in Washington, DC, during May 2007-December 2011. Demographic differences in testing refusals were examined using χ(2) tests and generalized linear models. HIV testing refusal rates were 47.7 % 95 % CI (46.7-48.7), 11.7 % (11.0-12.4), 10.7 % (10.0-11.4), 16.9 % (15.9-17.9) and 26.9 % (25.6-28.2) in 2007, 2008, 2009, 2010 and 2011 respectively. Persons 33-54 years of age [adjusted prevalence ratio (APR) 1.42, (1.36-1.48)] and those ≥ 55 years [APR 1.39 (1.31-1.47)], versus 33-54 years; and females versus males [APR 1.07 (1.02-1.11)] were more likely to refuse testing. Opt-out HIV testing is feasible and sustainable in urban ED settings. Efforts are needed to encourage testing among older patients and women.

  17. 30 CFR 780.25 - Reclamation plan: Siltation structures, impoundments, and refuse piles.

    Science.gov (United States)

    2010-07-01

    ... is capable of being done after consideration of cost, logistics, and available technology. The fact... COAL EXPLORATION SYSTEMS UNDER REGULATORY PROGRAMS SURFACE MINING PERMIT APPLICATIONS-MINIMUM..., and refuse piles. (a) General. Each application must include a general plan and a detailed design plan...

  18. 30 CFR 784.16 - Reclamation plan: Siltation structures, impoundments, and refuse piles.

    Science.gov (United States)

    2010-07-01

    ... of being done after consideration of cost, logistics, and available technology. The fact that one... COAL EXPLORATION SYSTEMS UNDER REGULATORY PROGRAMS UNDERGROUND MINING PERMIT APPLICATIONS-MINIMUM..., and refuse piles. (a) General. Each application must include a general plan and a detailed design plan...

  19. Effects from different types of construction refuse in the soil on electrodialytic remediation

    DEFF Research Database (Denmark)

    Ottosen, Lisbeth M.; Eriksson, Thomas; Hansen, Henrik K.

    2002-01-01

    At abandoned industrial sites some of the previous buildings are often left behind. If the soil at such site is polluted with heavy metals and is to be remediated by an electrochemical method, the construction refuse within the soil matrix will influence the remediation action. The influence of d...

  20. War Memories and the Refusal of Male Dominance in Shakir's "Oh, Lebanon"

    Science.gov (United States)

    Al-Momani, Hassan Ali Abdullah

    2017-01-01

    This study investigates the role of the war memories in the construction of the female gender identity in Evelyin Shakir's "Oh, Lebanon," in which the female protagonist refuses to belong to her Arab identity when she lives in the United States because of the brutal war memories she witnesses in Lebanon. Such memories make the…

  1. [Behavioural psychotherapy for encopresis shown on a girl with chronic "toilet-refusal-syndrome"].

    Science.gov (United States)

    Hansen, Berit; Lehmkuhl, Ulrike

    2007-01-01

    Encopresis is one of the areas of the psychiatric diseases in childhood and adolescence that has been less researched. There is not much literature on the treatment of encopresis. The article describes a standard behavioural therapy including a case report on a 7, 9 year old girl with chronic "toilet-refusal-syndrome".

  2. Refuse derived soluble bio-organics enhancing tomato plant growth and productivity

    International Nuclear Information System (INIS)

    Sortino, Orazio; Dipasquale, Mauro; Montoneri, Enzo; Tomasso, Lorenzo; Perrone, Daniele G.; Vindrola, Daniela; Negre, Michele; Piccone, Giuseppe

    2012-01-01

    Highlights: ► Municipal bio-wastes are a sustainable source of bio-based products. ► Refuse derived soluble bio-organics promote chlorophyll synthesis. ► Refuse derived soluble bio-organics enhance plant growth and fruit ripening rate. ► Sustainable chemistry exploiting urban refuse allows sustainable development. ► Chemistry, agriculture and the environment benefit from biowaste technology. - Abstract: Municipal bio-refuse (CVD), containing kitchen wastes, home gardening residues and public park trimmings, was treated with alkali to yield a soluble bio-organic fraction (SBO) and an insoluble residue. These materials were characterized using elemental analysis, potentiometric titration, and 13C NMR spectroscopy, and then applied as organic fertilizers to soil for tomato greenhouse cultivation. Their performance was compared with a commercial product obtained from animal residues. Plant growth, fruit yield and quality, and soil and leaf chemical composition were the selected performance indicators. The SBO exhibited the best performance by enhancing leaf chlorophyll content, improving plant growth and fruit ripening rate and yield. No product performance-chemical composition relationship could be assessed. Solubility could be one reason for the superior performance of SBO as a tomato growth promoter. The enhancement of leaf chlorophyll content is discussed to identify a possible link with the SBO photosensitizing properties that have been demonstrated in other work, and thus with photosynthetic performance.

  3. The Right of Psychiatric Patients to Refuse Medication: Where Should Social Workers Stand?

    Science.gov (United States)

    Bentley, Kia J.

    1993-01-01

    Addresses differences among competence, commitment, and mental illness; the right to privacy; and the prohibition against cruel and unusual punishment. Reviews professional motivations in relation to both sides of controversy over rights of psychiatric patients to refuse medication. Presents position for social work profession that stands for…

  4. A Study on the Perception of Jordanian EFL Learners’ Pragmatic Transfer of Refusals

    Directory of Open Access Journals (Sweden)

    Ibrahim Fathi Huwari

    2015-02-01

    Full Text Available This study investigates the perception of Jordanian EFL learners’ (JEFL pragmatic transfer of refusal strategies in terms of contextual and cultural factors. Data were collected using a discourse completion test (DCT and a scaled-response questionnaire (SRQ to elicit perception data from the participants. Data from the SRQ were analyzed based on the speaker’s right to refuse the initiating act. Findings revealed that the right the speaker has to refuse the initiating act was assigned high ratings by the three groups (i.e., M > 3.00 in all social categories. Individually, however, the groups displayed the rating value differently where the AEL1 group’s perception of the speaker’s right was relatively higher than that of the JEFL and JAL1 groups in all the social categories. The JEFL participants’ negative pragmatic transfer criteria were met in the first and third social categories. The study concludes with a discussion of important directions for future research. Keywords: Perception, Refusal, Pragmatic transfer, Pragmalinguistic transfer, Sociopragmatic transfer

  5. Correlates of Inconsistent Refusal of Unprotected Sex among Armenian Female Sex Workers

    Directory of Open Access Journals (Sweden)

    Karine Markosyan

    2014-01-01

    Full Text Available This cross-sectional study assessed the prevalence and correlates of inconsistent refusal of unprotected sex among female sex workers (FSWs in Armenia. One hundred and eighteen street-based FSWs between the ages of 20 and 52 completed a questionnaire assessing FSWs’ demographic, psychosocial, and behavioral characteristics. A total of 52.5% (n=62 of FSWs reported inconsistent refusal of unprotected sex with clients in the past 3 months. Logistic regression analysis controlling for participants’ age and education revealed that perceiving more barriers toward condom use (AOR = 1.1; P<0.01, reporting more types of abuse (AOR = 2.1; P<0.01, and setting lower fees for service (AOR = 0.9; P=0.02 significantly predicted inconsistent refusal of unprotected sex. HIV-risk-reduction behavioral interventions tailored to FSWs working in Yerevan Armenia should address the factors identified in this study toward the goal of enhancing refusal of unprotected sex and ultimately preventing acquisition of sexually transmitted infections (STIs including HIV.

  6. 37 CFR 204.8 - Appeal of refusal to correct or amend an individual's record.

    Science.gov (United States)

    2010-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Appeal of refusal to correct or amend an individual's record. 204.8 Section 204.8 Patents, Trademarks, and Copyrights COPYRIGHT OFFICE, LIBRARY OF CONGRESS COPYRIGHT OFFICE AND PROCEDURES PRIVACY ACT: POLICIES AND PROCEDURES § 204.8...

  7. Herpes labialis and Nigerian dental health care providers: knowledge, attitudes, behaviors, and refusal to treat.

    Science.gov (United States)

    Azodo, Clement Chinedu; Umoh, Agnes O

    2015-09-15

    The few existing studies on herpes labialis among health care workers have been predominantly among non-dental health care workers. The purpose of this study was to determine Nigerian dental health care providers' knowledge of, attitudes toward, preventive behaviors for, and refusal to treat patients with herpes labialis. This cross-sectional study was conducted among final-year dental students at the University of Benin, dental house officers, and residents at the University of Benin Teaching Hospital, Benin City, Nigeria. Data collection was via a self-administered questionnaire. Bivariate statistics and logistic regression were used to relate the dependent and independent variables. Of the 120 questionnaires distributed, 110 were completed and returned, giving a 91.7% retrieval rate. However, 15 of the returned questionnaires were discarded because they were improperly completed, leaving a total of 95 questionnaires for final analysis in this study. The majority of participants were over 28 years old (54.7%), male (67.4%), unmarried (66.3%), and postgraduate dental health care providers (51.6%). Less than half (43.2%) of participants demonstrated adequate overall knowledge of herpes labialis. About one-tenth (10.5%) and more than three-quarters (87.4%) of participants reported a positive attitude and performance of adequate preventive behaviors, respectively. A total of 16.8% of participants reported a high tendency to refuse treatment to patients with herpes labialis. Although not statistically significant, young, unmarried, male undergraduate participants reported a greater likelihood to refuse treatment to herpes labialis patients. We found a statistically significant positive correlation between attitude and refusal to treat patients with herpes labialis. However, marital status and the attitude of participants toward these patients emerged as the determinants for refusal to treat patients with herpes labialis. Data from this study revealed a high level of

  8. Predictors of condom use and refusal among the population of Free State province in South Africa

    Directory of Open Access Journals (Sweden)

    Chandran Thoovakkunon

    2012-05-01

    Full Text Available Abstract Background This study investigated the extent and predictors of condom use and condom refusal in the Free State province in South Africa. Methods Through a household survey conducted in the Free Sate province of South Africa, 5,837 adults were interviewed. Univariate and multivariate survey logistic regressions and classification trees (CT were used for analysing two response variables ‘ever used condom’ and ‘ever refused condom’. Results Eighty-three per cent of the respondents had ever used condoms, of which 38% always used them; 61% used them during the last sexual intercourse and 9% had ever refused to use them. The univariate logistic regression models and CT analysis indicated that a strong predictor of condom use was its perceived need. In the CT analysis, this variable was followed in importance by ‘knowledge of correct use of condom’, condom availability, young age, being single and higher education. ‘Perceived need’ for condoms did not remain significant in the multivariate analysis after controlling for other variables. The strongest predictor of condom refusal, as shown by the CT, was shame associated with condoms followed by the presence of sexual risk behaviour, knowing one’s HIV status, older age and lacking knowledge of condoms (i.e., ability to prevent sexually transmitted diseases and pregnancy, availability, correct and consistent use and existence of female condoms. In the multivariate logistic regression, age was not significant for condom refusal while affordability and perceived need were additional significant variables. Conclusions The use of complementary modelling techniques such as CT in addition to logistic regressions adds to a better understanding of condom use and refusal. Further improvement in correct and consistent use of condoms will require targeted interventions. In addition to existing social marketing campaigns, tailored approaches should focus on establishing the perceived need

  9. Feasibility of landfill gas as a liquefied natural gas fuel source for refuse trucks.

    Science.gov (United States)

    Zietsman, Josias; Bari, Muhammad Ehsanul; Rand, Aaron J; Gokhale, Bhushan; Lord, Dominique; Kumar, Sunil

    2008-05-01

    The purpose of this paper is to develop a methodology to evaluate the feasibility of using landfill gas (LFG) as a liquefied natural gas (LNG) fuel source for heavy-duty refuse trucks operating on landfills. Using LFG as a vehicle fuel can make the landfills more self-sustaining, reduce their dependence on fossil fuels, and reduce emissions and greenhouse gases. Acrion Technologies Inc. in association with Mack Trucks Inc. developed a technology to generate LNG from LFG using the CO2 WASH process. A successful application of this process was performed at the Eco Complex in Burlington County, PA. During this application two LNG refuse trucks were operated for 600 hr each using LNG produced from gases from the landfill. The methodology developed in this paper can evaluate the feasibility of three LFG options: doing nothing, electricity generation, and producing LNG to fuel refuse trucks. The methodology involved the modeling of several components: LFG generation, energy recovery processes, fleet operations, economic feasibility, and decision-making. The economic feasibility considers factors such as capital, maintenance, operational, and fuel costs, emissions and tax benefits, and the sale of products such as surplus LNG and food-grade carbon dioxide (CO2). Texas was used as a case study. The 96 landfills in Texas were prioritized and 17 landfills were identified that showed potential for converting LFG to LNG for use as a refuse truck fuel. The methodology was applied to a pilot landfill in El Paso, TX. The analysis showed that converting LFG to LNG to fuel refuse trucks proved to be the most feasible option and that the methodology can be applied for any landfill that considers this option.

  10. Is clinician refusal to treat an emerging problem in injury compensation systems?

    Science.gov (United States)

    Brijnath, Bianca; Mazza, Danielle; Kosny, Agnieszka; Bunzli, Samantha; Singh, Nabita; Ruseckaite, Rasa; Collie, Alex

    2016-01-20

    The reasons that doctors may refuse or be reluctant to treat have not been widely explored in the medical literature. To understand the ethical implications of reluctance to treat there is a need to recognise the constraints of doctors working in complex systems and to consider how these constraints may influence reluctance. The aim of this paper is to illustrate these constraints using the case of compensable injury in the Australian context. Between September and December 2012, a qualitative investigation involving face-to-face semistructured interviews examined the knowledge, attitudes and practices of general practitioners (GPs) facilitating return to work in people with compensable injuries. Compensable injury management in general practice in Melbourne, Australia. 25 GPs who were treating, or had treated a patient with compensable injury. The practice of clinicians refusing treatment was described by all participants. While most GPs reported refusal to treat among their colleagues in primary and specialist care, many participants also described their own reluctance to treat people with compensable injuries. Reasons offered included time and financial burdens, in addition to the clinical complexities involved in compensable injury management. In the case of compensable injury management, reluctance and refusal to treat is likely to have a domino effect by increasing the time and financial burden of clinically complex patients on the remaining clinicians. This may present a significant challenge to an effective, sustainable compensation system. Urgent research is needed to understand the extent and implications of reluctance and refusal to treat and to identify strategies to engage clinicians in treating people with compensable injuries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Energy efficacy used to score organic refuse pretreatment processes for hydrogen anaerobic production.

    Science.gov (United States)

    Ruggeri, Bernardo; Luongo Malave, Andrea C; Bernardi, Milena; Fino, Debora

    2013-11-01

    The production of hydrogen through Anaerobic Digestion (AD) has been investigated to verify the efficacy of several pretreatment processes. Three types of waste with different carbon structures have been tested to obtain an extensive representation of the behavior of the materials present in Organic Waste (OW). The following types of waste were selected: Sweet Product Residue (SPR), i.e., confectionary residue removed from the market after the expiration date, Organic Waste Market (OWM) refuse from a local fruit and vegetable market, and Coffee Seed Skin (CSS) waste from a coffee production plant. Several pretreatment processes have been applied, including physical, chemical, thermal, and ultrasonic processes and a combination of these processes. Two methods have been used for the SPR to remove the packaging, manual (SPR) and mechanical (SPRex). A pilot plant that is able to extrude the refuse to 200atm was utilized. Two parameters have been used to score the different pretreatment processes: efficiency (ξ), which takes into account the amount of energy produced in the form of hydrogen compared with the available energy embedded in the refuse, and efficacy (η), which compares the efficiency obtained using the pretreated refuse with that obtained using the untreated refuse. The best result obtained for the SPR was the basic pretreatment, with η=6.4, whereas the thermal basic pretreatment gave the highest value, η=17.0 for SPRex. The best result for the OWM was obtained through a combination of basic/thermal pretreatments with η=9.9; lastly, the CSS residue with ultrasonic pretreatment produced the highest quantity of hydrogen, η=5.2. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Is clinician refusal to treat an emerging problem in injury compensation systems?

    Science.gov (United States)

    Brijnath, Bianca; Mazza, Danielle; Kosny, Agnieszka; Bunzli, Samantha; Singh, Nabita; Ruseckaite, Rasa; Collie, Alex

    2016-01-01

    Objective The reasons that doctors may refuse or be reluctant to treat have not been widely explored in the medical literature. To understand the ethical implications of reluctance to treat there is a need to recognise the constraints of doctors working in complex systems and to consider how these constraints may influence reluctance. The aim of this paper is to illustrate these constraints using the case of compensable injury in the Australian context. Design Between September and December 2012, a qualitative investigation involving face-to-face semistructured interviews examined the knowledge, attitudes and practices of general practitioners (GPs) facilitating return to work in people with compensable injuries. Setting Compensable injury management in general practice in Melbourne, Australia. Participants 25 GPs who were treating, or had treated a patient with compensable injury. Results The practice of clinicians refusing treatment was described by all participants. While most GPs reported refusal to treat among their colleagues in primary and specialist care, many participants also described their own reluctance to treat people with compensable injuries. Reasons offered included time and financial burdens, in addition to the clinical complexities involved in compensable injury management. Conclusions In the case of compensable injury management, reluctance and refusal to treat is likely to have a domino effect by increasing the time and financial burden of clinically complex patients on the remaining clinicians. This may present a significant challenge to an effective, sustainable compensation system. Urgent research is needed to understand the extent and implications of reluctance and refusal to treat and to identify strategies to engage clinicians in treating people with compensable injuries. PMID:26792215

  13. 45 CFR 286.150 - Can a family, with a child under age 6, be penalized because a parent refuses to work because (s...

    Science.gov (United States)

    2010-10-01

    ... arrangements are unavailable. (b) Refusal to work when an acceptable form of child care is available is not... penalized because a parent refuses to work because (s)he cannot find child care? 286.150 Section 286.150... a parent refuses to work because (s)he cannot find child care? (a) If the individual is a single...

  14. Prevention of formation of acid drainage from high-sulfur coal refuse by inhibition of iron- and sulfur-oxidizing microorganisms. II. Inhibition in run of mine refuse under simulated field conditions

    Energy Technology Data Exchange (ETDEWEB)

    Dugan, P.R.

    1987-01-01

    The combination of sodium lauryl sulfate and benzoic acid effectively inhibits iron- and sulfur-oxidizing bacteria in coal refuse and prevents the conversion of iron pyrite to sulfate, ferric iron, and sulfuric acid, thereby significantly reducing the formation of acidic drainage from coal refuse. The inhibitors were effective in a concentration of 1.1. mg/kg refuse, and data indicate that the SLS was in excess of the concentration required. The treatment was compatible with the use of lime for neutralization of acid present prior to inhibition of its formation.

  15. Wife beating refusal among women of reproductive age in urban and rural Ethiopia.

    Science.gov (United States)

    Gurmu, Eshetu; Endale, Senait

    2017-03-16

    Wife beating is the most common and widespread form of intimate partner violence in Ethiopia. It results in countless severe health, socio-economic and psychological problems and has contributed to the violation of human rights including the liberty of women to enjoy conjugal life. The main purpose of this study is to assess the levels and patterns of wife beating refusal and its associated socio-cultural and demographic factors in rural and urban Ethiopia. The 2011 Ethiopian Demographic and Health Survey (EDHS) data based on 11,097 and 5287 women in the reproductive age group (i.e. 15-49 years) living in rural and urban areas, respectively,were used in this study. Cronbach's alpha was used to assess the internal consistency of the measure of women's attitudes towards wife beating. The Statistical Package for Social Sciences was applied to analyze the data. A binary logistic regression model was fitted to identify variables that significantly predict respondents' refusal of wife beating. Separate analysis by a place of residence was undertaken as attitude towards wife beating vary between rural and urban areas. The likelihood of refusing wife beating in Ethiopia was significantly higher among urban women (54.2%) than rural women (24.5%). Although there was a significant variations in attitude towards refusing wife beating among different regions in Ethiopia, increasing educational level, high access to media, age of respondents were associated with high level of refusal of wife beating. In contrast, rural residence, being in marital union, high number of living children, being followers of some religions (Muslim followers in urban and Protestants in rural) were associated with low level of refusal of wife beating. The findings of this study reveal that wife beating in Ethiopia is a function of demographic and socio-cultural factors among which age and educational attainment of respondents, number of living children, religious affiliation, marital commitment and

  16. Trans*+ing Classrooms: The Pedagogy of Refusal as Mediator for Learning

    Directory of Open Access Journals (Sweden)

    sj Miller

    2016-07-01

    Full Text Available Gender and sexuality norms, conscribed under cis/heteropatriarchy, have established violent and unstable social and educational climates for the millennial generation of lesbian, gay, bisexual, transgender, intersex, agender/asexual, gender creative, and questioning youth. While strides have been made to make schools more supportive and queer inclusive, schools still struggle to include lesbian, gay, bisexual, transgender*+, intersex, agender/asexual, gender creative, queer and questioning (LGBT*+IAGCQQ-positive curricula. While extensive studies must be done on behalf of all queer youth, this work specifically focuses on how to support classroom teachers to uptake and apply a pedagogy of refusal that attends to the most vulnerabilized population of queer youth to date, those that are trans*+. A pedagogy of refusal will be explored through an evolving theory of trans*+ness, then demonstrated through a framework for classroom application, followed by recommendations for change.

  17. CO-COMBUSTION OF REFUSE DERIVED FUEL WITH COAL IN A FLUIDISED BED COMBUSTOR

    Directory of Open Access Journals (Sweden)

    W. A. WAN AB KARIM GHANI

    2009-03-01

    Full Text Available Power generation from biomass is an attractive technology which utilizes municipal solid waste-based refused derived fuel. In order to explain the behavior of biomass-fired fluidized bed incinerator, biomass sources from refuse derived fuel was co-fired with coal in a 0.15 m diameter and 2.3 m high fluidized bed combustor. The combustion efficiency and carbon monoxide emissions were studied and compared with those from pure coal combustion. This study proved that the blending effect had increased the carbon combustion efficiency up to 12% as compared to single MSW-based RDF. Carbon monoxide levels fluctuated between 200-1600 ppm were observed when coal is added. It is evident from this research that efficient co-firing of biomass with coal can be achieved with minimum modification of existing coal-fired boilers.

  18. A right to choose how to live: the Australian common law position on refusals of care.

    Science.gov (United States)

    Curnow, Katherine

    2014-12-01

    There has been limited examination of the Australian common law position regarding contemporaneous refusals of care or medical treatment by competent adults since the first two Australian cases to adjudicate on refusals of this type: H Ltd v J and Brightwater Care Group (Inc) v Rossiter. This article maps the legal position in Australia in light of the two cases with particular emphasis on the finding in H Ltd v J that self-starvation is not suicide at common law. Finally, this article highlights the broader relevance of this area of the law and its capacity to inform debates as disparate as whether to legalise voluntary euthanasia and the possible implications for the autonomy of pregnant women of proposed laws giving legal status to fetuses (particularly Zoe's Law).

  19. The rights of the dying: the refusal of medical treatments in Argentine courts

    Directory of Open Access Journals (Sweden)

    Juan Pedro Alonso

    2016-10-01

    Full Text Available This paper addresses the judicialization of end of life medical decision-making, as part of the advance of the justice system in the regulation of medical practice and the rise of recognition of patient autonomy. The article analyzes, from a sociological standpoint, legal decisions regarding treatment refusal at the end of life produced by the Argentine courts between 1975 and 2015. Based on a qualitative design, 38 sentences collected from jurisprudential databases using key terms were analyzed. First, judicialized cases during the period are described; these are characterized by a high proportion of claims presented by health institutions, a pro-treatment bias in the legal actions requested, and a high percentage of unnecessary litigation in the absence of conflicts or in situations that do not require court intervention. Second, legal and extralegal factors affecting the justiciability of decisions to refuse or withdraw medical treatments, such as changes in the law and processes of politicization of claims, are analyzed.

  20. Do pharmacists have a right to refuse to fill prescriptions for abortifacient drugs?

    Science.gov (United States)

    Weinstein, B D

    1992-01-01

    Some pharmacists opposed to abortion on moral ground are concerned by having to fill prescriptions for abortifacient drugs like mifepristone (RU-486). The issue of the right of pharmacists to refuse to fill such prescriptions depends on the model of the physician-pharmacist-patient relationship. The libertarian model of pharmacy practice holds that physicians, pharmacists, and patients are bound only by the contract that they freely negotiate with one another, thus the pharmacist has no moral obligation to fill a prescription for mifepristone unless he or she has expressly contracted to do so. The American Pharmaceutical Association's 1981 Code of Ethics does not specify what a pharmacist ought to do in particular circumstances. The right to refuse is strongly supported by the principles of nonmaleficence and respect for autonomy. These are principles of the libertarian model of the pharmacist-patient relationship but are also present in the guild or societal models stressing the duty to avoid harming others. Justification for pharmacists right of refusal appeals to their autonomy rights as members of the moral community rather than the profession of pharmacy. Since the professional right to autonomy is not absolute, moral consideration circumscribe it: it is difficult to argue that a pharmacist who believes that homosexuality is immoral has the right to refuse to fill a prescription for AZT. Even if a person who presents such a prescription is homosexual there is no causal relationship between filling a prescription for AZT and participating in a homosexual act. At the opposite end the libertarians reject the notion of even a basic right to health care. A woman in the above situation would not have a right to the abortifacient drug, so a pharmacist has no duty to dispense it. According to the technician model of professionalism, the pharmacist's personal values do not matter, so a pharmacist has a duty to provide the service.

  1. Psychosocial Interventions for School Refusal with Primary and Secondary School Students: A Systematic Review

    OpenAIRE

    Brandy Maynard; Kristen E. Brendel; Jeffery J. Bulanda; David Heyne; Aaron M. Thompson; Therese D. Pigott

    2015-01-01

    BACKGROUND School refusal is a psychosocial problem characterized by a student’s difficulty attending school and, in many cases, substantial absence from school (Heyne & Sauter, 2013). It is often distinguished from truancy, in part because of the severe emotional distress associated with having to attend school and the absence of severe antisocial behavior. Truancy, on the other hand, is not typically associated with emotional distress and is commonly associated with severe externalizing ...

  2. The European investment bank and financing the installation of urban refuse treatment plants with energy recovery

    International Nuclear Information System (INIS)

    Marty-Gauquie, H.

    1992-01-01

    The European Investment Bank (BEI), the world's leading international financing institution, with an annual loans total of 15.3 billion Ecus in 1991, every year finances a number of projects for the treatment of refuse, with energy recovery from waste and heat distribution. This article describes the missions of the BEI and the parameters taken into account for authorizing investment. (author). 2 figs., 2 tabs

  3. Refusal to provide health care to people with HIV in France.

    OpenAIRE

    Douay , Caroline; Toullier , Adeline; Benayoun , Sarah; Castro , Daniela Rojas; Chauvin , Pierre

    2016-01-01

    International audience; Refusals to provide care to people with HIV have been reported in the USA, the UK and elsewhere in Europe but their frequency remains poorly documented. In 2015, the French parliament examined a law that includes an article on non-discrimination in access to health care and the possibility of doing tests to determine the extent and nature of the discrimination. During the legislative debates, AIDES did a situation testing survey4 to ascertain the frequency and nature o...

  4. [Organising and supporting the end of life when faced with a refusal of care].

    Science.gov (United States)

    Rautureau, Pascal

    2018-04-01

    Often ethically complex, end-of-life situations can mean nursing teams are confronted with a refusal of care. Through a representative clinical situation, a nurse describes the support provided by a multidisciplinary team, in the home, to comply with the wishes of a person at the end of life, support the family, anticipate possible difficulties and organise adapted care which respects all those concerned. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  5. Minors' rights to refuse medical treatment requested by their parents: remaining issues.

    Science.gov (United States)

    Griswold, D P; Griswold, D B

    2000-08-01

    Nurse practitioners are regularly faced with ethical and legal dilemmas when providing care to minors. Laws may not provide clear direction; there may even be conflicting precedents regarding the status of minors, particularly with regard to the juvenile justice system. This article reviews the status of minors' rights with regard to refusing or consenting to medical tests or treatments. Three cases from one author's (DPG) practice illustrate the issues involved.

  6. Vaccination Confidence and Parental Refusal/Delay of Early Childhood Vaccines.

    Directory of Open Access Journals (Sweden)

    Melissa B Gilkey

    Full Text Available To support efforts to address parental hesitancy towards early childhood vaccination, we sought to validate the Vaccination Confidence Scale using data from a large, population-based sample of U.S. parents.We used weighted data from 9,354 parents who completed the 2011 National Immunization Survey. Parents reported on the immunization history of a 19- to 35-month-old child in their households. Healthcare providers then verified children's vaccination status for vaccines including measles, mumps, and rubella (MMR, varicella, and seasonal flu. We used separate multivariable logistic regression models to assess associations between parents' mean scores on the 8-item Vaccination Confidence Scale and vaccine refusal, vaccine delay, and vaccination status.A substantial minority of parents reported a history of vaccine refusal (15% or delay (27%. Vaccination confidence was negatively associated with refusal of any vaccine (odds ratio [OR] = 0.58, 95% confidence interval [CI], 0.54-0.63 as well as refusal of MMR, varicella, and flu vaccines specifically. Negative associations between vaccination confidence and measures of vaccine delay were more moderate, including delay of any vaccine (OR = 0.81, 95% CI, 0.76-0.86. Vaccination confidence was positively associated with having received vaccines, including MMR (OR = 1.53, 95% CI, 1.40-1.68, varicella (OR = 1.54, 95% CI, 1.42-1.66, and flu vaccines (OR = 1.32, 95% CI, 1.23-1.42.Vaccination confidence was consistently associated with early childhood vaccination behavior across multiple vaccine types. Our findings support expanding the application of the Vaccination Confidence Scale to measure vaccination beliefs among parents of young children.

  7. On the relative contributions of positive reinforcement and escape extinction in the treatment of food refusal.

    OpenAIRE

    Piazza, Cathleen C; Patel, Meeta R; Gulotta, Charles S; Sevin, Bari M; Layer, Stacy A

    2003-01-01

    We compared the effects of positive reinforcement alone, escape extinction alone, and positive reinforcement with escape extinction in the treatment of the food and fluid refusal of 4 children who had been diagnosed with a pediatric feeding disorder. Consumption did not increase when positive reinforcement was implemented alone. By contrast, consumption increased for all participants when escape extinction was implemented, independent of the presence or absence of positive reinforcement. Howe...

  8. Refusal of recommended maternity care: Time to make a pact with women?

    Science.gov (United States)

    Jenkinson, Bec; Kruske, Sue; Kildea, Sue

    2018-03-28

    The right to refuse medical treatment can be contentious in maternity care. Professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy, but there is little guidance available to clinicians about the appropriate clinical responses when women decline recommended care. We propose a comprehensive, woman-centred, systems-level framework for documentation and communication with the goal of supporting women, clinicians and health services in situations of maternal refusal. We term this the Personalised Alternative Care and Treatment framework. The Personalised Alternative Care and Treatment framework addresses Australian policy, practice, education and professional issues to underpin woman-centred care in the context of maternal refusal. It embeds Respectful Maternity Care in system-level maternity care policy; highlights the woman's role as decision maker about her maternity care; documents information exchanged with women; creates a 'living' plan that respects the woman's birth intentions and can be reviewed as circumstances change; enables communication between clinicians; permits flexible initiation pathways; provides for professional education for clinicians, and incorporates a mediation role to act as a failsafe. The Personalised Alternative Care and Treatment framework has the potential to meet the needs of women, clinicians and health services when pregnant women decline recommended maternity care. Copyright © 2018. Published by Elsevier Ltd.

  9. An investigation on the fuel savings potential of hybrid hydraulic refuse collection vehicles.

    Science.gov (United States)

    Bender, Frank A; Bosse, Thomas; Sawodny, Oliver

    2014-09-01

    Refuse trucks play an important role in the waste collection process. Due to their typical driving cycle, these vehicles are characterized by large fuel consumption, which strongly affects the overall waste disposal costs. Hybrid hydraulic refuse vehicles offer an interesting alternative to conventional diesel trucks, because they are able to recuperate, store and reuse braking energy. However, the expected fuel savings can vary strongly depending on the driving cycle and the operational mode. Therefore, in order to assess the possible fuel savings, a typical driving cycle was measured in a conventional vehicle run by the waste authority of the City of Stuttgart, and a dynamical model of the considered vehicle was built up. Based on the measured driving cycle and the vehicle model including the hybrid powertrain components, simulations for both the conventional and the hybrid vehicle were performed. Fuel consumption results that indicate savings of about 20% are presented and analyzed in order to evaluate the benefit of hybrid hydraulic vehicles used for refuse collection. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. St. Louis demonstration final report: refuse processing plant equipment, facilities, and environmental evaluations

    Energy Technology Data Exchange (ETDEWEB)

    Fiscus, D.E.; Gorman, P.G.; Schrag, M.P.; Shannon, L.J.

    1977-09-01

    The results are presented of processing plant evaluations of the St. Louis-Union Electric Refuse Fuel Project, including equipment and facilities as well as assessment of environmental emissions at both the processing and the power plants. Data on plant material flows and operating parameters, plant operating costs, characteristics of plant material flows, and emissions from various processing operations were obtained during a testing program encompassing 53 calendar weeks. Refuse derived fuel (RDF) is the major product (80.6% by weight) of the refuse processing plant, the other being ferrous metal scrap, a marketable by-product. Average operating costs for the entire evaluation period were $8.26/Mg ($7.49/ton). The average overall processing rate for the period was 168 Mg/8-h day (185.5 tons/8-h day) at 31.0 Mg/h (34.2 tons/h). Future plants using an air classification system of the type used at the St. Louis demonstration plant will need an emissions control device for particulates from the large de-entrainment cyclone. Also in the air exhaust from the cyclone were total counts of bacteria and viruses several times higher than those of suburban ambient air. No water effluent or noise exposure problems were encountered, although landfill leachate mixed with ground water could result in contamination, given low dilution rates.

  11. The geo-environmental design of a coal refuse impoundment in Illinois

    International Nuclear Information System (INIS)

    Ripp, B.J.

    1997-01-01

    The coal refuse impoundment discussed was one of the first permitted under new regulatory standards within the State of Illinois. The new standards go beyond the geotechnial stability of the structure and must address the groundwater quality of the area and the impact of the impoundment on the groundwater system. The geotechnial design of the coal refuse impoundment dam and associated structures had its own particular challenges such as: 1) the construction of the structure over mined workings; 2) the close proximity of seismically active fault zones; and 3) the embankment configuration being controlled by the material balance of the mine refuse. The implementation of the groundwater protection plan included: 1) incorporating the groundwater quality standards and sampling protocols of several state agencies while the standards were being drafted; 2) sampling of the potential sources of groundwater impact; 3) establishing background levels; and 4) establishing the groundwater class. An initial groundwater transport model was developed and used as the basis for recommending a groundwater monitoring design in place of constructing a soil or synthetic liner. 15 refs., 2 figs., 3 tabs

  12. Heavy Metal Contamination of Foods by Refuse Dump Sites in Awka, Southeastern Nigeria

    Directory of Open Access Journals (Sweden)

    J. K. C. Nduka

    2008-01-01

    Full Text Available The impact of heavy metals from refuse dumps on soil, food, and water qualities in Awka, Nigeria was studied. Soil samples (top and 1.35 m deep were collected from five refuse dumps digested with conc. HNO3 and HClO4. The heavy metals (lead, manganese, arsenic, chromium, cadmium, and nickel in vegetables (spinach, fluted pumpkin, root crop (cocoyam, and surface and ground water were determined using an atomic absorption spectrophotometer (AAS. Chemical properties of the soil and bacteria were determined. Heavy metals were found to be more concentrated at a depth of 1.35 m. Manganese was high in shallow wells and borehole water samples with the highest levels as 0.538 and 0.325 mg/l, respectively. Nickel levels in the borehole sample ranged from 0.001 to 0.227 mg/l, whereas the highest level of lead was 0.01 mg/l. The Obibia stream had the highest levels of manganese and lead. Linear regression analyses showed that the relationship between soil heavy metals and farm produce heavy metals was strong. Taken together, we may conclude that the consumption of leafy vegetables and crops produced on contaminated soils may pose a health risk to those that reside around the refuse dumps.

  13. Social Cultivation of Vaccine Refusal and Delay among Waldorf (Steiner) School Parents.

    Science.gov (United States)

    Sobo, Elisa J

    2015-09-01

    U.S. media reports suggest that vastly disproportionate numbers of un- and under-vaccinated children attend Waldorf (private alternative) schools. After confirming this statistically, I analyzed qualitative and quantitative vaccination-related data provided by parents from a well-established U.S. Waldorf school. In Europe, Waldorf-related non-vaccination is associated with anthroposophy (a worldview foundational to Waldorf education)—but that was not the case here. Nor was simple ignorance to blame: Parents were highly educated and dedicated to self-education regarding child health. They saw vaccination as variously unnecessary, toxic, developmentally inappropriate, and profit driven. Some vaccine caution likely predated matriculation, but notable post-enrollment refusal increases provided evidence of the socially cultivated nature of vaccine refusal in the Waldorf school setting. Vaccine caution was nourished and intensified by an institutionalized emphasis on alternative information and by school community norms lauding vaccine refusal and masking uptake. Implications for intervention are explored. © 2015 by the American Anthropological Association.

  14. A Virtual Reality Curriculum for Pediatric Residents Decreases Rates of Influenza Vaccine Refusal.

    Science.gov (United States)

    Real, Francis J; DeBlasio, Dominick; Beck, Andrew F; Ollberding, Nicholas J; Davis, David; Cruse, Bradley; Samaan, Zeina; McLinden, Daniel; Klein, Melissa D

    Influenza vaccine hesitancy is common in the primary care setting. Though physicians can affect caregivers' attitudes toward vaccination, physicians report uneasiness discussing vaccine hesitancy. Few studies have targeted physician-patient communication training as a means to decrease vaccination refusal. An immersive virtual reality (VR) curriculum was created to teach pediatric residents communication skills when discussing influenza vaccine hesitancy. This pilot curriculum consisted of 3 VR simulations during which residents counseled graphical character representatives (avatars) who expressed vaccine hesitancy. Participants were randomized to the intervention (n = 24) or control (n = 21) group. Only residents in the intervention group underwent the VR curriculum. Impact of the curriculum was assessed through difference in influenza vaccine refusal rates between the intervention and control groups in the 3 months after the VR curriculum. Participants included postgraduate level (PL) 2 and PL3 pediatric residents. All eligible residents (n = 45) participated; the survey response rate was 100%. In patients aged 6 to 59 months, residents in the intervention group had a decreased rate of influenza vaccination refusal in the postcurriculum period compared to the control group (27.8% vs 37.1%; P = .03). Immersive VR may be an effective modality to teach communication skills to medical trainees. Next steps include evaluation of the curriculum in a larger, multisite trial. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  15. Psychosocial factors influencing parental decision to allow or refuse potentially lifesaving enucleation in children with retinoblastoma

    Directory of Open Access Journals (Sweden)

    Rolando Enrique D. Domingo

    2017-01-01

    Full Text Available Objective: Retinoblastoma is the most common malignancy of the eye and ocular adnexa in the Philippines. It is curable when treated early, but delay in enucleation is common due to the parental refusal of surgery for varied reasons. The aim of this study is to identify the psychosocial barriers and facilitating factors for accepting versus refusing enucleation as treatment for retinoblastoma. Methods: This is a cross-sectional descriptive study utilizing structured interviews and a questionnaire. It was conducted at the Retinoblastoma Clinic of the Philippine General Hospital. A questionnaire using the Likert scale was constructed after performing key informant interviews and focus group discussions. It was pretested and revised before parents of patients with retinoblastoma were invited to participate in the study. Descriptive statistics, quantitative item analyses using inter-item correlations and item-total correlations was performed. Results: Factors that correlate with refusal to enucleate are the beliefs that cancer is a fatal illness, the fear of unacceptable esthetic outcome of the surgery, and the cost of treatment. Favorable factors include value of life, high regard for the opinion of medical practitioners, and appreciation of the efficacy of treatment. Conclusions: There are several favorable factors and barriers that health practitioners must consider in facilitating parental decision-making toward enucleation for retinoblastoma.

  16. [School refusal and dropping out of school: positioning regarding a Swiss perspective].

    Science.gov (United States)

    Walitza, Susanne; Melfsen, Siebke; Della Casa, André; Schneller, Lena

    2013-01-01

    This article deals with refusal to attend school and dropping out of school from the point of view of child and adolescent psychiatry and psychology, in German speaking countries and from the perspective of Swiss schools and their administrative bodies. General epidemiological data on refusal to attend school show that approximately 5% of children and adolescents are likely to try to avoid attending school at some point. There is very little data available on the frequency of school drop-out. In the past two years (2011 and 2012), approximately 2% of all patients seen for the first time at the department of Child and Adolescent Psychiatry, University Zurich, were referred because of failure to attend school, making this phenomenon one of the most common reasons for referral in child and adolescent psychiatry. After a discussion of the epidemiology, symptomatology, causes and its risk factors, the article presents examples drawn from practice and guidelines for intervention in cases of refusal to attend school, and discusses ways of preventing school drop-out from the point of view of schools, hospitals and bodies such as educational psychology services in Switzerland.

  17. Influence of liming and topsoil thickness on vegetative growth and leachate quality on acidic coal refuse

    International Nuclear Information System (INIS)

    Li, R.S.; Daniels, W.L.

    1998-01-01

    Coal waste materials inhibit direct vegetation establishment due to adverse physical and chemical properties, particularly low water retention and high potential acidity. The Moss No. 1 coal refuse pile is located in Dickenson County, Virginia, and was idled in the late 1980's with little topsoil resource available for final closure. The refuse was acidic (Total-S = 0.38%; pH = 3.6), black, high (70%) in coarse fragments, and had a low water holding capacity (4.5% in 6.0 over a two-year period, which resulted in greater vegetative cover and biomass than the control plots. All topsoil treatments resulted in greater vegetative cover and biomass than plots treated with lime only due to improved surface soil physical and chemical properties. A topsoil treatment of 60 cm gave the thickest vegetative cover and biomass yield. Such a treatment, however, would be cost-prohibitive at this location. Application of 27 Mg/ha of lime to the refuse surface along with 15 cm of topsoil produced acceptable two-year vegetative cover and biomass, and appeared to be the optimal treatment for this particular situation. Both liming and topsoil had no affect on leachate pH and the electrical conductivity in leachates collected below the plots. This suggests that surface revegetation will have little effect on the quality of water draining through the pile, so long term water treatment requirements may not be reduced by successfully revegetating the pile surface

  18. Refuses and delays in the transportation by ship of radioactive material

    International Nuclear Information System (INIS)

    Xavier, Clarice; Sobreira, Ana Celia

    2011-01-01

    Some Class 7 materials can only be transported by ship, making that load and unload activities can be done in a port. In the Brazil, the port of Santos posses the most volume of cargo manipulation, and cargoes which contain radioactive material are always present with all manipulation requisites according to applicable regulations. The transport and manipulation operations of radioactive material are performed in accordance with national and international requisites but, some individuals posses yet a high risk perception according to our experience, involving members of Brazilian port authorities, the Navy and cargoes handlers at the ports. So, exist yet a high quantity of refuses and delays during the transport by ship. Therefore, a communication strategy was developed and applied, to inform the risk perception, supplying information on the very principles of ionizing radiation, legislation and uses of radiation, and so, diminishing the quantity of refuses and delays. From that initial communication strategy on, it becomes evident the necessity of training and conscience making a movement for the problem of refuses and delays be diminished

  19. Bioaerosol exposure during refuse collection: results of field studies in the real-life situation.

    Science.gov (United States)

    Neumann, H D; Balfanz, J; Becker, G; Lohmeyer, M; Mathys, W; Raulf-Heimsoth, M

    2002-07-03

    To determine the bioaerosol exposure of refuse collectors, field measurements were performed under real working conditions within the framework of a research project. Influencing variables such as different types of refuse, community structure, collection interval and season were taken into account. Overall, 1612 samples were taken in towns of Westfalia, Germany. With workplace levels on a scale of 10(3) to less than 10(4) CFU/m3 for the loader, the results show a surprisingly low total fungi concentration in comparison with earlier studies. Total bacteria concentrations, in contrast, were largely on a scale of 10(4) CFU/m3, with 10(5) CFU/m3 being registered sporadically, especially in apartment-block districts. Endotoxin levels were high especially in the summer months, occasionally reaching values of more than 50 EU/m3, whereas they were normally below 10 EU/m3 in autumn and winter. Inside the cab, the exposure level for the entire spectrum was at least one power of ten lower. The factors believed to account primarily for the low total fungi concentration were workplace hygiene, the prevailing 1-week collection interval, and the low in-process exposure time resulting from the effective deployment of automatic lifting devices. In contrast, the type of refuse was not found to have a significant influence.

  20. Pediatric transplantation using hearts refused on the basis of donor quality.

    Science.gov (United States)

    Bailey, Leonard L; Razzouk, Anees J; Hasaniya, Nahidh W; Chinnock, Richard E

    2009-06-01

    There is always more demand than supply of organs in pediatric heart transplantation. Yet, potential donor organs are regularly declined for a variety of reasons, among them donor organ quality as determined by United Network for Organ Sharing (UNOS) refusal code 830 or its equivalent. For the study group institutional and UNOS databases (July 2000 to December 2008) were reviewed to examine outcomes of pediatric heart transplantation using donor hearts that had been previously refused one or more times because of organ quality. Variation between outcomes of this cohort and recipients who received primarily offered heart grafts in a single institution was analyzed. In 29 recipients, transplantation or retransplantation was with heart grafts previously declined on the basis of quality. Recovery distances (p actuarial survival was 74% +/- 10.5%. At the present time, 24 of the 29 recipients (83%) are alive. These results do not vary statistically from those experienced by 84 recipients of 86 primarily offered donor organs during the same time. Despite longer distance recovery (ie, longer graft cold ischemic times), outcomes of pediatric heart transplantation using donor heart grafts refused on the basis of organ quality are highly competitive. Pediatric donor hearts should seldom be declined on the basis of organ quality (UNOS code 830).

  1. The Secret Drama at the Patient's Bedside-Refusal of Treatment Because of the Practitioner's Ethnic Identity: The Medical Staff 's Point of View.

    Science.gov (United States)

    Popper-Giveon, Ariela; Keshet, Yael

    2018-04-01

    Patients' refusal of treatment based on the practitioner's ethnic identity reveals a clash of values: neutrality in medicine versus patient-centered care. Taking the Israeli-Palestinian conflict into account, this article aims at examining Israeli health care professionals' points of view concerning patients' refusal of treatment because of a practitioner's ethnic identity. Fifty in-depth interviews were conducted with 10 managers and 40 health care professionals, Jewish and Arab, employed at 11 public hospitals. Most refusal incidents recorded are unidirectional: Jewish patients refusing to be treated by Arab practitioners. Refusals are usually directed toward nurses and junior medical staff members, especially if recognizable as religious Muslims. Refusals are often initiated by the patients' relatives and occur more frequently during periods of escalation in the conflict. The structural competency approach can be applied to increase awareness of the role of social determinants in shaping patients' ethnic-based treatment refusals and to improve the handling of such incidents.

  2. Delays and Refusal in Treatment for Breast Cancer Among Native American and Hispanic Women with Breast Cancer

    National Research Council Canada - National Science Library

    Saavedra, Elba

    2000-01-01

    ..., attitudinal, spiritual and demographic variables associated with delays and refusals in breast cancer treatment The focus of the semi-structured interview is to encourage the women in story-telling...

  3. Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust: Audit.

    Science.gov (United States)

    Umotong, Eno

    2016-12-01

    The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability.

  4. Insulin therapy refusal among type II diabetes mellitus patients in Kubang Pasu district, the state of Kedah, Malaysia.

    Science.gov (United States)

    Tan, Wei Leong; Asahar, Siti Fairus; Harun, Noor Liani

    2015-04-01

    Diabetes mellitus is a rising non-communicable disease in Malaysia. Insulin therapy refusal is a great challenge for healthcare providers, as it results in delayed insulin initiation. This study was conducted to determine the prevalence of insulin therapy refusal and its associated factors. This cross sectional study was conducted at seven public health clinics in Kubang Pasu district, Malaysia, from March to October 2012. A newly developed and validated questionnaire was used and participants were selected via systematic random sampling. Only patients diagnosed with type II diabetes mellitus (T2DM) and under the public health clinic care in Kubang Pasu were included in the study. Multiple logistic regressions were used to study the association between insulin therapy refusal and its associated factors. There were 461 respondents and the response rate was 100%. Among these 461 patients with T2DM, 74.2% refused insulin therapy. The most common reason given for refusal was a lack of confidence in insulin injection (85.4%). Multiple logistic regression revealed that respondents who had secondary education were 55.0% less likely to refuse insulin therapy than those who had primary or no formal education (p = 0.009, adjusted odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.25-0.82). There was also a significant inverse association between glycated haemoglobin (HbA1c) and insulin therapy refusal (p = 0.047, adjusted OR = 0.87, 95% CI = 0.76-1.00). Insulin therapy refusal is common in Kubang Pasu. Education status and HbA1c should be taken into consideration when counselling patients on insulin therapy initiation.

  5. Understanding Treatment Refusal Among Adults Presenting for HIV-Testing in Soweto, South Africa: A Qualitative Study

    OpenAIRE

    Katz, Ingrid T.; Dietrich, Janan; Tshabalala, Gugu; Essien, Thandekile; Rough, Kathryn; Wright, Alexi A.; Bangsberg, David R.; Gray, Glenda E.; Ware, Norma C.

    2015-01-01

    HIV treatment initiatives have focused on increasing access to antiretroviral therapy (ART). There is growing evidence, however, that treatment availability alone is insufficient to stop the epidemic. In South Africa, only one third of individuals living with HIV are actually on treatment. Treatment refusal has been identified as a phenomenon among people who are asymptomatic, however, factors driving refusal remain poorly understood. We interviewed 50 purposively sampled participants who pre...

  6. The use of town refuse ash in urban agriculture around Jos, Nigeria: health and environmental risks.

    Science.gov (United States)

    Pasquini, M W

    2006-01-15

    This paper reports on a study that examines the health and environmental risks of using town refuse ash in urban vegetable production in Jos, Nigeria, in terms of heavy metal accumulation in the food chain. Soil and crop samples, collected from five study farms, and samples of the river water used for irrigation, were analysed for seven heavy metals Fe, Mn, Zn, Cu, Ni, Cd and Pb. On the basis of the field data the paper discusses: (1) the potential soil deficiencies and toxicities; (2) the probable links between soil heavy metal levels and fertilisation practices; (3) the heavy metal concentrations in crop tissue in relation to crop growth and human health. The findings suggest that soil concentrations of the seven metals fall within 'typical' soil levels, and that there should not be any problems of either toxicities or deficiencies for crop growth. There was evidence of slight accumulation of Zn, Cu and Cd on some of the farms with a history of town refuse ash use. However, in all farms lettuce crops contained very large concentrations of Fe, and Pb concentrations that were 20 to 40 times higher than the WHO/FAO maximum recommended level in leafy vegetables for human consumption. The Cd content of carrot tissue was 10 times higher than the WHO/FAO recommended limit. The relatively small number of soil and crop samples precluded any formal attempt at correlating the concentrations of heavy metals found in the vegetable crops with the farm levels. Nevertheless, the data suggested that these were not linked. The paper goes on to consider various potential sources of the metals found in the crops, including irrigation water, town refuse ash and air-borne dust, and discusses additional health and environmental risks pertaining to the use of town refuse ash. Undoubtedly, the heavy Pb and Cd contamination of certain crops indicates the urgent need for future studies to ascertain the precise source of these metals, and although the practice of using town refuse ash does

  7. Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital.

    Science.gov (United States)

    Salam, Asma Abdus; Afshan, Gauhar

    2016-01-01

    Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries. A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal. Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively. This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information.

  8. Aggression Profiles in the Spanish Child Population: Differences in Perfectionism, School Refusal and Affect

    Directory of Open Access Journals (Sweden)

    María Vicent

    2018-01-01

    Full Text Available The aim of this study was to identify the existence of combinations of aggression components (Anger, Hostility, Physical Aggression and Verbal Aggression that result in different profiles of aggressive behavior in children, as well as to test the differences between these profiles in scores of perfectionism, school refusal and affect. It is interesting to analyze these variables given: (a their clinical relevance due to their close relationship with the overall psychopathology; and (b the need for further evidence regarding how they are associated with aggressive behavior. The sample consisted of 1202 Spanish primary education students between the ages of 8 and 12. Three aggressive behavior profiles for children were identified using Latent Class Analysis (LCA: High Aggression (Z scores between 0.69 and 0.7, Moderate Aggression (Z scores between −0.39 and −0.47 and Low Aggression (Z scores between −1.36 and −1.58. These profiles were found for 49.08%, 38.46% and 12.48% of the sample, respectively. High Aggression scored significantly higher than Moderate Aggression and Low Aggression on Socially Prescribed Perfectionism (SPP, Self-Oriented Perfectionism (SOP, the first three factors of school refusal (i.e., FI. Negative Affective, FII. Social Aversion and/or Evaluation, FIII. To Pursue Attention, and Negative Affect (NA. In addition, Moderate Aggression also reported significantly higher scores than Low Aggression for the three first factors of school refusal and NA. Conversely, Low Aggression had significantly higher mean scores than High Aggression and Moderate Aggression on Positive Affect (PA. Results demonstrate that High Aggression was the most maladaptive profile having a high risk of psychological vulnerability. Aggression prevention programs should be sure to include strategies to overcome psychological problems that characterize children manifesting high levels of aggressive behavior.

  9. Drinking Refusal Self-Efficacy and Intended Alcohol Consumption During a Mass-Attended Youth Event.

    Science.gov (United States)

    Jongenelis, Michelle I; Pettigrew, Simone; Biagioni, Nicole

    2018-04-16

    Mass-attended youth events represent a substantial public health challenge due to high levels of alcohol consumption and corresponding high rates of alcohol-related harm. Although previous research has documented the protective effect of high drinking refusal self-efficacy (DRSE) on alcohol consumption in general, there is a lack of research examining the role of DRSE in reducing consumption during mass-attended youth events and the factors associated with DRSE in these contexts. This study aimed to identify potentially modifiable factors that influence DRSE and drinking intentions to inform interventions designed to reduce alcohol-related harm during mass-attended events. Australian secondary school students (n = 586; 70% female) in their final two years of high school completed an online survey assessing their alcohol consumption intentions for Schoolies, their perceived degree of DRSE, and other individual and environmental factors. Path analysis was used to assess a mediational model examining factors associated with DRSE and alcohol consumption intentions. DRSE was found to be significantly associated with intended alcohol consumption during Schoolies. Specifically, leavers who believed they would not be able to refuse others' offers of alcoholic drinks reported significantly greater alcohol consumption intentions. Results also revealed that DRSE was enhanced in those respondents who believed there would be a variety of non-drinking activities and non-alcoholic beverages available to them during Schoolies. Results suggest the need to increase leavers' confidence in their ability to refuse unwanted alcoholic beverages and highlight the importance of providing celebration options that do not involve alcohol consumption.

  10. Women's, midwives' and obstetricians' experiences of a structured process to document refusal of recommended maternity care.

    Science.gov (United States)

    Jenkinson, Bec; Kruske, Sue; Stapleton, Helen; Beckmann, Michael; Reynolds, Maree; Kildea, Sue

    2016-12-01

    Ethical and professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy; the right to refuse care is well established. However, the existing literature is largely silent on the appropriate clinical responses when pregnant women refuse recommended care, and accounts of disrespectful interactions and conflict are numerous. Policies and processes to support women and maternity care providers are rare and unstudied. To document the perspectives of women, midwives and obstetricians following the introduction of a structured process (Maternity Care Plan; MCP) to document refusal of recommended maternity care in a large tertiary maternity unit. A qualitative, interpretive study involved thematic analysis of in-depth semi-structured interviews with women (n=9), midwives (n=12) and obstetricians (n=9). Four major themes were identified including: 'Reassuring and supporting clinicians'; 'Keeping the door open'; 'Varied awareness, criteria and use of the MCP process' and 'No guarantees'. Clinicians felt protected and reassured by the structured documentation and communication process and valued keeping women engaged in hospital care. This, in turn, protected women's access to maternity care. However, the process could not guarantee favourable responses from other clinicians subsequently involved in the woman's care. Ongoing discussions of risk, perceived by women and some midwives to be pressure to consent to recommended care, were still evident. These limitations may have been attributable to the absence of agreed criteria for initiating the MCP process and fragmented care. Varying awareness and use of the process also diminished women's access to it. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  11. Microbial community structure of leaf-cutter ant fungus gardens and refuse dumps.

    Science.gov (United States)

    Scott, Jarrod J; Budsberg, Kevin J; Suen, Garret; Wixon, Devin L; Balser, Teri C; Currie, Cameron R

    2010-03-29

    Leaf-cutter ants use fresh plant material to grow a mutualistic fungus that serves as the ants' primary food source. Within fungus gardens, various plant compounds are metabolized and transformed into nutrients suitable for ant consumption. This symbiotic association produces a large amount of refuse consisting primarily of partly degraded plant material. A leaf-cutter ant colony is thus divided into two spatially and chemically distinct environments that together represent a plant biomass degradation gradient. Little is known about the microbial community structure in gardens and dumps or variation between lab and field colonies. Using microbial membrane lipid analysis and a variety of community metrics, we assessed and compared the microbiota of fungus gardens and refuse dumps from both laboratory-maintained and field-collected colonies. We found that gardens contained a diverse and consistent community of microbes, dominated by Gram-negative bacteria, particularly gamma-Proteobacteria and Bacteroidetes. These findings were consistent across lab and field gardens, as well as host ant taxa. In contrast, dumps were enriched for Gram-positive and anaerobic bacteria. Broad-scale clustering analyses revealed that community relatedness between samples reflected system component (gardens/dumps) rather than colony source (lab/field). At finer scales samples clustered according to colony source. Here we report the first comparative analysis of the microbiota from leaf-cutter ant colonies. Our work reveals the presence of two distinct communities: one in the fungus garden and the other in the refuse dump. Though we find some effect of colony source on community structure, our data indicate the presence of consistently associated microbes within gardens and dumps. Substrate composition and system component appear to be the most important factor in structuring the microbial communities. These results thus suggest that resident communities are shaped by the plant degradation

  12. Developmentally sensitive cognitive behavioral therapy for adolescent school refusal: rationale and case illustration.

    Science.gov (United States)

    Heyne, David; Sauter, Floor M; Ollendick, Thomas H; Van Widenfelt, Brigit M; Westenberg, P Michiel

    2014-06-01

    School refusal can be difficult to treat and the poorest treatment response is observed among older school refusers. This poor response may be explained, in part, by the impact of developmental transitions and tasks upon the young person, their family, and the treatment process. This paper describes and illustrates the @school program, a cognitive behavioral therapy (CBT) designed to promote developmental sensitivity when planning and delivering treatment for adolescent school refusal. Treatment is modularized and it incorporates progress reviews, fostering a planned yet flexible approach to CBT. The treatment is illustrated in the case of Allison, a 16-year-old female presenting with major depressive disorder and generalized anxiety disorder. A case formulation guided the selection, sequencing, and pacing of modules targeting predisposing, precipitating, perpetuating, and protective factors. Treatment comprised 16 sessions with Allison (interventions addressing depression, anxiety, and school attendance) and 15 concurrent sessions with her mother (strategies to facilitate an adolescent's school attendance), including two sessions with Allison and mother together (family communication and problem solving to reduce parent-adolescent conflict). Two treatment-related consultations were also conducted with Allison's homeroom teacher. Allison's school attendance improved during the course of treatment. By post-treatment, there was a decrease in internalizing behavior, an increase in self-efficacy, and remission of depressive disorder and anxiety disorder. Clinically significant treatment gains were maintained at 2-month follow-up. Factors influencing outcome may include those inherent to the @school program together with less specific factors. Special consideration is given to parents' use of both authoritative and autonomy-granting approaches when helping an adolescent to attend school.

  13. Attitudes of prehospital emergency care professionals toward refusal of treatment: A regional survey in Turkey.

    Science.gov (United States)

    Erbay, Hasan; Alan, Sultan; Kadioglu, Selim

    2014-08-01

    Prehospital emergency medicine is a specific field of emergency medicine. The basic approach of prehospital emergency medicine is to provide patients with medical intervention at the scene of the incident. This special environment causes health professionals to encounter various problems. One of the most important problems in this field is ethics, in particular questions involving refusal of treatment and the processes associated with it. The objective of this study is to identify emergency health professionals' views regarding refusal of treatment. This study was conducted with 356 health professionals who were on active duty in prehospital emergency health services. The data were collected through a form which included 10 statements. The participants were asked to indicate their level of agreement with the statements given by rating them between 0 and 10. Before conducting the research, permission was received from the local ethics committee. Participants were given written information about the purpose of the study. Participants were assured that their participation was voluntary. The healthcare professionals with fewer years of experience in the profession and female participants adopted an attitude of giving priority to providing care. Young participants, in general, respected patient autonomy. However, paradoxically, when it comes to emergency medical cases, they expressed an opinion closer to paternalism. This study has found that prehospital emergency health professionals generally respect the patient's right to refuse treatment; however, they do not prioritize this right when there is a life-threatening situation or when the person does not have decision-making capacity. In these cases, prehospital emergency health professionals tended to adopt a more paternalistic approach. © The Author(s) 2013.

  14. Fluidized bed combustion of refuse-derived fuel in presence of protective coal ash

    Energy Technology Data Exchange (ETDEWEB)

    Ferrer, Eduardo [CIRCE, Universidad de Zaragoza, Maria de Luna, 3, Zaragoza (Spain); Aho, Martti [VTT Processes, P.O. Box 1603, 40101 Jyvaeskylae (Finland); Silvennoinen, Jaani; Nurminen, Riku-Ville [Kvaerner Power, P.O.Box 109, FIN-33101 Tampere (Finland)

    2005-12-15

    Combustion of refuse-derived fuel (RDF) alone or together with other biomass leads to superheater fouling and corrosion in efficient power plants (with high steam values) due to vaporization and condensation of alkali chlorides. In this study, means were found to raise the portion of RDF to 40% enb without risk to boilers. This was done by co-firing RDF with coal and optimizing coal quality. Free aluminum silicate in coal captured alkalies from vaporized alkali chlorides preventing Cl condensation to superheaters. Strong fouling and corrosion were simultaneously averted. Results from 100 kW and 4 MW CFB reactors are reported. (author)

  15. Terry Farrell between the gates: Part 2 - On postmodernism which refused to be deconstructed

    OpenAIRE

    Kolakowski, Marcin Mateusz

    1999-01-01

    “On postmodernism which refused to be deconstructed” Since 1991, the work of Terry Farrell has been connected with Asia. His saying “I am not afraid of looking backwards, as well as forwards” was again put to trial. There he had to join his contextual principles of architecture with the futuristic ambition of Asiatic investors: although the British Consulate in Hong Kong was called “very British”, its facade echoes both Hong Kong’s architecture and that of European Coliseum. Two wings of t...

  16. Performance Analysis of Cofiring Densified Refuse Derived Fuel in a Military Boiler.

    Science.gov (United States)

    1981-12-01

    Use of Waste Oils to Improve Densified Refuse-Derived Fuel 79 Study of the State of the Art of Dioxin from Corbustion Sour ,-es 81 Numerical...very large hammermills for shredu-,nt ii -et re C strean . Tne suitability of this technique has beer . : , 1:d aeauie of its undesirable proper- ,V.>- ir...oe iut- fraction while reducing the hrsepower requiie:: ,. ht uuty shredders have -c-en used as a pfre -. . :-r,der-s have not beer perfected wnich

  17. Electric refuse collection vehicle with a range extender; Elektrisches Abfallsammelfahrzeug mit Range Extender

    Energy Technology Data Exchange (ETDEWEB)

    Fuchs, Andreas

    2012-10-15

    At the Frankfurt Motor Show IAA 2012, MAN will be presenting the Metropolis, a heavy-duty truck for use in urban areas that produces no emissions and is ultra-quiet. Using mains electricity generated from renewable sources, it can operate without producing any CO{sub 2}. The truck's modular lithium-ion battery is located under the ab. A quiet and efficient diesel engine from the Volkswagen Group generates power as needed and functions as a range extender for the truck. At the end of 2012, the MAN Metropolis will start a two-year field test as a refuse collection vehicle. (orig.)

  18. Wernicke-Korsakoff Syndrome as a Consequence of Delusional Food Refusal: A Case Study.

    Science.gov (United States)

    Hargrave, David D; Schroeder, Ryan W; Heinrichs, Robin J; Baade, Lyle E

    2015-12-01

    Wernicke-Korsakoff syndrome is caused by thiamine (vitamin B1) deficiency, typically resulting from malnutrition secondary to chronic alcohol abuse. Less often, other conditions can lead to malnutrition and Wernicke-Korsakoff syndrome. We describe a 35-year-old man who developed Wernicke-Korsakoff syndrome with a typical neurologic and neuropsychological presentation after somatic delusions led him to refuse to eat. Cases like his serve to heighten awareness of the interplay between psychiatric and neurologic conditions, their sometimes atypical pathogenesis, and the value to primary care providers of consulting with psychiatrists, neurologists, and neuropsychologists when managing patients with possible Wernicke-Korsakoff syndrome.

  19. [The efficacy of care as perceived by adolescents presenting anxiety-based school refusal].

    Science.gov (United States)

    Sibeoni, Jordan; Orri, Massimiliano; Campredon, Sophie; Revah-Levy, Anne

    School refusal is a complex disorder which is sometimes difficult to treat and which has potentially significant consequences on the child's schooling and mental health. A qualitative study was carried out in 2014-2015 on the feelings of adolescents and their parents with regard to the efficacy of care. The results show that, while adolescents and parents do not share the same representation of the care objectives, they agree on the therapeutic levers identified as been effective: time and relationships. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  20. Thermogravimetric kinetic model of the pyrolysis and combustion of an ethylene-vinyl acetate copolymer refuse

    Energy Technology Data Exchange (ETDEWEB)

    Angela N. Garcia; Rafael Font [Universidad de Alicante, Alicante (Spain). Faculty of Sciences

    2004-06-01

    A kinetic study of the pyrolysis as well as the combustion of EVA copolymer refuse originating from the footwear industry was carried out by thermogravimetric analysis. Different runs were performed at heating rates between 5-20{sup o}C min{sup -1} and atmospheres with different percentages of oxygen: 0, 10 and 20% (v/v). Pyrolysis and combustion processes can be simulated by two series reactions. The results obtained indicate that the second reaction begins when the first one is almost finished which implies that a good correlation is also obtained by simulation of the thermal decomposition of two independent fractions. 32 refs., 4 figs., 3 tabs.

  1. Contact refusal by children following acrimonious separation: therapeutic approaches with children and parents.

    Science.gov (United States)

    Dejong, Margaret; Davies, Hilary

    2013-04-01

    This paper aims to build on the existing literature, by presenting some thoughts based on clinical experience with nine families of children referred for intractable contact refusal with one parent following marital separation. This particular group of high-conflict divorce cases engenders an inordinate amount of frustration both within the courts and therapeutic agencies. We outline here our assessment process and therapeutic strategies, as well as consideration of the role of the wider professional system and the courts. We conclude that whether or not direct contact with the rejected parent is achieved, useful therapeutic work can be carried out to assist children in moving on with their lives.

  2. On the relative contributions of positive reinforcement and escape extinction in the treatment of food refusal.

    Science.gov (United States)

    Piazza, Cathleen C; Patel, Meeta R; Gulotta, Charles S; Sevin, Bari M; Layer, Stacy A

    2003-01-01

    We compared the effects of positive reinforcement alone, escape extinction alone, and positive reinforcement with escape extinction in the treatment of the food and fluid refusal of 4 children who had been diagnosed with a pediatric feeding disorder. Consumption did not increase when positive reinforcement was implemented alone. By contrast, consumption increased for all participants when escape extinction was implemented, independent of the presence or absence of positive reinforcement. However, the addition of positive reinforcement to escape extinction was associated with beneficial effects (e.g., greater decreases in negative vocalizations and inappropriate behavior) for some participants.

  3. Disposable containers as larval habitats for Aedes aegypti in a city with regular refuse collection: a study in Marília, São Paulo State, Brazil.

    Science.gov (United States)

    Mazine, C A; Macoris, M L; Andrighetti, M T; Yasumaro, S; Silva, M E; Nelson, M J; Winch, P J

    1996-09-01

    In Marília, Brazil, refuse is collected at least every other day, yet non-useful, non-returnable containers such as cans, plastic bottles and tires account for almost half of the container habitats found positive for the Aedes aegypti mosquito. A study was therefore conducted to investigate why these containers exist despite regular refuse collection and a high level of awareness of dengue prevention, and how the control program could most effectively respond. Differing community perceptions as to what constitutes refuse were found to lead people to store a variety of containers in their yard. Other dimensions of the problem include the presence of informal refuse collectors in search of saleable materials, and dumping of refuse in vacant lots and along roads. An intervention based on these data will involve the informal refuse collectors in implementation of a community-based recycling project.

  4. Frequent fliers, school phobias, and the sick student: school health personnel's perceptions of students who refuse school.

    Science.gov (United States)

    Torrens Armstrong, Anna M; McCormack Brown, Kelli R; Brindley, Roger; Coreil, Jeannine; McDermott, Robert J

    2011-09-01

    This study explored school personnel's perceptions of school refusal, as it has been described as a "common educational and public health problem" that is less tolerated due to increasing awareness of the potential socioeconomic consequences of this phenomenon. In-depth interviews were conducted with school personnel at the middle school (N = 42), high school (N = 40), and district levels (N = 10). The findings focus on emergent themes from interviews with school health personnel (N = 12), particularly those themes related to their perceptions of and role in working with school-refusing students. Personnel, especially school health services staff, constructed a typification of the school-refusing student as "the sick student," which conceptualized student refusal due to reasons related to illness. Personnel further delineated sick students by whether they considered the illness legitimate. School health personnel referenced the infamous "frequent fliers" and "school phobics" within this categorization of students. Overarching dynamics of this typification included parental control, parental awareness, student locus of control, blame, and victim status. These typifications influenced how personnel reacted to students they encountered, particularly in deciding which students need "help" versus "discipline," thus presenting implications for students and screening of students. Overall, findings suggest school health personnel play a pivotal role in screening students who are refusing school as well as keeping students in school, underscoring policy that supports an increased presence of school health personnel. Recommendations for school health, prevention, and early intervention include the development of screening protocols and staff training. © 2011, American School Health Association.

  5. At the Intersection of Faith, Culture, and Family Dynamics: A Complex Case of Refusal of Treatment for Childhood Cancer.

    Science.gov (United States)

    Brown, Amy E Caruso

    2017-01-01

    Refusing treatment for potentially curable childhood cancers engenders much discussion and debate. I present a case in which the competent parents of a young Amish child with acute myeloid leukemia deferred authority for decision making to the child's maternal grandfather, who was vocal in his opposition to treatment. I analyze three related concerns that distinguish this case from other accounts of refused treatment. First, I place deference to grandparents as decision makers in the context of surrogate decision making more generally. Second, the maternal grandfather's ardent refusal of treatment and his rationale appeared to be inconsistent with the beliefs expressed by other family members and by members of the same Amish community, leading members of the medical team to question whether refusal of treatment should be treated differently when it appears to be based on the idiosyncratic beliefs of an individual rather than on community-wide values. Third, the medical team perceived tension and dissension between the nonverbal behavior of some family members and the verbal statements made by the maternal grandfather, leading the team to question the parents' true wishes and debate how to weigh nonverbal and indirect forms of communication. Finally, building upon the conclusions of these queries, I explore whether, if the child's prognosis was less favorable or if he were to relapse later, the maternal grandfather should have been permitted to drive a decision to refuse further treatment. Copyright 2017 The Journal of Clinical Ethics. All rights reserved.

  6. Carbon-13 nuclear magnetic resonance spectroscopic characterization of humic substances from municipal refuse decomposing in a landfill

    International Nuclear Information System (INIS)

    Newman, R.H.; Theng, B.K.G.; Filip, Z.

    1987-01-01

    Municipal refuse was disposed of in simulated landfills and left for periods of more than 20 months. Three different 40 m 3 systems of disposals were studied, namely (i) where the refuse was compacted, (ii) where it was mixed with sewage sludge and left uncompacted, and (iii) where it was compacted with sewage sludge. At 2, 6, 12 and 20 months, the humic substances were extracted from each system, purified, and characterised by cross-polarisation 13 C NMR spectroscopy with 'magic-angle' sample spinning. The areas under the various signals were related to carbon percentages in different structural categories. The aromaticity of the humic acids increased with time of decomposition; those from refuse mixed with sewage sludge were particularly high in phenolic content. A signal at 174 p.p.m., assigned primarily to secondary amide linkages, reached maximum strength after 6 to 12 months decomposition. The carbohydrate contents of the humic acids showed only small variations as decomposition progressed. Polymethylene chains in lipids, particularly for the uncompacted system, accounted for a diminishing fraction of total carbon as time of refuse disposal increased. The spectrum of a soil humic acid showed features similar to those observed in spectra of humic acids derived from refuse, but the signals were less well resolved. 19 refs.; 8 figs.; 3 tabs

  7. Exploring the relationship between postmigratory stressors and mental health for asylum seekers and refused asylum seekers in the UK.

    Science.gov (United States)

    Morgan, Gareth; Melluish, Steve; Welham, Alice

    2017-01-01

    Numerous studies have linked the high rates of traumatic events experienced by refugees to the elevated rate of mental health problems in these populations. A growing body of evidence has also highlighted the importance of considering postmigratory stressors when making sense of displaced person distress. This study explored the relationship between mental health and postmigratory stress for asylum seekers and refused asylum seekers in Britain. The study further examined if those refused asylum experienced elevated distress and postmigratory stress compared to those awaiting the outcome of asylum applications. Results indicated that participants ( N = 97) had endured a range of pre- and postmigratory stressors and had high scores on measures of anxiety, depression, and PTSD. A postmigratory factor comprising items associated with isolation, restrictive policies, and stressors associated with having an insecure immigration status, was significantly associated with PTSD scores. This relationship remained when controlling for the variance accounted for by premigratory trauma predictors. Being refused asylum was the strongest predictor of depression and anxiety. Those refused asylum scored higher on a factor associated with barriers to accessing services. Social materialist theories of distress are drawn upon to contextualise the heightened vulnerability of those refused asylum. The paper concludes by emphasising the problems associated with taking an exclusively trauma-focussed approach when working with asylum seekers and argues for community orientated interventions to support displaced people to cope with the various stressors endured in exile.

  8. Understanding the antecedents of Korean high school students' drinking refusal self-efficacy: parental influence, peer influence, and behavior.

    Science.gov (United States)

    Jang, Su Ahn; Cho, Namauk; Yoo, Jina

    2011-12-29

    The current study examined the factors that influence Korean adolescents' drinking refusal self-efficacy, which is known to be associated with alcohol use and drinking intentions. Specifically, this study considered parental monitoring, parent-child communication satisfaction, peer influence, and prior alcohol use as possible antecedents of Korean high school students' drinking refusal self-efficacy. High school students (n = 538) in South Korea responded to the current study. The data revealed that parent-child communication satisfaction facilitated parental monitoring, and these factors indirectly predicted adolescents' drinking behavior through peer influence. We also found that prior drinking, parental monitoring, and peer influence were directly associated with drinking refusal self-efficacy, and the self-efficacy, in turn, was associated with drinking intentions. These results not only suggest that drinking refusal self-efficacy are related to drinking behavior and intentions, but they also provide a theoretical explanation for how parental and peer influences are associated with adolescents' drinking refusal self-efficacy.

  9. Racial and Ethnic Disparities in Parental Refusal of Consent in a Large, Multisite Pediatric Critical Care Clinical Trial.

    Science.gov (United States)

    Natale, Joanne E; Lebet, Ruth; Joseph, Jill G; Ulysse, Christine; Ascenzi, Judith; Wypij, David; Curley, Martha A Q

    2017-05-01

    To evaluate whether race or ethnicity was independently associated with parental refusal of consent for their child's participation in a multisite pediatric critical care clinical trial. We performed a secondary analyses of data from Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE), a 31-center cluster randomized trial of sedation management in critically ill children with acute respiratory failure supported on mechanical ventilation. Multivariable logistic regression modeling estimated associations between patient race and ethnicity and parental refusal of study consent. Among the 3438 children meeting enrollment criteria and approached for consent, 2954 had documented race/ethnicity of non-Hispanic White (White), non-Hispanic Black (Black), or Hispanic of any race. Inability to approach for consent was more common for parents of Black (19.5%) compared with White (11.7%) or Hispanic children (13.2%). Among those offered consent, parents of Black (29.5%) and Hispanic children (25.9%) more frequently refused consent than parents of White children (18.2%, P refuse consent. Parents of children offered participation in the intervention arm were more likely to refuse consent than parents in the control arm (OR 2.15, 95% CI 1.37-3.36, P care clinical trial. Ameliorating this racial disparity may improve the validity and generalizability of study findings. ClinicalTrials.gov: NCT00814099. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Vegetation succession and soil infiltration characteristics under different aged refuse dumps at the Heidaigou opencast coal mine

    Directory of Open Access Journals (Sweden)

    Huang Lei

    2015-07-01

    Full Text Available Vegetation succession and soil infiltration characteristics under five different restoration models of refuse dumps including different-aged revegetated sites (1995, 1998, 2003 and 2005 in the northern, eastern and western open-pit coal mine dump and a reference site with native vegetation, which had never been damaged by coal mining activities on the Heidaigou Open Cut Coal Mine were studied. Changes in the plant species, soil properties and infiltration rates were evaluated at the different refuse dumps. The results indicated that the number of herbaceous species, plant cover, biomass, fine particles, and total N, P and SOM increased significantly with increasing site age. However, the number of shrub species decreased since revegetation, its cover increased from 17% to 41% initially and subsequently decreased to the present level of 4%. The natural vegetation community and the northern refuse dump had the highest cumulative infiltration rates of 3.96 and 2.89 cm s−1 in contrast to the eastern and western refuse dumps and the abandoned land, where the highest cumulative infiltration rates were 1.26, 1.04 and 0.88 cm s−1, respectively. A multiple linear regression analysis indicated that the infiltration rate was primarily determined by the silt percentage, SOM, plant coverage and the variation in soil bulk density. Our results provide new ideas regarding future soil erosion controls and sustainable development at open-pit coal mine refuse dumps.

  11. A quality of life quandary: a framework for navigating parental refusal of treatment for co-morbidities in infants with underlying medical conditions.

    Science.gov (United States)

    Kunz, Sarah N; McAdams, Ryan M; Diekema, Douglas S; Opel, Douglas J

    2015-01-01

    Parental refusal of a recommended treatment is not an uncommon scenario in the neonatal intensive care unit. These refusals may be based upon the parents' perceptions of their child's projected quality of life. The inherent subjectivity of quality of life assessments, however, can exacerbate disagreement between parents and healthcare providers. We present a case of parental refusal of surgical intervention for necrotizing enterocolitis in an infant with Bartter syndrome and develop an ethical framework in which to consider the appropriateness of parental refusal based upon an infant's projected quality of life. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

  12. Clinical practice guidelines of the French Association for Supportive Care in Cancer and the French Society for Psycho-oncology: refusal of treatment by adults afflicted with cancer.

    Science.gov (United States)

    Faivre, J C; Adam, V; Block, V; Metzger, M; Salleron, J; Dauchy, S

    2017-11-01

    The study's purpose was to develop practical guidelines for assessment and management of refusal of treatment by adults afflicted with cancer. The French Association for Supportive Care in Cancer and the French Society for Psycho-oncology gathered a task force that applied a consensus methodology to draft guidelines studied predisposing situations, the diagnosis, regulatory aspects, and the management of refusal of treatment by adults afflicted with cancer. We propose five guidelines: (1) be aware of the conditions/profiles of patients most often associated with refusal of treatment so as to adequately underpin the care and support measures; (2) understand the complexity of the process of refusal and knowing how to accurately identify the type and the modalities of the refused treatments; (3) apply a way to systematically analyze refusal, thereby promoting progression from a situation of disaccord toward a consensual decision; (4) devise procedures, according to the legal context, to address refusal of treatment that safeguards the stakeholders in situations of sustained disaccord; and (5) know the indications for ethical collective decision-making. The quality of the relationship between patients and health professionals, and the communication between them are essential components involved in reaching a point of consent or refusal of treatment. A process of systematic analysis of refusal is recommended as the only way to ensure that all of the physiological, psychological, and contextual elements that are potentially involved are taken into account.

  13. Augmenting Cognitive Behavior Therapy for School Refusal with Fluoxetine: A Randomized Controlled Trial.

    Science.gov (United States)

    Melvin, Glenn A; Dudley, Amanda L; Gordon, Michael S; Klimkeit, Ester; Gullone, Eleonora; Taffe, John; Tonge, Bruce J

    2017-06-01

    This study investigates whether the augmentation of cognitive behavior therapy (CBT) with fluoxetine improves outcomes in anxious school refusing adolescents (11-16.5 years). Sixty-two participants were randomly allocated to CBT alone, CBT + fluoxetine or CBT + placebo. All treatments were well tolerated; with one suicide-attempt in the CBT + placebo group. All groups improved significantly on primary (school attendance) and secondary outcome measures (anxiety, depression, self-efficacy and clinician-rated global functioning); with gains largely maintained at 6-months and 1-year. Few participants were anxiety disorder free after acute treatment. During the follow-up period anxiety and depressive disorders continued to decline whilst school attendance remained stable, at around 54 %. The only significant between-group difference was greater adolescent-reported treatment satisfaction in the CBT + fluoxetine group than the CBT alone group. These results indicate the chronicity of school refusal, and the need for future research into how to best improve school attendance rates.

  14. Refusal of Treatment by Mentally Competent Patient: The Choice of Doctor-Patient Relationship Models

    Directory of Open Access Journals (Sweden)

    Andrei M. Beliaev

    2010-01-01

    Full Text Available Introduction: In modern medicine professional relationship between the clinician and the patient is patient-centered. Patients become actively involved in the treatment decision making process and are encouraged to express their health-related preferences. Some patients may, however, refuse a favorable risk/benefit ratio treatment. This manuscript presents three cases of refusal of treatment by mentally competent surgical patients and discusses differences in their management. Conclusion: To achieve the best medical outcome for patients who possess the Actual Understanding test of mental competence clinicians use the deliberate model of medical professional relationship. For patients demonstrating the Understanding test of mental competence and wishing to utilize their health-related preferences physicians are obliged to deploy the interpretive model of doctor-patient relationship. In mentally competent patients with an illness-induced acute psychological regression the interpretive model of doctor-patient relationship as an initial strategy and cognitive behavior therapy can be useful in modifying treatment rejecting behavior and improving medical outcome.

  15. Perceptions of sexual assertiveness among adolescent girls: initiation, refusal, and use of protective behaviors.

    Science.gov (United States)

    Auslander, Beth A; Perfect, Michelle M; Succop, Paul A; Rosenthal, Susan L

    2007-06-01

    We describe adolescent girls' perceptions of sexual assertiveness and examine the relationship of these perceptions with developmental and interpersonal variables. Cross-sectional analysis. Participants were recruited from a school-based health clinic and local colleges, and through snowballing to participate in a 6-month study examining microbicide acceptability. 106 sexually experienced girls (ages 14 through 21 years). Girls described their demographics, sexual history, and romantic relationships and completed the Sexual Assertiveness Scale for Women (SAS-W), which assesses perceptions of sexual assertiveness: Initiation of Sex, Refusal of Unwanted Sex, and Pregnancy-STD Prevention. Girls perceived themselves as asserting themselves between 50% and 75% of the time with their current or most recent partner. The Initiation subscale was not related to the other two subscales. In final models, girls with a prior pregnancy perceived themselves as initiating sex more than girls without a prior pregnancy. Having a greater number of lifetime partners was related to perceptions of less refusal, whereas greater number of partners, being sexually experienced longer, and engaging in more unprotected sex were related to perceptions of less implementation of preventive methods. None of the relationship variables were related to scores on any subscale. Most of these girls perceived themselves as sexually assertive. Given that sexual experience, not relationship factors, were related to perceptions of sexual assertiveness, the design of counseling messages should incorporate sexual experience. These messages should find effective ways to help girls both to communicate their sexual desires and to enhance their ability to protect themselves.

  16. Role reversal method for treatment of food refusal associated with infantile feeding disorders.

    Science.gov (United States)

    Segal, Idit; Tirosh, Anat; Sinai, Tali; Alony, Sari; Levi, Anat; Korenfeld, Lia; Zangen, Tsili; Mizrachi, Avi; Boaz, Mona; Levine, Arie

    2014-06-01

    Infantile feeding disorders (IFDs) are common causes of food refusal and failure to thrive, and are frequently encountered by primary care physicians and specialists. We have published the Wolfson criteria for IFD, which have eased the approach to the diagnosis of IFDs. Along with and complementary to the Wolfson criteria, we have also developed the role reversal treatment method for IFD, which has been briefly described earlier. The aim of this study was to validate the role reversal treatment method on a cohort of infants diagnosed as having IFD and to present a detailed description of this method for the first time. Parents of infants and children diagnosed as having IFD were invited to participate in the study; they were handed over a questionnaire comprising 6 categories of questions related to patient and parents behaviors, attitudes, and perceptions, which was completed at initiation and at the end of treatment. Full response was defined as improved normative feeding, cessation of abnormal parental feeding, and improved or normal growth patterns. A partial response was defined as success with two-third categories. We enrolled 38 patients, and 32 patients completed the study. Improved feeding occurred in 78%, full recovery was documented in 53% of infants by 6 months, and partial response was observed in another 25%. All forms of pathological feeding improved significantly (mechanistic, nocturnal, persecutory, forced feeding, and distraction). The role reversal treatment method is a simple and effective approach to the treatment of food refusal associated with IFD.

  17. [Recommendations for making decisions when parents refuse to vaccinate their children: ethical analysis].

    Science.gov (United States)

    Riaño Galán, I; Martínez González, C; Sánchez Jacob, M

    2013-07-01

    Vaccinating children is the most effective primary prevention activity and many lives have been saved due to vaccines. Anti-vaccine movements have spread doubts about the safety and effectiveness of childhood vaccines, leading to some parents refusing to vaccinate their children. This refusal raises a conflict of values between the right of parents to the upbringing of their children according to their beliefs and justice, putting the immunity of the group at risk. In Spain, the law protects this ability for parents to decide not to comply with the official vaccine program. Pediatricians play an essential role in a parent's decision, and must provide accurate information about vaccination. It is necessary to explore The values of the parents, their concerns need to be empathetically examined, in order to reach an agreement. Respect for freedom does not exempt us from using discussion and persuasion to achieve attitudes and healthy choices for children. Our commitment to responsability promotion is essential for maintaining high vaccination levels that protect the health of children. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  18. Minors' capacity to refuse treatment: a reply to Gilmore and Herring.

    Science.gov (United States)

    Cave, Emma; Wallbank, Julie

    2012-01-01

    Re R and Re W allow a parent to consent to treatment a competent minor refuses, but the cases have not been tested post-Human Rights Act 1998. Gilmore and Herring offer a means by which they might be distinguished or sidelined. They interpret Gillick to say that in order to consent a minor need only have a full understanding of the particular treatment. They argue that the minors in Re R and Re W were refusing all treatment which requires a separate assessment of capacity-an assessment which was not made. We fear that this distinction would not be workable in clinical practice and argue that their interpretation of Gillick is flawed. From a clinician's point of view, competence cannot always be judged in relation to a specific treatment, but instead must relate to the decision. We show that a decision can incorporate more than one treatment, and more than one decision might be made about one treatment. A minor's understanding of a specific treatment is not always sufficient to demonstrate competence to make a decision. The result is that whilst there might be situations when a parent and a minor both have the power to consent to a particular treatment, they will not share concurrent powers in relation to the same decision. Consequently, a challenge to Re R and Re W, if forthcoming, would need to take a different form. We emphasise the necessity to minimise the dichotomy between legal consent and how consent works in medical practice.

  19. The stigma of "mental" illness: end stage anorexia and treatment refusal.

    Science.gov (United States)

    Campbell, Amy T; Aulisio, Mark P

    2012-07-01

    To answer the questions of whether psychiatric patients should ever be allowed to refuse life-sustaining treatment in favor of comfort care for a condition that is caused by a psychiatric disorder, and if so, under what conditions. Case discussion and normative ethical and legal analysis. We argue that psychiatric patients should sometimes be allowed to refuse life-sustaining treatment in favor of comfort care for a condition that is caused by that psychiatric disorder and articulate the core considerations that should be taken into account when such a case arises. We also suggest that unwillingness among many, especially mental health professionals, to consider seriously both of these questions risks perpetuating stigmatization of persons with psychiatric disorders, i.e., that the "mentally" ill should not be allowed to make significant decisions for themselves-a-a stigmatization that can result in persons with mental disorders both being prevented from exercising autonomous choice even when they are capable of it, and being denied good comfort care at the end of life--care which would be offered to patients with similarly life-threatening conditions that were not deemed to be the result of "mental" illness. Copyright © 2012 Wiley Periodicals, Inc.

  20. Overcoming healthcare workers vaccine refusal--competition between egoism and altruism.

    Science.gov (United States)

    Betsch, C

    2014-12-04

    Vaccination reduces the risk of becoming infected with and transmitting pathogens. The role of healthcare workers (HCWs) in controlling and limiting nosocomial infections has been stressed repeatedly. This has also been recognised at a political level, leading the European Council of Ministers in 2009 to encourage coverage of 75% seasonal influenza vaccine in HCWs. Although there are policies, recommendations and well-tolerated vaccines, still many HCWs refuse to get vaccinated. This article uses literature from psychology and behavioural economics to understand vaccination decisions and the specific situation of HCWs. HCWs are expected to be highly motivated to protect others. However, their individual vaccination decisions follow the same principles (of weighting individual risks) as everyone else’s vaccination decisions. This will lead to decisional conflict in a typical social dilemma situation, in which individual interests are at odds with collective interests. Failure to get vaccinated may be the result. If we understand the motivations and mechanisms of HCWs’ vaccine refusal, interventions and campaigns may be designed more effectively. Strategies to increase HCWs’ vaccine uptake should be directed towards correcting skewed risk perceptions and activating pro-social motivation in HCWs.

  1. Bonus Point System for Refuse Classification and Sustainable Development: A Study in China

    Directory of Open Access Journals (Sweden)

    Shijie Guo

    2017-09-01

    Full Text Available The rapid growth of household waste not only endangers the environment and people’s health, but also limits social and economic development. The effective sorting and recycling of garbage can control this problem. Adopting a semi-quantitative case study method, our researchers investigated the effect of a bonus point system for refuse classification that improves the accuracy of refuse classification and the residents’ environment awareness. In the system, residents will receive some gifts after sorting the garbage correctly. We also investigated the attitudes of residents and companies towards this novel system. Our researchers employed various methods to analyze garbage-sorting data, questionnaires completed by residents, and interview records. The results show that use of a bonus point system affects the management of domestic waste by improving the accuracy and enhancing the awareness of garbage sorting. Overall, residents support the system and benefit from it, which increases participation and consciousness of environmental protection. However, continuous publicity and coordination of various policies are required to promote the wide-range implementation and sustainable development of this system.

  2. When a Wife Says "No": Wife Sexual Refusal as a Factor in Husband-Wife Homicides in Ghana.

    Science.gov (United States)

    Adinkrah, Mensah

    2017-11-01

    In Ghana, wife sexual refusal is a key factor in uxoricides or husband-to-wife murders. Despite this, there is a dearth of systematic research that examines sexual strife as a precipitant of domestic violence and spousal murder. The present article addresses the current lack of research by systematically examining 25 cases of homicides and attempted homicides where wives were lethally and nonlethally assaulted by their husbands following the former's refusal to engage in husband-initiated sexual intercourse. A content analysis was conducted of all print and electronic media news items where a wife's refusal of sexual intercourse with a husband triggered lethal or aggravated violence. The results showed that the victims were aged 23 to 55 years old and were generally of low socioeconomic status. The assailants were aged 28 to 60 years old. Assailants used machetes, knives, and personal weapons to perpetrate the crimes, and extreme violence was a frequent feature of both lethal and nonlethal acts.

  3. When is it permissible to dismiss a family who refuses vaccines? Legal, ethical and public health perspectives.

    Science.gov (United States)

    Halperin, Beth; Melnychuk, Ryan; Downie, Jocelyn; Macdonald, Noni

    2007-12-01

    Although immunization is one of the most important health interventions of the 20th century, cases of infectious disease continue to occur. There are parents who refuse immunization for their children, creating a dilemma for the primary care physician who must consider the best interest of the individual child as well as that of the community. Some physicians, when faced with parents who refuse immunization on behalf of their children, choose to dismiss these families from their practice. Given the existing shortage of primary care physicians across Canada, this decision to dismiss families based on vaccine refusal has far-reaching implications. The present article explores this issue in the Canadian context from a legal, ethical and public health perspective.

  4. The impact of a multiple intelligences teaching approach drug education programme on drug refusal skills of Nigerian pupils.

    Science.gov (United States)

    Nwagu, Evelyn N; Ezedum, Chuks E; Nwagu, Eric K N

    2015-09-01

    The rising incidence of drug abuse among youths in Nigeria is a source of concern for health educators. This study was carried out on primary six pupils to determine the effect of a Multiple Intelligences Teaching Approach Drug Education Programme (MITA-DEP) on pupils' acquisition of drug refusal skills. A programme of drug education based on the Multiple Intelligences Teaching Approach (MITA) was developed. An experimental group was taught using this programme while a control group was taught using the same programme but developed based on the Traditional Teaching Approach. Pupils taught with the MITA acquired more drug refusal skills than those taught with the Traditional Teaching Approach. Urban pupils taught with the MITA acquired more skills than rural pupils. There was no statistically significant difference in the mean refusal skills of male and female pupils taught with the MITA. © The Author(s) 2014.

  5. Psychosocial Interventions for School Refusal with Primary and Secondary School Students: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Brandy Maynard

    2015-05-01

    Full Text Available BACKGROUND School refusal is a psychosocial problem characterized by a student’s difficulty attending school and, in many cases, substantial absence from school (Heyne & Sauter, 2013. It is often distinguished from truancy, in part because of the severe emotional distress associated with having to attend school and the absence of severe antisocial behavior. Truancy, on the other hand, is not typically associated with emotional distress and is commonly associated with severe externalizing behavior. The emotional distress associated with school refusal is often in the form of fear or anxiety, and sometimes in the form of depression. School refusal occurs for about 1-2% of young people, and estimates among clinically referred youth are considerably higher. There is substantial heterogeneity in both the presentation of school refusal and its associated risk factors. Significant adverse consequences may occur in the short- and long-term, including school dropout and problems with social adjustment. Family members and school staff are also affected by school refusal. The most commonly studied interventions for school refusal are behavioral approaches and cognitive-behavioral therapy (CBT. The overarching aim of these interventions is the reduction of the young person’s emotional distress and an increase in school attendance to help the young person follow a normal developmental pathway (Heyne & Sauter, 2013. Behavioral interventions include exposure-based interventions, relaxation training, and/or social skills training with the student, and contingency management procedures with the parents and school staff. CBT manuals additionally focus attention on the identification and modification of maladaptive cognition that may maintain the young person’s emotional distress and absenteeism. In some instances parent cognition is also targeted. Other interventions have been used to treat school refusal (e.g., psychodynamic treatment, family therapy

  6. The use of coal refuse as construction aggregates; Utilizacion de los Esteriles de Carbon como Aridos en Construccion

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-07-01

    The objective of this project was to carry out a study which would allow us to determine the nature and properties of coal refuse for its possible use as construction aggregates: roadbeds concrete, bituminous meagres, etc. and to establish criteria of acceptability, placing, and quality control. Two types of refuse, considered to be representative, were chosen (one black and one red) and various trials were performed at a grinding and classifying plant for the obtention of granular materials. The results of these trials determined the most appropriate plant treatment for each type of refuse and established the margin of acceptability, criteria of acceptability, and quality control tests to be applied to the materials obtained from coal refuse for use as construction aggregates. Laboratory testing with both types of refuse mixed with binders (cement, emulsions) were carried out. At the same time, real scale tests, through the construction of concrete slabs in local roads and in trial areas, using the proportions of aggregates and cement that are customary in the area, and also by varying the cement content, substituting it for airborne ash from the thermal La Pereda power station were also performed. From the results obtained, it can be deduced that coal refuse can be used as granular material for roadbeds in different ways: stabilised as gravel-cement, in the form of gravel emulsion, as gravel slag, or by itself. As far as its use in concrete manufacture, it is limited to marginal works. With regard to its decorative use in gardening, it is being used in various town halls in Asturias and Cantabria. (Author)

  7. Patient-related factors and circumstances surrounding decisions to forego life-sustaining treatment, including intensive care unit admission refusal.

    Science.gov (United States)

    Reignier, Jean; Dumont, Romain; Katsahian, Sandrine; Martin-Lefevre, Laurent; Renard, Benoit; Fiancette, Maud; Lebert, Christine; Clementi, Eva; Bontemps, Frederic

    2008-07-01

    To assess decisions to forego life-sustaining treatment (LST) in patients too sick for intensive care unit (ICU) admission, comparatively to patients admitted to the ICU. Prospective observational cohort study. A medical-surgical ICU. Consecutive patients referred to the ICU during a one-yr period. None. Of 898 triaged patients, 147 were deemed too well to benefit from ICU admission. Decisions to forego LST were made in 148 of 666 (22.2%) admitted patients and in all 85 patients deemed too sick for ICU admission. Independent predictors of decisions to forego LST at ICU refusal rather than after ICU admission were: age; underlying disease; living in an institution; preexisting cognitive impairment; admission for medical reasons; and acute cardiac failure, acute central neurologic illness, or sepsis. Hospital mortality after decisions to forego LST was not significantly different in refused and admitted patients (77.5% vs. 86.5%; p = .1). Decisions to forego LST were made via telephone in 58.8% of refused patients and none of the admitted patients. Nurses caring for the patient had no direct contact with the ICU physicians for 62.3% of the decisions in refused patients, whereas meetings between nurses and physicians occurred in 70.3% of decisions to forego LST in the ICU. Patients or relatives were involved in 28.2% of decisions to forego LST at ICU refusal compared with 78.4% of decisions to forego LST in ICU patients (p refused patients (vs. none of admitted patients) and were associated with less involvement of nurses and relatives compared with decisions in admitted patients. Further work is needed to improve decisions to forego LST made under the distinctive circumstances of triage.

  8. Evaluation of low-level solid radioactive waste generated by a large hospital and disposed of with ordinary refuse

    International Nuclear Information System (INIS)

    Conte, L.; Pedroli, G.; Monciardini, M.; Bianchi, L.; Novario, R.; Beretta, A.

    1996-01-01

    In the Lombardy region some hospitals have recently been reported to the local authorities because of the presence of radioactivity in hospital refuse sent to the municipal tips for incineration. On various occasions the refuse collectors coming from the hospitals had to return with their refuse as traces of radioactivity were detected at the entrance to the tips equipped with monitoring systems. Hospitals administering radioactive substances for diagnostic or therapeutic purposes produce radioactive waste mainly in solid and liquid form. This waste is principally present in patient excreta and in contaminated materials. Radioactive waste present in patient excreta is normally disposed of through the sewage system provided that the concentration limits and annual activity stipulated by law are respected. The contaminated materials coming from the departments that carry out radioisotopic investigations and therapy with unsealed sources can be collected separately and sent to a tip after a period of storage to permit radioactive decay. However, part of the radioactive waste escapes all checks and inevitably mixes with normal refuse or with special hospital refuse that is not considered radioactive. This occurs in the case of: 1. excreta from patients who are not hospitalised after a radioisotopic investigation and materials contaminated by the excreta; 2. excreta from hospitalised patients which are eliminated outside the nuclear medicine and radiotherapy departments; 3. contaminated materials produced with unsealed sources in hospital departments other than those of nuclear medicine and radiotherapy; The waste indicated in point 1 is probably the main problem in ecological terms as the patients who are not hospitalised eliminate radioactive excreta into domestic sewage systems and can also contaminate materials that are disposed of with normal household refuse. In this case any solution to the problem would seriously affect diagnostic activities carried out in the

  9. Assessing the Risk of Prehospital Administration of Naloxone with Subsequent Refusal of Care.

    Science.gov (United States)

    Levine, Michael; Sanko, Stephen; Eckstein, Marc

    2016-01-01

    EMS providers frequently encounter opioid-toxic patients who receive naloxone and then refuse further medical care. Older studies revealed this practice to be safe. In light of the evolving patterns of opioid abuse, this study attempted to determine the safety of this practice. This is a retrospective review of all patient encounters by the Los Angeles Fire Department (LAFD) between July 1, 2011-December 31, 2013. All LAFD patient encounters are stored electronically. These electronic records were reviewed for subjects who received naloxone had a documented respiratory rate (RR) less than 12, and subsequently refused transport. Data abstracted included name, social security number (SSN), date of birth (DOB), date of EMS encounter, age, and treatment rendered. The names, SSN, and DOB, as available, were supplied to the coroner's office. The Coroner's records were reviewed to determine if a patient with the same or similar name (e.g., Jon vs. Jonathan) had died within 24 hours, 30 days, or 6 months of the initial EMS encounter. The abstractor was blinded to the study hypothesis. 205 subjects were identified; the median (IQR) age was 41 (29-53) years. 27 (13%) were female. One subject (0.49%) died within 24 hours of the initial EMS encounter. The cause of death (COD) was coronary artery disease and heroin use. Two additional subjects (1. %) died within 30 days. One of these subjects died 6 days later; the COD is unknown. The other subject died 20 days after the EMS encounter; the COD was cardiovascular disease and liver cirrhosis. No additional subjects were identified at the 6 month follow up. A third subject died of a heroin overdose 16 months after the initial EMS encounter, but was beyond the pre-defined follow up period. The practice of receiving pre-hospital naloxone by paramedics and subsequently refusing care is associated with an extremely low short- and intermediate-term mortality. Despite an evolving pattern of opioid abuse, the results of this study

  10. Refusing to be Complicit in our Prison Nation: Teachers Rethinking Mandated Reporting

    Directory of Open Access Journals (Sweden)

    Erica Meiners

    2016-11-01

    Full Text Available Ensuring that Black Lives Matter in schools requires seismic shifts including excavating the ongoing practices and policies that reproduce heterogendered white supremacy in schools. However, what is too often erased in these movements is the key way the profession of teaching facilitates racialized surveillance and criminalization. Teachers are mandated reporters who are required by law to report suspected negligence and abuse. While on paper this charge looks neutral, this essay illustrates why teachers should rethink their roles and organize against mandated reporting laws. To teach to ensure that all Black Lives Matter requires refusing to be complicit in the mechanisms that contribute to the destruction of too many families and communities.

  11. Refuse-derived fuel as a secondary energy in Taiwan - Using Hotelling space allocation model

    International Nuclear Information System (INIS)

    Kwodong Wey; Sheueching Hong

    2006-01-01

    Most Taiwanese farmers usually blend rice straws into the soil after harvest. However, rice straws possess great thermal energy, which can be used to produce refuse-derived fuel (RDF-5). As Taiwan faces energy shortage, the development benefits of the RDF-5 industry are tempting. This study employs the Hotelling model to design the locations and the optimal numbers of RDF-5 plants. From the technology and material supply point of view, turning waste rice straws into RDF-5 is feasible in Taiwan. Nevertheless, from the business operation perspective, even if the RDF-5 plant is willing to lower its profit rate, its selling price is still hard to compete with imported RDF-5. If the Taiwanese government decides to pursue RDF-5 as an alternative energy, they might need to take a step further to subsidize entrepreneurs or provide appropriate tax benefits. Otherwise, the RDF-5 industry is hard to survive in Taiwan. (Author)

  12. [Perioperative management of Jehovah's Witness patients. Special consideration of religiously motivated refusal of allogeneic blood transfusion].

    Science.gov (United States)

    Habler, O; Voss, B

    2010-04-01

    The religious organization of Jehovah's Witnesses numbers more than 7 million members worldwide, including 165,000 members in Germany. Although Jehovah's Witnesses strictly refuse the transfusion of allogeneic red blood cells, platelets and plasma, Jehovah's Witness patients may nevertheless benefit from modern therapeutic concepts including major surgical procedures without facing an excessive risk of death. The present review describes the perioperative management of surgical Jehovah's Witness patients aiming to prevent fatal anemia and coagulopathy. The cornerstones of this concept are 1) education of the patient about blood conservation techniques generally accepted by Jehovah's Witnesses, 2) preoperative optimization of the cardiopulmonary status and correction of preoperative anemia and coagulopathy, 3) perioperative collection of autologous blood, 4) minimization of perioperative blood loss and 5) utilization of the organism's natural anemia tolerance and its acute accentuation in the case of life-threatening anemia.

  13. Buyer's guide of sewage and refuse treatment plants. B + A. Vol. 2. 6. rev. ed.

    International Nuclear Information System (INIS)

    Pluemer, C.H.

    1991-01-01

    The brochure gives an overview of appropriate forms and engineering offices concerned with construction and equipment of sewage and refuse treatment plants. Part one - an alphabetical listing of comparies giving information on their entry in the commercial registry; address; telephone; telefax and telex numbers and range of products. It includes references to their production programme or engineering offices on form representatives at home and abroad. Part Two is a ''product and service listing''. A list of product and service headings, under which the forms that provide that service or product are listed. Part Three is as ''Answer index'' which lists alphabetically the readings found in part two but listed in the German, English and French languages for easier use. Part Four is an overview of the present standards, regulations, codes of practice in the EC and a list of professional organisations. (orig./BBR) [de

  14. Conflicts between religious or spiritual beliefs and pediatric care: informed refusal, exemptions, and public funding.

    Science.gov (United States)

    2013-11-01

    Although respect for parents' decision-making authority is an important principle, pediatricians should report suspected cases of medical neglect, and the state should, at times, intervene to require medical treatment of children. Some parents' reasons for refusing medical treatment are based on their religious or spiritual beliefs. In cases in which treatment is likely to prevent death or serious disability or relieve severe pain, children's health and future autonomy should be protected. Because religious exemptions to child abuse and neglect laws do not equally protect all children and may harm some children by causing confusion about the duty to provide medical treatment, these exemptions should be repealed. Furthermore, public health care funds should not cover alternative unproven religious or spiritual healing practices. Such payments may inappropriately legitimize these practices as appropriate medical treatment.

  15. Steam gasification of tyre waste, poplar, and refuse-derived fuel: A comparative analysis

    International Nuclear Information System (INIS)

    Galvagno, S.; Casciaro, G.; Casu, S.; Martino, M.; Mingazzini, C.; Russo, A.; Portofino, S.

    2009-01-01

    In the field of waste management, thermal disposal is a treatment option able to recover resources from 'end of life' products. Pyrolysis and gasification are emerging thermal treatments that work under less drastic conditions in comparison with classic direct combustion, providing for reduced gaseous emissions of heavy metals. Moreover, they allow better recovery efficiency since the process by-products can be used as fuels (gas, oils), for both conventional (classic engines and heaters) and high efficiency apparatus (gas turbines and fuel cells), or alternatively as chemical sources or as raw materials for other processes. This paper presents a comparative study of a steam gasification process applied to three different waste types (refuse-derived fuel, poplar wood and scrap tyres), with the aim of comparing the corresponding yields and product compositions and exploring the most valuable uses of the by-products

  16. "No Thank You, We'd Rather Not": The Rights and Policies of Daily Newspapers Relating to Refusals to Accept Advertising.

    Science.gov (United States)

    Utt, Sandra H.; Pasternack, Steve

    A study investigated the types of advertisements newspapers refuse as well as the attitudes of advertising managers about guidelines and laws concerning advertising refusal. Newspapers were selected from the "1985 Editor and Publisher Yearbook" using a systematic probability sampling method, and questionnaires were mailed to advertising…

  17. Risky procedures by nurses in hospitals: problems and (contemplated) refusals of orders by physicians, and views of physicians and nurses: a questionnaire survey

    NARCIS (Netherlands)

    de Bie, J.; Cuperus-Bosma, J.M.; van der Jagt, M.A.; Gevers, J.K.M.; van der Wal, G.

    2005-01-01

    Occurrence of problems with, refusals of orders and contemplated refusals of orders for risky procedures by nurses in Dutch hospitals and views on the safety of performance was studied using postal questionnaires (600 physicians and 3200 nurses, response 60-71%). Of the respondents, 11-30%

  18. Graduated Exposure and Compliance Training Intervention for Blood Draw Avoidance and Refusal in a Woman with Intellectual Disability and Schizoaffective Disorder

    Science.gov (United States)

    Cromartie, R. Samuel; Flood, William A.; Luiselli, James K.

    2014-01-01

    This case report concerns a woman with intellectual disability, schizoaffective disorder, and avoidance and refusal of having her blood drawn. She required but refused blood draws to properly monitor the therapeutic dose of a necessary psychotropic medication. During intervention at a community-based habilitation setting and under simulated…

  19. Prevalence of depression in granted and refused requests for euthanasia and assisted suicide: a systematic review.

    Science.gov (United States)

    Levene, Ilana; Parker, Michael

    2011-04-01

    There is an established link between depression and interest in hastened death in patients who are seriously ill. Concern exists over the extent of depression in patients who actively request euthanasia/physician-assisted suicide (PAS) and those who have their requests granted. To estimate the prevalence of depression in refused and granted requests for euthanasia/PAS and discuss these findings. Methods A systematic review was performed in MEDLINE and PsycINFO in July 2010, identifying studies reporting rates of depression in requests for and cases of euthanasia/PAS. One author critically appraised the strength of the data using published criteria. 21 studies were included covering four countries. There was considerable heterogeneity in methods of assessing depression and selecting patients. In the highest quality studies, in the Netherlands and Oregon, 8-47% of patients requesting euthanasia/PAS had depressive symptoms and 2-17% of completed euthanasia/PAS cases had depressive symptoms. In the Netherlands, depression was significantly higher in refused than granted requests, and there was no significant difference in the rate of depression between euthanasia cases and similar patients who had not made a request for euthanasia. It is unclear whether depression increases the probability of making a request for euthanasia/PAS, but in the Netherlands most requests in depressed patients are rejected, leaving a depression rate in cases that is similar to the surrounding population. Less evidence is available elsewhere, but some level of depression has been identified in patients undergoing euthanasia/PAS in all the countries studied. Whether the presence of depression is ever compatible with an ethical decision on euthanasia/PAS is discussed.

  20. Energy recovery from municipal solid waste by refuse derived fuel production in Malaysia

    International Nuclear Information System (INIS)

    Sanaz Saheri; Noorezlin Ahmad Baseri; Masoud Aghajani Mir; Malmasi Saeed

    2010-01-01

    Energy recovery from municipal solid waste (MSW) is so beneficial both for the energy and for the positive environmental implications. Mainly related to the saving of primary energy derived from fossil fuel. Malaysia as a fast growing population country has the average amount of municipal solid waste (MSW) generated around 0.5-0.8 kg/person/day and it has been increased to 1.7 kg/person/day in major cities. Regarding characterization exercise, the main parts of the Malaysian MSW were found to be food, paper and plastic, which made up almost 80 % of the waste by weight. Furthermore, the average moisture content of the MSW was about 55 %, making incineration a challenging mission. In addition waste sectors in Malaysia contributes to 1.3 million ton of CH 4 compare to total CH 4 emission which is 2.2 MT. In order to overcome waste problem considering other technical, environmental and economical methods seems to be necessarily. Resource recovery centers recovers the maximum proportion of recyclable and recoverable resources from the mixed municipal solid waste .The resource recovery process itself is one of the step-by-step segregation and elimination of all non-combustibles , and separation of the combustibles in the desired form of fuel for good combustion. Then, a further mechanical separation process converts combustible materials to refuse derived fuel (RDF) with moisture content between 20 and 30 % and an average calorific fuel value of about 3450 kcal/kg. So, the aim of this paper is taking into account resource recovery from waste using refuse derived fuel as a secondary resource with regarding advantages and disadvantages of this kind of energy production in Malaysia as a developing country. (author)

  1. The moderating role of risk-taking tendency and refusal assertiveness on social influences in alcohol use among inner-city adolescents.

    Science.gov (United States)

    Epstein, Jennifer A; Botvin, Gilbert J

    2002-07-01

    Many etiological models of adolescent alcohol use concentrate on the main effects of risk and protective factors. This study examined the moderating influence of risk-taking tendency and refusal assertiveness on perceived friends' drinking as associated with alcohol use among inner-city adolescents. Participants (N = 2,400; 54% female) completed questionnaires that included measures of risk-taking tendency, refusal assertiveness, perceived friends' drinking and alcohol use (drinking frequency, drinking amount and drunkenness). Main effects for perceived friends' drinking, risk-taking tendency and refusal assertiveness were found for all three drinking measures, consistent with prior work. Furthermore, significant interactions were found between (1) risk-taking tendency and perceived friends' drinking and (2) refusal assertiveness and perceived friends' drinking. High risk-taking tendency and low refusal assertiveness increased the impact of perceived friends' drinking on alcohol use among inner-city adolescents. This suggests that these factors are important components in preventing alcohol use.

  2. 25 CFR 30.125 - What happens if a State refuses to allow a school access to the State assessment?

    Science.gov (United States)

    2010-04-01

    ... if a State refuses to allow a school access to the State assessment? (a) The Department will work directly with State officials to assist schools in obtaining access to the State's assessment. This can... access to the State's assessment, the Bureau-funded school must submit a waiver for an alternative...

  3. 77 FR 48159 - Draft Guidance for Industry and Food and Drug Administration Staff; Refuse To Accept Policy for...

    Science.gov (United States)

    2012-08-13

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-0523] Draft Guidance for Industry and Food and Drug Administration Staff; Refuse To Accept Policy for 510(k)s; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug...

  4. Effect of a redesigned two-wheeled container for refuse collecting on mechanical loading of low back and shoulders

    NARCIS (Netherlands)

    Kuijer, P. Paul F. M.; Hoozemans, Marco J. M.; Kingma, Idsart; van Dieën, Jaap H.; de Vries, Wiebe H. K.; Veeger, Dirk Jan; van der Beek, Allard J.; Visser, Bart; Frings-Dresen, Monique H. W.

    2003-01-01

    The objective of this study was to compare the mechanical and perceived workload when working with a redesigned two-wheeled container and working with a standard two-wheeled container for refuse collecting. The three changes in the design of the container were a displacement of the position of the

  5. [Participation refusal by probands in an epidemiologic long-term study--sociodemographic, clinical and psychometric findings].

    Science.gov (United States)

    Franz, M; Schepank, H; Wirth, T; Schellberg, D

    1992-11-01

    Usually little is known about probands who participated in an epidemiological longitudinal field survey but refused participation in follow-up investigations. For reasons of data protection and on account of the fact that investigative instruments used in longterm field surveys or panel studies are more focused on well defined issues (opinions, attitudes, assessment of behaviors) and less on personality variables, differentiated statements on probands who explicitly refused cooperation can hardly be made. In our epidemiological longitudinal field study on prevalence and course of psychogenic disorders we have a different situation. Within the limits of our study we had the unique opportunity to gain far-reaching information on probands who refused to participate in preceding investigations in regard to sociodemographic, psychometric and clinical variables. The clientele of refusers we present in our paper mainly comprises elderly, married, rather obsessive-compulsive structured, lower-class females. According to our data interactive aspects are equally responsible for reduced cooperativeness. The significance of our findings for the planning and carrying out of epidemiological longitudinal field surveys is discussed.

  6. Frequent Fliers, School Phobias, and the Sick Student: School Health Personnel's Perceptions of Students Who Refuse School

    Science.gov (United States)

    Torrens Armstrong, Anna M.; McCormack Brown, Kelli R.; Brindley, Roger; Coreil, Jeannine; McDermott, Robert J.

    2011-01-01

    Background: This study explored school personnel's perceptions of school refusal, as it has been described as a "common educational and public health problem" that is less tolerated due to increasing awareness of the potential socioeconomic consequences of this phenomenon. Methods: In-depth interviews were conducted with school personnel…

  7. Staff attitude and experience in dealing with rational nursing home patients who refuse to eat and drink.

    Science.gov (United States)

    Mattiasson, A C; Andersson, L

    1994-11-01

    This paper describes the personal attitudes of nursing home staff and their experience of coping with rational nursing home patients who refused to eat and drink. Professional caregivers in 13 nursing homes and nursing home units in the county of Stockholm, Sweden, were asked to judge an ethical conflict involving a situation in which a patient of sound mind refused to eat and drink. Two questions were raised: (a) What would your unit's decision be in this case? (b) What is your personal opinion in this case? Answers to question (a) showed that 20% believed that the patient's autonomy would be respected, i.e. the patient would be allowed to die without medical intervention. Concerning question (b), the results showed that approximately 50% believed that the patient's wishes regarding food refusal must be respected. Furthermore, the results suggested that both professional category and number of years' service made a difference to the staff views on patient autonomy. Finally, the findings indicated that the nursing homes included in the study did not show any distinct policy with regard to the autonomy of elderly nursing home patients in refusing to eat and drink.

  8. Observations of parent-child co-shoppers in supermarkets: children's involvement in food selections, parental yielding, and refusal strategies.

    Science.gov (United States)

    O'Dougherty, Maureen; Story, Mary; Stang, Jamie

    2006-01-01

    The study aimed to collect descriptive information on the decision-making processes of adult shoppers around food purchases when young children are present. Anthropological field observations were conducted on adult-child grocery shoppers. Eleven supermarkets in the Minneapolis-St. Paul metropolitan region. A convenience sample (n = 142) of adult-child shoppers at 8 budget and 3 deluxe supermarkets located in diverse urban and suburban areas. Observations registered adult-child interactions over food selections, including parental yielding or refusal strategies and child engagement in shopping. Means and frequencies were calculated for food items considered. In 67 (50.4%) of the total 133 observations, a child initiated a request. Half (55.2%) of the requests were for sweets or snacks. Nearly half (47.8%) of adults yielded to the child's request. Brands and marketing techniques appeared to be a factor in 28.6% of selections. The most frequent adult refusals either provided an explanation or ignored the request. Adults yield to children's requests for sweets and snacks nearly as often as they refuse them. However, effective refusal strategies are used by many adults. Opportunities exist in the grocery store for adults to reinforce young children's interest in food and nutrition.

  9. Free to become martyrs? The right to refuse medical treatment on religious grounds in a comparative perspective

    Directory of Open Access Journals (Sweden)

    Vincenzo Pacillo

    2016-09-01

     ABSTRACT: This study focuses on the right of patients to refuse medical treatments on religious grounds and on the (supposed right to the parents to refuse medical treatments on behalf of their children, emphasizing the links and connections between the freedom of religion, the right to self-determination and the right to refuse medical treatment based on religious motivations. After a comparison between the norms devoted to rule the exercise of these rights in the English (and Welsh and Italian legal systems, the article suggests that the approach of medical staff towards a Refusal of Medical Treatment on Religious Grounds ought to start an intercultural process. This process ought to be a cross-cultural dialogue devoted not only to translate medical language in a language which can be fully understood by the patient, but also to create a reciprocal comprehension between the (mainstream ethnocultural communication codes and instances of the staff and the (nondominant ethnocultural (and religious communication codes and instances of the patient (or of his/her parents.

  10. Functional Assessment of School Attendance Problems : An Adapted Version of the School Refusal Assessment Scale-Revised

    NARCIS (Netherlands)

    Heyne, D. A.; Vreeke, L. J.; Maric, M.; Boelens, H.; Van Widenfelt, B. M.

    2017-01-01

    The School Refusal Assessment Scale (SRAS) was developed to identify four factors that might maintain a youth’s school attendance problem (SAP), and thus be targeted for treatment. There is still limited support for the four-factor model inherent to the SRAS and its revision (SRAS-R). Recent studies

  11. Challenged by cognition : toward optimal measurement and greater understanding of youth cognition in school refusal and cognitive behavioural therapy outcome

    NARCIS (Netherlands)

    Maric, Marija

    2010-01-01

    The main purpose of this dissertation was to highlight and address seven challenges related to the measurement of youth cognition, understanding the role of cognitive constructs in anxiety and school refusal, and the examination of cognitive mediators of cognitive-behavioural treatment outcomes. The

  12. Refusal Strategies in L1 and L2: A Study of Persian-Speaking Learners of English

    Science.gov (United States)

    Babai Shishavan, Homa; Sharifian, Farzad

    2013-01-01

    The aim of this study was to explore pragmalinguistic strategies employed by a group of Iranian English language learners when making refusals to invitations, requests, offers and suggestions in their first (Persian) and second (English) languages. Data were collected from 86 participants through a Discourse Completion Test (DCT). The social…

  13. Understanding treatment refusal among adults presenting for HIV-testing in Soweto, South Africa: a qualitative study.

    Science.gov (United States)

    Katz, Ingrid T; Dietrich, Janan; Tshabalala, Gugu; Essien, Thandekile; Rough, Kathryn; Wright, Alexi A; Bangsberg, David R; Gray, Glenda E; Ware, Norma C

    2015-04-01

    HIV treatment initiatives have focused on increasing access to antiretroviral therapy (ART). There is growing evidence, however, that treatment availability alone is insufficient to stop the epidemic. In South Africa, only one third of individuals living with HIV are actually on treatment. Treatment refusal has been identified as a phenomenon among people who are asymptomatic, however, factors driving refusal remain poorly understood. We interviewed 50 purposively sampled participants who presented for voluntary counseling and testing in Soweto to elicit a broad range of detailed perspectives on ART refusal. We then integrated our core findings into an explanatory framework. Participants described feeling "too healthy" to start treatment, despite often having a diagnosis of AIDS. This subjective view of wellness was framed within the context of treatment being reserved for the sick. Taking ART could also lead to unintended disclosure and social isolation. These data provide a novel explanatory model of treatment refusal, recognizing perceived risks and social costs incurred when disclosing one's status through treatment initiation. Our findings suggest that improving engagement in care for people living with HIV in South Africa will require optimizing social integration and connectivity for those who test positive.

  14. 21 CFR 515.25 - Revocation of order refusing to approve a medicated feed mill license application or suspending...

    Science.gov (United States)

    2010-04-01

    ... medicated feed mill license application or suspending or revoking a license. 515.25 Section 515.25 Food and..., FEEDS, AND RELATED PRODUCTS MEDICATED FEED MILL LICENSE Administrative Actions on Licenses § 515.25 Revocation of order refusing to approve a medicated feed mill license application or suspending or revoking a...

  15. A Mandatory, High-Stakes National Teacher Evaluation System: Perceptions and Attributions of Teachers Who Actively Refuse to Participate

    Science.gov (United States)

    Tornero, Bernardita; Taut, Sandy

    2010-01-01

    This study examines why some public elementary school teachers openly refuse participation in a mandatory national, standards-based teacher evaluation program. We describe the perceptions these "rebel" teachers have of the evaluation system, studying their open resistance based on the meanings they construct, and elaborated an…

  16. Religious law versus secular law The example of the get refusal in Dutch, English and Israeli law

    NARCIS (Netherlands)

    Blois, M. de

    2010-01-01

    The tension between religious law and secular law in modern democracies is illustrated in this article by a discussion of the different approaches to the get (a bill of divorce) refusal (based on Jewish law) under Dutch, English and Israeli law. These legal orders share many characteristics, but

  17. The @school project : developmental considerations in the design and delivery of cognitive-behavioural therapy for adolescent school refusal

    NARCIS (Netherlands)

    Sauter, Floor Margriet

    2010-01-01

    School refusal is an attendance problem characterized by a young person’s difficulty in going to school, accompanied by emotional distress on the part of the young person and parental attempts to return the young person to regular school attendance. Prolonged absence from school has serious short-

  18. 78 FR 60292 - Draft Guidance for Industry on Abbreviated New Drug Application Submissions-Refuse-to-Receive...

    Science.gov (United States)

    2013-10-01

    ...--Refuse-to-Receive Standards.'' This guidance is intended to assist applicants preparing to submit to FDA.... 2201, Silver Spring, MD 20993-0002. Send one self-addressed adhesive label to assist that office in... Fishers Lane, Rm. 1061, Rockville, MD 20852. FOR FURTHER INFORMATION CONTACT: Johnny Young, Center for...

  19. Individual- and regional-level determinants of human papillomavirus (HPV) vaccine refusal: the Ontario Grade 8 HPV vaccine cohort study.

    Science.gov (United States)

    Remes, Olivia; Smith, Leah M; Alvarado-Llano, Beatriz E; Colley, Lindsey; Lévesque, Linda E

    2014-10-08

    Studies on the determinants of human papillomavirus (HPV) vaccine use have generally focused on individual-level characteristics, despite the potentially important influence of regional-level characteristics. Therefore, we undertook a population-based, retrospective cohort study to identify individual- and regional-level determinants of HPV vaccine refusal (non-receipt) in Ontario's (Canada) Grade 8 HPV Immunization Program. Ontario's administrative health and immunization databases were used to identify girls eligible for free HPV vaccination in 2007-2011 and to ascertain individual-level characteristics of cohort members (socio-demographics, vaccination history, health care utilization, medical history). The social and material characteristics of the girl's region (health unit) were derived from the 2006 Canadian Census. Generalized estimating equations (binomial distribution, logit link) were used to estimate the population-average effects of individual- and regional-level characteristics on HPV vaccine refusal. Our cohort consisted of 144,047 girls, 49.3% of whom refused HPV vaccination. Factors associated with refusal included a previous diagnosis of Down's syndrome (OR = 1.37, 95% CI 1.16-1.63) or autism (OR = 1.60, 95% CI 1.34-1.90), few physician visits (OR = 1.45, 95% CI 1.35-1.55), and previous refusal of mandatory (OR = 2.23, 95% CI 2.07-2.40) and optional (OR = 3.96, 95% CI 3.87-4.05) vaccines. Refusal was highest among the lowest and highest income levels. Finally, a previous diagnosis of obesity and living in an area of high deprivation were associated with lower refusal (OR = 0.87, 95% CI 0.83-0.92 and OR = 0.82 95%, CI 0.79-0.86, respectively). Studies on HPV vaccine determinants should consider regional-level factors. Efforts to increase HPV vaccine acceptance should include vulnerable populations (such as girls of low income) and girls with limited contact with the healthcare system.

  20. Informed, advance refusals of treatment by people with severe mental illness in a randomised controlled trial of joint crisis plans: demand, content and correlates.

    Science.gov (United States)

    Henderson, Claire; Farrelly, Simone; Flach, Clare; Borschmann, Rohan; Birchwood, Max; Thornicroft, Graham; Waheed, Waquas; Szmukler, George

    2017-11-24

    In the UK, crisis planning for mental health care should acknowledge the right to make an informed advance treatment refusal under the Mental Capacity Act 2005. Our aims were to estimate the demand for such treatment refusals within a sample of service users who had had a recent hospital admission for psychosis or bipolar disorder, and to examine the relationship between refusals, and service user characteristics. To identify refusals we conducted content analysis of Joint Crisis Plans, which are plans formulated by service users and their clinical team with involvement from an external facilitator, and routine care plans in sub-samples from a multi-centre randomised controlled trial of Joint Crisis Plans (plus routine mental health care) versus routine care alone (CRIMSON) in England. Factors hypothesised to be associated with refusals were identified using the trial data collected through baseline interviews of service users and clinicians and collection of routine clinical data. Ninety-nine of 221 (45%) of the Joint Crisis Plans contained a treatment refusal compared to 10 of 424 (2.4%) baseline routine care plans. No Joint Crisis Plans recorded disagreement with refusals on the part of clinicians. Among those with completed Joint Crisis Plans, adjusted analyses indicated a significant association between treatment refusals and perceived coercion at baseline (odds ratio = 1.21, 95% CI 1.02-1.43), but not with baseline working alliance or a past history of involuntary admission. We demonstrated significant demand for written treatment refusals in line with the Mental Capacity Act 2005, which had not previously been elicited by the process of treatment planning. Future treatment/crisis plans should incorporate the opportunity for service users to record a treatment refusal during the drafting of such plans. ISRCTN11501328 Registered 13th March 2008.

  1. [Granted, undecided, withdrawn and refused requests for euthanasia and physician-assisted suicide in the Netherlands; 2000-2002].

    Science.gov (United States)

    Onwuteaka-Philipsen, B D; Jansen-Van der Weide, M C; Van der Wal, G

    2006-02-04

    To determine the characteristics of patients who request euthanasia or physician-assisted suicide and whether these characteristics differ among those whose request is granted, those who die before the procedure, those who die before completion of the approval process, those who withdraw their request, and lastly, those whose request is refused by the physician. Questionnaire study. All general practitioners in 18 of the 23 Dutch general practitioner districts received a written questionnaire in which they were asked to describe the most recent request for euthanasia or physician-assisted suicide that they had received (response 60%, n=3614). Of all explicit requests, 44% resulted in euthanasia or physician-assisted suicide. Thirteen percent of patients died before the procedure, 13% died before completion of the approval process, 13% withdrew their request and 12% were refused by the physician. The most prominent symptoms were 'feeling bad', 'tiredness', and 'lack of appetite'. The most frequently mentioned reasons for requesting euthanasia or physician-assisted suicide were 'pointless suffering', 'loss of dignity', and 'general weakness'. The patients' situation met the official requirements for accepted practice best in the group of requests that resulted in euthanasia or physician-assisted suicide and least in the group of refused requests. A lesser degree of competence and less unbearable and hopeless suffering had the strongest associations with the refusal of a request. The complexity of euthanasia or physician-assisted suicide decision-making is reflected in the fact that, besides granting and refusing a request, 3 other situations could be distinguished. The decisions physicians made, the reasons for their decisions and the way they arrived at their decisions appeared to be based on patient evaluations and on the official requirements for accepted practice.

  2. Conscientious objection and refusal to provide reproductive healthcare: a White Paper examining prevalence, health consequences, and policy responses.

    Science.gov (United States)

    Chavkin, Wendy; Leitman, Liddy; Polin, Kate

    2013-12-01

    Global Doctors for Choice-a transnational network of physician advocates for reproductive health and rights-began exploring the phenomenon of conscience-based refusal of reproductive healthcare as a result of increasing reports of harms worldwide. The present White Paper examines the prevalence and impact of such refusal and reviews policy efforts to balance individual conscience, autonomy in reproductive decision making, safeguards for health, and professional medical integrity. The White Paper draws on medical, public health, legal, ethical, and social science literature published between 1998 and 2013 in English, French, German, Italian, Portuguese, and Spanish. Estimates of prevalence are difficult to obtain, as there is no consensus about criteria for refuser status and no standardized definition of the practice, and the studies have sampling and other methodologic limitations. The White Paper reviews these data and offers logical frameworks to represent the possible health and health system consequences of conscience-based refusal to provide abortion; assisted reproductive technologies; contraception; treatment in cases of maternal health risk and inevitable pregnancy loss; and prenatal diagnosis. It concludes by categorizing legal, regulatory, and other policy responses to the practice. Empirical evidence is essential for varied political actors as they respond with policies or regulations to the competing concerns at stake. Further research and training in diverse geopolitical settings are required. With dual commitments toward their own conscience and their obligations to patients' health and rights, providers and professional medical/public health societies must lead attempts to respond to conscience-based refusal and to safeguard reproductive health, medical integrity, and women's lives. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  3. Medication refusal in children with oppositional defiant disorder or conduct disorder and comorbid attention-deficit/hyperactivity disorder: medication history and clinical correlates.

    Science.gov (United States)

    Demidovich, Mark; Kolko, David J; Bukstein, Oscar G; Hart, Jonathan

    2011-02-01

    Abstract Objective: This study examines the characteristics of 96 children with attention-deficit/hyperactivity disorder (ADHD) and their families who refused a recommendation for medication as part of their treatment for disruptive disorders. The ADHD cases were taken from a sample of 139 youth (age 6-11) who were recruited for a clinical trial that compared the administration of a modular psychosocial treatment in an outpatient clinic or community settings. Medication management was an optional treatment module for children with ADHD in both conditions. Children who were (vs. were not) taking medication at intake, and children who accepted (vs. refused) medication recommendations during the study were compared on diagnostic and clinical measures related to child, school, parent, and family domains of functioning. Parents of 30% of the children refused study medication for ADHD. Parental medication acceptability and intake correlated highly with both medication history and study refusal of medication. Increased parental self-efficacy and emotional support for their youth correlated with medication refusal. No demographics and few child or school factors were associated with medication refusal. Medication use was associated with reductions in some key ADHD symptoms, but did not affect disruptive behaviors as did the psychosocial interventions. Medication refusers remain poorly understood but certain correlates, such as parental self-efficacy, parental emotional support for their youth, and medication acceptability, warrant further evaluation.

  4. The use of coal refuse bike substratoun in cultivate techniques without soils; Utilizacion de los Esteriles de Carbon como Sustratos en Cultivos sin Suelo 2 Fase

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-11-01

    Coal refuse poses several problems as regards both their storage and environmental impact: landscape alteration, pollution, high costs, an increasing difficulty in finding appropriate places for storage, etc. Therefore, the companies HUMOSA, HORPLASA and the C. S. I. C. Centre for Environmental Sciences carried out a joint study financed by OCICARBON. This study, completing other ones carried out previously, was aimed at determining the use as both a soilless medium for growing other vegetables than tomatoes and a basic component for container gardening. Then, based on previous experiments, two types of coal refuse were selected: coal refuse from dumps and burnt coal refuse. The characterization of the coal refuse was carried out and the investigation-line was established: (I) the adaption of techniques and know-how obtained up to that moment to the production of kidney beans faba de la granja, green beans and pepper; (II) to study the possibilities of coal refuse as basic components of substrates for container gardening of decorative outdoor plants different from the already investigated conifers in order examine thoroughly the cultivation techniques and, in particular, the methods of fertilization by irrigation. Exhaustive controls were carried out with both types of cultivation using as reference other cultivations with conventional substrates. The results obtained proved that coal refuse can be used as soilles growing medium for vegetables and for container gardening of decorative plants.

  5. Waste transport and storage: Packaging refused due to failure in fulfilling QC/QA requirements

    International Nuclear Information System (INIS)

    Bruno, N.C.; Brandao, R.O.; Cavalcante, V.L.

    2001-01-01

    The Brazilian Nuclear Programme comprises several nuclear and radioactive facilities including Angra I Nuclear Power Plant, in operation since 1981, and Angra II, scheduled to start its operation by the end of 1999. Among the other ones there are uranium mining and milling facilities, four research reactors and one industrial facility of monazite sands processing. The already existing waste generation and near future ones claim to a solution regarding waste disposal. Although site selection criteria for waste repository in Brazil has already been defined, political and psychosocial aspects have strong impact. Trauma generated by Goiania's radiological accident has led to difficulties when decisions about this matter have to be taken. As a consequence, the waste generated by Angra I is still in a provisional facility at the plant's site. Wastes from the medical sources are stored in research institutes while waste generated from monazite sands is kept in a dam system. In order to overpack non-qualified packages containing waste of Angra I NPP, 70 lost concrete shielding packagings had to be provided. Based on successfully designed and tested prototype, packagings and respective lids specifications were written, approved and released for serial production. As part of packaging certification process, Brazilian Competent Authority performed a regulatory inspection and audit. Various findings, such as weaknesses in quality control and quality assurance records, unacceptable test results as well as failure in modify the concrete composition during a testified packaging manufacturing, led Competent Authority to refuse the packagings as containers until complementary tests could be performed. Further tests and evaluations led the Competent Authority to conclude that the manufacturer failed to both comply with requirements established in packaging specification and fulfill quality control/quality assurance requirements. As responsible by federal law for the reception and

  6. Reasons for refusal of admission to intensive care and impact on mortality.

    Science.gov (United States)

    Iapichino, Gaetano; Corbella, Davide; Minelli, Cosetta; Mills, Gary H; Artigas, Antonio; Edbooke, David L; Pezzi, Angelo; Kesecioglu, Jozef; Patroniti, Nicolò; Baras, Mario; Sprung, Charles L

    2010-10-01

    To identify factors influencing triage decisions and investigate whether admission to the intensive care unit (ICU) could reduce mortality compared with treatment on the ward. A multicentre cohort study in 11 university hospitals from seven countries, evaluating triage decisions and outcomes of patients referred for admission to ICU who were either accepted, or refused and treated on the ward. Confounding in the estimation of the effect of ICU admission on mortality was controlled by use of a propensity score approach, which adjusted for the probability of being admitted. Variability across centres was accounted for in both analyses of factors influencing ICU admission and effect of ICU admission on mortality. Eligible were 8,616 triages in 7,877 patients referred for ICU admission. Variables positively associated with probability of being admitted to ICU included: ventilators in ward; bed availability; Karnofsky score; absence of comorbidity; presence of haematological malignancy; emergency surgery and elective surgery (versus medical treatment); trauma, vascular involvement, liver involvement; acute physiologic score II; ICU treatment (versus ICU observation). Multiple triages during patient's hospital stay and age were negatively associated with ICU admission. The area under the receiver operating characteristic (ROC) curve of the model was 0.83 [95% confidence interval (CI): 0.81-0.84], with Hosmer-Lemeshow test P = 0.300. ICU admission was associated with a statistically significant reduction of both 28-day mortality [odds ratio (OR): 0.73; 95% CI: 0.62-0.87] and 90-day mortality (0.79; 0.66-0.93). The benefit of ICU admission increased substantially in patients with greater severity of illness. We suggest that intensivists take great care to avoid ICU admission of patients judged not severe enough for ICU or with low performance status, and they tend to admit surgical patients more readily than medical patients. Interestingly, they do not judge age per se as

  7. Separation of harmful impurities from refuse derived fuels (RDF) by a fluidized bed.

    Science.gov (United States)

    Krüger, B; Mrotzek, A; Wirtz, S

    2014-02-01

    In firing systems of cement production plants and coal-fired power plants, regular fossil fuels are increasingly substituted by alternative fuels. Rising energy prices and ambitious CO2-reduction goals promote the use of alternative fuels as a significant contribution to efficient energy recovery. One possibility to protect energy resources are refuse-derived fuels (RDF), which are produced during the treatment of municipal solid, commercial and industrial waste. The waste fractions suitable for RDF have a high calorific value and are often not suitable for material recycling. With current treatment processes, RDF still contains components which impede the utilization in firing systems or limit the degree of substitution. The content of these undesired components may amount to 4 wt%. These, in most cases incombustible particles which consist of mineral, ceramic and metallic materials can cause damages in the conveying systems (e. g. rotary feeder) or result in contaminations of the products (e. g. cement, chalk). Up-to-date separation processes (sieve machine, magnet separator or air classifier) have individual weaknesses that could hamper a secure separation of these particles. This article describes a new technology for the separation of impurities from refuse derived fuels based on a rotating fluidized bed. In this concept a rotating motion of the particle bed is obtained by the tangential injection of the fluidization gas in a static geometry. The RDF-particles experience a centrifugal force which fluidized the bed radially. The technical principle allows tearing up of particle clusters to single particles. Radially inwards the vertical velocity is much lower thus particles of every description can fall down there. For the subsequent separation of the particles by form and density an additionally cone shaped plate was installed in the centre. Impurities have a higher density and a compact form compared to combustible particles and can be separated with a high

  8. Parent Refusal of Topical Fluoride for Their Children: Clinical Strategies and Future Research Priorities to Improve Evidence-Based Pediatric Dental Practice.

    Science.gov (United States)

    Chi, Donald L

    2017-07-01

    A growing number of parents are refusing topical fluoride for their children during preventive dental and medical visits. This nascent clinical and public health problem warrants attention from dental professionals and the scientific community. Clinical and community-based strategies are available to improve fluoride-related communications with parents and the public. In terms of future research priorities, there is a need to develop screening tools to identify parents who are likely to refuse topical fluoride and diagnostic instruments to uncover the reasons for topical fluoride refusal. This knowledge will lead to evidence-based strategies that can be widely disseminated into clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Storytelling in the context of vaccine refusal: a strategy to improve communication and immunisation.

    Science.gov (United States)

    Cawkwell, Philip B; Oshinsky, David

    2016-03-01

    The December 2014 outbreak of measles in California impacted over 100 children and served as a reminder that this disease still plagues the USA, even 50 years following the first licensed vaccine. Refusal of vaccination is a complicated and multifaceted issue, one that clearly demands a closer look by paediatricians and public health officials alike. While medical doctors and scientists are trained to practice 'evidence-based medicine', and studies of vaccine safety and efficacy speak the language of statistics, there is reason to believe that this is not the most effective strategy for communicating with all groups of parents. Herein, we consider other methods such as narrative practices that employ stories and appeal more directly to parents. We also examine how doctors are trained to disseminate information and whether there are reasonable supplementary methods that could be used to improve vaccine communication and ultimately immunisation rates. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Food refusal and insanity: sitophobia and anorexia nervosa in Victorian asylums.

    Science.gov (United States)

    van Deth, R; Vandereycken, W

    2000-05-01

    Although anorexia nervosa emerged as a new syndrome in the second half of the 19th century, this clinical picture seemed to be unknown in the psychiatric hospitals or asylums. In asylum medicine, the commonly used concept of sitophobia to designate food refusal in the insane covered a wide variety of mental disturbances and cannot be plainly equated with anorexia nervosa. A major difference is the occurrence of hallucinations and delusions specifically centered around religion and digestion. Most probably, anorectic patients were not treated in asylums, but at home, in the doctor's office, or in general hospitals. This pattern may be partly attributed to the fact that both patients and doctors were focusing on symptoms of self-starvation like emaciation, constipation, and amenorrhea, which were primarily interpreted as referring to somatic diseases. Additionally, wealthy families probably preferred private care in water-cure establishments, sanatoria, and rest homes to the stigmatizing referral of their anorectic daughter to an asylum. Hence, the fact that late 19th-century institutionalized psychiatry was only incidentally confronted with anorexia nervosa may explain its lack of interest in the emerging syndrome. Copyright 2000 by John Wiley & Sons, Inc.

  11. Determinants of efficiency in the provision of municipal street-cleaning and refuse collection services.

    Science.gov (United States)

    Benito-López, Bernardino; Moreno-Enguix, María del Rocio; Solana-Ibañez, José

    2011-06-01

    Effective waste management systems can make critical contributions to public health, environmental sustainability and economic development. The challenge affects every person and institution in society, and measures cannot be undertaken without data collection and a quantitative analysis approach. In this paper, the two-stage double bootstrap procedure of Simar and Wilson (2007) is used to estimate the efficiency determinants of Spanish local entities in the provision of public street-cleaning and refuse collection services. The purpose is to identify factors that influence efficiency. The final sample comprised 1072 municipalities. In the first stage, robust efficiency estimates are obtained with Data Envelopment Analysis (DEA). We apply the second stage, based on a truncated-regression, to estimate the effect of a group of environmental factors on DEA estimates. The results show the existence of a significant relation between efficiency and all the variables analysed (per capita income, urban population density, the comparative index of the importance of tourism and that of the whole economic activity). We have also considered the influence of a dummy categorical variable - the political sign of the governing party - on the efficient provision of the services under study. The results from the methodology proposed show that municipalities governed by progressive parties are more efficient. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Emissions of C&D refuse in landfills: a European case.

    Science.gov (United States)

    López, Ana; Lobo, Amaya

    2014-08-01

    A field study was developed in a new landfill for refuse from construction and demolition (C&D) material recovery plants of small size (4 Ha.) in Europe, with the aim of evaluating the liquid and gas emissions in this type of facility at a large scale. It included characterization of the materials, monitoring leachate and gas quantity and composition. Besides thermometers, piezometers and sampling ports were placed in several points within the waste. This paper presents the data obtained for five years of the landfill life. The materials disposed were mainly made up of wood and concrete, similar to other C&D debris sites, but the amount of gypsum drywall (below 3% of the waste) was significantly smaller than other available studies, where percentages above 20% had been reported. Leachate contained typical C&D pollutants, such as different inorganic ions and metals, some of which exceeded other values reported in the literature (conductivity, ammonium, lead and arsenic). The small net precipitation in the area and the leachate recirculation into the landfill surface help explain these higher concentrations, thus highlighting the impact of liquid to solid (L/S) ratio on leachate characteristics. In contrast to previous studies, neither odor nuisances nor significant landfill gas over the surface were detected. However, gas samples taken from the landfill inside revealed sulfate reducing and methanogenic activity. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Gray correlation analysis and prediction models of living refuse generation in Shanghai city.

    Science.gov (United States)

    Liu, Gousheng; Yu, Jianguo

    2007-01-01

    A better understanding of the factors that affect the generation of municipal living refuse (MLF) and the accurate prediction of its generation are crucial for municipal planning projects and city management. Up to now, most of the design efforts have been based on a rough prediction of MLF without any actual support. In this paper, based on published data of socioeconomic variables and MLF generation from 1990 to 2003 in the city of Shanghai, the main factors that affect MLF generation have been quantitatively studied using the method of gray correlation coefficient. Several gray models, such as GM(1,1), GIM(1), GPPM(1) and GLPM(1), have been studied, and predicted results are verified with subsequent residual test. Results show that, among the selected seven factors, consumption of gas, water and electricity are the largest three factors affecting MLF generation, and GLPM(1) is the optimized model to predict MLF generation. Through this model, the predicted MLF generation in 2010 in Shanghai will be 7.65 million tons. The methods and results developed in this paper can provide valuable information for MLF management and related municipal planning projects.

  14. [Voluntary Refusal of Food and Fluid in palliative care: a mapping literature review].

    Science.gov (United States)

    Klein Remane, Ursula; Fringer, André

    2013-12-01

    Voluntary Refusal of Food and Fluid (VRFF) is one possibility for patients in palliative situations to hasten death and avoid further suffering. By means of a mapping literature review this article describes the medical, nursing, ethical and legal perspective of care for people who wish to hasten death using VRFF. The results show that the wish to die is affected by psychological, social, spiritual and physical factors. VRFF is a little-known, legal and independently viable method to hasten death. Reducing fluid intake to 40 ml daily, the dying process takes one to three weeks. VRFF can be regarded as a natural death, foregoing treatment or as suicide. In contrast to physician assisted suicide or euthanasia, patients dying by VRFF experience a "natural" dying process and the decision is reversible in the first few days. As authority to act lies with the person wishing to die professionals and family caring for the dying are practicing palliative care, as opposed to assisted suicide or euthanasia. Professionals and family involved in the decision-making process are confronted with various ethical problems. Further research concerning VRFF and its implications for practice is necessary.

  15. The precarity of critique: Cultures of mistrust and the refusal of justification

    Directory of Open Access Journals (Sweden)

    Witte Daniel

    2017-01-01

    Full Text Available The paper reflects on recent developments towards authoritarianism and right-wing populism that have become apparent in a number of Western societies and aims at pinpointing possible cultural foundations for this trend. Using the example of the German PEGIDA movement and the wider milieu in which it is embedded, it identifies and describes a rapidly spreading culture of mistrust and discusses some of its political and epistemological implications. In a second step, the paper draws on Luc Boltanski’s theory of justification in order to attain a better understanding of this political movement’s specificities. It is argued that it is a quasi-violent refusal of justification which is constitutive for the movement in question, thereby transcending the reach of Boltanski’s framework to some extent. In a third step, a closer look is taken at the epistemological paradox that results from the fact that a number of the PEGIDA movement’s crucial points of criticism are effectively shared by a larger part of the overall population, raising severe problems for the question of sociological critique. The paper utilizes ideas by Bruno Latour in order to illuminate this paradox further and examine its consequences. It closes with remarks on the possibility to “reassemble” trust and critique as crucial but contested - and, hence, precarious - foundations of modern society.

  16. Rotary furnace for pyrolysis of refuse. Rotationstrommelofen zur Pyrolyse von Muell

    Energy Technology Data Exchange (ETDEWEB)

    Siepmann, H A

    1983-11-17

    The invention concerns a rotary furnace for the pyrolysis of refuse, in which the material to be treated passes through a rotating drum heated from outside. The drum rotating around a vertical axis, cone-shaped downwards, is situated at right angles to a combustion chamber surrounding the drum, through the upper and lower walls of which it passes, where the sealing at these walls is done by labyrinth seals carrying a liquid concentric to the axis of rotation. Inside the rotating drum a helical insert matched to the conical shape of the drum is situated spaced from its wall, which narrows in the upper section and to the hollow space of which pieces of pipe provided with slots are connected at the top and bottom, by which the insert is held inside the drum. A cylindrical degasification shaft may be connected to the upper end of the rotating drum which is connected to the degasification chamber and is also sealed by a labyrinth seal carrying a liquid, which a lower furnace chamber is connected to the lower end of the drum, in which a transport device for drawing off the material leaving the rotating drum is situated.

  17. Determinants of efficiency in the provision of municipal street-cleaning and refuse collection services

    International Nuclear Information System (INIS)

    Benito-Lopez, Bernardino; Rocio Moreno-Enguix, Maria del; Solana-Ibanez, Jose

    2011-01-01

    Effective waste management systems can make critical contributions to public health, environmental sustainability and economic development. The challenge affects every person and institution in society, and measures cannot be undertaken without data collection and a quantitative analysis approach. In this paper, the two-stage double bootstrap procedure of is used to estimate the efficiency determinants of Spanish local entities in the provision of public street-cleaning and refuse collection services. The purpose is to identify factors that influence efficiency. The final sample comprised 1072 municipalities. In the first stage, robust efficiency estimates are obtained with Data Envelopment Analysis (DEA). We apply the second stage, based on a truncated-regression, to estimate the effect of a group of environmental factors on DEA estimates. The results show the existence of a significant relation between efficiency and all the variables analysed (per capita income, urban population density, the comparative index of the importance of tourism and that of the whole economic activity). We have also considered the influence of a dummy categorical variable - the political sign of the governing party - on the efficient provision of the services under study. The results from the methodology proposed show that municipalities governed by progressive parties are more efficient.

  18. New techniques for the characterization of refuse-derived fuels and solid recovered fuels.

    Science.gov (United States)

    Rotter, Vera Susanne; Lehmann, Annekatrin; Marzi, Thomas; Möhle, Edda; Schingnitz, Daniel; Hoffmann, Gaston

    2011-02-01

    Solid recovered fuel (SRF) today refers to a waste-derived fuel meeting defined quality specifications, in terms of both origin (produced from non-hazardous waste) and levels of certain fuel properties. Refuse-derived fuel (RDF) nowadays is more used for unspecified waste after a basic processing to increase the calorific value and therefore this term usually refers to the segregated, high calorific fraction of municipal solid waste (MSW), commercial or industrial wastes. In comparison with conventional fuels, both types of secondary fuel show waste of inherently varying quality and an increased level of waste-specific contaminants.The transition from RDF to SRF in the emerging national and European market requires a quality assurance system with defined quality parameters and analytical methods to ensure reliable fuel characterization. However, due to the quality requirements for RDF and SRF, the current standardized analysis methods often do not meet these practical demands. Fast test methods, which minimize personnel, financial and time efforts and which are applicable for producers as well as users can be an important supporting tool for RDF- and SRF-characterization. Currently, a fast test system based on incineration and correlation analyses which enable the determination of relevant fuel parameters is under development. Fast test methods are not aimed at replacing current standardized test methods, but have to be considered as practical supporting tools for the characterization of RDF and SRF.

  19. Sexual revictimization during women's first year of college: self-blame and sexual refusal assertiveness as possible mechanisms.

    Science.gov (United States)

    Katz, Jennifer; May, Pamela; Sörensen, Silvia; DelTosta, Jill

    2010-11-01

    Although sexual victimization during adolescence increases risk for later revictimization, mechanisms for increased risk among new college students have not been identified. Female undergraduates (N = 87) were assessed at the start and end of their first academic year. Those who reported initial sexual victimization at Time 1 were more likely than other women to report later college victimization at Time 2. Path analyses showed that self-blame and decreased sexual refusal assertiveness (SRA) explained this effect. Specifically, initial victimization was associated with increased self-blame; in turn, self-blame indirectly predicted later college victimization via decreased sexual refusal assertiveness. Prevention efforts focused on self-blame and other barriers to SRA may reduce risk for revictimization during women's transition to college.

  20. [Refusal of application to care in Alzheimer's disease and related diseases: establishment of a mobile unit hospital extra].

    Science.gov (United States)

    Collignon, Julien; Rouch, Isabelle; Gonthier, Régis; Corbin-Seguin, Aude; Combe, Lorraine; Trombert-Paviot, Béatrice; Laurent, Bernard; Girtanner, Chantal

    2013-03-01

    Refusal of care and support in these patients with Alzheimer's disease and related illnesses at home is a cause of accelerated loss of autonomy and increases the risk of a crisis with early institutionalization. Factors contributing to the denial of care are poorly understood and very few epidemiological data exist. we compared age, diagnosis, level of severity of the disease, the type of behavioral, family status of 101 patients living in denial of care and support as seen by a mobile home (group UPEPc) to 136 control patients seen at the memory clinic (group CM). Patients living in denial of care appear to significantly low age [82/80.5, prefusing home care is specific and it is important to educate GPs conditions that favor an obstacle to medicalization. The advantage of a mobile extramural to analyze risk factors for refusal of care and propose alternatives should be further investigated.

  1. Duty of care or a matter of conduct -- can a doctor refuse a person in need of urgent medical attention?

    Science.gov (United States)

    Dean, Jessica; Mahar, Patrick; Loh, Erwin; Ludlow, Karinne

    2013-10-01

    Medical practitioners may have their particular skills called upon outside a direct professional context. The responsibilities of medical practitioners outside their defined scope of clinical practice may not be clear to all clinicians. To consider the possible legal consequences of a doctor refusing to assist a person in need of urgent medical attention both in terms of medical negligence and professional misconduct. Where an established clinical relationship does not exist, and a doctor does not wish to render aid, three particular scenarios may arise. A doctor may actively deny being a doctor, passively avoid identifying themselves as a doctor or acknowledge being a doctor, but refuse to render assistance. Aside from any ethical issues, how a doctor chooses to act and represent themselves may lead to different legal ramifications. There exists significant variation in state provisions relating to legal obligations to render aid, which may benefit from review and revision at a national level.

  2. Clinical Characteristics of the Suicide Attempters Who Refused to Participate in a Suicide Prevention Case Management Program

    OpenAIRE

    Park, Soyoung; Choi, Kyoung Ho; Oh, Youngmin; Lee, Hae-Kook; Kweon, Yong-Sil; Lee, Chung Tai; Lee, Kyoung-Uk

    2015-01-01

    Case management interventions for suicide attempters aimed at helping adjust their social life to prevent reattempts have high nonparticipation and dropout rates. We analyzed the clinical characteristics of the group who refused to participate in the suicide prevention program in Korea. A total of 489 patients with a suicide attempt who visited Uijeongbu St. Mary's Hospital, the Catholic University of Korea, from December 2009 to December 2013 were analyzed. All patients were divided into the...

  3. Hydrogeology and simulation of groundwater flow at the Green Valley reclaimed coal refuse site near Terre Haute, Indiana

    Science.gov (United States)

    Bayless, E. Randall; Arihood, Leslie D.; Fowler, Kathleen K.

    2011-01-01

    The Green Valley reclaimed coal refuse site, near Terre Haute, Ind., was mined for coal from 1948 to 1963. Subsurface coal was cleaned and sorted at land surface, and waste material was deposited over the native glacial till. Approximately 2.7 million cubic yards of waste was deposited over 159 acres (92.3 hectares) in tailings ponds and gob piles. During 1993, the Indiana Department of Natural Resources, Division of Reclamation, improved the site by grading gob piles, filling tailings ponds, and covering the refuse with a layer of glacial drift. During 2008, the Division of Reclamation and U.S. Geological Survey initiated a cooperative investigation to characterize the hydrogeology of the site and construct a calibrated groundwater flow model that could be used to simulate the results of future remedial actions. In support of the modeling, a data-collection network was installed at the Green Valley site to measure weather components, geophysical properties, groundwater levels, and stream and seep flow. Results of the investigation indicate that (1) there is negligible overland flow from the site, (2) the prevailing groundwater-flow direction is from northeast to southwest, with a much smaller drainage to the northeast, (3) there is not a direct hydraulic connection between the refuse and West Little Sugar Creek, (4) about 24 percent of the groundwater recharge emerges through seeps, and water from the seeps evaporates or eventually flows to West Little Sugar Creek and the Green Valley Mine Pond, and (5) about 72 percent of groundwater recharge moves vertically downward from the coal refuse into the till and follows long, slow flow paths to eventual dischage points.

  4. Phospholipid fatty acid analysis to monitor the co-composting process of olive oil mill wastes and organic household refuse

    OpenAIRE

    Barje , F.; Amir , S.; Winterton , Peter; Pinelli , Eric; Merlina , Georges; Cegarra , J.; Revel , Jean-Claude; Hafidi , Mohamed

    2008-01-01

    International audience; The co-composting of olive oil mill wastes and household refuse was followed for 5 months. During the thermophilic phase of composting, the aerobic heterotrophic bacteria (AHB) count, showed a significant rise with a slight regression of fungal biomass. In the same way, phospholipid fatty acids PLFAs common in bacteria, showed a significant increase of hydroxyl and branched PLFAs. The evaluation of the ratio of octadecenoic PLFAs to stearic acid (C18:1/C18:0) revealed ...

  5. Determinants of refusal of A/H1N1 pandemic vaccination in a high risk population: a qualitative approach.

    Directory of Open Access Journals (Sweden)

    Eugenie d'Alessandro

    Full Text Available BACKGROUND: Our study analyses the main determinants of refusal or acceptance of the 2009 A/H1N1 vaccine in patients with cystic fibrosis, a high-risk population for severe flu infection, usually very compliant for seasonal flu vaccine. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a qualitative study based on semi-structured interviews in 3 cystic fibrosis referral centres in Paris, France. The study included 42 patients with cystic fibrosis: 24 who refused the vaccine and 18 who were vaccinated. The two groups differed quite substantially in their perceptions of vaccine- and disease-related risks. Those who refused the vaccine were motivated mainly by the fears it aroused and did not explicitly consider the 2009 A/H1N1 flu a potentially severe disease. People who were vaccinated explained their choice, first and foremost, as intended to prevent the flu's potential consequences on respiratory cystic fibrosis disease. Moreover, they considered vaccination to be an indirect collective prevention tool. Patients who refused the vaccine mentioned multiple, contradictory information sources and did not appear to consider the recommendation of their local health care provider as predominant. On the contrary, those who were vaccinated stated that they had based their decision solely on the clear and unequivocal advice of their health care provider. CONCLUSIONS/SIGNIFICANCE: These results of our survey led us to formulate three main recommendations for improving adhesion to new pandemic vaccines. (1 it appears necessary to reinforce patient education about the disease and its specific risks, but also general population information about community immunity. (2 it is essential to disseminate a clear and effective message about the safety of novel vaccines. (3 this message should be conveyed by local health care providers, who should be involved in implementing immunization.

  6. Children with food refusal: an assessment of parental eating attitudes and their styles of coping with stress.

    Science.gov (United States)

    Tan, Seda; Yilmaz, Ayse Esra; Karabel, Musemma; Kara, Semra; Aldemir, Seçil; Karabel, Duran

    2012-05-01

    In this study, we aimed to assess the eating attitudes and stress coping styles of parents whose children presented to the clinic complaining of food refusal. The parents of 31 children aged ≥3 years, presented to the clinic with the complaint of food refusal. The control group consisted of 30 healthy children with no prior history of food refusal, and their parents. In both groups, birth features, body mass indexes (BMIs), eating attitudes and stress coping styles of the parents were assessed. The parents of both groups were studied, in part utilizing the eating attitudes test (EAT), and the coping styles of stress scale (CSSS). Our study found that body weights and BMI values of the fathers in the study group were significantly lower than fathers in the control group. There was no significant difference in EAT scores between the two groups; however, where the children's body weight and height for age percentile was under 25%, the parents had significantly lower EAT scores. When CSSS scores were assessed, the optimistic approach score of the mother and the self-confident score of the father were found to be significantly high in both groups. The parental perception and definition of eating problems does not necessarily indicate the presence of an eating disorder in a child. In fact, the eating attitudes of the fathers were related to the low percentile weight and height values of the children, and a child's food refusal was not dependent on the stress coping style used by the parent. Copyright © 2012. Published by Elsevier B.V.

  7. Copper leaching of MSWI bottom ash co-disposed with refuse: effect of short-term accelerated weathering.

    Science.gov (United States)

    Su, Lianghu; Guo, Guangzhai; Shi, Xinlong; Zuo, Minyu; Niu, Dongjie; Zhao, Aihua; Zhao, Youcai

    2013-06-01

    Co-disposal of refuse with municipal solid waste incinerator (MSWI) bottom ash (IBA) either multi-layered as landfill cover or mixed with refuse could pose additional risk to the environment because of enhanced leaching of heavy metals, especially Cu. This study applied short-term accelerated weathering to IBA, and monitored the mineralogical and chemical properties of IBA during the weathering process. Cu extractability of the weathered IBA was then evaluated using standard leaching protocols (i.e. SPLP and TCLP) and co-disposal leaching procedure. The results showed that weathering had little or no beneficial effect on Cu leaching in SPLP and TCLP, which can be explained by the adsorption and complexation of Cu with DOM. However, the Cu leaching of weathered IBA was reduced significantly when situated in fresh simulated landfill leachate. This was attributed to weakening Cu complexation with fulvic acid or hydrophilic fractions and/or intensifying Cu absorption to neoformed hydr(oxide) minerals in weathered IBA. The amount of total leaching Cu and Cu in free or labile complex fraction (the fraction with the highest mobility and bio-toxicity) of the 408-h weathered IBA were remarkably decreased by 86.3% and 97.6% in the 15-day co-disposal leaching test. Accelerated weathering of IBA may be an effective pretreatment method to decrease Cu leaching prior to its co-disposal with refuse. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Refuses and delays in the transportation by ship of radioactive material; Recusas e demoras no transporte maritimo de material radioativo

    Energy Technology Data Exchange (ETDEWEB)

    Xavier, Clarice; Sobreira, Ana Celia [REM Industria e Comercio Ltda., Sao Paulo, SP (Brazil)

    2011-10-26

    Some Class 7 materials can only be transported by ship, making that load and unload activities can be done in a port. In the Brazil, the port of Santos posses the most volume of cargo manipulation, and cargoes which contain radioactive material are always present with all manipulation requisites according to applicable regulations. The transport and manipulation operations of radioactive material are performed in accordance with national and international requisites but, some individuals posses yet a high risk perception according to our experience, involving members of Brazilian port authorities, the Navy and cargoes handlers at the ports. So, exist yet a high quantity of refuses and delays during the transport by ship. Therefore, a communication strategy was developed and applied, to inform the risk perception, supplying information on the very principles of ionizing radiation, legislation and uses of radiation, and so, diminishing the quantity of refuses and delays. From that initial communication strategy on, it becomes evident the necessity of training and conscience making a movement for the problem of refuses and delays be diminished

  9. Consent, Refusal, and Waivers in Patient-Centered Dysphagia Care: Using Law, Ethics, and Evidence to Guide Clinical Practice.

    Science.gov (United States)

    Horner, Jennifer; Modayil, Maria; Chapman, Laura Roche; Dinh, An

    2016-11-01

    When patients refuse medical or rehabilitation procedures, waivers of liability have been used to bar future lawsuits. The purpose of this tutorial is to review the myriad issues surrounding consent, refusal, and waivers. The larger goal is to invigorate clinical practice by providing clinicians with knowledge of ethics and law. This tutorial is for educational purposes only and does not constitute legal advice. The authors use a hypothetical case of a "noncompliant" individual under the care of an interdisciplinary neurorehabilitation team to illuminate the ethical and legal features of the patient-practitioner relationship; the elements of clinical decision-making capacity; the duty of disclosure and the right of informed consent or informed refusal; and the relationship among noncompliance, defensive practices, and iatrogenic harm. We explore the legal question of whether waivers of liability in the medical context are enforceable or unenforceable as a matter of public policy. Speech-language pathologists, among other health care providers, have fiduciary and other ethical and legal obligations to patients. Because waivers try to shift liability for substandard care from health care providers to patients, courts usually find waivers of liability in the medical context unenforceable as a matter of public policy.

  10. Parental refusal of life-saving treatments for adolescents: Chinese familism in medical decision-making re-visited.

    Science.gov (United States)

    Hui, Edwin

    2008-06-01

    This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the 'AP-physician-family-relationship' and the dominant role Chinese families play in medical decision-making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers from Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives 'weak' family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re-interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its 'parens patriae' power to defend the defenseless in society and the integrity of the medical profession.

  11. [Informed consent and parental refusal to medical treatment in childhood. The threshold of medical and social tolerance. Part I].

    Science.gov (United States)

    Guadarrama-Orozco, Jessica H; Garduño Espinosa, Juan; Vargas López, Guillermo; Viesca Treviño, Carlos

    Informed consent is a right of all individuals and no one can force anyone to receive treatment against their wishes. The right to accept or refuse treatment persists in individuals who are incompetent from a legal point of view; this is exercised on their behalf by a third party. Children are considered incompetent to make medical decisions about their own health and their parents or legal guardians are empowered to make those decisions. However, parental authority is not absolute and there are situations where their decisions are not the best, sometimes leading to jeopardizing the well-being and even the lives of their children, forcing the state to intervene on behalf of the best interests of the child. This is the reason why it is necessary to ask the following questions: is it really the child's best interest that moves us to legally intervene when a parent refuses to accept the proposed medical treatment or is the damage done to make this decision? What kind of parental decisions are those that should not be tolerated? After a review of the theme, we conclude that if the decision of the parents regarding a medical decision is considered to be made with maleficence that is harmful to the child, it is justified that the State intervenes. Finally, we exposed four criteria that can be used in making decisions in complex cases where parents refuse treatment for their children. Copyright © 2015. Publicado por Masson Doyma México S.A.

  12. Understanding patient acceptance and refusal of HIV testing in the emergency department

    Directory of Open Access Journals (Sweden)

    Christopoulos Katerina A

    2012-01-01

    Full Text Available ABSTRACT Background Despite high rates of patient satisfaction with emergency department (ED HIV testing, acceptance varies widely. It is thought that patients who decline may be at higher risk for HIV infection, thus we sought to better understand patient acceptance and refusal of ED HIV testing. Methods In-depth interviews with fifty ED patients (28 accepters and 22 decliners of HIV testing in three ED HIV testing programs that serve vulnerable urban populations in northern California. Results Many factors influenced the decision to accept ED HIV testing, including curiosity, reassurance of negative status, convenience, and opportunity. Similarly, a number of factors influenced the decision to decline HIV testing, including having been tested recently, the perception of being at low risk for HIV infection due to monogamy, abstinence or condom use, and wanting to focus on the medical reason for the ED visit. Both accepters and decliners viewed ED HIV testing favorably and nearly all participants felt comfortable with the testing experience, including the absence of counseling. While many participants who declined an ED HIV test had logical reasons, some participants also made clear that they would prefer not to know their HIV status rather than face psychosocial consequences such as loss of trust in a relationship or disclosure of status in hospital or public health records. Conclusions Testing for HIV in the ED as for any other health problem reduces barriers to testing for some but not all patients. Patients who decline ED HIV testing may have rational reasons, but there are some patients who avoid HIV testing because of psychosocial ramifications. While ED HIV testing is generally acceptable, more targeted approaches to testing are necessary for this subgroup.

  13. Hurdles to herd immunity: Distrust of government and vaccine refusal in the US, 2002-2003.

    Science.gov (United States)

    Lee, Charlotte; Whetten, Kathryn; Omer, Saad; Pan, William; Salmon, Daniel

    2016-07-25

    High rates of nonmedical exemptions (NMEs) from required childhood vaccinations have contributed to outbreaks of vaccine-preventable diseases, such as measles and pertussis. Understanding the parental decision to obtain an NME could help health professionals and public health programs improve vaccination rates in areas with high vaccine refusal. Using a 2002-2003 multi-state survey of parents of school age children (​n=2445), this study found that parental distrust of the government and of healthcare providers is a significant factor related to a number of vaccine-related beliefs and behaviors. The odds that parents who distrust the government have seen a complementary/alternative medicine (CAM) provider were 2.11 times greater than those of parents who trust the government (70.1% vs 52.6%; OR, 2.11; 95% CI, 1.59-2.84; Pgovernment had increased odds of trusting vaccine information from CAM providers compared to trusting parents (57.9% vs 46.3%; OR, 1.53; 95% CI, 1.16-2.01; Pgovernment also had increased odds of distrusting vaccine information acquired at their healthcare providers' offices (12.6% vs 4.7%; OR, 2.64; 95% CI, 1.64-4.24; Pgovernment sources of information about vaccines were unreliable, categorizing the CDC, the Food and Drug Administration (FDA), or local and state health departments as poor or very poor sources (distrust government vs trust government: 25.2% vs 11.7%; OR, 2.39; 95% CI, 1.70-3.36; Pgovernment and healthcare provider communications. Research into new and more effective techniques for delivering pro-vaccine messages is warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. A preliminary evaluation of a combined tire- and refuse-derived fuel (TDF-RDF)

    Energy Technology Data Exchange (ETDEWEB)

    Stessel, R.I.; Amari, T.; Themelis, N.J.; Wearnick, I.K.

    1999-07-01

    In dense urban areas of the US, it is now becoming clear that waste management is far from economically-optimum. Even with the popularity of inexpensive land disposal, hauling and recycling costs are driving up the average waste bill. An historic option has been refuse-derived fuel, or RDF. Difficulties included low energy content and difficulty obtaining uniformity. Today, many resource-recovery technologies used in RDF are finding their way into materials recovery facilities (MRFs), some of which are reviving the automated processing of waste. Any MRF, automated or not, will have residue streams. Currently, one of the most significant problems is waste tires. Local options are difficult to locate in dense urban areas. As fuels, tires typically have energy contents considerably above those for which most solid-fuel combustors are designed, leading to thermal imbalances and various forms of failure. This paper suggests a new fuel that can be either co-fired with coal, or used in its own right in a combustor primarily designed for coal: TDF-RDF. A preliminary examination is undertaken of thermal and emissions characteristics, and possible costs for a few applications of the fuel. Immediately, TDF is already cleaner-burning than many coals, even in sulfur emissions. RDF has been widely-regarded as being similarly cleanly. Posited MRF residue streams should be still cleaner, and more consistent, than RDF. Overall, there is quite a potential for developing a fuel that would allow old coal powerplants in historic urban centers to be better neighbors, while helping with a few problems in municipal waste management.

  15. US primary care physicians' opinions about conscientious refusal: a national vignette experiment.

    Science.gov (United States)

    Brauer, Simon G; Yoon, John D; Curlin, Farr A

    2016-02-01

    Previous research has found that physicians are divided on whether they are obligated to provide a treatment to which they object and whether they should refer patients in such cases. The present study compares several possible scenarios in which a physician objects to a treatment that a patient requests, in order to better characterise physicians' beliefs about what responses are appropriate. We surveyed a nationally representative sample of 1504 US primary care physicians using an experimentally manipulated vignette in which a patient requests a clinical intervention to which the patient's physician objects. We used multivariate logistic regression models to determine how vignette and respondent characteristics affected respondent's judgements. Among eligible respondents, the response rate was 63% (896/1427). When faced with an objection to providing treatment, referring the patient was the action judged most appropriate (57% indicated it was appropriate), while few physicians thought it appropriate to provide treatment despite one's objection (15%). The most religious physicians were more likely than the least religious physicians to support refusing to accommodate the patient's request (38% vs 22%, OR=1.75; 95% CI 1.06 to 2.86). This study indicates that US physicians believe it is inappropriate to provide an intervention that violates one's personal or professional standards. Referring seems to be physicians' preferred way of responding to requests for interventions to which physicians object. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. The use of refused tea as litter material for broiler chickens.

    Science.gov (United States)

    Atapattu, N S B M; Wickramasinghe, K P

    2007-05-01

    A completely randomized design experiment was conducted to determine the suitability of refused tea (RT) as a litter material for broiler chickens. Physiochemical properties of RT were compared with paddy husk (PH). Subsequently, broilers were raised on RT- or PH-based litter to compare the performances and litter qualities. Twenty-day-old broiler chicks (n = 150) were randomly allocated into 6 deep litter pens so that each treatment had 3 replicates. Chicks received 0.8 ft(2) of floor spacing until d 28 and 1.3 ft(2) thereafter. Each cage had a feeder and a drinker. Litter materials and litter samples taken on 28, 35, and 39 d were analyzed for bulk density, moisture, ash, and N. Chick mortality was low (1.3%) and similar on 2 types of litters. Live weights on d 28, 35, 39, and weight gains, feed intakes, dressing percentages, and feed conversion ratios were not affected by the type of litter material. The bulk density, moisture level, and pH of the RT were comparable with PH. Even though the water-holding capacity of PH (213%) was significantly higher (P litter had around 10% units higher moisture level than PH litter. By d 39, the moisture content of the RT litter was (48%) significantly higher (P = 0.05) than PH litter (37%). The N contents of RT litter were higher (P litter material for broilers. A higher N content in RT-based spent broiler litter would make it be a better organic fertilizer and ruminant feed compared with PH-based litter.

  17. Predicting the calorific value of refuse derived fuel from the characteristics of municipal solid waste

    International Nuclear Information System (INIS)

    Sivapalan Kathiravale; Muhd Noor Muhd Yunus; Mohamad Puad Abu; Mohamad Azman Che Mat Isa; Mohd Fairus Abdul Farid; Norasalwa Zakaria; Khaironie Mohd Takip; Rohyiza Ba'an

    2006-01-01

    The Imposing need to manage the municipal solid waste generated by society in a proper manner has urged municipalities to look into new management methods, which are not only environmentally friendly but also economically profitable. One such way is by converting this waste material into fuel. Currently, Kajang in the State of Selangor, Malaysia, generates about 700 tons of Municipal Solid Waste (MSW) a day. Due to rapid development, lack of land area for new landfill and the environmental impact of raw landfills, the local municipal council has collaborated with a local company in the management of this waste. The company has proposed to convert the MSW to Refuse Derived Fuel (RDF). In view of this, a pilot plant to convert MSW to RDF was erected by the company and begun operation in January 2002. This pilot plant has the capability of converting 15 tons of MSW to 5 tons of RDF. At the same time studies, have been carried out to assess the plant performance, the flue gas analysis, and also the MSW and RDF characteristic. This paper will highlight the findings of the MSW and RDF characterization work carried out over the past year. Sampling and analysis was carried in accordance with ASTM standards. Results of the waste analysis showed that the calorific value of the resulting RDF could be predicted from the physical characteristics as well as the moisture content. Regression analysis on the available data has been used to create equations relating the proximate composition and moisture content of the incoming municipal solid waste to the calorific value of the RDF

  18. Surface Soil Pollution By Heavy Metals A Case Study Of Two Refuse Dumpsites In Akure Metropolis

    Directory of Open Access Journals (Sweden)

    Anietie Olayemi Victoria

    2015-03-01

    Full Text Available ABSTRACT Heavy metals can be harmful to the biota and human beings when present above certain tolerable levels in the ecosystem. This lead to the study of the accumulation contamination and pollution of these metals in soils of two refuse dumpsites within and outskirts of Akure Township capital city of Ondo State Nigeria. The dumpsites are where wastes such as industrial wastes automobile wastes municipal wastes agricultural wastes etc were dumped. At each site soil samples were collected randomly from nine different points of about 1m part at depth of about 0-30cm and analyzed for heavy metals and pH. The metals analyzed include Zn Fe Co Cu Ni As Ba Pb Cr and Cd using Atomic Absorption Spectrophotometer AAS with HFAqua regia wet digestion method. The pH of the soils ranged between 7.49 and 8.66. The results revealed heavy metal presence and implicated wastes as the major sources of the heavy metals in the soils of the dumpsites. All the metals were detected in all the soil samples except Arsenic that was not detected in three points at site A. Fe had the highest concentrations while Ni had the least concentration in both sites. The trend in concentration was Fe Zn Pb Cu Cd Co Cr AsBaNi in site A While the trend in concentration was Fe Cr Zn Cu PbCd Co As Ba Ni in site B. The mean metal concentrations were compared with Department of Petroleum Resources DPR Standard values for soils in Nigeria all the metals except Cr and Cu are below the DPR target values while Cd and Arsenic are above the DPR intervention values for the two sites and this calls for immediate remediation.

  19. Combustion products of plastics as indicators for refuse burning in the atmosphere.

    Science.gov (United States)

    Simoneit, Bernd R T; Medeiros, Patricia M; Didyk, Borys M

    2005-09-15

    Despite all of the economic problems and environmental discussions on the dangers and hazards of plastic materials, plastic production worldwide is growing at a rate of about 5% per year. Increasing techniques for recycling polymeric materials have been developed during the last few years; however, a large fraction of plastics are still being discarded in landfills or subjected to intentional or incidental open-fire burning. To identify specific tracer compounds generated during such open-fire combustion, both smoke particles from burning and plastic materials from shopping bags, roadside trash, and landfill garbage were extracted for gas chromatography-mass spectrometry analyses. Samples were collected in Concón, Chile, an area frequently affected by wildfire incidents and garbage burning, and the United States for comparison. Atmospheric samples from various aerosol sampling programs are also presented as supportive data. The major components of plastic extracts were even-carbon-chain n-alkanes (C16-C40), the plasticizer di-2-ethylhexyl phthalate, and the antioxidants and lubricants/antiadhesives Irganox 1076, Irgafos 168, and its oxidation product tris(2,4-di-tertbutylphenyl) phosphate. Major compounds in smoke from burning plastics include the non-source-specific n-alkanes (mainly even predominance), terephthalic acid, phthalates, and 4-hydroxybenzoic acid, with minor amounts of polycyclic aromatic hydrocarbons (including triphenylbenzenes) and tris(2,4-di-tert-butylphenyl)phosphate. 1,3,5-Triphenylbenzene and tris(2,4-di-tert-butylphenyl)- phosphate were found in detectable amounts in atmospheric samples where plastics and refuse were burned in open fires, and thus we propose these two compounds as specific tracers for the open-burning of plastics.

  20. The role of positive/negative outcome expectancy and refusal self-efficacy of Internet use on Internet addiction among college students in Taiwan.

    Science.gov (United States)

    Lin, Min-Pei; Ko, Huei-Chen; Wu, Jo Yung-Wei

    2008-08-01

    Based on Bandura's social cognitive theory, this study was designed to examine positive and negative outcome expectancy and refusal self-efficacy of Internet use and their contribution to Internet addiction among college students by using hierarchical multiple regression analyses in a cross-sectional study design. Schools were first stratified into technical or nontechnical colleges and then into seven majors. A cluster random sampling by department was further applied to randomly choose participants from each major. A representative sample of 4,456 college students participated in this study. The Outcome Expectancy and Refusal Self-Efficacy of Internet Use Questionnaire and the Chen Internet Addiction Scale were used to assess the cognitive factors and the levels of Internet addiction. Results showed that both positive outcome expectancy and negative outcome expectancy were significantly and positively correlated with Internet addiction, and refusal self-efficacy of Internet use was significantly and negatively related to Internet addiction. Further analyses revealed that refusal self-efficacy of Internet use directly and negatively predicted Internet addiction. Moreover, we discovered that positive outcome expectancy positively predicted Internet addiction via refusal self-efficacy of Internet use; however, surprisingly, negative outcome expectancy had both a direct and indirect positive relationship in predicting Internet addiction via the refusal self-efficacy of Internet use. These results give empirical evidence to verify the theoretical effectiveness of the three cognitive factors to Internet addiction and should be incorporated when designing prevention programs and strategies for Internet addicted college students.

  1. Wastes disposal on board a ship. Crushing and volume reducing apparatus for combustible and non-combustible refuses; Senjo no haikibutsu shori. Kanen funen gomi no hasai gen`yo shori sochi

    Energy Technology Data Exchange (ETDEWEB)

    Kishida, Y. [Hitachi Zosen Corp., Osaka (Japan)

    1996-07-25

    This paper introduces a refuse crushing apparatus to reduce for storage the volume of refuses produced on board a ship by crushing. Refuses to be crushed are solid wastes including solid combustible refuses such as paper, wood pieces, and cloths, non-combustible refuses such as empty cans, metals and glass, and refuses unsuitable for combustion, such as plastics and stylofoam. Crushing methods include impact system, compression system and shearing system. The shearing system shears and crushes refuses by using blades rotating at a low speed. The system has a wide range of crush ability and excellent versatility, generates low levels of dust, noise and vibration, and is suitable as a marine use refuse disposing apparatus. However, empty cans and PET bottles are more difficult of getting into cutting blades requiring a large amount of time for crushing. Therefore, it is more suitable to reduce volume of refuses by using a compressor or the like apparatuses, and then crush them by using a double-axial shearing crusher. Stylofoam causes its crushed pieces to be electrically charged and deposited onto the apparatus, hence it is more suitable to reduce the volume of refuses and make them brittle by heating, and then crush them by using the double-axial crusher. 2 figs.

  2. Selection bias and subject refusal in a cluster-randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Rochelle Yang

    2017-07-01

    .92. Conclusions Though there appeared to be a higher consent rate for females than for males, the overall impact of potential selection bias and refusal to participate was minimal. Without rigorous methodology, selection bias may be a threat to external validity in cluster-randomized trials. Trial registration NCT01983813 . Date of registration: Oct. 28, 2013.

  3. Plasma gasification of refuse derived fuel in a single-stage system using different gasifying agents.

    Science.gov (United States)

    Agon, N; Hrabovský, M; Chumak, O; Hlína, M; Kopecký, V; Masláni, A; Bosmans, A; Helsen, L; Skoblja, S; Van Oost, G; Vierendeels, J

    2016-01-01

    The renewable evolution in the energy industry and the depletion of natural resources are putting pressure on the waste industry to shift towards flexible treatment technologies with efficient materials and/or energy recovery. In this context, a thermochemical conversion method of recent interest is plasma gasification, which is capable of producing syngas from a wide variety of waste streams. The produced syngas can be valorized for both energetic (heat and/or electricity) and chemical (ammonia, hydrogen or liquid hydrocarbons) end-purposes. This paper evaluates the performance of experiments on a single-stage plasma gasification system for the treatment of refuse-derived fuel (RDF) from excavated waste. A comparative analysis of the syngas characteristics and process yields was done for seven cases with different types of gasifying agents (CO2+O2, H2O, CO2+H2O and O2+H2O). The syngas compositions were compared to the thermodynamic equilibrium compositions and the performance of the single-stage plasma gasification of RDF was compared to that of similar experiments with biomass and to the performance of a two-stage plasma gasification process with RDF. The temperature range of the experiment was from 1400 to 1600 K and for all cases, a medium calorific value syngas was produced with lower heating values up to 10.9 MJ/Nm(3), low levels of tar, high levels of CO and H2 and which composition was in good agreement to the equilibrium composition. The carbon conversion efficiency ranged from 80% to 100% and maximum cold gas efficiency and mechanical gasification efficiency of respectively 56% and 95%, were registered. Overall, the treatment of RDF proved to be less performant than that of biomass in the same system. Compared to a two-stage plasma gasification system, the produced syngas from the single-stage reactor showed more favourable characteristics, while the recovery of the solid residue as a vitrified slag is an advantage of the two-stage set-up. Copyright

  4. Right to refuse treatment in Turkey: a diagnosis and a slightly less than modest proposal for reform.

    Science.gov (United States)

    Irmak, Nurbay

    2016-07-01

    This paper examines the current state of right to refuse medical treatment in Turkey. Even though there are only a few studies carried out with Turkish physicians on their attitude towards the right to refuse treatment, I argue that recent studies on physicians' views on informed consent and honest disclosure show that Turkish physicians do not tend to recognise their patients' right to decline treatment. This is because the refusal of treatment crucially requires that patients be properly informed and asked for their consent before the treatment. Turkish physicians and healthcare providers' tendency to ignore the right to decline medical treatment cannot be separated from their paternalistic approach to patients and their rights. I argue that part of the problem is the legal framework, which, in essence, is still paternalistic. More specifically, the frequent appearance of the phrase 'medical necessity' in the relevant legislation is conveniently used to justify medical intervention against a patient's will. I conclude the paper by proposing reforms in the legal documents defining and regulating patient rights, including the Constitution of the Turkish Republic, and I will argue that these reforms will help enhance patient rights in Turkey. Turkey has been discussing a new Constitution for the past several years, so my proposal should best be understood as contributing to public discussion of the new Constitution by initiating debate about medical paternalism and patient autonomy in Turkish medicine. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  5. Fiscal 2000 survey report. Refuse-fueled power generation introduction technology, etc. Part 2. Survey of general refuse-fueled power generation; 2000 nendo chosa hokokusho. Haikibutsu hatsuden donyu gijutsu chosa to - Ippan haikibutsu hatsuden chosa Part 2

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    Surveys were conducted of the effect on waste quality of the Law for Promotion of Sorted Collection and Recycling of Containers and Packaging, diffusion of PFI (private finance initiative) involving refuse-fueled power generation, recycling of slag, etc. Questionnairing was conducted for the survey of the effect on waste of the effectuation of the recycling law, size of population supplying the waste and the amount actually incinerated, actually measured data of the composition of incinerated waste, assorted collection programs, amount reducing measures, and the like. Studies were made as to if the empirical formulas applied in the survey of the preceding fiscal year would remain applicable after the coming into force of the recycling law. In the survey of PFI popularization, it was found that the rate it was taken into account for concrete projects was so low as 13.8% though most of the autonomous bodies had cognizance of PFI. It was requested that it be clearly stipulated that 'the conventional subsidies and grants apply also to PFI projects.' In the survey of conversion of residue into molten slag in refuse-fueled power generation and its reuse, four kinds of slag specimens were examined for physical properties, elution, and analyzed for ingredients, and then it was found that they posed no problems like heavy metal elution. (NEDO)

  6. Fiscal 2000 report on the development of high-efficiency refuse-fueled power generation technology; Kokoritsu haikibutsu hatsuden gijutsu kaihatsu 2000 nendo hokokusho

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    Efforts were made to develop a refuse gasification/fusion power generation technology to contribute to the effective utilization of unexploited energy and to reduction in greenhouse gas emissions. Developed in the technology of elevating steam temperature were the evaluation of high-temperature corrosion of SH materials and a high temperature dust removing system, dechlorination technology for the thermolysis process, and a ceramic-made high-temperature air heater. For the avoidance of exhaust gas reheating, development was carried out for a low-temperature denitration unit, stable refuse feeding system for reduction in the self-heat melting critical calorific value, waste plastic injection technology for reduction in the amount of external fuel injection, and so forth. The effect of the developed element technologies were evaluated and a detailed feasibility study was conducted for a refuse gas conversion power generation system using gas engine power generation for minor-scale general waste treatment facilities. In the survey of the trend of refuse-fueled power generation technologies, trend in Japan and advanced refuse-fueled power generation systems and their introduction in Europe and America were investigated. (NEDO)

  7. Research and Development of a New Silica-Alumina Based Cementitious Material Largely Using Coal Refuse for Mine Backfill, Mine Sealing and Waste Disposal Stabilization

    Energy Technology Data Exchange (ETDEWEB)

    Henghu Sun; Yuan Yao

    2012-06-29

    Coal refuse and coal combustion byproducts as industrial solid waste stockpiles have become great threats to the environment. To activate coal refuse is one practical solution to recycle this huge amount of solid waste as substitute for Ordinary Portland Cement (OPC). The central goal of this project is to investigate and develop a new silica-alumina based cementitious material largely using coal refuse as a constituent that will be ideal for durable construction, mine backfill, mine sealing and waste disposal stabilization applications. This new material is an environment-friendly alternative to Ordinary Portland Cement. The main constituents of the new material are coal refuse and other coal wastes including coal sludge and coal combustion products (CCPs). Compared with conventional cement production, successful development of this new technology could potentially save energy and reduce greenhouse gas emissions, recycle vast amount of coal wastes, and significantly reduce production cost. A systematic research has been conducted to seek for an optimal solution for enhancing pozzolanic reactivity of the relatively inert solid waste-coal refuse in order to improve the utilization efficiency and economic benefit as a construction and building material.

  8. Interim nuclear spent fuel storage facility - From complete refusal to public acceptance

    International Nuclear Information System (INIS)

    Kacena, Michal

    1998-01-01

    discuss anything. Step by step we realized a four year P.R. programme which included, for example, intensive discussions with people and their representatives in potential host regions, work with journalists, issuing information materials, organising information tps to nuclear facilities abroad sponsorship programmes, mobile exhibition and other activities. After such a long and difficult process, we feel that we are able to show others what we have done, what we have learned and what the results were. There were some good results in the end. We hit both of our main P.R. targets and maybe even a bit more: 1. We found a site, where the central storage is accepted by local representatives and where even most of them would welcome it. 2. The current Czech government changed the old decision to limit storage capacity at Dukovany NPP and recommended building two storage facilities at NPP's sites. The possibility of a central storage facility is being held in reserve. 3. Local representatives at both NPP sites are not refusing to discuss a new storage facility and are able to accept it. As usual in P.R., our work never ends. New targets have to be defined, new activities have to start: The whole site selection process has not been finished yet. Public hearings for both a central and the Dukovany NPP storage facilities will start next year. We expect to get a construction permit for the Dukovany site in three or four years. Then we intend to start the same at the Temelin site. But you probably know that never-ending P.R. story. (author)

  9. Pragmatic comprehension of apology, request and refusal: An investigation on the effect of consciousness-raising video-driven prompts

    Directory of Open Access Journals (Sweden)

    Ali Derakhshan

    2014-01-01

    Full Text Available Recent research in interlanguage pragmatics (ILP has substantiated that some aspects of pragmatics are amenable to instruction in the second or foreign language classroom. However, there are still controversies over the most conducive teaching approaches and the required materials. Therefore, this study aims to investigate the relative effectiveness of consciousness-raising video-driven prompts on the comprehension of the three speech acts of apology, request, and refusal on seventy eight (36 male and 42 female upper-intermediate Persian learners of English who were randomly assigned to four groups (metapragmatic, form-search, role play, and control. The four groups were exposed to 45 video vignettes (15 for each speech act extracted from different episodes of Flash Forward, Stargate TV Series and Annie Hall Film for nine 60-minute sessions of instruction twice a week. Results of the multiple choice discourse completion test (MDCT indicated that learners’ awareness of apologies, requests and refusals benefit from all three types of instruction, but the results of the Post hoc test of Tukey (HSD illustrated that the metapragmatic group outperformed the other treatment groups, and that form-search group had a better performance than role-play and control groups.

  10. The Experience of Psychiatric Care of Adolescents with Anxiety-based School Refusal and of their Parents: A Qualitative Study.

    Science.gov (United States)

    Sibeoni, Jordan; Orri, Massimiliano; Podlipski, Marc-Antoine; Labey, Mathilde; Campredon, Sophie; Gerardin, Priscille; Revah-Levy, Anne

    2018-01-01

    Anxiety-based school refusal in adolescence is a complex, sometimes difficult to treat disorder that can have serious academic and psychiatric consequences. The objective of this qualitative study was to explore how teens with this problem and their parents experience the psychiatric care received. This qualitative multicenter study took place in France, where we conducted semi-structured interviews with adolescents receiving psychiatric care for anxiety-based school refusal and with their parents. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. This study included 20 adolescents aged 12 to 18 years and 21 parents. Two themes emerged from the analysis: (1) the goals of psychiatric care with two sub-themes, " self-transformation " and problem solving ; and, (2) the therapeutic levers identified as effective with two sub-themes: time and space and relationships . Our results show a divergence between parents and teens in their representations of care and especially of its goals. Therapeutic and research implications about the terms of return to school within psychiatric care and also the temporality of care are discussed.

  11. Cascade of Refusal-What Does It Mean for the Future of Treatment as Prevention in Sub-Saharan Africa?

    Science.gov (United States)

    Katz, Ingrid T; Bangsberg, David R

    2016-04-01

    Recent recommendations by the World Health Organization support treatment for all people living with HIV (PLWH) globally to be initiated at the point of testing. While there has been marked success in efforts to identify and expand treatment for PLWH throughout sub-Saharan Africa, the goal of universal treatment may prove challenging to achieve. The pre-ART phase of the care cascade from HIV testing to HIV treatment initiation includes several social and structural barriers. One such barrier is antiretroviral therapy (ART) treatment refusal, a phenomenon in which HIV-infected individuals choose not to start treatment upon learning their ART eligibility. Our goal is to provide further understanding of why treatment-eligible adults may choose to present for HIV testing but not initiate ART when indicated. In this article, we will discuss factors driving pre-ART loss and present a framework for understanding the impact of decision-making on early losses in the care cascade, with a focus on ART refusal.

  12. Self-concept and adolescents' refusal of unprotected sex: a test of mediating mechanisms among African American girls.

    Science.gov (United States)

    Salazar, Laura F; DiClemente, Ralph J; Wingood, Gina M; Crosby, Richard A; Harrington, Kathy; Davies, Susan; Hook, Edward W; Oh, M Kim

    2004-09-01

    During adolescence, girls form self-concepts that facilitate the transition to adulthood. This process may entail engaging in risky sexual behaviors resulting in STD infection and pregnancy. This study assessed the relation between self-concept and unwanted, unprotected sex refusal among 335 African American adolescent girls. The second aim was to determine whether attributes of partner communication about sex would act as a mediating mechanism on this hypothesized relationship. These assessments were made within the context of several theoretical models (social cognitive theory and theory of gender and power). Self-concept was composed of self-esteem, ethnic identity, and body image, whereas attributes of partner communication about sex was conceptualized as frequency of communication, fear of condom use negotiation, and self-efficacy of condom use negotiation. Structural equation modeling was used to analyze data. The results showed that self-concept was associated with partner communication attributes about sex, which in turn, was associated with frequency of unprotected sex refusal. The hypothesized mediating role of partner communication was also supported. STD-HIV preventive interventions for this population may be more effective if they target self-concept as opposed to only self-esteem, incorporate an Afrocentric approach, and focus on enhancing several attributes of partner communication about sex.

  13. Beliefs and perceptions of women with newly diagnosed breast cancer who refused conventional treatment in favor of alternative therapies.

    Science.gov (United States)

    Citrin, Dennis L; Bloom, Diane L; Grutsch, James F; Mortensen, Sara J; Lis, Christopher G

    2012-01-01

    Although breast cancer is a highly treatable disease, some women reject conventional treatment opting for unproven "alternative therapy" that may contribute to poor health outcomes. This study sought to understand why some women make this decision and to identify messages that might lead to greater acceptance of evidence-based treatment. This study explored treatment decision making through in-depth interviews with 60 breast cancer patients identified by their treating oncologists. Thirty refused some or all conventional treatment, opting for alternative therapies, whereas 30 accepted both conventional and alternative treatments. All completed the Beck Anxiety Inventory and the Rotter Locus of Control scale. Negative first experiences with "uncaring, insensitive, and unnecessarily harsh" oncologists, fear of side effects, and belief in the efficacy of alternative therapies were key factors in the decision to reject potentially life-prolonging conventional therapy. Refusers differed from controls in their perceptions of the value of conventional treatment, believing that chemotherapy and radiotherapy were riskier (p communicate hope, educate them about their options, and allow them time to come to terms with their diagnosis before starting treatment might have led them to better treatment choices.

  14. Prevention of formation of acid drainage from high-sulfur coal refuse by inhibition of iron- and sulfur-oxidizing microorganisms. 1. Preliminary experiments in controlled shaken flasks

    Energy Technology Data Exchange (ETDEWEB)

    Dugan, P.R.

    1987-01-01

    Changes of pH and sulfate concentration in high-sulfur coal refuse slurries are used as measurements of microbial pyrite oxidation in the laboratory. Sodium lauryl sulfate (SLS), alkylbenzene sulfonate (ABS), benzoic acid (BZ) and combinations of SLS plus BZ and ABS plus BZ effectively inhibited formation of sulfate and acid when added in concentrations greater than 50 mg/l to inoculated 20 or 30% coal refuse slurries. Here 25 mg/l concentrations of SLS, ABS and ABS plus BZ stimulated acid production. Formic, hexanoic, oxalic, propionic, and pyruvic acids at 0.1% concentrations were also effective inhibitors. Four different lignin sulfonates were only slightly effective inhibitors at 0.1% concentrations. It was concluded that acid formation resulting from microbial oxidation in high-sulfur coal refuse can be inhibited. 22 references.

  15. Factors Associated with Participation, Active Refusals and Reasons for Not Taking Part in a Mortality Followback Survey Evaluating End-of-Life Care.

    Directory of Open Access Journals (Sweden)

    Natalia Calanzani

    Full Text Available Examination of factors independently associated with participation in mortality followback surveys is rare, even though these surveys are frequently used to evaluate end-of-life care. We aimed to identify factors associated with 1 participation versus non-participation and 2 provision of an active refusal versus a silent refusal; and systematically examine reasons for refusal in a population-based mortality followback survey.Postal survey about the end-of-life care received by 1516 people who died from cancer (aged ≥18, identified through death registrations in London, England (response rate 39.3%. The informant of death (a relative in 95.3% of cases was contacted 4-10 months after the patient died. We used multivariate logistic regression to identify factors associated with participation/active refusals and content analysis to examine refusal reasons provided by 205 nonparticipants.The odds of partaking were higher for patients aged 90+ (AOR 3.48, 95%CI: 1.52-8.00, ref: 20-49yrs and female informants (AOR 1.70, 95%CI: 1.33-2.16. Odds were lower for hospital deaths (AOR 0.62, 95%CI: 0.46-0.84, ref: home and proxies other than spouses/partners (AORs 0.28 to 0.57. Proxies of patients born overseas were less likely to provide an active refusal (AOR 0.49; 95% CI: 0.32-0.77. Refusal reasons were often multidimensional, most commonly study-related (36.0%, proxy-related and grief-related (25.1% each. One limitation of this analysis is the large number of nonparticipants who did not provide reasons for refusal (715/920.Our survey better reached proxies of older patients while those dying in hospitals were underrepresented. Proxy characteristics played a role, with higher participation from women and spouses/partners. More information is needed about the care received by underrepresented groups. Study design improvements may guide future questionnaire development and help develop strategies to increase response rates.

  16. Factors Associated with Participation, Active Refusals and Reasons for Not Taking Part in a Mortality Followback Survey Evaluating End-of-Life Care

    Science.gov (United States)

    Calanzani, Natalia; Higginson, Irene J; Koffman, Jonathan; Gomes, Barbara

    2016-01-01

    Background Examination of factors independently associated with participation in mortality followback surveys is rare, even though these surveys are frequently used to evaluate end-of-life care. We aimed to identify factors associated with 1) participation versus non-participation and 2) provision of an active refusal versus a silent refusal; and systematically examine reasons for refusal in a population-based mortality followback survey. Methods Postal survey about the end-of-life care received by 1516 people who died from cancer (aged ≥18), identified through death registrations in London, England (response rate 39.3%). The informant of death (a relative in 95.3% of cases) was contacted 4–10 months after the patient died. We used multivariate logistic regression to identify factors associated with participation/active refusals and content analysis to examine refusal reasons provided by 205 nonparticipants. Findings The odds of partaking were higher for patients aged 90+ (AOR 3.48, 95%CI: 1.52–8.00, ref: 20–49yrs) and female informants (AOR 1.70, 95%CI: 1.33–2.16). Odds were lower for hospital deaths (AOR 0.62, 95%CI: 0.46–0.84, ref: home) and proxies other than spouses/partners (AORs 0.28 to 0.57). Proxies of patients born overseas were less likely to provide an active refusal (AOR 0.49; 95% CI: 0.32–0.77). Refusal reasons were often multidimensional, most commonly study-related (36.0%), proxy-related and grief-related (25.1% each). One limitation of this analysis is the large number of nonparticipants who did not provide reasons for refusal (715/920). Conclusions Our survey better reached proxies of older patients while those dying in hospitals were underrepresented. Proxy characteristics played a role, with higher participation from women and spouses/partners. More information is needed about the care received by underrepresented groups. Study design improvements may guide future questionnaire development and help develop strategies to increase

  17. Point of care experience with pneumococcal and influenza vaccine documentation among persons aged ≥65 years: high refusal rates and missing information.

    Science.gov (United States)

    Brownfield, Elisha; Marsden, Justin E; Iverson, Patty J; Zhao, Yumin; Mauldin, Patrick D; Moran, William P

    2012-09-01

    Missed opportunities to vaccinate and refusal of vaccine by patients have hindered the achievement of national health care goals. The meaningful use of electronic medical records should improve vaccination rates, but few studies have examined the content of these records. In our vaccine intervention program using an electronic record with physician prompts, paper prompts, and nursing standing orders, we were unable to achieve national vaccine goals, due in large part to missing information and patient refusal. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  18. Metastatic neuroblastoma presenting as refusal to use the left upper extremity in a six-year-old girl

    Directory of Open Access Journals (Sweden)

    Casey Grover

    2014-12-01

    Full Text Available Neuroblastoma is the most common extracranial neoplasm in children, commonly presenting at an advanced stage. Despite the high prevalence of metastatic disease with neuroblastoma, metastases to the central nervous system are rare and predominantly involve the spinal cord. We present a case of neuroblastoma with metastases to the brain presenting as refusal to move the left arm. The lesion initially appeared to be both a subdural and epidural hematoma on computed tomography of the head, but upon magnetic resonance imaging, was found to represent metastatic neuroblastoma. In pediatric patients with systemic symptoms and neurologic deficits, metastatic disease, such as neuroblastoma, should be included in the differential diagnosis and appropriate imaging should be obtained.

  19. The Global Context of Vaccine Refusal: Insights from a Systematic Comparative Ethnography of the Global Polio Eradication Initiative.

    Science.gov (United States)

    Closser, Svea; Rosenthal, Anat; Maes, Kenneth; Justice, Judith; Cox, Kelly; Omidian, Patricia A; Mohammed, Ismaila Zango; Dukku, Aminu Mohammed; Koon, Adam D; Nyirazinyoye, Laetitia

    2016-09-01

    Many of medical anthropology's most pressing research questions require an understanding how infections, money, and ideas move around the globe. The Global Polio Eradication Initiative (GPEI) is a $9 billion project that has delivered 20 billion doses of oral polio vaccine in campaigns across the world. With its array of global activities, it cannot be comprehensively explored by the traditional anthropological method of research at one field site. This article describes an ethnographic study of the GPEI, a collaborative effort between researchers at eight sites in seven countries. We developed a methodology grounded in nuanced understandings of local context but structured to allow analysis of global trends. Here, we examine polio vaccine acceptance and refusal to understand how global phenomena-in this case, policy decisions by donors and global health organizations to support vaccination campaigns rather than building health systems-shape local behavior. © 2016 by the American Anthropological Association.

  20. Locating Purity within Corruption Rumors: Narratives of HPV Vaccination Refusal in a Peri-urban Community of Southern Romania.

    Science.gov (United States)

    Pop, Cristina A

    2016-12-01

    This article locates the symbolic construction of "corrupted purity"-as a key assertion in Romanian parents' HPV vaccination refusal narratives-within a multiplicity of entangled rumors concerning reproduction and the state. Romania's unsuccessful HPV vaccination campaign is not unique. However, the shifting discourses around purity and corruption-through which some parents conveyed anxieties about their daughters being targeted for the vaccine-place a particular twist on the Romanian case of resisting the HPV vaccination. Parental discourses took the form of clusters of rumors about state medicine's failure to provide adequate reproductive health care, additive-laden foods, and exposure to radioactive contamination. In these rumors, corruption becomes literally embodied, through ingestion, consumption, contact, or inoculation. Parental discourses about what is being injected into their daughters' pristine bodies express their uncertainty around navigating the unsettled post-socialist medical landscape. © 2016 by the American Anthropological Association.

  1. Feasibility Study of Economics and Performance of Solar Photovoltaics at the Refuse Hideaway Landfill in Middleton, Wisconsin

    Energy Technology Data Exchange (ETDEWEB)

    Salasovich, J.; Mosey, G.

    2011-08-01

    This report presents the results of an assessment of the technical and economic feasibility of deploying a photovoltaics (PV) system on a brownfield site at the Refuse Hideaway Landfill in Middleton, Wisconsin. The site currently has a PV system in place and was assessed for further PV installations. The cost, performance, and site impacts of different PV options were estimated. The economics of the potential systems were analyzed using an electric rate of $0.1333/kWh and incentives offered by the State of Wisconsin and by the serving utility, Madison Gas and Electric. According to the site production calculations, the most cost-effective system in terms of return on investment is the thin-film fixed-tilt technology. The report recommends financing options that could assist in the implementation of such a system.

  2. Social anxiety and drinking refusal self-efficacy moderate the relationship between drinking game participation and alcohol-related consequences.

    Science.gov (United States)

    Kenney, Shannon R; Napper, Lucy E; LaBrie, Joseph W

    2014-09-01

    Participation in drinking games is associated with excessive drinking and alcohol risks. Despite the growing literature documenting the ubiquity and consequences of drinking games, limited research has examined the influence of psychosocial factors on the experience of negative consequences as the result of drinking game participation. The current event-level study examined the relationships among drinking game participation, social anxiety, drinking refusal self-efficacy (DRSE) and alcohol-related consequences in a sample of college students. Participants (n = 976) reported on their most recent drinking occasion in the past month in which they did not preparty. After controlling for sex, age, and typical drinking, higher levels of social anxiety, lower levels of DRSE, and playing drinking games predicted greater alcohol-related consequences. Moreover, two-way interactions (Social Anxiety × Drinking Games, DRSE × Drinking Games) demonstrated that social anxiety and DRSE each moderated the relationship between drinking game participation and alcohol-related consequences. Participation in drinking games resulted in more alcohol problems for students with high social anxiety, but not low social anxiety. Students with low DRSE experienced high levels of consequences regardless of whether they participated in drinking games; however, drinking game participation was associated with more consequences for students confident in their ability to resist drinking. Findings highlight the important role that social anxiety and DRSE play in drinking game-related risk, and hence provide valuable implications for screening at-risk students and designing targeted harm reduction interventions that address social anxiety and drink refusal in the context of drinking games.

  3. Fundamental study for improvement of dewatering of fine coal/refuse. Final report, August 1981-December 1984

    Energy Technology Data Exchange (ETDEWEB)

    Chiang, S.H.; Klinzing, G.E.; Morsi, B.I.; Tierney, J.W.; Binkley, T.; Chi, S.M.; Huang, S.; Qamar, I.; Venkatadri, R.

    1984-12-01

    Fine coal in slurry form must be dewatered to minimize handling and transportation problems and be reduced to a desirable level for subsequent preparation of coal/water mixtures as a substitute utility fuel. The current practice is inadequate for the dewatering of fine coal, particularly for coal particles with sizes smaller than 400 mesh. Therefore, it is most desirable to develop improved mechanical methods for reducing the moisture content of fine coal. In the light of this, a fundamental study of the dewatering of fine coal/refuse was initiated in June 1979 and continued through 1984. The overall objective of the study is to seek improved methods of dewatering through a better understanding of the filtration and post-filtration processes. As a first step, efforts have been focused on the mechanism of dewatering in terms of the basic properties of coal (and refuse) particles and the microstructures of filter cakes, and their relations to filtration rate and final moisture content. Pittsburgh seam-Bruceton Mine coal was used as a base coal. During the past year, filter cakes from coals with widely varying size ranges were micrographically characterized. The effects of a number of surface active agents and of entrapped air bubbles on the filter cake properties were also studied. Modules of the network model for calculating single phase and two phase permeabilities were formulated and tested. The report is divided into four parts: summary and deliverables; work forecast for 1984-1985; detailed description of technical progress; and appendices. 21 refs., 55 figs., 17 tabs.

  4. A comparative life cycle assessment of diesel and compressed natural gas powered refuse collection vehicles in a Canadian city

    International Nuclear Information System (INIS)

    Rose, Lars; Hussain, Mohammed; Ahmed, Syed; Malek, Kourosh; Costanzo, Robert; Kjeang, Erik

    2013-01-01

    Consumers and organizations worldwide are searching for low-carbon alternatives to conventional gasoline and diesel vehicles to reduce greenhouse gas (GHG) emissions and their impact on the environment. A comprehensive technique used to estimate overall cost and environmental impact of vehicles is known as life cycle assessment (LCA). In this article, a comparative LCA of diesel and compressed natural gas (CNG) powered heavy duty refuse collection vehicles (RCVs) is conducted. The analysis utilizes real-time operational data obtained from the City of Surrey in British Columbia, Canada. The impact of the two alternative vehicles is assessed from various points in their life. No net gain in energy use is found when a diesel powered RCV is replaced by a CNG powered RCV. However, significant reductions (approximately 24% CO 2 -equivalent) in GHG and criteria air contaminant (CAC) emissions are obtained. Moreover, fuel cost estimations based on 2011 price levels and a 5-year lifetime for both RCVs reveal that considerable cost savings may be achieved by switching to CNG vehicles. Thus, CNG RCVs are not only favorable in terms of reduced climate change impact but also cost effective compared to conventional diesel RCVs, and provide a viable and realistic near-term strategy for cities and municipalities to reduce GHG emissions. - Highlights: ► Life cycle analysis is performed on two alternative refuse collection vehicle technologies. ► Real-time operational data obtained by the City of Surrey in British Columbia are utilized. ► The life cycle energy use is similar for diesel and CNG RCVs. ► A 24% reduction of GHG emissions (CO 2 -equivalent) may be realized by switching from diesel to CNG. ► CNG RCVs are estimated to be cost effective and may lead to reduced fuel costs.

  5. Evaluation of the Motivation to Consent to and to Refuse Organ Donation Among Participants of Educational Meetings Concerning Organ Transplantation.

    Science.gov (United States)

    Milaniak, I; Wilczek-Rużyczka, E; Wierzbicki, K; Sadowski, J; Kapelak, B; Przybyłowski, P

    2016-06-01

    Improvement of the consent rate for solid organ donation from deceased donors is a key component of strategies applied in many countries aiming to increase the availability of organs for transplantation. Attitudes toward living and posthumous donation are favorable. Research shows that the outlook on organ donation and the degree of the willingness to become an organ donor are associated with a wide range of variables. The main objective of this study was to identify factors that influence the willingness to donate organs and the reasons for refusing consent. The study included 191 participants (135 female and 56 male) aged 16 to 61 years (mean age 26.86 ± 12.88). A cross-sectional study was conducted during educational meetings concerning organ donation that was addressed to students, teachers, and nurses. Survey tools included the Individual Questionnaire: Study of attitudes toward transplantation, consisting of 26 closed questions (with the consent of the Statistical Office in Krakow). In all, 97.4% of the respondents accepted transplantation from living donors, and 95.8% accepted deceased donations. Of the respondents, 78.5% agreed to posthumous life-saving organ donation. There was a significant difference between the respondents' sex, age, social group, place of living, and the reasons for their willingness to donate organs both posthumously and during their lifetime, as well as reasons for refusal. Our findings showed that the study group in general had favorable views on treatment involving transplantation and declared willingness to make a posthumous organ donation. These views vary depending on demographic variables. The education on the subject of organ and tissue donation has a positive impact on donation and transplantation rates. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. [Informed consent and parental refusal for medical treatment in childhood. The threshold of medical and social tolerance. Part II].

    Science.gov (United States)

    Guadarrama-Orozco, Jessica H; Garduño Espinosa, Juan; Vargas López, Guillermo; Viesca Treviño, Carlos

    Medical care in pediatric patients is conditional to parental consent. Parents decide the time and type of treatment they want their children to receive when they are ill. The physician should request parental consent before carrying out the most appropriate therapy. When parents refuse the treatment offered, the physician should seek alternative therapies that may be better accepted by parents and find the most beneficial treatment for children and their families. If physicians and parents are unable to agree on the best therapeutic methods, then the physician becomes involved in an ethical conflict related to the best interests of the child and parental choices. From the above posture, the following questions arise: What should the physician do when faced with this situation? Should the physician use legal measures to force parents to accept treatment? Under what conditions is it justified to force parents and when should the decision be tolerated? What is the role of the Hospital Bioethics Committee concerning this issue? This second part focuses on proposing four practical criteria to be used by the physician and Hospital Bioethics Committee when all alternative therapies and conciliatory options have been exhausted with parents and they continue to refuse treatment. The physician then has to make a decision because the child is placed at risk of harm. This decision focuses on whether there is danger to the minor arising from the decisions of parents and if such harm is avoidable. Copyright © 2015 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

  7. 78 FR 100 - Guidance for Industry and Food and Drug Administration Staff; Refuse To Accept Policy for 510(k)s...

    Science.gov (United States)

    2013-01-02

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-0523] Guidance for Industry and Food and Drug Administration Staff; Refuse To Accept Policy for 510(k)s; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug...

  8. Importance of alcohol-related expectations and emotional expressivity for prediction of motivation to refuse alcohol in alcohol-dependent patients

    Directory of Open Access Journals (Sweden)

    Justina Slavinskienė

    2014-01-01

    Conclusions: Negative alcohol-related expectations, emotional impulse intensity and positive emotional expressiveness were significant even though quite weak triggers for alcohol-dependent patients’ different level of motivation to refuse alcohol consumption. An assumption could be made that by changing these triggers it is possible to change addictive behavior.

  9. "I No Like Get Caught Using Drugs": Explanations for Refusal as a Drug-Resistance Strategy for Rural Native Hawaiian Youths

    Science.gov (United States)

    Okamoto, Scott K.; Helm, Susana; Giroux, Danielle; Kaliades, Alexis

    2011-01-01

    This exploratory study examines the use of explanations for refusal as a drug-resistance strategy for rural Native Hawaiian youths. Fourteen gender-specific focus groups were conducted within seven middle or intermediate schools on the Island of Hawai'i (N = 64). Participants were asked to describe drug-resistance strategies in response to 15…

  10. Co-digestion of concentrated black water and kitchen refuse in an accumulation system within the DESAR (decentralized sanitation and reuse) concept

    NARCIS (Netherlands)

    Kujawa, K.; Elmitwally, T.A.; Gaillard, A.; Leeuwen, van M.; Zeeman, G.

    2003-01-01

    Co-digestion of concentrated black water and kitchen refuse within the DESAR concept was the objective of this pilot research. The digestion took place in two, non-mixed accumulation reactors (AC1 and AC2) inoculated with digested primary sludge from a WWTP at a temperature of 20degreesC for a

  11. Effect of the number of two-wheeled containers at a gathering point on the energetic workload and work efficiency in refuse collecting

    NARCIS (Netherlands)

    Kuijer, P. Paul F. M.; van der Beek, Allard J.; van Dieën, Jaap H.; Visser, Bart; Frings-Dresen, Monique H. W.

    2002-01-01

    The effect of the number of two-wheeled containers at a gathering point on the energetic workload and the work efficiency in refuse collecting was studied in order to design an optimal gathering point for two-wheeled containers. Three sizes of gathering points were investigated, i.e. with 2, 16 and

  12. Why Do They Refuse to Use My Robot? : Reasons for Non-Use Derived from a Long-Term Home Study

    NARCIS (Netherlands)

    De Graaf, Maartje; Ben Allouch, Somaya; Van Dijk, Jan

    2017-01-01

    Research on why people refuse or abandon the use of technology in general, and robots specifically, is still scarce. Consequently, the academic understanding of people's underlying reasons for non-use remains weak. Thus, vital information about the design of these robots including their acceptance

  13. 49 CFR 385.337 - What happens if a new entrant refuses to permit a safety audit to be performed on its operations?

    Science.gov (United States)

    2010-10-01

    ... safety audit to be performed on its operations? 385.337 Section 385.337 Transportation Other Regulations... TRANSPORTATION FEDERAL MOTOR CARRIER SAFETY REGULATIONS SAFETY FITNESS PROCEDURES New Entrant Safety Assurance Program § 385.337 What happens if a new entrant refuses to permit a safety audit to be performed on its...

  14. Hysteroscopic fetoscopy: A role as virtuopsy for parents who refuse full autopsy? A case of facial clefting, proboscis, and limb deformities

    Directory of Open Access Journals (Sweden)

    Gabriele Tonni

    2015-10-01

    Conclusion: Hysteroscopic fetoscopy (virtuopsy proved to be a valuable complementary diagnostic investigation and enhanced the parental bonding process concerning the fetal phenotype. Notwithstanding, the woman declared an acceptable compliance during the procedure. In selected cases, virtuopsy may be a valid option in confirming early prenatal ultrasound diagnosis in parents refusing conventional autopsy or when full postmortem examination may not be clinically indicated or warranted.

  15. [Conscious refusal of food and fluids by Dutch nursing home patients in order to hasten death: a matter regarding patient and physician?

    NARCIS (Netherlands)

    Koopmans, R.T.C.M.; Sindram, I.P.C.; Dekkers, W.J.M.

    2004-01-01

    Refusal of food and/or fluids frequently occurs in nursing home patients. If the patient's decision to stop eating and drinking has been taken consciously and with due consideration of the consequences, it is referred to in Dutch as 'versterven'. A mentally competent, 73-year-old male nursing home

  16. [Refusal of food and fluids of a psychiatric patient in order to hasten death: obstacles for patient, family and care-team].

    NARCIS (Netherlands)

    Koopmans, R.T.C.M.; Dekkers, W.J.M.

    2012-01-01

    In this case-report we present a patient with a psychiatric history of a chronic depressive disorder. After a period of several years of ambivalence, he decided to refuse nutrition and hydration because he--in the words of the Royal Dutch Medical Association--was "suffering from life". There was no

  17. Acceptance of HIV testing among women attending antenatal care in south-western Uganda: risk factors and reasons for test refusal.

    Science.gov (United States)

    Dahl, V; Mellhammar, L; Bajunirwe, F; Björkman, P

    2008-07-01

    A problem commonly encountered in programs for prevention of mother-to-child-transmission (PMTCT) of HIV in sub-Saharan Africa is low rates of HIV test acceptance among pregnant women. In this study, we examined risk factors and reasons for HIV test refusal among 432 women attending three antenatal care clinics offering PMTCT in urban and semi-urban parts of the Mbarara district, Uganda. Structured interviews were performed following pre-test counselling. Three-hundred-eighty women were included in the study, 323 (85%) of whom accepted HIV testing. In multivariate analysis, testing site (Site A: OR = 1.0; Site B: OR = 3.08; 95%CI: 1.12-8.46; Site C: OR = 5.93; 95%CI: 2.94-11.98), age between 30 and 34 years (refusal. Testing sites operating for longer durations had higher rates of acceptance. The most common reasons claimed for test refusal were: lack of access to antiretroviral therapy (ART) for HIV-infected women (88%; n=57), a need to discuss with partner before decision (82%; n=57) and fear of partner's reaction (54%; n=57). Comparison with previous periods showed that the acceptance rate increased with the duration of the program. Our study identified risk factors for HIV test refusal among pregnant women in Uganda and common reasons for not accepting testing. These findings may suggest modifications and improvements in the performance of HIV testing in this and similar populations.

  18. 45 CFR 261.15 - Can a family be penalized if a parent refuses to work because he or she cannot find child care?

    Science.gov (United States)

    2010-10-01

    ... work because he or she cannot find child care? 261.15 Section 261.15 Public Welfare Regulations... work because he or she cannot find child care? (a) No, the State may not reduce or terminate assistance based on an individual's refusal to engage in required work if the individual is a single custodial...

  19. 21 CFR 71.22 - Deception as a basis for refusing to issue regulations; deceptive use of a color additive for...

    Science.gov (United States)

    2010-04-01

    ... regulations; deceptive use of a color additive for which a regulation has issued. 71.22 Section 71.22 Food and...; deceptive use of a color additive for which a regulation has issued. The Commissioner shall refuse to issue... regulation for a color additive authorizing its use generally in or on a food, drug, or cosmetic shall not be...

  20. Il rifiuto / Le refus / The refusal

    Directory of Open Access Journals (Sweden)

    Dominici M. R.

    2010-12-01

    Full Text Available L’articolo parte dalla problematica legata alla complessità dei flussi migratori, che vengono esaminati da diversi punti di vista: da un lato, viene evidenziato il tentativo di sottrarsi, da parte di molte persone, a situazioni ambientali di difficoltà, di sofferenza e di miseria ; dall’altro lato, si sottolinea come tale fenomeno possa essere collegato strettamente alla criminalità transnazionale.In entrambe le prospettive, si generano situazioni e rischi di vittimizzazione.Successivamente, prendendo a prestito vecchie favole, vi si costruiscono attorno le esperienze di situazioni reali che riguardano un bambino, il senso e la perdità di identità.Cet article aborde le problème de la complexité des flux migratoires. Ces derniers sont observés selon différents points de vue : d’une part, l’auter met en évidence que de nombreuses personnes essaient d’échapper à des situations éprouvantes, de souffrance et de misère ; d’autre part, l’auter souligne que ce phénomène peut être strictement lié à la criminalité transnationale.Dans les deux cas, des risques de victimisation se créent.Ensuite, en empruntant de vieilles fables, l’auter construit autour d’elles les expériences de vie réelle qui incluent un enfant, le sens et la perte d’identité. This article discusses the problem related to the complexity of migration from different points of view : on the one hand, the author underlines that a large number of people seeks to escape from difficult situations of poverty ; on the other hand, the author highlights that this phenomenon can be strictly related to transnational crime. In both cases, these situations increase the risks of victimization. Then, borrowing old fables, the author builds around them some experiences of real life including the ones of a child and of the sense and the loss of identity.

  1. [THE INDIVIDUAL AND SOCIAL FACTORS EFFECTING REFUSAL FROM VACCINATION OF CHILDREN IN THE TOWN OF SEMEII OF THE REPUBLIC OF KAZAKHSTAN].

    Science.gov (United States)

    Baibusinova, A J; Musakhanova, A K; Shalgumbaeva, G M; Dauletiarova, M A; Tokanova, Sh E; Nurtasina, S K

    2015-01-01

    The number of cases of refusal from vaccination increases all over the world. In the Republic of Kazakhstan many studies are devoted to epidemiology of propagation of vaccine-controllable infections, medical aspects ofimmunization, analysis of immunological status and complications of immunization. The issues of awareness of population of the Republic of Kazakhstan about vaccination and refusal of it are investigated insufficiently. This occurrence became a cause of studying the given problem. The study was carried out to investigate attitude ofpopulation to vaccination and main factors of risk of refusal from vaccination of children residing in the city of Semeii and rural districts of the Eastern Kazakhstan oblast. The single-stage longitudinal study was carried out in the Centers of primary medical social care ofpopulation ofcity of Semeii and in polyclinic of the Abaiiskii district of the Eastern Kazakhstan oblast. The period of study continued from April 7 2015 to May 31 2015. The criteria of inclusion were conditionally healthy children. The questionnaire survey included 1184 respondents (mothers) with average age of 27.2 years. The sampling predominantly consisted ofKazakhs (805), Russians (307), representatives ofother nationalities (72). Among mothers, most of them had specialized secondary education (43.7%), the higher education had 30.5%, undergraduate higher education - 1.4%, secondary education - 21.6% and basic school education --2.8%. The results of study demonstrated that families refused from vaccination have negative attitude to vaccination in general though they are satisfied with functioning of vaccination room. The refusal of vaccination is more characterized to urban full families with satisfied income and having girls as children. The respondents consider that information about vaccination received by themfrom medical personnel contains surplus data concerning complications. They are not enouzh for activities in case of deterioration of

  2. Comparison of coal/solid recovered fuel (SRF) with coal/refuse derived fuel (RDF) in a fluidised bed reactor

    International Nuclear Information System (INIS)

    Wagland, S.T.; Kilgallon, P.; Coveney, R.; Garg, A.; Smith, R.; Longhurst, P.J.; Pollard, S.J.T.; Simms, N.

    2011-01-01

    An experimental study was undertaken to compare the differences between municipal solid waste (MSW) derived solid recovered fuel (SRF) (complying with CEN standards) and refuse derived fuel (RDF). Both fuels were co-combusted with coal in a 50 kW fluidised bed combustor and the metal emissions were compared. Synthetic SRF was prepared in the laboratory by grinding major constituents of MSW such as paper, plastic, textile and wood. RDF was obtained from a local mechanical treatment plant. Heavy metal emissions in flue gas and ash samples from the (coal + 10% SRF) fuel mixture were found to be within the acceptable range and were generally lower than that obtained for coal + 10% RDF fuel mixture. The relative distribution of heavy metals in ash components and the flue gas stream shows the presence of a large fraction (up to 98%) of most of the metals in the ash (except Hg and As). Thermo-gravimetric (TG) analysis of SRF constituents was performed to understand the behaviour of fuel mixtures in the absence and presence of air. The results obtained from the experimental study will enhance the confidence of fuel users towards using MSW-derived SRF as an alternative fuel.

  3. Management of small digital collections with Omeka: the MoRE experience (A Museum of REfused and unrealised art projects

    Directory of Open Access Journals (Sweden)

    Alberto Salarelli

    2016-11-01

    Full Text Available This article examines the main features of Omeka, a free and open source CMS (Content Management System for online digital collections developed by the Roy Rosenzweig Center for History and New Media at George Mason University. Omeka presents very interesting features: first, a remarkable ease of use that, however, does not affect its multiple functions; secondly, it provides tools to create, in an innovative way, virtual exhibitions for archives, libraries and museums in order to promote their collections on the web; thirdly, its extreme adaptability to collection size: in fact Omeka is used by large and celebrated institutions such as the New York Public Library and Europeana, but also by many small initiatives including MoRE (A Museum of REfused and unrealized art projects. Specifically, the second part of the article describes, in brief, the objectives and characteristics of this virtual museum dedicated to contemporary unrealized artworks; it is an experimental project, still under development, devised by a working group of the University of Parma (Italy, who found in Omeka the most suitable IT solution to collect and expose these unique museum materials.

  4. Comparative Study on Characteristics and Potential of Rice Straws and Dry Leaves as a Binder in Refuse Derived Fuel (RDF)

    International Nuclear Information System (INIS)

    Zulhafizal Othman; Lias, K.; Hashim, N.H.; Clement, F.N.

    2013-01-01

    Integrated waste management systems are one of the greatest challenges in order to develop the green environment. In this research, two types of binder were chosen in producing of Refuse Derived Fuel (RDF) which is rice straws and dry leaves. The objective of the research is to identify which types of binder that can give the optimum performance. This two binder was mixed with paper and plastic waste with controlled mixing ratio which is 3:1 (ratio 1), 3:1.5(ratio 2) and 3:2 (ratio 3). In order to identify the optimum ratio of RDF, 45 number of samples was prepared and their properties such as moisture content, carbon content, sulfur content, chlorine content and calorific value were evaluated. Result indicated that samples with rice straw as a binder give the optimum result with the ratio of 3:1. The optimum values of the carbon content is 50.9 %, moisture content is 5.5 %, chlorine content is 0.0 %, sulfur content is 2.1 % and calorific value is 29.0 MJ/ kg. Hence, rice straws shows a great potential to be used as binder in production of RDF. (author)

  5. Production and characterization refuse derived fuel (RDF) from high organic and moisture contents of municipal solid waste (MSW)

    Science.gov (United States)

    Dianda, P.; Mahidin; Munawar, E.

    2018-03-01

    Many cities in developing countries is facing a serious problems to dealing with huge municipal solid waste (MSW) generated. The main approach to manage MSW is causes environmental impact associated with the leachate and landfill gas emissions. On the other hand, the energy available also limited by rapid growth of population and economic development due to shortage of the natural resource. In this study, the potential utilized of MSW to produce refuse derived fuel (RDF) was investigate. The RDF was produced with various organic waste content. Then, the RDF was subjected to laboratory analysis to determine its characteristic including the calorific value. The results shows the moisture content was increased by increasing organic waste content, while the calorific value was found 17-36 MJ/kg. The highest calorific value was about 36 MJ/kg obtained at RDF with 40% organic waste content. This results indicated that the RDF can be use to substitute coal in main burning process and calcinations of cement industry.

  6. "If a woman has even one daughter, I refuse to perform the abortion": Sex determination and safe abortion in India.

    Science.gov (United States)

    Potdar, Pritam; Barua, Alka; Dalvie, Suchitra; Pawar, Anand

    2015-05-01

    In India, safe abortion services are sought mainly in the private sector for reasons of privacy, confidentiality, and the absence of delays and coercion to use contraception. In recent years, the declining sex ratio has received much attention, and implementation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act (2003) has become stringent. However, rather than targeting sex determination, many inspection visits target abortion services. This has led to many private medical practitioners facing negative media publicity, defamation and criminal charges. As a result, they have started turning women away not only in the second trimester but also in the first. Samyak, a Pune-based, non-governmental organization, came across a number of cases of refusal of abortion services during its work and decided to explore the experiences of private medical practitioners with the regulatory mechanisms and what happened to the women. The study showed that as a fallout from the manner of implementation of the PCPNDT Act, safe abortion services were either difficult for women to access or outright denied to them. There is an urgent need to recognize this impact of the current regulatory environment, which is forcing women towards illegal and unsafe abortions. Copyright © 2015. Published by Elsevier Ltd.

  7. Potensi Material Sampah Combustible pada Zona Pasif TPA Jatibarang Semarang sebagai Bahan Baku RDF (Refuse Derived Fuel

    Directory of Open Access Journals (Sweden)

    Irma Natasya Hutabarat

    2018-03-01

    Full Text Available Abstrak: Peningkatan jumlah timbulan sampah menyebabkan meningkatnya kebutuhan lahan pada TPA Jatibarang. Untuk menghindari terjadinya kekurangan lahan perlu dilakukan penanganan pada sampah yakni dengan mengubah sampah menjadi sumber energi seperti bahan baku RDF (Refused Derived Fuel. RDF merupakan salah satu teknik penanganan sampah dengan mengubah sampah menjadi sesuatu yang bermanfaat yaitu bahan bakar. Sampah tersebut dapat dimanfaatkan menjadi bahan baku RDF dengan cara menganalisis nilai kalor yang dihasilkan. Untuk menganalisis nilai kalor pada sampah combustible zona pasif TPA Jatibarang dapat dilakukan dengan cara pengujian sampel sebanyak 100 gram dengan alat bom kalorimeter. Sampel tersebut diambil pada kedalaman 0-3 m dengan metode random sampling. Kemudian akan didapat nilai kalor tinggi yang dihasilkan sampel tersebut. Nilai Kalor Tinggi yang dihasilkan sampel tersebut sebesar 5,25 kkal/ton pada kedalaman 0-1 m, 5,76 kkal/ton pada kedalaman 1-2 m dan 6,31 kkal/ton pada kedalaman 2-3 m. Nilai kalor tinggi yang dihasilkan sampah combustible tersebut menunjukkan bahwa semakin rendah kedalaman sampah maka akan semakin tinggi nilai kalor yang dihasilkan dan sampah tersebut berpotensi sebagai bahan baku RDF.

  8. Study of the feasibility of mixing Refuse Derived Fuels with wood pellets through the grey and Fuzzy theory

    Energy Technology Data Exchange (ETDEWEB)

    Moran, J.C.; Miguez, J.L.; Porteiro, J.; Patino, D.; Granada, E.; Collazo, J. [Universidad de Vigo E.T.S. Ingenieros Industriales, Lagoas-Marcosende, s/n. Dpto. Ing. Mecanica Maquinas y Motores Termicos, 36200 Vigo (Pontevedra) (Spain)

    2009-12-15

    This paper presents a combined grey relational and fuzzy analysis for the evaluation of the environmental feasibility of burning mixtures of pellet and RDF (Refuse Derived Fuel) in a small pellet boiler-stove. RDF is obtained from Municipal Solid Waste (MSW) and contains a biomass fraction and a non-organic fraction (plastic). As a first step, both fuels are characterized to define their properties. A special feeding system is also used to improve the stove plant and to facilitate pellet distribution, which maintains a constant rate between the two fuels. Small scale energy converters, such as chimneys, boilers, stoves, etc., which produce heat and/or hot water by burning biomass (wood, pellets, briquettes, etc.), are especially suited to domestic purposes. However, in common commercial combustion conditions, this kind of use still has some disadvantages: some emissions (volatile organic carbons, carbon monoxide or NO{sub x}) may still be high, and it is difficult to compare the quality and performance of equipment working in very different combustion conditions. The grey relational analysis of different energy and emission variables leads to the definition of a new single variable called the grey relational grade (GRG). Thus, evaluation and optimisation of complicated multiple responses can be converted into the optimisation of a standardised single variable. The aim of the work is to research the most feasible mixture of pellets according to a grey relational analysis, taking into consideration energy-related, financial and environmental aspects. (author)

  9. Effects of low-temperature pretreatment on enhancing properties of refuse-derived fuel via microwave irradiation.

    Science.gov (United States)

    Liu, Zhen; Wang, Han-Qing; Zhou, Yue-Yun; Zhang, Xiao-Dong; Liu, Jian-Wen

    2017-07-01

    The present study focuses on pretreatment of enhancing the properties of refuse-derived fuel (RDF) via low-temperature microwave irradiation. These improved properties include lower chlorine content, a more porous surface structure and better combustion characteristics. In this study, low-temperature microwave irradiation was carried out in a modified microwave apparatus and the range of temperature was set to be 220-300℃. We found that the microwave absorbability of RDF was enhanced after being partly carbonized. Moreover, with the increasing of the final temperature, the organochlorine removal ratio was greatly increased to 80% and the content of chlorine was dramatically decreased to an extremely low level. It was also interesting to find that the chlorine of RDF was mainly released as HCl rather than organic chloride volatiles. The finding is just the same as the polyvinyl chloride pyrolysis process. In addition, pores and channels emerged during the modifying operation and the modified RDF has better combustibility and combustion stability than traditional RDF. This work revealed that low-temperature modification of RDF via microwave irradiation is significant for enhancing the quality of RDF and avoiding HCl erosion of equipment substantially.

  10. Experimental investigation in separating the heavy metal elements of refuse incineration fly ashes by using molten iron

    Energy Technology Data Exchange (ETDEWEB)

    Yang, J. [Chongqing Univ., Chongqing (China)]|[CPI-Yuanda Environmental-protection Engineering Co. Ltd., Chongqing (China); Liu, Q.; Dong, L. [Chongqing Univ., Chongqing (China); Du, Y. [CPI-Yuanda Environmental-protection Engineering Co. Ltd., Chongqing (China)

    2008-07-01

    One of the main waste treatment methods in the world for municipal solid waste (MSW) is incineration. It is effective in toxic substance destruction, waste volume reduction, and energy recovery. Some chemical substances are accumulated during incineration, most notably lead, zinc, chromium and cadmium, as well as other heavy metals. Untreated fly ash disposed in landfills can pollute the soil, surface water and groundwater because of the high levels of hazardous heavy metals and high salt concentration that can be leached out. This paper presented an experiment that melt-separated the heavy metal elements from fly ash generated during refuse incineration. Molted iron, was used as resolvent to dissolve the heavy metal elements in it. The paper described the materials and methods as well as the results of the study. It was concluded that using molted iron to separate the heavy metal elements from MSW incineration fly ash was feasible. The removal ratio of the main heavy metal elements was above 80 per cent, and some of it was above 99 per cent. 5 refs., 7 tabs., 1 fig.

  11. Fundamental study for improvement of dewatering of fine coal/refuse. Annual report, August 1982-August 1983

    Energy Technology Data Exchange (ETDEWEB)

    Chiang, S.H.; Klinzing, G.E.; Morsi, B.J.; Tierney, J.W.; Adams, J.; Bhat, N.; Binkley, T.; Chi, S.M.; Kakwani, R.; Qamar, I.

    1983-09-01

    The overall objective of the study is to seek improved methods of dewatering through a better understanding of the filtration and post-filtration processes. As a first step, efforts have been focused on the mechanism of dewatering in terms of basic properties of coal (and refuse) particles and microstructures of filter cakes, and their relations to filtration rate and final moisture content. Pittsburgh seam-Bruceton Mine coal was used as a base coal with experiments also being conducted with Upper Freeport and Illinois No. 6 coals. During the past year, filter cakes from the above coals with widely varied size ranges were micrographically characterized. The effects of a number of surface active agents and of entrapped air bubbles on the filter cake properties were also studied. A module of the network model for calculating single phase permeabilities was completed and tested. The report is divided into four parts: summary and deliverables; work forecast for the 1983-84; detailed descriptions of technical progress for particle/filter cake characterization; theoretical modeling, and enhanced dewatering methods; and appendices. 11 references, 35 figures, 11 tables.

  12. Food refusal in prisoners: a communication or a method of self-killing? The role of the psychiatrist and resulting ethical challenges.

    Science.gov (United States)

    Brockman, B

    1999-12-01

    Food refusal occurs for a variety of reasons. It may be used as a political tool, as a method of exercising control over others, at either the individual, family or societal level, or as a method of self-harm, and occasionally it indicates possible mental illness. This article examines the motivation behind hunger strikes in prisoners. It describes the psychiatrist's role in assessment and management of prisoners by referring to case examples. The paper discusses the assessment of an individual's competence to commit suicide by starvation, legal restraints to intervention, practical difficulties and associated ethical dilemmas. Anecdotal evidence suggests that most prisoners who refuse food are motivated by the desire to achieve an end rather than killing themselves, and that hunger-strike secondary to mental illness is uncommon. Although rarely required, the psychiatrist may have an important contribution to make in the management of practical and ethical difficulties.

  13. Change in microbial community in landfill refuse contaminated with antibiotics facilitates denitrification more than the increase in ARG over long-term

    Science.gov (United States)

    Wu, Dong; Chen, Guanzhou; Zhang, Xiaojun; Yang, Kai; Xie, Bing

    2017-01-01

    In this study, the addition of sulfamethazine (SMT) to landfill refuse decreased nitrogen intermediates (e.g. N2O and NO) and dinitrogen (N2) gas fluxes to resistome facilitated the denitrification (the nitrogen accumulated as NO gas at ~6 μg-N/kg-refuse·h-1) to a lesser extent than OTC-amended samples. Further, deep sequencing results show that long-term OTC exposure partially substituted Hyphomicrobium, Fulvivirga, and Caldilinea (>5%) for the dominant bacterial hosts (Rhodothermus, ~20%) harboring nosZ and norB genes that significantly correlated with nitrogen emission pattern, while sulfamethazine amendment completely reduced the relative abundance of the “original inhabitants” functioning to produce NOx gas reduction. The main ARG carriers (Pseudomonas) that were substantially enriched in the SMT group had lower levels of denitrifying functional genes, which could imply that denitrification is influenced more by bacterial dynamics than by abundance of ARGs under antibiotic pressures.

  14. Le refus alimentaire de la personne âgée institutionnalisée capable de discernement: quelle prise en charge infirmière ?

    OpenAIRE

    Ayigah, Koffi Raoul; Mudry Gillioz, Mireille; Farine, Antonina

    2012-01-01

    Fortement interpellés par des situations de refus de soins émanant de personnes âgées institutionnalisées capables de discernement et par la façon dont les équipes y répondaient, nous avons décidé d’explorer cette thématique sous l’angle du refus alimentaire, puisque l’alimentation en gériatrie est un soin à part entière. La question à laquelle nous avons cherché à répondre par cette revue de littérature est : Comment prendre en soin une personne âgée institutionnalisée ayant sa capacité de d...

  15. Cross-cultural differences in the refusal to accept a small gift: the differential influence of reciprocity norms on Asians and North Americans.

    Science.gov (United States)

    Shen, Hao; Wan, Fang; Wyer, Robert S

    2011-02-01

    Asians are more likely than North Americans to refuse a small gift that is offered to them by a casual acquaintance. Five experiments confirmed this difference and explored the reasons for its occurrence. Asians, who are inclined to think of themselves in relation to others, are more likely than North Americans to invoke a reciprocity norm in exchanging gifts with casual acquaintances, and they refuse a gift in order to avoid the feeling of indebtedness they would experience if they cannot reciprocate. North Americans, however, who are inclined to think of themselves independently of others, are more likely to base their acceptance of the gift on its attractiveness without considering their obligation to reciprocate. These cultural differences are not evident when the gift is offered by a close friend with whom individuals have a communal relationship. Implications of our findings for miscommunication between members of different cultures are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  16. Ostentation et refus du travail chez Veblen : le cas des jeunes chômeurs et de la spécificité militaire

    Directory of Open Access Journals (Sweden)

    Sébastien Schehr

    2007-10-01

    Full Text Available Cette contribution entend interroger la notion de « refus du travail » chez Veblen, notamment dans son rapport à l’ostentation et à la symbolique des places. Elle comportera deux parties : la première où sera exposée et revisitée la thèse de Veblen sur la fonction du refus du travail comme signe distinctif de la classe de loisir ; la deuxième où nous confronterons l’héritage de Veblen à des phénomènes sociaux contemporains. À cette fin, nous nous appuierons sur le rapport au travail des jeunes chômeurs et, dans une moindre mesure, sur celui des militaires, pour montrer que le refus du travail reste un principe opératoire de différenciation des groupes sociaux.This article intends to evaluate the notion of “work refusal” which can be found within Veblen’s work about conspicuous consumption and the symbolic of places. This article is divided in two parts. First, we will expose and revise Veblen’s thesis about the function of “work refusal” as a distinctive mark of the Leisure Class. Secondly, we will confront Veblen’s heritage to contemporary social phenomenon. For that reason, we will study the cases of the relationship of employed youth to work and the military. We will show that the refusal work stays a main principle of differentiation within social groups.

  17. Fiscal 2000 survey of refuse-fueled power generation introduction technology, etc. Survey of industrial refuse-fueled power generation (Industrial refuse-fueled power generation case study implementation - 1); 2000 nendo chosa haikibutsu hatsuden donyu gijutsu chosa to - Sangyo haikibutsu hatsuden chosa (Sangyo haikibutsu hatsuden case study no jisshi - 1)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    Case studies were conducted of industrial refuse-fueled power generation using plastic waste, paper waste, and wood chips, and the same using the excretions of cattle. In the study of power generation fueled by mixed waste containing plastic waste, 325t/d, 220t/d, and 130t/d incinerators having the lower calorific value of 5,960-6,401 kcal/kg were taken up, and steam conditions, generator output, generating-end efficiency, station service power ratio, sending-end efficiency, etc., were tentatively calculated. As for cost efficiency, a manufacturer's estimate indicated that commercialization would be impossible in all the cases unless the construction cost was cut down. In the study of excretion-fueled power generation, cases were taken up where medium-temperature fermentation proceeded for the excretions of 620-29,853 dairy cows (32-1,576 t/d). A calculation was performed on conditions that the construction cost and maintenance/utility costs were as estimated by the manufacturer, that the excretion treatment and power generation facilities were covered by subsidies, and that personnel expenses of 6-million yen were necessary. It was then found that there would be commercial viability in case the yield was 790t/d or higher. (NEDO)

  18. Importance of alcohol-related expectations and emotional expressivity for prediction of motivation to refuse alcohol in alcohol-dependent patients.

    Science.gov (United States)

    Slavinskienė, Justina; Žardeckaitė-Matulaitienė, Kristina

    2014-01-01

    The aim of this study was to evaluate the importance of alcohol-dependent patients' emotional expressivity, alcohol-related expectations and socio-demographic factors for prediction of motivation to refuse alcohol consumption. The study sample consisted of 136 alcohol-dependent patients (100 men and 36 women) undergoing treatment in Kaunas center for addictive disorders. Only higher expression of negative alcohol-related expectations (std. beta=0.192, P=0.023), higher emotional impulse intensity (std. beta=0.229, P=0.021) and higher expression of positive emotional expressiveness (std. beta=0.021, P=0.020) as well as gender (std. beta=0.180, P=0.049), education (std. beta=-0.137, P=0.038) and alcohol dependency treatment conditions (members of support group after rehabilitation program) (std. beta=0.288, P=0.001; std. beta=0.608, P=0.001) were significant factors for predicting the different level of alcohol-dependent patients motivation to refuse alcohol consumption. Negative alcohol-related expectations, emotional impulse intensity and positive emotional expressiveness were significant even though quite weak triggers for alcohol-dependent patients' different level of motivation to refuse alcohol consumption. An assumption could be made that by changing these triggers it is possible to change addictive behavior. Copyright © 2014 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  19. Co-digestion of concentrated black water and kitchen refuse in an accumulation system within the DESAR (decentralized sanitation and reuse) concept.

    Science.gov (United States)

    Kujawa-Roeleveld, K; Elmitwalli, T; Gaillard, A; van Leeuwen, M; Zeeman, G

    2003-01-01

    Co-digestion of concentrated black water and kitchen refuse within the DESAR concept was the objective of this pilot research. The digestion took place in two, non-mixed accumulation reactors (AC1 and AC2) inoculated with digested primary sludge from a WWTP at a temperature of 20 degrees C for a period of around 150 days. Reactor AC1 was fed with a mixture of faeces, urine and kitchen refuse in the equivalent amount that one individual generates per day. The AC2 was fed with a mixture of faeces and kitchen refuse in the equivalent amount that two individuals produce per day. Some contribution of urine to AC2 was not to be avoided. Detailed characterisation of waste(water) was performed. The performance of the stratified reactor was followed by monitoring the reactor content for several reactors' heights as well as being based on the biogas production. In general the system exposed good process stability. The methanisation of 34 and 61% was obtained for AC1 and AC2 respectively. The biogas yield was 26.5 and 50.8 L/p/d for the respective reactors. Proper choice of inoculum as well as good buffering capacity did not lead to accumulation of VFA and an inhibitive effect due to relatively high ammonium concentration. The chosen process is a promising technology showing good process stability especially for high strength influent.

  20. Pandemic influenza A/H1N1 vaccination coverage, adverse reactions, and reasons for vaccine refusal among medical students in Brazil

    Directory of Open Access Journals (Sweden)

    Eduardo Pernambuco de Souza

    2012-04-01

    Full Text Available The aim of this cross-sectional study was to determine, among medical students at a public university in Rio de Janeiro, Brazil, the acceptance of the pandemic influenza A/H1N1 vaccine during the 2010 mass immunization campaign and the vaccine safety in this group and, among unvaccinated students, the reasons for refusing vaccination. Of a total of 858 students, 678 (79% participated in the study. Vaccination coverage was 60.4% among students aged 20 to 39 years (an age group targeted for vaccination and 43.8% among those who did not belong to this age group. The most frequent adverse reactions to the vaccine were pain at the injection site (8.7% and fever (7.9%. There were no serious adverse reactions. Among students aged 20 to 39 years, the most common reasons for refusing the vaccine were "lack of time" (42.4%, "fear of adverse reactions" (41.9%, and "difficult access to the vaccine" (11.5%. Other reasons for vaccine refusal were "uncertainties about vaccine safety and efficacy" and "vaccination was not needed". To increase the acceptance of the influenza vaccine, a comprehensive immunization program should be offered to these students.

  1. Plant growth and trace-element uptake on acidic coal refuse amended with lime or fly ash

    Energy Technology Data Exchange (ETDEWEB)

    Jastrow, J.D. (Argonne National Lab., IL); Zimmerman, C.A.; Dvorak, A.J.; Hinchman, R.R.

    1981-04-01

    Two commonly used revegetation species, Kentucky 31 tall fescue (Festuca arundinacea Schreb.) and Lincoln smooth brome (Bromus inermis Leyss.), were grown for 60 days in pots containing coarse coal mine refuse (referred to as gob, pH = 3.5) amended with either lime or alkaline powerplant fly ash. Both species were also grown in pots containing a silt loam surface soil as a control. Morphological growth parameters were measured over time; dry weights and shoot/root ratios were determined at harvest. Concentrations of Al, As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se, V, and Zn in the plant shoots were determined by atomic absorption spectrophotometry. Plant growth of both species was not as good on either lime- or fly ash-amended gob as it was on surface soil; however, more vigorous growth occurred on lime-amended gob than on fly ash-amended gob. Significant differences (rho < 0.05) in the tissue concentrations of Cd, Co, Fe, Hg, Mn, Pb, V, and Zn were found among the plants grown on the three substrates. Except for Hg and Pb, these elements were higher in plants grown on at least one of the amended-gob substrates than in plants grown on surface soil. Significant substrate differences were not observed for Al, As, Cr, Cu, Ni, and Se. The tissue concentrations of some elements - notably Al, Cu, Fe, Mn, V, and Zn - were high enough in plants from one or more of the substrates to either approach or exceed concentrations which have been reported to be associated with toxic effects in some plant species.

  2. Behaviour, capture and inertization of some trace elements during combustion of refuse-derived char from municipal solid waste

    Energy Technology Data Exchange (ETDEWEB)

    Vassilev, S.V.; Braekman-Danheux, C.; Laurent, P.; Thiemann, T.; Fontana, A. [Bulgarian Academy of Sciences, Sofia (Bulgaria). Central Lab. of Mineralogy and Crystallography

    1999-08-01

    An investigation of refuse-derived char (RDC) generated by thermolysis of municipal solid waste (MSW) was undertaken to elucidate the behaviour of some toxic and potentially toxic trace elements (Cr, Cu, Mn, Ni, Pb, Sb and Zn) plus Fe during combustion of RDC. About 87% of Sb, 66% of Pb, 60% of Cu and significant parts of Fe{gt}Zn{gt}Ni{gt}Mn{gt}Cr from the RDC are volatile at 1200{degree}C, and their behaviour in the temperature interval 500-1200{degree}C is characterized. The use of sorbents (zeolite, kaolinite, montmorillonite, coals enriched in kaolinite and calcite, and lime plus portlandite) for capture, solidification and inertization of the most volatile elements during combustion of RDC is also described. Perspective sorbents and inertants for a retention of the most volatile Pb, Sb and Cu in RDC ash are kaolinite and montmorillonite or coals enriched in these minerals. In addition, when there is an effective RDC washing (dechlorination and desulphurization), the use of sorbents for capture of some metals could be reduced or even avoided. Recommendations are given for RDC utilization and improvisation of the collection, separation procedures and removal efficiency of some heavy-metal, chloride and sulphate compounds from MSW and RDC prior to their use. The results show that a long-term strategy based on detailed understanding of the source, formation, behaviour and fate of the elements and their modes of occurrence in MSW, RDC and combustion waste residues is required in order to validate a perspective waste pyrolytic processes development. 55 refs., 3 figs., 6 tabs.

  3. Studies of the combustion of coal/refuse derived fuels using thermogravimetric-Fourier transform infrared-mass spectrometry

    International Nuclear Information System (INIS)

    Lu, Huagang; Li, Jigui; Lloyd, W.G.

    1995-01-01

    According to a report of the Environmental Protection Agency (EPA), 'Characterization of Municipal Solid Waste (MSW) in the United States', the total MSW produced in the U.S. increased from 179 million tons in 1988 to 195 million tons in 1990. The EPA predicted that the country would produce about 216 million tons of garbage in the year 2000. The amount of waste generated and the rapidly declining availability of sanitary landfills has forced most municipalities to evaluate alternative waste management technologies for reducing the volume of waste sent to landfills. The fraction of MSW that is processed by such technologies as separation and recycling, composting, and waste-to-energy was forecast to increase from a few percent today to 30-40% by the year 2000. Waste-to-energy conversion of MSW can appear to be attractive because of the energy recovered, the economic value of recycled materials, and the cost savings derived from reduced landfill usage. However, extra care needs to be taken in burning MSW or refuse-derived fuel (RDF) to optimize the operating conditions of a combustor so that the combustion takes place in an environmentally acceptable manner. For instance, polychlorinated dibenzodioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) have been found in the precipitator fly ash and flue gas of some incinerator facilities in the United States and Europe. The amount of PCDDs and PCDFs occurs only in the parts-per-billion to parts-per-trillion range, but these chlorinated organics exhibit very high toxicity (LD 50 < 10 μg/Kg). The compound 2,3,7,8-tetrachlorodibenzodioxin has been found to be acnegenic, carcinogenic, and teratogenic. This has slowed or even stopped the construction and operation of waste-to-energy plants

  4. Studies of the combustion of coal/refuse derived fuels using thermogravimetric-Fourier transform infrared-mass spectrometry

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Huagang; Li, Jigui; Lloyd, W.G.

    1995-11-01

    According to a report of the Environmental Protection Agency (EPA), `Characterization of Municipal Solid Waste (MSW) in the United States`, the total MSW produced in the U.S. increased from 179 million tons in 1988 to 195 million tons in 1990. The EPA predicted that the country would produce about 216 million tons of garbage in the year 2000. The amount of waste generated and the rapidly declining availability of sanitary landfills has forced most municipalities to evaluate alternative waste management technologies for reducing the volume of waste sent to landfills. The fraction of MSW that is processed by such technologies as separation and recycling, composting, and waste-to-energy was forecast to increase from a few percent today to 30-40% by the year 2000. Waste-to-energy conversion of MSW can appear to be attractive because of the energy recovered, the economic value of recycled materials, and the cost savings derived from reduced landfill usage. However, extra care needs to be taken in burning MSW or refuse-derived fuel (RDF) to optimize the operating conditions of a combustor so that the combustion takes place in an environmentally acceptable manner. For instance, polychlorinated dibenzodioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) have been found in the precipitator fly ash and flue gas of some incinerator facilities in the United States and Europe. The amount of PCDDs and PCDFs occurs only in the parts-per-billion to parts-per-trillion range, but these chlorinated organics exhibit very high toxicity (LD{sub 50} < 10 {mu}g/Kg). The compound 2,3,7,8-tetrachlorodibenzodioxin has been found to be acnegenic, carcinogenic, and teratogenic. This has slowed or even stopped the construction and operation of waste-to-energy plants.

  5. Understanding the perceived logic of care by vaccine-hesitant and vaccine-refusing parents: A qualitative study in Australia.

    Directory of Open Access Journals (Sweden)

    Paul R Ward

    efforts to engage with their vaccine refusal at a policy level.

  6. Characterization of Crew Refuse Returned from Shuttle Missions with Permanent Gas, Volatile Organic Compound, and Microbial Analyses

    Science.gov (United States)

    Peterson, B.; Hummerick, M.; Roberts, M.; Krummins, V.; Kish, A.; Garland, J.; Maxwell, S.; Mills, A.

    In addition to the mass and energy costs associated with bioregenerative systems for advanced life support, the storage and processing of waste on spacecraft requires both atmospheric and biological management. Risks to crew health may arise from the presence of potential human pathogens in waste or from decay processes during waste storage and/or processing. This study reports on the permanent gas, trace volatile organic and microbiological analyses of crew refuse returned from shuttle missions STS-105, 109 and 110. The research objective is to characterize the biological stability of the waste stream, to assess the risks associated with its storage, and to provide baseline measures for the evaluation of waste processing technologies. Microbiological samples were collected from packaging material, food waste, bathroom waste, and bulk liquid collected from the volume F waste container. The number of culturable bacteria and total bacteria were determined by plating on R2A media and by Acridine Orange direct count, respectively. Samples of the trash were analyzed for the presence of fecal and total coliforms and other human-associated bacteria. Dry and ash weights were determined to estimate both water and organic content of the materials. The aerobic and anaerobic bio-stability of stored waste was determined by on-line monitoring of CO2 and by laboratory analysis of off-gas samples for hydrogen sulfide and methane. Volatile organic compounds and permanent gases were analyzed using EPA method TO15 with gas chromatography/mass spectrometry and by gas chromatography with selective detectors . This study establishes a baseline measure of waste composition, labile organics, and microbial load for this material.

  7. Refusing What We Are

    DEFF Research Database (Denmark)

    Mcilvenny, Paul Bruce

    2017-01-01

    -conducts’, practices in which alternative modes of being governed are performed. By questioning the conduct of their conduct, participants simultaneously question the relationship of the self to itself, playing with and risking identity in the process. The case study scrutinises video recordings of the “United Nathans...... the ways in which fields of visibility and modes of rationality are sequentially and categorially organised in the contingent accomplishment of counter-identities....

  8. Visa refusal following compulsory hospital admission under the Mental Health Act 1983 (England and Wales): fact or fiction?

    Science.gov (United States)

    Ashmore, R

    2015-08-01

    Historically, compulsory hospital admission led to discrimination for service users. For example, until recently detention under the Mental Health Act 1983 (England and Wales) would disqualify a person from being a Member of Parliament. There is a belief among mental health professionals that compulsory hospital admission will result in service users being refused a tourist visa. However, there is a paucity of literature on this topic, particularly from an international perspective. Based on the information reviewed in this study, there is no evidence to support this belief. Of 262 travel destinations, 96 (36.6%) require British citizens to obtain a tourist visa. Six (2.3%) destinations require applicants to declare a mental health condition in order to obtain a tourist visa. None of these destinations ask applicants to declare a history of compulsory hospital admission. However, the possibility exists that anyone declaring a mental health problem may be asked to provide further information about their condition before a visa is granted. Mental health nurses require education to ensure that their knowledge of mental health legislation is up to date. This education should include information on the potential consequences of compulsory hospital admission for the service user's social life following discharge. Service users and their families should be provided with written information on the potential social impact of detention along with a list of organizations that can provide advice on specific issues. This study sought to establish whether a history of compulsory hospital admission prevented a person from obtaining a tourist visa. A visa application form and/or other relevant information were obtained for 262 travel destinations visited by British citizens. Ninety-six (36.6%) destinations require British citizens to obtain a tourist visa. All visas are issued subject to travellers meeting a number of conditions, for example being in possession of travel insurance

  9. Socio-cultural factors, gender roles and religious ideologies contributing to Caesarian-section refusal in Nigeria.

    Science.gov (United States)

    Ugwu, Nnanna U; de Kok, Bregje

    2015-08-12

    The death of women from pregnancy-related causes is a serious challenge that international development initiatives, including the Millennium Development Goals, have been trying to redress for decades. The majority of these pregnancy-related deaths occur in developing countries especially in Sub-Saharan Africa. The provision of Emergency Obstetric Care (EmOC), including Caesarean section (CS) has been identified as one of the key ingredients necessary for the reduction of high maternal mortality ratios. However, it appears that creating access to EmOC facilities is not all that is required to reduce maternal mortality: socio-cultural issues in Sub-Saharan countries including Nigeria seem to deter women from accepting CS. This study seeks to explore some of the socio-cultural concerns that reinforce delays and non-acceptance of CS in a Nigerian community. This is a mixed method study that combined both qualitative and quantitative strategies of enquiry. The hospital's delivery records from 2006-2010 provided data for quantitative analysis. This quantitative data was supplemented with prospective data collected during one month. Semi-structured interviews, focus group discussions (FGD) and informal observations served as the sources of data on the qualitative end. In total, 22% of maternity clients refused CS and more than 90% of the CSs in the focal hospital were emergencies which may indicate late arrival at the hospital after seeking assistance elsewhere. The qualitative analysis reveals that socio-cultural meanings informed by gender and religious ideologies, the relational consequences of having a C-section, and the role of alternative providers are some key factors which influence when, where and whether women will accept C-section or not. There is need to find means of facilitating necessary CS by addressing the prevailing socio-cultural norms and expectations that hinder its acceptance. Engaging and guiding alternative providers (traditional birth attendants

  10. An Investigation of the Use of politeness strategies in refusal among Characters with different power relations in English and Farsi Novels

    Directory of Open Access Journals (Sweden)

    Farahman Farrokhi

    2017-10-01

    Full Text Available One of the important concerns of communicative way of learning is to be able to convey meaning and not just physical words in a language. The study of speech acts could possibly help achieve this. When using speech acts, one should take into consideration the conversational rules of the language and in order to establish a safe and harmonious conversation, it is better to use certain strategies to eliminate their possible threatening effects. Attempt is made in the present study using a mixed-method design, to investigate the employment of politeness strategies proposed by Brown and Levinson (1987, among the interlocutors with different power relations in English and Farsi novels, when using the speech act of refusal. The speech act of refusal addressed in this study is a face threatening act (FTA (Brown & Levinson, 1987, which may be used differently by speakers of different languages, with different power relations, in different situations. The materials used are five English and five Farsi novels written by native speakers of English and Farsi. The taxonomy of Beebe, Takahashi and Uliss-Weltz (1990 were employed in order to categories different types of refusal. The frequency of their use and their percentages were calculated manually. The results indicated that even though reflecting two different cultures, the similarities among the English and Farsi novels regarding the use of both speech acts, were more than the differences. The differences were more obvious in the employment of politeness strategies. The findings of this study will probably give insights into the pragmatic and conversational rules of both languages.

  11. “The One Who Chases You Away Does Not Tell You Go”: Silent Refusals and Complex Power Relations in Research Consent Processes in Coastal Kenya

    Science.gov (United States)

    Kamuya, Dorcas M.; Theobald, Sally J.; Marsh, Vicki; Parker, Michael; Geissler, Wenzel P.; Molyneux, Sassy C.

    2015-01-01

    Consent processes have attracted significant research attention over the last decade, including in the global south. Although relevant studies suggest consent is a complex negotiated process involving multiple actors, most guidelines assume consent is a one-off encounter with a clear ‘yes’ or ‘no’ decision. In this paper we explore the concept of ‘silent refusals’, a situation where it is not clear whether potential participants want to join studies or those in studies want to withdraw from research, as they were not actively saying no. We draw on participant observation, in-depth interviews and group discussions conducted with a range of stakeholders in two large community based studies conducted by the KEMRI Wellcome Trust programme in coastal Kenya. We identified three broad inter-related rationales for silent refusals: 1) a strategy to avoid conflicts and safeguard relations within households, - for young women in particular—to appear to conform to the wishes of elders; 2) an approach to maintain friendly, appreciative and reciprocal relationships with fieldworkers, and the broader research programme; and 3) an effort to retain study benefits, either for individuals, whole households or wider communities. That refusals and underlying rationales were silent posed multiple dilemmas for fieldworkers, who are increasingly recognised to play a key interface role between researchers and communities in many settings. Silent refusals reflect and reinforce complex power relations embedded in decisions about research participation, with important implications for consent processes and broader research ethics practice. Fieldworkers need support to reflect upon and respond to the ethically charged environment they work in. PMID:25978465

  12. An investigation on the effect of Health Belief Model-based education on refusal skills in high risk situations among female students.

    Science.gov (United States)

    Boroumandfar, Khadijeh; Shabani, Fatemeh; Ghaffari, Mohtasham

    2012-03-01

    Various studies show an association between lack of social skills in adolescents and the future incidence of behavioral disorders. If girls, as future mothers, lack adequate health, awareness, self confidence and social skills, they may act as a source of many social problems. Therefore, the present study has tried to educate this group on one of the most essential social skills, refusal skill in high risk situation. This is a field quasi experimental study conducted on 145 female students in middle schools in Arak, Iran in 2010-2011. The schools were randomly selected. The subjects were selected through systematic random sampling from the schools' log book. The data were collected by questionnaires containing personal and familial characteristics, three health belief model structures, and behavioral intention in high risk situations. The data were analyzed by descriptive statistical tests (frequency distribution, mean, SD) and inferential tests of repetitive variance analysis and T-test through SPSS. In the present study, repetitive variance analysis showed that education by use of a health belief model had a positive effect on refusal skills in high risk situations as well as perceived barriers (p = 0.007), self-efficacy (p = 0.015), behavioral intention (p = 0.048) after educational intervention in the study group, but not on perceived benefits (p = 0.180). The results showed that education significantly increased refusal skills in high risk situations in the study group through the health belief model. With regard to the results, it is essential to equip the students with preventive behaviors to guarantee their physical, emotional and social health.

  13. Costs and outcomes after cardiac surgery in patients refusing transfusion compared with those who do not: a case-matched study.

    Science.gov (United States)

    Guinn, Nicole R; Roberson, Russell S; White, William; Cowper, Patricia A; Broomer, Bob; Milano, Carmelo; Chiricolo, Antonio; Hill, Steven

    2015-12-01

    Although numerous studies have demonstrated the feasibility of cardiac surgery for blood refusal patients, few studies match to controls, and fewer examine cost. This historical cohort study aims to compare costs and outcomes after cardiac surgery in Jehovah's Witness patients who refuse blood transfusion with a group of matched patients accepting transfusion. A retrospective database review was performed to find all patients having cardiac surgery who refused blood products from January 2005 to July 2012 at Duke University Medical Center. These 45 patients were closely matched 1:2 with controls who accepted transfusion based on characteristics likely to influence transfusion. Cost from day of surgery to hospital discharge and other outcome data (length of stay [LOS], discharge hemoglobin [Hb], acute kidney injury) were analyzed retrospectively. Forty-five Witnesses having cardiac surgery were temporally matched to two controls having the same surgery. Median euroSCORE was the same in both groups (6.0, p = 0.9981). In the matched-pairs comparison of cost, there was no significant difference in total cost for Witnesses and controls. There was no difference in intensive care unit LOS (median, 1 day, both groups) or total LOS (median, 9 days for Witnesses vs. 7 days for controls). Mean Hb at discharge was higher in Witnesses than in controls (11.7 g/dL vs. 9.8 g/dL, p conservation measures, cardiac surgery may be performed with similar outcomes and cost from day of surgery to discharge compared to controls in select patients without blood transfusion. © 2015 AABB.

  14. Computer simulation of flow ratios in a washing tower at Duesseldorf-Flingern refuse incineration plant; Computersimulation der Stroemungsverhaeltnisse in einem Waschturm der Muellverbrennungsanlage Duesseldorf-Flingern

    Energy Technology Data Exchange (ETDEWEB)

    Juengling, K [Technischer Ueberwachungs-Verein Rheinland e.V., Koeln (Germany); Koelle, P [Technischer Ueberwachungs-Verein Rheinland e.V., Koeln (Germany)

    1997-03-01

    Numeric investigations of flow ratios have been undertaken in order to optimise the operating performance of the washing towers of a refuse incineration plant during various modes of operation. On the basis of the kowledge gained from flow simulations, proposals have been developed, which have led to a significant prolongation of trouble-free operation. (orig.) [Deutsch] Zur Optimierung des Betriebsverhaltens der Waschtuerme einer Muellverbrennungsanlage bei unterschiedlichen Fahrweisen wurden numerische Untersuchungen der Stroemungsverhaeltnisse durchgefuehrt. Aufgrund der Erkenntnisse aus den Stroemungssimulationen wurden Vorschlaege entwickelt, die zu einer deutlichen Verlaengerung des stoerungsfreien Betriebs fuehrten. (orig.)

  15. Ethics and Rationing Access to Dialysis in Resource-Limited Settings: The Consequences of Refusing a Renal Transplant in the South African State Sector.

    Science.gov (United States)

    Etheredge, Harriet; Paget, Graham

    2015-12-01

    Resource constraints in developing countries compel policy makers to ration the provision of healthcare services. This article examines one such set of Guidelines: A patient dialysing in the state sector in South Africa may not refuse renal transplantation when a kidney becomes available. Refusal of transplantation can lead to exclusion from the state-funded dialysis programme. This Guideline is legally acceptable as related to Constitutional stipulations which allow for rationing healthcare resources in South Africa. Evaluating the ethical merit of the Guideline, and exploring the ethical dilemma it poses, proves a more complex task. We examine the actions of healthcare professionals as constrained by the Guideline. From a best interests framework, we argue that in these circumstances directing patient decision making (pressurising a patient to undergo renal transplantation) is not necessarily unethical or unacceptably paternalistic. We then scrutinise the guideline itself through several different ethical 'lenses'. Here, we argue that bioethics does not provide a definitive answer as to the moral merit of rationing dialysis under these circumstances, however it can be considered just in this context. We conclude by examining a potential pitfall of the Guideline: Unwilling transplant recipients may not comply with immunosuppressive medication, which raises questions for policies based on resource management and rationing. © 2014 John Wiley & Sons Ltd.

  16. Research report. Environmentally friendly energy community research business for Fujieda district (Refuse energy utilization); Fujieda chiku kankyo chowagata energy community chosa jigyo (haikibutsu energy riyo shisetsu) chosa hokokusho

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-03-01

    An environmentally friendly refuse energy utilizing business, for which RDF (refuse derived fuel) produced out of wastes discharged by industries belonging to a Fujieda city environmental protection council will provide the heat source, is proposed by the said council. The proposal is subjected to a study, a basic plan is drafted, and a decision is made on its profitability. In the study, surveys are conducted on the actualities of wastes and of demand for heat, and specifications are worked out relating to transportation and storage of RDF, production of steam by an RDF-fired boiler, routing of pipes for transmitting the steam to the industries in the district, facility costs, operating costs, etc. It is found that the amount of RDF produced out of the wastes discharged by the council member industries is so small that it can meet the demand of only one industry and that, even if more wastes are collected from a wider area, the increased amount will but meet the demand of two industries and a hot water pool. It is found that the system will be economically feasible, however, if the shortage of RDF-generated energy is covered by an oil-fired boiler and thereby impartiality is established in steam distribution and steam production unit price is reduced. In view of the intensification of control over dioxin, etc., the business will be gaining profit in 2002 and after. (NEDO)

  17. Medication errors of nurses and factors in refusal to report medication errors among nurses in a teaching medical center of iran in 2012.

    Science.gov (United States)

    Mostafaei, Davoud; Barati Marnani, Ahmad; Mosavi Esfahani, Haleh; Estebsari, Fatemeh; Shahzaidi, Shiva; Jamshidi, Ensiyeh; Aghamiri, Seyed Samad

    2014-10-01

    About one third of unwanted reported medication consequences are due to medication errors, resulting in one-fifth of hospital injuries. The aim of this study was determined formal and informal medication errors of nurses and the level of importance of factors in refusal to report medication errors among nurses. The cross-sectional study was done on the nursing staff of Shohada Tajrish Hospital, Tehran, Iran in 2012. The data was gathered through a questionnaire, made by the researchers. The questionnaires' face and content validity was confirmed by experts and for measuring its reliability test-retest was used. The data was analyzed by descriptive statistics. We used SPSS for related statistical analyses. The most important factors in refusal to report medication errors respectively were: lack of medication error recording and reporting system in the hospital (3.3%), non-significant error reporting to hospital authorities and lack of appropriate feedback (3.1%), and lack of a clear definition for a medication error (3%). There were both formal and informal reporting of medication errors in this study. Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence.

  18. Refuse dumps from leaf-cutting ant nests reduce the intensity of above-ground competition among neighboring plants in a Patagonian steppe

    Science.gov (United States)

    Farji-Brener, Alejandro G.; Lescano, María Natalia

    2017-11-01

    In arid environments, the high availability of sunlight due to the scarcity of trees suggests that plant competition take place mainly belowground for water and nutrients. However, the occurrence of soil disturbances that increase nutrient availability and thereby promote plant growth may enhance shoot competition between neighboring plants. We conducted a greenhouse experiment to evaluate the influence of the enriched soil patches generated by the leaf-cutting ant, Acromyrmex lobicornis, on the performance of the alien forb Carduus thoermeri (Asteraceae) under different intraspecific competition scenarios. Our results showed that substrate type and competition scenario affected mainly aboveground plant growth. As expected, plants growing without neighbors and in nutrient-rich ant refuse dumps showed more aboveground biomass than plants growing with neighbors and in nutrient-poor steppe soils. However, aboveground competition was more intense in nutrient-poor substrates: plants under shoot and full competition growing in the nutrient-rich ant refuse dumps showed higher biomass than those growing on steppe soils. Belowground biomass was similar among focal plants growing under different substrate type. Our results support the traditional view that increments in resource availability reduce competition intensity. Moreover, the fact that seedlings in this sunny habitat mainly compete aboveground illustrates how limiting factors may be scale-dependent and change in importance as plants grow.

  19. Informed consent for the administration of an intravenous contrast agent: importance and determinants of patient refusal; Consentimiento informado para la administracion de contraste intravenoso. Importancia y factores determinantes del rechazo por los pacientes

    Energy Technology Data Exchange (ETDEWEB)

    Martel, J. [Fundacion Hospital Alcorcon. Madrid (Spain); Garcia-Diaz, J. D. [Hospital Universitario Principe de Asturias. Alcala de Henares. Madrid (Spain)

    1999-07-01

    We proposed to determine the proportion of patients who refuse to undergo intravenous contrast administration and the factors that influence their refusal. Our series consisted of 442 patients who were supposed to undergo imaging studies involving the intravenous injection of an iodine contrast. In a personal interview, the patients were issued a questionnaire specifically designed for this study. The following parameters were recorded: sex, age, inpatient or outpatient status, medical history available, person who informed them about the procedure, person signing the informed consent (patient or other) , highest academic degree, attitude toward receiving the information and degree of concern after reading and signing the consent form. In our series 8.6% of the patients (95% confidence interval: 6-11.2) refused to sign the informed consent form. In addition, there were a number of patients who delayed the procedure or hindered the daily work schedule by some other means. When the relationship between each of the variables studied and refusal to sign the consent form was assessed, significant associations were observed between the latter and the academic level of the patient, his or her degree of concern and having received the information from a trained person. There was also a nearly significant trend toward the association between refusal and the patient's background. Relatively few patients refuse to sign the informed consent to receive intravenous contrast administration but this negative decision interferes with the health care practice. It is possible to identify certain correctable factors that influence the patient in this respect. (Author) 13 refs.

  20. The Danish Supreme Court rules on State action defense and refusal to supply under Danish competition law (Copenhagen Airport Terminal A)

    DEFF Research Database (Denmark)

    Bergqvist, Christian; Christensen, Laurits Peder Schmidt

    2015-01-01

    to the application of competition law to the matter at hand. Unhappy, not only with the outcome, but also the process, the access seeking party, Terminal A, lodged a case before the judiciary arguing that air security regulation did not prevent the application of competition law and an order for the granting...... of access. This submission was not accepted by the Danish Supreme Court that moreover held EU Article 106 (2) to be applicable as a defence for Copenhagen Airport’s refusal to lease the land to Terminal A. The case provides guidance on the scope of the state action defence under Danish competition law and...... for the purpose of building a new terminal A. Terminal A would compete with the airport in the supply of services to airlines. Copenhagen airport rejected the request which in turn lead the group of investors to complain to the Danish Competition and Consumer Authority ("DCCA"). In its draft decision the DCCA...

  1. Motivos de rejeição aos métodos contraceptivos reversíveis em mulheres esterilizadas Reasons why sterilized women refused reversive contraceptive methods

    Directory of Open Access Journals (Sweden)

    Marta Lucia de Oliveira Carvalho

    2005-10-01

    Full Text Available OBJETIVO: Identificar as representações sobre os métodos contraceptivos que poderiam ser alternativas à esterilização, para um grupo de mulheres esterilizadas, visando a entender os motivos de rejeição a esses métodos. MÉTODOS: Trata-se de trabalho descritivo, qualitativo, cuja população estudada foi constituída por 31 mulheres esterilizadas, aleatoriamente selecionadas da listagem de pacientes atendidas pelo Programa de Planejamento Familiar de um ambulatório de um hospital universitário. As informações foram obtidas das mulheres estudadas por meio de entrevistas semi-estruturadas. As transcrições foram analisadas segundo o método de Análise de Conteúdo. RESULTADOS: A rejeição aos métodos contraceptivos esteve baseada em representações resultantes de informações técnicas recebidas em serviços de saúde, de vivências anteriores com esses métodos ou de informações recebidas do meio social. A rejeição aos métodos hormonais e DIU baseou-se principalmente em representações de baixa inocuidade; os métodos comportamentais (Tabela, Billings foram rejeitados por representações de baixa eficácia; os métodos de barreira (diafragma e camisinha, por dificuldades no uso desses métodos relacionados a padrões culturais de exercício da sexualidade e representações de baixa eficácia. CONCLUSÕES: A opção pela esterilização feminina pode ser indicativa de rejeição às alternativas contraceptivas oferecidas pelos serviços de saúde. Os profissionais da área de saúde reprodutiva devem aprofundar seu conhecimento sobre os fatores pessoais, socioeconômicos e culturais que podem influenciar as mulheres na procura por um método contraceptivo que assegure maior controle de sua própria fecundidade.OBJECTIVE: To identify the representations of contraceptive methods within a group of sterilized women, aiming at understanding the reasons why they refused those methods. METHODS: A descriptive qualitative study

  2. N2O emissions from an intermittently aerated semi-aerobic aged refuse bioreactor: Combined effect of COD and NH4+-N in influent leachate.

    Science.gov (United States)

    Li, Weihua; Sun, Yingjie; Bian, Rongxing; Wang, Huawei; Zhang, Dalei

    2017-11-01

    The carbon-nitrogen ratio (COD/NH 4 + -N) is an important factor affecting nitrification and denitrification in wastewater treatment; this factor also influences nitrous oxide (N 2 O) emissions. This study investigated two simulated intermittently aerated semi-aerobic aged refuse bioreactors (SAARB) filled with 8-year old aged refuse (AR). The research analyzed how differences in and the combination of influent COD and NH 4 + -N impact N 2 O emissions in leachate treatment. Experimental results showed that N 2 O emissions increased as the influent COD/NH 4 + -N decreased. The influent COD had a greater effect on N 2 O emissions than NH 4 + -N at the same influent ratios of COD/NH 4 + -N (2.7 and 8.0, respectively). The maximum N 2 O emission accounted for 8.82±2.65% of the total nitrogen removed from the influent leachate; the maximum level occurred when the COD was 2000mg/L. An analysis of differences in influent carbon sources at the same COD/NH 4 + -N ratios concluded that the availability of biodegradable carbon substrates (i.e. glucose) is an important factor affecting N 2 O emissions. At a low influent COD/NH 4 + -N ratio (2.7), the N 2 O conversion rate was greater when there were more biodegradable carbon substrates. Although the SAARB included the N 2 O generation and reduction processes, N 2 O reduction mainly occurred later in the process, after leachate recirculation. The maximum N 2 O emission rate occurred in the first hour of single-period (24h) experiments, as leachate contacted the surface AR. In practical SAARB applications, N 2 O emissions may be reduced by measures such as reducing the initial recirculation loading of NH 4 + -N substrates, adding a later supplement of biodegradable carbon substrates, and/or prolonging hydraulic retention time (HRT) of influent leachate. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. The issue of legal protection of the intensive care unit physician within the context of patient consent to treatment. Part I: conscious patient, refusing treatment.

    Science.gov (United States)

    Siewiera, Jacek; Trnka, Jakub; Kübler, Andrzej

    2014-01-01

    In daily clinical practice, physicians working in intensive care units (ICUs) face situations when their professional duty to protect the patient's life is in conflict with the obligation to respect the will of the patient and to assess his or her chances of treatment. Although the mere fact of conflict between these fundamental values for the ICU physician is a natural and obvious element in the chosen specialisation, many 'non-medical' circumstances make the given conflict not only very difficult but also dangerous for the physician. So far, the ethical and legal aspects of dying have been commented upon by a large group of lawyers and experts involved in the interpretation of the Polish regulations. The authors believe that a detailed analysis of the regulations should be carried out by persons of legal education, possessing a genuine medical experience associated with the specificity of end of life care in ICUs. In this paper, the authors have compared the current regulations of legislative acts of the common law relating to medical activities at anaesthesiology and intensive care units as well as based on the judgements of the common court of law over the past ten years. In the act of dissuading an ICU doctor from a medical procedure, all factors influencing the doctor's responsibility should be taken into account in accordance with the criminal law. In the case of a patient's death due to a refusal of treatment with the patient's full awareness, and given proper notification as to the consequences of refusing treatment, the doctor's responsibility lies under article 150 of the Polish penal code.

  4. Fiscal 2000 achievement report on the followup research on high-efficiency refuse-fueled power generation technology development; 2000 nendo kokoritsu haikibutsu hatsuden gijutsu kaihatsu no follow up kenkyu seika hokokusho

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    Followup research was conducted using a high-efficiency refuse-fueled power generation pilot plant for interpolating research and development results, improvement on refuse-fueled power generation efficiency, and for introduction and popularization of refuse-fueled power generation. Operation control and safety control were performed in compliance with the pilot plant operation program, when high-temperature high-pressure steam (500 degrees C, 100 atm) was stably generated for approximately 7,600 hours in this fiscal year recording a total of approximately 22,000 hours when counted from the beginning of the verification test. Plant operation data were examined and every part of the furnace was checked and measured while the furnace was at rest, and it was found that the plant satisfied the intended specifications as refuse-fueled power plant facilities. As for its environmental impact, it was confirmed that it fully satisfied the standard values for substances in exhaust gas, which involved soot and dust, sulfur oxides, nitrogen oxides, hydrogen chloride, and dioxins. Dioxins, in particular, were far below the most rigorous legal level of 0.1ng-TEQ/m{sup 3}N. In the test of superheater materials, long-term data covering three years were acquired. (NEDO)

  5. Refusing intergroup help from the morally superior: How one group's moral superiority leads to another group's reluctance to seek their help. : How one group's moral superiority leads to another group's reluctance to seek their help

    NARCIS (Netherlands)

    Täuber, Susanne; van Zomeren, Martijn

    We examine how group members paradoxically refuse intergroup help where they might need it most: in the moral status domain. Based on the Sacred Value Protection Model (Tetlock, 2002), we predicted and found that group members felt stronger group-based anger and a stronger motivation to reaffirm

  6. Adsorption of metal ions and acid dyes on brewer's refuse and its crosslinked products; Biru shikomikasu oyobi sono kashikaketai ni taisuru kinzoku ion oyobi sansei senryo no kyuchaku

    Energy Technology Data Exchange (ETDEWEB)

    Shimizu, Y.; Kubota, Y.; Higashimura, T. [The University of Shiga Prefecture, Shiga (Japan). Department of Materials Sceince; Kawaguchi, M. [Seisui Kogyo Ltd., Osaka (Japan)

    2000-01-10

    To use brewer's refuse as adsorbent adsorption of metal ions and acid dyes on them and their reaction products with 1,3,5-triacryloylhexahydro-1,3,5-triazine(TAF) were examined. The refuse samples used in the present study are protein rich fraction(Pr) and cellulosics rich fraction(Hr) obtained by sifting brewer's refuse. Adsorptive experiments were conducted by a batchwise method at 303 K. Pr adsorbed more metal ions such as Cr{sup 6+}, Ni{sup 2+}, Co{sup 2+}, especially Fe{sup 3+}, Hg{sup 2+} and Cu{sup 2+} than Hr. But both refuses hardly adsorbed Ca{sup 2+}. Also Pr adsorbed more acid dyes, especially more hydrophobic C. I. Acid Red 88 than C. I. Acid Orange 7- than Hr at pH 5. By crosslinking Pr and Hr using TAF adsorption of acid dyes increased markedly, but adsorption of metal ions decreased. Therefore Pr can be used as adsorbent for acid dyes and metal ions as it is. Moreover the crosslinked products are excellent adsorbents for acid dyes. (author)

  7. When "no" might not quite mean "no"; the importance of informed and meaningful non-consent: results from a survey of individuals refusing participation in a health-related research project

    Directory of Open Access Journals (Sweden)

    McMurdo Marion ET

    2007-04-01

    Full Text Available Abstract Background Low participation rates can lead to sampling bias, delays in completion and increased costs. Strategies to improve participation rates should address reasons for non-participation. However, most empirical research has focused on participants' motives rather than the reasons why non-participants refuse to take part. In this study we investigated the reasons why older people choose not to participate in a research project. Methods Follow-up study of people living in Tayside, Scotland who had opted-out of a cross-sectional survey on activities in retirement. Eight hundred and eighty seven people aged 65–84 years were invited to take part in a home-based cross-sectional survey. Of these, 471 refused to take part. Permission was obtained to follow-up 417 of the refusers. Demographic characteristics of people who refused to take part and the reasons they gave for not taking part were collected. Results 54% of those invited to take part in the original cross-sectional survey refused to do so. However, 61% of these individuals went on to participate in the follow-up study and provided reasons for their original refusal. For the vast majority of people initial non-participation did not reflect an objection to participating in research in principle but frequently stemmed from barriers or misunderstandings about the nature or process of the project itself. Only 28% indicated that they were "not interested in research". The meaningfulness of expressions of non-consent may therefore be called into question. Hierarchical log-linear modelling showed that refusal was independently influenced by age, gender and social class. However, this response pattern was different for the follow-up study in which reasons for non-participation in the first survey were sought. This difference in pattern and response rates supports the likely importance of recruitment issues that are research and context specific. Conclusion An expression of non

  8. When "no" might not quite mean "no"; the importance of informed and meaningful non-consent: results from a survey of individuals refusing participation in a health-related research project.

    Science.gov (United States)

    Williams, Brian; Irvine, Linda; McGinnis, Alison R; McMurdo, Marion E T; Crombie, Iain K

    2007-04-26

    Low participation rates can lead to sampling bias, delays in completion and increased costs. Strategies to improve participation rates should address reasons for non-participation. However, most empirical research has focused on participants' motives rather than the reasons why non-participants refuse to take part. In this study we investigated the reasons why older people choose not to participate in a research project. Follow-up study of people living in Tayside, Scotland who had opted-out of a cross-sectional survey on activities in retirement. Eight hundred and eighty seven people aged 65-84 years were invited to take part in a home-based cross-sectional survey. Of these, 471 refused to take part. Permission was obtained to follow-up 417 of the refusers. Demographic characteristics of people who refused to take part and the reasons they gave for not taking part were collected. 54% of those invited to take part in the original cross-sectional survey refused to do so. However, 61% of these individuals went on to participate in the follow-up study and provided reasons for their original refusal. For the vast majority of people initial non-participation did not reflect an objection to participating in research in principle but frequently stemmed from barriers or misunderstandings about the nature or process of the project itself. Only 28% indicated that they were "not interested in research". The meaningfulness of expressions of non-consent may therefore be called into question. Hierarchical log-linear modelling showed that refusal was independently influenced by age, gender and social class. However, this response pattern was different for the follow-up study in which reasons for non-participation in the first survey were sought. This difference in pattern and response rates supports the likely importance of recruitment issues that are research and context specific. An expression of non-consent does not necessarily mean that a fully informed evaluation of the pros

  9. The geoarchaeology of urban wastes: from refuses to activities and towns organisation (France, 6th c. BC - 10th c. aD)

    Science.gov (United States)

    Borderie, Q.; Cammas, C.; Petit, C.

    2012-04-01

    In an urban context, geoarchaeological study of man-environment interaction is often neglected, although recent studies of urbic anthrosols and human induced processes show that it can provide a great amount of data. The sedimentary matrix of the archaeological layers, especially its organic and heavy metal contents (phosphore, organic carbon, lead…) and the pedo-sedimentary processes (such as bioturbation, percolation, decay of organic matter…), are evidence of ancient lifestyle and waste disposal habits. This data are even more useful when archaeological evidence is rare or inefficient, such as in the early medieval Dark Earth. This paper is based on several geoarchaeological studies undertaken since the 1990 in French towns ranging from the Iron Age to the early Middle Ages (Paris, Beauvais, Bayeux, Noyon, Macon, Metz, Lattara…), mainly from rescue excavations. Multi-scale, 3D and fine scale analyses of archaeological stratigraphy are combined with micromorphological studies of undisturbed samples and grain size as well as geochemical analysis of bulk samples (CaCO3, C/N, Fe, Pb, Zn, Cu…). Spatial sampling reveals complex pattern of activities in finely stratified and well defined architectural context like Lattara (Iron Age). Organic refuses were found mainly in specific urban spaces like courtyards or squares and animal housing areas could be delineate. In more undifferentiated stratigraphy (early medieval Dark Earth), bioturbation is one of the main formation process and seems to have obliterated others. Thus, we analysed the 3D pattern of macro-artefacts on field, combined with micromorphology, geochemical and semi quantitative counting of micro-artefacts on thin sections. It allowed us to characterise Dark Earth by the type of activity refuses, in relation with the pedo-sedimentary context and the uses of the areas. It also allowed us to assess the characters induced by in situ activities and those due to the local background. Moreover, in Metz

  10. Refuse derived fuel (RDF) plasma torch gasification as a feasible route to produce low environmental impact syngas for the cement industry.

    Science.gov (United States)

    López-Sabirón, Ana M; Fleiger, Kristina; Schäfer, Stefan; Antoñanzas, Javier; Irazustabarrena, Ane; Aranda-Usón, Alfonso; Ferreira, Germán A

    2015-08-01

    Plasma torch gasification (PTG) is currently researched as a technology for solid waste recovery. However, scientific studies based on evaluating its environmental implications considering the life cycle assessment (LCA) methodology are lacking. Therefore, this work is focused on comparing the environmental effect of the emissions of syngas combustion produced by refuse derived fuel (RDF) and PTG as alternative fuels, with that related to fossil fuel combustion in the cement industry. To obtain real data, a semi-industrial scale pilot plant was used to perform experimental trials on RDF-PTG.The results highlight that PTG for waste to energy recovery in the cement industry is environmentally feasible considering its current state of development. A reduction in every impact category was found when a total or partial substitution of alternative fuel for conventional fuel in the calciner firing (60 % of total thermal energy input) was performed. Furthermore, the results revealed that electrical energy consumption in PTG is also an important parameter from the LCA approach. © The Author(s) 2015.

  11. use of mutagens in the improvement of itaconic acid production by local isolate of aspergillus terreus ref from raw starchy materials and refused banana fruits

    International Nuclear Information System (INIS)

    Khalaf, S.A

    2004-01-01

    Itaconic acid (IA) production by local isolate o/Aspergillus terreus RBF from different acid hydrolyzed starchy materials such as corn starch, potato flour, sweet potato flour and market refused banana fruits extract (MRBFex) was investigated. Both production and yield were highest on corn starch with values of 12.9 g/l and 25.44%, respectively. MRBFex was explored as a good substrate for IA production with yield of '20.42%. The efficiency of IA production by this wild type strain was improved by ultraviolet, chemical and mixed mutagenic treatments. Three high IA yielding mutants, NA 2 , NAUV 2 4 and NASA 5 6 were obtained by gradient plating. One of these mutants (NAUV 2 4) was capable of producing about twice the yield of IA as the parent strain from acid hydrolyzed corn starch and/or MRBFex. Higher than 30 g/l of IA was produced by the mutant strain NAUV 2 4 in flask fermentation from medium containing of 120 g/l (as sugar) of MRBFex

  12. Religious law versus secular law
    The example of the get refusal in Dutch, English and Israeli law

    Directory of Open Access Journals (Sweden)

    Matthijs de Blois

    2010-06-01

    Full Text Available The tension between religious law and secular law in modern democracies is illustrated in this article by a discussion of the different approaches to the get (a bill of divorce refusal (based on Jewish law under Dutch, English and Israeli law. These legal orders share many characteristics, but also display important differences as to the role of religion and religious law in the public realm. The Dutch system is the most secular of the three; it does not recognize a role for religious law within the secular system as such. The English legislation provides for means that to a certain extent facilitate the effectuation of a religious divorce. In Israel, finally, the law of marriage and divorce is as such governed by the religious law of the parties concerned; for the majority of the population that is Jewish law. An evaluation of the different approaches in the framework of human rights law reveals the complexities of the collision of the underlying values in terms of equality, religious freedom and minority rights, also having regard to the diversity of opinions within religious communities.

  13. Breast-conservation treatment without any surgical procedure using new enzyme-targeting radiosensitization treatment for aged and/or op. refused patients with breast cancer

    International Nuclear Information System (INIS)

    Ogawa, Yasuhiro; Kubota, Kei; Miyatake, Kana

    2008-01-01

    We developed a new radiosensitizer containing hydrogen peroxide and sodium hyaluronate for topical tumor injection for various types of tumors, and the method was named KORTUC II (Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas, Type II). KORTUC II trial was accepted by our local ethical committee concerning of the injection for advanced skin cancer, advanced bone/soft tissue malignant neoplasms, breast cancer of op refused or aged patients, and metastatic lymph nodes. Concerning breast cancer, ten patients were enrolled in the KORTUC II trial upon fully informed consent. All of them showed clinically complete response by the new enzyme-targeting radiosensitization treatment (KORTUC II) without any severe complications excluding mild dermatitis (grade I). Nine of the 10 patients have so far shown neither local recurrence nor distant metastasis, and the mean follow-up period at the end of December 2007 was still short and approximately 12 months. Especially for patients with breast cancer, breast-conservation treatment without any surgical procedure can be performed by using our new radiosensitizer for topical injection into the tumor tissue. (author)

  14. Can a woman refuse sex if her husband has a sexually transmitted infection? Attitudes toward safer-sex negotiation among married women in Bangladesh.

    Science.gov (United States)

    Jesmin, Syeda S; Cready, Cynthia M

    2014-06-01

    In developing countries, HIV, sexually transmitted infections (STIs) and unintended pregnancy take an enormous toll on women's reproductive health, yet preventive programmes are lacking as married women's risks are frequently underestimated. We examined predictors of married Bangladeshi women's attitudes towards safer-sex negotiation using data on 15,178 currently married women aged 15-49 from the 2011 Bangladesh Demographic Health Survey. Approximately 92% of women believed that a wife's refusal to have sex with her husband is justified if he has an STI. Multilevel logistic regression analysis revealed that the likelihood of a woman holding this belief increased with her autonomy, as measured by the ability to go to a health centre/hospital without another adult, participation in household decision making and rejection of wife beating (p < 0.001). Other significant predictors were knowledge/awareness of STIs (p < 0.05), living in Dhaka division (p < 0.001) and younger age (p < 0.01). Our findings suggest that sexual health education programmes may be more effective if they include strategies to address social norms and cultural practices that limit women's autonomy in society.

  15. Refuse Derived Fuel (RDF) production and gasification in a pilot plant integrated with an Otto cycle ICE through Aspen plus™ modelling: Thermodynamic and economic viability.

    Science.gov (United States)

    Násner, Albany Milena Lozano; Lora, Electo Eduardo Silva; Palacio, José Carlos Escobar; Rocha, Mateus Henrique; Restrepo, Julian Camilo; Venturini, Osvaldo José; Ratner, Albert

    2017-11-01

    This work deals with the development of a Refuse Derived Fuel (RDF) gasification pilot plant using air as a gasification agent. A downdraft fixed bed reactor is integrated with an Otto cycle Internal Combustion Engine (ICE). Modelling was carried out using the Aspen Plus™ software to predict the ideal operational conditions for maximum efficiency. Thermodynamics package used in the simulation comprised the Non-Random Two-Liquid (NRTL) model and the Hayden-O'Connell (HOC) equation of state. As expected, the results indicated that the Equivalence Ratio (ER) has a direct influence over the gasification temperature and the composition of the Raw Produced Gas (RPG), and effects of ER over the Lower Heating Value (LHV) and Cold Gasification Efficiency (CGE) of the RPG are also discussed. A maximum CGE efficiency of 57-60% was reached for ER values between 0.25 and 0.3, also an average reactor temperature values in the range of 680-700°C, with a peak LHV of 5.8MJ/Nm 3 . RPG was burned in an ICE, reaching an electrical power of 50kW el . The economic assessment of the pilot plant implementation was also performed, showing the project is feasible, with power above 120kW el with an initial investment of approximately US$ 300,000. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Usage de la refusion par bombardement électronique pour la purification et le recyclage des alliages Application of the electron beam remelting for the purification and the recycling of alloys

    Directory of Open Access Journals (Sweden)

    Bellot Jean-Pierre

    2013-11-01

    Full Text Available Parmi les techniques de purification ultime de métaux à hauts points de fusion, le procédé de refusion par bombardement électronique associe une puissance thermique garantissant la fusion du métal, et une refusion sous vide permettant l'élimination d'impuretés par distillation. Ce papier présente la technique et le potentiel d'élimination par distillation. Among the ultimate purification techniques applied to the high melting point metallic materials, the electron beam remelting process, combining a high thermal power and vacuum, is particularly conducive to volatilization. This paper describes the technique and its efficiency to remove impurities by distillation.

  17. Combustion tests in a solid fuel boiler to clarify the emissions when co-firing refuse; Proveldning i fastbraenslepanna foer att kartlaegga emissioner vid inblandning av olika avfallsfraktioner

    Energy Technology Data Exchange (ETDEWEB)

    Blom, Elisabet; Lundborg, Rickard; Wrangensten, Lars

    2002-04-01

    In this Vaermeforsk-project tests have been performed in a 60 MW moving grate steam boiler at Tekniska Verken in Linkoeping. The boiler plant has an electrostatic filter for dust reduction and also a flue gas condensing plant with heat recovery. Vaermeforsk has financed the project. During the tests the following fuel fractions have been injected into the reference fuel, a mix of recovered wood chips (70 %) and bark (30 %): Paper/plastic/wood fuel (10 % and 25 % injection on an energy basis); Meat powder (10 % and 25 % injection on an energy basis); Napkin waste (10 % injection on an energy basis); Leather waste (10 % injection on an energy basis). The highest lower heating value was noted for meat powder, approx. 24 MJ/kg with a moisture content of 3,4 %. The heating values for the other fuel fractions were on the same level or just beneath the corresponding heating value for the reference fuel. The highest chlorine content was found in the paper/plastic/wood fraction respectively the leather waste fraction with 1,2 and 1,4 % (weight) of chlorine. The meat powder had the highest nitrogen content but all the fuel mixes had a quite high content of nitrogen with values over 1 % (weight). Analyses of sulphur in the fuels showed that leather waste had the lowest content just over 0, 1 %, considered as a low sulphur level for fuels in general. However, there are problems to get balance between in- and output for sulphur and chlorine based on fuel analysis. Difficulties to take representative fuel samples, especially when it comes to chlorine, can be an explanation. Video camera recordings and flue gas analysis in the furnace showed that the injection of refuse fractions seems to improve the combustion conditions with better local combustion of CO and hydrocarbons. The results from the emission measurements in the chimney can be summarised as follows (emission values at 11 % O{sub 2}): the lowest CO emission was noted with 25 % meat powder injection (<50 mg/nm{sup 3

  18. Joutes dharmiques. Note sur la volonté de donner, le refus de recevoir et la force contraignante de la vérité

    Directory of Open Access Journals (Sweden)

    Charles Malamoud

    2009-03-01

    Full Text Available Joutes dharmiques. Note sur la volonté de donner, le refus de recevoir et la force contraignante de la vérité. Les chapitres 199 et 200 du Çântiparvan font partie du Mokshadharma. Ils nous font connaître une controverse (vivâda entre un brahmane jâpaka et le roi Îkshvâku. L’intérêt de ce passage, qui n’a guère attiré l’attention des indianistes, semble-t-il, est que la discussion intellectuelle y déclenche des événements et se transforme en une sorte de drame : d’autres personnages se présentent dans l’ermitage du Jâpaka, interviennent avec leurs propres débats ; les échanges d’arguments ont des conséquences sur les destinées des protagonistes ; il y a une véritable intrigue, avec des surprises, des rebondissements, des reconnaissances, un dénouement. C’est cette dramaturgie que je me propose d’étudier. Mais je voudrais aussi mettre en lumière le contenu et les enjeux de cette joute dharmique. Elle porte sur le don : Qui est apte à donner ? Qui est apte à recevoir ? Que peut-on donner ? Y a-t-il des dons gratuits ? Et aussi : Existe-t-il dans l’Inde brahmanique quelque chose qui serait comparable au « point d’honneur » occidental et qui doublerait en quelque sorte la volonté de ne pas s’écarter de son dharma ?Dharmic jousting. A note on the desire to give, the refusal to receive and the constraining power of the truth. Chapters 199 and 200 of the Santiparvan are part of the Mokshadharma. They recount a controversy (vivâda between a jâpaka Brahmana and the king Ikshvaku. The interest of this passage, which does not appear to have attracted much attention from Indianists, lies in its description of an intellectual discussion triggering events and turning into a sort of drama: other characters arrive in the Jâpaka hermitage, intervening with their own debates; the exchange of arguments has an impact on the fate of the protagonists; there is a genuine intrigue, with surprises, new

  19. Hypofractionated stereotactic body radiation therapy for elderly patients with stage IIB–IV nonsmall cell lung cancer who are ineligible for or refuse other treatment modalities

    Directory of Open Access Journals (Sweden)

    Karam SD

    2014-10-01

    Full Text Available Sana D Karam,1 Zachary D Horne,2 Robert L Hong,2 Don McRae,2 David Duhamel,3 Nadim M Nasr2 1Department of Radiation Oncology, University of Colorado, Denver, CO, USA; 2Department of Radiation Oncology, 3Department of Pulmonary/Critical Care Medicine, Virginia Hospital Center, Arlington, VA, USA Objective: In elderly patients with stage IIB–IV nonsmall cell lung cancer who cannot tolerate chemotherapy, conventionally fractionated radiotherapy is the treatment of choice. We present our experience with hypofractionated stereotactic body radiation therapy (SBRT in the treatment of this patient population. Methods: Thirty-three patients with a median age of 80 years treated with fractionated SBRT were retrospectively analyzed. Most patients were smokers and had preexisting lung disease and either refused treatment or were ineligible. A median prescribed dose of 40 Gy was delivered to the prescription isodose line over a median of five treatments. The majority of patients (70% did not receive chemotherapy. Results: With a median follow-up of 9 months (range: 4–40 months, the actuarial median overall survival (OS and progression-free survival were 12 months for both. One year actuarial survival outcomes were 75%, 58%, 44%, and 48% for local control, regional control, progression-free survival, and OS, respectively. Increased volume of disease was a statistically significant predictor of worse OS. Three patients developed a grade 1 cough that peaked 3 weeks after treatment and resolved within 1 month. One patient developed grade 1 tracheal mucositis and three patients developed grade 1 pneumonitis. Both resolved 6 weeks after treatment. Three patients died within the first month of treatment, but the cause of death did not appear to be related to the treatment. Conclusion: Hypofractionated SBRT is a relatively safe and convenient treatment option for elderly patients with inoperable stage IIB–IV nonsmall cell lung cancer. However, given the small

  20. ACTIONS COMBINATOIRES DE L’ADJECTIF QUALIFICATIF ET DE L’ADVERBE DANS L’ECRITURE DU REFUS DE JEAN-ADIAFFI / COMBINATORIAL ACTIONS OF THE ADJECTIVE AND ADVERB IN WRITING THE REFUSAL OF JEAN-MARIE ADIAFFI / ACŢIUNILE COMBINATORICE ALE ADJECTIVULUI ŞI ADVERBULUI ÎN ELABORAREA SCRIERII REFUZULUI LA JEANMARIE ADIAFFI

    Directory of Open Access Journals (Sweden)

    Yao Kouadio Jean

    2015-11-01

    Full Text Available L’adjectif qualificatif et l’adverbe ont permis à Jean-Marie ADIAFFI d’asseoir l’écriture du refus qui vise l’affranchissement de la rigidité de la littérature française. En retour, le bossonnisme (le goût du sacré, le dadaïsme, le symbolisme sont les tremplins de l’affirmation de la raison et du sens de créativité du Négro-Africain. L’auteur met au cœur de esthétique littéraire négro-africaine qu’il projette le sacré, générateur de la créativité et du génie du négro-Africain. Alors, la liberté d’écriture est le leitmotiv de l’écrivain noir. Dès lors, il met en œuvre son esprit de créativité et sa spontanéité.